Investor Presentaiton
IJMS
INTERNATIONAL JOURNAL of
MEDICAL STUDENTS
XXI COMAPI
$52
Abstracts
Abstracts
nal scapular chondrosarcoma in an young patient. Case report: A
30-year-old male presented to a care service with pain and functional
limitation on the left shoulder girdle. Physical examination showed
a wide and mobile tumor, which was irregular and painful when
it was pressed on the left scapular area. Patient reported a prior
resection of chondroid lesions on the same location in June 2005.
A Computer Tomography (CT) showed an osteolytic lesion with soft
tissue component affecting all the left scapula. The biopsy of the
bone lesion diagnosed a malignant tumor consistent with well-diffe-
rentiated chondrosarcoma, whose resection margins were neoplasm
free. So, it was indicated an internal total scapulectomy with a par-
tial claviclectomy and grand dorsalis shred. Histological study of the
surgical specimen showed a lobulated and bright intraosseous sca-
pular lesion, measuring 18.0 X 11.0 x 7.0cm with cortical rupture and
invasion of soft tissues, what confirmed the diagnosis of a conven-
tional chondrosarcoma. Conclusion: The histopathological chondroid
neoplasms diagnosis is challenging, whereas histological features of
benign and malignant neoplasms are overlapped. However, the co-
rrelation between clinical, radiological and histopathological findings
allow an accurate diagnosis in most cases, particularly when there is
an unusual topography involvement, as we seen in this case.
43
Sensory Manifestations In Patients With Devic's Disease:
Report Of Two Cases
Rozangela Dos Santos Veloso; Carlos Fernando Rodrigues
Batista; Luiz Euripedes Almondes Santana Lemos; Gregory
Ramon Bandeira Da Silva; Raimundo Nonato Campos Sousa.
Introduction: Devic's disease has inflammatory and demyelinating
nature. It is characterized by optic neuritis and myelitis. Typically
manifests as unilateral or bilateral loss of visual acuity, severe pa-
raplegia or tetraplegia with sphincter dysfunction and impairment
of well defined sensory level, pain and spasms of the trunk and
extremities. The prevalence among all other demyelinating diseases
of the central nervous system (CNS) is only 1.5%. It is more common
in women, with peak incidence ranging from 35 to 45 years. Affec-
ted patients have an IgG autoantibody (NMO-IgG auto) targeting the
protein Aquaporin Channel 4. CASE REPORTS: 1) Patient 39, female,
white, lives in Teresina. 15 months ago She noticed severe reduction
of visual acuity in the right eye. 4 months ago she developed pa-
raesthesia and reduced tactile sensitivity in the left arm that exten-
ded to other areas of the body. Subsequently, there were transient
reduction in visual acuity in the left eye. Associately, She started
incontinence and constipation. On examination, we found changes
in the optic nerve, slight reduction of strength in the left limbs and
painful and sensory sensitivities and presence of Lhermitte's sign.
Magnetic resonance imaging (MRI) of the cervical spine were re-
quested, which showed hyperintensity on T2 in the central portion
of the cord with mieloedema extending from C2 to C5 and, among
other tests, serum antibody to aquaporin-4, with positive results.
2) Patient 19, female, white, resides in Parnaíba. 8 months ago,
She started low back pain. She evolved with urinary retention and
difficulty in walking. She refers episode of diffuse muscle spasms.
In recent months started throbbing bitemporal headache, bilateral
retro-orbital pain, blurred vision, muscle strength and reduced tactile
sensitivity in the lower limbs. In the current survey, there is grade
5 muscle strength and reduced tactile sensitivity in the lower limbs.
She can not stand. Among other tests, MRI of spine which showed
hyperintense T2 signal in the central portion of the spinal cord in vir-
tually its entire length were required, and measurement of antibody
to aquaporin-4, with positive results. Final thoughts: The Neuromye-
litis Optica is an autoimmune disorder of the central nervous system
rare. The dosage autoantibody increased to 4 aquaporina- became
important diagnostic criteria.
44
Severe Adverse Drug Reaction After Ending Of Dual Therapy
For Hepatitis C: A Rare Occurrence
Luíza Sá E Rêgo Tupinambá; André Freitas Nunes; Lorena
Araújo Luz; Matheus Filipe Oliveira Azevedo; Vítor Assunção
Da Ponte Lopes; Conceição De Maria Sá E Rêgo Vasconcelos.
Introduction: The classical treament for hepatitis C involves peg in-
terferon alfa and ribavirin. The use of these drugs may be involved
with the occurrence of systemic, psychiatric, hematologic, and skin
adverse reactions, like rash. The acute rash, morbilliform or scarla-
tiniform, that is usually urticarial and sometimes accompanied by
itching, may be associated with general symptoms, such as fever,
arthralgia and headache. The clinical develops suddenly, starting
at variable time. This report has the objective of describing a dual
therapy-related adverse drug reactions and to alert health care pro-
fessionals to monitor the occurrence of adverse reactions even after
the end of treatment. CASE REPORTS: Female patient with genotype
3 hepatitis C virus has undergone dual therapy with interferon and
ribavirin for 24 weeks. During the treatment, adverse effects, such
as anorexia, asthenia, depression, anemia and leukopenia, occurred,
but were solved without discontinuation of the treatment. One day
after the conclusion of the dual therapy, she presented itching and
erythematous lesions on the scalp progressing to neck, trunk and
limbs. Therefore, an acute generalized scarlatiniform erythema oc-
curred. She denies the use of other medications or substances that
could justify the rash. At first, utilized sunflower oil, petrolatum so-
dium, fexofenadine and clobetasol propionate cream. With 1 week
of treatment and no remission of symptoms, initiated prednisone
20 mg/day orally. Laboratory tests (07/03): hemoglobin: 10.2 g /
dl; hematocrit: 31.2%; leukocytes: 4,900 / mm with eosinophilia
of 29%; platelets: 150,000 mm ALT: 47 Histopathology consis-
tent with drug eruption. Her symptoms in two weeks disappeared
without sequelae. Final thoughts: This case describes the occurrence
of serious adverse drug-related reaction to hepatitis C dual therapy,
occurring after the end of treatment. This is an unusual condition,
since the peak incidence of these reactions occurs in the first two
weeks after the start of the drug. Then, it is necessary for physicians
to remain vigilant to possible adverse reactions even after the end
of treatment.
45
Study About The Occurrence of Dengue Hemorrhagic Fever
(DHF) In Teresina, In The Period of 2007-2012
Augusto César Evelin Rodrigues; José James Lima Da Silva
Segundo; Joycce Huanna De Souza Silva.
Introduction: Dengue is one of the most important diseases in Brazil.
A clinical manifestation of it that deserves attention is the Dengue
Hemorrhagic Fever (DHF), which has a high mortality rate. Divided
into 4 grades, DHF is diagnosed clinical and laboratory assessment,
and presents signs of hemorrhage, as well as the usual symptoms
of dengue. Objectives: To evaluate the occurrence of DHF cases in
Teresina during 2007-2012 by sex, age, grade, school, time of year,
area, mortality and lethality. Identify major complications and evo-
lutions. Methods: Epidemiological study of secondary quantitative
data taken from the Notifiable Diseases Information System (SINAN).
All data according to gender, age, grade, race, education, time of
year, area, mortality, and lethality were analyzed. Data were grou-
ped into Microsoft Excel spreadsheets and displayed in graphs and
tables. Results: We found 109 reported cases of DHF in the period.
67% of them were female. 45% of those aged 20-60 years and 28%
at 5-9 years with lower participation in other age groups. 57.8% oc-
curred in DHF grade II and others, altogether reached 34%. 38.5% of
the patients analyzed were illiterate or had only incomplete 1st to
4th grade and 11% had completed higher education. It was noticed
that 89.9% of cases occurred in the period from March to July, and
that 60% of cases were recorded in 2007. 97.3% of cases occurred in
urban areas. Patients with DHF represent from o to 2% of the total
cases of dengue. 89% were cured and 9.2% died. Conclusion: Preva-
lence in females due to higher predisposition, and aged 5-9 years on
low immunogenicity. The higher the degree study, more prevention
and education. 90% of cases occurred in the period from March to
July, coinciding with the rainy season in Teresina, setting a seasonal
disease. There was a predominance of cases in 2007, which can be
explained by the introduction of DENV 2 virus in Teresina, which has
great potential for developing DHF. It was noted that the number of
cases has increased in recent years due to greater chance of develo-
ping this clinical form, because most of the population have already
had at least one dengue infection. It is essentially an urban disease,
where there is greater circulation of the virus and the mosquito. It
was also observed, highly lethal. 9% of the patients died.
46
Study Of The Occurrence of Cases Of Meningitis In Teresina-Pi
In The Period 2007-2012
Joycce Huanna De Sousa Silva; Brunna De Sousa Silva; Maylla
Moura Araújo; Felipe Gomes Da Silva; Talisia Farias Castro;
Augusto César Evelin Rodrigues.
Introduction: Meningitis is an inflammation of the meninges, which
may originate through the bloodstream or as a result of other in-
fections, being a reportable disease. It is a serious and endemic
disease that can affect individuals of any age and is caused by va-
rious infectious agents. Objectives: To analyze the occurrence of ca-
ses of meningitis in Teresina 2007-2012; identify the distribution of
cases by age group (FE) and sex; raise the mortality and mortality of
meningitis and to investigate the main etiological agents of the di-
sease. Methodology: The present study is an epidemiological, cross-
sectional, quantitative and retrospective. The data were collected
from an active search in the databases of the Information System for
Notifiable Diseases (SINAN) and Interagency Network of Health Infor-
mation (RIPSA). We analyzed all cases according to sex, EF, etiology,
mortality and lethality in the period from 2007 to 2012 in Teresina-Pl.
The following data were tabulated through the Excel spreadsheet and
PrismaⓇ. Results: Of the 1701 reported cases, 196 (11.52%) occurred
in 2007, 384 (22.57%) in 2008, 502 (29.51%) in 2009, 243 (14.28%)
in 2010, 213 (12.52%) in 2011 and 163 (9.58%) in 2012 cases were
predominant in males, with 58% in 2008, 59% 2009, 61% in 2010,
55% in 2011 and 60% in 2012 and an equal number of cases in the
years 2007, 2007, 2010, 2011 and 2012, the FE greater number of
cases was 20-39 years and in 2008 and 2009 was 5-9 years. According
to the etiology, 83 (4.87%) cases were ignored / white, 1 (0.05%)
type meningococcemia, 11 patients (0.64%) meningococcal 5 (0.29%)
tuberculosis, 163 (9.58%) Bacterial, 442 (25.98%) unspecified, 935
(54.96%) Viral, 33 (1.94%) of Other etiologies, 2 (0.11%) Haemophilus
influenzae and 24 (1.41%) for pneumococcal. Of the total cases, 1586
were cured, 73 and 37 appeared for death as unknown. The mortality
rate in the study period was 4.3%. Conclusion: The high incidence
of cases in the period occurred in males, in EF 20-39 years and as a
cause viral meningitis, which had in 2009 a larger number of cases.
This same trend was obtained in relation to the etiology of the cases,
with regard to bacterial meningitis, pneumococcal and unspecified.
The mortality rate is still considered high and low lethality throug-
hout the study period, with a materially stable from 2007 to 2010 and
declining proportion in other years.
47
Subungual Epidermoid Carcinoma: A Case Report
Amanda Tauana Oliveira E Silva; Rayra Gomes Ribeiro; Antô-
nio José Silva Meneses Filho; Ana Lúcia Nascimento Araújo;
Lauro Lopes Lourival Filho; Sabas Carlos Vieira.
Introduction: Tumors of nail bed are rare and are associated with
chronic inflammation secondary to trauma, infection or exposure to
ultraviolet radiation. Squamous cell carcinoma is the most common
tumor of the nail bed. Onychomycosis can be the presenting symp-
tom, as well as a predisposing factor in patients with occupational
risk. The early detection of these tumors offers the best chance of
preserving the maximum hand function. Treatment modalities in-
clude chemotherapy, Mohs surgery, and amputation. Case report:
Patient, 50, male, no history of hypertension, diabetes or smoking.
Sought the dermatology service in June 2014 for a lesion on the first
finger of the right hand four years ago. Reported having conduc-
ted several topical treatments without success. Clinical examination
showed a granulomatous subungual bleeding lesion in the proximal
third. In the axilla there were no suspicious lymph nodes. A biopsy
of the tumor, which showed the presence of carcinoma metatypical.
The chest radiograph was normal. Was performed held excision of
the nail matrix and bed with biopsy freezing margins. We opted for
the shortening of the phalanx and flap in VY pulp to preserve half
the length of the distal phalanx and the distal interphalangeal joint
of the thumb. Immunohistochemical study revealed invasive squa-
mous cell carcinoma G2, HSM-3415-pan-keratin positive, p63 positive
and negative epithelial glycoprotein. No adjuvant treatment was in-
dicated. Patient had an uneventful recovery and two months after
surgical treatment lies in tracking. Conclusion: The presence of an
expanding lesion in the subungual region that does not respond to
medical therapy should draw attention to the diagnosis of malignant
lesion, avoiding delays in diagnosis as in the present, in which case
four years have passed since the beginning of symptoms to establis-
hing the correct diagnosis.
48
Surgical Correction Of Ectopic Penis And Ectopic Scrotum
Associated With Bilateral Orchidopexy
Daniel Santos Rocha Sobral Filho; Luis Gustavo Pinto; Lucas
Arrais Chaves Nascimento; Francisco Alves Vieira De Sá
Júnior; Helder Damásio Da Silva; Eulálio Damazio Da Silva
Júnior.
Purpose: Various congenital genital anomalies affecting males.
Among them, cryptorchidism is the most common. The bilateral
cryptorchidism constitutes one third of cases of anomalies. Others
diseases are the ectopic penis and ectopic scrotum, although being
rare. Ectopic penis is more reported in penoscrotal transposition ca-
ses. The case that will be reported has clinical importance by the
rarity of the association between ectopic penis, ectopic scrotum and
bilateral cryptorchidism. Case report: Male patient, 10 years, with
ectopic penis and ectopic scrotum located in the perineal region,
without penoscrotal transposition and with bilateral cryptorchidism.
He presented associated skeletal deformity of pubic shaft type with
ankylosis of the knees, and no association with abnormalities of the
urinary tract. MRI demonstrated cryptorchid and atrophied testes.
The left testicle was located near the base of the penis and the
right at inguinal canal. Previously, the child had undergone a left
orchidopexy. It was unsuccessfully due to the ectopic location of the
scrotum. The surgery was initiated by right inguinal incision, aiming
to mobilize the right testicle which, however, was only possible to
the anatomical position of the scrotum, and not to its real ectopic
position. The procedure continued with surgical correction of ectopic
penis and ectopic scrotum, which was initiated by an inverted Y inci-
sion. It was complemented inferiorly to separate penis from scrotum.
Then, penis was mobilized from perineum to its anatomical position.
A flap was mobilized from perineal scrotal skin to setup a scrotum
adjacent and inferior to the penis and to form the median raphe
and the two hemiscrotums. After flap mobilization, the orchidopexy
was initiated by right testicle positioning on right hemiscrotum and
was continued by left testicle disposal on left hemiscrotums. The
penis was sutured to the skin of pubic region. The scrotal flap with
the testes positioned was fixed in its anatomical position. At least,
a postectomy was performed and the perineal skin was sutured,
which was free of tension due to non-removal of scrotum-perineal
skin excess. Final considerations: Ectopic penis and ectopic scrotum
associated with bilateral cryptorchidism are rare congenital anoma-
lies and have few reports in the literature. The penis and scrotum
positioning surgical correction was essential to treat cryptorchidism
and to promote a gain in patient self-image.
49
Syndrome of Twin-Twin Transfusion: Case Repost
Eduardo França Do Vale Chaves Filho; Anielle Memória Da
Silva; Diego Ricardo Guimarães Rodrigues; Flávia Cristina
Araújo Siqueira; Cintia Maria De Melo Mendes.
Introduction: The syndrome of twin-twin transfusion (TTTS) occurs
in up to 30% of monochorionic twin pregnancies diamnióticas. It is
characterized by the unbalanced flow of blood of a fetus (donor) to
another (recipient) through placental vascular anastomoses. Severe
forms of the disease invariably show the anidrâmnio sequence (fe-
tus donor) polyhydramnios (receiver fetus), with or without modifi-
cation dopplervelocimetric fetoplacental, hydrops in the recipient or
death of one or both fetuses. Case report: Female 32 years G6P4A0,
monochorionic diamniotic twin pregnancy at 24 weeks gestation
with late Doppler sonographic diagnosis of TTTS, due to incomplete
realization of prenatal care. Performed a procedure to amniodrena-
gem as a palliative measure, evolving into premature birth of two
male children on the third day of hospitalization. The birth weights
of the newborns were 1,180 and 480 grams (g) send to the fetus of
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