Carlos Sobrado - Academia.edu (original) (raw)
Papers by Carlos Sobrado
Journal of Crohn's and Colitis, 2020
Background Perianal Crohn’s disease (PCD) is the main risk factor for squamous cells carcinoma (S... more Background Perianal Crohn’s disease (PCD) is the main risk factor for squamous cells carcinoma (SCC). The incidence of SCC in PCD patients is 0.26 per 1000 patients-years, affects females more than males, develops on average at 42 years of age, which is earlier than general population. Although epidemiological studies have shown that most anal cancers are associated with HPV infection, predominantly oncogenic types 16 and 18.1 prevalence of HPV on perianal Crohn`s disease (PCD) remains unknown. We aimed to estimate the Prevalence of HPV and the subtypes more frequently associated with PCD. Methods Adults with fistulising PCD under immunosuppressed medications who have required surgical intervention, were transversally recruited. A biopsy sample was obtained from perianal fistula tract during under anesthesia exam. INNO-LiPA test was performed on paraffin blocks containing fistula path for HPV testing. Results A total number of 45 PCD patients were recruited and underwent surgical in...
American Journal of Case Reports, 2021
Objective: Rare disease Background: Anorectal mucosal melanoma (AMM) is a rare and aggressive neo... more Objective: Rare disease Background: Anorectal mucosal melanoma (AMM) is a rare and aggressive neoplasm, with a 5-year survival rate of 10%. Due to its rarity and nonspecific symptoms, the diagnosis is often made late. Surgical resection remains the criterion standard for treatment of anorectal melanoma. Case Report: We present the case of an 81-year-old woman presenting with hematochezia, anal secretion, tenesmus, difficulty in defecation, and perianal pain. On physical examination, there was a prolapse of a 5-cm melanocytic nodule in the anal canal, hard on palpation. Biopsy confirmed anorectal melanoma. Staging revealed anal and metastatic disease, with adrenal, lymphatic, and hepatic involvement. As the patient continued to have bleeding, severe pain, and difficulty in defecation, she was submitted to a wide local excision. At 5-month followup, the anal lesion had relapsed, and the patient died 10 months after the procedure. Conclusions: AMM is a rare and extremely aggressive tumor. Symptoms are nonspecific but early diagnosis should be pursued to allow curative treatment. Surgical resection with free margins is the goal of surgical treatment. New therapies are being studied, including immunotherapy, which can improve the dismal prognosis of this rare disease.
Arquivos de Gastroenterologia, 2015
Objectives - Anemia is the most common hematological alteration in patients with Crohn's dise... more Objectives - Anemia is the most common hematological alteration in patients with Crohn's disease, and is frequently related to intestinal inflammatory activity. Its cause is multifactorial and mostly associated with absolute iron deficiency (iron deficiency anemia) and/or functional iron deficiency (inflammation anemia or anemia of chronic disease). It may also be identified through other causes, such as folic acid or vitamin B12 deficiency and secondary to adverse effects from medications (salicylic derivatives and immunosuppressive drugs). In the present study, patients with active Crohn's disease and anemia were evaluated and treated with intravenous ferric carboxymaltose. We discuss the therapeutic schemes (doses), safety, results and improvement of quality of life. Methods - In the present prospective study, 10 consecutive patients with Crohn's disease, with moderate to severe activity, with anemia (Hb: 6.7 to 10 g/dL), who were attended between March 2014 and March...
Rev. Hosp. Clin. Fac. …, 1998
Resumo: Desde o primeiro exame de fibrocolonoscopia em 1969, o continuo aperfeiçoamento das técni... more Resumo: Desde o primeiro exame de fibrocolonoscopia em 1969, o continuo aperfeiçoamento das técnicas para a sua execuçäo bem como a perspectiva terapeutica sobre inumeras doenças do intestino grosso foram os responsáveis pela propagaçäo e ...
Rev. Hosp. Clin. Fac. …, 1989
sbcp.org.br
ARTIGOS ORIGINAIS AVALIAÇÃO COMPUTADORIZADA DO ESVAZIAMENTO RETAL EM VOLUNTÁRIOS ASSINTOMÁTICOS. ... more ARTIGOS ORIGINAIS AVALIAÇÃO COMPUTADORIZADA DO ESVAZIAMENTO RETAL EM VOLUNTÁRIOS ASSINTOMÁTICOS. CARLOS WALTER SOBRADO JÚNIOR -TSBCP CARLOS EDUARDO FONSECA PIRES SERGIO ...
ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo), 2020
Background: Transanal haemorrhoidal dearterialization with mucopexy (THD-M) is a valuable option ... more Background: Transanal haemorrhoidal dearterialization with mucopexy (THD-M) is a valuable option for treating patients with haemorrhoidal disease. However, there is still controversy with regard to its efficacy for more advanced grades. Aim: To evaluate the effectiveness of THD-M technique for treating hemorrhoidal disease and to compare the immediate and late results in different grades. Method: Seven hundred and five consecutive patients with Goligher’s grade II, III or IV symptomatic haemorrhoids underwent surgical treatment using the THD-M method in five participating centres. Six well-trained and experienced surgeons operated on the patients. Average follow-up was 21 months (12-48). Results: Intraoperative complications were observed in 1.1% of cases, including four cases of haematoma, two of laceration of the mucosa, and two of bleeding. All of these were controlled by means of haemostatic suturing. In relation to postoperative complications, the most common of these were as f...
The American Journal of Gastroenterology, 2019
fact that it was necessary and an additional 22% were anxious about starting treatment. Patients ... more fact that it was necessary and an additional 22% were anxious about starting treatment. Patients started on tofacitinib first-line were significantly more likely to feel "excited" about beginning treatment than patients initiated on a first line biologic. CONCLUSION(S): With increased evidence of the success of early and aggressive use of biologics or JAKs for the treatment of IBD, it is important for gastroenterologists to begin having discussions with their patients at the first sign of necessity. On average, patients are not initiated on their first biologic or JAK treatment for over four months after physicians first propose the treatment options to their patients. Furthermore, physicians assess that over one in five of their first line biologic or JAK treated patients should have begun treatment earlier in their disease and a similar percent are reportedly "anxious" about starting advanced systemic therapy.
The American Journal of Gastroenterology, 2019
The American Journal of Gastroenterology, 2019
The American Journal of Gastroenterology, 2019
BACKGROUND: Inflammatory Bowel Disease (IBD) is a group of disorders that are characterized by ch... more BACKGROUND: Inflammatory Bowel Disease (IBD) is a group of disorders that are characterized by chronic or recurrent immune activation and inflammation of the digestive tract. The two main forms of IBD are Crohn's disease (CD) and Ulcerative Colitis (UC), both share many clinical and epidemiological characteristics, indicating that the underlying etiopathogenesis may be similar. Even though both illnesses are very different, with divergent treatment and prognosis, from a clinical point of view Crohn's disease cannot be distinguished from UC in approximately 10% of cases, in this particular case the disease is referred to as indeterminate colitis. There are many investigations that relate the use of applied biotechnology (antiTNF) and its immunomodulatory response at the histological level in the treatment of inflammatory bowel disease, however this therapeutic effect has never been reported in the Mexican population. METHODS: Objective: To correlate the use of antiTNF drugs and their effect at histological levels in inflammatory bowel disease in patients treated in the gastroenterology ward of the Centro Medico Nacional 20 de Noviembre. Observational, analytical and retrospective study. For qualitative variables, total values and percentages will be used, for quantitative variables central tendency measures such as mean and standard or median deviation will be used with minimum and maximum, as the case may be, according to normality tests (Shapiro-Wilck and kolmogorov-Smirnov). For the intragroup correlation analysis of histological activity and use of anti-TNF in patients with inflammatory bowel disease, Wilcoxon and McNemar test will be used according to the type of variable. The values of p , 0.05 will be considered statistically significant. RESULTS: A total of 18 patients with Crohn's disease in which 61.1% were of male sex and a total of 27 patients had UC of which 51.9% were of female sex, were analysed. The most used anti-TNF in patients with Crohn's disease was Adalimumab and Certolizumab in an equitable percentage with 38.9%. On the other hand, infliximab was the least used, with 22.2%. In patients with UC, a predominance of infliximab was observed with 40.7%, followed by adalimumab with 33.3% and certolizumab with 25.9%. The disease activity determined by histopathology indicated that patients with Crohn's disease had mostly moderate histopathological activity indexes with 66.7% and severe only in 33.3%. More severe histopathological activity indexes predominated in UC with 74.1%. CONCLUSION(S): The correlation of histological activity and use of anti-TNF in patients with inflammatory bowel disease was demonstrated in this analysis. For IBD in our center, a very high response to biological management was found. However, it is much lower for adalimumab compared to infliximab and certolizumab, showing a significant difference with a "p" of 0.009 for Crohn's and ,0.001 for CUCI.
Alimentary Pharmacology Therapeutics, 2010
Journal of Coloproctology, 2015
The objective of this study was to evaluate the consensus of expert societies and published guide... more The objective of this study was to evaluate the consensus of expert societies and published guidelines on the management of ulcerative colitis, and to compare with the experience of the authors, in order to standardize procedures that would help the reasoning and decision-making process of the physician. A search was performed in scientific literature, specifically in electronic databases: Medline/Pubmed, SciELO, EMBASE and Cochrane, and the following descriptors were used: ulcerative colitis, acute colitis, clinical treatment, surgery and randomized trial. It can be concluded that the goals of therapy in ulcerative colitis are clinical and endoscopic remission, deep, sustained remission without corticosteroids, prevention of hospitalizations and surgeries, and improved quality of life. The surgical indications are reserved for selected cases, ranging from medical intractability, complications (severe refractory acute colitis, toxic megacolon, perforation and hemorrhage) and maligna...
Revista do Hospital das Clínicas
In spite of the high incidence of pilonidal disease at young population and prolonged disabling p... more In spite of the high incidence of pilonidal disease at young population and prolonged disabling period that it demands, colorectal surgeons have not reached consensus about etiology or best treatment for this condition. The authors intend to analyse results from 154 cases operated on at HCFMUSP through a retrospective chart analysis regarding patients' sex, age and race, operative technique, complications and recurrence. Half patients were male. Eighty-three percent were between 11 and 30 yr-old. Incision and curettage was offered to 74.7% of the patients. Excision technique was used in 25.3%. In patients who underwent excision technique, there were no recurrences and a cicatrization defect was diagnosed in 2 (5.1%) patients. For patients who underwent incision and curettage, recurrence was 3.5% and cicatrization defect was seen in 1 (0.9%) case. Excision or incision plus curettage techniques seem to be both effective for treatment of chronic pilonidal disease although the forme...
Revista do Hospital das Clínicas
Since results from non-surgical procedures designed for treatment of chronic anal fissure are sti... more Since results from non-surgical procedures designed for treatment of chronic anal fissure are still controversial, sphincterotomy remain as the "state of the art" therapy for this condition. In a retrospective basis, the authors intend to review results from treatment of chronic anal fissure in 220 patients who underwent surgical procedure between 1984 and 1995. Data from chart review included age, sex, location of the lesion at the canal anal, associated anorectal disease, delivered surgical technique and complications. Seventy per cent of the patients were male. Mean age was 37.1 years. Fissure was located at the posterior midline in 86.1%. Associated anorectal conditions occurred in 41.4%. Fissurectomy plus posterior sphincterotomy was the treatment of choice in 84.1%. Complications occurred in 5 (2.3%) cases. There were no incontinent patients. Mean follow-up was 2.6 years. The authors conclude that partial internal anal sphincter section produces excellent results in ...
Revista do Hospital das Clínicas
Despite feared by patients and reserved for the minority of patients suffering from hemorrohoids,... more Despite feared by patients and reserved for the minority of patients suffering from hemorrohoids, hemorrhoidectomy remains as the most effective approach to this condition. To analyse results from 475 hemorrhoidectomies performed at University of São Paulo Hospital das Clínicas between 1984 and 1995, a retrospective chart review regarding gender, age, associated anorectal conditions, surgical technique, complications and their management and follow-up was addressed. Two hundred and seven (43.6%) were male. Age between fourth and sixth decades were observed for 70.8%. Associated anorectal conditions were diagnosed in 18.9%. Chronic anal fissure was the commonest one. Milligan-Morgan operation was performed in the majority of patients (91.2%) and Ferguson technique in 6.7%. There were no intraoperative complications postoperative complications occurred in 38 (8%) patients regardless of employed surgical technique. Urinary retention was the commonest postoperative complication. Mean fo...
ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo), 2012
INTRODUÇÃO: O tratamento cirúrgico para hemorroidas deve ter indicação individual e baseia-se no ... more INTRODUÇÃO: O tratamento cirúrgico para hemorroidas deve ter indicação individual e baseia-se no sintoma predominante (sangramento ou prolapso), na gravidade da doença e na presença ou ausência de componente externo (plicoma). Cabe ao cirurgião conhecer as mais variadas técnicas para que possa encontrar o tratamento mais adequado caso a caso. TÉCNICA: O procedimento THD consiste na ligadura alta seletiva e guiada por Doppler de até seis ramos arteriais submucosos que irrigam as hemorroidas, levando à sua desarterialização, associada à correção do prolapso (reparo anorretal ou lifting). Utiliza equipamento e kit especiais. CONCLUSÃO: A técnica do THD tem mostrado bons resultados iniciais. Por ser técnica cirúrgica em que se respeita a anatomia, ela age diretamente sobre a fisiopatologia da afecção e corrige suas principais consequências, ela parece bastante promissora. Sua aplicação inicial pode ser nos pacientes com doença hemorroidária de II grau, que tenham indicação de tratamento...
Revista do Hospital das Clínicas, 2004
The "best" surgical technique for the management of complete rectal prolapse remains un... more The "best" surgical technique for the management of complete rectal prolapse remains unknown. Due to its low incidence, it is very difficult to achieve a representative number of cases, and there are no large prospective randomized trials to attest to the superiority of one operation over another. PURPOSE: Analyze the results of surgical treatment of complete rectal prolapse during 1980 and 2002. METHOD: Retrospective study. RESULTS: Fifty-one patients underwent surgical treatment during this period. The mean age was 56.7 years, with 39 females. Besides the prolapse itself, 33 patients complained of mucous discharge, 31 of fecal incontinence, 14 of constipation, 17 of rectal bleeding, and 3 of urinary incontinence. Abdominal operations were performed in 36 (71%) cases. Presacral rectopexy was the most common abdominal procedure (29 cases) followed by presacral rectopexy associated with sigmoidectomy (5 cases). The most common perineal procedure was perineal rectosigmoidect...
Clinics, 2005
PURPOSE: Anal stenosis is a rare, incapacitating, and challenging condition, occurring mainly aft... more PURPOSE: Anal stenosis is a rare, incapacitating, and challenging condition, occurring mainly after hemorrhoidectomy, for which several surgical techniques have been devised. The purpose of this study was to describe early and late (1 year) results of 77 anoplasty operations performed in the Colorectal Unit of our institution. METHODS: From 1977 to 2002, 77 patients with moderate to severe anal stenosis underwent surgery using two sliding graft techniques: 58 underwent Sarner´s operation and 19 underwent Musiari´s technique. Bilateral flaps were used in 7 patients. RESULTS: Early morbidity was due to pruritus occurring in 2 patients, urinary infection in 1, and temporary incontinence in 1 patient. One patient needed early reoperation following suture line dehiscence. Late results (1 year) were classified as good in 67 cases (87%). There was no reoperation due to recurrence of stenosis. Conclusion: The ease of performance, good functional results, and lack of severe complications show that Sarner´s and Musiari´s flap advancement techniques are effective and safe methods for surgical correction of anal stenosis, particularly when cutaneous fibrosis plays a major role in its etiology.
ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo), 2009
RACIONAL: Atualmente cerca de 90% das operações anorretais podem ser realizadas em regime ambulat... more RACIONAL: Atualmente cerca de 90% das operações anorretais podem ser realizadas em regime ambulatorial. A técnica anestésica é fator fundamental na busca de menor tempo de internamento e redução de custos nestes procedimentos. Não há consenso na literatura sobre qual o melhor tipo de anestesia para essas operações. OBJETIVO: Comparar os custos da técnica de raquianestesia com bupivacaína 0,5% isobárica com a técnica de anestesia venosa com propofol associada ao bloqueio perianal local com lidocaína a 2% e bupivacaína 0,5% (anestesia combinada) em pacientes submetidos a operações anorretais. MÉTODOS: Foram analisados dados de 99 pacientes submetidos à operações anorretais, divididos em dois grupos: grupo I (raquianestesia), composto por 50 pacientes e grupo II (anestesia combinada), composto por 49 pacientes. Foram estudados os procedimentos cirúrgicos, tempo de procedimento anestésico-cirúrgico, tempo de internamento e custos globais de cada paciente. RESULTADOS: Não houve diferença...
Journal of Crohn's and Colitis, 2020
Background Perianal Crohn’s disease (PCD) is the main risk factor for squamous cells carcinoma (S... more Background Perianal Crohn’s disease (PCD) is the main risk factor for squamous cells carcinoma (SCC). The incidence of SCC in PCD patients is 0.26 per 1000 patients-years, affects females more than males, develops on average at 42 years of age, which is earlier than general population. Although epidemiological studies have shown that most anal cancers are associated with HPV infection, predominantly oncogenic types 16 and 18.1 prevalence of HPV on perianal Crohn`s disease (PCD) remains unknown. We aimed to estimate the Prevalence of HPV and the subtypes more frequently associated with PCD. Methods Adults with fistulising PCD under immunosuppressed medications who have required surgical intervention, were transversally recruited. A biopsy sample was obtained from perianal fistula tract during under anesthesia exam. INNO-LiPA test was performed on paraffin blocks containing fistula path for HPV testing. Results A total number of 45 PCD patients were recruited and underwent surgical in...
American Journal of Case Reports, 2021
Objective: Rare disease Background: Anorectal mucosal melanoma (AMM) is a rare and aggressive neo... more Objective: Rare disease Background: Anorectal mucosal melanoma (AMM) is a rare and aggressive neoplasm, with a 5-year survival rate of 10%. Due to its rarity and nonspecific symptoms, the diagnosis is often made late. Surgical resection remains the criterion standard for treatment of anorectal melanoma. Case Report: We present the case of an 81-year-old woman presenting with hematochezia, anal secretion, tenesmus, difficulty in defecation, and perianal pain. On physical examination, there was a prolapse of a 5-cm melanocytic nodule in the anal canal, hard on palpation. Biopsy confirmed anorectal melanoma. Staging revealed anal and metastatic disease, with adrenal, lymphatic, and hepatic involvement. As the patient continued to have bleeding, severe pain, and difficulty in defecation, she was submitted to a wide local excision. At 5-month followup, the anal lesion had relapsed, and the patient died 10 months after the procedure. Conclusions: AMM is a rare and extremely aggressive tumor. Symptoms are nonspecific but early diagnosis should be pursued to allow curative treatment. Surgical resection with free margins is the goal of surgical treatment. New therapies are being studied, including immunotherapy, which can improve the dismal prognosis of this rare disease.
Arquivos de Gastroenterologia, 2015
Objectives - Anemia is the most common hematological alteration in patients with Crohn's dise... more Objectives - Anemia is the most common hematological alteration in patients with Crohn's disease, and is frequently related to intestinal inflammatory activity. Its cause is multifactorial and mostly associated with absolute iron deficiency (iron deficiency anemia) and/or functional iron deficiency (inflammation anemia or anemia of chronic disease). It may also be identified through other causes, such as folic acid or vitamin B12 deficiency and secondary to adverse effects from medications (salicylic derivatives and immunosuppressive drugs). In the present study, patients with active Crohn's disease and anemia were evaluated and treated with intravenous ferric carboxymaltose. We discuss the therapeutic schemes (doses), safety, results and improvement of quality of life. Methods - In the present prospective study, 10 consecutive patients with Crohn's disease, with moderate to severe activity, with anemia (Hb: 6.7 to 10 g/dL), who were attended between March 2014 and March...
Rev. Hosp. Clin. Fac. …, 1998
Resumo: Desde o primeiro exame de fibrocolonoscopia em 1969, o continuo aperfeiçoamento das técni... more Resumo: Desde o primeiro exame de fibrocolonoscopia em 1969, o continuo aperfeiçoamento das técnicas para a sua execuçäo bem como a perspectiva terapeutica sobre inumeras doenças do intestino grosso foram os responsáveis pela propagaçäo e ...
Rev. Hosp. Clin. Fac. …, 1989
sbcp.org.br
ARTIGOS ORIGINAIS AVALIAÇÃO COMPUTADORIZADA DO ESVAZIAMENTO RETAL EM VOLUNTÁRIOS ASSINTOMÁTICOS. ... more ARTIGOS ORIGINAIS AVALIAÇÃO COMPUTADORIZADA DO ESVAZIAMENTO RETAL EM VOLUNTÁRIOS ASSINTOMÁTICOS. CARLOS WALTER SOBRADO JÚNIOR -TSBCP CARLOS EDUARDO FONSECA PIRES SERGIO ...
ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo), 2020
Background: Transanal haemorrhoidal dearterialization with mucopexy (THD-M) is a valuable option ... more Background: Transanal haemorrhoidal dearterialization with mucopexy (THD-M) is a valuable option for treating patients with haemorrhoidal disease. However, there is still controversy with regard to its efficacy for more advanced grades. Aim: To evaluate the effectiveness of THD-M technique for treating hemorrhoidal disease and to compare the immediate and late results in different grades. Method: Seven hundred and five consecutive patients with Goligher’s grade II, III or IV symptomatic haemorrhoids underwent surgical treatment using the THD-M method in five participating centres. Six well-trained and experienced surgeons operated on the patients. Average follow-up was 21 months (12-48). Results: Intraoperative complications were observed in 1.1% of cases, including four cases of haematoma, two of laceration of the mucosa, and two of bleeding. All of these were controlled by means of haemostatic suturing. In relation to postoperative complications, the most common of these were as f...
The American Journal of Gastroenterology, 2019
fact that it was necessary and an additional 22% were anxious about starting treatment. Patients ... more fact that it was necessary and an additional 22% were anxious about starting treatment. Patients started on tofacitinib first-line were significantly more likely to feel "excited" about beginning treatment than patients initiated on a first line biologic. CONCLUSION(S): With increased evidence of the success of early and aggressive use of biologics or JAKs for the treatment of IBD, it is important for gastroenterologists to begin having discussions with their patients at the first sign of necessity. On average, patients are not initiated on their first biologic or JAK treatment for over four months after physicians first propose the treatment options to their patients. Furthermore, physicians assess that over one in five of their first line biologic or JAK treated patients should have begun treatment earlier in their disease and a similar percent are reportedly "anxious" about starting advanced systemic therapy.
The American Journal of Gastroenterology, 2019
The American Journal of Gastroenterology, 2019
The American Journal of Gastroenterology, 2019
BACKGROUND: Inflammatory Bowel Disease (IBD) is a group of disorders that are characterized by ch... more BACKGROUND: Inflammatory Bowel Disease (IBD) is a group of disorders that are characterized by chronic or recurrent immune activation and inflammation of the digestive tract. The two main forms of IBD are Crohn's disease (CD) and Ulcerative Colitis (UC), both share many clinical and epidemiological characteristics, indicating that the underlying etiopathogenesis may be similar. Even though both illnesses are very different, with divergent treatment and prognosis, from a clinical point of view Crohn's disease cannot be distinguished from UC in approximately 10% of cases, in this particular case the disease is referred to as indeterminate colitis. There are many investigations that relate the use of applied biotechnology (antiTNF) and its immunomodulatory response at the histological level in the treatment of inflammatory bowel disease, however this therapeutic effect has never been reported in the Mexican population. METHODS: Objective: To correlate the use of antiTNF drugs and their effect at histological levels in inflammatory bowel disease in patients treated in the gastroenterology ward of the Centro Medico Nacional 20 de Noviembre. Observational, analytical and retrospective study. For qualitative variables, total values and percentages will be used, for quantitative variables central tendency measures such as mean and standard or median deviation will be used with minimum and maximum, as the case may be, according to normality tests (Shapiro-Wilck and kolmogorov-Smirnov). For the intragroup correlation analysis of histological activity and use of anti-TNF in patients with inflammatory bowel disease, Wilcoxon and McNemar test will be used according to the type of variable. The values of p , 0.05 will be considered statistically significant. RESULTS: A total of 18 patients with Crohn's disease in which 61.1% were of male sex and a total of 27 patients had UC of which 51.9% were of female sex, were analysed. The most used anti-TNF in patients with Crohn's disease was Adalimumab and Certolizumab in an equitable percentage with 38.9%. On the other hand, infliximab was the least used, with 22.2%. In patients with UC, a predominance of infliximab was observed with 40.7%, followed by adalimumab with 33.3% and certolizumab with 25.9%. The disease activity determined by histopathology indicated that patients with Crohn's disease had mostly moderate histopathological activity indexes with 66.7% and severe only in 33.3%. More severe histopathological activity indexes predominated in UC with 74.1%. CONCLUSION(S): The correlation of histological activity and use of anti-TNF in patients with inflammatory bowel disease was demonstrated in this analysis. For IBD in our center, a very high response to biological management was found. However, it is much lower for adalimumab compared to infliximab and certolizumab, showing a significant difference with a "p" of 0.009 for Crohn's and ,0.001 for CUCI.
Alimentary Pharmacology Therapeutics, 2010
Journal of Coloproctology, 2015
The objective of this study was to evaluate the consensus of expert societies and published guide... more The objective of this study was to evaluate the consensus of expert societies and published guidelines on the management of ulcerative colitis, and to compare with the experience of the authors, in order to standardize procedures that would help the reasoning and decision-making process of the physician. A search was performed in scientific literature, specifically in electronic databases: Medline/Pubmed, SciELO, EMBASE and Cochrane, and the following descriptors were used: ulcerative colitis, acute colitis, clinical treatment, surgery and randomized trial. It can be concluded that the goals of therapy in ulcerative colitis are clinical and endoscopic remission, deep, sustained remission without corticosteroids, prevention of hospitalizations and surgeries, and improved quality of life. The surgical indications are reserved for selected cases, ranging from medical intractability, complications (severe refractory acute colitis, toxic megacolon, perforation and hemorrhage) and maligna...
Revista do Hospital das Clínicas
In spite of the high incidence of pilonidal disease at young population and prolonged disabling p... more In spite of the high incidence of pilonidal disease at young population and prolonged disabling period that it demands, colorectal surgeons have not reached consensus about etiology or best treatment for this condition. The authors intend to analyse results from 154 cases operated on at HCFMUSP through a retrospective chart analysis regarding patients' sex, age and race, operative technique, complications and recurrence. Half patients were male. Eighty-three percent were between 11 and 30 yr-old. Incision and curettage was offered to 74.7% of the patients. Excision technique was used in 25.3%. In patients who underwent excision technique, there were no recurrences and a cicatrization defect was diagnosed in 2 (5.1%) patients. For patients who underwent incision and curettage, recurrence was 3.5% and cicatrization defect was seen in 1 (0.9%) case. Excision or incision plus curettage techniques seem to be both effective for treatment of chronic pilonidal disease although the forme...
Revista do Hospital das Clínicas
Since results from non-surgical procedures designed for treatment of chronic anal fissure are sti... more Since results from non-surgical procedures designed for treatment of chronic anal fissure are still controversial, sphincterotomy remain as the "state of the art" therapy for this condition. In a retrospective basis, the authors intend to review results from treatment of chronic anal fissure in 220 patients who underwent surgical procedure between 1984 and 1995. Data from chart review included age, sex, location of the lesion at the canal anal, associated anorectal disease, delivered surgical technique and complications. Seventy per cent of the patients were male. Mean age was 37.1 years. Fissure was located at the posterior midline in 86.1%. Associated anorectal conditions occurred in 41.4%. Fissurectomy plus posterior sphincterotomy was the treatment of choice in 84.1%. Complications occurred in 5 (2.3%) cases. There were no incontinent patients. Mean follow-up was 2.6 years. The authors conclude that partial internal anal sphincter section produces excellent results in ...
Revista do Hospital das Clínicas
Despite feared by patients and reserved for the minority of patients suffering from hemorrohoids,... more Despite feared by patients and reserved for the minority of patients suffering from hemorrohoids, hemorrhoidectomy remains as the most effective approach to this condition. To analyse results from 475 hemorrhoidectomies performed at University of São Paulo Hospital das Clínicas between 1984 and 1995, a retrospective chart review regarding gender, age, associated anorectal conditions, surgical technique, complications and their management and follow-up was addressed. Two hundred and seven (43.6%) were male. Age between fourth and sixth decades were observed for 70.8%. Associated anorectal conditions were diagnosed in 18.9%. Chronic anal fissure was the commonest one. Milligan-Morgan operation was performed in the majority of patients (91.2%) and Ferguson technique in 6.7%. There were no intraoperative complications postoperative complications occurred in 38 (8%) patients regardless of employed surgical technique. Urinary retention was the commonest postoperative complication. Mean fo...
ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo), 2012
INTRODUÇÃO: O tratamento cirúrgico para hemorroidas deve ter indicação individual e baseia-se no ... more INTRODUÇÃO: O tratamento cirúrgico para hemorroidas deve ter indicação individual e baseia-se no sintoma predominante (sangramento ou prolapso), na gravidade da doença e na presença ou ausência de componente externo (plicoma). Cabe ao cirurgião conhecer as mais variadas técnicas para que possa encontrar o tratamento mais adequado caso a caso. TÉCNICA: O procedimento THD consiste na ligadura alta seletiva e guiada por Doppler de até seis ramos arteriais submucosos que irrigam as hemorroidas, levando à sua desarterialização, associada à correção do prolapso (reparo anorretal ou lifting). Utiliza equipamento e kit especiais. CONCLUSÃO: A técnica do THD tem mostrado bons resultados iniciais. Por ser técnica cirúrgica em que se respeita a anatomia, ela age diretamente sobre a fisiopatologia da afecção e corrige suas principais consequências, ela parece bastante promissora. Sua aplicação inicial pode ser nos pacientes com doença hemorroidária de II grau, que tenham indicação de tratamento...
Revista do Hospital das Clínicas, 2004
The "best" surgical technique for the management of complete rectal prolapse remains un... more The "best" surgical technique for the management of complete rectal prolapse remains unknown. Due to its low incidence, it is very difficult to achieve a representative number of cases, and there are no large prospective randomized trials to attest to the superiority of one operation over another. PURPOSE: Analyze the results of surgical treatment of complete rectal prolapse during 1980 and 2002. METHOD: Retrospective study. RESULTS: Fifty-one patients underwent surgical treatment during this period. The mean age was 56.7 years, with 39 females. Besides the prolapse itself, 33 patients complained of mucous discharge, 31 of fecal incontinence, 14 of constipation, 17 of rectal bleeding, and 3 of urinary incontinence. Abdominal operations were performed in 36 (71%) cases. Presacral rectopexy was the most common abdominal procedure (29 cases) followed by presacral rectopexy associated with sigmoidectomy (5 cases). The most common perineal procedure was perineal rectosigmoidect...
Clinics, 2005
PURPOSE: Anal stenosis is a rare, incapacitating, and challenging condition, occurring mainly aft... more PURPOSE: Anal stenosis is a rare, incapacitating, and challenging condition, occurring mainly after hemorrhoidectomy, for which several surgical techniques have been devised. The purpose of this study was to describe early and late (1 year) results of 77 anoplasty operations performed in the Colorectal Unit of our institution. METHODS: From 1977 to 2002, 77 patients with moderate to severe anal stenosis underwent surgery using two sliding graft techniques: 58 underwent Sarner´s operation and 19 underwent Musiari´s technique. Bilateral flaps were used in 7 patients. RESULTS: Early morbidity was due to pruritus occurring in 2 patients, urinary infection in 1, and temporary incontinence in 1 patient. One patient needed early reoperation following suture line dehiscence. Late results (1 year) were classified as good in 67 cases (87%). There was no reoperation due to recurrence of stenosis. Conclusion: The ease of performance, good functional results, and lack of severe complications show that Sarner´s and Musiari´s flap advancement techniques are effective and safe methods for surgical correction of anal stenosis, particularly when cutaneous fibrosis plays a major role in its etiology.
ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo), 2009
RACIONAL: Atualmente cerca de 90% das operações anorretais podem ser realizadas em regime ambulat... more RACIONAL: Atualmente cerca de 90% das operações anorretais podem ser realizadas em regime ambulatorial. A técnica anestésica é fator fundamental na busca de menor tempo de internamento e redução de custos nestes procedimentos. Não há consenso na literatura sobre qual o melhor tipo de anestesia para essas operações. OBJETIVO: Comparar os custos da técnica de raquianestesia com bupivacaína 0,5% isobárica com a técnica de anestesia venosa com propofol associada ao bloqueio perianal local com lidocaína a 2% e bupivacaína 0,5% (anestesia combinada) em pacientes submetidos a operações anorretais. MÉTODOS: Foram analisados dados de 99 pacientes submetidos à operações anorretais, divididos em dois grupos: grupo I (raquianestesia), composto por 50 pacientes e grupo II (anestesia combinada), composto por 49 pacientes. Foram estudados os procedimentos cirúrgicos, tempo de procedimento anestésico-cirúrgico, tempo de internamento e custos globais de cada paciente. RESULTADOS: Não houve diferença...