Publications by authors named "Margarida Marques"

71 Publications

Clinical and pathological characterization of colon lymphomas.

Dig Liver Dis 2021 Jan 25. Epub 2021 Jan 25.

Gastroenterology Department, Centro Hospitalar de São João, Porto 4200-319, Portugal.

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http://dx.doi.org/10.1016/j.dld.2021.01.001DOI Listing
January 2021

Mantle cell lymphoma: A rare cause of colon polyposis.

Gastroenterol Hepatol 2020 Nov 9. Epub 2020 Nov 9.

Pathology Department, Centro Hospitalar de São João, Porto, Portugal.

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http://dx.doi.org/10.1016/j.gastrohep.2020.06.036DOI Listing
November 2020

Choosing the best approach for laterally spreading lesions at the anorectal junction.

Gut 2021 May 31;70(5):1003-1004. Epub 2020 Jul 31.

Gastroenterology Department, Centro Hospitalar S João, Faculty of Medicine, Porto, Portugal.

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http://dx.doi.org/10.1136/gutjnl-2020-322392DOI Listing
May 2021

Baseline anaemia increases locally advanced rectal cancer mortality in older patients undergoing preoperative chemoradiation.

Support Care Cancer 2021 Mar 15;29(3):1403-1411. Epub 2020 Jul 15.

Department of Radiotherapy, Centro Hospitalar Universitário de São João, E.P.E., 4200-319, Porto, Portugal.

Purpose: The median diagnosis age of rectal cancer (RC) is 70 years old. The standard of care for locally advanced RC (LARC) is preoperative chemoradiation (CRT) followed by surgery. Anaemia is a frequent condition in older patients but is not a pure consequence of ageing.

Methods: The patients aged 65 years or over, with clinical stage II/III LARC, and treated with preoperative concurrent CRT were retrospectively reviewed. Baseline haemoglobin (Hb) levels were collected.

Results: One hundred and seven patients enrolled in this study, but 17 were excluded in relation with treatment disruption. Fifty-seven (63.3%) males and 33 (36.7%) females completed preoperative CRT whose median age at diagnosis was 73. Twenty-five (27.8%) patients presented with anaemia at rectal cancer diagnosis, and median Hb was 13.5 g/dL (IQR = 1.45) and 11.2 g/dL (IQR = 1.35), for non-anaemic and anaemic patients, respectively. For the enrolled older population, only 2 patients reported acute grade 3 toxicity. Baseline anaemia tended to decrease the LARC-free interval and was associated with a significantly higher hazard of all-cause and LARC mortality, approximately 5 times (HR = 5.25; 95% CI 1.48-18.66) and 10 times (HR = 10.09; 95% CI 2.40-42.48), respectively. Patients older than 75 presented a significantly negative impact on overall survival (OS) and LARC-specific survival (HR = 6.20, 95% CI 2.00-19.22; and HR = 7.61, 95% CI 2.08-27.87, respectively). Conversely, no significant impact was found for age-adjusted Charlson comorbidity index on OS, LARC-specific survival and LARC-free interval.

Conclusions: Overall and LARC-specific survival were significantly lower for the baseline anaemic older patients and for those aged 75 years or over.
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http://dx.doi.org/10.1007/s00520-020-05618-3DOI Listing
March 2021

Screening endoscopy in patients with cirrhosis: screening of varices and gastrointestinal neoplasia.

Endoscopy 2020 07 24;52(7):623. Epub 2020 Jun 24.

Gastroenterology and Hepatology Department, Centro Hospitalar Sao Joao, Porto, Portugal.

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http://dx.doi.org/10.1055/a-1167-8190DOI Listing
July 2020

[The Impact of Patient Transfer After Rupture of an Abdominal Aortic Aneurysm].

Rev Port Cir Cardiotorac Vasc 2019 Oct-Dec;26(4):273-277

Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar e Universitário de Coimbra, Portugal.

Objective: determine whether patient transfer adversely affects the survival of ruptured abdominal aortic aneurysm (rAAA) patients after conventional surgery.

Methods: We performed a retrospective review of all patients undergoing attempted repair of an rAAA at a tertiary center, over January 2008 and December 2014. Patients were divided into those presenting directly to our center and those transferred from another hospital. The main outcome variable was 24-hour or 30-day mortality, with secondary variables including time to surgical treatment, length of intensive care unit stay and total length hospitalization.

Results: 78 patients (88% men) underwent attempted open repair of an rAAA during this period, 69% (54 cases) were transferred from another institution. Both groups were similar in terms of demographic characteristics, comorbidities and hemodynamic stability. The overall mortality rate was 51% at 30 days. Transferred patients took twice as long as direct patients to get to the operating room (median 7,9 vs. 3,9 horas, p < 0,05), Although the difference for surgery treatment, there was no difference in 24-hour and 30-day mortality between the transferred group and direct group (26% e 50% vs. 29% e 58%, p < 0,05). Mean intensive care unit stay (median, 12 vs. 4 dias, p = 0,04) and total hospitalization (median 11 vs. 4 dias, p = 0,04) were sustantially superior in the transferred group.

Conclusions: Transfer of patients with RAAA in this series results in a doubling of the time interval between initial patient presentation and arrival in the operating room. This, however, did not result in any disadvantage in the survival rate between the groups. The total length and resources consumption were higher in the transfer group. These results may be attributed to a pre-selection of patients (clinically stable) who are able to tolerate such a delay in surgical treatment, secondary to transfer.
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March 2020

Endoscopic Submucosal Dissection: Experience in Portugal.

GE Port J Gastroenterol 2020 Jan 20;27(1):71-72. Epub 2019 Aug 20.

Gastroenterology Department, Centro Hospitalar S. João, Porto, Portugal.

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http://dx.doi.org/10.1159/000501808DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6959110PMC
January 2020

Lewis score: a useful tool for diagnosis and prognosis in Crohn's disease.

Rev Esp Enferm Dig 2020 Feb;112(2):121-126

Gastrenterologia, Centro Hospitalar de São João, Portugal.

Background: videocapsule endoscopy (VCE) is currently the most sensitive diagnostic tool to detect early small bowel inflammation. A Lewis score (LS) of ≥ 135 as the cutoff value for the presence of significant inflammatory activity in patients undergoing VCE for suspected Crohn's disease (CD) has been suggested as a useful tool for the diagnosis of CD. The aim of this study was to evaluate the diagnostic and prognostic accuracy of the LS in patients with suspected CD undergoing VCE.

Methods: a retrospective single-center study was performed that included patients who underwent VCE for suspected CD between January 2010 and December 2015. Inflammatory activity was assessed with the LS. Patients were grouped according to the criteria of the International Conference on Capsule Endoscopy (ICCE) for the definition of suspected CD; group 1: patients not fulfilling ICCE and group 2: patients with ≥ 2 ICCE criteria.

Results: one hundred and ninety-one patients were included, 61% were female and the mean age was 39 ± 14 years. VCE detected significant inflammatory activity (LS ≥ 135) in 81 patients (42%); 24 patients from group 1 (32%) and 57 patients from group 2 (50%) (p = 0.014). During a mean follow-up period of 41 ± 21 months (12-79), a CD diagnosis was determined in 60 patients (31%); 55 patients with LS ≥ 135 (92%) and five patients with LS < 135 (5%) (p < 0.001). The LS showed a good diagnostic accuracy with an AUROC of 0.93 (p < 0.001). During the first year after diagnosis, there was a significant association between a higher LS and the need for immunomodulatory therapy, biological therapy, bowel resection surgery or hospital admission due to a CD flare-up.

Conclusions: the LS (cutoff ≥ 135) is very useful in the diagnosis of CD in patients undergoing VCE. Moreover, higher values of this score was associated with prognostic variables.
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http://dx.doi.org/10.17235/reed.2020.6434/2019DOI Listing
February 2020

Duodenal Vascular Spider's Web: Radiofrequency Ablation to the Rescue!

J Gastrointestin Liver Dis 2019 Dec 9;28(4):381. Epub 2019 Dec 9.

Gastroenterology Department, Hospital de São João, Porto, Portugal.

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http://dx.doi.org/10.15403/jgld-449DOI Listing
December 2019

Endoscopic treatment of a foreign body-associated colonic perforation.

Int J Colorectal Dis 2020 Jan 9;35(1):165-167. Epub 2019 Dec 9.

Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto. Al. Prof. Hernâni Monteiro, 4200 - 319, Porto, Portugal.

Background: Although the ingestion of foreign bodies is relatively common in the general population, intestinal perforation is rare but usually requires emergent surgery.

Case Presentation: We report a case of an 87-year-old woman that presented with a foreign body-associated colonic diverticular perforation. After multidisciplinary discussion, the foreign body was removed and the perforation was closed using an over-the-scope-clip. Percutaneous drainage of an adjacent intra-abdominal collection was performed. The patient had a favorable clinical evolution and was discharged 15 days after the endoscopic procedure.

Conclusion: This case highlights the possible growing role of endoscopic treatment of foreign body-associated colonic perforations, especially in high-risk surgical patients.
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http://dx.doi.org/10.1007/s00384-019-03465-1DOI Listing
January 2020

How should we select suspected Crohn's disease patients for capsule enteroscopy?

Scand J Gastroenterol 2019 Aug 3;54(8):991-997. Epub 2019 Aug 3.

Gastrsoenterology Department, Hospital Senhora da Oliveira - Guimarães , Guimarães , Portugal.

In suspected Crohn's disease (CD), non-diagnostic ileocolonoscopies are often followed by small bowel capsule endoscopy (SBCE). Adequate pre-selection of patients for SBCE is a key to optimize allocation of resources. We aimed to establish a rational approach for the CD diagnostic workflow, based on biochemical profile of patients with suspected CD, targeting an optimization of patients' selection for SBCE. Multicenter cohort study includes consecutive patients with suspected undergoing SBCE after non-diagnostic ileocolonoscopy. Minimum follow-up period after the capsule enteroscopy was six months. The outcome was confirmation of CD diagnosis. Univariate analysis and logistic regression were performed. In included 220 patients, 62.3% of women were with a mean age of 41 years [26-54]. A confirmed diagnosis of CD was established in 98 patients (44.5%). The initial univariate analysis identified variables above the threshold of marginal statistical association toward CD diagnosis ( < .15). The regression model identified high CRP levels (OR 1.028  = .128) and low serum Iron (OR 0.990  = .025) as the independent variables with consistent correlation with CD diagnosis. Those two variables present a suitable discriminative power (AUC = 0.669,  < .001) for the diagnosis of CD. In suspected CD, low serum iron and elevated CRP had a statistically significant association with CD diagnosis, being helpful to identify patients with higher CD probability before SBCE. However, the lack of a proper validation of the model leads us to currently recommend SBCE to all patients with suspected CD and negative ileocolonoscopy, as no specific biochemical profile can be used to confidently exclude small bowel CD.
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http://dx.doi.org/10.1080/00365521.2019.1649455DOI Listing
August 2019

Endoscopic submucosal dissection of gastrointestinal lesions on an outpatient basis.

United European Gastroenterol J 2019 03 6;7(2):326-334. Epub 2019 Jan 6.

Department of Gastroenterology, São João University Hospital, Porto, Portugal.

Background: Endoscopic submucosal dissection (ESD) is usually associated with hospital admission.

Objectives: To evaluate, prospectively, the feasibility, safety and efficacy of outpatient gastrointestinal ESD.

Methods: Patients with suitable lesions were invited to participate. Those that dwelt more than 1 hour from the hospital, lived alone, had severe co-morbidities, were <18 years old, had duodenal lesions, or that had ESD-related complications were admitted. The remaining patients were discharged if no complications were detected. A patients' inquiry was performed.

Results: Of the 164 ESD patients, 122 were outpatient-based, corresponding to 115 patients, 47% male and mean age 63 ± 12 years-old. Outpatients tended to be younger, female, to have gastric lesions, less advanced lesions, and shorter and less complicated ESDs (all  < 0.05). Outpatients' mean tumour size was 38 mm, en bloc and R0 resection rates were 88 and 78%, respectively. Seven ESD outpatients (5.7%) had complications: delayed bleeding ( = 4), pneumonitis ( = 2) or emphysema ( = 1), all managed conservatively. Colorectal location of the lesions was predictive of hospital admission ( = 0.03). In total, 97% of patients were satisfied with the outpatient strategy.

Conclusion: Risks of ambulatory ESD are low and complications can be successfully managed. This strategy has high patient satisfaction. More studies are needed to evaluate its implications on costs and patients' management.
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http://dx.doi.org/10.1177/2050640618823874DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6498798PMC
March 2019

Mixed Adenoneuroendocrine Tumor of the Rectum in an Ulcerative Colitis Patient.

GE Port J Gastroenterol 2019 Mar 8;26(2):125-127. Epub 2018 Jun 8.

aGastroenterology Department, Centro Hospitalar São João, Porto, Portugal.

Patients with inflammatory bowel disease present a higher risk of colorectal cancer, especially patients with a high degree of disease activity. Although rare, carcinoid tumors can also be associated with inflammatory bowel disease. Mixed adenoneuroendocrine tumor is defined as a neoplasm with dual differentiation (neuroendocrine and adenoma) with each component accounting for at least 30% of the tumor. We present a case of a mixed adenoneuroendocrine tumor in a patient with inflammatory bowel disease.
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http://dx.doi.org/10.1159/000489409DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6454396PMC
March 2019

Prevalence and Risk Factors for Augmented Renal Clearance in a Population of Critically Ill Patients.

J Intensive Care Med 2020 Oct 29;35(10):1044-1052. Epub 2018 Oct 29.

Department of Intensive Care, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal.

Background: Critically ill patients show a high, albeit variable, prevalence of augmented renal clearance (ARC). This condition has relevant consequences on the elimination of hydrophilic drugs. Knowledge of risk factors for ARC helps in the early identification of ARC. The aims of this study were evaluation of (1) risk factors for ARC and (2) the prevalence of ARC in critically ill patients over a period of 1 year.

Methods: A retrospective cohort study was performed for all consecutive patients admitted to our intensive care unit (ICU). Augmented renal clearance was defined by a creatinine clearance ≥130 mL/min/1.73 m. "Patient with ARC" was defined as a patient with a median of creatinine clearance ≥130 mL/min/1.73 m over the period of admission. Four variables were tested, Simplified Acute Physiology Score II (SAPS II), male gender, age, and trauma as cause for ICU admission. An analysis (patient based and clearance based) was performed with logistic regression.

Results: Of 475 patients, 446 were included in this study, contributing to 454 ICU admissions and 5586 8-hour creatinine clearance (8h-CL). Overall, the prevalence of patients with ARC was 24.9% (n = 113). In a subset of patients with normal serum creatinine levels, the prevalence was 43.0% (n = 104). Of the set of all 8h-CL measurements, 25.4% (1418) showed ARC. In the patient-based analysis, the adjusted odds ratio was: 2.0 (confidence interval [CI]:1.1-3.7; < .05), 0.93 (CI: 0.91-0.94; < .01), 2.7 (CI: 1.4-5.3; < .01), and 0.98 (CI: 0.96 -1.01; = .15), respectively, for trauma, age, male sex, and SAPS II. In the clearance-based analysis, the adjusted odds ratio were 1.7 (CI: 1.4-1.9; < .01), 0.94 (CI: 0.932-0.942; < .01), and 2.9 (CI: 2.4-3.4; < .01), respectively, for trauma, age, and male sex.

Conclusions: Trauma, young age, and male sex were independent risk factors for ARC. This condition occurs in a considerable proportion of critical care patients, which was particularly prevalent in patients without evidence of renal dysfunction.
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http://dx.doi.org/10.1177/0885066618809688DOI Listing
October 2020

Procalcitonin kinetics after burn injury and burn surgery in septic and non-septic patients - a retrospective observational study.

BMC Anesthesiol 2018 09 5;18(1):122. Epub 2018 Sep 5.

Department of Emergency and Intensive Care Medicine, Centro Hospitalar São João, Porto, Portugal.

Background: Early sepsis diagnosis is crucial for the correct management of burn patients, and it clearly influences outcomes. The systemic inflammatory response triggered by burns mimics sepsis presentation and complicates early sepsis diagnosis. Biomarkers were advocated to aid the diagnosis of early sepsis. Serum procalcitonin (PCT) exhibits fair accuracy and good correlation with sepsis severity, being used in diverse clinical settings. However, few studies have evaluated perioperative changes in PCT levels in burn patients. The present study evaluated PCT kinetics during the first days after burn injury and subsequent surgical interventions to assess PCT utility in distinguishing septic from non-septic inflammatory responses.

Methods: This study was a retrospective observational study of all burn patients admitted to the Coimbra Burns Unit (Portugal) between January 2011 and December 2014 who presented with a total burn surface area ≥ 15% and who underwent subsequent surgery. PCT kinetics were investigated a) during the first five days after burn injury and b) preoperatively during the five days after surgery in three subsets of patients, including those with no preoperative and no postoperative sepsis (NN), no preoperative but postoperative sepsis (NS), and preoperative and postoperative sepsis (SS). A total of 145 patients met the selection criteria and were included in the analysis.

Results: PCT levels in the first five days after burn injury were significantly higher in patients who developed at least one sepsis episode (n = 85) compared with patients who did not develop sepsis (n = 60). PCT values > 1.00 ng/mL were clearly associated with sepsis. Study participants (n = 145) underwent a total of 283 surgical interventions. Their distribution by preoperative/postoperative sepsis status was 142 (50.2%) in NN; 62 (21.9%) in NS; and 79 (27.9%) in SS. PCT values exhibited a parallel course in the three groups that peaked on the second postoperative day and returned to preoperative levels on the third day or later. The lowest PCT values were found in NN, and the highest values were observed in SS; the NS values were intermediate.

Conclusions: PCT kinetics coupled with a clinical examination may be helpful for sepsis diagnosis during the first days after burn injury and burn surgery.
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http://dx.doi.org/10.1186/s12871-018-0585-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6123981PMC
September 2018

Real-life evaluation of the safety, efficacy and therapeutic outcomes of endoscopic submucosal dissection in a Western tertiary centre.

United European Gastroenterol J 2018 Jun 23;6(5):702-709. Epub 2018 Jan 23.

Gastroenterology Department, Centro Hospitalar S. João, Porto, Portugal.

Background: Endoscopic submucosal dissection (ESD) enables accurate pathological evaluation and low recurrence rates. Large series describing ESD outcomes in Western countries are scarce.

Objective: To evaluate the real-life experience of ESD in a single Western centre.

Methods: Data of all the patients submitted to ESD in our centre were prospectively recorded in a database, from the first procedure in 2011 until May 2017. Feasibility, en bloc and R0 resection rates and safety were assessed.

Results: Three hundred and one ESDs were performed (37 in submucosal lesions) on 283 patients (54% male). Lesions were located in the oesophagus ( = 13), stomach ( = 169), duodenum ( = 4), colon ( = 35) and rectum ( = 80). ESD was technically successful in 292 lesions (97%); among malignant or premalignant epithelial lesions ( = 232), the en bloc resection rate was 91% and, of those, the R0 resection rate was 87% (between 69% in the colon and 93% in the stomach). Two patients needed surgery due to adverse events. Surgery for non-curative ESD was performed in 12 cases (58% without residual lesion). There were 10 perforations, 9 of them closed endoscopically. Mortality was 0%.

Conclusion: Our real-life experience shows that ESD is feasible, safe and effective in Western settings.
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http://dx.doi.org/10.1177/2050640618755237DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6068789PMC
June 2018

Impact of written information on control and adherence in type 2 diabetes.

Rev Assoc Med Bras (1992) 2018 Feb;64(2):140-147

Biostatistics Laboratory, Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal.

Introduction: Diabetes therapeutic education and information by leaflets is important. This study aimed to understand the effectiveness of written information to diabetic patients, after six months, in the control of diabetes and medication adherence.

Method: Non-pharmacological clinical trial. Randomized sample of diabetic patients of 65 volunteer doctors, distributed among the five health regions in Portugal. At the first appointment, patients were randomized in four groups (three intervention with validated leaflets and one control), leaflet reading being reinforced at the follow-up appointments in a 6-months period. Variables collected: HbA1c, home blood glucose, weight, waist circumference, blood pressure, cigarettes smoked, physical activity level, adherence to medication, medication, height, diabetes progression, age, sex and educational background. Descriptive and inferential statistics.

Results: From the 709 patients recruited, 702 were studied in this 6-months period with no statistical differences in the baseline variables studied. After six months of intervention, the adherence to medication improved in the leaflet group (p=0.034). This was noticed in those under 65 years of age (p=0.027), with diabetes for ≤ 5 years (p=0.010), with educational background up to 4 years (p=0.030) and 9 years (p=0.006) and with HbA1c ≥ 7% at the beginning of the study.

Conclusion: Interventions with leaflets handed in primary healthcare to people with diabetes type 2 can bring benefits in what concerns adherence to therapeutics, namely in younger people with a less studies.
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http://dx.doi.org/10.1590/1806-9282.64.02.140DOI Listing
February 2018

Endoscopic submucosal dissection of a schwann cell hamartoma mimicking a lateral spreading tumor of the rectum.

Acta Gastroenterol Belg 2017 Jul-Sep;80(3):429

Centro Hospitalar São João, Department of Pathology 3S, Ipatimup.

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April 2018

Phenotypic heterogeneity of hereditary diffuse gastric cancer: report of a family with early-onset disease.

Gastrointest Endosc 2018 Jun 15;87(6):1566-1575. Epub 2018 Feb 15.

Department of Pathology, Centro Hospitalar São João, Porto, Portugal; Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal; Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal; Institute for Research Innovation in Health (i3S), University of Porto, Porto, Portugal.

Background And Aims: The time course for the development of clinically significant hereditary diffuse gastric cancer (HDGC) is unpredictable. Little is known about the progression from preclinical, indolent lesions to widely invasive, aggressive phenotypes. Gastroendoscopy often fails to detect early lesions, and risk-reducing/prophylactic total gastrectomy (PTG) is the only curative approach. We present an HDGC family with early-onset disease in which clinical and histologic findings provided insight into the understanding of different HDGC phenotypes.

Methods: The proband was diagnosed at age 18 years with widely invasive, metastatic DGC. CDH1 genetic testing identified a pathogenic, germline CDH1 variant (c.1901C>T, p.Ala634Val). Thirty family members were tested, and 15 CDH1 carriers were identified.

Results: Six family members had PTG, with negative preoperative workup. The proband's 14-year-old sister is the youngest patient, reported to date, to have PTG after negative preoperative biopsy sampling. Intramucosal HDGC foci were detected in all PTG specimens (1-33). In contrast to the "indolent" phenotype of these foci, the aggressive DGC from the proband showed pleomorphic cells, absent E-cadherin expression, increased proliferation (Ki-67 index), and activation of oncogenic events (p53, pSrc and pStat3 overexpression). All family members had Helicobacter pylori gastritis. Cag-A-positive strains were detected in all specimens, except in the proband's sister.

Conclusions: HDGC is a heterogeneous disease regarding clinical behavior, endoscopic findings, histopathologic features, and immunophenotypic/molecular profile. The presence of bizarre, pleomorphic cells in endoscopic biopsy specimens is suggestive of advanced disease and should prompt clinical intervention. The involvement of a full multidisciplinary team is essential for the management of these patients.
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http://dx.doi.org/10.1016/j.gie.2018.02.008DOI Listing
June 2018

Endoscopic Mucosectomy in a Child Presenting with Gastric Heterotopia of the Rectum.

GE Port J Gastroenterol 2017 Nov 2;24(6):288-291. Epub 2017 Sep 2.

Serviço de Pediatria, Centro Hospitalar de São João, EPE, Porto, Portugal.

Gastric mucosal heterotopia has been described in all levels of the gastrointestinal tract. Its occurrence in the rectum is uncommon. We report the case of a 4-year-old boy referred to Pediatric Gastroenterology for intermittent rectal bleeding for the past 2 years. Total ileocolonoscopy revealed a flat, well-circumscribed lesion of 4 cm, with elevated margins, localized at 10 cm from the anal verge. Histologic examination showed typical gastric mucosa of the oxyntic type. Treatment with proton pump inhibitors was started without resolution of the symptoms and, therefore, an endoscopic mucosal resection was performed. Heterotopic gastric mucosa represents a rare cause of rectal bleeding in children and endoscopic evaluation is fundamental for diagnosis. Although not usually performed in pediatric ages, endoscopic mucosectomy allows complete resolution of the problem avoiding surgery.
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http://dx.doi.org/10.1159/000478939DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5731174PMC
November 2017

Spontaneous regression of a pulmonary adenocarcinoma after core needle biopsy.

Autops Case Rep 2017 Jul-Sep;7(3):20-25. Epub 2017 Sep 30.

University of Porto, Centro Hospitalar São João, Department of Anatomic Pathology. Porto, Portugal.

Spontaneous regression (SR) of cancer, especially lung cancer, is a rare biological event with a mechanism that is not currently understood. Immunological mechanisms seem to be the stronger explanation in SR of a lung cancer. We report the rare case of SR of a lung adenocarcinoma stage IA, in a 75-year-old man, which was incidentally diagnosed and histologically confirmed. Due to the patient's comorbidities and his poor pulmonary function, stereotactic radiotherapy was scheduled. However, by the time the treatment was due to start, the tumor was no longer detectable.
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http://dx.doi.org/10.4322/acr.2017.025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5634430PMC
September 2017

Clinical utility of the patency capsule: a large volume center experience.

Minerva Gastroenterol Dietol 2018 Mar 5;64(1):10-13. Epub 2017 Sep 5.

Department of Gastroenterology, Centro Hospitalar de São João, WGO Porto Training Center, Porto Medical School, University of Porto, Porto, Portugal.

Background: In patients with suspected or known obstructive gastrointestinal pathology, the use of patency capsule (PC) aims to minimize the risk of subsequent retention of the endoscopic capsule. However, its clinical utility is not consensual. The aim was to evaluate the indications, results and safety profile of the PC.

Methods: Retrospective analysis of PCs (agile patency capsule) conducted between 2011 and 2015. Patency evaluation was performed after 30 hours, with radiological confirmation if PC was detected.

Results: We included 369 PCs, 54% female. The average age was 42±16 years. Main indications included suspected Crohn disease (CD) (45%), CD staging (32%), neoplastic diseases (9%), radic enteritis (3%), prior surgery (3%), NSAIDs enteropathy (2%) and anemia (2%). Before the exam 5% of patients were taking constipation-induced medications and 5% reported occlusive symptoms; 38% of patients had previous abdominal surgeries, most often ileal resection due to CD (24%); 42% of patients had previous imaging studies, revealing strictures in 20% and bowel dilation in 11%. Patency capsule was negative (patent gastrointestinal tract) in 73% of cases at 30h and 2% of PCs were fully recovered in the following days. Seven patients (2.5%) showed self-limiting occlusive symptoms during the procedure. All patients with negative PC subsequently performed capsule endoscopy with no cases of retention. History of occlusive symptoms (P=0.023) and strictures in imaging studies (P=0.029) were associated with the detection of the PC at 30 hours.

Conclusions: PC is a safe and effective exam. Occlusive symptoms and imaging strictures were significantly associated with the retention. The retention rate was 25%, a similar result to that described in other series but higher than expected for the various indications, suggesting the importance of new research studies.
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http://dx.doi.org/10.23736/S1121-421X.17.02421-7DOI Listing
March 2018

Metabolic tumor burden quantified on [F]FDG PET/CT improves TNM staging of lung cancer patients.

Eur J Nucl Med Mol Imaging 2017 Dec 7;44(13):2169-2178. Epub 2017 Aug 7.

Nuclear Medicine Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.

Purpose: The purpose of our study was to test a new staging algorithm, combining clinical TNM staging (cTNM) with whole-body metabolic active tumor volume (MATV-WB), with the goal of improving prognostic ability and stratification power.

Methods: Initial staging [F]FDG PET/CT of 278 non-small cell lung cancer (NSCLC) patients, performed between January/2011 and April/2016, 74(26.6%) women, 204(73.4%) men; aged 34-88 years (mean ± SD:66 ± 10), was retrospectively evaluated, and MATV-WB was quantified. Each patient's follow-up time was recorded: 0.7-83.6 months (mean ± SD:25.1 ± 20.3).

Results: MATV-WB was an independent and statistically-significant predictor of overall survival (p < 0.001). The overall survival predictive ability of MATV-WB (C index: mean ± SD = 0.7071 ± 0.0009) was not worse than cTNM (C index: mean ± SD = 0.7031 ± 0.007) (Z = -0.143, p = 0.773). Estimated mean survival times of 56.3 ± 3.0 (95%CI:50.40-62.23) and 21.7 ± 2.2 months (95%CI:17.34-25.98) (Log-Rank = 77.48, p < 0.001), one-year survival rate of 86.8% and of 52.8%, and five-year survival rate of 53.6% and no survivors, were determined, respectively, for patients with MATV-WB < 49.5 and MATV-WB ≥ 49.5. Patients with MATV-WB ≥ 49.5 had a mortality risk 2.9-5.8 times higher than those with MATV-WB < 49.5 (HR = 4.12, p < 0.001). MATV-WB cutoff points were also determined for each cTNM stage: 23.7(I), 49.5(II), 52(III), 48.8(IV) (p = 0.029, p = 0.227, p = 0.025 and p = 0.001, respectively). At stages I, III and IV there was a statistically-significant difference in the estimated mean overall survival time between groups of patients defined by the cutoff points (p = 0.007, p = 0.004 and p < 0.001, respectively). At stage II (p = 0.365), there was a clinically-significant difference of about 12 months between the groups. In all cTNM stages, patients with MATV-WB ≥ cutoff points had lower survival rates. Combined clinical TNM-PET staging (cTNM-P) was then tested: Stage I < 23.7; Stage I ≥ 23.7; Stage II < 49.5; Stage II ≥ 49.5; Stage III < 52; Stage III ≥ 52; Stage IV < 48.8; Stage IV ≥ 48.8. cTNM-P staging presented a superior overall survival predictive ability (C index = 0.730) compared with conventional cTNM staging (C index = 0.699) (Z = -4.49, p < 0.001).

Conclusion: cTNM-P staging has superior prognostic value compared with conventional cTNM staging, and allows better stratification of NSCLC patients.
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http://dx.doi.org/10.1007/s00259-017-3789-yDOI Listing
December 2017

[Characteristics Associated with Uncontrolled Blood Pressure Among Portuguese Primary Care Patients with Type 2 Diabetes].

Acta Med Port 2017 Mar 31;30(3):197-204. Epub 2017 Mar 31.

Laboratório de Bioestatística e Informática Médica. Faculdade de Medicina. Universidade de Coimbra. Coimbra. Portugal.

Introduction: Determine whether socio-demographic, habits and risk factors are associated with a better tensional control in type 2 diabetes in primary care patients in order to identify a specific target population for compensatory interventions improving diabetes control and reducing its morbi-mortality.

Material And Methods: Cross-sectional study in primary care. Randomized type 2 diabetes patient data collection by their volunteer family doctors, proportionally stratified from the 5 Portuguese continental regions.

Variables: blood pressure, age, gender, education, diabetes duration, HbA1c, smoking habits, weight, waist circumference, physical activity and adherence to medication. Bivariate and logistic regression analysis to evaluate each measured variable's independent association with uncontrolled blood pressure (≥ 140/90).

Results: 709 patients were included in the study, 60.2% men, mean age 66.12 ± 10.47 years. In logistic regression analysis, the factors independently associated to uncontrolled BP were lower education (p = 0.014), shorter diabetes duration (p = 0.002), higher waist circumference (p < 0.001), higher pulse pressure (p < 0.001), higher physical activity level (p = 0.043) and being a smoker (p < 0.001).

Discussion: The main limitations are the fact that the sample was not totaly random and included only primary care patients, a possible inter-observer bias and being a cross-sectional study, thus not providing information on temporal relation or causality.

Conclusion: The sub-group of people with diabetes identified to have worse tensional control should have a different and more intensive approach in primary care. We recommend further longitudinal and population based confirmatory research.
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http://dx.doi.org/10.20344/amp.8321DOI Listing
March 2017

[Superiority of 18F-FNa PET/CT for Detecting Bone Metastases in Comparison with Other Diagnostic Imaging Modalities].

Acta Med Port 2017 Jan 31;30(1):53-60. Epub 2017 Jan 31.

Serviço de Medicina Nuclear. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal; Instituto de Ciências Nucleares Aplicadas à Saúde. Universidade de Coimbra. Coimbra. Portugal.

Introduction: The 18F-NaF positron emission tomography/computed tomography is being considered as an excellent imaging modality for bone metastases detection. This ability was compared with other imaging techniques.

Material And Methods: We retrospectively evaluated 114 patients who underwent 18F-NaF positron emission tomography/ computed tomography. Of these, 49 patients also had bone scintigraphy, 61 18F-FDG positron emission tomography/computed tomography and 10 18F-FCH positron emission tomography/computed tomography. We identified the technique that detected the largest number of bone metastases. For the detection of skeletal metastases with the 18F-NaF positron emission tomography/computed tomography study, the contribution of the positron emission tomography component was compared with the contribution of the computed tomography component. Cases in which 18F-NaF positron emission tomography/computed tomography and bone scintigraphy required further additional tests for diagnosis clarification were registered.

Results: The 18F-NaF positron emission tomography/computed tomography was superior to bone scintigraphy in 49% of the patients (p < 0.001); it was superior to 18F-FDG positron emission tomography/computed tomography in 59% of the patients (p < 0.001) and it was superior to 18F-FCH positron emission tomography/computed tomography in 40% of the patients (p < 0.001). None of the compared imaging techniques were superior to 18F-NaF positron emission tomography/computed tomography. The positron emission tomography component was superior to computed tomography in 35% of the cases (p < 0.001). Further investigation was suggested in only 3.5% of patients who underwent 18F-NaF positron emission tomography/computed tomography (45% for bone scintigraphy) (p < 0.001).

Discussion: As with other authors, our experience also confirms that 18F-NaF positron emission tomography/computed tomography is an excellent imaging modality for the detection of bone metastases, detecting lesions in more patients and more lesions per patient.

Conclusion: The 18F-NaF positron emission tomography/computed tomography showed a superior ability for the detection of bone metastases when compared with bone scintigraphy, 18F-FDG positron emission tomography/computed tomography and 18F-FCH positron emission tomography/computed tomography.
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http://dx.doi.org/10.20344/amp.7818DOI Listing
January 2017

Erratum: Single-balloon enteroscopy efficacy and degree of concordance with noninvasive evaluation of small bowel.

Endosc Int Open 2017 Feb;5(2):C1

Gastroenterology Department, Centro Hospitalar São João, Porto (Porto).

[This corrects the article DOI: 10.1055/s-0042-121415.].
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http://dx.doi.org/10.1055/s-0043-104759DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5421191PMC
February 2017

An immobile postsurgical nasojejunal tube: a case for King Arthur!

Rev Esp Enferm Dig 2017 Mar;109(3):222

Gastrenterologia, Centro Hospitalar São João, Portugal.

A patient was referred to an Endoscopy Unit for removal of a nasojejunal feeding tube that was previously inserted one week before during gastric surgery. Upper endoscopy revealed the nasojejunal tube sutured to the gastric wall and it was then removed with hot biopsy forceps. This case represents an uncommon complication of gastric surgery and highlights that a nasojejunal feeding tube should only be positioned after the suturing procedures and the mobility of the tube should always be tested during surgery.
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March 2017

Assessment of skeletal tumour burden on 18F-NaF PET/CT using a new quantitative method.

Nucl Med Commun 2017 Apr;38(4):325-332

Departments of aNuclear Medicine bTechnology and Information Systems, Centro Hospitalar e Universitário de Coimbra cLaboratory of Biostatistics and Medical Informatics, Faculty of Medicine dInstitute of Nuclear Sciences Applied to Health-ICNAS, University of Coimbra, Coimbra, Portugal eDepartment of Radiology, Division of Nuclear Medicine and Molecular Imaging, Stanford University, Stanford, California, USA.

Purpose: The purpose of this study was to test a method of quantifying skeletal tumour burden with F-NaF PET/CT.

Patients And Methods: We retrospectively reviewed the charts of 117 patients who underwent F-NaF PET/CT for the detection of bone metastases, 68 women and 49 men, 16-82 years old (mean±SD: 62.9±10.7 years). Mean standardized uptake values (SUVmean) were measured in five anatomic sites to evaluate normal skeleton activity. The influence of sex and age was investigated. Skeletal tumour burden was calculated in 69 exams positive for bone metastases using volumetric data and SUVmean values. Intraobserver and interobserver reproducibility was tested. In 10 patients with breast cancer, skeletal tumour burden in pretreatment and post-treatment F-NaF PET/CT was compared with tumour marker and clinical evolution.

Results: The range of normal skeleton SUVmean for the 410 volume of interests analysed was 2.2-5.9 (mean±SD: 4.4±1.5). A threshold of 10 was chosen to exclude F-NaF normal skeleton uptake. An inverse relationship was found between normal skeleton SUVmean and age (r=-0.237; P=0.032). Our results show excellent intraobserver and interobserver reproducibility, with intraclass correlation values of 0.995 and 0.997, respectively. The percentage change in the skeletal tumour burden in response to therapy shows a moderate direct correlation with the percentage variation of the tumour marker (r=0.668; P=0.035).

Conclusion: The methodology that we used to quantify skeletal tumour burden is easy to perform, highly reproducible and allows for the evaluation of bone tumour response to therapy in a subgroup of breast cancer patients. The possibility of skeletal tumour burden quantification is another advantage of F-NaF PET/CT over the visual and subjective interpretation of bone scintigraphy.
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http://dx.doi.org/10.1097/MNM.0000000000000654DOI Listing
April 2017

Single-balloon enteroscopy efficacy and degree of concordance with noninvasive evaluation of small bowel.

Endosc Int Open 2017 02;5(2):E96-E102

Gastroenterology Department, Centro Hospitalar São João, Porto (Porto).

 Clinical impact of single-balloon enteroscopy (SBE) is fairly known, as well as its diagnostic yield comparing with other small bowel gastrointestinal investigations. This study represents a contribution to better understand it and is designed to evaluate SBE efficacy and degree of concordance with previous evaluation of small bowel. This is a single-center retrospective study of patients that underwent SBE with suspected small bowel disease based on non-invasive imaging. Demographic, clinical, procedural and outcome data were collected for analysis. Agreement beyond positive findings was evaluated using κ-coefficient. A total of 197 SBEs were performed in 168 patients; mainly men (64.3 %) with mean age 53.3±17.6 years. Most SBEs (86.3 %) performed were preceded by a noninvasive evaluation: in 61.4 % (n = 119) of cases, capsule enteroscopy (CE) was performed, in 18.8 % (n = 37), computed tomography was performed, and in 6.1 % (n = 12) magnetic resonance enterography was performed. Fourty-three patients (25.6 %) underwent endoscopic treatments, mainly: argon plasma coagulation in angioectasias (53.4 %) and polypectomy (34.9 %). The most common diagnoses made with SBE were findings consistent with inflammatory small bowel disease (21.8 %) and vascular lesions (14.2 %). The diagnostic yield of SBE was of 69 %, confirming the suspicion of small bowel disease. The degree of concordance between CE and SBE for positive findings was substantial, κ-coefficient = 0.635 ( < 0.001). However, the degree of concordance between imaging examinations (CT or MR) and SBE was only moderate, κ-coefficient = 0.410 ( < 0.001). SBE had an immediate effect in 20 % of patients, changing diagnostic approaches, medical and surgical treatments. Our study supports the idea that for suspected small bowel disease, CE and SBE have an overall good degree of concordance for all the diagnostics included.
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http://dx.doi.org/10.1055/s-0042-121415DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5305424PMC
February 2017

Hyperprolinemia as a clue in the diagnosis of a patient with psychiatric manifestations.

Brain Dev 2017 Jun 13;39(6):539-541. Epub 2017 Feb 13.

Metabolic Unit, Hospital de Dona Estefânia, Lisbon, Portugal.

Lately, microdeletions of the 22q region, responsible for DiGeorge syndrome or velocardiofacial syndrome, have been increasingly related to neuropsychiatric disorders including schizophrenia and bipolar disorder. These manifestations seem to be related to certain genes located in the hemideleted region such as the proline dehydrogenase (PRODH) and the catechol-o-methyltransferase (COMT) genes. We describe a teenager who started his adolescent psychiatric care presenting cognitive impairment, irritable mood and aggressive behaviour with schizophrenia-like symptoms that scored 153 in the Positive and Negative Symptoms Scale (PANSS) assessment. Worsening of symptoms when the patient was treated with valproic acid, and plasma aminoacids showing an increase in alanine and proline, suggested a mitochondrial involvement of the proline metabolic pathway. Mild dysmorphic features also suggested a possible 22q11 deletion syndrome that was confirmed. A mutation for Hyperprolinemia type I was also detected. Knowledge of the correct diagnosis was crucial for an adequate treatment.
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http://dx.doi.org/10.1016/j.braindev.2017.01.008DOI Listing
June 2017