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Journal Cover   Acta Médica Portuguesa
  [SJR: 0.118]   [H-I: 11]   Follow
  This is an Open Access Journal Open Access journal
   ISSN (Print) 0870-399X - ISSN (Online) 1646-0758
   Published by Ordem dos Médicos Homepage  [1 journal]
  • Long-Term Home Oxygen Therapy in Children: Evidences and Open Issues

    • Authors: Lia Oliveira, Joana Coelho, Rosário Ferreira, Teresa Nunes, Ana Saianda, Luisa Pereira, Teresa Bandeira
      Abstract: Introduction: Long-term home oxygen therapy is indicated for patients with chronic hypoxemia. We intend to describe pediatric population on long-term home oxygen therapy followed-up at Pediatric Respiratory Unit of a tertiary care hospital between 2003-2012 and to compare with previous 1991-2000 review; to verify conformity with international and national recommendations and need for specific pediatric national guidelines, non-existent in Portugal.
      Material and Methods: Retrospective, descriptive and comparative study based on clinical files review. Review the guidelines for oxygen therapy in pediatric population.
      Results: We studied 86 patients (59.3% males). The median age at the beginning of oxygen therapy was 0.0 (0.0-216.0) months, with a median duration of 15.0 (3.0-223.0) months. The most frequent diagnosis was bronchopulmonary dysplasia (53.5%), followed by bronchiolitis obliterans (14.0%), neurologic disorders (10.5%), cystic fibrosis (8.1%), miscellaneous syndromes (5.8%), sickle-cell disease (3.5%), other neonatal lung diseases (2.3%) and interstitial lung diseases (2.3%). Are maintained on follow-up 53 (61.6%) patients, 38 on oxygen therapy; 12 (13.9%) died. The median time of follow-up was 39.5 (1.0-246.0) months, minim on other neonatal lung diseases and maximum on cystic fibrosis. Comparing with previous review, this shows a relative increase in bronchiolitis obliterans and bronchopulmonary dysplasia patients, with increased duration in the latter, and inclusion of neurologic and hematologic patients.
      Discussion: Prescription of long-term oxygen therapy in pediatric age mainly occurs in specific diseases of infants and pre-school aged. Neurologic and hematologic patients represent new indications, similarly to international publications.
      Conclusion: The knowledge of national reality and pediatric orientations are needed for care plans and rational prescription.
      Keywords: Child; Long-Term Care; Respiratory Insufficiency; Oxygen Inhalation Therapy; Portugal.
      PubDate: 2014-12-30
      Issue No: Vol. 27 (2014)
  • Foreign Body Ingestion: Rare Cause of Cervical Abscess

    • Authors: Liliana Costa, João Larangeiro, Carla Pinto Moura, Margarida Santos
      Abstract: Introduction: Foreign body ingestion is a frequent emergency occurrence. Serious complications, although rare, include pharyngooesophageal perforation, aorto-oesophageal fistula and deep neck infection.
      Material and Methods: A retrospective review was performed of all cases of foreign body ingestion requiring hospitalization between 1989 and 2011, in a tertiary Hospital. Cases complicated by deep cervical abscess were selected and their clinical presentation, results of diagnostic exams, therapeutics and clinical evolution are presented.
      Results: Among a total of 1679 cases, 319 were related to pediatric patients and 1360 to adults. Two cases were reported (0.12%): an adult, 41 years-old, with parapharyngeal abscess subsequent to fishbone ingestion, and a child, 13 months-old, with retropharyngeal abscess consequent to chicken bone ingestion. Complications appeared three and four days after foreign body removal, respectively. In both situations cervical computerized tomography scan with contrast and surgical drainage were accomplished; the child was also submitted to rigid esophagoscopy for residual foreign body removal and closure of the associated pharyngeal laceration.
      Discussion: Deep cervical abscesses are an uncommon but possible complication of foreign body ingestion and constitute a diagnostic challenge, particularly in children. Previous oesophageal manipulation by flexible endoscopy may be considered a risk factor for such complication. Imagiological studies proved to be crucial for diagnosis and therapeutic planning.
      Conclusion: Although a rare complication, given a recent history of foreign body ingestion/removal and the presence of compatible symptoms, cervical abscesses should be taken into account, highlighting their potential morbimortality in the absence of an appropriate therapeutic approach.
      Keywords: Foreign Body; Abscess; Esophagoscopy; Neck.
      PubDate: 2014-12-30
      Issue No: Vol. 27 (2014)
  • Evaluation of the Antimicrobial Susceptibility of Community-Acquired
           Urinary Tract Infection

    • Authors: Rui Passadouro, Raquel Fonseca, Felícia Figueiredo, Andreia Lopes, Cristina Fernandes
      Abstract: Introduction: The urinary tract infections, after respiratory infections, are the most common in the community. The knowledge about the prevalence of microbial strains and their antibiotic susceptibility is crucial to establish an effective empirical therapy. The aim of this study was to determine the antibiotic susceptibility patterns of bacterial strains isolated from positive urine cultures performed in patients from the central region of Portugal.
      Material and Methods: We carried out a documental analysis of 6008 urine bacteriological exams, to be made available to physicians, most of which run through the automated system VITEK 2, bioMérieux. The majority (80%) of the urine bacteriological exams were from female. Escherichia coli was the most prevalent bacterial pathogen (65.9%), followed by Klebsiella spp (12%).
      Results: Nitrofurantoin showed high levels of activity (96%) for Escherichia coli, as well as Fosfomycin (96.6%). Amoxicillin-clavulanic acid presents an activity level of only 81.1% for the same germ. Quinolones exhibit efficacy to only 78% of the strains of Escherichia coli, below the Fosfomycin and Nitrofurantoin. Nitrofurantoin showed high levels of activity (96%) for E. coli as well as Fosfomycin (96.6%). Amoxicillin-Clavulanic Acid presents a level of activity of only 81.1% for the same germ. The quinolones have a efficacy for only 78% of strains of E. coli, lower than Fosfomycin.
      Discussion: Escherichia Coli was the most prevalent uropathogen (65.9%). High efficacy against this pathogenic agent was found for Fosfomycin (96.6%) and Nitrofurantoin (96%).
      Conclusion: Further antimicrobial surveillance studies should be developed, in order to formulate local empirical therapy
      recommendations for optimized therapeutical choices.
      Keywords: Urinary Tract Infections; Drug Resistance, Bacterial; Anti-Bacterial Agents; Community-Acquired Infections.

      PubDate: 2014-12-30
      Issue No: Vol. 27 (2014)
  • Women’s Attachment as a Predictor of Pain During Labour and
           Post-Delivery: a Prospective Observational Study

    • Authors: José Manuel Costa Martins, Carlos Fernandes da Silva, Marco Pereira, Henriqueta Martins, Célia Oliveira, Alexandra Puga, Rui Coelho, Jorge Tavares
      Abstract: Introduction: Labour is considered to be one of the most painful and significant experiences in a woman’s life. The aim of this study was to examine whether women’s attachment style is a predictor of the pain experienced throughout labour and post-delivery.
      Material and Methods: Thirty-two pregnant women were assessed during the third trimester of pregnancy and during labour. Adult attachment was assessed with the Adult Attachment Scale – Revised. The perceived intensity of labour pain was measured using a visual analogue scale for pain in the early stage of labour, throughout labour and post-delivery.
      Results: Women with an insecure attachment style reported more pain at 3 cm of cervical dilatation (p < 0.05), before the administration of analgesia (p < 0.01) and post-delivery (p < 0.05) than those securely attached. In multivariate models, attachment style was a significant predictor of labour pain at 3 cm of cervical dilatation and before the first administration of analgesia but not of the perceived pain post-delivery.
      Discussion: These findings confirm that labour pain is influenced by relevant psychological factors and suggest that a woman’s attachment style may be a risk factor for greater pain during labour.
      Conclusion: Future studies in the context of obstetric pain may consider the attachment style as an indicator of individual differences in the pain response during labour. This may have important implications in anaesthesiology and to promote a relevant shift in institutional practices and therapeutic procedures.
      Keywords: Labor Pain; Labor, Obstetric; Maternal-Fetal Relations; Object Attachment.
      PubDate: 2014-12-30
      Issue No: Vol. 27 (2014)
  • Anxiety in Clinical Settings: Constructing a Scale for Medical Students

    • Authors: Joana Ramos Rodrigues, Miguel Castelo-Branco, Henrique Pereira, Rosa Marina Afonso
      Abstract: Introduction: The Scale of Anxiety in Clinical Setting (SACS) was constructed to assess the level of anxiety of medical students when exposed to the clinical setting and also to identify what situations are more likely to trigger higher levels of anxiety in that context.
      Material and Methods: This instrument consists of 12 items and was constructed on the basis of the review of the literature on the topic of anxiety in clinical setting, and data from a focus group conducted with students between the 1st and the 5th year of the Medical course at University of Beira Interior (n = 10). The Scale of Anxiety in Clinical Setting psychometric properties were tested through a study with 557 medical students of four Portuguese universities, between the 1st and the 6th year.
      Results: The Scale of Anxiety in Clinical Setting validation included the analysis of three key parameters: sensitivity, reliability and factorial validity, the last resulting in four factors: ‘displeasure before invasive procedures’, ‘anxiety toward the sick’, ‘anxiety about performance’ and ‘anxiety toward the human dimension’ with 70.6% of the variance explained.
      Discussion: Total Scale of Anxiety in Clinical Setting shows a good internal consistency (Cronbach’s Alpha = 0.84) and a good discriminatory ability, presenting as a consistent and reliable instrument for the assessment of anxiety in medical students when exposed to the clinical setting.
      Conclusion: The Scale of Anxiety in Clinical Setting evaluates the anxiety in medical students when exposed to the clinical setting and may be useful in the delineation of teaching strategies for the preparation of future doctors.
      Keywords: Anxiety; Education, Medical, Undergraduate; Students, Medical; Stress, Physiological; Questionnaires.
      PubDate: 2014-12-30
      Issue No: Vol. 27 (2014)
  • Adulthood Langerhans Cell Histiocytosis: Experience of Two Portuguese

    • Authors: Margarida Dantas de Brito, Ângelo Martins, Joaquim Andrade, José Guimarães, José Mariz
      Abstract: Introduction: Langerhans cell histiocytosis is a heterogeneous disease, more frequently diagnosed during childhood. Between 1/2001 and 12/2013, 20 adult patients were admitted at both Hospitals. This work aimed at ccharacterizing this population.
      Material and Methods: Retrospective study, review of clinical records.
      Results: 16 patients were eligible to analysis. The median age at diagnosis was 34 years (15-48); 10 males and 6 females. The referral motive was: respiratory complaints – 37.5%; bone changes – 37.5%; dental complaints - 25%; constitutional symptoms - 19%; mucocutaneous lesions – 6% and one patient (6%) was accidentally diagnosed after a thyroidectomy. The tissue of histological diagnosis was: bone - 50%; pulmonary tissue – 37.5%; liver, genital mucosa and thyroid - 6%, respectively. Staging was: single organ involvement (uni/multifocal) - 69% and multisystem disease in 31%. Clinical re-evaluation of these cases is being done at the moment. The median follow up was 5 years (1 month – 11 years) and the overall survival was 92%. Currently 19% are alive without signs of disease; 44% are alive with disease; 25% are under treatment and 12% died.
      Discussion: These results agree with published literature. Considering the actual guidelines 56% patients were incompletely staged, which probably lead to suboptimal treatment. There is heterogeneity of clinical procedures aiming at staging and treatment of these patients.
      Conclusion: The diagnosis of adulthood Langerhans cell histiocytosis is difficult considering the diversity of clinical behavior. Frequently this also leads to diagnosis delay. Prospective international clinical trials enrolling adult patients are important.
      Keywords: Adult; Histiocytosis, Langerhans-Cell.
      PubDate: 2014-12-30
      Issue No: Vol. 27 (2014)
  • Laparoscopic Cholecystectomy and Open Cholecystectomy in Acute
           Cholecystitis: Critical Analysis of 520 Cases

    • Authors: João Araújo Teixeira, Carlos Ribeiro, Luís M. Moreira, Fabiana de Sousa, André Pinho, Luís Graça, José Costa Maia
      Abstract: Introduction: Despite the skepticism with which it was initially seen, laparoscopic cholecystectomy is now the technique of choice for acute cholecystitis. It is, however, important to evaluate the results in comparison with classic cholecystectomy, since the latter is still used by some surgeons in certain situations.
      Material and Methods: Our research corresponds to the analysis of 520 patients operated on for acute cholecystitis performed in the department of surgery at the São João Hospital in Oporto - 412 (79.2%) laparoscopic cholecystectomies and 108 (20.8%) open cholecystectomies - from 2007 to 2013. We evaluated comorbidities, leukocytosis, time between diagnosis and surgery, ASA, per and postoperative complications, mortality, reoperations, lesion of main bile duct, conversion rate and hospital stay, in order to compare these two techniques. The conversion group was included in laparoscopic cholecystectomy. Statistical analysis was based on descriptive statistic procedures and the evaluation of contrast between groups was based on Fishers’ exact test. Significant values were considered for p < 0.05.
      Results: Laparoscopic Cholecystectomy versus Open Cholecystectomy: Mortality: 0.7% vs 3,7% (p = 0.0369); Peroperative complications: 3.6% vs 12.9% (p = 0.0006); Surgical postoperative complications: 7.7% vs 17.5% (p = 0.0055); Medical postoperative complications: 4.3% vs 5.5% (p = 0.6077); Lesion of the main bile duct: 0.9% vs 1.8% (p = 0.6091); Reoperation: 2.9% vs 5.5% (p = 0.2315); Hospital stay up to 4 days after surgery: 64.8% vs 18.5% (p < 0.001). The convertion rate was of 10.7%: 8.8% in early surgery (before 4 days after de diagnosis) and 13.7% in the late surgery (after this time but in the same stay) (p = 0.1425). Multiple causes led to convertion: surgical complications (biliary lesions, iatrogenic lesion of the small bowel, perfurations of the gallbladder with spillage of stones); complications during the pneumoperitoneum, unclear anatomy and scoliosis. Postoperative complications in laparoscopic cholecystectomies converted group vs non-converted: surgical 20.4% vs 6.2% (p = 0.0034) and medical 6.8% vs 4.1% (p = 0.4484).
      Discussion: There are few investigations concerning the comparison of laparoscopic cholecystectomy vs acute cholecystitis in patients with acute cholecystitis, corresponding mostly to multicenter studies. For this reason, we carry out an analysis inherent to 520 patients operated on with that disease in the surgery department of Hospital S. João in Oporto of which 412 were by laparoscopic cholecystectomy and 108 by acute cholecystitis. We found better results in laparoscopic cholecystectomy than in acute cholecystitis with respect to mortality, per and post-operative surgical complications and hospital stay. The incidence of main bile duct injury, medical
      complications and reoperations, although less evident in laparoscopic cholecystectomy, were not statistically significant. There were more complications in the group of laparoscopic cholecystectomy converted than in those where it was not be necessary the conversion. This raises the need, in complications during the laparoscopic cholecystectomy, not to perform the conversion too late. The analysis of this study, therefore, properly values laparoscopic cholecystectomy in the surgery of patients with acute cholecystitis.
      Conclusion: The results justify the frequency with which laparoscopic cholecystectomy is performed in acute cholecystitis, in comparison to open surgery, thus taking an increasingly prominent place in the treatment of this disease.
      Keywords: Cholecystectomy, Laparoscopic; Cholecystectomy; Cholecystitis.
      PubDate: 2014-12-30
      Issue No: Vol. 27 (2014)
  • Let’s Go Publishing!

    • Authors: Rui Tato Marinho, Carla De-Sousa, Helena Donato, João Massano, Jorge Crespo
      Abstract: Keywords: Information Science; Publishing; Medical Journalism.
      PubDate: 2014-12-30
      Issue No: Vol. 27 (2014)
  • Last Call...

    • Authors: José Costa-Maia
      Abstract: Keywords: Risk Management; Medical Errors.
      PubDate: 2014-12-30
      Issue No: Vol. 27 (2014)
  • Analysis of the Cochrane Review: Biomarkers as Point-Of-Care Tests to
           Guide Prescription of Antibiotics in Patients with Acute Respiratory
           Infections in Primary Care. Cochrane Database Syst Rev. 2014,11:CD10130

    • Authors: Pedro Azevedo, João Costa, António Vaz-Carneiro
      Abstract: Keywords: Primary Health Care; Respiratory Tract Infections; Biological Markers; Systematic Reviews; Anti-Bacterial Agents.
      PubDate: 2014-12-30
      Issue No: Vol. 27 (2014)
  • Crew Resource Management and Aircraft Science as a Contribution for
           Medical Science

    • Authors: Armindo Martins
      Abstract: Keywords: Health Knowledge, Attitudes, Practice; Patient Care Team; Quality Improvement.
      PubDate: 2014-12-30
      Issue No: Vol. 27 (2014)
  • Prevalence of Use of Preimplantation Genetic Diagnosis in Unidade
           Clínica de Paramiloidose from Centro Hospitalar do Porto

    • Authors: Kátia Valdrez, Elisabete Alves, Teresa Coelho, Susana Silva
      Abstract: Introduction: The Familial Amyloid Polyneuropathy, with the world’s largest focus in Portugal, is recognized by the National Board of Assisted Reproductive Technologies as a serious disease eligible for Preimplantation Genetic Diagnosis. This study aims to determine the prevalence of the use of Preimplantation Genetic Diagnosis in FAP carriers followed in Unidade Clínica de Paramiloidose, Centro Hospitalar do Porto, and to identify the associated factors.
      Material and Methods: Between January and May 2013, a representative sample of Portuguese Familial Amyloid Polyneuropathy carriers, aged between 18 and 55 years, was systematically recruited. The analysis is based on 111 carriers with previous familial diagnosis, who reported having ever tried to get pregnant after 2001. Data on sociodemographic characteristics and use of Preimplantation Genetic Diagnosis were collected through a self-administered questionnaire. Proportions were compared using the chi-square test. Crude and adjusted odds ratios (OR) and the respective confidence intervals of 95% (95% CI) were estimated using multivariate
      logistic regression.
      Results: The prevalence of use of Preimplantation Genetic Diagnosis was 20.7% (95% CI: 13.6-29.5). After adjustment, a household income above 1000 €/month (OR = 11.87; 95% CI 2.87-49.15) was directly associated with the use of Preimplantation Genetic Diagnosis, while carriers with an individual diagnosis (OR = 0.15; 95% CI 0.04-0.57) and children born after 2001 (OR = 0.07; 95% CI 0.02-0.32) revealed a prevalence of use significantly lower than those with a individual diagnosis and children born before 2001.
      Discussion: The low prevalence of use of Preimplantation Genetic Diagnosis, as well as the less frequent use of the technique by those with a lower household income, shows the importance of improving access to Preimplantation Genetic Diagnosis in the case of Familial Amyloid Polyneuropathy.
      Conclusion: This work contributes to increase the sensitivity of health professionals around the use and accessibility to Preimplantation Genetic Diagnosis among Familial Amyloid Polyneuropathy carriers.
      Keywords: Preimplantation Diagnosis; Amyloid Neuropathies, Familial; Genetic Testing; Assisted Reproductive Technologies.
      PubDate: 2014-12-30
      Issue No: Vol. 27 (2014)
  • Atypical Femoral Fractures and Bisphosphonates Treatment: Is it a Risk

    • Authors: Nuno Geada, Inês Mafra, Rogério Barroso, José Franco
      Abstract: Introduction: Bisphosphonates are effective in preventing osteoporotic fracture, however atypical femoral fractures with a well-defined radiological pattern have been described in association with prolonged treatment with bisphosphonates. Our objectives in this study were to characterize patients ≥ 65 years old with femoral fractures (subtrochanteric/diaphyseal) considered typical and atypical and the relationship between the occurrence of atypical fractures and bisphosphonate use.
      Material and Methods: We conducted a case-control study with patients admitted in our hospital with subtrochanteric or diaphyseal femur fracture in a period of five and a half years. After applying the exclusion criteria, the 92 fractures (91 patients) were classified as typical or atypical. The determination of prior bisphosphonate treatment was obtained through consultation of the individual medical history.
      Results: We found 11 atypical fractures (10 patients) and 81 typical fractures (81 patients). The median age of both groups was statistically different (72 years - atypical vs. 80 years - typical, p < 0.01). The reason for the use of bisphosphonates was 0.60 in atypical fractures and 0.01 in typical, and an odds ratio of 101.1 was obtained (p < 0.01).
      Discussion: Our results are supported and are in agreement with published studies relating to the occurrence of atypical femoral fractures associated with treatment with bisphosphonates.
      Conclusion: Despite the small number of cases it was possible to demonstrate a statistically significant relation between atypical femoral fractures and treatment with bisphosphonates. One should note that these atypical fractures occurred in patients significantly younger than patients with typical fractures.
      Keywords: Diphosphonates; Femoral Fractures; Risk Factors.
      PubDate: 2014-12-30
      Issue No: Vol. 27 (2014)
  • The Impact of the Lisbon Football Derby on the Profile of Emergency
           Department Admissions

    • Authors: André Almeida, Mónica Eusébio, Jaime Almeida, Matteo Boattini
      Abstract: Background: Variations in emergency department admissions have been reported to happen as a result of major sports events. The work presented assessed changes in volume and urgency level of visits to a major Emergency Department in Lisbon during and after the city’s football derby.
      Material and Methods: Volume of attendances and patient urgency level, according to the Manchester Triage System, were retrospectively analyzed for the 2008-2011 period. Data regarding 24-hour periods starting 45 minutes before kick-off was collected, along with data from similar periods on the corresponding weekdays in the previous years, to be used as controls. Data samples were organized according to time frame (during and after the match), urgency level, and paired accordingly.
      Results: A total of 14 relevant periods (7 match and 7 non-match) were analyzed, corresponding to a total of 5861 admissions. During the match time frame, a 20.6% reduction (p = 0.06) in the total number of attendances was found when compared to non-match days. MTS urgency level sub-analysis only showed a statistically significant reduction (26.5%; p = 0.05) in less urgent admissions (triage levels green-blue). Compared to controls, post-match time frames showed a global increase in admissions (5.6%; p = 0.45), significant only when considering less urgent ones (18.9%; p = 0.05).
      Discussion: A decrease in the total number of emergency department attendances occurred during the matches, followed by a subsequent increase in the following hours. These variations only reached significance among visits triaged green-blue.
      Conclusion: During major sports events an overall decrease in emergency department admissions seems to take place, especially due to a drop in visits associated with less severe conditions.
      Keywords: Emergency Service, Hospital; Triage; Sports; Soccer; Portugal.
      PubDate: 2014-12-30
      Issue No: Vol. 27 (2014)
  • Letters to the Editor Concerning the Article: Alexandre Oliveira Ferreira,
           Andrea Riphaus. Propofol to Increase Colorectal Cancer Screening in
           Portugal. Acta Med Port 2014;27:541-42.

    • Authors: Francisco Almeida Lobo, António Rodrigues Melo
      Abstract: Keywords: Colorectal Neoplasms; Hypnotics and Sedatives; Propofol; Endoscopy, Gastrointestinal; Colonoscopy.
      PubDate: 2014-12-30
      Issue No: Vol. 27 (2014)
  • Letters to the Editor Concerning the Article: Alexandre Oliveira Ferreira,
           Andrea Riphaus. Propofol to Increase Colorectal Cancer Screening in
           Portugal. Acta Med Port 2014;27:541-42.

    • Authors: Fernando Martins do Vale
      Abstract: Keywords: Colorectal Neoplasms; Hypnotics and Sedatives; Propofol; Endoscopy, Gastrointestinal; Colonoscopy.
      PubDate: 2014-12-30
      Issue No: Vol. 27 (2014)
  • Letters to the Editor Concerning the Article: Alexandre Oliveira Ferreira,
           Andrea Riphaus. Propofol to Increase Colorectal Cancer Screening in
           Portugal. Acta Med Port 2014;27:541-42.

    • Authors: Joaquim Figueiredo Lima
      Abstract: Keywords: Colorectal Neoplasms; Hypnotics and Sedatives; Propofol; Endoscopy, Gastrointestinal; Colonoscopy.
      PubDate: 2014-12-30
      Issue No: Vol. 27 (2014)
  • Letter to the Editor Concerning the Article: Ana Cardoso, David Jolley,
           Ann Regan, Michael Tapley. Dying with Dementia: a Challenge for Palliative
           Care Now and in the Future. Acta Med Port 2014;27:414-6.

    • Authors: Juliana Rocha, Ana Rita Pinto, Fernanda Costa
      Abstract: Keywords: Dementia; Continuity of Patient Care; Community Health Service; Terminal Care; Palliative Care; Aged; England.
      PubDate: 2014-12-30
      Issue No: Vol. 27 (2014)
  • Chronic Tophaceous Gout

    • Authors: Adelaide Spínola, Mónica Caldeira, Graça Dias
      Abstract: Keywords: Hyperuricemia; Gout; Arthritis, Rheumatoid.
      PubDate: 2014-12-30
      Issue No: Vol. 27 (2014)
  • Letter to the Editor Concerning the Article: Figueiredo J, Santos A,
           Clemente H, Lourenço A, Costa S, Grácio MA, Belo S.
           Schistosomiasis and Acute Appendicitis. Acta Med Port. 2014;27:396-9.

    • Authors: Beuy Joob, Viroj Wiwanitkit
      Abstract: Keywords: Appendicitis/parasitology; Schistosomiasis; Angola; África.
      PubDate: 2014-12-30
      Issue No: Vol. 27 (2014)
  • Beyond an Inflamed Ear

    • Authors: Cristina Ponte, Carla Macieira
      Abstract: Keywords: Ear Diseases; Ear, External; Polychondritis, Relapsing.
      PubDate: 2014-12-30
      Issue No: Vol. 27 (2014)
  • Unclassified Sex Cord Testis Tumor

    • Authors: Vânia Grenha, Paula Serra, Hugo Coelho, Edson Retroz, Paulo Temido, Alfredo Mota
      Abstract: Unclassified sex cord testis tumor is an extremely rare tumor, especially in the adult. It is characterized histologically for a nonspecific combination of testis stromal and epithelial elements, with varying degree of differentiation. Treatment usually consists of radical orchiectomy followed by clinical and imaging surveillance. The available literature about this pathology relies almost exclusively on clinical cases. It’s our aim to describe the case of a 37 years old man with an unclassified sex cord testis tumor, the first case described in Portugal, and to review the literature about this issue.
      Keywords: Testicular Neoplasms; Sex Cord-Gonadal Stromal Tumors.
      PubDate: 2014-12-30
      Issue No: Vol. 27 (2014)
  • Third Cranial Nerve Palsy in Sphenoid Sinusitis

    • Authors: Luís Almeida Dores, Marco Alveirinho Simão, Marta Canas Marques, Óscar Dias
      Abstract: Sphenoid sinus disease is particular not only for its clinical presentation, as well as their complications. Although rare, these may present as cranial nerve deficits, so it is important to have a high index of suspicion and be familiar with its diagnosis and management. Symptoms are often nonspecific, but the most common are headache, changes in visual acuity and diplopia due to dysfunction of one or more ocular motor nerves. The authors report a case of a 59 years-old male, who was referred to the ENT emergency department with frontal headaches for one week which had progressively worsened and were associated, since the last 12 hours, with diplopia caused by left third cranial nerve palsy. Neurologic examination was normal aside from the left third cranial nerve palsy. Anterior and posterior rhinoscopy excluded the presence of nasal masses and purulent rhinorrhea. The CT scan revealed a soft tissue component and erosion of the roof of the left sphenoid sinus. Patient was admitted for intravenous antibiotics and steroids treatment without any benefit after 48 hours. He was submitted to endoscopic sinus surgery with resolution of the symptoms 10 days after surgery. The authors present this case for its rarity focusing on the importance of differential diagnosis in patients with headaches and cranial nerves palsies.
      Keywords: Sphenoid Sinusitis; Oculomotor Nerve Diseases.
      PubDate: 2014-12-30
      Issue No: Vol. 27 (2014)
  • Incidental Asymptomatic Accessory Mitral Valve: a Differential Diagnosis
           for Intracardiac Mass

    • Authors: Esra Donmez, Taner Seker, Yahya Kemal Icen, Zafer Elbasan, Mustafa Gur, Murat Cayli
      Abstract: Accessory mitral valve is a rare entity which is commonly detected in children. It might present as a cause for left ventricular
      outflow obstruction, aortic regurgitation or a source for thromboembolic event. Diagnosis is based on echocardiographic findings, transesophageally when possible. Usually treatment is not required however treatment decisions are based on associated abnormalities and symptoms. Our aim is to report a case which was referred to our clinic as a suspected intracardiac mass.
      Keywords: Heart Defects, Congenital; Mitral Valve/abnormalities.
      PubDate: 2014-12-30
      Issue No: Vol. 27 (2014)
  • Computer-aided Method and Rapid Prototyping for the Personalized
           Fabrication of a Silicone Bandage Digital Prosthesis

    • Authors: Nuno Ventura Ferreira, Nuno Leal, Inês Correia Sá, Ana Reis, Marisa Marques
      Abstract: The fabrication of digital prostheses has acquired growing importance not only for the possibility for the patient to overcome psychosocial trauma but also to promote grip functionality. An application method of three dimensional-computer-aided design technologies for the production of passive prostheses is presented by means of a fifth finger amputee clinical case following bilateral hand replantation.
      Three-dimensional-computerized tomography was used for the collection of anthropometric images of the hands. Computer-aided design techniques were used to develop the digital file-based prosthesis from the reconstruction images by inversion and superimposing the contra-lateral finger images. The rapid prototyping manufacturing method was used for the production of a silicone bandage prosthesis prototype. This approach replaces the traditional manual method by a virtual method that is basis for the optimization of a high speed, accurate and innovative process.
      Keywords: Reconstructive Surgical Procedures; Fingers; Computer-Aided Design; Prostheses and Implants; Silicones.
      PubDate: 2014-12-30
      Issue No: Vol. 27 (2014)
  • Artificial Nutrition in Children (II): Parenteral Access

    • Authors: José Estevão-Costa
      Abstract: Parenteral nutrition is crucial when the use of the gastrointestinal tract is not feasible. This article addresses the main techniques for parenteral access in children, its indications, insertion details and maintenance, and complications. The type of venous access is mainly dictated by the expected duration of parenteral nutrition and by the body weight/stature. The peripheral access is viable and advantageous for parenteral nutrition of short duration (< 2 weeks); a tunneled central venous catheter (Broviac) is usually necessary in long-term parenteral nutrition (> 3 weeks); a peripherally introduced central catheter is an increasingly used alternative. Parenteral
      accesses are effective and safe, but the morbidity and mortality is not negligible particularly in cases of short bowel syndrome. Most complications are related to the catheter placement and maintenance care, and can be largely avoided when the procedures are carried out by experienced staff under strict protocols.
      Keywords: Child; Parenteral Nutrition; Catheterization, Central Venous; Catheterization, Peripheral.
      PubDate: 2014-12-30
      Issue No: Vol. 27 (2014)
  • Licit and Ilicit Uses of Medicines

    • Authors: Ricardo Jorge Dinis-Oliveira
      Abstract: Drugs of abuse are a heterogeneous group of xenobiotics or endobiotics that alter synaptic organization in the central nervous system in a transient or permanent basis, often leading to a compulsively use. What unites its members is that they confer pleasure (hedonism) to the abusers, namely by their action in the mesolimbic dopamine system. To exert its effects, different drugs of abuse will act on receptors and neurotransmitter transporters, modeling neurotransmitter release into the synaptic cleft. Besides acting on presynaptic
      neurons also function in neurotransmitter receptors and ion channels in postsynaptic neurons, thereby modifying the signaling pathways. In this work, the pharmacodynamic and the potential of some psychoactive substances that are typically subjected to abuse in Portugal, is reviewed. With this approach it was also possible a discussion of drugs of abuse that exhibit very different toxicological effects such as stimulants, depressants and hallucinogens. Particularly, the potential to induce dependence and addition, as well as to undergo illicit and licit uses, of central nervous system depressants, stimulants, anticholinergic antiparkinson drugs, opioids, cannabinoids and hallucinogens, is discussed.
      Keywords: Antiparkinson Agents; Central Nervous System Depressants; Cholinergic Antagonists; Analgesics, Opioid; Hallucinogens; Central Nervous System Stimulants.
      PubDate: 2014-12-30
      Issue No: Vol. 27 (2014)
  • Pulmonary Carcinoid: Analysis of a Single Institutional Experience and
           Prognostic Factors

    • Authors: Silvia da Silva Correia, Carlos Pinto, João Bernardo
      Abstract: Introduction: Carcinoid tumors of the lung are rare neoplasms of neuroendocrine origin. According to the World Health Organization, they can be classified into typical carcinoids and atypical carcinoids. The outcome, when compared to other lung neoplasms is usually favorable.
      Objectives: To characterize the population of patients with a diagnosis of carcinoid tumor, treated in a single institution and analyze the prognostic factors.
      Material and Methods: Retrospective analysis including all the patients with histological diagnosis of lung carcinoid tumor during an 11 year period, in a single institution. The tumors were classified according to the World Health Organization classification of carcinoids tumors in 2004. Staging was made according to the TNM classification of 2009 for non-small lung cancer: T (Tumor); N (Node); M (metastasis).
      Results: 59 patients were evaluated, including 53 with typical carcinoids and 6 with atypical carcinoid. 90% of the patients were submitted to surgery. The mean follow-up period was 57 months and the early post-operative mortality rate was 2% (one
      single case of palliative surgery). Histologic staging showed 49 patients in stage N0, one N1, eight N2 and one N3. The 5-year
      survival was 79.2%: 80.2% for typical carcinoids and 66.7% for atypical carcinoid (p < 0.05). The 5-year survival was 88.1%
      in T1 patients and 58.2% in T2-T4 patients (p < 0.01). In N0 patients, the 5-year survival was 89.7% while in N1-N3 it was 36% (p < 0.001). The 5-year survival was 85.9% in M0 disease and 0% in M1 disease (p < 0.01). Of the 11 patients who were submitted to adjuvant chemotherapy, 45.4% had atypical tumors.
      Discussion: In our sample, surgical treatment was safe, with a low postoperative complication rate. The prognosis was worse for atypical tumors, tumors with more than 3 cm, tumors with nodal involvement or metastasis. The five-year survival for typical carcinoid was excellent (80.2%), in agreement with the literature. For atypical carcinoid, the five-year was 66.7%, also similar to previous studies.
      Conclusions: In our institution, most of the lung carcinoids are typical and have an excellent long term survival. The mainstay of treatment is surgical resection. The factors that were related to a poor prognosis were the histological subtype (typical carcinoids versus atypical carcinoids), the size of the tumor, the mediastinal lymphatic involvement and the presence of metastasis.
      Keywords: Lung Neoplasms; Carcinoid Tumor; Neoplasm Staging.
      PubDate: 2014-12-30
      Issue No: Vol. 27 (2014)
  • Letters to the Editor Concerning the Article: Alexandre Oliveira Ferreira,
           Andrea Riphaus. Propofol to Increase Colorectal Cancer Screening in
           Portugal. Acta Med Port 2014;27:541-42.

    • Authors: Douglas K. Rex
      Abstract: Keywords: Colorectal Neoplasms; Hypnotics and Sedatives; Propofol; Endoscopy, Gastrointestinal; Colonoscopy.
      PubDate: 2014-12-30
      Issue No: Vol. 27 (2014)
  • Reply to the Letters to the Editor Concerning the Article: Alexandre
           Oliveira Ferreira, Andrea Riphaus. Propofol to Increase Colorectal Cancer
           Screening in Portugal. Acta Med Port 2014;27:541-42.

    • Authors: Andrea Riphaus, Alexandre Oliveira Ferreira
      Abstract: Keywords: Colorectal Neoplasms; Hypnotics and Sedatives; Propofol; Endoscopy, Gastrointestinal; Colonoscopy.
      PubDate: 2014-12-30
      Issue No: Vol. 27 (2014)
  • Escena familiar by Fernando Botero

    • Authors: Maria do Céu Machado
      Abstract: Keywords: Child; Obesity; Overweight; Paint.
      PubDate: 2014-12-30
      Issue No: Vol. 27 (2014)
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