Pancoast syndrome consists of signs and symptoms resulting from a tumor affecting the pulmonary apex and adjacent structures. The process is typically caused by a neoplasm. The majority of cases of Pancoast syndrome are caused by bronchogenic carcinoma. The most commonly found histologic subtypes are adenocarcinoma and epidermoid carcinoma. There have been very few reports of small cell lung carcinoma in the genesis of Pancoast syndrome. We describe the case of a patient with Pancoast syndrome caused by small cell lung carcinoma and discuss the aspects related to the diagnosis and treatment.

Chagas' disease carries high morbidity and mortality due to acute parasitemia or cardiac, digestive, cutaneous or neurologic chronic lesions. Latin American countries have the majority of infected or at risk people. Transplanted patients using immunosuppressive agents may develop severe and even fatal forms of the disease. The available treatment causes frequent severe side-effects. A 59 years-old woman with end stage renal disease and positive serology for Chagas` disease, but without any clinical manifestation of this pathology, underwent kidney transplantation from a cadaveric donor and displayed three months later a thigh panniculitis from which a biopsy unveiled amastigote forms of Trypanosoma cruzi. The skin lesions disappeared following treatment with benzonidazole, but the drug was discontinued due to severe pancytopenia. Along with this, infection with E. faecalis and cytomegalovirus were treated with vancomicin and ganciclovir. The patient kept very well afterwards, with no new skin lesions and with good graft function. One year and three months after the transplant, she had an emergency surgery for an aortic dissecting aneurysm. Irreversible shock and death occurred in the immediate post-surgical period. It was not possible to establish or to rule out a relationship between the trypanosomiasis and the aortic lesions. Chagas` disease must be remembered in differential diagnosis of several clinical situations in transplant patients, mainly in endemic areas. The treatment can yeld good clinical response, but serious side-effects from the drugs may ensue. More effective and better tolerated options are in need for treatment or prophylaxis.

Muromonab CD3 (murine monoclonal antibody towards the cluster of differentiation 3 antigen; OKT3) is a murine IgG 2a monoclonal antibody from the OKT series that specifically reacts with the epsilon chain of the CD3 molecular complex on the surface of circulating T lymphocytes. OKT3 can be used as a treatment for acute allograft rejection episodes and as "rescue" therapy for steroid-resistant allograft rejection [1][2][3][4][5][6][7] . OKT3 can also be used during the perioperative period as induction therapy in sequential immunosuppressive regimens. Recently, OKT3 has elicited renewed interest due to its capacity to induce immune tolerance. This aspect will probably lead to the revaluation of OKT3 role for organ transplants 1 . We report a patient who received intraoperative inductive OKT3 in renal retransplant to improve graft viability. The patient developed a very early aseptic OKT3-related meningoencephalopathy that complicated her management during the immediate postoperative period. We were unable to find in literature such early onset of meningoencephalopathy associated with use of OKT3. CASEA 26-year old female with end-stage renal failure of undefined cause was admitted for cadaveric renal retransplant. She was on hemodialysis since 1990 and underwent to an unsuccessful renal transplantation in 1993.Short before surgery hemodialysis was optimized in order to minimize CRS. Surgery started 19:00. Midazolam (15 mg) was used as anesthetic premedication. General anesthesia was induced with etomidate (0.2 mg/kg), sulfentanil (1 mg/kg) in bolus followed by atracurium (0.5 mg/kg) that was repeated every 30 minutes. She received epidural analgesia with bipuvocaine plus dimorphine. Anesthesia was maintained with O 2 /N 2 O [1:1] and isofluorane (concentration up to 1%) under controlled mechanical ventilation. Patient was monitored according with ASA recommendations. Inductive immunosuppressive therapy (sequential therapy) was applied through intravenous intraoperative use of 500 mg of methylprednisolone, followed by 5 mg OKT3 one hour later. These drugs were used before allograft perfusion. The surgery ended at about 23:00 h and all surgical and anesthetic procedures occurred without abnormalities. At about 01:15 h the patient presented fever (37.6ºC). During the next hours her body temperature ranged from 37.6 to 38.5ºC, while arterial pressure was stable, and arterial oxygen saturation ranged from 97% to100%, with O 2 administered through a Venturi mask. Since recovery from anesthesia was quite delayed, blood tests were ordered and she was admitted into the intensive care unit, where she was seen by a neurologist.Upon this first neurological evaluation she showed response only to vigorous physical stimuli. She presented nuchal rigidity and had miotic pupils, but normal oculocephalic reflexes. Generalized hypertonia was evident and deep tendon reflexes were briskly symmetrical. Bilateral Babinski's sign was present. At this time urea was 94 mg/dL, creatinine was 5.5 mg/dL, hemoglobin was 9.4 g/dL, hematocrit wa...

O transplante renal é o tratamento de escolha para pacientes com doença renal crônica terminal. Atualmente, vem aumentando a proporção de óbitos relacionados às doenças cardiovasculares nesses pacientes, as quais são as principais manifestações da doença aterosclerótica. Objetivos: avaliar a prevalência de aterosclerose carotídea em pacientes transplantados renais e em lista de espera para o procedimento no Hospital Universitário de Santa Maria por meio de ecografia de artérias carótidas e correlacionar sua presença com o escore de Framingham. Métodos: Estudo transversal, prospectivo, avaliou 59 pacientes transplantados renais e não transplantados que aguardavam em lista de espera para transplante renal do ambulatório de Transplante Renal do Hospital Universitário de Santa Maria entre janeiro de 2012 a março de 2013. Realizou-se ecografia de artérias carótidas para diagnóstico e quantificação de aterosclerose carotídea, bem como cálculo do escore de Framingham por meio das variáveis coletadas. Resultados: A prevalência de placas carotídeas foi de 59,38% nos pacientes submetidos ao transplante renal e de 70,37% naqueles em lista de espera. Não houve associação significativa entre os grupos quanto à presença de placas carotídeas (p=0,379) ou de sua gravidade (p=0,704). O grupo submetido a transplante renal esteve maior tempo em terapia dialítica (55,25 ±44,16 meses vs. 28,15 ± 36,50 meses, p=0,00079), tinha menor média de idade (45,09 ± 13,04 vs 52,48 ± 14,18 anos, p=0,042), menor número de pacientes diabéticos (9% vs 52%, p=0,00033) e menor escore de Framingham (8,72% ± 7,5 vs. 16,51% ± 11,97, p=0,002). Não houve diferença significativa entre a presença de placa carotídea e o tempo de transplante renal (p=0,399) ou tipo de esquema imunossupressor (p=0,939). Encontrou-se correlação intermediária (coef. Spearman =0,47, p=0,0065) entre o grau de Framingham e a gravidade da placa carotídea nos pacientes submetidos a transplante renal. Na análise de regressão logística para fatores associados à presença/ausência de placa carotídea, encontrou-se associação entre o Escore de Framingham e chance de placa carotídea (OR=1,104 [1,008-1,210, IC OR 95%], p=0,033). Conclusão: A doença aterosclerótica carotídea apresenta prevalência elevada na população estudada. Os fatores de risco cardiovasculares tradicionais, utilizados no escore de Framingham têm um papel importante no desenvolvimento das placas carotídeas.