Póvoa de Santa Iria, Portugal
Póvoa de Santa Iria, Portugal

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Silva F.C.D.,Centro Hospitalar Lisbon Central | Silva F.M.C.D.,Centro Hospitalar Lisbon Central | Goncalves F.,Klinika Lfuk | Santos A.,Hospital S Marcos | And 7 more authors.
European Urology | Year: 2014

Background Few randomised studies have compared antiandrogen intermittent hormonal therapy (IHT) with continuous maximal androgen blockade (MAB) therapy for advanced prostate cancer (PCa). Objective To determine whether overall survival (OS) on IHT (cyproterone acetate; CPA) is noninferior to OS on continuous MAB. Design, setting, and participants This phase 3 randomised trial compared IHT and continuous MAB in patients with locally advanced or metastatic PCa. Intervention During induction, patients received CPA 200 mg/d for 2 wk and then monthly depot injections of a luteinising hormone-releasing hormone (LHRH; triptoreline 11.25 mg) analogue plus CPA 200 mg/d. Patients whose prostate-specific antigen (PSA) was <4 ng/ml after 3 mo of induction treatment were randomised to the IHT arm (stopped treatment and restarted on CPA 300 mg/d monotherapy if PSA rose to ≥20 ng/ml or they were symptomatic) or the continuous arm (CPA 200 mg/d plus monthly LHRH analogue). Outcome measurements and statistical analysis Primary outcome measurement was OS. Secondary outcomes included cause-specific survival, time to subjective or objective progression, and quality of life. Time off therapy in the intermittent arm was recorded. Results and limitations We recruited 1045 patients, of which 918 responded to induction therapy and were randomised (462 to IHT and 456 to continuous MAB). OS was similar between groups (p = 0.25), and noninferiority of IHT was demonstrated (hazard ratio [HR]: 0.90; 95% confidence interval [CI], 0.76-1.07). There was a trend for an interaction between PSA and treatment (p = 0.05), favouring IHT over continuous therapy in patients with PSA ≤1 ng/ml (HR: 0.79; 95% CI, 0.61-1.02). Men treated with IHT reported better sexual function. Among the 462 patients on IHT, 50% and 28% of patients were off therapy for ≥2.5 yr or >5 yr, respectively, after randomisation. The main limitation is that the length of time for the trial to mature means that other therapies are now available. A second limitation is that T3 patients may now profit from watchful waiting instead of androgen-deprivation therapy. Conclusions Noninferiority of IHT in terms of survival and its association with better sexual activity than continuous therapy suggest that IHT should be considered for use in routine clinical practice. © 2013 European Association of Urology.

Vandewalle E.,University Hospitals Leuven | Pinto L.A.,University of Lisbon | Pinto L.A.,Centro Hospitalar Lisbon Central | Van Bergen T.,Catholic University of Leuven | And 7 more authors.
British Journal of Ophthalmology | Year: 2014

Aims: To investigate the efficacy and safety of a single intracameral bevacizumab injection to improve the outcome of trabeculectomy. Methods: A 12-month, prospective, randomised, double-masked, placebo-controlled trial. Patients with medically uncontrolled open-angle glaucoma scheduled for a primary trabeculectomy were recruited and randomised to receive 50 mL of either bevacizumab (1.25 mg) or placebo (balanced salt solution) peroperatively. Absolute success was defined as intraocular pressure (IOP) ≤18 mm Hg and >5 mm Hg with at least 30% reduction from baseline and no loss of light perception. Success through the use of additional medical and/or surgical IOP-lowering treatments was defined as qualified success. Results: 138 patients completed a 12-month follow-up, 69 of whom were in the bevacizumab treated group. IOP at 1 year postoperatively was significantly lower than baseline ( placebo: 25.6±9.9 mm Hg vs 11.5 ±3.9 mm Hg, p<0.01; bevacizumab: 24.8±8.1 mm Hg vs 11.9±3.8 mm Hg, p<0.01), with no difference between treatment groups ( p=0.69). However, absolute success was higher in the bevacizumab group (71% vs 51%, p=0.02), with the need for IOP-lowering interventions (needlings) being lower in this group (12% vs 33%, p=0.003). Complication rates were low and comparable between groups. Conclusions: Peroperative administration of intracameral bevacizumab significantly reduces the need for additional interventions during the follow-up of patients undergoing trabeculectomy.

Lopes R.,University of Coimbra | Simoes M.R.,University of Coimbra | Leal A.J.R.,Instituto Universitario Of Lisbon Iscte Iul | Leal A.J.R.,Centro Hospitalar Psiquiatrico Of Lisbon | Leal A.J.R.,Centro Hospitalar Lisbon Central
Epilepsy and Behavior | Year: 2014

Panayiotopoulos syndrome (PS) is a common epilepsy syndrome associated with rare clinical seizures and unknown localization of the epileptogenic area. Despite findings of normal development in patients with PS, recent neuropsychological studies point to subtle and diverse cognitive impairments. No well-outlined hypothesis about the localization of the brain dysfunction responsible for these impairments has been proposed. We further explored the cognitive dysfunctions in PS and made inferences on the most likely anatomical localization of brain impairment. A group of 19 patients (aged 6-12) with PS was rated according to spike activity and lateralization. The patients were submitted to a neuropsychological evaluation to assess general intelligence, memory, language, visual-perceptual abilities, attention, and executive functions. Using 35-channel scalp EEG recordings, the N170 face-evoked event-related potential (ERP) was obtained to assess the functional integrity of the ventral pathway. All patients with PS showed normal IQ but subtle and consistent neurocognitive impairments. Namely, we found abnormalities in the copy task of the Rey-Osterrieth Complex Figure and in the Narrative Memory Test. There was no correlation between neuropsychological impairments with spike activity and hemispheric spike lateralization. The N170 ERP was normal in all patients except for one. Our neuropsychological findings demonstrate impairments in visual-perceptual abilities and in semantic processing. These findings, paired with the absence of occipital lobe dysfunction in all neuropsychological studies of PS performed to this date, support the existence of parietal lobe dysfunction. © 2013 Elsevier Inc.

E Silva M.T.R.,Centro Hospitalar Lisbon Central
Arquivos de Medicina | Year: 2015

We present a case of a patient admited in an Internal Medicine ward with the main diagnosis of an acute bronchitis and heart failure. At the observation, the patient referred pain to the L1-L4 area, that wasn’t relieved by rest, a negative renal Murphy and a negative bilateral Lasègue. During the review of the lumbar radiographs, it was detected a sacular figure of calcified borders, before the L3-L4 vertebrae. By the concomitante presence of a pulsatile abdómen and a decrease of the peripheric pulse in the inferior members, the medical team ordered an AngioCT to despite a possible Abdominal aortic aneurysm(AAA). The exam confirmed a bulky AAA that impaired the arterial flux to the left renal artery. © 2015, ArquiMed. All rights reserved.

Figueiredo C.,Centro Hospitalar Lisbon Central | Candeias F.,Centro Hospitalar Lisbon Central | Brito M.J.,Centro Hospitalar Lisbon Central
Pediatric Infectious Disease Journal | Year: 2016

Acute Q fever can have multiple presentations but neurologic involvement is rare. We describe the case of a 16-year-old female with severe headache and aseptic meningitis with acute Coxiella burnetii infection. © 2015 Wolters Kluwer Health, Inc.

Torres R.,Centro Hospitalar Lisbon Central | Mendes N.,Centro Hospitalar Lisbon Central | Mendes N.,New University of Lisbon | Machado A.I.,Centro Hospitalar Lisbon Central | Marques C.,Centro Hospitalar Lisbon Central
Contraception | Year: 2013

Background: In situ breakage of Implanon® is a rare occurrence with unknown clinical significance. Authors report two different cases of broken Implanon® of women attended at our Family Planning Clinic. Discussion: In situ implants may spontaneously and asymptomatically break, although some uncertainty relies on whether that situation has a real impact on the contraceptive effectiveness or on bleeding patterns. Even more, it can be argued if, as a result of an occurrence of that nature, the implant shall or shall not be removed before the envisaged 3-year period of effectiveness. Conclusion: Currently, the clinical significance of implant breakage remains unknown. The decision to remove a broken or bent implant should be based on clinical judgements considering patients' wishes. © 2013 Elsevier Inc. All rights reserved.

Campos A.,Centro Hospitalar Lisbon Central | Campos A.,New University of Lisbon
Acta Medica Portuguesa | Year: 2015

Introduction: The role of acetyl salicylic acid (ASA or aspirin) in preeclampsia prevention and in other complications has been subject to studies and controversies for the last 30 years. The first research results concerning the role of placenta in preeclampsia have been published by the end of seventies and they showed an increase in the platelet activity and a prostaglandin synthesis disturbance, as a consequence of a deficient placentation. In the last twenty years of the XX century important studies were published on the aspirin prophylactic role in preeclampsia risk reduction. Material and Methods: To analyze published studies about Aspirin use for preeclampsia prevention and about the more adequate dosage to be administered, Medline was used for searching the most relevant prospective research papers on this subject in order to evaluate current evidence about the use of aspirin in this context. Relevant citations were extracted from Embase, PubMed and the Cochrane Central Register of Controlled Trials. We divided the studies in two groups; one with aspirine administration before 16 weeks and the other having a larger use, between the first and the third trimester. Results and Discussion: The first group of studies, with a lesser number of cases but an earlier time of administration until 16 weeks, concluded that a positive role of aspirine was possible in reducing severity of preeclampsia; the second group with a larger number of cases but less restricted conditions and timing of administration, had controversial results, with reduced positive actions of the drug. Meta-analysis of these published studies concluded that favorable results were associated to stricter criteria and ideal timing for starting the drug. Conclusion: As we do not have other pharmacologic alternatives, low dosage of Aspirin between 80-150 mg a day in the first trimester and until 16 weeks, at evening time, is a possible choice in cases of risk, and is still contributing for an early preeclampsia risk reduction. © Ordem dos Médicos 2015.

Leao R.N.,Centro Hospitalar Lisbon Central
BMJ case reports | Year: 2013

Urinary tract infections (UTIs) are a common pathological entity among elderly patients. The widespread use of antibiotics for uncomplicated UTIs has gained many opponents mainly due to the increasing drug resistance observed. Nitrofurantoin is a commonly used antibacterial drug because it has low side effects and a good antiurinary bacterial profile. However, in this paper, we present a case of a nitrofurantoin-induced DRESS (drug reaction/rash with eosinophilia and systemic symptoms) syndrome in a 77-year-old woman. During UTI treatment, the patient developed an acute skin rash which spread all over the body and a considerable decrease in urine volume. At the emergency department, we found her developing eosinophilic pneumonia, anaemia and renal impairment that we relate to nitrofurantoin administration. To our knowledge, this is the second published case report which evokes nitrofurantoin as a possible cause of DRESS syndrome.

Mazya M.V.,Karolinska University Hospital | Mazya M.V.,Karolinska Institutet | Ahmed N.,Karolinska University Hospital | Ahmed N.,Karolinska Institutet | And 6 more authors.
Stroke | Year: 2014

Background and Purpose: Intracerebral hemorrhage after treatment with intravenous recombinant tissue-type plasminogen activator for ischemic stroke can occur in local relation to the infarct, as well as in brain areas remote from infarcted tissue. We aimed to describe risk factors, 3-month mortality, and functional outcome in patients with the poorly understood complication of remote intracerebral hemorrhage, as well as local intracerebral hemorrhage. METHODS-: In this study, 43 494 patients treated with intravenous recombinant tissue-type plasminogen activator, with complete imaging data, were enrolled in the Safe Implementation of Treatments in Stroke-International Stroke Thrombolysis Register (SITS-ISTR) during 2002 to 2011. Baseline data were compared among 970 patients (2.2%) with remote parenchymal hemorrhage (PHr), 2325 (5.3%) with PH, 438 (1.0%) with both PH and PHr, and 39 761 (91.4%) without PH or PHr. Independent risk factors for all hemorrhage types were obtained by multivariate logistic regression. RESULTS-: Previous stroke (P=0.023) and higher age (P<0.001) were independently associated with PHr, but not with PH. Atrial fibrillation, computed tomographic hyperdense cerebral artery sign, and elevated blood glucose were associated with PH, but not with PHr. Female sex had a stronger association with PHr than with PH. Functional independence at 3 months was more common in PHr than in PH (34% versus 24%; P<0.001), whereas 3-month mortality was lower (34% versus 39%; P<0.001). CONCLUSIONS-: Differences between risk factor profiles indicate an influence of previous vascular pathology in PHr and acute large-vessel occlusion in PH. Additional research is needed on the effect of pre-existing cerebrovascular disease on complications of recanalization therapy in acute ischemic stroke. © 2014 American Heart Association, Inc.

Pereira O.,Centro Hospitalar Lisbon Central
BMJ case reports | Year: 2013

Acute oesophageal necrosis, also known as 'Black Oesophagus', is a rare endoscopic finding since its first description by Goldenberg in 1990. In endoscopic studies, the frequency ranged from 0.01% to 0.2%. The aetiology is undefined and is probably multifactorial. A 62-year-old woman, with chronic alcoholism, was admitted to the internal medicine department for dehydration and marked malnutrition problems. Melaena was detected, and oesophagogastroduodenoscopy showed black mucosa of the lower two-thirds of the oesophagus and candidiasis. The patient gradually recovered after conservative treatments (intravenous proton pump inhibitor and total parental nutrition) and fluconazole. Oesophagus stricture was developed after 1 month, and balloon dilatation was performed successfully.

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