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Álvaro Antônio

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Bandeira Ferraz

Edmundo Machado Ferraz

Universidade Federal de Pernambuco

Josemberg Marins Campos

Universidade Federal de Pernambuco

Luciana T. Siqueira

Universidade Federal de Pernambuco

Júlia Nóbrega de Brito

Universidade Federal de Pernambuco

Eudes Paiva de Godoy

Universidade Federal do Rio Grande do Norte

Juliana Andrea

Castañeda López

Alencar Queiroz

P. Afonso

Hospital de São Bernardo

Cooperative Institutions

Universidade Federal de Pernambuco

Hospital das Clínicas da Universidade Federal de Pernambuco

Universidade de Pernambuco

Universidade Cidade de São Paulo

Gastro Obeso Center

Universidade de São Paulo

Hospital de São Bernardo

Instituto de Medicina Integral Professor Fernando Figueira

Medico

Universidade Federal do Rio Grande do Norte

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Occurrence of hepatopulmonary syndrome in patients with cirrhosis who are candidates for liver transplantation* Ocorrência de síndrome hepatopulmonar em pacientes cirróticos candidatos a transplante de fígado

Liana Gonçalves Macêdo Edmundo Pessoa de Almeida Maria de Fátima Pessoa Flávio Henrique Amaral Pires Véras

Objective: To determine the occurrence of hepatopulmonary syndrome (HPS) in patients with cirrhosis who are candidates for liver transplantation; to compare demographic, clinical, laboratory, and spirometric characteristics, as well as echocardiography results, arterial blood gas analysis, and severity of liver disease between the groups of patients with and without HPS; and to describe the occurrence of HPS in the subgroup of patients with cirrhosis and schistosomiasis mansoni (mixed liver disease). Methods: Between January and November of 2007, we evaluated 44 patients under treatment at the Liver Transplant Outpatient Clinic of the Federal University of Pernambuco Hospital das Clinicas, in the city of Recife, Brazil. The diagnostic criteria for HPS were intrapulmonary vascular dilatation, identified by transthoracic echocardiography, and an alveolar-arterial oxygen tension difference ≥ 15 mmHg or a PaO 2 < 80 mmHg. Results: The mean age of the patients was 52 years, and 31 patients (70%) were males. The most common cause of cirrhosis was alcohol use. Schistosomiasis was present in 28 patients (64%). Of the 44 patients, 20 (45.5%) were diagnosed with HPS. No significant differences were found between those patients and the patients without HPS in terms of any of the characteristics studied. Of the 28 patients with cirrhosis and schistosomiasis, 10 (35.7%) were diagnosed with HPS. Conclusions: In the population studied, HPS was highly prevalent and did not correlate with any of the variables analyzed.

Hepatopulmonary syndrome

Liver disease

Outpatient clinic

Chronic liver disease

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Manejo endoscópico del síndrome de túnel del carpo, una experiencia de 5 años Endoscopic management of the carpal tunnel syndrome, an experience of 5 years

Álvaro Antônio Kafury Goeta Juliana Andrea Rojas Neira Jhon Fredy

RESUMEN Introduccion: El sindrome de tunel del carpo afecta el 1% de la poblacion, siendo la neuropatia por compresion mas frecuente, la liberacion endoscopica es una tecnica que presenta buenos resultados, aunque no esta exenta de complicaciones. Objetivo: El objetivo del estudio es determinar la prevalencia de complicaciones asociadas en una experiencia de 5 anos. Metodologia: Estudio de corte transversal en pacientes con diagnostico del tunel del carpo sometidos a liberacion endoscopica en un periodo de 5 anos, donde se documento todas las complicaciones neurologicas, vasculares e infeccion. Resultados: Se incluyeron 175 manos en 139 pacientes con un promedio de edad de 52 anos de edad; el 89.2% de los casos se presentaron en mujeres. Las comorbilidades encontradas fueron: hipertension arterial 31.6%, hipotiroidismo 29.5%, diabetes 5%, y consumo de cigarrillo 11%. La prevalencia de complicaciones fue del 5.7% (10 casos), de las cuales la lesion neurologica fue del 0.6% clasificada como neuropraxia del nervio cubital, 1.7% presentaron hematomas que resolvieron sin cirugia y 3.4% presentaron infeccion que resolvieron con manejo antibiotico y curaciones. Todas las complicaciones presentaron una recuperacion satisfactoria. El 99% de los pacientes presentaron resolucion de los sintomas. Conclusiones: La tecnica de liberacion endoscopica del tunel del carpo es una tecnica segura, en donde se encontro un porcentaje bajo de complicaciones siendo comparables a otras series.Palabras claves: Endoscopia, Sindrome de tunel carpiano, complicaciones.

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ENDOSCOPIC DILATION OF GASTROJEJUNAL ANASTOMOSIS AFTER GASTRIC BYPASS Dilatação endoscópica de anastomose gastrojejunal após bypass gástrico

Josemberg Marins Campos Fernando Salvo Torres de Mello Álvaro Antônio Bandeira Ferraz

Introduction - Roux-en-Y gastric bypass may result in stenosis of the gastrojejunal anastomosis. There is currently no well-defined management protocol for this complication. Aim - Through systematic review, to analyze the results of endoscopic dilation in patients with stenosis, including complication and success rates. Methods - The PubMed database was searched for relevant studies published each year from 1988 to 2010, and 23 studies were identified for analysis. Only papers describing the treatment of anastomotic stricture after Roux-en-Y gastric bypass were included, and case reports featuring less than three patients were excluded. Results - The mean age of the trial populations was 42.3 years and mean preoperative body mass index was 48.8 kg/m². A total of 1,298 procedures were undertaken in 760 patients (81% female), performing 1.7 dilations per patient. Through-the-scope balloons were used in 16 studies (69.5%) and Savary-Gilliard bougies in four. Only 2% of patients required surgical revision after dilation; the reported complication rate was 2.5% (n=19). Annual success rate was greater than 98% each year from 1992 to 2010, except for a 73% success rate in 2004. Seven studies reported complications, being perforation the most common, reported in 14 patients (1.82%) and requiring immediate operation in two patients. Other complications were also reported: one esophageal hematoma, one Mallory-Weiss tear, one case of severe nausea and vomiting, and two cases of severe abdominal pain. Conclusion - Endoscopic treatment of stenosis is safe and effective; however, further high-quality randomized controlled trials should be conducted to confirm these findings. ABCDDV/885

Perforation

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QA4 Cost-Utility of Sacral Neuromodulation Versus Augmentation Cystoplasty for Treatment of Refractory Urge Incontinence in México

Value in Health (2011)

P. Oliva-Oropeza M.E. Quiroz Angulo Álvaro Antônio

Sacral nerve stimulation

Cost–utility analysis

10.1016/j.jval.2011.08.1526

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A Portable and Low Cost System to Blood Glucose, Cholesterol and

José Renato Garcia Braga Álvaro Antônio Alencar Queiroz Alexandre Carlos Brandão Ramos

Over the last century there has been a considerable increase in human longevity and this made a large number of people to reach a critical age for development of several diseases. As a result of this increase in life expectancy health issues related, some examples are hypercholesterolemia, hyperglycemia and increased levels of blood urea. This paper presents a portable and low cost system using Artificial Neural Networks to blood metabolites identification. The system developed is based in amperometric biosensors and is able to perform the identification of glucose, cholesterol and urea concentrations in the blood. The main goals of this system is: the identification of three types of blood metabolites with their concentrations, the low cost of the entire system and the reuse capability of the biosensor.

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PROFILAXIA ANTIMICROBIANA NA CIRURGIA BARIÁTRICA ANTIBIOTIC PROPHYLAXIS IN BARIATRIC SURGERY

Álvaro Antônio Bandeira Ferraz Cristiano de Souza Leão Euclides Martins Filho A. Martins

ABSTRACTBackground: To analyze the results of the incidence of wound infection under 3 different antibiotics regiments. Methods:Between January, 1999 and December, 2004, 716 bariatric surgeries had been performed using the technique proposed byFobi/Capella. Three groups of patients had been compared, according to the antibiotic prophylaxys regimen: Group I: (n=185)ampicillin/sulbactam, 3g in two doses; Group II (n=280): ceftriaxone, 1g (single dose); and Group III: (n=251) ertapenem, 1g (single dose). Results: Our results demonstrate a rate of wound infection of 3.78% with ampicilina-sulbactam, 6.81% withceftriaxona and 1.99% in the ertapenem group. There was no significant differences between ampicilina/sulbactam or ceftriaxonain relation to the incidence of wound infection. However, there was a statistically significant difference between Group II(Ceftriaxona) and Group III (Ertapenem). Conclusion: The use of ertapenem as the antibiotic prophylaxis for the surgical ofmorbid obesity was associated to a lower incidence of wound infection than with the use of ceftriaxone, while being similar tha nampicillin/sulbactam.Key words: Surgical wound infection; Bariatric surgery; Infection; Antibiotic prophylaxis; Gastroplasty; Obesity, morbid.

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BYPASS GÁSTRICO LAPAROSCÓPICO COM USO REDUZIDO DE SUTURAS MECÂnICAS Laparoscopic gastric bypass with low use of stapler sutures

Josemberg Marins Campos Eudes Paiva de Godoy Luciana T. Siqueira Luis Fernando Lobato Álvaro Antônio

Campos JM, Godoy EP, Siqueira LT, Evangelista LFL, Vasconcelos CS, Ferraz AAB, Ferraz EM. Bypass gastrico laparoscopico com uso reduzido de suturas mecânicas. ABCD Arq Bras Cir Dig. 2008;21(2):73-6RESUMO – Racional – A execucao de bypass gastrico laparoscopico em hospital universitario publico tem sido dificil devido ao elevado custo dos grampeadores cirurgicos que prejudica o treinamento de medicos residentes e tem motivado a busca por tecnicas alternativas, de baixo custo, mantendo a eficacia. Objetivo – Apresentar a viabilidade de um metodo com menor uso de suturas mecânicas. Metodos – Foram operados 63 pacientes em 2 hospitais universitarios, sendo 12 homens e 51 mulheres (81%), com media de 33,5 anos de idade e IMC medio de 43. Aplicou-se a seguinte padronizacao tecnica: Seccao da alca com bisturi eletrico a 50 cm do ângulo duodeno-jejunal, anastomose termino-lateral, passagem da alca retrocolica e retrogastrica, confeccao da parede lateral da bolsa gastrica com 1 carga azul de 45 e outra de 60 mm apos a seccao horizontal com bisturi eletrico, sutura do estomago excluso e anastomose gastrojejunal. As anastomoses foram manuais e continuas com fio absorvivel. Re-sultados – O tempo operatorio medio foi de 5,5 horas. As complicacoes precoces foram: fistula no ângulo de esofago-gastrico (1,6%), estenose (1,6%) e fistula na anastomose gastrojejunal (1,6%) e torcao da anastomose intestinal (1,6%). A estenose foi tratada por dilatacao endoscopica e as outras complicacoes atraves de 3 re-operacoes (2 laparoscopicas e 1 laparotomica). O tempo de internacao variou de 2 a 20 dias, com media de 4 dias, nao havendo obito. Conclusao – Este metodo e viavel e com baixo custo operacional; todavia, e complexo e requer habilidade principalmente em suturas laparoscopicas.

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Diverticulite em Adolescente com Síndrome de Williams: Relato de Caso Diverticulitis in Adolescent with Williams Syndrome: Case Report

Josemberg Marins Campos Eduardo Bezerra De Albuquerque Lima Luciana T. Siqueira Carolina de Oliveira Souza Álvaro Antônio

ABSTRACT: The Syndrome of Williams is a rare genetic illness, attributed the deletion of the gene of the elastin in chromosome7. It is characterized by aortic stenosis, bladder diverticula’s, constipation, light mental retardation, dysmorphic facies, we aknessof the wall of the bladder and colon that they lead to the sprouting of diverticula. A case of acute diverticulitis in patient of 18 yearsis told, the result of the clinical treatment during 5 years and the differential diagnosis of acute abdomen in this illness. Theindication of elective colectomy is argued, considering the unfamiliarity of the natural history of the diverticulitis in thesyndrome.Key words: Diverticulitis, acute abdomen, adolescent, Williams Syndrome. REFERENCIAS 1. Williams JC, Barratt-Boyes BG, Lowe JB. Supravalvular aorticstenosis. Circulation. 1961 Dec;24:1311-8.2. Morris CA, Demsey SA, Leonard CO, Dilts C, BlackburnBL. Natural history of Williams syndrome: physicalcharacteristics. J Pediatr. 1988 Aug;113(2):318-263. Ewart AK, Morris CA, Ensing GJ, Loker J, Moore C, LeppertM, Keating M. A human vascular disorder, supravalvular aorticstenosis, maps to chromosome 7. Proc Natl Acad Sci U S A.1993 Apr;90(8):3226-30.4. Nickerson E, Greenberg F, Keating MT, McCaskill C, ShafferLG. Deletions of the elastin gene at 7q11.23 occur inapproximately 90% of patients with Williams syndrome. AmJ Hum Genet. 1995 May;56(5):1156-61.5. Cagle AP, Waguespack SG, Buckingham BA, Shankar RR,Dimeglio LA. Severe infantile hypercalcemia associated withWilliams syndrome successfully treated with intravenouslyadministered pamidronate. Am J Med Genet A. 2005Aug;137(1):52-4.6. Afzal NA, Thomson M. Best Pract Res Clin Gastroenterol.2002 Aug;16(4):621-34.7. Deshpande AV, Oliver M, Yin M, Goh TH, Hutson JM. Severecolonic diverticulitis in an adolescent with Williams syndrome.J Paediatr Child Health. 2005 Dec;41(12):687-8.8. Nelson RS, Velasco A, Mukesh BN. Management ofdiverticulitis in younger patients. Dis Colon Rectum. 2006Sep;49(9):1341-5.9. Jacobs DO. Clinical practice. Diverticulitis. N Engl J Med.2007 Nov;357(20):2057-66.10. Guzzo J, Hyman N. Diverticulitis in young patients: isresection after a single attack always warranted? Dis ColonRectum. 2004 Jul;47(7):1187-90.11. Farmakis N, Tudor RG, Keighley MR. The 5-year naturalhistory of complicated diverticular disease. Br J Surg. 1994May;81(5):733-5.12. Biondo S, Pares D, Marti Rague J, Kreisler E, Fraccalvieri D,Jaurrieta E. Acute colonic diverticulitis in patients under 50years of age. Br J Surg. 2002 Sep;89(9):1137-4113. Partsch CJ, Siebert R, Caliebe A, Gosch A, Wessel A, PankauR. Sigmoid diverticulitis in patients with Williams-Beurensyndrome: relatively high prevalence and high complicationrate in young adults with the syndrome. Am J Med Genet A.2005 Aug;137(1):52-4.

Williams Syndrome

Diverticulitis

Acute abdomen

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