José Sebastião dos Santos

Nonalcoholic fatty liver disease and obesity

PURPOSE The aim of this review is to update concepts of the nonalcoholic fatty liver disease (NAFLD) and to establish a relationship between this condition and obesity. METHODS By means of a comprehensive literature review where special attention was devoted to articles published in the last 5 years, NAFLD is discussed in view of new concepts, diagnosis, staging, and treatment. RESULTS NAFLD is emerging as one of the main causes of chronic liver disease and it is believed to be the hepatic component of the metabolic syndrome, whose central features include obesity, hyperinsulinemia, peripheral insulin resistance, diabetes, dyslipidemia, and hypertension. The surgical treatment of morbid obesity is one of the options available for the treatment of NAFLD. CONCLUSION Nonalcoholic fatty liver disease is strongly related with obesity.

Desperdício de alimentos intra-hospitalar

OBJETIVO: Verificar a ocorrencia do desperdicio, na forma de resto de alimentos, na Unidade de Alimentacao e Nutricao da Unidade de Emergencia do Hospital das Clinicas da Faculdade de Medicina de Ribeirao Preto, da Universidade de Sao Paulo. METODOS: Realizou-se analise descritiva de dados, levantados em um periodo de 14 dias, sobre os restos de alimentos deixados pelos clientes/pacientes, assim como dos custos estimados do total da producao e do resto de alimentos. RESULTADOS: Foram analisadas 650 dietas, totalizando 402kg de alimentos, tendo retornado a Unidade de Alimentacao e Nutricao 123kg (31%) de alimentos. Das dietas distribuidas, 71 (15%) retornaram intactas. Desconsiderando as dietas intactas, o peso total de alimentos produzidos foi de 353kg e o resto de 77kg (22%). O custo total mensal estimado das dietas foi de US

Single-Step EUS-Guided Endoscopic Treatment for Sterile Pancreatic Collections: A Single-Center Experience

25,000.00 e o custo estimado dos restos foi de US

The implementation of the Medical Regulation Office and Mobile Emergency Attendance System and its impact on the gravity profile of non-traumatic afflictions treated in a University Hospital: a research study

7,580.00. CONCLUSAO: Os resultados demonstram uma perda excessiva de alimentos, incompativel com as normas operacionais de uma Unidade de Alimentacao e Nutricao hospitalar, o que nos remete a necessidade de reflexao acerca das possibilidades de ajustes, introduzindo revisoes nas praticas gerenciais e operacionais do servico com enfoque nas acoes interdisciplinares.

Personalized medicine in gastric cancer: Where are we and where are we going?

Background and Aims: Endoscopic ultrasound (EUS) is useful for the treatment of sterile pancreatic fluid collections (PFC), either by means of transmural drainage or by complete aspiration. The aim of this study was to evaluate the efficacy and safety of single-step EUS-guided endoscopic approaches for treatment of sterile PFC. Patients and Methods: During a 3-year period, 77 consecutive patients with symptomatic, persistent sterile PFC were evaluated and treated with the linear EUS. We excluded patients with grossly purulent collections, chronic pseudocyst and those whose cytology diagnostic was neoplastic cyst of pancreas. 44 patients received a single 10-Fr plastic straight stent under EUS or fluoroscopic control (group I) and 33 of these underwent a single-step complete aspiration with a 19-gauge needle (group II). Results: The mean size of the sterile PFC was 48 mm in group I and 28 mm in group II (p < 0.001). Overall, endoscopic treatment was successful in 70 (90.9%) patients. The mean volume aspirated was 25 (18–65) ml. The total number of procedures was 50 in group I and 41 punctures in group II. After a mean follow-up of 64 ± 15.6 weeks there were 6 complications (13.6%): 2 recurrences (referred to surgery), 2 developing abscesses (submitted a new EUS-guided endoscopic drainage with success), 1 perforation that died (2.2%), and 1 case of bleeding (sent to surgery) in group I. In group II there were only 6 (18.1%) recurrences (submitted a new EUS-guided aspiration). None of the patients undergoing single-step aspiration developed infections, perforation or hemorrhage. Conclusion: The recurrence of pancreatic pseudocysts after endoscopic treatment was similar, either by means of plastic stents or by complete single-step aspiration.

Routine abdominal drains after Roux-en-Y gastric bypass: a prospective evaluation of the inflammatory response

BackgroundThe public health system of Brazil is structured by a network of increasing complexity, but the low resolution of emergency care at pre-hospital units and the lack of organization of patient flow overloaded the hospitals, mainly the ones of higher complexity. The knowledge of this phenomenon induced Ribeirão Preto to implement the Medical Regulation Office and the Mobile Emergency Attendance System. The objective of this study was to analyze the impact of these services on the gravity profile of non-traumatic afflictions in a University Hospital.MethodsThe study conducted a retrospective analysis of the medical records of 906 patients older than 13 years of age who entered the Emergency Care Unit of the Hospital of the University of São Paulo School of Medicine at Ribeirão Preto. All presented acute non-traumatic afflictions and were admitted to the Internal Medicine, Surgery or Neurology Departments during two study periods: May 1996 (prior to) and May 2001 (after the implementation of the Medical Regulation Office and Mobile Emergency Attendance System). Demographics and mortality risk levels calculated by Acute Physiology and Chronic Health Evaluation II (APACHE II) were determined.ResultsFrom 1996 to 2001, the mean age increased from 49 ± 0.9 to 52 ± 0.9 (P = 0.021), as did the percentage of co-morbidities, from 66.6 to 77.0 (P = 0.0001), the number of in-hospital complications from 260 to 284 (P = 0.0001), the mean calculated APACHE II mortality risk increased from 12.0 ± 0.5 to 14.8 ± 0.6 (P = 0.0008) and mortality rate from 6.1 to 12.2 (P = 0.002). The differences were more significant for patients admitted to the Internal Medicine Department.ConclusionThe implementation of the Medical Regulation and Mobile Emergency Attendance System contributed to directing patients with higher gravity scores to the Emergency Care Unit, demonstrating the potential of these services for hierarchical structuring of pre-hospital networks and referrals.

Urgent percutaneous transcatheter embolization of hemorrhagic hepatic lesions with N-butyl cyanoacrylate.

Despite improvements in adjuvant therapies for gastric cancer in recent years, the disease is characterized by high recurrence rates and a dismal prognosis. The major improvement in the treatment of recurrent or metastatic gastric cancer in recent years has been the incorporation of trastuzumab, a monoclonal antibody that inhibits human epidermal growth factor receptor 2 (HER2) heterodimerization, after the demonstrated predictive value of the overexpression and/or amplification of this receptor. Beyond HER2, other genetic abnormalities have been identified, and these mutations may be targetable by tyrosine kinase inhibitors or monoclonal antibodies. The demonstration of four distinct molecular subtypes of gastric cancer by the Cancer Genome Atlas study highlight the enormous heterogeneity of the disease and its complex interplay between genetic and epigenetic alterations and provide a roadmap to implement genome-guided personalized therapy in gastric cancer. In the present review, we aim to discuss, from a clinical point of view, the genomic landscape of gastric cancer described in recent studies, the therapeutic insights derived from these findings, and the clinical trials that have been conducted and those in progress that take into account tailored therapies for gastric cancer.

O complexo regulador da assistência à saúde na perspectiva de seus sujeitos operadores

BACKGROUND Despite the extensive published data regarding the use of drains in surgery, it is still controversial. Most bariatric surgeons use drains as routinely. However, drains have sometimes have been shown to be unhelpful and even to increase the anastomotic leak rates. The purpose of the present study was to evaluate the peritoneal inflammatory response in the presence of a drain left in place until the seventh postoperative day after bariatric surgery. METHODS All patients who underwent open Roux-en-Y gastric bypass from February 2007 to August 2008 were prospectively evaluated. A 24F Blake drain was left in place for 7 days. The peritoneal effluent from the drain was collected for the determination of cytokine levels and for microbiologic analysis. RESULTS A total of 107 obese patients were studied. A marked increase in the levels of tumor necrosis factor-α and interleukin-1β was observed by the seventh postoperative day, even in patients without any abdominal complications. Bacterial contamination of the peritoneal effluent was also demonstrated. CONCLUSION The results of our study have shown that at 7 days after surgery, a marked peritoneal inflammatory response and bacterial contamination are present. These findings could have resulted from the use of the drain for 7 postoperative days.

Alterações cronológicas do perfil dos pacientes e da modalidade de tratamento cirúrgico do megaesôfago chagásico

PURPOSE To report on our clinical experience with and the success rate and safety of percutaneous transcatheter embolization with N-butyl cyanoacrylate (NBCA) as the lone primary embolic agent used for arterial embolization of hemorrhagic liver lesions. MATERIALS AND METHODS This retrospective study enrolled all patients who presented to the emergency room with hemorrhagic liver lesions during a two-year period and were treated by percutaneous transcatheter embolization with NBCA. RESULTS Eight consecutive patients were evaluated, and 13 lesions were embolized exclusively with NBCA: eight pseudoaneurysms and five active bleeds. All patients were treated successfully using percutaneous transcatheter embolization with NBCA without re-bleedings or major complications. CONCLUSION Percutaneous transcatheter embolization with NBCA is a safe and effective method for treating hemorrhagic lesions.

Aspectos morfológicos da utilização intraperitoneal de prótese de dupla face na inguinoplastia em cães

This investigation aimed to evaluate aspects of the outcome from implementing the Regulatory Complex (RC) for public healthcare system organization in Ribeirao Preto, Brazil. The functional domain of the RC formed the scenario. Interviews were conducted with workers in different categories, within the administrative and operation al levels of the RC. The material was analyzed using thematic analysis. The findings showed that t he RC caused changes to the organizational accessibility and equity of the healthcare network, for both outpatient and hospital care. The need to create a resolutive and humanized network was highl ighted. The RC was shown to be a useful evaluation and management tool. Its implementation changed the subjects’ work processes and had little recognition among SUS users (Brazilian Unifi ed Health System).The evaluation showed that, despite the short time since implementation, the RC strategy has the strength to collaborate towards SUS sustainability, although investment, disseminat ion and improvement are needed.Trata-se de pesquisa avaliativa objetivando avaliar aspectos do resultado da implantacao do Complexo Regulador (CR) na organizacao do sistema publico de saude de Ribeirao Preto-SP. O cenario foi o espaco funcional do CR. Foram entrevistados trabalhadores de diferentes categorias que atuavam na gestao e no nivel operacional do CR e o material analisado segundo analise tematica. Os achados mostram que o CR provocou alteracoes na acessibilidade organizacional e equidade da rede de saude, tanto na atencao ambulatorial quanto hospitalar; destacou a necessidade de constituicao de rede resolutiva e humanizada e mostrou ser ferramenta proficua de avaliacao e gestao. A implantacao alterou o processo de trabalho dos sujeitos e teve pouco reconhecimento junto aos usuarios do SUS. A avaliacao apontou que, apesar do pouco tempo de implantacao, a estrategia do CR tem potencia para colaborar na sustentabilidade do SUS, mas se fazem necessarios: investimento, divulgacao e aperfeicoamento.