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- 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.
- Evaluation of MGP gene expression in colorectal cancerPublication . Caiado, Helena; Conceição, Natércia; Tiago, Daniel; Marreiros, Ana; Vicente, Susana; Enriquez, Jose Luis; Vaz, Ana Margarida; Antunes, Artur; Guerreiro, Horacio; Caldeira, Paulo; Leonor Cancela, M.Purpose: Matrix Gla protein (MGP) is a vitamin K-dependent, gamma-carboxylated protein that was initially found to be a physiological inhibitor of ectopic calcifications affecting mainly cartilage and the vascular system. Mutations in the MGP gene were found to be responsible for a human pathology, the Keutel syndrome, characterized by abnormal calcifications in cartilage, lungs, brain and vascular system. MGP was recently implicated in tumorigenic processes such as angiogenesis and shown to be abnormally regulated in several tumors, including cervical, ovarian, urogenital and breast. This fact has triggered our interest in analyzing the expression of MGP and of its regulator, the transcription factor runt related transcription factor 2 (RUNX2), in colorectal cancer (CRC). Methods: MGP and RUNX2 expression were analyzed in cancer and non-tumor biopsies samples from 33 CRC patients and 9 healthy controls by RT-qPCR. Consequently, statistical analyses were performed to evaluate the clinical-pathological significance of MGP and RUNX2 in CRC. MGP protein was also detected by immunohistochemical analysis. Results: Showed an overall overexpression of MGP in the tumor mucosa of patients at mRNA level when compared to adjacent normal mucosa and healthy control tissues. In addition, analysis of the expression of RUNX2 mRNA demonstrated an overexpression in CRC tissue samples and a positive correlation with MGP expression (Pearson correlation coefficient 0.636; p <= 0.01) in tumor mucosa. However correlations between MGP gene expression and clinical-pathological characteristics, such as gender, age and pathology classification did not provide relevant information that may shed light towards the differences of MGP expression observed between normal and malignant tissue. Conclusions: We were able to associate the high levels of MGP mRNA expression with a worse prognosis and survival rate lower than five years. These results contributed to improve our understanding of the molecular mechanism underlying MGP deregulation in cancer.
- 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 severity and recurrence of colonic diverticular bleedingPublication . Joaquim, Natércia; Caldeira, Paulo; Antunes, Artur; Eusébio, Marta; Guerreiro, HoracioBackground: Colonic diverticular bleeding is the most common cause of lower gastrointestinal bleeding. Risk factors related to severity and repeated bleeding episodes are not completely clearly defined. Objective: To characterize a Portuguese population hospitalized due to colonic diverticular bleeding and to identify the clinical predictors related to bleeding severity and rebleeding. Methods: Retrospective analysis of all hospitalized patients diagnosed with colonic diverticular bleeding from January 2008 to December 2013 at our institution. The main outcomes evaluated were bleeding severity, defined as any transfusion support requirements and/or signs of hemodynamic shock, and 1-year recurrence rate. Results: Seventy-four patients were included, with a mean age of 75.7 +/- 9.5 years; the majority were male (62.2%). Thirty-six patients (48.6%) met the criteria for severe bleeding; four independent risk factors for severe diverticular bleeding were identified: low hemoglobin level at admission (<= 11 g/dL; OR 18.8), older age (>= 75 years; OR 4.7), bilateral diverticular location (OR 14.2) and chronic kidney disease (OR 5.6). The 1-year recurrence rate was 12.9%. We did not identify any independent risk factor for bleeding recurrence in this population. Conclusion: In this series, nearly half of the patients hospitalized with diverticular bleeding presented with severe bleeding. Patients with low hemoglobin levels, older age, bilateral diverticular location and chronic kidney disease had a significantly increased risk for severe diverticular bleeding. In addition, a small number of patients rebled within the first year after the index episode, although we could not identify independent risk factors associated with the recurrence of diverticular bleeding.
- Gastric siderosis as a cause of dyspepsiaPublication . Antunes, Artur Gião; Cadillá, Jesus; Guerreiro, HoracioA 66-year-old man was referred to our clinic due to a new onset of postprandial fullness and early satiety. He had a relevant personal history of myelodysplastic syndrome with lifelong regular blood transfusions resulting in a transfusional haemosiderosis (heart failure, pulmonary haemosiderosis, cirrhosis and diabetes).
- Expression of DUSP4 transcript variants as a potential biomarker for colorectal cancerPublication . Varela, Tatiana; Laizé, Vincent; Conceição, Natércia; Caldeira, Paulo; Marreiros, Ana; Guerreiro, Horacio; Cancela, M. LeonorAim: To provide novel data on the expression of DUSP4 transcripts in colorectal cancer (CRC) tissues and to explore their potential as biomarkers. Materials & methods:DUSP4 transcripts expression was determined by quantitative real-time PCR in tissues from 28 CRC patients. Their association with clinicopathological factors and survival analysis was performed. Data from 380 CRC patients available at The Cancer Genome Atlas project were also analyzed. Results: All transcripts were overexpressed in CRC tissues. Variant X1 was the most upregulated and associated with KRAS mutations and poorly differentiated tumor. Overexpression of DUSP4 transcripts could distinguish all tumor stages from normal tissues. Similar results were found in The Cancer Genome Atlas cohort. Conclusion:DUSP4 transcripts have the potential to serve as diagnostic biomarkers for CRC, particularly variant X1.
- 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.
- Data on the evaluation of FGF2 gene expression in Colorectal CancerPublication . Caiado, Helena; Conceição, Natércia; Tiago, Daniel; Marreiros, Ana; Vicente, Susana; Enriquez, Jose Luis; Vaz, Ana Margarida; Antunes, Artur; Guerreiro, Horacio; Caldeira, Paulo; Cancela, M. LeonorThe data presented in this article is related with the research paper entitled "Evaluation of MGP gene expression in colorectal cancer", available on Gene journal [1]. From all the transcription factors known to regulate MGP, FGF2 is the most described in colon adenocarcinoma and colon tumor cell lines, where it was shown to: i) contribute for the invasiveness potential; and ii) promote proliferation and survival of colorectal cancer cells. These in vitro studies pose the hypothesis that FGF2 associated signaling pathways could be promoting the regulation of others genes, such as MGP, that may lead to tumor progression which ultimately could result in poor prognosis in colon adenocarcinoma.