Pseudotumor inflamatório do fígado: um diagnóstico diferencial raro de massa hepática / Inflammatory pseudotumor of the liver: a rare differential diagnosis of liver mass

Os pseudotumores inflamatórios são um conjunto de lesões raras, caracterizadas histologicamente por proliferação de fibroblastos e células inflamatórias permeadas por estroma fibroso. Nos casos de localização hepática, estas massas são difíceis de diferenciar de outras lesões, especialmente de neoplasias primárias ou secundárias. Descrevemos um caso em que os achados clínicos-laboratoriais e as imagens da ultrassonografia e da tomografia computadorizada de abdomen não foram suficientes para afastar uma neoplasia, e só foi possível estabelecer o diagnóstico através da biópsia direta, mediante ressecção cirúrgica da lesão. Diante de um paciente sem antecedentes dignos de nota, com massa hepática e marcadores tumorais negativos, o pseudotumor inflamatório de fígado deve ser lembrado sempre como um possível diagnóstico diferencial.

The inflammatory pseudotumors are a rare group of lesions characterized histologically by proliferation of fibroblasts and inflammatory cells penetrated by fibrous stroma. In cases of liver location, these masses are difficult to differentiate from other lesions, especially from the primary or secondary tumors. We described a case in which the abdomen clinical, laboratory, and the images of ultrasound and computed tomography findings were not sufficient to rule out a neoplasia and it was only possible to establish the diagnosis directly by biopsy with surgical excision of the lesion. When a patient has no history worth mentioning, negative liver mass and tumor markers, inflammatory pseudotumors of the liver should always be remembered as a possible differential diagnosis.

Hepatobiliary abnormalities in pediatric patients with sickle cell disease.

OBJECTIVE: to describe clinical, laboratory and ultrasonographic abnormalities in the hepatobiliary system of pediatric patients with sickle cell disease in the city of Salvador, Brazil. MATERIAL AND METHODS: pediatric patients with sickle cell disease were clinically evaluated, their charts were reviewed and findings of supplementary tests were examined to identify hepatobiliary abnormalities. RESULTS: a total of 134 patients were evaluated, 65 of whom (48.9%) presented hepatomegalia. Elevated transaminases were present in 42.2% and 11.4% presented cholelithiasis. There was a statistically significant association between the presence of hepatomegalia and SS homozygotes and between cholelithiasis and patients over 10 years of age (p = 0.01 and p = 0.00, respectively). CONCLUSION: hepatobiliary abnormalities in patients with sickle cell disease were common, particularly in patients with hemoglobin SS and in adolescent patients.

[Knowledge of obstetricians about the vertical transmission of hepatitis B virus]. / Conhecimento dos obstetras sobre a transmissão vertical da hepatite B.

CONTEXT: Vertical transmission is responsible for 35%-40% of the new cases of hepatitis B worldwide and it is associated with an increased risk of chronic hepatitis B, cirrhosis and hepatocellular carcinoma. OBJECTIVE: To describe obstetricians' knowledge on the recommended measures to the diagnosis of the infection by the hepatitis virus B in pregnant women and to prevent the transmission of this infection to the babies of infected mothers. METHODS: Obstetricians registered at the 'Sociedade de Ginecologia e Obstetrícia da Bahia', Salvador, BA, Brazil were randomly selected and invited to answer a questionnaire with questions regarding their academic formation, workplace, contact with medical students and their practices about the hepatitis virus B. Individuals who were not currently working as obstetricians or were not living in the state of Bahia were excluded from the study. Data were analyzed with the EpiInfo software with a 95% confidence interval. RESULTS: Three hundred and one obstetricians answered the questionnaire: 90.3% of them recognized that the hepatitis virus B could be transmitted vertically and 81.7% routinely screened their patients for hepatitis virus B infection during prenatal consultations; 66.0% considered HBsAg the best serological marker to be employed on the screening. Only 13.0% systematically recommended the vaccination against hepatitis virus B and the administration of immunoglobulin to the newborns of infected mothers in the first 12 hours of life. The frequency of correct answers about the vertical transmission of hepatitis virus B, the best serological marker for screening and the management of infected mothers and their newborns was higher among professionals who had the 'Título de Especialista em Ginecologia e Obstetrícia (TEGO)' than among the remaining ones (P = 0.018, P = 0.001 and P = 0.002, respectively). CONCLUSION: We observed that the knowledge of the obstetricians about the diagnosis and management of hepatitis virus B infection during pregnancy is not adequate, reinforcing the need of continuous medical education programs on the infections that can be transmitted vertically.

Conhecimento dos obstetras sobre a transmissão vertical da hepatite B / Knowledge of obstetricians about the vertical transmission of hepatitis B virus

CONTEXTO: A transmissão vertical é responsável por 35 por cento a 40 por cento dos novos casos de hepatite B no mundo e a infecção precoce pelo vírus da hepatite B aumenta o risco de evolução para a hepatite crônica, cirrose e carcinoma hepatocelular. OBJETIVO: Determinar o conhecimento dos obstetras sobre as práticas para o diagnóstico da infecção pelo vírus da hepatite B em gestantes e as condutas para a prevenção desta infecção em recém-nascidos de mães infectadas. MÉTODOS: Foram sorteados aleatoriamente profissionais de saúde cadastrados na Sociedade de Obstetrícia e Ginecologia da Bahia, que foram convidados a responder um questionário anônimo com informações sobre sua formação acadêmica, o local de trabalho, o contato com estudantes e as suas práticas profissionais em relação ao vírus da hepatite B. Adotou-se como critério de exclusão o não exercício atual da obstetrícia e a não residência na Bahia. A análise dos dados foi feita através do programa estatístico Epiinfo e para análise das correlações foi adotado intervalo de confiança de 95 por cento. RESULTADOS: Foram entrevistados 301 obstetras, dos quais 90,3 por cento reconheciam a transmissibilidade vertical do vírus da hepatite B e 81,7 por cento solicitavam algum exame para detecção de hepatite B durante o pré-natal de suas pacientes. Sessenta e seis por cento dos médicos entrevistados referiram o AgHBs como o marcador sorológico mais adequado para avaliar a presença de infecção pelo VHB. Apenas 13,0 por cento destes profissionais indicavam de modo sistemático a vacina contra a hepatite B e a administração de imunoglobulina nas primeiras 12 horas de vida do recém-nascido de mães infectadas. O número de respostas corretas quanto à transmissibilidade vertical do VHB, ao marcador sorológico mais adequado e à conduta para o recém-nascido de mãe infectada foi maior entre os obstetras que possuíam o Título de Especialista em Ginecologia e Obstetrícia que entre os demais profissionais...

CONTEXT: Vertical transmission is responsible for 35 percent-40 percent of the new cases of hepatitis B worldwide and it is associated with an increased risk of chronic hepatitis B, cirrhosis and hepatocellular carcinoma. OBJECTIVE: To describe obstetricians' knowledge on the recommended measures to the diagnosis of the infection by the hepatitis virus B in pregnant women and to prevent the transmission of this infection to the babies of infected mothers. METHODS: Obstetricians registered at the "Sociedade de Ginecologia e Obstetrícia da Bahia", Salvador, BA, Brazil were randomly selected and invited to answer a questionnaire with questions regarding their academic formation, workplace, contact with medical students and their practices about the hepatitis virus B. Individuals who were not currently working as obstetricians or were not living in the state of Bahia were excluded from the study. Data were analyzed with the EpiInfo software with a 95 percent confidence interval. RESULTS: Three hundred and one obstetricians answered the questionnaire: 90.3 percent of them recognized that the hepatitis virus B could be transmitted vertically and 81.7 percent routinely screened their patients for hepatitis virus B infection during prenatal consultations; 66.0 percent considered HBsAg the best serological marker to be employed on the screening. Only 13.0 percent systematically recommended the vaccination against hepatitis virus B and the administration of immunoglobulin to the newborns of infected mothers in the first 12 hours of life. The frequency of correct answers about the vertical transmission of hepatitis virus B, the best serological marker for screening and the management of infected mothers and their newborns was higher among professionals who had the "Título de Especialista em Ginecologia e Obstetrícia (TEGO)" than among the remaining ones (P = 0.018, P = 0.001 and P = 0,002, respectively). CONCLUSION: We observed that the knowledge...