Percorrer por autor "Peixe, Bruno"
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- A case of sclerosing angiomatoid nodular transformation of the spleen: Imaging and histopathological findingsPublication . Eusébio, Marta; Sousa, Ana Lucia; Vaz, Ana Margarida; da Silva, Silvia Gomes; Milheiro, Maria Adelaide; Peixe, Bruno; Caldeira, Paulo; Guerreiro, HorácioA 62-year-old woman presented with left upper quadrant pain and anorexia for 1 month. She had a past medical history of nephrolithiasis, extramembranous glomerulonephritis and a relevant atopic background. Physical examination as well as laboratory tests were unremarkable. Abdominal computed tomography, performed without endovenous contrast due to patient’s atopic history, highlighted a nodular density between the pancreatic tale and splenic hilum. On unenhanced magnetic resonance imaging this corresponded to a vascular structure, next to the spleen, with a ‘‘serpentine’’ shape and apparently in continuity with this organ. Additionally, within the spleen there were three, well circumscribed, macronodular lesions, with lobular borders, the biggest measuring 2.5 cm in greater diameter. These lesions were isointense on T1-weighted sequences and hypointense with mildly hyperintense septa on T2 and FATSAT Fiesta sequences. No other relevant lesions were identified.
- Fever and haematochezia: an unusual associationPublication . Antunes, Artur Gião; Peixe, Bruno; Guerreiro, HoracioA 72-year-old male patient presented to the emergency room for haematocheziafollowed bysyncope. In the past 2 days he had fever and asthenia. From his medical records, we registered a peripheral vascular disease, with an aortobifemoral bypass graft placed 12 years prior; 6 years later, the graft had a thrombosis event and the patient was submitted to an axillofemoral bypass graft. On physical examination, he had haemodynamic instability and fever (38°C); the abdominal examination showed no abnormalities. Laboratory tests were as follows: haemoglobin: 10.7 g/L, white cell count: 17.7×109/ L; international normalized ratio (INR): 6.26; C reactive protein: 202 mg/L; blood urea nitrogen (BUN): 44 U/L; and creatinine: 1.91 mg/dL. After haemodynamic resuscitation, given the clinical presentation and the hypothesis of secondary aortoenteric fistula (AEF), a CT angiography was performed (figure 1). Although no active bleeding was detected, the aortobifemoral bypass graft was found to be adjacent to the third part of duodenum, but at a level at which the lumen of the aorta was partially thrombosed. Also, an effacement of the fat plane between the graft and the adjacent portion of the duodenum was noticed.
- Is fluoroscopy necessary for oesophageal SEMS placement? A retrospective cohort studyPublication . Relvas, Luís Miguel; Gago, Tânia; Barros, Sónia; Carvalho, Isabel; Portugal, Margarida; Velasco, Francisco; Caldeira, Paulo; Peixe, BrunoIntroduction: self-expanding metal stents (SEMS) are widely used for the palliation of malignant esophageal conditions, including strictures, fistulas, and extrinsic compression. Placement may be guided by fluoroscopy, direct endoscopy, or both. However, few studies have directly compared the outcomes of these techniques. Objective: to compare the safety and efficacy of SEMS placement under endoscopic versus fluoroscopic control in a real-world clinical setting. Methods: we conducted a retrospective observational study of adult patients who underwent esophageal SEMS placement between January 2011 and December 2023. Patients were assigned to either the endoscopic control (EC) or fluoroscopic control (FC) group based on fluoroscopy availability. Outcomes included technical success, complication rates (early and late), and overall survival. Results: a total of 103 patients were included (mean age 69.4 years; 79 % male), with 43 receiving SEMS under EC and 60 under FC. The primary indication was malignant esophageal stricture (91.3 %). Technical success was achieved in 97 % of EC cases and 100 % of FC cases. Early complications occurred in 53 % of EC and 49 % of FC patients (p = 0.70), including chest pain (40.7 %), vomiting (22.3 %), and stent migration (5.8 %). Late complications occurred in 28 % of EC and 31 % of FC cases (p = 0.74), most commonly tumor overgrowth (14.6 %) and stent migration (10.7 %). Thirty-day mortality was 2.3 % in the EC group and 0 % in the FC group (p = 0.31). Median survival was 102 days (EC) versus 113 days (FC) (p = 0.44). Conclusions: SEMS placement under both endoscopic and fluoroscopic control is safe and effective, with no significant differences in complication rates, technical success, or survival. Endoscopic guidance may be a viable alternative to fluoroscopy in experienced hands, particularly in resource-limited settings.
- Molecular detection of multiple antimicrobial resistance genes in helicobacter pylori-positive gastric samples from patients undergoing upper gastrointestinal endoscopy with gastric biopsy in Algarve, PortugalPublication . Nunes, Francisco José Viegas Cortez; Aguieiras, Catarina; Calhindro, Mauro; Louro, Ricardo; Peixe, Bruno; Queirós, Patrícia; Castelo-Branco, Pedro; Mateus, Teresa LetraBackground/Objectives: Helicobacter pylori (H. pylori) is a common gastric pathogen linked to gastritis, gastroduodenal ulcers, and gastric cancer. Rising antimicrobial resistance (AMR) poses challenges for effective treatment and has prompted the WHO to classify H. pylori as a high-priority pathogen. This study aimed to detect the prevalence of AMR genes in H. pylori-positive gastric samples from patients in Algarve, Portugal, where regional data is scarce. Methods: Eighteen H. pylori-positive gastric biopsy samples from patients undergoing upper gastrointestinal endoscopy were analyzed. PCR and sequencing were used to identify genes associated with resistance to amoxicillin (Pbp1A), metronidazole (rdxA, frxA), tetracycline (16S rRNA mutation) and clarithromycin (23S rRNA). Sequence identity and homologies were verified using tBLASTx and the Comprehensive Antibiotic Resistance Database (CARD). Results: Out of the 18 H. pylori-positive samples, 16 (88.9%) contained at least one AMR gene. The most frequent genes were rdxA (83.3%) and frxA (66.7%) for metronidazole resistance, and the 16S rRNA mutation (66.7%) for tetracycline. Resistance to amoxicillin and clarithromycin was detected in 27.8% and 16.7% of cases, respectively. Most samples (72.2%) had multiple resistance genes. A significantly strong association was found between female sex and the presence of the rdxA gene (p = 0.043). Conclusions: The study reveals a high prevalence of H. pylori resistance genes in Algarve, particularly against metronidazole and tetracycline. These findings highlight the need for local surveillance and tailored treatment strategies. Further research with larger populations is warranted to assess regional resistance patterns and improve eradication efforts.
- Pancreatitis and cholangitis following intraductal migration of a metal clip 5 years after laparoscopic cholecystectomyPublication . Antunes, Artur Gião; Peixe, Bruno; Guerreiro, HoracioA 58-year-old male was admitted at our hospital for severe epigastric pain, nausea and vomiting. On physical examination patient was sweaty, restless and with marked tenderness in the epigastrum.
- Prevalence and diagnostic comparison of helicobacter pylori and non-helicobacter pylori helicobacter infections in patients undergoing upper gastrointestinal endoscopy with gastric biopsy in Algarve, PortugalPublication . Mateus, Teresa Letra; Aguieiras, Catarina; Louro, Ricardo; Peixe, Bruno; Calhindro, Mauro; Nunes, Francisco José Viegas Cortez; Queirós, Patrícia; Castelo-Branco, PedroH. pylori infects over half of the global population and is associated with various gastric and extra-gastric diseases. Other species, such as zoonotic non-Helicobacter pylori Helicobacters (NHPHs), have shown similar associations with gastritis and MALT lymphoma and H. pylori-negative cases with gastric disease have been identified, including gastric MALT lymphoma, chronic gastritis, and gastroduodenal ulcers. Accurate identification of these species is of great relevance but remains challenging using conventional diagnostic methods. This cross-sectional study aimed to determine the prevalence of H. pylori and NHPH infections, comparing standard histological protocols with molecular techniques. Between December 2024 and February 2025, 54 adult patients undergoing upper gastrointestinal endoscopy (UGE) with gastric biopsy in three hospitals in Algarve, Portugal were recruited. Endoscopic assessment was performed, and gastric biopsies were collected for histological and molecular analysis. DNA was extracted from antral biopsies and analyzed by conventional PCR to detect H. pylori and NHPH. H. pylori diagnostic techniques were compared, descriptive plus statistical analysis was performed, and p-values < 0.05 were considered to be statistically significant. Fifty-four patients were included in the study, with 51.9% of them presenting symptoms. Endoscopic gastritis was observed in 66.7% of patients, while histological gastritis was present in 88.9%, with statistically significant differences between the two diagnostic techniques (p = 0.004). Helicobacter spp. were identified in 44.4% (24/54) of the patients. H. pylori was detected in 42.6% of the patients by Modified Giemsa stain and in 33.3% by PCR. H. bizzozeronii was found in 35.9% of the patients, with 22.2% showing mixed infections. This study reveals a significant prevalence of Helicobacter spp. in patients from the Algarve region, with both H. pylori and zoonotic H. bizzozeronii detected. This is the first report of H. bizzozeronii DNA detection in gastric biopsies via PCR from patients undergoing UGE in Portugal, highlighting the need to consider NHPH in clinical diagnosis. It is important to include molecular methods in routine diagnostics and the need for broader studies to assess regional and national trends in Helicobacter infections besides H. pylori.
- Risk factors for recurrence in ischemic colitis: A 10-year retrospective studyPublication . Relvas, Luís; Carvalho, Isabel; Baltazar, Pedro Miguel; Gago, Tânia; Velasco, Francisco; Caldeira, Paulo; Peixe, BrunoBackground: recurrent ischemic colitis (IC) is uncommon but clinically relevant, and its risk factors remain poorly defined. This study aimed to assess the prevalence of recurrence and identify associated clinical predictors. Methods: a retrospective single-center cohort study was performed including all patients diagnosed with IC at the Algarve Local Health Unit (Faro, Portugal), between January 2011 and December 2021. Cases were identified using ICD-9/ICD-10 codes and confirmed by clinical presentation and at least one diagnostic modality (computed tomography [CT], colonoscopy, or histology). Patients younger than 18 years, pregnant women, and those with mechanical or inflammatory causes of colitis were excluded. Recurrent IC was defined as a new episode after a ≥ 30-day symptom-free interval. Demographic, clinical, imaging, and outcome data were collected. Associations with recurrence were analyzed using odds ratios (OR) with 95 % confidence intervals (CIs). Results: of 142 patients, eleven (7.7 %) had recurrent IC. Recurrence was associated with smoking (OR 5.6, 95 % CI: 1.5-20.3), coronary artery disease (OR 4.1, 95 % CI: 1.1-15.6), prior laparotomy (OR 5.8, 95 % CI: 1.3-26.0), and clopidogrel use (OR 5.2, 95 % CI: 1.3-20.1). Patients with recurrence required blood transfusion more often (OR 7.8, 95 % CI: 1.9-31.5) but presented with hematochezia less frequently (OR 0.16, 95 % CI: 0.04-0.57). Imaging and endoscopic findings were comparable across groups, although colonic necrosis was absent in recurrent cases. Conclusions: recurrent IC occurred in 7.7 % of patients and was linked to smoking, cardiovascular disease, prior laparotomy, and clopidogrel therapy. Its presentation was often less typical, which may hinder early recognition. Prospective, multicenter studies are required to confirm these findings.
- Verrucous carcinoma of the esophagus: a deceiving entity with an uncertain etiology – case reportPublication . Carvalho, Isabel Malta; Gago, Tânia; Relvas, Luís; Portugal, Margarida; Cadilla, Jesus; Peixe, BrunoVerrucous carcinoma of the esophagus is an extremely rare malignancy, described as a well-differentiated variant of esophageal squamous cell carcinoma, typically exhibiting exophytic/verrucous growth and intraluminal involvement that is often rich in inflammation and hyperkeratosis, which hampers histologic diagnosis and consequently delays treatment. We report the case of a 58-year-old woman with progressive dysphagia and a circumferential, verrucous esophageal lesion, without histologic confirmation despite multiple biopsies and endoscopic resections, showing only focal p16 positivity. After further evaluation with CT, endoscopic ultrasound, and FDG-PET/CT, a presumptive diagnosis of locally advanced verrucous carcinoma of the esophagus was assumed, and palliative chemotherapy was initiated, followed by a sustained endoscopic and radiologic response. This case highlights the importance of multidisciplinary discussion when verrucous carcinoma of the esophagus is suspected and the unexpected, sustained response despite unresectability.
- Widespread metastatic uveal melanoma with gastrointestinal and gallbladder involvement: a case reportPublication . de Oliveira, Raquel; Portugal, Margarida; Roseira, Joana; Peixe, BrunoMelanoma is a malignant tumour arising from melanocytes, with cutaneous melanoma accounting for the vast majority of cases. Less frequently, melanomas originate from extracutaneous melanocytes, including those of the uveal tract. Although primary gastrointestinal melanomas exist, gastrointestinal involvement by melanoma more commonly represents metastatic disease. Recognition of gastrointestinal metastatic lesions and their variable endoscopic appearance has become increasingly relevant with the advances in systemic therapies. Case Presentation: We report a case of a 74-year-old man referred for investigation of irondeficiency anaemia. Esophagogastroduodenoscopy revealed multiple flat, dark millimetric lesions in the distal oesophagus, stomach, and duodenum. Histopathological examination with immunohistochemistry revealed melanoma. Cross-sectional imaging and positron emission tomography demonstrated widespread metastatic disease involving the liver, lungs, brain, bone, and gallbladder, as well as a hypermetabolic intraocular lesion. Ophthalmological and dermatological evaluation was consistent with primary uveal melanoma, with no evidence of a cutaneous primary. The patient experienced rapid neurological deterioration due to brain metastases and died shortly after diagnosis. Conclusion: Gastrointestinal metastases of melanoma are rare, particularly in uveal melanoma, and are often clinically silent. Endoscopic findings are heterogeneous and may be detected during the investigation of nonspecific symptoms such as anaemia. This case highlights the importance of recognising and sampling atypical pigmented gastrointestinal lesions, as endoscopy may play a key role in the diagnosis of advanced melanoma and prompt multidisciplinary management.