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Vintimilla Moscoso A, Figueira ERR, Rocha‐Filho JA, Urner M, Lanchotte C, Jukemura J, Ximenes JLS, Nahas SC, D'Albuquerque LAC, Galvao FHF. Hexafluoroisopropanol decreases liver ischemia-reperfusion injury by downregulation of high mobility group box-1 protein. Pharmacol Res Perspect 2022; 10:e01027. [PMID: 36404629 PMCID: PMC9676687 DOI: 10.1002/prp2.1027] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/22/2022] [Accepted: 10/13/2022] [Indexed: 11/22/2022] Open
Abstract
Liver ischemia-reperfusion (IR) injury is associated with poor outcome after liver transplantation and liver resections. Hexafluoroisopropanol (HFIP) is a tri-fluorinated metabolites of volatile anesthetics and has modulatory effects on inflammation that have been observed mainly in cell culture experiments. In this survey, we investigated the effects of HFIP in a rat model of normothermic hepatic ischemia-reperfusion injury. Twenty-four male Wistar rats were randomized into three groups: (1) control in which animals were submitted to 30 min of partial liver ischemia with resection of non-ischemic liver lobes immediate after reperfusion, (2) pre-ischemia (PI) group in which animals received intravenous HFIP (67 mg/kg) 5 min before liver ischemia, and (3) pre-reperfusion (PR) group in which animals received intravenous HFIP (67 mg/kg) 5 min before reperfusion. Four hours after reperfusion, all animals were euthanized for sample collection. Aspartate and alanine transaminases, glucose, and high mobility group box-1 (HMGB-1) protein concentrations showed a significant decreased, and malondialdehyde was increased in the PR group compared with control and PI groups. Interleukin 6 (IL-6) was increased in the PI group compared with control and PR groups. IL-10 and -12 were increased in the PR and PI groups, respectively, when compared with the control group. Glucose decreased in the PR when compared with the control group. Post-conditioning with HFIP led to a decrease in hepatocellular injury and was associated with a downregulation of HMGB-1. The HFIP resulted in a better control of inflammatory response to ischemia-reperfusion even without causing a reduction in oxidative stress.
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Affiliation(s)
- Agustin Vintimilla Moscoso
- Laboratorio de Investigaçao Medica 37, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
| | - Estela Regina Ramos Figueira
- Laboratorio de Investigaçao Medica 37, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
- Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
| | - Joel Avancini Rocha‐Filho
- Laboratorio de Investigaçao Medica 37, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
- Disciplina de Anestesiologia, Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
| | - Martin Urner
- Divisao Interdepartamental de Medicina IntensivaUniversidade de TorontoTorontoOntarioCanada
- Instituto de Politicas, Gestao e Avaliaçao de SaudeUniversidade de TorontoTorontoOntarioCanada
| | - Cinthia Lanchotte
- Laboratorio de Investigaçao Medica 37, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
| | - Jose Jukemura
- Laboratorio de Investigaçao Medica 37, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
- Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
| | - Jorge Luiz Saraiva Ximenes
- Laboratorio de Investigaçao Medica 37, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
| | - Sergio Carlos Nahas
- Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
| | - Luiz Augusto Carneiro D'Albuquerque
- Laboratorio de Investigaçao Medica 37, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
- Serviço de Transplante de Figado e Orgaos do Aparelho Digestivo, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
| | - Flavio Henrique Ferreira Galvao
- Laboratorio de Investigaçao Medica 37, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
- Serviço de Transplante de Figado e Orgaos do Aparelho Digestivo, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
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Santos G, Figueira ERR, D'Albuquerque LAC, Lisboa PB, de Almeida MD, Filgueira NA, Boin I, Porta G, da Silva RDCMA, Viana CFG, Faria LC, Alvares-da-Silva MR, de Moraes ACP, Morsoletto DBG, Codes L, Paraná R. Evaluation of drug-induced liver injury as etiology for acute liver failure in Brazil. Ann Hepatol 2022; 23:100310. [PMID: 33508520 DOI: 10.1016/j.aohep.2021.100310] [Citation(s) in RCA: 5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES Little is known about the etiology of acute liver failure (ALF) in Latin America. The objective of this paper is to investigate the main etiologies of ALF in Brazil, including Drug Induced Liver Injury (DILI) using stringent causality criteria. PATIENTS OR MATERIAL AND METHODS All the cases of individuals who underwent liver transplantation (LT) in 12 centers in Brazil for ALF were reviewed. When DILI was stated as the cause of ALF, causality criteria were applied on site by the main investigator in order to rule out other etiologies. RESULTS 325 individuals had ALF mainly for unknown reasons (34%), DILI (27%) and AIH (18%). Reassessment of the 89 cases of DILI, using stringent causality criteria, revealed that in only 42 subjects could DILI be confirmed as the cause of ALF. Acetaminophen (APAP) toxicity (n = 3) or DILI due to herbal and dietary supplements (HDS) (n = 2) were not commonly observed. CONCLUSIONS Undetermined etiology and DILI are the main causes of ALF in Brazil. However, APAP toxicity and DILI due to HDS are mostly uncommon.
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Affiliation(s)
- Genario Santos
- Health Science Postgraduation, Faculty of Medicine, University Federal of Bahia, Brazil.
| | - Estela Regina Ramos Figueira
- Department of Gastroenterology, Division of Digestive Surgery, Hospital das Clinicas of University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
| | - Luiz Augusto Carneiro D'Albuquerque
- Department of Gastroenterology, Division of Digestive Surgery, Hospital das Clinicas of University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
| | | | | | | | - Ilka Boin
- Medical Sciences Faculty of Campinas State University, Campinas, São Paulo, Brazil.
| | - Gilda Porta
- Department of Pediatrics, Children's Institute, Medical School of the University of São Paulo, São Paulo, Brazil.
| | | | | | - Luciana Costa Faria
- Department of Internal Medicine, Federal University of Minas Gerais, School of Medicine, Belo Horizonte-MG, Brazil.
| | | | | | | | - Liana Codes
- Unit of Gastroenterology and Hepatology, Portuguese Hospital, Salvador-BA, Brazil..
| | - Raymundo Paraná
- Health Science Postgraduation, Faculty of Medicine, University Federal of Bahia, Brazil.
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Surjan RCT, do Prado Silveira S, Figueira ERR, Ardengh JC. First description of extended and tailored fluorescence guided lymphadenectomy during robotic distal pancreatosplenectomy: case report. J Vis Surg 2022. [DOI: 10.21037/jovs-22-32] [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: 11/30/2022]
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Gordon K, Figueira ERR, Rocha-Filho JA, Mondadori LA, Joaquim EHG, Seda-Neto J, da Fonseca EA, Pugliese RPS, Vintimilla AM, Auler Jr JOC, Carmona MJC, D'Alburquerque LAC. Perioperative blood transfusion decreases long-term survival in pediatric living donor liver transplantation. World J Gastroenterol 2021; 27:1161-1181. [PMID: 33828392 PMCID: PMC8006094 DOI: 10.3748/wjg.v27.i12.1161] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/20/2021] [Accepted: 03/13/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The impact of perioperative blood transfusion on short- and long-term outcomes in pediatric living donor liver transplantation (PLDLT) must still be ascertained, mainly among young children. Clinical and surgical postoperative complications related to perioperative blood transfusion are well described up to three months after adult liver transplantation.
AIM To determine whether transfusion is associated with early and late postoperative complications and mortality in small patients undergoing PLDLT.
METHODS We evaluated the effects of perioperative transfusion on postoperative complications in recipients up to 20 kg of body weight, submitted to PLDLT. A total of 240 patients were retrospectively allocated into two groups according to postoperative complications: Minor complications (n = 109) and major complications (n = 131). Multiple logistic regression analysis identified the volume of perioperative packed red blood cells (RBC) transfusion as the only independent risk factor for major postoperative complications. The receiver operating characteristic curve was drawn to identify the optimal volume of the perioperative RBC transfusion related to the presence of major postoperative complications, defining a cutoff point of 27.5 mL/kg. Subsequently, patients were reallocated to a low-volume transfusion group (LTr; n = 103, RBC ≤ 27.5 mL/kg) and a high-volume transfusion group (HTr; n = 137, RBC > 27.5 mL/kg) so that the outcome could be analyzed.
RESULTS High-volume transfusion was associated with an increased number of major complications and mortality during hospitalization up to a 10-year follow-up period. During a short-term period, the HTr showed an increase in major infectious, cardiovascular, respiratory, and bleeding complications, with a decrease in rejection complications compared to the LTr. Over a long-term period, the HTr showed an increase in major infectious, cardiovascular, respiratory, and minor neoplastic complications, with a decrease in rejection complications. Additionally, Cox hazard regression found that high-volume RBC transfusion increased the mortality risk by 3.031-fold compared to low-volume transfusion. The Kaplan-Meier survival curves of the studied groups were compared using log-rank tests and the analysis showed significantly decreased graft survival, but with no impact in patient survival related to major complications. On the other hand, there was a significant decrease in both graft and patient survival, with high-volume RBC transfusion.
CONCLUSION Transfusion of RBC volume higher than 27.5 mL/kg during the perioperative period is associated with a significant increase in short- and long-term postoperative morbidity and mortality after PLDLT.
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Affiliation(s)
- Karina Gordon
- Division of Anesthesiology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo 05403-000, Brazil
- Department of Anesthesiology, AC Camargo Cancer Center, São Paulo 01509-010, Brazil
| | - Estela Regina Ramos Figueira
- Department of Gastroenterology, Discipline of Liver and Gastrointestinal Transplantation, Laboratory of Medical Investigations LIM37 Hospital das Clinicas, University of São Paulo School of Medicine, São Paulo 05402-000, Brazil
| | - Joel Avancini Rocha-Filho
- Division of Anesthesiology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo 05403-000, Brazil
| | | | | | - Joao Seda-Neto
- Department of Liver Transplantation, AC Camargo Cancer Center, São Paulo 01525-901, Brazil
| | | | | | - Agustin Moscoso Vintimilla
- Department of Gastroenterology, Division of Liver and Gastrointestinal Transplant, Hospital das Clinicas, University of São Paulo School of Medicine, São Paulo 05402-000, Brazil
| | - Jose Otavio Costa Auler Jr
- Division of Anesthesiology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo 05403-000, Brazil
| | - Maria Jose Carvalho Carmona
- Division of Anesthesiology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo 05403-000, Brazil
| | - Luiz Augusto Carneiro D'Alburquerque
- Department of Gastroenterology, Division of Liver and Gastrointestinal Transplant, Hospital das Clinicas, University of São Paulo School of Medicine, São Paulo 05402-000, Brazil
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Figueira ERR, Franzini T, Costa TN, Madruga-Neto AC, Guedes HG, Romano VC, Ceconello I, de Moura EGH. Laparoscopic SpyGlass cholangioscopy evaluation during bilioenteric anastomosis for hepatolithiasis, a case report. Int J Surg Case Rep 2020; 78:140-144. [PMID: 33340982 PMCID: PMC7750126 DOI: 10.1016/j.ijscr.2020.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/01/2020] [Revised: 12/02/2020] [Accepted: 12/02/2020] [Indexed: 12/17/2022] Open
Abstract
Diagnosis and management of benign hepatobiliary diseases are often challenging. SpyGlass cholangioscopy has enhanced the diagnosis of biliary diseases. A multidisciplinary approach can ensure diagnosis and treatment of patients with hepatobiliary diseases. Association of laparoscopic hepaticojejunostomy to SpyGlass cholangioscopy is a safe and minimal invasive procedure.
Introduction Careful evaluation of intrahepatic injury of biliary tract diseases is crucial to assure proper management and estimate disease prognosis. Hepatholithiasis is a rare condition that can be associated to cholestatic liver diseases. Additional tools to improve diagnosis and patient care are of great interest specially if associated to decreased morbidity. Recently the spread of single-operator platforms of cholangioscopy brought this procedure back to scene. Our aim was to identify safety, feasibility and utility of SpyGlass cholangioscopy of biliary tract during laparoscopic hepaticojejunostomy. Presentation of case A 53 years-old man with hepatolithiasis associated to choledolithiasis under treatment with ursodeoxycholic acid and fenofibrate for 8 months, was submitted to laparoscopic hepaticojejunostomy with cholangioscopy for biliary duct evaluation. Spyscope was inserted through a right lateral laparoscopic trocar entering the common bile duct. Examination of intra-hepatic bile ducts showed injury of right biliary. Few microcalculi were visualized. Left biliary ducts presented normal mucosa. Histopathological examination showed a chronic inflammatory process. During the procedure contrasted radiologic images were performed to assure Spyscope location. Following cholangioscopy evaluation, a Roux-en-Y hepaticojejunostomy was performed. To enlarge hepatic duct, a small longitudinal incision was made, and a PDS-5.0 running suture was used for bilioenteric anastomosis. Patient was discharged on postoperative day 6, with drain removal on day 20. Conclusion SpyGlass cholangioscopy during laparoscopic hepaticojejunostomy is feasible leading to minimal additional invasion of the surgical. In this case the method was performed safely, providing detailed examination of injured biliary ducts, adding elements to determine disease prognosis and patient care.
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Affiliation(s)
- Estela Regina Ramos Figueira
- Hospital das Clinicas from University of São Paulo School of Medicine, Division of Digestive Surgery, Sao Paulo, Brazil.
| | - Tomazo Franzini
- Hospital das Clinicas from University of São Paulo School of Medicine, Gastrointestinal Endoscopy Unit, São Paulo, Brazil
| | - Thiago Nogueira Costa
- Hospital das Clinicas from University of São Paulo School of Medicine, Division of Digestive Surgery, Sao Paulo, Brazil
| | - Antonio Coutinho Madruga-Neto
- Hospital das Clinicas from University of São Paulo School of Medicine, Gastrointestinal Endoscopy Unit, São Paulo, Brazil
| | - Hugo Gonçalo Guedes
- Hospital das Clinicas from University of São Paulo School of Medicine, Gastrointestinal Endoscopy Unit, São Paulo, Brazil
| | - Vitor Carminatti Romano
- Hospital das Clinicas from University of São Paulo School of Medicine, Division of Digestive Surgery, Sao Paulo, Brazil; Hospital das Clinicas from University of São Paulo School of Medicine, Gastrointestinal Endoscopy Unit, São Paulo, Brazil; University of São Paulo School of Medicine, Sao Paulo, Brazil
| | - Ivan Ceconello
- Hospital das Clinicas from University of São Paulo School of Medicine, Division of Digestive Surgery, Sao Paulo, Brazil
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Franzini T, Cardarelli-Leite L, Figueira ERR, Morita F, Domingos FUG, Carnevale FC, de Moura EGH. SpyGlass percutaneous transhepatic cholangioscopy-guided lithotripsy of a large intrahepatic stone. Endoscopy 2017; 49:E292-E293. [PMID: 28926850 DOI: 10.1055/s-0043-117943] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Tomazo Franzini
- Department of Gastroenterology, Hospital das Clinicas from University of São Paulo School of Medicine, São Paulo, Brazil
| | - Leandro Cardarelli-Leite
- Department of Radiology, Hospital das Clinicas from University of São Paulo School of Medicine, São Paulo, Brazil
| | - Estela Regina Ramos Figueira
- Department of Gastroenterology, Hospital das Clinicas from University of São Paulo School of Medicine, São Paulo, Brazil
| | - Flávio Morita
- Department of Gastroenterology, Hospital das Clinicas from University of São Paulo School of Medicine, São Paulo, Brazil
| | | | - Francisco Cesar Carnevale
- Department of Radiology, Hospital das Clinicas from University of São Paulo School of Medicine, São Paulo, Brazil
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Abdo EE, Figueira ERR, Rocha-Filho JA, Chaib E, D'Albuquerque LAC, Bacchella T. PRELIMINARY RESULTS OF TOPICAL HEPATIC HYPOTHERMIA IN A MODEL OF LIVER ISCHEMIA/REPERFUSION INJURY IN RATS. Arq Gastroenterol 2017; 54:246-249. [PMID: 28723980 DOI: 10.1590/s0004-2803.201700000-30] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 04/12/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Ischemia/reperfusion causes organ damage but it is mandatory in hepatic transplantation, trauma and other complex liver surgeries, when Pringle maneuver is applied to minimize bleeding during these procedures. It is well known that liver ischemia/reperfusion leads to microcirculatory disturbance and cellular injury. In this setting hypothermia is known to reduce oxygen demand, lowering intracellular metabolism. OBJECTIVE: To evaluate the effects of hypothermia in liver ischemia/reperfusion injury, using a new model of topic isolated liver hypothermia. METHODS We used male Wistar rats weighting about 250 grams, kept in ad libitum feeding regime and randomly divided into two groups of nine animals: 1) Normothermic group, rats were submitted to normothermic ischemia of the median and left hepatic lobes, with subsequent resection of right and caudate lobes during liver reperfusion; and 2) Hypothermic group, rats were submitted to liver ischemia under hypothermia at 10°C. Liver ischemia was performed for 45 minutes. The animals were euthanized 48 hours after liver reperfusion for blood and liver tissue sampling. RESULTS The transaminases analyses showed a significant decrease of AST and ALT in Hypothermic group (P<0.01) compared to Normothermic group (1403±1234 x 454±213 and 730±680 x 271±211 U/L, respectively). Histology showed severe necrosis in 50% and mild necrosis in 50% of cases in Normothermic group, but severe necrosis in 10% and mild or absent necrosis 90% of the cases in hypothermic group. CONCLUSION: A simplified model of liver ischemia/reperfusion that simulates orthotopic liver autotransplantion was demonstrated. Topical hypothermia of isolated hepatic lobules showed liver protection, being a viable and practical method for any kind of in vivo liver preservation study.
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Affiliation(s)
- Emilio Elias Abdo
- Hospital das Clínicas, Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia, Divisão de Cirurgia Digestiva, São Paulo, SP, Brasil.,Hospital das Clínicas, Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia, Laboratório de Investigação Médica LIM37, São Paulo, SP, Brasil
| | - Estela Regina Ramos Figueira
- Hospital das Clínicas, Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia, Divisão de Cirurgia Digestiva, São Paulo, SP, Brasil.,Hospital das Clínicas, Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia, Laboratório de Investigação Médica LIM37, São Paulo, SP, Brasil
| | - Joel Avancini Rocha-Filho
- Hospital das Clínicas, Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia, Laboratório de Investigação Médica LIM37, São Paulo, SP, Brasil.,Hospital das Clínicas, Universidade de São Paulo, Faculdade de Medicina, Departamento de Cirurgia, Disciplina de Anestesiologia, São Paulo, SP, Brasil
| | - Eleazar Chaib
- Hospital das Clínicas, Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia, Laboratório de Investigação Médica LIM37, São Paulo, SP, Brasil.,Hospital das Clínicas, Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia, Divisão de Transplante de Fígado e Gastrointestinal, São Paulo, SP, Brasil
| | - Luiz Augusto Carneiro D'Albuquerque
- Hospital das Clínicas, Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia, Laboratório de Investigação Médica LIM37, São Paulo, SP, Brasil.,Hospital das Clínicas, Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia, Divisão de Transplante de Fígado e Gastrointestinal, São Paulo, SP, Brasil
| | - Telesforo Bacchella
- Hospital das Clínicas, Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia, Divisão de Cirurgia Digestiva, São Paulo, SP, Brasil.,Hospital das Clínicas, Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia, Laboratório de Investigação Médica LIM37, São Paulo, SP, Brasil
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Namur GN, Ribeiro TC, Souto MM, Figueira ERR, Bacchella T, Jureidini R. MINIMALLY INVASIVE SURGERY FOR PSEUDOPAPILLARY NEOPLASM OF THE PANCREAS. Arq Bras Cir Dig 2017; 29:97-101. [PMID: 27438035 PMCID: PMC4944744 DOI: 10.1590/0102-6720201600020008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 03/08/2016] [Indexed: 01/04/2023]
Abstract
Background: Solid pseudopapillary pancreatic neoplasia is usually a large well-circumscribed
pancreatic mass, with cystic and solid areas more frequently found in young women.
It is a benign pancreatic neoplasia in most cases, therefore minimally invasive
surgery could be an interesting approach. Aim: Evaluate the results of minimally invasive surgery for this neoplasia. Methods: Patients with this tumor who underwent minimally invasive pancreatectomies
between 2009 and 2015 in a single institution, were analyzed regarding
demographic, clinical-pathological futures, post-operative morbidity and
disease-free survival. Results: All were women, and their median age was 39 (18-54) years. Two patients with
tumor in the head of the pancreas underwent laparoscopic pancreaticoduodenectomy,
and another one underwent laparoscopic enucleation. Two patients with tumor in the
neck underwent central pancreatectomy. Distal pancreatectomies were performed in
the other five, one with splenic preservation. None required blood transfusion or
conversion to open surgery. Two (20%) developed clinical relevant pancreatic
fistulas, requiring readmission. Median length of postoperative hospital stay was
five days (2-8). All resection margins were negative. Patients were followed for a
median of 38 months (14-71), and there was no recurrence. Conclusions: Minimally invasive surgery for solid pseudopapillary pancreatic neoplasia is
feasible for tumors in different locations in the pancreas. It was associated with
acceptable morbidity and respected the oncologic principles for treatment.
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Affiliation(s)
| | - Thiago Costa Ribeiro
- Hospital de Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Marcelo M Souto
- Hospital de Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | | | - Telesforo Bacchella
- Hospital de Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Ricardo Jureidini
- Hospital de Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
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Ramos Figueira ER, Rocha Filho JA, Souto Nacif L, Carneiro D'Albuquerque L, Linetzky Waitzberg D. NUTRITIONAL SUPPORT FOR FULMINANT HEPATITIS. NUTR HOSP 2015; 32:2427-32. [PMID: 26667689 DOI: 10.3305/nh.2015.32.6.9769] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION fulminant hepatitis (FH) is associated with exacerbated hypercatabolism, hypoglycemia and hyperammonemia that are accompanied by the release of proinflammatory cytokines and catabolic hormones into the systemic circulation worsening patient's clinical condition. Nutritional support is a crucial element for the recovery of these patients. OBJECTIVES the aim of this review is to update Nutritional Support for Fulminant Hepatitis. METHODS the review was performed using electronic search on Medline-PubMed using Mesh-terms. RESULTS AND DISCUSSION there are not many data available on nutritional support to fulminant hepatitis or acute liver failure. Strategies for initial nutritional intervention are focused on the control of the previously described FH metabolic derangements, and should be individualized according to the severity of patient's clinical condition. Energy and protein can be provided in amounts of 25‑40 kcal/kg/day and 0.8-1.2 g/kg/day, respectively. Enteral nutrition therapy is indicated for patients with advancing encephalopathy or for those who cannot be properly fed orally. Euglycemia must be achieved and protein intake can be based on BCAA formulae. Lipids can be administered as energy supplementation with caution. Adequate nutrition therapy can potentially reduce morbidity and mortality of FH patients.
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Affiliation(s)
- Estela Regina Ramos Figueira
- Hospital das Clínicas from University of Sao Paulo School of Medicine, Discipline of Digestive Surgery and LIM37, Department of Gastroenterology, Sao Paulo..
| | - Joel Avancini Rocha Filho
- Hospital das Clínicas from University of Sao Paulo School of Medicine, Discipline of Anesthesiology (LIM08), Sao Paulo..
| | - Lucas Souto Nacif
- Hospital das Clínicas from University of Sao Paulo School of Medicine, Discipline of Liver and Gastrointestinal Transplant (LIM37), Department of Gastroenterology, Sao Paulo..
| | - Luiz Carneiro D'Albuquerque
- Hospital das Clínicas from University of Sao Paulo School of Medicine, Discipline of Liver and Gastrointestinal Transplant (LIM37), Department of Gastroenterology, Sao Paulo..
| | - Dan Linetzky Waitzberg
- Hospital das Clínicas from University of Sao Paulo School of Medicine, Discipline of Digestive Surgery (LIM35), Department of Gastroenterology, Sao Paulo, Brazil..
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Chaib E, Figueira ERR, Brunheroto A, Gatti AP, Fernandes DV, D'Albuquerque LAC. Does the patient selection with MELD score improve short-term survival in liver transplantation? Arq Bras Cir Dig 2014; 26:324-7. [PMID: 24510043 DOI: 10.1590/s0102-67202013000400014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 06/11/2013] [Indexed: 01/13/2023]
Abstract
INTRODUCTION The Model for End-Stage Liver Disease (MELD) score introduced in 2002 has come to improve selection of patients dying in the liver transplantation waiting list. OBJECTIVE To evaluate the short-term survival in liver transplantation around the world when MELD score was applied as selection criteria. METHODS - A review has been done at the online database PubMed/ Medline/Scielo. The expressions applied for the search were "liver transplantation and/or MELD and/or survival analysis" from 2002 to 2009. Among the 124 analyzed articles, 94 were excluded due to irrelevance of the subject and lack of information. Were considered L1, L2A and MELD>20 the sickest patient; L2B, L3 and MELD< 20 the healthiest. Was compiled the data of transplanted patients, their one-year survival rate related to MELD score and compare it with pre-MELD era. RESULTS MELD score has been applied, mainly in America and Europe patients, range from 8.4 to 30. One-year survival ranged from 66.5 to 92%. Analysis of patient survival rate significance between the pre-MELD and post-MELD era showed: Group I (L1 and L2A) x Group III (MELD>20), significant (p<0,0001); Group II (L2B and L3) x Group IV(MELD<20), not significant. Also, comparative one-year survival by country in the MELD era was search. CONCLUSION The MELD score have significantly improved short-term survival for the sickest patient on the waiting list for liver transplantation; additionally, it does not have any significant impact in survival for the healthiest patient.
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Freire MP, Soares Oshiro ICV, Bonazzi PR, Guimarães T, Ramos Figueira ER, Bacchella T, Costa SF, Carneiro D'Albuquerque LA, Abdala E. Surgical site infections in liver transplant recipients in the model for end-stage liver disease era: an analysis of the epidemiology, risk factors, and outcomes. Liver Transpl 2013; 19:1011-9. [PMID: 23744748 DOI: 10.1002/lt.23682] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [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] [Received: 02/16/2013] [Accepted: 05/19/2013] [Indexed: 12/12/2022]
Abstract
In recipients of liver transplantation (LT), surgical site infection (SSIs) are among the most common types of infection occurring in the first 60 days after LT. In 2007, the Model for End-Stage Liver Disease (MELD) scoring system was adopted as the basis for prioritizing organ allocation. Patients with higher MELD scores are at higher risk for developing SSIs as well as other health care-associated infections. However, there have been no studies comparing the incidence of SSIs in the pre-MELD era with the incidence in the period since its adoption. Therefore, the objectives of this study were to evaluate the incidence, etiology, epidemiology, and outcomes of post-LT SSIs in those 2 periods and to identify risk factors for SSIs. We evaluated all patients who underwent LT over a 10-year period (2002-2011). SSI cases were identified through active surveillance. The primary outcome measure was an SSI during the first 60 days after LT. Risk factors were analyzed via logistic regression, and 60-day survival rates were evaluated via Cox regression. We evaluated 543 patients who underwent LT 597 times. The SSI rates in the 2002-2006 and 2007-2011 periods were 30% and 24%, respectively (P = 0.21). We identified the following risk factors for SSIs: retransplantation, the transfusion of more than 2 U of blood during LT, dialysis, cold ischemia for >400 minutes, and a cytomegalovirus infection. The overall 60-day survival rate was 79%. Risk factors for 60-day mortality were retransplantation, dialysis, and a longer surgical time. The use of the MELD score modified the incidence and epidemiology of SSIs only during the first year after its adoption. Risks for SSIs were related more to intraoperative conditions and intercurrences after LT than to a patient's status before LT.
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Figueira ERR, Bacchella T, Coelho AMM, Sampietre SN, Molan NAT, Leitão RMC, Machado MCC. Timing-dependent protection of hypertonic saline solution administration in experimental liver ischemia/reperfusion injury. Surgery 2009; 147:415-23. [PMID: 20004454 DOI: 10.1016/j.surg.2009.10.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2008] [Accepted: 10/05/2009] [Indexed: 01/05/2023]
Abstract
BACKGROUND During liver ischemia, the decrease in mitochondrial energy causes cellular damage that is aggravated after reperfusion. This injury can trigger a systemic inflammatory syndrome, also producing remote organ damage. Several substances have been employed to decrease this inflammatory response during liver transplantation, liver resections, and hypovolemic shock. The aim of this study was to evaluate the effects of hypertonic saline solution and the best timing of administration to prevent organ injury during experimental liver ischemia/reperfusion. METHODS Rats underwent 1 hr of warm liver ischemia followed by reperfusion. Eighty-four rats were allocated into 6 groups: sham group, control of ischemia group (C), pre-ischemia treated NaCl 0.9% (ISS) and NaCl 7.5% (HTS) groups, pre-reperfusion ISS, and HTS groups. Blood and tissue samples were collected 4 hr after reperfusion. RESULTS HTS showed beneficial effects in prevention of liver ischemia/reperfusion injury. HTS groups developed increases in AST and ALT levels that were significantly less than ISS groups; however, the HTS pre-reperfusion group showed levels significantly less than the HTS pre-ischemia group. No differences in IL-6 and IL-10 levels were observed. A significant decrease in mitochondrial dysfunction as well as hepatic edema was observed in the HTS pre-reperfusion group. Pulmonary vascular permeability was significantly less in the pre-reperfusion HTS group compared to the ISS group. No differences in myeloperoxidase activity were observed. The liver histologic score was significantly less in the pre-reperfusion HTS group compared to the pre-ischemia HTS group. CONCLUSION HTS ameliorated local and systemic injuries in experimental liver ischemia/reperfusion. Infusion of HTS in the pre-reperfusion period may be an important adjunct to accomplish the best results.
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Affiliation(s)
- Estela Regina Ramos Figueira
- Liver Transplantation Service, Department of Surgery, University of São Paulo Medical School, São Paulo, Brazil.
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Medeiros DM, Oliveira AC, Barros MFA, Cury RA, Sette H, Abdala E, Canedo LF, Makdissi FF, Andraus W, Martino RB, Rocha-Santos V, Figueira ERR, Machado MAC, Carrilho FJ, Cançado ELR, Bacchella T, Machado MCC. Early mortality in liver transplantation: bilirubin as predictor of outcome. Transplant Proc 2005; 36:931-2. [PMID: 15194321 DOI: 10.1016/j.transproceed.2004.03.112] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The shortage of donor organs and the long waiting lists have increased the need to better select liver transplant candidates using predictors of success. We reviewed the results of 29 liver transplantations performed from January 2002 to February 2003 analyzing the correlations with early mortality (30 days) of patient data, pretransplant laboratory data, warm ischemia time, intraoperations blood unit transfusions, and postoperative complications of prolonged mechanical ventilation, dialysis, and infection. Overall early mortality was 27.6% and 44% in fulminant hepatic failure (n = 9), there were four retransplants with one death, and two intraoperative deaths. Only pretransplant bilirubin (P =.045) and postoperative lactate levels (P =.002) were significantly different between alive versus dead patients. In this small population bilirubin was more related to death than the MELD score. Lactate levels, nonspecific predictor of death in shock syndromes were probably related to septic complications.
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Affiliation(s)
- D M Medeiros
- Liver Transplantation Unit, Hospital das Clínicas, Medical School, University of São Paulo, Sao Paulo, Brazil.
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Bacchella T, Figueira ERR, Makdissi FF, Rocha-Santos V, Martino RB, Andraus W, Canedo LF, Machado MAC, Machado MCC. Biliary reconstruction without T-tube in liver transplantation. Transplant Proc 2004; 36:951-2. [PMID: 15194330 DOI: 10.1016/j.transproceed.2004.03.103] [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] [Indexed: 10/26/2022]
Abstract
Biliary complications have been reported in 9% to 34% of liver transplant patients. Although most centers seem to prefer a duct-to-duct anastomosis without a T-tube when feasible, the best method of biliary reconstruction remains controversial. The aim of this study was to review our experience on reconstruction of the biliary tract without drainage. Forty-one patients underwent 45 liver transplants over two periods. Forty patients underwent 15 liver transplants from October 1992 to March 1995; and 27 underwent 30 liver transplants from January 2002 to February 2003. Our standard biliary reconstruction was an end-to-end anastomosis without drain. The overall actuarial survival was 72.7% at 1 year, 64.7% at 3 years, and 56.6% at 5 years. The mean follow-up was 23 months. Eight patients (22.2%) developed biliary tract complications: five patients papillary dysfunction (13.9%); two, biliary stricture (5.5%); and one, biliary sludge without evidence of stricture (2.8%). Papillary dysfunction represented 62.5% of all complications. Biliary reconstruction without drainage may be routinely performed since the complications are only those not related to the T-tube.
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Affiliation(s)
- T Bacchella
- Transplante e Cirurgia do Fígade, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
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