Extrauterine leiomyomata presenting with sepsis requiring hemicolectomy / Leiomiomas extrauterinos com sepse que exigem hemicolectomia

Extrauterine leiomyomas are rare, benign, and may arise in any anatomic sites. Their unusual growth pattern may even mimic malignancy and can result in a clinical dilemma. Occasionally, uterine leiomyomas become adherent to surrounding structures. They also develop an auxiliary blood supply, and lose their original attachment to the uterus, thus becoming 'parasitic'. Parasitic myomas may also be iatrogenically created after uterine fibroid surgery, particularly if morcellation is used. This report presented two cases of parasitic myomas with sepsis, both requiring right hemicolectomy. It reviewed the pertinent literature.

Leiomiomas extrauterinos são raros e benignos e podem surgir em qualquer local anatômico. O padrão de crescimento não-usual destas lesões pode até mesmo imitar malignidade e resultar em dilema clínico. Ocasionalmente, os leiomiomas uterinos aderem-se às estruturas circunvizinhas, desenvolvem suprimento sanguíneo auxiliar e perdem sua ligação original ao útero, tornando-se assim "parasíticos". Os miomas parasíticos podem também ser criados iatrogenicamente após cirurgia fibroide uterina, especialmente se for utilizada morcelação. Este relato apresentou dois casos de miomas parasíticos com sepse, ambos exigindo hemicolectomia à direita, bem como revisão da literatura pertinente.

The role of gender in compliance and attendance at an outpatient clinic for type 2 diabetes mellitus in Trinidad / El papel del género en el cumplimiento del tratamiento y en la asistencia a dos clínicas ambulatorias para pacientes con diabetes sacarina en Trinidad

Objectives. To explore the association between gender and (1) attendance and (2) compliance with treatment in a population of patients with diabetes who attended outpatient clinics in the island of Trinidad (Trinidad and Tobago). Methods. A cross-sectional study was conducted with a sample of 360 patients who met the selection criteria. Simple consecutive sampling and a questionnaire were used to interview clinic attendees at two urban clinics in east and south Trinidad. Results. 74.2% (267) of the participants were women. A higher percentage of women than men were unemployed (79.4% vs. 59.1%, P < 0.001). Men were more likely to consume alcohol (26.9% vs. 11.6%, P < 0.001) and smoke cigarettes (20.4% vs. 5.6% , P < 0.001). Women were more compliant than men regarding diet (39.3% vs. 22.6%, P < 0.005) and prescribed medication (71.9% vs. 65.6%, P < 0.04). Women were more satisfied than men with dispensary (81.3% vs. 71.0%, P < 0.04) and clinic conditions (92.1% vs. 84.9%, P < 0.05). Conclusions. More women attended the clinic, and their compliance with the treatment regimen was better than in men. The latter were more likely to engage in health risk behaviors such as drinking and smoking. Efforts focused on men with diabetes mellitus in Trinidad and Tobago are needed to encourage greater compliance.

OBJETIVOS: Explorar la asociación entre el género y 1) la asistencia a consultas y 2) el cumplimiento del tratamiento en una población de pacientes con diabetes sacarina (mellitus) atendida en clínicas ambulatorias de la isla de Trinidad (en Trinidad y Tabago). MÉTODOS: Se llevó a cabo un estudio transversal con una muestra de 360 pacientes que llenaron los requisitos de inclusión. Se realizó un muestreo sencillo de pacientes consecutivos y se aplicó un cuestionario para entrevistar a personas atendidas en dos clínicas ambulatorias urbanas del oriente y sur de Trinidad. RESULTADOS: De los participantes, 74,2% eran mujeres. En términos porcentuales, más mujeres que hombres estaban sin empleo (79,4% frente a 59,1%; P < 0,001). Los hombres mostraron una mayor tendencia que las mujeres a consumir alcohol (26,9% frente a 11,6%; P < 0,001) y a fumar cigarrillos (20,4% frente a 5,6%; P < 0,001). Las mu-jeres observaron más el régimen alimentario que los hombres (39,3% frente a 22,6%; P < 0,005) y se ciñeron más que estos a los medicamentos prescritos (71,9% frente a 65,6%; P < 0,04). Las mujeres se mostraron más satisfechas que los hombres con las condiciones imperantes en los dispensarios (81,3% frente a 71,0%; P < 0,04) y clínicas (92,1% frente a 84,9%; P < 0,05). CONCLUSIONES: Más mujeres que hombres asistían a la clínica y el acatamiento del régimen terapéutico fue mayor entre las mujeres que entre los hombres. Estos se mostraron más propensos que las mujeres a incurrir en conductas peligrosas para la salud, tales como beber y fumar. Se necesitan intervenciones dirigidas hacia los hombres con diabetes sacarina en Trinidad y Tabago a fin de fomentar un mayor cumplimiento del tratamiento prescrito.