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Achenbach's syndrome describes the sudden occurrence of bruising, pain and swelling of one or more digits of the hand involving the volar aspect of the proximal and middle phalanges. Also known as the paroxysmal finger hematoma, it presents in dramatic fashion, sometimes with a prodrome of tingling, itching or numbness but despite its dramatic presentation, all investigations are normal. Routine blood investigations, as well as coagulation and thrombophilia screens are all negative as are vascular imaging and echocardiography. The diagnosis is solely clinical. Due to the nature of its presentation, almost all patients are referred for an urgent vascular consultation but the condition resolves spontaneously usually within 2-3 days, although the discoloration may persist for longer. Its appearance usually leads clinicians to start anticoagulation in the belief that it may progress but, in fact, it settles as quickly as it appears. Though there are episodic cases which recur years later, it is generally self-resolving with no complications nor residual morbidity. Although the etiology was previously unknown, there is now a recognized genetic link. Genes related to the acute phase reactive proteins and the coagulation and complement cascades appear to be linked to Achenbach's syndrome. This evidence may explain why only certain individuals seem prone to this acutely painful, bruising disorder. We review this interesting disorder and compare patients from the tropical Caribbean region with similar cases from the temperate United Kingdom and discuss whether there are climatic variations in presentations.
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Dedos/irrigação sanguínea , Hematoma/etiologia , Diagnóstico Diferencial , Traumatismos dos Dedos/complicações , Hematoma/diagnóstico por imagem , Hematoma/genética , Hematoma/patologia , Humanos , Dor , Recidiva , SíndromeRESUMO
Objetivo: describir y analizar los casos de siringomielia por malformación de Chiari tipo 1 con resolución espontánea. Método: se buscó en Pubmed bajo las palabras clave malformación de Chiari tipo 1, siringomielia y resolución espontánea todos los casos relacionados. Se registraron las características poblacionales de cada caso, evolución y mecanismos propuestos. Resultados: En la población adulta se encontraron 22 casos (edad media: 35,81) y en la población pediátrica se encontraron 37 casos (edad media: 9,82). Las hipótesis sobre los mecanismos que produjeron la resolución espontánea fueron: cambios en la posición de las amígdalas relacionadas con la edad, atrofia del cerebelo, fisura medular, reducción del esfuerzo físico, variaciones de la presión intraespinal, crecimiento del cráneo y disminución de la presión intracraneana. Conclusión: La resolución espontánea es posible en pocos casos. Si bien este hecho invita a realizar controles periódicos y evitar la cirugía, la espera conlleva riesgos ante la posibilidad de un agravamiento agudo o de que surjan secuelas permanentes. La información disponible hoy en día no permite predecir con seguridad la evolución de cada caso
Objective: describe and analyze the cases of syringomyelia caused by Chiari type 1 malformation with spontaneous resolution. Method: we searched in Pubmed with the key words Chiari malformation type 1, syringomyelia and spontaneous resolution all related cases. The population characteristics of each case were recorded along with its outcome and proposed mechanisms. Results: in the adult population there were 22 cases (medium age: 35.81) and in the pediatric population there were 37 cases (medium age: 9.82). The hypothesis about the mechanisms that produce the spontaneous resolution were: changes in tonsils position related to age, cerebellar atrophy, cord fissures, reduction of physical effort, variations in intraspinal pressure, skull growth and decrease in intracranial pressure. Conclusion: the spontaneous resolution of syringomyelia invites to carry out regular check-ups and avoid surgery. However, waiting carries risks with the possibility of acute worsening or permanent sequelae. The information available today does not allow to predict with certainty the evolution of each case.
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Malformação de Arnold-Chiari , Siringomielia , Fossa Craniana PosteriorRESUMO
Keratoacanthoma (KA) is a common and distinctive cutaneous neoplasm that behaves in a benign fashion, displaying rapid growth followed by spontaneous involution. Clinical and histological examinations are essential to confirm this diagnosis, although differentiating KA from squamous cell carcinoma is often difficult. In general, complete surgical excision is a standard of care for solitary KAs; however, the conservative approach could be considered in some selected situations. We present the case of a 59-year-old female patient who presented with a KA, on a high-risk area, displaying self-involution after undergoing a biopsy. This is one of the few cases in the literature in which spontaneous resolution process was photographically documented with good cosmetic results.
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Choroidal masses can be of varying etiologies including tumors of benign, primary, and metastatic nature. Herein, we report on 3 cases of well-documented solitary choroidal masses associated with exudative retinal detachments of unclear etiology (despite extensive workup) that resolved spontaneously.
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BACKGROUND: Chronic subdural hematomas (CSDHs) usually occur late in adults and older after mild head trauma. Surgical intervention is the first treatment option in CSDH with conservative management being adopted in few cases. CASE DESCRIPTION: We report a case of a 71-year-old man who presented a spontaneous resolution of a large CSDH. He presented with a difficulty of speech and an ataxic gait. Head (computed tomography scan) showed a low-density lesion located in the right frontal-temporal-parietal region. CONCLUSION: In this report, we discuss the spontaneous resolution of a large CSDH in elderly patients, without surgical intervention. Gradually, several successful nonsurgical therapies for the treatment of these hematomas are reported, although further studies are essential to establish the role of these nonsurgical treatments of CSDHs.
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We show here that the phenomenon of spontaneous resolution of enanti-omers occurs during the crystallization of the sodium and rubidium double salts of the transition metal complex tris-(oxalato)ferrate(III), namely sodium penta-rubidium bis-[tris-(oxalato)ferrate(III)], NaRb5[Fe(C2O4)3]2. One enanti-omer of the salt crystallizes in the cubic space group P4332 with Z = 4 and a Flack absolute structure parameter x = -0.01â (1) and its chiral counterpart in the space group P4132 with x = -0.00â (1). All metal ions are at crystallographic special positions: the iron(III) ion is on a threefold axis, coordinated by three oxalate dianions in a propeller-like conformation. One of the two independent rubidium ions is on a twofold axis in an eightfold coordination with neighbouring oxalate oxygen atoms, and the other one on a threefold axis in a sixfold RbO6 coordination. The sodium ion is at a site of D3 point group symmetry in a trigonal-anti-prismatic NaO6 coordination.
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RESUMEN La atelectasia maxilar crónica (AMC) es una condición adquirida y rara que consiste en la disminución persistente y progresiva del volumen del seno maxilar, con retracción centrípeta de sus paredes secundaria a la oclusión completa de tipo valvular del ostium natural. Esta condición genera presión negativa dentro del seno maxilar, conduciendo a atelectasia y colapso de la pared. La fisiopatología es compartida con síndrome de seno silente, por lo que se postula que se podrían englobar a ambas dentro de la misma enfermedad. Presentamos el caso de un paciente con diagnóstico de AMC bilateral por tomografía axial computarizada a la edad de 3 años, que se resolvió en forma espontánea en forma bilateral; el maxilar derecho a los 6 años y el izquierdo a los 10 años.
ABSTRACT Chronic maxillary atelectasis (CMA) is a rare and developed condition that consists in the progressive and persistent decrease volume of the maxillary sinus, with centripetal retraction of the walls secondary to the complete occlusion of the natural ostium. This condition generates negative pressure inside the maxillary sinus, heading to atelectasis and collapse of the walls. It is proposed that the disease includes the silent sinus syndrome, as the physiopathology is shared between them. We present the case of a 3 years old boy with bilateral chronic maxillary atelectasis observed in the CT scan, who evolved with spontaneous bilateral resolution. The right maxillary sinus CMA resolved at 6 years old, and the left at 10 years old.
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Humanos , Masculino , Pré-Escolar , Doenças dos Seios Paranasais/fisiopatologia , Doenças dos Seios Paranasais/diagnóstico por imagem , Seio Maxilar/fisiopatologia , Seio Maxilar/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Doença CrônicaRESUMO
Introducción. la alergia a la leche de vaca (aplv) es un problema sanitario global. Su diagnóstico adecuado y su seguimiento son esenciales ya que la leche de vaca es un alimento importante en la dieta de muchos lactantes. los desafíos orales doble ciego controlados por placebo (ddcpc) son la herramienta ideal para el diagnóstico y seguimiento de las alergias alimentarias. este estudio describe las características evolutivas de pacientes con aplv y las posibles variables que la pudieran modificar. material y métodos. Se estudiaron pacientes con diagnóstico de aplv previo con desafíos abiertos. Se catalogaron las reacciones de acuerdo a la normativa dracma. positivas fueron las pruebas en las que se presentaron alteraciones clínicas o variaciones hemodinámicas. negativas fueron aquellas en las que el paciente toleró la leche. Se consideraron edades de inicio y de realización del ddcpc, sexo y patología de aplv. resultados. Se estudiaron 106 pacientes (50 masculinos, 56 femeninos), promedio edad de inicio de síntomas 5,31 m (rango: 1-48 meses) y al procedimiento 23,14 m (5 meses - 5 años), y 13 pruebas positivas. un conjunto se refirió al mecanismo fisiopatológico y se dividió en ige mediadas (n=55) con 8 pruebas positivas y mixtas/celulares (n=51) con 5 pruebas positivas. otro conjunto fueron no gastrointestinales (n=61) con 7 pruebas positivas y gastrointestinales (n=45) con 6 pruebas positivas. todos los grupos fueron similares en cuanto a las variables demográficas. el sexo masculino y el diagnóstico de anafilaxia fueron factores de riesgo para no resolver su aplv (p=0,0125 y p=0,002 respectivamente). conclusiones. el momento de resolución de la aplv es independiente del mecanismo fisiopatológico subyacente o la edad de inicio de los síntomas. en general resuelven el problema de manera espontánea hacia los dos años de vida en más de un 87% de los casos. el sexo masculino (en ige mediadas) y el antecedente de anafilaxia podrían ser factores de riesgo para tener menos probabilidades de resolver la APLV. (AU)
Introduction: cow´s milk allergy (cma) is a global health issue. a proper diagnosis and follow up become essential. double blind placebo controlled challenges (dbpcc) is the gold standard for this purpose. this paper describes clinical evolution and characteristics of cma, as well as variables that may modify the affection course. methods & material: a group of patients, with a previous diagnosis of cma by open challenges, has been studied and its results cataloged according to dracma guidelines. tests with hemodynamic changes or clinical symptoms were considered as positives, while those with no clinical reaction were considered as negatives. variables involved were: age of symptoms starting, age of dbpcc performing, gender and cma clinical manifestations. results: 106 patients has been studied (50 male, 56 female), with a median age of 5,31 mo (range 5 48 mo) at the starting symptoms, and a median age of 23,14 mo (range 5 mo 5 y) at the performing of dbpcc. 13 tests were negative. as regards to the different immune mechanisms, 55 were ige dependent (8 negative), and 51 were mediated by mixed/cellular (5 negative). patients were divided into two groups: with gastrointestinal symptoms (n=45) and with no gastrointestinal symptoms (n=61). they showed 6 and 7 negative results, respectively. all groups were similar. male gender, and anaphylaxis diagnosis turned out to be risk factors not to resolve cma (p=0,0125 and p=0,002 respectively). conclusions: cma resolution is independent of the immune mechanisms involved or the age of its symptoms starting. cma is solved spontaneously towards the age of two in 87% of the cases. male gender, and anaphylaxis may become risk factors not to resolve cma.(AU)
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Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Hipersensibilidade a Leite , Substitutos do Leite Humano , Proteínas do Leite , Imunoglobulina E , Anafilaxia , Mucosa IntestinalRESUMO
Non-immune hydrops fetalis (NIHF) is a symptom caused by a heterogeneous group of conditions. Diagnostic investigations may constitute a real challenge. This study aimed to evaluate prospectively and systematically a series of NIHF cases using a research protocol expanded for studying inborn errors of metabolism (IEM) during 2 years-2010 and 2011. We also reviewed the frequency of IEM among the NIHF reported in literature. A clinical or etiopathogenic diagnosis was reached in 46 (86.8%) of the 53 studied cases. The main diagnostic groups were chromosomal anomalies (28.3%), syndromic (18.9%), isolated cardiovascular anomaly (7.5%) and congenital infection (7.5%). Metabolic causes were found in 5.7%, all lysosomal storage disorders (LSD). In seven (13.2%), no diagnosis was found in part because of incomplete evaluation. The hydrops was identified prenatally in 90.5% of cases. In 5.7% a spontaneous and complete resolution of the hydrops occurred during pregnancy. Overall mortality was 75.5%. The IEM frequency in the present study (5.7%) was higher than that usually reported. We suggest performing studies directed to IEMs if the more common causes are excluded.
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Transtornos Cromossômicos/genética , Hidropisia Fetal/diagnóstico , Hidropisia Fetal/genética , Doenças por Armazenamento dos Lisossomos/genética , Adulto , Aberrações Cromossômicas , Transtornos Cromossômicos/complicações , Transtornos Cromossômicos/diagnóstico , Feminino , Humanos , Hidropisia Fetal/mortalidade , Hidropisia Fetal/fisiopatologia , Recém-Nascido , Doenças por Armazenamento dos Lisossomos/diagnóstico , Doenças por Armazenamento dos Lisossomos/fisiopatologia , Masculino , Erros Inatos do Metabolismo/diagnóstico , Erros Inatos do Metabolismo/genética , GravidezRESUMO
We report a case of injury of the medial bucket handle meniscal tears (BH), which resolved spontaneously, in association with anterior cruciate ligament (ACL) injury. The patient twisted his left knee during a fight in martial arts, progressing to pain and joint locking and a sense of distortion. In NMR it could be seen bucket-handle tear of the medial meniscus with displacement of the fragment to the intercondylar region, rupture of the lateral meniscus and ACL tear. After conservative treatment and physiotherapy, in an interval of one year, later examinations showed that there was spontaneous healing of AB.
Neste trabalho é relatado um caso de lesão do menisco medial do tipo em alça de balde (AB), que se resolveu espontaneamente, em associação com lesão de ligamento cruzado anterior (LCA). O paciente torceu o joelho esquerdo durante uma luta em artes maciais, evoluindo com dor e bloqueio articular e sensação de falseamento. Na RMN havia rotura em alça de balde do menisco medial com deslocamento do fragmento para a região intercondilar, rotura do menisco lateral e rotura do LCA. Após tratamento clínico e fisioterápico, em um intervalo de um ano, o exame de controle demonstrou que havia ocorrido resolução espontânea da AB.
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Humanos , Masculino , Adolescente , Traumatismos em Atletas , Ligamento Cruzado Anterior/lesões , Traumatismos do Joelho/reabilitação , Traumatismos do Joelho/terapia , EsportesRESUMO
We report a case of injury of the medial bucket handle meniscal tears (BH), which resolved spontaneously, in association with anterior cruciate ligament (ACL) injury. The patient twisted his left knee during a fight in martial arts, progressing to pain and joint locking and a sense of distortion. In NMR it could be seen bucket-handle tear of the medial meniscus with displacement of the fragment to the intercondylar region, rupture of the lateral meniscus and ACL tear. After conservative treatment and physiotherapy, in an interval of one year, later examinations showed that there was spontaneous healing of AB.
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Patients with unspecific acute abdominal pain and patients with nonspecific acute abdominal pain and no conclusive physical examination for appendicitis are usually kept under medical control. In our Emergency Department, some pediatricians and surgeons have added a second ultrasound (US) examination to clinical follow-up in patients with low suspicion of appendicitis and discordant or no conclusive initial findings. The objective of this study was to evaluate the role of a second US scan in medical or surgical treatment. We retrospectively evaluated medical records (from november 2006 to June 2008) of 1.959 patients with a history of acute abdominal pain referred for abdominal US examination. Fifty-four patients, 22 males and 32 females aged between 3 and 14 years, received clinical indication for a second US study during that period. US monitoring was performed between 5 to 36 hours after the first examination. Patient history details, ultrasonographic characterization of cecal appendix, and clinical evolution were registered. Ten patients had progressive inflammatory appendicular changes. All of them underwent surgery and appendicitis was confirmed in eight cases (80 percent). Ten patients showed no changes on the second US scan; 40 percent of patients underwent surgery with biopsies confirming lymphoid hyperplasia (2), and congestive changes (2). Fifteen patients had a second US study that showed regression of inflammatory changes; all of them received medical treatment. In 19 patients, comparison was not feasible since appendixes appeared normal on US examination, or due to insufficient visualization of appendix. Our results suggest that ultrasound follow-up promotes adequate decision-making when facing surgical or medical treatment options for pediatric patients presenting with abdominal pain with initial clinical and imaging findings inconclusive for acute appendicitis.
Pacientes con dolor abdominal no específico o examen físico no concluyente para apendicitis aguda son usualmente mantenidos en control médico. En nuestro Sevicio de Urgencia algunos pediatras y cirujanos agregan una ultrasonografía (US) de control en la evolución de cuadros no concluyentes. El objetivo de este trabajo fue evaluar el rol de este segundo US en la toma de decisiones médicas o quirúrgicas. Para esto evaluamos retrospectivamente las fichas de 1959 pacientes referidos del Servicio de Urgencia para US abdominal con historia de dolor abdominal entre noviembre del 2006 y junio del 2008. Cincuenta y cuatro pacientes, 22 niños y 32 niñas entre 3 y 14 años recibieron durante ese período indicación de un segundo US. Estos exámenes fueron realizados entre 5 y 36 horas luego del primer estudio ultrasonográfico. Se registraron datos relacionados a la historia, caracterización ultrasongráfica del apéndice y evolución clínica. Diez pacientes tuvieron cambios inflamatorios progresivos. Todos fueron a cirugía y la apendicitis fue confirmada en ocho casos (80 por ciento). Diez pacientes tuvieron cambios inflamatorios que no se modificaron en el segundo US; 40 por ciento fue a cirugía con biopsias que demostraron hiperplasia linfoide (2) y cambios congestivos (2). Quince pacientes mostraron regresión de los cambios inflamatorios en el segundo US; todos recibieron tratamiento médico. En 19 pacientes la comparación no fue posible, por tratarse de apéndices ecográficamente normales o debido a insuficiente visualización del apéndice. Nuestros resultados sugieren que el seguimiento ecográfico ayuda en la decisión de tratamiento médico o quirúrgico en pacientes que se presentan con dolor abdominal cuyos hallazgos clínicos e imaginológicos iniciales no son concluyentes de apendicitis aguda.
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Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Apendicite , Dor Abdominal/etiologia , Apendicectomia , Apendicite/cirurgia , Apendicite/complicações , Dor Abdominal/diagnóstico , Estudos Retrospectivos , Seguimentos , Remissão Espontânea , Serviços Médicos de Emergência , Técnicas de Apoio para a DecisãoRESUMO
Sporotrichosis is the most common deep mycosis in Latin America. The zoonotic transmission from cats has been demonstrated over the last few decades in many countries. A forty year-old veterinarian examined a cat with multiple ulcerations, which mycological examination isolated Sporothrix schenckii. During the examination, she was bitten in the right index finger by the animal. Two weeks later, an inflammatory lesion appeared, which became ulcerated and was followed by ascendant lymphangitis. The diagnoses of lymphocutaneous sporotrichosis and of a six weeks pregnancy were established. The lesions were not treated and by the 28th week the ulceration healed and the abscesses showed involution. This case illustrates that non-life-threatening forms of sporotrichosis during pregnancy could be treated with systemic antifungals after delivery.
Esporotricose é a micose profunda mais comum na América Latina. Sua transmissão zoonótica a partir de gatos foi documentada nos últimos anos em vários países. Médica veterinária foi mordida por um gato, que apresentava múltiplas ulcerações, das quais foi isolado Sporothrix schenckii . Duas semanas depois surgiu lesão inflamatória e após uma ulceração no dedo mordido, seguida de linfangite ascendente. Esporotricose linfocutânea e de gravidez foram então diagnosticados. As lesões não foram tratadas e na 28ª semana de gravidez a ulceração cicatrizou e os abcessos sofreram involução. Esse caso demonstra que formas menos graves de esporotricose poderiam ser tratadas com antifúngicos sistêmicos depois do parto.