Measurements in First-Trimester Abortion Products: A Pathologic Study.

Context.—: Related to the advances in prenatal diagnosis and the emergence of medically challenging situations, there has been an increased interest in conducting a pathologic study of first-trimester abortion products.

Objective.

Graves' disease associated with juvenile idiopathic arthritis.

The authors report the case of a 10-year-old girl with Graves' disease (GD), treated with propylthiouracil, who developed uveitis and polyarticular arthritis, and whose mother also had GD and discoid lupus. The differential diagnosis of inflammatory arthritis that appears in a child with autoimmune thyroid disease managed with antithyroid drugs is discussed.

Proton pump inhibitors in patients treated with aspirin and clopidogrel after acute coronary syndrome.

Introduction: Clopidogrel is an antiplatelet agent converted to its active metabolite by cytochrome P-450 isoenzymes. Numerous drugs are known to inhibit P-450 isoenzymes, including proton pump inhibitors (PPIs), which are often associated with aspirin and clopidogrel to prevent adverse gastrointestinal effects. In vitro studies first showed that PPIs reduced the antiplatelet effect of clopidogrel, while recent clinical studies have raised concerns that the addition of a PPI to clopidogrel in acute coronary syndrome (ACS) patients could actually increase the risk of recurrent cardiovascular events.

Association between red blood cell distribution width and outcomes at six months in patients with acute coronary syndromes.

Background: Higher values of red ceildistribution width (RDW) may be associated with adverse outcomes in patients with heart failure and in those with stable coronary artery disease. We assessed the hypothesis that higher RDW values are associated with adverse cardiovascular outcomes in patients with acute coronary syndromes (ACS).

Methods: We studied 1796 patients with ACS admitted to a coronary care unit.

[COPD exacerbation or something else? Clinical case].

The authors present the case of a 45 -year -old female patient with Down syndrome, and known past medical history of COPD with multiple hospital admissions in the context of exacerbation of his lung disease. The facts refer to his latest hospitalization, whose motive, prior interpreted as a further exacerbation episode, after careful clinical reassessment and use of appropriate additional means of diagnosis, appeared to be due to an unusual cause. By presenting this case, the authors call the attention to the difficulty presented by particular situations, as well as to the risks of uncritical acceptance of common diagnoses.

Smoking in acute coronary syndromes--the "smoker's paradox" revisited.

Introduction: Although a well-known risk factor for coronary disease, smoking has long been associated with lower short-term mortality in acute coronary syndromes (ACS). There are few recent works on Portuguese populations examining all aspects of smoking in ACS, particularly the interaction between smoking and other risk factors, and the management and prognosis of patients according to smoking status.

Objective: We sought to examine clinical characteristics, presentation, in-hospital treatment, angiographic features and prognosis of patients with and without smoking history admitted with ACS.

Prognostic impact of hemoglobin drop during hospital stay in patients with acute coronary syndromes.

Introduction: Bleeding is currently the most common non-cardiac complication of therapy in patients with acute coronary syndromes (ACS), and may itself be associated with adverse outcomes. The aim of this study was to determine the effect of hemoglobin drop during hospital stay on outcome among patients with ACS.

Methods: Using Cox proportional-hazards modeling, we examined the association between hemoglobin drop and death or myocardial infarction (MI) at 6 months in 1172 patients admitted with ACS to an intensive cardiac care unit.

Echocardiographic assessment of a cardiac lymphoma: beyond two-dimensional imaging.

Lymphoma is usually recognized as the third most frequent metastatic malignancy involving the heart. In recent years, the incidence of cardiac lymphoma has increased, mainly because of HIV-infected patients. We present a case of secondary cardiac lymphoma in an HIV patient presenting with heart failure.

Erlotinib as an alternative treatment for NSCLC. Case Report.

Introduction: Erlotinib is an approved treatment for NSCLC locally advanced or with metastases, after failure of initial chemotherapy. The authors present a NSCLC clinical case of great clinical and imaging improvement, with no drug-induced toxicity observed, after treatment with erlotinib.

Case Presentation: A 76-year-old woman, never-smoker, had been diagnosed for lung adenocarcinoma, through thoracoscopy, after presenting a large-volume pleural effusion.

Pemetrexed in second line treatment of non-small cell lung cancer - The portuguese experience.

Until 2004, docetaxel in monotherapy was the standard for second-line treatment of non-small cell lung cancer (NSCLC). Pemetrexed (P) has shown similar activity in this setting with a better adverse event profile. In Portugal, it was introduced in October of 2004.

Prognostic impact of moderate renal dysfunction in acute coronary syndromes.

Introduction: End-stage renal disease is associated with high cardiovascular mortality. The prognostic importance of milder degrees of renal impairment in patients who have had an acute coronary syndrome (ACS) is less well defined. The purpose of this study was to evaluate the impact of baseline renal dysfunction assessed by estimated glomerular filtration rate (GFR) on mortality in patients admitted with an ACS.

Coexistence of coronary cameral fistulae and cor triatriatum sinister in an elderly patient.

Coronary cameral fistulae are unusual congenital or acquired anomalous communications between an epicardial coronary artery and a cardiac chamber. There are no reported cases of the association of coronary cameral fistulae and cor triatriatum, a rare congenital cardiac anomaly in which a fibromuscular membrane divides the left atrium into two chambers. We report the case of an 82-year-old man presenting with recurrent anterior chest pain.

Neonatal pyruvate dehydrogenase deficiency due to a R302H mutation in the PDHA1 gene: MRI findings.

Pyruvate dehydrogenase (PDH) deficiency is one of the most common causes of congenital lactic acidosis. Correlations between the genetic defect and neuroimaging findings are lacking. We present conventional and diffusion-weighted MRI findings in a 7-day-old male neonate with PDH deficiency due to a mosaicism for the R302H mutation in the PDHA1 gene.

Diffusion-weighted MR imaging findings in an isolated abscess of the clivus.

We report the finding of restricted diffusion in an isolated abscess of the clivus and discuss the imaging differential diagnosis, with an emphasis on the usefulness of diffusion-weighted imaging.

Diffusion-weighted magnetic resonance imaging findings in a patient with cerebral syphilitic gumma.

Cerebral syphilitic gummas are rare entities, consisting of masses of granulation tissue that result from an exacerbated cell-mediated inflammatory response to Treponema pallidum, usually arising from the meninges of the convexity. Conventional magnetic resonance imaging and computed tomography findings of cerebral gummas have been reported, but diffusion-weighted imaging findings have not been previously described. In our patient, magnetic resonance imaging revealed a juxtacortical lesion with nodular enhancement, moderately restricted diffusion, a dural tail, and surrounding vasogenic edema.

Simultaneous supratentorial and brainstem abscesses due to Listeria monocytogenes.

Multiple supratentorial abscesses caused by Listeria monocytogenes are rare. We report the simultaneous occurrence of multiple supratentorial and brainstem abscesses due to Listeria, in a patient under corticotherapy for an exacerbation of ulcerative colitis. MR imaging features before and after successful conservative treatments are depicted.

Isolated velopalatine paralysis associated with parvovirus B19 infection.

A case of isolated velopalatine paralysis in an 8-year-old boy is presented. The symptoms were sudden-onset of nasal speech, regurgitation of liquids into the nose and dysphagia. Brain MRI and cerebrospinal fluid examination were normal.

Smoking trends in Portuguese school-aged children and approaches for a control--an analysis based on the Health Behaviour in School-Aged Children (HBSC) data.

While smoking has negative health consequences for children and adolescents, the major risk of smoking onset by these age groups is tobacco dependence, in most cases for the rest of their lives, which can later lead to the suffering of diseases related to smoking. This fact shows the importance of smoking prevention in teens to avoid the negative health, economic and environmental effects related to smoking. Although Portugal does not have a National Smoking Prevention Programme, some schools have developed prevention campaigns to control the spread of the tobacco epidemic.

Reply to Letter: Outbreaks caused by parvovirus B19.

We are grateful for the comments provided by Kelly and Leydon, and Bernard J Cohen. They seem to share our previously expressed opinion that 'in the context of measles and rubella elimination programs, study protocols should include data collection procedures and laboratory tests able to confirm or discard the diagnosis of B19 infections.' [1].

[The global smoking prevention programme of Braga].

In spite of its negative impacts on health, in the society, in the economy and in the environment, smoking is a behaviour spread national and internationally. The data collected in 1999 by the Health National Inquire about smoking prevalence in people from 15 and over, in Portugal mainland, show that 29.3% of men and around 7.