Hospital Ana Costa

Santos, Brazil

Hospital Ana Costa

Santos, Brazil

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Dedivitis R.A.,Hospital das Clinicas | Dedivitis R.A.,Hospital Ana Costa | Aires F.T.,Hospital das Clinicas | Cernea C.R.,Hospital das Clinicas
Current Opinion in Otolaryngology and Head and Neck Surgery | Year: 2017

Purpose of review Permanent hypoparathyroidism is the most common long-term complication after total thyroidectomy and it can cause significant morbidity and increased costs. Its incidence varies from 30% to 60%. Recent findings The surgical technique and the extent of thyroidectomy are related to parathyroid injury and hypoparathyroidism. The glands should be identified in situ, carefully manipulated and preserved, as well as their vascularization. In case of incidental removal, routine autotransplantation is advocated. Low calcium levels, identification of fewer than two parathyroid glands at surgery, reoperation for bleeding, Graves disease and heavier thyroid specimens were considered independent predictors of permanent hypocalcemia. Intraoperative parathyroid hormone (PTH) measurements allows the early detection of hypocalcemia. Treatment is recommended for patients with symptoms of hypocalcemia or corrected serum calcium<7.5mg/dL. Acute hypocalcemia is treated with either oral calcium or an intravenous infusion. The goal is to preserve serum calcium in the low normal or mildly subnormal levels. Hypocalcemia symptoms should be considered a medical emergency. Treatment with PTH has been recently performed for the management of cases not adequately controlled with conventional therapy. Summary Hypoparathyroidism is the most common long-term complication after total thyroidectomy. Adequate recognition and management decrease its morbidity and costs. © 2017 Wolters Kluwer Health, Inc. All rights reserved.


PubMed | Hospital Ana Costa and University of Sao Paulo
Type: Journal Article | Journal: Revista da Associacao Medica Brasileira (1992) | Year: 2016

Hepatic encephalopathy (HE) is a bad prognostic factor in patients with liver cirrhosis and its incidence is associated with several triggering factors being the most prevalent gastrointestinal bleeding. Lactulose, despite its questionable efficacy in the literature, is considered a first line treatment in patients with HE.To evaluate the effectiveness of lactulose in preventing HE in cirrhotic patients with gastrointestinal bleeding.A systematic review of the literature using the Medline scientific database. Only randomized controlled clinical trials evaluating the efficacy of lactulose for HE prophylaxis in cirrhotic patients with gastrointestinal bleeding were included.The incidence of HE in the intervention group was 7%, while the control group was 26% (p=0.01). There was no significant difference in the incidence of mortality in the group treated with lactulose compared to the group that was not treated (p=0.48).Administering lactulose to cirrhotic patients with upper gastrointestinal bleeding reduces the incidence of hepatic encephalopathy.


Romano C.M.,University of Sao Paulo | de Matos A.M.,University of Sao Paulo | Araujo E.S.A.,Hospital Ana Costa | Villas-Boas L.S.,University of Sao Paulo | And 8 more authors.
PLoS ONE | Year: 2010

Dengue viruses (DENV) serotypes 1, 2, and 3 have been causing yearly outbreaks in Brazil. In this study, we report the reintroduction of DENV2 in the coast of São Paulo State. Partial envelope viral genes were sequenced from eighteen patients with dengue fever during the 2010 epidemic. Phylogenetic analysis showed this strain belongs to the American/Asian genotype and was closely related to the virus that circulated in Rio de Janeiro in 2007 and 2008. The phylogeny also showed no clustering by clinical presentation, suggesting that the disease severity could not be explained by distinct variants or genotypes. The time of the most recent common ancestor of American/Asian genotype and the São Paulo and Rio de Janeiro (SP/RJ) monophyletic cluster was estimated to be around 40 and 10 years, respectively. Since this virus was first identified in Brazil in 2007, we suggest that it was already circulating in the country before causing the first documented outbreak. This is the first description of the 2010 outbreak in the State of São Paulo, Brazil, and should contribute to efforts to control and monitor the spread of DENVs in endemic areas. © 2010 Romano et al.


Dedivitis R.A.,University of Sao Paulo | Aires F.T.,Hospital Ana Costa | Cernea C.R.,University of Sao Paulo | Brandao L.G.,University of Sao Paulo
Head and Neck | Year: 2015

Background Pharyngocutaneous fistula (PCF) is the most common surgical complication after total laryngectomy. Controversy still remains regarding the multiple risk factors implicated. The purpose of this study was to evaluate the potential risk factors for PCF. Methods The strategy for our literature survey included research in MEDLINE up to December 2013. The risk factors analyzed were age, sex, smoking habit, alcohol use, comorbidity, preoperative hemoglobin level, blood transfusion, preoperative tracheotomy, previous radiotherapy and chemoradiotherapy, primary tumor site, T classification, cartilage invasion, tumor grade, surgical margins, suture material, second layer of suture, reconstruction, tracheoesophageal prosthesis, and neck dissection. Results The electronic search resulted in 311 studies from which 63 met the inclusion criteria. Conclusion Chronic obstructive pulmonary disease (COPD), previous hemoglobin <12.5g/dL, blood transfusion, previous radiotherapy or chemoradiotherapy, advanced primary tumors, supraglottic subsite, hypopharyngeal tumor site, positive surgical margins, and the performance of neck dissection were risk factors for PCF. © 2014 Wiley Periodicals, Inc. Head Neck, 2014.


Campos L.A.A.F.,Hospital Ana Costa | Picado S.M.,Hospital Regional do Vale do Paraiba | Guimaraes A.V.,University of Sao Paulo | Ribeiro D.A.,Federal University of São Paulo | Dedivitis R.A.,Ana Clara Hospital
Brazilian Journal of Otorhinolaryngology | Year: 2012

There is controversy in the literature regarding the association between papillary thyroid carcinoma (PTC) and Hashimoto's thyroiditis (HT) and as to what would be the etiological relationship between them. Objective: To establish the proportion of cases among patients with TH and CPT, correlating it with histomorphological aspects. Method: A retrospective study of patients undergoing partial or total thyroidectomy for PTC between 2007 and 2009, a total of 41 cases. Results: Regarding the association of HT and CPT, we found 11 cases (26.8%), all females, but without statistical significance. The mean age was 44.9 years among the patients with coexistent TH and CPT, whereas it was 49.1 years without that association. The average size of tumors in those without TH was 20.53 mm and for those with TH it was 12.72 mm (p = 0.4). Regarding pathology staging, the ratiosbetween those with and those without TH were kept in T1a, T1b and T3. In T2, there were no cases of coexistence of HT and PTC. Conclusion: There is a rate of 26.8% of patients with association between TH and CPT, but without differences in relation to tumor size.


Aires F.T.,Centro Universitario Lusiada | Dedivitis R.A.,Hospital das Clinicas | Dedivitis R.A.,Hospital Ana Costa | Castro M.A.F.,Hospital Ana Costa | And 4 more authors.
Head and Neck | Year: 2014

Background Some primary studies compare manual and mechanical pharyngeal closures after total laryngectomy. The purpose of this study was to evaluate the advantages of the mechanical suture in pharyngeal closure. Methods The literature survey included research in MEDLINE, EMBASE, and LILACS. The intervention analyzed was stapler-assisted pharyngeal closure, whereas the control group was manual suture pharyngeal closure. Results The survey resulted in 319 studies. However, 4 studies were selected (417 patients). In the group of patients in whom the stapler was used, the incidence of pharyngocutaneous fistula was 8.7%, whereas in the other, it was 22.9%, with an absolute risk reduction of 15% (95% confidence interval [CI], 0.02-0.28; p =.02; I2 = 66%). Regarding the surgical time, the average difference was 80 minutes in favor of the stapler group (95% CI, 23.16-136.58 minutes; p <.006). Conclusion The difference for starting oral feeding was 8 days in favor of the mechanical suture (95% CI, 4.01-11.73 days; p <.001). Patients who underwent mechanical suture had a shorter hospitalization period. Copyright © 2013 Wiley Periodicals, Inc.


PubMed | Hospital Ana Costa, University of Sao Paulo and Metropolitan University of Santos
Type: | Journal: Case reports in ophthalmological medicine | Year: 2016

Introduction. Sarcoidosis is a rare multisystemic granulomatous inflammatory disease of unknown etiology affecting the respiratory system, skin, and eyes. Sarcoidosis outside the lacrimal gland is rare. The case study concerns a patient with a final diagnosis of orbital sarcoidosis. Case Report. A 37-year-old male patient went to the ophthalmic emergency room complaining of pain in the left eye, diplopia, and decreased visual acuity. An external eye examination showed hard and cold edema of the lower eyelid, ocular motility with limitation of adduction, and discreet ipsilateral proptosis. Magnetic resonance of the orbit showed left eye proptosis and thickening and increase of soft tissues associated with heterogeneous impregnation of contrast in the infralateral region of the left eyelid. A biopsy of the lesion showed a chronic inflammatory process, with numerous compact nonnecrotizing granulomas surrounded by lamellar hyaline collagen, providing histological confirmation of sarcoidosis. Discussion. A biopsy of the orbital tumor is essential for the diagnosis of sarcoidosis, in addition to the search for systemic findings such as hilar adenopathy or parenchymal lung disease found in 90% of patients.


Dedivitis R.A.,Hospital das Clinicas | Dedivitis R.A.,Hospital Ana Costa | Aires F.T.,Centro Universitario Lusiada | Pfuetzenreiter Jr. E.G.,Hospital Ana Costa | And 2 more authors.
Acta Otorhinolaryngologica Italica | Year: 2014

The use of a stapler for pharyngeal closure during total laryngectomy was first described in 1971. It provides rapid watertight closure without surgical field contamination. The objective of our study was to compare the incidence of pharyngocutaneous fistula after total laryngectomy with manual and mechanical closures of the pharynx. This was a non-randomised, prospective clinical study conducted at two tertiary medical centres from 1996 to 2011 including consecutive patients with laryngeal tumours who underwent total laryngectomy. We compared the incidence of pharyngocutaneous fistula between two groups of patients: in 20 patients, 75 mm linear stapler closure was applied, whereas in 67 patients a manual suture was used. Clinical data were compared between groups. The groups were statistically similar in terms of gender, age, diabetes mellitus, smoking and alcohol consumption and tumour site. The group of patients who underwent stapler-assisted pharyngeal closure had a higher number of patients with previous tracheotomy (p < 0.001) and previous chemoradiation (p < 0.001). The incidence of pharyngocutaneous fistula was 30% in the mechanical closure group and 20.9% in the manual suture group (p = 0.42). In conclusion the use of the stapler does not increase the rate of fistulae.


Background: Acute renal transplant glomerulopathy (ARTG) refers to a glomerular inflammation mainly within the three 1st months posttransplantation, characterized by the influx of lymphomononuclear cells and swelling of endothelial and mesangial cells. The reported occurrence of ARTG is between 4.3% and 14% of all renal allografts. Investigations on the pathogenesis and on the impact on graft survival have been critically reviewed. The simultaneous occurrence of ARTG and acute vascular rejection (AVR) is common. However, cases of ARTG with no vascular inflammation suggest distinct pathogenic mechanisms for the entities. The objective of the present work was to compare the immunophenotype of the infiltrating cells and the cytokine immunoexpression (ICE) in ARTG with those of arterial intimal inflammation in AVR. We also compared the glomerular ICE with that in acute tubulointerstitial rejection and in arterial intimal inflammation. Methods: Forty kidney transplant biopsy specimens were allocated to 4 groups: 10 cases of acute tubular necrosis without ARTG or AVR (group I, Control); 10 cases of ARTG without AVR (group II); 10 cases of ARTG with AVR (group III); and 10 cases of AVR without ARTG (group IV). Results: The immunoexpressions of CD68 (macrophages), CD8 (cytotoxic T lymphocyte), CD4 (helper T lymphocyte), CD20 (B lymphocyte), S100 protein (antigen-presenting cells), interleukin (IL)-4, IL-10, and interferon (INF)-γ-positive cells were evaluated in the glomeruli, arterial intima, and tubulointerstitium. In the comparative study between ARTG and arterial intimal inflammation, CD68+ cells predominated in the ARTG and T CD8+ cells in inflammation; the cytokine patterns were similar in both cases (IL-4 predominance). Conclusions: Altogether, the data suggested similar pathogenic mechanisms, with mild sequential differences, for the glomerulitis, intimitis, and tubulointerstitial inflammation in cellular acute rejection. These findings seem to confirm the immunological nature of ARTG, indicating that ARTG might be included in the Banff classification as an additional parameter for acute rejection. © 2010 Elsevier Inc. All rights reserved.


Artifon E.L.,Hospital Ana Costa
Revista de gastroenterología del Perú : órgano oficial de la Sociedad de Gastroenterología del Perú | Year: 2012

Self-expandable metal stents (SEMS) are often used for biliary drainage due to obstruction of neoplastic etiology, with better results than plastic stents, but seldom for biliary drainage of benign etiology. Primary end point: Verify bile duct patency after placement of self-expandable metal and (multiple) plastic stents in patients with benign strictures resulting from bile duct surgery with follow-up above five years. Secondary end point: Evaluate long-term complication rate in patients with metal self-expandable and plastic stents. Self-expandable stents were placed in 15 patients and multiple plastic stents in 16. Mean age was 45 years with prevalence of female patients in both groups and no statistical difference between groups was observed (SEMS: 66.7%; plastic multistent: 62.5%; p=0.8). Complication rate resulting from stents occurred more often in the metal stent group (40% versus 25%; p=0.37). In the metal stent group, most frequent complications were hemorrhage (n=3; 20%), stent migration (n=2; 13.3%) and perforation (n=1; 6.7%). In plastic multistent group, most frequent complications were perforation (n:2; 12.5%), hemorrhage (n=1; 6.2%) and ulcer (n=1; 6.2%). Long-term patency rate after biliary drainage was higher in the self-expandable metal stent group, SEMS: 81.67% ± 2.56; CI: 76.47-86.54; plastic multistent: 71.88% ± 2.93; CI: 66.08-77.27. The temporary passage of partially covered self-expandable metal stents is a feasible option for patients with benign bile duct strictures.

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