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Physiology and health assessment,risk balance,and model for endstage liver disease scores:Postoperative outcome of liver transplantation

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World Journal of Transplantation 2025年第1期15卷 86-94页

作者： Raquel Hohenreuther Andresa ThoméSilveira Edison Moraes Rodrigues Filho Anderson Garcez Bruna Goularth Lacerda Sabrina Alves Fernandes Claudio Augusto Marroni Postgraduate Program in Hepatology Universidade Federal de Ciências da Saúde de Porto AlegrePorto Alegre 90050-170Brazil department of Intensive Medicine Hospital de Clínicas de Porto AlegrePorto Alegre 90035-903Brazil department of Public Health University of Vale do Rio dos SinosSao Leopoldo 93022-750Brazil

BACKGROUND Liver transplantation aims to increase the survival of patients with end-stage liver diseases and improve their quality of *** number of organs available for transplantation is lower than the *** provide fair organ distribution,predictive mortality scores have been *** To compare the Acute Physiology and Chronic Health Evaluation IV(APACHE IV),balance of risk(BAR),and model for end-stage liver disease(MELD)scores as predictors of *** Retrospective cohort study,which included 283 adult patients in the postoperative period of deceased donor liver transplantation from 2014 to *** The transplant recipients were mainly male,with a mean age of 58.1 *** were mostly male,with a mean age of 41.6 *** median cold ischemia time was 3.1 hours,and the median intensive care unit stay was 5 *** APACHE IV,a mean of 59.6 was found,BAR 10.7,and MELD *** 28-day mortality rate was 9.5%,and at 90 days,it was 3.5%.The 28-day mortality prediction for APACHE IV was very good[area under the curve(AUC):0.85,Pderate for BAR and MELD,respectively,(AUC:0.66,Pdeaths and *** for the best value for liver transplantation,it was significant only for APACHE IV(Pdeceased donor liver transplant recipients.

关键词： Liver transplantation Acute physiology and chronic health evaluation IV Balance of risk Model for end-stage liver disease Mortality Intensive care unit

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Antihypertensive drugs in pregnancy

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Family Medicine and Community Health 2013年第1期1卷 37-50页

作者： ROSE GASNIER EDIMARLEI GONSALES VALERIO JOSE GERALDO LOPES RAMOS Post Graduate Program in Medicine Universidade Federal do Rio Grande do SulHospital de Clinicas de Porto AlegreBrazil Service of Obstetrician and Gynecology Hospital de Clinicas de Porto AlegreBrazil Universidade Federal do Rio Grande do Sul Porto AlegreBrazil

Chronic hypertension complicates 3%-5% of pregnancies and gestational hypertension occurs in 6% of *** complicates 25% of the pregnancies with chronic hypertension,and approximately 15%-45% of the patients with gestational hypertension will develop preeclampsia,a dangerous condition that harms the maternal and fetal *** medication is used to treat severe hypertension to prevent serious maternal and fetal complications,but there is no consensus on when and how to treat mild-to-moderate hypertension in *** article reviews the usage,effect and safety of first,second and third line antihypertensive drugs for mild-to-moderate hypertension in pregnancy.

关键词： Gestational hypertension Mild-to-moderate hypertension Antihypertensive drugs

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Should selection criteria for HCC be the same(or different)between LDLT and DDLT?

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Hepatoma Research 2020年第11期6卷 13-17页

作者： Flavia Feier Liver Transplantation department Hospital de Clinicas de Porto AlegrePorto Alegre 90035-903Brazil Pediatric Liver Transplantation department Irmandade Santa Casa de Porto AlegrePorto Alegre 90020-090Brazil

Since the Milan Criteria(MC)were adopted in many countries as the allocation policy criteria for patients with hepatocellular carcinoma to be transplanted,many groups started to expand it to provide a chance for patients with tumors outside the MC who could achieve similar survival *** the scarcity of deceased donors,Asian countries improved the results with living donor liver transplantation,allowing patients outside MC to be transplanted with a living *** prognostic models and a more profound understanding of tumor behavior are targeting better patient ***,patients are unevenly selected for liver transplantation and mostly separated into those fulfilling the MC and transplanted with a deceased donor and those with expanded criteria and transplanted with a living *** this paper,insight is brought into this debate.

关键词： Living donor hepatocellular carcinoma alpha-fetoprotein

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Giant hepatic extra-gastrointestinal stromal tumor treated with cytoreductive surgery and adjuvant systemic therapy:A case report and review of literature

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World Journal of Gastrointestinal Surgery 2021年第3期13卷 315-322页

作者： Michel Ribeiro Fernandes Caroline Lorenzoni Almeida Ghezzi Tomaz J M Grezzana-Filho Flávia Heinz Feier Ian Leipnitz Aljamir Duarte Chedid Carlos Thadeu Schmidt Cerski Marcio Fernandes Chedid Cléber RositoPinto Kruel department of Gastrointestinal Surgery and Transplantation Hospital de Clínicas de Porto AlegrePorto Alegre 90035-007RSBrazil Division of Radiology Hospital de Clínicas de Porto AlegrePorto Alegre 90035-903RSBrazil department of Pathology Hospital de Clínicas de Porto AlegrePorto Alegre 90035-007RSBrazil

BACKGROUND Primary extra-gastrointestinal stromal tumors(E-GIST)of the liver are *** clinical presentation may range from asymptomatic to bleeding or manifestations of mass *** surgery followed by adjuvant therapy with imatinib is the standard of ***,under specific circumstances,a cytoreductive approach may represent a therapeutic *** describe herein the case of an 84-year-old woman who presented with a tender,protruding epigastric *** computed tomography scan revealed a large,heterogeneous mass located across segments III,IV,V,and VIII of the *** initial approach was transarterial embolization of the tumor,which elicited no appreciable *** the large size and central location of the tumor and the advanced age of the patient,non-anatomic complete resection was *** to substantial intraoperative bleeding and hemodynamic instability,only a near-complete resection could be *** and immunohistochemical staining confirmed the diagnosis of primary E-GIST of the *** the risk/benefit ratio for therapeutic options,debulking surgery may represent a strategy to control pain and prolong *** SUMMARY Here,we present a case report of a patient diagnosed with E-GIST primary of the liver,which was indicated a cytoreductive surgery and adjuvant therapy with *** E-GIST primary of the liver is a rare conditional,the treatment is with systemic therapy and total resection ***,a cytoreductive surgery will be necessary when a complete resection is no possible.

关键词： Extra-gastrointestinal stromal tumor Primary gastrointestinal stromal tumor of the liver Cytoreductive surgery debulking surgery Case report

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Esophagogastric junction outflow obstruction successfully treated with laparoscopic Heller myotomy and Dor fundoplication: First case report in the literature

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World Journal of Gastrointestinal Surgery 2019年第2期11卷 112-116页

作者： Pedro F Pereira Andre RP Rosa Leonardo A Mesquita Marcelle J Anzolch Rafael N Branchi Augusto L Giongo Francisco C Paix?o Marcio F Chedid Cleber DP Kruel Division of Gastrointestinal Surgery and Liver Transplantation Hospital de Clinicas de Porto AlegreFederal University of Rio Grande do Sul

BACKGROUND Esophagogastric junction outflow obstruction(EGJOO) is a rare syndrome,characterized by an elevation of the integrated relaxation pressure of the lower esophageal sphincter, not accompanied by alterations in esophageal motility that may lead to the criteria for achalasia. We were unable to find any prior report of the combination of Heller myotomy with anterior partial fundoplication(Dor) as the treatment for EGJOO. We herein report a case of EGJOO treated with laparoscopic Heller myotomy combined with Dor *** SUMMARY A 26-year-old man presented with a 3-year history of solid dysphagia and a 30-kg weight loss. He was treated with oral nifedipine, isosorbide, and omeprazole,without resolution of symptoms. An upper gastrointestinal series(barium swallow) revealed a "bird's beak" sign. Esophagogastroduodenoscopy was positive for Los Angeles grade A peptic esophagitis. High-resolution esophageal manometry was compatible with EGJOO. Esophageal pH monitoring showed pathological acid reflux both in orthostatic and decubitus position. An 8-cm laparoscopic Heller myotomy combined with an anterior 220° Dor fundoplication was performed. Solid diet was introduced on postoperative day 2, and the patient was discharged home the same day. At 17-mo follow-up, he reported no symptoms. Barium swallow was compatible with complete radiologic *** esophageal manometry and upper endoscopy showed normal findings 9 mo after the *** Surgical treatment with Heller myotomy and Dor fundoplication is a potential treatment option for EGJOO refractory to medical treatment.

关键词： Esophagogastric junction outflow obstruction Heller myotomy Partial fundoplication Dor fundoplication Case report

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Liver preservation prior to transplantation: Past, present, and future

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World Journal of Gastrointestinal Surgery 2019年第3期11卷 122-125页

作者： Marcio F Chedid Marcelo A Pinto Jose Felipe G Juchem Tomaz J M Grezzana-Filho Cleber R P Kruel Liver Transplant and Hepatobiliary Surgery Unit Hospital de Clinicas de Porto AlegreFederal University of Rio Grande do Sul (UFRGS)

Since Dr. Thomas Starzl performed the first series of successful liver transplants(LTs), important advances have been made in immunosuppression, operative techniques, and postoperative care. In 1988, Belzer's group reported the first successful LT using the University of Wisconsin preservation solution(UW).Since then, UW has replaced EuroCollins solution and allowed prolonged and safer preservation of liver, kidney, and pancreas allografts, thus contributing to the improvement of transplant outcomes. Although UW is still considered the standard of care in the United States and in several countries worldwide, a recent meta-analysis revealed similar LT outcomes among UW, Celsior solution, and the Institut Georges Lopez-1 preservation solution, which were slightly superior to those obtained with histidine-tryptophan-ketoglutarate preservation *** preservation has been recently developed, and liver allografts are preserved mainly through the following methods: hypothermic machine perfusion, normothermic machine perfusion, and subnormothermic machine perfusion. Their use has the potential advantage of improving clinical results in LT involving extended criteria donor allografts. Although associated with increased costs, techniques employing machine perfusion of liver allografts have been considered clinically feasible. This editorial focuses on recent advances and future perspectives in liver allograft preservation.

关键词： Liver transplantation University of Wisconsin preservation solution Institute Georges Lopez preservation solution Celsior preservation solution Histidine-tryptophanketoglutarate preservation solution Dymamic preservation Normothermic ischemia Normothermic preservation Hypotermic machine preservation Static cold prreservation

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Incidence of hepatocellular carcinoma in outpatients with cirrhosis in Brazil: A 10-year retrospective cohort study

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World Journal of Gastroenterology 2016年第46期22卷 10219-10225页

作者： Marcelo Campos Appel-da-Silva Suelen Aparecida da Silva Miozzo Isabella de Azevedo Dossin Cristiane Valle Tovo Fernanda Branco Angelo Alves de Mattos Graduate Program:Hepatology Universidade Federal de Ciências da Saúde de Porto Alegre(UFCSPA)Porto AlegreRS 900150-170Brazil Ultrasound Imaging Servince Hospital Santa Casa de Porto AlegrePorto AlegreRS 90050-170Brazil

AIM To determine the incidence of hepatocellular carcinoma(HCC) and the impact of HCC surveillance on early diagnosis and survival of cirrhotic outpatients. METHODS In this retrospective cohort study, cirrhotic outpatients undergoing HCC surveillance between March 2005 and March 2014 were analyzed. Exclusion criteria were HIV coinfection; previous organ transplantation; diagnosis of HCC at first consultation; missing data in the medical chart; and less than 1 year of follow-up. Surveillance was carried out every six months using ultrasound and serum alpha-fetoprotein determination. Ten-year cumulative incidence and survival were estimated through Kaplan-Meier analysis. RESULTS Four hundred and fifty-three patients were enrolled, of which 57.6% were male. Mean age was 55 years. Hepatitis C virus and heavy use of alcohol were the main etiologic agents of cirrhosis. HCC was diagnosed in 75 patients(16.6%), with an estimated cumulative incidence of 2.6% in the 1st year, 15.4% in the 5th year, and 28.8% in the 10 th year. Median survival was estimated at 17.6 mo in HCC patients compared to 234 mo in non-HCC patients(P detected in patients who underwent surveillance every 6 mo or less(P = 0.05). However, survival was not different between patients with early stage vs non-early stage tumors [HR = 0.54(0.15-1.89), P = 0.33].CONCLUSION HCC is a frequent complication in patients with cirrhosis and adherence to surveillance programs favors early diagnosis.

关键词： Liver cirrhosis Hepatocellular carcinoma Epidemiology Surveillance Survival

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Glucose-6-phosphate-dehydrogenase deficiency and its correlation with other risk factors in jaundiced newborns in Southern Brazil

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Asian Pacific Journal of Tropical Biomedicine 2011年第2期1卷 110-113页

作者： Clarissa Gutirrez Carvalho Simone Martins Castro Ana Paula Santin Carina Zaleski Felipe Gutirrez Carvalho Roberto Giugliani Genetics Service Hospital de Clinicas de Porto AlegrePGP in PediatricsUFRGS Pharmacy School UFRGS Medical School UFRGS

Objective:To evaluate the correlation between glucose-6-phosphate-dehydrogenase(G6PD) deficiency and neonatal ***:Prospective,observational case-control study was conducted on 490 newborns admitted to hospital de clinicas de porto alegre for phototherapy, who all experienced 35 or more weeks of gestation,from March to december *** screening of G6PD activity was performed,followed by ***:There was prevalence of 4.6% and a boy-girl ratio of 3:1 in jaundiced *** jaundiced neonate with ABO incompatibility presented G6PD deficiency,and no Mediterranean mutation was found.A higher proportion of deficiency was observed in *** was no association with UGT1A1 variants. Conclusions:G6PD deficiency is not related to severe hyperbilirubinemia and considering the high miscegenation in this area of Brazil,other gene interactions should be investigated.

关键词： Glucosephosphate dehydrogenase Jaundice Hyperbilirubinemia Neonatal Hemoglobin

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Transarterial embolization is an acceptable bridging therapy to hepatocellular carcinoma prior to liver transplantation

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World Journal of Transplantation 2024年第2期14卷 126-134页

作者： Gabriel Lazzarotto-da-Silva Leandro A Scaffaro Mauricio Farenzena Lucas Prediger Rafaela K Silva Flávia Heinz Feier Tomaz J M Grezzana-Filho Pablo D Rodrigues Alexandre de Araujo Mario Reis Alvares-da-Silva Roberta C Marchiori Cleber Rosito Pinto Kruel Marcio Fernandes Chedid department of Liver Transplant and Hepatobiliary Surgery Unit Hospital de Clínicas de Porto AlegrePorto Alegre 90035-007Brazil department of Interventional Radiology Unit Hospital de Clínicas de Porto AlegrePorto Alegre 90035-007Brazil department of Gastroenterology and Hepatology Hospital de Clínicas de Porto AlegrePorto Alegre 90035-007Brazil

BACKGROUND Hepatocellular carcinoma(HCC)is an aggressive malignant neoplasm that requires liver transplantation(LT).despite patients with HCC being prioritized by most organ allocation systems worldwide,they still have to wait for long *** therapies(LRTs)are employed as bridging therapies in patients with HCC awaiting *** largely used in the past,transarterial embolization(TAE)has been replaced by transarterial chemoembolization(TACE).However,the superiority of TACE over TAE has not been consistently shown in the *** To compare the outcomes of TACE and TAE in patients with HCC awaiting *** All consecutive patients with HCC awaiting LT between 2011 and 2020 at a single center were *** patients underwent LRT with either TACE or *** patients also underwent percutaneous ethanol injection(PEI),concom-itantly or in different treatment *** choice of LRT for each HCC nodule was determined by a multidisciplinary *** primary outcome was waitlist dropout due to tumor progression,and the secondary outcome was the occurrence of adverse *** the subset of patients who underwent LT,complete pathological response and post-transplant recurrence-free survival were also *** Twelve(18.5%)patients in the TACE group(only TACE and TACE+PEI;n=65)and 3(7.9%)patients in the TAE group(only TAE and TAE+PEI;n=38)dropped out of the waitlist due to tumor progression(P log-rank test=0.29).Adverse events occurred in 8(12.3%)and 2(5.3%)patients in the TACE and TAE groups,respectively(P=0.316).Forty-eight(73.8%)of the 65 patients in the TACE group and 29(76.3%)of the 38 patients in the TAE group underwent LT(P=0.818).Among these patients,complete pathological response was detected in 7(14.6%)and 9(31%)patients in the TACE and TAE groups,respectively(P=0.145).Post-LT,HCC recurred in 9(18.8%)and 4(13.8%)patients in the TACE and TAE groups,respectively(P=0.756).Posttransplant recurrence-free survival was simila

关键词： Hepatocellular carcinoma Transarterial embolization Transarterial chemoembolization Liver transplantation Locoregional therapy Bridging

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Evolving treatment strategies for colorectal cancer: A critical review of current therapeutic options

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World Journal of Gastroenterology 2014年第4期20卷 877-887页

作者： Daniel C Damin Anderson R Lazzaron Division of Coloproctology Department of Surgery Hospital de Clinicas de Porto Alegre Federal University of Rio Grande do Sul Postgraduate Program in Surgery Federal University of Rio Grande do Sul

Management of rectal cancer has markedly evolved over the last two *** technologies of staging have allowed a more precise definition of tumor *** in surgical concepts and techniques have resulted in higher rates of sphincter preservation and better functional outcome for patients with this ***,preoperative chemoradiotherapy followed by total mesorectal excision has become the standard of care for locally advanced tumors,many controversial matters in management of rectal cancer still need to be *** include the feasibility of a non-surgical approach after a favorable response to neoadjuvant therapy,the ideal margins of surgical resection for sphincter preservation and the adequacy of minimally invasive techniques of tumor *** this article,after an extensive search in PubMed and Embase databases,we critically review the current strategies and the most debatable matters in treatment of rectal cancer.

关键词： Rectal cancer Colorectal cancer Staging Sphincter preservation Neoadjuvant chemo-radiotherapy Surgery

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