ALMIR FERREIRA DE ANDRADE

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Lattes
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Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/62 - Laboratório de Fisiopatologia Cirúrgica, Hospital das Clínicas, Faculdade de Medicina

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Autor: BOR-SENG-SHU, Edson ×

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Agora exibindo 1 - 10 de 23
  • article 11 Citação(ões) na Scopus
    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 Jacobsen
    Background. 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.
  • article 45 Citação(ões) na Scopus
    Prediction of Early TBI Mortality Using a Machine Learning Approach in a LMIC Population
    (2020) AMORIM, Robson Luis; OLIVEIRA, Louise Makarem; MALBOUISSON, Luis Marcelo; NAGUMO, Marcia Mitie; SIMOES, Marcela; MIRANDA, Leandro; BOR-SENG-SHU, Edson; BEER-FURLAN, Andre; ANDRADE, Almir Ferreira De; RUBIANO, Andres M.; TEIXEIRA, Manoel Jacobsen; KOLIAS, Angelos G.; PAIVA, Wellingson Silva
    Background: In a time when the incidence of severe traumatic brain injury (TBI) is increasing in low- to middle-income countries (LMICs), it is important to understand the behavior of predictive variables in an LMIC's population. There are few previous attempts to generate prediction models for TBI outcomes from local data in LMICs. Our study aim is to design and compare a series of predictive models for mortality on a new cohort in TBI patients in Brazil using Machine Learning. Methods: A prospective registry was set in Sao Paulo, Brazil, enrolling all patients with a diagnosis of TBI that require admission to the intensive care unit. We evaluated the following predictors: gender, age, pupil reactivity at admission, Glasgow Coma Scale (GCS), presence of hypoxia and hypotension, computed tomography findings, trauma severity score, and laboratory results. Results: Overall mortality at 14 days was 22.8%. Models had a high prediction performance, with the best prediction for overall mortality achieved through Naive Bayes (area under the curve = 0.906). The most significant predictors were the GCS at admission and prehospital GCS, age, and pupil reaction. When predicting the length of stay at the intensive care unit, the Conditional Inference Tree model had the best performance (root mean square error = 1.011), with the most important variable across all models being the GCS at scene. Conclusions: Models for early mortality and hospital length of stay using Machine Learning can achieve high performance when based on registry data even in LMICs. These models have the potential to inform treatment decisions and counsel family members.
  • article 16 Citação(ões) na Scopus
    Posttraumatic Refractory Intracranial Hypertension and Brain Herniation Syndrome: Cerebral Hemodynamic Assessment before Decompressive Craniectomy
    (2013) BOR-SENG-SHU, Edson; PAIVA, Wellingson Silva; FIGUEIREDO, Eberval G.; FUJIMOTO, Yasunori; ANDRADE, Almir Ferreira de; FONOFF, Erich Talamoni; TEIXEIRA, Andmanoel Jacobsen
    Background. The pathophysiology of traumatic brain swelling remains little understood. An improved understanding of intracranial circulatory process related to brain herniation may have treatment implications. Objective. To investigate the cerebral hemodynamic changes associated with brain herniation syndrome due to traumatic brain swelling. Methods. Nineteen head-injured patients with evidence of refractory intracranial hypertension and transtentorial herniation were prospectively studied. Cerebral hemodynamic assessment by transcranial Doppler (TCD) ultrasonography was performed prior to decompressive craniectomy. Patients and their cerebral hemispheres were classified according to TCD-hemodynamic patterns, and the data correlated with neurological status, midline shift on CT scan, and Glasgow outcome scale scores at 6 months after injury. Results. A wide variety of cerebral hemodynamic findings were observed. Ten patients (52.7%) presented with cerebral oligoemia, 3 patients (15.8%) with cerebral hyperemia, and 6 patients with nonspecific circulatory pattern. Circulatory disturbances were more frequently found in the side of maximal cerebral swelling than in the opposite side. Pulsatility index (PI) values suggested that ICP varied from acceptable to considerably high; patients with increased PI, indicating higher microvascular resistance. No correlation was found between cerebral hemodynamic findings and outcome. Conclusions. There is a marked heterogeneity of cerebral hemodynamic disturbances among patients with brain herniation syndrome.
  • conferenceObject
    CT PERFUSION IN TRAUMATIC ACUTE SUBDURAL HEMATOMA: A NEW TOOL TO PREDICT OUTCOME?
    (2014) AMORIM, Robson Luis; ANDRADE, Almir Ferreira de; GATTAS, Gabriel; MAYNART, Arthur; PETITO, Carlo Emanuel; TEIXEIRA, Manoel Jacobsen; BOR-SENG-SHU, Edson
  • article 23 Citação(ões) na Scopus
    Improved Hemodynamic Parameters in Middle Cerebral Artery Infarction After Decompressive Craniectomy
    (2014) AMORIM, Robson Luis; ANDRADE, Almir Ferreira de; GATTAS, Gabriel S.; PAIVA, Wellingson Silva; MENEZES, Marcos; TEIXEIRA, Manoel Jacobsen; BOR-SENG-SHU, Edson
    Background and Purpose Decompressive craniectomy (DC) reduces mortality and improves functional outcome in patients with malignant middle cerebral artery infarction. However, little is known regarding the impact of DC on cerebral hemodynamics. Therefore, our goal was to study the hemodynamic changes that may occur in patients with malignant middle cerebral artery infarction after DC and to assess their relationship with outcomes. Methods Twenty-seven patients with malignant middle cerebral artery infarction who were treated with DC were studied. The perfusion CT hemodynamic parameters, mean transit time, cerebral blood flow, and cerebral blood volume were evaluated preoperatively and within the first 24 hours after DC. Results There was a global trend toward improved cerebral hemodynamics after DC. Preoperative and postoperative absolute mean transit times were associated with mortality at 6 months, and the ratio of post- and preoperative cerebral blood flow was significantly higher in patients with favorable outcomes than those with unfavorable outcomes. Patients who underwent surgery 48 hours after stroke, those with midline brain shift >10 mm, and those who were >55 years showed no significant improvement in any perfusion CT parameters. Conclusions DC improves cerebral hemodynamics in patients with malignant middle cerebral artery infarction, and the level of improvement is related to outcome. However, some patients did not seem to experience any additional hemodynamic benefit, suggesting that perfusion CT may play a role as a prognostic tool in patients undergoing DC after ischemic stroke.
  • article 12 Citação(ões) na Scopus
    Experimental rnodel of intracranial hypertension with continuous multiparametric monitoring in swine
    (2013) ANDRADE, Almir Ferreira de; SOARES, Matheus Schmidt; PATRIOTA, Gustavo Cartaxo; BELON, Alessandro Rodrigo; PAIVA, Wellingson Silva; BOR-SENG-SHU, Edson; OLIVEIRA, Marcelo de Lima; NASCIMENTO, Clarissa Nobrega; NOLETO, Gustavo Sousa; ALVES JUNIOR, Aderaldo Costa; FIGUEIREDO, Eberval Gadelha; OTOCH, Jose Pinhata; TEIXEIRA, Manoel Jacobsen
    Objective: Intracranial hypertension (IN) develops in approximately 50% of all patients with severe traumatic brain injury (TBI). Therefore, it is very important to identify a suitable animal model to study and understand the pathophysiology of refractory IH to develop effective treatments. Methods: We describe a new experimental porcine model designed to simulate expansive brain hematoma causing IH. Under anesthesia, was simulated with a balloon insufflation. The IH variables were measured with intracranial pressure (ICP) parenchymal monitoring, epidural, cerebral oximetry, and transcranial Doppler (TCD). Results: None of the animals died during the experiment. The ICP epidural showed a slower rise compared with parenchymal ICP. We found a correlation between ICP and cerebral oximetry. Conclusion: The model described here seems useful to understand some of the pathophysiological characteristics of acute IH.
  • article 2 Citação(ões) na Scopus
    Evaluation of cerebral hemodynamics by transcranial Doppler ultrasonography and its correlation with intracranial pressure in an animal model of intracranial hypertension
    (2022) SOARES, Matheus Schmidt; ANDRADE, Almir Ferreira de; BRASIL, Sergio; DE-LIMA-OLIVEIRA, Marcelo; BELON, Alessandro Rodrigo; BOR-SENG-SHU, Edson; NOGUEIRA, Ricardo de Carvalho; GODOY, Daniel Agustin; PAIVA, Wellingson Silva
    Background: Transcranial Doppler has been tested in the evaluation of cerebral hemodynamics as a non-invasive assessment of intracranial pressure (ICP), but there is controversy in the literature about its actual benefit and usefulness in this situation. Objective: To investigate cerebral blood flow assessed by Doppler technique and correlate with the variations of the ICP in the acute phase of intracranial hypertension in an animal model. Methods:An experimental animal model of intracranial hypertension was used. The experiment consisted of two groups of animals in which intracranial balloons were implanted and inflated with 4 mL (A) and 7 mL (B) for controlled simulation of different volumes of hematoma. The values of ICP and Doppler parameters (systolic [FVs], diastolic [FVd], and mean [FVm] cerebral blood flow velocities and pulsatility index [PI]) were collected during the entire procedure (before and during hematoma simulations and venous hypertonic saline infusion intervention). Comparisons between Doppler parameters and ICP monitoring were performed. Results: Twenty pigs were studied, 10 in group A and 10 in group B. A significant correlation between PI and ICP was obtained, especially shortly after abrupt elevation of ICP. There was no correlation between ICP and FVs, FVd or FVm separately. There was also no significant change in ICP after intravenous infusion of hypertonic saline solution. Conclusions:These results demonstrate the potential of PI as a parameter for the evaluation of patients with suspected ICP elevation.
  • article 6 Citação(ões) na Scopus
    Estimation of intracranial pressure by ultrasound of the optic nerve sheath in an animal model of intracranial hypertension
    (2021) JENG, Brasil Chian Ping; ANDRADE, Almir Ferreira de; BRASIL, Sergio; BOR-SENG-SHU, Edson; BELON, Alessandro Rodrigo; ROBERTIS, Maira; DE-LIMA-OLIVEIRA, Marcelo; RUBIANO, Andres Mariano; GODOY, Daniel Agustin; TEIXEIRA, Manoel Jacobsen; PAIVA, Wellingson Silva
    Background: Ultrasound of the optic nerve sheath diameter (ONSD) has been used as a non-invasive and cost-effective bedside alternative to invasive intracranial pressure (ICP) monitoring. However, ONSD time-lapse behavior in intracranial hypertension (ICH) and its relief by means of either saline infusion or surgery are still unknown. The objective of this study was to correlate intracranial pressure (ICP) and ultrasonography of the optic nerve sheath (ONS) in an experimental animal model of ICH and deter-mine the interval needed for ONSD to return to baseline levels. Methods: An experimental study was conducted on 30 pigs. ONSD was evaluated by ultrasound at differ-ent ICPs generated by intracranial balloon inflation, saline infusion, and balloon deflation, and measured using an intraventricular catheter. Results: All variables obtained by ONS ultrasonography such as left, right, and average ONSD (AON) were statistically significant to estimate the ICP value. ONSD changed immediately after balloon inflation and returned to baseline after an average delay of 30 min after balloon deflation (p = 0.016). No statistical sig-nificance was observed in the ICP and ONSD values with hypertonic saline infusion. In this swine model, ICP and ONSD showed linear correlation and ICP could be estimated using the formula:-80.5 + 238.2 x AON. Conclusion: In the present study, ultrasound to measure ONSD showed a linear correlation with ICP, although a short delay in returning to baseline levels was observed in the case of sudden ICH relief.
  • article 3 Citação(ões) na Scopus
    The influence of intracranial hypertension on static cerebral autoregulation
    (2020) DE-LIMA-OLIVEIRA, Marcelo; FERREIRA, Almir Andrade; BELON, Alessandro Rodrigo; SALINET, Angela Macedo; NOGUEIRA, Ricardo Carvalho; PING, Brasil Chian; PAIVA, Wellingson Silva; TEIXEIRA, Manoel Jacobsen; BOR-SENG-SHU, Edson
    Objectives To analyze the influences of mild and severe intracranial hypertension on cerebral autoregulation (CA). Patients and Methods Duroc piglets were monitored with an intracranial pressure (ICP) catheter. Intracranial hypertension was induced via infusion of 4 or 7 ml of saline solution by a bladder catheter that was inserted into the parietal lobe. The static cerebral autoregulation (sCA) index was evaluated via cerebral blood flow velocities (CBFv). Piglets with ICPs <= 25 and > 25 mmHg were considered as group 1 and 2, respectively. Continuous variables were evaluated using the Kolmogorov-Smirnov goodness-of-fit test. The main parameters were collected before and after ICH induction and compared using two-factor mixed-design ANOVAs with the factor of experimental group (mild and severe ICH). Results In group 1 (ICP <= 25 mmHg), there were significant differences in sCA (p= .01) and ICP (p= .0002) between the basal and balloon inflation conditions. In group 2 (ICP > 25 mmHg), there were significant differences in CBFv (p= .0072), the sCA index (p= .0001) and ICP (p= .00001) between the basal and balloon inflation conditions. Conclusion We conclude that ICH may have a direct effect on mild and severe sCA.
  • conferenceObject
    CORRELATION BETWEEN CHANGES IN GREY AND WHITE MATTER RADIODENSITY WITH PROGNOSIS AFTER CRANIOPLASTY
    (2014) OLIVEIRA, Arthur Maynart Pereira; AMORIM, Robson Luis Oliveira de; PAIVA, Wellingson Silva; ANDRADE, Almir Ferreira de; PASCHOAL JUNIOR, Fernando Mendes; BOR-SENG-SHU, Edson; COELHO, Fernanda; GATTAS, Gabriel Scarabotolo; ANGHINAH, Renato; TEIXEIRA, Manoel Jacobsen