Se fosse hoje, o Eduardo seria Radiologista de Intervenção?

This perhaps audacious title will probably be as provocative as: "If it were today, would Eduardo be a member of Benfica Club"? We speak, of course, of Prof. Dr. Eduardo Barroso, Director of the Surgery Area of ​​the University Hospital Center of Central Lisbon (CHULC), who retired last month. He is a nationally and internationally renowned surgeon, with proven experience, being a reference in the field of hepatic-bile-pancreatic surgery and transplantation. He has chaired the Portuguese Society of General Surgery and the European Surgical Association, elected by his peers. He would hardly give up his professional passion for ours, but when we admire someone we try to project into the person all the qualities or virtues that stand out as the most positive.Este título, talvez audaz, provavelmente será tão provocador como: “se fosse hoje, o Eduardo seria Benfiquista”? Falamos, claro, do Prof. Doutor Eduardo Barroso, Director da Área de Cirurgia do Centro Hospitalar Universitário de Lisboa Central (CHULC), que se reformou no mês passado. Cirurgião reconhecido nacional e internacionalmente, com provas dadas, sendo uma referência na área da cirurgia hépato-bílio-pancreática e da transplantação, tendo presidido à Sociedade Portuguesa de Cirurgia Geral e à European Surgical Association, eleito pelos seus pares. Dificilmente largaria a sua paixão profissional pela nossa, mas quando admiramos alguém tentamos projectar na pessoa todas as qualidades ou virtudes que destacamos como mais positivas

Embolização Percutânea da Artéria Epigástrica Superior no contexto de Hematoma dos Músculos Rectos do Abdómen: a Propósito de dois Casos Clínicos.

Os hematomas dos músculos rectos abdominais são uma complicação frequente em doentes anticoagulados. Apesar da maioria ser tratada de forma conservadora, podem por vezes evoluir de forma potencialmente fatal. O embolização percutânea transarterial surge como uma alternativa terapêutica eficaz nesses casos. Contudo, na sua maioria, estão descritos na literatura hematomas com origem na artéria epigástrica inferior. Com estes dois casos clínicos, a par da revisão da literatura, os autores pretendem alertar para a necessidade de estudar o território epigástrico superior em doentes com hematomas com extensão ao 1/3 superior da parede abdominal anterior ou sem resolução após embolização do território da artéria epigástrica inferior

Retrospective Study of Transjugular Intrahepatic Portosystemic Shunt Placement for Cirrhotic Portal Hypertension

Background and Aims: Transjugular intrahepatic portosystemic shunt (TIPS) is used for decompressing clinically significant portal hypertension. The aims of this study were to evaluate clinical outcomes and adverse events associated with this procedure. Methods: Retrospective single-center study including 78 patients submitted to TIPS placement between January 2015 and November 2018. Follow-up data were missing in 27 patients, and finally 51 patients were included in the study sample. Data collected from individual registries included demographics, comorbidities, laboratory results, complications, and clinical results according to the indication. Results: Averagepre-TIPS portosystemic pressure gradient decreased from 18.1 ± 5 to 6 ± 3 mm Hg after TIPS placement. Indications for TIPS were refractory ascites (63%, n = 49), recurrent or uncontrolled variceal bleeding (36%, n = 28), and Budd-Chiari syndrome (1.3%, n = 1). TIPS-related adverse events occurred in 29/51 (56.8%) patients, with hepatic encephalopathy (HE) in 21 (41%) patients, sepsis in 3, liver failure in 2, hemolytic anemia in 1, acute pulmonary edema in 1, and capsular perforation in 1 patient. Mean follow-up was 15.7 ± 15 months. First-month mortality was 11.7% (n = 6) (sepsis, n = 3; acute liver failure, n = 2; and recurrence of variceal bleeding, n = 1) and was significantly higher for patients with Child-Pugh >9 points (p = 0.01), model of end-stage liver disease (MELD) scores >19 (p = 0.02), and for patients with a history of HE before the procedure (p = 0.001). Older age (p = 0.006) and higher levels of creatinine (p = 0.008) were significantly higher in patients developing HE after TIPS. Ascites persisted in 21.2% (7/33 patients) and was more frequent in patients with lower baseline albumin levels (p = 0.003). Recurrent variceal bleeding occurred in 22% (n = 4/18 patients) and was more frequent in patients with lower baseline hemoglobin levels (p = 0.03). Conclusion: TIPS is effective in up to 80% of patients presenting with variceal bleeding or refractory ascites. Careful patient selection based on age and HE history may reduce adverse events after TIPS.publishersversionpublishe

Overcoming Challenges with a Multidisciplinary Approach

Aneurysmal bone cysts are vascular benign fibroblastic lesions usually found in bone that are locally destructive, with a greater incidence in the first and second decades of life. Patients usually undergo curettage or, less frequently, surgical resection, which may lead to growth disturbances and deformities in cases of large or complex lesions. Minimally invasive techniques such as sclerotherapy and endovascular embolization have been developed as an alternative or complement to surgery, with promising results. The authors present a rare case of an extraskeletal aneurysmal bone cyst successfully treated with minimally invasive techniques followed by surgical resection and provide a literature review of the current treatment options.publishersversionpublishe

A Pooled Multicentric Analysis of Survival in 580 Patients

Funding Information: Filipe Veloso Gomes has received research grants from Terumo; educational grants from Terumo, Medtronic, Guerbet; speaker honoraria from Bayer, Guerbet, Medtronic, Roche. Thierry-de-Baere has received consulting fees from Astra-Zeneca, Boston-Scientific, Guerbet, Medtronic and Terumo. Gontran Verset has received honoraria for lectures from Terumo, BTG, Bayer. Élia Coimbra—no conflicts of interest Gerardo Tovar-Felice has received a research grant from Terumo. Katerina Malagari has received honoraria for lectures from Merit Medical, BTG, Boston Scientific, Terumo. Jordi Bruix has received consulting fees from AbbVie, Adaptimmune, Arqule, Astra-Medimmune, Basilea, Bayer-Shering Pharma, Bio-Alliance, BMS, BTG- Biocompatibles, Eisai, Gilead, Incyte, Ipsen, Kowa, Lilly, MSD, Nerviano, Novartis, Polaris, Quirem, Roche, Sirtex, Sanofi, Terumo; honararia for lectures from Bayer, Eisai, BTG/Boston Scientific, Sirtex, Terumo, Ipsen, Astra-Zeneca. Publisher Copyright: © 2023, The Author(s).Purpose: To evaluate survival, efficacy and safety of transarterial chemoembolization (TACE) in the treatment of patients with hepatocellular carcinoma (HCC), through a pooled analysis of patients with BCLC 0, A and B HCC stages, treated with polyethylene glycol drug eluting microspheres (PEG-DEM) TACE. Materials and Methods: Patients from 3 retrospective and 2 prospective registries were included. Overall survival (OS), progression-free survival (PFS), tumour response and safety were evaluated. Multivariate Cox regression analysis was performed to evaluate predictors of OS. Results: A total of 580 patients (72.1% males, mean age 66.9 ± 10.3 years) were included. 43.5% had BCLC A, and 41.0% BCLC B disease stage, and 85.8% were Child–Pugh class A. Complete and partial response (mRECIST or RECIST1.1) were achieved in 60.14% and 27.11% of patients, with overall response and disease control rates of 87.30% and 94.60%, respectively. Median OS was 50.8 months for the total population, and 61.2 and 38.1 months for BCLC 0 + A and BCLC B patients, respectively. Median PFS for the total population, BCLC 0 + A and BCLC B groups was 15.6, 21.6 and 12.7 months, respectively. Conclusions: This multicentric pooled analysis confirmed efficacy and safety of PEG-DEM TACE, with a median OS of 50.8 months.publishersversionepub_ahead_of_prin

Impact of grape pectic polysaccharides on anthocyanins thermostability

The impact of grape pectic polysaccharides on malvidin-3-O-β-d-glucoside thermostability was evaluated in model solutions. Pectic polysaccharides richer in homogalacturonan domains, with less neutral sidechains (chelator fraction) showed higher binding with malvidin-3-O-β-d-glucoside, by 1H NMR (Ka=505 M-1). Binding affinity with water soluble extract was estimated to be 10-fold lower, possibly due to the presence of neutral branched regions and more compacted structure, hampering the binding. Hydrophobic domains, such as rhamnogalacturonans-I domains in acid soluble polysaccharides, may participate in the formation of complexes with malvidin-3-O-β-d-glucoside. The thermostability of anthocyanin-polysaccharides complexes was evaluated at different temperatures, assessing anthocyanins degradation by HPLC-DAD. Polysaccharides showed to improve anthocyanin thermostability, with chelator and acid extract having the highest impact at lowest temperatures. Electrostatic interactions, additionally stabilized by hydrophobic effect contribute to the anthocyanin-polysaccharides binding and to the consequent thermostabilization. The protection provided by grape pectic polysaccharides foresees innovative anthocyanin food products with improved thermostability and colour features.publishe

Caso Clínico ARP nº10: qual o seu diagnóstico?

Paciente do sexo feminino de 19 anos, assintomática. Sem antecedentes de relevo.Em análises de rotina revelou alterações inespecíficas da função hepática, nomeadamente aumento da GGT, ALT,AST e FA, sem alterações dos valores de bilirrubina. Marcadores tumorais com valores dentro da normalidade

Caso Clínico ARP Nº10: Hemangioendotelioma Epitelioide

Paciente do sexo feminino de 19 anos, assintomática, sem antecedentes pessoais de relevo. Em análises de rotina foram identificadas alterações inespecíficas da função hepática, nomeadamente aumento da GGT, ALT, AST e FA, com bilirrubina normal. Restante avaliação laboratorial básica dentro dos parâmetros da normalidade

Transarterial Embolization of Iatrogenic Cystic Artery Pseudoaneurysm

Cystic artery pseudoaneurysm (CAP) is a rare entity most often resulting from inflammatory conditions (acute cholecystitis or pancreatitis) or iatrogenic trauma (cholecystectomy). We report the case of a 73-year-old female who presented with abdominal pain and gastrointestinal bleeding after an episode of acute cholecystitis and endoscopic retrograde cholangiopancreatography for choledocolithiasis removal. Computed tomography and angiography revealed a CAP measuring 5 cm. A right hepatic artery transcatheter embolization was performed with glue, excluding the pseudoaneurysm. The next day, the patient underwent open cholecystectomy with ligation of the cystic artery. Later, ischemic hepatitis and abscess developed.publishersversionpublishe