Browsing by Author "LIMA, E."
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- Clinical, multicentric, and open study to evaluate the efficacy of and tolerance to sildenafil in patients with erectile dysfunctionPublication . PALHA, A.P.; GOMES, F.A.; MARTINS, A.S.; PIMENTA, A.; NEVES, J.; GONCALVES, R.; RAMOS, L.; ABRANTES, P.; CANHAO, A.; SANTOS, G.; CARVALHO, L.F.; SOARES, J.; LIMA, E.; ROSA, G.Acta Med Port. 2002 Jul-Aug;15(4):249-56. [Clinical, multicentric, and open study to evaluate the efficacy of and tolerance to sildenafil in patients with erectile dysfunction] [Article in Portuguese] Palha AP, Gomes FA, Martins AS, Pimenta A, Neves J, Gonçalves R, Ramos L, Abrantes P, Canhão A, Santos G, Carvalho LF, Soares J, Lima E, Rosa G. Serviço de Psiquiatria e Urologia do Hospital de S. João, Instututo de Ciências Bimédicas, Hospital Geral de S. António, Porto. Abstract Erectile dysfunction (ED), defined by the Impotence-NIH Consensus Conference as the "persistent inability to achieve and/or maintain erection sufficient for satisfactory sexual activity" affect more than 100 million men worldwide, at particular severity levels. The global prevalence of ED is estimated to affect about 10%, but has been found to increase significantly with age (39% in men 40 years of age and 67% at 70 years of age). In men aged 40 to 70 years, the severe ED prevalence increased of three folds, 5 to 15%. In order to evaluate the efficacy and tolerance of sildenafil, it was conducted a national open, multicentre study on a portuguese population affected by ED. Subjects under ambulatory treatment were recruited in Psychiatry/Sexology Clinical units and Urology/Andrology. The results of the study carried out on a group of 62 men with ED, demonstrate that sildenafil was effective in the recovering of erectile function, increasing the number of attempts to sexual activity and improving their success rates (mainly in severe dysfunction). Fifty one patients treated with sildenafil, at the end of the study referred a global improvement in their erections (92.2%). Doses of 50 mg and 100 mg sildenafil were used and were well tolerated and also effective in the treatment of this pathology (70% and 69% respectively). Being this study a flexible dose one and taking into consideration that the final dose used was found the more suitable to the patients, can be concluded that 43.1% of the patients elected dose of 50 mg whereas 56.9% elected the maximum prescribed dose of 100 mg. Over and above global efficacy experimented by patients, a significant improvement in the sexual activity with partners was occurred. These results make possible a final conclusion--in the studied patients group affected by Erectile Dysfunction, aside from associated somatic pathology, sildenafil use provided a remarkable clinical profit, in what concerns global efficacy, by erectile function mechanisms improvement, concerning patients sensitivity of improvement, occurring in the major part of them, being these of high importance to the lifting up of their self-esteem. PMID: 12525018 [PubMed - indexed for MEDLINE
- Emergency ureteroscopic management of ureteral stones: why not?Publication . OSORIO, L.; LIMA, E.; SOARES, J.; AUTORINO, R.; VERSOS, R.; LHAMAS, A.; MARCELO, F.Urology. 2007 Jan;69(1):27-31; discussion 31-3. Emergency ureteroscopic management of ureteral stones: why not? Osorio L, Lima E, Soares J, Autorino R, Versos R, Lhamas A, Marcelo F. Department of Urology, Santo Antonio General Hospital, Oporto, Portugal. luis_osorio@netcabo.pt Abstract OBJECTIVES: To describe a single-center experience in the emergency ureteroscopic management of ureteral stones. METHODS: We retrospectively considered the data from 144 patients (mean age 49.6 years, range 23 to 82) who had had obstructive ureteral stones and had undergone emergency ureteroscopy with stone retrieval. Intracorporeal pneumatic lithotripsy was performed when necessary. At the end of the procedure, a ureteral catheter was systematically left in place in 100 patients (69.4%) and removed within 24 hours. In the remaining 44 patients, a double-J stent was preferred and was removed within 30 days, depending on the clinical course. Stone-free status was defined as the complete absence of fragments at 1 month of follow-up. RESULTS: The calculi were more frequently localized in the distal ureter than in the proximal one (90.3% versus 9.7%, respectively). The overall mean stone diameter was 9.1 mm (range 5 to 20). The overall stone-free rate was 92.4%. A greater stone-free rate was obtained in those with stones less than 10 mm (95.8%) than in those with stones larger than 10 mm (89%, P = 0.002). Similarly, a significantly better outcome occurred for those with stones located in the distal ureter (94.6%) than for those with stones in the proximal one (71.4%, P = 0.004). The overall complication rate was 4.2%. The mean hospital stay was 2.5 days (range 1 to 7). CONCLUSIONS: In our experience, emergency ureteroscopy in cases of obstructive ureteral stones proved to be safe and effective. It has the main advantage of offering both immediate relief from pain and stone fragmentation. Additional extensive studies are warranted to corroborate these findings. PMID: 17270606 [PubMed - indexed for MEDLINE
- Third‐generation nephrectomy by natural orifice transluminal endoscopic surgeryPublication . LIMA, E.; ROLANDA, C.; PÊGO, J.M.; HENRIQUES‐COELHO, T.; SILVA, D.; OSÓRIO, L.; MOREIRA, I.; CARVALHO, J.L.; CORREIA‐PINTO, J.Urol. 2007 Dec;178(6):2648-54. Epub 2007 Oct 22. Third-generation nephrectomy by natural orifice transluminal endoscopic surgery. Lima E, Rolanda C, Pêgo JM, Henriques-Coelho T, Silva D, Osório L, Moreira I, Carvalho JL, Correia-Pinto J. Life and Health Sciences Research Institute, School of Health Sciences, University of Minho, Braga, Portugal. Abstract PURPOSE: Recently there has been increasing enthusiasm for performing simple abdominal procedures by transgastric surgery. We previously reported the usefulness of a combined transgastric and transvesical approach to cholecystectomy. In this study we assessed the feasibility of combined transgastric and transvesical approach for performing a more complex surgical procedure, such as nephrectomy, in a porcine model. MATERIALS AND METHODS: In a nonsurvival study combined transgastric and transvesical approaches were established in 6 female pigs. Under ureteroscope guidance we installed a transvesical 5 mm over tube into the peritoneal cavity and a flexible gastroscope was passed orally into the peritoneal cavity by a gastrotomy. We performed right or left nephrectomy with instruments introduced by the 2 devices that worked in the renal hilum, alternating device intervention for dissection and retraction procedures. RESULTS: Four right and 2 left nephrectomies were performed. There were no complications during the creation of transvesical and transgastric access. In all animals we visualized the 2 kidneys. The renal vessels and ureter were reasonably individualized and ligated separately with ultrasonic scissors, which were introduced through the transvesical port. In 2 early cases mild hemorrhage occurred after ultrasonic ligation. To overcome this complication we applied clips successfully before ultrasonic ligation in the remaining animals. Thus, complete renal release and mobilization to the stomach were achieved in all animals. CONCLUSIONS: Nephrectomy by natural orifices using the combined transgastric and transvesical approach is technically feasible, although to our knowledge there is no reliable method for removing the specimen with current instruments. PMID: 17945287 [PubMed - indexed for MEDLINE]
- Transperitoneal laparoscopic adrenalectomy: initial experiencePublication . PALACIOS, A.; LIMA, E.; MASSO, P.; VERSOS, R.; AUTORINO, R.; RAMOS, M.; SOARES, J.; MARCELO, F.Arch Esp Urol. 2006 Nov;59(9):893-7. [Transperitoneal laparoscopic adrenalectomy: initial experience] [Article in Spanish] Palacios A, Lima E, Massó P, Versos R, Autorino R, Ramos M, Soares J, Marcelo F. Servicio de Urología, Hospital Geral de Santo António, Porto, Portugal. aphmmx5@hotmail.com Abstract OBJECTIVES: Since the first published report in 1992, laparoscopic adrenalectomy has been widespread and it is now accepted as the standard treatment option in most of benign diseases of the adrenal gland. Aim of the present study is to describe our initial experience with laparoscopic adrenalectomy. METHODS: Between May 2001 and December 2005, 15 patients were submitted to laparoscopic adrenalectomy for benign diseases of the adrenal gland. We analyzed patients characteristics (sex, age, initial diagnosis), operative and perioperative results (operative time, blood loss, time to first oral intake) and complications. RESULTS: Mean operative time was 143 minutes. Blood loss was minimal. Mean hospital stay was 90 hours. There was no need for open conversion and complication rate was low. CONCLUSIONS: Laparoscopic surgery of the adrenal gland is a safe and effective option which offers quality of life benefits to the patients. PMID: 17190212 [PubMed - indexed for MEDLINE
- Transvesical endoscopic peritoneoscopy: a novel 5 mm port for intra‐abdominal scarless surgeryPublication . LIMA, E.; ROLANDA, C.; PEGO, J.M.; HENRIQUES‐COELHO, T.; SILVA, D.; CARVALHO, J.L.; CORREIA‐PINTO, J.J Urol. 2006 Aug;176(2):802-5. Transvesical endoscopic peritoneoscopy: a novel 5 mm port for intra-abdominal scarless surgery. Lima E, Rolanda C, Pêgo JM, Henriques-Coelho T, Silva D, Carvalho JL, Correia-Pinto J. Life and Health Sciences Research Institute, School of Health Sciences, University of Minho, Portugal. Abstract PURPOSE: Recently various groups reported successful attempts to perform intra-abdominal surgery through a transgastric pathway. We assessed the feasibility and safety of a novel transvesical endoscopic approach to the peritoneal cavity through a 5 mm port in a porcine model. MATERIALS AND METHODS: Transvesical endoscopic peritoneoscopy was performed in 8 anesthetized female pigs, including 3 nonsurvival and 5 survival animals. Under cystoscopic guidance a vesical hole was created on the ventral bladder wall with an open-ended ureteral catheter. An over tube with a luminal diameter of 5.5 mm was placed in the peritoneal cavity, guided by a 0.035-inch guidewire. In all animals we performed peritoneoscopy of the entire abdomen as well as liver biopsy and falciform ligament section. A vesical catheter was placed for 4 days in all survival animals, which were sacrificed by day 15 postoperatively. RESULTS: After a learning curve in the first 3 nonsurvival animals the creation of a vesical hole and placement of the over tube were performed without complication in all survival animals. In these animals we easily introduced an EndoEYEtrade mark into the peritoneal cavity, which provided a view of all intra-abdominal viscera, as well as a 9.8Fr ureteroscope, which allowed simple surgical procedures without complications. In survival experiments all pigs recovered. Necropsy examination revealed complete healing of the vesical hole and no signs of infection or adhesions into the peritoneal cavity. CONCLUSIONS: Transvesical endoscopic peritoneoscopy was technically feasible and it could be safely performed in a porcine model. This study provides encouragement for additional preclinical studies of transvesical surgery with or without combinations with other natural orifices approaches to design new intra-abdominal scarless procedures in what seems to be third generation surgery. PMID: 16813951 [PubMed - indexed for MEDLINE]
- Transvesical thoracoscopy: a natural orifice translumenal endoscopic approach for thoracic surgeryPublication . LIMA, E.; HENRIQUES‐COELHO, T.; ROLANDA, C.; PÊGO, J.M.; SILVA, D.; CARVALHO, J.L.; CORREIA‐PINTO, J.Surg Endosc. 2007 Jun;21(6):854-8. Epub 2007 May 4. Transvesical thoracoscopy: a natural orifice translumenal endoscopic approach for thoracic surgery. Lima E, Henriques-Coelho T, Rolanda C, Pêgo JM, Silva D, Carvalho JL, Correia-Pinto J. Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal. Abstract BACKGROUND: Recently there has been an increasing enthusiasm for using natural orifices translumenal endoscopic surgery (NOTES) to perform scarless abdominal procedures. We have previously reported the feasibility and safety of the transvesical endoscopic peritoneoscopy in a long-term survival porcine model as useful for those purposes. Herein, we report our successful experience performing transvesical and transdiaphragmatic endoscopic approach to the thoracic cavity in a long-term survival study in a porcine model. METHODS: Transvesical and transdiaphragmatic endoscopic thoracoscopy was performed in six anesthetized female pigs. A 5 mm transvesical port was created on the bladder wall and an ureteroscope was advanced into the peritoneal cavity. After diaphragm inspection, we introduced through the left diaphragmatic dome a ureteroscope into the left thoracic cavity. In all animals, we performed thoracoscopy as well as peripheral lung biopsy. Animals were sacrificed by day 15 postoperatively. RESULTS: We easily introduced a 9.8 Fr ureteroscope into the thoracic cavity that allowed us to visualize the pleural cavity and to perform simple surgical procedures such as lung biopsies without complications. There were neither respiratory distress episodes nor surgical complications to report. Postmortem examination revealed complete healing of vesical and diaphragmatic holes, whereas no signs of infection or adhesions were observed in the peritoneal or thoracic cavities. CONCLUSION: This study demonstrates the feasibility of transvesical thoracoscopy in porcine model. However, although this study extends the potential applications of NOTES to the thoracic cavity, new instruments and further work are needed to provide evidence that this could be translated to humans and with advantages for patients. PMID: 17479317 [PubMed - indexed for MEDLINE]