VINCENZO PUGLIESE
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
20 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 20
- Clinical and pathological evaluation of fibrolamellar hepatocellular carcinoma: a single center study of 21 cases(2015) CHAGAS, Aline Lopes; KIKUCHI, Luciana; HERMAN, Paulo; ALENCAR, Regiane S. S. M.; TANI, Claudia M.; DINIZ, Marcio Augusto; PUGLIESE, Vincenzo; ROCHA, Manoel de Souza; D'ALBUQUERQUE, Luiz Augusto Carneiro; CARRILHO, Flair Jose; ALVES, Venancio A. F.OBJECTIVES: Fibrolamellar hepatocellular carcinoma is a rare primary malignant liver tumor that differs from conventional hepatocellular carcinoma in several aspects. The aim of this study was to describe the clinical, surgical and histopathological features of fibrolamellar hepatocellular carcinoma and to analyze the factors associated with survival. METHODS: We identified 21 patients with histopathologically diagnosed fibrolamellar hepatocellular carcinoma over a 22-year period. Clinical information was collected from medical records and biopsies, and surgical specimens were reviewed. RESULTS: The median age at diagnosis was 20 years. Most patients were female (67%) and did not have associated chronic liver disease. Most patients had a single nodule, and the median tumor size was 120 mm. Vascular invasion was present in 31% of patients, and extra-hepatic metastases were present in 53%. Fourteen patients underwent surgery as the first-line therapy, three received chemotherapy, and four received palliative care. Eighteen patients had ""pure fibrolamellar hepatocellular carcinoma,'' whereas three had a distinct area of conventional hepatocellular carcinoma and were classified as having ""mixed fibrolamellar hepatocellular carcinoma.'' The median overall survival was 36 months. The presence of ""mixed fibrolamellar hepatocellular carcinoma'' and macrovascular invasion were predictors of poor survival. Vascular invasion was associated with an increased risk of recurrence in patients who underwent surgery. CONCLUSION: Fibrolamellar hepatocellular carcinoma was more common in young female patients without chronic liver disease. Surgery was the first therapeutic option to achieve disease control, even in advanced cases. Vascular invasion was a risk factor for tumor recurrence. The presence of macrovascular invasion and areas of conventional hepatocellular carcinoma were directly related to poor survival.
bookPart Aspectos Técnicos dos Transplantes de Órgãos do Aparelho Digestório(2013) DAVID, André Ibrahim; PéCORA, Rafael Antonio Arruda; PUGLIESE, Vincenzoarticle 26 Citação(ões) na Scopus Impact of the severity of end-stage liver disease in cardiac structure and function(2013) SILVESTRE, Odilson Marcos; BACAL, Fernando; RAMOS, Danusa de Souza; ANDRADE, Jose L.; FURTADO, Meive; PUGLIESE, Vincenzo; BELLETI, Elisangela; ANDRAUS, Wellington; CARRILHO, Flair Jose; D'ALBUQUERQUE, Luiz Augusto Carneiro; FARIAS, Alberto QueirozBackground. The impact of end-stage liver disease (ESLD) in cardiac remodeling of patients with cirrhosis is unknown. Our aim was to correlate the severity of ESLD with morphologic and functional heart changes. Material and methods. 184 patients underwent a protocol providing data on the severity of ESLD and undergoing echocardiography to assess the diameters of the left atrium and right ventricle; the systolic and diastolic diameters of the left ventricle, interventricular septum, and posterior wall of the left ventricle; systolic pulmonary artery pressure; ejection fraction; and diastolic function. Severity of ESLD was assessed by the Model for End-Stage Liver Disease (MELD) score. Results. Left-atrial diameter (r = 0.323; IC 95% 0.190-0.455; p < 0.001), left-ventricular diastolic diameter (r = 0.177; IC 95% 0.033-0.320; p = 0.01) and systolic pulmonary artery pressure (r = 0.185; IC 95% 0.036-0.335; p = 0.02) significantly correlated with MELD score. Patients with MELD 16 had significantly higher left-atrial diameter and systolic pulmonary artery pressure, compared with patients with MELD scores < 16 points. Conclusions. Changes in cardiac structure and function correlate with the severity of ESLD.- Tumor growth pattern as predictor of colorectal liver metastasis recurrence(2014) PINHEIRO, Rafael S.; HERMAN, Paulo; LUPINACCI, Renato M.; LAI, Quirino; MELLO, Evandro S.; COELHO, Fabricio F.; PERINI, Marcos V.; PUGLIESE, Vincenzo; ANDRAUS, Wellington; CECCONELLO, Ivan; D'ALBUQUERQUE, Luiz CarneiroBACKGROUND: Surgical resection is the gold standard therapy for the treatment of colorectal liver metastases (CRM). The aim of this study was to investigate the impact of tumor growth patterns on disease recurrence. METHODS: We enrolled 91 patients who underwent CRM resection. Pathological specimens were prospectively evaluated, with particular attention given to tumor growth patterns (infiltrative vs pushing). RESULTS: Tumor recurrence was observed in 65 patients (71.4%). According to multivariate analysis, 3 or more lesions (P = .05) and the infiltrative tumor margin type (P = .05) were unique independent risk factors for recurrence. Patients with infiltrative margins had a 5-year disease-free survival rate significantly inferior to patients with pushing margins (20.2% vs 40.5%, P = .05). CONCLUSIONS: CRM patients with pushing margins presented superior disease-free survival rates compared with patients with infiltrative margins. Thus, the adoption of the margin pattern can represent a tool for improved selection of patients for adjuvant treatment.
- Intentional use of Schistosoma mansoni-infected grafts in living donor liver transplantation(2012) ANDRAUS, Wellington; PUGLIESE, Vicenzo; PECORA, Rafael; D'ALBUQUERQUE, Luiz Augusto C.
- Liver transplantation: Fifty years of experience(2014) SONG, Alice Tung Wan; AVELINO-SILVA, Vivian Iida; PECORA, Rafael Antonio Arruda; PUGLIESE, Vincenzo; D'ALBUQUERQUE, Luiz Augusto Carneiro; ABDALA, EdsonSince 1963, when the first human liver transplantation (LT) was performed by Thomas Starzl, the world has witnessed 50 years of development in surgical techniques, immunosuppression, organ allocation, donor selection, and the indications and contraindications for LT. This has led to the mainstream, wellestablished procedure that has saved innumerable lives worldwide. Today, there are hundreds of liver transplant centres in over 80 countries. This review aims to describe the main aspects of LT regarding the progressive changes that have occurred over the years. We herein review historical aspects since the first experimental studies and the first attempts at human transplantation. We also provide an overview of immunosuppressive agents and their potential side effects, the evolution of the indications and contraindications of LT, the evolution of survival according to different time periods, and the evolution of methods of organ allocation.
conferenceObject Combined Liver Kidney Transplantation at a Brazilian Universitary Hospital(2012) NACIF, Lucas Souto; ANDRAUS, Wellington; PUGLIESE, Vincenzo; D'ALBUQUERQUE, Luiz Augusto CarneiroIntroduction: Combined liver and kidney transplantation (CLKT) may be an option for treatment in patients with liver and kidney failure. It has been proven to be a favorable treatment for renal and hepatic end-stage diseases and it has been observed an increasing in the number of cases reported in the literature. Several transplant centers have reported their experiences of CLKT, and it is suggested that the transplanted liver can offer a protective immunologic effect on the kidney allograft. Here we present the experience and results of 27 CLKTs performed in our center. Methods: The clinical data of 27 CLKTs were retrospectively studied on period of January 2002 to December 2010, on the Department of Gastroenterology on Sao Paulo University School of Medicine. Results: We analyzed, within 8 years (2002 - 2010) retrospectively, all transplants performed in cases of CLKT . Among a total of 27 cases, 20 were men (66%) and 7 were women (33%). Ages ranged from 23 years to 65 years (mean age 44 years). The initial value of the MELD score (Model for End-Stage Liver Disease) ranged from 14 to 41 (mean MELD 27.5). In our 8 years of follow-up mortality rate was 33% and patient survival of 66%. Conclusion: CLKT is an effective therapy for end stage liver (ESLD) and kidney disease (ESRD).- Dimensão da margem cirúrgica nas ressecções de metástase hepática de câncer colorretal: impacto na recidiva e sobrevida(2013) HERMAN, Paulo; PINHEIRO, Rafael S.; MELLO, Evandro S.; LAI, Quirino; LUPINACCI, Renato M.; PERINI, Marcos V.; PUGLIESE, Vincenzo; ANDRAUS, Wellington; COELHO, Fabricio F.; CECCONELLO, Ivan; D'ALBUQUERQUE, Luiz C.BACKGROUND: Approximately 50% of the patients with a colorectal tumor develop liver metastasis, for which hepatectomy is the standard care. Several prognostic factors have been discussed, among which is the surgical margin. This is a recurring issue, since no consensus exists as to the minimum required distance between the metastatic nodule and the liver transection line. AIM: To evaluate the surgical margins in liver resections for colorectal metastases and their correlation with local recurrence and survival. METHODS: A retrospective study based on the review of the medical records of 91 patients who underwent resection of liver metastases of colorectal cancer. A histopathological review was performed of all the cases; the smallest surgical margin was verified, and the late outcome of recurrence and survival was evaluated. RESULTS: No statistical difference was found in recurrence rates and overall survival between the patients with negative or positive margins (R0 versus R1); likewise, there was no statistical difference between subcentimeter margins and those greater than 1 cm. The disease-free survival of the patients with microscopically positive margins was significantly worse than that of the patients with negative margins. The uni- and multivariate analyses did not establish the surgical margin (R1, narrow or less than 1 cm) as a risk factor for recurrence. CONCLUSION: The resections of liver metastases with negative margins, independently of the margin width, had no impact on tumor recurrence (intra- or extrahepatic) or patient survival
- Serum B-type natriuretic peptide in the initial workup of patients with new onset ascites: A diagnostic accuracy study (vol 59, pg 1043. 2014)(2014) FARIAS, Alberto Q.; SILVESTRE, Odilson M.; GARCIA-TSAO, Guadalupe; SEGURO, Luis F. B. da Costa; MAZO, Daniel F. de Campos; BACAL, Fernando; ANDRADE, Jose L.; GONCALVES, Luciana L.; STRUNZ, Celia; RAMOS, Danusa S.; POLLI, Demerson; PUGLIESE, Vincenzo; RODRIGUES, Ana C. T.; FURTADO, Meive S.; CARRILHO, Flair J.; D'ALBUQUERQUE, Luiz A. C.
conferenceObject Validation of Preoperative Coefficient Factor for Graft Weight Estimation in Living Donor Liver Transplantation(2013) PINHEIRO, Rafael S.; PECORA, Rafael A.; ANDRAUS, Wellington; MARTINS, Rodrigo B.; DAVID, Andre I.; HADDAD, Luciana B.; ARANTES, Rubens M.; SANTOS, Rafael M.; CRUZ JR., Ruy J.; PUGLIESE, Vincenzo; D'ALBUQUERQUE, Luiz A. C.