22 research outputs found
Neoplasia oculta : revisão da literatura e análise de pequena série de quatro casos clínicos
No full textTrabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2018Introdução: Neoplasia oculta ou neoplasia de localização primária não identificada engloba um grupo heterogéneo de situações clínicas definidas pela presença de metástases de crescimento agressivo sem tumor primário definido após uma investigação completa e exaustiva, ou pela presença de manifestações sistémicas relacionadas com a presença de síndromes paraneoplásicos, constituindo 3 a 5% de todos os diagnósticos de neoplasia. A neoplasia oculta é a terceira/quarta causa de morte por neoplasia, apresentando na maioria dos casos (80 a 85%) prognóstico desfavorável, com sobrevida média de 6 a 10 meses. A terapêutica da neoplasia oculta deve ser ponderada a nível individual, de acordo com as bases clinico-patológicas e subgrupo de prognóstico em que o doente se insere. Casos Clínicos: Neste trabalho apresentam-se quatro casos clínicos de doentes internados no serviço de Medicina 1C do Hospital de Santa Maria que constituem exemplos ilustrativos de neoplasia oculta, nomeadamente na gravidade da forma de apresentação, progressão rápida e dificuldade de estabelecer diagnóstico histológico. Conclusão: Nos casos apresentados evidenciou-se o rápido carácter evolutivo de mau prognóstico da neoplasia oculta, culminando invariavelmente em morte. Apesar de nos casos em questão se considerar o diagnóstico de neoplasia oculta pela apresentação de metástases sem tumor primário definido, os exames que seriam necessários para a obtenção de diagnóstico final não foram realizados por rápida evolução da doença, tendo a abordagem diagnóstica sido limitada, principalmente no que diz respeito à obtenção de biópsia. Para além disso, permaneceu a dúvida quanto ao regime terapêutico adequado bem como quanto à aplicabilidade das guidelines atuais.Introduction: Occult neoplasia or cancer of unknown primary is a diverse group of cancers that is defined by the presence of metastasis of aggressive growth without an identifiable primary tumor after a complete and exhaustive evaluation, or by the presence of systemic manifestations related to paraneoplastic syndromes, which accounts for 3 to 5% of all cancer cases. Occult neoplasia is the third/forth cause of death by neoplasia, and has a poor prognosis, with a life expectancy of 6 to 10 months, in the majority of cases (80 to 85%). Treatment must be settled individually, according to clinical and pathological findings and the prognostic subgroup in which the patient is in. Case Report: Here are described four clinical cases of patients admitted to Hospital de Santa Maria Internal Medicine IC care which are illustrative examples of occult neoplasia, in its aggressive presentation, rapid progression and difficulty in establishing histological diagnosis. Conclusion: In the cases presented, the aggressive evolution and poor prognosis of occult neoplasia are evident, since all the patients died. Even though the diagnosis of occult neoplasia was considered because of the presence of metastasis without an identifiable primary tumor, the necessary investigation to reach the final diagnosis was not completed due to the aggressive progression of the disease and the diagnostic approach was limited, especially when a biopsy was needed. In addition, the doubt remained as to the adequate therapeutic regimen to apply as well as the applicability of the current guidelines
IgG anti-apolipoprotein A-1 antibodies in patients with systemic lupus erythematosus are associated with disease activity and corticosteroid therapy: an observational study.
No full textIgG anti-apolipoprotein A-1 (IgG anti-apoA-1) antibodies are present in patients with systemic lupus erythematosus (SLE) and may link inflammatory disease activity and the increased risk of developing atherosclerosis and cardiovascular disease (CVD) in these patients. We carried out a rigorous analysis of the associations between IgG anti-apoA-1 levels and disease activity, drug therapy, serology, damage, mortality and CVD events in a large British SLE cohort
Neoplasia oculta : revisão da literatura e análise de pequena série de quatro casos clínicos
No full textTrabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2018Introdução: Neoplasia oculta ou neoplasia de localização primária não identificada engloba um grupo heterogéneo de situações clínicas definidas pela presença de metástases de crescimento agressivo sem tumor primário definido após uma investigação completa e exaustiva, ou pela presença de manifestações sistémicas relacionadas com a presença de síndromes paraneoplásicos, constituindo 3 a 5% de todos os diagnósticos de neoplasia. A neoplasia oculta é a terceira/quarta causa de morte por neoplasia, apresentando na maioria dos casos (80 a 85%) prognóstico desfavorável, com sobrevida média de 6 a 10 meses. A terapêutica da neoplasia oculta deve ser ponderada a nível individual, de acordo com as bases clinico-patológicas e subgrupo de prognóstico em que o doente se insere. Casos Clínicos: Neste trabalho apresentam-se quatro casos clínicos de doentes internados no serviço de Medicina 1C do Hospital de Santa Maria que constituem exemplos ilustrativos de neoplasia oculta, nomeadamente na gravidade da forma de apresentação, progressão rápida e dificuldade de estabelecer diagnóstico histológico. Conclusão: Nos casos apresentados evidenciou-se o rápido carácter evolutivo de mau prognóstico da neoplasia oculta, culminando invariavelmente em morte. Apesar de nos casos em questão se considerar o diagnóstico de neoplasia oculta pela apresentação de metástases sem tumor primário definido, os exames que seriam necessários para a obtenção de diagnóstico final não foram realizados por rápida evolução da doença, tendo a abordagem diagnóstica sido limitada, principalmente no que diz respeito à obtenção de biópsia. Para além disso, permaneceu a dúvida quanto ao regime terapêutico adequado bem como quanto à aplicabilidade das guidelines atuais.Introduction: Occult neoplasia or cancer of unknown primary is a diverse group of cancers that is defined by the presence of metastasis of aggressive growth without an identifiable primary tumor after a complete and exhaustive evaluation, or by the presence of systemic manifestations related to paraneoplastic syndromes, which accounts for 3 to 5% of all cancer cases. Occult neoplasia is the third/forth cause of death by neoplasia, and has a poor prognosis, with a life expectancy of 6 to 10 months, in the majority of cases (80 to 85%). Treatment must be settled individually, according to clinical and pathological findings and the prognostic subgroup in which the patient is in. Case Report: Here are described four clinical cases of patients admitted to Hospital de Santa Maria Internal Medicine IC care which are illustrative examples of occult neoplasia, in its aggressive presentation, rapid progression and difficulty in establishing histological diagnosis. Conclusion: In the cases presented, the aggressive evolution and poor prognosis of occult neoplasia are evident, since all the patients died. Even though the diagnosis of occult neoplasia was considered because of the presence of metastasis without an identifiable primary tumor, the necessary investigation to reach the final diagnosis was not completed due to the aggressive progression of the disease and the diagnostic approach was limited, especially when a biopsy was needed. In addition, the doubt remained as to the adequate therapeutic regimen to apply as well as the applicability of the current guidelines
Patologia cardiovascular aguda e sua abordagem inicial num SUC polivalente : apresentação de pequena série de casos clínicos
No full textTrabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2022A patologia cardiovascular (PCV) na sua multiplicidade de apresentações constitui um dos grupos nosológicos mais frequentes em Portugal com elevado peso na morbimortalidade global, tanto nas suas formas crónicas como na doença aguda. A PCV aguda é complexa, frequentemente grave e com elevado risco de mortalidade a curto prazo. A avaliação da maioria destas apresentações decorre frequentemente no contexto do serviço de urgência (SU), sendo a sua correta e célere abordagem ad initium crucial à sobrevivência do doente e à diminuição de incapacidade a médio/ longo prazo. O Hospital de Santa Maria (HSM) é um centro de referenciação terciária e o seu SU é polivalente, possibilitando avaliação presencial por todas as especialidades médicas e cirúrgicas, bem como intervenções altamente diferenciadas pelas mesmas, 24h/ dia, 7 dias por semana. Por estas características únicas, o SU do HSM recebe diariamente inúmeras situações clínicas agudas complexas, com elevada morbi-mortalidade, muitas das quais do foro cardiovascular (CV). Com este trabalho, pretende-se revisitar alguns casos clínicos ilustrativos de PCV aguda e sua abordagem desde o momento da admissão do doente no SU do HSM, da marcha diagnóstica inicial ao estabelecimento de um plano terapêutico, enfatizando a importância de uma intervenção rápida e dirigida na otimização do prognóstico de cada doente individual.Cardiovascular disease (CV) in its wide range of presentations represents one of the most prevalent nosological groups in Portugal with major impact in global morbidity and mortality, both in its chronic forms as well as in acute illness. Its acute presentations are complex, often severe and with a high risk of short-term mortality. The assessment of most of these cases takes place in the emergency department (ED), and appropriate early approach is crucial for patient survival and reduction of disability. Santa Maria Hospital (SMH) is a tertiary referral center and, consequentially, its ED allows for a multidisciplinary approach, namely through face-to-face assessment by all medical and surgical specialties as well as providing highly differentiated interventions, 24 hours a day, 7 days a week. Due to these unique characteristics, the ED of the HSM daily handles a wide range of complex acute clinical situations, with high potential morbidity and mortality, many of which are related with CV. With this work, we intend to revisit some illustrative clinical cases of acute CV pathology and their management from admission to the ED of the HSM, through the initial diagnostic process and, ultimately, to the establishment of a treatment plan, emphasizing the importance of a quick and efficient intervention, aimed at improving as much as possible the prognosis of each individual patient
Imaging Assessment of Cardiovascular Disease in Systemic Lupus Erythematosus
No full textSystemic lupus erythematosus is a multisystem, autoimmune disease known to be one of the strongest risk factors for atherosclerosis. Patients with SLE have an excess cardiovascular risk compared with the general population, leading to increased cardiovascular morbidity and mortality. Although the precise explanation for this is yet to be established, it seems to be associated with the presence of an accelerated atherosclerotic process, arising from the combination of traditional and lupus-specific risk factors. Moreover, cardiovascular-disease associated mortality in patients with SLE has not improved over time. One of the main reasons for this is the poor performance of standard risk stratification tools on assessing the cardiovascular risk of patients with SLE. Therefore, establishing alternative ways to identify patients at increased risk efficiently is essential. With recent developments in several imaging techniques, the ultimate goal of cardiovascular assessment will shift from assessing symptomatic patients to diagnosing early cardiovascular disease in asymptomatic patients which will hopefully help us to prevent its progression. This review will focus on the current status of the imaging tools available to assess cardiac and vascular function in patients with SLE
Atherosclerosis in systemic lupus erythematosus
No full textCardiovascular disease (CVD), comprising coronary heart disease and stroke, is one of the most important causes of death in patients with systemic lupus erythematosus (SLE). The risks of developing both clinical CVD and sub-clinical atherosclerosis are increased in patients with SLE. This increase is not fully explained by traditional cardiovascular risk factors such as smoking, hypertension and elevated cholesterol, and it is believed that immune dysfunction also contributes to CVD risk in SLE. In particular, recent studies have shown that abnormalities in both serum lipid profile and the autoantibody and T lymphocyte response to lipids may play a role in development of atherosclerosis. The standard CVD risk calculation algorithms based on traditional risk factors underestimate the risk of developing CVD in patients with SLE. Thus, novel algorithms incorporating new biomarkers such as pro-inflammatory high-density lipoprotein and use of imaging techniques such as carotid ultrasound scanning may become increasingly valuable
Towards a nonlinear quantum physics
No full textThe author of this book presents conceptual and experimental evidence showing that Heisenberg's uncertainty relations are not valid in all cases. Furthermore, he derives a more general set of uncertainty relations. The new relations result from the replacement of the Fourier nonlocal and nontemporal paradigm by wavelet local analysis. These results lead to a coherent and beautiful causal synthesis unifying quantum and classical physics
316. INCREASED RISK OF CARDIOVASCULAR DISEASE IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS WHO HAVE ASYMPTOMATIC PLAQUE ON VASCULAR ULTRASOUND: A 5 YEAR FOLLOW-UP STUDY
No full text323. Serum Anti-Apolipoprotein 1 Antibodies are Present in a Quarter of Patients with Systemic Lupus Erythematosus at the Time of Diagnosis and are Associated with Earlier Mortality
No full textP31 Anti-domain I positivity in SLE at diagnosis is predictive of atherosclerotic plaque development
No full text
