Browsing by Author "Rodrigues, D"
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- Aortic deformities: not all are aneurysmsPublication . Andrade, H; António, N; Rodrigues, D; Marinho da Silva, A; Providência, LA
- Cianose no pequeno lactente – desafio diagnósticoPublication . Amaral, ME; Silva, PV; Marinho, J; Francisco, A; Andrade, H; Martins, P; Santos, I; Rodrigues, D; Sousa, G; Pires, A; Marinho, A; Castela, E
- Controversies in the management of hyperglycaemic emergencies in adults with diabetesPublication . Cardoso, L; Vicente, N; Rodrigues, D; Gomes, L; Carrilho, FHyperglycaemic emergencies are associated with significant morbi-mortality and healthcare costs. Management consists on fluid replacement, insulin therapy, and electrolyte correction. However, some areas of patient management remain debatable. In patients without respiratory failure or haemodynamic instability, arterial and venous pH and bicarbonate measurements are comparable. Fluid choice varies upon replenishment phase and patient's condition. If patient is severely hypovolaemic, normal saline solution should be the first option. However, if patient has mild/moderate dehydration, fluid choice must take in consideration sodium concentration. Insulin therapy should be guided by β-hydroxybutyrate normalization and not by blood glucose. Variations of conventional insulin infusion protocols emerged recently. Priming dose of insulin may not be required, and fixed rate insulin infusion represents the best option to suppress hepatic glucose production, ketogenesis, and lipolysis. Concomitant administration of basal insulin analogues with regular insulin infusion accelerates ketoacidosis resolution and prevents rebound hyperglycaemia. Simpler protocols using subcutaneous rapid-acting insulin analogues for mild/moderate diabetic ketoacidosis treatment have proven to be safe and effective, but further studies are required to confirm these results. Treatment with bicarbonate, phosphate, and low-molecular-weight heparin is still disputable, and randomized controlled trials are urgently needed to optimize patient management and decrease the morbi-mortality of hyperglycaemic emergencies.
- Diabetes Mellitus após transplante renalPublication . Ruas, L; Bastos, M; Alves, R; Rodrigues, D; Barros, L; Mota, A; Carvalheiro, M; Ruas, A; Furtado, AL
- Embolização percutânea de fístula coronária: caso clínicoPublication . Rodrigues, D; Sá e Melo, A; Marinho da Silva, A; Ferreira, R; Martins, FM
- Encerramento Percutâneo de Fenestra uma Circulação de Fontan IntracardíacaPublication . Andrade, H; Rodrigues, D; Marinho da Silva, A; Martins, FM; Sá e Melo, AWe present a case of tricuspid atresia and the treatment that was used in a child now aged 12. The malformation was corrected at the age of five through intracardiac Fontan circulation. Later, the child developed a right-to-left shunt due to dehiscence in the intra-atrial conduit, causing significant desaturation. This was treated by transcatheter closure with a 10 mm Amplatzer device at 8 years of age. Currently the child is asymptomatic with no residual shunts, and the position of the device is normal. The percutaneous closure of Fontan fenestrations using the Amplatzer device is a therapeutic approach that provides good results. It results in normal oxygen saturation and has low morbidity. The technique is simple, available to most cardiac catheterization laboratories, safe, and offers a reasonable cost-benefit ratio. In addition, the design of the device is suitable for this type of defect.
- Extracção Percutânea de Corpos estranhos do Sistema CardiovascularPublication . Rodrigues, D; Sá e Melo, A; Marinho da Silva, A; Carvalheiro, VM; Manuel, OWe report our experience of seven patients referred to our hospital with foreign bodies embolized in the cardiovascular system, namely fragmented catheters and devices used in interventional techniques, which were retrieved by a percutaneous approach. The patients' ages ranged from 2 to 29 years, with a mean age of 17. The majority (57%) were male. The retrieval equipment used included a pigtail catheter, multipurpose catheter with hand-prepared snare, Amplatz gooseneck snare, nitinol multisnare set and basket catheter. The foreign bodies were successfully removed percutaneously in all cases, with no complications.
- High blood pressure in the pediatric age groupPublication . Andrade, H; António, N; Rodrigues, D; Marinho da Silva, A; Pego, M; Providência, LAThe definition of hypertension (HT) in the pediatric age group is based on the normal distribution of blood pressure (BP) in healthy children. Normal BP is defined as being below the 90th percentile for gender, age and height, and hypertension as equal to or higher than the 95th percentile on at least three separate occasions. If the values are above the 90th percentile but below the 95th percentile, the child should be considered prehypertensive. Ambulatory BP monitoring is useful in the assessment of BP levels in the young. P values in children and adolescents have creased in the last decade, in parallel with increases in body mass index, and HT now has a prevalence of 2-5%. Obesity in childhood and adolescence is one of the main predictors of HT in adulthood, but it is also associated with other cardiovascular risk factors such as dyslipidemia, abnormal glucose metabolism, insulin resistance, inflammation and impaired vascular function. Left ventricular hypertrophy is the most prominent evidence of target organ damage caused by hypertension in children and adolescents. The goal for antihypertensive treatment is to reduce BP below the 95th percentile. Weight control, with regular physical activity and dietary changes, is the primary therapy for obesity-related hypertension. Weight loss decreases not only BP but also other cardiovascular risk factors. The indications for use of antihypertensive drugs are: symptomatic hypertension, secondary hypertension, established hypertensive target organ damage, stage 2 hypertension and failure of nonpharmacologic measures.
- Implantação de Dispositivo de Amplatzer® Após Desinserção do PrimeiroPublication . Andrade, H; Rodrigues, D; Marinho da Silva, A; Ferreira, R; Martins, FM; Sá e Melo, A
- Implantação de Dispositivo de Amplatzer® Após Desinserção do PrimeiroPublication . Andrade, H; Rodrigues, D; Marinho da Silva, A; Ferreira, R; Martins, FM; Sá e Melo, A