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Development of a warning score for early detection of colorectal anastomotic leakage:Hype or hope?

World Journal of Gastrointestinal Surgery 2022年第11期14卷 1297-1309页

作者： nuno J G Rama Óscar Lourenço Patrícia C Motta Lima Maria Pedro S Guarino Diana Parente Ricardo Castro Ana Bento Anabela Rocha Fernando Castro-Poças João Pimentel Division of Colorectal Surgical Leiria Hospital CentreLeiria 2410-021Portugal Abel Salazar Biomedical Institute University of OportoOporto 4099-002Portugal Center for Innovative Care and Health Technology(ciTechCare) Polytechnic of LeiriaLeiria 2410-541Portugal Faculty of Economics CeBERUniversity of CoimbraCoimbra 3000-137Portugal Division of Clinical Pathology Leiria Hospital CentreLeiria 2410-541Portugal Division of Surgical Oporto Hospital CentreOporto 4099-001Portugal Department of Gastroenterology Santo António HospitalPorto Hospital CenterOporto 4099-001Portugal Institute of Biomedical Sciences Abel Salazar University of OPortoOporto 4099-001Portugal Faculty of Medicine University of CoimbraCoimbra 3004-531Portugal Division of Surgical Montes Claros HospitalCoimbra 3030-320Portugal

BACKGROUND Colorectal anastomotic leakage(CAL),a severe postoperative complication,is associated with high morbidity,hospital readmission,and overall healthcare *** detection of CAL remains a challenge in clinical ***,some decision models have been developed to increase the diagnostic accuracy of this *** To develop a score based on easily accessible variables to detect CAL *** Based on the least absolute shrinkage and selection operator method,a predictive classification system was developed[Early ColoRectAL Leakage(E-CRALL)score]from a prospective observational,single center cohort,carried out in a colorectal division from a non-academic *** score performance and CAL threshold from postoperative day(POD)3 to POD5 were *** on a precise analytical decision model,the standard clinical practice was compared with the E-CRALL adoption on POD3,POD4,or POD5.A cost-minimization analysis was conducted,on the assumption that all alternatives delivered similar health-related *** In this study,396 patients who underwent colorectal resection surgery with anastomosis,and 6.3%(n=25)developed *** of the patients who developed CAL(n=23;92%)were diagnosed during the first hospital admission,with a median time of diagnosis of 9.0±6.8 *** POD3 to POD5,the area under the receiver operating characteristic curve of the E-CRALL score was 0.82,0.84,and 0.95,*** POD5,if a threshold of 8.29 was chosen,87.4%of anastomotic failures were identified with E-CRALL ***,score usage could anticipate CAL diagnosis in an average of 5.2 d and 4.1 d,if used on POD3 and POD5,*** of score adoption,episode comprehensive costs were markedly greater(up to four times)in patients who developed CAL in comparison with patients who did not develop ***,the use of the E-CRALL warning score was associated with cost savings of€421442.20,with most(92.9%)of the savings from patients

关键词： Anastomotic leakage Colorectal Surgery Biomarkers Score Costs

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Discogenic pain: Who cares?

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Health 2013年第11期5卷 1929-1937页

作者： Jose Pedro Lavrador nuno Simas Edson Oliveira Joaquim Cruz Teixeira Diogo Simao Sergio Livraghi Neurosurgical Department Hospital Santa MariaLisbonPortugal

Chronic low back pain has a huge impact on daily living and a negative economic and professional effect. It is a matter of debate and concern for all health professionals involved, particularly spine surgeons. Recent discoveries on the innervation and biochemical properties of the intervertebral disc clarify the role of this structure as a possible cause of chronic low back pain. However, multiple causes may be present in the same patient making the diagnosis a challenging process. Discogenic pain is defined as a chronic low back pain induced by a degenerative disc disease. There are no specific characteristics of discogenic pain, although it has a higher incidence in younger age, it is usually localized medially in the back, worsens with axial loading and improves with recumbence. In the last decades we have assisted the emergence of multiple treatment techniques. However, neither the conservative treatment nor the interventional management has strong evidence in treating discogenic pain. Randomized control clinical trials are sought to improve patient outcome. Meanwhile, we believe each patient should be approached on an individual base. Discogenic pain: we care.

关键词： Discogenic Pain Low Back Pain Intervertebral Disc

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Abdominal Muscular Metastases of a Pulmonar Adenocarcinoma

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Advances in Lung Cancer 2015年第2期4卷 25-27页

作者： Joana de Castro Rocha Pedro nuno Brandao Ana Rita Cruz Vítor Valente Internal Medicine Department Centro Hospitalar do PortoPortoPortugal General Surgery Department Centro Hospitalar do PortoPortoPortugal

Metastases are synonymous of malignant neoplasm in advanced stage and so associated with a poor prognosis. As the first manifestation of cancer disease, the muscle metastasis is very rare. The definitive diagnosis of its presence is made based on histology. The authors presented the case of a patient with a lung adenocarcinoma, being with first manifestation of it, a muscle metastasis only about a month later there were clinical manifestations with imaging appearance that led to the diagnosis of a primary neoplasm. The rare manifestation of the disease motivated the study and surveillance of the patient and lead to the diagnosis.

关键词： Muscular Metastasis Adenocarcinoma Lung

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The Graft Thickness in Descemet Stripping Automated Endothelial Keratoplasty:What Is the Importance to the Final Visual Outcome?

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Open Journal of Ophthalmology 2017年第3期7卷 167-175页

作者： Diana Cristóvao Ana Fonseca nuno Alves Vítor Maduro Joao Feijao Pedro Candelária Instituto de Oftalmologia Dr.Gama Pinto(IOGP) LisbonPortugal Centro Hospitalar de Lisboa Central(CHLC) LisbonPortugal

Introduction: Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) is currently considered the procedure of choice for the treatment of endothelial dysfunctions. Despite DSAEK being a promising procedure to improve visual acuity (VA), the ideal graft thickness donor still remains under discussion. Purpose: To analyze the influence of graft thickness on postoperative VA and complications in DSAEK surgery. Methods: Retrospective study of 112 eyes that underwent DSAEK surgery. Donor grafts were obtained by dissection with automatic microkeratome, using different head sizes. Central corneal thickness (CCT) of donor corneas before dissection was measured by ultrasound pachymetry. The choice of the cutting depth was based on CCT measurements and the final desired residual corneal thickness, corresponding to the estimated donor graft thickness (EDGT). The eyes were divided into 3 groups, depending on the EDGT: 200 μm (Group 3). Intraoperative, postoperative complications and the best corrected visual acuity (BCVA) at 6 months postoperatively were evaluated, comparing these 3 groups. Results: The average EDGT was 164 ± 10 μm in Group 1188 ± 7 μm in Group 2 and 234 ± 30 μm in Group 3. At 6 months postoperative the average BCVA was significantly better in Group 1 (BCVA: 0.74 ± 0.20), compared to Group 2 (BCVA: 0.54 ± 0.20) and Group 3 (BCVA: 0.39 ± 0.18). Intraoperative and postoperative complications included: graft perforation during cutting (0.9% of cases), graft rejection (3.6%), primary graft failure (4.5%), and graft detachment (3.6%). Its distribution was uniform between the 3 groups. Conclusion: The study proves that DSAEK is an effective surgical technique for the treatment of endothelial dysfunction, demonstrating that the use of thinner grafts (EDGT < 180 μm) can improve the final visual outcome, with a significant improvement on BCVA, without increasing the risk of complications.

关键词： DSAEK Graft Thickness Visual Acuity Complications

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老有所养葡萄牙某老人之家

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室内设计与装修 2019年第4期 16-17页

作者： nuno Piedade Alexandre coco 不详

本项目始于2015年,直至2018年才完工。这是一个专为老年人设计的医疗保健住宅,包括10间双人间和4间单人间,所有的房间都配有自己独立的私人设施。该项目主要为了缓解现有医疗保健中心床位紧张的矛盾,建筑师从功能上考虑,在现有建筑和扩... 详细信息

本项目始于2015年,直至2018年才完工。这是一个专为老年人设计的医疗保健住宅,包括10间双人间和4间单人间,所有的房间都配有自己独立的私人设施。该项目主要为了缓解现有医疗保健中心床位紧张的矛盾,建筑师从功能上考虑,在现有建筑和扩建部分之间建立了内部联系和必要的交通流线。

关键词：老人之家建筑师现有建筑葡萄牙

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Accounting and the ＂Doctor-Manager Relationship＂

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Journal of Modern Accounting and Auditing 2013年第4期9卷 489-496页

作者： Ame1ia Cristina Ferreira-da-Silva Jose Manuel T. Pereira Humberto nuno Rito Ribeiro Polytechnic Institute of Porto Porto Portugal Jose Manuel T. Pereira Polytechnic Institute of Caivado and Ave Barcelos Portugal Polytechnic Institute of Braganca Braganga Portugal

The adoption of the ＂new public management＂ in the hospital sector brought about greater presence and power to professional managers in hospitals, thus increasing the risk of conflict in the doctor-manager relationship. Aiming to enrich the discussion on the factors that could be the bases for this conflict and considering the role of accounting, the study presented here corresponds, basically, to what we call ＂content analysis＂ of qualitative studies. The results demonstrate that the Portuguese doctors as the sample studied accept, in essence, the principles of enterprise management and recognize the use of accounting information in the scope of their functions as long as they are called to participate as legitimate actors, and authorities respect their desires to preserve a practice which they consider of quality.

关键词： doctor-manager relationship hospital management accounting information

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Usefulness of serum C-reactive protein and calprotectin for the early detection of colorectal anastomotic leakage:A prospective observational study

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World Journal of Gastroenterology 2022年第24期28卷 2758-2774页

作者： nuno J G Rama Marlene C C Lages Maria Pedro S Guarino Óscar Lourenço Patrícia C Motta Lima Diana Parente Cândida S G Silva Ricardo Castro Ana Bento Anabela Rocha Fernando Castro-Pocas João Pimente Colorectal Surgical Division Leiria Hospital CentreLeiria 2410-021Portugal Abel Salazar Biomedical Institute(ICBAS) University of OportoOporto 4099-002Portugal Center for Innovative Care and Health Technology(ciTechCare) Polytechnic of LeiriaLeiria 2410-541Portugal Faculty of Economics CeBERUniversity of CoimbraCoimbra 3000-137Portugal Clinical Pathology Division Leiria Hospital CentreLeiria 2410-541Portugal Surgical Division Oporto Hospital CentreOporto 4099-001Portugal Department of Gastroenterology Santo António HospitalPorto Hospital CenterPorto 4099-001Portugal Institute of Biomedical Sciences Abel Salazar University of PortoPorto 4099-001Portugal Faculty of Medicine University of CoimbraCoimbra 3004-531Portugal Surgical Division Montes Claros HospitalCoimbra 3030-320Portugal

BACKGROUND Colorectal anastomotic leakage(CAL)is one of the most dreaded complications after colorectal surgery,with an incidence that can be as high as 27%.This event is associated with increased morbidity and mortality;therefore,its early diagnosis is crucial to reduce clinical consequences and *** biomarkers have been suggested as laboratory tools for the diagnosis of *** To assess the usefulness of plasma C-reactive protein(CRP)and calprotectin(CLP)as early predictors of *** A prospective monocentric observational study was conducted including patients who underwent colorectal resection with anastomosis,from March 2017 to August *** were divided into three groups:G1–no complications;G2–complications not related to CAL;and G3–*** biomarkers were measured and analyzed in the first 5 postoperative days(PODs),namely white blood cell(WBC)count,eosinophil cell count(ECC),CRP,CLP,and procalcitonin(PCT).Clinical criteria,such as abdominal pain and clinical condition,were also *** correlation between biomarkers and CAL was *** operating characteristic(ROC)curve analysis was used to compare the accuracy of these biomarkers as predictors of CAL,and the area under the ROC curve(AUROC),specificity,sensitivity,positive predictive value,and negative predictive value(NPV)during this period were *** In total,25 of 396 patients developed CAL(6.3%),and the mean time for this diagnosis was 9.0±6.8 *** operative characteristics,such as surgical approach,blood loss,intraoperative complications,and duration of the procedure,were notably related to the development of *** length of hospital stay was markedly higher in the group that developed CAL compared with the group with complications other than CAL and the group with no complications(median of 21 d vs 13 d and 7 d respectively;P<0.001).For abdominal pain,the best predictive performance was on POD4 and POD5,with the largest AUROC of 0.84 on ***

关键词： Anastomotic leakage Colorectal Surgery Biomarkers C-reactive protein Calprotectin

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Gallstone ileus,clinical presentation,diagnostic and treatment approach

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World Journal of Gastrointestinal Surgery 2016年第1期8卷 65-76页

作者： carlos m nuno-guzmán maría eugenia marín-contreras mauricio figueroa-sánchez jorge l corona department of general surgery hospital civil de guadalajara"fray antonio alcalde"Guadalajara CP 44280JaliscoMéxico department of general surgery unidad médica de alta especialidadhospital de especialidades del centro médico nacional de occidenteinstituto mexicano del seguro socialGuadalajara CP 44340JaliscoMéxico department of gastrointestinal endoscopy unidad médica de alta especialidadhospital de especialidades del centro médico nacional de occidenteinstituto mexicano del seguro socialGuadalajara CP 44340JaliscoMéxico department of radiology hospital civil de guadalajara"fray antonio alcalde"Guadalajara CP 44280JaliscoMéxico

Gallstone ileus is a mechanical intestinal obstruction due to gallstone impaction within the gastrointestinal tract. Less than 1% of cases of intestinal obstruction are derived from this etiology. The symptoms and signs of gallstone ileus are mostly nonspecific. This entity has been observed with a higher frequency among the elderly, the majority of which have concomitant medical illness. Cardiovascular, pulmonary, and metabolic diseases should be considered as they may affect the prognosis. Surgical relief of gastrointestinal obstruction remains the mainstay of operative treatment. The current surgical procedures are:(1) simple enterolithotomy;(2) enterolithotomy, cholecystectomy and fistula closure(one-stage procedure); and(3) enterolithotomy with cholecystectomy performed later(two-stage procedure). Bowel resection is necessary in certain cases after enterolithotomy is performed. Large prospective laparoscopic and endoscopic trials are expected.

关键词： Intestinal obstruction Bouveret's syndrome Laparoscopic surgery Endoscopic treatment Gallstoneileus

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Rhino-Orbito-Cerebral Mucormycosis in a Diabetic Patient with Idiopathic CD4+Lymphocytopenia

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Advances in Infectious Diseases 2013年第4期3卷 248-252页

作者： nuno Rocha Pereira Paulo Andrade Laura Sa Candida Abreu Rita Figueiredo Roberto Silva Antonio Sarmento Infectious Diseases Department Centro Hospitalar Sao Joao and Faculty of Medicine of Porto UniversityPortoPortugal Neuroradiology Department Centro Hospitalar Sao JoaoPortoPortugal Pathology Department Centro Hospitalar Sao Joao and Faculty of Medicine of Porto UniversityPortoPortugal

A 54-year-old diabetic male, with idiopathic CD4 + lymphocytopenia, was presented with a two-month history of headache and periocular pain followed by vertigo, left hypoacusia and left peripheral facial palsy and hypoesthesia. More than a month after admission, a palate ulcer appeared and Infectious Diseases consultation was required. Mucormycosis was suspected and the diagnosis was confirmed by histologic examination. Despite early surgery and combination antifungal therapy, the patient did not survive. This case report illustrates the difficulty in diagnosing a rare condition with non-specific clinical manifestations and underlines the importance of a timely multidisciplinary approach in order to recognise this highly fatal disease earlier. It also describes a previously non-reported situation of mucormycosis in a patient with idiopathic CD4 + lymphocytopenia.

关键词： Mucormycosis Idiopathic CD4+Lymphocytopenia Diabetes Amphotericin B

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Role of endoscopic retrograde cholangiopancreatography inthe management of benign biliary strictures:What's new?

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World Journal of Gastrointestinal Endoscopy 2016年第4期8卷 220-231页

作者： Rosa Ferreira Rui Loureiro nuno Nunes António Alberto Santos Rui Maio Marília Cravo Maria AntóniaDuarte Gastroenterology Department Hospital BeatrizÂngelo2674-514 LouresPortugal Gastroenterology Department Hospital Divino Espírito Santo9500-370 São Miguel-AçoresPortugal Surgery Department Hospital BeatrizÂngelo2674-514 LouresPortugal

Benign biliary strictures comprise a heterogeneous group of diseases. The most common strictures amenable to endoscopic treatment are post-cholecystectomy, post-liver transplantation, related to primary sclerosing cholangitis and to chronic pancreatitis. Endoscopic treatment of benign biliary strictures is widely used as first line therapy, since it is effective, safe, noninvasive and repeatable. Endoscopic techniques currently used are dilation, multiple plastic stents insertion and fully covered self-expandable metal stents. The main indication for dilation alone is primary sclerosing cholangitis related strictures. In the vast majority of the remaining cases, temporary placement of multiple plastic stents with/without dilation is considered the treatment of choice. Although this approach is effective, it requires multiple endoscopic sessions due to the short duration of stent patency. Fully covered self-expandable metal stents appear as a good alternative to plastic stents, since they have an increased radial diameter, longer stent patency, easier insertion technique and similar efficacy. Recent advances in endoscopic technique and various devices have allowed successful treatment in most cases. The development of novel endoscopic techniques and devices is still ongoing.

关键词： Benign biliary strictures Bile duct stricture Endoscopic retrograde cholangiopancreatography Stents Cholecystectomy Liver transplantation Primarysclerosing cholangitis Chronic pancreatitis

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