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- ItemAcesso aberto (Open Access)Enteral nutrition during bone marrow transplantation in patients with pediatric cancer: a prospective cohort study(Associacao Paulista Medicina, 2012-01-01) Garófolo, Adriana [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)CONTEXT AND OBJECTIVE: Cancer patients undergoing bone marrow transplantation (BMT) often require nutritional therapy due to treatment toxicities. The aim here was to evaluate the use of tube feeding and its applicability, indications, contraindications and complications in these patients.DESIGN AND SETTING: Prospective observational study conducted at a public university in Sao Paulo between January 2002 and August 2007.METHODS: The patients were followed up daily in the BMT unit by a research dietitian. Tube feeding was indicated when oral supplementation proved to be insufficient, when the patient had severe malnutrition or there was an impediment to use of oral feeding. It was contraindicated in the presence of gastrointestinal toxicity of grade 3 and 4 or other conditions that implied a risk or hindered its use or placement. Complications of tube feeding were divided into minor and major, according to whether they had life-threatening implications.RESULTS: Forty-two (47.2%) patients had indications for tube feeding: the main reasons were transplantation inadequate food and supplement intake, insufficient intake with malnutrition or weight loss, severe malnutrition or need for oral fasting. Thirty-one (73.8%) received tube feeding: 11 autologous and 20 allogenic patients (P = 0.04). The main contraindications were severe gastrointestinal toxicities and sinusitis. Minor complications from tube feeding were more prevalent in patients with allogenic BMT, but no major complications were observed.CONCLUSION: Enteral nutrition is a feasible procedure in patients undergoing BMT and should be encouraged. The main difficulty in BMT patients, in relation to tube feeding, is gastrointestinal toxicities.
- ItemAcesso aberto (Open Access)Estudo comparativo randomizado entre enxerto de mucosa oral e de túnica vaginal para uretroplastia anterior(Universidade Federal de São Paulo (UNIFESP), 2013) Ximenes, Sergio Felix [UNIFESP]; Soler, Roberto [UNIFESP]; http://lattes.cnpq.br/1116555724359776; http://lattes.cnpq.br/3111239274730825Estudo comparativo randomizado entre enxerto de mucosa oral e de tunica vaginal para uretroplastia anterior Introdução e Objetivos: O enxerto de mucosa oral e o mais utilizados atualmente para uretroplastia de substituicao. Suas propriedades permitem uma reconstrucao uretral segura e com bons resultados. A possibilidade do uso da tunica vaginal como enxerto alternativo a mucosa oral e bem atraente, pois ele e de facil obtencao, geralmente pela mesma incisao da uretroplastia. Para avaliar se o enxerto de tunica vaginal e uma alternativa comparavel ao enxerto de mucosa oral, propusemos o presente estudo. Material e Metodos: Vinte e quatro pacientes do sexo masculino, com media de idade de 46,5 anos, e quadro de estenose de uretra anterior com indicacao de uretroplastia com uso de enxertos foram igualmente randomizados para receber mucosa oral (grupo 1) ou tunica vaginal (grupo 2). O enxerto foi posicionado ventral ou dorsalmente por decisao tecnica no intra-operatorio. Todos os pacientes foram mantidos com cateter uretral por 4 semanas e seguidos por dois anos com urofluxometria livre nos meses 1, 3, 6, 12, 18 e 24. Pacientes com sintomas de esvaziamento ou com urofluxometria inferior a 15 ml/s, foram submetidos a uretrocistografia retrograda e miccional. Foi definido como falha a necessidade de qualquer instrumentacao uretral, incluindo dilatacoes, uretrotomias ou uretroplastia, durante o seguimento. Resultados: Nao houve diferenca entre os dois grupo quanto a idade, peso, indice de massa corporea, comorbidades, etiologia ou uretroplastia previas. Nao houve diferenca em relacao ao local da estenose, com tres casos de estenose de uretra peniana e nove de uretral bulbar em cada grupo. A extensao da estenose e do enxerto foi respectivamente 3,8 e 4,4 cm no grupo 1 e 4,9 e 5,0 cm no grupo 2. Os enxertos foram posicionados ventralmente em tres pacientes, e dorsalmente em 8, em ambos os grupos. O tempo medio de cirurgia foi de 112,9 minutos no grupo 1 e 150 minutos no grupo 2. Apos 24 meses de seguimento, a taxa de sucesso foi de 75% no grupo de mucosa oral e 50% no grupo tunica vaginal (p=0,4). O tempo medio para recorrencia da estenose foi de 15 meses no grupo 1 e 7,7 meses no grupo 2 (p=0,14). Apos analise preliminar dos dados, foi decidido pela nao inclusao de novos pacientes, pela aparente, mas nao estatisticamente significante, inferioridade da tunica vaginal. Conclusao: O enxerto de mucosa oral apresentou taxa de sucesso numericamente, embora nao estatisticamente, superior ao enxerto de tunica vaginal. O tempo decorrido ate a falha do tratamento foi numericamente, embora nao estatisticamente, menor no grupo da tunica vaginal comparado ao grupo mucosa oral
- ItemSomente MetadadadosEstudo da estrutura e função do intestino e fígado para transplante e adesivos em cirurgia(Universidade Federal de São Paulo (UNIFESP), 2005) Taha, Murched Omar [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
- ItemAcesso aberto (Open Access)The role of ischemic preconditioning at the gracilis muscle of rats in the early phase of reperfusion injury(Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia, 2006-04-01) Webster, Ronaldo Scholze [UNIFESP]; Montero, Edna Frasson de Souza [UNIFESP]; Fagundes, Djalma José [UNIFESP]; Zettler, Cláudio Galleano; Coiro, José; Universidade Federal de São Paulo (UNIFESP); Federal College Foundation of Porto Alegre; Lutheran University of Brazil Electronic Microscopy LaboratoryPURPOSE: Verify the role of ischemic preconditioning (IPC) in ischemia and reperfusion injury on gracilis muscle of rats. METHODS: Wistar rats (n=30) were distributed in three groups, I/R and IPC groups were subdivided concerning ischemia time. A near-amputation model of the posterior limb was produced by a hip joint level incision, preserving the vascular bundle and the femur bone and ischemia was induced for 2h and 4h, G-I 2h/R (n=6) and G-I 4h/R (n=6), followed by 1h of vascular reperfusion. The preconditioned groups, G-PCI 2h (n=6) and G-PCI 4h (n=6), were preceded by 3 cycles of 5min of ischemia followed by 5min of vascular reperfusion before sustained ischemia. In the Control Group, C-G (n=6) animals were subjected to regional approach. The analysis was done with Light Microscopy (LM). RESULTS: The levels of fibril fragmentation were progressive in the G-I 2h/R (67% of muscle preservation) and in the G-I4 h/R (0% of muscle preservation). However in the group of the precondition the lesion degree being in level similar to the group controls in the G-I 2h/R (100% of muscle preservation) while at G-I 4h/r occur less protection (67% of muscle preservation). The degree of tissue inflammatory reaction was worst at G-I 4h/R (0% without inflammation signals) than at G-I 2h/R (50% without inflammation signals); while in the precondition group G-IPC-2h (83% without inflammation signals) was better than the G-IPC-4h (67% without inflammation signals). The vascular stasis was absent only in 17% of the G-I 4h/R and in 33% of the G-I 2h/R. In precondition group, however, the vascular stasis was absent in 33% at G-IPC 2h and absent in 50% at G-IPC 4h. CONCLUSION: The IPC showed, in an earlier phase, a benefic role at I/R derived injury on gracilis muscle of rats, as proven for the largest preservation of the fibers muscular, smaller inflammatory reaction and smaller vascular stasis.
- ItemAcesso aberto (Open Access)Vitiligo: analysis of grafting versus curettage alone, using melanocyte morphology and reverse transcriptase polymerase chain reaction for tyrosinase mRNA(Associação Paulista de Medicina - APM, 2005-01-01) Machado Filho, Carlos D'Apparecida Santos [UNIFESP]; Almeida, Fernando Augusto [UNIFESP]; Proto, Rodrigo Sestito; Landman, Gilles [UNIFESP]; Fundação do ABC Faculdade de Medicina Department of Dermatology; Universidade Federal de São Paulo (UNIFESP); Hospital do Câncer Treatment and Research CenterCONTEXT AND OBJECTIVE: Recent studies have indicated that vitiligo areas contain inactive or dormant melanocytes. Melanin synthesis is related to tyrosinase presence and indicative of active metabolic state. The aim of this study was to compare repigmentation, epidermal melanocyte distribution and tyrosinase mRNA detection through reverse transcriptase polymerase chain reaction, in tissue samples of vitiligo, before and after curettage, with or without subsequent autologous skin graft using a new method. DESIGN AND SETTING: Prospective, in the Department of Dermatology, Faculdade de Medicina do ABC, Santo André. METHODS: Two vitiligo areas were curetted. One subsequently received grafted normal sacral autologous skin, whereas the other had no further treatment. The curetted areas were examined after 30 days, to evaluate the degree of repigmentation. The melanocyte percentages and tyrosinase mRNA presence in normal skin and vitiligo areas, before and after curettage and grafting, were compared. RESULTS: Complete repigmentation was seen in all grafted areas, whereas non-grafted curetted vitiligo presented partial repigmentation. The melanocyte percentage in grafted areas was greater than in non-treated vitiligo skin (p = 0.01) and skin with curettage alone (p = 0.015). Tyrosinase mRNA was negative in 93.75% of non-treated vitiligo areas. After treatment (curettage alone or curettage and grafting), all lesions became positive for tyrosinase mRNA. CONCLUSION: Metabolically inactive or dormant melanocytes are probably present within vitiligo areas, and may be activated by exogenous or endogenous stimuli.