Browsing by Issue Date, starting with "2012-09"
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- Tuberculose e cancro – pior que um só dois!Publication . Couto, C.; Balona, F.; Sampaio, M.J.; Torres, A.; Pinto, A.; Ferreira, A.RESUMO Introdução: A tuberculose é um problema de saúde global e crescente. A doença pulmonar primária é a forma mais comum de apresentação da tuberculose activa. A tuberculose esquelética é pouco comum e representa 10 a 20% das formas extrapulmonares no doente imunocompetente. Quando existe imunossupressão, esta forma é mais frequente podendo estar presente, de modo isolado ou em associação com tuberculose pulmonar, em quase metade dos casos. A sua apresentação clínica é inespecífi ca e o diagnóstico diferencial inclui diversas patologias, sendo essencial um elevado índice de suspeição. Caso clínico: Os autores apresentam o caso clínico de uma criança com tumor de Wilms, em tratamento com quimioterapia, que desenvolveu tuberculose óssea. Discussão: Salienta-se a importância do diagnóstico diferencial da tuberculose com doença oncológica (primária ou secundária), a limitação dos métodos imagiológicos, a importância da confirmação diagnóstica através de estudos histopatológicos e microbiológicos, e a necessidade de um plano terapêutico adequado e o mais precoce possível. ABSTRACT Introduction: Tuberculosis is a global and growing health problem. Primary pulmonary disease is the most common form of presentation of active tuberculosis. The skeletal tuberculosis is uncommon and represents 10 to 20% of extrapulmonary disease in immunocompetent individuals. In immunosupressed patients, bone involvement is more common, either singly or in association with pulmonary tuberculosis, reaching half of the cases. Its clinical presentation is nonspecific and the differential diagnosis includes several pathologies, therefore a high index of suspicion is required. Case report: The authors report the clinical case of a child with Wilms’ tumor who was diagnosed with bone tuberculosis during the treatment of nephroblastoma. Discussion: It is emphasized the importance of differential diagnosis of tuberculosis with malignancy (primary or secondary), the limitation of imaging methods, the importance of diagnostic confi rmation by histopathological and microbiological studies, and the need for an appropriate treatment plan and as early as possible.
- Doença inflamatória intestinal - DiagnósticoPublication . Pereira, F.
- Hiperplasia supra-renal congénita - formas clássicasPublication . Borges, T.
- Metastatic Testicular Germ Cell Tumor or a Chemoresponsive Liver Hemangioma?Publication . Ferreira, J.; Magalhães, M.; Esteves, D.; Marques, F.Testicular germ cell tumors are the most common solid organ malignancy in young adult men. The presence of non-pulmonary visceral metastasis is an independent factor that places such patients into the higher risk group. Hepatic hemangiomas are the most common tumors of the liver and are entirely benign. Overlap between these entities may occur, particularly when metastases are hypervascular. We describe a case of a 27-year-old man with a testicular germ cell tumor and a nodule in the right hepatic lobe suggestive of hemangioma. After three cycles of chemotherapy, a size reduction in the hepatic nodule was confirmed, and this lesion was removed. Pathology revealed a fibrosing hemangioma. In this case report, the authors discuss the possible mechanisms for the hemangioma chemotherapy response.
- Hemoglobinúria paroxística ao frio: quando suspeitar?Publication . Matos, C.; Teixeira, S.; Lira, S.; Costa, E.; Barbot, J.RESUMO Introdução: A hemoglobinúria paroxística ao frio é uma forma rara de apresentação de anemia hemolítica auto-imune. Caso Clínico: Descreve-se o caso de uma criança, de 23 meses de idade, com icterícia e urina escura de início súbito. Havia referência a infecção das vias respiratórias superiores uma semana antes. Apresentava anemia grave com hemoglobinúria. A DHL era elevada e a prova de Coombs directa era positiva com especificidade anti-C3d. A positividade da prova de Donath-Landsteiner, ao demonstrar o carácter bifásico do autoanticorpo, confirmou o diagnóstico de hemoglobinúria paroxística ao frio. Conclusão: Com este caso os autores pretendem realçar a importância do reconhecimento desta patologia e do seu carácter de hemólise intra-vascular, de forma a contribuir para um diagnóstico e tratamento mais rápidos. ABSTRACT Introduction: The paroxysmal cold hemoglobinuria is a rare form of presentation of autoimmune hemolytic anemia. Case report: We describe the case of a 23 months-old child with jaundice and dark urine of sudden onset. There was reference to upper respiratory infection a week earlier. He presented severe anemia with hemoglobinuria. DHL was rised and the direct Coombs test was positive with specific anti-C3d. The positive of Donath-Landsteiner proof, to demonstrate the biphasic nature of the autoantibody, confirmed the diagnosis of paroxysmal cold hemoglobinuria. Conclusion: With this case report the authors aim to highlight the importance of recognizing this condition and the character of intravascular hemolysis, so that quicker diagnosis and treatment can be made.
- Restrição de crescimento intra-uterino - EtiologiaPublication . Rodrigues, M.C.
- Pulmão e doença sistémica - Cardiopatia congénitaPublication . Barbosa, T.
- Caso electroencefalográfico: epilepsia de ausências da infânciaPublication . Sá, A.; Chorão, R.ABSTRACT Introduction: Typical absence seizures are quite common in chidhood, in most cases fitting the criteria for childhood absence epilepsy. Differential diagnosis is mainly with inattention and focal hypomotor seizures. Response to adequate antiepileptic drug therapy is usually very good. Case report: We report a classical case of a school-age girl with many episodes per day of staring and eye rolling with a duration of some seconds. Hyperventilation during her first appointment elicited short-duration absences with slight eye blinking. The ictal video-EEG confirmed the diagnosis, showing generalized synchronous bursts of 3 Hz spike-wave discharges with a medium duration of eight seconds. The response to therapy with valproic acid was dramatic, and medication was withdrawn at the age of eleven with no recurrence of seizures. Conclusion: The most frequent epileptic syndrome with typical absences is childhood absence epilepsy. When inclusion and exclusion criteria are taken in consideration, we can expect a good prognosis, with remission by prepubertal age.
- Panorama Nacional do BullyingPublication . Ferreira, M.; Matos, M.G.; Equipa Aventura Social
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