Repositório RCAAP

Giant prostatic hyperplasia is a rare condition characterized by very high volume benign prostatic enlargement (>500g). Few cases have been reported so far and most of them are associated with severe lower urinary symptoms. We report the first case of asymptomatic giant prostatic hyperplasia in an elderly man who had a 720g prostate adenoma, sudden gross hematuria and hypovolemic shock. The patient was successfully treated with open transvesical prostatectomy and had an uneventful postoperative recovery.

Storiform collagenoma is a rare tumor, which originates from the proliferation of fibroblasts that show increased production of type-I collagen. It is usually found in the face, neck and extremities, but it can also appear in the trunk, scalp and, less frequently, in the oral mucosa and the nail bed. It affects both sexes, with a slight female predominance. It may be solitary or multiple, the latter being an important marker for Cowden syndrome. It presents as a painless, solid nodular tumor that is slow-growing. It must be considered in the differential diagnosis of other well-circumscribed skin lesions, such as dermatofibroma, pleomorphic fibroma, sclerotic lipoma, fibrolipoma, giant cell collagenoma, benign fibrous histiocytoma, intradermal Spitz nevus and giant cell angiohistiocytoma.

Most biliary stone diseases need to be treated surgically. However, in special cases that traditional biliary tract endoscopic access is not allowed, a multidisciplinary approach using hybrid technique with urologic instrumental constitute a treatment option. We report a case of a patient with complex intrahepatic stones who previously underwent unsuccessful conventional approaches, and who symptoms resolved after treatment with hybrid technique using an endourologic technology. We conducted an extensive literature review until October 2012 of manuscripts indexed in PubMed on the treatment of complex gallstones with hybrid technique. The multidisciplinary approach with hybrid technique using endourologic instrumental represents a safe and effective treatment option for patients with complex biliary stone who cannot conduct treatment with conventional methods.

Female patient, 42-years-old, complaining of difficulty in urinating and swelling in the vulvar area for one year. Her gynecological examination showed extensive injury in the vulvar region and the biopsy done was inconclusive. The removal of the lesion was conducted. After the procedure, the patient remains free of recurrence for 15 months. This case highlights the need to consider angiomyxoma in the differential diagnosis for tumors of unknown cause in the vulvar region.

Coexistence of breast cancer and tuberculosis is rare. In most cases, involvement by tuberculosis occurs in axillary lymph nodes. We report a case of a 43-years-old patient who had undergone adenomastectomy and left sentinel lymph node biopsy due to a triple negative ductal carcinoma. At the end of adjuvant treatment, the patient had an atypical lymph node in the left axilla. Lymph node was excised, and after laboratory analysis, the diagnosis was ganglion tuberculosis. The patient underwent treatment for primary tuberculosis. The development of these two pathologies can lead to problems in diagnosis and treatment. An accurate diagnosis is important to avoid unnecessary surgical procedures.

To perform a systematic review of the literature on the control of oral biofilms and the incidence of nosocomial pneumonia, in addition to assessing and classifying studies as to the grade of recommendation and level of evidence. The review was based on PubMed, LILACS, and Scopus databases, from January 1st, 2000 until December 31st, 2012. Studies evaluating oral hygiene care related to nosocomial infections in patients hospitalized in intensive care units were selected according to the inclusion criteria. Full published articles available in English, Spanish, or Portuguese, which approached chemical or mechanical oral hygiene techniques in preventing pneumonia, interventions performed, and their results were included. After analysis, the articles were classified according to level of evidence and grade of recommendation according to the criteria of the Oxford Centre for Evidence-Based Medicine. A total of 297 abstracts were found, 14 of which were full articles that met our criteria. Most articles included a study group with chlorhexidine users and a control group with placebo users for oral hygiene in the prevention of pneumonia. All articles were classified as B in the level of evidence, and 12 articles were classified as 2B and two articles as 2C in grade of recommendation. It was observed that the control of oral biofilm reduces the incidence of nosocomial pneumonia, but the fact that most articles had an intermediate grade of recommendation makes clear the need to conduct randomized controlled trials with minimal bias to establish future guidelines for oral hygiene in intensive care units.

Cervical adenitis >1.5cm in diameter is the less frequently observed criteria in patients with Kawasaki disease and it is usually found in association with other symptoms during the acute phase. Moreover, the finding of fever and lymphadenitis with intense local signs of inflammation and phlegmon is rarely seen as the initial manifestation of Kawasaki disease. We report the case of a 7-year-old boy who had cervical lymphadenitis with adjacent cellulitis and phlegmon mimicking bacterial adenitis as the first presentation of Kawasaki disease. The patient had fever, cervical lymphadenitis with adjacent cellulitis, and severe headache. Cefadroxil was prescribed based on the clinical diagnosis of bacterial adenitis. Because he remained febrile and phlogistic signs worsened, after 1 day of hospitalization, antibiotics were administrated intravenously (ceftriaxone and oxacillin). The computed tomography of the neck showed primary infectious/inflammatory process. On the fourth day, the patient had dry and scaly lips, and treatment with oxacillin was replaced by clindamycin because the patient was still febrile. On the ninth day, he presented non-exudative bilateral conjunctival injection. On the tenth day of febrile disease, a rash appeared on his trunk, hands and feet. Patient’s symptoms resolved after intravenous administration of immunoglobulin (2g/kg/dose), and he was discharged 2 days later. On the 14th day, the patient had lamellar desquamation of fingers. Kawasaki disease should be considered as a differential diagnosis in children with febrile cervical lymphadenitis unresponsive to empiric antibiotics even if they have adjacent cellulitis and phlegmon.

Ochoa syndrome is rare and its major clinical problems frequently unrecognized. We describe facial characteristics of six patients to help health professional recognize the inverted smile that these patients present and refer them to proper treatment. Patients’ medical records were reviewed and patients’ urological status clinically reassessed. At last evaluation patients’ mean age was 15.5 years, and age ranged from 12 to 32 years. Mean follow-up was 35 months (12 to 60). Initial symptoms were urinary tract infections in four patients (67%) associated with enuresis and incontinence in three of them (50%). One patient had only urinary tract infection and two lower urinary tract symptoms without infections. Initial treatment consisted of clean intermittent catheterization with anticholinergics for all patients. Four patients (67%) were submitted to bladder augmentation. Two patients had end-stage renal disease during follow-up, one received kidney transplantation and one patient remained on the waiting list for a renal transplantation. Familial consanguinity was present in only one case. This significant condition is rare, but it must be recognized by pediatricians, nephrologists and urologists in order to institute early aggressive urological treatment.

Acute limb ischemia can be potentially harmful to the limb and life threatening. Renal failure is a possible outcome associated with release of products of ischemic limb reperfusion. Some authors reported the benefit of performing angiography after embolectomy, even though iodine contrast is also nephrotoxic. We report a case of embolectomy on a patient with renal insufficiency in whom carbon dioxide was used as a substitute for iodine contrast.

When the frontal lobe of the brain is affected important behavioral changes may occur mainly at the level of executive functioning, i.e., planning, decision-making, judgment and self-perception. However, the behavioral changes may be of different nature with marked indifference and apathy. We report a clinical case of an 81-year-old patient with sudden onset of behavioral changes that were initially interpreted as an acute confusional episode of infectious etiology, but actually they were due to an ischemic lesion in the frontal lobe.

Sleep disorders are common in patients with Alzheimer dementia and affect the quality of life of patients and of their caregivers. Despite the rising number of studies in the area, almost all of them are about non-pharmacological treatment. Our objective was to review the literature concerning pharmacological and non-pharmacological approaches to treat sleep disorders of elderly patients with Alzheimer dementia in the ambulatory setting. The treatments revised consisted of sleep hygiene and/or use of intense light coupled or not with use of melatonin, cholinesterase inhibitors, antipsychotics, hypnotics or antidepressants. In addition to the non-pharmacological measures, there is evidence that the use of trazodone may aid the treatment of sleep disorders of older individuals with Alzheimer dementia. More studies are necessary to examine the non-pharmacological and pharmacological treatments revised herein.

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Objective To compare therapy for prophylaxis of venous thromboembolism and costs related to hospitalization of patients undergoing total knee and hip replacement within the context of the Brazilian health system.Methods A retrospective study of patients undergoing arthroplasty in 2010 in a public hospital and two private hospitals in the state of São Paulo, conducted by means of medical record review. Costs were estimated based on the use of health care resources during hospitalization. A descriptive analysis was performed using frequency and mean (standard deviation) according to the type of care delivered (by public or private organization).Results A total of 215 patients were evaluated, and 56.3% were submitted to knee surgery and 43.7%, to hip replacement. Approximately 88% and 98% of patients from public and private health services, respectively, received some form of venous thromboembolism prophylaxis, and enoxaparin was the drug most widely used in both systems. The total cost of prophylaxis was R$ 1,873.01 (R$ 26.38 per patient) in the public service and R$ 21,559.73 (R$ 163.33 per patient) in the private service. For the individuals who presented with thromboembolism, the average cost of hospitalization was R$ 6,210.80 and R$ 43,792.59 per patient in public and private health services, respectively.Conclusion Thromboembolism prophylaxis in patients undergoing arthroplasty is most commonly used in the private health services than public organizations, despite its high costs in both services. The cost per patient with thrombosis during hospitalization was higher than the total cost of prophylaxis, suggesting that prevention is associated to better cost-benefit ratio.

Resumo Este estudo apresenta as espécies de Primulaceae registradas para as áreas de canga da Serra dos Carajás, estado do Pará, incluindo descrição morfológica, comentários e ilustrações. São registrados dois gêneros e seis espécies para a área de estudo: Clavija lancifolia subsp. chermontiana, C. macrophylla, Cybianthus amplus, C. detergens, C. penduliflorus e Cybianthus sp. 1.

Resumo Este estudo compreende as espécies de Rubiaceae que ocorrem sobre canga na Serra dos Carajás, estado do Pará, Brasil, incluindo chaves de identificação, descrições detalhadas, ilustrações e comentários morfológicos das espécies, bem como a sinonimização de dois nomes (Chomelia parvifolia e Tocoyena bullata). No total, foram registradas 48 espécies em 24 gêneros, entre as quais distinguem-se, em ambientes abertos, táxons da tribo Spermacoceae, com um gênero monotípico endêmico da região, Carajasia cangae, bem como diversas espécies de distribuição restrita (e.g., Borreria carajasensis, B. elaiosulcata, B. heteranthera e Mitracarpus carajasensis). Nos ambientes florestais encontrados sobre canga, o gênero com maior número de espécies é Psychotria (9 espécies).

Resumo Este trabalho apresenta descrições e comentários morfológicos e ecológicos sobre as espécies de Santalaceae registradas para as cangas da Serra dos Carajás no estado do Pará. Foram registrados dois gêneros e oito espécies: Dendrophthora warmingii, Phoradendron crassifolium, P. dipterum, P. mucronatum, P. obtusissimum, P. piperoides, P. quadrangulare, amplamente distribuídas pelas Américas Central e Sul, e P. tunaeforme registrada somente na Venezuela e Brasil.

Resumo O presente estudo apresenta o tratamento taxonômico de Siparunaceae para as formações de canga da Serra dos Carajás (Pará, Brasil). Apenas uma espécie foi registrada, Siparuna ficoides, táxon ocorrente na Venezuela e norte do Brasil. Este registro representa o primeiro desta espécie para o estado do Pará; e provavelmente é o terceiro indivíduo conhecido da espécie, sendo o primeiro material examinado diferente dos descritos na obra original. São apresentadas descrição, comentários e ilustração da espécie.

Resumo Foi encontrada uma única espécie de Trigoniaceae nas cangas da Serra dos Carajás, Pará, Brasil: Trigonia nivea. São fornecidas descrição morfológica, prancha ilustrativa, comentários taxonômicos, distribuição geográfica e habitat da espécie.

Resumo Este estudo apresenta as espécies de Vochysiaceae que ocorrem em vegetação de canga na Serra dos Carajás, no estado do Pará, Brasil, incluindo descrições morfológicas, ilustrações e comentários. Foram registradas quatro espécies: Callisthene microphylla, Qualea multiflora, Q. parviflora e Vochysia haenkeana.

Resumo O presente estudo teve como objetivo investigar a variação de atributos funcionais de espécies arbóreas ao longo de diferentes posições topográficas, em uma floresta subtropical na região do Alto Uruguai, em Santa Catarina. Para as 20 espécies mais abundantes na área amostrada, foram determinados densidade básica da madeira (WD), altura potencial (Hmax), área foliar (LA), área foliar específica (SLA), regime de renovação foliar, guildas de regeneração e de dispersão. A estrutura funcional foi avaliada por meio dos valores dos atributos funcionais por parcela, ponderados para a comunidade (CWM). A partir de um Modelo Digital do Terreno na resolução de 1 m, foram extraídas para cada parcela a elevação, a declividade e curvatura. Os dados foram analisados por meio de correlações lineares, Análise de Coordenadas Principais (PCoA), Análises de Componente Principais (PCA) e modelo linear simples. Os resultados demonstraram correlações significativas e negativas entre Hmax x LA e Hmax x SLA. O gradiente topográfico influenciou de forma significativa a estrutura funcional do componente arbóreo. Conclui-se que a ocupação de diferentes posições no gradiente topográfico e ao longo do perfil vertical da floresta se deve ao fato das espécies apresentarem diferentes estratégias ecológicas.