Hepatoblastoma en un paciente pediátrico a propósito de un caso

La incidencia de hepatoblastoma alrededor del mundo permanece constante entre 0.5 y 1.5 casos por millón de niños por año. En los Estados Unidos de América se reporta para el hepatoblastoma una incidencia anual de aproximadamente 1 por millón en niños menores de 15 años de edad. En Ecuador, en una investigación realizada en la ciudad de Cuenca, ocupa el séptimo lugar entre los tumores pediátricos. Se trata de un tumor infrecuente, cuya incidencia parece aumentar en los últimos años. Puede aparecer de forma aislada o integrarse en el contexto de un síndrome de predisposición. Presentamos el caso de un paciente pediátrico, femenina, preescolar de 3 años de edad, sin antecedentes perinatales de importancia, producto de la tercera gesta, nacida por cesárea por distocia de presentación a las 39 semanas. Cuenta con esquema de vacunación completo para la edad. Como antecedentes patológicos personales requiere una hospitalización por enfermedad diarreica aguda a los 2 años. Sin antecedentes quirúrgicos, antecedentes patológicos familiares de tía materna con hipotiroidismo. Se realizó exámenes complementarios de sangre y de imagen, los cuales revelaron una masa abdominal dependiente de hígado compatible con hepatoblastoma con niveles de AFP superiores a 1000ng/ml

The incidence of hepatoblastoma around the world remains constant between 0.5 and 1.5 cases per million children per year. In the United States of America, an annual incidence of approximately 1 per million is reported for hepatoblastoma in children under 15 years of age. In Ecuador, in a study carried out in the city of Cuenca, it ranks seventh among pediatric tumors. It is an infrequent tumor, its incidence seems to have increased in recent years. It can appear in isolation or be part of a predisposing syndrome. We present the case of a 3-year-old preschool female pediatric patient with no significant perinatal history, product of a third pregnancy, born by cesarean section due to presentation of dystocia at 39 weeks. She had a complete vaccination for her age. As past medical history, she was hospitalized for acute diarrheal disease at 2 years of age. She had no surgical history, family pathological history except for a maternal aunt with hypothyroidism. Complementary blood and imaging tests were performed, which revealed an abdominal liver-dependent mass, compatible with hepatoblastoma with AFP levels greater than 1000 ng/ml.

Feocromocitoma Benigno vs Tumor Renal. Presentación de un caso / Benign Pheochromocytoma vs Kidney Tumor. A case presentation

RESUMEN Introducción: El feocromocitoma es una neoplasia neuroendocrina localizada en la médula adrenal. Objetivo: Destacar la importancia que todavía posee en la práctica clínica el interrogatorio y el examen físico minucioso, a pesar de los novedosos medios diagnósticos con que se cuenta en la actualidad. Presentación del caso : Se presenta caso clínico de paciente masculino de 17 años de edad, con incidentaloma suprarrenal izquierdo, catalogado inicialmente como tumor renal abscedado, cuya biopsia de pieza operatoria demostró finalmente que correspondía a un feocromocitoma benigno. La determinación de catecolaminas fue normal, en la tomografía computarizada se evidenció una masa retroperitoneal que involucraba riñón y suprarrenal izquierdos. Se realizó la resección de la neoplasia y fue dado de alta médica en buenas condiciones. Conclusiones: El feocromocitoma es una patología infrecuente y compleja, cuya resolución quirúrgica es mandatoria.

ABSTRACT Background: Pheochromocytoma is a neuroendocrine neoplasm located in the adrenal medulla. Objective: To highlight the importance of physical examination and the detailed clinical practice, despite the new diagnostic means that are currently available. Case presentation: A 17-years-old male patient with left adrenal incidentaloma, initially classified as an abscessed renal tumor, whose surgical specimen biopsy finally showed that it corresponded to a benign pheochromocytoma it is presented. The catecholamine determination was normal, the computed tomography revealed a retroperitoneal mass that involved the left kidney and adrenal. The neoplasm was resected and he was discharged in good condition. Conclusions: Pheochromocytoma is an infrequent and complex pathology, whose surgical resolution is necessary.

Introduction of a Social Determinants of Health Education Program into Clinical Clerkship at the University of Tsukuba / 医学教育

The University of Tsukuba School of Medicine introduced an education program on the social determinants of health (SDH). It consists of lectures during the 3rd year and a 4-week family practice and community medicine clerkship between 5th and 6th years. In the clinical clerkship, students receive lectures on the first day, are instructed to consider the SDH in a patient they met during the course, give group presentations and hand in written reports on the last day. Most students were able to analyze patients beyond the biomedical model, but only a few students were able to consider the social background and timeline of each patient. Our future challenge is to enhance students' understanding of SDH through educational programs for faculty members.

Sarcoma de células claras del pie. Presentación de un caso / Clear cell sarcoma of the foot. Case presentation

RESUMEN El sarcoma de células claras fue descrito por primera vez por Franz M. Enzinger en 1965. Está íntimamente asociado a tendones y aponeurosis, excepcionalmente compromete la epidermis. Afecta fundamentalmente a pacientes jóvenes y se caracteriza por múltiples recurrencias locales y metástasis tardías. Se presenta un paciente de 22 años de edad, masculino que fue sometido a tratamiento quirúrgico radical (amputación transmetatarseana del 1er y 2do rayo). Los estudios anatomopatológicos confirmaron el diagnóstico de un sarcoma de células claras. El paciente se encuentra libre de la enfermedad después de 6 años de operado e incorporado a su vida social (AU).

ABSTRACT The clear cell sarcoma was firstly described by Franz M. Enzinger in 1965. It is intimately associated to tendons and aponeurosis, exceptionally compromising the epidermis. It mainly affects young patients and is characterized by multiple local recurrences and late metastases. We present a male patient, aged 22 years, who underwent a radical surgical treatment (transmetatarsal amputation of the 1st and 2nd rays). The anatomic-pathological studies confirmed the diagnosis of clear cell sarcoma. 6 years after surgery, the patients is free of the disease and reincorporated to his social life (AU).

Hernia de Garengeot. A propósito de un caso / De Garengeot´s hernia. Apropos of a case

RESUMEN El epónimo hernia De Garengeot queda reservado para describir la presencia del apéndice cecal dentro de un saco herniario crural. Es infrecuente el hallazgo del apéndice dentro del canal femoral, situación que se presenta en el 0.9 % de las hernias femorales. La presencia de apendicitis dentro del canal femoral es una rareza, representando del 0.13 a 0.8% de todos los casos de apendicitis aguda. Se presenta un caso, se describe el cuadro clínico y el tratamiento quirúrgico (AU).

ABSTRACT The eponym De Garengeot´s hernia is reserved to describe the presence of the cecal appendix inside a crural hernia sac. It is infrequent to find the appendix inside the femoral canal, location presented in 0.9 % of femoral hernias. The presence of appendicitis inside the femoral canal is a rarity representing from 0.13 to 0.8 % of all the cases of acute appendicitis. A case is presented, and the clinical characteristics and the surgical treatment are described (AU).

Mesotelioma Peritoneal Maligno. Presentación de un caso / Malignant Peritoneal Mesothelioma. Case presentation

El mesotelioma es un tumor poco frecuente, sobretodo en localización peritoneal. Originado en las células mesoteliales de superficies serosas. Su etiología es desconocida, aunque en muchos casos se relaciona con exposición a asbestos. Su frecuencia va en aumento en los últimos años, tiene mayor incidencia en varones de edad media. Se presentó un paciente de 73 años diabético e hipertenso que llevaba 21 días con sensación de llenura, aumento de volumen del abdomen, decaimiento marcado, pérdida del apetito. En este período presentó una pérdida de peso corporal de 10 kilos. Por todo lo anterior se decidió su ingreso para estudio y tratamiento (AU).

The mesothelioma is a little frequent tumor, especially in peritoneal location, originated in the mesothelial cells of serous surfaces. Its etiology is unknown, although in many cases it is related with exposition to asbestos. Its frequency increases in the last years, showing higher incidence in medium-age male people. The case of a diabetic, hypertensive patient aged 73 years was presented. He was already 21 days feeling bloating, having increase of the abdominal volume, remarked weakness, appetite loss. In this period he had a body weight loss of 10 kg. For that all, his admission was decided for study and treatment (AU).

Apoio e acolhimento à mulher que se torna mãe: uma escuta psicanalítica / Giving support to women who become mothers: Psychoanalytic listening / Support et accueil de femmes qui deviennent mères: une écoute psychanalytique / Apoyo y recepción a las mujeres que se convierten madres: una escucha psicoanalítica / Unterstüetzung und Beratung für werdende Müetter: psychoanalytisches Zuhören

A proposta deste artigo é apresentar um modelo de escuta endereçado a questões que envolvem a maternidade. Para construir esse espaço de escuta psicanalítica no âmbito institucional, foi preciso, inicialmente, ampliar a compreensão das vicissitudes do processo que envolve o ser mãe. Um método respaldado no amparo e no acolhimento foi o modelo utilizado no atendimento de mulheres que estavam com os seus bebês internados na Unidade de Terapia Intensiva Neonatal (UTIN). A partir do caso exposto, foi possível apresentar um modelo de escuta que se fundamenta no referencial psicanalítico, mas que, ao mesmo tempo, amplia o modelo tradicional da psicanálise.

The purpose of this paper is to present a listening model for issues involving motherhood. In order to establish this psychoanalytical listening place within an institutional scope, it was initially necessary to broaden the understanding of the vicissitudes inherent to being a mother. A method based on support was used to offer care to women whose babies were hospitalized in a Neonatal Intensive Care Unit (NICU). Based on this case, it was possible to present a listening model that is based on psychoanalytical references, but which, at the same time, expands the traditional psychoanalysis model.

Le but de cet article est de présenter un modèle d’écoute par rapport aux questions liées à la maternité. Pour établir cet espace institutionnel d’écoute psychanalytique, il s’est avéré nécessaire, initialement, d’élargir la compréhension des vicissitudes du processus qui entraîne être mère. Une méthode basée sur le support et l’accueil des mères dont les nouveau-nés étaient internés dans l’Unité de Thérapie Intensive Néo-natale (UTIN) à été utilisée. C’est sur la base de cette étude qu’il fut possible de modéliser l’écoute sous l’angle psychanalytique, tout en élargissant le modèle traditionnel de la psychanalyse.

La propuesta de este artículo es presentar un modelo de escucha dirigido a las cuestiones relacionadas a la maternidad. Para construir este espacio de escucha psicoanalítica en el ámbito institucional, fue necesario inicialmente ampliar la comprensión de las vicisitudes implicadas en el proceso de ser madre. Un método respaldado en el amparo y en el acogimiento fue el modelo utilizado para atender a las mujeres que tenían a sus bebés internados en la Unidad de Cuidados Intensivos Neonatales (UCIN). A partir del caso expuesto, fue posible presentar un modelo de escucha que se fundamenta en el referencial psicoanalítico, pero que, al mismo tiempo, amplía el modelo tradicional del psicoanálisis.

Dieser Artikels stellt ein Modell des Zuhörens in Bezug auf Fragen zur Mutterschaft vor. Um diesen psychoanalitischen Raum des Zuhörens im institutionellen Bereich aufzubauen war es anfangs nötig, das Verständnis zu den Einzelheiten des Prozesses der Mutterschaft zu erweitern. Eine Methode, die auf Unterstützung und Aufnahme gegründet ist, wurde als Modell benutzt, um Frauen, deren Kinder in der Intensivstation für Neugeborene hospitalisiert waren, zu betreuen. Der dargelegte Fall erlaubte es uns, ein Hörmodell vorzustellen, das auf psychoanalytische Referenzen basiert, das aber gleichzeitig über das traditionelle Modell der Psychoanalyse hinausgeht.

Pulmonary Embolism.

First case (UTO) was a 42 year old Myanmar male who was admitted to Asia Royal Hospital on 31st December 2014 for shortness of breath and tightness of chest for duration of two days. He had a fainting attack on 30th December 2014 that lasted about one minute and recovered spontaneously. He had both long bone fractures in his right leg and POP was applied from foot to below knee. CT pulmonary angiogram (CTPA) revealed pulmonary embolism (PE) in both main pulmonary arteries and fi rst order branches. Color Doppler Vascular Ultrasound was done after removal of the POP cast in the right lower limb which revealed deep vein thrombosis. Low molecular weight (LMW) heparin (Enoxaprin) was given sub-cutaneously BID followed by oral anticoagulant, warfarin. He was discharged from hospital on 6th January 2015 with full recovery. The second case (Mr SFSW), was a 64 year old gentleman from New Zealand, residing in Yangon for over 20 years who was admitted to Asia Royal Hospital on 6th April 2015 for breathlessness and dyspnoea on exertion for three days. He had a past history of hypertension and type 2 diabetes mellitus for 15 years. He is grossly obese with a BMI of 50.99. Color Doppler ultra-sonography revealed deep vein thrombosis in the right lower limb. CT Pulmonary Angiogram (CTPA) revealed pulmonary embolism in the main pulmonary arteries on both sides extending into upper and lower lobe pulmonary arteries. He was treated with LMW heparin (Enoxaprin) sub-cutaneously BID followed by warfarin. He was also discharged on 17th April 2015 with full recovery.

Wegener’s granulomatosis: Is it rare?

A 52 year old lady was admitted with fever, productive cough and breathlessness for one month. She had past history of recurrent sinusitis. Clinically, she had bilateral sensorineural hearing impairment, nasal crusts and peripheral neuropathy apart from signs of consolidation. Vasculitic lesions appeared a day after admission. Investigations revealed multiple nodular like lesions scattered in both lungs on CXR. Blood tests revealed positive cANCA (Cytoplasmic fluorescence Antineutrophil Cytoplasmic Antibodies) and raised infl ammatory markers. She was treated with immunosuppressant and antibiotic. Clinical and radiological improvement was noted 2 weeks later.

Diagnóstico prenatal de artrogriposis múltiple congénita / Prenatal diagnosis of arthrogryposis multiplex congenita

La artrogriposis múltiple congénita puede definirse como una displasia articular sistémica, caracterizada por rigidez articular en múltiples localizaciones de forma congénita. Se presenta un caso en el que se diagnosticó prenatalmente este signo clínico, que puede tener múltiples causas subyacentes.

Arthrogryposis multiplex congenita may be defined as a systemic articular dysplasia characterized by articular rigidity in a many locations of congenital origin. A case was presented in which this clinical sign was diagnosed at prenatal phase and it may have many underlying causes.

Structured Clinical Case Presentation for Assessment of Undergraduates during Initial Clinical Postings.

Structured Clinical Case Presentation (SCCP) was designed as a modification of the long case to more objectively and systematically assess the communication, examination and analytical skills of undergraduate students. Students’ perception of the assessment by the long case or SCCP was noted using questionnaires and feedback collected from the examining faculty regarding the strengths and limitations of the new method.