Browsing by Author "Rosa, A"
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- 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.
- Derrame Pleural Recidivante por FÍstula Pancreático-PleuralPublication . Ribeiro, B; Gomes, D; Rosa, A; Amaro, P; Tomé, L; Leitão, M; Freitas, D
- 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.
- Laqueação endoscópica - uma opção terapêutica eficaz na hemostase urgente e electiva da hemorragia digestiva por angiodisplasias gástricasPublication . Sousa, HT; Rosa, A; Duque, AG; Gouveia, H; Leitão, M
- Mesenteric arteriovenous fistula causing portal hypertension and bleeding duodenal varicesPublication . Baranda, J; Pontes, JM; Portela, F; Silveira, L; Amaro, P; Ministro, P; Rosa, A; Pimenta, I; Andrade, P; Bernardes, A; Pereira, J; Leitão, M; Donato, A; Freitas, DWe report a case of portal hypertension associated with a non-traumatic arteriovenous fistula, presenting with bleeding duodenal varices. The patient was admitted for melaena. Emergency endoscopy showed oesophageal varices with no signs of recent bleeding and with no blood in the upper gastrointestinal tract. Arteriography of the coeliac axis and superior mesenteric artery failed to detect any bleeding source. Endoscopy was repeated because of persistent bleeding and revealed active bleeding from varices in the distal duodenum. The patient underwent surgery and a large paraduodenal varicose vein associated with an arteriovenous fistula was found. Resection of the paramural varix and surgical occlusion of the arteriovenous fistula were effective in the control of bleeding. Liver biopsy revealed mild portal fibrosis without cirrhosis. Three years after surgery the patient still has oesophageal varices but has not had recurrent bleeding. There was regression of intraduodenal varices.
- Mesotelioma maligno do peritoneu: a propósito de um caso clínicoPublication . Gonçalves, C; Sliva, F; Cotrim, I; Rosa, A; Cipriano, MA; Abecassis, N
- Spontaneous extensive esophageal tear with upper digestive haemorrhage treated by endoclip applicationPublication . Areia, M; Amaro, P; Figueiredo, P; Portela, F; Ferreira, M; Rosa, A; Romãozinho, JM
- Team approach to ERCP-directed single-brush cytology for the diagnosis of malignancy.Publication . Urbano, M; Rosa, A; Gomes, D; Camacho, E; Calhau, CA; Leitão, MOBJECTIVE: To evaluate the clinical usefulness of single-brush cytology performed at ERCP as initial method for detecting pancreatobiliary malignancy, ensuring a very close relationship between endoscopists, cytotechnicians, and cytopathologists. STUDY DESIGN: All 125 cytodiagnoses considered in this study correspond to the first brushing for each patient, collected by one of the three members of a fixed team of endoscopists in the presence of the same cytotechnician. Smears were fixed immediately with Merckofix spray, stained with Papanicolau, and analyzed by the same cytopathologist in a laboratory exclusively devoted to gastrointestinal cytopathology located at the endoscopy unit. RESULTS: Of 125 cytological diagnoses 94 were considered benign, 4 suspicious, and 27 malignant. These findings were compared to the final diagnosis of 45 malignant and 80 benign lesions obtained either by surgical pathology or after at least one year of clinical follow-up. The comparison yielded 30 true positives, 78 true negatives, 1 false positive and 16 false negative results, which corresponds to a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 65.2, 98.7, 96.8, 83, and 86.4%, respectively. CONCLUSION: Results seem to confirm the usefulness of an effective team approach to ERCP-directed brush cytology for the diagnosis of pancreatobiliary malignancy. However, sensitivity continues to be rather low.
- Úlcera Péptica Sangrante: Que Lugar para as Colas?Publication . Lérias, C; Rosa, A; Maçôas, F; Souto, P; Pina-Cabral, JE; Gregório, C; Sofia, C; Leitão, M; Donato, A; Freitas, D