The influence of subclinical active inflammation on IFX pharmacokinetic modeling and disease progression assessment: findings from a prospective real-world study in inflammatory bowel disease patients.

BACKGROUND AND AIMS: Effective management of inflammatory bowel disease (IBD) relies on a comprehensive understanding of infliximab (IFX) pharmacokinetics (PK). This study's primary goal was to develop a robust PK model, identifying key covariates influencing IFX clearance (CL), while concurrently evaluating the risk of disease progression during the maintenance phase of IBD treatment. METHODS: The multicenter, prospective, real-world DIRECT study was conducted in several care centers, which included 369 IBD patients in the maintenance phase of IFX therapy. A two-compartment population PK model was used to determine IFX CL and covariates. Logistic and Cox regressions were applied to elucidate the associations between disease progression and covariates embedded in the PK model. RESULTS: The PK model included the contributions of weight, albumin, antidrug antibody (ADA), and fecal calprotectin (FC). On average, higher ADA, FC concentration and weight, and lower albumin concentration resulted in higher IFX CL. In the multivariate regression analyses, FC levels influenced the odds of disease progression in all its different definitions, when adjusted for several confounding factors. Additionally, alongside FC, both IFX and CL demonstrated a significant impact on the temporal aspect of disease progression. CONCLUSION: In this 2-year real-world study, readily available clinical covariates, notably FC, significantly impacted IFX availability in IBD patients. We demonstrated that subclinical active inflammation, as mirrored by FC or CRP, substantially influenced IFX clearance. Importantly, FC emerged as a pivotal determinant, not only of IFX pharmacokinetics but also of disease progression. These findings underscore the need to integrate FC into forthcoming IFX pharmacokinetic models, amplifying its clinical significance.

Thiopurines have no impact on outcomes of Crohn's disease patients beyond 12 months of maintenance treatment with infliximab.

BACKGROUND: The emergence of new treatments the inflammatory bowel diseases (IBD) raised questions regarding the role of older agents, namely thiopurines. AIMS: To clarify the benefits of combination treatment with thiopurines on Crohn's disease (CD) patients in the maintenance phase of infliximab. METHODS: In this analysis of the 2-year prospective multicentric DIRECT study, patients were assessed in terms of clinical activity, faecal calprotectin (FC), C-reactive protein (CRP), and infliximab pharmacokinetics. A composite outcome based on clinical- and drug-related items was used to define treatment failure. RESULTS: The study included 172 patients; of these, 35.5 % were treated with combination treatment. Overall, 18 % of patients achieved the composite outcome, without statistically significant differences between patients on monotherapy and on combination treatment (21.6% vs 11.5 %, p = 0.098). Median CRP, FC, and infliximab pharmacokinetic parameters were similar in both groups. However, in the sub-analysis by infliximab treatment duration, in patients treated for less than 12 months, the composite outcome was reached in fewer patients in the combination group than in the monotherapy group (7.1% vs 47.1 %, p = 0.021). CONCLUSION: In CD patients in maintenance treatment with infliximab, combination treatment does not seem to have benefits over infliximab monotherapy beyond 12 months of treatment duration.

Disturbed by a sandfly: visceral leishmaniasis in ileal Crohn´s disease under combined immunosuppression.

This case reports illustrates a 44-year-old Caucasian male with ileal Crohn´s disease under combined immunosuppression that first presented with unspecific constitutional symptoms, newly pancytopenia and elevated inflammatory markers. The infectious screening was negative except for an ileal abscess that resolved with conservative antibiotic therapy. Due to concerns for lymphoproliferative disease in a patient under anti-TNF and azathioprine, a myelogram was performed that ruled out dysplastic changes. After abscess resolution the symptoms relapsed with evening fever, nocturnal sudoresis and worsen pancytopenia. A more thorough work-up was performed with bone marrow and ileal biopsies that demonstrated numerous intra-and-extracellular leishmania amastigote forms, which confirmed the diagnosis of visceral leishmaniasis infiltrating the small bowel. The patient recovered after adequate treatment and withheld of immunosuppression during follow-up.

Monitoring and Predicting Health Status in Neurological Patients: The ALAMEDA Data Collection Protocol.

(1) Objective: We explore the predictive power of a novel stream of patient data, combining wearable devices and patient reported outcomes (PROs), using an AI-first approach to classify the health status of Parkinson's disease (PD), multiple sclerosis (MS) and stroke patients (collectively named PMSS). (2) Background: Recent studies acknowledge the burden of neurological disorders on patients and on the healthcare systems managing them. To address this, effort is invested in the digital transformation of health provisioning for PMSS patients. (3) Methods: We introduce the data collection journey within the ALAMEDA project, which continuously collects PRO data for a year through mobile applications and supplements them with data from minimally intrusive wearable devices (accelerometer bracelet, IMU sensor belt, ground force measuring insoles, and sleep mattress) worn for 1-2 weeks at each milestone. We present the data collection schedule and its feasibility, the mapping of medical predictor variables to wearable device capabilities and mobile application functionality. (4) Results: A novel combination of wearable devices and smartphone applications required for the desired analysis of motor, sleep, emotional and quality-of-life outcomes is introduced. AI-first analysis methods are presented that aim to uncover the prediction capability of diverse longitudinal and cross-sectional setups (in terms of standard medical test targets). Mobile application development and usage schedule facilitates the retention of patient engagement and compliance with the study protocol.

How many biomarker measurements are needed to predict prognosis in Crohn's disease patients under infliximab?-A prospective study.

BACKGROUND: Timely stratification of Crohn's disease (CD) is essential for patients' management. The use of noninvasive accurate biomarkers is key to monitor treatment and to pursue mucosal healing, the ultimate treatment endpoint in CD. OBJECTIVE: We aimed to evaluate the performance of readily available biomarkers and develop risk matrices to predict CD progression. METHODS: Data from 289 CD patients receiving infliximab (IFX) maintenance therapy for 2 years was collected; those patients were included in DIRECT, a prospective multicenter observational study. Disease progression was evaluated using two composite outcomes incorporating clinical and drug-related factors, the first including IFX dose and/or frequency adjustments. Univariate and multivariable logistic regressions were used to calculate the odds ratios (OR) and to develop risk matrices. RESULTS: The isolated presence of anemia at least once during follow-up was a significant predictor of disease progression (OR 2.436 and 3.396 [p ≤ 0.001] for composite outcomes 1 and 2, respectively) regardless of confounding factors. Isolated highly elevated C-reactive protein (CRP; >10.0 mg/L) and fecal calprotectin (FC; >500.0 µg/g) in at least one visit were also significant predictors, while milder elevations (3.1-10.0 mg/L and 250.1-500.0 µg/g) were only relevant when detected in at least two visits (consecutive or not). The combination of biomarkers in risk matrices had good ability to predict progression; patients simultaneously presenting anemia, highly elevated CRP and FC at least once had 42%-63% probability of achieving the composite outcomes. CONCLUSION: The combined evaluation of hemoglobin, CRP, and FC in at least one time point and their incorporation into risk matrices seems to be the optimal strategy for CD management, as data from additional visits did not meaningfully influence the predictions and may delay decision-making.

Shared Decision-Making to Improve Health-Related Outcomes for Adults with Stroke Disease.

Stroke is one of the leading causes of disability and death worldwide, a severe medical condition for which new solutions for prevention, monitoring, and adequate treatment are needed. This paper proposes a SDM framework for the development of innovative and effective solutions based on artificial intelligence in the rehabilitation of stroke patients by empowering patients to make decisions about the use of devices and applications developed in the European project ALAMEDA. To develop a predictive tool for improving disability in stroke patients, key aspects of stroke patient data collection journeys, monitored health parameters, and specific variables covering motor, physical, emotional, cognitive, and sleep status are presented. The proposed SDM model involved the training and consultation of patients, medical staff, carers, and representatives under the name of the Local Community Group. Consultation with LCG members, consists of 11 representative people, physicians, nurses, patients and caregivers, which led to the definition of a methodological framework to investigate the key aspects of monitoring the patient data collection journey for the stroke pilot, and a specific questionnaire to collect stroke patient requirements and preferences. A set of general and specific guidelines specifying the principles by which patients decide to use wearable sensing devices and specific applications resulted from the analysis of the data collected using the questionnaire. The preferences and recommendations collected from LCG members have already been implemented in this stage of ALAMEDA system design and development.

Clinical Nutrition in Portuguese Gastroenterology Departments: A Multicentric Study.

BACKGROUND: Hospital nutrition is a major public health problem, as up to 50% of hospitalized patients suffer from undernutrition. Adequate nutritional support (NS) decreases morbidity/mortality, shortens the length of stay, and reduces costs. We aimed to evaluate the engagement of Portuguese gastroenterology departments in NS, especially in artificial nutrition (AN). METHODS: Cross-sectional multicentric study, using an online survey sent to 31 Portuguese gastroenterology departments. RESULTS: Nine centers were involved, and all departments were engaged in NS activities. The most performed nutrition technique was endoscopic gastrostomy and not all departments had the expertise to perform all nutrition procedures, namely, endoscopic jejunostomy. Two departments had an AN outpatient clinic. Five centers were involved in hospital nutrition committees. Only four performed systematic nutritional evaluation of every patient on admission. Two departments developed research in the nutrition field. An increase staff and nutrition training were pointed out as suggestions to improve NS. CONCLUSIONS: This study outlines a broad picture of NS/AN in Portuguese gastroenterology departments. Medical nutritional training and increasing nutrition teams' staff may contribute to developing NS/AN. Multidisciplinary management of nutrition-related disorders is of utmost importance, and gastroenterologists are expected to be at the core of hospital nutrition.

Teledentistry and oral health in older adults - aspects for implementation of the "Patient centric solution for smart and sustainable healthcare (ACESO)" project.

P u r p o s e: Oral health and diseases are significant components of general health. However, oral health-care remains at the lowest of older patients' priorities. The inability to obtain dental care can result in progression of dental disease, leading to a diminished quality of life and overall health. Teledentistry (TD) provides an opportunity to improve the quality of oral health services. The aim of our narrative review was to analyze the usefulness of teledentistry as a part of telemedicine to improve oral health in the elderly. Materials/Methods: The PubMed database search was done for: teledentistry, oral health, oral- health related diseases, elderly, older adults. R e s u l t s: The applicability of TD has been demonstrated from children to older adults. Older adults have many obstacles in getting oral health care, including low income, lack health insurance, frailty, anxiety, depression, mobility problems or other handicaps. Available data suggests that the usefulness of TD in the provision of oral care in elderly people living in residential aged care facilities. Moreover, TD procedures were found to be as accurate as traditional face-to-face dental examinations, they was cost-effective and well accepted among patients and caregivers. C o n c l u s i o n s: TD might be a very useful tool for professional education, improving access and patient satisfaction of dental care. However, such TD modes would be difficult to widely implementation in community-dwelling older people who cannot access dental care. The ongoing "Patient centric solution for smart and sustainable healthcare (ACESO)" project will add to the intelligent oral health solutions.

Multiple bezoars causing small bowel obstruction: a unique case of resolution with upper and low GI endoscopy.

Reports of obstructing foreign bodies in the small bowel are rare and the majority describe surgical resolution. We report a case of successful endoscopic treatment of a small bowel obstruction (SBO) caused by multiple bezoars. A 92-year-old female presented to the Emergency Department with a history of persistent vomiting. Computed tomography (CT) showed gastric distension and an intraluminal ovaloid foreign body with a heterogenous density in the second portion of the duodenum, suggestive of bezoar.

Combining Supervised and Unsupervised Learning Algorithms for Human Activity Recognition.

Human activity recognition is an extensively researched topic in the last decade. Recent methods employ supervised and unsupervised deep learning techniques in which spatial and temporal dependency is modeled. This paper proposes a novel approach for human activity recognition using skeleton data. The method combines supervised and unsupervised learning algorithms in order to provide qualitative results and performance in real time. The proposed method involves a two-stage framework: the first stage applies an unsupervised clustering technique to group up activities based on their similarity, while the second stage classifies data assigned to each group using graph convolutional networks. Different clustering techniques and data augmentation strategies are explored for improving the training process. The results were compared against the state of the art methods and the proposed model achieved 90.22% Top-1 accuracy performance for NTU-RGB+D dataset (the performance was increased by approximately 9% compared with the baseline graph convolutional method). Moreover, inference time and total number of parameters stay within the same magnitude order. Extending the initial set of activities with additional classes is fast and robust, since there is no required retraining of the entire architecture but only to retrain the cluster to which the activity is assigned.

COVID-19 in Gastroenterology Departments: The Impact of the First Wave.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) is a global pandemic that has severely affected health care systems around the world. During the emergency state declared in Portugal in the months of March and April 2020, there was a severe reduction in medical activity in order to reduce the pressure on health systems. This study aimed to assess the impact of COVID-19 in gastroenterology departments across Portugal and the strategies developed to overcome this challenge. METHODS: This was a cross-sectional study based on an online survey. A detailed questionnaire concerning different aspects of gastroenterology department activity was sent via e-mail to the heads of gastroenterology departments of Portuguese District Hospitals (Núcleo de Gastroenterologia dos Hospitais Distritais). Two periods were assessed, i.e., the emergency state and the recovery period between May and September. The responses were collected between September and October 2020. RESULTS: A total of 21 hospitals were enrolled (80.8% response rate). Twenty-eight percent of the responders reported healthcare professionals from their unit infected with COVID-19. At least 1 member (mostly fellows) of the department was deployed to another workplace in 66.7% of the hospitals. During the emergency state, 47.6% of the hospitals only performed urgent/emergent endoscopic procedures. In 38.5% of the hospitals the need to ration personal protective equipment led to the suspension of endoscopic training. Regarding the recovery period, nonurgent procedures were restarted in almost all of the centers. The same was reported for the colorectal cancer screening program. Remarkably, 81% of the responders confirmed that they had postponed procedures at patients' request for "fear of getting infected." Remote consultation was maintained in 81% of the hospitals. Globally, the fellows had resumed their training. DISCUSSION/CONCLUSION: This study provides a snapshot of the impact and consequences of the first wave of the COVID-19 pandemic across Portuguese hospitals. It is important to understand how the gastroenterology world dealt with the first impact of COVID-19 and what strategies were implemented in order to better prepare for what might follow.

INTRODUÇÃO: A doença por coronavirus 19 (COVID-19) é uma pandemia global que afetou gravemente os serviços de saúde em todo o mundo. Durante o estado de emergência declarado em Portugal nos meses de Março e Abril de 2020, verificou-se uma redução importante na atividade médica. Este estudo teve como objetivo avaliar o impacto da COVID-19 nos Serviços de Gastroenterologia portugueses e as estratégias implementadas para fazer face a este desafio. MÉTODOS: Tratou-se de um estudo transversal baseado num inquérito online. Um questionário pormenorizado acerca de diferentes aspetos da atividade dum Serviço de Gastroenterologia foi enviado por email para os Diretores de Serviço de Gastroenterologia dos Hospitais Distritais. Foram avaliados dois períodos: o estado de emergência e o período de recuperação entre maio e setembro. Foram registadas as respostas entre setembro e outubro 2020. RESULTADOS: Responderam 21 Hospitais (taxa de resposta: 80,8%). Vinte e oito porcento dos inquiridos tiveram profissionais da sua unidade infectados com COVID-19. Pelo menos um elemento foi mobilizado para outro local de trabalho em 66,7% dos hospitais, maioritariamente internos de formação específica de Gastroenterologia. Durante o estado de emergência, 47,6% dos Hospitais só realizaram endoscopias urgentes/emergentes. Em 38,5%, a necessidade de racionamento de equipamento de proteção individual levou à suspensão do treino em endoscopia. Relativamente ao período de recuperação, os procedimientos não urgentes foram retomados na maioria dos centros. O mesmo se verificou para o programa de rastreio do cancro colorectal. Salienta-se que 81% dos inquiridos confirmaram que adiaram exames a pedido dos doentes por "medo de ficarem infetados". Mantiveram-se consultas nãopresenciais em 81% dos Hospitais. De modo geral, as atividades de formação dos internos foram progressivamente retomadas. DISCUSSÃO/CONCLUSÃO: Este estudo oferece o retrato do impacto e consequências da primeira vaga da pandemia nos Hospitais portugueses. É importante compreender como os Serviços de Gastrenterologia nacionais lidaram com o primeiro impacto da COVID-19 e que estratégias foram implementadas de forma a melhor preparar o que se segue.

Digestive Oncology in the COVID-19 Pandemic Era.

INTRODUCTION: Since the rise of the COVID-19 pandemic there has been widespread concern regarding the possible delay in the diagnosis/treatment of cancer patients. We aimed to assess the impact of the COVID-19 pandemic on the diagnosis, treatment, and outcome of patients with digestive cancer. METHODS: This was a retrospective study including patients with an inaugural digestive cancer diagnosis discussed for the first time at our center during the weekly digestive oncology reunion (DOR) meeting. The study group was enlisted from March to August 2020, and a control group was sourced from the equivalent period of 2018. Patients with a previous digestive cancer diagnosis/discussion in the DOR were excluded. The following data were collected: demographics, referral origin, tumor staging, first DOR discussion timing, treatment, and outcome. RESULTS: A total of 235 patients were included: 107 in the study group (65.4% male, mean age 71.59 years); 128 in the control group (54.7% male, mean age 68.16 years). The mean number of clinical discussions per week was higher in 2018 (13.65 vs. 10.67, p = 0.040), without a difference in the mean number of patients discussed for the first time (inaugural diagnosis) between groups (p = 0.670). In the 2020 study group, more patients were referred to DOR from the emergency room (ER), fewer from the outpatient clinic/hospital wards (p < 0.001), and more were referred after urgent surgery (p = 0.022). There was no difference in the mean waiting time from diagnosis to first DOR discussion (p = 0.087). Tumor staging in colorectal, gastric, and esophageal cancer was not significantly different between the groups (p = 0897, p = 0.168, and p = 0.717). More patients in the study group presented with stage IV pancreatic cancer (p = 0.043). There was no difference in the time span from DOR until the beginning of neoadjuvant chemotherapy (p = 0.680) or elective surgery (p = 0.198), or from surgery until adjuvant chemotherapy (p = 0.396). Also, there was no difference in 30-day mortality from the first DOR date between the groups (p = 0.742). CONCLUSION: During the COVID-19 era there was a reduced number of clinical discussions in the DOR, but the number of debated patients with an inaugural digestive cancer diagnosis was similar. In the study group more patients were referred to DOR from the ER, and were referred after urgent surgery, suggesting a delayed demand for clinical attention. Study group patients were not significantly affected by the pandemic regarding timely DOR discussion, beginning of treatment, or 30-day mortality, reflecting the maintenance of the quality of care for digestive cancer patients.

INTRODUÇÃO: Desde o início da pandemia por COVID-19, desenvolveu-se a preocupação com o possível atraso no diagnóstico/tratamento dos doentes oncológicos. O nosso objetivo foi avaliar o impacto da pandemia no diagnóstico, tratamento e prognóstico dos doentes com cancro digestivo. MÉTODOS: Estudo retrospetivo, incluindo doentes com diagnóstico inaugural de cancro digestivo, discutidos pela primeira vez na reunião semanal de oncologia digestiva (ROD) do nosso hospital, de Março-Agosto 2020 (grupo de estudo) e do período equivalente de 2018 (grupo controlo). Excluídos doentes com diagnóstico prévio de cancro digestivo/discussão prévia na ROD. Colheram-se: dados demográficos, origem da referenciação, estadio tumoral ao diagnóstico, data da primeira discussão na ROD, tratamento e prognóstico. RESULTADOS: Incluídos 235 doentes, 107 no grupo de estudo (65.4% homens, idade média 71.59), 128 no grupo controlo (54.7% homens, idade média 68.16). Número médio de discussões clínicas semanais na ROD foi superior em 2018 (13.65 vs. 10.67, p = 0.040). Sem diferença estatisticamente significativa no número de doentes discutidos pela primeira vez na ROD (diagnóstico inaugural) entre os grupos (p = 0.670). Mais doentes referenciados à ROD do Serviço de Urgência (SU) em 2020, menos a partir do ambulatório/ enfermaria (p < 0.001) e mais doentes referenciados após cirurgia urgente em 2020 (p = 0.022). Sem diferença entre os dois grupos no tempo médio de espera desde diagnóstico até a primeira discussão na ROD (p = 0.087). O estadio tumoral do cancro colorretal, gástrico e esofágico não foi significativamente diferente nos dois grupos (p = 0897, p = 0.168 e p = 0.717). Mais doentes apresentaram cancro pancreático em estadio IV no grupo de estudo (p = 0.043). Sem diferença no tempo desde ROD até início de quimioterapia neoadjuvante (p = 0.680) ou cirurgia eletiva (p = 0.198), nem da cirurgia até quimioterapia adjuvante (p = 0.396). Sem diferença na mortalidade aos 30 dias após primeira discussão na ROD nos dois grupos (p = 0.742). CONCLUSÃO: Durante a pandemia, o número de discussões clínicas na ROD foi inferior, mas o número de doentes com diagnóstico inaugural de cancro digestivo foi semelhante. No grupo de estudo, mais doentes foram referenciados à ROD do SU e mais após cirurgia urgente, sugerindo maior demora dos doentes para procurar atenção médica. Em 2020, os doentes não foram significativamente afetados pela pandemia relativamente à discussão atempada na ROD, início de tratamento ou mortalidade aos 30 dias, refletindo a manutenção da qualidade do suporte clínico aos doentes com cancro digestivo.

Image Segmentation Using Encoder-Decoder with Deformable Convolutions.

Image segmentation is an essential step in image analysis that brings meaning to the pixels in the image. Nevertheless, it is also a difficult task due to the lack of a general suited approach to this problem and the use of real-life pictures that can suffer from noise or object obstruction. This paper proposes an architecture for semantic segmentation using a convolutional neural network based on the Xception model, which was previously used for classification. Different experiments were made in order to find the best performances of the model (eg. different resolution and depth of the network and data augmentation techniques were applied). Additionally, the network was improved by adding a deformable convolution module. The proposed architecture obtained a 76.8 mean IoU on the Pascal VOC 2012 dataset and 58.1 on the Cityscapes dataset. It outperforms SegNet and U-Net networks, both networks having considerably more parameters and also a higher inference time.

The AMIRO Social Robotics Framework: Deployment and Evaluation on the Pepper Robot.

Recent studies in social robotics show that it can provide economic efficiency and growth in domains such as retail, entertainment, and active and assisted living (AAL). Recent work also highlights that users have the expectation of affordable social robotics platforms, providing focused and specific assistance in a robust manner. In this paper, we present the AMIRO social robotics framework, designed in a modular and robust way for assistive care scenarios. The framework includes robotic services for navigation, person detection and recognition, multi-lingual natural language interaction and dialogue management, as well as activity recognition and general behavior composition. We present AMIRO platform independent implementation based on a Robot Operating System (ROS). We focus on quantitative evaluations of each functionality module, providing discussions on their performance in different settings and the possible improvements. We showcase the deployment of the AMIRO framework on a popular social robotics platform-the Pepper robot-and present the experience of developing a complex user interaction scenario, employing all available functionality modules within AMIRO.

A Comprehensive Survey of Indoor Localization Methods Based on Computer Vision.

Computer vision based indoor localization methods use either an infrastructure of static cameras to track mobile entities (e.g., people, robots) or cameras attached to the mobile entities. Methods in the first category employ object tracking, while the others map images from mobile cameras with images acquired during a configuration stage or extracted from 3D reconstructed models of the space. This paper offers an overview of the computer vision based indoor localization domain, presenting application areas, commercial tools, existing benchmarks, and other reviews. It provides a survey of indoor localization research solutions, proposing a new classification based on the configuration stage (use of known environment data), sensing devices, type of detected elements, and localization method. It groups 70 of the most recent and relevant image based indoor localization methods according to the proposed classification and discusses their advantages and drawbacks. It highlights localization methods that also offer orientation information, as this is required by an increasing number of applications of indoor localization (e.g., augmented reality).

Distant Thromboembolic Disease Diagnosed by Endoscopic Ultrasound in Pancreatic Cancer: A Case Series.

Thrombosis and cancer have a very well-known association. Pancreatic cancer has the highest risk for thrombotic events amongst gastrointestinal cancers and is a leading direct cause of death in cancer patients. We assessed the role of endoscopic ultrasound (EUS) in identifying distant thrombotic events in pancreatic cancer patients. We performed a retrospective review of all EUS cases for pancreatic cancer in two centers and assessed all remotely located thrombotic events diagnosed. In a period of 6 months, a total of 55 EUS for pancreatic neoplasm were performed and the following thrombotic events were identified in 4 patients (7.3%): pulmonary thromboembolism (75%) and vena cava thrombosis (25%). The authors present these 4 cases of thrombotic disease identified by EUS, 50% of them previously missed by noninvasive imaging. EUS evaluation is not seldom limited to the targeted lesion prior identified in other imaging studies. Vascular thrombus can be an incidental finding on EUS. If untreated, pulmonary embolism has a high overall mortality. This series underlines the importance of a systematic, station approach EUS technique, namely in the mediastinum, regardless of the clinical indication.

A trombose e o cancro têm uma associação bem conhe-cida. As neoplasias pancreáticas têm, de todos os tumores gastrointestinais, o risco mais elevado de eventos trom-bóticos e são uma das principais causas diretas de morte nestes doentes. Pretendeu avaliar-se o papel da ultrassonografia endoscópica (EUS) na identificação de eventos trombóticos à distância em doentes com neopla-sias pancreáticas. Realizámos uma análise retrospetiva de todas as EUS realizadas por neoplasias pancreáticas em dois centros e analisámos os eventos trombóticos re-motamente localizados diagnosticados. Num período de 6 meses, foram realizadas um total de 55 EUS por neopla-sias pancreáticas e foram identificados estes eventos trombóticos em 4 doentes (7.3%): 75% tromboembolis-mo pulmonar e 25% trombose da veia cava inferior. Os autores apresentam estes 4 casos de doença trombótica identificada na EUS, sendo que metade deles não tinham sido diagnosticados pelos métodos de imagem não inva-sivos já realizados. Não infrequentemente, a avaliação por EUS é limitada à lesão alvo previamente identificada por outros métodos de imagem. Os trombos vasculares po-dem ser um achado acidental na EUS. Se não tratado, o tromboembolismo pulmonar tem uma alta taxa de mor-talidade. Esta série reforça a importância de uma aborda-gem sistemática, por estação, na EUS, principalmente no mediastino, independentemente da indicação clínica.

Inverted diverticulum of the colon - a cautious diagnosis / Divertículo colónico invertido - un diagnóstico cauteloso

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