Browsing by Author "Castro e Sousa, F"
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- Alterações precoces dos enzimas hepáticos após colecistectomia: estudo prospectivo incluindo cintigrafia hepatobiliar quantificadaPublication . Milheiro, A; Diogo, C; Lapa, P; Cunha, MJ; Manso, E; Martins, L; Mártires, E; Pedroso de Lima, J; Castro e Sousa, F
- Colangiocarcinoma Intra-HepáticoPublication . Castro e Sousa, F; Tavares da Silva, E; Tralhão, JG; Costa, B; Martins, M; Serôdio, M; Martins, RIntrodução: o colangiocarcinoma intra-hepático (CCIhp) é um tumor maligno raro, normalmente diagnosticado num estadio avançado. São objectivos deste estudo avaliar os resultados da terapêutica do CCIhp e os factores prognósticos com significado estatístico na sobrevida de doentes com esta entidade nosológica tratados no nosso Serviço. Material e métodos: Vinte e um doentes submetidos a tratamento por CCIhp nos últimos anos, dos quais onze foram operados com intuitos curativos: quatro hepatectomias esquerdas, duas hepatectomias esquerdas alargadas aos segmentos V e VIII, duas hepatectomias direitas, duas bissegmentectomias e uma trissegmentectomia. Resultados: a mortalidade per-operatória foi de 0% e a pós-operatória (três meses) de 6%. As sobrevidas cumulativas aos 5 anos foram de 14% no total da população, 26% nos doentes submetidos a cirurgia com intuitos curativos e 26% para a sobrevida cumulativa livre de doença. Observou-se recidiva tumoral hepática em cinco doentes, a qual ocorreu aos 1,09 ± 0,82 anos (limites: 0,24-2,08). Os factores que influenciaram a sobrevida da globalidade dos doentes foram o tratamento cirúrgico com intuitos curativos (p=0,028), a presença de invasão vascular (p=0,002) e o valor da fosfatase alcalina no momento do diagnóstico (p=0,044). Entre os doentes operados com intuitos curativos, a presença de invasão vascular influenciou a sobrevida global (p=0,025) e a sobrevida livre de doença (p=0,002). Conclusões: A ressecção cirúrgica com intuitos curativos aumentou, de forma estatisticamente significativa, a sobrevida dos doentes com CCIhp. No entanto, sendo o diagnóstico geralmente tardio, apenas uma pequena percentagem destes doentes pode beneficiar deste tratamento.
- Estudo experimental do impacto da clampagem selectiva da veia porta na função hepatocelularPublication . Tralhão, JG; Abrantes, AM; Gonçalves, C; Carvalho, C; Portela, I; Laranjo, M; Oliveiros, B; Cardoso, D; Ribeiro, AB; Botelho, MF; Castro e Sousa, FThe influence of selective clamping of the elements of hepatic pedicle in the hepatocellular function and viability were evaluated in our department. AIM: Study the effect of selective clamping of the portal vein (CPV) in hepatocellular function in an animal model with normal liver. METHOD: Three groups of Wistar rats (males, 2 months) were subjected a CPV for 60 min: group A (n=21) submitted to a continuous inflow occlusion; group B (n=12) underwent to a CPV for 30 min with 5 min of reperfusion; group C (n=10) underwent a CPV for 15 min with 5 min of reperfusion. The group D (n=9) was not subjected to a CPV. A hepatic biopsy was done at the end of surgery. The degree of tissue injury was evaluated using: 1) blood markers: AST, ALT, total bilirubin (TB), GGT alkaline-phosphatase, LDH and hepatic extraction fraction (HEF) by radioisotopic methods three days before laparotomy (BS) and after surgery (AS); 2) apoptosis, necrosis were investigated after collagenase cell isolation from hepatectomy pieces by flow-cytometry using the followed probes: propidium-iodide and annexin-V. Statistical analysis: variance analysis, post-hoc comparisons by Turkey-test (p<0.05). RESULTS: 1) Mortality: Group A - 62%, Group B - 17%, Group C - 30%, Group D - 0% (p<0.03). 2) We observed statistical differences in these parameters: ALT (p<0,025) and LDH (p<0,002) preferentially in groups A but without differences between the A,B,C and D Groups (ns). 3) We also verified a significant decrease in HEF values (p<0,0001) preferentially in group A without differences between the groups. 4) No difference were observed when analysed apoptosis and necrosis and cell viability between the groups. CONCLUSIONS: Postoperative liver failure is the leading cause of mortality after hepatectomy, however selective clamping of the portal vein, is reflected in an increase in cell viability and a decrease in the type of cell death (necrosis ou apoptosis) compared to studies carried out previously by us and thus may be regarded as an alternative to the Pringle maneuver. However, selective clamping of the portal vein for periods above 30' should be avoided, given the high mortality verified.
- Factores preditivos de mortalidade operatória após ressecção hepática por hepatocarcinoma: estudo retrospectivo de 69 casosPublication . Pinto da Costa, B; Castro e Sousa, F; Serôdio, M; Carvalho, C
- Germline MUTYH (MYH) mutations in Portuguese individuals with multiple colorectal adenomasPublication . Isidro, G; Laranjeira, F; Pires, A; Leite, J; Regateiro, FJ; Castro e Sousa, F; Soares, J; Castro, C; Giria, J; Brito, MJ; Medeira, A; Teixeira, R; Morna, H; Gaspar, I; Marinho, C; Jorge, R; Brehm, A; Ramos, JS; Boavida, MGGerminal mutations in the base excision repair (BER) gene MUTYH (MYH) have recently been described in association with predisposition to multiple colorectal adenomas and cancer. In contrast to the classic dominant condition of familial adenomatous polyposis (FAP) due to germinal mutations in the APC gene, the MYH polyposis is an autosomal recessive disease. The identification of individuals affected by MYH polyposis brings new and important implications for the diagnostic, screening, genetic counseling, follow up and therapeutic options in these patients. In this study, screening for germinal mutations in the MYH gene was performed in 53 Portuguese individuals with multiple colorectal adenomas or classic adenomatous polyposis, in whom no mutation had been identified in the APC gene. The results revealed the presence of biallelic germline MYH mutations in 21 patients. In addition, we here report 3 mutations (c.340T>C [p.Y114H]; c.503G>A [p.R168H]; and c.1186_1187insGG [p.E396fsX437]) which, to our knowledge, have not been previously described
- Hepatectomy and liver regeneration: from experimental research to clinical applicationPublication . Tralhão, JG; Abrantes, AM; Hoti, E; Oliveiros, B; Cardoso, D; Faitot, F; Carvalho, C; Botelho, MF; Castro e Sousa, FBACKGROUND: The mechanisms and kinetics of hepatic growth have continuously been investigated. This study concerns liver regeneration in animal and patients who underwent partial hepatectomy evaluated by the hepatic extraction fraction (HEF) calculated through radioisotopic methods. METHODS: Thirty normal Wistar rats were submitted to an 85% hepatectomy, and 95 patients with primary and secondary liver tumours were included. In animal study, the liver regeneration kinetics was assessed by HEF using 99mTc-mebrofenin, the ratio liver/bodyweight and by using bromodeoxyuridine deoxyribonucleic acid incorporation. In patient study, the liver regeneration was evaluated by calculation of HEF before surgery, 5 and 30 days after hepatectomy. RESULTS: In animal, we verified a positive correlation between HEF kinetics and liver/bodyweight ratio or hepatocyte proliferation evaluated by bromodeoxyuridine deoxyribonucleic acid staining after 85% hepatectomy. In the clinical arm, no statistical differences of the HEF before hepatectomy, 5 and 30 days after hepatectomy, were observed. CONCLUSIONS: Our results support the view that human liver regeneration commences early, is fast, non-anatomical and functionally complete 5 days after hepatectomy. The fast functional liver regeneration may have a high clinical impact particularly concerning the post-operative oncological therapeutic approaches.
- Impactação de prótese dentária no esófago torácico: tratamento cirúrgico. A propósito de um caso clínicoPublication . Alexandrino, A; Fernandes, M; Ferreira, L; Tralhão, JG; Castro e Sousa, F
- Intermittent Pringle Maneuver and Hepatic Function: Perioperative Monitoring by Noninvasive ICG-ClearancePublication . Tralhão, JG; Hoti, E; Oliveiros, B; Abrantes, AM; Botelho, MF; Castro e Sousa, FBACKGROUND: Intermittent Pringle maneuver or selective portal clamping often are used to control inflow during parenchymal liver transection. This study was designed to determinate whether these maneuvers are associated with adverse hepatic function. METHODS: Resection was performed without portal clamping in 17 patients (group 1). Selective continuous portal clamping was performed in 11 patients (group 2) and the remaining 33 patients (group 3) had intermittent nonselective portal clamping (occlusion of the main portal trunk). The centers' protocol for total portal occlusion is 15-min occlusion alternated with 5-min reperfusion in patients with normal liver parenchyma or 10 min alternated with 5 min in patients with abnormal parenchyma. ICG elimination tests were conducted concurrently using a noninvasive monitor that tracks the plasma disappearance rate (PDR-ICG-%/min) and 15-min retention rate after administration (ICG-R15-%). RESULTS: There was no statistically difference between the three studied groups in terms of sequential changes of ICG-PDR (p < 0.625) or ICG-R15 (p < 0.398). CONCLUSIONS: Our study indicates that 15 min of intermittent Pringle maneuver or selective hemihepatic continuous portal clamping are safe methods of vascular control during liver resection, with no adverse effects on hepatocellular function.
- Liver transplantation for colorectal liver metastasis: Survival without recurrence can be achievedPublication . Toso, C; Pinto Marques, H; Andres, A; Castro e Sousa, F; Adam, R; Kalil, A; Clavien, PA; Furtado, E; Barroso, E; Bismuth, H
- Locally advanced adenocarcinoma of the rectum presenting with necrotising fasciitis of the perineum: successful management with early aggressive surgery and multimodal therapyPublication . Ferreira, L; Alexandrino, H; Soares Leite, J; Castro e Sousa, FColorectal cancer is a common malignant neoplasm and its treatment usually involves surgery associated, in some cases, depending on the staging, with chemoradiotherapy. Necrotising fasciitis of the perineum is a highly lethal infection of the perineum, perirectal tissues and genitals, requiring emergency surgical debridement, broad-spectrum antibiotics and control of sepsis. We present the case of a 59-year-old man with necrotising fasciitis of the perineum as the first clinical manifestation of locally advanced adenocarcinoma of the rectum, in which successful management consisted of early and aggressive surgical debridement, followed by multimodal therapy with curative intent. 2 years and 6 months after surgery the patient is well, with no evidence of local or systemic relapse.