MARCOS GIANNETTI MACHADO
Índice h a partir de 2011
6
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
5 resultados
Resultados de Busca
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- 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.
- 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.
- Long-Term Followup of a Large Cohort of Patients with Ovotesticular Disorder of Sex Development(2014) SIRCILI, Maria Helena Palma; DENES, Francisco Tibor; COSTA, Elaine Maria Frade; MACHADO, Marcos Giannetti; INACIO, Marlene; SILVA, Rosana Barbosa; SROUGI, Miguel; MENDONCA, Berenice Bilharinho; DOMENICE, SorahiaPurpose: We present the followup of a large cohort of patients with ovotesticular disorder of sex development treated at a single tertiary center. Materials and Methods: We reviewed the records of 20 patients with ovotesticular disorder of sex development. We retrospectively evaluated clinical and surgical characteristics. A prospective study was also performed, including evaluation of surgical results, gonadal function, sexual activity and voiding symptoms of these patients during adulthood. Results: All patients had ambiguous genitalia, including 18 with a 46, XX karyotype and 2 with a 46, XX/46, XY karyotype. Gender assignment at birth was male in 13 patients and female in 7. Three females were later reassigned to the male gender. Bilateral gonadectomy was performed in 10 patients. Testicular tissue was preserved in 8 males and ovarian tissue was preserved in 2 females. Average followup was 25 years (range 4 to 46). Puberty started spontaneously in 14 patients between ages 11 and 14 years. Seven patients showed spontaneous puberty after conservative gonadal surgery and 4 required hormonal replacement during adulthood. The most frequent complications in males were urethral fistula in 6 and late urethral stenosis in 3. Two patients with urethral stenosis had symptoms 10 years postoperatively. One female presented with temporary dyspareunia. In adulthood 8 males and 2 females reported sexual activity. All male patients reported orgasm and 2 reported ejaculation. Conclusions: Male gender assignment was more prevalent. Long-term followup revealed adequate pubertal development and sexual activity. Complications involving the urethra developed frequently in male patients.
- GONADAL TUMOR DETECTION AND TREATMENT IN PATIENTS WITH DISORDER OF SEX DEVELOPMENT (DSD): LONG-TERM ONCOLOGICAL OUTCOMES(2012) OLIVEIRA, Lorena; MACHADO, Marcos; MARCHINI, Giovanni; TAVARES, Alessandro; SIRCILI, Maria Helena; DOMENICE, Sorahia; COSTA, Elaine; DENES, Francisco; MENDONCA, Berenice; SROUGI, Miguel
- Laparoscopic ureteropyeloanastomosis in the treatment of duplex system(2012) HISANO, Marcelo; DENES, Francisco T.; BRITO, Artur H.; LUCON, Marcos; MACHADO, Marcos G.; BRUSCHINI, Homero; SROUGI, MiguelPurpose: Duplex system is one of the most common anomalies of upper urinary tract. Anatomical and clinical presentation determine its treatment. Usually, the upper moiety has a poor function and requires resection, but when it is not significantly impaired, preservation is recommended. Laparoscopic reconstruction with upper pole preservation is presented as an alternative treatment. Materials and Methods: Four female patients with duplex system, one presenting with recurrent urinary tract infection and the others with urinary incontinence associated to infrasphincteric ectopic ureter, were treated. Surgical procedure envolved a laparoscopic ureteropyeloanastomosis of the upper pole ureter to the pelvis of the lower moiety, with prior insertion of a double J stent. Results: Surgical time varied from 120 to 150 minutes, with minimal blood loss in all cases. Follow-up varied from 15 to 30 months, with resolution of the clinical symptoms and preservation of the upper moiety function. Conclusion: Laparoscopic ureteropyeloanatomosis is a feasible and safe minimally invasive option in the treatment of duplex system.