Choque: diagnóstico e tratamento na emergência / Shock: emergency diagnosis and treatment

O choque é uma síndrome caracterizada pela redução da perfusão tecidual sistêmica, levando a disfunção orgânica. É essencial o reconhecimento precoce para correção das disfunções e diagnóstico e tratamento da causa de base.

Shock is a syndrome characterized for the reduction of the systemic tissue perfusion. It leads to global organic dysfunction. Early recognition is essential for dysfunctions correction and to diagnosis and treat the basic cause.

Transverse myelitis associated to HCV infection

Complications involving the central nervous system in patients suffering from hepatitis C virus (HCV) infectionhave been rare. Among them, it appears the transverse myelitis, which has already been reported in likely association with HCV. This paper presents the case study of a 65-year-old woman who developed cervical transverse myelitis linked to chronic HCV infection and anti-HCV antibodies in the spinal fluid, being excluded other etiologies for transverse myelitis. Current evidence has reinforced the likely association between chronic HCV infection and transverse myelitis, especially as recurrent manifestations of the disease. These findings reveal the need for more searching to establish the causal relationship between transverse myelitis and hepatitis C.

Carcinoma adrenocortical apresentando-se como massa abdominal / Adrenocortical carcinoma presenting as abdominal mass

O câncer adrenocortical (CAC) é um tumor raro com um prognóstico reservado. O CAC pode ser diagnosticado pela investigação de síndromes endócrinas, de sintomas devido ao crescimento tumoral ou de incidentaloma adrenal. A investigação hormonal demonstra na maioria dos CACs uma hipersecreção esteroidal, mas a característica dominante é uma co-secreção de cortisol e de andrógenos. A TC mostra um tumor heterogêneo e grande. Os tumores restritos à glândula adrenal têm uma evolução melhor do que tumores invasivos e metastáticos. A remoção completa do tumor é o tratamento de escolha. Nos pacientes com doença metastática ou progressiva, o tratamento com mitotano deve ser iniciado. Este relato de caso tem o intuito de demonstrar a importância do correto diagnóstico de lesões tumorais, pois têm grande influência no tratamento e prognóstico dos pacientes

Adrenocortical cancer (ACC) is a rare malign tumor with a poor prognosis. ACC can be diagnosed by the investigation of endocrine syndromes, signs and symptoms due to tumor growth or an adrenal incidentaloma. Hormonal investigations demonstrate in most ACC steroid oversecretion, but dominant characteristic being a co-secretion of cortisol and androgens. The CT shows a large heterogeneous tumor. Tumors localized to the adrenal gland have a better outcome than invasive and metastatic tumors. The complete tumor removal is the treatment of choice. In patients with metastatic or progressive disease, the treatment with mitotano must be initiated. This case has intention to demonstrate the importance of the correct diagnosis of tumors, therefore it has great influence in the treatment and prognosis of the patients