Introduction Extragastrointestinal stromal tumors (EGIST) are rare mesenchymal tumor lesions located outside the gastrointestinal tract. A rare compressing tumor with difficult diagnosis is reported. Presentation of the Case A male patient, 63 years old, was admitted in the emergency room complaining of stretching and continuous abdominal pain for one day. He took Hyoscine, with partial improvement of symptoms, but got worse due to hyporexia, and the abdominal pain persisted. The patient also reported early satiety and ten-pound weight loss over the last month. Discussion EGIST could be assessed by CT-guided biopsy, leading to diagnosis and proper treatment with surgical resection or Imatinib. Conclusion This case report highlights the importance of considering EGIST an important differential diagnosis of compressing upper abdominal tumors.
Conflito de interesses: NãoAbstract Introduction: Chronic kidney disease (CKD) is a worldwide public health problem because it presents a high mortality rate, mainly due to cardiovascular complications. Objective: Assess the impact on quality of life and sleep in chronic renal patients with hypertension undergoing hemodialysis and those who reported chest pain. Patients and Methods: This is a descriptive, exploratory, and cross-sectional study, which involved 46 patients with chronic kidney disease and cardiovascular disease, who reported chest pain during the hemodialysis treatment. The World Health Organization Quality of Life-BREF questionnaire was used to assess the quality of life and the Pittsburg Sleep Quality Index were applied to asses sleep quality. In order to evaluate pain, we used the McGill Pain Questionnaire and the Brief Pain Inventory. We used statistical analysis with 5% significance level to analyze data. Results: Among the patients, there were more men (67.4%), mean age of 61.9 ± 15.8 years. The most prevalent type of pain was sensitive pain (24.5%). Impairment on the sleep quality was observed. There was evidence of impairment in quality of life, showing lower scores in physical and psychological domains, and moderate pain intensity. Conclusion: Factors such as pain, sleep, and quality of life are important aspects of people with severe and disabling diseases, which undergo prolonged and painful treatments, so they should be systematically evaluated.
Context: Neurosarcoidosis is common in 50-70% of cases of sarcoidosis, but polyradiculoptia in sarcoidosis is rare in 1.3% of cases. Case Report: a 48-year- old woman diagnosed with Sarcoidosis after skin, evolved with sporadic paresthesia of the lower limbs. The use of Methotrexate controlled the disease. However, she developed acute pancreatitis secondary to the treatment and suspended it. After 2 months, the patient presented paraparesis. In view of probable polyradiculoneuropathy, Human Immunoglobulin was administered. However, she evolved with mental confusion, flaccid tetraparesis and global arreflexia. CT of skull showed paramedian bridge hypodensity and left cerebellum, suggestive of vasculitis, and normal liquor. Methylprednisolone was administered. And despite the treatment, patient worsened with decreased level of consciousness and respiratory failure. MRI of skull showed hypersignal in bilateral temporal region, suggesting viral encephalitis secondary to immunosuppression, after methylprednisolone and immunoglobulin. Thus, Aciclovir was administered and there was improvement in the use of BIPAP. Discussion: Other differential diagnoses were considered: Guillain-Barré syndrome, inflammatory and chronic demyelinating polyneuropathies, spirochete infections, fungi or toxoplasmosis. The diagnosis of neurosarcoidosis is mainly due to MRI, high sensitivity and low specificity. Neural tissue biopsy is gold standard, but difficult to access. Conclusion: This clinical history shows an atypical involvement of the Central and Peripheral Nervous System for sarcoidosis: a viral encephalitis after polyradiculopathy and vasculitis treated.
Background: Bacterial meningitis is a serious infection that occurs in the Central Nervous System, which presents important morbidity and mortality, mainly in children. The main bacterial agents causing meningitis in the community are Haemophilus influenzae, Neisseria meningitidis and Streptococcus pneumoniae. Specific signs and symptoms suggest meningitis and cerebrospinal fluid analysis is the main exam leading to diagnosis. Objectives: To analyze the behavior of cerebrospinal fluid during the evolution of the patient with bacterial meningitis. Methods: A retrospective study revised the medical records of patients with bacterial meningitis confirmed by cerebrospinal fluid examination in the Base Hospital of São José do Rio Preto from January 1996 to December 2002. Results: in the 63 Patients, there were 18 cases (28.6%) of S. pneumoniae, 20 cases (31.7%) of H. influenzae, 12 cases (19%) of N.meningitides B and 13 (20.6%) cases of N. meningitidis C. In the 18 patients with pneumococcus, 10 (55.6%) were discharged and 8 (44.4%) died. In the 20 patients with HIB, only 3 (15%) died, there was no death patients with meningococcus B and C. Conclusion: There was no difference statistics in the cerebrospinal fluid of the patients who were discharged and those who died.
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