PAULO PUGLIA JUNIOR
Índice h a partir de 2011
6
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Radiologia, Hospital das Clínicas, Faculdade de Medicina - Médico
15 resultados
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Agora exibindo 1 - 10 de 15
- Human immunodeficiency virus-associated vasculopathy with CNS compartmentalization of HIV-1(2015) GUEDES, Bruno Fukelmann; GOMES, Helio Rodrigues; LUCATO, Leadro Tavares; PUGLIA JR., Paulo; NITRINI, Ricardo; CASTRO, Luiz Henrique Martins
- Juvenile angiofibroma: major and minor complications of preoperative embolization(2012) OGAWA, Alex Itar; FORNAZIERI, Marco Aurelio; SILVA, Leonardo Victor Espana Rueda da; PINNA, Fabio de Rezende; VOEGELS, Richard Louis; SENNES, Luis Ubirajara; PUGLIA JUNIOR, Paulo; CALDAS, Jose Guilherme Mendes PereiraIntroduction: Juvenile angiofibromas (JA) are highly vascular, benign tumours for which surgery is the treatment of choice. In most services, embolisation is performed prior to resection. Nevertheless, there are few data on the complications of preoperative embolisation for JA. Aim: To describe major and minor complications of preoperative embolisation in a 32-year experience of patients undergoing surgical resection of JA at a tertiary hospital. Methods: Retrospective chart review study of 170 patients who underwent surgical resection of JA at a tertiary hospital between September 1976 and July 2008. Results: All patients were male. Age ranged from 9 to 26 years. Ninety-one patients had no complications after embolisation. Overall, 105 complication events occurred of which four major and 101 minor. Conclusion: In our series, preoperative embolisation for JA produced no irreversible complications and no aesthetic or functional sequelae. The vast majority of complications were transient and amenable to clinical management.
- Surgical Treatment of Extracranial Arteriovenous Malformations after Multiple Embolizations: Outcomes in a Series of 31 Patients(2015) GOLDENBERG, Dov C.; HIRAKI, Patricia Y.; CALDAS, Jose Guilherme; PUGLIA, Paulo; MARQUES, Tatiana M.; GEMPERLI, RolfBackground: Surgical resection after embolization is the most accepted approach to treating arteriovenous malformations. The authors analyzed the outcome of surgically treated patients and how surgical resection was influenced by multiple embolizations. Methods: Thirty-one patients were included from January of 2000 to December of 2012. The mean patient age was 24.9 years. Anatomical involvement, definition of limits, functional impairment, number of embolizations, type of resection, reconstruction method, blood transfusion, and hospital stay were evaluated. Morbidity, mortality, and regrowth rates and need for additional procedures were evaluated. Results: Lesions were preferentially located at the orbits, cheeks, and lips. The number of embolizations per patient increased with lesion complexity. In 22 cases, total excision was accomplished, and in nine, subtotal resections were performed to favor function. After multiple embolizations, better lesion identification was observed. Primary closure was performed in 20 cases, local flaps were performed in seven cases, axial flaps were performed in two patients, and free flaps were performed in two cases. There were no deaths. Regrowth rates were influenced by limits between arteriovenous malformations and surrounding tissues (15.8 percent of cases with precise limits versus 58.3 percent of lesions with imprecise limits; p = 0.021) and by type of resection (18.2 percent of cases after total resection versus 66.7 percent after subtotal resections; p = 0.015). Conclusions: Multiple therapeutic embolizations seem to increase safety in the treatment of arteriovenous vascular malformations and suggest an additional positive effect besides bleeding control. Preoperative definition of limits and establishment of conditions for total resection are critical to determine management and risk of regrowth.
- Pearls & Oy-sters: Symptomatic innominate artery disease(2016) GUEDES, Bruno F.; VALERIANO, Rafael P.; PUGLIA JR., Paulo; ARANTES, Paula R.; CONFORTO, Adriana B.A 64-year-old man presented to the emergency department with left-sided weakness and speech impairment upon awakening. He had a history of multiple myocardial infarctions and had undergone coronary angioplasty and coronary artery bypass graft surgery 1 year previously. He was a heavy smoker and had arterial hypertension. He was taking aspirin 100 mg QD, clopidogrel 75 mg QD, simvastatin 40 mg QD, and enalapril 5 mg BID.
bookPart Neurorradiologia Vascular Intervencionista nas Urgências(2013) PUGLIA JUNIOR, Paulo; CALDAS, José Guilherme Mendes Pereira- Contralateral ictal electrographic involvement is associated with decreased memory performance in unilateral mesial temporal sclerosis(2015) PASSARELLI, Valmir; CASTRO-LIMA FILHO, Humberto; ADDA, Carla C.; PRETURLON-SANTOS, Ana P.; VALERIO, Rosa M.; JORGE, Carmen L.; PUGLIA- JR., Paulo; LYRA, Katarina; OTADUY, Maria G.; WEN, Hung-Tzu; CASTRO, Luiz H.Purpose: To evaluate the effect of contralateral electrographic involvement on memory performance (measured by neuropsychological and Wada memory testing) in patients with epilepsy associated with unilateral mesial temporal sclerosis (MTS). Methods: We studied 51 patients with medically-refractory epilepsy associated with unilateral MTS (27 women, 30/51, left MTS) submitted to prolonged non-invasive video-EEG monitoring and bilateral Wada testing. According to ictal electrographic involvement, patients were classified as: Contralateral ictal involvement, when one or more seizures evolved with rhythmic activity in the temporal region contralateral to the MTS or exclusive ipsilateral ictal involvement if all seizures showed ictal EEG activity exclusively on the MTS side. Wada testing involved a twelve-item memory paradigm. Wada memory asymmetry score was calculated for each patient subtracting the number of recalled items after injection on the lesion side from the number of recalled items after contralateral injection. Expected asymmetry (EA) was considered if Wade memory asymmetry > 0, and Symmetrical or Reversed memory asymmetry (S-RA) when <= 0. Neuropsychological testing was applied in the 51 patients and in 40 healthy controls. Verbal Memory was evaluated with the Rey Auditory Verbal Learning Test (RAVLT), considering the number of recalled items on immediate recall after the initial five consecutive encoding trials (RAVLT 6), a post-interference delayed (30 min) recall (RAVLT 7), and recall after 7 days. Nonverbal memory was tested with Wechsler Memory Scale-III (WMS-III) Faces subtests 1 e 2. Results: Groups did not differ in demographic, clinical and video-EEG monitoring variables. S-RA was observed more frequently in the group with contralateral ictal involvement (57.2% vs. 27.0%; p: 0.03). Logistic regression analysis considering demographic, clinical, hippocampal volume and video-EEG monitoring variables showed contralateral ictal involvement as the only independent variable associated with S-RA (coefficient = 1.32, p = 0.029, odds ratio 3.77; 95% CI 1.1-12.47). Additionally, the patient group with contralateral ictal EEG involvement displayed worse verbal and nonverbal memory scores compared to healthy controls. Conclusion: In this cohort of unilateral MTS patients, contralateral ictal involvement was associated with decreased memory performance on Wada and on neuropsychological testing.
- Endovascular management of acute epidural hematomas: clinical experience with 80 cases(2018) PERES, Carlos Michel A.; CALDAS, Jose Guilherme M. P.; PUGLIA JR., Paulo; ANDRADE, Almir F. de; SILVA, Igor A. F. da; TEIXEIRA, Manoel J.; FIGUEIREDO, Eberval G.OBJECTIVE Small acute epidural hematomas (EDHs) treated conservatively carry a nonmeasurable risk of late enlargement due to middle meningeal artery (MMA) lesions. Patients with EDHs need to stay hospitalized for several days, with neurological supervision and repeated CT scans. In this study, the authors analyzed the safety and efficacy of the embolization of the involved MMA and associated lesions. METHODS The study group consisted of 80 consecutive patients harboring small-to medium-sized EDHs treated by MMA embolization between January 2010 and December 2014. A literature review cohort was used as a control group. RESULTS The causes of head injury were falls, traffic-related accidents (including car, motorcycle, and pedestrian vs vehicle accidents), and assaults. The EDH topography was mainly temporal (lateral or pole). Active contrast leaking from the MMA was seen in 57.5%; arteriovenous fistulas between the MMA and diploic veins were seen in 10%; and MMA pseudoaneurysms were found in 13.6% of the cases. Embolizations were performed under local anesthesia in 80% of the cases, with N-butyl-2-cyanoacrylate, polyvinyl alcohol particles, or gelatin sponge (or a combination of these), obtaining MMA occlusion and complete resolution of the vascular lesions. All patients underwent follow-up CT scans between 1 and 7 days after the embolization. In the 80 cases in this series, no increase in size of the EDH was observed and the clinical evolution was uneventful, without Glasgow Coma Scale score modification after embolization and with no need for surgical evacuation. In contrast, the control cohort from the literature consisted of 471 patients, 82 (17.4%) of whom shifted from conservative treatment to surgical evacuation. CONCLUSIONS This study suggests that MMA embolization is a highly effective and safe method to achieve size stabilization in nonsurgically treated acute EDHs.
- Takayasu's arteritis and cerebral venous thrombosis: comorbidity or coincidence?(2012) NOGUEIRA, Ricardo de Carvalho; OLIVEIRA, Emanoela Faro de; CONFORTO, Adriana Bastos; BOR-SENG-SHU, Edson; PUGLIA, Paulo; LUCATO, Leandro Tavares; MARCHIORI, Paulo Euripedes
- High accuracy of bilateral and simultaneous petrosal sinus sampling with desmopressin for the differential diagnosis of pediatric ACTH-dependent Cushing's syndrome(2020) CAVALCANTE, Lara Bessa Campelo Pinheiro; FREITAS, Thais Castanheira; MUSOLINO, Nina Rosa Castro; CESCATO, Valter Angelo Sperling; SILVA, Gilberto Ochman; FRAGOSO, Maria Candida Barisson Villares; JR, Paulo Puglia; BRONSTEIN, Marcello Delano; MACHADO, Marcio CarlosPurpose To analyze the bilateral and simultaneous petrosal sinus sampling (BIPSS) in a subgroup of children and adolescents with ACTH-dependent Cushing's syndrome (ADCS) Methods Retrospective study in a tertiary reference center. From 1993 and 2017, 19 children and adolescents (PED) were submitted to the BIPSS, median age of 14 years (range 9-19 years), 53% were males, 18 had Cushing's disease (CD) and one had ectopic ACTH syndrome (EAS). All procedures were performed with 10 mu g of intravenous desmopressin. Results The catheter positioning was successful in all cases. The central ACTH gradient was met in 17/19 cases. At baseline, central gradient occurred in 16/19 (84%) with gradient values of 7.2 +/- 6.0. After stimulation, there was an increase in the center-periphery gradient values (33.6 +/- 44.3). In one case, central gradient was defined only after stimulation. Two cases presented without a central gradient; one case of CD with a false-negative and one EAS case. Lateralization occurred in all cases with a central gradient. Confirmation of the tumor location presumed by the procedure with the surgical description occurred in 60% of the cases. The BIPSS in this PED subgroup of ADCS presented a sensitivity of 94.4% and specificity of 100%. There were no complications of the procedure. Conclusion In a series of children and adolescents with ADCS, BIPSS was safe and highly accurate in defining the central to peripheral ACTH gradient using desmopressin as secretagogue. Nevertheless, there was a limited value of the ACTH-gradient between the petrosal sinuses for the tumor location.
- Dural arteriovenous fistula and cerebral venous thrombosis(2015) CONFORTO, Adriana Bastos; NADER, Saulo Nardy; PUGLIA JUNIOR, Paulo; YAMAMOTO, Fabio Iuji; GONÇALVES, Marcia Rubia Rodrigues; VASCONCELOS, Fernando Roberto Gondim C. de; SANTOS, Germana Titoneli dos