Browsing by Author "Capela, T"
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- Anorectal Involvement in a Patient with Multiple MyelomaPublication . Russo, P; Tomé, AL; Capela, T; Bettencourt, MJMultiple myeloma is a neoplastic proliferation of monoclonal plasma cells. Symptomatic gastrointestinal involvement is uncommon. We report the case of a 45-year-old patient admitted with an anorectal polypoid lesion, which progressed to colonic obstruction. Investigation revealed a secondary plasmacytoma associated with multiple myeloma. We discuss the characteristics of this rare entity with poor prognosis, its clinical implications and treatment options.
- Endoscopic Management of Sigmoid Volvulus in a Debilitated Population: What Relevance?Publication . Coelho da Rocha, M; Capela, T; Silva, MJ; Ramos, G; Coimbra, JBackground: Colonic volvulus, mainly from the sigmoid, is a relatively common cause of intestinal obstruction, particularly in the elderly and in patients with debilitating conditions. The high morbi-mortality of emergency surgery places the endoscopic approach as the first-line treatment for the resolution of this acute obstructive condition. Objectives: To assess the importance of endoscopic treatment for the resolution of colonic volvulus in a debilitated population. Method: This is a retrospective analysis of emergency lower gastrointestinal endoscopies in patients with colonic volvulus as diagnosis, performed over a 9-year period (2009-2018), as well as population characterization and follow-up after the first exam. Results: We performed 88 procedures in 52 patients (56.4% males, median age 83 years, range 33-94). Endoscopic resolution was effective in 86.4% (76/88) of the exams, without procedure complications. Eighty-one percent of patients presented with volvulus recurrence, 50% of which occurred during the 3 months after the initial procedure. Twenty-one were submitted to surgery, 12 of which were emergency procedures after endoscopic failure as the primary treatment (5 of which had mucosal necrosis at endoscopy). There was no mortality in elective surgery. In the emergency plus necrosis group, mortality was 60% (3/5) and 14.3% (1/7) in the emergency without necrosis group. Conclusions: Despite the high recurrence of volvulus after endoscopic treatment, it seems to be an adequate and low-risk first-line therapy for sigmoid volvulus in debilitated patients, allowing improvement of surgical conditions.
- Endoscopic Treatment of Early Gastric Obstruction After Sleeve Gastrectomy: Report of Two CasesPublication . Costa, M; Capela, T; Seves, I; Ribeiro, R; Rio-Tinto, RMorbid obesity is an epidemic and complex disease which imposes a multidisciplinary approach. Laparoscopic sleeve gastrectomy has become a frequent procedure given its effi- cacy and safety compared to other surgical options. However, it isn’t free from complications. Lax gastric fixation or incorrect positioning of the stomach during surgery can result in early gastric outlet obstruction caused by a volvulus-like mechanism by rotation of the stomach around its anatomic axes. This report refers to two cases of post sleeve gastric torsion resulting in persisting vomiting after initiating oral intake. The diagnosis was confirmed by upper gastrointestinal-contrast study and gastroscopy. In both cases, a fully covered self-expandable metallic stentwas insertedwhich prompted the gastric lumen to become permeable resulting in symptomatic resolution. The stents were removed endoscopically aftertwo and three months. Beyond more than three years offollow-up,the patients remain asymptomatic and no recurring ‘‘stenosis’’ was noticed.In these cases the use offully covered self-expandable metallic stents demonstrated to be effective and safe in the treatment of post sleeve gastric torsion.
- Intestinal Obstruction of Uncommon Cause and Point-of-Care Ultrasonography - Where Do We Stand?Publication . Capela, T; Sousa, P; Caldeira, A; Pereira, EMalignant neoplasms of the small bowel, especially from the jejunum, are among the rarest types of cancer. Given its location, a delayed diagnosis is frequent and sometimes only made in an emergency context. The authors present a case of intestinal obstruction, where ultrasonography was pivotal in establishing a diagnosis. Point-of-care ultrasonography seems to be particularly sensitive in assessing emergency patients with abdominal pain, allowing effective orientation and saving human and technical resources.
- Outcomes of Different Methods for Analysis of Biliary Brush Cytology and of Factors Associated with Positive Diagnosis in an Age-Dependent Retrospective ReviewPublication . Costa, M; Canena, J; Mascarenhas-Lemos, L; Loureiro, R; Silva, M; Carvalho, D; Capela, T; Russo, P; Ramos, G; Mateus-Dias, A; Ferraz-Oliveira, M; Mota Veiga, P; Coimbra, JBrush cytology during endoscopic retrograde cholangiopancreatography (ERCP) is the most frequently used strategy for obtaining a tissue sample from an indeterminate biliary stricture. A recent study reported that age is a factor associated with positive yields, but further analysis of how age influences the results was lacking. We aimed to evaluate clinical effectiveness of biliary cytology and prognostic factors for a positive outcome, especially age. Methods: This study was a single-center, retrospective, clinical study of 77 consecutive patients who underwent brush cytology during ERCP to obtain a diagnosis of an indeterminate biliary stricture. We compared 2 routine cytology techniques: A (smear); B (centrifugation of the cytological material collected and the cut-off brush + cell block when sufficient amount of material was available). The data were collected aiming to compare the accuracy of the different techniques used and the prognostic factors affecting the outcome, with a particular focus on age. The yield for brush cytology was compared with the gold standard defined as either definitive histology or the long-term clinical course. Results: The overall accuracy of the 2 used methods was 75.3%. Sensitivity was 52.5%, specificity was 100%, positive predictive value was 100%, and negative predictive value was 66.1%. Although not statistically significant, there was a trend toward accuracy for method B compared with method A (80.4 vs. 65.4%; p = 0.153). Multiple logistic regression analysis showed that younger age was the only independent prognostic factor associated with a positive diagnosis (OR 0.95; 95% CI 0.90-0.99; p = 0.039). Receiver operating characteristic curves for age yielded an area under the curve value of 68.2%. On the basis of the Youden index, 69 years was found to be the optimal cutoff for age. Conclusions: In this series, the accuracy of routine biliary brush cytology was not equal for all methods and ages; in particular, younger patients (below 69 years) tended to have a higher probability of a correct diagnosis.
- Response Regarding: Endoscopic Management of Sigmoid Volvulus in a Debilitated Population: What Relevance?Publication . Simões, G; Coelho da Rocha, M; Capela, T; Silva, MJ; Ramos, G; Coimbra, J