Early retinal neurovascular findings in post-transplant diabetes mellitus patients without clinical signs of diabetic retinopathy.

BACKGROUND: Post-transplant diabetes mellitus (PTDM) is a specific subtype of diabetes with an uncertain impact on mortality and morbidity in post-transplant patients. Diabetic retinopathy is the most common microvascular complication of diabetes mellitus, but the long-term clinical progression in PTDM is unknown. New technologies are being used to assess pre-clinical signs of retinal changes, such as swept-source optical coherence tomography (OCT) and OCT-angiography. The aim of this study was to detect pre-clinical structural and vascular changes in the retina using swept-source-OCT and OCT-angiography in patients with PTDM. METHODS: In this retrospective cohort study, post-kidney transplant patients were divided into PTDM and non-PTDM (control) groups. Both eyes of eligible PTDM patients and controls were included in this study. Inner retinal layer thickness was measured with swept-source-OCT. Retinal capillary density and the foveal avascular zone were measured with OCT-angiography. RESULTS: In the PTDM group, reduced thickness was found in the inferior ganglion cell layer plus inner plexiform layer (95% CI -8.76 to -0.68; p = 0.022) and the temporal inferior segment (95% CI -10.23 to -0.76; p = 0.024) of the inner retina, as well as in the retinal nerve fiber layer in the temporal (95% CI -34.78 to -9.28 p = 0.001) and temporal inferior segments (95% CI -33.26 to -5.03 p = 0.008). No significant differences were found in the vascular capillary plexus between groups at all depths, segments, or foveal avascular zone (p = 0.088). CONCLUSIONS: According to OCT-angiography, PTDM patients had reduced inner neurosensory retinal layers but no significant change in vascular density, which suggests that early neuroretinal degeneration might occur prior to vascular changes secondary to PTDM. Prospective studies could help elucidate the clinical course of retinal neuropathy and microvascular pathology in PTDM and provide a better understanding of PTDM complications.

Microvascular Complications of Posttransplant Diabetes Mellitus in Kidney Transplant Recipients: A Longitudinal Study.

Objective: To assesses microvascular complications in renal transplant recipients with posttransplant diabetes mellitus (PTDM). Research Design and Methods: In this observational study, patients with ≥5 years of PTDM were included from a cohort of 895 kidney recipients transplanted from 2000 through 2011. Diabetic retinopathy was evaluated by fundus photographs and optical coherence tomography (OCT). Diabetes kidney disease was evaluated by protein to creatinine ratio (PCR) and estimated glomerular filtration rate (eGFR). Distal polyneuropathy was assessed by Michigan Protocol and 10 g-monofilament feet examinations. The Ewing protocol identified cardiovascular autonomic neuropathy. Renal transplant recipients without PTDM diagnosis (NPTDM) were considered controls. Results: After 144.5 months of follow-up, 135 (15%) patients developed PTDM, and 64 had a PTDM duration ≥5 years. None of the patients with PTDM presented diabetic retinopathy at fundus photographs, but thinning of inner retinal layers was observed with OCT. More than 60% of patients with PTDM had distal polyneuropathy (OR, 1.55; 95% CI, 1.26 to 1.91; P < 0.001). Cardiovascular reflex tests abnormalities were similar between patients with PTDM and NPTDM (P = 0.26). During the first year and 8.5 ± 3.0 years after renal transplantation, eGFR and PCR did not differ significantly between patients with PTDM or NPTDM. Conclusions: This longitudinal study assesses microvascular complications in renal transplant patients with PTDM. A lower than expected prevalence as well as a different clinical course of the complications was observed. PTDM seems to be a unique type of diabetes, and its consequences may be milder than expected in type 1 and type 2 diabetes.

Doença de Madelung: relato de caso e revisão da literatura / Madelung's disease: a case report and literature review

Relata-se o caso de um paciente portador da doença de Madelung, definida clinicamente pela presença de múltiplos acúmulos de tecido adiposo não encapsulados, usualmente envolvendo a região cervical e superior do tórax, de distribuição simétrica. O exame de imagem eleito para confirmação do diagnóstico foi tomografia computadorizada, por ser menos dispendiosa e mais acessível, comparando-se à ressonância magnética.

The authors report the case of a patient with Madelung's disease, which is clinically described as the presence of multiple and symmetric non-encapsulated masses of fatty tissue, usually involving the neck and the upper region of the trunk. Computed tomography was selected as the imaging method for diagnosis confirmation, considering its lower cost and higher availability as compared with magnetic resonance imaging.

Hamartoma nodal angiomiomatoso / Angiomyomatous hamartoma

O Hamartoma Nodal Angiomiomatoso (HNA) é uma doença benigna rara, descrita pela primeira vez em 1992 por Chan et al. Apresenta-se como um tumor vascular primário dos linfonodos que ocorre, na maioria das vezes, exclusivamente nos linfonodos inguinais e femoral, e está ocasionalmente associado a edema de membro inferior ipsilateral. Relata-se o caso de uma paciente de 74 anos, do sexo feminino, com HNA envolvendo linfonodos inguinais direitos; descrevendo seus aspectos patogênicos, clínicos, diagnósticos e terapêuticos. Enfatiza-se a importância do reconhecimento desta patologia para adequado diagnóstico e tratamento. Juntamente com o relato de caso, será realizada breve revisão da literatura (AU)

Angiomyomatous Hamartoma (AH) is a rare benign disease which presents itself as a primary vascular tumor of the lymph nodes, primarily found in the inguinal and femoral lymph nodes and occasionally associated with edema of the ipsilateral limb. Here we report the case of a female patient with AH involving the right inguinal lymph nodes. In addition to the case report, a brief literature review is presented describing the pathogenic, clinical, diagnostic and therapeutic aspects of the condition. The importance of proper recognition of the disease is emphasized for adequate diagnosis and treatment (AU)

Ten-years comparative study after surgical treatment of perforated peptic ulcer according to ulcer relapse between H. Pylori positive, after eradication, and negative patients / Estudo comparativo quanto à recidiva ulcerosa do tratamento cirúrgico de úlcera péptica perfurada entre pacientes H. Pylori positivos, após erradicação, e negativos

BACKGROUND: The surgical treatment for perforated peptic ulcer is still a matter of discussion. The surgeons, for many years, made their options between acid-reducing procedures with some morbi-mortality and simpler procedures like closure of the perforation. But, in these cases, were faced with a high chance of ulcer relapse. Since the proved link between peptic ulcer and gastroduodenal infection caused by H. pylori, a recommendation for a change in their attitudes going back to simpler procedures with eradication of the bacteria was done.AIM: To analyse ulcer recurrence in patients treated with the same surgical procedure but belonging to two different groups: positive and negative to H. pilori.METHODS: A total of 144 patients were treated with simple closure of their perforated pre-pyloric, pyloric and duodenal ulcers. Thirty days after operation they were submitted to upper endoscopy and tested for the bacteria by urease and histopathological exams and divided into two groups according to the results of the tests: positive and negative. The positive ones were eradicated and, together with the negative group, were followed through six months interval endoscopies and detection tests looking for ulcer relapses and reinfection in the eradicated group. The positive group consisted of 25 patients, with two patients considered non eradicable according to the treatment protocol. They were followed for an average period of 38,21 months.RESULTS: Relapse was detected in four patients (17,39%), half of them (8,69%) were reinfected. The negative group consisted of 26 patients, with a median follow-up of 38,28 months and eight (30,76%) relapses were detected. There was no statistical significant difference due probably to the high dropout of patients.CONCLUSION: Simple suture with H. pilori eradication is the gold standard for the positive group, leaving the question of acid-reducing procedures open for the negative ones.

RACIONAL: O tratamento cirúrgico da úlcera péptica perfurada é assunto discutível. Os cirurgiões, por muitos anos, fizeram suas opções entre procedimentos de redução ácida, somente fechamento da perfuração - porém com maior chance de recidiva ulcerosa. Desde a comprovada vinculação da úlcera péptica e suas complicações à infecção gastroduodenal causada pelo Helicobacter pylori, houve recomendação para mudança na atitude dos cirurgiões na volta à operação mais simples com erradicação da bactéria.OBJETIVO: Analisar a recidiva ulcerosa em pacientes com úlcera perfurada H. pylori positiva que foram submetidos à simples sutura da lesão e omentopexia com erradicação da bactéria e compará-la com H. pylori negativo submetido ao mesmo tratamento cirúrgico.MÉTODOS: Cento e quatorze pacientes com úlceras pré-pilóricas, pilóricas e duodenais perfuradas foram atendidos com fechamento simples. Trinta dias após a operação submeteram-se à endoscopia digestiva alta com biópsias para testes da urease e histopatológicos. Foram divididos em dois grupos de acordo com o resultado dos testes: positivo e negativo.Os positivos foram erradicados e, junto com o grupo negativo, foram seguidos com endoscopias semestrais e testes de detecção para H. pylori procurando por recidiva ulcerosa e reinfecção no grupo erradicado.RESULTADOS: O grupo positivo foi formado por 25 pacientes, dos quais dois foram considerados não erradicáveis segundo os critérios do protocolo. Os demais foram seguidos por período médio de 38,21 meses e detectadas recidivas em quatro pacientes (17,39%), metade deles (8,69%) foram reinfectados. O grupo negativo foi formado por 26 pacientes, seguido por período médio de 38,28 meses e oito (30,76%) apresentaram recidiva ulcerosa. Não foi evidenciada diferença estatisticamente significativa entre os grupos...

Estenose traqueal após intubação orotraqueal / Tracheal stenosis after endotracheal intubation

A causa benigna mais comum de estenose das vias aéreas superiores, em todas as faixas etárias, é a lesão traqueal pós-intubação, que ocorre em 1% a 4% dos pacientes submetidos à ventilação mecânica por longo período. Não tratada, a estenose das vias aéreas cursa com significativa morbidade pulmonar e pode conduzir ao óbito devido ao comprometimento do aparelho respiratório. Dentre as lesões conseqüentes à intubação endotraqueal, é incomum a ocorrência de manifestações clínicas de estenose traqueal. Relata-se o caso de um paciente masculino de 56 anos, que desenvolveu estenose traqueal após ser submetido à intubação endotraqueal por 10 dias, descrevendo seus aspectos patogênicos, clínicos, diagnósticos e terapêutica (AU)

The most common benign cause of upper airway stenosis in all age groups is postintubation tracheal injury, which occurs in 1% to 4% of patients submitted to long-term ventilation. If untreated, airway stenosis causes significant pulmonary morbidity and can progress to life-threatening airway compromise. Among postintubation tracheal lesions, the occurrence of clinical symptoms of tracheal stenosis is uncommon. Here we present the case of a 56-year-old male who developed tracheal stenosis after being submitted to endotracheal intubation for 10 days, describing the physiopathology and clinical aspects of the case as well as its treatment (AU)