Cardiovascular monitoring: clinical applications of technologic advancements

Increasing senescence is leading to increased incidence of cardiovascular disease in the surgical population. Because of advances in technology, extensive cardiovascular monitoring is increasingly available, and guidelines for monitoring are being developed. An understanding of the cardiac risk of the patient allows proper choice of monitors. Several advances have been made in the monitoring of blood pressure, myocardial ischemia, infarction, arrhythmias, and various systemic parameters. The large-scale studies necessary to elucidate the impact of monitoring on clinical outcome have yet to be conducted.     

Cutaneous hemangioma: clinical aspects

Infantile cutaneous hemangioma is a benign vascular tumour present at 10% of the infants. It forms part of the group of the vascular tumours in the classification of International Society for Vascular Anomalies (ISSVA). Clinical diagnosis is easy in its triphasic typical form with a phase of sometimes brutal postnatal growth, a phase of stabilization and a phase of slow secondary regression. Classically, it is presented in the form of a mass or stains cutaneous red, of a subcutaneous mass or, generally, of a mixed form associating the two aspects.     

Visceral leishmaniasis in renal transplant recipients: clinical aspects, diagnostic problems, and response to treatment

Visceral leishmaniasis (VL) is a parasitic infection that uncommonly affects renal transplantation recipients, even in endemic areas. It may be associated with other infections, or masked by these, and may present subclinically and/or atypically for extended periods. The evolution may be particularly severe and diagnosis is often delayed. If not adequately diagnosed and treated, VL can be fatal and so should be suspected in renal transplantation recipients presenting unexplained fever, splenomegaly, and pancytopenia. The authors report 8 cases of VL out of a total of 800 renal transplant recipients from two transplant hospitals centers in Brazil. The clinical, diagnostic, and therapeutic features are reviewed.     

Human metabolism: pathways and clinical aspects

Metabolism describes the series of chemical reactions that are concerned with the provision of energy to biological systems. They may be divided into reactions involved in energy yield (catabolism: demand exceeds supply), and energy storage (anabolism: supply exceeds demand). Regulation of these pathways is critical for homeostasis, and derangements in metabolism are seen in a wide variety of pathological processes. Understanding metabolism is key to the treatment of many diseases, notably diabetes, as well as underpinning clinical nutritional support.     

Human metabolism: pathways and clinical aspects

Metabolism describes the series of chemical reactions that are concerned with the provision of energy to biological systems. They may be divided into reactions involved in energy yield (catabolism: demand exceeds supply), and energy storage (anabolism: supply exceeds demand). Regulation of these pathways is critical for homeostasis, and derangements in metabolism are seen in a wide variety of pathological processes. Understanding metabolism is key to the treatment of many diseases, notably diabetes, as well as underpinning clinical nutritional support.     

Severe asthma: clinical and pathogenic aspects

Difficult asthma is an uncommon disease (likely < 5% of total asthma). It is poorly understood and often difficult to treat. The first step is to make an accurate differential diagnosis and to avoid the most important factor, which influence the condition of the disease. Between these factors, the exposure to allergens and the gastro-esophageal reflux seems to be the most important. The term is usually applied to conditions that are hard to solve, sometimes dangerous or even life-threatening forms of asthma: corticoid-resistant asthma, corticoid-dependent asthma, brittle asthma, premenstrual asthma and near-fatal asthma.     

Arteriovenous malformations: clinical aspects and evolution

Arteriovenous malformations are rare high-flow malformations. As other malformations, they are present at birth but may remain quiescent for many years; their flow may speed up quickly consequently on an infection, traumatism or modification of the hormonal climate. A "nidus" appears in the heart of the malformation which acts as a real "turbo" on the blood flow; vascular shunts appear creating ulcerations (vascular steal phenomenon); cardiac failure may be observed. Among all vascular anomalies, arteriovenous malformation is the most dangerous in its evolution which may be fatal. Its control requires prudence and skill.     

Neuropsychiatric lupus: clinical and imaging aspects

Neuropsychiatric lupus (NPSLE) manifestations are common in adults and children and are associated with an increase in both morbidity and mortality. Cognitive dysfunction, when standardly assessed using sensitive neurocognitive instruments, is the most common NPSLE manifestation. The pathogenic etiologies of NPSLE manifestations are likely to be multifactorial and may involve autoantibody production, microangiopathy, intrathecal production of proinflammatory cytokines and athersclerosis. It is becoming more clear that the integrity of the blood-brain-barrier is very important in SLE-related neuropathology. Brain imaging is an important tool that allows us to evaluate the living brain. Thus far, anatomic brain imaging has revealed abnormalities such as subcortical white matter lesions and cerebral atrophy, but these findings are non-specific. Methods that evaluate metabolic processes and other functional imaging techniques have more promise as surrogates for central nervous system damage. This article reviews the current literature on clinical and imaging aspects of NPSLE.     

Granulomatous orchitis: clinical and pathologic aspects

3 cases of granulomatous orchitis are described. Treatment consisted of radical inguinal orchiectomy in 2 cases, and biopsy followed by steroid therapy in the 3. The clinical and pathologic aspects of this rare inflammatory disease of the testis are reviewed.     

Parathyroid carcinoma: clinical aspects and therapy

Parathyroid carcinoma is a rare entity with an 0,5-1% of incidence on primary hyperparathyroidism (HPP) in literature. The very high values of calcium and parathormone (PTH) and the clinical aspects of hypercalcemia are the characteristics findings in these patients. We present our experience on 6 pts on 153 cases with HPP treated (3,9%). The clinical and diagnostic suspects are frequently intraoperative findings and the decision making for the surgeon is not always easy (parathyroidectomy with or without hemithyroidectomy, lymphadenectomy, surgical resection of other tissues). The mortality rate is high and we have registered three deaths at 8,14 and 64 months.