Navegando por Autor "Alves, José Roberto"
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Artigo Fluctuating jaundice in the adenocarcinoma of the ampulla of Vater: a classic sign or an exception?(FapUNIFESP (SciELO), 2015) Souza, Dyego Leandro Bezerra de; Alves, José Roberto; Amico, Enio Campos; Oliveira, Patrick Vanttinny Vieira de; Maranhão, Icaro Godeiro de Oliveira; https://orcid.org/0000-0001-8426-3120Background - Some authors consider the fluctuating jaundice as a classic sign of the adenocarcinoma of the ampulla of Vater. Objetive - Assessing the frequency of fluctuating jaundice in their forms of its depiction in the patients with adenocarcinoma of the ampulla of Vater. Methods - Observational and retrospective study, conducted through analyses of medical records from patients subjected to pancreatic cephalic resections between February 2008 and July 2013. The pathological examination of the surgical specimen was positive to adenocarcinoma of the ampulla of Vater. Concepts and differences on clinical and laboratory fluctuating jaundice were standardized. It was subdivided into type A and type B laboratory fluctuating jaundice. Results - Twenty patients were selected. One of them always remained anicteric, 11 patients developed progressive jaundice, 2 of them developed clinical and laboratory fluctuating jaundice, 5 presented only laboratory fluctuating jaundice and one did not present significant variations on total serum bilirubin levels. Among the seven patients with fluctuating jaundice, two were classified as type A, one as type B and four were not classified due to lack information. Finally, progressive jaundice was the prevailing presentation form in these patients (11 cases). Conclusion - This series of cases suggested that clinical fluctuating jaundice is a uncommon signal in adenocarcinoma of the ampulla of VaterArtigo Hypervascular liver lesions in radiologically normal liver(FapUNIFESP (SciELO), 2017) Souza, Dyego Leandro Bezerra de; Amico, Enio Campos; Alves, José Roberto; Salviano, Fellipe Alexandre Macena; João, Samir Assi; https://orcid.org/0000-0001-8426-3120Background: The hypervascular liver lesions represent a diagnostic challenge. Aim: To identify risk factors for cancer in patients with non-hemangiomatous hypervascular hepatic lesions in radiologically normal liver. Method: This prospective study included patients with hypervascular liver lesions in radiologically normal liver. The diagnosis was made by biopsy or was presumed on the basis of radiologic stability in follow-up period of one year. Cirrhosis or patients with typical imaging characteristics of haemangioma were excluded. Results: Eightyeight patients were included. The average age was 42.4. The lesions were unique and were between 2-5 cm in size in most cases. Liver biopsy was performed in approximately 1/3 of cases. The lesions were benign or most likely benign in 81.8%, while cancer was diagnosed in 12.5% of cases. Univariate analysis showed that age >45 years (p< 0.001), personal history of cancer (p=0.020), presence of >3 nodules (p=0.003) and elevated alkaline phosphatase (p=0.013) were significant risk factors for cancer. Conclusion: It is safe to observe hypervascular liver lesions in normal liver in patients up to 45 years, normal alanine aminotransaminase, up to three nodules and no personal history of cancer. Lesion biopsies are safe in patients with atypical lesions and define the treatment to be established for most of these patientsArtigo Microbiological analysis of bile in patients with benign and malignant biliopancreatic diseases and its consequences(FapUNIFESP (SciELO), 2016) Souza, Dyego Leandro Bezerra de; Alves, José Roberto; Silva, Rodrigo do Carmo; Guerra, Sâmea Costa Pinheiro; Freitas, Tiago Tavares de; Amico, Enio Campos; https://orcid.org/0000-0001-8426-3120- Background - Bactibilia has several consequences to human health. Objetive - Assessing the bile microbiology of patients with biliopancreatic diseases in order to identify bacteria and their possible infectious complications. Methods - Retrospective study of 30 bile culture samples from patients with benign and malignant biliopancreatic diseases. The samples were assessed to set the bile microbiological flora and to search for its possible link with comorbidity, carcinogenesis and postoperative infectious complications. Results - Thirty bile samples from patients at mean age ≈57.7 years, mostly female (n=18), were assessed. Bactibilia was found in 12 cases, mostly in patients with benign diseases (n=8), older than 50 years (n=23) and female (n=10). Adenocarcinoma of the duodenal papilla (n=9) and cholelithiasis (n=8) were the most common diseases. Escherichia coli (n=5) and Klebsiella sp (n=3) were predominantly found in patients with benign diseases; and Klebsiella sp (n=2) and Streptococcus sp (n=2) were prevalent in cancer patients. There were postoperative infectious complications in seven cases, five of them in bactibilia-associated patients (P=0.084). Conclusion - Bactibilia was found in 12 samples and Escherichia coli and Klebsiella sp were most often identified in patients with benign diseases, as well as Streptococcus sp and Klebsiella sp in cancer patients. There was a trend of higher postoperative infectious complication incidence in patients with bactibiliaArtigo Outcomes from mesenteric-portal axis resection during pancreatectomy(SciELO, 2014-08-21) Moreira, Ricardo Wagner Costa; Amico, Enio Campos; Alves, José Roberto; João, Samir Assi; Silva Neto, José Linhares da; Medeiros, Joafran Alexandre Costa deRacional: Devido à complexidade e riscos, a ressecção e reconstrução do eixo mesentéricoportal durante pancreatectomia até o início dos anos noventa não era recomendada. Entretanto, com o aprimoramento técnico e redução da morbimortalidade ela tem sido indicada de forma rotineira nos grandes centros. Objetivo: Demostrar os resultados de uma série de casos submetida à ressecção do eixo mesentérico-portal durante a pancreatectomia. Método: Foram avaliados prospectivamente e consecutivamente pacientes submetidos à ressecção do eixo mesentéricoportal durante pancreatectomias. A indicação do procedimento baseou-se em critérios anatômicos definidos por exames de imagem ou por avaliação intra-operatória. Resultados: Foram incluídos 10 pacientes, metade do sexo masculino, com idade média de 55,7 anos (40-76). As doenças de base mais frequentes foram o adenocarcinoma de pâncreas e o tumor de Frantz. O tipo de ressecção e reconstrução vascular mais realizado foi respectivamente a ressecção circunferencial da veia porta associada à veia mesentérica superior com ligadura da veia esplênica (4 casos=40%) e a anastomose primária dos cotos vasculares (5 casos=50%). O tempo operatório variou entre 480 e 600 minutos (média=556 minutos) e o tempo de internação pós-operatória variou de 9 a 114 dias (média=34,8 dias). A morbidade foi de 60%, sendo a fístula pancreática clínica (grau B e C) a complicação mais frequente (3 casos=30%). A mortalidade foi de 10% (um caso). Conclusão: A ressecção do eixo mesentérico-portal é artifício técnico válido. Deve ser considerada após consideração que contemple não apenas as condições clínicas dos pacientes, as condições técnicas e anatômicas da infiltração tumoral do eixo mesentérico-portal, mais também, e de forma não menos importante, a expectativa de sobrevida com base no prognóstico oncológico do paciente.