Vila Nova de Gaia, Portugal
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Bettencourt N.,Centro Hospitalar Vila Nova Of Gaia Espinho | Nagel E.,King's College London
Current Cardiovascular Imaging Reports | Year: 2013

Multidetector computed tomography (MDCT) and cardiac magnetic resonance (CMR) are advanced, state-of-the-art imaging tools for detection of coronary artery disease (CAD), providing important complementary information in patients with suspected or established disease. While MDCT coronary angiography is an anatomical method and seems to be especially prepared for CAD detection, even in subclinical phases, CMR allows evaluation of ischemia and myocardial scar and is particularly efficient in the assessment of the functional significance of CAD and in guiding management. Over the last years, research focused on the development of anatomical and functional integrated techniques using both methods. While CMR coronary angiography is slowly but steadily developing, MDCT myocardial perfusion and MDCT virtual fractional flow reserve estimation are promising tools that may change the way noninvasive assessment of CAD is made in the near future. This review article focuses on CMR and MDCT ability for assessing CAD significance, taking into account the relevant research published in recent years. © 2013 Springer Science+Business Media New York.


Torres T.,Centro Hospitalar Do Porto | Torres T.,Abel Salazar Biomedical Sciences Institute | Bettencourt N.,Centro Hospitalar Vila Nova Of Gaia Espinho
Revista Portuguesa de Cardiologia | Year: 2014

Psoriasis is a common chronic inflammatory disease associated with serious comorbidities. In recent years, increased mortality due to cardiovascular disease (myocardial infarction and stroke) has been documented in patients with severe psoriasis. Patients with psoriasis have a higher prevalence of traditional cardiovascular risk factors such as diabetes, hypertension, dyslipidemia and obesity, but it has been suggested that the chronic inflammatory nature of psoriasis is also a contributing and potentially an independent risk factor for the development of cardiovascular disease. The authors highlight the need for early identification and treatment of psoriasis-related comorbidities and cardiovascular disease, as well as effective treatment of psoriasis, in order to reduce the underlying systemic inflammation, and also the importance of a multidisciplinary approach of severe psoriasis patients to optimize the diagnosis, monitoring and treatment of various comorbidities, so as to prevent cardiovascular events. © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España, S.L. All rights reserved.


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.


Morais N.,Hospital Of Braga | Mascarenhas L.,Centro Hospitalar Vila Nova Of Gaia Espinho | Soares-Fernandes J.P.,Hospital Of Braga | Silva A.,Hospital Of Braga | And 2 more authors.
Oncology Letters | Year: 2013

Primary spinal glioblastoma (GBM) is a rare disease, with an aggressive course and a poor prognosis. We report a case of a 19-year-old male with a 4-week history of progressive weakness in both lower limbs, which progressed to paraparesis with a left predominance and difficulty in initiating urination over a week. Spine magnetic resonance imaging (MRI) showed an intramedullary expansile mass localised between T6 and T11. We performed a laminotomy and laminoplasty between T6 and T11 and the tumour was partially removed. Histopathological study was compatible with GBM. The patient was administered focal spine radiotherapy with chemotherapy with temozolamide. Serial MRI performed after the initial surgery demonstrated enlargement of the enhancing mass from T3 to T12 and subarachnoid metastatic deposits in C2 and C4, the pituitary stalk, interpeduncular cistern, left superior cerebellar peduncle and hydrocephalus. We review the literature with regard to the disease and treatment options, and report the unique features of this case. Primary spinal GBM is an extremely rare entity with a poor prognosis and a short survival time. An aggressive management of the different complications as they arise and improvement of current modes of treatment and new treatment options are required to improve survival and ensure better quality of life. © 2013 Spandidos Publications Ltd.


Rocha V.,Centro HospitalarTamega e Sousa | Rocha D.,Centro Hospitalar Vila Nova Of Gaia Espinho | Santos H.,Centro Hospitalar Vila Nova Of Gaia Espinho | Marques J.S.,Centro Hospitalar Vila Nova Of Gaia Espinho
Journal of Pediatric Endocrinology and Metabolism | Year: 2015

Introduction: Mitochondrial respiratory chain (MRC) disorders, defined as primary diseases of the oxidative phosphorylation system, are a protean group of metabolic disorders, difficult to diagnose and classify. The diagnosis is complex and requires the integration of information obtained by clinical, laboratory testing, imaging and muscle biopsy. They may be associated with endocrine disorders, including hypothyroidism, diabetes mellitus, hyperinsulinemia and growth hormone (GH) deficiency. Case report: We describe a case of five years old male with polymalformative syndrome with a systemic involvement. At 6 months of age, he was sent to metabolic consultation because of facial dysmorphy and short stature. During the investigation it was diagnosed at the boy a growth hormone deficiency and because of his multisystemic involvement, muscle biopsy was carried out and showed reduced activity of complex II (38%) of the mitochondrial respiratory chain. Currently, the boy is under GH therapy with growth in the 5th percentile and coenzime Q10. Discussion: Mitochondrial biology is one of the fastest growing areas in genetics and medicine. Disturbances in mitochondrial metabolism are now known to play a role not only in rare childhood diseases, but also in many common diseases of aging. In mitochondrial disorders, short stature is a common symptom, but its underlying lesion, growth hormone deficiency, is rarely investigated. © 2015 by De Gruyter.


Costa V.,Centro Hospitalar do Alto Ave | Carrico A.,Centro Hospitalar Vila Nova Of Gaia Espinho | Valente F.,Centro Hospitalar Vila Nova Of Gaia Espinho
Progresos de Obstetricia y Ginecologia | Year: 2013

Intrauterine constriction of ductus arteriosus is a rare event which often results in severe fetal/neonatal morbidity and mortality. Fetal ductus constriction is usually associated with maternal exposure to non-steroidal anti-inflammatory drugs or structural cardiac lesions. The prognosis depends on the degree and interval of ductal flow obstruction. Detailed history taking is generally required to identify the cause of this diagnosis.We report two cases of fetuses with ductus arterious constriction diagnosed by routine echocardiography in the third- trimester. The cause of the ductus arterious constriction was identified as excess consumption of black and herbal tea. Around 2 weeks after stopping consumption of these substances, ductal constriction was reversed and hemodynamic values returned to normal. Pregnant women and clinicians should be sensitized to the effects of excess consumptions of foods with high concentrations of polyphenol. © 2012 SEGO.


Barros P.,Centro Hospitalar Vila Nova Of Gaia Espinho | Morais H.,Centro Hospitalar Vila Nova Of Gaia Espinho | Santos C.,Centro Hospitalar Of Entre O Douro E Vouga | Roriz J.,Centro Hospitalar Of Entre O Douro E Vouga | Coutinho P.,Centro Hospitalar Of Entre O Douro E Vouga
Arquivos de Neuro-Psiquiatria | Year: 2014

In 2002, Spring et al reported a family with an autosomal dominant form of hereditary sensory neuropathy; patients also presented adult onset of gastroesophageal reflux and cough. Since then, no further families have been described. Objective: To study a new Portuguese family with these characteristics. Method: To describe the clinical and neurophysiologic characteristics of one family with features of sensory neuropathy associated with cough and gastroesophageal erflux. Results: Three of five siblings presented a similar history of paroxysmal cough (5th decade). About a decade later they experienced numbness and paraesthesia in the feets and in all cases there was evidence of an axonal sensory neuropathy. A history of gastroesophageal reflux of variable severity and age of onset was also present. Discussion: Molecular genetic studies have demonstrated genetic heterogeneity between the hereditary sensory neuropathy type 1 subtypes. The identification of these families is of major importance because further work is required to identify the underlying genetic defect.


Correia de Sa M.,Centro Hospitalar Vila Nova Of Gaia Espinho
BMJ case reports | Year: 2013

Hirayama disease, also known as monomelic amyotrophy or juvenile spinal muscular atrophy of the distal upper extremity features the impairment of the anterior horn cells of the distal cervical spinal cord secondary to dural sac anterior displacement during cervical flexion. We describe a case of a 17-year-old boy with a history of scoliosis, evaluated in the emergency department for decreased muscle strength and atrophy of the left upper limb with progressive worsening for about 6 months. We performed electrophysiological studies that showed severe neurogenic atrophy involving the C7-T1 left myotomes. Brain and spine MRI performed showed flattening of the lower cervical cord and dura mater anterior displacement during cervical flexion. These findings were consistent with the diagnosis of Hirayama disease.


Dias J.,Centro Hospitalar Vila Nova Of Gaia Espinho | Xambre L.,Centro Hospitalar Vila Nova Of Gaia Espinho | Costa L.,Centro Hospitalar Vila Nova Of Gaia Espinho | Costa P.,Centro Hospitalar Vila Nova Of Gaia Espinho | Ferraz L.,Centro Hospitalar Vila Nova Of Gaia Espinho
International Urogynecology Journal and Pelvic Floor Dysfunction | Year: 2014

Introduction and hypothesis: Data on Altis® (Coloplast), a new adjustable single-incision sling (SIS) procedure for the treatment of female stress urinary incontinence (SUI), are scarce. Our aim was to evaluate the efficacy and complication rates of this procedure. Methods: In this prospective observational study, a total of 52 women with SUI were implanted with an Altis® sling in an ambulatory setting. Before and after intervention (3, 6, and 12 months), women completed the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF). In addition, patients underwent a cough stress test at each evaluation and a post-voiding residual urine volume estimation at 3 months. The main outcomes measured were subjective cure (ICIQ-SF=0), subjective improvement (ICIQ-SF >0 and < preoperative ICIQ-SF), and objective cure (negative cough stress test and no pad usage) rates. De novo overactive bladder (OAB) symptoms, changes in voiding habits and adverse events were also analyzed. Results: The subjective cure rate at 12 months was 84.0 %, with an additional improvement rate of 8.0 %. The objective cure rate was 90.2 %. Later postoperative complications included 1 case of vaginal extrusion (requiring surgical removal of the eroded mesh segment), 3 cases of vaginal exposure of the adjustment thread (managed conservatively), de novo urgency in 3 patients, and mild dyspareunia in 2 patients. Conclusions: The Altis® sling is a safe and effective SIS procedure for the treatment of SUI with a short-term follow-up. © 2014 The International Urogynecological Association.


PubMed | Centro Hospitalar Vila Nova Of Gaia Espinho
Type: | Journal: Case reports in neurological medicine | Year: 2017

The management of cluster headache (CH) may be challenging. We report a 50-year-old male with recurrent attacks of dull and severe unilateral periorbital pain, lasting 30-45 minutes, twice a day, exclusively during sleep, and accompanied by ipsilateral rhinorrhea and lacrimation. The pain switched sides within every attack. CH treatment was initiated but the patient maintained recurrence rates compatible with chronic CH, even after increasing verapamil to 460mg/day. Afterwards we decided to add lithium (800mg/day). With this treatment the severity and recurrence of CH substantially decreased, despite the patients autonomous decision to take lithium only during the acute phase of the cluster. The exclusively alternating location and the excellent response to short cycles of lithium represent two unique features of CH.

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