Browsing by Issue Date, starting with "2016-11"
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- Role of Intra-Aortic Balloon Pump Counterpulsation in the Treatment of Acute Myocardial Infarction Complicated by Cardiogenic Shock: Evidence from the Portuguese Nationwide RegistryPublication . Timóteo, AT; Nogueira, M; Aguiar Rosa, S; Belo, A; Cruz Ferreira, RBACKGROUND: In previous guidelines, intra-aortic balloon pump (IABP) use was strongly recommended in the treatment of cardiogenic shock in the context of acute myocardial infarction. The recent IABP-SHOCK II trial demonstrated no benefit in short- and medium-term mortality with the use of IABP. It was our objective to evaluate in a real life nationwide population of patients with acute myocardial infarction the impact of IABP in short- and medium-term mortality. METHODS: We included patients admitted with acute myocardial infarction in Killip class IV in the first 24 hours, all submitted to urgent coronary angiography. Our study objective was the occurrence of hospital and six-month all-cause mortality. RESULTS: From the 33,300 patients included in the registry, 4.2% presented with Killip class IV in the first 24 hours and 646 (43.6%) were submitted to urgent coronary angiography. IABP was implanted in 19.8% of these patients. The IABP group was younger, had higher admission heart rate, more multivessel disease and more left main disease. There were 260 hospital deaths (40.2%), similar between groups (46.1% vs. 38.8%, p=0.132). IABP use was associated with a deleterious effect in patients with previous MI and beneficial effect in patients with mechanical complications. IABP use had a neutral effect on mortality (hazard ratio 1.14, 95% confidence interval 0.84-1.56). This was further confirmed in a propensity score matching analysis. CONCLUSIONS: In a real life population of patients with acute myocardial infarction, the use of IABP for the treatment of cardiogenic shock was associated with a neutral effect.
- Associação da Intensidade de Dor no Tempo Até à Morte dos Doentes Oncológicos Referenciados aos Cuidados PaliativosPublication . Barata, P; Santos, F; Mesquita, G; Cardoso, A; Custódio, MP; Alves, M; Papoila, AL; Barbosa, A; Lawlor, PIntrodução: A dor é uma experiência frequente nos doentes com cancro, especialmente naqueles em fase final de vida. Com este estudo, pretendemos estudar a intensidade de dor nos doentes com cancro avançado, referenciados aos cuidados paliativos, analisar os factores associados à ocorrência de dor moderada ou intensa e avaliar a sua relação com o tempo até à morte destes doentes. Material e Métodos: Estudo prospectivo observacional que incluiu consecutivamente todos os doentes referenciados aos cuidados paliativos com tumores sólidos metastizados e sem tratamento oncológico específico. Foi considerada a intensidade de dor da escala de Edmonton, de acordo com a graduação zero a 10, onde 0 = ausência de dor e 10 = máxima dor possível. Resultados: Entre outubro de 2012 e junho de 2015, foram incluídos 301 doentes, com idade mediana de 69 anos (37 - 94), 57% homens e 64,8% dos doentes com performance status 3/4. Aproximadamente 42% dos doentes apresentaram dor ≥ 4 e cerca de 74,4% estavam medicados com analgesia opióide. A intensidade de dor esteve associada ao performance status dos doentes, de acordo com a análise multivariável (OR: 1,7; IC 95%: 1,0 - 2,7; p = 0,045). A mediana do tempo de sobrevivência foi de 37 dias (IC 95%: 28 - 46), tendo os doentes com dor moderada ou intensa (intensidade de dor ≥ 4) uma mediana de sobrevivência de 29 dias (IC 95%: 21 - 37), comparada com os 49 dias (IC 95%: 35 - 63) para os doentes sem dor ou dor ligeira (p = 0,022). Discussão: O performance status, para além de ter estado associado a uma maior intensidade de dor, esteve associado a um menor tempo até à morte dos doentes com cancro avançado referenciados aos cuidados paliativos. Também o internamento, a presença de metastização intra-abdominal e a analgesia opióide estiveram associados de forma negativa ao tempo até à morte destes doentes. Conclusão: A dor oncológica continua a ser um problema clinicamente relevante nos doentes com cancro avançado.
- New Perspectives on the Conservative Management of Osteoradionecrosis of the Mandible: a Literature ReviewPublication . Alpuim Costa, D; Porfírio Costa, T; Netto, E; Joaquim, N; Ventura, I; Pratas, AC; Winckler, P; Pires Silva, I; Pinho, AC; Goulão Sargento, I; Gamito Guerreiro, F; Moreira, AOver the last decades, several therapeutic options were considered in the treatment of the osteoradionecrosis (ORN) of the mandible, including supportive measures, ultrasound therapy, corticosteroids, hyperbaric oxygen, surgical resection with reconstruction, and, more recently, drugs capable of reversing the fibroatrophic process. Once established, the ORN does not spontaneously disappear and a standard treatment has not yet been defined. The clear clinical effectiveness of hyperbaric oxygen therapy (HBOT) varies according to the literature and there are some economic/logistic issues to be considered; the triplet tocopherol/pentoxifylline/clodronate demands greater evidence from randomized clinical trials and also resilience from the patient, given the long treatment duration and its possible side effects. Controversy around the ideal treatment of the initial stage ORN of the mandible persists. More rigorous randomized prospective trials are essential. The purpose of this article was to review the relevant literature on the physiopathology of ORN of the mandible and discuss the new perspectives of its conservative treatment. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1708-1716, 2016.
- Signal Intensity Change on Unenhanced T1-Weighted Images in Dentate Nucleus Following Gadobenate Dimeglumine in Patients With and Without Previous Multiple Administrations of GadodiamidePublication . Ramalho, J; Semelka, RC; AlObaidy, M; Ramalho, M; Nunes, RH; Castillo, MOBJECTIVES: To evaluate the impact of previous administration of gadodiamide and neural tissue gadolinium deposition in patients who received gadobenate dimeglumine. METHODS: Our population included 62 patients who underwent at least three administrations of gadobenate dimeglumine, plus an additional contrast-enhanced last MRI for reference, divided into two groups: group 1, patients who in addition to gadobenate dimeglumine administrations had prior exposure to multiple doses of gadodiamide; group 2, patients without previous exposure to other gadolinium-based contrast agent (GBCAs). Quantitative analysis was performed on the first and last gadobenate dimeglumine MRIs in both groups. Dentate nucleus-to-middle cerebellar peduncle signal intensity ratios (DN/MCP) and relative change (RC) in signal over time were calculated and compared between groups using generalized additive model. RESULTS: Group 1 showed significant increase in baseline and follow-up DN/MCP compared to group 2 (p < 0.0001). The RC DN/MCP showed a non-statistically significant trend towards an increase in patients who underwent previous gadodiamide (p = 0.0735). CONCLUSION: There is increased T1 signal change over time in patients who underwent gadobenate dimeglumine and had received prior gadodiamide compared to those without known exposure to previous gadodiamide. A potentiating effect from prior gadodiamide on subsequent administered gadobenate dimeglumine may occur. KEY POINTS: • Neural gadolinium deposition is associated with multiple administrations of less stable GBCAs. • Less stable GBCA effect on subsequent more stable GBCA administrations is undetermined. • Significant increase of DN/MCP was seen in patients with previous gadodiamide exposure. • RC DN/MCP showed a non-significant increase in patients who received previous gadodiamide. • Potentiating effects from prior gadodiamide on subsequent administered gadobenate dimeglumine may occur.
- Alzheimer's Disease: a Review of its Visual System Neuropathology. Optical Coherence Tomography-a Potential Role As a Study Tool in VivoPublication . Cunha, JP; Moura-Coelho, N; Proença, R; Dias-Santos, A; Ferreira, J; Louro, C; Castanheira-Dinis, AAlzheimer's disease (AD) is a prevalent, long-term progressive degenerative disorder with great social impact. It is currently thought that, in addition to neurodegeneration, vascular changes also play a role in the pathophysiology of the disease. Visual symptoms are frequent and are an early clinical manifestation; a number of psychophysiologic changes occur in visual function, including visual field defects, abnormal contrast sensitivity, abnormalities in color vision, depth perception deficits, and motion detection abnormalities. These visual changes were initially believed to be solely due to neurodegeneration in the posterior visual pathway. However, evidence from pathology studies in both animal models of AD and humans has demonstrated that neurodegeneration also takes place in the anterior visual pathway, with involvement of the retinal ganglion cells' (RGCs) dendrites, somata, and axons in the optic nerve. These studies additionally showed that patients with AD have changes in retinal and choroidal microvasculature. Pathology findings have been corroborated in in-vivo assessment of the retina and optic nerve head (ONH), as well as the retinal and choroidal vasculature. Optical coherence tomography (OCT) in particular has shown great utility in the assessment of these changes, and it may become a useful tool for early detection and monitoring disease progression in AD. The authors make a review of the current understanding of retinal and choroidal pathological changes in patients with AD, with particular focus on in-vivo evidence of retinal and choroidal neurodegenerative and microvascular changes using OCT technology.
- Metástase Tiroideia como Manifestação Inicial de um Carcinoma Renal de Células Claras AssintomáticoPublication . Carmelino, J; Tavares, AP; Crespo, A; Coutinho, JM; Lázaro, A; Ribeiro, V; Barroso, EIntrodução: A metastização para a glândula tiroideia de um carcinoma renal de células claras é rara e só diagnosticável após análise imunohistoquímica de uma amostra histológica. O objetivo deste artigo é reportar um caso de metastização tiroideia como primeira manifestação de um carcinoma renal de células claras. Caso Clínico: Doente do sexo masculino com um nódulo sólido no lobo esquerdo da tiróide, com 5,3 cm, suspeito de malignidade, submetido a tiroidectomia total com linfadenectomia do compartimento central. A análise histológica concluiu serem duas metástases de carcinoma renal de células claras. Após estudo dirigido ao rim, o doente foi submetido a nefrectomia radical quatro meses depois. Discussão: O interesse deste caso reside no facto de a metastização para a tiroide como primeira manifestação de carcinoma renal de células claras ser rara mas, se tratada precocemente, permite uma ‘dupla resseção cirúrgica’ que pode levar a sobrevidas aos cinco anos de 80%.
- A Case of Sclerosing Angiomatoid Nodular Transformation of the Spleen: Imaging and Histopathological FindingsPublication . Eusébio, M; Sousa, AL; Vaz, AM; Gomes da Silva, S; Milheiro, MA; Peixe, B; Caldeira, P; Guerreiro, H
- Leydig Cell Tumour and Mature Ovarian Teratoma: Rare Androgen-Secreting Ovarian Tumours in Postmenopausal WomenPublication . Palha, A; Cortez, L; Tavares, AP; Agapito, AAndrogen-secreting ovarian tumours are extremely rare accounting for <5% of all ovarian neoplasms. They are more frequent in postmenopausal women and should be suspected in the case of a rapid onset of androgenic symptoms. We report 4 cases of postmenopausal women who presented with signs of virilisation. All patients revealed increased serum levels of testosterone, normal dehydroepiandrosterone-sulfate and negative pelvic ultrasound for adnexal masses. An androgen-secreting ovarian tumour was suspected and all of them were submitted to bilateral oophorectomy. Histology confirmed the diagnosis of Leydig cell tumours in 3 patients and mature teratoma in 1. A successful response to surgery, which includes a decline in serum androgen levels and signs of hyperandrogenism, was observed in our patients. This case series demonstrates that androgen-secreting ovarian neoplasms may not be detectable by imaging studies, but should be considered in the differential diagnosis of all postmenopausal women with signs of hyperandrogenism.
- Retinal Neurodegeneration in Diabetic Patients Without Diabetic RetinopathyPublication . Tavares Ferreira, J; Alves, M; Dias-Santos, A; Costa, L; Santos, B; Cunha, JP; Papoila, AL; Abegão Pinto, LPURPOSE: To compare the thickness of all retinal layers between a nondiabetic group and diabetic patients without diabetic retinopathy (DR). METHODS: Cross-sectional study, in which all subjects underwent an ophthalmic examination including optical coherence tomography. After automatic retinal segmentation, each retinal layer thickness (eight separate layers and overall thickness) was calculated in all nine Early Treatment Diabetic Retinopathy Study (ETDRS) areas. The choroidal thickness (CT) also was measured at five locations. Generalized additive regression models were used to analyze the data. RESULTS: A total of 175 patients were recruited, 50 nondiabetic subjects and 125 diabetic patients without DR, stratified into three groups according to diabetes duration: group I (<5 years, n = 55), group II (5-10 years, n = 39), and group III (>10 years, n = 31). Overall, groups I and III of diabetic patients had a decrease in the photoreceptor layer (PR) thickness, when compared with the nondiabetic subjects in six ETDRS areas (P < 0.0007). Patients with more recent diagnosis (group I) had thinner PR than those with moderate duration (group II). Interestingly, patients with longer known disease (group III) had the thinnest PR values. There were no overall differences in the remaining retinal parameters. CONCLUSIONS: Retinal thickness profile is not linear throughout disease duration. Even in the absence of funduscopic disease, PR layer in diabetic patients seems to differ from nondiabetic subjects, thus suggesting that some form of neurodegeneration may take place before clinical signs of vascular problems arise.
- De Novo HIV Infection Diagnoses in a Department of Dermatology and Venereology in Lisbon, PortugalPublication . Mendes-Bastos, P; Brasileiro, A; Pires, E; Rodrigues, I; Marques, C; Coelho Macias, V; Fernandes, CBACKGROUND: Portugal has the highest prevalence rate of HIV infection in Western Europe. The proportion of patients with a late diagnosis, carried out in full-blown AIDS stage, remains high. Skin and mucous membrane manifestations are not rare in these patients. OBJECTIVE: A demographic, clinical, and laboratorial characterization of patients with de novo HIV infection diagnosis made in the Department of Dermatology and Venereology of a central hospital in Lisbon, Portugal. METHODS: Retrospective review of medical records of adult patients newly diagnosed with HIV infection (reactive immunoassay for antibodies to HIV-1/HIV-2 or HIV p24 antigen) in the Dermatology and Venereology Department of a Portuguese central hospital in the period between January 2005 and December 2013. RESULTS: During the study period, 97 new cases were diagnosed, 70 men and 27 women. The median age at diagnosis was 36 years. Of the total, 50 cases were diagnosed with a concomitant sexually transmitted infection (STI), more frequently syphilis and ano-genital HPV infection. The remaining 47 patients were diagnosed with other dermatological conditions such as prurigo nodularis, psoriasis, and Kaposi's sarcoma. The duration of complaints that lead to medical attention ranged from <1 week to 8 years, being significantly lower in patients diagnosed with a concomitant STI (p < 0.01). Basal viral load was also lower in this group of patients (p < 0.05). Of all the new diagnosed cases, 80% of patients are currently retained in care. CONCLUSION: This study grants a descriptive overview of de novo HIV infection diagnoses performed by dermatovenereologists in a central hospital in Lisbon, Portugal. As in the past, the importance of Dermato-Venereology for HIV infection diagnosis remains present in daily clinical practice.