Browsing by Issue Date, starting with "2016-01"
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- A Truly Visible Vessel in an Endoscopic Submucosal Dissection Scare: Thinking Outside RecommendationsPublication . Costa, MN; Libânio, D; Lage, J; Dinis-Ribeiro, M; Pimentel-Nunes, P
- Underneath the "Apple-Jelly"Publication . Mendes-Bastos, P; Oliveira, A; Fernandes, C
- Optimal First Trimester Preeclampsia Prediction: a Comparison of Multimarker Algorithm, Risk Profiles and Their Sequential ApplicationPublication . Gabbay-Benziv, R; Oliveira, N; Baschat, AAOBJECTIVE: To compare performance of multimarker algorithm, risk profiles and their sequential application in prediction of preeclampsia and determining potential intervention targets. STUDY DESIGN: Maternal characteristics, ultrasound variables and serum biomarkers were collected prospectively at first trimester. Univariate analysis identified preeclampsia associated variables followed by logistic regression analysis to determine the prediction rule. Combined characteristics of the cardiovascular, metabolic and the personal risk factors were compared to the multimarker algorithm and the sequential application of both methods. RESULTS: Out of 2433 women, 108 developed preeclampsia (4.4%). Probability scores considering nulliparity, prior preeclampsia, body mass index, diastolic blood pressure and placental growth factor had an area under the receiver operating characteristic curve 0.784 (95% CI = 0.721-0.847). While the multimarker algorithm had the lowest false negative rate, sequential application of cardiovascular and metabolic risk profiles in screen positives reduced false positives by 26% and identified blood pressure and metabolic risk in 49/54 (91%) women with subsequent preeclampsia as treatable risk factors. CONCLUSION: Sequential application of a multimarker algorithm followed by determination of treatable risk factors in screen positive women is the optimal approach for first trimester preeclampsia prediction and identification of women that may benefit from targeted metabolic or cardiovascular treatment
- Management and Outcomes of Patients with Recurrent Intrahepatic Cholangiocarcinoma Following Previous Curative-Intent Surgical ResectionPublication . Spolverato, G; Kim, Y; Alexandrescu, S; Pinto Marques, H; Lamelas, J; Aldrighetti, L; Clark Gamblin, T; Maithel, SK; Pulitano, C; Bauer, TW; Shen, F; Poultsides, GA; Tran, TB; Wallis Marsh, J; Pawlik, TMBACKGROUND: Management and outcomes of patients with recurrent intrahepatic cholangiocarcinoma (ICC) following curative-intent surgery are not well documented. We sought to characterize the treatment of patients with recurrent ICC and define therapy-specific outcomes. METHODS: Patients who underwent surgery for ICC from 1990 to 2013 were identified from an international database. Data on clinicopathological characteristics, operative details, recurrence, and recurrence-related management were recorded and analyzed. RESULTS: A total of 563 patients undergoing curative-intent hepatic resection for ICC who met the inclusion criteria were identified. With a median follow-up of 19 months, 400 (71.0 %) patients developed a recurrence. At initial surgery, treatment was resection only (98.8 %) or resection + ablation (1.2 %). Overall 5-year survival was 23.6 %; 400 (71.0 %) patients recurred with a median disease-free survival of 11.2 months. First recurrence site was intrahepatic only (59.8 %), extrahepatic only (14.5 %), or intra- and extrahepatic (25.7 %). Overall, 210 (52.5 %) patients received best supportive care (BSC), whereas 190 (47.5 %) patients received treatment, such as systemic chemotherapy-only (24.2 %) or repeat liver-directed therapy ± systemic chemotherapy (75.8 %). Repeat liver-directed therapy consisted of repeat hepatic resection ± ablation (28.5 %), ablation alone (18.7 %), and intra-arterial therapy (IAT) (52.8 %). Among patients who recurred, median survival from the time of the recurrence was 11.1 months (BSC 8.0 months, systemic chemotherapy-only 16.8 months, liver-directed therapy 18.0 months). The median survival of patients undergoing resection of recurrent ICC was 26.7 months versus 9.6 months for patients who had IAT (p < 0.001). CONCLUSIONS: Recurrence following resection of ICC was common, occurring in up to two-thirds of patients. When there is recurrence, prognosis is poor. Only 9 % of patients underwent repeat liver resection after recurrence, which offered a modest survival benefit.
- Understanding Medical Errors and Adverse Events in ICU PatientsPublication . Garrouste-Orgeas, M; Flaatten, H; Moreno, R
- Aseptic Meningitis Caused by Coxiella BurnetiiPublication . Figueiredo, C; Candeias, F; Brito, MJAcute Q fever can have multiple presentations but neurologic involvement is rare. We describe the case of a 16-year-old female with severe headache and aseptic meningitis with acute Coxiella burnetii infection.
- Preoperative Abnormalities in Serum Sodium Concentrations Are Associated with Higher in-Hospital Mortality in Patients Undergoing Major SurgeryPublication . Cecconi, M; Hochrieser, H; Chew, M; Grocott, M; Hoeft, A; Hoste, A; Jammer, I; Posch, M; Metnitz, P; Pelosi, P; Moreno, R; Pearse, RM; Vincent, JL; Rhodes, ABACKGROUND: Abnormal serum sodium concentrations are common in patients presenting for surgery. It remains unclear whether these abnormalities are independent risk factors for postoperative mortality. METHODS: This is a secondary analysis of the European Surgical Outcome Study (EuSOS) that provided data describing 46 539 patients undergoing inpatient non-cardiac surgery. Patients were included in this study if they had a recorded value of preoperative serum sodium within the 28 days immediately before surgery. Data describing preoperative risk factors and serum sodium concentrations were analysed to investigate the relationship with in-hospital mortality using univariate and multivariate logistic regression techniques. RESULTS: Of 35 816 (77.0%) patients from the EuSOS database, 21 943 (61.3%) had normal values of serum sodium (138-142 mmol litre(-1)) before surgery, 8538 (23.8%) had hyponatraemia (serum sodium ≤137 mmol litre(-1)) and 5335 (14.9%) had hypernatraemia (serum sodium ≥143 mmol litre(-1)). After adjustment for potential confounding factors, moderate to severe hypernatraemia (serum sodium concentration ≥150 mmol litre(-1)) was independently associated with mortality [odds ratio 3.4 (95% confidence interval 2.0-6.0), P<0.0001]. Hyponatraemia was not associated with mortality. CONCLUSIONS: Preoperative abnormalities in serum sodium concentrations are common, and hypernatraemia is associated with increased mortality after surgery. Abnormalities of serum sodium concentration may be an important biomarker of perioperative risk resulting from co-morbid disease.
- Neoplasia das Glândulas Salivares Pode Simular Patologia Odontogénica Comum. A Propósito de um Caso Clínico de Adenoma PleomórficoPublication . Fonseca, L; Ribeiro, N; Pinheiro, J; Fernandes, F; Proença, F; Araújo, CO ademona pleomórfico é responsável por cerca de 50% das neoplasias benignas das glândulas salivares menores. Apresenta-se normalmente como uma massa firme, de crescimento lento e indolor. Este trabalho pretende relatar um caso de adenoma pleomórfico em doente do sexo masculino, de 32 anos, previamente medicado com antibiótico por suspeita de abcesso odontogénico. À observação por Estomatologia apresentava massa palatina justa 2.5, com 4 semanas de evolução, de consistência duro-elástica e dolorosa a palpação. Após exclusão de causa odontogénica, procedeu-se a biópsia incisional que confirmou o diagnóstico de adenoma pleomórfico, tendo sido realizada a excisão da lesão com inclusão do periósteo subjacente. Até a data não há indícios de recidiva.
- EORTC Nomograms and Risk Groups for Predicting Recurrence, Progression, and Disease-Specific and Overall Survival in Non-Muscle-Invasive Stage Ta-T1 Urothelial Bladder Cancer Patients Treated with 1-3 Years of Maintenance Bacillus Calmette-GuérinPublication . Cambier, S; Sylvester, RJ; Collette, L; Gontero, P; Brausi, MA; van Andel, G; Kirkels, WJ; Calais da Silva, F; Oosterlinck, W; Prescott, S; Kirkali, Z; Powell, PH; de Reijke, TM; Turkeri, L; Collette, S; Oddens, JBACKGROUND: There are no prognostic factor publications on stage Ta-T1 non-muscle-invasive bladder cancer (NMIBC) treated with 1-3 yr of maintenance bacillus Calmette-Guérin (BCG). OBJECTIVE: To determine prognostic factors in NMIBC patients treated with 1-3 yr of BCG after transurethral resection of the bladder (TURB), to derive nomograms and risk groups, and to identify high-risk patients who should be considered for early cystectomy. DESIGN, SETTING, AND PARTICIPANTS: Data for 1812 patients were merged from two European Organization for Research and Treatment of Cancer randomized phase 3 trials in intermediate- and high-risk NMIBC. INTERVENTION: Patients received 1-3 yr of maintenance BCG after TURB and induction BCG. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Prognostic factors for risk of early recurrence and times to late recurrence, progression, and death were identified in a training data set using multivariable models and applied to a validation data set. RESULTS AND LIMITATIONS: With a median follow-up of 7.4 yr, 762 patients recurred; 173 progressed; and 520 died, 83 due to bladder cancer (BCa). Statistically significant prognostic factors identified by multivariable analyses were prior recurrence rate and number of tumors for recurrence, and tumor stage and grade for progression and death due to BCa. T1G3 patients do poorly, with 1- and 5-yr disease-progression rates of 11.4% and 19.8%, respectively, and 1- and 5-yr disease-specific death rates of 4.8% and 11.3%. Limitations include lack of repeat transurethral resection in high-risk patients and exclusion of patients with carcinoma in situ. CONCLUSIONS: NMIBC patients treated with 1-3 yr of maintenance BCG have a heterogeneous prognosis. Patients at high risk of recurrence and/or progression do poorly on currently recommended maintenance schedules. Alternative treatments are urgently required. PATIENT SUMMARY: Non-muscle-invasive bladder cancer patients at high risk of recurrence and/or progression do poorly on currently recommended bacillus Calmette-Guérin maintenance schedules, and alternative treatments are urgently required.
- Parâmetros Morfológicos no SD-OCT em Doentes com Degeneração Macular da Idade Antes e Após Terapêutica com BevacizumabPublication . Noronha, M; Borges, B; Cabugueira, A; Carvalho, B; Gomes, T; Marques, M; Flores, RObjectivo: Estudar a evolução dos parâmetros quantitativos e qualitativos obtidos na tomografia de coerência óptica spectral domain (SD-OCT) num sub-grupo de doentes com degeneração macular da idade (DMI) sujeitos a injecções intravítreas (IV) de bevacizumab. Procurou-se também verificar se estes parâmetros poderão funcionar como factores de prognóstico da acuidade visual (AV) pós- terapêutica com IV de bevacizumab. Material e Métodos: Estudo retrospectivo de 55 olhos de 50 doentes, com diagnóstico de DMI sem terapêutica prévia, submetidos a pelo menos 3 IVs mensais de bevacizumab. Foram estudados os parâmetros quantitativos [espessura foveal central (EFC), comprimento da membrana limitante externa (MLE) e zona elipsóide (ZE)] e qualitativos obtidos através do SD-OCT antes e após IV. Foi analisada a existência ou não de correlação entre estes parâmetros e a AV pré e pós IV. Resultados: A média da AV (Log MAR), EFC (μm), comprimento da MLE (μm) e comprimento da ZE (μm) variou de valores pré-IV de 0,59+/-0,40; 429,3+/-112,2; 381,2+/-380,5 e 149,1+/-266,1 para valores pós-IV de 0,49+/-0,42; 334,5+/-126,1; 540,4+/-424,2 e 159,6+/-209,0. Existiu correlação entre a AV pré-IV e da EFC (rs=0,30), comprimento da MLE (rs=-0,28) e disrupção da MLE (rs=-0,39) pré-IVs bem como correlação entre a AV pós-IV e comprimento da MLE pós-IV (rs=-0,42). A AV pós-IV apresentou correlação com os valores pré-IVs da AV (rs=0,59), do comprimento da MLE (rs=-0,36) e disrupção da MLE (rs=-0,47). Conclusão: Neste grupo de estudo a AV, o comprimento da MLE e a disrupção da MLE pré-IVs parecem poder funcionar como factores de prognóstico da AV pós-IV.