Vila Nova de Gaia, Portugal
Vila Nova de Gaia, Portugal

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Schuster A.,St Thomas Hospital | Paul M.,St Thomas Hospital | Bettencourt N.,St Thomas Hospital | Bettencourt N.,Centro Hospitalar Of Gaia Espinho | And 10 more authors.
International Journal of Cardiology | Year: 2013

Background: Low dose dobutamine stress magnetic resonance imaging is valuable to assess viability in patients with ischemic cardiomyopathy. Analysis is usually qualitative with considerable operator dependency. The aim of the current study was to investigate the feasibility of cine images derived quantitative cardiac magnetic resonance (CMR) myocardial feature tracking (FT) strain parameters to assess viability in patients with ischemic cardiomyopathy. Methods: 15 consecutive patients with ischemic cardiomyopathy referred for viability assessment were studied at 3 T at rest and during low dose dobutamine stress (5 and 10 μg/kg/min of dobutamine). Subendocardial and subepicardial circumferential (Eccendo and Eccepi) and radial (Err) strains were assessed using steady state free precession (SSFP) cine images orientated in 3 short axis slices covering 16 myocardial segments. Results: Dysfunctional segments without scar (n = 75) improved in all three strain parameters: Eccendo (Rest: - 10.5 ± 6.9; 5 μg: - 12.1 ± 6.9; 10 μg: - 14.1 ± 9.2; p < 0.05), Eccepi (Rest: - 7 ± 4.8; 5 μg: - 8.2 ± 5.5; 10 μg: - 9.1 ± 5.9; p < 0.05) and Err (Rest: 11.7 ± 8.3; 5 μg: 16 ± 10.9; 10 μg: 16.5 ± 12.8; p < 0.05). There was no response to dobutamine in dysfunctional segments with scar transmurality above 75% (n = 6): Ecc endo (Rest: - 4.7 ± 3.0; 5 μg: - 2.9 ± 2.5; 10 μg: - 6.6 ± 3.3; p = ns), Eccepi (Rest: - 2.9 ± 2.9; 5 μg: - 5.4 ± 3.9; 10 μg: - 4.5 ± 4.2; p = ns) and Err (Rest:9.5 ± 5; 5 μg:5.4 ± 6.2; 10 μg:4.9 ± 3.3; p = ns). Circumferential strain (Eccendo, Eccepi) improved in all segments up to a transmurality of 75% (n = 60; p < 0.05). Err improved in segments < 50% transmurality (n = 45; p < 0.05) and remained unchanged above 50% transmurality (n = 21; p = ns). Conclusions: CMR-FT is a novel technique, which detects quantitative wall motion derived from SSFP cine imaging at rest and with low dose dobutamine stress. CMR-FT holds promise of quantitative assessment of viability in patients with ischemic cardiomyopathy. © 2011 Elsevier Ireland Ltd.


PubMed | University of Coimbra, Centro Hospitalar do Alto Ave, Centro Hospitalar Of Gaia Espinho, University of Minho and 5 more.
Type: Journal Article | Journal: United European gastroenterology journal | Year: 2016

Device-assisted enteroscopies (DAEs) are recent endoscopic techniques that enable direct endoscopic small-bowel evaluation.The objective of this article is to evaluate the implementation of DAEs in Portugal and assess the main indications, diagnoses, diagnostic yield, therapeutic yield and complication rate.We conducted a multicenter retrospective series using a national Web-based survey on behalf of the Portuguese Small-Bowel Study Group. Participants were asked to fill out two online databases regarding procedural data, indications, diagnoses, endoscopic therapy and complications using prospectively collected institutional data records.A total of eight centers were enrolled in the survey, corresponding to 1411 DAEs. The most frequent indications were obscure gastrointestinal bleeding (OGIB), inflammatory bowel disease and small-bowel tumors. The pooled diagnostic yield was 63%. A relation between the diagnostic yield and the indications was clear, with a diagnostic yield for OGIB of 69% (p=0.02) with a 52% therapeutic yield. Complications occurred in 1.2%, with a major complication rate of 0.57%. Perforations occurred in four patients (0.28%).DAEs are safe and effective procedures, with complication rates of 1.2%, the most serious of which is perforation. Most procedures are performed in the setting of OGIB. Diagnostic and therapeutic yields are dependent on the indication, hence appropriate patient selection is crucial.


Duarte R.,Centro Hospitalar Of Gaia Espinho | Bettencourt N.,Centro Hospitalar Of Gaia Espinho | Costa J.C.,Joao Carlos Costa Diagnostico Por Imagem | Fernandez G.,Hospital POVISA
Revista Portuguesa de Cardiologia | Year: 2010

Introduction: The aim of this study was to evaluate the radiation dose, image quality and acquisition time of coronary computed tomography angiography (CCTA) using a 128-slice dual source scanner with prospective ECG-triggered high-pitch spiral acquisition (Flash Spiral). Methods: A series of 20 consecutive patients in sinus rhythm, with no contraindications to administration of iodinated contrast media and beta-blockers and no history of coronary revascularization, underwent CCTA either to rule out coronary artery disease (CAD) or to evaluate known or suspected CAD. Image quality was evaluated using a four-point scale (1 excellent, 4 poor). Data on acquisition time and radiation dose were recorded. Results: Mean acquisition time was 292±21 milliseconds. The mean effective radiation dose was 0.99 mSv±0.34 mSv. All of the 266 coronary artery segments analyzed were of diagnostic image quality. Conclusion: CCTA using a 128-slice dual source scanner with prospective ECG-triggered high-pitch spiral acquisition provides single cardiac cycle acquisition with high image quality at mean effective radiation doses of approximately 1 mSv.


PubMed | Centro Hospitalar Vila Nova Gaia, Centro Hospitalar Vila Nova Of Gaia Espinho and Centro Hospitalar Of Gaia Espinho
Type: | Journal: Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva | Year: 2017

Small bowel submucosal lesions (SBSL) and innocent bulges may have an identical appearance and be difficult to distinguish on small bowel capsule endoscopy (SBCE). Recently, Pirelli et al. proposed a score, smooth, protruding lesion index on capsule endoscopy (SPICE), in order to differentiate between the two. We aimed to evaluate and validate SPICE as a differentiation method between innocent bulges and SBSLs.We evaluated all SBCEs performed in our department between January 2005 and September 2015, and selected the ones with a smooth, round, protruding lesion in the small bowel. Lesions with suspicious characteristics were excluded. A video clip of the region of interest was created and SPICE was assigned blindly and independently by two endoscopists. We determined the discriminative ability of SPICE using the definitive diagnosis of each patient as the standard criteria.We included 30 SBCEs corresponding to 12 SBSLs (four gastrointestinal stromal tumors, two neuroendocrine tumors, four lipomas and two polypoid lymphangiectasias) and 18 innocent bulges. SPICE scores ranged from 0 to 4, allowing the distinction between SBSLs and innocent bulges (p < 0.001). SPICE > 2 had a 66.7% sensitivity, 100.0% specificity, 100.0% positive predictive value and 78.3% negative predictive value, and the area under the curve was 0.88 (95% CI, 0.73-1.00; p < 0.001) for the diagnosis of SBSL.Our data support SPICE, namely a score > 2, as a predictive method of SBSLs. Taking into account its simplicity, it may be very useful in the distinction between SBSLs and innocent bulges on SBCE.


Noronha-Matos J.B.,Abel Salazar Biomedical Sciences Institute | Costa M.A.,Abel Salazar Biomedical Sciences Institute | Magalhaes-Cardoso M.T.,Abel Salazar Biomedical Sciences Institute | Ferreirinha F.,Abel Salazar Biomedical Sciences Institute | And 7 more authors.
Journal of Cellular Physiology | Year: 2012

This study aimed at investigating the expression and function of uracil nucleotide-sensitive receptors (P2Y 2, P2Y 4, and P2Y 6) on osteogenic differentiation of human bone marrow stromal cells (BMSCs) in culture. Bone marrow specimens were obtained from postmenopausal female patients (68±5 years old, n=18) undergoing total hip arthroplasty. UTP and UDP (100μM) facilitated osteogenic differentiation of the cells measured as increases in alkaline phosphatase (ALP) activity, without affecting cell proliferation. Uracil nucleotides concentration-dependently increased [Ca 2+] i in BMSCs; their effects became less evident with time (7>21 days) of the cells in culture. Selective activation of P2Y 6 receptors with the stable UDP analog, PSB 0474, mimicked the effects of both UTP and UDP, whereas UTPγS was devoid of effect. Selective blockade of P2Y 6 receptors with MRS 2578 prevented [Ca 2+] i rises and osteogenic differentiation caused by UDP at all culture time points. BMSCs are immunoreactive against P2Y 2, P2Y 4, and P2Y 6 receptors. While the expression of P2Y 6 receptors remained fairly constant (7∼21 days), P2Y 2 and P2Y 4 became evident only in less proliferative and more differentiated cultures (7<21 days). The rate of extracellular UTP and UDP inactivation was higher in less proliferative and more differentiated cell populations. Immunoreactivity against NTPDase1, -2, and -3 rises as cells differentiate (7<21 days). Data show that uracil nucleotides are important regulators of osteogenic cells differentiation predominantly through the activation of UDP-sensitive P2Y 6 receptors coupled to increases in [Ca 2+] i. Endogenous actions of uracil nucleotides may be balanced through specific NTPDases determining whether osteoblast progenitors are driven into proliferation or differentiation. © 2011 Wiley Periodicals, Inc.


Ribeiro F.,University of Porto | Ribeiro F.,Polytechnic Health Institute of the North | Alves A.J.,University of Porto | Teixeira M.,Centro Hospitalar Of Gaia Espinho | And 4 more authors.
International Journal of Sports Medicine | Year: 2012

The present study assessed the effects of exercise training on biomarkers of inflammation in postinfarction patients. This single-centre prospective randomized controlled trial encompassed 42 patients after the first myocardial infarction divided into exercise-training (n=22) or usual care (n=20) groups. Complete randomization was performed by choosing one of 2 sealed envelopes. The exercise-training group participated in an 8-week programme comprising 3 aerobic exercise sessions per week. The control group received usual care. The main measures were changes in circulating levels of C-reactive protein, interleukin (IL)-6 and -10, soluble vascular cell adhesion molecule-1 (VCAM-1), soluble intercellular adhesion molecule-1 (ICAM-1), anthropometrics, dietary intake, daily physical activity, and cardiorespiratory fitness. 4 patients terminated the study prematurely, leaving 38 for the statistical analysis (exercise-training, n=20; control group, n=18). In comparison to control group, exercise-training group improved IL-10 levels [1.7(7.0) vs. 0.3(2.4) pg/mL, P<0.05], daily moderate-intensity physical activity (12.921.3 vs. 0.713.4min, P<0.05), and cardiorespiratory fitness (3.03.5 vs. 0.34.1ml/min/kg, P<0.05). Additionally, the change in VCAM-1 and ICAM-1 levels was significantly higher in the control group (respectively, 26.6112.1 vs. 94.190.0ng/mL and 7.341.0 vs. 35.039ng/mL, P<0.05). In conclusion, exercise training improved the inflammatory profile in post myocardial infarction patients by enhancing the anti-inflammatory cytokine IL-10. © Georg Thieme Verlag KG Stuttgart - New York.


Sampaio F.,Centro Hospitalar Of Gaia Espinho | Pimenta J.,Centro Hospitalar Of Gaia Espinho | Pimenta J.,University of Porto
World Journal of Gastroenterology | Year: 2016

Cirrhotic cardiomyopathy has been defined as a chronic cardiac dysfunction in patients with cirrhosis characterized by impaired contractile responsiveness to stress and/or altered diastolic relaxation with electrophysiological abnormalities in the absence of other known cardiac disease. Non-invasive cardiovascular imaging modalities play a major role in unmasking systolic and diastolic dysfunction in patients with cirrhosis. Echocardiography has been the most commonly used modality for assessing myocardial function in these patients. Conventional echocardiographic indices rely on several assumptions that may limit their applicability in patients with a hyperdynamic circulation. Newer imaging modalities may contribute to a more accurate diagnosis of cardiovascular abnormalities in cirrhotic patients, thereby influencing clinical management. We aimed to review the different non-invasive imaging technologies currently used for assessing left ventricular systolic and diastolic function in cirrhosis, as well as to describe new imaging modalities with potential clinical applicability in the near future. © The Author(s) 2016.


Gomes J.,Centro Hospitalar Of Gaia Espinho | Antunes A.,Centro Hospitalar Of Gaia Espinho | Carvalho A.,Centro Hospitalar Of Gaia Espinho | Duarte R.,Centro Hospitalar Of Gaia Espinho
Journal of Medical Case Reports | Year: 2011

Introduction. Esophageal involvement by Mycobacterium tuberculosis is rare and the diagnosis is frequently made by means of an esophageal biopsy during the evaluation of dysphagia. There are few cases reported in the literature. Case presentation. We present two cases of esophageal tuberculosis in 85- and 65-year-old male Caucasian patients with initial complaints of dysphagia and epigastric pain. Upper gastrointestinal endoscopy resulted in the diagnosis of esophageal tuberculosis following the biopsy of lesions of irregular mucosa in one case and a sessile polyp in the other. Pulmonary tuberculosis was detected in one patient. In one patient esophageal stricture developed as a complication. Antituberculous therapy was curative in both patients. Conclusion: Although rare, esophageal tuberculosis has to be kept in mind in the differential diagnosis of dysphagia. Pulmonary involvement has important implications for contact screening. © 2011 Gomes et al; licensee BioMed Central Ltd.


Sampaio F.,Centro Hospitalar Of Gaia Espinho | Sampaio F.,University of Porto | Pimenta J.,University of Porto | Bettencourt N.,Centro Hospitalar Of Gaia Espinho | And 8 more authors.
Liver International | Year: 2013

Background & Aims: Cardiac dysfunction has been described in patients with cirrhosis. Conventional echocardiographic methods are frequently unable to detect abnormalities at rest and have limitations. We aimed to evaluate cardiac function in cirrhosis patients assessing: (i) left ventricular systolic function using speckle-tracking imaging; (ii) diastolic function using a tissue-Doppler based algorithm and comparing it with previously proposed definition of diastolic dysfunction (DD). Methods: We included 109 hospitalized and ambulatory patients with cirrhosis and 18 healthy controls. Detailed echocardiographic evaluation was performed including tissue-Doppler and speckle-tracking analysis. Results: Peak systolic longitudinal strain (PLS) was lower in patients [-19.99% (-21.88 to -18.71) vs -22.02% (-23.10 to -21.18), P = 0.003]. Ejection fraction was similar in patients and controls [64% (59-67) vs 61% (60-65), P = 0.42)]. Based on mitral-flow pattern, DD was present in 44 patients (40.4%). Patients without DD had higher cardiac output compared with those with DD [6.4 L/min (5.4-7.2) vs 5.6 L/min (4.6-6.8), P = 0.02]. Using a tissue-Doppler based definition, the prevalence of DD was 16.5%. No differences in haemodynamic variables were found in patients with and without this definition of DD. The agreement between the two definitions of DD was weak (kappa = 0.24, P = 0.003). Echocardiographic abnormalities in systolic and diastolic function were not different in compensated vs decompensated patients in different Child-Pugh classes or cirrhosis aetiologies. Conclusions: Patients with cirrhosis have systolic and diastolic cardiac dysfunction at rest. Newer echocardiographic techniques may identify patients with functional impairment more accurately than conventional methods, which are more influenced by flow conditions. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.


PubMed | Centro Hospitalar Of Gaia Espinho
Type: Journal Article | Journal: World journal of gastroenterology | Year: 2016

Cirrhotic cardiomyopathy has been defined as a chronic cardiac dysfunction in patients with cirrhosis characterized by impaired contractile responsiveness to stress and/or altered diastolic relaxation with electrophysiological abnormalities in the absence of other known cardiac disease. Non-invasive cardiovascular imaging modalities play a major role in unmasking systolic and diastolic dysfunction in patients with cirrhosis. Echocardiography has been the most commonly used modality for assessing myocardial function in these patients. Conventional echocardiographic indices rely on several assumptions that may limit their applicability in patients with a hyperdynamic circulation. Newer imaging modalities may contribute to a more accurate diagnosis of cardiovascular abnormalities in cirrhotic patients, thereby influencing clinical management. We aimed to review the different non-invasive imaging technologies currently used for assessing left ventricular systolic and diastolic function in cirrhosis, as well as to describe new imaging modalities with potential clinical applicability in the near future.

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