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Results of endoscopic biliary drainage in patients with malignant hilar stricture
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Martins, Bruno Costa

; Perez, Caio A.

; Ruas, Jennifer N.

; Bento, Luiza H.

; Mendonça, Ernesto Q.

; Paulo, Gustavo A. de

; Uemura, Ricardo S.

; Geiger, Sebastian N.

; Lima, Marcelo Simas de

; Jukemura, Jose

; Ribeiro Jr., Ulysses

; Maluf Filho, Fauze

Clinics

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2023, Volume 78 elocation 100153

Abstract: En | Text: En | PDF: En

Abstract In Malignant Hilar Biliary Stricture (MHBS) palliative biliary drainage is a frequent strategy, improving the quality of life, reducing pruritus, loss of appetite and relieving cholangitis. The endoscopic approach is an effective, although challenging procedure. This study aimed to evaluate technical and clinical success rates of biliary drainage by ERCP. This is a retrospective study including all patients with MHBS referred to Instituto do Cancer do Hospital de São Paulo (ICESP) submitted to biliary drainage by ERCP, between January 2010 and December 2017. Multivariable logistic regression was performed to evaluate predictors of clinical failure, as total bilirubin levels, Bismuth classification, number of hepatic sectors drained and presence of cholangitis. In total, 82 patients presenting unresectable MHBS were included in this study. 58.5% female and 41.5% male, with a mean age of 60±13 years. Bismuth classification grades II, IIIA, IIIB and IV were noted in 23.2%, 15.9%, 14.6% and 46.3%, respectively. Technical and clinical success was achieved in 92.7% and 53.7% respectively. At multivariable logistic-regression analyses, Bismuth IV strictures were related to higher clinical failure rates when compared to other strictures levels, with an Odds Ratio of 5.8 (95% CI 1.28‒20.88). In conclusion, endoscopic biliary drainage for malignant hilar biliary stricture had a high technical success but suboptimal clinical success rate. Proximal strictures (Bismuth IV) were associated with poor drainage outcomes.

https://doi.org/10.1016/j.clinsp.2022.100153

Virtual Case-Based Learning: Nova Estratégia de Ensino e de Treinamento Médico Digital Humanizado em Cardiologia
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Canesin, Manoel Fernandes

; Furtado, Fabrício Nogueira

; Gonçalves, Rodrigo Marques

; Carraro, Diogo Cesar

; Oliveira, Thaísa Mariela Nascimento de

; Rodrigues, Ricardo

; Fuganti, Cláudio José

; Mesas, Cézar Eumann

; Uemura, Laércio

Arquivos Brasileiros de Cardiologia

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nov 2022, Volume 119 N. 5 Pages 35 - 42

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Fundamento A consolidação de novos paradigmas educacionais exige a implantação de estratégias inovadoras com potencial de transformar estudantes em profissionais competentes. Objetivos Analisar o conhecimento e a satisfação de estudantes antes e após a utilização de uma nova metodologia ativa de ensino médico de modelo digital humanizado chamada Virtual Case-Based Learning (VCBL). Métodos Estudo descritivo com análise documental sobre o processo de ensino-aprendizagem de estudantes de medicina. Dados obtidos da avaliação de conhecimento teórico e do instrumento de satisfação dos alunos nos anos de 2018 e 2019 foram analisados, e a nova metodologia proposta VCBL foi comparada com a metodologia ativa de ensino tradicional, o Problem-Based Learning (PBL). As análises descritivas e de associação foram realizadas utilizando o programa Statistical Package for the Social Sciences. Resultados Foram analisados 167 documentos aplicados a estudantes de medicina. Em relação à avaliação do conhecimento teórico, os alunos avaliados em 2018 obtiveram média 41,7%, comparados aos alunos de 2019 que alcançaram 73,3% (p<0,001). Entre os estudantes submetidos à avaliação da satisfação com a metodologia de aprendizagem proposta, 76,0% pontuaram o valor máximo para a questão um, e 83,0% para a questão número dois. Cerca de 70,0% dos estudantes classificaram positivamente o aprendizado adquirido após utilização da plataforma Paciente 360; 78,0% responderam que se sentem preparados para o atendimento ambulatorial; e 94,0% pontuaram de forma positiva a metodologia empregada. Conclusão Neste estudo inicial, os resultados indicaram que a nova ferramenta em metodologia ativa de ensino médico digital humanizado, o VCBL, pode auxiliar no aprimoramento do processo de ensino-aprendizagem, proporcionando conhecimento e satisfação dos estudantes.

Abstract Background The consolidation of new educational paradigms requires the implementation of innovative strategies to transform students into competent professionals. Objectives To assess knowledge and satisfaction of medical students before and after the use of a new humanized digital model of active learning, called virtual case-based learning (VCBL). Methods This was a descriptive, documentary analysis of the teaching-learning process of medical students. Data obtained from theoretical knowledge assessment and satisfaction evaluation questionnaires applied in 2018 and 2019 were analyzed, and the new VCBL was compared with the traditional active methodology PBL (problem-based learning). Descriptive and association analyses were made using the Statistical Package for the Social Sciences. Results A total of 167 evaluation forms administered to medical students were analyzed. In the evaluation of theoretical knowledge, the 2018 and the 2019 student groups had a mean of 41.7% and 73.3%, respectively (p<0.001). Among the students who responded to the satisfaction evaluation form, 76.0% gave the highest rating to question one, and 83.0% to question two. Nearly 70.0% of students positively evaluated knowledge acquisition with the Paciente 360 platform; 78.0% reported to feel prepared for working in outpatient care; and 94.0% positively evaluated the new method. Conclusion In this initial study, the results indicate that the new active method for humanized digital medical education, the VCBL, can help in the betterment of the teaching-learning process, promoting knowledge and satisfaction by the students.

https://doi.org/10.36660/abc.20220423

Implications for Clinical Practice from a Multicenter Survey of Heart Failure Management Centers
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Bocchi, Edimar Alcides

; Moreira, Henrique Turin

; Nakamuta, Juliana Sanajotti

; Simões, Marcus Vinicius

; Casas, Alberto de Almeida Las

; Costa, Altamiro Reis da

; Assis, Amberson Vieira de

; Durães, André Rodrigues

; Pereira-Barretto, Antonio Carlos

; Ravessa, Antonio Delduque de Araujo

; Macedo, Ariane Vieira Scarlatelli

; Biselli, Bruno

; Pinto, Carolina Maria Nogueira

; Filho, Conrado Roberto Hoffmann

; Costantini, Costantino Roberto

; Almeida, Dirceu Rodrigues

; Santos Jr, Edval Gomes dos

; Soliva Junior, Erwin

; Figueiredo, Estevão Lanna

; Albuquerque, Felipe Neves de

; Paulitsch, Felipe

; Neuenschwander, Fernando Carvalho

; Figueiredo Neto, José Albuquerque de

; Brito, Flavio de Souza

; Lopes, Heno Ferreira

; Villacorta, Humberto

; Souza Neto, João David de

; Sepulveda, João Mariano

; Ayoub, José Carlos Aidar

; Vilela-Martin, José F.

; Cardoso, Juliano Novaes

; Uemura, Laercio

; Moura, Lidia Zytynski

; Maia, Lilia Nigro

; Oliveira, Lucia Brandão de

; Maia, Lucimir

; Silva, Luís Beck da

; Gowdak, Luís Henrique Wolff

; Danzmann, Luiz Claudio

; Andrade, Marcus

; Braile-Sternieri, Maria Christiane Valeria Braga

; Moreira, Maria da Consolação Vieira

; França Neto, Olimpio R

; Filho, Otavio Rizzi Coelho

; Esteves, Paulo Frederico

; Raupp-da-Rosa, Priscila

; Silva, Ricardo Jorge de Queiroz e

; Mourilhe-Rocha, Ricardo

; Viégas, Ruy Felipe Melo

; Rassi, Salvador

; Mangili, Sandrigo

; Kaiser, Sergio Emanuel

; Martins, Silvia Marinho

; Kawabata, Vitor Sergio

Clinics

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2021, Volume 76 elocation e1991

Abstract: En | Text: En | PDF: En

OBJECTIVES: This observational, cross-sectional study based aimed to test whether heart failure (HF)-disease management program (DMP) components are influencing care and clinical decision-making in Brazil. METHODS: The survey respondents were cardiologists recommended by experts in the field and invited to participate in the survey via printed form or email. The survey consisted of 29 questions addressing site demographics, public versus private infrastructure, HF baseline data of patients, clinical management of HF, performance indicators, and perceptions about HF treatment. RESULTS: Data were obtained from 98 centers (58% public and 42% private practice) distributed across Brazil. Public HF-DMPs compared to private HF-DMP were associated with a higher percentage of HF-DMP-dedicated services (79% vs 24%; OR: 12, 95% CI: 94-34), multidisciplinary HF (MHF)-DMP [84% vs 65%; OR: 3; 95% CI: 1-8), HF educational programs (49% vs 18%; OR: 4; 95% CI: 1-2), written instructions before hospital discharge (83% vs 76%; OR: 1; 95% CI: 0-5), rehabilitation (69% vs 39%; OR: 3; 95% CI: 1-9), monitoring (44% vs 29%; OR: 2; 95% CI: 1-5), guideline-directed medical therapy-HF use (94% vs 85%; OR: 3; 95% CI: 0-15), and less B-type natriuretic peptide (BNP) dosage (73% vs 88%; OR: 3; 95% CI: 1-9), and key performance indicators (37% vs 60%; OR: 3; 95% CI: 1-7). In comparison to non- MHF-DMP, MHF-DMP was associated with more educational initiatives (42% vs 6%; OR: 12; 95% CI: 1-97), written instructions (83% vs 68%; OR: 2: 95% CI: 1-7), rehabilitation (69% vs 17%; OR: 11; 95% CI: 3-44), monitoring (47% vs 6%; OR: 14; 95% CI: 2-115), GDMT-HF (92% vs 83%; OR: 3; 95% CI: 0-15). In addition, there were less use of BNP as a biomarker (70% vs 84%; OR: 2; 95% CI: 1-8) and key performance indicators (35% vs 51%; OR: 2; 95% CI: 91,6) in the non-MHF group. Physicians considered changing or introducing new medications mostly when patients were hospitalized or when observing worsening disease and/or symptoms. Adherence to drug treatment and non-drug treatment factors were the greatest medical problems associated with HF treatment. CONCLUSION: HF-DMPs are highly heterogeneous. New strategies for HF care should consider the present study highlights and clinical decision-making processes to improve HF patient care.

https://doi.org/10.6061/clinics/2021/e1991 870 downloads

Endoscopy infection control strategy during the COVID-19 pandemic: experience from a tertiary cancer center in Brazil
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Pombo, Amanda A.M.

; Lenz, Luciano

; Paulo, Gustavo A.

; Santos, Mônica A.

; Tamae, Patricia K.

; Santos, Alisson L.D.R.

; Rezende, Daniel T.

; Martins, Bruno

; Kawaguti, Fabio S.

; Pennachi, Caterina M.P.S.

; Gusmon-Oliveira, Carla C.

; Uemura, Ricardo S.

; Geiger, Sebastian

; Lima, Marcelo S.

; Baba, Elisa R.

; Figueiredo, Viviane R.

; Safatle-Ribeiro, Adriana

; Maluf-Filho, Fauze

; Ribeiro-Júnior, Ulysses

Clinics

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2021, Volume 76 elocation e2280

Abstract: En | Text: En | PDF: En

OBJECTIVES: Strategic planning for coronavirus disease (COVID-19) care has dominated the agenda of medical services, which have been further restricted by the need for minimizing viral transmission. Risk is particularly relevant in relation to endoscopy procedures. This study aimed to describe a contingency plan for a tertiary academic cancer center, define a strategy to prioritize and postpone examinations, and evaluate the infection rate among healthcare workers (HCWs) in the endoscopy unit of the Cancer Institute of the State of São Paulo (ICESP). METHODS: We created a strategy to balance the risk of acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and to mitigate the effects of postponing endoscopic procedures in oncological patients. A retrospective analysis of prospectively collected data on all endoscopies between March and June 2020 compared with those during the same period in 2019 was carried out. All HCWs were interviewed to obtain clinical data and SARS-CoV-2 test results. RESULTS: During the COVID-19 outbreak, there was a reduction of 55% in endoscopy cases in total. Colonoscopy was the most affected modality. The total infection rate among all HCWs was 38%. None of the senior digestive endoscopists had COVID-19. However, all bronchoscopists had been infected. One of three fellows had a serological diagnosis of COVID-19. Two-thirds of all nurses were infected, whereas half of all technicians were infected. CONCLUSIONS: In this pandemic scenario, all endoscopy services must prioritize the procedures that will be performed. It was possible to maintain some endoscopic procedures, including those meant to provide nutritional access, tissue diagnosis, and endoscopic resection. Personal protective equipment (PPE) seems effective in preventing transmission of COVID-19 from patients to digestive endoscopists. These measures can be useful in planning, even for pandemics in the future.

https://doi.org/10.6061/clinics/2021/e2280 501 downloads

UNDERWATER ENDOSCOPIC MUCOSAL RESECTION FOR NON-PEDUNCULATED COLORECTAL LESIONS. A PROSPECTIVE SINGLE-ARM STUDY
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LENZ, Luciano

; MARTINS, Bruno

; KAWAGUTI, Fabio Shiguehisa

; TELLIAN, Alexandre

; PENNACHI, Caterina Maria Pia Simoni

; SORBELLO, Mauricio

; GUSMON, Carla

; PAULO, Gustavo Andrade de

; UEMURA, Ricardo

; GEIGER, Sebastian

; LIMA, Marcelo Simas de

; SAFATLE-RIBEIRO, Adriana

; BABA, Elisa

; HASHIMOTO, Claudio Lyoiti

; MALUF-FILHO, Fauze

; RIBEIRO JR, Ulysses

Arquivos de Gastroenterologia

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jun 2020, Volume 57 N. 2 Pages 193 - 197

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO CONTEXTO: A ressecção endoscópica da mucosa sob imersão d’água (REMS) surgiu como um método revolucionário que permite a ressecção de lesões colorretais sem injeção submucosa. A literatura brasileira sobre essa técnica é escassa. OBJETIVO: A finalidade deste estudo foi avaliar a eficácia e segurança da técnica REMS na remoção de lesões colorretais não pediculadas em dois centros terciários brasileiros. MÉTODOS: Este estudo prospectivo foi realizado entre junho de 2016 e maio de 2017. As lesões sem tentativa de ressecção prévia, não pediculadas e sem sinais de invasão submucosa foram ressecadas pela técnica REMS. RESULTADOS: Um total de 55 pacientes com 65 lesões foram incluídos. Todas as lesões, exceto uma, foram removidas com sucesso e completamente por REMS (taxa de sucesso de 98,5%). Durante a REMS, foram observados dois casos de sangramento (3,0%). Uma paciente apresentou dor abdominal no dia seguinte à ressecção sem pneumoperitônio. Não houve perfuração ou sangramento tardio. CONCLUSÃO: Este estudo apoia os dados existentes, indicando taxas aceitáveis de sucesso técnico e baixa incidência de eventos adversos com a REMS. Os resultados deste estudo brasileiro foram consistentes com estudos internacionais prévios.

ABSTRACT BACKGROUND: Underwater endoscopic mucosal resection (UEMR) has emerged as a revolutionary method allowing resection of colorectal lesions without submucosal injection. Brazilian literature about this technique is sparse. OBJECTIVE: The aim of this study was evaluate the efficacy and safety of UEMR technique for removing non-pedunculated colorectal lesions in two Brazilian tertiary centers. METHODS: This prospective study was conducted between June 2016 and May 2017. Naïve and non-pedunculated lesions without signs of submucosal invasion were resected using UEMR technique. RESULTS: A total of 55 patients with 65 lesions were included. All lesions, except one, were successfully and completely removed by UEMR (success rate 98.5%). During UEMR, two cases of bleeding were observed (3.0%). One patient had abdominal pain on the day after resection without pneumoperitoneum. There was no perforation or delayed bleeding. CONCLUSION: This study supports the existing data indicating acceptable rates of technical success, and low incidence of adverse events with UEMR. The results of this Brazilian study were consistent with previous abroad studies.

https://doi.org/10.1590/s0004-2803.202000000-37 913 downloads

Resistance of cassava genotypes to Vatiga manihotae (Drake 1922) (Hemiptera: Tingidae)
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Wengrat, Ana Paula Gonçalves da Silva

; Barilli, Diandro Ricardo

; Uemura-Lima, Daliana Hisako

; Gazola, Diego

; Guimarães, Ana Tereza Bittencourt

; Pietrowski, Vanda

Revista Brasileira de Entomologia

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2020, Volume 64 N. 3 elocation e20200017

Abstract: En | Text: En | PDF: En

ABSTRACT Vatiga manihotae (Drake 1922) (Hemiptera: Tingidae) is an important cassava pest due to the great potential damage and the increasing population in recent years. However, few studies about bioecology and control of the cassava lace bug have been conducted and their results don't provide adequate control strategies. An alternative to maintain the population below economic injury levels is through the adoption of host plant resistance. To improve the understanding about the bioecology and find new sources of resistance in cassava, the biological parameters and demographics of V. manihotae on five cassava genotypes (Santa Helena, MEcu 72, Col 22, Clone 02 and Clone 03) under controlled conditions (25±2°C, 14L/10D) were evaluated. Duration and viability of the stages, the period egg-adult, sex ratio, the pre-oviposition period, fecundity and longevity of male and female was determined, and a fertility life table was prepared. Insects fed on MEcu 72 showed increased nymphal, egg-adult, and pre-oviposition periods and reduced female fecundity and longevity in comparison to the other genotypes. Demographic parameters (Ro, rm, T, DT) showed a significant impact on the growth potential of V. manihotae fed on MEcu 72 indicating that the populations would diminish over time. The combined effect of these parameters indicated that MEcu 72 has resistance on V. manihotae specimens hindering their development.

https://doi.org/10.1590/1806-9665-rbent-2020-0017 689 downloads

Cirurgia híbrida na exérese de tumor glômico Shamblin II
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Amato, Alexandre Campos Moraes

; Ferreira, Diego Daniel Gomes

; Silva, Fernanda Teixeira Fonseca da

; Uemura, Marielly Ayako

; Stucchi, Thais de Oliveira

; Santos, Ricardo Virgínio dos

Jornal Vascular Brasileiro

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2019, Volume 18 elocation e20180122

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo O tumor glômico é uma neoplasia benigna rara originada de células paraganglionares da crista neural que se desenvolve na camada adventícia do vaso. São tumores não encapsulados e altamente vascularizados. Paciente feminina, 64 anos, foi diagnosticada com tumor glômico hipervascularizado com 5 cm posteriormente à bifurcação carotídea esquerda e oclusão de carótida contralateral. Optou-se por realizar embolização através de acesso endovascular seguida de punção percutânea direta, guiada por angiografia, para preenchimento da área remanescente. Após embolização, realizou-se a exérese cirúrgica do tumor com menor sangramento e maior facilidade para encontrar o plano de clivagem das estruturas adjacentes. Em acompanhamento tardio, a paciente apresenta-se sem recidiva tumoral. O tumor foi classificado como pertencente ao grupo Shamblin II, o qual inclui tumores apresentando de 4 a 6 cm com inserção arterial moderada. Através dessa dupla abordagem, foi possível notar uma redução relativa do sangramento intraoperatório e facilitação de identificação do plano de clivagem, colaborando para sua exérese e evitando o pinçamento cirúrgico.

Abstract Glomus tumors are rare benign neoplasms originating from paraganglionic cells of the neural crest developing in the adventitious layer of the vessel. They are nonencapsulated and highly vascularized. A 64-year-old female patient was identified with a hypervascularized glomus tumor measuring 5 cm, posterior to the left carotid bifurcation and contralateral carotid occlusion. We performed preoperative embolization via endovascular access followed by direct percutaneous puncture, guided by angiography, to fill the remaining area. After embolization, surgical excision of the tumor was performed with reduced bleeding and it was easier to find the cleavage planes to adjacent structures. At late follow-up, the patient is free from tumor recurrence. The tumor was classified as Shamblin II, measuring 4 to 6 cm with moderate arterial insertion. Through this double approach we observed a relative reduction in intraoperative bleeding and improved identification of the cleavage plane, facilitating excision and avoiding surgical clamping.

https://doi.org/10.1590/1677-5449.012218 2743 downloads

New Bemisia tuberculata (Hemiptera: Aleyrodidae) rearing method for studies in cassava
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Barilli, Diandro Ricardo

; Gonçalves Da Silva Wengrat, Ana Paula

; Uemura-Lima, Daliana Hisako

; Pietrowski, Vanda

; Ringenberg, Rudiney

; Silveira Garcia, Mauro

Revista Colombiana de Entomología

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dec 2018, Volume 44 N. 2 Pages 197 - 199

Abstract: Es En | Text: Es En | PDF: Es | PDF: En

Resumen El objetivo de este estudio fue desarrollar un método de cría de Bemisia tuberculata en plantas de yuca para la producción y el mantenimiento continuo de una colonia. La población inicial de B. tuberculata se obtuvo a partir de hojas recogidas de la planta con alta infestación de ninfas. Los adultos obtenidos fueron transferidos de la taza de plástico a jaulas de tul, en diferentes densidades. La densidad de 125 adultos de B. tuberculata por hojas fue el más adecuado para la cría. El método que se propone en este estudio ha demostrado ser eficaz y se recomienda, ya que el nivel de la población se mantuvo estable durante los experimentos.

Abstract The aim of this study was to develop a rearing method for Bemisia tuberculata on cassava plants that enables the production and ongoing maintenance of a colony. The initial population of B. tuberculata was obtained from leaves collected from plants with high nymph infestations. Emerging adults were transferred from plastic cups to voile cages in different densities. The density of 125 adults of the B. tuberculata per leaf was the most suitable for rearing. The rearing method proposed in this study has proven to be effective and is recommended since it allows for population levels to remain stable during experiments.

https://doi.org/10.25100/socolen.v44i2.7318 131 downloads

Gastrostomía endoscópica: análisis crítico en un hospital referencial regional
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Marques Fávaro, Gabriel

; Franco Vilela, Tiago

; Soares Coca, Diego

; Buch Cunha, Marco Antonio

; Sato Uemura, Ricardo

; Furuya Júnior, Carlos Kyoshi

; Aparício, Dayse

; Artifon, Everson L. A

Revista de Gastroenterología del Perú

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jan 2017, Volume 37 N. 1 Pages 33 - 38

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Introduction: Percutaneous endoscopic gastrostomy (PEG) is a safe and effective endoscopic surgical procedure for enteral access and gastrointestinal decompression, and it is an excellent alternative to surgical gastrostomy. There are various clinical indications and these mainly include the need for prolonged enteral nutritional support due to complications from neurological, geriatric and oncological diseases and decompression of the gastrointestinal tract. Although safe and effective, a number of possible complications relating to the time (early or late complications) and severity (minor or major complications) may occur. Objective: To evaluate the indications and complications relating to PEG among selected patients at the digestive endoscopy service of a regional referral hospital. Materials and methods: A retrospective study on patients who underwent PEG between May 2013 and April 2015 was conducted. The patients were identified through searching the medical records and using a standardized data form. Results: 53 cases were analyzed. The average age was 70.47 years and 60.37% of the patients were women. The main indication identified was the need for enteral nutritional support, and 73.58% of these indications were derived from neurological complications, 15.09% from geriatric complications and 9.43% from oncological complications and 1.88% were due to gastrointestinal decompression. Complications occurred in 24.52% of the cases: 23.07% were major and 76.93% were minor. Regarding the time, there were eight cases of late complications and five of early complications. Conclusion: PEG was shown to be an effective and safe method for enteral access. The indication and complication rates were similar to those reported in the literature.

Introducción: La gastrostomía endoscópica percutânea (GEP) es un procedimento endoscópico-quirúrgico seguro y efectivo para el acceso enteral y para la descompresión gastrointestinal, constituyéndose como una excelente alternativa a la gastrostomía quirúrgica. Las indicaciones clínicas son variadas y comprenden principalmente: necesidad de soporte nutricional enteral prolongado por complicaciones de las enfermedades neurológicas, geriátricas y oncológicas, así como la descompresión del tracto gastrointestinal. Aunque es segura y eficaz, se puede producir una serie de posibles complicaciones relacionadas al momento (precoz temprano o tardío) de la realización del procedimiento y a la gravedad (mayor o menor). Objetivo: Evaluar las indicaciones y complicaciones relacionadas a la realización de la GEP en pacientes seleccionados de un sector de endoscopia digestiva de un hospital regional de referencias. Materiales y métodos: Fue realizado un estudio retrospectivo de los pacientes sometidos a la GEP en el periodo de mayo de 2013 a abril de 2015. Los pacientes fueron identificados a partir de la investigación de los registros y formulario estándar de datos. Resultados: Fueron analizados 53 casos. La edad media fue de 70,47 años con un 60,37% del sexo femenino. La indicación principal verificada fue la necesidad de soporte nutricional enteral, siendo 73,58% por complicaciones neurológicas, 15,09% geriátricas, 9,43% oncológicas; y 1,88% de las indicaciones fueron para descomprensión gastrointestinal. Ocurrieron complicaciones en 24,52% de los pacientes: 23,07% mayores y 76,93% menores. En relación al momento, fueron verificados ocho casos de complicaciones tardías y cinco de complicaciones precoces (tempranas). Conclusión: La GEP se mostró como un método eficaz y seguro para el acceso enteral. Los índices de complicación fueron semejantes a los datos evidenciados en la literatura.

10.

Aspectos epidemiológicos de las resecciones endoscópicas de los pólipos colo-rectales en un centro de entrenamiento de endoscopía en la región de Santos, Brasil
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Vilela Filho, Tiago Franco

; Marques Fávaro, Gabriel

; Soares Coca, Diego

; Bonini Daniel, Lubia

; Ferreira Guenaga, Katia

; Sato Uemura, Ricardo

; Furuya Junior, Carlos Kyoshi

; Artifon, Everson L. A

Revista de Gastroenterología del Perú

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jan 2017, Volume 37 N. 1 Pages 47 - 52

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Introduction: Colorectal polyps are structures that project from the surface of the mucosal layer of the large intestine. They are classified as neoplastic or non-neoplastic. Early detection of pre-neoplastic lesions is important for preventing colorectal cancer. These can be resected so as to decrease the morbidity and mortality rates. Colonoscopy is the gold-standard procedure for diagnosing and resecting precursor lesions. Objective: To evaluate the epidemiological, endoscopic and histological aspects of endoscopic resection of lesions of the colon and rectum at a training center. Materials and method: A search was conducted in the database of our institution covering the period from January 2011 to July 2014. Cases that underwent endoscopic resection of polyps and/or colorectal lesions were selection. The following variables were defined: general data on the patients (age, gender and indication from the examination) and data on the polypoid lesion (number, histological type and topographic distribution). Results: 678 lesions were identified in 456 examinations. Regarding sex, 242 (53.1%) were female and 214 (46.9%) were male. The mean age was 64.54 years, with extremes of 5 and 94 years. The most frequent locations were the rectum (21%) and sigmoid (20%). Histologically, 34.7% were hyperplastic polyps and 58.9% were adenomatous polyps, of which 74.1% were tubular, 10.6% tubulovillous, 2% villous and 13% indeterminate; and 1.7% were adenocarcinomas. In 65.4% of the cases, the examination showed that only one polyps was present, while 34.6% had two or more lesions. Conclusion: In our clinic, with a mean of 250 examinations/month, the parameters evaluated were compatible with the results reported in the literature.

Introducción: Los pólipos colorrectales son estructuras que se proyectan en la superficie de la capa mucosa del intestino grueso. Son clasificados en neoplásicos y no neoplásicos. La detección precoz de lesiones preneoplásicas es relevante en la prevención del cáncer colorrectal. Pueden ser resecados y reducir los índices de morbimortalidad. La colonoscopia es el patrón de oro para el diagnóstico y resección de lesiones precursoras. Objetivo: Evaluar aspectos epidemiológicos, endoscópicos e histológicos relacionados a las resecciones endoscópicas de lesiones de colon y recto en un centro de entrenamiento. Matariales y métodos: Fue realizada una búsqueda en la base de datos de nuestra institución durante el período de enero de 2011 a julio de 2014. Se seleccionaron aquellos sometidos a las resecciones endoscópicas de pólipos y/o lesiones colorrectales. Las siguientes variables fueron definidas: datos generales de los pacientes (edad género e indicación del examen) y datos de la lesión polipoidea (número, tipo histológico, distribución topográfica). Resultados: Fueron identificadas 678 lesiones en 456 exámenes. Con relación al sexo, 242 (53,1 %) eran del género femenino y 214 (46,9 %) masculino. El promedio de edad fue de 64,54 años, con extremos de 5 y 94 años. La ubicación más frecuente fue en el recto (21 %) y sigmoide (20 %). Histológicamente, 34,7% eran pólipos hiperplásicos y 58,9% adenomatosos, siendo 74,1% tubulares, 10,6% tubulovellosos, 2% vellosos y 13% indeterminados y, 1,7% correspondieron a adenocarcinomas. En el 65,4% de los casos existía solamente un pólipo al hacer el examen, 34,6% presentaban dos o más lesiones. Conclusión: En nuestro trabajo, con un promedio de 250 exámenes/mes, los parámetros evaluados fueron compatibles a los resultados encontrados en la literatura.

11.

Biliary transpapillary endoscopic balloon dilation for treating choledocholithiasis
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Daniel, Lubia B

; Favaro, Gabriel M

; Filho, Tiago F.V

; Cunha, Marco A. B

; Aparício, Dayse S. P

; Uemura, Ricardo S

; Furuya Jr, Carlos K

; Artifon, Everson L. A

Revista de Gastroenterología del Perú

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jul 2015, Volume 35 N. 3 Pages 231 - 235

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Objective: To evaluate the efficacy and safety of transpapillary papilloplasty in patients with choledocholithiasis. Materials and methods: All endoscopic retrograde cholangiopancreatography (ERCP) procedures performed at Hospital Ana Costa, in the city of Santos, Brazil, over the last five years were retrospectively evaluated using the hospital’s information database. The success of the procedure and complications due to residual calculi, pancreatitis, bleeding and perforation were evaluated. Results: From January 2010 to May 2014, 1860 ERCP procedures were performed. Fifty-five patients were evaluated here. Their ages ranged from 12 to 98 years (mean, 66.3; standard deviation, 19.34; median, 71). Thirty-two patients (58.2%) were women. Sixteen (29.1%) presented giant choledocholithiasis, with calculi larger than 12 mm. Twenty-seven (49.1%) had multiple choledocholithiasis. Conclusion: In view of the therapeutic efficacy and low complication rate among our patients, we can conclude that endoscopic papilloplasty is a safe and effective method for endoscopic treatment of choledocolithiasis in selected cases.

Objetivo: Evaluar la eficacia y seguridad de la papiloplastía trnaspapilar en la colédoco litiasis. Material y métodos: Todas las colangoipancreatografías retrogradas endoscópicas (CPRE) realizadas en el Hospital Ana Costa en la ciudad de Santos Brasil, en los últimos cinco años fueron evaluadas retrospectivamente usando la base de datos del hospital. El éxito y las complicaciones del procedimiento debido a cálculos residuales, pancreatitis, sangrados y perforación fueron estudiados. Resultados: De enero del 2010 a mayo del 2014, se realizaron 1860 CPREs. Se estudiaron 55 pacientes, cuyas edades fluctuaron entre 12 a 98 años con una media de 66,3 y desviación estándar de 19,34. Treinta dos pacientes fueron mujeres (58,2%). 16 (29,1%) tuvieron litiasis coledociana gigante con cálculos mayores de 12 mm y veintisiete (49,1%) tuvieron litiasis múltiple. Conclusión: En vista de la eficacia y la poca frecuencia de complicaciones entre nuestros pacientes podemos concluir que la papilotomía endoscópica es un método seguro y efectivo para el tratamiento de la coledocolitiasis en casos seleccionados.

12.

Punção aspirativa de linfonodo axilar guiada pela ultrassonografia é eficaz como método de predição de acometimento linfonodal em pacientes com câncer de mama?
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Pessoa, Eduardo Carvalho

; Rodrigues, José Ricardo Paciência

; Pessoa, Carla Priscila Kamiya Carvalho

; Véspoli, Heloísa Maria de Luca

; Uemura, Gilberto

Revista Brasileira de Ginecologia e Obstetrícia

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mar 2014, Volume 36 N. 3 Pages 118 - 123

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

OBJETIVO: Avaliar a viabilidade e acurácia diagnóstica da ultrassonografia pré-operatória combinada com biopsia por agulha fina (US-PAAF) e do exame clínico da axila em pacientes com câncer de mama. MÉTODOS: Neste estudo prospectivo 171 axilas de pacientes com câncer de mama foram avaliadas pelo exame clínico e ultrassonografia (US) com e sem biopsia por agulha fina (PAAF). Os linfonodos com espessura cortical maior que 2,3 mm na ultrassonografia foram considerados suspeitos e submetidos a US-PAAF. RESULTADOS: A análise de regressão logística não mostrou correlação estatisticamente significativa entre exame clínico e axilas positivas no exame patológico. Em relação à avaliação axilar com US, o risco de achados anatomopatológicos positivos aumentou 12,6 vezes, valor Kappa de Cohen foi de 0,12 para exame clínico, 0,48 para US e 0,80 para US-PAAF. A acurácia foi de 61,4% para o exame clínico, 73,1% para os US e 90,1% para US-PAAF. Análise Receiver Operating Chracteristics (ROC) mostrou que uma espessura de 2,75 mm cortical correspondeu à mais elevada sensibilidade e especificidade na predição metástase axilar (82,7 e 82,2%, respectivamente). CONCLUSÕES: A US combinada com aspiração por agulha fina é mais precisa que o exame clínico na avaliação do status axilar no pré-operatório em mulheres com câncer de mama. Aquelas que são US-PAAF positivo podem ser direcionadas para esvaziamento linfonodal axilar imediatamente, e somente aqueles que são US-PAAF negativos devem ser considerados para biópsia de linfonodo sentinela.

PURPOSE: To assess the feasibility and diagnostic accuracy of preoperative ultrasound combined with ultrasound-guided fine-needle aspiration (US-FNA) cytology and clinical examination of axillary lymph node in patients with breast cancer. METHODS: In this prospective study, 171 axillae of patients with breast cancer were evaluated by clinical examination and ultrasonography (US) with and without fine needle aspiration (FNA). Lymph nodes with maximum ultrasonographic cortical thickness > 2.3 mm were considered suspicious and submitted to US-FNA. RESULTS: Logistic regression analysis showed no statistically significant correlation between clinical examination and pathologically positive axillae. However, in axillae considered suspicious by ultrasonography, the risk of positive anatomopathological findings increased 12.6-fold. Cohen's Kappa value was 0.12 for clinical examination, 0.48 for US, and 0.80 for US-FNA. Accuracy was 61.4% for clinical examination, 73.1% for US and 90.1% for US-FA. Receiver Operating Characteristics (ROC) analysis demonstrated that a cortical thickness of 2.75 mm corresponded to the highest sensitivity and specificity in predicting axillary metastasis (82.7 and 82.2%, respectively). CONCLUSIONS: Ultrasonography combined with fine-needle aspiration is more accurate than clinical examination in assessing preoperative axillary status in women with breast cancer. Those who are US-FNA positive can be directed towards axillary lymph node dissection straight away, and only those who are US-FNA negative should be considered for sentinel lymph node biopsy.

https://doi.org/10.1590/S0100-72032014000300005 13108 downloads Cited 1 time in SciELO

13.

Apendicite aguda atípica diagnosticada por colonoscopia
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Salles, Valdemir José Alegre

; Saba, Eduardo

; Cauduro, Antonio Baptista

; Staffa, Ricardo Naegele

; Uemura, Livia Alkmin

; Uemura, Terume

Jornal Português de Gastrenterologia

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may 2012, Volume 19 N. 3 Pages 156 - 157

Abstract: Pt | Text: Pt | PDF: Pt

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14.

Quais as características propostas pelo BIRADS-US que melhor diferenciam nódulos malignos dos benignos?
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Pessoa, Eduardo Carvalho

; Rodrigues, Jose Ricardo Paciência

; Kamiya, Carla Priscila

; Morceli, José

; Nabuco, José Joaquim Gomes

; Vespoli, Heloisa Maria De Luca

; Uemura, Gilberto

Revista Brasileira de Ginecologia e Obstetrícia

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dec 2007, Volume 29 N. 12 Pages 625 - 632

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

OBJETIVO: analisar qual das características propostas pelo BIRADS-US tem maior impacto na diferenciação das lesões benignas das malignas. MÉTODOS: estudamos as características ultra-sonográficas do BIRADS em 384 nódulos submetidos à biópsia percutânea no período de fevereiro de 2003 a dezembro de 2006. Utilizou-se, para o exame, o aparelho Logic 5, com transdutor linear multifreqüencial de 7,5-12 MHz. A análise ultra-sonográfica do nódulo foi baseada no BIRADS-US levando em conta: forma, orientação, margem, limites da lesão, ecogenicidade, características acústicas posteriores, o tecido circunjacente e a presença de calcificações. Estes dados foram submetidos à análise estatística com modelo de regressão logística. Para o estudo de associação entre estas variáveis utilizamos o teste do c² e também calculamos a sensibilidade e a especificidade das variáveis "tecido ao redor", "calcificações", "efeito posterior", "limite da lesão" e "orientação". RESULTADOS: as lesões benignas representaram 42,4% e as malignas, 57,6%. A análise por regressão logística encontrou odds ratio (OR) aumentado para câncer de 7,7 vezes quando o tecido ao redor esteve alterado, de 6,2 vezes quando houve presença das microcalcificações no interior das lesões, de 1,9 quando o efeito acústico foi sombra, de 25,0 vezes quando houve o halo ecogênico e de 7,1 vezes quando a orientação foi não paralela. CONCLUSÕES: dentre as características estudadas, o limite da lesão, representado pela presença ou não do halo ecogênico, é o mais importante diferenciador das massas benignas das malignas.

PURPOSE: to analyze which characteristics proposed by the BIRADS lexicon for ultrasound have the greatest impact on distinguishing between benign and malignant lesions. METHODS: ultrasonography features from the third edition of the BIRADS were studied in 384 nodes submitted to percutaneous biopsy from February 2003 to December 2006, at the Medical School of Botucatu. For the ultrasonography, the equipment Logic 5 with a 7.5-12 MHz multifrequential linear transducer was used. The ultrasonography analysis of the node considered the features proposed by the BIRADS lexicon for ultrasound. The data were submitted to statistical analysis by the logistic regression model. RESULTS: the benign lesions represented 42.4% and the malignant, 57.6%. The logistic regression analysis found an odds ratio (OR) for cancer of 7.69 times when the surrounding tissue was altered, of 6.25 times when there were microcalcifications in the lesions interior, of 1.95 when the acoustic effect is shadowing, of 25.0 times when there was the echogenic halo, and of 7.14 times when the orientation was non-parallel. CONCLUSIONS: among the features studied, the lesion limit, represented by the presence or not of the halogenic halo, is the most important differentiator of the benign from the malignant masses.

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15.

Avaliação da resposta à quimioterapia primária em amostra de mulheres brasileiras com tumores de mama localmente avançados
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Pessoa, Eduardo Carvalho

; Rodrigues, Jose Ricardo Paciência

; Michelin, Odair

; Luca, Heloisa Vespolli de

; Kamiya, Carla Priscila

; Traiman, Paulo

; Uemura, Gilberto

Revista Brasileira de Ginecologia e Obstetrícia

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jan 2007, Volume 29 N. 1 Pages 18 - 26

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

OBJETIVO: avaliar a resposta loco-regional à quimioterapia primária nas pacientes com câncer de mama nos estadios II e III. MÉTODOS: foi realizado um estudo clínico retrospectivo e analítico de 97 pacientes no estadios II e III, no período de janeiro de 1993 a dezembro de 2004, submetidas a três ou quatro ciclos de quimioterapia primária com 5-fluorouracil (500 mg/m²), epirrubicina (50 mg/m²) e ciclofosfamida (500 mg/m²) ou doxorrubicina (50 mg/m²) e ciclofosfamida (500 mg/m²) e posteriormente ao tratamento loco-regional cirúrgico conservador ou radical. Para estudo da associação entre as variáveis (idade, estado menopausal, volume tumoral pré-quimioterapia, estado axilar, estádio, esquema terapêutico e número de ciclos) foram utilizados os testes do chi2 e o exato de Fisher. Para as variáveis quantitativas (volume tumoral pelo estudo anátomo-patológico e volume tumoral clínico pós-quimioterapia) foi utilizado o coeficiente de correlação de Pearson. O nível de significância utilizado foi de 5%. RESULTADOS: a média de idade da população estudada foi de 52,2 anos. No estádio II, tivemos 56,8% dos casos e no estádio III, 43,2%. Aproximadamente metade das pacientes receberam FEC50 e 50%, AC. Obtivemos uma resposta clínica objetiva com o tratamento quimioterápico primário em 64,9% dos casos. A resposta clínica completa ocorreu em 12,3% das pacientes; já a resposta patológica completa aconteceu em 10,3% dos casos. Observamos uma correlação significante entre o número de ciclos e a resposta à quimioterapia primária. Também verificamos uma concordância significante entre a avaliação pelo exame clínico da resposta à quimioterapia primária e o achado anátomo-patológico. CONCLUSÕES: o número de ciclos foi importante para a resposta loco-regional, sendo que as pacientes que receberam maior número de ciclos obtiveram melhores respostas. Também foi possível avaliar a resposta tumoral pelo exame clínico, pois houve concordância com o anátomo-patológico.

PURPOSE: to evaluate the loco-regional response to primary chemotherapy in patients with breast cancer at stages II and III. METHODS: a retrospective and analytical clinical study carried out in 97 patients with an average age of 52.2 years old, with breast cancer at stages II and III, attended from January 1993 to December 2004, and submitted to 3 to 4 cycles of primary chemotherapy with 5-fluorouracil - 500 mg/m2, epirubicin - 50 mg/m2 and cyclophosphamide - 500 mg/m2 or doxorubicin - 50 mg/m2 e cyclophosphamide - 500 mg/m2, and then to loco-regional surgical conservative or radical surgical treatment. Chi-square and Fisher’s exact tests were used to study the association among the variables (age, menopausal state, pre-chemotherapy tumoral volume, axillary condition, stage, therapeutic scheme and number of cycles), while Pearson’s correlation coefficient was used for the quantitative variables (tumoral volume according to the anatomo-pathological study and the post-chemotherapy clinical tumoral volume. The significance level was 5%. RESULTS: there were 56.8% of cases at stage II and 43.2% at stage III. Approximately 50% of the patients received FEC50 and 50% AC. Objective clinical response with primary chemotherapy was obtained in 64.9% of the cases. Full clinical response occurred in 12.3% of patients, while full pathological response occurred in 10.3% of the cases. CONCLUSIONS: there was a statistically significant correlation between the number of cycles and the response to primary chemotherapy. Patients who received 4 cycles had better response than those who received 3 cycles. There was also a statistically significant concordance between the evaluation through clinical examination of the response to primary chemotherapy and the pathological findings. No statistically significant correlation was observed concerning age, menopausal status, tumoral volume, and pretreatment of axillary damage.

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