RESUMO
INTRODUCTION: Endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) is an accurate method of diagnosing and staging gastrointestinal and thoracic malignancy. A key issue in maximizing FNA accuracy is to ensure that an adequate specimen is obtained. On-site cytopathology increases the diagnostic yield of EUS-FNA. However, this increases the time and costs. Physicians trained in EUS and in pathology are capable of interpreting cytologic adequacy from EUS-FNA specimens. Furthermore, on-site interpretation by the endoscopist could reduce cost and procedure duration. The learning curve of endossonographers in on-site cytopathology and how they could contribute in EUS-FNA accuracy increase is unknown. OBJECTIVE: To determine the interobserver concordance of on-site cytopathology interpretation of EUS-FNA specimens by comparing endosonographers trained in cytology with a physician cytopathologist. METHODS: A prospective blinded study comparing one endossonographer with one physician cytopathologist. The study was developed in the Santa Casa Medical School, Brazil from February to November 2012. Fifteen different cases of EUS-FNA were analysed, in a total of 50 slides. Each observer described the slides for the adequate or not of tissue sampling, and classified as benign, suspicious, malign or undefined. The analyses were then matched. RESULTS: We analyzed the concordance of 50 slides description made by the endossonographer and physician cytopathologist, according to enough material, cellular group identification and final diagnosis. Kappa (κ) indexes were: Presence of material κ = 0.480 (P < 0.001); presence of malignance κ = 0.808 (P < 0.001); in subepithelial lesions κ = 0.615 (P = 0.06); in pancreatic lesions κ = 0.675 (P < 0.001); in mediastinal lesions κ = 0.243 (P = 0.128). CONCLUSION: Our study showed that endosonographers and cytopathologists had good concordance in EUS-FNA specimens on-site cytopathology interpretation, except in mediastinal/pulmonary cases.
RESUMO
INTRODUCTION: The objective of this case series study by retrospective analysis was to determine the relevance of endoscopic ultrasound (EUS) in therapeutic decision esophageal cancer. MATERIAL AND METHODS: Using medical records of the Department of Endoscopy of Santa Casa de São Paulo, we have collected data from 16 patients, in 4 years, diagnosed of esophageal cancer, and presented in the form of clinical cases to a specialist surgeon in esophageal cancer and a clinical oncologist, for therapeutic evaluation before and after the outcome of EUS. RESULTS: Both of them choose non-resective and not curative methods (68.8% by surgeon vs. 87.5% oncologist) before EUS. The best treatment by the surgeon was chemotherapy and palliative radiotherapy associated (25%) and palliative endoscopic prostheses (25%), and by the oncologist, neoadjuvant chemotherapy and radiotherapy associated (56.2%). After EUS, the resective surgical treatment was the both choice in only 6.2% of cases, and the rest of 93.8%, non-resective. The surgeon choice was chemotherapy and palliative radiotherapy associated (44%), and oncologist choice was neoadjuvant chemotherapy and radiotherapy associated (44%). Analysis by the Chi-square method, comparing respective versus non-resective treatment, surgeon versus oncologist, with and without the EUS, obtained values of P = 0.39 and P = 0.46, respectively. The comparison between healing and non-healing treatment had the same P value. Regarding the change in behavior (resective vs. non-resective), there was a change of approach by the surgeon in 25% of cases (P = 0.17) and the oncologist moved conduct in 6.25% of cases. Comparing the changing of behavior among experts, the P value was 0.33. Despite evidence of behavior change after the EUS, the statistical point of view, the P value had no significant relevance. The main factor involved is probably due to a reduced number of sample cases. However, this is a pilot study, and is needed other with a larger number of cases. CONCLUSION: The data obtained allow us to conclude that EUS proved to be an important test for the change in staging and therapeutic management of esophageal cancer.
RESUMO
INTRODUCTION: The endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has emerged as a minimally invasive and safe method for material procurement in the differential diagnosis of subepithelial lesions (SEL) of upper gastrointestinal tract (UGT), especially in suspicious lesions of gastrointestinal stromal tumors (GIST). There are few studies discussing the factors that influence the EUS-FNA in the diagnosis of SEL. AIM: To establish possible associations between lesion size, layer and organ of origin with the outcome of EUS-FNA in patients with SELs of UGT. METHODS: A retrospective analysis using data of patients referred to French-Brazilian Center of EUS of endoscopy Department of Santa Casa de São Paulo Hospital, with previous endoscopic diagnosis of SEL, which underwent EUS-FNA from May 2006 to August 2011. RESULTS: A total of 222 patients were submitted to EUS. 15 with extrinsic compressions and 207 with SEL. Of these, 89 underwent to EUS-FNA. Ninety-two SEL were diagnosed on EUS and punctured. The EUS-FNA was positive in 58.7%. In lesions measuring 2-3 cm and >3 cm, the EUS-FNA was positive in 80% and 72%, respectively (P < 0.001). CONCLUSION: The size of SELs was the only variable that influenced the outcome of EUS-FNA. Best results are achieved in lesions larger than 2 cm.
Assuntos
Adenocarcinoma/diagnóstico , Ampola Hepatopancreática/patologia , Neoplasias do Ducto Colédoco/diagnóstico , Neoplasias Esofágicas/diagnóstico , Paraganglioma/diagnóstico , Adenocarcinoma/complicações , Adenocarcinoma/cirurgia , Neoplasias do Ducto Colédoco/complicações , Neoplasias do Ducto Colédoco/cirurgia , Endossonografia , Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Paraganglioma/complicações , Paraganglioma/cirurgiaRESUMO
BACKGROUND AND STUDY AIM: Chronic radiation coloproctopathy (CRCP) is a well-recognized complication of radiotherapy, with rectal bleeding the most common presentation. It is frequently refractory to conservative management, but the optimal endoscopic treatment of bleeding secondary to CRCP is still controversial. The efficacy and safety of bipolar eletrocoagulation (BEC) and argon plasma coagulation (APC) in the management of bleeding from CRCP were evaluated and compared. PATIENTS AND METHODS: 30 patients (mean age 67.4 years) with active and chronic bleeding from telangiectasias, were randomly allocated to BEC or APC and stratified by severity of CRCP according to clinical severity and endoscopic findings (Saunders score). Success was defined as eradication of all telangiectasias, and therapeutic failure as need for more than seven sessions or for other treatment. Complications were categorized as minor (e.g. fever, anal or abdominal pain) or major (hemorrhagic). RESULTS: Both treatments were equally effective for the treatment of CRCP rectal bleeding. Only one failure was observed in each group (P = 1.000). There was no significant difference between the two groups regarding number of sessions, minor or major complications, or relapse. However, overall complication rate was significantly higher in the BEC group (P = 0.003). CONCLUSIONS: BEC and APC are both effective for the therapy of bleeding telangiectasias from CRCP. There are probably no major differences between them. Although APC seemed safer than BEC in this investigation, further studies, involving a much larger population, are needed to assess the complication rates and determine the best management option.
Assuntos
Eletrocoagulação/métodos , Hemorragia Gastrointestinal/cirurgia , Lesões por Radiação/cirurgia , Radioterapia/efeitos adversos , Doenças Retais/cirurgia , Doenças do Colo Sigmoide/cirurgia , Telangiectasia/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Coagulação com Plasma de Argônio/efeitos adversos , Doença Crônica , Colo Sigmoide/efeitos da radiação , Eletrocoagulação/efeitos adversos , Neoplasias do Endométrio/radioterapia , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Análise de Intenção de Tratamento , Masculino , Pessoa de Meia-Idade , Neoplasias da Próstata/radioterapia , Lesões por Radiação/complicações , Doenças Retais/etiologia , Reto/efeitos da radiação , Índice de Gravidade de Doença , Doenças do Colo Sigmoide/etiologia , Telangiectasia/complicações , Resultado do Tratamento , Neoplasias do Colo do Útero/radioterapiaRESUMO
AIM: Argon plasma coagulation (APC) is considered a safe treatment for haemorrhagic chronic radiation proctocolitis (CRPC), but bacteraemia is a rare complication. The study aimed to evaluate the frequency of bacteraemia after APC. METHOD: A prospective study of 21 patients who underwent APC (30 procedures) for CRPC was carried out. Blood cultures (Bactec(®) ) were obtained before and 30 min after the procedure (60 samples total). Patients were monitored for 48 h after the procedure to detect signs of infection. RESULTS: None of the 21 patients had fever or any sign suggestive of infection after any of the 30 sessions. All baseline blood cultures were negative and two (7%) of the 30-min blood cultures were positive (Staphylococcus hominis n = 1; Streptococcus bovis and Rhodotorula sp n = 1). The first was likely to be a contaminant and the second patient had no evidence of any other colonic disease (neoplasia or polyps) beside CRPC. CONCLUSION: APC is a low-risk procedure regarding bacteraemia and does not warrant prophylactic antibiotic administration.
Assuntos
Coagulação com Plasma de Argônio , Bacteriemia/etiologia , Proctocolite/cirurgia , Lesões por Radiação/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Proctocolite/etiologia , Estudos Prospectivos , Lesões por Radiação/etiologia , Radioterapia/efeitos adversosRESUMO
PURPOSE: The aim of this study was to examine the influence that the size of a neodymium:yttrium-aluminium-garnet (Nd:YAG) laser capsulotomy performed for posterior capsule opacification (PCO) has on visual acuity (VA), and on contrast VA and that in the presence of glare (glare VA). METHODS: A total of 41 consecutive eyes with PCO first underwent Nd:YAG laser capsulotomy of smaller than pupillary size, after which the capsulotomy was secondarily enlarged, 2 weeks later, to greater than pupillary size. Best-corrected VA, and contrast VA and glare VA under photopic and mesopic conditions were measured after the small and large capsulotomies were made. RESULTS: After enlargement, the mean capsulotomy area increased significantly from 4.8 to 15.3 mm(2) (P<0.0001). Best-corrected VA did not improve significantly after enlargement (P=0.1282). However, photopic contrast VA and glare VA at moderate to low contrast visual target before enlargement were significantly worse than those after enlargement (PAssuntos
Opacificação da Cápsula/cirurgia
, Extração de Catarata/métodos
, Terapia a Laser/métodos
, Cápsula do Cristalino/cirurgia
, Visão Ocular/fisiologia
, Acuidade Visual/fisiologia
, Idoso
, Idoso de 80 Anos ou mais
, Alumínio/uso terapêutico
, Opacificação da Cápsula/fisiopatologia
, Sensibilidades de Contraste/fisiologia
, Avaliação da Deficiência
, Feminino
, Ofuscação/efeitos adversos
, Humanos
, Masculino
, Neodímio/uso terapêutico
, Ítrio/uso terapêutico
RESUMO
BACKGROUND: Endoscopic ultrasonography (EUS) has evolved over the past 20 years with the emergence of novel diagnostic and therapeutic indications. Our goal was to identify the best evidence supporting the use of EUS. MATERIALS AND METHODS: A six-step approach was employed to develop recommendations using accepted methodology. Twenty-two experienced endosonographers identified topics and reviewed studies using MeSH (medical subject headings) terminology and free text in PubMed. Medline and society abstracts were reviewed if necessary. The quality of evidence, the strength of recommendations, and level of consensus were graded and voted on. RESULTS: Consensus was reached for several clinical scenarios for which the impact of EUS findings was supported by a high level of evidence. These included diagnosis and staging of esophageal cancer, differential diagnosis of subepithelial lesions, thickened gastric folds, assessment of peritoneal involvement in patients with gastric cancer, mucosa-associated lymphoid tissue lymphoma, diagnosis of common bile duct/gallbladder stones, diagnosis of chronic pancreatitis, differential diagnosis of a solid mass in patients with chronic pancreatitis, differential diagnosis of pancreatic cyst, rectal cancer staging, and diagnosis and staging of non-small-cell lung cancer. The recommendations were adopted by the Brazilian Society of Gastrointestinal Endoscopy. Several indications continue to emerge and require additional validation.
Assuntos
Conferências de Consenso como Assunto , Endossonografia , Medicina Baseada em Evidências , HumanosAssuntos
Colangiopancreatografia Retrógrada Endoscópica , Duodenoscópios , Cálculos Biliares/cirurgia , Derivação Gástrica , Complicações Pós-Operatórias/cirurgia , Esfinterotomia Endoscópica , Estômago/cirurgia , Adulto , Colangiografia , Estudos de Viabilidade , Cálculos Biliares/diagnóstico , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico , ReoperaçãoRESUMO
PURPOSE: To examine the effect of cataract surgery on intraocular pressure (IOP) control in eyes with angle-closure glaucoma (ACG) and open-angle glaucoma (OAG). SETTING: Hayashi Eye Hospital, Fukuoka, Japan. METHODS: This study included 74 eyes with ACG and 68 eyes with OAG having cataract surgery. The IOP was measured and the number of glaucoma medications recorded preoperatively, 1 month postoperatively, and then every 3 months. The IOP control in the 2 groups was compared using survival analysis, with failure criteria being an IOP greater than 21 mm Hg, addition of medications, or the need for additional glaucoma surgery. RESULTS: The mean IOP and number of medications decreased significantly after surgery in both groups (P <.0001). However, the mean decrease in IOP and percentage of IOP reduction in the ACG group were greater than in the OAG group, and fewer medications were required in the ACG group. The cumulative survival probability of IOP control at 24 months was 91.9% in the ACG group and 72.1% in the OAG group. The survival curve in the ACG group was significantly better than in the OAG group (P =.0012). The IOP was controlled without medication in 30 eyes (40.5%) in the ACG group and 13 (19.1%) in the OAG group; the difference between groups was significant (P =.0055). CONCLUSIONS: Cataract surgery substantially reduced IOP and the number of medications required for IOP control in glaucomatous eyes. Specifically, cataract extraction normalized the IOP in most eyes with ACG.
Assuntos
Glaucoma de Ângulo Fechado/fisiopatologia , Glaucoma de Ângulo Aberto/fisiopatologia , Pressão Intraocular/fisiologia , Facoemulsificação , Idoso , Idoso de 80 Anos ou mais , Catarata/complicações , Catarata/fisiopatologia , Catarata/terapia , Feminino , Glaucoma de Ângulo Fechado/complicações , Glaucoma de Ângulo Fechado/tratamento farmacológico , Glaucoma de Ângulo Aberto/complicações , Glaucoma de Ângulo Aberto/tratamento farmacológico , Humanos , Implante de Lente Intraocular , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tonometria OcularRESUMO
OBJECTIVE: To see whether there is a correlation between pupillary area or intraocular lens (IOL) decentration and tilt and the visual acuity (VA) at all distances for eyes with a zonal-progressive multifocal IOL or a monofocal IOL. DESIGN: Comparative, nonrandomized, interventional study. PARTICIPANTS: Fifty-five eyes of 55 patients undergoing five-zone refractive multifocal IOL implantation and 55 eyes of 55 age-matched patients undergoing monofocal IOL implantation. INTERVENTION: All eyes underwent phacoemulsification and IOL implantation. MAIN OUTCOME MEASURES: The VAs from far to near distances were examined using an all-distance vision tester at 1 month after surgery. The pupillary area was also measured using an infrared pupillometer, and the degrees of IOL decentration and tilt were measured using a Scheimpflug videophotography system. Univariate associations between VA and the pupillary area and IOL decentration or tilt were evaluated statistically. RESULTS: The mean intermediate VAs and contrast sensitivities at all spatial frequencies in the multifocal IOL group were worse than those in the monofocal IOL group, whereas near VA was better in the multifocal group. In the multifocal group, smaller pupillary area was associated significantly with worse near logarithm of the minimum angle of resolution (LogMAR) VA (r = 0.636), but not with far or intermediate VAs. When pupil diameter was 4.5 mm or greater, near mean VA reached 20/63. A greater degree of IOL decentration was associated significantly with worse far and intermediate LogMAR VAs (r = 0.460 at 5.0 m and 0.527 at 1.0 m) but not with near VA. When decentration was 0.9 mm or greater, distance mean VA did not reach 20/32. However, the correlation between tilt and VA was not statistically significant. In the monofocal group, no significant correlation was found between pupillary area, IOL decentration, or tilt and the VA. CONCLUSIONS: Smaller pupil size is correlated significantly with worse near VA, whereas greater decentration is correlated with worse distance and intermediate VA in eyes with refractive multifocal IOLs. Specifically, a pupil diameter of less than 4.5 mm cannot provide useful near VA, and decentration of 0.9 mm is the maximum allowable limit for adequate distance VA. However, pupil size and IOL decentration do not influence VA in eyes with monofocal IOLs.
Assuntos
Migração de Corpo Estranho/fisiopatologia , Lentes Intraoculares , Pupila/fisiologia , Acuidade Visual/fisiologia , Adulto , Idoso , Sensibilidades de Contraste/fisiologia , Feminino , Humanos , Implante de Lente Intraocular , Masculino , Pessoa de Meia-Idade , Facoemulsificação , Desenho de Prótese , Falha de Prótese , Refração OcularRESUMO
The objective of this study was to clarify the left atrial (LA) reservoir and booster pump function in patients with left ventricular (LV) diastolic dysfunction. To determine LA reservoir and booster pump function, a new algorithm to determine LA functional volume change curve (FVC) was developed from Doppler flow spectra of pulmonary venous flow and LV inflow by transthoracic echocardiography in 110 patients. Patients were classified into normal (N), and abnormal (AB) and pseudonormal (PN) groups on the basis of their Doppler flow patterns. From the indices of FVC, atrial reservoir volume (ARV), passive emptying volume (PEV) and active emptying volume (AEV) were obtained. ARV/stroke volume (SV) was increased in the AB group, but decreased in the PN group compared with N (N, 0.61+/-0.09; AB, 0.73+/-0.10; PN, 0.52+/-0.13, p<0.05). PEV/SV was significantly decreased in AB, but increased in PN compared with N (N, 0.27+/-0.07; AB, 0.19+/-0.07; PN, 0.31+/-0.18, p<0.05). AEV/SV was significantly increased in AB, but decreased in PN compared with N (N, 0.41+/-0.08; AB, 0.56+/-0.10; PN, 0.26+/-0.19, p<0.05). Thus, in patients with an abnormal relaxation pattern, the LA reservoir and booster pump function are augmented, but in patients with a pseudonormal pattern, both LA reservoir and booster pump function are deteriorated, suggesting a vulnerability to pulmonary congestion.
Assuntos
Função do Átrio Esquerdo/fisiologia , Velocidade do Fluxo Sanguíneo/fisiologia , Disfunção Ventricular Esquerda/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Ecocardiografia , Ecocardiografia Doppler em Cores , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Cardiovasculares , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/patologiaRESUMO
Co-stimulatory molecules of CD28, cytotoxic T lymphocyte-associated antigen-4 (CTLA-4), and the newly identified inducible co-stimulator (ICOS) are expressed on cell surfaces and provide regulatory signals for T-cell activation. Their genes are candidate susceptibility genes for type 1 diabetes because they co-localize to Chromosome 2q33 with the IDDM12 locus. After determining the genomic structure and screening for polymorphisms of the ICOS gene, we performed association studies between newly identified polymorphisms of the ICOS gene, together with known polymorphisms of CD28 and CTLA-4 genes, and type 1 diabetes. The 49A/G dimorphism in exon 1 and the (AT)n in the 3' untranslated region of the CTLA-4 gene were significantly associated with type 1 diabetes. Evaluation of the CTLA-4 49A-3'(AT)n 86-bp haplotype frequency in patients and controls confirmed the results from the analysis of each polymorphic site. Dimorphism in intron 3 of the CD28 gene was associated with type 1 diabetes only in the early-onset group. In contrast, there was no association with the microsatellite polymorphisms in the ICOS gene or dimorphisms in the promotor region of CTLA-4. Of the three genes encoding co-stimulatory molecules, the CTLA-4 gene appears to confer risks for the development of type 1 diabetes.
Assuntos
Antígenos de Diferenciação de Linfócitos T/genética , Antígenos de Diferenciação/genética , Antígenos CD28/genética , Diabetes Mellitus Tipo 1/genética , Imunoconjugados , Polimorfismo Genético , Abatacepte , Antígenos CD , Antígeno CTLA-4 , Feminino , Frequência do Gene , Predisposição Genética para Doença , Haplótipos , Humanos , Proteína Coestimuladora de Linfócitos T Induzíveis , Japão , Desequilíbrio de Ligação , Masculino , Poli dA-dT/genéticaRESUMO
AIM: To prospectively investigate changes in the area of the anterior capsule opening, and intraocular lens (IOL) decentration and tilt after implantation of a hydrogel IOL. METHODS: 100 patients underwent implantation of a hydrogel IOL in one eye and an acrylic IOL implantation in the opposite eye. The area of the anterior capsule opening, and the degree of IOL decentration and tilt were measured using the Scheimpflug videophotography system at 3 days, and at 1, 3, and 6 months postoperatively. RESULTS: The mean anterior capsule opening area decreased significantly in both groups. At 6 months postoperatively, the area in the hydrogel group was significantly smaller than that in the acrylic group. The mean percentage of the area reduction in the hydrogel group was also significantly greater than that in the acrylic group, being 16.9% in the hydrogel group and 8.8% in the acrylic group. In contrast, IOL decentration and tilt did not progress in either group. No significant differences were found in the degree of IOL decentration and tilt throughout the follow up period. CONCLUSIONS: Contraction of the anterior capsule opening was more extensive with the hydrogel IOL than with the acrylic IOL, but the degree of IOL decentration and tilt were similar for the two types of lenses studied.
Assuntos
Hidrogel de Polietilenoglicol-Dimetacrilato , Cápsula do Cristalino/patologia , Implante de Lente Intraocular/efeitos adversos , Lentes Intraoculares/efeitos adversos , Falha de Prótese , Resinas Acrílicas , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Método Duplo-Cego , Feminino , Humanos , Terapia a Laser , Masculino , Pessoa de Meia-Idade , Fotografação , Estudos Prospectivos , Reoperação/estatística & dados numéricos , Estatísticas não ParamétricasRESUMO
PURPOSE: To investigate the influence of cataract surgery on automated perimetry in patients with glaucoma. DESIGN: Interventional case series. METHODS: A total of 105 eyes of 105 consecutive patients with glaucoma who were scheduled for cataract surgery underwent Humphrey static threshold testing (30-2 program) before and at 1 month after surgery. These eyes were divided into two groups based on the presence of absolute or near absolute (dense) scotomata before surgery (minimum threshold value 5 decibels or less). Changes in numbers of the dense scotomata, mean deviation, pattern standard deviation, and corrected pattern standard deviation were analyzed. RESULTS: No significant changes were found in the numbers of dense scotomata and central dense scotomata within five-degree visual fields between before and after surgery. In the group with dense scotomata, the mean pattern standard deviation and corrected pattern standard deviation worsened significantly after surgery, whereas the mean deviation improved significantly. However, in the group without dense scotomata, the pattern standard deviation and corrected pattern standard deviation showed a slight improvement, whereas the mean deviation improved significantly. When the central scotoma was present in two or fewer meridians before surgery, the mean visual acuity after surgery reached 20/25 and was better than that in patients with three or four central scotomata (P =.0014). CONCLUSIONS: Cataract does not produce a dense scotoma on automated perimetry. However, because it does produce relative scotomata, actual glaucomatous visual field defects may be hidden to some extent. When a central dense scotoma is present before surgery in two or fewer meridians, the patient may well achieve substantial improvement in postoperative visual acuity.
Assuntos
Catarata/fisiopatologia , Glaucoma de Ângulo Fechado/fisiopatologia , Glaucoma de Ângulo Aberto/fisiopatologia , Facoemulsificação , Escotoma/fisiopatologia , Testes de Campo Visual/métodos , Campos Visuais , Adulto , Idoso , Idoso de 80 Anos ou mais , Capsulorrexe , Catarata/complicações , Feminino , Glaucoma de Ângulo Fechado/complicações , Glaucoma de Ângulo Aberto/complicações , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Escotoma/etiologia , Acuidade VisualRESUMO
PURPOSE: To prospectively evaluate the progression of posterior capsule opacification (PCO) after poly(methyl methacrylate) (PMMA), silicone, and acrylic intraocular lens (IOL) implantation. SETTING: Hayashi Eye Hospital, Fukuoka, Japan. METHODS: Three hundred eyes of 300 patients scheduled to have IOL implantation were initially randomized into 3 groups based on IOL type: PMMA, silicone, or acrylic. Of the 300 eyes, 269 completed the follow-up. The PCO density in these eyes was measured 1 week and 3, 6, 12, 18, and 24 months postoperatively using special computer software developed for the Scheimpflug videophotography system. Visual acuity and the incidence of neodymium:YAG (Nd:YAG) laser capsulotomy were also examined. RESULTS: Three months postoperatively and later, the mean PCO value in the PMMA group increased significantly (P <.0001); the increase in the silicone and acrylic groups was not significant. The PCO value in the PMMA group was significantly greater than in the silicone or acrylic group (P <.0001). The PCO value in the acrylic group was slightly less than in the silicone group at 18 and 24 months, but the difference was marginal. The survival rate not requiring Nd:YAG capsulotomy was least in the PMMA group, followed by the silicone and acrylic groups in that order (P <.0001). The mean logMAR visual acuity in the PMMA group increased postoperatively and was worse than in the silicone or acrylic group. CONCLUSIONS: The degree of PCO after PMMA IOL implantation progressed significantly with time, while the progression after silicone and acrylic IOL implantation was slight. Therefore, PCO in eyes with a PMMA IOL was significantly more extensive than in those with a silicone or acrylic IOL and resulted in marked impairment of visual acuity.
Assuntos
Resinas Acrílicas/efeitos adversos , Catarata/etiologia , Cápsula do Cristalino/patologia , Implante de Lente Intraocular/efeitos adversos , Polimetil Metacrilato/efeitos adversos , Elastômeros de Silicone/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Catarata/patologia , Feminino , Humanos , Lentes Intraoculares , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Acuidade VisualRESUMO
The presence of left atrial thrombus (LAT) is associated with an increased risk of embolic stroke. However, it has yet to be established definitively whether low-intensity warfarin therapy (INR: 1.5-2.0) can prevent LAT formation in patients with nonvalvular atrial fibrillation (NVAF). The present study analyzed the clinical and transesophageal echocardiography (TEE) features of 123 such patients to identify risk factors for LAT formation and the efficacy of prophylactic low-intensity warfarin therapy. Left atrial thrombi were found in 35 patients (28%) in whom systemic hypertension (49% vs 23%; p<0.01) and ischemic heart disease (17% vs 3%; p<0.01) were more frequent. Left ventricular ejection fraction (54+/-14% vs 60+/-11%; p<0.05), left ventricular end-diastolic dimension (51+/-7 mm vs 48+/-5 mm; p<0.05), spontaneous echo contrast (2.2+/-0.7 vs 1.4+/-0.9; p<0.01), left atrial diameter (50+/-6 mm vs 43+/-7 mm; p<0.01), left atrial appendage blood velocity (22.3+/-8.7 cm/s vs 37.2+/-21.5 cm/s; p<0.01) and the incidence of left ventricular hypertrophy (37% vs 15%; p<0.01) were also significantly different between the groups. Fourteen patients received continuous warfarin therapy (target INR: 1.5-2.0) and on the follow-up TEE study the left atrial thrombus resolved in 10 (71%). There were no thromboembolic events or major hemorrhagic complications in these patients, so it was concluded that low-intensity warfarin therapy is efficacious in treating LAT formation in patients with NVAF.
Assuntos
Anticoagulantes/administração & dosagem , Fibrilação Atrial/complicações , Ecocardiografia Transesofagiana , Cardiopatias/tratamento farmacológico , Trombose/tratamento farmacológico , Varfarina/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , Complicações do Diabetes , Avaliação de Medicamentos , Feminino , Átrios do Coração/diagnóstico por imagem , Cardiopatias/diagnóstico por imagem , Cardiopatias/prevenção & controle , Humanos , Hipertensão/complicações , Hipertireoidismo/complicações , Coeficiente Internacional Normatizado , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/complicações , Trombose/diagnóstico por imagem , Trombose/etiologia , Trombose/prevenção & controle , Resultado do Tratamento , Função Ventricular Esquerda , Varfarina/uso terapêuticoRESUMO
BACKGROUND: IFN-gamma and related molecules play important roles in the differentiation and function of TH2 cells. OBJECTIVE: We sought to determine whether IFNG and related genes contribute to any susceptibility to atopic asthma, a representative TH2-dominant disorder. METHODS: We investigated the association of IFNG (CA repeat polymorphism within the first intron), IRF1 (GT repeat polymorphism within the intron 7), IFNGR1 (Val 14 Met), and IFNGR2 (Gln 64 Arg) gene polymorphisms with atopic asthma in the Japanese child population. RESULTS: A significant association (P =.0018) was observed between IFNG gene polymorphism and atopic asthma. The tendency was more prominent in patients with age of onset of 3 years or younger (P =.0004) or patients with a family history of allergic diseases (P =.0038). Furthermore, there was a significant association between IRF1 gene whole-allele distribution and atopic asthma (P =.044). The tendency was more prominent in patients with onset at 3 years of age or less (P =.0058). On the other hand, IFNGR1 and IFNGR2 gene polymorphisms showed no association with atopic asthma. CONCLUSION: These results suggested that among IFNG and related genes, IFNG and IRF1 genes confer genetic susceptibility to atopic asthma in Japanese children.
Assuntos
Asma/genética , Proteínas de Ligação a DNA/genética , Hipersensibilidade Imediata/genética , Fosfoproteínas/genética , Fatores de Transcrição , Adolescente , Alelos , Criança , Pré-Escolar , Humanos , Lactente , Fator Regulador 1 de Interferon , Fator Regulador 2 de Interferon , Polimorfismo Genético , Proteínas Repressoras/genéticaRESUMO
BACKGROUND: Colorectal cancer is an important cause of death in western countries. Screening methods are based on flexible sigmoidoscopy, a cheap, effective, and less painful procedure, but some important lesions on the right colon can be missed. AIM: Evaluate how many important lesions would be missed if colonoscopy indicated only for patients with distal lesions identified during flexible sigmoidoscopy. MATERIAL AND METHODS: All consecutive colonoscopy performed in the Endoscopy Unit of the Gastroenterology Division of Federal University of São Paulo, SP, Brazil, with polyps and cancer suspicious lesions were reviewed. Patients with a second procedure, inflammatory bowel disease or colonic surgery were excluded. RESULTS: We reviewed 101 patients with 38 possible cancer lesions and 70 polyps. The mean age was 62 years (SD 13.7 years) and 45 were male. Forty five lesions were in the right colon, namely 23 adenomas, 10 adenocarcinomas, 1 lymphoma and 11 benign lesion. Among such lesions, 28 were isolated in the right colon (16 adenomas and 7 adenocarcinomas). CONCLUSION: In our study 23 patients (22.77%) had adenomas or adenocarcinomas isolated in the right colon, that would be missed if flexible sigmoidoscopy was used alone.