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São Paulo, Brazil

Ganc A.J.,Albert Einstein Jewish Hospital
Gastrointestinal Endoscopy | Year: 2010

Background: Schistosomiasis is a highly prevalent disease. It can evolve to its hepatosplenic form in up to 10% of the cases. The small-bowel lesions developed during the hepatosplenic stage of the disease have not been described in vivo. Objective: The aim of this study was to describe, for the first time, in a pilot study, the endoscopic aspects of the lesions in the small bowel of patients with portal hypertension due to schistosomiasis, using the PillCam SB, and to determine the usefulness of the method for the diagnosis of esophageal varices. Design: Case series. Setting: Tertiary-care medical center. Patients: Nine nonrandomized patients with hepatosplenic schistosomiasis and esophageal varices without previous GI bleeding were selected based on findings from the PillCam SB. Patients using medications that could alter the coagulation, with history of abdominal surgery, who were undergoing treatment of the portal hypertension other than beta-blocker, and with symptoms suggesting bowel obstruction were excluded. The findings were interpreted by a single endoscopist. Results: Capsule endoscopy was able to diagnose esophageal varices in all 9 patients. All of the patients presented angioectasias and venectasias in the small bowel. Small-bowel varices were present in 22.2% of the patients; edema and erosions were found in 66.7% and 88.9%, respectively. Lesions of so-called "scarred mucosa" were found in 55.5% of the patients. Limitations: Small number of patients; case series. Conclusion: The PillCam SB was effective, giving a significant contribution to the description of the esophageal varices and small-bowel lesions of the patients with portal hypertension caused by Schistosoma mansoni. © 2010 American Society for Gastrointestinal Endoscopy.

Papay P.,Medical University of Vienna | Ignjatovic A.,John Radcliffe Hospital | Karmiris K.,Venizeleio General Hospital | Amarante H.,Federal University of Parana | And 12 more authors.
Journal of Crohn's and Colitis | Year: 2013

Management of Crohn's disease has traditionally placed high value on subjective symptom assessment; however, it is increasingly appreciated that patient symptoms and objective parameters of inflammation can be disconnected. Therefore, strategies that objectively monitor inflammatory activity should be utilised throughout the disease course to optimise patient management. Initially, a thorough assessment of the severity, location and extent of disease is needed to ensure a correct diagnosis, identify any complications, help assess prognosis and select appropriate therapy. During follow-up, clinical decision-making should be driven by disease activity monitoring, with the aim of optimising treatment for tight disease control. However, few data exist to guide the choice of monitoring tools and the frequency of their use. Furthermore, adaption of monitoring strategies for symptomatic, asymptomatic and post-operative patients has not been well defined. The Annual excHangE on the ADvances in Inflammatory Bowel Disease (IBD Ahead) 2011 educational programme, which included approximately 600 gastroenterologists from 36 countries, has developed practice recommendations for the optimal monitoring of Crohn's disease based on evidence and/or expert opinion. These recommendations address the need to incorporate different modalities of disease assessment (symptom and endoscopic assessment, measurement of biomarkers of inflammatory activity and cross-sectional imaging) into robust monitoring. Furthermore, the importance of measuring and recording parameters in a standardised fashion to enable longitudinal evaluation of disease activity is highlighted. © 2013 European Crohn's and Colitis Organisation.

Cernea C.R.,University of Sao Paulo | Brandao L.G.,University of Sao Paulo | Hojaij F.C.,Albert Einstein Jewish Hospital | De Carlucci Jr. D.,University of Sao Paulo | And 3 more authors.
Head and Neck | Year: 2012

Background Recurrent nerve injury is 1 of the most important complications of thyroidectomy. During the last decade, nerve monitoring has gained increasing acceptance in several centers as a method to predict and to document nerve function at the end of the operation. We evaluated the efficacy of a nerve monitoring system in a series of patients who underwent thyroidectomy and critically analyzed the negative predictive value (NPV) and positive predictive value (PPV) of the method. Methods NIM System efficacy was prospectively analyzed in 447 patients who underwent thyroidectomy between 2001 and 2008 (366 female/81 male; 420 white/47 nonwhite; 11 to 82 years of age; median, 43 years old). There were 421 total thyroidectomies and 26 partial thyroidectomies, leading to 868 nerves at risk. The gold standard to evaluate inferior laryngeal nerve function was early postoperative videolaryngoscopy, which was repeated after 4 to 6 months in all patients with abnormal endoscopic findings. Results At the early evaluation, 858 nerves (98.8%) presented normal videolaryngoscopic features after surgery. Ten paretic/paralyzed nerves (1.2%) were detected (2 unexpected unilateral paresis, 2 unexpected bilateral paresis, 1 unexpected unilateral paralysis, 1 unexpected bilateral paralyses, and 1 expected unilateral paralysis). At the late videolaryngoscopy, only 2 permanent nerve paralyses were noted (0.2%), with an ultimate result of 99.8% functioning nerves. Nerve monitoring showed absent or markedly reduced electrical activity at the end of the operations in 25/868 nerves (2.9%), including all 10 endoscopically compromised nerves, with 15 false-positive results. There were no false-negative results. Therefore, the PPV was 40.0%, and the NPV was 100%. Conclusions In the present series, nerve monitoring had a very high PPV but a low NPV for the detection of recurrent nerve injury. © 2011 Wiley Periodicals, Inc.

Wroclawski M.L.,Albert Einstein Jewish Hospital | Serpa-Neto A.,ABC Medical School | Fonseca F.L.A.,ABC Medical School | Castro-Neves-Neto O.,ABC Medical School | And 4 more authors.
Tumor Biology | Year: 2013

The aim of this study was to evaluate the diagnostic and potential prognostic value of cell-free plasma DNA (CF-pDNA) in patients with suspected or histologically proven prostate cancer (PCa). We included 133 men with a diagnosis of PCa and 33 controls. PCa patients had blood samples prospectively drawn every 3 months for 2 years. CF-pDNA was measured by spectrophotometry. Considering a cut-off value of 140 ng/mL of CF-pDNA the area under the curve was of 0.824(0.757-0.879 with a sensitivity = 66.2 % and a specificity = 87.9 %) and the positive and negative likelihood ratio were of 5.46 and 0.39, respectively. CF-pDNA tends to decrease slightly and return to baseline values in about a week after biopsy. There was no statistical significant correlation between CF-pDNA levels at study entry with PSA, Gleason score, stage and biochemical recurrence free survival (BRFS). However, with a mean follow-up of 13.5 months, we could observe a significant shorter BRFS for patients with at least one value above 140 ng/mL of CF-pDNA during follow-up (p = 0.048). CF-pDNA is a potentially valuable biomarker for PCa diagnosis and a potential tool for the follow-up of patients with PCa. © 2013 International Society of Oncology and BioMarkers (ISOBM).

Roza B.A.,Albert Einstein Jewish Hospital | Pestana J.O.,Albert Einstein Jewish Hospital | Barbosa S.F.,Albert Einstein Jewish Hospital | Schirmer J.,Albert Einstein Jewish Hospital
Progress in transplantation (Aliso Viejo, Calif.) | Year: 2010

OBJECTIVE: To evaluate the impact of organ and tissue donation processes on family members of deceased donors and the probability that they would be an organ or tissue donor in the future. METHODS: Cross-sectional survey of 69 families of deceased donors of the organ procurement organizations of the Federal University of São Paulo. RESULTS: Donors were predominantly men (57% vs 43%) with a median age of 35.9 years. The primary causes of death were classified as natural (65%), traumatic injury (33%), and other (1%). Of the family members surveyed, 40% had an elementary school education and 59% were unemployed. Family members expressed an understanding of the brain death diagnosis (67%). Among them, 74% had no doubt about brain death and had time to ask questions. The diagnosis was provided by the doctor responsible for the patient (89%). Family members also used funeral aid benefit (63%), perceived organ donation positively (97%), and indicated that they would donate again (79%). A significant relationship was found between families that took advantage of the funeral aid benefit and families that would donate again (79% vs 22%, P = .002). CONCLUSION: The intent to donate organs for transplantation may be based more on moral and cultural factors that go beyond the family members' knowledge about the donation process per se.

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