Abstract: One of the biggest challenges in treating leprosy is the control of reaction events. Patients with lepromatous leprosy may present reaction type II, or erythema nodosum leprosum, during treatment, and this reaction can remain in a recurrent form after being released from the hospital, requiring the use of thalidomide and/or prednisone for long periods of time, in turn increasing the risk of side effects. Two reports of the use of antiTNF to treat erythema nodosum leprosum were found in the literature. A good response was found after an assay with infliximab and etanercept. This study reports on a patient with lepromatous leprosy and recurrent reaction, controlled by using etanercept and a 10-month follow-up, with the interruption of thalidomide and the maintenance of prednisone at 10 mg/day.

AbstractLivedo reticularis is a spastic-anatomical condition of the small vessels which translates morphologically by a reticular pattern, interspersing cyanosis, pallor and erythema. The same can be congenital or acquired. Among the acquired, we highlight the physiological livedo reticularis and the idiopathic livedo by vasospasm; the latter configures the most common cause. The drug-induced type is less common. The drugs amantadine and norepinephrine are often implicated. Cyanosis is usually reversible if the causative factor is removed, however, with chronicity, the vessels may become permanently dilated and telangiectatic. We report a case of a patient diagnosed with Parkinson's disease with chronic livedo reticularis associated with the use of amantadine and improvement after discontinuation of the drug.

RACIONAL: A ressecção cirúrgica é o principal elemento do tratamento do câncer colorretal com intenção curativa. OBJETIVO: Analisar os resultados pós-operatórios de ressecções colorretais laparotômicas e videolaparoscópicas por câncer colorretal. MÉTODOS: Estudo retrospectivo de uma série de 189 pacientes operados. As variáveis descritivas foram idade e gênero, e as de desfecho foram tipo de ressecção, número de linfonodos ressecados, margens, necessidade de ostomia, complicações, tempo operatório e tempo de internação. Elas foram analisadas por meio dos testes do Qui-quadrado, t de student e Mann-Whitney, com nível de significância <0,05. RESULTADOS: Dos 189 pacientes operados, 110 preencheram os critérios de inclusão, sendo 75 (68,2%) operados por cirurgia aberta e 35 (31,8%) por via videolaparoscópica. O cólon sigmóide foi o local mais comum de apresentação da neoplasia e a retossigmoidectomia foi a ressecção colorretal mais realizada, e mais por via aberta (p=0,042). A taxa de conversão foi de 7,9% (3/38). Os pacientes operados por via aberta apresentaram em 81,5% tempo operatório inferior a 180 minutos (p<0,001). Em ambas as vias, o número médio de linfonodos ressecados foi maior que 12, porém a técnica laparotômica permitiu, com maior frequência, a ressecção de 12 ou mais linfonodos (p=0,012). Nenhum paciente apresentou margem cirúrgica comprometida, mas a laparotomia permitiu um maior número de pacientes com margem maior que 5 cm em relação ao tumor (p=0,036). Maior número de pacientes tratados por via aberta esteve internado por tempo superior a sete dias (p<0,001). Não foram encontradas diferenças estatisticamente significantes quanto à necessidade de ostomias, complicações e mortalidade hospitalar. CONCLUSÕES: A abordagem videolaparoscópica foi tão segura e eficaz quanto a laparotômica no tratamento do câncer colorretal, e esteve associada a maior tempo operatório, a menor tempo de hospitalização e a relativa menor morbidade.

BACKGROUND: Surgical resection is the mainstay of treatment for colorectal cancer with curative intent. AIM: To evaluate the postoperative results of laparoscopic and laparotomic colorectal resections for colorectal cancer. METHODS: A retrospective study of a series of 189 patients. The descriptive variables were age and gender, and for outcome were type of resection, number of lymph nodes resected, free margins, the need for colostomy, complications, operative time and hospital stay. They were analyzed using the chi-square, Student t and Mann-Whitney test, with significance level <0.05. RESULTS: Of the 189 operated patients, 110 met the inclusion criteria, 75 (68.2%) operated by open surgery and 35 (31.8%) by laparoscopic. The sigmoid colon was the most common site presented by neoplasia and rectosigmoidectomy was performed more by open colorectal resection (p = 0.042). The conversion rate was 7.9% (3/38). The patients were operated by open surgery in 81.5% of time less than 180 minutes (p <0.001). In both pathways, the average number of removed lymph nodes was greater than 12, but laparotomy enabled, more frequently, the resection of 12 or more nodes (p = 0.012). No patient had surgical margins involved, but laparotomy allowed a greater number of patients with a margin greater than 5 cm from the tumor (p = 0.036). Increased number of patients treated by open surgery were hospitalized for more than seven days (p <0.001). There were no statistically significant differences regarding the need for ostomies, complications and mortality. CONCLUSIONS: The laparoscopic approach was as safe and effective as laparotomy in the treatment of colorectal cancer, and was associated with increased operative time, shorter hospital stay and less morbidity.