Hepatic Actinomycosis Mimicking Malignancy After Pancreaticoduodenectomy: A Case Report.

Abdominal actinomycosis is a rare disease caused by a Gram-positive bacillus (Actinomyces). Liver manifestation is rare and, in patients with a history of cancer, differential diagnosis with secondary malignant disease can be difficult. Microbiological result is necessary for a correct diagnosis, though not always possible in preoperative workout. The authors present a case of hepatic actinomycosis that mimicked oncological disease and led to a more aggressive surgical approach.

Euglycemic Diabetic Ketoacidosis after a Single Dose of Empagliflozin in a Patient with Pancreatitis.

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are the most recently approved drug class for the treatment of type 2 diabetes mellitus (T2D). Although they are largely well-tolerated, their intake has been associated with euglycemic diabetic ketoacidosis (DKA) in some rare cases. We report the case of a 70-year-old male with type 2 diabetes and no history of DKA, who started therapy with empagliflozin one day before presenting with acute pancreatitis and laboratory findings consistent with euglycemic DKA. SGLT2i can induce euglycemic DKA from the first dose. Given the atypical presentation, a high degree of clinical suspicion is required to recognize this complication.

Adenomyomatous Hyperplasia of Ampulla of Vater and a Concomitant Renal Tumor: A Case Report.

Adenomyomatous hyperplasia is an extremely rare lesion encountered in the ampulla of Vater. Less than 50 cases have been described, most of them with clinical consequences of biliary obstruction, misdiagnosing it as a malignancy. The authors present a concomitant case with a renal tumor, its diagnosis, management, and clinical relevance, as well as a brief revision of the literature. Ampullar and renal tumors were found in a 74-year-old female, in the imagiologic study of a low back pain, in the emergency department. Both were considered malign after further study, and pancreatoduodenectomy with partial nephrectomy was proposed. There is no accurate diagnostic tool to differentiate the benign nature of adenomyomatous hyperplasia and extensive operations are often performed. As an incidental finding in the study of another tumor, this case raises the concern about which and how to treat both tumors, taking into account the morbidity of the respective interventions.

Large mucinous cystic neoplasm of the pancreas during pregnancy: a case report.

Mucinous cystic neoplasms (MCNs) of the pancreas occurring during pregnancy constitute a rare condition requiring special management due to its large size, malignant potential and the risk of fetal growth restriction. The key points to manage MCNs are to perform a correct diagnosis, accurately evaluate the grade of malignant potential in order to establish the right time for pancreatic surgery and to choose the most appropriate fetal mode of delivery. We describe a case of an incidental abdominal mass detected in a third-trimester pregnant woman. At surgery, a huge pancreatic cystic tumour was found and a distal pancreatectomy with splenic preservation was performed. The histopathological analysis revealed an MCN of the pancreas with low-grade dysplasia. To our knowledge, this is the largest pancreatic MCN detected in a pregnant woman reported in the literature and one of the few successfully resected after vaginal delivery.

Promoção da participação ativa do pai durante o trabalho de parto / Promoting the father's active participation during labor

A Enfermagem de Saúde Materna e Obstetrícia exige ao Enfermeiro Especialista em Saúde Materna e Obstetrícia agir uma intervenção especializada, autónoma, independente e/ou interdependente, bem como o domínio de competências técnico-científicas, crítico-reflexivas, relacionais, comunicacionais, sociofamiliares e ético-deontológicas. O Estágio de Natureza Profissional permitiu desenvolvê-las e aprofundar conhecimentos sobre a participação do pai durante o Trabalho de Parto. Objetivos: Desenvolver competências na prestação de cuidados à parturiente/pai/recém-nascido durante o Trabalho de Parto, efetuando o parto num ambiente seguro e otimizando a saúde da parturiente e do recém-nascido na sua adaptação à vida extra-uterina; Promover a participação ativa do pai no apoio à parturiente e na interação com o recém-nascido durante o Trabalho de Parto. Metodologia: A prestação de cuidados à parturiente/pai/recém-nascido durante o Trabalho de Parto e intervenção na promoção da participação ativa do pai no apoio à parturiente e interação com o recém-nascido teve como pressuposto a teoria de relações interpessoais de Peplau e a das transições de Meleis. Os nove pais participantes foram selecionados através de um método de amostragem não probabilístico e critérios de inclusão. A intervenção junto do pai iniciou-se na admissão com uma entrevista para identificar conhecimentos acerca das suas medidas de participação no apoio à parturiente e interação com o recém-nascido, seguida da observação dessas medidas adotadas pelo pai participante e por último, uma entrevista semiestruturada para compreender a vivência do pai e a percepção deste sobre a intervenção do Enfermeiro Especialista em Saúde Materna e Obstetrícia. Resultados: Prestados cuidados especializados a 85 parturientes de baixo risco e 38 de risco, 87 puérperas/família, 73 recém-nascidos e três de risco, realizadas 110 consultas de enfermagem e 54 partos eutócicos. Da intervenção junto do pai resultaram: sete pais-expectantes do tipo expressivo e dois instrumentais; maior necessidade de formação e incentivo do Enfermeiro Especialista em Saúde Materna e Obstetrícia nas medidas de conforto e interação com o recém-nascido; totalidade da participação com iniciativa no apoio emocional à parturiente; vivências positivas; nascimento como momento mais marcante e valorização das competências sociorelacionais do Enfermeiro Especialista em Saúde Materna e Obstetrícia. Conclusões: Os cuidados especializados à parturiente/pai/recém-nascido/família durante o Trabalho de Parto exigiram a aquisição das competências definidas pela Ordem dos Enfermeiros pelo Enfermeiro Especialista em Saúde Materna e Obstetrícia e quando se promoveu o envolvimento do pai ocorria uma participação mais ativa deste durante o Trabalho de Parto.

The Maternal Health Nursing and Midwifery requires the Nurse Specialist in Maternal Health and Obstetrics one specialized, autonomous, independent and/or interdependent intervention, like the control of possess technical and scientific skills, critical-reflexive, relational, communicative, family social and ethical-deontological capabilities. This internship of a professional nature allowed developing and deepening knowledge on the father's participation/role during labor. Objectives: Develop care taking to the mother/father/newborn during labor, affecting the delivery in a way to insure a secure environment and optimizing the health of mother and newborn in its adaptation to life extra womb; Promote the active participation of the father in supporting the mother and in interaction with the newborn during labor. Methodology: The provision of care to the mother/father/newborn during labour and intervention in promoting active participation of the father in supporting the mother and newborn interaction was the assumption of Peplau interpersonal relationship theory and the transition theory of Meleis. The nine parent's participants were selected through a non-probabilistic sampling method and criteria for inclusion. The intervention by the father began on admission with an interview to identify the basic knowledge on procedures to participate in supporting the mother and how to interact with the newborn, followed by the observation that those procedures are carried out by the father and finally, a semi-structured interview to understand the father's experience and the lack of intervention of the Nurse Specialist in Maternal Health and Obstetrics. Results: Provided specialist care to low-risk women 85 and 38, 87 risk recent mothers/family, 73 newborns and three of risk, carried out 110 nursing consultations and 54 normal deliveries. The intervention with the father resulted in: seven expectant fathers expressive type and two instrumentals; acknowledging greater need for training and encouragement from the Nurse Specialist in Maternal Health and Obstetrics in dealing procedures of comfort and interaction with the newborn; full participation with emotional support initiative to the parturient; positive experience; birth as the most striking moment and valorization on relational competences in the role of a Nurse Specialist in Maternal Health and Obstetrics. Conclusions: The specialist care to the mother/father/newborn/family during labor required the acquisition of jurisdiction by the Portuguese order of Nurses by the Nurse Specialist in Maternal Health and Obstetrics promoting the involvement of father was more of assuring/requesting an active participation during labor.