Browsing by Issue Date, starting with "2010-09"
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- Hidropisia fetal e colestase neonatal - caso clínicoPublication . Afonso, A.; Alexandrino, A.M.; Silva, E.S.; Almeida, A.; Santos, G.N.As possíveis etiologias associadas a hidropisia fetal não imune e colestase neonatal são numerosas. A investigação destas situações, mesmo quando exaustiva, nem sempre permite estabelecer um diagnóstico etiológico. A abordagem clínica deverá assentar na exploração minuciosa dos dados da anamnese e do exame objectivo. A realização de exames complementares deve ser orientada pela clínica, tendo por objectivo identificar rapidamente os casos graves e as patologias potencialmente tratáveis. Os autores descrevem a abordagem diagnóstica e terapêutica de um recém-nascido admitido numa Unidade de Cuidados Intensivos Neonatais ao nascimento por hidropisia fetal e prematuridade, que desenvolveu um quadro de colestase a partir do 2º dia de vida. ABSTRACT There is a wide variety of disorders associated with non-immune hydrops fetalis and neonatal cholestasis. Besides exhaustive investigation, in some cases it is not possible to identify an etiological factor. The approach to these entities should be supported by detailed anamnesis and a meticulous physical examination. Additional testing must be oriented by clinical manifestations and the aim is prompt identification of potential lifethreatening diseases and treatable disorders. The authors present the diagnostic and therapeutic approaches in a premature newborn with hydrops fetalis, admitted in an Intensive Care Neonatal Unit soon after birth, who developed cholestasis from the 2nd day of life.
- Caso electroencefalográfico: mioclonias palpebraisPublication . Velon, A.; Xavier, C.; Ribeiro, A.; Chorão, R.ABSTRACT Introduction. Eyelid myoclonia with or without absences may occur in several epileptic conditions, and they are frequently misinterpreted as movement disorders. Case report. A seven-year-old boy was admitted for evaluation of eye blinking that started at age of six. He had never had generalized tonic-clonic or absence seizures. Video-EEG monitoring revealed 3-5 Hz irregular occipital or generalized polyspike and polyspike-wave complexes, precipitated by eye closure. They were accompanied by eye-lid myoclonia. Photic stimulation induced photoparoxysmal response. Brain MRI was normal. He was initially treated with clobazam and then levetiracetam with no response. Valproate was added with control of the symptoms. Conclusion. Eyelid myoclonia without absences are often difficult to classify. Video-EEG may help to clarify these cases.
- Um caso raro de retenção urinária agudaPublication . Santalha, M.; Fonte, M.; Correia, F.; Ferreira, C.A retenção urinária é pouco frequente na infância, podendo ser congénita ou secundária a processos traumáticos, inflamatórios, cirúrgicos, neurológicos, mecânicos, medicamentosos ou psicogénicos. Apresenta-se o caso clínico de uma adolescente de treze anos, com quadro de algia hipogástrica, retenção urinária e obstipação. Ao exame objectivo constatou-se uma massa arredondada hipogástrica. A radiografia simples do abdómen evidenciou imagem radiopaca no terço inferior do abdómen e a ecografia abdomino-pélvica mostrou conteúdo impuro sugerindo hematocolpos e hematometra. Realizada himeniotomia cirúrgica com evolução favorável. A inspecção atenta dos genitais externos é fundamental, logo após o nascimento, para o diagnóstico de hímen imperfurado. Quando não detectado e tratado no período neonatal, na sua maioria o diagnóstico é realizado tardiamente em idade pubertária perante o aparecimento de complicações. ABSTRACT Introduction: Acute urinary retention is uncommon in childhood, and it can be congenital or secondary to traumatic, inflammatory, surgical, neurological or mechanical processes, drug-induced or psychogenic. Case report: We report a clinical case of a thirteen year old girl with hypogastric pain, urinary retention and constipation. On physical examination a rounded hipogastric mass was palpable. An abdominal X-ray revealed a radiopaque image in the lower third of the abdomen and the abdominal-pelvic ultrasonography revealed an impure content suggesting hematocolpos and hematometra. A surgical incision of the hymen was performed, with favorable outcome. Conclusion: A careful inspection of the external genitalia immediately after birth is essential for the diagnosis of imperforated hymen. When not detected and treated in the neonatal period, most of them have a delayed diagnosis during puberty when complications may occur.
- Caso endoscópico: heterotopia gástrica do esófago próximalPublication . Pereira, F.We present a case of a five-year-old girl observed for vomiting after meals during the last two months. She had been evaluated by the age of six months for frequent regurgitation. The upper digestive tract X-ray and 24 hours pH monitoring were normal, establishing the diagnosis of physiologic gastro-esophageal refl ux. At the age of five the patient started having post-prandial vomiting, without other digestive or general symptoms. She had a normal development and normal physical examination and analytical profi le. The upper digestive endoscopy showed two islets of abnormal red mucosa, with irregular surface, slightly depressed, each measuring about 15mm in the upper oesophagus, below the sphincter. The histological study of mucosal biopsies concluded for ectopic gastric mucosa. The patient became symptoms-free under treatment with PPI (protonpump inhibitiors).
- Caso radiológico: tuberculose pleuralPublication . Almeida, A.; Macedo, F.The authors report a case of pleural tuberculosis in a 15-year-old boy submitted to screening after his father was diagnosed with the disease. This patient had constitutional symptoms in the last two months (such as significant weight loss, fatigue, anorexia and night sweats) but no respiratory complains. The thoracic X-ray complemented by a CT scan revealed pleural effusion with minimal pulmonary changes. Pleural fluid analysis and pleural biopsy confirmed the diagnosis of pleural tuberculosis. This case highlights the non specific clinic and imaging findings in tuberculosis and the need for a high index of suspicion to reach the diagnosis.
- Dor abdominal e retenção urinária aguda em adolescente: apresentação clínica de hematocolpos e revisão da literaturaPublication . Sousa, H.; Fonseca, H.; Sampaio, L.Introdução: O hematocolpos é uma patologia rara resultante da acumulação vaginal de sangue menstrual nas jovens com hímen imperfurado. Caso clínico: Adolescente de 13 anos e 11 meses, sexo feminino, previamente saudável, que recorreu ao serviço de urgência por dor abdominal e lombar, tenesmo e retenção urinária aguda. Ausência de menarca. Ao exame objectivo: estadio pubertário IV de Tanner, distensão abdominal e massa pélvica. O exame ginecológico revelou membrana himeneal azulada e proeminente. A ecografia pélvica evidenciou globo vesical muito exuberante, acumulação de fluido ecogénico na vagina e hímen imperfurado. A himenectomia de urgência, efectuada poucas horas depois, decorreu sem intercorrências. Clinicamente bem na reavaliação um mês pós-operatório. Conclusão: Numa adolescente com amenorreia primária e dor abdominal ou retenção urinária aguda, o hematocolpos é um diagnóstico a colocar. A avaliação do estadio pubertário e história menstrual deve ser incluída nas consultas de rotina. ABSTRACT Introduction: Hematocolpos in adolescents with imperforate hymen resulting from vaginal blood accumulation is a quite rare pathology. Case report: A previously healthy almost 14-year-old girl, was admitted to the emergency department with lower abdominal pain and acute urinary retention. No previous menstruation. Objective examination with pubertal Tanner stage IV, abdominal distension and pelvic mass. Gynecological examination revealed a blue imperforate hymen bulging from the vagina introitus outwards. Ultrasonography showed exuberant vesical globe and echogenic fluid accumulation in the vagina. Cruciate hymenotomy was uneventful. Asymptomatic in the follow-up, one month later. Conclusion: The diagnosis of imperforate hymen and hematocolpos is probable in an adolescent girl with primary amenorrhea, abdominal pain or acute urinary retention. Evaluation of the pubertal stage and menses should be included in routine practice.
- Paralisia facial periférica - diagnóstico, tratamento e orientaçãoPublication . Correia, T.; Sampaio, M.J.; Almeida, R.; Garrido, C.A paralisia facial periférica (PFP) é frequente em idade pediátrica. Inerente à sua designação existe um conceito anatómico que pressupõe a localização da lesão distalmente aos núcleos do sétimo nervo craniano. Contudo, define-se melhor pela clínica, consistindo na parésia dos músculos da mímica facial da hemiface ipsilateral à lesão, associada ou não a hiperacúsia, xeroftalmia e perda do paladar nos dois terços anteriores da língua. As principais causas médicas são a PFP idiopática ou de Bell (65%) e o Herpes Zoster Ótico (12%). Em áreas endémicas, também a doença de Lyme pode ter um papel relevante. Sendo um tema de consensos difíceis, os autores apresentam uma revisão da literatura e propõem um protocolo de actuação na perspectiva do diagnóstico, tratamento e orientação. ABSTRACT Facial palsy (FP) is a common disorder in children. It is caused by an aggression to the seventh cranial nerve distally to its emergence from the pons. The best way to define FP is by its clinical manifestations: paralisis of the muscles of the ipsilateral side of the face with or without hyperacusis, decreased production of tears, and loss of taste at the anterior two-thirds of the tongue. The most common medical causes are idiopathic FP, also known as Bell’s palsy (65%) and herpes zoster oticus (12%). In endemic areas, Lyme disease is also an important etiology. As this is a controversial subject, the authors present a review of the most recent literature and propose a protocol to guide diagnosis, treatment and follow up.
- Caso estomatológico: epúlide congénitaPublication . Amorim, J.A one month-old girl was referred to our department due a neoformation of the mandible. The excisional biopsy of the lesion revealed a congenital epulides of the newborn. This is an uncommon lesion, easy to diagnose, as it has a typical appearance and localisation. Surgical treatment is the option, namely when it impairs feeding, swallowing or breathing.
- Enurese Nocturna: a Experiência de uma Consulta Especializada no CHPV/VCPublication . Almeida, P.; Monteiro, J.; Madalena, C.Introdução: A enurese nocturna (EN) é um problema comum em Pediatria. Aos 5 anos, a sua prevalência é de cerca de 15%. A maioria corresponde a EN Monossintomática (ENM). Objectivos: Caracterizar a população de crianças com EN seguidas na consulta de Enurese (CE) do Centro Hospitalar da Póvoa de Varzim/Vila do Conde (CHPV/VC). Material e métodos: Estudo observacional, analítico e retrospectivo dos doentes da CE do CHPV/VC com 1ª consulta entre Julho/2003 e Dezembro/2007. Dados recolhidos da consulta do processo clínico tratados em Microsoft Excel 2007®. Resultados: Incluídas 137 crianças (67% rapazes), entre os 5 e os 17 anos. Em 87,6% a EN era primária, em 57,7% era ENM, em 76,5% havia episódios todas as noites e em 72% havia poliúria. Todas as crianças efectuaram exame de urina tipo II. Dos 77 casos de ENM, em 3 foram instituídas inicialmente apenas medidas de reforço positivo, tendo-se verificado cura em 2; em 74 foi instituído tratamento com desmopressina, curando 42%. Em 17 casos foi associado alarme sonoro (AS) à desmopressina, curando 88,2%. Nos 53 casos de EN Não -Monossintomática (ENNM) foi instituído tratamento com oxibutinina em todos os casos, com cura em 11% (em monoterapia). Em 47 crianças foi associada desmopressina, com cura em 43%. Em 7 casos associou-se AS à desmopressina, com cura em 43%. Discussão e conclusão: Na ENM houve bons resultados associando desmopressina ao AS, quando esta não teve sucesso terapêutico isoladamente. Nos casos de ENNM verificou-se que a terapêutica isolada com oxibutinina foi pouco eficaz, recorrendo-se frequentemente à associação de 2 fármacos e/ou AS. ABSTRACT Introduction: Nocturnal enuresis (NE) is a common problem in childhood healthcare. At the age of 5 nocturnal enuresis’ prevalence is 15%. Most patients have monosymptomatic NE (MNE). Objectives: To study the children with NE followed at the Enuresis Consult at the Centro Hospitalar da Póvoa de Varzim/ Vila do Conde(CHPV/VC). Material and methods: Observational, analytic and retrospective study of the patients of the Enuresis Consult at the CHPV/VC, with the first appointment between July 2003 and December 2007. The data was collected from clinical files and coded with Microsoft Excel 2007©. Results: The study included 137 children (67% of males), aged 5 to 17 years. In 87,6%, the NE was primary, in 57,7% it was MNE; in 76,5% there was enuresis every night and in 72% there was polyuria. All the children performed a urine analysis. Of the 77 cases of MNE, in 3 children positive enforcement was instituted with cure in 2; 74 children were treated with desmopressin, curing 42%. In 17 patients the alarm was associated to desmopressin, curing 88,2%. In the 53 cases of non-monosymptomatic NE (NMNE) it was instituted treatment with oxibutinin, with a cure rate of 11%. In 47 children desmopressin was added, with a cure rate of 43%. In 7 the desmopressin was associated to the alarm, with a cure rate of 43%. Discussion and conclusion: The association of desmopressin with alarm was efficacious in the treatment of MNE. In cases of NMNE the therapy with oxybutynin alone was ineffective, often resolving with the combination of two drugs and/or alarm.
- Caso dermatológico: alergia às caneleirasPublication . Oliveira, A.; Fernandes, I.; Lobo, I.; Selores, M.Many adverse events can occur when the skin comes in contact with external agents. Eczema is one of them. The eczema can be either allergic or irritant in nature. Irritant contact dermatitis (ICD) accounts for approximately 80% of all contact dermatitis and allergic contact dermatitis (ACD) accounts for the remaining 20%. ACD is a delayed-type hypersensitivity reaction that is elicited when the skin comes in contact with a chemical to which an individual has previously been sensitized. The classic picture of contact dermatitis is a well-demarcated erythematous vesicular (in the acute form) and/or scaly patch or plaque (in the chronic form) lesion, with well-defined margins corresponding to the area of contact. It requires an appropriate level of suspicion for the possibility of an allergen to elicit a contact dermatitis. Treatment is based on avoidance of the allergen associated with corticosteroids and antihistamines. The authors present a case of allergic contact dermatitis to football shin guards in a 12 year-old boy who regularly practiced soccer.