Introdução: O mesotelioma peritoneal maligno (MPM) é uma neoplasia rara das células mesoteliais no peritoneu. O fator de risco mais estabelecido é a exposição aos asbestos, mas as mutações germinativas BAP1 também aumentam a suscetibilidade a esse tumor. O diagnóstico é desafiador, uma vez que as manifestações clínicas são frequentemente inespecíficas. Caso Clínico: Reporta-se o caso de um homem de 53 anos, ex-trabalhador da construção civil, com história de exposição a asbestos. O doente apresentava um quadro de queixas dispépticas com 3 meses de evolução. Para estudo inicial, foram realizadas ecografia abdominal e endoscopia digestiva alta. Na endoscopia foi documentada gastrite crónica por Helicobacter pylori tendo feito tratamento de erradicação, mas sem melhoria sintomática. A ecografia abdominal revelou ascite de pequeno volume com focos hiperecogénicos em suspensão, o que foi posteriormente confirmado em tomografia computorizada, demonstrando a presença de nódulos peritoneais no grande epíplon e mesentério. Uma investigação exaustiva foi conduzida na suspeita de carcinomatose peritoneal, mas não foi encontrado nenhum tumor primário noutra localização. A citologia do líquido ascítico e os estudos imunocitoquímicos foram sugestivos de mesotelioma. O doente foi submetido a uma laparotomia exploradora na qual se documentou doença peritoneal inoperável. A biópsia peritoneal confirmou MPM do tipo epitelióide. Foi iniciado tratamento de quimioterapia com platino em associação com pemetrexed, com boa resposta. Seguimento atual de 38 meses pós-diagnóstico. Discussão/Conclusão: O diagnóstico de MPM é desafiante uma vez que requer um alto grau de suspeição. MPM tem um prognóstico reservado. O tratamento standard recomendado é a cirurgia citorredutora com a quimioterapia intraperitoneal hipertérmica. No entanto, nos doentes inoperáveis, a alternativa é a quimioterapia sistémica com pemetrexed-cisplatina. Dada a raridade da doença, é imperativo integrar estes doentes em ensaios clínicos com o objetivo de padronização do tratamento.

Introduction: Malignant peritoneal mesothelioma (MPM) is a rare malignancy of the mesothelial cells in the peritoneum. The best-defined risk factor is asbestos exposure, but germline mutations in BAP1 also increase susceptibility to this tumor. The diagnosis of MPM is challenging since clinical manifestations are often nonspecific. Case Presentation: We describe a case of MPM in a 53-year-old former construction worker with prior asbestos exposure. The clinical presentation was a 3-month history of dyspeptic complaints. As initial workup, abdominal ultrasound and upper gastrointestinal endoscopy were performed. Chronic gastritis due to Helicobacter pylori was detected, which was promptly treated but without symptom relief. Abdominal ultrasound showed small volume ascites with hyperechogenic foci, which was later confirmed on computed tomography scan showing the presence of peritoneal nodules in the greater omentum and mesentery. A thorough investigation was conducted based on the suspicion of peritoneal carcinomatosis. A non-peritoneal primary tumor was not found. Ascitic cytology and immunocytochemical studies were suggestive of mesothelioma. He underwent exploratory laparotomy and inoperable peritoneal disease was observed. Peritoneal biopsy confirmed epithelioid-type MPM. Systemic therapy was initiated with platinum plus pemetrexed with good response. The last follow-up was 38 months after the diagnosis. Discussion/ Conclusion: The diagnosis of MPM is challenging since it requires a high degree of suspicion. MPM has a poor prognosis. The standard of treatment recommended is cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. For those who are inoperable, systemic therapy with pemetrexed-cisplatin combination is the alternative. Given the infrequency of disease, it is imperative to ensure patient participation in clinical trials with the purpose of treatment standardization.

Abstract The aim of this study was to evaluate whether dentists and dental undergraduate students know the terminology of the International Caries Consensus Collaboration (ICCC), and make their restorative treatment decisions regarding carious tissue removal accordingly. Data collection was performed using an electronic questionnaire, considering: a) profile of the respondent; b) analysis of four clinical cases with respect to possible management strategies; and c) questions on cariology field terminology. Sample size consisted of 175 dentists and 66 last semester dental students. Statistical analyses were performed comparing profile, type of institution and dental specialty of the participants. Results showed students were less conservative and agreed less with the ICCC than dentists, and private schools, less than public institutions. Private institutions were 12% (95%CI = 0.833–0.949; p = 0.000) more likely to be less updated with the ICCC recommendations than public institutions, and dentists were 20% more likely to agree with them than students (95%CI = 1.118–1.302; p = 0.000). Dentists were 66% more likely to be conservative than students (95%CI = 0.203–0.554; p = 0.000); dentists and students who graduated or were graduating from public universities were twice as likely to be conservative as those from private universities (95%CI = 1.336–3.333; p = 0.001). In conclusion, students in the last semester are less conservative than dentists, and respondents who graduated or were graduating from public dental schools were more aligned with the current concepts of the ICCC. Several answers were not aligned with ICCC directives, thus showing that management of deep carious lesions still causes restorative therapeutic insecurity.

Crescentic IgA nephropathy represents an aggressive glomerular injury which can cause renal failure unless diagnosed and treated rapidly. There is currently no consensus on the most effective treatment strategy, although immunosuppressive drugs are usually used. Tuberculosis is rarely associated with glomerulonephritis and raises difficult questions about the safety and usefulness of immunosuppressive agents. We report a rare case of rapidly progressive renal failure associated with pleural tuberculosis in a 68-year-old man. The identification of crescents and fibrinoid necrosis in 12 out of 21 glomeruli and IgA deposits in the renal biopsy suggested the diagnosis of crescentic IgA nephropathy. Corticosteroids in combination with antituberculosis drugs were started with significant improvement in his general condition and cure of his pleural tuberculosis but without recovery of kidney function.

A diálise peritoneal é uma opção válida para o tratamento da doença renal crónica estádio 5. Como este procedimento provoca um aumento da pressão intra-abdominal, pode causar uma “fuga” pleuroperitoneal (hidrotórax). Esta complicação não infecciosa, sendo rara, pode ser fatal para doentes em diálise peritoneal; provavelmente secundária à passagem trans-diafragmática de líquido através de uma comunicação pleuroperitoneal. A sua etiologia não está ainda definida, foram propostas diversas causas: defeitos congénitos do diafragma; gradiente de pressão pleuroperitoneal; distúrbios da drenagem linfática; defeitos adquiridos do diafragma, como o aparecimento de fenestrações ou a escassez de fibras musculares diafragmáticas, situações agravadas pela pressão intra-abdominal durante a permanência de dialisante na diálise peritoneal. A cintigrafia peritoneal (peritoneocintigrafia 99mTc-MAA) é uma ferramenta útil no diagnóstico de comunicação pleuroperitoneal. Apresentamos quatro casos de hidrotórax associados a comunicação pleuroperitoneal num total de 290 doentes tratados com diálise peritoneal entre 1999 e 2014, na nossa Unidade. Analisamos a incidência, estratégia diagnóstica e terapêutica desta complicação.

Peritoneal dialysis is an established treatment option for patients with end-stage renal disease. As this procedure causes high pressure in the abdomen, it might lead to peritoneopleural leakage (hydrothorax). The latter is an uncommon non-infectious complication of peritoneal dialysis patients, possibly secondary to trans-diaphragmatic fluid leakage through a pleuroperitoneal communication. The aetiology of this condition is still unclear. A variety of mechanisms have been proposed: congenital diaphragmatic defects; pleuroperitoneal pressure gradient; lymph drainage disorder; acquired diaphragmatic defects that are a consequence of increased intra-abdominal pressure during the dwell period of peritoneal dialysis, such as fenestrations or acquired scarcity of muscle fibres in the tendinous part of the diaphragm. Peritoneal scintigraphy (99mTc-MAA peritoneoscintigraphy) is a useful diagnostic tool in the management of suspected pleuroperitoneal communication. We report four cases of hydrothorax related to pleuroperitoneal communication in 290 patients treated with chronic peritoneal dialysis, between 1999 and 2014, at our PD Unit. Here we analyse our department’s incidence of this complication and also present own experience in diagnosing and treating it.

A espiritualidade tem sido recentemente associada à saúde através do conceito de Bem estar espiritual (BEE). Este define-se como um estado dinâmico que se reflecte na qualidade das relações que o indivíduo estabelece consigo próprio, com os outros, com o ambiente e com algo que transcende o domínio humano. Apresentam-se os resultados psicométricos da adaptação portuguesa do Spiritual Well-being Questionnaire -SWBQp (SWBQ; Gomez & Fisher, 2003, 2005a,b). O SWBQp foi aplicado a uma amostra de 439 sujeitos adultos, com idade M=36.47, DP=10.77 (16-71 anos) e de ambos os sexos (F=61.6%; M=38.4%). O questionário inclui 20 itens que avaliam o grau em que o respondente sente estar a desenvolver cada um dos quatro domínios de BEE - pessoal, comunitário, ambiental e transcendental. O SWBQp apresenta globalmente uma estrutura factorial aceitável, congruente com a original e bons níveis de consistência interna. Os resultados são promissores e permitem prosseguir com a utilização deste instrumento para investigação, podendo, no entanto, ser melhorada.

The assumption that spirituality is linked to health led to the development of the spiritual well-being (SWB) concept. SWB can be defined as a dynamic state of being reflecting positive feelings, behaviours, and cognitions of relationships with oneself, others, the transcendent and nature. The psychometric properties of a Portuguese version of the Spiritual Well-being Questionnaire -SWBQp (SWBQ; Gomez & Fisher, 2003, 2005a,b) are presented. The SWBQp was administered to 439 adults, between 1671 years old (M=36.47, SD=10.77), 61.6 % were female and 38.4% were male. The SWBQp is a 20 item self-report instrument in which participants are asked to rate in what extent they are developing each one of the items that compose the four SWB domains (personal, communal, environmental and transcendental). The structural model of the measure is satisfactory and similar to the original version. It presents good internal consistency scores. These results suggest that the SWBQp is a valid and reliable measure to use in research studies. Nevertheless, it can be further improved.

OBJETIVO: Determinar a incidência de reações adversas em pacientes submetidos à angiofluoresceinografia pela primeira vez e determinar se hipertensão arterial sistêmica, diabetes ou história de alergia aumentam a chance de reações à fluoresceína intravenosa. MÉTODOS: Os dados foram coletados entre janeiro de 2001 e outubro de 2002 em Recife, Brasil. Pacientes com angiofluoresceinografia prévia, gestantes ou pacientes em uso de medicamentos corticosteróides, imunossupressores ou anti-histamínicos foram excluídos. RESULTADOS: Dos 1.500 pacientes iniciais, 1.039 (69,3%) realizavam o exame pela primeira vez. A idade média foi de 58 ± 16 anos e a mediana de 60 anos. Dentre esses, 628 (60,4%) pessoas eram do sexo feminino. Náusea ocorreu em 71 (6,83%) pacientes, vômito em 14 (1,35%), urticária em 11 (1,06%), broncoespasmo em 4 (0,38%) e edema de laringe em 1 (0,01%). Cinco pacientes apresentaram mais de uma reação adversa. Maiores incidências de reações adversas foram observadas em diabéticos [p<0,002, RR=1,80 (IC=1,24-2,60)], hipertensos [p<0,002, RR=1,84 (IC=1,26-2,71)] e pacientes com história de alergia [p<0,001, RR=3,90 (IC=2,70-5,63)]. CONCLUSÕES: Uma incidência cumulativa de 9,72% de reações adversas foi observada em pacientes submetidos à angiofluoresceinografia pela primeira vez. Presença de história de alergia, diabetes ou hipertensão arterial aumentou a incidência de reações adversas ao contraste.

PURPOSES: To determine both the incidence of adverse reactions in patients who underwent fluorescein angiography for the first time and to determine whether systemic arterial hypertension, diabetes or allergy history increases the chance of reaction to intravenous fluorescein. METHODS:Data collection was carried out between January 2001 and October 2002 in Recife, Brazil. Patients with prior fluorescein angiography history, pregnant patients or patients in use of corticosteroids, immunosuppressive or antihistamine drugs were excluded. RESULTS: Out of 1,500 enrolled patients, 1,039 (69.3%) underwent the test for the first time. The mean age was 58 ± 16 years and the median age was 60 years. Of these, 628 (60.4%) were women. Nausea occurred in 71 (6.83%) patients, vomiting in 14 (1.35%), urticaria in 11 (1.06%), bronchospasm in 4 (0.38%) and laryngeal edema in 1 (0.01%). Five patients presented more than one adverse reaction. Higher incidences of adverse reactions were observed in diabetic patients [p<0.002, RR=1.80 (CI=1.24-2.60)], patients with systemic arterial hypertension [p<0.002, RR=1.84 (CI=1.26-2.71)] and patients with allergy history [p<0.001, RR=3.90 (CI=2.70-5.63)]. CONCLUSIONS: A cumulative incidence of 9.72% adverse reactions was observed in patients who had undergone this test for the first time. The presence of the allergy history, diabetes or systemic arterial hypertension increased the incidence of adverse reactions to the dye.