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BackgroundThe muscle biopsy may be a fundamental technique in the suspicion of myopathy, with high specificity to distinguish between normal or abnormal muscle tissue. In association with clinical and laboratory findings, the muscle biopsy has an important role to a more accurate diagnosis.ObjectivesTo evaluate the usefulness and safety of muscle biopsies performed in a Rheumatology Unit in patients with suspected myopathy.MethodsRetrospective analysis of the clinical charts of patients submitted to muscle biopsy between January 2010 and December 2016 at our Rheumatology Unit. Demographic, clinical, laboratory, electromyographic and histological data were collected. The histological study was performed in a Neuropathology Specialized Unit.ResultsA total of 46 patients, 19 men and 27 women, with a mean age of 53.3±17.1 years, were evaluated. Clinical manifestations included muscle weakness, myalgia and decreased muscle strength. Most patients also had increased muscle enzymes, particularly creatine kinase, but in a patient with generalized muscle atrophy, muscle enzymes were overall diminished. Of the 46 biopsies, 12 (26.1%) did not show alterations, 8 (17.4%) showed nonspecific alterations and only 1 biopsy was not conclusive because the sample was inadequate. In 4 patients, the histological features did not present specific characteristics of a myopathy, but revealed a preferential atrophy of type 2 fibbers, usually associated with prolonged corticosteroid therapy. Among the others, 9 (19.6%) were compatible with inflammatory myopathies, namely polymyositis (6), dermatomyositis (1), inclusion body myopathy (1), and localized nodular myositis (1). In the latter case, the patient had a different clinical presentation, with intermittent episodes of pain, oedema and flushing of different muscle groups. In addition, 5 metabolic myopathies (2 McArdle's diseases and 3 non-specific metabolic disorders), 2 muscular dystrophies (1 Becker's muscular dystrophy and 1 dystrophinopathy), 1 suspected case of myotonic dystrophy and 1 myopathy associated with statins use were diagnosed. In a patient with muscle weakness and prior diagnosis of systemic vasculitis, the histology showed a chronic inflammatory process with no specific alterations. In the patient with overall decrease in muscle enzymes, the biopsy revealed neurogenic atrophy, without inflammatory infiltrates. Overall, the results of electromyography (EMG) did not correlate with the histological findings, because EMG identified alterations both in cases with histologically compatible inflammatory myopathy and in cases without histological pathology. On the other hand, EMG did not reveal any changes in some of the metabolic myopathies. Muscle biopsies were performed mainly in the deltoid muscle. There were no relevant immediate or late complications with this technique.ConclusionsAlthough muscle biopsy is an invasive technique, it is a safe technique and allows the differential diagnosis between the various myopathies, which is fundamental to an appropriate treatment.Ref...

24 anos, sexo masculino, etilista social, estava em acompanhamento ambulatorial de Doença de Crohn desde dezembro de 2017, quando foi iniciado tratamento com mesalazina oral e corticóide com boa resposta clínica. Em consulta de rotina, cinco meses após início do tratamento, enzimas hepáticas encontravam-se Palavras-chave: Doença de Crohn, fibrose, cirrose hepática, 5 ácido aminosalicilato (5 ASA) ABSTRACT G.H.P.S, a 24-year-old male, social drinker, was in outpatient follow-up for Crohn's Disease since December 2017, when treatment with oral mesalazine and corticoid was initiated with good clinical response. At a routine visit, five months after treatment initiation, liver enzymes were elevated. From then on, propaedeutics was initiated in order to investigate the cause for such alteration. Two months later, the patient developed jaundice and persisted with increased serum levels of liver enzymes. Therefore, a druginduced liver injury was suspected and mesalazine was discontinued until clinical and laboratory improvement. However, after discontinuing the drug, the patient's symptoms of inflammatory bowel disease worsened and she resumed use of the medication on her own. After fifteen days, he began to experience hyporexia, prostration, and nausea associated with worsening jaundice, choluria, fecal acholia, and maintenance of altered liver enzymes. He suspected hepatitis, but the initial diagnostic workup did not identify the etiology. He opted for a liver biopsy that showed moderate fibrosis and cholestasis, possibly associated with drug injury. In view of this, the hypothesis of chronic hepatopathy secondary to mesalazine was confirmed.

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A pele é o maior órgão do corpo humano sendo composta por três camadas: epiderme, derme e hipoderme, cada uma com funções e características própria. Está sujeita a fatores intrínsecos e extrínsecos capazes de alterarem sua constituição, sendo que uma lesão na pele, denominada ferida, prejudica o desempenho de suas funções. Essas lesões podem ser resultado de ilimitadas e variadas injúrias como traumas, isquemias, cirurgia, excesso de pressão ou agressão térmica, que agridem a estrutura do tecido tegumentar. Algumas doenças como insuficiência vascular arterial ou venosa, diabetes mellitus, úlceras por pressão podem predispor ao surgimento de feridas que agregam morbidade importante aos pacientes.  Nesses casos a causa de base sempre deve ser tratada, mas para adequada cicatrização dessas feridas o aporte de vitaminas, macro e micronutrientes é essencial . Nessa revisão narrativa 54 artigos foram convenientemente selecionados em diversas bases da dados. Conclui-se que no processo de cicatrização de feridas em que tanto o sistema imunológico quanto a cascata de coagulação precisam funcionar de maneira coesa e adequada, o aspecto nutricional necessita oferecer substrato para que isso aconteça. E a abordagem multidisciplinar é o pilar para tratamento dos pacientes.