Clínica de Cirurgia
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- Pelvic lipomatosisPublication . Prisco, R.M.; Peres, A.M.; Macedo, F.C.; Lhamas, A.P.; Araújo, D.R.; Pimenta, A.F.; Milheiro, A.A.Actas Urol Esp. 1998 Sep;22(8):717-20. [Pelvic lipomatosis] [Article in Spanish] Prisco RM, Peres AM, Macedo FC, Lhamas AP, Araújo DR, Pimenta AF, Milheiro AA. Servicio de Urología, Hospital Geral de Santo António, Porto, Portugal. Abstract Pelvian lipomatosis is a proliferative process of fatty tissue in the perivesical and perirectal pelvian space. The etiology is unknown and some authors consider that in reality is a localized form of obesity. Diagnosis can be incidental, or be part of a sequence within a study for unspecific symptoms such as pelvian complains or perineal problems. As part of the presentation of a clinical case report, the authors make a revision of this disease, focusing in several particular aspects, like diagnostic methods, treatment, etc. PMID: 9835097 [PubMed - indexed for MEDLINE]
- Acute scrotumPublication . OLIVEIRA, A.; DE CARVALHO, L.F.Acta Med Port. 1999 Jan-Mar;12(1-3):39-45. [Acute scrotum] [Article in Portuguese] Oliveira A, de Carvalho LF. Unidade de Andrologia, Hospital Geral de Santo António, Porto. Abstract Painful scrotum is a clinical entity that includes a variety of diseases, such as torsion of the spermatic cord, infectious conditions, injuries and oncology. This condition is more common in infants or youths. It is extremely important to recognize this condition and treat it promptly if the testicle is to be saved. PMID: 10423872 [PubMed - indexed for MEDLINE]
- HematuriaPublication . MILHEIRO, A.; PRISCO, R.Acta Med Port. 1999 Jan-Mar;12(1-3):13-7. [Hematuria]. [Article in Portuguese] Milheiro A, Prisco R. Serviço de Urologia, Hospital Geral de Santo António, Porto. Abstract Patients referred for hematuria work-up are frequently seen in the urologic practice. The initial evaluation does not require the participation of a urologist or nephrologist, due to the false sense of security in the evaluation of an asymptomatic and persistent hematuria. In fact, an adequate history and physical followed by urinalysis and radiologic tests, such as IVP and ultrasonography, must be made in the initial evaluation to exclude any serious urologic/nephrologic disease. PMID: 10423867 [PubMed - indexed for MEDLINE]
- Malignant carotid body tumor: a case reportPublication . Dias da Silva, A.; O`Donnel, S.; Gillespie, D.; Goff, J.; Shriver, C.; Rich, N.Abstract Carotid body tumors (CBTs) have an unpredictable history with no correlation between histology and clinical behavior. Of reported cases since 1891, local and distant metastases appear in approximately 10% of cases and remain the hallmark of malignancy. Currently, there are not enough data to support a single treatment regimen for malignant CBTs. The reported case demonstrates some unanswered issues with regard to malignant CBTs to include lymph node dissection, the need for carotid resection, and the role of radiation therapy. A 46-year-old pathologist underwent a resection of a Shamblin I CBT, to include jugular lymph node sampling, without complication. There was lymph node involvement, and tumor cells were found on the margins of the pathologic specimen. Subsequent carotid resection with reversed interposition saphenous vein graft and modified neck dissection were performed again without complication. Follow-up at 4 years has been uneventful. Diagnosis of CBTs with the use of magnetic resonance angiography, magnetic resonance imaging, color flow duplex scanning, and the role of arteriography are reviewed. The current treatment options are discussed with reference to primary lymph node sampling, carotid resection, and neck dissection in malignant cases. This case demonstrates that the unpredictable nature of CBTs and their malignant potential warrant aggressive initial local treatment to include jugular lymph node sampling and complete tumor resection.
- CMV infection of liver transplant recipients: comparison of antigenemia and molecular biology assays.Publication . Amorim, M.; Cabeda, J.; Seca, R.; Mendes, A.; Castro, A.; Amorim, J.Abstract BACKGROUND: CMV is a major clinical problem in transplant recipients. Thus, it is important to use sensitive and specific diagnostic techniques to rapidly and accurately detect CMV infection and identify patients at risk of developing CMV disease. In the present study, CMV infection after liver transplantation was monitored retrospectively by two molecular biology assays - a quantitative PCR assay and a qualitative NASBA assay. The results were compared with those obtained by prospective pp65 antigenemia determinations. MATERIALS AND METHODS: 87 consecutive samples from 10 liver transplanted patients were tested for CMV by pp65 antigenemia, and CMV monitor and NASBA pp67 mRNA assay. RESULTS: CMV infection was detected in all patients by antigenemia and CMV monitor, whereas NASBA assay identified only 8/10 patients with viremia. Furthermore, CMV infection was never detected earlier by molecular biology assays than by antigenemia. Only 5/10 patients with CMV infection developed CMV disease. Using a cut off value of 8 cells/50,000, antigenemia was found to be the assay that better identified patients at risk of developing CMV disease. However, the kinetics of the onset of infection detected by NASBA and CMV monitor seemed to have better identified patients at risk of developing CMV disease. Furthermore, before onset of disease, CMV pp67 mRNA was found to have similar or better negative and positive predictive values for the development of CMV disease. CONCLUSIONS: The present data, suggests that the concomitant use of antigenemia and pp67 mRNA assay gives the best identification of patients at risk of developing CMV disease.
- Neoplasia renal con extensión a la vena cavaPublication . Barradas, D.; Araújo, D.; Pimenta, A.La neoplasia renal con extensión a la vena cava es relativamente rara (4-10%). Cualquiera que sea la terapia coadjuvante (radioterapia, hormonal, quimioterapia e inmunoterapia), la exéresis completa del trombo tumoral de la vena cava continúa siendo la mejor forma de tratamiento. El valor pronóstico de la extensión cefálica de un trombo tumoral en la vena cava inferior en enfermos con carcinoma de células renales es controvertido. Es posible conseguir una larga supervivencia después del tratamiento quirúrgico en enfermos con carcinoma de células renales localizado (supervivencia de 50% en 5 años). Los autores describen un caso de carcinoma de células renales con extensión a la vena cava en un enfermo del sexo masculino, de 70 años de edad. El enfermo presentaba una historia de lumbalgia derecha y edema del miembro inferior homolateral. La resonancia magnética demostró la presencia y el nivel del trombo tumoral. El enfermo fue sometido a nefrectomía radical derecha y exéresis completa del trombo tumoral de la vena cava. Renal cancer with vena cava tumour thrombus is relatively rare (4 to 10%). Because of the poor results obtained with any kind of alternative therapy (e.g. radiation, hormonal, chemotherapy and immunotherapy) operation with complete removal of the vena cava tumour thrombus continues to be the better method of treatment. The prognostic significance of the cephalic extent of an inferior vena caval tumor thrombus associated with renal cell carcinoma is controversial. Long-term survival after surgical treatment is possible in patients with localized renal cell carcinoma (survival 50% at five years). The authors report a case of vena caval extension of renal cell carcinoma in a 70-years-old man. The patient presented with a history of right lombar pain and pedal edema. Magnetic Ressonance demonstrated the presence and the level of tumoral thrombus. The patient was submitted to a radical nefrectomy and complete removal of tumor thrombus from vena caval.
- Early gastric cancer: ten years of experiencePublication . NOGUEIRA, C.; SILVA, A.S.; SANTOS, J.N.; SILVA, A.G.; FERREIRA, J.; MATOS, E.; VILACA, H.World J Surg. 2002 Mar;26(3):330-4. Epub 2001 Dec 21. Early gastric cancer: ten years of experience. Nogueira C, Silva AS, Santos JN, Silva AG, Ferreira J, Matos E, Vilaça H. Surgery Department, Surgery 1, Hospital Geral de Santo António, Largo Prof. Abel Salazar, 4000 Oporto, Portugal. carlosnog2001@yahoo.com Abstract Gastric cancer is a disease in which the main treatment is surgical extirpation. The modifications introduced in the surgical treatment over the last decades were accompanied by a clear increase of survival, which reaches global values of 61% at 5 years in Japan. One of the reasons that contribute to this improvement is early diagnosis of the lesions. In the period between January 1, 1990 and December 31, 1999 662 patients with gastric adenocarcinoma were treated in the Service of Surgery 1 of our hospital; 110 were refused surgical treatment. Of the resected patients, 91 (21.4%) were classified as early gastric cancer according to the definition of the Japanese Society of Digestive Endoscopy. There were 30 women and 61 men, with a median age of 60.2 +/- 15 years; 3 patients had a preoperative diagnosis of gastric ulcer; 2 others were operated without recent histology; and 1 patient was urgently resected for a bleeding ulcer. In all the remaining patients biopsy confirmed the presence of cancer (89%) or serious dysplasia (4.6%). The lesions had been distributed essentially in the medium 1/3 (48.3%) and distal 1/3 of the stomach. Subtotal gastrectomy was accomplished in 48 patients, total gastrectomy in 40, total desgastrogastrectomy in 3, and in 9 patients the surgery involved the spleen (8 patients) and the spleen and tail of the pancreas in 1 patient. Lymphadenectomy was not performed in 5 patients, lymph nodes by the first lymph node barrier were removed in 25 patients and by the second barrier in 61 patients (67%). Median tumor size was 26 +/- 1.8 mm. The lesion reached the mucosa in 46 patients and the mucosa and submucosa in 45. In 6 patients the removed lymph nodes were microscopically invaded (6.7%). Five patients died (5.7%). The median follow-up of the patients is 41 +/- 26 months; 7 patients died (8.1%) during this period; 4 died unequivocally of disease progression. The median survival of patients was 85% at 5 years and 80% at 10 years. In our series, survival was affected by the presence of invaded lymph nodes, not by the penetration in depth of the lesion or the size of the tumor. PMID: 11865370 [PubMed - indexed for MEDLINE]
- 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
- Perforated peptic ulcer: main factors of morbidity and mortality.Publication . NOGUIERA, C.; SILVA, A.S.; SANTOS, J.N.; SILVA, A.G.; FERREIRA, J.; MATOS, E.; VILACA, H.World J Surg. 2003 Jul;27(7):782-7. Perforated peptic ulcer: main factors of morbidity and mortality. Noguiera C, Silva AS, Santos JN, Silva AG, Ferreira J, Matos E, Vilaça H. Surgery Department, Surgery 1, Hospital Geral de Santo António, Instituto de Ciencias Biomédicas Abel Salazar, Largo do Prof. Abel Salazar, 4099-001 Oporto, Portugal. Abstract It is well stated in the literature that medical treatment for peptic ulcer is based on a combination of proton pump inhibitors (PPIs) and antibiotics to eradicate Helicobacter pylori. This treatment is associated with a high rate of immediate success and a low rate of recurrence at 12 months, although it is not effective in all patients. Peptic ulcer (PU) perforation is a serious problem that leads to high complication and mortality rates. Surgical treatment, with its various possibilities, constitutes the ideal treatment. Surgical intervention in these cases, however, can be directed to treating the perforation alone, or it can offer definitive treatment of the ulcer itself. With the hope of establishing why such complications and mortality were seen in the patients in our hospital population, we gathered the facts about PU perforations and the types of surgery performed. We studied 210 consecutive patients (150 men, 60 women) who had undergone surgery at our hospital because of perforation between January 1, 1990 and December 31, 2000. The patients' median age was 53.0 +/- 20.6 years (men 47.7 +/- 17.3 years; women 66.3 +/- 22.0 years). Altogether, 86 patients had significant associated illnesses, 62 were admitted more than 24 hours after the perforation, and 25 were admitted in shock. We performed resections in 10 patients; 88 patients were treated by suturing the perforation with or without a patch of epiploon; and 112 underwent a troncular vagotomy with drainage (VT + Dr). A total of 21 patients died (10%). Significant risk factors that led to complications were identified by statistical studies. They were a perforation that had been present more than 24 hours, the coexistence of significant associated illnesses, and resection surgery. The significant risk factors that led to death were the presence of shock at admission, the coexistence of significant illnesses, and resection surgery. There was no statistically significant difference concerning morbidity and mortality between simple closure of the perforation and definitive surgery (VT + Dr). PMID: 14509505 [PubMed - indexed for MEDLINE]
- Vascular Surgery and TransplantationPublication . PEREIRA, M.C.Rev Port Cir Cardiotorac Vasc. 2003 Oct-Dec;10(4):215-217. [Vascular Surgery and Transplantation] [Article in Portuguese] Pereira MC. Abstract As Honorary President of the Joint Meeting of Portuguese Society for Cardiothoracic and Vascular Surgery and the Portuguese Society of Transplantation, the author addressed a conference in which he emphasized the straigth links existing between Vascular Surgery and Organ Transplantation Surgery, and describes his professional course and the historical development of transplantation in its Department and Hospital, as well as in the remaining country, an area in which he was proeminent protagonist and pionner, leading to his nomination to distinguished functions of National Coordinator of Organ Transplantation in Portugal. PMID: 15146258 [PubMed - as supplied by publisher]