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
6 resultados
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- 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.
- Effects of ganglioside GM1 and erythropoietin on spinal cord injury in mice: Functional and immunohistochemical assessments(2022) TORELLI, Alessandro Gonzalez; CRISTANTE, Alexandre Fogaca; BARROS-FILHO, Tarcisio Eloy Pessoa de; SANTOS, Gustavo Bispo dos; MORENA, Beatriz Cintra; CORREIA, Felipe Fernandes; PASCHON, VeraObjectives: To evaluate the functional and immunohistochemical effects of ganglioside GM1 and erythropoietin following experimental spinal cord injury. Methods: Thirty-two male BALB/c mice were subjected to experimental spinal cord injury using the NYU Impactor device and were randomly divided into the following groups: GM1 group, receiving standard ganglioside GM1 (30 mg/kg); erythropoietin group, receiving erythropoietin (1000 IU/kg); combination group, receiving both drugs; and control group, receiving saline (0.9%). Animals were evaluated according to the Basso Mouse Scale (BMS) and Hindlimb Mouse Function Score (MFS). After euthanasia, the immunohistochemistry of the medullary tissue of mice was analyzed. All animals received intraperitoneal treatment. Results: The GM1 group had higher BMS and MFS scores at the end of the experiment when compared to all other groups. The combination group had higher BMS and MFS scores than the erythropoietin and control groups. The erythropoietin group had higher BMS and MFS scores than the control group. Immunohistochemical tissue analysis showed a significant difference among groups. There was a significant increase in myelinated axons and in the myelinated axon length in the erythropoietin group when compared to the other intervention groups (p < 0.01). Conclusions: Erythropoietin and GM1 have therapeutic effects on axonal regeneration in mice subjected to experimental spinal cord injury, and administration of GM1 alone had the highest scores on the BMS and MFS scales.
- IMPACT OF THE COVID-19 PANDEMIC ON SPINE SURGERY IN A TERTIARY HEALTH CARE INSTITUTION(2022) JUNIOR, Mauro Costa Morais tavares; SILVA, Rafael Julio Garcia B. R. A. N. D. A. O. E.; MARCON, Raphael Martus; CRISTANTE, Alexandre Fogaca; FILHO, Tarcisio Eloy Pessoa de Barros; LETAIF, Olavo BiraghiObjectives: To assess postoperative complications, including COVID-19 infection, among patients undergoing surgeries at a tertiary institution during the pandemic, and to develop a local epidemiological profile of spine surgery patients. Methods: Ret-rospective descriptive study of all patients who underwent spine surgery between March 2020 and 14 January 2021 in a tertiary institution in Latin America. All patients who underwent spine sur-gery were included, without age restrictions. The main outcomes were postoperative complications, including COVID-19 infection. Results: 74 patients were included in the study, 43 males and 31 females. The average age was 49.6 years. The mean duration of hospitalization was 11.5 days. Urgent surgeries were performed in 60.81% of cases. During hospitalization, only 5 of 74 patients were diagnosed with COVID-19, and only 1 patient had pulmonary involvement estimated to be greater than 50%. On average, 1.9 surgical debridements were required after postoperative surgical site infection. Conclusions: During the hospitalization period, only 6.7% of patients were diagnosed with COVID-19 infection. The COVID-19 infection death rate was 1 in 5 cases. The postoperative surgical site infection rate was 10.8%, similar to the level before the pandemic. Level of Evidence IV; Observational retrospective descriptive study.
- Correlation between Scoliosis Flexibility Degree on Preoperative Imaging with Postoperative Curve Correction and Mechanical Complications(2022) TAVARES JUNIOR, Mauro Costa Morais; MARCON, Raphael Martus; CRISTANTE, Alexandre Fogaca; LETAIF, Olavo Biraghi(1) Background: In the preoperative planning stage of scoliosis surgery, it is routine to use radiographs obtained with and without traction to observe the curve flexibility in order to estimate curve correction, but its association with mechanical complications is not completely understood. (2) Methods: Retrospective cohort study of all patients undergoing infantile, congenital, neuromuscular or idiopathic adolescent scoliosis correction surgery at a single institution between 2015 and 2019, with a minimum follow-up of 24 months. Associations between qualitative variables were tested with the chi-square test. The association between qualitative and quantitative variables were tested with the Mann-Whitney test, and correlations between quantitative variables was tested with Spearman's correlation. (3) Results: A total of 330 patients, 88 males and 242 females, with a mean age of 16.98 years at surgery, were included. The mean value of preoperative main curves, its flexibility and postoperative value were 54.44 degrees, 21.73 degrees and 18.08 degrees, respectively. (4) Conclusions: Preoperative spinal X-ray examination with traction or bending films is a reasonable option for assessing scoliotic curve flexibility, and patients with neuromuscular scoliosis who are not ambulatory can be informed of the increased risks of late mechanical complications.
- Lumbar Interbody Fusion Surgeries: LIFS(2022) FERREIRA, R. J. R.; GONçALVES, M. V. M.; BORDINI, E. C.; CRISTANTE, A. F.The surgical techniques known as LIF (lumbar interbody fusion), LLIF (lateral), ALIF (anterior), OLIF (O), PLIF (posterior), and TLIF (transforaminal) consist of minimally invasive procedures. Numerous advantages are recognized for minimally invasive techniques, but neurological complications arising from this type of surgical procedure have been reported in several studies (Kepler et al., Eur Spine J 20(4):550-556, 2011; Le et al., Spine (Phila Pa 1976) 38(1):E13-E20, 2013; He et al., Zhonghua Yi Xue Za Zhi 94(3):178-181, 2014; Quinn et al., Spine (Phila Pa 1976) 40(12):942-947, 2015; Laratta et al., J Spine Surg 4(2):211-219, 2018; Riley et al., Spine J 18(10):1763-1778, 2018). In this chapter, the authors analyze the anatomical aspects of spinal surgeries through the lateral and anterior approaches (LLIF and ALIF), as well as the main stages of neural risk of each procedure. Furthermore, a step-by-step guide has been prepared, with the main techniques used in IONM to assist the neurophysiologist in these procedures. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.
bookPart Dor cervical(2022) ROCHA, Ivan Dias da; CRISTANTE, Alexandre Fogaça; FERRONATO, Danilo de Souza