Jornal de relatos de casos clínicos

Among general population, prevalence of symptomatic haemorrhoids is estimated to be about 4.4% worldwide. Even though most cases resolve spontaneously, surgery plays an important role in reducing relapsing symptoms compared to medical therapy alone. Longo haemorrhoidectomy technique, which has led to fewer major complications over the years compared to Milligan-Morgan technique (complications of which include faecal incontinence, anal stenosis, prolonged postoperative pain), can also result in rare but serious haemorrhagic consequences. In this casereport, we present an unexpected haemorrhagic complication after Longo haemorrhoidectomy, and its subsequent embolization treatment with super selective catheterise of the affected vessels. In this case haemorrhage was prominent and retroperitoneal. Diagnostic and subsequent interments radiology techniques have revealed to be essential in diagnosis and treatment.

Post-traumatic trigeminal neuropathy is a debilitating condition that may occur after dental, oral, and maxillofacial procedures. In this retrospective case series study, we describe the clinical and patient reported outcomes on 13 patients with trigeminal nerve injuries that occurred after various interventions who underwent surgical exploration and subsequent surgical treatment with buccal fat nerve wrapping. We observed both positive and negative neuropathic symptoms preoperatively. Postoperative pain and quality of life was measured with the Brief Pain Inventory. Medication use was recorded pre- and postoperatively. Surgical exploration of the inferior alveolar or lingual nerve was performed in all patients. The median time between the injury and the exploration surgery was 21 weeks. The actual treatment of the lesion depended on its nature. Upon closing the wound, buccal fat was wrapped around the damaged nerve to facilitate nerve regeneration and provide protection. Overall improvements in negative and/or positive symptoms was observed in 12 patients during a mean follow-up time of 36 months. All patients that experienced pain before surgery reported pain reduction, and 2 patients reported complete pain resolution. On the BPI questionnaire, six patients reported persistent pain. In conclusion, surgery and the use of buccal fat grafts successfully reduced positive and negative symptoms, including pain symptoms, after iatrogenic trigeminal nerve injuries. In addition, medication use was reduced postoperatively. Future research should evaluate whether the use of a fat graft might provide a more protective nerve regeneration environment, compared to conventional treatments.

The objective of this article is to examine the anatomical variants of hepatic arterial vascularization by 64-slice Angio-TC. When planning the treatment of patients with HCC that require surgery or endovascular therapy, it is useful to consider the variety of anatomical variants that are possible and it is the objective of this article to classify them using digital subtraction angiography (DSA) and CT. Examples of the application of these techniques in our hospital will also be illustrated. Angio-CT has the capability of visualizing these anatomical variants and therefore enabling the selection of an optimised surgical or endovascular treatment. Interventional radiology plays a key role in advanced endovascular treatment of liver tumours. The administration of drugs and/or chemo embolizing agents often requires super selective catheterization of arteries to the tumoral mass to preserve the healthy hepatic parenchyma.

A 25-year-old male with history of mild asthma presents with 4-month history of productive cough and weight loss accompanied with progressive shortness of breath. Patient was admitted, his CXR and CT scan of the lungs suggested active TB in the right lung. An acid-fast bacillus smear was positive for TB, which confirmed the CXR findings. Patient experienced sever hemoptysis of 620 ml of blood within 24 hours and underwent successful bronchial artery embolization using polyvinyl alcohol spheres.

Introduction: Hydatid disease usually affects the liver and lungs. Pulmonary disease is usually asymptomatic until the cyst enlarges sufficiently to compress other organs or erupts releasing a large amount of antigenic material.
Case report: An 18-year-old female patient was submitted to the emergency department fifteen days postpartum presenting fatigue, breathlessness and non-productive coughing. According to the patient’s description, symptoms first appeared two months ago displaying great aggravation for the past two weeks, along with episodes of conscious loss and eyesight loss during the last 24 hours. Imaging findings revealed a large cystic mass, 15 × 11 × 13 cm in size, occupying the right middle and lower chest cavity. The mass seemed to be in contact with the pericardium pressing onto the right atrium’s wall, the diaphragm and the right lung. A right thoracotomy was performed which revealed a big Echinococcus cyst full of serous fluid that occupied half of the right chest cavity’s volume.
Discussion: The extrinsic compression of the right atrium by an extracardiac mass has been very rarely reported in literature. In our case, the mass compressing the right atrium of the heart was an undiagnosed pulmonary hydatid cyst. Systematic realignments during natural childbirth, the size of the uterus, the widely used Valsalva pushing technique decrease venous return to the heart, diastolic filling and stroke volume. These changes deteriorate the operation of an already strained right atrium leading to a collapse of peripheral arterial pressure. The patient experienced symptoms of low blood pressure and lung compression, demanding urgent surgical operation for the removal of the cyst.
Conclusion: This is a rare case of a patient with pulmonary hydatid disease where the Echinococcus cyst compressed the right atrium’s wall. The heart’s strain deteriorated due to the patient’s pregnancy and childbirth, a clinical course leading to the need of urgent and immediate action.

Hepatoblastoma (HB) is the most common primary hepatic malignancy in children and accounts for 43% of the pediatric liver tumors. The usual presentation is the presence of an abdominal mass, vomiting, elevated αfetoprotein levels and thrombocytosis and it occurs in infants and children under 3 years of age. A 6-year-old male child presented to the outpatient department with complaints of mild to moderate grade fever, vomiting and loose stools for 3 days. The child was otherwise active and there was no palpable abdominal mass. USG abdomen and CT scan revealed the presence of an encapsulated solid hepatic tumor suggestive of HB. Complete blood count showed an elevated WBC count, high ESR and high α-fetoprotein levels (958 ng/ml) but no thrombocytosis. A nonanatomical excisional biopsy of the tumor confirmed it to be hepatoblastoma. The unusual features noticed in this case was presentation at a slightly later age (6 years), absence of abdominal mass and absence of thrombocytosis.

Background: Serum anti-hepatitis C virus antibody (anti-HCV Ab) has multipronged bedside interpretations. Given the inefficient B-cell response and paucity of T-cell response in HCV infection, we hypothesize that anti-HCV Ab represents persistence of HCVRNA irrespective of HCV polymerase chain reaction (HCVPCR) status.
Case report: We present long-term follow-up of two patients, infected with HCV since nearly 1.5 decade. Case 1: A 35-year old female presented to us in July 2003 with dyspepsia. Anti-HCV Ab was positive. Qualitative PCR for HCV (HCV RT-PCR) was positive in May 2007. HCVPCR is negative since treatment with interferon (IFN) and ribavirin in 2008. HCV RT-PCR is continuously negative for 7 times since 2008. Serum anti-HCV Ab tested negative in 2014 but reappeared in 2017. Post-treatment ALT “flare” was observed twice. Case 2: A 24-year old married female reported to us in April 2004 with elevated ALT. Anti-HCV Ab was positive. HCV RT-PCR tested positive in December 2005. She was successfully treated with IFN and ribavirin in 2006. Re-treatment with sofosbuvir and ribavirin was required for HCV relapse in December 2016. After initial treatment in 2006, HCV RT-PCR has remained negative for 9 times, with normalization of ALT. Anti-HCV Ab is persistently positive. HCV RT-PCR is negative since re-treatment in 2017. Conclusion: Since HCV re-activation may occur in seropositive persons, long-term follow up is recommended after treatment and on incidental detection of anti-HCV Ab.

The present study presents a case of primary pleomorphic rhabdomyosarcoma that occurs in the abdominal wall. A 52-year-old patient arrived in our department. In his clinical history they have been: 2016 advanced serous ovary papillary carcinoma; a diagnosis of a primary gynecological tumor with secondary extension, and the patient was prepared for bilateral total abdominal hysterectomy salpingo-oophorectomy, omentectomy. Macroscopic and histopathological evaluation of the specimen removed surgically showed a medially differentiated serous papillary carcinoma. The patient received Carbo-Taxol and avastin as postoperative chemotherapy. Postoperative followup and CT twelve months after surgery, revealed signs of tumor recurrence: two multilobate neoformations of 15 cm and 5 cm in size respectively with intestinal obstruction. The final histological diagnosis was pleomorphic rhabdomyosarcoma with neuroendocrine differentiation.

Subarachnoid haemorrhage (SAH) is a life-threatening type of stroke caused by bleeding into the space surrounding the brain. Here this case report explains SAH condition in pregnancy. Where this Pregnancy is a recognized risk factor for aneurysmal subarachnoid haemorrhage (SAH). However, if immediate surgical treatment is given, the prognosis is good.