VINCENZO PUGLIESE
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
11 resultados
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article 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.
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
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.conferenceObject Hepatic Artery Thrombosis after Liver Transplantation: Experience of Single Center(2012) NACIF, Lucas Souto; ANDRAUS, Wellington; DUCATTI, Liliana; PUGLIESE, Vincenzo; D'ALBUQUERQUE, Luiz Augusto CarneiroIntroduction: Hepatic artery thrombosis (HAT) is a feared complication in the postoperative period of liver transplantation. It is one of the most serious vascular complications in the postoperative period of liver transplantation (LT) and is associated with a significant increasing in morbidity, graft loss and mortality. Methods: This study was retrospectively on period of November 2009 to December 2011, on the Gastroenterology Department of Sao Paulo University School of Medicine. Results: In this period of the analysis we obtained 18 cases of hepatic artery thrombosis that correspond to 7, 4%, of a total of 243 liver transplantation in this period. Seven cases before 15 days (early arterial thrombosis) and eleven cases of late arterial thrombosis. In the early group, 4 of 7 cases were women and 3 were men. The MELD score (Model for End-Stage Liver Disease) average was 28.14. The survival rate of retransplantation of this group was 86% in this period. On the other hand, in the late group, among the 11 cases (5 women and 6 men), six were transplanted, two died and three cases are still waiting transplantation. Conclusion: Our cases are in agreement with the literature. Early indication of retransplantation has better results.conferenceObject Femoral Hernia and Massive Ascites(2013) PINHEIRO, Rafael S.; ANDRAUS, Wellington; PECORA, Rafael A.; HADDAD, Luciana B.; DAVID, Andre I.; NACIF, Lucas; MARTINS, Rodrigo B.; CRUZ JR., Ruy J.; PUGLIESE, Vincenzo; D'ALBUQUERQUE, Luiz A. C.- Trombose de veia porta no transplante hepático(2012) PÉCORA, Rafael Antonio Arruda; CANEDO, Bernardo Fernandes; ANDRAUS, Wellington; MARTINO, Rodrigo Bronze de; SANTOS, Vinicius Rocha; ARANTES, Rubens Macedo; PUGLIESE, Vincenzo; D´ALBUQUERQUE, Luiz Augusto CarneiroBACKGROUND: Portal vein thrombosis was considered a contraindication for liver transplantation in the past because of the high morbidity and mortality rates. Many advances made the results better. AIM: Review the advances and surgical strategies for liver transplantation in presence of portal vein thrombosis. METHOD: Survey of publications in Medline, Scielo and Lilacs databases. Headings crossed: portal vein thrombosis, liver transplantation, vascular complications, jump graft, graft failure, multivisceral transplant. Data analyzed were epidemiology, risk factors, classification, diagnosis, surgical strategies and outcomes. CONCLUSION: Portal vein thrombosis is not a contraindication for liver transplantation anymore. There are many strategies to perform the liver transplantation in this condition, depending on portal vein thrombosis grade. Regardless higher morbidity and re-trhombosis rates, the outcomes of liver transplantation in portal vein thrombosis are similar to series without portal vein thrombosis.
conferenceObject Impact of the severity of end-stage liver disease in cardiac remodeling(2012) SILVESTRE, Odilson M.; BACAL, Fernando; RAMOS, Danusa; BELLETI, Elisangela; ANDRADE, Jose L.; PUGLIESE, Vincenzo; ANDRAUS, Wellington; FURTADO, Meive; CARRILHO, Flair J.; D'ALBUQUERQUE, Luiz C.; FARIAS, Alberto Q.Background: The impact of end-stage liver disease (ESLD) severity in cardiac remodeling of patients with cirrhosis is unknown. Our aim was to correlate the severity of ESLD with morphologic and functional heart changes. 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, as assessed by echocardiography, correlate with the severity of ESLD in patients with cirrhosis.