Gastrenterologia
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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.
- Adenocarcinoma do pâncreas localmente avançado e metastizado com resposta completa a quimioterapiaPublication . Freire, P; Coelho, AJ; Rodrigues, A; Silva, MR; Lapa, P; Graça, B; Porto, AOs autores apresentam o caso clínico de doente do sexo feminino, 54 anos, raça branca, que recorreu ao médico assistente por dor abdominal associada a manifestações constitucionais. A ecografia revelou massa pancreática e formações nodulares hepáticas compatíveis com lesões secundárias, resultado posteriormente corroborado por tomografia computorizada, que acrescentou critérios de irressecabilidade, nomeadamente invasão dos vasos mesen- téricos e do duodeno. A biopsia ecoguiada obteve material cujo estudo anatomopatológico revelou tratar-se de adeno- carcinoma do pâncreas. Iniciou quimioterapia, verifican- do-se melhoria clínica progressiva. A reavaliação imagio- lógica, após 7 ciclos de tratamento, não detectou a lesão primitiva nem as lesões secundárias, sugerindo resposta completa. Foi mantido esquema regular de quimioterapia, persistindo a remissão 8 meses após a documentação da resposta completa.
- 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.
- Automatic polyp detection in pillcam colon 2 capsule images and videos: preliminary feasibility reportPublication . Figueiredo, P; Figueiredo, IN; Prasath, S; Tsai, RBackground. The aim of this work is to present an automatic colorectal polyp detection scheme for capsule endoscopy. Methods. PillCam COLON2 capsule-based images and videos were used in our study. The database consists of full exam videos from five patients. The algorithm is based on the assumption that the polyps show up as a protrusion in the captured images and is expressed by means of a P-value, defined by geometrical features. Results. Seventeen PillCam COLON2 capsule videos are included, containing frames with polyps, flat lesions, diverticula, bubbles, and trash liquids. Polyps larger than 1 cm express a P-value higher than 2000, and 80% of the polyps show a P-value higher than 500. Diverticula, bubbles, trash liquids, and flat lesions were correctly interpreted by the algorithm as nonprotruding images. Conclusions. These preliminary results suggest that the proposed geometry-based polyp detection scheme works well, not only by allowing the detection of polyps but also by differentiating them from nonprotruding images found in the films.
- 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.
- Beyond Maastricht IV: are standard empiric triple therapies for Helicobacter pylori still useful in a South-European country?Publication . Almeida, N; Donato, MM; Romãozinho, JM; Luxo, C; Cardoso, O; Cipriano, MA; Marinho, C; Fernandes, A; Calhau, C; Sofia, CBACKGROUND: Empiric triple treatments for Helicobacter pylori (H. pylori) are increasingly unsuccessful. We evaluated factors associated with failure of these treatments in the central region of Portugal. METHODS: This single-center, prospective study included 154 patients with positive (13)C-urea breath test (UBT). Patients with no previous H. pylori treatments (Group A, n = 103) received pantoprazole 40 mg 2×/day, amoxicillin 1000 mg 12/12 h and clarithromycin (CLARI) 500 mg 12/12 h, for 14 days. Patients with previous failed treatments (Group B, n = 51) and no history of levofloxacin (LVX) consumption were prescribed pantoprazole 40 mg 2×/day, amoxicillin 1000 mg 12/12 h and LVX 250 mg 12/12 h, for 10 days. H. pylori eradication was assessed by UBT 6-10 weeks after treatment. Compliance and adverse events were assessed by verbal and written questionnaires. Risk factors for eradication failure were determined by multivariate analysis. RESULTS: Intention-to-treat and per-protocol eradication rates were Group A: 68.9% (95% CI: 59.4-77.1%) and 68.8% (95% CI: 58.9-77.2%); Group B: 52.9% (95% CI: 39.5-66%) and 55.1% (95% CI: 41.3-68.2%), with 43.7% of Group A and 31.4% of Group B reporting adverse events. Main risk factors for failure were H. pylori resistance to CLARI and LVX in Groups A and B, respectively. Another independent risk factor in Group A was history of frequent infections (OR = 4.24; 95% CI 1.04-17.24). For patients with no H. pylori resistance to CLARI, a history of frequent infections (OR = 4.76; 95% CI 1.24-18.27) and active tobacco consumption (OR = 5.25; 95% CI 1.22-22.69) were also associated with eradication failure. CONCLUSIONS: Empiric first and second-line triple treatments have unacceptable eradication rates in the central region of Portugal and cannot be used, according to Maastricht recommendations. Even for cases with no H. pylori resistance to the used antibiotics, results were unacceptable and, at least for CLARI, are influenced by history of frequent infections and tobacco consumption.
- 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.
- Capsule endoscopy assisted by traditional upper endoscopyPublication . Almeida, N; Figueiredo, P; Lopes, S; Freire, P; Lérias, C; Gouveia, H; Leitão, MBACKGROUND AND AIMS: Capsule endoscopy (CE) can be prevented by difficulties in swallowing the device and/or its gastric retention. In such cases, endoscopic delivery of the capsule to duodenum is very useful. We describe the indications and outcomes of cases in which traditional endoscopic techniques allowed placement of the capsule in duodenum. PATIENTS AND METHODS: This is a retrospective, descriptive case series. All patients in the above conditions were identified and indications for CE, endoscopic-placement technique, complications and completeness of small bowel imaging were registered. RESULTS: Endoscopic-assisted delivery of the capsule was necessary in 13 patients (2.1% of all CE; 7 males; mean age--47.9 +/- 24.9 years, range 13 to 79 years). Indications for endoscopic delivery included: inability to swallow the capsule (7), gastric retention in previous exams (3), abnormal upper gastrointestinal anatomy (3). In eight patients, the capsule was introduced in GI tract with: foreign body retrieval net alone (3), retrieval net and a translucent cap (2), prototype delivery device (2) or a polypectomy snare (1). Five patients ingested the capsule that was then placed in duodenum with a polypectomy snare (3) or a retrieval net (2). No major complications occurred. Complete small bowel examination was possible in 10 patients (77%). CONCLUSIONS: Endoscopic placement of capsule endoscope in the duodenum is rarely needed. However it may be safely performed by different techniques avoiding some limitations of CE. The best methods for endoscopic delivery of the capsule in the duodenum seem to be retrieval net with a translucent cap when the patient is unable to swallow the device or a retrieval net only to capture the capsule in the stomach when the patients swallows it easily.