We present a case of a 53-year-old woman who developed an endometrioid adenocarcinoma six years after total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy (BSO), who was on estrogenic-only hormone replacement therapy (HRT).
OBJECTIVE: To develop evidence-based recommendations for the management of systemic glucocorticoid (GC) therapy in rheumatic diseases. METHODS: The multidisciplinary guideline development group from 11 European countries, Canada and the USA consisted of 15 rheumatologists, 1 internist, 1 rheumatologist-epidemiologist, 1 health professional, 1 patient and 1 research fellow. The Delphi method was used to agree on 10 key propositions related to the safe use of GCs. A systematic literature search of PUBMED, EMBASE, CINAHL, and Cochrane Library was then used to identify the best available research evidence to support each of the 10 propositions. The strength of recommendation was given according to research evidence, clinical expertise and perceived patient preference. RESULTS: The 10 propositions were generated through three Delphi rounds and included patient education, risk factors, adverse effects, concomitant therapy (ie, non-steroidal anti-inflammatory drugs, gastroprotection and cyclo-oxygenase-2 selective inhibitors, calcium and vitamin D, bisphosphonates) and special safety advice (ie, adrenal insufficiency, pregnancy, growth impairment). CONCLUSION: Ten key recommendations for the management of systemic GC-therapy were formulated using a combination of systematically retrieved research evidence and expert consensus. There are areas of importance that have little evidence (ie...
A tumour bank is a consequence of the modern medicine to follow the knowledge of bio-pathology of pre-neoplastic and neoplastic diseases in order to define diagnostic criteria and accurate therapy. It can be an independent unit but it should depend on a real or virtual net in the country or in connection between different states. The informed agreement of the patient and law are integrally followed according with each country legislation and medical ethics is never overtaken for the accomplishment of diagnosis in the departments of pathology. A tumour bank works in the department of pathology, depends on trained technicians and pathologists and requires specific equipment for the different types of re-collecting, after dealing with confidentiality and law determinations. There are already some tumour bank nets in Europe (Spain, Croatia, Holland, UK, Germany) and Portugal is starting now its way.
Newborn infants in intensive care units demonstrated a higher incidence of gestational age below 31 week. Obstetrical and neonatal diseases procedures required for the management of critically ill neonates are associated with an increased risk of infections. Gentamicin is an aminoglycoside antibiotic often used to treat gram-negative bacillary infections and suspected sepsis in neonates. The risk of toxicity or poor efficacy is further increased due to the recognised wide intra and interpatient variability of the newborn. The present work involved 49 infants of 31.3 +/- 4.1 (mean +/- SD) weeks of gestational age, weighing 1.7 +/- 0.8 kg and were treated with standard doses of gentamicin (3.8 +/- 0.9 mg/kg/day). Routine clinical care data were retrospectively collected from the medical records in the neonatal intensive-care unit at Coimbra University Hospital. Data analysis demonstrated that potentially toxic serum levels were observed in 49% of newborn infants (trough > 2 mg/L). Additionally, the obtained results also showed that 7.5% of peak concentrations were found to be higher than 10 mg/L. Potentially sub-therapeutic concentrations were observed in 15% of the patients (peak > 6 mg/L).
OBJECTIVE: Appropriate treatment and timing hinge on whether the lesion is benign or malignant. Study: A five years retrospective descriptive analysis was performed. Location : Department of General Surgery in Hospitals of the University of Coimbra. Patients: We present a series of 93 consecutive patients who had elective surgery for known gallbladder polyps, treated from January 2003 to December 2007.
METHODS: An analysis was performed using clinical and radiological files of patients electively treated for gallbladder polyp. Ninety-three consecutive patients were evaluated, treated and followed in a Department of General Surgery in a Central Hospital in that period. Biographic, clinical and radiological data were compiled.
RESULTS: In 91 patients a benign lesion was found. Two (2.16%) patients had adenocarcinoma. Among benign polyps, 73 (78,5%) were cholesterol polyps, 14 (15%) were hyper-plastic and 2 (2.19%) were premalignant adenomas. Mean diameter of benign polyps, excluding adenomas, was 6 mm. In 40 (43%) patients, multiple lesions were found. The mean diameter in the subset of malignant and premalignant polyps was 18.8 mm, in all instances these were found to be single lesions; and mean age at presentation was 57,7 years.
CONCLUSION: Cholecystectomy is the appropriate surgical treatment for gallbladder polyps...
Many approaches are used in the repair of skeletal defects in reconstructive orthopaedic surgery, and bone grafting is involved in virtually every procedure. Autografting remains the gold standard for replacing bone loss. However, the limited amount of bone that can be harvested and the morbidity associated with that procedure are major constraints to the clinical use of autografts. In contrast, bone allografts can be used in any kind of surgery, whether involving minor defects or major bone loss. Cortical strut allografts unite to host bone through callus formation, restoring bone stock and can be used as an onlay biological plate. These struts can be made from hemicylinders of tibia being fixed to host bone by circumferential metallic cables or by screws. The purpose of this study was to analyze the radiographic outcomes of twelve cryopreserved cortical onlay strut allografts, used in a group of nine patients, for revision hip arthroplasty of the femoral side, to stabilize femoral periprosthetic fractures, to reinforce poor cortical bone and to treat one atrophic femoral nonunion. The average follow-up period was 4.3 years (range, 1.6 to 9 years). No fractures, nonunions or progressive resorption of the bone allografts were observed. All struts were incorporated to the native femur with minimal resorption...
As fracturas da extremidade superior do fémur são um importante factor de morbilidade e mortalidade após os 60 anos. Várias causas contribuem para a sua incidência. As consequências que delas advêm são extremamente graves e incapacitantes, bem como originam elevados custos na economia nacional. Neste trabalho avalia-se a morbilidade e mortalidade causada por fracturas da extremidade superior do fémur numa população hospitalar, bem como os vários factores que possam ter influência no processo. Pretende-se valorizar a importância da prevenção, do tratamento precoce e da recuperação eficaz desta patologia. Abstract Hip fractures are associated with high morbidity and mortality over the age of 60. Several causes are contributive to their incidence. The consequences of these fractures are extremely severe, carrying high economic costs. We have studied the morbidity and mortality caused by hip fractures in a hospital population and the several factors that may have influence on the process. We intend to underline the value of prevention, early treatment and adequate rehabilitation in this pathology.
The presence of acute peripartum anaemia in a monochorionic twin pregnancy represents a clinical challenge requiring prompt recognition and management. Twin-to-twin transfusion syndrome (TTTS) is a major complication of these pregnancies and a medical emergency in its acute form. Acute intrapartum fetoplacental transfusion (AIFT) has been reported infrequently. The authors present a case of a probable acute TTTS in an uneventful monochorionic monoamnionic twin pregnancy, where typical ultrasound criteria for long-standing TTTS were absent. The first twin was born pale, hypotonic and developed hypovolemic shock due to acute anaemia. Soon after birth, she presented with seizures and a cerebral ultrasound detected a large parieto-occipital infarction. The second twin, although plethoric, was clinically well. The risk of acute TTTS and AIFT, although infrequent and unpredictable, should be kept in mind when planning delivery of monochorionic twins, because the consequences for one or both twins can be disastrous.
O problema principal no tratamento de fracturas em osso frágil é a fixação óssea dos diversos tipos de implantes. As placas com parafuso deslizante, as cavilhas endomedulares e o efeito em banda de tensão, encontram nestas situações traumáticas a sua melhor indicação, por a forma a maximizar a compressão óssea e diminuir a tensão na interface osso-implante. Para além disso, a vertebroplastia e a cifoplastia têm demonstrado bons resultados no tratamento das fracturas osteoporóticas da coluna vertebral.
Descrevem-se as estratégias mais recomendadas para o tratamento cirúrgico deste tipo particular de fracturas ósseas. O tratamento das fracturas em osso frágil inclui a aplicação dos mais recentes princípios de técnica cirúrgica, bem como a implantação dos dispositivos cirúrgicos mais adequados para se poder alcançar o melhor resultado.
Inflammatory pseudotumor (IP) is a benign lesion that can affect nearly any tissue in the body and which may be confused
clinically and in imaging for malignancy. Despite the widespread performance of breast biopsy, the finding of inflammatory
pseudotumor of the breast is exceedingly rare. Excision of the tumor is the treatment of choice, but there is a relatively high rate
of recurrence. The aim of this report is to describe the clinical, imaging, and pathologic features in a case of bilateral breast IP.
ABSTRACT The authors report a case of a 68-year-old man with an unrecognized insulinoma manifesting with neuropsychiatric symptoms. For two years, he presented with unspecified behavior changes, autonomic and neuroglycopenic symptoms, which led him to be misdiagnosed with a neurologic and psychiatric disorder before the insulinoma was recognized. Following neurological alterations in context of hypoglycemia, subsequent to longstanding food refusal, he was admitted in the psychiatric ward. Despite good global response and normal food intake, hypoglycemic episodes were still occurring and led to a careful evaluation which permitted the definitive diagnostic. This case highlights the diagnostic difficulties of medical disorders presenting with clinical features overlapping neurological and psychiatric syndromes. It also reflects the diagnostic difficulties in rare clinical entities, particularly in patients previously followed in psychiatry and underlines the need for a constant dialogue and updating of clinicians.