Background: Osteoporosis (OP) is a metabolic bone illness that may complicate celiac disease (CD). It can lead to devastating consequences because of low bone mass and fragility fractures.Purpose: To study the OP prevalence in a group of Brazilian patients with CD and the value of a gluten free diet (GFD).Methods: Retrospective study of celiac female patients from a single University Center followed with bone densitometries. Results from densitometry made at first visit were compared with a second study after a median time of 5 years. During this period, patients were submitted to a GFD according to orientations from special program training. Calcium and vitamin D were prescribed to those patients who did not reach the minimal daily requirement through diet.Results: Forty-one celiac female patients, mean age 46.1 ± 14.8 years, were included. The prevalence of osteopenia at first visit was 56.1% and that of osteoporosis 29.2%. Osteoporosis was associated with longer disease duration (p = 0.01). The second densitometry was performed in a median time of 5 years (range 1 to 13 years) and disclosed 58.9% osteopenia and 28.2% osteoporosis. The GFD improved bone mass, mainly at (of) spine (comparison of T score with p = 0.03 and of bone mass in g/cm

Background: The role of autonomic nervous system in the development and maintenance of portal hypertension is not fully elucidated. It is known that the gene expression of norepinephrine in the superior mesenteric artery varies with time, and it may contribute for splanchnic vasodilation and its consequent hemodynamic repercussions. It is still not known exactly how the adrenergic expression behaves at the heart level in the initial stages of this process. Aim: To evaluate the immunohistochemical expression of the enzyme tyrosine hydroxylase (tyrosine 3-monooxygenase), involved in the synthesis of norepinephrine, in the myocardium of rats submitted to partial ligation of the portal vein. Methods: Twenty-four Wistar rats were divided into two groups: Sham Operated and Portal Hypertension. The partial ligation was performed in the Portal Hypertension group, and after 1/6/24 h and 3/5/14 days the animals were euthanized. Immunohistochemical analysis was performed to quantify the expression of the stained enzyme using the ImageJ program. Results:The Portal Hypertension group expressed percentages between 4.6-6% of the marked area, while the Sham Operated group varied between 4-5%. Although there was no statistical significance, the percentage stained in the Portal Hypertension group followed an increasing pattern in the first 6 h and a decreasing pattern after 24 h, which was not observed in the Sham Operated group. Conclusion: The expression of noradrenaline in rat myocardium during the first two weeks after partial ligation of the portal vein, with tyrosine hydroxylase as marker, did not show differences between groups over time.

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blunt liver damage, especially those that cause uncontrollable bleeding. Despite the damage control approaches in order to achieve hemodynamic stability, many patients develop hypovolemic shock, acute liver failure, multiple organ failure and death. In this context, liver transplantation appears as the lifesaving last resort, and has been reported in the literature for over 25 years, but there aren't, however, a consensus about the exact indication and success of this therapy. We identified 46 case reported about patients undergoing liver transplant after liver trauma, the main trauma mechanism was the closed/blunt abdominal trauma with 83%, and severe trauma (> grade IV), 81%. The transplant can be done, in this context, by the 1-stage procedure (patient has a damaged organ removed and immediately receive the graft). When the two-stage approach is performed, na end-to-side temporary portacaval shunt is provided, until na organ be comes available to be transplanted. If we look at two different periods, from 1980 to 2000 and from 2000 to 2014, the survival rate increased significantly from 48% to 76%. Despite have indications quite restricted in the setting of hepatic injury, liver transplantation is a therapeutic modality viable and feasible today, and can be used in cases when surgical treatment as well as other therapeutic modalities, short and long term, do not provide the patient survival chances.

RESUMOA linfomatose cerebral (LC) é considerada uma rara variante do linfoma primário do sistema nervoso central (SNC). Descrevemos o caso de uma paciente com demência rapidamente progressiva secundária a extensa lesão em substância branca e núcleos da base bilateralmente, com evidente impregnação pelo contraste paramagnético. Dada a dificuldade diagnóstica, a paciente foi submetida a biópsia que revelou achados compatíveis com LC. Apesar do tratamento com metilprednisolona, ciclofosfamida e azatioprina, em 5 meses a paciente evoluiu para óbito. Devido à evolução subaguda e neuroimagem atípica, esta possibilidade diagnóstica pode não ser aventada e, com isso, não realizar a biopsia cerebral. O tratamento se baseia em altas doses de quimioterapia com metotrexato, sem indicação de ressecção tumoral. Contudo, sabe-se que é uma neoplasia de baixa resposta ao tratamento e com prognóstico reservado. Palavras-chave: Linfomatose cerebral; Linfoma; Demência rapidamente progressiva.ABSTRACT Lymphomatosis cerebri (LC) is considered a rare variant of primary lymphoma of the central nervous system (CNS). A patient with rapidly progressive dementia secondary to bilateral extensive injury in white matter and basal ganglia is described. Impregnation of paramagnetic contrast was intense. Given the diagnosis difficulty, the patient underwent biopsy revealing findings compatible with LC. Despite the treatment using methylprednisolone, cyclophosphamide, and azathioprine, after 5 months the patient evolved to death. Due to the subacute development, and atypical neuroimaging results, this diagnosis possibility would not be considered, and the brain biopsy not performed. Treatment is based on high-dose chemotherapy with methotrexate, and no indication of tumor resection. However, it is known that this neoplasm has low response to the treatment and poor prognosis.