ALEXANDRE FOGACA CRISTANTE
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Ortopediae Traumatologia, Faculdade de Medicina - Docente
LIM/41 - Laboratório de Investigação Médica do Sistema Músculoesquelético, Hospital das Clínicas, Faculdade de Medicina
LIM/41 - Laboratório de Investigação Médica do Sistema Músculoesquelético, Hospital das Clínicas, Faculdade de Medicina
117 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 117
- PROFILE OF SPINAL CORD TRAUMA VICTIMS TREATED AT A REFERENCE UNIT IN SÃO PAULO(2018) ARAUJO, ALEX OLIVEIRA DE; FERRONATO, DANILO DE SOUZA; ROCHA, IVAN DIAS DA; MARCON, RAPHAEL MARTUS; CRISTANTE, ALEXANDRE FOGAÇA; BARROS FILHO, TARCÍSIO ELOY PESSOA DEABSTRACT Introduction: Spinal cord trauma (SCT) is an important cause of morbidity and mortality around the world. It affects different age groups, especially young adults who are victims of high-energy trauma. The most effective way to reduce the incidence of spinal cord trauma and its consequences is through preventive campaigns and control and surveillance measures through public agencies. The objective of this study is to outline the epidemiological profile of patients with spinal cord trauma attended at a tertiary care center in the city of São Paulo. Methods: Retrospective, cross-sectional study performed at a reference center for the care of patients with spinal cord injury in the State of São Paulo. Data were collected from the medical records of patients with spinal cord trauma between 2012 and 2016. Results: Of the 515 patients with spinal trauma, 153 (29.7%) had spinal cord injury of which 131 (85.62%) were male, and 22 (14.37%) were female, in a ratio of approximately 6:1. The mean age was 39.45 years. The main cause of spinal cord trauma observed was the fall from heights, with 72 cases (47.05%), and 52.94% were classified as Frankel A. Conclusions: The results showed that the majority of the patients were young, economically active, with low educational level, exposed to accidents that could be largely avoided. Most of these patients also had severe disabling injuries, which usually bring considerable psychological sequelae and economic consequences to the individual and to society. Level of evidence: IV. Type of study: Case series.
- Feasibility of Intralaminar, Lateral Mass, or Pedicle Axis Vertebra Screws in Children Under 10 Years of Age: A Tomographic Study(2012) CRISTANTE, Alexandre Fogaca; TORELLI, Alessandro Gonzalez; KOHLMANN, Rafael Bellucci; ROCHA, Ivan Dias da; BIRAGHI, Olavo Letaif; IUTAKA, Alexandre Sadao; MARCON, Raphael Martus; OLIVEIRA, Reginaldo Perilo; BARROS FILHO, Tarcisio Eloy Pessoa deBACKGROUND: There are several techniques for screw insertion in upper cervical spine surgery, and the use of the 3.5-mm screw is usually the standard. However, there is no consensus regarding the feasibility of using these screws in the pediatric population. OBJECTIVE: To determine the measurement of the lamina angle, lamina and pedicle length and thickness, and lateral mass length of the topographic axial view of the axis vertebra of 2- to 10-year-old children to guide the use of surgical screws. METHODS: Seventy-five computed tomography scans from 24- to 120-month-old patients were studied. Measurements were taken in an axial view of C2 and correlated with 2 age groups and both sexes. Statistical analysis was performed with the Student t test. RESULTS: In the 24- to 48-month age group, only 5.5% of the lamina and 8.3% of the pedicles had thicknesses < 3.5 mm. In the 49- to 120-month age group, there were no lamina thickness values < 3.5 mm, and 1.2% of pedicle thicknesses were < 3.5 mm. Both age groups had no lamina and pedicle lengths < 12 mm and no lateral mass lengths > 12 mm. CONCLUSION: In the majority of cases, the use of 3.5-mm lamina and pedicle screws in children is feasible. A base value of 45 degrees for the spinolaminar angle can be adopted as a reference for insertion of screws in the C2 lamina. This information can be particularly useful for decision making during preoperative planning for C1-C2 or craniocervical arthrodesis in children.
- RADIATION EXPOSURE DURING SPINE SURGERY USING C-ARM FLUOROSCOPY(2019) CRISTANTE, Alexandre Fogaca; BARBIERI, Fabio; SILVA, Almy Anacleto Rodrigues da; DELLAMANO, Jose ClaudioObjective: To evaluate the radiation dose received by staff in spine surgeries, including those who are not considered occupationally exposed workers. Methods: All spinal surgeries performed in the same department during a period of 12 months were evaluated with regard to the exposure of surgeons, scrub nurses, and auxiliary personnel working in the operating room to radiation from C-arm fluoroscopy. Radiation was measured by 15 film badge dosimeters placed on the professionals' lapels, gloves, and room standardized sites. The films were analyzed in the dosimetry laboratory by collections per period. Results: During the 12 months, 81 spinal surgeries were performed by the same team, with surgical times ranging from 1 to 6 hours. The total radiation dose ranged from 0.16 mSv to 2.29 mSv depending on the dosimetry site. The most exposed site was the wrist of the main surgeon. Conclusion: The results showed that in the spinal surgeries in our setting, the radiation doses are low and within legal limits. Nevertheless, constant training of professionals is essential for radiation protection of medical staff and patients. Level of evidence I/b, exploratory cohort study.
- Pain inhibition through transplantation of fetal neuronal progenitors into the injured spinal cord in rats(2019) BATISTA, Chary M.; MARIANO, Eric D.; DALE, Camila S.; CRISTANTE, Alexandre F.; BRITTO, Luiz R.; OTOCH, Jose P.; TEIXEIRA, Manoel J.; MORGALLA, Matthias; LEPSKI, GuilhermeNeuropathic pain after spinal cord injury (SCI) is a complex condition that responds poorly to usual treatments. Cell transplantation represents a promising therapy; nevertheless, the ideal cell type in terms of neurogenic potential and effectiveness against pain remains largely controversial. Here, we evaluated the ability of fetal neural stem cells (fNSC) to relieve chronic pain and, secondarily, their effects on motor recovery. Adult Wistar rats with traumatic SCI were treated, 10 days after injury, with intra-spinal injections of culture medium (sham) or fNSCs extracted from telencephalic vesicles (TV group) or the ventral medulla (VM group) of E/14 embryos. Sensory (von Frey filaments and hot plate) and motor (the Basso, Beattie, Bresnahan locomotor rating scale and inclined plane test) assessments were performed during 8 weeks. Thereafter, spinal cords were processed for immunofluorescence and transplanted cells were quantified by stereology. The results showed improvement of thermal hyperalgesia in the TV and VM groups at 4 and 5 weeks after transplantation, respectively. Moreover, mechanical allodynia improved in both the TV and VM groups at 8 weeks. No significant motor recovery was observed in the TV or VM groups compared with sham. Stereological analyses showed that similar to 70% of TV and VM cells differentiated into NeuN(+) neurons, with a high proportion of enkephalinergic and GABAergic cells in the TV group and enkephalinergic and serotoninergic cells in the VM group. Our study suggests that neuronal precursors from TV and VM, once implanted into the injured spinal cord, maturate into different neuronal subtypes, mainly GABAergic, serotoninergic, and enkephalinergic, and all subtypes alleviate pain, despite no significant motor recovery. The study was approved by the Animal Ethics Committee of the Medical School of the University of Sao Paulo (protocol number 033/14) on March 4, 2016.
- Consensus of Clinical Neurorestorative Progress in Patients With Complete Chronic Spinal Cord Injury(2014) HUANG, Hongyun; SUN, Tiansheng; CHEN, Lin; MOVIGLIA, Gustavo; CHERNYKH, Elena; WILD, Klaus von; DEDA, Haluk; KANG, Kyung-Sun; KUMAR, Anand; JEON, Sang Ryong; ZHANG, Shaocheng; BRUNELLI, Giorgio; BOHBOT, Albert; SOLER, Maria Dolors; LI, Jianjun; CRISTANTE, Alexandre Fogaca; XI, Haitao; ONOSE, Gelu; KERN, Helmut; CARRARO, Ugo; SABERI, Hooshang; SHARMA, Hari Shanker; SHARMA, Alok; HE, Xijing; MURESANU, Dafin; FENG, Shiqing; OTOM, Ali; WANG, Dajue; IWATSU, Koichi; LU, Jike; AL-ZOUBI, AdeebCurrently, there is a lack of effective therapeutic methods to restore neurological function for chronic complete spinal cord injury (SCI) by conventional treatment. Neurorestorative strategies with positive preclinical results have been translated to the clinic, and some patients have gotten benefits and their quality of life has improved. These strategies include cell therapy, neurostimulation or neuromodulation, neuroprosthesis, neurotization or nerve bridging, and neurorehabilitation. The aim of this consensus by 31 experts from 20 countries is to show the objective evidence of clinical neurorestoration for chronic complete SCI by the mentioned neurorestorative strategies. Complete chronic SCI patients are no longer told, ""nothing can be done."" The clinical translation of more effective preclinical neurorestorative strategies should be encouraged as fast as possible in order to benefit patients with incurable CNS diseases. This manuscript is published as part of the International Association of Neurorestoratology (IANR) special issue of Cell Transplantation.
- Effects of estrogen on functional and neurological recovery after spinal cord injury: An experimental study with rats(2015) LETAIF, Olavo Biraghi; CRISTANTE, Alexandre Fogaca; BARROS FILHO, Tarcisio Eloy Pessoa de; FERREIRA, Ricardo; SANTOS, Gustavo Bispo dos; ROCHA, Ivan Dias da; MARCON, Raphael MartusOBJECTIVES: To evaluate the functional and histological effects of estrogen as a neuroprotective agent after a standard experimentally induced spinal cord lesion. METHODS: In this experimental study, 20 male Wistar rats were divided into two groups: one group with rats undergoing spinal cord injury (SCI) at T10 and receiving estrogen therapy with 17-beta estradiol (4mg/kg) immediately following the injury and after the placement of skin sutures and a control group with rats only subjected to SCI. A moderate standard experimentally induced SCI was produced using a computerized device that dropped a weight on the rat's spine from a height of 12.5 mm. Functional recovery was verified with the Basso, Beattie and Bresnahan scale on the 2nd, 7th, 14th, 21st, 28th, 35th and 42nd days after injury and by quantifying the motor-evoked potential on the 42nd day after injury. Histopathological evaluation of the SCI area was performed after euthanasia on the 42nd day. RESULTS: The experimental group showed a significantly greater functional improvement from the 28th to the 42nd day of observation compared to the control group. The experimental group showed statistically significant improvements in the motor-evoked potential compared with the control group. The results of pathological histomorphometry evaluations showed a better neurological recovery in the experimental group, with respect to the proportion and diameter of the quantified nerve fibers. CONCLUSIONS: Estrogen administration provided benefits in neurological and functional motor recovery in rats with SCI beginning at the 28th day after injury.
- Characterization of traumatic spinal cord injury model in relation to neuropathic pain in the rat(2019) BATISTA, Chary Marquez; MARIANO, Eric Domingos; ONUCHIC, Fernando; DALE, Camila Squarzoni; SANTOS, Gustavo Bispo dos; CRISTANTE, Alexandre Fogaca; OTOCH, Jose Pinhata; TEIXEIR, Manoel Jacobsen; MORGALLA, Matthias; LEPSKI, GuilhermePurpose/aim: Neuropathic pain following spinal cord injury (SCI) has a tremendous impact on patient's quality of life, and frequently is the most limiting aspect of the disease. In view of the severity of this condition and the absence of effective treatments, the establishment of a reliable animal model that reproduces neuropathic pain after injury is crucial for a better understanding of the pathophysiology and for the development of new therapeutic strategies. Thus, the objective of the present study was to standardize the traumatic SCI model in relation to neuropathic pain.Materials and methods: Wistar rats were submitted to SCI of mild intensity (pendulum height 12.5mm) or moderate intensity (pendulum height 25mm) using the New York University Impactor equipment. Behavioural assessment was performed during 8weeks. Thereafter, spinal cords were processed for immunohistochemistry.Results: The animals of the moderate injury group in comparison with mild injury had a greater motor function deficit, worse mechanical allodynia, and latter bladder recovery; moreover, histological analysis revealed more extensive lesions with lower neuronal population.Conclusions: Our study suggests that moderate SCI causes a progressive and long-lasting painful condition (at least 8weeks), in addition to motor impairment, and thus represents a reliable animal model for the study of chronic neuropathic pain after SCI.
- Fraturas do côndilo occipital: atualização da experiência em nosso serviço e revisão da literatura(2013) NORONHA, Henrique Gomes; LETAIF, Olavo Biraghi; ROCHA, Ivan Dias da; IUTAKA, Alexandre Sadao; CRISTANTE, Alexandre Fogaça; OLIVEIRA, Reginaldo Perilo de; BARROS FILHO, Tarcísio Eloy Pessoa deWe present a series of occipital condyle fractures diagnosed and treated in our hospital during the past 10 years. The present study continues an epidemiologic survey already performed in the period 1993-2000. From 2001 to 2011, six cases of fracture of the occipital condyle were diagnosed and all of them were treated conservatively, except one, in which a halo was initially placed. In the five cases treated conservatively, there were good results, with stable segment in functional radiographs, absence of limitation of motion and no pain. The patient treated with halo had FRANKEL C partial quadriplegia and associated fractures (C5, C6, L1, and L2), showing no neurological improvement, besides observing cervical motion limitation. We also highlight the importance of active research on lesions in the occipital-cervical transition, particularly in cases resulting from high-energy trauma, because in addition to the clinical implications of early detection of fracture, the best use of ancillary tests have been an important factor for the increased incidence of fractures of the occipital condyle. As is historically reported, conservative treatment is still effective and has a low rate of complications, and surgical treatment should be indicated in cases with established instability.
- TOMOGRAPHIC STUDY OF THE S2-ALAR-ILIAC SCREW TECHNIQUE IN BRAZILIAN MEN(2019) SOMBRA, LUIS PIMENTEL; SILVA, RICARDO TEIXEIRA E; ARAÚJO, THIEGO PEDRO FREITAS; BIRAGHI, OLAVO LETAIF; MARCON, RAPHAEL MARTUS; CRISTANTE, ALEXANDRE FOGAÇA; BARROS FILHO, TARCÍSIO ELOY PESSOA DEABSTRACT Objective The use of pedicle screws was a milestone for modern spinal surgery. This type of fixation, due to its superior biomechanics, gave greater fixation power, greater capacity to withstand the pulling forces and, therefore, greater stability and lower rates of pseudoarthrosis. Fixation of the lumbosacral junction, even with the development of these new implants, remains a challenge mainly because the considerable rates of pseudoarthrosis. The use of iliac screws solves the biomechanical difficulties. However, its use shows high rates of surgical wound problems. The S2-Alar-Iliac screw (S2AI) came as a solution to these complications. The lack of studies about anatomical and anthropometric parameters in the Brazilian population justifies the study. Methods Eleven hip tomographies of Brazilian adult males were analyzed by four evaluators. The right and left sides were considered. In each patient, measurements were made of greater and shorter bone length, greater and smaller bone diameter, distance from the entry point to the skin, sagittal and axial angles related to the hypothetical insertion of an S2AI screw and compared to the same measurements obtained with the iliac screw. Results The mean bone length was 136.7 mm, the greatest bone diameter was 24.8 mm, the smallest bone diameter was 19.7 mm and the distance from the screw to the skin was 42.1 mm for the S2AI screw. Conclusions The obtained data present an average of the sample that can be useful in the decision of the surgical technique in the studied group. Level of evidence I; Diagnostic Studies (Anatomical Investigation).
- High dose image-guided, intensity modulated radiation therapy (IG-IMRT) for chordomas of the sacrum, mobile spine and skull base: preliminary outcomes(2022) CHEN, Andre Tsin Chih; HONG, Carlos Bo Chur; NARAZAKI, Douglas Kenji; RUBIN, Virginio; SERANTE, Alexandre Ruggieri; RIBEIRO JUNIOR, Ulysses; LIMA, Luiz Guilherme Cernaglia Aureliano de; COIMBRA, Brian Guilherme Monteiro Marta; CRISTANTE, Alexandre Fogaca; TEIXEIRA, William Gemio JacobsenPurpose To report preliminary outcomes of high dose image-guided intensity modulated radiotherapy (IG-IMRT) in the treatment of chordomas of the sacrum, mobile spine and skull base. Methods Retrospective analysis of chordoma patients treated with surgery and/or radiotherapy (RT) in a single tertiary cancer center. Initial treatment was categorized as (A) Adjuvant or definitive high-dose RT (78 Gy/39fx or 24 Gy/1fx) vs (B) surgery-only or low dose RT. The primary endpoint was the cumulative incidence of local failure. Results A total of 31 patients were treated from 2010 through 2020. Median age was 55 years, tumor location was 64% sacrum, 13% lumbar, 16% cervical and 6% clivus. Median tumor volume was 148 cc (8.3 cm in largest diameter), 42% of patients received curative-intent surgery and 65% received primary RT (adjuvant or definitive). 5-year cumulative incidence of local failure was 48% in group A vs 83% in group B (p = 0.041). Tumor size > 330 cc was associated with local failure (SHR 2.2, 95% CI 1.12 to 7.45; p = 0.028). Eight patients developed distant metastases, with a median metastases-free survival of 56.1 months. 5-year survival for patients that received high dose RT was 72% vs 76% in patients that received no or low dose RT (p = 0.63). Conclusion Our study suggests high-dose photon IG-IMRT improves local control in the initial management of chordomas. Health systems should promote reference centers with clinical expertise and technical capabilities to improve outcomes for this complex disease.