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Biomedical subjects

J M de Almeida

Publications and source records attributed to J M de Almeida.

At least 19 recordsLinked to original sources
PubMed1999

Surgical treatment of lung metastases: prognostic factors for long-term survival.

BACKGROUND AND OBJECTIVES: Surgical resection of lung metastases is an established therapy for a large number of primary tumors, but there is some controversy about prognostic factors for long-term survival. METHODS: From 1968 to 1996, we performed a retrospective review of a series of 85 patients (100 operations) that have been operated for resection of lung metastases. The Kaplan-Meier method was used to estimate the probabilities of survival, the log-rank test for the univariate analysis of prognostic factors for survival, and the Cox model in the subsequent multivariate analysis. RESULTS: The operative mortality was 4% and the morbidity 18%. The mean follow-up after lung resection was 22.13 months (1-146). The actuarial 5-year survival rate was 29.2%. By univariate analysis, the following factors were associated with survival after resection: location and histology of the primary tumor, greatest dimension of the largest metastasis, radicality of the resection, involvement of the resection margins, and use of adjuvant therapy (P < 0.05). After multivariate analysis, only the dimension of the metastases and involvement of surgical margins have been found to be independently associated with survival. CONCLUSIONS: Surgical excision is a safe and effective therapy for lung metastases from a large number of primary tumors, provided a complete resection is feasible.

Adolescent↗
PubMed1998

Burden on the families of patients with schizophrenia: results of the BIOMED I study.

The burden, the coping strategies and the social network of a sample of 236 relatives of patients with schizophrenia, living in five European countries, were explored by well-validated assessment instruments. In all centres, relatives experienced higher levels of burden when they had poor coping resources and reduced social support. Relatives in Mediterranean centres, who reported lower levels of social support, were more resigned, and more often used spiritual help as a coping strategy. These data indicate that family burden and coping strategies can be influenced by cultural factors and suggest that family interventions should have also a social focus, aiming to increase the family social network and to reduce stigma.

Adaptation, Psychological↗
PubMed1997

[Current prospects in the community treatment of schizophrenia].

The advances of pharmacological and psychosocial therapies in recent years have deeply changed the perspectives on the treatment of schizophrenia in the community. The hospital-centred models are progressively being replaced with comprehensive community care models. After discussing the main aspects of this evolution at a conceptual level, the authors describe the currently available therapeutic interventions of schizophrenia in the community (pharmacological therapies, psychotherapies, psychosocial and family interventions) and their effectiveness. The authors also discuss the cost-effectiveness studies on the different models of treatment, namely those comparing the community-centred models with the more traditional ones. Finally, the organisational problems of the implementation of community-centred models are discussed and the perspectives in this field in our country are considered.

Combined Modality Therapy↗
PubMed1995

[Hepatocellular carcinoma. Rare forms of presentation].

The occurrence of metastases is documented in a varied number of hepato-cellular carcinomas (HCC). The indicative metastasis is very rarely the form of clinical presentation of the disease. Two cases of HCC which were clinically presented in a secondary location, in the bone and skeletal muscle respectively, are described.

Abdominal Muscles↗
PubMed1995

[The curative surgery of periampullary tumors. The results of 48 resections].

Periampullary tumors form a clinical entity with common symptoms, similar therapeutic options, unsatisfactory resectability rates and unfavorable prognosis. From April 1970 until March 1994, one hundred and twenty-seven patients with periampullary carcinoma were operated by our surgical team. In 48 of these patients, a resection for cure was performed (38%). Resectability rates varied according to the origin of these tumors, i.e., pancreas-20%, ampulla-76%; distal bile duct-71%, periampullary duodenum-88%. Pancreatic tumors showed a different resectability rate from the other periampullary carcinomas (p = 0.04). Forty-two of these patients had a pancreatoduodenectomy and in the remaining 6 cases a total pancreatectomy was performed. Fifteen patients had major post-operative morbidity (31%) and 8 of these cases died in-hospital (17%). Follow-up data was available in 81% of the patients, survival estimates were calculated according to the Kaplan-Meier method and survival comparisons were made with the Log-rank test. Median survival for resected pancreatic carcinoma was 6 months and for resected tumors of the ampulla 37 months. In this group of patients, pancreatic tumors showed a different survival rate from the remaining periampullary tumors (Log-rank-p = 0.002). This work evidences the need to improve management of periampullary tumors, particularly in-hospital mortality and long-term survival. To achieve these goals, patients with periampullary tumors should be treated in specialized centers and research to improve local and systemic control of this disease should be pursued.

Aged↗
PubMed1993

[Palliative surgery in carcinoma of the stomach. Retrospective study of 112 consecutive cases].

From January 1980 until October 1991 we operated 112 patients with Gastric cancer in which Surgery was considered palliative by intra-operative criteria or by pathological analysis of the resected specimen. Locally irresectable tumour was found in 24.1% of the cases, peritoneal metastases (mets.) in 21.4%, liver mets. in 17%, lymphatic mets. in 16.1%, and other mets. in 21.4%. Resections were possible in 57 patients (50.8%), with a mortality rate of 10.5%, which was similar to the mortality in the non-resection group (7%) p = 0.2. Median survival for the entire group was 7 months, the non-resection group had a median survival of 4 months, and the resection group of 18 months (p = 6.480 e-0.7). Locally advanced tumors had a better outcome than the metastatic group (p = 0.05), but no difference was observed between patients with liver or peritoneal mets. Patients in stage 3 and 4 of the disease had a different prognosis (p = 0.03), and the resection group within each stage fared better.

Adult↗
PubMed1993

Immunoscintigraphy with 99mTc-labelled anti-CEA monoclonal antibody in colorectal carcinoma.

With the introduction of immunoscintigraphy (IS) with 99mTc-labelled anti-CEA monoclonal antibodies (MoAb), a clinical relevant method in nuclear medicine can be expected in the diagnosis and follow up of colorectal cancers. We performed IS (whole body, planar and SPECT) with a 99mTc-labelled intact anti-CEA MoAb (BW 431/26) in 18 patients with primary colorectal carcinoma, metastases or suspicious recurrences from colorectal carcinoma. The results of anti-CEA IS, serum CEA and Ca 19-9 levels were evaluated. Immunoscintigraphy yielded an overall sensitivity of 70.0%, 37.5% for primary tumors, 75.0% for recurrences and 100% for distant metastases. Serum CEA levels were elevated in 10 out of 18 patients (sensitivity 55.5%) and Ca 19-9 were elevated in eight out of 18 patients (sensitivity 44.4%). In the group of patients with metastases, CEA had a sensitivity of 100% and Ca 19-9, of 83.3%. From this prospective study, we can conclude that IS with 99mTC-BW 431/26 is a reliable tool in the post-operative follow-up study of patients with colorectal carcinoma, namely in the detection of distant metastases.

Aged↗
PubMed1992

[Psychiatric morbidity in general hospital inpatients].

Psychiatric morbidity was studied in 73 patients of three Units (Medicine, Surgery and Obstetrics) of a general hospital (S. Francisco Xavier Hospital, Lisbon). In the first stage, the patients were clinically evaluated by their doctors. In the second stage, psychiatrists using the General Health Questionnaire (G.H.Q. 30) interviewed all the patients according to the clinical evaluation, 41% of the patients had a significant psychological disorder. However, very significant differences were found between the prevalence rates in the three units. As defined by the G.H.Q. 30, 50 patients (68.5%) had psychiatric disorders, which is statistically different from the results obtained through clinical evaluation. The depression and anxiety syndromes were the most frequent disorders. Organic mental disorders were less frequent and almost limited to medical patients. The results of this study confirm a high rate of psychiatric morbidity in the general hospital, although considerable differences exist between the three units included in the study. We can also conclude that many psychiatric disorders are not correctly identified. This fact, more frequent in units where there is a more brief doctor-patient relationship, supports the necessity of implementing liaison psychiatry programs.

Cross-Sectional Studies↗
PubMed1992

[Abdominal versus thoracic approach for myotomy in esophageal achalasia].

Miotomy is the most common operation for the treatment of achalasia of the esophagus. The most important complication of this operation is gastro-esophageal reflux, and controversy exists in the choice of a thoracic or abdominal approach to this operation. From 1974 until 1988, our group performed 45 miotomies for achalasia of the esophagus. Follow-up was obtained in 82% of the patients. The thoracic approach was used in 21 cases (tor), and 24 patients were operated through an abdominal approach (abd). All the miotomies had an anti-reflux procedure associated. Post-operative evaluation consisted of: clinical score determination; endoscopy with biopsy; manometry; 24 Phmetry. The clinical score revealed that 47% of the patients in the group tor were asymptomatic, and in the group abd this rate was 53%. Absence of macroscopic esophagitis was registered in 75% of the patients in the group tor, and in 91% in the group abd. Microscopic esophagitis was observed in 42% of the cases in the group tor, and in 45% of the group abd. Manometry revealed a low pressure in the inferior esophageal sphincter in 90% of the cases of the group tor, and in 80% of the group abd. Pathological gastro-esophageal reflux, detected by 24 h Phmetry, was present in 29% of the group tor, and in 36% of the group abd. The results in these two groups were very similar, uniformly favourable, and without evidence of superiority of either operation. The choice of a thoracic, or abdominal approach should depend on associated factors such as patient age, respiratory disease, etc.

Abdomen↗
PubMedDate not supplied

Curative surgery for gastric cancer: study of 166 consecutive patients.

From January 1980 to December 1991 we operated on 295 patients with a gastric carcinoma. In 166 cases (56.3%) surgery was performed with curative intent. In 93 patients (56%) a subtotal gastrectomy was performed, and in 73 cases (44%) a total gastrectomy. In all the cases a D-2 type lymphadenectomy was used. The global morbidity rate was 23%, and in-hospital mortality was 3.6%. The morbidity and mortality rates of these two operations were statistically different. Global 5-year survival estimate for the whole series is 61.3%. Univariate and multivariate analysis according to T and N (TNM classification), the number of positive nodes resected, and the relation of positive per resected nodes, revealed statistically different outcomes. This kind of quantitative classification allowed identification of high risk groups irrespective of site of nodal involvement. Tumors classified as intestinal or diffuse type by the Lauren classification had similar survival curves and 5-year survival estimates (p = 0.834). By univariate and multivariate analysis this classification did not reveal a prognostic value in this group of patients. In our opinion, tumor penetration and lymph node involvement are at present the most reliable prognostic factors available.

Adult↗
PubMedDate not supplied

[The repercussions of mental disease in the family. A study of the family members of psychotic patients].

UNLABELLED: Caregiving and related concepts such as family or caregiver burden have been widely discussed in recent literature. A descriptive, cross-sectional study was conducted in a sample (n = 80) of primary caregivers to severe mental patients (diagnosed schizophrenia, chronic psychosis or affective disorder). OBJECTIVES: To describe the caregivers' and corresponding patients' sample, as well as the nature of existing relationships. Levels of caregiver burden and psychological distress were evaluated and a preliminary analysis conducted on objective and subjective burden correlation. METHODS: Involvement Evaluation Questionnaire (IEQ), General Health Questionnaire (GHQ) and a semi-structured interview designed for this purpose. RESULTS: The extent of burden was found significant in this sample, being unevenly distributed in its components (e.g. tension, worrying or financial burden). Forty-one percent of caregivers experienced minor psychiatric morbidity. Measures of objective and subjective burden were moderately correlated. The same applied to magnitude of associations between each of them and distress parameters. Higher levels of burden were found in groups of caregivers to more severely ill or disabled patients, while diagnosis was not important for this purpose. CONCLUSIONS: Most relatives remain highly involved. These results suggest the need to implement specific interventions addressing psychotic patients as well as their families.

Adolescent↗