Idiopathic Adolescent Scoliosis: Living with a Physical Deformity

A qualitative, phenomenological, hermeneutical study with the aim of explaining the experience of having a body deformity diagnosed as idiopathic adolescent scoliosis. A semistructured interview conducted with scoliosis patients admitted to the unit of spinal cord at the Vall d’Hebron Hospital was used. The youth defined their scoliosis based on how they perceived their deformity. They spoke of pain and deformity as characteristic symptoms of suffering, and explained how this symptom affected their social relationships. Their deformity was associated with words such as “horrible”, “shame”, “complex” and “problem.” It is concluded that the symptommost referred is pain and the biggest concern of the youth was their body aesthetic and feelings associated with it. They attempt to solve this problem by adapting the way they dress and through surgery. Surgery can resolve the body deformity but not self-perception of their body image.

Renovascular hypertension in a 12 month old boy: what can the radiologist do?

We report a clinical case of renovascular disease, probably linked to fibromuscular dysplasia, in a 12 months old boy with severe arterial hypertension with target-organ damage, highlighting the radiological approach. Initial investigation included renal ultrasound that showed normal sized kidneys, with normal cortical echogenicity on the right and focally increased echogenicity of the posterior aspect of the left kidney, forming a mass-like lesion. Magnetic resonance imaging excluded renal tumor, which was confirmed by ultrasound guided biopsy. A doppler ultrasonography was also performed suggesting a right renal artery stenosis and decreased flow to the posterior aspect of the left kidney. Angiography with diagnostic and therapeutic intention was performed: right renal artery stenosis was detected and transluminal ballon dilation was performed; the left renal artery bifurcated precociously and the branch that irrigated the posterior part of the kidney had a stenosis which was also successfully dilated. After the intervention good blood pressure control with antihypertensive drugs was achieved, which was not possible before the angiographic procedure. The authors underline various methods of imaging used to accurately diagnose renovascular disease and the usefulness of interventional radiology treatment for this disease in very young children.

Hiperaldosteronismo primário

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Impaired renal endothelial nitric oxide synthase and reticulocyte production as modulators of hypertension induced by recombinant human erythropoietin in the rat

INTRODUCTION AND AIMS: Hypertension is a common side effect of recombinant human erythropoietin (rHuEPO) therapy; however, the exact pathways remain to be elucidated. The discovery of non-hematopoietic actions of rHuEPO increased the number of patients that could putatively benefit from this therapy; however, to achieve those effects higher doses are usually needed, which increase the risk and incidence of adverse events. Our aim was to study the effect of a broad range of rHuEPO doses on hematological and biochemical parameters, blood pressure and renal function and damage in the rat, focusing on endothelial nitric oxide synthase (eNOS) and hypoxia-inducible factors (HIFs). METHODS: Male Wistar rats were divided in 5 groups receiving different doses of rHuEPO (100, 200, 400 and 600 IU/kg body weight (BW)/week) and saline solution (control), during 3 weeks. Blood and 24h urine were collected to perform hematological and biochemical analysis. Blood pressure (BP) was measured by the tail-cuff method. The kidney tissue was collected to mRNA and protein expression assays and to characterize renal lesions. RESULTS: A dose-dependent increase in red blood cells count, hematocrit and hemoglobin levels was found with rHuEPO therapy, in rHuEPO200, rHuEPO400 and rHuEPO600 groups. Increased reticulocyte count was found in the rHuEPO400 and rHuEPO600 groups. BP raised in all groups receiving rHuEPO. The rHuEPO200 and rHuEPO600 groups presented increased kidney protein levels of HIF2α and a reduction in kidney protein levels of eNOS, along with the highest grade of vascular and tubular renal lesions. CONCLUSIONS: Our study showed that rHuEPO-induced hypertension might involve indirect (hematological) and direct (renal) effects which varies according to the dose used. Thus, rHuEPO therapy should be performed rationally and under adequate surveillance, as hypertension develops even with lower doses. Especial caution with higher doses should be taken, as rHuEPO-induced hypertension leads to early renal damage without alterations in traditional markers of renal function, thus masking the serious adverse effects and risks.

Doenças neurológicas

As convulsões são o problema neurológico mais comum nos animais de companhia. Convulsão é o quadro clínico gerado por descargas elétricas paroxísticas, descontroladas e transitórias nos neurónios do encéfalo, levando a alterações da consciência, atividade motora, funções viscerais, perceção sensorial, conduta e memória. A anamnese é muito importante para o diagnóstico, pois é o proprietário quem na maioria das vezes presencia o evento e, os dados obtidos podem auxiliar no plano de diagnóstico e terapêutico. É importante reconhecer, no entanto, que esta informação é coadjuvante ao exame neurológico. As convulsões podem ter causas extracranianas (ex: metabólicas e toxicas), intracranianas (ex: traumatismos, enfermidades infeciosas, malformações congénitas) e idiopáticas (epilepsia idiopática). É fundamental tentar identificar a causa das convulsões através da realização do exame clínico e neurológico, com atenção especial aos sistemas cardio-circulatório, respiratório, digestivo e urinário. Devem ser realizados exames complementares adequados (hemograma, urianálise, enzimas hepáticas, ureia, creatinina, glicemia, sorologias, reação em cadeia de polimerase, radiografias torácicas, ultrassonografia, tomografia computorizada e ressonância magnética quando disponíveis). O objetivo do tratamento antiepilético é controlar as convulsões sem efeitos adversos, no entanto, o clínico apenas pode tentar reduzir a frequência e severidade das convulsões a um nível que não comprometa substancialmente a qualidade de vida do animal e dos proprietários, evitando efeitos secundários.

Undiagnosed intracranial lipoma associated with sudden death

Intracranial lipomas represent less than 0.1% of all intracranial tumors. They are usually located in the callus area and often asymptomatic. This paper presents a sudden death case after an episode of convulsions on a 39 years old woman with a history of migraines and seizures since adolescence. The autopsy revealed the presence of an undiagnosed massive brain lipoma (60 × 35 mm) associated with atrophy of the corpus callosum. Although very rare and seldom malignant these may be associated with seizures and sudden death.

Intracranial EEG correlates of implicit relational inference within the hippocampus

Drawing inferences from past experiences enables adaptive behavior in future situations. Inference has been shown to depend on hippocampal processes. Usually, inference is considered a deliberate and effortful mental act which happens during retrieval, and requires the focus of our awareness. Recent fMRI studies hint at the possibility that some forms of hippocampus-dependent inference can also occur during encoding and possibly also outside of awareness. Here, we sought to further explore the feasibility of hippocampal implicit inference, and specifically address the temporal evolution of implicit inference using intracranial EEG. Presurgical epilepsy patients with hippocampal depth electrodes viewed a sequence of word pairs, and judged the semantic fit between two words in each pair. Some of the word pairs entailed a common word (e.g.,‘winter - red’, ‘red - cat’) such that an indirect relation was established in following word pairs (e.g, ‘winter - cat’). The behavioral results suggested that drawing inference implicitly from past experience is feasible because indirect relations seemed to foster ‘fit’ judgments while the absence of indirect relations fostered 'do not fit' judgments, even though the participants were unaware of the indirect relations. A event-related potential (ERP) difference emerging 400 ms post-stimulus was evident in the hippocampus during encoding, suggesting that indirect relations were already established automatically during encoding of the overlapping word pairs. Further ERP differences emerged later post-stimulus (1500 ms), were modulated by the participants' responses and were evident during encoding and test. Furthermore, response-locked ERP effects were evident at test. These ERP effects could hence be a correlate of the interaction of implicit memory with decision-making. Together, the data map out a time-course in which the hippocampus automatically integrates memories from discrete but related episodes to implicitly influence future decision making.

Cost of worksite hypertension treatment /

Mode of access: Internet.

Experimental renal hypertension,

Bibliography: p. 63-64.

Spontaneous hypertension, its pathogenesis and complications : proceedings of the 2d International Symposium on the Spontaneously Hypertensive Rat /

Mode of access: Internet.

Life stress and essential hypertension; a study of circulatory adjustments in man,

Bibliography: p.234-245.

HIV Status and Risk Factors for Hypertension in South African Adults

Thesis (Master's)--University of Washington, 2016-06

Hypertension and diabetes treatments and risk of adverse outcomes among breast cancer patients

Thesis (Ph.D.)--University of Washington, 2016-06

Sleep Patterns and Parents’ Experience in Caring for Young Children Newly Diagnosed with Juvenile Idiopathic Arthritis

Thesis (Ph.D.)--University of Washington, 2016-05