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- 231 laparoscopic cholecystectomy in ambulatory: what results?Publication . Goulart, A; Delgado, M; Antunes, MC; Braga dos Anjos, Jntroduction: Laparoscopic cholecystectomy is the gold standard procedure for the treatment of lithiasic gallblader pathology and acute cholecystitis. Whether or not it should be done as ambulatory surgery is still being discussed. The present study aims to analyze the quality and safety of laparoscopic cholecystectomy conducted by the Ambulatory Unit of Hospital de Braga and compare the results with those from other European surgical centers performing LC as ambulatory surgery. Material and Methods: Observational prospective study of patients submitted to laparoscopic cholecystectomy in ambulatory surgery during a period of 26 months. Data regarding patients' demography, peri- and postoperative complications, surgical time, time in recovery room, and readmission rates was collected. Results: A total of 231 patients were subjected to Laparoscopic cholecystectomy in the ambulatory unit with overnight stay (time to discharge less than 24 hours). Three patients presented with intra-operative complications, which needed conversion to laparotomy, and four patients were admitted after surgery. The mean time for the procedure was 58 minutes and the mean time for recovery was 19h19 minutes. Postoperative morbidity was 7.8% with 2 nonscheduled admission having occurred. Discussion: One of the controversies regarding laparoscopic cholecystectomy as an outpatient procedure is the need for overnight hospital surveillance. In our unit, we have started LC on an outpatient basis with an overnight stay. Using this protocol, over the past two years, we have operated 231 patients and our results show that this is a completely safe technique. Conclusions: Data from the study suggests that LC is a safe technique when performed in ambulatory practice, having similar results to other european surgical centers.
- Avaliação do risco cirúrgico nos doentes com cancro colo-rectal: POSSUM ou ACPGBIPublication . Goulart, A; Martins, SIntroduction: Several models have been developed with the purpose of predicting surgical risk of patients submitted to colorectal cancer surgery. However, to date, there isn’t any model that fulfills this purpose in a satisfactory manner. Methods: We consulted the clinical processes of 345 patients, who were submitted to surgical colorectal cancer treatment at the General Surgery department in Hospital de Braga, and calculated surgical risk based on the following risk assessment scales: Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (POSSUM), Portsmouth POSSUM (P-POSSUM), ColoRectal POSSUM (CR-POSSUM), Association of Coloproctology of Great Britain and Ireland (ACPGBI) and modified ACPGBI. For all scales, we compared observed and previewed mortality and calculated Receiver Operating Characteristic (ROC) curve. Results and conclusion:The study included 345 patients submitted to colorectal cancer surgery of which 219 were male and 126 were female, with an average age of 68 years old. Most patients (69,0%) presented with colon cancer and 86,4% were submitted to elective surgery. Post-operatory mortality at 30 days was 3,768%. In the present study, despite no model being statistically better than the other, the ACPGBI model was the one that showed more discriminative properties which, along with easier applicability, makes it the best model for evaluating surgical risk in our population.
- Prevalência do Síndrome de Frey após ParotidectomiaPublication . Goulart, A; Soares, V; Koch, PIntroduction: Frey’s syndrome is characterized by facial sweating, flushing and heat sensation in the parotid area. Its prevalence is highly variable. Methods: The present study included 33 selected patients, submitted to superficial parotidectomy. To the included patients, a clinical interview was conducted and Minor’s test, for objective evaluation of Frey’s syndrome, was applied. The degree of Frey’s syndrome severity was determined according to Luna Ortiz’s model and by using a 0-10 numeric scale. Results: Of the 33 initially selected patients, only 27 (81,8%) showed up for assessment at Hospital de Braga. Of the seven patients who referred sweating, only one classified it as “excessive”, giving it grade 6 on a “0-10” scale, while all of the others classified it as “1”, “2” or “3”. Minor’s test was positive in seven patients, one of which didn’t have any clinical complaints. According to Luna-Ortiz’s surgical severity model, three patients (42, 9%) were assessed as having moderate Frey’s syndrome and four patients (57,1%) had severe disease. Conclusion: The incidence of this condition, as determined by Minor’s test, is 26,9%, similarly to what is found in other studies.
- What is in? Pneumoperitoneum after sexual intercoursePublication . Botelho, P; Carvalho, AF; Torrão, H; Leão, P
- Hernioplasty in One-Day Surgery: result of 228 self-adhesive prosthesisPublication . Goulart, A; Delgado, M; Antunes, MC; Braga dos Anjos, JAim: To evaluate the outcomes of inguinal hernia repair with ProGrip® mesh in same-day surgery Methods: Follow-up data was collected at 24 hours and 30 days after surgery. Results: In one year, 228 patients underwent surgical repair of unilateral inguinal hernia. At 24 hours after surgery, 50.64% of patients reported some degree of pain and 66.3% were able to move around the house with few limitations. Thirty days after surgery, 94.39% of patients had returned to their routine activities. Conclusions: The use of the ProGrip® mesh is associated with low post-operative pain and rapid recovery.
- Role of endoglin and VEGF family expression in colorectal cancer prognosis and anti-angiogenic therapiesPublication . Martins, SF; Reis, RM; Mesquita-Rodrigues, A; Baltazar, F; Filho, ALColorectal cancer (CRC) is one of the cancer models and most of the carcinogenic steps are presently well understood. Therefore, successful preventive measures are currently used in medical practice. However, CRC is still an important public health problem as it is the third most common cancer and the fourth most frequent cause of cancer death worldwide. Nowadays, pathologic stage is a unique and well-recognized prognostic indicator, however, more accurate indicators of the biologic behavior of CRC are expected to improve the specificity of medical treatment. Angiogenesis plays an important role in the growth and progression of cancer but its role as a prognostic factor is still controversial. Probably the most important clinical implication of tumor angiogenesis is the development of anti-angiogenic therapy. The goal of this review is to critically evaluate the role of angiogenic markers, assessed by either endoglin-related microvessel density or expression of vascular endothelial growth factor family members in the CRC setting and discuss the role of these angiogenic markers in anti-angiogenic therapies.
- Tumores do estroma gastrointestinal (GIST): casuística do Departamento de CirurgiaPublication . Martins, S; Lamelas, J; Pinheiro, A; Mesquita-Rodrigues, AOs tumores do estroma gastrointestinal (GIST) constituem as neoplasias de origem mesenquimatosa mais frequentes do tubo digestivo. Só recentemente foi considerada uma entidade bem definida. Os autores realizaram um estudo retrospectivo com base nos processos clínicos com o diagnóstico de tumor do estroma gastrointestinal, diagnosticados no período de 2000-2004. (Introdução) Os tumores do estroma gastrointestinal (GIST) constituem as neoplasias de origem mesenquimatosa mais frequentes do tubo digestivo. Historicamente houve controvérsia em termos de nomenclatura, histogénese, diagnóstico e prognóstico. Só recentemente foi considerado uma entidade bem definida. Anteriormente eram classificados de forma variável e mais frequentemente considerados leiomiossarcomas. Actualmente considera-se que se originam a partir das células 'pacemaker' intestinais, células intersticiais de Cajal, uma vez que possuem características ultra-estruturais semelhantes, e ambos expressam o receptor KIT. A idade média de diagnóstico é de 58 anos (40-80 anos) sendo ligeiramente mais preponderante no sexo masculino. Em termos de localização, o estômago é o local mais frequente (cerca de 65% dos casos), seguido do intestino delgado (25%), do cólon e recto (5%) e do esófago (<5%). Raramente podem originar-se fora do trato GI: mesentério, epíplon e retroperitoneu. Também há casos relatados na bexiga e vesícula biliar. Clinicamente podem manifestar-se com sintomas gerais, dor ou desconforto abdominal, hemoperitoneu ou hemorragia gastrointestinal, ou constituírem achados durante o exame objectivo ou imagiológico. Para o diagnóstico é preciso ter um alto índice de suspeita. Em termos histológicos são considerados 2 grupos: mais frequentemente (70% dos casos) contém células fusiformes, e um outro grupo (cerca de 30% dos casos) contém células epitelóides, só raramente estando presentes os 2 tipos celulares. Esta divisão não tem qualquer relevância prognóstica, embora o limiar mitótico de malignidade seja menor nos epitelóides. Em termos imuno-histoquimicos, tipicamente demonstram uma captação intensa e difusa para a proteína KIT, mas outras neoplasias também a podem exprimir, embora com expressão focal e fraca, como p. ex. o melanoma, o angiosarcoma, o sarcoma de Ewing, o mastocitoma e o seminoma. Outros marcadores estão presentes em percentagens variáveis: o CD34 está presente em 70% dos casos, a actina em 20% dos casos, o S100 em 10% dos casos e a desmina em menos de 5% dos casos. O diagnóstico patológico baseia-se na presença de morfologia típica e imuno-reactividade para KIT. O consenso actual é que o diagnóstico de GIST assenta nos aspectos morfológicos típicos e KIT (raramente um tumor é considerado GIST sem imuno-reactividade para KIT). Relativamente ao prognóstico consideram-se 3 grupos consoante o tamanho e o índice mitótico tumoral (...). O tratamento padrão de doentes com GIST primário sem metástases é a ressecção cirúrgica. Mesmo depois da recessão completa do GIST primário, a maior parte dos doentes têm recorrência e eventualmente morrem da doença. O tempo médio de recorrência é de 2 anos, sendo os locais mais frequentes o fígado, peritoneu ou ambos. A sobrevida média aos 5 anos é de 50%. (Conclusões) Num período de 4 anos, 2000-2004, foram diagnosticados no Hospital de S. Marcos 18 casos de GIST. Verificou-se que foi mais frequente no sexo feminino, com uma idade média de diagnóstico de 55 anos no sexo feminino e de 67 anos no sexo masculino. A localização mais frequente foi no estômago e cerca de metade dos casos diagnosticados foram agrupados segundo o tamanho tumoral e o índice mitótico em 'GIST maligno'. Todos os doentes foram submetidos a terapêutica cirúrgica e nenhum realizou terapêutica adjuvante, encontrando-se à data sem recidiva tumoral.
- Operação de Hartmann: casuística do Departamento de CirurgiaPublication . Martins, S; Carneiro, T; Toscano, A; Soares, V; Kock, P; Mesquita-Rodrigues, Aoperação de Hartmann tem como vantagem a segurança do procedimento cirúrgico, e como principal desvantagem a necessidade de uma 2ª. intervenção cirúrgica para conclusão do tratamento. Os autores realizaram um estudo retrospectivo dos doentes submetidos a operação de Hartmann num período de 7 anos (1997-2003). (Introdução) A operação de Hartmann foi inicialmente descrita em 1921 para o tratamento de doentes com carcinoma do recto. Hoje em dia é principalmente utilizada sempre que está contra-indicada uma reconstrução num só tempo. Consiste na ressecção do segmento envolvido pela patologia, com encerramento do topo distal e construção de uma colostomia proximal terminal. Apresenta como principais vantagens a segurança do procedimento, isto é o facto de permitir remover a fonte do problema ao mesmo tempo que elimina o risco de uma anastomose sob condições desfavoráveis. A principal desvantagem resulta de necessitar de um 2º. tempo cirúrgico 'major', geralmente 6 ou mais semanas depois da 1ª. intervenção, que poderá ser dificultado pelo facto de o coto distal ser difícil de identificar e estar retraído, e ainda de ser preciso realizar a desmontagem da colostomia. No entanto alguns doentes ficam privados da 2ª. cirurgia, e a operação de Hartmann dá origem a um estoma definitivo. (Conclusões) As principais indicações para a operação de Hartmann, no Departamento de Cirurgia do Hospital de S. Marcos, foram o adenocarcinoma do cólon e a diverticulite complicada. Esta cirurgia foi realizada principalmente em doentes idosos. No entanto é relativamente segura, tendo-se verificado uma baixa morbilidade, e a mortalidade apresentada resultou da história natural da doença e não da intervenção cirúrgica. Só cerca de 50% dos doentes foram submetidos a reconstituição do trânsito, sendo este um procedimento cirúrgico seguro.
- Clinicopathological correlation and prognostic significance of VEGF-A, VEGF-C, VEGFR-2 and VEGFR-3 expression in colorectal cancer.Publication . Martins, SF; Garcia, EA; Luz, MA; Pardal, F; Mesquita-Rodrigues, A; Filho, ALBACKGROUND: Colorectal cancer (CRC) is the third most common type of cancer and the fourth most frequent cause of cancer death. Literature indicates that vascular endothelial growth factor is a predominant angiogenic factor and that angiogenesis plays an important role in the progression of CRC. PATIENTS AND METHODS: The present series consisted of tissue samples obtained from 672 patients who had undergone large bowel resection between 2005 and 2010 at the Braga Hospital, Portugal. Archival paraffin-embedded CRC tissue and normal adjacent samples were used to build up tissue microarray blocks and VEGF-A, VEGF-C, VEGFR-2 and VEGFR-3 expression was immunohistochemically assessed. RESULTS: We observed an overexpression of VEGF-C in CRC when tumour cells and normal-adjacent tissue were compared (p=0.004). In tumour samples, VEGF-C-positive cases were associated with VEGFR-3 expression (p=0.047). When assessing the correlation between VEGF-A, VEGF-C, VEGFR-2 and VEGFR-3 expressions and the clinicopathological data, it was revealed that VEGF-A positive cases were associated with male gender (p=0.016) and well-differentiated tumours (p=0.001); VEGF-C with colon cancers (p=0.037), exophytic (p=0.048), moderately-differentiated (p=0.007) and T3/T4 (p=0.010) tumours; VEGFR-2 with invasive adenocarcinoma (p=0.007) and VEGFR-3 with the presence of hepatic metastasis (p=0.032). Overall survival curves for CRC were statistically significant for rectal cancer, VEGF-C expression and stage III (p=0.019) and VEGFR-3 expression and stage IV (p=0.047). CONCLUSION: Quantification of VEGF-A, VEGF-C, VEGFR-2 and VEGFR-3 expression seems to provide valuable prognostic information in CRC and the correlation with clinicopathological data revealed an association with characteristics that contribute to progression, invasion and metastasis leading to poorer survival rates and prognosis.
- Grupo de Biópsia Aspirativa com Agulha Fina: análise dos primeiros 500 casosPublication . Ribas, S; Soares, V; Koch, PO Grupo de Biópsia Aspirativa com Agulha Fina está integrado na Unidade de Cabeça e Pescoço que pertence ao Departamento de Cirurgia do Hospital de S. Marcos. Este grupo foi constituído e iniciou a sua actividade em 2005 e é responsável pela realização de biópsias aspirativas de agulha fina, directas e ecoguiadas, de nódulos localizados na cabeça e pescoço. Este trabalho pretende analisar os primeiros 500 casos de biópsias aspirativas com agulha fina da glândula tiróide. The Group of Fine-needle Aspiration Biopsy is a part of the Unit for Head and Neck which belongs to the Department of Surgery of the Hospital of S. Marcos. This group was formed and started his activity in 2005 and is responsible for carrying out fine needle aspiration biopsies, direct and ultrasound-guided, of nodules found in the head and neck. This paper aims to examine the first 500 cases of fine-needle aspiration biopsies of the thyroid gland.