EDNA FRASSON DE SOUZA MONTERO
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cirurgia, Faculdade de Medicina - Docente
LIM/08 - Laboratório de Anestesiologia, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/08 - Laboratório de Anestesiologia, Hospital das Clínicas, Faculdade de Medicina - Líder
6 resultados
Resultados de Busca
Agora exibindo 1 - 6 de 6
- EUS-guided Choledochoduodenostomy Versus Hepaticogastrostomy A Systematic Review and Meta-analysis(2018) UEMURA, Ricardo S.; KHAN, Muhammad Ali; OTOCH, Jose P.; KAHALEH, Michel; MONTERO, Edna F.; ARTIFON, Everson L. A.Background and Aims: Endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as an alternative in cases of endoscopic retrograde cholangiopancreatography (ERCP) failure. Two types of EUS-BD methods for achieving biliary drainage when ERCP fails are choledochoduodenostomy (CDS) or hepaticogastrostomy (HGS). However, there is no consensus if one approach is better than the other. Therefore, we conducted a systematic review and meta-analysis to evaluate these 2 main EUS-BD methods. Methods: We searched MEDLINE, Embase, Scopus, Cochrane database, LILACS from inception through April 8, 2017, using the following search terms in various combinations: biliary drainage, biliary stent, transluminal biliary drainage, choledochoduodenostomy, hepaticogastrostomy, endoscopic ultrasound-guided biliary drainage. We selected studies comparing CDS and HGS in patients with malignant biliary obstruction with ERCP failure. Pooled odds ratio (OR) were calculated for technical success, clinical success, and adverse events and difference of means calculated for duration of procedure and survival after procedure. Results: A total of 10 studies with 434 patients were included in the meta-analysis: 208 underwent biliary drainage via HGS and the remaining 226 via CDS. The technical success for CDS and HGS was 94.1% and 93.7%, respectively, pooled OR = 0.96 [95% confidence interval (CI) = 0.39-2.33, I-2 = 0%]. Clinical success was 88.5% in CDS and 84.5% in HGS, pooled OR = 0.76 (95% CI = 0.42-1.35, I-2 = 17%). There was no difference for adverse events OR = 0.97 (95% CI = 0.60-1.56), I-2 = 37%. CDS was about 2 minutes faster with a pooled difference in means of was -2.69 (95% CI = -4.44 to -0.95). Conclusion: EUS-CDS and EUS-HGS have equal efficacy and safety, and are both associated with a very high technical and clinical success. The choice of approach may be selected based on patient anatomy.
- Comparative Systematic Review of Fixation Methods of the Coracoid and Conjoined Tendon in the Anterior Glenoid to Treat Anterior Shoulder Instability(2019) GARCIA JR., Jose Carlos; AMARAL, Felipe Machado do; BELCHIOR, Renan Juhasz; CARVALHO, Lucas Queiroz de; MARKARIAN, Gregory George; MONTERO, Edna Feasson de SouzaBackground: Coracoid process transfer for the treatment of recurrent glenohumeral dislocations is a safe and reliable procedure; however, there is no consensus as to which is the best method, the Bristow or Latarjet procedure. Purpose: To analyze the results of coracoid process transfer for the treatment of recurrent glenohumeral dislocations and to compare the results of this transfer between the Bristow and Latarjet techniques. Study Design: Systematic review; Level of evidence, 4. Methods: The databases surveyed for this review included J-STAGE; Cochrane Bone, Joint and Muscle Trauma Group Specialized Register; Cochrane Controlled Register of Trials; MEDLINE; Ovid; Embase; Google Scholar; and CINAHL. Inclusion criteria consisted of (1) studies related to anterior glenohumeral dislocations treated with transfer of the coracoid process to the anterior glenoid rim and (2) studies that could provide data to perform at least 1 meta-analysis or other statistical evaluation. Titles and abstracts were reviewed for inclusion; thereafter, outcomes and the risk of bias were extracted. Statistical analyses were performed according to the nature of the data. When possible, the 95% CI was included. Results: Of the 779 studies found, 63 were able to provide data assessing 3395 shoulders. There were no randomized, blinded, or double-blinded trials. The recurrence of dislocations was assessed in 41 studies that used the Bristow technique (n = 2346 shoulders; percentage redislocations [mean +/- SE], 1.00% +/- 0.20%) and 18 studies that used the Latarjet technique (n = 930 shoulders; percentage redislocations, 2.13% +/- 0.49%) (P = .04). The mean loss of external rotation was 12.91 degrees for the Bristow procedure (n = 1440 shoulders) and 11.70 degrees for the Latarjet procedure (n = 243 shoulders). The mean quality-of-life outcome scores were as follows for the Bristow and Latarjet procedures, respectively: Rowe score, 92.06 and 89.33; Western Ontario Shoulder Instability Index score, 16.44% and 19.68%; Japanese Orthopaedic Association score, 93.28 and 92.00; and American Shoulder and Elbow Surgeons score, 91.00 and 89.90. Conclusion: Transferring the coracoid to the anteroinferior border of the glenoid through the subscapularis tendon is effective, regardless of the technique. When comparing the Bristow and Latarjet techniques, the recurrence of dislocations was the only outcome that could undergo a meta-analysis, and it presented a statistically significant difference in favor of the Bristow procedure. All other outcomes presented no clinically significant differences between their effect sizes. More studies presenting better methodology are still needed to achieve more robust conclusions.
- Feasibility of an endoscopic approach to the axillary nerve and the nerve to the long head of the triceps brachii with the help of the Da Vinci Robot(2013) MELO, P. M. Porto de; GARCIA, J. C.; MONTERO, E. F. de Souza; ATIK, T.; ROBERT, E. -G.; FACCA, S.; LIVERNEAUX, P. -A.Surgery to transfer the axillary nerve and the nerve of the long head of the triceps presents two obstacles: 1) the access portals are not standardized and 2) the nerves are for their larger part approached through large incisions. The goal of this study was to explore the feasibility of an endoscopic microsurgical approach. The posterior aspect of a cadaver shoulder was approached through three communicating mini-incisions. The Da Vinci robot camera was installed on a central trocart, and the instrument arms on the adjacent trocarts. A gas insufflation distended the soft tissues up to the lateral axillary space. The branches of the axillary nerve and the nerve to the long head of the triceps brachii muscle were identified. The dissection of the axillary nerve trunk and its branches was easy. The posterior humeral circumflex veins and artery were dissected as well without any difficulty. Finding the nerve to the long head of the triceps brachii was found to be more challenging because of its deeper location. Robots properties allow performing conventional microsurgery elimination of the physiologic tremor and multiplication of the movements. They also facilitate the endoscopic approach of the peripheral nerves, as seen in our results on the terminal branches of the axillary nerve and the nerve to the long head of the triceps brachii.
- Assessment of left ventricle myocardial deformation in a hemorrhagic shock swine model by two-dimensional speckle tracking echocardiography(2022) VASCONCELLOS, Henrique Doria de; SAAD, Karen Ruggeri; SAAD, Paulo Fernandes; OTSUKI, Denise Aya; CIUFFO, Luisa A.; LESTER, Laeben; KOIKE, Marcia Kiyomi; ARMSTRONG, Anderson da Costa; LIMA, Joao A. C.; MONTERO, Edna Frasson de SouzaBACKGROUND Trauma-induced secondary cardiac injury has been associated with significant adverse cardiovascular events. Speckle tracking echocardiography is a novel technology that allows an accurate and reproducible cardiac structure and function assessment. We evaluated the left ventricle (LV) myocardial deformation by speckle tracking echocardiography in a hemorrhagic shock (HS) swine model. METHODS Seven healthy male Landrace pigs were included in this study. Severe HS was reached through three sequentially blood withdraws of 20% of estimated blood volume, and it was maintained for 60 minutes. Volume resuscitation was performed using all precollected blood volume. A 1.8- to 4.2-MHz phased-array transducer was used to acquire the two-dimensional echocardiography images. Strain measurements were obtained semiautomatically by wall motion tracking software. Results are presented as medians and interquartile ranges and compared using Wilcoxon rank-sum test. A p value of <0.05 was considered statistically significant. RESULTS The median weight was 32 (26.1-33) kg, and the median total blood volume withdrawn was 1,100 (1,080-1,190) mL. During the severe HS period, the median arterial systemic pressure was 39 (36-46) mm Hg, and the cardiac index was 1.7 (1.6-2.0) L/min/m(2). There was statistically significant absolute decrease in the global longitudinal strain 2 hours postresuscitation comparing with the basal measurements (-9.6% [-10.7 to -8.0%] vs. -7.9% [-8.1 to -7.4%], p = 0.03). There were no statistically significant differences between the basal and 2 hours postresuscitation assessments in the invasive/noninvasive hemodynamic, other two-dimensional echocardiogram (LV ejection fraction, 49.2% [44-54.3%] vs. 53.2% [51.5-55%]; p = 0.09), and circumferential strain (-10.6% [-14.4 to -9.0%] vs. -8.5% [-8.6 to -5.2%], p = 0.06) parameters. CONCLUSION In this experimental swine model of controlled HS, LV global longitudinal strain analysis accurately characterizes the timing and magnitude of subclinical cardiac dysfunction associated with trauma-induced secondary cardiac injury.
- Neutrophil proteomic analysis reveals the participation of antioxidant enzymes, motility and ribosomal proteins in the prevention of ischemic effects by preconditioning(2017) ARSHID, S.; TAHIR, M.; FONTES, B.; MONTERO, E. F. S.; CASTRO, M. S.; SIDOLI, S.; SCHWAMMLE, V.; ROEPSTORFF, P.; FONTES, W.Intestinal ischemia and reperfusion injury are widely used models, which result into tissue injury and multiple organ failure also observed after trauma and surgery. Ischemic preconditioning (IPC) preceding ischemia and re perfusion (IR) was shown to attenuate this injury and has a potential therapeutic application; however the exact underlying mechanism is not clear. Neutrophils play an important role in the mechanism of injuries caused by ischemia and reperfusion while IPC led to a decrease in neutrophil stimulation and activation. The effect of preconditioning on the neutrophil proteome is unclear. Proteomic analysis has been ratified as an appropriate tool for studying complex systems. In order to evaluate the effect of IPC preceding 45 min of ischemia on the proteome of neutrophils we used Wistar rats divided in four experimental groups: Control, sham laparotomy, intestinal ischemia reperfusion and ischemic preconditioning. After neutrophil separation, proteins were extracted, trypsin digested and the resulting peptides were iTRAQ labeled followed by HILIC fractionation and nLC-MS/MS analysis. After database searches, normalization and statistical analysis our proteomic analysis resulted in the identification of 2437 protein groups that were assigned to five different clusters based on the relative abundance profiles among the experimental groups. The clustering followed by statistical analysis led to the identification of significantly up and downregulated proteins in IR and IPC. Cluster based KEGG pathways analysis revealed up- regulation of actin cytoskeleton, metabolism, Fc gamma R mediated phagocytosis, chemokine signaling, focal adhesion and leukocyte transendothelial migration whereas downregulation in ribosome, spliceosome, RNA transport, protein processing in endoplasmic reticulum and proteasome, after intestinal ischemic preconditioning. Furthermore, enzyme prediction analysis revealed the regulation of some important antioxidant enzymes and having their role in reactive oxygen species production. To our knowledge, this work describes the most comprehensive and detailed quantitative proteomic study of the neutrophil showing the beneficial role of ischemic preconditioning and its effects on the neutrophil proteome. This data will be helpful to understand the effect of underlying protective mechanisms modulating the role of PMNs after IPC and provide a trustworthy basis for future studies. Biological significance: Preconditioning is a relevant strategy to overcome clinical implications from ischemia and reperfusion. Such implications have the neutrophil as a major player. Although many publications describe specific biochemical and physiological roles of the neutrophil in such conditions, there is no report of a proteomic study providing a broader view of this scenario. Here we describe a group of proteins significantly regulated by ischemia and reperfusion being such regulation prevented by preconditioning. Such finding may provide relevant information for a deeper understanding of the mechanisms involved, as well as serve as basis for future biomarker or drug target assays.
- Endoscopic approach for management of biliary strictures in liver transplant recipients: A systematic review and meta-analysis(2017) APARICIO, Dayse Pereira da Silva; OTOCH, Jose Pinhata; MONTERO, Edna Frasson de Souza; KHAN, Muhammad Ali; ARTIFON, Everson Luiz de AlmeidaThe most common biliary complication after liver transplantation is anastomotic stricture (AS) and it can occur isolated or in combination with other complications. Liver graft from a cadaveric donor or a living donor has an influence on the incidence of biliary strictures as well as on the response to endoscopic treatment. Endoscopic treatment using balloon dilation and insertion of biliary stents by endoscopic retrograde cholangiopancreatography (ERCP) is the initial approach to these complications. Aim: The aim of this article is to compare different endoscopic techniques to treat post-liver transplantation biliary strictures. Methods: The search was carried out on MEDLINE, EMBASE, Scielo-LILACS and Cochrane Library databases through June 2015. A total of 1100 articles were retrieved. Ten clinical trials were analyzed, and seven were included in the meta-analysis. Conclusions: The endoscopic treatment of AS was equally effective when compared the use of fully covered self-expandable metal stents (FCSEMS) vs. plastic stents, but the use of FCSEMS was associated with a lower complication risk. The treatment of AS with balloon dilation or balloon dilation associated with plastic stents presented similar results. Deceased donor liver transplantation reduced the risk of biliary stenosis and the endoscopic treatment in these patients was more effective when compared with Living donor liver transplantation.