1194 research outputs found
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Parotidites Recorrentes como apresentação do Síndrome de Sjögren
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Massas Cervicais em Idade Pediátrica: um Desafio Diagnóstico
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Gaining competence in needle-knife fistulotomy - can I begin on my own?
Get PDFBACKGROUND:
While there are guidelines for appropriate training in ERCP, these are non-existent for needle-knife precut. The aim of this study was: (1) evaluate the experience curve of three endoscopists in needle-knife fistulotomy (NKF); (2) propose a minimum number of NKF procedures to attest proficiency.
METHODS:
Between November 1997 and March 2011, the first 120 consecutive NKF performed by three endoscopists (A, B, and C) were selected (360 patients) from three centers. Each group of 120 patients was chronologically ordered into three subgroups of 40. The main outcomes were: NKF use, NKF success, and post-ERCP adverse events.
RESULTS:
The need for NKF did not decrease over time. The NKF success rate in the first attempt for endoscopist A and C in each of the three subgroups was 85 %/85 %, 87.5 %/87.5 %, and 87.5 %/90 %, respectively. Furthermore, both demonstrated a high NKF success in their initial 20 NKFs (85 % and 80 %, respectively). Endoscopist B however presented a different pattern as the success rate initiated at 60 %, then rose to 82.5 % and 85 % for the last group (P = 0.03). Adverse events were mild (28 of the 32 occurrences) with no clear reduction with increased experience.
CONCLUSIONS:
A skillful endoscopist may expect to master NKF easily with few adverse events. While some endoscopists could begin on their own because of their innate skills, a minimal training is needed for all, as we cannot predict skills in advance. We propose a minimum of 20 NKF precuts to attest a trainee's competence in this procedure
Temporal Bone Meningoencephalic Herniation
Get PDFIntrodução: As herniações meningoencefálicas do osso temporal correspondem à presença de parênquima encefálico e/ou meninges prolapsados através de um defeito ósseo temporal. Trata-se de uma condição rara, podendo ter consequências catastróficas para o paciente.
Descrição de Caso: Doente de 69 anos, sexo feminino, com antecedentes pessoais de otite média crónica, submetida a cirurgia otológica, hipertensão arterial e neoplasia da mama. Admitida no serviço de urgência por convulsões tónico-clónico generalizadas secundárias a meningoencefalite com ponto de partida em foco infecioso otológico. A investigação imagiológica revelou a presença de uma herniação meningoencefálica, que foi corrigida cirurgicamente por equipa multidisciplinar de Otorrinolaringologia e Neurocirurgia.
Discussão/Conclusões: O tratamento cirúrgico tem por objetivo a remoção de tecidos meningoencefálicos herniados, reparação do defeito ósseo e recuperação da audição. O tamanho e localização do defeito ósseo e da herniação meningoencefálica são fatores decisivos na escolha da via de abordagem cirúrgica
Abordagem terapêutica e taxas de remissão na acromegalia – um estudo retrospetivo
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Sweet's syndrome associated with cellulitis - a challenging diagnosis
Get PDFSweet's syndrome is a neutrophilic dermatosis with worldwide distribution that has been associated with inflammatory autoimmune diseases, infections, malignancies, drugs, and pregnancy. The disease is idiopathic in up to 50% of patients. A 64-year-old woman, diagnosed with right limb cellulitis (4 days of evolution), was seen at our department, due to persistent cellulitis and progressive appearance of painful nodules and plaques in both shins and the right forearm (2 days of evolution). Taken together, clinical, laboratory and pathological data suggested the diagnosis of Sweet's syndrome, probably secondary to cellulitis of the right inferior limb. We suggest that cellulitis may be associated with Sweet's syndrome, a rare association in the literature