SILVIA MOULIN RIBEIRO FONSECA
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
11 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 11
conferenceObject CARDIOVASCULAR MORTALITY AND MYOCARDIAL INFARCTION AFTER RADIATION THERAPY FOR LEFT VERSUS RIGHT SIDED BREAST CANCER: A META-ANALYSIS(2016) BITTENCOURT, Marcio Sommer; VECSEY-NAGY, Milan; SANTOS, Marilia; SILVA, Carolina; FONSECA, Silvia M.; BITTAR, Cristina S.; HOFF, Paulo G.; KALIL-FILHO, Roberto; HAJJAR, Ludhmila A.- Cardiovascular Manifestations of Erdheim-Chester's Disease: A Case Series(2018) COSTA, Isabela Bispo Santos da Silva; ABDO, Andre Neder Ramires; BITTAR, Cristina Salvadori; FONSECA, Silvia Moulin Ribeiro; MORAES, Aline Sabrina Holanda Teixeira; KALIL FILHO, Roberto; PEREIRA, Juliana; HAJJAR, Ludhmila AbrahaoErdheim-Chester Disease is a rare entity, classified as an inflammatory myeloid neoplasm, with an unknown incidence, occurring preferentially in men after 50 years of age. Classically, it has a multisystemic presentation, with the skeletal system being the most frequently affected (90% of the patients), followed by genitourinary involvement in 60% of cases and central nervous system in the pituitary and diabetes insipidus in 25% of the cases. Cardiovascular manifestations are present in more than half of the patients, with aortic infiltration and atrial pseudotumor being the most common forms.
conferenceObject Oncologic Patients Presenting Acute Coronary Syndromes Have High Atherosclerotic Burden, Complex Anatomical Plaques and Particular Plaque Rupture Distribution(2019) SELEME, Vinicius B.; CAMPOS, Carlos; BISPO, Isabela; BORGES, Diego C.; BITTAR, Cristina S.; CAROLINA, Silva; FONSECA, Silvia; PINTO, Giovani H.; RIBEIRO, Expedito E.; KALIL FILHO, Roberto; HAJJAR, Ludhmila- Acute coronary syndrome due to an invasive thymoma with blood supply by circumflex artery-a case report(2020) FIGUEIREDO, Clara Salles; COSTA, Isabela Bispo Santos da Silva; BITTAR, Cristina Salvadori; PAIVA, Antonio Fernando Lins de; LIMA, Ivanhoe Stuart; DIVINO, Paulo Henrique do Amor; SILVA, Carolina Maria P. D. de C.; FONSECA, Silvia Moulin Ribeiro; KALIL FILHO, Roberto; HAJJAR, Ludhmila AbrahaoThymomas are usually tumors with a good prognosis but with potential to invade nearby structures. We report a case of a 56-year-old woman previously diagnosed with an invasive thymoma that came to the emergence room with symptoms of acute coronary syndrome. After a coronary computed tomography angiography, it was seen that the tumor was invading the myocardial and it was irrigated by the left circumflex coronary and its branches. Considering her poor prognosis, it was decided not to make further interventions. This case highlights a unique and rare case of an unresectable thymoma that was invading the myocardium and it was irrigated by the left circumflex coronary and its branches, causing typical angina due to compromised coronary blood flow by the mass causing ischemia.
- Sympathetic neural overdrive and diminished exercise capacity in reduced ejection fraction heart failure related to anthracycline-based chemotherapy(2023) RODRIGUES, Amanda G.; SALES, Allan R. K.; FARIA, Diego; FONSECA, Silvia M. R.; BOND, Marina M. K.; JORDAO, Camila P.; SOUZA, Francis R. de; BITTAR, Cristina S.; SANTOS, Marilia H. H. Dos; SARMENTO, Adriana O.; NEGRAO, Marcelo V.; HAJJAR, Ludhmila A.; NEGRAO, Carlos E.; KALIL FILHO, RobertoCardiotoxicity is the most worrying cardiovascular alteration in patients treated with chemotherapy. To improve the understanding regarding the cardiotoxicity, we studied whether 1) patients with cardiac dysfunction related to anthracycline-based chemotherapy have augmented sympathetic nerve activity and decreased exercise capacity and 2) these responses are similar to those observed in patients with heart failure caused by other etiologies. Sixteen patients with heart failure with reduced ejection fraction related to anthracycline-based chemotherapy with or without chest radiation (HFrEFCA), 10 patients with heart failure with reduced ejection not related to cancer therapy (HFrEF), and 16 age- and body mass index (BMI)-matched healthy control subjects were studied. Left ventricular ejection fraction (LVEF, echocardiography), peak oxygen consumption (peak (V)over dot(O2), cardiopulmonary exercise test), muscle sympathetic nerve activity (MSNA, microneurography), and forearm blood flow (FBF, venous occlusion plethysmography) were measured. We found that peak oxygen consumption peak (V)over dot(O2) and LVEF were significantly reduced in patients with HFrEFCA compared with that of control subjects (P < 0.0001) but similar to those found in patients with HFrEFCA. The sympathetic nerve activity burst frequency and incidence were significantly higher in patients with HFrEFCA than that in control subjects (P < 0.0001). No differences were found between patients with HFrEF and HFrEFCA. Peak (V)over dot(O2) was inversely associated with MSNA burst frequency (r = -0.53, P = 0.002) and burst incidence (r = -0.38, P = 0.01) and directly associated with LVEF (r = 0.71, P < 0.0001). Taken together, we conclude that patients who develop heart failure due to anthracycline-based chemotherapy have sympathetic neural overdrive and reduced exercise capacity. In addition, these physiological changes are similar to those observed in patients with HFrEF.
- Atrial Fibrillation and Cancer(2021) HAJJAR, Ludhmila Abrahao; FONSECA, Silvia Moulin Ribeiro; MACHADO, Theuran Inahja VicenteCancer patients have a higher risk of atrial fibrillation (AF) than general population, the pathophysiology mechanisms involves the pro inflammatory status of immune system in these patients and the exacerbated inflammatory response to cancer treatment and surgeries. Adequate management and prophylaxis for its occurrence are important and reduce morbidity and mortality in this population. There is a challenge in AF related to cancer to predict thromboembolic and bleeding risk in these patients, once standard stroke and hemorrhagic prediction scores are not validated for them. It is used CHA2DS2-VASc and HAS-BLED scores, the same as used in general population. In this review, we demonstrate correlated mechanisms to occurrence AF in cancer patients as well as therapeutic challenges in this population.
- Takotsubo syndrome: an overview of pathophysiology, diagnosis and treatment with emphasis on cancer patients(2019) COSTA, Isabela Bispo Santos da Silva; FIGUEIREDO, Clara Salles; FONSECA, Silvia Moulin Ribeiro; BITTAR, Cristina Salvadori; SILVA, Carolina Maria Domingues de Carvalho; RIZK, Stephanie Itala; KALIL FILHO, Roberto; HAJJAR, Ludhmila AbrahaoTakotsubo syndrome is a disease of great clinical importance that remains underdiagnosed. It is a form of acute heart failure characterized by a transient wall motion abnormality of the left ventricular apex typically triggered by emotional or physical stress. Takotsubo syndrome is commonly associated with cancer and results in poor outcomes. Therefore, early recognition and prompt therapy are essential to improve prognosis. The aim of this manuscript is to review the consequences of the association between cancer and Takotsubo to summarize the available evidence to guide physicians to improve the management of these patients.
- Transfusion Requirements in Surgical Oncology Patients A Prospective, Randomized Controlled Trial(2015) ALMEIDA, Juliano Pinheiro de; VINCENT, Jean-Louis; GALAS, Filomena Regina Barbosa Gomes; ALMEIDA, Elisangela Pinto Marinho de; FUKUSHIMA, Julia T.; OSAWA, Eduardo A.; BERGAMIN, Fabricio; PARK, Clarice Lee; NAKAMURA, Rosana Ely; FONSECA, Silvia M. R.; CUTAIT, Guilherme; ALVES, Joseane Inacio; BAZAN, Mellik; VIEIRA, Silvia; SANDRINI, Ana C. Vieira; PALOMBA, Henrique; RIBEIRO JR., Ulysses; CRIPPA, Alexandre; DALLOGLIO, Marcos; DIZ, Maria del Pilar Estevez; KALIL FILHO, Roberto; AULER JR., Jose Otavio Costa; RHODES, Andrew; HAJJAR, Ludhmila AbrahaoBackground: Several studies have indicated that a restrictive erythrocyte transfusion strategy is as safe as a liberal one in critically ill patients, but there is no clear evidence to support the superiority of any perioperative transfusion strategy in patients with cancer. Methods: In a randomized, controlled, parallel-group, double-blind (patients and outcome assessors) superiority trial in the intensive care unit of a tertiary oncology hospital, the authors evaluated whether a restrictive strategy of erythrocyte transfusion (transfusion when hemoglobin concentration <7 g/dl) was superior to a liberal one (transfusion when hemoglobin concentration <9 g/dl) for reducing mortality and severe clinical complications among patients having major cancer surgery. All adult patients with cancer having major abdominal surgery who required postoperative intensive care were included and randomly allocated to treatment with the liberal or the restrictive erythrocyte transfusion strategy. The primary outcome was a composite endpoint of mortality and morbidity. Results: A total of 198 patients were included as follows: 101 in the restrictive group and 97 in the liberal group. The primary composite endpoint occurred in 19.6% (95% CI, 12.9 to 28.6%) of patients in the liberal-strategy group and in 35.6% (27.0 to 45.4%) of patients in the restrictive-strategy group (P = 0.012). Compared with the restrictive strategy, the liberal transfusion strategy was associated with an absolute risk reduction for the composite outcome of 16% (3.8 to 28.2%) and a number needed to treat of 6.2 (3.5 to 26.5). Conclusion: A liberal erythrocyte transfusion strategy with a hemoglobin trigger of 9 g/dl was associated with fewer major postoperative complications in patients having major cancer surgery compared with a restrictive strategy.
- Brazilian cardio-oncology: the 10-year experience of the Instituto do Cancer do Estado de Sao Paulo(2020) COSTA, Isabela B. S. da S.; BITTAR, Cristina S.; FONSECA, Silvia M. R.; SILVA, Carolina M. P. D. e; REHDER, Marilia H. H. dos Santos; RIZK, Stephanie I.; CRUZ, Cecilia B. B. V.; FIGUEIREDO, Clara S.; ANDRADE, Fernanda T. de A.; BARBERINO, Ludmila de A.; COSTA, Fernanda A. de S.; MACHADO, Letticya P.; GONZALEZ, Thalita B.; ALMEIDA, Marcel P. C.; FUKUSHIMA, Julia T.; KALIL FILHO, Roberto; HAJJAR, Ludhmila AbrahaoBackgroundIn recent years, the field of cardio-oncology has grown worldwide, bringing benefits to cancer patients in terms of survival and quality of life. This study reports the experience of a pioneer cardio-oncology programme at University Cancer Hospital in Brazil over a period of 10 years, describing the clinical profile of patients and the clinical outcomes.MethodsA retrospective study was conducted on a cohort of patients treated at the cardio-oncology programme from April 2009 to February 2019. We analysed the characteristics of patients and outcomes, including mortality, according to the type of clinical indication for outpatient care (general cardiology, perioperative evaluation and follow-up and treatment cardiotoxicity).ResultsFrom a total of 26,435 medical consultations, we obtained the data of 4535 individuals among the medical care outpatients. When we analysed the clinical characteristics of patients considering the clinical indication - general cardiology, perioperative evaluation and cardiotoxicity outpatient clinics, differences were observed with respect to age (59 [48-66], 66 [58-74] and 69 [62-76], p <0.001), diabetes (67 [15%], 635 [22.6%] and 379 [29.8%]; p <0.001), hypertension (196 [43.8%], 1649 [58.7%] and 890 [70.1%], p <0.001) and dyslipidaemia (87 [19.7%), 735 [26.2%] and 459 [36.2%], p <0.001). A similar overall mortality rate was observed in the groups (47.5% vs. 45.7% vs. 44.9% [p =0.650]).ConclusionThe number of oncologic patients in the Cardio-Oncology Programme has grown in the last decade. A well-structured cardio-oncology programme is the key to achieving the true essence of this area, namely, ongoing care for cancer patients throughout the disease treatment process, optimizing their cardiovascular status to ensure they can receive the best therapy against cancer.
- Tocilizumab in SARS-COVID19 following postoperative laparoscopic transhiatal esophagectomy for the adenocarcinoma of esophagogastric tumor: A case report(2021) TAKEDA, Flavio Roberto; MUNIZ, Renan Rosetti; FONSECA, Silvia Moulin Ribeiro; SOEIRO, Alexandre de Matos; ABREU, Barbara Seffair de Castro de; LITVOC, Marcelo NobregaIntroduction and importance: Esophagectomy for esophageal cancer is one of the most challenging surgical procedures, with high rates of morbidity, especially from respiratory complications. SARS-COVID19 represents a health threat nowadays. Peri-operative SARS-COVID19 infection after esophagectomy might negatively affect the postoperative outcomes. The use of tocilizumab as an alternative to reduce the inflammatory response in SARS-COVID19 is an option that has not been described in the literature after esophagectomy. Case presentation: A SARS-COVID19-vaccinated (CORONAVAC) 73-year-old man with pulmonary emphysema, coronary artery disease, previous asymptomatic pulmonary embolism, and adenocarcinoma of the esophagogastric junction tumor was submitted to laparoscopic transhiatal esophagectomy (ypT2N0M0) after perioperative neoadjuvant chemotherapy. He was also infected with SARS-COVID19, confirmed by PCR test at the 14th postoperative day. During follow-up, mild hypoxemia persisted without evidence of infection except for SARS-COVID19, and a high-flow cannula was required to maintain oxygenation. Tocilizumab was administered following high parameters of a high-flow cannula, and invasive mechanical ventilation was avoided. Discussion: Besides of the risk of secondary infection, after administration of tocilizumab, the parameters of oxygen supplementation were systematically reduced, and he stayed in the ICU for seven days. He was discharged from the ward six days later. He developed late cervical anastomotic leakage, which was treated with conservative therapy. Conclusion: Although the patient had high-risk comorbidities, esophagectomy, and SARS-COVID19 infection, the use of tocilizumab was safe and improved the pulmonary recovery.