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    Avaliação da influência da esteatose do enxerto no resultado do transplante de fígado
    (Universidade Federal de São Paulo (UNIFESP), 2014-12-17) Cezar, Leandro Dias [UNIFESP]; Linhares, Marcelo Moura Linhares [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introduction: Steatosis is frequently present in liver grafts, and it is usually admitted that small grade (<30%) of macrosteatosis is safe to transplant and is not advisable to use graft with severe (>=60%) macrosteatosis. However there is no consensus about the real cut off for extent of macrosteatosis and on the risk of microsteatosis. The aim of this study is to evaluate the steatosis influence on transplant outcome in a large unicentric cohort. Methods: We performed a retrospective analysis of a prospectively maintained database in a single center. Two thousand seven hundred and six patients (2.706) were transplanted from December 3, 1984 to December 31, 2010. Among these grafts, 1132 had steatosis (924 macro, 782 micro, 458 macro and micro). Graft biopsies were available in 98% of the cases. Donor and recipient data and surgical factors were analyzed. The end-points were primary dysfunction, delayed graft function (aspartate aminotransferase level >2.000 and TP<30%), 3-month, 1-year and 5-year survival. A multivariable analysis and logistic regression were performed to indentify the risk factors associated with the outcome. Results: The presence of microsteatosis or macrosteatosis at any percentage is a risk factor for graft dysfunction or primary nonfunction (OR: 1.41 and 1.39; P= 0.01 and 0.02 respectively). The 3-month and 1-year graft survival is only affected by macrosteatosis more than 30% (OR: 1,94, P= 0.002 and OR: 1.41, p= 0.02 respectively). According to the grade of macrosteatosis, the 1 year graft survival was 81% for <30% macrosteatosis, 73% for 30-50% macrosteatosis, 67% for 50-60% macrosteatosis, 58% for >=60% macrosteatosis; the 5 year graft survival was 67% for <30% macrosteatosis, 66% for 30-50% macrosteatosis, 44% for 50-60% macrosteatosis, 38% for >=60% macrosteatosis. Conclusion: The presence of graft steatosis, (macro or micro) does affect the initial graft function. Only Macrosteatosis more than 30% does affect graft survival. With more than 50% macrosteatosis risk of graft loss overexceeds 50% and becomes prohibitive.
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    Biological therapy in the treatment of moderate-to-severe ulcerative colitis patients: can colectomy be prevented?
    (Sociedade Brasileira de Coloproctologia, 2011-12-01) Teixeira, Fábio Vieira; Hossne, Rogério Saad; Kotze, Paulo Gustavo; Denadai, Rafael; Miszputen, Sender Jankiel [UNIFESP]; University of the State of São Paulo Botucatu Medical School Department of Surgery; Associação Beneficente Hospital Universitário and Clínica Gastrosaúde; Pontifícia Universidade Católica Department of Surgery; Hospital Universitário Cajuru Colorectal Unit; Universidade Federal de São Paulo (UNIFESP)
    Ulcerative colitis treatment intends to induce remission, and its maintenance. Biological drugs, such as infliximab, have been indicated in moderate and severe cases of the disease, which are unresponsive to conventional medication. Randomized controlled trials proved the efficacy of biological treatment with high rates of sustained disease remission and mucosal healing. Recently, the concept of mucosal healing has been inversely associated with surgical treatment. Patients treated with infliximab have lower colectomy rates than those receiving conventional therapies. We suppose that earlier use of biological drugs in disease's course would lead to better clinical control and mucosal healing, with a consequent reduction in colectomy rates. To support this hypothesis, a literature review from January, 1996 to April, 2011 was performed.