Browsing by Author "Neves, M."
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- Investigating a Case of Recurrent Pleural EffusionPublication . Rodrigues, P.; Neves, M.; Ferreira, J.; Abreu, M.; Almeida, F.We describe the case of a patient with long-standing Parkinson’s disease and recurrent bilateral pleural effusions. The pleural fluid was an exudate, rich in normal lymphocytes, and the echocardiogram, chest computerized axial tomography, and immunological, microbiological and cytological studies were negative. The patient had been taking bromocriptine, which can be related to chronic pleural effusions. Using Pubmed, we found about 40 cases of pleuropulmonary changes or constrictive pericarditis that were related to bromocriptine. We decided to suspend this drug, with resolution of the pleural effusion and respiratory complaints for more than a year now. We discuss possible underlining mechanisms for this and emphasize the importance of collecting the past medical history and medication and of considering possible iatrogenic effects.
- Massa eritematosa lingual: que etiologia?Publication . Santos, P.; Espada, F.; Neves, M.; Coutinho, P.; Bianchi, F.; Fonseca, M.A tiróide lingual é uma entidade clínica rara, que resulta da localização ectópica de tecido tiroideu por ausência de migração embrionária da glândula tiroideia do foramen caecum para a localização pré-traqueal final. Habitualmente assintomática, pode no entanto ser detectada no exame físico de rotina da orofaringe ou no contexto de infecção das vias aéreas superiores. Pode também manifestar-se por disfagia, dispneia, disfonia, tosse, hemorragia ou hipotiroidismo sintomático. Os autores apresentam o caso clínico de uma criança de 3 anos do sexo feminino, sem antecedentes patológicos relevantes que apresentava tosse irritativa com agravamento progressivo e acessos de tosse laríngea. Na observação da orofaringe foi visualizada uma massa eritematosa, localizada na linha média do terço posterior da língua. Os estudos realizados demonstraram tratar-se de tiróide lingual associada a hipotiroidismo compensado. Os autores salientam a necessidade de vigilância clínica e analítica desta situação pelo risco de aparecimento de sintomatologia respiratória ou digestiva grave e/ou descompensação do hipotiroidismo. A cirurgia com remoção da massa poderá ser uma opção terapêutica no caso de sintomatologia respiratória ou digestiva grave ou transformação maligna. ABSTRACT The lingual thyroid is a rare clinical entity, which results from the ectopic location of thyroid gland tissue due to the absence of embryonic migration of the thyroid gland from the foramen caecum to the final pretracheal position. Usually asymptomatic, it can be detected during routine oral examination or in the context of infection of the upper airways. It can also present as dysphagia, dyspnea, dysphonia, cough, hemorrhage or hypothyroidism. The authors present the clinical case of a three-year old girl, without pathological relevant past medical history, who had a progressive irritating cough and accesses of laryngeal cough. In the oral cavity, an erythematous mass was visualized; it was located in the middle line of the subsequent third of the tongue. The subsequent studies demonstrated a lingual thyroid associated with an analytical compensated hypothyroidism. The authors point out the need of a clinical and analytical vigilance of this situation because of the risk of appearance of respiratory or digestive serious symptoms and/or hypothyroidism. The surgery with removal of the mass is a therapeutic option in the case of respiratory or digestive serious symptoms or malignant transformation.
- Meretoja's Syndrome: Lattice Corneal Dystrophy, Gelsolin TypePublication . Casal, I.; Monteiro, S.; Abreu, C.; Neves, M.; Oliveira, L.; Beirão, JoãoLattice corneal dystrophy gelsolin type was first described in 1969 by Jouko Meretoja, a Finnish ophthalmologist. It is caused by an autosomal dominant mutation in gelsolin gene resulting in unstable protein fragments and amyloid deposition in various organs. The age of onset is usually after the third decade of life and typical diagnostic triad includes progressive bilateral facial paralysis, loose skin, and lattice corneal dystrophy. We report a case of a 53-year-old female patient referred to our Department of Ophthalmology by severe dry eye and incomplete eyelid closure. She had severe bilateral facial paresis, significant orbicularis, and perioral sagging as well as hypoesthesia of extremities and was diagnosed with Meretoja's syndrome at the age of 50, confirmed by the presence of gelsolin mutation. At our observation she had bilateral diminished tear film break-up time and Schirmer test, diffuse keratitis, corneal opacification, and neovascularization in the left eye. She was treated with preservative-free lubricants and topical cyclosporine, associated with nocturnal complete occlusion of both eyes, and underwent placement of lacrimal punctal plugs. Ocular symptoms are the first to appear and our role as ophthalmologists is essential for the diagnosis, treatment, and monitoring of ocular alterations in these patients.
- Paralisia do plexo braquial – uma manifestação rara de infeção osteo-articularPublication . Moutinho, A.; Valério, M.; Marques, I.; Carruscal, C.; Vieira, J.; Tavares, D.; Neves, M.Introdução: A paralisia do plexo braquial é uma entidade rara após o período neonatal. Resulta habitualmente de mecanismos físicos, mas pode estar relacionada com infeções osteo- articulares. Há poucos casos descritos de associação entre estas infeções e a paralisia secundária a neuropatia. Na maioria dos casos a manifestação mais frequente é a pseudo-paralisia ou fraqueza aparente do membro afetado. Casos Clínicos: Descrevem-se três casos de infeção osteo- articular manifestada por provável paralisia braquial sem os sinais sistémicos típicos de infeção. O tempo decorrido do início da doença ao estabelecimento do diagnóstico diferiu entre os casos, bem como as intervenções terapêuticas e o resultado. Discussão: A infeção osteo-articular pode passar despercebida na infância. Alerta-se para esta manifestação rara de infecção osteo-articular, de forma a evitar o atraso no diagnóstico e as respetivas sequelas.