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- A 10-Year Retrospective Analysis of Methyl Aminolevulinate Photodynamic Therapy Consultation at the Hospital de BragaPublication . Brito, C; Resende, C; Oliveira, PPhotodynamic therapy (PDT) is a well-established treatment for actinic keratosis (AK), basal cell carcinoma (BCC), and Bowen's disease (BD). The object of this study was to describe the results of a retrospective analysis of patients treated with methyl aminolevulinate PDT (MAL-PDT) with red light, over the past decade at the Hospital de Braga (Braga, Portugal).
- 20-year retrospective study of clinically non-functioning pituitary adenomas - a single center experiencePublication . Matta-Coelho, C; Ramos, R; Almeida, R; Marques, O
- 231 laparoscopic cholecystectomy in ambulatory: what results?Publication . Goulart, A; Delgado, M; Antunes, MC; Braga dos Anjos, JMntroduction: Laparoscopic cholecystectomy is the gold standard procedure for the treatment of lithiasic gallblader pathology and acute cholecystitis. Whether or not it should be done as ambulatory surgery is still being discussed. The present study aims to analyze the quality and safety of laparoscopic cholecystectomy conducted by the Ambulatory Unit of Hospital de Braga and compare the results with those from other European surgical centers performing LC as ambulatory surgery. Material and Methods: Observational prospective study of patients submitted to laparoscopic cholecystectomy in ambulatory surgery during a period of 26 months. Data regarding patients' demography, peri- and postoperative complications, surgical time, time in recovery room, and readmission rates was collected. Results: A total of 231 patients were subjected to Laparoscopic cholecystectomy in the ambulatory unit with overnight stay (time to discharge less than 24 hours). Three patients presented with intra-operative complications, which needed conversion to laparotomy, and four patients were admitted after surgery. The mean time for the procedure was 58 minutes and the mean time for recovery was 19h19 minutes. Postoperative morbidity was 7.8% with 2 nonscheduled admission having occurred. Discussion: One of the controversies regarding laparoscopic cholecystectomy as an outpatient procedure is the need for overnight hospital surveillance. In our unit, we have started LC on an outpatient basis with an overnight stay. Using this protocol, over the past two years, we have operated 231 patients and our results show that this is a completely safe technique. Conclusions: Data from the study suggests that LC is a safe technique when performed in ambulatory practice, having similar results to other european surgical centers.
- Abcesso isolado do clivus achados em ressonância magnética convencional: estudo de difusãoPublication . Fernandes, JS; Valle, JM; Morais, N; Ribeiro, M; Magalhães, Z; Moreira da Costa, JA; Rocha, J
- Abcesso ProstáticoPublication . Borges, N; Cabral-Ribeiro, J; Freire, J; Azevedo, TO abcesso da próstata é actualmente uma entidade pouco frequente, resultado de uma melhoria na terapêutica antibiótica. No entanto deve ser considerado em doentes com factores de risco (infecções urinárias complicadas) que no decurso de um quadro infeccioso, apresentam agravamento marcado da sintomatologia ou resposta inadequada à terapêutica. Apresentamos um caso clínico de um doente de 47 anos com diabetes mellitus não controlada, cujo abcesso prostático foi tratado com antibioterapia sistémica, associada a drenagem transrectal ecodirigida.
- Abdominal Catastrophe in Crohn's Disease SurgeryPublication . Palma Rios, H; Goulart, AM; Leão, PINTRODUCTION: Performing surgery on patients with Crohn's disease is a true challenge due to the elevated risk of complications related to the chronic proinflammatory response. Stenosis is the leading cause of intestinal resection in these patients. CASE REPORT: The authors present the case of a 50-year-old woman with inflammatory stenosis of the terminal ileum due to Crohn's disease. The patient underwent a laparoscopic ileocecal resection, which was complicated by a small anastomotic dehiscence with localized peritonitis. Several perforations and dehiscences were observed and necessitated an end ileostomy and an open abdomen treated with negative pressure wound therapy. Multiple surgical interventions in the abdomen were performed and negative pressure was maintained until all fistulas were sealed and granulation tissue formed. Patient was discharged after 134 days of hospitalization with both the abdomen and the ileostomy closed. After several months, a hernia repair was performed with bilateral component separation and polypropylene mesh without complications. CONCLUSIONS: Anastomotic dehiscence after intestinal resection can lead to an abdominal catastrophe. Severe peritonitis with enteric fistulas and an open abdomen demands a multidisciplinary approach. Negative pressure wound therapy and nutritional support are key treatments. In these patients, stoma closure and abdominal wall reconstruction after recovery from the acute event represents another surgical challenge.
- Abernethy malformation: beware in cases of unexplained hepatic encephalopathy in adults-case report and review of the relevant literaturePublication . Mesquita, RD; Sousa, M; Vilaverde, F; Cardoso, RThe Abernethy malformation consists of a congenital extrahepatic portosystemic shunt and is believed to be extremely rare in humans. The potential implications of abnormal portovenous shunting and decreased hepatic portal flow are numerous and potentially serious. Although congenital extrahepatic portosystemic shunts are increasingly suspected and diagnosed in specialized centres, much of their clinical presentation and natural history is not fully understood. Symptoms of portosystemic shunt are mainly caused by increased levels of ammonia, which lead to signs of encephalopathy. Therapeutic options depend on the type of shunt and its clinical course, so the classification of the congenital portosystemic shunt is a key finding in these patients.
- Accuracy of the new rapid test for monitoring adalimumab levelsPublication . Rocha, C; Afonso, J; Lago, P; Arroja, B; Vieira, AI; Dias, CC; Magro, FThe loss of response to adalimumab (ADL) has been related to low serum concentrations at trough. Currently, most methods commercially available for the quantification of ADL are enzyme-linked immunosorbent assay (ELISA) based, with a turnaround time of approximately 8 h, delaying the target dosage adjustment to the subsequent infusion. In this study, we aimed to evaluate the performance of the newly available rapid-test ADL quantification assay by comparing it with three established ELISA methods, using spiked samples and a set of clinical samples.
- Acetabular retroversion: Diagnosis and treatmentPublication . Direito-Santos, B; França, G; Nunes, J; Costa, A; Rodrigues, EB; Silva, AP; Varanda, PAcetabular retroversion (AR) consists of a malorientation of the acetabulum in the sagittal plane. AR is associated with changes in load transmission across the hip, being a risk factor for early osteoarthrosis. The pathophysiological basis of AR is an anterior acetabular hyper-coverage and an overall pelvic rotation.The delay or the non-diagnosis of AR could have an impact in the overall management of femoroacetabular impingement (FAI). AR is a subtype of (focal) pincer deformity.The objective of this review was to clarify the pathophysiological, diagnosis and treatment fundaments inherent to AR, using a current literature review.Radiographic evaluation is paramount in AR: the cross-over, the posterior wall and ischial spine signs are classic radiographic signs of AR. However, computed tomography (CT) evaluation permits a three-dimensional characterization of the deformity, being more reliable in its recognition.Acetabular rim trimming (ART) and periacetabular osteotomy (PAO) are the best described surgical options for the treatment of AR.The clinical outcomes of both techniques are dependent on the correct characterization of existing lesions and adequate selection of patients. Cite this article: EFORT Open Rev 2018;3:595-603. DOI: 10.1302/2058-5241.3.180015.
- Acidente Vascular Cerebral em Doente com Anemia de Células FalciformesPublication . Caridade, S; Machado, A; Ferreira, CStroke in patients with sickle cell anemia is multifactorial but occurs mainly by 2 mechanisms: occlusive arteriopathy and obliteration of small vessels with plugs of sickle cells. The high individual risk can be assessed by simple and well-defined strategies such as ultrasounds with transcranial and cervical Doppler Ultrasonography. The authors report the clinical case of a 25 year-old black female patient with sickle cell anemia, who was admitted with right hemiparesis. Cerebral MRI showed small recent fronto-temporo-parietal cortical-subcortical infarcts and several, older, posterior periventricular lacunae of left preponderance. A brief discussion is made, with particular emphasis on the proper treatment and prevention of its cerebrovascular complications.