287 resultados para HCC PAT CLIN
Resumo:
OBJECTIVE: Recognizing the potential impact of psychiatric and psychosocial factors on liver transplant patient outcomes is essential to apply special follow-up for more vulnerable patients. The aim of this article was to investigate the psychiatric and psychosocial factors predicted medical outcomes of liver transplanted patients. METHODS: We studied 150 consecutive transplant candidates, attending our outpatient transplantation clinic, including 84 who had been grafted 11 of whom died and 3 retransplanted. RESULTS: We observed that active coping was an important predictor of length of stay after liver transplantation. Neuroticism and social support were important predictors of mortality after liver transplantation. CONCLUSION: It may be useful to identify patients with low scores for active coping and for social support and high scores for neuroticism to design special modes of follow-up to improve their medical outcomes.
Resumo:
OBJECTIVES: We sought to investigate the improvement in quality of life (mental and physical components) at 1 and 6 months after liver transplantation. METHODS: A sample of liver transplant candidates (n = 60), comprising consecutive patients attending outpatient clinics of a liver transplantation central unit (25% of the patients had familial amyloid polyneuropathy [FAP] and the remaining patents had chronic liver diseases), was assessed by means of the Short Form (SF)-36, Portuguese-validated version, a self-rating questionnaire developed by the Medical Outcome Trust, to investigate certain primary aspects of quality of life, at 3 times: before, and at 1 and 6 months after transplantation. RESULTS: We observed a significant improvement in quality of life (both mental and physical components) by 1 month after transplantation. Between the first month and the sixth month after transplantation, there also was an improvement in the quality of life (both mental and physical components), although only the physical components of quality of life was significantly improved. CONCLUSIONS: Our findings suggested that quality of life improved early after liver transplantation (1 month). Between the first and the sixth months, there only was a significant improvement in the physical quality of life.
Resumo:
Descreve-se um caso de uma doente de 52 anos de idade, submetida a colecistectomia com o diagnstico de litiase biliar, baseado na colecistografia oral. No decurso do acto cirrgico, em que no se palparam clculos, o diagnstico inicial foi posto em dvida. A identificao da polipose mltipla s foi possvel aps colecistectomia. Com base na experincia colhida neste caso, faz-se uma reviso dos critrios diagnsticos e fundamenta-se a orientao teraputica, dado o potencial de malignidade destas leses.
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Para encarar a deteco crescente de distrbios do equilbrio cido-base e hidro-electroltico nos nossos servios hospitalares, descrevemos e exemplificamos um programa informtico auxiliar no diagnstico e teraputica destes distrbios. Partindo dos resultados dum ionograma e dos gases no sangue so apontados os sndromas presentes, e na sequncia de um curto dilogo mquina/utilizador os diagnsticos etiolgicos mais provveis. 0 programa prope tambm uma teraputica concreta para esse doente e fornece referncias bibliogrficas. So discutidas criticamente as possveis aplicaes deste trabalho na clnica e no ensino mdico.
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Os AA estudaram retrospectivamente os processos clnicos de 370 doentes com carcinoma da prstata, com o intuito de dar uma ideia da problemtica desta doena em Portugal. Ressalvando o facto de a anlise incidir sobre casos tratados por vrios urologistas e no haver assim uniformidade nos critrios, so apresentadas sucessivamente as manifestaes clnicas, mtodos de diagnstico presumvel e definitivo e a teraputica instituda. Apontam ainda a mortalidade, no pas, nos ltimos anos, por carcinoma da prstata e por tumores malignos em geral e apresentam uma tabela em que aquela comparada com a de outros pases.
Resumo:
A Hematria monossintomtica idioptica definida como a expresso clnica de uma doena glomerular que se reveste de uma grande variedade de alteraes estruturais. So revistos os critrios de diagnstico, os mecanismos patognicos envolvidos, assim como os padres histolgicos encontrados. Ressalta-se a baixa agressividade da doena que poder resultar de caractersticas prprias do sistema imunitrio e acentua-se a dvida quanto sua benignidade sob o ponto de vista do prognstico. A Bipsia Renal no est sistematicamente indicada devendo ser reservada para os casos cujos critrios selectivos so definidos. Em concluso, sugere-se uma atitude de prudente expectativa no follow-up da doena, quer esperando o aparecimento de novos sinais que incriminem uma etiologia, quer observando a evoluo da funo renal e a sua eventual deteriorao que exijam uma reavaliao da estratgia teraputica.
Resumo:
Introduo: Em 2011, foi introduzido um novo rastreio para a diabetes gestacional que permitiu um diagnstico mais precoce e de maior nmero de casos com o intuito de reduzir complicaes maternas e perinatais. O objectivo deste estudo foi avaliar a prevalncia da diabetes gestacional, comparar resultados obsttricos e perinatais do anterior e presente rastreio e os resultados e realizao da prova de reclassificao ps-parto. Material e Mtodos: Estudo retrospectivo em gestaes simples e diabetes gestacional diagnosticados em 2009 (n = 223) e 2012 (n = 237), vigiadas na Maternidade Dr. Alfredo da Costa, Portugal. Aps consulta de processos clnicos procedeu-se anlise de caractersticas demogrficas, histria mdica e obsttrica, aumento ponderal durante a gravidez, idade gestacional do diagnstico, teraputica utilizada, resultados perinatais e reclassificao ps-parto, seguida de comparao destas variveis entre os anos de 2009 e 2012. Resultados: Em 2012, houve maior prevalncia de diabetes gestacional, ganho ponderal inferior (p < 0,001), maior recurso teraputica farmacolgica (p < 0,001) e aumento dos casos diagnosticados no primeiro e segundo trimestres (p < 0,001). Relativamente aos resultados neonatais, o peso mdio do recm-nascido ao nascer foi significativamente menor (p = 0,001) com diminuio dos recm-nascidos grandes para a idade gestacional (p = 0,002). A taxa de reclassificao ps-parto foi semelhante nos dois anos mas em 2012 houve um aumento dos resultados normais e diminuio das anomalias da glicmia em jejum. Discusso: Critrios mais apertados do actual rastreio permitiram a reduo da maioria das complicaes da diabetes gestacional levantando novas questes. Concluso: A introduo do actual rastreio resultou num aumento de prevalncia, diagnstico mais precoce e reduo da macrossomia.
Resumo:
OBJECTIVES: We sought to investigate the psychosocial determinants of quality of life at 6 months after transplantation. METHODS: A sample of liver transplant candidates (n = 60), composed of consecutive patients (25% with familial amyloid polyneuropathy [FAP]) attending outpatient clinics was assessed in the pretransplant period using the Neo Five Factor Inventory, Hospital Anxiety and depression Scale (HADS), Brief COPE, and SF-36, a quality-of-life, self-rating questionnaire. Six months after transplantation, these patients were assessed by means of the SF-36. RESULTS: Psychosocial predictors where found by means of multiple regression analysis. The physical component of quality of life at 6 months after transplantation was determined based upon coping strategies and physical quality of life in the pretransplant period (this model explained 32% of variance). The mental component at 6 months after transplantation was determined by depression in the pretransplant period and by clinical diagnoses of patients. Because FAP patients show a lower mental component of quality of life, this diagnosis explained 25% of the variance. CONCLUSIONS: Our findings suggested that coping strategies and depression measured in the pretransplant period are important determinants of quality of life at 6 months after liver transplantation.
Resumo:
Bone histomorphometry is defined as a quantitative evaluation of bone micro architecture, remodelling and metabolism. Bone metabolic assessment is based on a dynamic process, which provides data on bone matrix formation rate by incorporating a tetracycline compound. In the static evaluation, samples are stained and a semi-automatic technique is applied in order to obtain bone microarchitectural parameters such as trabecular area, perimeter and width. These parameters are in 2D, but they can be extrapolated into 3D, applying a stereological formula. Histomorphometry can be applied to different areas; however, in recent decades it has been a relevant tool in monitoring the effect of drug administration in bone. The main challenge for the future will be the development of noninvasive methods that can give similar information. In the herein review paper we will discuss the general principles and main applications of bone histomorphometry.
Resumo:
The decrease in the number of cadaveric donors has proved a limiting factor in the number of liver transplants, leading to the death of many patients on the waiting list. The living donor liver transplantation is an option that allows, in selected cases, increase the number of donors. One of the most serious complications in liver transplantation is hepatic artery thrombosis, in the past considered potentially fatal without urgent re-transplantation. A white male patient, 48 years old, diagnosed with hepatocellular carcinoma in chronic liver failure caused by hepatitis B virus, underwent living donor liver transplantation (right lobe). Doppler echocardiography performed in the immediate postoperative period did not identify arterial flow in the right branch, having been confirmed thrombosis of the right hepatic artery in CT angiography. Urgent re-laparotomy was performed, which consisted of thrombectomy and re-anastomosis of the hepatic artery with segmental splenic artery allograft interposition. The patient started anticoagulation and antiplatelet therapy with acetylsalicylic acid. Serial evaluation with Doppler echocardiography showed hepatic artery patency. At present, the patient is asymptomatic. One of the most devastating complications in liver transplantation, and particularly in living liver donor, is thrombosis of the hepatic artery; thus, early diagnosis and treatment is vital. The rapid intervention for revascularization of the graft avoids irreversible ischemia of the bile ducts and hepatic parenchyma, thus avoiding the need for re-transplantation.
Resumo:
A dermatoscopia constitui uma tcnica de diagnstico no-invasiva, in vivo, que permite complementar a observao clnica de leses cutneas no-pigmentadas de etiologia diversa. Nos tumores cutneos no-pigmentados, a dermatoscopia facilita a observao de estruturas vasculares, aumentando a acuidade no seu diagnstico, distinguindo tumores melanocticos e no-melanocticos, benignos e malignos. Na parte I deste artigo so discutidos os princpios bsicos da avaliao dermatoscpica dos tumores cutneos no-pigmentados, incluindo a morfologia vascular e os padres de distribuio dos vasos, assim como de outras pistas adicionais.
Resumo:
A dermatoscopia constitui uma tcnica de diagnstico no-invasiva, in vivo, que permite complementar a observao clnica de leses cutneas no-pigmentadas de etiologia diversa. Nos tumores cutneos no-pigmentados, a dermatoscopia facilita a observao de estruturas vasculares, aumentando a acuidade no seu diagnstico, distinguindo tumores melanocticos e no-melanocticos, benignos e malignos. Na parte II descreve-se a variabilidade da aplicao clnica da dermatoscopia em leses cutneas no-pigmentadas tumorais.
Resumo:
Introduo: A doena de Hansen pode resultar em incapacidade funcional pelo compromisso do sistema nervoso perifrico. A preveno de incapacidade constitui o objectivo dos actuais programas de tratamento, nomeadamente da teraputica tripla da Organizao Mundial de Sade. Objectivos: Caracterizar e comparar dois grupos de doentes de Hansen, tratados antes (antigos) e depois (recentes) da introduo da teraputica tripla da Organizao Mundial de Sade, analisando o benefcio desta na reduo de incapacidade. Identificar as caractersticas dos doentes mais favorecidos nesta potencial reduo e, nos doentes recentes, determinar se o prolongamento da durao da teraputica beneficia a reduo de incapacidade. Material e Mtodos: Estudo retrospectivo e comparativo de 243 doentes, distribudos em dois grupos, 164 antigos e 79 recentes, caracterizados quanto ao sexo, idade data do diagnstico, intervalo entre incio de sintomas e diagnstico, forma clnica (Ridley e Jopling), ocorrncia de reaco, ndice bacteriolgico (IB) inicial, presena de sintomas neurolgicos iniciais, durao da teraputica anti-leprtica e presena e grau de incapacidade. Resultados: A comparao da presena de incapacidade nos dois grupos mostrou que esta mais elevada nos doentes antigos, sendo significativamente superior no sexo masculino, forma lepromatosa borderline, ocorrncia de reaco, IB inicial positivo e com sintomas neurolgicos iniciais. A incapacidade grau 2 tambm significativamente superior nos doentes antigos . Nos doentes recentes no se verificou relao entre a durao da teraputica da Organizao Mundial de Sade e a presena de incapacidade. Concluso: A preveno e reduo de incapacidade na doena de Hansen possvel atravs de um diagnstico precoce e tratamento adequado com a teraputica tripla da Organizao Mundial de Sade.
Resumo:
A 57-year-old male presented with a 6-month history of blisters and painful erosions on the right buccal mucosa. No skin or other mucosal involvement was seen. The findings of histopathological and direct immunofluorescence examinations were sufficient for the diagnosis of oral mucous membrane pemphigoid in the context of adequate clinical correlation. No response was seen after topical therapies and oral corticosteroids or dapsone. Intravenous immunoglobulin was started and repeated every three weeks. Complete remission was achieved after three cycles and no recurrence was seen after two years of follow-up. The authors report a rare unilateral presentation of oral mucous membrane pemphigoid on the right buccal and hard palate mucosa, without additional involvement during a period of five years. Local trauma or autoimmune factors are possible etiologic factors for this rare disorder, here with unique presentation.
