Ana Paula Gonçalves

Doença pulmonar obstrutiva crónica e exercício físico

Resumo A doenca pulmonar obstrutiva cronica (DPOC) e uma doenca que se pode prevenir e tratar. Tem um componente pulmonar com efeitos sistemicos significativos que contribuem para a gravidade das manifestacoes clinicas. A DPOC provoca um conjunto de alteracoes, incluindo as que levam a uma limitacao da tolerância ao exercicio e que conduzem a uma deterioracao progressiva da qualidade de vida do doente. A reabilitacao respiratoria (RR) constitui uma parte fundamental do tratamento. Os beneficios de RR sao independentes do sexo, idade e gravidade da doenca.No final do programa o doente devera ter adquirido um estilo de vida o mais autonomo e saudavel possivel. Com este artigo as autoras pretendem fazer uma revisao sobre os beneficios do exerciosteocio fisico na reabilitacao do doente com DPOC e das modalidades de treino utilizadas no programa de reabilitacao respiratoria estabelecido para cada doente.

Falsa asma – A propósito de um caso clínico

Resumo A maioria dos bocios mediastinicos sao extensoes de bocios cervicais. Geralmente os doentes sao do sexo feminino e so muito raramente apresentam sintomas4. As queixas mais frequentemente relatadas sao sensacao de “massa cervical”, dispneia, disfagia e tosse1. Os autores relatam o caso de uma doente de 67 anos, que recorreu ao servico de urgencia por queixas de dispneia, desconforto e sensacao de aperto cervical anterior. O quadro descrito tinha alguns meses de evolucao e havia agravamento na semana previa. A doente referiu antecedentes de asma bronquica, para a qual estava medicada, mas constatou-se que se tratava de um bocio mergulhante.

Yellow bronchoscopy: A severe case of tracheal and bronchial Jaundice

and histological findings were compatible with CCAM type 2. A diagnosis of CCAM type 2 associated with IL-PS was established based on imaging and histological findings. The patient remained asymptomatic 1 year after surgery. This case combines an unusual association of congenital malformations -IL-PS and CCAM -with an infrequent diagnosis in adulthood. Few cases are described in literature of CCAM and IL-PS association. We found reports of presenting in adulthood were even scarcer. These lesions are usually diagnosed prenatally or in the first years of life. Both can have a wide spectrum of presentations ranging from asymptomatic to neonatal death depending on the size of the mass and consequent physiological impairment. After the first year of life recurrent infections are the most common presentation for both pathologies. It is important to note that potential for malignant transformation has been described in both entities, with stronger evidence in CCAM. Imaging has an important part in diagnosis of these lesions. Before birth ultrasound has a key role and after birth CT scan is the gold standard. Morphological features, location and blood supply can help distinguish the different malformations but this differentiation can be particularly difficult. Final diagnosis is established by histological analysis. CCAM is found in most cases to be an isolated finding, although type 2 has been described with other anomalies. Whereas the existence of further congenital anomalies, such as lung, cardiac, diaphragm or chest wall anomalies, is more frequent in PS, particularly in cases of EL-PS, it only happens in 15% of IL-PS cases. The mainstay of treatment for CCAM and PS is surgical resection, lobectomy is the usual procedure of choice. The authors present this case because it is so rare. Although uncommon and infrequently diagnosed in adults, congenital malformations should be included in the differential diagnosis of repeated infections, particularly if they are on the same lobe. Conflicts of interest

Hemotórax espontâneo em doente com neurofibromatose tipo I – A propósito de um caso clínico

Resumo O hemotorax espontâneo e uma complicacao rara e potencialmente fatal da neurofibromatose. Varios mecanismos patologicos sao descritos para a vasculopatia associada a doenca: a) invasao dos vasos por tumores adjacentes, como shwannoma, neurofibroma ou neurofibrosarcoma; b) displasia vascular com formacao de aneurismas e estenoses6,7,9. Outros mecanismos envolvidos podem incluir patologias pleuropulmonares (infeccoes com necrose, embolia pulmonar, endometriose, neoplasias) e discrasia sanguinea. Os autores relatam o caso de uma jovem de 33 anos, que recorreu ao servico de urgencia por toracalgia superior direita, continua, irradiando para o ombro e escapula homolaterais, sem factores de agravamento nem de alivio e com oito dias de evolucao.

Quisto hidático do mediastino: A propósito de um caso clínico

Hydatid cyst is a zoonotic cycle parasitic infection caused by Echinococus granulosus tapeworm, whose larvae infect man as an intermediate host1,2. It is one of the most serious lung diseases caused by helminths1. It is rare to find it in the mediastinum; < 1%. The primitive, or seemingly primitive, location is due to the parasite in the cellular tissue of the mediastinum3. The authors report the case of a sixteen year old male, admitted to the E.R. for left posterior chest pain which had spread to the upper left limb.