Estenoses benignas faringo-esofágicas: um achado crescente ainda desafiante

(undefined)info:eu-repo/semantics/publishedVersio

Isolated gastric Kaposi's sarcoma

[Excerpt] A 47-year-old male patient presented with a 6-month A B history of epigastric pain, anorexia, weight loss of 10 kg, and night sweats. He confirmed engaging in high-risk sexual behavior. Physical examination was unremarkable, except for mild epigastric tenderness on abdominal palpation.[...

Role of a micronized purified flavonoid fraction as an adjuvant treatment to rubber band ligation for the treatment of patients with hemorrhoidal disease: a longitudinal cohort study

Nonsurgical treatment of hemorrhoidal disease (HD) includes medical and instrumental techniques. We aimed to compare the efficacy of the most frequently used nonsurgical strategies, either alone or in combination, applied in an ambulatory setting. Purpose: Nonsurgical treatment of hemorrhoidal disease (HD) includes medical and instrumental techniques. We aimed to compare the efficacy of the most frequently used nonsurgical strategies, either alone or in combination, applied in an ambulatory setting. Methods: Patients who received nonsurgical treatment for HD by proctology appointment at the Gastroenterology Department of Braga Hospital were evaluated. Isolated rubber band ligation (RBL) and a combination of RBL with a micronized purified flavonoid fraction (MPFF) were the 2 most frequently used strategies. Symptoms of HD (bleeding, pruritus, pain at rest, pain at defecation and prolapse) were assessed at days 0, 7, and 28 by using a severity grading scale (0 to 4/5). A Global Symptom score was constructed to assess the overall severity and compare the overall improvements of the HD symptoms between the 2 most frequently used strategies. Results: Nineteen patients underwent the combined treatment (RBL + MPFF group) and 25 the RBL treatment (RBL group). A comparison of the 2 treatment groups showed significant improvements in the combined treatment group in terms of bleeding at days 7 (P = 0.001) and 28 (P = 0.002) and in the pruritus intensity during the first week (P < 0.001). A trend toward clinical benefit was also verified in the combined treatment group for all other HD symptoms (pain at rest, pain at defecation and prolapse). Conclusion: A combined treatment approach with MPFF and RBL significantly reduced the intensity of bleeding during the first month and the pruritus during the first wee

Multi-pathology detection and lesion localization in WCE videos by using the instance segmentation approach

The majority of current systems for automatic diagnosis considers the detection of a unique and previously known pathology. Considering specifically the diagnosis of lesions in the small bowel using endoscopic capsule images, very few consider the possible existence of more than one pathology and when they do, they are mainly detection based systems therefore unable to localize the suspected lesions. Such systems do not fully satisfy the medical community, that in fact needs a system that detects any pathology and eventually more than one, when they coexist. In addition, besides the diagnostic capability of these systems, localizing the lesions in the image has been of great interest to the medical community, mainly for training medical personnel purposes. So, nowadays, the inclusion of the lesion location in automatic diagnostic systems is practically mandatory. Multi-pathology detection can be seen as a multi-object detection task and as each frame can contain different instances of the same lesion, instance segmentation seems to be appropriate for the purpose. Consequently, we argue that a multi-pathology system benefits from using the instance segmentation approach, since classification and segmentation modules are both required complementing each other in lesion detection and localization. According to our best knowledge such a system does not yet exist for the detection of WCE pathologies. This paper proposes a multi-pathology system that can be applied to WCE images, which uses the Mask Improved RCNN (MI-RCNN), a new mask subnet scheme which has shown to significantly improve mask predictions of the high performing state-of-the-art Mask-RCNN and PANet systems. A novel training strategy based on the second momentum is also proposed for the first time for training Mask-RCNN and PANet based systems. These approaches were tested using the public database KID, and the included pathologies were bleeding, angioectasias, polyps and inflammatory lesions. Experimental results show significant improvements for the prFCT national funds, under the national support to R&D units grant, through the reference project UIDB/04436/2020 and UIDP/04436/2020 and through the PhD Grants with the references SFRH/BD/92143/2013 and SFRH/BD/139061/201

Performance clínica de um novo software para detetar automaticamente angiectasias na endoscopia por cápsula

Background: Video capsule endoscopy (VCE) revolutionized the diagnosis and management of obscure gastrointestinal bleeding, though the rate of detection of small bowel lesions by the physician is still disappointing. Our group developed a novel algorithm (CMEMS-Uminho) to automatically detect angioectasias which display greater accuracy in VCE static frames than other methods previously published. We aimed to evaluate the algorithm overall performance and assess its diagnostic yield and usability in clinical practice. Methods: Algorithm overall performance was determined using 54 full-length VCE recordings. To assess its diagnostic yield and usability in clinical practice, 38 VCE examinations with the clinical diagnosis of angioectasias consecutively performed (2017-2018) were evaluated by three physicians with different experiences. The CMEMS-Uminho algorithm was also applied. The performance of the CMEMS-Uminho algorithm was defined by a positive concordance between a frame automatically selected by the software and a study independent capsule endoscopist. Results: Overall performance in complete VCE recordings was 77.7%, and diagnostic yield was 94.7%. There were significant differences between physicians in regard to global detection rate (p < 0.001), detection rate per capsule (p < 0.001), diagnostic yield (p = 0.007), true positive rate (p < 0.001), time (p < 0.001), and speed viewing (p < 0.001). The application of CMEMS-Uminho algorithm significantly enhanced all readers' global detection rate (p < 0.001) and the differences between them were no longer observed. Conclusion: The CMEMS-Uminho algorithm detained a good overall performance and was able to enhance physicians' performance, suggesting a potential usability of this tool in clinical practice.(undefined

Cytomegalovirus duodenitis in immunocompetent patients: what else should we look for?

Cytomegalovirus (CMV) infection is a well-recognised complication of immunodeficiency, although the burden of CMV disease in immunocompetent adults is still unknown. We present the case of a 54-year-old male patient admitted due to severe diarrhoea, epigastric pain and fever. Initial diagnostic workup revealed pericardial and pleural effusion, enlarged abdominal lymph nodes and mild elevation of liver enzymes. CMV serology was IgM positive, and upper endoscopy revealed proximal enteritis. Histology and immunohistochemistry of duodenal samples confirmed CMV disease. An extensive investigation of possible immunodeficiency was conducted with positron emission tomography (PET) scan revealing an abnormal hypermetabolic pulmonary nodule. The patient underwent a right superior lobectomy which, on analysis, confirmed an atypical bronchopulmonary carcinoid tumour. We report this case to reinforce the importance of considering CMV infection as a differential diagnosis in apparent immunocompetent patients and to emphasise the importance of looking for any condition that may cause any degree of immune dysfunction.(undefined)info:eu-repo/semantics/publishedVersio

Disseção endoscópica da submucosa no tratamento da neoplasia epitelial gástrica num centro Português

The emergence of endoscopic submucosal dissection (ESD) made possible en bloc resection of neoplastic gastric lesions, regardless of lesion size, with reduced rates of complications and recurrence. This technique has become the preferred method for curative resection, instead of conventional endoscopic mucosal resection and surgery, when distant metastases have negligible risk. In Western countries experience with this technique has evolved quickly, with an increasing number of case series reported in the literature. This study aims to report the short- and long-term outcomes of ESD in gastric epithelial neoplastic lesions by a single operator in a Portuguese centre.Introdução: O aparecimento da dissecção endoscópica da submucosa (ESD) tornou possível a resseção em bloco de lesões neoplásicas superficiais do estômago, independentemente da sua dimensão, com reduzidas taxas de complicações e recorrência. Esta técnica tem evoluído como método preferencial face à mucosectomia convencional e cirurgia, quando a metastização à distância tem risco negligenciável. No mundo ocidental a experiência nesta técnica tem evoluído de forma rápida surgindo um número crescente de séries na literatura. Este estudo tem como objetivo reportar os resultados a curto e longo prazo da ESD de lesões epiteliais gástricas realizadas por um único operador num centro Português. Metodologia: Análise retrospetiva unicêntrica dos casos de ESD de lesões epiteliais gástricas, realizadas durante um período de 5 anos, entre maio de 2012 e setembro de 2017. Resultados: Foram realizadas 114 ESDs de neoplasias epiteliais gástricas durante o período em estudo, com uma taxa de resseção em bloco de 96.5% e R0 de 87.6%. A resseção curativa confirmou-se em 83.2% dos casos. Ocorreram complicações em 13.2% dos procedimentos, incluindo hemorragia em 12 doentes (10.5%) e 1 perfuração (0.9%). Com uma mediana de follow-up de 12 meses (variação interquartil [IQR] 18), verificaram-se 6 casos de recorrência local: 4 lesões residuais e 2 recorrências em resseções R0 prévias. Observaram-se mais frequentemente lesões residuais de ESD de lesões de maiores dimensões (me­diana = 40.0 mm, IQR = 26 vs. mediana = 20.0 mm, IQR = 15, p = 0.008) e com margens horizontais (HM) positivas após a resseção (50.0% vs. 0.0%, Teste exato de Fisher, p c; 0.001). A incidência cumulativa de lesões gástricas metácronas aos 34 meses foi de 16.1%. Todas as novas lesões foram eficazmente tratadas por endoscopia. A sobrevivência específica aos 12 meses de follow-up foi de 100%. Conclusão: Este estudo mostra que a ESD gástrica é uma técnica eficaz e segura para o tratamento de lesões neoplásicas precoces confirmando a maioria das séries europeias. Embora a ESD permita geralmente uma resseção em bloco as HM positivas continuam a ser um problema em alguns doentes. A vigilância endoscópica pode detetar recorrência local e novas lesões, em estádios precoces, potencialmente tratáveis por endoscopia.(undefined

What recovery position should patients adopt after percutaneous liver biopsy?

Introduction Percutaneous liver biopsy (PLB) is an invasive procedure used for the assessment of liver diseases. The patient’s recovery position after the PLB differs among hospitals and departments. This study aims to evaluate adverse events and patient acceptability according to the recovery position adopted after the PLB. Patients and methods From September 2014 to March 2017, patients submitted to PLB were randomly assigned to a recovery position arm: right-side position (RRP), dorsal position (DRP), or combined position. A validated numerical rating scale was used to evaluate the level of pain and the overall acceptability of the PLB experience. Results Ninety (27 patients in RRP, 33 in DRP and 30 in combined position arm) patients were included in the study. There were no differences between the three groups regarding demographic and clinical parameters, except for the number of previous biopsies – higher in the combined group (P= 0.03). No major adverse events occurred. Minor complications described were pain (36.7% of patients), vasovagal reaction (2.2%) and nauseas/vomit (3.3%). Pain level and pain duration did not differ significantly between groups. Pain occurred more often in women (P=0.04) and younger patients (P= 0.02). The number of passages, operator and previous biopsy did not influence the occurrence of pain. The RRP group considered the procedure less acceptable than the DRP group (P=0.001) or the combined group (P= 0.002). There were no differences between the last two arms. Conclusion Although RRP is the most frequently used position, it appears to be less acceptable without any protective role in terms of adverse events