We present two cases of misplaced central venous catheters having in common the absence of free blood return from one lumen immediately after placement. The former is a case of right hydrothorax associated with central venous catheterization with the catheter tip in intra-pleural location. In this case the distal port was never patent. In the latter case there was an increased aspiration pressure through the middle port due to a catheter looping. The absence of free flow on aspiration from one lumen of a central catheter should not be undervalued. In these circumstances the catheter should not be used and needs to be removed.

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BackgroundVoice dysfunction or dysphonia may be associated with several clinical conditions. Among these, laryngeal human papillomavirus (HPV)-induced lesions should be considered as a possible causative factor. We report a case of dysphonia in a patient presenting with an HPV laryngeal lesion. We also discuss the clinical features of the disease, its histopathological findings, and treatment and rigorous follow-up.Case presentationWe report a case of laryngeal papilloma in a 29-year-old, Afro-descendant, male patient with dysphonia. He was a non-smoker and was not a drug user. Videolaryngostroboscopy revealed signs suggestive of pharyngolaryngeal reflux. The right vocal fold presented with a papillomatous aspect in the posterior third, which underwent excision. Histopathological examination showed a nodular lesion of the right vocal fold, conclusive of squamous papilloma with absence of malignancy.ConclusionPatients presenting with persistent voice dysfunction or dysphonia should be investigated for possible laryngeal HPV infection. Diagnostic confirmation by HPV genotyping is important for follow-up of potential recurrence.

814www.scielo.br/rsbmt I www.rsbmt.org.br Revista da Sociedade Brasileira de Medicina Tropical 47(6):814, Nov-Dec, 2014http://dx.doi. org/10.1590/0037-8682-0160-2014 A 27-year-old, Caucasian, university-graduated, married, puerperal female patient who lived in the City of Vitoria, State of Espírito Santo, Brazil, presented with recurring genital moniliasis, without a medical history of underlying diseases. She underwent regular cytology exams, including cervical and vaginal samples that showed no atypia. Clinical evaluation also remained unchanged.The test for Streptococcus agalactiae in the 37 th gestational week was negative. This primiparous patient underwent a cesarean section due to cephalo-pelvic disproportion 15 days prior to abscess drainage of the Bartholin's gland on the left side, which characterized a clinical case of acute bartholinitis.The onset of this condition was an extremely painful tumor in the genital area fi ve days after delivery. It was clinically detected as local redness, which started to bulge and then progressed to fl uctuation (abscess) (Figures A and B). Other possible differential diagnostic hypotheses were Skene duct cysts, which are rare; epidermal inclusion cyst; and papillary hidradenoma, among other Bartholin's gland benign lesions. Abscess drainage was performed, and purulent secretion material was collected for culture, which evidenced growth of Escherichia coli. Oral antibiotic therapy (500mg cephalexin) was prescribed every six hours for seven days.Remission of the Bartholin abscess at the end of the antibiotic therapy was observed. During the 5-year clinical follow-up in the gynecology assistance program up to now recurrence was not observed.

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