Browsing by Author "Portela, F"
Now showing 1 - 10 of 30
Results Per Page
Sort Options
- 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
- Capsule endoscopy in inflammatory bowel disease type unclassified and indeterminate colitis serologically negativePublication . Lopes, S; Figueiredo, P; Portela, F; Freire, P; Almeida, N; Lérias, C; Gouveia, H; Leitão, MCBACKGROUND: The value of capsule endoscopy in the setting of inflammatory bowel disease type unclassified (IBDU) and indeterminate colitis (IC) remains obscure. The aim was to evaluate the clinical impact of capsule endoscopy on IBDU/IC patients with negative serology. METHODS: Eighteen patients with long-standing IBDU (n = 14) and IC (n = 4) were enrolled to undergo a capsule endoscopy and then followed prospectively. Lesions considered diagnostic of Crohn's disease (CD) were 4 or more erosions/ulcers and/or a stricture. The median follow-up time after capsule endoscopy was 32 ± 11 months (23-54 months). RESULTS: Total enteroscopy was possible in all patients. In 2 patients the examination was normal (Group 1). In 9 patients subtle findings were observed (Group 2): focal villi denudation (n = 1) and fewer than 4 erosions/ulcers (n = 8). In 7 patients, 4 or more erosions/ulcers were detected (Group 3), leading to a diagnosis of CD. However, their treatment was not reassessed on the basis of the capsule findings. Until now, a definitive diagnosis has been achieved in 2 additional patients: 1 from Group 1 (ulcerative colitis) and another patient from Group 2 (CD), who began infliximab infusions. Nine patients remained indeterminate at follow-up. CONCLUSIONS: Although capsule endoscopy enabled the diagnosis of CD in 7 patients, in none of them was the clinical management changed. Moreover, a change in therapy due to a diagnosis of CD was made for only 1 patient, who presented nonspecific findings. Our results suggest that capsule findings are not helpful in the work-up of 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
- CARD15 Mutations and Perianal Fistulating Crohn’s Disease: Correlation and Predictive Value of Antibiotic ResponsePublication . Freire, P; Portela, F; Donato, MM; Ferreira, M; Andrade, P; Sofia, CBACKGROUND: CARD15 mutations alter bowel immunity and increase susceptibility to Crohn's disease (CD). However, the relation between these mutations and Crohn's perianal fistulas has not been fully clarified. AIMS: To assess whether CARD15 mutations are associated with risk of developing Crohn's perianal fistulas and whether these mutations are predictors of the response of perianal fistulas to antibiotics. METHODS: CARD15 mutations were investigated in 203 consecutive CD patients. Presence/absence of history of perianal fistula was recorded. Patients with history of perianal fistula were divided into two groups (with/without CARD15 mutations), and response to antibiotics was evaluated in both groups. RESULTS: Of the 203 patients, 60 (29.6%) showed at least one CARD15 mutation and 55 (27.1%) had history of perianal fistula. History of perianal fistula was identified in 13 (21.7%) patients with mutations and in 42 (29.4%) patients without mutations (P = 0.260). Mean age at diagnosis of first perianal fistula was similar in patients with/without CARD15 mutations (28.7 +/- 9.8 versus 29.7 +/- 10.1 years, P = 0.758). Average time between disease onset and diagnosis of first perianal fistula was also similar in the two groups (4.6 +/- 5.1 versus 5.0 +/- 5.9 years, P = 0.816). Response of perianal fistulas to antibiotics (metronidazole alone or combined with ciprofloxacin) was significantly higher in patients without CARD15 mutations (7.7% versus 40.5%, P = 0.041). CONCLUSIONS: In CD, CARD15 mutations are not associated with risk of developing perianal fistulas or with time of their outbreak. Nevertheless, patients with perianal fistulas and CARD15 mutations showed worse response to antibiotics.
- 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.
- Crohn's disease in a southern European country: Montreal classification and clinical activityPublication . Magro, F; Portela, F; Lago, P; Ramos de Deus, J; Vieira, A; Peixe, P; Cremers, I; Cotter, J; Cravo, M; Tavares, L; Reis, J; Gonçalves, R; Lopes, H; Caldeira, P; Ministro, P; Carvalho, L; Azevedo, L; Costa-Pereira, ABACKGROUND: Given the heterogeneous nature of Crohn's disease (CD), our aim was to apply the Montreal Classification to a large cohort of Portuguese patients with CD in order to identify potential predictive regarding the need for medical and/or surgical treatment. METHODS: A cross-sectional study was used based on data from an on-line registry of patients with CD. RESULTS: Of the 1692 patients with 5 or more years of disease, 747 (44%) were male and 945 (56%) female. On multivariate analysis the A2 group was an independent risk factor of the need for steroids (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.1-2.3) and the A1 and A2 groups for immunosuppressants (OR 2.2; CI 1.2-3.8; OR 1.4; CI 1.0-2.0, respectively). An L3+L3(4) and L(4) location were risk factors for immunosuppression (OR 1.9; CI 1.5-2.4), whereas an L1 location was significantly associated with the need for abdominal surgery (P < 0.001). After 20 years of disease, less than 10% of patients persisted without steroids, immunosuppression, or surgery. The Montreal Classification allowed us to identify different groups of disease severity: A1 were more immunosuppressed without surgery, most of A2 patients were submitted to surgery, and 52% of L1+L1(4) patients were operated without immunosuppressants. CONCLUSIONS: Stratifying patients according to the Montreal Classification may prove useful in identifying different phenotypes with different therapies and severity. Most of our patients have severe disease.
- Endoscopic treatment of bleeding gastric varices with histoacryl (N-butyl-2-cyanoacrylate): a South European single center experiencePublication . Monsanto, P; Almeida, N; Rosa, A; Maçôas, F; Lérias, C; Portela, F; Amaro, P; Ferreira, MC; Gouveia, H; Sofia, CBACKGROUND: Endoscopic injection of N-butyl-2-cyanoacrylate is the current recommended treatment for gastric variceal bleeding. Despite the extensive worldwide use, there are still differences related to the technique, safety, and long term-results. We retrospectively evaluated the efficacy and safety of cyanoacrylate in patients with gastric variceal bleeding. PATIENTS AND METHODS: Between January 1998 and January 2010, 97 patients with gastric variceal bleeding underwent endoscopic treatment with a mixture of N-butyl-2-cyanoacrylate and Lipiodol(TM). Ninety-one patients had cirrhosis and 6 had non-cirrhotic portal hypertension. Child-Pugh score at presentation for cirrhotic patients was A-12.1 %; B-53.8 %; C-34.1 % and median MELD score at admission was 13 (3-26). Successful hemostasis, rebleeding rate and complications were reviewed. Median time of follow up was 19 months (0.5-126). RESULTS: A median mixture volume of 1.5 mL (0.6 to 5 mL), in 1 to 8 injections, was used, with immediate hemostasis rate of 95.9 % and early rebleeding rate of 14.4 %. One or more complications occurred in 17.5 % and were associated with the use of Sengstaken-Blakemore tube before cyanoacrylate and very early rebleeding (p < 0.05). Hospital mortality rate during initial bleeding episode was 9.3 %. Very early rebleeding was a strong and independent predictor for in-hospital mortality (p < 0.001). Long-term mortality rate was 58.8 %, in most of the cases secondary to hepatic failure. CONCLUSION: N-butyl-2-cyanoacrylate is a rapid, easy and highly effective modality for immediate hemostasis of gastric variceal bleeding with an acceptable rebleeding rate. Patients with very early rebleeding are at higher risk of death.
- «
- 1 (current)
- 2
- 3
- »