Browsing by Issue Date, starting with "2016-06"
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- Isquemia Crítica dos Membros Superiores. Manifestação Inicial de Arterite de Células Gigantes - Caso ClínicoPublication . Abreu, R; Monteiro e Castro, J; Rodrigues, H; Vasconcelos, L; Rodrigues, G; Quintas, A; Ferreira, R; Camacho, N; Ferreira, ME; Albuquerque e Castro, J; Mota Capitão, LIntrodução: A arterite de células gigantes (ACG), de etiologia desconhecida, é a vasculite sistémica mais comum nos adultos e pode ter uma ampla variedade de apresentações clínicas. Atinge mais frequentemente os ramos extracranianos da artéria carótida mas, em 10-15% dos casos, pode ocorrer o envolvimento das artérias subclávia, axilar e braquial. Caso clínico: Tratava-se de uma doente do sexo feminino, de 80 anos, com antecedentes de HTA e doença cerebrovascular. Foi observada no serviço de urgência por arrefecimento e dor em repouso nos membros superiores, com evidências de cianose digital distal bilateral. As queixas tinham tido início 2 meses antes e agravamento progressivo desde então. Realizou um angio-TC que mostrou a existência de oclusão de ambas as artérias axilares/braquiais proximais e imagens sugestivas de vasculite ao nível de ambas as artérias subclávias, aorta e artérias femorais comuns. Foi medicada com corticoterapia; contudo, por não apresentar melhoria significativa após 5 dias, optou-se por realizar um bypass carotídeo-umeral bilateral. Após a cirurgia, ocorreu resolução completa das queixas e a doente apresentava pulso radial palpável bilateralmente. Seis meses após a cirurgia, a doente encontrava-se assintomática e os bypasses permeáveis. Conclusão: O presente trabalho pretende expor o caso de uma doente com o diagnóstico inaugural e ACG,que se apresentou com isquemia crítica bilateral e simultânea. Este quadro clínico exigiu a realização de um procedimento de revascularização raro.
- Secondary Epiretinal Membrane After TrabeculectomyPublication . Vieira, L; Cabugueira, A; Borges, B; Carvalho, V; Noronha, M; Abegão Pinto, L; Reina, M; Dutra Medeiros, MPurpose: To determine the frequency of epiretinal membranes (ERM) in eyes with primary open-angle glaucoma subjected to trabeculectomy. Methods: We conducted a retrospective study on patients subjected to trabeculectomy with at least a 6-month follow-up. Ophthalmologic examination and spectral-domain optical coherence tomography (SD-OCT) were analyzed. Eyes with previous surgical or laser treatments or other pathologies (other than glaucoma and ERM) were excluded. Results: A total of 50 eyes (40 patients) were included in this study. The mean follow-up time after surgery was 27.8 months. After surgery, 9 eyes (18%) had preretinal macular fibrosis and 19 eyes (38%) had cellophane macular reflex. Of the 16 eyes with a preoperative macular SD-OCT, 3 (18.8%) developed ERM and 4 (25%) progressed from cellophane macular reflex to preretinal macular fibrosis, after surgery. The ERM frequency did not differ significantly between eyes subjected to trabeculectomy with or without the use of antimetabolites (P=0.08), or between eyes subjected to simple or combined surgery (phacotrabeculectomy) (P=0.09). Conclusion: Trabeculectomy may predispose one to the appearance and progression of ERM. Further studies are needed to clarify this intriguing relation.
- Ki-67 Proliferation Index in Gastric Cancer - Biologic SignificancePublication . Nabais, C; Caldeira Fradique, A; Oliveira, M; Quaresma, L; Gualdino Silva, J; Vasconcelos, V; Sacadura, J; Costa, L; Cabrita, F; Mateus Marques, R; Esteves, J; Fernandez, G; Guedes da SilvaObjectives/Introdution: Ki-67 protein has been used as an indicator of proliferation activity in tumor cells. In gastric cancer the prognostic value has not been fully understood. This study was designed to assess the biologic significance of Ki-67 proliferation index (PI) in gastric cancer. Material/Methods: Seventy-two patients with gastric cancer were evaluated. These patients underwent gastric resection, and the tumor tissue was stained immunohistochemically. Ki-67 PI was defined as the percentage of tumor cells positive for Ki-67. Ki-67 PI was correlated with clinicopathological characteristics and patient survival. Results: A low Ki-67 PI (less than or equal to 50%) was associated with poorly differentiated histology - diffuse type (p=0.009) and signet ring cells (p=0.004) - and younger age (p=0.022). A worse prognosis in patients with low Ki-67 PI was also found (a mean survival of 41.8 vs 63 months for high Ki-67 PI group), but not statistically significant (p=0.623, log rank test). Discussion/Conclusion: We found an inversely correlation between Ki-67 PI and histological differentiation grade. Patients in group with low Ki-67 PI are younger, with poorly differentiated histology and have a lower mean survival. Like other studies already suggested, we may have two different tumors phenotypes - highly invasive with low proliferative capability, and less invasive potential with higher proliferative ability. However, in this sample, no significant prognostic value was achieved between both.
- Thoracic Duct Decompression for Protein-Losing Enteropathy in Failing Fontan CirculationPublication . António, M; Gordo, A; Pereira, C; Pinto, MF; Fragata, I; Fragata, JAn infrequent but devastating late complication of Fontan circulation is protein-losing enteropathy (PLE), which results from unbalanced lymphatic homeostasis. Surgical decompression of the thoracic duct by redirecting its drainage to the pulmonary venous atrium has been introduced recently as a possible treatment. This report describes a single-institution experience with this innovative procedure in 2 patients with failing Fontan circulation with PLE refractory to optimized medical therapy.
- Multicentre Study Highlighting Clinical Relevance of New High-Throughput Methodologies in Molecular Epidemiology of Pneumocystis Jirovecii PneumoniaPublication . Esteves, F; de Sousa, B; Calderón, EJ; Huang, L; Badura, R; Maltez, F; Bassat, Q; de Armas, Y; Antunes, F; Matos, OPneumocystis jirovecii causes severe interstitial pneumonia (PcP) in immunosuppressed patients. This multicentre study assessed the distribution frequencies of epidemiologically relevant genetic markers of P. jirovecii in different geographic populations from Portugal, the USA, Spain, Cuba and Mozambique, and the relationship between the molecular data and the geographical and clinical information, based on a multifactorial approach. The high-throughput typing strategy for P. jirovecii characterization consisted of DNA pooling using quantitative real-time PCR followed by multiplex-PCR/single base extension. The frequencies of relevant P. jirovecii single nucleotide polymorphisms (mt85, SOD110, SOD215, DHFR312, DHPS165 and DHPS171) encoded at four loci were estimated in ten DNA pooled samples representing a total of 182 individual samples. Putative multilocus genotypes of P. jirovecii were shown to be clustered due to geographic differences but were also dependent on clinical characteristics of the populations studied. The haplotype DHFR312T/SOD110C/SOD215T was associated with severe AIDS-related PcP and high P. jirovecii burdens. The frequencies of this genetic variant of P. jirovecii were significantly higher in patients with AIDS-related PcP from Portugal and the USA than in the colonized patients from Portugal, and Spain, and children infected with P. jirovecii from Cuba or Mozambique, highlighting the importance of this haplotype, apparently associated with the severity of the disease and specific clinical groups. Patients from the USA and Mozambique showed higher rates of DHPS mutants, which may suggest the circulation of P. jirovecii organisms potentially related with trimethoprim-sulfamethoxazole resistance in those geographical regions. This report assessed the worldwide distribution of P. jirovecii haplotypes and their epidemiological impact in distinct geographic and clinical populations.
- Neuroendocrine Carcinoma of the Esophagus: Single-Center Experience of 5 CasesPublication . Corado, S; Caldeira Fradique, A; Figueiredo, J; Quaresma, L; Pupo, A; Sacadura, J; Vasconcelos, V; Gualdino Silva, J; Fernandez, G; Costa, L; Mateus Marques, R; Oliveira, M; Esteves, J; Guedes da Silva; Barroso, E
- Uncommon Multicystic Lesion of the Interventricular Septum in a 7-Year-Old Boy: Unusual Presentation of an Intracardiac TeratomaPublication . Kahlbau, H; Gomes, I; Pinto, MF; Fragata, JIntracardiac teratomas are very rare primary cardiac tumors; only a few cases have been reported. We present the case of a 7-year-old boy who early in life showed pulmonary stenosis and needed percutaneous and surgical procedures, including sectioning of the right ventricular bands and reconstruction of the right ventricular outflow tract. At the age of 7 years the patient received a diagnosis of a multilobular cystic mass in the right ventricle adherent to the interventricular septum, which was not present at birth. Successful surgical resection was performed. Histologic examination revealed a mature teratoma. We emphasize the differential diagnosis of teratomas in cystic lesions of the interventricular septum.
- Sentinel Lymph Node in Gastric CancerPublication . Quaresma, L; Caldeira Fradique, A; Oliveira, M; Gualdino Silva, J; Vasconcelos, V; Sacadura, J; Mateus Marques, R; Esteves, J; Costa, L; Fernandez, G; Guedes da Silva
- Thrombolysis in Patients Aged over 80 Years Is Equally Effective and SafePublication . Pego, PM; Paiva Nunes, A; Ferreira, P; Sousa, C; Amaral-Silva, ABACKGROUND: Despite stroke's high prevalence in the elderly, intravenous thrombolysis is licensed in Europe only for patients younger than 80 years old. We aimed to compare the functional outcomes and complication rates in patients older versus younger than 80 years old treated with intravenous thrombolysis. METHODS: A retrospective observational study of patients who received intravenous thrombolysis in a stroke unit between January 1, 2009, and June 30, 2012, was conducted. Variables were compared between 2 subgroups (≤80 and >80 years). RESULTS: Overall, 512 patients underwent intravenous thrombolysis, of which 13.1% were over 80 years. The mean age was 65.4 years in the younger subgroup and 82.9 years in the older subgroup. Prior independence rates did not differ between the subgroups. Prevalence of atrial fibrillation and cardioembolic stroke was higher in the older subgroup (P = .004 and .026). Only 3% of the elderly with atrial fibrillation were taking oral anticoagulants. Symptoms-to-needle time was lower in the older subgroup (P = .048). Stroke severity was higher in patients over 80 years (P = .026). There was significant improvement in the National Institutes of Health Stroke Scale score 7 days after intravenous thrombolysis (P < .001) in both subgroups. The proportion of patients with 3 months' favorable outcome and independence, hemorrhagic transformation, and mortality rates were similar in both subgroups. CONCLUSIONS: Elderly patients' benefits and outcomes from intravenous thrombolysis treatment were identical to the younger subgroup without excess hemorrhagic transformation or mortality. These results favor the use of intravenous thrombolysis in patients over 80 years.
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