RESUMEN
A síndrome de arlequim é uma rara desordem autonômica que se caracteriza por anidrose e falta de rubor unilateral da face, podendo acometer as regiões cervical e torácica. De forma paradoxal, há rubor e sudorese compensatórios no lado contralateral à alteração. É idiopática na maioria dos casos, mas pode ser congênita, secundária a lesões estruturais e à iatrogenia pós-cirúrgica. O tratamento é direcionado ao fator causal. Descreve-se caso de paciente com diagnóstico de síndrome de arlequim idiopática, sendo realizada aplicação de toxina botulínica na hemiface acometida pelos sintomas compensatórios com boa resposta terapêutica
Harlequin syndrome is a rare autonomic disorder characterized by anhidrosis and lack of unilateral flushing of the face, which may affect the cervical and thoracic regions. Paradoxically, there is compensatory flushing and sweating on the contralateral side to the alteration. It is idiopathic in most cases, but it can be congenital or secondary to structural or post-surgical iatrogenic lesions. Treatment is directed at the causative factor. We describe the case of a patient with a diagnosis of idiopathic Harlequin Syndrome with botulinum toxin application in the hemiface affected by compensatory symptoms with good therapeutic response.
RESUMEN
ABSTRACT Introduction: The incidence of gastrointestinal disorders among patients with chronic kidney disease (CKD) is high, despite the lack of a good correlation between endoscopic findings and symptoms. Many services thus perform upper gastrointestinal (UGI) endoscopy on kidney transplant candidates. Objectives: This study aims to describe the alterations seen on the upper endoscopies of 96 kidney-transplant candidates seen from 2014 to 2015. Methods: Ninety-six CKD patients underwent upper endoscopic examination as part of the preparation to receive kidney grafts. The data collected from the patients' medical records were charted on Microsoft Office Excel 2016 and presented descriptively. Mean values, medians, interquartile ranges and 95% confidence intervals of the clinic and epidemiological variables were calculated. Possible associations between endoscopic findings and infection by H. pylori were studied. Results: Males accounted for 54.17% of the 96 patients included in the study. Median age and time on dialysis were 50 years and 50 months, respectively. The most frequent upper endoscopy finding was enanthematous pangastritis (57.30%), followed by erosive esophagitis (30.20%). Gastric intestinal metaplasia and peptic ulcer were found in 8.33% and 7.30% of the patients, respectively. H. pylori tests were positive in 49 patients, and H. pylori infection was correlated only with non-erosive esophagitis (P = 0.046). Conclusion: Abnormal upper endoscopy findings were detected in all studied patients. This study suggested that upper endoscopy is a valid procedure for kidney transplant candidates. However, prospective studies are needed to shed more light on this matter.
RESUMO Introdução: A incidência de doenças gastrointestinais altas em pacientes com doença renal crônica é elevada, porém não há boa correlação entre achados endoscópicos e sintomas. Assim, muitos serviços preconizam a realização de Endoscopia Digestiva Alta (EDA) nos candidatos a transplante renal. Objetivos: Descrever alterações endoscópicas presentes em 96 candidatos a transplante renal no período de 2014 a 2015. Métodos: Noventa e seis pacientes renais crônicos submetidos à EDA como preparo para transplante renal. Prontuários médicos dos pacientes foram revisados, os dados tabulados no programa Microsoft Office Excel 2016 e apresentados de maneira descritiva. Calculou-se média, mediana, intervalo interquartílico e intervalo de confiança de 95% das variáveis utilizadas. Alterações endoscópicas foram apresentadas quanto ao número, intervalo de confiança e valor de P, e correlacionadas com a presença ou ausência de infecção por Helicobacter pylori. Resultados: Dos 96 pacientes, 54,17% eram homens e 45,83% mulheres. As medianas de idade e tempo em diálise foram 50 anos e 50 meses, respectivamente. O achado mais comum na EDA foi pangastrite enantematosa (57,30%), seguida de esofagite erosiva (30,20%). Metaplasia intestinal gástrica e úlcera péptica foram encontradas em 8,33% e 7,30% dos pacientes, respectivamente. Pesquisa para H. pylori foi positiva em 49 pacientes, e somente houve correlação entre infecção por H. pylori e esofagite não erosiva (P = 0,046). Conclusão: Afecções gastrointestinais foram detectadas em todos os pacientes estudados. Os achados deste estudo sugerem que a realização de EDA em candidatos a receber transplante renal é desejável. Entretanto, estudos prospectivos são necessários para responder a esta questão.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Gastropatías/etiología , Enfermedades Duodenales/etiología , Enfermedades del Esófago/etiología , Insuficiencia Renal Crónica/complicaciones , Gastropatías/diagnóstico , Estudios Transversales , Endoscopía Gastrointestinal , Trasplante de Riñón , Enfermedades Duodenales/diagnóstico , Enfermedades del Esófago/diagnóstico , Insuficiencia Renal Crónica/cirugíaRESUMEN
INTRODUCTION: The incidence of gastrointestinal disorders among patients with chronic kidney disease (CKD) is high, despite the lack of a good correlation between endoscopic findings and symptoms. Many services thus perform upper gastrointestinal (UGI) endoscopy on kidney transplant candidates. OBJECTIVES: This study aims to describe the alterations seen on the upper endoscopies of 96 kidney-transplant candidates seen from 2014 to 2015. METHODS: Ninety-six CKD patients underwent upper endoscopic examination as part of the preparation to receive kidney grafts. The data collected from the patients' medical records were charted on Microsoft Office Excel 2016 and presented descriptively. Mean values, medians, interquartile ranges and 95% confidence intervals of the clinic and epidemiological variables were calculated. Possible associations between endoscopic findings and infection by H. pylori were studied. RESULTS: Males accounted for 54.17% of the 96 patients included in the study. Median age and time on dialysis were 50 years and 50 months, respectively. The most frequent upper endoscopy finding was enanthematous pangastritis (57.30%), followed by erosive esophagitis (30.20%). Gastric intestinal metaplasia and peptic ulcer were found in 8.33% and 7.30% of the patients, respectively. H. pylori tests were positive in 49 patients, and H. pylori infection was correlated only with non-erosive esophagitis (P = 0.046). CONCLUSION: Abnormal upper endoscopy findings were detected in all studied patients. This study suggested that upper endoscopy is a valid procedure for kidney transplant candidates. However, prospective studies are needed to shed more light on this matter.