Abstract BACKGROUND: The incidence of cervical agenesis with functional endometrium is unknown, but it’s estimated to be less than 0.1% in the general population. The reproductive prognosis in Müllerian malformations is limited and, in most cases, requires multiple surgical interventions to be improved. CASE REPORT: A 21-year-old primiparous patient with a history of agenesis of the cervix and two upper thirds of the vagina. Attended a first-time obstetric appointment at 38.1 weeks of gestation. She refers that the pregnancy was conceived spontaneously and denied complications during pregnancy. A cesarean section was scheduled to end the pregnancy, which had no trans or post-operative maternal-fetal morbidity. CONCLUSIONS: Spontaneous pregnancy in patients with congenital agenesis of the cervix should be addressed in time to ensure a favorable obstetric outcome.

Resumen ANTECEDENTES: La incidencia de agenesia cervical con endometrio funcional se desconoce, aunque se calcula menor a 0.1% en la población general. El pronóstico reproductivo de pacientes con malformaciones müllerianas es limitado y requiere múltiples intervenciones quirúrgicas. CASO CLÍNICO: Paciente primigesta de 21 años, con antecedente de agenesia de cuello uterino y dos tercios superiores de la vagina. Acudió a consulta a las 38.1 semanas de embarazo establecido conforme a la fecha de la última menstruación. Refirió haber concebido de forma espontánea y negó complicaciones durante el embarazo. Se programó para finalizar el embarazo mediante cesárea. El periodo trans y posquirúrgico transcurrió sin complicaciones maternas ni fetales. CONCLUSIÓN: El embarazo espontáneo en pacientes con malformaciones müllerianas debe tratarse a tiempo para asegurar que no surjan complicaciones que pongan en riesgo la vida de la madre y su hijo.

Apesar dos altos índices de cura, cerca de 20% dos pacientes com leucemia linfóide aguda (LLA) apresentam recidiva da doença. Recidiva isolada na cavidade oral é extremamente incomum. O objetivo deste trabalho é relatar um caso de recidiva isolada em criança com LLA de linhagem T. A apresentação clínica foi quadro de edema e dor na cavidade oral, na região superior da gengiva à direita, sem outras alterações clínicas ou hematológicas. O diagnóstico foi confirmado por meio de biópsia e imuno-histoquímica. O mielograma era normal. Cinco meses após a manifestação inicial na cavidade oral, foi detectada infiltração leucêmica na medula óssea. O tratamento com quimioterapia sistêmica foi reintroduzido. Este relato de caso ressalta a importância do acompanhamento clínico e odontológico durante e após o tratamento quimioterápico, não somente com o objetivo de tratar as alterações na cavidade oral decorrentes da própria doença ou dos efeitos adversos do tratamento, mas para que sejam detectadas apresentações incomuns de recidiva na LLA.

Despite high cure rates, approximately 20% of patients with acute lymphoblastic leukemia (ALL) have disease relapse. Isolated recurrence in oral cavity is extremely unusual. The aim of this paper is to report a case of an isolated relapse occurred in a child with T-lineage ALL. Clinical picture included swelling and pain in the right upper gingiva of the oral cavity, with no other clinical or hematological alterations. Diagnosis was confirmed by biopsy and immunohistochemical staining. Bone marrow aspiration was normal. Five months later leukemic infiltration of the bone marrow was detected and systemic chemotherapy was reintroduced. This case report highlights the relevance of dental care during and after chemotherapy, not only to treat lesions in the oral cavity resulting from the disease itself or from treatment side effects, but also to detect unusual sites of ALL relapse.

INTRODUCTION: The penile fracture is very frequent during the coitus when the organ is in erection undergoes a sudden flexion. OBJECTIVES: To describe the features of presentation and its entity characteristics, as well as its diagnostic and treatment. METHODS: A descriptive study was conducted from the medical records of 25 patients admitted in the Urology Service of the "Dr. Carlos J. Finlay" Military Hospital from January, 1997 to December, 2006 diagnosed with penile fracture. The variables described were: age, symptoms and signs, causal agents, diagnostic means used, applied treatment and present complications. RESULTS: There was predominance of ages from 26 to 44 years with the 565. The major symptom was a penile hematoma in the 100 % of cases and the more frequent cause was the trauma during coitus in the 68 %. In the 24% of patients it was necessary the penile single echography or Doppler to verify the diagnosis; surgical treatment was applied in the 72 % of patients. The complications were present in the non-operated on cases including fibrosis of cavernous bodies and an erectile sexual dysfunction. CONCLUSIONS: The penile fracture occurs mainly during the coitus. The clinical symptomatology is very important for diagnosis. If there are doubts the single echography or Doppler is very useful. The surgical treatment is the more appropriate to avoid sequelae in these patients.

INTRODUCCIÓN: La fractura de pene ocurre la mayoría de las veces durante el coito, cuando el órgano, al estar erecto, se flexiona bruscamente. OBJETIVOS: Describir aspectos de la presentación y características de esta entidad, así como su diagnóstico y tratamiento. MÉTODOS: Se realizó un estudio descriptivo, a partir de las historias clínicas de 25 pacientes ingresados en el servicio de urología del Hospital Militar Central "Dr. Carlos J. Finlay", de enero de 1997 a diciembre de 2006, con el diagnóstico de fractura de pene. Las variables descritas fueron: edad, síntomas y signos, agentes causales, medios diagnósticos utilizados, tratamiento aplicado y complicaciones presentadas. RESULTADOS: Predominó el grupo de edades de 26 a 44 años con el 56 %. El síntoma principal fue el hematoma del pene en el 100 % de los casos y la causa más frecuente fue el traumatismo durante el coito en el 68_%. En el 24 % de los pacientes fue necesario el auxilio de la ecografía peneana, simple o Doppler, para confirmar el diagnóstico; se aplicó el tratamiento quirúrgico en el 72 % de los pacientes. Las complicaciones se presentaron en los casos no operados y consistieron en fibrosis de los cuerpos cavernosos y la disfunción sexual eréctil. CONCLUSIONES: La fractura de pene ocurre fundamentalmente durante el coito. La sintomatología clínica tiene gran valor para el diagnóstico. En caso de dudas, la ecografía simple o Doppler resulta muy útil. El tratamiento quirúrgico es el indicado para evitar secuelas en estos pacientes.

A descriptive, cross-sectional and prospective study was conducted among 2 208 patients operated on by ambulatory major surgery at the surgery service of "Comandante Manuel Fajardo Rivero" Military Clinical and Surgical Hospital, in Santa Clara, from January, 1997, to December, 2001, aimed at showing the advantages of this method for the patient and the health institution. The patients operated on of inguinal, epigastric and umbilical hernias predominated. This method was also used with vesicular lithiasis, uterine fibromyomas, breast nodules, gynecomasties and hemorrhoids. Most of the patients were females and the groups aged 20-49 were the most benefitted with this method. The types of anesthesia preferably used were regional anesthesia and acupunctural surgical analgesia

Se realizó un estudio descriptivo, longitudinal y retrospectivo de 2 208 pacientes operados por el método de cirugía mayor ambulatoria en el servicio de cirugía del Hospital Militar Clinicoquirúrgico Docente "Comandante Manuel Fajardo Rivero" de Santa Clara, durante el período comprendido desde enero de 1997 hasta diciembre del 2001, con el propósito de demostrar las ventajas de este método para el paciente y para la institución. Los pacientes operados de hernias inguinales, epigástricas y umbilicales fueron los que predominaron. También fueron tratados por este método pacientes con litiasis vesicular, fibromiomas uterinos, nódulos de mamas, ginecomastias y hemorroides. Del total de los pacientes la mayor cantidad pertenecía al sexo femenino y en cuanto a la edad los grupos comprendidos entre 20 y 49 años fueron los que más se beneficiaron con este método. Los tipos de anestesia con preferencia a ser utilizados en estos pacientes fueron la anestesia regional y la analgesia quirúrgica acupuntural

OBJETIVO: Verificar a sobrevida de crianças com leucemia mielóide aguda antes e após a adoção de quimioterapia baseada no protocolo Berlim-Frankfurt-Munique-83. Analisar a influência prognóstica dos fatores idade, gênero, estado nutricional, leucometria inicial e introdução da droga etoposida na fase de indução da remissão. MÉTODOS: Estudo prospectivo/retrospectivo com 83 crianças portadoras de leucemia mielóide aguda, diagnosticadas no Hospital das Clínicas da UFMG entre 1986 e 2000. Até 1990, 15 crianças foram tratadas com dois a três ciclos de citarabina e daunorrubicina, seguidos de esquemas variados de consolidação/manutenção; de janeiro de 1991 a novembro de 1992, 15 pacientes em estudo piloto utilizaram etoposida na fase de indução do protocolo alemão; de dezembro de 1992 a junho de 1999, a etoposida foi utilizada aleatoriamente. RESULTADOS: O tempo mediano de seguimento foi de cinco anos. As taxas de remissão iniciais foram de 40% e 66%, antes e após a adoção do protocolo alemão (p = 0,11). O óbito durante a indução, causado por infecções e/ou hemorragia, foi a principal causa para não se obter a remissão. As probabilidades estimadas de sobrevida e de remissão clínica completa aos cinco anos foram de 31%±5,4% e 49,7%±7,4%, respectivamente. Recidivas ocorreram em 22 casos, todas medulares. Crianças abaixo de seis anos de idade tiveram prognóstico significativamente pior. Gênero, leucometria inicial e estado nutricional não influenciaram o prognóstico. Crianças que aleatoriamente utilizaram a etoposida tiveram a duração da remissão menor do que aquelas que não a usaram. CONCLUSÕES: A utilização de terapia baseada no protocolo alemão melhorou o prognóstico. A administração da etoposida foi desfavorável, não se encontrando explicação plausível para tal observação.

OBJECTIVE: To investigate the survival of children with acute myeloid leukemia (AML) before and after the introduction of a Berlin-Frankfurt-Munich-83 based protocol. To analyze the prognostic impact of age, gender, nutritional status, initial white blood cell count and use of etoposide in the remission induction phase. METHODS: This partly prospective/retrospective study comprised 83 children with AML diagnosed at Hospital das Clínicas, Universidade Federal de Minas Gerais, Brazil, between 1986 and 2000. Before 1991, 15 children were treated with 2-3 pulses of cytarabin plus daunomycin, followed by several consolidation/maintenance schemes. From January 1991 to November 1992 a pilot study (n = 15) was carried out to test etoposide toxicity in the induction phase. Etoposide was randomized from December 1992 to June 1999. RESULTS: Median follow-up period was 5 years. Initial remission rates were 40 and 66% before or after the introduction of the German protocol, respectively (p = 0.11). Induction failure was largely due to death caused by infection and/or hemorrhage. The 5-year estimated probabilities of survival and of continuous complete remission were 31±5.4% and 49.7±7.4%, respectively. All 22 relapses involved the bone marrow. Age below 6 years at diagnosis was significantly associated with a poor prognosis. Sex, initial leukocyte count, and nutritional variables were not significant prognostic factors. The randomized addition of etoposide in the induction phase unexpectedly decreased the probability of complete remission at 5 years. CONCLUSIONS: The introduction of a German-based protocol in 1991 significantly improved survival and duration of first remission. No plausible explanation for the unfavorable effect of etoposide was found.

9 patients that were operated on at the Provincial Clinical and Surgical Teaching Hospital and at the "Comandante Manuel Fajardo" Military Hospital, both in Santa Clara, for presenting solitary nonparasitic hepatic cyst were studied. It appeared mainly in patients over 60, and females were the most affected. 7 of the cysts were located in the right lobule and 2 in the left lobule of the liver. Abdominal pain and palpable tumors were the most important aspects in the clinical picture and in the physical examination. Laparoscopy, abdominal ultrasound and CAT were the most useful tests for the diagnosis. Cystojejunostomy was the most used surgical technique. 3 patients had complications, accounting for 33.3 %, and 1 died, which represents 11.1 % of mortality

Se estudian 9 pacientes intervenidos quirúrgicamente en los hospitales Clinicoquirúrgico Provincial Docente y Militar "Comandante Manuel Fajardo", ambos de Santa Clara, por presentar quiste solitario no parasitario del hígado. La edad de presentación predominante fue después de los 60 años, y el sexo femenino el más afectado. Siete de los quistes se localizaron en el lóbulo derecho, y 2 en el lóbulo izquierdo del hígado. El dolor abdominal y la tumoración palpable fueron los aspectos más llamativos en el cuadro clínico y el examen físico. La laparoscopia, el ultrasonido abdominal y la tomografía axial computadorizada (TAC) constituyeron los exámenes más útiles para el diagnóstico. La cistoyeyunostomía fue la técnica quirúrgica más utilizada. En 3 pacientes se presentaron complicaciones, para el 33,3 % y 1 falleció, lo que representa el 11,1 % de mortalidad

77 medical histories of patients who presented incidental injuries of the spleen occurred between 1985 and 1994, during intraabdominal operations and by laparoscopic examination, were reviewed. The immunological functions of the spleen and its role against infections are well defined, so the removal of this organ due to incidental injuries favors the appearance of infections in these patients for the rest of their lives. Of the 77 incidental injuries 47 (61 %) incidental splenectomies and 30 (39 %) conservative surgeries were performed. Duodenal ulcer and hiatal hernia proved to be the main causes of incidental splenectomy. There were 11 infections (23.4 %) and 1 death (2.1 %) in the incidental splenectomy compared with 1 infection (3.3 %) and no death in the conservative surgery. It is concluded that splenectomy is not justified because of its disadvantages

Se revisaron 77 historias clínicas de pacientes que presentaban lesiones incidentales del bazo ocurridas entre 1985 y 1994, durante operaciones intraabdominales y por examen laparoscópico. Las funciones inmunológicas del bazo y su papel contra las infecciones están bien definidas, por lo cual al ser suprimido este órgano a consecuencia de lesiones incidentales, favorecen las infecciones en dichos pacientes de por vida. De las 77 lesiones incidentales se realizaron 47(61 %) esplenectomías incidentales y 30(39 %) cirugías conservadoras. La úlcera duodenal y la hernia hiatal son las causas principales de esplenectomía incidental. Se presentaron 11 infecciones (23,4 %) y 1 fallecido (2,1 %) en la esplenectomía incidental contra 1 infección (3,3 %) y ningún fallecido en la cirugía conservadora. Se llega a la conclusión de que la esplenectomía no está justificada dadas las desventajas que presenta

A number of 274 medical histories presenting with spleen injuries were revised at "Comandante Manuel Fajardo Rivero" Military Hospital, and at the Teaching and Provincial Clinico surgical Hospital of Santa Clara during 1988-1994. The classification of splenic trauma grade 1 with 97 patients; grade 2 with 53 patients; grade 3 with 71 patients, grade 2 A with 33 patients, and grade 3 B with 20 patients, is described. Complications in splectomized patients were found to be 40 accounting for a morbidity of 22.3 %. There were 2 complications in patients who underwent a conservative surgical procedure, accounting for 2.1 %. There was no mortality rate regarding conservative surgery, but injuries less severe grades 1 and 2 occurred. Five patients died in the group of splectomized patients accounting for 2.7 % of mortality; the associated mortality was 9.8 %

Se revisaron 274 historias clínicas que presentaron traumatismo del bazo, en el Hospital Militar "Comandante Manuel Fajardo Rivero" y Hospital Provincial Clinicoquirúrgico Docente, ambos de Santa Clara, durante los años 1988-1994. Se describe la clasificación del trauma esplénico grado 1, con 97 pacientes; grado 2, 53 pacientes; grado 3, 71 pacientes, los grados 2A,33 pacientes y grado 3B, 20 pacientes. Las complicaciones en los esplenectomizados fueron 40, para una morbilidad del 22,3 % y hubo 2 complicaciones en los pacientes a quienes se les realizó cirugía conservadora, para el 2,1 %. No hubo mortalidad en la cirugía conservadora, pero es de señalar que ocurrieron en los traumas de menor cuantía, los grados 1 y 2. Hubo 5 pacientes fallecidos en los esplenectomizados para el 2,7 % de mortalidad, y fue la mortalidad asociada de 9,8 %