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
20 resultados
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Agora exibindo 1 - 10 de 20
- Suction versus slow-pull for endoscopic ultrasound-guided fine-needle aspiration of pancreatic tumors: a prospective randomized trial(2020) CHENG, Spencer; BRUNALDI, Vitor O.; MINATA, Mauricio K.; CHACON, Danielle A.; SILVEIRA, Eduardo B.; MOURA, Diogo T. H. de; SANTOS, Marcos E. L. Dos; MATUGUMA, Sergio E.; CHAVES, Dalton M.; FRANCA, Raony F.; JACOMO, Alfredo L.; ARTIFON, Everson L. A.Background: Suction (S) is commonly used to improve cell acquisition during endoscopic ultrasoundguided fine-needle aspiration (EUS-FNA). Slow-pull (SP) sampling is another technique that might procure good quality specimens with less bloodiness. We aimed to determine if SP improves the diagnostic yield of EUS-FNA of pancreatic masses. Methods: Patients with pancreatic solid masses were randomized to four needle passes with both techniques in an alternate fashion. Sensitivity, specificity, positive, and negative predictive values were calculated. Cellularity and bloodiness of cytological samples were assessed and compared according to the technique. Results: Sensitivity, specificity, and accuracy of suction vs. SP were 95.2% vs. 92.3%; 100% vs. 100; 95.7% vs. 93%, respectively. As to the association of methods, they were 95.6, 100 and 96%, respectively. Positive predictive values for S and SP were 100%. There was no difference in diagnostic yield between S and SP (p = 0.344). Cellularity of samples obtained with SP and Suction were equivalent in both smear evaluation (p = 0.119) and cell-block (0.980). Bloodiness of SP and suction techniques were similar as well. Conclusions: S and SP techniques provide equivalent sensitivity, specificity, and accuracy. Association of methods seems to improve diagnostic yield. Suction does not increase the bloodiness of samples compared to slow-pull.
- Polyethylene Glycol fusion associated with anti-oxidants: A new promise in the treatment of traumatic paralysis (vol 40, pg 1489, 2018)(2018) SALOMONE, Raquel; JACOMO, Alfredo Luiz; BENTO, Ricardo F.; NASCIMENTO, Silvia Bona do; LEZIROVITZ, Karina; HOJAIJ, Flavio Carneiro; COSTA, Heloisa J. Z. R.
- Efficacy and safety of a device used to prevent fogging and residue buildup on surgical optics during video-assisted thoracic surgical procedures (LacrimaSurg): a pilot in vivo study in 30 patients(2022) ABREU, Igor Renato Louro Bruno de; SILVA, Alessandra Rodrigues; CHIOVATTO, Eduardo; ABRAO, Fernando Conrado; YOUNES, Riad N; JACOMO, Alfredo LuizIntroduction Nowadays the majority of the surgical procedures are video surgeries. Despite technological advances, some problems remain. The buildup of residues in front of the lens is an example of this problem. To solve it, Abreu et al. (Surg Technol Int 26:43-47, 2015) developed LacrimaSurg, which works as a lacrimal duct in the optics preventing fogging and residues buildup on it. This had 98.1% of efficiency in an experimental study. Objective Study feasibility and safety of the device under real surgical conditions. Materials and Methods A pilot study included 30 patients undergoing thoracic procedures using LacrimaSurg. Procedures were recorded for further analysis by investigators. The characteristics of patients (age, sex, body mass index, Charlton comorbidity index), data of environment (Temperatures variances), and data of procedures (type of surgery and duration of it) were recorded. The investigators watched the videos and recorded the residue buildup and fogging events that impaired surgeon's vision. The number of times the optics got dirty, need for further jets of crystalloid solution, and need for mechanical cleaning were collected to evaluate efficacy. Comparative serum measurements of electrolytes before and after surgery were studied. Data were organized and analyzed by simple linear correlations and t test for continuous variables and Fisher's test for categorical variables. Results The use of the device allowed 97% of the procedures to be performed without interruption. No characteristics inherent to the patients or to the procedures that lead to fogging or filth of the optics were identified. There were no statistically significant differences between pre- and postoperative serum ions, and no postoperative complications related to the use of the device were observed. Conclusion The device was effective in preventing interruption of surgical procedures due to dirt or fogging, its use was considered safe, and did not cause postoperative complications.
- Doppler-guided hemorrhoidal artery ligation with rectal mucopexy technique: initial evaluation of 42 cases(2012) ROTTA, Carlos Mateus; MORAES, Fernando Oriolli de; VARELLA NETO, Araripe Fernandez; ROTTA, Thereza Cristina Ariza; GREGÓRIO, João Vitor Antunes Marques; JACOMO, Alfredo Luiz; MARTINEZ, Carlos Augusto RealThe treatment of hemorrhoidal disease (HD) by conventional hemorrhoidectomy is associated with significant morbidity, mainly represented by the postoperative pain and the late return to daily activities. Doppler-guided hemorrhoid artery ligation (DGHAL) is a minimal-invasive surgical treatment for HD that has been used as an alternative method in order to reduce these inconveniences. OBJECTIVE: To analyze the initial results of the DGHAL technique associated with rectal mucopexy in the treatment of HD. METHODS:Forty-two patients with stage I, III and IV hemorrhoids who were submitted to DGHAL were analyzed from December 2010 to August 2011. Eleven patients (26%) were stage II; 21 (50%), stage III; and 10 (24%), stage IV HD. All patients were operated by the same surgeon under spinal anesthesia and using the same equipment and technique to perform the procedure. The 42 patients underwent ligation of six arterial branches followed by rectal mucopexia by uninterrupted suture. Nine patients needed concomitant removal of perianal skin tag. In the postoperative, the following parameters were evaluated: pain, tenesmus, bleeding, itching, prolapse, mucus discharge and recurrence. The mean postoperative follow-up lasted four months (one to nine months). RESULTS: Tenesmus was the most common postoperative complaint for 85.7% of patients followed by pain, in 28.6%, perianal burning, in 12.3%, mucus discharge and perianal hematoma in 4.7%. Two patients had severe postoperative bleeding and required surgical haemostasis, one of which needed blood transfusion. Ninety-five percent of the patients declared to be satisfied with the method. CONCLUSION: Even though DGHAL has complications similar to those of other surgical methods, its results present less postoperative pain, allowing faster recovery and return to work. Studies with more cases and a longer follow-up are still necessary to assess the late recurrence.
- Is there something new regarding triceps brachii muscle insertion?(2020) AKAMATSU, Flavia Emi; NEGRAO, Jose Renato; RODRIGUES, Marcelo Bordalo; ITEZEROTE, Ana Maria; SALEH, Samir Omar; HOJAIJ, Flavio; ANDRADE, Mauro; JACOMO, Alfredo LuizPurpose: Previous studies have questioned whether the triceps brachii muscle tendon (TBMT) has a double or single insertion on the ulna. Aiming to provide an answer, we describe the anatomy of the TBMT and review a magnetic resonance imaging (MRI) series of the elbow. Methods: Forty-one elbows were dissected to assess the details of the triceps brachii insertion. Elbow plastination slices were analyzed to determine whether there was a space on the TBMT. Magnetic resonance imaging from the records of the authors were also obtained to demonstrate the appearance of the pre-tricipital space on MRI. Results: A virtual space on the medial aspect near the TBTM insertion site in the olecranon was consistently found on anatomic dissections. It was a distal pre-tricipital space. Magnetic resonance imaging demonstrated the appearance of the pre-tricipital space on MRI, and its extension was measured longitudinally either in elbow flexion or extension. There was no statistically significant difference between the measurements of this space in the right and left elbows or between flexion and extension (p > 0.05). The coefficient of variation was <10% for all measurements. Conclusion: Knowledge of this structure may be essential to avoid incorrect diagnosis and unnecessary therapeutic interventions.
- Metabolic Duodenal Switch: The Old Is New Again(2017) KAWAHARA, Nilton T.; ALSTER-VICENTE, Clarissa; KOYAISHI, Akemi; JACOMO, Alfredo L.
- Is the colon mucosa affected by ten days of gastric restriction in an animal model?(2019) AKAMATSU, Flavia Emi; FONTES, Luiz Gustavo; ITEZEROTE, Ana Maria; SALEH, Samir; TEODORO, Walcy Paganelli Rosolia; ARTIFON, Everson; HOJAIJ, Flavio; ANDRADE, Mauro; PEREIRA, Jose Aires; MARTINEZ, Carlos Augusto Real; JACOMO, Alfredo LuizPurpose: To identify whether the colon mucosa is affected by ten days of gastric restriction in an animal model. Methods: An experimental model of gastric restriction was devised using rats. The animals were submitted to surgical gastrostomy, and a cylindrical loofah was inserted into the stomach. We studied 30 adult male Wistar rats divided into three groups: the stomach restriction group (R10); the sham group (S10), which underwent the same procedure except for the loofah insertion; and the control group (C10). The expression of neutral and acid mucins was evaluated using histochemical techniques. Goblet cells and protein content were compared between groups using generalized estimation equations (GEEs). Bonferroni's multiple comparison was applied to identify differences between the groups. All tests considered a 5% significance level. Results: There was an increased expression of neutral mucins, acid mucins and goblet cells in the R10 group. Collagen was also enhanced in the R10 group. Conclusion: The colon mucosa is affected by ten days of gastric restriction in an animal model, increasing neutral mucins, acid mucins and collagen content with trophic maintenance.
- Aneurysm of the Fibular Vein: A Case Report(2018) SALEH, Samir Omar; ANDRADE, Mauro Figueired Carvalho de; CUADRADO, Guilherme de Arruda; SALEH, Kassem Samir; AKAMATSU, Flavia Emi; JACOMO, Alfredo LuizBackground: Aneurysms of the deep veins of the lower limbs are rare and often asymptomatic. Although natural history is unclear, these aneurysms have been associated with deep venous thrombosis and fatal pulmonary embolism events. To our knowledge, this case represents the fifth patient with isolated aneurysm of a calf vein described in the literature and the second one affecting the fibular vein. Methods: We report the case of a 20-year-old white man with an aneurysm of the fibular vein that we believe is the second case in the literature Results: After evaluation and diagnosis, the aneurysm was resected with full recovery of the patient. Conclusions: Treatment of this unusual condition seems to be mandatory for major thromboembolic events can be as high as 71% with 2 deaths, according to a review of 24 patients with popliteal vein aneurysms. Unlike proximal veins, where reconstruction is advisable, calf vein aneurysms can be safely managed by simple excision and ligature. In our patient, aneurysm resection eliminated symptoms, and good result was maintained in long follow-up.
- Surgical anatomy of the internal thoracic lymph nodes in fresh human cadavers: basis for sentinel node biopsy(2016) BARROS, Alfredo Carlos S. D.; MORI, Lincon Jo; NISHIMURA, Dolores; JACOMO, Alfredo L.Background: While the optimal management of early breast cancer patients with sentinel lymph node (SLN) involvement mapped in the internal thoracic chain is still debated, biopsy may be performed when surgeons select patients who are most likely to benefit. The aim of this study is to examine anatomical aspects of internal thoracic nodes (ITNs) to orientate SLN biopsy in the parasternal area. Methods: This study was based on dissections of 29 female cadavers. The parameters analyzed were the number of intercostal spaces (ICSs) containing at least one ITN, mean number of nodes in each ICS, position of the ITNs in relation to the internal thoracic artery (ITA), number of retrocostal spaces (RCSs) containing at least one ITN, and mean number of nodes in each RCS. Results: The ICS that was most likely to have at least one ITN was the third, with 86.2 % in the right side and 75.8 % in the left side. In the second ICS, the rates were 69.2 and 73.6 %, and in the fourth, the rates were 48.1 and 33.3 %. In the third ICS, on both sides, the mean number of ITNs was the highest (1.2). A tendency of the nodes to be laterally located in the second ICS and medially located in the downward dissection was observed. Most of the RCSs did not present any nodes. Conclusions: This study indicates that most of the second and third ICSs presented at least one ITN, and the mean number of nodes in the third space was greater. There is a tendency to find nodes medial to the artery downwards from the second to the fourth ICS. ITNs are generally located in ICSs, and the majority of RCSs did not contain any nodes.
- E-Cadherin Expression in Colonic Mucosa with and Without Fecal Stream(2013) KADRI, Caled Jaoudat; PEREIRA, Jose Aires; SILVA, Camila Morais Goncalves da; NONOSE, Ronaldo; NASCIMENTO, Enzo Fabricio do; JACOMO, Alfredo Luiz; MARTINEZ, Carlos Augusto RealThe tissue content of E-cadherin changes in inflammatory bowel diseases; however, similar changes have not yet been evaluated in diversion colitis. Objective: The aim of this study was to evaluate the tissue expression of E-cadherin in the mucosa of the colon in both segments with and without a fecal stream. Methods: Sixty Wistar rats were subjected to deviation of fecal stream by proximal colostomy in left colon and a distal mucosal fistula. Animals were divided into three experimental groups that were sacrificed 6, 12, and 18 weeks after surgery. In each experimental group, five animals underwent laparotomy without intestinal deviation (control subgroup). Colitis was diagnosed based on the presence of three independent histological parameters: reduction of the crypt length, neutrophil infiltration of the mucosa and submucosa, and epithelial erosion or ulceration. The E-cadherin expression was evaluated by immunohistochemistry and the tissue levels by computerized morphometry. The Mann-Whitney and Kruskal-Wallis test were used to compare the groups adopting a significance level of 5% (p < .05). Results: Segments without fecal stream showed a reduction in E-cadherin content when compared with segments with fecal stream. In the segments with a fecal stream, E-cadherin was expressed at the apical surface of colon glands, while segments without fecal stream showed a decrease in the amount of apical E-cadherin. The content of E-cadherin was maintained over the entire time of the intestinal exclusion. Conclusions: Diversion of the fecal stream decreases the expression of E-cadherin of the colon epithelium.