During a diagnostic investigation in a 40-year-old male with pericardial effusion associated with hypothyroidism, cholesterol pericarditis was detected. We report a brief review on the etiopathogeny, clinical findings, and therapeutical possibilities of this entity.Pericardial diseases have diverse causes, which determine the different types of morphological involvement. A rare but specific entity is cholesterol pericarditis. This term is used in cases of chronic pericardial effusion with the presence of cholesterol crystals or an elevated concentration of cholesterol, or both 1 . Cases associated with systemic diseases, such as tuberculosis, rheumatoid arthritis, and hypothyroidism have been reported, as have idiopathic cases.The objective of this study was to report a case of cholesterol pericarditis and review the medical literature. Case ReportThe patient is a 40-year-old male from the city of Recife, in the Brazilian state of Pernambuco, who was referred to the Instituto do Coração with a diagnosis of pericardial effusion of unknown etiology. The patient reported that 6 months prior to hospital admission he began to feel progressively tired on exertion, and also noted edema in the lower limbs and enlargement of the abdominal volume. A chest Xray depicted an enlarged cardiac silhouette. An electrocardiogram showed low-voltage QRS complexes. An echocardiogram revealed a significant pericardial effusion with no signs of restriction. The laboratory test results were as follows: total cholesterol of 322mg/dL; triglycerides of 386mg/ dL; antinuclear factor, LE cells, and rheumatoid factor were negative. Measurements of thyroid hormones were as follows: T3 = 0.2 ng/mL (0.8-2.0); T4 = 1.2 µg/dL (4.5-12.5); and TSH >47 µIU/mL (0.3-4.5). The diagnostic hypothesis of pericardial effusion secondary to hypothyroidism was established and treatment with 50 µg of levothyroxine (Puran T4®) per day was started. As the patient remained clinically symptomatic in NYHA functional class IV, we decided to perform a pericardial drainage via video pericardioscopy on 9/5/98. An anterior pericardiotomy was performed, and 2000 mL of pericardial fluid of a gold-yellow color were withdrawn. Microscopic examination revealed the presence of multinucleated giant cells compatible with a chronic inflammatory process. The search for neoplastic cells, bacteria, and fungi was negative. Results of the biochemical analysis of the pericardial fluid were as follows: amylase, 65; cholesterol, 63 (normal up to 70mg/dL); glucose, 83mg/dL; triglycerides, 10mg/dL; total protein, 7.1; albumin, 5; and lactic dehydrogenase, 218 U/L. The anatomicopathological study revealed mild fibrosis, lymphocytic and plasmacytic infiltrate, and proliferation of capillary vessels. The material adhered to the pericardium consisted of a large amount of xanthomatous macrophages ( fig. 1) and foreign body giant cells engulfing cholesterol crystals ( fig. 2). Deposits of intracytoplasmic hemosiderin in the macrophages were also found. On the basis of these findings, the diagno...

The true incidence of dysembryoplastic neuroepithelial tumor (DNT) is unknown. Variable estimations have been advanced according to the type of recruitment of patients. In series of patients with tumors who were operated on for pharmacoresistant epilepsy, the rates varied widely, from 5% to 87%. Among 600 pediatric tumors in a series, 9 DNT (1.5%) were found. Since DNT was identified only in 1988, we reviewed our cases (1975-1991) of gangliogliomas (n = 25), oligoastrocytomas (n = 9), temporal oligodendrogliomas (n = 11), temporal astrocytomas grade II (OMS 1993) (n = 44) irrespective to age, as well as all astrocytomas grade II (n = 61) and oligodendrogliomas (n = 10) in patients up to 20 years of age. Seven DNT were encountered. Four cases had been formerly diagnosed as gangliogliomas and 3 as astrocytomas grade II. From 1992 on, 4 more DNT were diagnosed, making up a total of 11 cases. Eight patients were under age 17 (6 y to 17 y, mean 10.3 y) and 3 were 27, 42 and 51 year-old. Eight tumors were temporal, 1 frontal and 2 occipital. All patients have had pharmacoresistant epilepsy. Among all neuroepithelial tumors diagnosed in our Division in the last 22 years, DNT comprises 1.2% in patients under age 20 (n = 660), 0.24% in patients over 20 years (n = 1254), and 0.63% all ages considered (n = 1914).

Introdução -O câncer é doença crônica não transmissível multifatorial e no rol dos seus fatores de risco estão aqueles relacionados ao trabalho. A radiação ionizante é considerada carcinogênica e está presente em alguns ambientes de trabalho. Vários estudos foram feitos no mundo no intuito de estudar a relação sobre a mortalidade e a incidência por câncer em trabalhadores com risco de exposição ocupacional à radiação ionizante. Objetivo -Este estudo visa estimar as taxas de mortalidade e de incidência por câncer em uma unidade de trabalho com radiação ionizante sediada no município de São Paulo e identificar a associação potencial entre câncer e exposição à radiação ionizante no ambiente de trabalho. Métodos -Foi feito estudo de coorte retrospectiva aberta com trabalhadores que tiveram vínculo empregatício desde 31/08/1956 até 31/12/2016 a partir de dados coletados na empresa e em registros oficiais de óbitos e casos novos. Foram calculadas as razões de mortalidade padronizadas (RMP) e as razões de incidência padronizadas (RIP) por sexo de cânceres agrupados segundo o tipo (sólido, indeterminado e hematopoiético), o fator de risco (etilismo, tabagismo, ocupacional e radiação gama e X) e o sistema orgânico (tratos digestório, respiratório, ossos e tecidos moles, pele, geniturinário, olhos e sistema nervoso central, endócrino, indeterminado e hematopoiético) na análise externa comparando a população de estudo com a população geral do município de São Paulo e na análise interna, comparando o subgrupo monitorado para radiação gama e X com o subgrupo não monitorado. Foram feitas análises de regressão de Poisson univariada e múltipla dos fatores associados à incidência de câncer.