[Isolated ileocecal tuberculosis simulating malignant neoplasia and Crohn's disease]. / Tuberculose ileocecal isolada simulando neoplasia maligna e doença de Crohn.

BACKGROUND: Isolated ileocecal involvement by tuberculosis in the absence of pulmonar disease is rare in Brasil, therefore causes a diagnostic dilemma as it mimics colonic malignancy and Crohn's disease. METHODS: Between 1969 and 1989, eight patients with isolated hypertrophic ileocecal tuberculosis were treated by surgery in the Gastroenterology Surgery Department of the HSPE-FMO. The most common complaint among them was abdominal pain (100%) with associated symptoms of weight loss (62.5%); nausea, vomiting, fever and general weekness appeared in half of the patients. A right iliac fossa mass was present in seven (87.5% ) of them. The mean duration of symptoms was 14.7 month (range 5-36 months). In all eight patients chest x-rays were negative for tuberculosis. Barium contrast studies showed abnormalities in all cases, but these could not be distinguished from carcinoma. Colonoscopy was helpful in establishing the diagnosis of suboclusive lesions of the ileocecal regions in three patients. Tuberculosis diagnosis was suspected in two of them because ofr the presence of granulomas in colonic biopsy material. RESULTS: Six patients were submitted to elective right hemicolectomy. The two remaining with suspect of tuberculosis were operated with signals of intestinal occlusion, and underwent a limited ileocaecal resection. The positive diagnosis of intestinal tuberculosis was made in all the patients by identification of acid-fast bacilli and by the presence of caseating granulomas in intestinal or lymph node tissue on histological examination. The outcome in all of them was favorable. They received treatment with three antituberculosis drugs over a twelve month period. CONCLUSION: Hypertrophic ileocecal tuberculosis must still be considered in the differential diagnosis of abdominal pathology localized in the right lower quadrant.

Tuberculose ileocecal isolada simulando neoplasia maligna e doença de Crohn / Isolated ileocecal tuberculosis simulating malignant neoplasia and Crohn's disease

OBJETIVO: No Brasil, a tuberculose ileocecal isolada, na ausência de tuberculose pulmonar ativa ou cicatrizada, é rara, sendo freqüentemente confundida com neoplasia e a doença de Crohn. MÉTODOS: Os autores apresentam oito doentes com essas características, tratados por cirurgia, em período de 20 anos. A dor abdominal na fossa ilíaca direita foi o principal sintoma (100 por cento), seguido da presença de perda de peso (62,5 por cento), febre, náuseas e vômitos e fadiga em 50 por cento dos doentes. Sete enfermos (87,5 por cento) apresentaram massa palpável na fossa ilíaca direita. A duraçäo média dos sintomas foi de 14,7 meses, variando de 5 a 36 meses. Todas as lesöes foram detectadas pelo enema opaco e mimetizavam aspecto neoplásico. A colonoscopia foi realizada em três doentes, evidenciando lesöes sub-oclusivas da regiäo íleo-cecal em dois; as biópsias foram sugestivas de tuberculose, näo sendo possível diferenciá-las da doença de Crohn. RESULTADOS: Seis enfermos com diagnóstico presuntivo de neoplasia foram submetidos a cirurgia eletiva, realizando-se neles a colectomia direita clássica. Os outros dois, com suspeita de tuberculose, foram operados na vigência de obstruçäo intestinal, sendo submetidos a ressecçäo limitada (ileocecectomia). O estudo anatomopatológico estabeleceu o diagnóstico final pelo encontro de necrose caseosa e de bacilos álcool ácido-resistentes no intestino ou nos linfonodos. A evoluçäo pós-operatória foi satisfatória, com pequena morbidade resolvida clinicamente. Posteriormente, todos os doentes receberam o esquema tríplice por 12 meses, variando a droga de acordo com a época do tratamento. CONCLUSÄO: Apesar de rara, a tuberculose hipertrófica ileocecal isolada freqüentemente é confundida com neoplasias e com a doença de Crohn, devendo ser lembrada no diagnóstico diferencial das lesöes localizadas no quadrante inferior direito do abdome

Remissäo completa de metástases endobrônquica, parenquimatosa e ganglionar hilar pulmonares de carcinoma de próstata após hormonioterapia antiandrogênica / Complete remission of endobronchial, parenchymal and hilar lymphatic lung metastases of prostatic carcinoma after anti-androgenic hormotherapy

Homem negro de 65 anos de idade referia, há 5 meses, queixas respiratórias e urinarias. A rivestigaçao realizada demonstrou a existência de carcinoma de próstata com metástases ósseas, brônquica, parenquimatosa e ganglionar hilar pulmonar. Biópsias de próstata e de brônquio revelaram carcinoma; a pesquisa de antígeno prostático específico foi positiva em ambas. O paciente foi submetido à prostatectomia e orquiectomia bilateral, bem como hormonioterapia antiandrogênica; houve involuçao das metástases brônquicas, pulmonar e ganglionar, mantendo-se inalteradas as ósseas. Em conclusao: metástases pulmonar e brônquica de carcinoma de próstata podem simular carcinoma brônquico primitivo; o tratamento hormonal foi satisfatório, evitando-se, assim, radio e quimioterapia; regressao completa com terapia antiandrogênica é possível, evitando-se radio e quimioteerapia.

[Complete remission of endobronchial, parenchymal and hilar lymphatic lung metastases of prostatic carcinoma after anti-androgenic hormotherapy]. / Remissão completa de metástases endobrônquica, parenquimatosa e ganglionar hilar pulmonares de carcinoma de próstata após hormonioterapia antiandrogênica.

UNLABELLED: A 65 year old male Negro had respiratory and urinary symptoms for the last 5 months. The work-up disclosed a prostatic carcinoma with metastases in bones, bronchus, lung parenchyma and hilar lymphnodes. Prostatic and bronchial biopsies revealed carcinoma; specific prostatic antigen was detected in both. A prostatectomy with bilateral orchiectomy was performed followed by anti-androgenic hormotherapy. Complete remission of metastatic bronchial, lung parenchyma and lymphatic lesions was observed; bone lesions did not change. IN CONCLUSION: lung and bronchial metastases of prostatic carcinoma may resemble primitive bronchial tumor; complete remission with anti-androgenic therapy is possible, saving the patient from unnecessary radio and/or chemotherapy.

Bilateral pleural effusion due to mediastinal fibrosis induced by radiotherapy.

A diagnosis of Hodgkin's disease was made 20 years ago in a 37-year-old woman; treatment included thoracic irradiation and chemotherapy. She was considered cured and remained well up to one year before, when she developed bilateral pleural effusion. No evidence of activity of Hodgkin's disease was detected. The pleural liquid was an exudate, with lymphocytic predominance. On thoracoscopy, enlarged lymphatic channels in the visceral pleura were noted, with tissue confirmation. To our knowledge, this report is the first to confirm by thoracoscopy and histologic study the proposed pathophysiologic condition of this uncommon entity.

[Iatrogenic pneumothorax caused by acupuncture]. / Pneumotórax iatrogênico por acunputura.

A 68 year-old white male patient with previous diagnosis of pulmonary emphysema was submitted to acupuncture. The needles were inserted into the precordial area and the patient immediately complained of worsening dyspnea. Four days later pneumothorax was detected by chest X-rays. A thoracic tube was inserted with total lung expansion.

[Bronchodilation induced by fenoterol in asthmatic patients: comparison of jet nebulization and spacer device]. / Broncodilatação induzida pelo fenoterol em asmáticos: comparação entre nebulizador a jato e espaçador.

OBJECTIVE: To compare bronchodilation attained by fenoterol administered through a jet nebulizer and through a spacer device. TYPE OF STUDY: Open, randomized. PATIENTS: 44 adults with asthma, peak-flow rate varying between 120 and 200 l/min. Patients were divided into two groups. TREATMENT [corrected]: Group A was treated with fenoterol (2.5 mg) with saline to complete 3 ml given through a jet nebulizer; 30 minutes later, an additional dose (1 mg) was given through a 500 ml spacer. Group B was treated with the same dosage, but the spacer [corrected] was used first. EVALUATION: Peak-flow meter in zero, 30 and 60 minutes. RESULTS: No significant difference in bronchodilation was seen between groups A and B. CONCLUSION: Fenoterol through a spacer can replace inhalation in adult asthma patients with non-severe obstruction. Lower cost and home treatment are the main advantages.

Pleural biopsy with Cope and Abrams needles.

The object of this study was to compare the diagnostic yield of Abrams and Cope needles. Pleural biopsies were performed in 24 patients with both needles. In two patients, the procedure was repeated within a few days. All patients had pleural effusion. The biopsies were performed at the same time; the biopsy sites were no more than 5 cm distant from each other. Diagnoses were exclusively pathologic. There was no difference between the needles in relation to diagnosis; greater size of the fragment, mesothelial cells, and fibrin were most frequently obtained by Abrams needle, while muscle was better obtained with the Cope needle. The biopsies with both needles were very similar regarding chronic inflammation, granuloma, caseous necrosis, neoplastic tissue, granulation, neutrophils, hemorrhage, vessels, nerves, adipose tissue and epidermis. The advantages of more pleural tissue obtained with the Abrams needle was not translated into better diagnostic yield in the present series.

Alteracoes da uricemia e da uricosuria induzidas por pirazinamida. Relacoes com comprometimento articular. / Changes of urecemia and uricosuria induced by pyrazinamide. Relations with joint involvement

As manifestacoes articulares e as concentracoes sericas e na urina de 24 horas do acido urico foram estudadas em quarenta pacientes com tuberculose e em tratamento com pirazinamida. Cinco pacientes apresentaram manifestacoes articulares e nao apresentaram diferencas significativas com os demais em relacao a idade, uricemia e diminuicao significativa da uricosuria diurna na fase de tratamento com pirazinamida foram observados em todos os pacientes - a uricosuria noturna nao se alterou significativamente.Nos periodos pre e pos-tratamento. Questionamos se do ponto de vista etico e justificada a utilizacao rotineira de uma droga que altera a eliminacao do acido urico em todos os pacientes, pois existem medicacoes alternativas com efeito terapeutico equivalente e com menores efeitos colaterais

Teste de provocacao bronquica com carbacol no diagnostico de asma. Relato de casos e comentarios. / Bronchial provocation test with carbachol in the diagnosis of asthma. Report of cases and comments

O teste de provocacao bronquica com carbacol e usado para demonstrar a presenca de hiperreatividade bronquica, a qual e universal entre os portadores de asma bronquica. Isto permite o diagnostico ou nao da doenca em diversas situacoes clinicas frequentes. Atraves do relato de casos e revisao bibliografica, e demonstrada a importancia deste teste em casos de:suspeita de asma de inicio recente, com exame clinico-funcional normal; tosse persistente e dispneia como manifestacoes isoladas de asma; diagnostico diferencial da asma bronquica e cardiaca; asma ficticia; e refluxo gastresofagiano simulando asma

Marcadores biologicos em carcinoma bronquico. / Biological markers in bronchial carcinoma

Em um grupo de 27 pacientes de carcinoma bronquico foram estudados, como marcadores biologicos, o antigeno carcinoembrionario, progesterona, hormonio luteinizante, insulina, prolactina, estradiol, hormonio foliculo estimulante, tiroxina, hormonio de crescimento, cortisol, testosterona, tri-iodotironina, hormonio estimulante da tiroide. Em 24 pacientes, um ou mais marcadores biologicos estavam aumentados; o antigeno carcinoembrionario, hormonio luteinizante, progesterona e a insulina apresentaram valores aumentados entre 35 e 50% dos pacientes, enquanto que o hormonio de crescimento, tiroxina, cortisol, testosterona, tri-iodotironina e o hormonio estimulante da tiroide so estavam elevados em menos de 5%; os demais situaram-se entre aqueles valores. Nos pacientes analisados de forma seriada, o unico marcador que apresentou correspondencia com a evolucao do processo tumoral foi o antigeno carcinoembrionario

Teste de reatividade bronquica com carbacol - resposta em normais e asmaticos. / Bronchial reactivity test with carbachol - response in normal and asthmatic patients

Cinquenta individuos, 25 normais e 25 asmaticos, foram estudados com doses crescentes de carbacol por nebulizador de jato A resposta foi medida por espirometria determinando-se a dose de provocacao que causou 15% de queda do VEF1,0(DP15). A media geometrica foi 3,89 +/- 0,30 em normais e 2,34 +/- 0,72 nos asmaticos (p<0,01 teste de Wilcoxon). A dose de 2,0 mg separou os dois grupos com sensibilidade e especificidade de 95%. Respostas com doses de carbacol entre 2,0 e 4,0 mg foram encontradas em tres de cinco normais que tinham parentes com asma, e em nenhum dos demais normais. Concluimos que a presenca de reatividade bronquica anormal pode ser estabelecida de maneira simples, inalando-se doses de carbacol de ate 4,0 mg