RESUMO
Organ damage predicts mortality, increased accrual of detriment, and poor quality of life in systemic lupus erythematosus patients. The objective of this study is to determine the damage-free survival and its predictive factors in a population of Colombian subjects. The method used in this study is the retrospective follow-up of a cohort; damage was measured with SLICC/ACR index. Predictors of impairment were assessed by logistic regression and survival analysis. One hundred sixty-one individuals were included; 28.9% suffered damage, primarily neuropsychiatric, renal, and vascular. Arterial hypertension, antiphospholipid antibodies, prednisone dose, and number of relapses were all predictors of detriment. Onset after age 50 and daily prednisone dose higher than 7.5 mg determined earlier occurrence of damage.
Assuntos
Anticorpos Antifosfolipídeos/sangue , Hipertensão/fisiopatologia , Rim/fisiopatologia , Lúpus Eritematoso Sistêmico/imunologia , Adolescente , Adulto , Colômbia , Progressão da Doença , Feminino , Humanos , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Lúpus Eritematoso Sistêmico/fisiopatologia , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Índice de Gravidade de Doença , Adulto JovemRESUMO
Introduction: Ureteral replacement by a loop of defunctionalized ileum was described more than 2 centuries ago and continues to be a therapeutic option at present. This series describes the technique of bilateral ureteral replacement with ileum. Aim: To report 4 cases of bilateral ileal ureteral replacement performed at our institution, its indications, the surgical technique, complications, and a review of the literature. Material and Method: We report 4 cases of extensive bilateral ureteral injury of different etiologies, whose treatment with curative intent was to replace the damaged ureter with a isoperistaltic small bowel segment. Results: The surgical technique used was standard in all cases. There were no intraoperative complications and only one patient had hyperchloremic acidosis. No patient has shown loss of renal function in the long-term follow up. Conclusion: Is an effective therapeutic, safe and reproducible technique to replacement of major bilateral ureteral injuries, independent of the original cause.
Introducción: La sustitución ureteral por un asa de íleon desfuncionalizada fue descrita hace más de 2 siglos y continúa siendo una alternativa terapéutica en la actualidad. Esta serie describe la técnica de sustitución ureteral bilateral con íleon. Objetivo: Presentar 4 casos de sustitución ureteral ileal bilateral realizados en nuestro centro, indicaciones de la técnica quirúrgica, complicaciones y revisión de la literatura. Material y Método: Presentamos 4 casos de lesión ureteral bilateral extensa, de etiologías diferentes, cuyo tratamiento con intención curativa fue la sustitución de la lesión ureteral por un segmento intestinal isoperis-táltico. Resultados: La técnica quirúrgica empleada fue estándar en todos los casos. No hubo complicaciones intraoperatorias, y sólo una paciente presentó descompensación metabólica por acidosis hiperclorémica. En ningún paciente se ha demostrado pérdida en la función renal. Conclusión: El segmento intestinal de íleon desfuncionalizado es una alternativa terapéutica eficaz, segura y reproducible, para el reemplazo de importantes lesiones ureterales bilaterales, independiente de la causa original.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Íleo/transplante , Ureter/cirurgia , Complicações Intraoperatórias , Seleção de Pacientes , Ureter/lesõesRESUMO
The transplacental exchange of moxidectin after maternal or fetal intravenous (i.v.) administration was studied using the chronically catheterized fetal sheep model. Nine pregnant Suffolk Down sheep of 65.7 +/- 5.9 kg body weight (bw) were surgically prepared to insert polyvinyl catheters in the fetal femoral artery and vein and amniotic sac. The ewes were randomly assigned to two experimental groups. In group 1 (maternal injection) five ewes were treated with an i.v. bolus of 0.2 mg of moxidectin/kg bw. In group 2, (fetal injection) an i.v. bolus of 1 mg of moxidectin was administered to the four fetuses by femoral vein catheters. Maternal and fetal blood and amniotic fluid samples were taken before and after moxidectin administration for a 144 h post-treatment period. Samples were analyzed by liquid chromatography. A noncompartmental pharmacokinetic analysis was performed and statistical differences were determined by mean of parametric and nonparametric statistical tests. Pharmacokinetic differences observed in maternal variables were shorter elimination half-life and mean residence time compared with values previously reported for ivermectin. Drug diffusion from maternal to fetal circulation (AUC(0-t) = 232.6 +/- 72.5 ng.h/mL) was statistically not different (P = 0.09) compared with fetal to maternal diffusion (AUC(0-t) = 158.0 +/- 21.6 ng.h/mL). Fetuses showed significantly (P = 0.008) lower drug body clearance values compared with those observed in the maternal side. Considering the observed transplacental passages between materno-fetal or feto-maternal circulations, we conclude that the placental barrier is not effective in preventing the moxidectin diffusion between mother and fetus.
Assuntos
Inseticidas/farmacocinética , Prenhez , Animais , Área Sob a Curva , Feminino , Sangue Fetal , Feto , Meia-Vida , Injeções Intravenosas , Inseticidas/sangue , Macrolídeos/sangue , Macrolídeos/farmacocinética , Troca Materno-Fetal , Taxa de Depuração Metabólica , Gravidez , OvinosRESUMO
The past decade of research has led to a greater understanding of the pathogenesis of asthma and, in particular, the pivotal role of the underlying inflammatory process. Along with inheritance in atopic patients, the presence of inhaled triggering allergens are considered the predominant predisposing factors in the development of the disease. We have conducted a longitudinal clinical therapeutic study, which included 45 pediatrics patients with asthma, in order to evaluate whether the removal of any potential inhaled triggering factor, could decrease the requirement of drug based anti-inflammatory therapy. Patients admitted in this study presented at least, two monthly asthma attacks during the last four months. A single treatment with theophylline (group A), beclomethasone (group B) or salbutamol (group C), was prescribed during the first 2 weeks, along with specific instructions to avoid inhaled allergens. Regardless of the drug used, patients showed impressive and prolonged clinical improvement during 6 months, reduction of total IgE serum levels in the three groups (p < 0.02; 0.005 and 0.02 respectively) and favorable modification of force expiratory volume at the first second, forced vital capacity and flow expiratory peak. During the observation period a constant monitoring of mites allergens concentrations was performed, showing a decrease of these antigens, associated with clinical improvement, and only in those patients who remained symptomatic (group A 31%, group B 29% and group C 9%), failures performing the measures designed to reduce their exposure to environmental allergens, was demonstrated. These results suggest that reduction of inhaled triggering factors may decrease the requirement of anti-inflammatory drug therapy to control the symptoms in patients with asthma.
Assuntos
Alérgenos , Antiasmáticos/administração & dosagem , Asma/tratamento farmacológico , Exposição por Inalação , Adolescente , Albuterol/administração & dosagem , Alérgenos/imunologia , Anti-Inflamatórios/administração & dosagem , Asma/fisiopatologia , Asma/prevenção & controle , Beclometasona/administração & dosagem , Broncodilatadores/administração & dosagem , Criança , Pré-Escolar , Interpretação Estatística de Dados , Poeira , Feminino , Humanos , Imunoglobulina E/sangue , Estudos Longitudinais , Masculino , Testes de Função Respiratória , Teofilina/administração & dosagem , Fatores de TempoRESUMO
Levels of Zn, Cu and Fe were measured in blood serum samples of 320 children: 160 boys and 160 girls randomly selected, ages between 7 and 14 years, all considered healthy and residing in the City of Merida, Venezuela. The metals were determined using flow injection analysis-flame atomic absorption spectrometry. There was a tendency for serum Zn (SZn) to increase with age. There was no significant difference in SZn levels between males and females in the different age groups. Serum copper (SCu) decreases significantly (p < 0.05) with age in male children, whereas it increases in female children. The concentration of serum iron (SFe) tends to be lower than that reported in the literature. However, the age groups studied showed no statistically significant sex and age-related differences. The results are compared with values previously reported for healthy children studied in other communities. The present study has shown that there is a complex interaction between SZn, SCu, SFe and age and sex of the children. On the other hand, our observations also suggest that more detailed studies of these metals should be done, and that the study should include metabolic balances and associations between SZn, SCu, SFe and anthropometric variables (height, weight, body mass index and skinfold thickness).
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Cobre/sangue , Saúde , Ferro/sangue , Zinco/sangue , Adolescente , Fatores Etários , Análise de Variância , Criança , Feminino , Humanos , Masculino , Fatores Sexuais , VenezuelaRESUMO
In order to study the ST-segment changes during isometric exercise (IE) we have reviewed the hemodynamic and cineangiographic protocols of 13 with Chaga's disease patients. On the basis of the electrocardiogram (EKG) and the left ventricular cineangiogram, the chagasic patients were divided in two groups. Chagas' group I: 6 patients with left ventricular apical aneurysm, Chagas' II: 7 patients with multiple left ventricular dyskinetic segment and occasional premature ventricular contractions. Fourteen subjects with normal left ventricular cineangiograms and normal EKG's were used as controls. The IE was performed by all chagasic and control subjects 31.9 +/- 18 (M +/- SD) months after the cardiac catheterization. The IE was performed at 25% of maximum voluntary capacity for 5 minutes. The precordial leads (V1-V6) were simultaneously recorded, in the standing position, immediately before and after the IE. The ST-segment changes were assessed by measuring the distance of the 'J point, of the ST-segment, to the baseline in three consecutive sinus beats. Immediately before the IE, 5 patients of Chagas' group I (86%) has ST-segment elevation (leadas V1-V2). In the control group, only 2 subjects (14%) had ST-segment elevation, (P less than 0.007). After IE, the control subjects "normalized" their ST-segment elevation, whereas it persisted elevated in the 5 Chagas' group I patients (P less than 0.003). These results suggest that in chagasic patients, the ST-segment changes observed during isometric exercise could be related to the presence of left ventricular apical aneurysm.
Assuntos
Cardiomiopatia Chagásica/fisiopatologia , Eletrocardiografia , Exercício Físico/fisiologia , Aneurisma Cardíaco/fisiopatologia , Adulto , Feminino , Ventrículos do Coração , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Chagasic patients may have a normal or abnormal response of heart rate to atropine. To determine if this response to atropine is related to the degree of left ventricular dysfunction, we studied 33 patients with a positive complement fixation test for Chagas' disease. Eleven subjects, with atypical chest pain and negative complement fixation test, were used as controls (sero-negative). Left ventricular wall motion and the left ventricular volumes were determined by ventricular cineangiography. Coronary arteriography was also performed. The sero-negative subjects had normal left ventricular wall motion and the left ventricular diastolic volume was 88 +/- 24 ml/m2. The response of heart rate to atropine was 50 +/- 8 (mean +/- SD) (range 40-65 beats/min). On the basis of the response to atropine, the chagasic patients were divided into groups with a normal response (greater than 40 beats/min) and those with an abnormal response (less than 40 beats/min). Sixty five per cent of those with a normal response had left ventricular apical aneurysms. The left ventricular end-diastolic volume was not significantly different from the sero-negative subjects (96 +/- 26 ml/m2). Six patients (30%) had a left ventricular diastolic volume between 110 and 140 ml/m2. Sixty two per cent of those chagasic subjects with an abnormal response had diffuse left ventricular hypokinesis, and the left ventricular end-diastolic volume was 192 +/- 49 ml/m2 (P less than 0.01). The response of heart rate and the left ventricular diastolic volume were inversely correlated in the chagasic patients (r = -0.88, P less than 0.01). Our results indicate that myocardial damage and the degree of left ventricular dilatation are more severe in chagasic patients with an abnormal response of their heart rate to atropine. Furthermore, the inverse correlation between these two variables is highly indicative of a relationship between the response of heart rate to atropine and the degree of left ventricular dysfunction.
Assuntos
Atropina , Cardiomiopatia Chagásica/fisiopatologia , Frequência Cardíaca/efeitos dos fármacos , Ventrículos do Coração/fisiopatologia , Adulto , Débito Cardíaco/efeitos dos fármacos , Eletrocardiografia , Feminino , Coração/inervação , Aneurisma Cardíaco/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Contração Miocárdica/efeitos dos fármacos , Sistema Nervoso Parassimpático/fisiopatologia , Nervo Vago/fisiopatologiaRESUMO
The ratio between maximal and minimal R-R intervals measured during the Valsalva maneuver is an adequate means of studying the functional state of the cardiac parasympathetic nervous system. We studied the changes in heart rate evoked during the Valsalva maneuver in 49 asymptomatic Chagasic patients with different degrees of myocardial involvement. The Chagasic patients were divided in three groups. Twelve patients had no evidence of heart disease except for an abnormal myocardial biopsy. Sixteen patients had a normal electrocardiogram but revealed evidence of localized myocardial damage as shown by left ventricular cineangiography. Twenty-one patients had abnormal electrocardiograms and revealed multiple areas of abnormal left ventricular wall motion. The Valsalva ratio (mean +/- standard error) was 1.62 +/- 0.12 for controls, 1.52 +/- 0.10 for those with an abnormal biopsy, 1.48 +/- 0.06 for those with localized myocardial damage, and 1.31 +/- 0.04 for those with an abnormal electrocardiogram. There were no statistically significant differences between the control group (normal sero-negative subjects) and those patients with normal electrocardiograms. Results in those with an abnormal electrocardiogram, however, were statistically different (P less than 0.05) from the other groups. These results are in discordance with the commonly accepted hypothesis that cardiac parasympathetic denervation causes a dilated myocardiopathy in patients with chronic Chagasic myocarditis.