CONTEXTO: O transplante ortotópico de fígado (TOF) é o tratamento de escolha em pacientes com doença hepática terminal. A cirrose por hepatite C é a principal indicação de transplante hepático no mundo. No entanto, pacientes transplantados por hepatopatias virais frequentemente apresentam coinfecções, como hepatite B associada a hepatite D. Atualmente, existem diferentes estratégias de manejo em pacientes pré e pós-transplantados conforme diferentes protocolos de conduta de serviços especializados em transplante. RELATO DE CASO: Apresentamos o raro caso de um homem de 58 anos diagnosticado com as hepatites crônicas B, C e D. O paciente evoluiu com cirrose e carcinoma hepatocelular. O tratamento consistiu de terapia antiviral para os três vírus e de transplante ortotópico de fígado. O desfecho do paciente foi satisfatório. CONCLUSÃO: O transplante ortotópico de fígado, associado à terapia antiviral com entecavir antes e após o procedimento, foi eficaz na depuração sustentada dos vírus B e D. A recidiva do vírus C após o transplante respondeu com sucesso ao tratamento padrão com alfapeginterferon 2A e ribavirina.

CONTEXT: Orthotopic liver transplantation (OLT) is the treatment of choice for end-stage liver disease. Cirrhosis due to hepatitis C infection is the leading indication for liver transplantation worldwide. However, patients who are given transplants because of viral liver diseases often present clinical coinfections, including hepatitis B together with hepatitis D. Currently, different strategies exist for patient management before and after liver transplantation, and these are based on different protocols developed by the specialized transplantation centers. CASE REPORT: We present a rare case of a 58-year-old man with chronic hepatitis B, C and D coinfection. The patient developed cirrhosis and hepatocellular carcinoma. His treatment comprised antiviral therapy for the three viruses and OLT. The patient's outcome was satisfactory. CONCLUSION: OLT, in association with antiviral therapy using entecavir, which was administered before and after transplantation, was effective for sustained clearance of the hepatitis B and D viruses. A recurrence of hepatitis C infection after transplantation responded successfully to standard treatment comprising peginterferon alfa-2A and ribavirin.

The lack of knowledge regarding polycystic hydatid disease results in delayed or even incorrect diagnosis. The lack of systematic information regarding treatment also makes it difficult to assess the results and prognosis in patients with peritoneal and hepatic lesions caused by Echinococcus vogeli. Here we describe the clinical features of patients, propose a radiological classification protocol and describe a therapeutic option for the treatment of hydatid disease that previously had only been used for cases of cystic echinococcosis (Echinococcus granulosus). A prospective cohort study was initiated in 1999 and by 2009 the study included 60 patients. These patients were classified according to the PNM classification (parasite lesion, neighbouring organ invasion and metastases) and placed in one of three therapeutic modalities: (i) chemotherapy with albendazole at a dose of 10 mg/kg/day, (ii) surgical removal of cysts or (iii) percutaneous puncture of the cysts via puncture, aspiration, injection and re-aspiration (PAIR). The results were stratified according to therapeutic outcome: "cure", "clinical improvement", "no improvement", "death" or "no information". The PNM classification was useful in indicating the appropriate therapy in cases of polycystic hydatid disease. In conclusion, surgical therapy produced the best clinical results of all the therapies studied based on "cure" and "clinical improvement" outcomes. The use of PAIR for treatment requires additional study.

Neotropical polycystic echinococcosis (NPE) is a parasitic disease caused by cestodes of Echinococcus vogeli. This parasite grows most commonly in the liver, where it produces multiples cysts that cause hepatic and vessel necrosis, infects the biliary ducts, and disseminates into the peritoneal cavity, spreading to other abdominal and thoracic organs. In cases of disseminated disease in the liver and involvement of biliary ducts or portal system, liver transplantation may be a favorable option. We present a report of the first case of liver transplantation for the treatment of advanced liver NPE caused by E. vogeli.

OBJETIVO: Rever, usando a metodologia de análise secundária de dados, os casos descritos de doença hidática policística (DHP) pelo Echinococcus vogeli, quanto às características clínico-epidemiológicas, de evolução e procedimentos terapêuticos. MÉTODO: Foram usados cinco bancos eletrônicos; anais de eventos científicos da área de Medicina Tropical; livros textos; consultas aos índices remissivos de revistas não-indexadas e a especialistas. As 52 variáveis estudadas foram categorizadas para cada caso de DHP e registradas em ficha-padrão. Somente foram incluídos os casos com comprovação histológica e/ou parasitológica do E. vogeli. RESULTADOS: Foram recuperados 131 trabalhos publicados e uma comunicação pessoal, sendo grande parte com somente um caso descrito, e entre estes apenas 17 (12,9%) tinham casos com comprovação do agente etiológico, com um total de 44 pacientes: 52,3% do sexo masculino; média de idade de 45,0 (± 16,7) anos; e 50% descritos no Brasil. A presença de massas e a dor abdominal foram registradas em 94,7% (18/19) e 92,6% (25/27), respectivamente. Não houve diferença estatística (p>0,20) entre os resultados do tratamento clínico (albendazol) e cirúrgico, mas as freqüências de "sem êxito" foram, respectivamente, de 0% e 28,6%, e as de óbitos de 0% e 21,4%. CONCLUSÕES: A maioria dos trabalhos sobre a DHP não tem pacientes com comprovação etiológica e, conseqüentemente, é possível que parte do conhecimento clínico atual sofra mudanças significativas por investigações futuras. De outra parte, os dados levantados indicam que a melhor opção terapêutica, nos casos irressecáveis, é o uso de albendazol.

BACKGROUND: We reviewed, using secondary analysis, the described cases of Polycystic Hydatid Disease (PHD) by Echinococcus vogeli, addressing epidemiological and clinical characteristics, therapeutical evolution and procedures. METHODS: Five electronic banks, annals of scientific events, textbooks, remissive index, non-indexed magazines and specialists were consulted. The 52 variables studied had been categorized for each case of PHD and registered in a standard file. Only the cases with histological and/or parasitological evidence of E. vogeli had been enclosed. RESULTS: One hundred and thirty-one published works had been recouped and a personal communication. The majority presents, only a described case, and between them only 17 (12.9%) had evidence of the etiologic agent. In a total of 44 patients, 52.3% were males, mean age of 45.0 (±16,7) years, and 50% were described in Brazil. The presence of masses and abdominal pain had been registered in 94.7% (18/19) and 92.6% (25/27), respectively, with no statistica difference (p>0.20) in the clinical outcome with the clinical treatment (albendazol) versus the surgical one, but the frequencies of no success had been, respectively, 0% and 28.6%, and deaths of 0% and 21.4%. CONCLUSIONS: The majority of studies on PHD does not include patients with etiologic evidence and consequently is possible that part of the current clinical knowledge suffers significant changes for future inquiries. Nevertheless, the raised data indicate that the best therapeutical option, in the non surgical approach, the use of albendazol.

We describe a case of leiomyosarcoma of the jejunum in which abdominal computed tomography showed an intestinal tumor with a "sui generis" metalic artefact inside, which made us think of a benign disease (foreign body granuloma), because the patient lived in the rural area and he had a manioc flour mill, which is one the basic foods of the majority of the population of the north in Brazil. Because of the aspect of the tumor, we decided on a large scale resection, considering the possibility of a malignant tumor since we don't have frozen sections. This assured us of an adequate treatment for the tumor. This type of pathology should be remembered even though it only accounts for 0,2-2% of the intestinal tract tumors.

A piomiosite tropical, apesar de ser uma patologia reconhecida em nosso meio há mais de cem anos, ainda é pouco divulgada no Brasil, e pode-se perder tempo e dinheiro em exames para afastar a possibilidade de tumores ou tratar sua incidência vem aumentando em regiões de clima temperado, devido à disseminação do Vírus da lmunodeticiência Humana e aos tratamentos imúnossupressivos. Apesar de realizado em instituições que muitas vezes não apresentam recursos diagnósticos de primeira linha, demonstramos que o tratamento pode ser adequado se houver experiência clínica e bom senso. São descritos quarenta casos de piomiosite tropical, atendidos consecutivamente por um mesmo cirurgião; a idade média dos pacientes foi de 16 anos e o sexo predominante o masculino. O diagnóstico foi clínico em 73% dos casos e o tratamento realizado foi drenagem por incisão direta sobre a massa, deixando dreno tubular, usado para irrigação do abscesso. O tempo médio de permanência do dreno no local foi de cinco dias, e a média de permanência hospitalar, sete dias. Dois casos (5%) evoluíram para osteomielite e um caso foi a óbito. A evolução foi satisfatória em 93% dos pacientes.

Tropical pyomyositis, although a recognized pathology for more than a century, is still poorly known in Brazil, and one could waste time and money on exams for negative diagnosis for tumors or inadequately treat a potentially fatal disease. Initially referred to as a tropical disease, its incidence is increasing in temperate regions due to the dissemination of the Human Immunodeficiency Virus and immunosuppressive treatments. In spite of our Institution frequently lacking quality diagnostic resources, we managed adequate treatment by using clinical experience and good judgement. A total of 40 cases of tropical pyomyositis are described, all treated by the same surgeon, with a mean age of 16 years, predominantly male. Clinical diagnosis was realized in 73% of the cases and the applied treatment was drainage through direct incision over the mass, leaving the drainage tube for irrigation of the abscess. The mean drain permanence was seven days. Two (5%) of the cases evolved into osteomyelitis, one (2%) died and the remainder evolved satisfactorily.