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Biomedical subjects

A de Oliveira e Silva

Publications and source records attributed to A de Oliveira e Silva.

At least 19 recordsLinked to original sources
PubMed1995

Laparoscopic cholecystectomy in cirrhotic patients.

Cholecystectomy in cirrhotic patients is commonly followed by high morbidity and mortality. In our study, laparoscopic cholecystectomy was performed in 12 cirrhotic patients (eight Child A and four Child B) in an effort to obtain lower complication and mortality rates. The mean age of the group was 51.8 years; seven of the 12 patients were men. Four patients had liver disease from virus B, five from virus C, one because of alcohol, and two had cryptogenic liver cirrhosis. The average operative time was 157 min. Intraoperative cholangiography could be performed in eight cases. No mortality or need to perform laparotomy occurred. Only one patient required blood transfusion (8.3%). Postoperative complications occurred in four patients, but these were easily controlled and included renal failure, diabetic impairment, hematoma with ascitic leakage through the wound, and wound abscess, one case each. No postoperative liver failure was observed. All patients walked and were refed in the first 24 h after surgery. They were dismissed in an average period of 2.5 days. Our primary view demonstrated that laparoscopic cholecystectomy was safe and well tolerated by selected cirrhotic patients (Child A and B) with clear indication for surgery.

Cholecystectomy, Laparoscopic↗
PubMed1994

Liver anatomy applied to the placement of transjugular intrahepatic portosystemic shunts.

PURPOSE: To study the vascular and biliary liver anatomy and its relevance to the creation of a transjugular intrahepatic portosystemic shunt (TIPS). MATERIALS AND METHODS: Acrylic casts of 25 normal human livers (necropsy specimens) were obtained. The anatomy of the hepatic veins, portal vein, hepatic artery, and bile ducts and the relationship of structures of the portal triad were evaluated. Diameters of the vessels and distances and relative position of the structures were recorded. Special attention was given to the puncture path used for TIPS. RESULTS: One right hepatic vein (RHV) was seen in 16 cases, two RHVs in one, and an accessory RHV in six. All were posterior to the portal bifurcation. The mean distance between the RHV and the portal bifurcation was 4.4 cm. In 13 cases, the path for TIPS puncture was free of major vascular and biliary structures. In 12 cases, portal, biliary, and/or arterial structures were seen in the puncture path. CONCLUSION: TIPS puncture should be performed in the postero-inferior aspect of the right portal trunk or at the posterior aspect of the bifurcation of the portal vein. Knowledge of the vascular liver anatomy is imperative to create the TIPS safely.

Adult↗
PubMed1991

[Chronic active hepatitis and possible relationship with immunosuppressive therapy].

A 54-year-old man with Chagas cardiomyopathy that was submitted to a heart transplantation and five months later presented a progressive increase in liver enzymes. Diagnosis of chronic active hepatitis was confirmed by histopathologic studies. A transitory interruption of treatment with azathioprine and the posterior re-introduction of small doses, as well as the use of lesser amounts of cyclosporin-A improved the clinical and laboratory pictures. Despite several investigations the pathogenesis of hepatitis remained undetermined, although some type of drug injury was presumed to be involved. The eventual role of viruses as the primary inciting event could not be completely ruled out.

Chagas Cardiomyopathy↗
PubMed1988

Embolization to reverse severe recurrent hepatic encephalopathy.

Five patients with porto-systemic shunts, four spontaneous and one surgically created, presenting severe recurrent hepatic encephalopathy rebel to clinical treatment were angiographically examined. A spontaneous splenic-renal veins shunt was observed in four cases and a mesocaval shunt was identified in the remaining patient. Two thirds embolization of the spleen was able to control hepatic encephalopathy in two patients. Percutaneous transhepatic portography and selective embolization of the shunt was performed in two other patients with good results. Percutaneous transcaval embolization of the mesocaval shunt succeeded to control hepatic encephalopathy in the remaining patient. Splenic embolization is able to control hepatic encephalopathy in patients with splenomegaly and spontaneous porto-systemic shunt. Direct embolization of the shunt is also able to control hepatic encephalopathy as should be expected.

Aged↗
PubMedDate not supplied

[Primary sclerosing cholangitis in children and adolescents].

Primary sclerosing cholangitis is a disease usually with a poor prognosis with a mean survival of 10-12 years, starting from the time of diagnosis. Among the different populations studied, males predominate in a ratio 2:1 with ages ranging from 20-78 (mean 42 years). This article describes four patients with this syndrome, a child of eight and three adolescents, thirteen and fourteen years old. It is possibly of autoimmune etiology, characterized by stenosis, dilatation and fibrosis involving the intrahepatic and extrahepatic biliary tree. We analyzed laboratory assays, clinical, immunological, laboratory assays, histological and cholangiographic aspects. In conclusion, in this age group perhaps of the small population sample there was no sex predominance, and 50% progressed without jaundice and without hepatomegaly. The serum levels of gamma glutamyltransferases and especially alkaline phosphatase were elevated compared to aminotransferases without increase of the serum auto antibodies. Only one patients displayed the typical histological appearance of primary sclerosing cholangitis. The diagnosis in al was confirmed by typical cholangiographic signs, restricted only to the intrahepatic biliary tree, identified in all those included in this study.

Adolescent↗
PubMedDate not supplied

[Immunological parameters in the differential diagnosis of ascites secondary to peritoneal carcinomatosis, hepatic cirrhosis, and congestive heart failure].

As a contribution to the study of ascites in patients with liver cirrhosis, congestive heart failure and peritoneal carcinomatosis evaluate in serum and ascites the concentrations of alphafetoprotein, carcinoembryonic antigen and fibronectin, they might suggest a diagnosis for the basic pathology. Forty-seven patients were studied, from whom 23 with cirrhosis, 17 peritoneal carcinomatosis and 7 with congestive heart failure. We conclude that: a) none of the tools usually employed in the analysis of ascitic fluid alone can make the base pathological process responsible for producing ascites; b) fibronectins were more useful for differential diagnosis between cirrhosis and carcinomatosis; c) alpha-fetoprotein and carcinoembryonic antigen were not useful for the definition for differential diagnosis.

Ascites↗
PubMedDate not supplied

[Hepatic hemangiomas. The importance of the image].

In the authors' experience, 0.24% of the patients submitted to liver imaging (ultrasound or computerized tomography) have hemangiomas. These are shown as solid nodular lesions, mostly found by chance. Sometimes they do not appear as typical solid vascular lesions. The authors' experience and the literature are discussed. A clear and concise approach to this benign neoplasm is suggested.

Adult↗
PubMedDate not supplied

Intestinal anastomoses.

Anastomotic dehiscence remains the main cause of morbidity and mortality of intestinal resections, mainly the colorectal (77, 95, 110). Very often in the literature the words dehiscence and fistula are misused for the same meaning. Nevertheless, attention must be paid to the fact that these two situations may be distinct. Dehiscence is defined as the failure of healing of the anastomoses, while fistula is the leakage of the intestinal content into the peritoneal cavity. So, the evidence of fistula is always accompanied by dehiscence, although a dehiscence may not develop into a fistula, should it be blocked by omentum or surrounding organs (110, 117). The incidence of overt dehiscence varies from 0.1% to 30% in the literature (13, 15, 17, 27, 31, 40, 44, 46, 76, 77, 81, 96, 113, 120, 123, 126, 133, 135). The Colon Cancer Project of the Saint Mary's Hospital in London, a multicentric study of patients submitted to bowel resections revealed a post operative mortality of 22% in patients with dehiscence and 7% for uncomplicated anastomoses. This led to the struggle various authors to achieve better results, regarding techniques and suture materials, such as the number of planes involved, inverted or everted sutures, wound healing and the influence of local and systemic factors, like infections, antibiotics, NSAIDs on sutures. Recently, surgical stapling gained importance among surgeons, due to its technical advantages. However, this is still very controversial and must undergo further investigations (93, 107, 109, 112, 115, 116). So, in order to understand the pathophysiology of the complications and to reduce morbidity and mortality, related to intestinal anastomoses, it is necessary to study the events involved in intestinal healing after resection, as well as the technique, materials used and the factors related to anastomotic failure.

Anastomosis, Surgical↗
PubMedDate not supplied

[Diagnosis of hepatocellular carcinoma performed by searching for serologic tumor markers].

Serum levels of alkaline phosphatase, gamma-glutamyltranspeptidase, -1 fucosidase and glutathione-S-transferase are increased in 60, 90, 75 and 64% of patients with hepatocellular carcinoma. In these patients the mean plasma fibrinogen levels is 461.78 mg/dl, while mean serum copper is 200.50 mg/dl. Serum levels of desgamma-carboxiprothrombin is over 900 mg/dl in 67% of the patients (60% of them have HB virus, mostly anti HBe positive). Forty to 95% of them have increased levels of -fetoprotein (AFP). The authors suggest that cirrhotic patients, with or without HB virus, specially those with increased AFP, should have ultrasound examination of the liver every 6 months. This method of imaging has been shown to be more sensitive than AFP (72% versus 25%) in the detection of hepatocellular carcinoma smaller than 2 cm in diameter.

Biomarkers, Tumor↗
PubMedDate not supplied

Prognostic value of preoperative tests in the surgical treatment of ascites with the implant of Le Veen shunts in cirrhotics.

In the period of January 1978 to October 1988, 32 Le Veen shunts (LVS) were implanted in 20 patients, out of which 16 were alcoholic cirrhotics and 4 postnecrotic cirrhotics. In the present study, we correlated preoperative laboratory data of these patients with their postoperative evolution, comparing the clinical results of patients who survived more than 30 days (13 patients = 65%) with the results of those who died within the same period (7 patients = 35%). For that matter, 14 laboratory tests were performed in order to measure the serum levels of hematocrit, hemoglobin, urea, creatinine, sodium, potassium, bilirubin, albumin, AST, ALT, alkaline phosphatase, fibrinogen, gamma GT and prothrombin activity. After statistical analysis, we observed that 6 of the 14 tests performed could be considered of prognostic value in the following decreasing order of importance: fibrinogen, alkaline phosphatase, prothrombin activity, urea, gamma GT and bilirubin. We observed that all the 7 patients who died prematurely presented 3 or more of these levels altered, when compared with standard values. Based on these data, we concluded that serum levels of fibrinogen, alkaline phosphatase, urea, gamma GT, bilirubin and activity of prothrombin proved to be important factors in determining the prognosis of immediate survival in cirrhotic patients who underwent LVS implantation. We also concluded that when 3 or more of these factors are altered, the implant of LVS is contraindicated, whatever clinical criteria for indication and contraindication were taken into account.

Adult↗
PubMedDate not supplied

[Surgical treatment of ascites with Le Veen shunt in patients with alcoholic liver disease].

Studies were carried out on 16 alcoholic cirrhotics with clinically intractable ascites who underwent the implant of peritoneovenous (LeVeen) shunts. Our purpose was to find out how this group of patients responded to this kind of surgical treatment for ascites. Fifteen of these patients were male and one female, with a median age of 51.3 years. According to Child classification, 7 were Child B and 9 Child C. Thirty-three surgeries were conducted, in that 5 were performed for revision of the shunt positioning and 12 for the replacement of the valves. A total of 28 shunts were used. Postoperative immediate mortality occurred in 5 patients (4 Child C and one Child B). The median late postoperative follow-up of the 11 patients who survived was 25.8 months. We concluded that LeVeen shunt implantation is a valid palliative therapeutic resource for the treatment of ascites in alcoholic cirrhotics. The results obtained with this patient population are similar to those observed in cirrhotics who presented other etiologies. We also concluded that late mortality was not related to the implant of a LeVeen shunt but was due to the normal course of the disease.

Ascites↗
PubMedDate not supplied

[Splenic abscess: report of 8 cases and review of the literature].

Eight patients with splenic abscess are reported. Etiological factors were sepsis, mainly due to endocarditis. Diagnosis was made by ultrasonography and computed tomography scans. Splenectomy was performed in four cases, transcutaneous drainage in three and abscess puncture in one case. Mortality was 12.5% (1/8). Since the introduction of US and CT scans early diagnosis and treatment was possible by which the mortality decreased.

Abscess↗
PubMedDate not supplied

[Intrahepatic and subcapsular hematoma of the liver after hepatic biopsy under laparoscopy. Contribution of ultrasonography].

Over the last few years, ultrasound became important in characterization of space -occupying solid lesions of the liver. Recently, Canadian authors using this method, described a 23% incidence of intrahepatic or subcapsular hematoma after liver biopsy. We prospectively evaluated the incidence of this complication after liver biopsy under laparoscopic guidance in 8 cirrhotic patients, 7 with steatosis, 7 chronic active hepatitis and 4 with intrahepatic cholestasis. Biopsy was performed under general anesthesia provided that prothrombin activity was over 50%, serum fibrinogen was over 100% and platelets over 50.000/mm3. In none of 26 consecutive patients, was an intrahepatic or subcapsular hematoma observed.

Adolescent↗