Browsing by Issue Date, starting with "2018-12"
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- Enhanced Pacing Modalities in Bradycardia Patients: Can Technology Reduce Costs?Publication . Oliveira, MM
- Celiac Trunk Adventure!Publication . Bilhim, T
- Hepatic Resection for Non-Functional Neuroendocrine Liver Metastasis: Does the Presence of Unresected Primary Tumor or Extrahepatic Metastatic Disease Matter?Publication . Xiang, JX; Zhang, XF; Beal, EW; Weiss, M; Aldrighetti, L; Poultsides, GA; Bauer, TW; Fields, RC; Maithel, SKumar; Pinto Marques, H; Pawlik, TMOBJECTIVES: The objective of this study was to assess the impact of unresected primary tumor, as well as extrahepatic metastasis, on the long-term prognosis of patients undergoing hepatic resection for non-functional neuroendocrine liver metastasis (NF-NELM). METHODS: Patients who underwent hepatic resection for NF-NELM were identified from a multi-institutional database. Data on clinical and pathological details, as well as the long-term overall survival (OS) were obtained and compared. Propensity score matching was performed to generate matched pairs of patients. RESULTS: Among the 332 patients with NF-NELM, 281 (84.6%) underwent primary tumor resection, while 51 (15.4%) did not. Patients who underwent primary resection were more likely to have a pancreatic primary and metachronous NELM. The long-term OS of patients who did and did not have the primary neuroendocrine tumor (NET) resected was comparable on both unmatched (10-year survival rate 66.8% vs. 54.0%, p = 0.192) and matched (10-year survival rate 75.7% vs. 60.4%, p = 0.271) analyses. In contrast, patients with NF-NELM and extrahepatic metastasis had a worse OS following resection compared with patients who had intrahepatic-only metastasis on unmatched (10-year survival rate 37.5% vs. 69.3%, p = 0.002) and matched (10-year survival rate 37.5% vs. 86.3%, p = 0.011) analyses. On multivariable analysis, while resection of the primary NET was not associated with OS (hazard ratio [HR] 0.7, 95% confidence interval [CI] 0.4-1.2, p = 0.195), the presence of extrahepatic metastasis was independently associated with long-term risk of death (HR 3.9, 95% CI 1.7-9.2, p = 0.002). CONCLUSIONS: While surgery should be considered for patients with NF-NELM who have an unresectable primary tumor, operative resection of NF-NELM may not be as beneficial in patients with extrahepatic disease.
- Epidemiology of Acute Liver Failure from a Regional Liver Transplant Center in PortugalPublication . Simões, C; Santos, S; Vicente, M; Cardoso, FSBackground and Aims: Acute liver failure (ALF) is a rare disease with potentially high mortality rates. We aimed to study the recent epidemiology of ALF in one of the Portuguese liver transplant (LT) regions. Methods: We assessed a retrospective cohort including 34 consecutive patients with ALF admitted to the intensive care unit (ICU) of Curry Cabral Hospital (Lisbon, Portugal) between October 2013 and December 2016. Results: The median age (IQR) was 49 (31-67) years, and 21 (62%) of the cohort were female. Non-paracetamol etiologies were found in 29 patients (85%). On ICU admission, grade 3-4 hepatic encephalopathy developed in 10 patients (29%); invasive mechanical ventilation, vasopressors, and renal replacement therapy were required for 8 (24%), 7 (21%), and 5 (15%) of the patients, respectively; the King's College criteria (KCC) were fulfilled by 16 patients (47%). Of the 15 (44%) nontransplanted patients, 11 (73%) died during their hospital stay. Of the 19 (56%) transplanted patients, 4 (21%) died during their hospital stay. KCC were not associated with hospital mortality (p = 0.97), but they were significantly associated with LT (p = 0.008). Conclusions: In a Portuguese cohort of patients with ALF, non-paracetamol etiologies were predominant. Hospital mortality was much lower amongst transplanted patients.
- Outcomes of Different Methods for Analysis of Biliary Brush Cytology and of Factors Associated with Positive Diagnosis in an Age-Dependent Retrospective ReviewPublication . Costa, M; Canena, J; Mascarenhas-Lemos, L; Loureiro, R; Silva, M; Carvalho, D; Capela, T; Russo, P; Ramos, G; Mateus-Dias, A; Ferraz-Oliveira, M; Mota Veiga, P; Coimbra, JBrush cytology during endoscopic retrograde cholangiopancreatography (ERCP) is the most frequently used strategy for obtaining a tissue sample from an indeterminate biliary stricture. A recent study reported that age is a factor associated with positive yields, but further analysis of how age influences the results was lacking. We aimed to evaluate clinical effectiveness of biliary cytology and prognostic factors for a positive outcome, especially age. Methods: This study was a single-center, retrospective, clinical study of 77 consecutive patients who underwent brush cytology during ERCP to obtain a diagnosis of an indeterminate biliary stricture. We compared 2 routine cytology techniques: A (smear); B (centrifugation of the cytological material collected and the cut-off brush + cell block when sufficient amount of material was available). The data were collected aiming to compare the accuracy of the different techniques used and the prognostic factors affecting the outcome, with a particular focus on age. The yield for brush cytology was compared with the gold standard defined as either definitive histology or the long-term clinical course. Results: The overall accuracy of the 2 used methods was 75.3%. Sensitivity was 52.5%, specificity was 100%, positive predictive value was 100%, and negative predictive value was 66.1%. Although not statistically significant, there was a trend toward accuracy for method B compared with method A (80.4 vs. 65.4%; p = 0.153). Multiple logistic regression analysis showed that younger age was the only independent prognostic factor associated with a positive diagnosis (OR 0.95; 95% CI 0.90-0.99; p = 0.039). Receiver operating characteristic curves for age yielded an area under the curve value of 68.2%. On the basis of the Youden index, 69 years was found to be the optimal cutoff for age. Conclusions: In this series, the accuracy of routine biliary brush cytology was not equal for all methods and ages; in particular, younger patients (below 69 years) tended to have a higher probability of a correct diagnosis.
- Renal Sarcoidosis: a Rare CasePublication . Menezes, M; Patarata, ESarcoidosis is a multisystemic granulomatous disease with rare renal involvement. We describe a case of a 45-year-old female patient admitted to the hospital with severe acute kidney injury and uveitis. After clinical investigation, sarcoidosis with renal, hepatic and ocular involvement was diagnosed. Renal biopsy revealed acute granulomatous interstitial nephritis and treatment with systemic corticosteroids was started with marked improvement in renal function.
- Bidirectional Ventricular Tachycardia Due to HypokalaemiaPublication . Santos, I; Alves Teixeira, J; Costa, C; Vale, L
- BRAF V600E Mutation and 9p21: CDKN2A/B and MTAP Co-Deletions - Markers in the Clinical Stratification of Pediatric GliomasPublication . Frazão, L; Martins, MC; Nunes, VM; Pimentel, J; Faria, C; Miguéns, J; Sagarribay, A; Matos, M; Salgado, D; Nunes, S; Mafra, M; Roque, LGenetic alterations in pediatric primary brain tumors can be used as diagnostic and prognostic markers and are the basis for the development of new target therapies that, ideally, would be associated with lower mortality and morbidity. This study evaluates the incidence and interplay of the presence of BRAF V600E mutation and chromosomal 9p21 deletions in a series of 100 pediatric gliomas, aiming to determine the role of these alterations in recurrence and malignant transformation, and to verify if they could be used in the clinical set for stratifying patients for tailored therapies and surveillance.
- [CoFI - Consensus on Infant Formulas: The Opinion of Portuguese Experts on Their Composition and Indications]Publication . Rêgo, C; Pereira-da-Silva, L; Ferreira, RIntrodução: O aleitamento materno tem benefícios únicos, sendo recomendado em exclusividade até ao sexto mês de idade e mantido durante a diversificação alimentar. Como alternativa, podem ser usadas fórmulas infantis, as quais procuram mimetizar o leite humano, promovendo um perfil metabólico e de crescimento semelhantes. Este estudo pretendeu avaliar a opinião de pediatras portugueses relativamente à composição, alegados benefícios e indicações das fórmulas infantis comercializadas em Portugal. Material e Métodos: Estudo baseado no método de Delphi, com a aplicação de um questionário desenvolvido por uma comissão científica a um painel de pediatras peritos em nutrição pediátrica. O questionário foi aplicado em duas voltas, tendo a versão inicial 65 itens abrangendo 11 temas. Resultados: Participaram 21 peritos, tendo sido atingida, após as duas voltas, 87,5% de respostas. Este painel foi consensual em 68,3% dos itens, nomeadamente na indicação das fórmulas infantis apenas nos que não podem beneficiar de aleitamento materno. O painel teve opiniões heterogéneas numa série de questões, destacando-se as relacionadas com vantagens e indicações das fórmulas ‘especiais’ ou modificadas (hidrólise parcial da proteína, anticólica, antirregurgitação e antiobstipação) e das fórmulas ‘de crescimento’ durante o segundo ano de vida. Discussão: Houve um consenso alargado dos peritos quanto à qualidade nutricional, segurança alimentar e indicações atribuídas às fórmulas infantis comercializadas, nomeadamente as fórmulas para lactente e de transição. Conclusão: O painel foi consensual relativamente à maioria dos tópicos inquiridos. A ausência de consenso verificou-se, de forma geral, em questões que na literatura permanecem em debate e carecem de evidência científica robusta.