ABSTRACT
RACIONAL: O transplante hepático é o único tratamento efetivo para as hepatopatias crônicas terminais e a taxa de sobrevida tem aumentado nas últimas décadas. No entanto, as complicações biliares têm alta incidência e permanecem como o "calcanhar de Aquiles" do transplante de fígado. OBJETIVO: Avaliar retrospectivamente os resultados do tratamento endoscópico das complicações biliares em pacientes submetidos à transplante hepático. MÉTODOS: Foram avaliados pacientes transplantados hepáticos para realização de colangiopancreatografia retrógrada endoscópica por suspeita de complicação biliar. RESULTADOS: Quinze pacientes (11 homens, média de idade de 49,57 anos) foram estudados. Nesse período foram realizadas 36 colangiopancreatografias retrógradas endoscópicas (2,4/paciente). Neste grupo, 100% receberam órgão de doador falecido. Estenose da anastomose coledococoledocociana foi diagnosticada em 13 pacientes e o sucesso da terapêutica endoscópica foi de 53,84% (38,46% ainda em tratamento). Fístula biliar foi diagnosticada em um paciente, sendo resolvida pelo tratamento endoscópico. Disfunção da âmpola hepatopancreaticobiliar com coledocolitíase foi diagnosticada em um paciente, também resolvida pela terapêutica endoscópica. CONCLUSÕES: As complicações biliares pós-transplante hepático são relativamente comuns, com predominância de estenoses. O tratamento endoscópico foi eficaz na maioria dos pacientes desta série.
BACKGROUND: Liver transplantation is the only effective treatment for chronic liver diseases and terminal survival rate has increased in recent decades. However, biliary complications have high incidence and remain as the "Achilles heel" for liver transplantation. AIM: To evaluate retrospectively endoscopic treatment outcomes of biliary complications in post-liver transplantations. METHODS: The sample consisted of post-liver transplantation patients for endoscopic retrograde cholangiopancreatography due to suspected biliary complications. RESULTS: Fifteen patients were included (10 male, mean age of 49.57 years) and 36 endoscopic retrograde cholangiopancreatographies were undertaken (2.4/patient). Biliary stricture was diagnosed in 13 patients and endoscopic treatment was successful in 56% (38,46% still in treatment). Biliary leaks were found in one patient and dysfunction of the hepatobilliary ampulla with choledocholithiasis was diagnosed in one patient, both cured by endoscopic treatment. CONCLUSIONS: Post-liver transplantation biliary complications are relatively common and endoscopic treatment may result in satisfactory outcome. Stenosis was the more frequent complication in this series.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Biliary Tract Diseases/etiology , Biliary Tract Diseases/surgery , Cholangiopancreatography, Endoscopic Retrograde , Liver Transplantation/adverse effects , Retrospective StudiesABSTRACT
Objetivo: descrever o perfil epidemiológico dos pacientes submetidos à endoscopia digestiva baixa em um centro terciário do Nordeste brasileiro, ressaltando a sua importância como método diagnóstico e terapêutico. Método: análise retrospectiva de 702 laudos de pacientes submetidos à colonoscopia e retossigmidoscopia em ambiente de hospital terciário no período de abril de 2002 a abril de 2009. Resultados: a idade média foi de 54,55 anos, e houve predomínio do sexo feminino (59,12%). Hemorragia Digestiva Baixa (14,39%), alteração do hábito intestinal (12,39%) e diarreia (11,82%) foram as indicações para realização de endoscopia digestiva baixa mais frequentes. As endoscopias digestivas baixas foram normais em 57,51%. Foram identificadas a doença inflamatória intestinal em 11,14% e a neoplasia maligna do trato gastrintestinal em 6,3% dos exames. Dentre os pacientes com neoplasia maligna do trato gastrintestinal, 23,07% dos pacientes realizaram o exame por apresentarem hemorragia digestiva baixa ou sangue oculto nas fezes. Utilizando-se do teste do Qui-quadrado, não houve uma relação significativa entre a idade dos pacientes e as alterações encontradas nos laudos de endoscopia digestiva baixa (P=0,2754, (x2: 1,189, DF=1). Conclusão: a colonoscopia e retossigmoidoscopia são excelentes métodos tanto diagnósticos como terapêuticos na investigação das doenças digestivas.
Purpose: to describe the epidemiological profile of patients undergoing lower gastrintestinal endoscopy in a teciary health service in Northeast Brazil, emphasizing their importance as diagnostic and therapeutic method. Materials and methods: retrospective analysis of 702 reports of patients undergoing to colonoscopy and retossigmoidoscopy in a teciary health service in the period april 2002 to april 2009. Results: the mean age was 54.55 years, and there was a predominance of females (59.12%). Lower gastrointestinal bleeding (14.39%), altered bowel habits (12.39%) and diarrhea (11.82%) were the indications for lower gastrointestinal endoscopy conducting more frequent. The lower gastrintestinal endoscopy were normal in 57.51% of the diagnoses identified in the reports and inflamatory bowel disease were identified in 11.14%.The malignancy of the gastrointestinal tract was identified in 6.3%. Among patients with malignancy of the gastrointestinal tract, 23.07% of the patients were examined because they have lower gastrointestinal bleeding, or fecal occult blood Using the chi-square, there was a significant relationship between patient age and the changes found in the reports of lower gastrintestnal endoscopy (P=0.2754, (x2: 1.189, DF=1). Conclusion: the flexible sigmoidoscopy and colonoscopy are excellent whether diagnostic or therapeutic methods in digestive disease research.
Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Health Profile , Endoscopy , Epidemiology , Endoscopy, Gastrointestinal , Colonoscopy , NeoplasmsABSTRACT
Introdução: o transplante hepático é o único tratamento efetivo para as hepatopatias crônicas terminais e a taxa de sobrevida tem aumentado nas últimas décadas. No entanto, as complicações biliares têm alta incidência e permanecem como o 'calcanhar de Aquiles do transplante de fígado'. Objetivo: avaliar retrospectivamente os resultados do tratamento endoscópico das complicações biliares em pacientes submetidos a transplante hepático. Métodos: foram avaliados pacientes transplantados hepáticos encaminhados ao Serviço de Endoscopia do Hospital Geral César Calls e a uma clínica particular de endoscopia, no período de dezembro de 2004 a julho de 2011, para realização de colangiopancreatografia retrógrada endoscópica por suspeita de complicação biliar. Resultados: quinze pacientes (11 homens, média de idade de 49,57 anos) foram estudados retrospectivamente entre dezembro de 2004 a julho de 2011. Nesse período foram realizadas 36 colangiopancreatografias retrógradas endoscópicas (2,4/ pacientes). Neste grupo, 100% receberam órgão de doador falecido. Estenose da anastomose colédoco-coledocociana foi diagnosticada em 13 pacientes e o sucesso da terapêutica endoscópica nestes casos foi de 53,84% (38,46% ainda em tratamento). Fístula biliar foi diagnosticada em 1 paciente, sendo resolvida pelo tratamento endoscópico. Disfunção da ampola da Vater com coledocolitíase foi diagnosticada em 1 paciente, também resolvida pela terapêutica endoscópica. Conclusões: complicações biliares pós-transplante hepático são relativamente comuns e o tratamento endoscópico mostra bons resultados.
Introduction: liver transplantation is the only effective treatment for chronic liver diseases and terminal survival rate has increased in recent decades. However, biliary complications have high incidence and remain the 'Achilles heel of liver transplantation'. Objective: to retrospectively evaluate endoscopic treatment outcomes of biliary complications in post-liver transplants. Methods: the sample consisted of post-liver transplantation patients referred to the Endoscopy Unit of Hospital Geral Cesar Calls and to the endoscopy private clinic, from December 2004 to July 2011, for endoscopic retrograde cholangiopancreatography due to suspected biliary complications. Results: Fifteen patients were retrospectively assessed from December 2004 to July 2011 (10 male, mean age of 49.57 years) were reviewed and 36 endoscopic retrograde cholangiopancreatographies were undertaken (2.4/ patient). Biliary stricture was diagnosed in 13 patients and endoscopic treatment was successful in 56% (38.46% still in treatment). Biliary leaks were found in one patient and dysfunction of the ampulla of Vater with choledocholithiasis was diagnosed in one patient, both resolved by endoscopic treatment. Conclusions: post-liver transplantation biliary complications were relatively common and endoscopic treatment had a satisfactory outcome.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Biliary Fistula , Cholangiopancreatography, Endoscopic Retrograde , Liver Transplantation , Constriction, Pathologic , Postoperative Complications , Retrospective StudiesABSTRACT
O esôfago é o local mais comum de tumor de células granulares de origem no trato gastrintestinal. Cerca de 270 casos de tumores de células granulares do esôfago têm sido relatados na literatura. A maioria é encontrada incidentalmente durante a endoscopia. Apesar de ser reconhecido facilmente por suas características endoscópicas, tem que ser diferenciado de outras lesões benignas e malignas da mucosa e submucosa. A maioria dos tumores de células granulares é assintomática e benigna, e o acompanhamento endoscópico pode ser considerado suficiente como manejo terapêutico. Novas opções terapêuticas devem ser consideradas especialmente para lesões maiores. Três casos são relatados de paciente com tumores de células granulares de esôfago inferior, diagnosticados por endoscopia digestiva alta.
The esophagus is the most common site of origin of gastrointestinal tract granular cell tumors. Approximately 270 cases of esophageal granular cell tumors have been reported in the literature. Most esophageal granular cell tumors are found incidentally during endoscopy. Although granular cell tumor of the esophagus has become easily recognizable by its endoscopic features, it has to be differentiated from other benign and malignant mucosal and submucosal lesions. The majority of esophageal granular cell tumors are asymptomatic and benign; thus, close follow-up of the patients with endoscopy could be considered sufficient as a therapeutic management. New therapeutic options should be considered especially for larger lesions. Three cases of granular cell tumors with complaints of epigastric discomfort, regurgitation, nausea, and vomiting, which were detected in the lower part of the esophagus on upper gastrointestinal tract endoscopy, are discussed.
Subject(s)
Humans , Female , Adolescent , Adult , Middle Aged , Granular Cell Tumor , Endoscopic Mucosal Resection , Esophageal Neoplasms , Endoscopy, Gastrointestinal , EsophagusABSTRACT
BACKGROUND: Liver transplantation is the only effective treatment for chronic liver diseases and terminal survival rate has increased in recent decades. However, biliary complications have high incidence and remain as the "Achilles heel" for liver transplantation. AIM: To evaluate retrospectively endoscopic treatment outcomes of biliary complications in post-liver transplantations. METHODS: The sample consisted of post-liver transplantation patients for endoscopic retrograde cholangiopancreatography due to suspected biliary complications. RESULTS: Fifteen patients were included (10 male, mean age of 49.57 years) and 36 endoscopic retrograde cholangiopancreatographies were undertaken (2.4/patient). Biliary stricture was diagnosed in 13 patients and endoscopic treatment was successful in 56% (38,46% still in treatment). Biliary leaks were found in one patient and dysfunction of the hepatobilliary ampulla with choledocholithiasis was diagnosed in one patient, both cured by endoscopic treatment. CONCLUSIONS: Post-liver transplantation biliary complications are relatively common and endoscopic treatment may result in satisfactory outcome. Stenosis was the more frequent complication in this series.
Subject(s)
Biliary Tract Diseases/etiology , Biliary Tract Diseases/surgery , Cholangiopancreatography, Endoscopic Retrograde , Liver Transplantation/adverse effects , Adult , Aged , Female , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
PURPOSE: To identify the lymph nodes positioned along the internal mammary vessels in isolated sternum of human cadaver and to standardize the surgical approach to those nodes, in order to establish anatomical landmarks to be used with the current techniques of mammary gland sentinel lymph node detection. METHODS: Ten sternum plates removed from unclaimed cadavers were used in this study. Sternal plates were removed using bilateral incisions of the ribs at the midclavicular lines. The characterization of the internal mammary vessels and the anatomical integrity of the parietal pleura were indispensable requirements during the procedure. RESULTS: A total of 29 lymph nodes were removed from the 2nd (13) and the 3rd (16) intercostals spaces. Almost 50% of all nodes collected were located medially to the vessels. CONCLUSION: The approach used is a reliable surgical technique for removing lymph node from sternal plates. The model is therefore valuable for breast surgeons training in sentinel node biopsy, an important procedure for breast cancer patients.
Subject(s)
Lymph Nodes/anatomy & histology , Mammary Arteries/anatomy & histology , Sentinel Lymph Node Biopsy/methods , Sternum/surgery , Cadaver , Humans , Mammary Arteries/surgery , Sentinel Lymph Node Biopsy/education , Sternum/anatomy & histologyABSTRACT
PURPOSE: To identify the lymph nodes positioned along the internal mammary vessels in isolated sternum of human cadaver and to standardize the surgical approach to those nodes, in order to establish anatomical landmarks to be used with the current techniques of mammary gland sentinel lymph node detection. METHODS: Ten sternum plates removed from unclaimed cadavers were used in this study. Sternal plates were removed using bilateral incisions of the ribs at the midclavicular lines. The characterization of the internal mammary vessels and the anatomical integrity of the parietal pleura were indispensable requirements during the procedure. RESULTS: A total of 29 lymph nodes were removed from the 2nd (13) and the 3rd (16) intercostals spaces. Almost 50 percent of all nodes collected were located medially to the vessels. CONCLUSION: The approach used is a reliable surgical technique for removing lymph node from sternal plates. The model is therefore valuable for breast surgeons training in sentinel node biopsy, an important procedure for breast cancer patients.
OBJETIVO: Identificar os linfonodos localizados ao longo dos vasos mamários internos em esternos isolados de cadáveres e padronizar a abordagem cirúrgica desses linfonodos, registrando os pontos de reparo a serem utilizados nas técnicas atuais de pesquisa do linfonodo sentinela da mama. MÉTODOS: Estudaram-se dez esternos isolados de cadáveres humanos. Os esternos foram obtidos através de secção bilateral do gradil costal ao nível das linhas hemiclaviculares. A individualização e a integridade anatômica da pleura parietal e dos vasos mamários internos foram requisitos imprescindíveis durante a dessecação das peças. RESULTADOS: Um total de 29 linfonodos foram removidos do 2° e 3° espaços intercostais (13 e 16 linfonodos respectivamente). Quase 50 por cento dos linfonodos removidos se situavam em posição medial aos vasos mamários. CONCLUSÃO: A abordagem cirúrgica usada neste estudo demonstrou ser uma técnica adequada para a exérese de linfonodos esternais. Conclui-se assim que o modelo utilizado se presta ao treinamento para o procedimento de biópsia de linfonodo sentinela, de grande valor na abordagem das pacientes portadoras de câncer da mama.