Browsing by Author "Caetano, AC"
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- Emergencies after endoscopic proceduresPublication . Rolanda, C; Caetano, AC; Dinis-Ribeiro, MEndoscopy adverse events (AEs), or complications, are a rising concern on the quality of endoscopic care, given the technical advances and the crescent complexity of therapeutic procedures, over the entire gastrointestinal and bilio-pancreatic tract. In a small percentage, not established, there can be real emergency conditions, as perforation, severe bleeding, embolization or infection. Distinct variables interfere in its occurrence, although, the awareness of the operator for their potential, early recognition, and local organized facilities for immediate handling, makes all the difference in the subsequent outcome. This review outlines general AEs' frequencies, important predisposing factors and putative prophylactic measures for specific procedures (from conventional endoscopy to endoscopic cholangio-pancreatography and ultrasonography), with comprehensive approaches to the management of emergent bleeding and perforation.
- Eosinophilic esophagitis-endoscopic distinguishing findingsPublication . Caetano, AC; Gonçalves, R; Rolanda, CEosinophilic esophagitis (EE) is the most frequent condition found in a group of gastrointestinal disorders called eosinophilic gastrointestinal diseases. The hypothetical pathophysiological mechanism is related to a hypersensitivity reaction. Gastroesophageal reflux disease-like complaints not ameliorated by acid blockade or occasional symptoms of dysphagia or food impaction are likely presentations of EE. Due to its unclear pathogenesis and unspecific symptoms, it is difficult to diagnose EE without a strong suspicion. Although histological criteria are necessary to diagnosis EE, there are some characteristic endoscopic features. We present the case of a healthy 55-year-old woman with dysphagia and several episodes of esophageal food impaction over the last six months. This case report stresses the most distinguishing endoscopic findings-mucosa rings, white exudative plaques and linear furrows-that can help in the prompt recognition of this condition.
- Injury to the Superior Gluteal Artery during Intramedullary Fixation of a Proximal Femoral Fracture - A Case ReportPublication . Fernandes, PX; Medeiros, DM; Teixeira, RC; Nunes, AM; Seco, AS; Caetano, ACProximal femoral fractures represent a health problem of global proportions. Iatrogenic vascular lesion in the treatment of these fractures is an unusual potentially lethal complication, reported in only 0.2% of trochanteric fractures treated with intramedullary implants. Superior gluteal artery injury is extremely rare, with only two cases reported in literature.
- Oncological outcomes after endoscopic removal of malignant colorectal polypsPublication . Gonçalves, BM; Fontainhas, V; Caetano, AC; Ferreira, A; Gonçalves, R; Bastos, P; Rolanda, CObjective: 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.
- Phenotypic characterization and familial risk in hyperplastic polyposis syndromePublication . Caetano, AC; Ferreira, H; Soares, J; Ferreira, A; Gonçalves, R; Rolanda, CBackground. Hyperplastic polyposis syndrome (HPS) is a rare condition characterized by numerous hyperplastic polyps (HP) with a pancolonic distribution. Genetic and environmental factors, including smoking, may be responsible for phenotypic differences. Objective. To characterize HPS patients' phenotype and to determine HPS risk and colorectal cancer (CRC) risk in the first-degree relatives (FDRs). Patients and methods. Eight HPS patients were followed at our Gastroenterology Department (2008-2012). The data included (1) macroscopic and histological analysis of polyps, (2) demographic information about patients and their families and (3) colonoscopy results of FDR that accepted a screening exam. Results. Six of the eight index cases (ICs) had family history of CRC. Of the 24 FDRs screened, 5 were diagnosed with HPS. In our study, HPS and CRC prevalence in FDR was 625 and 9 times higher than the risk of the general population. Polyps over 10 mm were preferentially located in proximal colon (p < 0.001). Advanced polyps were larger (p < 0.001) than HP and more frequent in older patients (p = 0.0054). Nonsmokers had smaller polyps (p = 0.037) preferentially in the proximal colon (p = 0.04) and a lower age at HPS diagnosis. Patients with CRC family history manifest HPS at an earlier age and patients whose relatives had CRC before 50 years had larger polyps (p = 0.0475). Smokers with CRC family history had larger polyps than nonsmokers (p = 0.048). Conclusion. Despite the small sample, the results reflect the phenotypic heterogeneity of HPS as well as the increased family risk of HPS and CRC. This study points out that CRC family history and smoking influence HPS expression.
- A rare cause of abdominal painPublication . Gonçalves, PM; Caetano, AC; Ferreira, A
- Rare Complication: What Kind of Colitis?Publication . Caetano, AC; Gonçalves, B; Rolanda, C