Cai, M; Zhou, P; Lourenço, L; Zhang, D
There has been booming interest in the endoscopic full-thickness resection (EFTR) technique since it was first described. With the advent of improved and more secure endoscopic closure techniques and devices, such as endoscopic suturing devices, endoscopists are empowered to perform more aggressive procedures than ever. This article focuses on the procedural technique and clinical outcomes of EFTR for gastrointestinal subepithelial tumors.
Portela, F; Dias, C; Caldeira, P; Cravo, M; Deus, JR; Gonçalves, R; Lago, P; Morna, H; Peixe, P; Ramos, J; Sousa, H; Tavares, L; Vasconcelos, H; Magro, F; Ministro, P
The use of complementary and alternative medicines is increasing among chronic patients, particularly those afflicted with inflammatory bowel diseases.
This study aimed to address the prevalence of complementary and alternative medicines use among Portuguese inflammatory bowel diseases' patients.
Patients were invited to fill an anonymous questionnaire concerning the use of complementary and alternative medicines.
Thirty-one per cent of the patients reported having used complementary and alternative medicines in the past, whereas 12% were using them by the time the questionnaire was administered. Fifty-nine per cent of the users did not share this information with their physician, whereas 14% and 8% discontinued their medication...
Lourenço, L; Horta, D; Rodrigues, C; Canena, J; Reis, J
Branco, J; Horta, D; Reis, J
Pancreaticopleural fistula is a rare complication of chronic pancreatitis. The diagnosis requires a high suspicion degree and its management frequently involves a multidisciplinary approach between gastroenterology and surgery.
Oliveira, AM; Branco, JC; Barosa, R; Rodrigues, JA; Ramos, L; Martins, A; Karvellas, C; Cardoso, F
Spontaneous bacterial peritonitis (SBP) is a prevalent and high mortality complication of cirrhosis. We aimed to describe these patients' clinical and microbiological characteristics and evaluate their impact on outcomes.
This was a retrospective cohort study including 139 consecutive patients with positive culture SBP from three Portuguese centers diagnosed between 2009 and 2014. Multivariate logistic regression was used to study associations with 30-day mortality.
The mean age of the patients was 62 years and 81% of patients were men. The mean model for end-stage liver disease score was 19. Hepatic encephalopathy, hepatorenal syndrome, and variceal bleeding developed in 47, 30, and 21% of...
Karvellas, C; Cardoso, F; Gottfried, M; Reddy, R; Hanje, A; Ganger, D; Lee, W
BACKGROUND & AIMS:
Acute liver failure (ALF) caused by hepatitis B virus (HBV) infection can occur after immunosuppressive treatment and be fatal, although it might be preventable. We aimed to characterize the causes, clinical course, and short-term outcomes of HBV-associated ALF after immune-suppressive therapy, compared with patients with HBV-associated ALF without immunosuppression (control subjects).
We performed a retrospective multicenter study of 156 consecutive patients diagnosed with HBV-associated ALF (22 with a solid or blood malignancy) enrolled in the Acute Liver Failure Study Group registry from January 1998 through April 2015. We collected data on results of serologic and hepatic biochemistry analyses, grade...
Rodrigues, C; Oliveira, A; Deus, JR
Canena, J; Coimbra, J; Carvalho, D; Rodrigues, C; Silva, M; Costa, M; Horta, D; Dias, A; Seves, I; Ramos, G; Ricardo, L; Coutinho, A; Romão, C; Veiga, P
Self-expandable metal stents (SEMSs) can be used for palliation of combined malignant biliary and duodenal obstructions. However, the results of the concomitant stent placement for the duration of the patients' lives, as well as the need for and efficacy of endoscopic revision, are unclear.
This study evaluated the clinical effectiveness of SEMS placement for combined biliary and duodenal obstructions throughout the patients' lives and the need for endoscopic revision.
This study is a retrospective multicenter study of 50 consecutive patients who underwent simultaneous or sequential SEMS placement for malignant biliary and duodenal obstructions. The data were collected to analyze the sustained relief...
Lourenço, L; Sousa, M; Oliveira, AM; Gomes, A; Rodrigues, C; Santos, I; Horta, D; Pignatelli, N; Nunes, V; Reis, J
Prémio Medtronic Investigação em Coloproctologia 2015, no XXV Congresso Nacional de Coloproctologia, que decorreu nos dias 26 e 27 de Novembro de 2015, no Porto.
Santos, S; Pires, E; Figueiredo, A; Silva, S; Deus, JR
A designação de polipo maligno significa a presença de um adenoma com um foco de carcinoma que invade a submucosa (carcinoma invasivo). Este tempo é habitualmente utilizado quando um polipo que foi ressecado por via endoscópica, se vem a comprovar, após exame histológico, conter carcinoma invasivo.
A incidência de polipos malignos, removidos endoscopicamente, é em média de 4,7% (0,2-9,4%).
O risco de malignidade está associado à dimensão, localização e configuração histológica.
A abordagem terapêutica dum polipo maligno varia entre uma atitude conservadora, considerando a polipectomia tratamento adequado e suficiente e uma atitude cirúrgica de ressecção complementar, no caso contrário.
A ressecção cirúrgica deverá tomar...
Pereira, A; Coelho, AP; Rodrigues, C; Costa, C; Carreteiro, M
O conceito de enfermeiro endoscopista ainda é recente, estando ligado em grande parte ao desenvolvimento das técnicas de diagnóstico e terapêutica em Gastroenterologia. A sua diversificação e complexidade tem vindo a reforçar o contributo do enfermeiro nesta área. Nesse sentido é da maior importância que se acompanhe esta evolução através da actualização de conhecimentos teóricos e práticos que se traduzam num desempenho eficaz e de qualidade.
Oliveira, AM; Cardoso, F; Rodrigues, C; Santos, L; Martins, A; Deus, JR; Reis, J
Introduction: Recently, it has been suggested an association between red cell distribution width
(RDW) and Crohn’s disease activity index (CDAI), but its use is not yet performed in daily clinical
Objectives: To determine whether RDW can be used as a marker of Crohn’s disease (CD) activity.
Methods: This was a cross-sectional study including patients with CD, observed consecutively
in an outpatient setting between January 1st and September 30th 2013. Blood cell indices,
erythrocyte sedimentation rate (ESR), and C-reactive protein were measured. CD activity was
determined by CDAI (active disease if CDAI ≥ 150). Associations were analyzed using logistic
regression (SPSS version 20).
Results: 119 patients (56% female) were...
Cardoso, F; Ricardo, L; Oliveira, AM; Horta, D; Papoila, A; Deus, JR; Canena, J
Introduction: C-reactive protein (CRP) and Bedside Index for Severity in Acute Pancreatitis
(BISAP) have been used in early risk assessment of patients with AP.
Objectives: We evaluated prognostic accuracy of CRP at 24 hours after hospital admission
(CRP24) for in-hospital mortality (IM) in AP individually and with BISAP.
Materials and Methods: This retrospective cohort study included 134 patients with AP
from a Portuguese hospital in 2009---2010. Prognostic accuracy assessment used area under
receiver---operating characteristic curve (AUC), continuous net reclassiﬁcation improvement
(NRI), and integrated discrimination improvement (IDI).
Results: Thirteen percent of patients had severe AP, 26% developed pancreatic necrosis, and 7%
died during index hospital stay. AUCs for CRP24 and...
Rodrigues, C; Oliveira, A; Santos, L; Pires, E; Deus, JR
Biodegradable 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...
Laureano, A; Mestre, T; Ricardo, L; Rodrigues, AM; Cardoso, J
Pancreatic panniculitis is a rare disease in which necrosis of fat in the panniculus and other distant foci occurs in the setting of pancreatic diseases; these diseases include acute and chronic pancreatitis, pancreatic carcinoma, pseudocyst, and other pancreatic diseases. This malady is manifested as tender erythematous nodules on the legs, buttock, or trunk. Histopathologically, it shows the pathognomonic findings of focal subcutaneous fat necrosis and ghost-like anucleated cells with a thick shadowy wall. We herein report a case of fatal pancreatic panniculitis that was associated with acute pancreatitis in a 50-yr-old man. He presented with a 3-week history of multiple...
Cravo, M; Ferreira, P; Sousa, P; Moura-Santos, P; Velho, S; Tavares, L; Deus, JR; Ministro, P; Silva, J; Correia, L; Velosa, J; Maio, R; Brito, M
AIM:To identify clinical and/or genetic predictors of response to several therapies in Crohn's disease (CD) patients.
METHODS:We included 242 patients with CD (133 females) aged (mean ± standard deviation) 39 ± 12 years and a disease duration of 12 ± 8 years. The single-nucleotide polymorphisms (SNPs) studied were ABCB1 C3435T and G2677T/A, IL23R G1142A, C2370A, and G9T, CASP9 C93T, Fas G670A and LgC844T, and ATG16L1 A898G. Genotyping was performed with real-time PCR with Taqman probes.
RESULTS:Older patients responded better to 5-aminosalicylic acid (5-ASA) and to azathioprine (OR 1.07, p = 0.003 and OR 1.03, p = 0.01, respectively) while younger ones responded better to biologicals (OR 0.95, p = 0.06). Previous surgery negatively influenced...
Oliveira, AM; Anapaz, V; Lourenço, L; Rodrigues, C; Alberto, S; Martins, A; Deus, JR; Reis, J
Several studies have shown a proximal shift of colorectal cancer (CRC) during the last decades. However, few have analyzed the changing distribution of adenomas over time.
The aim of this study was to compare the site and the characteristics of colorectal adenomas, in a single center, during two periods.
We conducted a retrospective, observational study in a single hospital of adenomas removed during a total colonoscopy in two one-year periods: 2003 (period 1) and 2012 (period 2). Patients with inflammatory bowel disease, familial adenomatous polyposis, hereditary non-polyposis colorectal cancer syndrome, or history of CRC were excluded from the study. The χ(2) statistical...
Canena, J; Horta, D; Coimbra, J; Meireles, L; Russo, P; Marques, I, e outros
Biliary leaks have been treated with endoscopic management using different techniques with conflicting results. Furthermore the appropriate rescue therapy for refractory leaks has not been established. We evaluated the clinical effectiveness of initial endotherapy for postcholecystectomy biliary leaks using an homogenous approach (sphincterotomy + placement of a 10-French plastic stent) in a large series of patients as well as the optimal and efficacy of rescue endotherapy for refractory biliary leaks.
This was a multicenter, retrospective study of 178 patients who underwent endoscopic management of postcholecystectomy biliary leaks with a combination of biliary sphincterotomy and the placement of a large-bore (10-French) plastic stent. Data...
Fidalgo, P; Ahmed, M; Meyer, S; Lien, D; Weinkauf, J; Cardoso, F; Jackson, K; Bagshaw, S
BACKGROUND:Acute kidney injury (AKI) is a serious complication following lung transplantation (LTx). We aimed to describe the incidence and outcomes associated with AKI following LTx.
A retrospective population-based cohort study of all adult recipients of LTx at the University of Alberta between 1990 and 2011. The primary outcome was AKI, defined and classified according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria, in the first 7 post-operative days. Secondary outcomes included risk factors, utilization of renal replacement therapy (RRT), occurrence of post-operative complications, mortality and kidney recovery.
Of 445 LTx recipients included, AKI occurred in 306 (68.8%), with severity classified as...