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- ItemAcesso aberto (Open Access)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.
- ItemSomente MetadadadosCochrane report - A systematic review of mannitol therapy for acute ischemic stroke and cerebral parenchymal hemorrhage(Lippincott Williams & Wilkins, 2000-11-01) Bereczki, Daniel; Liu, Ming; Prado, Gilmar Fernandes do [UNIFESP]; Fekete, Istvan; Univ Debrecen; W China Univ Med Sci; Universidade Federal de São Paulo (UNIFESP)Background-Mannitol was reported to decrease cerebral edema associated with tissue damage and is used to treat acute stroke in many countries.Summary of Review-We tested whether there is any evidence from unconfounded randomized clinical trials that treatment with mannitol reduces short- and long-term case fatality and dependency if administered after ischemic stroke or cerebral parenchymal hemorrhage. Trials were identified by the standard search strategy of the Cochrane Collaboration Stroke Review Group. A supplementary MEDLINE search was performed, and the Chinese Stroke Trials Register and the Latin-American databank LILACS were checked. A search was performed of master's and PhD degree theses in the databank of Sao Paulo University and in abstracts of medical congresses on neurology and neurosurgery during 1965-1997 in Brazil. Investigators were contacted for unpublished information. Only truly randomized unconfounded clinical trials were eligible for inclusion. Two of the reviewers independently extracted data from the trials. Data synthesis and analysis was performed with the use of the Cochrane Review Manager software RevMan version 4.0.4).Conclusions-Only 1 trial fulfilled the inclusion criteria. The number of included patients was small, and the follow-up was short. Case fatality, the proportion of dependent patients, and side effects were not reported and were not available from the investigators. As a result of lack of appropriate randomized trials, currently no conclusion can be drawn on the effects of mannitol in acute stroke. The routine use of mannitol in all patients with acute stroke is not supported by evidence from randomized controlled clinical trials.
- ItemSomente MetadadadosDoes valsalva leak point pressure predict outcome after the distal urethral polypropylene sling? Role of urodynamics in the sling era(Lippincott Williams & Wilkins, 2004-07-01) Rodriguez, Larissa V.; Almeida, Fernando Gonçalves de [UNIFESP]; Dorey, Frederick; Raz, Shlomo; Univ Calif Los Angeles; Universidade Federal de São Paulo (UNIFESP)Purpose: Recently sling procedures have been shown to be effective in the treatment of all types of incontinence. in this study we evaluated the role of preoperative Valsalva leak point pressure (VLPP) in predicting the outcome of sling surgery.Materials and Methods: We prospectively evaluated 174 consecutive patients who underwent a distal polypropylene sling procedure for the treatment of stress urinary incontinence (SUI). Using SEAPI scores patients were divided by VLPP into group 1-60 patients who did not leak on urodynamics, group 2-27 patients with VLPP greater than 80 cm H2O, group 3-71 patients with VLPP 30 to 80 cm H2O and group 4-16 patients with VLPP less than 30 cm H2O. Surgical outcomes were determined by symptom, bother and quality of life questionnaires filled out by patients. the physicians were blinded to patient response.Results: Mean followup was 14.7 months (range 12 to 30) and mean patient age was 62 years (range 32 to 88). the groups were well matched before surgery with respect to age, number of previous surgeries, and severity of SUI symptoms and urge incontinence. the percentage of patients who were cured or improved was similar among groups. After surgery there was no statistical difference among patient mean self-reported symptoms of or bother from SUI or urge incontinence.Conclusions: the distal urethral polypropylene sling provides similar symptom improvement in all patients regardless of preoperative VLPP. VLPP is helpful in the diagnosis of SUI but appears to be of minimal benefit in predicting the outcome of the distal urethral polypropylene sling procedure.
- ItemSomente MetadadadosA double-blind, randomized, controlled study of amitriptyline, nortriptyline and placebo in patients with fibromyalgia. An analysis of outcome measures(Clinical & Exper Rheumatology, 2001-11-01) Heymann, Roberto Ezequiel [UNIFESP]; Helfenstein Junior, Milton [UNIFESP]; Feldman, D. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective To study the efficacy and tolerability of amitriptyline and nortriptyline in a Brazilian population with fibromyalgia and to evaluate the instruments used to measure the efficacy, of the treatment.Methods A total of 118 fibromyalgia patients were randomly assigned to 3 groups: amitripyline (AM, n = 40), nortriptyline (NOR, n = 38) and placebo (PL, n = 40), and were blindly given 25 mg at bedtime of the assigned treatment for 8 weeks. Clinical evaluation before and at the end of the study included the number of tender points (NTP), FIQ score (FIQ), and global improvement as reported by, the patients on a verbal scale (VSGI).Results The 3 groups were comparable at baseline for all the parameters studied. After 8 weeks, the 3 groups improved in all parameters: (36.5% AM, 26.7% NOR and 24% PL patients improved on FIQ; 13.9% AM, 19.5% NOR and 8.57% PL patients improved on NTP; 86.5% AM, 72.2% NOR and 57.6% PL patients improved on VSGI). Only, the AM group differed from the PL group on VSGI Side effects were noted among the groups, but none were serious (16 in the AM group, 31 in the NOR group, and 25 in the PL group).Conclusion All three groups improved after treatment. Only the patient's subjective global assessment of improvement differed between the AM patients and the PL group (p less than or equal to 0.03). In fibromyalgia, placebo groups are important in drug trials. Different measures of therapeutic effect are not better than the patient's self assessment.
- ItemAcesso aberto (Open Access)Functional impact of hospitalization among elderly patients(Revista de Saude Publica, 2004-10-01) Siqueira, Ana Barros [UNIFESP]; Cordeiro, Renata Cereda [UNIFESP]; Perracini, Monica Rodrigues [UNIFESP]; Ramos, Luiz Roberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective To describe functional capacity changes of elderly during hospitalization and to assess the correlation of these changes at the time of hospital discharge and sociodemographics and clinical variables.Methods There were studied 94 patients aged 65 to 94 years admitted to a geriatric-gerontological hospital unit of a school hospital. the first functional capacity evalliation (number of daily living activities impaired) of the elderly patients was carried out up to 24 hours after admission and the last one immediately after discharge. Routine therapeutic interventions were performed by an interdisciplinary health care team in the study period. Data was analyzed using Chi-square test (alphaless than or equal to0.05).Results of all patient studied, 25.6% improved their functional capacity, 34.0% had not had functional changes, 19.1% had worsened functionally, and 21.3% died during the study period. A significant correlation was seen between functional deterioration and cognitive deficits, delirium, and low functional capacity at admission.Conclusions Functional capacity is an important marker of health in hospitalized elderly. Functional improvement during hospitalization is associated to lesser impairment in daily activities at the time of admission and better clinical conditions.
- ItemSomente MetadadadosGene expression pattern contributing to prognostic factors in childhood acute lymphoblastic leukemia(Informa Healthcare, 2013-02-01) Silveira, Vanessa S.; Scrideli, Carlos Alberto; Moreno, Daniel A.; Yunes, Jose Andres; Queiroz, Rosane Gomes P.; Toledo, Silvia Regina Caminada de [UNIFESP]; Lee, Maria Lucia de Martino [UNIFESP]; Petrilli, Antonio S. [UNIFESP]; Brandalise, Silvia R.; Tone, Luiz Gonzaga; Universidade de São Paulo (USP); Boldrini Inst; Universidade Federal de São Paulo (UNIFESP); Universidade Estadual de Campinas (UNICAMP)The present study evaluated the expression profile of 19 genes previously reported in microarray studies and associated with resistance or sensitivity to vincristine (RPLP2, CD44, TCFL5, KCNN1, TRIM24), prednisolone (F8A, CDK2AP1, BLVRB, CD69), daunorubicin (MAP3K12, SHOC2, PCDH9, EGR1, KCNN4) and L-asparaginase (GPR56, MAN1A1, CLEC11A, IGFBP7, GATA3). We studied 140 bone marrow samples at diagnosis from children with acute lymphoblastic leukemia (ALL) treated according to the Brazilian Childhood Leukemia Treatment Group (GBTLI) ALL-99 protocol. the expression profiles of the genes listed above were analyzed by real-time quantitative polymerase chain reaction (PCR) and then related to the clinical and biological prognostic factors. the results showed significant associations (p <= 0.05) between the expression levels of genes GPR56, BLVRB, IGFBP7 and white blood cell (WBC) count at diagnosis; GATA3, MAN1A1, CD44, MAP3K12, CLEC11A, SHOC2 and CD10 B-lineage ALL; TCFL5 and bone marrow status at day 14; MAP3K12 and TRIM24 and bone marrow status at day 28; and CD69, TCFL5 and TRIM24 genes and ETV6/RUNX1 positive ALL. the up-regulation of SHOC2 was also associated with better 5-year event-free survival (EFS) in univariate and multivariate analysis (p = 0.02 and p = 0.03, respectively). These findings highlight genes that could be associated with clinical and biological prognostic factors in childhood ALL, suggesting that these genes may characterize and play a role in the treatment outcome of some ALL subsets.
- ItemAcesso aberto (Open Access)Is the number of microembolic signals related to neurologic outcome in coronary bypass surgery?(Academia Brasileira de Neurologia - ABNEURO, 2001-03-01) Malheiros, Suzana Maria Fleury [UNIFESP]; Massaro, Ayrton Roberto; Gabbai, Alberto Alain [UNIFESP]; Pessa, Clodualdo J. N. [UNIFESP]; Gerola, Luís Roberto [UNIFESP]; Branco, João Nelson Rodrigues [UNIFESP]; Lira Filho, Edgar Bezerra; Christofalo, Dejaldo Marcos de Jesus; Federico, Darwin; Carvalho, Antonio Carlos [UNIFESP]; Buffolo, Enio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Coronary artery bypass surgery (CABG) without cardiopulmonary bypass (CPB) may potentially reduce the number of microembolic signals (MES) associated with aortic manipulation or generated by the pump circuit, resulting in a better neurologic outcome after surgery. Our aim was to compare the frequency of MES and neurologic complications in CABG with and without CPB. Twenty patients eligible to routine CABG without CPB were randomized to surgery with CPB and without CPB and continuously monitored by transcranial Doppler. Neurologic examination was performed in all patients before and after surgery. The two groups were similar with respect to demographics, risk factors, grade of aortic atheromatous disease and number of grafts. The frequency of MES in the nonCPB group was considerably lower than in CPB patients, however, we did not observe any change in the neurologic examination during the early postoperative period. Neurologic complications after CABG may be related to the size and composition of MES rather than to their absolute numbers. A large prospective multicentric randomized trial may help to elucidate this complex issue.
- ItemSomente MetadadadosProstatic carcinomas with neuroendocrine differentiation diagnosed in needle biopsies, a morphologic study of 7 cases among 465 sequential biopsies in a tertiary cancer center(Brazilian Soc Urol, 2011-09-01) Lima, M. V. A.; Nogueira, C.; Oliveira, J. A. A.; Muniz Neto, F. J.; Franco, M. [UNIFESP]; Tavora, Fabio Rocha Fernandes [UNIFESP]; Hosp Canc; Universidade Federal de São Paulo (UNIFESP)Purpose: Neuroendocrine carcinomas (NEC) of the prostate are rare, with only a few series hitherto reported. the objective of this study was to assess in a single institution the clinical and morphologic characteristics of neuroendocrine carcinomas diagnosed in needle core biopsies.Materials and Methods: the current study analyses seven cases diagnosed in needle biopsies at a large tertiary regional cancer center from Northeastern Brazil. Two pathologists reviewed specimens retrospectively, and demographic and morphologic characteristics were compared to 458 acinar tumors diagnosed in the same period.Results: There were five small cell carcinomas and two low-grade neuroendocrine carcinomas (carcinoid). NEC were associated with an acinar component in 5/7 cases and the Gleason score of the acinar component was always > 6. the number of cores involved in prostates with NEC was greater (65% compared to 24% of acinar tumors, p < 0.05). the mean PSA at diagnosis was 417.7 (range 5.7-1593, SD 218.3), compared to 100.5 (p = 0.1) of acinar tumors (range 0.3-8545, SD 22.7). Prostates harboring NEC were bigger (p < 0.001, mean volume 240 mL vs. 53 mL of acinar tumors). Treatment of NEC included palliative surgery, chemotherapy, and hormonal therapy.Conclusions: NEC of the prostate is rare and often associated with a high-grade acinar component. Prostates with NEC tend to be larger and involve a greater number of cores than acinar tumors. PSA at diagnosis does not seem to predict the presence of NE tumors in needle biopsy.
- ItemAcesso aberto (Open Access)Renal tumor and trauma: a pitfall for conversative management(Sociedade Brasileira de Urologia, 2011-08-01) Abib, Simone de Campos Vieira [UNIFESP]; Leite, Mila Torii Corrêa [UNIFESP]; Ribeiro, Rodrigo Chaves [UNIFESP]; Fachin, Camila Girardi [UNIFESP]; Demuner, Maris Salete [UNIFESP]; Cypriano, Monica [UNIFESP]; Schettini, Sérgio Tomaz [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)PURPOSE: Conservative management has been largely used for renal trauma. Although this approach is safe and highly recommended, it can hide a pre-existing unknown condition, such as tumors or urinary malformations. A high index of suspicion is needed for early recognition of these conditions. We present four cases treated at the Pediatric Oncology Institute - Federal University of São Paulo, which have been initially treated conservatively for renal trauma. MATERIALS AND METHODS: We reviewed all 218 renal cases of renal tumors treated at our institution in a 22-year period, searching for associated trauma events. RESULTS: Four cases of renal tumors were initially treated conservatively for blunt renal trauma of low energy mechanism. Patients' ages ranged from 7 to 12 years old. Two patients had no previous symptoms, one patient had hematuria and another had an abdominal mass. Computerized Axial Tomography (CT) of the abdomen revealed disparate magnitude of the renal bleeding to the low energy mechanism of trauma. All patients underwent surgical treatment. Kidney specimens showed Wilms tumor in three cases and renal carcinoma in one. CONCLUSIONS: The association between renal tumors and trauma should be suspected when renal trauma hemorrhage on abdominal CT scan does not match the low energy mechanism of blunt abdominal trauma. The key for a successful diagnosis of renal tumor or congenital malformations is the high index of suspicion for these conditions.
- ItemAcesso aberto (Open Access)Resultados em longo prazo da cirurgia endoscópica nasossinusal no tratamento da rinossinusite crônica com e sem pólipos nasais(Associação Brasileira de Otorrinolaringologia e Cirurgia Cervicofacial, 2013-06-01) Mascarenhas, Juliana Gama [UNIFESP]; Fonseca, Viviane Maria Guerreiro da; Chen, Vitor Guo; Itamoto, Caroline Harumi; Silva, Camila Atallah Pontes da [UNIFESP]; Gregório, Luiz Carlos [UNIFESP]; Kosugi, Eduardo Macoto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Chronic rhinosinusitis (CRS) significantly affects patient quality of life. Medical and surgical treatments aim to clinically manage the condition. OBJECTIVE: To assess the long-term quality of life and clinical management of CRS in patients submitted to endoscopic sinus surgery. METHOD: This prospective cross-sectional cohort study enrolled 38 patients and looked into the follow-up data of subjects diagnosed with CRS before surgery, three months after surgery, and at least two years after surgery. The Sinonasal Outcome Test 22 (SNOT-22) was used to assess response to treatment and long-term clinical management of the disease. RESULTS: Significant improvements in the SNOT-22 scores were seen between the preoperative (61.3) and postoperative assessments with three (16.9) and 24 (32.3) months. No statistically significant differences were seen when patients with polyps were compared to polyp-free subjects. Few patients were controlled in both groups, and 7.89% of the subjects had revision surgery during the study. CONCLUSION: Endoscopic sinus surgery significantly improved the quality of life of patients with chronic rhinosinusitis. Clinical control of the condition was acceptable, with few patients requiring re-operation within two years of the first surgery.
- ItemAcesso aberto (Open Access)Serum PSA and cure perspective for prostate cancer in males with nonpalpable tumor(Sociedade Brasileira de Urologia, 2005-10-01) Dall'Oglio, Marcos Francisco [UNIFESP]; Crippa, Alexandre [UNIFESP]; Passerotti, Carlo C. [UNIFESP]; Nesrallah, Luciano J. [UNIFESP]; Leite, Kátia Ramos Moreira [UNIFESP]; Srougi, Miguel [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)INTRODUCTION: Many studies have shown the association between PSA levels and the subsequent detection of prostate cancer. In the present trial, we have studied the relationship between preoperative PSA levels and clinical outcome following radical prostatectomy in men with clinical stage T1c. MATERIALS AND METHODS: 257 individuals with clinical stage T1c undergoing retropubic radical prostatectomy were selected in the period from 1991 to 2000. Following surgery, biochemical recurrence-free survival curves were constructed according to PSA levels between 0-4; 4.1-10; 10.1-20 and > 20 ng/mL. RESULTS: Of the total of 257 selected patients, 206 (80%) had Gleason scores from 2 to 6 and 51 (20%), presented Gleason scores 7 and 8, as defined by the pathological report from prostate biopsy. There was no biochemical recurrence of disease when the PSA was lower than 4, regardless of Gleason score. Biochemical recurrence-free survival according to PSA between 0-4; 4.1-10; 10.1-20 and > 20 was 100%, 87.6%, 79% and 68.8% for Gleason scores 2-6 and 100%; 79.4%; 40% and 100% for Gleason scores 7-8 respectively. When all individuals were grouped, regardless of their Gleason scores, the probability of biochemical recurrence-free survival was 100%, 65.1%, 53.4% and 72.2% according to PSA between 0-4; 4.1-10; 10.1-20 and > 20 ng/mL respectively. CONCLUSION: Non-palpable prostate cancer presents higher chances of cure when the PSA is inferior to 4 ng/mL.
- ItemSomente MetadadadosSurgical Treatment of Sleep Apnea: Association Between Surgeon/Hospital Volume With Outcomes(Wiley-Blackwell, 2014-01-01) Capobianco, Dirce M. [UNIFESP]; Batilana, Adelia; Gandhi, Mihir; Shah, Jatin; Ferreira, Rodrigo; Carvalho, Elias; Rivero, Thiago S.; Pietrobon, Ricardo; Atallah, Alvaro N. [UNIFESP]; Prado, Gilmar F. [UNIFESP]; Duke Univ; Universidade Federal de São Paulo (UNIFESP); Minist Educ Brazil; Singapore Clin Res Inst; Duke NUS Grad Med SchObjectives/HypothesisTo identify the association between surgeon/hospital volume with outcomes in surgical treatment for obstructive sleep apnea (OSA) in a nationally representative sample. We hypothesized that surgeons/hospitals with lower patient volumes would have: higher mortality rates, longer hospital length of stay (LOS), and higher postoperative complication rates and hospitalization charges.Study DesignSecondary data analysis of the 2007 Nationwide Inpatient Sample database.MethodsWe selected 24,298 adults undergoing OSA surgery. the data analysis included trend test, regression, and multivariate models that were adjusted by demographic and clinical variables.ResultsThe patients were mostly White (76.43%), male (78.26%), with a mean age of 46 years. Patients treated by surgeons with low volume of procedures (1 procedure/year) had significantly higher mortality rate (odds ratio [OR] 3.05; confidence interval [CI], 1.96-4.77), longer average LOS (increased until 8.16 hours), and higher hospitalization charges (increased up to $1701.75) versus medium- and high-volume surgeons (2-4 procedures/year; greater than/or equal to 5 procedures/year, respectively). Patients treated at hospitals with low volume of procedures (0-5/year) had significantly higher occurrence of oxygen desaturation (OR, 2.12; CI, 1.50-2.99), longer LOS (increased until almost 2 hours) and higher hospitalization charges (at least $951.50 more expensive) versus patients treated at high-volume hospitals (greater than/or equal to 18 procedures/year).ConclusionOur investigation validates the hypothesis that lower volume standards (surgeon/hospital) are associated with increase of LOS following surgery to treat OSA, as well as lower surgeon volume associated with increase of mortality and hospitalization charges and lower hospital volume with occurrence of oxygen desaturation as postoperative complication.Level of Evidence2c. Laryngoscope, 124:320-328, 2014