ALFREDO LUIZ JACOMO
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cirurgia, Faculdade de Medicina - Docente
LIM/02 - Laboratório de Anatomia Médico-Cirúrgica, Hospital das Clínicas, Faculdade de Medicina
LIM/02 - Laboratório de Anatomia Médico-Cirúrgica, Hospital das Clínicas, Faculdade de Medicina
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conferenceObject Paradigm change in clinical anatomical learning: lessons from students' evaluations(2013) JACOMO, Alfredo Luiz; AKAMATSU, Flavia Emi; ANDRADE, MauroTeaching and learning processes are constantly changing as medical knowledge increases exponentially and general students’ behavior demands a continuous improvement of techniques and approaches. The University of São Paulo Medical School has a systematic evaluation of each discipline where students grade 38 different topics ranging to physical conditions to the quality of the classes, allowing the course coordinators to redirect to adjust the course format as needed. We analyzed the changes in the Anatomy course from 1994 to the present and their impact based on the students’ evaluations. In this study, the different methods to teach Anatomy to 2nd. And 3rd. year students of Medicine employed from 1994 to 2012 were confronted to the students’ evaluations, comparing the general appreciation of the course in different teaching approaches and, in addition, comparing with simultaneous basic disciplines, evaluated by the same questionnaire. Significant difference in students’ evaluation was observed when the course changed from Problem Based Learning technique to a more formal approach with theoretical classes and practical demonstrations. A still better evaluation was obtained as the practical demonstrations focused aspects showed in theoretical classes given by specialists trained in Anatomy. A similar improvement was not seen in other disciplines. Continuous feedback from students is essential to adequate teaching strategies to modern challenges to obtain the best results in courses of Clinical Anatomy.- Cochlear implantation trough the middle cranial fossa: a novel approach to access the basal turn of the cochlea(2013) BITTENCOURT, Aline Gomes; TSUJI, Robinson Koji; TEMPESTINI, Joao Paulo Ratto; JACOMO, Alfredo Luiz; BENTO, Ricardo Ferreira; BRITO, Rubens deThe classic approach for cochlear implant surgery includes mastoidectomy and posterior tympanotomy. The middle cranial fossa approach is a proven alternative, but it has been used only sporadically and inconsistently in cochlear implantation. Objective: To describe a new approach to expose the basal turn of the cochlea in cochlear implant surgery through the middle cranial fossa. Method: Fifty temporal bones were dissected in this anatomic study of the temporal bone. Cochleostomies were performed through the middle cranial fossa approach in the most superficial portion of the basal turn of the cochlea, using the meatal plane and the superior petrous sinus as landmarks. The lateral wall of the internal acoustic canal was dissected after the petrous apex had been drilled and stripped. The dissected wall of the inner acoustic canal was followed longitudinally to the cochleostomy. Results: Only the superficial portion of the basal turn of the cochlea was opened in the fifty temporal bones included in this study. The exposure of the basal turn of the cochlea allowed the visualization of the scala tympani and the scala vestibuli, which enabled the array to be easily inserted through the scala tympani. Conclusion: The proposed approach is simple to use and provides sufficient exposure of the basal turn of the cochlea.
- E-Cadherin Expression in Colonic Mucosa with and Without Fecal Stream(2013) KADRI, Caled Jaoudat; PEREIRA, Jose Aires; SILVA, Camila Morais Goncalves da; NONOSE, Ronaldo; NASCIMENTO, Enzo Fabricio do; JACOMO, Alfredo Luiz; MARTINEZ, Carlos Augusto RealThe tissue content of E-cadherin changes in inflammatory bowel diseases; however, similar changes have not yet been evaluated in diversion colitis. Objective: The aim of this study was to evaluate the tissue expression of E-cadherin in the mucosa of the colon in both segments with and without a fecal stream. Methods: Sixty Wistar rats were subjected to deviation of fecal stream by proximal colostomy in left colon and a distal mucosal fistula. Animals were divided into three experimental groups that were sacrificed 6, 12, and 18 weeks after surgery. In each experimental group, five animals underwent laparotomy without intestinal deviation (control subgroup). Colitis was diagnosed based on the presence of three independent histological parameters: reduction of the crypt length, neutrophil infiltration of the mucosa and submucosa, and epithelial erosion or ulceration. The E-cadherin expression was evaluated by immunohistochemistry and the tissue levels by computerized morphometry. The Mann-Whitney and Kruskal-Wallis test were used to compare the groups adopting a significance level of 5% (p < .05). Results: Segments without fecal stream showed a reduction in E-cadherin content when compared with segments with fecal stream. In the segments with a fecal stream, E-cadherin was expressed at the apical surface of colon glands, while segments without fecal stream showed a decrease in the amount of apical E-cadherin. The content of E-cadherin was maintained over the entire time of the intestinal exclusion. Conclusions: Diversion of the fecal stream decreases the expression of E-cadherin of the colon epithelium.
conferenceObject PROGNOSTIC IMPACT OF THE LYMPH NODE METASTATIC RATIO IN 5-YEAR SURVIVAL OF PATIENTS WITH RECTAL CANCER NOT SUBMITTED TO PREOPERATIVE CHEMORADIATION.(2013) MARTINEZ, C. Real; JACOMO, A.; AKAMATSU, F.; PEREIRA, J.; NONOSE, R.; SATO, D.; RODRIGUES, M.- Anatomical Basis of the Myofascial Trigger Points of the Trapezius Muscle(2013) AKAMATSU, Flavia Emi; SALEH, Samir; PINESI, Henrique Trombini; RODRIGUES, Katarina Reichmann; ZANDONA, Cintia Benedicto; ANDRADE, Mauro; JACOMO, Alfredo LuizThis study aimed to bring the trapezius muscle, knowledge of the locations where the accessory nerve branches enter the muscle belly to reach the motor endplates and find myofascial trigger points (MTPs). Although anatomoclinical correlations represent a major feature of MTP, no previous reports describing the distribution of the accessory nerve branches and their anatomical relationship with MTP are found in the literature. Both trapezius muscles from twelve adult cadavers were carefully dissected by the authors (anatomy professors and medical graduate students) to observe the exact point where the branches of the spinal accessory nerve entered the muscle belly. Dissection was performed through stratigraphic layers to preserve the motor innervation of the trapezius muscle, which is located deep in the muscle. Eight points were identified: In all cases, these locations corresponded to clinically described MTPs. The eight points where common in these twelve cadavers. This type of clinical correlation between spinal accessory nerve branching and MPT is useful to achieve a better understanding of the anatomical correlation of MTP and the physiopathology of these disorders and may provide a scientific basis for their treatment, providing useful additional information to therapists to achieve better diagnoses and improve therapeutic approaches.