No abstract

INTRODUÇÃO: A pneumonia associada à ventilação mecânica é a infecção hospitalar mais comum nas unidades de terapia intensiva. OBJETIVO: Determinar o impacto da multirresistência dos microorganismos na morbidade e mortalidade dos pacientes com pneumonia associada à ventilação mecânica. MÉTODO: Estudo de coorte retrospectivo. Em 40 meses consecutivos, 91 pacientes sob ventilação mecânica tiveram o diagnóstico de pneumonia. Os casos foram divididos entre causados por microorganismo multirresistente e causados por microorganismo sensível à antibioticoterapia. RESULTADOS: Pneumonia foi causada por microorganismo multirresistente em 75 casos (82,4%) e por microorganismo sensível 16 (17,6%) deles. As características clínicas e epidemiológicas não foram estatisticamente diferentes entre os grupos. O Staphylococcus aureus foi responsável por 27,5% dos episódios de pneumonia associada à ventilação mecânica e a Pseudomonas aeruginosa por 17,6%. A doença foi de início recente em 33 pacientes (36,3%) e de início tardio em 58 deles (63,7%). Os tempos de ventilação mecânica, de internação em unidade de terapia intensiva e de internação hospitalar total não diferiram. O tratamento empírico foi considerado inadequado em 42 pacientes com pneumonia por microorganismo multirresistente (56%) e em 4 com pneumonia por microorganismo sensível (25%) (p = 0,02). Óbito ocorreu em 46 pacientes com a pneumonia por microorganismo multirresistente (61,3%), e em 4 daqueles com pneumonia por microorganismo sensível (25%) (p = 0,008). CONCLUSÃO: A multirresistência bacteriana não determinou nenhum impacto na morbidade, mas esteve associada à maior mortalidade.

Myofibroblastoma (MFB) is a rare mesenchymal tumor arising in breast's soft tissue with a great variety of microscopic features that can be mistaken with a wide variety of biphasic lesions. The authors report a rare case of myofibroblastoma of the breast arising in a mammary hamartoma (MH), present a review of the clinicopathological features of these lesions, and make some diagnostic considerations. The tumour consisted of a well-circumscribed nodule. MFB component comprised about fifty percent of the lesion and was made up of bipolar spindle cells arranged in fascicular clusters separated by bands of hyalinized collagen. There were fat cells and several residual hamartoma glands intermingled and distorted in MFB area. MFB component was positive for Desmin, CD34, bcl-2, and Calponin. To the best of our knowledge, MFB has not been reported in MH, neither has any of the reports described mammary glands joined within MFB.

OBJETIVO: Este estudo de casos do Rio Grande do Sul, Brasil, propõe-se a traçar um perfil local da sarcoidose, descrevendo as características dos pacientes, apresentação clínica, função pulmonar, achados radiológicos, histopatológicos e exames bioquímicos de uma série de casos, por ocasião do diagnóstico. MÉTODOS: Estudo retrospectivo de 92 pacientes com sarcoidose, atendidos no Pavilhão Pereira Filho, da Santa Casa de Porto Alegre (RS), entre 1990 e 2003. O protocolo incluiu dados clínicos, bioquímicos, radiológicos, espirométricos e de biópsia. RESULTADOS: Não houve diferença de freqüência entre homens e mulheres (42% e 58%, respectivamente). A média de idade foi de 41,8 ± 14,1 anos, situando-se 87% dos pacientes entre 20 e 60 anos. Houve predomínio em caucasianos (84%). Dados sobre tabagismo mostraram que 61% dos pacientes nunca fumaram, 29% eram ex-fumantes, e 10% ainda fumavam. O diagnóstico foi feito principalmente no inverno (33%). Dentre os dados clínicos destacaram-se: 12% eram assintomáticos, 18% tinham somente sintomas torácicos, 22% somente manifestações extratorácicas, e 48% apresentaram combinação de sintomas torácicos e extratorácicos. A espirometria foi realizada em 79% dos pacientes, no momento do diagnóstico, com resultados anormais em 45% deles, com os seguintes padrões: restritivo em 23%, obstrutivo em 18%, e misto em 4% deles. A distribuição dos tipos radiológicos mostrou 30% tipo I, 48% tipo II e 22% tipo III. CONCLUSÃO: Os achados desta série mostraram-se semelhantes aos descritos na literatura, particularmente na européia.

BACKGROUNDAppendicitis is defi ned as an infl ammation of the inner lining of the vermiform appendix which spreads to its other parts. Acute appendicitis is the most frequent cause of emergency abdominal surgery worldwide, 1 with its peak during the second and third decades of life. 2 Nearly 7.0% of individuals will undergo appendectomy during their lives. 3 4 Obstruction of the appendix has less commonly been associated with bacteria, foreign material, tumours and parasites. Many different types of parasites can be found in the appendicular lumen. Of these, Enterobius vermicularis (pinworms/threadworms) is the most commonly found and Strongyloides stercoralis 2 3 5 is a very unusual fi nding. CASE PRESENTATIONA 29-year-old Caucasian HIV-positive female presented in emergency with a history of intermittent fever, fl ank rebound pain and abdominal pain in the right iliac fossa. The pain was dull and spasmodic in character; it was not associated with nausea, vomiting, dysuria or diarrhoea. In addition, elected progressive weight loss (15 kg) and anorexia were found in recent months. On examination, the patient was febrile (39.5ºC) and haemodynamically stable. On palpation of the abdomen, there was fl atness, with involuntary muscle contraction, tenderness and positive Blumberg's sign.

No abstract

The high consumption of sugars is linked to the intermediate hyperglycemia and impaired glucose tolerance associated with obesity, inducing the prediabetes.However, the consequences of excessive invert sugar intake on glucose metabolism and genomic stability were poorly studied. The aim of this study was to evaluate the effects of invert sugar overload (32%) in rats, analyzing changes in obesity, glucose tolerance, pancreatic/hepatic histology and primary and permanent DNA damage. After 17 weeks, the rats became obese and had an excessive abdominal fat, as well as presented impaired glucose tolerance, caused by higher sugar caloric intake. Primary DNA damage, evaluated by the comet assay, was increased in the blood, however not in the pancreas.No protein carbonylation was seen in serum. Moreover, no increase in permanent DNA damage was seen in the bone marrow, evaluated using the micronucleus test. Some rats presented liver steatosis and that the pancreatic islets were enlarged, but not signifi cantly. In this study, invert sugar altered the glucose metabolism and induced primary DNA damage in blood, but did not cause signifi cant damage to the pancreas or liver, and neither changes in the levels of oxidative stress or permanent DNA damage.

Abdominal angiostrongyliasis (AA) is a disease caused by Angiostrongylus costaricensis, a nematode that can infect humans accidentally through the ingestion of larvae. Worms live inside intestinal small vessels and can lead to gastrointestinal symptoms and bowel necrosis in otherwise healthy patients. Therefore, abdominal angiostrongyliasis may be important in the differential diagnosis with systemic vasculitides and other rheumatic diseases with vascular involvement. We report a case of abdominal angiostrongyliasis in an 18-year-old woman presenting with necrosis of the terminal ileum.