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Search Results: 1 - 10 of 10126 matches for " Sergio;Cecconello "
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Es fago de Barrett: novos métodos diagnósticos
Cecconello Ivan,Szachnowicz Sergio
Arquivos de Gastroenterologia , 2003,
Acute postsurgical suppurative parotitis: current prevalence at Hospital das Clínicas, S?o Paulo University Medical School
Belczak, Sergio Quilici;Cleva, Roberto de;Utiyama, Edivaldo M.;Cecconello, Ivan;Rasslan, Samir;Parreira, José Gustavo;
Revista do Instituto de Medicina Tropical de S?o Paulo , 2008, DOI: 10.1590/S0036-46652008000500010
Abstract: postsurgical acute suppurative parotitis is a bacterial gland infection that occurs from a few days up to some weeks after abdominal surgical procedures. in this study, the authors analyze the prevalence of this complication in hospital das clínicas/s?o paulo university medical school by prospectively reviewing the charts of patients who underwent surgeries performed by the gastroenterological and general surgery staff from 1980 to 2005. diagnosis of parotitis or sialoadenitis was analyzed. sialolithiasis and chronic parotitis previous to hospitalization were exclusion criteria. in a total of 100,679 surgeries, 256 patients were diagnosed with parotitis or sialoadenitis. nevertheless, only three cases of acute postsurgical suppurative parotitis associated with the surgery were identified giving an incidence of 0.0028%. all patients presented with risk factors such as malnutrition, immunosuppression, prolonged immobilization and dehydration. in the past, acute postsurgical suppurative parotitis was a relatively common complication after major abdominal surgeries. its incidence decreased as a consequence of the improvement of perioperative antibiotic therapy and postoperative support. in spite of the current low incidence, we believe it is important to identify risks and diagnose as quick as possible, in order to introduce prompt and appropriate therapeutic measures and avoid potentially fatal complications with the evolution of the disease.
Manejo das hérnias paraestomais
Araujo, Sergio Eduardo Alonso;Seid, Victor Edmond;Campos, Fábio Guilherme Caserta Marysael de;Nahas, Sergio Carlos;Cecconello, Ivan;
ABCD. Arquivos Brasileiros de Cirurgia Digestiva (S?o Paulo) , 2011, DOI: 10.1590/S0102-67202011000400015
Abstract: introduction: paraestomal hernia represents a late complication of virtually all intestinal stoma. clinical manifestations range from a simple cosmetic problem to the strangulation of the herniated contents. the degree of disability produced by the hernia is variable. there is a wide range of procedures using or not using prosthetic material of different specificity and controversial results. methods: was performed a literature review on sites pubmed, bireme, scielo with the headings paraestomal hernias, surgery, hernia, colostomy and ileostomy. were selected mainly studies with the application of surgical techniques and added to the authors' clinical experience. conclusion: despite various techniques and available devices to handle the paraestomal hernias, there is no ideal method that may be recommended for all cases. thus, a careful analysis of risk factors can choose the best treatment option that should be done individualizely to each case.
Transanal endoscopic microsurgery (TEM): a minimally invasive procedure for treatment of selected rectal neoplasms
Nahas, Sergio C.;Nahas, Caio S. R.;Marques, Carlos Frederico S.;Dias, Andre Roncon;Pollara, Wilson M.;Cecconello, Ivan;
ABCD. Arquivos Brasileiros de Cirurgia Digestiva (S?o Paulo) , 2010, DOI: 10.1590/S0102-67202010000100009
Abstract: transanal endoscopic microsurgery (tem) provides a minimally invasive alternative to radical surgery for excision of benign and malignant rectal tumors. tem aims to provide an alternative to conventional abdominal surgery (low anterior resection or abdominoperineal amputations), which carries not inconsiderable morbidity and mortality. based on review of the literature and in the authors experience, this review present the method and indications for tem.
Origin of adenocarcinoma in Barrett's esophagus: P53 and Ki67 expression and histopathologic background
Szachnowicz, Sergio;Cecconello, Ivan;Iriya, Kiyoshi;Marson, Allan Garms;Takeda, Flávio Roberto;Gama-Rodrigues, Joaquim José;
Clinics , 2005, DOI: 10.1590/S1807-59322005000200005
Abstract: barrett's esophagus is the substitution of squamous epithelium of the distal esophagus by columnar epithelium. intestinal metaplasia in barrett's esophagus is considered to be the main risk factor for the development of adenocarcinoma. diffuse adenocarcinoma and barrett's esophagus without intestinal metaplasia are rare, and reports on the subject are scarce. purpose and method: to estimate the prevalence of adenocarcinoma in 297 patients with barrett's esophagus, during the period of 1990 to 2002, and in 13 patients undergoing surgery, to conduct detailed macroscopic and microscopic analysis, with performance of immunohistochemical tests for p53 and ki67, correlating the type of tumor with its adjacent epithelium. results: in our patients with barrett's esophagus, there was a prevalence of 5.7% of adenocarcinoma. the tumors developed only when the barrett's esophagus segment was long (>3.0 cm). tumors were located close to the squamous-columnar junction. the histological study revealed 2 patients (15.4%) with barrett's esophagus adjacent to a tumor with gastric metaplasia without the presence of intestinal metaplasia. tumors were classified according to nakamura's classification (23% differentiated pattern, and 77% undifferentiated pattern) and to lauren's classification (61% intestinal and 39% diffuse). the difference is due to the migration of microtubular and foveolar tumors of undifferentiated (gastric) pattern in nakamuras classification to the lauren's intestinal type. the immunohistochemical test for ki67 was strongly positive in all the patients, thus evidencing intense cell proliferation in both the columnar epithelium and tumor. expression of p53 was negative in 67% of the adjacent columnar epithelia and 42% of the tumors, without any correlation between the tissue types. conclusion: adenocarcinoma develops from mixed columnar epithelium, either intestinal or gastric, showing both the gastric and the intestinal patterns; thus, tumors can also grow in colu
Tratamento da doen?a de Crohn com infliximabe: primeira op??o?
Malheiros, Anna Paula Rocha;Teixeira, Magaly Gemio;Scanavini Neto, Arceu;Silva Filho, Edésio Vieira;Rodrigues, Leonardo Correa de Oliveira;Thierry, Roberta;Nahas, Sergio;Cecconello, Ivan;
ABCD. Arquivos Brasileiros de Cirurgia Digestiva (S?o Paulo) , 2009, DOI: 10.1590/S0102-67202009000200007
Abstract: background: crohn′s disease is a chronic inflammatory disorder of the gastrointestinal tract with difficult management. infliximab is a chimeric igg1 monoclonal antibody against tumor necrosis factor and is indicated for refractory luminal and fistulization in crohn's disease. aim: to observe the outcome of 60 patients with diagnosis of crohn′s disease treated with infliximab. methods: prospective study with 60 patients with crohn′s disease in six years of observation. exclusion criteria were: clinical infection in at last three months; tuberculosis; intestinal occlusion; pregnancy. all patients were submitted to thorax x-rays, leukogram, tuberculosis cutaneous test. they were treated with infliximabe 5mg/kg each two months. they were divided into three groups according to the time of the diagnosis: 5 years, 6 to 10 and more than 10 years. the results were considered better, worse or unchanged. results: after the initial treatment, 76% of the patients achieved a response. at the first dose, the ones with 10 years and with associated abdominal surgery had good results and similar to the ones with less than 5 years with no operations. conclusion: the treatment with infliximab was effective and tolerable in the managing of symptoms in patients with active crohn′s disease, refractory to the conventional treatment and can be a reasonable approach to avoid the surgical treatment.
Médicos residentes podem realizar com seguran?a e eficiência técnicas de Milligan-Morgan, Ferguson e grampeadores no tratamento cirúrgico das hemorróidas?
Nahas, Sérgio Carlos;Pinto, Rodrigo Ambar;Dias, André Roncon;Chow, Bruce;Nahas, Caio Sergio Rizkallah;Marques, Carlos Frederico Sparapan;Cecconello, Ivan;
ABCD. Arquivos Brasileiros de Cirurgia Digestiva (S?o Paulo) , 2011, DOI: 10.1590/S0102-67202011000300006
Abstract: background: surgery for symptomatic hemorrhoids is needed in almost 10% of the patients. although, literature about the surgical management of hemorrhoidal disease is vast, data concerning hemorrhoidectomy or hemorrhoidopexy performed by training residents is limited. aim: to analyze the results of these procedures in a teaching institution. methods: data from all patients who underwent surgical treatment for hemorrhoids from 1995 to 2007 in a single institution were retrospectively analyzed. residents supervised by assisting doctors performed all procedures. techniques were compared based on operative time, hospital stay, morbidity, and long-term efficacy. results: three hundred thirty three patients were included in the study, 182 males (54.6%), with a mean age of 45.3 years (± 12.02). third degree hemorrhoids were the main indication (81.7%). milligan-morgan was the most commonly performed procedure (57%), followed by ferguson and stapled hemorrhoidopexy. mean operative time was significantly lower in the stapled hemorrhoidopexy group when compared to the open and closed procedures: 49,4 ± 29.3 min vs. 61.1 ± 26.5 and 67.1 ± 28.3, respectively (p=0.0034). there was no statistically significant difference among the groups regarding postoperative complications or reoperation rate. length of stay was significantly higher in the milligan-morgan group when compared to ferguson and stapled hemorrhoidopexy (1.41 ± 0.86 days vs. 1.19 ± 0.43 vs. 1.16 ± 0.37 respectively). symptomatic recurrence, reoperation rates and band ligation usage were similar among groups. conclusion: residents under supervision can perform milligan-morgan, ferguson and stapled hemorrhoidopexy with low incidence of complications and good long-term results. stapled hemorrhoidopexy technique was associated with a shorter operative time, while milligan-morgan correlated with a longer length of stay.
Mucin pattern reflects the origin of the adenocarcinoma in Barrett's esophagus: a retrospective clinical and laboratorial study
Sergio Szachnowicz, Ivan Cecconello, Ulysses Ribeiro, Kiyoshi Iriya, Roberto El Ibrahim, Flávio Takeda, Carlos Corbett, Adriana Vaz Safatle-Ribeiro
World Journal of Surgical Oncology , 2009, DOI: 10.1186/1477-7819-7-27
Abstract: Specimens were retrospectively collected from thirteen patients who underwent esophageal resection due to adenocarcinoma in BE. Sections were scored for the grade of intestinal metaplasia. The tissues were examined by immunohistochemistry for MUC2 and MUC5AC antibodies.Eleven patients were men. The mean age was 61 years old (varied from 40 to 75 years old). The tumor size had a mean of 4.7 ± 2.3 cm, and the extension of BE had a mean of 7.7 ± 1.5 cm. Specialized epithelium with intestinal metaplasia was present in all adjacent mucosas. Immunohistochemistry for MUC2 showed immunoreactivity in goblet cells, while MUC5AC was extensively expressed in the columnar gastric cells, localizing to the surface epithelium and extending to a variable degree into the glandular structures in BE. Tumors were classified according to the mucins in gastric type in 7/13 (MUC5AC positive) and intestinal type in 4/13 (MUC2 positive). Two tumors did not express MUC2 or MUC5AC proteins. The pattern of mucin predominantly expressed in the adjacent epithelium was associated to the mucin expression profile in the tumors, p = 0.047.Barrett's esophagus adenocarcinoma shows either gastric or intestinal type pattern of mucin expression. The two types of tumors developed in Barrett's esophagus may reflect the original cell type involved in the malignant transformation.Barrett's esophagus (BE) is the eponymous term used to describe a condition with malignant potential where the lower esophagus becomes lined with a specialized columnar epithelium as a result of chronic gastroesophageal reflux. Nowadays, Barrett's esophagus represents the transition from normal squamous mucosa to columnar epithelium plus the identification of intestinal metaplasia. In macroscopic form, BE is classified as long, when the columnar epithelium is longer than 3 cm, and short when is lower than 3 cm [1,2].BE is a complex, mosaic of cell, gland, and architectural types, showing variable degrees of atrophy and maturation tow
Locally advanced colorectal cancer: results of surgical treatment and prognostic factors
Campos, Fábio Guilherme;Calijuri-Hamra, Maria Célia;Imperiale, Antonio Rocco;Kiss, Desidério Roberto;Nahas, Sergio Carlos;Cecconello, Ivan;
Arquivos de Gastroenterologia , 2011, DOI: 10.1590/S0004-28032011000400010
Abstract: objectives: to evaluate the incidence surgical results and prognostic factors of locally advanced colorectal cancer. methods: cohort study including 679 colorectal cancer patients treated from 1997 to 2007. clinical, surgical and histological data were analyzed. results: ninety patients (females 61%; median age 59 years) were treated for locally advanced carcinomas (13.2%), either in the colon (66%) or rectum (34%). extended resections most commonly involved the small bowel (19.8%), bladder (16.4%), uterus (12.9%) and ovaries (11.2%). postoperative morbidity and mortality occurred in 23 (25.6%) and 3 (3.3%) patients, respectively. survival and recurrence analysis among 76 r0 (84.4%) procedures revealed a 60% 5-year survival and 34% local recurrence rates. survival curves demonstrated reduced rates for rectal location (45% vs 65%), tumor depth (50% for t4 vs 75% for t3), vascular/ lymphatic/perineural invasion (35% vs 80%) and lymph node metastasis (35% vs 80%). conclusions: locally advanced carcinomas were found in 13.2% of patients. survival rates were negatively affected by rectal location and adverse histological features. number of involved organs and neoplastic adhesions did not influenced chances of survival. a radical r0 extended resection was achieved in a high proportion of cases, resulting in a 60% cancer-free survival under acceptable operative risks.
Influence of perineal prostatectomy on anal continence
Guilger, Nádia Ricci;Jorge, José Marcio Neves;Costa, Renato Prado;Salla, Fernando Cesar;Teixeira, Magaly Gemio;Nahas, Sergio Carlos;Cecconello, Ivan;
Clinics , 2011, DOI: 10.1590/S1807-59322011001200002
Abstract: objective: perineal prostatectomy has been proposed as a less invasive and safe procedure, but the risk of anal incontinence has been studied. this study aimed to evaluate the effects of perineal access on anal continence mechanisms after perineal prostatectomy. methods: from august 2008 to may 2009, twenty three patients underwent perineal prostatectomy. these patients were evaluated before surgery and eight months postoperatively using the cleveland clinic anal incontinence score, the fecal incontinence quality of life score, and anorectal manometry. results: the mean age of the subjects was 65 (range, 54-72) years, and the mean prostate weight was 34.5 (range, 24-54) grams. gleason scores ranged from 6-7, and the mean cleveland clinic anal incontinence score (mean±;standard deviation) values were 0.9±1.9 and 0.7±1.2 (p.0.05) before and after surgery, respectively. the fecal incontinence quality of life score did not change significantly after surgery. the mean values for anal manometric parameters before and after surgery were, respectively: resting pressures of 64±23 mmhg and 65±17 mmhg (p = 0.763), maximum squeezing pressures of 130±41 mmhg and 117±40 mmhg (p = 0.259), high pressure zones of 3.0±0.9 cm and 2.7±0.8 cm(p = 0.398), rectal sensory thresholds of 76±25 mland71±35 ml (p = 0.539), maximum tolerated rectal volumes of 157±48 ml and 156±56ml (p = 0.836), and sphincter asymmetry indexes 22.4±9% and 14.4±5% (p = 0.003). conclusion: there was a significant decrease in the sphincter symmetry index after perineal prostatectomy. with the exception of the sphincter asymmetry index, perineal prostatectomy did not affect anal continence parameters.
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