Santa Casa of Sao Paulo Medical School

São Paulo, Brazil

Santa Casa of Sao Paulo Medical School

São Paulo, Brazil
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Kassab P.,Santa Casa of Sao Paulo Medical School | Da Costa W.L.,Ac Camargo Cancer Center | Jacob C.E.,University of Sao Paulo | Cordts R.D.M.,Santa Casa of Sao Paulo Medical School | And 18 more authors.
Translational Gastroenterology and Hepatology | Year: 2017

The minimally invasive surgery for gastric cancer in Brazil has begun about two years after the first laparoscopic gastrectomy (LG) performed by Kitano in Japan, in 1991. Although the report of first surgeries shows the year of 1993, there was no dissemination of the technique until the years 2010. At that time with the improvement of optical devices, laparoscopic instruments and with the publications coming from Asia, several Brazilian surgeons felt encouraged to go to Korea and Japan to learn the standardization of the LG. After that there was a significant increase in that type of surgery, especially after the IRCAD opened a branch in Brazil. The growing interest for the subject led some services to begin their own experience with the LG and, since the beginning, the results were similar with those found in the open surgery. Nevertheless, there were some differences with the papers published initially in Japan and Korea. In those countries, the surgeries were laparoscopic assisted, meaning that, in the majority of cases, the anastomoses were done through a mini-incision in the end of the procedure. In Brazil since the beginning it was performed completely through laparoscopic approach due to the skills acquired by Brazilian surgeons in bariatric surgeries. Another difference was the stage. While in the east the majority of cases were done in T1 patients, in Brazil, probably due to the lack of early cases, the surgeries were done also in advanced cases. The initial experience of Zilberstein et al. revealed low rates of morbidity without mortality. Comparing laparoscopic and open surgery, the group from Barretos/IRCAD showed shorter surgical time (216x255 minutes), earlier oral or enteral feeding and earlier hospital discharge, with a smaller number of harvested lymph nodes (28 in laparoscopic against 33 in open surgery). There was no significant difference regarding morbidity, mortality and reoperation rate. In the first efforts to publish a multicentric study the Brazilian Gastric Cancer Association (BGCA) collected data from three institutions analyzing 148 patients operated from 2006 to 2016. There were 98 subtotal, 48 total and 2 proximal gastrectomies. The anastomoses were totally laparoscopic in 105, laparoscopic assisted in 21, cervical in 2, and 20 open (after conversion). The reconstruction methods were: 142 Roux-en-Y, two Billroth I, and three other types. The conversion rate was 13.5% (20/148). The D2 dissection was performed in 139 patients. The mean number of harvested lymph nodes was 34.4. If we take only the D2 cases the mean number was 39.5. The morbidity rate was 22.3%. The mortality was 2.7%. The stages were: IA-59, IB-14, IIA-11, IIB-15, IIIA-9, IIIB-19, IIIC-11 and stage IV-three cases. Four patients died from the disease and 10 are alive with disease. The participating services have already begun the robotic gastrectomy with satisfactory results. The intention of this group is to begin now a prospective multicentric study to confirm the data already obtained with the retrospective studies. © Translational Gastroenterology and Hepatology. All rights reserved.


Poulose B.K.,Vanderbilt University | Roll S.,Santa Casa of Sao Paulo Medical School | Murphy J.W.,William Beaumont Hospital Troy | Matthews B.D.,Carolinas Medical Center | And 6 more authors.
Hernia | Year: 2016

Purpose: Wide variation in care and costs exists regarding the management of abdominal wall hernias, with unproven benefit for many therapies. This work establishes a specialty society-based solution to improve the quality and value of care delivered to hernia patients during routine clinical management on a national scale. Methods: The Americas Hernia Society Quality Task Force was charged by the Americas Hernia Society leadership to develop an initiative that utilizes the concepts of continuous quality improvement (CQI). A disease-based registry was created to collect information for CQI incorporating real-time outcome reporting, patient reported outcomes, stakeholder engagement, and collaborative learning methods to form a comprehensive quality improvement effort. Results: The Americas Hernia Society Quality Collaborative (AHSQC) was formed with the mission to provide health care professionals real-time information for maximizing value in hernia care. The initial disease areas selected for CQI were incisional and parastomal hernias with ten priorities encompassing the spectrum of care. A prospective registry was created with real-time analytic feedback to surgeons. A data assurance process was implemented to ensure maximal data quality and completeness. Four collaborative meetings per year were established to meet the goals of the AHSQC. As of the fourth quarter 2014, the AHSQC includes nearly 2377 patients at 38 institutions with 82 participating surgeons. Conclusions: The AHSQC has been established as a quality improvement initiative utilizing concepts of CQI. This ongoing effort will continually refine its scope and goals based on stakeholder input to improve care delivered to hernia patients. © 2016, Springer-Verlag France.


PubMed | Medical College of Wisconsin, Santa Casa of Sao Paulo Medical School, New Hannover Regional Medical Center, Cleveland Clinic and 5 more.
Type: Journal Article | Journal: Hernia : the journal of hernias and abdominal wall surgery | Year: 2016

Wide variation in care and costs exists regarding the management of abdominal wall hernias, with unproven benefit for many therapies. This work establishes a specialty society-based solution to improve the quality and value of care delivered to hernia patients during routine clinical management on a national scale.The Americas Hernia Society Quality Task Force was charged by the Americas Hernia Society leadership to develop an initiative that utilizes the concepts of continuous quality improvement (CQI). A disease-based registry was created to collect information for CQI incorporating real-time outcome reporting, patient reported outcomes, stakeholder engagement, and collaborative learning methods to form a comprehensive quality improvement effort.The Americas Hernia Society Quality Collaborative (AHSQC) was formed with the mission to provide health care professionals real-time information for maximizing value in hernia care. The initial disease areas selected for CQI were incisional and parastomal hernias with ten priorities encompassing the spectrum of care. A prospective registry was created with real-time analytic feedback to surgeons. A data assurance process was implemented to ensure maximal data quality and completeness. Four collaborative meetings per year were established to meet the goals of the AHSQC. As of the fourth quarter 2014, the AHSQC includes nearly 2377 patients at 38 institutions with 82 participating surgeons.The AHSQC has been established as a quality improvement initiative utilizing concepts of CQI. This ongoing effort will continually refine its scope and goals based on stakeholder input to improve care delivered to hernia patients.


Lyra A.,Santa Casa of Sao Paulo Medical School | Bonfitto A.J.,Santa Casa of Sao Paulo Medical School | Barbosa V.L.P.,Santa Casa of Sao Paulo Medical School | Barbosa V.L.P.,Movere Institute | And 4 more authors.
Annals of Nutrition and Metabolism | Year: 2015

Aim: To compare the body composition of overweight children and adolescents by bioelectrical impedance analysis (BIA) and dual-energy X-ray absorptiometry (DXA) before and after physical activity program. Methods: One hundred and eleven patients with mean age (SD) of 12 (1.9) participated in the study. We assessed the weight, height, waist circumference (WC), and body composition by DXA and BIA. Patients underwent a program of diet and physical activity (1 h 30 min/day, 3 times a week for 3 months) and were evaluated before and after this period. Results: Mean initial zBMI were 2.3 (0.5) and waist SDS 5.9 (1.8). Significant differences were observed when we compared the measurements taken by DXA and BIA, respectively: total body fat percentage (40 and 31.5) and fat-free mass (43.1 and 50.6 kg). Regarding the trunk fat by DXA, there was a positive correlation with the WC/height ratio (r = 0.65; p < 0.01). After the intervention period, we observed a reduction in the zBMI, waist SDS, and total body fat and increase of fat-free mass by DXA. BIA only detected reduction in fat. Conclusion: BIA underestimates the percentage of fat and overestimates fat-free mass in relation to DXA. There is positive correlation between trunk fat and the ratio WC/height. In addition, DXA detected changes in body composition induced by a short period of physical training, unlike BIA. © 2014 S. Karger AG, Basel.


de Carvalho Aguiar I.,Nove de Julho University | Peixoto R.A.O.,Nove de Julho University | dos Santos I.R.,Nove de Julho University | Nacif S.R.,Nove de Julho University | And 6 more authors.
Clinical and Experimental Medical Letters | Year: 2012

Obesity is a major public health problem in both developed and developing countries alike and leads to a series of changes in cardiorespiratory physiology. There is a strong correlation between obesity and sleep disorders. Weight loss among such patients leads to a reduction in these pathological alterations, but clinical treatment is not effective over the long-term. Thus, bariatric surgery is a viable option. Morbid obesity is also associated with cardiomyopathy, increased left ventricular wall stress, left ventricular hypertrophy, and diastolic dysfunction. This process stimulates the autonomic nervous system (ANS), leading to systemic vasoconstriction and arterial hypertension. The heart rate variability (HRV) has been incorporated as an important method of assessment of ANS. The objective of this study was to analyze HRV in morbidly obese patients undergoing bariatric surgery before and 60 days after surgery. Material/Methods: The study included 14 patients (11 females), and data collection included BMI classification, abdominal and neck circumferences, Epworth sleepiness scale, a sleep study, and HRV analysis. Results: The mean age was 36.07±10.97. The mean BMI before surgery was 48.68±5.64 and after surgery it was 41.92±5.72 Kg/m2. Our findings demonstrate gains in HRV in all patients after surgery. Conclusions: We conclude that obese patients have a high prevalence of obstructive sleep apnea syndrome and unstable HRV during sleep, with a predominance of sympathetic activity. However, with weight reduction, after 60 days of bariatric surgery there is significant improvement in anthropometric, and sleep variables, and HRV. © Clin Exp Med Lett.


Rolim Rosa Lima S.M.,Santa Casa of Sao Paulo Medical School | Yamada S.S.,Santa Casa of Sao Paulo Medical School | Reis B.F.,Santa Casa of Sao Paulo Medical School | Reis B.F.,Sapucai Valley University | And 3 more authors.
Maturitas | Year: 2013

Objetive: To assess efficacy and tolerability of a isoflavone (Glycine max L. Merr.) vaginal gel to the treatment of vaginal atrophy in postmenopausal women. Methods: The double-blind, randomized, placebo-controlled, clinical trial. Ninety women were treated for 12 weeks with isoflavone vaginal gel 4% (1 g/day) and a placebo gel and conjugated equine estrogen cream (0.3 mg/day). After 4 and 12 weeks, the vaginal atrophy symptoms were classified at none, mild, moderate and severe and the vaginal cytology were taken to determine the maturation value. The endometrial safety (by transvaginal ultrasonography) was evaluated through at screening and the end of the trial. Results: Isoflavone vaginal gel appears to be effective for relief of vaginal dryness and dyspareunia symptons and an increase in the intermediate and superficial cells was noted. These results were similar to the effects with use of conjugated equine estrogens and superior to placebo gel. No changes in endometrial thickness, sera FSH and estradiol levels were observed at study endpoint. Conclusion: Glycine max (L.) Merr. at 4% vaginal gel on a daily basis in postmenopausal women led to improvements in vaginal atrophy symptoms and a significant increase in cell maturation values. Isoflavones proved good treatment options for relief of vulvovaginal symptoms especially in women who do not wish to use hormonal therapy or have contra-indications for this treatment. © 2012 Elsevier Ireland Ltd.


Reis B.F.,Santa Casa of Sao Paulo Medical School | Reis B.F.,Sapucai Valley University | Lima S.M.R.R.,Santa Casa of Sao Paulo Medical School | Silva G.M.D.,Santa Casa of Sao Paulo Medical School | And 4 more authors.
Histology and Histopathology | Year: 2016

Objective: A prospective randomized controlled trial was conducted to evaluate the effect of low dose of tibolone on the histology, expression of estrogen (ER) and progesterone receptors (PR) and Bcl- 2 protein, in endometrium of postmenopausal women. Method: Forty postmenopausal women consented to treatment and were allocated into two groups of 20 women: Group 1 (Control) without hormone replacement therapy (HRT); Group 2 (Tibolone) treatment at the dose of 1.25 mg/day of oral tibolone administered for a 24-week period. The effect on the endometrium was assessed by histology and the apoptosis marker Bcl-2. The immunoexpression of ER and PR were also measured. Results: Tibolone group showed higher expression of ER, PR and Bcl-2 protein in glandular epithelium and stroma compared to control group. Conclusion: Tibolone in a daily dose of 1.25 mg during 24 weeks demonstrated endometrial action that resulted in low proliferation and was shown to lead to atrophic endometrium. It had favorable effects on the postmenopausal endometrium due to its higher immunoexpression of PR and Bcl-2 protein in endometrial glandular epithelium, thereby creating a balance between pro-apoptotic and anti-apoptotic actions. © 2016, Histology and Histopathology. All right reserved.


Lima S.M.R.R.,Santa Casa of Sao Paulo Medical School | Reis B.F.,Santa Casa of Sao Paulo Medical School | Reis B.F.,Vale Do Sapuca University | Yamada S.S.,Santa Casa of Sao Paulo Medical School | And 6 more authors.
Climacteric | Year: 2011

Objective To evaluate the effect of drospirenone with 17b-estradiol on the histology and expression of estrogen and progesterone receptors and of Bcl-2 protein, in endometrium of postmenopausal women. Method Forty postmenopausal women, including controls, participated in this study evaluating oral hormone replacement treatment combining 2 mg/day of drospirenone with 1 mg/day of 17b-estradiol administered for a 24-week period. The effect on the endometrium was assessed by histology and the apoptosis marker Bcl-2. The immunoexpression of estrogen (ER) and progesterone (PR) receptors in the endometrium was also measured. Results No increase in endometrial thickness was evident after either treatment, although endometrial histology was atrophic in most biopsies. The drospirenone/estradiol group showed higher expression of ER and PR in glandular epithelium compared to stroma, but the Bcl-2 protein was more immunoreactive in stroma than in glandular epithelium. Compared to controls, drospirenone/ estradiol users showed higher immunoexpression of ER, PR and Bcl-2 in both glandular epithelium and endometrial stroma. Conclusion A 24-week course of drospirenone with 17b-estradiol resulted in low proliferation and was shown to lead to atrophic endometrium. The novel progestogen drospirenone seems to have favorable effects on the endometrium of postmenopausal women due to its pro-apoptotic action in glandular epithelium. © 2011 International Menopause Society.


PubMed | Santa Casa of Sao Paulo Medical School
Type: Journal Article | Journal: Annals of nutrition & metabolism | Year: 2015

To compare the body composition of overweight children and adolescents by bioelectrical impedance analysis (BIA) and dual-energy X-ray absorptiometry (DXA) before and after physical activity program.One hundred and eleven patients with mean age (SD) of 12 (1.9) participated in the study. We assessed the weight, height, waist circumference (WC), and body composition by DXA and BIA. Patients underwent a program of diet and physical activity (1 h 30 min/day, 3 times a week for 3 months) and were evaluated before and after this period.Mean initial zBMI were 2.3 (0.5) and waist SDS 5.9 (1.8). Significant differences were observed when we compared the measurements taken by DXA and BIA, respectively: total body fat percentage (40 and 31.5) and fat-free mass (43.1 and 50.6 kg). Regarding the trunk fat by DXA, there was a positive correlation with the WC/height ratio (r = 0.65; p < 0.01). After the intervention period, we observed a reduction in the zBMI, waist SDS, and total body fat and increase of fat-free mass by DXA. BIA only detected reduction in fat.BIA underestimates the percentage of fat and overestimates fat-free mass in relation to DXA. There is positive correlation between trunk fat and the ratio WC/height. In addition, DXA detected changes in body composition induced by a short period of physical training, unlike BIA.

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