Is there a role of percutaneous drainage in non-parasitic splenic cysts? Case report

Pathogenesis, classification and treatment of non-parasitic splenic cysts (NPSCs) are controversial. The utility of percutaneous aspiration of the cyst is not well understood. We report a case of a 32 year-old woman with a symptomatic giant epidermoid cyst of the spleen treated with laparoscopic splenectomy. A percutaneous transcatheter drainage was performed under ultrasound guidance before surgical procedure in order to classify the type of cyst and to choose the best treatment.

Uma abordagem sobre infecções endodônticas

As infeções endodônticas envolvem a invasão e multiplicação de microrganismos na polpa dentária e tecidos periapicais sendo responsáveis por dois tipos de patologias: as patologias pulpares e as patologias periapicais. Relativamente às patologias pulpares destacam-se a pulpite reversível, a pulpite irreversível e a necrose pulpar. Quanto às patologias periapicais, destacam-se o abcesso apical agudo, o abcesso apical crónico, a periodontite apical aguda, a periodontite apical crónica, o granuloma perirradicular e o quisto perirradicular. As doenças pulpares e periapicais apresentam manifestações clínicas diferentes que, em conjunto com os sinais e sintomas manifestados pelo paciente permitem diagnosticar o tipo de infeção endodôntica. As infeções endodônticas estão associadas a uma elevada diversidade de bactérias, sendo frequentemente intituladas de infeções endodônticas polimicrobianas. Sabe-se que os microrganismos são a causa principal das doenças pulpares e periapicais e, por esse motivo, o objetivo principal do Tratamento Endodôntico consiste na eliminação dos microrganismos e prevenção da re-infeção. O tratamento das infeções endodônticas baseia-se na preparação químico-mecânica do sistema de canais radiculares – instrumentação e irrigação – seguida da obturação e culminando com a restauração definitiva ou tratamento reabilitador. Este trabalho tem como objetivos adquirir um conhecimento mais amplo relativamente aos tipos de infeções endodônticas, à realização dos diversos diagnósticos e, principalmente, às várias opções de tratamento, disponíveis na área da Endodontia. Para tal foi realizada uma pesquisa bibliográfica baseada em artigos científicos, publicados nas bases de dados PubMed, Scielo e Science Direct bem como em alguns livros relacionados com o tema.

Desvios de erupção dos caninos superiores permanentes

Os caninos superiores permanentes possuem um longo e difícil trajeto de erupção, desde a sua formação até à sua posição final de erupção. Deste modo, estão susceptíveis a desvios de erupção por fatores etiológicos genéticos, ambientais ou locais. Quando se fala em desvios de erupção, a literatura remete-nos para casos de inclusão do canino permanente. Estes problemas clínicos são muito frequentes, sendo que o diagnóstico e tratamento desses problemas necessitam de uma abordagem multidisciplinar. Sendo de enorme importância o conhecimento dos padrões de normalidade que se estabelecem nos diferentes estágios de crescimento e desenvolvimento da dentição decídua, mista e permanente para um diagnóstico adequado e, posteriormente, para o sucesso do tratamento clínico. Quando não diagnosticado ou tratado inadequadamente, podem resultar no desenvolvimento de problemas, como: más oclusões, reabsorções dos dentes adjacentes, formação cística, infecções e problemas estéticos.

Giant cell tumor of tendon sheath: study of 64 cases and review of literature

The giant cell tumor of tendon sheath (GCTTS) is the most common benign neoplasm in the hand after the ganglion cyst. Several hypotheses were formulated about the etiological factors of these tumors, but still there is not a common opinion on etiology, prognostic factors and recurrence rate. This article presents a review of literature of the last 15 years about GCTTS to assess the demographic, clinical and histological profile. We compared the information obtained from literature with our experience of 64 cases between 2000 and 2012. Our study showed similar results to those reported in literature, except for the recurrence rate: only 3 cases (4.7%) of 64 patients reported recurrence (versus about 15% on average in literature). Among the various possible factors that predispose to recurrence, it is necessary that the surgeon ensures complete excision of the tumor and removal of any residual satellite nodules. Although the marginal excision is the treatment of choice, it is often difficult to perform due to for the location and the strict adherence of the tumor to the tendon or neurovascular bundles. We used in all cases a magnifying loupe to help a careful research of satellite lesions and to respect surrounding structures.

Estimating glomerular filtration rate in acute coronary syndromes: Different equations, different mortality risk prediction

AIMS: Renal dysfunction is a powerful predictor of adverse outcomes in patients hospitalized for acute coronary syndrome. Three new glomerular filtration rate (GFR) estimating equations recently emerged, based on serum creatinine (CKD-EPIcreat), serum cystatin C (CKD-EPIcyst) or a combination of both (CKD-EPIcreat/cyst), and they are currently recommended to confirm the presence of renal dysfunction. Our aim was to analyse the predictive value of these new estimated GFR (eGFR) equations regarding mid-term mortality in patients with acute coronary syndrome, and compare them with the traditional Modification of Diet in Renal Disease (MDRD-4) formula. METHODS AND RESULTS: 801 patients admitted for acute coronary syndrome (age 67.3±13.3 years, 68.5% male) and followed for 23.6±9.8 months were included. For each equation, patient risk stratification was performed based on eGFR values: high-risk group (eGFR<60ml/min per 1.73m2) and low-risk group (eGFR⩾60ml/min per 1.73m2). The predictive performances of these equations were compared using area under each receiver operating characteristic curves (AUCs). Overall risk stratification improvement was assessed by the net reclassification improvement index. The incidence of the primary endpoint was 18.1%. The CKD-EPIcyst equation had the highest overall discriminate performance regarding mid-term mortality (AUC 0.782±0.20) and outperformed all other equations (ρ<0.001 in all comparisons). When compared with the MDRD-4 formula, the CKD-EPIcyst equation accurately reclassified a significant percentage of patients into more appropriate risk categories (net reclassification improvement index of 11.9% (p=0.003)). The CKD-EPIcyst equation added prognostic power to the Global Registry of Acute Coronary Events (GRACE) score in the prediction of mid-term mortality. CONCLUSION: The CKD-EPIcyst equation provides a novel and improved method for assessing the mid-term mortality risk in patients admitted for acute coronary syndrome, outperforming the most widely used formula (MDRD-4), and improving the predictive value of the GRACE score. These results reinforce the added value of cystatin C as a risk marker in these patients.

Cystic echinococcosis therapy: Albendazole-loaded lipid nanocapsules enhance the oral bioavailability and efficacy in experimentally infected mice

International audience

Dor abdominal em adolescente

Doente do sexo feminino de 16 anos de idade, recorreu ao serviço de urgência por dor abdominal com duas semanas de evolução localizada à fossa ilíaca esquerda (FIE) associada a obstipação. Negava atividade sexual, referindo último cataménio três semanas antes. Apresentava palpação abdominal dolo- rosa na FIE, sem defesa ou sinais de irritação peritoneal. Estudo analítico inicial e exame sumário de urina normais. Ecografia abdomino-pélvica revelou quisto complexo na região anexial esquerda e ascite de médio volume. Foi doseada a hormona gonadotrofina coriónica sérica que foi positiva (2608 mUI/mL). A ecografia transvaginal revelou quisto simples com área adjacente de aspeto reticular, não evidenciando qualquer imagem de saco gestacional intrauterino. Foi submetida a laparotomia exploradora, constatando-se hemoperitoneu e gravidez ectópica tubar esquerda e efetuada salpingectomia esquerda. Os autores pretendem alertar para uma causa rara de dor abdominal na adolescência, que deverá ser considerada de for- ma a evitar um desfecho potencialmente fatal.

É simples o que faço com os quistos simples do ovário

É cada vez mais frequente o diagnóstico de quisto do ovário pelo uso crescente de exames radiológicos. É essencial a distinção entre quisto simples e quisto complexo, pois a sua abordagem é diferente, sendo o algoritmo de abordagem adaptado à mulher pré- ou pós-menopáusica [1]. A recomendação inicial a seguir varia em função do tamanho da lesão e do valor do CA 125.

Algoritmo de abordagem das lesões anexiais indeterminadas na ecografia

O esclarecimento do órgão de origem, ou principalmente da natureza benigna ou maligna de um tumor anexial ecograficamente indeterminado surge com frequência na prática clínica e obriga a uma investigação complementar da sua natureza de modo a evitar cirurgias inúteis, sem deixar de diagnosticar precocemente a patologia maligna. Neste trabalho apresentamos um algoritmo de diagnóstico por Ressonância Magnética (RM), que recentemente foi proposto pela European Society of Urogenital Radiology (ESUR), o qual permite um diagnóstico preciso dos casos indeterminados à ecografia e uma intervenção responsável na abordagem clínica destas doentes.

Evaluation of faecal sampling methods for the analysis of Giardia sp. in companion animals

Dissertação de Mestrado Integrado em Medicina Veterinária

Outcome of Multi-Cystic Dysplastic Kidneys in Children

Background: Renal cystic diseases are important causes of chronic kidney disease (CKD). Objectives: We report the pattern of renal cystic disease in children and evaluate the outcome of children with multicystic dysplastic kidney (MCDK). Patients and Methods: Retrospective study of all children with cystic kidney diseases at King Abdulaziz University hospital from 2006 to 2014. Results: Total of 55 children (30 males); 25 MCDK, 22 polycystic kidney diseases (PKD), 4 nephronophthises and 4 renal cysts. Consanguinity was positive in 96.2%. MCDK and simple renal cyst patients had good renal function while PKD and nephronophthisis developed renal impairment. Most MCKD were diagnosed ante-natally, 16 of them were followed up for 3.4 (1.97) year. Their last creatinine was 33.9 (13.5) umol/L. MCDK was spontaneously involuted at mean age of 2.6 (1.3) years in 56%. Conclusions: MCDK is the commonest cystic renal disease and diagnosed ante-natally in the majority of cases. It has a good prognosis.

Unraveling Sarcocystis miescheriana and Sarcocystis suihominis infections in wild boar

Sarcocystis species are worldwide spread cyst-forming protozoa that can infect wild boar but little is known about the prevalence of these parasites. In this study we assessed the prevalence of Sarcocystis spp. infections in wild boars from northeastern Portugal, for which novel PCR testing assays targeting Sarcocystis genus, S. miescheriana and S. suihominis were implemented, and risk factors potentially associated with these infections were evaluated. Samples from muscle tissue, namely diaphragm (n = 102), oesophagus (n = 96) and heart (n = 101), were collected from a total of 103 wild boar hunted between October 2011 and February 2012. Diaphragm muscle was used for the PCR detection of Sarcocystis nucleic acids since a higher proportion of samples showed the presence of cysts during histological examination. PCR assay targeting Sarcocystis genus yielded a 73.8% infection rate, which indicate a high level of exposure to these protozoan parasites among wild boars. These samples showed to be positive with the S. miescheriana-specific PCR assay and no sample was positive with the S. suihominis-specific assay, suggesting that a single species infecting wild boar is circulating in Portugal. These results were confirmed by the partial sequencing of the 18S rRNA gene amplified from selected samples from different geographic regions. Adults, young adults and female wild boars were found to be more likely infected. Hunters have an important role in the life cycle of S. miescheriana since potentially infected viscera and carcasses can be left behind promoting the protozoan dissemination to the scavenging final hosts. If hunting dogs bite and ingest infected meat they can perpetuate the life cycle of Sarcocystis spp. spreading oocysts or sporocysts in the environment.