LENINE GARCIA BRANDAO
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cirurgia, Faculdade de Medicina - Docente
LIM/28 - Laboratório de Cirurgia Vascular e da Cabeça e Pescoço, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/28 - Laboratório de Cirurgia Vascular e da Cabeça e Pescoço, Hospital das Clínicas, Faculdade de Medicina - Líder
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- Successful parathyroid tissue autograft after 3 years of cryopreservation: a case report(2014) LEITE, Ana K. N.; JUNIOR, Climerio P. do N.; ARAP, Sergio S.; MASSONI, Ledo; LOURENCO, Delmar M.; BRANDAO, Lenine Garcia; MONTENEGRO, Fabio L. de M.After a total parathyroidectomy, well-established protocols for the cryopreservation of parathyroid tissue and for the delayed autograft of this tissue exist, especially in cases of secondary hiperparathyroidism (HPT) or familial or sporadic parathyroid hyperplasia. Although delayed autografts are effective, the published success rates vary from 10% to 83%. There are numerous factors that influence the viability, and therefore the success, of an autograft, including cryopreservation time. Certain authors believe that the tissue is only viable for 24 months, but there is no consensus on how long the parathyroid tissue can be preserved. A 63-year-old male who was diagnosed with sporadic multiple endocrine neoplasia type 1 and primary hyperparathyroidism, and was submitted to a total parathyroidectomy and an autograft in the forearm. The implant failed, and the patient developed severe hypoparathyroidism in the months following the surgery. Thirty-six months after the total parathyroidectomy, the cryopreserved autograft was successfully transplanted, and hypoparathyroidism was reversed (most recent systemic parathyroid hormone, PTH, of 36 pg/mL, and total calcium of 9.1 mg/dL; no oral calcium supplementation). The case presented here indicates that cryopreserved parathyroid tissue may remain viable after 24 months in storage, and may retain the capacity to reverse permanent postsurgical hypoparathyroidism. These data provide reasonable evidence that the time limit for cryopreservation remains undetermined and that additional research would be valuable.
- Effects of Time on Ultrastructural Integrity of Parathyroid Tissue Before Cryopreservation(2011) BARREIRA, Carlos Eduardo Santa Ritta; CERNEA, Claudio Roberto; BRANDAO, Lenine Garcia; CUSTODIO, Melani Ribeiro; CALDINI, Elia Tamaso Espin Garcia; MONTENEGRO, Fabio Luiz de MenezesCryopreservation of parathyroid tissue is used in the surgical treatment of secondary hyperparathyroidism. After surgical resection, the tissue is temporarily maintained in a cell culture solution until it arrives at the specialized laboratory where the cryopreservation process will take place. The present study evaluates the time that the human hyperplastic parathyroid gland tissue can wait before cryopreservation, based on parathyroid cell ultrastructural integrity. This prospective study included 11 patients who underwent total parathyroidectomy with heterotopic autotransplantation and cryopreservation of parathyroid tissue fragments. Part of the tissue was kept in cell culture solution at 4A degrees C. Five time periods between 2 and 24 h were defined, and parathyroid fragments were kept in the solution for that length of time. At the end of each period, the fragments were removed from the transport solution, fixed, and prepared for ultrathin sections. Of the 11 cases studied, 10 showed ultrastructural findings consistent with cellular viability in tissue fragments that remained in the transport solution up to 12 h. Electron microscopy revealed that cell adhesion and the integrity of plasma membranes, nuclei, and mitochondria were preserved in one case for up to 24 h. Changes in mitochondrial structure represented the most constant ultrastructural damage seen in the cases studied, in addition to the presence of edema and cell vacuoles. Analysis of the ultrastructure of hyperplastic parathyroid gland tissue showed that ultrastructural integrity was in most cases properly maintained in fragments stored up to 12 h in a cell culture solution at 4A degrees C.
article 5 Citação(ões) na Scopus Transitory increase in creatinine levels after parathyroidectomy: evidence of another action of the parathyroid glands?(2011) MONTENEGRO, Fabio M.; BRANDAO, Lenine G.; FERREIRA, Gustavo F.; LOURENCO JR., Delmar M.; MARTIN, Regina M.; CUNHA-NETO, Malebranche B.; HELOU, Claudia B.; TOLEDO, Sergio A.; CORDEIRO, Anoi C.; IANHEZ, Luiz E.Objective: Little information is available on glomerular function changes after surgical treatment of primary hyperparathyroidism. The acute effects of some head and neck operations on renal function were studied. Materials and methods: Retrospective analysis of changes in creatinine levels and estimated glomerular filtration rate (eGFR) after surgery. Preoperative values were compared with values available until 72 hours after the operation. Results: In tertiary hyperparathyroidism, mean preoperative and postoperative eGFR values were 57.7 mL/min and 40.8 mL/min (p < 0.0001), respectively. A similar decrease was observed after parathyroidectomy for primary hyperparathyroidism, from 85.4 mL/min to 64.3 mL/min (p < 0.0001). After major head and neck procedures, there was a slight increase in eGFR (from 94.3 mL/min to 105.4 mL/min, p = 0.002). Conclusions: Parathyroidectomy may be followed by a transient decrease in eGFR that is not often observed in other head and neck operations. Arq Bras Endocrinol Metab. 2011;55(4):249-55- Supernumerary parathyroid glands in hyperparathyroidism associated with multiple endocrine neoplasia type 1(2012) D'ALESSANDRO, Andre Fernandes; MONTENEGRO, Fabio Luiz de Menezes; BRANDAO, Lenine Garcia; LOURENCO JR., Delmar Muniz; TOLEDO, Sergio de Almeida; CORDEIRO, Anoi CastroObjective: To evaluate frequency, anatomic presentation, and quantities of supernumerary parathyroids glands in patients with primary hyperparathyroidism (HPT1) associated with multiple endocrine neoplasia type 1 (MEN1), as well as the importance of thymectomy, and the benefits of localizing examinations for those glands. Methods: Forty-one patients with hyperparathyroidism associated with MEN1 who underwent parathyroidectomy between 1997 and 2007 were retrospectively studied. The location and number of supernumerary parathyroids were reviewed, as well as whether cervical ultrasound and parathyroid SESTAMIBI scan (MIBI) were useful diagnostic tools. Results: In five patients (12.2%) a supernumerary gland was identified. In three of these cases (40%), the glands were near the thyroid gland and were found during the procedure. None of the imaging examinations were able to detect supernumerary parathyroids. In one case, only the pathologic examination could find a microscopic fifth gland in the thymus. In the last case, the supernumerary gland was resected through a sternotomy after a recurrence of hyperparathyroidism, ten years after the initial four-gland parathyroidectomy without thymectomy. MIBI was capable of detecting this gland, but only in the recurrent setting. Cervical ultrasound did not detect any supernumerary glands. Conclusion: The frequency of supernumerary parathyroid gland in the HPT1/MEN1 patients studied (12.2%) was significant. Surgeons should be aware of the need to search for supernumerary glands during neck exploration, besides the thymus. Imaging examinations were not useful in the pre-surgical location of these glands, and one case presented a recurrence of hyperparathyroidism.