Gastrenterologia
Permanent URI for this community
Browse
Browsing Gastrenterologia by Author "Amaro, P"
Now showing 1 - 10 of 27
Results Per Page
Sort Options
- Apolipoproteína A1 e litíase biliar na cirrose hepáticaPublication . Baranda, J; Ministro, P; Amaro, P; Rosa, A; Pimenta, I; Donato, A; Freitas, DA prospective study was performed in 67 male patients with cirrhosis, admitted in our Department during one year. Biliary lithiasis was found in 37% of patients. The occurrence of lithiasis was not related to age, weight or severity of liver disease. Seric total bilirubin was higher in lithiasic patients (p < 0.05). Apolipoprotein A1 levels were lower in those ones with lithiasis (p < 0.005). Apolipoprotein A1 was the only factor associated independently with the finding of lithiasis.
- Caracterização da Hemorragia Digestiva Aguda Severa por AngiodisplasiaPublication . Sousa-Fernandes, S; Ferreira, M; Romãozinho, JM; Amaro, P; Leitão, MINTRODUÇÃO: As angiodisplasias são causas raras de hemorragia digestiva aguda. A natureza intermitente da hemorragia e a extensão de tubo digestivo envolvido colocam desafios particulares. OBJECTIVOS: Caracterizar as hemorragias digestivas agudas severas por angiodisplasia. DOENTES E MÉTODOS: Análise retrospectiva das hemorragias digestivas agudas por angiodisplasia admitidas na Unidade de Cuidados Intensivos de Gastrenterologia (UCIGE) dos Hospitais da Universidade de Coimbra, entre 1992 e 2008. RESULTADOS: Incluídos 21 doentes, representando 0,54% das admissões no período considerado. Registou-se predomínio do sexo masculino e idade média de 74 anos (42-92). Todos os doentes apresentavam co-morbilidades e 40% tomavam antiagregantes plaquetares ou anticoagulantes. A hemorragia foi proximal à ampola de Vater em 62% dos casos. Efectuou-se hemostase endoscópica em 18 doentes, que foi eficaz em todos eles. Outras terapêuticas menos utilizadas incluíram a embolização e enterectomia. Não ocorreu recidiva hemorrágica durante os internamentos. A mortalidade cifrou-se em 4,7%, correspondendo a um doente sujeito a laparotomia, falecido no pós-operatório imediato. CONCLUSÕES: A hemorragia digestiva aguda severa por angiodisplasia foi um evento raro na UCIGE. A endoscopia teve um papel fundamental no diagnóstico e na terapêutica. Os resultados corroboram a pertinência da admissão destes casos numa UCIGE, tendo em conta, nomeadamente, a importante comorbilidade que os caracteriza.INTRODUCTION: Angiodysplasias are rare causes of acute gastrointestinal bleeding. Brisk bleeding and extension of the bowel involved are associated with specific challenges. AIM: Descrption of the main features of gastrointestinal bleeding caused by angiodysplasia. PATIENTS AND METHODS: Retrospective analysis of gastrointestinal bleeding episodes caused by angiodysplasia in patients admitted to the Gastroenterology Intensive Care Unit of Hospitais da Universidade de Coimbra, between 1992 and 2008. RESULTS: Twenty-one patients were included, representing 0,54% of all admissions in the unit during the mentioned period. Most patients were men with an average age of 74 years (42-92). All patients had comorbidities; 40% were taking antiplatelet or anticoagulant drugs. Bleeding was proximal to the ampulla of Vater in 62% of the patients. Endoscopic hemostasis was performed and was successful in 18 patients. Other therapies rarely used were angiographic embolization and segmental enterectomy. There was no recurrent bleeding during hospital stay. CONCLUSIONS: Severe gastrointestinal bleeding caused by angiodysplasia was a rare event in the unit. Endoscopy had a major role both in diagnosis and therapy. The results underline the importance of criterious admission in the Gastroenterology Intensive Care Unit, attending to the comorbidities that characterize these patients.
- CARD15 mutations and colorectal cancer in a South European countryPublication . Freire, P; Portela, F; Donato, MM; Figueiredo, M; Amaro, P; Sá, A; Andrade, P; Gouveia, H; Sofia, CPURPOSE: CARD15 mutations are associated with higher susceptibility to Crohn's disease (CD) and longstanding colonic CD increases the risk of developing colorectal cancer (CRC). The relation between these mutations and sporadic CRC remains controversial. The aim of this study was to assess whether germline and/or somatic CARD15 mutations are risk factors for sporadic CRC in Portugal and whether there are genotype-phenotype correlations in these patients. METHODS: The three main CARD15 mutations (R702W, G908R and 3020insC) were researched in 112 sporadic CRC patients and 152 healthy subjects. RESULTS: Overall, CARD15 mutations were found in 18 patients (16.1%) and in 15 controls (9.9%; p = 0.132). Individually, the incidence of R702W was significantly higher in patients than in controls (12.5% vs. 5.3%, p = 0.035), whereas the genotype frequencies for G908R (2.7% vs. 3.3%) and 3020insC (0.9% vs. 1.3%) were not statistically different between the two groups. Entire genotypic agreement was found in patients genotyped for blood and neoplastic DNA. A significantly higher incidence of CARD15 mutations was detected in patients with CRC diagnosed under 60 years old (28.6% vs. 10.4%, p = 0.015) and in female patients (24.4% vs. 10.4%, p = 0.048). No associations were found between CARD15 mutations and family history, symptoms or CRC pathologic characteristics. CONCLUSIONS: The CARD15 R702W variant might be a predisposing factor to sporadic CRC in Portugal, particularly in patients under 60-years old and in female patients. This susceptibility appears to be linked with germline CARD15 mutations. Nevertheless, we have found no evidence that CARD15 mutations predict the pathologic characteristics of CRC.
- CARD15 Mutations and Colorectal Cancer in a South European CountryPublication . Freire, P; Portela, F; Donato, MM; Figueiredo, P; Duque, G; Ferreira, M; Amaro, P; Sá, A; Andrade, P; Gouveia, H; Sofia, C
- Um caso de síndrome de compressão do tronco celiaco com eventual componente iatrogénicoPublication . Almeida, N; Amaro, P; Gonçalves, C; Gregório, C; Gomes, D; Otero, M; Gouveia, H; Freitas, DApresenta-se o caso de um doente de 64 anos com epigastralgias, náuseas e vómitos recorrentes, associados a astenia, anorexia e emagrecimento significativo nos últimos meses. Estas queixas estavam presentes desde 1998 mas agravaram-se em 2002 após cirurgia para correcção de acalásia. Perante a avaliação efectuada colocaram-se como hipóteses diagnósticas uma pancreatite aguda idiopática recorrente ou uma isquémia mesentérica. A realização de arteriografia abdominal evidenciou uma estenose significativa do tronco celíaco, compatível com síndrome de compressão do tronco celíaco. A revisão do processo radiológico sugeriu eventual sequela de lobectomia superior esquerda realizada em 1994.
- Derrame Pleural Recidivante por FÍstula Pancreático-PleuralPublication . Ribeiro, B; Gomes, D; Rosa, A; Amaro, P; Tomé, L; Leitão, M; Freitas, D
- O Doente Cirrótico na Unidade de Cuidados Intensivos: Avaliação do PrognósticoPublication . Freire, P; Romãozinho, JM; Ferreira, M; Amaro, P; Leitão, MINTRODUÇÃO: Os doentes com cirrose hepática admitidos em Unidades de Cuidados Intensivos (UCI) têm um prognóstico particularmente reservado. O prognóstico destes doentes pode ser avaliado com scores gerais (SOFA, APACHE, SAPS) ou com scores específicos de cirrose hepática (MELD, Child-Pugh). OBJECTIVOS: Avaliar o valor prognóstico dos scores gerais (SOFA, APACHE e SAPS) e dos scores específicos de cirrose hepática (MELD e Child-Pugh) em doentes com cirrose hepática admitidos em UCI polivalentes ou em Unidades de Cuidados Intensivos de Gastrenterologia (UCIGE). MATERIAL E MÉTODOS: Os autores fazem uma revisão da literatura sobre a avaliação do prognóstico de doentes com cirrose hepática admitidos em ICUs e relatam também a sua experiência sobre esta temática no contexto duma UCIGE incluindo a análise de 124 internamentos. RESULTADOS: Nos diversos estudos efectuados em doentes com cirrose hepática admitidos em UCI polivalentes, os diferentes scores gerais e específicos revelaram um bom poder discriminativo, ou seja, com uma área sob a curva ROC (AUC) > 0,7. Considerando os seis estudos mais representativos, o valor médio da AUC dos scores SOFA, APACHE II, APACHE III, MELD e Child-Pugh foi 0,86, 0,74, 0,81, 0,79 e 0,77, respectivamente. O estudo de 124 internamentos consecutivos na UCIGE de doentes com cirrose hepática revelou que os doentes que faleceram pertenciam todos à classe C de Child-Pugh e tinham valores médios dos scores SOFA, APACHE II, SAPS II e MELD significativamente superiores aos dos doentes que não faleceram (10,1, 22,0, 47,5 e 30,7 nos que faleceram e 3,5, 13,6, 25,4 e 18,0 nos que não faleceram, respectivamente; p >< 0,05). Conclusões: Tanto os scores gerais como os específicos de cirrose hepática têm valor prognóstico na avaliação do risco de doentes com cirrose hepática internados em UCI polivalentes ou em UCIGE. Nas UCI polivalentes os scores gerais, e em particular o SOFA, apresentam melhor capacidade prognóstica do que os scores específicos de cirrose hepática
- Double pylorus with bleeding gastric ulcer - a rare eventPublication . Almeida, N; Romãozinho, JM; Ferreira, M; Amaro, P; Tomé, L; Gouveia, H; Leitão, M
- "Downhill" varices. A rare cause of esophageal hemorrhagePublication . Areia, M; Romãozinho, JM; Ferreira, M; Amaro, P; Freitas, D"Downhill" varices or upper esophageal varices are a rare cause of proximal digestive tract hemorrhage with only 16 cases described in the literature. In our series, hemorrhage due to "downhill" varices represents 0.1% of all acute esophageal variceal bleeding. Their etiology differs from that of the usual "uphill" varices secondary to portal hypertension, and the clinical management should be directed to vascular obstruction if present. We report a case of an 89-year-old male with hemorrhagic "downhill" varices not associated, as usually, with superior vena cava obstruction or compression, but with severe pulmonary hypertension and drug-related hemorrhagic risk factors, whose removal proved sufficient to prevent rebleeding.
- Drug-Induced Acute Pancreatitis and Pseudoaneurysms: An Ominous CombinationPublication . Branquinho, D; Ramos-Andrade, D; Elvas, L; Amaro, P; Ferreira, M; Sofia, CRupture of pseudoaneurysms is rare but can be life-threatening complications of acute or chronic pancreatitis, usually due to enzymatic digestion of vessel walls crossing peripancreatic fluid collections. We report the case of a 40 year-old female, with multisystemic lupus and anticoagulated for prior thrombotic events, admitted for probable cyclosporine-induced acute pancreatitis. Hemodynamic instability occurred due to abdominal hemorrhage from two pseudoaneurysms inside an acute peri-pancreatic collection. Selective angiography successfully embolized the gastroduodenal and pancreatoduodenal arteries. The hemorrhage recurred two weeks later and another successful embolization was performed and the patient remains well to date. The decision to restart anticoagulants and to suspend cyclosporine was challenging and required a multidisciplinary approach. Despite rare, bleeding from a pseudoaneurysm should be considered when facing a patient with pancreatitis and sudden signs of hemodynamic instability.
- «
- 1 (current)
- 2
- 3
- »