Despite the contributions to the diagnosis and treatment of cancer, the disease continues to present an adverse effect on patients' quality of life, with pain being a frequent complaint, with a prevalence varying from 50 to 53% in cancer patients at all stages and up to 70 % in cases of advanced disease. Cancer pain ismanifested by the primary site of cancer, metastasis, bone involvement, proximity to the nervous system, production of pain-promoting chemicals, and patient-related factors such as anxiety and depression. Because it is subjective, not palpable, and an individual experience and difficult to evaluate, requires for the health team educational support, knowledge and instruments that contribute to their understanding, being the elucidation of its biological mechanisms object of this literature review.
Tuberculosis, despite all the research and technological inputs developed in recent years, remains one of the most frequent causes of pleural effusion, especially in developing countries such as Brazil. In immunocompetent individuals, pleural tuberculosis is the most common form of extrapulmonary tuberculosis. The diagnosis of this form of the disease continues to be the detection of Mycobacterium tuberculosis in pleural fluid, or in pleural biopsy samples, either by microscopy and / or culture, and the histological existence of granulomas in the pleura, a valid instrument for the determination of the disease , although the agent is not isolated. We present in this paper the report of a male patient, 76 years old, referred to the Public General Hospital of Palmas (HGPP) in december 2018, with clinic suggestive of Tuberculosis and absence of isolation of M. tuberculosis in a classical research – acid fast bacilli (AFB) and cultures. The visualization of the granulomatous reaction in the pleura, in association with the clinic, proved to be safe for establishing the diagnosis and conduct. Keywords: tuberculosis; pleural tuberculosis; Mycobacterium tuberculosis; tuberculosis diagnosis. RESUMO A tuberculose, apesar de todas as pesquisas e insumos tecnológicos desenvolvidos nos últimos anos, continua sendo uma das causas mais frequentes de derrame pleural, especialmente em países em desenvolvimento como o Brasil. Em indivíduos imunocompetentes, a tuberculose pleural é a forma mais comum de tuberculose extrapulmonar. O diagnóstico desta forma da doença continua sendo a detecção de Mycobacterium tuberculosis em líquido pleural, ou em amostras de biópsia pleural, seja por microscopia e / ou cultura, tendo-se demonstrado a existência histológica de granulomas na pleura, instrumento válido para determinação da doença, ainda que não isolado o agente. Apresentamos neste trabalho o relato de um paciente, masculino, 76 anos, encaminhado ao Hospital Geral Público de Palmas (HGPP) em dezembro de 2018, com clínica sugestiva de Tuberculose e ausência de isolamento de M. tuberculosis em algoritmo clássico de investigação – pesquisa de bacilo álcool- ácido resistente (BAAR) e culturas. A visualização de reação granulomatosa em pleura, em associação com a clínica, se revelou segura para estabelecimento do diagnóstico e conduta. Palavras-chave: tuberculose; tuberculose pleural; Mycobacterium tuberculosis; diagnóstico de tuberculose.
Fournier's Gangrene is a rapidly evolving polymicrobial necrotizing fasciitis of the perineal, perianal, and genital region, extending to the thigh root, abdominal wall and retroperitoneum, which rarely affects women and children, with an overall incidence rate of 1,6 cases per 100,000 men / year and a peak incidence after the age of 50. Incomplete hygiene, exacerbated skin folds, mechanical trauma, prolonged catheterization and invasive procedures, as well as comorbidities such as diabetes mellitus, smoking, obesity, chronic alcoholism, hypertension, immunosuppression, HIV, cancer patients, and chronic diseases are factors that predispose to the appearance of the lesion.The objective of the study is to report the case of a female patient, 43 years old, without comorbidities, with a picture of Fournier's gangrene in the perineal region and genitalia, accompanied by the General Surgery Service of the General Public Hospital of Palmas - TO, and submitted to colostomy in a descending loop as a protective measure of choice for the spread of the infection to the abdominal cavity, interrupting the progression of the disease.
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