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Dourado E, Freitas R, Martins P, Saraiva L, Santiago T, Guimarães F, Costa E, Esperança Almeida D, Dinis SP, Pinto AS, Daniel A, Genrinho I, Couto M, Rodrigues M, Salvador MJ, Duarte AC, Cordeiro A, Santos MJ, Fonseca JE, Resende C, Cordeiro I. AB0696 Prevalence and clinical associations of different autoantibodies in the Reuma.pt systemic sclerosis cohort: is it all really set in stone? Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundDifferent autoantibodies (Ab) have been associated with distinct systemic sclerosis (SSc) phenotypes. Most of these associations have not been confirmed in Portuguese patients.ObjectivesTo evaluate SSc immuno-clinical associations in the Rheumatic Diseases Portuguese Register (Reuma.pt) cohort.MethodsMulticentre open cohort study including adult SSc patients registered in Reuma.pt up to February 2021. The associations between Ab expression and clinical data were established using Chi-Square, Fischer’s Exact or Mann-Whitney U tests. The Bonferroni correction for multiple comparisons was applied to get α≤0.05. Definite associations were defined by p≤0.002, and likely associations by p≤0.05.Results1080 patients were included, with a mean age and disease duration of 60.2±14.6 and 12.4±10.0 years, respectively. Most were females (87.5%) and had white European ancestry (WEA, 93.2%). The most common disease subtypes were limited cutaneous (lcSSc, 57.4%), diffuse cutaneous (dcSSc, 17.7%), and very early diagnosis of SSc (VEDOSS, 12.3%). Most patients expressed antinuclear Ab (ANA, 93.4%), and the most frequent were anti-centromere (ACA, 54.6%), anti-topoisomerase I (Scl70, 21.8%), and anti-Pm/Scl Ab (PmScl, 4.7%).ACA had definite positive associations with female sex, older age at diagnosis, lcSSc, lower modified Rodnan skin score (mRSS, median 0 vs 4), and isolated sclerodactyly, and likely associations with a higher diagnosis delay, WEA and VEDOSS. ACA had definite inverse associations with flexion contractures (FC), myositis, digital ulcers (DU), and interstitial lung disease (ILD), and likely inverse associations with pitting scars (PS) and oesophageal involvement (OI).Scl70 had definite positive associations with male sex, dcSSc, higher mRSS, FC, DU, PS, ILD, and OI, and likely associations with younger age at diagnosis, tendon friction rubs, active scleroderma pattern in capillaroscopy, and heart involvement.PmScl had a definite association with myositis and likely associations with male sex, calcinosis, joints involvement, and ILD. Anti-U1RNP Ab had definite associations with younger age at diagnosis, MCTD and myositis, and likely associations with a lower diagnosis delay, African ancestry and joint involvement. Anti-RNA polymerase III Ab (RP3) had likely associations with higher mRSS and renal involvement. Anti-U3RNP Ab had a definite association with dcSSc and likely associations with calcinosis and renal involvement. Anti-Th/To Ab had likely associations with male sex and myositis. Anti-Ku Ab had likely associations with systemic lupus erythematosus and mixed connective tissue disease (MCTD) overlap syndromes.ConclusionThere was a higher prevalence of ACA and PmScl compared to other cohorts, most likely due to the high proportion of WEA patients. Most immuno-clinical associations described in the literature apply, including ACA with lcSSc and Scl70 with dcSSc, DU, PS and ILD. However, Scl70+ patients did not have an increased risk of renal involvement, and ACA+ patients did not have an increased risk for calcinosis, PAH or OI, contrary to what was described in the literature. New findings included the association of PmScl with ILD and Scl70 with an active pattern in capillaroscopy. Also, anti-U3RNP+ and Th/To+ patients did not have an increased risk of ILD or PAH, contrarily to what was previously reported. These nuances may be specific to the Portuguese SSc population or signal previously reported associations as geographically specific.Disclosure of InterestsNone declared
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Calvao J, Costa C, Amador A, Pinto R, Carvalho M, Proenca T, Marques C, Cabrita A, Grilo P, Resende C, Torres S, Sousa C, Macedo F. Impact of severe mitral annular calcification on mitral regurgitation after transcatheter aortic valve implantation. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Transcatheter aortic valve implantation (TAVI) has become the standard of care treatment in patients with severe aortic stenosis who are at intermediate or high risk for surgical aortic valve replacement. Mitral annular calcification (MAC) is frequent in patients with aortic stenosis, and its presence is associated with increased cardiovascular morbidity and mortality. Not infrequently, it is associated with significant morphologic and functional abnormalities of the mitral valve apparatus.
Purpose
The aim of this work is to evaluate the relationship between severe MAC and the presence and development of significant mitral regurgitation after TAVI.
Methods
We retrospectively analyzed all patients who underwent TAVI at a tertiary center from October 2014 to November 2019. Clinical, echocardiographic and procedure-related data were collected until a follow-up of 6 months. Statistical analysis was conducted on IBM SPSS® Statistics software. Descriptive statistics were calculated for all variables. Sample T-test, Chi-square and Wilcoxon sign test were used. A p-value < 0.05 was considered significant. The presence and severity of MAC was defined according to echocardiographic data. Severe MAC was defined by the presence of calcification of more than half of the mitral annular circumference.
Results
A total of 343 patients were enrolled in the study. The mean age of the population was 80 ± 8 years, 45% were male. Mean functional area was 0.75 ± 0.18 cm2, mean transvalvular pressure gradient was 48 ± 15 mmHg and the mean left ventricular ejection fraction (LVEF) was 54 ± 14%. MAC was detected in 231 (67%) patients. In 44 (19%) of these patients, MAC was graded as severe. Patients with severe MAC tended to have higher prevalence of moderate (27.3 vs 20.4%, p = 0.30) as well as severe (4.5 vs 1.8%, p = 0.24) mitral regurgitation at baseline. After TAVI, the prevalence of moderate mitral regurgitation at 6 months was similar between both groups (22.5 vs 20.4%, p = 0.76). Although not reaching statistical significance, patients with severe MAC had higher prevalence of severe mitral regurgitation at 6 months post-procedure (12.2 VS 5.0%, p = 0.07) as well as higher incidence of worsening of mitral regurgitation (34.2 vs 23.7%, p = 0.16). The proportion of patients that had improvement (13.2 vs 15.0%, p = 0.76) or no change (52.6 vs 61.3%, p = 0.31) in the degree of mitral regurgitation was similar in both groups.
Conclusion
The presence of severe MAC at baseline echocardiography in patients undergoing TAVI may be associated with worsening of mitral regurgitation after the procedure. These patients tend to have higher prevalence of severe mitral regurgitation post-TAVI. Further studies are needed in order to further elucidate this association.
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Affiliation(s)
- J Calvao
- Sao Joao Hospital, Porto, Portugal
| | - C Costa
- Sao Joao Hospital, Porto, Portugal
| | - A Amador
- Sao Joao Hospital, Porto, Portugal
| | - R Pinto
- Sao Joao Hospital, Porto, Portugal
| | | | | | | | | | - P Grilo
- Sao Joao Hospital, Porto, Portugal
| | | | - S Torres
- Sao Joao Hospital, Porto, Portugal
| | - C Sousa
- Sao Joao Hospital, Porto, Portugal
| | - F Macedo
- Sao Joao Hospital, Porto, Portugal
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Freitas R, Martins P, Dourado E, Salvador MJ, Santiago T, Cordeiro I, Fernandes BM, Guimarães F, Garcia S, Samões B, Gonçalves N, Fernandes Lourenco MH, Pinto AS, Rocha M, Couto M, Costa E, Araújo F, Resende C, Godinho F, Cordeiro A, Santos MJ. POS0872 CLINICAL FEATURES AND OUTCOME OF 1054 PATIENTS WITH SYSTEMIC SCLEROSIS: AN ANALYSIS OF THE PORTUGUESE REUMA.PT REGISTRY FOR SCLERODERMA (REUMA.PT/SSC). Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Systemic sclerosis (SSc) may present distinctive manifestations and survival in different ethnic and geographic groups.Objectives:To describe the clinical features, treatments, and survival of adult SSc patients registered in Reuma.pt/SSc.Methods:Demographic features, SSc subsets, fulfilment of classification criteria, clinical and immunologic characteristics, comorbidities, medication and deaths were reviewed. Survival was calculated for patients included in the registry within the first 2 years of diagnosis.Results:In total, 1054 patients were included, 87.5% female, mean age at diagnosis 52.7 ± 14.8 years. The most common subset was limited cutaneous (lc)SSc (56.3%), followed by diffuse cutaneous (dc)SSc (17.5%), preclinical SSc (13%), overlap syndrome (9.8%) and SSc sine scleroderma (3.3%). Raynaud’s phenomenon (93.4%) and skin thickening (76.9%) were the most observed manifestations. Gastrointestinal (62.8% vs 47.8%), pulmonary (59.5% vs 23%) and cardiac (12.8% vs 6.9%) involvement were significantly more prevalent in dcSSc compared to lcSSc (Table 1). 52.5% of patients were ACA positive and 21% anti-topoisomerase positive, with significant differences between lcSSc and dcSSc. One third of patients was treated with immunomodulators, 53.6% with vasodilators, 23% received glucocorticoids and 2.3% biologics.During the median follow-up 12.4 years, 83 deaths (7.9%) were verified. The overall 1, 2 and 5 years survival was 98.0%, 96.8% and 92.6% respectively, without significant differences between lcSSc and dcSSc (Figure 1).Conclusion:Reuma.pt/SSc register is useful in routine patient monitoring and contributes to improve knowledge about this rare and complex disease. Clinical features of Portuguese SSc patients are similar to what has been described in other populations although the overall 5-year survival in recently diagnosed patients appears to be higher than previously reported.Table 1.Cumulative clinical and immunologic characteristics of Portuguese SSc patientsClinical and immunologic featuresTotalN=1054Limited cutaneous SScN= 576 (56.3%)Diffuse cutaneous SScN=180 (17.5%)P valueSkin involvement – N(%) N=987688 (90.6)525 (90.7)180 (100)<0.01Skin thickening * – N (%) N= 962680 (76.9)512 (88.9)180 (100)<0.01Digital ulcers – N (%) N=970325(33.5)186 (34.7)4 (51.5)<0.01Raynaud’s Phenomenon – N (%) N=1010943 (93.4)539 (95.7)157 (92.4)0.06Musculoskeletal involvement – N(%) N=972346 (45.6)247 (42.7)99 (55)<0.01Cardiac involvement –N(%) – N=92471 (7.7)36 (6.9)19 (12.8)0.02Renal involvement –N(%) – N= 91717 (1.9)8!1.5)6 (4.1)0.07Gastrointestinal involvement - N(%) N=933508 (48.2)277 (47.8)113 (62.8)<0.01Pulmonary involvement – N(%) N=915261 (28.5)119 (23)88 (59.5)<0.01PAH – N(%) N= 87114 (1.6)10 (2)1 (0.7)0.23Intersticial lung disease – N(%) N=765218 (28.5)100 (22.7)75 (57.7)<0.01Antinuclear antibodies - N(%) N=1040934 (89.8)522 (90.2)154 (88.5)0.57Anti-centromere – N(%) N= 1027540 (52.6)383 (67.1)16 (9.5)<0.01Anti-Scl70 – N(%) N=1020214 (21)12 (3.3)104 (60.1)<0.01Anti-RNA polymerase III – N(%) N=71025 (3.5)12 (3.3)7 (5.6)0.38ComorbiditiesHypertension – N(%) N=431117 (27.1)76 (29.7)67 (20.7)0.1Hyperlipidemia – N(%) N=43171 (13.4)72 (12.2)24 (15.9)0.08Neoplasia – N(%) N=105429 (2.8)12 (2.1)7 (3.9)0.14PDE-5 (phosdiasterase-5); PPIs (proton pump inhibitors); PAH-Pulmonary arterial hypertension confirmed by right heart catheterization. Immunomodulators includes Metothrexate, Leflunomide, Hydroxycloroquine; Azathioprine, Mycophenolate Mofetil and Cyclophosphamide; * Does not include sclerodactyly.Figure 1.Panel A - Survival in years from diagnosis of patients with SSc included in Reuma.pt in the first 2 years of disease (N=472). Panel B - survival according to SSc subset (lcSSc and dcSSC).Disclosure of Interests:None declared
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Proenca T, Martins Carvalho M, Alves Pinto R, Resende C, Grilo P, Torres S, Paiva M, Lebreiro A, Campelo M, Rema J, Sousa C, Maciel M. Supraventricular ectopic activity as a predictor of atrial fibrillation – what we didn't see 10 years ago. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cardioembolism induced by atrial fibrillation (AF) is responsible for up to 33% of all ischemic strokes. 24-hour Holter monitoring in stroke and transient ischemic attack (TIA) patients is used as a routine investigation to search for occult paroxysmal atrial fibrillation (PAF), which may have crucial prognostic impact. Excessive supraventricular ectopic activity (ESVEA) is also a stroke risk factor, probably related to the risk of developing AF.
Purpose
To observe the incidence of AF at a long-term follow-up and to evaluate the clinical, electrocardiographic and echocardiographic predictors of new onset AF in stroke patients.
Methods
Patients in sinus rhythm who performed Holter between October 2009 and October 2011 in the setting of post stroke or TIA were included; patients with previous AF were excluded. These patients were followed for 8 to 10 years. Clinical, electrocardiographic and echocardiographic data were collected. ESVEA was defined by ≥500 premature atrial contractions per 24 hours or any sustained supraventricular tachycardia episode.
Results
104 patients were included, 54% were male, with a mean age of 63.8±14.7 years at the time of the event. In relation to cardiovascular risk factors, 59% had hypertension, 47% dyslipidemia, 14% diabetes, 44% were smokers or previous smokers; 67% of patients were high consumers of alcohol. 79.8% had a stroke and 21.2% a TIA. 24-hour Holter monitoring revealed ESVEA in 13.5% of patients and PAF in 1.9%. All patients with PAF had a previous stroke and were older than 55.
At a follow-up of 8–10 years, new onset AF was detected in 11.5%; these patients had similar mortality comparing to those in sustained sinus rhythm (21.2% vs 16.7%, p=0.724). Alcohol intake, an established risk factor for development of AF, was associated with a non-significant increase of AF (17.3% vs 11.5%) while the presence of cardiovascular risk factors was not associated with AF development. We found a statistically significant difference between patients with and without ESVEA concerning to new onset of AF (35.7% vs 8.0%, p=0.010). ESVEA seems to be related with a higher mortality at a long follow-up, although this difference wasn't statistically significant (35.7% vs 18.2%, p=0.132). Concerning to echocardiographic parameters, patients whit left atrium enlargement showed a higher incidence of AF at follow-up (14.7% vs 7.9%), and the presence of mitral regurgitation were not related with new onset of AF. Patients' age was also not related with new onset of AF during follow-up.
Conclusion
Atrial fibrillation is considered the main cause of stroke. Our study showed that ESVEA is a strong predictor of new onset AF and highlights that Holter monitoring could be an important tool not only to diagnose AF but also to identify patients in risk of develop AF. Diagnostic of new AF during long-term follow up didn't correlate with higher mortality.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | | | | | | | | | - S Torres
- Sao Joao Hospital, Porto, Portugal
| | - M Paiva
- Sao Joao Hospital, Porto, Portugal
| | | | | | - J Rema
- Sao Joao Hospital, Porto, Portugal
| | - C Sousa
- Sao Joao Hospital, Porto, Portugal
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Cardoso Torres S, Vasconcelos M, Resende C, Diogo P, Pinto R, Proenca T, Carvalho J, Calvao J, Amador F, Costa C, Cruz C, Moreira J, Pinho P, Silva J, Maciel M. Coronary artery fistulas: a single-center case series. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Coronary artery fistulas (CAFs) are rare anomalous connections between a coronary artery and a major vessel or cardiac chamber. Currently they are being increasingly encountered due to the more widespread use of various imaging modalities and coronary angiography. Although the vast majority of CAFs are incidentally diagnosed and have no clinical relevance, they can cause significant morbidity such as myocardial infarction, congestive heart failure and endocarditis.
Methods
A consecutive series of 55867 coronary arteriograms performed in our Cardiology Department from 2007 to 2019 was retrospectively investigated for the presence of coronary artery fistulas. Patients clinical, angiographic and therapeutic data up to november 2019 were analyzed. Data were obtained from medical records of hospital stay and subsequent consultations.
Results
We identified 50 patients who were diagnosed with one or more CAFs, with ages between 5 and 85 years (mean 59 years). 62% (n=31) were males.
The great majority of patients had a single fistula (n=34, 68%), 11 patients had two fistulas (22%), 1 patient had 3 fistulas (2%) and 4 patients had multiple fistulas (8%).
CAFs arose more frequently from the left anterior descending artery (n=27), followed by the right coronary (n=18), left circumflex (n=15), left main (n=5) and intermediate artery (n=2). The most frequent drainage site was the pulmonary artery (n=38).
The majority of CAFs were incidentally found (n=32; 64%) and thought to have no significance for the patients' clinical status. As for the rest of the patients, CAFs were diagnosed during evaluation of: a heart murmur (n=7); exertional chest pain with no associated significant atherosclerotic coronary artery disease (n=7); exertional dyspnea (n=2); positive exercise stress test (n=1); NSTEMI and cardiac arrest (n=1).
Regarding treatment, watchful waiting was the main approach (n=40; 80%). 3 patients had their CAFs closed during surgery for another heart condition (CABG/aortic valve replacement). In 1 patient, heart surgery was specifically conducted for fistula closure. 6 patients (12%) underwent fistula transcatheter closure.
Conclusion
CAFs are rare coronary anomalies and the majority has no clinical relevance, so watchful waiting is the commonest approach. When they are hemodynamically significant or symptoms/complications arise, surgical or transcatheter closure should be considered. This study describes the angiographic, clinical and therapeutic data of CAFs detected along the last 12 years in a single tertiary care center catheterization laboratory.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S Cardoso Torres
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - M Vasconcelos
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - C.X Resende
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - P Diogo
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - R Pinto
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - T Proenca
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - J.M Carvalho
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - J Calvao
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - F Amador
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - C Costa
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - C Cruz
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - J Moreira
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - P Pinho
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - J.C Silva
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - M.J Maciel
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
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Martins P, Dourado E, Fonseca JE, Cordeiro I, Resende C. AB0589 THE IMPORTANCE OF A SYSTEMIC SCLEROSIS CLINIC IN A TERTIARY REFERRAL CENTER – A PORTUGUESE EXPERIENCE. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Systemic sclerosis (SSc) is a rare systemic rheumatic disease (SRD) characterized by small vessel inflammation and fibrosis of skin and internal organs. Pulmonary and cardiac involvement contribute to both morbidity and mortality associated with the disease. A multidisciplinary approach with strict monitoring is therefore key to attain clinical success.Objectives:To describe the organization and patient pathways of our SSc outpatient clinic.Methods:Observational study using data extracted from Reuma.pt/SSc (a subset of the Rheumatic Diseases Portuguese Register). Data extracted included demographic variables and clinical and immunological manifestations. The disease was classified according to the 2013 ACR/EULAR criteria. Our SSc clinic is managed by two dedicated Rheumatologists and up to two Rheumatology residents on a weekly basis, but it is a dynamic multidisciplinary clinic where various medical specialties collaborate closely. There are two associated subspecialty clinics (pulmonary hypertension and pulmonary fibrosis) where the Rheumatologists engage with pneumologists and cardiologists, allowing greater collaboration in the management of these patients. Patients’ data is systematically registered in Reuma.pt/SSc as a part of the routine activity of this clinic, contributing to real-world data on SSc.Results:A total of 220 patients were registered between July 2011 and June 2019. 196 (89.1%) were female, with a mean age of 58.9±14 years and a mean disease duration of 14.6±9 years. Ninety-seven patients (44.1%) had limited cutaneous SSc, 52 (23.6%) had diffuse cutaneous SSc, 35 (15.9%) had overlap SSc, 24 (10.9%) had preclinical SSc and 12 (5.4%) had SSc sine scleroderma. Raynaud phenomenon was present in 92% of the SSc patients and 40% had a history of digital ulcers. Gastrointestinal manifestations included esophageal dismotility in 39.5% of patients, gastric disease in 24.4% and intestinal involvement in 15.5%. Pulmonary involvement was found in 47.6% of SSc patients, heart disease in 43.6% and kidney involvement in only two patients. Antinuclear antibodies were positive in 92.2% of the patients, anti-centromere in 44.1%, anti-topoisomerase I antibodies in 39.1%, anti-U1RNP in 4.5% and only three patients had anti-PM-Scl and one had anti-RNA polymerase III. 31 patients were lost to follow-up and 32 died. 18 patients are currently being followed up in the pulmonary hypertension clinic and seven in the pulmonary fibrosis clinic.Conclusion:The implementation of a standardized approach with regular multidisciplinary work has proven very helpful in evaluating patients with SSc. The continuous registry of patients in Reuma.pt/SSc has been essential for patient care, research and healthcare planning.Disclosure of Interests:None declared
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Pereira CM, Veiga NJ, Amaral OP, Baptista M, Resende C, Cirnes L, Machado JC, Bastos I. The Influence of Oral Microflora on Oral Health Among a Sample of Portuguese Adolescents. Int J Epidemiol 2015. [DOI: 10.1093/ije/dyv096.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Fernandes S, Capela S, Resende C, Romeu JC, Pereira da Silva JA. Severe vertical atlanto-axial subluxation in rheumatoid arthritis. Acta Reumatol Port 2015; 40:91-92. [PMID: 25341803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Romao V, Saavedra M, Costa M, Macieira C, Vieira-Sousa E, Ramos F, Resende C, Capela S, Barros R, Polido-Pereira J, Rodrigues A, Madruga-Dias J, Campanilho-Marques R, Ponte C, Castro A, Furtado C, Fernandes S, Gonçalves M, Pereira da Silva J, Canhao H, Fonseca J. AB0413 Hepatitis B Serologic Profile and Reactivation in Rheumatic Patients Treated with Biological Therapies – Single Centre Experience. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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de Paula T, Resende C, Rossi M, Pavão M, Rehen S, Lapa e Silva J, Rezende G. Stellate cells and liver parenchyma gene transcription changes after stem cells therapy in experimental liver fibrosis and cirrhosis. Cytotherapy 2014. [DOI: 10.1016/j.jcyt.2014.01.366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Resende C, Araujo C, Duarte ML, Brito C. Rapidly lethal dermatomyositis associated with cutaneous lymphangitis carcinomatosa. Case Reports 2013; 2013:bcr-2013-010376. [DOI: 10.1136/bcr-2013-010376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ponte CB, Morais F, Campanilho-Marques R, Resende C, Pereira da Silva J. AB0491 High-resolution computed tomographic findings in patients with systemic sclerosis and their clinical correlations. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.2813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Romão VC, Saavedra MJ, Vieira-Sousa E, Costa M, Polido-Pereira J, Rodrigues AM, Ramos F, Macieira C, Capela S, Resende C, Madruga Dias J, Ponte C, Campanilho-Marques R, Castro A, Furtado C, Fernandes S, Gonçalves MJ, Pereira da Silva JA, Canhão H, Fonseca JE. AB0293 Can we safely start biological therapy in rheumatic patients with prior history of active tuberculosis? Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.2615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Romão VC, Saavedra MJ, Vieira-Sousa E, Costa M, Polido-Pereira J, Rodrigues AM, Ramos F, Macieira C, Capela S, Resende C, Madruga Dias J, Ponte C, Campanilho-Marques R, Castro A, Furtado C, Fernandes S, Gonçalves MJ, Pereira da Silva JA, Canhão H, Fonseca JE. FRI0203 Tuberculosis in rheumatic patients treated with biological therapies – is screening enough? Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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15
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Silva G, Almeida AG, Resende C, Marques JS, Silva D, David C, Amaro C, Costa P, Silva JAP, Diogo AN. 1067Myocardial fibrosis in systemic sclerosis: impact in
ventricular function and clinical presentation. Eur Heart J Cardiovasc Imaging 2013. [DOI: 10.1093/ehjci/jet070cd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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16
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Cascão R, Polido-Pereira J, Canhão H, Rodrigues AM, Navalho M, Raquel H, Neves-Costa A, Mourão AF, Resende C, da Silva JAP, Fonseca JE, Moita LF. Caspase-1 is active since the early phase of rheumatoid arthritis. Clin Exp Rheumatol 2012; 30:144. [PMID: 22272579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Accepted: 09/23/2011] [Indexed: 05/31/2023]
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17
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Cascao R, Polido-Pereira J, Canhao H, Rodrigues AM, Navalho M, Raquel H, Mourao AF, Resende C, da Silva JAP, Fonseca JE, Moita LF. Caspase-1 is active since the early phase of rheumatoid arthritis. Ann Rheum Dis 2011. [DOI: 10.1136/ard.2010.149096.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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18
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Moura RA, Canhao H, Polido-Pereira J, Rodrigues AM, Navalho M, Mourao AF, Resende C, da Silva JAP, Graca L, Fonseca JE. BAFF AND TACI mRNA expression are increased in very early rheumatoid arthritis patients. Ann Rheum Dis 2011. [DOI: 10.1136/ard.2010.149005.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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19
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Cascão R, Polido-Pereira J, Canhão H, Rodrigues AM, Navalho M, Raquel H, Mourão AF, Resende C, Fonseca JE, Moita LF. Caspase-1 is active since the early phase of rheumatoid arthritis. J Transl Med 2010. [PMCID: PMC3007779 DOI: 10.1186/1479-5876-8-s1-p35] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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20
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Mourão AF, Canhão H, Moura RA, Cascão R, Weinmann P, Rodrigues A, Pereira J, Resende C, Capela S, Pereira da Silva JA, Fonseca JE. Predictors of chronicity and the discriminative value of the new ACR/EULAR rheumatoid arthritis classification criteria in an untreated polyarthritis cohort with less than 6 weeks of disease duration. Lab Invest 2010. [PMCID: PMC3007812 DOI: 10.1186/1479-5876-8-s1-p65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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21
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Oliveira RS, Resende C, Campos J, Salgado C. [Surgical approach to sialorrhea: a casuistic review and evaluation of grade of satisfaction]. Cir Pediatr 2010; 23:211-214. [PMID: 21520552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Drooling or sialorrhea is the involuntary, passive spillage of saliva from the mouth due to inability to handle oral secretions. The medical, psychosocial and economic impact of drooling is underestimated. Treatment should always involve a multidisciplinary team and can include a medical or surgical approach. Various surgical techniques are used to manage drooling; re-routing of the salivary ducts is one of the preferred methods in more significant situations. OBJECTIVES To analyze retrospectively the group of children submitted to surgical correction of drooling in São Teotónio's Hospital and evaluate the clinical and caregiver satisfaction outcomes. MATERIAL AND METHODS We analyse the clinical process of children submitted to surgical correction of drooling. Satisfaction scores were obtained by phone interview. RESULTS Between January of 2003 and June of 2009, 16 child were submitted to surgical intervention for drooling, with a total of 17 surgeries. Most of them were males and have ages between 3 and 23 years, with the majority with ages between 10 and 15 years. All of them suffered from neurologic disease, mainly cerebral palsy. The majority were hospitalised for I to 2 days and no surgical complications were observed. In a significant percentage, good results were obtained and in 3 cases total resolution of drooling were reported. In about 44% of caregivers stayed very happy with the results of surgery. CONCLUSIONS Drooling is an important comorbility in child with neuro-muscular disease and is treatment can never be underestimated. By the analyses of the results of our surgical center, the re-routing of salivary ducts method reveals to be effective.
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Affiliation(s)
- R S Oliveira
- Departamento de Cirurgía Pedidtrica, Servicio de Pediatria, Hospital São Teotónio EPE, Viseu, Portugal.
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22
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Regalo G, Canedo P, Suriano G, Resende C, Campos ML, Oliveira MJ, Figueiredo C, Rodrigues-Pereira P, Blin N, Seruca R, Carneiro F, Machado JC. C/EBPbeta is over-expressed in gastric carcinogenesis and is associated with COX-2 expression. J Pathol 2007; 210:398-404. [PMID: 16981245 DOI: 10.1002/path.2063] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The CCAAT/enhancer-binding protein beta (C/EBPbeta) transcription factor has been associated with several cancer models. In this study, the expression of C/EBPbeta was analysed in a series of 90 gastric carcinomas (GCs). We also assessed the effect of C/EBPbeta on COX-2 expression. In normal gastric mucosa, C/EBPbeta expression was restricted to cells in the proliferative zone. In intestinal metaplasia, dysplasia, and GC of the intestinal and atypical subtypes, C/EBPbeta was over-expressed (p < 0.0001, for the association with histological type). C/EBPbeta and Ki67, a marker of cell proliferation, were also co-expressed in primary GC. We also observed an overlap between C/EBPbeta and COX-2 expression in GC. Using GC cell lines we show that C/EBPbeta can regulate the expression of endogenous COX-2 and transactivate the promoter of the COX-2 gene, depending on its methylation status. These results suggest that C/EBPbeta may be a marker of neoplastic transformation and also play an active role in gastric tumourigenesis by regulating COX-2 expression.
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Affiliation(s)
- G Regalo
- IPATIMUP - Institute of Molecular Pathology and Immunology of the University of Porto, Porto, Portugal
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Magina S, Santos J, Coroas A, Oliveira JG, Serrão P, Soares-Da-Silva P, Resende C, Pestana M. Salt sensitivity of blood pressure in patients with psoriasis on ciclosporin therapy. Br J Dermatol 2005; 152:773-6. [PMID: 15840112 DOI: 10.1111/j.1365-2133.2005.06518.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hypertension is one of the main side-effects of long-term therapy with ciclosporin. However, the influence of salt intake on the 24-h mean blood pressure of patients with psoriasis treated with ciclosporin is not known. OBJECTIVES To evaluate, in patients with psoriasis, the sodium sensitivity of the ciclosporin-induced rise in blood pressure. METHODS The 24-h ambulatory blood pressure was evaluated in 13 patients with psoriasis (age range 20-57 years) in two phases, before (phase I) and after the completion of 4 months of therapy with ciclosporin 3 mg kg(-1) daily (phase II). In both phases, the patients were studied in conditions of low sodium (LS) intake followed by a high sodium (HS) diet. RESULTS Twenty-four-hour mean +/- SD blood pressure during LS and HS intake was, respectively, 86.3 +/- 1.6 mmHg and 85.5 +/- 1.8 mmHg during phase I, and 88.5 +/- 1.5 mmHg and 91.8 +/- 2.2 mmHg (P < 0.001 vs. phase I, HS; P < 0.05 vs. phase II, LS) during phase II. The median (interquartile range) sodium sensitivity index was greater during phase II than during phase I: - 0.0028 (- 0.0071 to 0.0009) vs. 0.0065 (- 0.0055 to 0.0258) (P < 0.02). The plasma levels and the daily urinary excretion of noradrenaline did not differ between phases I and II. CONCLUSIONS The ciclosporin-induced rise in blood pressure is sodium sensitive. It is also suggested that sympathetic activation is not involved in the pathogenesis of ciclosporin-induced rise in blood pressure.
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Affiliation(s)
- S Magina
- Department of Dermatology, Hospital S. João, Portugal
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24
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Fonseca JE, Cortez-Dias N, Francisco A, Sobral M, Canhão H, Resende C, Castelão W, Macieira C, Sequeira G, Saraiva F, da Silva JAP, Carmo-Fonseca M, Viana Queiroz M. Inflammatory cell infiltrate and RANKL/OPG expression in rheumatoid synovium: comparison with other inflammatory arthropathies and correlation with outcome. Clin Exp Rheumatol 2005; 23:185-92. [PMID: 15895888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVES To evaluate if the immunofluorescence analysis of synovial tissue (ST) using antibodies against RANKL/OPG, conjugated with the immunophenotyping of lymphocytes and macrophages, could be of diagnostic and prognostic value in rheumatoid arthritis (RA) patients. METHODS 3-year prospective study of 103 consecutive patients submitted to closed needle biopsy for diagnostic purposes. ST was analyzed with routine histologic techniques and immunofluorescence, using monoclonal antibodies against RANKL, OPG, CD163, CD68, CD4, CD8, interferon-gamma and CD19. Patients were prospectively evaluated with a clinical, laboratorial and radiological protocol. At the end of the follow-up patients were divided according to the final diagnosis. Results of the initial histologic evaluation were compared between the main diagnostic groups and in RA patients histologic data was correlated with clinical and radiologic outcome measures. RESULTS The RANKL/OPG ratio and the inflammatory infiltrate were significatively higher in RA (n = 25) as compared to the same ratio observed in other inflammatory joint diseases (OIJD, n = 48) and in osteoarthritis (n = 17). The difference between RA and OIJD was specifically confirmed when the comparison involved spondyloarthropathy (n = 26). Final HAQ score and radiologic outcome were correlated with the density of intimal CD68+ macrophages. Radiologic progression was correlated with subintimal CD4+ lymphocytes and CD68+ macrophages and intimal CD68 and CD163+ macrophages. CONCLUSION The quantification of the RANKL/OPG ratio and of the number of lymphocytes in the ST might be useful to differentiate RA from other inflammatory joint diseases. The ST number of CD4+ lymphocytes and macrophages are probable predictors of radiologic progression in RA patients.
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Affiliation(s)
- J E Fonseca
- Rheumatology Department, Santa Maria Hospital, Lisbon, Portugal.
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25
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Abstract
An 86-year-old man presented with a painful reddish tumour on the scalp with a 3-month history, mental confusion with recent onset and lymphadenopathies. Histological examination of the lymph node and cutaneous lesion revealed a dense infiltrate of atypical and large B cells. There was no evidence of bone marrow invasion. According to REAL (Revised European-American Classification of Lymphoid Neoplasms), this lymphoma was considered as a diffuse large B-cell lymphoma with concurrent cutaneous and nodal involvement. Cerebral computerized tomography (CT) scan showed bone and dura mater invasion in the right parieto-occipital region with collapse of lateral ventricle. The patient was submitted to systemic chemotherapy with cyclophosphamide, vincristine and prednisolone (CVP). There was a good response with regression of the cutaneous lesion, but the patient died after the third cycle. We point out the unusual clinical presentation and aggressive behaviour of this lymphoma.
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MESH Headings
- Aged
- Aged, 80 and over
- Head and Neck Neoplasms/diagnosis
- Head and Neck Neoplasms/pathology
- Head and Neck Neoplasms/therapy
- Humans
- Lymphoma, B-Cell/diagnosis
- Lymphoma, B-Cell/pathology
- Lymphoma, B-Cell/therapy
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/therapy
- Male
- Neoplasm Invasiveness
- Scalp
- Skin/pathology
- Skin Neoplasms/diagnosis
- Skin Neoplasms/pathology
- Skin Neoplasms/therapy
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Affiliation(s)
- S Magina
- Departments of Dermatology and Venereology and Internal Medicine, Faculty of Medicine, Hospital de S. João, Alameda Prof. Hernani Monteiro, 4200 Porto, Portugal.
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Pereira Silva JA, Costa Dias F, Fonseca JE, Canhao H, Resende C, Viana Queiroz M. Low bone mineral density in professional scuba divers. Clin Rheumatol 2004; 23:19-20. [PMID: 14749976 DOI: 10.1007/s10067-003-0787-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2002] [Accepted: 07/15/2003] [Indexed: 10/26/2022]
Abstract
Scuba diving is associated with a 90% reduction in effective weight and with the loss of a weight-bearing effect on joints. These conditions are very similar to the continuous weightlessness that occurs in spaceflight and bed-rest, which are clearly associated with significant bone mass loss. Here, we studied the bone mineral density (BMD) of 66 professional scuba divers using a dual-photon densitometer, and have depicted a reduction in the BMD in comparison to a matched control group of non-divers. Our results suggest that diving is also an activity where the unloading effect alters bone metabolism, leading to a reduction in BMD.
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Affiliation(s)
- J A Pereira Silva
- Rheumatology Unit, Santa Maria Hospital, Av. Prof Egas Moniz, 1600, Lisbon, Portugal
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Magina S, Lisboa C, Resende C, Azevedo F, Amado F, Cardoso V, Almeida F, Mesquita-Guimarães J. Tuberculosis in a child presenting as asymptomatic oropharyngeal and laryngeal lesions. Pediatr Dermatol 2003; 20:429-31. [PMID: 14521563 DOI: 10.1046/j.1525-1470.2003.20513.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We describe an 11-year-old boy who had several, asymptomatic, erythematous papules in the oropharynx and larynx with recent onset, two cervical lymphadenopathies, and a painless, erythematous plaque on the right wrist with a 2.5-year history of slow growth. Histologic examination of the mucocutaneous lesions revealed a submucous infiltrate of lymphocytes and Langhans giant cells in the papules and granulomatous dermatitis in the plaque. The cervical lymph node was biopsied and on the surgical scar, an erythematous, nodular lesion developed. A biopsy specimen of this lesion showed tuberculoid granulomas with prominent caseation necrosis, and culture was positive for Mycobacterium tuberculosis. The Mantoux test was strongly positive with a vesicular response. A diagnosis of mucocutaneous lupus vulgaris and scrofuloderma secondary to cervical tuberculous lymphadenitis was made. Two months after initiation of antituberculosis therapy there was a complete resolution of mucous lesions and healing with atrophic scars on the neck and wrist. This is a rare presentation in the literature and reminds clinicians that tuberculosis should be kept in mind in the differential diagnosis of oral cavity lesions.
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Affiliation(s)
- S Magina
- Department of Dermatology, Faculty of Medicine, Hospital S. João, Porto, Portugal.
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28
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Abstract
The association between hepatitis C virus (HCV) infection, the presence of mixed cryoglobulinemia and peripheral neuropathy is well-documented (Apartis et al., 1996). HCV is the chief cause of essential mixed cryoglobulinemia (type II cryoglobulinemia) with cryoglobulins present in up to half of patients with HCV infection (Akriviadis et al., 1997). More recently it has been stated that peripheral polyneuropathy may be associated with HCV chronic infection without mixed cryoglobulinemia (Lidove et al., 2001). Patients usually present with a clinical and electrophysiology--predominantly sensory axonopathies (Apartis et al., 1996; Heckmann et al., 1999) or less frequently with fulminating vasculitis and mononeuropathy multiplex syndrome (David et al., 1996)--especially when associated with cryoglobulinemia. We report, for the first time, the association between pure motor-axonal polyneuropathy and HCV infection without cryoglobulinemia.
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Affiliation(s)
- J Costa
- Department of Neurology, Hospital de Santa Maria, Lisbon, Portugal
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29
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Fonseca JE, Canhão H, Costa Dias F, Leandro MJ, Resende C, Teixeira Da Costa JC, Pereira Da Silva JA, Viana Queiroz M. Amyloidosis in a series of 964 Portuguese rheumatoid arthritis patients: comment on the article by Myllykangas-Luosujärvi et al. Rheumatology (Oxford) 2001; 40:944-5. [PMID: 11511768 DOI: 10.1093/rheumatology/40.8.944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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30
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Pinto GM, Gonçalo MM, Resende C, Pereira A. [Psoriasis]. ACTA MEDICA PORT 2001; 14:219-45. [PMID: 11475988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
The purpose of these Guidelines is to summarize the most relevant features of the pathogenesis, clinical presentation and treatment of psoriasis. Patient education should include the deleterious effects that some drugs, trauma, alcohol, infection and stress may have on psoriasis; the beneficial action of careful sunlight exposure should also be emphasized. Topical treatment--emollients, keratolytics, coal tar preparations, anthralin, corticosteroids, calcipotriol--is essential for the control of plaque-type psoriasis and is also an important adjuvant therapy in more severe cases; the relative strength and the potential adverse effects of topical steroids are also referred. UV therapy (phototherapy and photochemotherapy) is recommended for psoriasis with generalized plaque, guttate or palmoplantar psoriasis refractory to topical therapies. Systemic therapy--retinoids, methotrexate, cyclosporine--is limited to severe plaque psoriasis unresponsive to topical or UV therapy, erythrodermic, pustular or arthropatic psoriasis. Combination and rotational therapies are likely to reduce the risks of each individual therapy and should be encouraged. Finally, a few diagrams are included, pointing out the scientific validity of the therapies currently available to help clinicians to optimize their management of psoriasis.
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Affiliation(s)
- G M Pinto
- Serviço de Dermatologia, Hospital Curry Cabral, Lisboa
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31
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Fonseca JE, Canhão H, Resende C, Saraiva F, da Costa JC, Pimentão JB, Carmo-Fonseca M, da Silva JA, de Queiroz MV. Histology of the synovial tissue: value of semiquantitative analysis for the prediction of joint erosions in rheumatoid arthritis. Clin Exp Rheumatol 2000; 18:559-64. [PMID: 11072594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
OBJECTIVE Routine histologic techniques are still the main procedure in the study of the synovial biopsy. The relationship between the typical histological changes of rheumatoid synovium and clinical manifestations has not been studied in detail. METHODS With the aim of determining whether a simple semiquantitative method of evaluating the changes in closed synovial biopsies was of clinical value in assessing both the diagnosis and prognosis of rheumatoid arthritis (RA) patients, we evaluated retrospectively 72 synovial biopsy specimens (26 RA patients, 30 patients with other inflammatory diseases and 16 osteoarthritis patients). Scores (0-10) were assigned to each biopsy specimen for each of 6 histologic features: synoviocyte hyperplasia; fibrosis in the subsynovial layer; proliferating blood vessels; perivascular infiltrates of lymphocytes; focal aggregates of lymphocytes; and diffuse infiltrates of lymphocytes. Scores were compared between the 3 groups and also between the RA subgroups with early and late disease; positive and negative rheumatoid factor; with and without joint erosions; and with and without systemic disease. RESULTS Significant differences in the mean global score (mean of the 6 scores) were found both between RA and osteoarthritis and between other inflammatory diseases and osteoarthritis (p < 0.01). The mean global score for RA was higher than the mean global score obtained for the other inflammatory diseases, but the difference was not significant. We found a significantly higher mean global score in the RA patients with erosions in comparison to the RA patients without erosions, this difference being particularly evident for the lymphocyte perivascular infiltrate (p < 0.05). There were no significant differences between the other RA subgroups. CONCLUSION In this study we have identified differences, using routine histologic techniques, between the rheumatoid synovial membrane of patients with and without erosions. Based on our present observations we suggest that the intensity of inflammatory histological features and, in particular, a high percentage of vessels with perivascular lymphocyte infiltrate might be of prognostic value in RA.
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Affiliation(s)
- J E Fonseca
- Rheumatology Unit, Santa Maria Hospital, Lisbon, Portugal
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Ferreira P, Morais L, Costa R, Resende C, Dias CP, Araújo F, Costa E, Barbot J, Vilarinho A. Hydrops fetalis associated with erythrocyte pyruvate kinase deficiency. Eur J Pediatr 2000; 159:481-2. [PMID: 10923218 DOI: 10.1007/s004310051314] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
UNLABELLED The authors report a case of hydrops fetalis due to severe pyruvate kinase deficiency, the most unusual clinical manifestation of this disease. CONCLUSION Pyruvate kinase deficiency, as other erythrocyte enzymopathies, must be considered in the differential diagnosis of non-immune hydrops fetalis. This has important implications for clinical investigations, therapy and genetic counselling.
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Affiliation(s)
- P Ferreira
- Unidade de Cuidados Intensivos, Hospital de Crianças Maria Pia, Porto, Portugal
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da Costa MG, Curto MM, Davies SG, Duarte M, Resende C, Teixeira FC. Novel synthesis of indazoles from (η6-arene)tricarbonylchromium complexes. J Organomet Chem 2000. [DOI: 10.1016/s0022-328x(00)00215-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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35
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Fonseca JE, Canhão H, Costa Dias F, Leandro MJ, Resende C, Teixeira da Costa JC, Pereira da Silva JA, Viana Queiroz M. Severity of rheumatoid arthritis in Portuguese patients: comment on the article by Drosos et al and on the letter by Ronda et al. Arthritis Rheum 2000; 43:470-2. [PMID: 10693895 DOI: 10.1002/1529-0131(200002)43:2<470::aid-anr36>3.0.co;2-d] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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36
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Saraiva JM, Dinis A, Resende C, Faria E, Gomes C, Correia AJ, Gil J, da Fonseca N. Schimke immuno-osseous dysplasia: case report and review of 25 patients. J Med Genet 1999; 36:786-9. [PMID: 10528861 PMCID: PMC1734237 DOI: 10.1136/jmg.36.10.786] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Immuno-osseous dysplasia is characterised by spondyloepiphyseal dysplasia, lymphopenia with defective cellular immunity, and progressive renal disease. We describe a patient with a severe form of the disease, review the features of another 24 patients, and discuss the previous classification. The differences between the two groups are not striking, and although similarities are greater between affected sibs, the same diagnosis of Schimke immuno-osseous dysplasia should apply to them all. The aetiology and physiopathology of this rare osteochondrodysplasia of presumed autosomal recessive inheritance remain unknown.
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Affiliation(s)
- J M Saraiva
- Consulta de Genética, Hospital Pediátrico de Coimbra, Portugal
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37
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Antunes I, Resende C, Granjo E, Mesquita-Guimãres J. Recombinant human erythropoietin alpha in the correction of anaemia in epidermolysis bullosa. J Eur Acad Dermatol Venereol 1999; 12:181-2. [PMID: 10343955 DOI: 10.1111/j.1468-3083.1999.tb01016.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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38
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39
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Neves C, Resende C, Do Rosário M, Ferreira AF. [Thermal colorectal lesions]. ACTA MEDICA PORT 1996; 9:407-8. [PMID: 9254543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A case report of thermal burns of the rectum and colon in a 94-year-old woman. The thermal lesions were caused by a scalding water enema. Flexible sigmoidoscopy was useful in documenting the extension of the lesions and histology was helpful in documenting the diagnosis. The authors review the enema's complications.
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Affiliation(s)
- C Neves
- Serviço de Cirurgia Geral, Hospital de S. Francisco Xavier, Lisboa
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Neves C, Resende C, Ferreira AF. [Acute pancreatitis of biliary etiology. The case histories of the Department of General Surgery of S. Francisco Xavier Hospital (1990-1993)]. ACTA MEDICA PORT 1995; 8 Suppl 1:S13-6. [PMID: 7653299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Gallstones and alcohol are the most important causes of acute pancreatitis, accounting for 80% of cases. One hundred and four cases of Acute Gallstone Pancreatitis were retrospectively studied, representing 39.5% of all cases of Acute Pancreatitis that have been treated between 1990-93. Abdominal ultrasound, demonstrating gallstones in 95% of the cases, was a very useful examination in the initial study of these patients. ERCP with sphincterotomy was performed in 25 patients: 6 in a urgent basis and the others as elective procedure. Gallstones have been treated during the initial admission in 80.6% of the cases and the others at a second admission: ERCP with sphincterotomy in 14 patients as the only etiologic treatment, open cholecystectomy in 50 cases and laparoscopic cholecystectomy in 29 cases. The overall mortality rate was 3.8%--four cases.
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Affiliation(s)
- C Neves
- Serviço de Cirurgia Geral, Hospital S. Francisco Xavier, Lisboa
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Correia O, Delgado L, Ramos JP, Resende C, Torrinha JA. Cutaneous T-cell recruitment in toxic epidermal necrolysis. Further evidence of CD8+ lymphocyte involvement. Arch Dermatol 1993; 129:466-468. [PMID: 8466217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
BACKGROUND Toxic epidermal necrolysis (TEN) is a life-threatening disease with severe mucocutaneous shedding. Although it is widely accepted that immune mechanisms are at play, the pathophysiology of TEN is still unknown. We studied the blister fluid inflammatory cells in three drug-related cases to further define the suspected T-cell involvement in TEN. OBSERVATIONS A peripheral blood lymphopenia, especially of CD4+ T lymphocytes, was associated with a high lymphocytic cellularity of the blister fluid. In two cases, immunophenotyping of blister fluid lymphocytes showed a predominance of the CD8 phenotype. Furthermore, using two-color flow cytometry in one patient, we could show the predominance of CD8+ CD29+ lymphocytes and CD45RA- negative cells. CONCLUSIONS Our findings point to a cutaneous recruitment of antigen-primed and cytotoxic T cells in TEN, further supporting the involvement of CD8+ lymphocytes in TEN pathogenesis and its immune mediation.
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Affiliation(s)
- O Correia
- Department of Immunology, Faculty of Medicine, Hospital S João, Porto, Portugal
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Pinto AR, Maciel LS, Carneiro F, Resende C, Chaves FC, Freitas AF. Systemic nodular panniculitis in a patient with alpha-1 antitrypsin deficiency (PiSS phenotype). Clin Exp Dermatol 1993; 18:154-5. [PMID: 8481993 DOI: 10.1111/j.1365-2230.1993.tb01000.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The association of alpha-1 antitrypsin deficiency (PiZ phenotype) with systemic nodular panniculitis has been well documented. Despite reports of cases of systemic nodular panniculitis associated with other alpha-1 antitrypsin deficiency phenotypes, it is still not known if this association is fortuitous rather than causal. We report a case of systemic nodular panniculitis associated with alpha-1 antitrypsin deficiency (PiSS phenotype), with clinico-pathological features similar to those reported in cases associated with the PiZ phenotype.
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Affiliation(s)
- A R Pinto
- Department of Medicine 2, Hospital de S. João, Porto, Portugal
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Abstract
The classical treatment of severe forms of dermatomyositis includes high doses of steroids and/or cytotoxic agents. Acute forms are frequently life threatening. Because cyclosporine is a fast-acting immunosuppressive drug, it appears to be a good candidate for the treatment of refractory forms of acute dermatomyositis. We report a dramatic improvement of a severe, acute, steroid-resistant adult form after cyclosporine administration. A rapid clinical and biochemical improvement is reported, and the reversibility of immunologic abnormalities is emphasized.
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Affiliation(s)
- O Correia
- Department of Dermatology, Oporto Medical School, Hospital S. João, Porto, Portugal
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Resende C, Sanga NM, Paschoalotti AL, Zerbini CA. [Neurologic manifestations in systemic lupus erythematosus]. Rev Paul Med 1988; 105:289-93. [PMID: 3043631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Cabral JM, Monteiro AC, Andrade JA, Fortunato JM, Dias MC, Braga A, Guimarães JM, Resende C, Vaz AL, Araújo D. [Hemostatic and vascular parameters in psoriasis. Preliminary study]. ACTA MEDICA PORT 1988; 1:191-5. [PMID: 3202006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Latorre LC, Mion D, Zerbini CA, Pastor EH, Resende C, Fidelis TS, Gabriel Júnior A, Assad RL, Cossermelli W. [Treatment of renal crisis in progressive systemic sclerosis with captopril]. Rev Hosp Clin Fac Med Sao Paulo 1985; 40:18-21. [PMID: 3903950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Luna RF, Resende C, Tishler JM, Aldrete JS, Shin MS, Rubin E, Rahn NH. Computerized tomography in evaluation of hepatic neoplasms. South Med J 1984; 77:1015-9. [PMID: 6087466 DOI: 10.1097/00007611-198408000-00020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
We reviewed our experience with computerized tomography (CT) of the abdomen in 212 patients with histologically documented liver neoplasms seen during a 30-month period. The CT findings in cavernous hemangioma and focal nodular hyperplasia were specific, and permitted accurate diagnosis of this lesion before biopsy. The CT appearance of all other lesions was variable. We consider CT useful in providing an accurate evaluation of the intrahepatic and extrahepatic extent of the neoplasm.
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Magalhães MC, Resende C, Magalhães MM. Effects of cycloheximide on the ultrastructure of the zona fasciculata of the young rat adrenal. Acta Endocrinol (Copenh) 1978; 88:149-56. [PMID: 580529 DOI: 10.1530/acta.0.0880149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The ultrasturctural changes induced in the cells of the young rat adrenal zona fasciculata by cycloheximide are studied. Thirty minutes after administration of doses producing inhibition of protein synthesis (1.5 and 4.5 mg/kg body weight) there was a significant increase in the relative volume of the nucleolus, as shown by stereologic methods, which was accompanied by extensive perinucleolar chromatin caps. In the cytoplasm, membranous whorls were observed in several organelles and the background cytoplasm, but the volume fractions of the organelles were not significantly altered. Nucleolar changes were interpreted as suggesting that the inhibition of cytoplasmic protein synthesis may be accompanied by an enhanced formation of nucleolar proteins.
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