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Pimentel J.,University of Lisbon | Tojal R.,Hospital Prof. Dr. Fernando Fonseca | Morgado J.,Centro Hospitalar Of Lisbon Central
Seizure | Year: 2015

Epilepsy is one of the commonest neurologic diseases and has always been associated with stigma. In the interest of safety, the activities of persons with epilepsy (PWE) are often restricted. In keeping with this, physical exercise has often been discouraged. The precise nature of a person's seizures (or whether seizures were provoked or unprovoked) may not have been considered. Although there has been a change in attitude over the last few decades, the exact role of exercise in inducing seizures or aggravating epilepsy still remains a matter of discussion among experts in the field. Based mainly on retrospective, but also on prospective, population and animal-based research, the hypothesis that physical exercise is prejudicial has been slowly replaced by the realization that physical exercise might actually be beneficial for PWE. The benefits are related to improvement of physical and mental health parameters and social integration and reduction in markers of stress, epileptiform activity and the number of seizures. Nowadays, the general consensus is that there should be no restrictions to the practice of physical exercise in people with controlled epilepsy, except for scuba diving, skydiving and other sports at heights. Whilst broader restrictions apply for patients with uncontrolled epilepsy, individual risk assessments taking into account the seizure types, frequency, patterns or triggers may allow PWE to enjoy a wide range of physical activities. © 2014 British Epilepsy Association.

Crespo T.C.,Instituto Nacional Of Saude Dr Ricardo Jorge | Crespo T.C.,Instituto Gulbenkian Of Ciencia | Silva B.,Instituto Nacional Of Saude Dr Ricardo Jorge | Marques L.,Instituto Nacional Of Saude Dr Ricardo Jorge | And 19 more authors.
Neurobiology of Aging | Year: 2014

Alzheimer's disease (AD) is the most common form of dementia in the elderly individuals, resulting from a complex interaction between environmental and genetic factors. Impaired brain iron homeostasis has been recognized as an important mechanism underlying the pathogenesis of this disease. Nevertheless, the knowledge gathered so far at the systemic level is clearly insufficient. Herein, we used an integrative approach to study iron metabolism in the periphery, at both genotypic and phenotypic levels, in a sample of 116 patients with AD and 89 healthy control subjects. To assess the potential impact of iron metabolism on the risk of developing AD, genetic analyses were performed along with the evaluation of the iron status profile in peripheral blood by biochemical and gene expression studies. The results obtained showed a significant decrease of serum iron, ferritin, and transferrin concentrations in patients compared with the control subjects. Also, a significant decrease of ferroportin (SLC40A1) and both transferrin receptors TFRC and TFR2 transcripts was found in peripheral blood mononuclear cells from patients. At the genetic level, significant associations with AD were found for single nucleotide polymorphisms in TF, TFR2, ACO1, and SLC40A1 genes. Apolipoprotein E gene, a well-known risk factor for AD, was also found significantly associated with the disease in this study. Taken together, we hypothesize that the alterations on systemic iron status observed in patients could reflect an iron homeostasis dysregulation, particularly in cellular iron efflux. The intracellular iron accumulation would lead to a rise in oxidative damage, contributing to AD pathophysiology. © 2014 Elsevier Inc.

Sousa M.,Hospital Prof. Dr. Fernando Fonseca | Gomes A.,Hospital Prof. Dr. Fernando Fonseca | Pignatelli N.,Hospital Prof. Dr. Fernando Fonseca | Nunes V.,Hospital Prof. Dr. Fernando Fonseca
International Journal of Surgery Case Reports | Year: 2016

Introduction Gastrosplenic fistula (GSF) is a rare condition almost always associated with lymphoma, with gastric and splenic involvement. Case report We report a 52 year old male with gastric lymphoma admitted to the emergency department with hematemesis. The first chemotherapy cycle had been completed four weeks before. Oesophagoduodenoscopy showed a pulsatile ulcerated lesion. Surgical hemostasis was performed. Four days after surgery, the patient initiated sudden and massive upper gastrointestinal bleeding with hemodynamic compromise. A gastrosplenic fistula was recognized during emergency laparotomy and an en bloc total gastrectomy and splenopancreatectomy resection was performed, with massive blood transfusion. Patient was discharged 13 days after the second surgery. Discussion Gastrosplenic fistula is a rare condition, previously described associated with gastric lymphoma at presentation or after treatment. A prompt recognition of the underlying pathology could avoid a second surgery. Conclusion A systematic and interdisciplinary approach is the key for success in rare challenging emergencies. Infrequent etiologies must always be considered as they need specific therapeutic approaches that defy paradigms. © 2016 The Authors. Published by Elsevier Ltd.

Rosado E.,Hospital Prof. Dr. Fernando Fonseca | Cabral P.,Hospital Prof. Dr. Fernando Fonseca | Campo M.,Hospital Prof. Dr. Fernando Fonseca | Tavares A.,Hospital Prof. Dr. Fernando Fonseca
Journal of Radiology Case Reports | Year: 2013

We report a case of a mesenchymal hamartoma of the liver in a two-year-old boy. He presented to the emergency room with abdominal distention and vomiting. Abdominal ultrasound and computed tomography were performed and revealed a large, intra-peritoneal lesion, with thick wall, multiple cysts of variable size and solid septa. The lesion was surgically resected. Pathological examination revealed a mesenchymal hamartoma of the liver. We are including a short literature review, highlighting the main features of mesenchymal hamartoma of the liver, and discussing its differential diagnosis.

Guerreiro C.,Instituto Nacional Of Saude Doutor Ricardo Jorge | Silva B.,Instituto Nacional Of Saude Dr Ricardo Jorge | Crespo T.C.,Instituto Nacional Of Saude Doutor Ricardo Jorge | Crespo T.C.,Instituto Gulbenkian Of Ciencia | And 19 more authors.
Biochimica et Biophysica Acta - Molecular Basis of Disease | Year: 2015

Alzheimer's disease (AD) is a neurodegenerative disorder of still unknown etiology and the leading cause of dementia worldwide. Besides its main neuropathological hallmarks, a dysfunctional homeostasis of transition metals has been reported to play a pivotal role in the pathogenesis of this disease. Dysregulation of iron (Fe) metabolism in AD has been suggested, particularly at the level of cellular iron efflux. Herein, we intended to further clarify the molecular mechanisms underlying Fe homeostasis in AD. In order to achieve this goal, the expression of specific Fe metabolism-related genes directly involved in Fe regulation and export was assessed in peripheral blood mononuclear cells (PBMCs) from 73. AD patients and 74 controls by quantitative PCR. The results obtained showed a significant decrease in the expression of aconitase 1 (ACO1; P= 0.007); ceruloplasmin (CP; P<. 0.001) and amyloid-beta precursor protein (APP; P= 0.006) genes in AD patients compared with healthy volunteers. These observations point out to a significant downregulation in the expression of genes associated with ferroportin-mediated cellular Fe export in PBMCs from AD patients, when compared to controls. Taken together, these findings support previous studies suggesting impairment of Fe homeostasis in AD, which may lead to cellular Fe retention and oxidative stress, a typical feature of this disease. © 2015 Elsevier B.V.

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