Colonic fibromatosis - a case report and review of the literature / Fibromatose colônica - relato de caso e revisão da literatura

ABSTRACT Intra-abdominal desmoids tumours are very rare and usually occur in patients with familiar adenomatous polyposis and previous surgery. They represent fibroepithelial growths with varied biologic behavior and therefore different prognosis. We report a case of a 60-year-old patient with a large right colonic mass who underwent right hemicolectomy. Histology proved morphological and immuno-histochemical features indicating fibromatosis. This desmoid tumour appeared growing from the colonic wall rather than the mesocolon, confirming a true colonic wall fibromatosis, a deep isolated form of intra-abdominal fibromatosis. Surgical resection is the treatment of choice in isolated well confirmed lesions. Multidisciplinary team approach is crucial for treatment and prognosis.

RESUMO Os tumores desmoides intra-abdominais são muito raros e geralmente ocorrem em pacientes com polipose adenomatosa familiar e cirurgia prévia. Eles representam crescimentos fibroepiteliais com comportamento biológico variado e, portanto, prognóstico diferente. Relatamos o caso de um paciente de 60 anos com grande massa colônica à direita, submetido a hemicolectomia direita. A histologia demonstrou características morfológicas e imuno-histoquímicas que indicavam fibromatose. Este tumor desmoide surgiu crescendo a partir da parede do cólon, e não do mesocólon, confirmando uma verdadeira fibromatose da parede do cólon, uma forma isolada profunda de fibromatose intra-abdominal. A ressecção cirúrgica é o tratamento de escolha em lesões isoladas bem confirmadas. A abordagem multidisciplinar é crucial para o tratamento e prognóstico.

Diabetic ketoacidosis in the pediatric patient.

Diabetic ketoacidosis is the major source of morbidity and mortality in patients with Type I diabetes mellitus. One population-based study noted that approximately 25% of newly diagnosed patients present with diabetic ketoacidosis. Most of those hospitalized with diabetes ketoacidosis, however, are those with poor control of their pre-existing diabetes. Cerebral edema has been found to be present in only 1% of children with diabetic ketoacidosis, but accounts for 20% of all diabetes-related deaths. Although the mortality rate has fallen dramatically over the course of the last century, the underlying mechanisms involved with the development of cerebral edema are still not clear. Several studies have shown specific risk factors to be associated with cerebral edema, but as of yet no reduction in the recent incidence of cerebral edema has been demonstrated. A discussion of these risk factors and a suggested protocol for treating diabetic ketoacidosis are included in this review.