Browsing by Author "Duarte, M"
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- Claudicação da Marcha - Três Casos, Três Diagnósticos...Publication . Duarte, M; Ramos, S; Conde, M; Gouveia, CIntrodução: A claudicação da marcha na criança é frequente tendo múltiplas etiologias (infeciosa, traumática, inflamatória, mecânica ou neoplásica). Apresentam-se três casos de gonalgia com diagnósticos distintos. Caso clínico:Caso clínico 1: Rapaz de 2 anos, com gonalgia com 4 dias de evolução, sinais inflamatórios e limitação funcional. Sem leucocitose, PCR 87mg/L, VS 68mm/h e ecografia com derrame articular. Realizou artrocentese com identificação de Kingellakingae no líquido articular, confirmando o diagnóstico de artrite séptica. Medicado com cefuroxime (30 dias) com ótima evolução. Caso clínico 2: Rapaz de 2 anos, com gonalgia há 15 dias, limitação da extensão do joelho e calor local. Análises com PCR 6.9mg/L, VS 30mm/h, ANAs positivos 1/160 e ecografia com derrame articular e sinovite. Submetido a artrocentese com HC e LA estéreis, não tendo apresentado resposta à antibioterapia (AB). Às 7 semanas por manter quadro com ritmo inflamatório foi feito o diagnóstico de artrite idiopática juvenil oligoarticular, medicado com anti-inflamatório e sinovectomia química com melhoria. Caso clínico 3: Rapaz de 3 anos, com gonalgia persistente com 3 semanas de evolução e sinais inflamatórios. Analiticamente sem parâmetros inflamatórios e sem resposta à AB. Radiografia com reação periosteal e alteração da densidade do fémur. Ressonância magnética evidenciou lesão ocupando espaço femoral distal sólida e heterogénea. A biópsia confirmou osteossarcoma de alto grau. Realizou quimioterapia e aguarda cirurgia. Conclusões: Estes casos ilustram a heterogeneidade e amplo espectro de gravidade etiológica dos quadros de claudicação da marcha. Apesar de frequentemente associados a quadros benignos, também podem ser resultado de patologias graves e crónicas.
- Embolisation of Prostatic Arteries as Treatment of Moderate to Severe Lower Urinary Symptoms (LUTS) Secondary to Benign Hyperplasia: Results of Short- and Mid-Term Follow-UpPublication . Pisco, JM; Rio Tinto, H; Pinheiro, LC; Bilhim, T; Duarte, M; Fernandes, L; Pereira, J; Oliveira, AOBJECTIVES: To evaluate the short- and medium-term results of prostatic arterial embolisation (PAE) for benign prostatic hyperplasia (BPH). METHODS: This was a prospective non-randomised study including 255 patients diagnosed with BPH and moderate to severe lower urinary tract symptoms after failure of medical treatment for at least 6 months. The patients underwent PAE between March 2009 and April 2012. Technical success is when selective prostatic arterial embolisation is completed in at least one pelvic side. Clinical success was defined as improving symptoms and quality of life. Evaluation was performed before PAE and at 1, 3, 6 and every 6 months thereafter with the International Prostate Symptom Score (IPSS), quality of life (QoL), International Index of Erectile Function (IIEF), uroflowmetry, prostatic specific antigen (PSA) and volume. Non-spherical polyvinyl alcohol particles were used. RESULTS: PAE was technically successful in 250 patients (97.9 %). Mean follow-up, in 238 patients, was 10 months (range 1-36). Cumulative rates of clinical success were 81.9 %, 80.7 %, 77.9 %, 75.2 %, 72.0 %, 72.0 %, 72.0 % and 72.0 % at 1, 3, 6, 12, 18, 24, 30 and 36 months, respectively. There was one major complication. CONCLUSIONS: PAE is a procedure with good results for BPH patients with moderate to severe LUTS after failure of medical therapy. KEY POINTS: • Prostatic artery embolisation offers minimally invasive therapy for benign prostatic hyperplasia. • Prostatic artery embolisation is a challenging procedure because of vascular anatomical variations. • PAE is a promising new technique that has shown good results.
- Escleroterapia do Varicocelo da Veia Ovárica: Resultados a Curto e Longo PrazoPublication . Pisco, JM; Duarte, M; Bilhim, T; Mota Capitão, L; Menezes, JD; Albino, JP; Branco, JPurpose: To evaluate the safety and efficiency of sclerotherapy in ovarian vein varicocele. Study population: During 6 years, 36 women with the clinical diagnosis of ovarian vein varicocele were evaluated. Methods: The diagnosis was confirmed by flebography of the ovarian vein in 35 of the patients. In these patients sclerotherapy of the ovarian vein was performed with success by selective retrograde catheterization of the ovarian vein by femoral approach in 31 patients and by brachial approach in 4 patients. Four to eight ml of polidocanol l3% was used in each vein. Results: There was clinical improvement with complete resolution of all symptoms in 29 patients(82.9%) and partial symptomatic relief in 6 (17.1%). Long term results, evaluated between 1 and 6 years (mean 37.3 months), showed complete resolution of symptoms in 27 (77.1%) and recurrence in 8 (22.9%). Four patients with recurrence, improved following repeated sclerotherapy. Thus, there was long term improvement in 31 patients (88.6%). Conclusion: Sclerotherapy of ovarian vein appears to be a safe and efficient treatment of ovarian vein varicocele.
- Hyperprolinemia as a Clue in the Diagnosis of a Patient with Psychiatric ManifestationsPublication . Duarte, M; Afonso, J; Moreira, A; Antunes, D; Ferreira, C; Correia, H; Marques, M; Sequeira, SLately, microdeletions of the 22q region, responsible for DiGeorge syndrome or velocardiofacial syndrome, have been increasingly related to neuropsychiatric disorders including schizophrenia and bipolar disorder. These manifestations seem to be related to certain genes located in the hemideleted region such as the proline dehydrogenase (PRODH) and the catechol-o-methyltransferase (COMT) genes. We describe a teenager who started his adolescent psychiatric care presenting cognitive impairment, irritable mood and aggressive behaviour with schizophrenia-like symptoms that scored 153 in the Positive and Negative Symptoms Scale (PANSS) assessment. Worsening of symptoms when the patient was treated with valproic acid, and plasma aminoacids showing an increase in alanine and proline, suggested a mitochondrial involvement of the proline metabolic pathway. Mild dysmorphic features also suggested a possible 22q11 deletion syndrome that was confirmed. A mutation for Hyperprolinemia type I was also detected. Knowledge of the correct diagnosis was crucial for an adequate treatment.
- New Prospects for the Management of Cardiovascular Effects of Tyrosine Kinase Inhibitors in Patients with Chronic Myeloid LeukemiaPublication . Almeida, A; Almeida, A; Melo, T; Guerra, L; Lopes, L; Ribeiro, P; Duarte, M; Mota, A; Fontes-Carvalho, RThe use of tyrosine kinase inhibitors (TKIs) for the treatment of chronic myeloid leukemia has significantly altered the prognosis of this disease, enabling close to normal life expectancy. Despite their undeniable benefits, the use of TKIs is associated with an increased risk of side effects on the cardiovascular system, particularly of atherothrombotic events. It is therefore necessary to understand and prevent the adverse effects of these drugs, in order to enable antileukemic therapy to continue and to minimize patients' toxic exposure. This multidisciplinary consensus document, developed through a collaboration between hematologists and cardiologists, aims to review the cardiovascular toxicity associated with various TKIs and to establish recommendations for the follow-up of these patients. Measures are also proposed for the assessment and reduction of cardiovascular risk in these patients and referral criteria, and relevant drug interactions are discussed.
- Osteoarticular Infections in Infants Under 3 Months of AgePublication . Branco, J; Duarte, M; Norte, S; Arcangelo, J; Alves, P; Brito, M; Tavares, D; Gouveia, CBackground: Acute osteoarticular infections (OAI) in infants under 3 months of age (≤3M) are rare and remain a diagnostic challenge. Orthopedic complications and functional sequelae have been less well described in this age group. Our aims were to evaluate trends in aetiology, management, and outcomes of OAI ≤ 3M, and to compare these younger children who have OAI with older children. Methods: A longitudinal observational study was conducted of OAI cases admitted to tertiary care pediatric hospital from 2008 to 2018. OAI ≤ 3M was compared with children above 3 months. Clinical, microbiological, imaging, and outcome data were analyzed. Results: We identified 24 (9.1%) of the 263 OAI in children under 3 months. Analyzing OAI ≤ 3M there was a twofold increase since 2014; 54% were males with a median age of 28 days (IQR: 13.5-60.0), 10 (41.7%) were premature and nine (37.5%) had healthcare-associated infections. Microbiological causes were identified in 87.5%, mostly Staphylococcus aureus (57.1%) and Group B Streptococcus (23.8%), and 25% were multidrug-resistant (5 methicillin-resistant S. aureus and 1 Enterobacter cloacae). Bacteremia (100% vs 36.8%, P = 0.037), multidrug resistant bacteria (75% vs 16, P = 0.04), and healthcare-associated infections (100% vs 26.3%, P = 0.014) were associated with sequelae. Comparing OAI ≤ 3M with older children, OAI ≤ 3M were treated with longer antibiotic courses, had more complications and sequelae (17.4% vs 3.2%, P = 0.002). Conclusions: S. aureus is still the most common cause of OAI ≤ 3M, and 25% of causative bacteria were multidrug-resistant bacteria. Complications and sequelae were more frequent in OAI ≤ 3M when compared with older children.
- Osteoarticular Infections in Paediatric Sickle Cell Disease: in the Era of Multidrugresistant BacteriaPublication . Gouveia, C; Duarte, M; Norte, S; Alves, P; Kjöllerström, P; Brito, M; Tavares, D
- Prostatic Arterial Embolization to Treat Benign Prostatic HyperplasiaPublication . Pisco, JM; Pinheiro, LC; Bilhim, T; Duarte, M; Mendes, J; Oliveira, APURPOSE: To evaluate whether prostatic arterial embolization (PAE) might be a feasible procedure to treat lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: Fifteen patients (age range, 62-82 years; mean age, 74.1 y) with symptomatic BPH after failure of medical treatment were selected for PAE with nonspherical 200-μm polyvinyl alcohol particles. The procedure was performed by a single femoral approach. Technical success was considered when selective prostatic arterial catheterization and embolization was achieved on at least one pelvic side. RESULTS: PAE was technically successful in 14 of the 15 patients (93.3%). There was a mean follow-up of 7.9 months (range, 3-12 months). International Prostate Symptom Score decreased a mean of 6.5 points (P = .005), quality of life improved 1.14 points (P = .065), International Index of Erectile Function increased 1.7 points (P = .063), and peak urinary flow increased 3.85 mL/sec (P = .015). There was a mean prostate-specific antigen reduction of 2.27 ng/mL (P = .072) and a mean prostate volume decrease of 26.5 mL (P = .0001) by ultrasound and 28.9 mL (P = .008) by magnetic resonance imaging. There was one major complication (a 1.5-cm(2) ischemic area of the bladder wall) and four clinical failures (28.6%). CONCLUSIONS: In this small group of patients, PAE was a feasible procedure, with preliminary results and short-term follow-up suggesting good symptom control without sexual dysfunction in suitable candidates, associated with a reduction in prostate volume.
- Prostatic Arterial Supply: Anatomic and Imaging Findings Relevant for Selective Arterial EmbolizationPublication . Bilhim, T; Pisco, JM; Rio Tinto, H; Fernandes, L; Pinheiro, LC; Furtado, A; Casal, D; Duarte, M; Pereira, J; Oliveira, A; Goyri-O'Neill, JPURPOSE: To describe the anatomy and imaging findings of the prostatic arteries (PAs) on multirow-detector pelvic computed tomographic (CT) angiography and digital subtraction angiography (DSA) before embolization for symptomatic benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: In a retrospective study from May 2010 to June 2011, 75 men (150 pelvic sides) underwent pelvic CT angiography and selective pelvic DSA before PA embolization for BPH. Each pelvic side was evaluated regarding the number of independent PAs and their origin, trajectory, termination, and anastomoses with adjacent arteries. RESULTS: A total of 57% of pelvic sides (n = 86) had only one PA, and 43% (n = 64) had two independent PAs identified (mean PA diameter, 1.6 mm ± 0.3). PAs originated from the internal pudendal artery in 34.1% of pelvic sides (n = 73), from a common trunk with the superior vesical artery in 20.1% (n = 43), from the anterior common gluteal-pudendal trunk in 17.8% (n = 38), from the obturator artery in 12.6% (n = 27), and from a common trunk with rectal branches in 8.4% (n = 18). In 57% of pelvic sides (n = 86), anastomoses to adjacent arteries were documented. There were 30 pelvic sides (20%) with accessory pudendal arteries in close relationship with the PAs. No correlations were found between PA diameter and patient age, prostate volume, or prostate-specific antigen values on multivariate analysis with logistic regression. CONCLUSIONS: PAs have highly variable origins between the left and right sides and between patients, and most frequently arise from the internal pudendal artery.
- Prostatic Artery Embolization in the Treatment of Benign Prostatic Hyperplasia: Short and Medium Follow-UpPublication . Rio Tinto, H; Pisco, JM; Bilhim, T; Duarte, M; Fernandes, L; Pereira, J; Pinheiro, LCTo evaluate the short and mid-term results of prostatic artery embolization in patients with benign prostatic embolization. Retrospective study between March 2009 and June 2011 with 103 patients (mean age 66.8 years, 50-85) that met our inclusion criteria with symptomatic benign prostatic hyperplasia. The clinical outcome was evaluated by the International Prostate Symptom Score (IPSS), quality of life (QoL), International Index of Erectile Function, prostate volume (PV), prostate-specific antigen (PSA), peak urinary flow (Q(max)), and post-void residual volume (PVR) measurements at 3 and 6 months, 1 year, 18 months, and 2 years after PAE and comparison with baseline values was made. Technical and clinical successes, as well as poor clinical outcome definitions, were previously defined. In this review, we evaluate the short and mid-term clinical outcomes and morbidity of patients treated only with non-spherical polyvinyl alcohol. Six months after the procedure, the PV decreased about 23%, IPSS changed to a mean value of 11.95 (almost 50% reduction), the QoL improved slightly more than 2 points, the Q(max) changed to a mean value of 12.63mL/s, the PVR underwent a change of almost half of the baseline value, and the PSA decreased about 2.3ng/mL. In the mid-term follow-up and comparing to the baseline values, we still assisted to a reduction in PV, IPSS, QoL, PVR, and PSA, and an increase in Q(max). Prostatic Artery Embolization is a safe procedure with low morbidity that shows good short- and mid-term clinical outcome in our institution.