NIVALDO ALONSO
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cirurgia, Faculdade de Medicina - Docente
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/04 - Laboratório de Microcirurgia, Hospital das Clínicas, Faculdade de Medicina - Líder
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/04 - Laboratório de Microcirurgia, Hospital das Clínicas, Faculdade de Medicina - Líder
11 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 11
- Facial Malformation in Crouzon's Syndrome Is Consistent with Cranial Base Development in Time and Space(2018) LU, Xiaona; FORTE, Antonio Jorge; SAWH-MARTINEZ, Rajendra; MADARI, Sarika; WU, Robin; CABREJO, Raysa; STEINBACHER, Derek M.; ALPEROVICH, Michael; ALONSO, Nivaldo; PERSING, John A.Background: In Crouzon's syndrome, cranial base deformities begin sequentially in the anterior cranial fossa initially, and later to the posterior cranial base. Facial characteristics are likely related to cranial base development. The temporal correlation between cranial base development and facial features is in need of clarification in Crouzon's patients, to clarify initial sites of deformity, which may impact surgical decision making. Methods: Thirty-six computed tomography scans of unoperated Crouzon's syndrome patients and 54 controls were included and divided into 5 age-subgroups. All the planes used for analysis were set as perpendicular to a defined ""midplane"" to offset the confounding factor caused by potential asymmetry. Results: The angle between Sella-Nasion plane and Frankfort horizontal plane was significantly increased before 6 months of age (P = 0.014), with an average 70% (P < 0.001) increase ultimately into adulthood. The angle between SN and maxillary plane and the angle between Sella-Nasion and occlusal planes increased consistently through infancy to adulthood (124% and 42%, respectively, both P < 0.001). The relative angle of mandibular plane to Frankfort horizontal plane increased before 6 months (28%, P = 0.007) with a peak timeframe from 2 to 18 years. Facial lateral curvature related measurements indicate the whole face is inclined posteriorly and inferiorly direction in relation to the anterior cranial base. Conclusion: Crouzon's facial malformation development is synchronous and positionally correlational with cranial base deformity. It transmitted from orbit to mandible, with the most evident morphologic changes are in the orbit and midface.
- Importance of Stem Cell Transplantation in Cleft Lip and Palate Surgical Treatment Protocol(2018) MAZZETTI, Marcelo Paulo Vaccari; ALONSO, Nivaldo; BROCK, Ryane Schmidt; AYOUB, Alexandre; MASSUMOTO, Sally Mizukami; ECA, Lilian PineroCleft lip and palate is a congenital malformation that requires a multidisciplinary treatment that evolves pediatrician, obstetrics, fetal medicine, genetics, plastic surgery, orthodontics, speech therapist, nursery, and psychology. Actually, the authors believe that it could be possible to ad protocols to use stem cells. The intrauterine diagnosis leads to preborn parental orientation and better parental collaboration to accept a precocious multidisciplinary treatment. After birth the authors' protocol is: orthodontic devices, phonoaudiology, and surgical procedures. The authors' cleft lip and palate reconstructive surgery protocol demands several steps and begins at 4 to 6-month old with rhinocheiloplasty and soft palate closure at the same moment. The treatment sequence involves the hard palate surgery (8-18 months after the first surgical step), alveoloplasty (after 10 years old), and secondary rhinoplasty (after 14 years old). New ideas to use stern cells and blood from the umbilical cord and also blood from placenta are discussed to improve final surgical results. Maternal stem cells are easy to collect, there are no damage to the patient and mother, it is autologous and it could be very useful in the authors' protocol. Nine patients with clef lip and palate were operated and had stem cells from umbilical cord blood and placenta blood injected into the bone and soft tissue during the primary procedure (rhinocheiloplasty). The stem cells activity into soft tissue and hone were evaluated. Preliminary results have shown no adverse results and improvement at the inflammatory response. A treatment protocol with stem cells was developed. It had a long time follow-up of 10 years.
- Surgical quality indicators in low-resource settings: A new evidence-based tool(2018) CITRON, Isabelle; SALUJA, Saurabh; AMUNDSON, Julia; FERREIRA, Rodrigo Vaz; LJUNGMAN, David; ALONSO, Nivaldo; MOUTINHO, Vitor; MEARA, John G.; STEER, MichaelBackground: Worldwide efforts to improve access to surgical care must be accompanied by improvements in the quality of surgical care; however, these efforts are contingent on the ability to measure quality. This report describes a novel, evidence-based tool to measure quality of surgical care in low-resource settings. Methods: We defined a widely applicable, multidimensional conceptual framework for quality. The suitability of currently available quality metrics to low-resource settings was evaluated. Then we developed new indicators with sufficient supportive evidence to complete the framework. The complete set of metrics was condensed into four collection sources and tools. Results: The following 15 final evidence-based indicators were defined: (1) Safe structure: morbidity and mortality conference; (2) safe process: use of the safe surgery checklist; (3) (4) safe outcomes: perioperative mortality rate and proportion of cases with complications graded >2 on the Clavien-Dindo scale; (5) effective structure: provider density; (6) effective process: procedure rate; (7) effective outcome: rate of caesarean sections; (8) patient-centered process: use of informed consent; (9) patient-centered outcome: patient hospital satisfaction questionnaire; (10) timely structure: travel time to hospital; (11) timely process: time from emergency department presentation to non-elective abdominal surgery; (12) timely outcome: patient follow-up plan; (13) efficient process: daily operating room usage; (14) equitable outcome: comparative income of patients compared with population; and (15) proportion of patients facing catastrophic expenditure because of surgical care. Conclusion: This tool provides an evidence-based conceptual tool to assess the quality of surgical care in diverse low-resource settings.
- Unilateral Cleft Lip and Palate Surgical Protocols and Facial Growth Outcomes(2018) PEREIRA, Rui Manuel Rodrigues; SIQUEIRA, Niedje; COSTA, Edna; VALE, Dione do; ALONSO, NivaldoBackground: Adequate dentofacial growth is an objective of unilateral cleft lip and palate treatment. No study exists, comparing the dental arch of 5-year-old relationship after 2 treatment protocols: one with single-stage palatoplasty and another with delayed hard palate closure (DI 1PC). The authors hypothesized that the DHPC protocol provides better dentofacial growth. Methods: A single-center, single-surgeon Randomized Clinical Trial was performed to evaluate the maxillomandibular relationships in 2 groups. The intervention group (GI) underwent palatoplasty with DHPC between ages 3 and 4 years; the control group (CG) underwent complete palatoplasty between 9 and 15 months. The authors evaluated oronasal fistulae rates. The dental arch relationship was evaluated via blinded panels using the Five Year Old Index. Kappa statistics were calculated to assess reliability. Trials were statistically tested with the t test and chi-squared test. Results: Sixty-four patients constituted the study sample. The incidence of oronasal fistulae was 9.4% (GI) and 6.7% (CG). Sixty-two models with an average age of 55 months were available for analysis. Good intra- and inter-rater reliabilities (0.73-0.93 and 0.60-0.94, respectively) were obtained. Average index scores ranging from 2.04 (GI) to 2.76 (CG) were significantly different (P = 0.007). Significant between-group differences (P=0.006) were found in scores, 1 and 2 in the GI (74%) and CG (52%). When the distributions were compared by the median, a difference was found (P = 0.024) in score, 1 between the GI (31.2%) and CG (3.3%). Conclusions: Although the DHPC protocol yielded better outcomes relating to dentofacial growth, other protocols should be investigated and findings verified by other researchers.
- Anterior convex lateral orbital wall: distinctive morphology in Apert syndrome(2018) LU, X.; FORTE, A. J.; SAWH-MARTINEZ, R.; WU, R.; CABREJO, R.; STEINBACHER, M.; ALPEROVICH, M.; ALONSO, N.; PERSING, J. A.Bony malformations of the orbit and alterations to the soft tissue in Apert syndrome contribute to ophthalmic dysfunction. Recognised structural malformation of the sphenoid and ethmoid sinuses, together with corresponding deformities in the anterior and middle cranial base, are characteristic. Our aim was to explore the underlying structural components of disfigurement and the consequent development of the orbit in patients with Apert syndrome over time by studying 18 preoperative computed tomographic (CT) scans of affected patients and 36 scans from controls. Cephalometric measurements related to the orbit were collected, and analysed with Materialise software. The patients with Apert syndrome had larger than normal external orbital horizontal angles between the ages of 6 months and 2 years. The inside horizontal angle was narrower at 16.36 degrees before 6 months, and continued to decrease into adulthood. The ethmoid and sphenoid side angles in affected patients consistently increased, starting at 7.93% and 14.68% of the external horizontal angle, respectively, during the first 6 months of age, and becoming 20.55% and 11.69%, respectively, in adulthood. In unaffected patients, both angles were less than 3% of the external horizontal angle overall. The orbital vertical angle also changed synchronously, with increasingly wide lateral orbits and shortened anteroposterior orbits. The anterior protrusion of the lateral orbital wall resulted from superior and posterior rotation of a curved, greater wing of the sphenoid, while the widened median orbital wall was caused by the widened ethmoid sinus. These resulted in bony deformities of the orbit, which predisposed to the visual impairments of Apert syndrome.
- Management of Intracranial Condylar Fracture With Intracranial Migration(2018) KURIMORI, Kleber Tetsuo; BASTOS, Endrigo Oliveira; OLIVEIRA, Walter Amorim de; ALONSO, NivaldoDespite condylar fractures representing one of the most common sites of mandibular fractures, intracranial condylar dislocation is a rare event. In this article, the authors report 2 patients. The first patient is a young female with signs and symptoms as commonly reported in the literature. The second patient reports the consequences of a delayed diagnosis of intracranial condylar fracture dislocation. Both patients underwent surgical treatment. These patients are discussed with a review of the literature, noting biomechanics and mechanism of injury, diagnostic methods, and the treatment for these fractures. Diagnosis also may be challenging at times, though it should always be suspected in patients with bite alterations associated with high energy trauma and the stigmata of direct chin trauma. There is no pathognomonic clinical examination and it is fundamental to use computed tomographic methods for confirmation. Treatment is often open reduction and internal fixation, though it should be tailored for each patient presentation.
- Global Craniofacial Surgery in Latin America(2018) ALONSO, Nivaldo
- Normal angulation of skull base in Apert syndrome(2018) LU, Xiaona; FORTE, Antonio Jorge; SAWH-MARTINEZ, Rajendra; WU, Robin; CABREJO, Raysa; STEINBACHER, Derek M.; ALPEROVICH, Michael; ALONSO, Nivaldo; PERSING, John A.Apert syndrome is characterized by the severe craniofacial deformities. The subsequent process of skeletal maldevelopment is likely to be influenced by multiple interactions at several levels, at a given time. In this study, we aimed to explore the evolution of cranial basal dysmorphology and the chronology of these deformities in Apert syndrome, by objectively analyzing three-dimensional measurements. Fifty-four CT scans from unoperated patients (Apert, n = 18; control, n = 36) were included in this study, with age range from 3 days to 24 years. Before 6 months of age, Apert's anterior cranial base was widened 60%. Between 6 months and 2 years of age, the whole cranial base length, anterior cranial base length and posterior cranial base length decreased 8%, 8% and 14%, respectively. The greater sphenoid wing angle was wider by 26.0 degrees, and continued into adulthood. The cranial base angles did not produce significant changes throughout life. The extra cranial distances synchronously and almost proportionally shortened after later infancy. The anterior and posterior cranial base length shortened at an almost proportional rate. The malformations of the skull vault are additive effects with cranial base fusion on skull length restriction, but the angulation of the skull base is virtually normal.
- Quality of Surgical Care Measurement Tool: A Pilot Study in Amazonas, Brazil(2018) RAMOS, Jania A.; ROA, Lina; CITRON, Isabelle; SALUJA, Saurabh; AMUNDSON, Julia R.; MOUTINHO, Vitor; LJUNGMAN, David M.; FERREIRA, Rodrigo Vaz; ALONSO, Nivaldo
- MRPL53, a New Candidate Gene for Orofacial Clefting, Identified Using an eQTL Approach(2018) MASOTTI, C.; BRITO, L. A.; NICA, A. C.; LUDWIG, K. U.; NUNES, K.; SAVASTANO, C. P.; MALCHER, C.; FERREIRA, S. G.; KOBAYASHI, G. S.; BUENO, D. F.; ALONSO, N.; FRANCO, D.; ROJAS-MARTINEZ, A.; SANTOS, S. E. dos; GALANTE, P. A.; MEYER, D.; HUENEMEIER, T.; MANGOLD, E.; DERMITZAKIS, E. T.; PASSOS-BUENO, M. R.A valuable approach to understand how individual and population genetic differences can predispose to disease is to assess the impact of genetic variants on cellular functions (e.g., gene expression) of cell and tissue types related to pathological states. To understand the genetic basis of nonsyndromic cleft lip with or without cleft palate (NSCL/P) susceptibility, a complex and highly prevalent congenital malformation, we searched for genetic variants with a regulatory role in a disease-related tissue, the lip muscle (orbicularis oris muscle [OOM]), of affected individuals. From 46 OOM samples, which are frequently discarded during routine corrective surgeries on patients with orofacial clefts, we derived mesenchymal stem cells and correlated the individual genetic variants with gene expression from these cultured cells. Through this strategy, we detected significant cis-eQTLs (i.e., DNA variants affecting gene expression) and selected a few candidates to conduct an association study in a large Brazilian cohort (624 patients and 668 controls). This resulted in the discovery of a novel susceptibility locus for NSCL/P, rs1063588, the best eQTL for the MRPL53 gene, where evidence for association was mostly driven by the Native American ancestry component of our Brazilian sample. MRPL53 (2p13.1) encodes a 39S protein subunit of mitochondrial ribosomes and interacts with MYC, a transcription factor required for normal facial morphogenesis. Our study illustrates not only the importance of sampling admixed populations but also the relevance of measuring the functional effects of genetic variants over gene expression to dissect the complexity of disease phenotypes.