SERGIO SAMIR ARAP
Projetos de Pesquisa
Unidades Organizacionais
LIM/28 - Laboratório de Cirurgia Vascular e da Cabeça e Pescoço, Hospital das Clínicas, Faculdade de Medicina
28 resultados
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Agora exibindo 1 - 10 de 28
- Could the Less-Than Subtotal Parathyroidectomy Be an Option for Treating Young Patients With Multiple Endocrine Neoplasia Type 1-Related Hyperparathyroidism?(2019) MONTENEGRO, Fabio Luiz de Menezes; BRESCIA, Manilla D'Elboux Guimaraes; JR, Delmar Muniz Lourenco; ARAP, Sergio Samir; D'ALESSANDRO, Andre Fernandes; SILVA FILHO, Gilberto de Britto e; TOLEDO, Sergio Pereira de AlmeidaBackground: The surgical treatment of primary hyperparathyroidism (HPT) in patients with multiple endocrine neoplasia type 1 (MEN1) has evolved due the concern of permanent hypoparathyroidism. As the diagnosis has increased, the extent of operation has decreased. Most MEN1 patients requiring parathyroidectomy are younger than 50 years and they pose a difficult balance to achieve between persistent HPT and life-long hypoparathyroidism. The aim of the present study is to review our experience with a large series of patients with MEN1-related HPT (HPT/MEN1) treated at a single institution in order to find clues to a better treatment decision in these younger cases. Method: Retrospective analysis of consecutive HPT/MEN1 cases treated at a single institution with different operations: total parathyroidectomy and immediate forearm autograft (TPTX-AG), subtotal (STPTX), unintentional less than subtotal (U-LSTPTX) and intentional less than subtotal parathyroidectomy (I-LSTPTX). Results: Considering 84 initial cases operated on since 2011 (TPTX-AG, 39; STPTX, 22, U-LSTPTX, 13, and I-LSTPTX, 10), the rates of hypoparathyroidism were 30.8% (U-LSTPTX), 28.2% (TPTX-AG), 13.6% (STPTX), and 0% (I-LSTPTX). Two-thirds of them (68%; 57/84) were young (< 50 years) or asdolescents. MIBI scan was more sensitive to show parathyroid glands and bilateral disease. Considering the concordance of MIBI and ultrasound for the possibility of unilateral clearance, it would be suitable to 22.6% of the cases. Intra-operative parathormone showed a significant decay even after unilateral exploration, but longer follow up is necessary. Overall, there were seven (4%) adolescents in 161 cases treated from 1987 to 2018, three underwent TPTX-AG and four had U-LSTPTX. Five are euparathyroid, one had mild recurrence, and one required a reoperation after 8 years due to the residual gland. Conclusions: Young patients are the most frequent candidates to parathyroidectomy. Less extensive procedures may be planned only if carefully reviewed preoperative imaging studies suggest a localized disease. Patients and their relatives should be fully informed of the risks and benefits during consent process. Future research with larger cohorts and long-term results are necessary to clarify if less than I-LSPTX or unilateral clearance are really adequate in selected groups of patients with HPT/MEN1 presenting lower volume of disease detected by preoperative imaging studies.
- Time to Recurrence as a Prognostic Factor in Parathyroid Carcinoma(2023) MAGNABOSCO, Felipe Ferraz; BRESCIA, Marilia D'Elboux Guimaraes; NASCIMENTO JUNIOR, Climerio Pereira; MASSONI NETO, Ledo Mazzei; ARAP, Sergio Samir; CASTRO JUNIOR, Gilberto de; LEDESMA, Felipe Lourenco; ALVES, Venancio Avancini Ferreira; KOWALSKI, Luiz Paulo; MARTIN, Regina Matsunaga; MONTENEGRO, Fabio Luiz de MenezesBackground Parathyroid carcinoma (PC) is a rare and challenging disease without clearly understood prognostic factors. Adequate management can improve outcomes. Characteristics of patients treated for PC over time and factors affecting prognosis were analyzed. Methods Retrospective cohort study including surgically treated patients for PC between 2000 and 2021. If malignancy was suspected, free-margin resection was performed. Demographic, clinical, laboratory, surgical, pathological, and follow-up characteristics were assessed. Results Seventeen patients were included. Mean tumor size was 32.5 mm, with 64.7% staged as pT1/pT2. None had lymph node involvement at admission, and 2 had distant metastases. Parathyroidectomy with ipsilateral thyroidectomy was performed in 82.2%. Mean postoperative calcium levels were different between patients who developed recurrence vs those who did not (P = .03). Six patients (40%) had no recurrence during follow-up, 2 (13.3%) only regional, 3 (20%) only distant, and 4 (26.6%) both regional and distant. At 5 and 10 years, 79% and 56% of patients were alive, respectively. Median disease-free survival was 70 months. Neither Tumor, Nodule, Metastasis system nor largest tumor dimension (P = .29 and P = .74, respectively) were predictive of death. En bloc resection was not superior to other surgical modalities (P = .97). Time between initial treatment and development of recurrence negatively impacted overall survival rate at 36 months (P = .01). Conclusion Patients with PC can survive for decades and have indolent disease course. Free margins seem to be the most important factor in initial surgery. Recurrence was common (60%), but patients with disease recurrence within 36 months of initial surgery had a lower survival rate.
- Successful parathyroid tissue autograft after 3 years of cryopreservation: a case report(2014) LEITE, Ana K. N.; JUNIOR, Climerio P. do N.; ARAP, Sergio S.; MASSONI, Ledo; LOURENCO, Delmar M.; BRANDAO, Lenine Garcia; MONTENEGRO, Fabio L. de M.After a total parathyroidectomy, well-established protocols for the cryopreservation of parathyroid tissue and for the delayed autograft of this tissue exist, especially in cases of secondary hiperparathyroidism (HPT) or familial or sporadic parathyroid hyperplasia. Although delayed autografts are effective, the published success rates vary from 10% to 83%. There are numerous factors that influence the viability, and therefore the success, of an autograft, including cryopreservation time. Certain authors believe that the tissue is only viable for 24 months, but there is no consensus on how long the parathyroid tissue can be preserved. A 63-year-old male who was diagnosed with sporadic multiple endocrine neoplasia type 1 and primary hyperparathyroidism, and was submitted to a total parathyroidectomy and an autograft in the forearm. The implant failed, and the patient developed severe hypoparathyroidism in the months following the surgery. Thirty-six months after the total parathyroidectomy, the cryopreserved autograft was successfully transplanted, and hypoparathyroidism was reversed (most recent systemic parathyroid hormone, PTH, of 36 pg/mL, and total calcium of 9.1 mg/dL; no oral calcium supplementation). The case presented here indicates that cryopreserved parathyroid tissue may remain viable after 24 months in storage, and may retain the capacity to reverse permanent postsurgical hypoparathyroidism. These data provide reasonable evidence that the time limit for cryopreservation remains undetermined and that additional research would be valuable.
bookPart Tireoidectomia por bócio simples(2012) FERRAZ, Alberto Rossetti; ARAP, Sérgio Samir; BRANDAO, Lenine Garcia- Transoral thyroidectomy: A reflexive opinion on the technique(2021) TINCANI, Alfio; LEHN, Carlos; CERNEA, Claudio; QUEIROZ, Emilson; DIAS, Fernando; WALDER, Fernando; HOJAIJ, Flavio; MONTEIRO, Francisco; KLIGERMAN, Jacob; PODESTA, Jose; BRANDAO, Lenine; MELLO, Luiz Eduardo Barbalho de; MEDINA, Luiz; ABRAHAO, Marcio; TAVARES, Marcos; BARBOSA, Mauro; CERVANTES, Onivaldo; DEMETRIO, Paula; CURIOSO, Ricardo; LIMA, Roberto; ARAP, Sergio; VASCONCELLOS, Sylvio
bookPart 0 Citação(ões) na Scopus When and how to performan open neck biopsy of a lateral cervical mass(2012) MICHALUART, P. Jr.; ARAP, S. S.- Functional Reconstruction of Temporomandibular Joint after Resection of Pigmented Villonodular Synovitis with Extension to Infratemporal Fossa and Skull Base: A Case Report(2016) VELLUTINI, Eduardo de Arnaldo Silva; ALONSO, Nivaldo; ARAP, Sergio Samir; GODOY, Luis Felipe Silva; SOUZA, Ricardo Antenor de Souza e; MATTEDI, Romulo Loss; OLIVEIRA, Matheus Fernandes deIntroduction Pigmented villonodular synovitis (PVNS) is a benign but aggressive lesion arising from sinovia. The temporomandibular joint (TMJ) is hardly ever involved. Methods We describe a case of PVNS arising in the left TMJ involving infratemporal fossa soft tissue and the skull base; we also present the reconstruction. Results A 37-year-old woman had progressive mandibular swelling for 6 months. Computed tomography of the skull revealed an osteolytic lesion in the left TMJ, involving the upper mandible, condyle, and glenoid fossa and extending to the infratemporal fossa and fossa media through a defect in temporal bone. Surgical management included a left pterional craniotomy to reach the temporal skull base and resect the intracranial tumor and a facial approach with partial leftmandibulectomy and resection of left condyle, glenoid fossa, and tumor removal in infratemporal fossa. Mandible function was restored with prosthetic reconstruction of the condyle. She progressively started to eat solid foods after 3 months, becoming increasingly functional and asymptomatic. At 30 months' follow-up, she had no sign of tumoral recurrence and showed asymptomatic and normal TMJ function. Conclusion PVNS should be considered in the differential diagnosis of bone neoplasms affecting young patients. In such cases, radical excision is mandatory and TMJ prosthesis for local reconstruction may be used to preserve functionality.
bookPart Hiperparatireoidismo(2021) MONTENEGRO, Fábio Luiz de Menezes; ARAP, Sérgio Samir- Response to the letter: Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA): Pioneers's Point of View(2021) TINCANI, Alfio; LEHN, Carlos; CERNEA, Claudio; QUEIROZ, Emilson; DIAS, Fernando; WALDER, Fernando; HOJAIJ, Flavio; MONTEIRO, Francisco; KLIGERMAN, Jacob; PODESTA, Jose; BRANDAO, Lenine; MELLO, Luiz Eduardo Barbalho de; MEDINA, Luiz; ABRAHAO, Marcio; TAVARES, Marcos; BARBOSA, Mauro; CERVANTES, Onivaldo; DEMETRIO, Paula; CURIOSO, Ricardo; LIMA, Roberto; ARAP, Sergio; VASCONCELLOS, Sylvio
- Green July 2020 and Another Good Reason to Quit Smoking: Help to Stop Spreading SARS-COV-2 and Save Lives!(2020) BRESCIA, Marilia D'Elboux Guimaraes; MONTENEGRO, Fabio Luiz de Menezes; ARAP, Sergio Samir; KULCSAR, Marco Aurelio Valmondes; TAVARES, Marcos Roberto; KOWALSKI, Luiz Paulo
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