Objetivos: avaliar a dificuldade diagnóstica, o tratamento e seu resultado em casos de insuficiência hepática aguda da gravidez. Métodos: sete pacientes com insuficiência hepática aguda da gravidez admitidas em nosso Serviço nos últimos quatro anos foram estudadas com ênfase nos sintomas presentes, achados laboratoriais, curso clínico, complicações maternas e sobrevida fetal. Resultados: a média de idade foi de 25,8 anos (sendo duas primigestas) com idade gestacional média de 30,1. Destas, quatro receberam diagnóstico final de esteatose hepática aguda da gravidez e três de colestase intra-hepática da gravidez. Os principais sinais e sintomas encontrados foram: anorexia, náusea, dor abdominal, icterícia e encefalopatia. Ocorreu morte materna em dois casos: uma paciente por falência hepática enquanto aguardava órgão para transplante e outra por falência hepática, coagulopatia grave e choque hemorrágico após biópsia hepática. Uma paciente com esteatose hepática aguda evoluiu para cronicidade e encontra-se viva um ano após transplante hepático. Nos quatro casos restantes houve completa remissão do quadro com as medidas de suporte, associadas à interrupção da gravidez. As mortalidades materna e fetal foram, respectivamente, 28,6% e 57,1%. Conclusões: concluiu-se, nesta experiência inicial, que a insuficiência hepática aguda da gravidez constitui evento clínico grave, de elevada mortalidade materno-fetal, e que seu pronto reconhecimento e encaminhamento para centros terciários especializados em fígado, além da imediata interrupção da gestação, são fatores decisivos para o sucesso do tratamento.

Purpose: to evaluate the diagnostic difficulties, treatment and outcome in cases of acute liver failure of pregnancy. Methods: seven patients with acute liver failure of pregnancy, managed during the past 4 years, were studied with emphasis on presenting symptoms, laboratory findings, clinical course, maternal complications and fetal outcome. Results: the mean age was 25.8 years (two were primigravidas), and the mean gestational age at onset was 30.1 weeks. The final diagnosis was acute fatty liver of pregnancy in four cases and intrahepatic cholestasis of pregnancy in three cases. Anorexia, nausea, abdominal pain, jaundice and encephalopathy were the main clinical findings. Two maternal deaths occurred: one due to hepatic failure, while waiting for transplantation, and another due to hepatic failure associated with coagulopathy and major intra-abdominal bleeding after liver biopsy. One patient with acute fatty liver of pregnancy underwent a successful liver transplantation one year ago (after chronification of her disease). The remaining four cases had complete resolution of the disorders after delivery and supportive measures. Maternal and fetal mortalities were 28.6% and 57.1%, respectively. Conclusion: from this initial experience, we conclude that acute liver failure of pregnancy is a serious disease, with high maternal-fetal mortality, and that early recognition of this illness, referral to tertiary liver centers, and prompt interruption of gestation are, together, very important for the success of the treatment.

Em 50 doentes matriculados para tratamento de tuberculose pulmonar no Centro de Saúde I de Sorocaba, SP (Brasil), foram estudadas as informações que antecederam ao diagnóstico da doença tais como: sintomatologia, hábitos, procedência, número de vezes que procurou auxílio médico, conhecimento de contágio prévio e sintomatologia da doença, tempo decorrido entre o início da sintomatologia e o início do tratamento, entre a apresentação ao posto de saúde e o início da terapêutica. Notou-se a importância da sintomatologia respiratória, a demora da procura do médico apesar dos sintomas, a falta de informações do doente a respeito da enfermidade. Apesar do bom desempenho técnico do pessoal médico e paramédico do centro de saúde, constatou-se demora acentuada para a detecção dos casos na população, e, conseqüentemente terapêutica.

Pulmonary tuberculosis still remains a serious public health problem in Brazil. The National Tuberculosis Control Program has as its aim the interruption of the chains of transmition by diagnosis and, consequently, by early treatment. It is known that specific chemotherapy reduces the degree of contagion in the first two weeks of treatment. The sooner the health program detects and begins therapy, the bigger average number of patients who will participate in it. With the intention of providing information to increase efficiency in detecting tuberculosis and contagious cases it was collected data relating to the patients' health before diagnosis and also to the time lag between this diagnosis and the beginning of specific treatment. Fifty out-patients (50) suffering from tuberculosis of the lungs were questioned, during treatment, for information relating to the period proceeding diagnosis. Information sought covered: symptomatology before contamination, place and number of consultations, habits time elapsed between the occurrence of first symptoms and first visit to the physician, lapse of time between the occurrence of first symptoms and the beginning of treatment, knowledge about symptomatology of the disease and lapse of time between the first appearance at the health clinic and the beginning of treatment. The importance of the factors: respiratory symptomatology, the considerable time lapse before looking for a physician and lack of information about the disease was observed. Despite the dedication of the medical and paramedical services there was delay in detecting the sick person within the community.

Em 50 doentes matriculados para tratamento de tuberculose pulmonar no Centro de Saúde I de Sorocaba, SP (Brasil), foram estudadas as informações que antecederam ao diagnóstico da doença tais como: sintomatologia, hábitos, procedência, número de vezes que procurou auxílio médico, conhecimento de contágio prévio e sintomatologia da doença, tempo decorrido entre o início da sintomatologia e o início do tratamento, entre a apresentação ao posto de saúde e o início da terapêutica. Notou-se a importância da sintomatologia respiratória, a demora da procura do médico apesar dos sintomas, a falta de informações do doente a respeito da enfermidade. Apesar do bom desempenho técnico do pessoal médico e paramédico do centro de saúde, constatou-se demora acentuada para a detecção dos casos na população, e, conseqüentemente terapêutica.

Pulmonary tuberculosis still remains a serious public health problem in Brazil. The National Tuberculosis Control Program has as its aim the interruption of the chains of transmition by diagnosis and, consequently, by early treatment. It is known that specific chemotherapy reduces the degree of contagion in the first two weeks of treatment. The sooner the health program detects and begins therapy, the bigger average number of patients who will participate in it. With the intention of providing information to increase efficiency in detecting tuberculosis and contagious cases it was collected data relating to the patients' health before diagnosis and also to the time lag between this diagnosis and the beginning of specific treatment. Fifty out-patients (50) suffering from tuberculosis of the lungs were questioned, during treatment, for information relating to the period proceeding diagnosis. Information sought covered: symptomatology before contamination, place and number of consultations, habits time elapsed between the occurrence of first symptoms and first visit to the physician, lapse of time between the occurrence of first symptoms and the beginning of treatment, knowledge about symptomatology of the disease and lapse of time between the first appearance at the health clinic and the beginning of treatment. The importance of the factors: respiratory symptomatology, the considerable time lapse before looking for a physician and lack of information about the disease was observed. Despite the dedication of the medical and paramedical services there was delay in detecting the sick person within the community.