Intracranial teratoma corresponds to a type of germ cell tumor (GCT) of the central nervous system which is characterized by the presence of tissues derived from the germinal layers, which may have hair and adipose tissue inside, for example. The literature on the subject is scarce, and the T2 magnetic resonance imaging (MRI) pattern commonly found is that of a heterogeneously hyperintense mass and, after contrast, teratoma presents heterogeneous enhancement. Therefore, the present case report aims to present atypical results of a GCT in a young adult woman. Data analysis and compilation were performed from medical records, as well as the neuroimaging study. Thus, the present case report demonstrates neuroimaging findings with homogeneous postcontrast enhancement in an adult patient, with an unusual age profile when compared with most of the studies published so far. This demonstrates that it is possible to have atypical neuroimaging findings for mature teratomas and that they can behave in a less aggressive way, not requiring adjuvant postoperative therapies.
Introdução: A paracoccidioidomicose é uma doença sistêmica causada por fungos do gênero Paraccocidioides spp., sendo a micose profunda mais predominante da América Latina. O envolvimento do sistema nervoso central ocorre em 10-27% dos casos e apresenta difícil diagnóstico, necessitando de exames complementares de imagem e histopatológicos para confirmação diagnóstica. Objetivo: Relatar caso raro de neuroparacoccidioidomicose, destacando os achados nos exames de imagem, anatomopatológico e tratamento. Metodologia: Paciente do sexo feminino, 30 anos, que após atendimento inicial, observação das manifestações clínicas e de neuroimagem, houve hipótese diagnóstica sugestiva de pseudotumor intracraniano. Todos os dados foram descritos e interpretados com base nas informações contidas do prontuário da paciente, exames de neuroimagem e laudo anatomopatológico. Resultado: Foi observada a confirmação diagnóstica de neuroparacoccidioidomicose em mulher jovem, a qual inicialmente teve hipótese diagnóstica para tumor intracraniano. As descrições do relato de caso aqui apresentadas são atípicas, visto que, as características ocupacionais e perfil etário da paciente não a colocavam como grupo de risco para tal condição. Conclusão: O relato de caso de neuroparacoccidioidomicose foi considerado atípico devido aos biomarcadores associados, sendo aqui descrita a discussão sobre a construção diagnóstica.
Abstract:Objectives: To quantify the frequency of incidental hepatocellular carcinoma (iHCC) and evaluate the reasons for liver transplantation in the study population and the accuracy of imaging tests in diagnosing hepatocellular carcinoma (HCC) in a liver transplant referral center. Methods: Retrospective sectional study conducted based on 426 medical records of patients who underwent liver transplantation at the Hospital Santa Isabel in Blumenau (SC), between January 2016 and December 2019. The pathology reports of the explanted livers, the evolution of the patients, and the reports of the imaging exams performed up to six months before the transplant were evaluated. Patients under 18 years of age, history of retransplantation, fulminant liver failure, metabolic liver disease, autoimmune hepatitis, and other etiologies of liver failure with a lower risk of developing HCC were excluded. Results: Of the 426 transplant patients, 89 were excluded. Among those included, 190 (56.38%) were transplanted for cirrhosis without previously diagnosed HCC and 147 (43.62%) for previously diagnosed HCC. The frequency of iHCC was 7.89% (15/190). Hepatitis C virus was more frequent among patients with previously diagnosed HCC than among those with iHCC (p = 0.033). Magnetic resonance imaging (MRI) was the most sensitive and least specific test (S = 100%; E = 75.76%). Computed tomography (CT) showed high sensitivity and specificity (S = 93.75%; E = 90%), while ultrasonography showed low sensitivity and high specificity (S = 56.76%; E = 97.86%). Conclusion: This study found similar data to the international literature regarding the frequency of iHCC. Ultrasonography was the least sensitive test, while CT and MRI showed higher sensitivity than seen in the literature. The MRI showed lower specificity than most of the references analyzed.
Resumen:Objetivos: Cuantificar la frecuencia del carcinoma hepatocelular incidental (CHCi) y evaluar las razones del trasplante hepático en la población estudiada y la exactitud de los exámenes de imagen en el diagnóstico de carcinoma hepatocelular (CHC) en el centro de referencia del trasplante hepático. Métodos: Estudio retrospectivo seccional realizado a partir de 426 registros médicos de pacientes sometidos a trasplante hepático en el Hospital Santa Isabel de Blumenau (SC) entre enero de 2016 y diciembre de 2019. Se evaluaron los resultados de los exámenes anatomopatológicos de los hígados explotados, la evolución de los pacientes y los resultados de los exámenes de imagen realizados hasta seis meses antes del trasplante. Se excluyeron los pacientes menores de 18 años de edad, antecedentes de retrasplante, insuficiencia hepática fulminante, enfermedad hepática metabólica, hepatitis autoinmune y otras etiologías de insuficiencia hepática con menor riesgo de desarrollo de ICC. Resultados: De los 426 pacientes sometidos a trasplante, se excluyeron 89. De los incluidos, 190 (56,38%) fueron trasplantados por cirrosis pre-diagnosticada sin CHC y 147 (43,62%) por CHC pre-diagnosticada. La frecuencia CHCi fue de 7,89% (15/190). El virus de la hepatitis C fue más frecuente entre los pacientes con CHC con enfermedad prediagnosticada que entre los pacientes con CHCi (p=0,033). La RM fue el examen más sensible y menos específico (S=100%; E=75,76%). La tomografía computarizada mostró alta sensibilidad y especificidad (S=93,75%; E=90%), mientras que la ultrasonido, baja sensibilidad y alta especificidad (S=56,76%; E=97,86%). Conclusión: Este estudio encontró datos similares de la literatura internacional sobre frecuencia CHCi. La ecografía fue el examen menos sensible, mientras que la tomografía computarizada y la resonancia magnética mostraron una mayor sensibilidad que la observada en la literatura. La resonancia magnética mostró una menor especificidad que la mayoría de las referencias analizadas.
Objetivos: Quantificar a frequência do carcinoma hepatocelular incidental (CHCi) e avaliar os motivos para transplante de fígado na população estudada e a acurácia dos exames de imagem no diagnóstico de carcinoma hepatocelular (CHC) em centro de referência de transplantes hepáticos. Métodos: Estudo seccional retrospectivo realizado com base em 426 prontuários de pacientes que foram submetidos a transplante de fígado no Hospital Santa Isabel de Blumenau (SC), entre janeiro de 2016 e dezembro de 2019. Foram avaliados os laudos dos exames anatomopatológicos dos fígados explantados, a evolução dos pacientes e os laudos dos exames de imagem feitos até seis meses antes do transplante. Excluíram-se os pacientes com menos de 18 anos, história de retransplante, insuficiência hepática fulminante, doença hepática metabólica, hepatite autoimune e outras etiologias de insuficiência hepática com menor risco de desenvolvimento de CHC. Resultados: Dos 426 pacientes transplantados, 89 foram excluídos. Entre os incluídos, 190 (56,38%) foram transplantados por cirrose sem CHC previamente diagnosticado e 147 (43,62%) por CHC previamente diagnosticado. A frequência de CHCi foi de 7,89% (15/190). O vírus da hepatite C foi mais frequente entre os pacientes com CHC previamente diagnosticado do que entre aqueles com CHCi (p=0,033). A ressonância magnética foi o exame mais sensível e menos específico (S=100%; E=75,76%). A tomografia computadorizada apresentou alta sensibilidade e especificidade (S=93,75%; E=90%), enquanto a ultrassonografia, baixa sensibilidade e alta especificidade (S=56,76%; E=97,86%). Conclusão: Este estudo encontrou dados semelhantes aos da literatura internacional quanto à frequência de CHCi. Ultrassonografia foi o exame menos sensível, enquanto a tomografia computadorizada e a ressonância magnética apresentaram sensibilidade mais elevada do que a vista na literatura. A ressonância magnética demonstrou especificidade menor que a da maioria das referências analisadas.
Chronic Obstructive Pulmonary Disease (COPD) and asthma are common respiratory diseases, but with complicated definitions. Spacers are devices used for the administration of inhaled medications, aiming to reduce the need for synchronization by the patient, allowing him/her to breathe normally during the administration of the medication. However, due to high cost and low availability, the use of commercial spacers is hampered in developing countries, such as Brazil. To solve this problem, several forms of homemade spacers have been developed. This project aims to expand knowledge on the main lung diseases seen in primary health care and their interventions based on the latest evidence and outpatient therapeutic updates, including the use of home-made inhaler devices. The aim is to promote adherence to inhalation treatment and improve patients' quality of life. The rationale for this project is that the use of spacers facilitates adherence to inhaled medication treatment for asthma and COPD, as well as for patients who have both conditions. The project aims to provide spacers for all patients who use this type of medication, respecting the principles of universality, equity and equality of the Unified Health System. The method used was an intervention project carried out in the health strategy from 05/25/2021 to 07/02/2021. Homemade spacers were manufactured using 500mL PET bottles, both in the adult and pediatric models. The spacers were distributed along with user manuals and guidance on the importance of asthma treatment. Users were randomly selected using a search for patients using the medications salbutamol spray and beclomethasone spray. The results of the project were positive, with the spacers being made and delivered within the stipulated time. This contributed to a better administration of inhalation drugs, enabling a better control of the diseases analyzed and optimizing the treatment of users. In conclusion, the method of administration of inhaled drugs using a spacer reduces oral deposition and optimizes the inhalation of particles of adequate size. There was a good response from users and adherence to treatment with the offer of homemade spacers, in addition to a correlation between the improvement of the profiles of users served in the ESF.
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