Hospital de Santa Maria
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Congenital Thoracic Venous Anomalies in Adults: Morphologic MR Imaging
No full textCongenital anomalies of the thoracic veins are rare yet important developmental abnormalities, usually classified into systemic and pulmonary. They may be encountered incidentally; as such the radiologist must be aware of their imaging presentation and clinical relevance. Furthermore, to understand these anomalies, knowledge of the embryological development and of the normal anatomy of the thoracic veins is required. In the age of non-invasive imaging modalities, magnetic resonance is paramount for the characterization of these developmental abnormalities
Quercetin in Cancer Treatment, Alone or in Combination with Conventional Therapeutics?
Get PDFCancer is a problem of global importance, since the incidence is increasing worldwide and therapeutic options are generally limited. Thus, it becomes imperative to find new therapeutic targets as well as new molecules with therapeutic potential for tumors. Flavonoids are polyphenolic compounds that may be potential therapeutic agents. Several studies have shown that these compounds have a higher anticancer potential. Among the flavonoids in the human diet, quercetin is one of the most important. In the last decades, several anticancer properties of quercetin have been described, such as cell signaling, pro-apoptotic, anti-proliferative and anti-oxidant effects, growth suppression. In fact, it is now well known that quercetin has diverse biological effects, inhibiting multiple enzymes involved in cell proliferation, as well as, in signal transduction pathways. On the other hand, there are also studies reporting potential synergistic effects when combined quercetin with chemotherapeutic agents or radiotherapy. In fact, several studies which aim to explore the anticancer potential of these combined treatments have already been published, the majority with promising results. Actually it is well known that quercetin can act on the chemosensitization and radiosensitization but also as chemoprotective and radioprotective, protecting normal cells of the side effects that results from chemotherapy and radiotherapy, which obviously provides notable advantages in their use in anticancer treatment. Thus, all these data indicate that quercetin may have a key role in anticancer treatment. In this context, this review is focused on the relationship between flavonoids and cancer, with special emphasis on the role of quercetin
Copy number variants prioritization after array-CGH analysis - a cohort of 1000 patients
Get PDFArray-based comparative genomic hybridization has been assumed to be the first genetic test offered to detect genomic imbalances in patients with unexplained intellectual disability with or without dysmorphisms, multiple congenital anomalies, learning difficulties and autism spectrum disorders. Our study contributes to the genotype/phenotype correlation with the delineation of laboratory criteria which help to classify the different copy number variants (CNVs) detected. We clustered our findings into five classes ranging from an imbalance detected in a microdeletion/duplication syndrome region (class I) to imbalances that had previously been reported in normal subjects in the Database of Genomic Variants (DGV) and thus considered common variants (class IV).info:eu-repo/semantics/publishedVersio
Management of Intra-Abdominal Desmoid Tumours associated with Familial Adenomatous Polyposis (FAP)
Get PDFTécnica de colheita de autoenxerto ósseo no decurso de uma artroplastia primária da anca
Get PDFDurante a implantação de uma prótese primária da anca para o tratamento de uma coxartrose, pode haver necessidade de se recorrer à aplicação de enxertos ósseos, na condição de medida terapêutica complementar. Para isso, os autoenxertos ósseos provenientes da cabeça femoral excisada sob diversas formas, dimensões e tipos encontram a melhor indicação.
Descreve-se uma técnica simples e eficaz para a colheita de autoenxerto ósseo sob a forma de grânulos a partir da cabeça femoral artrósica, no decurso de uma artroplastia primária da anca
Doença Tumoral Acetabular E Reconstrução Com Prótese De Pedestal LUMiC® - Análise De 2 Casos Clínicos
No full textAs resseções peri-acetabulares e reconstrução subsequente estão entre os procedimentos mais desafiantes na Ortopedia Oncológica. Os autores apresentam 2 casos em que foram aplicadas endopróteses modulares tripolares de reconstrução peri-acetabular com pedestal do ilíaco e os seus resultados clínico-funcionais. Apresenta-se uma mulher de 70 anos com metastização óssea única ao nível do acetábulo esquerdo, com origem primária num tumor papilar do urotélio vesical de alto grau. Entretanto sofreu queda da própria altura, da qual resultou fratura-luxação central patológica da anca esquerda, com lesão lítica acetabular na zona de carga. Foi então submetida a cirurgia de resseção tumoral, com resseção total da zona II (peri-acetábulo) e resseção parcial da zona III (púbis) de Enneking. Aplicou-se uma prótese LUMiC® com pedestal no ilíaco, componente acetabular com rebordo anti-luxante e cúpula de dupla mobilidade. A nível femoral, foi aplicada uma haste de Wagner, com utilização de manga de Trevira para reinserções musculares. Apresenta-se uma jovem do sexo feminino de 26 anos referenciada ao nosso centro por cordoma coccígeo recidivado, com envolvimento de várias estruturas, entre as quais pilar posterior do acetábulo, vértebras sagradas, músculos pélvicos incluindo os glúteos e parede retal. Através de abordagem multi-disciplinar foi submetida a resseção tumoral, com necessidade de osteotomia superior a nível da 2ª vértebra sagrada e de resseção do canal anal e ânus, com realização da respetiva colostomia. Depois da remoção tumoral, foi realizada osteotomia da zona II do acetábulo e reconstrução com prótese de pedestal no ilíaco com componente acetabular com rebordo anti-luxante e cúpula de dupla mobilidade, com haste cimentada a nível femoral. Para encerramento posterior, foi realizada passagem transabdominal de retalho músculo-cutâneo do reto anterior do abdómen. O pós-operatório imediato de ambas as pacientes consistiu inicialmente em repouso no leito em decúbito dorsal, com almofada entre as pernas e tornozelos imobilizados, sendo apenas permitidas semi-lateralizações. Após 4 semanas, a primeira paciente iniciou levante com ortótese anti-abdutora da anca e às 16 semanas fazia marcha autónoma com apoio de canadianas.
Na segunda paciente foi constatada uma dismetria de 3,5cm, pelo que foi necessária osteotomia femoral homolateral de encurtamento para correção. Teve episódios de deiscências de suturas e ao fim de 8 semanas foi realizada a osteotomia. Às 10 semanas iniciou levante e deambulação com andarilho/canadianas, sem queixas dolorosas relevantes. A resseção e reconstrução acetabular são das cirurgias mais desafiantes a nível da Ortopedia Oncológica. A anatomia complexa, dimensão tumoral e proximidade a estruturas neuro-vascular major leva a que muitas vezes seja difícil de conseguir margens de resseção adequadas. Em segundo lugar, a reconstrução de um membro funcional e indolor é cirurgicamente exigente devido à extensão da resseção e à biomecânica complexa a restaurar. Por outro lado, as reconstruções deste calibre estão associadas a risco elevado de infeção, chegando a 40% em alguns relatos. Os autores apresentam 2 casos clínicos em que a reconstrução peri-acetabular com recurso a endoprótese com pedestal no ilíaco permitiu excelentes resultados clínico-funcionais, apesar de extensa resseção (zonas II e III). Como complicações apenas se verificou dismetria acentuada do membro. Esta complicação foi verificada intra-operatoriamente, no entanto, preferiu-se garantir estabilidade da prótese a nível do ilíaco e posteriormente corrigir a dismetria. As reconstruções acetabulares são cirurgias complexas de elevado risco. O aparecimento de próteses de reconstrução acetabular para grandes defeitos ósseos pós-resseções tumorais, tais como as próteses modulares tripolares com pedestal no ilíaco, e a sua correta aplicação e indicação, permitem obter resultados promissores no tratamento e recuperação funcional capaz destes pacientes
Doença Meningocócica Invasiva: Aplicação do Base Excess and Platelets Score numa Unidade de Cuidados Intensivos Pediátricos Portuguesa
Get PDFINTRODUCTION:
Meningococcal infection has a high mortality and morbidity. Recently a new prognostic scoring system was developed for paediatric invasive meningococcal disease, based on platelet count and base excess â base excess and platelets score. The main objective of this study was to evaluate the accuracy of base excess and platelets score to predict mortality in children admitted to intensive care due to invasive meningococcal disease.
MATERIAL AND METHODS:
Observational study, with retrospective data collection, during a 13.5 years period (01/2000 to 06/2013). Mortality by invasive meningococcal disease and related factors (organ dysfunction and multi-organ failure) were analysed. The base excess and platelets score was calculated retrospectively, to evaluate its accuracy in predicting mortality and compared with Paediatric Risk of Mortality and Paediatric Index of Mortality2.
RESULTS:
Were admitted 76 children with invasive meningococcal disease. The most frequent type of dysfunction was cardiovascular (92%), followed by hematologic (55%). Of the total, 47 patients (62%) had criteria for multi-organ failure. The global mortality was 16%. Neurologic and renal dysfunction showed the strongest association with mortality, adjusted odds ratio 315 (26 - 3 804) and 155 (20 - 1 299). After application of receiver operating characteristic curves, Base Excess and Platelets score had an area under curve of 0.81, Paediatric Index of Mortality2 of 0.91 and Paediatric Risk of Mortality of 0.96.
DISCUSSION:
The Base Excess and Platelets score showed good accuracy, although not as high as Paediatric Risk of Mortality or Paediatric Index of Mortality 2.
CONCLUSIONS:
The Base Excess and Platelets score may be useful tool in invasive meningococcal disease because is highly sensitive and specific and is objectively measurable and readily available at presentation
Endovascular recanalization of a hepatic vein in Budd-Chiari syndrome: a collateral loop-guided approach
Get PDFApplication of imaging guidelines in patients with foreign body ingestion or inhalation: literature review
No full textIngestion, inhalation, and insertion of foreign bodies (FBs) are very common clinical occurrences. In any case, early diagnosis and prompt management are mandatory to avoid severe and life-threatening complications. Radiologists have an important role in revealing the presence, dimension, nature, and relationship with anatomical structures of a FB; selecting the most appropriate imaging modality; and enabling the best therapeutic choice. This review article focuses on the most frequent FBs ingested, inhaled, and inserted and presents the different tests and investigations to provide a correct radiological approach
Prognosis following acute coronary syndromes according to prior coronary artery bypass grafting: Meta-analysis
No full textPURPOSE:
Conduct a meta-analysis to study the prognostic influence of a previous coronary artery bypass grafting (CABG) in patients admitted for an acute coronary syndrome (ACS).
METHODS:
A systematic review of the literature was performed using electronic reference databases through January 2013 (MEDLINE, Cochrane Library, Web of Knowledge, Google Scholar and references cited in other studies). Studies in which ACS outcomes with a previous history of CABG were compared with ACS outcomes with no history of previous CABG were considered for inclusion. The main endpoints of interest were mortality and non-fatal acute myocardial infarction. Data was aggregated at three follow-up times using random-effects meta-analysis models.
RESULTS:
Twenty-four studies were included which provided 387,181 patients for analysis. Previous CABG ACS patients were older, more diabetic and had a more frequent history of a previous myocardial infarction. Pooled in-hospital mortality was higher for the previous CABG ACS patients (OR 1.22 [1.04-1.44], p<0.01, I(2) 88%). The pooled adjusted OR showed no significant differences for the two groups (adjusted OR 1.13 [0.93-1.37], p=0.22, I(2) 92%). Previous CABG ACS patient had a higher pooled 30-day mortality (OR 1.28 [1.05-1.55], p=0.02, I(2) 74%); a higher non-adjusted (OR 1.61 [1.38-1.88], p<0.01, I(2) 70%) and adjusted (adjusted OR 1.37 [1.15-1.65], p<0.01, I(2) 0%) long-term mortality. Both the in-hospital and the long-term re-infarction rates were higher for the previous CABG ACS patients.
CONCLUSIONS:
According to our data, ACS patients with previous CABG history had a higher risk for short- and long-term adverse events