Malignant triton tumor of the kidney in a child: A case report.

INTRODUCTION: Malignant triton tumor (MTT) is an extremely rare variant of the malignant peripheral nerve sheath tumors (MPNSTs) with rhabdomyosarcomatous differentiation, which was first described in 1932 by Mason. MTT affects, in most cases, patients under 35 years of age, and it is usually manifested as a mass that may or not be painful. However, the incidence in pediatric patients is atypical. This tumor presents an aggressive course and limited survival rate, and the prognosis is different between individuals with or without a concomitant diagnosis of neurofibromatosis type 1 (NF1). Currently, the recommended treatment is surgical resection, and adjuvant chemotherapy and radiotherapy, but its efficacy is not yet clear. PRESENTATION OF THE CASE: A 13-year-old female patient was referred to the pediatric oncology service due to the presence of an abdominal mass and weight loss, initially diagnosed with Wilms' tumor. After extensive investigation, surgical resection, and immunohistopathological evaluation, the diagnosis of malignant triton tumor was confirmed. The patient also underwent cycles of chemotherapy after resection, and is currently awaiting immunotherapy. DISCUSSION AND CONCLUSION: Malignant triton tumor is extremely rare and difficult to diagnose, especially in children or young people, age groups in which the incidence of the disease is even lower. This may be the reason it is rarely suspected, and it was a great challenge for the clinical care team. It is essential to consider and investigate this possibility of differential diagnosis, as patients diagnosed with this malignant tumor have a low survival rate and poor prognosis.

Sternal fractures in a level III trauma intensive care unit. / Fraturas de esterno em uma unidade de tratamento intensivo especializada em trauma.

OBJECTIVE: to evaluate epidemiology, anatomical characteristics, management, and prognosis of critical patients with sternum fractures. METHODS: retrospective analysis of patients admitted to intensive care unit (ICU) of a Level III trauma center in Sao Paulo, Brazil. RESULTS: 1552 trauma patients were admitted from January 2012 to April 2016. A total of 439 patients had thoracic trauma and among these, 13 patients had sternum fracture, making up 0.9% of all trauma admissions and 3% of all thoracic trauma cases. Three of these 13 patients had unstable chest, two underwent surgical management for fracture fixation, and three died (mortality was of 29%). In one of the deaths, sternum fracture was assessed as the main contributor to the outcome. CONCLUSION: sternum fracture was diagnosed in 0.9% of critical trauma patients in a specialized ICU. Only 15% of patients required specific surgical management in the acute phase. In most cases, mortality was due to other injuries.

OBJETIVO: avaliar epidemiologia, características anatômicas, manejo e prognóstico de pacientes críticos com fraturas de esterno. MÉTODOS: análise retrospectiva de pacientes internados em unidade de terapia intensiva (UTI) de emergências cirúrgicas e trauma de um centro de trauma Tipo III em São Paulo, Brasil. RESULTADOS: foram admitidos 1552 pacientes traumatizados no período de janeiro de 2012 a abril de 2016. Desses, 439 apresentavam trauma torácico e 13 apresentavam fratura de esterno, configurando 0,9% das admissões de trauma e 3% dos traumas torácicos. Desses pacientes, três apresentavam tórax instável e dois foram submetidos à conduta cirúrgica para fixação da fratura. A mortalidade de pacientes com fratura de esterno foi de 29% (três pacientes). Em um dos óbitos pôde-se atribuir a fratura do esterno como contribuinte principal para o desfecho. CONCLUSÃO: a fratura de esterno foi diagnosticada em 0,9% dos pacientes críticos vítimas de trauma em UTI especializada. Somente 15% dos pacientes necessitaram de conduta cirúrgica específica na fase aguda e a mortalidade foi decorrente das outras lesões na maior parte dos casos.

Thyroidectomy in children

Introduction: Surgical management of thyroid disease in children presents several peculiarities and has increasingly developed in recent years, but historically few studies conducted with this population have been published. Objective: Analysis of the surgical approach and postoperative outcomes of 59 pediatric patients submitted to thyroidectomy between 2003 and 2019. Methods: An outpatient postoperative follow-up of 59 patients aged 3-18 years submitted to thyroidectomy for different causes was performed, and immediate and late postoperative outcomes were analyzed. The operations were performed at a University Hospital as well as at Private Tertiary Hospitals. Results: The following postoperative outcomes were observed: three tracheostomies, 22 patients with transient hypoparathyroidism, eight patients with definitive hypoparathyroidism, and three patients with vocal fold paralysis. Conclusion: Thyroidectomy in children is a procedure with a higher complication rate and needs to be performed by a team of high-volume surgeons. This study focuses on the adverse events, so that those interested in the subject are aware of them.

Fraturas de esterno em uma unidade de tratamento intensivo especializada em trauma / Sternal fractures in a level III trauma intensive care unit

RESUMO Objetivo: avaliar epidemiologia, características anatômicas, manejo e prognóstico de pacientes críticos com fraturas de esterno. Métodos: análise retrospectiva de pacientes internados em unidade de terapia intensiva (UTI) de emergências cirúrgicas e trauma de um centro de trauma Tipo III em São Paulo, Brasil. Resultados: foram admitidos 1552 pacientes traumatizados no período de janeiro de 2012 a abril de 2016. Desses, 439 apresentavam trauma torácico e 13 apresentavam fratura de esterno, configurando 0,9% das admissões de trauma e 3% dos traumas torácicos. Desses pacientes, três apresentavam tórax instável e dois foram submetidos à conduta cirúrgica para fixação da fratura. A mortalidade de pacientes com fratura de esterno foi de 29% (três pacientes). Em um dos óbitos pôde-se atribuir a fratura do esterno como contribuinte principal para o desfecho. Conclusão: a fratura de esterno foi diagnosticada em 0,9% dos pacientes críticos vítimas de trauma em UTI especializada. Somente 15% dos pacientes necessitaram de conduta cirúrgica específica na fase aguda e a mortalidade foi decorrente das outras lesões na maior parte dos casos.

ABSTRACT Objective: to evaluate epidemiology, anatomical characteristics, management, and prognosis of critical patients with sternum fractures. Methods: retrospective analysis of patients admitted to intensive care unit (ICU) of a Level III trauma center in Sao Paulo, Brazil. Results: 1552 trauma patients were admitted from January 2012 to April 2016. A total of 439 patients had thoracic trauma and among these, 13 patients had sternum fracture, making up 0.9% of all trauma admissions and 3% of all thoracic trauma cases. Three of these 13 patients had unstable chest, two underwent surgical management for fracture fixation, and three died (mortality was of 29%). In one of the deaths, sternum fracture was assessed as the main contributor to the outcome. Conclusion: sternum fracture was diagnosed in 0.9% of critical trauma patients in a specialized ICU. Only 15% of patients required specific surgical management in the acute phase. In most cases, mortality was due to other injuries.