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Hemangiomas are usually diagnosed based on ultrasound findings. The presence of symptoms, rapid growth or atipical imagiological findings should make us consider other diagnoses, including malignant tumors such as angiosarcomas. We describe the case of a previously healthy 46-year-old female without a history of exposure to carcinogens who presented with abdominal pain for two months. Diagnostic work-up revealed elevated gamma-glutamyl transferase and lactate dehydrogenase levels. Abdominal ultrasound described a large nodular lesion in the right lobe of the liver described as a hemangioma. One month later, a computed tomography-scan was made and revealed the same lesion, which had grown from 13.5 to 20 cm, maintaining typical imaging characteristics of a hemangioma. A right hepatectomy was performed and pathology revealed an angiosarcoma. After surgery, a positron emission tomography-computed tomography scan showed hepatic and bone metastasis. The patient started taxane-based chemotherapy and lumbar palliative radiotherapy, but died 10 months after surgery. This case shows how difficult it is to diagnose hepatic angiosarcoma relying only on imaging findings. Two abdominal computed tomography -scans were performed and none suggested this diagnosis. Angiosarcoma is a very aggressive tumour with an adverse prognosis. Surgery is the only curative treatment available. However, it is rarely feasible due to unresectable disease or distant metastasis.

In Portugal, there is very few experience in pediatric retroperitoneoscopy. The authors present the first Portuguese series of retroperitoneal laparoscopic nephrectomies (RLN) in children younger than nine years-old, as well as a literature review about the theme.Retrospective analysis of clinical charts of all children submitted to RLN between January 2009 and December 2009 in a Pediatric Surgery Department. The literature review was made searching related articles in Medline.Eight RLN were preformed. The medium age of the patients was 4,5 years-old (minimum = 11 months, maximum = 8,6 years). The indications for surgery were: four multicystic kidneys, three reflux nephropathy, and one obstructive nephropathy. Four RLN were preformed on the left side. The medium operative time was 99 minutes (minimum = 50 minutes, maximum = 180 minutes). There was a shortening of operative time as the surgical team got more experienced. There were no conversions to open surgery. Medium hospital stay was 1,5 days (minimum = 1 day, maximum = 2 days). There were no intra-operative and no post-operative complications.RLN is feasible in children younger than nine years-old and should be considered standard treatment in pediatric population.

Most patients on chronic oral anticoagulant therapy are monitored through anticoagulation clinics, or rather by assistant physicians. Our aim was to compare warfarin anticoagulated patients who were treated with usual medical care (assistant physician) with those treated routinely at an anticoagulation clinic for anticoagulation control. The later was assessed by comparing in both groups of patients the proportion of INRs within the therapeutic range, above 5.0 and below 1.5. The group treated at an anticoagulation clinic achieved better anticoagulation control (both among the patients receiving lower-range anticoagulation therapy and in the patients requiring higher-range anticoagulation therapy) than the group treated with usual medical care.

A revisão de 337 cateteres de subclávia utilizados corno acesso vascular para hemodiálise durante um período de 3 anos, mostrou um índice de sucesso de ir plantação de 98% e uma baixa incidência de complicações: 2 hemotóraxes, 4 hematomas locais, 7 punções arteriais e nenhum pneumotórax. Urna análise prospectiva dos últimos 72 cateteres implantados mostrou urna vida média global dos cateteres de 21,4 dias, em que 45% de todos os cateteres foram removidos por já não serem necessários ou o doente ter falecido, e não devido a falência do cateter. A remoção dos cateteres foi condicionada principalmente por obstrução com uma incidência de 1/77 cateteres dia, mais à esquerda do que a direita (1/36 cateteres dia versus 1/127 cateteres dia, p < 0,001) e por infecção, 1 episódio por 126 cateteres dia.