RUY JORGE CRUZ JUNIOR
Projetos de Pesquisa
Unidades Organizacionais
LIM/37 - Laboratório de Transplante e Cirurgia de Fígado, Hospital das Clínicas, Faculdade de Medicina
6 resultados
Resultados de Busca
Agora exibindo 1 - 6 de 6
- Transplante de intestino delgado(2013) PÉCORA, Rafael Antonio Arruda; DAVID, André Ibrahim; LEE, André Dong; GALVÃO, Flávio Henrique; CRUZ-JUNIOR, Ruy Jorge; D'ALBUQUERQUE, Luiz Augusto CarneiroBACKGROUND: Small bowel transplantation evolution, because of its complexity, was slower than other solid organs. Several advances have enabled its clinical application. AIM: To review intestinal transplantation evolution and its current status. METHOD: Search in MEDLINE and ScIELO literature. The terms used as descriptors were: intestinal failure, intestinal transplantation, small bowel transplantation, multivisceral transplantation. Were analyzed data on historical evolution, centers experience, indications, types of grafts, selection and organ procurement, postoperative management, complications and results. CONCLUSION: Despite a slower evolution, intestinal transplantation is currently the standard therapy for patients with intestinal failure and life-threatening parenteral nutrition complications. It involves some modalities: small bowel transplantation, liver-intestinal transplantation, multivisceral transplantation and modified multivisceral transplantation. Currently, survival rate is similar to other solid organs. Most of the patients become free of parenteral nutrition.
- Diffuse Liver Cholangiocarcinoma Presenting as Fulminant Liver Failure(2013) PECORA, Rafael; CRUZ JR., Ruy J.; PINHEIRO, Rafael S.; MARTINO, Rodrigo Bronze de; TANIGAWA, Ryan Y.; D'ALBUQUERQUQ, Luiz Augusto CarneiroIntroduction: Cryptogenic acute liver failure (ALF) can occur in up to 40 % of cases. There are few reports of diffuse liver tumors (primary or metastatic) leading to ALF. We herein report an unusual case of ALF secondary to diffuse cholangiocarcinoma. Case report: A 55-year-old woman was admitted to hospital with jaundice over the past 15 days, associated with general fatigue, nausea, vomiting and fever. During the admission the patient developed confusion, lactic acidosis and hypotension. Her past medical history revealed a cholecystectomy and myomectomy 10 months ago, without any history of hepatotoxic medication use. There were no others comorbidities. Laboratory evaluation included: TB 11.3 mg/dL; AST 4248 IU/L; GGTP 289 IU/L, and INR of 2.66. Hepatitis serologies were negative. Ultrasound and CT scan revealed: heterogeneous enlarged liver without any focal lesions and no signs of portal hypertension. Main portal and hepatic veins were patent. Based on clinical and laboratory evaluation, patient underwent to liver transplantation 48 hours after ICU admission. Intraoperative liver macroscopy was compatible with ALF. Explanted liver revealed a diffuse poorly differentiated liver cholangiocarcinoma with multiple microvascular tumoral emboli. There were no signs of underlying disease (i.e. cirrhosis). Immunostaining for both cytokeratins 7 and 19 were positive. Conclusion: To the best of our knowledge this is the first report of ALF associated with cholangiocarcinoma. Neoplastic involvement of liver should be considered in the differential diagnosis of ALF of unknown etiology. Pre-transplant diagnosis should be always pursued due to the dismal prognosis of these conditions. Given the limitation of imaging studies in this setting, liver biopsy can be an option to obtain an accurate diagnosis.
conferenceObject Hepatocellular Carcinoma Meld Exception in Brazil.(2014) PINHEIRO, Rafael S.; NACIF, Lucas S.; ANDRAUS, Wellington; LOPES, Liliana D.; PECORA, Rafael A.; ROCHA-SANTOS, Vinicius; IBRAHIM, Andre D.; HADDAD, Luciana B.; CALIL, Igor L.; CRUZ JR., Ruy J.; D'ALBUQUERQUE, Luiz A. C.conferenceObject Validation of Preoperative Coefficient Factor for Graft Weight Estimation in Living Donor Liver Transplantation(2013) PINHEIRO, Rafael S.; PECORA, Rafael A.; ANDRAUS, Wellington; MARTINS, Rodrigo B.; DAVID, Andre I.; HADDAD, Luciana B.; ARANTES, Rubens M.; SANTOS, Rafael M.; CRUZ JR., Ruy J.; PUGLIESE, Vincenzo; D'ALBUQUERQUE, Luiz A. C.conferenceObject Femoral Hernia and Massive Ascites(2013) PINHEIRO, Rafael S.; ANDRAUS, Wellington; PECORA, Rafael A.; HADDAD, Luciana B.; DAVID, Andre I.; NACIF, Lucas; MARTINS, Rodrigo B.; CRUZ JR., Ruy J.; PUGLIESE, Vincenzo; D'ALBUQUERQUE, Luiz A. C.- Increasing Survival Results in High MELD Recipients, What We Learn(2013) DAVID, Andre I.; TREVIZOL, Allison; PECORA, Rafael A. A.; YAMASHITA, Eduardo T.; PINHEIRO, Rafael S. N.; CRUZ JUNIOR, Ruy J.; D'ALBUQUERQUE, Luiz Augusta C.High MELD recipients are very usual cases in development countries, like Brazil, because of donor shortage and few transplant centers, most in Sao Paulo State and few or none in other States. Despite high MELD recipients, extended criteria donors are commonly used in a dangerous combination. Attitudes to improve survival are necessary to keep satisfactory survival results. Casuistic: Were analized 72 cases done in the last 14 months, after some providences to improve results. The most important were: donor selection, multi-professional training at international transplant centers (most in US and Europe), investment in hospital infra-structure and research at LIM 37 (Laboratory of Investigative Medicine). Patients with high MELD where considered when MELD Score was more or equal to 30. Results: The improve in survival curve detached of the Sao Paulo State curve (Figure 1), in a development country with the largest Public Transplant Program of the world, Sao Paulo has the largest Liver Program. Conclusion Providences like high investment in human resources and infra-structure and improve the experience of the transplant (donor/recipient) team as in basic research are keys to keep good results in development countries.