ABSTRACT
BACKGROUND: Some studies have suggested that preoperative chemotherapy for hepatic colorectal metastases may cause hepatic injury and increase perioperative morbidity and mortality. AIM: To evaluate the prevalence of hepatic steatosis in patients undergoing preoperative chemotherapy for metastatic colorectal cancer. METHODS: Observational retrospective cohort study in which 166 patients underwent 185 hepatectomies for metastatic colorectal cancer with or without associated preoperative chemotherapy from 2004 to 2011. The data were obtained from a review of the medical records and an analysis of the anatomopathological report on the non-tumor portion of the surgical specimen. The study sample was divided into two groups: those who were exposed and those who were unexposed to chemotherapy. RESULTS: From the hepatectomies, 136 cases (73.5%) underwent preoperative chemotherapy, with most (62.5%) using a regimen of 5-fluorouracil + leucovorin. A 40% greater risk of cell damage was detected in 62% of the exposed group. The predominant histological pattern of the cell damage was steatosis, which was detected in 51% of the exposed cases. Exposure to chemotherapy increased the risk of steatosis by 2.2 fold. However, when the risk factors were controlled, only the presence of risk of hepatopathy was associated with steatosis, with a relative risk of 4 (2.7-5.9). CONCLUSION: Patients exposed to chemotherapy have 2.2 times the risk of developing hepatic steatosis, and its occurrence is associated with the presence of predisposing factors such as diabetes mellitus and hepatopathy. .
RACIONAL: Alguns estudos sugerem que a quimioterapia pré-operatória para metástases hepáticas do câncer colorretal pode causar dano celular e aumentar morbidade e mortalidade. OBJETIVO: Analisar a prevalência de esteatose hepática em fígados de pacientes expostos à quimioterapia pré-operatória por metástase de câncer colorretal. MÉTODOS: O delineamento do estudo foi observacional de coorte retrospectivo, no qual 166 pacientes foram submetidos a 185 hepactectomias por metástase de câncer colorretal, com e sem quimioterapia pré-operatória, no período de 2004 a 2011. Os dados foram extraídos da revisão dos prontuários e da análise do laudo anatomopatológico da parte não tumoral da peça cirúrgica. A amostra foi dividida em grupo exposto e não-exposto à quimioterapia. Os dados foram analisados por programa estatístico Stata 11.2, e aplicado o teste exato de Fischer para análise bivariada, e a regressão de Poisson, para análise multivariada; valores p< 0,05 foram considerados como significativos. RESULTADOS: Das hepatectomias, 136 casos (73,5%) receberam quimioterapia pré-operatória, e o regime mais utilizado (62,5%) foi 5-fluorouracila+leucovorin. No grupo exposto, a lesão hepatocelular esteve presente em 62% dos casos e correspondeu a risco de 40% em relação ao grupo não-exposto. O padrão histológico da lesão hepatocelular predominante foi a esteatose, em 51% de casos do grupo exposto. A exposição à quimioterapia aumentou em 2,2 vezes a possibilidade de esteatose. Entretanto, quando foram controlados os fatores de risco, somente a hepatopatia prévia esteve associada à presença de esteatose após quimioterapia com risco relativo de 4 (2,7-5,9). CONCLUSÕES: Pacientes expostos ...
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Antineoplastic Agents/adverse effects , Colorectal Neoplasms/pathology , Fatty Liver/chemically induced , Fatty Liver/epidemiology , Hepatectomy , Liver Neoplasms/drug therapy , Liver Neoplasms/secondary , Preoperative Care , Antineoplastic Agents/therapeutic use , Cohort Studies , Combined Modality Therapy , Liver Neoplasms/surgery , Prevalence , Retrospective StudiesABSTRACT
BACKGROUND: Some studies have suggested that preoperative chemotherapy for hepatic colorectal metastases may cause hepatic injury and increase perioperative morbidity and mortality. AIM: To evaluate the prevalence of hepatic steatosis in patients undergoing preoperative chemotherapy for metastatic colorectal cancer. METHODS: Observational retrospective cohort study in which 166 patients underwent 185 hepatectomies for metastatic colorectal cancer with or without associated preoperative chemotherapy from 2004 to 2011. The data were obtained from a review of the medical records and an analysis of the anatomopathological report on the non-tumor portion of the surgical specimen. The study sample was divided into two groups: those who were exposed and those who were unexposed to chemotherapy. RESULTS: From the hepatectomies, 136 cases (73.5%) underwent preoperative chemotherapy, with most (62.5%) using a regimen of 5-fluorouracil + leucovorin. A 40% greater risk of cell damage was detected in 62% of the exposed group. The predominant histological pattern of the cell damage was steatosis, which was detected in 51% of the exposed cases. Exposure to chemotherapy increased the risk of steatosis by 2.2 fold. However, when the risk factors were controlled, only the presence of risk of hepatopathy was associated with steatosis, with a relative risk of 4 (2.7-5.9). CONCLUSION: Patients exposed to chemotherapy have 2.2 times the risk of developing hepatic steatosis, and its occurrence is associated with the presence of predisposing factors such as diabetes mellitus and hepatopathy.
Subject(s)
Antineoplastic Agents/adverse effects , Colorectal Neoplasms/pathology , Fatty Liver/chemically induced , Fatty Liver/epidemiology , Hepatectomy , Liver Neoplasms/drug therapy , Liver Neoplasms/secondary , Preoperative Care , Aged , Antineoplastic Agents/therapeutic use , Cohort Studies , Combined Modality Therapy , Female , Humans , Liver Neoplasms/surgery , Male , Middle Aged , Prevalence , Retrospective StudiesABSTRACT
The prevalence of obese individuals has increased worldwide in recent years. The most alarming cases are known as morbidly obese. An effective method to change the anthropometric characteristics of this population with excess body weight and high fat mass is bariatric surgery. The objective of this study was to analyze the body composition of morbidly obese patients undergoing bariatric surgery in the city of Pelotas, southern Brazil. In a prospective cohort study, a group of morbidly obese patients was followed up 30 days before and 30 days after surgery. The sample consisted of 123 patients who underwent vertical banded Roux-en-Y gastroplasty between April 2003 and May 2010. Body composition (fat percentage) was determined by bioelectrical impedance analysis. The mean age of the patients was 36.1 ± 8.8 years and mean body weight loss was 14.1 ± 6.0 kg (p<0.001). The mean reduction in body mass index (BMI) was 5.2 ± 2.1 kg/m² (p<0.001). Body fat percentage and fat mass were reduced by 2.8% (p<0.001) and 9.7 ± 4.9 kg (p<0.001), respectively. In addition, there was a reduction of 4.4 ± 3.4 kg (p<0.001) in lean mass. We concluded that the surgical procedure significantly reduced body weight, BMI, fat percentage and fat mass and is an alternative when conventional treatments appear ineffective.
Os últimos anos destacam-se por uma alta prevalência de indivíduos obesos no âmbito mundial, sendo os casos mais alarmantes conhecidos como obesos mórbidos. Um método efetivo para alterar as características antropométricas desse público com excesso de peso e elevada massa gorda é a cirurgia bariátrica. O estudo teve como objetivo analisar as alterações na composição corporal de pacientes obesos mórbidos submetidos à cirurgia bariátrica na cidade de Pelotas, RS. O estudo se caracterizou por ser uma coorte prospectiva, acompanhando um grupo de obesos mórbidos 30 dias antes e 30 dias após a cirurgia. A amostra foi composta por 123 pacientes, submetidos à Gastroplastia Vertical em Y-Roux no período de abril de 2003 a maio de 2010. A composição corporal (percentual de gordura) foi determinada através de bioimpedância elétrica. A média de idade foi de 36,1 ± 8,8 anos. A perda de massa corporal média da amostra foi de 14,kg ± 6,0 (p<0,001) e a média de redução do índice de massa corporal (IMC) foi de 5,2 kg/m² ± 2,1 (p<0,001). Em relação às variáveis percentual de gordura e massa gorda, houve redução de 2,8% (p<0,001) e 9,7 kg ± 4,9 (p<0,001), respectivamente, ocorrendo, também, uma perda de 4,4 kg ± 3,4 (p<0,001) na massa magra. Concluiu-se que o procedimento cirúrgico implicou reduções significativas na massa corporal, no IMC, no percentual de gordura e na massa gorda, sendo uma alternativa a ser considerada quando as formas convencionais de tratamento se mostrarem pouco eficazes.
ABSTRACT
Os autores relatam um caso raro de hidatidose primaria do baço em paciente masculino de 18 anos de idade, que apresentou quadro inicial de dor abdominal e esplenomegalia de causa a esclarecer. A ultra-sonografia e o teste DD5 sao os principais exames no diagnostico definitivo e no acompanhamento tardio dos pacientes portadores de hidatidose abdominal. A cirurgia e o tratamento de escolha, sendo que a esplenectomia parcial nem sempre e possivel. Outras formas de diagnostico e terapeutica sao discutidas no artigo
Subject(s)
Adolescent , Humans , Male , Spleen/surgery , Echinococcosis/diagnosis , Echinococcosis/surgery , Echinococcosis/therapy , SplenectomyABSTRACT
O autor relata um caso de tricobezoar que cursou com abdome agudo, em consequencia de multiplas perfuraçoes do intestino delgado. Faz uma descriçao da evoluçao clinica, discutindo os principais aspectos semiologicos e terapeuticos e faz revisao da literatura sobre a conduta atual no bezoar gastrintestinal
