ALBERTO LUIZ MONTEIRO MEYER
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
15 resultados
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- Laparoscopically excised retroperitoneal presacral Schwannoma: atypical pre and postoperative manifestations - case report(2019) CARVALHO, Barbara Justo; MEDEIROS, Kayo Augusto de Almeida; MARTINES, Diego Ramos; NII, Fernanda; PIPEK, Leonardo Zumerkorn; MESQUITA, Gustavo Heluani Antunes de; D'ALBUQUERQUE, Luiz Augusto Carneiro; MEYER, Alberto; ANDRAUS, WellingtonBackground We are a reporting a rare case of retroperitoneal schwanomma with atypical pre and postoperative manifestations. Retroperitoneal schwannomas are rare tumors that are difficult to preoperatively diagnose. Case presentation This is a case report of a male patient, 41 years old, with symptoms of hipogastric and lower right member pain, as well as a history of a papilliferous thyroid tumor. Computerized tomography exams were inconclusive, showing a mass in the presacral region with dimensions of 4.4 x 3.9 x 3.4 cm. Removal was carried out by laparoscopic surgery, with self-limited postoperative complications. Diagnosis was carried out by anatomopathological examination, and syndromic hypotheses were discarded. Conclusions The postoperative complications of schwanomma are little reported in the literature. In the simultaneous occurrence of schwanomma and other endocrine tumors, further studies are warranted to better differentiate the cases that need investigation of syndromic causes.
- The impact of properly diagnosed sarcopenia on postoperative outcomes after gastrointestinal surgery: A systematic review and meta-analysis(2020) PIPEK, Leonardo Zumerkorn; BAPTISTA, Carlos Guilherme; NASCIMENTO, Rafaela Farias Vidigal; TABA, Joao Victor; SUZUKI, Milena Oliveira; NASCIMENTO, Fernanda Sayuri do; MARTINES, Diego Ramos; NII, Fernanda; IUAMOTO, Leandro Ryuchi; CARNEIRO-D'ALBUQUERQUE, Luiz Augusto; MEYER, Alberto; ANDRAUS, WellingtonBackground Sarcopenia is defined as the loss of muscle mass combined with loss of muscle strength, with or without loss of muscle performance. The use of this parameter as a risk factor for complications after surgery is not currently used. This meta-analysis aims to assess the impact of sarcopenia defined by radiologically and clinically criteria and its relationship with complications after gastrointestinal surgeries. Materials and methods A review of the literature was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO registration number: CRD42019132221). Articles were selected from the PUBMED and EMBASE databases that adequately assessed sarcopenia and its impact on postoperative complications in gastrointestinal surgery patients. Pooled estimates of pre-operative outcome data were calculated using the odds ratio (OR) and 95% confidence interval (CI). Subgroup analysis were performed to assess each type of surgery. Results The search strategy returned 1323, with 11 studies meeting the inclusion criteria. A total of 4265 patients were analysed. The prevalence of sarcopenia between studies ranged from 6.8% to 35.9%. The meta-analysis showed an OR for complications after surgery of 3.01 (95% CI 2.55-3.55) and an OR of 2.2 (95% CI 1.44-3.36) for hospital readmission (30 days). Conclusion Sarcopenia, when properly diagnosed, is associated with an increase in late postoperative complications, as well as an increase in the number of postoperative hospital readmissions for various types of gastrointestinal surgery. We believe that any preoperative evaluation should include, in a patient at risk, tests for the diagnosis of sarcopenia and appropriate procedures to reduce its impact on the patient's health.
- Instrument to evaluate the knowledge of patient with cirrhosis on his disease: construction and validity(2021) STELMACH, Mariana; MEDEIROS, Kayo Augusto de Almeida; CARVALHO, Barbara Justo; PIPEK, Leonardo Zumerkorn; MESQUITA, Gustavo Heluani Antunes de; NII, Fernanda; MARTINES, Diego Ramos; IUAMOTO, Leandro Ryuchi; D'ALBUQUERQUE, Luiz Augusto Carneiro; MEYER, Alberto; ANDRAUS, WellingtonBackgroundThe application of measurement instruments is a strategy to evaluate the patient's knowledge about the disease. This study aims to build an instrument that evaluates the patient's knowledge about liver cirrhosis.MethodThis study includes three phases. The first one was the construction of the instrument based on a literature review. In the second phase, five experts were participated in the evaluation of the instrument, to check the validity of the content. Quantitative and qualitative analyzes were made. The tool used was the CVI (Content Validity Index) and it was used the semantic study of the questions. The third phase was the process of the restructuring the instrument.ResultsThe final version of the instrument consisted of 36 questions. The instrument was evaluated in 91.7 by the average CVI and 94.4% by the universal CVI.ConclusionsThe questions are properly structured and clear, therefore, understandable. Thus, the final instrument presented satisfactory content validity, so that, it reached the aim of this study.
- Comparing dextrose prolotherapy with other substances in knee osteoarthritis pain relief: A systematic review(2022) CORTEZ, Vitor Santos; MORAES, Walter Augusto; TABA, Joao Victor; CONDI, Alberto; SUZUKI, Milena Oliveira; NASCIMENTO, Fernanda Sayuri do; PIPEK, Leonardo Zumerkorn; MATTOS, Vitoria Carneiro de; TORSANI, Matheus Belloni; MEYER, Alberto; HSING, Wu Tu; IUAMOTO, Leandro RyuchiThe objective of this study is to compare the effectiveness of dextrose-prolotherapy with other substances for pain relief in patients with primary knee osteoarthritis. The literature screening was done in January 2021 through Medline (PubMed), EMBASE, and Database of the National Institute of Health based on the following criteria: ran-domized clinical trials that subjected patients with primary knee osteoarthritis who underwent treatment with dextrose-prolotherapy and other substances for pain relief. Paired reviewers independently identified 3381 articles and included 8 trials that met the eligibility criteria. According to the findings of this review, participants that underwent dextrose-prolotherapy showed improvements between baseline and posterior assessments and when compared to saline injections, but when compared to other substances, the results were not clear. Although dextrose-prolotherapy is a useful treatment method by itself, it is still not possible to clearly affirm that it is supe-rior or inferior to its counterparts. There is an urgent need for further studies to bring more evidence to the field.
- Intussusception reveals MUTYH-associated polyposis syndrome and colorectal cancer: a case report(2019) MESQUITA, Gustavo Heluani Antunes de; CARVALHO, Barbara Justo; MEDEIROS, Kayo Augusto de Almeida; NII, Fernanda; MARTINES, Diego Ramos; PIPEK, Leonardo Zumerkorn; JARDIM, Yuri Justi; WAISBERG, Daniel Reis; OBARA, Marcos Takeo; SITNIK, Roberta; MEYER, Alberto; MANGUEIRA, Cristovao Luis PitangueirasBackground: We are reporting a rare case of MUTYH-associated polyposis, a colorectal cancer hereditary syndrome, diagnosticated after an intussusception. Colorectal cancer is an important cause of cancer related mortality that can be manifested by an intussusception, a rare occurrence in adults and almost always related to tumors. Approximately 5% of colorectal cancers can be attributed to syndromes known to cause hereditary colorectal cancer, such as MUTYH-associated polyposis, autosomal genetic syndrome associated with this disease. Case presentation: We present the case of a 44years old male, that sought medical consultation with a complaint of abdominal discomfort, that after five days changed its characteristics. The patient was sent to the emergency department were a CT-scan revealed intestinal sub-occlusion by ileocolic invagination. Right colectomy was carried out. The anatomic-pathological examination revealed a moderately differentiated mucinous adenocarcinoma and multiples sessile polyps, which led to the suspicion of a genetic syndrome. In the genetics analysis two mutations were observed in the MUTYH gene, and MUTYH-associated polyposis was diagnosticated. Conclusion: This case demonstrates the importance of meticulous analysis of the patient examinations results to identify possible discrete alterations that can lead to improved understanding of disease.
- Cirrhosis and hernia repair in a cohort of 6352 patients in a tertiary hospital Risk assessment and survival analysis(2022) PIPEK, Leonardo Zumerkorn; CORTEZ, Vitor Santos; TABA, Joao Victor; SUZUKI, Milena Oliveira; NASCIMENTO, Fernanda Sayuri do; MATTOS, Vitoria Carneiro de; MORAES, Walter Augusto; IUAMOTO, Leandro Ryuchi; HSING, Wu Tu; CARNEIRO-D'ALBUQUERQUE, Luiz Augusto; MEYER, Alberto; ANDRAUS, WellingtonThe prevalence of hernias in patient with cirrhosis can reach up to 40%. The pathophysiology of cirrhosis is closely linked to that of the umbilical hernia, but other types are also common in this population. The aim of this study is to evaluate factors that influence in the prognosis after hernia repair in patients with cirrhosis. A historical cohort of 6419 patients submitted to hernia repair was gathered. Clinical, epidemiological data and hernia characteristics were obtained. For patient with cirrhosis, data from exams, surgery and follow-up outcomes were also analyzed. Survival curves were constructed to assess the impact of clinical and surgical variables on survival. 342 of the 6352 herniated patients were cirrhotic. Patient with cirrhosis had a higher prevalence of umbilical hernia (67.5% x 24.2%, P<.001) and a lower prevalence of epigastric (1.8% x 9.0%, P<.001) and lumbar (0% x 0.18%, P=.022). There were no significant differences in relation to inguinal hernia (P=.609). Ascites was present in 70.1% of patient with cirrhosis and its prevalence was different in relation to the type of hernia (P<.001). The survival curve showed higher mortality for emergency surgery, MELD>14 and ascites (HR 12.6 [3.79-41.65], 4.5 [2.00-10.34], and 6.1 [1.15-20.70], respectively, P<.05). Hernia correction surgery in patient with cirrhosis has a high mortality, especially when performed under urgent conditions associated with more severe clinical conditions of patients, such as the presence of ascites and elevated MELD.
- Analysis of biliary MICRObiota in hepatoBILIOpancreatic diseases compared to healthy people [MICROBILIO]: Study protocol(2020) NASCIMENTO, Fernanda Sayuri do; SUZUKI, Milena Oliveira; TABA, Joao Victor; MATTOS, Vitoria Carneiro de; PIPEK, Leonardo Zumerkorn; D'ALBUQUERQUE, Eugenia Machado Carneiro; IUAMOTO, Leandro; MEYER, Alberto; ANDRAUS, Wellington; PINHO, Joao Renato Rebello; MOURA, Eduardo Guimaraes Hourneaux de; SETUBAL, Joao Carlos; CARNEIRO-D'ALBUQUERQUE, Luiz AugustoBackground The performance of the microbiota is observed in several digestive tract diseases. Therefore, reaching the biliary microbiota may suggest ways for studies of biomarkers, diagnoses, tests and therapies in hepatobiliopancreatic diseases. Methods Bile samples will be collected in endoscopic retrograde cholangiopancreatography patients (case group) and living liver transplantation donors (control group). We will characterize the microbiome based on two types of sequence data: the V3/V4 regions of the 16S ribosomal RNA (rRNA) gene and total shotgun DNA. For 16S sequencing data a standard 16S processing pipeline based on the Amplicon Sequence Variant concept and the qiime2 software package will be employed; for shotgun data, for each sample we will assemble the reads and obtain and analyze metagenome-assembled genomes. Results The primary expected results of the study is to characterize the specific composition of the biliary microbiota in situations of disease and health. In addition, it seeks to demonstrate the existence of changes in the case of illness and also possible disease biomarkers, diagnosis, interventions and therapies in hepatobiliopancreatic diseases. Trial registration NCT04391426. Registered 18 May 2020, https://clinicaltrials.gov/ct2/show/NCT04391426.
- MICRObiota on BILIOpancreatic malignant diseases [MICROBILIO]: A systematic review(2022) MATTOS, Vitoria Carneiro de; NASCIMENTO, Fernanda Sayuri do; SUZUKI, Milena Oliveira; TABA, Joao Victor; PIPEK, Leonardo Zumerkorn; MORAES, Walter Augusto Fabio; CORTEZ, Vitor Santos; KUBRUSLY, Marcia Saldanha; TORSANI, Matheus Belloni; IUAMOTO, Leandro; HSING, Wu Tu; CARNEIRO-D'ALBUQUERQUE, Luiz Augusto; MEYER, Alberto; ANDRAUS, WellingtonIntroduction: The increase in the incidence of pancreatic and biliary cancers has attracted the search for methods of early detection of diseases and biomarkers. The authors propose to analyze new findings on the association between microbiota and Pancreatic Ductal Adenocarcinoma (PDAC) or Cholangiocarcinoma (CCA). Methods: This systematic review was carried out according to the items of Preferred Reports for Systematic Reviews and Protocol Meta-Analysis (PRISMA-P). This study was registered by the Prospective Register of Systematic Reviews (PROSPERO), identification code CRD42020192748 before the review was carried out. Articles were selected from the PUBMED, EMBASE, and Cochrane databases.Results: Most studies (86.67%) used 16s rRNA as a sequencing method. The main comorbidities found were diabe-tes mellitus, systemic arterial hypertension, and dyslipidemia. Many studies were limited by the small number of participants, but the biases were mostly low. There was very little concordance about the composition of the microbiome of different sites, for both case and control groups when compared to other studies' results. Bile sam-ple analysis was the one with a greater agreement between studies, as three out of four studies found Escherichia in cases of CCA.Conclusion: There was great disagreement in the characterization of both the microbiota of cases and control groups. Studies are still scarce, making it difficult to adequately assess the data in this regard. It was not possible to specify any marker or to associate any genus of microbiota bacteria with PDAC or CCA.
- Change in neoadjuvant chemotherapy could alter the prognosis of patients with pancreatic adenocarcinoma: A case report(2021) MEYER, Alberto; CARVALHO, Barbara J.; MEDEIROS, Kayo A. A.; PIPEK, Leonardo Z.; NASCIMENTO, Fernanda S.; SUZUKI, Milena O.; MUNHOZ, Joao V. T.; IUAMOTO, Leandro R.; CARNEIRO-D'ALBURQUERQUE, Luiz A.; ANDRAUS, WellingtonBACKGROUND Neoadjuvant treatment has become a standard of care for borderline or locally advanced pancreatic cancer and is increasingly considered even for up-front resectable disease. The aim of this article is to present the case of a 62-year-old patient with locally advanced pancreatic adenocarcinoma who was successfully treated with gemcitabine plus nab-paclitaxel after the failure of the first line treatment. CASE SUMMARY Computerized tomography scan and magnetic resonance imaging demonstrated a nodular lesion of ill-defined limits in the body of the pancreas, measuring approximately 4.2 cm x 2.7 cm, with an infiltrative aspect. The tumor had contact with the superior mesenteric vein, splenomesenteric junction and the proximal segment of the splenic artery, causing focal reduction of its lumens. Due to vascular involvement, neoadjuvant chemotherapy treatment with eight cycles of ""folinic acid, 5-fluorouracil, irinotecan and oxaliplatine"" (FOLFIRINOX) were performed. At the end of the cycles, surgery was performed, but the procedure was interrupted due to finding of lesions suspected of metastasis. Gemcitabine plus nab-paclitaxel was then successfully used for neoadjuvant treatment with subsequent R0 surgical resection. CONCLUSION Gemcitabine plus nab-paclitaxel may be effective as an alternative regimen when FOLFIRINOX fails as the first line of treatment, suggesting the need for further studies to identify which patients would benefit from each type of therapeutic approach.
- The development of laparoscopic skills using virtual reality simulations: A systematic review(2021) TABA, Joao Victor; CORTEZ, Vitor Santos; MORAES, Walter Augusto; IUAMOTO, Leandro Ryuchi; HSING, Wu Tu; SUZUKI, Milena Oliveira; NASCIMENTO, Fernanda Sayuri do; PIPEK, Leonardo Zumerkorn; MATTOS, Vitoria Carneiro de; D'ALBUQUERQUE, Eugenia Carneiro; CARNEIRO-D'ALBUQUERQUE, Luiz Augusto; MEYER, Alberto; ANDRAUS, WellingtonBackground Teaching based on virtual reality simulators in medicine has expanded in recent years due to the limitations of more traditional methods, especially for surgical procedures such as laparoscopy. Purpose of review To analyze the effects of using virtual reality simulations on the development of laparoscopic skills in medical students and physicians. Data sources The literature screening was done in April 2020 through Medline (PubMed), EMBASE and Database of the National Institute of Health. Eligibility criteria Randomized clinical trials that subjected medical students and physicians to training in laparoscopic skills in virtual reality simulators. Study appraisal Paired reviewers independently identified 1529 articles and included 7 trials that met the eligibility criteria. Findings In all studies, participants that trained in virtual simulators showed improvements in laparoscopic skills, although the articles that also had a physical model training group did not show better performance of one model compared to the other. Limitations No article beyond 2015 met the eligibility criteria, and the analyzed simulators have different versions and models, which might impact the results. Conclusion Virtual reality simulators are useful educational tools, but do not show proven significant advantages over traditional models. The lack of standardization and a scarcity of articles makes comparative analysis between simulators difficult, requiring more research in the area, according to the model suggested in this review.