Acta médica portuguesa
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Fibromyalgia syndrome (FMS) affects predominantly females and is characterised by widespread musculoskeletal pain, fatigue, insomnia, nonrefreshing sleep, diffuse stiffness and other organic and psychic signs and symptoms. Diagnosis is essentially based on the 1990 American College of Rheumatology Classificative Criteria, but if, in some cases, they are not completely fulfilled, diagnosis is not excluded in a particular patient. ⋯ Tricycles antidepressants (i.e. amitriptilin) and some muscle relaxants (i.e. ciclobenzaprine) have demonstrated some beneficial effect contrary to the classic antirheumatic drugs (NSAID; corticosteroids; etc.). Physical exercise, multidisciplinary support (behavioural therapy, physical agents; etc.) and patient education are some of the other approaches which contribute to the correct management of FMS.
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Acta médica portuguesa · Dec 1994
Review Case ReportsCerebral toxoplasmosis after renal transplantation. Case report and review.
Infection caused by Toxoplasma gondii is a frequent event in Portugal. When this occurs in immunocompetent individuals, it is rarely a matter of concern; the contrary occurs with immunosuppressed patients or in pregnancy. Transplant patients are treated with immunosuppressive drugs which mainly disturb their mechanisms of cellular immunity, and that opens the way to infections by opportunistic intracellular microorganisms. We recently treated a renal transplant patient who suffered from cerebral toxoplasmosis, and this provided an opportunity for a review of the other 20 patients reported in medical literature to date.
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Questions of medical responsibility of doctors working at the emergency services of the public hospitals have been increasing during recent years in Portugal. Several reasons may be contributing to the present situation and some of them are analysed: the organization of the service, the triage, the team work and the co-responsibilization of the hospital administration. The sharing of the responsibility among these several entities is discussed within the framework of the Portuguese bylaws regarding the responsibility in general and that of the doctors in particular.
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Acta médica portuguesa · Jul 1994
Review Case Reports[Acute polyradiculoneuritis associated with boutonneuse fever].
We have recorded three cases of Mediterranean fever harboring peripheral nerve involvement. According to the time of occurrence of the neurological symptoms, the cerebrospinal fluid analysis and electromyographic features, we admit that the peripheral nervous system can be involved in two ways in this disease. One due to the direct action of the pathogenic agent, giving place to a vasculitis. The other by an immunological mechanism originating a Guillain-Barré syndrome.
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The presence of secondary effects following the administration of chemotherapeutic drugs is an important limitation to cancer therapy. Of these, cardiotoxicity is of crucial importance due to its negative influence on survival. The anthracyclines and cyclophosphamide are the most important cardiotoxic antineoplastic agents currently used. ⋯ Other chemotherapeutic agents like cyclophosphamide are associated with the presence of myopericarditis which is sometimes fatal. The cardiotoxic effects of anticancer treatment with 5-fluorouracil, mitoxantrone, carmustine, amsacrine and interferon are less frequent and usually more benign. Finally we discuss bone marrow transplantation and its related cardiotoxicity.