Somatização e alexitimia: um estudo nos cuidados de saúde primários

A somatização é um grave problema nos cuidados de saúde primários. Vários factores têm sido estudados para explicar a somatização, sendo a alexitimia um dos factores mais investigados. Embora exista trabalho anterior acerca da alexitimia e de algumas condições médicas, ainda pouca pesquisa tem sido efectuada entre pacientes somatizadores nos cuidados primários. O objectivo deste estudo descritivo transversal é investigar a relação entre a somatização e a alexitimia em pacientes dos cuidados primários. 143 pacientes de quatro Centros de Saúde da Região do Porto completaram as seguintes medidas: TAS-20, a PILL, a EEC, e uma versão reduzida da SCL-90. Os resultados indicam-nos que a somatização é um fenómeno comum entre os pacientes dos centros de saúde, estando associado a uma elevada morbilidade física e psiquiátrica. Quanto à associação entre somatização e a alexitimia, inicialmente constatámos uma associação positiva e moderada, mas ao procedermos ao controlo das variáveis ansiedade e depressão, essa associação diminui significativamente, tornando-se fraca. Os resultados mostraram-nos também que a alexitimia não se revelou factor preditivo. A investigação futura deverá avaliar a relação entre estas duas variáveis de forma a que sejam desenvolvidas intervenções eficazes para os pacientes somatizadores que tendem a sobrecarregar os cuidados de saúde primários.Several factors have been studied to understand somatization, and alexithymia is one of the most frequently assessed. Although there are previous studies that assess the relationship between alexithymia and some medical conditions, fewer exist on the presence of alexithymia amongst somatizing patients in the primary health care system. The objective of the current research is to study the relationship between alexithymia and somatization in a group of patients involved in visits to their primary health care physician. One hundred and forty-three patients completed the Toronto Alexithymia Scale, the Pennebaker Inventory of Limbic Languideness, Emotional Expression and Control Scale, and the SCL-90. Results showed that somatization is a frequent phenomenon in the primary health care system users, and is associated with highest levels physical and psychological morbidity. However, although the association between alexithymia and somatization was initially positive and of moderate size, it became weak when we controlled for levels of depression and anxiety. Results also showed that alexithymia levels didn’t predict for somatization. Future research should carefully assess the relationship between these two variables in order to develop efficient interventions for somatizing patients that tend to overflow primary care services

Endovascular Treatment of Internal Iliac Artery Aneurysms: Single Center Experience

Objective: Internal iliac artery aneurysms (IIAA) are rare, representing only 0.3% of aortoiliac aneurysms. Its treatment with open surgery is complex and associated with high morbidity and mortality, which led to increasing application of endovascular solutions. In this study, we aimed to evaluate outcomes of endovascular aneurysm repair (EVAR) of IIAA in one institution. Methods: We retrospectively reviewed all cases of IIAA treated with endovascular techniques between 2003 and 2014. Endpoints were morbidity, mortality, freedom from pelvic ischemic symptoms (buttock claudication, ischemic colitis, and spinal cord injury), and need for reintervention. Results: There were 16 patients, 13 males and 3 females, with mean age of 75.1±7 years. A total of 20 IIAA (4 cases were bilateral), with mean diameter of 37.9 mm, were treated. EVAR was performed in 13 (81.3%) patients, with associated internal iliac artery's outflow occlusion in 2. Iliac branch device was used in one patient. Two patients underwent endovascular IIAA embolization alone. One patient underwent percutaneous, transgluteal, IIAA embolization. IIAA flow preservation in at least one internal iliac artery was possible in 9 (56.3%) patients. Early mortality was 7% (1 case). Early morbidity was 18.8%. Pelvic ischemic complications occurred in 1 (7%) patient with buttock claudication. Late reintervention was needed in 3 patients, none of them for IIAA related complications. Conclusion: Endovascular treatment of IIAA is technically feasible and durable. Although overall morbidity is relatively high, major complications are infrequent and perioperative mortality is low. internal iliac artery flow preservation is technically challenging and, in a significant number of cases, not possible at all.info:eu-repo/semantics/publishedVersio

Palinología, Estratigrafía y Geometría de la cuenca continental pensIlvaniense de Santa Susana (Suroeste de Portugal)

The continental Pennsylvanian Santa Susana Basin (SSB) is located along an important N-S strike shear zone (Santa Susana Shear Zone - SSSZ) that separates the Ossa-Morena and South Portuguese Zones (SW Portugal). This shear zone controlled the sedimentation of the basin and probably its post-sedimentary evolution. The lower (basal) unit is mostly conglomeratic and is known essentially from drill-hole data while the upper unit, that covers most of the current surface area, is composed by sandstones, shales and some coal beds. Fluvial sedimentary rocks seem to prevail, but evidences of lacustrine sedimentation can be found in restricted areas within the upper unit. Palynological data indicate that at least part of the sedimentation took place during the Early Kasimovian (Cantabrian) but the sporomorph content of different localities suggest that significantly older sediments (Late Moscovian -Early Bashkirian) may be present. Geometrical, structural, and cartographical evidences indicate that the SSB formed as a pull-apart basin along the SSSZ and was later partially uplifted during latest Varsican and Alpine orogenies.>La cuenca continental Pensilvaniense de Santa Susana (SSB) está localizada a lo largo de una importante zona de cizalla con dirección aproximada N-S (Zona de Cizalla de Santa Susana - SSSZ) que separa las Zonas de Ossa-Morena y Sur-Portuguesa (Suroeste de Portugal). La zona de cizalla ha controlado la sedimentación en la cuenca y posiblemente su evolución post-sedimentaria. La unidad inferior (basal), estudiada fundamentalmente mediante datos de sondeos, es mayormente conglomerática, mientras que su unidad superior, que cubre actualmente una gran parte de la superficie expuesta, está compuesta por areniscas, pizarras y niveles de carbón. Las rocas de origen fluvial son las más abundantes, sin embargo existen evidencias de sedimentación lacustre en áreas muy limitadas de la unidad superior. Los datos palinológicos indican que al menos parte de la sedimentación tuvo lugar durante el Kasimoviense temprano (Cantabriense) aunque el contenido en esporomorfos de diferentes localidades sugieren la existencia de sedimentos significativamente más antiguos (Moscoviense tardio/Bashkiriense temprano). Evidencias geométricas, estructurales y cartográficas sugieren la creación de una cuenca en pull-apart a lo largo de la ZCSS

Institutional Impact of EVAR's Incorporation in the Treatment of Abdominal Aortic Aneurysm: a 12 Years' Experience Analysis

Introduction: Endovascular aneurysm repair (EVAR) was introduced as a less aggressive treatment of abdominal aortic aneurysms (AAA) for patients ineligible for open repair (OR). Objective: To analyze EVAR's incorporation impact in the treatment of infra-renal abdominal aortic aneurysms in our institution. Methods: A retrospective study of the patients with diagnostic of infra-renal AAA treated between December 2001 and December 2013 was performed. The choice between EVAR and OR was based on surgeon's experience, considering patient clinical risk and aneurysm's anatomical features. Patients treated by EVAR and by OR were analyzed. In each group, patient's and aneurysm's characteristics, surgical and anesthesia times, cost, transfusion rate, intraoperative complications, hospital stay, mortality and re-intervention rates and survival curves were evaluated. Results: The mean age, all forms of heart disease and chronic renal failure were more common in EVAR group. Blood transfusion, surgical and anesthesia times and mean hospital stay were higher for OR. Intraoperative complications rate was higher for endovascular aneurysm repair, overall during hospitalization complication rate was higher for open repair. The average cost in endovascular aneurysm repair was 1448.3€ higher. Re-interventions rates within 30 days and late re-intervention were 4.1% and 11.7% for endovascular aneurysm repair versus 13.7% and 10.6% for open repair. Conclusions: Two different groups were treated by two different techniques. The individualized treatment choice allows to achieve a mortality of 2.7%. Age ≥80 years influences survival curve in OR group and ASA ≥IV in EVAR group. We believe EVAR's incorporation improved the results of OR itself. Patients with more comorbidities were treated by endovascular aneurysm repair, decreasing those excluded from treatment. Late reinterventions were similar for both techniques.info:eu-repo/semantics/publishedVersio

Caracterização de Doentes com Espondilite Anquilosante em Hidrocinesiterapia – Uma Avaliação Multidimensional

OBJECTIVES: Clinical, functional and working characterization of an Ankylosing Spondylitis (AS) group of patients that perform hydrotherapy regularly in a physical and rehabilitation department. Assessment of the benefit of hydrotherapy in symptom relief, function and consumption of analgesics and non-steroidal anti-inflammatory drugs (NSAIDs). MATERIAL AND METHODS: A transversal characterization of a group of patients with SA undergoing hydrotherapy was performed. Demographic, clinical (including disease activity, function and health-related quality of life), radiographic and laboratorial data was collected. A questionnaire about working situation, presence of dyspnoea, smoking, number of sessions and benefit of hydrotherapy was applied. RESULTS: 22 patients (73% males) were enrolled in the study, mean age 55.6 ± 8.8 years, mean duration of the disease 28.0 ± 13.13 years. Apart from the axial involvement, 50% had a previous history of enthesitis, 54.5% peripheral arthritis, 18% dactylitis and 36% uveitis. At the day of assessment, 81% had low-back pain complaints (39% inflammatory rhythm), 18% oligoarthritis, 9.1% had total hip and/or knee prosthesis. The majority of the patients had active disease, accentuated functional deterioration and reduced health related quality of life. About 54.5% were retired due to disability, 18.2% were smokers and 36.4% had dyspnoea; 31.8% presented restrictive ventilatory alterations; 36.4% obstructive (predominance in the small airways); 13.6% mixed and in 18.2% the spiromety was normal. The mean total time of hydrotherapy was 13 ± 6.8 years. The patients attended a mean of 3 sessions per week and 3 series of 15 sessions per year. Of the 22.7% that performed another physical activity, 80% walked and 20% cycled. The ingestions of analgesics (p < 0.05) and NSAIDs (p < 0.01) were also reduced. CONCLUSION: A high percentage of spyrometric changes were identified. The majority of the patients are retired due to disability. The patients feel benefit with hydrotherapy, that contributed to reduction of the analgesic and NSAIDs consumption. The importance of the global systemic evaluation and multidisciplinary of the SA to optimize the therapeuthics and improve the quality of life of the patients is pointed out

Endovascular Abdominal Aneurysm Repair in Women: What are the Differences Between the Genders?

Introduction: Abdominal aortic aneurysm has a lower incidence in the female population, but a higher complication rate. It was been hypothesized that some anatomical differences of abdominal aortic aneurysm in women could be responsible for that. We proposed to analyze our data to understand the differences in the clinical and anatomical characteristics and the outcomes of patients undergoing endovascular aneurysm repair, according to gender. Methods: A retrospective analysis of patients undergoing endovascular aneurysm repair between 2001-2013 was performed. Patients were divided according gender and evaluated regarding age, atherosclerotic risk factors, aneurysm anatomic features, endograft type, anesthesic risk classification, length of stay, reinterventions and mortality. Two statistical studies were performed, first comparing women and men (Group A) and a second one comparing women and men, adjusted by age (Group B). Results: Of the 171 patients, only 5.8% (n=10) were females. Women were older (P<0.05) and the number of women with no atherosclerotic risk factor was significantly higher. The comparison adjusted by age revealed women with statistically less smoking history, less cerebrovascular disease and ischemic heart disease. Women had a trend to more complex anatomy, with more iliac intern artery aneurysms, larger aneurysm diameter and neck angulations statistically more elevated. No other variables were statistically different between age groups, neither reintervention nor mortality rates. Conclusion: Our study showed a clear difference in the clinical characteristics of women. The female population was statistically older, and when compared with men adjusted by age, had less atherosclerotic risk factors and less target organ disease. Women showed a more complex anatomy but with the same outcomes.info:eu-repo/semantics/publishedVersio

Is Age a Determinant Factor in EVAR as a Predictor of Outcomes or in the Selection Procedure? Our Experience

Introduction: Endovascular aneurysm repair (EVAR) is the therapy of choice in high risk patients with abdominal aortic aneurysm. The good results described are leading to the broadening of clinical indications to younger patients. However, reintervention rates seem higher and even with successful treatment sometimes there is growth of the aneurysm sac and rupture, meaning a failure of the therapeutic goal. This study proposes to analyse the impact of age in patients' selection and post-EVAR results. Methods: The clinical records of consecutive patients undergoing endovascular aneurysm repair, between 2001 and 2013, were retrospectively reviewed. Patients were divided according to age groups (80 years). Gender, body mass index, aneurysm anatomic features, neck characteristics, iliac morphology, surgical indication, endograft type, anesthesic risk classification, length of stay, reinterventions and mortality were analysed and compared. Results: The study included 171 patients, 161 (94.1%) men, and mean age 74.1±8.9 years. The age group under 70 had 32% of the patients. Only three characteristics were found different among age groups: 1) body mass index was higher in younger patients, with a considerable trend toward significance (P=0.06); 2) surgical indication, in the younger group, surgeon's and the patient's option were more proeminent (P<0.05); 3) erectile dysfunction was higher in elderly group (P<0.05). No other clinical and anatomical characteristics or final outcomes were found statisticaly different among age groups. Conclusion: The absence of statistically differences in mortality and reinterventions among age groups suggests that age by itself is not a relevant factor in endovascular aneurysm repair. Indeed, the three characteristics different in younger (obesity, sexual function and patient's choice) favor endovascular aneurysm repair.info:eu-repo/semantics/publishedVersio

A caracterização e proveniência geológica das lajes de antas da região de Lisboa

As antas são sepulcros megalíticos que representam uma das evidências mais conspícuas das populações dos 4º e primeira metade do 3º milénios a.n.e., tanto pela sua monumentalidade, como pelo investimento socioeconómico que terá representado a sua construção para aquelas comunidades neolíticas peninsulares, nomeadamente do Centro-Sul de Portugal. Estas construções foram erigidas no âmbito do fenómeno funerário designado por Megalitismo, um complexo conjunto de práticas mágico-religiosas relacionadas com a morte e não estritamente com um tipo de arquitectura. Apesar das antas serem estudadas pelos seus conteúdos e tipologias, a abordagem interdisciplinar de caracterização e proveniência geológica dos megálitos utilizados nas suas construções, não tem recebido a devida atenção da investigação.Da necessidade de sistematizar e promover um aporte significativo de informações com a finalidade de caracterizar do ponto de vista geológico as proveniências dos materiais construtivos dos monumentos funerários de cronologia neolítica, apresentam-se os resultados preliminares obtidos para alguns dos monumentos em análise na região de Lisboa, no âmbito do projecto de investigação “MEGAGEO: Movendo megálitos no Neolítico - A proveniência geológica dos esteios de antas do Centro-Sul de Portugal”. A caracterização das lajes destes monumentos recorreu a técnicas de análise petrográfica, mineralógica, química e isotópica, de suporte às observações macroscópicas dos elementos construtivos e dos afloramentos geológicos na sua sua vizinhança. As observações macroscópicas dos litótipos que constituem aqueles elementos,quando comparados com os afloramentos,permitiram numa primeira fase estabelecer similaridades entre ambos. Esta abordagem reveste-se, aliás, de fundamental importância para a definição de potenciais zonas de extracção na utilização dos recursos naturais disponíveis