Browsing by Issue Date, starting with "2012"
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- Pericardial and pleural effusions associated with sirolimus and discussion of possible mechanismsPublication . Rocha, S.; Pedroso, S.; Almeida, M.; Dias, L.; Martins, L.; Castro-Henriques, A.; Cabrita, A.Sirolimus, a mammalian target of rapamycin inhibitor, is an increasingly used immunosuppressant in solid-organ transplantation. There are an increasing number of reports of unusual oedematous adverse effects associated with this drug, including lymphoedema, ascites and pleural effusions, and a few reports of pericardial effusions. No pathophysiological explanation for these phenomena has been disclosed. We report a 33-year-old sirolimus-treated kidney transplant recipient with chronic pericardial and pleural effusions identified nine years after transplantation. He was initially treated for a presumed tuberculous pericarditis, even though cultures for Mycobacterium tuberculosis were negative. After 12 months of antitubercular therapy, visceral effusions persisted. Pericardial effusion was drained and stabilised. After exclusion of other causes, sirolimus toxicity was considered the most likely cause. Two months after discontinuation of sirolimus, visceraleffusions disappeared. Interaction of mammalian target of rapamycin inhibitors with mediators of lymphangiogenesis may be a common link in oedematous states associated with sirolimus.
- Langerhans cell histiocytosis: Two clinical presentations in the same patientPublication . Oliveira, A.; Pinto-Almeida, T.; Lobo, I.; Machado, S.; Selores, M.Langerhans cell histiocytosis (LCH) is a heterogeneous group of diseases characterized by a pathological proliferation of cells phenotypically similar to Langerhans cells. The disease course is variable, alternating between resolving and potentially fatal forms. The diagnosis is based on clinical appearance and confirmed by CD1a positivity and / or immunohistochemistry. We report the case of a male child of 3 months with two different presentations of Langerhans cell-histiocytosis (LCH) at different times. The first presentation was classified as a self-healing LCH (formerly known as Hashimoto-Pritzker). The last presentation, although clinically suggestive of Letterer-Siwe (former designation), was not associated with systemic disease. This emphasizes that LCH cannot be compartmentalized into four groups, but considered a single disease with a wide spectrum of clinical presentations. This case underscores the importance of frequent and long-term follow-up of these patients.
- Vesico-bullous subacute cutaneous lupus erythematosus – An uncommon entity successfully treated with dapsone and hydroxychloroquinePublication . Pinto-Almeida, T.; Sanches, M.; Alves, R.; Selores, M.Vesico-bullous subacute cutaneous lupus erythematosus is an uncommon and severe presentation. The authors report an exuberant case of vesico-bullous subacute cutaneous lupus erythematosus successfully treated with dapsone and hydroxychloroquine
- Do you know this syndrome?Publication . Rosmaninho, A.; Pinto-Almeida, T.; Fernandes, I.; Machado, S.; Selores, M.Abstract Lipomas are among the most common tumors seen in the soft body parts and usually are solitary lesions. The authors report a case of a male patient that presented for evaluation of multiple subcutaneous nodules that caused important functional and cosmetic impairment. The diagnosis of familial multiple lipomatosis was made. Physicians should be able to recognize and characterize this rare disease.
- Arterial Spin Labeling: Experiência Inicial, Indicações Clínicas e DificuldadesPublication . Carneiro, A.; Pina, S.; Moreira, B.RESUMO O arterial spin labeling (ASL) é uma técnica de perfusão por ressonância magnética (RM) que usa os protões das moléculas de água do sangue arterial como marcador endógeno. As suas principais vantagens residem no facto de ser um método não invasivo, rápido e que dispensa a administração de contraste. Actualmente os seus resultados são reprodutíveis de modo robusto, o que o torna uma ferramenta cada vez mais utilizada na prática clínica. O objectivo deste trabalho é apresentar a nossa experiência inicial com o ASL, salientando os aspectos técnicos, as principais solicitações clínicas, os resultados obtidos e as dificuldades experimentadas. Métodos: Foi efectuada uma revisão dos exames realizados durante um período de oito meses, usando uma técnica de ASL pulsado, num aparelho de 3T. A avaliação dos mapas de perfusão foi realizada de modo qualitativo. Resultados: As principais indicações clínicas para a realização de ASL foram epilepsia, doenças neuro-degenerativas e tumores intra-parenquimatosos. Embora o ASL não tenha sido, em nenhum dos casos, a principal ferramenta diagnóstica, contribuiu, por vezes, com dados fisiológicos importantes para o diagnóstico e para a orientação terapêutica. Salientam-se os casos de doentes com múltiplas crises epilépticas nos quais foi possível identificar focos de hiperperfusão pós-ictal (cujos resultados foram concordantes com o SPECT). Destacam-se ainda casos de doenças neuro-degenerativas nos quais o ASL identificou áreas de hipoperfusão típicas das respectivas entidades nosológicas. As principais dificuldades estiveram relacionadas com o carácter qualitativo da avaliação e com a valorização clínica dos achados. Conclusão: O estudo da perfusão cerebral por ASL tem um potencial diagnóstico importante. Com este trabalho mostramos que, com uma aquisição rápida e pós-processamento simples, pode facilmente integrar os estudos de RM de rotina. Abstract Arterial spin labelling (ASL) is a MR perfusion technique that uses protons from water molecules of the arterial blood as an endogenous tracer. It is fast, non-invasive and does not require gadolinium administration. Due to the increasing robustness of the results, it is becoming an important clinical tool. In this article we present our initial experience with ASL, highlighting some technical aspects, the main clinical applications, some achieved results and most important difficulties. Methods: Review of the examinations performed during eight months, using a pulsating ASL technique in a 3T machine. Perfusion maps were evaluated qualitatively. Results: The most frequent clinical applications were epilepsy, neurodegenerative disorders and tumours. Although perfusion data from ASL had never been crucial for diagnosis, it still provided substantial information. We highlight two epileptic patients who had had recent seizures, in which ASL depicted distinct post-ictal hyperperfusion areas (with the results being confirmed by SPECT studies). The impact was also remarkable in patients with neurodegenerative disorders in which ASL depicted hypoperfusion areas, typical of each nosological entity. The main difficulties were related to the lack of quantitative evaluation and to the clinical interpretation of the results obtained. Conclusion: ASL perfusion studies have a great potential in several clinical conditions. In this article we show that, with a fast acquisition and easy post-processing, it can integrate routine MRI examinations.
- Stability of blood gases when refrigeratedPublication . Ferreira, J.; Silva, S.; Rodrigues, P.; Abreu, M.; Maia, J.; Carvalho, D.; Carvalho, L.Background: Blood gas analysis is a widely used procedure. In clinical practice, the physicians may not always have a blood gas analyzer in their proximity. Not infrequently, blood gas samples are stored in a fridge or on ice and read retrospectively. Continued anaerobic and aerobic metabolism in the blood may alter blood gases in the interval between drawing arterial blood and its analysis, which may cause a fall in the PaO2 and pH and a rise in the PaCO2. Methods: Two sets of arterial blood samples were obtained from hospitalized patients. After the initial analysis, one sample from each patient was put in raw ice within a specimen bag (0 to +1 oC) and the other in the fridge (+4 to +8 oC). These samples were submitted to serial analysis at 30 minutes, 1 hour and 2 hours after the initial analysis. Results: Two hundred arterial blood gas results from 25 patients were analysed. The mean values of PaO2, PaCO2, HCO3-, Na+, K+, Ca2+ and lactate at 0 minutes, 30 minutes, 1 hour and 2 hours were not signifi cantly different between the two alternatives of storage. However, within each group, signifi cant changes were found over time for PaO2, K+, Na+, Ca2+ and lactate. Conclusions: When using plastic syringes, arterial blood gas analysis should be processed shortly after collecting the sample. Despite the fact that low temperatures can slow down the metabolism, neither the ice nor the fridge preserved all the sample parameters.
- Are Anti-Ro52 Antibodies Associated with Pulmonary Involvement in Scleroderma?Publication . Ferreira, J.; Almeida, I.; Marinho, A.; Cerveira, C.; Vasconcelos, C.Abstract Introduction: The presence of anti-Ro52 antibodies has been reported in a wide variety of autoimmune diseases, particularly in myositis, scleroderma and autoimmune liver diseases. Clinical significance of anti-Ro52 antibodies remains controversial. Studies are lacking in clarifying the association of anti-Ro52 with pulmonary involvement in scleroderma. Objectives: To determine if anti-Ro52 antibodies are associated with pulmonary involvement (interstitial, indirect pulmonary hypertension, or both) in scleroderma. Methods: Single center, retrospective study based on immunoblotting panel analysis and patients clinical records. Pulmonary manifestations were sub-grouped in: 1) interstitial (alveolitis and/or fibrosis), 2) pulmonary artery systolic pressure (PASP) ≥40 mmHg plus interstitial pulmonary disease, and 3) isolated PASP≥40 mmHg (purely vascular). Results: Our scleroderma cohort included 200 patients, of which 137 had immunoblotting panels with anti-Ro52 reactivity analysis. The search was conducted between January 2010 and July 2011. The frequency of pulmonary manifestations in patients with positive anti-Ro52 antibodies was 67.7% (n=31), and 60% (n=24) in the negative anti-Ro52 group, showing no significant differences between groups (p=0.621). Still no significant differences were found when pulmonary manifestations were evaluated according to the subgroups (p=0.525). Sensitivity, specificity, positive and negative predictive values of anti-Ro52 reactivity for determining pulmonary involvement in scleroderma were low. Conclusion: No association was found between positive anti-Ro52 antibodies and pulmonary involvement in scleroderma.
- Assessment of left ventricular diastolic function with cardiovascular MRI: what radiologists should knowPublication . Duarte, R.; Fernadez-Perez, G.; Bettencourt, N.; Sampaio, F.; Miranda, D.; França, M.; Portugal, P.Abstract Diastolic dysfunction is a common entity and the predominant cause of heart failure in 40%-50% of patients. Diagnosis of diastolic dysfunction is clinically relevant and is associated with a poor prognosis. The aim of this essay was to review the pathophysiology and different grades of diastolic dysfunction and to provide an overview on the role of cardiovascular magnetic resonance imaging in the assessment of diastolic function.
- O efeito da referenciação de utentes para a Rede de Cuidados Continuados Integrados sobre a demora média dos internamentos no Centro Hospitalar do PortoPublication . Ferreira, LeonardoO envelhecimento constitui para as sociedades mais desenvolvidas uma questão cada vez mais decisiva, assumindo reflexos e implicações sobre as respostas sociais e de saúde dirigidas ao cidadão idoso. O modelo da Rede Nacional de Cuidados Continuados Integrados, implementado em 2006, surge como a operacionalização em Portugal de uma resposta articulada, intersectorial e de cariz holístico face às profundas necessidades de saúde e apoio social prevalentes numa sociedade envelhecida. A implementação deste modelo veicula um aumento da oferta disponível no âmbito do sistema de saúde e de solidariedade social, definindo estrategicamente uma agilização nos processos de alta de utentes e uma diminuição no tempo de internamento e nos custos dos hospitais de agudos. A presente investigação tem como objetivo principal estudar o efeito da referenciação de utentes para a Rede Nacional de Cuidados Continuados Integrados sobre a demora média dos internamentos do Centro Hospitalar do Porto. O estudo de natureza quantitativa recorre a uma análise econométrica com base num Modelo de Regressão Linear Múltipla, estudando o efeito das variáveis idade, sexo, complexidade patológica, referenciação e alta para a Rede Nacional de Cuidados Continuados Integrados sobre o tempo de internamento por episódio no período de 2010 e 2011. Paralelamente investigam-se discrepâncias ao nível das variáveis, entre utentes referenciados e não referenciados, bem como, a mediana do número de dias das etapas do circuito de referenciação no âmbito da instituição. Os resultados evidenciam que a referenciação e a alta de utentes para a Rede Nacional de Cuidados Continuados Integrados acarretam um aumento do tempo de internamento e dos custos associados no Centro Hospitalar do Porto. As etapas do circuito de referenciação intrínsecas à instituição apresentam uma mediana de número de dias substancialmente superior à mediana regional, podendo justificar parte do acréscimo verificado no tempo de internamento.