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- STATs in Lung Development: Distinct Early and Late Expression, Growth Modulation and Signaling Dysregulation in Congenital Diaphragmatic HerniaPublication . Piairo, P; Moura, RS; Baptista, MJ; Correia-Pinto, J; Nogueira-Silva, CCongenital diaphragmatic hernia (CDH) is a life-threatening developmental anomaly, intrinsically combining severe pulmonary hypoplasia and hypertension. During development, signal transducers and activators of transcription (STAT) are utilized to elicit cell growth, differentiation, and survival.
- Neuroendocrine factors regulate retinoic acid receptors in normal and hypoplastic lung developmentPublication . Pereira-Terra, P; Moura, RS; Nogueira-Silva, C; Correia-Pinto, JRetinoic acid (RA) and ghrelin levels are altered in human hypoplastic lungs when compared to healthy lungs. Although considerable data have been obtained about RA, ghrelin and bombesin in the congenital diaphragmatic hernia (CDH) rat model, neuroendocrine factors have never been associated with the RA signalling pathway in this animal model. In this study, the interaction between neuroendocrine factors and RA was explored in the CDH rat model. The authors found that normal fetal lung explants treated with RA, bombesin and ghrelin showed an increase in lung growth. Hypoplastic lungs presented higher expression levels of the RA receptors α and γ. Moreover bombesin and ghrelin supplementation, in vitro, to normal lungs increased RA receptor α/γ expression whereas administration of bombesin and ghrelin antagonists to normal and hypoplastic lungs decreased it. These data reveal for the first time that there is a link between neuroendocrine factors and RA, and that neuroendocrine factors sensitise the lung to the RA action through RA receptor modulation.
- Correção Laparoscópica de Atresia Duodenal Associada a Pâncreas AnularPublication . Barroso, C; Correia-Pinto, JA atresia duodenal é a causa mais comum de obstrução intestinal congénita. Frequentemente associa-se a outras malformações, como o pâncreas anular. A abordagem laparoscópica, ainda que tecnicamente exigente, traz para o recém-nascido benefícios evidentes. Os autores reportam o caso de um recém-nascido com diagnóstico pré-natal de atresia duodenal proposto para laparoscopia, durante a qual foi constatada a existência de pâncreas anular, e realizada a duodeno-duodenostomia em diamante.
- Progresso Interdisciplinar da MedicinaPublication . Correia-Pinto, J
- Correção Laparoscópica de Atresia Duodenal Associada a Pâncreas AnularPublication . Barroso, C; Correia-Pinto, JDuodenal atresia is the most common cause of congenital bowel obstruction. Often it is associated with other congenital anomalies, such as annular pancreas. The laparoscopic approach, although technically demanding, brings about clear benefits to the newborn. The authors report the case of a newborn with prenatal diagnosis of duodenal atresia, proposed for a laparoscopy, during which an annular pancreas was identified and a laparoscopic diamond-shaped duodenal anastomosis was performed.
- Scarless laparoscopic repair of epigastric hernia in childrenPublication . Moreira-Pinto, J; Correia-Pinto, JBACKGROUND: Despite the small size of the incision, the scar left by open repair of epigastric hernia in children is unaesthetic. Few laparoscopic approaches to epigastric hernia repair have been previously proposed, but none has gain wide acceptance from pediatric surgeons. In this study, we present our experience with a scarless laparoscopic approach using a percutaneous suturing technique for epigastric hernia repair in children. METHODS: Ten consecutive patients presenting with epigastric hernia 15 mm or further from the umbilicus were submitted to laparoscopic hernia repair. A 5-mm 30º-angle laparoscope is introduced through a umbilical trocar and a 3-mm laparoscopic dissector is introduced through a stab incision in the right flank. After opening and dissecting the parietal peritoneum, the fascial defect is identified and closed using 2-0 polyglactin thread through a percutaneous suturing technique. Intraoperative and postoperative clinical data were collected. RESULTS: All patients were successfully submitted to laparoscopic epigastric hernia repair. Median age at surgery was 79 months old and the median distance from the umbilicus to the epigastric defect was 4 cm. Operative time ranged from 35 to 75 min. Every hernia was successfully closed without any incidents. Follow-up period ranges from 2 to 12 months. No postoperative complications or recurrence was registered. No scar was visible in these patients. CONCLUSION: This scarless laparoscopic technique for epigastric hernia repair is safe and reliable. We believe this technique might become gold standard of care in the near future.
- Benefits of radial distortion correction in arthroscopic surgery: a first experimental study on a knee modelPublication . Duarte, RM; Ferre, NV; Oliveira, AM; Fonseca, FP; Vieira da Silva, M; Correia-Pinto, JBACKGROUND: Lens probes used in arthroscopy typically have a small diameter and wide field-of-view. This introduces strong radial distortion (RD) into the image, ultimately affecting the surgeon's hand-eye coordination. This study evaluates potential benefits of using distortion-free images in arthroscopic surgery. METHODS: Distortion-free images were obtained using RDFixer™ software (Perceive3D, SA) to remove RD in the input video stream. Twelve orthopedic residents performed an arthroscopic task (loose body removal) in a dry-knee model using video with and without distortion. Residents were questioned about image quality, and surgical performance was rated using an adapted Global Rating Scale. RESULTS: A statistically significant improvement of all parameters was observed with distortion-free images. Residents perceived distortion-free images as providing a wider field-of-view and a better notion of relative depth and distance. CONCLUSION: RD correction improved the surgical performance of residents, potentially decreasing their learning curve. Future work will study whether the benefits are observable in experienced surgeons.
- Hybrid endoscopic thymectomy : combined transesophageal and transthoracic approach in a survival porcine model with cadaver assessmentPublication . Moreira-Pinto, J; Ferreira, A; Miranda, A; Rolanda, C; Correia-Pinto, JBACKGROUND: Video-assisted thoracoscopic surgery thymectomy has been used in the treatment of Myastenia Gravis and thymomas (coexisting or not). In natural orifice transluminal endoscopic surgery, new approaches to the thorax are emerging as alternatives to the classic transthoracic endoscopic surgery. The aim of this study was to assess the feasibility and reliability of hybrid endoscopic thymectomy (HET) using a combined transthoracic and transesophageal approach. METHODS: Twelve consecutive in vivo experiments were undertaken in the porcine model (4 acute and 8 survival). The same procedure was assessed in a human cadaver afterward. For HET, an 11-mm trocar was inserted in the 2nd intercostal space in the left anterior axillary line. A 0° 10-mm thoracoscope with a 5-mm working channel was introduced. Transesophageal access was created through a submucosal tunnel using a flexible gastroscope with a single working channel introduced through the mouth. Using both flexible (gastroscope) and rigid (thoracoscope) instruments, the mediastinum was opened; the thymus was dissected, and the vessels were ligated using electrocautery alone. RESULTS: Submucosal tunnel creation and esophagotomy were performed safely without incidents in all animals. Complete thymectomy was achieved in all experiments. All animals in the survival group lived for 14 days. Thoracoscopic and postmortem examination revealed pleural adhesions on site of the surgical procedure with no signs of infection. Histological analysis of the proximal third of the esophagus revealed complete cicatrization of both mucosal defect and myotomy site. In the human cadaver, we were able to replicate all the procedure even though we were not able to identify the thymus. CONCLUSIONS: Hybrid endoscopic thymectomy is feasible and reliable. HET could be regarded as a possible alternative to classic thoracoscopic approach for patients requiring thymectomy.
- Acute pancreatitis in children : a tertiary hospital reportPublication . Antunes, H; Nascimento, J; Mesquita, A; Correia-Pinto, JINTRODUCTION: The incidence of acute pancreatitis (AP) in children has increased significantly in the past two decades. OBJECTIVE: All cases of AP, acute recurrent pancreatitis (ARP), and chronic pancreatitis examined between May 2002 and May 2012 at Hospital de Braga, Portugal, were reviewed. MATERIAL AND METHODS: Patients were identified by searching the hospital's electronic discharge records for the International Classification of Disease, Ninth Revision (ICD-9) code 577.0 (acute pancreatitis). ARP was considered as two or more episodes of AP per year or more than three episodes over a lifetime with intervening return to baseline. The following data were analyzed: demographic information, clinical, laboratory and imaging test results, etiology of pancreatitis, medical and surgical management, length of hospitalization, and outcome. The clinical and laboratory factors used in the pediatric acute pancreatitis severity score system and computed tomography severity index (CTSI) score were compared between patients with mild and severe disease. RESULTS: A total of 37 patients, 31 episodes of AP and 6 patients with ARP, were documented. The most prevalent etiologies were biliary stones/sludge (24.3%) and trauma (16.2%). Admission elevated white blood cell count (p=0.011), 48-h trough calcium (p=0.007), and 48-h rise in blood urea nitrogen (p=0.025) correlated significantly with disease severity. CTSI on admission had a score below 4 in three patients with severe disease. CONCLUSION: This Portuguese pediatric pancreatitis report highlights the multiple and complex etiology of this disease. Better pediatric scoring systems and management algorithms are needed.
- Unique Tracheal Fluid MicroRNA Signature Predicts Response to FETO in Patients With Congenital Diaphragmatic Hernia.Publication . Pereira-Terra, P; Deprest, JA; Kholdebarin, R; Khoshgoo, N; DeKoninck, P; Boerema-De Munck, AA; Wang, J; Zhu, F; Rottier, RJ; Iwasiow, BM; Correia-Pinto, J; Tibboel, D; Post, M; Keijzer, ROBJECTIVE AND BACKGROUND:: Our objective was to determine the fetal in vivo microRNA signature in hypoplastic lungs of human fetuses with severe isolated congenital diaphragmatic hernia (CDH) and changes in tracheal and amniotic fluid of fetuses undergoing fetoscopic endoluminal tracheal occlusion (FETO) to reverse severe lung hypoplasia due to CDH. METHODS:: We profiled microRNA expression in prenatal human lungs by microarray analysis. We then validated this signature with real-time quantitative polymerase chain reaction in tracheal and amniotic fluid of CDH patients undergoing FETO. We further explored the role of miR-200b using semiquantitative in situ hybridization and immunohistochemistry for TGF-β2 in postnatal lung sections. We investigated miR-200b effects on TGF-β signaling using a SMAD-luciferase reporter assay and Western blotting for phospho-SMAD2/3 and ZEB-2 in cultures of human bronchial epithelial cells. RESULTS:: CDH lungs display an increased expression of 2 microRNAs: miR-200b and miR-10a as compared to control lungs. Fetuses undergoing FETO display increased miR-200 expression in their tracheal fluid at the time of balloon removal. Future survivors of FETO display significantly higher miR-200 expression than those with a limited response. miR-200b was expressed in bronchial epithelial cells and vascular endothelial cells. TGF-β2 expression was lower in CDH lungs. miR-200b inhibited TGF-β-induced SMAD signaling in cultures of human bronchial epithelial cells. CONCLUSIONS:: Human fetal hypoplastic CDH lungs have a specific miR-200/miR-10a signature. Survival after FETO is associated with increased miR-200 family expression. miR-200b overexpression in CDH lungs results in decreased TGF-β/SMAD signaling.