IVAN CECCONELLO
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Gastroenterologia, Faculdade de Medicina - Docente
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/35 - Laboratório de Nutrição e Cirurgia Metabólica do Aparelho Digestivo, Hospital das Clínicas, Faculdade de Medicina - Líder
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/35 - Laboratório de Nutrição e Cirurgia Metabólica do Aparelho Digestivo, Hospital das Clínicas, Faculdade de Medicina - Líder
33 resultados
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- A novel approach for the treatment of pelvic abscess: transrectal endoscopic drainage facilitated by transanal endoscopic microsurgery access(2012) MARTINS, B. C.; MARQUES, Carlos Frederico Sparapan; NAHAS, Caio Sergio Rizkallah; HONDO, Fabio Yuji; POLLARA, Wilson; NAHAS, Sergio Carlos; RIBEIRO JUNIOR, U.; CECCONELLO, Ivan; MALUF-FILHO, FauzePostoperative pelvic abscesses in patients submitted to colorectal surgery are challenging. The surgical approach may be too risky, and image-guided drainage often is difficult due to the complex anatomy of the pelvis. This article describes novel access for drainage of a pelvic collection using a minimally invasive natural orifice approach. A 37 year-old man presented with sepsis due to a pelvic abscess during the second postoperative week after a Hartmann procedure due to perforated rectal cancer. Percutaneous drainage was determined by computed tomography to be unsuccessful, and another operation was considered to be hazardous. Because the pelvic fluid was very close to the rectal stump, transrectal drainage was planned. The rectal stump was opened using transanal endoscopic microsurgery (TEM) instruments. The endoscope was advanced through the TEM working channel and the rectal stump opening, accessing the abdominal cavity and pelvic collection. The pelvic collection was endoscopically drained and the local cavity washed with saline through the scope channel. A Foley catheter was placed in the rectal stump. The patient's recovery after the procedure was successful, without the need for further intervention. Transrectal endoscopic drainage may be an option for selected cases of pelvic fluid collection in patients submitted to Hartmann's procedure. The technique allows not only fluid drainage but also visualization of the local cavity, cleavage of multiloculated abscesses, and saline irrigation if necessary. The use of TEM instrumentation allows safe access to the peritoneal cavity.
- Metabolic Improvements in Obese Type 2 Diabetes Subjects Implanted for 1 Year with an Endoscopically Deployed Duodenal-Jejunal Bypass Liner(2012) MOURA, Eduardo G. H. de; MARTINS, Bruno C.; LOPES, Guilherme S.; ORSO, Ivan R.; OLIVEIRA, Suzana L. de; GALVAO NETO, Manoel P.; SANTO, Marco A.; SAKAI, Paulo; RAMOS, Almino C.; GARRIDO JUNIOR, Arthur B.; MANCINI, Marcio C.; HALPERN, Alfredo; CECCONELLO, IvanBackground: The purpose of this study was to evaluate the effect of the duodenal-jejunal bypass liner (DJBL), a 60-cm, impermeable fluoropolymer liner anchored in the duodenum to create a duodenal-jejunal bypass, on metabolic parameters in obese subjects with type 2 diabetes. Methods: Twenty-two subjects (mean age, 46.2 +/- 10.5 years) with type 2 diabetes and a body mass index between 40 and 60 kg/m(2) (mean body mass index, 44.8 +/- 7.4 kg/m(2)) were enrolled in this 52-week, prospective, open-label clinical trial. Endoscopic device implantation was performed with the patient under general anesthesia, and the subjects were examined periodically during the next 52 weeks. Primary end points included changes in fasting blood glucose and insulin levels and changes in hemoglobin A1c (HbA1c). The DJBL was removed endoscopically at the end of the study. Results: Thirteen subjects completed the 52-week study, and the mean duration of the implant period for all subjects was 41.9 +/- 3.2 weeks. Reasons for early removal of the device included device migration (n = 3), gastrointestinal bleeding (n = 1), abdominal pain (n = 2), principal investigator request (n = 2), and discovery of an unrelated malignancy (n = 1). Using last observation carried forward, statistically significant reductions in fasting blood glucose (-30.3 +/- 10.2 mg/dL), fasting insulin (-7.3 +/- 2.6 mu U/mL), and HbA1c (-2.1 +/- 0.3%) were observed. At the end of the study, 16 of the 22 subjects had an HbA1c < 7% compared with only one of 22 at baseline. Upper abdominal pain (n = 11), back pain (n = 5), nausea (n = 7), and vomiting (n = 7) were the most common device-related adverse events. Conclusions: The DJBL improves glycemic status in obese subjects with diabetes and therefore represents a nonsurgical, reversible alternative to bariatric surgery.
- Resultados da gastrectomia D2 para o câncer gástrico: dissecção da cadeia linfática ou ressecção linfonodal múltipla?(2012) ZILBERSTEIN, Bruno; MUCERINO, Donato Roberto; YAGI, Osmar Kenji; RIBEIRO-JUNIOR, Ulysses; LOPASSO, Fabio Pinatel; BRESCIANI, Claudio; JACOB, Carlos Eduardo; COIMBRA, Brian Guilherme Monteiro Marta; CECCONELLO, IvanBACKGROUND: Eastern literature is remarkable for presenting survival rates for surgical treatment of gastric adenocarcinoma superior to those presented in western countries. AIM: To analyze the long-term result after D2 gastrectomy for gastric cancer. METHODS: Two hundred seventy four underwent gastrectomy with D2 lymph node dissection as exclusive treatment. The inclusion criteria were: 1) lymph node removal according to Japanese standardized lymphatic chain dissection; 2) potentially curative surgery described in medical records as D2 or more lymph node dissection; 3) tumoral invasiveness of gastric wall restricted to the organ (T1 - T3); 4) absence of distant metastasis (N0-N2/M0); 5) a minimum of five years follow-up. Clinical pathological data included sex, age, tumor location, Borrmann's macroscopic tumor classification, type of gastrectomy, mortality rates, hystological type, TNM classification and staging according to UICC TNM 1997. RESULTS: Total gastrectomy was performed in 77 cases (28.1%) and subtotal gastrectomy in 197 (71.9%). The tumor was located in the upper third in 28 cases (10.2%), in the middle third in 53 (19.3%), and in the lower third in 182 (66.5%). Among patients that had their Borrmann's classification assigned, five cases (1.8%) were BI, 34 (12.4%) BII, 230 (84.0%) BIII and 16 (5.9%) BIV. Tumors were histologically classified as Laurén intestinal type in 119 cases (43.4%) and as diffuse type in 155 (56.6%). According to UICC TNM 1997 classification, early gastric cancer (T1) was diagnosed in 68 cases (24.8 %); 51 (18.6%) were T2, and 155 (56.6%) were T3. No lymph node involvement (N0) was observed in 129 cases (47.1%), whereas 100 (36.5%) were N1 (1-6 lymph nodes), and 45 (16.4%) were N2 (7-15 lymph nodes).The median number of lymph nodes dissected was 35. The overall long-term (five-year) survival rate, for stages I to IIIb was 70.4%. CONCLUSION: Digestive surgeons must be stimulated in performing D2 gastrectomies to avoid wasting the only treatment to gastric adenocarcinoma that has proven to be efficient up to this days. It must be emphasized that standardized lymph nodes dissection according to tumor location is more important that only the number of removed nodes
- Weakness of expiratory muscles and pulmonary complications in malnourished patients undergoing upper abdominal surgery(2012) LUNARDI, Adriana C.; MIRANDA, Camila S.; SILVA, Karoline M.; CECCONELLO, Ivan; CARVALHO, Celso R. F.Background and objective: Malnutrition is prevalent in hospitalized patients and causes systemic damage including effects on the respiratory and immune systems, as well as predisposing to infection and increasing postoperative complications and mortality. This study aimed to assess the impact of malnutrition on the rate of postoperative pulmonary complications, respiratory muscle strength and chest wall expansion in patients undergoing elective upper abdominal surgery. Methods: Seventy-five consecutive candidates for upper abdominal surgery (39 in the malnourished group (MNG) and 36 in the control group (CG)) were enrolled in this prospective controlled cohort study. All patients were evaluated for nutritional status, respiratory muscle strength, chest wall expansion and lung function before surgery. Postoperative pulmonary complications (pneumonia, tracheobronchitis, atelectasis and acute respiratory failure) before discharge from hospital were also evaluated. Results: The MNG showed expiratory muscle weakness (MNG 65 +/- 24 vs CG 82 +/- 22 cm H2O; P < 0.001) and decreased chest wall expansion (P < 0.001), whereas inspiratory muscle strength and lung function were preserved (P > 0.05). The MNG also had a higher incidence of postoperative pulmonary complications compared with the CG (31% and 11%, respectively; P = 0.05). In addition, expiratory muscle weakness was correlated with BMI in the MNG (r = 0.43; P < 0.01). The association between malnutrition and expiratory muscle weakness increased the likelihood of postoperative pulmonary complications after upper abdominal surgery (P = 0.02). Conclusions: These results show that malnutrition is associated with weakness of the expiratory muscles, decreased chest wall expansion and increased incidence of pulmonary complications in patients undergoing elective upper abdominal surgery.
- PROFESSOR HENRIQUE WALTER PINOTTI, MD, PHD (1929-2010)(2012) CECCONELLO, Ivan
- Isolated splenic metastasis from lung squamous cell carcinoma(2012) DIAS, Andre R.; PINTO, Rodrigo A.; RAVANINI, Juliana N.; LUPINACCI, Renato M.; CECCONELLO, Ivan; RIBEIRO JR., UlyssesIsolated splenic metastasis from lung cancer is a very rare occurrence with only a few reports available. Here, we report the case of a 82-year-old male who underwent a bilobectomy for a lung squamous cell carcinoma and 16 months later developed an isolated splenic metastasis. Additionally, previous reports are reviewed and discussed.
book conferenceObject Balloon Assisted Enteroscopy Is Advised in the Long Term Follow-Up of Patients With On-Going Obscure Gastrointestinal Bleeding(2012) SAFATLE-RIBEIRO, Adriana V.; ARRAES, Livia R.; RIBEIRO, Ulysses; REIMAO, Silvia M.; MEDRADO, Bruno F.; SANTOS, Thiago N.; KAWAGUTI, Fabio S.; MOURA, Eduardo G. De; SAKAI, Paulo; CECCONELLO, IvanconferenceObject Assessment of Body Composition in Morbid Obesity: a Comparative Study Between Body Impedance and Adiposity index Methods(2012) SANTO, M. A.; RICCIOPPO, D.; PAJECKI, D.; KAWAMOTO, F.; MATSUDA, M.; CECCONELLO, IIntroduction Obesity has become an epidemic public health problem. A reliable method to assess body composition and monitor the effectiveness of treatments for the morbid obesity is mandatory. However, there is still controversy as to which method to use for this purpose. Two Methods are validated in the literature, bioelectrical impedance analysis (BIA) and body adiposity index (BAI). The present study compared these methodologies. Materials & Methods We evaluated 167 patients undergoing bariatric surgery, women prevailed (82.59 %), averaging 44 years-old and mean BMI of 49.48 kg/m2. Weight, height and hip circumference were measured. Body fat (BF) was calculated by BIA and BAI. The following formulas were used: BIA: BF in kg=023.25+(0.09x resistance in ohms)+(1.00x weight in kg)-(0.08xheight in cm)+(0.13x age in years). BAI: BF% of the total weight 0 (hip circumference in centimeters/height in meters x height in meters)-18. Results The patients had an average of 53.35 % (± 5.37) of BF according to BIA, and BAI showed 50.51 % (± 13.59) of BF. There is no difference between the two Methods (p<0,05), even when stratified by BMI (BMI<45, 4550). Essa diferença variou quando o IMC foi dividido em três faixas, abaixo de 45 kg/m2 a diferença foi de 3,1 %, entre 45,1 a 49,99 kg/m2 a diferença foi de 3,78 %, acima de 50 kg/m2 a diferença foi de 1,86%. Discussion The BAI is a simple method of implementation, low cost and effective, when compared to other Methods validated for morbidly obese patients. Conclusion BAI is an effective method to assess BF, comparable to BIA, and also proved to be effective in super obese patients.conferenceObject Preoperative Weight Loss in Super Obesity: Influence on Perioperative Morbidity and Mortality in Patients undergoing Gastric Bypass(2012) SANTO, M. A.; RICCIOPPO, D.; PAJECKI, D.; KAWAMOTO, F.; MATSUDA, M.; CECCONELLO, IIntroduction Super obesity (SO) is increasing in greater proportions, and now represents 30 % of morbidly obese patients. In SO morbidity and mortality rates are greater. The preoperative weight loss in SO decreases operative time, and apparently diminishes morbidity. Based on these data, we initiated a program of preoperative weight loss for the SO. The treatment is based on hospitalization, low-calorie diet, biometrics control and physical activities, aiming to analyze weight loss and influence of weight loss in the perioperative outcome. Materials & Methods Thirty patients underwent our SO preop weight loss program, from 2006 to 2011. The mean age was 46 years, and mean BMI of 66 kg/m2 and the majority was female. All patients underwent gastric bypass after the weight loss. The average caloric intake was 5 cal/Kg/day. Results The mean weight loss was 1.9 kg/week, and after 14 weeks the mean weight loss was15.2 % of initial weight. The mean hospital stay was 21.3 weeks, and the mean weight loss was 19.7 %. All had satisfactory recovery from surgery. The mortality was null. In the last five years, from the total of 592 surgeries, 193 was performed in SO. The SO and general morbidity was 11.14 % and 20.2 %, respectively, and mortality 0.84 % and 2.07 %. Discussion In SO a preoperative weight loss is an important tool to reduce surgical risks. Hospitalization, with low-calorie diet and multidisciplinary follow-up is a safe and effective way to achieve weight loss preoperatively. Conclusion After a mean of 19,7 % of initial body weight loss, the studied group showed an important decreasing in morbimortality when compared with our previous experience. Preoperative weight loss should be encouraged in SO, and a specific program can significantly diminish surgical risks in this complex group of obeses.