LUCAS FARACO SOBRADO
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
37 resultados
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Agora exibindo 1 - 10 de 37
- Dronedarone's Inhibition of I-f Current Is the Primary Mechanism Responsible for Its Bradycardic Effect(2013) SOBRADO, Lucas F.; VARONE, Bruno B.; MACHADO, Ananda D.; NEARING, Bruce D.; ZENG, Dewan; BELARDINELLI, Luiz; VERRIER, Richard L.Dronedarone's Bradycardic Effect IntroductionThe mechanism(s) whereby dronedarone reduces sinus rate are not well understood, although L-type calcium channel antagonism, beta-adrenergic blockade, and inhibition of I-f are plausible. Methods and ResultsIn anesthetized pigs, we compared the effects of dronedarone to the prototypical I-f inhibitor, ivabradine, and the L-type calcium channel antagonist diltiazem on heart rate, mean arterial blood pressure (MAP), and contractility. Dronedarone's effects on the phenylephrine-induced rise in MAP and on the chronotropic response to isoproterenol were also investigated. Cumulative doses of dronedarone (0.5mg/kg, i.v., and 5.0mg/kg, i.v.; plasma level: 8016.1 nM) progressively reduced heart rate (P<0.02) without changes in MAP or contractility as assessed by LV dP/dt (N = 6). Ivabradine (0.5mg/kg, i.v.) similarly reduced heart rate (P<0.01) without change in MAP (N = 6). Diltiazem (0.8mg/kg, i.v.) reduced heart rate and MAP and decreased contractility (N = 6). Dronedarone blunted phenylephrine's alpha-receptor-mediated increase in MAP but did not alter the marked beta-adrenergic receptor (BAR)-mediated increase in heart rate induced by isoproterenol. When dronedarone injection was preceded by ivabradine, no further decrease in heart rate or change in MAP was observed (N = 6). ConclusionsDronedarone reduced heart rate without affecting MAP or contractility, effects that differ from L-type calcium channel blockade. Dronedarone did not antagonize BAR stimulation, and its heart-rate lowering effects were eliminated by prior administration of ivabradine. Thus, dronedarone's bradycardic action is likely due to inhibition of I-f and not to blockade of either L-type calcium channels or BAR.
- Pretreatment colostomy in patients with anal squamous cell carcinoma: Risk factors for a permanent stoma(2022) SOBRADO, Lucas F.; NAHAS, Caio S. R.; MARQUES, Carlos F. S.; SOBRADO, Carlos W.; NAHAS, Sergio C.Background The current standard of care for anal squamous cell carcinoma (SCC) is concurrent chemoradiation (CRT), which enables tumor eradication while preserving the anal sphincter. Patients with locally advanced tumors, however, may experience complications that preclude treatment before stoma creation. Objective To evaluate the reversal rate of pretreatment stomas and the risk factors associated with nonreversal. Methods This single-institution retrospective cohort study using a prospective database included patients diagnosed with anal SCC from January 2008 to December 2020 who required a stoma before curative CRT. Results In total, 651 patients were identified; 65 required a stoma before chemoradiation due to obstruction (43.1%), rectovaginal fistula (20%), and perianal sepsis (36.9%). The stoma was reversed in nine patients after a mean follow-up of 35.8 months. Risk factors associated with a permanent stoma were perianal sepsis (p = 0.010), interruptions during radiotherapy for more than 7 days (p = 0.010), male sex (p = 0.013), poor performance status (Eastern Cooperative Oncology Group [ECOG] >= 2) (p = 0.023), large tumors (p = 0.045), and cisplatin-based chemotherapy (p = 0.047). Conclusions Pretreatment stomas are unlikely to be reversed, and risk factors for a permanent stoma are perianal sepsis, interruptions during radiotherapy for more than 7 days, male sex, poor performance status (ECOG >= 2), large tumors, and cisplatin-based chemotherapy.
conferenceObject MINIMALLY INVASIVE PELVIC LATERAL LYMPHADENECTOMY IN LOCALLY ADVANCED RECTAL CANCER AFTER NEOADJUVANT TREATMENT.(2022) COTTI, G.; BUSTAMANTE-LOPEZ, L.; NAHAS, C. S.; MARQUES, C. F.; IMPERIALE, A.; BRAGHIROLI, O.; HORVAT, N.; SOBRADO, L. F.; AVERBACH, P.; CIRENZA, C.; NAHAS, S. C.- Suture Rectopexy and Repair of the Pouch of Douglas for Rectal Intussusception and Enterocele(2022) SOBRADO, Lucas Faraco; NAHAS, Sergio Carlos; SOBRADO, Carlos Walter
bookPart Malformações anogenitais(2021) SOBRADO, Carlos Walter; ALMEIDA, José Alcione Macedo; SOBRADO, Lucas Faraco; OLIVEIRA, Vanessa Heinrich Barbosa de- Surgery in Brazilian Health Care: funding and physician distribution(2017) ALONSO, NIVALDO; MASSENBURG, BENJAMIN B.; GALLI, RAFAEL; SOBRADO, LUCAS; BIROLINI, DARIOABSTRACT Objective: to analyze demographic Brazilian medical data from the national public healthcare system (SUS), which provides free universal health coverage for the entire population, and discuss the problems revealed, with particular focus on surgical care. Methods: data was obtained from public healthcare databases including the Medical Demography, the Brazilian Federal Council of Medicine, the Brazilian Institute of Geography and Statistics, and the National Database of Healthcare Establishments. Density and distribution of the medical workforce and healthcare facilities were calculated, and the geographic regions were analyzed using the public private inequality index. Results: Brazil has an average of two physicians for every 1,000 inhabitants, who are unequally distributed throughout the country. There are 22,276 board certified general surgeons in Brazil (11.49 for every 100,000 people). The country currently has 257 medical schools, with 25,159 vacancies for medical students each year, with only around 13,500 vacancies for residency. The public private inequality index is 3.90 for the country, and ranges from 1.63 in the Rio de Janeiro up to 12.06 in Bahia. Conclusions: A significant part of the local population still faces many difficulties in accessing surgical care, particularly in the north and northeast of the country, where there are fewer hospitals and surgeons. Physicians and surgeons are particularly scarce in the public health system nationwide, and better incentives are needed to ensure an equal public and private workforce.
- Fournier’s Gangrene During Pregnancy in a Patient with Crohn’s Disease(2022) SOBRADO, L. F.; AVERBACH, P.; JAYME, V. R.; CAMARGO, M. G. M. de; SOBRADO, C. W.; NAHAS, S. C.Patient: Female, 29-year-old Final Diagnosis: Crohn’s associated Perianal and perirectal abscess • Fournier’s gangrene Symptoms: Anal pain Medication: — Clinical Procedure: — Specialty: Surgery Objective: Background: Case Report: Conclusions: Unusual clinical course Fournier’s gangrene (FG) is a rapidly progressive necrotizing infection of the perineum. Risk factors include male sex and immunosuppression. Inflammatory bowel disease and pregnancy may alter immune response by complex mechanisms but have rarely been associated with necrotizing infections of the perineum. To the best of our knowledge, only 5 cases of FG in association with IBD have been reported in the literature, and none of them occurred during pregnancy. We report the case of a young woman with long-standing Crohn’s disease in clinical remission with Infliximab monotherapy who developed FG in the third trimester of pregnancy. A cesarean section was undertaken at 35 weeks due to fetal distress, followed by debridement, diverting stoma, and vacuum-assisted therapy. The perineal defect was closed following 4 debridements and vacuum-therapy exchanges with a unilateral medial thigh advancement flap, and a draining seton was placed in the suprasphincteric fistula. The patient was dis-charged after 28 days and her recovery was unremarkable. The neonate also recovered well. The treatment of FG is multidisciplinary and includes early debridement and intestinal diversion. Perianal pain should not be disregarded, as it may be the initial symptom of severe perianal sepsis in the immunosuppressed. To the best of our knowledge, this is the first case report of FG during pregnancy in a patient with Crohn’s disease. © Am J Case Rep, 2022.
- Anoplastia com plicoma sentinela para o tratamento de fissura anal crônica.(2019) SOBRADO JÚNIOR, Carlos Walter; HORA, José Américo Bacchi; SOBRADO, Lucas Faraco; GUZELA, Vivian Regina; NAHAS, Sérgio Carlos; CECCONELLO, IvanABSTRACT Objective: to evaluate the long-term results of the correction of chronic anal fissures (CAF) in patients without anal hypertonia using the technique of anoplasty with skin tag flap. Methods: we conducted a prospective study of CAF patients refractory to conservative treatment without anal hypertonia, subjected to anoplasty with the use of anal plicoma to cover the bloody area. We confirmed the absence of anal hypertonia through rectal exam and electromanometry. We applied a visual pain questionnaire and the Cleveland Clinic fecal incontinence score before and after surgery. Results: we followed 15 patients with chronic anal fissure for a mean period of 29 months (12-56). The mean age was 41 years (29-69) and the duration of symptoms ranged from six months to five years. Healing occurred between three and six weeks for 13 patients (86.7%). The other two patients underwent debridement and new anoplasty successfully. No plicoma necrosis or anal stenosis occurred in any patient. The anal incontinence score did not change after the procedure, and all patients reported reduced pain. After 12 months of follow-up, none of the patients presented recurrence or anal incontinence, and 93.3% (14/15) of the patients were very satisfied. Conclusion: fissurectomy and anoplasty with the use of sentinel plie is a safe technique that results in improvement in pain without change of fecal continence and with high satisfaction rates.
conferenceObject Low Doses of Ranolazine and Dronedarone in Combination Exert Potent Protection against Atrial Fibrillation and Vulnerability to Ventricular Arrhythmias during Acute Myocardial Ischemia(2012) VERRIER, Richard L.; PAGOTTO, Vitor P.; KANAS, Alexandre F.; SOBRADO, Marcel F.; NEARING, Bruce D.; ZENG, Dewan; BELARDINELLI, Luiz- A NEW APPROACH FOR HEMORRHOID DISEASE: SELECTIVE DEARTERIALIZATION AND MUCOPEXY WITHOUT DOPPLER GUIDANCE(2021) SOBRADO, Carlos Walter; SOBRADO, Lucas Faraco; NAHAS, Sergio Carlos; CECCONELLO, IvanBackground: Transanal hemorrhoidal dearterialization (THD) is safe and effective minimally invasive treatment for hemorrhoidal disease, but reports regarding recurrence and postoperative complications (pain and tenesmus) vary significantly. Aim: To evaluate if selective dearterialization and mucopexy at the symptomatic hemorrhoid only, without Doppler guidance, achieves adequate control of the prolapse and bleeding and if postoperative morbidity is reduced with this technique. Methods: Twenty consecutive patients with grade II and III hemorrhoids were treated with this new approach and were evaluated for postoperative complications and recurrence. Results: Control of prolapse and bleeding was achieved in all patients (n=20). Postoperative complications were tenesmus (n=2), external hemorrhoidal thrombosis (n=2) and urinary retention (n=2). After a mean follow-up of 13 months no recurrences were diagnosed. Conclusion: Selective dearterialization and mucopexy is safe and achieves adequate control of prolapse and bleeding and, by minimizing sutures in the anal canal, postoperative morbidity is diminished. Doppler probe is unnecessary for this procedure, which makes it also more interesting from an economic perspective.