[Hidradenocarcinoma of the Scrotum with Lymph Node Metastasis]. / Hidradenocarcinoma do Escroto com Metastização Ganglionar.

Hidradenocarcinoma is a rare neoplasm of the eccrine cells of the sweat glands, usually asymptomatic with slow growing and higher incidence between 50 and 80 years, occurring in both sexes and preferentially located in the palmar, plantar, frontal, axillary and nuchal regions. It has an aggressive behavior, with high rate of local recurrence and distance metastasis, associated with a poor prognosis. We present a case of hidradenocarcinoma of the scrotum manifested by lymph node metastasis through an exercise of clinical and histological differential diagnosis of an inguinal adenopathy in a young adult.

O hidradenocarcinoma é uma neoplasia rara das células écrinas das glândulas sudoríparas, geralmente assintomática e de crescimento lento, com maior incidência entre os 50 e os 80 anos, atingindo ambos os sexos e com localização preferencial nas regiões palmar, plantar, frontal, axilar e nuca. Tem um comportamento agressivo, com alta taxa de recorrência local e metastização à distância, associando-se a mau prognóstico. Apresentamos um caso raro de hidradenocarcinoma do escroto manifestado por metastização ganglionar justificando exercício de diagnóstico diferencial clínico e histológico de adenopatia inguinal num adulto jovem.

Takotsubo syndrome in a premenopausal patient.

Takotsubo syndrome is a rare clinical condition, with a pathophysiology that is not fully understood. Characterised by an acute and usually reversible heart failure, the condition is often preceded by a stressful event. For the diagnosis of Takotsubo syndrome to be possible, the absence of coronary artery disease as a cause is required. We report a case of Takotsubo syndrome in a 47-year-old woman of fertile age. Electrical and echocardiographic presentations were classical in the patient. However, abnormally elevated cardiac biomarkers were registered. The patient showed signs of clinical improvement, with a follow-up angiography excluding coronary artery disease and therefore leading to a diagnosis of Takotsubo syndrome.

[Takotsubo Cardiomyopathy: Cause of a Cardiogenic Shock]. / Miocardiopatia de Takotsubo: Na Origem do Choque Cardiogénico.

Takotsubo cardiomyopathy, of unknown etiology, is characterized by sudden and transient systolic dysfunction of the mid-apical segments of the left ventricle without significant coronary disease, and full normalization of segmental changes. More common in middle-aged women, it is cause of differential diagnosis with acute coronary syndrome. We present the case of a 59 year old woman admitted to the emergency room with sudden chest pain and dyspnea. At presentation: acute hypotensive pulmonary edema requiring aminergic support and invasive ventilation. Blood tests showed elevated necrosis myocardial enzymes. Serial electrocardiograms: sinus rhythm with progressive inversion of the T wave through the precordial leads (v2 - v6). Control echocardiograms: overall decreased systolic function with apical akinesia, and full reversal of the changes in 2 weeks. Cardiogenic shock of unknown etiology was admitted and a coronary computed tomography angiography was performed excluding coronary heart disease, supporting the diagnosis of Takotsubo cardiomyopathy.

A miocardiopatia de Takotsubo, de etiologia desconhecida, caracteriza-se pela disfunção sistólica súbita e transitória dos segmentos médio-apicais do ventrículo esquerdo, sem doença coronária significativa, com total normalização das alterações segmentares. É aais frequente em mulheres de meia-idade, implicando diagnóstico diferencial com a sindrome coronária aguda. Apresentamos o caso de uma mulher de 59 anos que recorreu ao Serviço de Urgência por dispneia súbita e dor torácica. Á admissão apresentava-se em edema pulmonar agudo hipotensivo com necessidade de suporte aminérgico e ventilação invasiva. A avaliação analítica demonstrava elevaçãodos marcadores cardíacos. Electrocardiogramas seriados em ritmo sinusal com inversão progressiva da onda T nas derivações precordiais (v2 - v6). Ecocardiogramas de controlo revelando acinésia apical com diminuição da função sistólica global, e reversão total das alterações em duas semanas. Admitido choque cardiogénico de etiologia não esclarecida foi excluída doença coronária, sustentando o diagnóstico de miocardiopatia de Takotsubo.

[Ectopic parathyroid adenoma]. / Adenoma paratiroideu ectópico. caso clínico.

Ectopic parathyroid adenoma is a rare cause of primary hyperparathyroidism and can become a diagnostic challenge. We present a case report of an ectopic mediastinal parathyroid adenoma leading to primary hyperparathyroidism and responsible for a persistent asymptomatic hypercalcemia. The preoperative location of the tumor assessed by imaging studies contribute to the choice of the surgical cervical approach. Tumor resection was successful and the calcemia levels promptly returned to normal levels.

Echocardiography in emergency.

The use of echocardiography is still far from optimal. It is difficult or impossible to ensure the 24-hour presence at a hospital of a cardiologist with experience in echocardiography. As a result other specialties are becoming familiar with this technique. Echocardiography has been recognized as of paramount importance in diagnosis, prognosis and therapeutic decisions in several diseases and therefore echocardiographic training with different levels of experience should be supported and coordinated by a reference group in such matters. The authors review some aspects of echocardiography in emergency. They emphasize the importance of continuous training and accreditation as required conditions to perform echocardiography.