Oliveira, AM; Rodrigues, C; Borges, A; Martins, A; Santos, S; Pires, F; Araújo, JM; Deus, JR
BACKGROUND: Pseudomyxoma peritonei is an uncommon condition with an estimated incidence of one to two per million (worldwide) per year. It is characterized by the peritoneal deposition of mucinous tumors, most commonly of the appendix, and occasionally from the ovary, coupled by mucinous ascites.
CASE PRESENTATION: We report the case of a 76-year-old woman who presented with increased abdominal girth and dyspnea for 2 weeks. She was diagnosed as a case of pseudomyxoma peritonei. She was submitted to right oophorectomy, omentectomy, and pseudomyxoma debulking. The histology was compatible with a mucinous tumor of colorectal/appendicular origin. Chemotherapy was not administered because of...
Henriques, C; Lopéz, B; Mestre, T; Grima, B; Panarra, A; Riso, N
Leprosy or Hansen's disease is a chronic granulomatous infectious disease caused by Mycobacterium leprae with a high prevalence in some developing countries however, it is rarely seen in non-endemic regions. Arthritis has been described in all types of Hansen's disease. Chronic arthritis is known to exist even in paucibacillary forms, resolved or treated disease and in patients without reaction, suggesting a perpetuated inflammatory process. In these cases leprosy can mimic some autoimmune diseases such as rheumatoid arthritis. When a patient with a history of leprosy presents with a symmetric, distal, polyarthritis the diagnosis may not be linear. Possibly it is...
Paula, F; Alves, J
Therapeutic options for patients suffering from the more severe forms of spondyloarthritis have been rather limited in the last decades. There is now accumulating evidence that antitumor necrosis factor therapy is highly effective in spondyloarthritis, especially in ankylosing spondylitis and psoriatic arthritis. Based on the data recently published on more than 500 patients with ankylosing spondylitis and psoriatic arthritis, this treatment seems to be even more effective than in rheumatoid arthritis. The antitumor necrosis factor-alpha agents currently available, infliximab (Remicade), etanercept (Enbrel), and adalimumab (Humira), are approved for the treatment of rheumatoid arthritis in the United States and partly in...
Caetano, J; Oliveira, S
Caetano, J; Neves, M; Cardoso, F
A giardíase é uma infecção intestinal causada pelo protozoário Giardia lamblia. Afecta principalmente crianças e
imunocomprometidos. As manifestações clínicas são variáveis, podendo traduzir-se por diarreia, má-absorção, por vezes com
anemia ferropénica, ou ser assintomática. Descrevemos um caso de uma doente, 35 anos, ama em infantário, referenciada ao
serviço de urgência por anemia (hemoglobina 6,6g/dL, em análises realizadas por astenia e palidez com 2 meses de evolução),
sem perdas hemáticas visíveis e com amenorreia há 8 meses. Analiticamente destacava-se: anemia microcítica, hipocrómica
grave e ferropénia. Fez endoscopia digestiva alta e o exame histológico da mucosa duodenal revelou arquitectura preservada
e infecção por Giardia lamblia. Iniciou terapêutica com...
Amorim, S; Oliveira, R
A hepatite C tem uma prevalência global de aproximadamente 3%, correspondendo a cerca de 170 milhões de indivíduos infectados.
Pelo seu impacto socioeconómico tem sido uma área em actualização constante, nomeadamente ao nível das novas terapêuticas.
Actualmente, o tratamento standard é a associação de peginterferão com ribavirina por um período de 24 a 72 semanas. O facto de ser
um tratamento longo e que provoca inúmeros efeitos secundários leva, muitas vezes, à falta de adesão terapêutica por parte do doente e
consequentemente, à diminuição da resposta do mesmo ao tratamento. Segundo Larrey et al (2011) “a educação terapêutica realizada por
um enfermeiro especializado aumenta a...
International Team for the Revision of the International Criteria for Behçet's Disease (ITR-ICBD); Duarte, F, et al.
OBJECTIVE: Behçet's disease (BD) is a chronic, relapsing, inflammatory vascular disease with no pathognomonic test. Low sensitivity of the currently applied International Study Group (ISG) clinical diagnostic criteria led to their reassessment.
METHODS: An International Team for the Revision of the International Criteria for BD (from 27 countries) submitted data from 2556 clinically diagnosed BD patients and 1163 controls with BD-mimicking diseases or presenting at least one major BD sign. These were randomly divided into training and validation sets. Logistic regression, 'leave-one-country-out' cross-validation and clinical judgement were employed to develop new International Criteria for BD (ICBD) with the training data. Existing...
Capela, A; Martinho, A; Duarte, F; Garcia, H; Pires, F; Manso, R; Aparício, S; Costa, A
Os tumores oncocíticos da supra-renal são neoplasias pouco frequentes. Atualmente existem 147 casos publicados.
Os autores descrevem o caso de um homem de 34 anos admitido no hospital por lombalgias e febre. À observação identificava-se
massa no quadrante superior esquerdo do abdomen. Os doseamentos das hormonas da supra-renal foram normais e a angiotomografia
abdominal mostrou lesão retroperitoneal esquerda com 145 x 157 x 128 mm com extensas áreas necrosadas e hemorrágicas.
O doente foi submetido a ressecção cirúrgica completa da lesão. O tumor pesava 1495 g e o exame anatomo-patológico concluiu
tratar-se de tumor oncocítico da supra-renal com potencial maligno incerto.
A maioria dos tumores oncocíticos...
Pinto, E; Lourenço, L; Gomes, A; João, P; Rosado, E; Penha, D; Paixão, P
Gomes, A; Rocha, R; Theias, R; Jonet, M; Santiago, I; Aleluia, C; Nunes, V
Martins, H; Cunha, L; Freitas, P
BACKGROUND: The Manchester Triage System (MTS) is a 5-point triage scale used to triage patients presenting to the emergency department. It was introduced in the UK in 1996 and is now widespread, especially in Europe, and has been in use in our hospital since 2000 via a computerised protocol. A study was undertaken to determine whether the subgroups created by the application of MTS have different propensities for indirect triage outcomes such as death in the A&E department or being admitted to hospital.
METHODS: A database of 321 539 patients triaged during a 30-month period (from January 2005 to June 2007)...
Fernández-Guarino, M; Boixeda, P; Anaya, MJ; Beldar, P; Jaén, P
BACKGROUND: Tuberous sclerosis is an uncommon neurocutaneous syndrome characterized by the appearance of hamartomas in multiple organs. Diagnosis is based on clinical criteria. OBJECTIVE. To report the clinical findings in a series of 67 patients with tuberous sclerosis.
MATERIAL AND METHODS: This was a descriptive and observational retrospective study of patients with tuberous sclerosis referred to our dermatology clinics between January 1994 and March 2007.
RESULTS: All patients presented neurological or dermatological disorders. Other disorders, in descending frequency, were psychiatric (55.5%), renal (32.8%), cardiac (22.4%), skeletal and pulmonary (13.4%), and ophthalmological (11.9%).
CONCLUSIONS: We report the clinical findings in a series of patients...
Medical school professors and lecturers are often called to be practicing clinicians, researchers in their own field, in addition to executing their education and curricular responsibilities. Some further accumulate healthcare management responsibilities. These areas pose conflicting demands on time and intellectual activity, but despite their apparent differences, knowledge and skills from management, leadership and informatics may prove useful in helping to smooth these conflicts and hence increase personal effectiveness in these areas. This article tries to clarify some concepts and advance why training in management, leadership and health informatics would seem particularly useful for the medical academic. As opposed to...
Garcia, A; Patrícia, T; Perloiro, MC
Zakout, R; Perloiro, MC; Freitas, P
We present a patient with leptospirosis infection who presented septic
shock with multiple-organ dysfunction syndrome, severe rhabdomyolysis
and acute myocarditis. He developed biphasic blood
calcium pattern with hypocalcemia in the oliguric phase followed
by hypercalcemia during the recovery diuretic phase in the context
of rhabdomyolysis and oliguric acute kidney injury. Meanwhile,
he developed an extensive calcification of the myocardium. Severe
renal magnesium wasting was observed during the convalescence
phase. Follow-up showed progressive resorption and later almost
total disappearance of the calcific deposits in the heart by the 18th
month after discharge. Renal magnesium wasting decreased gradually,
but yet persisted beyond the 18th and was normalized only by
the 36th month after discharge....
Martinho, A; Capela, A; Duarte, F
O Síndrome de Sjögren é uma doença auto-imune sistémica caracterizada por inflamação crónica das glândulas exócrinas. As manifestações extraglandulares têm uma incidência até 25%. O envolvimento renal ocorre em 18,4-67% dos casos, e nestes a nefrite tubulointersticial é a lesão mais frequente. Apresenta-se o caso clínico de uma mulher de 37 anos, internada por fraqueza muscular generalizada de grau 2 com uma semana de evolução. Objectivou-se hipocaliémia, rabdomiólise, pH urinário 6,5, proteinúria, e acidémia metabólica. O estudo da acidose renal tubular distal com hipocaliémia conduziu ao diagnóstico de nefrite tubulo-intersticial linfoplasmocitária, confirmada na biópsia renal, e à suspeita de Síndrome...
Faria, C; Zakout, R; Araújo, JM
It is now widely accepted that Helicobacter pylori may play a role in several extra-gastric diseases. In particular, H. pylori infection seems to be implicated in various autoimmune diseases. Many recent studies have shown a healing or an improvement in different autoimmune disorders after H. pylori eradication therapy in infected patients. The exact mechanisms behind this relationship remain under discussion, but molecular mimicry is a consistent hypothesis. This subject is particularly relevant taking into consideration the high prevalence of H. pylori infection, the existence of inexpensive and noninvasive diagnostic methods, as the urea breath test or the stool antigen test,...
Soto, K; Coelho, S; Rodrigues, B; Martins, H; Frade, F; Lopes, S; Cunha, L; Papoila, A; Devarajan, P
BACKGROUND AND OBJECTIVES: The diagnosis of acute kidney injury (AKI) is usually based on changes in serum creatinine, which is a poor marker of early renal dysfunction. The discriminative and predictive abilities of serum and urinary cystatin C were examined for the prediction of AKI.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In this prospective cohort study, serum and urinary cystatin C were serially measured in a heterogeneous group of patients (n = 616) presenting to a tertiary care emergency department. The primary outcome was AKI, classified according to RIFLE and AKIN criteria. The secondary outcome was an adjudication based on clinical criteria...