Groove Pancreatitis with Biliary and Duodenal Stricture: An Unusual Cause of Obstructive Jaundice

INTRODUCTION: Groove pancreatitis is an uncommon cause of chronic pancreatitis that affects the groove anatomical area between the head of the pancreas, duodenum, and common bile duct. CLINICAL CASE: A 67-year-old man with frequent biliary colic and an alcohol consumption of 30-40 g/day was admitted to the hospital complaining of jaundice and pruritus. Laboratory analysis revealed cholestasis and the ultrasound scan showed intra-hepatic biliary ducts dilatation, middle third cystic dilatation of common bile duct, enlarged Wirsung and pancreatic atrophy. The magnetic resonance cholangiopancreatography showed imaging findings compatible with groove pancreatitis. An esophagogastroduodenoscopy later excluded duodenal neoplasia. He was submitted to a Roux-en-Y cholangiojejunostomy because of common bile duct stricture. Five months later a gastrojejunostomy was performed due to a duodenal stricture. The patient remains asymptomatic during follow-up. DISCUSSION: Groove pancreatitis is a benign cause of obstructive jaundice, whose main differential diagnosis is duodenal or pancreatic neoplasia. When this condition causes duodenal or biliary stricture, surgical treatment can be necessary.info:eu-repo/semantics/publishedVersio

Perioperative tumor cell dissemination in patients with primary or metastatic colorectal cancer

INTRODUCTION: Although there is general correlation between the TNM stage of colorectal cancer (CRC) and its prognosis, there is often significant variability of tumor behaviour and individual patient outcome, which is unaccounted for by pathologic factors alone. Our aim was to estimate perioperative tumor cell dissemination in patients with primary or CRC liver metastases as a possible factor influencing the outcome. METHODS: Forty patients were prospectively enrolled in the study from the year 2007 to 2008. Eighteen patients had histologically proven CRC (50% rectal, 44% colonic, 6% colonic and rectal). Sixteen patients (47%) had CRC liver metastases only. The remaining six patients who underwent colon or liver resection for benign conditions, acted as the control group. All patients with malignant pathologies had R0 resections. Blood samples were taken before the surgical incision (T0), immediately after tumor resection (T1) and at the end of the surgical intervention (T2). Data acquisition was performed using a dual-laser FACSCalibur flow cytometer. Circulating malignant cells were identified as being CD45-/cytokeratin+. RESULTS: The analysis of patients overall (CRC resection subgroup and hepatectomy subgroup) revealed that there was no statistically significant difference of the tumoral cell count in the blood per million of hematopoietic cells at T0, T1 and T2. CONCLUSIONS: This study demonstrates no differences in the detected circulating numbers of tumor cells at different stages of surgical intervention

Venoarterial extracorporeal membrane oxygenation bridge to HeartMate 3: An Iberian first

info:eu-repo/semantics/publishedVersio

Acção anti-cancerígena da Quercetina no Carcinoma Hepatocelular: o papel do GLUT-1

Hepatocellular Carcinoma (HCC) is one of the most fatal cancers, with rising incidence. Without specific treatment, the prognosis is very poor and diminished survival. The most effective therapy is liver transplantation and complete surgical resection, however, since only 15% of patients are candidates for such therapies, a wide range of patients are subjected to treatment with conventional therapies, and the rate success is greatly diminished. It is thought that the expression of glucose transporter 1 (GLUT-1) may be altered in HCC. A recent study showed that suppression of GLUT-1 expression, using siRNA (small interfering RNA) could significantly reduce tumorigenesis in HCC cell lines, suggesting that GLUT-1 may be a therapeutic target for this highly aggressive tumor. Thus, this project aims to evaluate the anticancer effect of quercetin, a possible inhibitor of GLUT-1, in a human HCC cell line HepG2, as well as check the effect of theis compound on 18F-FDG (a glucose radiolabelled analogue) uptake in this cell line. These results shown that quercetin have anti-proliferative effect on HCC cell line studied. This compound also have shown ability to decrease the 18F-FDG uptake. However, using flow cytometry it was found that HepG2 cells remain viable after treatment with quercetin, and this compound doesn’t inhibit the GLUT-1 protein expression. These results indicate that quercetin inhibits the GLUT-1 function, but doesn’t inhibit the expression of this transporter.Keywords: Quercetin, Hepatocellular Carcinoma, GLUT-1 O Carcinoma Hepatocelular (CHC) é um dos cancros mais letais, com uma crescente incidência em diversas regiões por todo o mundo. Sem tratamento específico, o prognóstico é muito pobre e a sobrevida diminuta. A terapia mais eficaz consiste no transplante hepático e na ressecção cirúrgica, no entanto, e uma vez que apenas 15% dos doentes são candidatos a tratamento cirúrgico, torna-se urgente a procura de novas opções terapêuticas para este tipo de tumor. Alguns estudos demonstraram que a expressão do transportador de glucose-1 (GLUT-1) pode estar alterada neste tipo de tumor. Um estudo recente demonstrou que a supressão da expressão de GLUT-1, recorrendo a siRNA (small interfering RNA) conseguiu reduzir significativamente a tumorigénese em culturas celulares de CHC, sugerindo que o GLUT-1 pode ser um alvo terapêutico para este tipo de tumor altamente agressivo. Assim, o objectivo deste trabalho experimental foi avaliar o efeito anti-cancerígeno da quercetina, um possível inibidor do GLUT-1, numa linha celular humana de CHC (HepG2, ATCC), assim como avaliar o seu efeito na captação de 18F-FDG, um análogo da glucose radiomarcado com Flúor-18. Com os resultados obtidos verificou-se que a quercetina possui a capacidade de inibir a proliferação da linha celular em estudo e, para além disso, parece ter influência na captação de 18F-FDG já que conseguiu diminuir a percentagem de captação do radiofármaco nesta linha celular. No entanto, através da técnica de citometria de fluxo verificou-se que as células permanecem viáveis, e que este composto não inibe a expressão proteica do GLUT-1. Estes resultados indicam que a quercetina inibe este transportador de glucose quanto à função, mas não quanto à expressão. Palavras-chave: Quercetina, Carcinoma Hepatocelular, GLUT-1

Cardiac Intensive Care in Portugal: the Time for Change

In recent years, the number of patients requiring acute cardiac care has increased, with progressively more complex cardiovascular conditions, often complicated by acute or chronic non-cardiovascular comorbidities, which affects the management and prognosis of these patients. Coronary care units have evolved into cardiac intensive care units, which provide highly specialized health care for the critical heart patient. In view of the limited human and technical resources in this area, we consider that there is an urgent need for an in-depth analysis of the organizational model for acute cardiac care, including the definition of the level of care, the composition and training of the team, and the creation of referral networks. It is also crucial to establish protocols and to adopt safe clinical practices to improve levels of quality and safety in the treatment of patients. Considering that acute cardiac care involves conditions with very different severity and prognosis, it is essential to define the level of care to be provided for each type of acute cardiovascular condition in terms of the team, available techniques and infrastructure. This will lead to improvements in the quality of care and patient prognosis, and will also enable more efficient allocation of resources.info:eu-repo/semantics/publishedVersio

Cinética da regeneração hepática e sua correlação com a função hepática após hepatectomia

Resumo da comunicação apresentado ao XII Congresso Nacional de Medicina Nuclear, 12-14 Novembro 2009, Mealhad

Estudo da cinética da regeneração hepática no homem pós-hepatectomia por métodos radioisotopicos

Resumo da comunicação apresentado ao XII Congresso Nacional de Medicina Nuclear, 12-14 Novembro 2009, Mealhad

MRI-conditional pacemakers: current perspectives

António M Ferreira,1,2 Francisco Costa,2 António Tralhão,2 Hugo Marques,3 Nuno Cardim,1 Pedro Adragão1,2 1Cardiology Department, Hospital da Luz, 2Cardiology Department, Hospital Santa Cruz- CHLO, 3Radiology Department, Hospital da Luz, Lisbon, Portugal Abstract: Use of both magnetic resonance imaging (MRI) and pacing devices has undergone remarkable growth in recent years, and it is estimated that the majority of patients with pacemakers will need an MRI during their lifetime. These investigations will generally be denied due to the potentially dangerous interactions between cardiac devices and the magnetic fields and radiofrequency energy used in MRI. Despite the increasing reports of uneventful scanning in selected patients with conventional pacemakers under close surveillance, MRI is still contraindicated in those circumstances and cannot be considered a routine procedure. These limitations prompted a series of modifications in generator and lead engineering, designed to minimize interactions that could compromise device function and patient safety. The resulting MRI-conditional pacemakers were first introduced in 2008 and the clinical experience gathered so far supports their safety in the MRI environment if certain conditions are fulfilled. With this technology, new questions and controversies arise regarding patient selection, clinical impact, and cost-effectiveness. In this review, we discuss the potential risks of MRI in patients with electronic cardiac devices and present updated information regarding the features of MRI-conditional pacemakers and the clinical experience with currently available models. Finally, we provide some guidance on how to scan patients who have these devices and discuss future directions in the field. Keywords: pacemakers, magnetic resonance imaging, MRI, MRI-conditional devices, safet