Publications by authors named "Mauro Masson Lerco"

15 Publications

  • Page 1 of 1

The Glasgow Prognostic Score. An useful tool to predict survival in patients with advanced esophageal squamous cell carcinoma.

Acta Cir Bras 2015 Aug;30(8):580-5

Department of Pathology, Botucatu Medical School, UNESP, Botucatu, SP, BR.

Purpose: To evaluate the usefulness of the Glasgow Prognostic Score (GPS) in patients with esophageal carcinoma (EC).

Methods: A total of 50 patients with EC were analyzed for GPS, nutritional and clinicopathologic parameters. Patients with CRP ≤ 1.0mg/L and albumin ≥ 3.5mg/L were considered as GPS = 0. Patients with only CRP increased or albumin decreased were classified as GPS = 1 and patients with CRP > 1.0mg/L and albumin < 3.5mg/L were considered as GPS = 2.

Results: GPS of 0, 1 and 2 were observed in seven, 23 and 20 patients, respectively. A significant inverse relationship was observed between GPS scores and the survival rate. The survival rate was greatest in patients with GPS = 0 and significantly higher than those from patients with GPS = 1 and GPS = 2. Minimum 12-month survival was observed in 71% patients with GPS = 0 and in 30% patients with GPS = 1. None of the patients with GPS = 2 survived for 12 months. A significant relationship between CRP or albumin individually and the survival rate was observed. No significant relationship among nutritional, clinic pathological parameters and survival was found.

Conclusion: Glasgow Prognostic Score is an useful tool to predict survival in patients with esophageal carcinoma.
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http://dx.doi.org/10.1590/S0102-8650201500800000010DOI Listing
August 2015

Epidemiological features of esophageal cancer. Squamous cell carcinoma versus adenocarcinoma.

Acta Cir Bras 2014 Jun;29(6):389-93

Department of Pathology, Botucatu Medical School, UNESP, Botucatu, SP, Brazil.

Purpose: To analyze the epidemiological features of patients with esophageal cancer according to the histopathological types: squamous cell carcinoma or adenocarcinoma.

Methods: A total of 100 patients with esophageal cancer, being 50 squamous cell carcinomas and 50 adenocarcinomas were analyzed for demographics, nutritional factors, lifestyle habits, benign pathological conditions associated, like Barrett's esophagus and megaesophagus, tumor stage and survival rates. The nutritional factors evaluated included body mass index, percent weight loss, hemoglobin and albumin serum levels.

Results: Esophageal cancer occurred more often in men over 50 years-old in both histological groups. No significant differences on age and gender were found between the histological groups. Squamous cell carcinoma was significantly more frequent in blacks than adenocarcinoma. Alcohol consumption and smoking were significantly associated with squamous cell carcinoma. Higher values of body mass index were seen in patients with adenocarcinoma. Barrett's esophagus was found in nine patients (18%) with adenocarcinoma, and megaesophagus in two patients (4%) with squamous cell carcinoma. The majority of patients were on stages III and IV in both histological groups. The mean survival rates were 7.7 ± 9.5 months for patients with squamous cell carcinoma and 8.0 ± 10.9 months for patients with adenocarcinoma. No significant differences on tumor stage and survival rates were detected between the histological groups.

Conclusion: Epidemiological features are distinct for the histopathological types of esophageal cancer. Squamous cell carcinoma is associated with black race, alcohol and smoking, while adenocarcinoma is related to higher body mass index, white race and Barrett's esophagus.
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http://dx.doi.org/10.1590/s0102-86502014000600007DOI Listing
June 2014

Pharyngoesophageal diverticulum: evaluation of treatment results.

Rev Col Bras Cir 2013 Mar-Apr;40(2):104-9

Department of Surgery and Orthopedics, Medical School of Botucatu-Paulista State University, Botucatu, São Paulo State, Brazil.

Objective: To evaluate the postoperative outcome of patients with pharyngoesophageal diverticulum submitted to surgical and endoscopic treatments.

Methods: We retrospectively analyzed 36 patients with pharyngo-esophageal diverticulum treated at the Hospital of the Medical School of Botucatu - UNESP. Patients were divided into two groups, depending on the treatment: group 1 (n = 24): diverticulectomy associated myotomy through a left cervicotomy; group 2 (n = 12): endoscopic diverticulostomy with linear stapler.

Results: Operative mortality was zero in both groups. Early complications: group 1 - two patients developed cervical fistula and two, hoarseness; group 2 - none. Late complications: group 1 - none; group 2: recurrence of dysphagia in four patients (p = .01). Mean follow-up was 33 months for group 1 and 28 months for group 2.

Conclusion: Both procedures were effective in remission of dysphagia. Surgical treatment showed superiority to endoscopy, with resolution of dysphagia with a single procedure. Endoscopic treatment should be reserved for the elderly and those with comorbidities.
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http://dx.doi.org/10.1590/s0100-69912013000200004DOI Listing
April 2014

Outcome of superficial squamous cell carcinoma of the esophagus: a clinicopathological study.

Acta Cir Bras 2013 May;28(5):373-8

Gastroenterology Surgery Division, Department of Surgery, Botucatu Medical School, São Paulo State University, SP, Brazil.

Purpose: To analyze the clinicopathological features and outcome of patients with pathologically proven superficial squamous cell carcinoma of the esophagus.

Methods: A total of 234 consecutive cases of esophageal carcinoma in a 15-year period were reviewed.

Results: Superficial esophageal cancer was found in five patients (2.1%). They were four men and one woman and the mean age was 52.5 years. Smoking and alcohol were the main risk factors. Achalasia due to Chagas disease occurred in one patient and a second primary tumor developed in the larynx in another patient. Four patients underwent esophagectomy and one patient received chemoradiotherapy. The histopathologic diagnosis was of squamous cell carcinoma in all cases. Intramucosal tumor (Tis) was identified in three cases and superficially invasive carcinoma in two cases. Four patients are free of disease with survival times of two, four, six and nine years. The patient who developed laryngeal cancer died six years after esophagectomy.

Conclusion: Long-term survival in patients with esophageal cancer is related to early diagnosis. Therefore, a less aggressive surgical approach, such as endoscopic resection, may be a good option for these patients, if depth of tumor invasion can be accurately predicted by the new imaging tools.
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http://dx.doi.org/10.1590/s0102-86502013000500009DOI Listing
May 2013

Salivary parameters and teeth erosions in patients with gastroesophageal reflux disease.

Arq Gastroenterol 2012 Jul-Sep;49(3):214-8

General Surgery Bases, Department of Surgery and Orthopedy, Botucatu School of Medicine, State University of São Paulo, Brazil.

Context: In the gastroesophageal reflux disease (GERD), a highly prevalent digestive disorder, gastric content may return to the esophagus and reach the mouth, thus leading to a small number of carious lesions and high incidence of dental erosion. Since saliva plays a major role in oral homeostasis, evaluating salivary parameters is necessary in attempting to explain such outcome.

Objectives: This study aimed at analyzing salivary parameters (salivary flow, pH and buffering capacity), bacterial count, caries index and dental erosion in patients with GERD.

Materials: Sixty patients were studied, and of these, 30 had GERD (group 1), and 30 were controls (group 2). Gastroesophageal reflux disease diagnosis confirmation was achieved by means of endoscopy, manometry and pH metric esophageal monitoring. The above mentioned salivary parameters were evaluated in patients from groups 1 and 2.

Results: The number of erosions in patients with GERD (group 1) was larger than in controls (P<0.001). The number of carious teeth was smaller in group 1 than in group 2 (P<0.001). Salivary flow (non-stimulated and stimulated) and pH did not show differences between the 2 groups (P = 0.49; P = 0.80 and P = 0.85, respectively). Salivary buffering capacity in patients with GERD showed lower values in controls (P = 0.018). The number of bacteria (Lactobacilli and Streptococci) was smaller in patients with gastroesophageal reflux disease than in controls (P = 0.0067 and P = 0.0017, respectively).

Conclusion: It was concluded that the large number of erosions must be a result of GERD patients reduced salivary buffering capacity. The reduced number of caries of patients in group 1 can be explained by the low prevalence of bacteria (Lactobacilli and Streptococci), observed in the saliva of patients with chronic reflux.
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http://dx.doi.org/10.1590/s0004-28032012000300009DOI Listing
February 2013

Gastroesophageal reflux disease and vocal disturbances.

Arq Gastroenterol 2011 Apr-Jun;48(2):98-103

Department of Surgery and Orthopedics, Botucatu Medical School, São Paulo State University, SP, Brasil.

Context: Gastroesophageal reflux disease is a chronic disease in which gastroduodenal contents reflux into the esophagus. The clinical picture of gastroesophageal reflux disease is usually composed by heartburn and regurgitation (typical manifestations). Atypical manifestations (vocal disturbances and asthma) may also be complaint.

Objective: To analyse the clinical, endoscopic, manometric and pHmetric aspects of patients suffering from gastroesophageal reflux disease associated with vocal disturbances.

Methods: Fifty patients with gastroesophageal reflux disease were studied, including 25 with vocal disturbances (group 1 - G1) and 25 without these symptoms (group 2 - G2). All patients were submitted to endoscopy, manometry and esophageal pHmetry (2 probes). The group 1 patients were submitted to videolaryngoscopy.

Results: Endoscopic findings: non-erosive reflux disease was observed in 95% of G1 patients and 88% of G2. Videolaryngoscopy: vocal fold congestion, asymmetry, nodules and polyps were observed in G1 patients. Manometric findings: pressure in the lower esophageal sphincter (mm Hg): 11.6 ± 5.2 in G1 and 14.0 ± 6.2 in G2 (P = 0.14); pressure in the upper esophageal sphincter (mm Hg): 58.4 ± 15.9 in G1 and 69.5 ± 30.7 in the controls. pHmetric findings: De Meester index: 34.0 ± 20.9 in G1 and 15.4 ± 9.4 in G2 (P<0.001); number of reflux episodes in distal probe: 43.0 ± 20.4 in G1 and 26.4 ± 17.2 in G2 (P = 0.003); percentage of time with esophageal pH value lower than 4 units (distal sensor): 9.0% ± 6.4% in G1 and 3.4% ± 2.1% in G2 (P<0.001); number of reflux episodes in proximal probe: 7.5 ± 10.9 in G1 and 5.3 ± 5.7 in G2 (P = 0.38); percentage of time with esophageal pH values lower than 4 units (Proximal probe): 1.2 ± 2.7 in G1 and 0.5 ± 0.7 in G2 (P = 0.21).

Conclusions: 1) The clinical, endoscopic, and manometric findings observed in patients with vocal disturbance do not differ from those without these symptoms; 2) gastroesophageal reflux intensity is higher in patients with vocal disturbance; 3) patients without vocal disturbance can also present reflux episodes in the proximal probe.
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http://dx.doi.org/10.1590/s0004-28032011000200003DOI Listing
February 2012

[Preoperative and postoperative nutritional evaluation in patients with non-advanced megaesophagus].

Arq Gastroenterol 2009 Oct-Dec;46(4):341-2

Departamento de Cirurgia e Ortopedia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista - UNESP, Botucatu, SP. rhenry

Unlabelled: Megaesophagus, an affection characterized by the aperistalsis of the esophageal body and deficient relaxation of the lower esophageal sphincter presents dysphagia as the most frequent complaint. The goal of this study was to evaluate the nutritional status of patients with non-advanced megaesophagus in pre and postoperative periods of laparoscopic cardiomyotomy. Ten patients were studied in five moments (pre operative and at 1, 3, 6 and 12 months after surgery). The anthropometric, hematimetric and biochemical parameters were studied in five moments.

Conclusions: 1) most patients with non-advanced megaesophagus were eutrophic; 2) surgical treatment led to improvement in nutritional status and increase of HDL cholesterol fraction.
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http://dx.doi.org/10.1590/s0004-28032009000400017DOI Listing
September 2010

Painful cervical esophageal erosion in a patient with advanced colorectal cancer treated with bevacizumab.

Invest New Drugs 2010 Dec 2;28(6):882-3. Epub 2009 Sep 2.

Oncological and Hemato-oncological Center, São Paulo State University, Botucatu, SP, Brazil.

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http://dx.doi.org/10.1007/s10637-009-9312-yDOI Listing
December 2010

Biliary tract reconstruction using jejunal tube: an experimental study in dogs.

Hepatobiliary Pancreat Dis Int 2009 Apr;8(2):179-85

State University of Campinas, Faculty of Medical Sciences, Department of Surgery, 17017-240-Bauru-SP-Brazil.

Background: To physiologically reconstruct the biliary tract, Crema et al suggested the application of the Monti principle to the biliary tract, already used in humans for the urinary tract. With this technique, a jejunal segment is transversely retubularized. This study aimed to evaluate the efficacy of jejunal tube interposition between the common bile duct and duodenum in dogs.

Methods: Thirteen dogs underwent a laparoscopic common bile duct ligature, followed by a biliodigestive connection by jejunal tube interposition after one week. The levels of glutamic-pyruvic and glutamic-oxalacetic transaminases, total bilirubins, alkaline phosphatase and gamma-glutamyltransferase were assessed before surgery and thereafter weekly until euthanasia, which was performed 6 weeks after biliodigestive connection.

Results: Data on 9 dogs were analyzed statistically. The dogs presented with obstructive jaundice after common bile duct ligature, as confirmed by biochemical examination. They showed a statistically significant reduction in cholestasis after biliodigestive connection by jejunal tube interposition and were healthy until the end of the experiment.

Conclusion: A statistically significant reduction was seen in total bilirubin and canalicular enzymes (alkaline phosphatase and gamma-glutamyltransferase) in the 9 dogs 6 weeks after biliodigestive connection by jejunal tube interposition.
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April 2009

[Plasma taurine levels in patients with esophagus cancer].

Arq Gastroenterol 2008 Jul-Sep;45(3):199-203

Programa de Pós-Graduação em Bases Gerais da Cirurgia, Faculdade de Medicina, Universidade Estadual Paulista, Botucatu, SP, Brazil.

Background: The esophagus cancer-host has a two way close relationship as seen in its sulphur-amino acid metabolism. Taurine one of these compounds has ubiquous role in host defense and other physiological mechanisms related to survival.

Aim: To study the plasma levels of taurine and its precursors in patients with esophagus cancer.

Methods: In a sectional design both groups, patients (n = 16, 43-73 yrs old) and healthy controls (n = 20, 27-65 yrs old) were assessed for anthropometry, body-weight lost, hematology (Hb, Ht, total leukocytes and lymphocyte counts), general biochemistry (albumin, glucose, lipids and aminotransferases) and chromatographic analysis for taurine, cysteine, and homocysteine. The survival time was registered there since from the clinical-histopathological diagnosis. All participants had a written ethical consent for the research.

Results: The cancer patients were predominantly, white males of low social economic class, with spinocellular carcinoma stage IV located at upper 3rd half of them presented hypoalbuminemia and 16% referred significant body-weight loss. The patients showed statistically lower values of Hb, Ht, total and HDL cholesterol and cysteine and significantly higher values of taurine, homocysteine and aminotransferases than healthy controls. A positive relationship was found between taurine and either TLC (r = 0.50) and survival (r = 0.81).

Conclusions: Lower plasma cysteine along with higher levels of taurine and homocysteine and the positive direct association of taurine with indications of survival suggest an effective role of this compound and therefore a prospective special nutritional care in its precursors (cysteine, methionine and B vitamins) of these patients.
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http://dx.doi.org/10.1590/s0004-28032008000300006DOI Listing
August 2009

[Study in oral cavity alterations in patients with gastroesophageal reflux disease].

Arq Gastroenterol 2008 Apr-Jun;45(2):132-6

Curso de Pós-graduação em Bases Gerais da Cirurgia, Universidade Estadual Paulista, Botucatu, SP.

Background: The gastroesophageal reflux disease, which has become highly and increasingly incident, may be manifested by typical (pyrosis and regurgitation) and atypical (pulmonary, otorhinolaryngological and buccal) symptoms.

Aim: To analyze alterations in the oral cavity patients with gastroesophageal reflux disease.

Methods: One hundred patients were studied being 50 gastroesophageal reflux disease patients (group 1) and 50 controls (group 2). All patients were submitted to an oral clinical exam and specific survey. Patients in group 1 were submitted to upper endoscopy, manometry and esophageal pH monitoring.

Results: The upper endoscopy revealed esophagitis in all patients, 20 erosive esophagitis, 30 no-erosive esophagitis and 38 hiatal hernia. Average pressure of the lower esophageal sphincter was 11 +/- 4,8 mm Hg and of the upper esophageal sphincter 75 +/- 26,5 mm Hg. In 42 patients of group 1 (84%) pathological gastroesophageal reflux was observed. Clinical exams revealed: dental erosions in group 1: 273 faces and in group 2: 5 tooth decays in group 1: 23 and 115 in group 2; abrasion in group 1: 58 and in group 2: 95; attrition wear: 408 in group 1 and 224 in group 2. The most damages was the palatine face. In group 1, 21 patients complained about frequent episodes of canker sores, 35 of tooth sensibility, 26 of burning mouth and 42 of sour taste in the mouth. In group 2 the complaints were observed in lower number of patients.

Conclusions: Patients with gastroesophageal reflux disease present higher incidence of dental erosion, canker sores, mouth burning sensation, sensitivity and sour taste than controls. Patients with gastroesophageal reflux disease show lower incidence of tooth decays as compared to controls.
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http://dx.doi.org/10.1590/s0004-28032008000200008DOI Listing
April 2009

[Esophageal cancer in patient with chagasic megaesophagus].

Arq Gastroenterol 2007 Apr-Jun;44(2):151-5

Departamento de Cirurgia e Ortopedia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP.

Background: Megaesophagus constitutes a public health problem in our country since it affects individuals in the most productive phase of their lives. During the development of the disease, people suffering from it may present association with esophageal cancer.

Aim: To analyze the clinical and epidemiological aspects of patients with megaesophagus and esophageal cancer.

Methods: Twenty patients with megaesophagus and cancer (group 1) and 20 patients with esophageal cancer (group 2) were retrospectively analyzed. Demographic data, habits (alcoholism and smoking), tumor histological type, lesion location, cellular differentiation, staging, treatment and survival were assessed.

Results: No difference was observed between the groups in relation to age, sex, lesion location, tumor histological type, cellular differentiation, staging or survival. As regards habits, the association of alcoholism with smoking was observed in a larger number of patients with esophageal cancer without the megaesophagus antecedent.

Conclusion: The clinical characteristics of patients with megaesophagus and cancer do not differ from those of patients with malignant esophageal neoplasia, particularly as regards the unfavorable prognosis with the instituted treatment. Patients with megaesophagus may present esophageal tumor at any part of the organ.
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http://dx.doi.org/10.1590/s0004-28032007000200013DOI Listing
June 2008

Reduction of podocytes number in late diabetic alloxan nephropathy: prevention by glycemic control.

Acta Cir Bras 2007 Sep-Oct;22(5):337-41

Experimental Laboratory-Technique of Surgery, Department of Surgery and Orthopedics, School of Medicine, São Paulo State University, Botucatu, SP, Brazil.

Purpose: To determine podocyte number and GBM thickness in diabetic rats either under glycemic control or without glycemic control at 6 and 12 months after diabetes induction.

Methods: 100 Wistar rats weighing 200-300g were divided into 6 groups: Normal group (N6 and N12- 25 rats); Diabetic group (D6 and D12- 25 rats), diabetic treated group ( DT 6 and DT 12- 25 rats) on insulin 1,8- 3,0 IU/Kg associated with acarbose (50 mg to 100g of food) daily mixed in chow. Alloxan was injected intravenously in a dose of 42 mg/Kg of weight. Body weight, water intake, 24-h diuresis, glycemia and glucosuria were determined before induction, 7 and 14 days after induction and monthly thereafter. Treatment started at day 14. Three groups were sacrificed at 6 months (N6,D6, DT6) and 3 groups at 12 months (N12, D12, DT12) with the renal tissue being prepared for electron microscopy.

Results: Glycemia in DT6" and in DT12 was significantly different from that in D6 and D12 rats and similar to that in N6 and N12 animals. The number of podocytes in DT6 was not different from that in N6 and D6 (median = 11); the number of podocytes in DT12 (median = 11) differed from that in D12 (median = 8), but not from that in N12 (median = 11). GBM thickness in D6 (0.18 micrometers) was lower than in D12 (0.29 micrometers); while in DT6 (0.16 micrometers) it was lower than in D6 (0.18 micrometers). In DT12 (0.26 micrometers), it was lower than in D12 (0.29 micrometers).

Conclusion: The control of hyperglycemia prevented GBM thickening in early and late (12 mo) alloxan diabetic nephropathy and podocyte number reduction.
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http://dx.doi.org/10.1590/s0102-86502007000500003DOI Listing
September 2008

The number of podocyte and slit diaphragm is decreased in experimental diabetic nephropathy.

Acta Cir Bras 2006 Mar-Apr;21(2):87-91. Epub 2006 Mar 21.

Department of Surgery and Orthopedics, School of Medicine, UNESP, São Paulo State University, Botucatu, Brazil.

Purpose: To determine the number of podocyte, slit diaphragms, slit diaphragm extensions and GBM thickness in diabetic nephropathy.

Methods: Sixty "Rattus Wistar"of both sexes weighing 200-300 g were divided in two experimental groups: normal group 10 animals, and alloxan diabetic rats--50 animals. Alloxan was administered in a single IV dose of 42 mg/kg body weight. Body weight, water and food intake, diuresis, and blood and urine glucose were determined in both groups before alloxan injection and two weeks, six and twelve months after alloxan injection. Proteinuria was measured at 12 months in both groups. After 12 months animals were sacrificed, and the right kidney processed for electron microscopy.

Results: Clear clinical and laboratory signs of severe diabetes were seen, in all alloxan-diabetic rats at all follow-up times. Glomerular basement membrane (GBM) thickening, podocyte number, and slit diaphragm number and extension were determined. GBM of all diabetic rats was significantly thicker (median=0.29 microm; semi-interquartile range=0.065 microm) than in the normal rats (0.23 microm; 0.035 microm). Diabetic rat podocyte number (8; 1), slit diaphragm number (4; 1), and slit diaphragm extension (0.021 microm; 0.00435 microm) were significantly lower than in normal rats (11; 1) and (7; 1.5), and (0.031 microm; 0.0058 microm). Diabetic rat proteinuria (0.060 mg/24 h; 0.037 mg/24 h) was higher than in normal rats (0.00185 mg/24 h; 0.00055 mg/24 h).

Conclusion: Experimental diabetes is associated with significant (p<0.05) changes in podocyte foot process, slit number, slit diaphragm extension, and GBM thickness.
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http://dx.doi.org/10.1590/s0102-86502006000200006DOI Listing
March 2007
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