FRANCISCO CESAR CARNEVALE
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Radiologia, Hospital das Clínicas, Faculdade de Medicina - Médico
7 resultados
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- Prostatic Artery Embolization: Indications, Preparation, Techniques, Imaging Evaluation, Reporting, and Complications(2021) JR, Ubenicio Silveira Dias; MOURA, Mauricio Ruettimann Liberato de; VIANA, Publio Cesar Cavalcante; ASSIS, Andre Moreira de; MARCELINO, Antonio Sergio Zanfred; MOREIRA, Airton Mota; LEITE, Claudia Costa; CERRI, Giovanni Guido; CARNEVALE, Francisco Cesar; HORVAT, NatallyBenign prostatic hyperplasia (BPH) is a noncancerous growth of the transitional zone of the prostate, which surrounds the prostatic urethra. Consequently, it can cause lower urinary tract symptoms (LUTS) and bladder outlet obstruction symptoms that may substantially reduce a patient's quality of life. Several treatments are available for BPH, including medications such as alpha-blockers and 5 alpha-reductase inhibitors and surgical options including transurethral resection of the prostate and prostatectomy. Recently, prostatic artery embolization (PAE) has emerged as a minimally invasive treatment option for selected men with BPH and moderate to severe LUTS. Adequate pre- and postprocedural evaluations with clinical examinations and questionnaires, laboratory tests, and urodynamic and imaging examinations (particularly US, MRI, and CT) are of key importance to achieve successful treatment. Considering that the use of PAE has been increasing in tertiary hospital facilities, radiologists and interventional radiologists should be aware of the main technical concepts of PAE and the key features to address in imaging reports in pre- and postprocedural settings. An invited commentary by Lopera is available online. Online supplemental material is available for this article. (C) RSNA, 2021
- Virtual reality in interventional radiology education: a systematic review(2021) GELMINI, And Yara Particelli; DUARTE, Márcio Luís; ASSIS, André Moreira de; GUIMARÃES JUNIOR, Josias Bueno; CARNEVALE, Francisco CésarAbstract The aim of this study was to compare virtual reality simulation with other methods of teaching interventional radiology. We searched multiple databases-Cochrane Library; Medline (PubMed); Embase; Trip Medical; Education Resources Information Center; Cumulative Index to Nursing and Allied Health Literature; Scientific Electronic Library Online; and Latin-American and Caribbean Health Sciences Literature-for studies comparing virtual reality simulation and other methods of teaching interventional radiology. This systematic review was performed in accordance with the criteria established by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Best Evidence Medical Education (BEME) Collaboration. Eligible studies were evaluated by using the quality indicators provided in the BEME Guide No. 11 and the Kirkpatrick model of training evaluation. After the eligibility and quality criteria had been applied, five randomized clinical trials were included in the review. The Kirkpatrick level of impact varied among the studies evaluated, three studies being classified as level 2B and two being classified as level 4B. Among the studies evaluated, there was a consensus that virtual reality aggregates concepts and is beneficial for the teaching of interventional radiology. Although the use of virtual reality has been shown to be effective for skill acquisition and learning in interventional radiology, there is still a lack of studies evaluating and standardizing the employment of this technology in relation to the numerous procedures that exist within the field of expertise.
- Intravesical Prostatic Protrusion Does Not Influence the Efficacy of Prostatic Artery Embolization(2021) MEIRA, Marcio; ASSIS, Andre M. de; MOREIRA, Airton M.; ANTUNES, Alberto A.; CARNEVALE, Francisco C.; SROUGI, MiguelPurpose: To compare the outcomes of prostatic artery embolization (PAE) in patients with different intravesical prostatic protrusion (IPP) grades. Materials and Methods: This retrospective single-center study included 128 patients (aged 50-86 years) who underwent PAE from 2013 to 2017. IPP grades were classified as follows: grade 1 (<10 mm), grade II (10-19 mm), and grade III (>= 20 min). Nineteen patients (14.8%) had grade I [mean [PP 7.8 mm, prostatic volume (PV) 64.1 cm(3)], 77 (60.2%) had grade II (mean IPP 14.9 win, PV 87.0 cm(3)), and 32 (25%) had grade III (mean IPP 26.2 mm, PV 132.6 cm(3)), P < .01. The outcomes, including PV, international prostate symptom score (1PSS), and quality of life (QoL), were compared between the IPP grades at the 12-month follow-up. Clinical failure was defined as IPSS >7 or QoL >2. Results: IPP decreased (I: -8.2%, II: -27.3%, and III: -38.7%, P = .01), and all other endpoints improved (P < .01). Adjusted covariance analysis, considering baseline PV as a confounding factor, showed no correlation between the 12-month outcomes and baseline IPP. Clinical failure was observed in 17/128 patients (13.3%) and was similar in prevalence among the IPP groups (P = .20). Minor complications occurred in 43 patients (33.6%) and major in 3 (2.3%). There were statistical differences in the complications between IPP grades II and III (P < .01). Conclusions: PAE was similarly effective in all the IPP grades at the 12-month follow-up, and there was no difference in the clinical failure between the groups. Complications in IPP Bade II were more frequent than those in IPP grade II.
- Prostatic artery embolization for giant prostatic hyperplasia: a single-center experience(2021) ASSIS, André Moreira de; MOREIRA, Airton Mota; CARNEVALE, Francisco Cesar; LANZ-LUCES, José RamónAbstract Objective: To describe the safety and efficacy of prostatic artery embolization (PAE) in patients with a markedly enlarged prostate. Materials and Methods: This was a retrospective study including 18 consecutive patients (mean age, 74 years) with benign prostatic hyperplasia, all with a prostate volume ≥ 200 cm3, who were enrolled to receive PAE for the treatment of moderate-to-severe lower urinary tract symptoms. Results: The PAE procedure was technically successful in 17 patients (94.4%). During follow-up, clinical failure (defined as an International Prostate Symptom Score [IPSS] ≥ 8) was observed in two (11.1%) of those 18 patients. At 3 months of follow-up, there was significant improvement over baseline in all relevant outcome measures: total IPSS (from 15.7 to 2.9); IPSS quality of life score (from 5.2 to 1.0); prostate specific antigen (from 11.4 to 1.82 ng/mL); peak urinary flow rate (from 7.45 to 18.6 mL/s); prostate volume (from 252.4 to 151.6 cm3); and post-void residual volume (from 143.7 to 28.3 mL)-p < 0.05 for all. Of the 18 patients, one (5.6%) presented detachment of prostate tissue and self-limited hematuria, which did not require specific treatment. Conclusion: In patients with a markedly enlarged prostate, PAE proved to be safe and effective, resulting in significant improvements in clinical, imaging, and urodynamic parameters.
- Phosphodiesterase 2A and 3B variants are associated with primary aldosteronism(2021) RASSI-CRUZ, Marcela; MARIA, Andrea G.; FAUCZ, Fabio R.; LONDON, Edra; VILELA, Leticia A. P.; SANTANA, Lucas S.; BENEDETTI, Anna Flavia F.; GOLDBAUM, Tatiana S.; TANNO, Fabio Y.; SROUGI, Vitor; CHAMBO, Jose L.; PEREIRA, Maria Adelaide A.; CAVALCANTE, Aline C. B. S.; CARNEVALE, Francisco C.; PILAN, Bruna; BORTOLOTTO, Luiz A.; DRAGER, Luciano F.; LERARIO, Antonio M.; LATRONICO, Ana Claudia; V, Maria Candida B. Fragoso; MENDONCA, Berenice B.; ZERBINI, Maria Claudia N.; STRATAKIS, Constantine A.; ALMEIDA, Madson Q.Familial primary aldosteronism (PA) is rare and mostly diagnosed in early-onset hypertension (HT). However, 'sporadic' bilateral adrenal hyperplasia (BAH) is the most frequent cause of PA and remains without genetic etiology in most cases. Our aim was to investigate new genetic defects associated with BAH and PA. We performed whole-exome sequencing (paired blood and adrenal tissue) in six patients with PA caused by BAH that underwent unilateral adrenalectomy. Additionally, we conducted functional studies in adrenal hyperplastic tissue and transfected cells to confirm the pathogenicity of the identified genetic variants. Rare germline variants in phosphodiesterase 2A (PDE2A) and 3B (PDE3B) genes were identified in three patients. The PDE2A heterozygous variant (p.Ile629Val) was identified in a patient with BAH and early-onset HT at 13 years of age. Two PDE3B heterozygous variants (p.Arg217Gln and p.Gly392Val) were identified in patients with BAH and HT diagnosed at 18 and 33 years of age, respectively. A strong PDE2A staining was found in all cases of BAH in zona glomerulosa and/or micronodules (that were also positive for CYP11B2). PKA activity in frozen tissue was significantly higher in BAH from patients harboring PDE2A and PDE3B variants. PDE2A and PDE3B variants significantly reduced protein expression in mutant transfected cells compared to WT. Interestingly, PDE2A and PDE3B variants increased SGK1 and SCNN1G/ENaCg at mRNA or protein levels. In conclusion, PDE2A and PDE3B variants were associated with PA caused by BAH. These novel genetic findings expand the spectrum of gene tic etiologies of PA.
- Advanced image guidance for prostatic artery embolization - a multicenter technical note(2021) CARNEVALE, Francisco Cesar; MCCLURE, Timothy; CADOUR, Farah; VIDAL, Vincent; ASSIS, Andre Moreira de; MOREIRA, Airton Mota; ROCHA, Arthur Diego Dias; REBET, Aya; NUTTING, CharlesBackground Prostatic artery embolization (PAE) is associated with patients' quality of life improvements and limited side effects compared to surgery. However, this procedure remains technically challenging due to complex vasculature, anatomical variations and small arteries, inducing long procedure times and high radiation exposure levels both to patients and medical staff. Moreover, the risk of non-target embolization can lead to relevant complications. In this context, advanced imaging can constitute a solid ally to address these challenges and deliver good clinical outcomes at acceptable radiation levels. Main text This technical note aims to share the consolidated experience of four institutions detailing their optimized workflow using advanced image guidance, discussing variants, and sharing their best practices to reach a consensus standardized imaging workflow for PAE procedure, as well as pre and post-operative imaging. Conclusions This technical note puts forth a consensus optimized imaging workflow and best practices, with the hope of helping drive adoption of the procedure, deliver good clinical outcomes, and minimize radiation dose levels and contrast media injections while making PAE procedures shorter and safer.
- Role of Ultrasound Elastography in Patient Selection for Prostatic Artery Embolization(2021) ASSIS, Andre Moreira de; MOREIRA, Airton Mota; CARNEVALE, Francisco Cesar; MARCELINO, Antonio Sergio Zafred; ANTUNES, Alberto Azoubel; SROUGI, Miguel; CERRI, Giovanni GuidoPurpose: To determine the effects of prostatic artery embolization (PAE) on prostate elasticity as assessed using ultrasound elastography (US-E) and to describe baseline US-E's potential role in patient selection. Materials and Methods: This was a prospective investigation that included 20 patients undergoing PAE to treat lower urinary tract symptoms attributed to benign prostatic hyperplasia (BPH). US-E with measurement of the prostatic elastic modulus (EM) and shear wave velocity (SWV) was performed before PAE and at 1-month follow-up. Baseline, 3-month, and 1-year follow-up evaluations included prostate-specific antigen, uroflowmetry, pelvic magnetic resonance imaging, and clinical assessment using the International Prostate Symptom Score (IPSS) and quality of life (QoL) metrics. Results: Seventeen patients entered statistical analysis. US-E showed a significant reduction in mean prostatic EM (34.4 kPa vs 46.3 kPa, similar to 24.7%, P <.0001) and SWV (3.55 m/s vs 4.46 m/s, similar to 20.0%, P <.0001) after PAE. There were moderate positive correlations between baseline EM and 1-year IPSS (R = 0.62, P = .007) and between baseline SWVand 1-year IPSS (R = 0.68, P = .002). Baseline SWV >= 5.59 m/s and baseline EM >= 50.14 kPa were associated with suboptimal IPSS and QoL outcomes after PAE with high degrees of sensitivity (100%) and specificity (69-100%). Conclusions: PAE led to a positive effect on the BPH dynamic component related to prostatic elasticity. There was a moderate positive correlation between baseline prostatic elastographic parameters and 12-month IPSS. Measurement of baseline elastographic characteristics may become useful for the evaluation and selection of patients for PAE.