Hospital de Santa Maria
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Shear-Wave Elastography: Is it possible to distinguish “unaffected” skin in scleroderma patients from healthy skin?
No full textPretransplant biopsy in expanded criteria donors: do we really need it?
No full textAbstract
INTRODUCTION:
Renal transplantation is the best treatment for end-stage renal disease, including when using expanded criteria donors (ECD) kidneys. However, these suboptimal kidneys should be evaluated rigorously to meet their usefulness. Opinions differ about the best way to evaluate them.
MATERIALS AND METHODS:
We retrospectively reviewed kidneys from ECD harvested by a single academic institution between January 2008 and September 2013. Needle biopsies were performed at the time of the harvest when considered relevant by the transplant team. Two pathologists where responsible for their analysis; the Remuzzi classification has been used in all cases.
RESULTS:
We evaluated 560 ECD kidneys. Biopsies were made in 197 (35.2%) organs, 20 of which were considered not usable and 36 good only for double transplantation. Sixty-three kidneys (11.3%) were discarded by the transplant team based on the biopsy result and clinical criteria. Donors who underwent a biopsy were older (P < .001) and had a worse glomerular filtration rate (GFR; P = .001). Comparing donors approved and rejected by the biopsy, the rejected donors were heavier (P = .003) and had a lower GFR (P = .002). Cold ischemia time was longer for the biopsy group (P < .001). Regarding graft function, the biopsy overall score correlated with the transplant outcome in the short and long term. Separately, glomeruli and interstitium scores were correlated with recipient's GFR in the earlier periods (3 months; P = .025 and .037), and the arteries and tubules correlated with GFR in the longer term (at 3 years P = .004 and .010).
CONCLUSION:
The decision on the usability of ECD grafts is complex. At our center, we chose a mixed approach based on donor risk. Low-risk ECD do not require biopsy. In more complex situations, especially older donors or those with a lower GFR, prompted a pretransplant biopsy. The biopsy results proved to be useful as they relate to subsequent transplant outcomes, thereby allowing us to exclude grafts whose function would most probably be less than optimal
Memory functioning in children with epilepsy: frontal lobe epilepsy, childhood absence epilepsy, and benign epilepsy with centrotemporal spikes
Get PDFSpecific cognitive deficits have been identified in children with epilepsy irrespective of results on intelligence tests. Memory deficits are traditionally attributed to temporal lobe epilepsy, whereas the impact of frontal lobe epilepsy on memory functions has remained controversial. The aim of this study was the examination of memory abilities in other childhood common epilepsy syndromes (frontal lobe epilepsy (FLE), childhood absence epilepsy (CAE), and benign epilepsy with centrotemporal spikes (BECTS)) and the influence of epilepsy-related variables. Memory was examined in 90 children with epilepsy (each epilepsy group consisted of 30 children), aged 6-15, and compared with 30 control children. Children with FLE showed significant deficits in verbal and visual memory. In addition, type of epilepsy, earlier age at epilepsy onset, and longer active duration of epilepsy were associated with memory problems. Seizure frequency and treatment, however, did not influence memory performance. This study indicates that children with FLE show greater risk of developing memory deficits than children with CAE or BECTS, thus highlighting the importance of assessing also memory functions in frontal lobe epilepsy.info:eu-repo/semantics/publishedVersio
Arachnoid cyst spontaneous rupture
Get PDFArachnoid cysts are benign congenital cerebrospinal fluid collections, usually asymptomatic and diagnosed incidentally in children or adolescents. They may become symptomatic after enlargement or complications, frequently presenting with symptoms of intracranial hypertension. We report an unusual case of progressive refractory headache in an adult patient due to an arachnoid cyst spontaneous rupture. Although clinical improvement occurred with conservative treatment, the subdural hygroma progressively enlarged and surgical treatment was ultimately needed. Spontaneous rupture is a very rare complication of arachnoid cysts. Accumulation of cerebrospinal fluid accumulation in the subdural space causes sustained intracranial hypertension that may be life-threatening and frequently requires surgical treatment. Patients with arachnoid cysts must be informed on their small vulnerability to cyst rupture and be aware that a sudden and severe headache, especially if starting after minor trauma or a Valsalva manoeuvre, always requires medical evaluation.info:eu-repo/semantics/publishedVersio
Updating the OMERACT filter: implications of filter 2.0 to select outcome instruments through assessment of "truth": content, face, and construct validity
Get PDFOBJECTIVE:
The Outcome Measures in Rheumatology (OMERACT) Filter provides guidelines for the development and validation of outcome measures for use in clinical research. The "Truth" section of the OMERACT Filter requires that criteria be met to demonstrate that the outcome instrument meets the criteria for content, face, and construct validity.
METHODS:
Discussion groups critically reviewed a variety of ways in which case studies of current OMERACT Working Groups complied with the Truth component of the Filter and what issues remained to be resolved.
RESULTS:
The case studies showed that there is broad agreement on criteria for meeting the Truth criteria through demonstration of content, face, and construct validity; however, several issues were identified that the Filter Working Group will need to address.
CONCLUSION:
These issues will require resolution to reach consensus on how Truth will be assessed for the proposed Filter 2.0 framework, for instruments to be endorsed by OMERACT.info:eu-repo/semantics/publishedVersio
Congenital Muscular Torticollis
No full textObjetivos: Caracterizar a população de crianças observadas por torcicolo muscular congénito na consulta de
Reabilitação Pediátrica.
Material e Métodos: Estudo longitudinal retrospetivo com revisão dos processos das crianças com torcicolo
muscular congénito seguidas na Consulta de Reabilitação Pediátrica do Centro Hospitalar e Universitário de
Coimbra, entre Janeiro de 2008 e Novembro de 2011.
Resultados: Foram observadas 91 crianças, 67% do sexo masculino, com uma média de idades de 20 semanas.
Setenta e dois e nove décimas por cento dos partos foram distócicos, 14 com apresentações fetais anómalas e
61,1% resultaram de mães primíparas. A palpação do músculo esternocleidomastoideu revelou um nódulo em
43,8% das crianças e 63,8% apresentavam limitação das amplitudes articulares cervicais. Foi feito o ensino de
medidas posturais a todos os cuidadores e prescrito um programa de reabilitação a 78 crianças. A maioria das
crianças apresentou resolução completa do quadro e apenas uma foi submetida a tratamento cirúrgico.
Conclusões: O torcicolo muscular congénito é a causa mais frequente de torcicolo na criança. Na maioria dos casos
foi atingido um bom resultado com terapia conservadora
