Hospital de Santa Maria
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Controlo ambiental das áreas de processamento dos aloenxertos
Get PDFOs Banco de Tecidos Alógenos do Sistema Musculoesquelético devem incluir nos seus procedimentos disposições especiais relativas à manipulação de tecidos por forma a evitar não só a contaminação de outros tecidos como também garantir a qualidade ambiente e a segurança do pessoal de acordo com a Lei 12/2009 de 26 de março alterada pela Lei 1/2015 de 8 de janeiro. Neste âmbito, são descritos diversos procedimentos que incluem:
o controlo ambiental das áreas de colheita, processamento e preservação dos tecidos; a utilização de técnica assética cirúrgica na manipulação dos tecidos, controlo da temperatura e humidade; controlos microbiológicos das superfícies e do ar; controlo do ambiente frio para conservação dos aloenxertos; equipamentos com condições particulares de instalação e, ainda, procedimentos sobre a prevenção de contaminações
Hidden musculoskeletal involvement in inflammatory bowel disease: a multicenter ultrasound study
No full textBACKGROUND:
Inflammatory bowel diseases are associated with a variety of extra-intestinal manifestations. The most frequent of these is joint involvement, which affects 16-33 % of IBD patients. Our aim was to evaluate the ultrasound prevalence of sub-clinical joint and entheseal involvement in patients with IBD without musculoskeletal symptoms, and to correlate the US findings with clinical and laboratory variables.
METHODS:
We recorded the clinical and laboratory data of 76 patients with IBD, 20 patients with spondyloarthritis (SpA) and 45 healthy controls at three rheumatology centers. All of the IBD patients and healthy controls were clinically examined by a rheumatologist in order to confirm the absence of musculoskeletal symptoms, and all of the subjects underwent grey-scale (GS) and power Doppler (PD) US examinations of the second and third metacarpophalangeal joints, knees and lower limbs in order to detect joint or entheseal abnormalities.
RESULTS:
A total of 1410 entheseal sites and 1410 joints were evaluated by US. Of the 76 patients with IBD, 64 (84.1 %) had at least one GS entheseal abnormality, and 11 (13.9 %) had more than one PD-positive entheseal site; 32 (42.1 %) showed sub-clinical joint involvement. There was a significant difference between the IBD patients and healthy controls in terms of global entheseal, PD-positive entheseal, and joint involvement (p < 0.0001), but no difference between the IBD and SpA patients. Anti-neutrophil cytoplasmic antibodies predicted entheseal involvement in patients with IBD (OR 6.031; p = 0.015).
CONCLUSIONS:
The prevalence of sub-clinical joint and entheseal involvement was higher in IBD patients than healthy controls, but there was no difference between the IBD and SpA patients
Congenital Milium of the Nipple
No full textA 12-month-old girl presented with an asymptomatic, pearly nodule on the left nipple that had been present from birth and was currently 3 mm in diameter and growing. Assuming the diagnosis of congenital primary milium of the nipple, we took a "wait and see" approach. After 3 months, the pearl disappeared without any scarring
ESGAR consensus statement on liver MR imaging and clinical use of liver-specific contrast agents
Get PDFTo develop a consensus and provide updated recommendations on liver MR imaging and the clinical use of liver-specific contrast agents
The European Federation of Organisations for Medical Physics Policy Statement No. 6.1: Recommended Guidelines on National Registration Schemes for Medical Physicists
Get PDFThis EFOMP Policy Statement is an update of Policy Statement No. 6 first published in 1994. The present version takes into account the European Union Parliament and Council Directive 2013/55/EU that amends Directive 2005/36/EU on the recognition of professional qualifications and the European Union Council Directive 2013/59/EURATOM laying down the basic safety standards for protection against the dangers arising from exposure to ionising radiation. The European Commission Radiation Protection Report No. 174, Guidelines on Medical Physics Expert and the EFOMP Policy Statement No. 12.1, Recommendations on Medical Physics Education and Training in Europe 2014, are also taken into consideration. The EFOMP National Member Organisations are encouraged to update their Medical Physics registration schemes where these exist or to develop registration schemes taking into account the present version of this EFOMP Policy Statement (Policy Statement No. 6.1"Recommended Guidelines on National Registration Schemes for Medical Physicists")
Pediatric ocular rosacea, a misdiagnosed disease with high morbidity: Proposed diagnostic criteria
No full textOcular rosacea is an important and underdiagnosed chronic inflammatory disorder observed in children.
A clinical spectrum ranging from chronic eyelid inflammation,
recurrent ocular redness, photophobia
and/or hordeola/chalazions and conjunctival/corneal
phlyctenules evolving to neovascularization and scarring
may occur. Visual impairment and consequent amblyopia
are frequent and corneal perforation although rare is
the most feared complication. Ocular manifestations
usually precede cutaneous lesions. Although few cases of
pediatric ocular rosacea (POR) have been reported in the
literature, many cases must have been underdiagnosed
or misdiagnosed. The delay in diagnosis is greater than
one year in the large majority of cases and may lead to
serious ocular sequelae. This review aims to highlight
the clinical features of POR, its epidemiology, easy
diagnosis and effective treatment. We also propose new
diagnostic criteria, in which at least three of the five
clinical criteria must be present: (1) Chronic or recurrent
keratoconjunctivitis and/or red eye and/or photophobia;
(2) Chronic or recurrent blepharitis and/or chalazia/
hordeola; (3) Eyelid telangiectasia documented by an
ophthalmologist; (4) Primary periorificial dermatitis and/
or primary features of rosacea; and (5) Positive familial
history of cutaneous and/or ocular rosacea
Encephalopathy Associated with Autoimmune Thyroid Disease: A Potentially Reversible Condition
Get PDFAutoimmune thyroid disease may occasionally associate with unspecific neurological symptoms, which are more commonly insidious, include cognitive or behavioural symptoms, and may associate with tremor, myoclonus, or ataxia. We report a 61-year-old female patient who presented with chronic headache, insidious mood, and cognitive disturbance which evolved in a few months to dementia associated with exuberant limb myoclonus. Diagnostic workup revealed high anti-thyroid peroxidase antibody titers and an inflammatory CSF profile, and it was negative for other possible etiologies. Treatment with steroids induced significant improvement. The diagnosis of encephalopathy associated with autoimmune thyroid disease is still controversial given the fact that the clinical presentation and diagnostic workup are unspecific, the pathophysiology is still undetermined, and the diagnosis is mostly of exclusion. No direct correlation is found between anti-thyroid antibody titers and clinical presentation, and it is currently speculated that other still unrecognized antibodies may be responsible for this clinical entity. It is extremely important to recognize this entity because it is potentially treatable with immunotherapies. It is also increasingly recognized that clinical improvement with first-line treatment with steroids may be absent or incomplete, and other immunotherapies as immunosuppressants, intravenous immunoglobulin, or plasma exchange must be attempted in the clinical suspicion of EEAT.info:eu-repo/semantics/publishedVersio
Autoimmune alternating hyper- and hypo-thyroidism: a rare condition in pediatrics
Get PDFAlternating between hyper- and hypo-thyroidism may be explained by the simultaneous presence of both types of TSH receptor autoantibodies (TRAbs) - thyroid stimulating autoantibodies (TSAbs) and TSH blocking autoantibodies (TBAbs). It is a very rare condition, particulary in the pediatric age. The clinical state of these patients is determined by the balance between TSAbs and TBAbs and can change over time. Many mechanisms may be involved in fluctuating thyroid function: hormonal supplementation, antithyroid drugs and levels of TSAbs and TBAbs. Frequent dose adjustments are needed in order to achieve euthyroidism. A definitive therapy may be necessary to avoid switches in thyroid function and frequent need of therapeutic changes. We describe an immune-mediated case of oscillating thyroid function in a 13-year-old adolescent. After a short period of levothyroxine treatment, the patient switched to a hyperthyroid state that was only controlled by adding an antithyroid drug.
LEARNING POINTS:
Autoimmune alternating hypo- and hyper-thyroidism is a highly uncommon condition in the pediatric age.It may be due to the simultaneous presence of both TSAbs and TBAbs, whose activity may be estimated in vitro through bioassays.The clinical state of these patients is determined by the balance between TSAbs and TBAbs and can change over time.The management of this condition is challenging, and three therapeutic options could be considered: I-131 ablation, thyroidectomy or pharmacological treatment (single or double therapy).Therapeutic decisions should be taken according to clinical manifestations and thyroid function tests, independent of the bioassays results.A definitive treatment might be considered due to the frequent switches in thyroid function and the need for close monitoring of pharmacological treatment. A definitive treatment might be considered due to the frequent switches in thyroid function and the need for close monitoring of pharmacological treatment.info:eu-repo/semantics/publishedVersio
