Pelvic Ewing Sarcoma: The Great Mimicker.

Ewing sarcoma is the most common malignant bone tumor of the pelvis in children and young adults. Even with aggressive treatment, its survival rate is amongst the poorest. Classical presentation may not be the rule. It may simulate clinically, imagiologically and histopathologically other nonmalignant entities. Therefore, its suspicion should not be overlooked. We report two cases of pelvic Ewing sarcoma: the first mimicking eosinophilic granuloma, and the second mimicking osteomyelitis. In the latter, we also report an atypical finding of its natural history: an initial response to antibiotic and anti-inflammatory treatment. In both cases, we highlight the possibility of an inconclusive percutaneous bone biopsy and the importance of immunochemistry and cytogenetics for the definitive diagnosis.

Pelvic Ewing Sarcoma: The Great Mimicker / Sarcoma de Ewing pélvico: o grande imitador

Abstract Ewing sarcoma is the most common malignant bone tumor of the pelvis in children and young adults. Even with aggressive treatment, its survival rate is amongst the poorest. Classical presentation may not be the rule. It may simulate clinically, imagiologically and histopathologically other nonmalignant entities. Therefore, its suspicion should not be overlooked. We report two cases of pelvic Ewing sarcoma: the first mimicking eosinophilic granuloma, and the second mimicking osteomyelitis. In the latter, we also report an atypical finding of its natural history: an initial response to antibiotic and anti-inflammatory treatment. In both cases, we highlight the possibility of an inconclusive percutaneous bone biopsy and the importance of immunochemistry and cytogenetics for the definitive diagnosis.

Resumo O sarcoma de Ewing é o tumor ósseo maligno da pelve mais comum em crianças e adultos jovens. Mesmo com tratamento agressivo, sua taxa de sobrevivência está entre as piores. A apresentação clássica pode não ser a regra. Ele pode simular clinicamente, imaginologicamente e histopatologicamente outras entidades não malignas. Portanto, sua suspeita não deve ser negligenciada. Relatamos dois casos de sarcoma pélvico: o primeiro imitando granuloma eosinofílico e o segundo imitando osteomielite. Neste último, também relatamos um achado atípico de sua história natural: uma resposta inicial ao antibiótico e ao tratamento anti-inflamatório. Em ambos os casos, destacamos a possibilidade de uma biópsia óssea percutânea inconclusiva e a importância da imunoquímica e da citogenética para o diagnóstico definitivo.

Cervical Spinal Epidural Abscess Due to Mycobacterium tuberculosis without Osseous Involvement: A Case Report.

CASE: We present a rare case of cervical spinal epidural abscess due to Mycobacterium tuberculosis without osseous involvement that was treated with decompression and arthrodesis in a 2-stage procedure. CONCLUSION: Spinal epidural abscess due to Mycobacterium tuberculosis is the least common of the various forms of spinal tuberculosis. This abscess represents a severe infection of the epidural space that can compromise neural elements and can require urgent surgical intervention to avoid permanent neurological deficits. Early diagnosis and early decompression remain the 2 most important predictors of a successful neurological outcome.

Sleepiness and sleep-disordered breathing in truck drivers : risk analysis of road accidents.

BACKGROUND: Portugal has one of the highest road traffic fatality rates in Europe. A clear association between sleep-disordered breathing (SDB) and traffic accidents has been previously demonstrated. This study aimed to determine prevalence of excessive daytime sleepiness (EDS) and other sleep disorder symptoms among truck drivers and to identify which individual traits and work habits are associated to increased sleepiness and accident risk. METHODS: We evaluated a sample of 714 truck drivers using a questionnaire (244 face-to-face interviews, 470 self-administered) that included sociodemographic data, personal habits, previous accidents, Epworth Sleepiness Scale (ESS), and the Berlin questionnaire (BQ). RESULTS: Twenty percent of drivers had EDS and 29 % were at high risk for having obstructive sleep apnea syndrome (OSAS). Two hundred sixty-one drivers (36.6 %) reported near-miss accidents (42.5 % sleep related) and 264 (37.0 %), a driving accident (16.3 % sleep related). ESS score ≥ 11 was a risk factor for both near-miss accidents (odds ratio (OR)=3.84, p<0.01) and accidents (OR=2.25, p<0.01). Antidepressant use was related to accidents (OR=3.30, p=0.03). We found an association between high Mallampati score (III-IV) and near misses (OR=1.89, p=0.04). CONCLUSION: In this sample of Portuguese truck drivers, we observed a high prevalence of EDS and other sleep disorder symptoms. Accident risk was related to sleepiness and antidepressant use. Identifying drivers at risk for OSAS should be a major priority of medical assessment centers, as a public safety policy.

[Evaluation of the reasons underlying drop-out and identification of predictive factors in psychiatric patients]. / Avaliação dos motivos subjacentes e identificação de fatores preditivos do drop-out de doentes psiquiatricos.

INTRODUCTION/OBJECTIVES: The evaluation of psychiatric interventions results should be multidimensional, including clinical and social variables, such as individual experience of the mentally ill. The patient satisfaction with care has been recognized as an important variable, despite not being the main objective of the service or of the psychiatrist. However, if the user's perspective is not included, there's a risk of bias by the perception of the heath care providers. In this study, our aim was to understand if the abandonment of treatment (drop-out) represents an improvement or worsening of subjective well-being of patients and / or dissatisfaction with the services received, as well as to find predictors of drop-out. MATERIAL AND METHODS: Identification of drop-outs in a 2-year cohort of patients who had initial psychiatric consultations in the Psychiatric Unit at Centro Hospitalar do Médio Ave - Unidade de Famalicão (Local Mental Health Service). RESULTS: We identified 512 patients who had a first psychiatric consultation, 57 of which unilaterally abandoned the treatment for at least six months, without making any contacts in order to reschedule the appointment during this period. Of these only 38 completed the assessment (telephone response to a semi-structured questionnaire). Three predictive factors for the drop-out were found: age, education and diagnosis. CONCLUSIONS: The reasons for treatment abandonment focused mainly in forgetfulness and dissatisfaction, the last one involving doctor-patient relationship issues. These results should be a starting point for assessing and improving care.