Quadriplegia e afonia após punção epidural: relato de caso / Quadriplegia and aphonia after epidural puncture: a case report

Justificativa e objetivos: complicações de anestesia epidural são pouco frequentes, principalmente aquelas que levam à perda de funções sensoriais com envolvimento de áreas cognitivas. Diversas hipóteses podem ser aventadas, entretanto, não se pode afirmar com exatidão o diagnóstico que levou ao transcurso clínico. Medidas simples e eficazes odem contornar a intercorrência com segurança. Relato do caso: paciente de 36 anos ASA I, submeteu-se à anestesia epidural para procedimento em membro inferior D, desenvolveu após 15 min quadriplegia e afonia, com agitação moderada. (AU)

Justification and objectives: Complications upon epidural anesthesia are rare, specially those leading to loss of sensory functions and compromise of cognitive areas. Several hypotheses can be formulated, but no diagnosis is precise enough to explain the cause of such incidences. Simple and efficient measures may help overcome the intercurrence safely. Case report: A 36-year-old ASA I patient that had epidural anesthesia applied for a procedure in the right lower limb developed quadriplegia and aphonia with mild agitation upon 15 minutes.(AU)

Xerostomia, hyposalivation and sialadenitis in patients with chronic hepatitis C are not associated with the detection of HCV RNA in saliva or salivary glands.

OBJECTIVE: Salivary gland disorders in patients with chronic hepatitis C (CHC) have been considered oral extrahepatic manifestations, reinforcing the hepatitis C virus (HCV) as a sialotropic virus. Hence, the authors investigated the prevalence of HCV RNA in saliva and salivary glands and its possible association with xerostomia, hyposalivation and sialadenitis in patients with CHC. PATIENTS AND METHODS: In 65 patients with confirmed CHC, the HCV RNA was investigated by nested RT-PCR in saliva samples and minor salivary glands. Xerostomia, hyposalivation, clinical and histopathological evidence of sialadenitis were also evaluated. Univariate and multivariate analyses were employed to verify associations. RESULTS: HCV RNA was detected in the saliva of 26/65 (40.0%) patients and in 12/65 (18.5%) salivary glands. Xerostomia was reported by 23/65 (35.4%) patients, and hyposalivation was diagnosed in 13/65 (20.0%) patients. Sialadenitis was confirmed by histopathological features in 31/65 (47.7%) patients. Twelve (38.7%) of the 31 patients with sialadenitis presented HCV RNA in saliva and 2/31 (6.5%) in salivary glands. No associations were found between xerostomia, hyposalivation or sialadenitis and the detection of HCV RNA in saliva or in salivary glands. CONCLUSIONS: Although xerostomia, hyposalivation and sialadenitis are frequent findings in CHC patients, our study did not confirm the association between the detection of HCV RNA in saliva or salivary glands with these salivary gland disorders. However, an indirect role of HCV by immune-mediated virus mechanisms in the pathogenesis of salivary gland disorders in this group of patients cannot be ruled out.

Necrólise epidérmica tóxica precipitada por excipiente medicamentoso: relato de caso / Toxic epidermic necrolysis triggered by drug excipient: case report

Este trabalho salienta a possibilidade de a alteração do excipiente de medicamentos tomados por longos períodos desencadear a Necrólise Epidérmica Tóxica. É feita a descrição clínica de paciente de 30 anos com farmacodermia associada ao uso de antirretrovirais.

This work emphasizes the possibility that changing the excipient of some drugs taken over long periods can trigger Toxic Epidermic Necrolysis. This article shows the clinical aspects of a patient who took AZT/r since March/2007. Thus, the suspicion that this drug would trigger Stevens-Johnson syndrome isn’t significative. On the other hand, the fact that the antiretroviral vehicle has been changed leads to a strong suspicion that it could be involved in triggering this syndrome. It is reported the clinical description of a 30-year patient eruption associated with the use of retroviral.