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Liver Transplant After Neoadjuvant Treatment for Long-Term Survivors With Intrahepatic Cholangiocarcinoma: Does It Have a Role?
Publication . Teixeira, Carina; Viamonte, Bárbara; Graça, Luís; Pinto Marques, Hugo; Rego, Inês; Ribeiro, Maria João
Cholangiocarcinoma is a rare and heterogeneous disease that often requires multimodal treatment. The role of liver transplantation in these tumors has been controversial due to historically poor prognosis and higher recurrence rates. However, in recent years, scientific evidence has challenged this notion. We report the case of a 49-year-old woman with locally advanced intrahepatic cholangiocarcinoma. The therapeutic approach for this patient was complex, involving locoregional and systemic therapies. Despite the tumor's characteristics, namely, large size, multifocality, and vascular involvement, the good response to the treatment allowed a liver transplant 57 months after diagnosis.
Técnicas Cirúrgicas Bariátricas e Ganho Metabólico
Publication . Nabais, Celso; Borges, Nuno; Manaças, Leonor; Vaz Rodrigues, Sara; Rego de Figueiredo, Inês; Dhanani, Anjum; Paula, Filipa; Oliveira Torres, João; Silva-Nunes, José; Albuquerque, António; Guerra, Anabela
A cirurgia bariátrica é a intervenção mais eficaz no tratamento da obesidade, permitindo uma perda ponderal sustentada, elevadas
taxas de remissão da diabetes mellitus tipo 2, redução do risco cardiovascular e mortalidade. Este artigo de revisão aborda as
principais técnicas cirúrgicas e enquadra os respetivos ganhos metabólicos, que se iniciam muito precocemente após cirurgia, e se
mantêm a longo prazo. Os mecanismos fisiopatológicos associados, e que extrapolam os componentes restritivo e malabsortivo
classicamente descritos, são sumariamente explanados neste artigo, e que incluem, a exclusão do intestino proximal, a chegada
precoce dos nutrientes ao intestino distal, a modulação neuroendócrina e de hormonas reguladoras do apetite, as modificações no
metabolismo dos ácidos biliares e no microbioma intestinal. Conclui-se, sublinhando que a escolha da técnica deve ser individualizada, ponderando a eficácia metabólica que pode proporcionar, face ao risco de complicações cirúrgicas e nutricionais, e sempre no âmbito de um programa multidisciplinar.
Global 30-Day Morbidity and Mortality of Primary Bariatric Surgery Combined with Another Procedure: The BLEND Study.
Publication . Martinino, Alessandro; Nanayakkara, Kushan D L; Madhok, Brij; Wong, Geoffrey Yuet Mun; Abouelazayem, Mohamed; Pereira, Juan Pablo Scarano; Wazir, Ishaan; Balasubaramaniam, Vignesh; Said, Amira; Marques, Cláudia; Abdelbaeth, Amr; Al-Shami, Khayry; Albashari, Muna; Alkaseek, Akram; Almayouf, Mohammad Abdullah; Aloulou, Mohammad; Alqahtan, Awadh Robaan; Askari, Alan; Attia, Meena Faiez Assad; Awad, Ahmed K; Aykota, Muhammed Rasid; Bacalbasa, Nicolae; Barrera-Rodriguez, Francisco J; Benavoli, Domenico; Billa, Srikar; Borrelli, Vincenzo; Çalıkoğlu, İsmail; Campanelli, Michela; Carbajo, Miguel A; Chowdhury, Sharfuddin; Cristin, Luca; Dapri, Giovanni; Dong, Zhiyong; Elfawal, Mohamad Hayssam; Elgazar, Amr; Elhadi, Muhammed; Gentileschi, Paolo; Graham, Yitka; Haj, Bassel; Johnson, Joseph Andrew; Kalmoush, Abd-Elfattah Morsi; Kamal, Ayman; Kamocka, Anna; Khamees, Almu'atasim; Lisi, Giorgio; Hernandez, Edgard Efren Lozada; Marinari, Giuseppe M; Martines, Gennaro; Meric, Serhat; Mier, Fernando; Ali, Ahmed Mohamed; Mohammed, Diyaaldeen; Mohamed, Karim Mostafa; Mulita, Francesk; Musella, Mario; O'Malley, William Edward; Olmi, Stefano; Omarov, Taryel; Osama, Omnya; Perera, HMinali R; Piscitelli, Giovanni; Poghosyan, Tigran; Ramírez, David; Rezvani, Masoud; Ribeiro, Rui; Sabbota, Aaron; Sakran, Nasser; Sawaftah, Khaled Ahmad; Schiavone, Kaci; Şen, Ozan; Sotiropoulou, Maria; Tartaglia, Nicola; Tokocin, Merve; Trotta, Manuela; Türkçapar, Ahmet Gökhan; Uccelli, Matteo; Vargas, Cesar; Verras, Georgios -Ioannis; Wang, Cunchuan; Wei, Zhuoqi; Yang, Wah; Zerrweck, Carlos; Owen, Eloise; Gkoutos, Georgios V; Cardoso, Victor Roth; Singhal, Rishi; Mahawar, Kamal
Background: No robust data are available on the safety of primary bariatric and metabolic surgery (BMS) alone compared to primary BMS combined with other procedures.
Objectives: The objective of this study is to collect a 30-day mortality and morbidity of primary BMS combined with cholecystectomy, ventral hernia repair, or hiatal hernia repair.
Setting: This is as an international, multicenter, prospective, and observational audit of patients undergoing primary BMS combined with one or more additional procedures.
Methods: The audit took place from January 1 to June 30, 2022. A descriptive analysis was conducted. A propensity score matching analysis compared the BLEND study patients with those from the GENEVA cohort to obtain objective evaluation between combined procedures and primary BMS alone.
Results: A total of 75 centers submitted data on 1036 patients. Sleeve gastrectomy was the most commonly primary BMS (N = 653, 63%), and hiatal hernia repair was the most commonly concomitant procedure (N = 447, 43.1%). RYGB accounted for the highest percentage (20.6%) of a 30-day morbidity, followed by SG (10.5%). More than one combined procedures had the highest morbidities among all combinations (17.1%). Out of overall 134 complications, 129 (96.2%) were Clavien-Dindo I-III, and 4 were CD V. Patients who underwent a primary bariatric surgery combined with another procedure had a pronounced increase in a 30-day complication rate compared with patients who underwent only BMS (12.7% vs. 7.1%).
Conclusion: Combining BMS with another procedure increases the risk of complications, but most are minor and require no further treatment. Combined procedures with primary BMS is a viable option to consider in selected patients following multi-disciplinary discussion.
Anti-Melanoma Differentiation-Associated Protein 5 (MDA5)-Positive Dermatomyositis With Rapidly Progressive Interstitial Lung Disease (ILD): A Rare and Lethal Entity to Recognize Early.
Publication . Bernardino, Rita; Ferreira, Inês; Valente, André; Loureiro, Conceição
Anti-melanoma differentiation-associated protein 5 (anti-MDA5) clinically linked amyopathic dermatomyositis (CADM) is a rare autoimmune condition strongly linked to rapidly progressive interstitial lung disease (RP-ILD), a life-threatening complication. We present a 63-year-old female patient with anti-MDA5-positive CADM, who developed RP-ILD with an imaging pattern consistent with organizing pneumonia. She presented with Gottron's papules, periungual erythema, progressive dyspnea, and anorexia. Despite timely initiation of combination immunosuppressive therapy with corticosteroids, rituximab, and mycophenolate, her disease progressed rapidly, complicated by infections and treatment intolerance, culminating in acute respiratory failure. This case underscores the aggressive nature of anti-MDA5-positive CADM with RP-ILD, highlighting the critical need for prompt recognition and comprehensive multidisciplinary care. Urgent research efforts are essential to develop and refine treatment strategies for this life-threatening disease.
Cuidados de Saúde Primários e o Potencial de Coordenação com os Bancos de Leite Humano
Publication . Fabrício de Almeida, Mafalda; Torgal, Ana Lúcia; Macedo, Israel; Figueiredo, Cristiano