Adriana Muradás Girardi

Diabetes insipidus como manifestação inicial de leucemia mieloide aguda em paciente com monossomia do cromossomo 7

O diabetes insipidus (DI) central e uma sindrome caracterizada pela incapacidade de concentracao urinaria devido a deficiencia do hormonio antidiuretico. O envolvimento do sistema nervoso central e frequente nas leucemias, mas a ocorrencia de DI e rara e confere pior prognostico. A patogenese do DI na leucemia nao e totalmente conhecida, mas a infiltracao do eixo hipotalamo-hipofisario por celulas leucemicas parece ser um fator responsavel. O presente relato descreve o caso de um paciente que apresentou DI como primeira manifestacao de leucemia mieloide aguda e que evoluiu com dificuldades de ajustes do sodio serico, da poliuria e da reposicao volemica, necessitando de permanencia prolongada em unidade de cuidados intensivos. Palavras-chave: diabetes insipidus ; leucemia mieloide aguda; monossomia; cromossomo 7.

Upper limb revascularization with reversed vein graft and microvascular anastomoses after brachial artery aneurysm resection in a child with tuberous sclerosis

The authors present an unusual case of a 3-year-old girl who was diagnosed with a fast-growing brachial aneurysm due to tuberous sclerosis. The patient was submitted to aneurysm resection and microsurgical reconstruction with reversed greater saphenous vein graft at the same time. She had a favorable follow-up, without neuromuscular deficits. Doppler ultrasonography has been performed for diagnosis, vein graft choosing, and postoperative follow-up. It is the opinion of the authors that such combined approach may be the routine for pediatric vascular reconstructions. Finally, this reconstruction has been rarely reported in tuberous sclerosis patients.

A giAnt negliected pleomorphic AdenomA of the submAndibulAr sAlivAry glAnd: A cAse report

Corresponding author: Adriana Muradas Girardi E-mail: adriana.m.girardi@gmail.com Universidade Federal do Rio Grande do Sul Av. Independencia, 354, ap 1602. 90035-070, Porto Alegre, RS, Brasil. A 73-year-old Brazilian man from the countryside of Rio Grande do Sul State presented to our head and neck surgery department because of a large tumor on the right submandibular zone. The tumor had increased in size over a 40-year period. There was no manifestation of pain nor signs of dysphagia or dysphonia. The patient was otherwise healthy, but had a history of tobacco use since the age of 12. On examination, the tumor was multinodular, hard, and mobile, and measured about 12 centimeters in its largest diameter (figure 1). Submandibular lymph nodes could not be palpated due to the tumor mass. No other nodes were palpable. The skin had no signs of infiltration. There were no signs of facial palsy or hypomobility of tongue. The clinical diagnosis was of a pleomorphic adenoma (PA). Computerized tomography (CT) showed a large heterogeneous mass involving the right submandibular space and neck levels II-III, crossing the midline about 1 cm, with diffuse calcifications and central hypodensity suggesting necrosis. The epicenter of the tumor was within the right submandibular gland (figure 2). Bony surface of the mandible was within normal limits, although lesion was in contact with it. As tumor seemed resectable on imaging tests and the authors considered lymphoma an unlikely hypothesis, any kind of biopsy was unconsidered. An en bloc resection of the tumor was done with resection of a segment of the overlying skin. During dissection, it was found that the tumor was in intimate contact with the right internal jugular vein, but this structure was able to be preserved. There were no transoperative or postoperative

Parapharyngeal branchial cleft cyst: a case report

A 30-year-old woman presented with a 2-year history of right-sided pharyngeal foreign body sensation. There were no signs of dysarthria, dysphagia, odynophagia, or dyspnea. On physical examination, we observed a fluctuant, painless mass in the oropharynx, pressing against the right lateral pharyngeal wall, covered with normal mucosa. Full examination of the head and neck, including cranial nerve evaluation, detected no further abnormalities.

Solitary fibrous tumor of the larynx: report of two new cases

O tumor fibroso solitario e uma neoplasia rara. Foram descritos poucos casos em cabeca e pescoco, sendo nao mais de 11 na laringe. Descrevemos dois novos casos de tumor fibroso solitario da laringe, um em um homem de 64 anos e outro em uma mulher de 77 anos, ambos com lesoes supragloticas submucosas e nodulares. Os casos foram submetidos a tratamento cirurgico e ambos apresentaram imunorreatividade a CD-34 e bcl-2, e negatividade para S-100 e actina de musculo liso. Apos 24 e 22 meses de seguimento pos-operatorio, respectivamente, nao apresentam sinais de doenca em atividade.