Browsing by Author "Baptista, A"
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- Acidente Vascular Cerebral Hemorrágico Associado ao Consumo de CocaínaPublication . Conceição, MC; Gomes, V; Baptista, AOs autores apresentam o caso clínico de um homem de 37 anos, fumador de cocaína, que foi admitido no serviço por acidente vascular cerebral hemorrágico. Faz-se a discussão dos diagnósticos diferenciais e uma referência aos tipos, formas de administração, metabolismo, características clínicas e toxicidade da cocaína.
- Análise da Capacidade Reactiva da Circulação Intracerebral pelo Efeito do CO2. Um Método de Fácil ExecuçãoPublication . Baptista, A; Ribeiro, JA manutenção de uma adequada pressão de perfusão cerebral é essencial para a prevenção de isquémia cerebral. Flutuações fisiológicas da pressão arterial a montante são compensadas localmente pela autoregulação cerebral. A reserva vascular cerebral necessária à eficácia desta autoregulação pode ser determinada medindo as modificações no fluxo sanguíneo cerebral em resposta a estímulos vasodilatadores. O Doppler Transcraneano tem sido usado para a determinação da velocidade do fluxo sanguíneo cerebral modificada por esses estímulos. Descrevemos um método de análise da capacidade de reserva da circulação cerebral pelo Doppler Transcraneano sob efeito do CO2. Este método pode ser útil para a caracterização das alterações hemodinâmicas que ocorrem em vários tipos de doença isquémica cerebral.
- Avaliação da Informação aos Pais do Recém-Nascido Pré-TermoPublication . Tanganho, C; Tomé, T; Ferreira, L; Pires, A; Trindade, F; Baptista, A; Mendes, M; Costa, TForam estudados dois grupos de recém-nascidos pré-termo (RN PT) com idade gestacional inferior a 32 semanas, sem diferenças clínicas significativas. Comparou-se a conduta habitual na Unidade de Cuidados Intensivos (UCI) na vertente informação e apoio aos pais, com outras medidas, valorizando uma informação personalizada, as capacidades do pré-termo e o apoio psicoterapêutico. Utilizaram-se como instrumentos de avaliação um registo do comportamento interactivo, um questionário de avaliação parental e uma escala de sentimentos maternais aplicada 1 a 2 meses após a alta. Concluiu-se que no grupo experimental, existem mais mães a acariciar o seu filho. A sensação de tranquilidade com a informação recebida também foi maior neste grupo. Não foram encontradas diferenças quanto aos sentimentos maternais.
- Função Plaquetária - Métodos Laboratoriais e Aplicações ClínicasPublication . Camacho, AC; Baptista, A; Marques, MJ; Campos, MMOs métodos para estudo da agregação plaquetária têm como objectivo a medição quantitativa dessa agregação após exposição das plaquetas a diferentes agonistas. Entidades clínicas distintas apresentam padrões de agregação característicos, sendo a agregometria fundamental para o diagnóstico e atitude terapêutica subsequente. Este artigo começa por rever a hemóstase primária, principais alterações da função plaquetária e aborda as principais técnicas utilizadas na sua avaliação, as suas aplicações práticas, vantagens e limitações. A Agregometria por Transmissão de Luz, foco principal deste trabalho, mede a transmissão da luz através de uma amostra de plasma rico em plaquetas após adição de determinados agonistas, sendo actualmente o gold standard. Nesta revisão, apresentamos gráficos ilustrativos deste método, resultados reais de doentes do Centro Hospitalar de Lisboa Central.
- Immunosuppression and Renal Dysfunction in Liver TransplantationPublication . Ferreira, AC; Nolasco, F; Sampaio, S; Baptista, A; Pessegueiro, P; Viana, H; Monteiro, E; Martins, A; Barroso, E
- Impact of Renal Dysfunction on Liver Transplantation: a Retrospective Study in 708 Orthotopic Liver Transplant RecipientsPublication . Ferreira, AC; Nolasco, F; Sampaio, S; Baptista, A; Pessegueiro, P; Monteiro, E; Barroso, ERenal dysfunction often complicates the course of orthotopic liver transplant recipients and is associated with increased morbid -mortality. The aims of this study were to determine the incidence of chronic renal disease and its impact on patient survival. Clinical data included age, gender and weight,aetiology of hepatic failure, presence of diabetes,hypertension, hepatitis B and C infection, renal dysfunction pretransplant and immunosuppression. Laboratory data included serum creatinine at days 1, 7, 21, month 6, 12 and yearly. The glomerular filtration rate was determined by Cockcroft-Gault equation. We studied retrospectively from September 1992 to March 2007 708 orthotopic liver transplant recipients. Mean age 44±12.6 years, 64% males, 17% diabetic, 18.8% hypertensive, 19.9% with hepatitis C and 3.8% hepatitis B. Renal dysfunction pretransplant was known in 21.6%. Mean follow-up was 3.6 years. Mean transplant survival 75% at 12 months. 154 patients died. Univariate and multivariate analyses were performed and a p<0.05 was considered significant. Acute kidney injury occurred in 33.2%. Chronic kidney disease stage 3 was observed in 34.3%,stage 4 in 6.2% and stage 5 in 5.1%. At the time of this study, 46.4% were on Cyclosporine A, 44.7% on tacrolimus and 8.9% on sirolimus. Using multivariate analysis, renal dysfunction was correlated with renal dysfunction pre -orthotopic liver transplant (p<0.001), acute kidney injury (p<0.001), haemodialysis development (p<0.001), and inversely correlated with the use of mycophenolate mophetil (p<0.001); mortality was positively correlated with renal dysfunction pretransplant (p=0.03),chronic kidney disease stage 4 (p=0.001), chronic kidney disease stage 5 (p<0.001) and inversely correlated with the use of tacrolimus (p=0.006). In conclusion orthotopic liver transplant recipients are disposed to renal complications that have a negative impact on survival of these patients.
- Impact of RIFLE Classification in Liver TransplantationPublication . Ferreira, AC; Nolasco, F; Carvalho, D; Sampaio, S; Baptista, A; Pessegueiro, P; Monteiro, E; Mourão, L; Barroso, EAcute renal failure (ARF) is common after orthotopic liver transplantation (OLT). The aim of this study was to evaluate the prognostic value of RIFLE classification in the development of CKD, hemodialysis requirement, and mortality. Patients were categorized as risk (R), injury (I) or failure (F) according to renal function at day 1, 7 and 21. Final renal function was classified according to K/DIGO guidelines. We studied 708 OLT recipients, transplanted between September 1992 and March 2007; mean age 44 +/- 12.6 yr, mean follow-up 3.6 yr (28.8% > or = 5 yr). Renal dysfunction before OLT was known in 21.6%. According to the RIFLE classification, ARF occurred in 33.2%: 16.8% were R class, 8.5% I class and 7.9% F class. CKD developed in 45.6%, with stages 4 or 5d in 11.3%. Mortality for R, I and F classes were, respectively, 10.9%, 13.3% and 39.3%. Severity of ARF correlated with development of CKD: stage 3 was associated with all classes of ARF, stages 4 and 5d only with severe ARF. Hemodialysis requirement (23%) and mortality were only correlated with the most severe form of ARF (F class). In conclusion, RIFLE classification is a useful tool to stratify the severity of early ARF providing a prognostic indicator for the risk of CKD occurrence and death.
- Impact of RIFLE Classification in Liver TransplantationPublication . Ferreira, AC; Nolasco, F; Sampaio, S; Viana, H; Baptista, A; Pessegueiro, P; Monteiro, E; Mourão, L; Martins, A; Barroso, E
- Maxillary Sinus Kaposi Sarcoma: Case Report in an HIV-Negative Patient with ThymomaPublication . Carvalho Araújo, B; Baptista, A; Mascarenhas, L; Barros, EIntroduction: Kaposi sarcoma is an angioproliferative disorder that requires infection with human herpesvirus 8 (HHV-8) for its development. The majority of cases are associated with HIV infection or other immunocompromising conditions. Thymomas are occasionally associated to cytopenia, which may alter the patients' immune responses. Methods: Case report using clinical records. Results: Case report of a 46-year-old male patient diagnosed with thymoma and myasthenia gravis. The patient was referred to an otolaryngology consultation with complaints of facial pain in the right malar region, interpreted as an acute sinusitis. Following examination, an expansive maxillary sinus mass was found, and endoscopic surgery was undertaken. After careful investigation, it was diagnosed as a Kaposi sarcoma. Conclusions: It is thought to be the first described case of a maxillary sinus Kaposi sarcoma in an HIV-negative patient. Thus, this entity has to be considered in the differential diagnosis of sinus masses, even in non-HIV patients.
- Orthotopic Liver Transplantation in Familial Amyloidotic Polyneuropathy Is Associated with Long-Term Progression of Renal DiseasePublication . Ferreira, AC; Nolasco, F; Sampaio, S; Baptista, A; Pessegueiro, P; Monteiro, E; Barroso, EOrthotopic liver transplantation has become the treatment of choice for familial amyloidotic polyneuropathy. The aims of this study were to evaluate the renal complications post orthotopic liver transplantation in familial amyloidotic polyneuropathy and their impact. We retrospectively studied 185 recipients who underwent 217 orthotopic liver transplants. Mean age 36.8±9.5 years, 59% males, 14.3% with renal dysfunction pre orthotopic liver transplantation. Mean follow-up 3.6±3.7 years. Thirty-two patients died. Univariate and multivariate analysis were performed, and p<0.05 was considered significant. Acute kidney injury occurred in 57 patients and renal replacement therapy was needed in 16/57. In multivariate analysis, acute kidney injury was correlated with development of chronic kidney disease (p<0.001). Relating to development of chronic kidney disease, 23.5% had progress to stage 3, 6% to stage 4 and 5.1% to stage 5d. According to Spearmen correlation, risk factors for chronic kidney disease development were age (p<0.001), renal dysfunction pre orthotopic liver transplantation (p<0.001) and acute kidney injury post orthotopic liver transplantation (p<0.001). Mortality was correlated with age (p<0.001), retransplantation need (p=0.004), renal dysfunction pre orthotopic liver transplantation (p<0.001), acute kidney injury post orthotopic liver transplantation (p=0.04), and chronic kidney disease stage 5 (p<0.001). Using binary regression, mortality was correlated with chronic kidney disease development (p=0.02). In conclusion, familial amyloidotic polyneuropathy patients are disposed to renal complications that have a negative impact on the survival of these patients.