Angina bullosa hemorrhagica is a rare benign condition characterized by the sudden appearance of painless solitary blood-filled bullous lesions within the oral cavity. The bullous lesions usually rupture and heal spontaneously without any further scarring. When the presentation is typical, the diagnosis is clinical, reserving biopsy for doubtful cases. Since it presents a spontaneous resolution, the treatment is supportive, aiming at preventing infection and enhancing healing. With the presentation of this clinical case, we intend to draw attention to the existence of this condition, which is a frequent cause of concern for patients and health professionals leading to unnecessary investigations and interventions despite being benign and self-limiting.

Images of a clinical case of a 77-year- -old man hospitalized for an abdominal mass are presented. The volume of the neoplasm observed may have as a factor, in addition to the location and slow growth of the lesion in the context of psychiatric illness, the difficulties caused by the delay in diagnosis originatig in the context of the SARS-CoV-2 pandemic.

Pulmonary thromboembolism (PTE) corresponds to the occlusion of the pulmonary circulation, having as itsetiology the thrombi that may originate in another part of the body (for example in the venous circulation of the lower limbs). Virchow’s triad describes the 3 main components that lead to the formation of PTE. As a matter of physiological aging, PTE is more frequent in the elderly population. However, there are risk factors that increase the likelihood of this pathology developing in the younger population. This article presents the case of a 26-year- -old patient who, due to dyspnea and pleuritic chest pain, is seen by a general and family medicine practioner, and is later referref and diagnosed with PTE in a hospital setting.

Introduction: In patients who undergo percutaneous coronary intervention (PCI), contrast induced acute kidney injury is a common complication, with a prevalence of up to 10-15%, associated with an increase in morbidity and mortality, its prevention imperative. Scientific evidence expresses that the ratio between the median contrast volume administered (VolC) during PCI and the creatinine clearance (CrCl) is an independent predictor of AKI-IC development post PCI in patients with acute coronary syndrome (ACS). However, the optimal value remains controversial. This study aims to determine witch is the optimal value for the ratio VolC/CrCl, that allows the prevention of AKI-CI development in patients with ACS who undergo PCI. Methods: Retrospective observational study based on the information from the National register for acute coronary syndrome, that includes all patients with ACS, admitted to the Algarve Hospital center, between 1/1/2018 e 31/12/2020, that were submitted to PCI. We carried out descriptive, comparative, and inferential statistic as well as a multivariate analysis through logistic regression and optimal binning. Results: Sample essentially masculine (78,7%). Female sex associated with a higher incidence of AKI (22,76%) and mortality (11,25%) after PCI. Gender, being an ex-smoker and having renal insufficiency as past medical history appear as predictors of AKI development post PCI and, the development of AKI, is associated with increased mortality (56%). VolC/ClCreat of 2 favours the nonoccurrence of AKI post PCI. Conclusions: A ratio VolC/ClCreat of 2, even though it does not completely prevent the development of AKI-CI, it potentiates approximately five times the non-occurrence of AKI-CI when compared to its occurrence.

Medical teaching and education are emergent topics in the medical community. The Portuguese general residency is the first step to autonomy in clinical practice in our country. To improve the quality of the residency, the authors evaluate the internal medicine rotation by way of a questionnaire to all general residents. Introduction and integration in this area, as well as moments to learn, acquire knowledge and autonomy are analyzed. As a result, we propose changes in the department, in order to improve learning in our area. Internal Medicine, with a holistic approach and a broad range of diseases is a pilar of importance in medical education.

The attraction between medicine and photography was immediate. This attraction is so expressive that just a few months after the birth of photography in 1839, the medical sciences were already using it. In 1845, after 5 years of preparation, the first medical book with engravings based on photography was published. The use of photography in medicine is such a suitable partnership that it is came to stay.

On the heels of Covid-19, the excision of larger tumours has become quite challenging. But, we keep pushing boundaries and seem to find ways to replace the volume excised to obtain not only a good oncologic but also an esthetic result. The use of intercostal perforator flaps, also known as chest wall perforator flaps, has been recently introduced in breast cancer surgery. We report our centre experience using these local perforator flaps. The study is a retrospective observational cohort of a small series of patients who underwent breast conservation surgery relying on perforator flaps for volume replacement from August 2022 to January 2023. Seven patients were included in the study. Clinicopathological, surgical details, adjuvant treatment were retrieved from the Institutional electronic register system. Four lateral, two anterior and one anterior and lateral intercostal artery perforators were utilized. All tumours were close to two cms or greater and located in the external or inferior breast quadrants. Three patients had tumor invasion of the skin where skin islands were needed. IPF has been found by us to be a very useful technique for partial breast reconstruction in women who have some skin laxity and sufficient subcutaneous fatty tissue to replace the volume of the breast tumour defect with a local perforator flap after excision of the tumor. Although the series is small with a short follow-up, we saw no complications. Patient satisfaction was very good. However, more time is needed to see how the flaps do under exposure to radiotherapy.

The triad, which summarizes the causes of venous thrombosis - vein wall changes, stasis, and hypercoagulability - is attributed to Virchow. This study aims to demonstrate that the triad attributed to Virchow does not belong to him. The father of Anatomopathology published two books that have become famous: “Die Cellularpathologie in ihrer Begrundung auf physiologische und pathologische Gewebelchre” (1839) [Cellular pathology based on physiological and pathological tissue problems] and “Thrombose und embolie“ (1856). However, Virchow studied the genesis of emboli and their effects on pulmonary arteries, trying to contradict the Cruveilhier theory, “phlebitis is the cause of all pathology”, and not the genesis of venous thrombi. This study analyses the items mentioned in Thrombose und Embolie, which have caused this misinterpretation, and in this paper the first of two, after a Historical Introduction, is showed different theories by some scientists who preceded Virchow, such as Wiseman, John Hunter and Cruvelhier, who spoke about the elements of the Triad. Several authors have given many arguments in favour of the role of inflammation of the vein wall and stasis, or both, in the genesis of venous thrombosis. Although none referred to hypercoagulability, some suggested that factors in the blood itself were at the basis of thrombosis. In this first part of the paper, the author covers elements of the history of pathophysiology related to the triad in question.

Breast Cancer in women is the leading cause of cancer worldwide. Different parameters in breast cancer are evaluated due to their predictive value. Individuals with high-risk metastatic disease are selected for neoadjuvant treatments for better disease control and treatment. A retrospective study, with data retrieved between January 2001 and December 2022 from Centro Hospitalar e Universitário do Algarve-Portimão, was conducted to characterize a population of breast cancer patients who underwent neoadjuvant chemotherapy. From a universe of 2336 patients, 276 were included in this study. Of the patients selected, 275 (99,64%) were female and one (0,36%) was male. The mean age was 51,9 ± 12 years. The primary breast cancers identified were hormone receptor subtypes, HR+ (36,33%), HER2+ (8,59%), TNBC (21,09%), triple positive (12,11%), and ER+ (12,11%). The main intrinsic subtypes were Luminal-A (51,17%), Basal-like/TNBC (21,09%) and Luminal-B (19,14%). Our data corroborates with current literature, with HR+ and Luminal-A tumours being the most common subtypes. The HER2+ subtype was not the most widespread subtype in this region, contrary to national data. Breast cancer patients who underwent neoadjuvant chemotherapy in our Institution are the focus of interest for this analysis, as they are at greater risk of recurrence and disease progression. Through this study, we have gained a better understanding of our patients and breast cancer, in general.