Browsing by Author "Martins, P"
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- Cianose no pequeno lactente – desafio diagnósticoPublication . Amaral, ME; Silva, PV; Marinho, J; Francisco, A; Andrade, H; Martins, P; Santos, I; Rodrigues, D; Sousa, G; Pires, A; Marinho, A; Castela, E
- Doença de Hodgkin apresentando-se como síndrome febril indeterminadoPublication . Branco, V; Salvador, MJ; Silva, MR; Martins, P; Carvalho, A; Almiro, E; Porto, A
- Elbow Arthroplasty in a patient with Juvenile Idiopathic ArthritisPublication . Martins, P; Moura, DL; Ferreira, J; Reis, A; Capelão, M; Fonseca, FIntroduction: Juvenile Idiopathic Arthritis (JIA) is an autoimmune systemic chronic inflammatory disease that affects the joints as a chronic inflammatory synovitis. It appears before the 16 years old and there are many disease types, like the oligoarticular, polyarticular, systemic, etc. The orthopedic treatment and prognosis are defined by the joint sequelae grades, affecting mostly the hips, knees, ankles, elbows and wrists. Objectives: Case report of a patient with JIA which conservative treatment was ineffective. A new stage of treatment was proposed, with bone preservation total elbow prosthesis. A good function, increasing range of motion and pain relief was achieved. Methods: We present a clinical case of a 35 year-old female with diagnosis of a polyarticular JIA with evolution of 30 years. The disease stadium is the articular sequelae phase, affecting the vertebral column, hips, knees, shoulders, elbows and hands. The patient is referred to our centre because of intense pain and progressive amplitudes loss of the left elbow, with 5 years evolution. The plain radiograph of the left elbow shows bone erosions and diffuse osteopenia, signs of inflammatory active process at this joint. At this time, the patient is treated non surgically with disease modifying anti-rheumatoid, anti-inflammatory and pain killer drugs. After six months, the elbow pain and stiffness are worse, so the patient is submitted to a surgical arthrolisis, with no improvement. After 6 months, it is performed another arthrolisis, with the same unsuccessful results. The symptoms became incapacitating, with intense pain and crepitation of the joint, and severe limitation of the daily activities. The Mayo Score was 15. The movement arc was 90º of flexion and 20º of extension. At this time, the x-ray shows a grade 4 elbow arthrosis, with numerous osteophytes and an almost complete disappearance of the interarticular space. Being aware of the age of the patient and the severe limitation and prejudice on the life quality, it is performed a total elbow arthroplasty. The intraoperative findings were extense synovitis and aderences and a total juxtaposition of the articular surfaces, conditioning severe joint stiffness. It was used a bone preservation total elbow prosthesis. Results: The surgery had no intercurrences and during the first 3 weeks it was done a cast immobilization with 90º elbow flexion. After this time, the patient began psychiatric rehabilitation programs that lead to progressive gain of joint amplitudes. One month after the joint replacement, the patient has 120º flexion and 15º extension, with no signs of joint instability and pain only at the movement limits. The patient was satisfied with the recuperation and at the third postoperative month the Mayo Sore was 100. Conclusions: JIA can result in extreme situations of incapacitating osteoarthosis, frequently of the elbow joint. This disease affecting a young active patient is an indication to total elbow arthroplasty, that in the inflammatory arthritis generally results in pain relief and an important function recuperation of the joint amplitudes movements.
- Pro-inflammatory triggers in childhood obesity: correlation between leptin, adiponectin and high-sensitivity C-reactive protein in a group of obese Portuguese childrenPublication . Pires, A; Martins, P; Pereira, AM; Marinho, J; Vaz Silva, P; Marques, M; Castela, E; Sena, C; Seiça, RINTRODUCTION: Pediatric obesity is increasingly prevalent in the Portuguese population. Adipocyte dysfunction results in the expression of pro-inflammatory mediators that are responsible for the low-grade inflammatory process that characterizes obesity. OBJECTIVES: The aim of this study was to investigate the relationship between markers of adiposity, inflammation and adipokines in a Portuguese obese pediatric population. METHODS: One hundred and twenty children of both sexes, aged 6-17 years, were included in this study. The control group consisted of 41 healthy normal-weight children. The variables analyzed were age, gender, body mass index, waist circumference, fat mass percentage, high-sensitivity C-reactive protein (hs-CRP), leptin and adiponectin. RESULTS: There were significant differences between controls and obese children for all parameters analyzed. In the obese group, after controlling for age and gender, hs-CRP (p=0.041), adiponectin (p=0.019) and leptin (p<0.001) still showed significant statistical differences. A direct correlation was found between hs-CRP, leptin, body mass index and waist circumference, the strongest being with leptin (r=0.568; p<0.001). This trend remained statistically significant, regardless of gender or pubertal age. CONCLUSIONS: Considering the role of leptin, adiponectin and hs-CRP in the genesis of endothelial dysfunction, they may be used in clinical practice for risk stratification, as well as in the assessment of weight control programs.
- O sopro num coração normalPublication . Martins, P; Dinis, A; Canha, J; Ramalheira, G; Castela, EInnocent heart murmur is a frequent auscultatory finding in children. The diagnosis is essentially clinical, without need for further investigation. However, excluding heart disease can be a difficult task. This review article describes some features of medical history and physical examination that help in this differentiation. The role of diagnostic tests is also examined.
- USPIO-enhanced magnetic resonance imaging for nodal staging in patients with head and neck cancerPublication . Curvo-Semedo, L; Diniz, M; Miguéis, J; Julião, MJ; Martins, P; Pinto, A; Caseiro-Alves, FPURPOSE: To determine the accuracy of ultrasmall superparamagnetic iron oxide (USPIO)-enhanced magnetic resonance imaging (MRI) for nodal staging in patients with head and neck cancer. MATERIALS AND METHODS: Twenty patients with carcinomas of the upper aerodigestive tract were prospectively enrolled. MRI was performed before and 24-36 hours after intravenous infusion of an USPIO agent, ferumoxtran-10 (Sinerem; Guerbet, France; and Combidex; Advanced Magnetics) at a dose of 2.6 mg Fe/kg using T2-weighted spin-echo and gradient-echo sequences. Surgery was performed the same day or the day after the ferumoxtran-10-enhanced MR examination. Based on MRI, selected nodes were surgically removed and directly correlated with pathology using hematoxylin-eosin (H&E) and Perls stainings. RESULTS: A total of 63 nodes were studied; 36 were nonmetastatic, 25 metastatic, and two inflammatory. Ferumoxtran-10-enhanced MRI allowed diagnosis of 24 metastatic and 30 nonmetastatic nodes, yielding a sensitivity of 96%, a specificity of 78.9%, a positive predictive value of 75%, and a negative predictive value of 96.8%, compared to 64%, 78.9%, 66.6%, and 76.9%, respectively, for nonenhanced MRI. Accuracy of ferumoxtran-10-enhanced MRI was 85.7%. The gradient-echo T2-weighted sequence was the most accurate to detect signal loss in nonmetastatic nodes. CONCLUSION: USPIO-enhanced MRI is useful for nodal staging of patients with head and neck cancers