PAULO MANUEL PEGO FERNANDES
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cardio-Pneumologia, Faculdade de Medicina - Docente
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
LIM/61 - Laboratório de Pesquisa em Cirurgia Torácica, Hospital das Clínicas, Faculdade de Medicina - Líder
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
LIM/61 - Laboratório de Pesquisa em Cirurgia Torácica, Hospital das Clínicas, Faculdade de Medicina - Líder
134 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 134
- Great expectations(2012) PEGO-FERNANDES, Paulo Manuel; BIBAS, Benoit Jacques
- Impact of gastroesophageal reflux in the pathogenesis of tracheal stenosis(2020) CARDOSO, Paulo Francisco Guerreiro; MINAMOTO, Helio; BIBAS, Benoit Jacques; PEGO-FERNANDES, Paulo ManuelBenign airway stenosis is a multifactorial and heterogeneous disease often occurring after tracheal intubation. Despite the frequent finding of pathological gastroesophageal reflux (GER) in benign tracheal stenosis, the cause-and-effect relationship between these two entities and its impact on the outcome of the stenosis itself have not been established. The altered ventilatory dynamics caused by an increased thoracoabdominal pressure gradient in such patients has been proposed as a central cause. The presence of GER in a setting of microaspiration can also induce changes in the local collagen proliferation response, as well as in the local microbiome of the tracheal stenosis site, which may potentially cause and enhance the harm imposed to the already diseased tracheal wall. Diagnosis of GER remains underestimated in the general population, thus making its accurate detection and treatment in central airway stenosis a matter of investigation. The high prevalence of GER in tracheal stenosis patients often occurs in the absence of typical upper digestive signs and symptoms, therefore requiring an objective assessment using a 24-hour ambulatory esophageal pH/impedance study that has shown abnormal results in more than half the patients. The impact of the treatment of GER in patients with benign tracheal has been scarcely reported. Our group showed recently that the surgical control of GER through laparoscopic fundoplication in selected patients with tracheal stenosis can improve substantially the chance of resolution of the tracheal stenosis as opposed to the medical management with high dose proton pump inhibitors. This chapter describes the impact of GER in the pathogenesis of tracheal stenosis with a focus on its mechanisms, diagnosis and treatment strategy.
- Adverse events after pleurodesis in patients with malignant pleural effusion(2020) TERRA, Ricardo Mingarini; COSTA, Priscila Berenice da; VEGA, Alberto Jorge Monteiro Dela; PEGO-FERNANDES, Paulo ManuelBackground: Malignant pleural effusion (MPE) is an important sign of advanced disease in metastatic cancer. Pleurodesis is one option to treat recurrent MPE. The Inflammatory response after pleurodesis may lead to important adverse events (AE) in a set of very ill patients. Methods: Retrospective analysis of patients submitted to pleurodesis (2009-2013). Clinical and laboratory data were collected. We compare the values in the day of pleurodesis, 2nd, 5th and 10th days after. Results: One hundred fourteen patients were undergone to pleurodesis with silver nitrate (46%), iodine (52%) and talc (2%). Female was the most frequent (86%) and the breast cancer was the most common primary site. The most frequent adverse event was low hemoglobin account (37), followed by pain (31). 68% of patients presented AEs and 28% had at least one AE with grade 3 or higher. The most altered was CRP that peaked in the 5th day after pleurodesis. Changes in CRP curve were less severe with the use of iodine when compared with the other two agents. Conclusions: Pleurodesis leads to important systemic inflammatory response detected by different serum markers. The occurrence of adverse events in this set of patients was great number of events with being marked as grade 3 or higher.
- Lung transplantation: overall approach regarding its major aspects(2015) CAMARGO, Priscila Cilene Leon Bueno de; TEIXEIRA, Ricardo Henrique de Oliveira Braga; CARRARO, Rafael Medeiros; CAMPOS, Silvia Vidal; AFONSO JUNIOR, Jose Eduardo; COSTA, Andre Nathan; FERNANDES, Lucas Matos; ABDALLA, Luis Gustavo; SAMANO, Marcos Naoyuki; PEGO-FERNANDES, Paulo ManuelO transplante pulmonar é uma terapia bem estabelecida para pacientes com doença pulmonar avançada.A avaliação do candidato para o transplante é uma tarefa complexa e envolve uma equipe multidisciplinar que acompanha o paciente para além do período pós-operatório.O tempo médio atual em lista de espera para transplante pulmonar é de aproximadamente 18 meses no estado de São Paulo. Em 2014, dados da Associação Brasileira de Transplante de Órgãos mostram que 67 transplantes pulmonares foram realizados no Brasil e que 204 pacientes estavam na lista de espera para transplante pulmonar.O transplante pulmonar é principalmente indicado no tratamento de DPOC, fibrose cística, doença intersticial pulmonar, bronquiectasia não fibrocística e hipertensão pulmonar.Esta revisão abrangente teve como objetivos abordar os aspectos principais relacionados ao transplante pulmonar: indicações, contraindicações, avaliação do candidato ao transplante, avaliação do candidato doador, gestão do paciente transplantado e complicações maiores. Para atingirmos tais objetivos, utilizamos como base as diretrizes da Sociedade Internacional de Transplante de Coração e Pulmão e nos protocolos de nosso Grupo de Transplante Pulmonar localizado na cidade de São Paulo.
article 5 Citação(ões) na Scopus An experimental rat model of ex vivo lung perfusion for the assessment of lungs after prostacyclin administration: inhaled versus parenteral routes(2011) CARDOSO, Paulo Francisco Guerreiro; PAZETTI, Rogerio; MORIYA, Henrique Takachi; PEGO-FERNANDES, Paulo Manuel; ALMEIDA, Francine Maria de; CORREIA, Aristides Tadeu; FECHINI, Karina; JATENE, Fabio BiscegliObjective: To present a model of prostaglandin I(2) (PGI(2)) administration (inhaled vs. parenteral) and to assess the functional performance of the lungs in an ex vivo lung perfusion system. Methods: Forty Wistar rats were anesthetized and placed on mechanical ventilation followed by median sterno-laparotomy and anticoagulation. The main pulmonary artery was cannulated. All animals were maintained on mechanical ventilation and were randomized into four groups (10 rats/group): inhaled saline (IS); parenteral saline (PS); inhaled PGI(2) (IPGI(2)); and parenteral PGI(2) (PPGI(2)). The dose of PGI(2) used in the IPGI(2) and PPGI(2) groups was 20 and 10 mu g/kg. respectively. The heart-lung blocks were submitted to antegrade perfusion with a low potassium and dextran solution via the pulmonary artery, followed by en bloc extraction and storage at 4 degrees C for 6 h. The heart-lung blocks were then ventilated and perfused in an ex vivo lung perfusion system for 50 min. Respiratory mechanics, hemodynamics, and gas exchange were assessed. Results: Mean pulmonary artery pressure following nebulization decreased in all groups (p < 0.001), with no significant differences among the groups. During the ex vivo perfusion, respiratory mechanics did not differ among the groups, although relative oxygenation capacity decreased significantly in the IS and PS groups (p = 0.04), whereas mean pulmonary artery pressure increased significantly in the IS group. Conclusions: The experimental model of inhaled PGI(2) administration during lung extraction is feasible and reliable. During reperfusion, hemodynamics and gas exchange trended toward better performance with the use of PGI(2) than that with the use of saline.- Evolution of the surgical treatment of lung cancer at a tertiary referral center in Brazil, 2011-2018(2021) SOARES, Mariana Schettini; COLTRO, Laura Maria; LEITE, Pedro Henrique Cunha; COSTA, Priscila Berenice; LAURICELLA, Leticia Leone; PEGO-FERNANDES, Paulo Manuel; TERRA, Ricardo MingariniObjective: To evaluate the evolution of clinical and epidemiological data, as well as data related to diagnosis, staging, treatment, and survival, among patients undergoing curative surgery for lung cancer at a tertiary referral center in the city of Sao Paulo, Brazil. Methods: This was a retrospective study of cases in the International Association for the Study of Lung Cancer database. We selected only cases of patients undergoing curative surgery between January of 2011 and April of 2018. We determined overall and disease-free survival at 36 months and compared the data between two periods (2011-2014 and 2015-2018). Results: Comparing the two periods (N = 437 cases), we observed trends toward increases in the number of female patients, as well as in the proportions of former smokers (44.09% vs. 53.59%), of patients diagnosed with adenocarcinoma (52.21% vs. 59.72%), and of patients diagnosed at an earlier pathological stage, together with a decrease in 30-day mortality (4.05% vs. 2.39%). There were significant increases in the proportions of cases diagnosed at an earlier clinical stage (p = 0.002) or incidentally (p = 0.003). Although lobectomy was the main surgical technique employed, there was a proportional increase in segmentectomies (2.67% vs. 7.11%; p = 0.026). Overall and disease-free survival rates were 79.4% (95% CI: 74.0-83.9%) and 75.1% (95% CI: 69.1-80.1%), respectively. The difference in overall survival between the periods lost statistical significance when adjusted for pathological stage, the only factor that affected survival (log-rank: p = 0.038 to p = 0.079). Conclusions: The clinical and epidemiological evolution presented in this study corroborates global trends. The decrease in 30-day mortality was probably due to better patient selection and improved surgical techniques.
- Prolonged survival after thoracic metastasectomy in patients with nonseminomatous testicular cancer(2024) FONINI, Jaqueline Schaparini; ARAUJO, Pedro Henrique Xavier Nabuco de; 'AMBROSIO, Paula Duarte D.; SALERNO, Juliana Vieira de Oliveira; CIARALO, Pedro Prosperi Desenzi; TERRA, Ricardo Mingarini; PE, Paulo ManuelIntroduction: Almost 20 % of patients with Non-Seminomatous Germinative Cell Tumors (NSGCT) will require intrathoracic metastasectomy after chemotherapy. The authors aim to determine their long-term survival rates. Methods: Retrospective study including patients with NSGCT and intrathoracic metastasis after systemic therapy from January 2011 to June 2022. Treatment outcomes and overall survival were analyzed with the Kaplan-Meier method. Results: Thirty-seven male patients were included with a median age of 31.8 years. Six presented with synchronous mediastinum and lung metastasis, nine had only lung, and 22 had mediastinal metastasis. Over half had retroperitoneal lymph node metastasis. Twenty-two had dissimilar pathologies, with a discordance rate of 62 %. Teratoma and embryonal carcinoma were the prevalent primary tumor types, 40.5 % each, while teratoma was predominant (70.3 %) in the metastasis group. Thoracotomy was the main surgical approach (39.2 %) followed by VATS (37.2 %), cervico-sternotomy (9.8 %), sternotomy (5.8 %), and clamshell (3.9 %). Lung resection was performed in 40.5 % of cases. Overall, 10-year survival rates were 94.3 % with no surgical-related mortality. Conclusion: Multimodality treatment with systemic therapy followed by radical surgery offers a high cure rate to patients with intrathoracic metastatic testicular germ cell tumors.
- Mediastinal Ganglionar Tuberculosis Postcardiac Transplantation(2018) LISBOA, Joao Bruno Ribeiro Machado; RODRIGUES, Guilherme de Abreu; MONDADORI, Diego Corsetti; MACEDO, Joao Paulo Cassiano de; FREITAS FILHO, Orival de; PEGO-FERNADES, Paulo ManuelThe diagnosis and treatment of tuberculosis (TB) in transplanted receivers presents several challenges. TB is an opportunistic infection with high morbidity and mortality in solid organs of transplanted patients, therefore, the diagnosis difficulties. A case of a 30-year-old male, heart transplanted patient, who after being submitted to mediastinoscopy, obtained a result of lymph node TB.
- The 500th Lung Transplantation at the Faculdade de Medicina da Universidade de Sao Paulo: Reflecting on Our Journey and Looking Ahead(2023) REIS, Flavio Pola dos; PEGO-FERNANDES, Paulo Manuel
- Soluble factors of mesenchimal stem cells (FS-MSC) as a potential tool to reduce inflammation in donor's lungs after hypovolemic shock(2021) DIAS, Vinicius Luderer; BRAGA, Karina Andrighetti de Oliveira; NEPOMUCENO, Natalia Aparecida; RUIZ, Liliane Moreira; PEREZ, Juan David Ruiz; CORREIA, Aristides Tadeu; CAIRES JUNIOR, Luiz Carlos de; GOULART, Ernesto; ZATZ, Mayana; PEGO-FERNANDES, Paulo ManuelObjective: The shortage of viable lungs is still a major obstacle for transplantation. Trauma victims who represent potential lung donors commonly present hypovolemic shock leading to pulmonary inflammation and deterioration and rejection after transplantation. Seeking to improve lung graft, new approaches to donor treatment have been tested. This study focuses on treatment with mesenchymal stem cells (MSCs) or soluble factors produced by MSCs (FS-MSC) using a rat model for lung donors after hemorrhagic shock. Methods: Forty-eight rats were divided into four groups: Sham (n=12), animals without induction of hypovolemic shock; Shock (n=12), animals submitted to hypovolemic shock (mean arterial pressure 40 mmHg); MSC (n=12), animals submitted to hypovolemic shock and treated with MSCs, and FS (n=12), animals submitted to hypovolemic shock and treated with FS- MSC. The animals were subjected to a 50-minute hypovolemic shock (40 mmHg) procedure. The treated animals were monitored for 115 minutes. We performed histopathology of lung tissue and quantification of inflammatory markers (TNF-alpha, IL-1 beta, IL-6, IL-10, iCAM and vCAM) in lung tissue and peripheral blood leukocytes (PBLs). Results: Hemorrhagic shock resulted in higher PBLs and neutrophil infiltrate in the lungs. FS animals had lower neutrophil density comparing with Shock and MSC animals (p<0.001). No differences in the cytokine levels in lung tissue were observed between the groups. Conclusions: The lungs of rats submitted to hemorrhagic shock and treated with FS-MSC showed reduced inflammation indicated in a decrease in lung neutrophil infiltrate.