Browsing by Author "Vasco Costa, N"
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- Malformação Artério-Venosa Renal e Tratamento por Embolização - Caso Clínico e Revisão da LiteraturaPublication . Pegado, P; Lopes Dias, J; Vasco Costa, N; Bilhim, TAs malformações vasculares do rim são processos patológicos que envolvem as veias e as artérias renais incluindo-se neste grupo as malformações arterio-venosas e as fístulas arterio-venosas. Estas lesões podem apresentar-se clinicamente por um grande espectro de sinais e sintomas que variam desde a hipertensão, a hematúria ou por massas renais. A presença de um shunt arterio-venoso caracteriza quer as malfomações quer as fístulas. Reportamos um caso de uma mulher com uma malformação arterio-venosa congénita desconhecida, que se apresentou inicialmente no serviço de urgência com hematúria, tendo sido tratada com sucesso por embolização endovascular. A lesão foi cateterizada selectivamente com um microcateter tendo a embolização sido realizada pela injecção de uma mistura contendo N–butil-2-cianoacrilato e lipiodol. São discutidas as diferentes técnicas de diagnóstico radiológico assim como a técnica de embolização.
- Randomised Clinical Trial of Prostatic Artery Embolisation Versus a Sham Procedure for Benign Prostatic HyperplasiaPublication . Martins Pisco, J; Bilhim, T; Vasco Costa, N; Torres, D; Pisco, J; Campos Pinheiro, L; Gouveia Oliveira, ABackground: Prostatic artery embolisation (PAE) has been associated with an improvement of lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH), but conclusive evidence of efficacy from randomised controlled clinical trials has been lacking. Objective: To assess the safety and efficacy of PAE compared with a sham procedure in the treatment of LUTS/BPH. Design, setting, and participants: A randomised, single-blind, sham-controlled superiority clinical trial was conducted in 80 males ≥45yr with severe LUTS/BPH refractory to medical treatment from 2014 to 2019 in a private clinic, with efficacy assessments at 6 and 12 mo after randomisation. One patient in the PAE group and three in the sham group did not complete the study. Intervention: Patients were randomised 1:1 upon successful catheterisation of a prostatic artery to either PAE or a sham PAE procedure without embolisation. After 6 mo, all 38 patients randomised to the sham group who completed the single-blind period underwent PAE, and both groups completed a 6-mo open period. Outcome measurements and statistical analysis: An intention-to-treat analysis of all randomised patients was performed. The coprimary outcomes were the change from baseline to 6 mo in the International Prostate Symptom Score (IPSS) and the quality of life (QoL) score at 6 mo, analysed with analysis of covariance and t test, respectively. Results and limitations: Mean age was 63.8±6.0yr, baseline IPSS 26.4±3.87, and QoL score 4.43±0.52. At 6 mo, patients in the PAE arm had a greater improvement in IPSS, with a difference in the change from baseline of 13.2 (95% confidence interval [CI] 10.2-16.2, p<0.0001), and a better QoL score at 6 mo (difference: 2.13; 95% CI 1.57-2.68, p<0.0001) than the patients in the sham arm. The improvements in IPSS and QoL in the sham group 6 mo after they performed PAE were, respectively, 13.6±9.19 (p<0.0001) and 2.05 ± 1.71 (p<0.0001). Adverse events occurred in 14 (35.0%) patients after PAE and in 13 (32.5%) after sham, with one serious adverse event in the sham group during the open period. No treatment failures occurred. Limitations include a single-centre trial, only severe LUTS/BPH, and follow-up limited to 12 mo. Conclusions: The improvements in subjective and objective variables after PAE are far superior from those due to the placebo effect. Patient summary: Clearly superior efficacy of prostatic artery embolisation (PAE) compared with a sham procedure was found in this study, which supports the use of PAE in patients with typical symptoms associated with benign prostatic hyperplasia.
- Recurrent Stroke in a Young Woman with a Single Pulmonary Arteriovenous Fistula: An Unusual AssociationPublication . Sousa, S; Vasco Costa, N; Carmona, C; Coimbra, E; Pita, FINTRODUCTION: Cryptogenic stroke is present in about 40% of ischemic stroke patients. Extracardiac shunt related to pulmonary arteriovenous fistula (PAVF) could be a rare potential risk factor for embolic stroke. Most PAVFs are multiple, congenital, and associated with hereditary conditions. On the other hand, isolated PAVFs are rare conditions and an uncommon cause of cryptogenic stoke. CASE REPORT: We describe a case of a young woman without history of respiratory diseases or vascular risk factors, who presented with acute onset of transitory aphasia and right hemiplegia. She had a history of a transient ischemic attack, 3 years before, and migraine headaches. Brain MRI showed an acute cortical ischemic lesion and a chronic ischemic lesion. Diagnostic workup with transcranial Doppler ultrasonography revealed a significant right-to-left shunt with curtain pattern, and echocardiogram did not show structural abnormalities. An isolated small PAVF was diagnosed on pulmonary angiogram. Despite the rare association between isolated small PAVF and stroke, we decided to treat it with coil embolization because of recurrence of stroke, cortical lesions suggestive of embolic source, significant right-left shunt, and risk of future complications. CONCLUSIONS: This case highlights the importance of search, identification, and interpretation of causes of cryptogenic strokes to better choose therapy to reduce the stroke recurrence risk. Although unusual, PAVF detection is a treatable cause of stroke and the therapeutic decisions should take into account the characteristics of the PAVF and the degree of suspicion regarding the cause-effect relationship between PAVF and stroke.
- The Utility of Apparent Diffusion Coefficient Values in the Risk Stratification of Prostate Cancer Using a 1.5 T Magnetic Resonance Imaging Without Endorectal CoilPublication . Lopes Dias, J; Magalhães Pina, J; Vasco Costa, N; Carmo, S; Leal, CPurpose: To evaluate the relationship between mean apparent diffusion coefficient (ADC) and post-surgical Gleason scores. To determine the diagnostic accuracy of multiparametric magnetic resonance imaging (mp-MRI) on a 1.5 T magnet in distinguishing low, intermediate and highgrade prostate tumors. Material and methods: This is a retrospective institutional-review-board-approved, singlecenter study including 30 patients (median age, 60 years) who underwent mp-MRI before prostatectomy for prostate cancer. Using histological reports for guidance, the tumors were localized in ADC maps, and mean ADCs were measured and examined for correlation with Gleason scores. 2 patients had 2 measurable foci, so a total of 32 tumors were studied. The diagnostic accuracy of the mean ADC was assessed by using the area under the receiver operating characteristic curve (ROC). Results: In the differentiation of tumors with a Gleason score of 6 from those with a Gleason score of at least 7, mean ADC yielded an AUC of 0.76 (95% confidence interval: 0.59, 0.93). In the differentiation of tumors with Gleason scores of 6 or 7 from those with a Gleason score of at least 8, mean ADC yielded an AUC of 0.94 (95% confidence interval: 0.86, 1.00). Conclusion: Mean ADC values may allow a correct assessment of the patient risk using a 1.5 T magnet without ERC.