Percorrer por autor "Sousa, J"
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- Endovascular Treatment of Symptomatic Renal Artery Aneurysm with Hostile AnatomyPublication . Sousa, J; Mansilha, A
- Endovascular Treatment of Symptomatic Renal Artery Aneurysm with Hostile AnatomyPublication . Sousa, J; Mansilha, A
- Necrotizing mesenteric vasculitis in systemic lupus erythematosusPublication . Lourenço, MH; Bento Silva, A; Sousa, J; Oliveira, H; Silva, I; Costa, M; Branco, JC; Gonçalves, MJSystemic lupus erythematosus (SLE) is a multisystemic autoimmune disorder which may affect the gastrointestinal system. Half of the patients with SLE experience gastrointestinal symptoms, with the most common being nausea, vomiting, anorexia, and abdominal pain. Mesenteric vasculitis is a severe and rare complication of SLE and one of the most frequent causes of severe acute abdominal pain. The authors present a case of a 57-year-old woman with SLE who was diagnosed with necrotizing mesenteric vasculitis following a urinary septic shock. The patient was treated with high-dose corticosteroid therapy and cyclophosphamide, with resolution of the clinical picture.
- Pathophysiological Mechanisms of Chronic Venous Disease and Implications for Venoactive Drug TherapyPublication . Mansilha, A; Sousa, JChronic venous disease (CVD) is a common pathology, with significant physical and psychological impacts for patients and high economic costs for national healthcare systems. Throughout the last decades, several risk factors for this condition have been identified, but only recently, have the roles of inflammation and endothelial dysfunction been properly assessed. Although still incompletely understood, current knowledge of the pathophysiological mechanisms of CVD reveals several potential targets and strategies for therapeutic intervention, some of which are addressable by currently available venoactive drugs. The roles of these drugs in the clinical improvement of venous tone and contractility, reduction of edema and inflammation, as well as in improved microcirculation and venous ulcer healing have been studied extensively, with favorable results reported in the literature. Here, we aim to review these pathophysiological mechanisms and their implications regarding currently available venoactive drug therapies.
- Percutaneous Endovascular Aortic Repair with Local Anesthesia - One Day SurgeryPublication . Sousa, J; Brandão, D; Barreto, P; Ferreira, J; Almeida Lopes, J; Mansilha, ATo evaluate the results of the abdominal aortic aneurism endovascular treatment (EVAR), percutaneously and with local anesthesia, according to the concept of one day surgery. MATERIAL AND METHODS: Unicentric, retrospective analysis of patients with aorto-iliac aneurysmal disease, consecutively treated by EVAR with percutaneous access trough the Preclose technique (pEVAR), according to the outpatient criteria, with one overnight stay in the hospital. The technical success, exclusion of the aneurysmal sac, endoleak, re-intervention and mortality were evaluated. RESULTS: Twenty consecutive patients (all male; mean age 74.65 years) were treated by EVAR with percutaneous access and local anesthesia, from which 95% (19) presented with abdominal aortic aneurysm and 5% (1) common iliac aneurysm. All implants were sucessfully performed, with an initial endoleak rate of 10% (2), determined by one type 1a endoleak successfully corrected intra-operatively and one type 2a endoleak diagnosed in the first imaging control, which sealed spontaneously on the second control. Initial technical success for percutaneous closure was 97.5%, with one case reported of femoral pseudo-aneurism, posteriorly treated by percutaneous thrombin injection. Median length of stay was one day [1-10], with a mean follow-up of 11.4 months [1-36]. Both the re-intervention and mortality rate are 0% for the selected period. CONCLUSION: Our one day surgery model for the outpatient treatment of abdominal aortic aneurysm by the pEVAR technique is innovative, safe and effective, as long as the selection criteria are respected.
- Trauma Associado às Touradas à Corda nos Açores: Um Estudo TransversalPublication . Vieira, B; Taranu, V; Vieira, A; Soares, D; Soares, A; Silva, A; Galvão, D; Bagnari, I; Melo, D; Pimentel, F; Sousa, J; Martins, L; Pinheiro, L; Vargas, M; Reis, Ó; Valente, S; Bettencourt, R; Oliveira, T; Mora, AIntroduction: The aim of the study was to describe trauma injuries associated with rope bullfights in the Azores, Portugal, regarding the cause of the incident, trauma mechanism, most affected anatomical areas, and injury severity. Methods: Two-year cross-sectional study in the local hospital with prospective data collection. Patients who were consecutively admitted to the local hospital’s emergency department with trauma injuries from the bull’s direct impact or from falls either during the bull’s escape or when handling the rope, were included. Data on general demographics, lesion characteristics, treatments, need for hospitalization and mortality were collected. Results: Fifty-six incidents and 80 trauma injuries were identified. The main cause of trauma was the bull’s direct impact (37; 66.07%) and the mechanism of injury was blunt trauma in all patients (100%; 56). Head and neck injuries (27; 33.75%) were the most common. The median Injury Severity Score at the emergency department admission was 4. Major trauma was noted in five patients (8.92%). Ten patients (17.85%) needed hospitalization with a median hospital stay of seven days. Three of the 10 hospitalized patients (30%) were previously admitted to the intensive care unit. Surgery was performed in six patients (10.71%). Conclusion: The main cause of trauma was the bull’s direct impact, and the mechanism of injury was blunt trauma. The most affected anatomical areas were the head and neck. These findings are a wake-up call to the impact of these events regarding the economic costs they entail, the costs for the health of the local population, the safety measures currently implemented and the availability of the necessary means to treat these patients.
- Velocidade da Onda de Pulso e Estratificação do Risco CardiovascularPublication . Mendonca, MI; Palma dos Reis, R; Sousa, AC; Gomes, S; Faria, P; Pereira, A; Silva, B; Serrão, M; Santos, N; Sousa, FS; Silva, JA; Sousa, J; Ornelas, I; Freitas, S; Cardoso, Almada; Araújo, JJIntrodução: A compliance arterial ou distensibilidade é uma determinante fundamental nas doenças cardiovasculares, apresentando grande interesse a sua medição não invasiva. A velocidade da onda de pulso (VOP) é usada, actualmente, como um índice de distensibilidade arterial. Objectivos: Avaliar se a VOP constitui um factor de risco, independente, para doença das artérias coronárias (DAC). Investigar se a determinação da mesma pode constituir uma ferramenta útil, na estratificação do risco cardiovascular, tanto nos indivíduos assintomáticos, como nos doentes com DAC População e Métodos: 811 indivíduos, 301 consecutivos com DAC, confirmada por coronário-angiografia, média de idade 53,7±10,0 anos e 510 assintomáticos, seleccionados das listas eleitorais, média de idade 46,1±10,0 anos. Os indivíduos assíntomáticos formavam o grupo A e eram subdivididos em A1 (grupo sem HTA, dislipidémia e ou diabetes) e A2 (grupo com HTA, dislipidémia, e ou diabetes). Os doentes coronários constituiam o grupo B, também sub dividido em B1 sem HTA, dislipidémia e ou diabetes e B2 com HTA, dislipidemia e ou diabetes. Os dados foram expressos em média ± desvio padrão (DP). O teste t de Student foi usado para comparar as variáveis contínuas e o c2 para comparar as variáveis categóricas. A força da correlação independente entre as variáveis contínuas foi avaliada segundo Pearson. Finalmente, foi efectuado um modelo de regressão logística (step by step) para avaliar quais as variáveis que se relacionavam de forma significativa e independente com a DAC. A análise estatística foi efectuada através do software SPSS for Windows, sendo o valor de p <0,05 considerado significativo. Resultados: Comparando os dois grupos, A1 e A2, no primeiro, a média da VOP foi significantemente mais baixa em relação ao A2. Comparando o grupo B1 e B2, também no grupo B1 a média da VOP é mais baixa. No grupo A1 a VOP correlacionou-se, segundo Pearson, com a idade, pressão arterial sistólica (PAS), diastólica e média, IMC, glicémia, colesterol total, LDL, relação CT/HDL, ApoB, triglicerídeos, ingestão de álcool, relação cintura/anca (C/A), e proteína C reactiva(as). A correlação foi inversa com o colesterol HDL. No grupo A2 a correlação da VOP foi positiva com a idade, PAS, PAM, PAD, glicémia, CT/ HDL e pressão do pulso (PP). No grupo B1 a correlação foi positiva e significante com a idade, PAS, PAM, PAD e PP. Foi inversa com a fracção de ejecção do VE. No grupo B2, foi positiva e significante com a idade, PAS, PAM, relação C/A, PP e homocisteína. Conclusão: A VOP foi sempre, quer nos indivíduos assintomáticos quer nos doentes coronários, mais elevada nos grupos com maior número de factores de risco. Esta constatação sugere influência cumulativa dos factores de risco, no processo de rigidez arterial. Correlacionou-se de forma positiva e significativa, com alguns dos factores de risco clássicos e alguns dos novos marcadores bioquímicos de risco. Após análise de regressão logística, manteve-se na equação de forma significativa, mostrando ser um factor de risco independente para DAC. Assim, a avaliação da distensibilidade arterial, através da medição da VOP, poderá representar um método simples, rápido e não invasivo, capaz de estratificar o risco de DAC, tanto nos indivíduos assintomáticos com nos doentes coronários.