A 74-year-old woman, previously healthy, presented with right upper quadrant pain. She had no history of trauma, surgery, biopsy, or known hepatic disease. On physical examination she had mild tenderness in the right upper quadrant, without hepatosplenomegaly or palpable abdominal masses. Laboratory analyses including liver-associated enzymes were within normal limits.
Haemangiomas are common focal liver lesions, generally detected in the work-up of asymptomatic patients. From the pathological point of view, they can be classified as small (capillary) or large, with cavernous vascular spaces that may show thrombosis, calcifications and hyalinisation. The polymorphic imaging appearance of haemangiomas depends on their histological features and flow pattern. The widespread use of cross-sectional imaging has allowed an increased detection rate and a better characterisation of this benign tumour. Recent developments of ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) providing high spatial and temporal resolution, together with the use of new contrast agents and/or pulse sequences has broadened the spectrum of imaging findings, contributing to diagnostic refinement in difficult cases. The scope of the present article is to provide an overview of the range of appearances of haemangiomas, explored with recent cross-sectional imaging modalities, emphasising its atypical findings as explored by temporally resolved contrast-enhanced imaging.
We report a case of severe type IV hypersensitivity reaction to amoxicillin, which occurred in a person with a 12-year history of SLE. The present case illustrates the wide differential diagnosis in a SLE patient who presents with an allergic drug reaction. The attribution of the presenting symptoms to the underlying SLE and/or to the drugs used to treat SLE and coexisting conditions is a major challenge.
INTRODUÇÃO: As angiodisplasias são causas raras de hemorragia digestiva aguda. A natureza intermitente da hemorragia e a extensão de tubo digestivo envolvido colocam desafios particulares. OBJECTIVOS: Caracterizar as hemorragias digestivas agudas severas por angiodisplasia. DOENTES E MÉTODOS: Análise retrospectiva das hemorragias digestivas agudas por angiodisplasia admitidas na Unidade de Cuidados Intensivos de Gastrenterologia (UCIGE) dos Hospitais da Universidade de Coimbra, entre 1992 e 2008. RESULTADOS: Incluídos 21 doentes, representando 0,54% das admissões no período considerado. Registou-se predomínio do sexo masculino e idade média de 74 anos (42-92). Todos os doentes apresentavam co-morbilidades e 40% tomavam antiagregantes plaquetares ou anticoagulantes. A hemorragia foi proximal à ampola de Vater em 62% dos casos. Efectuou-se hemostase endoscópica em 18 doentes, que foi eficaz em todos eles. Outras terapêuticas menos utilizadas incluíram a embolização e enterectomia. Não ocorreu recidiva hemorrágica durante os internamentos. A mortalidade cifrou-se em 4,7%, correspondendo a um doente sujeito a laparotomia, falecido no pós-operatório imediato. CONCLUSÕES: A hemorragia digestiva aguda severa por angiodisplasia foi um evento raro na UCIGE. A endoscopia teve um papel fundamental no diagnóstico e na terapêutica. Os resultados corroboram a pertinência da admissão destes casos numa UCIGE...
In this report, we demonstrate that a fetal mouse skin-derived dendritic cell line produces nitric oxide (NO) in response to the endotoxin [lipopolysaccharide (LPS)] and to cytokines [tumor necrosis factor-alpha (TNF-alpha) and granulocyte-macrophage colony-stimulating factor (GM-CSF)]. Expression of the inducible isoform of NO synthase (iNOS) was confirmed by immunofluorescence with an antibody against iNOS. The tyrosine kinase inhibitor genistein decreased LPS- and GM-CSF-induced nitrite (NO(-2)) production. The effect of LPS and cytokines on NO(-2) production was inhibited by the Janus kinase 2 (JAK2) inhibitor tyrphostin B42. The p38 mitogen-activated protein kinase (p38 MAPK) inhibitor SB-203580 also reduced the NO(-2) production evoked by LPS, TNF-alpha, or GM-CSF, but it was not as effective as tyrphostin B42. Inhibition of MAPK kinase with PD-098059 also slightly reduced the effect of TNF-alpha or GM-CSF on NO(-2) production. Immunocytochemistry studies revealed that the transcription factor nuclear factor-kappaB was translocated from the cytoplasm into the nuclei of fetal skin-derived dendritic cells (FSDC) stimulated with LPS, and this translocation was inhibited by tyrphostin B42. Our results show that JAK2 plays a major role in the induction of iNOS in FSDC.
OBJECTIVE: Stroke is a major complication after coronary surgery, occurring in 1-4% of the patients. In this study, we evaluate the incidence and pre- and intraoperative risk factors for the development of a cerebrovascular accident (CVA) and the impact of such an event on perioperative mortality and on hospital length of stay.
METHODS: Data from 4567 patients submitted to isolated coronary artery bypass grafting (CABG) with hypothermic ventricular fibrillation between 1992 and 2001 were entered prospectively into a dedicated computerized database and analyzed retrospectively at this time. Univariate and multivariate analyses were performed where appropriate.
RESULTS: The incidence of postoperative CVA was 2.5% (116 patients). Multivariable logistic regression identified the following variables to be independent predictors of a postoperative CVA: cerebrovascular disease (P
HYPOTHESIS: The Portuguese version of Mini-Tinnitus Questionnaire (Mini-TQ) is as valid as the English version to assess tinnitus-associated distress in the Portuguese-speaking population.
BACKGROUND: Tinnitus is a major symptom in ENT practice affecting subjects in all demographic groups. Our objective is to validate a Portuguese version of Mini-TQ (Mini-TQ-pv) to be used in clinical practice and research.
METHODS: Mini-TQ-pv was administered to 51 patients with chronic tinnitus. Statistical analysis was done to determine the psychometric properties of the instrument.
RESULTS: After double translation, face and content validity were confirmed by high internal consistency (Cronbach alpha = 0.861) and significant correlation between individual items and total score. The questionnaire was easy and quick to administer (2.57 min).
CONCLUSION: We provide a suitable Mini-TQ-pv to be used in the assessment of Portuguese-speaking patients with tinnitus
Nuclear medicine in Portugal has been an autonomous speciality since 1984. In order to obtain the title of Nuclear Medicine Specialist, 5 years of training are necessary. The curriculum is very similar to the one approved under the auspices of the European Union of Medical Specialists, namely concerning the minimum recommended number of diagnostic and therapeutic procedures. There is a final assessment, and during the training the resident is in an approved continuing education programme. Departments are accredited by the Medical College in order to verify their capacity to host nuclear medicine residencies.
Rare copy-number variation (CNV) is an important source of risk for autism spectrum disorders (ASDs). We analyzed 2,446 ASD-affected families and confirmed an excess of genic deletions and duplications in affected versus control groups (1.41-fold, p = 1.0 × 10(-5)) and an increase in affected subjects carrying exonic pathogenic CNVs overlapping known loci associated with dominant or X-linked ASD and intellectual disability (odds ratio = 12.62, p = 2.7 × 10(-15), ∼3% of ASD subjects). Pathogenic CNVs, often showing variable expressivity, included rare de novo and inherited events at 36 loci, implicating ASD-associated genes (CHD2, HDAC4, and GDI1) previously linked to other neurodevelopmental disorders, as well as other genes such as SETD5, MIR137, and HDAC9. Consistent with hypothesized gender-specific modulators, females with ASD were more likely to have highly penetrant CNVs (p = 0.017) and were also overrepresented among subjects with fragile X syndrome protein targets (p = 0.02). Genes affected by de novo CNVs and/or loss-of-function single-nucleotide variants converged on networks related to neuronal signaling and development, synapse function, and chromatin regulation.