SILVIA MOULIN RIBEIRO FONSECA
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
5 resultados
Resultados de Busca
Agora exibindo 1 - 5 de 5
- 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.
- 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.
- 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.
- 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.