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BACKGROUND: Breast cancer is the most frequently diagnosed cancer worldwide. It is the leading cause of death by malignant disease in women. CASE SUMMARY: A female patient, 73 years of age, sought care due to weakness, mild abdominal pain, arthralgia, and weight loss. She was taking anastrazole as maintenance therapy for localized breast cancer and had moderate anemia and elevated acute-phase markers. Upper digestive endoscopy showed isolated erosion in the gastric corpus. This lesion was compatible with signet-ring cell adenocarcinoma in anatomopathological study and was confirmed as metastasis of a breast carcinoma in immunohistochemistry, which was positive for estrogen antibody. Further imaging studies determined numerous proximal bone metastases. The patient was treated with prednisone for paraneoplastic syndrome, which improved the anemia and rheumatic disease, and with chemotherapy, which greatly improved the symptoms. She has been followed-up for 6 mo, and her anemia, arthralgias, and acute phase markers have normalized. CONCLUSION: Systemic treatment strategies seem to be the best choice for gastric metastasis from breast cancer, resulting in disease control and relapse-free survival. Prospective studies with longer follow-up are needed to better understand the biological, pathological, and clinicopathological characteristics and outcomes of the endoscopic features associated with metastatic gastric cancer from breast carcinoma.
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BACKGROUND AND OBJECTIVES: This study aimed to investigate the association between pain perception and catastrophising at the beginning of orthodontic treatment; and the association between pain during orthodontic treatment and demographic, clinical and other psychological factors. METHODS: A cohort study with 44 patients (28.9 ± 15.05 years old; 25 females and 19 males) under orthodontic treatment with fixed appliances had their pain perception evaluated through a visual analogue scale at baseline (before activation), 6 h, 24 h, 2nd day, 3rd day, 5th day and 7th day after activation. The scores at each evaluation period after the first (T1), second (T2) and third (T3) appointments were compared by analysis of variance. A multivariate Poisson regression analysis verified the association between pain perception and Pain Catastrophising Scale (PCS); and demographic (age, gender), clinical (tooth crowding, tooth loss, analgesic intake and archwire characteristics) and other psychological (dental anxiety and previous negative dental experiences) independent variables (p < .05). RESULTS: Catastrophising (RR = 1.03, 95%CI 1.01-1.05, p = .0001) showed a weak risk of pain perception at T1. The peak of pain occurred 24 h after activation at T1, T2 and T3. Significant higher scores were observed at T1 in comparison to T2 (FT1,T2 = 11.82, p = .005) and T3 (FT1,T3 = 5.09, p = .03). Wire diameter, tooth crowding and single-arch treatment were found as risk factors for pain. Patients without tooth loss had half of the risk of pain perception, while analgesics intake and older patients were also found with a weak protective association. Dental anxiety and negative dental experience were not associated with pain perception. CONCLUSION: Catastrophising has a mild influence on pain perception and only after the first orthodontic activation. Patients with tooth losses, tooth crowding and using thicker archwires are more likely to report pain after orthodontic activations.
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Percepção da Dor , Dor , Adolescente , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Aparelhos Ortodônticos Fixos , Dor/etiologia , Medição da Dor , Adulto JovemRESUMO
BACKGROUND: Paracoccidioidomycosis is a systemic mycosis considered endemic and limited to Latin America with the majority of registered cases originating from Brazil. The purpose of this paper was to report a case of a female patient with paracoccidioidomycosis mimicking inflammatory bowel disease and to systematically review available cases of the intestinal presentation of this infectious disease. CASE REPORT: Female patient, 32-years old, previously asymptomatic, presenting with acute pain in the lower right abdomen, associated with signs of peritoneal irritation and abdominal distension. Urgent surgery was performed, which identified a severe suppurative perforated ileitis. The anatomopathological study revealed fungal structures shaped as a ship's pilot wheel in Grocott-Gomori's staining, suggestive of Paracoccidioides spp. METHODS: Studies were retrieved based on Medical Subject Headings and Health Sciences Descriptors, which were combined using Boolean operators. Searches were run on the electronic databases Scopus, Web of Science, MEDLINE (PubMed), BIREME (Biblioteca Regional de Medicina), LILACS (Latin American and Caribbean Health Sciences Literature), SciELO (Scientific Electronic Library Online), Embase, and Opengray.eu. Languages were restricted to English, Spanish and Portuguese. There was no date of publication restrictions. The reference lists of the studies retrieved were searched manually. Simple descriptive analysis was used to summarize the results. RESULTS: Our search strategy retrieved 581 references. In the final analysis, 34 references were included, with a total of 46 case reports. The most common clinical finding was abdominal pain and weight loss present in 31 (67.3%) patients. Most patients were treated with itraconazole (41.3%) and amphotericin B (36.9%). All-cause mortality was 12.8%. CONCLUSIONS: Paracoccidioidomycosis should be suspected in endemics areas, specially as a differential diagnosis for inflammatory bowel disease. Endoscopic tests and biopsy are useful for diagnosis and treatment with antifungal drugs seem to be the first treatment option to achieve a significant success rate.
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Paracoccidioides , Paracoccidioidomicose , Adulto , Anfotericina B , Antifúngicos/uso terapêutico , Feminino , Humanos , Itraconazol , Paracoccidioidomicose/diagnóstico , Paracoccidioidomicose/tratamento farmacológicoRESUMO
Refractory celiac disease is an uncommon condition which might be associated to poor prognosis. It is often treated with immunosuppressive medications, with poor results. It is divided in type 1 and type 2, the latter carrying a high risk for lymphoma and mortality. A case of a 41 year old female patient with refractory celiac disease type 2 is reported. She was treated with oral budesonide for six months, achieving histological remission.
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Doença Celíaca , Adulto , Budesonida , Doença Celíaca/diagnóstico , Feminino , HumanosRESUMO
Background: Osteosyntheses, orthopedic surgeries that cause highly painful stimulation, are increasingly common inveterinary medicine. Epidural anesthesia is used to provide intraoperative and postoperative analgesia in mammals undergoing pelvic limb surgery. In birds, the synsacrum, the bone originating from the fusion of the lumbar and sacral vertebrae,makes this route inapplicable, thus peripheral nerve block is an easier option in this species. This report describes a caseof local hypersensitivity following the association of lidocaine and bupivacaine in anesthetic blocks of the femoral andsciatic nerves in chickens (Gallus gallus domesticus).Case: A study was conducted in chickens evaluating the effectiveness of anesthetic sciatic and femoral nerve blocks, guidedby a neural stimulator. Thirty-two 42-day-old male chickens of the species Gallus gallus domesticus, double breasted,weighing 1.86 ± 0.5 kg, were randomly divided into four groups: control (CG), lidocaine (LG), bupivacaine (BC) andthe association of lidocaine and bupivacaine (LBG). The doses used were 4 mg/kg of 2% lidocaine and 2 mg/kg of 0.5%bupivacaine, without vasoconstrictor. For CG, 0.9% NaCl solution was used, respecting the total volume of 1 mL/kg.Only one bird from the LBG showed side effects, presenting sensory and motor loss for 24 h after the administration ofthese drugs, before euthanasia was performed using anesthetic induction with isoflurane through a face mask, followedby the intravenous administration of propofol and then potassium chloride. The chicken was submitted to a necropsy andmacroscopically, soft, irregular, brownish lesions with a grayish focus were observed...(AU)
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Animais , Masculino , Galinhas/cirurgia , Anestesia/veterinária , Bloqueio Nervoso/veterinária , Lidocaína , Bupivacaína , IsofluranoRESUMO
SUMMARY Refractory celiac disease is an uncommon condition which might be associated to poor prognosis. It is often treated with immunosuppressive medications, with poor results. It is divided in type 1 and type 2, the latter carrying a high risk for lymphoma and mortality. A case of a 41 year old female patient with refractory celiac disease type 2 is reported. She was treated with oral budesonide for six months, achieving histological remission.
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Humanos , Masculino , Feminino , Doença Celíaca/diagnóstico , BudesonidaRESUMO
Background: Osteosyntheses, orthopedic surgeries that cause highly painful stimulation, are increasingly common inveterinary medicine. Epidural anesthesia is used to provide intraoperative and postoperative analgesia in mammals undergoing pelvic limb surgery. In birds, the synsacrum, the bone originating from the fusion of the lumbar and sacral vertebrae,makes this route inapplicable, thus peripheral nerve block is an easier option in this species. This report describes a caseof local hypersensitivity following the association of lidocaine and bupivacaine in anesthetic blocks of the femoral andsciatic nerves in chickens (Gallus gallus domesticus).Case: A study was conducted in chickens evaluating the effectiveness of anesthetic sciatic and femoral nerve blocks, guidedby a neural stimulator. Thirty-two 42-day-old male chickens of the species Gallus gallus domesticus, double breasted,weighing 1.86 ± 0.5 kg, were randomly divided into four groups: control (CG), lidocaine (LG), bupivacaine (BC) andthe association of lidocaine and bupivacaine (LBG). The doses used were 4 mg/kg of 2% lidocaine and 2 mg/kg of 0.5%bupivacaine, without vasoconstrictor. For CG, 0.9% NaCl solution was used, respecting the total volume of 1 mL/kg.Only one bird from the LBG showed side effects, presenting sensory and motor loss for 24 h after the administration ofthese drugs, before euthanasia was performed using anesthetic induction with isoflurane through a face mask, followedby the intravenous administration of propofol and then potassium chloride. The chicken was submitted to a necropsy andmacroscopically, soft, irregular, brownish lesions with a grayish focus were observed...
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Masculino , Animais , Anestesia/veterinária , Bloqueio Nervoso/veterinária , Galinhas/cirurgia , Bupivacaína , Isoflurano , LidocaínaRESUMO
ABSTRACT Background: Paracoccidioidomycosis is a systemic mycosis considered endemic and limited to Latin America with the majority of registered cases originating from Brazil. The purpose of this paper was to report a case of a female patient with paracoccidioidomycosis mimicking inflammatory bowel disease and to systematically review available cases of the intestinal presentation of this infectious disease. Case report: Female patient, 32-years old, previously asymptomatic, presenting with acute pain in the lower right abdomen, associated with signs of peritoneal irritation and abdominal distension. Urgent surgery was performed, which identified a severe suppurative perforated ileitis. The anatomopathological study revealed fungal structures shaped as a ship's pilot wheel in Grocott-Gomori's staining, suggestive of Paracoccidioides spp. Methods: Studies were retrieved based on Medical Subject Headings and Health Sciences Descriptors, which were combined using Boolean operators. Searches were run on the electronic databases Scopus, Web of Science, MEDLINE (PubMed), BIREME (Biblioteca Regional de Medicina), LILACS (Latin American and Caribbean Health Sciences Literature), SciELO (Scientific Electronic Library Online), Embase, and Opengray.eu. Languages were restricted to English, Spanish and Portuguese. There was no date of publication restrictions. The reference lists of the studies retrieved were searched manually. Simple descriptive analysis was used to summarize the results. Results: Our search strategy retrieved 581 references. In the final analysis, 34 references were included, with a total of 46 case reports. The most common clinical finding was abdominal pain and weight loss present in 31 (67.3%) patients. Most patients were treated with itraconazole (41.3%) and amphotericin B (36.9%). All-cause mortality was 12.8%. Conclusions: Paracoccidioidomycosis should be suspected in endemics areas, specially as a differential diagnosis for inflammatory bowel disease. Endoscopic tests and biopsy are useful for diagnosis and treatment with antifungal drugs seem to be the first treatment option to achieve a significant success rate.
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Humanos , Feminino , Adulto , Paracoccidioides , Paracoccidioidomicose/diagnóstico , Paracoccidioidomicose/tratamento farmacológico , Anfotericina B , Itraconazol , Antifúngicos/uso terapêuticoRESUMO
OBJECTIVE: This study investigated the influence of different irrigants and the use of orange oil solvent in the removal of filling materials during root canal retreatment. METHODS: Forty maxillary premolars were shaped using the ProTaper System up to file F3 (size 30, 0.09 taper) and filled by Tagger's hybrid technique using the AH Plus. Samples were randomly assigned to four groups (n=10) according to the irrigating protocol during endodontic retreatment with the ProTaper Universal Re-treatment System: G1, 2% chlorhexidine (CHX) gel; G2, 2% CHX gel with an orange oil solvent; G3, 5% sodium hypochlorite (NaOCl); and G4, 5% NaOCl with an orange oil solvent. Afterwards, the samples were longitu-dinally split into two halves, and the root wall images were prepared by scanning electron microscopy. Two pre-calibrated evaluators analyzed the images using a filling materials remnants score system. Data were statistically analyzed using the Kruskal-Wallis and Dunn's tests (p<0.05). RESULTS: All samples had residual filling materials in the root canal walls after instrumentation. According to the presence of the filling material remnants in the total area of samples, the groups were ranked in the follow-ing order: G2=G4>G1=G3. No statistical differences were found when the CHX and NaOCl were used (p>0.05). Groups in which a solvent was used showed a less effective cleaning ability (p<0.05). The use of NaOCl with solvent presented the highest amounts of filling materials remnants in the critical apical area (p<0.05). CONCLUSION: The use of orange oil with NaOCl or CHX does not improve the removal of residual root canal filling materials.
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BACKGROUND: Paragangliomas are tumors that arise from the paraganglion system, which is a component of the neuroendocrine system. Approximately 10% are located in the extra-adrenal paraganglion system. Paragangliomas of the spine, however, are rare. They usually present as an intradural tumor in the cauda equina. There are only three reports of primary intraosseous paragangliomas of the sacrum. CASE DESCRIPTION: A 69-year-old man presented with low back pain and urinary incontinence. Imaging revealed a large intraosseous mass at S2, S3 and S4. Surgical resection was accomplished through a posterior midline incision exposing the spine from L5 to the coccyx. The tumor was located in the extradural space. It was friable, grayish and bleeding. Total tumor removal was performed, with normal bone margins. Follow-up at 2 years showed complete resolution of the preoperative symptoms and no evidence of local recurrence. CONCLUSION: Although rare, the possibility of paraganglioma should be included in the differential diagnosis of sacral tumors. The majority of the spinal paragangliomas are benign, slowly growing tumors with low proliferative activity. Despite these characteristics, local recurrence has been reported in cases of both macroscopically total and subtotal resection. Postoperative radiation therapy for patients with incomplete excision may not prevent recurrence, so gross tumor removal should be the goal of surgery.