RUBENS ANTONIO AISSAR SALLUM
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
8 resultados
Resultados de Busca
Agora exibindo 1 - 8 de 8
- MANAGEMENT OF SYMPTOMS RECURRENCE AFTER MYOTOMY FOR ACHALASIA. A PRACTICAL APPROACH(2023) TUSTUMI, Francisco; SZACHNOWICZ, Sergio; ANDREOLLO, Nelson Adami; SEGURO, Francisco Carlos Bernal da Costa; BIANCHI, Edno Tales; DUARTE, Andre Fonseca; NASI, Ary; SALLUM, Rubens Antonio AissarBACKGROUND: Achalasia is an esophageal motility disorder, and myotomy is one of the most used treatment techniques. However, symptom persistence or recurrence occurs in 9 to 20% of cases. AIMS: This study aims to provide a practical approach for managing the recurrence or persistence of achalasia symptoms after myotomy. METHODS: A critical review was performed to gather evidence for a rational approach for managing the recurrence or persistence of achalasia symptoms after myotomy. RESULTS: To properly manage an achalasia patient with significant symptoms after myotomy, such as dysphagia, regurgitation, thoracic pain, and weight loss, it is necessary to classify symptoms, stratify severity, perform appropriate tests, and define a treatment strategy. A systematic differential diagnosis workup is essential to cover the main etiologies of symptoms recurrence or persistence after myotomy. Upper digestive endoscopy and dynamic digital radiography are the main tests that can be applied for investigation. The treatment options include endoscopic dilation, peroral endoscopic myotomy, redo surgery, and esophagectomy, and the decision should be based on the patient's individual characteristics. CONCLUSIONS: A good clinical evaluation and the use of proper tests jointly with a rational assessment, are essential for the management of symptoms recurrence or persistence after achalasia myotomy.
- Prognostic Value of Bone Marrow Uptake Using 18F-FDG PET/CT Scans in Solid Neoplasms(2022) TUSTUMI, Francisco; ALBENDA, David Gutierrez; PERROTTA, Fernando Simionato; SALLUM, Rubens Antonio Aissar; RIBEIRO JUNIOR, Ulysses; BUCHPIGUEL, Carlos Alberto; DUARTE, Paulo SchiavomBackground: Fluorine-18-fluorodeoxyglucose positron emission tomography/computerized tomography (18F-FDG PET/CT) uptake is known to increase in infective and inflammatory conditions. Systemic inflammation plays a role in oncologic prognosis. Consequently, bone marrow increased uptake in oncology patients could potentially depict the systemic cancer burden. Methods: A single institute cohort analysis and a systematic review were performed, evaluating the prognostic role of 18F-FDG uptake in the bone marrow in solid neoplasms before treatment. The cohort included 113 esophageal cancer patients (adenocarcinoma or squamous cell carcinoma). The systematic review was based on 18 studies evaluating solid neoplasms, including gynecological, lung, pleura, breast, pancreas, head and neck, esophagus, stomach, colorectal, and anus. Results: Bone marrow 18F-FDG uptake in esophageal cancer was not correlated with staging, pathological response, and survival. High bone marrow uptake was related to advanced staging in colorectal, head and neck, and breast cancer, but not in lung cancer. Bone marrow 18F-FDG uptake was significantly associated with survival rates for lung, head and neck, breast, gastric, colorectal, pancreatic, and gynecological neoplasms but was not significantly associated with survival in pediatric neuroblastoma and esophageal cancer. Conclusion: 18F-FDG bone marrow uptake in PET/CT has prognostic value in several solid neoplasms, including lung, gastric, colorectal, head and neck, breast, pancreas, and gynecological cancers. However, future studies are still needed to define the role of bone marrow role in cancer prognostication.
- 18F-FDG-PET/CT-measured parameters as potential predictors of residual disease after neoadjuvant chemoradiotherapy in patients with esophageal carcinoma(2022) TUSTUMI, Francisco; ALBENDA, David Gutiérrez; SALLUM, Rubens Antonio Aissar; NAHAS, Sergio Carlos; RIBEIRO JUNIOR, Ulysses; BUCHPIGUEL, Carlos Alberto; CECCONELLO, Ivan; DUARTE, Paulo SchiavomAbstract Objective: To evaluate the maximum and mean standardized uptake values, together with the metabolic tumor value and the total lesion glycolysis, at the primary tumor site, as determined by 18F-fluorodeoxyglucose positron-emission tomography/computed tomography (18F-FDG-PET/CT), performed before and after neoadjuvant chemoradiotherapy (nCRT), as predictors of residual disease (RD) in patients with esophageal cancer. Materials and Methods: The standardized uptake values and the volumetric parameters (metabolic tumor value and total lesion glycolysis) were determined by 18F-FDG-PET/CT to identify RD in 39 patients before and after nCRT for esophageal carcinoma. We used receiver operating characteristic curves to analyze the diagnostic performance of 18F-FDG-PET/CT parameters in the definition of RD. The standard of reference was histopathological analysis of the surgical specimen. Results: Eighteen patients (46%) presented RD after nCRT. Statistically significant areas under the curve (approximately 0.72) for predicting RD were obtained for all four of the variables evaluated after nCRT. Considering the presence of visually detectable uptake (higher than the background level) at the primary tumor site after nCRT as a positive result, we achieved a sensitivity of 94% and a specificity of 48% for the detection of RD. Conclusion: The use of 18F-FDG-PET/CT can facilitate the detection of RD after nCRT in patients with esophageal cancer.
- A case report of esophageal heterotopic pancreas presenting as recurrent mediastinal abscess, treated by minimally invasive esophagectomy(2019) BIANCHI, Edno Tales; TUSTUMI, Francisco; DUARTE, Andre Fonseca; ORTIZ, Evelin Sanchez; SZACHNOWICZ, Sergio; SEGURO, Francisco Carlos Bernal Costa; SALLUM, Rubens Antonio Aissar; CECCONELLO, IvanINTRODUCTION: Heterotopic pancreas is a rare congenital anomaly. We report a case of esophageal heterotopic pancreas complicated by recurrent mediastinal abscess and treated by minimally invasive resection. PRESENTATION OF CASE: A 31-year-old woman was admitted with a history of recurrent chest pain, dysphagia, and heartburn. CT scan revealed focal confined collection in the lower mediastinum surrounding esophagus. Endoscopic ultrasound revealed a subepithelial lesion. The patient was treated by minimally invasive esophagectomy and made an uneventful postoperative recovery. DISCUSSION: The management of subepithelial lesions would depend on their size, ability to exclude other etiologies and their associated symptoms. The patient, in this case, was obviously symptomatic and accurate differentiation from malignant etiologies could not be accurately made. CONCLUSION: Although pancreatic heterotopia is rare, it should be remembered in the differential diagnosis of various gastrointestinal lesions. (C) 2019 The Author(s).
- Surgical treatment of Killian-Jamieson diverticulum: A case report and literature review(2019) JEISMANN, Vagner Birk; BIANCHI, Edno Tales; SZACHNOWICZ, Sergio; SEGURO, Francisco Carlos Bernal da Costa; TUSTUMI, Francisco; DUARTE, Andre Fonseca; SALLUM, Rubens Antonio Aissar; CECCONELLO, IvanThis study describes a patient with symptomatic Killian-Jamieson, a rare entity, successfully treated by cervical approach with diverticulum resection and esophagomyotomy.
- Post-esophagectomy Symptomatic Dunbar Syndrome: A rare diagnosis of abdominal pain after surgery(2020) TAKEDA, Flavio Roberto; DARCE, George Felipe Bezerra; SOBRADO, Lucas Faraco; FARIA, Luisa Leitao de; TUSTUMI, Francisco; SALLUM, Rubens Antonio Aissar; ROCHA, Manoel de Souza; RIBEIRO JUNIOR, Ulysses; CECCONELLO, IvanINTRODUCTION: Dunbar syndrome is a rare anatomical abnormality characterized by the extrinsic compression of the celiac trunk by the median arcuate ligament (MAL). Though it is rarely misdiagnosed, the clinical diagnosis may be difficult, especially after complex visceral surgery such as esophagectomy. PRESENTATION OF CASE: A 62-year-old male patient with a squamous cell carcinoma of the distal esophagus, placed under trimodal treatment (chemotherapy, radiotherapy followed by hybrid minimal invasive 2-field esophagectomy) presented with abdominal pain refractory to analgesics, anti-spasmodic, opioids, and neuronal celiac plexus ablation in the late post-operative period. He was diagnosed with extrinsic celiac trunk compression based on abdominal angiotomography findings. Retrospectively, similar images were found in conventional abdominal tomography at pre-operative staging, but this time, the patient had only dysphagia. After surgical treatment of MAL, the patient had total relief of pain and symptoms. DISCUSSION: Abdominal pain after complex surgical procedures is very frequent and its investigation is mandatory, even more after refractory clinical management. Dunbar syndrome is related to ambiguous abdominal pain. It is uncommon and its diagnosis with angiotomography is accessible. CONCLUSION: Vascular disorders should be investigated in cases of abdominal pain after complex surgical procedures. (C) 2020 The Authors.
- Variables Associated to Pathologic Complete Response, Overall Survival and Disease-Free Survival in the Neoadjuvant Setting for Esophageal Cancer: A Retrospective Cohort Analysis(2018) TAKEDA, Flavio Roberto; VIYUELA, Mateus Silva; CRUZ JUNIOR, Jurandir Batista da; TUSTUMI, Francisco; BRAGHIROLI, Oddone Freitas Melro; NOBRE, Karolyne Ernesto Luiz; RIBEIRO JUNIOR, Ulysses; SALLUM, Rubens Antonio Aissar; CECCONELLO, IvanObjective: The aim of the study was to evaluate prognostic factors during neoadjuvant therapy that can predict pathologic complete response (pCR), overall survival (OS), or disease-free survival (DFS). Summary of background data: Variables that can predict tumor response to neoadjuvant therapy are required for esophageal cancer management. Methods: A retrospective cohort was performed with esophageal cancer patients submitted to neoadjuvant therapy. pCR, OS, and DFS were evaluated. Logistic regression was used to evaluate prognostic factors. This study covered 140 patients, 94 squamous cell carcinomas (SCC), and 44 adenocarcinomas. SCC is more often associated with pCR (compared to adenocarcinoma, OR: 8.07, 95% CI: 2.91-22.38); it has higher probability of DFS (HR for death or recurrence was 0.6, 95% CI: 0.37-0.98); and a higher probability of OS (HR for death was 0.59, 95% CI: 0.35-1). Gender, age, grade of cellular differentiation, chemotherapy regimen, and neoplasm circumferential involvement before neoadjuvant therapy are variables that are unrelated to DFS. Relief of dysphagia, and weight gain were also unrelated to the outcomes. In the multivariate analysis, the weight loss during neoadjuvant therapy was related to higher risk for recurrence or death (HR 1.02, 95% CI: 1-1.04). SCC histologic type was associated with higher probability of pCR, and higher OS and DFS rates. Gender, grade of cellular differentiation, and chemotherapy regimen are variables that are unrelated to pCR, OS, and DFS. Relief of dysphagia and increased levels of albumin after neoadjuvant therapy were also unrelated to the studied outcomes. Weight loss during neoadjuvant chemotherapy was associated with poor DFS rate in the multivariate analysis.
- Preoperative botulinum toxin type A: A case report of a proposed new strategy for giant hiatal hernia management(2020) TUSTUMI, Francisco; BIANCHI, Edno Tales; SZACHNOWICZ, Sergio; CEDRO, Rider May; MIRANDA NETO, Antonio Afonso de; MORRELL, Andre Luiz Gioia; ABDALLA, Ricardo Zugaib; SALLUM, Rubens Antonio Aissar; CECCONELLO, IvanThe use of preoperative ventral botulinum toxin for giant hiatal hernia management.