Correcção de uma má-oclusão de Classe II divisão 1 em duas fases de tratamento

A influência dos aparelhos funcionais no crescimento craniofacial assim como a filosofia dos tratamentos ortodônticos que envolvem duas fases são assuntos controversos. O tratamento das más-oclusões de Classe II Divisão 1 executado em duas fases visa, na primeira fase diminuir a discrepância sagital. A segunda fase pretende obter uma oclusão de acordo com os padrões de oclusão funcional. O objectivo deste artigo consiste em apresentar a sequência de tratamento de um caso clínico de má-oclusão de Classe II Divisão 1, tratado em duas fases, em que foi utilizado um activador do tipo Teuscher, na primeira fase.The influence of functional appliances on craniofacial growth as well as the two-phase orthodontic treatment philosophy are still controversial subjects. The main purpose of the two-phase treatment involving activators is to promote dento-alveolar changes. The goal of the second phase is creating an occlusion according to functional occlusion patterns. The aim of this article is to present the sequence of a Class II Division 1 treatment case in two phases, in which a Teuscher activator is used in the first phase

A Rare Case of Pleural Empyema Caused by Campylobacter Rectus

Campylobacter rectus is considered to be a primary periodontal pathogen that is rarely identified in extraoral specimens. We report a case of pleural empyema caused by Campylobacter rectus: the pathogen was isolated in the drained pleural fluid sample. Since the patient had previously undergone multiple antibiotic treatments, oral cultures were highly unlikely to be positive, although poor dental hygiene appears to be the leading risk factor for C. rectus systemic infections. The present case illustrates that C. rectus can be a cause of not only periodontal disease but also pulmonary infection.info:eu-repo/semantics/publishedVersio

Vasculitis, a Rare Presentation of a Post-Streptococcal Syndrome

Post-streptococcal vasculitis is not awell-recognized non-suppurative complication of Group A streptococcal infections. Seventeen-year-old male was admitted with palpable purpura in the limbs, ankle swelling, microscopic hematuria and elevated inflammation markers. After short remission period, an extensive exudative pleural effusion was identified. High anti-streptococcal antibodies titers were found. This report illustrates an atypical and rare presentation of a post-streptococcal syndrome

Bacille Calmette-Guérin adenitis: diagnostic and therapeutic guidelines

A linfadenite regional da BCG, designada por BCGite, é uma complicação esporádica da vacinação, sem gravidade na maior parte dos casos e que apenas em situações excepcionais pode orientar para uma imunodeficiência. Descrevemos seis casos de BCGite internados no nosso serviço (2005-7) para tratamento cirúrgico, com BCG administrada no período neonatal, cinco do sexo masculino e com mediana de idade na apresentação clínica de 5,5 meses. Três crianças apresentaram supuração espontânea, uma com envolvimento axilar e supraclavicular. Cinco necessitaram de drenagem por supuração ou persistência da adenopatia. A criança com envolvimento ganglionar múltiplo realizou antibacilares por suspeita de imunodeficiência primária. O estudo imunológico não revelou alterações em nenhum dos casos. O tempo médio de seguimento foi 15 meses. A abordagem terapêutica da linfadenite supurativa e a decisão de investigar uma imunodeficiência subjacente não é consensual. Na ausência de doença disseminada os autores defendem uma atitude expectante

Mesotelioma Maligno Primário do Peritoneu Associado a Carcinoma de Células Renais. Revisão Concisa

O Mesotelioma peritoneal maligno é um tumor maligno relacionado frequentemente com exposição prolongada a fibras de amianto, de mau prognóstico, de diagnóstico geralmente tardio, face à pouca expressão clínica na fase inicial da doença. Como o mesotelioma evolui geralmente só na cavidade peritoneal, doentes seleccionados poderão ter maior sobrevivência se for possível a peritonectomia extensa e quimioterapia hipertérmica intraperitoneal intraoperatória. Os autores referem a sincronicidade ainda não descrita, de mesotelioma peritoneal maligno primário e carcinoma de Grawitz. São revistos concisamente: a clínica destes tumores, síndromes paraneoplásicos (disfunção bioquímica hepática, emagrecimento extremo); etiopatogenia da acção cancerígena das fibras de amianto; mecanismos de disseminação intraperitoneal; avaliação tomodensitométrica; importância da imunohistoquímica no diagnóstico histopatológico; estadiamento; importância do tratamento multidisciplinar destes tumores

IgE-mediated hypersensitivity after ibuprofen administration

Although many immunoglobulin-related drug sensitivities have been described, there is a paucity of reports regarding IgE-related drug sensitivities. Here we describe a case of a patient who demonstrated IgE-mediated sensitivity to ibuprofen

Rede Nacional de Cuidados Continuados Integrados – o seu impacto no funcionamento de um Serviço de Urologia

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An unusual cause of acute cardiogenic shock in the operating room

A 51-year-old man with a renal carcinoma with inferior vena cava (IVC) invasion was referred to our hospital for the performance of a radical nephrectomy with IVC thrombus excision. To prevent embolism, an IVC filter was implanted the day before surgery below the suprahepatic veins. On nephrectomy completion, the clinical status of the patient started to deteriorate and an unsuccessful attempt was made to excise the IVC thrombus. The patient developed profound refractory hypotension without significant bleeding and worsening splanchnic stasis was noted. A transesophageal echocardiogram was immediately performed in the operating room, revealing a hemispheric mass protruding from the IVC ostium to the right atrium, completely blocking all venous return. Volume depletion was evident by low left and right atrial volumes and increased septum mobility. No other abnormalities were found that could explain the shock, namely ventricular dysfunction or valvular disease. Cardiac surgery consultation was immediately obtained, ultimately deciding to perform a median sternotomy with direct exploration of right atrium. Under cardiopulmonary bypass, a 6-cm long thrombotic mass was identified, involving the IVC filter, blocking all lower body venous return; the removal of the mass reversed the shock. The patient had an uneventful recovery. Adverse outcomes associated with IVC filters are common. Our case highlights the importance of a team approach to rapid changes in hemodynamic status in the operating room, including the surgeon, the anesthesiologist, and the cardiologist. It also emphasizes the pivotal role of transesophageal echocardiogram in the clinical evaluation of severely unstable patien

Depression Among Portuguese Pregnant Women During Covid-19 Lockdown: A Cross Sectional Study

Introduction: Coronavirus disease 2019 was declared as a pandemic on March 2020. Research on its psychological effects is still lacking. Perinatal depression is a medical complication of pregnancy, especially in situations of stress. In this study, we aimed to investigate the presence of symptoms of depression in pregnant women during the lockdown period in Portugal. Methods: This study consisted in a cross-sectional study among Portuguese pregnant women, who completed an online self-report questionnaire between 25th April and 30th April 2020. An anonymous online questionnaire was developed to assess depression and concerns related to COVID-19. This study was approved by the IRB of Hospital Dona Estefânia and performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. Eligibility criteria included pregnant women, ≥ 18 years and living in Portugal. The primary outcome was to evaluate the presence of depressive symptoms and its association to socio-demographic characteristics and to concerns related to COVID-19. Results: A total of 1698 pregnant women were enrolled. The mean age was 31.9 years. 82.4% felt a negative impact of the pandemic in the surveillance of pregnancy and 43% felt insufficient support. 26.3% showed "possible depression" according to the EPDS. A regression analysis revealed the possibility of depression increased as the concerns about COVID increased and was lower for women with support. The possibility of depression was higher for women with psychiatric medical history. Conclusion: This study demonstrated a significant increase in clinically significant depressive symptoms in pregnant women during the lockdown. It also revealed some of the socio-demographic characteristics of women at risk for depression. If left untreated, depression tends to persist, affecting the woman and also the child. Our findings suggest that COVID-19 represents a serious challenge for this population and reinforce the urgent need for early detection and intervention on mental health issues during pregnancy, especially during the pandemic.info:eu-repo/semantics/publishedVersio