Browsing by Author "Oliveira, J"
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- Choque cardiogénico…ou algo maisPublication . Arantes, C; Ribeiro, S; Marques, J; Vieira, C; Ramos, V; Galvão-Braga, C; Martins, J; Salgado, A; Oliveira, J; Pereira, E; Rocha, S; Correia, A
- Encapsulated Abdominal Fat NecrosisPublication . Magalhães, R; Oliveira, J; Caridade, S
- Lesões TalâmicasPublication . Morais, N; Oliveira, J; Afonso, M; Abreu-Lima, J; Moreira da Costa, JA; Serviço de Neurocirurgia, Hospital de Braga
- Metformina: causa ou coincidência?Publication . Monteiro, M; Oliveira, J; Gonçalves, M
- Pharmacological versus microvascular decompression approaches for the treatment of trigeminal neuralgia: clinical outcomes and direct costsPublication . Lemos, L; Alegria, C; Oliveira, J; Machado, A; Oliveira, P; Almeida, AIn idiopathic trigeminal neuralgia (TN) the neuroimaging evaluation is usually normal, but in some cases a vascular compression of trigeminal nerve root is present. Although the latter condition may be referred to surgery, drug therapy is usually the first approach to control pain. This study compared the clinical outcome and direct costs of (1) a traditional treatment (carbamazepine [CBZ] in monotherapy [CBZ protocol]), (2) the association of gabapentin (GBP) and analgesic block of trigger-points with ropivacaine (ROP) (GBP+ROP protocol), and (3) a common TN surgery, microvascular decompression of the trigeminal nerve (MVD protocol). Sixty-two TN patients were randomly treated during 4 weeks (CBZ [n = 23] and GBP+ROP [n = 17] protocols) from cases of idiopathic TN, or selected for MVD surgery (n = 22) due to intractable pain. Direct medical cost estimates were determined by the price of drugs in 2008 and the hospital costs. Pain was evaluated using the Numerical Rating Scale (NRS) and number of pain crises; the Hospital Anxiety and Depression Scale, Sickness Impact Profile, and satisfaction with treatment and hospital team were evaluated. Assessments were performed at day 0 and 6 months after the beginning of treatment. All protocols showed a clinical improvement of pain control at month 6. The GBP+ROP protocol was the least expensive treatment, whereas surgery was the most expensive. With time, however, GBP+ROP tended to be the most and MVD the least expensive. No sequelae resulted in any patient after drug therapies, while after MDV surgery several patients showed important side effects. Data reinforce that, (1) TN patients should be carefully evaluated before choosing therapy for pain control, (2) different pharmacological approaches are available to initiate pain control at low costs, and (3) criteria for surgical interventions should be clearly defined due to important side effects, with the initial higher costs being strongly reduced with time.
- Ryanodine myopathies without central cores-clinical, histopathologic, and genetic description of three cases.Publication . Rocha, J; Taipa, R; Melo Pires, M; Oliveira, J; Santos, R; Santos, MBACKGROUND: Mutations in ryanodine receptor 1 gene (RYR1) are frequent causes of myopathies. They classically present with central core disease; however, clinical variability and histopathologic overlap are being increasingly recognized. PATIENTS: Patient 1 is a 15-year-old girl with mild proximal, four-limb weakness from age 5, presenting with a progressive scoliosis starting at age 10. Patient 2 is an 18-year-old girl with progressively worsening muscle hypotrophy and mild proximal, four-limb weakness. She developed a rapidly progressive scoliosis from age 11 and needed surgical treatment at age 14 years. Patient 3 is an 11-year-old boy with moderate proximal limb weakness and progressive neck flexor weakness, first noticed at age 2. Muscle biopsies revealed type 1 fiber predominance (Patients 1 and 2) or abnormal type 1 fiber uniformity (Patient 3). Different RYR1 variants were identified in all patients. In Patients 1 and 3, these changes were validated as being pathogenic. CONCLUSIONS: These patients illustrate early-onset, progressive myopathies with predominant axial involvement. Histopathologic findings were abnormal but not specific for a diagnosis, particularly central core myopathy. Genetic testing helped broaden the range of phenotypes included in the RYR1-related myopathies. Our patients reinforce the need to recognize the broad histopathologic variability of RYR1-related myopathies and sometimes lack of pathognomonic findings that may reduce the diagnostic threshold of this disease. We suggest that the predominance of type 1 fibers and involvement of axial muscles may be an important element to consider the RYR1 gene as candidate.
- Severe malaria: clinical casePublication . Pires, A; Capela, C; Gouveia, P; Mariz, J; Gomes, G; Oliveira, J
- Síndrome do choque tóxico por Streptococcus PyogenesPublication . Antunes, R; Diogo, M; Carvalho, A; Pimentel, T; Oliveira, JRecently there has been an exponential increase in invasive infections caused by Streptococcus ß hemolyticcus group A. In about one third of cases they are complicated by toxic shock syndrome, characterized by septic shock and multiorgan failure. The authors, by their rarity, report a case of bacteraemia caused by Streptococcus pyogenes complicated by toxic shock syndrome.