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Search Results: 1 - 10 of 185644 matches for " Alexandre Coutinho Teixeira de; "
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Carcinoma da glandula supra-renal
Freitas, Alexandre Coutinho Teixeira de;
ABCD. Arquivos Brasileiros de Cirurgia Digestiva (S?o Paulo) , 2007, DOI: 10.1590/S0102-67202007000300002
Abstract: background: adrenal gland neoplasm may be originated from diverse histological types. carcinomas are rare findings, and correspond to only 0,02% of all neoplasms. aim: to review the latest advances in relation to the treatment of adrenal gland carcinomas. methods: a literature review was performed using medline, text books and authors, as well as references obtained from relevant articles. conclusion: approximately 79% of adrenal gland carcinomas are functional. the most commonly secreted hormone is cortisol, which causes cushing′s syndrome. patients with non-functional lesions may complain about local growth of the lesion. this type of carcinoma is present in a series of other neoplasic syndromes of familiar origen. according to the symptoms, initial diagnostic investigation involves dosage of urinary cortisol, as well as aldosterone and renin serum levels. abdominal tomography or magnetic ressonance are first class image tests. fluorodeoxyglucose pet scan is a tool that can be used to differentiate benign and malignant lesions. fine needle biopsy is not indicated due to the high rate of complications. the choosen treatment is usually surgery with block ressection of adjacent organs if necessary. aortic and retroperitoneal lymphadenectomy should be performed. local recurrence and metastasis occur in 80% of the cases. cytoreductive surgical procedures benefit cases of advanced disease. quimiotherapy using mitotane is indicated to patients who were submitted to cytoreductive surgery, who have had local recurrence and in those with metastasis. radiotherapy is the treatment of choice in the event of bone metastasis and adjuvant treatment is used in a few cases with elevated recurrence risks. in adults, the overall average life span in 5 years varies between 10% to 35%. after curative surgery it varies between 20% to 58%.
Cirurgia gastrointestinal no tratamento da diabete tipo 2
Freitas, Alexandre Coutinho Teixeira de;
ABCD. Arquivos Brasileiros de Cirurgia Digestiva (S?o Paulo) , 2007, DOI: 10.1590/S0102-67202007000200012
Abstract: background: the ability of gastrointestinal surgical interventions, mainly bariatric surgery, to promote the control of type 2 diabetes, has already been well documented. aim: to review the literature related to the effects of gastrointestinal surgery regarding type 2 diabetes, especially in relation to metabolic control and its physiopathology. methods: literature was reviewed on medline, pages on the internet, references from relevant articles and studies presented and published on the annals of the international conference on gastrointestinal surgery to treat type 2 diabetes, which occurred in rome in 2007. conclusions: among all bariatric surgeries, biliopancreatic diversion, presented the best control rates for type 2 diabetes followed by gastric bypass and gastric banding. this control is related to weight loss and reduction on food intake. biliopancreatic diversion and gastric bypass also presented important modifications in gut hormones. the most significant ones being: glp-1, gip, pyy, ghrelin, leptin, igf-1, adiponectin. these hormones promote loss of appetite, promote actions over ? cells, increase the secretion of insulin, and increase insulin sensitivity. two theories have been formulated to explain the changes observed on these hormones: the foregut theory, where the bypass of the duodenum and proximal jejunum avoids the secretion of an unknown factor that induces insulin resistance; and the hindgut theory, where the early presentation of food to the ileum anticipates the production of hormones that control diabetes. recently, new promising procedures have been developed. among them are the duodenal-jejunal bypass, ileal interposition, and intestinal resection associated to vertical gastrectomy. these new procedures are still considered experimental.
Uso da mirtazapina no tratamento da náusea e v?mito refratários a terapia habitual após deriva??o gástrica em Y de Roux
Freitas, Alexandre Coutinho Teixeira de;Coelho, Júlio Cezar Uili;
ABCD. Arquivos Brasileiros de Cirurgia Digestiva (S?o Paulo) , 2008, DOI: 10.1590/S0102-67202008000100009
Abstract: background: bariatric surgery is related to significant morbidity. mechanical complications such as stricture of the anastomotic sites are the most common causes of persistent nausea and vomiting. some patients present such symptoms in the absence of these complications. aim: to report the use of mirtazapine in a patient submitted to bariatric surgery, presenting persistent nausea and vomiting in the absence of mechanical complications, and unresponsive to conventional antiemetic drugs. case report: a morbidly obese patient submitted to laparoscopic roux-en-y gastric bypass presented persistent nausea and vomiting unresponsive to treatment with ondansetron, metoclopramide, and bromopride. no mechanical complications were identified. he was treated with an oral daily dose of 30 mg of mirtazapine for 60 days. after two days, the patient presented significant clinical improvement. mirtazapine is an effective drug most commonly used in the treatment of depression, presenting an antiemetic effect due to the blockade of 5-ht3 serotonin receptors in the brainstem. conclusion: mirtazapine can be useful in cases of roux-en-y gastric bypass that present nausea and vomiting unsuccessfully treated with conventional antiemetic drugs when mechanical causes are excluded.
Efeitos da cirurgia bariátrica na fun o do assoalho pélvico Effects of bariatric surgery on pelvic floor function
Larissa Araújo de Castro,Wagner Sobottka,Giorgio Baretta,Alexandre Coutinho Teixeira de Freitas
ABCD. Arquivos Brasileiros de Cirurgia Digestiva (S?o Paulo) , 2012,
Abstract: RACIONAL: A incontinência urinária é bem documentada como comorbidade da obesidade. Estudos demonstram resolu o ou atenua o da incontinência após a perda de peso. Porém, os mecanismos pelos quais isso ocorre ainda n o est o claros. OBJETIVO: Avaliar os efeitos da cirurgia bariátrica na fun o do assoalho pélvico em mulheres. MéTODOS: Foram avaliadas 30 mulheres que estavam em lista de espera para realizar a opera o. Foi verificada a prevalência de incontinência urinária no pré e no pós-operatório e seu impacto na qualidade de vida através do King's Health Questionnaire. A qualidade da contra o muscular do assoalho pélvico foi avaliada através da Escala de Oxford Modificada e da perineometria. RESULTADOS: Vinte e quatro mulheres finalizaram o estudo. O índice de massa corporal passou de 46,96±5,77 kg/m2 no pré-operatório para 29,97±3,48 kg/m2 no pós-operatório, e a perda percentual do excesso de peso média foi de 70,77±13,26%. A prevalência de incontinência urinária passou de 70,8% no pré-operatório para 20,8% no pós-operatório. Após um ano da cirurgia bariátrica, houve redu o do impacto da incontinência urinária na qualidade de vida em sete dos nove domínios avaliados no questionário. A mediana da Escala de Oxford Modificada aumentou de três no pré-operatório para quatro no pós-operatório. A perineometria apresentou aumento significativo na média das três contra es solicitadas, passou de 21,32±12,80 sauers para 28,83±16,17 sauers na compara o pré e pós-operatória. O pico de contra o também aumentou significativamente no pós-operatório em rela o ao pré-operatório, passou de 25,29±14,49 sauers para 30,92±16,20 sauers. CONCLUS O: A perda massiva de peso através da cirurgia bariátrica repercute positivamente na fun o do assoalho pélvico e na qualidade de vida das mulheres com obesidade mórbida. BACKGROUND: Urinary incontinence is well documented as a comorbidity of obesity. Studies demonstrate improvement of incontinency after weight loss. However, the mechanisms are still not clear. AIM: To analyze the effects of bariatric surgery on pelvic floor function in women. METHODS: Thirty women were invited to participate. They were waiting for bariatric surgery. Evaluations were done on pre-operative period and one year after surgery. It comprehended: body mass index, urinary incontinence prevalence, quality of life through the King's Health Questionnaire, quality of pelvic floor muscular contraction through the Oxford Modified Scale and perineometry. RESULTS: Twenty four women were included in the study. The body mass index reduced from 46.96±5.77 kg/m
Rotura hepática espontanea na síndrome HELLP
Freitas, Alexandre Coutinho Teixeira de;Schulz, Gustavo;Mori, Rafael;Coelho, Julio Cezar Uili;
ABCD. Arquivos Brasileiros de Cirurgia Digestiva (S?o Paulo) , 2009, DOI: 10.1590/S0102-67202009000300008
Abstract: background: hellp syndrome, a condition with signs of hemolysis, elevated liver enzymes and low platelet count, is an obstetric condition that can present with severe complications to the mother including subcapsular hematoma with risk to peritoneal rupture. case report: a case of spontaneous liver rupture secondary to hellp syndrome is presented. the patient was submitted to exploratory laparotomy due to hemorrhagic shock. conclusion: hellp syndrome is a dangerous disease with death risk to mother and fetus. the surgical treatment can be indicated when there is an association to hepatic rupture.
Análise da margem cirúrgica proximal do est?mago em pacientes submetidos à gastrectomia subtotal por adenocarcinoma
Freitas, Alexandre Coutinho Teixeira de;Dias, Josiane Mour?o;Okawa, Luciano;Coelho, Júlio Cezar Uili;
ABCD. Arquivos Brasileiros de Cirurgia Digestiva (S?o Paulo) , 2008, DOI: 10.1590/S0102-67202008000300002
Abstract: background: subtotal gastrectomy is considered the gold standard treatment for gastric neoplasms localized in the distal and medial thirds of the stomach. nevertheless, it has been shown that residual neoplasm into the proximal margin is associated to worse prognosis. aim: to identify factors related to residual neoplasm into the proximal margin determined on pathology examination of patients subjected(submitted) to subtotal gastrectomy for gastric adenocarcinoma. methods: the charts of the patients subjected(submitted) to subtotal gastrectomy due to gastric adenocarcinoma of the distal and medial thirds were reviewed from january 1998 to december 2007. it was recorded data referred to age, sex, lauren and borrmann staging, neoplasm diameter, localization inside the stomach, tnm staging and angiolymphatic invasion. these data were submitted to univariate analysis in relation to residual neoplasm into the proximal margin. results: a hundread and four cases were included: 34 females and 70 males. the median age was 57±13 years. twelve patients (12.3%) presented residual neoplasm into the proximal margin. the univariate analysis showed association between only the borrmann staging and the residual neoplasm. conclusion: borrmann staging is associated to residual neoplasm into the proximal margin in patients subjected(submitted) to subtotal gastrectomy for medial and distal thirds gastric adenocarcinoma.
Carcinoma hepatocelular: impacto do tempo em lista e das formas de tratamento pré-operatório na sobrevida do transplante de fígado cadavérico na era pré-MELD em um centro no Brasil
Freitas, Alexandre Coutinho Teixeira de;Parolin, M?nica Beatriz;Stadnik, Lucinei;Coelho, Júlio Cezar Uili;
Arquivos de Gastroenterologia , 2007, DOI: 10.1590/S0004-28032007000300002
Abstract: background: liver transplantation is the main treatment option for hepatocellular carcinoma in patients with cirrhosis. aim: three months and 3 years survival were analysed in patients with cirrhosis and hepatocellular carcinoma and in patients with only cirrhosis. methods: charts of patients subjected to cadaveric liver transplantation at the clinical hospital of the federal university of paraná, curitiba, pr, brazil, between january 5th of 2001 and february 17th of 2006 were reviewed. patients were divided into two groups for 3 months and 1 year survival analysis: cirrhosis and hepatocellular carcinoma and cirrhosis only. the two groups were also compared in relation to donor and recipient sex and age, etiology of cirrhosis, child-pugh and meld scores at the time of the transplantation, warm isquemia time, cold isquemia time, units of red blood cells transfused during the transplantation, intensive care unit stay and total hospital stay. results: one hundred and forty six liver transplantation patients were analysed: 75 were excluded because of incomplete data and 71 were included. general 3 months and 1 year survivals were 77,4% and 74,6% respectively. patients with hepatocellular carcinoma (n = 12) presented 3 months and 1 year survivals of 100%. these rates were significantly higher than those of patients without hepatocellular carcinoma (n = 59; 72,8% and 69,4%). mean meld score, mean child-pugh score and mean number of red blood cells transfused were significantly higher in patients without hepatocellular carcinoma. in this group it was also observed more child-pugh b and c patients and the diagnosis of cirrhosis because other causes. the rate of child-pugh a and hepatitis c was higher in patients with hepatocellular carcinoma. the two groups were identical in all other parameters analysed. conclusion: patients with cirrhosis and hepatocellular carcinoma presented better 3 months and 1 year survival rates than patients with only cirrhosis. this is possibly du
Ressec??o laparoscópica do segmento lateral esquerdo do fígado em doador para transplante hepático inter-vivos
Coelho, Julio Cezar Uili;Freitas, Alexandre Coutinho Teixeira de;Mathias, Jorge Eduardo Fouto;
Revista do Colégio Brasileiro de Cirurgi?es , 2009, DOI: 10.1590/S0100-69912009000600015
Abstract: laparoscopic resection of the left lateral segment of the liver in donors of living liver transplantation. the authors present a case of laparoscopic resection of the left lateral segment of the liver in a donor of living liver transplantation. the procedure was done in six hours and the left lateral segment of the liver was removed through a 15 cm right subcostal incision. the patient was discharged on the 5th post-operative day. a 40 ml intrabdominal collection of bile was percutaneously drained guided by ultra-sonography. the drain was removed after five days. afterwards, the patient had good recovery with no other complication.
Anomalia anat?mica da veia porta: uma causa rara de impossibilidade de doa??o do lobo direito em transplante hepático intervivos
Freitas, Alexandre Coutinho Teixeira de;Matias, Jorge Eduardo Fouto;Coelho, Júlio Cezar Uili;
Revista do Colégio Brasileiro de Cirurgi?es , 2006, DOI: 10.1590/S0100-69912006000400014
Abstract: living related liver transplantation is being increasingly used for patients that can not wait for a cadaveric organ. we describe a case of a right lobe donor who had a type iii portal vein anomaly. on this anomaly the portal vein gives branches first to the right posterior vein and then to the right anterior vein and the left portal vein. the recipient had portal vein thrombosis that was recognized only during the surgery. the doppler examination performed before the operation did not detect this thrombosis. the transplant was not accomplished. anatomical anomaly of the portal vein may be a rare cause impossibility to organ donation in living related liver transplantation.
Transplante hepático em paciente soropositivo para o HIV
Freitas, Alexandre Coutinho Teixeira de;Sobottka, Wagner;Parolin, M?nica Beatriz;Matias, Jorge Eduardo Fouto;Coelho, Júlio Cezar Uili;
ABCD. Arquivos Brasileiros de Cirurgia Digestiva (S?o Paulo) , 2009, DOI: 10.1590/S0102-67202009000300009
Abstract: background: with the advent of highly active antiretroviral therapy and improved ability to prevent hiv-related complications, transplantation of hiv-infected patients has been done in selected cases. case report: to report a case of an hiv infected patient submitted to liver transplantation due to liver cirrhosis and hepatocellular carcinoma secondary to hepatitis b infection. he was on antiretroviral and hepatitis b therapy and never presented opportunistic infections. conclusion: liver transplantation can be indicated in special cases of hiv positive patients with advanced hepatic disease.
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