Browsing by Author "Freitas, D"
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- Aberrant crypt foci: endoscopic assessment and cell kinetics characterizationPublication . Figueiredo, P; Donato, MM; Urbano, M; Goulão, H; Gouveia, H; Sofia, C; Leitão, M; Freitas, DBACKGROUND AND AIMS: Aberrant crypt foci (ACF) are preneoplastic lesions in animal models of colorectal cancer. The aim of the study is to investigate if ACF are involved in human colorectal carcinogenic process and if they can be helpful in predicting the presence of a colorectal neoplasia. METHODS: The study included, between 2003 and 2005, 182 patients, 62 with adenoma, 55 with colorectal carcinoma, 53 without colorectal lesions, and 12 with nonneoplastic mucosal polyps. The number of rectal ACF was determined by colonoscopy. Proliferation and apoptosis indexes were evaluated by immunohistochemistry in rectal ACF, in normal rectal mucosa, and in carcinomatous tissue. RESULTS: The mean number of rectal ACF in patients with rectal neoplasia was 12.64, significantly higher than in patients with neoplastic lesions elsewhere in the colon (p=0.01). The apoptosis index in ACF of patients with colorectal carcinoma or adenoma aged 50 years or older was significantly lower than in younger patients (1.3% vs 2.7%, p=0.01) and, in patients with carcinoma, lower than in normal mucosa (1.1% vs 2.1%, p=0.002). The proliferation index was significantly higher in ACF of patients with colorectal neoplasia aged less than 50 years than in normal mucosa (10.9% vs 7.7%, p=0.02). The apoptosis index in ACF foci of patients with carcinoma (1.1%) was significantly lower than in patients without lesions (2.2%) and than in normal mucosa (2%). The mean number of ACF is significantly higher in patients with polyps larger than 1 cm (11.28 vs 6.27, p=0.02). CONCLUSION: Aberrant crypt foci probably precede the appearance of neoplasia and may be helpful in predicting the presence of a colorectal neoplastic lesion.
- Adenoma seroso oligoquístico do pâncreas: a propósito de um caso clínicoPublication . Almeida, N; Alves, S; Borges, I; Gregório, C; Gomes, D; Portela, F; Sérgio, M; Rui, M; Urbano, M; Gouveia, H; Martinho, F; Freitas, D
- An unusual foreign body in the rectum.Publication . Bastos, I; Gomes, D; Gregório, C; Baranda, J; Gouveia, H; Donato, A; Freitas, DThis is the report of an unusual foreign body in the rectum which was a complication of the migration of an esophageal Celestin's prosthesis.
- 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.
- O balão intragástrico nas formas graves de obesidadePublication . Almeida, N; Gomes, D; Gonçalves, C; Gregório, C; Brito, D; Campos, JC; Gouveia, H; Freitas, DIntroduction: In patients with morbid obesity the intragastric balloon (IGB) can be a “bridge” to surgery or a temporary treatment in patients who are not candidates for surgery. Objective: Evaluate IGB efficacy in morbidly obese patients. Patients and Methods: In 2003/2004 seventeen IGB Bioenterics ® filled with normal saline and methylene blue were placed in 17 patients [11 women, median age was 49.2 (27-69 years); median body mass index was 55.6 (40.2-74.2 Kg/m2)], followed by nutritionists and/or endocrinologists. They had previously tried dietetic and/or pharmacological measures with limited results. Co-morbidities were present in 13 (76.5%). Results: Eight (47%) patients presented nausea/vomiting in the first 24-72h that persisted in 4 (23.5%) leading to dehydration and pre-renal insufficiency and forcing premature removal of the balloon (0.5 to 4 months). In the other patients, the device was removed at 6 months treatment (in 1 patient at 10 months). All patients suffered weight loss (5-70 Kg); median loss-19.6 Kg (p<0.001). No cases of spontaneous deflation/displacement occurred. Six (35.3%) underwent bariatric surgery. Conclusions: The IGB is a useful method for weight loss in morbidly obese patients. Nausea and vomiting are the most common complications. Although desirable, subsequent surgery is not always performed.
- 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.
- Citologia de aspirados por agulha fina ecoendoscopicamente guiada na avaliação de massas pancreáticas suspeitas de malignidadePublication . Urbano, M; Portela, F; Pontes, JM; Barroso, M; Fernandes, G; Calhau, CA; Gouveia, H; Leitão, M; Freitas, D
- Colite pseudomembranosa : uma casuística de internamentosPublication . Almeida, N; Silva, N; Parente, F; Portela, F; Gouveia, H; Alexandrino, MB; Alves-Moura, JJ; Freitas, DIntroduction: pseudomembranous colitis (PMC) is an infectious disease that generally begins after antibiotic treatment. Objectives: Characterize the patients with PMC in two Services of a Central Hospital. Material and Methods: we considered the patients admitted in a Medicine (MS) and in a Gastroenterology (GES) Service with primary or secondary diagnosis of PMC, between January/1995 and July/2003 and registered the age, gender, clinical presentation, antibiotics (AB) and other risk factors, diagnostic procedures, complications and treatment. Results: we considered 80 patients (43 - GES and 37 - MS); Mean age - 68,6 ± 17,7 years; 52,5% were male; Antibiotic treatment in the previous 3 months - 85%; Mean time of antibiotic treatment - 10,5 ± 6,1 days. Most Commonly Involved Antibiotics: cephalosporins, amoxicillin/clavulanic acid and quinolones. Associated risk factors: renal insufficiency (22,5%); cardiac insufficiency (22,5%); previously dependent patient ( 36,3%). Diagnostic procedures: toxin search-58 patients ( in 36 ), colonoscopy - 62 ( in 53); culture - 23 (in 17 ). The mortality rate was 18,8% (n = 15); recurrence rate - 10% (n = 8). Therapeutics: metronidazol - 37 patients (46,3%); vancomycin - 24 (30%); metronidazol + vancomycin – 12 (15%). Differences Between Services: mean age (MS - 72,9 and GES - 64,9); admission criteria (GES - intestinal disorders, MS – respiratory infections); diagnostic procedures (colonoscopy more frequent in GES); therapeutic options (MS - metronidazol; GES - vancomycin and metronidazol + vancomycin). Conclusions: PMC is more common in older patients that were generally submitted to previous antibiotic treatment, especially with ß-lactamics. Considering two distinct Services we observed differences concerning age, co-morbility and risk factors that implied distinct diagnostic and therapeutic approaches.
- Depressão, ideação suicida e desesperança em doentes alcoólicosPublication . Vicente, S; Nunes, A; Viñas, C; Freitas, D; Saraiva, CB
- Derrame Pleural Recidivante por FÍstula Pancreático-PleuralPublication . Ribeiro, B; Gomes, D; Rosa, A; Amaro, P; Tomé, L; Leitão, M; Freitas, D
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