Introduction: Gestational gigantomastia (GG) is a rare condition known for the massive growth of one or both breasts during pregnancy. Objectives: to describe three cases of GG in patients assisted Hospital de Clínicas do Paraná. Case Reports: Case 1 ‒ Twenty-four year old pregnant woman, of 9 weeks, presented with mastalgia and increasing breast volume associated with phlogistic signs and orange peel-like skin. Breast ultrasound showed diffuse inflammatory process. A biopsy was performed and showed ductal ectasia and stromal fibroadenomatoid changes. On the 20th week, she was hospitalized with fever, voluminous breasts and drainage of purulent secretion and long ulcers in the inframammary fold. She was administered antibiotics and local care. The choice was to interrupt the pregnancy of 33 weeks. She presented with relative reduction of the breasts and breastfed, but had severe psychological problems caused by the aesthetic dissatisfaction. Case 2 ‒ Eighteen-year old patient presented with infiltrating ductal breast carcinoma in the right breast, treated with sectorectomy, with sentinel lymph node and conventional radiotherapy. After one year of follow-up, ductal carcinoma in situ (DCIS) was diagnosed in the left breast, being submitted to sectorectomy and intraoperative radiotherapy. Two years after DCIS, she became pregnant and presented with GG only in the left breast, with remarkable asymmetry and skin edema. After the Cesarean section, breastfeeding was normal on the GG side, but not on the right side, due to a sequel from total radiotherapy. Case 3 ‒ Twenty-two year old pregnant women, of 12 weeks, presented with mastalgia and exaggerated growth of the breasts, with and orange peel-like skin. Breast ultrasound showed bilateral inflammatory process. On the 15th week, she presented with bleeding ulcers, right breast with latero-lateral diameter of 48 cm, and craniocaudal diameter of 56 cm, and left breast with 49 cm and 58 cm, respectively. Due to the fast and progressive growth of the breasts, with difficulties to breath, major venous and lymph stasis and extensive skin ulceration/maceration, with risk of infection, the patient and relatives agreed on conducting a therapeutic abortion, followed by a reduction mammoplasty. Discussion: It is a rare disease, and its etiology remains unknown. Medicinal therapy seems to be first option, but it is often necessary to complement it with a surgical procedure. Conclusions: GG is a pathology of great morbidity, with tendency to recede in the puerperium. In case it is not possible to wait, the recommendation is to intervene in the pregnancy.

Podendo atingir quase 60% da população maior de 70 anos, os acrocórdons são muito prevalentes em consultórios dermatológicos. Entre as abordagens terapêuticas possíveis estão a crioterapia de contato e a eletrocirurgia. Objetivos: Comparar a tolerância à dor, o resultado estético e a preferência dos participantes entre as técnicas de eletrocoagulação e crioterapia de contato no tratamento de acrocórdons. Métodos: Dez participantes, com no mínimo quatro acrocórdons cada um, tiveram suas lesões divididas em dois grupos. Um grupo foi submetido à eletrocoagulação e o outro à crioterapia de contato. A tolerância à dor foi medida pela escala analógica de dor (EAD). O resultado estético foi avaliado por comparação visual entre os grupos de tratamento, em cada participante. A preferência foi avaliada com perguntas objetivas ao participante. Resultados: Todos os pontos avaliados tiveram significância estatística. Os participantes deram notas mais baixas na EAD às lesões submetidas à crioterapia de contato. O resultado estético avaliado após 30 dias foi superior nas lesões do grupo da eletrocoagulação. Todos os participantes preferiram a técnica de crioterapia de contato. Conclusões: A crioterapia de contato é o método preferido e com melhor tolerância à dor no tratamento de acrocórdons, porém o resultado estético foi melhor com a eletrocoagulação.

Introduction: Inadequate eating habits and physical inactivity directly contribute to changes in nutritional status. Patients with Down syndrome (DS) are more prone to obesity due to genetic and / or environmental factors, which favors cardiovascular diseases with the possibility of complications and reduced life expectancy. Objective: To describe the nutritional status of patients followed up at an outpatient referral center for Down's syndrome in a Brazilian tertiary hospital. Methodology: Retrospective, cross-sectional and descriptive study with analysis of 1,056 medical records of patients with DS, from 2014 to 2016. Food was considered adequate if it consisted of food from all groups in three main meals and one / two snacks and water in breaks. Sedentary lifestyle was considered if the time of physical activity was less than 300 minutes per week. Nutritional status was assessed using the World Health Organization (WHO) body mass index curves, 2007. The data were analyzed using the Excel program. The Pearson's chi-square test was used to compare data from children and adolescents. The level of significance was set at p <0.05. Approved by the Human Research Ethics Committee of the service referred to under number 04542712.3.0000.0096. Results: 517 children (3 to 9 years, 11 months and 29 days) and 539 adolescents (10 to 20 years of age) were evaluated. Food was adequate for 395 (76.4%) children and 336 (62.3%) adolescents (p <0.001). The nutritional status was adequate in 397 (76.8%) children and 371 (68.8%) adolescents, overweight was seen in 40 (8%) children and 64 (12%) adolescents (p <0.01); obesity in 50 (9.7%) children and 96 (17.8%) adolescents (p <0.001) and thinness in 30 (5.8%) children and 8 (1.5%) adolescents (p <0.001). As for physical activity, 39 (7.5%) children and 168 (31.1%) adolescents (p <0.001) were sedentary. Discussion and Conclusion: There was an association of increased body mass index with inadequate diet and physical inactivity with increasing age of patients. Individuals with DS, children and adults, are 30 to 50% susceptible to becoming obese in childhood. According to the classic literature, the presence of hypothyroidism, food error and physical inactivity are associated with overweight and obesity in this population. The prevalence of overweight and obesity in children with intellectual disabilities is almost twice as high as in peers without disabilities. And it is observed that people with DS are less involved in physical activities compared to their siblings. For adolescents, behavioral problems such as impulsiveness, recommendation behavior and disobedience discourage good lifestyle habits. Food inadequacy and physical inactivity were more prevalent in the adolescent population. The body mass index increases the age, therefore the consolidation according to the good practices of life habits requires continuous education of the family and the individual. Multidisciplinary monitoring is essential for the prevention of overweight and obesity.

Introduction: Newborn represent a population at high risk for brain damage. Intracranial hemorrhages in newborn are uncommon, and epidural hematoma (EH) is rare. Material and methods: The authors present a literature review about EH in newborn. Results: EH in newborn occurs in only 2% and is frequently associated with the type of delivery. The clinical presentation is asymptomatic or heterogeneous. The diagnosis is made from anamnesis and imaging exams, and the treatment depends on the size of the EH. Conclusion: The knowledge of neurosurgeons, obstetricians and pediatricians about the occurrence of EH in newborn is extremely important. The rapid identification and management of the case is of paramount importance, to reduce neurological sequelae.

RESUMO: Objetivo: Descrever e comparar hábito nutricional, prática de atividade física e índice de massa corporal (IMC) de crianças e adolescentes com síndrome de Down acompanhados em ambulatório especializado de um hospital terciário no sul do Brasil. Método: Estudo transversal realizado a partir da análise de prontuário de pacientes com síndrome de Down em idade escolar e adolescentes acompanhados em ambulatório especializado do Complexo Hospital de Clínicas da Universidade Federal do Paraná. A alimentação foi considerada adequada se consistisse em alimentos de todos os grupos nas três refeições principais e um ou dois lanches e água nos intervalos. Sedentarismo foi definido como tempo de atividade física inferior a 300 minutos por semana. O estado nutricional foi avaliado usando as curvas de IMC da Organização Mundial da Saúde, 2007. Resultados: O estudo incluiu 755 pacientes, sendo 236 (31,3%) crianças e 519 (68,7%) adolescentes. Sobrepeso e obesidade foram observados em 10,7% e 14,8% da população, respectivamente, sem diferença significativa entre os gêneros. Alimentação inadequada foi observada em 34,6% e sedentarismo em 23,7% dos pacientes. IMC elevado foi observado em 20,3% das crianças e 27,9% dos adolescentes (p=0,026). Observou-se sedentarismo em 29,5% dos adolescentes e 11% das crianças (p<0,001). Alimentação inadequada também foi mais prevalente em adolescentes, porém sem diferença estatística. Pacientes com IMC elevado, em comparação com eutróficos, tiveram maior prevalência de alimentação inadequada e sedentarismo, com significância estatística. Nesse subgrupo, o sedentarismo foi observado em 25% das crianças e 57,2% dos adolescentes (p<0,001). Conclusão: Adolescentes com síndrome de Down apresentam maiores taxas de IMC elevado e sedentarismo comparados com crianças. Estudos específicos em educação em saúde para essa população são necessários com o objetivo de promover hábitos de vida saudáveis e prevenir a obesidade com efetividade.