RESUMO
OBJECTIVE: Primary leiomyosarcoma of the inferior vena cava (IVC) is best managed with surgical resection when technically feasible. However, consensus is lacking regarding the best choice of conduit and reconstruction technique. The aim of the present multicenter study was to perform a comprehensive assessment through the VLFDC (Vascular Low Frequency Disease Consortium) to determine the most effective method for caval reconstruction after resection of primary leiomyosarcoma of the IVC. METHODS: A multicenter, standardized database review of patients who had undergone surgical resection and reconstruction of the IVC for primary leiomyosarcoma from 2007 to 2017 was performed. The demographics, periprocedural details, and postoperative outcomes were analyzed. RESULTS: A total of 92 patients (60 women and 32 men), with a mean age of 60.1 years (range, 30-88 years) were treated. Metastatic disease was present in 22%. The tumor location was below the renal veins in 49 (53%), between the renal and hepatic veins in 52 (57%), and above the hepatic veins in 13 patients (14%). The conduits used for reconstruction included ringed polytetrafluoroethylene (PTFE; n = 80), nonringed PTFE (n = 1), Dacron (n = 1), autogenous vein (n = 1), bovine pericardium (n = 4), and cryopreserved tissue (n = 5). Complete R0 resection was accomplished in 73 patients (79%). In-hospital mortality was 2%, with a median length of stay of 8 days. The primary patency of PTFE reconstructed IVCs was 97% and 92% at 1 and 5 years, respectively, compared with 73% at 1 and 5 years for the non-PTFE reconstructed IVCs. The overall 1-, 3-, and 5-year survival for the entire cohort were 94%, 86%, and 65%, respectively CONCLUSIONS: The findings from our multi-institutional study have demonstrated that complete en bloc resection of IVC leiomyosarcoma with vascular surgical reconstruction in selected patients results in low perioperative mortality and is associated with excellent long-term patency. A ringed PTFE graft was the most commonly used conduit for caval reconstruction, yielding excellent long-term primary patency.
Assuntos
Implante de Prótese Vascular , Leiomiossarcoma , Animais , Bovinos , Feminino , Humanos , Leiomiossarcoma/diagnóstico por imagem , Leiomiossarcoma/cirurgia , Masculino , Pessoa de Meia-Idade , Politetrafluoretileno , Estudos Retrospectivos , Resultado do Tratamento , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/patologia , Veia Cava Inferior/cirurgiaAssuntos
Antineoplásicos/uso terapêutico , Diagnóstico por Imagem/métodos , Inflamação/etiologia , Neoplasias/diagnóstico , Neoplasias/terapia , Antineoplásicos/farmacologia , Ensaios Clínicos como Assunto , Progressão da Doença , Humanos , Inflamação/induzido quimicamente , National Cancer Institute (U.S.) , Neoplasias/tratamento farmacológico , Neoplasias/radioterapia , Valor Preditivo dos Testes , Apoio à Pesquisa como Assunto , Resultado do Tratamento , Estados UnidosRESUMO
The Alexander Project, initiated in 1992 as an international, multicentre, longitudinal surveillance study of antimicrobial susceptibility among common respiratory pathogens, has been pivotal in defining the role of global surveillance. At the time, there were few studies in which data were collected in a way that allowed meaningful comparisons to be made between studies, locations or over time. The project instituted the use of a central laboratory and standardized methods for the collection of isolates and determination of susceptibility, and this was continued with the addition of two further reference laboratories. Data from the study have provided a resource for measuring trends in the susceptibility patterns of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis at country, regional and global levels. Determination and publication of quantitative MICs enabled detailed assessment of changes in susceptibility distributions and assessment of microbiological and potential clinical susceptibility using different breakpoints, including those based on pharmacokinetic/pharmacodynamic parameters. Comparisons of antimicrobial usage patterns and resistance prevalences over time allowed hypotheses to be examined with respect to the role of quantity and type of antimicrobial use in the selection and spread of resistance. The resulting collection of isolates has provided a valuable resource for molecular studies into the evolution of resistance over time and location; a substantial proportion of this collection is now in the public domain. This paper reviews the 10 years of the Alexander Project and the benefits it has brought to an understanding of the evolution of antibacterial resistance in community respiratory bacteria.
Assuntos
Antibacterianos/farmacologia , Bactérias/efeitos dos fármacos , Infecções Respiratórias/microbiologia , Antibacterianos/uso terapêutico , Ásia , Bactérias/isolamento & purificação , Farmacorresistência Bacteriana , Europa (Continente) , Haemophilus influenzae/efeitos dos fármacos , Haemophilus influenzae/isolamento & purificação , Humanos , Testes de Sensibilidade Microbiana/métodos , Testes de Sensibilidade Microbiana/normas , Moraxella catarrhalis/efeitos dos fármacos , Moraxella catarrhalis/isolamento & purificação , Estudos Multicêntricos como Assunto , Vigilância da População , Infecções Respiratórias/tratamento farmacológico , África do Sul , América do Sul , Streptococcus pneumoniae/efeitos dos fármacos , Streptococcus pneumoniae/isolamento & purificação , Estados UnidosRESUMO
La resonancia magnética (RM) por difusión (DWI) y perfusión es útil para asesorar el daño tisular en el ictus isquémico agudo. Reducciones del coeficiente de difusión aparente (ADC) podrían ocurrir en regiones del cerebro destinadas a interfase. Sin embargo, esto no puede ser establecido en la RM inicial, puesto que el tamaño final del infarto es determinado en estudios subsecuentes. El propósito de este estudio es determinar si las regiones del cerebro hipoperfundidas pero no infartadas (penumbra isquémica) en la RM inicial exhiben edema citotóxico precoz
Assuntos
Isquemia Encefálica , Espectroscopia de Ressonância Magnética , Acidente Vascular CerebralAssuntos
Otite Média/prevenção & controle , Criança , Proteção da Criança , Pré-Escolar , Farmacorresistência Bacteriana/fisiologia , Previsões , Humanos , Incidência , Lactente , Bem-Estar do Lactente , Recém-Nascido , Otite Média/epidemiologia , Otite Média/microbiologia , Infecções Pneumocócicas , Vacinas Pneumocócicas/uso terapêutico , Resultado do Tratamento , Estados Unidos/epidemiologia , Vacinas Conjugadas/uso terapêuticoRESUMO
Se han detectado cepas de S. pneumoníae resistentes a los agentes antimicrobianos en todos los continentes llegando a constituir patógenos predominantes en algunas áreas; muchas de estas cepas son multiresistentes. Debido a la importancia de los neumococos en la etiología de meningitis, cepas con una concentración inhibitorio mínima (CIM) de penicilina G de < 0,06 pg/mi son consideradas sensibles, mientras que las con una CIM de 0,1 a 1 pg/mi son catalogadas como de sensibilidad intermedia y las con CIM de > 1 pg/ mi son denominadas resistentes. Esta revisión comprende los métodos de su detección, las técnicas de estudio de sensibilidad y la terapia de infecciones neumocócicas causadas por cepas resistentes. Recientemente se han definido los métodos de estudio de sensibilidad para ser usados en S. pneumoníae. Se recomienda la evaluación de resistencia a penicilina con discos de 1 pg de oxacilina en todas las cepas aisladas de infecciones clinicamente significativas, el estudio de la actividad in vítro de otros beta-lactámicos en cepas resistentes a penicilina y la determinación de la CIM para otros grupos de agentes antimicrobianos. El tratamiento de infecciones neumocóccicas resistentes depende del grado de resistencia a penicilina y a otros fármacos, de la dosis y vía de administración de ellos, del sitio de la infección, la severidad de la enfermedad y la presencia de condiciones subyacentes. Las recomendaciones actuales de tratamiento son empíricas o están basadas en estudios retrospectivos y por lo tanto, se necesitan estudios prospectivos adecuados que puedan proveer una información más fundamentada