Intussuscepção intestinal em gestante pós by-pass gástrico: relato de caso / Intestinal intussusception in pregnant women after gastric bypass: case report

RESUMO: Em todo o mundo, estima-se que aproximadamente 634.897 pessoas são submetidas a procedimentos bariátricos a cada ano, com gastrectomia vertical e by-pass gástrico, representando 53,6% e 30%, respectivamente. Entre pacientes operados, aproximadamente metade são mulheres em idade reprodutiva. Em adultos, a intussuscepção é tipicamente devida a um local patológico no intestino, que pode ser maligno em mais da metade dos casos. A in-tussuscepção intestinal é rara em adultos, representando 1 a 5% das obstruções intestinais mecânicas. A intussus-cepção em gestantes pós by-pass gástrico é uma patologia muito rara de origem desconhecida com alto poder de lesão e injúria de órgãos e sistemas. Suas manifestações clínicas são como abdômen agudo obstrutivo, porém, na paciente gestante dificulta o diagnóstico precoce. Este relato de caso apresenta uma paciente de 38 anos, gestante de 22 semanas, com quadro de dor abdominal de forte intensidade acompanhada de vômitos em grande quantidade há um dia, antecedente de by-pass gástrico há quatro anos. O diagnóstico do quadro de intussuscepção intestinal foi possível após o sétimo dia de internação com auxílio de exame de imagem - RNM, sendo indicado o tratamento cirúrgico para correção do caso. Evoluiu com choque séptico com necessidade de internação prolongada em leito de CTI, recebendo alta após 27 dias de internação. (AU)

ABSTRACT: Worldwide, it is estimated that approximately 634,897 people undergo bariatric procedures each year, with vertical gastrectomy and gastric bypass, representing 53.6% and 30%, respectively. Among operated patients, approxi-mately half are women of reproductive age. In adults, intussusception is typically due to a pathological site in the intestine, which can be malignant in more than half of cases. Intestinal intussusception is rare in adults, repre-senting 1 to 5% of mechanical intestinal obstructions. Intussusception in pregnant women after gastric bypass is a very rare pathology of unknown origin with high power of injury and injury to organs and systems. Its clinical manifestations are like acute obstructive abdomen, but in pregnant women it is difficult to make an early diagnosis. This case report presents a 38-year-old patient, a 22-week pregnant woman, with severe abdominal pain accom-panied by vomiting in large quantities for 1 day, a history of gastric bypass for 4 years. The diagnosis of intestinal intussusception was possible after the seventh day of hospitalization with the aid of an image exam - MRI. Surgical treatment is indicated to correct the case. He developed septic shock requiring prolonged hospitalization in an ICU bed, being discharged after 27 days of hospitalization. (AU)

Occult hepatitis B virus infection in liver transplant patients in a Brazilian referral center

Estimates of occult hepatitis B virus (HBV) infection prevalence varies among different studies depending on the prevalence of HBV infection in the study population and on the sensitivity of the assay used to detect HBV DNA. We investigated the prevalence of occult HBV infection in cirrhotic patients undergoing liver transplantation in a Brazilian referral center. Frozen liver samples from 68 adults were analyzed using a nested polymerase chain reaction assay for HBV DNA. The specificity of the amplified HBV sequences was confirmed by direct sequencing of the amplicons. The patient population comprised 49 (72.1%) males and 19 (27.9%) females with a median age of 53 years (range=18-67 years). Occult HBV infection was diagnosed in three (4.4%) patients. The etiologies of the underlying chronic liver disease in these cases were alcohol abuse, HBV infection, and cryptogenic cirrhosis. Two of the patients with cryptic HBV infection also presented hepatocellular carcinoma. Markers of previous HBV infection were available in two patients with occult HBV infection and were negative in both. In conclusion, using a sensitive nested polymerase chain reaction assay to detect HBV DNA in frozen liver tissue, we found a low prevalence of occult HBV infection in cirrhotic patients undergoing liver transplant, probably due to the low prevalence of HBV infection in our population.

Serodiagnosis of Helicobacter pylori infection by Cobas Core ELISA in adults from Minas Gerais, Brazil

We evaluated the accuracy of a 2nd generation ELISA to detect Helicobacter pylori infection in adults from a developing country in view of variations in sensitivity and specificity reported for different populations. We studied 97 non-consecutive patients who underwent endoscopy for evaluation of dispeptic symptoms. The presence of H. pylori was determined in antral biopsy specimens by culture, by the preformed urease test and in carbolfuchsin-stained smears. Patients were considered to be H. pylori positive if at least two of the three tests presented a positive result or if the culture was positive, and negative if the three tests were negative. Sixty-five adults (31 with peptic ulcer) were H. pylori positive and 32 adults were H. pylori negative. Antibodies were detected by Cobas Core anti-H. pylori EIA in 62 of 65 H. pylori-positive adults and in none of the negative adults. The sensitivity, specificity and positive and negative predictive values of the test were 95.4, 100, 100 and 91.4 per cent, respectively. The Cobas Core anti-H. pylori EIA presented high sensitivity and specificity when employed for a population in Brazil, permitting the use of the test both to confirm the clinical diagnosis and to perform epidemiologic surveys.

Isolation Leishmania sp from aqueous humor of a patient with cutaneous disseminated leishmaniasis and bilateral iridocyclitis (preliminary report)

Os autores descrevem um caso raro de leishmaniose con lesoes cutaneas disseminadas, manifestacoes sistemicas e comprometimento ocular, sendo este caracterizado por iridociclite bilateral nao granulomatosa. A gravidade do quadro oftalmologico e a ausencia de resposta ao tratamento, a despeito da melhora das manifestacoes cutaneas e sistemicas, levaram a realizacao de puncao propedeutica da camada anterior ocular. A partir do humor aquoso isolou-se Leishmania sp. Os autores desconhecem na literatura qualquer outro caso onde tal achado tenha sido demonstrado