Persistence of left superior vena cava: a rare cause of hemodialysis tunneled catheter malposition / Persistência de veia cava superior esquerda: uma causa rara de posicionamento inadequado do cateter tunelizado para hemodiálise

Abstract Hemodialysis central venous catheter (CVC) insertion can be complicated in patients with anomalous vessel anatomy. In such cases detailed knowledge of thoracic vessel anatomy is necessary to identify the exact location of the catheter. Central venous placement under ultrasound control has significantly reduced the complications associated with blind puncture and allows an appropriate puncture of the desired vessel, but the CVC can still get misplaced if it follows an anomalous route. Herein, we report a case of dialysis catheter placed into a left sided superior vena cava, only diagnosed after CT scan study.

Resumo A inserção do cateter venoso central (CVC) para hemodiálise pode ser complicada em pacientes com anatomia anômala dos vasos. Nesses casos, o conhecimento detalhado da anatomia do vaso torácico é necessário para identificar a localização exata do cateter. A colocação venosa central sob controle de ultrassom tem reduzido significativamente as complicações associadas à punção às cegas e permite uma punção apropriada do vaso desejado, mas o CVC ainda pode ficar mal posicionado se seguir uma rota anômala. Aqui, relatamos um caso de cateter de diálise colocado em uma veia cava superior esquerda, apenas diagnosticado após estudo de tomografia computadorizada.

COVID-19-associated secondary sclerosing cholangitis - A case series of 4 patients.

We report a case series of four patients diagnosed with COVID-19-associated secondary sclerosing cholangitis (SSC), a recently described rare late complication of severe COVID-19. Following prolonged stays in the intensive care unit, these patients developed marked sustained cholestasis and jaundice despite clinical improvement. Cholangiography showed beaded appearance of intra-hepatic bile ducts and bile casts were removed in one patient. None of the patients reached normalization of liver enzymes and at least one progressed to liver cirrhosis (follow-up time of 11 to 16 months). COVID-19-associated SSC has a dismal prognosis with rapid progression to advanced chronic liver disease.

Persistence of left superior vena cava: a rare cause of hemodialysis tunneled catheter malposition.

Hemodialysis central venous catheter (CVC) insertion can be complicated in patients with anomalous vessel anatomy. In such cases detailed knowledge of thoracic vessel anatomy is necessary to identify the exact location of the catheter. Central venous placement under ultrasound control has significantly reduced the complications associated with blind puncture and allows an appropriate puncture of the desired vessel, but the CVC can still get misplaced if it follows an anomalous route. Herein, we report a case of dialysis catheter placed into a left sided superior vena cava, only diagnosed after CT scan study.

Congenital extrahepatic portosystemic shunt type II occluded with cardiac closure device.

Congenital extrahepatic portosystemic shunts are a rare cause of lower gastrointestinal bleeding in children. They result from the connection of a systemic vessel with the portomesenteric vasculature before the division of the main portal vein. Herein, we report a case of a congenital extrahepatic portosystemic shunts type II in a 4-year-old male diagnosed by Doppler ultrasonography during the investigation of abdominal pain and recurrent hematochezia, later confirmed by computed tomography. Conventional angiography with a balloon occlusion test revealed patent intrahepatic portal branches not depicted by previous imaging techniques. Successful shunt closure was achieved by endovascular approach with an Amplatzer Septal Occluder without complications.

La clínica con pacientes crónicos y terminales / The clinic with chronic and terminal patients

El presente trabajo desarrolla la problemática de un sujeto desde que conoce su enfermedad. ¿Cómo vivencia el diagnóstico el pronóstico y la terapia sugerida? ¿Cómo afecta esta situación al resto de los integrantes de la familia? ¿Cuál es el abordaje con pacientes crónicos y terminales? Además se hace incapié en la importancia de un tratamiento interdisciplinario. El rol del psicólogo frente a este tipo de pacientes consiste en sostener una postura ética que no haga foco solo en el diagnóstico orgánico, sino que tome en cuenta el sufrimiento de quien nos convoca, escuchando cuál es su deseo y su proyecto de vida más allá de la enfermedad. Se abordan los siguientes temas: la clínica con niños, el acompañamiento de docentes, clowns o payamédicos en la internación hospitalaria o domiciliaria: el lugar de la familia en este proceso, sus angustias y temores; los avances en la legislación sobre muerte digna; los cuidados paliativos. Algunas viñetas clínicas acompañan los aportes teóricos.

The present work develops the problem of a subject from the knowledge of his illness. How do you experience the diagnosis, prognosis and suggested therapy? How does this situation affect the rest of the family members? What is the approach with chronic and terminal patients? and the importance of an interdisciplinary treatment. The psychologist's role in dealing with this type of patients is to maintain an ethical stance that does not only remain with the organic diagnosis but also takes into account the suffering of the person who summons us, listening to what is his desire and his life project beyond the illness. The following topics are addressed: the clinic with children. The accompaniment of the teachers, clowns or payamédicos in the hospitalization or domiciliary hospitalization. The place of the family in this process, their anxieties and fears. Advances in legislation on dignified death. Palliative care. Some clinical vignettes accompany the theoretical contributions.

Non-Invasive Assessment Method Using Thoracic-Abdominal Profile Image Acquisition and Mathematical Modeling with Bezier Curves.

The study was performed at Brasov County Hospital, in the Internal Medicine, Diabetes, Gastroenterology and Cardiology Wards with the collaboration of Transylvania University of Brasov, as a study approved by the Ethical Board of the university. The study aimed at assessing the connection between the anthropometric parameters of abdominal adiposity (measured by means of an original experiment designed to determine the curvature of the thoracic-abdominal adiposity for the patients and processed by help of a mathematical model based upon Bezier curves geometry) and the fat load of the liver (assessed by ultrasound by measuring the diameters of both hepatic lobes) for the patients diagnosed with Non-Alcoholic Fatty Liver Disease (NAFLD). The existence of ten types of thoracic-abdominal curves profiles were statistically analyzed in order to evaluate in a simple manner the liver size in NAFLD. The method of diagnosis is based on an easily reproduced experiment, it is original, innovative, non-invasive, and cost-effective. Can be implemented anywhere in the world, there is no need for investment, only for determining the profile of the belly.

Screening and monitoring antiretrovirals and antivirals in the serum of acquired immunodeficiency syndrome patients by micellar liquid chromatography.

Thirteen different antiretrovirals are commonly used in hospital protocols for suppressing the activity of the human immunodeficiency virus (HIV) and associated opportunistic diseases in patients with acquired immunodeficiency syndrome (AIDS). In this work, three micellar mobile phases are recommended for screening these substances, using UV detection, and the process can be performed in less than 18 min. The first mobile phase (sodium dodecyl sulphate or SDS 50mM) is used for the group consisting of acyclovir, didanosine, ganciclovir, stavudine and zidovudine. The second mobile phase (SDS 120 mM/4.5% propanol) is used for the group containing abacavir, lamivudine, nevirapine, valaciclovir and zalcitabine, whereas the third mobile phase (SDS 150 mM/5% pentanol) is used for efavirenz, indinavir and ritonavir. The use of micellar liquid chromatography (MLC) as an analytical tool allows serum samples to be injected directly. The method was validated over the range of 0-10 microg mL(-1). The limits of detection (signal-to-noise ratio of 3), which ranged from 6 to 30 ng mL(-1), were adequate for monitoring these substances. Intra- and inter-day relative standard deviations of the assay were below 3% for all compounds. The recoveries in spiked serum samples were in the 89.5-104.4% range. The method can be applied to the screening, monitoring and control of patients' treatment with antiretrovirals and antivirals.

Determination of sulfonamides in milk after precolumn derivatisation by micellar liquid chromatography.

A simple method to identify and determine six sulfonamides (sodium sulfacetamide, sulfamethizole, sulfaguanidine, sulfamerazine, sulfathiazole and sulfamethoxazole) in milk by micellar liquid chromatography (MLC) is reported. The assay makes use of a precolumn diazotisation-coupling derivatisation including the formation of an azo dye that can be detected at 490 nm. Furthermore, the use of MLC as an analytical tool allows the direct injection of non-purified samples. The separation was performed with an 80 mM SDS-8.5% propanol eluent at pH 7. Analysis times are below 16 min with a complete resolution. Linearities (r>0.9999), as well as intra- and inter-day precision (below 2.7%), were studied in the validation of the method. The limits of detection and quantification ranged from approximately 0.72 to 0.94 and 2.4 to 3.1 ng mL(-1), respectively. The detection limit was below the maximum residue limit established by the European Community. Finally, recoveries in spiked milk samples were in the 83-103% range.

[MRI evaluation of fistula in ano]. / Avaliação por ressonância magnética nuclear de fístulas peri-anais.

Fistula in ano is a frequent disease, which often has a difficult diagnosis and mapping, and comports significant morbidity. Today, Magnetic Resonance (MRI) allows a rapid, simple and precise mapping of peri anal fistula, which leads to a correct surgical treatment. In this paper, the authors review its pathology and MRI role in diagnosis and mapping. The authors also report a retrospective and descriptive study on the MRI results for the mapping of fistula in ano performed in Hospital Fernando Fonseca for a 38-month period.

[Splenic Epidermoid Cyst--imaging features]. / Quisto epidermóide esplénico: aspectos imagiológicos.

Splenic Epidermoid Cyst is a rare entity and the imaging methods play a major role in the diagnosis, although this can only be accomplished by the histological features. The authors report a case of splenic epidermoid cyst in a child of eleven years old, which presented with one month history of post-traumatic abdominal pain. They illustrate the imaging features on ultrasound, CT and MR with pathologic correlation. A review of imaging aspects in the characterization and diagnosis of this clinical entity is made.