Browsing by Issue Date, starting with "2017-04"
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- Mielinólise Centropôntica e Extrapôntica: Experiência de um Centro de Transplante HepáticoPublication . Fernandes, MA; Miranda, S; Marcelino, P; Mega, I; Machado, J; Perdigoto, R; Barroso, EIntrodução: A mielinólise centropôntica e extrapôntica (MCPEP) é uma síndrome desmielinizante rara. A MCPEP é mais prevalente em receptores de transplante hepático tendo um prognóstico desfavorável associado. A correção rápida de hiponatremia e agentes imunossupressores, como os inibidores da calcineurina, foram identificados como causas possíveis para o desenvolvimento desta patologia. Métodos: Os autores descrevem uma revisão casuística com cinco casos apresentados em tabela simples de doentes que no decorrer do internamento na unidade de cuidados intensivos após transplantação hepática, desenvolveram sinais e sintomas neurológicos concomitantemente com alterações imagiológicas identificadas através de ressonância magnética crânio encefálica compatível com MCPEP. Resultados: O consumo de etanol em excesso, síndrome de encefalopatia hepática e hiponatremia foram os 3 pontos mais comummente identificados no período pré-cirúrgico. Quatro dos cinco doentes apresentaram, durante o período intraoperatório, variação dos níveis séricos de sódio superior aos valores de referência. Conclusão: De forma de avaliar a prevalência, as manifestações clinicas e os resultados da patologia, os autores reviram os casos documentados de MCPEP num centro de referência de transplantação hepática.
- The Airway Approach to a Neonate with Treacher Collins Syndrome. Case ReportPublication . Marques-Pires, R; Trindade, HNeonates and small infants with syndromes characterized by the presence of craniofacial abnormalities may represent great challenges regarding the management of the airway. We describe the case of a 9-day-old neonate with Treacher Collins syndrome, in which a laryngeal mask was essential to improve the airway obstruction, ventilate the patient and serve as an airway conduit for a fiberoptic intubation. By presenting this case, we intend to show that in neonates with Treacher Collins syndrome, in whom difficulties ventilation and intubation are expected, a thoughtful airway management planning is mandatory.
- Bicuspid Aortic Valve OutcomesPublication . Rodrigues, I; Agapito, A; Sousa, L; Oliveira, JA; Branco, LM; Galrinho, A; Abreu, J; Timóteo, AT; Aguiar Rosa, S; Cruz Ferreira, RBACKGROUND: Bicuspid aortic valve is the most common CHD. Its association with early valvular dysfunction, endocarditis, thoracic aorta dilatation, and aortic dissection is well established. OBJECTIVE: The aim of this study was to assess the incidence and predictors of cardiac events in adults with bicuspid aortic valve. METHODS: We carried out a retrospective analysis of cardiac outcomes in ambulatory adults with bicuspid aortic valve followed-up in a tertiary hospital centre. Outcomes were defined as follows: interventional - intervention on the aortic valve or thoracic aorta; medical - death, aortic dissection, aortic valve endocarditis, congestive heart failure, arrhythmias, or ischaemic heart disease requiring hospital admission; and a composite end point of both. Kaplan-Meier curves were generated to determine event rates, and predictors of cardiac events were determined by multivariate analysis. RESULTS: A total of 227 patients were followed-up over 13±9 years; 29% of patients developed severe aortic valve dysfunction and 12.3% reached ascending thoracic aorta dimensions above 45 mm. At least one cardiac outcome occurred in 38.8% of patients, with an incidence rate at 20 years of follow-up of 47±4%; 33% of patients were submitted to an aortic valve or thoracic aorta intervention. Survival 20 years after diagnosis was 94±2%. Independent predictors of the composite end point were baseline moderate-severe aortic valve dysfunction (hazard ratio, 3.19; 95% confidence interval, 1.35-7.54; p<0.01) and aortic valve leaflets calcification (hazard ratio, 4.72; 95% confidence interval, 1.91-11.64; p<0.005). CONCLUSIONS: In this study of bicuspid aortic valve, the long-term survival was excellent but with occurrence of frequent cardiovascular events. Baseline aortic valve calcification and dysfunction were the only independent predictors of events.
- The Value of Right Ventricular Longitudinal Strain in the Evaluation of Adult Patients With Repaired Tetralogy of Fallot: a New Tool for a Contemporary ChallengePublication . Almeida-Morais, L; Pereira-da-Silva, T; Branco, LM; Timóteo, AT; Agapito, A; Sousa, L; Oliveira, JA; Thomas, B; Jalles-Tavares, N; Soares, R; Galrinho, A; Cruz Ferreira, ROBJECTIVE: The role of right ventricular longitudinal strain for assessing patients with repaired tetralogy of Fallot is not fully understood. In this study, we aimed to evaluate its relation with other structural and functional parameters in these patients. METHODS: Patients followed-up in a grown-up CHD unit, assessed by transthoracic echocardiography, cardiac MRI, and treadmill exercise testing, were retrospectively evaluated. Right ventricular size and function and pulmonary regurgitation severity were assessed by echocardiography and MRI. Right ventricular longitudinal strain was evaluated in the four-chamber view using the standard semiautomatic method. RESULTS: In total, 42 patients were included (61% male, 32±8 years). The mean right ventricular longitudinal strain was -16.2±3.7%, and the right ventricular ejection fraction, measured by MRI, was 42.9±7.2%. Longitudinal strain showed linear correlation with tricuspid annular systolic excursion (r=-0.40) and right ventricular ejection fraction (r=-0.45) (all p<0.05), which in turn showed linear correlation with right ventricular fractional area change (r=0.50), pulmonary regurgitation colour length (r=0.35), right ventricular end-systolic volume (r=-0.60), and left ventricular ejection fraction (r=0.36) (all p<0.05). Longitudinal strain (β=-0.72, 95% confidence interval -1.41, -0.15) and left ventricular ejection fraction (β=0.39, 95% confidence interval 0.11, 0.67) were independently associated with right ventricular ejection fraction. The best threshold of longitudinal strain for predicting a right ventricular ejection fraction of <40% was -17.0%. CONCLUSIONS: Right ventricular longitudinal strain is a powerful method for evaluating patients with tetralogy of Fallot. It correlated with echocardiographic right ventricular function parameters and was independently associated with right ventricular ejection fraction derived by MRI.
- Criteria for Inclusion of Newer Bariatric and Metabolic Procedures into the Mainstream: a Survey of 396 Bariatric SurgeonsPublication . Mahawar, K; Borg, CM; Agarwal, S; Ribeiro, R; De Luca, M; Small, PKBACKGROUND: There is currently no consensus on the criteria for inclusion of new bariatric procedures into routine clinical practice. This study canvasses bariatric surgeons in an attempt to define these criteria. METHODS: Bariatric Surgeons from around the world were invited to participate in a questionnaire-based survey on SurveyMonkey ®. RESULTS: 396 bariatric surgeons, 337 International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) members, took the survey. Five clinical studies conducted under the strict monitoring of an Institutional Review Board would satisfy most surgeons (67.7 %, n = 266). When asked regarding the number of patients in these studies, a cumulative number of 500 patients would satisfy 64.5 % (n = 255) of the surgeons. Most respondents regarded endorsement by their national society and IFSO as 'very important' or 'extremely important'. An overwhelming 74.4 % (n = 294) felt that every new procedure should undergo a randomized comparison against one of the established alternatives like Roux-en-Y Gastric Bypass or Sleeve Gastrectomy. CONCLUSION: Evaluation of a new bariatric procedure in at least 5 adequately supervised clinical studies (four of which must be randomized comparisons with one of the existing alternatives) reporting at least 5 years results on a minimum of 500 patients would satisfy majority of bariatric surgeons for the inclusion of a new bariatric procedure into clinical practice. The findings of this survey are simply aimed at starting a discussion on this topic and cannot be used to influence the ground reality until an international consensus can be reached amongst experts.
- Dermoscopic Characteristics of Melanoma According to the Criteria "Ulceration" and "Mitotic Rate" of the AJCC 2009 Staging System for MelanomaPublication . Deinlein, T; Arzberger, E; Zalaudek, I; Massone, C; Garcias-Ladaria, J; Oliveira, A; Schulter, G; Hofmann-Wellenhof, ROBJECTIVE: The present study was conducted to identify possible dermoscopic patterns, associated with mitotic rate > 1/mm2, histological ulceration in melanoma and metastatic disease. METHODS: For this retrospective data analysis all clinical and dermoscopic digital images of primary malignant melanomas between 2008 and 2013 documented at the Department of Dermatology Graz were included, using the internal image data-base. 550 patients with 559 melanomas were included. RESULTS: While clinical or dermoscopic analysis considered ulceration to be present in 120 (21.5%) and 117 (20.9%) of all lesions, respectively, histopathology reported ulceration in only 96 cases (17.2%). The presence of milky-red areas, shiny-white streaks, a blue-white veil and blue-grey areas in dermoscopy is highly correlated with histological ulceration and a mitotic rate > 1/mm2. The dermoscopic patterns shiny-white streaks, milky-red areas and blue-white veil were also significantly associated with development of distant metastases. CONCLUSION: Our study proves a significant correlation between the dermoscopic patterns "blue white veil", "milky-red areas"and "shiny-white streaks"and the histological findings "ulceration"and "mitotic rate > 1/mm2". Furthermore these dermoscopic patterns are highly related to distant metastases. Thus, dermoscopy renders earlier prognostic statements possible.
- Retina and Choroid of Diabetic Patients Without Observed Retinal Vascular Changes: A Longitudinal StudyPublication . Ferreira, J; Proença, R; Alves, M; Dias-Santos, A; Santos, B; Cunha, JP; Papoila, AL; Abegão Pinto, LPURPOSE: To identify changes in choroidal thickness (CT) and all retinal layers of diabetic patients without diabetic retinopathy (DR) after 1 year of follow-up. DESIGN: Prospective observational cohort study. METHODS: Overall, 125 diabetic patients without DR were included. Two visits were scheduled: the first visit (V1) and a second visit after 12 months (V2). At both visits, patients received a complete ophthalmologic evaluation that included OCT. Each retinal layer thickness was calculated for 9 ETDRS sectors, and CT was measured at 13 locations. Generalized linear mixed-effects models were used. RESULTS: Of the 125 patients, 103 completed the study, and 9 of the 103 developed DR (8.7%). CT was significantly higher at V2 than at V1, with an average value of 10-17 μm at almost half the locations (500, 1000, and 1500 μm temporal; 500 and 1000 μm nasal; and 1000 μm superior to the fovea) (P < .001-.003). The thicknesses of the ganglion cell layer (I3 and N6 sectors), inner plexiform layer (S6 and N6 sectors), inner nuclear layer (T6 and N6 sectors), and outer plexiform layer (S6 sector), as well as the overall retinal thickness (RT) (S3, N3, I3, S6, and T6 sectors), were decreased at V2 (P < .001). Visible retinopathy was negatively associated with overall RT (central, S3, T3, I3, and N3 sectors, P = .004-.024) and the thickness of the ONL (T6 and I6 sectors, P = .007 and P = .009) and photoreceptor layer (N6 sector, P = .038). The presence of DR decreased the overall RT by 13.04-16.63 μm. CONCLUSIONS: Diabetic patients without DR showed a thicker choroid and a thinner retina, particularly in inner layers, after 1 year of follow-up. These structural changes may correspond to the early neurodegenerative phase of DR.
- Pneumonia por Aspiração de Peça DentáriaPublication . Rodrigues, M; Nunes, A; Bento, L
- Managing the Patient with Acute Liver FailurePublication . Cardoso, FS; Karvellas, C
- The Who-When-Why Triangle of CAM Use Among Portuguese IBD PatientsPublication . Portela, F; Dias, C; Caldeira, P; Cravo, M; Deus, J; Gonçalves, R; Lago, P; Morna, H; Peixe, P; Ramos, J; Sousa, H; Tavares, L; Vasconcelos, H; Magro, F; Ministro, PBACKGROUND: The use of complementary and alternative medicines is increasing among chronic patients, particularly those afflicted with inflammatory bowel diseases. AIM: This study aimed to address the prevalence of complementary and alternative medicines use among Portuguese inflammatory bowel diseases' patients. METHODS: Patients were invited to fill an anonymous questionnaire concerning the use of complementary and alternative medicines. RESULTS: Thirty-one per cent of the patients reported having used complementary and alternative medicines in the past, whereas 12% were using them by the time the questionnaire was administered. Fifty-nine per cent of the users did not share this information with their physician, whereas 14% and 8% discontinued their medication and periodical examination, respectively. Steroids prescription (OR=2.880) and a higher instruction level (OR=3.669) were predictors of complementary and alternative medicines use in this cohort. CONCLUSIONS: Roughly a third of Portuguese IBD patients had used CAM. Steroid treatment and an academic degree are associated with CAM use. Given the potential side effects and interactions, patient information about the benefits and limitations of conventional and complementary treatments should be reinforced.