Assuntos
Retalhos de Tecido Biológico/irrigação sanguínea , Sobrevivência de Enxerto/fisiologia , Mamoplastia/métodos , Mastectomia , Complicações Pós-Operatórias/cirurgia , Reto do Abdome/irrigação sanguínea , Adulto , Artérias Epigástricas/transplante , Feminino , Hospitais Comunitários , Humanos , Mamoplastia/reabilitação , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Seleção de Pacientes , Complicações Pós-Operatórias/fisiopatologia , Reto do Abdome/transplante , Estudos RetrospectivosRESUMO
Recently, active remodeling may indicate a good prognosis in idiopathic interstitial pneumonias. In this study we sought to validate the importance of the collagen/elastic system in the extracellular matrix remodeling and to study the relationships between the collagen/elastic system in nonspecific interstitial idiopathic pneumonia (NSIP) and collagen vascular disease associated with nonspecific interstitial idiopathic pneumonia (CVD-NSIP). We examined collagen/elastic system fibers in open lung biopsies of 20 idiopathic NSIP and 21 CVD-NSIP patients. The clinical features were analyzed with respect to age, gender, pulmonary functional tests, chest X-ray and computed tomography, treatment, and survival. We used the picrosirius polarization method and Weigert's resorcin-fuchsin histochemistry and morphometric analysis to evaluate the amount of collagen/elastic system fibers and their association with the NSIP histologic pattern. No differences in clinical features and pulmonary function tests were observed between idiopathic NSIP and CVD-NSIP, but a significantly higher collagen and elastic fiber proliferation was detected in CVD-NSIP lungs and fibrosing NSIP histologic pattern. Multivariate Cox model analysis demonstrated that sex and quantitative elastic fiber staining added important prognostic information (p=0.01) and was indicative of a worse prognosis than collagen staining. A cut point at the mean staining of 1.5% for elastic fibers divided the patients into two groups with distinctive survival times. Those with elastic fibers greater than 1.5% had a median survival time of just 52 months. We concluded that idiopathic NSIP and CVD-NSIP were clinically similar but pathologically different, suggesting that different remodeling profiles in NSIP may represent evolutionary adapted responses to injury grade, which depend, at least in part, on the extent of elastic extracellular matrix deposition. Patients with greater than 1.5% of elastic fibers comprise a subset with a high risk for dying due to NSIP and may be an appropriate target for prospective studies.
Assuntos
Doenças Pulmonares Intersticiais/patologia , Pulmão/patologia , Corticosteroides/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Colágeno/análise , Tecido Elástico , Feminino , Humanos , Imunossupressores/uso terapêutico , Estudos Longitudinais , Pulmão/diagnóstico por imagem , Doenças Pulmonares Intersticiais/classificação , Doenças Pulmonares Intersticiais/mortalidade , Masculino , Pessoa de Meia-Idade , Prognóstico , Radiografia , Análise de Regressão , Testes de Função Respiratória , Fatores de RiscoRESUMO
A insuficiência renal aguda induzida por contraste (IRAIC) é considerada, atualmente, uma importante causa de disfunção renal em pacientes hospitalizados submetidos à cinecorioangiografia (CAG). Este achado adquire maior importância quando se verifica que a IRAIC é responsável por um aumento significativo dos índices de morbidade e mortalidade hospitalar / Radiocontrast-induced nephropathy (RIN) is considered an importante cause of renal failure in patients undergoing coronary. This data becomes more relevant when it presents a positive correlation with higher morbidity and mortality rates...