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São Paulo, Brazil

Schiavon C.A.,Hospital do Coracao HCor | Drager L.F.,University of Sao Paulo | Bortolotto L.A.,University of Sao Paulo | Amodeo C.,Dante Pazzanese Institute of Cardiology | And 3 more authors.
Current Atherosclerosis Reports | Year: 2016

Obesity and hypertension are growing epidemics in the modern world. Lifestyle changes and medical treatment for obesity have disappointing long-term results and albeit drugs for hypertension are usually very effective, the necessity of multiple pills and frequent side effects make the adherence to treatment a huge challenge for healthcare systems. Bariatric/metabolic surgery is a very effective treatment and an exponential number of studies have been showing its positive impact beyond weight loss, mainly on type 2 diabetes. There is also growing evidence suggesting that bariatric/metabolic surgery is associated with reduced incidence of cardiovascular events, but the impact on hypertension and other components of metabolic syndrome usually derive from trials’ secondary end points. Taking this limitation in mind, bariatric/metabolic surgery action on blood pressure is reaching a significant proportion of hypertension resolution or improvement. In this review, we discussed the current evidence on the impact of bariatric/metabolic surgery on blood pressure control and pointed out perspectives in this research area. © 2016, Springer Science+Business Media New York.

Skaf A.Y.,Hospital do Coracao HCor | Filho G.H.,Santa Casa de Sao Paulo Hospital | Dirim B.,Izmir Ataturk Training and Research Hospital | Wangwinyuvirat M.,Rajavithi Hospital | And 3 more authors.
Skeletal Radiology | Year: 2012

Objective: The pericruciate fat pad is located in the intercondylar fossa, intimate with the cruciate ligaments. With MR imaging, signal abnormality of the pericruciate fat pad has been observed in patients with posterior knee pain. The purpose of this study was to describe the anatomy of the pericruciate fat pad in cadaveric specimens and to document the clinical spectrum of pericruciate fat pad inflammation. Materials and Methods: Twelve cadaveric knees underwent MR imaging with T1 and T2 multiplanar images. Cadaveric sections were then prepared for macroscopic evaluation, with additional histologic analysis performed in four cases. MR images in seventeen patients (ten males, seven females; average age, 31.5 years; age range, 19-57 years) involved in intensive sporting activity and with posterior knee pain were reviewed. Results: MR images in cadaveric specimens showed a fat pad that was located above and between the cruciate ligaments, near their attachment sites in the inner portion of the femoral condyles, within the intercondylar fossa. Fatty tissue covered by a thin layer of synovial membrane was confirmed at histology. Seventeen patients with posterior knee pain and without gross cartilage, meniscal, or ligamentous abnormalities all revealed an increased signal in this fat pad in fluid-sensitive fatsuppressed images, mainly in the sagittal and axial planes. In eight cases, enhancement of this fat pad was demonstrated following intravenous gadolinium administration. Conclusions: The pericruciate fat pad is a structure located in the intercondylar fossa, intimate with both the anterior and posterior cruciate ligaments. Inflammatory changes in this fat pad may be found in patients, especially athletes with posterior knee pain. © ISS 2012.

dos Prazeres C.E.E.,Hospital do Coracao HCor | Cury R.C.,Hospital do Coracao HCor | Carneiro A.C.C.,Hospital do Coracao HCor | Rochitte C.E.,Hospital do Coracao HCor | Rochitte C.E.,University of Sao Paulo
Arquivos Brasileiros de Cardiologia | Year: 2013

The coronary computed tomography angiography has recently emerged as an accurate diagnostic tool in the evaluation of coronary artery disease, providing diagnostic and prognostic data that correlate directly with the data provided by invasive coronary angiography. The association of recent technological developments has allowed improved temporal resolution and better spatial coverage of the cardiac volume with significant reduction in radiation dose, and with the crucial need for more effective protocols of risk stratification of patients with chest pain in the emergency room, recent evaluation of the computed tomography coronary angiography has been performed in the setting of acute chest pain, as about two thirds of invasive coronary angiographies show no significantly obstructive coronary artery disease. In daily practice, without the use of more efficient technologies, such as coronary angiography by computed tomography, safe and efficient stratification of patients with acute chest pain remains a challenge to the medical team in the emergency room. Recently, several studies, including three randomized trials, showed favorable results with the use of this technology in the emergency department for patients with low to intermediate likelihood of coronary artery disease. In this review, we show data resulting from coronary angiography by computed tomography in risk stratification of patients with chest pain in the emergency room, its diagnostic value, prognosis and cost-effectiveness and a critical analysis of recently published multicenter studies.

Ribeiro M.A.,Sao Paulo State University | Gameiro L.F.O.,Sao Paulo State University | Scarano W.R.,Sao Paulo State University | Briton-Jones C.,Reproductive Medicine Partners of New York | And 5 more authors.
Jornal Brasileiro de Reproducao Assistida | Year: 2016

The aim of this study as to analyze published evidence regarding the effectiveness of aromatase inhibitor therapy on improving spermatogenesis in infertile men. We carried out a systematic review of randomized controlled trials. The date of the most recent search was October 4, 2015. Two authors independently selected relevant clinical trials, assessing their methodological quality and extracting data. Three studies were included in this review with a total of 100 participants; however, we were able to include data from only 54 participants in the analysis. In the representation of meta-analysis with a single study comparing testolactone versus placebo, related to the hormone concentrations, there was a statistically significance difference favoring the use of testolactone for Luteinizing Hormone (LH); Estrogen (E2); free Testosterone (free T); free Estrogen (free E2); 17-Hydroxyprogesterone (17OHP); prolactin (PRL). In another analysis from a single study comparing letrozole versus anastrozole, there was also a statistically significance difference favoring the use of letrozole for the increase in both the sperm count and LH. There is only low quality evidence regarding the effectiveness of aromatase inhibitor therapy in infertile men. Further trials are needed with standardized interventions and outcomes. © 2016, Sociedade Brasileira de Reproducao Assistida. All right reserved.

Dias D.A.,Hospital do Coracao HCor and Teleimagem | Castro F.L.O.,Hospital do Coracao HCor and Teleimagem | Yared J.H.,Hospital do Coracao HCor | Lucas Junior A.,Hospital do Coracao HCor | And 2 more authors.
Radiologia Brasileira | Year: 2014

In a simplistic and succinct way, Liliequist membrane may be understood as a projection formed by an arachnoid membrane extending from the dorsum sellae to the mammillary bodies. In spite of being well known to neurosurgeons, many radiologists neither know this anatomical structure nor give importance to its study. The imaging evaluation of this membrane is feasible and may be interesting for a better preoperative planning; postoperative evaluation of third ventriculostomies; and understanding of suprasellar arachnoid cysts and perimesencephalic hemorrhage. The present article illustrates the anatomy of the membrane, with emphasis on imaging findings, besides describing its possible clinical and surgical implications. © Colégio Brasileiro de Radiologia e Diagnóstico por Imagem.

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