Browsing by Author "Carvalho, S"
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- Accidental Epinephrine AdministrationPublication . Duran, J; Carvalho, S; Botelho, MA administração intravenosa acidental de adrenalina é um erro raro mas potencialmente fatal. Descrevemos um caso de uma mulher de 74 anos que durante uma intervenção cirúrgica a uma Colelitíase recebeu por acidente 4 mg de adrenalina intravenosa em vez de Neostigmina, no despertar da anestesia. A doente apresentou um episódio de Taquicardia Supra Ventricular (TSV) juntamente com uma crise hipertensiva e sinais de perfusão periférica fracos. O tratamento adequado resultou numa recuperação favorável sem sequelas. Discutimos a gestão adequada desta complicação e possíveis mecanismos para evitar erro humano na administração de fármacos durante a anestesia.
- Actinomicose Mandibular Crónica. Implicações Anestésicas e Infecciosas: a Propósito de um Caso ClínicoPublication . Chaves, A; Madeira, C; Carvalho, SDoente do sexo feminino, 18 anos, raça negra, natural da Guiné-Bissau, com quadro clínico com 8 anos de evolução, de sinais inflamatórios ao nível de ambos os ângulos da mandíbula, com nódulos palpáveis e drenagem espontânea de material aquoso não purulento, após exodontia de molar mandibular. Para diagnóstico definitivo foi colocada indicação para biópsia mandibular sob anestesia geral. Na avaliação pré-operatória destacava-se uma via aérea previsivelmente muito difícil: mallampati IV, micrognátia com abertura da boca muito limitada (1 cm), distância tiromentoniana < 6 cm e mobilidade cervical limitada, pelo que se programou intubação endotraqueal guiada por fibroscopia. Procedeu-se à intubação nasotraqueal guiada por fibroscopia com tubo 7,0 com cuff, sob sedação endovenosa com midazolam e fentanil, sem intercorrências. A apresentação deste caso tem como objectivo realçar as dificuldades inerentes ao diagnóstico de actinomicose com frequente necessidade de procedimentos invasivos, sob anestesia geral, o que condiciona um risco anestésico importante associado à dificuldade na abordagem da via aérea.
- An Unexpected Infection in a Venous Leg Ulcer: a Case ReportPublication . Veríssimo, M; Guimarães, D; Casal, D; Carvalho, S; Matias, M; Barbosa, R; Bexiga, JProvidencia rettgeri is a Gram-negative bacillus that is most usually seen in urinary tract infections. Skin and soft tissue infections with P rettgeri are rare and there few case reports described in the literature. A 43-yearold woman presented to the emergency department with a leg ulcer of 3 months duration. Microbiological results isolated P rettgeri and Pseudomonas aeruginosa. She underwent surgical debridement and split-thickness skin grafting alongside IV antibiotic therapy and dressing care, with complete resolution of the wound 3 months after admission. The differential diagnosis of leg ulcers is wide and must include infection and venous insufficiency. Although venous ulcers are common, typically they are not responsible for rapid evolving ulcers that destroy tissues below the muscular fascia. In this case report, the authors hypothesise that P rettgeri had a major role in the severity of the ulcer in an otherwise healthy woman. A greater understanding of how P rettgeri affects wound pathophysiology is needed in order to distinguish between colonisation versus infection and discriminate bacterial synergy, as well as having better treatment guidelines.
- Lesões Traumáticas Iatrogénicas das Veias Femorais no Decurso da Cirurgia de VarizesPublication . Albino, JP; Meireles, N; Martins, J; Silva Castro, J; Duarte, J; Gonçalves, A; Amaral, C; Bettencourt, V; Gonçalves, D; Mota Capitão, L; Carvalho, STraumatic lesions of the femoral veins during varicose veins surgery are very uncommon and they raise several therapeutic difficulties. They occur in 1/1000 cases of varicose veins operated. The authors describe four cases of lesions of this type that were seen and treated for the last six years, probably because there was an increase in the number of varicose veins operated on in the Lisbon area. The authors discuss the surgical options and they concluded that these complications can be minimized with good anatomical and surgical skills, specially of the saphenous-femoral and saphenous-popliteal junctions.
- Mastocytosis: a Rare Case of Anaphylaxis in Paediatric Age and Literature ReviewPublication . Silva, I; Carvalho, S; Leiria-Pinto, P; Machado, S; Rosado-Pinto, JThe term “mastocytosis” denotes a heterogeneous group of disorders characterised by abnormal growth and accumulation of mast cells (MC) in one or more organ systems. Symptoms result from MC chemical mediator’s release, pathologic infiltration of neoplastic MC in tissues or both. Multiple molecular, genetic and chromosomal defects seem to contribute to an autonomous growth, but somatic c-kit D816V mutation is more frequently encountered, especially in systemic disease. We present a literature review of mastocytosis and a rare case report of an 18 month-old-girl with a bullous dermatosis, respiratory distress and anaphylaxis, as clinical manifestations of mastocytosis. The developments of accepted classification systems and novel useful markers allowed a re-evaluation and updating of the classification of mastocytosis. In paediatric age cutaneous forms of disease prevail and may regress spontaneously. SM is more frequently diagnosed in adults and is a persistent(clonal) disease of bone marrow. The clinical course in these patients is variable.Today diagnostic criteria for each disease variant are reasonably well defined. There are, however, peculiarities, namely in paediatric age, that makes the diagnostic approach difficult. Systemic disease may pose differential diagnostic problems resulting from multiple organ systems involvement. Coversly, the “unexplained” appearance of those symptoms with no skin lesions should raise the suspicion of MC disease. This case is reported in order to stress the clinical severity and difficult diagnostic approach that paediatric mastocytosis may assume.
- A Rare Malignancy in the Post -Transplant Period: Myeloma Cast NephropathyPublication . Mesquita, I; Viana, H; Possante, M; João, C; Carvalho, S; Silva, C; Aires, I; Ferreira, A; Remédio, F; Carvalho, F; Nolasco, FMyeloma-associated renal disorders are rare events among renal transplants and can occur as recurrent or de novo disease. We describe an unusual case of renal allograft dysfunction due to myeloma cast nephropathy occurring 19 years after having received a renal transplant in a patient with no prior history of multiple myeloma or monoclonal gammopathy preceding transplantation. Our patient was treated with five cycles of chemotheraphy(bortezomib, melphalan and steroids), which resulted in short-term improvement in allograft dysfunction and complete haematological remission. The longer patient and graft survival after renal transplantation make post-transplant lymphoproliferative disease more frequent. Multiple myeloma after kidney transplant is rare and an elevated index of suspicion is necessary to make a timely diagnosis of this serious disease. Further work is needed to identify the best treatment options for these patients.