ROBSON LUIS OLIVEIRA DE AMORIM
Projetos de Pesquisa
Unidades Organizacionais
LIM/62 - Laboratório de Fisiopatologia Cirúrgica, Hospital das Clínicas, Faculdade de Medicina
12 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 12
- Computed Tomography Angiography for Detection of Middle Meningeal Artery Lesions Associated with Acute Epidural Hematomas(2014) PAIVA, Wellingson Silva; ANDRADE, Almir Ferreira; AMORIM, Robson Luis Oliveira De; BOR-SENG-SHU, Edson; GATTAS, Gabriel; NEVILLE, Iuri Santana; CALDAS, Jose Guilherme; FIGUEIREDO, Eberval Gadelha; TEIXEIRA, Andmanoel JacobsenBackground. The natural history of traumatic aneurysms of the middle meningeal artery (MMA) is not well known, but patients with these lesions are more likely to have delayed bleeds. In this paper, we described a series of patients with epidural hematoma who underwent angiotomography (CTA) for MMA vascular lesion diagnosis. Methods. Eleven patients admitted to our emergency unit with small acute epidural hematoma were prospectively studied. All patients with temporal acute epidural hematomas underwent CTA and cerebral angiogram at our institution for diagnosis of posttraumatic lesions of middle meningeal artery. The findings of angiotomography and digital angiography were reviewed by radiologist and angiographers, respectively, to ensure that the lesions were readily diagnosed without knowing the results of angiotomography and to compare CTA findings with standard angiogram. Results. The causes of head injury were traffic accidents, falls, and aggression. Three of these patients presented traumatic MMA pseudoaneurysm. CT angiography was able to diagnose all of them, with dimensions ranging from 1.5 to 2.8 mm. Conventional angiography confirmed the findings of CT angiography, and the lesions presented with similar dimensions at both methods. Conclusions. We believe that angiotomography can be a useful technique for diagnosis of vascular lesion associated with small epidural hematoma.
- Repetitive TMS does not improve cognition in patients with TBI(2019) NEVILLE, Iuri Santana; ZANINOTTO, Ana Luiza; HAYASHI, Cintya Yukie; RODRIGUES, Priscila Aparecida; GALHARDONI, Ricardo; ANDRADE, Daniel Ciampi de; BRUNONI, Andre Russowsky; AMORIM, Robson L. Oliveira; TEIXEIRA, Manoel Jacobsen; PAIVA, Wellingson SilvaObjective To determine whether high-frequency repetitive transcranial magnetic stimulation (rTMS) improves cognition in patients with severe traumatic brain injury. Methods A single-center, randomized, double-blind, placebo-controlled study of rTMS was conducted in patients aged 18-60 years with chronic (> 12 months postinjury) diffuse axonal injury (DAI). Patients were randomized to either a sham or real group in a 1:1 ratio. A 10-session rTMS protocol was used with 10-Hz stimulation over the left dorsolateral prefrontal cortex (DLPFC). Neuropsychological assessments were performed at 3 time points: at baseline, after the 10th rTMS session, and 90 days after intervention. The primary outcome was change in executive function evaluated using the Trail Making Test Part B. Results Thirty patients with chronic DAI met the study criteria. Between-group comparisons of performance on TMT Part B at baseline and after the 10th rTMS session did not differ between groups (p = 0.680 and p = 0.341, respectively). No significant differences were observed on other neuropsychological tests. No differences in adverse events between treatment groups were observed. Conclusions Cognitive function in individuals with chronic DAI is not improved by high-frequency rTMS over the left DLPFC, though it appears safe and well-tolerated in this population.
- Safety and costs analysis of early hospital discharge after brain tumour surgery: a pilot study(2020) NEVILLE, Iuri Santana; URENA, Francisco Matos; QUADROS, Danilo Gomes; SOLLA, Davi J. F.; LIMA, Mariana Fontes; SIMOES, Claudia Marquez; VICENTIN, Eduardo; RIBEIRO JR., Ulysses; AMORIM, Robson Luis Oliveira; PAIVA, Wellingson Silva; TEIXEIRA, Manoel JacobsenBackground A daily algorithm for hospital discharge (DAHD) is a key point in the concept of Enhanced Recovery After Surgery (ERAS) protocol. We aimed to evaluate the length of stay (LOS), rate of complications, and hospital costs variances after the introduction of the DAHD compared to the traditional postoperative management of brain tumour patients. Methods This is a cohort study with partial retrospective data collection. All consecutive patients who underwent brain tumour resection in 2017 were analysed. Demographics and procedure-related variables, as well as clinical outcomes, LOS and healthcare costs within 30 days after surgery were compared in patients before/pre-implementation and after/post-implementation the DAHD, which included: stable neurological examination; oral feeding without aspiration risk; pain control with oral medications; no intravenous medications. The algorithm was applied every morning and discharge was considered from day 1 after surgery if criteria was fulfilled. The primary outcome (LOS after surgery) analysis was adjusted for the preoperative performance status on a multivariable logistic regression model. Results A total of 61 patients were studied (pre-implementation 32, post-implementation 29). The baseline demographic characteristics were similar between the groups. After the DAHD implementation, LOS decreased significantly (median 5 versus 3 days; p = 0.001) and the proportion of patients who were discharged on day 1 or 2 after surgery increased (44.8% vs 3.1%; p < 0.001). Major and minor complications rates, readmission rate, and unplanned return to hospital in 30-day follow-up were comparable between the groups. There was a significant reduction in the median costs of hospitalization in DAHD group (US$2135 vs US$2765, p = 0.043), mainly due to a reduction in median ward costs (US$922 vs US$1623, p = 0.009). Conclusions Early discharge after brain tumour surgery appears to be safe and inexpensive. The LOS and hospitalization costs were reduced without increasing readmission rate or postoperative complications.
- Transcranial Direct Current Stimulation for Post-Concussion Syndrome: Study Protocol for a Randomized Crossover Trial(2017) AMORIM, Robson Luis Oliveira de; BRUNONI, Andre Russowsky; OLIVEIRA, Mirian Akiko Furutani de; ZANINOTTO, Ana Luiza Costa; NAGUMO, Marcia Mitie; GUIRADO, Vinicius Monteiro de Paula; NEVILLE, Iuri Santana; BENUTE, Glaucia Rosana Guerra; LUCIA, Mara Cristina Souza de; PAIVA, Wellingson Silva; ANDRADE, Almir Ferreira de; TEIXEIRA, Manoel JacobsenBackground: Mild traumatic brain injury (MTBI) represents 70-80% of all treated brain injuries. A considerable proportion of MTBI patients experience post-concussion symptoms for a prolonged period after MTBI, and these symptoms are diagnosed as persistent post-concussion syndrome (PPCS). PPCS is defined as a range of physical, cognitive, and emotional symptoms. However, memory and executive dysfunction seems to be one of the most debilitating symptoms. Recently, non-invasive brain stimulation has been studied as a potential treatment method for traumatic brain injury (TBI) patients. Therefore, our primary goal is to verify the effects of transcranial direct current stimulation (tDCS) in patients with PPCS who demonstrate cognitive deficits in long-term episodic memory, working memory, and executive function following MTBI. Methods/design: This is a randomized crossover trial of patients with a history of MTBI with cognitive deficits in memory and executive function. Thirty adult patients will be randomized in a crossover manner to receive three weekly sessions of anodal tDCS (2mA) at left dorsolateral prefrontal cortex, left temporal cortex, and sham stimulation that will be performed at 7-day intervals (washout period). The clinical diagnosis of PPCS will be determined using the Rivermead Post-Concussion Symptoms Questionnaire. Patients who meet the inclusion criteria will be assessed with a neuropsychological evaluation. A new battery of computerized neuropsychological tests will be performed before and immediately after each stimulation. Statistical analysis will be performed to determine trends of cognitive improvement. Discussion: There is paucity of studies regarding the use of tDCS in TBI patients, and although recent results showed controversial data regarding the effects of tDCS in such patients, we will address specifically patients with PPCS and MTBI and no brain abnormalities on CT scan other than subarachnoid hemorrhage. Moreover, due to the missing information on literature regarding the best brain region to be studied, we will evaluate two different regions to find immediate effects of tDCS on memory and executive dysfunction.
- Early Surgery Does Not Seem to Be a Pivotal Criterion to Improve Prognosis in Patients with Frontal Depressed Skull Fractures(2014) NEVILLE, Iuri Santana; AMORIM, Robson Luis; PAIVA, Wellingson Silva; SANDERS, Felipe Hada; TEIXEIRA, Manoel Jacobsen; ANDRADE, Almir Ferreira deIntroduction. There has been much debate about the ideal timing of surgery of frontal depressed skull fractures (DSF). In this paper, we assess whether timing of surgery may have influenced outcome. Methods. Retrospective cohort of 40 consecutive patients with frontal DSF who underwent surgical treatment over a 36-month period. The patients were divided into early surgery group (ESG) which were operated within 24 h and delayed surgery group (DSG). Results. The population comprised 39 (97.50%) men and the mean age was 27.9 years (range, 2-81 yr). There was no difference of age (P = 0.53), gender male (P = 1.00), presence of focal lesion on head CT (P = 0.89), hypotension (P = 0.28), and hypoxia (P = 0.15). Mean Glasgow Coma Scale (GCS) was significantly lower in patients of ESG than DSG (8.75 and 11.7, resp., P = 0.02). There was no difference between the groups in relation to death (P = 0.13), unfavourable outcome (P = 0.41), late posttraumatic epilepsy (P = 0.64), and smell-and-taste disturbances (P = 1.00). Only one patient (3.5%) evolved meningitis during follow-up. Conclusion. We found no difference between the ESG and DSG in respect to death, unfavourable outcome, LPE, and STD.
- Repetitive Transcranial Magnetic Stimulation (rTMS) for the cognitive rehabilitation of traumatic brain injury (TBI) victims: study protocol for a randomized controlled trial(2015) NEVILLE, Iuri Santana; HAYASHI, Cintya Yukie; HAJJ, Simone Alves El; ZANINOTTO, Ana Luiza Costa; SABINO, Juliana Perez; SOUSA JR., Leonardo Moura; NAGUMO, Marcia Mitie; BRUNONI, Andre Russowsky; SHIEH, Barbara Dal Forno Silva; AMORIM, Robson Luis Oliveira; TEIXEIRA, Manoel Jacobsen; PAIVA, Wellingson SilvaBackground: Repetitive Transcranial Magnetic Stimulation (rTMS) has been proposed as a new tool in neurological rehabilitation of victims of traumatic brain injury (TBI). However, its usefulness to treat this condition has never been tested rigorously. The primary goal is to conduct a study protocol to determine whether rTMS used to cognitive rehabilitation of victims of TBI with diffuse axonal injury (DAI) is a safe instrument and if it enhances cognitive function recovery. Methods: Double-blind randomized controlled trial of patients with diffuse axonal injury. Thirty-six patients will be randomized to either an active coil group or sham group in a 1: 1 ratio. rTMS protocol: 10 sessions of high-frequency rTMS (10 Hz) over the left dorsolateral prefrontal cortex (DLPFC). Cortical Excitability measures will be obtained. Neuropsychological evaluations will be performed 1 week before, 1 week and 3 months after rTMS. There are 2 study hypotheses: (1) rTMS over the left DLPFC in patients with DAI will improve cognitive function and (2) whether rTMS is safe in TBI patients. Discussion: This study evaluates the immediate and delayed effects of rTMS over the DLPFC on the cognitive domain of patients with DAI following TBI. rTMS has shown good results in treating major depression and may be promising for patients with TBI. As such, the results of this study can greatly modify the cognitive rehabilitation strategies.
conferenceObject Safety and Costs Analysis of Early Hospital Discharge after Brain Tumor Surgery: A Pilot Study(2020) SANTOS, Alexandra; NEVILLE, Iuri; URENA, Francisco; QUADROS, Danilo; SOLLA, Davi; LIMA, Mariana; CAVALHEIRO, Vitor; AMORIM, Robson; PAIVA, Wellingson; TEIXEIRA, ManoelconferenceObject EARLY SURGERY FOR FRONTAL DEPRESSED SKULL FRACTURE IS NOT ASSOCIATED WITH BETTER OUTCOME(2014) NEVILLE, Iuri S.; AMORIM, Robson Luis Oliveira de; PAIVA, Wellingson Silva; SANDERS, Felipe Hada; SILVA, Vinicius Trindade Gomes da; MENENDEZ, Djalma Felipe S.; ANDRADE, Almir Ferreira de- Monoblock external ventricular drainage system in the treatment of patients with acute hydrocephalus: A pilot study(2014) ANDRADE, Almir Ferreira de; PAIVA, Wellingson Silva; NEVILLE, Iuri Santana; NOLETO, Gustavo Sousa; ALVES JUNIOR, Aderaldo; SANDON, Luiz Henrique Dias; BOR-SENG-SHU, Edson; AMORIM, Robson Luis; TEIXEIRA, Manoel JacobsenBackground: Infection is a major complication in patients undergoing external ventricular drainage (EVD). Our study aimed to evaluate the incidence of infection in a series with the monoblock EVD system. Material/Methods: 46 patients treated with EVD at our emergency department were analyzed prospectively to research the incidence of infections with a new EVD system. Results: The average rate of infection was 8.7%. When we stratified the patients according to the exclusive use of EVD without craniotomies, we identified a reduction in the overall incidence of ventriculitis from 8.7% to 2.3%. Age, etiology, and the presence of ventricular bleeding were not statistically significant risk factors. Conclusions: Despite the small sample examined in this study, we believe that the monoblock system is a simple, inexpensive device that reduces accidental disconnection of the system.
- Comprehensive cognitive and cerebral hemodynamic evaluation after cranioplasty(2014) COELHO, Fernanda; OLIVEIRA, Arthur Maynart; PAIVA, Wellingson Silva; FREIRE, Fabio Rios; CALADO, Vanessa Tome; AMORIM, Robson Luis; NEVILLE, Iuri Santana; ANDRADE, Almir Ferreira de; BOR-SENG-SHU, Edson; ANGHINAH, Renato; TEIXEIRA, Manoel JacobsenDecompressive craniectomy is an established procedure to lower intracranial pressure and can save patients' lives. However, this procedure is associated with delayed cognitive decline and cerebral hemodynamics complications. Studies show the benefits of cranioplasty beyond cosmetic aspects, including brain protection, and functional and cerebrovascular aspects, but a detailed description of the concrete changes following this procedure are lacking. In this paper, the authors report a patient with trephine syndrome who underwent cranioplasty; comprehensive cognitive and cerebral hemodynamic evaluations were performed prior to and following the cranioplasty. The discussion was based on a critical literature review.