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Search Results: 1 - 10 of 3762 matches for " Manuela; Rom?ozinho "
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Gastric suture line ulcer: An unexpected cause of gastrointestinal bleeding
Ferreira,Rosa; Amaro,Pedro; Ferreira,Manuela; Romozinho,José Manuel;
Jornal Português de Gastrenterologia , 2012,
Abstract: gastrointestinal bleeding due to suture line ulceration has been attributed to use of non?absorbable silk sutures. we report a case of a 63?year?old male with gastrointestinal bleeding due to gastric suture line ulceration after splenectomy performed 11 years ago. emergent upper endoscopy revealed a small gastric ulcer with a visible vessel and raised the suspicion of gastric varices. an endoscopic ultrasound was performed, showing a gastric hyperechogenic area in the mucosa layer with an acoustic shadow. upper endoscopy with a transparent cap was repeated and a mobile foreign body in the ulcer′s bed was found. it was successfully removed by forceps. after the procedure a silk suture line of 3.5 cm was identified
Prognostic scores in cirrhotic patients admitted to a gastroenterology intensive care unit Marcaciones pronósticas en pacientes con cirrosis admitidos en una unidad de cuidados intensivos gastroenterológicos
Paulo Freire,José M. Romozinho,Pedro Amaro,Manuela Ferreira
Revista Espa?ola de Enfermedades Digestivas , 2011,
Abstract: Background: prognostic scores have been validated in cirrhotic patients admitted to general Intensive Care Units. No assessment of these scores was performed in cirrhotics admitted to specialized Gastroenterology Intensive Care Units (GICUs). Aim: to assess the prognostic accuracy of Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) II, Sequential Organ Failure Assessment (SOFA), Model for End-stage Liver Disease (MELD) and Child-Pugh-Turcotte (CPT) in predicting GICU mortality in cirrhotic patients. Methods: the study involved 124 consecutive cirrhotic admissions to a GICU. Clinical data, prognostic scores and mortality were recorded. Discrimination was evaluated with area under receiver operating characteristic curves (AUC). Calibration was assessed with Hosmer-Lemeshow goodness-of-fit test. Results: GICU mortality was 9.7%. Mean APACHE II, SAPS II, SOFA, MELD and CPT scores for survivors (13.6, 25.4, 3.5, 18.0 and 8.6, respectively) were found to be significantly lower than those of non-survivors (22.0, 47.5, 10.1, 30.7 and 12.5, respectively) (p < 0.001). All the prognostic systems showed good discrimination, with AUC = 0.860, 0.911, 0.868, 0.897 and 0.914 for APACHE II, SAPS II, SOFA, MELD and CPT, respectively. Similarly, APACHE II, SAPS II, SOFA, MELD and CPT scores achieved good calibration, with p = 0.146, 0.120, 0.686, 0.267 and 0.120, respectively. The overall correctness of prediction was 81.9%, 86.1%, 93.3%, 90.7% and 87.7% for the APACHE II, SAPS II, SOFA, MELD and CPT scores, respectively. Conclusions: in cirrhotics admitted to a GICU, all the tested scores have good prognostic accuracy, with SOFA and MELD showing the greatest overall correctness of prediction.
O Doente Cirrótico na Unidade de Cuidados Intensivos: Avalia o do Prognóstico The Cirrhotic Patient in the Intensive Care Unit: Evaluation of the Prognosis
Paulo Freire,José Manuel Romozinho,Manuela Ferreira,Pedro Amaro
Jornal Português de Gastrenterologia , 2011,
Abstract: INTRODU O: Os doentes com cirrose hepática admitidos em Unidades de Cuidados Intensivos (UCI) têm um prognóstico particularmente reservado. O prognóstico destes doentes pode ser avaliado com scores gerais (SOFA, APACHE, SAPS) ou com scores específicos de cirrose hepática (MELD, Child-Pugh). OBJECTIVOS: Avaliar o valor prognóstico dos scores gerais (SOFA, APACHE e SAPS) e dos scores específicos de cirrose hepática (MELD e Child-Pugh) em doentes com cirrose hepática admitidos em UCI polivalentes ou em Unidades de Cuidados Intensivos de Gastrenterologia (UCIGE). MATERIAL E MéTODOS: Os autores fazem uma revis o da literatura sobre a avalia o do prognóstico de doentes com cirrose hepática admitidos em ICUs e relatam também a sua experiência sobre esta temática no contexto duma UCIGE incluindo a análise de 124 internamentos. RESULTADOS: Nos diversos estudos efectuados em doentes com cirrose hepática admitidos em UCI polivalentes, os diferentes scores gerais e específicos revelaram um bom poder discriminativo, ou seja, com uma área sob a curva ROC (AUC) > 0,7. Considerando os seis estudos mais representativos, o valor médio da AUC dos scores SOFA, APACHE II, APACHE III, MELD e Child-Pugh foi 0,86, 0,74, 0,81, 0,79 e 0,77, respectivamente. O estudo de 124 internamentos consecutivos na UCIGE de doentes com cirrose hepática revelou que os doentes que faleceram pertenciam todos à classe C de Child-Pugh e tinham valores médios dos scores SOFA, APACHE II, SAPS II e MELD significativamente superiores aos dos doentes que n o faleceram (10,1, 22,0, 47,5 e 30,7 nos que faleceram e 3,5, 13,6, 25,4 e 18,0 nos que n o faleceram, respectivamente; p >< 0,05). Conclus es: Tanto os scores gerais como os específicos de cirrose hepática têm valor prognóstico na avalia o do risco de doentes com cirrose hepática internados em UCI polivalentes ou em UCIGE. Nas UCI polivalentes os scores gerais, e em particular o SOFA, apresentam melhor capacidade prognóstica do que os scores específicos de cirrose hepática. INTRODUCTION: Cirrhotic patients admitted in Intensive Care Units (ICU) have a poor prognosis. The prognosis of these patients can be evaluated with general scores (SOFA, APACHE, SAPS) or with specific scoring systems for liver disease (MELD, Child-Pugh). AIMS: To evaluate the prognostic value of general scores (SOFA, APACHE and SAPS) and of liver-specific scores (MELD and Child-Pugh) in patients with liver cirrhosis admitted to general ICUs or to Gastroenterology Intensive Care Units (GICU). MATERIAL AND METHODS: The authors present a literature review on the assessment of th
Gastric suture line ulcer: An unexpected cause of gastrointestinal bleeding úlcera gástrica por fi o de sutura: uma causa inesperada de hemorragia digestiva
Rosa Ferreira,Pedro Amaro,Manuela Ferreira,José Manuel Romozinho
Jornal Português de Gastrenterologia , 2012,
Abstract: Gastrointestinal bleeding due to suture line ulceration has been attributed to use of non absorbable silk sutures. We report a case of a 63 year old male with gastrointestinal bleeding due to gastric suture line ulceration after splenectomy performed 11 years ago. Emergent upper endoscopy revealed a small gastric ulcer with a visible vessel and raised the suspicion of gastric varices. An endoscopic ultrasound was performed, showing a gastric hyperechogenic area in the mucosa layer with an acoustic shadow. Upper endoscopy with a transparent cap was repeated and a mobile foreign body in the ulcer′s bed was found. It was successfully removed by forceps. After the procedure a silk suture line of 3.5 cm was identified A hemorragia digestiva por ulcera o da linha de sutura tem sido atribuída ao uso de fios de sutura de seda, n o absorvíveis. Os autores relatam um caso de um homem de 63 anos com hemorragia digestiva devido a úlcera gástrica por fio de sutura após esplenectomia realizada 11 anos antes. A endoscopia digestiva urgente revelou uma pequena úlcera gástrica com vaso visível e levantou a suspeita de varizes gástricas. A eco endoscopia mostrou uma área hiperecogénica na camada mucosa do est mago, esbo ando cone de sombra. Repetiu se a endoscopia digestiva com um cap, visualizando se um corpo estranho móvel no leito da úlcera, que foi removido com uma pin a e identificado como um fio de sutura de seda de 3,5 cm
O Doente Cirrótico na Unidade de Cuidados Intensivos: Avalia??o do Prognóstico
Freire,Paulo; Romozinho,José Manuel; Ferreira,Manuela; Amaro,Pedro; Leit?o,Maximino Correia;
Jornal Português de Gastrenterologia , 2011,
Abstract: introduction: cirrhotic patients admitted in intensive care units (icu) have a poor prognosis. the prognosis of these patients can be evaluated with general scores (sofa, apache, saps) or with specific scoring systems for liver disease (meld, child-pugh). aims: to evaluate the prognostic value of general scores (sofa, apache and saps) and of liver-specific scores (meld and child-pugh) in patients with liver cirrhosis admitted to general icus or to gastroenterology intensive care units (gicu). material and methods: the authors present a literature review on the assessment of the prognosis of cirrhotic patients admitted to icus and also report your experience on this issue in the context of a specialized gicu including the analysis of 124 admissions. results: in several studies on patients with liver cirrhosis admitted to general icus, both general and liver-specific scores showed good discrimination, with an area under receiver operating characteristic curve (>auc) > 0.7. considering the six most representative studies, the mean value of auc on sofa, apache ii, apache iii, meld and child-pugh scores was 0.86, 0.74, 0.81, 0.79 and 0.77, respectively. the study of 124 consecutive cirrhotic admissions to a gicu showed that patients who died belonged exclusively to the class c of child-pugh and had average values of sofa, apache ii, saps ii and meld scores significantly higher than those of the patients who survived (10.1, 22.0, 47.5 and 30.7 in those who died and 3.5, 13.6, 25.3 and 18.0 in those who survived, respectively; p < 0.05). conclusions: both general scores and liver-specific scores have prognostic value in the risk assessment of patients with liver cirrhosis admitted to general icus or to gicus. in the icus the general scores, and particularly the sofa score, have better prognostic ability than the liver-specific scores.
Prognostic scores in cirrhotic patients admitted to a gastroenterology intensive care unit
Freire,Paulo; Romozinho,José M.; Amaro,Pedro; Ferreira,Manuela; Sofia,Carlos;
Revista Espa?ola de Enfermedades Digestivas , 2011, DOI: 10.4321/S1130-01082011000400002
Abstract: background: prognostic scores have been validated in cirrhotic patients admitted to general intensive care units. no assessment of these scores was performed in cirrhotics admitted to specialized gastroenterology intensive care units (gicus). aim: to assess the prognostic accuracy of acute physiology and chronic health evaluation (apache) ii, simplified acute physiology score (saps) ii, sequential organ failure assessment (sofa), model for end-stage liver disease (meld) and child-pugh-turcotte (cpt) in predicting gicu mortality in cirrhotic patients. methods: the study involved 124 consecutive cirrhotic admissions to a gicu. clinical data, prognostic scores and mortality were recorded. discrimination was evaluated with area under receiver operating characteristic curves (auc). calibration was assessed with hosmer-lemeshow goodness-of-fit test. results: gicu mortality was 9.7%. mean apache ii, saps ii, sofa, meld and cpt scores for survivors (13.6, 25.4, 3.5, 18.0 and 8.6, respectively) were found to be significantly lower than those of non-survivors (22.0, 47.5, 10.1, 30.7 and 12.5, respectively) (p < 0.001). all the prognostic systems showed good discrimination, with auc = 0.860, 0.911, 0.868, 0.897 and 0.914 for apache ii, saps ii, sofa, meld and cpt, respectively. similarly, apache ii, saps ii, sofa, meld and cpt scores achieved good calibration, with p = 0.146, 0.120, 0.686, 0.267 and 0.120, respectively. the overall correctness of prediction was 81.9%, 86.1%, 93.3%, 90.7% and 87.7% for the apache ii, saps ii, sofa, meld and cpt scores, respectively. conclusions: in cirrhotics admitted to a gicu, all the tested scores have good prognostic accuracy, with sofa and meld showing the greatest overall correctness of prediction.
Limpeza Intestinal Anterógrada com Fosfo-Soda: Efeitos Colaterais Graves e Sua Preven o
C. Romozinho
Jornal Português de Gastrenterologia , 2007,
Abstract:
An Unusual Endoscopic Image of a Submucosal Angiodysplasia
Rita Carvalho,Nuno Almeida,Manuela Ferreira,Pedro Amaro,António Bernardes,Maria Augusta Cipriano,J. M. Rom ozinho,Hermano Gouveia,Carlos Sofia
Case Reports in Gastrointestinal Medicine , 2012, DOI: 10.1155/2012/186065
Abstract: Obscure gastrointestinal bleeding is responsible for 2–10% of the cases of digestive bleeding. Angiodysplasia is the most common cause. The authors report a case of a 70-year-old female patient admitted to our Gastrointestinal Intensive Care Unit with a significant digestive bleeding. Standard upper and lower endoscopy showed no abnormalities, and we decided to perform a capsule enteroscopy that revealed a submucosal nodule with active bleeding in the jejunum. An intraoperative enteroscopy confirmed the presence of a small submucosal lesion with a central ulceration, and subsequently a segmental enterectomy was performed. Surprisingly, the histopathological diagnosis was angiodysplasia. The patient remains well after a two-year period of follow-up. We present this case of obscure/overt gastrointestinal bleeding to emphasize the role of capsule and intraoperative enteroscopy in the evaluation of these situations, and because of the unusual endoscopic appearance of the angiodysplasia responsible for the hemorrhage.
An Unusual Endoscopic Image of a Submucosal Angiodysplasia
Rita Carvalho,Nuno Almeida,Manuela Ferreira,Pedro Amaro,António Bernardes,Maria Augusta Cipriano,J. M. Romozinho,Hermano Gouveia,Carlos Sofia
Case Reports in Gastrointestinal Medicine , 2012, DOI: 10.1155/2012/186065
Abstract: Obscure gastrointestinal bleeding is responsible for 2–10% of the cases of digestive bleeding. Angiodysplasia is the most common cause. The authors report a case of a 70-year-old female patient admitted to our Gastrointestinal Intensive Care Unit with a significant digestive bleeding. Standard upper and lower endoscopy showed no abnormalities, and we decided to perform a capsule enteroscopy that revealed a submucosal nodule with active bleeding in the jejunum. An intraoperative enteroscopy confirmed the presence of a small submucosal lesion with a central ulceration, and subsequently a segmental enterectomy was performed. Surprisingly, the histopathological diagnosis was angiodysplasia. The patient remains well after a two-year period of follow-up. We present this case of obscure/overt gastrointestinal bleeding to emphasize the role of capsule and intraoperative enteroscopy in the evaluation of these situations, and because of the unusual endoscopic appearance of the angiodysplasia responsible for the hemorrhage. 1. Case Presentation Obscure gastrointestinal bleeding may present as obscure or overt (OOGIB). The overt form is sometimes massive but the new enteroscopy methods, namely, capsule endoscopy (CE) and deep enteroscopy, revolutionized the approach to this kind of gastrointestinal bleeding. Even so, intraoperative enteroscopy (IOE) is still an important diagnostic/therapeutic examination that must be considered in these patients. The authors report a case of a 70-year-old female patient that was admitted to our Gastrointestinal Intensive Care Unit, transferred from another hospital, with the diagnosis of OOGIB, presenting with persistent hematochezia. The patient had history of mitral valve prosthesis and was on warfarin therapy. On admission she was hemodynamically stable despite maintained hematochezia. Her physical examination was otherwise normal. Laboratory investigations showed anemia (hemoglobin of 7,9?g/dL, medium globular volume of 70?fL) and an international normalized ratio of 1,37. An upper gastrointestinal endoscopy and a total colonoscopy had already been performed in the hospital of origin. Even so, we decided to repeat standard endoscopic examinations, but no bleeding lesions were found. Although the patient remained hemodynamically stable, the hemorrhage persisted, with relevant transfusion requirements (1-2 units of red blood cells/24 hour period). At day four of hospitalization, we decided to perform a CE. A submucosal nodule of small size, with active bleeding, was identified in the jejunum (Figure 1). Although there was blood
Profilaxia de úlceras de Stresse numa Unidade de Cuidados Intensivos: Estado da Arte
Pinho,R.; Romozinho,J. M.;
Jornal Português de Gastrenterologia , 2008,
Abstract: stress related mucosal lesions of the gastro-duodenal mucosa are common in the intensive care setting. they may result in clinically significant gastrointestinal bleeding with increased mortality. splanchnic hypoperfusion has a central role in their pathophysiology. several risk factors were identified, the most important being respiratory failure requiring mechanical ventilation and coagulopathy. fluid resuscitation and enteral nutrition are important measures to prevent these lesions. pharmacologic prophylaxis is indicated in patients with known risk factors. anti-acids, sucralfate and h2-receptor antagonists are the most extensively studied drugs. recent studies evaluating the role of proton pump inhibitors were published. the choice of the prophylactic regimen should be based on the route of administration, possible advantages and disadvantages of the drugs, including their comparative cost and available evidence of their efficacy.
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