JOAQUIM MAURICIO DA MOTTA LEAL FILHO
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
7 resultados
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- Endovascular management of giant common iliac artery pseudoaneurysm after complications in simultaneous pancreas-kidney transplant: a case report(2021) LEITE, Tulio Fabiano de Oliveira; PAZINATO, Lucas Vatanabe; NUNES, Thiago Franchi; LEAL FILHO, Joaquim Mauricio da MottaBackground Pancreatic transplantation is a definitive treatment for selected patients with insulin-dependent diabetes. It is a technically challenging surgery, and vascular complications are the most common cause of pancreatic graft failure. Although rare, pancreas transplants present higher rates of pseudoaneurysms at the vascular anastomosis than other visceral transplants. We present a case of a simultaneous pancreas-kidney transplant complicated with graft failure and common iliac artery pseudoaneurysm that was successfully treated through endovascular techniques. Case presentation A 34-year-old White woman presented with abdominal pain and a history of type 1 diabetes mellitus, end-stage renal disease, and two previous pancreas transplantation failures. The first was a simultaneous pancreas-kidney transplantation performed 7 months prior that was complicated by pancreas graft thrombosis within 1 month and required graft resection. Five months later, she underwent a second pancreas transplantation with another pancreatic graft thrombosis requiring graft resection. Abdominal angiotomography revealed a pseudoaneurysm in the right common iliac artery at the point of the previous graft anastomosis. The patient was successfully treated endovascularly with a covered stent in the common iliac artery. Conclusion Stent graft implantation for the treatment of common iliac artery pseudoaneurysm as a complication of simultaneous pancreas-kidney transplantation is a safe and feasible procedure.
- Diagnostic Yield of Computed Tomography-Guided Procedures for Spondylodiscitis(2022) PAZINATO, Lucas Vatanabe; URAKAWA, Felipe Shoiti; SETUGUTI, Daniel Takeshi; MOTTA-LEAL-FILHO, Joaquim Mauricio da; MENEZES, Marcos Roberto dePurpose To identify the diagnostic yield and predictive factors for microbiological diagnosis in patients with spondylodiscitis through computed tomography (CT)-guided biopsy or aspiration. Materials and methods A retrospective review of 102 patients with suspected spondylodiscitis who underwent CT-guided procedures in an 8-year period was conducted. Analyzed variables were demographic data, C-reactive protein, pre-biopsy MRI findings, prior antibiotic use, site of biopsy/aspiration, histopathological findings, culture results and radiation dose. Results The culture yield among all sites was 56%, 85.6% for paravertebral/discal fluid aspiration, 66.7% for disk-only biopsy, 52.9% for paravertebral soft tissue biopsy, and 39.6% for endplate bone-disk unit. Patients with paravertebral/disk collection on MRI had better yields when submitted to fluid aspiration instead of biopsy of other sites (78.9% vs. 36.6%; p = 0,006). Pyogenic etiology corresponded to 68.3% of cases and Staphylococcus aureus was the most common agent. Prior antibiotics exposure was associated with a lower yield (66.2% vs. 40.9%, p = 0,016). Conclusions CT-guided procedures are safe and well-tolerated in patients with suspected spondylodiscitis, with good microbiologic yield particularly in the presence of paravertebral/discal abscess.
- Endovascular Removal of Intravascular Foreign Bodies: A Single-Center Experience and Literature Review(2022) LEITE, Tulio Fabiano de Oliveira; PAZINATO, Lucas Vatanabe; BORTOLINI, Edgar; PEREIRA, Osvaldo Ignacio; NOMURA, Cesar Higa; LEAL FILHO, Joaquim Mauricio da MottaObjective: To describe causes, clinical signs, experience and endovascular techniques for extraction of intravenous foreign bodies (IFB) and literature review. Methods: This retrospective study was based on data collected from the medical records of 51 consecutive patients (26 women and 25 men) treated from July 2007 to May 2020 at a single quaternary center in Brazil and case series with data, published in the literature since 2000 on IFB removal, of at least 5 patients. The average patient age was 43.54 years (range, 2 months to 84 years). The different retrieval method using the following was used in the procedure: gooseneck snare, guidewire, balloon, and custom snares. Results: The retrieval process rate was 100%. Thirty-one port-a-caths, 6 guidewires, 4 double lumens, 3 permcaths, 3 Shiley (R) catheters, 1 intra cath, 2 peripherally inserted central catheters, and one stent were extracted. The locations where the IFBs were most frequently trapped were the right atrium (39.2%), the pulmonary artery (17.64%), the superior vena cava (13.72%), and the right ventricle (16.12%). Single venous access was used in 67.07% of the patients. Femoral access, which was the most commonly used approach, was used in 85.71% of the patients. The loop was used in 64.70% of the patients. A fractured catheter was the main IFB in 60.76% of the cases (31 patients). Only one complication related to the extraction of an IFB was noted in a single patient who suffered from atrial fibrillation (1.96%). The 30 day mortality rate was zero. Conclusion: Percutaneous IFB removal should be considered as an alternative for the treatment and retrieval of IFBs because it is a minimally invasive procedure that is relatively simple, safe, and has low complication rates.
- Chemotherapy taste and bronchospasm: a consequence of a fistula between the superior vena cava and the right main bronchi(2021) LEITE, Tulio Fabiano de Oliveira; PAZINATO, Lucas Vatanabe; LEAL FILHO, Joaquim Mauricio da MottaA 56-year-old female patient with upper lobe neoplasia of the right lung and superior vena cava syndrome. The patient complained about the taste of the medications during the chemotherapy sessions. Interventional radiology diagnosed cava-bronchial fistula when it injected contrast into the inferior and superior vena cava.
- Endovascular treatment of intrarenal aneurysms bleeding and angiomyolipomas in a patient with tuberous sclerosis and polycystic kidney disease(2023) LEITE, Túlio; PAZINATO, Lucas Vatanabe; VIDAL, Maria Juliana de Aquino; FREITAS, Danielo de; LEAL FILHO, Joaquim Mauricio da MottaAbstract Tuberous sclerosis complex (TSC) and autosomal dominant polycystic kidney disease (ADPKD) are conditions related to renal failure that can rarely occur in association as a contiguous gene syndrome. Angiomyolipomas (AMLs) are renal tumors strongly related to TSC that may rupture and cause life-threatening bleedings. We present a patient with TSC, ADPKD, and renal AMLs with persistent hematuria requiring blood transfusion. The persistent hematuria was successfully treated through endovascular embolization, a minimally invasive nephron sparing technique.
- Percutaneous insertion of bilateral double J in pelvic cancer patients: Indications, complications, technique of antegrade ureteral stenting(2021) LEITE, Tulio Fabiano de Oliveira; PAZINATO, Lucas Vatanabe; LEAL FILHO, Joaquim Mauricio da MottaBackground: Antegrade percutaneous insertion of a double J seems to be a good alternative when retrograde insertion fails. Malignant ureteral obstruction occurs due to occlusion of the ureter secondary to tumor invasion, extrinsic compression, which prevents intermittent urine flow, leading to acute renal failure, increased morbidity, mortality and interruption of cancer treatment. Case: A 26-year-old woman with endometrial carcinoma with internal invasion of pelvic structures due to urosepsis and acute renal failure. She underwent anterograde percutaneous double-J implantation by interventional radiology due to the failure of retrograde catheter implantation. Conclusion: The antegrade double-J percutaneous implant technique is an alternative when the retrograde technique fails. This technique is feasible, with low morbidity and mortality and good quality of life for continuing cancer treatment.
- Percutaneous retrieval of intravascular foreign body in children: a case series and review(2022) PAZINATO, Lucas Vatanabe; LEITE, Tulio Fabiano de Oliveira; BORTOLINI, Edgar; PEREIRA, Osvaldo Ignacio; NOMURA, Cesar Higa; MOTTA-LEAL-FILHO, Joaquim Mauricio daBackground Percutaneous retrieval of intravascular foreign bodies has recently increased as a treatment option. Purpose To report our single-center experience of the percutaneous retrieval of 14 intravascular embolized catheter fragments in children and to conduct a literature review. Material and Methods MEDLINE databases were searched for case reports and series including children and iatrogenic catheter fragments or guidewires retrieved through percutaneous techniques. We also conducted a retrospective analysis of 14 cases from our institution over a 14-year period. A total of 27 studies were selected comprising 74 children, plus our 14 unpublished cases. Statistical analyses were performed using Microsoft Excel version 2016. Results Port catheter fragments and peripherally inserted central catheters (PICCs) were the most embolized foreign bodies and the pulmonary artery was the most common site of embolization in 44.1% of cases. Analysis of the retrieval technique demonstrated a preference for extraction through the femoral vein (81.7%) and using snare techniques (93.5%). The success rate of percutaneous retrieval was 96.6% with only 1.1% of procedure-related complications. Patients were asymptomatic in 77.2% of cases, presented septic complications in 2.3%, and no deaths were reported. Median fluoroscopy time was 10 min (range = 1.7-80 min) and median procedure length was 60 min (range = 35-208 min). Conclusion Percutaneous retrieval of intravascular foreign bodies is a feasible, safe, and efficient technique in children and should be considered the preferred treatment option.