Acta Medica Port
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As we enter the 21st century, growth of the elderly population, the costs of care, and the advances of medical science and technology will continue to have an impact on the patient-physician relationship. Transformation of the health care system will also raise ethical issues inherent to changing roles. The special nature of Alzheimer's patients and the natural course of their disease require special care on the part of physicians to meet the ethical challenges and establish medical goals, in conjunction with their patients and their families. ⋯ Finally, comfort is the last and the most important goal of care in late stages of dementia, using appropriate medical strategies and eliminating aggressive interventions (cardiopulmonary resuscitation, acute care setting, tube feeding and antibiotic treatment). The future work will focus on promoting more evidence-based decision-making on treatment and guidelines for prognostic information. Physician must be knowledgeable about broadly intersecting medical, legal, finance and ethics, underlying the long-term management of dementia.
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A retrospective study was conducted. ⋯ The results of this study further demonstrate the considerable potential for neurologic recovery after TSCI, emphasizing the importance of the rehabilitation investment continuity, especially for the ones with incomplete cord injury.
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Although previous studies show that physicians generally agree that nutrition knowledge is important for their daily clinical practice, several other studies report their poor knowledge of the subject. One of the strongest reasons given for this is the non-incorporation of Nutrition as a compulsory subject for the medical sciences degree. Dietary counselling and assessment of the patients' nutritional status don't seem to be systematic. ⋯ About 95% stated they provided written or verbal nutritional guidance, and most of the physicians had already sought the assistance of a nutritionist. This study shows that the clinical body of the CHVR/PR is aware of the importance nutrition knowledge has in their daily practice. It must be noted, though, that although almost one third of the physicians rate their nutrition knowledge poor, most of them provide nutritional guidance to their patients.
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Neuroepithelial cysts, heterogeneous group of lesions, are fluid collections similar to CSF, lined by epithelial cells, frequently found in the lateral ventricles and choroidal fissure; intraparenchymal cysts are relatively uncommon. We report CT and MRI imaging findings of four intraparenchymal neuroepithelial cysts, two of which have histological confirmation of the diagnosis.
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Paraneoplastic neurological syndromes (PNS) are remote effects of cancer, which are not caused by invasion of the tumour or its metastasis, but presumably immunologic mediated. They developed in less than 1% of patients with systemic cancers, most Limbic encephalitis (LE) is the most common clinical paraneoplastic syndrome attainting the CNS (Central Nervous System), and it is characterized by involvement of hippocampus and amygdala; LE is also the only one with clearly defined imaging features. We report a 64 year old man, former smoker, which presented multiple paraneoplastic syndromes, namely LE, opsoclonus-myoclonus, subacute cerebellar degeneration, brainstem encephalitis, sensory-motor neuropathy and inappropriate antidiuretic hormone secretion syndrome (SIADH); these syndromes were identifiable in the clinical and imaging examination, confirmed by the neuro-pathological study. ⋯ A mediastinal adenopathy depicted a metastasis from low differentiated neoplasm cells, with some signs of neuroendocrine differentiation. With this case we provide a comprehensive illustration of the PNS, from a clinical, imaging and pathological point of view. This report also emphasises the importance of a diagnosis based on early clinical and imaging findings, given that, in most cases the cancer is not apparent.