Browsing by Author "Bilhim, T"
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- Acuidade Diagnóstica da Angiografia por TC nas Lesões Infrapopliteias de Doentes com Pé Diabético Submetidos a Revascularização EndovascularPublication . Sousa Pereira, JA; Vaz Costa, N; Neves, J; Bilhim, TIntrodução: A angiografia por tomografia computorizada (AngioTC) é aceite como técnica para seleção de doentes com doença arterial periférica candidatos a terapêutica endovascular ou cirúrgica. Não existe suficiente evidencia em relação à sua acuidade em doentes com pé diabético e patologia infrapopliteia. Objetivo: Avaliar a acuidade diagnóstica da AngioTC nas artérias infrapopliteias em doentes com pé diabético. Métodos: Estudo unicêntrico retrospetivo dos achados AngioTC e da angiografia digital de subtração em 14 doentes submetidos a revascularização endovascular periférica com pé diabético. A sensibilidade e especificidade da AngioTC foram calculadas para cada segmento arterial de acordo com uma classificação modificada da classificação de Rutherford. Resultados: A sensibilidade e especificidade global da AngioTC na deteção de lesões estenóticas significativas foi de 1 (95% C.I. 0.89-1) e 0.7 (95% C.I. 0.35-0.93), respetivamente. Por segmento arterial a sensibilidade e especificidade foram de 0.96 (95% C.I. 0.88-0.99) e 0.86 (95% C.I. 0.57-0.98) na artéria tibial anterior, de 0.98 (95% C.I. 0.90-0.99) e 0.93 (95% C.I. 0.66-0.99) na artéria tibial posterior, de 0.93 (95% C.I. 0.83-0.98) e 0.72 (95% C.I. 0.42-0.92) na artéria peroneal, respetivamente. Conclusão: A AngioTC tem excelente acuidade diagnóstica e permite a triagem de doentes diabéticos com doença arterial periférica infrapopliteia.
- AdenomyosisPublication . Bilhim, T
- Adrenal Vein Sampling in the Management of Primary Aldosteronism: The Added Value of Intraprocedural Cortisol AssessmentPublication . Manique, I; Amaral, S; Matias, A; Bouça, B; Serranito, S; Torres, J; Gutu, O; Bilhim, T; Coimbra, E; Rodrigues, I; Godinho, C; Cortez, L; Silva-Nunes, JIntroduction: Primary aldosteronism is the most common cause of secondary hypertension. Adrenal vein sampling is the gold standard for subtyping primary aldosteronism. However, this procedure is technically challenging and often has a low success rate. Our center is one of the very few performing this technique in our country with an increasing experience. Objective: The aim of this study was to evaluate the role of the cortisol intraprocedural assay in improving the performance of adrenal vein sampling. Design: We enrolled all of the patients with primary aldosteronism that underwent adrenal vein sampling from February 2016 to April 2023. The cortisol intraprocedural assay was introduced in October 2021. Methods: We enrolled a total of 50 adrenal vein samplings performed on 43 patients with the diagnosis of primary aldosteronism. In this sample, 19 patients and 24 patients underwent adrenal vein sampling before and after intraprocedural cortisol measurement, respectively. The procedure was repeated in seven patients (one before and six after intraprocedural cortisol measurement), given the unsuccess of the first exam. Selectivity of the adrenal vein sampling was assumed if the serum cortisol concentration from the adrenal vein was at least five times higher than that of the inferior vena cava. Lateralization was assumed if the aldosterone to cortisol ratio of one adrenal vein was at least four times the aldosterone to cortisol ratio of the contralateral side. Results: The mean age of the patients that underwent adrenal vein sampling (N = 43) was 55.2 ± 8.9 years, and 53.5% (n = 23) were female. The mean interval between the diagnosis of hypertension and the diagnosis of primary aldosteronism was 9.8 years (±9.9). At diagnosis, 62.8% of the patients (n = 27) had hypokalemia (mean value of 3 mmol/L (±0.34)), 88.4% (n = 38) had adrenal abnormalities on preprocedural CT scan, and 67.4% (n = 29) described as unilateral nodules. There were no statistically significant differences in the patients' baseline characteristics between the two groups (before and after intraprocedural cortisol measurement). Before intraprocedural cortisol measurement, adrenal vein sampling selectivity was achieved in 35% (n = 7) patients. Selectivity increased to 100% (30/30) after intraprocedural cortisol measurement (p < 0.001). With the exception of one patient who refused it, all patients with lateralized disease underwent unilateral adrenalectomy with normalization of the aldosterone to renin ratio postoperatively. Conclusions: The lack of effective alternatives in subtyping primary aldosteronism highlights the need to improve the success rate of adrenal vein sampling. In this study, intraprocedural cortisol measurement allowed a selectivity of 100%. Its addition to this procedure protocol should be considered, especially in centers with a low success rate.
- Adrenal Vein Sampling: How We Do ItPublication . Resende Neves, T; Proença Caetano, A; Manique, I; Amaral, S; Godinho, C; Bilhim, T; Coimbra, EPrimary aldosteronism is the most common cause of secondary hypertension. When unilateral disease is present, patients can be treated curatively by adrenalectomy. Adrenal vein sampling (AVS) is considered essential for discrimination between unilateral versus bilateral disease. Knowledge of normal and variant anatomy of the adrenal veins is important to avoid misleading results and increase technical success. The main reason for technical failure of AVS is the inability to catheterize the right adrenal vein. Pre-procedural CT imaging can help identify the venous anatomy of the adrenals. To validate the technical success of AVS, the catheterization index is calculated comparing the cortisol levels in each adrenal gland with those of the inferior vena cava. To assess the laterality index, the aldosterone levels are compared between both adrenals. We generally use a femoral access and a 4Fr Berenstein catheter for the left adrenal vein and a 5Fr Cobra, Simmons or Micahelson for the right adrenal vein. Some centers adopt an intravenous perfusion of a synthetic peptide of the adrenocorticotropic hormone immediately prior to the procedure to stimulate the adrenal glands. AVS is a safe and feasible procedure, with low risk of failure. Due to the technical difficulties of execution, especially right adrenal vein cannulation, AVS has low usage among hospital centers. The learning curve is estimated to be around 20 to 30 procedures, with a maintenance of about 15 annual procedures to achieve satisfactory results.
- Aneurisma Venoso Popliteu. Relato de 2 CasosPublication . Pereira, AM; Moniz, L; Formiga, A; Bilhim, T; Neves, JO aneurisma da veia popliteia (AVP) é uma entidada rara mas que comporta um risco importante de trombose venosa profunda (TVP) e consequente tromboembolismo pulmonar (TEP). Uma vez que a anticoagulação não é eficaz na prevenção dessas complicações, a cirurgia é o tratamento indicado pela quase totalidade dos autores. Apresentamos dois casos tratados no nosso serviço que ilustram o caráter pleomórfico desta doença – o primeiro manifestando-se como uma massa popliteia pouco sintomática e o segundo como um quadro semelhante a TVP numa doente cuja mãe falecera por TEP de causa não esclarecida. Ambos foram tratados pela técnica de aneurismectomia com venorrafia lateral, com bom resultado confirmado imagiologicamente ao fim de 6 meses. Fazemos ainda uma discussão com base na literatura. O AVP é uma entidade rara e de etiologia não esclarecida, cuja principal complicação é o TEP. O tratamento cirúrgico é a abordagem de eleição. A técnica cirúrgica utilizada de aneurismectomia com venorrafia lateral apresenta bons resultados e pode ser considerada curativa. Por esses motivos é uma doença a considerar no diagnóstico diferencial quer de massas popliteias quer de fenómenos tromboembólicos de repetição.
- ARP Case Report nº 21: What is your Diagnosis?Publication . Conde Vasco, I; Bilhim, T
- Caso Clínico ARP Nº10: Hemangioendotelioma EpitelioidePublication . Torres, D; Barbosa, L; Correia, M; Bilhim, T; Gomes, F; Coimbra, E
- Celiac Trunk Adventure!Publication . Bilhim, T
- Chemoembolization of Hepatocellular Carcinoma with Drug-Eluting Polyethylene Glycol Embolic Agents: Single-Center Retrospective Analysis in 302 PatientsPublication . Veloso Gomes, F; Oliveira, J; Tomé Correia, M; Costa, NV; Abrantes, J; Torres, D; Pereira, P; Ferreira, AI; Luz, JH; Spaepen, E; Bilhim, T; Coimbra, EPurpose: To evaluate the efficacy and safety of transarterial chemoembolization with polyethylene glycol (PEG) drug-eluting embolic agents in the treatment of hepatocellular carcinoma (HCC). Materials and methods: A single-center retrospective study of 302 patients (258 men; 85.4%) with HCC treated during a 20-month period was conducted. The mean patient age was 66 years ± 10; 142 (47%) had Barcelona Clinic Liver Cancer stage A disease and 134 had (44.4%) stage B disease; 174 (57.6%) had a single HCC tumor, 65 (21.5%) had 2, and 62 (20.9%) had 3 or more. Mean index tumor size was 36.6 mm ± 24.8. One-month follow-up computed tomography (CT) response per modified Response Evaluation Criteria In Solid Tumors and clinical and biochemical safety were analyzed. Progression-free and overall survival were calculated by Kaplan-Meier method. Results: Median follow-up time was 11.9 months (95% confidence interval, 11.0-13.0 mo). One-month follow-up CT revealed complete response in 179 patients (63.2%), partial response in 63 (22.3%), stable disease in 16 (5.7%), and progressive disease in 25 (8.8%). The most frequent complications were postembolization syndrome in 18 patients (6%), liver abscess in 5 (1.7%), and puncture-site hematoma in 3 (1%). Biochemical toxicities occurred in 57 patients (11.6%). Survival analysis at 12 months showed a progression-free survival rate of 65.9% and overall survival rate of 93.5%. Patients who received transplants showed a 57.7% rate of complete pathologic response. Conclusions: Chemoembolization with PEG embolic agents for HCC is safe and effective, achieving an objective response rate of 85.5%.
- CIRSE Standards of Practice on Conducting Meetings on Morbidity and MortalityPublication . Chun, JY; Bharadwaz, A; Tun, J; Bilhim, T; Gonzalez-Junyent, C; Kawa, BThis CIRSE Standards of Practice document is developed by an expert writing group under the guidance of the CIRSE Standards of Practice Committee. It aims to assist Interventional Radiologists in their daily practice by providing best practices for conducting meetings on morbidity and mortality.