Challenges in the surgical treatment of a 8-year old child living with Prune Belly syndrome: case report / Desafios no tratamento tardio da síndrome de Prune Belly: relato de caso

Prune Belly syndrome, also known as Eagle-Barret syndrome, is a rare disease, with a prevalence of 3.8 live births per 100,000 births. Its main characteristic is the hypoplasia of the abdominal muscles, giving rise to the name "prune belly syndrome". The gold standard treatment is surgery, ideally with correction of cryptorchidism and phimosis between 6 to 18 months of life. Correction of urinary malformations and abdominoplasty should be performed up to 4 years of age. Little evidence exists in the literature about late treatment and its implications for prognosis. The context mentioned above led us to present an uncommon case of a six years old child in which a surgical approach was performed later than usual.

Introdução: A síndrome de Prune Belly é uma doença rara, com prevalência de 3,8 nascidos vivos a cada 100 mil nascimentos. Tem como principal caraterística a hipoplasia da musculatura abdominal gerando a origem do nome "síndrome da barriga de ameixa". O tratamento padrão ouro é cirúrgico, idealmente com correção da criptorquidia e fimose entre 6 a 18 meses e a correção das malformações urinárias e abdominoplastia devem ser realizadas até os 4 anos. Aqui descreve-se um caso ainda menos comum, em que foi realizada abordagem cirúrgica de forma mais tardia que o habitual. Há pouca evidência na literatura acerca do tratamento tardio e suas implicações em relação ao prognóstico.

Stage effect of chronic kidney disease in erectile function

ABSTRACT Purpose The study aims to assess the influence of the stage of chronic kidney disease and glomerular filtration rate on prevalence and degree of erectile dysfunction. Materials and Methods This transversal study, conducted from May 2013 to December 2015, included patients with chronic kidney disease in conservative treatment, stages III/IV/V. Erectile dysfunction was evaluated by the International Index of Erectile Function. Data classically associated with erectile dysfunction were obtained by medical record review. Erectile dysfunction, degree of erectile dysfunction, and other main variables associated with erectile dysfunction were compared between patients with chronic kidney disease on conservative treatment stages III versus IV/V using the Chi-square test. The relationship between score of the International Index of Erectile Dysfunction and glomerular filtration rate was established by Pearson correlation coefficient. Results Two hundred and forty five patients with chronic kidney disease in conservative treatment participated of the study. The prevalence of erectile dysfunction in patients with chronic kidney disease in stages IV/V was greater than in stage III. Glomerular filtration rate positively correlated with score of the International Index of Erectile Dysfunction. Conclusions The study suggests that chronic kidney disease progression (glomerular filtration rate decrease and advance in chronic kidney disease stages) worsen erectile function. Hypothetically, diagnosis and treatment of erectile dysfunction may be anticipated with the analysis of chronic kidney disease progression.

Atypical presentation of intra-abdominal extralobar pulmonary sequestration detected in prenatal care: a case report / Apresentação atípica de sequestro pulmonar extralobar intra-abdominal detectado no pré-natal: relato de caso

Objective: To describe an unusual clinical presentation of intra-abdominal extralobar pulmonary sequestration in a 2-year, 9 month-old patient and assess diagnostic and treatment aspects of this pathology. Case description: An undefined intra-abdominal mass was identified in the right adrenal region in a male fetus. Postnatal evaluation with ultrasound images, computed tomography, magnetic resonance imaging and laboratory testing was insufficient to determine the nature of the lesion. After two years, laparoscopic resection of the mass and histopathological examination of the surgical specimen allowed to establish the diagnosis of intra-abdominal extralobar pulmonary sequestration. Comments: This malformation can be monitored clinically; however, surgical excision is often performed, probably due to the impossibility of attaining diagnosis with non-invasive methods, such as in the present case, in which the lesion appeared in an unusual position for intra-abdominal extralobar pulmonary sequestration. Therefore, the surgical approach seems to be the key to attain the diagnosis and establish the conduct for this type of congenital malformation.

Objetivo: Descrever apresentação clínica incomum de sequestro pulmonar extralobar intra-abdominal em um paciente de dois anos e nove meses e avaliar aspectos diagnósticos e de tratamento dessa patologia. Descrição do caso: Uma massa intra-abdominal indefinida em topografia suprarrenal direita de feto masculino. A avaliação pós-natal com imagens de ultrassom, tomografia computadorizada, ressonância magnética e testes laboratoriais não foi suficiente para determinar a natureza da lesão. Após dois anos, a resseção laparoscópica da massa e o exame histopatológico do espécime cirúrgico permitiram estabelecer o diagnóstico de sequestro pulmonar extralobar intra-abdominal. Comentários: Essa malformação pode ser monitorada clinicamente; entretanto, a excisão cirúrgica frequentemente é feita, provavelmente devido à impossibilidade de diagnóstico com métodos não invasivos, como ocorreu no presente caso, na qual a lesão apresentou-se em posição não habitual para sequestro pulmonar extralobar intra-abdominal. Desse modo, a abordagem cirúrgica parece ser a chave para o diagnóstico e a condução desde tipo de malformação congênita.

Associated factors and prevalence of erectile dysfunction in hemodialysis patients

Purpose: The proposal of this study was to determine the prevalence and the associated factors of erectile dysfunction (ED) among hemodialysis (HD) patients. Materials and Methods: This was a cross-sectional study based on data collected from HD male patients. Clinical, demographic and laboratory data of all patients were collected in three HD clinics from December 2010 to June 2011. Patients answered questions of erectile function domain from International Index of Erectile Function. Data were evaluated by descriptive analysis and by univariate (ULRA) and multivariate logistic regression analysis (MLRA). Results: Three hundred and five patients participated of the study. The prevalence of ED was 68.19%. ED was associated with diabetes (DM), benign prostatic hyperplasia, glomerulonephritis as cause of chronic renal failure (CRF), smoking habits, lower creatinine levels (ULRA), use of calcium channel blocker (MLRA), aging, lower education level, alcohol consumption, DM (as cause of CRF) and coronary insufficiency (ULRA and MLRA). Conclusions: ED was highly prevalent in the HD men. It was independently associated with aging, current use of alcohol, long alcohol use (even for those who do not drink more), lower education level, diabetes as cause of CRF, coronary insufficiency and use of channel blockers calcium. .

Biotypes of Candida albicans isolates from Aids patients

The phenotypic features of C. albicans oral isolates recovered from AIDS patients were determined by serotyping, morphotyping and byotyping in nine media with different biochemical characteristics. The patients were divided into: Group I, comprising subjects with detectable lesions of the oral mucosa and Group 2, corresponding to carrier patients. Despite observing a greater frequency of serotype B isolates among subjects with symptomatic oral candidosis as compared to the other group of patients, these results were not statistically significant. When correlating the presence of serotypes A and B with T lymphocyte counts, we verified the occurrence of serotype B was more prevalent (p<0.05) than serotype A in individuals with CD4+ T < 200 cells/mm³. The occurrence of fringes greater than 3 mm in lenght was a typical feature of the oral isolates from our AIDS patients, though no differences in this respect were detected between the two groups of subjects. A lack of ability to assimilate urea and sorbose and variation in sensibility to 5-fluorocytosine were also features expressed by the majority of the isolates, with a predominance of the biotype 347 in 51,9 percent of all the oral isolates studied.

Frequência e caraterizaçäo de leveduras na mucosa bucal de usuários de próteses dentárias / Frequency and characterization of Candida albicans in the mouth of people with dental prosthesis

O uso de próteses dentárias totais tem sido correlacionado com o aumento de leveduras do gênero Candida na cavidade bucal. As características adquiridas por isolado de Candida albicans servem como um marcador epidemiológico. Neste trabalho foram coletadas amostras de 57 indivíduos portadores de próteses dentárias totais e de 3o indivíduos dentados, cultivadas em ágar Sabouraud dextrose. As leveduras isoladas foram identificadas através de produçäo de tubo germinativo e clamidósporos, além de provas bioquímicas de assimilaçäo de fontes de carbono e nitrogênio...

Etiologia e epidemiologia das dermatofitoses em Goiânia, GO, Brasil / Etiology and epidemiology in dermatophytosis in Goiânia, State of Goiás, Brazil

As dermatofitoses säo infecçöes superficiais capazes de produzir lesöes em tecidos queratinizados, como pele, pêlo e unhas. Foram examinados 6068 indivíduos procedentes de Goiânia, com suspeita clínica de infecçöes fúngicas, durante 5 anos (1993-1997), verificandose a incidência e a etiologia das dermatofitoses nos referidos pacientes. Material coletado de várias regiöes corpóreas permitiu caracterizar 1595 dermatófitos em 1345 indivíduos. A identificaçäo dos dermatófitos realizada através de cultivo em ágar Sabouraud e microcultivo em lâmina, permitiu verificar uma maior frequência de Trichophyton rubrum (37,4 por cento), T. mentagrophytes (36,4 por cento)e Microsporum canis (16 por cento). Os dermatófitos foram mais frequentemente encontrados produzindo lesöes nos pés (30,5 por cento), regiäo inguino crural (l 7, 8 por cento) e regiäo glabra do corpo (15,5 por cento). Foi analisada a distribuiçäo corporal das lesöes de dermatofitoses com os respectivos agentes etiológicos encontrados. Melhores condiçöes higiênicas e diagnóstico precoce da doença säo necessários para controlar e diminuir a incidência de dermatofitoses na nossa regiäo

Cryptococcus neoformans var. gattii isolados em pacientes com AIDS no estado de Goiás / Cryptococcus neofarmans var. gattii isolated from patients with AIDS in Goiás state

A criptocose é uma das importantes complicaçöes nos indivíduos com AIDS. Nestes pacientes tem predominado como agente etiológico C.neoformans var. neoformans e muito raramente relata-se C.neoformans var. gattii, mesmo nas regiöes onde se verifica a sua prevalência. O liquído cefalorraquidiano (LCR) de pacientes com AIDS foram submetidos ao exame direto com tinta nanquim, cultura em ágar Sabouraud dextrose e em ágar Guizotia abyssinica mantidos à temperatura ambiente e à temperatura de 37§C, identificando-se Cryptococcus neiformans pelas suas características macro e microscópicas. O meio L-canavanina-glicina-azul de bromotimol (CGB) foi utilizado para difderenciar as variedades, sendo identificados 42 Cryptococcus neoformans var. neoformans e 3 var. gattii. O trabalho relata a meningite criptocócica causada por C.neoformans var. neoformans e C. neoformans var. gattii e pacientes com AIDS.

Drug resitance of yeasts isolated from oropharyngeal candidiasis in AIDS patients

"Candida spp" was isolated from 59 (68.60 (per cent)) out of eighty six samples of oral mucosa of AIDS patients. The identification, based or the production of a germ tube and chlamydospores, and on the assimilation and fermentation of carbohydrates, revealed 52 strains (88.13 (per cent)) of "C. albicans", 4 (6.77 (per cent)) od "C. tropicalis" and 3 (5.08 (per cent)) of "C. krusei". The susceptibility of these strains to amophotericin B, flucytosine, itraconazole, fluconazole and ketoconazole was determined using the agar dilution method. Comparing the minimum inhibitory concentration values found in the susceptibility test with the serum levels achieved by these drugs, only 8.47 (per cent) and 5.08 (per cent) of the yeast strains proved to be resistant to amphotericin B and flucitosyne, repsctively. A high frequency of strains resistant to azole derivates (25.42 (per cent) to intraconazole, 45.76 (per cent), to ketoconazole and 66.10 (per cent) to fluconazole) was observed.