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2.
World J Surg ; 41(10): 2471-2479, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28474273

RESUMO

OBJECTIVE: To evaluate the feasibility and outcomes of patients operated on for uncomplicated acute appendicitis (UAA) in our 24-h emergency outpatient surgery unit. METHODS: This was a prospective observational study with intention-to-treat (ITT) analysis. From 12/2013 to 03/2015, all consecutive patients admitted for acute appendicitis (AA) were prospectively screened. A computed tomography or abdominal ultrasound confirmed the diagnosis of AA. Eligibility criteria for outpatient appendectomy were: UAA, no comorbidity, no physical or mental condition preventing participation in the study, absence of pregnancy, age older than 15 years, an accompanying adult person available for the hospital discharge and place of residence within 1 h of our hospital. In the case of intraoperative complication (abscess, local or general peritonitis) or complication of general anesthesia, patients were excluded from the outpatient pathway. The primary endpoint was the feasibility of outpatient appendectomy among all consecutive patients admitted for UAA. RESULTS: Of the 194 screened patients, 150 (77%) presented an UAA and 102 (68%) were eligible for an outpatient procedure. Thirteen eligible patients (13%) were excluded from the outpatient circuit (7 intraoperative and 6 postoperative contraindications). Outpatient appendectomy was performed in 89 patients, representing 59% (89/150) of the ITT population and 87% (89/102) of the eligible patients. The median length of hospital stay was 13 h. Postoperative complications were observed in six patients (6%). CONCLUSIONS: This study reports a safe and feasible management of UAA. Our organization allows a short hospitalization for postoperative recovery without using conventional surgery beds and enables discharge throughout the night.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Apendicectomia , Apendicite/cirurgia , Serviço Hospitalar de Emergência , Seleção de Pacientes , Adolescente , Adulto , Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Apendicectomia/efeitos adversos , Apendicite/diagnóstico por imagem , Estudos de Viabilidade , Feminino , Humanos , Análise de Intenção de Tratamento , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Adulto Jovem
3.
Obes Surg ; 26(3): 704-5, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26732500

RESUMO

BACKGROUND: Sleeve gastrectomy (SG) is a safe and efficient procedure with comparable results between conventional and single-incision approach in selected patients. However, the critical point in both approaches is the retraction of the hypertrophic and fatty left lobe of the liver which increases technical difficulties and limit the exposure of the hiatus. Traditional liver retractors require an additional sub-xiphoid incision for insertion and cause post-operative pain as well as iatrogenic liver injuries. Various techniques have been described to allow adequate liver retraction through smaller incisions or fewer ports without compromising patient safety. However, some disadvantages of these methods are the need for incision of the liver ligament or diaphragmatic crura puncture rendering the device difficult to reposition. MATERIALS AND METHODS: Two morbidly obese patients underwent a SG by conventional laparoscopy and by trans-umbilical single-incision using a novel minimal invasive internal liver retractor: the Versa Lifter Band®. RESULTS: This soft and flexible internal retractor was fully repositionable and adjustable intraoperatively. The time required to complete the liver retraction was 4 min 12 s in conventional surgery and 5 min 23 s in single-incision approach. Liver retraction was always satisfying resulting in limited intra-operative difficulties without the need of additional retractors/ports or conversion in both patients. No adverse outcomes occurred during the intra and post-operative periods without rise in aspartate aminotransferase and alanine-aminotransferase serum levels. CONCLUSION: In our preliminary experience, this internal liver retractor was easy to handle and provided an effective and safe retraction with good exposure of the surgical field and improved ergonomy in single incision as well as reduced port laparoscopic SG.


Assuntos
Gastrectomia/instrumentação , Laparoscopia/instrumentação , Fígado/cirurgia , Obesidade Mórbida/cirurgia , Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Gastrectomia/métodos , Humanos , Laparoscopia/métodos , Obesidade Mórbida/sangue , Período Pós-Operatório
4.
Gastroenterology ; 146(2): 401-11.e1, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24512910

RESUMO

BACKGROUND & AIMS: Patients with colorectal tumors with microsatellite instability (MSI) have better prognoses than patients with tumors without MSI, but have a poor response to 5-fluorouracil­based chemotherapy. A dominant-negative form of heat shock protein (HSP)110 (HSP110DE9) expressed by cancer cells with MSI, via exon skipping caused by somatic deletions in the T(17) intron repeat, sensitizes the cells to 5-fluorouracil and oxaliplatin.We investigated whether HSP110 T(17) could be used to identify patients with colorectal cancer who would benefit from adjuvant chemotherapy with 5-fluorouracil and oxaliplatin. METHODS: We characterized the interaction between HSP110 and HSP110DE9 using surface plasmon resonance. By using polymerase chain reaction and fragment analysis, we examined how the size of somatic allelic deletions in HSP110 T(17) affected the HSP110 protein expressed by tumor cells. We screened 329 consecutive patients with stage II­III colorectal tumors with MSI who underwent surgical resection at tertiary medical centers for HSP110 T(17). RESULTS: HSP110 and HSP110DE9 interacted in a1:1 ratio. Tumor cells with large deletions in T(17) had increased ratios of HSP110DE9:HSP110, owing to the loss of expression of full-length HSP110. Deletions in HSP110 T(17) were mostly biallelic in primary tumor samples with MSI. Patients with stage II­III cancer who received chemotherapy and had large HSP110 T(17) deletions (≥5 bp; 18 of 77 patients, 23.4%) had longer times of relapse-free survival than patients with small or no deletions (≤4 bp; 59 of 77 patients, 76.6%) in multivariate analysis (hazard ratio, 0.16; 95% confidence interval, 0.012­0.8; P = .03). We found a significant interaction between chemotherapy and T17 deletion (P =.009). CONCLUSIONS: About 25% of patients with stages II­III colorectal tumors with MSI have an excellent response to chemotherapy, due to large, biallelic deletions in the T(17) intron repeat of HSP110 in tumor DNA.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Sequência de Bases , Biomarcadores Tumorais/genética , Neoplasias Colorretais/tratamento farmacológico , Proteínas de Choque Térmico HSP110/genética , Instabilidade de Microssatélites , Deleção de Sequência , Idoso , Antineoplásicos/administração & dosagem , Biomarcadores Tumorais/química , Biomarcadores Tumorais/metabolismo , Western Blotting , Linhagem Celular Tumoral , Quimioterapia Adjuvante , Colectomia , Neoplasias Colorretais/genética , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/cirurgia , Feminino , Fluoruracila/administração & dosagem , Seguimentos , Proteínas de Choque Térmico HSP110/química , Proteínas de Choque Térmico HSP110/metabolismo , Humanos , Íntrons , Leucovorina/administração & dosagem , Masculino , Modelos Moleculares , Compostos Organoplatínicos/administração & dosagem , Oxaliplatina , Estudos Retrospectivos , Ressonância de Plasmônio de Superfície , Análise de Sobrevida , Resultado do Tratamento
5.
Cell Mol Life Sci ; 70(4): 729-42, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23007843

RESUMO

Links between cancer and stem cells have been proposed for many years. As the cancer stem cell (CSC) theory became widely studied, new methods were developed to culture and expand cancer cells with conserved determinants of "stemness". These cells show increased ability to grow in suspension as spheres in serum-free medium supplemented with growth factors and chemicals. The physiological relevance of this phenomenon in established cancer cell lines remains unclear. Cell lines have traditionally been used to explore tumor biology and serve as preclinical models for the screening of potential therapeutic agents. Here, we grew cell-forming spheres (CFS) from 25 established colorectal cancer cell lines. The molecular and cellular characteristics of CFS were compared to the bulk of tumor cells. CFS could be isolated from 72 % of the cell lines. Both CFS and their parental CRC cell lines were highly tumorigenic. Compared to their parental cells, they showed similar expression of putative CSC markers. The ability of CRC cells to grow as CFS was greatly enhanced by prior treatment with 5-fluorouracil. At the molecular level, CFS and parental CRC cells showed identical gene mutations and very similar genomic profiles, although microarray analysis revealed changes in CFS gene expression that were independent of DNA copy-number. We identified a CFS gene expression signature common to CFS from all CRC cell lines, which was predictive of disease relapse in CRC patients. In conclusion, CFS models derived from CRC cell lines possess interesting phenotypic features that may have clinical relevance for drug resistance and disease relapse.


Assuntos
Neoplasias Colorretais/patologia , Esferoides Celulares/patologia , Animais , Antimetabólitos Antineoplásicos/farmacologia , Biomarcadores Tumorais/genética , Linhagem Celular Tumoral , Proliferação de Células/efeitos dos fármacos , Colo/efeitos dos fármacos , Colo/metabolismo , Colo/patologia , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/genética , Fluoruracila/farmacologia , Regulação Neoplásica da Expressão Gênica , Humanos , Camundongos , Camundongos Nus , Recidiva Local de Neoplasia , Reto/efeitos dos fármacos , Reto/metabolismo , Reto/patologia , Esferoides Celulares/efeitos dos fármacos , Esferoides Celulares/metabolismo , Células Tumorais Cultivadas
6.
Obes Surg ; 20(6): 791-5, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20213289

RESUMO

The prevalence of morbid obesity is rapidly increasing worldwide. As surgery has been recognized to be the only effective treatment for morbid obesity, the number of bariatric procedure realized each year has dramatically increased. Among all the surgical options, gastric bypass in considered as the gold standard. A possible drawback of this operation is the difficult access to the excluded proximal intestinal tract and, consequently, to the biliary tract. As gallstone formation may be frequent after a rapid weight loss induced by surgery, surgeons could be frequently asked to face the need of exploration of the biliary tree after anatomical changes induced by this kind of surgery. Many technical solutions, mainly based on a combined laparoscopic and endoscopic approach, have been proposed by several authors to face this problem. We herein describe an original technique to allow endoscopic exploration of biliary tract after a laparoscopic gastric bypass based on temporary restoration of physiological digestive continuity followed by re-establishment of the Roux-en-Y loop.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/métodos , Jejuno/cirurgia , Esfinterotomia Endoscópica/métodos , Estômago/cirurgia , Dor Abdominal/etiologia , Dor Abdominal/cirurgia , Adulto , Anastomose Cirúrgica , Colecistectomia Laparoscópica/métodos , Feminino , Derivação Gástrica/métodos , Humanos , Jejuno/diagnóstico por imagem , Laparoscopia/métodos , Estômago/diagnóstico por imagem , Resultado do Tratamento
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