Browsing by Author "Ferreira, F."
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- Endoscopic Ultrasound-Guided Biliary Drainage in Two Patients with Difficult Biliary AccessPublication . Libânio, D.; Giestas, S.; Martinez-Ares, D.; Ferreira, F.; Canena, J.; Certo, M.; Lopes, L.Introduction: Endoscopic retrograde cholangiopancreatography is the method of choice for biliary drainage, although in some cases standard biliary access is difficult or even impossible. Endoscopic ultrasound (EUS)-guided endoluminal procedures are an alternative in these cases, although experience with these techniques is still limited. Clinical Case: We present two cases of successful EUS-guided biliary drainage. In the first case, a hepaticogastrostomy was performed in a patient with stage IV gastric adenocarcinoma with obstructive jaundice due to compression of the hilum, where malignant gastric stenosis and previous palliative gastrojejunostomy precluded access to the second part of the duodenum. In the second case, a patient with a pancreatic head adenocarcinoma with duodenal invasion that precluded major papillae identification was submitted to a choledochoduodenostomy. Both procedures occurred without immediate or delayed adverse events, with technical and clinical success. Discussion: Although experience with EUS-guided biliary drainage is still limited, its efficacy and safety is favorable when compared with percutaneous and surgical drainage, and should be considered an alternative to these techniques where sufficient expertise exists.
- Increased red cell distribution width in Fanconi anemia: a novel marker of stress erythropoiesisPublication . Sousa, R.; Gonçalves, C.; Guerra, I.; Costa, E.; Fernandes, A.; Bom-Sucesso, M.; Azevedo, J.; Rodriguez, A.; Rius, R.; Seabra, C.; Ferreira, F.; Ribeiro, L.; Ferrão, A.; Castedo, S.; Cleto, E.; Coutinho, J.; Carvalho, F.; Barbot, J.; Porto, B.BACKGROUND: Red cell distribution width (RDW), a classical parameter used in the differential diagnosis of anemia, has recently been recognized as a marker of chronic inflammation and high levels of oxidative stress (OS). Fanconi anemia (FA) is a genetic disorder associated to redox imbalance and dysfunctional response to OS. Clinically, it is characterized by progressive bone marrow failure, which remains the primary cause of morbidity and mortality. Macrocytosis and increased fetal hemoglobin, two indicators of bone marrow stress erythropoiesis, are generally the first hematological manifestations to appear in FA. However, the significance of RDW and its possible relation to stress erythropoiesis have never been explored in FA. In the present study we analyzed routine complete blood counts from 34 FA patients and evaluated RDW, correlating with the hematological parameters most consistently associated with the FA phenotype. RESULTS: We showed, for the first time, that RDW is significantly increased in FA. We also showed that increased RDW is correlated with thrombocytopenia, neutropenia and, most importantly, highly correlated with anemia. Analyzing sequential hemograms from 3 FA patients with different clinical outcomes, during 10 years follow-up, we confirmed a consistent association between increased RDW and decreased hemoglobin, which supports the postulated importance of RDW in the evaluation of hematological disease progression. CONCLUSIONS: This study shows, for the first time, that RDW is significantly increased in FA, and this increment is correlated with neutropenia, thrombocytopenia, and highly correlated with anemia. According to the present results, it is suggested that increased RDW can be a novel marker of stress erythropoiesis in FA.
- Sindrome de X frágil: pessoas, contextos & percursosPublication . Franco, V.; Martins, M.; Jorge, P.; Ferreira, F.; Bertão, A.; Apolónio, A.; Pires, H.; Melo, M.; Albuquerque, C.; Cunha, M.; Carmona, C.; Costa, T.; Reis, S.; Jiménez, S.
- A tríade clássica de uma doença ainda actualPublication . Sousa, C.; Guardiano, M.; Correia, C.; Rego, C.; Ferreira, F.A doença de Kala-azar é uma patologia actualmente rara que regista, na ausência de tratamento adequado, uma elevada taxa de mortalidade. Apresenta-se um caso clínico de doença de Kala-azar numa lactente de 10 meses com a tríade clínica clássica de febre, palidez e esplenomegalia. A propósito deste caso, os autores reforçam a importância do diagnóstico de suspeição, apresentam as opções terapêuticas disponíveis e abordam aspectos epidemiológicos da doença. ABSTRACT Kala-azar is nowadays an uncommon disease that presents a high mortality rate in the absence of adequate treatment. The authors present the case of a ten months infant with the common clinical fi ndings of fever, pallor and splenomegaly. The importance of the diagnosis suspicion is reinforced and the treatment choices and epidemiologic aspects of the disease are discussed.