Navegando por Palavras-chave "Embolização terapêutica"
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- ItemAcesso aberto (Open Access)Associação da partição hepática à ligadura da veia porta em hepatectomia estagiada versus hepatectomia em dois tempos convencional para metástase hepática de neoplasia colorretal: a elaboração de um protocolo de revisão sistemática Cochrane(Universidade Federal de São Paulo, 2021) Shiraiwa, Daniel Kitayama [UNIFESP]; Linhares, Marcelo Moura [UNIFESP]; Riera, Rachel [UNIFESP]; http://lattes.cnpq.br/0591884301805680; http://lattes.cnpq.br/0461653687573670; http://lattes.cnpq.br/7045859054713617Introdução: A ressecção das metástases hepáticas de neoplasia colorretal é um dos pilares do tratamento desta doença. Existem estratégias para induzir o futuro fígado remanescente durante o perioperatório para evitar insuficiência hepática no pós-operatório de hepatectomias maiores ou estendidas. Ainda não há consenso entre cirurgiões hepatobiliares sobre a melhor estratégia de induzir a hipertrofia do futuro fígado remanescente nestas situações. Objetivo: Criar um protocolo de revisão sistemática do tipo estudo de intervenção, comparando as técnicas de associação partição hepática à ligadura da veia porta em hepatectomia estagiada e a hepatectomia em dois tempos convencional em pacientes portadores de metástase hepática de neoplasia colorretal Métodos: Foi utilizada a metodologia Cochrane e com o uso do software Review Manager Web. Seguindo recomendações da Cochrane, foram definidos critérios de inclusão dos participantes, estratégias de busca na literatura, métodos de avaliação, coleta e síntese de dados dos estudos incluídos. Resultados: O produto dessa fase foi um protocolo de revisão sistemática sobre estudo de intervenção terapêutica, na fase de editoração do Grupo Hepatobiliar da Cochrane e em processo de publicação. Conclusões: Foi elaborado um projeto de pesquisa estruturado com os padrões metodológicos da Colaboração Cochrane, envolvendo apenas ensaios clínicos randomizados, revisado e aprovado por revisores e editores especializados da Cochrane.
- ItemAcesso aberto (Open Access)Avaliação da contratilidade uterina por ressonância magnética em mulheres submetidas a embolização de miomas uterinos(Universidade Federal de São Paulo (UNIFESP), 2018-09-06) Fornazari, Vinicius Adami Vayego [UNIFESP]; Goldman, Suzan Menasce [UNIFESP]; Szejnfeld, Denis; Bonduki, Claudio Emilio; http://lattes.cnpq.br/7384818983129643; http://lattes.cnpq.br/5784659077054234; http://lattes.cnpq.br/4903816455277036; http://lattes.cnpq.br/9458061365748156; http://lattes.cnpq.br/9458061365748156; Universidade Federal de São Paulo (UNIFESP)Purpose: To evaluate the impact of uterine fibroid embolization (UFE) on uterine contractility using ultrafast magnetic resonance (cineMR) sequences. Method: This prospective study included 26 patients, aged between 30 and 41 years (mean age: 36 years), with symptomatic uterine fibroids undergoing UFE. Patients underwent cineRM sequences before and 6 months after EMUT. Contractility was classified as absent, ordered or disordered. Patients were divided into three patterns of evolution of contractility after UFE: unchanged (group A), favorable modification (group B) and loss of contractility (group C). The following variables were also evaluated: uterine volume, dominant localization of fibroids, fibroidmyometrial index (predominance of myometrium versus predominance of fibroids) and pattern of necrosis of the dominant myometrial nodule after the procedure. Results: Of the 26 patients, eight (30.7%) had no contractility before the procedure, 18 (69.2%) presented with some type of contractility, 11 (61%) were classified as ordered and seven (39%) as disordered. After UFE, the eight patients without contractility presented with contractions, five ordered and three disordered. Of the 11 patients who initially showed ordered contractility, nine remained ordered and two showed loss of contractility. Of the seven patients who initially presented with disordered contractility, one remained disordered, five began to have ordered contractions and one showed loss of contractility. Regarding the evolution of the contractility pattern, 10 (38%) patients had no change in the pattern (group A), 13 (50%) had a positive change in contractility (group B) and three had loss of contractility (group C). Uterine volume, dominant location of fibroids, fibroidmyometrial index and pattern of myometrial nodule necrosis were not statistically significant when comparing the evolution pattern groups. Conclusion: UFE may be related to an improvement in uterine contractility pattern. Uterine volume, fibroid location, fibroidmyometrial index and pattern of fibroid necrosis do not seem to be related to the evolution of the uterine contractility pattern.
- ItemAcesso aberto (Open Access)Estudo das doses recebidas por pacientes e equipe médica nas embolizações vasculares e neurológicas(Universidade Federal de São Paulo (UNIFESP), 2016-06-30) Castilho, Alvaro Adolfo Vilas Boas [UNIFESP]; Medeiros, Regina Bitelli [UNIFESP]; http://lattes.cnpq.br/2665030032263086; http://lattes.cnpq.br/5075107232526984; Universidade Federal de São Paulo (UNIFESP)Objective: To estimate doses during occupational exposure in embolization procedures, as well as maximum doses on patients skin in neurological, hepatic and uterine embolization procedures. Methods: There were evaluated ninety-two procedures in which thirty patients underwent cerebral embolization, other fifty to chemoembolization and twelve to embolization of uterine myoma. In twenty-eight of them radiochromic films were used, around head, called group 1 and in the abdomen / pelvis region, called group 2, in order to estimate the maximum dose on skin (PSD). The total time of exposure values, number of images and values of Kerma-area products (DAP in Gy.cm²) for fluoroscopy and cineradiography (cine) were registered for each procedure. Occupational doses on physicians team were measured in the left temporal region, anterior and posterior regions of chest and left ankle using active dosimeters. A reference dosimeter was fixed in the center of the arch C. The doses on nursing team were evaluated on the anterior and posterior regions of chest. Results: The 3rd quartile values (median) for KAP, considering the patients who underwent embolization of groups 1 and 2 were 408.1 (235.3) Gy.cm² and 584.4 (449.4) Gy.cm2 for total dose. The total exposure time was 36.1 (24.8) minutes for group 1 and 34.5 (32.5) minutes for group 2, and the number of images acquired in cine mode ranged from 87 to 1179 between the groups. The 3rd quartile values (median) for occupational doses on groups 1 and 2 were 0.35 (0.21) mSv (eye region), 0.25 (0.15) mSv (chest) and 1.47 (0 64) mSv (ankle). For nursing team the occupational doses were 0.06 (0.05) mSv on anterior chest region. Doses for posterior chest have not overcome the natural radiation levels. The PSD value obtained in vascular procedures was 1004.4 (786.4) mGy between groups 1 and 2. Conclusions: Occupational doses in the eye region were higher when compared to the chest, which demonstrates the importance of proper eye protection such as plumbiferous glasses and suspended guard shield. The values obtained in the ankle region were the highest among the measured points, suggesting the need of using the plumbiferous skirt attached to the table. The nursing team doses were lower compared to the physician ones. The PSD values were lower to the threshold for tissue reactions when compared to those reported in the literature, however the risks should not be neglected considering the uncertainties related to the number of cases studied and the high complexity of the procedures.
- ItemAcesso aberto (Open Access)Gravidez e parto após embolização arterial para tratamento de leiomioma uterino(Federação Brasileira das Sociedades de Ginecologia e Obstetrícia, 2006-10-01) Bonduki, Cláudio Emilio [UNIFESP]; Gonçalves, Patrícia; Yokohama, Cláudio [UNIFESP]; Costa, Odon Ferreira Da; Baracat, Edmund Chada [UNIFESP]; Lima, Geraldo Rodrigues De; Girão, Manoel João Batista Castello [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Hospital Sírio Libanês; Hospital Sírio Libanês Departamento de Radiologia VascularPURPOSE: To analyze gestation evolution and deliveries after myoma treatment by embolization of the uterine arteries. METHODS: In the initial evaluation, 112 patients submitted to embolization of uterine arteries were included for treatment of myoma. From those, only nine wanted to be submitted to conservative treatment in order to keep their reproductive capacity. This procedure was indicated to the nine patients, since they were not susceptible to a conservative surgical treatment. They were submitted to embolization of the uterine arteries with particles of polyvinyl alcohol or embospheres with diameters ranging from 500 to 700 µm, and they have evolved without intercurrence. RESULTS: During the follow-up of these patients, there was a good clinical response with significant reduction in the uterus and myoma volumes. Four of them got pregnant, two had an early abortion and two evolved normally till the end of gestation with a term delivery. One of these had twins. CONCLUSION: Embolization of the uterine arteries is an option for the treatment of uterine myoma, and presents good clinical and anatomical results, allowing patients to preserve their reproductive capacity.
- ItemAcesso aberto (Open Access)Impacto da embolização arterial do leiomioma uterino no volume uterino, diâmetro do mioma dominante e na função ovariana(Universidade Federal de São Paulo (UNIFESP), 2011-05-25) Bernardo, Andre [UNIFESP]; Bonduki, Claudio Emilio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)PURPOSE: To evaluate the impact of the mioma arterial embolization (EAM) by uterine volume, mioma diameter greater and in the ovarian function, was carried through before and after three months of the procedure, pelvic ultrasonography for the transvaginal way (USPTV) and dosages of FSH (follicle-stimulating hormone). METHODS: Thirty patients carrying of symptomatic leiomyomas had participated of the study that they had been submitted to the EAM after science and signature of the term of free and clarified assent, obeying the criteria of inclusion of the study. Examinations of USPTV for the same professional had been carried through, in the same device before and after three months of the EAM. The uterus volume was express in cm³ e mioma diameter greater in cm. Had been made dosages of FSH before and after three months of the EAM in the central laboratory of the Hospital São Paulo. The values had been quantified in UI/ml, analyzed and express for medium+/-shunting line standard. The data then had been submitted the statistics analysis for the test distribution free of Mann-Whitney. RESULTS: It had the exclusion of a patient due to lack of data after EAM. The average before EAM uterine volume was 402,4±165,9cm³, before-EAM mioma diameter greater 5,928±2,126cm. The observed result was after-EAM uterine volume was 258,9±118,6cm³ and after-EAM mioma diameter greater 4,607±1,858cm. The average of the dosage before-EAM FSH was 4,997 (±3,520) UI/ml and after-EAM FSH was 5,500 (±4,759) UI/ml with p=0,581*. In hormone dosages, 29 cases had been evaluated. One case, that is equivalent 3.4% of the total, attended a course with definitive increase of FSH. It had reduction of 35% of the uterus volume, of 22% in the size of the mioma diameter greater and the EAM did not modify the FSH values significantly after 3 months. CONCLUSION: The procedure causes reduction of the uterine volume and leiomyomas preserving the uterus and, does not provoke ovarian function alterations.