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1.
Rev. baiana saúde pública ; 45(Supl. Especial 2): 141-150, 2021/12/28.
Article in Portuguese | LILACS | ID: biblio-1352346

ABSTRACT

Este relato aborda o caso de um homem de 52 anos, portador de neoplasia prostática (Gleason 3 + 3), que deu entrada no pronto-socorro com quadro de lesão renal aguda, anemia normocrômica e normocítica e relato de fratura patológica. Encaminhado para o hospital geral, foi iniciada a investigação do quadro. Alguns achados em exames laboratoriais, como inversão da relação albumina-globulina e lesões líticas em exame de imagem, fizeram os médicos levantarem um importante diagnóstico diferencial no contexto de metástase óssea e neoplasias: o mieloma múltiplo. Diante disso, foi indicado aspirado de medula óssea e imunofetipagem, que, surpreendentemente, teve como resultado principal a presença de 12% de células plasmocitárias com caraterísticas anômalas. O tratamento inicial foi estabelecido com dexametasona, ciclofosfamida e pamidronato com melhora progressiva dos parâmetros laboratoriais e clínicos, sendo encaminhado para acompanhamento ambulatorial em cidade de origem com onco-hematologista e urologista.


This study describes the case of a 52-year-old male patient with prostate cancer (Gleason 3+3) admitted to the emergency room with acute kidney injury, normochromic and normocytic anemia, and a pathological fracture report. The patient was referred to the General Hospital to investigate the condition. Laboratory tests indicated inversion of the albumin-globulin ratio and imaging exams evinced lytic lesions, leading physicians to raise an important differential diagnosis in the context of bone metastases and neoplasms: multiple myeloma. Bone marrow aspirate and immunophetyping indicated the presence of 12% plasma cells with anomalous characteristics. After initial treatment with dexamethasone, cyclophosphamide, and pamidronate, the patient showed progressive improvement in laboratory and clinical parameters, being referred for outpatient follow-up in the city of origin with an onco-hematologist and urologist.


Este es un reporte de caso de un varón de 52 años de edad, con cáncer de próstata (Gleason 3 +3) ingresado en urgencias por lesión renal aguda, anemia normocrómica y normocítica y reporte de fractura patológica. Derivado al Hospital General, se inició una investigación de la condición. Algunos hallazgos en las pruebas de laboratorio, como la inversión del cociente albúmina globulina y las lesiones líticas en los exámenes de imagen, llevaron a los médicos a plantear un importante diagnóstico diferencial, en el contexto de las metástasis óseas y las neoplasias: el mieloma múltiple. Por tanto, se indicó el aspirado de médula ósea y la inmunofenotipificación, que sorprendentemente tuvo como principal resultado la presencia de un 12% de células plasmáticas con características anómalas. Se estableció el tratamiento inicial con dexametasona, ciclofosfamida y pamidronato, con mejoría progresiva de los parámetros analíticos y clínicos, siendo remitido para seguimiento ambulatorio en su ciudad de origen con un oncohematólogo y un urólogo.


Subject(s)
Prostatic Neoplasms , Immunophenotyping , Diagnosis, Differential , Urologists , Multiple Myeloma
2.
Article in Portuguese | LILACS | ID: biblio-1353116

ABSTRACT

Nevo epidérmico verrucoso inflamatório linear e diagnóstico diferencial com a psoríase linear: a respeito de um caso RELATO DE CASOMaria Isabel Muniz Zemero1, Maria Amélia Lopes dos Santos1, Alena Margareth Darwich Mendes1, Carla Andrea Avelar Pires1,O nevo epidérmico verrucoso inflamatório linear (NEVIL) é uma variedade clínica rara de nevo epidérmico verrucoso, que se manifesta no início da infância, como lesões inflamatórias de superfície ceratósica, que coalescem e se distribuem em faixa, acompanhando as linhas de Blaschko. Faz diagnóstico diferencial com a psoríase linear, sendo difícil a diferenciação, dado os aspectos clínicos e histopatológicos comuns aos dois, enfantizando-se a necessidade de conhecer as características específicas de cada um. O objetivo deste relato é demonstrar uma afecção relativamente rara, descrita em uma menina de 5 anos, evoluindo desde os primeiros dias de vida com placas papuloceratósicas dispostas linearmente, acompanhadas de sinais inflamatórios e áreas erosadas ocupando grandes lábios, períneo e face interna e superior da coxa esquerda. Também pápulas e placas ceratósicas na região cervical posterior e borda lateral externa da planta do pé esquerdo, ascendendo ao longo da região posterior deste membro. Os critérios clínicos e histopatológicos corroboram o diagnóstico de NEVIL na diferenciação com a psoríase linear, ressaltando a importância do estabelecimento de critérios/ ferramentas que auxiliem na diferenciação destas duas dermatoses visando agilizar o diagnóstico, otimizar o tratamento e minimizar o desconforto para esses pacientes. O acompanhamento a longo prazo dos portadores é sugerido pela possibilidade ainda que mínima de malignização do NEVIL. (AU)


Inflammatory linear verrucous epidermal nevus and differential diagnosis with linear psoriasis: about a caseCASE REPORTMaria Isabel Muniz Zemero1, Maria Amélia Lopes dos Santos1, Alena Margareth Darwich Mendes1, Carla Andrea Avelar Pires1,Inflammatory Linear Verrucous Epidermal Nevus (ILVEN) is a rare clinical variety of verrucous epidermal nevus that manifests in early childhood as inflammatory lesions of keratosis surface, which coalesce and spread in band, following Blaschko lines. It makes a differential diagnosis with Linear Psoriasis; it is difficult to differentiate them given the clinical and histopathological aspects common to both, emphasizing the need to know the specific characteristics of each. The purpose of this report is to demonstrate a relatively rare affection, expressed in a 5-year-old girl, evolving from the first days of life with papulokeratosic plaques arranged linearly, followed by inflammatory signs and eroded areas, placed linearly, overtaking labia majora, perineum, the inner and upper face of the left thigh. Also, the patient showed keratotic papules and plaques in the posterior cervical region and external lateral border of the left foot plant, ascending along the posterior region of this limb. The clinical and histopathological criteria corroborate the diagnosis of ILVEN in differentiation with linear psoriasis, emphasizing the importance of establishing criteria/instruments to assist in distinguishing these two dermatoses in order to expedite the diagnosis, to optimize the treatment and minimize patients' discomfort. Long-term follow-up of patients with this disease is suggested due to the possibility, albeit minimal, of ILVEN malignancy. (AU)


Subject(s)
Humans , Female , Child, Preschool , Psoriasis , Skin Diseases , Diagnosis, Differential , Ectromelia , Nevus, Sebaceous of Jadassohn/diagnosis , Genitalia/pathology , Keratosis
3.
Dement. neuropsychol ; 15(3): 405-412, Sept. 2021. tab, graf
Article in English | LILACS | ID: biblio-1339794

ABSTRACT

ABSTRACT. The differential diagnosis of primary progressive aphasia (PPA) is challenging due to overlapping clinical manifestations of the different variants of the disease. This is particularly true for the logopenic variant of PPA (lvPPA), in which such overlap was reported with regard to impairments in repetition abilities. In this study, four individuals with lvPPA underwent standard neuropsychological and language assessments. The influence of psycholinguistic variables on their performance of in word, nonword and sentence repetition tasks was also specifically explored. Some level of heterogeneity was found in cognitive functions and in language. The four participants showed impairment in sentence repetition in which their performance was negatively affected by semantic reversibility and syntactic complexity. This study supports the heterogeneity of lvPPA with respect to the cognitive and linguistic status of participants. It also shows that sentence repetition is influenced not only by length, but also by semantic reversibility and syntactic complexity, two psycholinguistic variables known to place additional demands on phonological working memory.


RESUMO. O diagnóstico diferencial da afasia progressiva primária (APP) é desafiador devido às sobreposições das manifestações clínicas das diferentes variantes da doença. Isso é particularmente verdadeiro para a variante logopênica do APP (APPlg), em que tal sobreposição foi relatada em relação à deficiências nas habilidades de repetição. No presente estudo, quatro indivíduos com APPlg foram submetidos à avaliações neuropsicológica e de linguagem. A influência de variáveis psicolinguísticas em seu desempenho de palavras, não-palavras e tarefas de repetição de frases também foi especificamente explorada. Certo nível de heterogeneidade foi encontrado nas funções cognitivas e na linguagem. Os quatro participantes apresentaram prejuízo na repetição de frases em que seu desempenho foi afetado negativamente pela reversibilidade semântica e complexidade sintática. O estudo apoia a heterogeneidade do APPlg no que diz respeito ao status cognitivo e linguístico dos participantes. Mostra também que a repetição de sentenças é influenciada não apenas pelo comprimento, mas também pela reversibilidade semântica e complexidade sintática, duas variáveis psicolinguísticas conhecidas por colocarem demandas adicionais na memória operacional fonológica.


Subject(s)
Humans , Aphasia, Primary Progressive , Specific Language Disorder , Psycholinguistics , Diagnosis, Differential
4.
Medicina (B.Aires) ; 81(4): 649-651, ago. 2021. graf
Article in Spanish | LILACS | ID: biblio-1346520

ABSTRACT

Resumen La apendicitis del muñón es una complicación poco frecuente de la apendicectomía. Puede aparecer desde unas semanas a varios años luego del procedimiento quirúrgico. Para arribar a su diagnóstico es necesario un alto índice de sospecha. El objetivo de esta publicación es hacer una reseña de dos casos de esta entidad ocurridos en nuestra institución y mencionar sus hallazgos imagenológicos más frecuentes. La tomografía computarizada es un excelente método para valorar esta entidad, no solo para su diagnóstico sino también para descartar otras patologías que presentan un cuadro clínico similar.


Abstract Stump appendicitis is a rare complication of appendectomy. It may develop from a few weeks to several years after the surgical procedure. To achieve its diagnosis a high index of suspicion is necessary. The objective of this publication is to make a re view of two cases of this entity that occurred in our institution and to mention its most frequent imaging findings. Computed tomography is an excellent method to assess this entity, not only for its diagnosis but also to rule out other pathologies that present similar clinical features.


Subject(s)
Humans , Appendicitis/surgery , Appendicitis/etiology , Appendicitis/diagnostic imaging , Appendectomy , Postoperative Complications/etiology , Postoperative Complications/diagnostic imaging , Tomography, X-Ray Computed , Diagnosis, Differential
5.
Rev. urug. cardiol ; 36(2): e701, ago. 2021. tab
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1289999

ABSTRACT

El debut del lupus eritematoso sistémico (LES) durante el embarazo, intrincado con preeclampsia grave, asociado a edema vulvar masivo gestacional, es raro y de difícil diagnóstico. Se reporta una paciente de 19 años, con 35 semanas de gestación, que debutó con LES durante el tercer trimestre del embarazo, y que consulta por manifestaciones cutáneas, dadas por eritemas en pulpejos de dedos de manos. Se constata preeclampsia severa. Se realiza cesárea de urgencia, e ingresa a la unidad de cuidados intensivos. Instala edema de vulva masivo que incapacita la deambulación.


The onset of systemic lupus erythematosus during pregnancy, complicated with severe preeclampsia, associated with massive gestational vulvar edema, is rare and difficult to diagnose. A 19-year-old patient is reported, with 35 weeks of gestation, who started with systemic lupus erythematosus during her third trimester of pregnancy, and consulted due to cutaneous manifestations caused by erythema on the pads of the fingers. Severe preeclampsia was observed. An emergency cesarean section was performed, and the patient was admitted to the Intensive Care Unit. She developed a massive vulvar edema that disabled ambulation.


O aparecimento de lúpus eritematoso sistêmico durante a gravidez, intrincado com pré-eclâmpsia grave é raro e de difícil diagnóstico. É relatada uma paciente de 19 anos, com 35 semanas de gestação, que estreou com lúpus eritematoso sistêmico no terceiro trimestre de gestação, e que se consultou por manifestações cutâneas causadas por eritema nas pontas dos dedos das mãos. Também existe uma pré-eclâmpsia grave. E realizada cesárea de emergência e ela é internada na Unidade de Terapia Intensiva. Instala um edema vulvar maciço que impede a deambulação.


Subject(s)
Humans , Female , Pregnancy , Adult , Pre-Eclampsia , Vulva/pathology , Edema/surgery , Lupus Erythematosus, Systemic/diagnosis , Lupus Erythematosus, Systemic/drug therapy , Catastrophic Illness , Diagnosis, Differential
6.
Arch. argent. pediatr ; 119(4): e340-e344, agosto 2021. tab, ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1281780

ABSTRACT

La acrodisostosis es una displasia esquelética rara, de herencia autosómica dominante, que se caracteriza por la presencia de disostosis facial y periférica, talla baja y diferentes grados de obesidad. La acrodisostosis de tipo 1, secundaria a la mutación heterocigota en el gen PRKAR1A (17q24.2), se caracteriza por la asociación de resistencia hormonal múltiple con anomalías esqueléticas. Su incidencia está infradiagnosticada debido a que comparte rasgos clínicos y de laboratorio con otras entidades como el seudohipoparatiroidismo. Presentamos el caso de una niña de 8 años, con acrodisostosis tipo 1, confirmada mediante estudio genético. Además del fenotipo característico descrito, la talla baja y la resistencia hormonal, la paciente presentó una afectación progresiva de la función pulmonar: un patrón pulmonar obstructivo no reversible. En la literatura revisada, no se han encontrado otros casos que describan esta asociación entre acrodisostosis y afectación respiratoria.


Acrodysostosis is a rare skeletal displasia, of autosomal dominant inheritance, characterized by the presence of facial and peripheral dysostosis, short stature and obesity. Type 1 acrodysostosis is secondary to a mutation in the PRKAR1A (17q24.2) gene, which results in multi hormonal resistance and skeletal anomalities. This syndrome is under-diagnosed as it shares analytical and clinical characteristics with other entities, such as pseudohypoparathyroidism. We report the case of an eight-year-old girl with genetically confirmed type 1 acrodysostosis. In addition to the characteristic phenotype described, the short stature and the hormonal resistance, the patient suffered a progressive lung function deterioration: an irreversible pulmonary obstructive pattern. We have not found in previous literature cases reporting an association between acrodysostosis and lung function impairement.


Subject(s)
Humans , Female , Child , Osteochondrodysplasias/complications , Dysostoses/complications , Lung Diseases, Obstructive/complications , Osteochondrodysplasias/genetics , Osteochondrodysplasias/diagnostic imaging , Spirometry , Diagnosis, Differential , Dysostoses/genetics , Dysostoses/diagnostic imaging , Dyspnea/complications , Mutation/genetics
7.
Arch. argent. pediatr ; 119(4): S198-S211, agosto 2021. tab, ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1281043

ABSTRACT

La pandemia ocasionada por el nuevo coronavirus (SARS-CoV-2), declarada por la Organización Mundial de la Salud OMS) en marzo de 2020, afecta a un reducido número de pacientes pediátricos, quienes presentan, en su mayoría, compromiso respiratorio leve y evolución favorable. Sin embargo, en niños previamente sanos, comenzó a observarse un aumento de casos definidos como síndrome inflamatorio multisistémico (SIM-C) o similar a Kawasaki (Kawasaki-like) asociado a la enfermedad por el nuevo coronavirus (COVID-19) (KL-C) que evolucionan al shock y requieren internación en la unidad de cuidados intensivos.Los cuadros de SIM-C y los KL-C se caracterizan por fiebre, signos de inflamación, síntomas gastrointestinales y disfunción cardiovascular; las formas graves de presentación tienen mayor incidencia de hipotensión y/o shock. En el laboratorio se observan marcadores de inflamación, hipercoagulabilidad y daño miocárdico. El tratamiento farmacológico de primera línea consiste en la administración de inmunoglobulina por vía intravenosa más ácido acetilsalicílico por vía oral.Se recomienda un abordaje multidisciplinario para un diagnóstico certero y un tratamiento temprano y eficaz para disminuir la morbimortalidad.


The pandemic caused by the SARS-CoV-2 virus declared by the WHO in March 11th 2020, affects a small number of pediatric patients, who mostly present mild respiratory compromise and favorable evolution.However began to be observed in previously healthy children, an increase in cases defined as "Multisystemic Inflammatory Syndrome" (MIS-C) or "Kawasaki-like" post-COVID 19 (KL-C) that evolve to shock and require hospitalization in the Pediatric Intensive Care Unit.MIS-C and KL-C are characterized by fever; signs of inflammation, gastrointestinal symptoms, and cardiovascular dysfunction, associated with sever forms of presentation with higher incidence of hypotension and/or shock. In the laboratory, markers of inflammation, hypercoagulability and myocardial damage are observed. First-line drug treatment consists of intravenous immunoglobulin plus oral acetylsalicylic acid.A multidisciplinary approach is recommended for an accurate diagnosis and an early and effective treatment, in order to reduce morbidity and mortality.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Systemic Inflammatory Response Syndrome/therapy , COVID-19/therapy , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Aspirin/therapeutic use , Immunoglobulins, Intravenous/therapeutic use , Systemic Inflammatory Response Syndrome/complications , Systemic Inflammatory Response Syndrome/diagnosis , Critical Care , Diagnosis, Differential , COVID-19/complications , COVID-19/diagnosis , Mucocutaneous Lymph Node Syndrome/complications , Mucocutaneous Lymph Node Syndrome/diagnosis , Mucocutaneous Lymph Node Syndrome/therapy
8.
Arch. argent. pediatr ; 119(3): e252-e255, Junio 2021. ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1248221

ABSTRACT

Las infecciones por coronavirus son habituales en los pacientes pediátricos. Por lo general, producen un cuadro clínico leve de infección del tracto respiratorio superior que no suele afectar a los pulmones, salvo en prematuros y niños con enfermedades crónicas de base. Excepcionalmente, afectan a otros órganos (corazón, cerebro, tracto gastrointestinal) e incrementan su gravedad.En relación con la coincidencia temporal con el inicio de la actual pandemia por el nuevo beta coronavirus (SARS-CoV-2), responsable de su enfermedad asociada (COVID-19), se presenta el caso clínico de un paciente de 5 años con fracaso multiorgánico y secuelas neurológicas por afectación bulbar y trombosis vascular ocasionados por un alfa coronavirus (CoV-NL63) debido a su gravedad y excepcionalidad


Coronavirus infections (CoV) are common in pediatric patients. In general, they produce a mild clinical presentation consisting of an upper respiratory tract infection that does not usually infect the lungs, with the exception of preterm infants and children with chronic diseases. These infections exceptionally affect other organs (heart, brain, gastrointestinal tract), thus increasing their severity.In relation to the temporal coincidence with the beginning of the current situation of pandemic by the new beta coronavirus SARS-CoV-2 responsible for its associated disease (COVID-19), this study presents a clinical case of a 5-year-old patient showing multiple-organ failure and neurological sequelae due to bulbar injury and vascular thrombosis caused by an alpha coronavirus (CoV-NL63) due to its severity and exceptionality


Subject(s)
Humans , Male , Child, Preschool , Respiratory Tract Infections/diagnosis , Coronavirus Infections/diagnosis , Coronavirus NL63, Human/isolation & purification , Multiple Organ Failure/virology , Respiratory Tract Infections/complications , Coronavirus Infections/complications , Diagnosis, Differential , Multiple Organ Failure/diagnosis
9.
Arch. argent. pediatr ; 119(3): e202-e214, Junio 2021. tab, ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1223316

ABSTRACT

La trombocitopenia, definida como recuento plaquetario inferior a 100 x 109/l, es un hallazgo muy frecuente en el período neonatal, que ocurre, en especial, en niños críticamente enfermos y en prematuros. Sus causas son múltiples: puede deberse tanto a enfermedades del niño como a otros factores involucrados en la interrelación niño-placenta-madre. En este primer artículo, se enumeran las causas de trombocitopenia; se plantea el enfoque diagnóstico frente a un neonato trombocitopénico y se describen detalladamente las distintas entidades correspondientes a trombocitopenias de etiología inmune. Se presentan los diferentes mecanismos causales y se revisan las distintas características de la trombocitopenia secundaria a trombocitopenia inmune materna y de la trombocitopenia neonatal aloinmune. Se describen las diversas estrategias terapéuticas disponibles para cada una de ellas, tanto para su manejo posnatal como para el prenatal. Se enfatiza sobre la gravedad de la enfermedad y las serias complicaciones y secuelas asociadas a la trombocitopenia neonatal aloinmune


Thrombocytopenia, defined as a platelet count below 100 x 109/L, is a very common finding in the neonatal period, especially in critically ill infants and preterm newborns. Its causes are multiple: it may be due both to pediatric conditions and to other factors involved in the fetal-placental-maternal interface. This initial article describes the causes of thrombocytopenia, proposes a diagnostic approach to manage a thrombocytopenic newborn infant, and provides a detailed description of the different conditions corresponding to thrombocytopenia of immune etiology. It also describes the different causative mechanisms and reviews the varying characteristics of thrombocytopenia secondary to maternal immune thrombocytopenia and neonatal alloimmune thrombocytopenia. The different treatment approaches to each of the different conditions are described both for their pre- as well as their postnatal management. The severity of thrombocytopenia and the serious complications and sequelae associated with the neonatal alloimmune thrombocytopenia are highlighted.


Subject(s)
Humans , Male , Female , Infant, Newborn , Thrombocytopenia, Neonatal Alloimmune/etiology , Thrombocytopenia, Neonatal Alloimmune/therapy , Immunoglobulin G/therapeutic use , Platelet Transfusion , Diagnosis, Differential , Thrombocytopenia, Neonatal Alloimmune/diagnosis , Hemorrhage
10.
Int. j. med. surg. sci. (Print) ; 8(2): 1-5, jun. 2021. ilus
Article in English | LILACS | ID: biblio-1284513

ABSTRACT

Epidermoid cyst is a type of cutaneous cyst commonly found in daily practice. The facial area is the most common area for emergence of this benign condition. Simple extirpation is usually performed to remove epidermoid cysts. However, in rare cases, epidermoid cysts can evolve into malignancies such as basal cell carcinoma (BCC) or can mimic them, which adds difficulty when making a proper diagnosis. In cases of doubt, histopathology plays a key role in aiding diagnosis. This case report is about a 33-year-old woman with suspected nodular lesion that mimicked BCC, but after histopathological analysis was confirmed to be epidermoid cyst


El quiste epidermoide es un tipo de quiste cutáneo que se encuentra frecuentemente en la práctica diaria. El área facial es el área más común para la aparición de esta lesión benigna. La extirpación quirúrgica simple es el procedimiento habitual para eliminar los quistes epidermoides. Sin embargo, en casos raros, los quistes epidermoides pueden evolucionar en neoplasias malignas como el carcinoma basocelular (CCB) o pueden imitarlos, lo que añade dificultad al hacer un diagnóstico adecuado. En caso de duda, la histopatología desempeña un papel clave en la ayuda al diagnóstico. Este informe de caso trata sobre una mujer de 33 años con sospecha de lesión nodular que imitaba el CCB, pero después de que se confirmó con el análisis histopatológico, que se trataba de un quiste epidermoide.


Subject(s)
Humans , Female , Adult , Skin Diseases/diagnosis , Epidermal Cyst/diagnosis , Carcinoma, Basal Cell/diagnosis , Diagnosis, Differential , Epidermal Cyst/surgery
11.
Int. j. med. surg. sci. (Print) ; 8(2): 1-18, jun. 2021. ilus, tab
Article in English | LILACS | ID: biblio-1284462

ABSTRACT

Idiopathic retroperitoneal fibrosis is a rare fibro-inflammatory disease of varied etiology which usually originates around aorta and spreads caudally along Iliac vessels into adjacent retroperitoneum causing ureteral obstruction as the most frequent complication.A 53-year-old male patient presented with complaint of mild pain in both the legs off and on. On investigating further, we found that he had been struggling with intermittent relapses every 3-4 years for last 20 years since he was first diagnosed with Idiopathic Retroperitoneal Fibrosis. He was 33-year-old when he first developed the symptoms of anuria for 48 hours and was diagnosed with Idiopathic retroperitoneal fibrosis. This was followed by atrophy of left kidney and hypertension 6 years later, then hypothyroidism after another 3years and finally involvement of Inferior Vena Cava and acute Deep Vein Thrombosis of lower limbs after another 3-4 years. His deep vein thrombosis was well managed in time. He was put on glucocorticoids everytime he had a relapse and a complication.We did a review of literature to understand recent advances about its pathogenesis, diagnosis, investigations and management. We searched in PubMed using terms like retroperitoneal fibrosis alone and in combination with related terms such as Inferior Vena Cava thrombosis, Deep Vein Thrombosis, Tamoxifen, Methotrexate. This case is unique as it is very rare to find acute Deep Vein Thrombosis in Idiopathic retroperitoneal fibrosis without development of any collaterals when Inferior Vena Cava lumen is compromised to almost complete obstruction.After a follow up of 20 years patient is doing well in terms of physical activity and psychological wellbeing with anti-hypertensives, thyroxine and anti-coagulants. Is the disease-free interval actually free of the disease or it just subsided with immunosuppressants to become active after some time?


La fibrosis retroperitoneal idiopática es una enfermedad fibroinflamatoria rara, de etiología variada que generalmente se origina alrededor de la aorta y se propaga caudalmente a lo largo de los vasos ilíacos en retroperitoneo adyacente causando obstrucción ureteral como la complicación más frecuente.Reportamos el caso de un paciente varón de 53 años que se presentó con un dolor leve en ambas piernas. Al investigar más a fondo, descubrimos que había estado luchando con recaídas intermitentes cada 3-4 años durante los últimos 20 años desde que se le diagnosticó por primera vez fibrosis retroperitoneal idiopática. Tenía 33 años cuando desarrolló por primera vez los síntomas de anuria durante 48 horas y se le diagnosticó fibrosis retroperitoneal idiopática. Esto fue seguido por atrofia del riñón izquierdo e hipertensión 6 años después, luego hipotiroidismo después de otros 3 años y finalmente afectación de la vena cava inferior y trombosis venosa profunda aguda de las extremidades inferiores después de otros 3-4 años. Su trombosis venosa profunda se controló bien a tiempo. Le recetaron glucocorticoides cada vez que tenía una recaída y una complicación.Hicimos una revisión de la literatura para comprender los avances recientes sobre su patogenia, diagnóstico, investigaciones y manejo. Se realizaron búsquedas en PubMed utilizando términos como fibrosis retroperitoneal sola y en combinación con términos relacionados como trombosis de la vena cava inferior, trombosis venosa profunda, tamoxifeno, metotrexato. Este caso es único, ya que es muy raro encontrar trombosis venosa profunda aguda en fibrosis retroperitoneal idiopática sin desarrollo de colaterales cuando la luz de la vena cava inferior está comprometida hasta una obstrucción casi completa.Después de un seguimiento de 20 años, el paciente se encuentra bien en términos de actividad física y bienestar psicológico con antihipertensivos, tiroxina y anticoagulantes. ¿El intervalo libre de enfermedad está realmente libre de la enfermedad o simplemente disminuyó con inmunosupresores para activarse después de algún tiempo?


Subject(s)
Humans , Male , Middle Aged , Retroperitoneal Fibrosis/complications , Retroperitoneal Fibrosis/diagnosis , Retroperitoneal Fibrosis/therapy , Recurrence , Time Factors , Tomography, X-Ray Computed , Diagnosis, Differential , Hypothyroidism , Immunosuppressive Agents/therapeutic use
12.
Rev. colomb. gastroenterol ; 36(supl.1): 19-25, abr. 2021. graf
Article in Spanish | LILACS | ID: biblio-1251541

ABSTRACT

Resumen La pancreatitis del surco (PS) o "groove pancreatitis", es una forma de pancreatitis crónica infrecuente; nombrada así por su localización en el surco pancreatoduodenal. Suele predominar en varones con antecedente de ingesta de alcohol. Es de gran importancia realizar diagnóstico diferencial con cáncer de páncreas, dada su ubicación. Los avances en los métodos diagnósticos, como la ultrasonografía endoscópica, han permitido un abordaje más certero, sin embargo, no se cuenta con guías de manejo y las aproximaciones terapéuticas siguen siendo basadas en patologías similares.


Abstract Groove pancreatitis (GP) is a rare form of chronic pancreatitis located in the pancreaticoduodenal groove, hence its name. It is predominant in males with a history of alcohol intake. Making a differential diagnosis between this condition and pancreatic cancer is highly relevant given its location. Advances in diagnostic methods, such as endoscopic ultrasonography, have allowed a more accurate approach. However, no management guidelines are available and therapeutic approaches are still based on similar pathologies.


Subject(s)
Humans , Male , Adult , Pancreatitis, Chronic , Similar , Diagnosis, Differential , Ethanol
13.
Revista Digital de Postgrado ; 10(1): 275, abr. 2021. tab
Article in Spanish | LILACS, LIVECS | ID: biblio-1147596

ABSTRACT

El hígado graso del embarazo es una patología poco frecuente en la especialidad obstétrica, cuyo diagnóstico se realiza basado en los criterios de Swansea, muchas veces es un diagnóstico que se realiza por exclusión; usualmente se presenta entre las semanas 30 y 35 del embarazo, y la cura definitiva se realiza con la interrupción expedita del mismo; con una tasa de recuperación casi del 100% si se realiza la interrupción oportuna y una tasa de mortalidad materno fetal actual del 10%. Es importante estar atentos a la ganancia ponderal de la embarazada durante el control prenatal, la epigastralgia, y los signos clínicos asociados a hipoglicemia(AU)


Fatty liver of pregnancy is a rare pathology in obstetrics, whose diagnosis is made based on the Swansea criteria, many times it is a diagnosis that is made by exclusion; It usually occurs between weeks 30 and 35, and the definitive cure is carried out with the expeditious interruption of pregnancy; with a recovery rate of almost 100% if timely interruption is made and a current maternal-fetal mortality rate of 10%. It is important to be attentive to the weight gain of the pregnant woman during prenatal control, epigastric pain, and clinical signs associated with hypoglycemia


Subject(s)
Humans , Female , Pregnancy , Pregnancy Complications/diagnosis , Fatty Liver/diagnosis , Pregnancy Complications/surgery , Pregnancy Trimester, Third , Cesarean Section , Acute Disease , HELLP Syndrome/diagnosis , Diagnosis, Differential , Fatty Liver/surgery , Fatty Liver/complications , Hypoglycemia/diagnosis , Jaundice/complications , Jaundice/diagnosis
14.
Rev. cient. odontol ; 9(1): e050, ene.-mar. 2021. ilus
Article in English | LILACS, LIPECS | ID: biblio-1254402

ABSTRACT

Objective: The aim of this study was to update the concepts of the diagnosis of idiopathic osteosclerosis (IO) of the jaws by digital panoramic radiographs and cone beam tomography and describe the impact of this disease on oral and general health. Methods: A search of the main databases of dental medical research was carried out using the search terms "osteosclerosis, panoramic radiography, cone beam computed tomography, jaws". Articles without language restriction until September 30, 2020 were identified. The prevalence and clinical and radiographic characteristics of IO of the jaws were examined in 2D and 3D imaging studies, as well as the interaction during treatments in the various dental specialties. Results: We analyzed the current situation regarding the diagnosis of IO, with an update of the diagnostic criteria used to accurately identify IO in the latest generation imaging studies, as well determine its possible interactions in oral an general health. Conclusions: It is important to have a clear differential diagnosis of IO and be able to distinguish different radiopacities in the maxilla. Accurate reporting and monitoring of the morphometric characteristics are necessary taking into account the impact the presence of IO of the jaws has on future dental treatments. (AU)


Objetivo: El propósito de esta investigación fue actualizar las consideraciones para el diagnóstico de la osteoesclerosis idiopática en radiografías panorámicas digitales y tomografías de haz cónico, a fin de determinar sus implicancias en la salud oral y general. Métodos: Se realizó las pesquisas en las principales bases de datos de investigación médica estomatológica, utilizando las palabras "osteoesclerosis", "radiografía panorámica", "tomografía computarizada de haz cónico" y "mandíbula". Se identificaron artículos sin restricción de idioma, desde las primeras publicaciones hasta el 30 de septiembre del 2020. Se examinaron la prevalencia, las características clínicas y radiográficas en estudios imagenológicos de dos y tres dimensiones, así como su interacción durante los tratamientos realizados en las diversas especialidades estomatológicas. Resultados: La información obtenida nos permitió analizar la situación actual con respecto al diagnóstico de la OI y actualizar los criterios diagnósticos para una identificación certera de la OI en los estudios imagenológicos de última generación, así como sus posibles interacciones en la salud oral y general. Conclusiones: Es importante tener un criterio diagnóstico diferencial claro al distinguir las diferentes radiopacidades como la OI, que se pueden presentar en los maxilares, mediante un registro preciso de sus características morfométricas y seguimiento en el tiempo, teniendo en cuenta su existencia y sus implicancias en los tratamientos dentales a futuro. (AU)


Subject(s)
Humans , Osteosclerosis , Radiography, Panoramic , Diagnosis, Differential , Cone-Beam Computed Tomography , Mandible
15.
Rev. cuba. estomatol ; 58(1): e3304, ene.-mar. 2021. graf
Article in Portuguese | LILACS, CUMED | ID: biblio-1156425

ABSTRACT

Introdução: O adenoma pleomorfo é a neoplasia benigna de glândula salivar mais comum, podendo acometer glândulas salivares maiores e menores. Essa neoplasia ocorre em uma ampla faixa etária, e se caracteriza por uma ampla variabilidade clinico-patológica e por altas taxas de recorrência. Objetivo: Relatar um caso de um adenoma pleomorfo, com enfoque nos aspectos clinico-patológicos, diagnóstico diferencial e manejo clínico. Relato de caso: Paciente do sexo masculino, 72 anos, exibiu lesão nodular, bem delimitada, localizada em fundo de sulco maxilar esquerdo, com tempo de evolução de quatro anos. A biópsia excisional foi realizada, e as hipóteses diagnósticas de hiperplasia linfoide, adenoma pleomorfo e lipoma foram consideradas, sendo esta última reforçada pelo fato de ter flutuado em formol. Sob análise microscópica, observou-se uma proliferação de células epiteliais e mioepiteliais em meio a um estroma variável. Com isso, o diagnóstico histopatológico de adenoma pleomorfo foi emitido. Conclusão: O presente estudo enaltece a importância da realização de análise histopatológica criteriosa para exclusão de outras hipóteses diagnósticas e neoplasias malignas. Dessa forma, a partir da associação dos achados clínicos e microscópicos, é possível obter um diagnóstico correto, guiando, consequentemente, na adoção de uma conduta terapêutica adequada(AU)


Introducción: El adenoma pleomórfico es la neoplasia benigna de glándulas salivales más común, que puede afectar a las glándulas salivales mayores y menores. Esta neoplasia se presenta en un amplio grupo de edad y se caracteriza por una amplia variabilidad clínica y patológica y altas tasas de recurrencia. Objetivo: Describir un caso de adenoma pleomórfico, con énfasis en aspectos clínicos y patológicos, diagnóstico diferencial y manejo clínico. Caso clínico: Paciente masculino, de 72 años, que presentó una lesión nodular bien definida ubicada en la parte inferior del surco maxilar izquierdo, con un tiempo de evolución de cuatro años. Se realizó una biopsia escisional. Se consideraron las hipótesis diagnósticas de hiperplasia linfoide, adenoma pleomórfico y lipoma, con mayor atención este último por el hecho de que flotaba en formaldehído. Bajo análisis microscópico, se observó una proliferación de células epiteliales y mioepiteliales en medio de un estroma variable. Por lo tanto, se emitió el diagnóstico histopatológico de adenoma pleomorfo. Conclusión: El presente estudio destaca la importancia de llevar a cabo un cuidadoso análisis histopatológico para excluir otras hipótesis diagnósticas y neoplasias malignas. Luego, con base en la asociación de hallazgos clínicos y microscópicos, es posible obtener un diagnóstico correcto, imprescindible en la adopción de un enfoque terapéutico apropiado(AU)


Introduction: Pleomorphic adenoma is the most common benign salivary gland neoplasm. It may affect major and minor salivary glands. It presents at a broad age range and is characterized by great clinical and pathological variability and high recurrence rates. Objective: Describe a case of pleomorphic adenoma, with emphasis on clinical and pathological aspects, differential diagnosis and clinical management. Case report: A male 72-year-old patient presents with a well-defined nodular lesion in the lower section of the left maxillary groove with a time of evolution of four years. Excisional biopsy was performed. The diagnostic hypotheses considered were lymphoid hyperplasia, pleomorphic adenoma and lipoma, with greater attention to the latter, due to the fact that it floated in formaldehyde. Microscopic examination revealed proliferation of epithelial and myoepithelial cells amidst a variable stroma. Thus, a histopathological diagnosis of pleomorphic adenoma was issued. Conclusion: The present study highlights the importance of careful histopathological examination to rule out other diagnostic hypotheses and malignant neoplasms. Next, clinical and microscopic findings will lead to an accurate diagnosis indispensable to adopt an appropriate therapeutic approach(AU)


Subject(s)
Humans , Male , Aged , Biopsy/methods , Salivary Gland Neoplasms/epidemiology , Adenoma, Pleomorphic/pathology , Diagnosis, Differential
16.
Arq. gastroenterol ; 58(1): 82-86, Jan.-Mar. 2021. tab, graf
Article in English | LILACS | ID: biblio-1248979

ABSTRACT

ABSTRACT BACKGROUND: Hepatocellular carcinoma (HCC) is the most frequent primary cancer of the liver and cirrhosis is considered a pre-malignant disease. In this context, the evolutionary sequence from low grade dysplastic nodule and high grade dysplastic nodule (HGDN) to early HCC and advanced HCC has been studied. The differential diagnosis between HGDN and early HCC is still a challenge, especially in needle biopsies OBJECTIVE: To evaluate an immunohistochemistry panel to differentiate dysplastic nodules and HCC. METHODS: Patients with cirrhosis who underwent surgical resection or liver transplantation were included. The sensitivity, specificity and accuracy for the diagnosis of neoplasia were analyzed by evaluating five markers: heat shock protein 70, glypican 3, glutamine synthetase, clathrin heavy chain and beta-catenin. P≤0.05 was considered statistically significant. RESULTS: One hundred and fifty-six nodules were included; of these, 57 were HCC, 14 HGDN, 18 low grade dysplastic nodules and 67 regenerative macronodules. Sensitivity of HCC diagnosis was 64.9% for glypican 3 and 77.2% for glutamine syntetase, while specificity was 96.0% and 96.0% respectively. When the panel of four markers was considered (excluding beta catenin), the specificity ranged from 87.9% for one positive marker to 100% for at least three markers. The best accuracy for HCC diagnosis was obtained with at least two positive markers, which was associated with a sensitivity of 82.5% and specificity of 99%. CONCLUSION: Differential diagnosis of dysplastic nodules and HCC by morphological criteria can be challenging. Immunomarkers are useful and should be used for the differential diagnosis between HCC and HGDN.


RESUMO CONTEXTO: O carcinoma hepatocelular (CHC) é o câncer primário do fígado mais frequente e a cirrose é considerada uma doença pré-maligna. Nesse contexto, a sequência evolutiva do nódulo displásico de baixo grau e nódulo displásico de alto grau (NDAG) para CHC precoce e CHC avançado tem sido estudada. O diagnóstico diferencial entre NDAG e CHC precoce ainda é um desafio, principalmente em biópsias por agulha. OBJETIVO: Avaliar um painel de imunohistoquímica para diferenciar nódulos displásicos de CHC. MÉTODOS: Foram incluídos pacientes com cirrose submetidos à ressecção cirúrgica ou transplante de fígado. A sensibilidade, especificidade e acurácia para o diagnóstico da neoplasia foram analisadas avaliando cinco marcadores: proteína de choque térmico 70kDa, glipican 3, glutamina sintetase, clatrina de cadeia pesada e beta-catenina. P≤0,05 foi considerado estatisticamente significativo. RESULTADOS: Cento e cinquenta e seis nódulos foram incluídos; destes, 57 eram CHC, 14 NDAG, 18 nódulos displásicos de baixo grau e 67 macronódulos regenerativos. A sensibilidade do diagnóstico de CHC foi de 64,9% para glipican 3 e 77,2% para glutamina sintetase, enquanto a especificidade foi de 96,0% e 96,0%, respectivamente. Quando o painel de quatro marcadores foi considerado (excluindo beta catenina), a especificidade variou de 87,9% para um marcador positivo a 100% para pelo menos três marcadores. A melhor acurácia para o diagnóstico de CHC foi obtida com pelo menos dois marcadores positivos, o que foi associado a uma sensibilidade de 82,5% e especificidade de 99%. CONCLUSÃO: O diagnóstico diferencial de nódulos displásicos e CHC por critérios morfológicos pode ser desafiador. Imunomarcadores são úteis e devem ser usados para o diagnóstico diferencial entre CHC e NDAG.


Subject(s)
Humans , Carcinoma, Hepatocellular/diagnosis , Neoplasms/diagnosis , Immunohistochemistry , Diagnosis, Differential , Liver Cirrhosis/diagnosis
19.
Rev. argent. reumatolg. (En línea) ; 32(1): 31-35, mar. 2021. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1279757

ABSTRACT

Se presenta el caso de un paciente con quistes en el hueso iliaco como causa atípica de lumbalgia crónica a la cual se puede enfrentar el reumatólogo, y se hará una revisión de la literatura sobre los tipos de quistes óseos y sus diagnósticos diferenciales. También se hará mención de sus opciones de tratamiento.


The case of a patient with cysts in the iliac bone is presented as an atypical cause of chronic low back pain that the rheumatologist may face, and a review of the literature on the types of bone cysts and their differential diagnoses will be made. Mention will also be made of your treatment options.


Subject(s)
Low Back Pain , Therapeutics , Bone Cysts , Back Pain , Cysts , Diagnosis, Differential
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