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  • Leucoeritroplasias - Lesões com Potencial Maligno
    Publication . Fonseca, L; Pinheiro, J
    2017-02Other Open access Show more
  • Iliac Seal Zone Dynamics and Clinical Consequences After Endovascular Aneurysm Repair
    Publication . Bastos Gonçalves, F; Oliveira, NF; Josee van Rijn, M; Ultee, KH; Hoeks, SE; Ten Raa, S; Stolker, RJ; Verhagen, HJ
    OBJECTIVE: To evaluate the dynamics of the iliac attachment zone after EVAR, and the association with clinical events. METHODS: A tertiary institution's prospective EVAR database was searched to identify common iliac arteries at risk. Internally validated measurements were made, using centre lumen line reconstructions. Iliac dilatation and endograft limb retraction were the main endpoints. Associations between dilatation, retraction, oversizing, and distal seal length were investigated. Association with clinical events (sealing or occlusion) was also explored. RESULTS: Of 452 primary EVAR patients treated from 2004 to 2012, 341 were included (mean age 72 years, 12% female, 597 common iliac arteries). Median follow-up was 4.7 years. At 30 days, the mean iliac diameter increased from 14 mm to 15 mm (p < .001). Over follow-up, it increased to 18 mm (p < .001). Iliac dilatation ≥20% occurred in 295 cases (49.4%) and exceeded the implanted endograft diameter in 170 (28.7%). Limb retraction ≥5 mm was identified in 54 patients (9.1%) and was associated with iliac seal complications (p < 0.001). Iliac endograft extension diameter ≥24 mm (OR 3.3, 95% CI 1.7-6.4) and iliac artery dilatation beyond the endograft (OR 2.1, 95% CI 1.2-3.8) were independent risk factors. Overall, there were 34 (5.7%) iliac seal complications. Retraction of the iliac endograft (OR 1.17 per mm, 95% CI 1.10-1.24) and baseline AAA diameter (1.04 per mm, 95% CI 1.01-1.07) were independent risk factors for seal related complications. Greater initial post-operative iliac seal length was protective (OR 0.94 per mm, 95% CI 0.90-0.97). CONCLUSIONS: Iliac dilatation and endograft retraction are common findings during follow-up, potentially leading to adverse clinical events. Optimisation of the iliac seal zone providing a long distal seal length and added attention to patients with large aneurysms or receiving ≥24 mm diameter iliac extensions are recommended. Also, long-term surveillance including CTA is advised to reveal and correct loss of seal at the iliac attachments before adverse clinical events occur.
    2017-02Journal article Open access Show more
  • Dermoscopic and Reflectance Confocal Microscopic Presentation of Hailey‐Hailey Disease: a Case Series
    Publication . Oliveira, A; Arzberger, E; Pimentel, B; Sousa, V; Leal‐Filipe, P
    Background/purpose: Hailey-Hailey disease is a rare inherited acantholytic skin disorder characterized by heterogeneous clinical presentation. Its differential diagnosis might be wide, including other genodermatoses, inflammatory, and infectious skin diseases. Although histopathology remains as diagnostic gold standard, noninvasive techniques such as dermoscopy and reflectance confocal microscopy may assist clinical examination. Herein, we aim to further characterize the dermoscopic and reflectance confocal microscopic presentation of Hailey-Hailey disease with histologic correlation. Methods: Eight patients with Hailey-Hailey disease were consecutively recruited. All patients were examined using dermoscopy and reflectance confocal microscopy. Results: In all cases, dermoscopy enabled the visualization of polymorphous vessels, including glomerular and linear-looped vessels, within a pink-whitish background. Reflectance confocal microscopy revealed wide suprabasilar partial acantholysis and clefting, crusts, dilated papillae with tortuous vessels, and inflammatory cells. Dyskeratosis, uplocated papillae, and adnexal sparing were also observed. Conclusion: Although definite diagnosis was obtained by histopathology in all cases, dermoscopy and reflectance confocal microscopy allowed the identification of common features (even in cases with dissimilar clinical presentation) that may support an early diagnosis of Hailey-Hailey disease, and its differentiation from other more frequent skin disorders.
    2017-02Journal article Open access Show more
  • 2017-02Journal article Open access Show more
  • Anastomose Biliar no Transplante Hepático: Com ou Sem Tubo em T?
    Publication . Carmelino, J; Rodrigues, S; Pinto Marques, H; Ribeiro, V; Virella, D; Alves, M; Martins, A; Barroso, E
    Introdução: Complicações biliares ocorrem em 10% - 30% dos transplantes hepáticos. O objetivo deste trabalho é comparar as incidências dessas complicações nos transplantes hepáticos em que foi ou não utilizado tubo em T na anastomose biliar. Material e Métodos: Análise de dois grupos de doentes submetidos a transplante hepático entre 2008 e 2012. Consideraram-se os doentes em que o tubo em T foi utilizado (G1) e em que não o foi (G2). Procuraram-se depois modelos explicativos da ocorrência de complicações biliares por regressão logística, incluindo as variáveis identificadas na análise univariável. Resultados: Estudaram-se 506 doentes consecutivos submetidos a um primeiro transplante hepático (G1 = 363; G2 = 143). A incidência global de complicações biliares foi 24,7% (IC 95% 21,1 - 28,6): 27,0% no G1 e 18,9% no G2 (p = 0,057). As incidências de estenose e de fístula biliar foram tendencialmente mais elevadas em G1: 19,6% (IC 95% 15,7-23,8) vs 15,4% (IC 95% 10,1 - 22,0) (p = 0,275) e 6,6% (IC 95% 4,4 - 9,5) vs 2,8% (IC 95% 0,9 - 6,6) (p = 0,091). Não se encontraram diferenças estatisticamente significativas nas taxas de colangiopancreatografia retrógrada endoscópica, reoperação e retransplante. Verificaram-se dois óbitos no G1. Não se encontrou associação entre a ocorrência de complicações biliares e os diâmetros das vias biliares ou o tempo de isquemia fria. O modelo explicativo ajustado à idade do recetor e do dador, e ao diagnóstico de base identifica o uso do tubo em T como aumentando a possibilidade da ocorrência de complicações biliares (AdjOR 1,71; IC 95% 1,04 - 2,80; p = 0,034). Discussão e Conclusão: A utilização do tubo em T deve ser uma decisão tomada caso a caso e baseada no julgamento intra-operatório de cirurgiões experientes.
    2017-02Journal article Open access Show more
  • Severe Hypercapnia and Outcome of Mechanically Ventilated Patients with Moderate or Severe Acute Respiratory Distress Syndrome
    Publication . Nin, N; Muriel, A; Peñuelas, O; Brochard, L; Lorente, JA; Ferguson, N; Raymondos, K; Ríos, F; Violi, DA; Thille, A; González, M; Villagomez, AJ; Hurtado, J; Davies, AR; Du, B; Maggiore, SM; Soto, L; D'Empaire, G; Matamis, D; Abroug, F; Moreno, R; Soares, MA; Arabi, Y; Sandi, F; Jibaja, M; Amin, P; Koh, Y; Kuiper, MA; Bülow, HH; Zeggwagh, AA; Anzueto, A; Sznajder, J; Esteban, A
    PURPOSE: To analyze the relationship between hypercapnia developing within the first 48 h after the start of mechanical ventilation and outcome in patients with acute respiratory distress syndrome (ARDS). PATIENTS AND METHODS: We performed a secondary analysis of three prospective non-interventional cohort studies focusing on ARDS patients from 927 intensive care units (ICUs) in 40 countries. These patients received mechanical ventilation for more than 12 h during 1-month periods in 1998, 2004, and 2010. We used multivariable logistic regression and a propensity score analysis to examine the association between hypercapnia and ICU mortality. MAIN OUTCOMES: We included 1899 patients with ARDS in this study. The relationship between maximum PaCO2 in the first 48 h and mortality suggests higher mortality at or above PaCO2 of ≥50 mmHg. Patients with severe hypercapnia (PaCO2 ≥50 mmHg) had higher complication rates, more organ failures, and worse outcomes. After adjusting for age, SAPS II score, respiratory rate, positive end-expiratory pressure, PaO2/FiO2 ratio, driving pressure, pressure/volume limitation strategy (PLS), corrected minute ventilation, and presence of acidosis, severe hypercapnia was associated with increased risk of ICU mortality [odds ratio (OR) 1.93, 95% confidence interval (CI) 1.32 to 2.81; p = 0.001]. In patients with severe hypercapnia matched for all other variables, ventilation with PLS was associated with higher ICU mortality (OR 1.58, CI 95% 1.04-2.41; p = 0.032). CONCLUSIONS: Severe hypercapnia appears to be independently associated with higher ICU mortality in patients with ARDS.
    2017-02Journal article Open access Show more
  • ProACS Risk Score: an Early and Simple Score for Risk Stratification of Patients with Acute Coronary Syndromes
    Publication . Timóteo, AT; Rosa, S; Nogueira, M; Belo, A; Cruz Ferreira, R
    INTRODUCTION: There are barriers to proper implementation of risk stratification scores in patients with acute coronary syndromes (ACS), including their complexity. Our objective was to develop a simple score for risk stratification of all-cause in-hospital mortality in a population of patients with ACS. METHODS: The score was developed from a nationwide ACS registry. The development and internal validation cohorts were obtained from the first 31829 patients, randomly separated (60% and 40%, respectively). The external validation cohort consisted of the last 8586 patients included in the registry. This cohort is significantly different from the other cohorts in terms of baseline characteristics, treatment and mortality. Multivariate logistic regression analysis was used to select four variables with the highest predictive potential. A score was allocated to each parameter based on the regression coefficient of each variable in the logistic regression model: 1 point for systolic blood pressure ≤116 mmHg, Killip class 2 or 3, and ST-segment elevation; 2 points for age ≥72 years; and 3 points for Killip class 4. RESULTS: The new score had good discriminative ability in the development cohort (area under the curve [AUC] 0.796), and it was similar in the internal validation cohort (AUC 0.785, p=0.333). In the external validation cohort, there was also excellent discriminative ability (AUC 0.815), with an adequate fit. CONCLUSIONS: The ProACS risk score enables easy and simple risk stratification of patients with ACS for in-hospital mortality that can be used at the first medical contact, with excellent predictive ability in a contemporary population.
    2017-02Journal article Open access Show more
  • 2017-02Journal article Open access Show more
  • Nutritional Risk Assessment and Cultural Validation of the Modified NUTRIC Score in Critically Ill Patients-A Multicenter Prospective Cohort Study
    Publication . Mendes, R; Policarpo, S; Fortuna, P; Alves, M; Virella, D; Heyland, D
    PURPOSE: Characterize the nutritional risk of critically ill patients with the modified NUTrition Risk in the Critically ill (NUTRIC) score. MATERIALS: National, multicenter, prospective, observational study conducted in 15 polyvalent Portuguese intensive care unit (ICU), during 6 months. Adult patients were eligible. Those transferred from another ICU or readmitted, brain dead at admission, and with length of ICU stay (LOS) of 72 hours or less were excluded. NUTRIC score was calculated at admission; scores ≥5 represent a high nutritional risk. Main outcome was mortality from all causes at 28 days after admission to the ICU; LOS and days without mechanical ventilation (days free of MV) were secondary outcomes. RESULTS: From 2061 admissions, 1143 patients were considered, mostly males (n = 744, 64.7%) with median (P25-P75) age of 64 (51-75). Patients at high nutritional risk were 555 (48.6%). High NUTRIC score was associated with longer LOS (P < .001), less days free of MV (P = .002) and higher 28-day mortality (P < .001). The area under the curve of NUTRIC score ≥5 for predicting 28-day mortality was 0.658 (95% CI, 0.620-0.696). NUTRIC score ≥5 had a positive predictive value 32.7% and a negative predictive value 88.8% for 28-day mortality. CONCLUSIONS: Almost half of the patients in Portuguese ICUs are at high nutritional risk. NUTRIC score was strongly associated with main clinical outcomes.
    2017-02Journal article Open access Show more
  • Sobre Dois Casos de Fibroma Ossificante Periférico: Apresentação Clínica e Diagnóstico Diferencial
    Publication . Prates, M; Caixeirinho, P; Machado, MC; Martins, A; Ribeiro, N; Fernandes, F
    2017-02-04Other Open access Show more