Browsing by Author "Carvalho, AF"
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- Day and night surgery: is there any influence in the patient postoperative period of urgent colorectal intervention?Publication . Fernandes, S; Carvalho, AF; Rodrigues, AJ; Costa, P; Sanz, M; Goulart, A; Rios, H; Leão, PBACKGROUND: Medical activity performed outside regular work hours may increase risk for patients and professionals. There is few data with respect to urgent colorectal surgery. The aim of this work was to evaluate the impact of daytime versus nighttime surgery on postoperative period of patients with acute colorectal disease. METHODS: A retrospective study was conducted in a sample of patients with acute colorectal disease who underwent urgent surgery at the General Surgery Unit of Braga Hospital, between January 2005 and March 2013. Patients were stratified by operative time of day into a daytime group (surgery between 8:00 and 20:59) and the nighttime group (21:00-7:59) and compared for clinical and surgical parameters. A questionnaire was distributed to surgeons, covering aspects related to the practice of urgent colorectal surgery and fatigue. RESULTS: A total of 330 patients were included, with 214 (64.8%) in the daytime group and 116 (35.2%) in the nighttime group. Colorectal cancer was the most frequent pathology. Waiting time (p < 0.001) and total length of hospital stay (p = 0.008) were significantly longer in the daytime group. There were no significant differences with respect to early or late complications. However, 100% of surgeons reported that they are less proficient during nighttime. CONCLUSIONS: Among patients with acute colorectal disease subjected to urgent surgery, there was no significant association between nighttime surgery and the presence of postoperative medical and surgical morbidities. Patients who were subjected to daytime surgery had longer length of stay at the hospital.
- Epigastric pain: Incarceration or rotation?Publication . Carvalho, AF; Rodrigues, AJ; Leão, P
- Extensive Subcutaneous Emphysema as a Presentation of Ischemic ColitisPublication . Carvalho, AF; Branco, C; Leão, P; Antunes, CIntroduction. Subcutaneous emphysema is usually benign and self-limited; however, it may be associated with a life-threating situation. Case Report. An elderly woman with progressive malaise with extensive subcutaneous emphysema (cervical to abdominal wall) was observed at the emergency department. Colonic perforation was diagnosed and the patient underwent surgery. Intraoperatively, necrosis and perforation of the sigmoid colon into the retroperitoneum were found and a Hartmann procedure was performed. Conclusion. Cervical and thoracic subcutaneous emphysema may be the first sign of intra-abdominal lesion.
- Omental whirl associated with bilateral inguinal hernia: a case reportPublication . Silva, E; Carvalho, AF; Rocha, D; Rodrigues, AM; Pereira, R; Rodrigues, AJ; Leão, PTorsion of the omentum is a rare cause of abdominal pain. It is clinically similar to common causes of acute surgical abdomen and is often diagnosed during surgery. Inguinal hernia is a common condition but not frequently related with torsion of the omentum. CASE PRESENTATION: A 40-year-old Caucasian man came to our emergency department with abdominal pain of the left quadrant and abdominal distension for 2 days. His medical history included an untreated left inguinal hernia in the last year. Computed tomography revealed densification of mesocolon with left omentum "whirl" component and other signs of omental torsion. During an exploratory laparoscopy, a wide twist of his omentum with necrotic alterations that extended to the bilateral inguinal hernial content was observed. Omentectomy and surgical repair of bilateral inguinal hernia were performed. CONCLUSIONS: Torsion of the omentum is a rare entity and usually presents a diagnostic challenge. The use of abdominal computed tomography can help diagnosing torsion of the omentum preoperatively and, thus, prevents a surgical approach. Nonetheless, some cases of torsion of the omentum require surgical repair. Accordingly, a laparoscopic approach is minimally invasive and efficient in performing omentectomy.
- Submucosal lesion of the oesophagus: not everything is what it seemsPublication . Carvalho, AF; Rodrigues, AJ; Sousa, N; Leão, P
- The Impact of Prenatal Exposure to Dexamethasone on Gastrointestinal Function in RatsPublication . Ramalhosa, F; Soares-Cunha, C; Seixal, RM; Sousa, N; Carvalho, AFAntenatal treatment with synthetic glucocorticoids is commonly used in pregnant women at risk of preterm delivery to accelerate tissue maturation. Exposure to glucocorticoids during development has been hypothesized to underlie different functional gastrointestinal (GI) and motility disorders. Herein, we investigated the impact of in utero exposure to synthetic glucocorticoids (iuGC) on GI function of adult rats. Wistar male rats, born from pregnant dams treated with dexamethasone (DEX), were studied at different ages. Length, histologic analysis, proliferation and apoptosis assays, GI transit, permeability and serotonin (5-HT) content of GI tract were measured. iuGC treatment decreased small intestine size and decreased gut transit. However, iuGC had no impact on intestinal permeability. iuGC differentially impacts the structure and function of the GI tract, which leads to long-lasting alterations in the small intestine that may predispose subjects prone to disorders of the GI tract.
- Trait determinants of impulsive behavior: a comprehensive analysis of 188 ratsPublication . Soares, AR; Esteves, M; Moreira, PS; Cunha, AM; Guimarães, MR; Carvalho, MM; Raposo-Lima, C; Morgado, P; Carvalho, AF; Coimbra, B; Melo, A; Rodrigues, AJ; Salgado, AJ; Pêgo, JM; Cerqueira, JJ; Costa, P; Sousa, N; Almeida, A; Leite-Almeida, HImpulsivity is a naturally occurring behavior that, when accentuated, can be found in a variety of neuropsychiatric disorders. The expression of trait impulsivity has been shown to change with a variety of factors, such as age and sex, but the existing literature does not reflect widespread consensus regarding the influence of modulating effects. We designed the present study to investigate, in a cohort of significant size (188 rats), the impact of four specific parameters, namely sex, age, strain and phase of estrous cycle, using the variable delay-to-signal (VDS) task. This cohort included (i) control animals from previous experiments; (ii) animals specifically raised for this study; and (iii) animals previously used for breeding purposes. Aging was associated with a general decrease in action impulsivity and an increase in delay tolerance. Females generally performed more impulsive actions than males but no differences were observed regarding delay intolerance. In terms of estrous cycle, no differences in impulsive behavior were observed and regarding strain, Wistar Han animals were, in general, more impulsive than Sprague-Dawley. In addition to further confirming, in a substantial study cohort, the decrease in impulsivity with age, we have demonstrated that both the strain and sex influences modulate different aspects of impulsive behavior manifestations.
- What is in? Pneumoperitoneum after sexual intercoursePublication . Botelho, P; Carvalho, AF; Torrão, H; Leão, P