RMMG - Revista Médica de Minas Gerais

Colorectal Adenocarcinoma with signet-ring cells is a mucinous variant of adenocarcinoma. This type of neoplasm is common in patients with advanced age, being sufficiently uncommon in children and diagnosied in advanced periods of training already, presenting one worse prognostic and supervened tax of below five year. The diagnostic is carried through anatomy-pathological examination, associate the image examinations and picture physician-evolution. We present and we argue a case report of colorectal adenocarcinoma with signet-ring cells in a patient of fourteen years.

Keywords Adenocarcinoma; Colorectal Neoplasms; Rectal Diseases; Colonic Diseases; Carcinoma, Signet Ring Cell.

We present the case of a patient under acetabular risk fracture secondary to an ostheolytic painful metastasis treated by a successful percutaneous acetabular cementoplasty in the interventional radiology service. The clinical, imaging and technical aspects are discussed.

Keywords Neoplasms; Acetabulum; Interventional Radiology.

BACKGROUND AND OBJECTIVES: Fibrous Dysplasia (FD) of bone is a benign not hereditary congenital disorder of medullary bone maintenace in which bone undergoing physiologic lysis is replaced by abnormal proliferation of fibrous tissue, resulting in assymmetric distortion and expantion of bone. It may be confined to a single bone (monostotic) or involve several bones (polyostotic). Prompt recognition of this disease is important once it takes part in a wide group of differential diagnosis. This review is intended to provide clinicians with an understanding of the pathophysiology that underlies FD and its presentation forms.
METHODS: This article reviews and analyzes literature relevant to the pathophysiology and management of FD and presents a case-study of a five-year-old boy who came down with it. Methods include search of MEDLINE, and bibliographic search of current textbooks and journal articles.
RESULTS AND CONCLUSIONS: The patient who was investigated had, at the beginning, bone pain and other symptoms leading to a possible diagnosis of FD, which was confirmed by bone biopsy. He remains asymptomatic.

Keywords Fibrous Dysplasia of Bone; Fibrous Dysplasia, Monostotic; Fibrous Dysplasia, Polyostotic.

It will be initially revised by the authors the most actual aspects of the concept, clinical situation, diagnosis and treatment concerning to a metabolic disturbance of the copper, Wilson's disease. Afterwards it will be described the clinical case of a young man attacked of a sequence of superposed symptoms of gastrintestinal, neurological and psychiatric origin. For the multiplicity and gravity of the symptoms acute polimórfico with intense psicomotora inhibition had the final diagnosis of "psychotic Upheaval". Starting from an integrated analysis of the exams, it was suspected about a metabolic disturbance of hereditary or acquired origin that justify all the symptoms simultaneously. The disturbance of the excretion of copper, Wilson's disease, came to justify all the referred symptomatology and it was confirmed by the decrease sanguine dosage of ceruloplasmin, the presence of rings of Kayser-Fleischer in the córnea of the patient and of neurological lesion at the magnetic nuclear ressonance. The diagnosis of Wilson's disease in patients with simultaneous digestive (hepática cirrhosis), neurological and inexplicable psychiatric disturbances will always have to be faneed because the precocious treatment will mainly prevent serious and permanent organic damages for the liver and brain. The specific treatment was initiated and the maintenance of exactly has provoked significant improvements and a gradual new outbreak of the symptoms reintegrating the patient the family and the society.

Keywords Hepatolenticular Degeneration/diagnosis; Hepatolenticular Degeneration/therapy; Copper.

This is a case-report of an HIV - infected patient who was admitted to hospital with chronic diarrhea. The diagnosis obtained by intestinal biopsy was ulcerative colitis. After initiating treatment with prednisone, the patient's symptoms improved. This case-report should alert the clinicians to the importance of including non- infectious and non-opportunist pathologies in the differential diagnosis of chronic diarrhea in a patient infected with the HIV.

Keywords Gastroenteritis; Colitis, Ulcerative; Diarrhea; HIV Seropositivity.

Mandible fractures are among the most common lesions encountered in the trauma centers. They are usually caused by assault or gunshot and the risk factors include low socioeconomic level, drug abuse and unemployment, being male young adults the most frequent victims. This report is about a patient who was brought to the emergency room with a severe gunshot comminuted mandible fracture. He was submitted to an early surgical repair, in which fixation and reconstruction plates were needed. There was a 28 day in-hospital stay and the patient showed facial deformation and difficulty in word pronunciation at discharge. Due to the aggressive management with early surgical repair and adequate resources the patient presented with good functional and aesthetical results in the follow up.

Keywords Mandibular Injuries; Fractures, Boné; Fracture Fixation; Orthopedic Fixation Devices; Firearms

This is a report of a 62 years old patient with haemangioma epithelioid in a very uncommon site. We study histopathological aspects, biological behaviour and prognosis.

Keywords Angiolymphoid Hyperplasia with Eosinophilia; Hemangioma; Vulva.

Describe a newborn with recurrent congenital herpes, disease with high mortality and morbidity, mainly when central nervous system is involved (CNS). Vertical transmission occurs mainly in primary maternal infection. Beyond CNS, clinical manifestations can be cutaneus and disseminated infection (multiple organs disease).
DESCRIPTION: Newborn whose mother had genital herpes not diagnosed at labor. He presented cutaneous lesions and encephalitis at the first manifestation of herpes. Treatment was performed with endovenous acyclovir during 28 days. Thereupon, he had skin lesions that recurred twice, requiring new treatments. Prophylaxis with oral acyclovir was introduced and prescribed until the children attained one year old.
COMMENTS: Literature recognizes the importance of early diagnosis, prevention and treatment of maternal herpes, in order to minimize mortality and morbidity for the newborn, mainly related to CNS involvement. Prophylaxis with oral aciclovir is not well defined, but was successful in this case.

Keywords Herpes Simplex; Infant, Newborn; Acyclovir.

Common Variable Immunodeficiency Syndrome (CVIS) is the most frequent syndrome of primary immunodeficiency. It is an immunologic disorder characterized by a defect in antibodies synthesis, recurrent infections, especially in the respiratory tract, auto-immune manifestations and cancer. We describe a case of a 61-year-old patient with a previous history of hepatitis B and a suspicion of pleural and lymph node tuberculosis who was admitted showing weight loss, fever, weakness, ascites and oliguria. Dialytic treatment has been initiated and chronic terminal renal disease due to hypertensive nephrosclerosis was diagnosed. She had hepatic cirrhosis, severe anemia non-responsive to erythropoietin treatment, refractory ascites and and she was malnourished. The white blood cell count was normal. During the dialytic treatment, the patient presented cervical, supraclavicular and right axilla lymphadenosis. The lymph nodes were mobile, fibroelastic, painful and some of them suppurative. Biopsy of the cutaneal cervical lesion showed dermoepidermitis fistulized with granuloma and necrosis of undetermined etiology, nonreactor PPD and negative findings for fungus as well as for alcohol-acid resistant bacilli. She also had recurrent infections of the hemodialysis central catheter and septic arthritis. Her clinical status deteriorated and she died from septic shock. For a long time during the treatment, it was hypothesized the patient had been affected by tuberculosis. The CVIS was inquired as a possible diagnostic just after the patient's death. Facing uncommon diseases as well as unusual clinical presentations still remain a challenge for the clinician and should always be considered in unexpected clinical evolution in patients on chronic renal replacement therapy.

Keywords Lynphadenitis; Granuloma; Agammaglobulinemia; Kidney Disease.

A case of pregnant patient with undetermined fever of origin is described. The result of blood culture demonstrated Lysteria monocytogenes. A review of the literature was made

Keywords Listeria Infections; Pregnancy; Infeccion.

This is a report of 44 years old patient with renal malakoplakia. We study histopathological aspects and pathogenesis of this lesion.

Keywords Malacoplakia; kidney.

Systemic mastocytosis is a rare disturb of the mast cells and its progenitors. Even so the low incidence, the disease is epidemiologically important because of the high mortality and the misdiagnosed cases. The symptoms are due to systemic infiltration and activation of pathologic mast cells. Recent studies have documented the difference between the molecular and cellular biology of mast cells in patients with mastocytosis and those of healthy individuals. These findings are being used in formulating diagnostic criteria as well as dictating new treatment approaches to the disease. Is reported a clinic case of a male, 58 years old, with the history of fever of undetermined origin and malaise, ascitis and low platelets. The diagnosis criteria for systemic mastocytosis were established.

Keywords Mastocytosis, Systemic; Proto-Oncogene Proteins c-kit; imatinib mesylate.

Diabetes mellitus is a chronic disease that attacks more than 120 million people in the world, many of them having foot ulcers which may lead to foot amputation, what causes great damages to the patient and the health care system. Ozone therapy is a promissing coadjuvant alternative for the treatment of such lesions, due to its bioxidative, antimicrobial effects, and its role in neoangiogenesis. It also increases the average number of fibroblasts, improves oxygen transport by erythrocytes, and stimulates the immune system. The present case reports treatment of a patient with diabetes and atherosclerosis, with a history of an infected ulcer associated to osteomyelitis in the right fourth toe, and blood perfusion incompatible with cicatrization. Surgical debridements and revascularization had been followed by recurrent infections. Topic ozone, hydro-ozone therapy, bagging (gaseous mixture of O3/O2) and dressings with ozonated sunflower oil and cream were introduced as coadjuvant to the conventional therapy. The treatment showed reduction of the purulent exsudate, rapid formation of granulation tissue, reparation of a large area of the wound, and relief of pain. There was an episode of infection recurrence, which was surgically treated and resulted in similar therapeutic response. Complete healing occurred in approximately 90 days.

Keywords Ozone/therapeutic use; Wound Healing; Diabetic Foot/therapy.

A patient sought help in our emergency department with symptoms suggestive of intestinal obstruction. He was taken to the operating room and an exploratory laparotomy was performed, which revealed an abdominal abscess and intestinal perforation by ingested foreign body, a bamboo toothpick. The perforation was sutured and the abscess drained. The patient had complications in the postoperative period, with surgical site infection and suture dehiscence. The majority of ingested foreign bodies pass through the whole gastrointestinal tract without any problems, in 1% of the cases though there can be complications such as intestinal perforation. Perforations can present with many different clinical manifestations, such as obstruction, sepsis, hepatic or abdominal abscess and diagnosis is usually difficult. The general surgeon must always keep in mind this possibility in patients with atypical acute abdominal symptoms. Whenever in doubt, one should choose to operate.

Keywords Intestine, Small; Intestinal Perforation; Foreign Bodies; Abdominal Abscess; Laparotomy.

This is a case-report of a young female, adult pacient, with intermitent acute porphyria, whose initial presentation was an acute abdomen. The delayed diagnosis, after two surgical interventions, was responsible of increaded morbity. The objective of this report is to warn doctors that works in emergency centers the importance of the diferential diagnosis in the acute abdomen.

Keywords Abdomen, Acute; Diagnosis, Differential; Porphyria, Acute Intermittent.

In spite laparoscopy has been widely utilized in the management of retroperitoneals pathologies, there are still few reports of laparoscopic resections of retroperitoneals tumors. We report a case of a retroperitoneal benign Schwannoma treated by retroperitoneoscopy. The troubles on diagnostic and advantages of the retroperitoneal approach by laparoscopic way are discussed.

Keywords Retroperitoneoscopy, lumbuscopy laparoscopy, retroperitoneal tumor, Schwannoma.

A classic clinical picture of yellow nail syndrome is described in a patient 52 years old. His symptom beginning for 23 years with lymphatic edema in inferior member, occurred later to frequently infection in his leg for erysipelas. Two years later present nail gross and yellow in his hands and feet that don't get better with antifungals. For 3 years initiate the recurrent pleural effusion to right that was treaty in definitive in begin of 2004 with a pleurodesis make with iodopolvidone (PVPI). The last publication about treatment of recurrent pleural effusion utilized iodopolvidone, however don't have related in patient that have the yellow nail syndrome.

Keywords Pleural Effusion; Lymphedema; Nail Diseases; Iodine/therapeutic use.

Lesions associated with human papilomavirus (HPV), excluding intraepithelial cervical neoplasias, are more prevalent among women infected with type 1 human immunodeficiency virus (HIV-1). Despite the radical opinions favoring surgical treatment for most of these lesions, the most adequate therapeutic conduct should be planned on an individual basis.
CASE REPORT: A 25-year-old HIV-infected woman with an extensive vulvar condylomatous lesion of one year duration measuring 10 cm in its widest diameter was investigated. Exeresis of the lesion was performed by radio frequency waves surgery. Evaluation 90 days after surgery showed no signs of recurrence, and no lesions were observed in the vagina or uterine cervix. Anatomopathological examination confirmed the diagnostic hypothesis of condyloma acuminatum.
DISCUSSION: surgical treatment of condylomata in immunodepressed women is an option of choice in order to reduce the transmissibility of HPV infection and the risk of vulvar carcinoma, which is apparently increased in these patients. In addition, the aim of surgery is to eliminate symptoms, relieve the psychological burden due to the social stigma and improve the aesthetic appearance of the patient.

Keywords Condylomata Acuminata/therapy; Papillomavirus Infections/therapy; HIV-1.

This work relates a occurrence of a patient victim of a motor vehicle crash that developed signs of unilateral paralysis few hours after the trauma. At investigation a diagnosis of ischemic stroke due a right carotid artery thrombosis was made. The objective of this article is to alert about the blunt vascular trauma as a differential diagnostic of neurologic injuries.

Keywords Wounds and Injuries; Carotid Artery Injuries; Stroke; Differential Diagnosis; Hemiplegia.

We report a case of a patient 43-year-old woman with a history of cigarette smoking and use of luteinizing hormone releasing hormone (LHRH), that came to emergency with typical precordial pain. Electrocardiography evidenced inversion of T wave in DII, DIII, avF and V1 to V4 derivations, without cardiac enzymes alteration. The patient was treated as an acute coronary syndrome (ACS). Elective coronary angiography showed normal coronaries and pulmonary angiotomography evidenced pulmonary massive thromboembolism and lung infarction. Specific treatment was instituted and the patient had a good clinical evolution. The pulmonary embolism must be remembered in those patients who present in the emergency with thoracic pain as in the presented case.

Keywords Acute Coronary Syndrome; Pulmonary Embolism; Chest pain.

This study aims to report a case of a ileal carcinoid tumor, a rare and malignant condition. The authors present an carcinoid tumor case in the terminal ileum, diagnosticated by clinic, image studies and histopathologic exam, in a patient of 45 year old. The patient consulted the surgery unit complaining of midintestinal subocclusive symptoms. During the physical examination was noted a distended and painful abdomen with out peritonitis sign's. No abnormalities were found laboratory tests except for a PCR of 40 mg/ml. The patient was referred to the image unit for realization of complementary examinations (XR, ultrasonographic, TC) revealing a retention and dilation of the small bowel consequent a inflammatory inespecific cause in terminal ileum. After image studies the exploratory laparotomy and consequent ileum-right colon resection was performed. The histopathologic confirmed the diagnosis of carcinoid tumor. A correct diagnosis is rarely made before operation by radiologists or surgeons primarily because of failure to recognize this entity. It therefore is important to consider this lesion in differential diagnosis to avoid mistaken conduct.

Keywords Carcinoid Tumor; Intestine, Small; Neoplasms; Case Reports.