Lingual thyroid: can we 'wait and see'?

A 42-year-old Caucasian woman presented with a sensation of fullness in the throat and dry cough of 1-month duration. Physical examination showed a mass located in the midline of the tongue base. Cervical ultrasound confirmed the absence of thyroid gland tissue in the normal position. MRI of the neck showed a mass suggestive of lingual thyroid and scintigraphy confirmed the diagnosis. Thyroid function was normal. Despite normal thyroid function, to decrease the size of the mass and perhaps solve the problem, we decided to start levothyroxine suppression therapy. The patient had palpitations and one episode of angina pectoris as a side effect, resulting in the medication being interrupted. After 3 years of follow-up, she remains in clinical surveillance and without symptoms.

Pediatric atrophic rhinosinusitis: what can we do?

A 5-year-old female had history of chronic foul smelling nasal discharge. Rhinoscopy showed greenish crusts lining the nasal cavities and inferior turbinates were shriveled significantly. Nasal cavity cultures of crusts by swab revealed Klebsiella ozaenae making the diagnosis of primary atrophic rhinosinusitis. After several unsuccessful treatment, we have decided to try sulfamethoxazole-trimethoprim prophylaxis and 1 year later there was a complete clinical improvement. There are many medical therapies and surgical options described, but none of them showed effective at long term. We present antibiotic prophylaxis as a viable alternative for long term control of the disease.

[Sensitization to house dust and storage mites in allergic adults from the South of Mexico city]. / Sensibilización a ácaros intradomiciliarios y de almacenamiento en adultos alérgicos del sur de la Ciudad de México.

BACKGROUND: Mites are the most common cause of respiratory allergy. Sensitization to house dust mites is estimated at 30%. Families Euroglyphus and Dermatophagoides, are the most important. Recently, storage mites, from the families Acaridae and Glyciphagidae, have become more important as a cause of allergic respiratory diseases. OBJECTIVE: The aim of this study was to identify sensitization to house dust and storage mites by skin tests in adult patients with allergic respiratory diseases. METHODS: This is a descriptive study in patients with asthma and/or allergic rhinitis, with the approval of the local research committee 2009-3601-46. Patients underwent skin prick tests, with seven standardized extracts of mites (IPI ASACR). The results were analyzed with descriptive statistics. RESULTS: A total of 150 patients, 109 women and 41 men, with an average age 31 years (±11) were studied. The more common allergic diseases in this group of patients were: asthma and rhinitis 72 and 26%, respectively, and asthma plus rhinitis 3.2%. Positive skin tests for Dermatophagoides pteronyssinus and Dermatophagoides farinae were 82.1% 71.5%, respectively, and for storage mites: A. siro 51.7%, Tyrophagus 47.4%, Glycyphagus 47.7%, B. tropicalis 39.7% and Lepidoglyphus 39.1%. Storage mites produced greater sensitization than house dust mites, 32% vs 10%. CONCLUSIONS: The results show that adult patients with respiratory allergy, in southern Mexico City, have a higher rate of sensitization to storage mites than the one reported in the literature.

Avaliação do nível de conhecimento e aderência da conduta nutricional em pacientes submetidos e candidatos à cirurgia bariátrica / Assessment of the awareness level and the compliance with the nutritional approach for patients submitted, and to be submitted, to bariatric surgery

A obesidade é considerada atualmente um problema de saúde pública no Brasil e no mundo, aumentando a incidência de morbidades e mortalidade oriundas de doenças como diabetes, acidente vascular cerebral, doenças cardiovasculares, dislipidemias entre outras. Estas patologias são evidentes em indivíduos com obesidade grau III, classificada como obesidade mórbida, que é quando o índice de massa corpórea (IMC) ultrapassa 40 kg/m². Após o fracasso dos tratamentos menos invasivos, a indicação das cirurgias bariátricas vem crescendo. O objetivo do trabalho foi identificar o conhecimento do paciente candidato à cirurgia sobre a conduta nutricional a serseguida após a operação, assim como dos pacientes que já foram submetidos ao procedimento. Foram aplicados testes de entendimento e participaram 50 pacientes. Observou-se, no pré-cirúrgico, que 40% deles apresentaram dúvidas sobre a ocorrência de vômitos, 48% sobreo paladar que pode ser modificado e 40% não sabiam da possibilidade de depressão. Pacientes que já realizaram a cirurgia concordaram que a mastigação deve ser lenta, que a atividade física é recomendada (96%) e 40% responderam que o consumo de refrigerantes pode ocorrer mais de três vezes na semana. Portanto, verificou-se que há dúvidas e inseguranças quanto à conduta nutricional a ser seguida. Por outro lado, identificou-se IMC em torno de 30 kg/m² entre aqueles que já realizaram a cirurgia, o que pode sugerir seguimento adequado das orientações dietoterápicas. Ficou evidente a importância da atuação da equipe multidisciplinar.

Obesity is currently considered a public health problem in Brazil and worldwide as it increases the morbidities and mortality from diabetes, cerebral vascular accident, cardiovascular disease, dsilipidemia, etc. These pathologies are more evident in people withclass 3 obesity, classified as morbid obesity, that is, when the body mass index (BMI) exceeds 40 kg/m². After the failure of the less invasive treatment, the bariatric surgery indication is increasing nowadays. This paper aims at identifying the knowledge of patients to be submitted to bariatric surgery with respect to the nutritional approach to be followed after the operation, as well as, patients submitted tosuch procedure. Awareness tests were carried out with 50 patients. It was observed, in the presurgery period –that 40% of them were indoubt about the occurrence of vomits; 48% whether the taste would be altered, and 40% were not aware of the possibilities of depression. Patients who were already operated agreed that chewing must be slow, physical activity is recommended (96%), and 40% answered that the consumption of soda may occur more than three times a week. Therefore, it was verifi ed that there are doubts and insecurity concerning thenutritional behavior to be followed. On the other hand, BMI around 30kg/m² was identifi ed among those who had surgery, what suggests roper following of the dietary orientations. The importance of the multidisciplinary team approach was evident.