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- Acute Kidney Injury Associated with COVID-19 Infection: a Case ReportPublication . Duarte, T; Caeiro, F; Góis, M; Matos, A; Viana, H; Vieira, C; Paulos, J; Paixão, P; Matos, B; Germano, N; Nolasco, FSARS-Cov2 infection is a highly transmissible disease associated with serious pulmonary disease. Renal involvement is frequent and associated with poor prognosis; however, mechanisms of kidney injury are not well established. We present a SARS-Cov2 patient with severe acute kidney injury. Kidney biopsy findings revealed a pattern of acute tubular necrosis with isometric vacuolization of the proximal tubule. The interstitium and glomeruli were normal. Electronic microscopy showed multiple viral-like particles in both the glomeruli and proximal tubule. This case study shows how SARS-Cov 2 infection can result in different kinds of kidney lesion.
- Adenocarcinoma e Carcinóide GástricosPublication . Cunha, P; Cunha, JF; Burnay, MO; Galhordas, A; Fernandes, R; Calinas, FOs autores apresentam um caso clínico de adenocarcinoma e carcinóide gástricos síncronos. Discutem o diagnóstico de carcinóide gástrico e a sua associação a adenocarcinoma
- Adult Pancreatoblastoma - Case Report and Review of LiteraturePublication . Vilaverde, F; Reis, A; Rodrigues, P; Carvalho, A; Scigliano, HMost cases of pancreatoblastoma, a rare malignant epithelial tumor of the pancreas, are seen in the pediatric population. The rarity of pancreatoblastoma, the similar radiologic findings to those seen in other pancreatic lesions, and its histopathologic heterogeneity, make its preoperative diagnosis in adults a real challenge. We report ultrasound, computed tomography and magnetic resonance imaging correlative findings of a histologically proven pancreatoblastoma in a 37-year-old woman. Pancreatoblastoma should be considered in the differential diagnosis of a pancreatic mass presenting uncommon imaging features.
- Alterações Estruturais dos Vasos Pulmonares e Artérias Coronárias na Síndrome do Coração Esquerdo HipoplásicoPublication . Macedo, A; Pinto, E; Ramos, S; Brito, MJ; Costa, MM; Serrano, I; Torrezão, I; Lima, M; Silva, E; Roriz, ML; Silva, S; Sampayo, FCom o objectivo de correlacionar variantes anatómicas com alterações pulmonares e coronárias na síndrome do coração esquerdo hipoplásico (SCEH), fez-se o estudo morfológico e histológico de 15 peças de necrópsia coração-pulmão de recém-nascidos falecidos com aquela patologia. Encontrou-se a forma clássica de SCEH em II peças das quais 3 tinham atrésia da válvula mitral. Nas restantes 4 a aorta saía do ventrículo direito, com ventrículo esquerdo virtual e atrésia da válvula mitral. A histologia pulmonar mostrou aumento da percentagem de espessura das arteríolas e veias pulmonares e extensão intra-acinar da camada muscular das arteríolas em todas as peças. Mas em 8 peças com foramen ovale encerrado ou com diâmetro médio de 5 mm as alterações pulmonares foram mais marcadas do que nas restantes com diâmetro médio do foramen ovale de 9mm. A distribuição coronária foi normal, mas 4 das 8 peças com válvula mitral permeável apresentavam alterações das artérias coronárias não encontradas nas 7 peças com atrésia da válvula mitral. Conclui-se que na SCEH, a existência de foramen ovale encerrado ou restritivo, e de válvula mitral permeável, podem condicionar alterações pulmonares e coronárias, aumentando o risco cirúrgico pelas complicações pós operatórias que possam induzir.
- Aluminum and Sulphate Removal by a Highly Al-Resistant Dissimilatory Sulphate-Reducing Bacteria CommunityPublication . Martins, M; Taborda, R; Silva, G; Assunção, A; Matos, AP; Costa, MCA highly Al-resistant dissimilatory sulphatereducing bacteria community was isolated from sludge of the wetland of Urgeiriça mine (community W). This community showed excellent sulphate removal at the presence of Al3+. After 27 days of incubation, 73,86 and 81% of sulphate was removed in the presence of 0.48, 0.90 and 1.30 mM of Al3+, respectively. Moreover,Al3+ was simultaneously removed: 55,85 and 78% of metal was removed in the presence of 0.48, 0.90 and 1.30 mM of Al3+, respectively. The dissociation of aluminiumlactate soluble complexes due to lactate consumption by dissimilatory sulphate-reducing bacteria can be responsible for aluminum removal, which probably precipitates as insoluble aluminium hydroxide. Phylogenetic analysis of 16S rRNA gene showed that this community was mainly composed by bacteria closely related to Desulfovibrio desulfuricans. However, bacteria affiliated to Proteus and Ralstonia were also present in the community.
- Anatomical Basis, Histological Findings and Hemodinamics in the Modern Perfusion Model for Human CorpsesPublication . Júnior, E; Bettencourt-Pires, M; Alves, S; Casal, D; Pais, D; Goyri O’neill, J; Vassilenko, VsSeveral modern human cadaveric fixation methods are subject to permanent evaluation. Formaldehyde is the oldest and still the most widely used method of embalming. However, the International Agency for Research on Cancer has proven its high carcinogenic potential and its use was banned, with the recommendation of research for better alternatives in the conservation of corpses. The embalming method of excellence, which preserves all features, while keeping the disinfectant properties against cadaveric decomposition was proposed by João Goyri O’Neill. Their method was considered “the most modern and efficient technique in cadaveric preservation”. The aim of this present study was to analyze the quality of this original perfusion technique, at the organic level, based on central and peripheral hemodynamics. The cadaveric material was embalmed through a pulsed arterial perfusion system, connected to an automatic intermittent pump, that permits stability of the microvascular network, as well as the computerized measurement of the main perfusion parameters, such as flow and pressure. This procedure ensures good preservation of color, elasticity, texture, flexibility and fresh appearance, for several years. The morphological characteristics of the organs exhibited astonishing similarity to the living organic tissues, even several years after embalming and high freezing. Microscopic analysis demonstrated preservation of the structure of vessels, such as the aorta. Further studies on the integrity of the endocardial layer of the heart will enable to adapt the intermittent perfusion pump system to best simulate cardiac rhythm and arterial pulse, during cadaveric surgical training.
- Angiossarcoma do BaçoPublication . Sousa, C; Martins, I; Gonçalves, M; Cocco Martins, C; Carvalho, ROs tumores primitivos do baço são extremamente raros. Descrevemos o 1° caso dos Hospitais Civis de Lisboa, em S. José, numa mulher de 70 anos que apresentava espleno egália. Havia história anterior de irradiação pélvica. A ressonância magnética esclareceu a presença de massa tumoral e a angiografia caracterizou-a como vascular. A doente está bem um ano após esplenectomia. Encontrámos na literatura a descrição de 61 casos deste tumor de etiopatogenia não esclarecida. A esplenectomia precoce deve ser a primeira abordagem terapêutica pelo risco de ruptura. Esta foi a forma de apresentação em 34° o dos casos da série de Autry et al. Por se tratar de um tumor tão raro, não há estudos sobre a eficácia da quimioterapia, mas nas formas disseminadas podem utilizar-se esquemas de tratamentos citostáticos activos em sarcomas de partes moles.
- Animal Models of Acute Gastric Mucosal Injury: Macroscopic and Microscopic EvaluationPublication . Simões, S; Lopes, R; Dias Campos, MC; Marruz, MJ; Meirinhos da Cruz, ME; Corvo, LAcute gastric mucosal injury is a common disorder of the gastrointestinal tract and the search for new therapeutics is ongoing. The aim of this study is to update and expand the information related to the most widely used rat models of acute gastric ulcer, the ethanol-induced ulcer and the indomethacin-induced ulcer. These two models are compared in terms of macroscopic and microscopic features. Experimentally, ethanol was given orally in a single dose and indomethacin was subcutaneously injected into male Wistar rats. After ulcerative challenges, the stomachs were removed and visually inspected. Anti-ulcerative drugs were used to validate the models. Histological analysis of the stomachs determined the microscopic score. The methodology used for model evaluation applied to macroscopic and microscopic gastric lesions. With these methods it was possible to induce lesions in the gastric mucosa. Microscopic evaluation permitted assessment of the inflammatory and apoptotic impact in the mucosa not observable by macroscopic evaluation. Groups of animals were treated with two standard drugs: sulcralfate suspension or lansoprazole solution. Both drugs reduced macroscopic and microscopic lesions, particularly the hemorrhagic ones. Both models induced acute gastric mucosal injury and no single evaluation method can address all the aspects of the pathology of gastric lesions. As a complement to macroscopic evaluation, microscopy appears to be a relevant tool to selectively identify specific aspects of the development of mucosal injury, quantify the extent of lesions, and contribute to an appropriate interpretation of results. The score systems established here offer a reliable method for testing antiulcer drugs.
- Apendicite Aguda - Clínica Versus HistologiaPublication . Henriques, J; Reimão, C; Pereira, S; Figueiredo, B; Vital, VP; Casella, PIntrodução: A apendicite aguda continua a ser um dos principais diagnósticos nos Serviços de Cirurgia Pediátrica. A taxa de apendicectomia negativa (apendicectomia sem evidência histológica de patologia), frequentemente utilizada como índice de qualidade hospitalar, permanece alta, apesar dos esforços para a reduzir, especialmente em crianças com menos de 6 anos. Objectivos: os objectivos primários foram: o cálculo da taxa de apendicectomia negativa, da concordância entre diagnóstico clínico (pós-operatório) e diagnóstico histológico e a caracterização da discordância diagnóstica por tipo de apendicite (fleimonosa, gangrenada, perfurada). A caracterização dos grupos apendicectomia negativa (A) e apendicites perfuradas (B), bem como a relação entre estes dois grupos ao longo dos anos, constituíram objectivos secundários. Material e Método: Estudo retrospectivo dos dados clínicos de 1000 doentes consecutivamente operados com o diagnóstico clínico de apendicite aguda, no Hospital de Dona Estefânia, no período de 1 de Janeiro 2003 – 30 de Setembro 2007, procedendo-se à consulta da folha de requisição de exame histo-patológico enviada para o Serviço de Anatomia Patológica. Foram revistos os dados epidemiológicos, a qualidade da informação da referida folha de requisição e calculada a taxa de apendicectomia negativa nesta amostra. Resultados: O diagnóstico clínico pós-operatório foi concordante com o diagnóstico histológico em cerca de 60% casos, sendo subvalorizado ou sobrevalorizado nos restantes casos. A taxa de apendicectomia negativa observada foi de 5,5%, o que está abaixo dos valores apresentados na literatura. Conclusões: As apendicectomias negativas devem ser um “mal menor” em relação às apendicites perfuradas. A discordância clínico-histológica pode ter implicações médico-legais e tem seguramente implicações clínicas e económicas pelo que urge reavaliar o modelo de abordagem desta patologia tão frequente.
- Atypical Presentation of Langerhans Cell HistiocytocisPublication . Marujo, F; Oliveira, MI; Martins, M; Brito, MJ