RESUMO
BACKGROUND: We aimed to evaluate the long-term results of the patients who had positive cross-match (XM) test results and underwent living donor renal transplantation after desensitization with different combinations of intravenous immunoglobulin (IVIG), plasmapheresis (PP), and rituximab. MATERIAL AND METHODS: Forty-nine patients who were positive for complement-dependent cytotoxicity (CDC), flow cytometric (FC), and Luminex-XM test were included in the study. Renal transplantation was performed in 16 patients who had XM (-) test after desensitization with different combinations of IVIG (n =15), PP (n =13), and rituximab (n =10). Anti-human leukocyte antigens (HLA) antibodies (anti-HLA Abs) were detected by the Luminex single antigen bead assay. Anti-thymocyte globulin was used for induction, and tacrolimus, mycophenolic acid, and prednisolone were used for maintenance therapy. Also, we evaluated the relationship between different donor-specific anti-HLA Abs and the parameters mentioned above. RESULTS: Antibody-mediated rejection (AMR) and acute T cell-mediated rejection rates were 18.8 % and 6.3 %, respectively. Graft survival rates at the first, third, and fifth years post-transplantation were 93.8 %, 85.2 %, and 85.2 %, respectively, and the patients' survival rates were found to be 100 %. Serum creatinine level and glomerular filtration rate were 1.5 ± 1.2 mg/dl and 69.9 ± 30.4 ml/min, respectively. The mean follow-up time was 39 ± 24 months. CONCLUSIONS: Our study showed that kidney transplantation could be performed by effective desensitization in XM test positive patients. It was also shown that donor-specific anti-HLA DQ Ab and non-HLA Ab determination might be useful in diagnosing patients with positive cross-test and/or diagnosis of AMR. HIPPOKRATIA 2020, 24(4): 182-190.
Assuntos
Alopecia em Áreas/complicações , Perda Auditiva Neurossensorial/diagnóstico , Perda Auditiva Neurossensorial/etiologia , Melanócitos/fisiologia , Adolescente , Adulto , Idoso , Alopecia em Áreas/patologia , Alopecia em Áreas/fisiopatologia , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
OBJECTIVES: The aim of our study was to see whether the neutrophil/lymphocyte ratio (NLR) and the platelet/lymphocyte ratio (PLR) are the markers of idiopathic sudden hearing loss to be used in prognosis or not. MATERIALS AND METHODS: This study is a retrospective, case-control clinical trial. Forty-five patients diagnosed with idiopathic sudden hearing loss and treated with the same treatment protocol between March 2014 and December 2015 and 47 healthy volunteers coming to the hospital for a routine health check and accepting audiological and laboratory tests were included in our study. NLR and PLR values were calculated in consequence of complete blood count results obtained from the study and control groups. In addition, the study group was classified as treatment responsive and treatment unresponsive groups as a result of audiological examination performed after three months according to the Siegel criteria. NLR and PLR ratios between the groups were statistically evaluated. RESULTS: Average NLR and PLR values were significantly higher in the study group compared to the control group (P<0.001). Average NLR ratio of the group, which was treated with the same protocol but did not respond to treatment was found to be significantly higher compared to the group which responded to the treatment (P<0.001). There was no significant change in average PLR ratio. CONCLUSION: Although NLR and PLR are two important markers that can be detected from peripheral blood samples of patients developing idiopathic sudden hearing loss and can be calculated easily, increased NLR values were also found to be related to poor prognosis.
Assuntos
Plaquetas/citologia , Glucocorticoides/administração & dosagem , Perda Auditiva Súbita/diagnóstico , Perda Auditiva Súbita/tratamento farmacológico , Linfócitos/citologia , Hemissuccinato de Metilprednisolona/administração & dosagem , Neutrófilos/citologia , Administração Oral , Adulto , Biomarcadores/sangue , Estudos de Casos e Controles , Feminino , Perda Auditiva Súbita/sangue , Humanos , Contagem de Leucócitos , Masculino , Prognóstico , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: MicroRNAs (miRNAs) and the miRNA biogenesis components are potential biomarkers of some prevalent diseases, such as cancer and diabetes. In light of this information, we aimed to investigate the expression profiles of miRNA biogenesis components in renal transplant patients before and after transplantation and how these profiles are related to immunosuppressive treatment and clinical outcomes of these patients. METHODS: In this study, gene and protein expression profiles of Dicer, Drosha, Pasha (DGCR8), Exportin5 (XPO5), and Argonaute2 (AGO2) in peripheral blood mononuclear cells (PBMCs) of renal transplant patients were evaluated by means of real-time quantitative polymerase chain reaction and Western blot methods before and 3 months after transplantation. Patients who had transplant procedures for the first time were included in the study. RESULTS: Gene expressions were significantly reduced after transplantation. The reduction rate of expressions in 1 patient undergoing chronic rejection was higher. In addition, in patients under everolimus treatment, gene expression of Dicer did not change and gene expression of AGO2 increased. Dicer, Drosha, DGCR8, and AGO2 protein expressions were reduced in all patients, but no change was observed in XPO5 protein expression in nonrejecting patients. Interestingly, in the patient undergoing chronic rejection, protein expression profiles other than Dicer were distinctive from nonrejecting patients. However, XPO5 protein expression was higher in that patient. CONCLUSIONS: Our study shows the importance of the global effect of immunosuppressive treatment on the miRNA biogenesis pathway. miRNA biogenesis components are potential biomarkers indicative of graft outcome and pharmacologic target molecules.
Assuntos
Biomarcadores/análise , Hospedeiro Imunocomprometido/genética , Transplante de Rim , MicroRNAs/biossíntese , Western Blotting , Feminino , Perfilação da Expressão Gênica , Humanos , Terapia de Imunossupressão , Masculino , MicroRNAs/análise , Reação em Cadeia da Polimerase em Tempo Real , TranscriptomaRESUMO
OBJECTIVE: The aim of our study is to investigate whether systemic microvascular function affects the development and prognosis of sudden idiopathic hearing loss (SHL). TYPE OF STUDY: A prospective case-control study. MATERIALS AND METHODS: Fifty patients diagnosed with SHL at our hospital between September 2015 and May 2016 were included as the SHL group, and 50 healthy volunteers who came to the hospital for medical screening were included in the control group. Thirty-one patients from the SHL group who responded to treatment and 19 patients who did not respond to treatment were identified according to the Siegel criteria and were grouped. Patients with comorbid disorders were excluded from the study. To determine microvascular function, the videocapillaroscopic examination was conducted from the nailfold, measuring the capillary density (CD) and post-occlusive reactive hyperaemia (PORH) values and statistical analysis was performed between the groups. RESULT: While CD was an average of 83.1 ± 6 in the SHL group, it was measured as 96.2 ± 10 in the control group. The CD value was significantly lower in the SHL group than the control group (P < 0.05). While the average PORH value in the SHL group was 80.5 ± 7.7, it was measured as 97.5 ± 10 in the control group. The PORH value was significantly lower in the SHL group than the control group (P < 0.05). The CD value did not differ significantly (P > 0.05) between the group that responded to treatment (83.4 ± 5.5) and the group that did not respond to treatment (82.7 ± 6.9). The PORH value was significantly lower (P < 0.05) in the group that did not respond to treatment (75.2 ± 7.9) than the group that did (83.8 ± 5.6). CONCLUSION: To our best knowledge, our study is the first study in the literature. Although the role of specific mechanisms in SHL is not entirely understood, the capillaroscopic examination can show the importance of microvascular function in SHL. CD and PORH values were found to be low in SHL patients, and a low PORH value was found to be a factor of poor prognosis.
Assuntos
Dexametasona/administração & dosagem , Perda Auditiva Súbita/etiologia , Audição/fisiologia , Metilprednisolona/administração & dosagem , Microvasos/fisiopatologia , Vasoconstrição/fisiologia , Administração Oral , Adolescente , Adulto , Audiometria , Estudos de Casos e Controles , Quimioterapia Combinada , Feminino , Seguimentos , Glucocorticoides/administração & dosagem , Perda Auditiva Súbita/tratamento farmacológico , Perda Auditiva Súbita/fisiopatologia , Humanos , Injeção Intratimpânica , Masculino , Angioscopia Microscópica , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Fatores de Risco , Adulto JovemRESUMO
AIM: The aim of this study was to determine the effects of hepatitis B surface antigen (HBsAg) positivity of the donors on graft survival and liver complications in HBsAg(+) renal transplant recipients. PATIENTS AND METHOD: A group of 55 patients who underwent renal transplantation (RTx) in our hospital between 2001 and 2012 were included in the study. Patients were divided into 2 groups. Group 1 (n = 50) consisted of HBsAg(+) renal transplant recipients (RTR) whose donors were HBsAg(-). In Group 2 (n = 5), RTR and donors were both HBsAg(+). Lymphocyte cross matches, number of mismatches, donor types, renal replacement treatment modalities, drugs of induction treatment, and preoperative hepatitis B virus DNA titers of the groups were similar. In Group 1, 42 patients were taking lamivudine, 3 patients were taking entecavir, and 5 patients were taking tenofovir. All of the patients in Group 2 were taking lamivudine. Patient and graft survival rates, graft functions, acute hepatitis rates, acute rejection rates, and other clinical outcomes of the groups were compared. RESULTS: Demographic data of the groups were similar. Acute rejection rates (P = 0.458), graft survival rates (P = 0.515), and patient survival rates (P = 0.803) were also similar. No significant difference was found between the groups in terms of acute hepatitis rate (P = 0.511), glomerular filtration rate (calculated by Modification of Diet in Renal Disease formula) in the last follow-up (P = 0.988), alanine aminotransferase levels (P = 0.069), or delayed graft function rate (P = 0.973). Rates of chronic allograft dysfunction and new onset diabetes mellitus after transplantation were similar. CONCLUSION: Our study revealed that, RTx from HBsAg(+) donors to HBsAg(+) recipients is safe with antiviral treatment.
Assuntos
Antígenos de Superfície da Hepatite B/imunologia , Vírus da Hepatite B/imunologia , Hepatite B/virologia , Transplante de Rim/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Adulto , Antivirais/administração & dosagem , Feminino , Taxa de Filtração Glomerular , Rejeição de Enxerto , Sobrevivência de Enxerto , Guanina/administração & dosagem , Guanina/análogos & derivados , Humanos , Lamivudina/administração & dosagem , Fígado/virologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/virologia , Tenofovir/administração & dosagem , Doadores de Tecidos , TransplantadosRESUMO
Renal transplantation is the most effective treatment method for end-stage renal disease (ESRD). However, new treatment modalities are being investigated, such as immunotoleration, to avoid the acute and chronic side effects of immunosuppressant drugs. We report a case in which a man had undergone allogenic stem cell transplantation from his brother 16 years ago due to chronic myeloid leukemia, and who then developed ESRD due to arterial hypertension and underwent renal transplantation (Rtx) from the same brother. The patient was followed up without immunosuppression due to full chimerism.
Assuntos
Terapia de Imunossupressão/métodos , Falência Renal Crônica/cirurgia , Transplante de Rim , Transplante de Células-Tronco , Humanos , Tolerância Imunológica , Falência Renal Crônica/imunologia , Leucemia Mielogênica Crônica BCR-ABL Positiva/cirurgia , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Irmãos , Resultado do TratamentoRESUMO
AIM: We evaluated the outcomes of patients who underwent renal transplantation (Rtx) due to end-stage renal disease (ESRD) related to Alport syndrome in our study. MATERIALS AND METHODS: Twenty-five patients (female/male: 9 [36%]/16 [64%]) who underwent Rtx at our center between 2002 and 2014 were enrolled in the study. Mean ages of patients and donors (cadaveric/living: 8 [32%]/17 [68%]) were 28.2 ± 11.6 and 42.3 ± 15.8 years, respectively. As immunosuppressive therapy, tacrolimus plus mycophenolic acid were used for 17 (68%) patients and cyclosporin plus mycophenolic acid were used for 8 (32%) patients where induction therapy was basiliximab 20 mg (day 0 and 4) for 11 (44%) patients and anti-thymocyte globulin for 8 (32%) patients. Acute rejection was diagnosed using biopsy and evaluated with Banff classification. Analyses were performed by using SPSS 20.0 software with outcomes of mean 75.4 ± 31.4 months follow-up. Patient and graft survival were measured by using Kaplan-Meier survival curve and compared by using log-rank test. RESULTS: Graft survival rate was 89%, patient survival rate was 92.9%, and acute rejection rate was 12% (3 cases; 1 was cellular and 2 were antibody-mediated). Delayed graft function was observed in 4 (16%) cases, 1 patient (4%) had BK virus nephropathy and 2 (8%) patients required hemodialysis and had cytomegalovirus infection. At the last follow-up, mean serum creatinine level was 1.57 ± 1.23 mg/dL, spot urine protein creatinine ratio was 0.13 (0.04-1.84), and glomerular filtration rate was 71.7 ± 34.9 mL/min. CONCLUSION: Rtx is an effective and successful treatment modality for ESRD cases related to Alport syndrome.
Assuntos
Rejeição de Enxerto/epidemiologia , Falência Renal Crônica/cirurgia , Transplante de Rim , Nefrite Hereditária/complicações , Adulto , Feminino , Sobrevivência de Enxerto , Humanos , Incidência , Falência Renal Crônica/etiologia , Masculino , Taxa de Sobrevida/tendências , Turquia/epidemiologia , Adulto JovemRESUMO
BACKGROUND: This study was designed to compare donors who underwent open (ODN) versus retroperitonoscopic nephrectomy (RDN) in terms of intra-operative oxidative stress and recipients graft function in the early postoperative period. METHODS: Among 40 patients who underwent donor nephrectomy, 23 were operated via an open method and 17 via retroperitonoscopic method. To analyze oxidative stress, we measured plasma levels of malondialdehyde (MDA), protein carbonyl, and protein sulfhydryl moieties in donor venous blood before induction of anesthesia and postoperatively at 0, 6, and 24 hours. The influence of oxidative stress on graft function was evaluated by means of the postoperative 5th day recipient creatinine and estimated glomerular filtration rate (eGFR) Modification of Diet in Renal Disease Formula (MDRD) to evaluate delayed graft function (DGF) status. RESULTS: ODN patients showed significantly higher 24-hour mean levels of MDA, (6,139 ± 1,854 vs 4,813 ± 1,771 nmol/L; P = .01), protein carbonyl (366 ± 64 vs 311 ± 62 µmol/L; P = .01) and protein sulfhydryl (468 ± 110 vs 386 ± 75 µmol/L; P = .01) moieties compared with those RDN patients. However, ODN and RDN recipients were similar in terms of 5th day mean creatinine and eGFR (1.1 ± 0.3 vs 1.4 ± 0.8 mg/dL and 69.15 ± 12.24 vs 56.31 ± 25.2, respectively) and DGF status (4.4% [1/23] vs 5.9% [1/17], respectively). CONCLUSIONS: Although ODN donors were more prone to intra-operative oxidative stress than RDN donors, based on significantly higher levels of oxidative stress markers, this difference seems to not significantly influence recipients early graft function.
Assuntos
Peroxidação de Lipídeos , Nefrectomia/métodos , Peritônio/cirurgia , Proteínas/metabolismo , Doadores de Tecidos , Adulto , Creatinina/sangue , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Malondialdeído/sangue , Pessoa de Meia-Idade , Estresse OxidativoRESUMO
Neuroblastoma is an embryonal malignancy of the sympathetic nervous system. Spontaneous regression and differentiation of neuroblastoma is observed in a subset of patients, and has been suggested to represent delayed activation of physiologic molecular programs of fetal neuroblasts. Homeobox genes constitute an important family of transcription factors, which play a fundamental role in morphogenesis and cell differentiation during embryogenesis. In this study, we demonstrate that expression of the majority of the human HOX class I homeobox genes is significantly associated with clinical covariates in neuroblastoma using microarray expression data of 649 primary tumors. Moreover, a HOX gene expression-based classifier predicted neuroblastoma patient outcome independently of age, stage and MYCN amplification status. Among all HOX genes, HOXC9 expression was most prominently associated with favorable prognostic markers. Most notably, elevated HOXC9 expression was significantly associated with spontaneous regression in infant neuroblastoma. Re-expression of HOXC9 in three neuroblastoma cell lines led to a significant reduction in cell viability, and abrogated tumor growth almost completely in neuroblastoma xenografts. Neuroblastoma growth arrest was related to the induction of programmed cell death, as indicated by an increase in the sub-G1 fraction and translocation of phosphatidylserine to the outer membrane. Programmed cell death was associated with the release of cytochrome c from the mitochondria into the cytosol and activation of the intrinsic cascade of caspases, indicating that HOXC9 re-expression triggers the intrinsic apoptotic pathway. Collectively, our results show a strong prognostic impact of HOX gene expression in neuroblastoma, and may point towards a role of Hox-C9 in neuroblastoma spontaneous regression.
Assuntos
Regulação Neoplásica da Expressão Gênica , Proteínas de Homeodomínio/genética , Regressão Neoplásica Espontânea/genética , Neoplasias do Sistema Nervoso/genética , Neuroblastoma/genética , Apoptose/genética , Caspases/genética , Caspases/metabolismo , Diferenciação Celular , Linhagem Celular Tumoral , Pré-Escolar , Citocromos c/metabolismo , Proteínas de Homeodomínio/metabolismo , Humanos , Lactente , Mitocôndrias/metabolismo , Mitocôndrias/patologia , Proteína Proto-Oncogênica N-Myc , Estadiamento de Neoplasias , Neoplasias do Sistema Nervoso/metabolismo , Neoplasias do Sistema Nervoso/mortalidade , Neoplasias do Sistema Nervoso/patologia , Neuroblastoma/metabolismo , Neuroblastoma/mortalidade , Neuroblastoma/patologia , Proteínas Nucleares/genética , Proteínas Nucleares/metabolismo , Proteínas Oncogênicas/genética , Proteínas Oncogênicas/metabolismo , Prognóstico , Transdução de Sinais , Análise de Sobrevida , Ensaios Antitumorais Modelo de XenoenxertoRESUMO
OBJECTIVE: We sought to report the postoperative complications, vascular reconstruction techniques and graft outcomes among our series of renal transplantations performed using grafts with multiple renal arteries. METHODS: We reviewed retrospectively the medical records of 196 renal transplant patients of mean age 35.6 ± 13.3 years (range, 6-68) including 130 males and 66 females whose grafts from living (n = 164) or deceased (n = 32) donor with multiple arteries between 2006-2012. We noted the number of renal arteries, graft function, surgical technique, as well as vascular, urological and other complications. RESULTS: Of the 196 patients, 182 had 2 and 14 had ≥ 3 renal arteries. The surgical technique was separate anastomosis of renal arteries to the external and/or common iliac artery in the majority of patients (86.2%), while 13.8% of patients underwent anastomosis as a single renal artery after cuff reconstruction. Three patients experienced a lymphocele and only 1, a urinary leak from lower end of ureter, which was repaired surgically. Graft survival was 96.9% with losses in 6 cases due to rejection. CONCLUSIONS: Grafts bearing multiple renal arterial displayed low postoperative complication rates and good outcomes.
Assuntos
Artérias , Transplante de Rim , Rim/irrigação sanguínea , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVE: We sought to report the graft and patients survival of pre-emptive and non-pre-emptive kidney transplantations performed in our center. METHODS: The 859 subjects showed a mean age of 36.1 years and included 64.6%; males, who received grafts from living (n = 665) or deceased (n = 194) donors between January 2008 and June 2011. We reviewed their medical records retrospectively, to separately pre-emptive versus non-pre-emptive recipients for year transplant outcomes. RESULTS: Among the 859 patients, 153 (17.8%) underwent pre-emptive and 706 (82.2%), non-pre-emptive kidney transplantations. The rate of living donors was higher in the pre-emptive group (97.4% vs 73%, respectively). The 1-year graft survivals were 99.3% and 95.8% in pre-emptive and non-pre-emptive transplantation groups, respectively (P > .05). There was no significant difference between groups with respect to patient survival at 1 year (P > .05). CONCLUSION: In conclusion, graft and patient survival rates between pre-emptive and non-pre-emptive kidney transplantation cases were comparable at 1 year. Pre-emptive kidney transplantation, which eliminates hemodialysis costs and complications, should be preferred as the optimal renal replacement therapy for end-stage renal disease patients.
Assuntos
Sobrevivência de Enxerto , Transplante de Rim , Taxa de Sobrevida , Adulto , Feminino , Humanos , Masculino , TurquiaRESUMO
To show drug interactions between tacrolimus and ertapenem, we retrospectively evaluated 13 renal transplant recipients who had been treated with ertapenem for urinary tract infections during prescription of a constant dose. The mean dose of tacrolimus to achieve desired therapeutic concentrations decreased significantly after beginning ertapenem. The decrease from 0.079 mg/kg to 0.043 mg/kg occurred 2 days after initiation of ertapenem (P < .005). These results suggest that ertapenem, which is not metabolized through the cytochrome (CYP) P450 3A metabolic pathway, interacts with tacrolimus by an unknown mechanism. This report recommends tacrolimus concentration monitoring and dose reductions when the two drugs are administered in combination.
Assuntos
Antibacterianos/uso terapêutico , Imunossupressores/administração & dosagem , Transplante de Rim/imunologia , Tacrolimo/administração & dosagem , beta-Lactamas/uso terapêutico , Adulto , Idoso , Antibacterianos/efeitos adversos , Citocromo P-450 CYP3A/metabolismo , Cálculos da Dosagem de Medicamento , Interações Medicamentosas , Monitoramento de Medicamentos , Ertapenem , Feminino , Humanos , Imunossupressores/efeitos adversos , Imunossupressores/sangue , Transplante de Rim/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tacrolimo/efeitos adversos , Tacrolimo/sangue , Adulto Jovem , beta-Lactamas/efeitos adversosRESUMO
Porencephaly is an extensively encountered condition in pediatric neurology practice and leads to serious morbidity with its complications. Important etiological factors are trauma, hemorrhage, infection and thrombophilic factors that may cause destruction in the developing brain. Col4A1 mutations were also shown in familial porencephaly cases. We describe two siblings with porencephaly, hemiparesis, epilepsy, atrophic kidney in one of the siblings and asymptomatic mothers with an arachnoid cyst. We performed Col4A1 gene mutation screening and detected a novel mutation in mother and both of the children. This family has some features previously undescribed in patients with mutations of Col4A1 gene like atrophic kidney in one sibling and arachnoid cyst in the mother. We discuss here the possible relationship between these abnormalities and the mutation.
Assuntos
Cistos Aracnóideos/genética , Doenças Cerebelares/genética , Colágeno Tipo IV/genética , Mutação/genética , Adulto , Cerebelo/anormalidades , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , PorencefaliaRESUMO
OBJECTIVE: The aim of this study was to evaluate the effects of periodontal treatment on serum and gingival crevicular fluid (GCF) proinflammatory cytokine levels in hyperlipidemic patients with periodontitis. MATERIALS AND METHODS: Fifty-two patients with hyperlipidemia and periodontitis and 28 systemically healthy controls with periodontitis (C) were included in the study. Hyperlipidemic groups were divided into two groups as suggested diet (HD) and prescribed statin (HS). The clinical periodontal parameters, fasting venous blood, and GCF samples were obtained, and serum tumor necrosis factor-alpha (TNF-α), interleukin (IL) 1-beta, and IL-6 levels were evaluated at baseline and at 3 months follow-up (3MFU) after the completion of the non-surgical periodontal treatment that included scaling and root planning. RESULTS: Percentage of bleeding on probing was significantly higher in the HS group than both the HD and C groups. In the HD and HS groups, there were significant decreases in serum IL-6 and GCF TNF-α levels between the 3MFU and baseline. A significant decrease was also found in GCF IL-6 at the end of the study period in the HS group. CONCLUSION: The combination of the periodontal therapy and antilipemic treatment may provide beneficial effects on the metabolic and inflammatory control of hyperlipidemia.
Assuntos
Citocinas/análise , Hiperlipidemias/imunologia , Mediadores da Inflamação/análise , Periodontite/terapia , Adulto , Atorvastatina , Índice de Massa Corporal , Colesterol/sangue , LDL-Colesterol/sangue , VLDL-Colesterol/sangue , Citocinas/sangue , Raspagem Dentária , Dieta com Restrição de Gorduras , Feminino , Seguimentos , Líquido do Sulco Gengival/imunologia , Hemorragia Gengival/sangue , Hemorragia Gengival/imunologia , Hemorragia Gengival/terapia , Ácidos Heptanoicos/uso terapêutico , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hiperlipidemias/sangue , Hiperlipidemias/terapia , Mediadores da Inflamação/sangue , Interleucina-1beta/análise , Interleucina-1beta/sangue , Interleucina-6/análise , Interleucina-6/sangue , Masculino , Pessoa de Meia-Idade , Periodontite/sangue , Periodontite/imunologia , Pirróis/uso terapêutico , Aplainamento Radicular , Triglicerídeos/sangue , Fator de Necrose Tumoral alfa/análiseRESUMO
The main pathological condition in patients with impaired wound healing is diabetes mellitus. These patients have significantly low circulating nitric oxide (NO) levels because the stimulatory action of insulin on NO synthesis is absent. Additionally, asymmetric dimethylarginine (ADMA), an inhibitor of NO synthase, is increased owing to the generation of oxidative stress. NO was thought to contribute to wound healing. Hyperbaric oxygen (HBO) treatment is generally used in order to accelerate the healing of wounds. The aim of this study was to determine the changes in plasma procollagen type I and III N-terminal peptides (PINP and PIIINP), total nitrite/nitrate (NO(x)) and ADMA levels; and to evaluate their relation to healing during the HBO treatment of foot ulcers. Data obtained from 18 diabetic patients before and after the HBO therapy were compared statistically by the Wilcoxon test. NO(x) was increased in 11 and ADMA was decreased in 12 patients following HBO treatment. Both PINP (32.6 +/- 29.4 microg/l vs 44.3 +/- 33.4 microg/l) and PIIINP (6.97 +/- 3.01 microg/l vs 7.92 +/- 2.49 microg/l) were significantly increased (p < 0.05). Progressive reductions were observed in wound areas, as assessed by the digital wound imaging. In 12 patients, wounds healed by 50% or higher; whereas only two subjects had minimal improvements (15% or less healing). The duration of diabetes correlated negatively with wound healing (r = -498, p < 0.05). This study suggests that increased collagen synthesis is associated with wound healing during hyperbaric oxygen therapy. Nitric oxide generation may also contribute to the healing process.
Assuntos
Arginina/análogos & derivados , Colágeno/biossíntese , Pé Diabético/terapia , Oxigenoterapia Hiperbárica , Óxido Nítrico/sangue , Cicatrização , Idoso , Arginina/sangue , Biomarcadores/sangue , Pé Diabético/metabolismo , Pé Diabético/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fragmentos de Peptídeos/sangue , Pró-Colágeno/sangue , Fatores de Tempo , Resultado do TratamentoRESUMO
Feingold syndrome (FS) is a dominantly inherited combination of microcephaly with or without learning disabilities, hand and foot abnormalities, short palpebral fissures and esophageal/duodenal atresia. The syndrome has autosomal dominant inheritance with full penetrance, and variable expressivity. Digital anomalies are almost always present. The gene for FS is localized to a 2.2 cM region in 2p23-p24. We report on the first Turkish family with Feingold syndrome. The propositus is a male infant with microcephaly, frontal balding, brachymesophalangy of the second and fifth fingers, bilateral syndactyly of toes 2-3, facial anomalies, choanal atresia and focal epilepsy. His father has microcephaly, and more severe hands and feet abnormalities. One of his brothers died because of eosofageal atresia. Clinical presentation of the family was suggestive of Feingold syndrome, and genetic testing of the MYCN gene confirmed the diagnosis. The missense mutation we report here has not been described previously. FS is an autosomal dominant condition, and therefore, the diagnosis has important implications for genetic counseling.
Assuntos
Anormalidades Múltiplas/genética , Aberrações Cromossômicas , Duodeno/anormalidades , Atresia Esofágica/genética , Dedos/anormalidades , Genes Dominantes/genética , Atresia Intestinal/genética , Microcefalia/genética , Mutação de Sentido Incorreto/genética , Proteínas Nucleares/genética , Proteínas Oncogênicas/genética , Fenótipo , Anormalidades Múltiplas/diagnóstico , Anormalidades Craniofaciais/diagnóstico , Anormalidades Craniofaciais/genética , Atresia Esofágica/diagnóstico , Humanos , Lactente , Atresia Intestinal/diagnóstico , Masculino , Microcefalia/diagnóstico , Proteína Proto-Oncogênica N-Myc , Espasmos Infantis/diagnóstico , Espasmos Infantis/genética , Síndrome , TurquiaRESUMO
Frontonasal dysplasia (FND, also called frontonasal dysostosis or median cleft face syndrome) includes a spectrum of abnormalities affecting the eyes, forehead and nose, and resulting from midfacial dysraphia. The clinical picture is highly variable, but major findings in FND include ocular hypertelorism, a broad nasal root, median cleft affecting nose or both the nose and upper lip, and widow's peak. It is usually a sporadic disorder, although a few familial cases have been reported. We report here a three-generation family with multiple affected members with frontonasal dysplasia. This observation suggests autosomal dominant inheritance. Furthermore, some of the features e.g. over-riding toes, nail changes, vertical crease on plantar region of the feet in the index patient were not reported up to now.
Assuntos
Disostose Craniofacial , Osso Frontal/anormalidades , Osso Nasal/anormalidades , Pré-Escolar , Fenda Labial , Fissura Palatina , Disostose Craniofacial/genética , Disostose Craniofacial/patologia , Saúde da Família , Feminino , Humanos , Hipertelorismo , LinhagemRESUMO
BACKGROUND AND AIM: Carotid artery intima-media thickness (CIMT) and brachial artery flow-mediated dilation percentage (FMD%) are two commonly used parameters for detecting subclinical atherosclerosis. However, studies investigating the relationship between CIMT and brachial artery FMD% in different populations have produced conflicting results. The aim of this study was to determine the relationship between CIMT and brachial artery FMD% in patients on peritoneal dialysis (PD) METHODS: Fifty-two PD patients without known cardiovascular disease and 30 age-gender matched controls were included in the study. Endothelial function was determined using ultrasonography (US) to measure the FMD of the brachial artery, and this parameter was expressed as the percentage change from the baseline diameter of the brachial artery (FMD%). We also measured CIMT by US and analysed the relationship between CIMT and brachial FMD%. RESULTS: The CIMT was significantly higher in patients than in the control group (0.84 +/- 0.08 vs. 0.75 +/- 0.06 mm, P < 0.01), whereas brachial artery FMD% was lower in patients than in the controls (8.2 +/- 5.0 vs. 11.7 +/- 5.5%, P < 0.01). There was no significant correlation between CIMT and FMD% (r = -0.004, P = 0.94). CONCLUSION: Although PD patients are known to be characterized by an impaired flow-mediated vasodilatation of brachial artery and increased in CIMT, we did not find a significant correlation between FMD% and CIMT in our PD patient cohort. One possible explanation for our results is that each method measures a different aspect and stage of atherosclerosis.
Assuntos
Artéria Braquial/fisiopatologia , Artérias Carótidas/patologia , Falência Renal Crônica/patologia , Falência Renal Crônica/fisiopatologia , Diálise Peritoneal , Vasodilatação/fisiologia , Adulto , Artérias Carótidas/diagnóstico por imagem , Estudos de Casos e Controles , Doença da Artéria Coronariana/etiologia , Feminino , Humanos , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional/fisiologia , Fatores de Risco , Túnica Íntima/diagnóstico por imagem , Túnica Íntima/patologia , Túnica Média/diagnóstico por imagem , Túnica Média/patologia , UltrassonografiaRESUMO
AIM: We evaluated the effects of the radial artery on the functional outcomes and endothelium when the harvest was made either by harmonic scalpel or by high-frequency electrocautery. METHODS: Between 2002 and 2007, 982 patients with coronary artery diseases were operated for coronary artery revascularization. The radial arteries were harvested for 101 of these patients and divided into two groups depending on the use of the harmonic scalpel (Group A; N=51) and the high-frequency electrocautery (Group B; N=50). Harvesting time, use of hemostatic clips, frequency of spasm, in situ free flow, and endothelial damage were compared between the two groups. RESULTS: Conventional high-frequency electrocautery technique used 8.7+/-3.9 hemostatic clips versus 1.5+/-1 clips (P<0.001). In situ free blood flow was 85+/-5.5 mL/min for Group B versus 114+/-21.7 mL/min for Group A (P<0.006). The endothelial damage of the radial arteries taken down with the harmonic scalpel was significantly less than when taken down with the high-frequency electrocautery (P<0.05). There was no statistically significant difference in terms of harvesting time and spasm between the two groups (P>0.05). CONCLUSION: Ultrasonic dissection with harmonic scalpel of the radial artery is associated with a decreased use of hemostatic clips. Moreover, the harmonic scalpel has a positive effect on endothelial preservation and it was associated with increased free blood flow of the radial artery.