Acta médica portuguesa
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One ethical dilemma which neonatologists are faced with on a regular basis is selective non-treatment, that is, clinical decisions made after the birth of a liveborn infant to withhold or to withdraw treatment in certain circumstances. Although the outcome of extremely preterm of critically ill infants has significantly improved over the last decade, many are often left to die at birth by withholding resuscitation or neonatal intensive care. Criteria for initiating life-sustaining treatment must be developed with proper ethical considerations. ⋯ The decision-making process of selective non-treatment should involve less medical paternalism and more informed parental involvement. The process is built on trust between the neonatal staff and parents, and requires time, information, honesty and empathy. Ethical issues must be approached with extreme responsibility, extraordinary sensitivity and heroic compassion.
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Acta médica portuguesa · Feb 1997
Comparative Study[A comparison of 4 pregnancy assessment scales (CRIB, SNAP, SNAP-PE, NTISS) in premature newborns. Clinical Risk Index for Babies. Score for Neonatal Acute Physiology. Score for Neonatal Acute Physiology-Perinatal Extension. Neonatal Therapeutic Intervention Scoring System].
In recent years a number of neonatal risk scores have been developed in order to assure a more accurate evaluation of results obtained by different NICU's. It is noteworthy that throughout the years an effort has been made to adapt the scores to the specific neonatal problems and to make them easier to use. We felt that it would be important to compare various scores (CRIB, SNAP, SNAP-PE, NTISS) in a population of premature infants. ⋯ The area under the ROC curve (for predicting in-hospital mortality) in each score was: CRIB 0.90; SNAP 0.88; SNAP-PE 0.88; NTISS 0.85. The CRIB score was easier to perform (only 5 minutes, in contrast to 20-30 minutes for the other scores). From this study CRIB score is apparently a suitable and accurate method easily performed in clinical practice.
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Acta médica portuguesa · Jan 1997
Review Case Reports[Aplastic anemia. Alternative treatment by bone marrow transplantation].
We report a case of a 25-year-old woman, with the diagnosis of severe aplastic anemia without a histocompatible sibling donor for bone marrow transplantation. The patient has been treated successfully with a combination of two immunosuppressive agents, cyclosporine and antilymphocyte globulin, after not responding to primary therapy with corticosteroids and growth factors. She showed a complete response to treatment, with transfusional independence, after a follow-up of 14 months. The pathophysiology of aplastic anemia, the mechanism of action and secondary effects of these treatments are discussed.
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Acta médica portuguesa · Dec 1995
Case Reports[Autoimmune hemolytic anemia and ulcerative colitis].
Although several associations of autoimmune disorders with ulcerative colitis have been reported, autoimmune hemolytic anemia is extremely rare. We report a case of a 35 year-old white woman with a twelve-year history of mild ulcerative colitis treated in the last 5 years with 5-amino-salycilic acid who developed a severe autoimmune hemolytic anemia. We discuss some particular aspects of the association of these two immunologically mediated disorders as well as the controversial aspects of autoimmune hemolytic anemia therapy in this context.
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Acta médica portuguesa · Jul 1995
Review[Ret proto-oncogene mutations associated with type 2 multiple endocrine neoplasms (MEN 2). Clinical implications].
Multiple endocrine neoplasia type 2 (MEN 2) is an autosomal dominant cancer syndrome. Clinical features and diagnostic aspects of this syndrome are reviewed with a focus on progress biochemical screening to genetic analysis of those at risk. The clinical implications resulting from the application of the new methods of molecular biology are discussed.