RESUMO
Background: Gallstone ileus represents 4% of the causes of bowel obstruction in general population, but it increases to 25% in patients above 65 years of age. Gallstone ileus does not present with unique symptoms, making diagnosis difficult. It has a high mortality (12 to 27%) due to associated comorbidities and diagnostic delay. The aim of this case report is to communicate the importance of prompt diagnosis and surgical management of gallstone ileus. Clinical case: It is presented the clinical case of a 67-year-old female patient with a history of long-standing diabetes mellitus without medical control, without previous surgical history, who began suffering 2 days prior to admission to the emergency room with signs and symptoms of intestinal occlusion. She was given medical management without improvement and diagnostic delay of mechanical intestinal occlusion that was surgically intervened 7 days after the onset of clinical symptoms, finding gallstone ileus in the exploratory laparotomy, with satisfactory resolution of the pathology despite the diagnostic delay. Conclusions: Gallstone ileus is a difficult clinical entity to diagnose and therefore requires a high index of suspicion. The aim of gallstone ileus treatment is to release the obstruction, which is done through enterolithotomy. It is the recommended technique for gallstone ileus management because of its lower morbidity and mortality, compared with the other techniques.
Introducción: el íleo biliar representa el 4% de las causas de obstrucción intestinal en la población en general, pero incrementa a un 25% en los pacientes de más de 65 años. No presenta síntomas únicos, lo cual hace difícil su diagnóstico. Tiene una alta mortalidad (entre 12 y 27%) debido a las comorbilidades asociadas y al retraso diagnóstico. El objetivo de este caso clínico es comunicar la importancia del diagnóstico oportuno y el manejo quirúrgico del íleo biliar. Caso clínico: se presenta el caso clínico de una paciente de 67 años con antecedente de diabetes mellitus de larga evolución sin control médico, sin antecedentes quirúrgicos previos, cuyo padecimiento comenzó dos días antes de su ingreso a urgencias con signos y síntomas de oclusión intestinal. Se le dio manejo médico sin mejoría y hubo retraso diagnóstico de oclusión intestinal mecánica, la cual fue intervenida quirúrgicamente siete días después del inicio del cuadro clínico. En la laparotomía exploradora se encontró un íleo biliar, con resolución satisfactoria de la patología a pesar del retraso diagnóstico. Conclusiones: el íleo biliar es una entidad clínica de difícil diagnóstico que requiere un alto índice de sospecha. El objetivo del tratamiento del íleo biliar es liberar la obstrucción por medio de la enterolitotomía. Comparada con las otras técnicas, esta es la técnica recomendada para el manejo del íleo biliar, debido a su menor morbimortalidad.
Assuntos
Cálculos Biliares , Íleus , Obstrução Intestinal , Feminino , Humanos , Idoso , Cálculos Biliares/complicações , Cálculos Biliares/diagnóstico , Cálculos Biliares/cirurgia , Diagnóstico Tardio/efeitos adversos , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Íleus/diagnóstico , Íleus/etiologia , Íleus/cirurgiaRESUMO
BACKGROUND: Common variable immunodeficiency (CVID) is a rare disease that affects children and adults and is often difficult to diagnose. Despite being one of the most frequent causes of immunodeficiency, involving gastrointestinal (GI), respiratory, and hematological systems, the disease onset can have heterogeneous and intermittent symptoms, frequently leading to diagnostic delay. GI symptoms are common and can include diarrhea, but the asymptomatic periods lead to overlooking the recurrent pattern. The same can occur with respiratory infections, thus delaying CVID suspicion. The starting point for CVID diagnosis is the decreased gamma globulin levels in serum protein electrophoresis (SPE), also observed through direct immunoglobulin's dosage. CASE PRESENTATION: The patient is a 38 years-old man who had intermittent diarrhea and recurrent airway infections for 19 years, but the CVID diagnosis was achieved only after SPE was carried out. At that time, he was already malnourished, and developed other complications related to CVID in a short period. CONCLUSIONS: SPE is readily available and inexpensive, but is not part of the laboratory approach in diarrhea. According to the case presented herein, it can be useful for patients with recurrent infections or other clues of the disease.
Assuntos
Imunodeficiência de Variável Comum , Diagnóstico Tardio , Adulto , Proteínas Sanguíneas , Imunodeficiência de Variável Comum/complicações , Imunodeficiência de Variável Comum/diagnóstico , Diagnóstico Tardio/efeitos adversos , Diarreia/etiologia , Eletroforese , Humanos , MasculinoRESUMO
INTRODUCTION: posterior glenohumeral fracture dislocation (PGHFD) is a rare injury. It may present secondary to a seizure, electrocution or due to direct trauma. It is usually missed, and late diagnosis is common which increases the rate of complications and sequalae. CASE REPORT: 52 year old male, transferred to a reference trauma center due to a tonic-clonic seizure and a right PGHFD. Upon admission radiographs are requested and right shoulder injury is confirmed. Additionally, a simple left posterior glenohumeral dislocation (that was missed in the initial assessment of the patient) is observed. A computed tomography (CT) scan is obtained for both shoulders to plan surgery. The CT scan showed a bilateral PGHFD with severe comminution in the left shoulder, showing considerable worsening of the left shoulder since admission. Open reduction and bilateral locked plate osteosynthesis were performed in a one stage surgery. At two years follow up the patient evolved favorably with a Quick DASH score of 5% and a CONSTANT score of 72 and 76 for his right and left shoulder, respectively. CONCLUSION: PGHFD is an infrequent injury, which requires a high level of suspicion to avoid diagnostic delay and prevent complications and sequelae. Bilateral cases may be seen in cases of seizure. With prompt surgical treatment, satisfactory results can be achieved with a complete return to normal activities.
INTRODUCCIÓN: la luxofractura glenohumeral posterior (LFGHP) es una lesión poco frecuente. Puede ser secundaria a una crisis convulsiva, casos de electrocución, o por traumatismo directo. Su diagnóstico suele ser tardío, lo que aumenta la tasa de complicaciones y secuelas. CASO CLÍNICO: paciente de sexo masculino de 52 años, trasladado a centro de alta complejidad por convulsión tónico-clónica y LFGHP derecha. En el estudio inicial con radiografías se confirma lesión de hombro derecho y se diagnostica luxación glenohumeral posterior simple de hombro izquierdo no pesquisada previamente. Se complementa estudio con tomografía computarizada (TC) de ambos hombros, observándose una LFGHP bilateral, lo que demuestra agravamiento intrahospitalario de la lesión del hombro izquierdo. Se realiza reducción abierta y osteosíntesis con placa bloqueada bilateral en un tiempo. El hombro izquierdo requirió dos reintervenciones, una por falla de osteosíntesis y otra para liberación articular. Dos años después del procedimiento el paciente evoluciona satisfactoriamente con 5% en la escala Quick DASH y un puntaje de 72 y 76 en la escala de Constant en el hombro derecho e izquierdo, respectivamente. CONCLUSIÓN: la LFGHP es una lesión poco frecuente que requiere un alto índice de sospecha para evitar el retraso diagnóstico y la aparición de secuelas. En casos de convulsión se debe sospechar compromiso bilateral. Con un tratamiento quirúrgico oportuno se pueden obtener resultados satisfactorios y reintegración del paciente a sus actividades habituales.
Assuntos
Fraturas Ósseas , Luxação do Ombro , Masculino , Humanos , Pessoa de Meia-Idade , Luxação do Ombro/diagnóstico por imagem , Luxação do Ombro/etiologia , Diagnóstico Tardio/efeitos adversos , Fraturas Ósseas/complicações , Convulsões/complicações , Diagnóstico PrecoceRESUMO
OBJECTIVE: To estimate the incidence of congenital syphilis and temporal trends of the reported cases of the disease in the state of Santa Catarina between 2007 and 2017. METHODS: Observational study with retrospective cohort design, with secondary data from the Injury of Notification Information System (SINAN). Linear trend test and geoprocessing were performed to verify the behavior of the cases in the period. RESULTS: There were 2,898 reported cases of congenital syphilis in the period, with an average of 2.9 per 1,000 live births in the period. There was an exponential increase of 0.9 percentage points per year, considered statistically significant (p<0.001). There was no difference between the incidences of cases in the different regions of the State. The fatality rate was 8.5%, considering deaths from syphilis, miscarriages and stillbirths. The profile was predominant of white mothers, with low schooling and 11.8% did not perform prenatal care. For this reason, 26.9% of them had a diagnosis of syphilis at the time of delivery. Most of the pregnant women (51.9%) had inadequate pharmacological treatment and 65.1% of the partners were not treated. CONCLUSIONS: There was an exponential increase tendency in cases of congenital syphilis in the State of Santa Catarina in the period studied in all regions of the State, which reveals the failure of prenatal care, late diagnosis and inadequate treatment of the pregnant woman and her partner.
Assuntos
Diagnóstico Tardio/efeitos adversos , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Sífilis Congênita/epidemiologia , Sífilis Congênita/mortalidade , Aborto Espontâneo/epidemiologia , Adolescente , Adulto , Brasil/epidemiologia , Escolaridade , Feminino , Humanos , Incidência , Transmissão Vertical de Doenças Infecciosas/estatística & dados numéricos , Sistemas de Informação/normas , Nascido Vivo/epidemiologia , Mortalidade/tendências , Mães/estatística & dados numéricos , Gravidez , Cuidado Pré-Natal , Estudos Retrospectivos , Parceiros Sexuais , Natimorto/epidemiologia , Sífilis Congênita/complicações , Fatores de Tempo , Falha de Tratamento , Adulto JovemRESUMO
La hidrocefalia normotensiva es una patología caracterizada por alteración en la marcha, incontencia vesical, déficit cognitivo, hallazgos imagenológicos de ventriculomegalia comunicante y, presión normal de líquido cefalorraquídeo. Por la ambigüedad de sus síntomas y por la falta de criterios imagenológicos muy concluyentes es una patología de difícil diagnóstico inicial; el paciente muchas veces acude a distintos especialistas por síntomas aislados hasta que se relacionan los mismos y, se deriva el caso a Neurología / Neurocirugía. Se presenta el caso de un paciente de 65 años que presentó un cuadro de 2 años de evolución de incontinencia urinaria tratado como alteración de la micción secundaria a una hiperplasia prostática benigna sin mejoría alguna en ese intervalo de tiempo. Luego se agregó al cuadro una alteración en la marcha que fue poco valorada por el paciente y su entorno, sin ser conscientes del déficit cognitivo hasta que se realizó la evaluación neuropsicológica. Si bien el paciente presentaba la triada clásica que caracteriza a la hidrocefalia de presión normal, no fue hasta dos años luego del inicio del cuadro que se llegó al diagnóstico y, fue intervenido quirúrgicamente. Se colocó una válvula de derivación ventrículo peritoneal de presión media, con la cual presentó una evolución favorable y, resolución absoluta de los síntomas.
Normotensive hydrocephalus is a pathology characterized by impaired gait, bladder incontinence, cognitive deficit, images findings of communicating ventriculomegaly and normal cerebrospinal fluid pressure. Due to the ambiguity of its symptoms and the lack of conclusive images criteria, it is difficult initial diagnosis pathology; the patient often goes to different specialists for isolated symptoms until they are related, and the case is referred to Neurology / Neurosurgery. We present the case of a patient who presented a 2-year history of urinary incontinence treated as an alteration of urination secondary to a benign prostatic hyperplasia without any improvement in that time interval. Then a gait disturbance was added to the picture that was poorly valued by the patient and his environment, without being aware of the cognitive deficit until a neuropsychological evaluation. Although the patient presented the classic triad that characterizes normal pressure hydrocephalus, it was not until two years after the onset of the condition that the diagnosis was reached and underwent surgery. A peritoneal ventricular shunt of medium pressure was placed, presenting a favorable evaluation and complete resolution of symptoms.
Assuntos
Diagnóstico Tardio/efeitos adversos , Hidrocefalia de Pressão NormalRESUMO
ABSTRACT Objective: To estimate the incidence of congenital syphilis and temporal trends of the reported cases of the disease in the state of Santa Catarina between 2007 and 2017. Methods: Observational study with retrospective cohort design, with secondary data from the Injury of Notification Information System (SINAN). Linear trend test and geoprocessing were performed to verify the behavior of the cases in the period. Results: There were 2,898 reported cases of congenital syphilis in the period, with an average of 2.9 per 1,000 live births in the period. There was an exponential increase of 0.9 percentage points per year, considered statistically significant (p<0.001). There was no difference between the incidences of cases in the different regions of the State. The fatality rate was 8.5%, considering deaths from syphilis, miscarriages and stillbirths. The profile was predominant of white mothers, with low schooling and 11.8% did not perform prenatal care. For this reason, 26.9% of them had a diagnosis of syphilis at the time of delivery. Most of the pregnant women (51.9%) had inadequate pharmacological treatment and 65.1% of the partners were not treated. Conclusions: There was an exponential increase tendency in cases of congenital syphilis in the State of Santa Catarina in the period studied in all regions of the State, which reveals the failure of prenatal care, late diagnosis and inadequate treatment of the pregnant woman and her partner.
RESUMO Objetivo: Estimar a incidência de sífilis congênita e a tendência temporal dos casos notificados da doença no estado de Santa Catarina no período entre 2007 e 2017. Métodos: Estudo observacional com desenho de coorte retrospectiva, com dados secundários coletados no Sistema de Informação de Agravos de Notificação (SINAN). Foi realizado o teste de tendência linear e o geoprocessamento para verificar o comportamento dos casos no período. Resultados: No período, foram notificados 2.898 casos de sífilis congênita, com média de 2,9 a cada mil nascidos vivos. Houve crescimento exponencial de 0,9 ponto percentual ao ano, sendo estatisticamente significante (p<0,001). Não houve diferença entre a incidência de casos nas diferentes regiões do Estado. A taxa de letalidade foi de 8,5%, considerando os óbitos por sífilis, os abortos e os natimortos. O perfil predominante foi de mães da raça branca e com baixa escolaridade. Do total de mães analisadas, 11,8% não realizaram pré-natal - por esse motivo, 26,9% delas tiveram o diagnóstico de sífilis no momento do parto. A maioria das gestantes (51,9%) teve tratamento farmacológico inadequado e 65,1% dos parceiros não foram tratados. Conclusões: No período estudado, houve tendência de aumento exponencial dos casos de sífilis congênita em todas as regiões do Estado de Santa Catarina, o que revela a falha no pré-natal, o diagnóstico tardio e o tratamento inadequado da gestante e do seu parceiro.
Assuntos
Humanos , Feminino , Gravidez , Adolescente , Adulto , Adulto Jovem , Sífilis Congênita/mortalidade , Sífilis Congênita/epidemiologia , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Diagnóstico Tardio/efeitos adversos , Cuidado Pré-Natal , Sífilis Congênita/complicações , Fatores de Tempo , Brasil/epidemiologia , Sistemas de Informação/normas , Parceiros Sexuais , Aborto Espontâneo/epidemiologia , Incidência , Estudos Retrospectivos , Mortalidade/tendências , Falha de Tratamento , Transmissão Vertical de Doenças Infecciosas/estatística & dados numéricos , Escolaridade , Nascido Vivo/epidemiologia , Natimorto/epidemiologia , Mães/estatística & dados numéricosRESUMO
Colorectal cancer is the third most common cancer in the world and the fourth most common cause of death related to cancer. Signet ring cell carcinoma represents an uncommon histological type for rectal cancer with less than 1% of all rectal neoplasms. It usually behaves aggressively and has an inferior prognosis. We present the case of a young man diagnosed with signet ring cell rectal carcinoma. He underwent neoadjuvant therapy with partial response, had surgery with curative intent and showed local recurrence after only 3 months. Disease progression happened only weeks after recurrence with metastasis to vertebrae, extraocular muscles, bone marrow and skin. He is currently receiving palliative chemotherapy.
Assuntos
Neoplasias da Medula Óssea/secundário , Carcinoma de Células em Anel de Sinete/secundário , Neoplasias Oculares/secundário , Hemorragia Gastrointestinal/patologia , Neoplasias Retais/patologia , Neoplasias Cutâneas/secundário , Adulto , Carcinoma de Células em Anel de Sinete/diagnóstico por imagem , Carcinoma de Células em Anel de Sinete/patologia , Colonoscopia , Diagnóstico Tardio/efeitos adversos , Progressão da Doença , Hemorragia Gastrointestinal/diagnóstico por imagem , Humanos , Masculino , Cuidados Paliativos , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/tratamento farmacológico , Redução de PesoRESUMO
Appendicitis is the inflammation of the vermiform appendix. Acute appendictis is the most common surgical emergency, and the most frequent cause of abdominal pain. It is considered that between 7 to 12% of the world population will develop the disease in some ciurcumstances of their lifes, being more frequent during the second and third decades. The aim of this study was to evaluate the comlications derivated from the delay in the anagement of the patients with this complaint. Usually, the signs and symptoms are frequently typical and the diagnosis quickly made. However, the classic syndrome may not be evident and the correct diagnosis may be obscure, in whom a delay in diagnosis can result in a lifebreatening situation. Inflammation of the appendix usually results from the obstruction of the appendiceal lumen. The diagnosis of appendicitis depends primarily on the history and physical findings, but confirmation of the diagnosis usually requires appropriate laboratory, radiographic or endoscopic studies. Pain is usually the first simptom. vomiting usually develops. Acute appendicitis should always be included in the differential diagnosis of abdominal pain. Low-grade fewer is usual. The most characteristic sign is point tenderness at Mc-Burney's pint, which is located one third of the distance from the anterior-superior iliac spine to the umbilicus.We present a retrospective analysis, descriptive and observational. In our study the Alvarado score was empliye. The complications observed are detailed, and the results obtained are commented
Assuntos
Humanos , Apendicite/complicações , Apendicite/diagnóstico , Epidemiologia Descritiva , Estudos Retrospectivos , Diagnóstico Tardio/efeitos adversos , Ílio/cirurgiaRESUMO
We report a retrospective study of 171 consecutive patients with a lateral ankle sprain. All the patients with direct or blunt force trauma were excluded. Within 21 days of injury, 115 (67.25%) patients had undergone magnetic resonance imaging to evaluate for more serious or significant injuries. The average patient age was 44.09 years. Of the 115 patients, 75 (65.23%) had findings noted to be "significant." MRI can serve as a valuable and underused tool in the evaluation of acute lateral ankle injuries. The underuse of MRI might explain the high degree of variability in patients recovering from a lateral ankle sprain.
Assuntos
Fraturas do Tornozelo/diagnóstico por imagem , Traumatismos do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/diagnóstico por imagem , Diagnóstico Tardio , Imageamento por Ressonância Magnética , Entorses e Distensões/diagnóstico por imagem , Adulto , Fatores Etários , Diagnóstico Tardio/efeitos adversos , Diagnóstico Tardio/prevenção & controle , Erros de Diagnóstico/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Sensibilidade e Especificidade , Tálus/diagnóstico por imagem , Tálus/lesões , Adulto JovemRESUMO
Abstract Background Colorectal cancer in pregnancy is a rare pathology with limited high-grade evidence available for guidance. The diagnosis of CRC in pregnant women is usually delayed, and once diagnosis is made, challenges exist as treatment options may be limited. Objective The study aims to highlight the importance of early investigation of symptomatic patients during pregnancy, as well as to update treatment and prognosis in CRC. Methods A literature search in PubMed database, including articles from 2006 to 2016 and cross-research articles with the initial research. Results Pregnancy can limit and contraindicate the utilization of standard diagnostic and therapeutic tools, which in particular can hamper the liberal use of colonoscopy and CT. Physical evaluation and abdominal US are first recommended; besides, MRI or CT may be used, only in indicated cases. Surgery is the main stay of treatment but radiotherapy and chemotherapy have significant role in posterior management of tumour. Conclusions Many studies are needed in order to achieve development in CRC pathogenesis during pregnancy as well as in treatment outcomes. The potential curative treatment of the disease should be the main aim of treatment when considering CRC in pregnancy. However, it is crucial to adapt the treatment to each patient, taking into account conscious decision on pregnancy further management.
Resumo Introdução O cancro colorretal na gravidez é uma patologia rara, com limitada evidência científica para orientação terapêutica. O diagnóstico de cancro coloretal em mulheres grávidas é tardio e, quando o diagnóstico é feito, as opções de tratamento podem ser limitadas. Objetivo O objetivo deste estudo é ressalvar a importância da investigação precoce de pacientes sintomáticas durante a gravidez, assim como avaliar os atuais métodos de tratamento e prognóstico no CCR. Métodos A pesquisa bibliográfica foi realizada na base de dados PubMed, incluindo artigos a partir de 2006 até 2016, assim como artigos de pesquisa cruzada com os artigos iniciais. Resultados A gravidez pode limitar e contra-indicar a utilização de ferramentas de diagnóstico e terapêuticas convencionais, assim como dificultar o uso indiscriminado de colonoscopia e tomografia computadorizada. A avaliação física e a ecografia abdominal são a primeira linha para diagnóstico. No entanto, em casos selecionados, a ressonância magnética ou a tomografia computadorizada também podem ser usadas. A cirurgia é o gold-standard mas a radioterapia e a quimioterapia assumem um papel cada vez mais relevante no tratamento multidisciplinar destes tumores. Discussão Como os sintomas abdominais são comuns na gravidez e cancro coloretal pode simulá-los, o diagnóstico diferencial entre estas duas patologias é crucial, já que intervenções precoces podem ser curativas. Após diagnóstico, o seguimento das grávidas deve ser individualizado, dependendo de vários fatores. Porém, já que atualmente o tratamento do cancro é possível na gravidez, a probabilidade de sobrevivência da paciente não deve ser diminuída devido ao diagnóstico tardio. Conclusões Mais estudos são necessários para saber mais acerca da patogénese do cancro coloretal na gravidez, assim como os resultados após tratamento. O potencial objetivo é o tratamento oncológico do cancro coloretal. No entanto, é crucial adaptar o tratamento a cada paciente, tendo em conta a sua decisão consciente acerca da continuação da gravidez.