SILVIA MOULIN RIBEIRO FONSECA
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
6 resultados
Resultados de Busca
Agora exibindo 1 - 6 de 6
- 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.
- 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.