Incidental diagnosis of breast cancer in the pursuit of the treatment of intestinal obstruction

Intestinal lipomatosis is rare and often asymptomatic but can present with intestinal obstruction. Occasionally, metastatic breast cancer is identified in the ovary before a breast primary is discovered. We report the case of a 50-year-old woman diagnosed with synchronous intestinal obstruction due to lipomatosis, and incidental ovarian metastases from breast cancer. The patient presented with a 12-day history of nausea, diffuse abdominal pain, and constipation. An abdominal x-ray showed air-fluid levels, and computed tomography documented small bowel distention. An explorative laparotomy was performed, which revealed small bowel distention, an obstructive lesion of the ileocecal valve, three terminal ileum lesions, ascites, and heterogeneous ovaries. Right ileocolic resection and left oophorectomy were performed. The pathological diagnosis revealed lipomatous submucosal lesion of the ileocecal valve and ileum, and 17 lymph nodes, which were all negative for malignant cells. The oophorectomy revealed ovarian metastasis from breast carcinoma. Ascitic fluid was positive for malignant cells. Mammography and breast/axillary ultrasonography showed a solid nodule of the left breast, ductal carcinoma, and multiple enlarged left axillary lymph nodes, which were positive for neoplastic cells. Immunohistochemical evaluation showed hormonal receptor positivity and C-erb2 negativity. Breast magnetic resonance imaging showed a 14 mm left nodule and a positron emission tomography scan revealed 18F-FDG uptake in the left breast, left axillary lymph nodes, right ovary, and peritoneum. The tumor was staged as stage IV ductal breast carcinoma, cT1N1M1, Grade 2, Luminal B-like. The multidisciplinary oncological meeting proposed chemotherapy, and a re-staging breast MRI after chemotherapy, which showed a complete response. The patient started treatment with letrozole and remains disease-free 22 months after finishing chemotherapy

VARIANTE ANATÓMICA DA ARTÉRIA HEPÁTICA: IMPORTÂNCIA DO PLANEAMENTO PRÉ-OPERATÓRIO

Anatomic variations of the hepatic artery are not uncommon and may lead to iatrogenic injuries during pancreatoduodenectomy (PD). Two classifications (Michels’ and Hiatt’s) have been used to describe the different variations. Ligation of an aberrant hepatic artery may result in life-threatening complications, such as liver necrosis. Preoperative imaging is crucial for detection of these variations.As variações anatómicas da artéria hepática não são incomuns e podem levar a lesões iatrogénicas durante a duodenopancreatectomia. Duas classificações (Michels´e Hiatt´s) têm sido usadas para descrever as diferentes variações conhecidas. A laqueação da artéria hepática aberrante pode resultar em complicações graves, como necrose hepática. O estudo cuidado das imagens pré-operatórias é crucial para a deteção destas variações. &nbsp

CORREÇÃO CIRÚRGICA DE RECIDIVA DE HÉRNIA DA REGIÃO SACROCOCCÍGEA APÓS RESSECÇÃO DE UM TUMOR PRÉ-SAGRADO: ABORDAGEM POSTERIOR (PROCEDIMENTO DE KRASKE)

Presacral tumors are rare and mostly congenital. If, on the one hand, the Kraske procedure ensures complete excision, reducing local recurrence, on the other hand, it has the development of an incisional sacral hernia as a complication. We present a case of a 44-year-old woman with a relapsing sacral hernia after a posterior approach (Kraske procedure) for the resection of a presacral extra-ovarian fibroma. We describe a surgical repair with dual mesh via a posterior open approach. Twelve months after this surgical procedure, the patient shows no signs of recurrence. To the best of our knowledge, this is the first report, in the literature, on surgical correction of presacral hernia after a Kraske procedure.Os tumores pré-sagrados são raros e, maioritariamente, têm origem congénita. Embora a via posterior (procedimento de Kraske) assegure uma excisão completa, com diminuição da taxa de recidiva, tem como complicação possível o desenvolvimento de hérnia incisional sagrada. Os autores apresentam o caso de uma mulher de 44 anos com o diagnóstico de hérnia sagrada recidivante após resseção de fibroma extraovárico por via posterior. Neste artigo, é descrita a correção cirúrgica com prótese plana por via aberta posterior da hérnia descrita. Doze meses após a correção, a doente não apresenta sinais ou sintomas sugestivos de recidiva. Este caso clínico é o primeiro, na literatura, a descrever a correção cirúrgica de uma hérnia incisional após cirurgia de resseção tumoral por via de Kraske

Patient-reported outcomes and experiences assessment in women with breast cancer: Portuguese case study

In 2020, female breast cancer was the most commonly diagnosed cancer worldwide, representing the type of cancer with the highest incidence among women and the second most common cause of cancer death among women in all OECD countries. The conventional measures addressing the burden of breast cancer by measuring mortality, incidence, and survival do not entirely reflect the quality of life and patients' experience when receiving breast cancer care. The main objective of this study is to capture patient-reported outcomes and experiences in women with breast cancer in Portugal using methods developed for international benchmarking purposes, such as the OECD Patient-reported Indicators Surveys. The study included 378 women with breast cancer, with the age distribution being 19.8% aged 15 to 49 years and 80.2% aged 50 years and over. The data collection procedure and analysis followed the "OECD Breast Cancer Patient Reported Outcomes Working Group" protocol, allowing subsequent comparability with data from other OECD member countries. Most women were satisfied with the treatment outcome regarding the shape of their lumpectomy breasts when wearing a bra (96.1%) and with the equal size of both breasts (78.3%). Findings on the WHO QOL-BREF showed that women manifest a lower score in well-being when compared with the general population or populations living with chronic diseases. This study shows the feasibility of implementing and using patient-reported metrics (PROM and PREM) in breast cancer services in Portugal. Measuring PROMs and PREMs from Portuguese women receiving breast cancer care provides insightful evidence of the quality and value of cancer care.info:eu-repo/semantics/publishedVersio

Recomendações e Consensos do Grupo de Estudos de Esclerose Múltipla e da Sociedade Portuguesa de Neurorradiologia sobre Ressonância Magnética na Esclerose Múltipla na Prática Clínica: Parte 1

Magnetic resonance imaging is established as a recognizable tool in the diagnosis and monitoring of multiple sclerosis patients. In the present, among multiple sclerosis centers, there are different magnetic resonance imaging sequences and protocols used to study multiple sclerosis that may hamper the optimal use of magnetic resonance imaging in multiple sclerosis. In this context, the Group of Studies of Multiple Sclerosis and the Portuguese Society of Neuroradiology, after a joint discussion, appointed a committee of experts to create recommendations adapted to the national reality on the use of magnetic resonance imaging in multiple sclerosis. The purpose of this document is to publish the first Portuguese consensus recommendations on the use of magnetic resonance imaging in multiple sclerosis in clinical practice.This work had a investigational grant from Roche Farmaceutica Quimica LDA: EPAM129844-G.info:eu-repo/semantics/publishedVersio

Recommendations about multiple sclerosis management during pregnancy, partum and post-partum : consensus position of the Portuguese Multiple Sclerosis Study Group

Copyright © Ordem dos Médicos 2020Multiple sclerosis typically affects young women of reproductive age. Therefore, all healthcare professionals involved in the follow-up of multiple sclerosis patients must be prepared to discuss pregnancy and breastfeeding issues and provide the best possible counselling. However, there are still many doubts and heterogeneous clinical approaches partly due to the lack of consensus and guidelines. Concerning the handling of disease modifying therapies during pregnancy and postpartum, existing uncertainties have been complicated by the increase in the number of treatments available in recent years. This article aims to present the state-of-the-art and provide guidance based on the best level of available evidence and expert opinion regarding the management of multiple sclerosis patients at different stages: pregnancy planning, pregnancy, partum, and the postpartum period.Este trabalho teve o financiamento de uma bolsa de investigação da Roche Farmacêutica Química LDA: EPAM129844-G.info:eu-repo/semantics/publishedVersio

Avaliação biomecânica de implantes osseointegráveis curtos hexágono externo e cone morse na maxila posicionados em diferentes níveis ósseos (M.E.F) / Biomechanical avaliation of short external hexagon and cone morse implants in the maxillary positioned at different bone levels (F.E.M)

Os implantes osseintegráveis curtos representam uma opção de tratamento previsível e são indicados para situações com pouca disponibilidade óssea vertical. Os esforços matigatórios geram tensões no osso ao redor dos implantes osseointegráveis que podem causar reabsorções ósseas, condição que pode comprometer a terapia com implantes curtos. Este trabalho teve como objetivo avaliar pelo método dos elementos finitos bidimensional a biomecânica de implantes curtos osseointegráveis hexágono externo (HE) e cone morse (CM) na maxila em diferentes níveis ósseos. Utilizando o software Rhinoceros®, foram confeccionados três modelos virtuais simulando a região de primeiro molar superior, sendo M1 com implante curto HE (5 mm x 7 mm), M2 com implante curto CM (5 mm x 6 mm) posicionado a nível ósseo e M3 com implante curto CM (5 mm x 5 mm) 2 mm infraósseo. Através do software Patran®, as malhas e condições de contorno foram geradas. A restrição de movimento foi feita na base da maxila e forças de 100N no sentido axial e oblíquo foram distribuídas sobre toda superfície oclusal. As tensões obtidas foram analisadas pelo critério de von Misses e somente na parte óssea foi utilizado o critério de tração compressão. As tensões no osso na carga oblíqua foram maiores que na carga axial nas três situações. Os modelos com os implantes curtos cone morse distribuíram melhor a tensão no osso em relação ao HE. Na carga axial o implante curto infra ósseo distribuiu melhor a tensão e na carga oblíqua, condição mais próxima da realidade, o implante curto cone morse no nível ósseo distribuiu melhor a tensão. As conclusões foram que os implantes curtos com conexão morse são mais favoráveis ao tecido ósseo e os HE menos favoráveis. E que em situações com pouca disponibilidade óssea vertical os implantes curtos cone morse posicionados no nível ósseo são mais favoráveis ao osso, ao ponto de vista de dissipação de carga e tensão

Recommendations about multiple sclerosis management during pregnancy, partum and post-partum: consensus position of The Portuguese Multiple Sclerosis Study Group and The Portuguese Society of Obstetrics and MaternalFetal Medicine

A esclerose múltipla afeta tipicamente mulheres jovens em idade reprodutiva. Desta forma, todo os profissionais de saúde envolvidos no seguimento destes doentes deverão estar preparados para abordar as questões relacionadas com a gravidez e amamentação e fornecer o melhor aconselhamento possível. No entanto, existem ainda muitas dúvidas e abordagens clínicas heterogéneas em parte devido à ausência de consensos e normas orientadoras. No que concerne ao manuseamento das terapêuticas modificadoras de doença durante os períodos de gravidez e pós-parto, as incertezas têm sido agravadas devido ao aumento do número de fármacos disponíveis nos últimos anos. Este artigo visa apresentar a informação mais atual e fornecer orientações baseadas no melhor nível de evidência disponível e na opinião de peritos relativamente ao seguimento das doentes com esclerose múltipla em diferentes etapas: planificação da gravidez, gravidez, parto e período pós-parto.Multiple sclerosis typically affects young women of reproductive age. Therefore, all healthcare providers involved in the follow-up of multiple sclerosis patients must be prepared to discuss pregnancy and breastfeeding issues, and provide the best possible counselling. However, there are still many doubts and heterogeneous clinical approaches partly due to the lack of consensus and guidelines. Concerning the handling of disease modifying therapies during pregnancy and the postpartum period, uncertainties have been complicated by the increase in recent years of the number of available treatments. This article aims to present the state-of-the-art and provide guidance based on the best level of available evidence and expert opinion regarding the management of multiple sclerosis patients at different stages: pregnancy planning, pregnancy, partum, and the postpartum period

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio