Silva F.B.,Karolinska University Hospital |
Dinis-Ribeiro M.,Portuguese Institute of Oncology |
Vieth M.,Institute of Pathology |
Rabenstein T.,Diakonissen Stiftungs Krankenhaus |
And 9 more authors.
Gastrointestinal Endoscopy | Year: 2011
Background: Three different classification systems for the evaluation of Barrett's esophagus (BE) using magnification endoscopy (ME) and narrow-band imaging (NBI) have been proposed. Until now, no comparative and external evaluation of these systems in a clinical-like situation has been performed. Objective To compare and validate these 3 classification systems. Design Prospective validation study. Setting Tertiary-care referral center. Nine endoscopists with different levels of expertise from Europe and Japan participated as assessors. Patients Thirty-two patients with long-segment BE. Interventions From a group of 209 standardized prospective recordings collected on BE by using ME combined with NBI, 84 high-quality videos were randomly selected for evaluation. Histologically, 28 were classified as gastric type mucosa, 29 as specialized intestinal metaplasia (SIM), and 27 as SIM with dysplasia/cancer. Assessors were blinded to underlying histology and scored each video according to the respective classification system. Before evaluation, an educational set concerning each classification system was carefully studied. At each assessment, the same 84 videos were displayed, but in different and random order. Main Outcome Measurements Accuracy for detection of nondysplastic and dysplastic SIM. Interobserver agreement related to each classification. Results The median time for video evaluation was 25 seconds (interquartile range 20-39 seconds) and was longer with the Amsterdam classification (P < .001). In 65% to 69% of the videos, assessors described certainty about the histology prediction. The global accuracy was 46% and 47% using the Nottingham and Kansas classifications, respectively, and 51% with the Amsterdam classification. The accuracy for nondysplastic SIM identification ranged between 57% (Kansas and Nottingham) and 63% (Amsterdam). Accuracy for dysplastic tissue was 75%, irrespective of the classification system and assessor expertise level. Interobserver agreement ranged from fair (Nottingham, κ = 0.34) to moderate (Amsterdam and Kansas, κ = 0.47 and 0.44, respectively). Limitation No per-patient analysis. Conclusions All of the available classification systems could be used in a clinical-like environment, but with inadequate interobserver agreement. All classification systems based on combined ME and NBI, revealed substantial limitations in predicting nondysplastic and dysplastic BE when assessed externally. This technique cannot, as yet, replace random biopsies for histopathological analysis. © 2011 American Society for Gastrointestinal Endoscopy.
Amorim-Costa C.,S Joao Hospital |
Amorim-Costa C.,University of Porto |
Mota R.,S Joao Hospital |
Rebelo C.,Pedro Hispano Hospital |
And 2 more authors.
Acta Obstetricia et Gynecologica Scandinavica | Year: 2011
Postpartum hemorrhage due to uterine atony continues to be one of the major causes of maternal morbidity and mortality. Several uterine compression suture techniques have been described and are increasingly being used worldwide as a conservative approach. However, little is known about the long-term effects on the uterine cavity, as well as fertility and pregnancy outcomes. We reviewed the reported complications and uterine findings after the use of compression sutures, both in examinations to evaluate the cavity (hysteroscopy, hysterosalpingography or sonohysterography) and at cesarean section, in order to assess the possible usefulness of routine postoperative cavity evaluation. Overall, the use of uterine compression sutures is effective and safe; however, some severe and potentially life-threatening complications have been reported and could possibly have been prevented if uterine cavity evaluation had been performed. Routine follow-up, both by hysteroscopy and an imaging technique, seems worthwhile. © 2011 The Authors Acta Obstetricia et Gynecologica Scandinavica © 2011 Nordic Federation of Societies of Obstetrics and Gynecology.
PubMed | Legnano Hospital, Minimally Invasive Surgery Unit, Tondela Viseu Hospital Center, Goethe University Frankfurt and 7 more.
Type: Journal Article | Journal: European journal of trauma and emergency surgery : official publication of the European Trauma Society | Year: 2016
The European Society for Trauma and Emergency Surgery (ESTES) identified the need for general and trauma surgeons involved in the management of critically ill surgical patients to embrace and learn both basic and advanced US skills. A steering group was created to address this deficit.Modular UltraSound ESTES Course (MUSEC) is a modular blended-learning course. It incorporates pre-test/post-test examinations, pre-course online materials, didactic and interactive lectures, interactive case scenarios discussion with pathological US clips, hands-on practice on healthy volunteer models, and on original phantoms for simulating both pathological US findings and practicing US-guided interventional maneuvers. Four independent modules were provided. Surgical decision-making didactics were also included in the course curriculum. Learning gain ( of the rating of pre-test and post-test) was calculated for each module. An anonymous post-course satisfaction survey was also administered (16 questions with a Likerts 5-point scale of evaluation).Twenty-three MUSEC Courses were run in a 30months period, training 416 doctors from 29 countries. A total of 52 modules were delivered. The mean pre-test and post-test grades were 8.3/12 and 10.7/12, respectively, yielding a significant mean learning gain of 28.9% (p=0.001). Post-course satisfaction survey got an overall ranking of 4.5/5.MUSEC is an effective and original educational format, enjoyed by candidates, that fills an educational gap for tailored US education as a procedural skill to acute care surgeons. Ongoing revisions should reduce the current limitations and increase the educational value, in terms of number of modules and post-course credentialing.
Serino J.,Pedro Hispano Hospital |
Martins J.,Pedro Hispano Hospital |
Paris L.,The Institute Of Ophthalmology Dr Gama Pinto |
Duarte A.,Pedro Hispano Hospital |
Ribeiro I.,Pedro Hispano Hospital
International Ophthalmology | Year: 2015
A 59-year-old man who complained of binocular vertical diplopia after an exploratory laparotomy, complicated by cardiorespiratory arrest during anesthetic induction, was found to have Collier’s sign, anisocoria, complete paralysis of upward vertical gaze associated with convergence-retraction nystagmus on attempted upgaze and skew deviation with hypertropia in the left eye without ptosis, and an absent Bielschowsky sign. Magnetic resonance imaging of the brain showed a small lesion in the left paramedian midbrain compatible with microvascular ischemic sequelae. This patient was diagnosed with Parinaud’s syndrome (dorsal midbrain syndrome) associated with a vertical strabismus from an unilateral vascular ischemic paramedian midbrain lesion. © 2015, Springer Science+Business Media Dordrecht.
Furtado A.,Pedro Hispano Hospital |
Arantes M.,Pedro Hispano Hospital |
Silva R.,Pedro Hispano Hospital |
Romao H.,Pedro Hispano Hospital |
And 2 more authors.
Clinical Neuropathology | Year: 2010
Two new cases of extraventricular neurocytoma are reported. The first concerns an 18-year-old female with a left frontal lobe lesion and the second occurred in a 54-year-old female in the thoracic spinal cord. The first patient is free of disease after 18 months of follow up. The second patient is stable after 16 months of follow up. Both were operated - total excision in Case 1 and partial resection in Case 2. The latter underwent adjuvant radiotherapy due to atypical histological features. Cases of extraventricular neurocytoma are reviewed. Differences and similarities between extraventricular and central neurocytoma are outlined. ©2010 Dustri-Verlag Dr. K. Feistle.
PubMed | Pedro Hispano Hospital
Type: Journal Article | Journal: Orbit (Amsterdam, Netherlands) | Year: 2016
Periorbital cellulitis is a relatively common ocular disease in the pediatric population. Early diagnosis of this disease with a prompt intervention is critical to avoid vision and life-threatening complications. In the last years, medical therapy has been expanding for the treatment of orbital cellulitis, instead of the standard surgical approach. The purpose of this study was to describe the outcome of treatment with intravenous antibiotic of periorbital cellulitis in children. A retrospective review of all children admitted with periorbital cellulitis in our hospital between January 2002 and July 2013 was conducted. Cases were divided in two subgroups, pre-septal and post-septal infection. The demographics, clinical findings, treatment and outcomes were analyzed. In total 110 children were included, 93 with pre-septal and 17 with post-septal cellulitis. The mean age was 3.5 years in children with pre-septal cellulitis and 5.5 years in those with post-septal cellulitis (p = 0.149). For both subgroups the most common predisposing factor was sinusitis. Intravenous antibiotic therapy was successful in all except one patient with an orbital abscess who required surgical intervention. In our study complete recovery was achieve in all (except for one) children with periorbital cellulitis treated with intravenous antibiotics only.
PubMed | Pedro Hispano Hospital
Type: Journal Article | Journal: European journal of ophthalmology | Year: 2016
To evaluate phacoemulsification surgery results and complications in patients with nanophthalmos.The records of 9 patients with nanophthalmos who had cataract surgery from January 2011 through January 2015 were retrospectively reviewed. Nanophthalmos was diagnosed by the presence of an eye with an axial length (AL) less than 20.5 mm. The records were reviewed for ocular diagnosis, keratometry, anterior chamber depth (ACD), AL, ocular surgeries, visual acuity, and complications.A total of 14 eyes of 9 patients (8 women, 1 man) with a mean age of 72 years (range 48-86) were reviewed. Mean AL was 18.72 mm and mean ACD was 2.30 mm. Mean preoperative spherical equivalent (+8.55 6.44 diopters (D)) was reduced to +0.30 2.17 D at last follow-up visit. Mean best-corrected visual acuity (BCVA) was +0.68 0.55 logarithm of the minimum angle of resolution (logMAR) preoperatively and improved to +0.55 0.73 logMAR at last follow-up visit. Visual acuity remained stable or improved in 11 eyes. Five eyes did not achieve final BCVA +0.3 logMAR. Complications occurred in 3 eyes (21.4%) and included 1 case of posterior capsule rupture, 1 case of severe iritis and rhegmatogenous retinal detachment 2 weeks postoperatively, and 1 other case of iritis. No postoperative uveal effusion was seen.Although phacoemulsification seems to be relatively safe in nanophthalmic eyes, surgeons need to be aware of the challenges of this procedure in these high-risk eyes. Nevertheless, with careful preoperative evaluation and planning, most cases were uncomplicated and resulted in improvement of BCVA.
PubMed | University of Porto and Pedro Hispano Hospital
Type: Journal Article | Journal: American journal of infection control | Year: 2016
Medical education should include infection control precautions (ICPs). Portuguese medical students showed reasonable knowledge in ICPs; however, contact isolation and glove and mask use should be reinforced. Only 25% referred to the curriculum as the most important information source. There was a positive association between academic year (P=.032), previous training in ICPs (P=.016), and knowledge. Main strategies proposed to acquire competences in ICPs were bedside teaching (26.9%) and curriculum and bedside teaching (20.2%).
PubMed | Pedro Hispano Hospital
Type: | Journal: BMJ case reports | Year: 2015
A 42-year-old Caucasian woman presented with a sensation of fullness in the throat and dry cough of 1-month duration. Physical examination showed a mass located in the midline of the tongue base. Cervical ultrasound confirmed the absence of thyroid gland tissue in the normal position. MRI of the neck showed a mass suggestive of lingual thyroid and scintigraphy confirmed the diagnosis. Thyroid function was normal. Despite normal thyroid function, to decrease the size of the mass and perhaps solve the problem, we decided to start levothyroxine suppression therapy. The patient had palpitations and one episode of angina pectoris as a side effect, resulting in the medication being interrupted. After 3 years of follow-up, she remains in clinical surveillance and without symptoms.
PubMed | Pedro Hispano Hospital
Type: Case Reports | Journal: International journal of pediatric otorhinolaryngology | Year: 2015
A 5-year-old female had history of chronic foul smelling nasal discharge. Rhinoscopy showed greenish crusts lining the nasal cavities and inferior turbinates were shriveled significantly. Nasal cavity cultures of crusts by swab revealed Klebsiella ozaenae making the diagnosis of primary atrophic rhinosinusitis. After several unsuccessful treatment, we have decided to try sulfamethoxazole-trimethoprim prophylaxis and 1 year later there was a complete clinical improvement. There are many medical therapies and surgical options described, but none of them showed effective at long term. We present antibiotic prophylaxis as a viable alternative for long term control of the disease.