ESTELA REGINA RAMOS FIGUEIRA
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/37 - Laboratório de Transplante e Cirurgia de Fígado, Hospital das Clínicas, Faculdade de Medicina
LIM/37 - Laboratório de Transplante e Cirurgia de Fígado, Hospital das Clínicas, Faculdade de Medicina
25 resultados
Resultados de Busca
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- Advanced age does not increase morbidity in pancreaticoduodenectomy(2018) NAMUR, Guilherme Naccache; DANTAS, Anna Carolina Batista; JUREIDINI, Ricardo; RIBEIRO, Thiago Costa; RIBEIRO JUNIOR, Ulysses; FIGUEIRA, Estela; CECCONELLO, Ivan; BACCHELLA, TelesforoBackground: Due to rising life expectancy of population, very complex surgical procedures such as pancreaticoduodenectomy (PD), are more commonly being performed in elderly patients. The objective of this study was to evaluate the safety of PD in patients older than 75 years old and the risk factors associated with severe complications. Methods: Patients who underwent PD for periampullary tumors were retrospectively reviewed and divided into two groups, A (<75 years) and B (>75 years). The primary endpoint was severe postoperative complications (Clavien 3 or greater). Secondary endpoints were mortality and any complications. Results: Ninety consecutive patients underwent PD for periampullary tumors in the studied period, 70 in group A and 20 in group B. Clinical and pathological characteristics of both groups were equivalents except for age. There were no difference regarding the incidence of severe complications (17% vs. 10%, P=0.72) or all complications (50% vs. 50%, P>0.999). Although mortality was greater in group A (8.6% vs. 0%), it was not statistically significant (P=0.333). On multivariate analyses, only male sex, obesity and American Society of Anesthesiology Score of 3 or 4 were associated with severe postoperative complications. Conclusions: Poor clinical status, obesity and male gender are associated with severe complications in PD, but not age greater than 75 years, therefore PD can be considered safe in elderly patients and age itself should not be a contraindication for PD.
- A new heparin fragment decreases liver ischemia-reperfusion injury(2022) VASQUES, Enio R.; FIGUEIRA, Estela R. R.; ROCHA-FILHO, Joel A.; LANCHOTTE, Cinthia; XIMENES, Jorge L. S.; NADER, Helena B.; TERSARIOL, Ivarne L. S.; LIMA, Marcelo A.; RODRIGUES, Tiago; CUNHA, Jose E. M.; CHAIB, Eleazar; D'ALBUQUERQUE, Luiz A. C.; GALVAO, Flavio H. F.
- Insights of Outcome after Resection of Small Nonfunctioning Neuroendocrine Pancreatic Tumors(2021) FIGUEIRA, Estela Regina Ramos; RIBEIRO, Julia Fray; RIBEIRO, Thiago Costa; JUREIDINI, Ricardo; NAMUR, Guilherme Naccache; COSTA, Thiago Nogueira; BACCHELLA, Telesforo; CECCONELLO, IvanBackground. The incidence of small nonfunctioning neuroendocrine pancreatic tumors (NF-PNETs) has been increasing systematically in the last few decades. Surgical resection was once considered the treatment of choice but has been questioned in the direction of a more conservative approach for selected patients. Our aim was to analyze the outcome of surgical resection of small (<= 3cm) NF-PNETs. Methods. We retrospectively evaluated 14 patients with sporadic NF-PNETs who underwent pancreatic resection. Data were collected from patients' medical records. Results. Of the 14 patients included, 35.71% were men, and the average age was 52.36 +/- 20.36 years. Comorbidities were present in 92.86% of the cases. The incidence of postoperative complications was 42.86%, the 30-day mortality was zero, and the length of follow-up was 3.31 +/- 3.0 years. The results of pathological evaluations revealed WHO grade I in 42.86% of cases, II in 21.43%, and neuroendocrine carcinoma in 35.71%. The median tumor size was 1.85cm (range, 0.5-3cm), and 2 cases had synchronous metastasis. The median TNM stage was IIa (range, I-IV). The disease-free and patient survival rates were 87.5% and 100% at 3 years and 43.75% and 75% at 10 years, respectively. The tumor pathological grade was significantly higher in head tumors than body-tail tumors, but there were no differences with respect to tumor size and TNM staging. Conclusion. A surgical approach to treat small sporadic NF-PNETs is safe with low mortality and high patient survival. Based on these data, small pancreatic head tumors can be more aggressive, suggesting that surgical resection is still the best option to treat small nonfunctioning PNETS. Thus, conservative treatment should be indicated very cautiously for only cases with absolute contraindications for surgery.
- Evaluation of drug-induced liver injury as etiology for acute liver failure in Brazil(2021) SANTOS, Genario; FIGUEIRA, Estela Regina Ramos; D'ALBUQUERQUE, Luiz Augusto Carneiro; LISBOA, Paulo Bittencourt; ALMEIDA, Marcio Dias de; FILGUEIRA, Norma Arteiro; BOIN, Ilka; PORTA, Gilda; SILVA, Rita de Cassia Martins Alves da; VIANA, Cyntia Ferreira Gomes; FARIA, Luciana Costa; ALVARES-DA-SILVA, Mario Reis; MORAES, Adriano Claudio Pereira de; MORSOLETTO, Daphne Benatti Goncalves; CODES, Liana; PARANA, RaymundoIntroduction and objectives: Little is known about the etiology of acute liver failure (ALF) in Latin America. The objective of this paper is to investigate the main etiologies of ALF in Brazil, including Drug Induced Liver Injury (DILI) using stringent causality criteria. Patients or material and methods: All the cases of individuals who underwent liver transplantation (LT) in 12 centers in Brazil for ALF were reviewed. When DILI was stated as the cause of ALF, causality criteria were applied on site by the main investigator in order to rule out other etiologies. Results: 325 individuals had ALF mainly for unknown reasons (34%), DILI (27%) and AIH (18%). Reassessment of the 89 cases of DILI, using stringent causality criteria, revealed that in only 42 subjects could DILI be confirmed as the cause of ALF. Acetaminophen (APAP) toxicity (n = 3) or DILI due to herbal and dietary supplements (HDS) (n = 2) were not commonly observed. Conclusions: Undetermined etiology and DILI are the main causes of ALF in Brazil. However, APAP toxicity and DILI due to HDS are mostly uncommon. (c) 2021 Published by Elsevier Espa?a, S.L.U. on behalf of Fundaci?n Cl?nica M?dica Sur, A.C. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/
- Nutritional support for fulminant hepatitis(2015) FIGUEIRA, Estela Regina Ramos; ROCHA FILHO, Joel Avancini; NACIF, Lucas Souto; D'ALBUQUERQUE, Luiz Carneiro; WAITZBERG, Dan LinetzkyIntroduction: fulminant hepatitis (FH) is associated with exacerbated hypercatabolism, hypoglycemia and hyperammonemia that are accompanied by the release of proinflammatory cytokines and catabolic hormones into the systemic circulation worsening patient's clinical condition. Nutritional support is a crucial element for the recovery of these patients. Objectives: the aim of this review is to update Nutritional Support for Fulminant Hepatitis. Methods: the review was performed using electronic search on Medline-PubMed using Mesh-terms. Results and discussion: there are not many data available on nutritional support to fulminant hepatitis or acute liver failure. Strategies for initial nutritional intervention are focused on the control of the previously described FH metabolic derangements, and should be individualized according to the severity of patient's clinical condition. Energy and protein can be provided in amounts of 25-40 kcal/kg/day and 0.8-1.2 g/kg/day, respectively. Enteral nutrition therapy is indicated for patients with advancing encephalopathy or for those who cannot be properly fed orally. Euglycemia must be achieved and protein intake can be based on BCAA formulae. Lipids can be administered as energy supplementation with caution. Adequate nutrition therapy can potentially reduce morbidity and mortality of FH patients.
- Pentoxifylline enhances the protective effects of hypertonic saline solution on liver ischemia reperfusion injury through inhibition of oxidative stress(2014) ROCHA-SANTOS, Vinicius; FIGUEIRA, Estela R. R.; ROCHA-FILHO, Joel A.; COELHO, Ana M. M.; PINHEIRO, Rafael Soraes; BACCHELLA, Telesforo; MACHADO, Marcel C. C.; D'ALBUQUERQUE, Luiz A. C.BACKGROUND: Liver ischemia reperfiision (IR) injury triggers a systemic inflammatory response and is the main cause of organ dysfunction and adverse postoperative outcomes after liver surgery. Pentoxifylline (PTX) and h-ypertonic saline solution (HTS) have been identified to have beneficial effects against IR injury This study aimed to investigate if the addition of PTX to HTS is superior to HTS alone for the prevention of liver IR injury. METHODS: Male Wistar rats were allocated into three groups. Control rats underwent 60 minutes. of partial liver ischemia, HTS rats were treated with 0.4 mL/kg of intravenous 7.5% NaC1 15 minutes before reperfusion, and HPTX group were treated with 7.5% NaC1 plus 25 mg/kg of PTX 15 minutes before reperfusion. Samples were collected after reperfusion for determination of ALT, AST, TNF-alpha, IL-6, IL-10, mitochondrial respiration, lipid peroxidation, pulmonary permeability and myeloperoxidase. RESULTS: HPTX significantly decreased TNF-alpha 30 minutes after reperfusion. HPTX and HTS significantly decreased ALT, AST, IL-6, mitochondrial dysfunction and pulmonary myeloperoxidase 4 hours after reperfusion. Compared with HTS only, HPTX significantly decreased hepatic oxidative stress 4 hours after reperfusion and pulmonary permeability 4 and 12 hours after reperfusion. CONCLUSION: This study showed that PTX added the beneficial effects of HTS on liver IR injury through decreases of hepatic oxidative stress and pulmonary permeability.
- SpyGlass percutaneous transhepatic cholangioscopy-guided lithotripsy of a large intrahepatic stone(2017) FRANZINI, Tomazo; CARDARELLI-LEITE, Leandro; FIGUEIRA, Estela Regina Ramos; MORITA, Flavio; DOMINGOS, Fernanda Uchiyama Golghetto; CARNEVALE, Francisco Cesar; MOURA, Eduardo Guimaraes Hourneaux de
- First description of extended and tailored fluorescence-guided lymphadenectomy during robotic distal pancreatosplenectomy: case report(2023) SURJAN, R. C. T.; SILVEIRA, S. P.; FIGUEIRA, E. R. R.; ARDENGH, J. C.Background: Minimally invasive distal pancreatosplenectomies for the treatment of pancreatic duct adenocarcinoma (PDAC) of the pancreatic body have become a well-established approach. To improve oncologic resection and lymph node (LN) dissection, technical alternatives have emerged on the last few years, such as the radical antegrade modular pancreatosplenectomy (RAMPS). While it is accepted that 12 LNs should be retrieved during distal pancreatosplenectomies, during RAMPS procedure the mean harvest is described to be 21 LNs (range, 11–30). With the objective of performing extended and tailored lymphadenectomies during robotic distal pancreatosplenectomies, we developed a novel technique for LN dissection with the use of real-time near-infrared robotic fluorescence and direct injection of indocyanine green in the pancreas as a contrast agent. Case Description: The patient presented pathologically confirmed PDAC on the body of the pancreas and was submitted to totally robotic distal pancreatosplenectomy. After exposing the pancreatic body and under intraoperative sonography guidance, 1 mL of indocyanine green was injected on the pancreas just proximal to the tumor. Using robotic fluorescence, we could clearly identify the lymphatic drainage of the pancreatic body, in order to perform fluorescence-guided, extended and tailored lymphadenectomy. Operative time was 4 hours and 43 minutes. Forty-three LNs were retrieved. Surgical margin was free from neoplasia. Postoperative period was uneventful. Conclusions: Fluorescence-guided extended lymphadenectomy with intrapancreatic injection of indocyanine green is a novel technique that may improve oncological results and staging during robotic distal pancreatosplenectomies for the treatment of PDAC of the pancreatic body.
- Hypertonic saline solution decreases oxidative stress in liver hypothermic ischemia(2021) NUNES, Giolana; FIGUEIRA, Estela Regina Ramos; ROCHA-FILHO, Joel Avancini; LANCHOTTE, Cinthia; NACIF, Lucas Souto; FERREIRA, Diego Mendes; ROMANO, Vitor Carminatti; ABDO, Emilio Elias; D'ALBUQUERQUE, Luiz Augusto Carneiro; GALVAO, Flavio Henrique FerreiraBackground: Liver ischemia reperfusion injury is still an unsolved problem in liver surgery and transplantation. In this setting, hypothermia is the gold standard method for liver preservation for trans-plantation. Hypertonic saline solution reduces inflammatory response with better hemodynamic recovery in several situations involving ischemia reperfusion injury. Here, we investigated the effect of hypertonic saline solution in hypothermic liver submitted to ischemia reperfusion injury. Methods: Fifty male rats were divided into 5 groups: SHAM, WI (animals submitted to 40 minutes of partial warm liver ischemia and reperfusion), HI (animals submitted to 40 minutes hypothermic ischemia), HSPI (animals submitted to hypothermic ischemia and treated with 7.5% hypertonic saline solution preischemia), and HSPR (animals submitted to hypothermic ischemia and treated with hypertonic saline solution previously to liver reperfusion). Four hours after reperfusion, the animals were euthanized to collect liver and blood samples. Results: Aspartate aminotransferase and alanine aminotransferase, histologic score, and hepatocellular necrosis were significantly decreased in animals submitted to hypothermia compared with the warm ischemia group. Malondialdehyde was significantly decreased in hypothermic groups with a further decrease when hypertonic saline solution was administrated preischemia. Hypothermic groups also showed decreased interleukin-6, interleukin-10, and tumor necrosis factor-alpha concentrations and better recovery of bicarbonate, base excess, lactate, and glucose blood concentrations. Moreover, hypertonic saline solution preischemia was more effective at controlling serum potassium concentrations. Conclusion: Hypertonic saline solution before hypothermic hepatic ischemia decreases hepatocellular oxidative stress, cytokine concentrations, and promotes better recovery of acid-base disorders secondary to liver ischemia reperfusion.
- Graft-versus-host disease after liver transplantation(2011) CHAIB, Eleazar; SILVA, Felipe D.; FIGUEIRA, Estela R. R.; LIMA, Fabiana R.; ANDRAUS, Wellington; D'ALBUQUERQUE, Luiz Augusto C.
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