Centro Hospitalar Lisboa Norte Research Articles

Retrospective Study of Oral and Maxillofacial Trauma in Portuguese Population.

The increasing significance of medicolegal evaluation following maxillofacial traumatic events constitutes a complex issue. This clinical research aimed to assess the current etiology of oral and maxillofacial injuries in Portuguese population. An epidemiological clinical observational study was conducted in Centro Hospitalar Lisboa Norte on a sample of 384 subjects diagnosed with oral and maxillofacial trauma, between 2018 and 2020. Data were collected through clinical reports and analyzed using SPSS version 27. Women and men were nearly identical in the number and distribution, with 49.5% females and 50.5% males. In 2020, there was a decrease in the number of traumatic incidents compared to other years. Falls or accidental descents were found to be the most common cause of injury, accounting for 44.3%, followed by assaults accounting for 24.7%. A total of 84 subjects exhibited soft tissue injuries related to periodontal region. The upper central incisors (174) were the most frequently affected teeth with uncomplicated fractures, and the predominant form of treatment was the administration of pain medication. A correlation between falls or accidental descents, female subjects, and advancing age, as well as between assaults, male subjects, and adults, has been established. Falls or accidental descents and assault were the predominant etiologies, and the year 2020 exhibited a decrease in the incidents of traumatic events.

Critical analysis of the electroconvulsive therapy unit of centro hospitalar lisboa norte

IntroductionElectroconvulsivotherapy (ECT) one of the oldest treatments in biological psychiatry, is used nowaday mainly due to safety, efficacy and tolerability. Can be first-line treatment for mood disorders with catatonic or psychotic symptoms, and a second-line tretament to pharmacoherapy resistance or intolerable side effects.ObjectivesTo analyze the number of ECTs done, the number of patients submitted to this procedure in the ECT Unit in Centro Hospitalar Lisboa Norte (CHULN) comparing their diagnosis. To evaluate the number of patients that underwent maintenance and/or continuation treatment.MethodsRetrospective study involving patients submitted to ECT from 1 of January to 31 of December of 2019. A literature review exploring the use of ECT in psychiatry was conducted.ResultsDuring the 12-month period were performed 179 sessions, corresponding to 18 patients. The diagnosis were schizophrenia, 55%, bipolar disorder, 39% and 6% with major depression. Only 28% underwent continuation and/or maintenance treatment.ConclusionsIn this sample, of those diagnosed with schizophrenia, 90% were submitted to ECT due to oral therapy failure and 10% due to catatonia. Of those diagnosed with bipolar disorder 42.9% had a depressive episode and of these 14.2% had psychotic symptoms. This Unit is integrated in the biggest hospital of Portugal, it is import to understand the small number of patients submitted to this treatment and identify factors that may be preventing the referral of patients to this treatment. Clinicians may have the impression that ECT should be left as a last resort treatment which may explain the low percentage of major depression among our patients.DisclosureNo significant relationships.

Acute kidney disease and long-term outcomes in critically ill acute kidney injury patients with sepsis: a cohort analysis.

BackgroundAcute kidney injury (AKI) is frequent during hospitalization and may contribute to adverse short- and long-term consequences. Acute kidney disease (AKD) reflects the continuing pathological processes and adverse events developing after AKI. We aimed to evaluate the association of AKD, long-term adverse renal function and mortality in a cohort of patients with sepsis.MethodsWe performed a retrospective analysis of adult patients with septic AKI admitted to the Division of Intensive Medicine of the Centro Hospitalar Lisboa Norte (Lisbon, Portugal) between January 2008 and December 2014. Patients were categorized according to the development of AKI using the Kidney Disease: Improving Global Outcomes (KDIGO) classification. AKI was defined as an increase in absolute serum creatinine (SCr) ≥0.3 mg/dL or by a percentage increase in SCr ≥50% and/or by a decrease in urine output to <0.5 mL/kg/h for >6 h. AKD was defined as presenting at least KDIGO Stage 1 criteria for >7 days after an AKI initiating event. Adverse renal outcomes (need for long-term dialysis and/or a 25% decrease in estimated glomerular filtration rate after hospital discharge) and mortality after discharge were evaluated.ResultsFrom 256 selected patients with septic AKI, 53.9% developed AKD. The 30-day mortality rate was 24.5% (n = 55). The mean long-term follow-up was 45.9 ± 43.3 months. The majority of patients experience an adverse renal outcome [n = 158 (61.7%)] and 44.1% (n = 113) of patients died during follow-up. Adverse renal outcomes, 30-day mortality and long-term mortality after hospital discharge were more frequent among AKD patients [77.5 versus 43.2% (P < 0.001), 34.1 versus 6.8% (P < 0.001) and 64.8 versus 49.1% (P = 0.025), respectively]. The 5-year cumulative probability of survival was 23.2% for AKD patients, while it was 47.5% for patients with no AKD (log-rank test, P < 0.0001). In multivariate analysis, AKD was independently associated with adverse renal outcomes {adjusted hazard ratio [HR] 2.87 [95% confidence interval (CI) 2.0–4.1]; P < 0.001} and long-term mortality [adjusted HR 1.51 (95% CI 1.0–2.2); P = 0.040].ConclusionsAKD after septic AKI was independently associated with the risk of long-term need for dialysis and/or renal function decline and with the risk of death after hospital discharge.

Hospitalizations due to Angioedema without Urticaria in a Portuguese Center: Five Year Retrospective Study.

Hospitalizations due to angioedema are important especially in debilitating or life-threatening situations. The aim of thisstudy was to evaluate the frequency and etiology of angioedema without urticaria in hospital admissions. The admissions between 2009 and 2013 in Centro Hospitalar Lisboa Norte with a diagnosis grouped under theICD9 codes of angioedema were retrospectively analysed. The episodes of angioedema with urticaria were excluded. The admissionswere categorized into 2 groups: A - hospitalizations motivated by the angioedema; B - hospitalizations in which the angioedema wasan incidental finding. There were 169 hospitalizations (52% females, 96% adults, mean age 52 ± 20.8 years), distributed by 23 hospital departments,51% in the Immunoallergology department. The mean annual angioedema admission rate was 72/100 000. In 68% of the cases,angioedema was the cause for the admission; in 32% an incidental finding. In 38% there was upper airway involvement. The etiologieswere: hereditary angioedema in 24%, angiotensin converting enzyme inhibitor induced angioedema in 31%, idiopathic angioedema in21%, thrombolysis induced angioedema in 13%, nonsteroidal anti-inflammatory drug-induced angioedema in 5%. The main etiology was angiotensin converting enzyme inhibitor angioedema, followed by hereditary angioedema andthrombolysis induced angioedema, and these findings concur with the international literature. The mean annual angioedema admission rate was 72/100 000 and there was airway involvement in 38% of hospitalizations.

Neutrophil, lymphocyte and platelet ratio as a predictor of postoperative acute kidney injury in major abdominal surgery

BackgroundSurgery is one of the leading causes of acute kidney injury (AKI) in hospitalized patients. Major abdominal surgery has the second higher incidences of AKI, after cardiac surgery. AKI results from a complex interaction between hemodynamic, toxic and inflammatory factors. The pathogenesis of AKI following major abdominal surgery is distinct from cardiac and vascular surgery. The neutrophil, lymphocytes and platelets (N/LP) ratio has been demonstrated as an inflammatory marker and an independent predictor for AKI and mortality after cardiovascular surgery. The aim of this study was to evaluate the prognostic ability of the post-operative N/LP ratio after major abdominal surgery.MethodsWe cross-examined data of a retrospective analysis of 450 patients who underwent elective or urgent major nonvascular abdominal surgery at the Department of Surgery II of Centro Hospitalar Lisboa Norte from January 2010 to February 2011. N/LP ratio was determined using maximal neutrophil counts and minimal lymphocyte and platelet counts in the first 12 h after surgery. AKI was considered when developed within 48 h after surgery.ResultsOne-hundred and one patients (22.4%) developed AKI. Patients with higher N/LP ratio had an increased risk of developing postoperative AKI (6.36 ± 7.34 vs 4.33 ± 3.36, p < 0.001; unadjusted OR 1.1 (95% CI 1.04–1.16), p = 0.001; adjusted OR 1.05 (95% CI 1.00–1.10), p = 0.048). Twenty-nine patients died (6.44%). AKI was an independent predictor of mortality (20.8 vs 2.3%, p < 0.0001; unadjusted OR 11.2, 95% CI 4. 8-26.2, p < 0.0001; adjusted OR 3.56, 95% CI 1.0 2-12.43, p = 0.046). In a multivariate analysis higher N/LP ratio was not associated with increased in-hospital mortality.ConclusionPostoperative N/LP ratio was independently associated with AKI after major abdominal surgery, although there was no association with in-hospital mortality.

Prediction of acute kidney injury in cirrhotic patients: a new score combining renal, liver and inflammatory markers.

IntroductionAcute kidney injury (AKI) is common in hospitalized patients with cirrhosis and is associated with poor prognosis. A risk prediction score combining values easily measured at admission could be valuable to stratify patients for prevention, monitoring and early intervention, ultimately improving patient care and outcomes. The aim of this study was to develop a risk score for AKI in a cohort of cirrhotic patients.Patients and methodsWe cross-examined the data from a retrospective analysis of 186 patients with cirrhosis admitted to the Gastroenterology and Hepatology Service of Centro Hospitalar Lisboa Norte from January 2003 to December 2005. AKI was defined as an increase in serum creatinine (SCr)≥0.3 mg/dL within 48 hours or a percentage increase in SCr≥50% from baseline. Neutrophil-to-lymphocyte ratio (NLR) was used as a marker for inflammation. A receiver operating characteristic (ROC) curve was produced to assess the discriminative ability of the variables. Cutoff values were defined as those with highest validity. The final AKI risk score model was assessed using the ROC curve.ResultsA total of 52 patients (28%) developed AKI. Higher baseline SCr (p<0.001), more severe liver disease as evaluated by the modified Model of End-stage Liver Disease (MELD)-Na score (p<0.001) and higher NLR (p=0.028) were independently associated with AKI. The area under the ROC (AUROC) curve for the prediction of AKI was 0.791 (95% CI 0.726–0.847) for SCr, 0.771 (95% CI 0.704–0.829) for modified MELD-Na and 0.757 (95% CI 0.689–0.817) for NLR. Cutoff values with the highest validity for predicting AKI were determined and defined as 0.9 for the SCr, 21.7 for the modified MELD-Na and 6 for the NLR. The risk score was created allowing 3 points if the SCr is higher than 0.9, 1 point if the modified MELD-Na is higher than 21.7 and 1 point if the NLR is higher than 6. The AUROC curve of the risk prediction score for AKI was 0.861. A risk score of ≥2 points predicts AKI in cirrhotic patients with a sensitivity of 88.5% and specificity of 72.4%.ConclusionA new score combining SCr, MELD-Na and NLR demonstrated a strong discriminative ability to predict AKI in cirrhotic patients.

Neuromyelitis Optica Spectrum Disorder in a Patient With Systemic Lupus Erythematosus

Rheumatology and Metabolic Bone Diseases Department Lisbon, Portugal Neurology Department Hospital de Santa Maria Centro Hospitalar Lisboa Norte Lisbon, Portugal Rheumatology and Metabolic Bone Diseases Department Lisbon, Portugal The authors declare no conflict of interest.

Obesity, acute kidney injury and mortality in patients with sepsis: a cohort analysis

Although the prognostic effect of obesity has been studied in critically ill patients its impact on outcomes of septic patients and its role as a risk factor for acute kidney injury (AKI) is not consensual. We aimed to analyze the impact of obesity on the occurrence of AKI and on in-hospital mortality in a cohort of critically ill septic patients. This study is retrospective including 456 adult patients with sepsis admitted to the Division of Intensive Medicine of the Centro Hospitalar Lisboa Norte (Lisbon, Portugal) between January 2008 and December 2014. Obesity was defined as a body mass index of 30 kg/m2 or higher. The Kidney Disease Improving Global Outcomes classification was used to diagnose and classify patients developing AKI. AKI occurred in 87.5% of patients (19.5% with stage 1, 22.6% with stage 2 and 45.4% with stage 3). Obese patients developed AKI more frequently than non-obese patients (92.8% versus 85.5%, p = .035; unadjusted OR 2.2 (95% CI: 1.04–4.6), p = .039; adjusted OR 2.31 (95% CI: 1.07–5.02), p = .034). The percentage of obese patients, however, did not differ between AKI stages (stage 1, 25.1%; stage 2, 28.6%; stage 3, 15.4%; p = .145). There was no association between obesity and mortality (p = .739). Of note, when comparing AKI patients with or without obesity in terms of in-hospital mortality there were also no significant differences between those groups (38.4% versus 38.4%, p = .998). Obesity was associated with the occurrence of AKI in critically ill patients with sepsis; however, it was not associated with in-hospital mortality.

Is There a Role for Primary Care in the Follow-Up of Colorectal Cancer Patients? The Case of a Portuguese University Hospital

Background: In Portugal, colorectal cancer is the second most common type of cancer. With the increasing number of cancer survivors, follow-up is perceived as a chronic disease, with a significant impact on hospital care. Objective: To characterize colorectal patients in follow-up at Centro Hospitalar Lisboa Norte, EPE, and to determine the profile of economic resources consumed as well as the consultation workload. Materials and Methods: We characterized colorectal patients in follow-up at Centro Hospitalar Lisboa Norte, EPE, registered from 2008 until 2013 and the profile of economic resources consumed. Results: The Department of Oncology is responsible for 56.2% of colorectal patients’ follow-up. In this study, only 0.4% of cases had follow-up secured in primary care, which translates to a significant impact in terms of resources allocation and consultation management, especially if we consider that 41% of patients are in follow-up for longer than 3 years. The average annual adjusted cost of follow-up per patient is EUR 539.09. Patients who were alive on 31 January 2014 had generated 2,930 follow-up hospital appointments per year, representing 12% of the total number of oncology appointments reported in 2013. Discussion and Conclusions: The follow-up of colorectal cancer patients is associated with significant hospital resource allocation and physicians’ time consumption. Other follow-up models might emerge as an alternative to traditional hospital-centered follow-up, such as the shared-care follow-up, which requires a multidisciplinary and survivor-centered approach, ensuring that information and communication are shared between settings with a clear definition of responsibilities, a survivor care plan, and mechanisms for future referencing when justified.

Benzodiazepines intake at youth–experience from adolescent consultation at centro hospitalar Lisboa Norte

IntroductionThe increasing intake of psychotropic medication by children and adolescents is a reality that worries many mental health professionals. Recently, european school survey project on alcohol and other drugs showed that tranquillizers and sedatives were mainly consumed by Portuguese youth, without medical prescription, bringing this topic to medical and health stakeholders’ attention.ObjectivesCharacterize benzodiazepine prescription in the youth population followed in a psychiatric consultation at centro hospitalar Lisboa Norte psychiatric department.AimsDiscuss Portuguese trends in mental health among youths.MethodsAnalysis of 127 adolescents, seen for the first time from January to December of 2015, using Microsoft office excel.ResultsOur sample is comprised by adolescents from 12 to 20 years old, 81 female and 46 male. Only 16% of the adolescents were medicated with benzodiazepines, although low neuroleptic doses were often required, and 30% carried out psychotherapy. Sixty-five per cent of the diagnosis corresponds to anxiety, depressive and impulse control disorders.ConclusionAlthough trends in Portuguese youth mental health seem to be encouraging, as highlighted by local reports, European Union Joint Action on Mental Health and Well-Being recommends community and school active roles in primary and secondary prevention. Our experience shows that benzodiazepines’ use is rarely necessary and symptoms as anxiety, impulsivity and insomnia decreased with other strategies. Coping strategies must be discussed with the adolescents, in formal psychotherapy or in a supportive and containing therapeutic relationship, as well as discussed in family interventions. Community initiatives promotion and increased mental health care services accessibility should be priorities.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Histopathological features of post-mortem pituitaries: A retrospective analysis.

As a result of the use of neuroimaging techniques, silent pituitary lesions are diagnosed more and more frequently; however, there are few published post-mortem studies about this gland. Incidence data of pituitary lesions are rare and in Portugal they are outdated or even non-existent. The aim of this study is to determine the prevalence of normal patterns and incidental post-mortem pituitary pathology at Centro Hospitalar Lisboa Norte, analyzing the associations with clinical data and assessing the clinical relevance of the findings. We reviewed retrospectively and histologically 167 pituitaries of a consecutive series of autopsies from the Department of Pathology of this centre. They were done between 2012 and 2014, and in all cases medical records were reviewed. The morphological patterns observed, were classified into three major groups: 1) Normal histological patterns and variants; 2) Infectious-inflammatory pathology, metabolic and vascular disorders; 3) Incidental primary proliferation and secondary to systemic diseases. The subjects included in this study were of all age groups (from 1 day to 91 years old), 71 were female and 96 male. Fifty-seven of these glands didn't show any alteration; 51 showed colloid cysts arising from Rathke cleft; 44 presented hyperplasia in adenohypophysis and we identified 20 adenomas in 19 glands (immunohistochemically, eight PRL-producing and five ACTH-producing tumors), ten of which associated with obesity, 11 to hypertension and six to diabetes mellitus. There were two cases with metastasis. Subclinical pathology in our country is similar to that seen in other parts of the world, but at older ages.

Her Aching Bones: Atypical Parathyroid Adenoma

Her Aching Bones: Atypical Parathyroid Adenoma Filipe Brogueira Rodrigues, MD, Catarina Bekerman, MD, Joana Briosa Neves, MD, Joao Sousa, MD, Joana Vieira, MD, Antonio Alves, MD, Ana Palha, MD, Jose Rocha, MD, Vitor Ramalhinho, MD Departments of Medicine, Pathology, and Surgery, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, the Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, and the Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal.

Characterization of Executive Functioning in a Portuguese Sample of Candidates for Bariatric Surgery

AimThe prevalence of obesity has been steadily increasing and is a major worldwide public health problem. It is associated with multiple medical and psychological conditions and recent research supports a link to several cognitive deficit domains, including executive functioning. The aim of this article is to describe socio-demographic, clinical and neuropsychological characteristics of a sample of candidates for bariatric surgery (BS) and to compare their performance with normative values.MethodBetween May 2012 and May 2013 we evaluated the neuropsychological performance of 42 patient candidates for BS at the Morbid Obesity Consultation at Centro Hospitalar Lisboa Norte (CHLN).ResultsThe population was predominantly female and education was equally distributed between basic, secondary and tertiary levels. The neuropsychological results showed a significant decrease on Recall (p &lt; .01), Learning (p &lt; .10), Nonverbal Memory (p &lt; .001), Cognitive Flexibility (p &lt; .01) and Resistance to Interference (p &lt; .05).ConclusionDespite the limitations inherent to a small sample, the results obtained in the Portuguese population coincide with those of earlier studies; namely that obesity differentially effects instrumental functions.

Antyhypertensive drugs and Blood pressure control in patients with obstructive sleep apnea: a prospective observational study

e10 Volume 37 Number 8S ANTyhyperTeNSiVe drugS ANd Blood preSSure CoNTrol iN pATieNTS wiTh oBSTruCTiVe Sleep ApNeA: A proSpeCTiVe oBSerVATioNAl STudy LN. Diogo; P. Pinto; C. Barbara; A.L. Papoila; and E.C. Monteiro CEDOC, Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal; Centro Hospitalar Lisboa Norte (CHLN), Lisbon, Portugal; and CEAUL, Lisbon, Portugal Background: Obstructive sleep apnea (OSA) is an independent risk factor for hypertension. Continuous positive airway pressure (CPAP) is considered the gold standard treatment for symptomatic OSA patients, but its effectiveness on blood pressure (BP) control is modest and concomitant antihypertensive therapy is still required. The best antihypertensive regimen for BP control in these patients remains unknown. The present work aimed to contribute to the identification of the most effective antihypertensive regimen prescribed in current treatment practice, investigating a hypothetical association between ongoing antihypertensive medication and BP control rates in patients with OSA. Methods: We conducted a prospective observational study (ClinicalTrials.gov: NCT01803815) in a cohort of 205 patients with OSA and hypertension who underwent a sleep study and 24-hour ambulatory blood pressure monitoring (ABPM). Ongoing antihypertensive medication profile was recorded. Logistic regression models were used to investigate the association between antihypertensive regimen and BP control before (n = 205) and, when applicable, after CPAP adaptation (n = 90). Results: According to current guidelines and antihypertensive medication and/or 24-hour ABPM, 63.9% (205/321) of the patients were diagnosed with OSA and hypertension. One hundred fifty-five (155/205) were under antihypertensive medication, and 31 different antihypertensive regimens were found. However, the antihypertensive regimens and the number of antihypertensive drugs were not associated with BP control (P = 0.847; P = 0.991). After CPAP adaptation, a decrease in median nighttime systolic and diastolic BP was observed (P = 0.001; P = 0.006). Nevertheless, the lack of association between antihypertensive regimens and the number of antihypertensive drugs and BP control remained (P = 0.864; P = 0.800). Conclusions: This study shows, for the first time, that BP control is independent of both antihypertensive regimen and the number of antihypertensive drugs and suggests that none of the currently available antihypertensive drugs seem to be effective for the control of BP in patients with OSA. Support: CEDOC/FCT (SFRH/BD/48335/2008 and PTDC/SAUTOX/112264/2009).

Psychiatric Day Care Hospital at Centro Hospitalar Lisboa Norte: Does It Prevent Re-admissions?

Introduction Centro Hospitalar Lisboa Norte's Psychiatric Day Care Hospital (CHLN-PDC) offers a psychotherapeutic oriented program. Objectives To characterize the CHLN-PDC population and to determine if the subjects' HSM-PDC treatment leads to variation in the number of re-admissions to psychiatric wards. Methods Retrospective analysis of all patients admitted to the CHLN-PDC between July 1, 2008 and June 30, 2011, assessing for gender, age, diagnoses, time of admittance, and number of re-admissions in psychiatric wards, three years before and three years after the program. Results During this period, 71 patients were admitted (17 males, 54 females), with an average age of 33 years old (no difference between genders). Mean duration of the program was 267 days (260 for females, 291 for males). The most frequent diagnoses were Depressive Episode (N=30), Personality Disorder (N=29, in general co-morbid to other diagnoses), Obsessive Compulsive Disorder (N=5), Generalized Anxiety Disorder (N=5), Schizophrenia (N=3) and Schizoaffective Disorder (N=3). The number of admissions to psychiatric wards reduced from 86 before to 36 after the program. The reduction was more evident for patients with Bipolar Disorder and Personality Disorder. Patients who completed the full program remained in average 303 days, but re-admissions were reduced greatly when compared to those who did not complete the full program (increase of re-admissions). Conclusions The majority of patients were women, with no difference of age between genders. Most common diagnoses were Depressive Episode and Personality Disorder. The program, when completed to its fullest extent, lead to a decrease in the number of re-admissions.

Medical physics training for radiation oncology residents in Greece

s / Physica Medica 30 (2014) e45ee74 e49 Results: Although all of the 120 sunglasses tested in this study were effective in reducing the intensity of visible light, nearly none of the sunglasses could offer efficient protection against UV radiation. The UVA and UVB transmittance of the sunglasses were in the range of 0.31% (price category of more than 150$) and 72.2% (price category of 30-90$). Conclusion: The majority of sunglasses tested in this study strongly decreased the visible light intensity but couldn’t block all UV radiation. According to the ANSI Z80.3-2001 (U.S. standard) the lens should have a UVB (280 to 315 nm) transmittance of no more than 1%. These findings lead us to this conclusion that these sunglasses can endanger the vision due to dilation of the pupil and overexposure of the lens to UV radiation. MEDICAL PHYSICS TRAINING FOR RADIATION ONCOLOGY RESIDENTS IN GREECE G. Pissakas , S. Nikoletopoulos , P. Georgolopoulou , D. Kardamakis . Hellenic Society of Radiation Oncology, Greece; Hellenic Association of Medical Physicists, Greece; Medical Physics Department, G.Anticancer Athens Hospital “Saint Savvas”, Greece Purpose: Medical physics is an essential part of recommended curricula for residents in radiation oncology (RO). With no official training programs in place, medical physics training is often incidental and incomplete for RO residents in Greece. The aim of this work is to measure the effectiveness of an educational session on medical physics offered to RO trainees of the country. Method: The Hellenic Society of Radiation Oncology (EEAO) hosts quarterly educational meetings for RO residents of all levels. On April 2013 a physics-dedicated meeting was planned for a body of 52 residents. Topics ranged from basic radiation physics, physics of radiotherapy, brachytherapy, 3DCRT, IMRT to physics of specialized treatment modalities. Attendance compared favourably to 30 previous EEAO meetings focusing on clinical issues. Assimilation of material was measured by completion of a test at the end of the meeting focused on main Learning Objectives (LO). Results: Test questions covered all sessions of the meeting with equal weights. Main Bloom’s taxonomy categories were represented. Top 3% of grades achieved corresponded to residents whose home institutes put a substantial effort in training. Students responded better to sessions of an interactive naturewith higher grades on respective LO’s but indicated their enthusiasm over sessions on cutting edge technology. Given the lack of adequately equipped training institutes in the country, this suggests the need for rotation of residents, as recommended by international guidelines on RO training programs (IAEA, ESTRO, ASTRO). Conclusions: Educational meetings for RO residents focused in medical physics are quite effective in bringing together the physics background needed in their clinical practice. The need remains for implementing official training programs throughout the country and for rotation of residents in different institutes during their training. PORTUGUESE PATHWAY TO THE IMPLEMENTATION OF THE NEW EUROPEAN GUIDELINES ON MEDICAL PHYSICS EXPERT Ana Rita Figueira , Esmeralda Poli , Jorge Isidoro , Maria do Carmo Lopes . a Professional Matters and Education and Training Technical Commissions of the Medical Physics Division of the Portuguese Physics Society (DFM-SPF); Centro Hospitalar S~ ao Jo~ ao, EPE e Porto Portugal; Centro Hospitalar Lisboa Norte, EPE e Lisboa Portugal; Centro Hospitalar Universit ario de Coimbra, EPE e Coimbra e Portugal; e Instituto Portugues de Oncologia de Coimbra de Francisco Gentil, EPE e Coimbra e

Adenocarcinoma in Facial Nerve

*Hospital Pulido Valente - Centro Hospitalar Lisboa Norte, Lisbon, Portugal; and †House Ear Institute and Keck School of Medicine of the University of Southern California, Los Angeles, California, U.S.A. Address correspondence and reprint requests to Fred H. Linthicum, Jr., M.D., House Ear Institute, 2100 W. Third Street, Los Angeles, CA 90057, U.S.A.; E-mail: [email protected]