Navegando por Palavras-chave "Pancreatite"
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- ItemSomente MetadadadosAlterações pancreáticas na esquistossomose experimental de camundongos geneticamente selecionados como bons e maus produtores de anticorpos(Universidade Federal de São Paulo (UNIFESP), 1993) Barbo, Maria Lourdes Peris [UNIFESP]; Saad, Fued Abdalla [UNIFESP]
- ItemAcesso aberto (Open Access)Avaliação da reprodutibilidade da tomografia computadorizada no estadiamento da pancreatite aguda(Colégio Brasileiro de Radiologia e Diagnóstico por Imagem, 2007-12-01) Freire Filho, Edison de Oliveira [UNIFESP]; Shigueoka, David Carlos [UNIFESP]; Bekhor, Daniel [UNIFESP]; Vieira, Renata La Rocca [UNIFESP]; Yamada, André Fukunishi [UNIFESP]; Freire, Maxime Figueiredo de Oliveira [UNIFESP]; Ajzen, Sergio Aron [UNIFESP]; D'Ippolito, Giuseppe [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To evaluate the reproducibility of unenhanced and contrast-enhanced computed tomography in the assessment of patients with acute pancreatitis. MATERIALS AND METHODS: Fifty-one unenhanced and contrast-enhanced abdominal computed tomography studies of patients with acute pancreatitis were blindly reviewed by two radiologists (observers 1 and 2). The morphological index was separately calculated for unenhanced and contrast-enhanced computed tomography and the disease severity index was established. Intraobserver and interobserver reproducibility of computed tomography was measured by means of the kappa index (kappa). RESULTS: Interobserver agreement was kappa = 0.666, 0.705, 0.648, 0.547 and 0.631, respectively for unenhanced and contrast-enhanced morphological index, presence of pancreatic necrosis, pancreatic necrosis extension, and disease severity index. Intraobserver agreement (observers 1 and 2, respectively) was kappa = 0.796 and 0.732 for unenhanced morphological index; kappa = 0.725 and 0.802 for contrast-enhanced morphological index; kappa = 0.674 and 0.849 for presence of pancreatic necrosis; kappa = 0.606 and 0.770 for pancreatic necrosis extension; and kappa = 0.801 and 0.687 for disease severity index at computed tomography. CONCLUSION: Computed tomography for determination of morphological index and disease severity index in the staging of acute pancreatitis is a quite reproducible method. The absence of contrast-enhancement does not affect the computed tomography morphological index reproducibility.
- ItemSomente MetadadadosColecistectomia: riscos para o doente transplantado renal(Universidade Federal de São Paulo (UNIFESP), 2019-08-20) Rinaldis, Alessandro De [UNIFESP]; Pestana, Jose Osmar Medina De Abreu [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective: Compare the risks of cholecystectomy between patients with and without kidney transplant. Method: This is a retrospective observational study through the collection of data from patients’ medical records submitted to cholecystectomy from January 2004 to December 2018, at Hospital do Rim / UNIFESP. Results: 230 kidney transplanted recipients (57,2%) and 172 controls (42,8%) were included in the study for a total of 402 cholelithiasis patients. The transplanted group presented higher rates of surgical conversion (5,7% x 1,2%), drainage (7,8% x 2,3%), postoperative complications (10,0% x 4,7%) and longer hospitalizations stay (p<0,05). When the analysis was performed according to surgery’s type (urgent x elective), the urgently transplanted group had higher rates of postoperative complications (27,8% x 5,9%), deaths (11,1% x 0%), conversion (13,9% x 5,9%), drainage (33,3% x 23,5%) and length of hospital stay (p<0,05). Multiple logistic regression revealed that the renal transplant patients presented an increased risk of choledococholithiasis (OR: 5,89) and pancreatitis (OR: 6,89). The presence of diabetes mellitus was an isolated factor for postoperative complications (OR: 3,80), and there was an 82% increase in the risk of presenting postoperative complications at each point of increased creatinine levels. Conclusion: Renal transplant patients on elective surgery were similar to the control group with the same rates of postoperative complications. However, when operated urgently, they had longer surgery time and hospitalization as well as increase in complications. Renal transplant patients had a higher risk of developing pancreatitis and choledocholitiasis.
- ItemSomente MetadadadosContribuição ao estudo da secreção pancreática exocrina em alcoólatras: caracterização do estado de hipersecreção(Universidade Federal de São Paulo (UNIFESP), 1978) Neves, Manoel Martins das [UNIFESP]
- ItemAcesso aberto (Open Access)Critérios laboratoriais para o diagnóstico diferencial entre pancreatite aguda biliar e não biliar(Universidade Federal de São Paulo, 2021) Azevedo, Barbra Rafaela de Melo Santos [UNIFESP]; Fagundes, Djalma José [UNIFESP]; http://lattes.cnpq.br/8694381071456316; http://lattes.cnpq.br/7116422825350792Objetivos: estabelecer critérios laboratoriais para o diagnóstico diferencial entre pancreatite aguda de causa biliar e não biliar e identificar testes com sensibilidade suficiente para propor a criação de um algoritmo para essa finalidade. Métodos: análise retrospectiva observacional, com delineamento transversal, de exames laboratoriais de dois grupos de pacientes com pancreatite aguda: A – causa não biliar e B – causa biliar. Foram investigados os exames: hematócrito, número de leucócitos, lactato desidrogenase (LDH), glicose, lipase, amilase, bilirrubina total, transaminase oxalacética (TGO/AST), transaminase pirúvica (TGP/ALT), gamaglutamiltransferase (GGT) e fosfatase alcalina (FA). Os dados de 701 pacientes foram submetidos a testes não paramétricos e ao Receiver Operating Characteristic (ROC). Resultados: os valores de hematócrito, número de leucócitos, LDH e glicose não apresentaram diferença significante entre os grupos (p > 0.1); já os valores de lipase, amilase, bilirrubina total, TGO, TGP, GGT e FA apresentaram diferença significante entre os grupos (p < 0.05), sendo que os testes de TGP, TGO e FA mostraram-se os mais sensíveis na determinação da causa biliar, possibilitando o estabelecimento de um ponto de corte pelo teste ROC, a partir do qual a probabilidade de acerto aumenta: TGP: 123,0 U/L (S: 69,2%; E: 81,5%), TGO: 123,5 U/L (S: 57,3%; E: 78,8%), FA: 126,5 U/L (S: 66,1%; E: 69,4%). Conclusão: foi possível estabelecer critérios baseados em testes laboratoriais, para o diagnóstico diferencial entre pancreatite aguda de origem biliar e não biliar, no entanto, os testes não mostraram sensibilidade suficiente para propor a criação de um algoritmo.
- ItemSomente MetadadadosDisfunção pancreática precoce em etilistas assintomáticos(Universidade Federal de São Paulo (UNIFESP), 1992) Neves, Manoel Martins das [UNIFESP]
- ItemSomente MetadadadosDoença hepática em indivíduos com pancreatite cronica alcoólica(Universidade Federal de São Paulo (UNIFESP), 1993) Chebli, Julio Maria Fonseca [UNIFESP]; Neves, Manoel Martins das [UNIFESP]
- ItemSomente MetadadadosImportancia da determinacao serica da proteina C reativa na avaliacao das pancreatites agudas(Universidade Federal de São Paulo (UNIFESP), 1997) Gaburri, Ana Karla [UNIFESP]As pancreatites agudas caracterizam-se por curso clinico variavel com potencial evolucao para formas graves e com prognostico reservado em alguns pacientes. Estes pacientes devem ser prontamente identificados visto que evoluem rapidamente com complicacoes e mesmo para obito. Apesar dos esforcos em estudos realizados ainda nao existe criterio ideal para predicao da gravidade das pancreatites agudas. Neste estudo avaliamos a dosagem serica da Proteina C Reativa como criterio preditivo de gravidade bem como indicativo de surgimento de complicacoes nas pancreatites agudas. Estudamos consecutivamente 43 pacientes com diagnostico de pancreatite aguda. Todos foram submetidos a tomografia computadorizada com injecao endovenosa de contraste em oboluso. A partir da analise das tomografias foi aplicado indice prognostico anteriormente descrito e os pacientes divididos em dois grupos: grupo I constituido de 12 pacientes com pancreatite aguda grave caracterizadas por indice > 5 e grupo II constituido por 31 pacientes com pancreatite aguda leve caracterizadas por indice < 5. As dosagens sericas da Proteina C Reativa foram realizadas pelo metodo de imunodifusao radial, a partir de amostras de sangue coletadas nos 20, 50 e 70 dias de evolucao dos quadros de pancreatite. Verificamos que as concentracoes sericas de Proteina C Reativa foram superiores nos pacientes com pancreatite aguda grave em relacao aos com pancreatite aguda leve, sendo a diferenca estatisticamente significante. Maior significancia foi observada para niveis de Proteina C Reativa superiores a 7,5 mg/dl, tendo a sensibilidade e especificidade respectivamente de 83% e 61% no 20 dia, 75% e 70% no 50 dia e 70% e 82% no 70 dia. Os valores preditivos positivo e negativo foram respectivamente de 45% e 90% nos 20 dia, 50% e 88% nos 50 dia e 63% e 88% nos 70 dia. Analisando comportamento da Proteina C Reativa em relacao ao surgimento de complicacoes pudemos observar que o grupo de pacientes que evoluiram com complicacoes apresentaram niveis sericos superiores aos dos que nao as apresentaram sendo a diferenca estatisticamente significante. No entanto, analise individual destes pacientes nao foi util para diagnostico do surgimento de complicacoes
- ItemSomente MetadadadosInducao de pancreatites aguda e cronica com uso de toxina do escorpiao Tituyus serrulatus: modelo experimental em ratos(Universidade Federal de São Paulo (UNIFESP), 1995) Novaes, Geovana [UNIFESP]
- ItemSomente MetadadadosInfluência da hipovolemia na evolução da pancreatite aguda edematosa em ratos(Universidade Federal de São Paulo (UNIFESP), 1987) Bassi, Deomir Germano [UNIFESP]; Speranzini, Manlio Basilio [UNIFESP]
- ItemSomente MetadadadosInfluência do choque hemorrágico na evolução anaáomo patológica da pancreatite aguda edematosa em ratos hipertensos (S. H. R.)(Universidade Federal de São Paulo (UNIFESP), 1991) Bassi, Deomir Germano [UNIFESP]; Speranzini, Manlio Basilio [UNIFESP]
- ItemAcesso aberto (Open Access)Microcristais biliares na pancreatite aguda idiopática: indício para etiologia biliar oculta subjacente(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, 2000-04-01) Chebli, Julio Maria Fonseca [UNIFESP]; Ferrari, Angelo Paulo [UNIFESP]; Silva, Maria Regina Regis [UNIFESP]; Borges, Durval Rosa [UNIFESP]; Atallah, Álvaro Nagib [UNIFESP]; Neves, Manoel Martins Das [UNIFESP]; Universidade Federal de Juiz de Fora; Universidade Federal de São Paulo (UNIFESP)The main causes of pancreatic inflammation worldwide are biliary lithiasis and alcoholism. However, 10 to 30% of patients have been considered to have idiopathic acute pancreatitis. Recently, some studies showed that a significant rate of the so called idiopathic pancreatitis are caused by microlithiasis and/or biliary sludge, identified by the presence of cholesterol monohidrate and/or calcium bilirubinate microcrystals in the biliary sediment. In the present study, the analysis of microcrystals from bile obtained during endoscopic retrograde cholangiopancreatography was done in patients with pancreatitis (idiopathic, biliary or alcoholic -- 20 in each group). Patients with idiopathic pancreatitis and microcrystals in the bile underwent cholecystectomy whenever possible. Those who refused or were inapt to surgery underwent endoscopic sphincterotomy or received continuous therapy with ursodeoxycholic acid. Patients with idiopathic pancreatitis without biliary crystals did not receive any specific treatment. The prevalence of biliary microcrystals in patients with idiopathic pancreatitis (75%) and biliary pancreatitis (90%) was significantly higher than in those with alcoholic pancreatitis (15%). In the identification of the etiology of biliary pancreatitis, the presence of microcrystals had a sensitivity of 90%, specificity of 85%, positive predictive value of 85,7%, negative predictive value of 89,4% and accuracy of 87,5%. In the patients with recurrent idiopathic pancreatitis, with biliary crystals, there was an statistically significant reduction in the number of pancreatitis episodes after specific treatment. In the follow-up of this group during 23,3 ± 4,8 months, recurrence of pancreatitis occurred only in patients with persistent biliary factor (choledocholithiasis and/or persistence of cholesterol monohidrate). All patients with idiopathic pancreatitis who underwent cholecystectomy had chronic cholecystitis. Moreover, cholelithiasis was present in one case. In the ultrassonographic follow-up of the patients with idiopathic acute pancreatitis with microcrystals in the bile, cholelithiasis was detected in one case. In the subgroup of five patients with idiopathic pancreatitis without biliary microcrystals recurrence occurred in one case. Ultrassonographic study during follow-up did not reveal biliary stones in any of these patients. We concluded that the detection of biliary microcrystals in idiopathic pancreatitis suggested an underlying biliary etiology, even if occult. What's more, early specific therapeutic procedure (cholecystectomy, endoscopic sphincterotomy or ursodeoxycholic acid) in patients with recurrent idiopathic pancreatitis with microcrystals in the bile reduced significantly the recurrence during the follow-up. Finally, acute pancreatitis (specially recurrent) should not be called idiopathic before the microscopic analysis of the bile, aiming to detect or exclude the presence of microcrystals.
- ItemSomente MetadadadosMicrocristais biliares: papel no diagnostico da pancreatite aguda idiopática(Universidade Federal de São Paulo (UNIFESP), 1996) Chebli, Julio Maria Fonseca [UNIFESP]; Neves, Manoel Martins das [UNIFESP]
- ItemSomente MetadadadosNiveis sericos de insulina e peptideo C em alcoolistas assintomaticos e com pancreatite cronica(Universidade Federal de São Paulo (UNIFESP), 1995) Oliveira, Sonia Cancado de [UNIFESP]
- ItemSomente MetadadadosPancreatite aguda necro-hemorragica induzida por taurocolato de sodio: estudo das lesoes anatomo-patologicas em ratos(Universidade Federal de São Paulo (UNIFESP), 1992) Tonini-Chaib, Karla Conceicao [UNIFESP]
- ItemAcesso aberto (Open Access)Parenteral nutrition versus enteral nutrition in severe acute pancreatitis(Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia, 2010-10-01) Vieira, Josiel Paiva; Araújo, Gutemberg Fernandes De; Azevedo, José Raimundo Araújo De; Goldenberg, Alberto [UNIFESP]; Linhares, Marcelo Moura [UNIFESP]; Federal University of Maranhao Surgical Department; UFMA Surgical Department; Sao Domingos Hospital; Universidade Federal de São Paulo (UNIFESP)PURPOSE: To compare the effect of parenteral versus enteral nutritional support in severe acute pancreatitis, with respect to efficacy, safety, morbidity, mortality and length of hospitalization. METHODS: The study was comprised of 31 patients, divided into a parenteral group (n=16) and an enteral group (n=15), who met severity criteria for abdominal tomography (Balthazar classes C, D, and E). The patients were compared by demographics, disease etiology, antibiotic prophylaxis, use or not of somatostatin, nutritional support, complications and disease progression. RESULTS: There was no statistical difference in the average duration of nutritional support, somatostatin, or antibiotics in the two groups. Imipenem was the drug of choice for prophylaxis of pancreatic infections in both groups. More complications occurred in the parenteral group, although the difference was not statistically significant (p=0.10). Infectious complications, such as catheter sepsis and infections of the pancreatic tissue, were significantly more frequent in the parenteral group (p=0.006). There was no difference in average length of hospitalization in the two groups. There were three deaths in the parenteral group and none in the enteral group. CONCLUSION: Enteral nutritional support is associated with fewer septic complications compared to parenteral nutritional support.
- ItemAcesso aberto (Open Access)Resultados do tratamento da pancreatite aguda grave(Colégio Brasileiro de Cirurgiões, 2012-10-01) Apodaca-Torrez, Franz Robert [UNIFESP]; Lobo, Edson Jose [UNIFESP]; Monteiro, Lilah Maria Carvas [UNIFESP]; Melo, Geraldine Ragot de [UNIFESP]; Goldenberg, Alberto [UNIFESP]; Herani Filho, Benedito [UNIFESP]; Triviño, Tarcisio [UNIFESP]; Lopes Filho, Gaspar de Jesus [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To evaluate the results of the Protocol for treatment of patients with severe acute pancreatitis. METHODS: We consecutively analyzed age, gender, etiology, length of hospital stay, type of treatment and mortality of 37 patients with severe acute pancreatitis from January 2002. RESULTS: The patients' ages ranged from 20 to 88 years (average 50 years), 27% were female and 73% male. Mean overall hospital stay was 47 days. Thirteen patients were treated surgically, the average operations per patient was two. There were six deaths among patients undergoing surgical treatment (46%) and two deaths in the group submitted to medical treatment alone (8.3%). The overall mortality was 21%. CONCLUSION: After modification in the form of management of patients with severe acute pancreatitis, there was a decrease in mortality and a trend for conservative management.
- ItemSomente MetadadadosTomografia computadorizada na pancreatite aguda(Universidade Federal de São Paulo (UNIFESP), 1987) Secaf, Marcelo [UNIFESP]
- ItemSomente MetadadadosO valor da tomografia computadorizada sem contraste na avaliacao inicial de pacientes com pancreatite aguda(Universidade Federal de São Paulo (UNIFESP), 2007) Freire Filho, Edison de Oliveira [UNIFESP]