Publications by authors named "Teresa Dionísio"

10 Publications

  • Page 1 of 1

Giant bezoar: young Rapunzel.

BMJ Case Rep 2018 Mar 20;2018. Epub 2018 Mar 20.

Family Medicine, Centro de Saude de Baião, Fafe, Portugal.

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http://dx.doi.org/10.1136/bcr-2017-222956DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878315PMC
March 2018

Teenage boy with high fever and rash: what could we be missing?

BMJ Case Rep 2018 Feb 8;2018. Epub 2018 Feb 8.

Paediatric Intensive Care Unit, Hospital Pediátrico de Coimbra, Coimbra, Portugal.

A 15-year-old boy was admitted to a local hospital with high fever, generalised rash and a mild sore throat. He was started on intravenous flucloxacillin and 12 hours later develops a sustained low diastolic blood pressure (DBP), unresponsive to fluid volume expansion and cardiovascular support with dopamine. Intravenous clindamycin was added and transportation to paediatric intensive care unit arranged. Dopamine dosing was increased and norepinephrine infusion was added subsequently with immediate stabilisation of DBP. A sacrococcygeal pilonidal abscess was identified, requiring prompt surgical drainage. The microbiological culture of abscess material was positive for an enterotoxin-producing He was free of symptoms after 4 days. This case report summarises a potential severe complication of the pilonidal disease.
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http://dx.doi.org/10.1136/bcr-2017-223497DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5836690PMC
February 2018

Superior mesenteric artery syndrome in a young woman.

BMJ Case Rep 2017 Mar 7;2017. Epub 2017 Mar 7.

Department of Radiology, Hospital de Braga, Braga, Portugal.

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http://dx.doi.org/10.1136/bcr-2017-219421DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5353506PMC
March 2017

Invasive Meningococcal Disease: Application of Base Excess and Platelets Score in a Portuguese Paediatric Intensive Care Unit.

Acta Med Port 2015 May-Jun;28(3):342-6. Epub 2015 Jun 30.

Serviço de Cuidados Intensivos Pediátricos. Hospital Pediátrico. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal.

Introduction: Meningococcal infection has a high mortality and morbidity. Recently a new prognostic scoring system was developed for paediatric invasive meningococcal disease, based on platelet count and base excess â base excess and platelets score. The main objective of this study was to evaluate the accuracy of base excess and platelets score to predict mortality in children admitted to intensive care due to invasive meningococcal disease.

Material And Methods: Observational study, with retrospective data collection, during a 13.5 years period (01/2000 to 06/2013). Mortality by invasive meningococcal disease and related factors (organ dysfunction and multi-organ failure) were analysed. The base excess and platelets score was calculated retrospectively, to evaluate its accuracy in predicting mortality and compared with Paediatric Risk of Mortality and Paediatric Index of Mortality2.

Results: Were admitted 76 children with invasive meningococcal disease. The most frequent type of dysfunction was cardiovascular (92%), followed by hematologic (55%). Of the total, 47 patients (62%) had criteria for multi-organ failure. The global mortality was 16%. Neurologic and renal dysfunction showed the strongest association with mortality, adjusted odds ratio 315 (26 - 3 804) and 155 (20 - 1 299). After application of receiver operating characteristic curves, Base Excess and Platelets score had an area under curve of 0.81, Paediatric Index of Mortality2 of 0.91 and Paediatric Risk of Mortality of 0.96.

Discussion: The Base Excess and Platelets score showed good accuracy, although not as high as Paediatric Risk of Mortality or Paediatric Index of Mortality2.

Conclusions: The Base Excess and Platelets score may be useful tool in invasive meningococcal disease because is highly sensitive and specific and is objectively measurable and readily available at presentation.
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August 2017

Renovascular hypertension: a case with atypical neurological signs.

BMJ Case Rep 2015 Sep 8;2015. Epub 2015 Sep 8.

Pediatric Intensive Care Unit, Hospital Pediátrico de Coimbra, Coimbra, Portugal.

Secondary hypertension is the most frequent form of hypertension in children. Renovascular disease accounts for 5-10% of all childhood hypertension and should be suspected in the presence of severe hypertension found difficult to manage with medical therapy. Uncontrolled hypertension can lead to severe target organ damage. We describe the case of a 13-month-old baby boy with failure to thrive, recent muscular weakness of the lower extremities and irritability. Hypertension was detected and he was admitted to the paediatric intensive care unit with a refractory hypertensive emergency, despite multiple antihypertensive therapies. Bilateral renal artery stenosis was diagnosed through renal angiography and balloon dilation was performed, leading to lower blood pressure. He is currently withdrawing from antihypertensive medication, and slowly gaining weight and recovering from target organ damage. However, weakness of the lower extremities persists and he has been diagnosed with a neurogenic bladder.
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http://dx.doi.org/10.1136/bcr-2014-208336DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4567731PMC
September 2015

[Meningococcal disease admissions in a paediatric intensive care unit].

Acta Med Port 2014 May-Jun;27(3):291-4. Epub 2014 Jun 30.

Serviço de Cuidados Intensivos. Hospital Pediátrico de Coimbra. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal.

Introduction: Meningococcal infection has a high mortality and morbidity in children. Aggressive initial shock approach, early referral, secondary transport and vaccination are potential factors with impact in reducing its mortality. Objectives were to characterize children admitted to intensive care due to invasive meningococcal disease, to evaluate their prognostic scores and mortality.

Material And Methods: Observational study, with retrospective data collection. Two periods were created according to the year of admission (A: 2000-2005 and B: 2006-2011). Prognostic parameters, organ failure and mortality rates were compared in these groups.

Results: 70 children were admitted with invasive meningococcal disease. When compared with other causes of admission, a decrease in the number of admissions due to invasive meningococcal disease was observed (period A: 3.4%; period B: 1.5%; p = 0.001). The presence of meningitis was 41% in period A and 29% in period B (p = 0.461). Rapidly progressive purpura occurred in 78% in period A and 50% in period B (p = 0.032). Children from period A had multi-organ failure (80%), disseminated intravascular coagulation (76%) and coma (22%) more frequently than children from period B (29%, 29%, 0%; p < 0.05). Mortality was 26% in period A and 0% in period B (p = 0.006) and standardized mortality by PRISM was 1.3 and 0 in period A and B respectively.

Discussion: The decrease in the number of admissions due to invasive meningococcal disease can be explained by the introduction of anti-meningococcal C vaccine in 2006. Mortality decline can be possibly explained by an improvement in the initial patient stabilization and to secondary transport.

Conclusion: A decrease in the number of admissions due to invasive meningococcal disease and in mortality was observed.
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March 2016

[Asymptomatic cardiac tumor in a child: an incidental diagnosis].

Rev Port Cardiol 2011 Oct;30(10):795-7

Serviço de Cardiologia Pediátrica, Hospital Pediátrico de Coimbra, Coimbra, Portugal.

Cardiac tumors in the pediatric population are rare, their incidence range between 0.001% and 0.003%. They are mostly benign, rhabdomyomas the most common type, followed by fibromas. The clinical features are being usually nonspecific and depend on the size and location of the tumor within the heart. We report the case of a previously healthy four-year-old boy referred for flu-like symptoms. A respiratory infection was suspected and a chest X-ray showed an increased cardiothoracic index. An echocardiogram revealed a single large heterogeneous mass in the left ventricle emerging from the lateral wall. Despite its size, the mass did not obstruct the left ventricular outflow tract or affect mitral valve function. Cardiac magnetic resonance imaging showed a large mass whose imaging features were suggestive of a fibroma. He became symptomatic during follow-up and was referred for surgical excision of the mass. Histological study confirmed a fibroma. At present the patient remains asymptomatic.
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http://dx.doi.org/10.1016/S0870-2551(11)70028-2DOI Listing
October 2011

Left ventricular noncompaction: analysis of a pediatric population.

Rev Port Cardiol 2011 Mar;30(3):295-311

Serviço de Cardiologia Pediátrica do Hospital Pediátrico de Coimbra, Coimbra, Portugal.

Introduction: Left ventricular noncompaction (LVNC) is a rare and potentially progressive cardiomyopathy, characterized by the persistence of multiple trabeculations and deep intratrabecular recesses in the ventricular myocardium. Although two-dimensional and color Doppler echocardiography are the most useful diagnostic modalities, cardiac magnetic resonance imaging has proved to have high sensitivity and specificity in the diagnosis of this anomaly.

Objective: To characterize the clinical and imaging features of LVNC in a pediatric population and to assess their evolution.

Methods And Results: We performed a retrospective chart review of five pediatric patients with LVNC, followed at Coimbra Pediatric Hospital between January 1999 and December 2007. Median age at presentation was five months (ranging from one day to 13 years), and they were mainly male (1.5:1). Two of the children had a family history of sudden death. In one case the clinical presentation was cardiac arrest due to ventricular fibrillation and in three others, congestive cardiac failure. None of the five cases had associated congenital cardiac anomalies. Involvement of the ventricular apical region was found in all cases. Four children additionally had ventricular dysfunction which improved with diuretic and vasodilator therapy. Mean follow-up was 34 months, ranging from six months to seven years. In one case a change in the morphological phenotype was noted, from a dilated to a hypertrophic form. In this case and in the child's father a mutation in the MYBPC3 gene was identified, which is associated with hypertrophic cardiomyopathy. No thromboembolic phenomena or deaths occurred during the study period.

Conclusion: In the pediatric population, congestive cardiac failure is the most common clinical presentation of LVNC, which can coexist with other cardiomyopathies, particularly dilated and hypertrophic forms. The sample presented in this analysis is statistically non-significant due to its limited size and the authors highlight the need for larger prospective studies in the pediatric population in order to clarify this disease and its diagnostic criteria.
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March 2011

[Circumferential pulmonary vein isolation with the cryoballoon technique].

Rev Port Cardiol 2010 Jun;29(6):1055-8

Serviço de Cardiologia, Centro Hospitalar de Lisboa Ocidental, Hospital de Santa Cruz, Carnaxide, Portugal.

We present a clinical case on cryoballoon ablation of paroxysmal atrial fibrillation. This is a report of the first case performed at our center using this new technology.
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June 2010

Atrial fibrillation ablation using simultaneous multielectrode application of radiofrequeney energy.

Rev Port Cardiol 2010 Jan;29(1):125-37

Serviço de Cardiologia, Hospital de Santa Cruz, Carnaxide, Portugal.

Despite technological advances in equipment for ablation of atrial fibrillation (AF), conventional pulmonary vein (PV) isolation with point-by-point radiofrequency application encircling the PV ostia remains a complex procedure requiring a high degree of operator skill and experience. Novel multielectrode catheters have been developed that deliver duty-cycled bipolar and unipolar radiofrequency energy, designed for PV electrical isolation and for ablation of complex fractionated electrograms in the left atrium. Initial studies suggest good results, reducing procedure time and with safety and efficacy equivalent to the conventional method. We describe the first four cases of AF ablation in our center using this method, with acute success in two patients: one with paroxysmal AF and the other with chronic AF.
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January 2010