Percorrer por autor "Almeida, Rui"
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- Hemodialysis Acess - A Creative Attitude is NecessaryPublication . Sousa, Pedro Pinto; Almeida, Paulo; Almeida, Rui; Sá Pinto, PedroCreating and maintaining a functional vascular access (VA) is a critical factor in the survival of a dialysis patient. It implies a creative attitude either to maintain its functionality or to build a new one wherever possible, being it autologous or synthetic. We describe the VA history of a 59 years-old male patient, with extreme obesity, which started in 2012 with failed attempts of VA construction in both forearms until a functional brachiocephalic arteriovenous fistula (AVF) in the right upper limb was achieved. However, it required ligation due to severe venous hypertension secondary to central venous disease related to previous CVC use. As he had no good superficial conduit in the left arm we decided to harvest the arterialized right cephalic vein and implant it in the left arm, creating an autologous arteriovenous shunt between the brachial artery and axillary vein (AV). Despite initial patency, it failed irreversibly approximately one year after creation. As no more superficial veins were available in the upper limbs, a prosthetic access was the next step. We decided for a hybrid graft (HG) between the left brachial artery and the AV because of the patient's biotype and scarred axilla that impeded a safe re-intervention on the AV. This graft was used between 2015 and 2017 with multiple interventions to maintain patency. In 2017 a significant diffuse prosthesis deterioration and reduced AVF flow were noticed with no possible segmental reconstruction. We were then forced to proceed with subtotal graft substitution preserving the outflow stented segment of the HG, using an early cannulation graft to prevent CVC use. After this successful reconstruction, the patient started hemodialysis on the following day with no intercurrences registered.
- Imaging clinical casePublication . Gonçalo, Ana Lia; Almeida, Rui; Pereira, MarcoCase report: The authors present the case of a 15-year-old adolescent boy with occipital spur noticed since the previous year and with progressive enlargement. No history of trauma or other associated symptoms was evident. Physical examination showed a hard tumefaction with no inflammatory signs and x-ray revealed occipital hyperostosis. The boy spent most free time playing with mobile gadgets, with poor body posture. Discussion/Conclusion: Although considered a normal feature, occipital spur in adolescents and young adults may be linked to poor posture, for instance associated with prolonged use of handheld technology. Exaggerated technology use may be associated with several complaints and musculoskeletal symptoms should not be neglected.
- Vaping: A Pediatric problem?Monteiro, Sara; Almeida, RuiElectronic cigarettes were developed almost two decades ago. Their use, colloquially known as vaping, has gradually increased among young people.Although initially marketed as an alternative to traditional cigarettes, electronic cigarettes expose users to substances associated with adverse health effects and are not recognized by the World Health Organization as a smoking cessation method. The use of new flavors, esthetically appealing devices, and low perceived risk appear to be contributing to increased use among adolescents worldwide, a trend also observed in Portugal. However, their health risks are not fully understood. Recently, a new entity - e-cigarette or vaping-associated lung injury (EVALI) – has been described, with increasing incidence and significant morbimortality. The treatment of nicotine dependence in adolescents who smoke electronic cigarettes is challenging.Electronic cigarettes are addicting a new generation and posing associated health risks. Their increasing use should alert physicians and encourage the development of strategies to address this issue among adolescents.