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Azevedo I, Ortigão R, Pimentel-Nunes P, Bastos P, Silva R, Dinis-Ribeiro M, Libânio D. Anastomotic Leakages after Surgery for Gastroesophageal Cancer: A Systematic Review and Meta-Analysis on Endoscopic versus Surgical Management. GE Port J Gastroenterol 2023. [DOI: 10.1159/000527769] [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: 01/25/2023]
Abstract
<b><i>Introduction:</i></b> With the increase of esophageal and gastric cancer, surgery will be more often performed. Anastomotic leakage (AL) is one of the most feared postoperative complications of gastroesophageal surgery. It can be managed by conservative, endoscopic (such as endoscopic vacuum therapy and stenting), or surgical methods, but optimal treatment remains controversial. The aim of our meta-analysis was to compare (a) endoscopic and surgical interventions and (b) different endoscopic treatments for AL following gastroesophageal cancer surgery. <b><i>Methods:</i></b> Systematic review and meta-analysis, with search in three online databases for studies evaluating surgical and endoscopic treatments for AL following gastroesophageal cancer surgery. <b><i>Results:</i></b> A total of 32 studies comprising 1,080 patients were included. Compared with surgical intervention, endoscopic treatment presented similar clinical success, hospital length of stay, and intensive care unit length of stay, but lower in-hospital mortality (6.4% [95% CI: 3.8–9.6%] vs. 35.8% [95% CI: 23.9–48.5%]. Endoscopic vacuum therapy was associated with a lower rate of complications (OR 0.348 [95% CI: 0.127–0.954]), shorter ICU length of stay (mean difference −14.77 days [95% CI: −26.57 to −2.98]), and time until AL resolution (17.6 days [95% CI: 14.1–21.2] vs. 39.4 days [95% CI: 27.0–51.8]) when compared with stenting, but there were no significant differences in terms of clinical success, mortality, reinterventions, or hospital length of stay. <b><i>Conclusions:</i></b> Endoscopic treatment, in particular endoscopic vacuum therapy, seems safer and more effective when compared with surgery. However, more robust comparative studies are needed, especially for clarifying which is the best treatment in specific situations (according to patient and leak characteristics).
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Ortigão R, Pereira B, Silva R, Pimentel-Nunes P, Bastos P, Abreu de Sousa J, Faria F, Dinis-Ribeiro M, Libânio D. Anastomotic Leaks following Esophagectomy for Esophageal and Gastroesophageal Junction Cancer: The Key Is the Multidisciplinary Management. GE Port J Gastroenterol 2021; 30:38-48. [PMID: 36743992 PMCID: PMC9891149 DOI: 10.1159/000520562] [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: 08/04/2021] [Accepted: 10/14/2021] [Indexed: 12/24/2022]
Abstract
Introduction Anastomotic leakage after esophagectomy is associated with high mortality and impaired quality of life. Aim The objective of this work was to determine the effectiveness of management of esophageal anastomotic leakage (EAL) after esophagectomy for esophageal and gastroesophageal junction (GEJ) cancer. Methods Patients submitted to esophagectomy for esophageal and GEJ cancer at a tertiary oncology hospital between 2014 and 2019 (n = 119) were retrospectively reviewed and EAL risk factors and its management outcomes determined. Results Older age and nodal disease were identified as independent risk factors for anastomotic leak (adjusted OR 1.06, 95% CI 1.00-1.13, and adjusted OR 4.89, 95% CI 1.09-21.8). Patients with EAL spent more days in the intensive care unit (ICU; median 14 vs. 4 days) and had higher 30-day mortality (15 vs. 2%) and higher in-hospital mortality (35 vs. 4%). The first treatment option was surgical in 13 patients, endoscopic in 10, and conservative in 3. No significant differences were noticeable between these patients, but sepsis and large leakages were tendentially managed by surgery. At follow-up, 3 patients in the surgery group (23%) and 9 in the endoscopic group (90%) were discharged under an oral diet (p = 0.001). The in-hospital mortality rate was 38% in the surgical group, 33% in the conservative group, and 10% in endoscopic group (p = 0.132). In patients with EAL, the presence of septic shock at leak diagnosis was the only predictor of mortality (p = 0.004). ICU length-of-stay was non-significantly lower in the endoscopic therapy group (median 4 days, vs. 16 days in the surgical group, p = 0.212). Conclusion Risk factors for EAL may help change pre-procedural optimization. The results of this study suggest including an endoscopic approach for EAL.
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Affiliation(s)
- Raquel Ortigão
- Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal,*Raquel Ortigão,
| | - Brigitte Pereira
- Intensive Care Unit, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Rui Silva
- Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Pedro Pimentel-Nunes
- Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal,MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Pedro Bastos
- Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal
| | | | - Filomena Faria
- Intensive Care Unit, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Mário Dinis-Ribeiro
- Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal,MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Diogo Libânio
- Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal,MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
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Pinto CMM, Rodriguez M, Souto Moura M, Afonso M, Bastos P, Dinis Ribeiro M. Gastric Metastatic Melanoma Mimicking a Hyperplastic Lesion. GE Port J Gastroenterol 2021; 30:79-81. [PMID: 36743982 PMCID: PMC9891148 DOI: 10.1159/000520211] [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: 03/02/2021] [Accepted: 04/21/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Cláudia Martins Marques Pinto
- Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal,*Cláudia Martins Marques Pinto,
| | - Marta Rodriguez
- Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal
| | | | - Mariana Afonso
- Pathology Department, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Pedro Bastos
- Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Mário Dinis Ribeiro
- Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal,MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
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Abstract
INTRODUCTION Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is the main method for acquisition of tissue from gastrointestinal subepithelial lesions (SELs). Despite the development of new needles, diagnostic yield remains low. A new method of aspiration has been described, where the needle is filled with saline [wet-suction technique (WST)], with promising results in pancreatic lesions. This method has not been tested in SELs. AIMS AND METHODS Prospective single center study to assess the diagnostic yield of EUS-FNA+WST in the diagnosis of SELs, without the use of rapid on-site evaluation. In mesenchymal tumors, the diagnosis was considered positive only when immunohistochemistry could differentiate between gastrointestinal stromal tumor and leiomyoma. RESULTS Eighty-seven patients with SELs were included (55% male, mean age 66 years). Mean SEL size was 25 mm (min 10 mm, max 120 mm), mean number of passes was 3 (±0.8). A 22G needle was used in 72 patients (83%), 19G in 10 (12%) and 25G in 5 (6%). We obtained a conclusive cytopathological diagnosis in 74 cases (diagnostic yield of 85%) and immunohistochemistry was performed in 70 cases (81%). The most frequent diagnoses were gastrointestinal stromal tumor (n = 34, 37%), leiomyoma (n = 13, 15%) and metastases (n = 10, 11%). CONCLUSION Wet suction technique allowed an excellent diagnostic yield in the EUS-guided evaluation of SELs. We suggest that, after proper replication of these results, WST may become the first-line method in the management of these lesions.
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Affiliation(s)
- Inês Pita
- Gastroenterology Department, Portuguese Oncology Institute
| | - Pedro Pimentel-Nunes
- Gastroenterology Department, Portuguese Oncology Institute
- Departamento de Medicina da Comunidade, Informação e Decisão em Saúde (MEDCIDS)
- Surgery and Physiology Department, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Mário Dinis-Ribeiro
- Gastroenterology Department, Portuguese Oncology Institute
- Departamento de Medicina da Comunidade, Informação e Decisão em Saúde (MEDCIDS)
| | - Pedro Bastos
- Gastroenterology Department, Portuguese Oncology Institute
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Bastos P, Carpentier G, Patel V, Papy-Garcia D, Watson T, Cook R. Real-Time Optical Vascular Imaging, a new method for the diagnosis and monitoring of oral diseases. J Microsc 2020; 288:73-86. [PMID: 33119132 DOI: 10.1111/jmi.12975] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/23/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Real-Time Optical Vascular Imaging (RTOVI) is a technology developed in the Centre for Oral Clinical & Translational Sciences, within the Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, that allows rapid and preparation free, in vivo imaging of the microvascular anatomy of the human oral cavity. Microvascular changes are known to be related to disease subtypes, in particular cancer. This makes in vivo microvascular examination clinically valuable. However, at present there is lack of any analytical method able to objectively assess microvascular morphology images. DISCUSSION The assessment of microvascular morphology based on a subjective evaluation was proven to be unreliable. There was a need to develop a software-based analysis for in vivo microvascular images to support the validation of RTOVI. This paper reviews the authors work to develop and test an automated microvascular analysis method for RTOVI based on ImageJ, an open-source software. This allowed to determined which parameters offered a more robust mathematical representation of the microvascular anatomy of the gingival margin, such as the mean area per capillary and mean aspect ratio. However, in vivo microvascular images from elsewhere within the oral cavity posed a bigger challenge to the analysis procedure due to the microvascular architectural complexity and poorer contrast. Angiogenesis Analyzer, a well-known ImageJ plugin used for the quantification of in vitro microvascular images, is under development in collaboration with the University of Paris Est Créteil. The aim of this work is to obtain an automated analysis method for in vivo microvascular images able to offer a solid foundation for the diagnostic potential of RTOVI and subsequent clinical integration of this technology. CONCLUSION An automated analysis method for in vivo microvascular images is paramount before any attempt to clinically validate RTOVI. Our initial work of testing a software-based analysis demonstrated the effectiveness of some parameters, which is valuable for future work, and led us to move into a more sophisticated method involving customising the Angiogenesis Analyzer plugin. This is an essential step, aiming to extend the potential of in vivo microscopy with the clinical integration of RTOVI. LAY DESCRIPTION This article summarises the initial research work done in the field on in vivo microvascular imaging aiming to develop a technique for the diagnosis of oral diseases based on the shape of small blood vessels found just below the surface of the "skin" inside the mouth. This offers the potential to examine lesions without the need to take a sample (biopsy/cutting tissue) to observe it microscopically. This ultimately offers a potential to accelerate diagnostic decision making, avoid unpleasant and often deterrent surgical procedures and reducing diagnostic laboratory time and cost burdens. However, in order to assess images of small blood vessels obtained in clinic, we needed to develop and test a software-based analysis to avoid the subjective human interpretation, known not to work. This article describes the authors journey to achieve an automated and sophisticated analysis method unique in the world for in vivo microvascular images derived from real-time optical vascular imaging.
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Affiliation(s)
- P Bastos
- Faculty of Dentistry, Oral & Craniofacial Sciences, The Centre for Oral, Clinical and Translational Sciences, Guy's Campus, King's College London, London, UK
| | - G Carpentier
- Laboratoire Gly-CRRET Faculté des Sciences et Technologie, Université Paris-Est Créteil Val de Marne, Paris, France
| | - V Patel
- Oral Surgery, Guys & St Thomas' NHS Foundation Trust, London, UK
| | - D Papy-Garcia
- Laboratoire Gly-CRRET Faculté des Sciences et Technologie, Université Paris-Est Créteil Val de Marne, Paris, France
| | - T Watson
- Faculty of Dentistry, Oral & Craniofacial Sciences, The Centre for Oral, Clinical and Translational Sciences, Guy's Campus, King's College London, London, UK
| | - R Cook
- Faculty of Dentistry, Oral & Craniofacial Sciences, The Centre for Oral, Clinical and Translational Sciences, Guy's Campus, King's College London, London, UK
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Libânio D, Bastos P, Pimentel-Nunes P. Safe and Valuable Endoscopy in the COVID Era. GE Port J Gastroenterol 2020; 27:219-223. [PMID: 32775541 PMCID: PMC7273905 DOI: 10.1159/000507896] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/15/2020] [Indexed: 01/17/2023]
Affiliation(s)
- Diogo Libânio
- Gastroenterology Department, Instituto Português de Oncologia do Porto, Porto, Portugal
- MEDCIDS – Department of Community Medicine, Health Information and Decision, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Pedro Bastos
- Gastroenterology Department, Instituto Português de Oncologia do Porto, Porto, Portugal
| | - Pedro Pimentel-Nunes
- Gastroenterology Department, Instituto Português de Oncologia do Porto, Porto, Portugal
- MEDCIDS – Department of Community Medicine, Health Information and Decision, Faculty of Medicine, University of Porto, Porto, Portugal
- Surgery and Physiology Department, Faculty of Medicine, University of Porto, Porto, Portugal
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Banjar A, Abdrabuh A, Al-Habshi M, Parambil M, Bastos P, Abed H. Labial pyogenic granuloma related to trauma: A case report and mini-review. Dent Traumatol 2020; 36:446-451. [PMID: 31869498 DOI: 10.1111/edt.12537] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 12/15/2019] [Accepted: 12/16/2019] [Indexed: 11/29/2022]
Abstract
This paper reports a case of a labial pyogenic granuloma in the lower lip of a 15-year-old boy due to chronic trauma from the maxillary left central incisor. The case report is based on the CARE (CAse REport) Checklist developed by the Joanna Briggs Institute. A further aim is to present a mini-review about the link between labial pyogenic granuloma and trauma, through searching in three databases (MEDLINE, EMBASE, and Global Health) using a predefined search strategy and keywords. The Cochrane Library and PROSPERO were also searched for published and ongoing systematic reviews, respectively. Only five case reports were found that discussed the link between labial pyogenic granuloma and trauma. Chronic trauma was found to be the most common cause of pyogenic granuloma affecting the lip. Excisional biopsy was the preferable treatment due to the advantage of allowing histopathologic assessment, which is necessary to establish a definitive diagnosis. Dentists advise to include labial pyogenic granuloma in their differential diagnosis (ie, mucocele, cyst, abscess, hematoma, minor salivary gland trauma or tumor) when assessing lesions in the upper and lower lips, in particular when related to a history of trauma.
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Affiliation(s)
- Assim Banjar
- Faculty of Dentistry, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Abrar Abdrabuh
- College of Dentistry, Al-Farabi Colleges, Jeddah, Saudi Arabia
| | - Manaf Al-Habshi
- King Faisal Hospital and Research Centre, Makkah, Saudi Arabia
| | | | - Pedro Bastos
- Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK.,Guy's Hospital, London, UK
| | - Hassan Abed
- Faculty of Dentistry, Umm Al-Qura University, Makkah, Saudi Arabia.,Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK.,Guy's Hospital, London, UK
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Bastos P, Fry A, Cascarini L, Yeung E, Cook R. Real-time optical vascular imaging: a method to assess the microvascular circulation of myofascial free flaps used in the head and neck region. Int J Oral Maxillofac Surg 2019; 49:582-586. [PMID: 31839496 DOI: 10.1016/j.ijom.2019.11.005] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 10/01/2019] [Accepted: 11/14/2019] [Indexed: 11/17/2022]
Abstract
Microvascular free flaps are considered the gold standard in head and neck reconstructive surgery. Myofascial flaps, in particular, are useful in certain oral and maxillofacial reconstruction cases, where mucosal regeneration over the transplanted tissue is planned. Despite high success rates, 1-6% of free flaps fail. A plethora of methods are available to assess transplanted tissue viability after reconstruction, including clinical observational monitoring, surface Doppler, implantable Doppler probe, colour Doppler sonography, laser Doppler flowmeter, surface temperature and indocyanine green angiography. However, no method has demonstrated adequate reliability or has proven to be cost-effective. The authors tested a technique called real-time optical vascular imaging to evaluate the microvascular circulation of myofascial free flaps. This technique was develop at Guy's Hospital, London to observe the microvascular anatomy of the oral cavity in vivo, non-invasively and without the need for patient preparation, with the aim of detecting and monitoring oral diseases. This technology detects the red blood cells flowing inside the microvasculature at a depth of approximately 2mm, allowing the microvascular architecture and blood flow to be determined. This study showed that RTOVI may prove to be beneficial for the early detection of vascular compromise due to its immediacy and the feasibility of assessing multiple graft tissue regions.
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Affiliation(s)
- P Bastos
- Centre for Oral, Clinical & Translational Sciences, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, Guy's Hospital, London, UK.
| | - A Fry
- Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London, UK
| | - L Cascarini
- Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London, UK
| | - E Yeung
- Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London, UK
| | - R Cook
- Centre for Oral, Clinical & Translational Sciences, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, Guy's Hospital, London, UK; Department of Oral Medicine, Guy's and St Thomas' NHS Foundation Trust and King's College London, Guy's Hospital, London, UK
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Azevedo R, Libânio D, Bastos P, Dinis Ribeiro M, Brandão C. Going through the Mesh: Argon Plasma Trimming of a Metal Biliary Stent. GE Port J Gastroenterol 2019; 26:295-297. [PMID: 31328147 PMCID: PMC6624663 DOI: 10.1159/000493352] [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: 07/18/2018] [Accepted: 08/27/2018] [Indexed: 06/10/2023]
Affiliation(s)
- Richard Azevedo
- Gastroenterology Department, Instituto Português de Oncologia do Porto Francisco Gentil, Porto, Portugal
- Gastroenterology Department, Amato Lusitano Hospital, Castelo Branco, Portugal
| | - Diogo Libânio
- Gastroenterology Department, Instituto Português de Oncologia do Porto Francisco Gentil, Porto, Portugal
| | - Pedro Bastos
- Gastroenterology Department, Instituto Português de Oncologia do Porto Francisco Gentil, Porto, Portugal
| | - Mário Dinis Ribeiro
- Gastroenterology Department, Instituto Português de Oncologia do Porto Francisco Gentil, Porto, Portugal
| | - Catarina Brandão
- Gastroenterology Department, Instituto Português de Oncologia do Porto Francisco Gentil, Porto, Portugal
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Pita I, Libânio D, Ponte A, Pimentel-Nunes P, Dinis-Ribeiro M, Bastos P. LAMS to the SEMS Rescue! GE Port J Gastroenterol 2018; 26:70-72. [PMID: 30675507 PMCID: PMC6341363 DOI: 10.1159/000487277] [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: 01/02/2018] [Revised: 01/27/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Inês Pita
- Department of Gastroenterology, Portuguese Institute of Oncology Francisco Gentil, Porto, Portugal
| | - Diogo Libânio
- Department of Gastroenterology, Portuguese Institute of Oncology Francisco Gentil, Porto, Portugal
| | - Ana Ponte
- Department of Gastroenterology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Pedro Pimentel-Nunes
- Department of Gastroenterology, Portuguese Institute of Oncology Francisco Gentil, Porto, Portugal
| | - Mário Dinis-Ribeiro
- Department of Gastroenterology, Portuguese Institute of Oncology Francisco Gentil, Porto, Portugal
| | - Pedro Bastos
- Department of Gastroenterology, Portuguese Institute of Oncology Francisco Gentil, Porto, Portugal
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Bastos P, Pita I, Ferreira A. How to Brush Your Way into the Bile Duct. GE Port J Gastroenterol 2018; 26:1-2. [PMID: 30675497 PMCID: PMC6341311 DOI: 10.1159/000487821] [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: 02/16/2018] [Revised: 02/20/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Pedro Bastos
- Serviço de Gastroenterologia, Instituto Português de Oncologia do Porto, Porto, Portugal
| | - Inês Pita
- Serviço de Gastroenterologia, Instituto Portugues de Oncologia Francisco Gentil, Porto, Portugal
| | - Aníbal Ferreira
- Departamento de Gastrenterologia, Hospital de Braga, Braga, Portugal
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Bastos P, Patel V, Festy F, Hosny N, Cook RJ. In-vivo imaging of the microvasculature of the soft tissue margins of osteonecrotic jaw lesions. Br Dent J 2018; 223:699-705. [PMID: 29123273 DOI: 10.1038/sj.bdj.2017.888] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2017] [Indexed: 01/20/2023]
Abstract
Introduction Given the increasing incidence of medication-related jaw osteonecrosis, and recognition of the mucosal blood supply's importance, we have developed a non-invasive Real Time Optical Vascular Imaging (RTOVI) instrument. Imaging the red blood cells within the sub-mucosal capillary networks demonstrates the microcirculatory anatomy. We report a small trial, demonstrating the technique's viability, examining mucosal microcirculatory changes adjacent to osteonecrotic lesions.Aims Imaging the microvasculature of soft tissue margins of patients' exposed necrotic bone lesions in situ was intended to provide unique observational as well as quantitative data, using an image analysis routine, based on ImageJ software. Our interest was to evaluate whether this could offer valuable information for complex wound margin management.Methods Four osteoradionecrosis and four medication-related osteonecrosis patients (M:F 1:1 mean 68.25 years) were enrolled under the NRES Ethics 11/LON/0354 and KCL Research Ethics Committee (REC) BDM/14/15-14 approvals. Microvascular images from mucosal margins of exposed mandibular osteonecrosis lesions were compared with equivalent images from both uninvolved contralateral mucosa and similar mucosal sites in four healthy subjects.Results We demonstrated narrow hypo-vascularised oedematous lesion margins surrounded by a concentric inflammatory band and normal mucosa beyond. Parameters reporting individual capillary shape, via mean percentage of occupancy per capillary per field of view and capillary loop aspect ratio, differed significantly between groups (ANOVA, p = 0.0002 and p = 0.04 respectively). Values reporting capillary number and area showed expected changes but did not reach statistical significance.Conclusion This pilot study demonstrated the feasibility of mucosal microvascular imaging in assessing the microvascular changes found in the soft tissues at the margins of osteonecrotic lesions, with potential to inform therapeutic interventions and clinical decisions to continue or modify regime strategies at the earliest opportunity. Given the increasing incidence of medication-related jaw osteonecrosis, and the recognition of the importance of mucosal blood supply, we developed a non-invasive instrument demonstrating microcirculation anatomy by imaging transiting red blood cells.
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Affiliation(s)
- P Bastos
- Dept. Tissue Engineering & Biophotonics KCL Dental Institute, Guy's Campus, London, SE1 9RT
| | - V Patel
- Dept. Tissue Engineering & Biophotonics KCL Dental Institute, Guy's Campus, London, SE1 9RT.,Dept. Oral Surgery GSTFT & KCL Dental Institute, Guy's Campus, London, SE1 9RT
| | - F Festy
- Dept. Tissue Engineering & Biophotonics KCL Dental Institute, Guy's Campus, London, SE1 9RT
| | - N Hosny
- Dept. Tissue Engineering & Biophotonics KCL Dental Institute, Guy's Campus, London, SE1 9RT
| | - R J Cook
- Dept. Tissue Engineering & Biophotonics KCL Dental Institute, Guy's Campus, London, SE1 9RT.,Dept. of Oral Medicine, GSTFT & KCL Dental Institute, Guy's Campus, London, SE1 9RT
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Pinho J, Montezuma D, Monteiro P, Dinis-Ribeiro M, Bastos P. Endoscopic ultrasound diagnosis of Merkel cell carcinoma metastasising to pancreas. Cytopathology 2018; 29:478-481. [PMID: 29665210 DOI: 10.1111/cyt.12553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2018] [Indexed: 11/28/2022]
Affiliation(s)
- J Pinho
- Gastroenterology Department, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - D Montezuma
- Pathology Department, Instituto Português de Oncologia do Porto, Porto, Portugal
| | - P Monteiro
- Pathology Department, Instituto Português de Oncologia do Porto, Porto, Portugal
| | - M Dinis-Ribeiro
- Gastroenterology Department, Instituto Português de Oncologia do Porto, Porto, Portugal
| | - P Bastos
- Gastroenterology Department, Instituto Português de Oncologia do Porto, Porto, Portugal
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Pinho J, Luis A, Bastos P. An unusual cause of bowel obstruction diagnosed by EUS. Gastrointest Endosc 2018; 87:1160-1161. [PMID: 29030002 DOI: 10.1016/j.gie.2017.09.041] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 09/29/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Juliana Pinho
- Gastroenterology Department, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Ana Luis
- Pathology Department, Instituto Português de Oncologia, Porto, Portugal
| | - Pedro Bastos
- Gastroenterology Department, Instituto Português de Oncologia, Porto, Portugal
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Bastos P, Vieira G, Reis ID, Costa R, Lopes G. Comportamento alimentar de paralarvas do polvo Octopus vulgaris Tipo II (Cuvier, 1797) alimentadas com artêmia enriquecida com microalgas e suplementada com DHA. ARQ BRAS MED VET ZOO 2018. [DOI: 10.1590/1678-4162-9731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- P. Bastos
- Universidade Federal de Santa Catarina, Brazil
| | - G.C. Vieira
- Universidade Federal de Santa Catarina, Brazil
| | | | - R.L. Costa
- Universidade Federal de Santa Catarina, Brazil
| | - G.R. Lopes
- Universidade Federal de Santa Catarina, Brazil
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Pita I, Bastos P, Dinis-Ribeiro M. Pelvic Catastrophe after Elastic Band Ligation in an Irradiated Rectum. GE Port J Gastroenterol 2018; 25:42-46. [PMID: 29457050 DOI: 10.1159/000477769] [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: 03/14/2017] [Revised: 05/23/2017] [Indexed: 12/16/2022]
Abstract
Chronic radiation proctopathy is a frequent complication after both pelvic external radiation therapy and brachytherapy and most commonly presents as rectal bleeding. Deep rectal ulcers and fistulae are much rarer and more clinically challenging consequences. We present the case of a 72-year-old male with a history of prostate adenocarcinoma treated with brachytherapy, who was referred to our institution due to a deep painful rectal ulcer refractory to medical treatment. The ulcer presented shortly after a haemorrhoid elastic band ligation and progressed to rectourethral fistulisation despite both faecal and urinary diversion. Our case demonstrates the importance of favouring a conservative approach when dealing with an irradiated rectum.
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Affiliation(s)
- Inês Pita
- Serviço de Gastroenterologia, Instituto Português de Oncologia Francisco Gentil, Porto, Portugal
| | - Pedro Bastos
- Serviço de Gastroenterologia, Instituto Português de Oncologia Francisco Gentil, Porto, Portugal
| | - Mário Dinis-Ribeiro
- Serviço de Gastroenterologia, Instituto Português de Oncologia Francisco Gentil, Porto, Portugal
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Bastos P, Reis ID, Costa R, Ferreira J. Desempenho do polvo Octopus vulgaris alimentado com monodieta de mexilhão (Perna perna ). ARQ BRAS MED VET ZOO 2018. [DOI: 10.1590/1678-4162-9363] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- P. Bastos
- Universidade Federal de Santa Catarina, Brazil
| | | | - R.L. Costa
- Universidade Federal de Santa Catarina, Brazil
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Abstract
Early detection of oropharyngeal carcinoma is imperative in order to minimise morbidity and increase survival rate, but most of these patients present to the specialist with already advanced stages of malignancy, when the prognosis is relatively poor. General dental practitioners and dental care professionals have a unique opportunity during routine examination to detect any suspicious lesions. However, we continue to rely mostly on conventional examination, which is known to have limitations. There are diagnostic adjuncts available to help detect oral squamous cell carcinoma (OSCC) and oral potentially malignant disorders (OPMD), such as vital staining, brush cytology and macroscopic light-based detection techniques, discussed elsewhere in this issue. However a recent meta-analysis demonstrated that these techniques are not reliable enough as standalone diagnostics and that conventional biopsy remains the diagnostic gold standard. This article shows a new imaging technique which has the potential to detect early signs of oral cancer. This technique is based on the use of green light which allows the observation of oral microvasculature. General dental practitioners and dental care practitioners have a privileged opportunity during routine examination to detect any suspicious lesions in the head and neck region and refer when necessary to specialist care. However, they rely mostly on conventional examination, which is known to be insufficient for the detection of early signs of malignancy. There are diagnostic adjuncts available to help detect oral cancer and oral premalignant disorders, such as vital staining, brush cytology and macroscopic light-based detection techniques, but a recent meta-analysis has concluded that alone, these are not reliable enough to make a full tissue diagnosis. In the main, their value is more as a guide to indicate need for and to locate sites for conventional biopsy, which remains the diagnostic gold standard. However, biopsy also has inherent limitations such as sample handling and site errors and is associated with patient morbidity at every sampling event. The authors have developed and tested a new real-time optical vascular imaging technique (RTOVI) to observe the gingival microvasculature as a direct reporter of local tissue function and behaviour. In addition to direct imaging, the reliability of a potential image analysis method, developed for microvascular images, was assessed. The images were assessed for number of capillaries, capillary area (CA), total capillary area (TCA) and aspect ratio (AR). The mean number of capillaries found in our study (45.06 per mm2) which was higher than figures identified in previous 'same-location' oral mucosal studies (15.42 per mm2). This may reflect the wide variation between individuals and potentially improved resolution and contrast optics between studies. This small study suggests that mean values in CA, TCA and AR may be reliable parameters for thresholding normal values, for comparison between individuals and for the assessment of the microvasculature over time. This assessment of normal is essential to pave the way for further studies involving inflammatory and mitotic lesions.
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Affiliation(s)
- Pedro Bastos
- Division of Tissue Engineering & Biophotonics, Kings College London Dental Institute, Guy's Hospital Campus, London, UK
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Polkowski M, Jenssen C, Kaye P, Carrara S, Deprez P, Gines A, Fernández-Esparrach G, Eisendrath P, Aithal GP, Arcidiacono P, Barthet M, Bastos P, Fornelli A, Napoleon B, Iglesias-Garcia J, Seicean A, Larghi A, Hassan C, van Hooft JE, Dumonceau JM. Technical aspects of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Guideline - March 2017. Endoscopy 2017; 49:989-1006. [PMID: 28898917 DOI: 10.1055/s-0043-119219] [Citation(s) in RCA: 222] [Impact Index Per Article: 31.7] [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] [Indexed: 02/08/2023]
Abstract
For routine EUS-guided sampling of solid masses and lymph nodes (LNs) ESGE recommends 25G or 22G needles (high quality evidence, strong recommendation); fine needle aspiration (FNA) and fine needle biopsy (FNB) needles are equally recommended (high quality evidence, strong recommendation).When the primary aim of sampling is to obtain a core tissue specimen, ESGE suggests using 19G FNA or FNB needles or 22G FNB needles (low quality evidence, weak recommendation).ESGE recommends using 10-mL syringe suction for EUS-guided sampling of solid masses and LNs with 25G or 22G FNA needles (high quality evidence, strong recommendation) and other types of needles (low quality evidence, weak recommendation). ESGE suggests neutralizing residual negative pressure in the needle before withdrawing the needle from the target lesion (moderate quality evidence, weak recommendation).ESGE does not recommend for or against using the needle stylet for EUS-guided sampling of solid masses and LNs with FNA needles (high quality evidence, strong recommendation) and suggests using the needle stylet for EUS-guided sampling with FNB needles (low quality evidence, weak recommendation).ESGE suggests fanning the needle throughout the lesion when sampling solid masses and LNs (moderate quality evidence, weak recommendation).ESGE equally recommends EUS-guided sampling with or without on-site cytologic evaluation (moderate quality evidence, strong recommendation). When on-site cytologic evaluation is unavailable, ESGE suggests performance of three to four needle passes with an FNA needle or two to three passes with an FNB needle (low quality evidence, weak recommendation).For diagnostic sampling of pancreatic cystic lesions without a solid component, ESGE suggests emptying the cyst with a single pass of a 22G or 19G needle (low quality evidence, weak recommendation). For pancreatic cystic lesions with a solid component, ESGE suggests sampling of the solid component using the same technique as in the case of other solid lesions (low quality evidence, weak recommendation).ESGE does not recommend antibiotic prophylaxis for EUS-guided sampling of solid masses or LNs (low quality evidence, strong recommendation), and suggests antibiotic prophylaxis with fluoroquinolones or beta-lactam antibiotics for EUS-guided sampling of cystic lesions (low quality evidence, weak recommendation). ESGE suggests that evaluation of tissue obtained by EUS-guided sampling should include histologic preparations (e. g., cell blocks and/or formalin-fixed and paraffin-embedded tissue fragments) and should not be limited to smear cytology (low quality evidence, weak recommendation).
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Affiliation(s)
- Marcin Polkowski
- Department of Gastroenterology, Hepatology, and Oncology, Medical Centre for Postgraduate Education, Warsaw, Poland.,Department of Gastroenterological Oncology, The M. Skłodowska-Curie Memorial Cancer Centre, Warsaw, Poland
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Academic Teaching Hospital of the Medical University of Brandenburg, Germany
| | - Philip Kaye
- Nottingham Digestive Diseases Centre, NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, UK
| | - Silvia Carrara
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano, Italy
| | - Pierre Deprez
- Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Angels Gines
- Endoscopy Unit, Department of Gastroenterology, ICMDM, IDIBAPS, CIBEREHD, Hospital Clínic, Barcelona, Spain
| | - Gloria Fernández-Esparrach
- Endoscopy Unit, Department of Gastroenterology, ICMDM, IDIBAPS, CIBEREHD, Hospital Clínic, Barcelona, Spain
| | - Pierre Eisendrath
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Université Libre de Bruxelles, Hôpital Erasme & Hôpital Saint-Pierre, Brussels, Belgium
| | - Guruprasad P Aithal
- Nottingham Digestive Diseases Centre, NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, UK
| | - Paolo Arcidiacono
- Pancreato-Biliary Endoscopy and Endosonography Division, San Raffaele University, Milan, Italy
| | - Marc Barthet
- Service de Gastroentérologie, Hôpital NORD AP-HM, Aix-Marseille-Université, Marseille, France
| | - Pedro Bastos
- Gastroenterology Department Instituto Português de Oncologia do Porto, Porto, Portugal
| | - Adele Fornelli
- Anatomic Pathology Unit, AUSL of Bologna, Maggiore Hospital, Bologna, Italy
| | - Bertrand Napoleon
- Department of Gastroenterology, Ramsay Générale de Santé, Private Hospital Jean Mermoz, Lyon, France
| | - Julio Iglesias-Garcia
- Gastroenterology Department, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Andrada Seicean
- Regional Institute of Gastroenterology and Hepatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Alberto Larghi
- Digestive Endoscopy Unit, Catholic University, Rome, Italy
| | - Cesare Hassan
- Digestive Endoscopy Unit, Catholic University, Rome, Italy
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
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de Sousa Antunes Dias Padrão EF, Torres Redondo M, Jacob M, Magalhães A, Morais A, Queiroga H, Fernandes G, Guimarães S, Souto Moura C, Maciel J, Bastos P, Hespanhol V. Early recurrence in complete resected non-small cell lung cancer patients. Lung Cancer 2017. [DOI: 10.1183/1393003.congress-2017.pa4291] [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: 11/05/2022]
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21
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Dumonceau JM, Deprez PH, Jenssen C, Iglesias-Garcia J, Larghi A, Vanbiervliet G, Aithal GP, Arcidiacono PG, Bastos P, Carrara S, Czakó L, Fernández-Esparrach G, Fockens P, Ginès À, Havre RF, Hassan C, Vilmann P, van Hooft JE, Polkowski M. Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline - Updated January 2017. Endoscopy 2017; 49:695-714. [PMID: 28511234 DOI: 10.1055/s-0043-109021] [Citation(s) in RCA: 202] [Impact Index Per Article: 28.9] [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] [Indexed: 02/06/2023]
Abstract
For pancreatic solid lesions, ESGE recommends performing endoscopic ultrasound (EUS)-guided sampling as first-line procedure when a pathological diagnosis is required. Alternatively, percutaneous sampling may be considered in metastatic disease.Strong recommendation, moderate quality evidence.In the case of negative or inconclusive results and a high degree of suspicion of malignant disease, ESGE suggests re-evaluating the pathology slides, repeating EUS-guided sampling, or surgery.Weak recommendation, low quality evidence.In patients with chronic pancreatitis associated with a pancreatic mass, EUS-guided sampling results that do not confirm cancer should be interpreted with caution.Strong recommendation, low quality evidence.For pancreatic cystic lesions (PCLs), ESGE recommends EUS-guided sampling for biochemical analyses plus cytopathological examination if a precise diagnosis may change patient management, except for lesions ≤ 10 mm in diameter with no high risk stigmata. If the volume of PCL aspirate is small, it is recommended that carcinoembryonic antigen (CEA) level determination be done as the first analysis.Strong recommendation, low quality evidence.For esophageal cancer, ESGE suggests performing EUS-guided sampling for the assessment of regional lymph nodes (LNs) in T1 (and, depending on local treatment policy, T2) adenocarcinoma and of lesions suspicious for metastasis such as distant LNs, left liver lobe lesions, and suspected peritoneal carcinomatosis.Weak recommendation, low quality evidence.For lymphadenopathy of unknown origin, ESGE recommends performing EUS-guided (or alternatively endobronchial ultrasound [EBUS]-guided) sampling if the pathological result is likely to affect patient management and no superficial lymphadenopathy is easily accessible.Strong recommendation, moderate quality evidence.In the case of solid liver masses suspicious for metastasis, ESGE suggests performing EUS-guided sampling if the pathological result is likely to affect patient management, and (i) the lesion is poorly accessible/not detected at percutaneous imaging, or (ii) a sample obtained via the percutaneous route repeatedly yielded an inconclusive result.Weak recommendation, low quality evidence.
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Affiliation(s)
| | - Pierre H Deprez
- Cliniques universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch Oderland Strauberg/Wriezen, Germany
| | - Julio Iglesias-Garcia
- Gastroenterology Department, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Alberto Larghi
- Digestive Endoscopy Unit, Catholic University, Rome, Italy
| | - Geoffroy Vanbiervliet
- Department of Gastroenterology and Endoscopy, Hôpital Universitaire l'Archet, Nice, France
| | - Guruprasad P Aithal
- Nottingham Digestive Diseases Centre, NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, United Kingdom
| | - Paolo G Arcidiacono
- Pancreato-Biliary Endoscopy and Endosonography Division, San Raffaele University, Milan, Italy
| | - Pedro Bastos
- Gastroenterology Department Instituto Português de Oncologia do Porto, Porto, Portugal
| | - Silvia Carrara
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano, Italy
| | - László Czakó
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Gloria Fernández-Esparrach
- Endoscopy Unit, Department of Gastroenterology, ICMDM, IDIBAPS, CIBEREHD, Hospital Clínic, Barcelona, Spain
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - Àngels Ginès
- Endoscopy Unit, Department of Gastroenterology, ICMDM, IDIBAPS, CIBEREHD, Hospital Clínic, Barcelona, Spain
| | - Roald F Havre
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen and Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Cesare Hassan
- Digestive Endoscopy Unit, Catholic University, Rome, Italy
| | - Peter Vilmann
- Department of Surgical Gastroenterology, Herlev Hospital and Gentofte, Hospital, Copenhagen University, Denmark
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - Marcin Polkowski
- Department of Gastroenterology and Hepatology, Medical Centre for Postgraduate Education and Department of Gastroenterology, M. Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland
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Kendall F, Abreu P, Pinho P, Oliveira J, Bastos P. The role of physiotherapy in patients undergoing pulmonary surgery for lung cancer. A literature review. Rev Port Pneumol (2006) 2017. [PMID: 28623106 DOI: 10.1016/j.rppnen.2017.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
This review aims to appraise the role of physiotherapy care in patients submitted to pulmonary surgery, in preoperative, perioperative, and postoperative phases. Pulmonary surgery is the gold standard treatment for patients with lung cancer if it is completely resectable. However, the major impairments and complications induced by surgery are well known. Physiotherapy has been regularly used both in the preparation of the surgical candidates; in their functional recovery in the immediate postoperative period, and in the medium/long term but there is a lack of concise evidence-based recommendations. Therefore, the aim of this review is to appraise the literature about the role of physiotherapy interventions in patients undergoing lung surgery for lung cancer, in preoperative, perioperative, postoperative and maintenance stages, to the recovery and well-being, regardless of the extent of surgical approach. In conclusion, physiotherapy programs should be individually designed, and the goals established according to surgery timings, and according to each subject's needs. It can also be concluded that in the preoperative phase, the main goals are to avoid postoperative pulmonary complications and reduce the length of hospital stay, and the therapeutic targets are respiratory muscle training, bronchial hygiene and exercise training. For the perioperative period, breathing exercises for pulmonary expansion and bronchial hygiene, as well as early mobilization and deambulation, postural correction and shoulder range of motion activities, should be added. Finally, it can be concluded that in the postoperative phase exercise training should be maintained, and adoption of healthy life-style behaviours must be encouraged.
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Affiliation(s)
- F Kendall
- Department of Cardio-Thoracic Surgery, Centro Hospitalar de São João, Porto, Portugal; CESPU, Polytechnic Health Institute of the North, Gandra, Portugal; CIAFEL, Faculty of Sports, University of Porto, Porto, Portugal.
| | - P Abreu
- Department of Physiotherapy, Escola Superior Saúde Dr. Lopes Dias, Polytechnic Institute of Castelo Branco, Castelo Branco, Portugal
| | - P Pinho
- Department of Cardio-Thoracic Surgery, Centro Hospitalar de São João, Porto, Portugal
| | - J Oliveira
- CIAFEL, Faculty of Sports, University of Porto, Porto, Portugal
| | - P Bastos
- Department of Cardio-Thoracic Surgery, Centro Hospitalar de São João, Porto, Portugal
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Cozar-Leon R, Bastos P, Perez L, Alzueta J, Martinez-Ferrer JB, Arizon JM, Fernandez-Lozano I, Vinolas X, Jimenez J, Fernandez De La Concha J, Garcia Campo E, Ruiz-Duthil AD, Diaz-Infante E. P1738Incidence and risk factors for the development of fast ventricular tachycardia in recipients of implantable cardioverter defibrillators. Europace 2017. [DOI: 10.1093/ehjci/eux161.048] [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: 11/14/2022] Open
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Cozar-Leon R, Ruiz-Duthil AD, Perez L, Alzueta J, Martinez-Ferrer JB, Arizon JM, Fernandez-Lozano I, Vinolas J, Jimenez J, Fernandez De La Concha J, Garcia Campo E, Bastos P, Diaz-Infante E. P1737Incidence and risk factors for the development of slow ventricular tachycardia in recipients of implantable cardioverter defibrillators. Europace 2017. [DOI: 10.1093/ehjci/eux161.047] [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: 11/12/2022] Open
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Santos MM, Bastos P, Catela I, Zalewska K, Branco LC. Recent Advances of Metallocenes for Medicinal Chemistry. Mini Rev Med Chem 2017; 17:771-784. [DOI: 10.2174/1389557516666161031141620] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 06/10/2016] [Accepted: 09/16/2016] [Indexed: 11/22/2022]
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Affiliation(s)
- Inês Pita
- Serviço de Gastroenterologia, Instituto Português de Oncologia Francisco Gentil, Porto, Portugal
| | - Pedro Bastos
- Serviço de Gastroenterologia, Instituto Português de Oncologia Francisco Gentil, Porto, Portugal
| | - Mário Dinis-Ribeiro
- Serviço de Gastroenterologia, Instituto Português de Oncologia Francisco Gentil, Porto, Portugal
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Bastos P, Gomes T, Ribeiro L. Catechol-O-Methyltransferase (COMT): An Update on Its Role in Cancer, Neurological and Cardiovascular Diseases. Rev Physiol Biochem Pharmacol 2017; 173:1-39. [DOI: 10.1007/112_2017_2] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Guerra M, Mendes-Ferreira P, Adão R, Pereira E, Vieira M, Lourenço AP, Brás-Silva C, Bastos P, Vouga L, Leite-Moreira AF. Improvement in left intraventricular pressure gradients after aortic valve replacement in aortic stenosis patients. Exp Physiol 2017; 102:411-421. [DOI: 10.1113/ep086191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 02/10/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Miguel Guerra
- Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine; University of Porto; Alameda Professor Hernâni Monteiro Porto Portugal
- Department of Cardiothoracic Surgery; Centro Hospitalar de Vila Nova de Gaia/Espinho; Rua Conceição Fernandes Vila Nova de Gaia Portugal
| | - Pedro Mendes-Ferreira
- Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine; University of Porto; Alameda Professor Hernâni Monteiro Porto Portugal
| | - Rui Adão
- Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine; University of Porto; Alameda Professor Hernâni Monteiro Porto Portugal
| | - Eulália Pereira
- Department of Cardiothoracic Surgery; Centro Hospitalar de Vila Nova de Gaia/Espinho; Rua Conceição Fernandes Vila Nova de Gaia Portugal
- Department of Cardiology; Centro Hospitalar de Vila Nova de Gaia/Espinho; Rua Conceição Fernandes Vila Nova de Gaia Portugal
| | - Manuela Vieira
- Department of Anesthesiology; Centro Hospitalar de Vila Nova de Gaia/Espinho; Rua Conceição Fernandes Vila Nova de Gaia Portugal
| | - André P. Lourenço
- Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine; University of Porto; Alameda Professor Hernâni Monteiro Porto Portugal
| | - Carmen Brás-Silva
- Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine; University of Porto; Alameda Professor Hernâni Monteiro Porto Portugal
- Faculty of Nutrition and Food Sciences; University of Porto; Porto Portugal
| | - Pedro Bastos
- Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine; University of Porto; Alameda Professor Hernâni Monteiro Porto Portugal
- Department of Cardiothoracic Surgery; Centro Hospitalar São João; Alameda Professor Hernâni Monteiro Porto Portugal
| | - Luís Vouga
- Department of Cardiothoracic Surgery; Centro Hospitalar de Vila Nova de Gaia/Espinho; Rua Conceição Fernandes Vila Nova de Gaia Portugal
| | - Adelino F. Leite-Moreira
- Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine; University of Porto; Alameda Professor Hernâni Monteiro Porto Portugal
- Department of Cardiothoracic Surgery; Centro Hospitalar São João; Alameda Professor Hernâni Monteiro Porto Portugal
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Gonçalves BM, Bastos P, Leão P, Rolanda C. Ectopic varices in a pancreatojejunal anastomosis: a rare cause of hemorrhage. Endoscopy 2016; 47 Suppl 1 UCTN:E269-70. [PMID: 26099086 DOI: 10.1055/s-0034-1391871] [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)
| | - Pedro Bastos
- Department of Gastroenterology, Hospital Braga, Braga, Portugal
| | - Pedro Leão
- Department of General Surgery, Hospital Braga, Braga, Portugal
| | - Carla Rolanda
- Department of Gastroenterology, Hospital Braga, Braga, Portugal
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Fernandes D, Domingues S, Gonçalves BM, Bastos P, Ferreira A, Rodrigues A, Gonçalves R, Lopes L, Rolanda C. Acute Treatment of Malignant Colorectal Occlusion: Real Life Practice. GE Port J Gastroenterol 2016; 23:66-75. [PMID: 28868436 PMCID: PMC5580112 DOI: 10.1016/j.jpge.2015.10.005] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 10/02/2015] [Indexed: 12/27/2022]
Abstract
Introduction Colorectal cancer presents itself as acute bowel occlusion in 10–40% of patients. There are two main therapeutic approaches: urgent surgery and endoluminal placement self-expandable metallic stents (SEMS). Aims and Methods This study intended to better clarify the risk/benefit ratio of the above-mentioned approaches. We conducted a retrospective longitudinal multicenter study, including 189 patients with acute malignant colorectal occlusion, diagnosed between January 2005 and March 2013. Results Globally (85 patients – 35 bridge-to-surgery and 50 palliative), SEMS's technical success was of 94%. Palliative SEMS had limited clinical success (60%) and were associated with 40% of complications. SEMS occlusion (19%) was the most frequent complication, followed by migration (9%) and bowel perforation (7%). Elective surgery after stenting was associated with a higher frequency of primary anastomosis (94% vs. 76%; p = 0.038), and a lower rate of colostomy (26% vs. 55%; p = 0.004) and overall mortality (31% vs. 57%; p = 0.02). However, no significant differences were identified concerning postoperative complications. Regarding palliative treatment, no difference was found in the complications rate and overall mortality between SEMS and decompressive colostomy/ileostomy. In this SEMS subgroup, we found a higher rate of reinterventions (40% vs. 5%; p = 0.004) and a longer hospital stay (14, nine vs. seven, three days; p = 0.004). Conclusion SEMS placement as a bridge-to-surgery should be considered in the acute treatment of colorectal malignant occlusion, since it displays advantages regarding primary anastomosis, colostomy rate and overall mortality. In contrast, in this study, palliative SEMS did not appear to present significant advantages when compared to decompressive colostomy.
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Soares JB, Iglesias-Garcia J, Goncalves B, Lindkvist B, Lariño-Noia J, Bastos P, Caetano ACL, Ferreira A, Pimentel-Nunes P, Lopes L, Moutinho-Ribeiro P, Dominguez-Muñoz JE. Interobserver agreement of EUS elastography in the evaluation of solid pancreatic lesions. Endosc Ultrasound 2015; 4:244-9. [PMID: 26374584 PMCID: PMC4568638 DOI: 10.4103/2303-9027.163016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background and Objectives: Previous reports assessing the reproducibility of endoscopic ultrasound elastography (EUS-E) in evaluation of solid pancreatic lesions (SPL) involved only experienced endosonographers. We aimed to assess the interobserver agreement (IOA) of EUS-E in the evaluation of SPL by endoscopists with different levels of experience in EUS and EUS-E. Materials and Methods: A cross-sectional observational multicenter study was designed and included 11 endoscopists who were divided into four groups: Group A (long experience in EUS and EUS-E); Group B (short experience in EUS and EUS-E); Group C (long experience in EUS and no experience in EUS-E); and Group D (no experience in EUS or EUS-E). The observers independently classified the patterns of 60 video sequences of EUS-E, after a 20-min training session. For each group, we calculated IOA (kappa statistic, κ) of EUS-E and the diagnostic accuracy of EUS-E for pancreatic malignancy, by comparing the pattern of EUS-E indicative of malignancy (heterogeneous or homogenous blue) with the final diagnosis. Results: The overall IOA was moderate (κ = 0.42; 95% confidence interval (CI) 0.33-0.52). The IOA of Group A (κ = 0.80; 95% CI 0.65-1.00) was significantly higher than that of Groups B (κ = 0.54; 95%CI 0.40-0.71), C (κ = 0.54; 95%CI 0.39-0.68), and D (κ = 0.28; 95%CI 0.14-0.40). IOA of Groups B and C was not significantly different, but it was significantly higher than that of Group D. The diagnostic accuracy of Group A (area under the curve under summary receiver operating characteristic (AUROC) = 0.83; 95%CI 0.75-0.90) was not significantly different from that of Group B (AUROC = 0.77; 95%CI 0.71-0.83), but it was significantly higher than that of Groups C (AUROC = 0.74; 95%CI 0.67-0.81) and D (AUROC = 0.74; 95%CI 0.67-0.81). No significant difference was seen between Groups B, C, and D for diagnostic accuracy. Conclusion: EUS-E is reproducible in the evaluation of SPL, even between endoscopists with no or limited experience in EUS and/or EUS-E. Reproducibility and diagnostic accuracy increase with experience in EUS and EUS-E.
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Gonçalves B, Soares JB, Bastos P. Endoscopic Ultrasound in the Diagnosis and Staging of Pancreatic Cancer. GE Port J Gastroenterol 2015; 22:161-171. [PMID: 28868399 PMCID: PMC5580187 DOI: 10.1016/j.jpge.2015.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 03/17/2015] [Accepted: 04/23/2015] [Indexed: 02/08/2023]
Abstract
Pancreatic cancer is one of the digestive cancers with the poorest prognosis, so an early and correct diagnosis is of utmost importance. With the development of new therapeutic options an accurate staging is essential. Endoscopic ultrasonography (EUS) has a major role in all stages of the management of these patients. EUS has a high accuracy in the diagnosis of pancreatic adenocarcinoma and the possibility to perform fine-needle aspiration/biopsy (FNA/FNB) increases the diagnostic yield of EUS. There is still no consensus on the several technical aspects of FNA, namely on the rapid on-site evaluation (ROSE), the diameter and type of needle, the number of passes and the use of stylet and suction. Contrast-enhanced EUS (CE-EUS) and EUS elastography (EUS-E) have been used in recent years as an adjunct to EUS-FNA. Given the higher sensitivity of these techniques a negative cytology by EUS-FNA should not exclude malignancy when CE-EUS and/or EUS-E are suggestive of pancreatic neoplasia. EUS remains one of the main methods in the staging of pancreatic adenocarcinoma, namely to further evaluate patients with non-metastatic disease that appears resectable on initial imaging. EUS is crucial for an accurate preoperative evaluation of pancreatic cancer which is essential to choose the correct management strategy. The possibility to obtain samples from suspicious lesions or lymph nodes, by means of EUS-guided fine-needle aspiration as well as the use of contrast-enhanced and elastography, makes EUS an ideal modality for the diagnosis and staging of pancreatic cancer.
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Affiliation(s)
- Bruno Gonçalves
- Gastroenterology Department, Hospital de Braga, Braga, Portugal
| | | | - Pedro Bastos
- Gastroenterology Department, Hospital de Braga, Braga, Portugal
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Soares JB, Iglesias-Garcia J, Gonçalves B, Lindkvist B, Lariño-Noia J, Bastos P, Caetano AC, Ferreira A, Pimentel-Nunes P, Lopes L, Moutinho P, Dominguez-Muñoz JE. Interobserver agreement of contrast-enhanced harmonic endoscopic ultrasonography in the evaluation of solid pancreatic lesions. Endosc Int Open 2015; 3:E205-9. [PMID: 26171432 PMCID: PMC4486026 DOI: 10.1055/s-0034-1391415] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 01/07/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND STUDY AIMS Previous reports assessing the reproducibility of contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) in the evaluation of solid pancreatic lesions (SPLs) involved mainly experienced endosonographers. We aimed to assess the interobserver agreement (IOA) of CH-EUS in the evaluation of SPLs by endoscopists with different levels of experience in EUS and CH-EUS. PARTICIPANTS AND METHODS A cross-sectional observational multicenter study was designed and included 11 endoscopists who were divided into four groups according to their experience in EUS and CH-EUS: group A (long experience in EUS and CH-EUS); group B (short experience in EUS and CH-EUS); group C (long experience in EUS and no experience in CH-EUS); and group D (no experience in EUS or CH-EUS). The observers independently classified the patterns of 60 CH-EUS video sequences of 60 SPLs after a 20-minute training session. For each group, we calculated the IOA (kappa statistic, κ) of CH-EUS and the accuracy of CH-EUS for the diagnosis of pancreatic adenocarcinoma by comparing the pattern of CH-EUS indicative of pancreatic adenocarcinoma (hypo-enhanced contrast pattern) with the final diagnosis. RESULTS The overall IOA for CH-EUS was fair (κ = 0.32; 95 %CI 0.22 - 0.41). Group A (κ = 0.63; 95 %CI 0.45 - 0.85) had the highest IOA, followed by group C (κ = 0.54; 95 %CI 0.39 - 0.71), group B (κ = 0.38; 95 %CI 0.22 - 0.55), and group D (κ = 0.21; 95 %CI 0.07 - 0.36). The IOA of groups A and C was significantly higher than that of group D. No significant difference was seen between groups A, B, and C or between groups B and D in terms of IOA. Group A (area under the curve under summary receiver operating characteristic [AUROC] = 0.67; 95 %CI 0.58 - 0.75) had the highest accuracy for the diagnosis of pancreatic adenocarcinoma, followed by group C (AUROC = 0.58; 95 %CI 0.50 - 0.65), group B (AUROC = 0.55; 95 %CI 0.48 - 0.63), and group D (AUROC = 0.51; 95 %CI 0.43 - 0.58). The diagnostic accuracy of group A was not significantly different from that of group C, but it was significantly higher than that of groups B and D. No significant difference was seen between groups B, C, and D in terms of diagnostic accuracy. CONCLUSIONS CH-EUS is reproducible in the evaluation of SPLs, even between endoscopists with no or limited experience in EUS and/or CH-EUS. Long experience in EUS is a major contributor to the IOA and diagnostic accuracy of CH-EUS.
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Affiliation(s)
- João-Bruno Soares
- Department of Gastroenterology, Hospital of Braga, Braga, Portugal ,Corresponding author João-Bruno Soares, MD Department of Gastroenterology, Hospital of BragaSete Fontes – S. Victor Apartado 2056 4701-901 Braga Portugal+351-253-027999
| | - Julio Iglesias-Garcia
- Department of Gastroenterology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain,Foundation for Research in Digestive Diseases (FIENAD), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Bruno Gonçalves
- Department of Gastroenterology, Hospital of Braga, Braga, Portugal
| | - Björn Lindkvist
- Department of Gastroenterology, Sahlgrenska University Hospital, Gothenburg, Sweden,Sahlgrenska Academy, University of Gothenburg Institute of Medicine, Gothenburg, Sweden
| | - Jose Lariño-Noia
- Department of Gastroenterology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain,Foundation for Research in Digestive Diseases (FIENAD), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Pedro Bastos
- Department of Gastroenterology, Hospital of Braga, Braga, Portugal
| | - Ana Célia Caetano
- Department of Gastroenterology, Hospital of Braga, Braga, Portugal ,Surgical Sciences Research Domain, Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
| | - Aníbal Ferreira
- Department of Gastroenterology, Hospital of Braga, Braga, Portugal ,Surgical Sciences Research Domain, Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
| | - Pedro Pimentel-Nunes
- Department of Gastroenterology, Portuguese Institute of Oncology – Oporto, Porto, Portugal,Department of Physiology, Cardiovascular Research and Development Unit, University of Porto Faculty of Medicine, Porto, Portugal
| | - Luís Lopes
- Surgical Sciences Research Domain, Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal,Department of Gastroenterology, Hospital Center of Alto Minho, Viana do Castelo, Portugal
| | - Pedro Moutinho
- Department of Gastroenterology, Hospital Center of Alto Ave, Guimarães, Portugal
| | - J. Enrique Dominguez-Muñoz
- Department of Gastroenterology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain,Foundation for Research in Digestive Diseases (FIENAD), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
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Gonçalves BM, Fontainhas V, Caetano AC, Ferreira A, Gonçalves R, Bastos P, Rolanda C. Oncological outcomes after endoscopic removal of malignant colorectal polyps. Rev Esp Enferm Dig 2015; 105:454-61. [PMID: 24274442 DOI: 10.4321/s1130-01082013000800003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE malignant colorectal polyp, defined by submucosally invasive adenocarcinoma, is the earliest form of clinically relevant colorectal cancer (CRC). After endoscopic resection additional surgery may be necessary, although decision criteria remain debatable. The objective of this study was to assess oncologic outcomes in terms of locoregional disease and to identify areas of improvement that may facilitate patients' management. METHODS retrospective study of 40 patients with T1 CRC endoscopically resected between 2007 and 2012. Clinicopathological features were assessed and correlated with residual disease (RD), defined as presence of adenocarcinoma in intestinal wall and/ or lymph nodes. RESULTS thirty-one patients underwent surgery while 9 were followed-up. After surgery, RD was confirmed in 15 (48.4%) patients: 8 (53.3%) wall disease, 5 (33%) nodal metastasis, and 2 (13.3%) with both. No recurrence was detected in the follow-up group. The characteristics of the lesions that were associated with DR were sessile configuration (p = 0.03), the degree of differentiation G3 (p = 0.01) and intercepted/indeterminate margins (p = 0.01). Twenty-two patients were operated because of inadequate evaluation, mainly due to piecemeal resection, and half of them were disease free. Postoperative complications were found in 9 (30%) patients, mainly anastomotic leakage that was associated with rectum anterior resection (p = 0.03). CONCLUSIONS surgery should be considered in the presence of any risk factor for residual disease, while follow-up can be offered in low risk settings. Was also demonstrated a clear need for technical improvement in endoscopic resection and pathology evaluation in order to prevent unnecessary surgeries.
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Affiliation(s)
| | - Ana C Caetano
- Department of Gastroenterology, Hospital Braga, Portugal
| | | | - Armanda Cruz
- Department of Gastroenterology, Hospital Braga, Portugal
| | - Pedro Bastos
- Department of Gastroenterology, Hospital Braga, Portugal
| | - Carla Rolanda
- Department of Gastroenterology, Hospital Braga, Portugal
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Gonçalves BM, Ferreira A, Caetano AC, Bastos P, Rolanda C. Endoloop application for the removal of a self-expandable metallic stent (SEMS) in an esophagocolonic anastomotic stricture. Endoscopy 2014; 45 Suppl 2 UCTN:E209. [PMID: 23888460 DOI: 10.1055/s-0033-1344132] [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 M Gonçalves
- Department of Gastroenterology, Hospital Braga, Portugal.
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van Zeller M, Bastos P, Fernandes G, Magalhães A. Clinical challenges of persistent pulmonary air-leaks--case report. Rev Port Pneumol 2013; 20:162-6. [PMID: 24268518 DOI: 10.1016/j.rppneu.2013.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 07/03/2013] [Accepted: 07/12/2013] [Indexed: 12/01/2022] Open
Abstract
Air leaks are a common problem after pulmonary resection and can be a source of significant morbidity and mortality. The authors describe the case of a 68-year-old male patient who presented with a persistent air-leak after pulmonary resection. Watchful waiting, surgical procedures, as well as medical therapy like pleurodesis and implantation of endobronchial one-way valves on the bronchial segments identified using systematic occlusion of the bronchial segments, were all tried unsuccessfully. During that time the patient remained hospitalized with a chest tube. The instillation of methylene blue through the chest tube was used to identify the segments leading to the persistent air-leak; this enabled successful endobronchial valve placement which sufficiently reduced the size of the air-leak so that the chest tube could be removed. Nonsurgical approaches seem promising and, for some patients may be the only treatment option after all conventional treatments have failed or are considered too high risk.
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Affiliation(s)
- M van Zeller
- Serviço de Pneumologia, Centro Hospitalar de São João, Porto, Portugal.
| | - P Bastos
- Serviço de Cirurgia Cardio-Torácica, Centro Hospitalar de São João, Porto, Portugal; Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - G Fernandes
- Serviço de Pneumologia, Centro Hospitalar de São João, Porto, Portugal; Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - A Magalhães
- Serviço de Pneumologia, Centro Hospitalar de São João, Porto, Portugal
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Barroca H, Souto Moura C, Lopes JM, Lisboa S, Teixeira MR, Damasceno M, Bastos P, Sobrinho-Simões M. PNET with neuroendocrine differentiation of the lung: Report of an unusual entity. Int J Surg Pathol 2013; 22:427-33. [PMID: 24141023 DOI: 10.1177/1066896913502227] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Ewing's sarcoma/primitive neuroectodermal tumor (PNET) has been the subject of recent reports describing morphologic variants (adamantinoma-like, large cell, spindle cell, sclerosing, clear cell, and vascular-like) of the most classic form, as well as cases displaying unusual morphologic differentiation and atypical immunohistochemical features. We report a case of an uncommon lung tumor in a 20-year-old female, morphologically and molecularly consistent with an Ewing's sarcoma/PNET tumor with foci of squamous differentiation, and peculiar expression of vimentin, high-molecular-weight keratins, p63, synaptophysin, and chromogranin. This case raises a challenging differential diagnostic problem with therapeutic implications: Should the patient be treated following the protocols for Ewing's sarcoma/PNET tumors or as for lung carcinoma with neuroendocrine features? The patient we report here was treated with neoadjuvant chemotherapy for Ewing's sarcoma/PNET according to Euro Ewing 99 study protocol followed by surgery and has no evidence of disease 15 months after the initial diagnosis. This highlights the importance of achieving the correct diagnosis of these atypical tumors using all clinical, morphological, and ancillary methods available to allow for their correct and timely treatment.
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Affiliation(s)
- Helena Barroca
- Centro Hospitalar S João, Porto, Portugal Departamento de Patologia e Oncologia Médica da Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Conceição Souto Moura
- Centro Hospitalar S João, Porto, Portugal Departamento de Patologia e Oncologia Médica da Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - José Manuel Lopes
- Centro Hospitalar S João, Porto, Portugal Departamento de Patologia e Oncologia Médica da Faculdade de Medicina da Universidade do Porto, Porto, Portugal Instituto de Patologia e Imunologia Molecular da Universidade do Porto (IPATIMUP), Porto, Portugal
| | - Susana Lisboa
- Instituto Português de Oncologia do Porto e Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal
| | - Manuel R Teixeira
- Instituto Português de Oncologia do Porto e Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal
| | - Margarida Damasceno
- Centro Hospitalar S João, Porto, Portugal Departamento de Patologia e Oncologia Médica da Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | | | - Manuel Sobrinho-Simões
- Centro Hospitalar S João, Porto, Portugal Departamento de Patologia e Oncologia Médica da Faculdade de Medicina da Universidade do Porto, Porto, Portugal Instituto de Patologia e Imunologia Molecular da Universidade do Porto (IPATIMUP), Porto, Portugal
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Baldaque-Silva F, Marques M, Lunet N, Themudo G, Goda K, Toth E, Soares J, Bastos P, Ramalho R, Pereira P, Marques N, Coimbra M, Vieth M, Dinis-Ribeiro M, Macedo G, Lundell L, Marschall HU. Endoscopic assessment and grading of Barrett's esophagus using magnification endoscopy and narrow band imaging: impact of structured learning and experience on the accuracy of the Amsterdam classification system. Scand J Gastroenterol 2013; 48:160-7. [PMID: 23215965 DOI: 10.3109/00365521.2012.746392] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [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] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Several classification systems have been launched to characterize Barrett's esophagus (BE) mucosa using magnification endoscopy with narrow band imaging (ME-NBI). The good accuracy and interobserver agreement described in the early reports were not reproduced subsequently. Recently, we reported somewhat higher accuracy of the classification developed by the Amsterdam group. The critical question then formulated was whether a structured learning program and the level of experience would affect the clinical usefulness of this classification. MATERIAL & METHODS Two hundred and nine videos were prospectively captured from patients with BE using ME-NBI. From these, 70 were randomly selected and evaluated by six endoscopists with different levels of expertise, using a dedicated software application. First, an educational set was studied. Thereafter, the 70 test videos were evaluated. After classification of each video, the respective histological feedback was automatically given. RESULTS Within the learning process, there was a decrease in the time needed for evaluation and an increase in the certainty of prediction. The accuracy did not increase with the learning process. The sensitivity for detection of intestinal metaplasia ranged between 39% and 57%, and for neoplasia between 62% and 90%, irrespective of assessor's expertise. The kappa coefficient for the interobserver agreement ranged from 0.25 to 0.30 for intestinal metaplasia, and from 0.39 to 0.48 for neoplasia. CONCLUSION Using a dedicated learning program, the ME-NBI Amsterdam classification system is suboptimal in terms of accuracy and inter- and intraobserver agreements. These results reiterate the questionable utility of corresponding classification system in clinical routine practice.
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Affiliation(s)
- Francisco Baldaque-Silva
- Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
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Affiliation(s)
- J B Soares
- Department of Gastroenterology, Braga Hospital, Braga, Portugal.
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Albuquerque A, Bastos P, Macedo G. Gastric necrosis caused by gastric banding. Gastrointest Endosc 2012; 75:1098; discussion 1098-9. [PMID: 22365438 DOI: 10.1016/j.gie.2011.12.024] [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] [Received: 01/23/2011] [Accepted: 12/20/2011] [Indexed: 02/08/2023]
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Rodrigues S, Bastos P, Macedo G. A rare cause of hematemesis: gastric metastases from renal cell carcinoma. Gastrointest Endosc 2012; 75:894; discussion 895. [PMID: 22440203 DOI: 10.1016/j.gie.2012.01.025] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Accepted: 01/18/2012] [Indexed: 02/08/2023]
Affiliation(s)
- Susana Rodrigues
- Department of Gastroenterology, Hospital São João, Porto, Portugal
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Vaz AP, Fernandes G, Souto Moura C, Bastos P, Queiroga H, Hespanhol V. Integrated PET/CT in non small cell lung cancer staging--clinical and pathological agreement. Rev Port Pneumol 2012; 18:109-14. [PMID: 22405953 DOI: 10.1016/j.rppneu.2012.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Accepted: 01/10/2012] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Integrated PET/CT has become a fundamental tool in the preoperative assessment of non small lung cancer (NSCLC) providing useful anatomical and metabolic information to characterize tumoral lesions and to detect unsuspected metastatic disease. AIM To compare the agreement between clinical and pathological staging before and after the use of PET/CT. MATERIAL AND METHODS Retrospective study of patients with NSCLC who underwent potentially curative surgery throughout 10.5 years. Cohen's kappa coefficient was used to evaluate staging agreement. RESULTS One hundred and fifty patients were evaluated, 78% males, with a mean age of 65 (±9.6) years. Thirteen percent were submitted to neoadjuvant chemotherapy. PET/CT was performed in 41%. Global agreement between clinical and pathological staging was 51% (kappa=0.3639). There was a statistically significant difference between the staging results in patients who underwent PET/CT, when compared to the subgroup who did not (p=0.003). For those with PET/CT false negatives occurred in less 39%, false positives in more 12% and clinical and pathological staging coincided in more 27%. The overall results reflected an improvement in the agreement between clinical and pathological staging in the PET/CT subgroup (67%, kappa=0.5737 vs 40%, kappa=0.2292). PET/CT accuracy was enhanced when patients re-staged after neoadjuvant therapy were excluded and a substantial staging agreement was obtained for those who had the exam only for staging purposes (73%, kappa=0.6323). CONCLUSION Inclusion of PET/CT in NSCLC preoperative assessment improved the accuracy of the clinical staging, with a good level of agreement with pathological staging.
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Affiliation(s)
- A P Vaz
- Serviço de Pneumologia, Centro Hospitalar de São João, Porto, Portugal.
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Ferreira F, Bastos P, Ribeiro A, Marques M, Azevedo F, Pereira P, Lopes S, Ramalho R, Macedo G. A comparative study between fluoroscopic and endoscopic guidance in palliative esophageal stent placement. Dis Esophagus 2011; 25:608-13. [PMID: 22151881 DOI: 10.1111/j.1442-2050.2011.01288.x] [Citation(s) in RCA: 15] [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] [Indexed: 12/11/2022]
Abstract
Self-expanding metallic stents (SEMS) are the treatment of choice for incurable obstructive malignant esophageal strictures. Although the placement of SEMS is usually performed with fluoroscopic control (FC), recently several authors have shown the feasibility of placing SEMS under endoscopic control alone (EC). However, studies comparing the two techniques are lacking. The objective of this study was to compare the feasibility and safety of SEMS insertion under fluoroscopic control and endoscopic control. The study was performed through the retrospective analysis of patients who underwent SEMS insertion for malignant dysphagia between January 2005 and January 2010. Data concerning early and late complications and survival were retrieved. Early complications were defined as pain, vomiting, bleeding, malposition/migration, perforation, and/or dysphagia occurring until 30 days of SEMS insertion; and late complications as tumor ingrowth and overgrowth, migration, hemorrhage, fistulae, food impaction, and/or esophagitis occurring after 30 days. We placed 126 SEMS of which 87% for esophageal stricture, 8% for esophagus-respiratory fistula, and 5% for extrinsic compression. The mean age of the patients was 62 years, and 93 were male. SEMS insertion was performed with FC in 66 patients and EC in 60. Early complications occurred in 34 patients (52%) in the FC group and 28 (47%) in the EC group (P=0.71), including: pain in 22 patients of the FC group and 15 of the EC group (P=0.31); vomiting in 15 of the FC group and nine of the EC group (P=0.27); malposition/migration in three of the FC group and four of the EC group (P=0.60); hemorrhage in one of the FC group and two of the EC group (P=0.27); and dysphagia in two of the FC group and three of the EC group (P=0.57). Late complications occurred in 20 patients (30%) in the FC group and 22 (37%) in the EC group (P=0.44), including: tumor in/overgrowth in 13 patients of the FC group and 10 of the EC group (P=0.66); prostheses migration in five of the FC group and eight of the EC group (P=0.28); hemorrhage in two of the FC group and two of the EC group (P=0.54); appearance of esophageal fistulae in seven of the FC group and four of the EC group (P=0.43); food impaction in nine of the FC group and eight of the EC group (P=0.96); esophagitis in 12 of the FC group and 15 of the EC group (P=0.35). Median survival was 107 days (95% confidence interval [CI]=6-369 days) with no difference between the two groups. There were no statistical significant differences in the incidence of complications and in survival between patients undergoing SEMS placement under fluoroscopic control or endoscopic control.
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Affiliation(s)
- F Ferreira
- Gastroenterology Department, Hospital de São João, Porto, Portugal.
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Affiliation(s)
- F Ferreira
- Gastroentrology Department, Hospital S. João and Faculty of Medicine, Porto, Portugal.
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Monteiro F, Tavares G, Ferreira M, Amorim A, Bastos P, Rocha C, Araújo F, Cunha-Ribeiro LM. Technologies involved in molecular blood group genotyping. ACTA ACUST UNITED AC 2011. [DOI: 10.1111/j.1751-2824.2011.01425.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Bastos P, Cardoso H, Ferreira F, Pimentel-Nunes P, Bartosch C, Souto-Moura C, Ribeiro A, Macedo G. Adenocarcinoma of the colon associated with hyperplastic polyposis. Gastroenterol Hepatol 2010; 33:470-1. [PMID: 20363055 DOI: 10.1016/j.gastrohep.2010.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Revised: 01/17/2010] [Accepted: 01/22/2010] [Indexed: 01/24/2023]
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Melo N, Figueiredo S, Morais A, Moura CS, Pinho P, Bastos P, Oliveira T. Erratum to "Biópsia pulmonar cirúrgica em doentes sob ventilação invasiva e com suspeita de doença difusa do parênquima pulmonar" [Rev Port Pneumol 2009; XV(4):597-611]. Revista Portuguesa de Pneumologia 2009; 15:1211-8. [DOI: 10.1016/s0873-2159(15)30204-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Melo N, Figueiredo S, Morais A, Souto Moura C, Pinho P, Bastos P, Oliveira T. Open lung biopsy in patients on mechanical ventilation with suspected diffuse lung disease. Rev Port Pneumol 2009; 15:597-611. [PMID: 19547894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND While open lung biopsy (OLB) performed in patients on mechanical ventilation (MV) with diffuse lung diseases (DLD) can be extremely important in establishing the diagnosis, the associated risk of this procedure should be taken into account. AIM To determine the diagnostic yield, therapeutic changes, complications and mortality in patients with DLD on MV submitted to OLB. METHODS Retrospective study of 19 patients admitted to S. João Hospital between January 1999 and July 2007 (8.5 years). Data analysed included demographic data, ventilation variables before and after biopsy, diagnostic yield, effect on subsequent treatment changes and complications of OLB. Statistical analysis was performed using SPSS 14.0. RESULTS The mean age of patients was 58+/-16.3 years old and 53% were male. The mean duration of hospital stay in Intensive Care Unit before performing OLB was 13+/-7 days. All biopsies were performed by thoracotomy. The diagnostic yield was 95%. There were no significant differences in partial pressure of arterial oxygen/fraction of inspired oxygen (PaO(2)/ FiO(2)) ratio and the positive end expiratory pressure (PEEP) before and after OLB. Postoperative complications occurred in 4 patients (21%; persistent air leak). Alteration in the diagnosis occurred in 14 patients (74%) and in 8 patients (42%) there was a modification in the treatment regimen. Global mortality was 47% (9 patients) but there were no biopsy-related deaths. CONCLUSION The high diagnostic yield and the low incidence of complications make OLB a useful procedure in patients on MV with DLD of unknown aetiology. However, early OLB may lead to even better results in some patients.
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Affiliation(s)
- Natália Melo
- Pulmonology Unit, Hospital de S João Alameda Professor Hernâni Monteiro, Porto, Portugal.
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Abstract
OBJECTIVE To assess results in patients with primary cysts and tumours of the mediastinum who under- went surgery. METHODS A retrospective single-centre study was undertaken into patients with primary cysts and tumours of the mediastinum who underwent surgery between January 1992 and December 2004. We analysed demographic data, clinical presentation, type of surgery carried out and procedure, lesion location and histological diagnosis. Predictive malignancy factors were also evaluated. Postoperative morbidity and mortality were noted, as was medium-term results. RESULTS 171 patients underwent surgery over a 13-year period; 73 female (43%) and 98 male (57%). Mean age was 40.3+/-19.7 years (20 days-78 years). A primary cystic lesion was present in 15 patients (9%). The pri- mary tumours included thymic neoplasms (31%), lymphoma (22%), neurogenic tumours (16%), germ cell tumours (9%) and a miscellaneous group (13%). Malignant neoplasms were present in 78 patients (46%). The antero-superior mediastinum was the most commonly involved site to have a primary cyst or tumour (58%), followed by the posterior mediastinum (24%) and the middle mediastinum (18%). Symptoms were present in 68% of the patients and included chest pain (20%), fever and chills (13%), myasthenia gravis (11%), cough (10%), dyspnoea (10%), and superior vena caval syndrome (7%). Univariate analysis identified symptoms as a predictive factors of malignancy (p<0.001). Types of surgery carried out included postero-lateral thoracotomy (64 patients), median sternotomy (51 patients), anterior mediastinostomy (27 patients), antero-lateral thoracotomy (18 patients), video-assisted thoracic surgery (9 patients) and mediastinoscopy (2 patients). Total excision was performed in 116 patients, enlarged resection in 8 patients, subtotal re- section in 7 patients and biopsy in 40 patients. There was one postoperative death (0.6%). Follow-up was available in 165 patients (96.5%) and ranged from 34 days to 13.4 years (mean 5.7+/-4.0 years). Complementary treatment with chemo and/or radiotherapy was provided in 75 patients. Six patients had to be reoperated on for local recurrence (3) or metastasis (3) of the primary lesion. Fifteen patients died of their disease during the follow-up period. Actuarial survival at five years was 97.6% for benign lesions and 76.4% for malignant tumours. CONCLUSION Results support surgical resection for benign lesions and an aggressive multimodal approach for malignant tumours.
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Affiliation(s)
- Pedro Bastos
- Autonomous Surgery Management Unit, Faculty of Medicine. Hospital de S. João.
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