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Gonçalves A, Leal C, Vasconcelos H, Marcos P. Veiled pancreas: Unmasking the riddle of an invisible organ. United European Gastroenterol J 2024; 12:526-527. [PMID: 38683661 DOI: 10.1002/ueg2.12578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 04/19/2024] [Indexed: 05/01/2024] Open
Affiliation(s)
- André Gonçalves
- Gastroenterology Department, Unidade de Saúde Local da Região de Leiria, Leiria, Portugal
| | - Carina Leal
- Gastroenterology Department, Unidade de Saúde Local da Região de Leiria, Leiria, Portugal
| | - Helena Vasconcelos
- Gastroenterology Department, Unidade de Saúde Local da Região de Leiria, Leiria, Portugal
| | - Pedro Marcos
- Gastroenterology Department, Unidade Local de Saúde Cova da Beira, Covilhã, Portugal
- Department of Medical Sciences, Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
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2
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Gonçalves A, Leal C, Cotrim I, Vasconcelos H. An elderly patient's pancreatobiliary puzzle: unraveling diagnosis and treatment challenges. Rev Esp Enferm Dig 2024. [PMID: 38205689 DOI: 10.17235/reed.2024.10125/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
Pancreatobiliary fistulas associated withntraductal Papillary Mucinous Neoplasm (IPMN) are rare and present therapeutic challenges. The authors describe the clinical course of an 81-year-old woman presenting with acute cholangitis, ultimately diagnosed with IPMN involving secondary ducts with focal high-grade dysplasia. Initial manifestations included elevated inflammatory markers, cholestasis, and imaging findings of a pancreatic lesion. Endoscopic retrograde cholangiopancreatography revealed dilation of both intrahepatic and extrahepatic bile ducts, along a cystic cluster originating from the pancreas, fistulizing into the common bile duct. Despite initial endoscopic interventions, recurrent cholestasis persisted. Subsequent multidisciplinary evaluation led to a cephalic duodenopancreatectomy. This case underscores the rarity of pancreatobiliary fistulas associated with IPMNs and the subsequent therapeutic challenges. The absence of standardized treatment algorithms for such intricate cases emphasizes the importance of individualized approaches. The fluoroscopy image displaying a cystic cluster originating from the pancreas and showing fistulization into the common bile duct is a rare image presented in our report, unique to this case.
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Affiliation(s)
| | - Carina Leal
- Gastroenterology, Centro Hospitalar de Leiria, Portugal
| | - Isabel Cotrim
- Gastroenterology, Centro Hospitalar de Leiria, Portugal
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Silva MA, Ruge A, Vicente N, Fernandes A, Pereira E, Vasconcelos H. Pancreatic Insulinoma: When Surgery Is Not an Option. GE Port J Gastroenterol 2023; 30:451-454. [PMID: 38476152 PMCID: PMC10928855 DOI: 10.1159/000527034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/22/2022] [Indexed: 03/14/2024]
Affiliation(s)
- Maria Azevedo Silva
- Department of Gastroenterology, Centro Hospitalar de Leiria, Leiria, Portugal
| | - André Ruge
- Department of Gastroenterology, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Nuno Vicente
- Department of Endocrinology, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Alexandra Fernandes
- Department of Gastroenterology, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Eduardo Pereira
- Department of Gastroenterology, Centro Hospitalar de Leiria, Leiria, Portugal
- Department of Gastroenterology, Hospital Amato Lusitano, Castelo Branco, Portugal
| | - Helena Vasconcelos
- Department of Gastroenterology, Centro Hospitalar de Leiria, Leiria, Portugal
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Silva MA, Leal C, Ruge A, Fernandes A, Cunha MF, Vasconcelos H. Testicular Seminoma Presenting as Gastrointestinal Bleeding: A Rare Cause of Metastatic Disease in the Stomach. GE Port J Gastroenterol 2023; 30:311-315. [PMID: 37767307 PMCID: PMC10521319 DOI: 10.1159/000526427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 05/18/2022] [Indexed: 09/29/2023]
Abstract
Introduction Gastric metastases are quite infrequent. When arising from testicular germ cell tumors, gastric metastases are usually associated with nonseminomas. Case Report A 45-year-old man presented with upper gastrointestinal bleeding, severe anemia, and elevated lactate dehydrogenase. Endoscopy revealed three atypical-looking gastric ulcers. Abdominal computed tomography showed an extensive heterogeneous retroperitoneal mass and a smaller one in the pelvis. Biopsies of both the ulcers and the retroperitoneal mass revealed a highly proliferative neoplasia of unknown origin. While the diagnostic work up was taking place, the patient complained of a testicular mass which was resected, after suspicious findings in the ultrasound. Histopathologic findings revealed a testicular seminoma. Revision of previous biopsies was compatible with metastatic seminoma to the stomach and the retroperitoneum. Discussion/Conclusion Gastric metastasis arising from testicular seminoma is quite infrequent and usually diagnosed after the primary tumor is known. We report a rare case of a testicular seminoma presenting as upper gastrointestinal bleeding due to gastric metastases. This case highlights the importance of detailed anamnesis and physical examination in the differential diagnosis of atypical gastric ulcers with initial inconclusive work up and emphasizes an unusual manifestation of a germ cell malignancy.
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Affiliation(s)
- Maria Azevedo Silva
- Department of Gastroenterology, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Carina Leal
- Department of Gastroenterology, Centro Hospitalar de Leiria, Leiria, Portugal
| | - André Ruge
- Department of Gastroenterology, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Alexandra Fernandes
- Department of Gastroenterology, Centro Hospitalar de Leiria, Leiria, Portugal
| | | | - Helena Vasconcelos
- Department of Gastroenterology, Centro Hospitalar de Leiria, Leiria, Portugal
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Gonçalves A, Azevedo-Silva M, Vasconcelos H. Senile amyloidosis. Endoscopic findings as a starting point for diagnosis. Rev Gastroenterol Mex (Engl Ed) 2023; 88:287-288. [PMID: 37419856 DOI: 10.1016/j.rgmxen.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 04/24/2023] [Indexed: 07/09/2023]
Affiliation(s)
- A Gonçalves
- Departamento de Gastroenterología, Centro Hospitalar de Leiria, Leiria, Portugal.
| | - M Azevedo-Silva
- Departamento de Gastroenterología, Centro Hospitalar de Leiria, Leiria, Portugal
| | - H Vasconcelos
- Departamento de Gastroenterología, Centro Hospitalar de Leiria, Leiria, Portugal
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Azevedo Silva M, Ruge Gonçalves A, Fernandes A, Vasconcelos H. Hilar cholangiocarcinoma presenting with hematochezia due to metastases to the rectum. Rev Esp Enferm Dig 2023; 115:330. [PMID: 36148664 DOI: 10.17235/reed.2022.9173/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
An 84-year-old female, with history of endometrial and gallbladder adenocarcinomas, both submitted to curative surgeries, was admitted to the emergency room with obstructive jaundice. Computed tomography and subsequent magnetic resonance cholangiopancreatography revealed a common hepatic duct stenosis with intrahepatic biliary dilatation. She underwent percutaneous transhepatic cholangiography with successful biliary drainage. During the same admission, the patient experienced episodes of hematochezia. Rectosigmoidoscopy showed a 20 mm ulcer in the distal rectum and congestion of the rectal mucosa. Computed tomography revealed rectal wall circumferential thickening. Ulcer biopsies were compatible with a neoplasia of biliary origin.
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Gonçalves A, Simas D, Barbeiro S, Vasconcelos H. Gastric heterotopia in the rectum: a rare entity with potential pitfalls. Rev Esp Enferm Dig 2023. [PMID: 37170532 DOI: 10.17235/reed.2023.9693/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Gastric heterotopia (GHT) is a medical condition where the gastric mucosa is found at a non-phyysiological part of the body. GHT can present itself anywhere in the gastrointestinal tract from the mouth to the anorectal area, as well as in the hepatobiliary system. However, it is relatively rare to find GHT in the rectum, with only around 50 documented cases reported in medical literature. We present the case of a 51-year-old man who underwent average-risk screening colonoscopy. He had no clinically significant comorbidities and was otherwise asymptomatic, with no family history. Notable findings included a pseudopolypoid lesion in the distal rectum, adjacent to the dentate line, measuring approximately 15 mm with regular-appearing mucosa under narrow-band-imaging. Biopsy specimens showed histological characteristics of oxyntic-type gastric mucosa without inflammation or dysplasia. GHT has the potential to progress to malignancy, although the rate of malignancy is currently unknown. Awareness of this entity is important given its frequency and potential for misdiagnosis.
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Affiliation(s)
| | - Diogo Simas
- Gastroenterology, Centro Hospitalar de Leiria
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Correia C, Almeida N, Leal C, Branquinho D, Fernandes A, Gravito-Soares E, Calhau C, Bastos I, Vasconcelos H, Figueiredo P. Single-capsule bismuth-based quadruple therapy as a rescue therapy for Helicobacter pylori eradication. Scand J Gastroenterol 2023; 58:227-231. [PMID: 36189844 DOI: 10.1080/00365521.2022.2119097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Helicobacter pylori (H. pylori) infection is highly prevalent in Portugal and its eradication is formally recommended. However, the indiscriminate use of antimicrobials has led to a drastic rise in antibiotic resistance, with the failure of traditional eradication schemes. A single-capsule bismuth-based quadruple therapy became recently available in Portugal. This study aims to evaluate the efficacy and safety of a bismuth-based quadruple therapy as a second-line or rescue therapy. PATIENTS AND METHODS This was a multicentric study. All consecutive patients that were treated with bismuth-based quadruple therapy, as second-line or salvage treatment between July 2017 and April 2019 were enrolled. Their medical records were reviewed and clinical and laboratorial parameters, as well as data on treatment efficacy and adverse events were retrieved. Patients were also contacted by phone after treatment to confirm compliance, adverse events, and global satisfaction with this specific therapy. RESULTS A total of 151 subjects were included (female-68.9%; mean age-56 ± 13.5 years). Patients were previously submitted to 212 eradication schemes (Median-1; 1-5; IQR:4): 33.5% triple clarithromycin-based, 25% sequential, 7.5% concomitant, 5.2% others, and in 28.8% it was not possible to know the previous eradication scheme(s) followed by the patient. The PPI of choice was esomeprazole (39.7%), followed by omeprazole (27.8%). Compliance was achieved in 93.4% and the overall eradication rate was 90.1% (95% CI: 84.6-94.2). Treatment-related adverse effects were experienced by 63 patients (41.7%; 95% CI: 34-49.7), being mild in 29, moderate in 19, and severe in 15. The main drawbacks of the treatment, from the patient's perspective, were the high price (47%) and the adverse effects (16.6%). Failure to eradicate H. pylori was correlated with the following: previous rifabutin-based scheme (0 vs. 100%; p = 0.010) and a higher number of previous treatment schemes (1.5 ± 0.7 vs. 2.3 ± 1.2; p < 0.001). CONCLUSION In this South-European country a single-capsule bismuth-based quadruple therapy is an excellent option as a second-line or rescue therapy, with acceptable compliance and side effects.
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Affiliation(s)
- Catarina Correia
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Nuno Almeida
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Carina Leal
- Gastroenterology Department, Leiria Hospital Centre, Leiria, Portugal
| | - Diogo Branquinho
- Gastroenterology Department, Baixo Vouga Hospital Centre, Aveiro, Portugal
| | | | - Elisa Gravito-Soares
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Carlos Calhau
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Isabel Bastos
- Gastroenterology Department, Baixo Vouga Hospital Centre, Aveiro, Portugal
| | | | - Pedro Figueiredo
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Vasconcelos H, Matias A, Mendes J, Araújo J, Dias B, Jorge PA, Saraiva C, de Almeida JMM, Coelho LC. Compact biosensor system for the quantification of hydrogen peroxide in milk. Talanta 2022. [DOI: 10.1016/j.talanta.2022.124062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Leal C, Almeida N, Silva M, Santos A, Vasconcelos H, Figueiredo P. Appropriateness of Endoscopic Procedures: A Prospective, Multicenter Study. GE Port J Gastroenterol 2022; 29:5-12. [PMID: 35111959 PMCID: PMC8787496 DOI: 10.1159/000515839] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 02/19/2021] [Indexed: 11/01/2023]
Abstract
INTRODUCTION Advances in endoscopy and open-access systems led to an increase in endoscopic procedures. However, overuse of endoscopy has been consistently reported. This study aims to assess the appropriateness of esophagogastroduodenoscopy (EGD) and colonoscopy referral in the private and public setting. PATIENTS AND METHODS We conducted a prospective, multicenter study at 2 public and 5 private endoscopy units. Patients scheduled for elective EGD or colonoscopy were enrolled. Clinical data and endoscopy findings were recorded. Appropriateness of endoscopy was defined according to the American Society for Gastrointestinal Endoscopy guidelines (for EGD) and the European Panel on Appropriateness of Gastrointestinal Endoscopy II (for colonoscopy). RESULTS Regarding EGD: 215 patients enrolled (43.7% were males) with a mean age of 61.0 ± 15.1 years; 54.0% (n = 116) were in public hospitals. Referral by a gastroenterologist was made for 34.9% (n = 75). Appropriate indications were made for 62.3% (n = 134): 42.4% in private versus 79.3% in public endoscopy units (odds ratio [OR] 5.20; 95% confidence interval [CI] 2.85-9.49; p < 0.01). Rate of appropriate EGD was 74.7% for gastroenterologist referral and 56.1% for other specialties (OR 2.31; 95% CI 1.24-4.28; p < 0.01). Diagnostic yield for relevant findings was 47.9%. No association between indication appropriateness, gastroenterologist referral, and relevant endoscopic findings was found. Regarding colonoscopy: 287 patients enrolled (49.1% were males) with a mean age of 60.4 ± 14.4 years; 48.1% (n = 138) were in public hospitals. Referral by a gastroenterologist was made for 20.6% (n = 59). Appropriate indications were made for 70.0% (n = 201): 53.0% in private vs. 88.4% in public endoscopy units (OR 6.75; 95% CI 3.66-12.47; p < 0.01). Diagnostic yield was 57.1%. Relevant endoscopic diagnosis was associated with indication: 63.2% in the appropriate vs. 43.0% in the nonappropriate indication group (p < 0.05). DISCUSSION A significant percentage of endoscopies, mainly in the private setting, were performed without an appropriate indication. This influenced the diagnostic yield. The use of adequate criteria is fundamental for the rational use of an open-access system.
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Affiliation(s)
- Carina Leal
- Department of Gastroenterology, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Nuno Almeida
- Department of Gastroenterology, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Maria Silva
- Department of Gastroenterology, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Antonieta Santos
- Department of Gastroenterology, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Helena Vasconcelos
- Department of Gastroenterology, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Pedro Figueiredo
- Department of Gastroenterology, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Silva MA, Leal C, Ruge A, Fernandes A, Eliseu L, Vasconcelos H. Adenoma Recurrence after Endoscopic Piecemeal Mucosal Resection of Colorectal Flat Lesions: Applicability of the Sydney EMR Recurrence Tool in a Non-Tertiary Centre. GE Port J Gastroenterol 2021; 29:247-255. [PMID: 35979253 PMCID: PMC9274828 DOI: 10.1159/000518445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 06/23/2021] [Indexed: 11/19/2022]
Abstract
<b><i>Introduction:</i></b> Endoscopic mucosal resection (EMR) is the treatment of choice for non-invasive colorectal flat lesions. When endoscopic piecemeal mucosal resection (EPMR) is performed, endoscopic surveillance is necessary due to the risk of recurrence. The Sydney EMR Recurrence Tool (SERT) is a 0–4 scale that classifies lesions according to size, occurrence of intraprocedural bleeding (IPB) and presence of high-grade dysplasia (HGD). Our goal is to evaluate the applicability of SERT in predicting adenoma recurrence (AR) after EPMR. <b><i>Methods:</i></b> This is a retrospective single-centre study with inclusion of lateral spreading lesions ≥20 mm, consecutively resected by EPMR from March 2010 to February 2018, with at least 1 endoscopic re-evaluation. <b><i>Results:</i></b> A total of 181 lesions were included, corresponding to 174 patients with a mean age of 68 years and male gender predominance (61%; <i>n</i> = 106). The most frequent location was the ascending colon (34%; <i>n</i> = 62). Lesions were assessed according to Paris Classification (PC): 0-IIa: 39% (<i>n</i> = 71); 0-IIb: 24% (<i>n</i> = 43); 0-IIa + Is: 23% (<i>n</i> = 42); 0-IIa + IIb: 6% (<i>n</i> = 11); 0-IIa + IIc: 2% (<i>n</i> = 3). The mean size of the lesions was 33 ± 11 mm, with 25 (14%) being ≥40 mm. IPB occurred in 9 cases (5%), and 44 lesions (24%) displayed HGD. Sixty-six lesions (36.5%) were classified as SMSA (size, morphology, site, and access score) level 4. Adjunctive therapy with argon plasma coagulation (APC) was used in 37% (<i>n</i> = 67) of cases. The 6-month AR rate was 16% (<i>n</i> = 29). According to SERT groups, the AR rate was: SERT 0: 12% (14/120); SERT 1: 17% (6/35); SERT 2: 25% (3/12); SERT 3: 30% (3/10); SERT 4: 75% (3/4). Two of the three SERT variables (size ≥40 mm and IPB) were associated with recurrence at 6 months (<i>p</i> < 0.05). HGD and the remaining tested variables (age, gender, localization, accessibility, PC, use of APC/biopsy forceps and occurrence of delayed bleeding) were not associated with AR. SERT 0 lesions showed an inferior risk of 6-month AR (adjusted OR = 2.62; <i>p</i> = 0.035), with a negative predictive value of 88%. SMSA correlated with SERT (<i>p</i> < 0.001) and SMSA level 4 was associated with 6-month AR (<i>p</i> = 0.007). Lesions classified both as SERT 0 and SMSA level <4 had the lowest 6-month recurrence rate (9.2%). The 24-month recurrence rate was 23% (<i>n</i> = 41). When applying the Kaplan-Meier method, cumulative recurrence was significantly lower in SERT 0 lesions (<i>p</i> = 0.006, log-rank test). <b><i>Discussion/Conclusion:</i></b> Resection of flat colorectal lesions by EPMR has a considerable risk of recurrence, mostly in SERT 1–4 lesions. SERT 0 lesions, especially with SMSA level <4, show a lower risk of recurrent adenoma, which might allow longer intervals to first endoscopic surveillance in the future.
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Vasconcelos H, de Almeida JMM, Matias A, Saraiva C, Jorge PA, Coelho LC. Detection of biogenic amines in several foods with different sample treatments: An overview. Trends Food Sci Technol 2021. [DOI: 10.1016/j.tifs.2021.04.043] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Ferreira HDS, Ferrer F, Cabanelas N, Nelumba T, Ferreira AR, Faustino M, Antunes S, Vasconcelos H, Beringuilho M, Polena C, Borralho C, Madeira F, Morais C. Artificial intelligence: an attempt to automate remote device follow-up. Europace 2021. [DOI: 10.1093/europace/euab116.517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Artificial intelligence (AI) through machine learning (ML) refers to the simulation of human intelligence with the capacity for achieving goals within computers. In electrophysiology, ML has many applications in electrocardiography, intracardiac mapping and cardiac implantable electronic devices (CIEDs).
Remote monitoring (RM) of patients equipped with CIEDs associates the analysis of event reports and calendar-based remote follow-ups (FU). ML applications have allowed for risk stratification, improved arrhythmia localisation and streamlined remote monitoring which may significantly reduce the workload faced by electrophysiologists.
Aim
To develop a system that automates cardiac implantable electronic devices remote follow-up.
Methods and Results
We created a Java software application, that uses the latest optical character recognition techniques combined with artificial intelligence and natural language processing to extract information from PDF reports of RM of CIEDs from different manufacturers. The current version is HIPAA (Health Insurance Portability and Accountability Act) complaint and runs on local computers only.
Using the current system, we were able to run and extract data from 30 remote follow-up PDF reports of Cardiac Implantable Defibrillators (ICDs) and Cardiac Resynchronization Therapy with Defibrillator (CRT-Ds).
Time taken from data extraction to conversion of all 30 device PDFs was under 5 minutes.
Process and data extracted are presented in the figure below. (Figure 1)
Conclusion
This machine learning algorithm proved that it is possible to facilitate and automate remote follow-up of cardiac implantable electronic devices.
In a near future this will allow to us to efficiently increase productivity, by speeding and facilitating interpretation of remote device follow-ups, leading to improvements in patientcare and precision cardiovascular medicine.
Furthermore, in the current and future pandemics it may help prevent unnecessary in-person medical visits, avoiding additional, unnecessary strain on an already overburdened and overwhelmed healthcare system, and saving costs. Abstract Figure 1
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Affiliation(s)
- HDS Ferreira
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - F Ferrer
- Immutable Data Inc., Ontario, Canada
| | - N Cabanelas
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - T Nelumba
- Hospital de Santa Cruz, Pediatric Cardiology Department, Lisbon, Portugal
| | - AR Ferreira
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - M Faustino
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - S Antunes
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - H Vasconcelos
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - M Beringuilho
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - C Polena
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - C Borralho
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - F Madeira
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - C Morais
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
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Vasconcelos H, Coelho LCC, Matias A, Saraiva C, Jorge PAS, de Almeida JMMM. Biosensors for Biogenic Amines: A Review. Biosensors (Basel) 2021; 11:bios11030082. [PMID: 33805834 PMCID: PMC8000219 DOI: 10.3390/bios11030082] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 01/11/2023]
Abstract
Biogenic amines (BAs) are well-known biomolecules, mostly for their toxic and carcinogenic effects. Commonly, they are used as an indicator of quality preservation in food and beverages since their presence in higher concentrations is associated with poor quality. With respect to BA’s metabolic pathways, time plays a crucial factor in their formation. They are mainly formed by microbial decarboxylation of amino acids, which is closely related to food deterioration, therefore, making them unfit for human consumption. Pathogenic microorganisms grow in food without any noticeable change in odor, appearance, or taste, thus, they can reach toxic concentrations. The present review provides an overview of the most recent literature on BAs with special emphasis on food matrixes, including a description of the typical BA assay formats, along with its general structure, according to the biorecognition elements used (enzymes, nucleic acids, whole cells, and antibodies). The extensive and significant amount of research that has been done to the investigation of biorecognition elements, transducers, and their integration in biosensors, over the years has been reviewed.
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Affiliation(s)
- Helena Vasconcelos
- School of Agrarian and Veterinary Sciences, University of Trás-os-Montes and Alto Douro, 5001-801 Vila Real, Portugal; (H.V.); (C.S.)
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science and Faculty of Sciences, University of Porto, 4169-007 Porto, Portugal; (L.C.C.C.); (A.M.); (P.A.S.J.)
| | - Luís C. C. Coelho
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science and Faculty of Sciences, University of Porto, 4169-007 Porto, Portugal; (L.C.C.C.); (A.M.); (P.A.S.J.)
| | - Ana Matias
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science and Faculty of Sciences, University of Porto, 4169-007 Porto, Portugal; (L.C.C.C.); (A.M.); (P.A.S.J.)
| | - Cristina Saraiva
- School of Agrarian and Veterinary Sciences, University of Trás-os-Montes and Alto Douro, 5001-801 Vila Real, Portugal; (H.V.); (C.S.)
| | - Pedro A. S. Jorge
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science and Faculty of Sciences, University of Porto, 4169-007 Porto, Portugal; (L.C.C.C.); (A.M.); (P.A.S.J.)
- Department. of Physics and Astronomy, Faculty of Sciences, University of Porto, 4169-007 Porto, Portugal
| | - José M. M. M. de Almeida
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science and Faculty of Sciences, University of Porto, 4169-007 Porto, Portugal; (L.C.C.C.); (A.M.); (P.A.S.J.)
- Department of Physics, School of Science and Technology, University of Trás-os-Montes and Alto Douro, 5001-801 Vila Real, Portugal
- Correspondence:
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Viveiros D, de Almeida JMMM, Coelho L, Vasconcelos H, Maia JM, Amorim VA, Jorge PAS, Marques PVS. Temperature Stability and Spectral Tuning of Long Period Fiber Gratings Fabricated by Femtosecond Laser Direct Writing. Sensors (Basel) 2020; 20:s20143898. [PMID: 32668738 PMCID: PMC7412330 DOI: 10.3390/s20143898] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 11/16/2022]
Abstract
Long period fiber gratings (LPFGs) were fabricated in a standard single mode fiber (SMF-28e) through femtosecond (fs) laser direct writing. LPFGs with longer and shorter periods were fabricated, which allows coupling from the fundamental core mode to lower and higher order asymmetric cladding modes (LP1,6 and LP1,12, respectively). For the grating periods of 182.7 and 192.5 µm, it was verified that the LP1,12 mode exhibits a TAP at approximately 1380 and 1448 nm in air and water, respectively. Characterization of the LPFGs subjected to high-temperature thermal treatment was accomplished. Fine-tuning of the resonance band’s position and thermal stability up to 600 °C was shown. The temperature sensitivity was characterized for the gratings with different periods and for different temperature ranges. A maximum sensitivity of −180.73, and 179.29 pm/°C was obtained for the two resonances of the 182.7 µm TAP LPFG, in the range between 250 and 600 °C.
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Affiliation(s)
- Duarte Viveiros
- Center for Applied Photonics, INESC TEC, 4200-465 Porto, Portugal; (J.M.M.M.d.A.); (L.C.); (H.V.); (J.M.M.); (V.A.A.); (P.A.S.J.); (P.V.S.M.)
- Department of Physics and Astronomy, Faculty of Science, University of Porto, 4169-007 Porto, Portugal
- Correspondence: ; Tel.: +351-22-040-2301
| | - José M. M. M. de Almeida
- Center for Applied Photonics, INESC TEC, 4200-465 Porto, Portugal; (J.M.M.M.d.A.); (L.C.); (H.V.); (J.M.M.); (V.A.A.); (P.A.S.J.); (P.V.S.M.)
- Department of Physics, University of Trás-os-Montes e Alto Douro, 5001-801 Vila Real, Portugal
| | - Luís Coelho
- Center for Applied Photonics, INESC TEC, 4200-465 Porto, Portugal; (J.M.M.M.d.A.); (L.C.); (H.V.); (J.M.M.); (V.A.A.); (P.A.S.J.); (P.V.S.M.)
| | - Helena Vasconcelos
- Center for Applied Photonics, INESC TEC, 4200-465 Porto, Portugal; (J.M.M.M.d.A.); (L.C.); (H.V.); (J.M.M.); (V.A.A.); (P.A.S.J.); (P.V.S.M.)
- Department of Physics, University of Trás-os-Montes e Alto Douro, 5001-801 Vila Real, Portugal
| | - João M. Maia
- Center for Applied Photonics, INESC TEC, 4200-465 Porto, Portugal; (J.M.M.M.d.A.); (L.C.); (H.V.); (J.M.M.); (V.A.A.); (P.A.S.J.); (P.V.S.M.)
- Department of Physics and Astronomy, Faculty of Science, University of Porto, 4169-007 Porto, Portugal
| | - Vítor A. Amorim
- Center for Applied Photonics, INESC TEC, 4200-465 Porto, Portugal; (J.M.M.M.d.A.); (L.C.); (H.V.); (J.M.M.); (V.A.A.); (P.A.S.J.); (P.V.S.M.)
- Department of Physics and Astronomy, Faculty of Science, University of Porto, 4169-007 Porto, Portugal
| | - Pedro A. S. Jorge
- Center for Applied Photonics, INESC TEC, 4200-465 Porto, Portugal; (J.M.M.M.d.A.); (L.C.); (H.V.); (J.M.M.); (V.A.A.); (P.A.S.J.); (P.V.S.M.)
- Department of Physics and Astronomy, Faculty of Science, University of Porto, 4169-007 Porto, Portugal
| | - Paulo V. S. Marques
- Center for Applied Photonics, INESC TEC, 4200-465 Porto, Portugal; (J.M.M.M.d.A.); (L.C.); (H.V.); (J.M.M.); (V.A.A.); (P.A.S.J.); (P.V.S.M.)
- Department of Physics and Astronomy, Faculty of Science, University of Porto, 4169-007 Porto, Portugal
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16
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Marcos P, Eliseu L, Vasconcelos H. Esophagogastroduodenoscopy: how far should we go? A point of view. Rev Esp Enferm Dig 2020; 112:78. [PMID: 31909632 DOI: 10.17235/reed.2019.6585/2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Pedro Marcos
- Gastroenterology, Centro Hospitalar de Leiria, Portugal
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Marcos P, Eliseu L, Henrique M, Vasconcelos H. Syphilitic hepatitis: Case report of an overlooked condition. Clin Case Rep 2020; 8:123-126. [PMID: 31998501 PMCID: PMC6982489 DOI: 10.1002/ccr3.2588] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 10/24/2019] [Accepted: 10/30/2019] [Indexed: 11/11/2022] Open
Abstract
Syphilis is an overlooked cause of hepatitis. Syphilitic hepatitis should be a differential diagnosis in all patients with abnormal liver biochemical marker levels. Syphilitic hepatitis has been defined as the combination of increased liver enzymes, positive serology for syphilis, the absence of alternative causes for hepatobiliary injury, and liver enzyme improvement with proper antibiotic therapy.
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Affiliation(s)
- Pedro Marcos
- Gastroenterology DepartmentCentro Hospitalar de LeiriaLeiriaPortugal
| | - Liliana Eliseu
- Gastroenterology DepartmentCentro Hospitalar de LeiriaLeiriaPortugal
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18
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Marcos P, Atalaia-Martins C, Barbeiro S, Fernanda-Cunha M, Eliseu L, Vasconcelos H. Gastric Myeloid Sarcoma. GE Port J Gastroenterol 2019; 27:293-295. [PMID: 32775553 DOI: 10.1159/000504761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 10/27/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Pedro Marcos
- Gastroenterology Department, Centro Hospitalar de Leiria, Leiria, Portugal
| | | | - Sandra Barbeiro
- Gastroenterology Department, Centro Hospitalar de Leiria, Leiria, Portugal
| | | | - Liliana Eliseu
- Gastroenterology Department, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Helena Vasconcelos
- Gastroenterology Department, Centro Hospitalar de Leiria, Leiria, Portugal
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19
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Marcos P, Capelão G, Atalaia-Martins C, Clara P, Eliseu L, Vasconcelos H. Sigmoid Perforation by a Migrated Plastic Biliary Stent. GE Port J Gastroenterol 2019; 27:215-218. [PMID: 32509931 DOI: 10.1159/000503076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 08/31/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Pedro Marcos
- Gastroenterology Department, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Gustavo Capelão
- General Surgery Department, Centro Hospitalar de Leiria, Leiria, Portugal
| | | | - Paulo Clara
- General Surgery Department, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Liliana Eliseu
- Gastroenterology Department, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Helena Vasconcelos
- Gastroenterology Department, Centro Hospitalar de Leiria, Leiria, Portugal
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20
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Noll FB, Nascimento FS, Vasconcelos H. Special Section: Social Insects in the Neotropics. Neotrop Entomol 2018; 47:729-730. [PMID: 30430414 DOI: 10.1007/s13744-018-0650-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- F B Noll
- Depto de Zoologia e Botânica, IBILCE-UNESP, Rua Cristóvão Colombo 2265, São José do Rio Preto, SP, 15054-000, Brasil.
| | - F S Nascimento
- Depto de Biologia, FFCLRP-USP, Ribeirão Preto, SP, Brasil
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21
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Atalaia-Martins C, Marcos P, Leal C, Barbeiro S, Fernandes A, Santos A, Eliseu L, Gonçalves C, Cotrim I, Vasconcelos H. Variation between Pathological Measurement and Endoscopically Estimated Size of Colonic Polyps. GE Port J Gastroenterol 2018; 26:163-168. [PMID: 31192284 DOI: 10.1159/000491611] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 06/15/2018] [Indexed: 12/15/2022]
Abstract
Background and Aims Accurate determination of colonic polyp size is vital to an appropriate surveillance. The main aim of this study was to evaluate variation between the polyp size reported by the endoscopist and its pathological measurement. Methods A retrospective analysis of all colonic adenomatous polyps resected in a 12-month period was performed at our center. Endoscopic and pathological size for each polyp were compared, and overestimation rates, underestimation rates, and endoscopic-pathological variation (EPV) were calculated. Results Among the 573 polyps that were included, the mean endoscopic and pathological sizes were 8.00 and 6.66 mm, respectively. The most frequent error, in 62.1%, was overestimation by the colonoscopist. Overestimation and EPV were associated with resection technique (higher in endoscopic mucosal resection and smaller with biopsy forceps) and colonoscopist. They were not associated with years of experience in colonoscopy. Overestimation was more frequent in larger polyps. Conclusions Our study shows significant discordance between endoscopic and pathological size of colonic polyps with a clear tendency for endoscopic overestimation. Larger polyps are more difficult to accurately assess than smaller ones. This propensity for error was not related to colonoscopist's years of experience and seems to be an individual tendency.
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Affiliation(s)
| | - Pedro Marcos
- Gastroenterology Department, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Carina Leal
- Gastroenterology Department, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Sandra Barbeiro
- Gastroenterology Department, Centro Hospitalar de Leiria, Leiria, Portugal
| | | | - Antonieta Santos
- Gastroenterology Department, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Liliana Eliseu
- Gastroenterology Department, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Cláudia Gonçalves
- Gastroenterology Department, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Isabel Cotrim
- Gastroenterology Department, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Helena Vasconcelos
- Gastroenterology Department, Centro Hospitalar de Leiria, Leiria, Portugal
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de Almeida JMMM, Vasconcelos H, Jorge PAS, Coelho L. Plasmonic Optical Fiber Sensor Based on Double Step Growth of Gold Nano-Islands. Sensors (Basel) 2018; 18:s18041267. [PMID: 29677108 PMCID: PMC5948548 DOI: 10.3390/s18041267] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 04/17/2018] [Accepted: 04/18/2018] [Indexed: 01/09/2023]
Abstract
It is presented the fabrication and characterization of optical fiber sensors for refractive index measurement based on localized surface plasmon resonance (LSPR) with gold nano-islands obtained by single and by repeated thermal dewetting of gold thin films. Thin films of gold deposited on silica (SiO₂) substrates and produced by different experimental conditions were analyzed by Scanning Electron Microscope/Dispersive X-ray Spectroscopy (SEM/EDS) and optical means, allowing identifying and characterizing the formation of nano-islands. The wavelength shift sensitivity to the surrounding refractive index of sensors produced by single and by repeated dewetting is compared. While for the single step dewetting, a wavelength shift sensitivity of ~60 nm/RIU was calculated, for the repeated dewetting, a value of ~186 nm/RIU was obtained, an increase of more than three times. It is expected that through changing the fabrication parameters and using other fiber sensor geometries, higher sensitivities may be achieved, allowing, in addition, for the possibility of tuning the plasmonic frequency.
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Affiliation(s)
- José M M M de Almeida
- CAP/INESC TEC-Technology and Science and FCUP-Faculty of Sciences, University of Porto, 4169-007 Porto, Portugal.
- Department of Physics, School of Sciences and Technology, University of Trás-os-Montes e Alto Douro, 5001-801 Vila Real, Portugal.
| | - Helena Vasconcelos
- CAP/INESC TEC-Technology and Science and FCUP-Faculty of Sciences, University of Porto, 4169-007 Porto, Portugal.
| | - Pedro A S Jorge
- CAP/INESC TEC-Technology and Science and FCUP-Faculty of Sciences, University of Porto, 4169-007 Porto, Portugal.
| | - Luis Coelho
- CAP/INESC TEC-Technology and Science and FCUP-Faculty of Sciences, University of Porto, 4169-007 Porto, Portugal.
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Augusto JB, Antunes S, Faustino M, Cabanelas N, Vasconcelos H, Madeira F, Morais C. P1500A novel means to assess left ventricular overload: pacemaker with sleep apnea monitor. Europace 2017. [DOI: 10.1093/ehjci/eux158.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Portela F, Dias CC, Caldeira P, Cravo M, Deus J, Gonçalves R, Lago P, Morna H, Peixe P, Ramos J, Sousa H, Tavares L, Vasconcelos H, Magro F, Ministro P. The who-when-why triangle of CAM use among Portuguese IBD patients. Dig Liver Dis 2017; 49:388-396. [PMID: 28117198 DOI: 10.1016/j.dld.2016.12.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 12/29/2016] [Accepted: 12/30/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND The use of complementary and alternative medicines is increasing among chronic patients, particularly those afflicted with inflammatory bowel diseases. AIM This study aimed to address the prevalence of complementary and alternative medicines use among Portuguese inflammatory bowel diseases' patients. METHODS Patients were invited to fill an anonymous questionnaire concerning the use of complementary and alternative medicines. RESULTS Thirty-one per cent of the patients reported having used complementary and alternative medicines in the past, whereas 12% were using them by the time the questionnaire was administered. Fifty-nine per cent of the users did not share this information with their physician, whereas 14% and 8% discontinued their medication and periodical examination, respectively. Steroids prescription (OR=2.880) and a higher instruction level (OR=3.669) were predictors of complementary and alternative medicines use in this cohort. CONCLUSIONS Roughly a third of Portuguese IBD patients had used CAM. Steroid treatment and an academic degree are associated with CAM use. Given the potential side effects and interactions, patient information about the benefits and limitations of conventional and complementary treatments should be reinforced.
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Affiliation(s)
- Francisco Portela
- Serviço de Gastrenterologia, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal.
| | - Camila C Dias
- CIDES - Department of Health Information and Decision Sciences, Faculty of Medicine, University of Porto, Portugal; CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal
| | - Paulo Caldeira
- Gastroenterology Department, Centro Hospitalar do Algarve, Portugal
| | - Marilia Cravo
- Serviço de Gastrenterologia, Hospital Beatriz Ângelo, Loures, Portugal
| | - João Deus
- Serviço de Gastrenterologia, Hospital Fernandes da Fonseca, Amadora, Portugal
| | | | - Paula Lago
- Gastroenterology Department, Centro Hospitalar Porto-Hospital Santo António, Portugal
| | - Henrique Morna
- Serviço de Gastrenterologia, Hospital do Funchal, Funchal, Portugal
| | - Paula Peixe
- Serviço de Gastrenterologia, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Jaime Ramos
- Serviço de Gastrenterologia, Hospital dos Capuchos, Lisboa, Portugal
| | - Helena Sousa
- Gastroenterology Department, Centro Hospitalar do Algarve, Portugal; Biomedical Sciences and Medicine Department, University of Algarve, Portugal
| | - Lurdes Tavares
- Serviço de Gastrenterologia, Hospital de Santa Maria, Lisboa, Portugal
| | | | - Fernando Magro
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal; Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Portugal; MedInUP - Centre for Drug Discovery and Innovative Medicines, University of Porto, Portugal
| | - Paula Ministro
- Serviço Gastrenterologia, Centro Hospitalar de Tondela - Viseu, Viseu, Portugal
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Portela F, Lago P, Cotter J, Gonçalves R, Vasconcelos H, Ministro P, Lopes S, Eusébio M, Morna H, Cravo M, Peixe P, Cremmers I, Sousa H, Deus J, Duarte M, Magro F. Anaemia in Patients with Inflammatory Bowel Disease - A Nationwide Cross-Sectional Study. Digestion 2017; 93:214-20. [PMID: 27022722 DOI: 10.1159/000443927] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 01/08/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Anaemia is the most common complication in patients with inflammatory bowel disease (IBD). This study aims to assess the prevalence of anaemia in IBD patients and to know its characteristics with regard to the main IBD clinical features. METHODS An observational cross-sectional multicentre study was conducted. We included all patients who had an appointment at the 15 participating centres during the period of 1 month, and who met the following selection criteria: age ≥18, diagnosis of IBD. Disease activity was evaluated by Harvey-Bradshaw Index (HBI) for Crohn's disease (CD), and by Simple Clinical Colitis Activity Index (SCCAI) for ulcerative colitis (UC). RESULTS One thousand three hundred and thirteen patients, were included: 54.8% female, mean age 42.8 (interquartile range (25th-75th): 31-53 years), 59% had a diagnosis of CD, 39% of UC and 2% IBD unclassified. The median follow-up since diagnosis was 7 years. The ongoing treatment was aminosalicylates (63.1%), corticosteroids (11.6%), immunomodulators (36.4%) and anti-tumour necrosis factor (27.3%). Anaemia was identified in 244 patients, representing a prevalence of 18.6% (95% CI 16.6-20.9). A majority of cases (90%) have mild/moderate anaemia (mean haemoglobin 11.3 ± 0.8 g/dl). Anaemia was significantly higher in females (p = 0.006), but there were no differences between CDs (19.1%) and UCs (17.7%; p = 0.688). Anaemia was more frequent in patients with active disease (HBI >4; SCCAI >2) than in those in clinical remission (33.6 vs. 15.6%, p < 0.001) and in patients on steroids (36.8%) vs. other treatments (p < 0.001). Only 47% of patients with anaemia were under any specific treatment (oral iron 67%; intravenous iron 41%). CONCLUSION Anaemia was more frequent in patients with active disease and in those on corticosteroids. The treatment of anaemia still seems undervalued, whereas more than half of anaemic patients were not receiving any specific treatment and the use of oral iron prevails contrarily to current recommendations.
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Saraiva C, Vasconcelos H, de Almeida JM. A chemometrics approach applied to Fourier transform infrared spectroscopy (FTIR) for monitoring the spoilage of fresh salmon ( Salmo salar ) stored under modified atmospheres. Int J Food Microbiol 2017; 241:331-339. [DOI: 10.1016/j.ijfoodmicro.2016.10.038] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 09/14/2016] [Accepted: 10/30/2016] [Indexed: 01/21/2023]
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Barbeiro S, Atalaia-Martins C, Marcos P, Gonçalves C, Cotrim I, Vasconcelos H. A Case Series of Anal Carcinoma Misdiagnosed as Idiopathic Chronic Anal Fissure. GE Port J Gastroenterol 2016; 24:227-231. [PMID: 29255757 DOI: 10.1159/000452869] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 10/17/2016] [Indexed: 12/31/2022]
Abstract
Chronic anal fissure is a linear ulcer in the anal canal that has not cicatrized for more than 8-12 weeks of treatment. Most anal fissures are idiopathic and are located in the posterior midline. Squamous cell carcinoma of the anus commonly presents as bleeding and anal pain. It may also present as a mass, nonhealing ulcer, itching, discharge, fecal incontinence and fistulae. Not uncommonly, small and early cancers are misdiagnosed as benign anorectal disorders like anal fissures or hemorrhoids. The clinical suspicion of squamous cell carcinoma of the anus is of paramount importance in patients with nonhealing anal fissures, fissures in atypical positions or with indurated or ulcerated anal tags and in patients with risk factors for the development of anal squamous intraepithelial lesions that are precursors of invasive anal squamous cell carcinoma. The authors present 3 cases of squamous cell carcinoma of the anus initially misdiagnosed as benign chronic anal fissure.
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Affiliation(s)
- Sandra Barbeiro
- Gastroenterology Department, Centro Hospitalar de Leiria, Leiria, Portugal
| | | | - Pedro Marcos
- Gastroenterology Department, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Cláudia Gonçalves
- Gastroenterology Department, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Isabel Cotrim
- Gastroenterology Department, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Helena Vasconcelos
- Gastroenterology Department, Centro Hospitalar de Leiria, Leiria, Portugal
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Barbeiro S, Martins C, Gonçalves C, Alves P, Gil I, Canhoto M, Silva F, Cotrim I, Amado C, Eliseu L, Vasconcelos H. Black Anal Canal: Acute Necrosis. Ann Coloproctol 2016; 32:156-8. [PMID: 27626027 PMCID: PMC5019969 DOI: 10.3393/ac.2016.32.4.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 05/31/2016] [Indexed: 11/21/2022] Open
Abstract
Acute ischemia of the rectum or anal canal resulting in necrosis is extremely uncommon because both the rectum and the anal canal have excellent blood supplies. We present a case with spontaneous necrosis of the anal canal without rectal involvement. Surgical debridement was accomplished, and the recovery was uneventful. The patient was elderly, with probable atherosclerotic arterial disease, and presented with hypotension. Due to the lack of other precipitating factors, the hypoperfusion hypothesis seems to be the most suitable in this case. To the best of our knowledge, no similar cases have been reported in the literature on this subject.
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Affiliation(s)
- Sandra Barbeiro
- Department of Gastroenterology, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Catarina Martins
- Department of Gastroenterology, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Cláudia Gonçalves
- Department of Gastroenterology, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Paulo Alves
- Department of Surgery, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Inês Gil
- Department of Surgery, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Manuela Canhoto
- Department of Gastroenterology, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Filipe Silva
- Department of Gastroenterology, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Isabel Cotrim
- Department of Gastroenterology, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Cristina Amado
- Department of Pathology, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Liliana Eliseu
- Department of Gastroenterology, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Helena Vasconcelos
- Department of Gastroenterology, Centro Hospitalar de Leiria, Leiria, Portugal
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Barbeiro S, Atalaia-Martins C, Marcos P, Gonçalves C, Canhoto M, Arroja B, Silva F, Cotrim I, Eliseu L, Santos A, Vasconcelos H. Long-term outcomes of Botulinum toxin in the treatment of chronic anal fissure: 5 years of follow-up. United European Gastroenterol J 2016; 5:293-297. [PMID: 28344798 DOI: 10.1177/2050640616656708] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 06/01/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Chronic anal fissure is a frequent and disabling disease, often affecting young adults. Botulinum toxin and lateral internal sphincterotomy are the main therapeutic options for refractory cases. Botulinum toxin is minimally invasive and safer compared with surgery, which carries a difficult post-operative recovery and fecal incontinence risk. The long-term efficacy of Botulinum toxin is not well known. OBJECTIVE The aim of this study was to evaluate the long-term efficacy and safety of Botulinum toxin in the treatment of chronic anal fissure. METHODS This was a retrospective study at a single center, including patients treated with Botulinum toxin from 2005 to 2010, followed over at least a period of 5 years. All patients were treated with injection of 25U of Botulinum toxin in the intersphincteric groove. The response was registered as complete, partial, refractory and relapse. RESULTS Botulinum toxin was administered to 126 patients, 69.8% (n = 88) were followed over a period of 5 years. After 3 months, 46.6% (n = 41) had complete response, 23.9% (n = 21) had partial response and 29.5% (n = 26) were refractory. Relapse was observed in 1.2% (n = 1) at 6 months, 11.4% (n = 10) at 1 year, 2.3% (n = 2) at 3 years; no relapse at 5 years. The overall success rate was 64.8% at 5 years of follow-up. Botulinum toxin was well tolerated by all patients and there were no complications. CONCLUSION The use of Botulinum toxin to treat patients with chronic anal fissure was safe and effective in long-term follow-up.
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Affiliation(s)
- Sandra Barbeiro
- Department of Gastroenterology, Centro Hospitalar de Leiria, Leiria, Portugal
| | | | - Pedro Marcos
- Department of Gastroenterology, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Cláudia Gonçalves
- Department of Gastroenterology, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Manuela Canhoto
- Department of Gastroenterology, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Bruno Arroja
- Department of Gastroenterology, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Filipe Silva
- Department of Gastroenterology, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Isabel Cotrim
- Department of Gastroenterology, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Liliana Eliseu
- Department of Gastroenterology, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Antonieta Santos
- Department of Gastroenterology, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Helena Vasconcelos
- Department of Gastroenterology, Centro Hospitalar de Leiria, Leiria, Portugal
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Barbeiro S, Martins C, Gonçalves C, Arroja B, Canhoto M, Silva F, Cotrim I, Amado C, Eliseu L, Vasconcelos H. Schwannoma-A Rare Subepithelial Lesion of the Colon. GE Port J Gastroenterol 2015; 22:70-74. [PMID: 28868377 PMCID: PMC5580119 DOI: 10.1016/j.jpge.2015.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 01/28/2015] [Indexed: 02/07/2023]
Abstract
Schwannoma is a benign tumor arising from Schwann cells that form the neural sheath. Primary schwannoma of the colon is rare and a few cases have been reported. We report a case of schwannoma of the colon and present the differential diagnosis that must be considered in the evaluation of colonic subepithelial lesions.
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Affiliation(s)
- Sandra Barbeiro
- Gastroenterology Department, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Catarina Martins
- Gastroenterology Department, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Cláudia Gonçalves
- Gastroenterology Department, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Bruno Arroja
- Gastroenterology Department, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Manuela Canhoto
- Gastroenterology Department, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Filipe Silva
- Gastroenterology Department, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Isabel Cotrim
- Gastroenterology Department, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Cristina Amado
- Pathology Department, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Liliana Eliseu
- Gastroenterology Department, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Helena Vasconcelos
- Gastroenterology Department, Centro Hospitalar de Leiria, Leiria, Portugal
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31
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Freire P, Figueiredo P, Cardoso R, Manuel Donato M, Ferreira M, Mendes S, Silva MR, Cipriano MA, Ferreira AM, Vasconcelos H, Portela F, Sofia C. Predictive value of rectal aberrant crypt foci for intraepithelial neoplasia in ulcerative colitis - a cross-sectional study. Scand J Gastroenterol 2014; 49:1219-29. [PMID: 25157637 DOI: 10.3109/00365521.2014.951390] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Ulcerative colitis (UC) is associated with an increased risk of colorectal cancer (CRC). Aberrant crypt foci (ACF) are important biomarkers of sporadic CRC risk. Their correlation with the risk of intraepithelial neoplasia (IN) in UC remains unclear. AIMS To assess whether ACF are a risk factor for IN in long-standing UC and to investigate any correlation between the clinico-epidemiological characteristics and prevalence/number of ACF in these patients. METHODS Seventy-six patients with long-standing UC were prospectively screened by colonoscopy with chromoendoscopy-guided endomicroscopy. ACF were sought in the lower rectum. RESULTS Eight INs were detected in seven (9.2%) patients. The ACF prevalence and mean number were 60.5% and 2.4 ± 2.8, respectively. The number of ACF was independently associated with the risk of having IN (odds ratio = 1.338; 95% confidence interval 1.030-1.738). ACF number revealed a good calibration (area under the receiver operating characteristic curve = 0.829) and discriminative ability (p = 0.205, Hosmer-Lemeshow test) for the prediction of synchronous IN. Patients with ≥3 ACF have a significantly higher prevalence of IN than patients with <3 ACF (22.6% vs. 0%, p = 0.001). Using this cut-off value, the performance of ACF in predicting the presence of IN was as follows: sensitivity = 100%, specificity = 65.2%, positive predictive value = 22.6%, and negative predictive value = 100%. Age >40 years, family history of CRC, and increased body mass index (BMI) were associated with a significantly higher number of ACF. CONCLUSION Long-standing UC patients with ≥3 ACF have a significantly higher likelihood of having IN. Age >40 years, family history of CRC, and increased BMI have significant positive associations with the number of ACF.
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Affiliation(s)
- Paulo Freire
- Department of Gastroenterology , Centro Hospitalar e Universitário de Coimbra , Coimbra , Portugal
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Freire P, Cardoso R, Figueiredo P, Donato MM, Ferreira M, Mendes S, Ferreira AM, Vasconcelos H, Portela F, Sofia C. NOD2 gene mutations in ulcerative colitis: useless or misunderstood? Int J Colorectal Dis 2014; 29:653-61. [PMID: 24651958 DOI: 10.1007/s00384-014-1850-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2014] [Indexed: 02/06/2023]
Abstract
PURPOSE NOD2 mutations have been linked to an increased risk of Crohn's disease and to some of its phenotypes. The association between NOD2 mutations and susceptibility to ulcerative colitis (UC) remains somewhat controversial and potential correlations between these mutations and UC phenotype have not been studied. AIM To assess whether NOD2 mutations are a risk factor for UC in Portugal and if there are any genotype-phenotype correlations in these patients. METHODS The three main NOD2 mutations were searched in 200 patients with UC and in 202 healthy controls. RESULTS NOD2 mutations were present in 28 patients with UC (14.0 %) and in 27 controls (13.4 %) (p = 0.853). Mutation carriers were more likely to receive steroids during the first year of disease than non-carriers (54.2 % vs. 29.6 %, p = 0.018) and among these patients the need for intravenous administration was more frequent in those with the R702W polymorphism (90.0 % vs. 45.5 %, p = 0.014). In patients with severe colitis admitted for intravenous steroids, a greater proportion of mutation carriers was considered intravenous-steroid refractory and required salvage therapy (90.0 % vs. 38.1 %, p = 0.004). Patients with NOD2 mutation were submitted to colectomy more frequently than non-carriers (17.9 % vs. 4.1 %. p = 0.015). No correlation with the need for immunosuppressants/immunomodulators was found. CONCLUSIONS In the Portuguese population, NOD2 mutations do not increase the risk of UC but are associated with a more aggressive course including greater need of steroids in the first year, increased incidence of intravenous-steroid refractoriness and a higher colectomy rate.
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Affiliation(s)
- Paulo Freire
- Department of Gastroenterology, Centro Hospitalar e Universitário de Coimbra, Avenida Bissaya Barreto, 3000, Coimbra, Portugal,
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Vasconcelos H, Saraiva C, de Almeida JMMM. Evaluation of the Spoilage of Raw Chicken Breast Fillets Using Fourier Transform Infrared Spectroscopy in Tandem with Chemometrics. FOOD BIOPROCESS TECH 2014. [DOI: 10.1007/s11947-014-1277-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Vasconcelos H, Marques I, Santos AR, Melo P, Pires I, Figueira J, de Abreu JF, Cachulo ML, Silva R. Long-term chorioretinal changes after photodynamic therapy for chronic central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol 2013; 251:1697-705. [DOI: 10.1007/s00417-013-2270-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 11/24/2012] [Accepted: 01/15/2013] [Indexed: 12/17/2022] Open
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Canhoto M, Arroja B, Silva F, Gonçalves C, Cotrim I, Vasconcelos H. Haemophilus ducreyi and Treponema pallidum co-infection in an HIV-negative male presenting with anal ulceration. Colorectal Dis 2012; 14:e749-50. [PMID: 22340627 DOI: 10.1111/j.1463-1318.2012.02989.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- M Canhoto
- Department of Gastroenterology, Hospital de Santo André, E.P.E., Leiria, Portugal
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Canhoto M, Arroja B, Silva F, Gonçalves C, Cotrim I, Vasconcelos H. Needle-knife incisional treatment of refractory esophagic caustic stenosis. Endoscopy 2012; 43 Suppl 2 UCTN:E386. [PMID: 22275011 DOI: 10.1055/s-0030-1256941] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- M Canhoto
- Department of Gastroenterology, Hospital de Santo André EPE, Leiria, Portugal.
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Arroja B, Canhoto M, Barata P, Gonçalves C, Silva F, Cotrim I, Vasconcelos H, Pais J, Pardal V. Hemobilia after pseudoaneurysm of a right hepatic artery branch. Rev Esp Enferm Dig 2010; 102:386-7. [PMID: 20575601 DOI: 10.4321/s1130-01082010000600009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- B Arroja
- Department of Digestive Diseases, Hospital de Santo André, EPE, Leiria, Portugal
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38
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Affiliation(s)
- B Arroja
- Department of Gastroenterology, Hospital de Santo André, EPE, Leiria, Portugal
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39
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Affiliation(s)
- B Arroja
- Department of Gastroenterology, Hospital de Santo André EPE, Leiria, Portugal.
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40
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Arroja B, Gonçalves C, Silva F, Cotrim I, Vasconcelos H. Infolding of Ultraflex self-expanding metal stent on insertion. Endoscopy 2009; 41 Suppl 2:E80-1. [PMID: 19370522 DOI: 10.1055/s-0029-1214434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- B Arroja
- Department of Gastroenterology, Hospital de Santo André EPE, Leiria, Portugal.
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de Andrade AD, Silva TNS, Vasconcelos H, Marcelino M, Rodrigues-Machado MG, Filho VCG, Moraes NH, Marinho PEM, Amorim CF. Inspiratory muscular activation during threshold® therapy in elderly healthy and patients with COPD. J Electromyogr Kinesiol 2005; 15:631-9. [PMID: 16051499 DOI: 10.1016/j.jelekin.2005.06.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
UNLABELLED Inspiratory muscles training in COPD is controversial not only in relation to the load level required to produce muscular conditioning effects but also in relation to the group of patients benefiting from the training. Consequently, inspiratory muscular response assessment during Threshold therapy may help optimizing training strategy. The objective of this study was to evaluate the participation of the diaphragm and the sternocleidomastoid (SMM) muscle to overcome with a 30% Threshold load using surface electromyography (sEMG) and to analyze the correlation between SMM activation, maximum strength level of inspiratory muscles (MIP) and obstruction degree in COPD patients (FEV1). We studied seven healthy elderly subjects, mean age of 68+/-4 years and seven COPD patients, FEV1 45+/-17% of the predicted value, with mean age 66+/-8 years. sEMG analysis of SMM muscles and diaphragm were obtained through RMS (root-mean-square) during three stages: pre-loading, loading and post-loading. RESULTS In the COPD group, the RMS of the SMM increased 28% during load (p<0.05) while the RMS of the diaphragm remained constant. In the elderly there was a trend of a 11% increase in diaphragm activity and of 7% in SMM activity but, without reaching significance levels. SMM activity demonstrated good correlation with the obstruction level (r=-0.537). CONCLUSION To overcome the load required by Threshold therapy, COPD patients demonstrated an increase of accessory muscles activity, represented by SMM. For the same relative load this increase seems to be proportional to the degree of pulmonary obstruction.
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Affiliation(s)
- F G Silva
- Department of Gastroenterology, Santo André Hospital, Leiria, Portugal
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Romão Z, Pontes J, Lopes H, Vasconcelos H, Portela F, Andrade P, Leitão MC, Donato A, Freitas D. Endosonography in the diagnosis of "blue rubber bleb nevus syndrome": an uncommon cause of gastrointestinal tract bleeding. J Clin Gastroenterol 1999; 28:262-5. [PMID: 10192619 DOI: 10.1097/00004836-199904000-00019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Blue rubber bleb nevus syndrome is a rare condition characterized by the presence of multiple angiomatic lesions of the skin. These are associated with similar lesions in other organs, namely in the gastrointestinal tract, causing anemia through chronic bleeding. We describe the case of a 72-year-old woman with microcytic anemia. A barium study revealed irregular lacunae in the distal esophagus. A subsequent endoscopy showed blue nodular lesions similar to angiomas of the esophagus and stomach fundus. Endosonography confirmed its angiomatic nature. Exploration of other organs, using magnetic resonance and cranial computed tomography, did not reveal the presence of this type of lesion. In physical examination, two angiomatic lesions were observed on the face and lips, respectively. These were blue in color and compressible, leaving an empty wrinkled sac that rapidly refilled, typical of angiomas.
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Affiliation(s)
- Z Romão
- Department of Gastroenterology, Coimbra University Hospital, Portugal
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Pontes JM, Leitão MC, Portela F, Andrade P, Lopes H, Vasconcelos H, Romão Z, Pimentel J, Donato A, Freitas D. Gastric ascariasis: a rare cause of upper gastrointestinal bleeding. Endoscopy 1996; 28:792-3. [PMID: 9007448 DOI: 10.1055/s-2007-1005619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- J M Pontes
- Dept. of Gastroenterology, Coimbra University Hospital, Portugal
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Pompeu F, Sztajnberg M, Teixeira I, Carneiro S, Schulz I, Ribeiro S, Vasconcelos H, Albuquerque E. [Parkinson's syndrome and L-dopa]. Arq Neuropsiquiatr 1971; 29:174-83. [PMID: 4946063 DOI: 10.1590/s0004-282x1971000200005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Os autores assinalam o efeito favorável da L-Dopa no tratamento da síndrome parkinsoniana, apresentados por 25 pacientes. Tecem considerações sobre os efeitos colaterais e resultados terapêuticos. Assinalam a presença de eosinofilia após o tratamento em alguns casos e chamam a atenção sobre dois casos que tiveram crises convulsivas durante o tratamento.
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