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
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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.
conferenceObject Elastography for the Diagnosis and Graduation of Liver Disease in Patients with Long Term Parenteral Nutrition(2021) GALVAO, F.; VEZOZZO, D.; LEE, A.; WAISBERG, D.; ROCHA, M.; NACIF, L.; PINHEIRO, R.; FIGUEIRA, E.; CASSENOTE, A.; CARRILHO, F.; WAITZBERG, D.; CARNEIRO-D'ALBUQUERQUE, L.conferenceObject Prognostic Factors for Recurrence of Sporadic Pancreatic Neuroendocrine Tumors after Surgical Resection(2016) FIGUEIRA, E. R. R.; BACCHELLA, T.; JUREIDINI, R.; CUNHA, J. E. M.; NAMUR, G. N.; RIBEIRO, T. C.; OKUBO, J.; V, A. G. Fernandes; CECCONELLO, I- Anesthetic Conditioning in Liver Transplantation: Results of a Multicenter Randomized Controlled Trial(2013) BONVINI, John M.; SCHADDE, Erik; CLAVIEN, Pierre-Alain; LESURTEL, Mickael; FIGUEIRA, Estela R. R.; FILHO, Joel A. Rocha; REYNTJENS, Koen; BREITENSTEIN, Stefan; BECK-SCHIMMER, BeatriceBackground data: In the age of organ scarcity and the increased use of older and steatotic organ grafts, protective strategies during transplantation are gaining importance. Volatile anesthetics such as sevoflurane attenuate ischemia-reperfusion injury in liver resection and lead to improved clinical outcome. Whether volatile anesthetics change clinical outcome in liver transplantation is unknown. Methods: Cadaveric liver recipients were randomized from 03/2009 to 08/2012 at three University Centers (Zurich, Sao Paulo, Ghent). Standard liver transplant patients were randomly assigned to propofol anesthesia (control group) or conditioning with sevoflurane (sevoflurane group). Postoperative peak of the aspartate transaminase (AST) was defined as primary endpoint. Secondary endpoints were in-hospital complications, hospital- and ICU stay. Results: Ninety-eight patients, who underwent liver transplantation, were randomized to propofol (n=48) or sevoflurane (n=50). Peak AST after transplantation was 925 U/l (512-3274) in the propofol group (p=0.73) and 1097 U/l (interquartile range 540-2633) in the sevofluorane one. While the overall complication rate was not different, there was a trend towards less severe complications in the sevoflurane group: median complication score was grade IIIa (IQR II-IVb) for the propofol and grade II (IQR 0-IIIb) for the sevoflurane group (Odds ratio 0.51, 0.24 to 1.09, p=0.08). Conclusions: This first multicenter trial with different anesthesia regimens in liver transplantation showed comparable surrogate markers postoperatively, but a trend towards less severe complications in the sevoflurane group. Future trials should be adequately powered to assess complications and identify subgroups, which might benefit from anesthetic conditioning.
- 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