CARLOS WALTER SOBRADO JUNIOR
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
43 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 43
- 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.
bookPart Manifestações clínicas na doença inflamatória intestinal(2015) CARDOZO, Wilton Schmidt; SOBRADO, Carlos Walter- Efficacy of Early Optimization of Infliximab Guided by Therapeutic Drug Monitoring during Induction-A Prospective Trial(2023) GARCIA, Karoline Soares; AZEVEDO, Matheus Freitas Cardoso de; CARLOS, Alexandre de Sousa; BARROS, Luisa Leite; OBA, Jane; SOBRADO JUNIOR, Carlos Walter; SIPAHI, Aytan Miranda; ALVES, Olivia Duarte de Castro; NAVARRO-RODRIGUEZ, Tomas; PARRA, Rogerio Serafim; CHEBLI, Julio Maria Fonseca; CHEBLI, Liliana Andrade; FLORES, Cristina; VIEIRA, Andrea; CEARA, Christianne Damasceno Arcelino do; QUEIROZ, Natalia Sousa Freitas; DAMIAO, Aderson Omar Mourao CintraTherapeutic drug monitoring (TDM) during induction therapy with anti-tumor necrosis factor drugs has emerged as a strategy to optimize response to these biologics and avoid undesired outcomes related to inadequate drug exposure. This study aimed to describe clinical, biological, and endoscopic remission rates at six months in Brazilian inflammatory bowel disease (IBD) patients following a proactive TDM algorithm guided by IFX trough levels (ITL) and antibodies to IFX (ATI) levels during induction, at week six. A total of 111 IBD patients were prospectively enrolled, excluding those previously exposed to the drug. ITL & GE; 10 & mu;g/mL was considered optimal. Patients with suboptimal ITL (<10 & mu;g/mL) were guided according to ATI levels. Those who presented ATI & LE; 200 ng/mL underwent dose intensification in the maintenance phase, and patients with ATI > 200 ng/mL discontinued IFX. In our study, proactive TDM was associated with persistence in the IFX rate at six months of 82.9%. At that time, rates of clinical, biological, and endoscopic remission in patients under IFX treatment were 80.2%, 73.9%, and 48.1%, respectively. Applying a simplified TDM-guided algorithm during induction seems feasible and can help improve patients' outcomes in clinical practice.
bookPart Tratamento da doença de crohn perianal fistulizante(2015) CARDOZO, Wilton Schmidt; SOBRADO, Carlos Walter- Suture Rectopexy and Repair of the Pouch of Douglas for Rectal Intussusception and Enterocele(2022) SOBRADO, Lucas Faraco; NAHAS, Sergio Carlos; SOBRADO, Carlos Walter
bookPart Hemorroidas e Doença Hemorroidária(2013) NAHAS, Sergio Carlos; MARQUES, Carlos Frederico Sparapan; SOBRADO, Carlos Walter; NAHAS, Caio Sergio Rizkallah- 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.