Últimos itens adicionados do Acervo: Centro Hospitalar de Lisboa Central

O Repositório do Centro Hospitalar de Lisboa Central, EPE é constituído pela produção cinetífica dos hospitais: Hospital S. José, Hospital de Sto. António dos Capuchos, Hospital de Sta. Marta, Hospital D. Estefânia, Hospital Curry Cabral e Maternidade Dr. Alfredo da Costa.

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Compliance with ESPGHAN Position on Complementary Feeding in a Multicultural European Community. Does Ethnicity Matter?

Nóbrega, S; Andrade, M; Heleno, B; Alves, M; Papoila, A; Sassetti, L; Virella, D
Fonte: Elsevier Doyma Publicador: Elsevier Doyma
Tipo: Artigo de Revista Científica
Publicado em //2014 Português
Introduction: In 2008, ESPGHAN published a position paper on complementary feeding providing recommendations to health care professionals. Cultural and socio-economic factors might affect the compliance to these orientations. Aim: To estimate the prevalence of inadequacies during complementary feeding (ESPGHAN, 2008) and its association with different ethnic backgrounds. Methods: Cross-sectional survey of a convenience sample of caretakers of children up to 24 months of age in a single community health centre in Greater Lisbon, through a volunteer, self-applied questionnaire. Results: From a sample of children with wide cultural diversity, 161 valid questionnaires were obtained (median child’s age 9 months, median mother’s age 32 years). The prevalence rate of at least one complementary feeding inadequacy was 46% (95%CI: 38.45-53.66). The commonest inadequacies were: avoiding lumpy solid foods after 10 months of age (66.7%), avoidance or delayed introduction of foods beyond 12 months (35.4%), introduction of gluten beyond 7 months (15.9%) or salt before 12 months (6.7%). For each increase of 1 month in the age of the child, the odds of inadequacies raised 36.7% (OR = 1.37; 95%CI: 1.20-1.56; p < 0.001). The odds for inadequacies in children of African or Brazilian offspring was three times higher that of Portuguese ancestry (OR = 3.31; 95%CI: 0.87-12.61; p = 0.079). The influence of grandparents was related to an increase in the odds of inadequacies (OR = 3.69; 95%CI: 0.96-14.18; p = 0.058).Conclusion: Inadequacies during complementary feeding are frequent and may be influenced by the cultural background.

Tuberculose Primária do Esófago; Primary Tuberculosis of the Esophagus

Lagos, AC; Marques, I; Reis, J; Esteves, P; Costeiro, J; Afonso, A; Costa Neves, B
Fonte: Elsevier Doyma Publicador: Elsevier Doyma
Tipo: Artigo de Revista Científica
Publicado em //2012 Português
Os autores reportam o caso de uma doente de 38 anos de idade com um quadro clínico de odinofagia, dor retroesternal e emagrecimento. Os exames complementares de diagnóstico revelaram a presença de uma lesão ulcerada no esófago, como forma de manifestação de tuberculose primária do esófago. A Tuberculose esofágica é uma doença pouco frequente, sendo responsável por 0,15% da mortalidade por tuberculose. A Tuberculose primária do esófago, sem envolvimento de outros órgãos, como o nosso caso clínico, é ainda mais raro. A maioria dos casos é tratada de forma eficaz com tuberculostáticos, sendo que o atraso no diagnóstico e início da terapêutica dita um mau prognóstico.

Fulminant Hepatitis E in a Pregnant Woman; Hepatite E Fulminante numa Mulher Grávida

Velosa, M; Figueiredo, A; Glória, H; Mateus, E; Neves, Z; Araújo, A; Carvalho, A; Oliveira, J; Barroso, E
Fonte: Elsevier Doyma Publicador: Elsevier Doyma
Tipo: Artigo de Revista Científica
Publicado em //2013 Português
Hepatitis E is an inflammatory liver disease caused by hepatitis E virus (HEV) infection, which is endemic in China, India, Nepal, and in several Asian and African countries, where the prevalence can be as high as 50%. In non-endemic countries, an increasing number of non-travel associated HEV has been reported in recent years, particularly in Europe. The authors describe the clinical case of a puerperal 24-year-old woman from Pakistan admitted to our Tertiary Care Medical Center with acute hepatic failure developed during the third trimester of her pregnancy. She was icteric with grade III encephalopathy and hypothermia. Laboratory values showed significant AST, ALT and LDH elevations of twelve times the upper normal limit, and total bilirubin was significantly elevated (41.20 mg/dL). Prothrombin time was prolonged (4 s) and factor V activity was diminished (15.1%). Extracorporeal albumin dialysis was initiated, but clinical deterioration occurred within 48 h, so she underwent OLT at day 4 post-admission. Severe forms of HEV are known to be more pronounced in pregnant women. Even though most of the described cases of acute hepatic failure associated to HEV during pregnancy had a favorable clinical course, some cases of fulminant liver failure and death are described. It is unknown whether liver transplant outcomes in this setting are different from other causes of acute liver failure. To our knowledge...

Desmoplastic Trichoepithelioma and Melanocytic Nevus: Dermoscopic and Reflectance Confocal Microscopy Presentation of a Rare Collision Tumor

Oliveira, A; Arzberger, E; Zalaudek, I; Hofmann-Wellenhof, R
Fonte: Elsevier Publicador: Elsevier
Tipo: Artigo de Revista Científica
Publicado em //2015 Português

Melanoma and Satellite Blue Papule

Oliveira, A; Arzberger, E; Massone, C; Zalaudek, I; Fink-Puches, R; Hofmann-Wellenhof, R
Fonte: Pubmed Central Publicador: Pubmed Central
Tipo: Artigo de Revista Científica
Publicado em //2014 Português
The colors that are seen in dermoscopy depend on the anatomic level of the skin at which the chromophores are seen. Blue color can be found in a variety of melanocytic and nonmelanocytic lesions. An 89-year-old man presented with a 3-year history of a slow-growing, hyperpigmented patch located on the distal third of the right arm. Dermoscopy showed an atypical network, irregularly distributed globules, pigmented internal streaks and a milky-red area. Based on these findings a diagnosis of slow-growing malignant melanoma was made. Simultaneously, a well-defined blue papule was seen on the proximal third of the same arm. Dermoscopy disclosed a homogeneous blue pattern. After clinical and dermoscopic correlation our differential diagnosis for this blue lesion included cutaneous melanoma metastasis, blue nevus and foreign body reaction. The patient recalled its onset 75 years ago after a grenade explosion. We also discuss the blue lesion appearance under reflectance confocal microscopy and high-definition optical coherence tomography. Histopathological examination after excision of the hyperpigmented patch and blue papule revealed a melanoma in situ and a foreign body reaction, respectively. The diagnostic evaluation of a blue lesion should always rely on the integration of all data...

Early Sac Shrinkage Predicts a Low Risk of Late Complications After Endovascular Aortic Aneurysm Repair

Bastos Gonçalves, F; Baderkhan, H; Verhagen, HJM; Wanhainen, A; Björck, M; Stolker, RJ; Hoeks, SE; Mani, K
Fonte: Wiley Publicador: Wiley
Tipo: Artigo de Revista Científica
Publicado em //2014 Português
BACKGROUND: Aneurysm shrinkage has been proposed as a marker of successful endovascular aneurysm repair (EVAR). Patients with early postoperative shrinkage may experience fewer subsequent complications, and consequently require less intensive surveillance. METHODS: Patients undergoing EVAR from 2000 to 2011 at three vascular centres (in 2 countries), who had two imaging examinations (postoperative and after 6-18 months), were included. Maximum diameter, complications and secondary interventions during follow-up were registered. Patients were categorized according to early sac dynamics. The primary endpoint was freedom from late complications. Secondary endpoints were freedom from secondary intervention, postimplant rupture and direct (type I/III) endoleaks. RESULTS: Some 597 EVARs (71.1 per cent of all EVARs) were included. No shrinkage was observed in 284 patients (47.6 per cent), moderate shrinkage (5-9 mm) in 142 (23.8 per cent) and major shrinkage (at least 10 mm) in 171 patients (28.6 per cent). Four years after the index imaging, the rate of freedom from complications was 84.3 (95 per cent confidence interval 78.7 to 89.8), 88.1 (80.6 to 95.5) and 94.4 (90.1 to 98.7) per cent respectively. No shrinkage was an independent risk factor for late complications compared with major shrinkage (hazard ratio (HR) 3.11; P < 0.001). Moderate compared with major shrinkage (HR 2.10; P = 0.022)...

Cutaneous Infection by Different Alternaria Species in a Liver Transplant Recipient

Brás, S; Sabino, R; Laureano, A; Simões, H; Fernandes, C; Marques-Pinto, G; Cardoso, J; Veríssimo, C
Fonte: Elsevier Publicador: Elsevier
Tipo: Artigo de Revista Científica
Publicado em //2015 Português
Fungal invasive infections are rare in general population but are an emergent cause of infection in the immunocompromized population, especially in the solid organ transplant recipients. Herein the authors report a clinical case of a liver transplanted patient suffering a cutaneous co-existent infection with A. alternata as well as A. infectoria. To our knowledge this is the first case of cutaneous concomitant infection due to those two species reported not only in Portugal but also worldwide. The patient was treated with surgical excision of the lesions and oral itraconazol without relapse.

Intramural Hematoma of the Esophagus After Thrombolysis for Ischemic Stroke

Silva, MJ; Saiote, J; Salvado, V; Paiva Nunes, A; Duarte, P
Fonte: Elsevier Publicador: Elsevier
Tipo: Artigo de Revista Científica
Publicado em //2015 Português
Intramural dissecting hematoma is an unusual esophageal condition with a threatening presentation but excellent prognosis when managed conservatively.We report the case of an 88-year-old woman who developed an intramural hematoma of the esophagus after intravenous thrombolysis for an acute ischemic stroke. Before thrombolysis, nasogastric intubation was attempted unsuccessfully. She was kept on nil by mouth, intravenous hydration, proton pump inhibitor, antiemetics,and an antibiotic initiated 2 days before for periodontal disease. The esophageal hematoma regressed, and she resumed oral diet asymptomatically.To our knowledge, this is the first report of this type of lesion after thrombolysis for an ischemic stroke. A brief discussion and literature review are presented.

Expert Panel Appraisal of the Treatment of Chronic Kidney Disease-Related Mineral and Bone Disorders (CKD-MBD): an Opinion-Based Approach

Adragão, T; Ferreira, A; Frazão, J; Ponce, P; Vinhas, J
Fonte: Sociedade Portuguesa de Nefrologia Publicador: Sociedade Portuguesa de Nefrologia
Tipo: Artigo de Revista Científica
Publicado em //2009 Português

Disruption of Urate Transport in Familial Renal Glucosuria and Report on SGLT2 Expression in Normal and Pathological Kidney; Alteração do Transporte de Ácido Úrico na Glicosúria Renal Familiar e Expressão de SGLT2 no Rim Normal e Patológico

Aires, I; Santos, AR; Bogarin, R; Genc, G; Pratas, J; Ozkaya, O; Carvalho, F; Rueff, J; Nolasco, F; Calado, J
Fonte: Sociedade Portuguesa de Nefrologia Publicador: Sociedade Portuguesa de Nefrologia
Tipo: Artigo de Revista Científica
Publicado em //2013 Português
Familial renal glucosuria (FRG) is a rare co -dominantly inherited benign phenotype characterized by the presence of glucose in the urine. It is caused by mutations in the SLC5A2 gene that encodes SGLT2, a Na+ -glucose co -transporter. The purpose of our current work was twofold: to characterize the molecular and phenotype findings of an FRG cohort and, in addition, to detail the SGLT2 expression in the adult human kidney. The phenotype of FRG pedigrees was evaluated using direct sequencing for the identification of sequence variations in the SLC5A2 gene. The expression of SGLT2 in the adult human kidney was studied by immunofluorescence on kidney biopsy specimens. In the absence of renal biopsies from FRG individuals, and in order to evaluate the potential disruption of SGLT2 expression in a glucosuric nephropathy, we have selected cases of nucleoside analogues induced proximal tubular toxicity. We identified six novel SLC5A2 mutations in six FRG pedigrees and described the occurrence of hyperuricosuria associated with hypouricaemia in the two probands with the most severe phenotypes. Histopathological studies proved that SGLT2 is localized to the brush -border of the proximal tubular epithelia cell and that this normal pattern was found to be disrupted in cases of nucleoside analogues induced tubulopathy. We present six novel SLC5A2 mutations...

Collapsing Glomerulopathy. A Treatable Disease?

Ferreira, AC; Carvalho, D; Carvalho, F; Nolasco, F; Ribeiro dos Santos, J
Fonte: Sociedade Portuguesa de Nefrologia Publicador: Sociedade Portuguesa de Nefrologia
Tipo: Artigo de Revista Científica
Publicado em //2008 Português
Renal disease is a relatively common complication in human immunodeficiency virus (HIV) infected patients and has become the fourth leading cause of death in AIDS individuals, immediately following septicaemia, pneumonia and hepatic disease. HIV associated nephropathy, HIV associated immune complex renal disease and HIV associated thrombotic microangiopathy are the main causes of chronic renal failure in this population. The authors report a case of a 44 year-old black male, HIV 1 infected with low CD4 count, admitted to the nephrology department with non nephrotic proteinuria and renal failure. Renal biopsy revealed a focal segmental glomerulosclerosis collapsing variant. The patient was treated with highly active antiretroviral therapy and an ACE inhibitor and, at 3 months of follow-up, has recovered his renal function. This case illustrates the efficacy of highly active antiretroviral therapy (HAART) on HIV associated nephropathy. Prospective studies are needed to evaluate HAART in the treatment of HIV associated nephropathies.

Triple Regimen with Rituximab, Plasmapheresis and Intravenous Immunoglobulin in the Treatment of Dialysis Dependent Acute Humoral-Mediated Rejection in Kidney Grafts

Pessegueiro, P; Nolasco, F; Sampaio, S; Carvalho, F; Manuel, F; Barber, E; Viana, H; Sousa, J; Possante, M; Domingos, M; Reimão Pinto, J; Ribeiro Santos, J; Barroso, E
Fonte: Sociedade Portuguesa de Nefrologia Publicador: Sociedade Portuguesa de Nefrologia
Tipo: Artigo de Revista Científica
Publicado em //2006 Português
Introduction: The clinical importance of humoral-mediated acute rejection has been progressively recognised. Early recognition and treatment with plasmapheresis and intravenous immunoglobulin have recently improved short term prognosis. Case report: In this report we describe the clinical features of three 2nd transplant patients developing severe acute humoral rejection during the first week post-transplant while on anti-thymocyte globulin therapy. Treatment with plasmapheresis/ intravenous immunoglobulin/rituximab resulted in rapid reversal of oliguria,and recovery of renal function within the 1st week of treatment in 2/3 patients. Diagnosis was confirmed by graft biopsies revealing peritubular neutrophiles and C4d deposits. Sequential graft biopsies in all three patients revealed complete histological recovery within two weeks. One patient never recovered renal function, and one patient lost his graft at three months following hemorrhagic shock. After 2 years follow up, the remaining patient maintains a serum creatinine of 1.1mg/dl. Conclusion: The regimen using plasmapheresis plus intravenous immunoglobulin and rituximab was effective in rapidly reversing severe acute humoral rejection.

Nova Abordagem ao Diagnóstico da Sindroma de Alport: Pesquisa da Cadeia α5 do Colagénio Tipo IV na Pele

Teixeira e Costa, F; Galvão, MJ; Carvalho, F
Fonte: Sociedade Portuguesa de Nefrologia Publicador: Sociedade Portuguesa de Nefrologia
Tipo: Artigo de Revista Científica
Publicado em //2005 Português
Em 2000, os autores iniciaram no Serviço de Nefrologia do Hospital de Curry Cabral, um protocolo de avaliação do papel do estudo imunopatológico da biópsia cutânea no diagnóstico da Sindroma de Alport (SA). A SA é uma doença hereditária, secundária a um defeito do colagénio tipo IV (col. IV), principal componente das membranas basais. O col. IV é constituído por 6 cadeias distintas (α1 a α6). A cadeia α5 está presente nas membranas basais glomerulares e da epiderme (MBE). Em cerca de 85% dos casos de SA (forma de transmissão ligada ao cromossoma X) verifica-se uma alteração da cadeia α5, com consequente ausência ou intermitência desta cadeia, na MBE. O objectivo deste trabalho foi pesquisar a presença da cadeia α5 do col. IV na MBE, e consequentemente avaliar o papel da biópsia cutânea no diagnóstico da SA. Para o efeito estudámos as biópsias cutâneas de dezanove indivíduos pertencentes a seis famílias distintas. Em cada uma das famílias havia pelo menos um indivíduo com história de SA. As biópsias cutâneas foram avaliadas por método de imunofluorescência indirecta, com antisoros dirigidos às cadeias α1, α3 e α5 do col. IV. No padrão normal há a presença das cadeias α5 e α1 e ausência de α3 na MBE.Verificou-se a ausência de α5 na MBE em quatro homens com SA enquanto que um caso de SA apresentou um padrão positivo. Nas mulheres com SA verificámos a intermitência da α5. Nas sintomáticas...

Visualização: Uma Intervenção Possível em Psicologia da Saúde

Cabete, D; Cavaleiro, AM; Pinteus, MT
Fonte: ISPA - Instituto Superior de Psicologia Aplicada Publicador: ISPA - Instituto Superior de Psicologia Aplicada
Tipo: Artigo de Revista Científica
Publicado em //2003 Português

Harlequin Phenomenon at Birth: And She Was Born With a White Stocking…

Santos, S; Abreu, MR
Fonte: BMJ Publishing Group Publicador: BMJ Publishing Group
Tipo: Artigo de Revista Científica
Publicado em //2015 Português

Diagnosis of Eosinophilic Esophagitis in an Infant Undergoing Milk Oral Immunotherapy - A Case Report

Morais Silva, P; Antunes, J; Chambel, M; Prates, S; Leiria-Pinto, P
Fonte: Associazione Italiana Allergologi Immunologi Territoriali e Ospedalier Publicador: Associazione Italiana Allergologi Immunologi Territoriali e Ospedalier
Tipo: Artigo de Revista Científica
Publicado em //2014 Português
Although the standard of care for cow’s milk (CM) allergy is strict food avoidance, oral immunotherapy (OIT) is being widely investigated as an alternative management option in certain cases. Immediate adverse reactions to OIT have been described, but its long-term effects are much less often reported. We present the case of a girl diagnosed with IgE-mediated CM allergy that was proposed for our CM OIT protocol at the age of 3 years. The first sessions (dose escalation up to 5 ml) were well tolerated, however eight hours after her daily morning dose of 5ml CM the child developed late episodes of vomiting. No other symptoms, particularly immediately after CM ingestion, were reported. These episodes became progressively worse and on the third day she presented mild dehydration and blood eosinophilia. After OIT interruption, a progressive clinical improvement was observed. An esophageal endoscopy was performed, showing signs of eosinophilic esophagitis (EoE) with peak 20 eosinophils/hpf. After treatment with topical swallowed fluticasone (500 mcg bid) and a CM-free diet for 4 months, the child was asymptomatic and endoscopy and biopsy findings were normal. The long-term effects of milk OIT are still in part unknown. We hypothesize that eosinophilic esophagitis may have been a consequence of OIT in this case. The findings seem to indicate that food allergy may play a role in the pathogenesis of esophageal eosinophilia and stress the importance of a well programmed long-term follow-up of patients that have undergone milk OIT.

Hepatic Actinomycosis

Ávila, F; Santos, V; Massinha, P; Pereira, JR; Quintanilha, R; Figueiredo, A; Lázaro, A; Barroso, E; Duarte, MA
Fonte: Elsevier España Publicador: Elsevier España
Tipo: Artigo de Revista Científica
Publicado em //2015 Português
Actinomycosis is a rare disorder caused by an anaerobic gram-positive bacillus (Actinomyces), predominantly by the Actinomyces israelii species. Only 20% of cases show an abdominal manifestation, the appendix and ileocecal valve being the most frequent locations. Definitive diagnosis is based on microbiological cultures, microscopy or macroscopy examination. Nevertheless, histological examination of the percutaneous biopsy and blood microbiological cultures are rarely positives. Preoperative diagnosis is hampered by the lack of specific clinical and imaging manifestations, which often mimic malignancy. The rate of preoperative diagnosis is less than 10%, however, the outcome is excellent, with a low mortality rate. The authors describe the case of a patient who was diagnosed with primary hepatic actinomycosis only by a histological examination of the surgical specimen of left hepatectomy extended to segments V and VIII, for suspected malignant lesion. This case demonstrates the difficulties in diagnosing hepatic actinomycosis.

Síndrome de Mauriac: Uma Apresentação Rara de Uma Doença Mais Comum

Constantino, C; Farela Neves, J; Marta, R; Pereira, G; Barata, D; Lopes, L
Fonte: Hospital de Crianças Maria Pia - Centro Hospitalar do Porto Publicador: Hospital de Crianças Maria Pia - Centro Hospitalar do Porto
Tipo: Artigo de Revista Científica
Publicado em //2010 Português
Introdução: A diabetes mellitus tipo 1 (DM1) é uma doença metabólica crónica cuja incidência anual tem vindo a aumentar. Pode cursar com alterações sistémicas, como a hepatomegalia e o atraso de crescimento, decorrentes de controlo glicémico inadequado. Caso clínico: Adolescente de 14 anos com o diagnóstico de DM1 desdeos três anos de idade e com mau controlo glicémico, internada numa Unidade de Cuidados Intensivos por cetoacidose grave. Do exame objectivo destacavam-se baixa estatura, hepatomegalia não dolorosa e estadio pubertário P1, M2 de Tanner. Analiticamente apresentava aumento das transaminases, hipercolestorolemia e hipertrigliceridemia. Discussão: A síndrome de Mauriac, caracteriza -se por: DM tipo 1 mal controlada, baixa estatura, atraso pubertário, hipercolesterolémia, aumento das transaminases e hepatomegalia por depósito hepático de glicogénio. O mecanismo fi siopatológico não está totalmente esclarecido, sendo provavelmente a combinação de vários factores etiológicos. É uma situação rara, cujo diagnóstico, essencialmente clínico, assume extrema importância dada a reversibilidade do quadro com a optimização terapêutica.

Hematoma Subdural em Pediatria Diagnosticar e Tratar Precocemente

Carvalho, M; Leal, E; Santos, M; Ramos, J; Távora, L; Barata, D
Fonte: Hospital de Crianças Maria Pia - Centro Hospitalar do Porto Publicador: Hospital de Crianças Maria Pia - Centro Hospitalar do Porto
Tipo: Artigo de Revista Científica
Publicado em //2011 Português
Introdução: O hematoma subdural agudo não traumático é uma entidade rara em Pediatria. A presença de sintomas neurológicos de instalação aguda associada a anti coagulação obriga à exclusão desta entidade. Caso clínico: Apresentamos o caso de uma criança, do sexo masculino, de sete anos de idade, com prótese mitral mecânica, medicada com varfarina, que recorreu ao serviço de urgência por cefaleias intensas e progressivas, associadas a alteração no estado de consciência e convulsões. A nível laboratorial o INR (International Normalized Ratio) era de 4,2. Foi admitida na Unidade de Cuidados Intensivos Pediátricos (UCIP) em coma com anisocoria. Iniciou ventilação mecânica, medidas anti-edema cerebral e antiepilépticos. O exame de imagem mostrou hematoma subdural agudo à esquerda, com desvio da linha média. Foi submetida a craniotomia descompressiva, 56 horas após o início da sintomatologia, com recuperação clínica e actualmente sem sequelas. Conclusão: Este caso clínico ilustra a importância da suspeição clínica de hematoma subdural em doentes anti coagulados, bem como a necessidade de optimização das condições cirúrgicas e da utilização das técnicas não invasivas na monitorização do nível de consciência.

Diabetes Mellitus tipo 1 … Que Passos para a Cura?

Limbert, C
Fonte: Hospital de Crianças Maria Pia - Centro Hospitalar do Porto Publicador: Hospital de Crianças Maria Pia - Centro Hospitalar do Porto
Tipo: Artigo de Revista Científica
Publicado em //2011 Português