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Search Results: 1 - 10 of 71022 matches for " José Cesar Assef "
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Tratamento da recidiva hemorrágica por varizes do es?fago em doentes esquistossomóticos operados
Assef, José Cesar;Capua Junior, Armando de;Szutan, Luiz Arnaldo;
Revista da Associa??o Médica Brasileira , 2003, DOI: 10.1590/S0104-42302003000400032
Abstract: objective: to standardize the treatment recurrent hemorrhage esophageal varices in schistosomotic patients after non decompressive surgery. methods: we treated 45 patients with schistosomotic portal hypertension who presented recurrent hemorrhage esophageal varices. performance of abdominal ultra-sonography and arteriographic studies and two groups were defined: group a: nineteen patients (42,2%) with absence of spleen, occluded splenic artery and patency of left gastric artery and vein, thus characterizing splenectomy at prior operation. group b: twenty six patients (57,8%) with absence of spleen image, occluded splenic and left gastric artery and non-opacified left gastric vein, showing splenectomy and some type of gastroesophageal devascularization performed before. patients of group a were reoperated to carry out the gastroesophageal devascularization and patients of group b were submitted to a sclerotherapy program. results: in group a, one patient (5.3%) presented recurrent hemorrhage on the late postoperative period. the esophageal varices decreased in number or diameter in 14 patients (73.7%), disappeared in three (15.8%) and remained unchanged in two (10.5%), under final endoscopic evaluation. in group b, six patients (23.1%) presented recurrent bleeding. in four patients the acute hemorrhagic event were controlled. two patients who underwent mesocaval shunt owing to unsuccess of these methods died postoperatively. esophageal varices disappeared in 17 patients (65.4%), decreased in number or diameter in seven (26.9%) and remained unchanged in two (7.7%) after the last endoscopic evaluation. conclusions: 1) the gastroesophageal devascularization is appropriated to splenectomized patients, with patency of left gastric artery and vein. 2) a long term of esophageal varices endoscopic sclerotherapy may be an option to splenectomized patients, with occluded left gastric artery and non-opacified left gastric ven.
Tratamento da recidiva hemorrágica por varizes do es fago em doentes esquistossomóticos operados
Assef José Cesar,Capua Junior Armando de,Szutan Luiz Arnaldo
Revista da Associa??o Médica Brasileira , 2003,
Abstract: OBJETIVO: Padronizar o tratamento da recidiva hemorrágica por varizes do es fago em esquistossomóticos, após opera es n o-derivativas. MéTODOS: Tratamos 45 doentes esquistossomóticos que apresentaram recidiva hemorrágica por varizes do es fago. Realizamos ultra-sonografia abdominal, e, estudos angiográficos constituindo-se dois grupos: Grupo A - Dezenove doentes (42,2%) com ausência do ba o, artéria esplênica ocluída e artéria e veia gástricas esquerdas pérvias, caracterizando a esplenectomia na opera o anterior. Grupo B - Vinte e seis doentes (57,8%) com imagem esplênica ausente, artérias esplênica e gástrica esquerda ocluídas e veia gástrica esquerda n o-opacificada, evidenciando esplenectomia e alguma forma de desvasculariza o gastroesofágica praticadas anteriormente. Os doentes do Grupo A foram reoperados para executar a desvasculariza o gastroesofágica e os do Grupo B, submetidos a programa de escleroterapia endoscópica. RESULTADOS: No Grupo A, um paciente (5,3%) apresentou recidiva hemorrágica no pós-operatório tardio. Na avalia o endoscópica final, as varizes esofágicas diminuíram, em número ou calibre, em 14 doentes (73,7%), desapareceram em três (15,8%) e em dois (10,5%), permaneceram inalteradas. No Grupo B, seis pacientes (23,1%) apresentaram recidiva do sangramento, controlada em quatro deles e em dois, que persistiram com sangramento praticou-se a deriva o mesentérico-cava e ambos morreram. Na última avalia o endoscópica, as varizes esofágicas desapareceram em 17 doentes (65,4%), reduziram o número ou calibre em sete (26,9%) e, em dois (7,7%), permaneceram inalteradas. CONCLUS ES: 1) A desvaculariza o gastroesofágica é adequada para os doentes esplenectomizados, com a artéria e a veia gástricas esquerdas pérvias. 2) Um programa de longa dura o de escleroterapia endoscópica das varizes do es fago pode ser uma op o para os doentes esplenectomizados, com a artéria gástrica esquerda ocluída e veia gástrica esquerda n o-opacificada.
Análise comparativa entre as les?es encontradas em motociclistas envolvidos em acidentes de transito e vítimas de outros mecanismos de trauma fechado
Parreira, José Gustavo;Gregorut, Felipe;Perlingeiro, Jacqueline A. Giannini;Solda, Silvia C.;Assef, José Cesar;
Revista da Associa??o Médica Brasileira , 2012, DOI: 10.1590/S0104-42302012000100018
Abstract: objective: to conduct a comparative analysis of the lesions found among motorcycle riders involved in traffic accidents and victims of other mechanisms of blunt trauma. methods: analysis of data prospectively collected on protocols for trauma patients older than 13 years, admitted from 06/10/2008 to 09/01/2009, victims of blunt trauma. data collected included trauma mechanism, vital signs at admission, laboratory tests, injuries, and treatment.stratification of trauma and lesion severity was performed by calculating the trauma index: glasgow coma scale (gcs), revised trauma score (rts), abbreviated injury scale (ais), injury severity score (iss) and triss. we compared the variables between motorcycle riders (group a) and the others (group b). severe injuries were considered when ais > 3. for statistical analysis, we used student's t, mann whitney, chi-square and fisher's test, with p < 0.05 considered statistically significant. results: the study included 3,783 blunt trauma victims, aged 14 to 99 years, of which 76.0% were males. the most frequent trauma mechanisms were accidents involving motorcycle riders (24.4%) and pedestrians (22.6%). when comparing the variables between groups a and b, we observed that motorcycle riders were significantly (p < 0.05) younger (28.9 ± 8.5 years vs. 42.4 ± 18.5 years) and had lower mean ais in the head segment (0.3 ± 0.9 vs. 0.8 ± 1.1), as well as higher mean gcs at admission (14.5 ± 1.9 vs. 14.2 ± 2.2), ais in the extremities (1.5 ± 1.2 vs. 0.9 ± 1.2), rts (7.8 ± 0.5 vs. 7.7 ± 0.6) and triss (0.98 ± 0.1 vs. 0.97 ± 0.1). men were significantly more frequent in group a (87.9% vs. 72.6%). when comparing injuries between groups, we observed that the motorcycle riders had significantly (p < 0.05) lower frequency of extradural hematomas (0.6% vs. 2.1%), subdural hematomas (0.9% vs. 2.1%), subarachnoid hemorrhage (0.9% vs. 2.2%), brain injury (1.2 vs. 3.6%), and severe head injuries (4.8% vs. 9.4% ), as well as higher frequency of diffu
Classifica o de gravidade na pancreatite aguda Classification of severity of acute pancreatitis
Tercio De Campos,José Gustavo Parreira,José Cesar Assef,Sandro Rizoli
Revista do Colégio Brasileiro de Cirurgi?es , 2013,
Abstract: De acordo com a Classifica o de Atlanta a pancreatite aguda pode ser dividida, baseado em sua severidade, em uma forma leve ou grave. Uma série de aspectos têm sido discutidos nos últimos anos, tais como, quantas categorias de gravidade devem ser consideradas; se o doente com falência organica é igual ao doente com necrose infectada; qual o papel da falência organica transitória; e como avaliar a falência organica. A reuni o de revista"Telemedicina Baseada em Evidência - Cirurgia do Trauma e Emergência" (TBE-CiTE) realizou uma avalia o crítica de artigos relacionados a este tema, considerando três artigos recentes que delinearam duas grandes revis es publicadas nos últimos meses. Estes artigos sugerem a classifica o de gravidade em três ou quatro categorias, ao invés de pancreatite aguda leve ou grave, além de discutir qual o melhor escore para avaliar a falência organica. As seguintes recomenda es foram propostas: (1) A pancreatite aguda deve ser classificada em quatro categorias: leve, moderada, grave e crítica, o que permite uma melhor determina o das características dos doentes; (2) Avalia o de falência organica com um escore de gravidade, preferencialmente algum que avalie diretamente cada falência organica, tais como o SOFA e o MODS (Marshall). O SOFA parece ter maior acurácia, mas o MODS tem melhor aplicabilidade devido à facilidade de uso. Based on the Atlanta Classification, acute pancreatitis is classified according to its severity in either mild or severe acute pancreatitis. In recent years, several issues regarding acute pancreatitis have been discussed in the literature. These issues include how many categories of severity should be considered; whether or not a patient with organ failure holds similar holds severity of disease and prognosis of a patient with infected necrosis; the role of transient organ failure; and how to evaluate organ failure. The"Evidence-based Telemedicine - Trauma and Acute Care Surgery" (EBT-TACS) conducted a review of the recent literature on the topic, and critically appraised its most relevant pieces of evidence.. The articles discussed suggested classifying the severity of acute pancreatitis in three or four categories, rather than mild or severe only, and addressed which is the best score to assess organ failure. The following recommendations were proposed: (1) Acute pancreatitis should be classified into four categories: mild, moderate, severe and critical, which allows a better determination of the characteristics of patients, (2) Evaluation of organ failure with a severity score that preferably evaluat
Effect of esophagogastric devascularization with splenectomy on schistossomal portal hypertension patients' immunity
Ferreira, Fabio Gon?alves;Forte, Wilma Carvalho Neves;Assef, José Cesar;Capua Jr., Armando de;
Arquivos de Gastroenterologia , 2007, DOI: 10.1590/S0004-28032007000100010
Abstract: background: surgical treatment of hemorrhagic complication in schistosomal portal hypertension in our hospital is an esophagogastric devascularization procedure with splenectomy. infectious risks and immunological alterations imputed to splenectomy may have significant importance. to minimize the consequences of spleen absence, the use of subtotal splenectomy and spleen auto-transplantation were stimulated. aim: to verify the immunologic alterations imposed by this procedure in our patients. method: twenty-eight patients with schistosomal portal hypertension and previous history of upper digestive bleeding due to esophagogastric varices rupture underwent elective esophagogastric devascularization and splenectomy. they were prospectively studied before esophagogastric devascularization procedure with splenectomy, 15 and 30 days, 3 and 6 months after the procedure. t and b-lymphocytes, cd4 and cd8 subpopulations were determinated by monoclonal antibodies. immunoglobulins a, m, g and c3, c4 components of the complement were determinated by radial immunodiffusion. results: we observed important reduction of all immune cells, increase of igg and normal levels of igm, iga, c3 and c4 at preoperative. cd4/cd8 relation was normal. six months after esophagogastric devascularization procedure with splenectomy, significant increase in t-lymphocytes, cd4, cd8 and b-lymphocytes were observed. cd4/cd8 relation remained normal. we noted significant increase in c3. iga, igm, igg and c4 had increased, but without significant difference. conclusion: esophagogastric devascularization procedure with splenectomy determines an increase in t and b-lymphocytes, cd4 and cd8 subpopulations without compromising immunoglobulins and components of complement levels.
Changes in the management of patients with severe acute pancreatitis
De Campos, Tercio;Braga, Candice Fonseca;Kuryura, Laíse;Hebara, Denise;Assef, José Cesar;Rasslan, Samir;
Arquivos de Gastroenterologia , 2008, DOI: 10.1590/S0004-28032008000300002
Abstract: background: severe acute pancreatitis is present in up to 25% of patients with acute pancreatitis, with considerable mortality. changes in the management of acute pancreatitis in the last 2 decades contributed to reduce the mortality. aim: to show the evolution in the management of severe acute pancreatitis, comparing two different approaches. methods: all patients with severe acute pancreatitis from 1999 to 2005 were included. we compared the results of a retrospective review from 1999 to 2002 (group a) with a prospective protocol, from 2003 to 2005 (group b). in group a severe pancreatitis was defined by the presence of systemic or local complications. in group b the atlanta criteria were used to define severity. the variables analyzed were: age, gender, etiology, apache ii, leukocytes, bicarbonate, fluid collections and necrosis on computed tomography, surgical treatment and mortality. results: seventy-one patients were classified as severe, 24 in group a and 47 in group b. the mean apache ii in groups a and b were 10.7 ± 3.5 and 9.3 ± 4.5, respectively. necrosis was seen in 12 patients (50%) in group a and in 21 patients (44.7%) in group b. half of the patients in group a and two (4.3%) in group b underwent to pancreatic interventions. mortality reached 45.8% in group a and 8.5% in group b. conclusion: a specific approach and a prospective protocol can change the results in the treatment of patients with severe acute pancreatitis.
Análise comparativa das características do trauma entre pacientes idosos e n?o idosos
Parreira, José Gustavo;Soldá, Silvia C;Perlingeiro, Jaqueline A. Giannini;Padovese, Camila C;Karakhanian, Walter Z;Assef, José Cesar;
Revista da Associa??o Médica Brasileira , 2010, DOI: 10.1590/S0104-42302010000500014
Abstract: objective: assess the characteristics of trauma in the elderly by comparison to a group of younger trauma patients. methods: trauma protocols from june 10, 2008 to march 9, 2009 were evaluated including all trauma patients above 13 years of age admitted in the emergency room. data on trauma mechanism, concomitant diseases, vital signs upon admission, diagnosed injuries, trauma indexes, exams and treatment was collected. patients above 60 years of age. were included in the elderly group (group i). data was compared between this group and the younger patients (group ii), using the student's t, chi square and fisher exact tests, considering p<0.05 as significant. results: two thousand and seventy five victims of trauma were included (77.1% male), 211 (10.2%) in group i. the most frequent trauma mechanisms in the elderly were falls (from their own height) (41%) and pedestrian struck (28%). concomitant diseases were more frequent in group i, including systemic arterial hypertension and diabetes mellitus. in group i, the most frequent lesions were located at extremities in 106 patients (50.2%). fractures were present in 18% of the elderly. in comparison to younger trauma patients, the elderly had significantly higher head ais (0.75 + 1.17 vs 0.54 + 1.04) (p=0.014) and lower thoracic (0.15 + 0.62 vs 0.26 + 0.86) (p=0.018) and abdominal (0.05 + 0.43 vs 0.21 + 0.82) (p<0.001) ais. severe injuries (ais > 3) in the head were more frequently observed in group i (11.4% vs 7%) (p=0,023). some injuries were more frequent in group i: subdural hematomas (2.8% vs 0.8%) (p=0.008), subarachnoid hemorrhage (3.8% vs 1.3%) (p=0.005) and cerebral contusions (5.2% vs 2.3%) (p=0.015). conclusion: in comparison to younger trauma patients, the elderly group was characterized by a higher frequency of falls from their own height, , concomitant diseases and severe injuries in the head, mainly subdural hematomas, cerebral contusions and subarachnoid hemorrhage.
Recidiva hemorrágica em pacientes esquistossomóticos operados
Assef, José Cesar;Fávero, Sérgio San Gregório;Szutan, Luiz Arnaldo;Capua Júnior, Armando de;
Revista do Colégio Brasileiro de Cirurgi?es , 1998, DOI: 10.1590/S0100-69911998000400009
Abstract: the authors studied 30 schistosomotic patients between 1987 to 1991, previously submitted to non-decompressive surgery for the treatment of upper gastrointestinal hemorrhage who rebled after the surgery. upper digestive endoscopy, abdominal ultrasonography and angiographic study were carried out in this patients with the aim of trying to detemine the source of rebleeding, and possible factors correlated to this new onset of bleeding. an attempt was also made to determine the influence of previous surgery in the free-time interval from bleding till the first episode of upper hemorrhage. 1t was concluded that esophageal varices are the most common site of bleeding in the rebleeding (86.7%). it was found that peptic gastric ulcer (13.3%) non-gastroesophagic devascularization (30%), uncomplet devascularization (16.7%), and portal thrombosis (26.7%), are present in most cases of rebleeding. it was also found that the association of the gastroesophagic devascularization to esplenectomy did not significantly alter the average time interval between previous surgery and first episode of the rebleeding.
Les?es graves em vítimas de queda da própria altura
Parreira, José Gustavo;Vianna, André Mazzini Ferreira;Cardoso, Gabriel Silva;Karakhanian, Walter Zavem;Calil, Daniela;Perlingeiro, Jaqueline A. Giannini;Soldá, Silvia C.;Assef, José Cesar;
Revista da Associa??o Médica Brasileira , 2010, DOI: 10.1590/S0104-42302010000600013
Abstract: objective: assess characteristics of trauma patients who sustained falls from their own height, more specifically focusing on presence of severe injuries, diagnosis and treatment. methods: retrospective study including all adult blunt trauma patients admitted in the emergency room in a period of 9 months. lesions with ais (abbreviated injury scale)>3 were considered "severe". variables were compared between victims of fall from their own height (group i) and other blunt trauma mechanisms (group ii). student's t, chi square and fisher exact tests were used for statistical analysis, considering p<0.05 as significant. results: of the 1993 trauma patients included, 305 (15%) were victims of falls from their own height. in group i, mean age was 52.2 ± 20.8 years and 64.8% were male. injuries in the head segment were the most frequently observed (62.2%), followed by injuries in the extremities (22.3%), thorax (1.3%) and abdomen (0.7%). severe injuries (ais>3) were more frequent in the head (8.9%), followed by extremities (4,9%). in group i, craniotomies were needed in 2.3%. by comparing groups, we observed that victims of falls from their own height had significantly higher mean age, higher mean systolic blood pressure, and higher head ais mean, as well as lower iss mean, thorax ais mean, abdomen ais mean and extremities ais mean. conclusion: importance of the trauma mechanism in victims of falls from own height should be emphasized due to a considerable possibility of occult severe injuries, mainly in the cephalic segment.
Fratura de pelve: um marcador de gravidade em trauma
Cordts Filho, Roberto de Moraes;Parreira, José Gustavo;Perlingeiro, Jaqueline A. Giannini;Soldá, Silvia C.;Campos, Tércio de;Assef, José Cesar;
Revista do Colégio Brasileiro de Cirurgi?es , 2011, DOI: 10.1590/S0100-69912011000500005
Abstract: objective: to assess whether the presence of a pelvic fracture is associated with greater severity and worse prognosis in victims of blunt trauma. methods: a retrospective analysis of protocols and records of victims of blunt trauma admitted from june 2008 to march 2009 was separated into two groups: those with pelvic fracture (group i) and those without it (group ii). data were collected from pre-hospital admission rates of trauma, laboratory tests, diagnosed lesions, treatment and outcome. we used the student t test, fisher's exact test and chi-square test for statistical analysis, considering p <0.05 as significant. results: during the study period, 2019 individuals had multiple trauma protocols completed, of which 43 (2.1%) had pelvic fractures. patients in group i had significantly lower average blood pressure, higher mean heart rate, lower mean glasgow coma scale, the highest average ais in the segments head, chest, abdomen and extremities, as well as higher mean iss and lower mean triss and rts on admission. group i more frequently presented with traumatic subarachnoid hemorrhage (7% vs. 1.6%), spinal cord injury (9% vs. 1%), thoracic and abdominal injuries, as well as need for laparotomy (21% vs. 1 %), chest drainage (32% vs. 2%) and damage control (9% vs. 0%). complications were more frequent in group i: ards (9% vs. 0%), persistent shock (30% vs. 1%), coagulopathy (23% vs. 1%), acute renal failure (21% vs. 0%) and death (28% vs. 2%). conclusion: the presence of a pelvic fracture is a marker of greater severity and worse prognosis in victims of blunt trauma.
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