RESUMO
UNLABELLED: The optimal immunosuppressive regimen for simultaneous kidney pancreas transplantation (SKPT) is still not established. We conducted a study to compare the safety and efficacy of no induction versus anti-IL-2 receptor induction protocols in SKPT recipients receiving the same maintenance regimen. METHODS: Sixty-three SKPT recipients were divided into two groups: no induction group (n = 42) and anti-IL-2 receptor induction group (n = 21). All patients were maintained on tacrolimus, mycophenolate mofetil, and prednisone. Primary endpoints were 1-year acute rejection incidence and patient and graft survivals. RESULTS: Demographic characteristics were similar between the groups. Acute rejection incidence at 1 year was equal in both groups (28.6%). Kidney and pancreas allograft survival in the no induction group were 78.6% and 76.2%, and in the anti-IL-2R induction group, 81% and 71.4%, respectively (P = NS). Patient survival was also similar: 83.3% in the no induction versus 85.7% in the anti-IL-2R induction group. Deaths due to sepsis were higher in the anti-IL-2R induction group, albeit not significantly. CONCLUSION: The use of a no-induction protocol in SKPT is safe and effective immunosuppression that also reduces transplantation costs.
Assuntos
Imunossupressores/uso terapêutico , Transplante de Rim/imunologia , Transplante de Pâncreas/imunologia , Receptores de Interleucina-2/imunologia , Adulto , Anticorpos Monoclonais/uso terapêutico , Anticorpos Monoclonais Humanizados , Biópsia , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/prevenção & controle , Daclizumabe , Quimioterapia Combinada , Rejeição de Enxerto/tratamento farmacológico , Rejeição de Enxerto/epidemiologia , Rejeição de Enxerto/patologia , Sobrevivência de Enxerto , Humanos , Imunoglobulina G/uso terapêutico , Terapia de Imunossupressão/métodos , Transplante de Rim/mortalidade , Ácido Micofenólico/análogos & derivados , Ácido Micofenólico/uso terapêutico , Transplante de Pâncreas/mortalidade , Seleção de Pacientes , Prednisona/uso terapêutico , Análise de SobrevidaRESUMO
Hypothalamic gangliocytomas have been shown to contain immunoreactivity for hypophysiotropic peptides and some have been associated with endocrine dysfunction. Extrahypothalamic gangliocytomas are usually not associated with endocrine abnormalities. We studied nine cerebral or cerebellar gangliocytomas from six men and three women; none of the patients had detectable alterations of endocrine homeostasis. On histological examination, the tumor cells resembled hypothalamic neurons. Electron microscopy disclosed the presence of dense-core vesicles in neuronal cytoplasm and processes resembling Herring bodies, and there were synaptic contacts between tumor cells. All but two tumors contained immunocytochemical positivity for at least one peptide hormone or amine; these included somatostatin, corticotropin-releasing hormone, beta-endorphin, galanin, vasoactive intestinal peptide, calcitonin, serotonin, catecholamines or met-enkephalin. These tumors have been thought to represent neoplasms arising in ectopic autonomic neural tissue. Their morphological features, their similarity to hypothalamic gangliocytomas and the multiple immunoreactivities shown here suggest that they can be regarded as tumors of peptidergic neurons that are widely distributed throughout the central nervous system.
Assuntos
Neoplasias Encefálicas/patologia , Neoplasias Cerebelares/patologia , Ganglioneuroma/patologia , Adolescente , Adulto , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/metabolismo , Neoplasias Cerebelares/diagnóstico , Neoplasias Cerebelares/metabolismo , Feminino , Ganglioneuroma/diagnóstico , Ganglioneuroma/metabolismo , Humanos , Imuno-Histoquímica , Lactente , Imageamento por Ressonância Magnética , Masculino , Microscopia Eletrônica , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
Immunohistochemical studies with antisera against four peroxisomal enzymes, catalase and beta-oxidation enzymes (acyl-coenzyme A oxidase, bifunctional protein, and 3-ketoacyl-CoA thiolase), were performed on brain, liver, and kidney specimens from patients with peroxisomal disorders, as well as specimens from three control subjects, by using conventional paraffin-embedded autopsy material. The patients included eight with Zellweger syndrome and one with neonatal adrenoleukodystrophy. In the liver and kidney specimens from all patients, except one with Zellweger syndrome, diffuse immunostaining with all antisera in the cytoplasm of hepatocytes and renal tubular epithelium suggested an absence of peroxisomes but the presence of peroxisomal enzymes. Examination of brain specimens indicated a weak or negative reaction of neurons in the cerebral cortex and a weak reaction of glial cells in the white matter, which suggested maturational delay compared with control subjects. The delayed immunoreactive pattern of peroxisomal enzymes in Zellweger syndrome and neonatal adrenoleukodystrophy may be related to the significant neuropathologic features of polymicrogyria and dysmyelinogenesis. One patient with Zellweger syndrome had a unique finding of a positive granular catalase reaction and a negative reaction with antisera to 3-ketoacyl-coenzyme A thiolase, which suggested a diagnosis of pseudo-Zellweger syndrome. This study validates the application of these immunohistochemical methods to the study of peroxisomal enzymes. Use of these methods improves the accuracy of diagnosis of peroxisomal disorders.
Assuntos
Adrenoleucodistrofia/diagnóstico , Encéfalo/patologia , Rim/patologia , Fígado/patologia , Microcorpos/enzimologia , Síndrome de Zellweger/diagnóstico , Acetil-CoA C-Aciltransferase/análise , Acil-CoA Oxidase , Catalase/análise , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Neuroglia/patologia , Neurônios/patologia , Oxirredutases/análiseRESUMO
Ultrasound brain scans sometimes demonstrate increased echogenicity or cysts, or both, in the periventricular white matter, superolateral to the ventricle, in the most common site of periventricular infarction. Over 33 months, 23 preterm infants dying after 20 or more days of life were entered into this study. Superolateral echogenicity or cysts were found in 13 (57%) cases. Periventricular infarction was present at autopsy in 12 (52%) cases. Ultrasound accurately diagnosed the size, site, and extent of periventricular infarction in 78% of scans. Interpretive errors were made with poor-quality scans and with early and late studies. We conclude that sector ultrasound brain scans accurately diagnose major periventricular infarction. Hemorrhage into the site of infarction is not a prerequisite for diagnosis of periventricular infarction by ultrasound.
Assuntos
Infarto Cerebral/diagnóstico , Ventrículos Cerebrais/patologia , Doenças do Prematuro/diagnóstico , Ultrassonografia , Autopsia , Infarto Cerebral/patologia , Feminino , Humanos , Recém-Nascido , Doenças do Prematuro/patologia , MasculinoAssuntos
Infecções por Citomegalovirus/prevenção & controle , Doenças do Recém-Nascido/prevenção & controle , Doenças do Prematuro/prevenção & controle , Reação Transfusional , Infecções por Citomegalovirus/etiologia , Humanos , Lactente , Recém-Nascido , Doenças do Recém-Nascido/etiologia , Doenças do Prematuro/etiologiaRESUMO
Congenital muscular dystrophy (muscular dystrophy presenting from birth) with a wide spectrum of clinical severity is reported in 24 patients. Progression of symptoms was evident, leading to significant motor handicap in all patients and death in eight cases. Muscle enzyme studies did not always correlate with the severity of the disease. In six cases, initial muscle biopsy showed only minimal, nonspecific abnormalities; however, characteristic dystrophic changes were evident on repeat biopsies. Histochemical and electron microscopic studies did not show consistent changes, except type I predominance in a few cases. Evidently the condition is rarely, if ever, benign and the clinical course cannot be predicted from the initial presentation or early pathologic findings. Clinical, laboratory and pathologic characteristics are outlined for the diagnosis of this disorder.
Assuntos
Distrofias Musculares/congênito , Biópsia , Criança , Pré-Escolar , Creatina Quinase/metabolismo , Eletromiografia , Feminino , Humanos , Lactente , Masculino , Músculos/enzimologia , Músculos/fisiopatologia , Distrofias Musculares/patologia , Distrofias Musculares/fisiopatologia , Condução NervosaAssuntos
Morte Súbita do Lactente/patologia , Nervo Vago/patologia , Fatores Etários , Doenças dos Nervos Cranianos/complicações , Humanos , Lactente , Recém-Nascido , Fibras Nervosas/patologia , Fibras Nervosas Mielinizadas/patologia , Respiração , Morte Súbita do Lactente/etiologia , Nervo Vago/fisiopatologiaRESUMO
Brain biopsies for neurodegenerative disease performed at The Hospital for Sick Children, Toronto, over a 12-year period (1964 to 1976) were reviewed. Of 64 biopsies, major histologic abnormalities with diagnostic or prognostic significance comprised 39% of the total cases, minor abnormalities represented 13%, and 48% appeared normal. The procedure failed to provide prognostic assistance in 41%. With the advent for newer diagnostic techniques (enzyme assays and muscle, skin, peripheral nerve, rectal, and appendix biopsies) for neurodegenerative disease in childhood, a much lower yield is noted (15 to 20%). Only two progressive degenerative childhood conditions remain in which cerebral tissue is necessary for diagnosis--Alexander disease and Canavan spongy degeneration.