GUILHERME DE ARRUDA CUADRADO
Projetos de Pesquisa
Unidades Organizacionais
LIM/02 - Laboratório de Anatomia Médico-Cirúrgica, Hospital das Clínicas, Faculdade de Medicina
6 resultados
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conferenceObject Lymph Drainage of the Upper Limb and Mammary Region to the Mille. Anatomical Study in Stillbirths(2015) CUADRADO, Guilherme; ANDRADE, Mauro; AKAMATSU, Flavia; JACOMO, Alfredo- Lymph drainage of the upper limb and mammary region to the axilla: anatomical study in stillborns(2018) CUADRADO, Guilherme de Arruda; ANDRADE, Mauro Figueiredo Carvalho de; AKAMATSU, Flavia Emi; JACOMO, Alfredo LuizPurpose We studied the lymphatic drainage of the upper limb and mammary region directing to the axilla to investigate whether independent pathways can be observed or whether anastomoses and shared drainage occur between them. This analysis aimed to assess the safety of axillary reverse mapping (ARM) in breast cancer treatment and to understand the development of lymphedema after sentinel lymph node biopsy (SLNB) alone. Methods Seven unfixed stillborn fetuses were injected with a modified Gerota mass in the peri-areolar area, palm and dorsum of the hands, formalin fixed, and then submerged in 10% hydrogen peroxide solution. Microsurgical dissection was then performed on the subcutaneous cellular tissue of the upper limb, axillary region, and anterior thorax to expose the lymphatic vessels and lymph nodes. Results The dye injected into the upper limb reached either the lateral axillary group, known to be exclusively responsible for upper limb drainage, or the anterior group, which is typically related to breast drainage. There was great proximity among the pathways and lymph nodes. Communicating lymphatic vessels among these groups of lymph nodes were also found in all studied cases. Discussion Lymphedema remains a challenging morbidity in breast cancer treatment. ARM and SLNB aim to avoid unnecessary damage to the lymphatic drainage of the upper limb. However, our anatomical study suggests that ARM may have potential oncological risks because preserved lymph nodes may harbor malignant cells due their proximity, overlapping drainage pathways, and connecting lymph vessels among lymph nodes.
article 3 Citação(ões) na Scopus Anatomy of the Lymphatic Drainage of the Upper Limb and Breast and its Role in Lymphedema Prevention after Breast Cancer Treatment(2016) CUADRADO, G. A.; ANDRADE, M. F. C.; AKAMATSU, F. E.; JACOMO, A. L.The surgical treatment of breast cancer has been enhanced throughout the years in order to offer oncologically safer and more effective results with lower esthetic impact and fewer sequelae. The lymphedema of the upper limb is still an iatrogenic result of great incidence and morbidity after this treatment. A possible existence of independent breast and upper limb lymphatic pathways has become the issue of many researchers willing to minimize its occurrence. This review aims to compare the lymphatic pathways in the axilla described by traditional anatomy books and recently published articles about Axillary Reverse Mapping (ARM). With this purpose, a comparative table was made with the descriptions found in books and articles, a statistic table of the data collected, a flowchart of anastomoses among nodes and an analytical drawing of the most statistically mentioned drained areas. It was observed that there is great variability in the descriptions of drainage and anastomoses among the lymph nodes in the references used, so there should be a consensus of a universal description which also assembles possible anatomical variations. Furthermore, the findings brought about by recent studies show possible anastomoses among pathways and lymph nodes, however they have not been taken into consideration when ARM was initially proposed. Therefore, the axillary resection with the preservation of the posterior and lateral axillary lymph nodes is theoretically possible to avoid lymphedema of the upper limb, but the development of an updated universal description that involves all possible anatomical variations will provide a safer and more effective treatment.- Aneurysm of the Fibular Vein: A Case Report(2018) SALEH, Samir Omar; ANDRADE, Mauro Figueired Carvalho de; CUADRADO, Guilherme de Arruda; SALEH, Kassem Samir; AKAMATSU, Flavia Emi; JACOMO, Alfredo LuizBackground: Aneurysms of the deep veins of the lower limbs are rare and often asymptomatic. Although natural history is unclear, these aneurysms have been associated with deep venous thrombosis and fatal pulmonary embolism events. To our knowledge, this case represents the fifth patient with isolated aneurysm of a calf vein described in the literature and the second one affecting the fibular vein. Methods: We report the case of a 20-year-old white man with an aneurysm of the fibular vein that we believe is the second case in the literature Results: After evaluation and diagnosis, the aneurysm was resected with full recovery of the patient. Conclusions: Treatment of this unusual condition seems to be mandatory for major thromboembolic events can be as high as 71% with 2 deaths, according to a review of 24 patients with popliteal vein aneurysms. Unlike proximal veins, where reconstruction is advisable, calf vein aneurysms can be safely managed by simple excision and ligature. In our patient, aneurysm resection eliminated symptoms, and good result was maintained in long follow-up.
- Inflammation Precedes Fat Deposition in an Experimental Model of Lymphedema(2021) CUADRADO, Guilherme A.; ANDRADE, Mauro F. C. de; ARIGA, Suely K.; LIMA, Thais M. de; SOUZA, Heraldo P.Background: Chronic lymphedema is a common complication of lymphatic obstruction, particularly after cancer treatment, characterized by an increased volume of the affected extremity, partly caused by the accumulation of excessive adipose tissue. The relationship between lymph vessels' obstruction and fat deposit is, however, poorly understood. Objective: Our central hypothesis was that the inflammatory process caused by lymph stasis precedes the adipocyte differentiation and fat deposition. Methods and Results: We used a modified mouse tail model to produce secondary lymphedema. Animals were treated with dexamethasone, or the procedure was performed in nitric oxide synthase 2 (NOS2)-deficient mice to evaluate the role of inflammation in lymphedema formation. Adipose tissue (Lipin) and inflammatory markers (IL-6, MCP-1, and F4-80) were analyzed in histological samples and by quantitative polymerase chain reaction. We observed an increased deposition of fat into the affected area that starts 3 weeks after lymph vessel ligation; it further increased after 6 weeks. Genes involved in the inflammatory process were upregulated before adipocyte maturation. Treatment with dexamethasone or the use of inducible nitric oxide synthase knockout mice blocked the inflammatory reaction and inhibited the accumulation of fat distal to the lymphatic obstruction. Conclusion: In the modified mouse tail lymphedema, inflammation precedes adipogenesis. Our data suggest that MCP-1 and nitric oxide may be potential targets for lymphedema management.
article 2 Citação(ões) na Scopus A MODIFIED MOUSE-TAIL LYMPHEDEMA MODEL(2020) ARRUDA, G.; ARIGA, S.; LIMA, T. M. de; SOUZA, H. P.; ANDRADE, M.One of the main obstacles to studying the pathophysiology of lymphedema development is the lack of appropriate experimental models. Following up on a mouse-tail method that has been described, we performed changes to the method which made it easier to perform in our hands and demonstrated similar results. Twenty C57Black mice were operated on using the previous technique and euthanized after 3 or 6 weeks. Another twenty mice were submitted to the new technique developed in our laboratory and euthanized at the same time points. Tissue samples were collected from the proximal part of the tail (control) and from the distal part (lymphedema) for both models. Animals in both operative groups developed marked edema in the distal part of the tail. This was characterized by lymph vessels dilation, edema, inflammatory cell infiltration, and adipose tissue deposition. Lymphedema was detected after 3 weeks in both models, reaching its maximum after 6 weeks. Adipocytes detected by histology (Oil red O staining) and molecular markers for adipogenesis, lymphangiogenesis and inflammation (lipin 1 and 2, SLP76, and F4-80) were demonstrated to be increased equally in both models. In conclusion, both models provide a reliable method to study lymphedema pathophysiology. However; our modified technique is easier and faster to perform while still providing reliable and consistent results.