RESUMO
BACKGROUND: Dysphagia is a rare complication of esophageal webs. OBJECTIVE: To describe a patient with dystrophic epidermolysis bullosa who developed dysphagia produced by an esophageal web that simulated carcinoma. CASE REPORT: A 26 year-old male with dystrophic epidermolysis bullosa developed severe dysphagia and subsequently aphagia secondary to an upper third esophageal obstruction. A (CT) scan showed a circumferential esophageal wall thickening of the affected area. The patient was submitted to surgical neck exploration with endoscopic assistance to identify the obstruction and a esophagotomy was carried on detecting a complete esophageal web that was excised. CONCLUSIONS: Esophageal web must be considered a cause of esophageal obstruction in patients with dystrophic epidermolysis bullosa.
Assuntos
Epidermólise Bolhosa Distrófica/complicações , Estenose Esofágica/etiologia , Adulto , Diagnóstico Diferencial , Neoplasias Esofágicas/diagnóstico , Estenose Esofágica/diagnóstico , Humanos , MasculinoRESUMO
La epidermólisis bulosa distrófica (EBD) es una patología cutánea, que frecuentemente se asocia a la presencia de cánceres epidermoides cutáneos de conducta agresiva. El tratamiento quirúrgico constituye la principal modalidad de tratamiento, debido a la presencia de metástasis en forma temprana, debe consolidarse con quimioterapia o radioterapia. El uso de estas modalidades se dificulta, debido a la patología cutánea de base. Se presenta el manejo con inmunoterapia utilizando una mezcla de citocinas naturales (IRX-2), en un paciente de 27 años con cáncer epidermoide de lengua recurrente, metastásico a cuello, en quien, por sus condiciones generales, no fue posible administrar otras modalidades terapéuticas. El uso de inmunoterapia indujo una respuesta objetiva parcial y paliación sintomática sin toxicidad. El uso de este tratamiento pudiera ser considerado como manejo paliativo en pacientes con cáncer epidermoide (CE) asociado a EBD.
Assuntos
Humanos , Masculino , Adulto , Epidermólise Bolhosa Distrófica/diagnóstico , Epidermólise Bolhosa Distrófica/terapia , Imunoterapia , Neoplasias da Língua , Ciclofosfamida , CitocinasRESUMO
BACKGROUND: Intrahepatic extraductal biliary collections are a rare complication of abdominal trauma. OBJECTIVE: To describe two patients with diagnosis of posttraumatic intrahepatic extraductal biliary collections. CASE REPORT: Two male patients suffered multiple severe injuries, one of them from blunt trauma and the other from penetrating trauma; their main clinical manifestations were fever and jaundice. CT scan was the best suited diagnostic tool for evidencing the intrahepatic collections. Both patients underwent surgical drainage, only one of them had a satisfactory evolution. CONCLUSIONS: Posttraumatic intrahepatic extraductal biliary collections are a rare complication of abdominal trauma, its presence should be suspected in patients with hepatic trauma showing jaundice, fever and/or right upper quadrant pain between the second and sixth week following abdominal trauma.
Assuntos
Bile , Sistema Biliar/lesões , Fígado/lesões , Ferimentos não Penetrantes , Ferimentos Penetrantes , Adulto , Sistema Biliar/diagnóstico por imagem , Colangiopancreatografia Retrógrada Endoscópica , Drenagem , Humanos , Fígado/diagnóstico por imagem , Masculino , Radiografia Abdominal , Tomografia Computadorizada por Raios XRESUMO
The effects of either chronic or acute estrogenic treatment on the "in vitro" vasomotor responses to phenylephrine (10(-9)-10(-5) M) and to carbachol (10(-9)-10(-5) M) of aortic rings excised from ovariectomized rats were analyzed. Chronic estrogenic treatment consisted in a single subcutaneous dose of 1 mumol estradiol 17-stearate. Effects of acute estrogenic treatment were evaluated by recording the responses of aortic rings excised from untreated ovariectomized rats both before and after the addition of 17 beta-estradiol to the superfusing solutions. In order to identify the endothelium-dependent responses each experiment was performed simultaneously on pairs of rings from the same aorta, one with and the other without functional endothelium. The contractile responses to phenylephrine of endothelium-intact vessels were attenuated by chronic estrogenic treatment; this attenuation was further increased by preincubation of the vessels with indomethacin and was reverted by N omega-nitro-L-arginine methyl ester. Either chronic or acute estrogenic treatment enhanced the carbachol-induced endothelium dependent relaxation of phenylephrine-precontracted rings. The results may be explained by assuming that estrogens increase the basal release of both nitric oxide and a cyclooxygenase-dependent vasoconstricting prostanoid as well as the receptor-mediated release of nitric oxide from the endothelium of the rat aorta.