NIVALDO ALONSO
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cirurgia, Faculdade de Medicina - Docente
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/04 - Laboratório de Microcirurgia, Hospital das Clínicas, Faculdade de Medicina - Líder
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/04 - Laboratório de Microcirurgia, Hospital das Clínicas, Faculdade de Medicina - Líder
19 resultados
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- Avaliação da patência nasal após rinoplastia através do espelho de Glatzel(2012) POCHAT, Victor Diniz de; ALONSO, Nivaldo; MENDES, Rogério Rafael da Silva; GRAVINA, Paula Rocha; CRONENBERG, Eduardo Valente; MENESES, José Valber LimaINTRODUCTION: Objective evaluation of nasal function is a constant challenge for plastic surgeons, otolaryngologists, and allergists. The modified Glatzel mirror can evaluate nasal expiratory flow; however, there is little information on this method and its use in the measurement of nasal patency after surgical procedures. OBJECTIVE: To compare, in a prospective study, the functional results before and after cosmetic rhinoplasty and evaluate the use of the Glatzel mirror as an objective method to assess nasal patency. METHODS: To achieve this objective, we analyzed the functional results of surgery through a subjective questionnaire and objective evaluation through a modified Glatzel mirror, and evaluated the correlation between the 2 methods. Twenty patients (14 women and 6 men) underwent aesthetic rhinoplasty using spreader grafts. Pre- and postoperative evaluation (90-120 days) included a respiratory quality score (subjective) and modified Glatzel mirror test (objective). Subsequently, the Spearman test was used to compare the pre- and postoperative subjective and objective data. RESULTS: The subjective evaluation demonstrated a statistical difference between pre- and postoperative scores (8 ± 2 and 9.4 ± 0.7, P< 0.001). There was no statistical difference in mean nasal patency by modified Glatzel mirror. No statistically significant correlation was observed when comparing the modified Glatzel mirror values with the subjective scores reported by patients pre- or postoperatively. CONCLUSION: The Glatzel method lacks sensitivity in detecting patient-reported improvements in breathing following rhinoplasty. This suggests that the method is a poor assessment tool to detect small, post-surgical changes in the nasal airways.
- Pharyngoplasty Applied to Velopharyngeal Insufficiency: Efficacy versus Morbidity(2012) LIMA JUNIOR, Jonas E.; TANIKAWA, Daniela Y. S.; ROCHA, Diogenes L.; ALONSO, Nivaldo
- Efeitos de diferentes pressões de aspiração do tecido adiposo na obtenção de células-tronco mesenquimais(2012) TISSIANI, Luiz Alexandre Lorico; AGUENA, Meire; PASSOS-BUENO, Maria Rita; ALONSO, NivaldoBACKGROUND: In recent years, fat grafts have become useful in plastic surgery. They are mainly used to fill soft tissues, refine breast reconstructions, and for volumetric facial rejuvenation. They are also a rich source of mesenchymal stem cells (i.e., adipose-derived stem cells [ADSCs]), which directly influence fat graft survival. Since ADSCs play an important role in angiogenesis and adipogenic differentiation, it is essential to optimize their isolation. Therefore, in this study, we evaluated and compared 2 procedures used to isolate viable cells from the stromal vascular fraction of abdominal adipose tissue and assess the expressions of surface markers. METHODS: We examined 9 female subjects who were scheduled to undergo liposuction. The adipose tissue was isolated from the abdominal infraumbilical region. Fat (20 mL) was collected from the right side by using a cannula attached to a syringe; the plunger was pulled back every 2 cm³ to create low-pressure suction (manual group). The same procedure was repeated on the left side, but the cannula was attached to a sterile and intermediate collector coupled to a vacuum pump that provided a constant negative pressure of 350 mmHg (pump group). The samples were centrifuged, and the adipocytes of the intermediate layer were counted, cultured, and immunophenotyped. RESULTS: The isolation of abdominal adipocytes with a pump providing a negative pressure of 350 mmHg yielded a higher concentration of cells in the stromal vascular fraction than that obtained using 10-mL syringes and low-pressure suction, although the difference was not significant. CONCLUSIONS: A negative pressure of 350 mmHg may be safely applied to isolate ADSCs. The cell yield did not indicate any statistically significant difference between the techniques.
- FGFR2 Mutation Confers a Less Drastic Gain of Function in Mesenchymal Stem Cells Than in Fibroblasts(2012) YEH, Erika; ATIQUE, Rodrigo; ISHIY, Felipe A. A.; FANGANIELLO, Roberto Dalto; ALONSO, Nivaldo; MATUSHITA, Hamilton; ROCHA, Katia Maria da; PASSOS-BUENO, Maria RitaGain-of-function mutations in FGFR2 cause Apert syndrome (AS), a disease characterized by craniosynostosis and limb bone defects both due to abnormalities in bone differentiation and remodeling. Although the periosteum is an important cell source for bone remodeling, its role in craniosynostosis remains poorly characterized. We hypothesized that periosteal mesenchymal stem cells (MSCs) and fibroblasts from AS patients have abnormal cell phenotypes that contribute to the recurrent fusion of the coronal sutures. MSCs and fibroblasts were obtained from the periostea of 3 AS patients (S252W) and 3 control individuals (WT). We evaluated the proliferation, migration, and osteogenic differentiation of these cells. Interestingly, S252W mutation had opposite effects on different cell types: S252W MSCs proliferated less than WT MSCs, while S252W fibroblasts proliferated more than WT fibroblasts. Under restrictive media conditions, only S252W fibroblasts showed enhanced migration. The presence of S252W mutation increased in vitro and in vivo osteogenic differentiation in both studied cell types, though the difference compared to WT cells was more pronounced in S252W fibroblasts. This osteogenic differentiation was reversed through inhibition of JNK. We demonstrated that S252W fibroblasts can induce osteogenic differentiation in periosteal MSCs but not in MSCs from another tissue. MSCs and fibroblasts responded differently to the pathogenic effects of the FGFR2(S252W) mutation. We propose that cells from the periosteum have a more important role in the premature fusion of cranial sutures than previously thought and that molecules in JNK pathway are strong candidates for the treatment of AS patients.
- IRF6 is a Risk Factor for Nonsyndromic Cleft Lip in the Brazilian Population(2012) BRITO, Luciano A.; BASSI, Camila F. S.; MASOTTI, Cibele; MALCHER, Carolina; ROCHA, Katia M.; SCHLESINGER, David; BUENO, Daniela F.; CRUZ, Lucas A.; BARBARA, Ligia K.; BERTOLA, Debora R.; MEYER, Diogo; FRANCO, Diogo; ALONSO, Nivaldo; PASSOS-BUENO, Maria RitaNonsyndromic cleft lip with or without cleft palate (NSCL/P) is a complex disorder with a worldwide incidence estimated at 1:700. Among the putative susceptibility loci, the IRF6 gene and a region at 8q24.21 have been corroborated in different populations. To test the role of IRF6 in NSCL/P predisposition in the Brazilian population, we conducted a structured association study with the SNPs rs642961 and rs590223, respectively, located at 5' and 3' of the IRF6 gene and not in strong linkage disequilibrium (LD), in patients from five different Brazilian locations. We also evaluated the effect of these SNPs in IRF6 expression in mesenchymal stem cells (MSC). We observed association between rs642961 and cleft lip only (CLO) (P = 0.009; odds ratio (OR) for AA genotype = 1.83 [95% Confidence interval (CI), 0.64-5.31]; OR for AG genotype = 1.72 [95% CI, 1.03-2.84]). This association seems to be driven by the affected patients from Barbalha, a location which presents the highest heritability estimate (H-2 = 0.85), and the A allele at rs642961 is acting through a dominant model. No association was detected for the SNP rs590223. We did not find any correlation between expression levels and genotypes of the two loci, and it is possible that these SNPs have a functional role in some specific period of embryogenesis. (C) 2012 Wiley Periodicals, Inc.
- Frontal-orbital advancement for the management of anterior plagiocephaly(2012) MATUSHITA, Hamilton; ALONSO, Nivaldo; CARDEAL, Daniel Dante; ANDRADE, Fernanda deThe main purposes of this manuscript are to provide an overview of various modalities of surgical correction of anterior plagiocephaly and to emphasize their differences with the classic open frontal-orbital advancement. Advancement of technology provides development of many other ways to achieve the same results. The authors describe the classic open frontal-orbital advancement and compare with other proposed techniques for correction of frontal plagiocephaly. The main limitation of the use of new forms of treatment of the anterior plagiocephaly is the age of the patient. There is still no consensus on criteria for quantitative evaluation of surgical results, and new forms of treatment do not present results with long follow-up. Frontal-orbital advancement is the preferred procedure to correct unicoronal synostosis due to its universal indication regardless of the age and degree of deformation of the anterior plagiocephaly.
- Anatomical Variations of the Upper Lateral Cartilages and Their Implications in Rhinoplasty(2012) POCHAT, Victor Diniz de; ALONSO, Nivaldo; RIBEIRO, Emilie B.; ROCHA, Emanuelle A. da; TENORIO, Edinho G.; MENESES, Jose Valber LimaUpper lateral cartilage manipulation is often associated with compromise of the middle-third vault. Although the anatomical details of the upper lateral cartilages are of great importance for the maintenance or even the creation of an aesthetically pleasing dorsum with proper respiratory function, the literature includes few studies related to these themes. Thus, this study aimed to evaluate the total length of the upper lateral cartilages and their extension under the nasal bones and caudally, and examine the anatomical variations of the upper lateral cartilages and their implications in rhinoplasty. An anatomical study was performed on 32 upper lateral cartilages of 16 fresh adult cadavers. The upper lateral cartilages were measured for total length, cephalad length (overlapped by the nasal bones), and caudal length (caudally to the nasal bones) using a millimeter ruler. The measurements were recorded and analyzed by BioEstat 5.0 software. The statistical tests were performed at the significance level of 0.05. A total of 13 male specimens and 3 female specimens with ages ranging between 20 and 60 years were analyzed. The length of the upper lateral cartilage portion under the nasal bones on the right side ranged from 3 to 7 mm (4.62 +/- A 1.20 mm). On the left side, it ranged from 2 to 7 mm (4.56 +/- A 1.26 mm). The total length of the upper lateral cartilages ranged from 16 to 28 mm (20.44 +/- A 3.26 mm) on the right side and 17 to 30 mm (20.75 +/- A 3.71 mm) on the left side. Data from this study confirmed the anatomical variations of the upper lateral cartilages, including the portion lying under the nasal bones. This has important surgical implications given the attention required during spreader graft fabrication in order to maintain dorsal aesthetic lines and proper respiratory function.
- Nasal patency after open rhinoplasty with spreader grafts(2012) POCHAT, Victor D. de; ALONSO, Nivaldo; MENDES, Rogerio R. S.; CUNHA, Marcelo S.; MENEZES, Jose V. L.Background: Spreader grafts have been used in cosmetic rhinoplasty, but little information is available about the objective results of treatment. This study sought to determine subjective and objective functional results of open cosmetic rhinoplasty with spreader grafts. Methods: Twenty patients (14 women, six men; mean age, 31 +/- 6 years) had open cosmetic rhinoplasty. Surgery included dissection of the upper lateral cartilages, from the septum, and placement of spreader grafts, symmetrically, along the dorsal edge of the septal cartilage. Preoperative and postoperative evaluation included breathing quality score, acoustic rhinometry and a modified Glatzel mirror test. Results: Evaluation after surgery (range, 5-18 months) showed significant improvement of breathing quality (before surgery, 8; after surgery, 9.4; P <= 0.001) and a mean minimal cross-sectional area of the left side (before surgery, 0.6 cm(2); after surgery, 0.9 cm(2); P <= 0.01). There was no significant change of the mean minimal cross-sectional area of the right side (acoustic rhinometry) or nasal patency (modified Glatzel mirror test) between preoperative and postoperative evaluation. Complications included postoperative synechiae in two patients and septal granuloma in one patient. Conclusions: Open structure rhinoplasty using spreader grafts is effective in reconstructing the internal nasal valve and preserving or improving nasal patency. Level of evidence: : IV (case series with preoperative and postoperative testing).
- Modified technique to increase nostril cross-sectional area after using rib and septal cartilage graft over alar nasal cartilages(2012) WULKAN, Marcelo; SA, Alvaro Julio de Andrade; ALONSO, NivaldoPURPOSE: Describe a modified technique to increase nostril cross-sectional area using rib and septal cartilage graft over alar nasal cartilages. METHODS: A modified surgical technique was used to obtain, carve and insert cartilage grafts over alar nasal cartilages. This study used standardized pictures and measured 90 cadaveric nostril cross-sectional area using Autocad (c); 30 were taken before any procedure and 60 were taken after grafts over lateral crura (30 using costal cartilage and 30 using septal cartilage). Statistical analysis were assessed using a model for repeated measures and ANOVA (Analysis of Variance) for the variable ""area"". RESULTS: There's statistical evidence that rib cartilage graft is more effective than septal cartilage graft. The mean area after the insertion of septal cartilage graft is smaller than the mean area under rib graft treatment (no confidence interval for mean difference contains the zero value and all P-values are below the significance level of 5%). CONCLUSIONS: The technique presented is applicable to increase nostril cross section area in cadavers. This modified technique revealed to enhance more nostril cross section area with costal cartilage graft over lateral crura rather than by septal graft.
- Management of an Unusual Presentation of Ascher Syndrome(2012) DE FIGUEREDO, Adson Andrade; DE POCHAT, Victor Diniz; BARRETO, Thais Fagundes; MENDES, Rogerio Silva; ALONSO, Nivaldo; MENESES, Jose ValberAscher syndrome is defined by the association between double lip, blepharochalasis, and nontoxic goiter. Because it is a rare disease, it is most often misdiagnosed, despite its implications for quality of life. We report a variation of an incomplete type of Ascher syndrome affecting the upper lip, upper eyelids, and lateral canthi of a young male patient. The surgical management, follow-up, and a brief overview of the syndrome are described. The results presented show an aesthetic and functional improvement of the facial deformities.