MARCIO ROBERTO FACANALI JUNIOR
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
13 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 13
- Neurotuberculosis in a patient with Ulcerative Colitis using adalimumab for a long period in Brazil(2021) FACANALI, M.; FACANALI, C. Bortolozzo Graciolli; BOARINI, L. Rodrigues; RIBEIRO, A. Vaz Safatle; SOBRADO, C. W.
- A Sessile Serrated Lesion Overlying a Submucosal Colonic Lipoma: An Endoscopic Rarity Identified Using Artificial Intelligence(2023) FACANALI, Carolina Bortolozzo Graciolli; FACANALI JUNIOR, Marcio Roberto; SOBRADO JUNIOR, Carlos Walter; SAFATLE-RIBEIRO, Adriana VazObjective: Rare coexistence of disease or pathologyBackground: Lipomas are benign, slow-growing mesenchymal neoplasms, more prevalent in females, with a peak incidence in the fifth to sixth decades of life. Generally, due to their low clinical relevance, they receive little attention in the literature. Uncommon in the colon, lipomas are most often identified as an incidentaloma in asymptomatic patients during colonoscopy, and overlapping with epithelial lesions is a rare finding. Serrated polyps used to be considered as hyperplastic polyps without any malignant potential; however, currently, the serrated pathway accounts for one-third of all colorectal cancers. Here, we describe a rare case of a sessile serrated lesion on a submucosal lipoma identified with the aid of artificial intelligence.Case Report: A 60-year-old woman underwent screening colonoscopy for colorectal cancer after a positive fecal immunochemical test. A high-definition colonoscopy with the aid of artificial intelligence (Fujifilm CAD EYE) was performed. A flat lesion at the right colon was diagnosed with white-light endoscopy simultaneously identified by artificial intelligence, which classified the lesion as hyperplastic. Resection was performed through mucosectomy, and a sign of naked fat was observed at the base of the resected lesion. Histopathology of the specimen characterized a submucosal lipoma associated with a sessile serrated lesion.Conclusions: We describe a rare case of sessile serrated lesion on a colon lipoma, identified with the aid of artificial intelligence. We carried out a brief literature review and discussed the main findings and aspects related to the literature.
bookPart Perfuração esofágica: observar, operar ou prótese endoscópica(2022) BERNINI, Celso de Oliveira; FACANALI JUNIOR, Marcio Roberto- EUS-guided choledochoduodenostomy for malignant biliary obstruction: A multicenter comparative study between plastic and metallic stents(2023) SILVA, Rodrigo Roda Rodrigues da; FACANALI JUNIOR, Marcio Roberto; BRUNALDI, Vitor Ottoboni; OTOCH, Jose Pinhata; ROCHA, Ana Carolina Aguiar; ARTIFON, Everson Luiz de AlmeidaBackground and Objectives: EUS-guided choledochoduodenostomy (EUS-CDS) is commonly employed to address malignant biliary obstruction (MBO) after a failed ERCP. In this context, both self-expandable metallic stents (SEMSs) and double-pigtail stents (DPSs) are suitable devices. However, few data comparing the outcomes of SEMS and DPS exist. Therefore, we aimed to compare the efficacy and safety of SEMS and DPS at performing EUS-CDS. Methods: We conducted a multicenter retrospective cohort study between March 2014 and March 2019. Patients diagnosed with MBO were considered eligible after at least one failed ERCP attempt. Clinical success was defined as a drop of direct bilirubin levels >= 50% at 7 and 30 postprocedural days. Adverse events (AEs) were categorized as early (<= 7 days) or late (> 7 days). The severity of AEs was graded as mild, moderate, or severe. Results: Forty patients were included, 24 in the SEMS group and 16 in the DPS group. Demographic data were similar between the groups. Technical success rates and clinical success rates at 7 and 30 days were similar between the groups. Similarly, we found no statistical difference in the incidence of early or late AEs. However, there were two severe AEs (intracavitary migration) in the DPS group and none in the SEMS cohort. Finally, there was no difference in median survival (DPS 117 days vs. SEMS 217 days; P = 0.99). Conclusion: EUS-guided CDS is an excellent alternative to achieve biliary drainage after a failed ERCP for MBO. There is no significant difference regarding the effectiveness and safety of SEMS and DPS in this context.
- Neurotuberculosis in a Patient with Ulcerative Colitis Using Long-Term Adalimumab: A Rare Case(2023) FACANALI, Carolina Bortolozzo Graciolli; FACANALI JUNIOR, Marcio Roberto; RIBEIRO, Adriana Vaz Safatle; SOBRADO JUNIOR, Carlos WalterObjective: Rare disease Background: Tuberculosis (TB), a global public health problem, is a disease with a high incidence and prevalence worldwide. The risk of developing TB increases after starting anti-tumor necrosis factor (TNF) therapy in the management of ulcerative colitis (UC). Isolated neurotuberculosis (NTB) without other manifestations is a rare form of infec-tion in these patients. This article reports a case of a severe UC patient with isolated NTB following long-term therapy with adalimumab and discusses the clinical aspects, diagnosis, management, and prognosis. Case Report: A 34-year-old female patient with severe UC with pancolitis reported continuous and progressive holocranial headaches associated with a daily fever of 38 degrees C and night sweats after 4 years of using adalimumab and af-ter being in deep remission. Annually, she was screened for latent TB with chest X-rays and a Mantoux tuber-culin skin test, and she always had negative results for TB. On cerebral magnetic resonance imaging with post -contrast sequences, small cortical lesions in the left frontal lobe and 2 larger lesions were visualized and were suggestive of tuberculomas. The initial management consisted of the suspension of immunosuppressive ther-apy and treatment with rifampicin, isoniazid, ethambutol, pyrazinamide, and prednisone. The patient showed clinical and neurological improvement and was clinically asymptomatic, with no changes in laboratory tests. Also, she had no neurological sequelae and was taking maintenance therapy with prednisone as indicated by the neurologist. Conclusions: Early recognition of symptoms of neurological involvement of TB, suspension of anti-TNF and adequate treat-ment are fundamental steps to prevent complications.
- The relationship of major depressive disorder with Crohn?s disease activity(2023) FACANALI, Carolina Bortolozzo Graciolli; SOBRADO JUNIOR, Carlos Walter; FRAGUAS JUNIOR, Renerio; FACANALI JUNIOR, Marcio Roberto; BOARINI, Lucas Rodrigues; SOBRADO, Lucas Faraco; CECCONELLO, IvanIntroduction: Crohn's disease (CD) has been related to an increased prevalence of psychiatric disorders and suicide risk (SR). However, the nature of their relationship still deserves clarification. The aim of this study is to assess the prevalence of major depressive disorder (MDD) in patients with CD, and to investigate the relationship between MDD and CD outcomes.Methods: A cross-sectional study involving CD patients was performed. CD activity was evaluated by the Harvey -Bradshaw index and CD phenotype by the Montreal classification. The presence of MDD was assessed by the Patient Health Questionnaire score-9 (PHQ-9). Sociodemographic data and other characteristics were retrieved from electronic medical records.Results: 283 patients with CD were included. The prevalence of MDD was 41.7%. Females had a risk of MDD 5.3 times greater than males. CD disease duration was inversely correlated with MDD severity. Individuals with active CD were more likely to have MDD (OR = 796.0; 95% CI 133.7-4738.8) than individuals with CD remis-sion. MDD was more prevalent in inflammatory behavior (45.5%) and there were no statistical differences regard-ing the disease location. 19.8% of the sample scored positive for SR.Conclusion: The present results support data showing an increased prevalence of MDD in individuals with CD. Additionally, it indicates that MDD in CD might be related to the activity of CD. Prospective studies are warranted to confirm these results and to address whether MDD leads to CD activity, CD activity leads to MDD or both ways are existent.
- Quality indicators in colonoscopy: observational study in a supplementary health system(2022) KUGA, Rogerio; FACANALI JUNIOR, Marcio Roberto; ARTIFON, Everson Luiz de AlmeidaPurpose: Colorectal cancer is responsible for 9.4% of cancer deaths, and low polyp detection rate and cecal intubation rate increase the risks of interval colorectal cancer. Despite several population studies that address colonoscopy quality measures, there is still a shortage of these studies in Latin America. The aim of this study was to assess quality indicators in colonoscopy, enabling future strategies to improve colorectal cancer prevention. Methods: An observational retrospective study, in which all colonoscopies performed in 11 hospitals were evaluated through a review of medical records. Information such as procedure indication, colorectal polyp detection rate, cecal intubation rate, quality of colonic preparation, and immediate adverse events were collected and analyzed. Results: In 17,448 colonoscopies performed by 86 endoscopists, 57.9% were in patients aged 50 to 74 years old. Colon preparation was adequate in 94.4% procedures, with rates of cecal intubation and polyp detection of 94 and 36.6%, respectively. Acute adverse events occurred in 0.2%. In 53.9%, high-definition imaging equipment was used. The procedure location, colon preparation and high-definition equipment influenced polyp detection rates (p < 0.001). Conclusion: The extraction and analysis of electronic medical records showed that there are opportunities for improvement in colonoscopy quality indicators in the participating hospitals.
- Spontaneous Knot Formation in a Central Venous Catheter(2021) FACANALI, Carolina Bortolozzo Graciolli; PAIXAO, Vanessa Simoes; SOBRADO, Carlos Walter; FACANALI, Marcio RobertoObjective: Challenging differential diagnosis Background: Central venous catheterization (CVC) is indispensable in the management of critically ill patients in the emergency room and intensive care units, either to avoid the various peripheral punctures and vasoactive drugs administration in decompensated patients, or even to administer parenteral nutrition. CVC is an invasive procedure with possible mechanical, infectious, and thrombotic complications. The complete knotting of a catheter is a rare complication. The aim of this study is to report a case of a simple tight knot 2 cm from the catheter tip. We provide insights for early identification of catheter knotting, as well as its management. Case Report: A 63-year-old man with a previous history of angioplasty and non-pharmacological coronary stent in a marginal branch of the circumflex coronary artery evolved to junctional bradycardia and cardiogenic shock and was transferred to the reference hospital. He had a CVC inserted in the right jugular vein; however, it did not have any blood flow. The hypothesis of catheter knotting was suggested and confirmed through a chest X-ray. Venotomy was performed and it was successfully removed. Conclusions: Knotting in CVC obstruction is a rare complication. Recognition of this complication is essential to avoid major complications, such as catheter fragmentation and venous injury. Radiological follow-up after the procedure in patients with difficult anatomy is essential, and echo-guided catheterization should be encouraged when available. Despite the rarity of a knotted intravascular catheter, it is important to note this possible late complication that must be considered in the absence of catheter blood flow.
- Major Depression in patients with Crohn's disease and its relationship with clinical activity and disease's phenotype(2021) FACANALI, C.; QUEIROZ, N. Sousa Freitas; FACANALI, M. R.; BOARINI, L. Rodrigues; GONCALVES, J. L. Amuratti; BORBA, M. Rodrigues; NAHAS, S. C.; SOBRADO, C. W.
- Public and private fundraising as a tool for professional development: What is fundraising?(2023) ARTIFON, Everson Luiz de Almeida; MAGON, Mariana Goncalves; JR, Marcio Roberto Facanali; MONTERO, Edna Frasson de Souza