MARCOS DE LORENZO MESSINA
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/58 - Laboratório de Ginecologia Estrutural e Molecular, Hospital das Clínicas, Faculdade de Medicina
LIM/58 - Laboratório de Ginecologia Estrutural e Molecular, Hospital das Clínicas, Faculdade de Medicina
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bookPart Embolização do mioma uterino (EMUT)(2016) MESSINA, Marcos de Lorenzo; ZLOTNIK, Eduardo; PEREGRINO, Pedro Felipe Magalhães; BOZZINI, Nilo; BARACAT, Edmund ChadabookPart Ultrassom de alta intensidade no tratamento do leiomioma uterino (HIFU)(2016) PEREGRINO, Pedro Felipe Magalhães; MESSINA, Marcos de Lorenzo; BOZZINI, Nilo; JúNIOR, José Maria Soares; BARACAT, Edmund Chada- Predictive factors for pelvic magnetic resonance in response to arterial embolization of a uterine leiomyoma(2014) ZLOTNIK, Eduardo; DE LORENZO MESSINA, Marcos; NASSER, Felipe; AFFONSO, Breno Boueri; BARONI, Ronaldo Hueb; WOLOSKER, Nelson; BARACAT, Edmund ChadaOBJECTIVE: Minimally invasive methods are used as alternatives to treat leiomyomas and include uterine artery embolization, which has emerged as a safe, effective method. This study aims to evaluate the magnetic resonance imaging predictors for a reduction in leiomyoma volume in patients undergoing uterine artery embolization. METHODS: This prospective longitudinal study was performed at a university hospital. We followed 50 symptomatic premenopausal women with uterine leiomyomas who underwent uterine artery embolization. We examined 179 leiomyomas among these patients. Magnetic resonance imaging was performed one month before and six months after uterine artery embolization. Two radiologists who specialized in abdominal imaging independently interpreted the images. Main Outcome Measures: The magnetic resonance imaging parameters were the uterus and leiomyomas volumes, their localizations, contrast perfusion pattern and node-to-muscle ratio. RESULTS: Six months after treatment, the average uterine volume reduction was 38.91%, and the leiomyomas were reduced by 55.23%. When the leiomyomas were submucosal and/or had a higher node-to-muscle ratio in the T2 images, the volume reduction was even greater (greater than 50%). Other parameters showed no association. CONCLUSIONS: We conclude that symptomatic uterine leiomyomas in patients undergoing uterine artery embolization exhibit volume reductions greater than 50% by magnetic resonance imaging when the leiomyomas are submucosal and/or had a high node-to-muscle ratio in the T2 images.
- Review of magnetic resonance-guided focused ultrasound in the treatment of uterine fibroids(2017) PEREGRINO, Pedro Felipe Magalhaes; MESSINA, Marcos de Lorenzo; SIMOES, Ricardo dos Santos; SOARES-JUNIOR, Jose Maria; BARACAT, Edmund ChadaUterine leiomyoma is the most frequently occurring solid pelvic tumor in women during the reproductive period. Magnetic resonance-guided high-intensity focused ultrasound is a promising technique for decreasing menorrhagia and dysmenorrhea in symptomatic women. The aim of this study is to review the role of Magnetic resonance-guided high-intensity focused ultrasound in the treatment of uterine fibroids in symptomatic patients. We performed a review of the MEDLINE and Cochrane databases up to April 2016. The analysis and data collection were performed using the following keywords: Leiomyoma, High-Intensity Focused Ultrasound Ablation, Ultrasonography, Magnetic Resonance Imaging, Menorrhagia. Two reviewers independently performed a quality assessment; when there was a disagreement, a third reviewer was consulted. Nineteen studies of Magnetic resonance-guided high-intensity focused ultrasound-treated fibroid patients were selected. The data indicated that tumor size was reduced and that symptoms were improved after treatment. There were few adverse effects, and they were not severe. Some studies have reported that in some cases, additional sessions of Magnetic resonance-guided high-intensity focused ultrasound or other interventions, such as myomectomy, uterine artery embolization or even hysterectomy, were necessary. This review suggests that Magnetic resonance-guided high-intensity focused ultrasound is a safe and effective technique. However, additional evidence from future studies will be required before the technique can be recommended as an alternative treatment for fibroids.
- Safety, efficacy, and prognostic factors in endovascular treatment of pelvic congestion syndrome(2014) NASSER, Felipe; CAVALCANTE, Rafael N.; AFFONSO, Breno B.; MESSINA, Marcos L.; CARNEVALE, Francisco C.; GREGORIO, Miguel A. deObjective: To evaluate the safety and effectiveness of transcatheter embolization using coils for treatment of pelvic congestion syndrome (PCS) and to elucidate prognostic factors for clinical success. Methods: Data were retrospectively analyzed from 113 women with PCS who underwent endovascular embolization of ovarian and pelvic varicose veins at Hospital Clinic Universitario, Zaragoza, Spain between January 2001 and January 2011. Pain score was evaluated before and after the procedure via a visual analog scale (VAS). Associated symptoms (dysmenorrhea, dyspareunia, urinary urgency, and lower limb symptoms) were also evaluated. Patients were followed up for 12 months. Results: The technical and clinical success was 100%. At 12 months, 53% of patients had no pelvic pain and 47% reported a reduction in pelvic pain. The average VAS was 7.34 before the procedure and 0.47 at 12 months. Complete relief of pain and associated symptoms was achieved for 37% of patients. Urinary urgency, lower limb symptoms, and vulvar and lower limbs varicosities were prognostic factors related to incomplete treatment success. The global complication rate was low (5/113,4.4%). Conclusion: Transcatheter embolization was a safe and effective treatment for PCS. Lower limb symptoms, urinary urgency, and varicosities were associated with incomplete clinical success.
- Revisao de 15 casos submetidos a oclusao temporaria bilateral de arteria iliaca interna em pacientes com alto risco para hemorragia obstetrica(2013) KRUTMAN, Mariana; GALASTRI, Francisco Leonardo; AFFONSO, Breno Boueri; NASSER, Felipe; TRAVASSOS, Fabiellen Berzoini; MESSINA, Marcos de Lourenco; WOLOSKER, NelsonOBJECTIVE: To analyze the results of 15 cases of patients at high risk of obstetric hemorrhage who underwent prophylactic temporary occlusion of internal iliac arteries. METHODS: A retrospective analysis was performed of the medical records of 15 patients who underwent prophylactic balloon occlusion of the internal iliac arteries between January 2008 and December 2011. All patients included in the study were diagnosed antenatally with a placental disease associated with a high risk of obstetric hemorrhage. RESULTS: The mean age of the patients studied was 36 years (32-42 years). Nine patients had placenta accreta, 4 had placenta previa, 1 had an ectopic pregnancy and 1 had uterine fibroids and coagulopathy associated with systemic lupus erythematous. The total volume of contrast used in each procedure ranged from 20 to 160 ml (mean 84 ml). The average total number of days in hospital and the average number of days in hospital after the procedure were 12.4 and 4.9 days respectively. In 8 (53%) cases there was no need for blood transfusion during surgery or after surgery. The mean number of units of blood transfused was 2.06. The only complication associated with the procedure was arterial thrombosis of the external iliac artery, observed in 2 cases. CONCLUSION: Temporary occlusion of hypogastric arteries is a safe and effective method for control of bleeding in patients at high risk of obstetric hemorrhage, when performed by experienced staff. The results of this study are observational, retrospective and nonrandomized, therefore we cannot support the routine use of this technique, however, we can include it our arsenal to treat selected cases with potentially unstable hemodynamics.
bookPart Leiomioma uterino: diagnóstico(2016) ARAZAWA, Lilian Renata Fiorelli; NARDE, Ivy; MESSINA, Marcos de Lorenzo; BOZZINI, NilobookPart Leiomioma Uterino(2016) MESSINA, Marcos de Lorenzo; PEREGRINO, Pedro Felipe Magalhães; JúNIOR, José Maria Soares; BOZZINI, Nilo; BARACAT, Edmund Chada- Controlled-release oxycodone improves pain management after uterine artery embolisation for symptomatic fibroids(2017) FREIRE, G. M. G.; CAVALCANTE, R. N.; MOTTA-LEAL-FILHO, J. M.; MESSINA, M.; GALASTRI, F. L.; AFFONSO, B. B.; ROCHA, R. D.; NASSER, F.AIM: To evaluate if pre-and post-procedure administration of controlled-release oxycodone (CRO) in combination with standard analgesia improves pain control and decreases the amount of required post-procedure opioids in uterine fibroid embolisation (UFE). MATERIALS AND METHODS: Between January 2009 and March 2010, 60 consecutive women were prospectively randomised in two groups for UFE: the control group, in which 30 patients underwent the standard anaesthetic procedure and the CRO group, in which 30 patients underwent the standard anaesthetic procedure with the addition of CRO. Age, pain, nausea/ vomiting, fibroid volume, length of hospital stay, and use and dose of morphine received via the patient-controlled analgesia (PCA) device in both groups were evaluated to compare the two methods of pain control. Fibroid volume as measured at magnetic resonance imaging (MRI) was evaluated for correlation with post-embolisation pelvic pain over a period of 24 hours. RESULTS: A significant difference was seen in the pain scores at 24 hours (p = 0.029), with less pain in the CRO group. More patients from the control group required morphine (p = 0.017), and at higher levels (p = 0.130). Pruritus was lower in patients of the CRO group, probably because they received less morphine (p = 0.029). No correlation was seen between leiomyoma volume and pain levels over 24 hours (Spearman's r = 0.02; p = 0.881). Length of hospital stay was not different between the two groups. CONCLUSION: The addition of CRO to standard analgesia for UFE provides more effective analgesia, with a reduction in pain scores in 24 hours, less morphine use, and decreased side effects, mainly pruritus.