Choice Exams Research Articles

Tromboembolismo pulmonar em criança com Distrofia Muscular de Duchenne: relato de caso

OBJECTIVES: To describe a clinical case of pulmonary thromboembolism (PE) in a child with Duchenne muscular dystrophy. METHODS: A detailed description of the clinical picture and a review of the patients medical record were carried out, in addition to a discussion based on a literature review. DISCUSSION: PTE is not common in children and in 95% of cases it is secondary to an underlying cause or disease, with Duchennes disease being a predisposing condition due to the hypercoagulable state. Diagnosis in the pediatric population is not supported by tests validated as for adults; in this case, CT angiography was the exam of choice with sensitivity and specificity above 90%. In addition to diagnosis, a risk classification is essential, and supports the therapeutic choice. Therefore, low-risk patients receive anticoagulation, while high-risk patients receive thrombolytic therapy; in patients with contraindications to these drugs, surgical intervention may be necessary. Correct identification and early management are essential to delay disease progression and prevent sequelae, as well as avoid unnecessary invasive approaches. CONCLUSION: Due to the difficulty in diagnosing pulmonary thromboembolism in children, a detailed clinical investigation is essential, through the discussion of differential diagnoses and assessment of risk factors, since other diseases can mimic this clinical condition, which can present with signs and nonspecific symptoms.

Pulmonary thromboembolism in children with Duchenne Musculary Dystrophy: A Case Report

Objectives: To describe a clinical case of pulmonary thromboembolism (PE) in a child with Duchenne muscular dystrophy. Methods: A detailed description of the clinical picture and a review of the patients medical record were carried out, in addition to a discussion based on a literature review. Discussion: PTE is not common in children and in 95% of cases it is secondary to an underlying cause or disease, with Duchennes disease being a predisposing condition due to the hypercoagulable state. Diagnosis in the pediatric population is not supported by tests validated as for adults; in this case, CT angiography was the exam of choice with sensitivity and specificity above 90%. In addition to diagnosis, a risk classification is essential, and supports the therapeutic choice. Therefore, lowrisk patients receive anticoagulation, while high-risk patients receive thrombolytic therapy; in patients with contraindications to these drugs, surgical intervention may be necessary. Correct identification and early management are essential to delay disease progression and prevent sequelae, as well as avoid unnecessary invasive approaches. Conclusion: Due to the difficulty in diagnosing pulmonary thromboembolism in children, a detailed clinical investigation is essential, through the discussion of differential diagnoses and assessment of risk factors, since other diseases can mimic this clinical condition, which can present with signs and nonspecific symptoms.

PS-C37-3: MULTIPLE VISITS TO THE EMERGENCY SERVICE - A CASE OF NUTCRACKER SYNDROME

Background: Nutcracker Syndrome (NS) is a rare clinical entity consisting of compression of the left renal vein by the superior mesenteric artery as it travels between it and the abdominal aorta. The compressive process leads to different levels of extrinsic renal artery stenosis, from asymptomatic episodes to episodes of macroscopic hematuria, proteinuria, renovascular hypertension, left flank pain, dyspareunia, dysmenorrhea and pelvic varicose veins. It is more prevalent in females and it can be diagnosed at any age, but particularly during the 2nd and 3rd decades of life. Renal veins Doppler ultrasonography is the exam of choice in the initial evaluation, being confirmed by imaging exams such as CT and MRI. The treatment is controversial, ranging from conservative treatment to nephrectomy. Case Description: Between 2015 and 2022, a 24-year-old Caucasian woman, without noteworthy personal and family clinical background, resorted several times to the Emergency Department with vomiting, diarrhea and abdominal distension and pain. Numerous alternative diagnoses have been made, such as Acute Gastroenteritis, Urinary Tract Infection, among other. Due to the large number of emergency episodes, the patient was examined by gastroenterologist who requested an abdominal CT, and diagnosed NS. The patient underwent an unsuccessful left renal vein stenting, which subsequently forced a renal auto transplantation, which was performed without complications. Take Home Message: In the GP daily practice, establishing NS diagnosis is difficult and usually made after the exclusion of other problematics. A great level of suspicion is therefore crucial in patients with diversified clinical findings.

Tromboembolismo venoso em Idade Pediátrica: Um olhar de 20 anos numa Unidade de Cuidados Intensivos Pediátricos

Objective: Clinical characterization and approach of patients with thromboembolism (VTE). Methods: Retrospective, descriptive study of patients aged <18 years with VTE in a pediatric intensive care unit in a tertiary care hospital over 20 years [2002-2021]. Results: Identified 51 patients: deep vein thrombosis (DVT) (n=30), cerebral vein thrombosis (CVT) (n=21), pulmonary thromboembolism (PTE) (n=4), portal vein thrombosis (PVT) (n=2) and renal vein thrombosis (RVT) (n=1). In 5 patients CVT and DVT coexisted (n=1); PTE and DVT (n=3); and RVT and DVT (n=1). Mean 2.6 cases/year. 52.3% male, median 6 years [1M;17Y]. The presence of a central venous catheter was the main risk factor (72%) in DVT associated with edema in the region; Doppler ultrasound was the exam of choice. All with PTE were adolescents; 75% had chest complaints confirmed by angio-CT; identified =2 risk factors in each patient. The case of RVT was a 2-year-old child with renal neoplasm. The cases of PVT were adolescents with symptoms of portal hypertension. The main symptom in CVT was headache (63.6); 52.4% secondary to upper respiratory infection; thrombophilia study positive in 42.9%. Analytically, all had elevated D-dimers. Most started anticoagulation with enoxaparin (86.3%), which they maintained for 3 to 6 months after discharge. Mean hospital stay was 17.6 days. There was 1 episode of recurrence and 1 death unrelated to VTE.

Localized Pigmented Villonodular Synovitis in a Child: About a Case

Pigmented Villonodular synovitis (PVNS) is a rare benign proliferative condition affecting synovial membranes of joints; it occurs in two forms, localized (LPVNS) and diffuse (DPVNS). We report a case of a 12 years old with LPVNS, confirmed on surgical biopsy. The patient underwent a surgical synovectomy, with good evolution after 1 year follow-up. PVNS is most common in early to middle age, It still exceptional in children. Clinically, its symptology remains aspecefic. This is often a cause of delay in diagnosis. Magnetic resonance imaging (MRI) is the exam of choice. Only a synovial biopsy with histological study confirms the diagnosis; the treatment typically involves surgery: synovectomy, with a risk of recurrence.

Ten questions about intracranial epidural hematoma

Introduction: Intracranial epidural hematoma (EH) is considered a neurosurgical emergency. Its knowledgement has been increasingly prominent in literature. Methods: a literature review was performed on ten questions related to intracranial EH, such as age, sex, causes, location, imaging findings, neurological examination, lucid interval, hematoma size, treatment and prognosis. Conclusion: EH affects more young adult males. It does not cross the lines of cranial sutures. The lucid interval has been commonly described, however, it is not pathognomonic of EH, and may occur in other lesions of expanding mass. The computed tomography (CT) scan of the skull has been the exam of choice. The size influences prognosis and sequelae, when small and asymptomatic the treatment has been conservative and, if bulky, it requires surgical intervention. Early recognition and appropriate treatment for a good prognosis is of great importance.

Che cos’è l’ematocolpo?

Hematocolpos is a term given to a blood-filled dilated vagina due to menstrual blood. When there is concurrent uterine distention, the term hematometrocolpos is used. These conditions are mostly in the setting of an anatomical obstruction, usually an imperforate hymen. Usually, clinical presentation may be characterized by primary amenhorrea, recurrent abdominal or pelvic pain, urinary retention and dys-uria or constipation. Imaging techniques such as trans-abdominal ultrasound and nuclear magnetic res-onance are respectively the exam of choice and the “gold standard” exam for diagnosing hematocolpos. The paper reports the case of a 12-year-old girl with a sacral pain present for a month, not associated with other symptoms with a diagnosis of hematocolpos that became evident to the magnetic resonance.

Total Face Approach (TFA) 3D Cephalometry and Superimposition in Orthognathic Surgery: Evaluation of the Vertical Dimensions in a Consecutive Series.

Background: Cephalometry is fundamental in diagnosis, analysis, and planning of orthodontic-surgical treatment as it reveals skeletal relationship between the upper and lower jaw as well as facial aesthetic parameters. Nevertheless, 3D cephalometry has still not become the exam of choice in orthognathic treatment even though today CBCT (Cone Beam Computed Tomography) is routinely used in other branches of dentistry. Methods: In a sample of 13 patients undergoing bimaxillary orthognathic surgery a chin-vertex CBCT exam was prescribed prior to orthodontic treatment (OT) and 12 months after surgery (T1). The DICOM files uploaded to MaterialiseSimplant Ortho software pro 2.1 (Materialise Co., Leuven, Belgium) were analyzed following the multiplane 3D Total Face cephalometry protocol (TFA). Results: Results comparing pre-op and post-op TFA 3D cephalometry, were then evaluated considering reference values reported in literature. The CBCT, carried out pre- and post-surgery, were subsequently analyzed employing the superimposition method using cranial base as reference. The aim of this study is to evaluate the advantages and disadvantages of the two methods in orthognathic surgery. Conclusions: Multiplane 3D TFA allows the clinician to locate where major or minor skeletal discrepancies are found with respect to ideal parameters and is also useful in classifying skeletal intermaxillary relation. The superimposition method is highly intuitive but does not provide information on the quantity and location of osteotomic movement.

Impact du diastasis des muscles droits de l’abdomen sur les symptômes pelvi-périnéaux : revue de la littérature

The diastasis of the rectus abdominis muscles is common during pregnancy and post-partum. To determine the prevalence of this pathology, methods of diagnosis, association with pelvic-perineal disorders and therapies that may be proposed. Review of Pubmed, Medline, Embase and Cochrane literature using the following words and MeSH: diastasis, diastasis and pregnancy, diastasis of the rectus abdominis muscle, increase of the inter-recti distance. Among the 124articles found, 61were selected. Ultrasound seems to be the exam of choice both in terms of feasibility and reproducibility for the diagnosis of this pathology (intra-class correlation coefficients (ICC) high 0.81to 0.94). The risk factors identified vary from one study to another: heavy load bearing (OR=2.18 (95% CI 1.05to 4.52) P=0.04), weight gain. Studies are discordant regarding the association between diastasis and low back pain (RR=1.39 (95% CI 0.91-2.14), P=0.17), urinary incontinence (RR=0.86 (95% CI 0.55-1.33) P>0.65) and prolapse (OR=2.25 (95% CI 1.51-3.37) P<0.001), but the diastasis seems to play a role in the alteration of the quality of life for these patients. Knowledge about risk factors, consequences of diastasis and management is still limited today. It is therefore necessary to establish prospective studies on larger numbers in order to improve knowledge on the diastasis of the rectus abdominis muscles.

Síndrome del granuloma leproso en un perro en la ciudad de Pelotas: Relato de caso

The leproide canine granuloma syndrome is an uncommon disease of mycobacterial etiology, probably underdiagnosed. Clinically, cutaneous lesions occur preferentially in regions more susceptible to insect bites, such as ears and head. In most of the reported cases, the affected dogs present good general health and are found as a clinical finding, without involvement of other organs. The diagnosis can be quite suggestive by the racial pattern. However, confirmation of the diagnosis should be made through biopsy or histopathology. In most cases the CAAF is the exam of choice, for practicality, speed and safety. Most cases are self-limiting and regress spontaneously between one and three months after the initial onset, but usually occur with localized or generalized chronic skin infection. Thus, the objective of the present study is to report the case of a dog with definitive diagnosis of canine leprosy granuloma syndrome in Pelotas city, clarifying the behaviors made with the patient from the care to the return of the localized lesion.

Cisto Epidermoide do IV Ventrículo. Relato de caso e revisão da literatura

Introdução: Cisto epidermoide (CE) é um tumor congênito benigno, originário do ectoderma. Ocorre na terceira e quinta década de vida. Corresponde aproximadamente a 0,2 a 1,8% dos tumores intracranianos. A localização no quarto ventrículo é rara. O exame de eleição é ressonância magnética (RM), mas a confirmação diagnóstica é através da anatomia patológica. O tratamento ideal é a exérese total. Relato do caso: Paciente sexo feminino, 27 anos de idade com história de cefaleia e ataxia da marcha há um ano. Resultado: RM de crânio mostrou presença de lesão expansiva no quarto ventrículo. Submetida a exérese cirúrgica total da lesão. Resultado da anatomia patológica foi CE. Conclusão: CE é uma lesão intracraniana benigna e raramente localiza-se no quarto ventrículo. Seu tratamento é cirúrgico e cursa com bom prognóstico.

Traitement conservateur d’une adénomyose compressive : à propos d’un cas

Adenomyosis is frequent, mostly asymptomatic. A hypertrophy of the smooth muscular cells around ectopic endometrial glands might induce a compressive syndrome. We report the case of an embolization of a voluminous adenomyosic uterus which has triggered venous iliac's compression in patient refusing surgery. This treatment was efficient in reduction of uterin volume, without recurrence after three years. MR imaging is the exam of choice particularly when diagnosis is still uncertain and allows a non-invasive and good evaluation, and follow-up. Embolization is not actually recommended. But, it appears to be efficient, relatively safe and contributes to the conservation of fertility.

Algodystrophie des membres inférieurs au cours de la grossesse

Algodystrophy (AD) of the lower limbs during pregnancy is rare and probably underdiagnosed. The physiopathologic mechanisms remain under discussion and seem multiple and complex. This report describes a retrospective survey of 6 patients seen between 1993 and 2004 who had algodystrophy of the lower limbs during pregnancy. Comparing the clinical, radiological and evolutionary results to the literature allows for identifying the main features of AD during pregnancy: disease progression during the second or third trimester, preferential localization of the left hip associated or not with other lower limb joint involvement and decalcification as seen on radiography. Magnetic resonance imaging (MRI), which is accurate, specific and non-invasive, is currently the exam of choice in early and differential diagnosis. The evolution is favourable in a few months, with general recovery without disability.

A description and four-year analysis of a clinical clerkship evaluation system.

Major issues related to evaluating student performance in clinical clerkships are reviewed, and the development of a clerkship evaluation system which attempts to deal with each issue is described. Three evaluation methods are utilized: multiple choice examination, oral examination, and ward ratings. Scores from each evaluation method for the classes of 1977-80 were analyzed to determine dependability and validity. Results indicate that the multiple choice and oral exam scores were highly dependable each year; however, the ward ratings were not dependable during the first year of use. Over the four-year period, the ward rating criteria were kept the same, annual feedback to individual faculty was provided, and residents were added as raters. The cumulative effect appears to have been a pronounced improvement in the dependability of the ward rating scores. As a result, ward rating scores now receive greater emphasis in evaluating student clerkship performance.