ALFREDO LUIZ JACOMO
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cirurgia, Faculdade de Medicina - Docente
LIM/02 - Laboratório de Anatomia Médico-Cirúrgica, Hospital das Clínicas, Faculdade de Medicina
LIM/02 - Laboratório de Anatomia Médico-Cirúrgica, Hospital das Clínicas, Faculdade de Medicina
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- Long-Term Results of Intraoperative Radiation Therapy for Early Breast Cancer Using a Nondedicated Linear Accelerator(2023) HANNA, Samir Abdallah; BEVILACQUA, Jose Luiz Barbosa; BARROS, Alfredo Carlos Simo Dornellas de; ANDRADE, Felipe Eduardo Martins de; PIATO, Jose Roberto Morales; PELOSI, Edilson Lopes; MARTELLA, Eduardo; SILVA, Joao Luis Fernandes da; CARVALHO, Heloisa de Andrade; JACOMO, Alfredo LuizPurpose: To present the long-term results of intraoperative radiation therapy (IORT) for early breast cancer using a nondedicated linear accelerator. Methods and Materials: The eligibility criteria were biopsy-proven invasive carcinoma, age >= 40 years, tumor size <= 3 cm, and N0M0. We excluded multifocal lesions and sentinel lymph node involvement. All patients had previously undergone breast magnetic resonance imaging. Breast-conserving surgery with margins and sentinel lymph node evaluation using frozen sections were performed in all cases. If there were no margins or involved sentinel lymph nodes, the patient was transferred from the operative suite to the linear accelerator room, where IORT was delivered (21 Gy). Results: A total of 209 patients who were followed up for >= 1.5 years from 2004 to 2019 were included. The median age was 60.3 years (range, 40-88.6), and the mean pT was 1.3 cm (range, 0.2-4). There were 90.5% pN0 cases (7.2% of micrometastases and 1.9% of macrometastases). Ninety-seven percent of the cases were margin free. The rate of lymphovascular invasion was 10.6%. Twelve patients were negative for hormonal receptors, and 28 patients were HER2 positive. The median Ki-67 index was 29% (range, 0.1-85). Intrinsic subtype stratification was as follows: luminal A, 62.7% (n = 131); luminal B, 19.1% (n = 40); HER2 enriched 13.4% (n = 28); and triple negative, 4.8% (n = 10). Within the median follow-up of 145 months (range, 12.8-187.1), the 5-year, 10-year, and 15-year overall survival rates were 98%, 94.7%, and 88%, respectively. The 5-year, 10-year, and 15-year disease-free rates were 96.3%, 90%, and 75.6%, respectively. The 15-year local recurrence-free rate was 76%. Fifteen local recurrences (7.2%) occurred throughout the follow-up period. The mean time to local recurrence was 145 months (range, 12.8-187.1). As a first event, 3 cases of lymph node recurrence, 3 cases of distant metastasis, and 2 cancer-related deaths were recorded. Tumor size >1 cm, grade III, and lymphovascular invasion were identified as risk factors. Conclusions: Despite approximately 7% of recurrences, we may infer that IORT may still be a reasonable option for selected cases. However, these patients require a longer follow-up as recurrences may occur after 10 years. (c) 2023TheAuthor(s).
- Proximal endoscopic repair of the hamstring tendons: a cadaveric anatomical study of posterior hip portals(2023) RANZONI, Lucas Verissimo; GUBEROVICH, Matheus Almeida; EJNISMAN, Leandro; MIYAHARA, Helder Souza; RATH, Ehud; GURGEL, Henrique Melo de Campos; JACOMO, Alfredo LuizArthroscopy and endoscopic hip surgery have attracted increasing attention in the orthopedic field. In the case of arthroscopy, portals and their relationships with neurovascular bundle structures at risk are well established. However, studies on endoscopic portals used for the repair of hamstring tendon injuries are insufficient. Hamstring injuries are the most common muscle injury in sports medicine, and up to 12% can present as a tendon rupture. Endoscopic surgery is advantageous because it has a lower rate of bleeding and avoids excessive handling of the gluteal muscles. The objective of this study is to perform an anatomical evaluation of endoscopic portals for hamstring repair and measure their distance to neurovascular structures-mainly sciatic nerve and posterior femoral cutaneous nerve (PFCN). Fifteen hips from frozen and formalized cadavers were evaluated. Specimens that showed any modification in their anatomy were excluded. Portals were simulated using Steinmann pins, and anatomical dissection was performed. Distances from neurovascular structures were measured using a digital caliper. Four male cadaver hips (26%) and eleven female cadaver hips (74%) were included. Two dissected hips presented PFCN injury through the posterolateral portal- mean 20.28 mm (+/- 8.14), and one through the distal accessory portal- 21.87 mm (+/- 12.03). The injury rate for PFCN was 3/15 or 20%. None of the portals presented sciatic nerve injury. Conclusion: There is an imminent risk of nerve injury to the PFCN by performing the lateral portals for hamstring repair. To avoid this, we recommend starting the procedure through the most medial (posteromedial) portal, and the other portals must be performed under direct visualization.
- Ensino da anatomia: dissecção em associação com a tecnologia no curso de Medicina(2023) VIEIRA, Joaquim Edson; AKAMATSU, Flávia Emi; JÁCOMO, Alfredo LuizAbstract: Introduction: A 2010 study pointed out the future needs of medical education, with integrated contents and practices, fostered by virtual educational technology and by prioritizing competence, not time. Anatomy, indistinguishable from other fundamentals of medicine, faces restrictions on cadaver dissection. Objective: Essay on the teaching of anatomy in clinical contexts and the use of technologies Method: The “pubmed” platform of the National Library of Medicine and descriptors ((anatomy[MeSH Terms]) AND (method, teaching[MeSH Terms])) AND (surgery[MeSH Terms]) were used. Result: There are indications of 316 articles in the period 2000-2022 (June 2022). The main question about the teaching of Anatomy is the replacement of the dissection technique and, consequently, the use of the cadaver. Studies suggest maintaining the use of dissection, prosection and greater use of digital and model means. Conclusion: Cadaveric material should be secured with greater use of prosection and dissection being directed or elective. Virtual reality and permanent material must be assimilated as instrumental and supervised by qualified anatomists and enriched by interpretation and clinical applicability.