Browsing by Author "Coelho, M"
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- Catástrofe Peniana. Infecção de Prótese Peniana – A propósito de um Caso ClínicoPublication . Palmas, A; Lourenço, M; Coelho, M; Cardoso, AP; Fonseca, JA infecção de prótese peniana é uma das complicações mais devastadoras da cirurgia de implante, dada a magnitude da situação, podendo assumir consequências catastróficas. Relatamos o caso clínico de infecção de prótese peniana, de difícil controlo, tendo terminado em Uretrostomia Perineal e contrução de “Pseudo Pénis”, isto apesar do cumprimento rigoroso da técnica cirúrgica e da profilaxia antibiótica sistémica e local.
- Color Doppler ultrasonographic scanning in acute bacterial prostatitisPublication . Palmas, A; Coelho, M; Fonseca, JOBJECTIVES: The purpose of this study was to reveal parenchymal and vascular changes in acute prostatitis and to determine the role of color Doppler sonography in monitoring patients with this pathology. MATERIAL AND METHODS: Twenty five patients with a clinical diagnosis of acute bacterial prostatitis (NIH 1) admitted to our institution were studied prospectively. Clinical, analytical and microbiological data were recorded. Color Doppler and transrectal ultrasonography (TRUS) were performed 1 week after antibiotic therapy and afterwards at 6 weeks, 3 and 6 month visits. The findings were recorded and scored using standardized criteria to characterize the degree and distribution of prostatic vascularity. RESULTS: Blood flow was observed to the entire prostate capsule (grade 2) in 23 (92%) patients at first visit (1 week) and were present in 11 (44%), 6 (24%) and 2 (8%) at 6 weeks, 3 and 6 month visits respectively. The amount and distribution of blood flow within the prostatic parenchyma were evaluated using several criteria. Using the 2-point scale flow were classified as grade 2 22 (88%), 18 (72%), 12 (48%) and 3 (12%) patients at first, second, third and fourth visit respectively. Similar findings were noted using the Doppler spot scale which revealed that flow was grade 2 (15 spots or more) in 23 (92%), 19 (76%), 11 (44%) and 3 (12%) patients respectively. Mean number of Doppler spots in the prostate parenchyma was 23.1 +/- 11.1 at first visit, 10.3 +/- 9.5 after the end of therapy and 8.3 +/- 5.4 and 7.9 +/- 5.1 at 3 and 6 monthly respectively. CONCLUSIONS: Patients with acute prostatitis require prolonged treatment and subsequent follow up for at least 6 months. Color Doppler sonography is a useful tool in monitoring response to treatment and in predicting clinical outcome.
- Considerações anestésicas perante um doente com angioedema hereditário: caso clínicoPublication . Vilaça, MJ; Coelho, M; Faísco, A; Carmona, CO angioedema hereditário (AEH), com uma prevalência estimada de 1:50000 pessoas, é uma doença rara mas potencialmente fatal. Pode se apresentar com edema sistêmico recorrente do tecido subcutâneo e das mucosas. Os doentes com AEH têm um risco acrescido de agudização clínica com o estresse cirúrgico, podem desenvolver síndromes de dificuldade respiratória por compromisso da via aérea e de instabilidade hemodinâmica. A abordagem perioperatória desses doentes requer intervenções específicas. Apresentamos um caso clínico de uma mulher de 50 anos com AEH tipo II proposta para ureterenoscopia com colocação de stent.
- Da embriologia à terapeutica: rim em ferraduraPublication . Coelho, M; Furtado, A; Dores, J
- Divertículos da uretra feminina: uma revisão contemporâneaPublication . Neves, J; Dores, J; Coelho, MIntroduc¸ão: Os divertículos uretrais femininos (DUF) afetam de 0,6 a 4,7% das mulheres, causam frequentemente sintomas urinários persistentes e podem associar-se a complicac¸ões como litíase e transformac¸ão maligna. Existe ainda elevado subdiagnóstico de DUF, bem como atraso diagnóstico e terapêutico. O objetivo deste trabalho é analisar o estado de arte em relac¸ão à etiologia, diagnóstico e terapêutica desta patologia. Materiais e métodos: Revisão bibliográfica de artigos obtidos até janeiro/2014 na base de dados Medline utilizando as palavras-chave: «female urethral diverticula», «female urethral diverticulum», «urethral diverticula», «urethral diverticulum» e «female urethra»; e após pesquisa de referências bibliográficas relevantes nos artigos obtidos. Resultados: A maioria dos DUF parecem surgir secundariamente à infec¸ão das glândulas periuretrais e uretrais. Apesar da associac¸ão clássica à tríade de disúria, dispareunia e gotejo pós-miccional, as manifestac¸ões clínicas são diversas e inespecíficas. Mais de um terc¸o são palpáveis ao exame ginecológico. Os métodos imagiológicos disponíveis, nomeadamente a ressonância magnética e a ecografia, apresentam elevada capacidade diagnóstica e contribuem para o planeamento cirúrgico. Dependendo da localizac¸ão, conformac¸ão e sintomatologia associada, a terapêutica dos DUF poderá ser conservadora ou, na maioria dos casos, cirúrgica. Discussão: A avaliac¸ão clínica permanece essencial para o diagnóstico de DUF. A ressonância magnética é a modalidade com maior taxa de diagnóstico e de exclusão de complicac¸ões pré ou pós-operatórias. Foram descritas técnicas menos invasivas, porém a diverticulectomia uretral transvaginal permanece a terapêutica com maior cura sintomática. Conclusão: A sensibilizac¸ão da comunidade médica é a melhor arma no combate ao subdiagnóstico e atraso diagnóstico dos DUF.
- Erectile dysfunction of vascular cause: statistical evaluation on the plurimetabolic syndrome's risk factors and their correlation with penile eco-doppler rates.Publication . Coelho, M; Santos, PIntroduction: The Plurimetabolic Syndrome is a clustering of vascular risk factors (dyslipemia, abdominal perimeter, HTA and impaired glucose tolerance) with great importance in the development of cardiovascular disease (CVD) and diabetes (DM). CDV and DM are responsible for near 70% of the erectile dysfunction causes. Eco-doppler is the first line exam for the evaluation of cavernous arterial integrity. Methods and Materials: A epidemiologic retrospective study and statistic evaluation of the risk factors was made from a population of 176 patients who were submitted to penile eco-doppler with a 12 MHz BK ultrasound. The procedure was done with 20 to 40 μg of prostaglandin E1 and by the some investigator. The criteria of ED of arterial origin were the peak systolic velocity (PSV) < 30 cm/seg and the resistance index (IR) < 0,75. For the ED of venous-occlusive origin was the peak diastolic velocity (PDV) > 10 cm/seg with normal PSV. The control group was the patients without risk factors and with normal eco-doppler values. Results / Conclusion: The mean age was 49 (17-77) years old. The vascular diseases were present in 41% of the population. The venous-occlusive correspond to 11% of the diagnosis of vascular diseases and 89% to arterial origin. The PSV and the IR become lower with the age and the PDV has no variation (Spearman correlation coefficient, p < 0,001). The PSV and the IR become lower when the risk factors are present and when there are more than one risk factor (Mann-Whitney test, p < 0,001). The PDV had no variation. We were not able to prove the risk grade of the vascular factors analysed in the PSV and the IR (Kruskal-Wallis test, p = 0,2048).
- Giant nephrothoracic abscess: a misleading disease, a surgical challenge, and an unexpected complicationPublication . Kronenberg, P; Graça, B; Coelho, MA rare case of perinephric abscess with unilateral secondary pulmonary involvement that was further complicated by spillover of purulent content into the contralateral lung is reported here. Its diagnosis, treatment, and evolution are described and discussed along with certain features of nephropulmonary fistulas. The diagnosis of these abscesses is difficult, largely because of the paucity of primary symptoms and the frequent presence of misleading secondary symptoms. Deceptive cases like this one highlight the importance of its contemplation in every physician's differential diagnosis.
- Glanulectomia total no Cancro do Pénis. Controlo oncológico e qualidade de vidaPublication . Graça, B; Carrasquinho, E; Bargão, P; Coelho, M; Ribeiro, F; Cardoso, APO carcinoma do pénis é uma neoplasia maligna pouco frequente, sendo muitas vezes diagnosticado com indicação para cirurgia conservadora. Apresentamos uma técnica cirúrgica conservadora que, não comprometendo o controlo oncológico, oferece maior qualidade de vida com preservação das funções miccional, sexual e estética. Apresentamos ainda um fluxograma terapêutico do cancro do pénis sem gânglios inguinais palpáveis, com as actuais indicações para linfadenectomia.
- Impact of positive surgical margins on biochemical relapse after radical retropubic prostatectomy (RRP)Publication . Santos, P; Graça, B; Lourenço, M; Coelho, M; Ribeiro, F; Fonseca, J; Cardoso, AP; Varregoso, J; Ferrito, F; Carrasquinho, FIntroduction. RP (radical prostatectomy) technique continues the major treatment option for men with potential cure and life expectancy exceeding 10 years. The aim of the study is to assess the impact of PSM on BR (biochemical relapse), to identify PSM risk factors, to clarify the factors involved in BR in the absence of PSM. Material and methods. Consultation of 171 medical-records from patients submitted to RRP (radical retropubic prostatectomy) between January/2000-December/2005. Mean-age: 64 yr. Mean – PSA (positive surgical margin):11.88 ng/ml. Clinical staging: 67.8% cT1, 32.2% cT2. GS: ≤6 (66.1%), =7 (21.1%), 8-10 (12.3%). PS: pT0 1.2%, pT2 50.3%, pT3a 36.3%, pT3b 12.9%, pT4 0.6%. pathological Gleason score: ≤6 39.2%, =7 40.9%, 8-10 19.3%. RB definition was PSA ≥0.2 ng/ml. Adjusted Odds-Ratios with 95% confidence intervals (CI) were estimated through univariate logistic regression. Results. There were PSM in 46 specimens, 28 had single PSM and 18 multiple PSM (≥2). BR occurred in 57 patients (33.3%), with an average time after surgery of 23.5 months – 26 patients had PSM and 31 had not. Statistical significant results for BR in variables PSA, PS and PSM. Quadruples if PSM (p <0.0001), triples in single PSM (p = 0.01) and is 6x higher in multiple PSM (p = 0.001). Regarding factors that influence the presence of PSM, only PS ≥pT3a reach statistical significance (p <0.0001). Patients with BR but without PSM (54.38%), variables statistically significant were: initial PSA >10, (p = 0.029) and pathological Gleason score ≥8 with a risk nearly 4x higher than pathological Gleason score ≤6 (p = 0.027). Conclusions. Statistical risk analysis concluded that the presence of PSM in RRP is strongly influenced by PS ≥pT3a. The presence of PSM and their number increase significantly the risk of BR compared to other factors. In the absence of PSM, the factors that seem to be crucial and with greater impact on BR are initial PSA>10 and pathological Gleason score ≥8.
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