Silva I.,Hospital Santo Antonio |
Almeida J.,Centro Hospitalar Of Vila Nova Of Gaia |
Vasconcelos C.,Hospital Santo Antonio |
Vasconcelos C.,University of Porto
Autoimmunity Reviews | Year: 2015
Vasculopathy has a major role in the pathogenesis and tissue injury in systemic sclerosis (SSc). Raynaud's phenomenon (RP) is frequently the first clinical manifestation of SSc preceding by years other clinical manifestations. RP in SSc patients is frequent, often very severe and long lasting. The repeated bouts of RP lead to prolonged digital ischemia that may progress to digital ulceration or in extreme to critical digital ischemia with gangrene. Digital ulcers (DU) are a true burden for all patients. They are very painful, with a long and slow healing course, have high risk of infection and are extremely disabling. In adults, up to 40-50% of patients will experience at least one DU in the course of the disease and of these 31-71% will have recurrent ulcers. In order to try to identify predictive risk factors for DU in SSc patients, an extensive literature review was conducted, according to the guidelines proposed at the PRISMA statement. MEDLINE database (PubMed) and Thomson Reuters Web of Knowledge platform were searched for articles published in peer-reviewed journals since 1990 with the last search run on June 2014 and published in English language. The keyword search terms included: digital ulcer/s, systemic sclerosis, scleroderma, digital scars, ischemic complications, autoantibodies, biomarkers, endothelium dysfunction, endothelin-1, vascular endothelial growth factor (VEGF), endostatin, ADMA, endoglin, angiostatin, and capillaroscopy. The following criteria were included: (1) cohorts of SSc patients including patients with DU, (2) endothelium dysfunction and angiogenesis biomarkers compared with a healthy control group, (3) autoantibodies, capillary morphology and distribution, endothelium dysfunction and angiogenesis biomarkers compared between patients with and without digital ulcers, (4) detailed description of the statistical methods used to conclude for predictive factors, and (5) English language. Our search provided a total of 376 citations. Of these, 297 studies were discarded for not meeting the criteria proposed. © 2014 Elsevier B.V.
Guedes R.,Centro Hospitalar Of Vila Nova Of Gaia |
Leite L.,Clinica Laser de Belem
Indian Journal of Dermatology | Year: 2012
Unilateral nevoid telangiectasia is a rare congenital or acquired disorder. The majority of the authors propose that it is probably related to elevated estrogen receptors, although other authors advocate different theories. We report the occurrence of lesions clinically compatible with this diagnosis in a child and two adults. Only one of the patients had a background of estrogen elevation. The other two patients were healthy. We stress the occurrence of this disease in a rare idiopathic form and point out to the relative elevated incidence of it, because the patients discussed in this article were observed for a short period of time.
Fontes-Carvalho R.,Servico de Fisiologia |
Fontes-Carvalho R.,Centro Hospitalar Of Vila Nova Of Gaia |
Leite-Moreira A.,Servico de Fisiologia |
Leite-Moreira A.,Hospital Of Sao Joao
Arquivos Brasileiros de Cardiologia | Year: 2011
Over the last decades, heart failure with preserved ejection fraction (HFpEF) has received less attention by the medical and scientific communities, which led to the emergence of a number of misconceptions concerning its characteristics, diagnostic and therapeutic approach. In recent years, new studies have changed the concepts traditionally associated with HFpEF, contributing to a new view towards this disease. This review is intended to discuss the latest evidence on HFpEF and to fight the main misconceptions associated with it in order to improve its diagnostic and therapeutic approach. Today we have several data showing that HFpEF is a condition that requires a different clinical approach from that used in systolic heart failure (SHF). HFpEF is no longer seen as a "benign" disease because it is associated with a poor prognosis and high prevalence. Its pathophysiology is complex and not fully clarified. In addition to diastolic dysfunction, we now know that other cardiac and extracardiac factors are also involved in its onset and progression. Using recent consensus guidelines we have objective criteria for its diagnosis, especially by using the new echocardiographic parameters for assessing diastolic function, including the E/e' ratio obtained by tissue Doppler. Finally, treatment of HFpEF remains unknown, because no therapeutic strategy has been shown to improve HFpEF prognosis. Thus, in this review we will also discuss the potentially new therapeutic targets for HFpEF.
Guedes R.,Centro Hospitalar Of Vila Nova Of Gaia |
Leite L.,Clinica Laser Belem
Dermatologic Therapy | Year: 2011
Pityriasis rubra pilaris (PRP) or Devergie's disease is a chronic and rare papulosquamous disorder of unknown etiology characterized by reddish orange scaly plaques, palmoplantar keratoderma, and keratotic follicular papules. The present authors report a case of a 30-year-old woman with clinical and histologic signs of PRP (type I adult onset, Griffith's classification). After a few unsuccessful treatments, the present authors chose to start etanercept. Total clearing of the lesions was achieved 5 months after starting the drug. Etanercept is a TNF-α inhibitor, and today it is largely used in the treatment of several dermatological diseases through blockage of the inflammatory cytokine. The true mechanism of action in PRP remains to be explained; however, the favorable results in our case raise new questions about TNF-α's role in PRP and suggest a therapeutic alternative for resistant cases to classic treatments. To date, there are only three case reports of PRP treated with etanercept in the literature. © 2011 Wiley Periodicals, Inc.
Santos I.,Centro Hospitalar Of Vila Nova Of Gaia |
Clissold S.,Content Ed Net
Gynecological Endocrinology | Year: 2010
Urogenital disorders associated with oestrogen deficiency affect many women throughout menopausal transition. Symptoms such as vaginal dryness, burning, pruritus, dyspareunia, urinary tract urgency/frequency and incontinence have a significant impact on the individual's quality of life. For younger and healthy menopausal women, systemic oestrogen replacement may improve both vasomotor and urogenital symptoms and will be the treatment of choice. However, a proportion of women on systemic therapy still experience symptoms associated with urogenital atrophy, and patients with oestrogen-dependent cancers may be at risk from systemic oestrogen replacement. For women with mainly urogenital symptoms, local oestrogen is a logical choice and it is often more effective than systemic hormone replacement therapy. Generally speaking, there are no contraindications to local therapy. In terms of which topical preparation to use, a wide range of products are available. Promestriene is an analogue of oestradiol which is minimally absorbed and it has been shown to be effective in reversing atrophic changes caused by oestrogen deficiency in women undergoing natural or surgically induced menopause. Given the absence of systemic activity, promestriene may be a good choice in women requiring purely locally oestrogen, and those who have survived, or who are at risk of breast cancer and who have severe vulvo-vaginal symptoms. © 2010 Informa UK Ltd.
Myocardial remote ischemic preconditioning: From pathophysiology to clinical application [Pré-condicionamento isquémico remoto do miocárdio: Dosmecanismos fisiopatológicos à aplicacão na prática clínica]
Costa J.F.,University of Porto |
Fontes-Carvalho R.,University of Porto |
Fontes-Carvalho R.,Centro Hospitalar Of Vila Nova Of Gaia |
Leite-Moreira A.F.,University of Porto |
Leite-Moreira A.F.,Centro Hospitalar Sao Joao
Revista Portuguesa de Cardiologia | Year: 2013
Short periods of myocardial ischemia followed by reperfusion induce a cardiopro-tective mechanism when the myocardium is subsequently subjected to a prolonged period ofischemia, a phenomenon known as ischemic preconditioning.As well as its application in the myocardium, ischemic preconditioning can also be inducedby brief interruptions of blood flow to other organs, particularly skeletal muscle. Transientischemia induced noninvasively by inflating a cuff on a limb, followed by reperfusion, helpsreduce the damage caused to the myocardium by interruption of the coronary circulation.Remote ischemic preconditioning involves activation of humoral and/or neural pathways thatopen mitochondrial ATP-sensitive potassium channels in the myocardium and close mitochon-drial permeability transition pores, making cardiomyocytes less vulnerable to ischemia-inducedcell death.This cardioprotective mechanism is now being translated into clinical practice, with positiveresults in several clinical trials in coronary artery bypass surgery, surgical repair of abdominalaortic aneurysms, valve replacement surgery and percutaneous coronary intervention. However,certain factors weaken the subcellular mechanisms of preconditioning - Age, comorbidities,medication, anesthetic protocol - And appear to explain the heterogeneity of results in somestudies.Detailed understanding of the pathways involved in cardioprotection induced by ischemic pre-conditioning is expected to lead to the development of new drugs to reduce the consequencesof prolonged ischemia. © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España, S.L. All rightsreserved.
Castro J.,Centro Hospitalar Of Vila Nova Of Gaia
BMJ case reports | Year: 2013
Arthrogryposis multiplex congenita refers to a clinical condition or syndrome characterised by multiple congenital contractures that affect two or more different areas of the body. Of the cases reported so far, an important percentage had to be terminated before pregnancy term, predominantly by caesarean section. We describe a 36 year-old woman who wanted to conceive. A multidisciplinary approach was set from the preconceptional period and special attention was given to respiratory function, potential anaesthetic difficulties and thromboembolic risks. She delivered by caesarean section at 38 weeks. This case emphasises the possibility of achieving a term delivery in these patients and points out the importance of a multidisciplinary team, specially of obstetricians and anaesthesiologists.
Bronchoscopic dilation techniques and topical application of mitomycin-C in the treatment of tracheal stenosis post intubation - Two case reports [Técnicas de dilatação broncoscópica e aplicação tópica de mitomicina C no tratamento da estenose traqueal pós-entubação - A propósito de dois casos clínicos]
Moura E Sa J.,Centro Hospitalar Of Vila Nova Of Gaia
Revista Portuguesa de Pneumologia | Year: 2010
Tracheal stenosis follows any injury to the airway mucosa, such as ischaemic, traumatic and other injuries. The treatment of tracheal stenosis remains a challenging problem despite all the advances in endoscopic and surgical techniques. Scar formation and reestenosis are the main causes of treatment failure. The authors present two cases of successful treatment of a tracheal stenosis after tracheal injury from prolonged oro-tracheal intubation / tracheostomy following dilatation with rigid broncoscope and laser therapy, associated with topical application of mitomycin C as an adjuvant treatment.
Xara S.,Centro Hospitalar Of Vila Nova Of Gaia |
Amaral T.F.,University of Porto |
Parente B.,Centro Hospitalar Of Vila Nova Of Gaia
Revista Portuguesa de Pneumologia | Year: 2011
Cancer is related to a deterioration of nutritional status and quality of life (QoL), but the extent of these conditions in patients with Non Small Cell Lung Cancer (NSCLC) has not been studied. The aim of the present study was to assess the association between QoL and undernutrition in NSCLC patients. Nutritional status was evaluated with Patient Generated - Subjective Global Assessment and QoL using the European Organization for Research and Treatment of Cancer Quality of Life - C30 and also with the specific module for lung cancer patients. A consecutive sample of fifty six patients diagnosed with NSCLC was evaluated. A high proportion of patients is undernourished (35.7%), 1.8% in early stages vs 33.9% in advanced stages of disease. Undernutrition is related to measured dimensions of QoL: lack of appetite (rho = 0.70), fatigue (rho = 0.54), nausea and vomiting (rho = 0.52) and constipation (rho = 0.56). Undernourished patients have worse global health status, physical, emotional, social and role functioning. Patients with NSCLC have high frequency of undernutrition in advanced stages of disease. Undernourished patients present more symptoms, a worse global health status/QoL, physical, role, emotional and social functioning than patients without undernutrition. Undernutrition is associated with worse QoL, specifically in the parameters: appetite loss, nausea and vomiting, constipation and fatigue. © 2011 Published by Elsevier España.
Guerra M.,Centro Hospitalar Of Vila Nova Of Gaia |
Mota J.C.,Centro Hospitalar Of Vila Nova Of Gaia
Interactive Cardiovascular and Thoracic Surgery | Year: 2012
Complete revascularization is considered superior to incomplete revascularization (IR), with better long-term survival and a lower rate of reintervention. However, it has yet to be established whether this difference is due directly to IR as a surgical strategy or whether this approach is merely a marker of more severe coronary disease and more rapid progression. We believe that IR is a prognostic marker for a more complex coronary pathology, and adverse effects are probably due to the preoperative condition of the patient. In fact, although IR may negatively affect long-term outcomes, it may be, when wisely chosen, the ideal treatment strategy in selected high-risk patients. IR can derive from a surgical strategy of target vessel revascularization, where the impact of surgery is minimized to reduce perioperative mortality and morbidity, aiming to achieve the best feasible safe revascularization. © The Author 2011.