Auxiliar Inform��tico Para o Diagnóstico e Terap��utica de Altera����es do Equil��brio ��cido-Base e Hidro-Electrol��tico

Para encarar a detecção crescente de dist��rbios do equil��brio ��cido-base e hidro-electrol��tico nos nossos servi��os hospitalares, descrevemos e exemplificamos um programa inform��tico auxiliar no diagnóstico e terap��utica destes dist��rbios. Partindo dos resultados dum ionograma e dos gases no sangue s��o apontados os s��ndromas presentes, e na sequ��ncia de um curto di��logo m��quina/utilizador os diagnósticos etiol��gicos mais prov��veis. 0 programa prop��e tamb��m uma terap��utica concreta para esse doente e fornece refer��ncias bibliogr��ficas. S��o discutidas criticamente as poss��veis aplica����es deste trabalho na cl��nica e no ensino m��dico.

Electroencefalograma Interictal. Sensibilidade e Especificidade no Diagnóstico de Epilepsia

O electroencefalograma (EEG) �� um m��todo n��o invasivo, econ��mico e acess��vel, universalmente utilizado na investiga����o da epilepsia. Realiz��mos uma revis��o dos principais trabalhos sobre a preval��ncia de actividade epileptiforme em EEGs de doentes epil��pticos e n��o epil��pticos, com o objectivo de tirar conclus��es sobre a sensibilidade e especificidade deste exame no diagnóstico de epilepsia. Conclu��mos que o primeiro EEG tem uma sensibilidade global de 50-55% podendo atingir os 92% com a repeti����o do exame e recurso a registos de sono e t��cnicas de activa����o. A especificidade atinge os 96%, sendo afectada por m��ltiplos factores.

Mixomas Card��acos, 13 Anos de Experi��ncia no seu Diagnóstico Ecocardiogr��fico

INTRODUCTION: Transthoracic echocardiography is the method of choice for the diagnosis of cardiac myxomas, but the transesophageal approach provides a better definition of the location and characteristics of the tumor. The authors review their thirteen years' experience on the echocardiographic diagnosis of this pathology. METHODS: From 1994 to 2007, 41 cardiac tumors were diagnosed in our echocardiographic laboratory, of which 27 (65.85%) were cardiac myxomas. The exams and the patients' clinical files were retrospectively reviewed. RESULTS: Of the 27 patients, 22 (81.5%) were female, with a mean age of 62.1 +/- 13.6 years (25-84 years). The predominant clinical features were due to the obstruction caused by the tumor in more than two thirds of the patients, followed by constitutional symptoms in one third and embolic events in 30%. In the lab results, anemia was found in three patients and elevated sedimentation rate and CRP in two. In two patients the myxoma was found by chance. All the cases were of the sporadic type, although we found a prevalence of thyroid disease of 14% (4 patients). All patients underwent urgent surgical resection except one, in whom surgery was refused due to advanced age and comorbidities. The myxomas followed a typical distribution with 24 (88.8%) located in the left atrium, 18 of them attached to the atrial septum (AS) and two to the mitral valve. In one patient, the tumor involved both atria. The other two cases originated in the right atrium at the AS. Embolic phenomena were more frequent in small tumors (p = 0.027) and in those with a villous appearance (p = 0.032). Obstructive manifestations were associated with larger tumors (p = 0.046) and larger left atria (p = 0.048). In our series, there were no deaths during hospitalization or in the follow-up period of 5.2 +/- 3.7 years in 19 patients. There were two recurrences, both patients being successfully reoperated. CONCLUSION: Myxoma is the most common cardiac tumor. Transesophageal echocardiography provides excellent morphologic definition, aiding in diagnosis and follow-up. Most clinical manifestations are obstructive and are associated with larger tumors. Small tumors with a friable appearance have a higher chance of embolization. Surgical resection is usually curative and the long-term prognosis is excellent.

Bases Cl��nicas e Laboratoriais para o Diagnóstico e Compreens��o das Doen��as Metab��licas Neonatais

The authors divide neonatal metabolic diseases into two major groups: intoxication and energy deficiency. The main signs which allow for the suspicion of the diagnosis are indicated for each group. The complementary examinations to be carried out by the Clinical Pathology Service of the Central Hospital and those which must be carried out by the metabolic diseases Reference Centre are reviewed. Based on the clinical framework and on the examination results, the authors establish five syndromatic groups to orientate diagnosis. The authors conclude by presenting differential diagnosis tables based on the original systematic classification by Jean-Marie Saudubray, with up-dated modifications from their own experience.

Diagnóstico do Cancro da Bexiga

Exame f��sico (incluindo toque rectal). Ultrasonografia renal e da bexiga e/ou UIV Cistoscopia com descri����o de tamanho, e localiza����o do tumor (o diagrama da bexiga deve ser inclu��do). Urina Tipo II; Citologia urin��ria, RTU com bi��psia da base tumoral. Bi��psias de todas as ��reas suspeitas; bi��psias randomizadas na presen��a da citologia positiva, tumor >3cm, ou tumor n��o papilar; bi��psia da uretra prost��tica em casos de Cis ou suspeita de carcionoma in situ. Quando o tumor da bexiga �� invasivo e est�� indicado um tratamento radical, �� mandat��rio RX do t��rax, UIV e/ou tomografia axial computorizada abdominal e p��lvica, Ultasonografia hep��tica, cintigrafia ��ssea se houver sintomas ou se fosfatase alcalina for elevada.

Avalia����o e Tratamento do Doente com Acne - Parte I: Epidemiologia, Etiopatogenia, Cl��nica, Classifica����o, Impacto Psicossocial, Mitos e Realidades, Diagnóstico Diferencial e Estudos Complementares

O Portuguese Acne Advisory Board (PAAB), grupo de dermatologistas portugueses que, �� semelhan��a de grupos cong��neres internacionais, tem dedicado particular aten����o �� defini����o de linhas de orienta����o para o tratamento da acne, pretende que o presente documento constitua uma ferramenta ��til na abordagem dos doentes com esta patologia. Elaborou-se um dossier, para educa����o m��dica cont��nua, subdividido em 2 partes: Parte I ��� etiopatogenia e cl��nica; Parte II ��� abordagem terap��utica. Nesta Parte I, rev��em-se os principais aspectos da cl��nica e da fisiopatogenia da acne �� luz dos conhecimentos actuais. Discute-se a import��ncia do impacto psicol��gico e social desta entidade e analisam-se os principais mitos e realidades com ela relacionados. Descrevem-se, sucintamente, as patologias mais relevantes no diagnóstico diferencial das les��es de acne. Enumeram-se as indica����es para estudo hormonal, bem como os exames a efectuar nos doentes com esta patologia.

Tumores do Corpo Carot��deo. Experi��ncia de um Servi��o no Diagnóstico e Tratamento nos ��ltimos 10 Anos

INTRODUCTION: Carotid body tumours (CBT) are neoplasms that develop from paragangionic cells of this structure. They are rare, with an estimated incidence of 1:30000 and can be associated with other neuro-endocrine neoplasia. The authors report their experience in the management of the disease, in the last 10 years. MATERIAL AND METHODS: Eight patients (with eight tumours) were treated, all submitted to tumour resection. 75% were female and the mean age was 56 years. We report a 12,5% incidence of neurological sequelae from surgery, and no mortality. In the follow-up (which varied between 1 and 10 years), no local or contralateral recurrence or metastasis were registered. Also, we did not found family cases of this disease. CONCLUSIONS: The authors noticed an unusually high proportion of female patients. The tumour resection was curative in all patients, with a rate of neurological complications inferior to that reported in other published series. These neurological sequelae were reported in patients with large tumours, thus reinforcing the outmost importance of an early diagnosis. Pre-operative selective embolization of these tumours can be helpful in the resection of large tumours, allowing a potential reduction in neurological complications.

Tromboembolismo Venoso na Gravidez. Diagnóstico e Tratamento

O tromboembolismo venoso �� uma das principais causas de morbilidade e mortalidade materna. Quando n��o diagnosticado e n��o tratado, o embolismo pulmonar (EP) pode levar a morte materna. �� assim, muito importante a classe m��dica estar atenta para esta patologia.O eco-Doppler-colorido e a cintigrafia de ventila����o-perfus��o s��o fundamentais, durante a gravidez, para o diagnóstico de trombose venosa profunda (TVP) e EP respectivamente. Em doentes com suspeita cl��nica de TVP ou EP, deve-se iniciar terap��utica com heparina n��o fraccionada ou de baixo peso molecular, at�� que o diagnóstico seja exclu��do, a menos que a anticoagula����o seja fortemente contra-indicada.

Hemoperitoneu Como Forma de Apresenta����o de Carcinoma Hepatocelular. Contributo da Tomografia Computorizada Para o Diagnóstico

Nos pa��ses europeus, o hemoperitoneu por ruptura de carcinoma hepatocelular (HCC) �� muito raro. Apresentam-se dois casos cl��nicos de hemoperitoneu secund��rio a ruptura espont��nea de carcinoma hepatocelular, em que a Tomografia Computorizada (TC) abdominal foi de primordial import��ncia para o diagnóstico. A prop��sito faz-se revis��o da literatura sobre os aspectos mais relevantes desta patologia.

As Perturba����es Emocionais: Ansiedade e Depress��o na Crian��a e no Adolescente.

A Perturba����o da Ansiedade e a Perturba����o Depressiva constituem entidades cl��nicas de elevada preval��ncia na inf��ncia e na adolesc��ncia, e podem ser precursoras de psicopatologia na idade adulta. Por ambos os motivos, o seu diagnóstico precoce e interven����o atempada tornam-se essenciais, assim como a detecção de eventuais factores de risco que as possam promover. Os Cuidados de Sa��de Prim��rios assumem, neste contexto, uma fun����o primordial na triagem de casos, assim como na interven����o e eventual referencia����o para os servi��os de Pedopsiquiatria. Neste artigo, abordamos, abreviadamente, aspectos referentes aos factores de risco, preval��ncia, diagnóstico, interven����o cl��nica e progn��stico para as Perturba����es da Ansiedade e Depressiva.

Teste de Inclina����o no Diagnóstico e Tratamento da S��ncope

A s��ncope neurocardiog��nica �� uma entidade com preval��ncia e incid��ncia significativas. Apesar da baixa mortalidade relacionada com esta entidade, s��o significativas as implica����es na qualidade de vida dos doentes. A metodologia para o seu diagnóstico est�� hoje claramente estabelecida nas recomenda����es internacionais e o teste de inclina����o �� um elemento ��til na abordagem diagn��stica, em particular na s��ncope recorrente de causa desconhecida e frequente. V��rios protocolos t��m vindo a ser descritos nos ��ltimos anos, inicialmente passivos e posteriormente com introdu����o de agentes provocativos, dos quais os nitratos sub-linguais s��o os mais largamente aceites, pela simplicidade e bons resultados da sua utiliza����o. O recurso ao teste de inclina����o na avalia����o da terap��utica est�� limitado por problemas relacionados com a reprodutibilidade, que contudo est��o na base de uma forma de tratamento ��� o treino de ortostatismo (tilt training) ��� embora com taxas de sucesso vari��veis. Na presente revis��o, iremos abordar os v��rios aspectos relacionados com a aplica����o do teste de inclina����o na pr��tica cl��nica.

F��stulas Car��tido-Cavernosas. Perspectivas de Diagnóstico e Terap��utica

Even though in clinical practice carotid cavernous fistulas (CCF) are not a frequent pathology, it should be a diagnostic hypothesis in face of a suggestive clinical presentation. We intended to review the diagnosis and the therapeutics, comparing them with the actual perspectives. Files of 25 patients with the diagnostic hypothesis of CCF, confirmed by conventional angiography in the HSAC Neuroradiology Department, were reviewed. In this group of patients, (5 males and 20 females), the fistulous aetiology was spontaneous in 10 and traumatic in 15. Clinically the symptom most often presented was diplopia (23 cases) and the most frequent encountered sign was ophthalmoplegia (20 cases). Of the Neuroradiologic investigation, CT scan (done to all patients) have shown an prominent superior ophthalmic vein as the most frequent abnormality. Angiographic study was based on Lasjaunias et al protocol (Surgical Neuroangiography, Vol. 2, Springer-Verlag). Surgery was the therapeutic approach for the traumatic fistulas; only 2 of the spontaneous were treated by endovascular route. Three patients are still under observation. In all the others cases there was a fistula exclusion.

A Angiografia no Diagnóstico da Patologia Vascular Cerebral. Indica����es Actuais e Controv��rsias

The role of cerebral angiography in the diagnosis of cerebrovascular disease is currently being questioned due to both the increasing availability of carotid sonography and the recent introduction of Magnetic Resonance Angiography (MRA). After a technical foreword about the different modalities available today in Cerebral Angiography, we discuss its present indications (Conventional or Digital subtraction by intra-arterial route), in patients with extra and intra cranial atherosclerotic cerebro vascular disease, subarachnoid hemorrhage and arterial aneurysms, in vascular malformations, particularly arterio-venous malformations (AVM's), in occlusive non-atherosclerotic non hypertensive arteriopathies and in occlusive venous pathology. Although it is possible that the future will show us the progressive replacement of the invasive technologies by MRA, at the present stage of Magnetic Resonance development there is still an important role, if not crucial, for catheter angiography in the diagnosis of most of the diseases producing stroke syndromes.