FABIO BISCEGLI JATENE

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Departamento de Cardio-Pneumologia, Faculdade de Medicina - Docente
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Hospital das Clínicas, Faculdade de Medicina - Líder

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Autor: PEGO-FERNANDES, Paulo Manuel ×

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Agora exibindo 1 - 10 de 28
  • 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 Biscegli
    Objective: 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.
  • article 3 Citação(ões) na Scopus
    Respiratory failure after lung transplantation: extracorporeal membrane oxygenation as a rescue treatment
    (2012) PEGO-FERNANDES, Paulo Manuel; HAJJAR, Ludhmila Abrahao; GALAS, Filomena Regina Barbosa Gomes; SAMANO, Marcos Naoyuki; RIBEIRO, Alexandre Kazantzi Fonseca; PARK, Marcelo; SOARES, Rodolfo; OSAWA, Eduardo; JATENE, Fabio Biscegli
  • article 8 Citação(ões) na Scopus
    Desmoid tumors of the chest wall: surgical challenges and possible risk factors
    (2011) ABRAO, Fernando Conrado; WAISBERG, Daniel Reis; FERNANDEZ, Angelo; BERNARDO, Wanderley Marques; PEGO-FERNANDES, Paulo Manuel; JATENE, Fabio Biscegli
  • article 4 Citação(ões) na Scopus
    Ex vivo experimental model: split lung block technique
    (2011) MARIANI, Alessandro Wasum; MEDEIROS, Israel Lopes de; PEGO-FERNANDES, Paulo Manuel; FERNANDES, Flavio Guimares; UNTERPERTINGER, Fernando do Valle; FERNANDES, Lucas Matos; CANZIAN, Mauro; JATENE, Fabio Biscegli
    Since they were first established, ex vivo models of lung reconditioning have been evaluated extensively. When rejected donor lungs are used, the great variability among the cases can hinder the progress of such studies. In order to avoid this problem, we developed a technique that consists of separating the lung block into right and left blocks and subsequently reconnecting those two blocks. This technique allows us to have one study lung and one control lung.
  • article 20 Citação(ões) na Scopus
    Videotoracoscopia como uma opção no tratamento cirúrgico do quilotórax após cirurgia cardíaca pediátrica*
    (2011) PEGO-FERNANDES, Paulo Manuel; NASCIMBEM, Mauro Boldrini; RANZANI, Otavio T.; SHIMODA, Monica Satsuki; MONTEIRO, Rosangela; JATENE, Fabio Biscegli
    Objective: To evaluate the use of video-assisted thoracoscopy in the surgical treatment of chylothorax developed after the surgical correction of congenital heart disease in children. Methods: We reviewed the medical charts of 3,092 children who underwent surgery for congenital heart disease between February of 2002 and February of 2007 at the Heart Institute of the University of Sao Paulo School of Medicine Hospital das Clinicas, in Sao Paulo, Brazil. Results: Of the 3,092 children, 64 (2.2%) presented with chylothorax as a postoperative complication. In 50 (78.1%) of those patients, the clinical management was successful, whereas it failed in 14 (21.9%), all of whom were then submitted to thoracic duct ligation by video-assisted thoracoscopy. The thoracic duct ligation was successful in 12 patients (86%) but failed in 2. In the postoperative period, additional clinical measures, such as a low-fat diet and parenteral nutrition, were required in order to resolve those 2 cases. There was no surgical morbidity or mortality. Of the 14 patients who underwent thoracic duct ligation, 5 (35%) died due to cardiac or infectious complications. Conclusions: Video-assisted thoracic duct ligation can be safely performed in patients with severe heart disease, and the outcomes are favorable.
  • article 4 Citação(ões) na Scopus
    Cold ischemia or topical-ECMO for lung preservation: a randomized experimental study
    (2014) MARIANI, Alessandro Wasum; MEDEIROS, Israel Lopes; PEGO-FERNANDES, Paulo Manuel; FERNANDES, Flavio Guimaraes; UNTERPERTINGUER, Fernando Do Vale; FERNANDES, Lucas Matos; CARDOSO, Paulo Francisco; CANZIAN, Mauro; JATENE, Fabio Biscegli
    CONTEXT AND OBJECTIVE: Lung preservation remains a challenging issue for lung transplantation groups. Along with the development of ex vivo lung perfusion, a new preservation method known as topical-ECMO (extracorporal membrane oxygenation) has been proposed. The present study compared topical-ECMO with cold ischemia (CI) for lung preservation in an ex vivo experimental model. DESIGN AND SETTING: Randomized experimental study, conducted at a public medical school. METHOD: Fourteen human lungs were retrieved from seven brain-dead donors that were considered unsuitable for transplantation. The lung bloc was divided and each lung was randomized to be preserved by means of topical-ECMO or CI (4-7 degrees C) for eight hours. These lungs were then reconnected to an ex vivo perfusion system for functional evaluation. Lung biopsies were obtained at three times. The functional variables assessed were oxygenation capacity (OC) and pulmonary artery pressure (PAP); and the histological variables were lung injury score (LIS) and apoptotic cell count (ACC). RESULTS: The mean OC was 468 mmHg (+/- 81.6) in the topical-ECMO group and 455.8 (+/- 54) for CI (P = 0.758). The median PAP was 140 mmHg (120-160) in the topical-ECMO group and 140 mmHg (140-150) for CI (P = 0.285). The mean LIS was 35.57 (+/- 4.5) in the topical-ECMO group and 33.86 (+/- 6.1) for CI (P = 0.367). The ACC was 25.00 (+/- 9.34) in the topical-ECMO group and 24.86(+/- 10.374) for CI (P = 0.803). CONCLUSIONS: The present study showed that topical-ECMO was not superior to cold ischemia for up to eight hours of lung preservation.
  • article 12 Citação(ões) na Scopus
    Adverse Effects of Immunosuppressant Drugs upon Airway Epithelial Cell and Mucociliary Clearance: Implications for Lung Transplant Recipients
    (2013) PAZETTI, Rogerio; PEGO-FERNANDES, Paulo Manuel; JATENE, Fabio Biscegli
    Optimal post-transplantation immunosuppression is critical to the survival of the graft and the patient after lung transplantation. Immunosuppressant agents target various aspects of the immune system to maximize graft tolerance while minimizing medication toxicities and side effects. The vast majority of patients receive maintenance immunosuppressive therapy consisting of a triple-drug regimen including a calcineurin inhibitor, a cell cycle inhibitor and a corticosteroid. Although these immunosuppressant drugs are frequently used after transplantation and to control inflammatory processes, limited data are available with regard to their effects on cells other than those from the immunological system. Notably, the airway epithelial cell is of interest because it may contribute to development of bronchiolitis obliterans through production of pro-inflammatory cytokines. This review focuses the current armamentarium of immunosuppressant drugs used after lung transplantation and their main side effects upon airway epithelial cells and mucociliary clearance.
  • article 23 Citação(ões) na Scopus
    Methylene blue attenuates ischemia-reperfusion injury in lung transplantation
    (2014) ABREU, Marcus da Matta; PAZETTI, Rogerio; ALMEIDA, Francine Maria de; CORREIA, Aristides Tadeu; PARRA, Edwin Roger; SILVA, Lais Pereira da; VIEIRA, Rodolfo de Paula; PEGO-FERNANDES, Paulo Manuel; JATENE, Fabio Biscegli
    Background: Ischemia-reperfusion injury (IRI) is one of the principal obstacles for the lung transplantation (LTx) success. Several strategies have been adopted to minimize the effects of IRI in lungs, including ex vivo conditioning of the grafts and the use of antioxidant drugs, such as methylene blue (MB). We hypothesized that MB could minimize the effects of IRI in a LTx rodent model. Methods: Forty rats were divided into four groups (n = 10) according to treatment (saline solution or MB) and graft cold ischemic time (3 or 6 h). All animals underwent unilateral LTx. Recipients received 2 mL of saline or MB intraperitoneally before transplantation. After 2 h of reperfusion, arterial blood and exhaled nitric oxide samples were collected and bronchoalveolar lavage performed. Then animals were euthanized, and histopathology analysis as well as cell counts and cytokine levels measurements in bronchoalveolar lavage fluid were performed. Results: There was a significant decrease in exhaled nitric oxide, neutrophils, interleukin-6, and tumor necrosis factor-alpha in MB-treated animals. PaO2 and uric acid levels were higher in MB group. Conclusions: MB was able in attenuating IRI in this LTx model.
  • article 1 Citação(ões) na Scopus
    Does methylene blue attenuate inflammation in nonischemic lungs after lung transplantation?
    (2018) ABREU, Marcus da Matta; ALMEIDA, Francine Maria de; SANTOS, Kelli Borges dos; ASSIS, Emilio Augusto Campos Pereira de; HAMADA, Rafael Kenji Fonseca; JATENE, Fabio Biscegli; PEGO-FERNANDES, Paulo Manuel; PAZETTI, Rogerio
  • article 4 Citação(ões) na Scopus
    The impact of topically applied preservation solutions on the respiratory epithelium of tracheal grafts submitted to cold ischemia: functional and morphological analysis
    (2013) AZEVEDO-PEREIRA, Artur Eugenio de; SAKA, Juliana Akemi; OLIVEIRA-BRAGA, Karina Andrighetti de; PAZETTI, Rogerio; CANZIAN, Mauro; PEGO-FERNANDES, Paulo Manuel; JATENE, Fabio Biscegli
    OBJECTIVE: Advances in graft reepithelialization and revascularization have renewed interest in airway transplantation. This study aims to determine whether topically applied preservation solutions can ameliorate ischemic injury to tracheal grafts. We analyzed 1) the effects of cold ischemia on the mucociliary clearance of tracheal grafts and 2) the impact of topically applied preservation solutions on the effects of cold ischemia on mucociliary clearance. METHOD: Tracheal segments (n = 217) from 109 male Wistar rats were harvested, submerged in low-potassium-dextran-glucose, histidine-tryptophan-ketoglutarate, or saline solution (saline group), and stored at 4 degrees C for 6, 10, 16, or 24 hours. A control group (not submerged) was analyzed immediately after harvesting. In situ mucociliary transport and ciliary beating frequency were measured using a stroboscope. Epithelial integrity, cellular infiltration, and mucus storage were quantified by light microscopy and image analysis software, along with transmission electron microscopy. RESULTS: 1) The effects of cold ischemia: in situ mucociliary transport and ciliary beating frequency were greater in the control group than after cold ischemia. Microscopic analysis results were similar between groups. 2) The effects of preservation solutions: there was no difference between the low-potassium-dextran-glucose, histidine-tryptophan-ketoglutarate, and saline groups in functional or light microscopy analysis. The saline group presented stronger signs of ischemic injury with transmission electron microscopy. CONCLUSIONS: Cold ischemia diminished the mucociliary clearance of the tracheal respiratory epithelium. Topically applied preservation solutions did not ameliorate the injury caused by cold ischemia to the tracheal respiratory epithelium.