Vitorino Modesto dos Santos

Universidade Católica de Brasília, Brasília, Federal District, Brazil

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Publications (111)66.32 Total impact

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    ABSTRACT: We report the case of a 19-year-old male patient admitted to hospital with fever, asthenia, vomiting, abdominal and chest pains, cough with yellowish sputum, and hypotension. Laboratory tests showed leukocytosis and high creatine phosphokinase levels, without hyperbilirubinaemia or renal failure. The tomographic images of the chest and abdomen showed a right basal pneumonia and acalculous cholecystitis. The electrocardiograms revealed significant characteristics of acute pericarditis. Specific serology for leptospirosis done in the second and third weeks of disease showed positive results. The use of ceftriaxone 1g intravenously, twice a day for 7 days, resulted in an overall clinic improvement. The role of the suspicion index for diagnosis of leptospirosis is emphasized in anicteric patients, as well as the unsuspected possibility of pulmonary, pericardial and gallbladder involvement.
    09/2014; 22(3):236-40.
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    ABSTRACT: Introduction: Cardiovascular diseases (CVDs) are the leading cause of death in terminal patients with chronic kidney failure (CKF). Diverse risk factors are involved in the pathogenesis, and are classified as traditional, which affect the general population; and non-traditional, which are peculiar to patients with CKF. Secondary hyperparathyroidism, a non-traditional and common factor in CKF, can cause an increased rate of bone absorption with mobilization of calcium and phosphorus. If the product of calcium x phosphorus is increased, the solubility of this ionic pair may be exceeded and deposition of calcium phosphate in cardiac and vascular tissues occur (called metastatic calcification). Objective: To verify eventual relationship between the thickness of the common carotid artery and the levels of PTH in patients with CKF. Methods: Evaluations by Doppler ultrasonography were performed to measure the width of the carotid artery wall and to search for possible correlations between different values of PTH serum levels, mineral disturbances and traditional risk factors in the carotid changes found in individuals with dialytic CKF and secondary hyperparathyroidism. Results: Differences in the cholesterol level and age were observed in patients with signals of arterial calcification. A significant relationship was also observed between the PTH serum levels and the carotid artery wall thickness (r = 0.31, p = 0.03). Conclusion: Data from this study show the possible concomitance of traditional factors and factors related to CKF in the genesis of CVDs in uremia.
    Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia. 09/2014; 36(3):315-319.
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    ABSTRACT: Pachyonychia congenital (PC) is a rare autosomal dominant genodermatosis characterized hyperkeratosis affecting the nails and palmoplantar areas, oral leukokeratosis, and cystic lesions. A 39-year-old woman with PC type 1 (Jadassohn-Lewandowsky syndrome) and B-cell lymphoma is described. No similar disorders or parental consanguinity were found in her family. Typical features of PC developed since her early childhood and the diagnosis of B-cell lymphoma was established seven years ago, without a clear causal relation between these entities. Despite inherent limitations of a single case, this report may contribute to PC understanding.
    Acta medica Iranica 07/2014; 52(7):578-81.
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    ABSTRACT: Giant cystadenocarcinomas of the ovary are rarely described conditions. The authors describe a 57-year-old Brazilian woman who presented with an increase in abdominal girth in February 2003. Imaging studies showed a giant abdominal pelvic mass with probable origin in the right ovary. Cancer antigen-125 was elevated, while carcinoembrionic antigen and alpha-fetoprotein were normal. Total abdominal hysterectomy, bilateral salpingoophorectomy and omentectomy were done. The mass weighed 40Kg, and the histopathology study revealed a mucinous cystadenocarcinoma. She underwent chemotherapy with paclitaxel and cisplatin with no side effects. Under follow-up for more than 10 years, she is asymptomatic and with normal imaging and laboratory parameters, including the cancer antigen-125 marker. This huge tumor evolved for a long time unsuspected and without metastases in a patient from a developing region. The diagnostic and management challenges posed by this unexpected and unusual presentation of an ovarian cystadenocarcinoma are discussed.
    Journal of Medical Case Reports 03/2014; 8(1):82.
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    ABSTRACT: The authors describe the case of a renal transplant patient who developed late infective endocarditis associated with an intracardiac fragment of a catheter inserted 16 years before. Clinical presentation was anemia of undetermined cause and weight loss. Three blood cultures were positive for Burkholderia cepacia. Transesophageal echocardiography revealed a foreign body in the right atrium and right ventricle, confirmed by computed tomography. The patient underwent intravenous antibiotic therapy, followed by cardiac surgery to remove the foreign body. There were no postoperative complications, with improvement of anemia and stabilization of renal function.
    Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology. 02/2014;
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    ABSTRACT: The authors describe the case of a renal transplant patient who developed late infective endocarditis associated with an intracardiac fragment of a catheter inserted 16 years before. Clinical presentation was anemia of undetermined cause and weight loss. Three blood cultures were positive for Burkholderia cepacia. Transesophageal echocardiography revealed a foreign body in the right atrium and right ventricle, confirmed by computed tomography. The patient underwent intravenous antibiotic therapy, followed by cardiac surgery to remove the foreign body. There were no postoperative complications, with improvement of anemia and stabilization of renal function.
    Revista Portuguesa de Cardiologia. 01/2014;
  • Anales del sistema sanitario de Navarra 08/2013; 36(2):339-345. · 0.35 Impact Factor
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    ABSTRACT: A 21-year-old mole was admitted because of fever, fatigue, headache, pharyngitis, abdominal pain, loss of appetite, vomiting and dark urine for three days. The patient denied recent use of medicines or any other drug. His physical examination disclosed jaundice, hepato-splenomegaly, whitish-yellow covered tonsils, bilateral anterior and posterior cervical lymph node enlargement associated with edema on the face and neck. Routine blood tests detected abnormalities in serum bilirubins and liver enzymes (total bilirubin: 14.5 mg/dl, direct-reacting bilirubin: 12.9 mg/dl, AST: 697 U/l, ALT: 619 U/l, alkaline phosphatases: 260 U/l, and GGT: 413 U/l). Serological tests showed negative results for viral hepatitis, cytomegalovirus, HIV-1 and HIV-2, and toxoplasmosis markers, while serology for recent infection by EBV was positive (IgM: 70 and 29 U/ml; EBV IgG: 25 and 156 U/ml). Although infrequently, EBV infection can cause acute hepatitis with accentuated cholestatic jaundice (5% of cases), which may constitute an additional diagnostic challenge for primary care physicians. The patient improved with supportive management and was discharged after 12 days. This case study might contribute to increase the suspicion index about acute hepatitis related to EBV.
    Revista medica de Chile 07/2013; 141(7):917-21. · 0.36 Impact Factor
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    ABSTRACT: A 76-year-old male with adenocarcinoma on the right lung underwent five cycles of chemotherapy with pemetrexed disodium, cisplatin, and dexamethasone. Imaging studies of control showed a node in a cavitary lesion on the left lung, and the main hypothesis was Aspergillus infection. PCR was utilized and contributed to establish the early diagnosis in this patient with invasive aspergillosis. Furthermore, the species Aspergillus fumigatus was characterized by its growing at 50 °C but not at 10 °C, typical culture features, and presence of subclavate vesicles. Diagnosis criteria for Aspergillus pulmonary infection include characteristic clinical and imaging findings, elevated C-reactive protein and erythrocyte sedimentation rate, positive specific serological test, and isolation of Aspergillus from bronchoalveolar cultures. Molecular methods, as PCR, have been useful to complement the conventional microbiological investigations in immunocompromised people with invasive fungal infections. The patient was successfully treated with a schedule of voriconazole 4 mg/kg intravenous infusion every 12 h for 21 days and then switched to oral administration of 200 mg twice a day. He has been comfortable, maintaining normal vital signs, and the results of the periodical microbiologic tests of control are negative. Pathogenesis of invasive aspergillosis in patients with lung cancer is not completely understood. Case studies may contribute to a better knowledge about Aspergillus infection in this setting.
    Mycopathologia 04/2013; · 1.65 Impact Factor
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    ABSTRACT: We report the case of a man with a diagnosis of invasive gastric adenocarcinoma associated with scattered osteoblastic metastases. This 65-year-old patient was admitted with nausea, vomiting and abdominal pain, in addition to loss of weight (13 Kg in 3 months). Upper digestive endoscopy revealed extensive infiltrating changes in the body of the stomach, and histopathologic data confirmed the diagnosis of a Borrmann IV gastric adenocarcinoma. Complementary exams were indicative of a gastric cancer with bone metastases, characterized by disseminated osteoblastic images of the scintigraphy of the skeleton. Palliative chemotherapy was the treatment of first choice. High serum levels of CA 19-9, CEA and alkaline phosphatase can constitute useful indicative tools of this challenging condition. Images from a scintigraphy study of the skeleton can characterize the type and extension of bone metastases. The aim of this case study is to report a case of a very uncommon condition, considering that disseminated osteoblastic metastases rarely develop in this kind of tumor.
    Anales del sistema sanitario de Navarra 04/2013; 36(1):153-157. · 0.35 Impact Factor
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    ABSTRACT: We report a 38-year-old woman presenting with febrile neutropenia, acute myeloid leukemia (AML) and invasive mucormycosis. Bone marrow aspirate was characteristic of AML minimally differentiated (WHO classification 2008). Flow cytometric immunophenotyping analysis showed blasts positive for CD7, CD33, CD34, CD71, CD117, HLA-DR, MPO, and TdT, with normal karyotype (46, XX), and the absence of the FLT3-ITD and NPM1 mutations. The patient's management included chemotherapy with cytarabine and idarubicin, and treatment with liposomal amphotericin B, deferasirox, hyperbaric oxygen therapy, and antibiotics. Nowadays, she is in complete hematological remission, and CT images of control are normal. Invasive mucormycosis is an uncommon and severe condition, which involves diagnosis and treatment challenges. Clinical features and predisposing factors should be highlighted in order to enhance the suspicion index, contributing to early diagnosis and disease control. Our aim is to report classical features of this uncommon condition and to emphasize usual management challenges.
    Mycopathologia 02/2013; · 1.65 Impact Factor
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    ABSTRACT: We describe a 69-year-old-woman with antecedent of breast cancer and recent transitory neurological symptoms. Physical examination showed yellow to orange skin pigmentation, more conspicuous on her palms and soles, while discoloration changes were absent in the eye and oral mucous membranes. Routine laboratory findings were not indicative of hemolytic anemia, liver or bile disorders, nephrotic syndrome, hypothyroidism or diabetes mellitus. We emphasize the role of her excessive ingestion of papaw and tomato. These foods are rich in carotenoids (β-carotene and lycopene), which are associated with pigmentation disorders. The skin discoloration improved in about two months after correction of the inadequate diet. Major concerns about differential diagnosis of yellow skin pigmentation are also highlighted.
    Acta medica Iranica 01/2013; 51(3):195-8.
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    ABSTRACT: A 62-year-old male patient presenting with schizophrenia, arterial hypertension, and non-dialysable renal failure was referred to our service because of acute urinary infection. He was chronically using amlodipine, quetiapine, clonazepan, and levopromazine. Since a young age, he had undergone dermatological evaluations, including skin biopsies, because of recurrent episodes of desquamative plaques over the skin of extensor regions. There was no evidence of joint involvement nor any classical nail deformities, and he had often used oral or topical corticosteroids to control the cutaneous lesions. During the last two years, he claimed pruritus on the eyelids and periorbital areas. On admission, he was obese, hypertensive, without lymph node enlargements or visceromegaly; and presented with an ocular mucopurulent discharge, erythematous changes and inspissations of the eyelids. Ophthalmologic evaluation detected blepharitis and keratoconjunctivitis, and ruled out pterygium, pinguecula, uveitis, cataracts and glaucoma; but moderate retinal vascular changes of arterial hypertension were found. Multiple scaling plaques were observed on the buttocks, elbows, ankles, and distal interphalangeal joints, in addition to crops of vesicles in the plantar regions (Figure 1). Laboratory data confirmed a diagnoses of bacterial conjunctivitis and urinary infection, and these were well controlled with moxifloxacin eye drops, and intravenous ceftriaxone. He was then discharged to outpatient surveillance at Dermatology and Ophthalmology.
    Marmara Medical Journal 01/2013;
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    ABSTRACT: Se presenta el caso de un varón de 71 años con estenosis aórtica diagnosticada diez años antes, que acude al hospital por disnea durante dos meses y reciente hemorragia digestiva baja. La analítica y la endoscopia oral y colonoscopia realizadas en el momento de la admisión revelaron anemia y angiodisplasia cecal con sangrado activo. El ecocardiograma mostró estenosis aórtica severa. El síndrome de Heyde clásico está descrito como asociación entre estenosis aórtica y sangrado por angiodisplasia gastrointestinal, con anemia secundaria. Se destaca el antecedente de radioterapia mediastinal para tratamiento de enfermedad de Hodgkin durante su juventud, y eventuales efectos adversos tardíos que pueden incluir trastornos de las válvulas aórtica y mitral. Durante la colonoscopia se realizó la electrocoagulación con argón del punto de sangrado activo. Posteriormente se realizó cirugía de sustitución valvular aórtica utilizando una bioprótesis. El paciente permanece asintomático, realizando un seguimiento ambulatorio a largo plazo, y con exámenes de control normales. El objetivo de este estudio es enfatizar las dificultades relacionadas al diagnóstico, y resaltar el papel de los estudios endoscópicos y de imágenes para confirmar una hipótesis de esta entidad subestimada.
    Anales del sistema sanitario de Navarra 01/2013; 36(2):339-45. · 0.35 Impact Factor
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    ABSTRACT: A 61-year-old white right-handed man was admitted because of recent loss of weight and difficulty in swallowing solid foods. There was gradually progressive apathy, postural instability with falls backwards and cognitive deficit. His past history included controlled diabetes mellitus and arterial hypertension, tobacco smoking and heavy alcoholism. During the last two years, an unexplained bilateral contraction developed in some of his fingers. He was not a manual worker nor a guitar or piano player, and denied previous hand trauma or similar disturbance in members of his family. Physical examination confirmed postural instability and revealed vertical gaze palsy, and the suspicion of progressive supranuclear palsy (PSP) was confirmed, based on clinical data and the study of brain images. Moreover, there was bilateral contraction of the middle, ring and little fingers, and thickened linear structures were palpated over the third, fourth and fifth flexor tendons on both palms. Furthermore, the patient was not able to lay his palms flat on a tabletop; and conspicuous hypotrophy of the lumbrical and interosseus muscles was observed (Figure 1). The evaluation of the shoulders, plantar and genital regions showed no abnormality. Laboratory tests were unremarkable, and specific studies were made to clear the hand changes. The patient was treated with conservative clinical, nutritional, and physiotherapy procedures, before being referred for specialized treatment and outpatient surveillance.
    Marmara Medical Journal 01/2013;
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    ABSTRACT: A 56-year-old woman was admitted with jaundice, and laboratory data were indicative of pancreatitis, which recurred in spite of adequate clinical and nutritional management. The patient was an overweight diabetic using metformin, who had antecedents of cholelithiasis and recent cholecystectomy. Clinical and laboratory features were not conclusive about the cause of this acute pancreatitis. However, imaging data contributed to diagnosis suspicion, and the histopathology study of the transpapillary biopsy confirmed the ampullary adenocarcinoma. Whipple´s surgery was the procedure of choice, associated with radical lymphadenectomy, followed by an uneventful outcome. Recrudescence of signs and symptoms of acute pancreatitis, with elevated serum levels of bilirrubins and of hepatic canalicular enzymes, should enhance the suspicion index about periampullary tumors. High levels of CA 19-9 can constitute a useful marker of this condition. Transpapillary biopsy can characterize the diagnosis of ampullary malignancies.
    Anales del sistema sanitario de Navarra 12/2012; 35(3):501-505. · 0.35 Impact Factor
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    ABSTRACT: Solitary bone plasmacytoma (SPB) can progress to generalized myeloma if not treated early. The elderly population is increasing and delays in diagnosis of plasma cell malignancies are frequent among them. Hyperglobulinemia of multiple myeloma (MM) plays a role in hyperviscosity syndrome (HVS). A 65-year-old woman with hypertension and diabetes mellitus was admitted due to loss of appetite, muscle weakness, breathlessness and discrete expectoration, without fever. Chest X-ray showed an abnormal shadow projection on the right lung field, while computed tomography (CT) revealed an osteolytic mass at the sixth rib. There were more than 50% of plasma cells in the bone marrow samples and high IgA levels according to serum electrophoresis. Rib plasmacytoma and overt IgA-producing myeloma with HVS were diagnosed, but treatment was unsuccessful. Case studies may enhance the awareness about this ominous condition, which may develop unnoticed, particularly in elderly patients with renal insufficiency, and can pose difficulties with diagnosis in primary care settings.
    Archives of Iranian medicine 08/2012; 15(8):517-9. · 1.22 Impact Factor
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    ABSTRACT: Corticosteroid-induced lipomatosis is not a rare condition, but lipoma in the central veins has scarcely been described. According to the databases consulted, this is the first report of a lipoma within the central veins coexistent with long-term use of corticosteroid. It involved a 47-year-old male under treatment for pulmonary sarcoidosis with prednisone. Computerized tomography of the thorax was performed and incidentally the images showed a mass within the central veins with the characteristics of lipoma. He was asymptomatic and refused surgical procedures. The intraluminal lipoma originated in the right brachiocephalic and subclavian veins. Control tomography showed a slow development of this lipoma, without obstructive effects or malignant features. Oral prednisone was changed for methotrexate. The patient is asymptomatic and under longstanding out-patient surveillance. Corticosteroid treatments for sarcoidosis can play a role in the development of intravascular lipoma, but this association is not well defined. Case reports could contribute to clarifying whether this relationship is causal or merely casual.
    Anales del sistema sanitario de Navarra 08/2012; 35(2):317-322. · 0.35 Impact Factor
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    ABSTRACT: A case of transverse sinus thrombosis is described in an adolescent male with antecedent meningomyelocele corrected by surgery, and ventriculo-peritoneal derivation. Four months before the occurrence of thrombosis, he presented with bilateral otitis media and mastoiditis, and was treated with antibiotic. Magnetic resonance images were not obtained before referral to our hospital. The patient received full anticoagulation and his clinical course was uneventful. He remains asymptomatic under outpatient surveillance till this report. The aim of reporting the case is to emphasize the role of otologic infections in the origin of intracranial thrombotic phenomena, and highlights the findings of magnetic resonance venography for characterization of intracranial sinus thrombosis.
    Journal of the College of Physicians and Surgeons--Pakistan : JCPSP. 07/2012; 22(7):470-2.
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    ABSTRACT: Background: We report a 54-year-old woman with an stage IIA (T2N0M0) RE and RP negative and HER2-positive ductal invasive breast cancer who developed a reversible cardiotoxicity associated with chemotherapy. After surgery, she received four cycles of doxorubicin and cyclophosfamide. Later, she used paclitaxel and trastuzumab. At the 7th cycle of trastuzumab, she had symptoms of heart failure with left ventricle ejection fraction = 59%. Trastuzumab dosage was reduced in 25%, and heart function progressively improved. Two years after her discharge, the patient remains asymptomatic. Systolic function of the left ventricle was normal before the initial dosis of trastuzumab, but significantly worsened following the beginning of drug administration. Moreover, a clear improvement of heart function was observed soon after the daily dose of trastuzumab was reduced. Better knowledge of risk factors for cardiotoxicity related to chemotherapy, and longstanding surveillance with serial echocardiograms can avoid more severe cardiotoxicity by chemotherapy.
    Revista medica de Chile 06/2012; 140(6):763-766. · 0.36 Impact Factor

Publication Stats

135 Citations
66.32 Total Impact Points

Institutions

  • 2005–2014
    • Universidade Católica de Brasília
      Brasília, Federal District, Brazil
  • 2008–2013
    • Hospital Universitario de Brasilia
      Brasília, Federal District, Brazil
  • 2009–2012
    • The Catholic University of America
      Washington, Washington, D.C., United States
    • University of Brasília
      Brasília, Federal District, Brazil
  • 2007
    • Armed Forces Medical College
      Poona, Mahārāshtra, India