NELSON DE LUCCIA
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cirurgia, Faculdade de Medicina - Docente
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/02 - Laboratório de Anatomia Médico-Cirúrgica, Hospital das Clínicas, Faculdade de Medicina - Líder
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/02 - Laboratório de Anatomia Médico-Cirúrgica, Hospital das Clínicas, Faculdade de Medicina - Líder
17 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 17
bookPart Tratamento minimamente invasivo da doença arterial periférica(2016) ZERATI, Antonio Eduardo; LUCCIA, Nelson de; WOLOSKER, Nelson- Open and endovascular repair of juxtarenal abdominal aortic aneurysms: a systematic review(2014) BELCZAK, Sergio Quilici; LANZIOTTI, Luiz; BOTELHO, Yuri; AUN, Ricardo; SILVA, Erasmo Simao da; PUECH-LEAO, Pedro; LUCCIA, Nelson deThis systematic review focuses on the 30-day mortality associated with open surgery and fenestrated endografts for short-necked (<15 mm) juxtarenal abdominal aortic aneurysms. A search for studies published in English and indexed in the PubMed and Medline electronic databases from 2002 to 2012 was performed, using ""juxtarenal abdominal aortic aneurysm"" and ""treatment"" as the main keywords. Among the 110 potentially relevant studies that were initially identified, eight were in accordance with the inclusion criteria in the analysis. Similar outcomes for open and endovascular repair were observed for 30-day mortality. No differences were observed regarding the secondary outcomes (duration of surgery, hospital stay, postoperative renal dysfunction and late mortality), except that the late mortality rate was significantly higher for the patients treated with open repair after a median follow-up of 24 months. Fenestrated endografting is a viable alternative to conventional surgery in juxtarenal abdominal aortic aneurysms with a proximal neck <15 mm.
- Cateteres venosos totalmente implantáveis: histórico, técnica de implante e complicações(2017) ZERATI, Antonio Eduardo; WOLOSKER, Nelson; LUCCIA, Nelson de; PUECH-LEÃO, PedroAbstract Access to the venous system is of vital importance for diagnosis and treatment of patients with the most varied range of clinical conditions, whether for taking blood samples or for infusion of solutions. In 1616, Harvey described the circulatory system on the basis of studies in animals and 4 decades later Sir Christopher Wren conducted the first intravenous infusions in living beings. Since then there has been constant evolution in access technique and infusion devices. Of particular note is the creation of long-term catheters in the 1970s, particularly totally implantable devices, which revolutionized cancer treatment, increasing both safety and comfort for oncology patients. The objectives of this article are to review historical data on vascular access and discuss the implantation technique and the main complications associated with procedures for placement and use of totally implantable venous access devices.
- Biomechanical Properties and Microstructural Analysis of the Human Nonaneurysmal Aorta as a Function of Age, Gender and Location: An Autopsy Study(2015) NINOMIYA, Otavio Henrique; MONTEIRO, Jose Augusto Tavares; HIGUCHI, Maria de Lourdes; PUECH-LEAO, Pedro; LUCCIA, Nelson de; RAGHAVAN, Madhavan Lakshmi; SILVA, Erasmo Simao daIntroduction: The biomechanical failure properties and histological composition of the human nonaneurysmal aorta were studied. Methods: Twenty-six human aortas were harvested from fresh cadavers at autopsy. A total of 153 circumferentially oriented strips were obtained from the aortas for biomechanical and histological studies. Results: The failure load (6.18 +/- 2.03 vs. 4.85 +/- 2.04 N; p = 0.001), failure tension (19.88 +/- 9.05 vs. 14.53 +/- 7 N/cm; p = 0.001), failure strain (0.66 +/- 0.31 vs. 0.49 +/- 0.25; p = 0.003) and amount of elastic fibers (19.39 +/- 15.57 vs. 14.06 +/- 9.5%; p = 0.011) were all significantly higher for the thoracic than the abdominal aorta. There was a significant negative correlation between age and failure load (R = -0.35; p < 0.0001), failure stress (R = -0.63; p < 0.0001), failure tension (R = -0.52; p < 0.0001) and failure strain (R = -0.8; p < 0.0001). Male aortas had a higher failure load and failure tension than female aortas. Conclusion: The thoracic aorta has a higher strength and elasticity than the abdominal aorta. The elderly have weaker and stiffer aortas than the young. Male aortas are stronger than female aortas. (C) 2016 S. Karger AG, Basel
- Influence of Criteria Used in Determining Prevalence of Metabolic Syndrome (NCEP-ATPIII versus IDF) in Patients with Intermittent Claudication(2014) ZERATI, Antonio Eduardo; GUIMARAES, Ana Lucia Monteiro; CARVALHO, Heitor Andrei Miranda de; SAES, Glauco Fernandes; RAGAZZO, Luciana; WOLOSKER, Nelson; LUCCIA, Nelson deBackground: In patients with peripheral arterial disease, metabolic syndrome is associated with less favorable evolution of intermittent claudication. Methods: The aims of this study were to determine the prevalence of metabolic syndrome in claudicant patients using the IDF and the NCEP-ATPIII criteria, and to assess the level of agreement between the two definitions. Results: In this cross-sectional study, 200 consecutive patients with intermittent claudication (65% male) were classified with or without metabolic syndrome according both criteria. The kappa coefficient was used to assess the level of agreement. Prevalence of metabolic syndrome was 60.5% when using the NCEP-ATPIII definition and 66.5% when using the IDF definition (P = 0.088). Among men, the prevalence of MetS was 55.4% according to the NCEP-ATPIII and 63.1% according to the IDF (P = 0.110) and, among women, 70.0% according to the NCEP-ATPIII and 72.9% according to the IDF (P = 0.754). Conclusion: Although the prevalence rates were similar, the reliability analysis showed that the agreement was substantial only among women and just moderate in the total population and among men.
- Impact of the period of the day on all-cause mortality and major cardiovascular complications after arterial vascular surgeries(2023) ARTIOLI, Thiago; GUALANDRO, Danielle Menosi; CARDOZO, Francisco Akira Malta; ROJAS, Maria Carmen Escalante; CALDERARO, Daniela; YU, Pai Ching; CASELLA, Ivan Benaduce; LUCCIA, Nelson de; CARAMELLI, BrunoBackgroundConflicting results are reported about daytime variation on mortality and cardiac outcomes after non-cardiac surgeries. In this cohort study, we evaluate whether the period of the day in which surgeries are performed may influence all-cause mortality and cardiovascular outcomes in patients undergoing non-cardiac arterial vascular procedures. Methods1,267 patients who underwent non-cardiac arterial vascular surgeries between 2012 and 2018 were prospectively included in our cohort and categorized into two groups: morning (7 a.m. to 12 a.m., 79%) and afternoon/night (12:01 p.m. to 6:59 a.m. in the next day, 21%) surgeries. Primary endpoint was all-cause mortality within 30 days and one year. Secondary endpoints were the incidence of perioperative myocardial injury/infarction (PMI), and the incidence of major adverse cardiac events (MACE, including acute myocardial infarction, acute heart failure, arrhythmias, cardiovascular death) at hospital discharge. ResultsAfter adjusting for confounders in the multivariable Cox proportional regression, all-cause mortality rates at 30 days and one year were higher among those who underwent surgery in the afternoon/night (aHR 1.6 [95%CI 1.1-2.3], P = 0.015 and aHR 1.7 [95%CI 1.3-2.2], P < 0.001, respectively). Afternoon/night patients had higher incidence of PMI (aHR 1.4 [95%CI 1.1-1.7], P < 0.001). There was no significant difference in the incidence of MACE (aHR 1.3 [95%CI 0.9-1.7], P = 0.074). ConclusionsIn patients undergoing arterial vascular surgery, being operated in the afternoon/night was independently associated with increased all-cause mortality rates and incidence of perioperative myocardial injury/infarction.
- Comparison of high-sensitivity cardiac troponin I and T for the prediction of cardiac complications after non-cardiac surgery(2018) GUALANDRO, Danielle M.; PUELACHER, Christian; LURATIBUSE, Giovanna; LAMPART, Andreas; STRUNZ, Celia; CARDOZO, Francisco A.; YU, Pai C.; JAFFE, Allan S.; BARAC, Sanela; BOCK, Lukas; BADERTSCHER, Patrick; LAVALLAZ, Jeanne du Fay de; MARBOT, Stella; SAZGARY, Lorraine; BOLLIGER, Daniel; RENTSCH, Katharina; TWERENBOLD, Raphael; HAMMERER-LERCHER, Angelika; MELO, Edielle S.; CALDERARO, Daniela; DUARTE, Alberto J. S.; LUCCIA, Nelson de; CARAMELLI, Bruno; MUELLER, ChristianBackground: We aimed to directly compare preoperative high-sensitivity cardiac troponin (hs-cTn) I and T concentration for the prediction of major cardiac complications after non-cardiac surgery. Methods: We measured hs-cTnI and hs-cTnT preoperatively in a blinded fashion in 1022 patients undergoing non-cardiac surgery. The primary endpoint was a composite of major cardiac complications including cardiac death, cardiac arrest, myocardial infarction, clinically relevant arrhythmias, and acute heart failure within 30 days. We hypothesized that the type of surgery may impact on the predictive accuracy of hs-cTnI/T and stratified all analyses according to the type of surgery. Results: Major cardiac complications occurred in 108 (11%) patients, 58/243 (24%) patients undergoing vascular surgery and 50/779 (6%, P < .001) patients undergoing non-vascular surgery. Using regulatory-approved 99th percentile cut-off concentrations, preoperative hs-cTnI elevations were less than one-fifth as common as preoperative hs-cTnT elevations (P < .001). Among patients undergoing vascular surgery, preoperative hs-cTnI concentrations, but not hs-cTnT, was an independent predictor of cardiac complications (adjusted odds ratio (aOR) 1.5, 95% confidence interval (95% CI) 1.0-2.1). The area under the receiver-operating characteristics curve (AUC) was 0.67 (95% CI, 0.59-0.75) for hs-cTnI versus 0.59 (95% CI 0.51-0.67, P=.012) for hs-cTnT. In contrast, among patients undergoing non-vascular surgery both preoperative hs-cTnI and hs-cTnT were independent predictors of the primary endpoint (aOR 1.6, 95% CI 1.3-2.0, and aOR 3.0, 95% CI 2.0-4.6, respectively) and showed higher predictive accuracy (AUC 0.77, 95% CI, 0.71-0.83, and 0.79, 95% CI 0.73-0.85, P = ns). Conclusions: Preoperative hs-cTnI and hs-cTnT concentrations predict major cardiac complications after non-vascular surgery, while, in patients undergoing vascular surgery, hs-cTnI may have better accuracy.
- Common Carotid Artery Occlusion: A Single-Center Experience in 40 Cases(2016) BELCZAK, Sergio; MULATTI, Grace Carvajal; ABRAO, Sergio Ricardo; SILVA, Erasmo Simao da; AUN, Ricardo; PUECH-LEAO, Pedro; LUCCIA, Nelson deThe incidence of common carotid artery occlusion (CCAO) is approximately 3% in patients who undergo angiography for symptomatic cerebrovascular disease; however, few studies have reported on management of this condition. The objective of this article was to analyze risk factors, therapeutic options, and clinical benefits of surgical treatment at a hospital in the city of Sao Paulo, Brazil. Data were collected from medical records of 40 patients with CCAO who were treated from June 2002 to October 2013. Results were analyzed retrospectively. Most of the patients were men (63.0%), who were significantly younger than women. Most of the participants had hypertension (90.0%), and more than half had a history of smoking (52.5%). The mean number of coexisting comorbidities/risk factors was 2.9 +/- 1.0. Half of our sample had ipsilateral patent internal and external carotid artery, and 32.5% presented with an occluded internal carotid artery and a patent external artery. Patients with both an internal and an external occluded carotid artery (12.5%) were significantly older. Contralateral arteriosclerosis was observed in 65% of the patients, mainly represented by 50 to 90% stenosis. Most patients were symptomatic (67.5%), and hemiparesis was the most common symptom (55.0%) found. Most (77.5%) of the patients underwent the medical treatment; one out of three endovascular approaches failed. During the mean follow-up of 55 +/- 43 months (range, 2-136 months), 17.5% of the patients died within 4 days after surgical repair and after along 123 months of clinical follow-up. Coexisting comorbidities/risk factors were significantly associated with fatal outcomes, such as acute myocardial infarction. This study provides scientific evidences on treatment and outcomes of CCAO.
- Atualização e enfoque em operações vasculares arteriais da II diretriz de avaliação perioperatória da Sociedade Brasileira de Cardiologia(2013) MARQUES, Andre Coelho; BELLEN, Bonno Van; CARAMELLI, Bruno; PRESTI, Calogero; PINHO, Claudio; CALDERARO, Daniela; GUALANDRO, Danielle Menosi; CARVALHO, Francine Correa de; CARMO, Gabriel Assis Lopes do; CASELLA, Ivan Benaduce; FORNARI, Luciana S.; VACANTI, Luciano Janussi; VIEIRA, Marcelo Luiz Campos; MONACHINI, Maristela C.; LUCCIA, Nelson de; YU, Pai Ching; FARSKY, Pedro Silvio; HEINISCH, Roberto Henrique; GUALANDRO, Sandra F. Menosi; MATHIAS JR., Wilson
- Analysis of risk factors and diseases associated with atherosclerosis in the progression of carotid artery stenosis(2016) BATAGINI, Nayara Cioffi; SILVA, Erasmo Simao da; PINTO, Carlos A. V.; PUECH-LEAO, Pedro; LUCCIA, Nelson deObjective The objective of this study was to analyze the roles of demographic, clinical, and laboratory factors on the progression of atherosclerotic stenosis in carotid bifurcation. It was based on prospective information from records entered on a specific application form for follow-up outpatients at a tertiary university service. Methods Consecutive symptomatic and asymptomatic patients (n=210) who had undergone more than one carotid duplex scan but no surgical intervention were selected for the analysis. The patients were divided into two groups: patients whose duplex scans did not show bilateral progression of carotid stenosis and patients with carotid stenosis progression of <50%, 50%-69%, or >70%. Clinical and demographic parameters were compared between groups. Results Group II levels of plasma urea (51.627.8mg/dl) and fibrinogen (493.2 +/- 113.3mg/dl) were higher than the Group I levels (43.0 +/- 14.9mg/dl and 441.3 +/- 106.7mg/dl, respectively) with statistical significance (p urea=0.013 and p fibrinogen=0.018). Paradoxically, the mean body mass index was higher in Group I (26.4 +/- 4.6kg/m(2)) than in Group II (24.6 +/- 3.9kg/m(2); p=0.02). Conclusions Traditional risk factors for the development of atherosclerosis in a carotid bifurcation are important but not unique. Metabolic and inflammatory factors can contribute to disease progression.