Gastric rupture during fiberoptic bronchoscopy, a rare complication of oxygen administration by nasopharyngeal cannula: a case report

Abstract Concomitant use of a nasopharyngeal catheter is frequently used for oxygen supply during fiberoptic bronchoscopy (FOB). This is a procedure that presents possible complications that are not negligible. We demonstrate the case of a 61-year-old woman who underwent FOB due to a history of hemoptoic sputum. During the procedure, gastric rupture occurred with a large pneumoperitoneum and bilateral pneumothorax requiring immediate drainage of the air and an emergent laparotomy. This was probably a complication of the nasopharyngeal catheter. The knowledge of these complications is essential for their correct identification and treatment.

Análise das alterações endometriais nas histeroscopias de pacientes em tratamento de câncer de mama com bloqueadores hormonais / Analysis of endometrial changes in the histeroscopies of patients treating breast cancer with hormonal blockers

Objetivo: analisar lesões endometriais de pacientes com câncer de mama em tratamento com Tamoxifeno® presentes nas histeroscopias e relacioná-las com a dose de medicamento utilizada, tempo de terapêutica, presença de lesões endometriais prévias e estado de pré ou pós menopausa. Método: estudo retrospectivo, transversal e analítico. Dados analisados pelo teste qui quadrado, p<0,05. Resultados: dentre as 75 histeroscopias analisadas, 12 eram normais (16%) e 63 apresentaram alteração endometrial (84%). Dentre os achados das histeroscopias, 49 foram pólipos endometriais (67.12%), 7 foram pólipos endocervicais (9.58%), 11 foram hiperplasia simples sem atipias (15.06%), 1 foi hiperplasia complexa sem atipias (1.36%), 1 foi hiperplasia complexa com atipias (1.36%), 2 foram leiomiomas (2.73%) e 2 foram adenocarcinoma endometrioide (2.73%). Conclusão: O Tamoxifeno® predispõe o aparecimento de lesões endometriais, que podem ser malignas. Nesse estudo, a incidência dessas lesões foi expressivamente maior do que os valores encontrados na literatura

Objective: To analyze the endometrial lesions in hysteroscopies of patients with breast cancer undergoing treatment with Tamoxifeno® and to relate them to the dose of medication used, time of therapy, presence of previous endometrial lesions and pre or postmenopausal status. Method: retrospective, cross-sectional and analytical study. Data were statistically analyzed using the chi-square test, p <0.05. Results: Among the 75 hysteroscopies analyzed, 12 were normal (16%) and 63 presented endometrial alteration (84%). Among the hysteroscopic findings, 49 were endometrial polyps (67.12%), 7 were endocervical polyps (9.58%), 11 were simple hyperplasia without atypias (15.06%), 1 was complex hyperplasia without atypias (1.36%), 1 was complex hyperplasia with atypia (1.36%), 2 were leiomyomas (2.73%) and 2 were endometrioid adenocarcinoma (2.73%). Conclusion: Tamoxifen predisposes the appearance of endometrial lesions, which may be malignant. In this study, the incidence of these lesions was significantly higher than the values found in the literature

Double Crush Syndrome of the Median Nerve: A Literature Review

Double crush syndrome (DCS) is defined as the compressive involvement of the same peripheral nerve in different segments.When this syndrome affects the median nerve, a proximal compression of a spinal nerve that will constitute this structure (often the spinal nerve at the C6 vertebra) is usually noted at the cervical spine level as a herniated disc and as a distal compression at the level of the carpal tunnel. Epidemiological data on median nerve compromise by DCS are still very scarce in the medical literature. The diagnosis can be inferred by symptoms and signs occurring proximally and distally in the arm, as well as by alterations revealed by upper limb electromyography and neuroimaging studies, such as magnetic resonance imaging (MRI) of the cervical spine. Nowadays, information on which compressed neuroanatomical point should be initially addressed still depends on further studies. Limited data infer that these patients, when submitted to surgical treatment in only one of the median nerve compression points, evolve with worse functional outcomes than the surgically-treated group with carpal tunnel syndrome without DCS.

Lacan e o Deus-infinito de Pascal: considerações sobre a aposta pascaliana e o início de uma análise / Lacan and the God-infinite of Pascal: considerations about Pascal's wager and the beginning of a psychoanalysis treatment / Lacan y el Dios-infinito de Pascal: consideraciones sobre la apuesta de Pascal y el inicio de un análisis

O artigo tem como objetivo analisar a utilização que Jaques Lacan faz de um ponto específico da obra de Blaise Pascal, relacionado à aposta em um Deus-infinito. Lacan complementa o estudo da aposta pascaliana com uma referência à graça religiosa como momento inaugural de abertura ao infinito. A partir dessas considerações, sustenta-se a hipótese de que a aposta de Pascal pode ser aproximada à operação necessária para o início de uma análise. A aposta de Pascal coloca em jogo o infinito. Com a ajuda do filósofo Alain Badiou, tentaremos demonstrar que Lacan parte da mesma ideia ao considerar que não há abertura ao inconsciente - correlativa ao início de uma análise - sem alguma dimensão de infinitude

The article aims to analyze the use of a certain point in the work of Blaise Pascal, according to Jacques Lacan's, specifically about the wager on a God-infinite. Lacan complements the study of the Pascal's wager referring to the concept of the religious grace as the inaugural moment of opening to the infinite. From these considerations, the supported hypothesis is that Pascal's wager approaches the course necessary to the beginning of the psychoanalysis treatment. Pascal's wager puts infinite at stake. With the help of the philosopher Alain Badiou, we will try to demonstrate that Lacan shares the same idea when he considers that there is no opening to the unconscious - correlative to the beginning of an analysis - without some dimension of infinity

El artículo tiene como objetivo analizar la utilización que Jaques Lacan hace de un punto específico de la obra de Blaise Pascal, relacionada con apostar en un Dios-infinito. Lacan complementa el estudio de la apuesta de Pascal con una referencia a la gracia religiosa como momento inaugural de apertura al infinito. A partir de estas consideraciones se apoya la hipótesis de que la apuesta de Pascal se aproxima a la operación requerida para iniciar un análisis. La apuesta de Pascal pone en juego el infinito. Con la ayuda del filósofo Alain Badiou, trataremos de demostrar que Lacan parte de la misma idea al considerar que no hay apertura al inconsciente - correlativo al comienzo de un análisis- sin alguna dimensión de infinidad

Phaeohyphomycosis infection in the knee / Infecção por feohifomicose em joelho

Phaeohyphomycosis is caused by cutaneous fungi and rarely affects large joints. This is a case report on phaeohyphomycosis in the left knee of an elderly individual without immunosuppression. It was accompanied by pain and swelling the anterior knee. The case was first suspected to be suprapatellar bursitis, and was treated with nonsteroidal anti-inflammatory drugs, without remission of symptoms. Surgical treatment was performed, with resection of the suprapatellar bursa and anterior region of the quadriceps tendon. The material was sent for anatomopathological examination and culturing. The pathological examination showed phaeohyphomycosis. The treatment instituted consisted of itraconazole, 200 mg/day for six weeks, and complete remission of symptoms was achieved. The physical examination remained normal after one year of follow-up. This is the first published case of phaeohyphomycosis infection in the suprapatellar region of the knee. Although almost all the cases reported have been associated with immunosuppressed patients, this was an exception. It is important to suspect phaeohyphomycosis in cases of knee infection, in the area of the suprapatellar bursa, when the symptoms do not resolve after clinical treatment.

A feohifomicose, causada por fungos demáceos, raramente acomete grandes articulações. Este é um relato de caso de feohifomicose, em joelho esquerdo de idoso não imunossuprimido, acompanhado de dor e aumento de volume em região anterior do joelho. Suspeitou-se de bursite suprapatelar, sendo medicado com anti-inflamatório não esteroidal, sem apresentar remissão dos sintomas. Fez-se tratamento cirúrgico, foram ressecadas a bursa suprapatelar e a região anterior do tendão do quadríceps sendo a peça encaminhada para exame anatomopatológico e cultura. No exame anatomopatológico foi possível evidenciar o diagnóstico de feohifomicose. O tratamento instituído foi itraconazol, 200 mg/dia por seis semanas, apresentando remissão completa do quadro. O exame físico se manteve normal após um ano de seguimento. Este é o primeiro caso publicado a respeito da infecção por feohifomicose em região suprapatelar. Apesar de quase todos os casos registrados estarem associados a pacientes imunossuprimidos, este foi uma exceção. É importante que se suspeite de feohifomicose nas infecções de joelho, na área da bursa suprapatelar, quando os sintomas não resolverem após o tratamento clínico medicamentoso.

Abordagem clínica e dermatoscópica das principais neoplasias de pele / Clinical and dermatoscopic approach of main skin neoplasms

Este trabalho tem por objetivo abordar as principais características dos tumores de pele sob o ponto de vista dermatoscópico, um importante instrumento diagnóstico.

This paper aims to address the main features of skin tumor by a dermatoscopy point of view, an important diagnostic tool.