Alexandre Bakonyi Neto

Evaluation of nutritional indicators and body composition in patients with advanced liver disease enrolled for liver transplantation

PURPOSE Malnutrition is prevalent in patients with advanced liver disease (LD) related to multifactorial causes. Fluid retention can underestimate the nutritional status based on anthropometric measures. We evaluated nutritional indicators and body composition (BC) in patients with liver cirrhosis and correlated them with LD severity. METHODS Forty three patients with LD enrolled for liver transplantation were evaluated by Anthropometric measures, subjective evaluation (Global Assessment of Nutritional Status - SGA) and biochemical indicators. Single-frequency electrical bioimpedance (SFE-BIA) was used to evaluate body composition (BC). It measured resistance (R), reactance (Xc) and the phase angle (PA). LD severity was estimated by Child-Pugh and Meld criteria (Model for End-Stage Liver Disease). RESULTS Child-Pugh index between patients was 7.11 ± 1.70 and Meld was 12.23 ± 4.22. Arm Circumference, Arm Muscle Circumference and Arm Muscle Area, SGA, hemoglobin, hematocrit and albumin showed better correlation with disease severity. Xc and PA showed correlation both with Meld and Child-Pugh score when BC were evaluated. PA was depleted in 55.8% of the patients. CONCLUSIONS Diagnosis of malnutrition varied according to the method. Global assessment of nutritional status showed better correlation with disease severity than with objective methods. Single-frequency electrical bioimpedance for body composition analysis in cirrhotic patients must be cautiously used; however, primary vectors seems to be valid and promising in clinical practice.

Melanoma anorretal: relato de 2 casos e revisão da literatura

Malignant tumors of the anal canal and anus are rare pathologic events, representing less than 2% of all tumors of the colon, rectum and anus; according to reports, the incidence of melanoma does not achieve 0,1 to 1,2% of malignant tumors. Authors describe two cases of melanoma, discussing the data described in literature, focusing on the diagnosis aspects, treatment, evolution and prognosis. Cure rates are low and the disease presents high rates of mortality in short term.

Peritoneal pseudomyxoma associated with synchronic malignant mucinous neoplasias of the cecum, appendix and rectum: case report and review of the literature

Peritoneal pseudomyxoma is a pathological condition that compromises the peritoneum, characterized by the production of large quantities of mucinous liquid, which progressively fills the peritoneal cavity, originating in general from mucinous appendicular or ovarian tumors. We report a peritoneal pseudomyxoma associated with mucinous adenocarcinoma of the appendix synchronic with adenocarcinoma of the rectum in a 44 year old patient, where the initial diagnosis was rectal adenocarcinoma. Tumour of the appendix and peritoneal pseudomyxoma were incidental and found intraoperatively. We focus the histological patterns of the lesions, diagnosis and the treatment, with revision of the literature.

Colite por citomegalovirus em paciente transplantada renal: relato de caso e revisão da literatura

Cytomegalovirus infection frequently develops in immunocompromised patients, either in post-transplanted patients or in patients with diseases that affects the immune system, such as AIDS; we present a case of a 49 year old female patient in late post surgery (14 years) of a kidney transplant, using immunosuppressing medication. The patient presented abdominal pain, weight loss and initial diarrhea, she was hospitalized and developed severe hematochezia and hypotension. The patient was submitted to a colonoscopy and presented friable aspect mucosa, with aphthoid ulcers, fibrin and pseudopolyp formation; biopsy revealed cytomegalovirus. Her condition did not improve after the use of foscarnet, and surgical treatment was necessary. The patient died 5 days later.

Chimerism induction by nonmyeloablactive preconditioning and bone marrow infusion in rat small bowel transplantation

Em estudo recente demonstramos que a infusao de celulas da medula ossea do doador apos o transplante intestinal nao aumentou a sobrevida do enxerto quando se utilizou series curtas de drogas imunossupressoras. OBJETIVO: Neste estudo avaliamos se a utilizacao de diferentes regimes de irradiacao em associacao com a infusao de medula ossea altera a sobrevida do enxerto e a morbidade sobre receptor. METODOS: Realizou-se o transplante heterotopico de intestino delgado, utilizando-se ratos Lewis como receptores e DA como doadores, imunossuprimidos com FK 506 na dose de 1mg/kg/dia por 5 dias e distribuidos em 4 grupos: G1 (n= 4), nao irradiado e sem infusao de medula ossea; G2 (n= 6), G3 (n= 9) e G4 (n= 6) foram infundidos com 100 x 106 celulas de medula apos o transplante. Grupos 3 e 4 foram irradiados com 250 e 400 rd respectivamente. Os animais foram examinados diariamente para a deteccao de rejeicao e reacao do enxerto versus hospedeiro, tendo sido colhidas amostras semanais de sangue para estudos de quimerismose biopsias quinzenais da estomia. RESULTADOS: Animais nos G1 e G2 apresentaram rejeicao minima no 15o pos-operatorio, enquanto a reacao do enxerto versus hospedeiro foi caracterizada nos G3 e G4. Os niveis de quimerismo total e de celulas T foram maiores nos grupos irradiados em comparacao aos nao irradiados. A causa mortis nos G1 e G2 foi a rejeicao enquanto que nos G3 e G4 foi a reacao do enxerto versus hospedeiro. CONCLUSAO: Concluimos que a utilizacao de baixas doses de irradiacoes retardam o aparecimento da rejeicao, mas nao previne a ocorrencia da reacao do enxerto versus hospedeiro.