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Perez RO, São Julião GP, Habr-Gama A, Kiss D, Proscurshim I, Campos FG, Gama-Rodrigues JJ, Cecconello I. The role of carcinoembriogenic antigen in predicting response and survival to neoadjuvant chemoradiotherapy for distal rectal cancer. Dis Colon Rectum 2009; 52:1137-43. [PMID: 19581858 DOI: 10.1007/dcr.0b013e31819ef76b] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [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: 12/14/2022]
Abstract
PURPOSE Carcinoembriogenic antigen (CEA) is the most frequently used tumor marker in rectal cancer. A decrease in carcinoembriogenic antigen after radical surgery is associated with survival in these patients. Neoadjuvant chemoradiotherapy may lead to significant primary tumor downstaging, including complete tumor regression in selected patients. Therefore, we hypothesized that a decrease in CEA after neoadjuvant chemoradiotherapy could reflect tumor response to chemoradiotherapy, affecting final disease stage and ultimately survival. METHODS Patients with distal rectal cancer managed by neoadjuvant chemoradiotherapy and available pretreatment and postchemoradiotherapy levels of CEA were eligible for the study. Outcomes studied included final disease stage, relapse, and survival, and these were compared according to initial CEA level, post-chemoradiotherapy CEA level, and the reduction in CEA. RESULTS Overall 170 patients were included. Post-chemoradiotherapy CEA levels <5 ng/ml were associated with increased rates of complete clinical response and pathologic response. Additionally, postchemoradiotherapy CEA levels <5 ng/ml were associated with increased overall and disease-free survival (P = 0.01 and P = 0.03). There was no correlation between initial CEA level or reduction in CEA and complete response or survival. CONCLUSION A postchemoradiotherapy CEA level <5 ng/ml is a favorable prognostic factor for rectal cancer and is associated with increased rates of earlier disease staging and complete tumor regression. Postchemoradiotherapy CEA levels may be useful in decision making for patients who may be candidates for alterative treatment strategies.
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Affiliation(s)
- Rodrigo O Perez
- Colorectal Surgery Division, University of São Paulo School of Medicine, Sao Paulo, Brazil.
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2
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Pajecki D, Zilberstein B, Cecconello I, Dos Santos MAA, Yagi OK, Gama-Rodrigues JJ. Larger amounts of nitrite and nitrate-reducing bacteria in megaesophagus of Chagas' disease than in controls. J Gastrointest Surg 2007; 11:199-203. [PMID: 17390173 DOI: 10.1007/s11605-006-0066-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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] [Indexed: 01/31/2023]
Abstract
In the megaesophagus of Chagas' disease, chronic esophagitis is caused by stasis of swallowed food and saliva. In this environment, the overgrowth of aerobic and anaerobic bacteria, including nitrate-reducing bacteria, is observed. The reduction of nitrate into nitrite by the action of these bacteria has been associated with the formation of volatile nitrosamines in different situations of gastric bacterial overgrowth. We have hypothesized that this phenomenon could occur in the esophageal lumen of patients with megaesophagus. To evaluate the concentration of nitrite, the presence of volatile nitrosamines and the concentration of nitrate-reducing bacteria in the esophageal lumen of patients with non-advanced megaesophagus of Chagas' disease and in a group of patients without esophageal disease. Fifteen patients with non-advanced megaesophagus [megaesophagus group (MG)] and 15 patients without any esophageal disease [control group (CG)] were studied. Saliva samples were taken for nitrate and nitrite quantitative determination and esophageal stasis liquid samples were taken for nitrate and nitrite quantitative determination, volatile nitrosamines qualitative determination and reductive bacteria quantitative determination. MG and CG were equivalent in nitrate and nitrite saliva concentration and in nitrate esophageal concentration. Significant difference was found in nitrite (p = 0.003) and reductive bacteria concentration (p < 0.0001), both higher in MG. Volatile nitrosamines were identified in three MG patients and in none of the CG patients, but this was not significant (p = 0.113). There is a higher concentration of reductive bacteria in MG, responsible for the rise in nitrite concentration at the esophageal lumen and, eventually, for the formation of volatile nitrosamines.
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Affiliation(s)
- D Pajecki
- Department of Gastroenterology, Surgical Division, University of Sao Paulo School of Medicine, Av 9 de julho 4440, Jd Paulista, Sao Paolo 01406-100, Brazil.
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3
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Andrade CG, Cecconello I, Nasi A, Zilberstein B, Filho JR, Campos Carvalho PJ, Donahue P, Gama-Rodrigues JJ. Lower esophageal sphincter analysis using computerized manometry in patients with chagasic megaesophagus. Dis Esophagus 2006; 19:31-5. [PMID: 16364041 DOI: 10.1111/j.1442-2050.2006.00534.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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] [Indexed: 12/11/2022]
Abstract
Due to the introduction of computer technology into manometry laboratories, three-dimensional manometric images of the lower esophageal sphincter can be constructed based on radially oriented pressures, a method termed 'computerized axial manometry.' Calculation of the sphincter pressure vector volume using this method is superior to standard manometric techniques in assessing lower esophageal sphincter function in patients with gastroesophageal reflux disease and idiopathic achalasia. Despite similarities between idiopathic achalasia and chagasic esophagopathy found using clinical, radiological, and manometric studies, controversy around lower esophageal sphincter pressure persists. The goal of this study was to analyze esophageal motor disorders in Chagas' megaesophagus using computerized axial manometry. Twenty patients with chagasic megaesophagus (5 men, 15 women, and average age 50.1 years, range 17-64) were prospectively studied. For three-dimensional imaging construction of the lower esophageal sphincter, a low-complacency perfusion system and an eight-channel manometry probe with four radial channels placed in the same level were used. For probe traction, the continuous pull-through technique was used. Results showed that the lower esophageal sphincter of patients with chagasic megaesophagus have significantly elevated pressure, length, asymmetry, and vector volumes compared to those of normal volunteers (P < 0.05). Aperistalsis of the esophageal body waves was observed in all patients and contraction amplitude was lower than that in normal patients. We conclude that patients with chagasic megaesophagus have hypertonic lower esophageal sphincter and aperistalsis of the esophageal body.
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Affiliation(s)
- C G Andrade
- Department Of Gastroenterology, University Of São Paulo Medical School, São Paulo, Brazil.
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4
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Artifon ELA, Sakai P, Hondo FY, Lopasso FP, Ishioka S, Gama-Rodrigues JJ. An evaluation of gastric scintigraphy pre- and postpyloroduodenal peptic stenosis dilation. Surg Endosc 2006; 20:243-8. [PMID: 16391961 DOI: 10.1007/s00464-005-0129-2] [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: 03/03/2005] [Accepted: 07/19/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND The usual treatment of pyloroduodenal peptic stenosis has been mainly surgical, through pyloroplasty or gastric resection, with or without vagotomy. Since the first description of treatment for this peptic complication by endoscopic balloon dilation perfomed by Benjamin in 1982 [2], this procedure has become a therapeutic option in association with the medical treatment of peptic disease. The aim of this study is to evaluate the results involving clinical, endoscopic, and gastric emptying scintigraphy parameters. METHODS Between August 1998 and February 2000, 20 patients with pyloroduodenal stenosis refractory to conservative treatment were treated at the Gastrointestinal Endoscopy Unit of the University of São Paulo Medical School. All patients who presented clinical manifestations of pyloroduodenal stenosis underwent upper gastrointestinal endoscopy to confirm peptic stenosis. Biopsy of the narrowing for the confirmation of a benign disease and gastric biopsy for Helicobacter pylori detection were performed. The treatment consisted of dilation of the stenosis with type TTS (Through The Scope) hydrostatic balloon under endoscopic control, treatment of Helicobacter pylori infection, and gastric acid suppression with oral administration of proton pump inhibitor. All patients, except one who was excluded from this study, were submitted to a clinical endoscopic assessment and gastric emptying evaluation by ingestion of (99m)Tc before and after the treatment. Endoscopic evaluation considered the diameter of the stenotic area before and after treatment. A scintigraphic study compared the time of gastric emptying before and after balloon dilation. RESULTS Nineteen patients completed treatment by hydrostatic balloon dilation. Clinical symptoms such as bloating (p < 0.0001), epigastric pain (p = 0.0159), gastric stasis (p < 0.0001), and weight gain (p = 0.036) showed significant improvement. The diameter of the stenotic area increased significantly (p < 0.01) after the dilation treatment as well as a better gastric emptying of (99m)Tc (p < 0.0001). CONCLUSION The dilation of the peptic pyloroduodenal stenosis using a hydrostatic balloon is a safe and effective procedure. The evaluation with gastric scintigraphy by ingestion of (99m)Tc is an effective method of assessment for the improvement of gastric function, because its results corresponded to the clinical improvement after endoscopic treatment.
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Affiliation(s)
- E L A Artifon
- Gastrointestinal Endoscopy Unit, University of São Paulo Medical School, São Paulo, Brazil.
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5
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Rosário MTA, Ribeiro U, Corbett CEP, Ozaki AC, Bresciani CC, Zilberstein B, Gama-Rodrigues JJ. Does CO2 pneumoperitoneum alter the ultra-structuture of the mesothelium? J Surg Res 2005; 133:84-8. [PMID: 16360175 DOI: 10.1016/j.jss.2005.09.032] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [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: 04/28/2005] [Revised: 08/19/2005] [Accepted: 09/26/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Pneumoperitoneum may be responsible for ultra-structural alterations in the mesothelium during laparoscopy. To characterize the effect of pneumoperitoneum on the mesothelial cells with CO(2) and compressed air; and to compare to laparotomy and control group (anesthesia only). MATERIALS AND METHODS Forty C-57 mice were divided in four groups of 10 animals each: CO(2), air, laparotomy, and control group. The animals were submitted to pneumoperitoneum at 8 mmHg during 30 min (CO(2) or compressed air). Five animals of each group were sacrificed 2 and 24 h after the procedure. Fragments of parietal peritoneum were collected and processed for scanning electron microscopy. RESULTS Control group revealed uninterrupted mesothelial cells, without any evidence of cellular limits; close contact between the cells; absence of intercellular clefts and presence of microvilli. In the laparotomy group, similar results to the control group, with decreased microvilli were noted. Air pneumoperitoneum was associated with alterations in the morphology of the mesothelial cells, clear cellular limits, and cells with spherical and fusiforme formats. CO(2) pneumoperitoneum showed mesothelial cells with clear cellular limits, predominantly spherical cellular format, and intercellular clefts that allowed the visualization of the exposed basal membrane. These alterations were more intense after 24 h. There was a statistical significance between CO(2) group (2 and 24 h) compared to the control group and laparotomy for cellular limits, intercellular clefts and microvilli, P < 0.0001. CONCLUSIONS Pneumoperitoneum causes damage in the mesothelial ultra-structure, which differs from the laparotomy group. CO(2) pneumoperitoneum is more harmful to the mesothelium than the air.
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Affiliation(s)
- Marcos T A Rosário
- Department of Gastroenterology, University of São Paulo, São Paulo, Brazil
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6
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Abstract
Achalasia, a poorly relaxing lower esophageal sphincter, produces a functional obstruction and the expected symptoms of dysphagia, regurgitation and eventually weight loss. The cause of achalasia remains largely unknown in Western countries, Chagas' disease being the most frequent etiology in Brazil. We report on two sets of monozygotic male twins with typical manifestations of achalasia. The majority of authors attribute a limited contribution unless achalasia is related to a multisystem disorder, like the triple-A or Allgrove's syndrome, an autosomal recessive disease characterized by the triad of adrenocorticotropic hormone (ACTH) resistant adrenal insufficiency, achalasia and alacrima. The four cases reported demonstrated the genetic influence of achalasia in patients without multisystem disorders. We believe that idiopathic achalasia is a syndrome with similar clinical, pathological, radiological and manometric evolution, but with a great variety of etiological agents, one of them being the congenital form.
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Affiliation(s)
- B Zilberstein
- Department of Gastroenterology, Hospital das Clínicas - University of São Paulo Medical School, Brazil.
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Sakai P, Kuga R, Safatle-Ribeiro AV, Faintuch J, Gama-Rodrigues JJ, Ishida RK, Furuya CK, Yamamoto H, Ishioka S. Is it feasible to reach the bypassed stomach after Roux-en-Y gastric bypass for morbid obesity? The use of the double-balloon enteroscope. Endoscopy 2005; 37:566-9. [PMID: 15933931 DOI: 10.1055/s-2005-861444] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.2] [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] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND STUDY AIMS Endoscopic evaluation of the excluded stomach after Roux-en-Y gastric bypass surgery for morbid obesity is a challenge, and the pathological changes that take place in the bypassed stomach are unclear. A new double-balloon method of evaluating the bypassed stomach after Roux-en-Y gastric bypass surgery for morbid obesity is described here. PATIENTS AND METHODS This new enteroscope uses two balloons, one attached to the tip of the endoscope and the other to the distal end of the soft overtube. The procedures were carried out in six patients using the retrograde route, through the end-to-side jejunal anastomosis via the duodenobiliopancreatic limb up to the bypassed stomach. RESULTS The bypassed stomach was reached in five of six patients (83.3 %). An endoscopic appearance of atrophic gastritis was found in three patients, mild in two cases and severe in one case with intestinal metaplasia. Erosive and hemorrhagic gastritis was found in two patients. CONCLUSIONS Endoscopic evaluation of the bypassed stomach via the retrograde route after Roux-en-Y gastric bypass for morbid obesity is feasible using the double-balloon enteroscope.
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Affiliation(s)
- P Sakai
- Endoscopy Unit, Dept. of Gastroenterology, São Paulo University Medical School, Hospital das Clinicas, São Paulo, Brazil.
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8
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Oliveira CPMS, Faintuch J, Rascovski A, Furuya CK, Bastos MDS, Matsuda M, Della Nina BI, Yahnosi K, Abdala DSP, Vezozzo DCP, Alves VAF, Zilberstein B, Garrido AB, Halpern A, Carrilho FJ, Gama-Rodrigues JJ. Lipid Peroxidation in Bariatric Candidates with Nonalcoholic Fatty Liver Disease (NAFLD) – Preliminary Findings. Obes Surg 2005; 15:502-5. [PMID: 15946429 DOI: 10.1381/0960892053723493] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [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: 11/08/2022]
Abstract
BACKGROUND Pathogenesis of nonalcoholic fatty liver disease (NAFLD) remains incompletely known, and oxidative stress is one of the mechanisms incriminated. The aim of this study was to evaluate the role of liver oxidative stress in NAFLD affecting morbidly obese patients. METHODS 39 consecutive patients with BMI >40 kg/m2 submitted to Roux-en-Y gastric bypass were enrolled, and wedge liver biopsy was obtained during operation. Oxidative stress was measured by concentration of hydroperoxides (CEOOH) in liver tissue. RESULTS Female gender was dominant (89.7%) and median age was 43.6 +/- 11.1 years. Histology showed fatty liver in 92.3%, including 43.6% with nonalcoholic steatohepatitis (NASH), 48.7% with isolated steatosis and just 7.7% with normal liver. Liver cirrhosis was present in 11.7% of those with nonalcoholic steatohepatitis. Concentration of CEOOH was increased in the liver of patients with NASH when compared to isolated steatosis and normal liver (0.26+/- 0.17, 0.20+/- 0.01 and 0.14+/- 0.00 nmol/mg protein, respectively) (P < 0.01). Liver biochemical variables were normal in 92.3% of all cases, and no difference between NASH and isolated steatosis could be demonstrated. CONCLUSIONS 1) Nonalcoholic steatosis, steatohepatitis and cirrhosis were identified in substantial numbers of morbidly obese patients; 2) Concentration of hydroperoxides was increased in steatohepatitis, consistent with a pathogenetic role for oxidative stress in this condition.
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Affiliation(s)
- Claudia P M S Oliveira
- Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
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9
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Abstract
BACKGROUND The appropriate extent of lymph node clearance during gastrectomy for cancer remains controversial. METHODS Medline, Embase, the Cochrane register and other databases were searched for studies reporting node dissection technique, 5 year survival and mortality after gastrectomy. Comparisons with systematic bias in treatment allocation and patients who received perioperative chemotherapy were excluded. Meta-analysis was performed separately for randomized and non-randomized comparisons. RESULTS Two randomized and two non-randomized comparisons of limited (D1) versus extended (D2) node dissection and 11 reports of one dissection type were analysed. For D2 the randomised trials showed no overall survival benefit (Risk ratio (RR) = 0.95, 95 per cent c.i. 0.83-1.09) and an increased postoperative mortality (RR = 2.23, c.i. 1.45-3.45), apparently related to pancreatico-splenectomy and surgical inexperience. A trend towards survival benefit for D2 was observed for T3+ tumours (RR = 0.68, c.i. 0.42-1.10). Non-randomized comparisons found no survival benefit for D2 (RR = 0.92, c.i. 0.83-1.02), but decreased postoperative mortality (RR = 0.65, c.i. 0.45-0.93). Nine observational studies of D2 reported better results than two studies of D1 surgery, but in very different settings. CONCLUSIONS Evidence for D2 dissection is inconclusive. No overall survival advantage has emerged, but some patients with intermediate stage disease may benefit. Excess operative mortality appears to be associated with pancreatico-splenectomy, low case volume and lack of specialist training.
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Affiliation(s)
- P McCulloch
- Academic Unit of Surgery, University Hospital Aintree, University of Liverpool, Liverpool, UK.
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Perez RO, Katayama FF, Bresciani C, Jacob CE, Coser RB, Alves PRA, Habr-Gama A, Gama-Rodrigues JJ, Kiss DR, Cimelli M. Aortoenteric fistula to the sigmoid colon—case report. ACTA ACUST UNITED AC 2005; 62:49-54. [PMID: 15708145 DOI: 10.1016/j.cursur.2004.06.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [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: 10/25/2022]
Abstract
Aortoenteric fistula is defined as a communication between the aorta and any adjacent segment of the bowel. It may be primary or secondary. The former occurs de novo in patients with intestinal or vascular diseases, whereas secondary aortoenteric fistula is a rare and dreadful complication of aortic reconstruction with vascular prosthesis. We report a case of a 62-year-old man who presented to the emergency department with acute rectal bleeding. The patient had previous aortoiliac surgery with the utilization of an aorto-bifemoral vascular graft. Diagnosis of secondary aortoenteric fistula was made between the aortoiliac graft and sigmoid colon. After exploratory laparotomy, Hartmann's procedure, excision of the graft, oversewing of the aortic stump, and axilobifemoral bypass were successfully performed. This study reports a rare type of secondary aortoenteric fistula to the left colon, and it describes an unusual and successful surgical treatment.
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Affiliation(s)
- Rodrigo O Perez
- Colorectal Surgery Division, Department of Gastroenterology, School of Medicine, University of São Paulo, São Paulo, Brazil
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Beer I, de Cleva R, Faintuch J, Matsuda M, Zilberstein B, Gama-rodrigues J. Crit Care 2005; 9:P121. [DOI: 10.1186/cc3665] [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: 11/10/2022] Open
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Chaves DM, Ishioka S, Félix VN, Sakai P, Gama-Rodrigues JJ. Removal of a foreign body from the upper gastrointestinal tract with a flexible endoscope: a prospective study. Endoscopy 2004; 36:887-92. [PMID: 15452785 DOI: 10.1055/s-2004-825856] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.2] [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] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND STUDY AIMS There have so far been no prospective studies on the value of flexible endoscopy for removing foreign bodies in the upper gastrointestinal tract. This study presents a clinical analysis of accidents with foreign bodies and prospectively evaluates the effectiveness of flexible endoscopy for removing them. PATIENTS AND METHODS A total of 105 cases of foreign-body ingestion in the upper gastrointestinal tract were evaluated, 29 (27.6 %) in children and 76 (72.4 %) in adults. Thirty patients (28.5 %) had esophageal strictures. RESULTS Thirty-nine of the foreign bodies (37.1 %) consisted of food and 66 (62.9 %) were not food-related. The success rate of foreign-body extraction using only a conventional flexible endoscope and accessories for treatment was 98.0 %, and with only a polypectomy snare and rat-toothed forceps it was 91.2 %. Complications at the moment of foreign-body removal occurred in nine patients (8.6 %); there was only one (1 %) esophageal perforation. The incidence of complications related to the duration of foreign-body impaction was six (10.5 %) with foreign bodies impacted for up to 24 h, 13 (52.0 %) for those impacted for 24-48 h, and three (60.0 %) for those impacted for 48-72 h ( P < 0.05). CONCLUSIONS The flexible endoscope is an effective and safe device for removing foreign bodies from the upper gastrointestinal tract, with a high success rate using only the polypectomy snare and the rat-toothed forceps as accessories. If foreign-body impaction lasts for more than 24 h, there is a significant increase in the incidence of complications.
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Affiliation(s)
- D M Chaves
- Endoscopy Service, University of São Paulo School of Medicine, São Paulo, Brazil.
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Abstract
UNLABELLED Inactivation of tumor suppressor genes has been frequently observed in gastric carcinogenesis. Our purpose was to study the involvement of p53, APC, DCC, and Rb genes in gastric carcinoma. METHOD Loss of heterozygosity of the p53, APC, DCC and Rb genes was studied in 22 gastric cancer tissues using polymerase chain reaction; single-strand conformation polymorphism of the p53 gene exons 5-6 and exons 7-8 was studied using 35S-dATP, and p53 expression was detected using a histological immunoperoxidase method with an anti-p53 clone. RESULTS AND DISCUSSION No loss of heterozygosity was observed in any of these tumor suppressor genes; homozygous deletion was detected in the Rb gene in 23% (3/13) of the cases of intestinal-type gastric carcinoma. Eighteen (81.8%) cases showed band mobility shifts in exons 5-6 and/or 7-8 of the p53 gene. The presence of the p53 protein was positive in gastric cancer cells in 14 cases (63.6%). Normal gastric mucosa showed negative staining for p53; thus, the immunoreactivity was likely to represent mutant forms. The correlation of band mobility shift and the immunoreactivity to anti-p53 was not significant (P =.90). There was no correlation of gene alterations with the disease severity. CONCLUSIONS The inactivation of Rb and p53 genes is involved in gastric carcinogenesis in our environment. Loss of the Rb gene observed only in the intestinal-type gastric cancer should be further evaluated in association with Helicobacter pylori infection. The p53 gene was affected in both intestinal and diffuse histological types of gastric cancer.
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Affiliation(s)
- Rejane Mattar
- Department of Gastroenterology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil.
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15
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Pinotti AC, Cecconello I, Filho FM, Sakai P, Gama-Rodrigues JJ, Pinotti HW. Endoscopic ablation of Barrett's esophagus using argon plasma coagulation: a prospective study after fundoplication. Dis Esophagus 2004; 17:243-6. [PMID: 15361098 DOI: 10.1111/j.1442-2050.2004.00415.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [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] [Indexed: 12/11/2022]
Abstract
The aim of the prospective clinical study presented here is to test the effectiveness of a multimode approach consisting of argon plasma coagulation combined with laparoscopic fundoplication in the management of Barrett's esophagus. Argon plasma coagulation was performed in 19 patients with Barrett's esophagus who had previously undergone surgical antireflux treatment. The mean follow-up time was 17 months, ranging between 6 and 27 months. Squamous epithelium was completely restored in all patients. In 68.4% of cases two sessions were required. The most frequent complications were chest discomfort and retrosternal pain. In 11 patients the symptoms lasted 3 days and in six cases persisted for a longer period, requiring analgesic medication. Short-term dysphagia and odynophagia were observed in four patients.
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Affiliation(s)
- A C Pinotti
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
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16
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Perez RO, Bresciani C, Jacob CE, Perez CG, Coser RB, Honda LFK, Gama-Rodrigues JJ. Negative pressure post-extubation pulmonary edema complicating appendectomy in a young patient: Case report. ACTA ACUST UNITED AC 2004; 61:463-5. [PMID: 15475096 DOI: 10.1016/j.cursur.2004.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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
Negative-pressure pulmonary edema after endotracheal intubation is an uncommon and potentially serious complication of patients undergoing general anesthesia for different surgical procedures. We report a case of a healthy 20-year-old male patient with the diagnosis of acute appendicitis. The patient was submitted to appendectomy under general anesthesia and developed negative-pressure pulmonary edema immediately after extubation. The present paper reports this potentially serious complication illustrating the main radiological findings consistent with alveolar hemorrhage in this setting and the treatment performed.
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Affiliation(s)
- Rodrigo O Perez
- Colorectal Surgery Division, Department of Gastroenterology, School of Medicine, University of São Paulo, São Paulo, Brazil.
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17
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Abstract
BACKGROUND Serious nutritional complications after Roux-en-Y gastric bypass (RYGBP) are infrequent. In a retrospective study of patients operated during a 68-month period, malnutrition was investigated to analyze circumstances associated with nutritional failure. METHODS In 236 consecutive RYGBPs, 11 patients with severe malnutrition were identified (4.7%) with age 45.1 +/- 10.6 years (10 females/1 male) and initial BMI 54.6 +/- 8.4 kg/m(2). RESULTS In these 11 patients, the derangement was diagnosed 17.9 +/- 15.8 months after RYGBP, following defined events in 63.6% (gastric stenosis, associated diseases ) or mostly exaggeration of expected symptoms in 36.4% (vomiting without endoscopic abnormalities). BMI then was 31.4 +/- 8.6 kg/m(2) (42.5 +/- 9.9% total reduction, or 2.4 +/- 2.1% decrease/month), and serum albumin and hemoglobin were 24.0 +/- 8.2 g/L and 97.0 +/- 23.0 g/L respectively. Edema was present in 45.4% (5/11), hospitalization was required in 54.5% (6/11), and 18.2% (2/11) eventually died. CONCLUSIONS Serious malnutrition was unusual but not exceedingly rare in this series. Exogenous precipitating factors were clearly identified in 63.6% of the patients. Careful clinical and nutritional follow-up is recommended to prevent these uncommon but potentially dangerous complications.
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Affiliation(s)
- Joel Faintuch
- Obesity Group, Hospital das Clínicas, São Paulo, SP, Brazil.
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Teixeira MG, Perini MV, Marques CFS, Habr-Gama A, Kiss D, Gama-Rodrigues JJ. Blue rubber bleb nevus syndrome: case report. Rev Hosp Clin Fac Med Sao Paulo 2003; 58:109-12. [PMID: 12845364 DOI: 10.1590/s0041-87812003000200009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The case of a patient with blue rubber bleb nevus syndrome who is infected by acquired immunodeficiency syndrome virus due to multiple blood transfusions is presented. This case shows that although it is a rare systemic disorder, blue rubber bleb nevus syndrome has to be considered in the differential diagnosis of chronic anemia or gastrointestinal bleeding. Patients should be investigated by endoscopy, which is the most reliable method for detecting these lesions. The patient underwent gastroscopy and enteroscopy via enterotomy with identification of all lesions. Minimal resection of the larger lesions and string-purse suture of the smaller ones involving all the layers of the intestine were performed. The string-purse suture of the lesions detected by enteroscopy proved to be an effective technique for handling these lesions, avoiding extensive intestinal resection and stopping the bleeding. Effective management of these patients demands aggressive treatment and should be initiated as soon as possible to avoid risks involved in blood transfusions, as occurred in this case.
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Affiliation(s)
- Magaly Gemio Teixeira
- Department of Gastroenterology, Division of Gastrosurgery and Coloproctology, Hospital das Clînicas, Faculty of Medicine, University of São Paulo, Brazil
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Machado MM, Rosa ACF, Barros ND, Pugliese V, Herman P, Saad WA, Machado MC, Cerri LMDO, Gama-Rodrigues JJ, Habr-Gama A, Cerri GG. História da ultra-sonografia intra-operatória. Radiol Bras 2002. [DOI: 10.1590/s0100-39842002000600008] [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
A ultra-sonografia intra-operatória foi realizada especialmente a partir de 1960, com alguns relatos de experiências iniciais nos anos 50. Inicialmente foram avaliados tumores cerebrais, posteriormente estudando-se também cálculos de vias biliares e cálculos renais. Entretanto, a ultra-sonografia intra-operatória em modo A ou modo B estático não adquiriu grande aceitação no meio médico. Não obstante, os primeiros estudos forneceram as bases para o desenvolvimento da moderna ultra-sonografia intra-operatória, com a utilização dos equipamentos ultra-sonográficos em modo B em tempo real. Os autores discorrem sobre a utilização da ultra-sonografia intra-operatória desde o seu início até os dias atuais.
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Abstract
Exogenous agents correlated with hepatocellular carcinoma (HCC) have been identified and well characterized. These agents, including the different viruses that cause chronic hepatitis and cirrhosis, can lead to regenerative nodules and dysplastic nodules/adenomatous hyperplasia. These conditions associated with several molecular alterations of hepatocyte ultimately culminate in hepatocellular carcinoma. Recently, there has been a great progress in the identification of somatic and germinative mutations that may be correlated with the development of HCC, justifying a review on the subject. Hence, the factors involved in the process of hepatic carcinogenesis, such as infection by the hepatitis B and C viruses, with a special focus in the molecular alterations described in recent years are discussed herein, pointing out areas potentially relevant for clinical development.
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Affiliation(s)
- Marcelo Eidi Nita
- Discipline of Clinical Gastroenterology, Department of Gastroenterology, School of Medicine, University of São Paulo, São Paulo, SP, Brazil.
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21
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de Oliveira IR, Widman A, Fukushima JT, Saad WA, Gama-Rodrigues JJ, Cerri GG. [Doppler ultrasonography evaluation of paraumbilical vein and portal hypertension]. J Radiol 2001; 82:1627-31. [PMID: 11894548] [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] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
UNLABELLED Portal hypertension is associated to the development of portosystemic collateral veins, particularly the paraumbilical vein. PURPOSE To evaluate the biometric and hemodynamic characteristics of the portal vessels related to the presence of a patent paraumbilical vein, in the setting of portal hypertension secondary to hepatosplenic schistosomiasis. METHODS 75 patients with portal hypertension secondary to hepatosplenic schistosomiasis were evaluated by Doppler US. The patients were studied based on the presence (group B) or not (Group A) of a patent paraumbilical vein. The diameter and blood flow velocity of the portal vessels and of the paraumbilical vein were recorded. RESULTS The paraumbilical vein was detected in 17.33% of patients. The results showed an increase of the diameter of the main and left portal vessels whenever a patent paraumbilical vein was present (portal vein: A = 1.14 +/- 0.29 cm/B = 1.33 +/- 0.16 cm; left branch: A = 0.95 +/- 0.25 cm/B = 1.30 +/- 0.24 cm). The mean blood flow velocity was also increased in the portal trunk (A = 15.96 +/- 6.17 cm/sec/B = 19.82 +/- 6.26 cm/sec) and in the left portal branch (A = 14.77 +/- 4.29 cm/sec/B = 19.92 +/- 6.88 cm/sec). CONCLUSION The presence of a patent paraumbilical vein is related to significant biometric and hemodynamic variations in the portal venous system, in the setting of portal hypertension secondary to hepatosplenic schistosomiasis.
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Affiliation(s)
- I R de Oliveira
- Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
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22
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Nasi A, Filho JP, Zilberstein B, Cecconello I, Gama-Rodrigues JJ, Pinotti HW. Gastroesophageal reflux disease: clinical, endoscopic, and intraluminal esophageal pH monitoring evaluation. Dis Esophagus 2001; 14:41-9. [PMID: 11422305 DOI: 10.1111/j.1442-2050.2001.00130.x] [Citation(s) in RCA: 13] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
One hundred and twenty-two patients with gastroesophageal reflux disease were studied (90 with and 32 without esophagitis) with the objective of analyzing possible differences between those with and without esophagitis. Evaluation consisted of clinical interview, endoscopy of the high digestive tract, esophageal manometry, and pH monitoring. There was no significant difference between the groups in age, sex, or symptoms. The incidence of hiatal hernia was greater in the group with esophagitis. Although the frequency of motor changes was similar, the type of anomaly was different. The reflux pattern was very similar in both groups. Therefore, the concept of reflux disease, esophagitis, and pathological reflux still needs a broader definition for greater diagnostic precision and for comparing the results of different studies on the subject. Normal reflux (confirmed using pH esophageal monitoring) in 12.2% of patients with esophagitis suggests that other factors are implicated in the etiology of the disease besides those measured using this examination.
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Affiliation(s)
- A Nasi
- University of São Paulo Medical School, Department of Gastroenterology, São Paulo, Brazil.
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23
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Fahey MT, Hamada GS, Nishimoto IN, Kowalski LP, Iriya K, Gama-Rodrigues JJ, Tsugane S. Ethnic differences in serum pepsinogen levels among Japanese and non-Japanese Brazilian gastric cancer patients and controls. Cancer Detect Prev 2001; 24:564-71. [PMID: 11198270] [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] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
A low level of serum pepsinogen I (Pg I) is a risk factor for gastric cancer (GC); low levels of Pg I and the pepsinogen ratio (Pg I:Pg II) are correlated with chronic atrophic gastritis. We report serum Pg levels and compare the degree of association with GC among Japanese and non-Japanese Brazilians. Sera were cross-sectionally ascertained from 93 Japanese Brazilian patients category matched by age and sex with 110 controls, and 228 non-Japanese Brazilian patients individually matched by age and sex with one control. Among non-Japanese Brazilians, GC was associated with a Pg I level <30 ng/ml (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.7-3.8) and a Pg I:Pg II ratio < 3.0 (OR, 3.4; 95% CI, 2.2-5.3). However, among Japanese Brazilians, the association was present with a level of Pg I < 30 ng/ml (OR, 3.5; 95% CI, 1.9-6.3), and was weak with a Pg I:Pg II ratio < 3.0 (OR, 1.3; 95% CI, 0.73-2.4). Serum Pg I may be preferred to the Pg I:Pg II ratio to study the association between Pg and GC among Japanese Brazilians.
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Affiliation(s)
- M T Fahey
- Epidemiology and Biostatistics Division, National Cancer Center Research Institute East, Japan
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Abstract
Refeeding syndrome encompasses fluid and electrolyte imbalances and metabolic, intestinal, and cardiorespiratory derangements associated with appreciable morbidity and mortality. Although refeeding syndrome has been well documented in concentration-camp subjects, and more recently during parenteral therapy of critically ill patients, little is known about the importance of refeeding syndrome during recovery from a hunger strike. Thus, we studied the response to a four-step dietary replenishment routine in eight hunger strikers who refused food for 43 d. In this retrospective, observational study, we assessed the safety and efficacy of the refeeding procedure and analyzed the clinical and nutritional course of the cohort during both starvation and refeeding, mainly on the basis of clinical as well as a few biochemical determinations. During starvation, average weight loss was about 18% and, with the exception of occasional oral vitamins and electrolytes, the subjects consumed only water. Available body-composition and biochemical profiles showed no clinically significant changes during starvation, but one-half of the group displayed spontaneous diarrhea at some time before refeeding. Stepwise nutritional replenishment lasted for 9 d, after which all patients tolerated a full, unrestricted diet. Only one episode of diarrhea occurred during this phase, and both clinical and biochemical indexes confirmed a favorable clinical course, without any manifestation of refeeding syndrome. In conclusion, we observed the following: 1) Hypophosphatemia and other micronutrient imbalances did not occur, nor was macronutrient intolerance detected. 2) Despite some episodes of diarrhea, nutritional replenishment was not associated with significant enteral dysfunction. 3) There was some fluid retention, but this was mild. 4) Acute-phase markers were abnormally elevated during the refeeding phase, without associated sepsis or inflammation.
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Affiliation(s)
- J Faintuch
- Nutrition Group and Department of Emergency Medicine, Hospital das Clinicas, São Paulo, Brazil.
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25
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Gama-Rodrigues JJ, Silva JH, Aisaka AA, Jureidini R, Falci R, Maluf Filho F, Chong AK, Tsai AW, Bresciani C. Intestinal intussusception and occlusion caused by small bowel polyps in the Peutz-Jeghers syndrome. Management by combined intraoperative enteroscopy and resection through minimal enterostomy: case report. Rev Hosp Clin Fac Med Sao Paulo 2000; 55:219-24. [PMID: 11313662 DOI: 10.1590/s0041-87812000000600005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
UNLABELLED The Peutz-Jeghers syndrome is a hereditary disease that requires frequent endoscopic and surgical intervention, leading to secondary complications such as short bowel syndrome. CASE REPORT This paper reports on a 15-year-old male patient with a family history of the disease, who underwent surgery for treatment of an intestinal occlusion due to a small intestine intussusception. DISCUSSION An intra-operative fiberscopic procedure was included for the detection and treatment of numerous polyps distributed along the small intestine. Enterotomy was performed to treat only the larger polyps, therefore limiting the intestinal resection to smaller segments. The postoperative follow-up was uneventful. CONCLUSION We point out the importance of conservative treatment for patients with this syndrome, especially those who will undergo repeated surgical interventions because of clinical manifestation while they are still young.
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Affiliation(s)
- J J Gama-Rodrigues
- Department of Gastroenterology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo
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26
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Faintuch J, Soriano FG, Ladeira JP, Janiszewski M, Velasco IT, Gama-Rodrigues JJ. Changes in body fluid and energy compartments during prolonged hunger strike. Rev Hosp Clin Fac Med Sao Paulo 2000; 55:47-54. [PMID: 10959123 DOI: 10.1590/s0041-87812000000200003] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
UNLABELLED Prolonged total food deprivation in non-obese adults is rare, and few studies have documented body composition changes in this setting. In a group of eight hunger strikers who refused alimentation for 43 days, water and energy compartments were estimated, aiming to assess the impact of progressive starvation. Measurements included body mass index (BMI), triceps skinfold (TSF), arm muscle circumference (AMC), and bioimpedance (BIA) determinations of water, fat, lean body mass (LBM), and total resistance. Indirect calorimetry was also performed in one occasion. The age of the group was 43.3+/-6.2 years (seven males, one female). Only water, intermittent vitamins and electrolytes were ingested, and average weight loss reached 17.9%. On the last two days of the fast (43rd-44th day) rapid intravenous fluid, electrolyte, and vitamin replenishment were provided before proceeding with realimentation. Body fat decreased approximately 60% (BIA and TSF), whereas BMI reduced only 18%. Initial fat was estimated by BIA as 52.2+/-5.4% of body weight, and even on the 43rd day it was still measured as 19.7+/-3.8% of weight. TSF findings were much lower and commensurate with other anthropometric results. Water was comparatively low with high total resistance, and these findings rapidly reversed upon the intravenous rapid hydration. At the end of the starvation period, BMI (21.5+/-2.6 kg/m2) and most anthropometric determinations were still acceptable, suggesting efficient energy and muscle conservation. CONCLUSIONS 1) All compartments diminished during fasting, but body fat was by far the most affected; 2) Total water was low and total body resistance comparatively elevated, but these findings rapidly reversed upon rehydration; 3) Exaggerated fat percentage estimates from BIA tests and simultaneous increase in lean body mass estimates suggested that this method was inappropriate for assessing energy compartments in the studied population; 4) Patients were not morphologically malnourished after 43 days of fasting; however, the prognostic impact of other impairments was not considered in this analysis.
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Affiliation(s)
- J Faintuch
- Department of Emergency Medicine, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, Brazil
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Faintuch S, de Cleva R, Faintuch J, Gama-Rodrigues JJ. Increased intestinal permeability after upper gastrointestinal surgery during enteral nutrition. JPEN J Parenter Enteral Nutr 2000; 24:49-50. [PMID: 10638472 DOI: 10.1177/014860710002400149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Affiliation(s)
- M Perosa
- Hospital Beneficência Portuguesa de São Paulo, Brasil
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Bresciani C, Borges PC, Gama-Rodrigues JJ, Yamashita R, Marques CF, Strassmann V, Pinotti HW. Fatal pulmonary thromboembolism in gastrectomy intraoperative procedures by gastric adenocarcinoma: case report. Rev Hosp Clin Fac Med Sao Paulo 1999; 54:115-20. [PMID: 10779818 DOI: 10.1590/s0041-87811999000400003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The case of a patient with gastric adenocarcinoma with indication for gastrectomy is reported. The surgery took place without complications. A palliative, subtotal gastrectomy was performed after para-aortic lymph nodes compromised by neoplasm were found, which was confirmed by pathological exam of frozen sections carried out during the intervention. At the end of the gastroenteroanastomosis procedure, the patient began to show intense bradycardia: 38 beats per minute (bpm), arterial hypotension, changes in the electrocardiogram's waveform (upper unlevelling of segment ST), and cardiac arrest. Resuscitation maneuvers were performed with temporary success. Subsequently, the patient had another circulatory breakdown and again was recovered. Finally, the third cardiac arrest proved to be irreversible, and the intra-operative death occurred. Necropsy showed massive pulmonary embolism. The medical literature has recommended heparinization of patients, in an attempt to avoid pulmonary thromboembolism following major surgical interventions. However, in the present case, heparinization would have been insufficient to prevent death. This case indicates that it is necessary to develop preoperative propedeutics for diagnosing the presence of venous thrombi with potential to migrate, causing pulmonary thromboembolism (PTE). If such thrombi could be detected, preventative measures, such as filter installation in the Cava vein could be undertaken.
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Affiliation(s)
- C Bresciani
- Clinical Surgery Division, Medical School, University of São Paulo, São Paulo, SP, Brazil
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Safatle-Ribeiro AV, Ribeiro Júnior U, Habr-Gama A, Gama-Rodrigues JJ. Double pylorus: case report and review of the literature. Rev Hosp Clin Fac Med Sao Paulo 1999; 54:131-4. [PMID: 10779821 DOI: 10.1590/s0041-87811999000400006] [Citation(s) in RCA: 14] [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] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Double pylorus is an unusual condition in which a double communication between the gastric antrum and the duodenal bulb occurs. It may be congenital, or it may be acquired complication of peptic ulcer disease. We present a case of double pylorus in a gentleman with epigastric pain and previous history of peptic ulcer disease. The relationship between Helicobacter pylori and this disease was assessed. A review of the literature, the role of associated diseases and the role of H. pylori are discussed.
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Affiliation(s)
- A V Safatle-Ribeiro
- Clínica Cirúrgica do Aparelho Digestivo da Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
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Faintuch J, Leme RB, Cruz ME, Lima AM, Giannella Neto D, Gama-Rodrigues JJ. Low blood glucose levels and other complications during growth hormone supplementation in sepsis. Rev Hosp Clin Fac Med Sao Paulo 1999; 54:135-8. [PMID: 10779822 DOI: 10.1590/s0041-87811999000400007] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Blood glucose levels in the high normal range or even moderate hyperglycemia is the expected profile in septic postoperative patients receiving high-calorie enteral alimentation. The addition of growth hormone as an anabolic agent should additionally reinforce this tendency. In a cancer patient undergoing partial gastrectomy with lymphadenectomy and suffering from postoperative subphrenic abscess and prolonged sepsis, tube feeding (38.3 kcal/kg/day) and growth hormone (0.17 IU/kg/day) were simultaneously administered for 25 days. Blood glucose levels were in the lower limits of the normal range before growth hormone introduction, and continued with a similar tendency during most of the therapeutic period. Two additional complications, namely heart arrest and peripheral edema, were documented during the same period. It is concluded that sepsis was the most likely mechanism for low glucose values, and that high-calorie enteral diet and growth hormone supplementation did not prevent that result. It is uncertain whether heart arrest was due to the drug, but its association with peripheral edema is well documented in clinical series.
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Affiliation(s)
- J Faintuch
- Nutrition Group, Department of Gastroenterology, Hospital das Clínicas, São Paulo, SP, Brazil
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32
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Okumura M, Pinto PL, Takami R, Nunes EV, Guilherme CS, Oliveira Júnior OC, Gama-Rodrigues JJ, Iriya K. Cytokine-like substance: origin and fate in Chagas' disease a new hypothesis about the local inflammatory reaction etiopathogenesis (experimental study in white mice). Rev Hosp Clin Fac Med Sao Paulo 1999; 54:73-4. [PMID: 10668275 DOI: 10.1590/s0041-87811999000300001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Scremin LH, Corbett CE, Laurenti MD, Nunes EV, Gama-Rodrigues JJ, Okumura M. Megabladder in experimental Chagas disease: pathological features of the bladder wall. Rev Hosp Clin Fac Med Sao Paulo 1999; 54:43-6. [PMID: 10513065 DOI: 10.1590/s0041-87811999000200003] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Mega-organs, primarily in the digestive tract, are well known to occur in chronic Chagas disease. Acute experimental infection with Trypanosoma cruzi results in parasitism of a wide range of cells, tissues, and organs, including the urinary bladder. Infection of BALB/c mice with 100,000 bloodstream forms of the Y strain of T. cruzi induced acute infection with intense parasitism of all layers of the urinary bladder. Parasites were found in the mucosa, lamina propria, muscular, adventitial connective, and fat tissue. Desquamate epithelial cells with amastigotes in the bladder lumen were also found. After 60 days of infection, mice inoculated with 50 bloodstream forms developed dilated, thin-walled bladders that had inflammatory infiltrates and foci of fibrosis replacing areas of damaged muscular layer. These lesions result from direct damage to the muscle fibers by the T. cruzi, leading to myosites, muscle damage, and scarring. Direct damage of paraganglia cells secondary to parasitism, leading to dilatation, damage of muscle fibers, and scarring with replacement of muscular tissue with connective tissue, should also be considered as a cause of functional disturbance of the urinary bladder.
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Affiliation(s)
- L H Scremin
- Infectious Diseases Pathology Laboratory, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
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Ribeiro U, Safatle-Ribeiro AV, Habr-Gama A, Gama-Rodrigues JJ, Sohn J, Reynolds JC. Effect of Chagas' disease on nitric oxide-containing neurons in severely affected and unaffected intestine. Dis Colon Rectum 1998; 41:1411-7. [PMID: 9823808 DOI: 10.1007/bf02237058] [Citation(s) in RCA: 21] [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] [Indexed: 02/08/2023]
Abstract
PURPOSE The pathophysiology of Chagas' disease is incompletely understood. Neuronal nitric oxide has been cited as a candidate neurotransmitter responsible for relaxation of the internal anal sphincter. Neuronal nicotinamide adenine dinucleotide phosphate diaphorase can be used as a marker for neuronal nitric oxide synthase. This study was designed to examine the alterations of the nitric oxide-containing neurons in the enteric nervous system of the colon of patients who underwent resections for advanced megacolon and to compare these specimens with small-bowel specimens from the same patients and with specimens from control subjects. METHODS Specimens from resected rectum and extramucosal small-bowel biopsy specimens from 11 patients with Chagas megacolon but no apparent small-bowel clinical involvement were compared with the uninvolved colon and jejunum of 10 control patients with colon cancer. Tissues were fixed in Zamboni solution and evaluated by histochemistry for nicotinamide adenine dinucleotide phosphate diaphorase-containing neurons. Reactivity was evaluated on a 0 to 4 scale in the longitudinal muscle, myenteric plexus, circular muscle, submucosal plexus, and mucosa. RESULTS Specimens from control patients showed well-stained myenteric and submucosal neurons and an abundant network of terminal nerve fibers in the muscle layers. Chagasic specimens had decreased staining in all layers of the gut. Overall there was a statistically significant decrease in nicotinamide adenine dinucleotide phosphate diaphorase-containing neurons. Biopsy specimens from clinically uninvolved small bowel of patients with Chagas' disease also showed decreased reactivity, but to a lesser degree. CONCLUSIONS Nicotinamide adenine dinucleotide phosphate diaphorase activity is decreased in patients with advanced megacolon. The alterations are more relevant in the myenteric plexus and the circular muscle. Reactivity is also diminished in the clinically uninvolved small bowel, but to a lesser extent.
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Affiliation(s)
- U Ribeiro
- Department of Surgery, University of Pittsburgh, Pennsylvania, USA
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35
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Okumura M, Pinto PL, Nunes EV, Guilherme CS, Gama-Rodrigues JJ, Amato Neto V, Corbett CE. Young forms of Trypanosoma cruzi in the circulation of experimentally infected mice. Rev Hosp Clin Fac Med Sao Paulo 1998; 53:275-6. [PMID: 10413940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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36
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Ribeiro U, Gama-Rodrigues JJ, Safatle-Ribeiro AV, Bitelman B, Ibrahim RE, Ferreira MB, Laudanna AA, Pinotti HW. Prognostic significance of intraperitoneal free cancer cells obtained by laparoscopic peritoneal lavage in patients with gastric cancer. J Gastrointest Surg 1998; 2:244-9. [PMID: 9841981 DOI: 10.1016/s1091-255x(98)80019-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [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] [Indexed: 02/09/2023]
Abstract
Laparoscopy is a safe and useful method for examining the local extent and regional spread of disease in patients with gastric cancer. Peritoneal dissemination remains a frequent type of recurrence after surgical treatment. The aim of this study was to determine the prognostic value of intraperitoneal free cancer cells (IFCCs) detected by laparoscopic peritoneal lavage. Forty-nine patients with advanced gastric cancer underwent laparoscopy with cytologic examination for staging. Peritoneal lavage was performed when ascites was not present. Aspirated fluid from the peritoneal cavity was centrifuged and subjected to cytologic examination using Giemsa and Papanicolaou staining methods. Patients were surgically treated and followed for a minimum of 5 years. IFCCs were detected in 41% of the patients. In eight cases (16.3%) laparoscopy revealed carcinomatosis and/or multiple liver metastases, so laparotomy was not performed. Patterns of recurrence after curative resection included the following: peritoneal (n = 3), local (n = 4), liver (n = 1), and other (n = 1). All patients who tested positive for IFCCs had peritoneal recurrence. The absence of IFCCs was associated with improved overall survival (21 months for a 95% confidence interval of 7.4 to 34.6 vs. 4 months for a 95% confidence interval of 2.4 to 5.6). Overall survival adjusted for type of resection also demonstrated a favorable outcome for patients who were negative for IFCCs. The following conclusions were drawn: (1) laparoscopic peritoneal lavage cytology may be useful in identifying patients at high risk for peritoneal relapses and may alter treatment, and (2) lFCCs provide additional prognostic information in patients with gastric cancer.
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Affiliation(s)
- U Ribeiro
- Department of Gastroenterology, University of São Paulo, São Paulo, Brazil.
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37
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Ribeiro U, Gama-Rodrigues JJ, Bitelman B, Ibrahim RE, Safatle-Ribeiro AV, Laudanna AA, Pinotti HW. Value of peritoneal lavage cytology during laparoscopic staging of patients with gastric carcinoma. Surg Laparosc Endosc Percutan Tech 1998; 8:132-5. [PMID: 9566568] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Forty-nine consecutive patients with advanced gastric carcinoma underwent preoperative staging by laparoscopy between June 1991 and June 1992. Peritoneal lavage with cytologic examination was performed when ascites was not present. In eight cases (16.3%), laparoscopy revealed carcinomatosis and/or multiple hepatic metastases, so laparotomy was not performed. Intraperitoneal free cancer cells (IFCCs) were detected in 41% of patients (65% in patients with ascites and 28% by peritoneal lavage). In the absence of macroscopic peritoneal dissemination, IFCCs were encountered in 29% of patients. IFCCs were present only when invasion of the gastric serosa was >3 cm2 or when adjacent organs and structures were already invaded. Mucinous adenocarcinoma, Borrmann class IV tumors, and Stage IV patients had higher incidence of IFCCs. Cytologic results were similar at laparoscopy and laparotomy (p > 0.05). Therefore, cytologic evaluation of peritoneal lavage added sensitivity to laparoscopy in assessing patients with advanced gastric carcinoma and may alter their therapeutic approach.
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Affiliation(s)
- U Ribeiro
- Department of Gastroenterology, University of São Paulo, Brazil
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Corbett CE, Laurenti MD, Nunes EV, Gama-Rodrigues JJ, Okumura M. Cytokines and Chagas disease in mice. Rev Hosp Clin Fac Med Sao Paulo 1998; 53:1-2. [PMID: 9659734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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39
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Guimarães AC, Kawarabayashi M, Nunes EV, Ferraz SN, Chiosini CB, Tolezano JE, Gama-Rodrigues JJ, Okumura M. Experimental toxoplasmosis, and immunosuppression (parasite evaluation and histological alterations). Rev Hosp Clin Fac Med Sao Paulo 1997; 52:316-20. [PMID: 9629741] [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] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
With the purpose of studying immunosuppressant drug action on parasites, the effect of Cyclosporine and cortisone in experimental toxoplasma evaluation, a highly virulent strain of Toxoplasma gondii (RH strain) was used. The animals were divided in two groups: control and immunosuppressed. Two animals from each group were sacrificed daily. Evaluation was based on parasitemia and parasitism of peritoneal exsudate and presence of the parasite in heart, lung, liver, spleen, small bowel, brain, cerebellum, spinal cord and eyes. Parasite infestation in peritoneal exsudate was 10 times greater than parasitemia. Red spots were observed after the second day; after the fourth day, focal necrosis with softening and fluidification of brain tissue spattered throughout the nervous tissue with enhanced vascularization. Capillaries obstructed by Toxoplasmas gondii were found, causing infarction and necrosis due to toxic or enzymatic substances. Images suggestive of cells an "owl-eye", Cytomegalovirus-like were found, with T. gondii, both in the brain, as well as in the tear glands and small bowel. Blood stream parasite infestation was observed, no histopathological lesions were found in the remaining tissue, possibly due to lack of time, for all animals died within a week's observation. We conclude that immunosuppression has worsened the outcome, anticipating the disease in 24 hours.
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Affiliation(s)
- A C Guimarães
- Instituto Adolfo Lutz, Instituto de Medicina Tropical de São Paulo, Brazil
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Okumura M, Mester M, Iriya K, Gama-Rodrigues JJ, Amato Neto V. An alert to organ transplant centers. Rev Hosp Clin Fac Med Sao Paulo 1997; 52:237-8. [PMID: 9595775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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41
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Safatle-Ribeiro AV, Ribeiro Júnior U, Reynolds JC, Gama-Rodrigues JJ, Iriya K, Kim R, Bakker A, Swalsky PA, Pinotti HW, Finkelstein SD. Morphologic, histologic, and molecular similarities between adenocarcinomas arising in the gastric stump and the intact stomach. Cancer 1996. [PMID: 8940997 DOI: 10.1002/(sici)1097-0142(19961201)78:11<2288::aid-cncr4>3.0.co;2-j] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Patients with gastric remnants resulting from partial resections have an increased risk for carcinoma. It is unclear whether adenocarcinoma arising in the gastric stump (GSca) differs from intact stomach carcinoma (Gca). The goal of this study was to examine the pathologic and molecular features of GSca and compare them with Gca. METHODS Adjacent nonmalignant areas and tumors from 14 patients who were 19-55 years postgastrectomy (mean, 32.1 years) were compared with 14 Gca by pathologic and molecular analysis. Formalin fixed, paraffin embedded specimens were immunohistochemically stained for p53 followed by topographic genotyping. Exons 5-8 were amplified by the polymerase chain reaction and directly sequenced. RESULTS No differences were noted between the two groups regarding gender, types of metaplasia, dysplasia, morphology, or histologic tumor type. However, a higher incidence of cystic dilatation and foveolar hyperplasia were present in GSca. p53 gene point mutations occurred in 5 of 14 (35.7%) GSca patients. GSca p53 mutations included missense point mutations (G:A transitions in four patients and G:C transversion in one patient) with allelic loss. In four of the five patients with p53 mutations, the same mutation was also observed in the adjacent area. p53 point mutations were present in 4 of 14 Gca (28.6%), in exons 5, 6, and 8. In one case, the same mutation was also detected in the adjacent nonmalignant mucosa. CONCLUSIONS Similarities in clinical, pathologic, and molecular features between GSca and Gca suggest the possibility that they share similar mechanisms of carcinogenesis. p53 gene alterations in premalignant areas may denote a possible early role of this gene in gastric carcinoma.
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Affiliation(s)
- A V Safatle-Ribeiro
- Division of Gastroenterology and Hepatology, University of Pittsburgh Medical Center, Pennsylvania, USA
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Safatle-Ribeiro AV, Ribeiro U, Reynolds JC, Gama-Rodrigues JJ, Iriya K, Kim R, Bakker A, Swalsky PA, Pinotti HW, Finkelstein SD. Morphologic, histologic, and molecular similarities between adenocarcinomas arising in the gastric stump and the intact stomach. Cancer 1996. [DOI: 10.1002/(sici)1097-0142(19961201)78:11<2288::aid-cncr4>3.0.co;2-j] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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43
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Vieira MJ, Gama-Rodrigues JJ, Habr-Gama A, Faintuch J, Waitzberg DL, Pinotti HW. Preoperative assessment in cases of adult megacolon suffering from moderate malnutrition. Nutrition 1996; 12:491-5. [PMID: 8878140 DOI: 10.1016/s0899-9007(96)91724-4] [Citation(s) in RCA: 6] [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: 02/02/2023]
Abstract
Acquired megacolon is a chronic disease associated with constipation and malnutrition. Surgical treatment may be required for the alleviation of the intestinal symptoms, emphasizing the interest of nutritional assessment in this population. In a prospective study of 33 patients suffering from acquired megacolon and requiring either anterior resection or pull-through operation, standard anthropometric and biochemical measurements as well as the PNI of Buzby and Mullen were preoperatively assessed. Mean age of the population was 49 +/- 13 y, with 17 males and 16 females. The combined nutritional score indicated 63.6% of the population were malnourished (21/33) of the patients, whereas the Prognostic nutritional index (PNI) revealed 3 high-risk cases (9.1%), 9 with moderate risk (27.3%), and reduced risk for all others. Indeed, 39.4% (13/33) of the patients displayed surgical or septic problems. Chi-square analysis confirmed that both studied criteria were significantly associated with complications (p < 0.05), as morbidity was restricted predominantly to cases with unfavorable Prognostic nutritional index (PNI) results or clear signs of nutritional deficit. Both PNI and conventinoal nutritional assessment are valuable tools for the screening of these surgical candidates. Artificial alimentation was not used in this experience, but deserves consideration in selected patients. Nutritional status improved in the late postoperative period, with normalization of bowel function.
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Affiliation(s)
- M J Vieira
- Division of Gastrointestinal Surgery, Hospital das Clínicas, São Paulo, Brazil
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Engler-Pinto Júnior P, Meneguetti C, Lopasso FP, Gama-Rodrigues JJ, Pinotti HW. Identification of heterogenous motility patterns of the stomach in duodenal ulcer disease. Rev Hosp Clin Fac Med Sao Paulo 1995; 50:267-71. [PMID: 8578091] [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] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
This study aims to compare gastric emptying of solid meals in two different duodenal ulcer populations and their respective control groups. The same authors, utilized the same methods, but on different occasions. Four study groups were composed as follow: DU I--15 patients, CI--12 patients, DU II--16 patients, C II--15 patients. All individuals underwent high gastrointestinal tract evaluation. Endoscopy was normal in all subjects of the control groups. The ulcers were active but without reducing of the duodenal lumen. Gastric emptying was studied with the use of 30 grams of Tc tagged chicken liver. Measurements of Gastric emptying were taken by a gamma camera Ohio-series ON-150) with 15 minutes intervals during 120 minutes. Emptying rates expressed as percent of the test meal remaining in the stomach were submitted to KRUSKAL-WALLIS STATISTICAL analysis at each time and were identical in the groups, DU I, C I and C II. Emptying rates were significantly lower in the DU II group compared to the others. This study permits us to conclude that the gastric emptying in duodenal ulceration can be normal or delayed for reasons not clearly understood.
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Faintuch J, Waitzburg DL, Bertevello PL, Silva ML, Borges VC, Pereira SS, Gama-Rodrigues JJ, Pinotti HW. Conservative management of septic parenteral nutrition catheters. JPEN J Parenter Enteral Nutr 1995; 19:428-9. [PMID: 8577029 DOI: 10.1177/0148607195019005428] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Mucerino DR, Waitzberg DL, de Campos FG, Auricchio MT, Gama-Rodrigues JJ, Lima-Gonçalves E. [Nutritional and energy metabolism changes in abdominal irradiation--experimental study]. Rev Hosp Clin Fac Med Sao Paulo 1995; 50:67-75. [PMID: 7481460] [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] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In this study the effects on nutritional status and energetic metabolism due to abdominal irradiation were analysed. Adult male Wistar rats (48), were divided in two groups Control (C) and Radiated (R). The rats were maintained all time in metabolic cages. The study was done in two periods: Period 1 begun at 0 day, where rats adapted to cages and oral diet, had food and water "ad libitum". At the day 4 indirect calorimetric measurements were performed (calorimetry I). At Period 2, group R rats abdominal radiation at a 300cGy/day rate, for 5 consecutive days, and group C started a pair feeding process linked individually to R rats and suffered application of simulated-radiation. Two other calorimetric measurements (II,III) were performed during Period 2. After radiation the last calorimetry was performed (IV). At sacrifice (day 14) blood was collected for determination of hemoglobin, haematocrit, albumin and transferrin. There were no statistical differences among groups C and R during Period 1 (p < 0.05). Great reduction in food intake and weight variation were found in Period 2, but weight loss was significantly higher in R rats. Nitrogen balance decreased in Period 2, but without difference among the groups (p < 0.05). Serum albumin was significantly lower in R rats. Respiratory quotient decreased in both groups during Period 2, but R rats kept it lower (p < 0.05). The energy expenditure level decreased after radiation in Group R. During Period 2 total substrate oxidation decreased in R rats. Radiation decreased glucose and protein oxidation.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- D R Mucerino
- Disciplina de Cirurgia do Aparelho Digestivo, Hospital das Clínicas e GANEP, São Paulo
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Faintuch J, Waitzberg DL, Bertevello PL, Borges VC, Silva ML, Santoro S, Gama-Rodrigues JJ, Pinotti HW. [Infections of central venous catheters]. Rev Hosp Clin Fac Med Sao Paulo 1995; 50:52-4. [PMID: 7481456] [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] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The central venous catheter is considered the lifeline of patients requiring long-term parenteral nutrition, and its infectious complications accordingly represent a frequent cause for hospitalization and morbidity. Modern catheters made of Silastic increase the duration and efficiency of venous access, but their substitution is also more complex and expensive. In a small series of patients undergoing home parenteral nutrition due to short bowel syndrome, and carrying. Silastic catheters, infection of the cannula was treated by administration of systemic as well as local antimicrobial agents. The septic process was resolved without the need of removing the catheters, and with excellent tolerance to the medications. It is concluded that in-situ sterilization of long-term catheters should be attempted in selected cases.
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Affiliation(s)
- J Faintuch
- Disciplina de Cirurgia do Aparelho Digestivo, da Faculdade de Medicina da Universidade de São Paulo
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de Oliveira e Silva A, D'Albuquerque LA, Roldan Molina LF, dos Santos TE, Gurgel JDM, Santo GC, Genzini T, de Carvalho AA, Gama-Rodrigues JJ. [Hepatocyte necrosis and intrahepatic cholestasis in the postoperative period of patients undergoing heart surgery with the use of extracorporeal circulation: significance of clinical, epidemiologic, surgical and laboratory parameters in evaluating prognosis]. Arq Gastroenterol 1989; 26:55-64. [PMID: 2627163] [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] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Sixteen patients with jaundice after heart surgery with extracorporeal circulation, were studied. They were divided in 2 groups, according to the postoperative outcome; either death (group I) or hospital discharge (group II). Clinical, epidemiological, surgical and laboratorial aspects were compared in order to ascertain their role in the outcome. The results were analysed by the Student-t test. The main cause of death was low output syndrome, which occurred in 10 cases (62.5%), 5 of them died (31%). A statistically significant difference was observed in the postoperative values of serum GOT (p less than 0.01), GPT (p less than 0.01) and total bilirubin (p less than 0.01), which were then considered prognostic indicators in these patients.
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Oliveira e Silva A, Roldan Molina LF, dos Santos TE, Santo GC, Gama-Rodrigues JJ, D'Albuquerque LA. [Wilson's disease. Hepatic manifestations]. Arq Gastroenterol 1989; 26:47-9. [PMID: 2697201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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50
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de Oliveira e Silva A, D'Albuquerque LA, Roldan Molina LF, da Costa Filho CF, Gurgel JDM, dos Santos TE, Santo GC, Gama-Rodrigues JJ. [Intrahepatic and subcapsular hematoma of the liver after hepatic biopsy under laparoscopy. Contribution of ultrasonography]. Arq Gastroenterol 1989; 26:3-8. [PMID: 2532499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Over the last few years, ultrasound became important in characterization of space -occupying solid lesions of the liver. Recently, Canadian authors using this method, described a 23% incidence of intrahepatic or subcapsular hematoma after liver biopsy. We prospectively evaluated the incidence of this complication after liver biopsy under laparoscopic guidance in 8 cirrhotic patients, 7 with steatosis, 7 chronic active hepatitis and 4 with intrahepatic cholestasis. Biopsy was performed under general anesthesia provided that prothrombin activity was over 50%, serum fibrinogen was over 100% and platelets over 50.000/mm3. In none of 26 consecutive patients, was an intrahepatic or subcapsular hematoma observed.
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