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Brandalise A, Herbella FAM, Luna RA, Szachnowicz S, Sallum RAA, Domene CE, Volpe P, Cavazzolla LT, Furtado ML, Claus CMP, Farah JFDM, Crema E. BRAZILIAN HERNIA AND ABDOMINAL WALL SOCIETY STATEMENT ON LARGE HIATAL HERNIAS MANAGEMENT. Arq Bras Cir Dig 2024; 36:e1787. [PMID: 38324849 PMCID: PMC10841492 DOI: 10.1590/0102-672020230069e1787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 10/21/2023] [Indexed: 02/09/2024]
Abstract
Large hiatal hernias, besides being more prevalent in the elderly, have a different clinical presentation: less reflux, more mechanical symptoms, and a greater possibility of acute, life-threatening complications such as gastric volvulus, ischemia, and visceral mediastinal perforation. Thus, surgical indications are distinct from gastroesophageal reflux disease-related sliding hiatal hernias. Heartburn tends to be less intense, while symptoms of chest pain, cough, discomfort, and tiredness are reported more frequently. Complaints of vomiting and dysphagia may suggest the presence of associated gastric volvulus. Signs of iron deficiency and anemia are found. Surgical indication is still controversial and was previously based on high mortality reported in emergency surgeries for gastric volvulus. Postoperative mortality is especially related to three factors: body mass index above 35, age over 70 years, and the presence of comorbidities. Minimally invasive elective surgery should be offered to symptomatic individuals with good or reasonable performance status, regardless of age group. In asymptomatic and oligosymptomatic patients, besides obviously identifying the patient's desire, a case-by-case analysis of surgical risk factors such as age, obesity, and comorbidities should be taken into consideration. Attention should also be paid to situations with greater technical difficulty and risks of acute migration due to increased abdominal pressure (abdominoplasty, manual labor, spastic diseases). Technical alternatives such as partial fundoplication and anterior gastropexy can be considered. We emphasize the importance of performing surgical procedures in cases of large hiatal hernias in high-volume centers, with experienced surgeons.
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Affiliation(s)
- André Brandalise
- Centro Médico de Campinas, Robotic Surgery Program - Campinas (SP), Brazil
| | | | - Renato Abrantes Luna
- Universidade Federal do Estado do Rio de Janeiro, Faculty of Medicine and Surgery, Hospital Federal dos Servidores do Estado - Rio de Janeiro (RJ), Brazil
| | - Sergio Szachnowicz
- Universidade de São Paulo, Department of Gastroenterology - São Paulo (SP), Brazil
| | | | | | - Paula Volpe
- Centro Integrado de Medicina Avançada - São Paulo (SP), Brazil
| | - Leandro Totti Cavazzolla
- Universidade Federal do Rio Grande do Sul, University Hospital, General Surgery Unit - Porto Alegre (RS), Brazil
| | - Marcelo Lopes Furtado
- Sociedade Brasileira de Hérna e Parede Abdominal, Hospital Pintagueiras, Videolaparoscopic Surgery Service - Jundiaí, São Paulo (SP), Brazil
| | - Christiano Marlo Paggi Claus
- Universidade Positivo, Postgraduate Program in Minimally Invasive Surgery, Department of Surgical Clinic - Curitiba (PR), Brazil
| | | | - Eduardo Crema
- Universidade Federal do Triângulo Mineiro, Digestive Surgical Unit - Uberaba (MG), Brazil
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Crema E, Melani AGF, Romagnolo LGC, Marescaux J. Ten years of IRCAD, Barretos, SP, Brazil. Acta Cir Bras 2022; 37:e370608. [PMID: 36134854 PMCID: PMC9488511 DOI: 10.1590/acb370608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 05/20/2022] [Indexed: 11/22/2022] Open
Abstract
Minimally invasive surgery represented a significant milestone in modern surgery; however, continuous innovation and the emergence of new technologies pose new challenges in terms of surgical learning curves since new interventions are associated with increased surgical complexity and a higher risk of complications. For this reason, surgeons are aware of the beneficial effects of "learning before doing" and the importance of safely implementing new surgical procedures in order to obtain better patient outcomes. Considered the largest Latin American training center in minimally invasive surgery, IRCAD Barretos, São Paulo, Brazil, makes it possible to acquire surgical skills through training in different and the most complex areas of medicine, providing the experience of real and simulated situations, with focus on innovation. The center possesses state-of-the-art infrastructure and technology, with a very high-level teaching staff and an affectionate and hospitable reception. Since its inauguration, in 2011, the center has already qualified numerous professionals and has placed the country in a privileged position in terms of surgical knowledge. The present article describes the activities developed over these ten years of the institute in Brazil as the largest training center for surgeons of the continent in order to address the importance of surgical skills training.
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Affiliation(s)
- Eduardo Crema
- PhD, full professor. Universidade Federal do Triângulo Mineiro - Division of Digestive Tract Surgery - Uberaba (MG), Brazil
| | - Armando Geraldo Franchini Melani
- MSc, technical and scientific director. IRCAD Latin America, and physician at Americas Integrated Oncology Center - Rio de Janeiro (RJ), Brazil
| | - Luís Gustavo Capochin Romagnolo
- MD. Hospital de Câncer de Barretos - Pio XII Foundation, and scientific coordinator, IRCAD Latin America - Barretos (SP), Brazil
| | - Jacques Marescaux
- MD, founder and scientific coordinator. IRCAD Latin America - Barretos (SP), Brazil
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Munari FF, Sichero L, Carloni AC, Lacerda CF, Nunes EM, de Oliveira ATT, Scapulatempo-Neto C, da Silva SRM, Crema E, Adad SJ, Rodrigues MAM, Henry MACA, Guimarães DP, Reis RM, Villa LL, Longatto-Filho A. Frequency of Human Papillomavirus Detection in Chagasic Megaesophagus Associated or Not with Esophageal Squamous Cell Carcinoma. Pathobiology 2021; 89:29-37. [PMID: 34818254 DOI: 10.1159/000518697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 07/26/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Chagasic megaesophagus (CM) as well as the presence of human papillomavirus (HPV) has been reported as etiological factors for esophageal squamous cell carcinoma (ESCC). OBJECTIVE We assessed the prevalence of HPV DNA in a series of ESCCs associated or not with CM. Data obtained were further correlated to the pathological and clinical data of affected individuals. METHODS A retrospective study was performed on 92 formalin-fixed and paraffin-embedded tissues collected from patients referred to 3 different hospitals in São Paulo, Brazil: Barretos Cancer Hospital, Barretos, São Paulo; Federal University of Triângulo Mineiro, Uberaba, Minas Gerais; and São Paulo State University, Botucatu, São Paulo. Cases were divided into 3 groups: (i) 24 patients with CM associated with ESCC (CM/ESCC); (ii) 37 patients with ESCC without CM (ESCC); and (iii) 31 patients with CM without ESCC (CM). Detection of HPV DNA was assessed in all samples by a genotyping assay combining multiplex polymerase chain reaction and bead-based Luminex technology. RESULTS We identified a high prevalence of high-risk HPV in patients in the CM group (12/31, 38.8%) and CM/ESCC (8/24, 33.3%), compared to individuals in the ESCC group (6/37, 16.3%). The individuals in the groups with cancer (ESCC and CM/ESCC) had a higher frequency of HPV-16 (4/9, 44.5% and 2/8, 25.0%). The other types of high-risk HPVs detected were HPV-31, 45, 51, 53, 56, 66, and 73. We also observed in some samples HPV coinfection by more than one viral type. Despite the high incidence of HPV, it did not show any association with the patient's clinical-pathological and molecular (TP53 mutation status) characteristics. CONCLUSION This is the first report of the presence of HPV DNA in CM associated with ESCC. HPV infection was more presence in megaesophagus lesions. Further studies are needed to confirm and better understand the role of persistent HPV infection in patients with CM.
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Affiliation(s)
| | - Laura Sichero
- Center for Translational Research in Oncology, Instituto do Cancer do Estado de Sao Paulo-ICESP, Cerqueira César, Brazil
| | | | - Croider Franco Lacerda
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil.,Department of Digestive Surgery, Barretos Cancer Hospital, Barretos, Brazil
| | - Emily Montosa Nunes
- Center for Translational Research in Oncology, Instituto do Cancer do Estado de Sao Paulo-ICESP, Cerqueira César, Brazil
| | | | - Cristovam Scapulatempo-Neto
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil.,Department of Pathology, Diagnosis of Biopsies and Surgical Specimens, Barretos Cancer Hospital, Barretos, Brazil
| | | | - Eduardo Crema
- Department of Digestive Surgery and Pathology, Medical School, UFTM, Federal University of Triangulo Mineiro, Uberaba, Brazil
| | - Sheila Jorge Adad
- Departament of Gastroenterology Surgery and Pathology, Medical School, UNESP, São Paulo State University, Botucatu, Brazil
| | | | | | - Denise Peixoto Guimarães
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil.,Department of Endoscopy, Barretos Cancer Hospital, Barretos, Brazil
| | - Rui Manuel Reis
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil.,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Luisa Lina Villa
- Center for Translational Research in Oncology, Instituto do Cancer do Estado de Sao Paulo-ICESP, Cerqueira César, Brazil.,Department of Radiology and Oncology, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Adhemar Longatto-Filho
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil.,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,Department of Radiology and Oncology, Medical School, University of São Paulo, Butanta, Brazil.,Medical Laboratory of Medical Investigation (LIM) 14, Department of Pathology, Medical School, University of São Paulo, Butanta, Brazil
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Borges MR, de Oliveira NML, Antonelli IBS, Silva MB, Crema E, Fernandes LFRM. Transcutaneous electrical nerve stimulation is superior than placebo and control for postoperative pain relief. Pain Manag 2020; 10:235-246. [DOI: 10.2217/pmt-2019-0063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Aim: To determine whether transcutaneous electrical nerve stimulation (TENS) is more efficient than placebo TENS and control groups for pain relief. Design: Randomized, single-blinded, placebo-controlled trial. Setting & participants: A total of 78 adults with postoperative pain, after cholecystectomy, at the University Hospital. They were randomized into active TENS, placebo TENS and control. Intervention: A total of 30-min interventions applied in the first 24 h after the surgery. Outcome: Pain intensity. Results: Pain significantly decreased for both TENS; however, the active TENS was better. A decrease of 2 points or more on the visual analog scale for 53.8% active TENS and 11.5% placebo. Conclusion: There was a greater reduction in pain of important clinical relevance in the active TENS group. Clinical Trial registration: Brazilian Clinical Trial (REBEC): RBR-6cgx2k.
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Affiliation(s)
- Maraísa Rodrigues Borges
- Department of Applied Physiotherapy, Federal University of Triangulo Mineiro, Uberaba, MG, Brazil
| | | | | | - Maristella Borges Silva
- The study was performed at Clinics Hospital of the Federal University of Triangulo Mineiro, Uberaba, MG, Brazil
| | - Eduardo Crema
- Medical School, Federal University of Triangulo Mineiro, Uberaba, MG, Brazil
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Abstract
The objective of this study was to evaluate a pH-dependent system of ileocolonic release of active ingredients using the polymer Eudragit® S100. A spouted bed was used in the coating process of soft capsules containing palm oil and of hard capsules containing glutamine under standardised experimental conditions. The height and diameter of the palm oil and glutamine capsules were measured using a calliper. The following variables were analysed: Eudragit® S100 dispersion amount used in the capsule coating process, nozzle air pressure, nozzle air flow rate, spray rate and temperature of the spouted bed coating process. The Eudragit® S100 dispersion formulation, trademarked as Quickstart® by Evonik Industries, was used with modifications to prepare the enteric coating. The results showed that the adequate temperature for the spouted bed coating process was 50°C and that 0.2 mL of 6.5% Eudragit® S100 coating per cm2 capsule was resistant for 60 minutes at pH 6.8. The findings demonstrate the pharmaceutical application of Eudragit® S100 in the modification of the coating and the preparation of a delayed-release system of hard and soft capsules, thus enabling ileal release of active ingredients.
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Tosta ADM, Borges MDC, Silva ÉMCD, Silva AAD, Crema E. Pre- and postoperative respiratory muscle strength, body mass index and fasting glucose profile of patients with type 2 diabetes mellitus submitted to metabolic surgery. Fisioter mov 2020. [DOI: 10.1590/1980-5918.033.ao51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: The lung is considered a target organ in diabetes mellitus as a consequence of alterations secondary to chronic hyperglycemia that compromise respiratory muscle strength. Metabolic surgery for improving diabetes mellitus has beneficial effects on weight loss and glucose metabolism. Objective: The objective of this study was to evaluate the respiratory muscle strength, assessed by MIP and MEP, body mass index (BMI) and fasting glucose profile of patients with type 2 diabetes mellitus before and after metabolic surgery without gastric resection. Method: Seventeen patients with type 2 diabetes mellitus participated in the study. The participants had a mean age of 44.8 ± 11.81 years. Results: The results showed a significant decrease of MEP values in the immediate postoperative period when compared to the preoperative period (p=0.001), while no significant results were obtained for MIP. Regarding BMI and fasting glucose, significant weight loss and a significant reduction in fasting glucose levels were observed in the late postoperative period (p=0.006 and p=0.007, respectively). Conclusion: The MIP and MEP were reestablished and satisfactory results were obtained for BMI and fasting glucose in the late postoperative period. Further studies are needed to monitor patients in the pre- and postoperative period of metabolic surgery, identifying complications and acting on the care and recovery of these patients.
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Perales SR, Souza LRMF, Crema E. COMPARATIVE EVALUATION OF MAGNETIC RESONANCE CHOLANGIOPANCREATOGRAPHY AND PERIOPERATIVE CHOLANGIOGRAPHY IN PATIENTS WITH SUSPECT CHOLEDOCHOLITHIASIS. Arq Bras Cir Dig 2019; 32:e1416. [PMID: 30624525 PMCID: PMC6323631 DOI: 10.1590/0102-672020180001e1416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 09/27/2018] [Indexed: 01/06/2023]
Abstract
Background: Cholelithiasis is a highly prevalent condition, and choledocholitiasis is a high morbidity complication and requires accurate methods for its diagnosis. Aim: To evaluate the population of patients with suspected choledocholitiasis and check the statistical value of magnetic resonance cholangiopancreatography, ultrasonography, the laboratory and the clinic of these patients comparing them to the results obtained by perioperative cholangiography. Methods: This is a retrospective cohort study, which were evaluated 76 patients with cholelithiasis and suspected choledocholithiasis. Results: It was observed that the presence of dilatation of the biliary tract or choledocholithiasis in the ultrasonography was four and eight times increased risk of perioperative cholangiography for positive choledocholithiasis, respectively. For each unit increased in serum alkaline phosphatase was 0.3% increased the risk of perioperative cholangiography for positive choledocholithiasis. In the presence of dilatation of the bile ducts in the ultrasonography was four times greater risk of positive magnetic resonance cholangiopancreatography for choledocholithiasis. In the presence of pancreatitis these patients had five times higher risk of positive magnetic resonance cholangiopancreatography for choledocholithiasis. On the positive magnetic resonance cholangiopancreatography presence to choledocholithiasis was 104 times greater of positive perioperative cholangiography for choledocholithiasis. Conclusions: The magnetic resonance cholangiopancreatography is a method with good accuracy for propedeutic follow-up for the diagnosis of choledocholithiasis, consistent with the results obtained from the perioperative cholangiography; however, it is less invasive, with less risk to the patient and promote decreased surgical time when compared with perioperative cholangiography.
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Affiliation(s)
- Simone Reges Perales
- Program of Post-Graduation in Health Sciences, Federal University of the Triângulo Mineiro), Uberaba, MG, Brazil
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Munari FF, Cruvinel-Carloni A, Lacerda CF, de Oliveira ATT, Scapulatempo-Neto C, da Silva SRM, Crema E, Adad SJ, Rodrigues MAM, Henry MACA, Guimarães DP, Longatto-Filho A, Reis RM. PIK3CA mutations are frequent in esophageal squamous cell carcinoma associated with chagasic megaesophagus and are associated with a worse patient outcome. Infect Agent Cancer 2018; 13:43. [PMID: 30619505 PMCID: PMC6311070 DOI: 10.1186/s13027-018-0216-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 12/05/2018] [Indexed: 12/16/2022] Open
Abstract
Background Chronic diseases such as chagasic megaesophagus (secondary to Chagas’ disease) have been suggested as etiological factors for esophageal squamous cell carcinoma; however, the molecular mechanisms involved are poorly understood. Objective We analyzed hotspot PIK3CA gene mutations in a series of esophageal squamous cell carcinomas associated or not with chagasic megaesophagus, as well as, in chagasic megaesophagus biopsies. We also checked for correlations between the presence of PIK3CA mutations with patients’ clinical and pathological features. Methods The study included three different groups of patients: i) 23 patients with chagasic megaesophagus associated with esophageal squamous cell carcinoma (CM/ESCC); ii) 38 patients with esophageal squamous cell carcinoma not associated with chagasic megaesophagus (ESCC); and iii) 28 patients with chagasic megaesophagus without esophageal squamous cell carcinoma (CM). PIK3CA hotspot mutations in exons 9 and 20 were evaluated by PCR followed by direct sequencing technique. Results PIK3CA mutations were identified in 21.7% (5 out of 23) of CM/ESCC cases, in 10.5% (4 out of 38) of ESCC and in only 3.6% (1 case out of 28) of CM cases. In the CM/ESCC group, PIK3CA mutations were significantly associated with lower survival (mean 5 months), when compared to wild-type patients (mean 2.0 years). No other significant associations were observed between PIK3CA mutations and patients’ clinical features or TP53 mutation profile. Conclusion This is the first report on the presence of PIK3CA mutations in esophageal cancer associated with chagasic megaesophagus. The detection of PIK3CA mutations in benign chagasic megaesophagus lesions suggests their putative role in esophageal squamous cell carcinoma development and opens new opportunities for targeted-therapies for these diseases.
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Affiliation(s)
- Fernanda Franco Munari
- 1Molecular Oncology Research Center, Barretos Cancer Hospital, Rua Antenor Duarte Villela, 1331, Barretos, SP CEP 14784 400 Brazil
| | - Adriana Cruvinel-Carloni
- 1Molecular Oncology Research Center, Barretos Cancer Hospital, Rua Antenor Duarte Villela, 1331, Barretos, SP CEP 14784 400 Brazil
| | - Croider Franco Lacerda
- 1Molecular Oncology Research Center, Barretos Cancer Hospital, Rua Antenor Duarte Villela, 1331, Barretos, SP CEP 14784 400 Brazil.,2Department of Digestive Surgery, Barretos Cancer Hospital, Barretos, SP Brazil
| | | | - Cristovam Scapulatempo-Neto
- 1Molecular Oncology Research Center, Barretos Cancer Hospital, Rua Antenor Duarte Villela, 1331, Barretos, SP CEP 14784 400 Brazil.,3Department of Pathology, Diagnosis of Biopsies and Surgical Specimens, Barretos Cancer Hospital, Barretos, SP Brazil
| | - Sandra Regina Morini da Silva
- 3Department of Pathology, Diagnosis of Biopsies and Surgical Specimens, Barretos Cancer Hospital, Barretos, SP Brazil
| | - Eduardo Crema
- 4Department of Digestive Surgery and Pathology, Medical School, UFTM - Federal University of Triangulo Mineiro, Uberaba, Minas Gerais Brazil
| | - Sheila Jorge Adad
- 4Department of Digestive Surgery and Pathology, Medical School, UFTM - Federal University of Triangulo Mineiro, Uberaba, Minas Gerais Brazil
| | | | | | - Denise Peixoto Guimarães
- 1Molecular Oncology Research Center, Barretos Cancer Hospital, Rua Antenor Duarte Villela, 1331, Barretos, SP CEP 14784 400 Brazil.,6Department of Endoscopy, Barretos Cancer Hospital, Barretos, SP Brazil
| | - Adhemar Longatto-Filho
- 1Molecular Oncology Research Center, Barretos Cancer Hospital, Rua Antenor Duarte Villela, 1331, Barretos, SP CEP 14784 400 Brazil.,7Department of Radiology and Oncology, Medical School, USP - University of São Paulo, São Paulo, Brazil.,8Medical Laboratory of Medical Investigation (LIM) 14, Department of Pathology, Medical School, USP - University of São Paulo, São Paulo, Brazil.,9Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
| | - Rui Manuel Reis
- 1Molecular Oncology Research Center, Barretos Cancer Hospital, Rua Antenor Duarte Villela, 1331, Barretos, SP CEP 14784 400 Brazil.,9Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.,10ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
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Crema E, Terra Júnior JA, Borges MC, Queiroz CAS, Soares LA, Silva AAD. Preservation of the vagus nerves in subtotal esophagectomy without thoracotomy. Acta Cir Bras 2018; 33:834-841. [PMID: 30328916 DOI: 10.1590/s0102-865020180090000012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 08/12/2018] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To evaluate the outcome of transhiatal esophagectomy without thoracotomy and with preservation of the vagal trunks for the treatment of advanced megaesophagus. METHODS Between March 2006 and September 2017, it was performed 136 transhiatal esophagectomies without thoracotomy by laparoscopy, with preservation of the vagus nerves. All patients were evaluated pre and postoperatively for respiratory and nutritional aspects Post operatively, some surgical aspects were evaluated like radiology and endoscopy of the digestive tract. RESULTS Follow-up for 7 months to 12 years by clinical, radiologic, endoscopic and pH monitoring revealed satisfactory and encouraging outcomes of the procedure. CONCLUSION The laparoscopic transhiatal esophagectomy is a feasible and safe technique with good postoperative outcomes.
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Affiliation(s)
- Eduardo Crema
- PhD, Full Professor, Division of Digestive Surgery, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba-MG, Brazil. Conception of the study, analysis and interpretation of data, manuscript writing, critical revision
| | - Júverson Alves Terra Júnior
- PhD, Assistant Professor, Division of Surgical Technique and Experimental Surgery, UFTM, Uberaba-MG, Brazil. Conception of the study, analysis and interpretation of data, manuscript writing, critical revision
| | - Marisa Carvalho Borges
- Postdoctoral Fellow, Postgraduate Program in Health Sciences, UFTM, Uberaba-MG, Brazil. Conception of the study, analysis and interpretation of data, manuscript writing, critical revision
| | - Carlos Alfredo Salci Queiroz
- Assistant Professor, Division of Surgical Technique and Experimental Surgery, UFTM, Uberaba-MG, Brazil. Conception of the study, analysis and interpretation of data, manuscript writing, critical revision
| | - Luciana Arantes Soares
- Postdoctoral Fellow, Postgraduate Program in Health Sciences, UFTM, Uberaba-MG, Brazil. Conception of the study, analysis and interpretation of data, manuscript writing, critical revision
| | - Alex Augusto da Silva
- PhD, Associate Professor, Division of Digestive Surgery, UFTM, Uberaba-MG, Brazil. Conception of the study, analysis and interpretation of data, manuscript writing, critical revision
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Oliveira RSD, Silva PD, Queiroz CAS, Terra-Júnior JA, Crema E. PREVALENCE OF BACTERIOBILIA IN PATIENTS UNDERGOING ELECTIVE COLECYSTECTOMY. Arq Bras Cir Dig 2018; 31:e1392. [PMID: 30133684 PMCID: PMC6097031 DOI: 10.1590/0102-672020180001e1392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 06/28/2018] [Indexed: 01/24/2023]
Abstract
Background: Cholelithiasis is one of the diseases with greater surgical indication.
Currently, laparoscopic cholecystectomy is the gold standard in the
treatment of cholelithiasis. Aim: To analyze the culture of bile from patients with cholelithiasis, mainly in
the occurrence of brown and mixed stones. Methods: Was carried out a prospective study with 246 cases with biliary lithiasis
who underwent elective laparoscopic cholecystectomy. Bile culture was
performed in all. During anesthetic induction the patients received a single
dose of intravenous cefazolin 1 g. At the end of the surgery, the
gallbladder was punctured, its contents extracted and immediately placed in
a sterile 20 ml propylene flask and promptly sent to bacterioscopy with
Maconkey and blood agars. Incubation at 37° C for 24 h was carried out. A
protocol was elaborated to include the main factors potentially related to
cholelithiasis and the possible presence of associated bacterial infection.
Results: Of the 246 patients, 201 had negative bile culture and 45 positive. Of the 45
patients with bacteriobilia, 34 had growth of a single type of bacterium in
bile culture and 11 more than one. Conclusions: It was observed a relationship between bacteriobilia and age, suggesting
that age is a risk factor for bacteriobilia. The use of antibiotic
prophylaxis in the elderly is therefore recommended.
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Affiliation(s)
| | - Paula da Silva
- Federal University of Triângulo Mineiro, Uberaba, MG, Brazil
| | | | | | - Eduardo Crema
- Federal University of Triângulo Mineiro, Uberaba, MG, Brazil
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Tosta ADM, Borges MDC, Silva ÉMCD, Takeuti TD, Terra Júnior JA, Crema E. Pulmonary function evaluation in type 2 diabetes mellitus patients submitted to metabolic surgery. Fisioter mov 2018. [DOI: 10.1590/1980-5918.031.ao20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Diabetes Mellitus (DM) is a multifactorial metabolic disorder. As considered a public health problem needing additional treatment options. Objective: This prospective study aimed at evaluating pulmonary function through spirometry, before and after metabolic surgery without gastric resection in type 2 DM patients. Methods: Sample was composed by 17 type 2 DM females. They were analyzed in pre (24 hours before surgical procedure), immediate post-operative period POST1 (24 hours after surgical procedure) and in the late postoperative period POST2 (two years after surgical procedure). Besides statistical analysis, it was evaluated the following spirometric parameters: forced vital capacity (FVC), forced expiratory volume in the first second (FEV1) and the FEV1 / FVC ratio (%). Results: Spirometric parameters showed a value increase when compared PRE and POS2 values, except for FVC and FEV1, which was not statistically significant. Conclusion: Type 2 DM women submitted to metabolic surgery without gastric resection showed spirometric value increased after two-year surgical procedure, when compared to preoperative period values. It is important additional studies about pulmonary function, diabetic patients and metabolic surgery without gastric resection.
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Campanella NC, Lacerda CF, Berardinelli GN, Abrahão-Machado LF, Cruvinel-Carloni A, De Oliveira ATT, Scapulatempo-Neto C, Crema E, Adad SJ, Rodrigues MAM, Henry MACA, Guimarães DP, Reis RM. Presence of microsatellite instability in esophageal squamous cell carcinoma associated with chagasic megaesophagus. Biomark Med 2018; 12:573-582. [PMID: 29873509 DOI: 10.2217/bmm-2017-0329] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
AIM The molecular pathogenesis of esophageal squamous cell carcinoma (ESCC) has been increasingly studied, but there is no report on the role of MSI in ESCC development associated with chagasic megaesophagus (CM).Results/methodology: In four ESCC/CM (4/19) we found microsatellite instability (MSI) alterations (21.1%), being three MSI-L (15.8%) and one MSI-H (5.3%). Four out of 35 ESCC cases showed MSI-L (11.4%) and only one out of 26 CM cases presented MSI-L (3.9%). The MSI-H was observed in an ESCC/CM patient that presents lack of MSH6 immunostaining corroborating deficiency in MMR pathway. Interestingly, the MSI-H ESCC/CM case also presented a deletion the HSP110 poly(T)17 gene. DISCUSSION/CONCLUSION Taking together, we concluded that MSI is a rare event in esophageal squamous cell carcinoma, but can be associated with CM.
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Affiliation(s)
- Nathália C Campanella
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Croider Franco Lacerda
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil.,Department of Digestive Surgery, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | | | | | | | | | - Cristovam Scapulatempo-Neto
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil.,Department of Pathology & Molecular Diagnostics, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Eduardo Crema
- Department of Digestive Surgery & Pathology, Medical School, UFTM -Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Sheila Jorge Adad
- Department of Digestive Surgery & Pathology, Medical School, UFTM -Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | | | | | - Denise Peixoto Guimarães
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil.,Department of Endoscopy, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Rui Manuel Reis
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil.,Life & Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
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13
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Borges MDEC, Gouvea AB, Marcacini SFB, Oliveira PFDE, Silva AADA, Crema E. Pulmonary function in women: comparative analysis of conventional versus single-port laparoscopic cholecystectomy. Rev Col Bras Cir 2018; 45:e1652. [PMID: 29846465 DOI: 10.1590/0100-6991e-20181652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 01/16/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to evaluate the pulmonary function of women submitted to conventional and single-port laparoscopic cholecystectomy. METHODS forty women with symptomatic cholelithiasis, aged 18 to 70 years, participated in the study. We divided the patients into two groups: 21 patients underwent conventional laparoscopic cholecystectomy, and 19, single-port laparoscopic cholecystectomy. We assessed pulmonary function through forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and the FEV1/FVC ratio, measured before and 24 hours after the procedure. RESULTS in both groups, FVC and FEV1 were lower in the postoperative period than those obtained in the preoperative period, with a greater reduction in the group undergoing conventional laparoscopic cholecystectomy. Regarding the FEV1/FVC (%) values, there was no statistically significant difference in any of the groups or times analyzed. CONCLUSION there was a greater decline in FVC and FEV1 in the postoperative group of patients submitted to conventional laparoscopic cholecystectomy.
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Affiliation(s)
| | - Aline Borges Gouvea
- Department of Surgery, Triângulo Mineiro Federal University, Uberaba, MG, Brazil
| | | | | | | | - Eduardo Crema
- Department of Surgery, Triângulo Mineiro Federal University, Uberaba, MG, Brazil
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14
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Cunha FMRD, Borges MDC, Fanan JMV, Oliveira PFD, Volpe MS, Crema E. Evaluation of the effectiveness of preoperative outpatient pulmonary preparation in patients undergoing esophageal surgery. Fisioter mov 2018. [DOI: 10.1590/1980-5918.031.ao06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction: Preoperative inspiratory muscle training (IMT) can minimize the occurrence of complications after esophagectomy. Objective: To evaluate the effects of preoperative IMT in patients undergoing esophageal surgery by determining respiratory muscle strength (PImax and PEmax), pulmonary function (FEV1, FVC, FEV1/FVC) and functional capacity by the 6-minute walk test (6MWT). Methods: Twenty-two patients were randomized into two groups: a control group (CG; n = 10) and an intervention group (IG; n = 12). Only IG performed IMT for a minimum period of 2 weeks. The assessments were conducted pre- and post-surgery. Results: An increase of PImax was observed in IG, but not in CG, in the second preoperative assessment (p = 0.014). Assessment on postoperative day 1 showed a reduction in maximal respiratory pressures in the two groups, but the reduction was more marked in IG (p < 0.05). Partial recovery of the variables evaluated was observed at discharge in the two groups. These variables had fully returned to initial values on postoperative day 30. The distance walked in the 6MWT was greater in IG, but the difference was not significant (p = 0.166). There was no difference in the frequency of pulmonary complications between groups. Conclusion: Preoperative IMT performed in our study improved inspiratory muscle strength but did not influence the postoperative pulmonary function or functional capacity of patients undergoing esophagectomy.
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15
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Agrelli TF, Borges MDC, Cunha FMRD, Silva ÉMCD, Terra Júnior JA, Crema E. Combination of preoperative pulmonary and nutritional preparation for esophagectomy. Acta Cir Bras 2018; 33:67-74. [PMID: 29412234 DOI: 10.1590/s0102-865020180010000007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 12/20/2017] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To compare pulmonary and nutritional parameters before and after inspiratory muscle training (IMT) and enteral feeding support in patients with esophageal disease undergoing preoperative outpatient follow-up. METHODS Thirty patients with a mean age of 55.83 years, 16 men and 14 women, were included. Pulmonary assessment consisted of the measurement of MIP, MEP, and spirometry. Anthropometric measurements and laboratory tests were performed for nutritional assessment. After preoperative evaluation, inspiratory muscle training and enteral nutrition support were started. A p<0.05 was considered statistically significant. RESULTS After an outpatient follow-up period of 4 weeks, a significant increase in MIP (-62.20 ± 25.78 to -81.53 ± 23.09), MEP (73.4 ± 31.95 to 90.33 ± 28.39), and FVC (94.86 ± 16.77 to 98.56 ± 17.44) was observed. Regarding the anthropometric variables, a significant increase was also observed in BMI (20.18 ± 5.04 to 20.40 ± 4.69), arm circumference (23.38 ± 3.28 to 25.08 ± 4.55), arm muscle circumference (21.48 ± 3.00 to 22.07 ± 3.36), and triceps skinfold thickness (5.62 ± 2.68 to 8.33 ± 6.59). CONCLUSION Pulmonary and nutritional preparation can improve respiratory muscle strength, FVC and anthropometric parameters. However, further studies are needed to confirm the effectiveness of this preoperative preparation.
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Affiliation(s)
- Taciana Freitas Agrelli
- PhD, Physiotherapist, Department of Surgery, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba-MG, Brazil. Intellectual and scientific content of the study, manuscript writing, critical revision
| | - Marisa de Carvalho Borges
- PhD, Physiotherapist, Department of Surgery, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba-MG, Brazil. Intellectual and scientific content of the study, manuscript writing, critical revision
| | - Fernanda Maria Rodrigues da Cunha
- MSc, Physiotherapist, Department of Surgery, UFTM, Uberaba-MG, Brazil. Intellectual and scientific content of the study, manuscript writing, critical revision
| | - Élida Mara Carneiro da Silva
- PhD, Physiotherapist, Department of Surgery, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba-MG, Brazil. Intellectual and scientific content of the study, manuscript writing, critical revision
| | - Júverson Alves Terra Júnior
- PhD, Full Professor, Department of Surgery, UFTM, Uberaba-MG, Brazil. Scientific content of the study, technical procedures, critical revision
| | - Eduardo Crema
- PhD, Full Professor, Department of Surgery, UFTM, Uberaba-MG, Brazil. Scientific content of the study, technical procedures, critical revision
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16
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Borges MDC, Takeuti TD, Terra JA, Silva AAD, Crema E. Comparative study of respiratory muscle strength in women undergoing conventional and single-port laparoscopic cholecystectomy. Acta Cir Bras 2017; 32:881-890. [PMID: 29160375 DOI: 10.1590/s0102-865020170100000010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 09/18/2017] [Indexed: 01/24/2023] Open
Abstract
PURPOSE To evaluate respiratory muscle strength (PImax and PEmax) before and 24 and 48 h after conventional and single-port laparoscopic cholecystectomy. METHODS Forty women with symptomatic cholelithiasis (18 to 70 years) participated in the study. The patients were divided into two groups: 21 patients undergoing conventional laparoscopic cholecystectomy and 19 patients undergoing single-port laparoscopic cholecystectomy. Differences were considered to be significant when p<0.05. RESULTS The results showed a greater decline in PImax after 24 h in the group submitted to conventional laparoscopic cholecystectomy, with a significant difference between groups (p=0.0308). CONCLUSION Recovery of the parameters studied was more satisfactory and respiratory muscle strength was less compromised in the group submitted to single-port laparoscopic cholecystectomy.
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Affiliation(s)
- Marisa de Carvalho Borges
- PhD, Physiotherapist, Department of Surgery, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba-MG, Brazil. Intellectual and scientific content of the study, manuscript writing, critical revision
| | - Tharsus Dias Takeuti
- PhD of Health Sciences, Department of Surgery, UFTM, Uberaba-MG, Brazil. Intellectual and scientific content of the study, manuscript writing, critical revision
| | - Júverson Alves Terra
- PhD, Full Professor, Department of Surgery, UFTM, Uberaba-MG, Brazil. Scientific content of the study, technical procedures, critical revision
| | - Alex Augusto da Silva
- PhD, Full Professor, Department of Surgery, UFTM, Uberaba-MG, Brazil. Scientific content of the study, technical procedures, critical revision
| | - Eduardo Crema
- PhD, Full Professor, Department of Surgery, UFTM, Uberaba-MG, Brazil. Scientific content of the study, technical procedures, critical revision
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17
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Terra Júnior JA, Terra GA, Borges MDC, Takeuti TD, Castro LGP, Lima SS, Fernandes LFRM, Silva AAD, Crema E. Comparative study of pain in women submitted to conventional laparoscopic cholecystectomy versus single-port laparoscopic cholecystectomy. Acta Cir Bras 2017; 32:475-481. [DOI: 10.1590/s0102-865020170060000008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 05/26/2017] [Indexed: 01/07/2023] Open
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18
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Lacerda CF, Cruvinel-Carloni A, de Oliveira ATT, Scapulatempo-Neto C, López RVM, Crema E, Adad SJ, Rodrigues MAM, Henry MACA, Guimarães DP, Reis RM. Mutational profile of TP53 in esophageal squamous cell carcinoma associated with chagasic megaesophagus. Dis Esophagus 2017; 30:1-9. [PMID: 28375484 DOI: 10.1093/dote/dow040] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 12/30/2016] [Indexed: 02/07/2023]
Abstract
Chaga's disease is an important communicable neglected disease that is gaining wider attention due to its increasing incidence worldwide. Achalasia due to chagasic megaesophagus (CM), a complication of this disease, is a known-yet, poorly understood-etiological factor for esophageal squamous cell carcinoma (ESCC) development. In this study, we aimed to perform the analysis of TP53 mutations in a series of Brazilian patients with ESCC that developed in the context CM (ESCC/CM), and to compare with the TP53 mutation profile of patients with benign CM and patients with nonchagasic ESCC. Additionally, we intended to correlate the TP53 mutation results with patient's clinical pathological features. By polymerase chain reaction (PCR) followed by direct sequencing of the hotspot regions of TP53 (exon 5 to 8), we found that TP53 mutations were present in 40.6% (13/32) of the ESCC/CM group, 45% (18/40) of the nonchagasic ESCC group, and in only 3% (1/33) of the benign CM group. Missense mutations were the most common in the three groups, yet, the type and mutated exon mutation varied significantly among the groups. Clinically, the groups exhibited distinct features, with both cancer groups (ESCC and ESCC/CM) been significantly associated higher consumption of alcohol and tobacco, older age, worse Karnofsky performance status, poor outcome than the patients with benign CM. No significant association was found between TP53 mutation profile and clinical-pathological features in any of the three groups. We describe first the time the analysis of TP53 mutations in ESCC that developed in the context of CM, and the observed high frequency of mutations, suggest that TP53 also plays an important role in the tumorigenic process of this unexplored etiological condition.
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Affiliation(s)
- C F Lacerda
- Department of Digestive Surgery, Barretos Cancer Hospital, Barretos, São Paulo, Brazil.,Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - A Cruvinel-Carloni
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | | | - C Scapulatempo-Neto
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil.,Department of Pathology, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - R V M López
- Centre for Researcher Support, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - E Crema
- Department of Digestive Surgery and Pathology, Medical School, UFTM -Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - S J Adad
- Department of Digestive Surgery and Pathology, Medical School, UFTM -Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - M A M Rodrigues
- Department of Gastroenterology Surgery and Pathology, Medical School, UNESP - São Paulo State University, Botucatu, São Paulo, Brazil
| | - M A C A Henry
- Department of Gastroenterology Surgery and Pathology, Medical School, UNESP - São Paulo State University, Botucatu, São Paulo, Brazil
| | - D P Guimarães
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil.,Department of Endoscopy, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - R M Reis
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil.,Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
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19
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Ribeiro MCB, Araújo ABD, Terra-Júnior JA, Crema E, Andreollo NA. LATE EVALUATION OF PATIENTS OPERATED FOR GASTROESOPHAGEAL REFLUX DISEASE BY NISSEN FUNDOPLICATION. Arq Bras Cir Dig 2017; 29:131-134. [PMID: 27759771 PMCID: PMC5074659 DOI: 10.1590/0102-6720201600030001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 04/07/2016] [Indexed: 12/13/2022]
Abstract
Background: Surgical treatment of GERD by Nissen fundoplication is effective and safe,
providing good results in the control of the disease. However, some authors have
questioned the efficacy of this procedure and few studies on the long-term
outcomes are available in the literature, especially in Brazil. Aim: To evaluate patients operated for gastro-esophageal reflux disease, for at least
10 years, by Nissen fundoplication. Methods: Thirty-two patients were interviewed and underwent upper digestive endoscopy,
esophageal manometry, 24 h pH monitoring and barium esophagogram, before and after
Nissen fundoplication. Results: Most patients were asymptomatic, satisfied with the result of surgery (87.5%) 10
years after operation, due to better symptom control compared with preoperative
and, would do it again (84.38%). However, 62.5% were in use of some type of
anti-reflux drugs. The manometry revealed lower esophageal sphincter with a mean
pressure of 11.7 cm H2O and an average length of 2.85 cm. The average
DeMeester index in pH monitoring was 11.47. The endoscopy revealed that most
patients had a normal result (58.06%) or mild esophagitis (35.48%). Barium swallow
revealed mild esophageal dilatation in 25,80% and hiatal hernia in 12.9% of cases.
Conclusion: After at least a decade, most patients were satisfied with the operation,
asymptomatic or had milder symptoms of GERD, being better and with easier control,
compared to the preoperative period. Nevertheless, a considerable percentage still
employed anti-reflux medications.
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Affiliation(s)
- Maxwel Capsy Boga Ribeiro
- Clinics Hospital and Department of Surgery, Faculty of Medicine, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | - Amanda Bueno de Araújo
- Clinics Hospital and Department of Surgery, Faculty of Medicine, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | - Juverson Alves Terra-Júnior
- Clinics Hospital and Department of Surgery, Faculty of Medicine, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | - Eduardo Crema
- Clinics Hospital and Department of Surgery, Faculty of Medicine, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | - Nelson Adami Andreollo
- Program in Sciences of Surgery, State University of Campinas, Unicamp, Campinas, SP, Brazil
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20
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Borges MDC, Takeuti TD, Terra GA, Ribeiro BM, Rodrigues-Júnior V, Crema E. COMPARATIVE ANALYSIS OF IMMUNOLOGICAL PROFILES IN WOMEN UNDERGOING CONVENTIONAL AND SINGLE-PORT LAPAROSCOPIC CHOLECYSTECTOMY. Arq Bras Cir Dig 2017; 29:164-169. [PMID: 27759779 PMCID: PMC5074667 DOI: 10.1590/0102-6720201600030009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 06/02/2016] [Indexed: 01/26/2023]
Abstract
Background Surgical trauma triggers an important postoperative stress response characterized by significantly elevated levels of cytokines, an event that can favor the emergence of immune disorders which lead to disturbances in the patient's body defense. The magnitude of postoperative stress is related to the degree of surgical trauma. Aim To evaluate the expression of pro-inflammatory (TNF-α, IFN-γ, IL-1β, and IL-17) and anti-inflammatory (IL-4) cytokines in patients submitted to conventional and single-port laparoscopic cholecystectomy before and 24 h after surgery. Methods Forty women with symptomatic cholelithiasis, ranging in age from 18 to 70 years, participated in the study. The patients were divided into two groups: 21 submitted to conventional laparoscopic cholecystectomy and 19 to single-port laparoscopic cholecystectomy. Results Evaluation of the immune response showed no significant difference in IFN-γ and IL-1β levels between the groups or time points analyzed. With respect to TNF-α and IL-4, serum levels below the detection limit (10 pg/ml) were observed in the two groups and at the time points analyzed. Significantly higher postoperative expression of IL-17A was detected in patients submitted to single-port laparoscopic cholecystectomy when compared to preoperative levels (p=0.0094). Conclusions Significant postoperative expression of IL-17 was observed in the group submitted to single-port laparoscopic cholecystectomy when compared to preoperative levels, indicating that surgical stress in this group was higher compared to the conventional laparoscopic cholecystectomy.
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Affiliation(s)
| | - Tharsus Dias Takeuti
- Department of Surgery, Federal University of Triangulo Mineiro, Uberaba, MG, Brazil
| | | | | | | | - Eduardo Crema
- Department of Surgery, Federal University of Triangulo Mineiro, Uberaba, MG, Brazil
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21
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Borges MDC, Terra GA, Takeuti TD, Ribeiro BM, Silva AA, Terra-Júnior JA, Rodrigues-Júnior V, Crema E. IMMUNOLOGICAL EVALUATION OF PATIENTS WITH TYPE 2 DIABETES MELLITUS SUBMITTED TO METABOLIC SURGERY. Arq Bras Cir Dig 2016; 28:266-9. [PMID: 26734798 PMCID: PMC4755180 DOI: 10.1590/s0102-6720201500040012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 08/31/2015] [Indexed: 01/18/2023]
Abstract
BACKGROUND Immunological and inflammatory mechanisms play a key role in the development and progression of type 2 diabetes mellitus. AIM To raise the hypothesis that alterations in immunological parameters occur after duodenojejunal bypass surgery combined with ileal interposition without gastrectomy, and influences the insulin metabolism of betacells. METHODS Seventeen patients with type 2 diabetes mellitus under clinical management were submitted to surgery and blood samples were collected before and six months after surgery for evaluation of the serum profile of proinflammatory (IFN-γ, TNF-α, IL-17A) and anti-inflammatory cytokines (IL-4, IL-10). In addition, anthropometric measures, glucose levels and insulin use were evaluated in each patient. RESULTS No changes in the expression pattern of proinflammatory cytokines were observed before and after surgery. In contrast, there was a significant decrease in IL-10 expression, which coincided with a reduction in the daily insulin dose, glycemic index, and BMI of the patients. Early presentation of food to the ileum may have induced the production of incretins such as GLP-1 and PYY which, together with glycemic control, contributed to weight loss, diabetes remission and the consequent good surgical prognosis of these patients. In addition, the control of metabolic syndrome was responsible for the reduction of IL-10 expression in these patients. CONCLUSION These findings suggest the presence of low-grade inflammation in these patients during the postoperative period, certainly as a result of adequate glycemic control and absence of obesity, contributing to a good outcome of surgery.
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Affiliation(s)
| | | | - Tharsus Dias Takeuti
- Department of Surgery, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil
| | | | - Alex Augusto Silva
- Department of Surgery, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil
| | | | | | - Eduardo Crema
- Department of Surgery, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil
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22
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Fonseca FM, Etchebehere RM, Queiroz DMDM, Rocha AMC, Junqueira IS, Fonseca DND, Rodrigues ALB, Crema E, de Oliveira AG. Histological and endoscopic features of the stomachs of patients with Chagas disease in the era of Helicobacter pylori. Rev Soc Bras Med Trop 2014; 47:739-46. [DOI: 10.1590/0037-8682-0180-2014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 11/27/2014] [Indexed: 11/22/2022] Open
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Takeuti TD, Terra GA, da Silva AA, Terra JA, da Silva LM, Crema E. Effect of the ingestion of the palm oil and glutamine in serum levels of GLP-1, PYY and glycemia in diabetes mellitus type 2 patients submitted to metabolic surgery. Arq Bras Cir Dig 2014; 27 Suppl 1:51-5. [PMID: 25409967 PMCID: PMC4743520 DOI: 10.1590/s0102-6720201400s100013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 06/26/2014] [Indexed: 11/22/2022]
Abstract
Background Incretins are hormones produced by the intestine and can stimulate the secretion
of insulin, helping to diminish the post-prandial glycemia. The administration of
an emulsion of palm oil can help in the maintenance of the weight, and can
increase circulating incretins levels. Glutamine increases the concentration of
incretins in diabetic people. Both can help in metabolic syndrome. Aim To analyze the effects of ingestion of palm oil and glutamine in glycemia and in
incretins in patients with diabetes submitted to surgical duodenojejunal exclusion
with ileal interposition without gastrectomy. Methods Eleven diabetic type 2 patients were included and were operated. They were called
to laboratory follow-up without eating anything between eight and 12 hours. They
had there blood collected after the stimulus of the palm oil and glutamine taken
in different days. For the hormonal doses were used ELISA kits. Results The glycemia showed a meaningful fall between the fast and two hours after the
stimulus of the palm oil (p=0,018). With the glutamine the GLP-1 showed an
increase between the fast and one hour (p=0,32), the PYY showed an important
increase between the fast and one hour after the stimulus (p=0,06), the glycemia
showed a meaningful fall after two hours of the administration of the stimulus
(p=0,03). Conclusion Palm oil and glutamine can influence intestinal peptides and glucose
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Affiliation(s)
| | | | | | | | | | - Eduardo Crema
- Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brazil
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Crema E, Trentini EA, Teles CJO, Monti PR, Lacerda CF, Junior JAT, Silva AA. Laparoscopic reconstruction of the extrahepatic bile duct using a jejunal tube: an innovative, more physiological and anatomical technique for biliodigestive derivation†. J Surg Case Rep 2014; 2014:rjt106. [PMID: 24876319 PMCID: PMC3913425 DOI: 10.1093/jscr/rjt106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The incidence of bile duct injuries has increased as a consequence of the increasing number of cholecystectomies. However, the results of biliodigestive derivation currently used for bile duct reconstruction are unsatisfactory. We report here the case of a patient with iatrogenic Bismuth II bile duct injury and propose a new technique that permits more anatomical and physiological reconstruction of extensive bile duct injuries using transverse retubularization of a pedicled jejunal segment interposed between the bile duct and duodenum.
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Affiliation(s)
- Eduardo Crema
- Department of Digestive Surgery, Triangulo Mineiro Federal University, Uberaba, Minas Gerais, Brazil
| | - Eliane Anrain Trentini
- Department of Digestive Surgery, Triangulo Mineiro Federal University, Uberaba, Minas Gerais, Brazil
| | | | - Paulo Ricardo Monti
- Department of Digestive Surgery, Triangulo Mineiro Federal University, Uberaba, Minas Gerais, Brazil
| | - Croider Franco Lacerda
- Department of Digestive Surgery, Triangulo Mineiro Federal University, Uberaba, Minas Gerais, Brazil
| | | | - Alex Augusto Silva
- Department of Digestive Surgery, Triangulo Mineiro Federal University, Uberaba, Minas Gerais, Brazil
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Silva AA, Camara CACR, Martins Júnior A, Teles CJO, Terra Júnior JA, Crema E. Intraoperative cholangiography during elective laparoscopic cholecystectomy: selective or routine use? Acta Cir Bras 2013; 28:740-3. [DOI: 10.1590/s0102-86502013001000009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 09/12/2013] [Indexed: 01/26/2023] Open
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Crema E, Etchebehere RM, Gonzaga MN, Lima RS, Bertulucci PA, da Silva AA. Splenic lymphangioma: a rare benign tumor of the spleen treated by laparoscopic surgery. Arq Bras Cir Dig 2013; 25:178-9. [PMID: 23411808 DOI: 10.1590/s0102-67202012000300009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Terra Júnior JA, Terra GA, Silva AAD, Crema E. Evaluation of anatomical and functional changes esophageal stump of patients with advanced megaesophagus submitted to subtotal laparoscopic esophagectomy. Acta Cir Bras 2013; 27:650-8. [PMID: 22936092 DOI: 10.1590/s0102-86502012000900011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 07/19/2012] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Evaluate anatomical and functional changes of the esophageal stump and gastric fundus of patients with advanced megaesophagus, submitted to laparoscopic subtotal esophagectomy. METHODS Twenty patients with advanced megaesophagus, previously submitted to a videolaparoscopic subtotal esophagectomy, were evaluated. Were conducted: radiological evaluation of the stump esophagus with transposed stomach, electromanometric, endoscopic examination and histopathology of the esophageal stump and gastric fundus, without making gastric tube or pyloroplasty. RESULTS It was observed that the average height and pressure of the anastomosis, in the electromanometric evaluation, were 23.45cm (±1.84cm) and 7.55mmHg (±5.65mmHg). In patients with megaesophagus III, the pressure of the anastomosis was 10.91mmHg (±6.33mmHg), and pressure from the UES, 31.89mmHg (±14.64mm Hg), were significantly higher than those in grade IV. The pathological evaluation detected mild esophagitis in 35% of patients, moderate in 20% and acanthosis glicogenica in 45%. The examination of the gastric fundus showed that 50% of patients were infected with Helicobacter pylori. Chronic gastritis occurred in 95% of the patients. CONCLUSIONS The laparoscopic esophagectomy shown to be effective in the treatment of advanced achalasia. The cervical level anastomosis protects the esophageal stump from the aggression resulted from gastric reflux after the esophagectomy.
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Carneiro EM, Ramos MDC, Terra GA, Rodrigues Júnior V, Matos D, Crema E. Evaluation of breathing exercise in hormonal and immunological responses in patients undergoing abdominal surgery. Acta Cir Bras 2013; 28:385-90. [PMID: 23702942 DOI: 10.1590/s0102-86502013000500011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Accepted: 04/14/2013] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To evaluate the effects of sustained deep inspiration in the prevention of postoperative pulmonary complications, the hormonal and immunological responses in patients submitted to abdominal surgery. METHODS This randomized clinical trial study included 75 patients submitted to abdominal surgery, of which 36 were randomly allocated in the experimental group and underwent sustained deep inspiration during five seconds, in three sets of ten repetitions per day. The others 39 patients were allocated in the control group and were not submitted to any breathing exercise. The following parameters were measured preoperatively, 24h and 48h postoperatively: chest x-ray, serum ACTH, cortisol, IL-4, IL-10, TNF-α, forced expiratory volume in first second (FEV1), forced expiratory flow 25-75% (FEF 25-75), forced vital capacity (FVC), paO2 and paCO2. RESULTS Mean serum cortisol in patients of the experimental and control groups before surgery were 12.8 mcg/dl (4.6-50) and 10.48 mcg/dl (1-29.1), respectively (p=0.414). The experimental group had significantly increase in serum cortisol levels, 23.6 mcg/dl (9.3-45.8), especially 24h postoperatively (p=0.049). CONCLUSION Sustained deep inspiration in patients submitted to abdominal surgery determined important changes in serum cortisol, however, without significantly influence the postoperative pulmonary complications and the endocrine and immune responses.
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Affiliation(s)
- Elida Mara Carneiro
- Department of Surgery, Federal University of Triangulo Mineiro, Uberaba-MG, Brazil
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Henry MACDA, Lerco MM, Naresse LE, Crema E, Rodrigues MAM. Outcome of superficial squamous cell carcinoma of the esophagus: a clinicopathological study. Acta Cir Bras 2013; 28:373-8. [DOI: 10.1590/s0102-86502013000500009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 04/22/2013] [Indexed: 02/06/2023] Open
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Fonseca FM, Queiroz DMDM, Rocha AMC, Prata A, Crema E, Rodrigues Junior V, Ramirez LE, Oliveira AGD. Seroprevalence of Helicobacter pylori infection in chagasic and nonchagasic patients from the same geographical region of Brazil. Rev Soc Bras Med Trop 2012; 45:194-8. [PMID: 22534991 DOI: 10.1590/s0037-86822012000200011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2011] [Accepted: 09/30/2011] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION In this study, we evaluated the seroprevalence of Helicobacter pylori infection among chagasic and non-chagasic subjects as well as among the subgroups of chagasic patients with the indeterminate, cardiac, digestive, and cardiodigestive clinical forms. METHODS The evaluated subjects were from the Triângulo Mineiro region, Minas Gerais, Brazil. Chagasic patients showed positive reactions to the conventional serological tests used and were classified according to the clinical form of their disease. Immunoglobulin G antibodies specific to H. pylori were measured using a commercial enzyme-linked immunosorbent assay kit. RESULTS The overall H. pylori prevalence was 77.1% (239/310) in chagasic and 69.1% (168/243) in non-chagasic patients. This difference was statistically significant even after adjustment for age and sex (odds ratio = 1.57; 95% confidence interval, 1.02-2.42; p = 0.04) in multivariate analysis. The prevalence of infection increased with age in the non-chagasic group (p = 0.007, χ² for trend), but not in the chagasic group (p = 0.15, χ² for trend). H. pylori infection was not associated with digestive or other clinical forms of Chagas disease (p = 0.27). CONCLUSIONS Our findings demonstrate that chagasic patients have a higher prevalence of H. pylori compared to non-chagasic subjects; a similar prevalence was found among the diverse clinical forms of the disease. The factors contributing to the frequent co-infection with H. pylori and Trypanosoma cruzi as well as its effects on the clinical outcome deserve further study.
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Ramos MDC, Agrelli TF, Carneiro ÉM, Crema E. Tabagismo não limita o incremento da força muscular respiratória em pacientes submetidos ao treinamento muscular inspiratório pré-esofagectomia. Fisioter Pesqui 2012. [DOI: 10.1590/s1809-29502012000100012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Um programa de treinamento muscular respiratório (TMR) para pacientes tabagistas no pré-operatório ambulatorial pode melhorar a força muscular e a capacidade funcional respiratória, evitando complicações que aumentem a permanência do paciente no hospital. O objetivo deste trabalho foi avaliar a eficácia do treinamento muscular inspiratório (TMI) em pacientes tabagistas e não tabagistas que seriam submetidos à cirurgia do megaesôfago. Foram estudados 17 pessoas, divididas em dois grupos: o tabagista (GT), composto por 10 pacientes (58,82%), e o não tabagista (GNT), com 7 pacientes (41,18%). A análise dos dados relacionando os dois foi expressa da seguinte forma: os valores de idade e as medidas antropométricas foram comparadas pelo teste t de Student e os valores da pressão inspiratória máxima (PImáx) e da pressão expiratória máxima (PEmáx) pelo teste t de Student pareado. Os dados foram expressos em média±desvio-padrão quando verificada a normalidade. Consideraram-se diferenças estatisticamente significativas se p<0,05. Na análise comparativa, observou-se aumento significativo da PImáx após as 4 semanas do TMI, como se segue: PImáx no GT de -57,20±18,76 para -79,00±15,38 e no GNT de -52,00±18,76 para -72,66±19,33. A fisioterapia profilática no pré-operatório ambulatorial proporcionou aumento significativo na força dos músculos inspiratórios em ambos os grupos, evidenciada pelo acréscimo na PImáx com consequente melhora da capacidade ventilatória.
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Crema E, Silva ECRR, Franciscon PM, Rodrigues Júnior V, Martins Júnior A, Teles CJO, Silva AA. Prevalence of cholelithiasis in patients with chagasic megaesophagus. Rev Soc Bras Med Trop 2011; 44:324-6. [PMID: 21739075 DOI: 10.1590/s0037-86822011005000043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Accepted: 02/08/2011] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The prevalence of cholelithiasis in the general population ranges from 9 to 18%. This prevalence is known to be higher in the presence of parasympathetic nerve damage of the biliary tract either due to surgery (vagotomy) or neuronal destruction (Chagas disease). The objective of this study was to evaluate the association of cholelithiasis and chagasic or idiopathic megaesophagus. METHODS The ultrasound scans of 152 patients with megaesophagus submitted to cardiomyotomy and subtotal esophagectomy surgery were evaluated. The presence of cholelithiasis was compared between chagasic and idiopathic esophagopathy and ultrasound and clinical findings were correlated with age, sex and race. RESULTS A total of 152 cases of megaesophagus, including 137 with chagasic megaesophagus and 15 with idiopathic megaesophagus, were analyzed. The mean age was 56.7 years (45-67) in the 137 patients with chagasic megaesophagus and 35.6 years (27-44) in the 15 cases of idiopathic megaesophagus, with a significant difference between the two groups (p < 0.0001). The group with chagasic megaesophagus consisted of 59 (43%) women and 78 (56.9%) men, while the group with idiopathic megaesophagus consisted of 8 (53.3%) women and 7 (46.6%) men, showing no significant difference between the groups. Of the 137 patients with confirmed chagasic megaesophagus, 39 (28.4%) presented cholelithiasis versus one case (6.6%) in the 15 patients with idiopathic megaesophagus. CONCLUSIONS The prevalence of cholelithiasis is high in patients with chagasic megaesophagus and preoperative ultrasound should be performed routinely in these patients in order to treat both conditions during the same surgical procedure.
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Affiliation(s)
- Eduardo Crema
- Disciplina de Cirurgia do Aparelho Digestivo, Universidade Federal do Triângulo Mineiro, Uberaba,MG, Brasil.
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Crema E, Camara CACR, Pastore R, Teles CJO, Terra Júnior JA, Silva AA. Assessment of positive perioperative cholangiography in patients undergoing elective laparoscopic cholecystectomy. Rev Col Bras Cir 2011; 37:403-6. [PMID: 21340254 DOI: 10.1590/s0100-69912010000600005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Accepted: 01/30/2010] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To evaluate the positivity of cholangiography in patients without formal indication of this exam undergoing elective cholecystectomy. METHODS We included, in the study, 100 patients whose clinical, laboratory and imaging not older than 10 days before the operation showed no change and therefore kept us unsuspicious of choledocholithiasis. The cholangiographies were analyzed and examined by the surgical team, the radiologist and the authors. The reports were compared and correlated with patients' previous clinical and laboratory findings. RESULTS The incidence of preoperatively unsuspected choledocholithiasis was only one case (1%). CONCLUSION The use of selective cholangiography is safe and should be used in the treatment of calculous cholecystitis.
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Affiliation(s)
- Eduardo Crema
- Universidade Federal do Triângulo Mineiro, Uberaba, Minas Gerais, Brazil.
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Ferreira de Souza LRM, Pascoal G, Marques Cappellari PF, Saldanha Cardoso M, Franco Lacerda C, Crema E. Giant Choledochal Cyst as a Differential Diagnosis for Hepatic Cyst. Journal of Diagnostic Medical Sonography 2010. [DOI: 10.1177/8756479310381129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Choledochal cysts are rare congenital anomalies of the biliary tract characterized by dilation of the biliary tree. Most cases are diagnosed during the first decade of life, whereas only 20% are diagnosed in adulthood. They present as a classic trio: abdominal pain, jaundice, and a tangible mass. The mass is identified in just one-third of the cases. This case presents a patient with the trio, with a painful palpable mass of 15 cm in the epigastrium and right hypochondrium. Sonography and computed tomography were performed initially and suggested that this was a case of a hepatic cyst. However, magnetic resonance cholangiography was decisive in diagnosing this as a case of giant choledochal cyst (Todani I), which was confirmed by anatomopathology.
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Affiliation(s)
| | - Gianne Pascoal
- Federal University of Triangulo Mineiro, Uberaba, Brazil
| | | | | | | | - Eduardo Crema
- Federal University of Triangulo Mineiro, Uberaba, Brazil
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Trentini EA, Crema E, Llanos JC, Lerco MM, Magna LA, Leonardi LS. Biliary tract reconstruction using jejunal tube: an experimental study in dogs. Hepatobiliary Pancreat Dis Int 2009; 8:179-85. [PMID: 19357033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND To physiologically reconstruct the biliary tract, Crema et al suggested the application of the Monti principle to the biliary tract, already used in humans for the urinary tract. With this technique, a jejunal segment is transversely retubularized. This study aimed to evaluate the efficacy of jejunal tube interposition between the common bile duct and duodenum in dogs. METHODS Thirteen dogs underwent a laparoscopic common bile duct ligature, followed by a biliodigestive connection by jejunal tube interposition after one week. The levels of glutamic-pyruvic and glutamic-oxalacetic transaminases, total bilirubins, alkaline phosphatase and gamma-glutamyltransferase were assessed before surgery and thereafter weekly until euthanasia, which was performed 6 weeks after biliodigestive connection. RESULTS Data on 9 dogs were analyzed statistically. The dogs presented with obstructive jaundice after common bile duct ligature, as confirmed by biochemical examination. They showed a statistically significant reduction in cholestasis after biliodigestive connection by jejunal tube interposition and were healthy until the end of the experiment. CONCLUSION A statistically significant reduction was seen in total bilirubin and canalicular enzymes (alkaline phosphatase and gamma-glutamyltransferase) in the 9 dogs 6 weeks after biliodigestive connection by jejunal tube interposition.
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Affiliation(s)
- Eliane Anrain Trentini
- State University of Campinas, Faculty of Medical Sciences, Department of Surgery, 17017-240-Bauru-SP-Brazil.
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Crema E, Ribeiro LBP, Sousa RC, Terra Júnior JA, Silva BF, Silva AA, Silva AV. Esofagectomia transhiatal laparoscópica para o tratamento do megaesôfago avançado: análise de 60 casos. Rev Col Bras Cir 2009; 36:118-22. [DOI: 10.1590/s0100-69912009000200005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Accepted: 11/13/2008] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Utilizamos esta pesquisa para estudar e demonstrar que a esofagectomia subtotal através do acesso laparoscópico e transmediastinal para o preparo do estômago, dissecção do esôfago, abdominal e torácico, e cervicotomia esquerda para retirada da peça e anastomose esôfago-gástrica é facultativa e segura no tratamento do megaesôfago avançado. MÉTODOS: Foram realizadas 60 esofagectomias transhiatais por laparoscopia de setembro de 1996 até dezembro de 2006 (10 casos com preservação dos nervos vagos). A idade média dos pacientes foi 56,4 anos (18 - 76) e antes da operação foram submetidos à sorologia para T. cruzi, esofagograma, endoscopia digestiva de alta resolução, eletromanometria, ultrassom de vesícula biliar e pHmetria de 24 horas, avaliação nutricional, fisioterapia respiratória e suporte nutricional através de sonda nasoenteral. As indicações para o tratamento cirúrgico foram: megaesôfago avançado, diagnosticado radiologicamente e manometricamente, recidiva de megaesôfago após operação envolvendo a junção esôfago-gástrica e associação com disfagia acentuada e/ou neoplasia. O acompanhamento foi de 6 a 118 meses. RESULTADOS: Não houve mortalidade, o tempo médio das operações foi de 160 minutos (110 - 325) e houve melhora de todos os parâmetros avaliados. Doze dos 60 pacientes (20%) apresentaram complicações. Ocorreram oito casos de hemopneumotórax (13,34%), três casos de estase gástrica (5%), quatro casos de fístula cervical (6,67%) com resolução clínica e nove casos de disfonia (15%). CONCLUSÃO: Os resultados observados na esofagectomia transhiatal laparoscópica foram satisfatórios. Demonstraram que a técnica é segura e traz excelentes resultados pós-operatórios.
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Crema E, Gomes MGZ, Monteiro IDO, Silva AA, Micheletti AMR. Leiomiossarcoma de veia cava inferior. Rev Col Bras Cir 2008. [DOI: 10.1590/s0100-69912008000600017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Ribeiro BM, Crema E, Rodrigues V. Analysis of the cellular immune response in patients with the digestive and indeterminate forms of Chagas' disease. Hum Immunol 2008; 69:484-9. [DOI: 10.1016/j.humimm.2008.05.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2007] [Revised: 05/27/2008] [Accepted: 05/30/2008] [Indexed: 10/21/2022]
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Crema E, Silva BF, Lamounier e Silva P, Rodrigues Júnior V, Cunha F. Innovative technique for the study of pneumoperitoneum in the evaluation of abdominal pain after chemical irritation with zymozan. Acta Cir Bras 2008; 23:258-61. [PMID: 18552997 DOI: 10.1590/s0102-86502008000300008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2007] [Accepted: 02/20/2008] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To assess the influence of pneumoperitoneum in mice submitted to peritoneal irritation provoked by the biological agent Saccharomyces cerevisae, by counting the number of abdominal contractions elicited. METHODS To study the effects of pneumoperitoneum analgesic action, 60 mice were divided into two groups: the experimental group, subjected to pneumoperitoneum; and the control group, without pneumoperitoneum. The both groups received intraperitoneal injection of zymosan at a dose of 1mg/0,2ml/mouse. RESULTS The sum of the number of abdominal contractions of the experimental group (with pneumoperitoneum) was significantly lower than that of the control group (without pneumoperitoneum). In the experimental group, a lower number of contractions occurred in each min compared to the control. CONCLUSION The observation of the analgesic effect of pneumoperitoneum using CO2 in mice submitted to peritoneal irritation by zymosan was verified.
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Affiliation(s)
- Eduardo Crema
- Department of Digestive Surgery, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil.
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Herbella FAM, Aquino JLB, Stefani-Nakano S, Artifon ELA, Sakai P, Crema E, Andreollo NA, Lopes LR, de Castro Pochini C, Corsi PR, Gagliardi D, Del Grande JC. Treatment of achalasia: lessons learned with Chagas' disease. Dis Esophagus 2008; 21:461-7. [PMID: 18430188 DOI: 10.1111/j.1442-2050.2008.00811.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Chagas' disease (CD) is highly prevalent in South America. Brazilian surgeons and gastroenterologists gained valuable experience in the treatment of CD esophagopathy (chagasic achalasia) due to the high number of cases treated. The authors reviewed the lessons learned with the treatment of achalasia by different centers experienced in the treatment of Chagas' disease. Preoperative evaluation, endoscopic treatment (forceful dilatation and botulinum toxin injection), Heller's myotomy, esophagectomy, conservative techniques other than myotomy, and reoperations are discussed in the light of personal experiences and review of International and Brazilian literature. Aspects not frequently adopted by North American and European surgeons are emphasized. The review shows that nonadvanced achalasia is frequently treated by Heller's myotomy. Endoscopic treatment is reserved to limited cases. Treatment for end-stage achalasia is not unanimous. Esophagectomy was a popular treatment in advanced disease; however, the morbidity/mortality associated to the procedure made some authors seek different alternatives, such as Heller's myotomy and cardioplasties. Minimally invasive approach to esophageal resection may change this concept, although few centers perform the procedure routinely.
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Affiliation(s)
- F A M Herbella
- Department of Surgery, Division of Esophagus and Stomach, Federal University of Sao Paulo, Sao Paulo, Brazil.
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Abstract
Leiomyosarcoma of the inferior vena cava is an extremely rare tumor that is characterized by a poor prognosis and nonspecific symptoms, a fact that may delay the diagnosis for several years. The only therapeutic modality proven to prolong the survival of patients is total surgical resection of the tumor. In this study, the authors report the case of a 50-year-old patient with a diagnosis of leiomyosarcoma of the inferior vena cava, affecting the middle and distal thirds, who was submitted to surgical treatment.
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Affiliation(s)
- Eduardo Crema
- Department of Surgery, Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brasil,
| | | | | | - Tatiana Silva de Lima
- Department of Surgery, Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brasil
| | - Alex Augusto Silva
- Department of Surgery, Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brasil
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Crema E, Fonseca AMR, Ribeiro LBP, Bello CAD, Martins PRJ, Silva AA. Síndrome de Plummer-Vinson: uma rara associação na talassemia. Rev Bras Hematol Hemoter 2007. [DOI: 10.1590/s1516-84842007000400016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Crema E, Ribeiro LBP, Adad SJ, Ectchebehere RM, Martins Júnior A, Silva AA. Gallbladder neuron count in cholelithiasis patients with and without Chagas disease. Rev Soc Bras Med Trop 2007; 40:15-7. [PMID: 17486247 DOI: 10.1590/s0037-86822007000100003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2005] [Accepted: 01/12/2007] [Indexed: 11/22/2022] Open
Abstract
Various investigators agree that the incidence of cholelithiasis is greater in patients with Chagas disease. The most plausible explanation for this is based on the parasympathetic denervation that occurs over the whole digestive tract due to Chagas disease. In order to analyze the occurrence of this alteration, gallbladder neuron counts were performed on cholelithiasis patients with and without Chagas disease who were being treated at the Department of Digestive Surgery, Universidade Federal do Triângulo Mineiro, Uberaba, Brazil. In the present study, a notable reduction in the number of neurons in the gallbladder wall was observed in Chagas patients, in comparison with non-Chagas subjects.
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Affiliation(s)
- Eduardo Crema
- Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brasil.
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Crema E, Trentini EA, Llanos JC. Proposal of a new technique for bile duct reconstruction after iatrogenic injury: study in dogs and review of the literature. Acta Cir Bras 2007; 22:162-7. [PMID: 17546287 DOI: 10.1590/s0102-86502007000300002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2007] [Accepted: 03/16/2007] [Indexed: 11/22/2022] Open
Abstract
PURPOSE: Interposition of a jejunal tube between the common bile duct and duodenum. METHODS: Five adult mongrel dogs of both sexes, weighing on average 22.3 kg (18 to 26.5 kg), were used. Obstructive jaundice was induced by ligation of the distal common bile duct. After one week, a 2.5-cm long jejunal tube was fabricated from a segment of the loop removed 15 cm from the Treitz angle and interposed between the common bile duct and duodenum. RESULTS: The animals presented good clinical evolution and no complications were observed. After 6 weeks, complete integration was noted between the bile duct mucosa, tube and duodenum and a significant reduction in total bilirubin and alkaline phosphatase was observed when compared to the values obtained one week after ligation of the common bile duct. CONCLUSION: The jejunal tube interposed between the dilated bile duct and duodenum showed good anatomic integration and reduced total bilirubin and alkaline phosphatase levels in the animals studied.
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Affiliation(s)
- Eduardo Crema
- Experimental Laboratory of Surgery Techniques, Department of Surgery, Federal University of Triângulo Mineiro (UFTM), Minas Gerais, Brazil.
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Crema E, Werneck AM, Martins Júnior A, Ribeiro LBP, Lima TSD, Silva AA. Comparative analysis of preparation of human hepatocytes by the ethylenediamine tetraacetic acid and collagenase technique. Acta Cir Bras 2007; 22:53-6. [PMID: 17293951 DOI: 10.1590/s0102-86502007000100010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2006] [Accepted: 10/10/2006] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To compare the viability of human hepatocytes dissociated by the ethylenediaminetetraacetic acid and collagenase techniques. METHODS Hepatocytes were prepared by dissociation of liver fragments obtained from hepatectomies performed for therapeutic purposes at the Service of Digestive Tract Surgery, Federal University of Triângulo Mineiro. RESULTS During the first 4 days of the experiment, 70% of the cells presented birefringent membranes and were not stained with 2% erythrosine, and were therefore considered to be viable. During the first 3 days, hepatocyte viability was on average 71% in the EDTA group and 76% in the collagenase group, with no significant difference between groups. No significant difference was observed between groups at any time. The secretion of albumin by the cultured hepatocytes was preserved up to the seventh day. Mean albumin secretion during the first 3 days was 50 microg/ml in the two groups and a reduction of albumin production was observed from the fourth to the seventh day. Again, no significant difference was observed between groups at any time. CONCLUSION Cell viability and preservation of albumin secretion by hepatocytes are similar for the EDTA and collagenase techniques.
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Affiliation(s)
- Eduardo Crema
- Experimental Laboratory Technique of Surgery, Department of Surgery, Federal University of Triângulo Mineiro, Brazil.
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Crema E, Fatureto MC, Gonzaga MN, Pastore R, da Silva AA. Fístula esôfago-traqueal após ingestão cáustica. J Bras Pneumol 2007; 33:105-8. [PMID: 17568876 DOI: 10.1590/s1806-37132007000100019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2005] [Accepted: 03/13/2006] [Indexed: 11/22/2022] Open
Abstract
As fístulas esôfago-traqueais são incomuns e apresentam diversas etiologias, entre elas, a queimadura química esofágica devida à ingestão cáustica. Relatamos o caso de um paciente de 27 anos com história de ingestão cáustica havia catorze dias, com dor retroesternal em queimação, fraqueza, tosse com escarro purulento e dispnéia associada à rouquidão no último dia. A endoscopia digestiva alta e a broncofibroscopia revelaram fístula esôfago-traqueal. O tratamento consistiu no suporte clínico, drenagem torácica bilateral, exclusão do transito esofágico com esofagostomia cervical terminal e gastrostomia. Houve cicatrização espontânea da fístula esôfago traqueal em seis semanas. Posteriormente, realizou-se a reconstrução do trânsito alimentar através de faringocoloplastia. A evolução pós-operatória foi satisfatória.
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Affiliation(s)
- Eduardo Crema
- Department of Surgical Gastroenterology, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil
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Crema E, Ribeiro LBP, Terra JA, Silva AA. Laparoscopic transhiatal subtotal esophagectomy for the treatment of advanced megaesophagus. Ann Thorac Surg 2006; 80:1196-201. [PMID: 16181840 DOI: 10.1016/j.athoracsur.2004.10.059] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2004] [Revised: 10/25/2004] [Accepted: 10/26/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND Chagas' disease affects about 5 to 8 million individuals in Brazil, with 5% to 8% of them developing megaesophagus. In view of the transformation of the esophagus into an inert tube unable to propel food to the stomach, and in order to prevent complications, the elected treatment for advanced megaesophagus is subtotal esophagectomy. We evaluate here the outcome of laparoscopic transhiatal subtotal esophagectomy in the treatment of advanced megaesophagus. METHODS Thirty patients with advanced esophagopathy, 26 with chagasic and 4 with idiopathic megaesophagus, were submitted to transhiatal subtotal esophagectomy without thoracotomy through laparoscopy and left cervicotomy. Contrast exams of the esophagus, stomach, and duodenum (ESD), upper digestive tract endoscopy (UDE), esophageal electromanometry, and 24-hour pHmetry were performed during the preoperative and postoperative period. With respect to the surgical technique, pyloroplasty was not performed. The cervical esophagus was dissected through a left cervicotomy and the esophagogastric anastomosis was performed between the cervical segment of the esophagus and the posterior wall of the stomach. RESULTS No death or conversion to open surgery occurred in the present series. Complications were observed in 8 patients (26.7%): 6 cases of pneumothorax (20%), 2 of cervical fistulas (6.7%), 7 of transient dysphonia (23.3%), and 1 of anastomotic esophagogastric stenosis (3.3%). One (3.3%) of the patients developed dysphagia for solid food after 36 months despite normal ESD, UDE, electromanometry, and 24-hour pHmetry. CONCLUSIONS The present results show that laparoscopic transhiatal subtotal esophagectomy is a feasible and safe procedure with an excellent postoperative outcome.
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Affiliation(s)
- Eduardo Crema
- Department of Digestive Surgery, Federal School of Medicine, Uberaba, Minas Gerais, Brazil.
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Lages-Silva E, Ramírez LE, Pedrosa AL, Crema E, da Cunha Galvão LM, Pena SDJ, Macedo AM, Chiari E. Variability of kinetoplast DNA gene signatures of Trypanosoma cruzi II strains from patients with different clinical forms of Chagas' disease in Brazil. J Clin Microbiol 2006; 44:2167-71. [PMID: 16757616 PMCID: PMC1489452 DOI: 10.1128/jcm.02124-05] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The clinical course of Chagas' disease varies widely among different patients and geographic regions. For reasons that are not completely understood but involve host and parasite factors, some patients never develop the disease while others present cardiac and/or gastrointestinal symptoms. Many studies have been conducted in order to correlate the genetic variability of the parasites with the clinical forms of the disease, but no conclusive data have been obtained. Our research aims at characterizing the genetic profiles of Trypanosoma cruzi isolates recently obtained from 70 chagasic patients who either showed pathological lesions with symptoms of various intensities or were asymptomatic. All patients came from an area where Chagas' disease is endemic in southeast Brazil where vectorial transmission has been controlled and different clinical forms of the disease can be found. The molecular characterization of parasites evaluated the polymorphisms of the 3' region of the 24Salpha rRNA gene and the variability of kinetoplast DNA (kDNA) minicircles of T. cruzi populations by low-stringency single specific primer PCR. Data presented here provide a strong correlation between T. cruzi II and human infection in this region. However, a high degree of variability was observed within T. cruzi II, as demonstrated by intense kDNA polymorphism among all clinical forms and also within each of them, irrespective of the intensity of pathological processes.
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Affiliation(s)
- Eliane Lages-Silva
- Departamento de Ciências Biológicas, Universidade Federal do Triângulo Mineiro, Uberaba, Brazil.
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Crema E, Silva PLE, Silva GMD, Rodrigues Junior V, Gomes RADS. Operação do refluxo gastro-esofágico isolada ou associada à colecistectomia: avaliação do estresse cirúrgico pela dosagem hormonal e de citocinas. Rev Col Bras Cir 2006. [DOI: 10.1590/s0100-69912006000300005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: O objetivo do presente estudo é comparar o estresse cirúrgico por meio de dosagens hormonais (ACTH e cortisol) e de citocinas (IL-4, IL-10, TNF-a, e IFN-g), em pacientes que foram submetidos somente à operação da transição esofagogástrica com aqueles submetidos à operação da transição esofagogástrica associada à colecistectomia. MÉTODO: Foram estudados 31 pacientes , sendo 19 submetidos à operação da transição esofagogástrica e 12, que apresentavam associação de colelitíase, foram submetidos à colecistectomia e à operação da transição esofagogástrica. A coleta do sangue foi realizada no pré operatório e às 24, 48 e 72 horas no período pós-operatório. Foram realizadas as dosagens de hormônios (ACTH e cortisol) e citocinas (IL-4, IL-10, TNF-a e IFN-g). As variáveis contínuas foram submetidas a teste de normalidade. Foram aplicados testes não paramétricos Mann-Whitney, com significância estabelecida a p<0,05. RESULTADOS: Quanto ao ACTH, os valores foram maiores no grupo 1, às 24 e 48 horas. Na análise do cortisol, TNF-a, IFN-g, IL-4 e IL-10, verificou-se que os valores foram maiores no grupo 2, às 24 e 48 horas. Não se verificou diferença estatisticamente significativa entre os grupos em quaisquer dos tempos de análise. CONCLUSÕES: Com base neste material, pode-se inferir que associar a colecistectomia à operação da transição esofagogástrica não aumenta o stresse cirúrgico, mensurado pelo ACTH, cortisol e citocinas (TNF- a, INF-g, IL-4 e IL-10).
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Pastore R, Crema E, Silveira MDC, Presoto AF, Herbella FAM, Del Grande JC. Eletromanometria esofágica e pHmetria de 24 horas na avaliação pós-operatória da hiatoplastia e válvula anti-refluxo total laparoscópica. Arq Gastroenterol 2006; 43:112-6. [PMID: 17119665 DOI: 10.1590/s0004-28032006000200010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2006] [Accepted: 02/02/2006] [Indexed: 11/22/2022]
Abstract
RACIONAL: A operação de "short floppy Nissen" tem como objetivo tratar o refluxo gastroesofágico. Avaliações clínicas e endoscópicas de sua eficiência têm sido demonstradas por diferentes autores, porém estudos comparando pHmetria ácida de 24 horas com exames realizados no pré e pós-operatório têm sido pouco freqüentes. OBJETIVOS: Avaliar os resultados da hiatoplastia e válvula anti-refluxo total laparoscópica no tratamento da doença do refluxo gastroesofágico não complicada através de estudo comparativo pré e pós-operatório de aspectos manométricos e pHmétricos. MÉTODOS: Cinqüenta e nove indivíduos com sintomas típicos de refluxo gastroesofágico submetidos a cirurgia de "short floppy Nissen" por laparoscopia foram estudados prospectiva e consecutivamente no período de março de 2002 a agosto de 2003. Realizou-se no período pré e pós-operatório, em um tempo mínimo de 3 meses, endoscopia digestiva alta, manometria esofágica e pHmetria ácida de 24 horas. RESULTADOS: Dezoito (30,5%) doentes eram do sexo masculino e 41 (69,5%) do feminino, com idade média de 43,8 anos. Houve diferença nos seguintes achados manométricos, quando comparados no período pré e pós-operatório: localização do esfíncter inferior do esôfago em relação à borda nasal; extensão do esfíncter inferior do esôfago; pressão de repouso do esfíncter inferior do esôfago; pressão do corpo esofágico. Houve diferença nos seguintes achados pHmétricos quando comparados no período pré e pós-operatório: redução do número de refluxo ácidos totais; número de refluxos ácidos prolongados; número de refluxos ácidos prolongados em decúbito dorsal; número de refluxos ácidos prolongados em posição ereta; fração de tempo de acidificação em minutos; índice de DeMeester. CONCLUSÕES: A eletromanometria e a pHmetria esofágicas mostraram melhora em cada um dos seus parâmetros com significância estatística entre os pacientes no período pré e pós-operatório de hiatoplastia e válvula anti-refluxo, demonstrando a eficiência do procedimento operatório quando avaliado por esses exames.
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