Browsing by Author "Manso, RT"
Now showing 1 - 10 of 44
Results Per Page
Sort Options
- Adenoma da paratiroideiaPublication . Manso, RT; Santos, S
- An 18-year-old woman with a 34-cm metaplastic breast carcinomaPublication . Gomes, A; Santos, V; Dias, G; Manso, RT; Gonçalves, L; Coiteiro, M; Gaspar, H; Nazaré, AMetaplastic breast carcinomas (MBCs) are rare malignancies usually with poor prognosis. We report a case of an 18-year-old African female patient who presented with a 34-cm tumor on the right breast. Biopsy showed an extensively necrotic MBC negative for estrogen receptor, progesterone receptor and human epidermal growth factor receptor 2 (triple negative). A modified right radical mastectomy was performed, followed by adjuvant chemotherapy. Histology confirmed a widely necrotic undifferentiated malignant tumor, with strong and diffuse expression of vimentin and B-cell lymphoma 2, focal high-molecular-weight keratins and focal CD34 expression; Ki67 was >90%. There was no skin, deep margin or lymph node involvement. Six months after surgery, the patient showed a 9 × 7 cm nodule adjacent to the suture and adherent to the anterior chest wall. The tumor was considered unresectable and the patient evolved with rapid systemic deterioration. The patient had a progression-free survival of 6 months and overall survival of 9 months.
- Anemia perniciosa e tumor neuroendócrino gástricoPublication . Proença, L; Manso, RT; Leichsenring, C; Almeida, S; Santos, A; Louro, F
- Angiomiolipoma epitelióide: a propósito de dois casosPublication . Cuesta, L; Manso, RT; Aparício, S; Silva, S
- Associação entre anemia perniciosa e tumor carcinóide gástrico: a propósito de um caso clínicoPublication . Carvalho, R; Leichsenring, C; Félix, J; Gomes, F; Manso, RT; Geraldes, V; Cuña, L; Branquinho, F; Perloiro, MCOs tumores carcinóides gástricos são raros, representando ≤ 1% dos tumores gástricos e 8,7% de todos os carcinóides gastrentestinais. Os autores descrevem o caso clínico de uma mulher de 32 anos admitida por anemia macrocítica, e cuja investigação etiológica revelou tratar-se de uma anemia perniciosa (AP). Realizou uma endoscopia digestiva alta (EDA), onde se encontraram 6 nódulos bem delimitados no corpo e fundo gástricos. O resultado histopatológico foi consistente com o diagnóstico de tumor carcinóide, bem diferenciado. Após exclusão de metastização secundária (por TC e cintigrafia com octreótido), tendo em conta o envolvimento multifocal do tumor e a presença de metaplasia intestinal completa no corpo e fundo gástricos, a doente foi proposta para gastrectomia total que decorreu sem intercorrências. Iniciou terapêutica com vitamina B-12, com excelente resposta clínica e analítica. O objectivo da publicação deste caso assenta no alertar para o risco do aparecimento dos carcinóides gástricos nos doentes com AP e da necessidade de realização de EDA imediatamente após o diagnóstico da mesma. Nos carcinóides gástricos tipo I que não apresentam doença à distância, a evolução é benigna.
- Atypical renal presentation of antiphospholipid syndromePublication . Gaspar, A; Manso, RT; Pereira, F; Cunha, L; Inchaustegui, L; Serra, A; Rodrigues, B; Correia, PAntiphospholipid syndrome (APS) is a systemic autoimmune disease which can occur as a primary disease or in association with other autoimmune diseases, the most frequent being Systemic Lupus Erythematosus (SLE). Although renal manifestations of SLE are well known, antiphospholipid syndrome renal manifestations such as antiphospholipid syndrome nephropathy and glomerulopathies have yet to be better characterized. The authors present the case of a 39 -year -old Caucasian woman with antiphospholipid syndrome diagnosis and a previous history of deep venous thrombosis and intermittent polyarthralgia, who was referred to a nephrology consultation for proteinuria and microscopic haematuria with preserved renal function. The renal biopsy showed a pattern of membranous glomerulopathy and thrombotic microangiopathy in association with antiphospholipid syndrome nephropathy. This case report illustrates a complex clinical and anatomopathological case of a 39 - year -old woman with a previous antiphospholipid syndrome diagnosis who presented with unspecific manifestations such as proteinuria and microscopic haematuria and preserved renal function. The histological findings alert us to the range of possible renal manifestations of APS and the need to better characterize these patients by preforming renal biopsy.
- Caso 551? manifestação invulgar de doença raraPublication . Martins, N; Sousa, M; Manso, RT; Romero, I; Rodrigues, A; Nunes, V; Ferreira, M
- Causes of Death in an Acute Psychiatric Inpatient Unit of a Portuguese General HospitalPublication . Barbosa, S; Sequeira, M; Castro, S; Manso, RT; Klut, C; Trancas, B; Santos, NB; Maia, TINTRODUCTION: Psychiatric patients are at increased risk of death from a number of natural and unnatural causes. This study examines the mortality causes of all psychiatric inpatients of an acute psychiatric unit at a general hospital in Portugal for sixteen years (1998 to 2013). MATERIAL AND METHODS: Twenty-one inpatients died at the inpatient unit between 1998 and 2013 (average 1.3 per year). A retrospective study through case-file review was carried to collect demographic characteristics, medical and psychiatry diagnosis. Patients transferred to other wards during their admission were not included. RESULTS: Circulatory system diseases were the most prevalent causes of death, occurring in 2/3 of patients and include pulmonary embolism (n = 6), acute stroke (n = 3), cardiac arrhythmia (n = 2), acute myocardial infarction (n = 1), abdominal aortic aneurysm rupture (n = 1) and heart failure (n = 1). Two patients died with pneumonia and in four cases the cause of death was undetermined. Only one case of suicide was registered. DISCUSSION: Circulatory conditions were the most frequent causes of death in our inpatient unit. Albeit a relatively rare event, inpatient suicide does occur and, in addition to its complex consequences on staff, family and patients should remain a focus for continued prevention. CONCLUSION: Mortality studies are important for determining quality of health care and to create recommendations for preventive measures.
- Cellular Variant of Focal Segmental Glomerulosclerosis Treated with Plasma ExchangePublication . Cunha, L; Pereira, F; Manso, RT; Fervenza, F; Soto, KFocal segmental glomerulosclerosis (FSGS) is the most common primary glomerular disease in nephrotic patients in the United States, frequently leading to end stage renal disease (ESRD). The cellular variant is a rare form of FSGS commonly associated with poor outcome. We report a case of cellular variant FSGS with progressive kidney dysfunction successfully treated with plasma exchange (PE). A 49-year-old Caucasian female presented with two days of ankle edema and hypertension. Laboratory findings showed serum creatinine (SCr) 1.6 mg/dL, urine albumin/creatinine ratio (uACR) 2.8 g/g, haematuria 3+ and no immunological abnormalities. Kidney biopsy revealed a cellular FSGS variant with segmental endocapillary proliferation on light microscopic, negative immunofluorescence and widespread foot process effacement by electronic microscopic. Prednisolone 1 mg/Kg was started. Four days later the SCr worsened (3.6 mg/dL) and the patient became severely nephrotic with uACR of6.8g/g, quickly attaining a maximum of 24.6 g/g in a short time and albumin of 2.15g/dL. Pulsed methyl prednisolone was started. Despite a 10 course of steroids, no clinical improvement was observed. Considering the rapidly worsening renal function and severe nephrotic syndrome, PE was begun in association with mycophenolate mofetil and tacrolimus. Kidney function recovered after one week. Complete remission was achieved at 3rd week and remains in complete remission at 27 months follow-up. Prolonged remission is a challenge in primary FSGS. PE associated with combined immunosuppression was effective in the present case. The short and long-term effects of plasma exchange in primary FSGS should be evaluated in prospective studies.
- Clinicopathologic predictors of renal outcomes in light chain cast nephropathy: a multicenter retrospective studyPublication . Royal, V; Leung, N; Troyanov, S; Nasr, Sh; Écotière, L; LeBlanc, R; Adam, BA; Angioi, A; Alexander, MP; Asunis, AM; Barreca, A; Bianco, PC; Cohen, C; Drosou, ME; Fatima, H; Fenoglio, R; Gougeon, F; Goujon, JM; Herrera, GA; Knebelmann, B; Lepori, N; Maletta, F; Manso, RT; Motwani, SS; Pani, A; Rabant, M; Rennke, HG; Rocatello, D; Rosenblum, F; Sanders, PW; Santos, A; Soto, K, et al.Light chain cast nephropathy (LCCN) in multiple myeloma often leads to severe and poorly reversible acute kidney injury. Severe renal impairment influences the allocation of chemotherapy and its tolerability; it also affects patient survival. Whether renal biopsy findings add to the clinical assessment in predicting renal and patient outcomes in LCCN is uncertain. We retrospectively reviewed clinical presentation, chemotherapy regimens, hematologic response, and renal and patient outcomes in 178 patients with biopsy-proven LCCN from 10 centers in Europe and North America. A detailed pathology review, including assessment of the extent of cast formation, was performed to study correlations with initial presentation and outcomes. Patients presented with a mean estimated glomerular filtration rate (eGFR) of 13 ± 11 mL/min/1.73 m2, and 82% had stage 3 acute kidney injury. The mean number of casts was 3.2/mm2 in the cortex. Tubulointerstitial lesions were frequent: acute tubular injury (94%), tubulitis (82%), tubular rupture (62%), giant cell reaction (60%), and cortical and medullary inflammation (95% and 75%, respectively). Medullary inflammation, giant cell reaction, and the extent of cast formation correlated with eGFR value at LCCN diagnosis. During a median follow-up of 22 months, mean eGFR increased to 43 ± 30 mL/min/1.73 m2. Age, β2-microglobulin, best hematologic response, number of cortical casts per square millimeter, and degree of interstitial fibrosis/tubular atrophy (IFTA) were independently associated with a higher eGFR during follow-up. This eGFR value correlated with overall survival, independently of the hematologic response. This study shows that extent of cast formation and IFTA in LCCN predicts the quality of renal response, which, in turn, is associated with overall survival.