Resumo Justificativa: A síndrome de Marfan (SMF) é uma doença do tecido conjuntivo que envolve principalmente os sistemas cardiovascular, musculoesquelético e visual. Os problemas mais graves incluem dilatação da raiz da aorta e dissecção. O manejo anestésico é vital para a melhoria da morbidade perioperatória. Relato de caso: Homem de 61 anos com SMF, apresentou-se principalmente com pectus carinatum, escoliose, ectopia da lente, pneumotórax espontâneo anterior e aneurisma da aorta e dissecção, submetido à colocação de prótese aórtica toracoabdominal. O paciente foi submetido à colecistectomia videolaparoscópica de rotina devido à litíase. Os achados importantes ao exame pré-operatório foram cifoescoliose toracolombar e murmúrio metálico em exame cardíaco. A radiografia de tórax revelou ângulo de Cobb de 70° e o ecocardiograma mostrou evidência de prótese mecânica aórtica sem alterações. Discussão: A avaliação pré-operatória deve ter como foco as anormalidades cardiopulmonares. O anestesiologista deve estar preparado para uma intubação potencialmente difícil. O posicionamento adequado e o apoio para o membro antes da indução são fundamentais para evitar lesões nas articulações. Profilaxia antibiótica deve ser considerada para endocardite bacteriana subaguda. O paciente deve ser cuidadosamente posicionado para evitar lesões das articulações. O monitoramento cardiovascular é obrigatório no período intraoperatório: evitar manobras que podem levar à taquicardia ou hipertensão; controlar a pressão das vias aéreas para evitar pneumotórax e manter uma volemia adequada para diminuir as chances de prolapso, especialmente em caso de laparoscopia. Nenhum agente anestésico ou técnica demonstrou superioridade no período intraoperatório. O tratamento adequado da dor no pós-operatório é de vital importância para evitar os efeitos deletérios da hipertensão e da taquicardia.

Abstract Background: Marfan's Syndrome (MFS) is a disorder of connective tissue, mainly involving the cardiovascular, musculoskeletal, and ocular systems. The most severe problems include aortic root dilatation and dissection. Anesthetic management is vital for the improvement on perioperative morbidity. Case report: 61-year-old male with MFS, presenting mainly with pectus carinatum, scoliosis, ectopia lens, previous spontaneous pneumothorax and aortal aneurysm and dissection submitted to thoracoabdominal aortic prosthesis placement. Underwent routine laparoscopic cholecystectomy due to lithiasis. Important findings on preoperative examination were thoracolumbar kyphoscoliosis, metallic murmur on cardiac exam. Chest radiograph revealed Cobb angle of 70°. Echocardiogram showed evidence of aortic mechanical prosthesis with no deficits. Discussion: Preoperative evaluation should focus on cardiopulmonary abnormalities. The anesthesiologist should be prepared for a potentially difficult intubation. Proper positioning and limb support prior to induction is crucial in order to avoid joint injuries. Consider antibiotic prophylaxis for subacute bacterial endocarditis. The patient should be carefully positioned to avoid joint injuries. Intraoperatively cardiovascular monitoring is mandatory: avoid maneuvers that can lead to tachycardia or hypertension, control airway pressure to prevent pneumothorax and maintain an adequate volemia to decrease chances of prolapse, especially if considering laparoscopic surgery. No single intraoperative anesthetic agent or technique has demonstrated superiority. Adequate postoperative pain management is vitally important to avoid the detrimental effects of hypertension and tachycardia.

Abstract Actinic keratoses are premalignant lesions of the skin caused by excessive sun exposure. Lesions may become mainly squamous cell carcinoma. Cryotherapy with liquid nitrogen is one of the main treatments. In order to evaluate the response of actinic keratosis to cryotherapy by histopathology, two lesions were selected in each of 14 patients with multiple actinic keratoses. In one lesion a biopsy was performed and in the other lesion a biopsy was performed after cryotherapy. Subsequently, both biopsies were compared histologically. Of the thirteen patients who completed the study, the best results were obtained in lesions undergoing cryotherapy concerning the atypia of keratinocytes, epithelial thickness and corneal layer and lymphocytic infiltrate. Despite the small number of patients, it was concluded that, if performed correctly, cryotherapy has high efficacy in the treatment of actinic keratoses.

Introdução: A infecção pelo vírus Epstein Barr (VEB) tem uma prevalência elevada sendo mais de 90% da população mundial seropositiva. A maioria das infecções primárias pelo VEB é subclínica. As complicações agudas são raras mas potencialmente letais. Caso clínico: Criança do sexo feminino com nove anos admitida por febre elevada com 13 dias de evolução, dor abdominal e odinofagia. Os exames auxiliares de diagnósticos foram compatíveis com hepatite vírica aguda com valores muito aumentados de transaminases. O diagnóstico de infecção pelo VEB foi confirmado pela presença de anticorpos heterófilos e marcadores serológicos. Conclusão: Na infecção pelo VEB a lesão hepática, apesar de frequente, é habitualmente insignificante, com aumento leve e auto-limitado das transaminases, sendo raros os casos de hepatite clinicamente relevante. Os autores descrevem este caso pela inesperada gravidade das alterações hepáticas.

Introduction:Epstein Barr virus (VEB) infection is very prevalent with more than 90% of adults worldwide seropositive. The majority of primary VEB infections are subclinical. Acute complications are very rare but can be fatal. Case report: A nine-year-old girl was admitted with fever for 13 days, abdominal pain and sore throat. Laboratory results were consistent with an acute viral hepatitis with markedly elevated transaminase levels. The diagnosis of acute VEB infection was confirmed by the positive heterophilic antibody monospot assay and serological markers. Conclusion: Although common, liver disease is usually mild with transient elevation of serum aminotransferases, and cases of severe hepatitis are rare. The authors report this case due to the unexpected severity of liver disease.

Introduction. Eyelid myoclonia with or without absences may occur in several epileptic conditions, and they are frequently misinterpreted as movement disorders. Case report. A seven-year-old boy was admitted for evaluation of eye blinking that started at age of six. He had never had generalized tonic-clonic or absence seizures. Video-EEG monitoring revealed 3-5 Hz irregular occipital or generalized polyspike and polyspike-wave complexes, precipitated by eye closure. They were accompanied by eye-lid myoclonia. Photic stimulation induced photoparoxysmal response. Brain MRI was normal. He was initially treated with clobazam and then levetiracetam with no response. Valproate was added with control of the symptoms. Conclusion. Eyelid myoclonia without absences are often difficult to classify. Video-EEG may help to clarify these cases.