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Browsing by Author "Coelho, JS"

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  • Nefrectomia Radical e Nefroureterectomia Laparoscópica "Hand-Assited": a Experiência dos Primeiros 21 Casos
    Publication . Pinheiro, LC; Farinha, R; Fonseca, J; Coelho, JS; Pena, A; Pereira, P; Martins, A
    Objectivos: Os autores apresentam a sua casuística com os primeiros 21 casos submetidos a nefrectomia radical e nefroureterectomia laparoscópica "hand- assisted" e laparoscópica pura. Material e Métodos: Entre o período de Janeiro 2003 a Junho de 2004 procedeu-se à realização de nefrectomia radical e nefroureterectomia laparoscópica em 21 doentes com o diagnóstico clínico de carcinoma de células renais e de carcinoma de células de transição do trato urinário alto. Optámos pela assistência da mão apenas quando útil ou necessário. Realizamos 16 nefrectomias radicais laparoscopicas "hand-assisted", 2 nefroureterectomias radicais laparoscopicas "hand- assisted" com desincer- ção endoscópica do meato ureteral e 3 nefrectomias radicais laparoscopicas "puras". A idade média deste grupo foi de 62 anos.O diâmetro médio da massa renal foi de 4,8 cm. O diagnóstico anatomo-patológico revelou a existência de 17 carcinomas de células renais, 2 carcinomas de células de transição, 1 hemangioma e 1 quisto renal complicado. Tivemos uma taxa de conversão de 5%, e a duração da cirurgia foi de 1,46 horas. O follow- up destes doentes variou entre 1 e 2 anos, não se tendo verificado quaisquer recidivas. Nesta série houve um re-internamento. Conclusão: a nefrectomia radical laparoscópica "hand-assisted" e a nefroureterectomia laparoscópica "hand-assisted" são exequíveis sendo a curva de aprendizagem relativamente curta. A taxa de complicações é baixa.
    2004Journal article Open access Show more
  • Pancreas Rejection in the Artificial Intelligence Era: New Tool for Signal Patients at Risk
    Publication . Vigia, E; Ramalhete, L; Ribeiro, R; Barros, I; Chumbinho, B; Filipe, E; Pena, A; Bicho, L; Nobre, A; Carrelha, S; Sobral, M; Lamelas, J; Coelho, JS; Ferreira, A; Pinto Marques, H
    Introduction: Pancreas transplantation is currently the only treatment that can re-establish normal endocrine pancreatic function. Despite all efforts, pancreas allograft survival and rejection remain major clinical problems. The purpose of this study was to identify features that could signal patients at risk of pancreas allograft rejection. Methods: We collected 74 features from 79 patients who underwent simultaneous pancreas-kidney transplantation (SPK) and used two widely-applicable classification methods, the Naive Bayesian Classifier and Support Vector Machine, to build predictive models. We used the area under the receiver operating characteristic curve and classification accuracy to evaluate the predictive performance via leave-one-out cross-validation. Results: Rejection events were identified in 13 SPK patients (17.8%). In feature selection approach, it was possible to identify 10 features, namely: previous treatment for diabetes mellitus with long-term Insulin (U/I/day), type of dialysis (peritoneal dialysis, hemodialysis, or pre-emptive), de novo DSA, vPRA_Pre-Transplant (%), donor blood glucose, pancreas donor risk index (pDRI), recipient height, dialysis time (days), warm ischemia (minutes), recipient of intensive care (days). The results showed that the Naive Bayes and Support Vector Machine classifiers prediction performed very well, with an AUROC and classification accuracy of 0.97 and 0.87, respectively, in the first model and 0.96 and 0.94 in the second model. Conclusion: Our results indicated that it is feasible to develop successful classifiers for the prediction of graft rejection. The Naive Bayesian generated nomogram can be used for rejection probability prediction, thus supporting clinical decision making.
    2023Journal article Open access Show more
  • The Impact of Donor Risk Index, Recipients’ and Operative Characteristics on Post Liver Transplant One-Year Graft Failure: A Cohort Analysis
    Publication . Cardoso, FS; Bagulho, L; Coelho, JS; Lamelas, J; Mateus, E; Mendes, M; Glória, H; Ribeiro, V; Mega, R; Pena, A; Pinto Marques, H; Germano, N; Nolasco, F; Perdigoto, R; Martins, A
    Background and Aims: The donor risk index (DRI) quantifies donor-related characteristics potentially associated with increased risk of early graft failure. We aimed to assess the impact of the DRI, recipient and perioperative factors on post liver transplant (LT) outcomes. Methods: This was a singlecenter retrospective cohort study including all adult (≥18 years) patients who underwent LT from 01/2019 to 12/2019 at Curry Cabral Hospital, Lisbon, Portugal. Primary endpoint was 1-year graft failure post LT. Associations were studied with logistic regression. Results: A total of 131 cadaveric donor LT procedures were performed in 116 recipients. Recipients’ median (IQR) age was 57 (47–64) years and 101/131 (77.1%) were males. Cirrhosis was the underlying etiology in 95/131 (81.2%) transplants. Based on 8 predefined donors’ characteristics, median (IQR) DRI was 1.96 (1.67–2.16). Following adjustment for MELDNa score pre LT and SOFA score (adjusted odds ratio [aOR], 95% confidence interval [CI] = 0.91 [0.56–1.47]) or lactate (aOR [95% CI] = 2.76 [0.71–10.7]) upon intensive care unit (ICU) admission post LT, DRI was not associated with 1-year graft failure. However, higher SOFA score (aOR [95% CI] = 1.20 [1.05–1.37]) or lactate (aOR [95% CI] = 1.27 [1.10–1.46]) upon ICU admission post LT were independently associated with higher odds of 1-year graft failure. Conclusions: In a recent cohort of patients who underwent LT, DRI, despite being high, was not associated with 1-year graft failure, but SOFA score or lactate upon ICU admission post LT were.
    2023Journal article Open access Show more