RESUMO
El absceso del psoas es una enfermedad infecciosa infrecuente y de difícil diagnóstico, caracterizado por una colección purulenta a nivel de este músculo, que provoca un síndrome de respuesta inflamatoria sistémica. La infección puede ser primaria por diseminación hematógena, o secundaria, a partir de un foco infeccioso cercano. Su presentación durante el embarazo es rara, y predomina la forma primaria, razón por la cual se decidió realizar este artículo. Se presenta el caso de una gestante con 28,4 semanas de edad gestacional que ingresó por dolor inguinal con posterior irradiación a la cadera, flanco y región lumbar derechos; postura en flexión de la cadera derecha y marcha antiálgica, así como aparición, a los nueve días de iniciados los síntomas, de una masa dolorosa entre fosa ilíaca y flanco derechos. Los hallazgos de la ecografía abdominal y la resonancia permitieron el diagnóstico de un plastrón apendicular con un apéndice retrocecal, así como absceso del psoas derecho, los cuales se trataron con antibioticoterapia y drenaje percutáneo del absceso, con resultados satisfactorios. El absceso del psoas secundario puede constituir el debut de una apendicitis atípica retrocecal, y para su diagnóstico hay que tener un alto nivel de sospecha por su clínica inespecífica.
The psoas abscess is a rare infectious disease that is difficult to diagnose, characterized by a purulent collection at the level of this muscle, which causes a systemic inflammatory response syndrome. The infection can be primary by hematogenous dissemination, or secondary, from a nearby infectious focus. Its presentation during pregnancy is rare, and the primary form predominates, which is why it was decided to write this article. The case of a pregnant woman with a gestational age of 28.4 weeks who was admitted due to inguinal pain with subsequent irradiation to the right hip, flank, and lumbar region; flexed posture of the right hip and analgesic gait, as well as the appearance, nine days after the onset of symptoms, of a painful mass between the right iliac fossa and flank it is presented. The findings of the abdominal ultrasound and MRI allowed the diagnosis of an appendiceal plastron with a retrocecal appendix, as well as a right psoas abscess, which were treated with antibiotic therapy and percutaneous drainage of the abscess, with satisfactory results. Secondary psoas abscess may constitute the debut of atypical retrocecal appendicitis, and its diagnosis requires a high level of suspicion due to its non-specific symptoms.
RESUMO
El bocio endotorácico remanente se define como el hallazgo de tejido tiroideo mediastinal después de una tiroidectomía total. Es una entidad infrecuente y generalmente el tumor se encuentra en el mediastino anterior, en posición retroesternal. Se presenta el caso de un paciente con bocio endotorácico remanente postiroidectomía total diagnosticado 6 años después. Se le realizó una exéresis a la enferma de la lesión sin complicaciones intra ni posoperatorias(AU)
Unusual endothoracic goiter is defined as the finding of mediastinal thyroid tissue after total thyroidectomy. It is uncommon and generally the tumor is located in the anterior mediastinum at retrosternal position. This was a patient with unusual endothoracic goiter after total thyroidectomy and diagnosed six years later. The lesion was excised with no intraoperative or postoperative complications(AU)
Assuntos
Humanos , Feminino , Idoso , Bócio Subesternal/diagnóstico , Bócio Subesternal/tratamento farmacológico , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/métodosRESUMO
La falla renal aguda (FRA) inducida por rabdomiolisis en el paciente con múltiples traumas es altamente mortal. La identificación de rabdomiolisis y FRA, permite reducir la morbi-mortalidad. La rabdomiolisis se determina con los valores séricos de creatinquinasa (CK) y la FRA se establece con la monitorización de la creatinina sérica (Cr) y el gasto urinario. Este proyecto tenía como objetivo describir la incidencia de FRA inducida por rabdomiolisis en los pacientes con múltiples traumas que consultan en el Hospital Nacional Rosales (HNR) en el periodo de un año. El HNR es el principal centro de consulta y referencia a nivel nacional, cuenta con el equipo necesario para manejo de estos pacientes, y no se ha descrito la incidencia de este problema
Assuntos
Injúria Renal Aguda , Rabdomiólise , Cirurgia GeralRESUMO
El fibrotecoma ovárico es una neoplasia poco frecuente y su localización extraovárica es más rara aún. Se observa generalmente como tumor sólido unilateral, de tamaño variable, en mujeres premenopáusicas. En su mayoría, es benigno y puede ser funcionales o no. Actualmente solo se han reportado tres pacientes y solo una de ellas de localización retroperitoneal. Se presenta un caso de una paciente con fibrotecoma extraovárico gigante retroperitoneal. Se realizó a la paciente exéresis de la lesión sin complicaciones intra ni posoperatorias.
Ovarian fibrothecoma is a rare malignancy and its extraovarian location is even rarer. It is generally seen as unilateral solid tumor, of variable size, in premenopausal women. It is mostly benign and it can be functional or not. Currently only three patients have been reported and only one of retroperitoneal location. A case of a patient with giant retroperitoneal extraovarian fibrothecoma is presented in this paper. The patient underwent excision of the lesion showing no intraoperative or postoperative complications.
Assuntos
Humanos , Feminino , Adulto , Neoplasias Ovarianas/cirurgia , Neoplasias Retroperitoneais/cirurgia , Tumor da Célula Tecal/cirurgiaRESUMO
La ingestión de cuerpos extraños durante la alimentación es frecuente, siendo en su mayoría espinas de pescado y huesos de pollo. En gran parte de los casos ocurre accidentalmente en personas alcohólicas, con enfermedad mental o que usan prótesis dentaria. Generalmente pasan a través del tubo digestivo sin causar daño y son expulsadas cerca de los 7 días de la ingestión, pero en algunos pacientes produce perforación del tubo digestivo, siendo las zonas más afectadas las regiones ileocecal y rectosigmoidea por su angulación. Presentamos un paciente masculino de 54 años de edad con perforación yeyunal por espina de pescado ingerida con 5 días de anterioridad, al que se le realizó sutura de la perforación, evolucionando satisfactoriamente.
The ingestion of foreign bodies during the intake is frequent; in the majority of the cases are fish or chicken bones. It generally occurs in alcoholics, mental illness patients or persons using dental prosthesis. Therefore its passes through the digestive tract without causing damage, a few patients present digestive perforation, and the most affected zones are the ileocecal and rectosigmoid regions. A patient with yeyunal perforation by fish bone ingested 5 days ago was presented. The patient required suture of perforation, the progress was satisfactory.
RESUMO
La diverticulosis yeyunoileal es una enfermedad rara que afecta con mayor frecuencia a hombres y mayores de 60 años. Los divertículos son más frecuentes en yeyuno, y se observa asociación con iguales lesiones en otras vísceras como colon y vejiga. La enfermedad generalmente es asintomática y la complicación más frecuente es la diverticulitis, por lo que se diagnostica incidentalmente en estudios radiológicos contrastados o en laparotomías. Se presenta un caso de una paciente de 87 años con antecedentes de hipertensión arterial y cardiopatía isquémica, que aquejaba dolor abdominal generalizado de 48 h de evolución, intenso, acompañado de náuseas, distensión abdominal y reacción peritoneal globalmente, por lo que fue intervenida quirúrgicamente de urgencia, encontrándose la presencia de diverticulosis yeyunoileal con divertículo yeyunal perforado, por lo que se realizó resección y anastomosis de intestino delgado. La paciente falleció por edema agudo del pulmón en la Unidad de Cuidados Intensivos del Hospital General Docente Enrique Cabrera, La Habana, Cuba.
Yeyuno-ileal diverticulosis is a rare illness that affects more frequently men and older than 60 years. Diverticula are more frequently in yeyuno than ileum, and are associated with similar lesions in colon or bladder. It is generally asymptomatic and diverticulitis is the most frequent complication that is why it is diagnosed through radiologic studies or laparotomies. An 87- year-old patient with hypertension and previous heart attack, who was complaining of generalized abdominal pain of 48 hours of evolution, intense, besides nausea, abdominal growth and tenderness. Because of these, she was operated for acute abdomen finding a yeyuno-ileal diverticulosis with a yeyunal diverticula perforated, that required resection and anastomosis of large bowel. The patient died from acute lung edema in the Intensive Care Unit of Enrique Cabrera General Teaching Hospital, Havana, Cuba.
RESUMO
El apéndice cecal en un saco herniario inguinal, con o sin apendicitis, es denominado hernia de Amyand. Se observa aproximadamente en el 1 % de los casos de hernia inguinal, es mucho más frecuente en los varones, y en el lado derecho, debido a la localización del apéndice cecal. Clínicamente, se presenta como una hernia inguinal complicada, con síntomas como fiebre o signos de oclusión intestinal mecánica, en dependencia del estado del apéndice. Este último determina el tipo de acceso quirúrgico y la reparación herniaria. Se presenta el tercer caso de hernia de Amyand atendido en el Hospital Enrique Cabrera, paciente al que se le realizó apendicectomía y herniorrafia inguinal, evolucionando satisfactoriamente.
Presence of the vermiform appendix in an inguinal hernia sac, with or without appendicitis, is called Amyand’s hernia. It occurs in approximately 1% of inguinal hernia patients. It is more common in men and is frequently found on the right side due to the location of the appendix. Clinically, it presents as a complicated inguinal hernia causing symptoms such as fever or signs of mechanical intestinal obstruction, depending on the state of the appendix. The latter determines the type of surgical approach and hernia repair. The third Amyand’s hernia case treated at the Enrique Cabrera Hospital is presented. The patient underwent an appendectomy and inguinal hernia repair with satisfactory outcomes.
RESUMO
El fibrotecoma ovárico es una neoplasia poco frecuente y su localización extraovárica más rara aún. Se observa por lo general, como tumor sólido unilateral, de tamaño variable, en mujeres premenopáusicas. En su mayoría es benigno y puede ser funcionales o no. En la actualidad se han reportado tres pacientes y solo una de ellas de localización retroperitoneal. Se realizó este trabajo con el objetivo de describir el diagnóstico y tratamiento de esta rara enfermedad. Argumentada a través, de la presentación de un caso de fibrotecoma extraovárico gigante retroperitoneal; se le efectuó a la enferma la exéresis de la lesión sin complicaciones intra ni posoperatorias.
Ovarian fibrothecoma is a rare neoplasm and its extraovarian location is even rarer. It is usually seen as unilateral solid tumor, of variable size, in premenopausal women. It is usually seen as unilateral solid tumor, of variable size, in premenopausal women. Mostly it is benign and it can be functional. At present, three patients have been reported and only one has it in retroperitoneal location. This paper was conducted to describe the diagnosis and treatment of this rare disease. Reasoned through the presentation of a case of a giant retroperitoneal extraovarian fibrothecoma; He will be performed at the patient's tumor was excision without intra or postoperative complications. The patient underwent the excision of the lesion without intra or postoperative complications.
RESUMO
Radioimmunotherapy (RIT) may improve the management of malignant gliomas. A Phase I clinical trial was performed to evaluate, for the first time, the toxicity and clinical effect of an intracavitary administration of a single dose of Nimotuzumab (h-R3) labeled wit (188)Re. Nimotuzumab is a humanized monoclonal antibody directed against epidermal growth factor receptors. Three patients with anaplastic astrocytoma (AA) and 8 with glioblastoma multiforme (GBM) were intended to be treated with 3 mg of mAb labelled with 10 or 15 mCi of (188)Re. In patients treated with 10 mCi (n=6) transitory worsening of pre-existing neurological symptoms were observed. Two patients treated with 15 mCi (n=4) developed early severe neurological symptoms and one also developed late severe toxicity (radionecrosis). In the group treated with 10 mCi, 1 GBM patient died in progression 6 months after the treatment, 2 patients (1 GBM and 1 AA) developed stable disease during 3 months. One GBM patient had partial response for more than 1 year and 2 patients (1 GBM and 1 AA) were asymptomatic and in complete response after 3 years of treatment. Maximal tolerated dose of the radioimmunoconjugate (188)Re-Nimotuzumab was 3 mg of the h-R3 labelled with 10 mCi of (188)Re. The radioimmunoconjugate showed a high retention in the surgical created resection cavity and the brain adjacent tissues with a mean value of 85.5 % of the injected dose one hour post-administration. This radioimmunoconjugate may be relatively safe and a promising therapeutic approach for treating high grade gliomas.
Assuntos
Anticorpos Monoclonais/toxicidade , Neoplasias Encefálicas/radioterapia , Glioma/radioterapia , Radioimunoterapia/métodos , Rênio/efeitos adversos , Adulto , Idoso , Anticorpos Monoclonais/farmacocinética , Ensaios Clínicos Fase II como Assunto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Radioimunoterapia/efeitos adversos , Radioisótopos/efeitos adversos , Radioisótopos/uso terapêutico , Rênio/uso terapêuticoRESUMO
OBJECTIVE: To evaluate the biodistribution, internal radiation dosimetry and safety of the 188Re-labelled humanized monoclonal antibody nimotuzumab in the locoregional treatment of malignant gliomas. METHODS: Single doses of 370 or 555 MBq of 188Re-labelled nimotuzumab were locoregionally administered to nine patients with recurrent high-grade gliomas, according to an approved dose-escalation study. SPECT, planar scintigraphy and magnetic resonance images were combined for dosimetric and pharmacokinetic studies. Blood and urine samples were collected to evaluate clinical laboratory parameters and for absorbed doses calculations. Biodistribution, internal dosimetry, human anti-mouse antibody response and toxicity were evaluated and reported. RESULTS: The 188Re-nimotuzumab showed a high retention in the surgically created resection cavity with a mean value of 85.5+/-10.3%ID 1 h post-injection. It produced mean absorbed doses in the tumour region of approximately 24.1+/-2.9 Gy in group I (patients receiving 370 MBq) and 31.1+/-6.4 Gy in group II (patients receiving 555 MBq); the normal organs receiving the highest absorbed doses were the kidneys, liver and urinary bladder. About 6.2+/-0.8%ID was excreted by the urinary pathway. The maximum tolerated dose was 370 MBq because two patients showed severe adverse effects after they received 555 MBq of 188Re-nimotuzumab. No patient developed human anti-mouse antibody response. CONCLUSIONS: A locoregional single dose of 188Re-labelled nimotuzumab of approximately 370 MBq could be used safely in the routine treatment of patients suffering with high-grade gliomas. The efficacy of this therapy needs to be evaluated in a phase II clinical trial.