Browsing by Author "Pedroto, I."
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- Colon carcinoma staging by endoscopic ultrasonography miniprobesPublication . Castro-Pocas, F.; Dinis-Ribeiro, M.; Rocha, A.; Santos, M.; Araújo, T.; Pedroto, I.BACKGROUND AND OBJECTIVES: Due to the increasing use of endoscopic techniques for colon cancer resection, pretreatment locoregional staging may gain critical interest. The use of endoscopic ultrasonography (EUS) miniprobes in this context has been seldom reported. Our aim was to determine the accuracy of EUS miniprobes for colon cancer staging. MATERIALS AND METHODS: Forty patients with colon cancer (2 in the cecum, 9 in the ascending colon, 5 in the transverse colon, 5 in the descending colon, and 19 in the sigmoid colon) were submitted to staging using 12 MHz EUS miniprobes. EUS and the anatomopathological results were compared with regard to the T and N stages. It was assessed if the location, longitudinal extension, or circumferential extension of the tumor had any influence on the accuracy in EUS staging. RESULTS: Tumor staging was feasible in 39 (98%) patients except in one case with a stenosing tumor (out of 6). Globally, T stage was accurately determined in 88% of the cases. In the assessment of the presence or absence of lymph node metastasis, miniprobes presented an accuracy of 82% with a sensitivity of 67%. These results were neither affected by the location nor by the longitudinal or circumferential extension of the tumor. CONCLUSIONS: EUS miniprobes may play an important role in assessing T and N stages in colon cancer and may represent an incentive to the research of new therapeutic areas for this disease.
- Evolução do Processo de Avaliação e Controlo de RiscosPublication . Pereira, L.F.; Pedroto, I.; Freitas, M.; Oliveira, M.M.; Pacheco, H.
- Hydatid Cyst Diagnosed by Endoscopic UltrasoundPublication . Castro-Poças, F.; Araújo, T.; Coelho, A.; Silva, D.; Pedroto, I.A 69-year-old female with unremarkable past history underwent endoscopy for dyspepsia. She denied weight loss or anorexia. Upper endoscopy revealed a bulge in the lesser curvature and posterior wall of the stomach with 4-5 cm. Endoscopic ultrasound was performed which showed a heterogeneous lesion, anechogenic in the major part, with a floating membrane inside, the greatest diameter of 90.8 × 17.2 mm, originated in the left liver lobe. Surgical resection was performed. Pathologic examination revealed a cystic lesion with an acellular thick fibrous wall, surrounded by a conspicuous inflammatory reaction. The cyst wall revealed a characteristic lamellar pattern of the fibers. In the internal surface of the lesion, there were remains of membranous structures, amidst which a vestigial Protoscolex was noted. In the presented case, a floating membrane was observed, which is a pathognomonic feature, establishing the diagnosis of hydatid cyst type 3. Fine needle aspiration guided by ultrasound was not performed due to the certainty in the diagnosis. To the authors' knowledge, these are the first images by endoscopic ultrasound of hydatid cyst of liver presented as a bulge in the stomach with pathognomonic features, which allowed the definitive diagnosis with no need for further diagnostic tests.
- Metabolic control of T cell immune response through glycans in inflammatory bowel diseasePublication . Dias, A.; Correia, A.; Pereira, M.; Almeida, C.; Alves, I.; Pinto, V.; Catarino, T.; Mendes, N.; Leander, M.; Oliva-Teles, M.; Maia, L.; Delerue-Matos, C.; Taniguchi, N.i; Lima, Margarida; Pedroto, I.; Marcos-Pinto, Ricardo; Lago, P.; Reis, C.; Vilanova, M.; Pinho, S.Mucosal T lymphocytes from patients with ulcerative colitis (UC) were previously shown to display a deficiency in branched N-glycosylation associated with disease severity. However, whether this glycosylation pathway shapes the course of the T cell response constituting a targeted-specific mechanism in UC remains largely unknown. In this study, we demonstrated that metabolic supplementation of ex vivo mucosal T cells from patients with active UC with N-acetylglucosamine (GlcNAc) resulted in enhancement of branched N-glycosylation in the T cell receptor (TCR), leading to suppression of T cell growth, inhibition of the T helper 1 (Th1)/Th17 immune response, and controlled T cell activity. We further demonstrated that mouse models displaying a deficiency in the branched N-glycosylation pathway (MGAT5-/-, MGAT5+/-) exhibited increased susceptibility to severe forms of colitis and early-onset disease. Importantly, the treatment of these mice with GlcNAc reduced disease severity and suppressed disease progression due to a controlled T cell-mediated immune response at the intestinal mucosa. In conclusion, our human ex vivo and preclinical results demonstrate the targeted-specific immunomodulatory properties of this simple glycan, proposing a therapeutic approach for patients with UC.
- O perfil clínico-epidemiológico da cirrose hepáticaPublication . Alves, C.; Pedroto, I.
- Primary intestinal Hodgkin's lymphoma associated with Crohn's diseasePublication . Salgueiro, P.; Lago, P.; Farrajota, P.; Santos, M.; Pedroto, I.
- Risco clínico e segurança do doentePublication . Pedroto, I.A Gestão de Risco Clínico e Segurança do Doente desempenha um papel fulcral na integração de todos estes elementos: análise de incidentes, indicadores de segurança e auditorias clínicas; mas essencialmente, numa primeira fase, numa mudança de atitudes: desenvolver uma cultura de segurança e de confiança; a responsabilização e colaboração de todos os profissionais; o trabalho em grupo e a multidisciplinaridade. A prática clínica já não pode ser exclusivamente centralizada na interacção médico-doente. Nos serviços hospitalares existem uma série de processos que necessitam de ser urgentemente sincronizados. O doente é sempre o produto final de qualquer actividade e está sempre presente em todos os processos. A moderna gestão hospitalar radica hoje num novo paradigma de gestão centrada na Qualidade como visão e desígnio na prestação de cuidados de saúde, centrada na participação e no bem estar do doente, na prevenção e manuseamento do risco clínico, na infusão de uma cultura de segurança, no contexto de uma melhoria contínua da prática clínica e de uma administração clínica integrada e omnicompreensiva. Uma cultura de Qualidade que requer a assumpção e a adesão clara aos seus princípios orientadores, o envolvimento empenhado das estruturas dirigentes e, sobretudo, um trabalho de equipa sério e comprometido em que todos são parte interessada, corpo clínico, enfermeiros, pessoal administrativo e auxiliar e demais estruturas de suporte à administração hospitalar, e em que todos se sintam participantes activos. Penso que serão os hospitais capazes de acompanhar a mudança e assumir esta «nova forma de estar» que «farão a diferença» no futuro.
- Successful endoscopic closure of gastrocutaneous fistula with an over-the-scope clipPublication . Magalhães, K.; Barrias, S.; Rolanda, C.; Salgado, M.; Magalhães, M.; Simões, V.; Pedroto, I.