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de Souza LR, Magro DO, Teixeira FV, Parra RS, Miranda EF, Féres O, Saad-Hossne R, Soares Prates Herrerias G, Nisihara RM, Coy CSR, Sassaki LY, Kotze PG. Adalimumab Serum Concentrations, Clinical and Endoscopic Disease Activity in Crohn's Disease: A Cross-Sectional Multicentric Latin American Study. Pharmaceutics 2023; 15:pharmaceutics15020586. [PMID: 36839908 PMCID: PMC9967155 DOI: 10.3390/pharmaceutics15020586] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/30/2023] [Accepted: 02/03/2023] [Indexed: 02/12/2023] Open
Abstract
Despite some variability in ideal serum Adalimumab (ADA) concentrations, there is increasing evidence that higher concentrations of anti-TNF-α agents can be associated with sustained efficacy, and low or undetectable levels may lead to loss of response. This study aims to correlate serum ADA concentrations with clinical and endoscopic activity in patients with Crohn's disease (CD). A cross-sectional and multicentric study was performed with patients with CD, who used ADA for at least 24 weeks. Patients were allocated into groups according to the presence of clinical or endoscopic disease activity. Serum ADA concentrations were measured and compared between groups. Overall, 89 patients were included. A total of 27 patients had clinically active CD and 62 were in clinical remission. Forty patients had endoscopic disease activity and 49 were in endoscopic remission. The mean serum ADA concentration was 10.2 μg/mL in patients with clinically active CD and 14.3 μg/mL in patients in clinical remission (p = 0.395). The mean serum ADA concentration in patients with endoscopic activity was 11.3 μg/mL as compared to 14.5 μg/mL in those with endoscopic remission (p = 0.566). There was no difference between serum ADA concentrations regarding clinical or endoscopic activity in CD, as compared to patients in remission.
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Affiliation(s)
- Letícia Rodrigues de Souza
- Colorectal Surgery Unit, Pontificia Universidade Católica do Paraná, PUCPR, Curitiba 80910-215, Brazil
- Correspondence: (L.R.d.S.); (P.G.K.)
| | - Daniela Oliveira Magro
- Colorectal Surgery Unit, Universidade Estadual de Campinas, UNICAMP, Campinas 13083-970, Brazil
| | | | - Rogério Serafim Parra
- Colorectal Surgery Unit, Universidade de São Paulo, USP, Ribeirão Preto 05508-090, Brazil
| | - Eron Fábio Miranda
- Colorectal Surgery Unit, Pontificia Universidade Católica do Paraná, PUCPR, Curitiba 80910-215, Brazil
| | - Omar Féres
- Colorectal Surgery Unit, Universidade de São Paulo, USP, Ribeirão Preto 05508-090, Brazil
| | - Rogério Saad-Hossne
- IBD Outpatient Clinics, São Paulo State University, UNESP, Botucatu 01049-010, Brazil
| | | | | | | | - Ligia Yukie Sassaki
- IBD Outpatient Clinics, São Paulo State University, UNESP, Botucatu 01049-010, Brazil
| | - Paulo Gustavo Kotze
- Colorectal Surgery Unit, Pontificia Universidade Católica do Paraná, PUCPR, Curitiba 80910-215, Brazil
- Correspondence: (L.R.d.S.); (P.G.K.)
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Zabot GP, Cassol OS, Quaresma AB, Gonçalves Filho FDA, Baima JP, Imbrizi M, Rolim ADS, Carmo AMD, Alves Junior AJT, Santos CHMD, Sobrado Junior CW, Miranda EF, Albuquerque ICD, Souza MMD, Kaiser Junior RL, Parra RS, Kotze PG, Saad-Hossne R. SURGICAL MANAGEMENT OF ADULT CROHN'S DISEASE AND ULCERATIVE COLITIS PATIENTS: A CONSENSUS FROM THE BRAZILIAN ORGANIZATION OF CROHN'S DISEASE AND COLITIS (GEDIIB). Arq Gastroenterol 2023; 59:1-19. [PMID: 36995887 DOI: 10.1590/s0004-2803.2022005s1-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/05/2022] [Indexed: 03/31/2023]
Abstract
BACKGROUND Despite optimized medical therapy, contemporary risk of surgery in inflammatory bowel diseases (IBD) after 10 years of diagnosis is 9.2% in patients with ulcerative colitis (UC) and 26.2% in Crohn's disease, (CD) in the biological era. OBJECTIVE This consensus aims to detail guidance to the most appropriate surgical procedures in different IBD scenarios. In addition, it details surgical indications and perioperative management of adult patients with CD and UC. METHODS Our consensus was developed by colorectal surgeons and gastroenterologists representing the Brazilian Study Group of Inflammatory Bowel Diseases (GEDIIB), with the Rapid Review methodology being conducted to support the recommendations/statements. Surgical recommendations were structured and mapped according to the disease phenotypes, surgical indications, and techniques. After structuring the recommendations/statements, the modified Delphi Panel methodology was used to conduct the voting by experts in IBD surgery and gastroenterology. This consisted of three rounds: two using a personalized and anonymous online voting platform and one face-to-face presential meeting. Whenever participants did not agree with specific statements or recommendations, an option to outline possible reasons was offered to enable free-text responses and provide the opportunity for the experts to elaborate or explain disagreement. The consensus of recommendations/statements in each round was considered to have been reached if there was ≥80% agreement. RESULTS AND CONCLUSION This consensus addressed the most relevant information to guide the decision-making process for adequate surgical management of CD and UC. It synthesizes recommendations developed from evidence-based statements and state-of-art knowledge. Surgical recommendations were structured and mapped according to the different disease phenotypes, indications for surgery and perioperative management. Specific focus of our consensus was given to elective and emergency surgical procedures, determining when to indicate surgery and which procedures may be the more appropriate. The consensus is targeted to gastroenterologists and surgeons interested in the treatment and management of adult patients with CD or UC and supports decision-making of healthcare payors, institutional leaders, and/or administrators.
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Affiliation(s)
- Gilmara Pandolfo Zabot
- Hospital Moinhos de Vento e Coloprocto Clínica do Aparelho Digestivo, Porto Alegre, RS, Brasil
| | | | | | | | - Júlio Pinheiro Baima
- Universidade Nove de Julho, Bauru, Hospital das Clínicas da Faculdade de Medicina de Botucatu, Botucatu, SP, Brasil
| | | | | | | | | | | | | | - Eron Fábio Miranda
- Pontifícia Universidade Católica do Paraná, Hospital Universitário Cajuru; Curitiba, PR, Brasil
| | | | | | | | - Rogerio Serafim Parra
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Paulo Gustavo Kotze
- Pontifícia Universidade Católica do Paraná, Programa de Pós-Graduação em Ciências da Saúde, Curitiba, PR, Brasil
| | - Rogério Saad-Hossne
- Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
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Castro PCSD, Magro DO, Nones RB, Furlan TK, Miranda EF, Kotze PG. USTEKINUMAB IN CROHN'S DISEASE MANAGEMENT: A BRAZILIAN OBSERVATIONAL STUDY. Arq Gastroenterol 2022; 59:S0004-28032022005001206. [PMID: 36515346 DOI: 10.1590/s0004-2803.202204000-89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/04/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Real-world data on the use of Ustekinumab (UST) in Brazilian and Latin American patients with Crohn's disease (CD) are scarce. OBJECTIVE The primary endpoint was assessment of clinical remission at weeks 8 and 52, and secondary endpoints were: assessment of clinical response at weeks 8 and 52, endoscopic remission, adverse events, and rates of CD-related abdominal surgery during follow-up. METHODS observational and retrospective study, including patients with CD treated at two centers, who received UST at any time during their treatment. Remission and clinical response were defined as a Harvey-Bradshaw index ≤4 and ≥3 points reduction, respectively. RESULTS Seventy-four patients were included, 85.1% previously exposed to anti-TNFs. Clinical remission was observed in 45.8% and 59.4% of patients at weeks 8 and 52, respectively. The clinical response rates were 54.2% and 67.6% at weeks 8 and 52. Endoscopic remission was observed in 21.8% of patients. Seventeen patients had adverse events, mostly mild infections, with 22.9% of patients undergoing abdominal surgery (ileocolectomy being the most common procedure). CONCLUSION UST therapy resulted in significant rates of remission and clinical response, as described in other real-world studies. Few patients had adverse events during treatment, showing its adequate safety profile.
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Affiliation(s)
- Paula Cenira Senger de Castro
- Pontifícia Universidade Católica do Paraná, Faculdade de Medicina, Programa de Pós-Graduação em Ciências da Saúde, Curitiba, PR, Brasil
| | - Daniéla Oliveira Magro
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Cirurgia, Campinas, PR, Brasil
| | - Rodrigo Bremer Nones
- Pontifícia Universidade Católica do Paraná, Faculdade de Medicina, Programa de Pós-Graduação em Ciências da Saúde, Curitiba, PR, Brasil
| | - Thaisa Kowalski Furlan
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Gastroenterologia, Curitiba, PR, Brasil
| | - Eron Fábio Miranda
- Pontifícia Universidade Católica do Paraná, Faculdade de Medicina, Programa de Pós-Graduação em Ciências da Saúde, Curitiba, PR, Brasil
| | - Paulo Gustavo Kotze
- Pontifícia Universidade Católica do Paraná, Faculdade de Medicina, Programa de Pós-Graduação em Ciências da Saúde, Curitiba, PR, Brasil
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Ropelato RV, Kotze PG, Froehner Junior I, Dadan DD, Miranda EF. Postoperative mortality in inflammatory bowel disease patients. Journal of Coloproctology 2021. [DOI: 10.1016/j.jcol.2017.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Abstract
Introduction Since the 1960s, mortality in Crohn's disease and Ulcerative Colitis patients had a significant decrease due to advances in medical and surgical therapy. An important proportion of these patients are submitted to surgical procedures during their disease course, with postoperative mortality between 4 and 10%.
Methods 157 inflammatory bowel disease patients submitted to surgical therapy were retrospectively identified and allocated in 2 groups (Crohn's and colitis). Deaths were individually discriminated in detail.
Results 281 surgical procedures were performed. In the colitis group, 43 operations were performed in 24 patients; in the abdominal Crohn's subgroup, 127 procedures in 90 patients and in the perineal Crohn's subgroup, 115 in 64 patients, respectively. Nine postoperative deaths were observed (3 in the colitis and 6 in the Crohn's groups). Overall postoperative mortality was 5.7% (4.5% for Crohn's; 6.6% in abdominal Crohn's and 12.5% for Colitis). Most of deaths were related to emergency procedures and previous use of corticosteroids. The cause of death in all patients was sepsis.
Conclusions Overall postoperative mortality in inflammatory bowel disease was 5.7%, and it was attributed to the severity of the cases referred.
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Affiliation(s)
- Renato Vismara Ropelato
- Pontifícia Universidade Católica do Paraná (PUCPR), Hospital Universitário Cajuru (SeCoHUC), Unidade de Cirurgia Colorectal, Curitiba, PR, Brazil
| | - Paulo Gustavo Kotze
- Pontifícia Universidade Católica do Paraná (PUCPR), Hospital Universitário Cajuru (SeCoHUC), Unidade de Cirurgia Colorectal, Curitiba, PR, Brazil
| | - Ilário Froehner Junior
- Pontifícia Universidade Católica do Paraná (PUCPR), Hospital Universitário Cajuru (SeCoHUC), Unidade de Cirurgia Colorectal, Curitiba, PR, Brazil
| | - Danieli D. Dadan
- Pontifícia Universidade Católica do Paraná (PUCPR), Hospital Universitário Cajuru (SeCoHUC), Unidade de Cirurgia Colorectal, Curitiba, PR, Brazil
| | - Eron Fábio Miranda
- Pontifícia Universidade Católica do Paraná (PUCPR), Hospital Universitário Cajuru (SeCoHUC), Unidade de Cirurgia Colorectal, Curitiba, PR, Brazil
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Boaron L, Facchin L, Bau M, Zacharias P, Ribeiro D, Miranda EF, Barcelos IFD, Ropelato RV, Steckert Filho Á, Meira Junior JDD, Sassaki L, Saad-Hossne R, Kotze PG. Postoperative complication rates between Crohn's disease and Colorectal cancer patients after ileocolic resections: a comparative study. Journal of Coloproctology 2021. [DOI: 10.1016/j.jcol.2017.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Abstract
Introduction Ileocolic resection (ICR) is the most common surgical procedure performed for Crohn's disease (CD). Similarly, right-sided Colorectal cancer (CRC) is treated by the same operation. The primary aim of this study was to analyze and compare the frequency and profile of early postoperative complications of ICR between patients with CD and CRC.
Methods Retrospective and observational study with patients submitted to ICR from two Brazilian tertiary referral units in colorectal surgery. We included patients with diagnosis of CD or CRC, treated with ICR, at any stage of follow-up. Variables analyzed: age at surgery, gender, diagnosis, surgical approach (open or laparoscopy), type of anastomosis (hand-sewn/stapled; end-to-end/side-to-side), presence and type of early postoperative complications (30 days) and mortality, among others.
Results 109 patients were included, 73 with CD (67%) and 36 with CRC (33%). CD patients were younger (42.44 ± 12.73 years vs. 66.14 ± 11.02 years in the CRC groups, p < 0.0001) and had more previous resections (20 ± 27.4 in CD and 0 in CCR, p = 0.001). There were no significant differences between the groups in terms of overall early postoperative complications [17/73 (23.3%) in the CD and 5/36 (13.9%) in the CRC groups (p = 0.250)]. There was no significant difference between the groups in relation to anastomotic leakage (p = 0.185), surgical site infections (p = 0.883), other complications (0.829) and deaths (p = 0.069).
Conclusions There was no significant difference in early postoperative complications in patients with CD or CRC submitted to ICR.
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Affiliation(s)
- Larissa Boaron
- Pontifícia Universidade Católica do Paraná (PUCPR), Hospital Universitário Cajuru, Serviço de Coloproctologia (SeCoHUC), Curitiba, PR, Brazil
| | - Luiza Facchin
- Pontifícia Universidade Católica do Paraná (PUCPR), Hospital Universitário Cajuru, Serviço de Coloproctologia (SeCoHUC), Curitiba, PR, Brazil
| | - Mariella Bau
- Pontifícia Universidade Católica do Paraná (PUCPR), Hospital Universitário Cajuru, Serviço de Coloproctologia (SeCoHUC), Curitiba, PR, Brazil
| | - Patricia Zacharias
- Pontifícia Universidade Católica do Paraná (PUCPR), Hospital Universitário Cajuru, Serviço de Coloproctologia (SeCoHUC), Curitiba, PR, Brazil
| | - Diogo Ribeiro
- Pontifícia Universidade Católica do Paraná (PUCPR), Hospital Universitário Cajuru, Serviço de Coloproctologia (SeCoHUC), Curitiba, PR, Brazil
| | - Eron Fábio Miranda
- Pontifícia Universidade Católica do Paraná (PUCPR), Hospital Universitário Cajuru, Serviço de Coloproctologia (SeCoHUC), Curitiba, PR, Brazil
| | - Ivan Folchini de Barcelos
- Pontifícia Universidade Católica do Paraná (PUCPR), Hospital Universitário Cajuru, Serviço de Coloproctologia (SeCoHUC), Curitiba, PR, Brazil
| | - Renato Vismara Ropelato
- Pontifícia Universidade Católica do Paraná (PUCPR), Hospital Universitário Cajuru, Serviço de Coloproctologia (SeCoHUC), Curitiba, PR, Brazil
| | | | | | - Ligia Sassaki
- Universidade Estadual Paulista (UNESP), Ambulatório de Doenças Inflamatórias Intestinais, Botucatu, SP, Brazil
| | - Rogério Saad-Hossne
- Universidade Estadual Paulista (UNESP), Ambulatório de Doenças Inflamatórias Intestinais, Botucatu, SP, Brazil
| | - Paulo Gustavo Kotze
- Pontifícia Universidade Católica do Paraná (PUCPR), Hospital Universitário Cajuru, Serviço de Coloproctologia (SeCoHUC), Curitiba, PR, Brazil
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Kotze PG, Ludvig JC, Teixeira FV, Malluta EF, Miranda EF, Hardt MR, Olandoski M, da Silva Kotze LM, Kleinubing H. Disease duration did not influence the rates of loss of efficacy of the anti-TNF therapy in Latin American Crohn’s disease patients. Digestion 2015; 91:158-63. [PMID: 25721295 DOI: 10.1159/000371655] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 12/18/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIMS The efficacy of both Infliximab (IFX) and Adalimumab (ADA) can be reduced over time. The aim of this study was to analyze the incidence of loss of efficacy (LOE) of both IFX and ADA, and outline the influence of disease duration on its occurrence. METHODS Retrospective, multicenter, observational cohort study, with CD patients treated with anti-TNF therapy. LOE was defined as the need for steroids, occurrence of major abdominal surgery during treatment, dose increase, interval shortening or switching of the anti- TNF agent. Patients were allocated in three subgroups based on disease duration (DD): <24 months, between 24 and 60 months and >60 months. RESULTS 175 patients were included in the study (117 under IFX and 58 under ADA therapy). LOE occurred in 32% of patients with DD <24 months, in 33.3% with DD between 24 and 60 months and in 31.3% of subjects with DD over 60 months (p = 0.975). CONCLUSIONS Disease duration (DD) did not influence LOE rates. These results suggest that in real-world observational practice, patients with early CD might have the same rates of LOE than patients with a disease prolonging for a longer duration.
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Kotze PG, Abou-Rejaile VR, Uiema LA, Olandoski M, Sartor MC, Miranda EF, Kotze LMDS, Saad-Hossne R. Adalimumab for maintenance therapy for one year in Crohn's disease: results of a Latin American single-center observational study. Arq Gastroenterol 2014; 51:39-45. [PMID: 24760063 DOI: 10.1590/s0004-28032014000100009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 11/18/2013] [Indexed: 12/15/2022]
Abstract
CONTEXT Adalimumab is a fully-human antibody that inhibits TNF alpha, with a significant efficacy for long-term maintenance of remission. Studies with this agent in Latin American Crohn's disease patients are scarce. OBJECTIVES The objective of this study was to outline clinical remission rates after 12 months of adalimumab therapy for Crohn's disease patients. METHODS Retrospective, single-center, observational study of a Brazilian case series of Crohn's disease patients under adalimumab therapy. Variables analyzed: demographic data, Montreal classification, concomitant medication, remission rates after 1, 4, 6 and 12 months. Remission was defined as Harvey-Bradshaw Index ≤ 4, and non-responder-imputation and last-observation-carried-forward analysis were used. The influence of infliximab on remission rates was analyzed by Fischer and Chi-square tests (P<0.05). RESULTS Fifty patients, with median age of 35 years at therapy initiation, were included. Remission rates after 12 months of therapy were 54% under non-responder-imputation and 88% under last-observation-carried-forward analysis. After 12 months, remission on patients with previous infliximab occurred in 69.23% as compared to 94.59% in infliximab-naïve patients (P = 0.033). CONCLUSIONS Adalimumab was effective in maintaining clinical remission after 12 months of therapy, with an adequate safety profile, and was also more effective in infliximab naïve patients.
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Affiliation(s)
- Paulo Gustavo Kotze
- Unidade de Cirurgia Colorretal, Universidade Católica do Paraná, Curitiba, PR, Brasil
| | | | | | - Marcia Olandoski
- Disciplina de Bioestatística, Universidade Católica do Paraná, Curitiba, PR, Brasil
| | - Maria Cristina Sartor
- Unidade de Cirurgia Colorretal, Universidade Católica do Paraná, Curitiba, PR, Brasil
| | - Eron Fábio Miranda
- Unidade de Cirurgia Colorretal, Universidade Católica do Paraná, Curitiba, PR, Brasil
| | | | - Rogério Saad-Hossne
- Depatamento de Ciurgia Digestiva, Universidade de São Paulo, UNESP, Botucatu, SP, Brasil
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Froehner Junior I, Kotze PG, Rocha JG, Miranda EF, Sartor MC, Martins JF, Abou-Rejaile V, Steckert Filho Á, Correa MF. Postoperative topical analgesia of hemorrhoidectomy with policresulen and cinchocaine: a prospective and controlled study. Rev Col Bras Cir 2014; 41:92-8. [DOI: 10.1590/s0100-69912014000200004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 11/02/2013] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE: To evaluate the effects of topical policresulen and cinchocaine in the postoperative pain behavior of open hemorrhoidectomy.METHODS: We conducted a prospective, double-blinded, controlled study. The control group received the usual guidelines with oral medications. The topical treatment group received, in addition, the application of the ointment and was comprised of two subgroups (policresulen + cinchocaine, and placebo). Pain intensity was recorded with the visual analogue scale.RESULTS: 43 patients were operated on: control group - n = 13, one excluded; placebo - n = 15; and policresulen + cinchocaine - n = 15. The mean age was 45.98 years and 37.2% were men. The average pain intensity was 4.09 (immediate postoperative), 3.22 (hospital discharge), 5.73 (day 1) , 5.77 (day 2), 5.74 (day 3), 5.65 (day 7), 5.11 (day 10), 2.75 (day 15) and 7.70 (first bowel movement), with no difference between groups in all periods.CONCLUSION: This study showed no reduction in pain after hemorrhoidectomy with the use of topical policresulen and cinchocaine.
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Miranda EF, Froehner Junior I, Steckert JS, Freitas CD, Martins JF, Kotze PG. Sacrococcygeal hernia: a challenge for the coloproctologist. J Coloproctol (Rio J ) 2012. [DOI: 10.1590/s2237-93632012000400010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Steckert JS, Sartor MC, Miranda EF, Rocha JG, Martins JF, Wollmann MCFDAS, Freitas CD, Steckert Filho A, Kotze PG. Análise das complicações tardias em operações anorretais: experiência de um serviço de referência em coloproctologia. ACTA ACUST UNITED AC 2010. [DOI: 10.1590/s0101-98802010000300006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUÇÃO: as operações anorretais correspondem a 80% do movimento do coloproctologista. O índice de complicações tardias após estas operações é indefinido, e varia de acordo com o tipo de operação e serviço onde estas são realizadas. OBJETIVO: estabelecer a taxa de complicações tardias decorrentes das operações anorretais e fatores de risco que pudessem estar associados a estas complicações. MÉTODO: estudo retrospectivo (série de casos) dos pacientes submetidos a operações anorretais entre janeiro de 2007 e julho de 2009. Variáveis estudadas: sexo, idade, operação, sistema de saúde, técnica de anestesia, complicações tardias, além da taxa de reoperações realizadas. RESULTADOS: foram avaliados 430 pacientes (234 mulheres - 54,4%), submetidos a 453 operações anorretais. A hemorroidectomia foi o mais freqüente procedimento realizado: 50,3% das operações. Encontrou-se 102 complicações tardias pós-operatórias, representando 22,52% dos casos. A fissura anal residual foi a complicação mais freqüente (54%/ n=55). Somente 38 pacientes necessitaram de reintervenção cirúrgica (8,83%). Não houve diferença significativa em relação ao sexo, idade, sistema de saúde e ao tipo de operação realizada com as complicações encontradas. CONCLUSÕES: a taxa de complicações tardias foi de 22,52%, com reintervenções cirúrgicas em 8,83% dos pacientes. Não houve fator de risco para complicações identificado nesta série de casos.
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Kotze PG, Freitas CD, Froehner Junior I, Steckert JS, Ishie E, Steckert Filho Á, Martins JF, Miranda EF. Análise do número de linfonodos em espécimes de ressecções colorretais por neoplasia entre a cirurgia aberta e videolaparoscópica. ACTA ACUST UNITED AC 2010. [DOI: 10.1590/s0101-98802010000200001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Introdução: o estadiamento patológico com a análise do número de linfonodos dissecados é fator importante na determinação da segurança oncológica das ressecções por câncer colorretal, independentemente da via de acesso. Em fase inicial de curva de aprendizado em laparoscopia colorretal, a equivalência entre a cirurgia convencional e laparoscópica pode ser comprometida. O objetivo do presente estudo foi analisar o número de linfonodos dissecados em espécimes de ressecções por câncer colorretal pela via convencional e laparoscópica, e verificar a equivalência oncológica entre ambas. Método: estudo retrospectivo de uma série de casos de pacientes submetidos a ressecções por câncer colorretal por via convencional e laparoscópica. Variáveis analisadas: idade, sexo, via de acesso, tipo de procedimento, estadiamento de Dukes e número de linfonodos dissecados nas peças. Análise estatística pelo método de Mann-Whitney. Resultados: 50 pacientes foram analisados (33 operados por via convencional, 17 por via laparoscópica). Houve maior número de colectomias direitas e retossigmoidectomias altas nos dois grupos. O número médio de linfonodos dissecados foi de 10,35 no grupo laparoscópico e de 10,15 no grupo de acesso convencional (p=0,859). Conclusões: não houve diferença estatística entre o número médio de linfonodos dissecados entre os espécimes ressecados por via convencional e laparoscópica, numa fase inicial de curva de aprendizado.
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Kotze PG, Martins JF, Steckert JS, Scolaro BL, Rocha JG, Miranda EF, Sartor MC. Infestação por miíase em prolapso retal: relato de caso e revisão de literatura. ACTA ACUST UNITED AC 2009. [DOI: 10.1590/s0101-98802009000300014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
INTRODUÇÃO: a miíase é uma afecção causada pela presença de larvas de moscas em órgãos ou tecidos do homem e de outros animais. Sua localização preferida em humanos é na pele, com ocorrências descritas nas cavidades naturais. Seu tratamento é baseado na remoção mecânica das larvas e no desbridamento cirúrgico de tecidos desvitalizados. OBJETIVO: descrição do caso de um paciente com prolapso retal associado à infestação por miíase, discutindo sua incidência, sintomatologia e tratamento. RELATO DO CASO: L.C.S, 36 anos, masculino, com prolapso retal há um ano. Habitante de região rural, com baixo nível sócio-econômico, não possuía banheiros ou qualquer tipo de saneamento básico em sua residência. Ao exame proctológico, evidenciava-se prolapso retal edemaciado, com áreas cavitárias com necrose, secreção purulenta e grande quantidade de larvas de míiase. Realizou-se retirada mecânica das larvas com posterior debridamento cirúrgico. Optou-se pela confecção de uma colostomia em alça do sigmóide, devido à extensa área cruenta com lesão esfincteriana interna. CONCLUSÕES: O acometimento da miíase retal em prolapsos é raro, e deve ser prontamente diagnosticado e tratado. Um simples exame proctológico é fundamental para este fim. Salienta-se a necessidade contínua da educação em saúde, bem como se enfatiza a importância dos hábitos de higiene na população.
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Gutiérrez del Pozo R, Miranda EF, Serrallach Milá N, Casalots Serramia J. [Prostatic endometrioid adenocarcinoma; report of a case]. Actas Urol Esp 1984; 8:85-6. [PMID: 6720357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Miranda EF. Stressful situations and coping mechanisms of intensive care unit nurses at X Hospital. ANPHI Pap 1980; 16:21-8. [PMID: 6919410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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