FRANCISCO CESAR CARNEVALE
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Radiologia, Hospital das Clínicas, Faculdade de Medicina - Médico
8 resultados
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- Development of Research Agenda in Prostate Artery Embolization: Summary of Society of Interventional Radiology Consensus Panel(2020) DAVIS, Clifford; GOLZARIAN, Jafar; WHITE, Sarah; FISCHMAN, Aaron; RASTINEHAD, Ardeshir; ISAACSON, Ari; CARNEVALE, Francisco; FOSTER JR., Harris; FINDEISS, Laura; SAPOVAL, Marc; BOROFSKY, Michael; AYYAGARI, Raj; SALEM, Riad; BHATIA, Shivank; CARIDI, TheresaPurpose: To summarize the Society of Interventional Radiology Foundation's Research Consensus. Panel development of a research agenda on prostate artery embolization (PAE). Materials and Methods: PAE for the treatment of lower urinary tract symptoms has been shown to be safe and effective in decreasing symptoms and prostate size. Lack of randomized controlled trials (RCTs) on PAE in the United States has prevented inclusion in American Urologic Association guideline recommendations for treatment of lower urinary tract symptoms resulting from benign prostatic hyperplasia. Recognizing the need for well-designed trials, the SIR Foundation funded a Research Consensus Panel to prioritize a research agenda. The panel included interventional radiologists, urologists, SIR Foundation leadership, and industry representatives. I The goal of the meeting was to discuss weaknesses with current data and study design for development of US trials to report long-term outcomes data. Results: Final consensus on a research design could not be made because the group was split on 3 research designs: (i) RCT of PAE versus sham with crossover of the sham group. (ii) RCT of PAE versus simple prostatectomy. (iii) RCT of PAE versus holmium laser enucleation of the prostate/thulium laser enucleation of the prostate. The panel recommended a nonindustry-funded registry to obtain real-world data. Conclusions: Level 1 data are required to be included in the American Urologic Association guidelines for treatment of benign prostatic hyperplasia. Because of concerns with all 3 study designs, the panel did not reach a consensus. Further meetings are planned with the panel to select among these research designs.
- Society of Interventional Radiology Research Reporting Standards for Prostatic Artery Embolization(2020) UFLACKER, Andre B.; HASKAL, Ziv J.; BAERLOCHER, Mark O.; BHATIA, Shivank S.; CARNEVALE, Francisco C.; DARIUSHNIA, Sean R.; FAINTUCH, Salomao; GABA, Ron C.; GOLZARIAN, Jafar; MIDIA, Mehran; NIKOLIC, Boris; SAPOVAL, Marc R.; WALKER, T. Gregory
- Improvements in Irritative Versus Obstructive Symptoms of the International Prostate Symptom Score After Prostatic Artery Embolization in 174 Patients, in a Single Center(2020) MOREIRA, Airton Mota; ASSIS, Andre Moreira de; CARNEVALE, Francisco Cesar; OLIVEIRA, Daniel Simoes; ANTUNES, Alberto AzoubelAim The aim of this study is to compare the improvements in irritative versus obstructive symptoms of the International Prostate Symptom Score (IPSS) after prostatic artery embolization (PAE) in patients with benign prostatic hyperplasia (BPH). Materials and Methods Between 2010 and 2018, 186 patients underwent PAE in a single center and 174 patients were retrospectively selected. The inclusion criteria were symptoms due to BPH, refractory to pharmacological treatment and IPSS >= 8. The mean age of the patients was 63.7 +/- 7.2 years, the mean prostate volume 89.5 +/- 42.5 cm(3), and the mean IPSS 19.0 +/- 6.2 points. Patient data were reviewed at baseline, 3, 12 and 24 months and compared using the ANOVA mixed models and the Tukey's multiple comparison test. Results Obstructive subscores dropped more significantly than irritative subscores (p < 0.0001). The mean decrease in each IPSS item was frequency 2.4 (83%); urgency 0.8 (87%); nocturia 1.3 (49%); incomplete emptying 2.6 (83%); intermittency 2.3 (91%); weak stream 2.9 (82%); straining 1.6 (91%). The area under the curve for baseline obstructive scores was 0.7 (p = 0.006) and 0.59 (p = 0.182) for irritative scores. The most common BPH clinical manifestations include irritative and/or obstructive symptoms, the latter usually more prevalent. The IPSS drop observed after PAE suggests that it acts predominantly over obstructive symptoms (p < 0.0001). Conclusion Although a predominant improvement in obstructive symptoms may be observed after PAE, nocturia complaints may require special attention. The severity of baseline obstructive symptoms may significantly predict clinical outcomes.
- CIRSE Standards of Practice on Prostatic Artery Embolisation(2020) CORNELIS, Francois H.; BILHIM, Tiago; HACKING, Nigel; SAPOVAL, Marc; TAPPING, Charles R.; CARNEVALE, Francisco Cesar
- Prostatic Artery Embolization: Equipment, Procedure Steps, and Overcoming Technical Challenges(2020) CARNEVALE, Francisco Cesar; ASSIS, Andre Moreira de; MOREIRA, Airton MotaIn the last decade, prostatic artery embolization (PAE) established itself as a safe and effective treatment option for lower urinary tract symptoms (LUTS) attributed to benign prostate hyperplasia (BPH), with reproducible results across multiple centers and endorsement by important international societies. However, PAE is also known to be a technically demanding procedure. Accompanying the prevalence of benign prostate hyperplasia, the procedure is usually performed in older patients, in whom atherosclerosis and comorbidities are common features. Also, prostatic vascular anatomy is described to be complex and variable, and pelvic structures are deeply interconnected by anastomosis. Thus, PAE demands a deep familiarization with materials and devices, intraprocedure imaging techniques, microcatetherization skills and with the pelvic vascular anatomy. Especially in the beginning of the learning curve, the procedure can be time-consuming and related to high radiation exposure for both medical team and the patient. In this article, the main points of technical concern during PAE are described and discussed, such as the equipment needed, the effect of different embolic materials, patient's preparation for the procedure, arterial access sites, identifying and catheterizing the prostatic arteries, the embolization techniques, among others. Finally, the most frequent technical challenges are presented, and the possible strategies to overcome them are exemplified and discussed.
- Retrievable celect (TM) filter placement in the superior vena cava: A case report(2020) LEITE, Tulio Fabiano De Oliveira; SILVA, Thiago Oliveira E.; PEREIRA, Osvaldo Ignacio; CARNEVALE, Francisco CesarINTRODUCTION: Venous thromboembolism is an important cause of morbidity and mortality in the world. Upper Extremity Deep Venous Thrombosis (UEDVT) may be a cause of pulmonary embolism. Anticoagulation is the treatment of choice for venous thromboembolism, which is associated with low hemorrhagic complications. However, there are situations that anticoagulation becomes contraindicated as gastrointestinal tract hemorrhages, stroke, progression of deep venous thrombosis in the presence of adequate anticoagulation, where the vena cava filter is recommended. CASE REPORT: Patient 65 years old, female undergoing neurosurgical treatment of a mass suggestive of schwannoma with asymmetrical edema in the right upper limb, confirming the acute deep venous thrombosis by Doppler ultrassonogarphy. Anticoagulation was contraindicated by neurosurgery and after a multidisciplinary discussion, the superior vena cava filter was chosen. DISCUSSION: The Retrievable Celect (TM) Filter was implant in superior vena cava and may be considered as an alternative therapeutic method in cases where anticoagulation can not be performed. CONCLUSION: Superior vena cava filter is controversial, but is safe, feasible and effective, in preventing symptomatic pulmonary embolisms in patients in whom anticoagulation is contraindicated. (C) 2020 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
- Prostatic Artery Embolization for the Treatment of Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia: 10 Years' Experience(2020) CARNEVALE, Francisco Cesar; MOREIRA, Airton Mota; ASSIS, Andre Moreira de; ANTUNES, Alberto Azoubel; RODRIGUES, Vanessa Cristina de Paula; SROUGI, Miguel; CERRI, Giovanni GuidoBackground: Long-term experience with prostatic artery embolization (PAE) for benign prostatic hyperplasia remains limited. Purpose: To evaluate the efficacy, safety, and long-term results of PAE for benign prostatic hyperplasia. Materials and Methods: This retrospective single-center study was conducted from June 2008 to June 2018 in patients with moderate-to severe benign prostatic hyperplasia-related symptoms. International Prostate Symptom Score (IPSS), quality-of-life score, maximum urinary flow rate, postvoid residual volume, prostate-specific antigen (PSA), and prostate volume were assessed. PAE was performed with 100-500-mu m embolic microspheres. Mixed-model analysis of variance and Kaplan-Meyer method was accessed, as appropriate. Results: A total of 317 consecutive men (mean age 6 standard deviation, 65 years 6 8) were treated. Follow-up ranged from 3 months to 96 months (mean, 27 months). Bilateral and unilateral PAE was performed in 298 (94%) and 19 (6%) men, respectively. Early clinical failure occurred in six (1.9%) and symptom recurrence in 72 (23%) men at a median follow-up of 72 months. Mean maximum improvement was as follows: IPSS, 16 points +/- 7; quality-of-life score, 4 points +/- 1; prostatic volume reduction, 39 cm(3) +/- 39 (39% +/- 29); maximum urinary flow rate, 6 mL/sec +/- 10 (155% +/- 293); and postvoid residual volume, 70 mL +/- 6121 (48% +/- 81) (P < .05 for all). Unilateral PAE was associated with higher recurrence (42% vs 21%; P =.04). Baseline PSA was inversely related with recurrence (hazard ratio, 0.9 per nanograms per milliliter of PSA; 95% confidence interval [CI], 0.8, 0.9; P < .001). Embolization with combined particle sizes (100-500 mu m) did not relate to symptom recurrence (hazard ratio, 0.4; 95%CI: 0.2, 1.1 for 100-500-mu m group vs 300-500-mu m group and hazard ratio, 0.4; 95% CI: 0.1, 1.5 for 100-500-mu m group vs 100-300-mm group; P =.19). None of the patients presented with urinary incontinence or erectile dysfunction. Conclusion: Prostatic artery embolization was a safe and effective procedure for benign prostatic hyperplasia with good long-term results for lower urinary tract symptoms. (C) RSNA, 2020
- Management of Hepatocellular Carcinoma during the COVID-19 Pandemic - Sao Paulo Clinicas Liver Cancer Group Multidisciplinary Consensus Statement(2020) CHAGAS, Aline Lopes; FONSECA, Leonardo Gomes; COELHO, Fabricio Ferreira; SAUD, Lisa Rodrigues Cunha; ABADALA, Edson; ANDRAUS, Wellington; FIORE, Lucas; MOREIRA, Airton Mota; MENEZES, Marcos Roberto; CARNEVALE, Francisco Cesar; TANI, Claudia Megumi; ALENCAR, Regiane S. S. M.; D'ALBUQUERQUE, Luiz Augusto Carneiro; HERMAN, Paulo; CARRILHO, Flair JoseMore than 18 million people in 188 countries have been diagnosed as having coronavirus disease (COVID-19), and COVID-19 has been responsible for more than 600,000 deaths worldwide. Brazil is now the second most affected country globally. Faced with this scenario, various public health measures and changes in the daily routines of hospitals were implemented to stop the pandemic. Patients with hepatocellular carcinoma (HCC) are at an increased risk for severe COVID-19 as they present with two major diseases: cancer and concomitant chronic liver disease. The COVID-19 pandemic can significantly impact the management of HCC patients from diagnosis to treatment strategies. These patients need special attention and assistance at this time, especially since treatment for tumors cannot be delayed in most cases. The aim of this guideline was to standardize the management of HCC patients during the COVID-19 pandemic. This document was developed, on the basis of the best evidence available, by a multidisciplinary team from Instituto do Cancer do Estado de Sao Paulo (ICESP), and Instituto Central of the Hospital das Clinicas da Universidade de Sao Paulo (HC-FMUSP), which are members of the Sao Paulo Cli ' nicas Liver Cancer Group.