UENIS TANNURI
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Pediatria, Faculdade de Medicina - Docente
Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/30 - Laboratório de Investigação em Cirurgia Pediát, Hospital das Clínicas, Faculdade de Medicina - Líder
Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/30 - Laboratório de Investigação em Cirurgia Pediát, Hospital das Clínicas, Faculdade de Medicina - Líder
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conferenceObject Impact of surgery and chemotherapy over renal function in bilateral Wilms tumor patients(2012) DUARTE, R. J.; CRISTOFANI, L. M.; GIRON, A. M.; DENES, F. T.; ODONE-FILHO, V; TANNURI, U.; SROUGI, M.INTRODUCTION & OBJECTIVES: Bilateral Wilms’ tumor represents 3% of all cases. The challenge of this situation is curing these patients preserving their renal function and quality of life (dialysis free status). Our purpose was to evaluate the success of renal function preservation in children treated for bilateral Wilms’ tumor. MATERIAL & METHODS: From January/1982 through June/2009, 13 children with bilateral Wilms’ tumor (4F: 9M, median age 16 months) were diagnosed. All patients received preoperative chemotherapy with VCR/ACTD (13 patients), VCR/ACTD/ADRIA (10 patients), VCR/ACTD/ADRIA/CBDCA/ETO (3 patients), VCR/ACTD/ADRIA/CBDCA/ETO/IFO (2 patients), for 8 through 40 weeks (median 16 weeks). All patients were submitted to surgical procedure nephron sparing objective. RESULTS: Radical unilatera l nephrectomy was performed in 9 patients (combined with contralateral nodulectomy in 8), bilateral nodulectomy in 3, and unilateral nodulectomy in 1. Two patients presented unilateral disappearing of the disease after preoperative chemotherapy on image and surgical evaluation. The histhopatological analysis revealed the classic triphasic Wilms’ tumor in 9 patients, rhabdomyoblastic differentiation in 3 and blastematous rests in one patient. Four patients relapsed: 2 in the remaining kidney, 1 in the tumoral bed and 1 in lungs (9mo, 1mo, 5mo and 6 mo after surgery). A ll, except the lung relapsed patient, were rescued, achieving a second remission, but one presented a second diffuse abdominal relapse and died. 11/13 patients have normal renal function and are alive and free of disease for 23+ months to 28+years. 1/13 patients presents microalbuminuria and mild systemic hypertension, requiring medication support. CONCLUSIONS: Bilateral Wilms’ tumor was successfully treated and renal function was preserved in 84.6% of surviving patients, even those cases that received nephrotoxic drugs.- Effects of local and remote ischemic postconditioning methods on ischemia-reperfusion injury in a young animal model of acute mesenteric ischemia(2023) ABREU, Mateus Souza; TANNURI, Ana Cristina Aoun; RODRIGUES, Rafael Felipe Goncalves; SILVA, Rafael Jose da; GONCALVES, Josiane de Oliveira; SERAFINI, Suellen; TANNURI, UenisPurpose: Acute mesenteric ischemia (AMI) is a condition in pediatric surgery that ranges from intestine necrosis to death. Ischemic postconditioning (IPoC) methods were developed to reduce the damage caused by revascularization. This study aimed to evaluate the efficacy of these methods in an experimental weaning rat model. Methods: Thirty-two 21-day-old Wistar rats were allocated into four groups according to the surgical procedure performed: control, ischemia-reperfusion injury (IRI), local (LIPoC) and remote IPoC (RIPoC). At euthanasia, fragments of the intestine, liver, lungs, and kidneys were submitted to histological, histomorphometric, and molecular analyses. Results: In the duodenum, intestines, and kidneys histological alterations promoted by IRI were reversed by remote postconditioning method. In the distal ileum, the histomorphometric alterations could be reversed by the postconditioning methods with more evident effects promoted by the remote method. The molecular analysis found that the levels of expression of Bax (proapoptotic) and Bcl-XL (antiapoptotic) genes in the intestine were increased by IRI. These alterations were equally reversed by the postconditioning methods, with more evident effects of the remote method. Conclusion: IPoC methods positively reduced the damage caused by IRI in weaning rats.
- Effects of serum sodium and chloride levels in the outcome of critically ill pediatric patients in the post-operative period of liver transplantation(2023) LUGLIO, Michele; CARVALHO, Werther B. de; TANNURI, Uenis; TANNURI, Ana Cristina A.; MATSURA, Rodrigo Hideki; FRANCA, Gardenia Morais; DELGADO, Artur F.BackgroundSodium and chloride disturbances have attracted increasing attention in recent years. Many pathophysiological effects are associated with hyperchloremia, including reduction in mean arterial pressure and acute renal disease. Pediatric patients undergoing liver transplantation are at risk of developing various electrolyte and biochemical abnormalities, with an impact on their postoperative outcomes.ObjectiveTo analyze the impacts of serum sodium and chloride levels on prognosis of Pediatric Liver Transplant receptors.MethodsThis was a retrospective analytical observational study performed in a single transplant reference center in Sao Paulo, Brazil. Included patients were pediatric patients who underwent liver transplantation between January 2015 and July 2019. Statistical regression analysis and General Estimating Equations analysis were performed to evaluate the impacts of sodium and chloride disturbances on the development of acute renal failure and mortality.ResultsA total of 143 patients were included in this study. The main diagnosis was Biliary Atresia (62.9%). Twenty-seven patients died (18.9%), and graft dysfunction was the main cause of death (29.6%). The only variable individually associated with 28-days mortality was PIM-3 score (HR 1.59, CI 95% 1.165-2.177, p = 0.004). Forty-one patients (28.6%) developed moderate or severe AKI. PIM-3 score (OR 3.052, 95% CI 1.56-5.97, p = 0.001), hypernatremia (OR 3.49, 95% CI 1.32-9.23, p = 0.012), and hyponatremia (OR 4.24, 95% CI 1.52-11.85, p = 0.006) were independently associated with the development of moderate/severe AKI.ConclusionsIn pediatric patients after liver transplantation, PIM-3 score, and abnormal serum sodium levels were correlated with AKI development.
- Development of a prognostic model for pediatric acute liver failure in a Brazilian center(2022) COLLETI JUNIOR, Jose; TANNURI, Ana Cristina Aoun; TANNURI, Uenis; DELGADO, Artur Figueiredo; CARVALHO, Werther Brunow deObjective: Pediatric acute liver failure (PALF) is a heterogeneous, rare, and severe condition, which outcome is survival due to liver spontaneous recovery or death. The patients who do not recover may be allocated to liver transplantation, which is the standard treatment. This study aimed to build a prognostic model to support the clinical decision to indicate liver transplanta-tion for patients with PALF in a Brazilian center. Methods: The authors retrospectively analyzed the clinical variables of 120 patients in the liver transplantation program of the 'Children's Institute of the University of Sa similar to o Paulo, Brazil. The authors conducted a univariate analysis of variables associated with survival in PALF. Logistic multivariate analysis was performed to find a prognostic model for the outcome of patients with pediatric acute liver failure. Results: Risk factors were analyzed using univariate analysis. Two prognostic models were built using multiple logistic regression, which resulted in 2 models: model 1(INR/ALT) and model 2 (INR/Total bilirubin). Both models showed a high sensitivity (97.9%/96.9%), good positive predic-tive value (89.5%/90.4%), and accuracy (88.4%/88.5%), respectively. The receiver operating characteristic was calculated for both models, and the area under the curve was 0.87 for model 1 and 0.88 for model 2. The Hosmer-Lemeshow test showed that model 1 was good. Conclusion: The authors built a prognostic model for PALF using INR and ALT that can contribute to the clinical decision to allocate patients to liver transplantation. (c) 2022 Sociedade Brasileira de Pediatria.
- A new systematization of histological analysis for the diagnosis of Hirschsprung's disease(2023) SERAFINI, Suellen; SANTOS, Maria Merces; TANNURI, Ana Cristina Aoun; LORETO, Celso Di; GONCALVES, Josiane de Oliveira; TANNURI, UenisBackground: Hirschsprung's Disease (HD) is characterized by intestinal sub-occlusion and the absence of enteric ganglion cells. A rectal biopsy examination is performed to confirm the diagnosis. In a recent study, we demon-strated that the analysis of 60 sections of rectal mucosa and submucosa stained by H&E may ensure a 90% diag-nostic accuracy. Although the need to analyze so many sections makes the process of reading the slides more time-consuming, this encouraged us to study their distribution in the healthy rectal submucosa, to simplify the diagnosis.Objectives: To develop a method that facilitates HD diagnosis by studying the distribution of ganglion cells in the submucosal plexus. Methods: Using the calretinin technique, we studied the distribution of plexuses in 60 fragments of rectal submu-cosa from 19 cadavers. After the study, the reading method created was used for diagnosis in 47 cases of suspected HD, using H&E staining. The accuracy was verified by comparing the results obtained with H&E to those obtained with the acetylcholinesterase technique, the golden standard in our laboratory.Results: The study of submucosal plexus distribution showed that just by examining the submucosal region every 20 mu m, approximately, it is possible to locate a ganglionic plexus, and we have already been able to diagnose HD with 93% accuracy. Conclusion: The study of ganglion cell distribution enabled the creation of a simplified method for reading the slides. The method applied achieved good accuracy and it can be used as an alternative method in HD diagnosis.
- Wilms tumor in children: A multivariate analysis of prognostic factors, with emphasis on inferior vena cava/right atrium extension. Results from a single-center study(2023) BRENER, Pedro Zanetta; TANNURI, Ana Cristina Aoun; TEIXEIRA, Roberto Augusto Plaza; CRISTOFANI, Lilian Maria; EVANGELISTA, Ana Beatriz Rabelo; SUGIYAMA, Renata Morita; TANNURI, UenisBackground: To identify prognostic factors for overall survival through the analysis of 132 patients with Wilms tumor followed at a single center, with emphasis on the inferior vena cava/right atrium extension.Methods: Retrospective analysis of overall survival using logistic regression models and including age, sex, clinical features, associated syndromes, comorbidities, tumor size before chemotherapy, stage, presence of metastatic disease and its site, invasion of adjacent structures, inferior vena cava/right atrium extension, laterality, tumor histology, chemotherapy protocol, and radiotherapy as potential risk factors.Results: From January 2000 through November 2021, 132 patients met the inclusion criteria, 64 females and 68 males; 15 (11.4%) patients presented with tumoral extension to inferior vena cava/right atrium and 44 had metastatic disease (33.3%). Based on logistic regression, the factors correlating to a fatal outcome were male sex (p = 0.046), high risk histology (p = 0.036), and the presence of metastatic disease (p = 0.003). None of the patients presenting inferior vena cava/right atrium extension died (p = 0.992). In a specific analysis of metastatic sites, hepatic metastasis alone showed correlation with a fatal outcome (p = 0.001).Conclusion: These results underline the importance of identifying and treating metastatic disease and high-risk tumors. The female gender as a potential driver for a less aggressive disease is a new finding that deserves further investigation. The accurate identification of inferior vena cava/right atrium extension, subsequent preoperative chemotherapy, and resection with a skilled team promoted survival rates of all patients.Level of evidence: II.
- Post-natal prognostic factors in CDH: experience of 11 years in a referral center in Brazil(2023) NAM, Camila Pinho Brasileiro Martins; CAMPOS, Carolina Vieira; LEAL, Gabriela Nunes; TANNURI, Uenis; CECCON, Maria Esther Jurfest Rivero; CARVALHO, Werther Brunow deObjective: To describe post-natal risk factors associated with death in Newborns (NB) with Congenital Diaphragmatic Hernia (CDH) in a Brazilian reference center.Methods: In this retrospective cohort study, post-natal clinical factors of all NB diagnosed with CDH were reviewed in an 11-year period (2007-2018). The primary outcome was death. Secondary outcomes included clinical features, prognostic indexes, type of mechanical ventilation, complications during hospitalization and surgical repair.Results: After applying the exclusion criteria, the authors analyzed 137 charts. Overall mortality was 59% (81/ 137), and the highest rates were observed for low-birth-weight NB (87%), syndromic phenotype (92%), and those with major malformations (100%). Prognostic indexes such as Apgar, SNAPPE-II and 24hOI (best oxygenation index in 24 hours) were all associated with poor evolution. In a multivariate analysis, only birth weight and 24hOI were statistically significant risk factors for mortality, with a reduction in mortality risk of 17.1% (OR = 0.829, 95% IC 0.72-0.955, p = 0.009) for each additional 100g at birth and an increase by 26.5% (OR = 1.265, 95% IC 1.113-1.436, p = 0.0003) for each unitary increase at the 24hOI.Conclusion: Prognostic indexes are an important tool for predicting outcomes and improving resource allocation. Post-natal risk factors may be more suitable for settings where antenatal diagnosis is not universal. Classical risk factors, such as prematurity, low birth weight, higher need for supportive care, and poorer prognostic indexes were associated with mortality in our CDH population.
- Early parenteral nutrition in enterectomized dogs(2018) PATRICIO, Geni C. F.; EYHERABIDE, Ana R.; DIAS, Ricardo A.; TANNURI, Uenis; BRUNETTO, Marcio A.; CORTOPASSI, Silvia R. G.The aim of this study was to explore the role of early central parenteral nutrition support with and without lipid emulsion in enterectomized dogs undergoing small bowel partial resection. Enterectomized dogs often cannot be fed properly via an oral or enteral route immediately post-surgery. After enterectomy, the animals received parenteral nutrition or crystalloid solution until they were able to voluntarily take in an oral diet. All dogs were recruited at the University of Sao Paulo veterinary teaching hospital. Eighteen dogs with intussusception, a foreign intestinal body, linear foreign intestinal body, or intussusception associated with a foreign intestinal body underwent enterectomy surgery and were randomly assigned to receive one of three treatments: crystalloid solution (CS group), parenteral nutrition with a mix of glucose and amino acids (GA group) or parenteral nutrition with a mix of glucose, amino acids and lipids (GAL group). A serum chemistry panel and complete blood count were collected prior to surgery and at the end of the study. Albumin increased in the GA and GAL group (p=0.042 and p=0.038 respectively) after hospitalization, but no significant differences were identified among the groups. Body weight decreased by 4.9% (p=0.042) in the CS group, but there were no significant changes in the GAL and GA groups. There was a significant decrease in the recovery scores in the GA and GAL groups during hospitalization (p=0.039 in both groups). Early parenteral nutrition was beneficial for patient recovery in post-surgical small bowel partial resection, indicating better quality, and no major complications or side effects were observed during the hospitalization period in the studied dogs.