Our intention in editing the "Revista de Medicina" is to support students' scientific production and stimulate the reading of scientific articles. Undoubtedly, medical practice requires constant updating and the unquestionable need to read scientific articles. Therefore, it is important to get used to this since Graduation.
Universidade de São Paulo. Faculdade de Medicina
Women's Health in Focus: Challenges and Possibilities in Communication between a Gynecologist and a Deaf Patient
Objective: To understand the challenges and possibilities in medical care between gynecologists and deaf patients in the municipality of Itumbiara-GO, in preventive care for women's health. Method: This is a qualitative study involving gynecologists and deaf patients in the municipality of Itumbiara-GO. Data collection took place in March and April 2024, using semi-structured interviews as a data collection tool, containing questions about the challenges and potential encountered by deaf patients and what gynecologists find in the medical care of these patients. Three gynecologists and two deaf women who use Brazilian Sign Language (Libras) took part in the study. The research was submitted to and approved by the Ethics Committee and all the participants signed an informed consent form. Results: The results of the research show significant challenges in communication between gynecologists and deaf patients in Itumbiara-GO, highlighting the urgent need for more inclusive medical training. The interviews reveal that, although there is a mutual effort to overcome communication barriers, the lack of knowledge in Libras on the part of health professionals often results in dependence on companions or interpreters, which compromises patients' autonomy. Conclusion: In order to improve public health in gynecological care for deaf women, it is crucial to implement public and educational policies that encourage the continuous training of health professionals in Libras and the hiring of qualified interpreters in health services
Copyright (c) 2026 Barbara Antunes Braga, Ana Clara Leal, Isabela Samara Gomes, Jéssica Antonieta Reis Borges, Rogério Pacheco Rodrigues https://creativecommons.org/licenses/by-sa/4.0
Child Neurodevelopment at 36 Months of Age: The Role Early Life Adversities Analysis
Early life adversities (ELAs) represent a major public health concern due to their long-term consequences for clinical and developmental outcomes (1). Understanding how ELAs shape child development is essential for informing effective prevention and intervention strategies aimed at improving both individual and population-level development outcomes. The Dimensional Model of Adversity and Psychopathology (DMAP) offers a neurobiologically grounded framework to conceptualize how distinct environmental experiences influence neurodevelopment via partially unique mechanisms (2). Moreover, DMAP also contemplates the examination of multiple, co-occurring adversities that children are exposed to (3), especially in underdeveloped countries, where certain forms of adversity remain insufficiently studied (4). Here, we report our contribution to this discussion by examining how the dimensions of threat and deprivation relate to neurodevelopment at 36 months within a context of multiple overlapping adversities. We analyzed data from 36-month-old participants of the São Paulo Western Region Birth Cohort (ROC) (5). Composite measures of threat and deprivation were derived from validated caregiver-reported questionnaires. The threat dimension captured exposure to domestic and community violence, whereas deprivation reflected indicators of household quality, food security, and caregiver education. Multivariable regression models adjusted for contextual confounders were used to assess associations between ELA dimensions and neurodevelopmental outcomes, including effortful control, global development, and internalizing and externalizing problems. Of the 3,619 children enrolled, 1,567 met eligibility criteria based on data availability and absence of comorbidities. Bootstrapped estimates revealed that threat exposure was significantly associated only with internalizing problems (β = 0.43, 95% CI [0.11–0.74], p = 0.008). In contrast, deprivation showed consistent associations across all assessed outcomes, including internalizing problems (β = 0.17, 95% CI [0.03–0.29], p = 0.022), externalizing problems (β = 0.29, 95% CI [0.11–0.47], p = 0.002), reduced effortful control (β = –1.46, 95% CI [–2.08 to –0.88], p < 0.001), and poorer global development (β = –2.44, 95% CI [–3.11 to –1.80], p < 0.001).
Copyright (c) 2025 Tiago Choi; Alexandra Brentani, Verônica Euclydes, Helena Brentani https://creativecommons.org/licenses/by-sa/4.0
The hazing gap: The concealed burden in Brazilian medical schools and the need for validated assessment tools
The university learning environment plays a crucial role in shaping students’ mental health and overall well-being. Although these settings are often associated with personal and academic growth, they can also expose students to conditions that contribute to psychological distress1. Recent evidence shows that certain aspects of college life, especially in medical schools, are linked to high rates of anxiety and depression among medical students. Factors such as academic pressure, performance demands, and the broader institutional culture help explain these findings2,3. For newly admitted students, these factors are predominantly linked to the process of entering a new environment. The transition into university often involves seeking belonging within groups such as sports teams, student organizations, and residence communities4. Initiation rituals are part of this integration process and can range from welcoming and harmless to violent and abusive5. These violent and potentially abusive practices are collectively known as “hazing”, which includes various forms of violence, such as gender or racial violence, bullying, and institutional violence6.
Juliane Piasseschi de Bernardin Gonçalves
Copyright (c) 2025 Euripedes Constantino Miguel, Giancarlo Lucchetti, Rodolfo Furlan Damiano, Clarissa Garcia, Laura Fernandes Berto, Rodrigo Hadade, Juliane Piasseschi de Bernardin Gonçalves, Bianca Besteti Fernandes Damiano, Elizabeth J. Allan, David Kerschner, Oscarina da Silva Ezequiel, Alessandra Lamas Granero Lucchetti, Lisabeth F. Dilalla, Homero Vallada https://creativecommons.org/licenses/by-sa/4.0
Epidemiological profile of sickle cell trait in blood collection units in the North and Northeast regions of Brazil: a narrative review
Introduction: Sickle cell trait is a condition caused by a mutation in hemoglobin, leading to the formation of a variant molecule, hemoglobin S (HbS). Its prevalence among blood donors in Brazil is higher in men and is present in 2.49% of the national population. Objective: To investigate the epidemiological profile of sickle cell trait in blood collection units in the North and Northeast regions of Brazil, based on the scientific literature. Method: This is a narrative literature review. The searches were conducted in six databases, using the following Health Sciences Descriptors (DeCS/MeSH): Sickle Cell Trait, Blood Donors and Brazil, applying the Boolean operator AND. Original qualitative and quantitative studies conducted in blood collection units, systematic reviews with or without meta-analyses, case studies, and technical notes published from 2014 to 2024 in English or Portuguese were included. Duplicate studies, course completion papers, master's dissertations and doctoral theses were excluded. Results: Ten articles were selected, of which two refer to studies conducted in the North Region and eight refer to studies in the Northeast Region. In the blood centers of the North Region, there is a prevalence of 1.3 to 1.41% of donors affected by the HbAS allele, with a predominance of black and mixed-race males, while in the Northeast Region there is a variable prevalence of 0.79% to 3.92% of carriers of the sickle cell trait, with a predominance of mixed-race or mixed-race men aged between 20 and 40 years. Conclusion: A similar epidemiological pattern was observed in the North and Northeast regions, with a predominance of male donors and of mixed-race individuals. In addition, there is a scarcity of studies on the sickle cell trait in these regions, highlighting the need for further research on this subject.
Francisco Dimitre Rodrigo Pereira Santos
Copyright (c) 2026 João Pedro Ferreira Duarte, Ana Alice Coutinho de Oliveira, Lucas dos Santos, Francisco Dimitre, Saulo Meira, Beatriz Roriz https://creativecommons.org/licenses/by-sa/4.0
Rare case of recurrent thymoma with invasion of the thoracolumbar spine.
Does not apply - letter to the editor.
Copyright (c) 2025 Giovanni Scorzoni Paro, Italo Gerardo Rotondo, Douglas Kenji Narazaki, Matheus Augusto Maciel Santiago https://creativecommons.org/licenses/by-sa/4.0
Understanding how Nonsuicidal Self-injury occurs in low- or middle-income countries
Nonsuicidal self-injury (NSSI), defined as the deliberate destruction of body tissue without suicidal intent, represents a major public health concern among adolescents and young adults worldwide [1]. However, data from low- and middle-income countries (LMICs) remain scarce, particularly from community-based samples. In this context, Souza et al. conducted the first representative community-based study on NSSI in Brazil, using data from the Brazilian High-Risk Cohort Study (BHRC) [2]. This research provides novel findings on the six-month prevalence and psychopathological correlates of occasional and repetitive NSSI among Brazilian youth. Weighted analyses revealed patterns consistent with global findings, highlighting the importance of understanding NSSI in diverse sociocultural contexts. Importantly, the study demonstrated a robust association between NSSI and psychiatric comorbidities, particularly depressive and anxiety disorders, as well as a dose–response relationship between the number of concurrent diagnoses and NSSI severity. While occasional NSSI was not significantly associated with psychopathology, repetitive NSSI showed strong correlations with mood, anxiety, and externalizing disorders, highlighting distinct clinical trajectories and developmental pathways [3]. By integrating survey-weighted models and zero-inflated negative binomial regressions, this study contributes essential epidemiological evidence on NSSI in a large LMIC population. These findings emphasize the need for early detection and preventive strategies, as well as longitudinal investigations to understand how NSSI evolves from adolescence into adulthood. Overall, this work represents a significant contribution to developmental psychiatry, bridging an important knowledge gap in the epidemiology of self-injurious behaviors in emerging countries.
Copyright (c) 2025 Gabriel Ângelo Ferreira Faria de Souza, Caio Fernandes Lins Peixoto , Giovanni Abrahão Salum, Pedro Mario Pan, Marcelo José Abduch Ada Brañas, Euripedes Constantino Miguel, Marcos Signoretti Croci https://creativecommons.org/licenses/by-sa/4.0
The Impact of the MadAlegria Project on Humanized Training and the Development of Empathy among Alumni
In recent decades, the remarkable scientific and technological progress in healthcare has been accompanied by a marked distancing in interpersonal relationships within care settings. This scenario contrasts with the definition of health proposed by the World Health Organization — as a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity¹ — and with the principles of Brazil’s National Humanization Policy (Política Nacional de Humanização, PNH) within the Unified Health System, which recognizes the centrality of the individual in all dimensions of care². In Brazil, the concept of health was further expanded in 1990, when it was established as a fundamental human right under the Law 8.080/1990³. In 2003, the National Humanization Policy was created to value all subjects involved in the care process — including users, professionals, and managers — guided by principles such as transversality, inseparability between care and management, and autonomy, co-responsibility, and protagonism of individuals and collectives²,⁴. Humanization is therefore an essential component of both clinical practice and the education of healthcare professionals. In the training of such professionals, the development of competencies such as empathy, active listening, and receptiveness is fundamental to ensuring patient-centered care⁵⁻⁷. However, the growing gap between technical-scientific advancement and the quality of human interactions in healthcare underscores the need for educational strategies focused on humanized training⁸⁻¹². Within this context, the MadAlegria Project was created to foster humanized practices in both learning and professional behavior. Established in 2011 by students and faculty members at the University of São Paulo (USP), MadAlegria is a Culture and University Extension Project aimed at promoting humanization in healthcare education—particularly at the undergraduate level—and at improving the hospital environment, making it more welcoming for patients, families, and healthcare staff. Since 2012, the project has incorporated two artistic and playful languages: hospital clowning and storytelling. These approaches are used as pedagogical tools to enhance relational competencies such as empathy, active listening, teamwork, and sensitivity to others’ experiences¹³⁻¹⁵.
Humanization, Behavior, Medical education, volunteers, empathy
Copyright (c) 2025 Santos, JA, Ribeiro, LCSL, Costa, PB, Ferreira, EAG https://creativecommons.org/licenses/by-sa/4.0
MadAlegria: An academic outreach project restoring humanization in healthcare through the art of presence, connection, and empathy
Introduction: IIllness often provokes distress in patients and their support networks. Humanization should be part of the training of healthcare professionals. Founded in 2011 by undergraduate students in Medicine, Physical Therapy, Occupational Therapy, Speech-Language Pathology, Nursing, and Nutrition, MadAlegria draws on storytelling and hospital clowning to foster empathy, promote humanized care, create more welcoming hospital environments, and expand students’ understanding of illness beyond its biological aspects. Objectives: To describe the MadAlegria Project, that promotes humanization in the education of healthcare professionals. Methods: MadAlegria develops two main activities: (1) annual training in Hospital Clowning or Storytelling; and (2) weekly visits to inpatients in oncology, dermatology, and obstetrics units. Teams engage in brief, respectful interactions guided by consent and institutional availability. Other actions include organizing the Humanization in Healthcare Symposium, participating in institutional events, promoting blood donation and integrative workshops. Results: Between 2017 and 2023, MadAlegria trained 578 volunteers, conducted 2.345 visits, involving 1.193 companions and 2,354 healthcare professionals. Data collected via REDCap® revealed that 99% of participants reported a positive impact, mainly in terms of empathy, humanization, and attentive listening. Only 6% of volunteers remain active. Discussion: MadAlegria has been achieving its goal of humanizing the training of healthcare professionals with empathy, while also conducting a large number of visits and interactions with patients, companions, and healthcare professionals in the hospital. Keeping volunteers active in the project for many years is a challenge influenced by other variables such as time and priority. Even if the volunteer does not continue with the project's activities, it is considered a success if they have become a more empathetic healthcare professional. Conclusion: MadAlegria strengthens humanized practice in healthcare education, promoting empathy and compassion in the hospital environment. The continuation of the project depends on institutional support.
Copyright (c) 2025 RIBEIRO, LCSL, SANTOS, J A, COSTA, P B , FERREIRA, E A G https://creativecommons.org/licenses/by-sa/4.0
Letter to the editor - Hypoparathyroidism after parathyroidectomy in patients with multiple endocrine neoplasia type 1
Multiple endocrine neoplasia type 1 (MEN1) is a genetic syndrome caused by inactivation of the MEN1 tumor suppressor gene, which confers increased susceptibility to the development of neoplasms, especially endocrine tumors such as parathyroid adenomas.¹ Although it is a rare disease, primary hyperparathyroidism resulting from hyperplasia and/or neoplasia of the parathyroid glands occurs in up to 97% of individuals with the syndrome.² The treatment for hyperparathyroidism is surgical, and the two main techniques currently used are subtotal parathyroidectomy, involving the removal of 3.5 glands, and total parathyroidectomy with autotransplantation, in which all four glands are removed and a graft is prepared in the forearm.³ Although both approaches are employed, the choice of the optimal surgical technique for this condition remains under debate. A single study with a small cohort of 32 participants compared these two procedures and found no significant differences between them.⁴ The choice of surgical technique must consider the risk of recurrent hyperparathyroidism, given the multiglandular nature of the disease, and the risk of complications for example, hypoparathyroidism — defined by inappropriately low PTH levels in the presence of hypocalcemia.⁵ Traditionally, postoperative hypoparathyroidism is considered permanent when it persists for more than six months after surgery.⁶ However, this arbitrary definition is based on patients undergoing thyroidectomy and who do not have MEN1. Patients with MEN1 may have additional factors that delay the recovery of parathyroid function, such as previous malabsorptive surgeries, prolonged hungry bone syndrome, and removal of multiple glands. The latest international hypoparathyroidism guideline, published in 2022, proposed extending this limit to twelve months⁷, recognizing that functional recovery may be slower in specific contexts.
Copyright (c) 2025 Rafaela Mendes Battiferro, Felipe Ferraz Magnabosco, Marília D'Elboux Guimarães Brescia, Delmar Muniz Lourenço Junior, Fábio Luiz de Menezes Montenegro https://creativecommons.org/licenses/by-sa/4.0
Registration of the epidemiological and cunctional clinical profile of patients post traumatic brain injury at a high complexity hospital in the interior of the state of São Paulo
Traumatic Brain Injury (TBI) results from physical forces that cause brain lesions and functional impairment. Although the Glasgow Coma Scale (GCS) is widely used, it fails to capture all neurological deficits, leading to the development of the Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI), based on the NIHSS and designed to assess post-TBI sequelae. This prospective study aimed to create a clinical registry of TBI cases at FSCMF (Franca, São Paulo, Brazil), characterize the clinical and functional profile of patients, and analyze predictive factors for six-month outcomes. Adults with TBI admitted between October 2023 and December 2024 were included. Clinical assessments were conducted at admission, during hospitalization, and six months after discharge using the GCS, NOS-TBI, TICS-M, Modified Rankin Scale, and Edinburgh Handedness Inventory. The final sample consisted of 40 patients, predominantly male (72.5%), with a median age of 51 years. The main causes of TBI were traffic accidents (44.7%) and falls (31.6%). Regarding severity, 70% had mild TBI, 12.5% moderate, and 17.5% severe. The NOS-TBI demonstrated excellent internal consistency (α>0.9) and high interrater reliability (K>0.8), with perfect agreement in some items (K=1). Despite the strong reliability of the scale, only nine patients completed the six-month follow-up, limiting the analysis of functional outcomes. Most showed satisfactory recovery, although severe TBI, older age, and high-impact trauma mechanisms were associated with poorer prognosis. This study reinforces the utility of the NOS-TBI as a sensitive tool for early identification of neurological deficits and as a complement to the GCS. Difficulties in patient follow-up highlight the need to improve post-discharge tracking strategies and strengthen the integration of care within the Brazilian Unified Health System (SUS).
Copyright (c) 2026 Leonardo Ribela de Alvarenga, Mariana de Oliveira Lima, Giovanna Dorneles e Silva, Maria Júlia Sindou Siqueira https://creativecommons.org/licenses/by-sa/4.0
Therapeutic Management of Exocrine Pancreatic Insufficiency in Patients with Cystic Fibrosis: An Integrative Review
The study analyzed evidence on therapy for exocrine pancreatic insufficiency in patients with cystic fibrosis, based on a search conducted in the PubMed and Virtual Health Library (Biblioteca Virtual de Saúde) databases. Studies published between 2019 and 2024 were included, resulting in a final selection of 48 articles, 24 of which focused on therapeutic interventions. The management of pancreatic insufficiency relies on three pillars: pancreatic enzyme replacement therapy (PERT), nutritional support, and continuous monitoring. PERT is essential for correcting malabsorption, utilizing enzymes derived from pigs, but it faces challenges such as patient adherence and variability in treatment response. The need to take multiple capsules and errors in administration are obstacles that require ongoing follow-up. Nutritional support is crucial, involving high-calorie diets and supplementation with fat-soluble vitamins. Despite the importance of nutrition, patient adherence to interventions remains low. CFTR modulators, such as ivacaftor, have emerged as innovative alternatives, but treatment discontinuation reverses the benefits, highlighting the need for further research. The article underscores the importance of integrated and personalized strategies for managing pancreatic insufficiency in cystic fibrosis.
Copyright (c) 2025 Helena Meurer Heidemann, Laís Corrêa de Carvalho, Bruna Eduarda Weirich, Yasmin Guimarães Rodrigues https://creativecommons.org/licenses/by-sa/4.0
Aspecto linear da hanseníase borderline em paciente do sexo feminino: uma apresentação atípica de lesão no tegumento
Leprosy is a chronic infection influenced by the immune response of each host, and its inflammatory immunopathology can present both neural and dermatological manifestations. This case involves a 17-year-old female patient, phototype IV, diagnosed with leprosy, who developed a hypochromic, erythematous, infiltrated linear plaque along the ulnar pathway, accompanied by claw hand deformity in the right upper limb. Additionally, complementary examinations, including histopathological analysis, confirmed the diagnosis of borderline leprosy. During the second month of clinical follow-up, the patient’s β-HCG test returned positive, indicating pregnancy. Literature suggests that the heterogeneous cutaneous presentation observed in DD leprosy reflects an intensely variable immune response, with lesions oscillating between the multibacillary and paucibacillary poles of the disease spectrum. This leprous lesion exhibits a unique aspect not documented in the literature, highlighting the need for further investigation into these diverse manifestations in order to prevent misdiagnosis and facilitate early treatment.
Copyright (c) 2025 Nivin Mazen Said, Airton Kenji Motizuki, Nirlando Igor Fróes Miranda, Marília Brasil Xavier https://creativecommons.org/licenses/by-sa/4.0
Association between glucose homeostasis and mental disorders in type 1 diabetic patients
Introduction: Type 1 diabetes mellitus (DM1) is a disease characterized by autoimmune degeneration of insulin-producing pancreatic cells. Thus, glycemic control in DM1 patients is difficult to achieve due to a complete insulin deficiency. Hyperglycemia, hypoglycemia, and ketoacidosis are common complications of DM1, and the stress of living with these disorders has been associated with detrimental effects on mental health and quality of life. Objective: The study aimed to evaluate the quality of life and mental health of community-dwelling patients with DM1. Method: This was an analytical cross-sectional study involving adults with DM1. Mental health was assessed using the Depression Anxiety and Stress Scale (DASS-21) and the Quality of Life Assessment Questionnaire (SF-36). Results: Significant correlations were observed between elevated glycated hemoglobin (HbA1c) levels and worse quality of life indices, as well as higher levels of anxiety, stress, and depression. Complications of DM1 impact mental health, increase cardiovascular risks, hospitalizations and healthcare costs, and reduce life expectancy and quality, treatment adherence, and the adequate glycemic control. Conclusion: The research highlights the importance of screening for mental disorders in patients with type 1 diabetes to promote treatment adherence and prevent complications.
Copyright (c) 2025 Karen Coelho, Lucas Gomes de Souza, Mariana Soares Gaudio, Letícia Medeiros de Oliveira, Maria Paula Maia Mariano, Aline Bomfim Madeira, Gabriela Leandro Alves, Aluana Santana Carlos, Joana da Costa Pinto d’Avila https://creativecommons.org/licenses/by-sa/4.0
Burnout syndrome's impact on hospital pharmacists in a brazilian state during the covid-19 pandemic
Burnout Syndrome is characterized by emotional and physical exhaustion resulting from chronic occupational stress and is prevalent among healthcare professionals. This study aims to identify the presence of Burnout Syndrome and classify its levels among pharmacists working in hospital pharmacies in the state of Espírito Santo, Brazil. This interventional, descriptive, and cross-sectional study was conducted in three stages: pre-questionnaire, intervention through weekly message delivery via WhatsApp, and post-questionnaire. The initial sample consisted of 31 pharmacists, 74% of whom were female, with a mean age of 36 years. In the pre-questionnaire, 61.3% of participants showed high levels of Emotional Exhaustion, 54.8% high levels of Depersonalization, and 67.7% high levels of Personal Accomplishment. Women presented moderate to high levels of Personal Accomplishment, while men predominantly reported high levels, with no statistically significant difference between sexes. Variables such as age group, weekly working hours, work shift, use of personal protective equipment (PPE), training, and changes in sleep patterns were also analyzed, with no relevant statistical associations found. The intervention was adhered to by 11 pharmacists, and the post-questionnaire was completed by 10 participants. When comparing scores before and after the intervention, no statistically significant differences (p≥0.05) were observed in the dimensions of Emotional Exhaustion, Depersonalization, and Personal Accomplishment. Although no statistically significant results were found after the intervention, the data reveal high levels of emotional strain among these professionals, highlighting the urgent need for occupational health promotion strategies for hospital pharmacists, as well as further studies on Burnout Syndrome in this specific context.
Copyright (c) 2025 Liliani Travezani Martins, Marcelita França Marques, Mônica Cola Cariello Brotas Corrêa, Denise Coutinho Endringer https://creativecommons.org/licenses/by-sa/4.0
Analysis of the profile of gynecological and obstetric procedures in a hospital in the Vale do Jequitinhonha
Epidemiology is essential for assessing the quality and adequacy of healthcare services and becomes even more relevant in the Jequitinhonha Valley (Minas Gerais - MG), where there is a significant disparity in cultural wealth and economic reality. This article aimed to explore the epidemiological profile of patients who underwent gynecological and obstetric surgeries in the city of Gouveia, MG. The study was conducted through the analysis of medical records of obstetric and gynecological surgeries in the mentioned city between the years 2020 and 2023, with the aim of analyzing the performed interventions, age, race, and other parameters. Of the 272 medical records, 92.5% corresponded to gynecological procedures, while only 1.4% were obstetric. Among these, the predominant age group was 41 to 50 years. Regarding race, the vast majority self-identified as mixed-race, accounting for 73.1% of the patients. The two most performed procedures in the hospital in question were hysterectomy, representing 26.1% of cases, and tubal ligation, with 25.7%, followed by procedures such as semiotic curettage (with and without cervical dilation), type 3 cervical excision, and colpoperineoplasty. Additionally, 99.2% of the procedures were covered by the Sistema Único de Saúde (SUS) (Brazil’s Unified Health System). Based on this, there is a noticeable demand for family planning among women in the region, particularly those who self-identify as black, through permanent procedures. Furthermore, the real accessibility of healthcare services for the entire female population in the area can be questioned, considering that there are 5,746 women but only 272 procedures recorded for the period. Thus, this study highlights the need for further research on the population and the procedures performed, in order to develop new policies and protocols aimed at increasing inclusion, accessibility, and the quality of care for all women who rely on this healthcare system.
Copyright (c) 2025 Bárbara Silva Vicentini, Letícia Couto Freitas, Breno Wesley da Cunha Oliveira, Bruna Fonseca dos Santos, Laryssa Balmant Lima, Letícia Leite dos Santos, Maria Isabel Martins de Castro, Bianca Cristina Lopes da Silva, Ramon Wellison da Silva Leite https://creativecommons.org/licenses/by-sa/4.0
Evaluation of the prevalence and prognosis of the association between subclinical hypothyroidism and heart failure in hospitalized elderly patients
Subclinical hypothyroidism (SCH) presents as raised TSH with normal free T4. It may be associated with long-term cardiovascular complications, such as heart failure (HF), although this relationship remains uncertain. This study aims to better understand the association between SCH and HF, focusing on prevalence and prognosis in hospitalized elderly patients. This is a retrospective, cross-sectional observational study conducted with patients aged ≥ 60 years hospitalized with HF in a cardiology reference hospital. TSH levels and additional tests were assessed in 241 elderly patients who met the study's inclusion and exclusion criteria. The mean age of the participants was 70.59 years, with the majority being male and of mixed ethnicity. SCH was present in 15.8% of the participants, and in-hospital mortality occurred in 9.5%. Although the mean left ventricular ejection fraction (LVEF) was lower in the SCH group, the difference between the groups was not statistically significant. Notably, 18.4% of patients with SCH died during hospitalization, compared to 7.9% in the control group; however, this difference was also not statistically significant. Therefore, in elderly patients hospitalized for heart failure, the presence of HSC did not result in worse laboratory and imaging test outcomes, nor in more severe clinical outcomes.
Copyright (c) 2025 Paulo Daniel Medeiros Braulino, Mathaus Matos Santos, Bianca Xavier Torres Ferreira, Humberto Caldas de Oliveira Melo, Luiz Henrique Maciel Griz, Irina Gomes Maia Maia, Athina Gomes Maia, Luiz Felipe Nunes Palhares https://creativecommons.org/licenses/by-sa/4.0
Tranexamic acid in postpartum hemorrhage: clinical evidence and its use in prophylaxis and treatment
Introduction: Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide. In this context, tranexamic acid (TXA), an antifibrinolytic agent, has been studied as an effective strategy for the prevention and management of PPH. The impact of PPH is significant, especially in low- and middle-income countries, where limited access to emergency obstetric care contributes to increased maternal morbidity and mortality. Therefore, investigating accessible and easily administered therapies, such as TXA, is essential for improving clinical protocols and enabling favorable maternal outcomes. Objective: To evaluate the efficacy of TXA in the prophylaxis and treatment of PPH. Methods: This is an integrative literature review conducted in March 2025, with searches in the PubMed and WHO ICTRP databases. In the PubMed database, the search strategy used the descriptors ("Tranexamic Acid"[Mesh] OR "Tranexamic Acid/therapeutic use"[MAJR] OR "TXA"[tiab]) AND ("Postpartum Hemorrhage"[Mesh] OR "Postpartum Hemorrhage/drug therapy"[MAJR] OR "Obstetric Hemorrhage"[tiab]). Randomized clinical trials published in English between 2020 and 2025 were included. In the WHO ICTRP, a search was conducted with the descriptor "tranexamic acid," using the "With results only" filter, yielding 77 articles (28 from PubMed and 49 from WHO ICTRP). After screening by title and abstract, and full-text reading, 7 clinical trials were included. Additionally, one study was manually added due to its exceptional historical relevance, totaling 8 articles for analysis. Variables were collected using a previously validated form. Results: Based on this data, prophylaxis studies consistently demonstrated that TXA, administered before cesarean incision or after vaginal delivery, significantly reduced blood loss and/or the incidence of PPH. However, the impact on reducing the need for blood transfusion was not uniformly significant in these prophylactic studies, with no statistical difference reported. Regarding the treatment of established PPH, a large-scale clinical trial showed a significant reduction in mortality from bleeding when TXA was administered early (ideally within the first three hours), but it did not find a significant reduction in the hysterectomy rate. In contrast, a later study focusing on women with PPH and pre-existing moderate to severe anemia found no benefit of TXA in reducing the progression to severe PPH or in bleeding-related mortality in this specific subpopulation. None of the eight studies analyzed reported a significant increase in thromboembolic events associated with TXA use, and there was no evidence of an increase in puerperal infections. Conclusion: This review indicates that TXA selectively improves maternal prognosis. In prophylaxis, it consistently reduces blood loss, although its impact on reducing transfusions is less clear. In the treatment of established PPH, the medication may decrease mortality from bleeding, but this benefit was not confirmed in anemic women, and the effects on transfusions or surgical interventions were inconsistent. The validation of these approaches through future studies is crucial for the development of safer and more effective clinical guidelines.
Copyright (c) 2026 Maria Eduarda Furieri Machado, Manuela Vilela de Freitas Drumond, Yasmin Ramos Marianelli, Laura Miranda Zandonade, Tainá Goes Pires Kuster, Simone Karla Apolonio Duarte, Hudson Pereira Pinto, Julianna Vaillant Louzada Oliveira, Ludmila Vittoraci Bernardi https://creativecommons.org/licenses/by-sa/4.0
Clinical and epidemiological profile, anesthetic-surgical procedure, and clinical outcomes of neurosurgical patients
Background: Neuroanesthesia and neurosurgery are crucial approaches for managing pathologies of the human nervous system, responsible for minimizing the severity of pain, physical limitations and cognitive-functional impairment. In view of this question, this study aims to describe the clinical-epidemiological profile, anesthetic-surgical procedure, postoperative pain management and clinical evolution. Methods: Descriptive cross-sectional study conducted at a tertiary hospital, involving patients undergoing elective neurosurgery from January 2020 to December 2022, with data collected from electronic medical records. Results: In the sample (n=171), males were predominant (53.8%), aged between 60 and 69 years (21.0%; mean 56.1 ± 2.5 years), white skin color (94.2%), current or previous smoking (33.9%), alcohol consumption (55.6%), non-eutrophic (60.4%), comorbidities (94.2%) and previous surgeries (86.0%). In the anesthetic-surgical procedure, preoperative hospitalization duration was 1 day (46.8%), surgical time ranged between 61 and 120 minutes (26.9%), cranial surgical site (56.7%), with cranioplasty (31.0%), general anesthesia (90.6%), orotracheal intubation (90.6%) and dorsal decubitus (77.1%). Hemocomponent reserve and transfusion occurred in, respectively, 40.4% and 26.3% of procedures. Regarding clinical evolution, the total duration of hospitalization (33.9%; mean 8.7 ± 1.8 days) and preoperative (41.5%; mean 6.4 ± 1.1 days) was between 4 and 5 days, intensive care unit admission (17.0%), hospital discharge (90.1%), and death (2.3%) were highlighted. Conclusion: Elective neurosurgical patients are predominantly men aged 60 to 69 years with non-eutrophic nutritional status, comorbidities, and previous surgeries, undergoing cranial procedures with general anesthesia, orotracheal intubation, multimodal postoperative analgesia, and hospital discharge.
Copyright (c) 2026 Shana Ginar da Silva, Lucas Dalla Maria, Ivana Loraine Lindemann, Eugenio Pagnussatt Neto https://creativecommons.org/licenses/by-sa/4.0
Subacute granulomatous thyroiditis mimicking thyroid carcinoma: diagnostic challenges
Background: Subacute granulomatous thyroiditis (SGT) is a self-limiting inflammatory disease of the thyroid gland, often associated with viral infections. It is typically diagnosed through clinical and laboratory evaluation, although ultrasonography can be a useful adjunct. However, the most common ultrasonographic finding—nodular hypoechoic areas—may raise suspicion for other pathologies, such as thyroid carcinoma. Case Description: A 34-year-old female patient presented with neck pain and progressive odynophagia. Thyroid ultrasound and cytology revealed a suspicious thyroid nodule. Ultrasonography showed a nodule in the right lobe measuring 1,4cm x 1,8cm x 0,6cm, with increased Doppler vascularity, and fine-needle aspiration cytology was classified as Bethesda V, suggestive of neoplasia. A right lobectomy was performed, and histopathological examination confirmed the diagnosis of SGT. Discussion: Although SGT is a benign condition, its clinical and cytological features may mimic those of thyroid carcinoma, posing a diagnostic challenge that may require more invasive procedures for histopathological evaluation and clinical decision-making. Histopathological findings such as the presence of giant cells, follicular atypia, and inflammatory patterns can lead to suspicion of malignancy. Recognizing this entity in histopathological analysis is essential. Conclusion: It is important to correlate clinical, laboratory, and imaging findings in the evaluation of thyroid nodules, especially in the presence of cytological features suggestive of malignancy. In this context, considering SGT as part of the differential diagnosis is crucial to guide appropriate therapeutic decisions.
Copyright (c) 2025 Milena Leite de Oliveira, Michel Antonio Kiyota Moutinho, Roberta Teixeira de Moraes, Lucimar Retto da Silva de Avó, Débora Gusmão de Melo, Carla Maria Ramos Germano, Victor Hugo Maion https://creativecommons.org/licenses/by-sa/4.0
Effects of exposure to a short video excerpt from a medical fiction film on the empathic performance of medical students at a private university center in Minas Gerais
Introduction: Empathy is a multidimensional competence, encompassing cognitive and emotional components, essential to medical practice and amenable to development through pedagogical strategies. This study evaluated the impact of a brief fictional audiovisual stimulus on the empathic performance of medical students. Methods: Cross-sectional study with 224 students (1st–12th term) from a university center in Minas Gerais, Brazil (REC/UNIFAGOC Report No. 6,245,274), divided into exposed (n=92) and non-exposed (n=70) groups to a 1min37s video. Cognitive empathy was assessed using the Reading the Mind in the Eyes Test (0–36 points) and analyzed by Poisson regression. Results: After exclusions, 162 participants (F=111; M=51; 25.3±6.9 years) were analyzed. Women scored higher than men (27.3±3.5 vs. 24.7±4.0; p<0.001). Video exposure increased female scores (27.8±3.0 vs. 26.7±3.9) and reduced male scores (23.9±4.2 vs. 26.1±3.2). Best performance occurred between 20–40 years. The gender×exposure interaction was significant (β=-0.131; p=0.007). Conclusion: Empathic performance varied by gender, age, and video exposure, suggesting that short audiovisual interventions may benefit specific groups. Continuous, tailored pedagogical strategies may enhance empathy development in medical education.
Copyright (c) 2026 Vitória Carneiro Larocca Almeida, Júlia de Almeida Peixoto, Gean Pereira Damaceno, João Domingos Scalon, Puebla Cassini Vieira https://creativecommons.org/licenses/by-sa/4.0
Abscesso parafaríngeo compressivo pós-exodontia em adolescente
Abscessos periodontais são infecções agudas dos tecidos de suporte dentário, frequentemente associadas à progressão de periodontites ou a procedimentos odontológicos. Essas infecções podem evoluir rapidamente, acometendo espaços cervicofaciais profundos e levando a complicações graves, como obstrução de vias aéreas. O diagnóstico precoce e o manejo multidisciplinar são fundamentais para prevenir desfechos adversos.Relato de Caso: Paciente do sexo feminino, 16 anos, previamente saudável, procurou atendimento de emergência com dor intensa e inchaço na hemiface esquerda há cinco dias. Dez dias antes, havia apresentado dor dentária e realizado extração do terceiro molar inferior esquerdo. O procedimento ocorreu sem intercorrências e foi prescrita amoxicilina com clavulanato. Apesar do uso correto do antibiótico, evoluiu com piora do quadro local, sem sintomas sistêmicos. No exame, apresentava sinais flogísticos em região submandibular esquerda. Tomografia computadorizada revelou infecção periapical do primeiro molar inferior, erosão da mandíbula e coleção purulenta extensa, ocupando espaços bucal e submandibular, com compressão da via aérea e extensão para o espaço parafaríngeo. Foi indicada internação para drenagem cirúrgica do abscesso. No pós-operatório imediato, apresentou edema facial, trismo e pequena secreção, sem dor significativa. Iniciou-se antibioticoterapia intravenosa com ceftriaxona e clindamicina, além de corticoterapia. Evoluiu bem, recebendo alta após três dias, com prescrição de sintomáticos e antibiótico oral. No retorno ambulatorial, apresentava cicatrização adequada e discreto edema residual.Discussão: Abscessos odontogênicos podem evoluir rapidamente e atingir espaços cervicofaciais profundos, mesmo em pacientes jovens e saudáveis. O diagnóstico por imagem e a intervenção cirúrgica precoce são essenciais para evitar complicações graves. A antibioticoterapia adequada, aliada à drenagem do abscesso, garante bom prognóstico. A orientação e o acompanhamento do paciente são fundamentais para prevenir recorrências e complicações.
Copyright (c) 2025 Tiago Choi, Rodrigo Frati, Brenda Martines https://creativecommons.org/licenses/by-sa/4.0
Volvo intestinal: apresentação clínica e abordagem terapêutica
O volvo de sigmóide é uma emergência clínica que representa de 2 a 5% das obstruções intestinais em adultos. Caracteriza-se pela torção do cólon sigmóide, levando à isquemia e potencial necrose tecidual se não tratada rapidamente. O diagnóstico precoce e a intervenção cirúrgica oportuna são fundamentais para o prognóstico. Este relato descreve a apresentação clínica e o manejo cirúrgico de uma paciente idosa com volvo de sigmóide. Relato de Caso: Uma mulher de 76 anos procurou atendimento após três dias de distensão abdominal progressiva e vômitos biliosos. Relatou episódios de diarreia líquida, sem sangue ou muco. Ao exame físico, encontrava-se em mau estado geral, com abdome distendido, timpânico e ruídos hidroaéreos diminuídos. A tomografia computadorizada de abdome mostrou imagem sugestiva de volvo de sigmóide, com torção de 360° e sinal do “grão de café”, além de dilatação colônica proximal. Devido ao quadro clínico e ao estado geral comprometido, foi realizada laparotomia exploradora emergencial, que confirmou alça sigmóide desserosada, porém sem sinais de isquemia. Realizou-se retossigmoidectomia com técnica de Hartmann, incluindo ressecção do cólon sigmóide, colostomia terminal no cólon descendente e fechamento do reto residual. No pós-operatório, a paciente recebeu hidratação venosa, correção de distúrbios hidroeletrolíticos e analgesia, tendo alta hospitalar no vigésimo sétimo dia, com seguimento ambulatorial. Discussão: O volvo de sigmóide é causa frequente de obstrução intestinal em idosos, resultando da torção do cólon ao redor do seu eixo mesentérico. O tratamento inicial, na ausência de peritonite ou perfuração, é a descompressão endoscópica, geralmente por sigmoidoscopia flexível. Quando há sinais de isquemia, perfuração ou falha da descompressão, a intervenção cirúrgica é indicada. A colectomia sigmóide é recomendada em casos de recorrência ou complicações. A avaliação anatômica pode identificar pacientes em risco, e a cirurgia precoce contribui para melhores desfechos, especialmente em idosos ou portadores de comorbidades.
Copyright (c) 2025 Taciana Pereira Boog Betoni, Brenda Martines, Rodrigo Frati, Hian Vechiato Betoni, Gabriel Petrin Alonso, Vitor de Paula Casagrande https://creativecommons.org/licenses/by-sa/4.0
Volvo gástrico associado à hérnia hiatal gigante: relato de caso e manejo cirúrgico
Volvo gástrico é uma condição rara e potencialmente grave, caracterizada pela rotação do estômago, que pode causar obstrução e comprometimento vascular. A hérnia hiatal gigante, com aumento significativo do hiato diafragmático, é um importante fator predisponente, pois permite a migração e rotação do estômago para a cavidade torácica. O diagnóstico precoce e o tratamento cirúrgico são essenciais para evitar complicações severas, como necrose e perfuração gástrica. Este relato descreve um caso de vólvulo gástrico associado à hérnia hiatal gigante, abordando apresentação clínica, diagnóstico e tratamento.Relato de Caso: Um homem de 59 anos apresentou vômitos persistentes e parada da eliminação de gases e fezes há quatro dias. A tomografia de tórax e abdome revelou volumosa hérnia gástrica pelo hiato esofágico, com sinais de vólvulo gástrico mesentero-axial. A endoscopia digestiva alta, mostrou desvio do eixo do estômago, rotação e estase líquida, com progressão do endoscópio apenas até o corpo médio.O paciente foi submetido a uma laparotomia supraumbilical, que confirmou volvo gástrico com rotação a partir da grande curvatura, direcionada ao tórax. O hiato diafragmático apresentava diâmetro superior a 10 cm, caracterizando hérnia hiatal gigante, mas o estômago não apresentava sinais de isquemia ou necrose. Realizou-se redução gástrica, lise de aderências, sutura da crura diafragmática e confecção de válvula antirrefluxo. O pós-operatório transcorreu sem intercorrências, e o paciente evoluiu bem, com progressão da dieta líquida no segundo dia. Discussão: O vólvulo gástrico é uma emergência cirúrgica que pode evoluir para isquemia e necrose se não tratado rapidamente. A hérnia hiatal gigante facilita a rotação gástrica, sendo fator predisponente importante. Os sintomas clássicos incluem vômitos, dor abdominal e parada da eliminação de gases e fezes. O diagnóstico é confirmado por tomografia e endoscopia, que também avaliam lesões secundárias, como úlceras por estase. A ausência de sofrimento gástrico permitiu uma abordagem cirúrgica conservadora.
Copyright (c) 2025 Nicholas Koterba, Brenda Martines, Rodrigo Frati https://creativecommons.org/licenses/by-sa/4.0
Volvo de sigmóide e comorbidade psiquiátrica: relato de caso de um paciente com transtorno do espectro autista
O volvo de sigmóide ocorre pela torção de um segmento do sigmóide sobre seu próprio eixo, podendo causar obstrução intestinal, isquemia e perfuração. O diagnóstico precoce, baseado na clínica de abdome agudo obstrutivo e exames de imagem, é fundamental para o sucesso do tratamento. As opções terapêuticas incluem métodos conservadores, como enema e colonoscopia, e intervenção cirúrgica, indicada diante de sinais de complicação. Relato de Caso: Um homem de 58 anos deu entrada com distensão abdominal progressiva há dois dias, associada à piora do estado geral e recusa alimentar, sem vômitos ou parada confirmada de fezes e flatos. Apresentava antecedentes de constipação crônica e transtorno do espectro autista, em uso de olanzapina, sem cirurgias prévias. No exame físico, encontrava-se em estado geral regular, hemodinamicamente estável, com abdome distendido, ruídos aumentados e ampola retal vazia. Suspeitou-se de abdome obstrutivo. A sonda nasogástrica apresentou débito fecalóide. Exames laboratoriais mostraram lactato elevado (62 mmol/L) e bicarbonato baixo (15 mEq/L). A tomografia computadorizada abdominal evidenciou dilatação colônica acentuada no sigmóide, com pneumatose intestinal. Diante dos sinais de isquemia, indicou-se laparotomia de urgência. A cirurgia revelou distensão do cólon e isquemia no sigmóide, confirmando volvo complicado. Realizou-se colectomia total com ileostomia terminal. O paciente evoluiu bem, inicialmente na UTI, com posterior transferência para enfermaria.Discussão: O volvo de sigmóide acomete principalmente homens idosos, com fatores de risco como constipação e doenças neuropsiquiátricas, presentes neste caso. A tomografia abdominal é o exame padrão, com alta sensibilidade e especificidade, permitindo identificar complicações como isquemia. O tratamento varia conforme a gravidade; casos com sinais de peritonite, perfuração ou isquemia exigem cirurgia, enquanto a abordagem endoscópica pode ser eficaz em situações menos graves. A presença de sinais clínicos e radiológicos de isquemia neste paciente justificou a intervenção cirúrgica imediata.
Copyright (c) 2025 Eduardo Gallon, Marina Imamura Ibanez, Laura Fernandes Berto, Rodrigo Flores Escudero Nunes, Rodrigo Frati https://creativecommons.org/licenses/by-sa/4.0
Volvo de ceco de apresentação atípica: relato de caso
O volvo de ceco é a torção do ceco móvel e do cólon ascendente, responsável por cerca de 1 a 3% das obstruções do intestino grosso. Se não tratado, pode evoluir para isquemia, necrose ou perfuração intestinal. Embora o volvo possa ocorrer em outras partes do trato digestivo, o ceco e o cólon sigmóide são os locais mais comuns. Existem três tipos de volvo cecal, classificados conforme o padrão de torção e deslocamento do ceco. Relato de Caso: Uma paciente feminina de 37 anos apresentou dor abdominal persistente por quatro dias, associada à parada de eliminação de flatos e fezes nas últimas 24 horas, além de vômitos biliosos. No pronto-socorro, o exame físico revelou abdome distendido e dor localizada em flanco e hipocôndrio direito. Considerando a hipótese de abdome agudo obstrutivo, realizou-se tomografia de abdome, que evidenciou volvo de ceco com torção do mesentério. Os exames laboratoriais apresentaram leucócitos de 9.650/mm³, hemoglobina de 14,0 g/dL e PCR de 8 mg/L, sem alterações significativas. A paciente foi submetida a uma laparotomia exploradora. Durante a internação, apresentou boa evolução clínica, sem intercorrências, e recebeu alta no sexto dia pós-operatório, com acompanhamento laboratorial adequado.Discussão:Este caso ilustra que o volvo de ceco pode causar complicações graves, como perfuração intestinal, exigindo intervenção cirúrgica imediata. Por ser uma condição rara, o diagnóstico pode ser desafiador, o que reforça a importância da suspeita clínica e do uso de exames de imagem, especialmente a tomografia. Relatar casos como este contribui para ampliar o conhecimento sobre a doença, facilitando diagnósticos mais rápidos e tratamentos eficazes, prevenindo complicações e melhorando o prognóstico dos pacientes.
Copyright (c) 2025 Bruno Verri Jardine, Marina Ramos Gonçalves, Gabriella Ramos Martines, Rodrigo Frati, Brenda Martines https://creativecommons.org/licenses/by-sa/4.0
Úlcera gástrica perfurada com abordagem cirúrgica: um relato de caso
A perfuração de víscera oca é uma emergência abdominal grave, frequentemente associada a úlcera péptica, uso de anti-inflamatórios não esteroidais (AINEs) e condições como doença do refluxo gastroesofágico (DRGE). O uso de cocaína pode provocar complicações gastrointestinais severas devido à vasoconstrição intensa e isquemia, embora a perfuração gástrica relacionada a essa droga seja rara e pouco documentada. Relato de Caso: Um paciente masculino, previamente saudável e usuário de cocaína, apresentou dor abdominal súbita há três dias, iniciando no epigástrio e irradiando para todo o abdome, com intensidade progressiva e nota 10/10. Referiu episódio de vômito noturno, sem uso de AINEs ou histórico de úlcera péptica ou DRGE. No exame físico, encontrava-se em bom estado geral, com abdome em tábua e dor difusa, mais intensa no epigástrio. Os exames laboratoriais mostraram leucocitose (20.250/mm³) com neutrofilia (90,9%), hemoglobina 15,2 g/dL e discretos aumentos de amilase e lipase. A tomografia abdominal evidenciou pneumoperitônio, sinais de peritonite e área sugestiva de úlcera perfurada na região antropilórica. Realizou-se laparotomia exploradora, que revelou líquido seroso turvo e processo inflamatório na região pilórica, com epíplon aderido, mas sem perfuração visível mesmo após manobra de inspeção detalhada. O paciente evoluiu bem no pós-operatório, com estabilidade hemodinâmica, controle da dor, aceitação progressiva de dieta e alta no quarto dia, sob antibioticoterapia. Discussão: Este caso apresenta quadro típico de perfuração de víscera oca, com dor abdominal súbita, peritonite e pneumoperitônio. A cocaína pode induzir vasoconstrição intensa, causando isquemia e predispondo a úlceras e perfurações gastrointestinais. A ausência de perfuração visível na cirurgia sugere microperfurações autolimitadas ou resolução espontânea, especialmente em pacientes jovens e sem comorbidades. A laparotomia exploradora foi crucial para excluir lesão ativa e prevenir complicações sépticas. O manejo clínico e antibiótico adequado permitiu recuperação satisfatória.
Copyright (c) 2025 Mateus Carlos Andrade, Brenda Martines, Enzo Radaic Pastore, Murilo Marcelino Bono, Gabriel Fona Duarte, Rodrigo Frati https://creativecommons.org/licenses/by-sa/4.0
Úlcera gástrica perfurada com complicações abdominais em paciente idoso: relato de caso
A úlcera gástrica perfurada é uma emergência cirúrgica que pode evoluir para peritonite química e infecciosa, apresentando alta morbidade e mortalidade, especialmente em pacientes idosos com comorbidades. O diagnóstico precoce e a intervenção cirúrgica imediata são essenciais para melhorar o prognóstico. Complicações como necrose visceral e comprometimento hemodinâmico agravam o quadro clínico e dificultam o manejo. Relato de Caso:Um homem de 70 anos procurou atendimento relatando dor abdominal difusa, irradiada para o dorso, há quatro dias, associada a hiporexia e náuseas. Dois dias antes da admissão, apresentou anúria, parada da eliminação de flatos e fezes e piora da dor abdominal. Inicialmente, recebeu antibioticoterapia para sepse abdominal, com exames laboratoriais que evidenciaram elevação significativa de amilase e lipase. Ao chegar ao pronto-socorro, encontrava-se hemodinamicamente instável, em uso de noradrenalina, com abdome globoso e doloroso, sem descompressão brusca positiva, e anúrico. A tomografia abdominal revelou descontinuidade parietal no antro gástrico, pneumoperitônio e líquido livre. Durante a internação, evoluiu com choque séptico, livedo, pele pegajosa e rebaixamento do nível de consciência, sendo indicada laparotomia exploratória. No intraoperatório, constatou-se úlcera gástrica de 3 cm acometendo as paredes anterior e posterior, contaminação abdominal grave, necrose do cólon direito e sofrimento vascular no íleo distal. Realizaram grampeamento do estômago, duodeno, cólon e íleo, ligadura do mesentério e omentectomia segmentar, seguida de lavagem e fechamento em peritoneostomia. O paciente foi encaminhado à UTI, permaneceu intubado e em uso de drogas vasoativas, evoluindo a óbito após parada cardiorrespiratória.Discussão:A úlcera gástrica perfurada exige diagnóstico rápido e intervenção cirúrgica imediata para evitar peritonite generalizada, sepse e falência orgânica. A tomografia é fundamental para confirmar o diagnóstico e localizar a perfuração. A necrose visceral associada indica gravidade e rápida evolução para choque séptico. Apesar do manejo agressivo, a mortalidade permanece alta, especialmente em idosos instáveis.
Copyright (c) 2025 Marcos Augusto de Abreu Sandmann, Brenda Martines, Rodrigo Frati, Edson Gabriel Rocha, Fernanda Lopes Mesquita, Paulo José Pouparina Canedo https://creativecommons.org/licenses/by-sa/4.0
Úlcera de aorta ascendente com hematoma e derrame pericárdico: correlação radiológico-cirúrgica de um caso de síndrome aórtica aguda
Síndrome aórtica aguda (SAA) engloba condições potencialmente fatais, como dissecção aórtica, hematoma intramural e úlcera penetrante da aorta. Úlcera penetrante da aorta ascendente, embora menos comum, apresenta alto risco de progressão para dissecção e ruptura. A angiotomografia computadorizada (AngioTC) é o exame de escolha para diagnóstico e planejamento cirúrgico, permitindo avaliar detalhadamente a anatomia aórtica e suas complicações, como hematoma mediastinal e derrame pericárdico. Relato de Caso: Mulher de 70 anos, com hipertensão, dislipidemia e poliglobulia, deu entrada no PS com dor torácica súbita, perda de consciência e vômitos. Recebeu ácido acetilsalicílico no atendimento pré-hospitalar. Na admissão, estava estável, sem dor recorrente. A AngioTC revelou úlcera penetrante na parede medial da aorta ascendente proximal, logo após a junção sinotubular, medindo 2,0x1,4x0,6cm, associada a hematoma mediastinal e derrame pericárdico de 1,6cm. Indicou-se cirurgia de urgência, realizando-se operação de Bentall-De Bono com extensão para hemiarco. Durante o procedimento, identificou-se dissecção atípica tipo A com orifício no seio coronariano direito, e implantou-se tubo valvulado St. Jude. Procedimento apresentou intercorrência no controle da coagulação. No PO a paciente evoluiu com instabilidade hemodinâmica, múltiplas paradas cardiorrespiratórias, acidose metabólica e necessidade de suporte vasoativo, culminando em óbito.Discussão:A úlcera penetrante da aorta resulta da ruptura de placa aterosclerótica com extensão para a camada média, podendo evoluir para hematoma intramural ou dissecção. Clinicamente, apresenta dor torácica súbita semelhante a outras formas de SAA. A AngioTC é superior para identificar localização e extensão da lesão, especialmente na aorta ascendente e mediastino. A presença de derrame pericárdico eleva a suspeita de ruptura iminente, indicando cirurgia emergencial. A cirurgia de Bentall-De Bono é padrão para doenças da raiz aórtica com risco de ruptura. Apesar da intervenção precoce, a mortalidade da SAA tipo A permanece elevada, mesmo em centros especializados.
Copyright (c) 2025 Arthur Murad Vervloet, Júlia Leal Bassan, Taina Shi, ndressa Santos Benati, Rodrigo Frati, Brenda Martines https://creativecommons.org/licenses/by-sa/4.0
Tumor testicular com metástases retroperitoneais e pulmonares: relato de caso
O tumor de testículo, embora raro, é a neoplasia sólida mais comum em homens entre 15 e 35 anos. Sua apresentação clínica típica inclui massa escrotal indolor, embora a dor local possa ocorrer em casos associados a inflamação ou hemorragia intratumoral. Relatamos um caso de tumor testicular com metástases retroperitoneais e pulmonares, destacando a importância do diagnóstico precoce e da abordagem multidisciplinar. Relato do Caso: Paciente masculino, 28 anos, previamente hígido, apresentou dor escrotal e aumento progressivo do volume testicular direito há duas semanas. Negava febre, trauma local ou sintomas urinários. Ao exame físico, identificou-se massa testicular direita endurecida, sem eritema ou calor local. A ultrassonografia Doppler escrotal revelou aumento volumétrico heterogêneo do testículo direito, com vascularização aumentada e ausência de fluxo sugestivo de torção. A tomografia de abdome e tórax evidenciou testículo direito heterogêneo e nódulo pulmonar não calcificado no lobo inferior direito. O paciente foi submetido à orquiectomia radical inguinal direita para diagnóstico histopatológico e estadiamento. Encaminhado à oncologia para quimioterapia baseada e planejamento de linfadenectomia retroperitoneal pós-quimioterápica, caso necessário. Discussão: Este caso ilustra a disseminação linfática e hematogênica característica dos tumores germinativos testiculares. Os linfonodos retroperitoneais são o primeiro sítio metastático, seguidos por pulmões, fígado e cérebro. A dor escrotal, presente neste paciente, ocorre em aproximadamente 20% dos casos, muitas vezes retardando o diagnóstico devido à confusão com orquiepididimite. A ultrassonografia Doppler é essencial para diferenciar massas neoplásicas de processos inflamatórios, enquanto a tomografia define o estadiamento e orienta a terapêutica. A quimioterapia permanece como base do tratamento em estágios avançados, com taxas de cura superiores a 80% mesmo em doença metastática. A linfadenectomia retroperitoneal pós-quimioterápica é indicada para resíduos tumorais >1 cm, visando remover teratoma residual ou carcinoma viável. O relato reforça a necessidade de investigação rápida de massas testiculares.
Copyright (c) 2025 Renan Campos Vieira, Brenda Martines, Rodrigo Frati https://creativecommons.org/licenses/by-sa/4.0
Ressecção cirúrgica ampliada e reconstrução microcirúrgica em fibrossarcoma epitelioide esclerosante recidivado de cavidade nasal: relato de caso
O fibrossarcoma epitelioide esclerosante (FEE) é uma neoplasia mesenquimal rara e agressiva, caracterizada por crescimento lento, alta taxa de recidiva local (até 50%) e potencial metastático tardio. O acometimento da região nasofacial é incomum e apresenta desafios diagnósticos e terapêuticos devido à complexidade anatômica e proximidade de estruturas nobres, como órbitas e base do crânio. O tratamento de escolha é a ressecção cirúrgica com margens amplas, frequentemente associada à radioterapia adjuvante, embora o tumor tende a recidivar precocemente.Relato de Caso: Um paciente masculino de 30 anos, sem comorbidades prévias, apresentou em 2023 uma massa progressiva e indolor no dorso nasal direito, com desconforto estético e obstrução nasal. Em janeiro de 2024, realizou ressecção cirúrgica inicial, evidenciando invasão óssea e comprometimento da derme profunda. O exame anatomopatológico confirmou fibrossarcoma epitelioide esclerosante com margens comprometidas. Recebeu radioterapia adjuvante em 25 frações. Menos de oito meses depois, apresentou recidiva local agressiva, com tumoração volumosa, dor intensa e rápida progressão. Em janeiro de 2025, submeteu-se a frontoetmoidectomia associada à maxilectomia bilateral, seguida de reconstrução microcirúrgica com retalho livre anterolateral da coxa direita (ALT). Discussão O FEE apresenta crescimento infiltrativo e alta recidiva precoce, com potencial metastático para pulmões, ossos e sistema nervoso central. A matriz esclerosante densa dificulta o diagnóstico, podendo ser confundida com carcinomas ou linfomas. A ausência de marcadores imunohistoquímicos específicos torna o manejo clínico desafiador. A cirurgia com ressecção ampla e margens negativas é a principal forma de controle, pois quimioterapia e radioterapia apresentam eficácia limitada devido à biologia tumoral resistente e à matriz fibrosa que dificulta a penetração de drogas e oxigenação tecidual. O retalho ALT proporcionou reconstrução funcional e estética eficaz, com vantagens como vascularização confiável, grande área de tecido disponível, moldagem versátil e baixa morbidade da área doadora.
Copyright (c) 2025 Valdemir de Carvalho dos Santos, Alexandre Bezerra dos Santos https://creativecommons.org/licenses/by-sa/4.0