Browsing by Author "Pereira, S."
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- Atypical presentation of sigmoid carcinomaPublication . Malta, W.; Pereira, S.; Gaspar, J.; Silva, A.; Moreira-Costa, A.Colorectal carcinoma is common worldwide and its metastasis represents the main cause of mortality related to the disease. Inguinal metastization of this tumor has been considered almost impossible, owing to colon anatomy and its cranial lymphatic drainage. We report the case of a 63-year-old man submitted to laparoscopical sigmoid colectomy, due a sigmoid adenocarcinoma. During follow-up, a right inguinal lymphadenopathy with 25 mm was detected. Fine needle aspiration biopsy revealed that it was a colon adenocarcinoma metastasis, and thus the patient underwent an inguinal lymphadenectomy. The histological study confirmed metastatic adenocarcinoma of the colon and the patient was submitted to 5-fluouracil and oxaliplatin chemotherapy. This case coursed with metastasis to the right inguinal region; although, the pathophysiological mechanism involved is difficult to understand. There are no solid data for the management of these patients. Inguinal lymphadenectomy and chemotherapy, proved to be effective.
- Bone Mineral Density After Simultaneous Kidney–PancreasPublication . Pereira, S.; Pedroso, S.; Martins, L.; Santos, P.; Almeida, M.; Freitas, C.; Dias, L.; Dores, J.; Almeida, R.; Henriques, A.C.; Teixeira, M.ABSTRACT Bone disease and an high risk of fractures are major problems in transplantation. Among diabetic patients undergoing simultaneous kidney–pancreas (SKP) transplantation, there are few studies assessing long-term effects on bone mass. The aim of this study was to evaluate bone mineral density (BMD) over 4 years follow-up after SKP transplantation. Fifty-seven patients had 22.8 5.3 years of prior diabetes, 65% were female, and the overall mean age was 24.3 5.93 years. At the time of transplantation, the lumbar spine and femoral neck T-scores were 1.75 1.05 and 1.95 0.73, respectively; 28% of subjects had evidence of osteoporosis. One year after transplantation, 77.6% of patients displayed improved lumbar T-scores to 1.33 0.94 (.044) with stable femoral neck T-scores. Bone densitometry enhanced gradually through the 4 years follow-up: lumbar T-score to 1.04 0.67 (.004) and femoral neck T-score to 1.69 0.49 (.12). At year 4, no osteoporosis cases were detected but 86.7% of patients did not receive steroids in the immunosuppressive regimen. The graft function remained stable (serum creatinine, 1.2 mg/dL; fasting glucose, 87.7 mg/dL). During the follow-up, BMD improved more significantly at cortical sites. Our study reports a reduced prevalence of fractures (8.7%) compared with the literature, which could be related to a steroid-sparing protocol and/or aggressively treatment of osteoporosis.
- Long-term psychological outcome after discharge from intensive carePublication . Pereira, S.; Cavaco, S.; Fernandes, J.; Moreira, I.; Almeida, E.; Seabra-Pereira, F.; Castro, H.; Malheiro, M.; Cardoso, A.; Aragão, I.; Cardoso, T.Objective: To investigate the longterm psychological outcome in survivors of critical illness after intensive care unit discharge. Methods: A prospective cohort of survivors admitted to a mixed intensive care unit between January and September 2010 was evaluated six months and five years after hospital discharge. The Dementia Rating Scale-2, the Hospital Anxiety and Depression Scale, the Posttraumatic stress syndrome 14-questions inventory, the Euro Quality of Life 5 Dimensions (EQ-5-D), and the Visual Analogue Scale (EQ VAS) were assessed at both follow-up periods. Results: Of 267 patients, 25 patients were evaluated at 6 months after discharge (62 ± 16 years); 12 (48%) presented cognitive impairment, 6 (24%) anxiety, 4 (16%) depression, and 4 (16%) post-traumatic stress disorder. Among those re-evaluated five years after discharge (n = 17; 65 ± 15 years), the frequency of cognitive impairment dropped from 8 (47%) to 3 (18%) (p = 0.063), due to improvement in these patients over time, and other patients did not acquire any dysfunction after discharge. At five years after discharge, only two patients (12%) reported anxiety, and none had depression or post-traumatic stress disorder. No differences were found between the six-month and five-year follow-ups regarding EQ-5-D and EQ VAS. Conclusion: Survivors do not show a progressive decline in cognitive function or quality of life within five years after intensive care unit discharge. Psychopathological symptoms tend to decrease with time.
- Pancreas-Kidney Transplantation: Complications and Readmissions in 9-Years of Follow-upPublication . Martins, L.; Henriques, A.C.; Dias, L.; Almeida, M.; Pedroso, S.; Freitas, C.; Pereira, S.; Fructuoso, M.; Dores, J.; Oliveira, F.; Almeida, R.; Cabrita, A.; Teixeira, M.ABSTRACT Over years, we have performed 93 simultaneous pancreas-kidney transplants (SPKT) The morbidity of this procedure is high compared with kidney transplantation alone; readmissions are frequent and costs are higher. Herein we have presented the complica- tions during follow-up of these 93 patients. Their mean age was 34 years and prior dialysis time was 32 25 months. The median hospital stay on the first admission for the transplant procedure was 22 days, including days in the intensive care unit. Bleeding, thrombosis, and infection were the most frequent reasons for prolonged hospitalization. Thirty patients underwent surgical reinterventions. Incidence of acute rejection episodes was 11.8%After discharge, 74.2% of the patients had 197 readmission episodes with infection being the main cause, urinary tract infections, the most frequent; however, systemic viral and fungal infections required the longest readmission periods. The need for surgical interventions, graft dysfunction, and vascular problems were the remaining causes of readmission. At the end of follow-up, 87 patients were alive, 86 with well-functioning kidneys and 74 with normal functioning pancreata. Global survival rates for patient, kidney, and pancreas were 96%95%and 81% at 1-year; 93%90%and 79% at 5-years; and 93%90% and 79% at 9-years. Although pancreas–kidney transplant patients are complex presenting many management difficulties, our overall results represent positive stimulus for diabetic patients.
- Remoção do pelo na adolescênciaPublication . Pereira, S.; Machado, S.; Selores, ManuelaIntrodução: Durante a puberdade devido à estimulação hormonal, ocorrem alterações do tipo e distribuição do pelo. Os pelos indesejados no corpo e na face, em ambos os sexos, podem ter um impacto psicológico negativo no adolescente. Existem disponíveis diversos métodos de remoção do pelo, mas a escolha do modo mais apropriado para cada indivíduo pode suscitar dúvidas. Objectivo: Rever os principais métodos de remoção do pelo e clarificar as suas indicações, vantagens e desvantagens. Desenvolvimento: Os métodos de remoção do pelo actualmente disponíveis são variados. A depilação com lâmina e com produtos químicos depilatórios são métodos temporários, em que existe a necessidade de repetição frequente do procedimento, uma vez que apenas existe a remoção do pelo junto à superfície cutânea. Os métodos epilatórios em que se procede à extração completa do pelo, incluem: epilação com cera, linha, pinça, máquinas epilatórias, laser, luz intensa pulsada, e eletrólise. Conclusão: A idade de inicio da remoção do pelo e a escolha do método deve ser individualizada e ter em consideração o tipo de pele e pelo, local, problemas dermatológicos e endocrinológicos, frequência de remoção, custo e preferências pessoais.
- Síndrome de Gorlin-Goltz: caso clínicoPublication . Domingues, S.; Pereira, S.; Machado, A.; Bezerra, R.; Figueira, F.; Cunha, B.; Machado, L.Introdução: O Síndrome de Gorlin-Goltz é uma condição hereditária autossómica dominante rara caracterizada por: carcinomas basocelulares, queratoquistos odontogénicos, depressões palmo-plantares, calcificações da foice cerebral e malformações esqueléticas. Associa-se também a meduloblastoma e outras neoplasias. Caso Clínico: Adolescente de 11 anos, com antecedentes de macrocefalia. Referenciada à consulta de estomatologia por quistos mandibulares recidivantes. O exame anátomo-patológico revelou tratarem-se de queratoquistos odontogénicos, pelo que é encaminhada para a consulta de pediatria. Objetivamente, apresentava macrocefalia e facies “gros seiro” com bossas frontais e hipertelorismo. Efetuou estudo genético, que detetou mutação do gene PTCH1, confirmando a suspeita clínica. Discussão: Os queratoquistos odontogénicos são o achado mais representativo do síndrome de Gorlin-Goltz nas duas primeiras décadas de vida, sendo de extrema importância um elevado índice de suspeição por parte do pediatra, com especial relevância para as alterações minor. Após o estabelecimento do diagnóstico, é necessária uma equipa multidisciplinar para um adequado seguimento e tratamento atempado.
- Vacuum-assisted closure therapy after resection of giant basal cell carcinoma of the scalpPublication . Pereira, S.; Malta, W.; Canha, A.; Polónia, J.Management of complicated wounds is a challenge in head and neck reconstruction. Although the negative pressure wound therapy or wound vacuum-assisted closure has been widely used in complicated wounds and shows promising results, its application in the head and neck region after reconstruction for the head and neck cancer is rarely presented. A 77-year-old woman underwent a radical resection of an extensive basal cell carcinoma of the scalp and forehead involving the periosteum, where classic reconstruction was difficult, but successfully treated with negative pressure wound therapy. Negative pressure wound therapy is an efficacious tool in cases of complex and extensive defects, when we expect immediate reconstruction with poor results, as would be probable with this scalp lesion.
- Visceral Obesity and Metabolic Syndrome Are Associated with Well-Differentiated Gastroenteropancreatic Neuroendocrine TumorsPublication . Santos, A.; Santos, A.; Castro, C.; Raposo, L.; Pereira, S.; Torres, I.; Henrique, R.; Cardoso, H.; Monteiro, M.The determinants for gastroenteropancreatic neuroendocrine tumors (GEP-NET) recent burden are matters of debate. Obesity and metabolic syndrome (MetS) are well established risks for several cancers even though no link with GEP-NETs was yet established. Our aim in this study was to investigate whether well-differentiated GEP-NETs were associated with obesity and MetS. Patients with well-differentiated GEP-NETs (n = 96) were cross-matched for age, gender, and district of residence with a control group (n = 96) derived from the general population in a case-control study. Patients presented gastro-intestinal (75.0%) or pancreatic (22.9%) tumors, grade G1 (66.7%) or G2 (27.1%) with localized disease (31.3%), regional metastasis (16.7%) or distant metastasis (43.8%) at diagnosis, and 45.8% had clinical hormonal syndromes. MetS was defined according to Joint Interim Statement (JIS) criteria. Well-differentiated GEP-NETs were associated with MetS criteria as well as the individual components' waist circumference, fasting triglycerides, and fasting plasma glucose (p = 0.003, p = 0.002, p = 0.011 and p < 0.001, respectively). The likelihood of the association was higher when the number of individual MetS components was greater than four. MetS and some individual MetS components including visceral obesity, dyslipidemia, and increased fasting glucose are associated with well-differentiated GEP-NET. This data provides a novel insight in unraveling the mechanisms leading to GEP-NET disease.