ARTUR HENRIQUE BRITO
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
17 resultados
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conferenceObject FACTORS ASSOCIATED WITH SEVERE SEPTIC EVENTS AFTER SURGICAL DECOMPRESSION OF OBSTRUCTING URETERAL STONES: A PROSPECTIVE ANALYSIS(2016) MARCHINI, Giovanni; MOSCARDI, Paulo; SROUGI, Victor; VICENTINI, Fabio; TORRICELLI, Fabio; BRITO, Artur; CAMARA, Cesar; SROUGI, Miguel; MAZZUCCHI, EduardoconferenceObject THE GUY'S STONE SCORE: A VERY PRACTICAL AND USEFUL TOOL TO PREDICT THE OUTCOMES OF PERCUTANEOUS NEPHROLITHOTOMY (PCNL)(2012) VICENTINI, Fabio Carvalho; MARCHINI, Giovanni Scala; MAZZUCCHI, Eduardo; CHEDID NETO, Elias Assad; BRITO, Arthur Henrique; DANILOVIC, Alexandre; HISANO, Marcelo; CLARO, Joaquim Almeida; SROUGI, MiguelOBJECTIVE: To evaluate the applicability of the Guy’s stone score for complete supine PCNL. METHODS: 117 patients that underwent to complete supine PCNL were classified according the Guy’s stone score. The data were prospectively collected but the classification according to the score was done by review of the pre-operative CT scans. All patients were operated by the same surgeon and had a pre and post operative CT scan and at the final followup. The outcomes and complications were compared among the 4 groups. RESULTS: The table 1 shows the demographic and outcomes. The groups were similar except for the median stone diameter. The differences among groups were statistically different after stratification according to the Guy’s stone score in relation to operative time, hemoglobin drop, transfusions, complications, tubeless rate, immediate success, auxiliary procedures, PCNL revisions and final success rate. CONCLUSIONS: The Guy’s stone score showed to be a very practical and useful tool to predict the outcomes of PCNL.- Irreversible Renal Function Impairment Due to Silent Ureteral Stones(2016) MARCHINI, Giovanni S.; VICENTINI, Fabio Carvalho; MONGA, Manoj; TORRICELLI, Fabio Cesar; DANILOVIC, Alexandre; BRITO, Artur Henrique; CAMARA, Cesar; SROUGI, Miguel; MAZZUCCHI, EduardoOBJECTIVE To evaluate if renal function loss and hydronephrosis due to a silent ureteral stone might be reversed. MATERIALS AND METHODS We prospectively selected patients with silent ureteral stones between January 2006 and January 2014. A silent case was considered if there were no specific or subjective symptoms related to the ureteral stone. Patient, stone, and kidney characteristics were evaluated preoperatively, 3 and 12 months postoperatively. Renal function was accessed in the same intervals with serum creatinine (SCr), glomerular filtration rate (GFR), and Tc-99m-dimercaptosuccinic acid. Patients without complete pre-and postoperative evaluation were excluded. Primary end point was midterm progress of global and ipsilateral renal function. Secondary end points included the evaluation of renal and collecting system anatomy from diagnosis to 12 months after treatment. Analysis of variance with repeated measures and marginal homogeneity test were used to evaluate renal function and hydronephrosis progression. RESULTS Twenty-six patients met our inclusion criteria. Mean preoperative SCr and GFR were 1.24 mg/dL and 72.5 mL/min, respectively. At initial scintigraphy, mean renal function was 33.4%. Laser ureterolithotripsy was performed in 84.6% of cases and all patients were rendered stone free. Two patients (8%) developed ureteral stenosis. There was no difference regarding SCr (P =.89), GFR (P =.48), and renal function at scintigraphy (P =.19) during follow-up. Hydronephrosis significantly improved from preoperatively to 3 months postoperatively (P < .0001), but not from 3 to 12 months (P =.065). CONCLUSION Patients with silent ureteral stones present with significant impairment of ipsilateral renal function and hydronephrosis at diagnosis. On midterm follow-up evaluation, renal function of the affected unit remains stable whereas hydronephrosis improves after treatment. (C) 2016 Elsevier Inc.
bookPart Ureteroscopia semirrígida(2014) BRITO, Artur HenriquebookPart Hematúria unilateral crônica(2014) BRITO, Artur Henrique- Marchini et al.: Silent Ureteral Stones: Effect on Kidney Function-Can Treatment of Silent Ureteral Stones Preserve Kidney Function? (Urology 2012; 79: 304-308) Reply(2012) MARCHINI, Giovanni S.; VICENTINI, Fabio C.; MAZZUCCHI, Eduardo; BRITO, Arthur; EBAID, Gustavo; SROUGI, Miguel
bookPart Catete duplo j calcificado(2014) BRITO, Artur HenriqueconferenceObject PROSPECTIVE MID-TERM EVALUATION OF THE IMPACT OF SILENT URETERAL STONE TREATMENT ON RENAL FUNCTION USING 99MTC-DMSA(2016) MARCHINI, Giovanni; VICENTINI, Fablo; TORRICELLI, Fabio; DANILOVIC, Alexandre; BRITO, Artur; CAMARA, Cesar; MAZZUCCHI, Eduardo; SROUGI, MiguelconferenceObject Elaborating a learning program on laparoscopy: Assessment of the evolution of the novices' performance according to initial training with simulator or animal model(2012) DUARTE, R. J.; BRITO, A. H.; PASSEROTTI, C.; JR, J. R. Colombo; ARAP, M.; I, A. Mitre; SROUGI, M.INTRODUCTION & OBJECTIVES: This study sought to determinate the most efficient sequence for training new surgeons in laparoscopy: beginning with simulators, followed by surgery on animals, or beginning with surgery on animals and then using manual and virtual simulators. MATERIAL & METHODS: Forty-eight medical students without any experience in laparoscopy were enrolled and split into two groups. Group A consisted of 24 students who started with laparoscopic nephrectomy on pigs, followed by the use of simulators. Group B consisted of 24 students who started with manual and virtual simulators, followed by nephrectomy. In group A, one student performed the surgery, while the other used a camera over a one hour period, after which they switched roles(arterial clipping 30 points; vein clipping 30 points; complete nephrec tomy 20 points; no accidents 20 points). In group B, six pairs of students started with the virtual simulator in cutting and tying activities(50 points). Another six pairs of students began with the manual simulator, evaluated by a board incutting and tying(50 points). After one hour, the students changed roles. Nonparametric test was init ially applied to assess any starting point difference among groups. Then groups A and B were assessed regarding the score index improvement independently of the training sequence, in order to disclose an eventual difference of rhythm of improvement between groups. If a di fference of rhythm of improvement of the score between groups A and b was detected, the data were analyzed in order to disclose the sequence with the most increased score variation. RESULTS: There was no absolute variation of score between groups from the starting until the end of training (p=0.124 and p= 0.053). However, there was a difference in the rhythm of improvement of the novices, when we compare groups from the start to the end of training period (p<0.0001). The analysis of the absolute variation of the score according to the initial sequence of training, showed that the group who started in the animal model presented a skill improvement of 30.5% when after training on the si mulator, although those who started training in simulators presented a performance improvement of 98% after training in animal(p<0.001). CONCLUSIONS: Our data show that nov ice surgeons who start training in animal model have poor improvement with forward training with simulators. These data and the ethical and economic issues will be considered for the refinement of an educational curriculum.- Silent Ureteral Stones: Impact on Kidney Function-Can Treatment of Silent Ureteral Stones Preserve Kidney Function?(2012) MARCHINI, Giovanni S.; VICENTINI, Fabio C.; MAZZUCCHI, Eduardo; BRITO, Arthur; EBAID, Gustavo; SROUGI, MiguelOBJECTIVE To report our experience with silent ureteral stones and expose their true influence on renal function. METHODS We analyzed 506 patients who had undergone ureterolithotripsy from January 2005 to May 2010. Silent ureteral stones were calculi found in the absence of any specific or subjective ureteral stone-related symptoms. Of the 506 patients, 27 (5.3%) met these criteria (global cohort). All patients were assessed postoperatively with dimercaptosuccinic acid scintigraphy (DMSA). A difference in relative kidney function of >10% was considered abnormal. Pre- and postoperative comparative DMSA analyses were electively obtained for 9 patients (kidney function cohort). A t test was used to assess the numeric variables, and the chi-square test or Fisher's exact test was used for categorical variables. Two-tailed P < .05 was considered statistically significant. RESULTS Stones were diagnosed by radiologic abdominal evaluation for nonurologic diseases in 40% and after previous nephrolithiasis treatment in 33%. The primary therapy was ureterolithotripsy in 88%. The mean follow-up time was 23 months. The overall ureteral stone-free rate after 1 and 2 procedures was 96% and 100%, respectively. In the global cohort, the mean pre- and postoperative serum creatinine levels were similar (P = .39), and the mean postoperative function on DMSA was 31%. In the kidney function cohort, no difference was found between the pre-and postoperative DMSA findings (22% +/- 12.1% vs 20% +/- 11.8%; P = .83) and serum creatinine (0.8 +/- 0.13 mg/dL vs 1.0 +/- 0.21 mg/dL; P = .45). CONCLUSION Silent ureteral stones are associated with decreased kidney function present at the diagnosis. Hydronephrosis tends to diminish after stone removal, and kidney function remains unaltered. UROLOGY 79: 304-309, 2012. (C) 2012 Elsevier Inc.