Metástase cardíaca de carcinoma hepatocelular / Cardiac metastasis in hepatocellular carcinoma

As metástases cardíacas são cerca de 40 vezes mais comuns do que os tumores primários. Metástases de carcinoma hepatocelular ocorrem em estágios avançados da neoplasia, para ossos, pulmões e suprarrenais, sendo raras para o coração. O presente relato apresenta paciente portador de carcinoma hepatocelular, associado à metástase cardíaca, confirmada ao ecocardiograma transesofágico. Ausência de trombo no sistema porta, neste relato de caso, é um achado incomum.

Laryngeal and vocal evaluation in untreated growth hormone deficient adults.

OBJECTIVE: To evaluate the consequences of lifetime, severe and untreated isolated growth hormone deficiency (IGHD) on vocal and laryngeal function. STUDY DESIGN: Cross-sectional. SUBJECTS AND METHODS: A total of 23 IGHD adult subjects and 22 controls were administered a questionnaire about vocal complaints and harmful voice habits, and underwent videolaryngostroboscopic examination, voice evaluation by perceptual-auditory analysis with GRBAS scale including grade of dysphonia, roughness, breathiness, asthenia and strain items, objective voice evaluation by maximum phonation time (MPT), and acoustic analysis. RESULTS: There was no difference in vocal complaints between IGHD subjects and controls. Vocal abuse and smoking were more frequent in IGHD subjects. IGHD subjects presented higher values for roughness, breathiness, and strain. Laryngopharyngeal reflux (LPR) signs and laryngeal constriction were more frequent in IGHD individuals. MPT was similar in the two groups. Fundamental frequency was higher in IGHD females and males. Harmonic to noise ratio was higher in IGHD in both genders and shimmer was lower in IGHD females. CONCLUSIONS: IGHD subjects have higher prevalence of signs of LPR and laryngeal constriction, with high pitch in both genders, which suggests a prominent role of IGHD on these parameters.