Factores de recidiva de Bócio

Dissertação de Doutoramento em Medicina apresentada à Faculdade de Medicina da Universidade do PortoA recidiva de bócio nodular representa um problema sério. Várias taxas de recidiva têm sido publicadas, a maioria apontando para valores entre 0% e 35%, não havendo, no entanto, consenso em relação aos critérios utilizados na sua definição (critérios clínicos, ecográficos e cirúrgicos).A recidiva de bócio constitui a causa mais comum de reintervenção cirúrgica sobre a glândula tireoideia. O risco de complicações resulta, essencialmente, da dissecção do tecido cicatricial, junto ao nervo recurrente e ao pedículo vascular das glândulas paratireoideias, e é maior que na cirurgia inicial. Por isso, é importante prevenir a recidiva de bócio e as reintervenções. Não há, também, consenso sobre a abordagem cirúrgica do bócio em relação à extensão da ressecção, porque a sua história natural e a da recidiva não estão bem esclarecidas, e são desconhecidos os factores de que depende essa recidiva.O objectivo deste trabalho foi estudar a prevalência da recidiva do bócio, a sua história natural e os factores que a podem influenciar, numa tentativa de clarificação dos mecanismos subjacentes ao seu desenvolvimento.Numa população constituída por 249 doentes operados por bócio nodular entre 1971 e 1989, efectuamos os estudos a seguir discriminados:1. Determinação da prevalência da recidiva.2. Estudo da influência dos seguintes factores na recidiva: género, escolaridade, tempo de evolução pré-operatória, extensão da cirurgia, idade à data da cirurgia, histologia da lesão inicial, terapêutica pós-operatória com a levotiroxina, história familiar de bócio, tireoglobulina e TSH séricas, iodúria e tempo decorrido desde a cirurgia.3. Estudo da relação entre a recidiva de bócio e o número de nódulos, a imunorreactividade nos nódulos da peça inicial para a citoqueratina 19 (desenvolvimento neoplásico), MIB-1 (proliferação celular) e vimentina (estudo da vascularização).4. Estudo da relação entre a recidiva de bócio e as populações linfocitárias do sangue periférico (linfócitos T hel ..

Bile duct injuries during laparoscopic cholecystectomy

Introduction: Most studies on the subject have shown that bile duct injury (BDI) occurs more commonly in laparoscopic cholecystectomy than in the open procedure. Even though there is a certain awareness of this problem, more attention should be paid to early recognition and prevention of BDI. Methods: A review of English language literature from the last 15 years on the occurrence, management and prevention of bile duct injury was performed. Older benchmark articles on the subject were also included. Data resources: PubMed and Scopus database research. Results: Approximately 1500 articles came as a result of searching the keywords “bile duct injuries”and “laparoscopic cholecystectomy”. A selection of 68 articles was made based on the abstract, directed according the subject of interest for the discussion of this review and 49 were included on the bibliography, for being considered of most interest. Conclusions: Bile duct injury could be avoided by proper and precise anatomical identification and careful dissection. Intraoperative cholangiography helps in decreasing incidence and early recognition, in case of an injury. Improved outcome is related to early detection and repair

Real-time tracking system for a moored oil tanker: a kalman filter approach

This paper presents a tracking system developed to study the behavior of an oil tanker moored at the Berth "A" of the Leixões oli terminal, Porto, Portugal

Robust and real-time motion capture of rigid bodies based on stereoscopic vision

This paper presents a stereoscopic vision system developed to measure the motion of rigid bodies in real-time along its six degrees of freedom (6DOF). The idea was to use it in the measurement of the motions of a full-scale oil tanker moored at the oil terminal of the Port of Leixões, Portugal, in the scope of an R&D project. Prior to its installation on site the system was tested and validated in laboratory. For that, use was made of ongoing physical modeltests of the behaviour of a moored oil tanker (scale 1/100). To analyse its accuracy the results obtained with the developed system were compared with a commercial motion capture system built for "in house" applications

Real-time tracking system for a moored oil tanker : a kalman filter approach

This paper presents a tracking system developed to study the behavior of an oil tanker moored at the Berth “A” of the Leixões Oil Terminal, Porto, Portugal. A brief description of the local environmental conditions and the existing operational conditions at that oil terminal are presented. Due to extreme outdoor working conditions a Kalman filter was implemented to ensure the robustness and reliability of the obtained measurements. Tests were performed in laboratory on a physical model of a moored oil tanker at a scale 1/100. The results were compared with a commercial motion capture system installed in laboratory. The presented measurement system was developed as part of the DOLPHIN project that aims to study the behavior of moored ships in harbors

Inflammatory and Cardiometabolic Risk on Obesity: Role of Environmental Xenoestrogens

Some chemicals used in consumer products or manufacturing (eg, plastics, pesticides) have estrogenic activities; these xenoestrogens (XEs) may affect immune responses and have recently emerged as a new risk factors for obesity and cardiovascular disease. However, the extent and impact on health of chronic exposure of the general population to XEs are still unknown.info:eu-repo/semantics/publishedVersio

Persistent organic pollutant levels in human visceral and subcutaneous adipose tissue in obese individuals - Depot differences and dysmetabolism implications

Background: The role of persistent organic pollutants (POPs) with endocrine disrupting activity in the aetiology of obesity and other metabolic dysfunctions has been recently highlighted. Adipose tissue (AT) is a common site of POPs accumulation where they can induce adverse effects on human health. Objectives: To evaluate the presence of POPs in human visceral (vAT) and subcutaneous (scAT) adipose tissue in a sample of Portuguese obese patients that underwent bariatric surgery, and assess their putative association with metabolic disruption preoperatively, as well as with subsequent body mass index (BMI) reduction. Methods: AT samples (n=189) from obese patients (BMI ≥35) were collected and the levels of 13 POPs were determined by gas chromatography with electron-capture detection (GC-ECD). Anthropometric and biochemical data were collected at the time of surgery. BMI variation was evaluated after 12 months and adipocyte size was measured in AT samples. Results: Our data confirm that POPs are pervasive in this obese population (96.3% of detection on both tissues), their abundance increasing with age (RS=0.310, p<0.01) and duration of obesity (RS=0.170, p<0.05). We observed a difference in AT depot POPs storage capability, with higher levels of ΣPOPs in vAT (213.9±204.2 compared to 155.1±147.4 ng/g of fat, p<0.001), extremely relevant when evaluating their metabolic impact. Furthermore, there was a positive correlation between POP levels and the presence of metabolic syndrome components, namely dysglycaemia and hypertension, and more importantly with cardiovascular risk (RS=0.277, p<0.01), with relevance for vAT (RS=0.315, p<0.01). Finally, we observed an interesting relation of higher POP levels with lower weight loss in older patients. Conclusion: Our sample of obese subjects allowed us to highlight the importance of POPs stored in AT on the development of metabolic dysfunction in a context of obesity, shifting the focus to their metabolic effects and not only for their recognition as environmental obesogens

Persistent organic pollutant levels in human visceral and subcutaneous adipose tissue in obese individuals - Depot differences and dysmetabolism implications

Background: The role of persistent organic pollutants (POPs) with endocrine disrupting activity in the aetiology of obesity and other metabolic dysfunctions has been recently highlighted. Adipose tissue (AT) is a common site of POPs accumulation where they can induce adverse effects on human health. Objectives: To evaluate the presence of POPs in human visceral (vAT) and subcutaneous (scAT) adipose tissue in a sample of Portuguese obese patients that underwent bariatric surgery, and assess their putative association with metabolic disruption preoperatively, as well as with subsequent body mass index (BMI) reduction. Methods: AT samples (n=189) from obese patients (BMI ≥35) were collected and the levels of 13 POPs were determined by gas chromatography with electron-capture detection (GC-ECD). Anthropometric and biochemical data were collected at the time of surgery. BMI variation was evaluated after 12 months and adipocyte size was measured in AT samples. Results: Our data confirm that POPs are pervasive in this obese population (96.3% of detection on both tissues), their abundance increasing with age (RS=0.310, p<0.01) and duration of obesity (RS=0.170, p<0.05). We observed a difference in AT depot POPs storage capability, with higher levels of ΣPOPs in vAT (213.9±204.2 compared to 155.1±147.4 ng/g of fat, p<0.001), extremely relevant when evaluating their metabolic impact. Furthermore, there was a positive correlation between POP levels and the presence of metabolic syndrome components, namely dysglycaemia and hypertension, and more importantly with cardiovascular risk (RS=0.277, p<0.01), with relevance for vAT (RS=0.315, p<0.01). Finally, we observed an interesting relation of higher POP levels with lower weight loss in older patients. Conclusion: Our sample of obese subjects allowed us to highlight the importance of POPs stored in AT on the development of metabolic dysfunction in a context of obesity, shifting the focus to their metabolic effects and not only for their recognition as environmental obesogens

Tratamento cirúrgico do hiperparatiroidismo primário não familiar

O hiperparatiroidismo primário é uma doença endócrina comum e a principal causa de hipercalcemia na comunidade. Nas últimas décadas, o número de casos tem aumentado devido à realização de rastreios bioquímicos de rotina com doseamento de cálcio. O diagnóstico é feito, maioritariamente na fase assintomática, através de doseamento de cálcio e PTH. O tratamento cirúrgico representa a única possibilidade de cura. A cirurgia está indicada na maioria dos doentes sintomáticos e em casos selecionados de assintomáticos. Uma vez que até 90% dos casos se devem a adenoma único, e graças aos avanços recentes das técnicas de localização pré-operatória e doseamento intra-operatório da PTH, o tratamento tradicional com exploração bilateral tem vindo a ser substituído pela paratiroidectomia seletiva com taxas de cura e de complicações semelhantes. Existe controvérsia sobre qual o melhor método de localização pré-operatória, monitorização intra-operatória da PTH e a melhor estratégia cirúrgica. A decisão final deve ser baseada no doente, na experiência do cirurgião e nos recursos da instituição