Acir Rachid

Pericardial effusion with cardiac tamponade as a form of presentation of primary hypothyroidism.

The authors describe a case of pericardial effusion accompanied by cardiac tamponade caused by primary hypothyroidism. Diagnosis was made by exclusion, because other causes of cardiac tamponade are more frequent. Emergency treatment of cardiac tamponade is pericardiocentesis (with possible pericardial window), and, after stabilization, performance of hormonal reposition therapy with L-thyroxin.

A case study of disseminated histoplasmosis linked to common variable immunodeficiency

Histoplasma capsulatum, a ground fungus, can infect humans, normally in endemic areas; the resulting disease can be asymptomatic or it can have a benign development, but in rare cases it can develop into a serious clinical condition and can even be fatal. Its most characteristic initial location is in the lungs, resembling tuberculosis, often accompanied by mediastinitis and an exuberant fibrotic response. The spread of this infection can be caused by the concomitance of another illness that alters the immunological balance. Sometimes such an association is not clear. Therefore, disseminated histoplasmosis is defined as a clinical condition where the fungus is present in more than one location. Common variable immunodeficiency is characterized by a generalized failure in the synthesis of antibodies, leading the affected individuals to present recurrent infections, especially those caused by encapsulated bacteria, most often involving the respiratory tract. We studied a serious case of disseminated histoplasmosis, accompanied by common variable immunodeficiency, observed at the Infirmary of the department of Medical Practice of the Federal University at Paraná Hospital das Clínicas.

Síndrome de Parsonage-Turner em paciente HIV positivo

Parsonage-Turner syndrome is a rare disorder of unknown etiology, nevertheless with high evidences of association with viral infections, including HIV, which affects the shoulder girdle and unleash pain and weakness of the shoulder and upper extremity. The diagnosis is rarely made in acute setting and few diagnostic tests are helpful, except for electroneuromyography. The treatment is basically supportive and full recovery is expected in most patients. For being a rare ailment allied with difficult diagnosis, the authors report a case of a patient with clinical and laboratorial findings of Parsonage-Turner syndrome associated with acquired immunodeficiency virus seropositivity.

Miopatia por propoxifeno: relato de 2 casos com histoquimica de músculos

The cases of a 43 years old-man with gout and a 24 years-old woman with severe back pain who developed dextro-propoxyphene addiction during pain treatment are reported. They had severe edema and fibrosis of skin, subcutaneous tissue and muscle involving the upper and lower limbs. ESR was elevated, CPK and LDH were normal. EMG in proximal muscles showed decreased duration and voltage of potentials, excess of short polyphasics and increased recruitment (BSAP), with positive waves and fibrillations; distal muscles had fasciculations, fibrillations, positive waves, normal voluntary potentials, decreased recruitment. Lymphography indicate delayed progression of contrast media and obstruction in the thighs. Muscle biopsy on fresh-frozen section and histochemistry showed extensive connective tissue proliferation with intense acid and alkaline phosphatase activity in the perimysial and endomysial area, infiltration of lymphocytes near and around small vessels and capillaries. There were perifascicular and type II fiber atrophy. After discharge the patients returned to propoxyphene addiction and the symptoms who subsided during drug withdrawal come back again. New admission, new drug withdrawal and they were discharged free of symptoms and pathologic changes.The cases of a 43 years old-man with gout and a 24 years-old woman with severe back pain who developed dextro-propoxyphene addiction during pain treatment are reported. They had severe edema and fibrosis of skin, subcutaneous tissue and muscle involving the upper and lower limbs. ESR was elevated, CPK and LDH were normal. EMG in proximal muscles showed decreased duration and voltage of potentials, excess of short polyphasics and increased recruitmente (BSAP), with positive waves and fibrilations; distal muscles had fasciculations, fibrilations, positive waves, normal voluntary potentials, decreased recruitment. Limphography indicate delayed progression of contrst media and obstruction in the thighs. Muscle biopsy on fresh-frozen section and histochemistry showed extensive connective tissue proliferation with intense acid and alkaline phosphatase activity in the perimisial and endomisial area, infiltration of limphocytes near and around small vessels and capilaries. There was perifascicular and type II fiber atrophy. After discharge the patients returned to propoxyphene addiction and the symptons who subsided during drug withdrawl como back again. New admission, new drug withdrawl and they were discharged free of symptoms. Possibly the repeated needles trauma, irritation by the propoxyphene and impairment of lymphatics drainage were the cause of symptoms and pathologic changes.The cases of a 43 years old-man with gout and a 24 years-old woman with severe back pain who developed dextro-propoxyphene addiction during pain treatment are reported. They had severe edema and fibrosis of skin, subcutaneous tissue and muscle involving the upper and lower limbs. ESR was elevated, CPK and LDH were normal. EMG in proximal muscles showed decreased duration and voltage of potentials, excess of short polyphasics and increased recruitmente (BSAP), with positive waves and fibrilations; distal muscles had fasciculations, fibrilations, positive waves, normal voluntary potentials, decreased recruitment. Limphography indicate delayed progression of contrst media and obstruction in the thighs. Muscle biopsy on fresh-frozen section and histochemistry showed extensive connective tissue proliferation with intense acid and alkaline phosphatase activity in the perimisial and endomisial area, infiltration of limphocytes near and around small vessels and capilaries. There was perifascicular and type II fiber atrophy. After discharge the patients returned to propoxyphene addiction and the symptons who subsided during drug withdrawl como back again. New admission, new drug withdrawl and they were discharged free of symptoms. Possibly the repeated needles trauma, irritation by the propoxyphene and impairment of lymphatics drainage were the cause of symptoms and pathologic changes.

Um caso atípico de polimiosite com acometimento da língua

Polymyositis is an idiopathic systemic disease, characterized by an inflammatory non-supurative process in the skeletal muscle tissue, whose main clinical feature is symmetrical proximal muscle weakness. We report an uncommon and interesting case of polymyositis whose dominant manifestation was tongue involvement in a 54 year-old woman with glossodynia and previous extensive, inconclusive investigation. In the literature, we found only one similar case published; therefore, this could be the second case described in the international literature.

Mielopatia induzida por medicação anticoagulante: relato de um caso com hematoma epidural espinhal

A 51 year-old female patient, under anticoagulant therapy due to thrombophebitis and pulmonary embolism, developped sudden paraplegia. Emergency myelogram showed a total block at L2 level and an epidural hematoma was removed at surgery, but the motor deficit remained unchanged postoperatively. The pertinent literature is reviewed, etiological considerations are made and emphasis is placed on early diagnosis and prompt treatment.A 51 year-old female patient, under anticoagulant therapy due to thrombophlebitis and pulmonary embolism, developed sudden paraplegia. Emergency myelogram showed a total block at L2 level and an epidural hematoma was removed at surgery, but the motor deficit remained unchanged post-operatively. The pertinent literature is reviewed, etiological considerations are made and emphasis is placed on early diagnosis and prompt treatment.

Análise imunofenotípica de subpopulações linfocitárias do sangue periférico na esclerose sistêmica

Systemic sclerosis (SSc) is a chronic inflammatory connective tissue disease of unknown etioiogy characterized by fibrosis and microvascuiar injury in affected organs. It has become clear that th e activation of celluiar immune system piays a central roie in the pathogenesis of SSc. OBJECTIVE: The purpose oE this study was to anaiyze numerically iymphocytic subpopuiations in the biood of systemic sclerosis patients and their relations with clinicai and iaboratory mani[estations. METHODS: We studied a group of 42 patients with SSc and a group oE 28 matched normai controis by flow cytometry using the following iymphocyte celi-surrace markers: CD2, CD3, CD4, CDS, CD19, CD25, CD45RA, CD56, CD71, HLADR, TCRα/β and TCRγ/δ. RESULTS: SSc patients had similar percentages of CD2+, CD3+, CD3+CD4+, CD3+CDS+, CD25+, CD4+CD45RA+, CDS+CD45RA+, CD71+ cells and CD4+/ CDS+ celi ratio when compared to . normal controis. ln contrast, the percentages of TCRγ/δ cells were significantiy iower in SSc patients with diffuse and iate-stage disease with puimonary and muscle invoivement and the presence of anti-Scl-70 antibodies. Patients with diffuse SSc in early and iate-stage disease had significantly increased percentages of HLA-DR in CD4+ and CDS+ celis; patients with iate-stage disease had increased percentages of CD4+CD45RA+ T celis; patients with iimited and eariy-stage disease had small pereentages of B eelis (CD19+): and patients with diffuse and iate-stage disease had small pereentages of NK eells (CD56 +). CONCLUSIONS: These results suggest that T, B and NK eell alterations may be invoived in the onset of the disease and/ or in the perpetuation of disease, and may eventuaJJy be usefui as a prognostie indieator in seleeted patient subgroups.

Brazilian bibliography on rheumatic fever since 1980 up to 2002

Cientes de que os interessados em febre reumática (FR) encontram expressiva dificuldade em coletar dados bibliográficos nacionais, dispusemo-nos a compilar esta bibliografia. Achamos conveniente nos limitarmos às publicações em português, porquanto em outras línguas há o uso possível do Index Medicus. Não foram incluídos artigos escritos por brasileiros e publicados em periódicos de outra língua, porque fugiria de nosso desideratum. Eventuais artigos que não constem desta publicação deverão ser inseridos em uma próxima revisão. Separamos os artigos gerais das teses defendidas, porquanto estas últimas se referem a estudos mais amplos e mais originais.

Etiopatogenia da febre reumática

Although there is a consensus about the responsibility of betahemolytic streptococcus in the rheumatic fever (RF) etiology, in this article the author claims that persist doubts about a possible concomitant viral condition. This paper also reviews the streptococcus structures and stresses the fact that each outbreak of the disease is produced by a different streptococcus serotype. Concerning the pathogenesis, the author discusses three different mechanisms: a) slow bacterial action, b) the action produced by toxins and c) hypersensitivity reactions. Finally, the author also emphasizes the recent discovery of a B cell antigen called D 8/17.