SROS - Artigos publicados em revistas indexadas na Medline
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- Corpus cavernosum from men with vasculogenic impotence is partially resistant to adenosine relaxation due to endothelial A(2B) receptor dysfunctionPublication . Faria, M.; Cardoso, T.; Lafuente-de-Carvalho, J.; Sá, P.ABSTRACT Although adenosine has been implicated in penile erection in human males, the receptor subtype responsible for adenosine regulation of human corpus cavernosum (HCC) smooth muscle tone is still a matter of debate. Using selective adenosine agonists and antagonists, we aimed at characterizing the adenosine receptors mediating relaxation of precontracted (with 1 M phenylephrine) HCC strips. HCC specimens were collected from control subjects (organ donors) and from patients with severe vasculogenic erectile dysfunction (ED). In control subjects, adenosine and 5 -N-ethyl-carboxamide adenosine (NECA) fully relaxed HCC. The selective A2A receptor agonist 2-[4-(2-p-carboxy ethyl)phenylamino]-5 -N-ethylcarboxamido adenosine (CGS21680C) produced only a partial relaxation (30–50%) of HCC, which could be further enhanced by simultaneous application of 100 M NECA. The selective A2B receptor antagonist N-(4-acetylphenyl)-2-[4-(2,3,6,7-tetrahydro- 2,6-dioxo-1,3-dipropyl-1H-purin-8-il)phenoxy] acetamida (MRS1706) (10 nM) attenuated NECA-induced relaxation without affecting CGS21680C action. The A2A receptor antagonist 4-{2-[7-amino-2-(2-furyl)[1,2,4]triazolo-[2,3-a][1,3,5]triazin-5- ylamino]ethyl}phenol (ZM241385) (50 nM) consistently reduced the actions of both agonists. In contrast to CGS21680C, NECAinduced relaxation was attenuated when endothelial production of NO and prostanoids was reduced by 100 M NG-nitro-Larginine and 10 M indomethacin, respectively. HCC strips from patients with vasculogenic ED were partially resistant to NECA but kept relaxation to CGS21680C; the remaining effect was sensitive to blockade of A2A receptors with 50 nM ZM241385. Data suggest that adenosine regulates HCC smooth muscle tone through the activation of two receptor populations, CGS21680C-sensitive (A2A) and -insensitive (A2B) receptors, located on smooth muscle fibers and on endothelial cells, respectively. Endothelial dysfunction may be correlated with a loss of adenosine A2B receptor activity in penile vessels from men with vasculogenic ED.
- First Trimester Aneuploidy Screening Program for Preeclampsia Prediction in a Portuguese Obstetric PopulationPublication . Teixeira, C.; Tejera, E.; Martins, H.; Pereira, A.; Costa-Pereira, A:; Rebelo, I.Objective. To evaluate the performance of a first trimester aneuploidy screening program for preeclampsia (PE) prediction in a Portuguese obstetric population, when performed under routine clinical conditions. Materials and Methods. Retrospective cohort study of 5672 pregnant women who underwent routine first trimester aneuploidy screening in a Portuguese university hospital from January 2009 to June 2013. Logistic regression-based predictive models were developed for prediction of PE based on maternal characteristics, crown-rump length (CRL), nuchal translucency thickness (NT), and maternal serum levels of pregnancy-associated plasma protein-A (PAPP-A) and free beta-subunit of human chorionic gonadotropin (free β-hCG). Results. At a false-positive rate of 5/10%, the detection rate for early-onset (EO-PE) and late-onset (LO-PE) PE was 31.4/45.7% and 29.5/35.2%, respectively. Although both forms of PE were associated with decreased PAPP-A, logistic regression analysis revealed significant contributions from maternal factors, free β-hCG, CRL, and NT, but not PAPP-A, for prediction of PE. Conclusion. Our findings support that both clinical forms of EO-PE and LO-PE can be predicted using a combination of maternal history and biomarkers assessed at first trimester aneuploidy screening. However, detection rates were modest, suggesting that models need to be improved with additional markers not included in the current aneuploidy screening programs.
- Grávidas adolescentes e grávidas adultas. Diferentes circunstâncias de risco?Publication . Figueiredo, B.; Pacheco, A.; Magarinho, R.Resumo: Este estudo teve por objectivo caracterizar as circunstâncias em que decorre a gravidez na adolescência e na idade adulta e analisar as principais diferenças, ao nível das condições demográficas, sociais, anteriores de existência e actuais da gravidez. Uma amostra de 130 utentes da Maternidade Júlio Dinis (Porto) (66 grávidas adolescentes e 64 grávidas adultas) foi entrevistada através da Contextual Assessment of the Maternity Experience (CAME, Bernazzani, Marks, Siddle, Asten, Bifulco, et al, 2004), no último trimestre de gravidez. Os resultados mostram que à gravidez na adolescência se associa um elevado número de condições menos favoráveis, que podem comprometer a gestação e os cuidados ao bebé, como por exemplo: desemprego, monoparentalidade, consumo de tabaco, condições anteriores de existência adversas e gravidez não desejada. No entanto, outras circunstâncias adversas estão associadas à gravidez na idade adulta, como seja: história de problemas de fertilidade e de problemas psicológicos com tratamento ou internamento e ausência por morte de pelo menos um dos pais. Conclui-se que um número considerável de grávidas adolescentes vive em condições desfavoráveis, pelo que, não obstante a sua variabilidade, o grupo enquanto um todo pode ser considerado de risco, quando comparado ao grupo de grávidas adultas. Conclui-se ainda que grávidas adolescentes e adultas vivem a gravidez em condições específicas; observam-se diferentes circunstâncias de risco junto de cada um destes dois grupo, que devem ser atendidas na adequação da ajuda prestada pelos técnicos de saúde às reais necessidades das mães.
- LESÃO MEDULAR TRAUMÁTICA: Recuperação Neurológica e FuncionalPublication . Andrade, M.; Gonçalves, S.Objectivo: Avaliar a recuperação neurológica e funcional dos doentes com Traumatismo Vertebro-Medular (TVM). Métodos: Foi realizado um estudo retrospectivo, que incluiu os 93 doentes com o diagnóstico de TVM admitidos no Serviço de Fisiatria do Hospital Geral de Santo António, entre Janeiro de 1993 e Dezembro de 2002. Os dados demográficos e médicos foram recolhidos dos processos clínicos. O registo da avaliação de cada doente foi efectuado na admissão, à data da alta hospitalar e 1 e 3 anos após a lesão. O estado neurológico foi classificado de acordo com os critérios da American Spinal Injury Association (ASIA), e o estado funcional através da Medida de Independência Funcional (MIF). Resultados: 87% doentes eram do sexo masculino, sendo a média de idades de 40 anos. Os acidentes de viação e as quedas foram a causa mais frequente da lesão. A maioria dos traumatismos foi dorsal e cervical (45% e 42% respectivamente). O tratamento inicial incluiu: administração intravenosa de metilprednisolona, que ocorreu nas primeiras oito horas após lesão em 54% dos casos; intervenção cirúrgica precoce, realizada em 77%. Registou-se maior recuperação nos doentes com lesão medular incompleta, particularmente naqueles classificados como C na escala da ASIA. Foi encontrada uma associação estatisticamente significativa entre os resultados obtidos no internamento e os registados no período de três anos de follow-up. A recuperação neurológica não se correlacionou com a idade dos doentes, o nível de lesão, administração de corticoides em altas doses ou cirurgia realizada nas primeiras 24 horas após a lesão (p >0,05). Os resultados funcionais registados através da MIF revelaram-se bastante favoráveis, particularmente os que foram alcançados em regime de internamento. Conclusões: Os resultados revelados neste estudo demonstram o considerável potencial para uma recuperação neurológica após um TVM, enfatizando a importância do investimento na continuidade dos programas de reabilitação nos anos que se seguem à lesão, particularmente nas lesões incompletas. Study Design: A retrospective study was conducted Objective: Evaluate the neurologic and functional recovery in patients with Traumatic Spinal Cord Injury (TSCI). Methods: A retrospective study was conducted, including the 93 patients with a diagnosis of TSCI admitted for rehabilitation in the Physical and Rehabilitation Medicine Department, Santo António General Hospital, between January 1993 and December 2002. Demographic and clinical data were collected from the hospital charts. The patients were evaluated at admission for rehabilitation, before discharging, 1 year and 3 years after injury. Neurologic status was registered according to the standards of the American Spinal Injury Association (ASIA) and functional status by the Functional Independence Measure (FIM). Results: The sample population was 87% men, with a mean age of 40 years. Motor vehicle accidents and falls were the commonest mechanism of injury. The majority sustained dorsal and cervical lesions (45% and 42% respectively). The initial management included: intravenous high dose methylprednisolone, administered within eight hours after injury in 54% of the sample; early surgical stabilization, performed on 77%. Incomplete cord injury carried a better prognosis of motor improvement, especially the patients classified as C on the ASIA Impairment Scale (AIS). A significant statistical association was found between the outcomes obtained during the initial rehabilitation, and the ones achieved on the 3 year followup period. The neurologic recovery was not related with the patient’s age, injury level, high dose steroid administration or surgery performed in the first 24 hours after injury (p >0,05). The FIM scores demonstrated the favourable functional outcomes achieved, especially during the inpatient rehabilitation. Conclusions: The results of this study further demonstrate the considerable potential for neurologic recovery after TSCI, emphasizing the importance of the rehabilitation investment continuity, especially for the ones with incomplete cord injury.
- Successful pregnancy in a severely hypoxemic patient with pulmonary alveolar proteinosisPublication . Belchior, I.; Cerdeira, A.; Santos, M.; Braga, J.; Aragâo, I.; Martins, A.Abstract Pulmonary alveolar proteinosis (PAP) is a rare disorder characterized by abnormal accumulation of a lipoproteinaceous material in the alveoli, which may lead to respiratory failure and has an associated high risk for infections. The mainstay treatment for PAP is whole lung lavage. A pregnant woman, previously diagnosed with primary PAP, the most common form of PAP, was admitted with dyspnea and worsening respiratory function. In one month period, a wholelung bronchopulmonary lavage was performed twice, with clinical and functional improvement. Pregnancy was carried to term and a healthy baby was delivered. The mechanisms of respiratory impairment are discussed as well as treatment options and response. Resumo A proteinose alveolar pulmonar (PAP) é uma doença rara caracterizada pela acumulação anormal de material lipoproteináceo nos alvéolos, que pode levar a insufi ciência respiratória, estando associada a um risco elevado de infecções. O tratamento gold-standard da PAP é a lavagem pulmonar total.
- Testículos no palpables: experiencia del Hospital Central Especializado de Crianças Maria PiaPublication . Bonet, B.; Recaman, M.; Ferreira-Sousa, J.; Carvalho, F.; Enes, C.; Cidade-Rodrigues, J.La incidencia de criptorquidia es del 1% en niños de 1 año de edad, siendo en el 20% de los casos el testículo no palpable. El objetivo de este trabajo fue estudiar la contribución de la cirugía mínimamente invasiva en el diagnóstico y tratamiento de estos pacientes. Los autores realizaron un estudio prospectivo, analítico y longitudinal durante el período de enero de 2001 a diciembre de 2004, englobando 89 niños portadores de 98 testículos no palpables sometidos a laparoscopia. Los autores analizaron los siguientes parámetros: localización del testículo no palpable, examen objetivo bajo anestesia general ecografía inguinoescrotal, edad de la intervención, hallazgos laparoscópicos, tratamiento efectuado, resultados anatomopatológicos de las piezas extirpadas y seguimiento después de la cirugía.
- The effects of spinal anaesthesia for elective caesarean section on uterine and umbilical arterial pulsatility indexes in normotensive and chronic hypertensive pregnant women: a prospective, longitudinal studyPublication . Guedes-Martins, L.; Graça, H.; Saraiva, J.; Guedes, L.; Gaio, R.; Cerdeira, A.; Macedo, F.; Almeida, H.BACKGROUND: Despite the known effects of neuraxial blockade on major vessel function and the rapid decrease in uterine vascular impedance, it is unclear how the blockade affects the utero-placental circulation in the near-term. We hypothesize that among women with chronic hypertension, a loss of sympathetic tonus consequent to spinal block may cause significant changes in the utero-placental haemodynamics than the changes typical in normal pregnant women. Therefore, the main study objective was to analyse the effect of spinal anaesthesia for caesarean section on uterine and umbilical arterial impedance in pregnant women at term diagnosed with stage-1 chronic hypertension. METHODS: A prospective, longitudinal study was performed in singleton pregnant women (203 low-risk and 33 with hypertension) scheduled to undergo elective caesarean section. The mean arterial blood pressure and pulsatility indexes for the uterine and umbilical arteries were recorded before and after spinal anaesthesia was performed using 8-9 mg hyperbaric bupivacaine (5 mg/mL) and 2-2.5 μg sufentanil (5 μg/mL). Multiple linear regression models with errors capable of correlation or with unequal variances were fitted using the generalized least squares. RESULTS: In normotensive women, the mean arterial blood pressure decreased after administering spinal anaesthesia (p < 0.05). The pulsatility index of the uterine and umbilical arteries did not change after spinal anaesthesia. In the hypertensive women, the mean arterial blood pressure (p < 0.05) and uterine artery pulsatility index (p < 0.05) decreased. In both groups, the umbilical artery pulsatility index did not change after spinal anaesthesia. CONCLUSIONS: In stage-1 chronic hypertensive pregnant women at term, spinal anaesthesia for caesarean section reduces uterine artery impedance but not umbilical artery impedance.
- Varicocoelectomy in adolescents: laparoscopic versus open high ligation techniquePublication . Moreira-Pinto, J.; Osorio, A.; Carvalho, F.; Castro, J.; Enes, C.; Reis, A.; Cidade-Rodrigues, J.Background: Treatment of varicocoele is aimed at eliminating the retrograde reflux of venous blood through the internal spermatic veins. The purpose of this investigation was to compare laparoscopic varicocoelectomy (LV) with open high ligation technique in the adolescent population. Materials and Methods: We retrospectively evaluated 33 adolescents who underwent varicocoelectomy at our paediatric hospital, between May 2004 and September 2008. Patients were divided into two groups depending on the technique: those who had an LV and those submitted to an open varicocoelectomy (OV). We analysed side, age of surgery, follow-up period and the incidence of recurrence/persistence, hydrocoele formation and wound complication. Results: There were 24 patients in the LV group and 9 in the OV group. All varicocoeles were in the left side. Mean age was 12 years in both groups. Mean follow-up time was 32 months for the LV group and 38 months for the OV group (P = 0.49). There was no significant difference in the incidence of hydrocoele in both the groups (25% versus 22%, P = 0.626). There was no recurrence/persistence on the LV group, while in the OV group there were three cases (P = 0.015). Conclusion: LV seems more efficient than open high ligation technique in the treatment of adolescents«SQ» varicocoeles. Larger series are necessary to draw more reliable conclusions.