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
8 resultados
Resultados de Busca
Agora exibindo 1 - 8 de 8
- GAUCHO-Trial Genicular Artery Embolization Using Imipenem/Cilastatin vs. Microsphere for Knee Osteoarthritis: A Randomized Controlled Trial(2022) CORREA, Mateus Picada; MOTTA-LEAL-FILHO, Joaquim M.; LUGOKESKI, Ricardo; MEZZOMO, Marcio; LEITE, Lucas RicciGenicular artery embolization (GAE) has emerged as a treatment option to improve quality of life in patients suffering from moderate-to-severe pain refractory to conservative treatment of knee osteoarthritis, with encouraging results. This paper describes the study protocol of a single-center, double-blind, randomized controlled trial designed to evaluate and compare the safety and efficacy of GAE using imipenem/cilastatin vs. microspheres for the treatment of moderate-to-severe pain associated with knee osteoarthritis. We hypothesized that there will be no difference in safety and efficacy outcomes. The study received ethics approval of the institutional review board with number 4.364.391 / CAAE: 37590820.3.0000.5342 and is registered onto the Registro Brasileiro de Ensaios Clinicos (ReBEC), with number RBR-2h5rwgb. Technical success was defined as embolization of at least 1 feeding artery supplying the hyperemic synovium of the knee joint. Primary outcome: clinical success was defined as improvement in symptoms, 50% reduction in Western Ontario and McMaster Universities Osteoarthritis Index pain scores or an increase of at least 10 points in the Knee Injury and Osteoarthritis Outcome Score from baseline to 3 months of follow-up. Secondary outcome: radiological success was defined as significant improvement in the Whole-Organ Magnetic Resonance Imaging Score for knee synovitis considering the embolized areas at 12 months of follow-up after GAE and a reduction in the analgesia or other conservative therapies for knee pain used by the patient at 3 and 12 months of follow-up. Clinical assessments will be performed before GAE, during GAE and at hospital discharge (for Visual Analog Scale of pain), and at 30 days, 3 months, and 12 months after GAE.
- 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.
- Long-term results of oversized balloon dilation for benign anastomotic biliary strictures: initial two-center experience(2022) NUNES, Thiago Franchi; INCHINGOLO, Riccardo; MORAIS NETO, Reinaldo; TIBANA, Tiago Kojun; FORNAZARI, Vinicius Adami Vayego; MOTTA-LEAL-FILHO, Joaquim Maurício da; SPILIOPOULOS, StavrosAbstract Objective: To describe, assess the feasibility of, and quantify the long-term patency achieved with percutaneous transhepatic biliary dilation using the anastomotic biliary stricture (ABS) oversized balloon dilation technique as a single-step procedure for the treatment of benign anastomotic biliary strictures following hepatobiliary surgery. Materials and Methods: This was a retrospective, two-center study including 16 consecutive cases of symptomatic benign biliary-enteric strictures. After assessment of the diameter of the bile duct by computed tomography or magnetic resonance imaging, the strictures were dilated with oversized balloons (40-50% larger than the bile duct diameter) and an external biliary-enteric drain was placed. After drain removal, clinical symptoms and laboratory test results were evaluated every three months, whereas follow-up magnetic resonance imaging was performed at 30 days out and follow-up computed tomography was performed at 6 and 12 months out. Results: The mean follow-up time was 31.8 ± 8.15 months. Kaplan-Meier-estimated 1-, 2-, and 3-year patency rates were 88.2%, 82.4%, and 82.4%, respectively. There was one major complication—a small dehiscence of the anastomosis—which extended the catheter dwell time. Minor complications occurred in two cases—one small perihepatic hematoma and one segmental thrombosis of the left portal branch—neither of which required further intervention. Conclusion: The single-step ABS oversized balloon dilation technique is a feasible treatment for benign anastomotic biliary-enteric strictures. The technique appears to be associated with high rates of long-term clinical success and patency.
- Prostatic Artery Embolization for the Treatment of Benign Prostatic Hyperplasia: To Infinity and Beyond(2022) MOTTA-LEAL-FILHO, Joaquim Mauricio
- Challenges of Interventional Radiology in Brazil!(2022) FORNAZARI, Vinicius Adami Vayego; MOTTA-LEAL-FILHO, Joaquim Mauricio da
- 6-Month Follow-up of Lateral Femoral Circumflex Artery Embolization to Control Pain Related to Hip Osteoarthritis and Greater Trochanteric Pain Syndrome(2022) CORREA, Mateus Picada; MOTTA-LEAL-FILHO, Joaquim M.; BERVIAN JUNIOR, Eduardo; MANSANO, Rodolfo Marques; DEUSCHLE, Julia Succolotti; PUTON, Renan Camargo; SALEH, Jaber Nashat de Souza; NOEL, Rafael Stevan; BAJERSKI, Julio CesarPurpose To present the preliminary results of a cohort of 13 patients with hip osteoarthritis (OA) and great trochanteric pain syndrome (GTPS) refractory to conservative management or physical therapy and no indication for surgery treated with embolization of the lateral femoral circumflex artery. Material and Methods This is a single-center prospective cohort from July 2019 to September 2020. Visual analogue scale (VAS) and Western Ontario and MacMaster Universities (WOMAC) were used to compare the symptoms before and after 6-month follow-up. Technical success was considered when at least one artery responsible for the hyperemic synovium was embolized. Complications and adverse events were noted. Results In total, 13 patients were included; mean age was 62.4 (+/- 11.0) years. 10 (76.9%) patients were treated for GTPS and 3 (23.1%) for hip OA. Nine patients were treated with imipenem/cilastatin (I/C) alone. Microsphere 100-300 mu m and I/C were combined in 4 patients. The WOMAC Index had a statistically significant decrease in the total from 77 to 27 points (p = 0.001). Pain, rigidity and physical activity have also significantly reduced (19 to 5, p = 0.001; 6 to 2, p = 0.002 and 53 to 22, p = 0.001, respectively). VAS score had a significant decrease (10 to 2, p = 0.002). Two patients present posterior tight numbness, spontaneously improved within 30 days. Conclusion In this cohort, lateral femoral circumflex artery embolization was a safe and effective treatment for patients with hip pain due to OA and GTPS.
- 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.