Assuntos
Anestesia Geral , Respiração com Pressão Positiva/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Respiração com Pressão Positiva/efeitos adversos , Complicações Pós-Operatórias/etiologia , Tamanho da AmostraRESUMO
Donor-derived Strongyloides stercoralis infections in transplant recipients are a rare but recognized complication. In this case series, we report donor-derived allograft transmission of Strongyloides in three solid organ transplant recipients. Following detection of infection in heart and kidney-pancreas recipients at two different transplant centers, a third recipient from the same donor was identified and diagnosed. S. stercoralis larvae were detected in duodenal aspirates, bronchial washings, cerebrospinal fluid, urine and stool specimens. Treatment with ivermectin and albendazole was successful in two of the three patients identified. The Centers for Disease Control and Prevention was contacted and performed an epidemiologic investigation. Donor serology was strongly positive for S. stercoralis antibodies on retrospective testing while all pretransplant recipient serum was negative. There should be a high index of suspicion for parasitic infection in transplant recipients and donors from endemic regions of the world. This case series underscores the need for expanded transplant screening protocols for Strongyloides. Positive serologic or stool tests should prompt early treatment or prophylaxis in donors and recipients as well as timely notification of organ procurement organizations and transplant centers.
Assuntos
Hospedeiro Imunocomprometido , Transplante de Órgãos/efeitos adversos , Strongyloides stercoralis/isolamento & purificação , Estrongiloidíase/transmissão , Doadores de Tecidos , Adolescente , Animais , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estrongiloidíase/diagnóstico , Estrongiloidíase/parasitologia , Transplantados , Transplante HomólogoRESUMO
Among 23 pediatric patients who underwent orthotopic liver transplant (OLT), we report two (11 and 26 months old) with posttransplant lymphoproliferative disease (PTLD) that occurred in the early posttransplantation period. They were Epstein-Barr Virus (EBV)-negative and received graft from EBV-positive donors. The surveillance for EBV viremia using serial EBV polymerase chain reaction determinations in the peripheral blood was positive at 10 and 90 days after OLT concomitant with symptoms of primary infection, both patients were treated with gancyclovir. The patients should progression to a Burkitt's and a non-Hodgkin's lymphoma that appeared 3 months posttransplantation. They were treated by withdrawal of immunosuppression and six courses of cyclophosphamide as well as anti-CD20 monoclonal antibody (Rituximab) every 21 days. One patient experienced acute graft rejection, which resolved with steroids and low doses of tacrolimus, she is free of disease at 24 months after the end of treatment. The other patient relapsed with a cerebral lymphoma, receiving aggressive chemotherapy, but died due to sepsis. In conclusion, PTLD occurred among in 2/23 patients who underwent OLT and appeared in the first quarter post OLT. The risk factors associated with early PTLD were primary EBV infection after OLT, young age, and EBV-negative recipient receiving a transplant from an EBV-positive donor. Antiviral treatment alone was inefficient; withdrawal of immunosuppression and courses of Rituximab and cyclophosphamide were well tolerated and controlled PTLD. The risk of graft rejection was increased by withdrawal of immunosuppression. One patient died.
Assuntos
Transplante de Fígado/efeitos adversos , Transtornos Linfoproliferativos/epidemiologia , Atresia Biliar/cirurgia , Linfoma de Burkitt/diagnóstico , Pré-Escolar , Progressão da Doença , Infecções por Vírus Epstein-Barr/diagnóstico , Evolução Fatal , Feminino , Humanos , Lactente , Linfoma/diagnóstico , Período Pós-Operatório , Resultado do TratamentoRESUMO
Introducción: Nuestro grupo recientemente demostró una asociación significativa entre periodontitis, placas coronarias aguda y extensión de la enfermedad coronaria aterosclerótica en pacientes con síndrome coronario agudo. Objetivo: Desarrollar un modelo experimental animal para estudiar el posible efecto pro-aterogénico de la inducción de periodontitis por Porphyromona Gingivalis (PG) en ratones deficientes en la apolipoproteína E (APO-E KO). Métodos: En 12 ratones APO-E KO mantenidos con dieta hiperlipidémica se realizaron tocaciones con PG cepa ATCC 53977 en el surco gingival de los molares mandibulares a las 8 semanas de vida. Igual número de ratones APO-E KO fue intervenido con el mismo procedimiento, pero sólo con el vehículo de las tocaciones. Estos procedimientos se repitieron a las 48, 72 y 120 hrs de la infección inicial. Luego de 4 semanas post-inoculación con PG se realizaron estudios histomorfométricos en la aorta proximal para medir la severidad de las lesiones ateromatosas y en las mandíbulas, para evaluar la pérdida del hueso alveolar. Resultados: No se observó una diferencia significativa en el daño del hueso alveolar en las mandíbulas de los animales infectados versus el grupo control. En las aortas, la razón tamaño placa/pared vascular fue mayor en el grupo infectado con PG que en el grupo control (0.132 ± 0.2 versus 0.103 ± 0.15, respectivamente), pero esta diferencia no fue estadísticamente significativa. Conclusión: El diseño experimental del presente estudio no permitió establecer si la periodontitis inducida por PG es capaz o no de acelerar el proceso aterogénico de los ratones APO-E KO. Será necesario aplicar un protocolo de infección periodontal más agresivo en estos animales para evaluar más adecuadamente el efecto de PG sobre la ateroesclerosis.
Assuntos
Animais , Camundongos , Arteriosclerose/microbiologia , Infecções por Bacteroidaceae/complicações , Porphyromonas gingivalis , Periodontite/complicações , Periodontite/microbiologia , Aorta/patologia , Apolipoproteínas E/deficiência , Dieta Aterogênica , Modelos Animais de Doenças , Hiperlipidemias , Porphyromonas gingivalis , Camundongos Knockout/microbiologiaRESUMO
We report on improvements in cryoprobe design and techniques of cryoablation as a minimally invasive alternative to open surgery for the treatment of benign breast tumors. In the study, which was conducted in 12 centers, 124 lesions in 102 patients were monitored for a period of 12 months after cryoablation. Two different treatment techniques were used: Double HI FREEZE and Tailored Freeze. In patients treated with the Tailored Freeze technique significantly better results were recorded 12 months after the procedure: the median reduction in tumor volume was 91%, 73% of all tumors treated were nonpalpable, 84% of lesions less than 2.5 cm in maximum diameter were nonpalpable, and none of the 31 mammograms performed yielded abnormal findings. Patient satisfaction was good to excellent in 92% of the patients. The safety profile of this technique was excellent; all complications were minor. Evolution of cryoablation freezing techniques, coupled with improvements in cryoprobe design, has resulted in significant improvements in both safety and effectiveness.
Assuntos
Neoplasias da Mama/cirurgia , Criocirurgia/métodos , Fibroadenoma/cirurgia , Adulto , Biópsia por Agulha , Neoplasias da Mama/diagnóstico , Feminino , Fibroadenoma/diagnóstico , Humanos , Mamografia , Pessoa de Meia-Idade , Resultado do Tratamento , Ultrassonografia MamáriaRESUMO
BACKGROUND: Alloantigen mismatch and cold ischemia have been shown to induce transplant arteriosclerosis. Pravastatin (PR) decreases arteriosclerosis probably related to an immunosuppressive effect. Statins possess other nonimmune properties that may be beneficial to transplantation. We studied the effect of PR on cold ischemia and alloantigen-induced transplant arteriosclerosis in syngeneic (SYN) and allogeneic (ALLO) aortic transplantation models. METHODS: Lewis rats served as the donors and recipients for SYN transplants and Brown Norway rats were donors for ALLO transplants. Aortic segments that had been preserved at 4 degrees C in Euro-Collins solution for 0 or 24 hours were transplanted to the infrarenal aorta of the recipients PR (10 mg/kg/d) was administered for 12 weeks prior to morphometric studies. Areas of intimal thickness and its relation to total vessel area were calculated. Lipid levels were measured at 12 weeks. RESULTS: Aorta rings preserved for 24 hours showed marked intimal thickening compared to controls (SYN, CI 0 hours = 21.5% +/- 16.5% vs SYN, CI 24 hours = 50.7 +/- 9.5%, P <.05). PR significantly decreased thickening (SYN, CI 24 hours + PR = 41.7 +/- 12.2 (P <.05) vs SYN, CI 0 hours on SYN, CI 24 hours). There was a nonsignificant decrease in thickening among ALLO transplants treated with PR (ALLO = 31.4 +/- 15.9 vs ALLO + PR = 23.8 +/- 18.8; P >.05). PR had no effect on lipid levels. PR decreases cold ischemia induced transplant arteriosclerosis in this syngeneic aortic transplant model, but does not affect an alloantigen-mediated process. The beneficial effect of PR is not related to its lipid-lowering properties but probably to a nonimmune effect.
Assuntos
Aorta Abdominal/transplante , Arteriosclerose/prevenção & controle , Pravastatina/farmacologia , Transplante Homólogo/fisiologia , Animais , Aorta Abdominal/efeitos dos fármacos , Aorta Abdominal/patologia , Arteriosclerose/etiologia , Temperatura Baixa , Modelos Animais de Doenças , Inibidores de Hidroximetilglutaril-CoA Redutases/farmacologia , Isquemia , Isoantígenos , Masculino , Ratos , Ratos Endogâmicos BN , Ratos Endogâmicos Lew , Transplante Homólogo/patologia , Transplante Isogênico/patologia , Transplante Isogênico/fisiologia , Túnica Íntima/patologiaRESUMO
UNLABELLED: Chile has one of the highest rates of gastric cancer in the world and most children and adolescents in the country are colonized by Helicobacter pylori. This study assessed the nature and extent of the gastric lesions in 73 consecutive patients aged 5-17 y, referred for upper gastrointestinal endoscopy. Their H. pylori-associated gastric pathology was characterized and these data were compared with their sociodemographic status. Endoscopic assessment was normal in 43 patients while in 30 there was a variety of mucosal lesions. Sixty patients (83%) had histological chronic gastritis of the antrum and in 45 (63%) the lesions also involved the gastric corpus; 90% of patients with chronic gastritis were colonized by H. pylori. Although most of these patients had epithelial erosions and dedifferentiation of the pit epithelium, atrophy and metaplasia were not found. Patients' socioeconomic status was inversely correlated with their rate of colonization by H. pylori (p < 0.005), the frequency of gastric lesions on endoscopy (p < 0.01) and the frequency of involvement of antral and corpus mucosa by chronic gastritis (p < 0.002). This latter feature was positively correlated with age (p < 0.001). CONCLUSION: This study shows a high frequency of extensive lesions of H. pylori-associated chronic gastritis in young Chilean patients. This histological picture is consistent with the hypothesis of a H. pylori-associated progressive gastric pathology which may represent a major factor in the high local rate of gastric cancer.
Assuntos
Mucosa Gástrica/patologia , Gastrite/epidemiologia , Gastrite/patologia , Infecções por Helicobacter/diagnóstico , Infecções por Helicobacter/epidemiologia , Helicobacter pylori/isolamento & purificação , Adolescente , Distribuição por Idade , Biópsia por Agulha , Criança , Pré-Escolar , Chile/epidemiologia , Doença Crônica , Feminino , Mucosa Gástrica/microbiologia , Gastrite/microbiologia , Gastroscopia , Humanos , Masculino , Prevalência , Probabilidade , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de Doença , Distribuição por SexoRESUMO
BACKGROUND: Insomnia with predominant thalamic involvement and minor cortical and cerebellar pathologic changes is not characteristic of familial Creutzfeldt-Jakob disease (CJD) but is a hallmark of fatal familial insomnia. OBJECTIVE: To report a 53-year-old woman with intractable insomnia as her initial symptom of disease. METHODS: The authors characterized clinical, pathologic, and molecular features of the disease using EEG, polysomnography, neurohistology, Western blotting, protein sequencing, and prion protein (PrP) gene (PRNP) analysis. RESULTS: The patient developed dysgraphia, dysarthria, bulimia, myoclonus, memory loss, visual hallucinations, and opisthotonos, as well as pyramidal, extrapyramidal, and cerebellar signs. Polysomnographic studies showed an absence of stages 3 and 4, and REM. She died 8 months after onset. On neuropathologic examination, there was major thalamic involvement characterized by neuronal loss, spongiform changes, and prominent gliosis. The inferior olivary nuclei exhibited chromatolysis, neuronal loss, and gliosis. Spongiform changes were mild in the neocortex and not evident in the cerebellum. PrP immunopositivity was present in these areas as well as in the thalamus. PRNP analysis showed the haplotype E200K-129M. Western blot analysis showed the presence of proteinase K (PK)-resistant PrP (PrP(sc)) with the nonglycosylated isoform of approximately 21 kd, corresponding in size to that of type 1 PrP(sc). N-terminal protein sequencing demonstrated PK cleavage sites at glycine (G) 82 and G78, as previously reported in CJD with the E200K-129 M haplotype. CONCLUSIONS: Insomnia may be a prominent early symptom in cases of CJD linked to the E200K-129M haplotype in which the thalamus is severely affected.
Assuntos
Síndrome de Creutzfeldt-Jakob/complicações , Síndrome de Creutzfeldt-Jakob/patologia , Distúrbios do Início e da Manutenção do Sono/etiologia , Distúrbios do Início e da Manutenção do Sono/patologia , Tálamo/patologia , Sequência de Aminoácidos , Substituição de Aminoácidos/genética , Western Blotting , Síndrome de Creutzfeldt-Jakob/genética , Evolução Fatal , Feminino , Humanos , Pessoa de Meia-Idade , Dados de Sequência Molecular , Polissonografia , Príons/análise , Príons/genética , Privação do Sono/etiologia , Privação do Sono/genética , Privação do Sono/patologia , Distúrbios do Início e da Manutenção do Sono/genéticaRESUMO
El rechazo crónico (RC) es la principal causa de pérdida de injertos en el transplante. En la génesis del RC participan tanto factores inmunológicos (rechazos agudos, histocompatibilidad) como no inmunológicos (edad del donante, tiempo de isquemia, drogas nefrotóxicas). El factor común de este tipo de rechazo es la lesión vascular (arteriosclerosis post transplante) caracterizada por hiperplasia concéntrica de la íntima de los vasos. El objetivo de este trabajo es presentar un modelo experimental y los resultados de un estudio para evaluar la importancia de factores no inmunológicos (tiempo de isquemia fría y ciclosporina (CsA) en la génesis del RC es un modelo de trasplante aórtico singénico en ratas. Rata Sprague Dowley machos de entre 250-300grs. sirven de receptores de injertos de aorta trrácica de la misma cepa. Mediante técnicas microquirúrgicas se anastomosa un injerto de 1-2 cms procurado de la aorta torácica, a la aorta infrarenal de otro animal. Los injertos son preservadores en solución de Eurocollins y se someten a 2 tiempos distintos de isquemia fría a 4C por 0 y 24 hrs y al efecto de la CsA (10 mg/kg/día), generando 4 grupos experimentales (n=7) (GRUPO A isquemia 0; GRUPO B isquemia 0 + CsA; GRUPO C isquemia 24 hrs; GRUPO D isquemia 24 hrs + CsA). Los animales se sacrifican a las 12 semanas de observación. Al menos 3 segmentos distintos de aorta son evaluados en forma ciega por un patólogo y se asigna un puntaje de 0 a 4 al grado de hiperplasia intima (HI), atrofia de la media, infiltrado celular de la adventicia y otras alteraciones histológicas. Las ratas sometidas a 24 hrs de isquemia tienen un mayor grado de HI que sus respectivos controles sin isquemia (grupo A 1,57 ± 0,5 vs grupo C2,57 ± 0,9 p<0,05), (grupo B 1,75 ± 0,4 vs grupo D 3,2 ± 0,7; p<0,01). Se observó una tendencia a un mayor grado de HI en los animales que recibieron CsA y sometidos a 24 hrs de isquemia fría pero que no fue estadísticamente significativa (grupo C 2,57 ± 0,9 vs grupo D 3,2 ± 0,7; p= 0,15). Concluimos que el modelo de autotrasplante aórtico es reproducible y de gran utilidad para el estudio del RC. Se confirma el profundo impacto de factores no inmunológicos como la isquemia prolongada en la génesis del RC. Al parecer la CsA no tiene efecto significativo sobre la arterioesclerosis post trasplante en este modelo singénico de autotrasplante aórtico.
Assuntos
Animais , Ratos , Aorta Torácica/transplante , Ciclosporina , Rejeição de Enxerto , IsquemiaRESUMO
El carcinoma de células transicionales del tracto urinario superior representa aproximadamente el 5 por ciento de todos los tumores de urotelio. El tratamiento estándar es la nefroureterectomía, aunque en años recientes se ha producido un mayor desarrollo de técnicas conservadoras para tumores superficiales y de bajo grado. El objetivo de este trabajo es presentar una descripción de los pacientes operados por esta enfermedad tumoral durante los últimos 10 años en nuestra institución, evaluando la importancia de los probables factores pronósticos de recurrencia y sobrevida después del tratamiento quirúrgico. Los datos fueron obtenidos mediante revisión de fichas clínicas, informes de anatomía patológica y certificados de defunción, además de seguimiento telefónico, de los pacientes operados un nuestro centro entre 1992 y 2001. Fueron registradas las características de los pacientes y de los tumores, la forma de presentación, el estudio diagnóstico, el tratamiento recibido, las recurrencias y las muertes, señalando la causa de éstas. Para el análisis estadístico se compararon curvas de Kaplan-Meier mediante log-rank test. Se obtuvieron datos de 25 pacientes, 16 hombres y 9 mujeres. El seguimiento fue de 100 por ciento, con una mediana de seguimiento de 13,8 meses (1-56 meses). La edad promedio fue de 69±13 años. El tumor primario se localizó en pelvis, uréter y unión pieloureteral en 76 por ciento, 16 por ciento y 8 por ciento de los casos respectivamente. El factor de riesgo más importante fue el tabaquismo (40 por ciento de los pacientes). El 88 por ciento de los pacientes tuvo hematuria macroscópica como forma de presentación. En el 90 por ciento de los casos fue necesario realizar dos o más estudios de imágenes para el diagnóstico. El tratamiento inicial de todos los pacientes fue quirúrgico: nefrectomía en 18 pacientes (72 por ciento), nefrectomía en 4, nefrectomía parcial en 1 y nefroureterectomía distal en 1. El tumor fue superficial (Ta/T1) en 20 por ciento e invasor (T2-T4) en el 80 por ciento de los casos. El 70 por ciento de los tumores tuvo grado III o IV de Broders. La linfadenectomía fue positiva en 2 de 6 pacientes. Se empleo quimioterapia y/o radioterapia adyuvante en 4 pacientes. La tasa de sobrevida actuarial cáncer-específica a 5 años fue de 100 por ciento para los tumores superficiales (Ta/T1) y de 40 por ciento para los tumores invasores (t2-t4)...