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PubMed | Centro Hospitalar Gaia Espinho, UOSD Angiologia e Diagnostica Vascolare, Hospital Reina Sofia, Ramon y Cajal Hospital and IRYCIS and 5 more.
Type: Journal Article | Journal: Chest | Year: 2016

A comprehensive evaluation of temporal trends in the treatment of patients who have DVT may assist with identification of modifiable factors that contribute to short-term outcomes.We assessed temporal trends in length of hospital stay and use of pharmacological and interventional therapies among 26,695 adults with DVT enrolled in the Registro Informatizado de la Enfermedad TromboEmblica registry between 2001 and 2014. We also examined temporal trends in risk-adjusted rates of all-cause, pulmonary embolism-related, and bleeding-related death to 30days after diagnosis.The mean length of hospital stay decreased from 9.0days in 2001 to 2005 to 7.6days in 2010 to 2014 (P< .01). For initial DVT treatment, the use of low-molecular-weight heparin decreased from 98%to 90%(P< .01). Direct oral anticoagulants use increased from 0.5%in 2010 to 13.4%in 2014 (P< .001). Risk-adjusted rates of 30-day all-cause mortality decreased from 3.9%in 2001 to 2005 to 2.7%in 2010 to 2014 (adjusted rate ratio per year, 0.84; 95%CI, 0.74-0.96; P< .01). VTE-related mortality showed a nonstatistically significant downward trend (adjusted rate ratio per year, 0.70; 95%CI, 0.44-1.10; P= .13), whereas 30-day bleeding-related mortality significantly decreased from 0.5%in 2001 to 2005 to 0.1%in 2010-2014 (adjusted rate ratio per year, 0.55; 95%CI, 0.40-0.77; P<.01).This international registry-based temporal analysis identified reductions in length of stay for adults hospitalized for DVT. The study also found a decreasing trend in adjusted rates of all-cause and bleeding-related mortality.

PubMed | Centro Hospitalar Gaia Espinho, Sao Joao Hospital Center, Hospital Pulido Valente, New University of Lisbon and University of Coimbra
Type: Journal Article | Journal: Revista portuguesa de pneumologia | Year: 2016

There are currently no reliable instruments for assessing the onset and progression of chronic obstructive pulmonary disease (COPD) or predicting its prognosis. Currently, a comprehensive assessment of COPD including several objective and subjective parameters is recommended. However, the lack of biomarkers precludes a correct assessment of COPD severity, which consequently hampers adequate therapeutic approaches and COPD control. In the absence of a definition of well-controlled disease, a consensus regarding COPD control will be difficult to reach. However, COPD patient assessment should be multidimensional, and anchored in five points: control of symptoms, decline of pulmonary function, levels of physical activity, exacerbations, and Quality of Life. Several non-pharmacological and pharmacological measures are currently available to achieve disease control. Smoking cessation, vaccination, exercise training programs and pulmonary rehabilitation are recognized as important non-pharmacological measures but bronchodilators are the pivotal therapy in the control of COPD. This paper discusses several objective and subjective parameters that may bridge the gap between disease assessment and disease control. The authors conclude that, at present, it is not possible to reach a consensus regarding COPD control, essentially due to the lack of objective instruments to measure it. Some recommendations are set forth, but true COPD control awaits further objective assessments.

Duarte R.,Centro Hospitalar Gaia Espinho | Fernandez G.,Hospital POVISA | Castellon D.,Hospital POVISA | Costa J.C.,JCC Diagnostico por Imagem
Heart Lung and Circulation | Year: 2011

Objective: New technologies for computed tomography coronary arteries imaging aim to reduce the radiation dose whilst maintaining image quality. The purpose of our study was to compare radiation dose and image quality parameters of Coronary Computed Tomography Angiography (CCTA) performed with retrospective 64-MDCT and prospective 128-MDCT. Patients and Methods: A series of 77 consecutive patients were first randomised to either retrospective 64-MDCT (n = 37) or prospective 128-MDCT (n = 40) for CCTA. All patients in the retrospective 64-MDCT group were scanned with tube current modulation as strategy for reduction dose. Data regarding acquisition time and radiation dose were recorded. Two blinded radiologists independently assessed image quality of all coronary segments by using a four-point scale (1, excellent; 4, poor). Discrepancies were settled by consensus. Results: No significant differences were found regarding sex, age, body weight and heart rate. CTTA effective radiation dose was 2.1 ± 0.9 vs. 8.2 ± 4. mSv in prospective and retrospective ECG-gating MDCT groups, respectively. Mean image quality score was 2.2 ± 0.9 for prospective 128-MDCT group and 1.4 ± 0.7 points for retrospective 64-MDCT representing a mean difference of 0.8 points (CI: 0.9 to 0.7). Conclusion: In selected patients, CCTA using a 128-MDCT with prospective ECG-gating provides higher image quality with significant lower radiation dose when compared to 64-MDCT using retrospective ECG-gating. © 2010 Australasian Society of Cardiac and Thoracic Surgeons and the Cardiac Society of Australia and New Zealand.

Torres T.,Centro Hospitalar Do Porto | Torres T.,Abel Salazar Biomedical Sciences Institute | Bettencourt N.,Centro Hospitalar Gaia Espinho | Mendonca D.,University of Porto | And 6 more authors.
Journal of the European Academy of Dermatology and Venereology | Year: 2015

Background: Psoriasis is a chronic, immune-mediated disease associated with several cardio-metabolic comorbidities, accelerated atherosclerosis and cardiovascular disease (CVD). Other causes beyond systemic inflammation and traditional cardiovascular risk factors (CVRF) may be implicated in the increased risk of CVD observed in these patients. Epicardial adipose tissue (EAT), a type of visceral adipose tissue surrounding the heart and coronary vessels has been implicated in the development of coronary artery disease, by endocrine mechanisms, but particularly by local inflammation. Objective: To compare EAT volumes in psoriasis patients and controls using multidetector computed tomography (MDCT) and to analyse if eventual differences were independent from abdominal visceral adiposity; to determine, within psoriasis patients, its relation with subclinical atherosclerosis and other markers of cardiometabolic risk. Methods: One hundred patients with severe psoriasis, without CVD underwent MDCT, with EAT and abdominal visceral fat (AVF) assessment and coronary artery calcification (CAC) quantification and were compared with 202 control patients. Results: EAT volume was increased in psoriasis patients compared to control subjects, independently from age, sex and AVF, being, on average, 15.2 ± 4.41 mL higher (95% CI: 6.5-26.0, P = 0.001) than in controls. Moreover, psoriasis patients had a statistically significant higher risk of having subclinical atherosclerosis (OR 2.52, 95% CI: 1.23-5.16) than controls, after adjusting for traditional CVRF. Within psoriasis patients EAT volume was associated with subclinical atherosclerosis, independently of age, sex, psoriasis duration, classical CVRF and AVF. Conclusion: This study showed that psoriasis was associated with increased EAT volume independently of visceral abdominal fat and with subclinical atherosclerosis. Within psoriasis patients EAT volume was independently associated with CAC. EAT may be another important contributor to the higher cardiovascular risk observed in psoriasis. © 2014 European Academy of Dermatology and Venereology.

Graca S.,Centro Hospitalar Gaia Espinho
BMJ case reports | Year: 2012

Neuroendocrine breast cancer is thought to account for about 1% of all breast cancers. This rare type of breast malignancy is more common in older women and presents as a low-grade, slow-growing cancer. The most definitive markers that indicate neuroendocrine carcinoma are the presence of chromogranin, synaptophysin or neuron-specific enolase, in at least 50% of malignant tumour cells. The authors present a case report of an 83-year-old woman, admitted to their institution with right breast lump. Physical examination, mammography and ultrasonography showed a 2.4 cm nodule, probably a benign lesion (BI-RADS 3). A fine needle aspiration biopsy was performed and revealed proliferative epithelial papillary lesion. She was submitted to excisional biopsy and histology showed endocrine breast cancer well differentiated (G1). Immunohistochemically, tumour cells were positive for synaptophysin. These breast cancers are characterised for their excellent prognosis and conservative treatment is almost always enough to obtain patient cure.

Costa S.,Centro Hospitalar Gaia Espinho
BMJ case reports | Year: 2012

Angiosarcomas are rare malignant tumours that arise from endothelial cells lining vascular channels, representing 0.04% of malignant neoplasms of the breast. Breast angiosarcomas (BAs) were first described by Schmidt in 1887, and may be primary or secondary to the pre-existing conditions. Primary BAs are more common in young women and present as a palpable mass. Secondary BAs arise in older patients, frequently 5-6 years after radiotherapy, and present as a rash.The authors describe the case of an 83-year-old woman with no history of thoracic radiotherapy or surgery. She had been observed for a breast nodule where biopsy revealed phyllodes tumour. The patient refused surgery and returned 2 years later because of an impressive increase in tumour volume and skin ulceration. She underwent mastectomy with local skin flaps. Histopathological result revealed high-grade angiosarcoma of 15×12 cm. There was follow-up without evidence of recurrence, after radiotherapy.

Costa S.,Centro Hospitalar Gaia Espinho
BMJ case reports | Year: 2012

Angiomyolipomas are rare mesenchymal tumours consisting of smooth muscle, blood vessels and adipocytes in variable proportions. These tumours are more usually seen in kidneys (incidence 0.3-3%), and the extrarenal location is rare. Since its initial description by Ishak in 1976, only about 200 cases of hepatic angiomyolipomas have been reported. We describe the case of a 59-year-old woman, without tuberous sclerosis, with a 6 cm tumour in hepatic segments II and III, gallbladder with parietal calcification and lithiasis. She was proposed to bisegmentectomy (II and III) and cholecystectomy, which were performed without complications. The pathological examination confirmed the diagnosis of hepatic angiomyolipoma (positive for HMB45 and focally positive for HHF35) and chronic cholecystitis. Although typically benign, the emergence of cases with malignant behaviour--recurrence or distant metastasis--led to a change in attitude towards these lesions, from clinical surveillance to surgical excision, with few exceptions.

Costa S.,Centro Hospitalar Gaia Espinho
BMJ case reports | Year: 2013

Visceral artery aneurysms (VAAs), unlike aortic aneurysms, are very rare, but are also a potentially lethal vascular disease. Jejunal artery aneurysms only account for less than 3% of VAAs, but have a 30% risk of rupture, with 20% death rate, presenting with only few and vague symptoms. We report the case of a 76-year-old man presenting at the emergency department (ED) with a crampy epigastric pain and vomiting. An ultrasound performed diagnosed free abdominal fluid and immediate CT scan diagnosed jejunal artery aneurysm spontaneously rupturing, followed by hypovolaemic shock. Emergent surgery was undertaken, and aneurysmectomy, followed by partial enterectomy with primary anastomosis were performed, because of segmentary jejunal ischaemia. The patient's recovery was unremarkable. High level of suspicion, rapid diagnosis capability and prompt surgical or endovascular intervention, as well as an effective teamwork in the ED are critical to avoid the devastating consequences of ruptured VAAs.

Graca S.A.,Centro Hospitalar Gaia Espinho
BMJ case reports | Year: 2011

Morbid obesity is a huge problem of the twenty-first century, mostly treated by bariatric surgery. The authors report the case of a patient with port site metastases from an unknown rectal adenocarcinoma when bariatric surgery took place. Implants in the site of the subcutaneous access port to the band are problematic, particularly in patients with occult intra-abdominal malignancy. This case underlines the importance of preventive measures to avoid cell implant in port sites in benign such as malignant diseases.

Duarte R.,Hospital Particular Of Viana Do Castelo | Duarte R.,Centro Hospitalar Gaia Espinho | Costa J.C.,Hospital Particular Of Viana Do Castelo
Radiologia | Year: 2012

Purpose: The aim of our study was to directly evaluate the effectiveness of percutaneous laser disc decompression (PLDD) for treatment of lumbar discogenic radicular pain. Materials and methods: From June 2006 through July 2009, 205 patients with contained disc herniation demonstrated on computed tomography (CT) or magnetic resonance, concordance between the radicular pain and the nerve root compressed by the herniated disc, neurological findings referring to a single nerve root and no improvement after conservative therapy for a minimum of six weeks were enrolled. All patients were treated with PLDD under CT guidance and local anaesthesia. Follow-up was scheduled at 1, 2 days, 3, 6 months. Subsequent follow-ups at 12, 24 and 36 months were carried out through visits or by telephone. Clinical outcome was quantified using the MacNab criteria. Results: The age of patients ranged from 27 to 78 years (mean 58 ± 11 years). The levels of involvement were 18 cases at L3-L4, 123 cases at L4-L5 and 64 cases at L5-S1. Using the MacNab criteria, the results were as follows: 67% (n = 137) showed a good outcome and 9% (n = 18) a fair outcome. There were no serious complications in our series. Conclusion: PLDD is effective treatment for lumbar discogenic radicular pain, associated with only minimal discomfort to the patient. This minimally invasive technique is a valid alternative for those patients not responding to conservative medical treatment, allowing in many cases to obviate the need of spine surgery. © 2010 SERAM. Publicado por Elsevier Espańaa, S.L. Todos los derechos reservados.

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