Browsing by Author "Andrade, CS"
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- Bezoar gástrico e intestinal: caso clínico e revisão da literaturaPublication . Andrade, CS; Lopes, S; Pinheiro, C; Figueiredo, P; Tomé, L; Pinho, A; Martinho, F; Sofia, C; Leitão, MOs bezoars gastrointestinais são achados relativamente raros, apresentando uma variação regional na sua distribuição relacionada com diferenças na ingestão de alimentos ricos em fibras. A sua verdadeira incidência é desconhecida. A sua ocorrência apresenta uma tendência crescente, em provável relação com a maior taxa de cirurgias gastroduodenais realizadas no último século, consideradas factores de risco para a sua formação. Os autores apresentam o caso de um doente com antecedentes de cirurgia gastroduodenal, com quadro clínico caracterizado por vómitos alimentares, dor e distensão abdominal, paragem de emissão de fezes, anorexia e perda ponderal. O estudo complementar levantou a suspeita da existência de dois bezoars, um gástrico e um intestinal, a qual foi confirmada por laparotomia.Gastrointestinal bezoars are relatively uncommon findings and its distribution has a regional variation that correlates with differences in fibre enriched alimentary products ingestion. Its true incidence is unknown but its occurrence shows a growing tendency, which is probably related with the higher number of gastroduodenal surgeries performed in the past century, considered to be risk factors for bezoar formation. The authors present the case of a patient with a past history of gastric and duodenal surgery, admitted with vomiting, abdominal pain and distension, anorexia and weight loss. The diagnostic workup brought about the possibility of the existence of two bezoars, one gastric and one intestinal, which were confirmed by surgery.
- Metastização Cólica: Uma forma rara de apresentação do carcinoma gástricoPublication . Andrade, CS; Alves, S; Tomé, L; Sofia, C; Cipriano, MA; Urbano, M; Leitão, MO carcinoma gástrico é uma neoplasia com distribuição mundial, estando as fases avançadas da doença associadas à metastização à distância para múltiplos órgãos. Contudo, as metástases para o cólon são raras e habitualmente surgem como recidiva da doença, geralmente nos primeiros 5 anos após o diagnóstico. Os autores apresentam o caso clínico de um doente do sexo masculino, 69 anos de idade, com um quadro clínico de diarreia aquosa, de predomínio nocturno, sem sangue, muco ou pus, acompanhada de dor abdominal. Os exames complementares de diagnóstico revelaram a presença de metástases cólicas, como forma de apresentação de um adenocarcinoma gástrico, do tipo difuso, com células em anel desinete.Worldwide gastric carcinoma is a common malignancy and advanced stages of the disease result in distant metastases to multiple organs. Metastasis to the colon are rare and usually arise as recurrence of the disease, mostly in the first five years after diagnosis. The authors present a case of a 69 year old male with symptoms of watery diarrhoea, mostly nocturnal, without blood, mucus or pus, together with abdominal pain. Diagnostic workup revealed the presence of colonic metastases as the first manifestation of a diffuse type gastric adenocarcinoma, with signet ring cell.
- Mil colonoscopias totais: que relação entre os achados distais e proximais?Publication . Andrade, CS; Figueiredo, P; Lopes, S; Gouveia, H; Sofia, C; Leitão, MBACKGROUND: Flexible sigmoidoscopy is indicated for colorectal cancer screening. The decision about who needs total colonoscopy based on distal findings is still controversial because of the uncertainty of the associations between distal and proximal findings. AIM: The purpose of the study was to characterize distal findings in patients with total colonoscopy, to investigate its importance as markers of advanced proximal lesions and to evaluate the usefulness of a clinical Predictive Index, already published in the literature, in the identification of these lesions. METHODS: Retrospective analysis of the patients submitted to total colonoscopy between January 2006 and February 2007, with selection of 1000 consecutive cases with reference to polyps. We analysed demographic data, indication for the exam and morphological and histological characteristics of the polyps. Advanced lesion was defined as any adenoma larger than 10 mm or any polyp with villous characteristics, high grade dysplasia or cancer. The Predictive Index was obtained through the assignment of points to 3 categories: sex, age and distal findings, which result in 3 groups: low, intermediate and high risk. RESULTS: The mean age of patients was 64,69 years and 65,1% were male. Distal and proximal polyps were identified in 829 (82,9%) and 369 (36,9%) patients, respectively. Advanced distal lesion was found in 342 patients (34,2%) and advanced proximal lesion in 98 (9,8%). 587 patients (58,7%) were in the high risk group. In the group of patients with advanced proximal lesion, a third presented low and intermediate risk, 52% had no distal polyps, 88,7% had less than three distal polyps and 71,4% had no advanced distal lesion. Sensitivity values for these four categories ranged between 11,2% and 66,6%. CONCLUSION: If the decision to perform total colonoscopy is based on distal colonic findings or on the Predictive Index, the ability to identify advanced proximal lesion is markedly reduced, endangering the aim of a screening program.