AMILCAR MARTINS GIRON
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
8 resultados
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conferenceObject Impact of surgery and chemotherapy over renal function in bilateral Wilms tumor patients(2012) DUARTE, R. J.; CRISTOFANI, L. M.; GIRON, A. M.; DENES, F. T.; ODONE-FILHO, V; TANNURI, U.; SROUGI, M.INTRODUCTION & OBJECTIVES: Bilateral Wilms’ tumor represents 3% of all cases. The challenge of this situation is curing these patients preserving their renal function and quality of life (dialysis free status). Our purpose was to evaluate the success of renal function preservation in children treated for bilateral Wilms’ tumor. MATERIAL & METHODS: From January/1982 through June/2009, 13 children with bilateral Wilms’ tumor (4F: 9M, median age 16 months) were diagnosed. All patients received preoperative chemotherapy with VCR/ACTD (13 patients), VCR/ACTD/ADRIA (10 patients), VCR/ACTD/ADRIA/CBDCA/ETO (3 patients), VCR/ACTD/ADRIA/CBDCA/ETO/IFO (2 patients), for 8 through 40 weeks (median 16 weeks). All patients were submitted to surgical procedure nephron sparing objective. RESULTS: Radical unilatera l nephrectomy was performed in 9 patients (combined with contralateral nodulectomy in 8), bilateral nodulectomy in 3, and unilateral nodulectomy in 1. Two patients presented unilateral disappearing of the disease after preoperative chemotherapy on image and surgical evaluation. The histhopatological analysis revealed the classic triphasic Wilms’ tumor in 9 patients, rhabdomyoblastic differentiation in 3 and blastematous rests in one patient. Four patients relapsed: 2 in the remaining kidney, 1 in the tumoral bed and 1 in lungs (9mo, 1mo, 5mo and 6 mo after surgery). A ll, except the lung relapsed patient, were rescued, achieving a second remission, but one presented a second diffuse abdominal relapse and died. 11/13 patients have normal renal function and are alive and free of disease for 23+ months to 28+years. 1/13 patients presents microalbuminuria and mild systemic hypertension, requiring medication support. CONCLUSIONS: Bilateral Wilms’ tumor was successfully treated and renal function was preserved in 84.6% of surviving patients, even those cases that received nephrotoxic drugs.- Urethral duplication type influences on the complications rate and number of surgical procedures(2017) LOPES, Roberto Iglesias; GIRON, Amilcar Martins; MELLO, Marcos Figueiredo; BARBOSA NETO, Cristovao Machado; SANTOS, Joana dos; MOSCARDI, Paulo Renato Marcelo; SROUGI, Victor; DENES, Francisco Tibor; SROUGI, MiguelIntroduction: Urethral duplication is rare. Characterized by the presence of two urethral channels. This anomaly presents a great variety of clinical findings that depend on the type of duplication that often is associated with other anomalies. Material and Methods: We report thirteen boys with urethral duplication managed in our institution between 1988-02015. Clinical findings, associated anomalies, treatment of urethral duplication and our results are described. Patients were classified according to Effmann classification. Results: Mean patient's age was 38.3 +/- 34.7 months (3-0136 months). Mean follow-up was 7.7 +/- 3.4 years (3y8m-014y2m). Type II A2 was the most common pattern (8/13 patients, 61.5%), followed by type IA (3/13 patients, 23%) and IIA1 (2/13 patients, 15.3%). The most frequent clinical manifestations were urinary tract infections (UTI) observed in 11/13 patients (84.6%) and anal urinary leakage, found in 7/13 patients (53.8%). Associated anomalies were found in 9/13 patients (69.2%). Required surgeries were 3.53 +/- 2.84 procedures per patient. Considering groups: Type IIA2 4.25 +/- 3.28, type IIA1 4 +/- 1.41 and type IA 1.33 +/- 0.57 needed procedures per patient. Complications rate were 0% for type IA, 50% for type IIA1 and 75% for type IIA2. Conclusions: Patients with incomplete duplication (type I A or I B) can totally be asymptomatic, with no need of surgical correction. Type IIA2 is the most complex form of duplication to correct and multiple procedures might be required because of the very hypoplastic orthotopic dorsal urethral tissue. Surgical treatment should be individualized and parents should be advised on complications and need of multiple surgeries according to urethral duplication type.
- Single-stage Abdominoplasty Using Groin Flaps Without Osteotomies: Management of Exstrophy-epispadias Complex(2018) GIRON, Amilcar Martins; MELLO, Marcos Figueiredo; BERJEAUT, Ricardo Haidar; MACHADO, Marcos Giannetti; SILVA, Gabriel Carvalho dos Anjos; CEZARINO, Bruno Nicolino; OLIVEIRA, Lorena Marcalo; LOPES, Roberto Iglesias; DENES, Francisco TiborBACKGROUND The optimal treatment for children born with exstrophy-epispadia complex is still a matter of AND OBJECTIVE debate.(1,2,3) We demonstrate the Single-Stage Abdominoplasty using Groin Flap technique to close the abdominal wall of children with classic bladder exstrophy (CBE) without osteotomy neither radical soft tissue mobilization. Advantages over current techniques are less risk of penile tissue loss and avoidance of osteotomies. MATERIAL AND METHODS Abdominal wall repair consists in using the hypogastric skin, rectus, and obliquus externus abdom inalis muscle fascial flaps. These groin flaps are rotated medially resulting in a very strong abdominal wall support. Groin flaps are made of rectus anterior fascia rotated medially, flipped over, and sutured with Prolene sutures to close the defect. By rotating the fascial flaps medially, complete reinforcement of the abdominal wall to the level of the pubic bone is achieved. This permits abdominal closure maintenance without tension. RESULTS Groin flap was applied to 128 patients with CBE referenced from all over the country. Most of these patients returned to their home areas making difficult their follow up. However, we have 44 cases that have regular clinical visits. Mean follow-up was 10.3 4.5 years (2 years 8 months-16 years). Successful closure was achieved in 43 patients (97.7%) as a single procedure; one patient had a complete wound dehiscence and needed another reconstruction (2.2%). Four patients (9.1%) presented abdominal hernias that needed surgical management. When continence is evaluated, we present similar literature rates (60%).(4) CONCLUSION Abdominal reconstruction using Groin flaps has advantages over the traditional approaches to CBE. It reduces the surgical steps and facilitates the closure of the abdominal wall without the need of osteotomies and consequent immobilization during the postoperative period. It is feasible at any age and can be also very useful as a salvage technique even after previous failed procedures. Finally, it minimizes the number of surgeries. (C) 2018 Elsevier Inc.
conferenceObject Misdiagnosis in Wilms tumor: Concerns on the use of preoperative chemotherapy(2012) DUARTE, R. J.; CRISTOFANI, L. M.; DENES, F. T.; GIRON, A. M.; ODONE-FILHO, V; SROUGI, M.INTRODUCTION & OBJECTIVES: Modern image armamentarium allows the preoperative diagnosis of Wilms tumor and the use of preoperative chemotherapy as precluded by SIOP protocols without a biopsy specimen. However, misdiagnosis is possible even with very accurate examination. This paper describes our experience with children who were preoperatively considered as having Wilms tumor and who received preoperative chemotherapy as SIOP 2001 protocol, and after delayed surgery, a different diagnosis was revealed. MATERIAL & METHODS: The charts of children admitted to our institution with diagnosis of Wilms tumor from January 2000 through December 2010 were reviewed in order to disclose all those who were submitted to preoperative chemotherapy followed by surgical removal of the tumor. The histopathological diagnosis and the subsequent treatment were reviewed. RESULTS: 81 children were admitted to our institution with the diagnosis of Wilms tumor during the analyzed period. Median age was 3.2 years (range 7 mo trough 5 years). All children presented with renal mass suggestive of Wilms tumor on abdominal ultrasonography and computerized tomography. All received preoperative chemotherapy with vincristine plus dactinomycin for four weeks, been afterwards submitted to nephrectomy. Histopathological analysis confirmed Wilms tumor in 78/81 cases (96%), but in 3/81 (4%) of the cases the diagnosis was clear cell sarcoma (1/81), multicystic kidney (1/81) and neuroblastoma (1/81). No further chemotherapy was administered to the child with multicystic kidney and the other two children were treated according to specific protocols. CONCLUSIONS: In spite of the refined image methods available in our days, misdiagnosis of Wilms tumor is still possible and it should be a concern when preoperative chemotherapy is the first line treatment.- One - staged reconstruction of bladder exstrophy in male patients: long - term follow-up outcomes(2017) GIRON, Amilcar Martins; MELLO, Marcos Figueiredo; CARVALHO, Paulo Afonso; MOSCARDI, Paulo Renato Marcelo; LOPES, Roberto Iglesias; SROUGI, MiguelIntroduction: The surgical correction of bladder exstrophy remains challenging. In our institution, the repair has evolved from a staged repair to one-stage reconstruction. The one-stage reconstruction includes; bladder closure, Cantwell-Ransley neourethroplasty and abdominoplasty using groin flaps, without the need of pelvic ostheotomies. Repair of urinary continence (UC) and vesicoureteral reflux (VUR) is done after development of the infant. Objective: To present our experience of our modified one-stage reconstruction of bladder exstrophy in male patients. Materials and Methods: Medical records of male patients submitted to one-stage reconstruction of bladder exstrophy were analyzed retrospectively. Fifteen exstrophy bladder patients with mean age 4.2 +/- 7 years were treated at our institution between 1999-2013. Results: Eleven patients were referred to us after previous surgery. Sixteen procedures were performed; one patient had complete wound dehiscence and needed another reconstruction (6.7%). Mean follow up was 10.3 +/- 4.5 years. No patient has had a loss of renal function. Postoperative complications: four patients (26.6%) presented small fistulas, one presented penile rotation. Eleven patients (73.3%) patients underwent bladder-neck surgery. Five (33.3%) required bladder augmentation. Three cases (20%) needed subsequent treatment of VUR. At the time of our review nine (60%) patients achieved UC, two (13.3 %) patient without additional procedure. A mean of 3 +/- 1.1 procedures (2-5) was accomplished per children. Conclusions: One-stage reconstruction minimizes the number of surgical procedures required to achieve UC and potentiates bladder-neck function. The advantages of using groin flaps over current techniques for complete repair are the small risk for penile tissue loss and the avoidance of ostheotomies.
conferenceObject GONADAL FUNCTION AND REPRODUCTIVE SYSTEM ANATOMY IN POST PUBERAL PRUNE BELLY SYNDROME PATIENTS(2017) TIBOR-DENES, Francisco; TAVARES, Alessandro; COCUZZA, Marcello; TISEU, Bruno; MACHADO, Marcos Gianetti; GIRON, Amilcar Martins; SROUGI, Miguel- Bladder exstrophy: reconstructed female patients achieving normal pregnancy and delivering normal babies(2011) GIRON, Amilcar Martins; PASSEROTTI, Carlo Camargo; Hiep Nguyen; CRUZ, Jose Arnaldo Shiomi da; SROUGI, MiguelPurpose: Bladder exstrophy (BE) is an anterior midline defect that causes a series of genitourinary and muscular malformations, which demands surgical intervention for correction. Women with BE are fertile and able to have children without this disease. The purpose of this study is to assess the sexual function and quality of life of women treated for BE. Materials and Methods: All patients in our institution treated for BE from 1987 to 2007 were recruited to answer a questionnaire about their quality of life and pregnancies. Results: Fourteen women were submitted to surgical treatment for BE and had 22 pregnancies during the studied period. From those, 17 pregnancies (77.2%) resulted in healthy babies, while four patients (18.1%) had a spontaneous abortion due to genital prolapse, and there was one case (4.7%) of death due to a pneumopathy one week after delivery. There was also one case (5.8%) of premature birth without greater repercussions. During pregnancy, three patients (21.4%) had urinary tract infections and one patient (7.14%) presented urinary retention. After delivery, three patients (21.4%) presented temporary urinary incontinence; one patient (7.14%) had a vesicocutaneous fistula and seven patients (50%) had genital prolapsed. All patients confirmed to have achieved urinary continence, a regular sexual life and normal pregnancies. All patients got married and pregnant older than the general population. Conclusions: BE is a severe condition that demands medical and family assistance. Nevertheless, it is possible for the bearers of this condition to have a satisfactory and productive lifestyle.
- MMP9 overexpression is associated with good surgical outcome in children with UPJO: Preliminary results(2016) REIS, Sabrina Thalita; LEITE, Katia R. M.; VIANA, Nayara Izabel; LOPES, Roberto Iglesias; MOURA, Caio Martins; IVANOVIC, Renato F.; MACHADO, Marcos; DENES, Francisco Tibor; GIRON, Amilcar; NAHAS, William Carlos; SROUGI, Miguel; PASSEROTTI, Carlo C.Background: Ureteropelvic junction obstruction (UPJO) diagnosed prenatally occurs in 1: 150 -1: 1200 pregnancies. Although many studies investigating the molecular changes of this obstructed segment have been performed, the underlying mechanisms are still unclear. The role of extracellular matrix (ECM) components remains controversial, and the investigations in the field of ECM changes, might help the better understanding of the pathogenesis of this common condition. The aim of the present study was to investigate for the first time in the literature whether MMP9 and its specific inhibitors, TIMP1 and RECK, are expressed in a reproducible, specific pattern in UPJ. Methods: UPJO specimens were obtained from 16 children at the time of dismembered pyeloplasty due to intrinsic UPJ stenosis. Expression levels of the three genes (MMP9, TIMP1 and RECK) were analyzed by quantitative real-time polymerase chain reaction (qRT-PCR). Then correlated the expression levels of the genes according to grade study population that was divided in 2 categories according to Society of Fetal Urology classification, grade 3 (moderate) and 4 (severe). For DTPA we subdivided the childrens in 2 groups, obstructive (T 1/2 more than 20 min) and partial obstructive (T 1/2 between 10 and 20 min) and success in a surgery was defined as decrease in T 1/ 2 to less than 20 min, absence of symptoms, improving renal function and decreasing dilatation on successive exams. Results: MMP9 was underexpressed and TIMP1 and RECK were overexpressed in children with obstructive DTPA but the differences were not statistically significant. Overexpression of MMP9 was higher among patients with severe grade of UPJ compared to those with moderate grade. Surprisingly expression levels of MMP-9 was three times higher in children who were successfully treated by surgery (n = 10) (p = 0.072), so those who were followed for at least 1 year after surgery and remained with improvement in renal function and decreasing dilation on intravenous urogram and TIMP-1 was underexpressed in 100 % of this cases (p = 0.00). Conclusions: We showed an increase in expression of MMP9 and a decrease in expression of TIMP1 in children who improving renal function and decreasing dilation after surgery. We believe that the higher expression of MMP9 in these cases can reflect an increase in degradation and remodeling process that could be used as a marker for surgical outcome.