RESUMO
Objetivo: describir un caso de parotidis aguda transitoria, posterior a anestesia regional por bloqueo espinal subaracnoideo para esterilización quirúrgica y revisión de la literatura. Reporte del caso: paciente femenina de 32 años, sin antecedentes de enfermedad asociada que se programó de forma electiva para salpingectomía bilateral y se realizó anestesia regional por bloqueo espinal subaracnoideo. A las seis horas del posoperatorio se observó un progresivo aumento bilateral de volumen de la glándula parótida, se interpretó como una parotiditis aguda y se trató con vitaminoterapia y antibiótico. Hubo evolución con recuperación progresiva total del cuadro de forma espontánea tres horas después, y fue dada de alta hospitalaria al día siguiente. Conclusión: la parotiditis aguda transitoria posanestésica no solo se debe asociar a la instrumentación de la cavidad orofaríngea durante la anestesia general, pues debe tenerse en cuenta su diagnóstico luego del empleo del sulfato de atropina en cualquier acto anestésico general o regional.
Objective: to describe a case of transient acute parotitis, after regional anesthesia by subarachnoid spinal block for surgical sterilization and literature review. Case report: 32 year old female patient with no history of associated disease was scheduled for bilateral salpingectomy and regional anesthesia was spinal subarachnoid block was used. Six hours after the operation there was a progressive bilateral increase of parotid gland volume, which was interpreted as acute parototis and she was treated with vitamin therapy and antibiotics. Evolution with total progressive recovery was observed spontaneously three hours later, and the patient was discharged from hospital the following day. Conclusion: postanesthesic transient acute parotitis should not be only associated with the instrumentation of oropharyngeal cavity for general anesthesia, since its diagnosis should be noted after using atropine sulfate in any general or regional anesthesia.
RESUMO
Objetivo: Este estudo relata um caso incomum de parotidite aguda em um paciente adulto jovem, saudável e com boa higiene oral. Relato de Caso: O paciente procurou o Departamento de Estomatologia, na Universidade Estadual de Ponta Grossa devido a um inchaço na região da glândula parótida direita. O paciente foi submetido a exames clínicos e radiológicos e foi prescrito tratamentos com drogas anti-inflamatórias e antibióticos. No quinto dia os sinais e sintomas haviam desaparecido. Conclusão: O desenvolvimento de parotidite aguda em adultos jovens saudáveis com uma boa higiene oral é possível, mas isso torna o diagnóstico mais difícil. Anti-inflamatórios, antibióticos e fisioterapia associada com calor pode contribuir para a recuperação dos sinais e sintomas após 5 dias de tratamento.
Aim: This study reports an unusual case of acute parotitis in a healthy young adult with good oral hygiene. Case Report: The patient sought the Department of Stomatology, at Ponta Grossa State University due to a swollen on the right parotid gland region. The patient underwent clinical and radiological treatments and was prescribed anti-inflammatory drugs and antibiotics. On the fifth day the signs and symptoms had disappeared. Conclusion: The development of acute parotitis in healthy young adults with good oral hygiene is possible, but this makes the diagnosis more difficult. Anti-inflammatory, antibiotic and heat physiotherapy can contribute to the recovery of the signs and symptoms after 5 days of treatment.
RESUMO
Objective To analyze the prognostic factors of patients with leukemia treated with single fraction total body irradiation (SFTBI) followed by hernatopoietic stem cell transplantation (HSCT).Methods From January 2001 to September 2008, 102 patients received HSCT. The differences of the survival rate, relapse rate and incidence of interstitial pneumonia (IP) between groups regarding different genders, ages, pathological types, transplantation methods and TBI parameters were compared and the factors related with the survival rate, relapse rate and incidence of IP were analyzed. Results The followup time ranged from 15 to 1482 days (median, 406 days). The follow-up rate was 95.1%. 86 and 55patients were followed up more than one year and three years. The 1-and 3-year survival rates were 59.0%and 44.0%. In univariate analysis, the 3-year survival rate was signifcantly different between the groups with and without relapse before transplantation (20% vs. 55%, χ2 = 6.33, P = 0. 012), allogeneictranplantation versus autologous tranplantation (39% vs. 68%, χ2 = 8.06, P = 0.005), grade 3 or more acute graft versus host disease (aGVHD) and grade 0 -2 aGVHD (0% vs. 54%, χ2 = 7.52, P = 0.006),with and without relapse after transplantation (19% vs. 58%, χ2 = 10.13, P =0.001), with and without IP (23% vs. 58%, χ2 =8.35, P=0.004). Multivariate analysis showed that grade 3 or more aGVHD was the only statistically significant prognostic factors (χ2 = 12. 74 ,P =0. 000). The l-and 3-year relapse rateswere 30. 0% and 50. 0%. The incidence of relapse was obviously higher in the group with relapse before transplantation than that without (47% vs. 16%, χ2 =7. 32, P=0. 007). Multivariate analysis showed thatrelapse before transplantation was a significant factor predicting relapse after transplantation (χ2 = 9. 39,P =0. 020). The cumulative incidence of IP was 35.0%. The incidence of IP was different between groups with dose homogeneity > 3% and ≤ 3% (27% vs. 4%, χ2 = 5. 21, P = 0. 023), with and without acute parotitis (34% vs. 3%, χ2 = 14. 15, P= 0.000), allogeneic transplantation group and autologous transplantation group (31% vs. 8%, χ2= 7.70, P= 0.006). Multivariate analysis showed that transplantation methods, acute parotitis and dose homogeneity were statistically significant factors in predictingIP (χ2 = 10. 08 , 10. 08 and 7.69 , P = 0. 002 , 0. 002 and 0. 010 , respectively) . Conclusions Patients who develop grade 3 or higher aGVHD have poor prognosis. Dose homogeneity influences the incidence of IP. Patients undergoing allogeneic transplantation are apt to have IP. Acute parotitis is related with IP and might be a predictor.
RESUMO
Postsurgical acute suppurative parotitis is a bacterial gland infection that occurs from a few days up to some weeks after abdominal surgical procedures. In this study, the authors analyze the prevalence of this complication in Hospital das Clínicas/São Paulo University Medical School by prospectively reviewing the charts of patients who underwent surgeries performed by the gastroenterological and general surgery staff from 1980 to 2005. Diagnosis of parotitis or sialoadenitis was analyzed. Sialolithiasis and chronic parotitis previous to hospitalization were exclusion criteria. In a total of 100,679 surgeries, 256 patients were diagnosed with parotitis or sialoadenitis. Nevertheless, only three cases of acute postsurgical suppurative parotitis associated with the surgery were identified giving an incidence of 0.0028 percent. All patients presented with risk factors such as malnutrition, immunosuppression, prolonged immobilization and dehydration. In the past, acute postsurgical suppurative parotitis was a relatively common complication after major abdominal surgeries. Its incidence decreased as a consequence of the improvement of perioperative antibiotic therapy and postoperative support. In spite of the current low incidence, we believe it is important to identify risks and diagnose as quick as possible, in order to introduce prompt and appropriate therapeutic measures and avoid potentially fatal complications with the evolution of the disease.
A parotidite supurativa pós-cirúrgica é infecção bacteriana da glândula que ocorre poucos dias até algumas semanas após procedimento cirúrgico. Os autores analisam a prevalência desta complicação cirúrgica nos últimos 25 anos do Hospital das Clínicas de São Paulo. Foram analisados os prontuários das cirurgias realizadas pelos serviços de Cirurgia do Aparelho Digestivo e Cirurgia Geral da Faculdade de Medicina da Universidade de São Paulo no período de 1980 a 2005, num total de 106790 cirurgias. Todos os prontuários que apresentaram entre os diagnósticos das altas complicações cirúrgicas, parotidite ou sialoadenite foram avaliados. Foram identificados 256 prontuários. Pacientes com outras complicações, ou que já apresentavam sialolitíase ou parotidite crônica anterior à internação foram excluídos do estudo. Foram identificados apenas três casos de parotidite aguda supurativa pós-cirúrgica, revelando incidência de 0,0028 por cento. A parotidite supurativa pós-cirúrgica foi complicação relativamente comum de grandes cirurgias abdominais no passado, com acentuada redução atual da sua incidência decorrente da antibioticoterapia de amplo espectro, além de preparação pré-operatória adequada e suporte pós-operatório dos pacientes. Apesar da baixa incidência atual, consideramos importante identificar seus fatores de risco, assim como realizar diagnóstico precoce, conduta terapêutica apropriada para evitar complicações letais associadas a esta infecção.