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BACKGROUND: Trigeminal schwannoma is a rare type of tumor that arises from the Schwann cells of the trigeminal nerve. METHOD: We present a case of a patient with a giant V2 trigeminal schwannoma with painful swelling in the left maxilla. A complete resection using a combined open maxillectomy and endoscopic endonasal approach was performed. CONCLUSION: This case highlights the importance of a multidisciplinary approach to perform a combined open and endoscopic approach for safe resection while preserving adequate speech and swallowing.
Assuntos
Neoplasias dos Nervos Cranianos , Neurilemoma , Humanos , Neoplasias dos Nervos Cranianos/cirurgia , Neoplasias dos Nervos Cranianos/patologia , Neoplasias dos Nervos Cranianos/diagnóstico por imagem , Endoscopia/métodos , Maxila/cirurgia , Maxila/diagnóstico por imagem , Cirurgia Endoscópica por Orifício Natural/métodos , Neurilemoma/cirurgia , Neurilemoma/diagnóstico por imagem , Neurilemoma/patologia , Resultado do Tratamento , Nervo Trigêmeo/cirurgia , Nervo Trigêmeo/patologia , Doenças do Nervo Trigêmeo/cirurgia , Doenças do Nervo Trigêmeo/patologiaRESUMO
Background: Synovial sarcoma (SS) is part of soft tissue sarcomas (STS). An incidence between 5% to 10% is estimated. The origin is mesenchymal mainly affecting the extremities. Being even rarer at the chest level and vertebral body, representing around 1%. Histologically, it consists of 3 variants: monophasic, biphasic, and poorly differentiated. Surgical resection is a priority when it comes to multidisciplinary management. The prognosis of patients with SS over the years has improved markedly. Purpose: Understand and evaluate the multidisciplinary management of SS considering that the SS has a lowe prevalence and highly malignancy. Study Design: We present a case of a 31-year-old male who has a history of monophasic synovial sarcoma diagnosed in 2019 and underwent surgery. Patient came back after two years without symptoms and posterior to a control MRI we observed a local recurrence of SS. Methods: The literature was reviewed with a focus on best clinical and surgical strategy for recurrence of SS. Results: The patient recovered well with return to his normal daily activities. The review of the literature shows us the importance of the multidisciplinary management for the optimal clinical and surgical approach of SS recurrence. Conclusions: SS represents a unique variant of STS, with malignant and metastatic potential. Being a rare pathology, an adequate multidisciplinary management is essential when providing optimal care for the patient.
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Introducción: El acretismo placentario es una complicación obstétrica compleja. Según el grado de profundidad se clasifica en placenta acreta, increta y percreta, siendo esta última una presentación rara. Objetivo: Reportar la evolución clínica quirúrgica de una paciente con diagnóstico de acretismo placentario (placenta percreta) con compromiso vesical. Caso clínico: Paciente segundigesta de 28 años, con antecedente de una cesárea anterior hace aproximadamente 4 años, ingresa por consultorio externo debido a estudio ecográfico sugestivo de probable acretismo placentario con invasión vesical realizada en el tercer trimestre, motivo por el cual es hospitalizada para un mejor estudio y tratamiento. Sometida a cirugía por equipo multidisciplinario, a cesárea-histerectomía modificada, con resección parcial de vejiga y ligadura de hipogástricas, con corta estancia en Unidad de Cuidados Intensivos y hospitalización sin complicaciones urológicas posteriores. Conclusiones: La detección temprana permite una planificación preoperatoria adecuada con equipo multidisciplinario especializado, considerando la participación temprana del urólogo en la toma de decisiones(AU)
Introduction: Placental accreta is a complex obstetric complication. According to the degree of depth, it is classified into placenta accreta, increta and percreta, the latter being a rare presentation. Objective: To report the surgical clinical evolution of a patient with a diagnosis of placental accreta (placenta percreta) with bladder involvement. Clinical case report: A 28-year-old second-pregnant patient, with a history of a previous cesarean section approximately 4 years ago, was admitted to an outpatient clinic due to a probable placental accreta with bladder invasion performed in the third trimester which was suggestive in ultrasound study. She was hospitalized for better study and treatment and she underwent surgery by a multidisciplinary team. A modified cesarean section-hysterectomy, with partial bladder resection and hypogastric ligation, with a short stay in the Intensive Care Unit and hospitalization without subsequent urological complications. Conclusions: Early detection allows adequate preoperative planning with a specialized multidisciplinary team, considering the early participation of the urologist in decision-making(AU)
Assuntos
Humanos , Feminino , Placenta Acreta/cirurgia , Placenta Acreta/diagnósticoAssuntos
Doença Hepática Terminal/cirurgia , Parada Cardíaca/terapia , Hemodinâmica/fisiologia , Transplante de Fígado/métodos , Assistência Perioperatória/métodos , Embolia Pulmonar/terapia , Ressuscitação/métodos , Doença Hepática Terminal/diagnóstico , Feminino , Parada Cardíaca/etiologia , Parada Cardíaca/fisiopatologia , Humanos , Pessoa de Meia-Idade , Embolia Pulmonar/complicações , Embolia Pulmonar/diagnósticoRESUMO
OBJECTIVE: To evaluate clinical outcomes and steroid side effects in a cohort of patients with Duchenne muscular dystrophy (DMD) treated with long-term daily glucocorticoid therapy. Although daily glucocorticoid therapy has been shown to extend ambulatory function in DMD, less frequent dosing is often used because of side effect concerns. STUDY DESIGN: Retrospective study of 97 patients with DMD aged 10 to <16 years treated with daily glucocorticoid (89% on deflazacort) for a mean of 8.5 years. Outcome measures were motor, pulmonary, and cardiac function, and scoliosis. Side effects were growth failure and weight gain, facial fullness, blood pressure, bone health, cataracts, gastrointestinal symptoms, behavior, hypertrichosis, and need for medication interventions. RESULTS: For 13- to 16-year-old patients, 40% could rise from the floor and 50% could perform the 30-foot run test. Forced vital capacity for the entire cohort was well preserved. Thirteen percent of younger (10- to <13-year-old) and 21% of older patients had findings of left ventricle systolic dysfunction. Six percent (all aged 16 years) developed scoliosis (Cobb angle >20 degrees). Eighty-six percent had normal weight velocities; 30% had no increased facial fullness; 72% had short stature; and 19% had asymptomatic cataracts. Asymptomatic spine compression deformities were noted in 76% and long bone fractures in 30%. One patient stopped glucocorticoid because of behavioral concerns. CONCLUSIONS: With evidence for improved outcomes and manageable side effects, we recommend use of daily glucocorticoid therapy for patients with DMD with anticipatory management of side effects and a coordinated interdisciplinary care approach.
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Glucocorticoides/administração & dosagem , Glucocorticoides/efeitos adversos , Distrofia Muscular de Duchenne/tratamento farmacológico , Equipe de Assistência ao Paciente/organização & administração , Adolescente , Fatores Etários , Criança , Estudos de Coortes , Relação Dose-Resposta a Droga , Esquema de Medicação , Terapia por Exercício/métodos , Seguimentos , Fraturas Ósseas/induzido quimicamente , Fraturas Ósseas/fisiopatologia , Humanos , Resistência à Insulina , Assistência de Longa Duração , Masculino , Distrofia Muscular de Duchenne/diagnóstico , Distrofia Muscular de Duchenne/reabilitação , Osteoporose/induzido quimicamente , Osteoporose/fisiopatologia , Prednisona/administração & dosagem , Prednisona/efeitos adversos , Pregnenodionas/administração & dosagem , Pregnenodionas/efeitos adversos , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento , Aumento de PesoRESUMO
Inflammatory bowel disease (IBD) is a chronic, idiopathic disease characterized by inflammation of the gastrointestinal tract. It affects more than 5 million people worldwide and in Chile studies suggest that IBD incidence has increased in recent years. It is manifested by periods of remission and activity, requiring permanent pharmacological treatment. Both, the occurrence of a crisis episode and the need for lifetime medical treatment could affect the quality of life of IBD patients. Studies suggest that patients with IBD require education to develop self-management of their disease and adhere to treatment, thus reducing the risk of crisis episodes. The importance of this strategy or action is significant if we consider that studies have shown that the level of knowledge of IBD patients regarding their pathology is low. The purpose of this article is to review the effect of education on the management of IBD patients and the implications of a multidisciplinary team with an IBD specialist nurse.
La enfermedad inflamatoria Intestinal (EII) es una enfermedad crónica, idiopática, caracterizada por la inflamación del tracto gastrointestinal. Afecta a más de 5 millones de personas en el mundo y en Chile estudios sugieren que ha ido en aumento en los últimos años. Se manifiesta por períodos de remisión y actividad, siendo necesario un tratamiento farmacológico permanente. Tanto la presencia de crisis como la necesidad de un tratamiento médico de por vida, podrían afectar la calidad de vida de estos pacientes. Estudios sugieren que los pacientes con EII requieren de educación para poder desarrollar un buen autocuidado de su enfermedad, adherirse al tratamiento y disminuir así el riesgo de crisis. Esta estrategia o acción no deja de ser importante si consideramos que estudios han mostrado que el nivel de conocimiento de los pacientes con EII respecto a su patología es bajo. El propósito de este artículo es revisar el efecto de la educación en el manejo de los pacientes con EII, y las implicancias de un equipo multidisciplinario con una enfermera especialista en EII que realice el seguimiento de estos pacientes.
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Humanos , Equipe de Assistência ao Paciente , Doenças Inflamatórias Intestinais/terapia , Educação de Pacientes como Assunto/métodos , Qualidade de Vida , Doenças Inflamatórias Intestinais/enfermagem , Colite Ulcerativa/terapia , Doença de Crohn/terapia , Conhecimentos, Atitudes e Prática em Saúde , Cooperação do Paciente , Cooperação e Adesão ao TratamentoRESUMO
RESUMO JUSTIFICATIVA E OBJETIVOS: A síndrome de Ehlers-Danlos é uma doença do tecido conjuntivo que em alguns casos torna-se incapacitante. O objetivo deste estudo foi apresentar um caso raro diagnosticado no Ambulatório de Controle de Sintomas e Cuidados Paliativos com quadro doloroso importante. RELATO DO CASO: Paciente do gênero masculino, 17 anos, apresentou-se ao ambulatório com queixa de dor no corpo generalizada havia 4 anos. Referia história de hipermobilidade articular notada desde a infância. CONCLUSÃO: Neste caso realizou-se o diagnóstico de Síndrome de Ehlers-Danlos, tipo hipermobilidade, com base na história clínica e no exame físico, além dos critérios de Brighton. A adesão ao tratamento multidisciplinar mostrou impactante melhora na qualidade de vida do paciente.
ABSTRACT BACKGROUND AND OBJECTIVES: Ehlers-Danlos Syndrome is a connective tissue disease which becomes disabling in some cases. This study aimed at presenting a rare case diagnosed in the Ambulatory of Symptoms Control and Palliative Care with severe pain. CASE REPORT: Male patient, 17 years old, who came to the ambulatory complaining of widespread pain for 4 years. He referred history of joint hypermobility noticed since childhood. CONCLUSION: Based on clinical history and physical evaluation, in addition to Brighton criteria, patient was diagnosed as having hypermobility-type Ehlers-Danlos Syndrome.
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BACKGROUND AND OBJECTIVES: The prevalence of chronic pelvic pain among females is approximately 4%, similar to the prevalence of migraine (2.1%), asthma (3.7%) and low back pain (4.1%). Its diagnosis and management are major challenges for the health team. This report aimed at showing the difficulty of diagnosing and managing chronic pelvic pain and the importance of the multidisciplinary team for pain relief. CASE REPORT: Forty-five years old patient with pelviperineal pain for six years after hysteroscopy and uterine polyp excision. Severe pain, starting in the immediate postoperative period has evolved along this period without improvement, leading her to look for the Chronic Abdominal, Pelvic and Perineal Pain Outpatient Clinic of the Interdisciplinary Pain Center, Clinicas Hospital, School of Medicine, University of São Paulo. CONCLUSION: Multidisciplinary management, involving drugs, inactivation of trigger-points (anesthetic infiltration, dry needling, acupuncture), physiotherapy, postural reeducation and psychosocial support, has provided patient's significant pain relief and improved quality of life.
JUSTIFICATIVA E OBJETIVOS: A prevalência de dor pélvica crônica no sexo feminino é de aproximadamente 4%, similar à prevalência da enxaqueca (2,1%), asma (3,7%) e dor lombar (4,1%). Seu diagnóstico e tratamento constitui um grande desafio para a equipe de saúde. Este estudo teve por objetivo mostrar a dificuldade no diagnóstico e tratamento de dor pélvica crônica e a importância da equipe multidisciplinar no alívio do quadro doloroso. RELATO DO CASO: Paciente de 45 anos, com quadro de dor pelviperineal há 6 anos, após histeroscopia para exérese de pólipo uterino. A dor que iniciou no pós-operatório imediato, de forte intensidade, evoluiu ao longo desse período sem melhora e motivou-a a buscar o Ambulatório de Dor Abdominal, Pélvica e Perineal Crônica do Centro Interdisciplinar de Dor do Hospital de Clínicas da Faculdade de Medicina da Universidade de São Paulo. CONCLUSÃO: O tratamento multidisciplinar que abrangeu o uso de fármacos, inativação dos pontos-gatilho (infiltração com anestésicos, agulhamento seco, acupuntura), fisioterapia, reeducação postural e suporte psicossocial, proporcionou melhora significativa da dor e da qualidade de vida da paciente.
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Síndromes da Dor Miofascial , Dor Pélvica , Qualidade de VidaRESUMO
O termo epidermólise bolhosa descreve um grupo variado de doenças hereditárias, crônicas, não inflamatórias, epiteliais e da mucosa, que são caracterizadas por excepcional fragilidade e reduzida resistência após trauma moderado. Esta doença é classificada em forma simples, juncional ou distrófica, com pelo menos 23 subtipos, e é uma doença rara que afeta toda a população, qualquer grupo racial e igualmente homens e mulheres. OBJETIVO: os autores relatam problemas sistêmicos e bucais associados à epidermólise bolhosa, norteando atitudes clínicas multidisciplinares quando o paciente necessita de tratamento ortodôntico.
The term epidermolysis bullosa describes a varied group of hereditary, chronic, non-inflammatory diseases of the skin and mucosa, which are characterized by remarkable skin fragility and reduced resistance after moderate trauma. This disease is classified as simple, junctional or dystrophic form, with at least 23 subtypes, and is a rare disease found in all populations and racial groups, equally affecting males and females. AIM: the authors reports systemic and oral problems associated with epidermolysis bullosa, guiding the multidisciplinary clinical attitudes when the patient needs orthodontic treatment.