Browsing by Author "Coutinho, M"
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- Correlations between virtual touch imaging and quantification absolute skin stiffness, Nailfold capillaroscopy pattern and digital ulcers in systemic sclerosis patientsPublication . Santiago, T; Coutinho, M; Salvador, MJ; Del Galdo, F; Redmond, AC; Pereira da Silva, JA
- Doença pulmonar intersticial como manifestação isolada de sindrome anti-sintetasePublication . Monteiro, P; Coutinho, M; Machado, P; Garcia, J; Salvador, MJ; Inês, L; Silva, J; Malcata, ABThe authors report a clinical case of a woman who had a 3 years diagnosis of hipersensitivity pneumonitis based on intersticial lung disease whithout other manifestations. The diagnosis of antisynthetase syndrome was made three years after the initial symptoms upon the onset of systemic manifestations with articular involvement, myositis and determination of anti-PL 7 antibodies. In this syndrome, the isolated pulmonary involvement is rare.
- Dor abdominal por enterite lúpica: causa rara de uma queixa frequentePublication . Coutinho, M; Inês, L; Malcata, ABAbdominal pain is a frequent complaint in patients with Systemic Lupus Erythematosus (SLE). The authors describe the case of a 33-year-old SLE female patient, followed in their rheumatology clinic, who presented with acute and diffuse abdominal pain, vomiting and diffuse rebound tenderness at abdominal examination. Abdominal ultrasound and CT scans showed small bowel wall thickening, with target sign on the CT scan, which suggested the diagnosis of Lupus Enteritis. The patient was treated with high-dose corticosteroids, with rapid resolution of all abdominal abnormalities. Lupus Enteritis is a rare complication of SLE, due to intestinal small-vessel vasculitis. It is a very serious complication of SLE, but the prognosis can be greatly improved with early diagnosis and adequate treatment, as in the case presented here.
- Elastography: A new imaging method for evaluating scleroderma skinPublication . Santiago, T; Coutinho, M; Salvador, MJ; Del Galdo, F; Redmond, AC; Pereira da Silva, JA
- Low-impact humeral fracture revealer of chondrosarcoma: a case of exuberant tissue destructionPublication . Coutinho, M; Laranjo, A; Casanova, J
- Milwaukee shoulder (and knee) syndrome.Publication . Santiago, T; Coutinho, M; Malcata, AB; Pereira da Silva, JA
- Paraneoplastic sclerodermiform syndrome--case report.Publication . Rovisco, J; Serra, S; Abreu, P; Coutinho, M; Santiago, T; Inês, L; Pereira da Silva, JAOccasionally, auto-immune diseases may emerge as paraneoplastic syndromes. This is especially recognized in the case of polymyositis/dermatomyostis, but it is an extremely rare event in systemic sclerosis (SSc). The authors report the case of a sixty-year-old woman who presented with Raynaud's phenomenon and rapidly progressing skin thickness of the forearms, hands and lower limbs. Patient evaluation revealed a colorectal carcinoma. The patient was referred to the oncology department. This concomitance of cancer and SSc with rapid progression of the latter, suggests that the scleroderma might have a paraneoplastic origin. Such an hypothesis deserves consideration in every case as early diagnosis may be decisive to control the progression of either disease.
- Pigmented Villonodular Synovitis: a diagnostic challenge. Review of 28 casesPublication . Coutinho, M; Laranjo, A; Casanova, JOBJECTIVE: Pigmented Villonodular Synovitis (PVNS) is a benign and uncommon clinical entity, characterized by excessive proliferation of synovial membrane of joints, tendon sheaths and bursas. The objective of this study was to evaluate demographic and clinical parameters, diagnostic and treatment procedures and the outcome of 28 patients with PVNS. MATERIAL AND METHODS: Retrospective study of the histologically proven cases of PVNS, diagnosed between January 1998 and April 2010 in the Orthopaedics Department of Coimbra University Hospital. Clinical data were reviewed for each patient and the following parameters were evaluated: gender, age at diagnosis, initial clinical symptoms and site of onset, symptom duration, main imaging findings (x-ray and magnetic resonance imaging of the involved structure), histological features of the lesion, treatment, follow-up duration, evidence of recurrence and time between surgery and recurrence. RESULTS: A total of 28 patients with histologically proven PVNS were included. The majority of patients were female (53.6%) and the mean age at the time of diagnosis was 39.2 ± 19.1 years (mean ± SD). The time between onset of symptoms and diagnosis was un- known in one patient and, in the other 27 patients, mean delay in diagnosis was 24.4 ± 20.5 months (mean ± SD). The knee was the most frequently affected site (75% of the cases). Pain and progressive local swelling sensation were the most frequent symptoms at onset (in 82.1% and 71.4% of the cases, respectively). Joint x-ray identified abnormalities in only 17.8% of the patients. Magnetic resonance imaging (MRI) of the affected structure identified the presence of synovial membrane proliferation in all cases and extra-articular extension of the lesion and bone erosions in 39.1% and 34.8%, respectively. Diagnosis was histologically proven in all cases (27 with synovial joint origin and 1 with tenosynovial origin). Subtotal synovectomy, total synovectomy, local excision of the lesion, synovectomy associated with arthroplasty and synovectomy associated with arthrodesis were performed in 53.6%, 21.4%, 10.7%, 7.1% and 3.6% of the cases, respectively. Local recurrence occurred in 25% of the patients, with a mean time of recurrence of 60.8 months after surgery. CONCLUSION: In PVNS patients, the non-specific symptoms often contribute to a delay in establishing a diagnosis. As in the majority of the reported studies, in this study the knee was also the most commonly affected articular site. Although the x-ray of the affected joint revealed abnormalities in just a few number of patients,MRI identified the presence of synovial membrane proliferation in all cases, proving its value in the diagnostic approach to this entity. However, only the histological study of the lesion allows establishing a definitive diagnosis.
- Qualidade de vida e vivência da dor crónica nas doenças reumáticasPublication . Oliveira, P; Monteiro, P; Coutinho, M; Salvador, MJ; Costa, ME; Malcata, ABObjectives: To assess differences among health-related quality of life, pain threshold and perception, and passive coping strategies with chronic pain (specifically retreating, worrying, and resting), as well as associations among variables in three groups of rheumatic patients – fibromyalgia (FM), rheumatoid arthritis (RA), and osteoarthritis (OA). Material and methods: 86 participants diagnosed with FM (n = 25), RA (n = 31) and OA (n = 30) completed the following measures: Clinical and Sociodemographic Questionnaire (QSDC), Medical Outcomes Study 36-item Short Form Health Survey (SF-36v2), Pain Coping Inventory (PCI), visual analogic scale (VAS) for pain, and dolorimeter for threshold pain. SPSS software was used to perform statistical analyses. Results: FM patients reported the lowest levels of quality of life and threshold pain, as well as the highest levels of pain perception and passive coping with chronic pain. Associations between variables support that experience with chronic pain is managed more successfully in OA patients, followed by RA patients and, finally, by FM patients. Conclusions: Our findings support the adoption of a biopsychosocial model for assessment and intervention with rheumatic patients, considering specificities associated to each illness.
- Selecting men for bone densitometry: performance of osteoporosis risk assessment tools in Portuguese menPublication . Machado, P; Coutinho, M; Pereira da Silva, JAClinicians need tools to identify patients most likely to benefit from bone mineral density (BMD) testing, for which cost-effectiveness does not allow generalized screening. This study supports the utility of osteoporosis risk assessment tools in selecting men for BMD testing. Different cutoff values may be appropriate for different countries and/or ethnic origins. INTRODUCTION: Our aim was to evaluate the utility of three osteoporosis (OP) risk assessment tools in a large group of Portuguese men aged 50 or more and to determine the best cutoff value to be used for selecting men for bone densitometry. METHODS: We assessed the performance of three simple tools in 202 randomly selected men: body weight criterion (BWC), osteoporosis self-assessment tool for Asians (OSTA), and a modified version of the OSTA equation (OST). Previously published cutoff values (validated in postmenopausal women) and three additional cutoff values were tested. Sensitivity (SE), specificity (SP), predictive values, and area under the receiver operating characteristic (AUROC) curve for correctly selecting men with OP (defined by BMD testing) were determined. RESULTS: Mean age of the cohort was 63.8 years. According to the World Health Organization diagnostic categories, 16.8% had osteoporosis. The best performing cutoffs for correctly selecting men with OP for BMD testing were OST < 3 (SE = 75.5%, SP = 50.0%, AUROC = 0.632), OSTA < 3 (SE = 73.5%, SP = 58.3%, AUROC = 0.659), and BWC < 75 kg (SE = 73.5%, SP = 61.3%, AUROC = 0.674). CONCLUSIONS: OP risk assessment tools seem to be useful in men aged 50 or more. Best cutoff values are different from those recommended for postmenopausal women. Different cutoff values may be appropriate for different countries and/or ethnic origins.