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- Montelukast in 2 atopic patients with intolerance to nonsteroidal anti-inflammatory drugs and paracetamol: 5-year follow-upPublication . Morais-Almeida, M; Marinho, S; Gaspar, A
- Periodontal impact of surgically induced dental lesions in mandibular osteodistraction: an animal study.Publication . Soares Correia, PE; Wehrbein, H; Mommaerts, MYAIM: The objective of the study was to evaluate the impact of dental lesions on the periodontium, in a canine model of mandibular osteodistraction. MATERIAL AND METHODS: In six adult male Beagle dogs, an osteotomy was made between the right second lateral incisor and canine, and a distraction device placed. The roots adjacent to the osteotomy were deliberately damaged by the reciprocating saw and chisel, with preservation of the attached gingiva. The osteodistraction protocol used was: latency of 7 days, rate of distraction 1mm per day, and rhythm once a day for 5 days. Vital staining was carried out with tetracycline, Xylenol Orange and Calcein Green. The dogs were sacrificed after 12 weeks of consolidation and the specimens were evaluated with light microscopy (native, polarized light, fluorescence, and after toluidin blue staining). RESULTS: The periodontal ligament (PDL) regeneration was observed in the 2500 slices examined. Cementum and dentine lesions were repaired by cellular cementum. Loose dentine and cementum-dentine fragments were embedded in regenerated PDL and their surface repaired by cementum. By means of light microscopic examination and within the limited observation time, no degenerative pulpal changes were found, when the pulp canal was not entered. Extensive pulp exposure and destruction resulted in ingrowth of the PDL and bone-like tissue. In that case, cellular cementum also lined the dentine surface of the pulp canal. CONCLUSION: Although there was an extensive reparative response to the para-pulpal lesions, none of the changes observed showed evidence of a loss of functional integrity of the periodontium at the distraction site. The fate of the tooth with exposed pulp canal remains uncertain.
- Enterocolic phlebitis" mimicking a primary tumor of the cecum--a rare presentation of an unusual entity.Publication . Cruz, J; Almeida, M; Soares, JIntestinal vasculitis is an infrequent entity in the absence of systemic vasculitis or chronic inflammatory bowel disease. The primary involvement of gut restricted to mesenteric venous territory is exceedingly rare. We report a pseudotumoural lesion of the cecum caused by localized phlebitis and venulitis associated with thrombosis, with a putative immune etiology, in a young adult presenting with obstructive intestinal crisis.
- Evaluating Residual Activity in 18F-FDG administrationPublication . Santos, A; Geão, A; Dias, L; Mota, A; Fernandes, MThe Positron Emission Tomography (PET) is an imaging technique, based on functional, biochemical and molecular information. It is also a useful tool in oncological examination. 18F-FluoroDeoxyGlucose (FDG) is a radiopharmaceutical widely used in nuclear medicine departments with PET facilities. FDG’s corrects administration is very important in order to achieve good images and correct Standard Uptake Values (SUV). The aim of this study was to evaluate the residual activity, according to the method used in our department. Materials & Methods: Residual activities of the syringes used to administer FDG to 125 patients were measured and recorded, during one month. The intravenous administration was always performed by the same four nuclear medicine technologists. These technologists are trained in this procedure, according with the developed technique, based on the procedure guidelines for PET imaging. This technique consists in administering FDG in a catheter with a triple channel system (standard system with three-way tap to enable saline flush); the syringe is always filled to its maximum capacity (5cc) and rinsed once, including needle rinsing. Registered time in every procedure was calibrated, in order not to include bias. Results: according to the analysis of the registered data, less than 1% of the activity calculated and measured for each patient remained on the syringe. Conclusions: regarding the search for the best administration procedure, we conclude that the technique used in our department results in a very low residual activity, meaning that it is an accurate technique that leads to reliable SUV values.
- Systemic corticosteroid hypersensitivity in childrenPublication . Sousa, NG; Santa Marta, C; Morais-Almeida, MWe describe 5 cases of immediate-type reactions to systemic corticosteroids observed during the last 2 decades in boys aged 2, 4, 8, 9, and 10 years. Symptoms ranged from generalized urticaria and angioedema to anaphylactic shock immediately after administration. Oral betamethasone was implicated in 2 cases, oral prednisolone in 2 cases, and intravenous prednisolone in 1 case. The parents of patient 5 refused the skin tests. The remaining patients underwent skin prick tests with the following undiluted corticosteroids: parenteral prednisolone, oral prednisolone, parenteral methylprednisolone, parenteral dexamethasone, parenteral hydrocortisone, and oral betamethasone. If the results were negative, intradermal tests were performed with the same drugs at increasing concentrations. Skin test results were positive for all suspect corticosteroids, thus indicating an immunoglobulin E-mediated mechanism. Two patients had positive skin test results to other corticosteroids, suggesting cross-reactivity. An oral challenge test was performed with deflazacort in 4 cases and with betamethasone in 1 case; the results were negative.
- Comparing two pharmacological stress tests: adenosine vs ATP infusion – patient’s tolerance and image qualityPublication . Santos, A; Geão, A; Mota, A; Pereira, E; Dias, L; Delgado, P; Figueiredo, S; Jerónimo, VAim: Adenosine and Adenosine Triphosphate (ATP) are vasodilator agents that are used for pharmacologic stress testing in Myocardial Perfusion Imaging (MPI). Both pharmaceuticals may cause side-effects that are similarly described in the literature. Although, the half-life of these molecules are slightly different and patient’s tolerance might be different. These molecules have also been associated to an increase in the sub diaphragmatic tracer uptake that may reduce image quality, interfering with image interpretation. The aim of this study was to compare pharmacologic stress tests induced by adenosine infusion and by ATP infusion in terms of side-effects referred by patients and the corresponding image quality. Materials & Methods: Two hundred and forty eight (248) patients that underwent MPI were divided in two groups: Group 1 – Adenosine infusion (n=157); Group 3 – ATP infusion (n=91). Each group was further divided according to the presence or absence of side effects, their number and the need to administer pharmacological therapy to control symptoms: A- No side-effects; B - One side-effect; C – Two side-effects; D – Three or more side-effects and/or pharmacologic therapy needed. Image quality was evaluated according to the requirement of a new stress acquisition due to extra-cardiac activity that interfered with image quality and interpretation. Microsoft ExcelTM and SPSSTM were used in this analysis. We also correlated the two populations (Adenosine and ATP) according to the risk factors for cardiac events and the MPI result (normal or pathologic), in order to ensure that uniformity between both groups. Results: The most common effects were facial flushing, abdominal/throat pressure and discomfort in the arms. (See Table 1). Conclusions: The group with the highest percentage of no side-effects and the smaller percentage of three or more side-effects was group 2. However, in spite of the higher percentage of one side effect for group 2 (group 2=38% vs group 1=34%), the difference between them is not statistically significant (p=0,065), so we can assume that both groups had the same percentage of only one side-effect. Additionally, this group had less acquisition repetition, if compared to group 1 (acquisitions repeated: group 1=19,9%, group 2= 9,9%, p= 0,001). So, the group that had better results in terms of patient’s tolerance and image quality was group 2 – ATP infusion.
- Schwannoma, a rare tumor of the seminal vesiclePublication . Furtado, AM; Carrasquinho, E; Ferreira, M; Afonso, A; Ferrito, FWe present a rare case of a schwannoma of the seminal vesicle that occurred in a 43-year-old male with symptoms of the lower urinary tract. Ultrasonography and magnetic resonance imaging documented a solid mass in the patient's left seminal vesicle. A transvesical approach with a transtrigonal midline incision was successfully performed. The microscopic aspect was compatible with schwannoma.
- Allergic conjunctivitis and conjunctival provocation tests in atopic dogs.Publication . Lourenço-Martins, AM; Delgado, E; Neto, I; Peleteiro, MC; Morais-Almeida, M; Correira, JHINTRODUCTION: Canine atopic dermatitis (cAD) is a very common disease, but little is known about eye involvement. The conjunctival provocation test (CPT) is used in human to study the ocular response to allergenic stimuli and to evaluate anti-allergic therapy. To our knowledge it has not been used in dogs. OBJECTIVES: To evaluate the prevalence of ocular signs in a population of atopic dogs and relate these with clinical cAD scores; and the usefulness of CPT for dust mites in atopic dogs with itchy eyes. PROCEDURES: Sixty cAD patients were evaluated for (i) ocular signs of allergic conjunctivitis including conjunctival hyperemia, chemosis, epiphora, ocular discharge, pruritus and corneal involvement, graded 0 to 3 according to severity, and (2) cAD Extent and Severity Index (CADESI-03). Additionally, CPTs for Dermatophagoides farinae (n = 12) and Dermatophagoides pteronyssinus (n = 12) were performed in sensitized atopic dogs and 24 control dogs. RESULTS: Periocular and ocular signs of allergy were present in 60% (36/60) of cases. Conjunctival hyperemia (90%) was the most common sign. Severity of ocular signs was significantly correlated with eye pruritus (r(s) = 0.690, P = <0.001) and skin lesions score for head region (r(s) = 0.261, P = 0.04). A highly significant difference (P < 0.001, Fisher test) was found in CPTs between the test and the control groups. CONCLUSION: Allergic conjunctivitis signs associated with cAD seem under valuated so these patients would benefit from an ophthalmologic evaluation. Furthermore, we found CPT to be a reliable, easy to perform and safe test for the etiologic diagnosis of allergic conjunctivitis in the dog.
- Comparação de dois tipos de colóides tecneciados na detecção de gânglio sentinelaPublication . Dias, L; Geão, A; Mota, A; Santos, A; Quaresma, P; Colarinha, PIntrodução: O gânglio sentinela define-se como o primeiro gânglio detectado numa via de drenagem linfática do tumor primário. O marcador ideal para pesquisa de gânglio sentinela deve apresentar: retenção persistente neste gânglio, reduzida acumulação de radiofármaco nos gânglios satélites e depuração rápida do local de injecção. Há dois tipos de colóides tecneciados que são frequentemente utilizados em linfocintigrafia – colóides de albumina humana e colóides de sulfureto de rénio. Objectivo: Comparar os dois radiofármacos tecneciados - colóides de albumina humana e colóides de sulfureto de rénio – quanto a: 1) tempo de migração e visualização do gânglio sentinela e 2) incidência de gânglios satélites, quando utilizados em linfocintigrafias para pesquisa de gânglio sentinela em doentes com carcinoma da mama. Material e Métodos: Analisaram-se os estudos de pesquisa de gânglio sentinela de 138 pacientes com carcinoma da mama. Em 63 doentes a linfocintigrafia foi realizada com colóides de albumina humana (Nanocoll®) e em 75 doentes o radiofármaco utilizado foi colóides de sulfureto de rénio (Nanocis®). Procedeu-se à aquisição de imagens iniciais após administração do radiofármaco e foram sendo adquiridas imagens seriadas aos 60min, 90min, 120min, 180min, 240min, 300min e 360min até aparecer o gânglio sentinela. Considerou-se como término do estudo o momento de visualização do gânglio sentinela. Em 5 pacientes não se visualizou gânglio sentinela; 3 correspondiam a colóides de albumina humana e 2 correspondiam a colóides de sulfureto de rénio. Estes 5 casos foram excluídos deste estudo. Resultados: Verificou-se que no grupo de doentes a quem foi administrado colóides de albumina humana, o intervalo de tempo para visualização do gânglio sentinela foi de; 130’ (média), 120’(mediana), com um tempo mínimo de 10’ e máximo de 330’. Neste grupo não foram visualizados gânglios satélites. No grupo de doentes a quem foi administrado colóides de sulfureto de rénio o intervalo de tempo para visualização do gânglio sentinela foi de; 145’(média) 150’(mediana), com 10’ de mínimo e 360’ de tempo máximo. Neste grupo de doentes foram observados gânglios satélites em 2 casos. Conclusão: Nesta amostra não foi observada diferença significativa entre os dois radiofármacos utilizados quanto a: taxa de detecção e tempo para visualização do gânglio sentinela, assim como quanto à incidência de visualização de gânglios satélite.
- The technical challenge of Functional 18F-FDG-PET Brain imaging in paediatric epilepsyPublication . Mota, AM; Geão, A; Santos, A; Dias, L; Quaresma, P; Colarinha, PEpilepsy is a chronic brain disease, characterized by the appearance of crisis (whit or without convulsions), caused by abnormal electric activity on brain cells. Neuroimaging might be necessary in the work-up of epilepsy for localisation of the seizure focus for possible surgical cure. In our department, we started performing inter-ictal 18F-2-deoxyglucose (FDG)-PET/TC Brain imaging in 2009, in paediatric patients, following EANM procedure guidelines. Aim: the aim of the study was to retrospectively review all the performed inter-ictal 18F-FDG-PET/TC brain imaging, to assess the difficulties found during these procedures and the deviation according to guideline recommendations. We also intend to focus on the major importance of an optimal cooperation with other departments, such as anaesthesiology and neurophysiology. Material and Methods: between 2009 and 2012, eleven patients (pt) were referred for an 18F-FDG-PET-TC brain study, with ages between 10 months - 18 years old all with medically intractable epilepsy. The exams were performed with different conditions according to the needs of each patient, because we know that exceptional procedures call for special conditions. Results: All files were review for pt information pertinent to performance of the procedure, pt pre-arrival preparation, pt pre-injection preparation, pt monitoring for ictal crises before injection (EEG), pt sedation, variability of radiopharmaceutical administration and data acquisition parameters. 8 of the pt were performed with anaesthesia while 3 without since the pediatric patient were cooperative. All of the pt were monitored under parental surveillance, one with additional movie recording and other with EEG. Conclusion: We found that this process of retrospective review of this pool of paediatric patients with epilepsy enhanced the learning curve in this very specific procedure. We also found it critical to request the collaboration of the departments of anaesthesiology and neurophysiology.