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- Air embolism as a complication of venovenous bypass during liver transplant for diffuse hemangiomatosisPublication . Viana, JS; Furtado, E; Romero, A; Furtado, AL
- An unusual cause of acute cardiogenic shock in the operating roomPublication . Baptista, R; Fonseca, J; Marconi, L; Furriel, F; Prieto, D; Bento, C; Antines, MJ; Figueiredo, AA 51-year-old man with a renal carcinoma with inferior vena cava (IVC) invasion was referred to our hospital for the performance of a radical nephrectomy with IVC thrombus excision. To prevent embolism, an IVC filter was implanted the day before surgery below the suprahepatic veins. On nephrectomy completion, the clinical status of the patient started to deteriorate and an unsuccessful attempt was made to excise the IVC thrombus. The patient developed profound refractory hypotension without significant bleeding and worsening splanchnic stasis was noted. A transesophageal echocardiogram was immediately performed in the operating room, revealing a hemispheric mass protruding from the IVC ostium to the right atrium, completely blocking all venous return. Volume depletion was evident by low left and right atrial volumes and increased septum mobility. No other abnormalities were found that could explain the shock, namely ventricular dysfunction or valvular disease. Cardiac surgery consultation was immediately obtained, ultimately deciding to perform a median sternotomy with direct exploration of right atrium. Under cardiopulmonary bypass, a 6-cm long thrombotic mass was identified, involving the IVC filter, blocking all lower body venous return; the removal of the mass reversed the shock. The patient had an uneventful recovery. Adverse outcomes associated with IVC filters are common. Our case highlights the importance of a team approach to rapid changes in hemodynamic status in the operating room, including the surgeon, the anesthesiologist, and the cardiologist. It also emphasizes the pivotal role of transesophageal echocardiogram in the clinical evaluation of severely unstable patient
- Anti-inflammatory, anti-proliferative and antioxidant profiles of selective cyclooxygenase-2 inhibition as chemoprevention for rat bladder carcinogenesisPublication . Parada, B; Sereno, J; Reis, F; Teixeira-Lemos, E; Garrido, P; Pinto, AF; Xavier da Cunha, MF; Pinto, R; Mota, A; Figueiredo, A; Teixeira, FPURPOSE: To evaluate the efficacy of a selective cyclooxygenase-2 (COX-2) inhibitor in rat bladder cancer chemoprevention, as well as to assess the relevance of inflammation, proliferation and oxidative stress in tumor growth and in its prevention. RESULTS: The main findings were: (I) the incidence of carcinoma was: control: 0% (0/8); BBN: 65% (13/20); CEL: 0% (0/8) and BBN + CEL: 12.5% (1/8); (II) the mean tumor volume per rat with tumor and per tumor were significantly lower in the BBN + CEL group (21.2 and 5.3 +/- 0.4 mm(3)) vs. BBN (138.5 +/- 7.5 and 112.5 +/- 6.4 mm(3)); (III) the incidence of pre-neoplasic (hyperplasia and dysplasia) and neoplasic (papillary tumors and carcinoma in situ-CIS) lesions were notoriously reduced in the CEL + BBN treatment; (IV) CEL significantly reduced serum TGFbeta1 and CRP and increase TNFalpha and IL-1beta (p < 0.001); (V) CEL reduced MDA formation in serum (p < 0.001) and liver (p < 0.05) and also showed a trend to reduction in kidney. METHODS: Drug treatments were performed during the first 8 w, followed by 12 w for tumor expression/prevention, in the following groups: control-vehicle; carcinogen-0.05% of N-butyl-N-(4-hydroxybutyl)nitrosamine (BBN); celecoxib (CEL)-10 mg/kg/day and preventive CEL + BBN. The bladders were analyzed for number and volume of tumor and nature of urothelium lesions. Serum was assessed for markers of inflammation, proliferation and redox status. CONCLUSIONS: Celecoxib has demonstrated an outstanding inhibitory effect on bladder cancer chemoprevention, which might be due to its expected anti-inflammatory actions, as well as by anti-proliferatory and antioxidant actions. This data supports a pivotal role of cancer chemoprevention strategies based on COX-2 inhibition.
- Cadaveric donor factor variations during a 12-year period: influence on kidney transplant outcomesPublication . Nunes, P; Parada, B; Pratas, J; Roseiro, A; Figueiredo, A; Macário, F; Rolo, F; Mota, AOur purpose was to evaluate changes in cadaveric donor factors between 1993 and 2004 and their impact on the short- and long-term outcomes of renal transplants in a single center. PATIENTS AND METHODS: Cadaveric renal transplants performed in our unit between 1993 and 2004 were divided in two groups of identical length: A (n = 455; 1993-1998) and B (n = 465; 1999-2004). Major differences related to donor, graft, and recipient factors were analyzed between groups and correlated with main outcome parameters. Recipient age, gender, weight, etiology of end-stage renal disease, average length of dialysis, and cold ischemia were not different in the two periods. RESULTS: Grafts harvested in our hospital were more frequent in group A (92.3 vs 78.2%; P < .005). Traumatic causes of death were more frequent before 1999: 90.9 vs 70.9% (P < .001). Mean donor age was higher after 1999: 31.37 vs 35.94 years (P < .005). Female donors were more frequent in the second period: 20.5 vs 26.6% (P < .05). Mean donor weight was also higher: 52.36 vs 67.86 kg (P < .05). All of these differences were unfavourable characteristics regarding graft outcomes. Delayed graft function (A = 13%, B = 24.2%), acute rejection episodes (A = 41.2%, B = 28%), and chronic allograft dysfunction (A = 23.5%, B = 14.4%) were also significantly different between the two cohorts (P < .005). Graft function (serum creatinine at 1 and 2 years), patient and graft survivals, causes of graft loss, and of patient death were similar across time. CONCLUSION: The unfavorable tendency in the quality of cadaveric donors during the last 12 years had no negative impact on graft function and patient outcome.
- Calcineurin inhibitor-free immunosuppression in renal transplantationPublication . Parada, B; Mota, A; Nunes, P; Macário, F; Pratas, J; Bastos, C; Figueiredo, APURPOSE: To describe our initial results using a calcineurin inhibitor-free immunosuppression protocol in renal transplants. PATIENTS AND METHODS: Between October 2001 and June 2003, 56 recipients of a renal allografts were started on an immunosuppression protocol without calcineurin inhibitors, consisting of basiliximab, sirolimus, mycophenolate mofetil, and steroids. We analyzed patient and graft survival, acute rejection episodes, and renal function. RESULTS: The mean follow-up was 19.6 months. Actuarial patient survival at 1 and 2 years was 98.1% and 95.3%, respectively. Actuarial graft survival at 1 and 2 years was 92.9% and 87.6%, respectively. Acute rejection occurred in 27.8% of the patients, usually Banff 1 (73.3%). There was stable renal function with mean serum creatinine of 1.3, 1.4, 1.3, and 1.3 mg/dL at 1, 6, 12, and 24 months after transplant. CONCLUSIONS: The use of immunosuppression free of calcineurin inhibitors is effective and safe. Further follow-up is needed to evaluate the impact on long-term results.
- Chemopreventive Efficacy of Atorvastatin against Nitrosamine-Induced Rat Bladder Cancer: Antioxidant, Anti-Proliferative and Anti-Inflammatory PropertiesPublication . Parada, B; Reis, F; Pinto, A; Sereno, J; Xavier-Cunha, M; Neto, P; Rocha-Pereira, P; Mota, A; Figueiredo, A; Teixeira, FTo investigate the anti-carcinogenic effects of Atorvastatin (Atorva) on a rat bladder carcinogenesis model with N-butyl-N-(4-hydroxibutil)nitrosamine (BBN), four male Wistar rat groups were studied: (1) Control: vehicle; (2) Atorva: 3 mg/kg bw/day; (3) Carcinogen: BBN (0.05%); (4) Preventive Atorva: 3 mg/kg bw/day Atorva + BBN. A two phase protocol was used, in which the drug and the carcinogen were given between week 1 and 8 and tumor development or chemoprevention were expressed between week 9 and 20, when the bladders were collected for macroscopic, histological and immunohistochemical (p53, ki67, CD31) evaluation. Serum was assessed for markers of inflammation, proliferation and redox status. The incidence of bladder carcinoma was: control 0/8 (0%); Atorva 0/8 (0%); BBN 13/20 (65%) and Atorva + BBN 1/8 (12.5%). The number and volume of tumors were significantly lower in the Atorva + BBN group, with a marked reduction in hyperplasia, dysplasia and carcinoma in situ lesions. An anti-proliferative, anti-inflammatory and antioxidant profile was also observed in the preventive Atorva group. p53 and ki67 immunostaining were significantly increased in the BBN-treated rats, which was prevented in the Atorva + BBN group. No differences were found for CD31 expression. In conclusion, Atorvastatin had a clear inhibitory effect on bladder cancer development, probably due to its antioxidant, anti-proliferative and anti-inflammatory properties.
- The Coimbra University Hospital experience in liver transplantation in patients with familial amyloidotic polyneuropathyPublication . Perdigoto, R; Furtado, AL; Furtado, E; Oliveira, FJ; Geraldes, B; Mota, O; Ferrão, J; Tomé, L; Viana, JS
- Colangiocarcinoma Intra-HepáticoPublication . Castro e Sousa, F; Tavares da Silva, E; Tralhão, JG; Costa, B; Martins, M; Serôdio, M; Martins, RIntrodução: o colangiocarcinoma intra-hepático (CCIhp) é um tumor maligno raro, normalmente diagnosticado num estadio avançado. São objectivos deste estudo avaliar os resultados da terapêutica do CCIhp e os factores prognósticos com significado estatístico na sobrevida de doentes com esta entidade nosológica tratados no nosso Serviço. Material e métodos: Vinte e um doentes submetidos a tratamento por CCIhp nos últimos anos, dos quais onze foram operados com intuitos curativos: quatro hepatectomias esquerdas, duas hepatectomias esquerdas alargadas aos segmentos V e VIII, duas hepatectomias direitas, duas bissegmentectomias e uma trissegmentectomia. Resultados: a mortalidade per-operatória foi de 0% e a pós-operatória (três meses) de 6%. As sobrevidas cumulativas aos 5 anos foram de 14% no total da população, 26% nos doentes submetidos a cirurgia com intuitos curativos e 26% para a sobrevida cumulativa livre de doença. Observou-se recidiva tumoral hepática em cinco doentes, a qual ocorreu aos 1,09 ± 0,82 anos (limites: 0,24-2,08). Os factores que influenciaram a sobrevida da globalidade dos doentes foram o tratamento cirúrgico com intuitos curativos (p=0,028), a presença de invasão vascular (p=0,002) e o valor da fosfatase alcalina no momento do diagnóstico (p=0,044). Entre os doentes operados com intuitos curativos, a presença de invasão vascular influenciou a sobrevida global (p=0,025) e a sobrevida livre de doença (p=0,002). Conclusões: A ressecção cirúrgica com intuitos curativos aumentou, de forma estatisticamente significativa, a sobrevida dos doentes com CCIhp. No entanto, sendo o diagnóstico geralmente tardio, apenas uma pequena percentagem destes doentes pode beneficiar deste tratamento.
- Cytokine-producing T lymphocytes as a marker of prognosis and rejection episodes in orthotopic liver transplantationPublication . Paiva, A; Pereira, SV; Ballesteros, R; Freitas, A; Perdigoto, R; Mota, O; Ferrão, J; Tomé, L; Furtado, E; Cipriano, MA; Geraldes, B; Oliveira, FJ; Furtado, AL; Regateiro, FJ
- De novo tacrolimus – associated hemolytic uremic syndrome after renal transplantation - Case reportPublication . Neto, P; Lopes, K; Macário, F; Alves, R; Mota, A; Campos, M