Hospital de Santa Maria
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Neuroticism: The Elephant in the Room
No full textThe term neurosis has a long tradition in psychiatric nosology. It was first introduced by Cullen referring to diseases of the nervous system in which there were no obvious physical lesion. It evolved to a wide use with the assumption of an aetiological meaning in the psychodynamic literature. Partially as a result, it has been removed as an organizing principle in psychiatric classifications subsisting, however, in the heading of one group of disorders of ICD-10.
Nevertheless, in the clinical context, the terms “neuroticism” and “neurotic” are often used as an informal diagnostic for a relatively large group of patients described as presenting both depressive and anxiety symptoms of fluctuating, chronic pattern and frequently associated with underlying maladaptive personality traits.
Most interestingly, a sparking debate subsists among clinicians and researchers on how to categorize such patients. The concept of dysthymia is challenged by several methodological and epistemological issues, along with a raising number of authors sustaining other constructs as better describing the developmental nature of what Schneider called “the aristocracy of suffering”.
The authors address these issues revising the available scientific literature, suggesting that, paradoxically, current classifications on the subject do not effectively describe the core aspects of a common and highly resource-consuming set of patients
Favorable outcome of total hip arthroplasty with insufficient bone coverage of the roof reinforcement ring: a case report
Get PDFA 59-year-old male patient underwent a total hip arthroplasty for the treatment of end-stage dysplastic osteoarthritis. A roof reinforcement ring, a cemented polyethylene cup, and a cementless stem were used. Extensive superolateral portion of the ring was uncovered by host bone. Morsellized autogenous femoral-head graft was impacted to fill the space between superolateral border of the ring and superior part of the dysplastic acetabulum.
At the follow-up after 4-years, the patient had no complaints and was very satisfied with the operation result. The hip radiograph revealed no signs of instability of the acetabular component, and no bone graft resorption. Despite the suboptimal implantation of the ring compromising, apparently, mechanical stability of the prosthesis, the outcome was favorable. This result can be supported by the fixation of the metal ring with screws, the adequate orientation of the prosthesis, the position of hip´s center of rotation, and bone graft incorporation
Resultado dos casos referenciados a consulta de Ortopedia Infantil por suspeita de Displasia de Desenvolvimento da Anca
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Transient neonatal hyperthyroidism
No full textGraves’ disease is the main cause of hyperthyroidism in women of childbearing age. It occurs by the presence
of serum immunoglobulins which stimulate the thyrotropin receptor (TRAbs) and may cross the
placenta. It has serious consequences when uncontrolled, leading to fetal and/or neonatal hyperthyroidism
or hypothyroidism. The authors describe the case of a newborn from a mother with poorly controlled
Graves’ disease during pregnancy. He had an uneventful early neonatal period but developed hyperthyroidism
in the second week of life. He was treated for two days with propranolol to manage tachycardia
and metimazol during 4 months, with favourable clinical and laboratory outcome.
During pregnancy, it is essential to control thyroid function and TRAbs in women with Graves’ disease.
Newborns should be screened for thyroid function at birth and must have a regular follow up as it allows
the diagnosis of transient hyperthyroidism or hypothyroidism and its early treatment, avoiding short
and long term complications.
Based on this case and literature review, the authors present a proposal of protocol in infants born to
mothers with Graves’ disease
Neonatal Appendicitis – an Uncommon Diagnosis, not to be Forgotten
Get PDFAcute appendicitis is a common disease in older children, but extremely rare in the
neonate. Nevertheless, the true incidence might be underestimated, given the difficulty
of the diagnosis. Subtle clinical signs and symptoms usually result in high morbidity
and mortality due to delayed diagnosis and surgical intervention. The presentation
of neonatal appendicitis can be identical to necrotizing enterocolitis, leading to
misdiagnosis. Appendicitis should therefore be considered in the differential diagnosis
for necrotizing enterocolitis and needs strong clinical suspicion.
We report a case of a premature newborn who presented with vomiting, abdominal
distension and free intra-peritoneal air on plain x-ray. He was initially diagnosed
and treated as necrotizing enterocolitis, but the absence of clinical improvement with
standard treatment led to exploratory laparotomy. Surgical exploration revealed an
acutely inflamed appendix with normal small and large intestines and appendectomy
was performed. The post-operatory period was uneventful and the infant was
discharged home. Follow-up confirmed a normal growth and neurodevelopment.
We herein report this case in order to raise awareness to this unusual pathology, so
that an early diagnosis and treatment can lead to a better outcome, improving survival
rate and reducing long term morbidity. We believe uncommon pathologies, like
neonatal appendicitis, should be reported to facilitate proper epidemiologic studies
Intrastromal corneal ring segments: how successful is the surgical treatment of keratoconus?
No full textThis review evaluates the outcomes of intrastromal corneal ring segment (ICRS) implantation for the treatment of keratoconus considering a new grading system based on the preoperative visual impairment of the patient. Additionally, a five-year follow-up analysis of patients with stable and progressive keratoconus is performed in order to assess the long term stability of the surgical procedure. Corrected distance visual acuity decreased statistically significantly in patients with mild keratoconus (P < 0.01) but statistically significantly increased in all other grades (P < 0.05). The improvement in visual acuity and the decrease of keratometric and aberrometric values were stable throughout a long period of time in patients with stable keratoconus. In patients with progressive form keratoconus, a significant improvement was found immediately after the procedure, however clinically relevant regression greater than 3 D was observed at the end of the follow up period
Oculo-auriculo-vertebral spectrum: a review of the literature and genetic update
No full textOculo-auriculo-vertebral spectrum (OAVS, OMIM 164 210) is a developmental disorder primarily involving structures derived from the first and second pharyngeal arches during embryogenesis. The phenotype is clinically heterogeneous and is typically characterised by abnormal development of the ear, mandible anomalies and defects of the vertebral column. OAVS may occur as a multiple congenital abnormality, and associated findings include anomalies of the eye, brain, heart, kidneys and other organs and systems. Both genetic and environmental factors are thought to contribute to this craniofacial condition, however, the mechanisms are still poorly understood. Here, we present a review of the literature on OAVS, discussing what is known about the aetiology, candidate loci, possible mechanisms and the range of clinical features that characterise this condition. We also comment on some important aspects of recurrence risk counselling to aid clinical management