Browsing by Issue Date, starting with "2008"
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- Esophagectomy with colon reconstruction for achalasiaPublication . Leão, P; Botelho, P; Luís, D; Gomes, A
- O “paradoxo dos fumadores” revisitado.Publication . Gaspar, A; Nabais, S; Torres, M; Rocha, S; Brandão, A; Azevedo, P; Álvares-Pereira, M; Correia, AIntrodução: O termo “paradoxo dos fumadores” surgiu na sequência de vários estudos que descreveram uma menor mortalidade a curto prazo nos doentes com história de tabagismo, internados com Síndrome Coronário Agudo (SCA). No entanto, trabalhos mais recentes têm contestado a existência deste fenómeno. Objectivo: Avaliar a ocorrência do “paradoxo dos fumadores” na nossa população de doentes internados por SCA. Métodos: Foram analisados 1228 doentes admitidos consecutivamente por SCA de Janeiro 2004 a Março 2007. Os doentes foram classificados em 2 grupos, o grupo I incluindo os doentes sem história de tabagismo (n=778) e o grupo II os doentes com história de tabagismo (n=450). Os “endpoints” foram a morte no internamento e morte total aos 6 meses. Resultados: Verificou-se que os doentes sem história de tabagismo eram mais idosos (68,25 ± 12,22 anos contra 58,13 ± 11,91 anos), mais frequentemente do sexo feminino, e apresentavam com maior frequência diabetes mellitus (DM), hipertensão arterial (HTA) e insuficiência renal (p <0,05). Os doentes que nunca fumaram tiveram mais frequentemente enfarte agudo do miocárdio (EAM) sem supra de ST enquanto os doentes com história de tabagismo tiveram mais EAM com supra de ST (p <0,05). Os doentes sem história de tabagismo eram mais frequentemente medicados com nitratos, diuréticos e antagonistas de cálcio e menos com β – bloqueadores (p <0,05), não se tendo encontrado diferenças quanto à restante terapêutica médica. Os doentes com história tabágica foram mais frequentemente submetidos a coronariografia (p <0,01). Apesar de se observar, na análise univariável, maior mortalidade intra-hospitalar e aos 6 meses nos doentes sem antecedente de tabagismo (p <0,05), a análise multivariável, com o ajuste para os factores de risco mais reconhecidos (idade, classe KK na admissão, pressão arterial sistólica e frequência cardíaca na admissão, disfunção ventricular esquerda, presença de insuficiência renal) não permitiu confirmar esta associação. Conclusão: Na nossa população de doentes internados por SCA, não se verificou nenhum “paradoxo dos fumadores”. A ocorrência de maior mortalidade observada entre os doentes sem história de tabagismo correlaciona-se provavelmente com as diferenças das características basais dos doentes, nomeadamente idade mais avançada e maior número de co-morbilidades (DM, HTA e insuficiência renal).
- Coexistence of coronary cameral fistulae and cor triatriatum sinister in an elderly patientPublication . Nabais, S; Salomé, N; Brandão, A; Simões, A; Marques, J; Costa, J; Basto, L; Costeira, A; Correia, ACoronary cameral fistulae are unusual congenital or acquired anomalous communications between an epicardial coronary artery and a cardiac chamber. There are no reported cases of the association of coronary cameral fistulae and cor triatriatum, a rare congenital cardiac anomaly in which a fibromuscular membrane divides the left atrium into two chambers. We report the case of an 82-year-old man presenting with recurrent anterior chest pain. Echocardiographic examination identified non-obstructive cor triatriatum, mitral valve prolapse resulting in significant mitral regurgitation, dilated coronary arteries, and established the entry site of coronary artery fistulae at the apex of the left ventricle (Figure 1). Coronary angiography confirmed the existence of a plexiform fistula between the left anterior descending coronary artery and the left ventricle. Tetrofosmine scintigraphy revealed the presence of stress-induced ischaemia in the apex. To our knowledge, we report the oldest person with coronary cameral fistulae presenting with angina only at this stage, and the interesting case of the coexistence of two, although unconnected, congenital conditions in an elderly patient. In addition, this report highlights the important role of transthoracic and transoesophageal echocardiography to the characterization of these unusual anomalies, and the complementary information offered by three-dimensional transthoracic echocardiography.
- Diffusion-weighted MR imaging findings in an isolated abscess of the clivusPublication . Soares-Fernandes, JP; Valle-Folgueral, JM; Morais, N; Ribeiro, M; Moreira da Costa, JAWe report the finding of restricted diffusion in an isolated abscess of the clivus and discuss the imaging differential diagnosis, with an emphasis on the usefulness of diffusion-weighted imaging.
- Prognostic impact of moderate renal dysfunction in acute coronary syndromesPublication . Nabais, S; Rocha, S; Costa, J; Marques, J; Torres, M; Magalhães, S; Pereira, MA; Correia, AINTRODUCTION: End-stage renal disease is associated with high cardiovascular mortality. The prognostic importance of milder degrees of renal impairment in patients who have had an acute coronary syndrome (ACS) is less well defined. The purpose of this study was to evaluate the impact of baseline renal dysfunction assessed by estimated glomerular filtration rate (GFR) on mortality in patients admitted with an ACS. METHODS: We studied all patients with an ACS consecutively admitted to an Intensive Cardiac Care Unit over 18 months. The GFR was estimated by means of the four-component Modification of Diet in Renal Disease study equation. Patients were grouped according to their estimated GFR (less than 45.0; 45.0 to 59.9; 60.0 to 74.9; and at least 75.0 ml/min/1.73 m2). Primary outcome was death from any cause. RESULTS: The mean age of the 589 study patients was 64.1 years, 73.7% were male, and 49.2% had an ACS with ST-segment elevation. Arterial hypertension, diabetes mellitus, prior myocardial infarction, and Killip class > I were incrementally more common across increasing renal dysfunction strata (p < 0.01). The use of reperfusion therapy, beta-blockers, and coronary angioplasty was lower in groups with reduced estimated GFR (p < 0.001). Overall six-month mortality was 13.6%. Using the group with an estimated GFR of at least 75.0 ml/min/1.73 m2 as the reference group yielded odds ratios for six-month mortality that increased with the degree of renal impairment. After adjusting for baseline characteristics, impaired renal funtion remained associated with increased mortality. The multivariable-adjusted odds ratio for six-month mortality in patients with mild renal impairment (GFR 60.0 to 74.9 ml/min/1.73 m2) was 2.71 (95% confidence interval [CI] 1.09 to 6.69), compared with 7.53 (95% CI, 3.21 to 17.71) and 8.10 (95% CI, 3.18 to 20.60) in patients with moderate and more severe renal dysfunction, respectively. CONCLUSIONS: Baseline renal dysfunction, as assessed by estimated GFR, is a potent and easily identifiable determinant of outcome after an ACS. Even mild levels of renal impairment are independently associated with increased mortality after an ACS.
- Hérnia de MorgagniPublication . Leão, P; Carneiro, T; Luís, D; Gomes, A
- Lesões TalâmicasPublication . Morais, N; Oliveira, J; Afonso, M; Abreu-Lima, J; Moreira da Costa, JA; Serviço de Neurocirurgia, Hospital de Braga
- Intrasellar rupture of a paraclinoid aneurysm with subarachnoid hemorrhage: usefulness of MR imaging in diagnosisPublication . Ribeiro, M; Howard, P; Willinsky, R; Brugge, K; Agid, R; Thines, L; Costa, LCharacterization of paraclinoid aneurysms may be difficult because of the complexity of anatomic structures involved, and differentiation between intradural and extradural lesions is crucial. We report a case of a patient with a unique presentation of a paraclinoid aneurysm with intrasellar hemorrhage in which the presence of intrasellar blood and the relationship of the paraclinoid aneurysmal neck and sac to the dural rings were elegantly demonstrated on MR imaging and were critical in choosing the target lesion for treatment.
- Tratamiento quirúrgico de duplicidad peneana completaPublication . Carvalho, AP; Ramires, R; Soares, J; Carvalho, LF; Filinto, MPenile duplication is a rare anomaly with an incidence of 1 in 5,500,000. It is almost associated with other malformations like double bladder, presence of the cloaca, imperforate anus, duplication of the recto sigmoid and vertebral deformities. The authors present the surgical technique to resolve a rare case of complete penile duplication in a 4 years old child, without any other malformation.
- Ratio dos Gânglios Linfáticos Metastizados como Factor de Prognóstico no Carcinoma GástricoPublication . Leão, P; Braga dos Anjos, JM; Gomes, A