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Get PDFA neurocisticercose é a infecção parasitária mais comum do sistema nervoso central e a principal causa de epilepsia nos
países em desenvolvimento. As manifestações clínicas mais comuns são convulsões, cefaleia, hipertensão intracraniana, demência, meningite, síndrome medular e alterações psíquicas.
Apresenta-se o caso de um homem de 39 anos com hábitos etanólicos, admitido no Serviço de Urgência (SU) por agitação
psicomotora e tremor dos membros superiores. Ao exame objectivo encontrava-se orientado, sem sinais focais ou outras
alterações a destacar. Na avaliação neuroimagiológica objectivadas múltiplas formações quísticas nodulares com imagem
punctiforme central, favorecendo a presença de neurocisticercose em fase quístico nodulares. O quadro foi interpretado
como manifestações de privação etanólica, sem relação com os achados imagiológicos. Iniciou terapêutica com albendazol e
foi encaminhado à consulta de Neurologia.
Este caso demonstra que a admissão no SU, por motivos alheios à neurocistiscercose, constituiu um vector para o seu
diagnóstico, investigação e tratamento.info:eu-repo/semantics/publishedVersio
Mesothelial cyst of the pulmonary ligament: an uncommon lesion.
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Acute mastoiditis in children: Middle ear cultures may help in reducing use of broad spectrum antibiotics
Get PDFAcute mastoiditis (AM) is a suppurative infection of the mastoid air cells, representing the most frequent complication of acute otitis media. AM remains an important entity in children due to its potential complications and sequelae. We aim to describe the cases of AM admitted at our department, identify risk factors potentially associated with complications and analyse the changes in clinical approach of AM over time.
METHODS:
Case review of clinical files of children admitted with acute mastoiditis from June 1996 to May 2013 at a Lisbon metropolitan area hospital. Data was divided into two groups (prior and after May 2005) in order to evaluate changes in AM approach over the years.
RESULTS:
135 AM episodes were included. The median age was 3.8 years and 42% children were less than 24 months of age. Symptoms at presentation included fever (69%), ear pain (56%) and otorrhea (40%). Complications occurred in 22% patients and were more common in children under 24 months (33% vs 15%, p ≤ 0.01). Leukocyte count was significantly higher in children with complications (16.7 vs 14.5 × 109/μL, p ≤ 0.05) as was C-Reactive Protein value (13 vs 6.3 mg/dL, p ≤ 0.001). There was a significant association between the development of complications and C-Reactive Protein value at admission (OR 1.892; IC95%: 1.018-2.493, p ≤ 0.01). The optimal cut-off value was 7.21 mg/dL. Over time there was a significant increase in middle ear cultures obtained by tympanocentesis during surgery (2% vs 16%, p ≤ 0,01) and also a decrease in the use of broad spectrum antibiotherapy as initial treatment (52% vs 25%,p ≤ 0,001).
CONCLUSIONS:
Children under 24 months, with high leukocyte count or with high C-Reactive Protein value should be monitored closely since complications tend to be more frequent. A CRP value of 7.21 mg/dL at admission seems to be a good cut-off to monitor children for potential complications. Throughout the period analysed more cultures were performed allowing identification of the pathogens and implementation of appropriate antibiotic therapy.info:eu-repo/semantics/publishedVersio
Actinomycosis Causing Recurrent Perianal Fistulae
Get PDFActinomycosis is a rare but easily curable infection that should be considered in the differential diagnosis of perianal fistulizing disease. We present the case of a 26-year-old woman with complex perianal fistulae, including trans-sphincteric and suprasphincteric fistulous tracts and a rectovaginal fistula, requiring multiple abscess drainages, seton placement, and antibiotic courses, with little improvement. After extensive investigation, Actinomyces spp. was identified in anal cytology. The patient underwent a 6-week course of intravenous penicillin followed by oral amoxicillin, with remarkable improvement. This case illustrates the importance of pursuing less common diagnoses in refractory complex perianal disease, such as actinomycosis.info:eu-repo/semantics/publishedVersio
Early liver transplantation for severe alcoholic hepatitis - are we exploring all the tools?
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Choroidal Melanoma
Get PDFChoroidal melanoma is the most common primary intraocular malignant tumor in adults. None of the different treatments available offers advantages of survival, resorting more and more to conservative treatments such as brachytherapy, which has been available in Portugal since 2013. In this article we review the clinical characteristics, risk factors, diagnosis, complementary exams and therapeutic options in choroidal melanoma.info:eu-repo/semantics/publishedVersio
Senile Systemic Amyloidosis: An Underdiagnosed Disease.
Get PDFSenile systemic amyloidosis is caused by a non-mutated form of transthyretin with the heart being the major organ involved. This infiltrative cardiomyopathy usually presents as slowly progressive heart failure. An 82-year-old female patient was admitted for newly diagnosed heart failure. A year later she presented with decompensated heart failure and syncope. Inpatient work-up showed persistently elevated troponin and N-terminal-pro BNP levels, rapid progression to severe left ventricular concentric hypertrophy, and sinus pauses on the Holter. Cardiac MRI revealed diffuse late gadolinium enhancement in the left ventricle. The demonstration of amyloid protein with the clinical findings and complementary investigations allowed for the diagnosis of senile systemic amyloidosis.
LEARNING POINTS:
Senile systemic amyloidosis is a rare disease with a common clinical presentation that is probably underdiagnosed in patients with heart failure with preserved systolic function.A new unexplained heart failure diagnosis, increased ventricular wall thickness and particularly low voltage on the ECG should raise the suspicion of cardiac amyloidosis.Histopathological evidence of amyloid deposition elsewhere and typical advanced imaging features can support the diagnosis, rendering endomyocardial biopsy no longer mandatory.info:eu-repo/semantics/publishedVersio