Comunicações em Eventos - LIM/30

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https://observatorio.fm.usp.br/handle/OPI/3716

A coleção de Comunicações em Eventos compreende trabalhos completos ou resumos de conferências, comunicações orais ou posteres, apresentados em congressos, seminários, jornadas, simpósios ou outros tipos de eventos de caráter técnico-científico ou artístico-cultural, publicados em anais impressos ou em meios eletrônicos.

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A comparative study of full-thickness blepharotomy vs. transconjunctival eyelid lengthening in the correction of upper eyelid retraction in Graves' Orbitopathy
(2017) GONCALVES, Allan Christian Pieroni; NOGUEIRA, Thiago; MONTEIRO, Mario R.
Model of Short Bowel Syndrome and Segmental Intestinal Autotransplantation in Swine
(2017) GALVAO, Flavio; TANNURI, Ana; JABUR, Gabriel; LEE, Andre; CRUZ, Ruy; ARANTES, Rubens; LOPES, Liliana; CHAIB, Eleazar; UENIS, Tannuri; D'ALBUQUERQUE, Luiz
Impact of Clinical Anatomy League of University of Sao Paulo Medical School (FMUSP) on motivation and performance of anatomy learning
(2015) IUAMOTO, Leandro; NOGUEIRA, Thiago; SOUZA, Braian; RIBEIRO, Joao; HOJAIJ, Flyvio; AKAMATSU, Flyvia; ANDRADE, Mauro; JACOMO, Alfredo
Histopathological markers as clinical indicators of early liver transplantation in biliary atresia
(2012) LONGO-SANTOS, L. R.; TEODORO, W.; VELOSA, A. P.; MELLO, E.; PARRA, E.; COELHO, M. C.; ALVES, V.; CAPELOZZI, V.; TANNURI, U.
Objective: Biliary atresia (BA) is the most common neonatal cholestatic disorder and the prime indication for liver transplantation (LTx) in children. Histopathological markers in liver biopsies emerge promise as indicator of early LTx in patients with BA. Method: Ductular proliferation, ductal plate malformations and type I, III, IVand V collagen deposition were evaluated on Kasai portoenterostomy (KPE) and liver transplantation (LTx) biopsies from 36 children with BA. Formalin fixed and paraffin embedded liver biopsies were stained with hematoxylin-eosin, picrosirius-polarization and immunofluorescence methods. There were analyzed liver histoarchitecture, biliary ductus and collagen deposition in hepatic compartments. Pathologic findings were graded according to a 5-point semi-quantitative severity-based scoring system. Impact of these markers was tested on LTx time (<2 year and >2 year). Results: Median age of KPE was 12 weeks (range 6–20) and of LTx was 27 months (range 6–120). In KPE liver biopsies, ductular proliferation, ductal plate malformations and collagen deposition were increased but these parameters presented no association with clinical evolution for early LTx. Furthermore, collagen V prominent deposition was found along of hepatic sinusoids and type I, III and IV were more frequent in portal compartment. Conclusion: These results suggest that histopathological parameters evaluation presented may not determine early LTx in biliary atresia.
Impact of surgery and chemotherapy over renal function in bilateral Wilms tumor patients
(2012) DUARTE, R. J.; CRISTOFANI, L. M.; GIRON, A. M.; DENES, F. T.; ODONE-FILHO, V; TANNURI, U.; SROUGI, M.
INTRODUCTION & OBJECTIVES: Bilateral Wilms’ tumor represents 3% of all cases. The challenge of this situation is curing these patients preserving their renal function and quality of life (dialysis free status). Our purpose was to evaluate the success of renal function preservation in children treated for bilateral Wilms’ tumor. MATERIAL & METHODS: From January/1982 through June/2009, 13 children with bilateral Wilms’ tumor (4F: 9M, median age 16 months) were diagnosed. All patients received preoperative chemotherapy with VCR/ACTD (13 patients), VCR/ACTD/ADRIA (10 patients), VCR/ACTD/ADRIA/CBDCA/ETO (3 patients), VCR/ACTD/ADRIA/CBDCA/ETO/IFO (2 patients), for 8 through 40 weeks (median 16 weeks). All patients were submitted to surgical procedure nephron sparing objective. RESULTS: Radical unilatera l nephrectomy was performed in 9 patients (combined with contralateral nodulectomy in 8), bilateral nodulectomy in 3, and unilateral nodulectomy in 1. Two patients presented unilateral disappearing of the disease after preoperative chemotherapy on image and surgical evaluation. The histhopatological analysis revealed the classic triphasic Wilms’ tumor in 9 patients, rhabdomyoblastic differentiation in 3 and blastematous rests in one patient. Four patients relapsed: 2 in the remaining kidney, 1 in the tumoral bed and 1 in lungs (9mo, 1mo, 5mo and 6 mo after surgery). A ll, except the lung relapsed patient, were rescued, achieving a second remission, but one presented a second diffuse abdominal relapse and died. 11/13 patients have normal renal function and are alive and free of disease for 23+ months to 28+years. 1/13 patients presents microalbuminuria and mild systemic hypertension, requiring medication support. CONCLUSIONS: Bilateral Wilms’ tumor was successfully treated and renal function was preserved in 84.6% of surviving patients, even those cases that received nephrotoxic drugs.
Is prematurity associated with neonatal mortality in severe isolated congenital diaphragmatic hernia after fetal tracheal occlusion?
(2013) RUANO, Rodrigo; SILVA, Marcos; GRASSI, Marcilia; CECCON, Maria; TANNURI, Uenis; ZUGAIB, Marcelo
OBJECTIVE: Fetoscopic tracheal occlusion (FETO) has been indicated for severe isolated CDH. However, this fetal intervention is related with prematurity (mean gestational age at delivery 35 weeks). In this study, we sought to evaluate if prematurity was associated with mortality after FETO. STUDY DESIGN: This is a prospective cohort study of 35 fetuses with severe isolatedCDHthat underwent FETO between 26-30 weeks. Preterm birth (<37 weeks) and extreme preterm birth (<32 weeks) were analyzed according to neonatal mortality using Fisher exact test. Other variables were also evaluated such as the lung-to-head ratio (LHR) prior to FETO, gestational age at FETO, duration of tracheal occlusion and duration of the procedure using t-test and Man-Whitney U test. RESULTS: Survival rate after FETO was 54.3%. Mean gestational age at delivery was 35.9±2.4 weeks in survivors and 34.9±2.8 weeks in those that died (p=0.28). Preterm birth and extreme preterm birth were not associated with mortality (p= 0.51 and p=0.34, respectively). The only variable associated with mortality was the LHR prior to FETO (0.73±0.02 vs. 0.84±0.09; p<0.01). CONCLUSION: In the present cohort of fetuses with severe CDH that underwent FETO, preterm birth and extreme preterm birth were not associated with mortality. The LHR prior to FETO can be used to predict outcome after tracheal occlusion performed between 26-30 weeks.
A NEW MODEL OF LARGE-FOR-SIZE PORCINE LIVER TRANSPLANTATION WITH AORTIC CLAMPING
(2013) LEAL, Antonio Jose Goncalves; BELON, Alessandro Rodrigo; TANNURI, Ana Cristina Aoun; GUIMARAES, Raimundo Renato Nunes; COELHO, Maria Cecilia Mendonca; GONCALVES, Josiane De Oliveira; SOKOL, Suellen Serafini; MELO, Evandro Sobroza De; OTOCH, Jose Pinhata; TANNURI, Uenis
OBJECTIVE: The objective of the present study was to create a swine model of large-for-size liver transplantation, without venovenous bypass but clamping of the supraceliac aorta during the hepatic phase. MATERIAL AND METHODS: Fourteen Landrace-Large white pigs (weight 17 to 20 kg) were anesthetized with continuous infusion of propofol and fentanyl, and mechanically ventilated. They underwent orthotopic liver transplantation(OLT) with whole liver grafts and were divided randomly into two experimental groups, according to donor size. Regular size group (NS-n=7): donors weight were similar to the receptors (17–20 kg). Large-for-size group (LFS-n=7): donors weight was nearly two times the receptor ′ s (40–50 kg). Blood for serum levels of aspartate aminotransferase (AST) and hepatic tissue for histological examination and quantification of Bax (a proapoptotic protein) gene expression though real time PCR were sampled from the recipient at baseline, 1 and 3 h after portal reperfusion. RESULTS: In NS group, one death was related to hemodynamic instability just after aortic release and another due to bleeding by laceration on graft surface. In LFS 1,3 group, the two deaths were associated to hemodynamic instability just after aortic release. Table 1 shows the changes in AST levels over the experiment in both groups. Table 2 presents the histological results. Table 3 shows the results of Bax gene expression for the NS and LFS groups. CONCLUSION: This large-animal model is straightforward, reproducible, and clinically relevant. It provides the appropriate size and anatomy that resemble humans for the development and practice of new surgical techniques.
REX SHUNT FOR ACUTE PORTAL VEIN THROMBOSIS AFTER PEDIATRIC LIVER TRANSPLANT IN CHILDREN WITH BILIARY ATRESIA
(2013) GIBELLI, Nelson Elias Mendes; ANDRADE, Wagner de Castro; VELHOTE, Manoel Carlos Prieto; AYOUB, Ali Abdul Rahman; SILVA, Marcos Marques da; PINHO-APEZZATO, Maria Lucia de; TANNURI, Ana Cristina Aoun; BARROS, Fabio de; RICARDI, Luis Roberto Schlaich; MOREIRA, Daniel de Albuquerque Rangel; MIYATANI, Helena Thie; PEREIRA, Paulo Renato Alencar; TANNURI, Uenis
BACKGROUND/PURPOSE: zPost transplant portal vein thrombosis (PVT)can be extremely disastrous, and portal hypertension and other consequences of the long term privation of portal inflow to the graft may be hazardous, especially in the very young children. Since 1998, Rex shunt has been used successfully to treat these patients. In 2007 we started to perform this surgery in patients with idiopathic PVT and late post transplant PVT. We report our experience with this technique in acute post transplant PVT. METHODS: Case report of six patients (age–12–18 months) submitted to cadaveric (1) and living donor (5) liver transplant (LT). All patients had biliary atresia with portal vein hipoplasia and developed acute portal vein thrombosis (PVT) in the first post-operative day. They were submitted to a mesenteric-portal surgical shunt (Rex shunt) with left internal jugular vein autograft (5) and cadaveric iliac vein graft (1) in the first post-operative day. RESULTS: Current follow-up of 12 months. Postoperative Doppler ultrasounds confirmed shunt patency. There were no biliary complications until now. CONCLUSION: The mesenteric-portal shunt (Rex shunt) with left internal jugular vein autograft should be considered in children with acute PVT after liver transplantation. These children usually have small portal veins, and reanastomosis is often unsuccessful. In addition, this technique has the advantage that we do not manipulate the biliary anastomosis and the hepatic hilum, thus avoiding biliary complications. Although this is an initial experience, we conclude that this technique is feasible, with great benefits for these patients and with low risks.
LIVER TRANSPLANTATION IN CHILDREN: 14 YEARS OF EXPERIENCE WITH LIVING DONORS
(2013) ANDRADE, Wagner de Castro; VELHOTE, Manoel Carlos Prieto; AYOUB, Ali Abdul Rahman; SILVA, Marcos Marques da; GIBELLI, Nelson Elias Mendes; PINHO-APEZZATO, Maria Lucia de; TANNURI, Ana Cristina Aoun; BARROS, Fabio de; RICARDI, Luis Roberto Schlaich; MOREIRA, Daniel de Albuquerque Rangel; MIYATANI, Helena Thie; PEREIRA, Paulo Renato Alencar; TANNURI, Uenis
OBJECTIVES: Report on the experience with 170 living donors in pediatric liver transplantation. MATERIAL AND METHODS: Retrospective analysis of the medical records of donors operated between June 1998 and October 2012. RESULTS: Over the past 14 yrs, 169 liver transplants were performed in pediatric recipients of living donor grafts. In a potential left lateral segment donor, there was a minor injury in the right branch of portal vein, repaired without consequences for the patient, but resulting in abortion of the transplant. From the remaining donors, 151 left lateral segments (89.34%), 17 left lobes (10.06%) and 1 right lobe (0.6%) were removed. Donor age ranged from 16 to 53 yrs and weight ranged from 47 to 106 kg. Transfusion of blood products was required in 14 donors (8.3%). The mean hospital stay was 5 days. Complications were identified in 21 patients (12.4%): 11 showed intense dyspeptic symptoms and abdominal pain (two patients underwent reoperation), seven presented minor bile leaks, and three developed extra-peritoneal infection (incision abscess, phlebitis and pneumonia). There was no mortality in this series. Eight grafts (4.7%) had primary dysfunction, resulting in death of the recipient (three cases of fulminant hepatitis, one metabolic disease carrier, one Alagille Syndrome carrier and three cases of biliary atresia in infants under 1 yr of age). CONCLUSION: Living-related liver transplantation in children generates low risk and morbidity for the donors of left lobe or left lateral segment grafts, with good outcomes for the recipients, eliminating the disadvantages of the waiting list for cadaveric grafts.
ACUTE LIVER FAILURE WITH ASSOCIATED APLASTIC ANEMIA IN CHILDREN
(2013) MOREIRA, Daniel de Albuquerque Rangel; ANDRADE, Wagner de Castro; VELHOTE, Manoel Carlos Prieto; AYOUB, Ali Abdul Rahman; SILVA, Marcos Marques da; GIBELLI, Nelson Elias Mendes; PINHO-APEZZATO, Maria Lucia de; TANNURI, Ana Cristina Aoun; BARROS, Fabio de; MIYATANI, Helena Thie; PEREIRA, Paulo Renato Alencar; TANNURI, Uenis
OBJECTIVES: Herein we describe the experience of six cases of acute liver failure with associated aplastic anemia treated at ICR – HCFMUSP. MATERIAL AND METHODS: We reviewed the records of patients undergoing liver transplantation for acute liver failure with associated aplastic anemia treated at ICR–HCFMUSP between 2007 and 2012. We collected information regarding the type of treatment offered, diagnosis, bone marrow recovery time, interval between onset of symptoms until liver transplantation and the diagnosis of bone marrow aplasia. RESULTS: In this period we found five patients who met the criteria established, four boys and a girl. The mean age was 9.6 yrs (9–12). The time between onset of symptoms and liver transplantation was 25.2 days (17–30) and until the appearance of pancytopenia 35 days (20–45). Two patients were treated with thymoglobulin and median time to recovery of bone marrow function after treatment was 17.5 days. One patient died from sepsis after treatment and another from bleeding without taking thymoglobulin. CONCLUSION: Aplastic anemia is a potentially fatal complication associated with acute liver failure. There is no standardized treatment in the literature. Reports show cases of liver and bone marrow recovery after immunosuppressive therapy with anti-thymocyte globulin and anti-lymphocytes despite the risk inherent in the use of such substances in critically ill patients the presence of large numbers of activated T lymphocytes in the marrow and liver biopsies from these patients corroborates this therapeutic. In severe cases of aplastic anemia with HLA compatible sibling hematopoietic stem cell transplantation has been performed successfully in the treatment of this condition.

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