CARLOS WALTER SOBRADO JUNIOR
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
46 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 46
- 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.
- Long-term real life efficacy of infliximab in Crohn's disease: Brazilian initial experience since 1999(2019) ARCEU, Scanavini Neto; NATALIA, Queiroz; MARCELO, Borba; CARLOS, Sobrado; MAGALY, Teixeira; EDESIO, Silva-Fillho; SERGIO, Nahas; IVAN, Cecconello
- Pretreatment colostomy in patients with anal squamous cell carcinoma: Risk factors for a permanent stoma(2022) SOBRADO, Lucas F.; NAHAS, Caio S. R.; MARQUES, Carlos F. S.; SOBRADO, Carlos W.; NAHAS, Sergio C.Background The current standard of care for anal squamous cell carcinoma (SCC) is concurrent chemoradiation (CRT), which enables tumor eradication while preserving the anal sphincter. Patients with locally advanced tumors, however, may experience complications that preclude treatment before stoma creation. Objective To evaluate the reversal rate of pretreatment stomas and the risk factors associated with nonreversal. Methods This single-institution retrospective cohort study using a prospective database included patients diagnosed with anal SCC from January 2008 to December 2020 who required a stoma before curative CRT. Results In total, 651 patients were identified; 65 required a stoma before chemoradiation due to obstruction (43.1%), rectovaginal fistula (20%), and perianal sepsis (36.9%). The stoma was reversed in nine patients after a mean follow-up of 35.8 months. Risk factors associated with a permanent stoma were perianal sepsis (p = 0.010), interruptions during radiotherapy for more than 7 days (p = 0.010), male sex (p = 0.013), poor performance status (Eastern Cooperative Oncology Group [ECOG] >= 2) (p = 0.023), large tumors (p = 0.045), and cisplatin-based chemotherapy (p = 0.047). Conclusions Pretreatment stomas are unlikely to be reversed, and risk factors for a permanent stoma are perianal sepsis, interruptions during radiotherapy for more than 7 days, male sex, poor performance status (ECOG >= 2), large tumors, and cisplatin-based chemotherapy.
- 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.
- FUNCTIONAL AND ANATOMICAL ANALYSIS OF THE ANORECTUM OF FEMALE SCLERODERMA PATIENTS AT A CENTER FOR PELVIC FLOOR DISORDERS(2018) PINTO, Rodrigo Ambar; CORRÊA NETO, Isaac José Felippe; NAHAS, Sérgio Carlos; BUSTAMANTE LOPES, Leonardo Alfonso; SOBRADO JÚNIOR, Carlos Walter; CECCONELLO, IvanABSTRACT BACKGROUND: Scleroderma or progressive systemic sclerosis is characterized by a chronic inflammatory process with proliferation of fibrous connective tissue and excessive deposition of collagen and extracellular matrix in the skin, smooth muscle, and viscera. The smooth muscle most involved in scleroderma is that of the esophagus, and dysphagia is the most commonly reported symptom. However, the internal anal sphincter may also be impaired by degeneration and fibrosis, leading to concomitant anal incontinence in scleroderma patients. These patients may neglect to complain about it, except when actively questioned. OBJECTIVE: To assess anorectal function and anatomy of female scleroderma patients with symptoms of anal incontinence through Cleveland Clinic Florida Fecal Incontinence Score (CCFIS), anorectal manometry and endoanal ultrasound at the outpatient clinic of colorectal and anal physiology, Clinics Hospital, University of São Paulo Medical School (HC-FMUSP). METHODS: Female scleroderma patients were prospectively assessed and questioned as to symptoms of anal incontinence. The anorectal manometry and endoanal ultrasound results were correlated with clinical data and symptoms. RESULTS: In total, 13 women were evaluated. Their mean age was 55.77 years (±16.14; 27-72 years) and their mean disease duration was 10.23 years (±6.23; 2-23 years). All had symptoms of fecal incontinence ranging from 1 to 15. Seven (53.8%) patients had fecal incontinence score no higher than 7; three (23.1%) between 8 and 13; and three (23.1%) 14 or higher, corresponding to mild, moderate, and severe incontinence, respectively. Ten (76.92%) patients had hypotonia of the internal anal sphincter. Three-dimensional endoanal ultrasound showed tapering associated with muscle atrophy of the internal sphincter in six cases and previous muscle defects in three cases. CONCLUSION: A functional and anatomical impairment of the sphincter is an important factor to assess in patients with progressive systemic sclerosis and it should not be underestimated.
- Suture Rectopexy and Repair of the Pouch of Douglas for Rectal Intussusception and Enterocele(2022) SOBRADO, Lucas Faraco; NAHAS, Sergio Carlos; SOBRADO, Carlos Walter
- 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.
- Disease severity is associated with depressive symptoms and suicidal thoughts in Brazilian patients with inflammatory bowel disease(2023) FACANALI, Carolina; RONCETE, Guilherme; DAMIANO, Rodolfo Furlan; SOBRADO, Carlos
- Is there a higher frequency of anal dysplasia and infection by human papillomavirus in Crohn?s disease patients?(2022) GUZELA, V. R.; SOBRADO JR., C. W.; NADAL, S. R.; VILLA, L. L.; MOTA, G. R.; GONCALVES, A. P.; NADAL, C. R. M.; NAHAS, C. S. R.; NAHAS, S. C.The aim of this study was to compare the frequency of dysplasia and human papillomavirus (HPV) infection in the anal canal of patients with Crohn???s disease (CD) with a control group and assess whether there is a correlation between use of immunosuppressants and anal manifestation of CD. Patients with CD and control individuals were submitted to anal cytology and material collection for polymerase chain reaction (PCR). The cytology was classified as normal, atypical squamous cells of undetermined significance (ASCUS), low-grade squamous intraepithelial lesion (LSIL), or high-grade (HSIL). PCR was considered positive or negative according to virus presence or absence. A total of 117 patients were included (54 in the control group and 63 in the CD group, being 32 without and 31 with immunosuppressants). ASCUS and LSIL were found in 25.9 and 22.2% of control patients and 28.6 and 39.7% of CD patients. HPV was identified in 14.8% of the control group and 27% of the CD group. In CD patients, HPV was found in 37.5 and 16.1% of those without and with immunosuppressants, respectively. Patients with perianal involvement had 15.6% of PCR positivity. There was no statistical difference in dysplasia and infection by HPV between the groups. Use of immunosuppressants did not influence the result, but anal manifestation was inversely proportional to viral detection.
- Fournier’s Gangrene During Pregnancy in a Patient with Crohn’s Disease(2022) SOBRADO, L. F.; AVERBACH, P.; JAYME, V. R.; CAMARGO, M. G. M. de; SOBRADO, C. W.; NAHAS, S. C.Patient: Female, 29-year-old Final Diagnosis: Crohn’s associated Perianal and perirectal abscess • Fournier’s gangrene Symptoms: Anal pain Medication: — Clinical Procedure: — Specialty: Surgery Objective: Background: Case Report: Conclusions: Unusual clinical course Fournier’s gangrene (FG) is a rapidly progressive necrotizing infection of the perineum. Risk factors include male sex and immunosuppression. Inflammatory bowel disease and pregnancy may alter immune response by complex mechanisms but have rarely been associated with necrotizing infections of the perineum. To the best of our knowledge, only 5 cases of FG in association with IBD have been reported in the literature, and none of them occurred during pregnancy. We report the case of a young woman with long-standing Crohn’s disease in clinical remission with Infliximab monotherapy who developed FG in the third trimester of pregnancy. A cesarean section was undertaken at 35 weeks due to fetal distress, followed by debridement, diverting stoma, and vacuum-assisted therapy. The perineal defect was closed following 4 debridements and vacuum-therapy exchanges with a unilateral medial thigh advancement flap, and a draining seton was placed in the suprasphincteric fistula. The patient was dis-charged after 28 days and her recovery was unremarkable. The neonate also recovered well. The treatment of FG is multidisciplinary and includes early debridement and intestinal diversion. Perianal pain should not be disregarded, as it may be the initial symptom of severe perianal sepsis in the immunosuppressed. To the best of our knowledge, this is the first case report of FG during pregnancy in a patient with Crohn’s disease. © Am J Case Rep, 2022.