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- 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.
- Tumores del estroma gastrointestinal. Estudio retrospectivo de 43 casosPublication . Alberto, S; Sánchez, P; Oliveira, M; Cuesta, L; Gomes, F; Figueiredo, A; Pinheiro, N; Deus, JRIntroducción: los tumores del estroma gastrointestinal (GIST) son poco frecuentes, con una incidencia de 10 a 20 casos por millón de habitantes y año. Aparecen en todo el tubo digestivo, mesenterio o epiplón adyacente; siendo más frecuentes en el estómago(60-70%); también pueden aparecer en el intestino delgado (20-25%), colon y recto (5%) y esófago (< 5%). Su presentación varía desde pequeños nódulos asintomáticos hasta formas más agresivas. Su clasificación se realiza actualmente con base a los criterios de Fletcher. Objetivo: revisión y caracterización de los casos de GIST observados en nuestro centro durante un periodo de 10 años. Métodos: estudio retrospectivo de pacientes diagnosticados con GIST (identificados por criterios inmunohistoquímicos) desde enero de 1997 hasta diciembre de 2007 y clasificados por los criterios de Fletcher. Resultados: se estudiaron 43 pacientes (24 hombres y 19 mujeres), con una edad media de 62,7 años. La mayoría de los GIST encontrados se localizaban en el estómago (n = 20, 46,5%), intestino delgado (n = 18, 41,9%) y en 5 casos se detectaron como metástasis de un tumor oculto. Dieciocho casos fueron asintomáticos. Por los criterios de Fletcher 19 eran casos de alto riesgo, 7 de riesgo intermedio, 12 de bajo riesgo y 5 de riesgo indeterminado. Diez pacientes fallecieron por progresión de la enfermedad y 13 pacientes presentaron metástasis a distancia. Conclusiones: en nuestra serie, tal como en la literatura, se observa un predominio del sexo masculino y mayor frecuencia de localización gástrica. La supervivencia fue del 42% a los 5 años. La aplicación de los criterios de Fletcher fue consistente con la evolución.
- A rectocolic hemangioma as the cause of rectal bleeding and treated with rubber-band ligation and sclerotherapy.Publication . Alberto, S; Martins, A; Pires, S; Figueiredo, A; Deus, JR
- Crohn’s disease in a southern european country: Montreal classification and clinical activityPublication . Magro, F; Portela, F; Lago, P; Deus, JR; Vieira, A; Peixe, PBACKGROUND: Given the heterogeneous nature of Crohn's disease (CD), our aim was to apply the Montreal Classification to a large cohort of Portuguese patients with CD in order to identify potential predictive regarding the need for medical and/or surgical treatment. METHODS: A cross-sectional study was used based on data from an on-line registry of patients with CD. RESULTS: Of the 1692 patients with 5 or more years of disease, 747 (44%) were male and 945 (56%) female. On multivariate analysis the A2 group was an independent risk factor of the need for steroids (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.1-2.3) and the A1 and A2 groups for immunosuppressants (OR 2.2; CI 1.2-3.8; OR 1.4; CI 1.0-2.0, respectively). An L3+L3(4) and L(4) location were risk factors for immunosuppression (OR 1.9; CI 1.5-2.4), whereas an L1 location was significantly associated with the need for abdominal surgery (P < 0.001). After 20 years of disease, less than 10% of patients persisted without steroids, immunosuppression, or surgery. The Montreal Classification allowed us to identify different groups of disease severity: A1 were more immunosuppressed without surgery, most of A2 patients were submitted to surgery, and 52% of L1+L1(4) patients were operated without immunosuppressants. CONCLUSIONS: Stratifying patients according to the Montreal Classification may prove useful in identifying different phenotypes with different therapies and severity. Most of our patients have severe disease.
- Dieulafoy’s lesion in Treitz’s anglePublication . Alberto, S; Oro, I; Pires, E; Alves, N; Godinho, A; Figueiredo, A; Deus, JR
- Rectal ulcer as a complication of Longo’s haemorrhoidopexyPublication . Alberto, S; Oro, I; Sanchez, P; Godinho, A; Garcia, H; Figueiredo, A; Deus, JR
- Insuficiência hepática agudaPublication . Alberto, S; Pires, S; Figueiredo, A; Deus, JRIntrodução: Define-se como insuficiência hepática aguda o desenvolvimento rápido de falência hepática em indivíduos sem doença hepática prévia ou com doença hepática crónica compensada. Etiologia: É variada e é o principal indicador do prognóstico, pelo que a sua rápida identificação é vital. Avaliação inicial e diagnóstico: Atendendo a uma possível progressão para falência multiorgânica é necessário o internamento destes doentes numa Unidade de Cuidados Intensivos. A primeira abordagem terapêutica inclui medidas intensivas de suporte até determinar a etiologia exacta, para um tratamento dirigido. Para além da encefalopatia porto-sistémica podem ocorrer um conjunto de complicações sistémicas responsáveis pela alta morbilidade e mortalidade desta entidade e que exigem uma vigilância e terapêutica rigorosas. Os sistemas artificiais de suporte hepático são alternativas de tratamento ainda em estudo e sem influência comprovada a longo prazo, sendo o transplante hepático a terapêutica final. Atendendo às limitações inerentes a este procedimento, a sua decisão depende de um prognóstico correcto baseado em vários modelos estatísticos de previsão.
- Ulcerative colitis in a Southern European country: a national perspectivePublication . Portela, F; Magro, F; Lago, P; Cotter, J; Cremers, I; Deus, JR; Vieira, A; Lopes, H; Caldeira, P; Barros, L; Reis, J; Carvalho, L; Gonçalves, R; Campos, M; Ministro, P; Duarte, M; Amil, J; Rodrigues, S; Azevedo, L; Costa-Pereira, ABACKGROUND: The incidence, prevalence, and even the clinical behavior of ulcerative colitis (UC) are highly variable in different world regions. In previous studies, Portugal was reported as having a milder clinical behavior. The aim of this study was to apply the Montreal Classification in a large group of UC Portuguese patients in order to describe their clinical characteristics and evaluate variables potentially useful for outcome prediction. METHODS: A cross-sectional study based on data collected from a nationwide online registry was undertaken. RESULTS: In all, 2863 patients with UC were included. Twenty-one percent had ulcerative proctitis, 52% left-sided colitis, and 28% extensive colitis. Sixty percent of patients had taken steroids, 14% immunosuppressors, 1% biologicals, and 4.5% were submitted to surgery. Patients with extensive colitis had more severe activity, needing more steroids, immunosuppressors, and surgery. At the time of diagnosis 61% were less than 40 years old and 5% less than 16. Younger patients also had a more aggressive initial course. Thirty-eight percent of patients had only taken salicylates during the disease course and were characterized by a lower incidence of systemic symptoms at presentation (3.8% versus 8.8%, P < 0.001), fewer extraintestinal manifestations (7.7% versus 24.0%, P < 0.001), and a higher prevalence of proctitis (32.1% versus 10.0%). CONCLUSIONS: A more aggressive phenotype was found in extensive colitis and in the initial course of younger patients, with an increased need for steroids and immunosuppressors. In addition, a significant percentage of patients, particularly with proctitis, showed a milder clinical evolution and were maintained in remission only with salicylates.
- 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.
- Prevalência de hipertensão arterial em adolescentes portugueses da cidade de LisboaPublication . Silva, D; Matos, A; Magalhães, T; Martins, V; Ricardo, L; Almeida, HIObjetivo: Determinar a prevalência de pré-hipertensão arterial (pré-HTA) e hipertensão arterial (HTA) em adolescentes portugueses da cidade de Lisboa e averiguar a relac¸ão da pressão arterial (PA) com os fatores de risco: sexo, obesidade, tabagismo, alcoolismo, prática de exercício físico e história familiar de HTA. Metodologia: Estudo epidemiológico observacional, descritivo e transversal, numa amostra de conveniência de adolescentes de ambos os sexos, com idades compreendidas entre os 16 e 19 anos. A informac¸ão referente a hábitos comportamentais e história familiar de HTA foi obtida através de um questionário estruturado, autopreenchido. Resultados: Foram incluídos 234 adolescentes, com idade média de 16,4 ± 0,9 anos, 57% do sexo masculino. Registou-se uma prevalência de HTA de 34%, superior no sexo masculino (44 versus 21%, p = 0,001) e uma prevalência de pré-HTA de 12%, superior no sexo feminino (13 versus 10%, p = 0,001). O aumento do índice de massa corporal associou-se de forma significativa a maior prevalência de pré-HTA (categoria normoponderais: 9,40%; excesso de peso: 16,10%; obesidade: 22,70%) e HTA (normoponderais: 30,4%; excesso de peso: 45,2%; obesidade: 45,5%). Na presenc¸a de história familiar de HTA, a prevalência de HTA e de pré-HTA foi aproximadamente o dobro (41 versus 28% e 18 versus 9%, respetivamente). A prática regular de exercício físico, os hábitos tabágicos e o consumo alcoólico não revelaram associac¸ão estatisticamente significativa com os valores de pressão arterial. Conclusão: A prevalência de pré-HTA e HTA na amostra estudada foi elevada. Dos fatores de risco avaliados, apenas o sexo, a obesidade e a história familiar de HTA se associaram de forma significativa aos valores de PA.