Cateterização venosa central guiada por ultrassom --- abordagem ‘‘Syringe-Free’’

Background and objectives Central venous catheterization of the internal jugular vein is a commonly performed invasive procedure associated with a significant morbidity and even mortality. Ultrasound-guided methods have shown to significantly improve the success of the technique and are recommended by various scientific societies, including the American Society of Anesthesiologists. The aim of this report is to describe an innovative ultrasound-guided central line placement of the internal jugular vein. Technique The authors describe an innovative ultrasound-guided central line placement of the internal jugular vein based on an oblique approach – the “Syringe-Free” approach. This technique allows immediate progression of the guide wire in the venous lumen, while maintaining a real-time continuous ultrasound image. Conclusions The described method adds to the traditional oblique technique the possibility of achieving a continuous real-time ultrasound-guided venipuncture and a guide wire insertion that does not need removing the probe from the puncture field, while having a single operator performing the whole procedure

Unknown Primary Merkel Cell Carcinoma With Cutaneous Spread

The authors present the case of a woman in the seventh decade of life with medical history of: left nephrectomy for renal tuberculosis and non-Hodgkin's lymphoma treated with chemotherapy (QT) and radiotherapy. She presented with a 2-month history of non-tender, left inguinal lymph node enlargement. Positron Emission Tomography (PET)-CT -scanshowed hypermetabolic inguinal and retroperitoneal lymphadenopathies, no primary tumour. On the second dermatological examination a pink, 2 cm plaque on the anterior left knee was noted. The histopathological analysis revealed Merkel cell carcinoma. The patient underwent two lines of systemic QT, with life-threatening toxicities limiting treatment. Followed overwhelming disease progression with lymphoedema and numerous skin metastases in the left lower limb. The patient received palliative care until death. The rare incidence of such neoplasia and its uncommon clinical presentation justifies reporting this case and highlights the importance of multidisciplinary teams in the management of cancer patients.info:eu-repo/semantics/publishedVersio

not so rare after all

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Experiência no curso de estudantes de 1º ano – um estudo no âmbito das tutorias de acompanhamento na Universidade de Évora

O presente estudo pretende conhecer a experiência no curso de estudantes de 1º ano que ingressaram na Universidade de Évora no final do 1º semestre. Estudos realizados sobre a percepção dos estudantes relativa ao contexto de aprendizagem no ensino superior indicam forte relação com as abordagens à aprendizagem e apresentam forte relevância para a compreensão da forma como os estudantes acedem ao conhecimento e para a definição de processos de aprendizagem de elevada qualidade (Entwistle, 2009; Chaleta & Entwistle, 2011). Os dados foram obtidos através da aplicação do CEQP (Ramsden, 2005; 2006; Chaleta et al, 2012) com 565 estudantes de diferentes cursos e áreas científicas. Os resultados indicaram que a experiência no curso é positiva para o conjunto dos estudantes havendo necessidade de observar com mais atenção as questões relacionadas com a avaliação. A grande maioria dos estudantes revela também satisfação com o curso que frequenta. Palavras-Chave: Experiência no Curso; Tutorias de Acompanhamento; CEQP; Ensino Superior. Abstract This study examine the experience in the course of the 1st year students who entered at the University of Évora. Studies on the perception of students on the learning environment in higher education indicate a strong relationship with the approaches to learning and have strong relevance to the understanding how students access the knowledge and the definition of high quality learning processes (Entwistle, 2009; Chaleta & Entwistle, 2011). The data were obtained by applying the CEQP (Ramsden, 2005, 2006; Chaleta et al, 2012) with 565 students from different courses and scientific areas. The results indicated that the course experience is positive for all the students but we need to look more closely at the issues related to assessment. The vast majority of students also reveals satisfaction with the course who attends Keywords: Course Experience; Mentor Monitoring; CEQP; Higher Education

Clinical course of physiotherapy treatment response in patients with chronic low back pain- a prospective cohort study with survival analysis

Trabalho apresentado 10th Congress of European Pain Federation (EFIC), 6-9 setembro de 2017, Copenhaga, DinamarcaN/

Pilomatrixoma Recurring As Giant Form

Pilomatrixoma is a benign skin tumor that originates from the hair matrix. It usually appears in children and young adults and is preferably in the head and neck region. It clinically presents as an asymptomatic firm, solitary subcutaneous mass of less than 3 cm. When located in the preauricular area, it is often misdiagnosed as benign or malignant parotids, skin tumors, or sebaceous cysts. Its treatment of choice is surgery, and recurrence is due to incomplete excision. We present a case of a male referred to our hospital with a diagnosis of recurrent pilomatrixoma in its giant form. The lesion was fully excised with no signs of recurrence and no functional impairment.info:eu-repo/semantics/publishedVersio

Avaliação Retrospetiva da Reconstrução Oncológica da Cabeça e Pescoço com 114 Retalhos Livres num Centro Oncológico Terciário Português

Introduction: The Portuguese experience in microsurgical reconstruction of the head and neck after oncological surgery is scantly described. The primary aim of this study was to characterize the use of microvascular reconstruction after head and neck tumor resection in a Portuguese tertiary oncological centerMaterial and Methods: The authors retrospectively evaluated 114 microvascular free flap procedures performed for head and neck reconstruction after oncological resection in a department of Head and Neck Surgery of a Portuguese tertiary oncological center. Patients were operated on from January 2012 to May 2018. Data on patient demographic features, tumour characteristics, perioperative complications, postoperative aesthetic and functional results, survival time and time to recurrence were extracted. Results: Most tumours mandating microsurgical reconstruction were mucosal squamous cell carcinomas (85%) and were located in the oral region (95.6%). Around 45% of the patients had a T4a tumour and 30% a T2 tumour. Cervical metastases were present in 45.6% of the cases. The radial forearm flap and the fibular flap were the most commonly used microsurgical reconstructive options (58% and 41%, respectively). More than 80% of patients had no post-operative complications. Partial necrosis of the flap occurred in 6.1% of patients, while total flap necrosis occurred in 3.5% of cases. Aesthetic and functional results were considered at least satisfactory in all patients in which the flaps survived. Discussion: This study is by far the largest series of microsurgical head and neck reconstruction after oncological surgery reported by a single tertiary centre in Portugal. Survival and functional benefits are similar to those reported in other large oncological centres in the world. Conclusion: Microvascular reconstruction seems like a reliable treatment option in head and neck oncological surgery at our institution.info:eu-repo/semantics/publishedVersio

Duodenal duplication cyst complicated by haemorrhage

A 61-year-old male presented to the hospital with a 5-day history of epigastric pain, vomiting and regurgitation. The physical examination was positive only for upper abdominal tenderness. Laboratory findings were unremarkable

Congenital cystic lesions of the biliary tree

OBJECTIVE: The purpose of this essay is to illustrate the imaging findings of congenital cystic lesions of the biliary tract. CONCLUSION: Congenital cystic lesions of the biliary tract include ductal plate malformations and choledochal cysts and can be recognized with characteristic imaging findings and basic knowledge of the embryologic development of the biliary tree

Usefulness of Perfusion CT to Assess Response to Neoadjuvant Combined Chemoradiotherapy in Patients with Locally Advanced Rectal Cancer

RATIONALE AND OBJECTIVES: To prospectively evaluate perfusion computed tomography (CT) for assessment of changes in tumor vascularity after chemoradiation therapy (CRT) in locally advanced rectal cancer and to analyze the correlation between baseline perfusion parameters and tumor response. MATERIALS AND METHODS: Twenty patients with rectal cancer underwent baseline perfusion CT before CRT, and in 11 an examination after CRT was also performed. For each tumor, blood flow (BF), blood volume (BV), mean transit time (MTT), and permeability-surface area product (PS) were quantified. The Mann-Whitney U test compared baseline perfusion parameters of responders and nonresponders and pre- and post-CRT measurements were compared by the Wilcoxon signed-rank test (P < .05 statistically significant for both tests). RESULTS: Baseline BF was significantly lower (P = .013) and MTT was significantly higher (P = .006) in responders. Both were able to discriminate responders from nonresponders with a sensitivity of 80% and 100% and a specificity of 73.3% and 86.7%, respectively, for BF and MTT. Baseline BV and PS were not significantly different in responders and nonresponders. Perfusion parameters changed significantly in post-CRT scans compared to baseline: BF (P = .003), BV (P = .003), and PS (P = .008) decreased, whereas MTT increased (P = .006). CONCLUSION: Baseline BF and MTT can discriminate patients with a favorable response from those that fail to respond to CRT, potentially selecting high-risk patients with resistant tumors that may benefit from an aggressive preoperative treatment approach