Browsing by Author "Pereira, P"
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- ABO-Incompatible Liver Transplantation in Acute Liver Failure: A Single Portuguese Center StudyPublication . Mendes, M; Ferreira, AC; Ferreira, A; Remédio, F; Aires, I; Cordeiro, A; Mascarenhas, A; Martins, A; Pereira, P; Glória, H; Perdigoto, R; Veloso, J; Ferreira, P; Oliveira, J; Silva, M; Barroso, E; Nolasco, FINTRODUCTION: ABO-incompatible liver transplantation (ABOi LT) is considered to be a rescue option in emergency transplantation. Herein, we have reported our experience with ABOi LT including long-term survival and major complications in these situations. PATIENT AND METHODS: ABOi LT was performed in cases of severe hepatic failure with imminent death. The standard immunosuppression consisted of basiliximab, corticosteroids, tacrolimus, and mycophenolate mofetil. Pretransplantation patients with anti-ABO titers above 16 underwent plasmapheresis. If the titer was above 128, intravenous immunoglobulin (IVIG) was added at the end of plasmapheresis. The therapeutic approach was based on the clinical situation, hepatic function, and titer evolution. A rapid increase in titer required five consecutive plasmapheresis sessions followed by administration of IVIG, and at the end of the fifth session, rituximab. RESULTS: From January 2009 to July 2012, 10 patients, including 4 men and 6 women of mean age 47.8 years (range, 29 to 64 years), underwent ABOi LT. At a mean follow-up of 19.6 months (range, 2 days to 39 months), 5 patients are alive including 4 with their original grafts. One patient was retransplanted at 9 months. Major complications were infections, which were responsible for 3 deaths due to multiorgan septic failure (2 during the first month); rejection episodes (4 biopsy-proven of humoral rejections in 3 patients and 1 cellular rejection) and biliary. CONCLUSION: The use of ABOi LT as a life-saving procedure is justifiable in emergencies when no other donor is available. With careful recipient selection close monitoring of hemagglutinins and specific immunosuppression we have obtained acceptable outcomes.
- 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%.
- Dominant and Recessive RYR1 Mutations in Adults with Core Lesions and Mild Muscle SymptomsPublication . Duarte, ST; Oliveira, J; Santos, R; Pereira, P; Barroso, C; Conceição, I; Evangelista, TINTRODUCTION: Ryanodine receptor gene (RYR1) mutations have been associated with central core disease (CCD), multiminicore/minicore/multicore disease (MmD), and susceptibility to malignant hyperthermia (MH). METHODS: Patients with muscle symptoms in adulthood, who had features compatible with CCD/MmD, underwent clinical, histological, and genetic (RYR1 and SEPN1 genes) evaluations. Published cases of CCD and MmD with adult onset were also reviewed. RESULTS: Eight patients fulfilled the criteria for further analysis. Five RYR1 mutations, 4 of them unreported, were detected in 3 patients. Compound heterozygosity was proven in 1 case. CONCLUSIONS: To our knowledge, this is the only report of adult onset associated with recessive RYR1 mutations and central core/multiminicores on muscle biopsy. Although adult patients with CCD, MmD, and minimally symptomatic MH with abnormal muscle biopsy findings usually have a mild clinical course, differential diagnosis and carrier screening is crucial for prevention of potentially life-threatening reactions to general anesthesia.
- Nefrectomia Radical e Nefroureterectomia Laparoscópica "Hand-Assited": a Experiência dos Primeiros 21 CasosPublication . Pinheiro, LC; Farinha, R; Fonseca, J; Coelho, JS; Pena, A; Pereira, P; Martins, AObjectivos: 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.
- Spontaneous Intracranial Hypotension and Multi-Level Cervical and Lumbar Epidural Blood Patches: A Case ReportPublication . Parra, A; Relvas, F; Pereira, P; Carrilho, ASpontaneous intracranial hypotension (SIH) is a neurologic condition where the intracranial pressure is reduced due to a loss of cerebrospinal fluid from its reservoir, the intrathecal space, to surrounding tissues. It is commonly characterized by an incapacitating headache, phono-photophobia, nausea, and vomiting, commonly refractory to medical treatment and requires further investigation. We describe the case of a healthy young man who presented to the emergency room with a postural headache, accompanied by nausea, vomiting, and phono-photophobia. Brain computed tomography (CT) imaging study was unremarkable and he was initially treated symptomatically. Because of persisting pain even on medical treatment, additional imaging studies, including a myelo-CT scan, were performed and a diagnosis of multi-level cerebrospinal fluid fistulas was made. To treat the underlying cause, a first epidural blood patch (EBP) was initially performed at C7-T1 with 20 mL of autologous blood, but failed to provide complete symptomatic relief. Months later, a second EBP was conducted at C6-C7 with higher volume (30 mL) but as in the first EBP this procedure too did not result in total resolution of the headache and accompanying symptoms. Since there was no surgical indication from Orthopedics and Neurosurgery and the symptoms persisted, a third EBP was carried out, this time at a lumbar level (L2-L3) with infusion of 60 mL of blood so the upper dorsal and cervical epidural space was reached. This resulted in a better symptom relief, allowing the patient to now carry out his normal activities with only residual pain. The need for repeat procedures is one of the pitfalls of the blood patching technique. If possible, it should be performed at the level of the documented fistula, but always with safety in mind and by experienced hands, especially when cervical levels are concerned. A consensus has not been reached regarding the blood volume to be administered; however, any discomfort or pain reported by the patient should be seen as warning sign and the procedure should be interrupted. Although not being a perfect solution, EBP can completely or partially resolve SIH symptoms, without the need for surgical intervention.