Repositório Institucional - Unifesp :: Navegando por Palavras-chave "Endoscopy"

Navegando por Palavras-chave "Endoscopy"

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Acesso aberto (Open Access)
Acute inflammatory response to transgastric natural orifice transluminal endoscopic surgery peritoneoscopy: An experimental study in swine
(Hospital Clinicas, Univ São Paulo, 2013-01-01) Rezende, Marcelo [UNIFESP]; Montero, Edna Frasson de Souza [UNIFESP]; Salomão, Reinaldo [UNIFESP]; Brunialti, Milena [UNIFESP]; Rodrigues, Rodrigo [UNIFESP]; Gomes, Gustavo [UNIFESP]; Della Libera, Alice; Ferrari, Angelo Paulo [UNIFESP]; Della Libera, Ermelindo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)
OBJECTIVE: To investigate the impact of transgastric peritoneal access on plasma biomarkers of acute inflammatory response in comparison to laparoscopy.METHODS: This was a prospective and comparative study in a porcine model. Transgastric peritoneal access performed by natural orifice transluminal endoscopic surgery was compared with laparoscopy. Laparotomy and sham groups were used as positive and negative controls, respectively. Thirty-four pigs were assigned to receive transgastric natural orifice transluminal endoscopic surgery (n = 12), laparoscopy (n = 8), laparotomy (n = 8) or a sham procedure involving only anesthesia (n = 6). in the natural orifice transluminal endoscopic surgery group, peritoneoscopy was performed with a gastroscope via transgastric access. Blood samples were collected at baseline and 1, 3, 6, 9 and 24 h after the surgical procedure for measurement of interleukins 1 beta, 6 and 10 and tumor necrosis factor-alpha. A complete blood count was performed, and C-reactive protein levels were measured at baseline and at 24 h.RESULTS: All surgical and endoscopic procedures were performed without major complications. Peritoneal cavity inventory showed no signs of peritonitis in any animal. Interleukin 1 beta, interleukin 10 and tumor necrosis factor-alpha levels were below the threshold of detection. the mean level of interleukin 6 was statistically significantly higher in the laparotomy group than in the other groups (p < 0.05), with no significant differences among the sham, laparoscopy and natural orifice transluminal endoscopic surgery groups (p > 0.05). C-reactive protein analysis indicated significant increases in all groups, with no differences among the groups. Complete blood count analysis showed no differences among the groups.CONCLUSIONS: Based on the observed interleukin 6 patterns, the systemic inflammatory response resulting from transgastric peritoneal access by natural orifice transluminal endoscopic surgery is similar in intensity to the response that occurs after laparoscopy.
Acesso aberto (Open Access)
Angled telescopic surgery, an approach for laryngeal diagnosis and surgery without suspension
(Associação Paulista de Medicina - APM, 1999-09-02) Morgado, Plínio Ferreira; Abrahão, Márcio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
CONTEXT: Many methods have been used successfully for the diagnosis and treatment of laryngeal diseases. Microscopic and, recently, telescopic surgery represent the state of the art in endoscopic laryngeal surgery but drawbacks are possible during their application. To keep the suspension apparatus adequately positioned, excessive force is sometimes placed on the upper teeth and tongue with the laryngoscope tube causing damage. Complications in relation to the pharynx, larynx and cardiovascular system have also been reported. OBJECTIVE: In order to reduce complications resulting from the manipulation or stimulation of the upper aerodigestive tract and from torque forces on the upper teeth. We present a method of larynx surgery in which laryngeal suspension is not required. DESIGN: Technical report. TECHNIQUES: We have devised a fiber-optic telescope with its 40mm distal portion deviated 60 degrees from the direction of the proximal portion. This angle was taken by measuring patients immediately before standard microlaryngeal surgery was performed. The surgical instruments have the same angle as the telescope, in order to work on the larynx. This technique provides an image that is not limited by the distal aperture of the laryngoscope and has an advantage in that magnification and illumination may be provided by changing the distance of the lesion from the tip of the instrument. we have operated on four patients with laryngeal diseases and have had no complications as a result of this approach. We feel that this technique gives us the freedom to view the lesions better and helps to minimize the drawbacks caused by laryngeal suspension.
Acesso aberto (Open Access)
Avaliação da rinussinusite bacteriana aguda em pacientes asmáticos com base em parâmetros clínicos, exame otorrinolaringológico e estudo de imagem
(Sociedade Brasileira de Pneumologia e Tisiologia, 2008-06-01) Faure, Alecsandra Calil Moises [UNIFESP]; Santoro, Ilka Lopes [UNIFESP]; Weckx, Luc Louis Maurice [UNIFESP]; Lederman, Henrique Manoel [UNIFESP]; Fernandes, Artur da Rocha Correa [UNIFESP]; Fernandes, Ana Luisa Godoy [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
OBJECTIVE: To evaluate paranasal sinuses in patients with stable or acute asthma in order to determine the prevalence of acute bacterial rhinosinusitis. METHODS: A cross-sectional study including 30 patients with acute asthma (73% females) treated in the emergency room and 30 patients with stable asthma (80% females) regularly monitored as outpatients. All patients completed a questionnaire on respiratory signs and symptoms and were submitted to ear, nose and throat (ENT) examination, as well as to X-ray and computed tomography (CT) imaging of the sinuses. RESULTS: Based on the clinical diagnosis, the prevalence of acute bacterial rhinosinusitis was 40% in the patients with acute asthma and 3% in those with stable asthma. The ENT examination findings and the imaging findings in isolation were not useful to confirm the diagnosis. CONCLUSIONS: In themselves, ENT examination findings, X-ray findings and CT findings were not useful for the diagnosis of acute bacterial rhinosinusitis. Our results provide further evidence that a clinical diagnosis of bacterial rhinosinusitis should be made with caution.
Acesso aberto (Open Access)
Avaliação do teste rápido da urease conservado em geladeira
(Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia - IBEPEGE Colégio Brasileiro de Cirurgia Digestiva - CBCD Sociedade Brasileira de Motilidade Digestiva - SBMD Federação Brasileira de Gastroenterologia - FBGSociedade Brasileira de Hepatologia - SBHSociedade Brasileira de Endoscopia Digestiva - SOBED, 2000-07-01) Ornellas, Laura Cotta [UNIFESP]; Cury, Marcelo de Souza [UNIFESP]; Lima, Vinícius Machado de [UNIFESP]; Ferrari, Angelo Paulo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
The rapid urease test is an accurate and cheap method, which results are readily available, and broadly used for routine Helicobacter pylori infection diagnosis. Aim - The evaluation of rapid urease test stored in refrigerator at 4 °C (SRUT) compared to regular rapid urease test. Patients and Method - Endoscopic biopsies were obtained from gastric antrum in 104 consecutive patients. Diagnosis of Helicobacter pylori infection was accomplished by rapid urease test, histology and rapid urease test stored (kept in refrigerator by a period ranging from 1 to 8 days). Results - Infection was considered present if both rapid urease test and histology were positive. Helicobacter pylori was present in 45/104 patients (42%). Rapid urease test stored had specificity comparable to rapid urease test (93%), with sensitivity of 88%. Conclusion - We concluded that rapid urease test can be stored in refrigerator for up to 1 week, without loss of clinical applicability, and that can make the test even easier to use for routine Helicobacter pylori tests in a busy endoscopy unit.
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Contribuição ao diagnóstico imediato das lesões ulceradas gastro-esofágicas atraves da citopatologia: estudo comparativo de 580 casos de biópsias com escovados dirigidos pela endoscopia
(Universidade Federal de São Paulo (UNIFESP), 1994) Souza, Antonio Francisco de [UNIFESP]; Stávale, João Norberto [UNIFESP]
Acesso aberto (Open Access)
Eficácia e complicações da drenagem de pseudocistos de pâncreas guiada por ecoendoscopia
(Universidade Federal de São Paulo (UNIFESP), 2019-05-30) Sousa, Giovana Biasia De [UNIFESP]; Libera Junior, Ermelindo Della [UNIFESP]; Nakao, Frank Shigueo [UNIFESP]; http://lattes.cnpq.br/8755026089314875; http://lattes.cnpq.br/0528784228011000; http://lattes.cnpq.br/8684478554601684; Universidade Federal de São Paulo (UNIFESP)
Introduction: Pancreatic pseudocyst refers specifically to a fluid collection in the peripancreatic tissues that it surrounded by a well defined wall and contains essentially no solid material. It has been successfully treated by EUS-guided drainage using different stents. Aims: to evaluate the safety and efficacy of EUS-guided pancreatic pseudocyst drainage using plastic double-pigtail stents in a tertiary hospital. Patients and Methods: we reviewed the results of 9 patients (median age 42 years [range: 14 – 79]; 67% male) with symptomatic pancreatic pseudocyst. Indication EUS-guided drainage was abdominal pain (8), gastric outlet obstruction (4) and biliary obstruction (1). The etiology was acute pancreatitis (4), chronic pancreatitis (3) and blunt abdominal trauma (2). Pseudocyst mean size was 9,8cm (range 5,3-13,5cm). Only patients presenting pancreatic pseudocyst according to The Revised Atlanta Classification were included in this study. Pseudocysts were treated with EUS-guided cystogastrostomy (8) and cystoduodenostomy (1). Overall recorded outcomes were technical success rate, clinical success rate, minor and major adverse events, mortality and recurrence. The criterion for stent removal was pseudocyst resolution on computed tomography scan. Results: Technical success rate was 100% (6 patients with 2 double-pigtail plastic stents and 3 patients with only one double-pigtail plastic stent). Overall clinical success and image pseudocyst resolution 4 – 6 months after initial drainage was 89% (8/9). Minor adverse events occurred in 3/9 patients (33%): false guidewire path with no clinical consequence, early stent migration and stent occlusion. There were no major events adverses. There was a recurrence in (1/9 patients) and no mortality. Conclusions: We concluded that EUS-guided transmural drainage of pancreatic pseudocyst using plastic double-pigtail stents is a safe procedure, resulting in clinical improvement and pseudocyst resolution in most of the patients.
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ENDONASAL VERSUS SUPRAORBITAL KEYHOLE REMOVAL of CRANIOPHARYNGIOMAS and TUBERCULUM SELLAE MENINGIOMAS
(Lippincott Williams & Wilkins, 2009-05-01) Fatemi, Nasrin; Dusick, Joshua R.; Paiva Neto, Manoel A. de [UNIFESP]; Malkasian, Dennis; Kelly, Daniel F.; St Johns Hlth Ctr; Univ Calif Los Angeles; Universidade Federal de São Paulo (UNIFESP)
OBJECTIVE: Endonasal and supraorbital eyebrow craniotomies are increasingly being used to remove craniopharyngiomas and tuberculum sellae meningiomas. Herein, we assess the relative advantages, disadvantages, and selection criteria of these 2 keyhole approaches.METHODS: All consecutive patients who had endonasal or supraorbital removal of a 1 craniopharyngioma or tuberculum sellae meningioma were analyzed.RESULTS: of 43 patients, 22 had a craniopharyngioma (18 endonasal, 4 supraorbital), and 21 had a meningioma (12 endonasal, 7 supraorbital, 2 both routes); 33% had prior surgery. Craniopharyngiomas were primarily retrochiasmal in location in 78% of endonasal cases versus 25% of supraorbital cases (P = 0.08). Meningiomas were larger when approached by the supraorbital route versus the endonasal route (33 10 versus 25 +/- 8 mm, respectively; P = 0.008). Endoscopy was used in 84% of endonasal approaches and in 31% of supraorbital approaches (P = 0.001). of patients having p first-time surgery for a craniopharyngioma (n = 14) or meningioma (n = 15), total/near total removal was achieved in 83% and 80% of patients by the endonasal route and in 50% and 80% of patients by the supraorbital route, respectively. Vision improved in 87% and 70% of patients who had surgery by an endonasal versus supraorbital route, i respectively (P = 0.3). Visual deterioration occurred in 2 patients with meningiomas, 1 1 by endonasal (7%), and 1 by supraorbital (11%) removal. the endonasal approach was associated with a higher rate of postoperative cerebrospinal fluid leaks (16 versus 0%; P = 0.3), 4 of 5 of which occurred in patients with meningioma.CONCLUSION: the endonasal route is preferred for removal of most retrochiasmal craniopharyngiomas, whereas the supraorbital route is recommended for meningiomas larger than 30 to 35 mm or with growth beyond the supraclinoid carotid arteries. for smaller midline tumors, either approach can be used, depending on surgeon experience and tumor anatomy. Compared with traditional craniotomies, the major limitation of both approaches is a narrow surgical corridor. the endonasal approach has the added challenges of restricted lateral suprasellar access, a greater need for endoscopy, and a more demanding cranial base repair.
Acesso aberto (Open Access)
Endoscopic Evaluation of Adenoids: Reproducibility Analysis of Current Methods
(Korean Soc Otorhinolaryngol, 2013-03-01) Feres, Murilo Fernando Neuppmann [UNIFESP]; Hermann, Juliana Sato [UNIFESP]; Sallum, Ana Carolina [UNIFESP]; Pignatari, Shirley Shizue Nagata [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Objectives. TO investigate intra- and interexaminers' reproducibility of usual adenoid hypertrophy assessment methods, according to nasofiberendoscopic eXamination.Methods. Forty children of both sexes, ages ranging between 4 and 14 years, presenting with nasal obstruction and oral breathing suspected to be caused by adenoid hypertrophy, were enrolled in this study, Patients were evaluated by nasofiberendoscopy, and records were referred to and evaluated by two experienced otolaryngologists. Examiners analysed the records according to different evaluation methods; i.e., estimated, and measured percentage of choanal occlusion; as well as Subjective and objective classificatory systems of adenoid hypertrophy.Results. Data disclosed excellent intraexarniner reproducibility for both estimated and measured choanal occlusion. Interexaminers analysis revealed lower reproducibility rates of estimated in relation to measured choanal occlusion. Measured choanal occlusion also demonstrated less agreement among evaluations made through the right and left sides of the nasal cavity. Alternatively, intra- and interexaminers reliability analysis revealed higher agreement for subjective than objective classificatory system. Besides, subjective method demonstrated higher agreement than the objective classificatory system, when opposite sides were compared.Conclusion. Our results suggest that Measured is superior to estimated percentage of choanal occlusion, particularly if employed bilaterally, diminishing the lack of agreement between sides. When adenoid categorization is used instead, the authors recommend Subjective rather than objective classificatory system of adenoid hypertrophy.
Acesso aberto (Open Access)
Esophageal ulcer and alendronate
(Associação Paulista de Medicina - APM, 1998-11-01) Ferrari, Angelo Paulo [UNIFESP]; Domingues, Sérgio Hernani Stuhr [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
OBJECTIVE: To describe a case of esophageal ulcer associated with the use of alendronate.CASE REPORT: This is the fifth case ever described in the literature according to our bibliographic review. In our patient, the association between the drug and the esophageal lesions was masked by the presence of a hiatal hernia, potentially a cause of the esophageal lesion. The persistence of the lesions despite high doses of anti-reflux therapy called attention to the possibility of the relationship. The esophageal lesion healed soon after suspension of alendronate.DISCUSSION: The authors present a review of the literature and point to the need for diagnostic investigation, to suspend such a drug from patients who experience dyspeptic symptoms while using it.
Acesso aberto (Open Access)
Estapedotomia endoscópica versus microscópica : comparação de resultados
(Universidade Federal de São Paulo (UNIFESP), 2017-05-31) Lira, Francisco Iure Sampaio [UNIFESP]; Testa, José Ricardo Gurgel [UNIFESP]; http://lattes.cnpq.br/1154965263654209; http://lattes.cnpq.br/0292186947921833; Universidade Federal de São Paulo (UNIFESP)
Objetivo: Comparar os resultados da estapedotomia realizada com o microscópio com a feita via endoscópica, bem como possíveis diferenças na incidência de complicações pós-operatórias. Método: Estudo de coorte histórica, transversal, por meio de revisão de prontuários, de todos os pacientes com diagnóstico de otosclerose submetidos a estapedotomia no período de fevereiro de 1994 a dezembro de 2015. Os pacientes foram divididos em grupo I (microscópio) e grupo II (endoscópio). Foram avaliados gap aéro-ósseo, PTA da via óssea e IRF pré e pós-operatórios, além das complicações em ambos os grupos, e comparados entre si. No total, foram identificados 121 pacientes e 129 procedimentos. Todas as cirurgias foram feitas pelo mesmo cirurgião. Resultados: Não houve diferença estatística entre os grupos, seja no fechamento do gap aéro-ósseo, variação do PTA da via óssea ou IRF. A incidência de complicações também foi semelhante entre os grupos. Conclusão: O endoscópio pode ser utilizado na realização da estapedotomia, com bons resultados e baixa incidência de complicações.
Acesso aberto (Open Access)
Estudo prospectivo randomizado do tratamento endoscópico da coloproctopatia actínica crônica hemorrágica: eletrocauterização com plasma de argônio versus bipolar
(Universidade Federal de São Paulo (UNIFESP), 2010-02-24) Lenz Tolentino, Luciano Henrique [UNIFESP]; Ferrari, Angelo Paulo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Introduction: Chronic radiation coloproctopathy (CRCP) is a well-recognized complication of radiotherapy. Rectal bleeding is the most common symptom of radiation injury and the optimal endoscopic treatment of bleeding due to CRCP is still controversial. Aim: To compare the efficacy and safety of bipolar eletrocauterization (BEC) and argon plasma eletrocauterization (APE) in the management of bleeding from CRCP. Methods: Thirty patients with active bleeding from telangiectasias were enrolled, randomized into two groups (15 BEC and 15 APE) and classified according to Saunders score. Power settings were 50 W for BEC and 40 W for APE. Initial treatment was performed after a complete colonoscopy to rule out synchronous lesions and follow-up was performed with flexible sigmoidoscopies. Success was defined as eradication of all telangiectasias. Failure was defined whenever more than seven sessions or other therapies were necessary for treatment of bleeding. Complications were divided into three different groups: sensory (anal pain, abdominal pain and/or fever), hemorrhagic (worsening of bleeding during treatment, bleeding from ulcers) and anatomic/motor (tapered feces, stenosis and/or pseudopolyps). Results: Mean age was 67.4 years (range 33-82), with 14 women and 16 men. There was no significant difference regarding the number of sessions in both groups (p = 0.313). There were no significant differences regarding sensory (p = 0.245) hemorrhagic (p = 0.169) or anatomic/motor (p = 0.700) complications between both groups. However, the overall complication rate was significantly higher in EB group (p = 0.020). Only one failure was observed in each group (p = 1.000). There was also no significant difference regarding relapse (p = 1.000) Conclusions: BEC and APE are equally effective in patients with bleeding telangiectasias from CRCP. Nevertheless, APE is safer than EB.
Acesso aberto (Open Access)
Estudo tomográfico dos septos intraesfenoidais e de suas relações com a artéria carótida interna
(Universidade Federal de São Paulo (UNIFESP), 2015-09-24) Ramalho, Clauder Oliveira [UNIFESP]; Zymberg, Samuel Tau [UNIFESP]; http://lattes.cnpq.br/9399440722396953; http://lattes.cnpq.br/9935159506667085; Universidade Federal de São Paulo (UNIFESP)
Introdução: Septos intraesfenoidais são estruturas ósseas encontradas no interior dos seios esfenoidais. Quando possuem proximidade à artéria carótida interna podem aumentar o risco de lesão vascular durante a realização da cirurgia transesfenoidal expandida, na qual uma ampla esfenoidotomia com ressecção desses septos é necessária. Esse trabalho visa avaliar os septos intraesfenoidais e suas relações com a artéria carótida interna. Métodos: Tomografias de 421 pacientes sem história de doenças em seios paranasais e cirurgia endonasal foram analisadas. Os septos intraesfenoidais foram classificados em interesfenoidias e acessórios. A frequência da relação entre os septos e a artéria carótida interna foi descrita. Realizou-se também uma classificação dos seios esfenoidais em tipos 1 a 5, de acordo com a aeração em relação à sela turca, com objetivo de avaliar se há diferença nessa frequência para cada tipo de pneumatização sinusal. Resultados: Um total de 359 (85,3%) dos pacientes apresentavam septo interesfenoidal e 135 (37,6%) deles relacionavam-se à artéria carótida interna. Em seios tipo 4 e 5, essa relação chegou a 44,7 e 43,5%, respectivamente. Em seios tipo 3, essa relação foi de apenas 14,1%. Septos acessórios foram encontrados em 255 (60,6%) dos pacientes e 140 (54,9%) deles relacionavam-se à artéria carótida interna. Um total de 219 (52%) pacientes tinham achados tomográficos de qualquer tipo septo ligado à artéria carótida interna. Tipos 1 e 2, pela pouca aeração, não apresentavam essa relação. Entre apenas os seios tipo 3, 4 e 5, em 219 (62,4%) ela estava presente. Esses valores foram maiores que os descritos em estudos prévios, exceto por um trabalho. Conclusão: A alta frequência de septos intraesfenoidais relacionados à artéria carótida interna implica em uma atenção especial no estudo pré-operatório dessas estruturas, visando reduzir o risco de lesão vascular em cirurgia transesfenoidal expandida.
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Gastroesophageal reflux disease. International evidence-based consensus on the definition of GERD in children and adolescents
(Springer, 2010-02-01) Sherman, P. M.; Hassall, E.; Fagundes-Neto, U. [UNIFESP]; Gold, B. D.; Kato, S.; Koletzko, S.; Orenstein, S.; Rudolph, C.; Vakil, N.; Vandenplas, Y.; Univ Munich; Univ Toronto; Univ British Columbia; Universidade Federal de São Paulo (UNIFESP); Emory Univ; Tohoku Univ; Univ Pittsburgh; Med Coll Wisconsin; Univ Wisconsin; Marquette Univ; Vrije Univ Brussels
An international consensus on the definition of gastroesophageal reflux disease (GERD) in pediatrics was sought.After a systematic literature search, a set of key statements was developed by an international panel of pediatric gastroenterologists and voted anonymously in a modified Delphi process. the strength of each statement was assessed using the GRADE system.Consensus was reached on 98% of the 59 statements. Consensus items of particular note were: (1) GERD is present when reflux of gastric contents causes troublesome symptoms and/or complications. the definition is restricted in the case of children under similar to 8 years, due to unreliable reporting of incriminating symptoms; (2) the primary role of histology is to exclude other conditions, rather than to establish the diagnosis of GERD; (3) Barrett's esophagus characterizes an esophageal metaplasia that is intestinal metaplasia-positive or -negative; (4) extraesophageal conditions may be associated with GERD, but for most of these conditions causality remains to be established.The consensus statements were developed by means of a rigorous process and can form the basis for clinical trials and practice guidelines.
Acesso aberto (Open Access)
Hemorragia digestiva por fístula de artéria subclávia direita anômala com o esôfago
(Associação Médica Brasileira, 1998-06-01) Colleoni Neto, Ramiro [UNIFESP]; Figueira, A. [UNIFESP]; Belassai, E. [UNIFESP]; Jorge Junior, M.e. [UNIFESP]; Del Grande, José Carlos [UNIFESP]; Cardoso, S.h. [UNIFESP]; Haddad, C.m. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Bleeding from an arterio-esophageal fistula is a rare and nearly lethal condition and surgical treatment is the only curative option. We report a case of bleeding from a fistula from an aberrant right subclavian artery to the esophagus. Diagnosis was made only at necropsy, despite of three previous laparotomies. This anatomical variation is found in 0.5% of the general population. Development of a communication between this artery and the esophagus, secondary to aneurysmatic dilatation or to prolonged nasogastric intubation, as probably occurred with this patient, is a extremely rare condition. Surgical treatment depends on the early recognition of clinical signs of the arterio-esophageal comunication, before the onset of systemic complications of hypovolemic shock.
Acesso aberto (Open Access)
Infecção por H. pylori, aspectos endoscópicos, histológicos e da proliferação celular na mucosa gástrica de pacientes submetidos à gastroplastia em Y de Roux com anel de contenção: estudo transversal endoscópico e imuno-histoquímico
(Universidade Federal de São Paulo (UNIFESP), 2015-09-30) Nogueira, Thiago de Bortoli [UNIFESP]; Waisberg, Jaques [UNIFESP]; Artigiani Neto, Ricardo [UNIFESP]; Herani Filho, Benedito [UNIFESP]; http://lattes.cnpq.br/7014919949145135; http://lattes.cnpq.br/8460046196903231; http://lattes.cnpq.br/8934019906857162; Universidade Federal de São Paulo (UNIFESP)
Introdução: A cirurgia bariátrica é a abordagem mais eficaz para alcançar a perda de peso em pacientes com obesidade grave. Uma das mais realizadas é a gastroplastia vertical com derivação gastrojejunal em Y de Roux (DGYR). Inicialmente, essa técnica foi bastante realizada com anel de contenção, envolvendo a porção distal da bolsa gástrica. Entretanto essa técnica precisa ser mais bem avaliada em estudos de longo prazo, que analisem a existência de alterações macroscópicas e histopatológicas gástricas. Objetivo: Analisar os achados endoscópicos e histológicos, a expressão do antígeno Ki67 e a prevalência do Helicobacter pylori na mucosa do antro e corpo gástricos, no pré-operatório e na bolsa gástrica no pós-operatório de pacientes submetidos ao tratamento cirúrgico para obesidade mórbida, pela gastroplastia vertical com derivação gastrojejunal em Y de Roux com anel de contenção. Métodos: Foram avaliados, retrospectivamente, 33 pacientes submetidos à gastroplastia vertical com DGYR e anel de contenção, durante mais de 60 meses de seguimento pós-operatório. Foi realizado o estudo comparativo dos achados endoscópicos e histológicos do trato digestivo superior no pré e no pós-operatório e da proliferação celular por meio da expressão imuno-histoquímica do anticorpo Ki67. Resultados: A mucosa gástrica estava endoscopicamente normal no pré-operatório em 24 (72,7%) pacientes e no pós-operatório também em 24 (72,7%). No pré-operatório foram encontrados 3 (9,0%) pacientes com gastrite erosiva leve de corpo e antro, e que normalizaram o aspecto da mucosa gástrica no pós-operatório. Houve um (3,0%) paciente com gastrite enantematosa multifocal moderada no pré-operatório, e que apresentou, no pós-operatório, úlceras pépticas na porção gástrica e jejunal da anastomose, com erosão parcial do anel de contenção. No pré-operatório, foi encontrada gastrite histológica em 23 (69,7%) pacientes. No pós-operatório observou-se metaplasia intestinal em 3 (9,0%) pacientes e atrofia da mucosa gástrica em 4 (12,1%); outros 3 (9,0%) deles apresentavam os dois achados. Gastrite histológica pós-operatória ocorreu em 28 (84,8%) casos. No pré-operatório, o H. pylori estava histologicamente presente em 6 (18,2%) pacientes e no pós-operatório em 19 (57,5%) casos. Em dois (6%) pacientes, o H. pylori esteve presente antes e ausente após a operação. No pré-operatório, o índice de proliferação celular avaliado pela imunoexpressão do marcador Ki-67 no antro e no corpo gástrico, foi de 18,1% e 16,2%, respectivamente, enquanto que no pós-operatório foi de 23,8% na bolsa gástrica. Não se observou concordância estatística entre os achados endoscópicos e histológicos (p=0,1). O tempo de pós-operatório não apresentou concordância significante em relação aos achados endoscópicos (p=0,5) e histológicos (p=0,3). O maior índice de proliferação celular associou-se à presença do H. pylori (p<0,05). A intensidade da gastrite histológica da bolsa gástrica associou-se à presença do H. pylori (p < 0,05). Conclusões: Os achados histológicos indicaram prevalência elevada de gastrite crônica na bolsa gástrica e que não se relacionou com os achados endoscópicos. A intensidade da inflamação e o maior índice de proliferação celular encontrados na bolsa gástrica associaram-se à presença de H. pylori e foram maiores no período pós-operatório. A presença do H. pylori foi mais elevada na bolsa gástrica de pacientes com maior tempo de pós-operatório.
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Influence of the Actual Diameter of the Gastric Pouch Outlet in Weight Loss After Silicon Ring Roux-en-Y Gastric Bypass: An Endoscopic Study
(Springer, 2010-09-01) Mali, Jorge [UNIFESP]; Mardiros Herbella Fernandes, Fernando Augusto [UNIFESP]; Valezi, Antonio Carlos; Matsuo, Tiemi; Menezes, Mariano de Almeida; Universidade Estadual de Londrina (UEL); Universidade Federal de São Paulo (UNIFESP)
Some sort of restriction of the pouch emptying is supported by many surgeons to allow a sustained weight loss through the use of a ring placed circumferentially around the gastric pouch. Most previous studies focused on the length of the ring, not the actual diameter of the gastric pouch outlet. This study aims to evaluate the association between the actual diameter of the gastric pouch outlet and the weight loss in obese patients submitted to silicon ring Roux-en-Y gastric bypass. We studied prospectively 257 patients that underwent silicon ring (65 mm) Roux-en-Y gastric bypass between July 2005 and August 2007. Upper digestive endoscopy was performed to measure the diameter of the gastric pouch outlet at 1 and 2 years with the aid of calibrated balloons. the diameter of the gastric pouch outlet ranged from 9 to 14 mm (mean = 11 mm). Excess weight loss ranged from 37% to 127% (mean = 69%) during the first year and 29% to 110% (mean = 69%) during the second year. A negative correlation between the diameter of the gastric pouch outlet and excess weight loss at first year (r = -0.792, p < 0.001) and at the second year of follow-up (r = -0.921, p < 0.001) was found. the actual diameter of the gastric pouch outlet was associated with weight loss after silicon ring Roux-en-Y gastric bypass during the 2-year follow-up.
Acesso aberto (Open Access)
Micro-endoscopic ear anatomy of guinea pig applied to experimental surgery
(Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia, 2014-01-01) Barros, Bruno Borges de Carvalho [UNIFESP]; Andrade, José Santos Cruz de [UNIFESP]; Garcia, Leandro Borborema; Pifaia, Gustavo Ribeiro; Cruz, Oswaldo Laércio Mendonça [UNIFESP]; Onishi, Ektor Tsuneo; Penido, Norma de Oliveira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Federal University - São Paulo
PURPOSE:To describe topographic and endoscopic anatomy of guinea pig ear for development of surgical approaches in experimental studies.METHODS:Experimental study. Eight adult guinea pigs (Cavia porcellus) were used in this study. Four animals were described through endoscopic view and four animals were used to describe topographic anatomy.RESULTS:The main structures of middle ear were well identified through endoscopy view: oval and round window, ossicles and vascular structures. Temporal bone position, landmarks and its relations to skull are perceived with topographic description.CONCLUSION:Topographic anatomic description allowed exposition of temporal bone relations for external surgical approaches. Alternatively, grooves and middle ear structures were identified and may be used to transcanal accesses.
Acesso aberto (Open Access)
Over-expression of cyclooxygenase-2 in endoscopic biopsies of ectopic gastric mucosa
(Associação Brasileira de Divulgação Científica, 2007-11-01) Martins, Fernanda Prata [UNIFESP]; Artigiani Neto, Ricardo [UNIFESP]; Oshima, Celina Tizuko Fujiyama [UNIFESP]; Costa, Patricia Piauilino da [UNIFESP]; Forones, Nora Manoukian [UNIFESP]; Ferrari, Angelo Paulo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Ectopic gastric mucosa (EGM) is considered to be a congenital condition. Rare cases of adenocarcinoma have been described. There are no data justifying regular biopsies or follow-up. Cyclooxygenase-2 (COX-2) is a protein involved in gastrointestinal tumor development by inhibiting apoptosis and regulating angiogenesis. The aim of this prospective study was to evaluate COX-2 expression in EGM and compare it with normal tissue and Barrett's esophagus. We evaluated 1327 patients. Biopsies were taken from the inlet patch for histological evaluation and from the gastric antrum to assess Helicobacter pylori infection. Biopsies taken from normal esophageal, gastric antrum and body mucosa and Barrett's esophagus were retrieved from a tissue bank. EGM biopsies were evaluated with respect to type of epithelium, presence of H. pylori, and inflammation. COX-2 was detected by immunohistochemistry using the avidin-biotin complex. EGM islets were found in 14 patients (1.1%). Histological examination revealed fundic type epithelium in 58.3% of cases, H. pylori was present in 50% and chronic inflammation in 66.7%. Expression of COX-2 was negative in normal distal esophagus, normal gastric antrum and normal gastric body specimens (10 each). In contrast, EGM presented over-expression of COX-2 in 41.7% of cases and Barrett's esophagus in 90% of cases (P = 0.04 and 0.03, respectively). COX-2 immunoexpression in EGM was not related to gender, age, epithelium type, presence of inflammation or intestinal metaplasia, H. pylori infection, or any endoscopic finding. Our results demonstrate up-regulation of COX-2 in EGM, suggesting a possible malignant potential of this so-called harmless mucosa.
Acesso aberto (Open Access)
Percutaneous endoscopic gastrostomy in porcines performed with standard medical instruments used in a general hospital routine
(Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia, 2004-10-01) Nascimento, Luiz Roberto Do [UNIFESP]; Nascimento, Caroline Moreira Do; Camargos, Fabiano Andrade; Grecco, Eduardo Carlos; Universidade Federal de São Paulo (UNIFESP); UNIFENAS Alfenas Medical School; Santa Catarina Hospital Gastroenterological Endoscopy Center Head of Colonoscopy Unit
PURPOSE: To perform a endoscopic gastrostomy by the introducer method with routine instruments used in a general hospital, without special instruments or special kits. METHODS: This procedure was performed in pigs (Sus scrofa domesticus) under observation for seven days and then submitted to euthanasia.The technique was evaluated for macroscopic and histologic parameters. RESULTS: All animals had a good evolution without major complications. Some minor complications occurred like a rupture of Foley catheter balloon and subcutaneous space abscess. CONCLUSION: The percutaneous gastrostomy with routine general hospital instruments is successful performed, is safe,cheap and must be performed by skilled endoscopists.
Acesso aberto (Open Access)
Quebrando paradigmas na epistaxe grave: a importância de procurar o S-point
(Assoc Brasileira Otorrinolaringologia & Cirurgia Cervicofacial, 2018) Kosugi, Eduardo Macoto [UNIFESP]; Balsalobre, Leonardo [UNIFESP]; Mangussi-Gomes, Joao [UNIFESP]; Tepedino, Miguel Soares; San-da-Silva, Daniel Marcus [UNIFESP]; Cabernite, Erika Mucciolo; Hermann, Diego; Stamm, Aldo Cassol
Introduction: Since the introduction of nasal endoscopy into the field of Otorhinolaryngology, the treatment paradigm for cases of severe epistaxis has shifted toward early and precise identification of the bleeding site. Although severe epistaxis is usually considered to arise from posterior bleeding, an arterial vascular pedicle in the superior portion of the nasal septum, around the axilla projection of the middle turbinate, posterior to the septal body, frequently has been observed. That vascular pedicle was named the Stamm's S-point. Objective: The aim of this study was to describe the S-point and report cases of severe epistaxis originating from it. Methods: A retrospective case series study was conducted. Nine patients with spontaneous severe epistaxis, where the S-point was identified as the source of bleeding, were treated between March 2016 and March 2017. Results: Male predominance (77.8%) with age average of 59.3 years old were reported. Most cases presented comorbidities (88.9%) and were not taking acetylsalicylic acid (66.7%). A predominance of left sided involvement (55.6%) and anteroposterior bleeding being the principal initial presentation (77.8%) was seen. Six patients (66.7%) presented with hemoglobin levels below 10g/dL, and four (44.4%) required blood transfusion. Cauterization of S-point was performed in all patients, with complete resolution of bleeding. No patient experienced recurrence of severe epistaxis. Conclusion: The Stamm's S-point, a novel source of spontaneous severe epistaxis, is reported, and its cauterization was effective and safe. Otolaryngologists must actively seek this site of bleeding in cases of severe epistaxis. (C) 2018 Associacao Brasileira de Otorrinolaringologia e Cirurgia Cervico-Facial. Published by Elsevier Editora Ltda. This is an open access article under the CC BY license.

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