ELOISA MARIA MELLO SANTIAGO GEBRIM
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Radiologia, Hospital das Clínicas, Faculdade de Medicina - Médico
6 resultados
Resultados de Busca
Agora exibindo 1 - 6 de 6
- Cochlear-Facial Dehiscence Detected After Cochlear Implant(2020) CAMERIN, Gabriela R.; PASSOS, Ula Lindoso; COSTA, Sady Selaimen da; GEBRIM, Eloisa Maria Mello Santiago; CRUZ, Oswaldo Laercio Mendonca
- Muscle and visceral fat infiltration: A potential mechanism to explain the worsening of obstructive sleep apnea with age(2023) D'ANGELO, Giovanna F.; MELLO, Andre A. F. de; SCHORR, Fabiola; GEBRIM, Eloisa; FERNANDES, Mariana; LIMA, Giovanni F.; GRAD, Gustavo F.; YANAGIMORI, Marcela; LORENZI-FILHO, Geraldo; GENTA, Pedro RodriguesStudy objectives: Aging is a major risk factor for obstructive sleep apnoea (OSA) and is associated with increased upper airway collapsibility, but the mechanisms are largely unknown. We hypothesized that the increase in OSA severity and upper airway collapsibility with age are partially mediated by upper airway, visceral and muscle fat infiltration.Methods: Male subjects underwent full polysomnography, upper airway collapsibility determination (Pcrit) after sleep induction with midazolam, upper airway and abdominal computed tomography. Tongue and abdominal muscle fat infiltration were assessed by the determination of muscle attenuation with computed tomography. Results: Eighty-four males with a wide range of age (47 +/- 13 years, range 22-69 years) and apnea-hypopnea index (AHI) (30 [14-60] events/h, range 1-90 events/h), were studied. Younger and older males were grouped according to the mean age. Despite similar body mass-index (BMI), older subjects had higher AHI, higher Pcrit, larger neck and waist circumference, higher visceral and upper airway fat volumes (P < 0.01) as compared to younger subjects. Age was associated with OSA severity, Pcrit, neck and waist circumference, upper airway fat volume and visceral fat (P < 0.05), but not with BMI. Older subjects had lower tongue and abdominal muscle attenuation as compared to younger subjects (P < 0.001). Age was inversely associated with tongue and abdominal muscle attenuation, indicating muscle fat infiltration.Conclusions: The associations between age, upper airway fat volume, visceral and muscle fat infiltration may help to explain the worsening of OSA and increased upper airway collapsibility with aging.(c) 2023 Elsevier B.V. All rights reserved.
- Upper Airway Collapsibility is Associated with Obesity and Hyoid Position(2014) GENTA, Pedro R.; SCHORR, Fabiola; ECKERT, Danny J.; GEBRIM, Eloisa; KAYAMORI, Fabiane; MORIYA, Henrique T.; MALHOTRA, Atul; LORENZI-FILHO, GeraldoStudy Objectives: Upper airway anatomy plays a major role in obstructive sleep apnea (OSA) pathogenesis. An inferiorly displaced hyoid as measured by the mandibular plane to hyoid distance (MPH) has been consistently associated with OSA. The hyoid is also a common landmark for pharyngeal length, upper airway volume, and tongue base. Tongue dimensions, pharyngeal length, and obesity are associated with OSA severity, although the link between these anatomical variables and pharyngeal collapsibility is less well known. We hypothesized that obesity as measured by body mass index (BMI), neck and waist circumferences, and variables associated with hyoid position (pharyngeal length, upper airway volume, and tongue dimensions) would be associated with passive pharyngeal critical closing pressure (Pcrit). Design: Cross-sectional. Setting: Academic hospital. Patients: 34 Japanese-Brazilian males age 21 to 70 y. Interventions: N/A. Measurements and Results: We performed computed tomography scans of the upper airway, overnight polysomnography, and Pcrit measurements in all subjects. On average, subjects were overweight (BMI = 28 +/- 4 kg/m(2)) and OSA was moderately severe (apnea-hypopnea index = 29 [13-51], range 1-90 events/h). Factor analysis identified two factors among the studied variables: obesity (extracted from BMI, neck and waist circumferences) and hyoid position (MPH, pharyngeal length, tongue length, tongue volume, and upper airway volume). Both obesity and hyoid position correlated with Pcrit (r = 0.470 and 0.630, respectively) (P < 0.01). In addition, tongue volume, tongue length, pharyngeal length, and MPH correlated with waist and neck circumferences (P < 0.05). Conclusions: Pharyngeal critical closing pressure is associated with obesity and hyoid position. Tongue dimensions, pharyngeal length, and the mandibular plane to hyoid distance are associated with obesity variables. These findings provide novel insight into the potential factors mediating upper airway collapse in obstructive sleep apnea.
- Influence of interface and position on upper airway collapsibility assessed by negative expiratory pressure(2017) HIRATA, Raquel Pastrello; KAYAMORI, Fabiane; SCHORR, Fabiola; MORIYA, Henrique Takachi; ROMANO, Salvatore; INSALACO, Giuseppe; GEBRIM, Eloisa; OLIVEIRA, Luis Vicente Franco de; GENTA, Pedro Rodrigues; LORENZI-FILHO, GeraldoPurpose Negative expiratory pressure (NEP) is a simple technique for the evaluation of upper airway collapsibility in patients with obstructive sleep apnea (OSA). Most studies evaluated NEP using a mouthpiece that may exclude the cephalic portion of the upper airway. We hypothesize that NEP determination is influenced by interface and position. Methods We evaluated patients with suspected OSA using polysomnography, NEP (-5 cmH(2)O in sitting and supine position with mouthpiece and nasal mask). A subgroup also underwent computed tomography (CT) of the upper airway. Results We studied a total of 86 subjects (72 male, age 46 +/- 12 yrs, body mass index 30.0 +/- 4.4 kg/m(2), neck circumference 40.0 +/- 3.5 cm, AHI 32.9 +/- 26.4, range 0.5 to 122.5 events/hour). NEP was influenced by interface and position (p = 0.007), and upper airwaywas more collapsible with mouthpiece than with nasal mask in sitting position (p = 0.001). Position influenced NEP and was worse in supine only when evaluated by nasal mask. Expiratory resistance (R-0.2) at 0.2 s during NEP was significantly higher and independent of position with mouthpiece than with nasal mask (20.7 versus 8.6 cmH(2)O/L s(-1), respectively, p = 0.018). NEP evaluated with nasal mask in supine position and with mouthpiece in sitting position, but not when evaluated with mouthpiece in supine position, were correlated with upper airway anatomical measurements including tongue dimensions and pharyngeal length. Conclusions Interface and position influence NEP. NEP evaluated with nasal mask in supine position may convey more relevant information for patients under investigation for OSA than when evaluated with mouthpiece.
- Upper Airway Collapsibility Assessed by Negative Expiratory Pressure while Awake is Associated with Upper Airway Anatomy(2016) HIRATA, Raquel P.; SCHORR, Fabiola; KAYAMORI, Fabiane; MORIYA, Henrique Takachi; ROMANO, Salvatore; INSALACO, Giuseppe; GEBRIM, Eloisa M.; OLIVEIRA, Luis Vicente Franco de; GENTA, Pedro R.; LORENZI-FILHO, GeraldoStudy Objectives: There is a growing interest to develop a simple method to characterize the mechanisms leading to upper airway collapse in order to guide treatment options in patients with obstructive sleep apnea (OSA). Critical closing pressure (Pcrit) during sleep is able to predict the anatomical component of OSA. However, Pcrit is a laborious method that is only used for research purposes. The application of negative expiratory pressure (NEP) is a simple method to assess upper airway collapsibility that can be easily performed during wakefulness. We hypothesized that NEP will be, similarly to Pcrit, associated with upper airway anatomy assessed by computed tomography (CT) scan. Methods: Patients under investigation for OSA underwent polysomnography, CT of the upper airway, NEP while awake, and Pcrit during sleep. NEP was performed with -5 cm H2O in supine position using a nasal mask. Pcrit was measured during sleep induced by low doses of midazolam. Results: Twenty-eight male subjects were studied (age 45 +/- 13 y, body mass index 29.4 +/- 4.9 kg/m(2), apnea-hypopnea index (AHI) 30 +/- 26, range 2 to 86 events/ h). NEP and Pcrit were similarly associated with tongue area (r = 0.646 and r = 0.585), tongue volume (r = 0.565 and r = 0.613) and pharyngeal length (r = 0.580 and r = 0.611), respectively (p < 0.05 for all comparisons). NEP and Pcrit were also significantly correlated with AHI (r = 0.490 and r = 0.531). NEP and Pcrit were significantly higher in patients with severe OSA than the remaining population. Conclusions: NEP is a simple and promising method that is associated with the anatomical component of upper airway collapsibility. NEP may be valuable to select patients for noncontinuous positive airway pressure alternative therapies for OSA.
- Quantification of Orbital Apex Crowding for Screening of Dysthyroid Optic Neuropathy Using Multidetector CT(2012) GONCALVES, A. C. P.; SILVA, L. N.; GEBRIM, E. M. M. S.; MONTEIRO, M. L. R.BACKGROUND AND PURPOSE: DON, a serious complication of GO, is frequently difficult to diagnose clinically in its early stages because of confounding signs and symptoms of congestive orbitopathy. We evaluated the ability of square area measurements of orbital apex crowding, calculated with MDCT, to detect DON. MATERIALS AND METHODS: Fifty-six patients with GO were studied prospectively with complete neuro-ophthalmologic examination and MDCT scanning. Square measurements were taken from coronal sections 12 mm, 18 mm, and 24 mm from the interzygomatic line. The ratio between the extraocular muscle area and the orbital bone area was used as a Cl. Intracranial fat prolapse through the superior orbital fissure was recorded as present or absent. Severity of optic nerve crowding was also subjectively graded on corona! images. Orbits were divided into 2 groups (with or without clinical evidence of DON) and compared. RESULTS: Ninety-five orbits (36 with and 59 without DON) were studied. The CIs at all 3 levels and the subjective crowding score were significantly greater in orbits with DON (P<.001). No significant difference was observed regarding intracranial fat prolapse (P=.105). The area under the ROC curves was 0.91, 0.93, and 0.87 for CIs at 12, 18, and 24 mm, respectively. The best performance was at 18 mm, where a cutoff value of 57.5% corresponded to 91.7% sensitivity, 89.8% specificity, and an odds ratio of 97.2 for detecting DON. A significant correlation (P<.001) between the CIs and VF defects was observed. CONCLUSIONS: Orbital Cls based on area measurements were found to predict DON more reliably than subjective grading of orbital crowding or intracranial fat prolapse.