Browsing by Author "Santos, A"
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- Anemia perniciosa e tumor neuroendócrino gástricoPublication . Proença, L; Manso, RT; Leichsenring, C; Almeida, S; Santos, A; Louro, F
- Carcinoma de células renais com trombo gigante na veia cava inferior: abordagem cirúrgica multidisciplinarPublication . Furtado, A; Graça, B; Gonçalves, F; Ferrito, F; Morais, A; Santos, AA nefrectomia radical associada a trombectomia da veia cava inferior constitui a única opção terapêutica passível de melhoria prognóstica dos carcinomas de células renais com trombos venosos major. Descrevemos o caso de um homem, 55 anos, com o diagnóstico de tumor renal com trombo intra-cávico de grandes dimensões. O doente foi alvo de uma abordagem multidisciplinar, tendo sido submetido a nefrectomia radical à direita, trombectomia e cavoplastia, com recurso ainda a bypass cardiopulmonar e circulação extra-corpórea. O pós-operatório não registou intercorrências. A análise histológica concluiu tratar-se de um carcinoma de células renais, variante células claras e trombo excisado na totalidade, sem invasão da parede venosa. Aos dois anos de pós-operatório o doente encontra-se sem evidência de recidiva tumoral nem foram descritos eventos de embolização pulmonar.
- Caso invulgar de esofagite infecciosa em doente imunocompetentePublication . Santos, C; Proença, L; Ricardo, L; Godula, K; Santos, L; Santos, A; Louro, F
- Clinicopathologic predictors of renal outcomes in light chain cast nephropathy: a multicenter retrospective studyPublication . Royal, V; Leung, N; Troyanov, S; Nasr, Sh; Écotière, L; LeBlanc, R; Adam, BA; Angioi, A; Alexander, MP; Asunis, AM; Barreca, A; Bianco, PC; Cohen, C; Drosou, ME; Fatima, H; Fenoglio, R; Gougeon, F; Goujon, JM; Herrera, GA; Knebelmann, B; Lepori, N; Maletta, F; Manso, RT; Motwani, SS; Pani, A; Rabant, M; Rennke, HG; Rocatello, D; Rosenblum, F; Sanders, PW; Santos, A; Soto, K, et al.Light chain cast nephropathy (LCCN) in multiple myeloma often leads to severe and poorly reversible acute kidney injury. Severe renal impairment influences the allocation of chemotherapy and its tolerability; it also affects patient survival. Whether renal biopsy findings add to the clinical assessment in predicting renal and patient outcomes in LCCN is uncertain. We retrospectively reviewed clinical presentation, chemotherapy regimens, hematologic response, and renal and patient outcomes in 178 patients with biopsy-proven LCCN from 10 centers in Europe and North America. A detailed pathology review, including assessment of the extent of cast formation, was performed to study correlations with initial presentation and outcomes. Patients presented with a mean estimated glomerular filtration rate (eGFR) of 13 ± 11 mL/min/1.73 m2, and 82% had stage 3 acute kidney injury. The mean number of casts was 3.2/mm2 in the cortex. Tubulointerstitial lesions were frequent: acute tubular injury (94%), tubulitis (82%), tubular rupture (62%), giant cell reaction (60%), and cortical and medullary inflammation (95% and 75%, respectively). Medullary inflammation, giant cell reaction, and the extent of cast formation correlated with eGFR value at LCCN diagnosis. During a median follow-up of 22 months, mean eGFR increased to 43 ± 30 mL/min/1.73 m2. Age, β2-microglobulin, best hematologic response, number of cortical casts per square millimeter, and degree of interstitial fibrosis/tubular atrophy (IFTA) were independently associated with a higher eGFR during follow-up. This eGFR value correlated with overall survival, independently of the hematologic response. This study shows that extent of cast formation and IFTA in LCCN predicts the quality of renal response, which, in turn, is associated with overall survival.
- Congenital esophageal stenosis: a rare case of dysphagiaPublication . Serrão, E; Santos, A; Gaivão, A; Tavares, A; Ferreira, SCongenital esophageal stenosis (CES) is a rare anomaly, resulting from incomplete separation of the respiratory tract from the primitive foregut at the 25th day of life. First clinical signs are abnormalities of the swallowing mechanism caused by the intrinsic narrowing of the esophagus. Diagnosis is usually delayed, requiring an accurate history and high level of suspicion, alongside with an esophagogram. Definite diagnosis is only confirmed by histological examination. Treatment usually involves surgery, depending on the severity, location and type of stenosis. We report the case of an 18 months old toddler diagnosed with CES. The characteristic radiographic and CT features are presented as well as the histology.
- De ‘bouffée délirante’ a perturbação psicótica aguda e transitória: revisitação do conceito a propósito de um caso clínicoPublication . Ribeiro, J; Oliveira, P; Santos, A; Silva, T; Madeira, NIntrodução: Desde o Séc. XIX que têm sido descritos quadros psicóticos de início súbito e duração limitada. Tendo sido a ‘Bouffée Délirante’ o primeiro quadro a ser descrito, ao longo da história da Psiquiatria várias foram as entidades nosológicas que, entretanto, surgiram nas diferentes escolas: Psicose Ciclóide, Psicose Psicogénica, Psicose Atípica, entre outros. Objetivos: Neste artigo, a propósito de um caso clínico, os autores propõem-se realizar uma revisão dos conceitos históricos das Perturbações Psicóticas Agudas e Transitórias. Métodos: Descrição de um caso clínico e revisão da literatura. Resultados: Caso clínico de um doente de 44 anos com quadro psicótico de início agudo e curta duração, com remissão completa em três dias e retorno ao seu nível de funcionamento habitual. Discussão/Conclusão: Apesar das divergências entre as diferentes concepções teóricas que se mantiveram durante décadas como entidades independentes, actualmente, esses conceitos encontram-se reunidos na 10ª edição da Classificação Internacional de Doenças (CID-10) sob a denominação de Perturbações Psicóticas Agudas e Transitórias. Embora estas classificações não incluam todas as características clínicas inicialmente descritas, procurando o estabelecimento de critérios diagnósticos mais específicos, existe ainda uma percentagem significativa de doentes nos quais o diagnóstico é revisto para uma doença mental crónica.
- Dyschromatopsia in Multiple Sclerosis Patients: A Marker of Subclinical Involvement?Publication . Felgueiras, H; Parra, J; Cruz, S; Pereira, P; Santos, A; Rua, A; Meira, D; Fonseca, P; Pedrosa, C; Cardoso, J; Almeida, C; Araújo, M; Santos, EBACKGROUND: In multiple sclerosis (MS), even in the absence of a clinical episode of optic neuritis (ON), the optic nerve and retinal nerve fiber layer (RNFL) may be damaged leading to dyschromatopsia. Subclinical dyschromatopsia has been described in MS associated with lower motor and cognitive performances. OBJECTIVES: To set the prevalence of dyschromatopsia in eyes of MS patients without a history of ON, to compare its prevalence in patients with and without ON history, and to explore the association between dyschromatopsia and disease duration, average peripapillary RNFL thickness, macular volume, and cognitive and motor performances. METHODS: An observational cross-sectional study was conducted at multiple medical centers. Data were collected after single neurological and ophthalmological evaluations. Dyschromatopsia was defined by the presence of at least 1 error using Hardy-Rand-Rittler plates. RESULTS: In our population of 125 patients, 79 patients (63.2%) never had ON and 35 (28.8%) had unilateral ON. The prevalence of dyschromatopsia in eyes of patients without ON was 25.7%. Patients with dyschromatopsia had a statistically significant lower RNFL thickness (P = 0.004 and P = 0.040, right and left eyes, respectively) and worse performance in symbol digit modalities test (P = 0.012). No differences were found in macular volume or motor function tasks. CONCLUSIONS: Dyschromatopsia occurs frequently in MS patients. It may be associated with a worse disease status and possibly serve as a marker for the detection of subclinical disease progression since it was detected even in the absence of ON. It correlated with thinner peripapillary RNFL thickness and inferior cognitive performance.
- Ecoendoscopia digestiva na prática clínica parte II a: utilidade na avaliação do pâncreasPublication . Rodrigues, C; Pereira, E; Caldeira, A; Santos, A; Sousa, H; Banhudo, ADesde a altura em que foi desenvolvida, na década de 80, a ecoendoscopia tem vindo a assumir uma importância crescente no diagnóstico de várias doenças pancreáticas benignas e malignas. O papel que detém actualmente na abordagem da patologia pancreática veio confirmar a razão histórica da sua implementação. Pela proximidade do transdutor e reduzida interferência acústica, a ecoendoscopia fornece imagens ultrassonográficas de alta resolução do pâncreas e com grande detalhe anatómico, acrescentando à informação obtida por tomografia computorizada ou por ressonância magnética aspetos essenciais na investigação dos doentes com suspeita de patologia pancreática. A ecoendoscopia tem, além disso, a capacidade única de guiar a punção aspirativa de lesões pancreáticas e estruturas adjacentes para obtenção de um diagnóstico cito-histológico. Nos últimos anos, a aplicação à ecoendoscopia de novas modalidades da ultrassonografia, como a elastografia e o uso de contrastes, tem revelado resultados promissores e está a ampliar as potencialidades desta técnica. Na sequência de artigos de revisão sobre ecoendoscopia, este primeiro capítulo da segunda parte pretende abordar as principais indicações desta técnica no diagnóstico da patologia do pâncreas, bem como os achados endossonográficos que a caracterizam.
- Manchester triage system version II and resource utilisation in emergency departmentPublication . Santos, A; Freitas, PT; Martins, HEmergency department (ED) triage systems aim to direct the best clinical assistance to those who are in the greatest urgency and guarantee that resources are efficiently applied.The study's purpose was to determine whether the Manchester Triage System (MTS) second version is a useful instrument for determining the risk of hospital admission, intrahospital death and resource utilisation in ED and to compare it with the MTS first version.This was a prospective study of patients that attended the ED at a large hospital. It comprised a total of 25 218 cases that were triaged between 11 July and 13 October 2011. The MTS codes were grouped into two clusters: red and orange into a 'high acuity/priority' (HP) cluster, and yellow, green and blue into a 'low acuity/priority' cluster.The risk of hospital admission in the HP cluster was 4.86 times that of the LP cluster for both admission route and ages. The percentage of patient hospital admission between medical and surgical specialties, in high and low priority clusters, was similar. We found the risk of death in the HP cluster to be 5.58 times that of the risk of the low acuity/priority cluster. The MTS had an inconsistent association relative to the utilisation of x-ray, while it seemed to portray a consistent association between ECG and laboratory utilisation and MTS cluster.There were no differences between medical and surgical specialities risk of admission. This suggests that improvements were made in the second version of MTS, particularly in the discriminators of patients triaged to surgical specialties, because this was not true for the first version of MTS.
- p16: método de rastreio precoce da infecção por HPV de alto grauPublication . Santos, A; Manso, RT; Ramalhosa, MM; Perpétua, F; Silva, S