BRAZILIAN GASTRIC CANCER ASSOCIATION GUIDELINES (PART 2): UPDATE ON TREATMENT.

Background: : The II Brazilian Consensus on Gastric Cancer of the Brazilian Gastric Cancer Association BGCA (Part 1) was recently published. On this occasion, countless specialists working in the treatment of this disease expressed their opinion in the face of the statements presented.

Aim: : To present the BGCA Guidelines (Part 2) regarding indications for surgical treatment, operative techniques, extension of resection and multimodal treatment.

BRAZILIAN GASTRIC CANCER ASSOCIATION GUIDELINES (PART 1): AN UPDATE ON DIAGNOSIS, STAGING, ENDOSCOPIC TREATMENT AND FOLLOW-UP.

Background: The II Brazilian Consensus on Gastric Cancer by the Brazilian Gastric Cancer Association (ABCG) was recently published. On this occasion, several experts in gastric cancer expressed their opinion before the statements presented.

Aim: To present the ABCG Guidelines (part 1) regarding the diagnosis, staging, endoscopic treatment and follow-up of gastric cancer patients.

Impact of multisection and immunohistochemistry in lymph node staging of Gastric Carcinoma - Case series.

Gastric carcinoma (GC) locoregional recurrence may occur even in cases where the tumor has been completely resected, possibly due to lymph node (LN) micrometastases. It is estimated that in 10% to 30% of cases, LN micrometastases are not detected by a conventional method for histological assessment of LN metastases with hematoxylin-eosin (HE). A cross-sectional study assessed 51 patients with GC by histological evaluation of the LN micrometastases through LN multi sectioning associated with immunohistochemistry analysis with monoclonal antibodies AE1 and AE3.

PRE-OPERATIVE GASTRIC GIST DOWNSIZING: THE IMPORTANCE OF NEOADJUVANT THERAPY.

Introduction: Gastric gastrointestinal tumors (GIST) are a rare and usually asymptomatic neoplasm that can present as abdominal mass in more advanced scenarios. Since surgical resection is the main aspect of the treatment, locally advanced tumors require multivisceral resection and, therefore, higher postoperative morbidity and mortality.

Objective: To perform a review the literature on the topic, with emphasis on the neoadjuvant therapy.

Gastric Emptying and Food Tolerance Following Banded and Non-banded Roux-en-Y Gastric Bypass.

Introduction: Gastric emptying (GE) and food tolerance (FT) can be altered after Roux-en-Y gastric bypass (RYGB) has been performed, especially when it involved the use of a restrictive mechanism (such as a silastic ring).

Aim: To assess GE and FT in patients who underwent banded (BRYGB) or non-banded Roux-en-Y gastric bypass (RYGB).

Methods: Forty-seven BRYGB patients and 47 RYGB patients underwent gastric emptying scintigraphy (GES) and FT assessment (by means of a questionnaire) between 6 months and 2 years postoperatively.

Tolerance of early oral feeding in patients subjected to total laryngectomy.

Background: The purpose of this study was to assess the tolerance of early oral feeding after total laryngectomy.

Method: A randomized multicenter study was conducted that included 89 individuals subjected to total laryngectomy. The participants were allocated to 2 groups: early (n = 44), early oral feeding; and late (n = 45), late oral feeding.

Complementation by argon plasma coagulation after endoscopic piecemeal resection of large colorectal adenomas.

Objective: To evaluate the efficacy of complement by argon plasma coagulation to reduce the rate of residual or recurrent tumor after complete endoscopic piecemeal resection of large sessile colorectal adenomas.

Inclusion Criteria: patients with large sessile colorectal adenomas (e" 20 mm), without morphological signs of deep infiltration, submitted to complete endoscopic piecemeal resection studied with chromoendoscopy and magnification of images. Patients were randomized into two groups: group 1 - no additional procedure, and group 2 - complementation by argon plasma coagulation.

Predictors of salivary fistula after total laryngectomy.

Objective: To evaluate the incidence of pharyngocutaneous fistula after total laryngectomy and try to identify its predictors.

Methods: From May 2005 to April 2010, 93 patients underwent total laryngectomy. We evaluated complications during and after surgery and compared them with the following variables: gender, nutritional status, previous tracheotomy, tumor location, type of surgery, TNM staging, prior treatment with chemotherapy and/or radiotherapy, use of flaps for reconstruction and surgical margin.

Ischemia/reperfusion injury after continuous or intermittent hepatic pedicle clamping in rabbits.

Background: The control of bleeding in hepatectomy is a challenge for surgeons. The hepatic pedicle clamping is a surgical maneuver that can provide reduction in bleeding, but it provokes a hepatocellular suffering. This, along with reperfusion after the clamping finishes, leads to an injury known as ischemia/reperfusion injury.

Predictors factors for post-thyroidectomy hypocalcaemia.

Objective: To evaluate the incidence and predictors of post-thyroidectomy definitive hypocalcemia and hypoparathyroidism.

Methods: We assessed ionic calcium preoperatively and postoperatively (first, second and 30th day) in 333 patients undergoing thyroidectomy. In those presenting hypocalcemia, measurements were also made 90 and 180 days after surgery, when parathormone was also dosed.

Short-term and mid-term control of type 2 diabetes mellitus by laparoscopic sleeve gastrectomy with ileal interposition.

Background: Standard surgical procedures used for the treatment of morbid obesity constitute optional treatments for type 2 diabetes mellitus (T2DM). The aim of the present study was to evaluate the short- and mid-term effects of laparoscopic sleeve gastrectomy (SG) with ileal interposition (II) in T2DM patients (n = 30).

Methods: The variables investigated were the feasibility of the procedure, remission/alleviation of the disease, morbidity, mortality, and weight loss.

Biodistribution and antitumoral effect of long-circulating and pH-sensitive liposomal cisplatin administered in Ehrlich tumor-bearing mice.

Cisplatin (CDDP) is one of the most active cytotoxic agents and has been widely used in the treatment of peritoneal carcinomatosis by the intraperitoneal (i.p.) route.

Evolution of blood magnesium and phosphorus ion levels following thyroidectomy and correlation with total calcium values.

Context And Objective: magnesium ion concentration is directly related and phosphorus ion concentration is inversely related to calcemia. The aim of this study was to evaluate the evolution of magnesium and phosphorus ion levels in patients undergoing thyroidectomy and correlate these with changes to calcium concentration.

Design And Setting: prospective study at the Alpha Institute of Gastroenterology, Hospital das Clínicas, Universidade Federal de Minas Gerais.

Long-term outcomes of reversal of laryngotracheal separation.

The aim of this study was to evaluate the long-term outcomes of the reversal of laryngotracheal separation (LTS) in patients who underwent extensive resection of tumors located in the upper aerodigestive tract. We performed a retrospective analysis of the medical records of eight patients who had LTS reversal. The operation was successful in six patients who were followed up for a period of 17-99 months (mean = 46.

Acute toxicity of long-circulating and pH-sensitive liposomes containing cisplatin in mice after intraperitoneal administration.

Aims: The objective of this work was to evaluate the acute toxicity of long-circulating and pH-sensitive liposomes containing cisplatin (SpHL-CDDP), after their intraperitoneal administration in male and female mice.

Main Methods: After single administration of free CDDP (5,10,and 20 mg/kg) or SpHL-CDDP (7,12,30,45 and 80 mg/kg), the body weight was recorded and the LD(50) was calculated. Blood samples were collected for biochemical and hematological analysis.

Gastric emptying before and after cholecystectomy in patients with cholecystolithiasis.

Background/aims: The objective of the present study was to measure gastric emptying time of solids and semisolids in dyspeptic individuals with cholecystolithiasis before and 6 months after cholecystectomy in order to determine whether cholecystectomy interferes with gastric emptying.

Methodology: A prospective, self-pairing study was conducted on 29 patients selected according to appropriate inclusion and exclusion criteria. Gastric emptying time of solids and semisolids was determined before and six months after laparoscopic cholecystectomy by the 13C-octanoic acid and 13C-acetate breath tests, respectively.

Influence of jejunoileal and common limb length on weight loss following Roux-en-Y gastric bypass.

Background: Capella surgery is one of the technical variations of Roux-en-Y gastric bypass. The method includes the preparation of an alimentary (Roux) limb with a standardized length (110 cm) in order to induce deficiencies in the absorption of macronutrients and thereby contribute to weight loss. The recognized variation in jejunoileal length in humans (approximately 4 to 9 m) is not considered, although this range correlates with the wide variation in the length of the common limb.

Histological esophagitis before and after surgical treatment of morbid obesity (Capella technique): a prospective study.

Background: The effects of vertical banded gastroplasty/Roux-en-Y gastric bypass (Capella) on the esophageal mucosa of patients with histological esophagitis are poorly understood. To evaluate long-term effects, we investigated the persistence, aggravation or disappearance of histological esophagitis in patients with morbid obesity and reflux esophagitis (diagnosed by endoscopic biopsy) after Roux-en-Y gastric bypass.

Methods: Twenty-one patients with morbid obesity and esophagitis (histological diagnosis) were submitted to gastric bypass (Fobi-Capella technique) and underwent upper endoscopy and esophageal biopsy during the late postoperative period.

Gastric emptying of solids and semi-solids in morbidly obese and non-obese subjects: an assessment using the 13C-octanoic acid and 13C-acetic acid breath tests.

Background: It has been suggested that obesity is associated with an altered rate of gastric emptying. The objective of the present study was to determine whether the rates of solid and semi-solid gastric emptying differ between morbidly obese patients and lean subjects.

Methods: The Gastric-emptying time (GET) of solid and semi-solid meals were compared between lean healthy subjects and morbidly obese patients enrolled in two previously published studies.

Laryngotracheal separation surgery: outcome in 60 patients.

Objective: To determine the outcome of laryngotracheal separation (LTS) in 60 patients in terms of the control and prevention of severe and persistent aspiration, morbidity and mortality, reversibility rate, and the influence of the presence of a tracheostomy.

Study Design: Retrospective study.

Results: LTS showed significant efficacy rates in terms of both treatment (87%) and prevention (100%) of pulmonary aspiration.

Botulinum A toxin injected into the gastric wall for the treatment of class III obesity: a pilot study.

Background: Obesity represents a major public health problem in western countries. Initial studies suggest that injection of botulinum A toxin (Btx-A) into the antropyloric region inhibits propulsive contractions of the antral pump, with delay in gastric emptying, early satiety and weight loss.

Methods: After approval by the University Ethics Committee, we prospectively evaluated 12 patients with class III obesity divided into 4 groups of 3 patients each.

Treatment of superior mesenteric artery embolism with a fibrinolytic agent: case report and literature review.

Successful treatment of superior mesenteric artery embolism depends on an aggressive approach in patients at risk for mesenteric ischemia. This approach favors an early diagnosis and permits the reestablishment of arterial flow within an appropriate time, with prevention of vasospasm and control of organic insufficiencies. We report here a case of superior mesenteric artery embolism in which arterial flow was reestablished by selective intra-arterial infusion of streptokinase.