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- ItemAcesso aberto (Open Access)Efficacy of absolute alcohol injection compared with band ligation in the eradication of esophageal varices(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, 2005-06-01) Ferrari, Angelo Paulo [UNIFESP]; Paulo, Gustavo Andrade De [UNIFESP]; Macedo, Claudia Maria Ferreira De; Araújo, Isabela [UNIFESP]; Della Libera Jr, Ermelindo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)BACKGROUND: Endoscopic sclerotherapy is an absolute indication for treating esophageal varices. Re-bleeding is common during the treatment period, before all varices become eradicated. AIM: To compare two techniques of endoscopic esophageal varices eradication: sclerotherapy with absolute alcohol and banding ligation. PATIENTS AND METHOD: Forty-six patients with liver cirrhosis and esophageal varices were prospectively randomized into two treatment groups: endoscopic sclerotherapy with absolute alcohol and banding ligation. Patients were included if they had large varices with signs of high bleeding risk. Informed writing consent was obtained from every patient and the Ethics Committee of Federal University of São Paulo, SP, Brazil, approved the study. After eradication, all patients were followed up to 1 year to look for re-bleeding episodes and variceal recurrence. RESULTS: Both groups were similar except that male gender was more common in the sclerotherapy group. There was no statistical difference regarding variceal eradication (78.3% in sclerotherapy group vs 73.9% in the ligation group), recurrence (26.7% vs 42.9%, respectively) and death related to any cause (21.7% vs 13.9%). In the sclerotherapy group more sessions were need to obtain complete variceal eradication. In this group we did observe a high re-bleeding rate (34.8%) and more ulcers associated with retrosternal pain right after the procedure. There was no difference regarding overall morbidity and mortality. CONCLUSIONS: Banding ligation requires fewer sessions than sclerotherapy with absolute alcohol to eradicate esophageal varices. Both methods are equally efficient regarding variceal eradication and recurrence during a short follow-up period.
- ItemSomente MetadadadosLigadura com algodão e com grampos de titânio em artérias de cães: estudo comparativo em máquina simuladora de pressão(Universidade Federal de São Paulo (UNIFESP), 1996) Soares, Adriano Leite [UNIFESP]; Goldenberg, Saul [UNIFESP]
- ItemAcesso aberto (Open Access)Ligadura com algodão e com grampos de titânio em artérias de cães: estudo experimental em máquina simuladora de pressão(Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia, 2001-12-01) Soares, Adriano Leite [UNIFESP]; Goldenberg, Saul [UNIFESP]; Novo, Neil Ferreira [UNIFESP]; Lima, Cirilo Antônio De Paula [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)The development of the video laparoscopic surgery has brought the necessity of standardizing the artery ligation with titanium clips in order to minimize operation time. The aim of this study is to investigate and compare the arterial ligation with cotton thread, and also with one, two or three titanium clips. Consequently, eigthy arteries of twenty mongrel s dogs were utilized. Each of the dog had their right and left axillary arteries, as well as the rigth and left femoral arteries used. Those arteries had been previously distributed in 4 groups, being previously chosen by lot and in turns. After arterial dissection and ligation, the arteries were submitted to 100 mmHg and 300 mmHg of pressure, and a pulsation rate of 70 bumps per minute, that was obtained by an arterial pressure simulation machine. There was a liquid escape from 3 arteries, which belonged to the one-titanio-clip group. This escape, that is statistically significant occurred in less than 15 minutes. Furthermore, the results show that the arterial ligation with one titanio clip has a great probability of escaping, contrary to the ligation done with cotton thread, as well as the ones done with two or three titanium clips. Therefore, there is no difference between the ligation with cotton thread and two or three titânio clips, if they are submited to 300 mmHg of pressure and a pulsation rate of 70 bumps per minutes.
- ItemSomente MetadadadosLigadura da veia renal esquerda em ratos EPM 1-Wistar: complicações renais, testiculares e supra-renais(Universidade Federal de São Paulo (UNIFESP), 1994) Baptista-Silva, José Carlos Costa [UNIFESP]; Miranda Junior, Fausto [UNIFESP]
- ItemSomente MetadadadosLigadura elástica ou escleroterapia para tratamento das varizes de esôfago: resultados de um estudo prospectivo, randomizado, duplo cego em pacientes portadores da forma hepatoesplênica da Esquistossomose Mansoni(Universidade Federal de São Paulo (UNIFESP), 1996) Siqueira, Eduardo Sampaio [UNIFESP]; Ferrari, Angelo Paulo [UNIFESP]
- ItemAcesso aberto (Open Access)Ligation of the left renal vein in epm1-wistar rats: functional and morphologic alterations in the kidneys, testes and suprarenal glands(Associação Paulista de Medicina - APM, 1997-08-01) Baptista-Silva, José Carlos Costa [UNIFESP]; Dolnikoff, Miriam Sterman [UNIFESP]; Moura, Luiz Antonio Ribeiro de [UNIFESP]; Pestana, Jose Osmar Medina [UNIFESP]; Vieira, Jose Gilberto Henriques [UNIFESP]; Miranda Jr, Fausto [UNIFESP]; Schor, Nestor [UNIFESP]; Peres, Clovis de Araujo [UNIFESP]; Burihan, Emil [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: The ligation of the left renal vein (LLVR) in man is a contraversial procedure in view of the risks of lesion to the renal parenchyma. With the objective of studying the morphologic and functional alterations caused by these lesions, we conducted experimental research with rats. MATERIAL AND METHODS: 64 male adult EPM1-WISTAR rats were used, divided into 8 groups - 4 for LLRV and four for control. Each LLRV group and corresponding control group were sacrificed progressively on the 7th, 15th, 30th and 60th day after the initial surgery. RESULTS: We found morphofunctional alterations only in animals that underwent LLRV in the four periods of sacrifice.The proteinuria creatinine in serum, testosterone in serum and serum corticosterone in serum showed practically no alteration in relation to the normal values for rats. Statistically significant severe histological lesions were found in the kidneys and testes of the LLRV groups. Lesions in the suprarenal glands were also present in these groups, but no sufficient to demonstrate statistical significance CONCLUSION: Based on these results we can conclude that the ligation of the left renal vein is a procedure of high risk in these animals.
- ItemAcesso aberto (Open Access)Prospective study of bacteremia rate after elective band ligation and sclerotherapy with cyanoacrylate for esophageal varices in patients with advanced liver disease(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, 2011-12-01) Bonilha, Danielle Queiroz [UNIFESP]; Correia, Lucianna Motta [UNIFESP]; Monaghan, Marie; Lenz, Luciano [UNIFESP]; Santos, Marcus [UNIFESP]; Libera, Ermelindo Della [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); King's College London School of Medicine; Laboratório FleuryCONTEXT: Band ligation (BL) is the most appropriate endoscopic treatment for acute bleeding or prophylaxis of esophageal variceal bleeding. Sclerotherapy with N-butyl-2-cyanoacrylate (CY) can be an alternative for patients with advanced liver disease. Bacteremia is an infrequent complication after BL while the bacteremia rate following treatment with CY for esophageal varices remains unknown. OBJECTIVES: To evaluate and compare the incidence of transient bacteremia between cirrhotic patients submitted to diagnostic endoscopy, CY and BL for treatment of esophageal varices. METHODS: A prospective study comprising the period from 2004 to 2007 was conducted at Hospital of Universidade Federal de São Paulo (UNIFESP), UNIFESP, SP, Brazil. Cirrhotic patients with advanced liver disease (Child-Pugh B or C) were enrolled. The patients were divided into two groups according treatment: BL Group (patients undergoing band ligation, n = 20) and CY Group (patients receiving cyanoacrylate injection for esophageal variceal, n = 18). Cirrhotic patients with no esophageal varices or without indication for endoscopic treatment were recruited as control (diagnostic group n = 20). Bacteremia was evaluated by blood culture at baseline and 30 minutes after the procedure. RESULTS: After 137 scheduled endoscopic procedures, none of the 58 patients had fever or any sign suggestive of infection. All baseline cultures were negative. No positive cultures were observed after CY or in the control group - diagnostic endoscopy. Three (4.6 %) positive cultures were found out of the 65 sessions of band ligation (P = 0.187). Two of these samples were positive for coagulase-negative staphylococcus, which could be regarded as a contaminant. The isolated microorganism in the other case was Klebsiella oxytoca. The patient in this case presented no evidence of immunodeficiency except liver disease. CONCLUSIONS: There was no significant difference in bacteremia rate between these three groups. BL or CY injection for non-bleeding esophageal varices may be considered as low-risk procedures regarding bacteremia even when performed on patients with advanced liver disease.
- ItemAcesso aberto (Open Access)Rubber band ligation and infrared photocoagulation for the outpatient treatment of hemorrhoidal disease(Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia, 2008-02-01) Ricci, Maurício Pichler [UNIFESP]; Matos, Delcio [UNIFESP]; Saad, Sarhan Sydney [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)PURPOSE: To compare the results of rubber band ligation and infrared photocoagulation for the treatment of hemorrhoidal disease through the analysis of the incidence of complications after each treatment and respective success rate. METHODS: Forty-eight patients with first, second or third degree hemorrhoidal disease were randomized to recieve treatment with either rubber band ligation (n=23) or infrared photocoagulation (n=25). Each patient was assessed at 1 week and 4 week intervals after treatment. We compared the incidence of complications and efficiency of each treatment modality and Qui-square, Fisher's Exact Test and Student's t Test were used to statistical analysis. RESULTS: Bleeding occured in eigth (34,7%) patients treated with rubber band ligation and in four (16,0%) after infrared photocoagulation (p=0,243). Thirteen (52,0%) patients felt pain during infrared photocoagulation and 9 (39,1%) after rubber band ligation (p=0,546). After rubber band ligation, 14 (60,8%) required medication for pain relief. One patient (4,0%) required medication after infrared photocoagulation (p<0,001). Three (13,0%) patients treated with rubber band ligator and 1 (4,0%) treated with infrared photocoagulation had symptomatic mucosal ulcers. Perianal dermatitis occured in two (8,0%) patients treated with infrared photocoagulation and one patient (4,3%) was observed to have prolapsed thrombosed piles after rubber band ligation. One month after treatment, 17 of 23 patients treated with rubber band ligation (73,9%) and 18 of 25 patients treated with infrared photocoagulation were asymptomatic. Rubber band ligation treated bleeding and prolapse in 90,0% and 82,4% respectively. Infrared photocoagulation treates bleeding and prolapse in 93,7% and 87,5% respectively. Those differences are not significant. CONCLUSION: Rubber band ligation causes significantly more pain than infrared photocoagulation during the first week after the procedures and their success rate are not different after four weeks of treatment.