Publications by authors named "Walmar Kerche de Oliveira"

6 Publications

  • Page 1 of 1

Effectiveness of Open Fenestration for Autosomal Dominant Polycystic Liver Disease.

Case Rep Gastroenterol 2022 Jan-Apr;16(1):201-208. Epub 2022 Mar 31.

Department of Internal Medicine, São Paulo State University (Unesp), Medical School, Botucatu, Brazil.

Autosomal dominant polycystic liver disease (ADPLD) is a rare disease with variable clinical presentations, characterized by cystic enlargement of the liver. The diagnosis is made based on family history, patient's age, and liver phenotype and is confirmed by imaging tests. The treatment aims to reduce symptoms caused by the increased liver volume and can be performed by aspiration with sclerotherapy, fenestration, and liver resection. Although ADPLD is a rare disease, it is an important differential diagnosis of cystic diseases such as polycystic kidney disease; therefore, the aim of this article was to present the diagnostic and therapeutic approach of a case of ADPLD and conducting a literature review. This is the case of a 32-year-old male patient, who was hospitalized due to abdominal pain, hepatomegaly, lack of appetite, and weight loss. Imaging propaedeutics showed a significant increase in the liver volume due to hepatic cysts. After a multidisciplinary evaluation, given the clinical changes and the location of the hepatic cysts, fenestration was performed by laparotomy. The postoperative period was uneventful. The treatment was efficient in promoting symptomatic relief and improving the quality of life in this patient. Case reports on this disease are quite limited in the currently available literature, and there are gaps in knowledge with regard to the diagnosis and management of ADPLD. The importance of this article is that it will highlight the limitations in treatment options and allow physicians to make a more informed decision when diagnosing and treating a patient with ADPLD in the future.
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March 2022

Model for establishing a new liver transplantation center through mentorship from a university with transplantation expertise.

PLoS One 2022 30;17(3):e0266361. Epub 2022 Mar 30.

Liver and Digestive Organs Transplantation Division, Gastroenterology Department, Clinical Hospital of São Paulo University - HCFMUSP, São Paulo Faculty of Medicine, Universidade de São Paulo - USP, São Paulo, São Paulo, Brazil.

Background: Setting up new liver transplant (LT) centers is essential for countries with organ shortages. However, good outcomes require experience, because LT learning depends on a high number of surgeries. This study aims to describe how a new center was set up from a partnership between the new center and an experienced one. The step-by-step preparation process, the time needed and the results of the new center are depicted.

Material And Methods: The mentoring process lasted 40 months, in which half of the 52 patients included on the transplant list received LT. After the mentorship, a 22-month period was also analyzed, in which 46 new patients were added to the waiting list and nine were operated on.

Results: The 30-day survival rates during (92.3%) and after (66.7%) the partnership were similar to the other LT centers in the same region, as well as the rates of longer periods. The waiting time on the LT list, the characteristics of the donors and the ischemia times did not differ during or after the mentorship.

Conclusion: The partnership between universities is a suitable way to set up LT centers, achieving good results for the institutions and the patients involved.
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March 2022

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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August 2015

Atrophic gastritis: risk factor for esophageal squamous cell carcinoma in a Latin-American population.

World J Gastroenterol 2013 Apr;19(13):2060-4

Endoscopy Department, Cancer Hospital of Barretos, Barretos, São Paulo 147830-066, Brazil.

Aim: To study the association between atrophic gastritis (AG) and esophageal squamous cell carcinoma (ESCC) in a Latin-America population.

Methods: A case-control study was performed at two reference Brazilian hospitals including patients diagnosed with advanced ESCC and dyspeptic patients who had been subjected to upper gastrointestinal endoscopy, with biopsies of the gastric antrum and body. All cases with ESCC were reviewed by a single pathologist, who applied standard criteria for the diagnosis of mucosal atrophy, intestinal metaplasia, and dysplasia, all classified as AG. The data on the patients' age, sex, smoking status, and alcohol consumption were collected from clinical records, and any missing information was completed by telephone interview. The association between AG and ESCC was assessed by means of univariate and multiple conditional logistic regressions.

Results: Most patients were male, and the median age was 59 years (range: 37-79 years) in both the ESCC and control groups. Univariate analysis showed that an intake of ethanol greater than 32 g/d was an independent risk factor that increased the odds of ESCC 7.57 times (P = 0.014); upon multiple analysis, alcohol intake of ethanol greater than 32 g/d exhibited a risk of 4.54 (P = 0.081), as adjusted for AG and smoking. Smoking was shown to be an independent risk factor that increased the odds of ESCC 14.55 times (P = 0.011) for individuals who smoked 0 to 51 packs/year and 21.40 times (P = 0.006) for those who smoked more than 51 packs/year. Upon multiple analyses, those who smoked up to 51 packs/year exhibited a risk of 7.85 (P = 0.058), and those who smoked more than 51 packs/ year had a risk 11.57 times higher (P = 0.04), as adjusted for AG and alcohol consumption. AG proved to be a risk factor that increased the odds of ESCC 5.33 times (95%CI: 1.55-18.30, P = 0.008) according to the results of univariate conditional logistic regression.

Conclusion: There was an association by univariate conditional logistic regression between AG and ECSS in this sample of Latin-American population.
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April 2013

[Preoperative progressive pneumoperitoneum in voluminous abdominal wall hernias].

Arq Gastroenterol 2009 Apr-Jun;46(2):121-6

Departamento de Cirurgia e Ortopedia, Disciplina de Gastroenterologia Cirúrgica da Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brazil.

Context: Correction of voluminous hernias and large abdominal wall defects is a big challenge in surgical practice due to technical difficulties and the high incidence of respiratory and cardiovascular complications.

Objectives: To present the authors experience with inducing progressive pneumoperitoneum preoperative to surgical treatment of voluminous hernias of the abdominal wall.

Methods: Retrospective study of six patients who presented voluminous hernias of the abdominal wall and were operated after installation of a pneumoperitoneum. The procedure was performed by placing a catheter in the abdominal cavity at the level of the left hypochondrium with ambient air insufflation for 10 to 15 days.

Results: Four of the six patients were female and two male. Ages ranged from 42 to 62 years. Hernia duration varied from 5 to 40 years. Four patients had incisional, one umbilical, and one inguinal hernias. Mean pneumoperitoneum time was 11.6 days. There were no complications related to pneumoperitoneum installation and maintenance. All hernias were corrected without technical difficulties. The Lichtenstein technique was used to correct the inguinal hernia, peritoneal aponeurotic transposition for one of the incisional hernias, with the rest corrected using polypropylene mesh. One death and one wall infection were observed post operatively. No recurrences were reported until now, in 4 to 36 months of follow-up.

Conclusion: Preoperative progressive pneumoperitoneum is a safe and easy executed procedure, which simplifies surgery and reduces post-operative respiratory and cardiovascular complications. It is indicated for patients with hernias that have lost the right of domain in the abdominal cavity.
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October 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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June 2008