Percorrer por autor "Velasco, Francisco"
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- Anorectal melanoma: a rare entityPublication . Relvas, Luís Miguel; Gago, Tânia; Velasco, Francisco; Barros, Sónia; Carvalho, Isabel; Caldeira, PauloAnorectal melanoma is a rare malignant tumor with the potential of simulating a benign anorectal disease, making its diagnosis difficult. We describe a case of anorectal melanoma, in which the interpretation of symptoms as hemorrhoidal disease delayed diagnosis and appropriate intervention.
- 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.
- Olmesartan-induced enteropathy: an unusual cause of villous atrophyPublication . Eusébio, Marta; Caldeira, Paulo; Antunes, Artur Gião; Ramos, André; Velasco, Francisco; Cadill, Jesús; Guerreiro, HoracioWe report a case of a 63-year-old-man presenting with chronic diarrhea and weight loss while on olmesartan treatment for hypertension. Investigation showed multiple nutritional deficiencies associated with diffuse intestinal villous atrophy. Serologies for celiac disease were negative and other causes of villous atrophy were excluded. Olmesartan as a precipitant agent was suspected and withdrawn. Clinical improvement occurred in days with no need for other therapeutic measures. Follow-up at three months showed clinical remission and almost complete recovery of intestinal atrophy. Olmesartan is an angiotensin receptor blocker commonly prescribed for the management of hypertension. Spruelike enteropathy associated with this drug is a recently described entity with few cases reported. It presents with chronic diarrhea and intestinal villous atrophy and should be included in its differential diagnosis. This case intends to alert clinicians for the possibility of this event in a patient on treatment with this drug.
- 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.
- Russell body gastritis in an Hp-negative patientPublication . Antunes, Artur Gião; Cadillá, Jesus; Velasco, FranciscoA 79-year-old woman with a longstanding gastrooesophageal reflux disease was admitted to the emergency room for haematemesis without other symptoms.