Repositório RCAAP

Background: Proper vascular access is essential for effective hemodialysis. There are three main access modalities: arte- riovenous fistula (AVF), arteriovenous graft (AVG), and central venous catheter. AVF has better patency and fewer complications, with lower morbidity and mortality rates. Some patients have limited superficial venous patrimony, and the best vascular access remains undetermined, with AVG and brachial vein transposition (BVT) representing upper limb alternatives. Our aim is to inves- tigate BVT and AVG followed by our institution regarding patency and need for intervention. Methods: This paper is based on a retrospective analysis of BVT and AVG followed/intervened our center between 2014 and 2018. To primary outcome was to define and compare patency rates for each group. Primary failure and need for reinterven- tion were considered secondary outcomes. Results: There was no statistically significant difference between primary and secondary patency in both groups. BVT has a higher post-intervention primary patency and fewer interventions due to thrombosis, despite the overall number of inter- ventions per patient similar to AVG. Conclusions: Despite the absence of a statistically significant difference in secondary patency and the need for reinter- vention between BVT and AVG, thrombosis-free time is higher in the BVT group. Overall, BVT is a valid access option that should be considered in patients with no other autogenous access alternative in upper limbs.

Postoperative chylothorax can be a serious complication. We report on the case of a neonate who had a postoperative chylothorax immediately after esophageal surgery that did not respond to conservative measures or the first two attempts of surgical management of chylothorax. Lastly, a successful pleuroperitoneal shunt was placed and the patient was discharge at 3-months-old. A pleuroperitoneal shunt is usually the last surgical option but may be a curative measure.

The authors present a case of a 72-year-old man diagnosed with pneumomediastinum in a positron emission tomography scan (18F-FDG PET-CT) to assess the tumor response to palliative chemotherapy. The patient was asymptomatic and had no special findings in physical examination. Conservative approach was decided by the multidisciplinary team. The patient had an uneventful recovery.

Civilian penetrating injuries to the upper extremities are becoming seldom, with few case reports presented in the recent literature. Nevertheless, the brachial artery is the most frequently injured artery, accounting for approximately 30% of all vascular injuries. The authors present two clinical cases of brachial artery penetrating trauma with a stab corrected with an interposition saphenous bypass graft.

Bovine arch is an aortic arch variant in which the left common carotid artery and the brachiocephalic trunk share the same origin. Several vascular pathologies, as aneurysm, dissection or strokes have an increased prevalence in patients with this anatomic variant. We describe the first reported case of a young patient with a symptomatic aortic arch floating thrombus in association with a bovine arch.

A 59 year-old male presents with fever and left parasternal pain. Past medical history included arterial hypertension, dyslipidemia, smoking, obesity. His clinical exam was unremarkable. Both C-reactive protein and leucocytes were elevated. Chest computed tomography (CT) demonstrated a 18mm saccular pseudoaneurysm of the aortic arch with extensive adjacent densification and adenopathy (Figure 1 and 2). Methicillin-sensible Staphylococcus aureus was isolated from blood cultures. A transesophageal echocardiogram excluded endocarditis. Control Angio-CT after seven days showed a contained rupture and increase in diameter of the pseudoaneurysm. He underwent emergent surgery with circulatory arrest and anterograde cerebral perfusion; extensive resection of the pseudoaneurysmal aorta was performed, with reconstruction of the aortic arch using autologous pericardium, without implantation of foreign or synthetic material (Figure 3 and 4). He completed 4 weeks of Flucloxacillin IV, having been discharged under oral antibiotics.

Planos para igualdade, Organizações portuguesas, Mainstreaming de género, Princípios de boa governança

Cidadania, Direitos Humanos, Violências, Salazarismo

trabalho, ontologia da vida, visão formalista, visão substantiva, capitalismo

crise, experiência, aprendizagem, cidadania, ação coletiva

Formação profissional, Itinerários de transição, Inclusão social, Exclusão social, Jovens

acesso ao ensino superior, formação complementar, educação inclusiva, ações afirmativas, populações afrodescendentes, indígenas

mobilização social, participação cívica, (multi)deficiência, música

Pobreza, exclusão social, concetualizações teóricas, visões pessoais

Avaliação geriátrica, género, saúde, idoso, idoso fragilizado

Sindicalismo, crise, revitalização, Internet, democracia digital

Estruturas de consumo

Boltanski, crítica, capitalismo, trabalho

segregação laboral, estereótipos de género, especialidades médicas

Política, desigualdades de género, Lei da Paridade, mudanças, transformações de género