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dos Santos LL, Fraga IDA, de Almeida VA, Santos AHR, Almeida IM, Nascimento TR, Porto BC, Passerotti CC, Artifon ELDA, Otoch JP, da Cruz JAS. Antibiotics prophylaxis at the time of catheter removal after radical prostatectomy: a systematic review of the literature and meta-analysis. Acta Cir Bras 2024; 39:e390424. [PMID: 38324800 PMCID: PMC10854371 DOI: 10.1590/acb390424] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/16/2023] [Indexed: 02/09/2024] Open
Abstract
PURPOSE To conduct a systematic literature review with meta-analysis to identify whether antibiotic prophylaxis after removal of the indwelling urinary catheter reduces posterior infections. METHODS A systematic literature review was conducted in the databases PubMed, Embase, Cochrane, Google Scholar, and Latin American and Caribbean Health Sciences Literature, using the keywords "antibiotics" AND "prostatectomy" AND "urinary catheter." RESULTS Three articles were identified having the scope of our review, with 1,040 patients, which were subjected to our meta-analysis revealing a marginally significant decrease in the risk of urinary infection after indwelling urinary catheter removal (odds ratio-OR = 0.51; 95% confidence interval-95%CI 0.27-0.98; p = 0.04; I2 = 0%). No difference was found regarding the presence of bacteriuria (OR = 0.39; 95%CI 0.12-1.24; p = 0.11; I2 = 73%). CONCLUSIONS In our meta-analysis, there was a significant decrease in urinary tract infection with antibiotic prophylaxis after indwelling urinary catheter removal following radical prostatectomy.
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Affiliation(s)
| | | | | | | | | | | | - Breno Cordeiro Porto
- Universidade de São Paulo – School of Medicine – Surgical Technique and Experimental Surgery – São Paulo (SP) – Brazil
| | - Carlo Camargo Passerotti
- Universidade de São Paulo – School of Medicine – Surgical Technique and Experimental Surgery – São Paulo (SP) – Brazil
- Hospital Alemão Oswaldo Cruz – Specialized Center for Urology – São Paulo (SP) – Brazil
| | | | - Jose Pinhata Otoch
- Universidade de São Paulo – School of Medicine – Surgical Technique and Experimental Surgery – São Paulo (SP) – Brazil
| | - José Arnaldo Shiomi da Cruz
- Universidade Nove de Julho – São Paulo (SP) – Brazil
- Universidade de São Paulo – School of Medicine – Surgical Technique and Experimental Surgery – São Paulo (SP) – Brazil
- Hospital Alemão Oswaldo Cruz – Specialized Center for Urology – São Paulo (SP) – Brazil
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2
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Pissaia TB, Belkovsky M, Passerotti CC, Artifon ELDA, Otoch JP, da Cruz JAS. Diameter of ureteral access sheath and ureteral stenosis development: a systematic review. Acta Cir Bras 2023; 38:e387423. [PMID: 37909598 PMCID: PMC10637340 DOI: 10.1590/acb387423] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 09/22/2023] [Indexed: 11/03/2023] Open
Abstract
PURPOSE Ureteral access sheaths (UAS) are widely used in ureteroscopy. UAS are believed to pose a significant risk for ureteral stenosis due to ureteral mucosal compression, but little evidence supports this claim. Our systematic review aimed to investigate the relationship between different UAS diameters and stenosis risk. METHODS A systematic search was conducted in PubMed, Embase, Web of Science, Scopus, and Cochrane, from its inception to May 2023. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Cochrane guidelines were followed. χ2 test was performed to compare the prevalence within the groups. RESULTS Six nonrandomized trials and one randomized, with a total of 962 patients, were included. The overall incidence of ureteral stenosis of 0.9%. UAS sizes were: 9.5/11.5Fr, 10/12Fr, 11/13Fr, 12/14Fr, and 14/16Fr. Within each subgroup, the incidence of ureteral stenosis was: 0.4, 8, 0, 1, and 1% (p = 0.099). No trend for stenosis was observed among larger UAS. CONCLUSIONS In this systematic review, no relationship between UAS diameter and incidence of ureteral stenosis was observed. Nonetheless, additional randomized controlled trials are required to support this finding.
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Affiliation(s)
| | - Mikhael Belkovsky
- Universidade de São Paulo – Medical School – Surgical Technique Department – São Paulo (SP) – Brazil
| | - Carlo Camargo Passerotti
- Hospital Alemão Oswaldo Cruz – Prostate Institute – Urology Department – São Paulo (SP) – Brazil
| | | | - Jose Pinhata Otoch
- Universidade de São Paulo – Medical School – Surgical Technique Department – São Paulo (SP) – Brazil
| | - José Arnaldo Shiomi da Cruz
- Universidade Nove de Julho – Urology Department – São Paulo (SP) – Brazil
- Universidade de São Paulo – Medical School – Surgical Technique Department – São Paulo (SP) – Brazil
- Hospital Alemão Oswaldo Cruz – Prostate Institute – Urology Department – São Paulo (SP) – Brazil
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da Silva RRR, Facanali Junior MR, Brunaldi VO, Otoch JP, Rocha ACA, Artifon ELDA. EUS-guided choledochoduodenostomy for malignant biliary obstruction: A multicenter comparative study between plastic and metallic stents. Endosc Ultrasound 2023; 12:120-127. [PMID: 36861511 PMCID: PMC10134915 DOI: 10.4103/eus-d-21-00221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 07/21/2022] [Indexed: 03/03/2023] Open
Abstract
Background and Objectives EUS-guided choledochoduodenostomy (EUS-CDS) is commonly employed to address malignant biliary obstruction (MBO) after a failed ERCP. In this context, both self-expandable metallic stents (SEMSs) and double-pigtail stents (DPSs) are suitable devices. However, few data comparing the outcomes of SEMS and DPS exist. Therefore, we aimed to compare the efficacy and safety of SEMS and DPS at performing EUS-CDS. Methods We conducted a multicenter retrospective cohort study between March 2014 and March 2019. Patients diagnosed with MBO were considered eligible after at least one failed ERCP attempt. Clinical success was defined as a drop of direct bilirubin levels ≥ 50% at 7 and 30 postprocedural days. Adverse events (AEs) were categorized as early (≤7 days) or late (>7 days). The severity of AEs was graded as mild, moderate, or severe. Results Forty patients were included, 24 in the SEMS group and 16 in the DPS group. Demographic data were similar between the groups. Technical success rates and clinical success rates at 7 and 30 days were similar between the groups. Similarly, we found no statistical difference in the incidence of early or late AEs. However, there were two severe AEs (intracavitary migration) in the DPS group and none in the SEMS cohort. Finally, there was no difference in median survival (DPS 117 days vs. SEMS 217 days; P = 0.99). Conclusion EUS-guided CDS is an excellent alternative to achieve biliary drainage after a failed ERCP for MBO. There is no significant difference regarding the effectiveness and safety of SEMS and DPS in this context.
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Affiliation(s)
- Rodrigo Roda Rodrigues da Silva
- General Surgery Department, University of São Paulo Medical School, São Paulo, Brazil
- Alfa Institute of Gastroenterology, HC/EBSERH, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Vitor Ottoboni Brunaldi
- Center for Digestive Endoscopy, Surgery and Anatomy Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Jose Pinhata Otoch
- General Surgery Department, University of São Paulo Medical School, São Paulo, Brazil
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Morioka CY, Cesar Machado MC, Otoch JP, Schneider LP, Rodrigues Lima EM, Garcia ME, Saito S, Watanabe A, Morioka EK, Huang CC. PCL20-116: Can Antisense Oligonucleotides Targeted to K-Ras Gene Inhibit the Tumor Growth, Invasiveness and Expression of MMP-2 and MMP-9 In Vitro and In Vivo in Hamster Experimental Pancreatic Cancer Model? J Natl Compr Canc Netw 2020. [DOI: 10.6004/jnccn.2019.7514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Cintia Yoko Morioka
- aUniversity of Sao Paulo, Hospital Sirio Libanes, Sao Paulo, Brazil
- bAdvantage Health, Sao Paulo, Brazil
- cToyama University, Toyama, Japan
| | | | | | | | | | - Marcelo Engracia Garcia
- aUniversity of Sao Paulo, Hospital Sirio Libanes, Sao Paulo, Brazil
- dUNAERP, Sao Paulo, Brazil
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Morioka CY, Cesar Machado MC, Otoch JP, Schneider LP, Rodrigues Lima EM, Garcia ME, Silva J, Costa A, Herrera V, Aguiar P, Herrera E, Aguiar T, Kublik M, Silva A, Silva K, Morioka E, Huang CC. PCL20-117: Can Green Tea Extract Inhibit the Tumor Growth and Invasiveness of 5-FU and Gemcitabine-Resistant Metastatic and Remetastatic Cell Lines in a Hamster Pancreatic Cancer Model? J Natl Compr Canc Netw 2020. [DOI: 10.6004/jnccn.2019.7515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Cintia Yoko Morioka
- aUniversity of Sao Paulo, Hospital Sirio Libanes, Sao Paulo, Brazil
- bAdvantage Health, Sao Paulo, Brazil
- cToyama University, Toyama, Japan
| | | | | | | | | | - Marcelo Engracia Garcia
- aUniversity of Sao Paulo, Hospital Sirio Libanes, Sao Paulo, Brazil
- dUNAERP, Sao Paulo, Brazil
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Guedes HG, Ferreira ZMCC, Leão LRS, Montero EFS, Otoch JP, Artifon ELA. Reply letter to: Letter to the editor on the article "Virtual reality simulator versus box-trainer to teach minimally invasive procedures: A meta-analysis". Int J Surg 2019; 67:89-90. [PMID: 31125661 DOI: 10.1016/j.ijsu.2019.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 05/08/2019] [Accepted: 05/14/2019] [Indexed: 10/26/2022]
Affiliation(s)
- H G Guedes
- General Surgery Department, University of Sao Paulo School of Medicine, Carvalho Aguiar Street, number 255, São Paulo, SP, 05422-090, Brazil.
| | - Z M C C Ferreira
- Potiguar University, Senador Salgado Filho Avenue, number 1610, Lagoa Nova, Natal, RN, 59056-000, Brazil
| | - L R S Leão
- Hospital Israelita Albert Einstein, Albert Einstein Avenue, number 627/701, Morumbi, São Paulo, SP, 05652-900, Brazil
| | - E F S Montero
- General Surgery Department, University of Sao Paulo School of Medicine, Carvalho Aguiar Street, number 255, São Paulo, SP, 05422-090, Brazil
| | - J P Otoch
- General Surgery Department, University of Sao Paulo School of Medicine, Carvalho Aguiar Street, number 255, São Paulo, SP, 05422-090, Brazil
| | - E L A Artifon
- General Surgery Department, University of Sao Paulo School of Medicine, Carvalho Aguiar Street, number 255, São Paulo, SP, 05422-090, Brazil
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Batista CM, Mariano ED, Onuchic F, Dale CS, dos Santos GB, Cristante AF, Otoch JP, Teixeira MJ, Morgalla M, Lepski G. Characterization of traumatic spinal cord injury model in relation to neuropathic pain in the rat. Somatosens Mot Res 2019; 36:14-23. [DOI: 10.1080/08990220.2018.1563537] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Chary Marquez Batista
- Department of Neurology, School of Medicine, Universidade de São Paulo, São Paulo, Brazil
| | - Eric Domingos Mariano
- Department of Neurology, School of Medicine, Universidade de São Paulo, São Paulo, Brazil
| | - Fernando Onuchic
- Department of Neurology, School of Medicine, Universidade de São Paulo, São Paulo, Brazil
| | | | - Gustavo Bispo dos Santos
- Department of Orthopedic and Traumatology, School of Medicine, Universidade de São Paulo, São Paulo, Brazil
| | - Alexandre Fogaça Cristante
- Department of Orthopedic and Traumatology, School of Medicine, Universidade de São Paulo, São Paulo, Brazil
| | - Jose Pinhata Otoch
- Department of Surgery, School of Medicine, Universidade de São Paulo, São Paulo, Brazil
| | | | - Matthias Morgalla
- Department of Neurosurgery, Eberhard-Karls University, Tuebingen, Germany
| | - Guilherme Lepski
- Department of Neurosurgery, Eberhard-Karls University, Tuebingen, Germany
- Department of Psychiatry, School of Medicine, University de São Paulo, São Paulo, Brazil
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Gaspar MTDC, Maximiano LF, Minamoto H, Otoch JP. Tracheal stenosis due to endotracheal tube cuff hyperinflation: a preventable complication. Autops Case Rep 2019; 9:e2018072. [PMID: 30863738 PMCID: PMC6394355 DOI: 10.4322/acr.2018.072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 04/06/2018] [Accepted: 10/08/2018] [Indexed: 11/23/2022] Open
Abstract
Endotracheal intubation injuries are rare, but may be devastating-mostly among the pediatric patients or when these occur in the distal trachea. Such complications typify a therapeutic challenge, which, besides requiring intellectual and technical resources, takes a long time to reach a resolution. The authors present the case of a 15-year-old girl admitted with an abnormal state of consciousness due to diabetic ketoacidosis. She was submitted to endotracheal intubation with hyperinflation of the tube cuff, which rendered tracheal necrosis and detachment of the tracheal mucosa, and consequent obstruction. Later, she developed scarring retraction and stenosis. The patient was successfully treated with an endotracheal prosthesis insertion. The aim of this report is to illustrate a preventable complication.
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Affiliation(s)
| | | | - Hélio Minamoto
- Universidade de São Paulo (USP), Heart Institute, Thoracic Surgery Service.São Paulo, SP,Brazil
| | - Jose Pinhata Otoch
- Universidade de São Paulo (USP), Hospital Universitário, Surgery Division.São Paulo, SP,Brazil
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Furuya CK, Sakai P, Marinho FRT, Otoch JP, Cheng S, Prudencio LL, de Moura EGH, Artifon ELDA. Papillary fistulotomy vs conventional cannulation for endoscopic biliary access: A prospective randomized trial. World J Gastroenterol 2018; 24:1803-1811. [PMID: 29713133 PMCID: PMC5922998 DOI: 10.3748/wjg.v24.i16.1803] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 02/25/2018] [Revised: 03/12/2018] [Accepted: 03/25/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To compare the cannulation success, biochemical profile, and complications of the papillary fistulotomy technique vs catheter and guidewire standard access.
METHODS From July 2010 to May 2017, patients were prospectively randomized into two groups: Cannulation with a catheter and guidewire (Group I) and papillary fistulotomy (Group II). Amylase, lipase and C-reactive protein at T0, as well as 12 h and 24 h after endoscopic retrograde cholangiopancreatography, and complications (pancreatitis, bleeding, perforation) were recorded.
RESULTS We included 102 patients (66 females and 36 males, mean age 59.11 ± 18.7 years). Group I and Group II had 51 patients each. The successful cannulation rates were 76.5% and 100%, respectively (P = 0.0002). Twelve patients (23.5%) in Group I had a difficult cannulation and underwent fistulotomy, which led to successful secondary biliary access (Failure Group). The complication rate was 13.7% (2 perforations and 5 mild pancreatitis) vs 2.0% (1 patient with perforation and pancreatitis) in Groups I and II, respectively (P = 0.0597).
CONCLUSION Papillary fistulotomy was more effective than guidewire cannulation, and it was associated with a lower profile of amylase and lipase. Complications were similar in both groups.
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Affiliation(s)
- Carlos Kiyoshi Furuya
- Department of Gastrointestinal Endoscopy Unit, University of Sao Paulo, Sao Paulo 05409001, Brazil
| | - Paulo Sakai
- Department of Gastrointestinal Endoscopy Unit, University of Sao Paulo, Sao Paulo 05409001, Brazil
| | | | - Jose Pinhata Otoch
- Department of Surgery, University of Sao Paulo, Sao Paulo 05403000, Brazil
| | - Spencer Cheng
- Department of Gastrointestinal Endoscopy Unit, University of Sao Paulo, Sao Paulo 05409001, Brazil
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de Faria JWV, Teixeira MJ, de Moura Sousa Júnior L, Otoch JP, Figueiredo EG. Virtual and stereoscopic anatomy: when virtual reality meets medical education. J Neurosurg 2016; 125:1105-1111. [PMID: 26871375 DOI: 10.3171/2015.8.jns141563] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors sought to construct, implement, and evaluate an interactive and stereoscopic resource for teaching neuroanatomy, accessible from personal computers. METHODS Forty fresh brains (80 hemispheres) were dissected. Images of areas of interest were captured using a manual turntable and processed and stored in a 5337-image database. Pedagogic evaluation was performed in 84 graduate medical students, divided into 3 groups: 1 (conventional method), 2 (interactive nonstereoscopic), and 3 (interactive and stereoscopic). The method was evaluated through a written theory test and a lab practicum. RESULTS Groups 2 and 3 showed the highest mean scores in pedagogic evaluations and differed significantly from Group 1 (p < 0.05). Group 2 did not differ statistically from Group 3 (p > 0.05). Size effects, measured as differences in scores before and after lectures, indicate the effectiveness of the method. ANOVA results showed significant difference (p < 0.05) between groups, and the Tukey test showed statistical differences between Group 1 and the other 2 groups (p < 0.05). No statistical differences between Groups 2 and 3 were found in the practicum. However, there were significant differences when Groups 2 and 3 were compared with Group 1 (p < 0.05). CONCLUSIONS The authors conclude that this method promoted further improvement in knowledge for students and fostered significantly higher learning when compared with traditional teaching resources.
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De Souza TF, Artifon ELDA, Mestieri LHM, Reimão SM, Aires FT, Bernardo WM, Otoch JP, De Moura EGH. Systematic review and meta-analysis of endoscopic ablative treatment of Barrett's esophagus. Rev Gastroenterol Peru 2014; 34:217-224. [PMID: 25293990] [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: 06/03/2023]
Abstract
BACKGROUND Barrett's esophagus (BE) is the main risk factor for esophageal adenocarcinoma. Its therapeutic approach is controversial and surgical treatment in the presence of high-grade intraepithelial neoplasia may be indicated. Endoscopic approach is an alternative with lower mortality and morbidity rates and favorable results. OBJECTIVE To define the best option, according to literature, to treat Barrett's Esophagus. DESIGN Systematic review of PUBMED, EMBASE, LILACS, and Cochrane Library databases was conducted and articles of randomized, controlled studies on BE endoscopic ablative treatment were selected. The systematic review through PUBMED retrieved results with higher evidence level and available recommendation grade regarding BE ablative therapy. Nine articles on randomized, controlled studies classified as A or B according to the Oxford table were selected. Cryotherapy, laser, photodynamic therapy (PDT), multipolar electrocoagulation (MPEC), and ablation through argon plasma coagulation (APC) and radiofrequency were considered ablation therapies. PATIENTS 649 patients from 10 different studies were analysed. RESULTS PDT was found to present an increase in treatment failure compared with APC, NNH = -7. BE ablation through MPEC or APC was found to have similar risk for treatment failure in meta-analysis. PDT associated with proton pump inhibitor (PPI) is beneficial for BE ablation regarding PPI use alone, NNT = 2.Radiofrequency with PPI is an efficient method to reduce risk of treatment failure, NNT = 1. CONCLUSIONS There are no studies demonstrating the benefit of indicating cryotherapy or laser therapy for BE endoscopic approach. APC ablation was found to have superior efficacy compared with PDT and ablation through APC and MPEC was found to present effective, similar results. Radiofrequency is the most recent approach requiring comparative studies for indication.
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Affiliation(s)
- Thiago Ferreira De Souza
- Gastrointestinal Endoscopy Unit, Departmentof Gastroenterology, University of São Paulo. São Paulo, Brasil
| | | | | | - Sílvia Mansur Reimão
- Gastrointestinal Endoscopy Unit, Departmentof Gastroenterology, University of São Paulo. São Paulo, Brasil
| | - Felipe Toyama Aires
- Gastrointestinal Endoscopy Unit, Departmentof Gastroenterology, University of São Paulo. São Paulo, Brasil
| | - Wanderley Marques Bernardo
- Gastrointestinal Endoscopy Unit, Departmentof Gastroenterology, University of São Paulo. São Paulo, Brasil
| | - Jose Pinhata Otoch
- Gastrointestinal Endoscopy Unit, Departmentof Gastroenterology, University of São Paulo. São Paulo, Brasil
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Artifon ELA, Tchekmedyian AJ, Otoch JP, Gutierrez Galiana JP, Canseco S, Caro LE. [Contributions of endoscopic ultrasound to pancreatic cystic lesions]. Acta Gastroenterol Latinoam 2014; 44:129-137. [PMID: 25199308] [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: 06/03/2023]
Abstract
Cystic lesions of the pancreas are peculiar in relation to their diagnosis and treatment. The use of endoscopic ultrasonography (EUS) has provided better sensitivity and specificity to differentiate benign from malignant cysts, condition that provides an early diagnosis and an effective and definite treatment.
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13
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Lederman A, Saliture Neto FT, Ferreira R, de Figueiredo LFP, Otoch JP, Aun R, da Silva ES. Endovascular model of abdominal aortic aneurysm induction in swine. Vasc Med 2014; 19:167-174. [DOI: 10.1177/1358863x14534006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Abdominal aortic aneurysms are among the main causes of death. The high morbidity and mortality associated with aneurysm rupture and repair represents a challenge for surgeons and high risk for patients. Although experimental models are useful to understand, train, and develop new treatment and diagnostic methods for this pathology, animal models developed to date are far from ideal. Animals are either too small and do not represent the pathology of humans, or the procedures employ laparotomy, or the aortic behavior does not resemble that of a true aneurysm. We developed a novel, less invasive and effective method to induce true aortic aneurysms in Large White pigs. Animals were submitted to an endovascular chemical induction using either calcium chloride (25%) or swine pancreatic elastase. Controls were exposed to saline solution. All animals were operated on using the same surgical technique under general anesthesia. They were followed weekly with ultrasound examinations and at 4 weeks the aorta was harvested. Although elastase induced only arterial dilation, imaging, histological, and biomechanical studies of the aorta revealed the formation of true aneurysms in animals exposed to calcium chloride. Aneurysms in the latter group had biomechanical failure properties similar to those of human aneurysms. These findings indicate that the endovascular approach is viable and does not cause retroperitoneal fibrosis.
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Affiliation(s)
- Alex Lederman
- Vascular Surgery, Hospital Universitário, Universidade de São Paulo (USP), São Paulo, Brazil
- Vascular Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Rimarcs Ferreira
- Pathology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Jose Pinhata Otoch
- Surgical Techniques, Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, Brazil
| | - Ricardo Aun
- Vascular Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Vascular Surgery, Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, Brazil
| | - Erasmo Simão da Silva
- Vascular Surgery, Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, Brazil
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Artifon ELA, Takada J, Okawa L, Ferreira F, Santos M, Moura EGH, Otoch JP, Sakai P. Successful endoscopic ultrasound-guided overstenting biliary drainage through a pre-existing proximal migrated metal biliary stent. Rev Gastroenterol Mex 2014. [PMID: 22041320 DOI: 10.3348/kjr.2012.12.s1.s74] [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] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Biliary endoscopic drainage using metallic self-expanded stents has become a well-established method for palliative treatment of malignant biliary obstruction. However, its occlusion, mainly by tumor overgrowth, is still the main complication without a standard treatment. We here describe a new method of treatment for biliary metallic stent occlusion, through the echo guided biliary drainage. We present a 68-year-old patient with metastatic pancreatic cancer previously treated for jaundice with ERCP and self-expandable metallic stent insertion. Four weeks later, the patient developed jaundice and symptoms of gastric outlet obstruction. A new ERCP confirmed obstruction of the second portion of the duodenum, due to diffuse tumor growth. EUS was performed, and the previous metal biliary stent was seen occluded at the distal portion in the common bile duct. A EUS-guided choledocododenostomy was performed and then, an overlapping self-expanding metal enteral stent was placed through the malignant obstruction. There were no early complications and the procedure was also clinically effective in relieving jaundice and gastric outlet obstruction symptoms. If ERCP fails in the management of occluded biliary metallic stents, EUS biliary drain can provide effective biliary decompression and should be considered an alternative to other endoscopic techniques.
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Affiliation(s)
- E L A Artifon
- Endoscopy Unit, University of Sao Paulo, Sao Paulo, Brazil.
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Medrado BF, Carneiro FOAA, Vilaça TG, Gouveia TS, Frazão MSV, de Moura EGH, Sakai P, Otoch JP, Artifon ELA. Endoscopic ultrasound-guided drainage of giant liver abscess associated with transgastric migration of a self-expandable metallic stent. Endoscopy 2014; 45 Suppl 2:E331-2. [PMID: 24150733 DOI: 10.1055/s-0033-1344128] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [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: 12/24/2022]
Affiliation(s)
- B F Medrado
- Gastrointestinal Endoscopy Unit - Gastroenterology Department, University of São Paulo - School of Medicine, São Paulo, Brazil
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Andrade AFD, Soares MS, Patriota GC, Belon AR, Paiva WS, Bor-Seng-Shu E, Oliveira MDL, Nascimento CN, Noleto GS, Alves Junior AC, Figueiredo EG, Otoch JP, Teixeira MJ. Experimental model of intracranial hypertension with continuous multiparametric monitoring in swine. Arq Neuro-Psiquiatr 2013; 71:802-6. [DOI: 10.1590/0004-282x20130126] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 05/31/2013] [Indexed: 11/21/2022]
Abstract
Objective Intracranial hypertension (IH) develops in approximately 50% of all patients with severe traumatic brain injury (TBI). Therefore, it is very important to identify a suitable animal model to study and understand the pathophysiology of refractory IH to develop effective treatments. Methods We describe a new experimental porcine model designed to simulate expansive brain hematoma causing IH. Under anesthesia, IH was simulated with a balloon insufflation. The IH variables were measured with intracranial pressure (ICP) parenchymal monitoring, epidural, cerebral oximetry, and transcranial Doppler (TCD). Results None of the animals died during the experiment. The ICP epidural showed a slower rise compared with parenchymal ICP. We found a correlation between ICP and cerebral oximetry. Conclusion The model described here seems useful to understand some of the pathophysiological characteristics of acute IH.
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Artifon ELA, Ferreira F, Benevides G, Marcaccio FH, Otoch JP, Takada J, Carnevale FC, Mota AM, Moura E, Rasslan S, de Figueiredo LP, Sakai P. Extrahepatic anterograde covered self-expandable metallic stent placement across malignant biliary obstruction passed by endoscopic ultrasound guidance access: a challenging technique. ACTA ACUST UNITED AC 2013. [PMID: 23214354 DOI: 10.1080/11250007009436941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The authors report the case of a female patient submitted to endoscopic cholangiography intending to drain the biliary tree due to jaundice. The patient had gastrointestinal deviation due to an advanced gastric cancer that evolved with a distal extrahepatic mass. Abdominal CT scan demonstrated a distal mass, extrahepatic biliary dilation and a normal intra-hepatic tree. In this condition and after a multidisciplinary discussion, an endoscopic ultrasound guided extrahepatic access with the deployment of a partially covered self-expandable metallic stent was performed. The patient normalized her bilirubin levels after a successful procedure.
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Affiliation(s)
- Everson L A Artifon
- Surgery, Gastroenterology and Radiology Departments, University of São Paulo, Brazil.
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Vila JJ, Artifon ELA, Otoch JP. Post-endoscopic retrograde cholangiopancreatography complications: How can they be avoided? World J Gastrointest Endosc 2012; 4:241-6. [PMID: 22720126 PMCID: PMC3377867 DOI: 10.4253/wjge.v4.i6.241] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 02/23/2012] [Accepted: 05/27/2012] [Indexed: 02/05/2023] Open
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) has a significant complication rate which can be lowered by adopting technical variations of proven beneficial effect and prophylactic maneuvers such as pancreatic stenting during ERCP or periprocedural non-steroidal anti-inflammatory drug administration. However, adoption of these prophylactic maneuvers by endoscopists is not uniform. In this editorial we discuss the beneficial effects of the aforementioned maneuvers.
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Affiliation(s)
- Juan J Vila
- Juan J Vila, Endoscopy Unit, Gastroenterology Department, Complejo Hospitalario de Navarra, Pamplona 31008, Spain
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Artifon ELA, Ferreira FC, Otoch JP. [Endoscopic ultrasound-guided choledochoduodenostomy for relieving malignant distal biliary obstruction]. Rev Gastroenterol Mex 2012; 77:31-37. [PMID: 22450018] [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: 05/31/2023]
Abstract
Ultrasound-guided biliary drainage is a new and effective method for relieving obstructive lesions of the biliary tract. In the hands of experienced operators, ultrasound-guided diversion of the mid portion of the common bile duct and the duodenal bulb is a feasible strategy for the relief of jaundice secondary to distal obstruction (distal bile duct tumors, pancreatic head cancer, or major duodenal papillary tumor), with low morbidity and mortality rates. The technical aspects of the procedure and its indications are reviewed herein, emphasizing its performance in institutions equipped with experienced personnel adhering to strict study protocols.
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Affiliation(s)
- E L A Artifon
- University of São Paulo Medical School. Av. Dr. Enéas de Carvalho Aguiar 255, Cerqueira César. Z.P. 05403-000, Sao Paulo, Brasil.
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Batista ML, Peres SB, McDonald ME, Alcantara PSM, Olivan M, Otoch JP, Farmer SR, Seelaender M. Adipose tissue inflammation and cancer cachexia: possible role of nuclear transcription factors. Cytokine 2011; 57:9-16. [PMID: 22099872 DOI: 10.1016/j.cyto.2011.10.008] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [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: 07/28/2011] [Revised: 09/16/2011] [Accepted: 10/17/2011] [Indexed: 01/14/2023]
Abstract
Cancer cachexia is a multifaceted syndrome whose aetiology is extremely complex and is directly related to poor patient prognosis and survival. Changes in lipid metabolism in cancer cachexia result in marked reduction of total fat mass, increased lipolysis, total oxidation of fatty acids, hyperlipidaemia, hypertriglyceridaemia, and hypercholesterolaemia. These changes are believed to be induced by inflammatory mediators, such as tumour necrosis factor-α (TNF-α) and other factors. Attention has recently been drawn to the current theory that cachexia is a chronic inflammatory state, mainly caused by the host's reaction to the tumour. Changes in expression of numerous inflammatory mediators, notably in white adipose tissue (WAT), may trigger several changes in WAT homeostasis. The inhibition of adipocyte differentiation by PPARγ is paralleled by the appearance of smaller adipocytes, which may partially account for the inhibitory effect of PPARγ on inflammatory gene expression. Furthermore, inflammatory modulation and/or inhibition seems to be dependent on the IKK/NF-κB pathway, suggesting that a possible interaction between NF-κB and PPARγ is required to modulate WAT inflammation induced by cancer cachexia. In this article, current literature on the possible mechanisms of NF-κB and PPARγ regulation of WAT cells during cancer cachexia are discussed. This review aims to assess the role of a possible interaction between NF-κB and PPARγ in the setting of cancer cachexia as well as its significant role as a potential modulator of chronic inflammation that could be explored therapeutically.
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Affiliation(s)
- M L Batista
- Laboratory of Adipose Tissue Biology, Center for Integrated Biotechnology, University of Mogi das Cruzes, Mogi das Cruzes, Sao Paulo, Brazil.
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Artifon ELA, Pinhata Otoch J, Yábar A, Poli-de-Figueiredo LF, Sakai P, Rasslan S. Endoscopy Ultra- Sonography -guided biliary drainage in the surgical -endoscopy era. Rev Gastroenterol Peru 2011; 31:365-375. [PMID: 22476126] [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: 05/31/2023]
Abstract
BACKGROUND US-guided hepatico - gastrostomy, choledocho-duodenostomy and choledocho-antrostomy are advanced procedures on biliary and pancreatic endoscopy and together make up the echo-guided biliary drainage. Hepatico - gastrostomy is indicated in cases of hiliar obstruction, while the procedure of choice is choledocho - duodenostomy in distal lesions. Both procedures must be done only after unsuccessful ERCP. AIMS To clarify to the readers about indication of these procedures, they must be made under a multidisciplinary view while sharing information with the patient or legal guardian. METHODS All series cases report and selected cohort studies were selected according to the DDTS system in which key words were EUS biliary drainage, choledocho-duodenostomy, hepatico-gastrostomy, EUS, palliation and pancreatic biliary advanced cancer. RESULTS Separately it was stated definition on the EUS biliary drainage procedures and it includes the techniques details and critical analysis. CONCLUSION Hepatico- gastrostomy and Choledocho- duodenostomy are feasible when performed by endoscopists with expertise in bilio pancreatic endoscopy and advanced echo-endoscopy and should be performed currently under rigorous protocol in educational institutions.
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Affiliation(s)
- Everson L A Artifon
- GI Endoscopy Service, Department of Surgery,University of Sao Paulo-Sao Paulo, Brazil
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Bousso A, Baldacci E, Ejzenberg B, Otoch JP, Okay Y. The role of lung biopsy in deteriorating lung disease with unfavorable evolution. J Pediatr 2001; 138:786-7. [PMID: 11343069 DOI: 10.1067/mpd.2001.112762] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Averbach M, de Carvalho FG, Fava G, Otoch JP, Tolosa EM, Ferreira EA. [Duodenocolonic fistula. Report of a case and review of the literature]. Arq Gastroenterol 1989; 26:127-30. [PMID: 2486032] [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
Malignant duodenocolic fistula due to carcinoma of the colon is an infrequent condition. The authors describe a case treated by right hemicolectomy associated with gastrectomy and partial duodenectomy. After a review of the literature, they discuss the surgical possibilities.
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Affiliation(s)
- M Averbach
- Divisão de Clínica Cirúrgica, Hospital Universitário, Universidade de São Paulo
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