Septic pelvic thrombophlebitis (SPT) is a rare and severe entity, which may occur after abortion, delivery, gynecological diseases, or surgeries. Diagnosis is challenging when no risk factor is clearly present, since clinically, symptoms are non-specific. Nowadays, with the aid of imaging methods, diagnosis has become more achievable, but the treatment still bears some uncertainties. The authors present a fatal case of SPT in a young woman who sought medical care already presenting signs of septic shock, referring fever and non-characteristic abdominal pain. The patient evolved rapidly to multiple organ failure and respiratory distress, which was also due to septic pulmonary embolism. The autopsy confirmed the computed tomographic findings of a right ovarian vein septic thrombophlebitis and multiple septic pulmonary embolization foci. The patient did not present any of the recognized risk factors; neither did she present signs of pelvic inflammatory disease on admission or at autopsy. However, an intrauterine device was present. The authors call attention to this entity in the differential diagnosis of a woman with fever and abdominal pain, as well as for an empiric broad-spectrum antibiotic regimen in these cases.

BACKGROUND: Carotid intima-media thickness (CIMT), as measured by ultrasound, has been used in large studies as a non-invasive marker for subclinical atherosclerosis. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) is a cohort of 15,105 civil servants in six Brazilian cities that included CIMT evaluation in its baseline assessment. The aim of the present narrative review was to provide an overview of ELSA-Brasil CIMT articles published up to July 31, 2017. DESIGN AND SETTING: Narrative review of ELSA-Brasil CIMT studies using baseline assessment data. METHODS: We searched PubMed for the terms “ELSA-Brasil” and “intima-media”. This search yielded 21 published articles using CIMT data from the ELSA-Brasil baseline assessment, which were included in this review. We also present information about intima-media thickness assessment from ongoing onsite reevaluations of the study participants. RESULTS: Most published studies focused on the association with traditional and novel cardiovascular risk factors. Studies also presented information about the ELSA-Brasil CIMT protocol at baseline and CIMT value distribution in this large sample. CONCLUSIONS: Analyses on the ELSA-Brasil data led to important insights on CIMT interpretation and physiology. Besides the highlighted contributions which have already been made in this field, new data gathered during the ongoing third onsite assessment will enable investigation of substantially new research questions.

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The Achilles tendon xanthoma is a rare disease and has a high association with primary hyperlipidemia. An early diagnosis is essential to start treatment and change the disease course. Imaging exams can enhance diagnosis. This study reports the case of a 60-year-old man having painless nodules on his elbows and Achilles tendons without typical gout crisis, followed in the microcrystalline disease clinic of Unifesp for diagnostic workup. Laboratory tests obtained showed dyslipidemia. The ultrasound (US) showed a diffuse Achilles tendon thickening with hypoechoic areas. Magnetic resonance imaging (MRI) showed a diffuse tendon thickening with intermediate signal areas, and a reticulate pattern within. Imaging studies showed relevant aspects to diagnose a xanthoma, thus helping in the differential diagnosis.

Agradeço a Deus pelo dom da vida Ao meu orientador professor Dr Paulo Lotufo, pela oportunidade, inspiração e grande aprendizado. O professor Lotufo nos mostra que podemos ser melhores a cada dia. Ao professor Dr. Itamar Souza Santos, pelo apoio, incentivo, orientações e amizade.A professora Dra. Isabela Bensenor e professor Dr Márcio Sommer, por toda orientação e disponibilidade. Ao professor Dr Cláudio Campi, pelo incentivo e exemplo de profissionalismo.A toda equipe do ELSA-Brasil, centro São Paulo, pelo profissionalismo e apoio.Aos colegas e amigos do HU-USP por todo incentivo e companheirismo.Aos meus pais, sogra, avó, irmãos, tios, cunhados, cunhadas e sobrinhos por todo amor e apoio. Agradecimento especial ao meu irmão Dr Pedro, grande incentivador de toda a vida, além apoio na coleta e discussão de dados. Aos meus filhos Davi(in memoriam), João e André e minha esposa Clarissa. Vocês são o meu maior amor, minha maior inspiração e fonte de incentivo. Meu eterno agradecimento a todos que contribuíram nesse trabalho , diretamente ou indiretamente. EPÍGRAFE " O otimismo é a fé em ação. Nada se pode levar a efeito sem otimismo." Helen Adams Keller, ativista social norte-americana.