Browsing by Issue Date, starting with "2018-01"
Now showing 1 - 10 of 15
Results Per Page
Sort Options
- Meningioma and Breast Cancer: Survival of Patients with Synchronous and Metachronous Meningioma and Breast CancerPublication . Lavrador, JP; Valente Pinto, M; Mascarenhas Lemos, L; Ribeiro, C; Peralta Santos, AThe prognosis of the association between Breast Cancer (BC) and Meningioma (M) is unknown. To evaluate the survival impact of tumor exposure sequence in patients with both tumors. Patients were divided in groups according to the tumors sequence: BC before M (group 1), synchronous BC + M (group 2) and BC after M (group 3). The SEER database was used. Demographics, meningioma and breast cancer variables were analyzed. The primary outcome was oncological survival. A total of 1715 patients were included (median follow-up:84 months). Group 2 had the shortest survival (median:32 months) and group 1 the longest (median:110 months). On the unadjusted analysis, group 2 had the shortest survival (HR:3.13, 95% CI 1.62-6.04) and adjusted analysis confirmed this finding (HR 3.11, 95% CI 1.58-6.19), with no statistical difference between the metachronous tumors groups. Increasing age (HR:1.13, 95% CI 1.11-1.15, p < 0.005) and grade III meningioma (HR:4.51, 95% CI 1.90-10.69, p < 0.005) were related with lower survival. Meningioma treatment had no influence on the survival (p > 0.05). The association between surgery and radiotherapy in BC treatment improved the outcome (HR 0.37, 95% CI 0.23-0.93, p < 0.05). Grade III meningioma and receptor hormonal status influenced synchronous tumors (p < 0.05) but had no influence on metachronous tumors survival (p > 0.05) on stratified analysis. Synchronous tumors were associated with lower survival. Increasing age had a negative influence on patient survival. Although surgery and radiotherapy for breast cancer had a positive influence in the outcome, meningioma treatment was not related with survival. Grade III meningioma and hormonal receptor status only influenced synchronous tumors patient survival.
- Hand Surgery in PortugalPublication . Mouzinho, MM
- Risk Factors for the Development of Postembolization Syndrome after Transarterial Chemoembolization for Hepatocellular Carcinoma TreatmentPublication . Lima, M; Dutra, S; Veloso Gomes, F; Bilhim, T; Coimbra, EIntroduction: Hepatic transarterial chemoembolization is a widely used technique for the treatment of hepatocellular carcinoma. The most common complication of this procedure is postembolization syndrome. The main objective of this study was to assess risk factors for the development of postembolization syndrome. Material and Methods: Single-centre retrospective analysis of 563 hepatic transarterial chemoembolization procedures from January 1st, 2014 – December 31st, 2015. Hepatic transarterial chemoembolization was performed with ½ - 2 vials of 100 - 300 μm microspheres loaded with doxorubicin. Patients who experienced postembolization syndrome were identified based on prolongation of hospitalization due to pain, fever, nausea and/or vomiting. A control group with the patients who did not have postembolization syndrome was randomly created (three controls for one case). Descriptive analysis and multivariate logistic regression were performed. Results: The overall prevalence of postembolization syndrome was 6.2%. Hepatic transarterial chemoembolization with doxorubicin dosage above 75 mg (more than one vial), the size of the largest nodule and female gender had statistically significant relation with development of postembolization syndrome (p = 0.030, p = 0.046 and p = 0.037, respectively). Discussion: Doxorrubicin dosage above 75 mg is associated with a higher risk of postembolization syndrome. This result can be helpful for decision-making in clinical practice, whenever it is possible to avoid a higher dose without compromising the efficacy of the treatment. The size of the largest nodule and female gender also constitute risk factors for postembolization syndrome. The other variables studied were not related to the development of postembolization syndrome. Conclusion: The dose of doxorrubicin, the size of the largest nodule treated and female gender are potential risk factors for the development of postembolization syndrome after hepatic transarterial chemoembolization for hepatocellular carcinoma.
- Hidrosadenite Supurativa: Tratamento Combinado com Matriz Dérmica, Enxerto de Pele Parcial e Vacuoterapia, um Caso ClínicoPublication . Mata Ribeiro, L; Silva Guerra, AA hidrosadenite supurativa é uma doença inflamatória crónica com grande impacto a nível físico e psicológico. Apesar de tratamentos conservadores serem utilizados em casos de doença ligeira, nos casos mais graves preconiza-se a excisão alargada da área afetada e posterior reconstrução. O objetivo deste trabalho é descrever o nosso procedimento reconstrutivo em dois passos para o tratamento deste tipo de lesões. Apresentamos o caso clínico de uma doente com hidrosadenite axilar bilateral grave. Num primeiro tempo cirúrgico realizámos a excisão alargada das lesões e cobrimos o defeito com uma matriz de regeneração dérmica sob vacuoterapia. Num segundo tempo cirúrgico realizou-se a cobertura com enxerto de pele parcial sob o qual se aplicou, novamente, vacuoterapia. Os enxertos ficaram completamente integrados. O aspeto estético final é aceitável e não foram observadas limitações funcionais. Não foi detetada nenhuma recorrência (follow-up de nove meses).
- Pitfalls of Diffusion-Weighted Imaging of the Female PelvisPublication . Duarte, AL; Lopes Dias, J; Cunha, TMDiffusion-weighted imaging (DWI) is widely used in protocols for magnetic resonance imaging (MRI) of the female pelvis. It provides functional and structural information about biological tissues, without the use of ionizing radiation or intravenous administration of contrast medium. High signal intensity on DWI with simultaneous low signal intensity on apparent diffusion coefficient maps is usually associated with malignancy. However, that pattern can also be seen in many benign lesions, a fact that should be recognized by radiologists. Correlating DWI findings with those of conventional (T1- and T2-weighted) MRI sequences and those of contrast-enhanced MRI sequences is mandatory in order to avoid potential pitfalls. The aim of this review article is the description of the most relevant physiological and benign pathological conditions of the female pelvis that can show restricted diffusion on DWI.
- Intestinal Obstruction of Uncommon Cause and Point-of-Care Ultrasonography - Where Do We Stand?Publication . Capela, T; Sousa, P; Caldeira, A; Pereira, EMalignant neoplasms of the small bowel, especially from the jejunum, are among the rarest types of cancer. Given its location, a delayed diagnosis is frequent and sometimes only made in an emergency context. The authors present a case of intestinal obstruction, where ultrasonography was pivotal in establishing a diagnosis. Point-of-care ultrasonography seems to be particularly sensitive in assessing emergency patients with abdominal pain, allowing effective orientation and saving human and technical resources.
- The Relation Between Household Income and Surgical Outcome in the Dutch Setting of Equal Access to and Provision of HealthcarePublication . Ultee, K; Tjeertes, EK; Bastos Gonçalves, F; Rouwet, EV; Hoofwijk, AG; Stolker, RJ; Verhagen, HJ; Hoeks, SEBACKGROUND: The impact of socioeconomic disparities on surgical outcome in the absence of healthcare inequality remains unclear. Therefore, we set out to determine the association between socioeconomic status (SES), reflected by household income, and overall survival after surgery in the Dutch setting of equal access and provision of care. Additionally, we aim to assess whether SES is associated with cause-specific survival and major 30-day complications. METHODS: Patients undergoing surgery between March 2005 and December 2006 in a general teaching hospital in the Netherlands were prospectively included. Adjusted logistic and cox regression analyses were used to assess the independent association of SES-quantified by gross household income-with major 30-day complications and long-term postoperative survival. RESULTS: A total of 3929 patients were included, with a median follow-up of 6.3 years. Low household income was associated with worse survival in continuous analysis (HR: 1.05 per 10.000 euro decrease in income, 95% CI: 1.01-1.10) and in income quartile analysis (HR: 1.58, 95% CI: 1.08-2.31, first [i.e. lowest] quartile relative to the fourth quartile). Similarly, low income patients were at higher risk of cardiovascular death (HR: 1.26 per 10.000 decrease in income, 95% CI: 1.07-1.48, first income quartile: HR: 3.10, 95% CI: 1.04-9.22). Household income was not independently associated with cancer-related mortality and major 30-day complications. CONCLUSIONS: Low SES, quantified by gross household income, is associated with increased overall and cardiovascular mortality risks among surgical patients. Considering the equality of care provided by this study setting, the associated survival hazards can be attributed to patient and provider factors, rather than disparities in healthcare. Increased physician awareness of SES as a risk factor in preoperative decision-making and focus on improving established SES-related risk factors may improve surgical outcome of low SES patients.
- Mutations in SELENBP1, encoding a novel human methanethiol oxidase, cause extraoral halitosisPublication . Pol, A; Renkema, GH; Tangerman, A; Winkel, EG; Engelke, UF; de Brouwer, AM; Lloyd, KC; Araiza, RS; van den Heuvel, L; Omran, H; Olbrich, H; Oude Elberink, M; Gilissen, C; Rodenburg, R; Sass, JO; Schwab, KO; Schäfer, H; Venselaar, H; Sequeira, JS; Op den Camp, HM; Wevers, RASelenium-binding protein 1 (SELENBP1) has been associated with several cancers, although its exact role is unknown. We show that SELENBP1 is a methanethiol oxidase (MTO), related to the MTO in methylotrophic bacteria, that converts methanethiol to H2O2, formaldehyde, and H2S, an activity not previously known to exist in humans. We identified mutations in SELENBP1 in five patients with cabbage-like breath odor. The malodor was attributable to high levels of methanethiol and dimethylsulfide, the main odorous compounds in their breath. Elevated urinary excretion of dimethylsulfoxide was associated with MTO deficiency. Patient fibroblasts had low SELENBP1 protein levels and were deficient in MTO enzymatic activity; these effects were reversed by lentivirus-mediated expression of wild-type SELENBP1. Selenbp1-knockout mice showed biochemical characteristics similar to those in humans. Our data reveal a potentially frequent inborn error of metabolism that results from MTO deficiency and leads to a malodor syndrome.
- Anatomical and Physiological Basis of Continuous Spike-Wave of Sleep Syndrome after Early Thalamic LesionsPublication . Leal, A; Calado, E; Vieira, JP; Mendonça, C; Ferreira, JC; Ferreira, H; Carvalho, D; Furtado, F; Gomes, R; Monteiro, JPOBJECTIVE: Early neonatal thalamic lesions account for about 14% of continuous spike-wave of sleep (CSWS) syndrome, representing the most common etiology in this epileptic encephalopathy in children, and promise useful insights into the pathophysiology of the disease. METHODS: We describe nine patients with unilateral neonatal thalamic lesions which progressed to CSWS. Longitudinal whole-night and high-density electroencephalograms (EEGs) were performed, as well as detailed imaging and clinical evaluation. Visual evoked potentials were used to probe cortical excitability. RESULTS: Thalamic volume loss ranged from 19% to 94%, predominantly on medial and dorsal nuclei and sparing the ventral thalamus. Lesions produced white matter loss and ventricle enlargement on the same hemisphere, which in four patients was associated with selective loss of thalamic-cortical fibers. Cortical thickness quantification failed to reveal hemispheric asymmetries. Impact on EEG rhythms was mild, with a volume-loss-related decrease in alpha power and preservation of sleep spindles. The sleep continuous spiking was lateralized to the hemisphere with the lesion. Visual cortex stimulation in five patients with posterior cortex spiking revealed an abnormal frequency-dependent excitability at 10-20Hz on the side of the lesion. SIGNIFICANCE: Unilateral selective thalamic-cortical disconnection is a common feature in our patients and is associated with both a focal pattern of CSWS and a pathological type of frequency-dependent excitability (peak: 10-20Hz). We propose that this excitability represents an abnormal synaptic plasticity previously described as the augmenting response. This synaptic plasticity has been described as absent in the corticocortical interactions in healthy experimental animals, emerging after ablation of the thalamus and producing a frequency-dependent potentiation with a peak at 10-20Hz. Because this response is potentiated by sleep states of reduced brainstem activation and by appropriate stimulating rhythms, such as sleep spindles, the simultaneous occurrence of these two factors in nonrapid-eye-movement sleep is proposed as an explanation for CSWS in our patients.
- Delirium: o 7º Parâmetro Vital?Publication . Prayce, R; Quaresma, F; Galriça Neto, IIntrodução: O delirium é uma síndrome neuropsiquiátrica transitória e flutuante com início súbito frequente nos doentes internados, em particular na população geriátrica e paliativa. Material e Métodos: Através de uma breve revisão da literatura, os autores propuseram-se a sistematizar a definição, fisiopatologia e etiologia do delirium, principais ferramentas para o seu diagnóstico, prevenção e tratamento, bem como o seu impacto socioeconómico. Resultados e Discussão: O delirium é uma entidade pouco reconhecida pelos profissionais de saúde, que se associa a maior morbimortalidade e custos, interfere com a avaliação e abordagem da dor e de outros sintomas e acarreta elevado distress nos doentes, famílias e profissionais de saúde. O melhor tratamento do delirium é a prevenção, que se baseia em intervenções multidisciplinares sob os principais fatores de risco para o seu desenvolvimento. A evidência científica para o tratamento do delirium existe, mas é escassa, sendo a terapêutica preferencial a não farmacológica, com implementação de estratégias ambientais, comportamentais e sociais. O tratamento farmacológico é de segunda linha e deverá ser instituído de forma a prevenir que o doente se coloque em risco, nomeadamente através do uso de antipsicóticos. Conclusão: O reconhecimento e prevenção do delirium são essenciais, pelo que é fundamental a educação e formação dos profissionais de saúde, bem como o acompanhamento e apoio aos familiares. É por todo o impacto que tem nos serviços de saúde, nos profissionais e, sobretudo, nos doentes e seus familiares, que sugerimos maior atenção ao delirium e, porque não, passar a considerá-lo como o 7º sinal vital.