Browsing by Author "Pires, E"
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- Apresentação rara de um tumor torácicoPublication . Bento, L; Melo, R; Liberato, H; Pires, E; Silva, M; Almeida, A; Beptista, M; Santos, S; Rodrigues, F
- Biodegradable stent for the treatment of a colonic stricture in Crohn's diseasePublication . Rodrigues, C; Oliveira, A; Santos, L; Pires, E; Deus, JRBiodegradable polydioxanone stents were developed for the treatment of refractory benign esophageal strictures but have been suggested as a new therapeutic option for intestinal strictures. The primary advantage of biodegradable stents over self-expandable metallic stents is that removal is not required. There are, however, few data available on their use in the small or large bowel. We herein describe the case of a 33-year-old patient with long-standing Crohn's disease (CD) who developed a fibrotic stricture of the sigmoid too long to be amenable to balloon dilation. The use of a biodegradable polydioxanone stent was chosen to avoid surgery. Combined endoscopic and fluoroscopic placement of the stent was technically simple, safe and clinically successful, and no recurrence of obstructive symptoms occurred during a 16-mo follow-up. Further studies are needed to evaluate the long-term efficacy and safety of biodegradable stents in the treatment of intestinal strictures, particularly in the context of CD.
- Dieulafoy’s lesion in Treitz’s anglePublication . Alberto, S; Oro, I; Pires, E; Alves, N; Godinho, A; Figueiredo, A; Deus, JR
- Estudo avaliação da qualidade das preparações para colonoscopiaPublication . Caldeira, P; Diogo, S; Castro, S; Bejar, S; Lourenço, S; Louro, A; Moura, P; Fonseca, A; Rodrigues, J; Coelho, P; Leitão, A; Pires, E; Deus, JR
- Hepatic abscess induced by foreign body: case report and literature reviewPublication . Santos, S; Alberto, S; Cruz, E; Pires, E; Figueira, T; Coimbra, E; Estevez, J; Oliveira, M; Novais, L; Deus, JRHepatic abscess due to perforation of the gastrointestinal tract caused by ingested foreign bodies is uncommon. Pre-operative diagnosis is diffi cult as patients are often unaware of the foreign body ingestion and symptoms and imagiology are usually non-specific. The authors report a case of 62-year-old woman who was admitted with fever and abdominal pain. Further investigation revealed hepatic abscess, without resolution despite antibiotic therapy. A liver abscess resulting from perforation and intra-hepatic migration of a bone coming from the pilorum was diagnosed by surgery. The literature concerning foreign body-induced perforation of the gastrointestinal tract complicated by liver abscess is reviewed.
- Lesões cáusticas do tracto gastrointestinal superior - revisão da literatura e proposta de protocolo de actuaçãoPublication . Santos, S; Pires, E; Freitas, P; Deus, JRIntrodução: A ingestão de substâncias cáusticas, voluntária ou acidental, pode resultar em lesões graves do tracto gastrointestinal superior. Vários pontos na estratégia de actuação destes doentes permanecem controversos, no âmbito da Gastrenterologia e dos Cuidados Intensivos. Objectivos: Revisão da epidemiologia, fisiopatologia, manifestações clínicas, abordagem e terapêutica, no que concerne às lesões do tubo digestivo alto por cáusticos e estabelecimento de um protocolo de actuação. Materiais e Métodos: Foi realizada uma revisão da literatura, seleccionada, em bases de dados médicas informatizadas (MEDSCAPE, MEDLINE) e livros de referência, nas áreas de Gastrenterologia e Cuidados Intensivos. Resultados/Discussão: A apresentação clínica destes doentes é variável, não parecendo existir correlação directa entre a sintomatologia e gravidade das lesões. A realização de endoscopia permite a estratificação dos doentes com base nas lesões endoscópicas, apresentando valor prognóstico e orientador na abordagem do doente. Existem ainda alguns pontos de controvérsia em relação à terapêutica destes doentes; a alimentação parentérica total assim como a corticoterapia não são recomendados, excepto em casos seleccionados. Conclusões: A elevada morbilidade e mortalidade relacionadas com lesões cáusticas, bem como a manutenção de pontos controversos na sua abordagem, torna a existência de estudos adicionais necessária. Aelaboração de protocolos de actuação poderá contribuir para a uma adequada avaliação e orientação destes doentes.
- Proteção adultos vulneráveis: procedimentos situações de violênciaPublication . Fernandes, JM; Gomes, A; Pires, E; Conceição, A; Campos, C; Martins, L
- Sustained relief of obstructive symptoms for the remaining life of patients following placement of an expandable metal stent for malignant colorectal obstructionPublication . Canena, J; Liberato, M; Marques, I; Rodrigues, C; Lagos, A; Patrocínio, S; Tomé, M; Pires, E; Romão, C; Coutinho, A; Veiga, P; Neves, B; Deus, JR; Além, H; Gonçalves, JBACKGROUND: self-expanding metal stents are currently being used as a definitive palliative treatment for malignant colorectal obstruction in patients with incurable disease. Few studies have followed large numbers of patients from stent placement until death, and those few have reported conflicting results in the long-term clinical outcome data. AIMS: this study evaluated the clinical effectiveness of stent placement for malignant colorectal obstruction throughout the patients lives and related factors affecting stent patency, clinical success and complications. METHODS: this was a multicentre, retrospective study of 89 consecutive patients who had undergone attempted expandable stent placement for symptomatic malignant colorectal obstruction during a 10-year period. Data were collected to analyse the sustained relief of obstructive symptoms throughout the patients lives, as well as the technical success, immediate clinical success, stent patency, complications, reinterventions, survival, prognostic factors associated with stent patency and long-term clinical efficacy and risk factors for complications. RESULTS: technical and immediate clinical success were achieved in 95.5% and 91.0% of patients, respectively. A total of 68 out of 89 patients (76.4%) maintained relief of obstruction from stent implantation until death without reintervention. Twenty patients (22.5%) had complications including perforation (n = 4; 4.5%), stent obstruction (n = 8; 9.0%), migration (n = 5; 5.6%) and haemorrhage (n = 3; 3.4%). Stent-related mortality was seen in 1 patient (1.1%). The estimated median survival and estimated mean stent patency were 87.0 and 322.7 days, respectively. In total, 12 of the initial 89 patients (13.5%) needed a colostomy for long-term relief of the obstructive symptoms. Univariate and multivariate analysis detected no significant prognostic factors associated with stent patency, long term clinical efficacy and risk factors for complications; however, the multivariate logistic model revealed a non-significant trend by which the use of chemotherapy was a risk factor for migration (OR = 11.89; p = 0.06). CONCLUSIONS: for palliation of incurable malignant colorectal obstruction, expandable stents can provide sustained relief of obstruction in approximately 75% of patients. The procedure is associated with acceptable morbidity, need for reintervention and minimal mortality.
- Úlceras do colon por anti-inflamatórios não esteróides: caso clínico e revisão da literaturaPublication . Santos, S; Pires, E; Figueiredo, A; Silva, S; Deus, JRO uso de anti-inflamatórios não esteróides (AINE) tem sido associado a efeitos adversos gastrointestinais, não apenas ao nível do tracto gastrointestinal superior, mas também ao nível do jejuno, ileon e colon, com importante morbilidade e mesmo mortalidade. Descrevemos o caso de um doente que desenvolveu um quadro de diarreia sanguinolenta, 48 horas apos o inicio de ibuprofeno. A observação endoscópica revelou a existência de múltiplas úlceras no cólon direito. A avaliação histológica foi sobreponível à descrita nas lesões farmacológicas, tendo-se verificado completa remissão clinica e endoscópica apos interrupção do fármaco. É apresentada uma breve revisão da literatura sobre as lesões ao nível do intestino menos conhecidas, resultantes do efeito adverso dos AINE.