RESUMO
BACKGROUND/PURPOSE: Near-infrared (NIR) light with high water absorption enables us to visualize the water content distribution appeared in the superficial skin layer. The light penetration depth with the wavelength of 1920 nm is almost 100 µm from the skin surface. Thus, the water distribution in the stratum corneum can be effectively imaged by detecting the wavelength band around 1920 nm. The aim of this article was to measure the time-lapse behavior of the tiny droplet of the moisturizer spreading on the skin surface by imaging in 1920 nm wavelength band for investigating the correlation with the traditional index of the skin condition such as the water content and transepidermal water loss (TEWL). METHODS: Experiment is performed with three moisturizer products and seven volunteer subjects. The NIR image is acquired by an originally designed imaging scope equipped with the white light of the strong brightness [super continuum (SC) light], the bandpass filter with the center wavelength of 1920 nm, and the NIR image sensor. A tiny droplet of the moisturizer is put on the surface of the skin and the time-lapse images are saved. Each acquired image is analyzed from a view point of the droplet area and elapsed time for absorption into the skin. The water content and TEWL of all subjects are measured by the conventional electrical method for investigating the relationship with the measured droplet dynamics parameters. RESULTS: Elapsed time for moisturizer droplet to be absorbed into the skin, the droplet area just before absorption for three moisturizer products, skin water contents, and TEWL for seven subjects were measured and correlation coefficients for each parameters were calculated. It was found that the skin with higher water contents or lower TEWL absorbed the moisturizer faster and spreads moisturizer wider. Also absorption and spreading speed depend on moisturizer property (moisturizing or fresh) which is originated from the moisturizer constituents. CONCLUSION: The correlation values between the moisturizer dynamics on the skin surface and the traditional index of the skin property were clarified. It was found that the skin with the high water content or low TEWL absorbs the moisturizer droplet fast. The spreading area depends not only on the skin property but on the constituents of the moisturizers.
Assuntos
Água Corporal/metabolismo , Emolientes/farmacocinética , Absorção Cutânea/fisiologia , Pele/metabolismo , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Perda Insensível de Água/fisiologia , Adulto , Fármacos Dermatológicos/administração & dosagem , Fármacos Dermatológicos/farmacocinética , Emolientes/administração & dosagem , Humanos , Pessoa de Meia-Idade , Imagem Molecular/métodos , Pele/citologia , Análise Espectral Raman/métodos , Propriedades de Superfície , Distribuição TecidualRESUMO
BACKGROUND/PURPOSE: We investigate the measurement sensitivity for the water content distribution in Near-infrared (NIR) imaging ranging up to 2 µm. METHODS: To evaluate the sensitivity, our attention is focused to the light penetration depth in the skin tissue because the thickness of a layer where the water content can be varied is very thin and deep light penetration decreases the signal variation. The light penetration depths in the wavelengths of 1300, 1450, and 1920 nm are calculated theoretically based on the Monte Carlo light transport simulation. RESULTS: It is clarified that the wavelength of 1920 nm gives the smallest penetration depth. A NIR imaging experiment is demonstrated to verify the difference of imaging sensitivity. The experiment result shows that the NIR image taken at 1920 nm gives the most sensitive measurement of the water content distribution in skin.
Assuntos
Água Corporal/metabolismo , Epiderme/metabolismo , Modelos Biológicos , Nefelometria e Turbidimetria/métodos , Absorção Cutânea/fisiologia , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Adulto , Simulação por Computador , Feminino , Humanos , Masculino , Refratometria/métodos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Distribuição Tecidual , Perda Insensível de Água/fisiologiaRESUMO
Anopheles gambiae sensu lato complex (An. gambiae s.l.) describes a group of nine morphologically indistinguishable members that vary in their distribution, ability to transmit malaria, and susceptibility to pyrethroids. Here, we recorded the spatial patterns of PCR-identified An. gambiae s.l. complex species collected from four sites in Cross River State, Nigeria that represented three different ecological zones. Trapping was conducted between October 2015 and June 2016. Anopheles gambiae s.l. complex species identification was performed using species-specific primers followed by An. gambiae and An. coluzzii differentiation using the restriction fragment length polymorphism (RFLP) method. Bivariate and multivariate logistic regression models were used to identify ecological and seasonal variables closely associated with An. coluzzii and An. gambiae distribution. Out of 1,388 An. gambiae s.l. successfully amplified, 1,074 (77.4%) were An. coluzzii, 278 (20%) were An. gambiae, and 25 (1.8%) were hybrids (An. coluzzii/An. gambiae). A very small number of An. arabiensis (0.8%, n = 11) were also collected. Statistical analysis indicated that An. coluzzii is predominant in Guinea-savannah and tropical rainforest, and is highly associated with rainy seasons, while, An. gambiae is prevalent in mangrove swamp forest during dry seasons. Only 13 An. gambiae s.l. females were infected with Plasmodium falciparum (P. falciparum). The sporozoite infection rate was higher in mangrove swamp forest (53.8%, n = 7) than in rain forest (38.5%, n = 5) followed by Guinea-savannah (7.7%, n = 1) ecological zones. These results provide important insights for strategic planning of malaria control programs in Nigeria.
Assuntos
Anopheles , Malária , Animais , Anopheles/genética , Feminino , Mosquitos Vetores , Nigéria , Plasmodium falciparum , Reação em Cadeia da PolimeraseRESUMO
We examined the influence of insect cadaver desiccation on the virulence and production of entomopathogenic nematodes (EPNs), common natural enemies of many soil-dwelling insects. EPNs are often used in biological control, and we investigated the feasibility of applying EPNs within desiccated insect cadavers. Desiccation studies were conducted using the factitious host, Galleria mellonella (Lepidoptera: Pyralidae, wax moth larvae) and three EPN species (Heterorhabditis bacteriophora 'HB1', Steinernema carpocapsae 'All', and Steinernema riobrave). Weights of individual insect cadavers were tracked daily during the desiccation process, and cohorts were placed into emergence traps when average mass losses reached 50%, 60%, and 70% levels. We tracked the proportion of insect cadavers producing infective juveniles (IJs), the number and virulence of IJs produced from desiccated insect cadavers, and the influence of soil water potentials on IJ production of desiccated insect cadavers. We observed apparent differences in the desiccation rate of the insect cadavers among the three species, as well as apparent differences among the three species in both the proportion of insect cadavers producing IJs and IJ production per insect cadaver. Exposure of desiccated insect cadavers to water potentials greater than -2.75 kPa stimulated IJ emergence. Among the nematode species examined, H. bacteriophora exhibited lower proportions of desiccated insect cadavers producing IJs than the other two species. Desiccation significantly reduced the number of IJs produced from insect cadavers. At the 60% mass loss level, however, desiccated insect cadavers from each of the three species successfully produced IJs when exposed to moist sand, suggesting that insect cadaver desiccation may be a useful approach for biological control of soil insect pests.
Assuntos
Dessecação , Hidratação , Lepidópteros/parasitologia , Rabditídios/patogenicidade , Solo , Água , Animais , Cadáver , Controle Biológico de Vetores , Reprodução/fisiologia , Rabditídios/fisiologia , Virulência/fisiologiaRESUMO
Arbovirus transmission by Aedes mosquitoes has long been a significant problem in Africa. In West Africa, Aedes vector management faces significant challenges; lack of recent Aedes distributional data and potential distributional modeling hinder effective vector control and pose serious public health issues. In this study, larval and adult mosquitoes were collected from four study sites in Enugu State, Nigeria every other month between November 2017 and September 2018. A total number of 2997 Aedes mosquitoes were collected and identified, and 59 positive field occurrence points for both Aedes adult and larvae were recorded. A total of 18 positive occurrence points were used for modeling. Ecological Niche Models (ENMs) were used to estimate the current geographic distribution of Aedes species (spp.) in Enugu State, south-east Nigeria, and mosquito presence was used as a proxy for predicting risk of disease transmission. Maximum Entropy distribution modeling or "MaxEnt" was used for predicting the potential suitable habitats, using a portion of the occurrence records. A total of 23 environmental variables (19 bioclimatic and four topographic) were used to model the potential geographical distribution area under current climatic conditions. The most suitable habitat for Aedes spp. was predicted in the northern, central, and southeastern parts of Enugu State with some extensions in Anambra, Delta, and Edo States in the west, and Ebonyi State in the east. Seasonal temperature, precipitation of the wettest month, mean monthly temperature range, elevation, and precipitation of the driest months were the highest estimated main variable contributions associated with the distribution of Aedes spp. We found that Aedes spp. prefer to be situated in environmental conditions where precipitation of wettest month ranged from 265 to 330 mm, precipitation of driest quarter ranged from 25 to 75 mm while precipitation of wettest quarter ranged from 650 to 950 mm. Aedes mosquitoes, such as Ae. aegypti and Ae. albopictus, pose a significant threat to human health, hence, the results of this study will help decision makers to monitor the distribution of these species and establish a management plan for future national mosquito surveillance and control programs in Nigeria.
RESUMO
Multiple primary malignant neoplasms in 5,456 consecutive autopsy cases from 1962 to 1981 in the National Cancer Center were analyzed. There were 285 (5.2%) double primary cancers, 58 (1.1%) triple or more, and 65 (1.2%) minute cancers of the thyroid or prostate gland. Higher incidence of second cancer is observed in cancers of the oropharynx, intestine, larynx, uterus, bladder, and thyroid. Organ association between the two cancers was present in certain organs; for example, there was a tendency for upper gastrointestinal tract cancers to be associated with lower gastrointestinal tract cancers. Influence of histologic subtypes in multiple cancer cases is discussed for lung cancer.
Assuntos
Neoplasias Primárias Múltiplas/epidemiologia , Adulto , Fatores Etários , Autopsia , Neoplasias da Mama/epidemiologia , Feminino , Neoplasias Gastrointestinais/epidemiologia , Humanos , Japão , Masculino , Neoplasias Faríngeas/epidemiologia , Fatores de Tempo , Neoplasias Uterinas/epidemiologiaRESUMO
The dose response of tumor induction after single s.c. injections of 3-methylcholanthrene (MC) into the groin of mice and the growth rates of the tumors formed were examined. The dose-response curve of tumor induction appeared to be linear at low doses of MC. Analysis of 182 sarcomas produced between 50 and 400 days after MC injection into WB and C3H/He mice, together with previous data on ICR/JCL mice, showed that there was no correlation between the volume-doubling time of tumors and the length of time before tumor appearance or the dose of carcinogen applied. The overall average volume-doubling time of sarcomas in the three strains of mice was 2.6 days. Assuming that a tumor originates from a single cell and that its growth rate before its appearance is constant, individual growth curves were extrapolated to the time of origin of each tumor. Histograms of the distribution of times of origin of tumors showed peaks at about 50 days after application of carcinogen. A one-hit and possibly two-stage type of tumor induction with MC is proposed.
Assuntos
Metilcolantreno/toxicidade , Neoplasias Cutâneas/induzido quimicamente , Animais , Divisão Celular , Relação Dose-Resposta a Droga , Cinética , Camundongos , Camundongos Endogâmicos , Neoplasias Experimentais/fisiopatologia , Neoplasias Cutâneas/fisiopatologiaRESUMO
A 34-year-old man with Marfan syndrome was admitted to our hospital for surgical treatment of aortic regurgitation due to annuloaortic ectasia. He had no history of bleeding complications. Preoperative investigation revealed a slight prolongation of an activated partial thromboplastin time, which went unnoticed. He underwent aortic root replacement with a composite valve graft. During the operation, he had excessive bleeding due to coagulopathy after the termination of cardiopulmonary bypass, and needed a large amount of blood transfusion to obtain hemostasis. Before his discharge from our hospital, he was diagnosed as mild hemophilia A because of the decline in his factor VII level. To our knowledge, there has been no published case of cardiac operations in Marfan syndrome with hemophilia A.
Assuntos
Insuficiência da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca , Hemofilia A/complicações , Síndrome de Marfan/cirurgia , Adulto , Hemofilia A/diagnóstico , Humanos , Masculino , Síndrome de Marfan/complicaçõesRESUMO
The Heartstring proximal anastomotic system is a device designed to facilitate the creation of a clampless hand-sewn proximal anastomosis. Thirty-four patients who underwent coronary artery revascularization had 40 proximal anastomoses using the Heartstring device. There were 26 men and 8 women, with the mean age of 70 +/- 8.9 years. Thirty-one patients underwent coronary artery bypass grafting through off-pump procedures and 3 patients on-pump beating procedures. In all patients, saphenous vein grafts were anastomosed to the aorta using the Heartstring device, the median number of distal anastomoses being 2.4 +/- 0.7. Either emergent or urgent surgery was required in 14 patients (41%). Diseased aorta was found in 11 patients (32%). One patient (2.9%) died postoperatively due to ischemic necrosis of the small intestine and the colon. There was no occurrence of postoperative stroke. Of 40 saphenous vein grafts anastomosed with the Heartstring system, 39 (97.5%) were patent. The occluded saphenous vein was not considered to be device related. Our clinical experience demonstrated that the Heartstring system allow us to create clampless and reproductive hand-sewn proximal anastomosis and to decrease the incidence of neurological complication.
Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea , Doença das Coronárias/cirurgia , Veia Safena/transplante , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/instrumentação , Ponte de Artéria Coronária , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Recently, three natural products have been identified, the epothilones, eleutherobin, and discodermolide, whose mechanism of action is similar to that of Taxol in that they stabilize microtubules and block cells in the mitotic phase of the cell cycle. In this report, we have compared and contrasted the effects of these new agents in Taxol-sensitive and -resistant cell lines. We also have taken advantage of a human lung carcinoma cell line, A549-T12, that was isolated as a Taxol-resistant cell line and found to require low concentrations of Taxol (2-6 nM) for normal cell division. This study then examined the ability of these new compounds to substitute for Taxol in sustaining the growth of A549-T12 cells. Immunofluorescence and flow cytometry have both indicated that the epothilones and eleutherobin, but not discodermolide, can substitute for Taxol in this Taxol-dependent cell line. In A549-T12 cells, the presence of Taxol significantly amplified the cytotoxicity of discodermolide, and this phenomenon was not observed in combinations of Taxol with either the epothilones or eleutherobin. Median effect analysis using the combination index method revealed a schedule-independent synergistic interaction between Taxol and discodermolide in four human carcinoma cell lines, an effect that was not observed between Taxol and epothilone B. Flow cytometry revealed that concurrent exposure of A549 cells to Taxol and discodermolide at doses that do not induce mitotic arrest caused an increase in the hypodiploid population, thereby indicating that a possible mechanism for the observed synergy is the potentiation of apoptosis. Our results suggest that Taxol and discodermolide may constitute a promising chemotherapeutic combination.
Assuntos
Alcanos , Antineoplásicos/farmacologia , Carbamatos , Diterpenos , Epotilonas , Lactonas/farmacologia , Neoplasias Pulmonares/tratamento farmacológico , Paclitaxel/farmacologia , Subfamília B de Transportador de Cassetes de Ligação de ATP/metabolismo , Alcaloides/farmacologia , Animais , Contagem de Células/efeitos dos fármacos , Divisão Celular/efeitos dos fármacos , Linhagem Celular , Citoesqueleto/efeitos dos fármacos , Citoesqueleto/metabolismo , Relação Dose-Resposta a Droga , Sinergismo Farmacológico , Compostos de Epóxi/farmacologia , Citometria de Fluxo , Humanos , Neoplasias Pulmonares/metabolismo , Neoplasias Pulmonares/patologia , Microtúbulos/efeitos dos fármacos , Microtúbulos/metabolismo , Mitose/efeitos dos fármacos , Pironas , Tiazóis/farmacologia , Células Tumorais CultivadasRESUMO
Metabolism-based autofluorescence redox imaging is one of the promising options for non-invasive screening of digestive tumors. In this paper, autofluorescence from fluorescent coenzymes such as NADH and FAD related to cellular metabolism as well as total hemoglobin and oxygen saturation are analyzed based on a point spectrum. As a redox index based on the metabolism, the ratio of the 450nm-490nm fluorescence intensities for 365nm and 405nm excitation wavelengths (F365/F405) is used. Although F365/F405 is a good index in many samples, inversion and weakened contrast are observed. A Simplified models with and without collagen based on Lambert-Beer law are built to explain how F365/F405 depicts the tumor region.
Assuntos
Neoplasias , Endoscopia , Humanos , Oxirredução , Espectrometria de FluorescênciaRESUMO
Eighty-four patients with previously untreated invasive carcinoma of the uterine cervix were treated by high-dose-rate intracavitary irradiation using a remotely controlled afterloading system (Ralstron) with or without external irradiation at the National Cancer Center Hospital, Tokyo, between 1977 and 1981. Survival rates and local control rates were comparable to those for 372 patients treated by low-dose-rate intracavitary irradiation with or without external irradiation from 1972 to 1981 at the hospital. The incidence of major complications was 5.1 and 2.4% for the patients treated by low-dose-rate intracavitary irradiation and by high-dose-rate irradiation, respectively. The results are comparable to those reported by other institutions. We have abandoned the conventional low-dose-rate intracavitary irradiation with the impression that the high-dose-rate remotely controlled afterloading system is a good alternative to the conventional one.
Assuntos
Braquiterapia , Neoplasias do Colo do Útero/radioterapia , Adulto , Idoso , Braquiterapia/efeitos adversos , Radioisótopos de Cobalto/uso terapêutico , Estudos de Avaliação como Assunto , Feminino , Humanos , Pessoa de Meia-Idade , Dosagem Radioterapêutica , Neoplasias do Colo do Útero/mortalidadeRESUMO
To elucidate the factor(s) accelerating the autoimmune disease processes, we induced two types of experimental autoimmune encephalomyelitis (EAE), severe and very mild, in F344 rats by immunization with myelin basic protein (MBP) plus pertussis toxin (PT) (PT+) or with MBP alone (PT-) and compared the differences between the two. Immunohistochemical examinations showed that although the nature of inflammation was essentially the same between the two groups, the proportion of Vbeta8.2(+) T cells in the CNS lesion of PT (+) rats was larger than that of PT (-) rats. Cytokine analysis by competitive PCR revealed that IL-10 mRNA in the lymphoid organ was significantly suppressed in the PT(+) group, whereas levels of IFN-gamma,TNF-alpha and TGF-beta mRNA were insignificantly different after PT administration. In addition, T cells taken from PT (+) rats proliferated well in response to MBP, while those from PT (-) rats showed a marginal response to the same antigen. However, this finding does not indicate the switching of non-encephalitogenic to encephalitogenic T cells upon PT administration because PT (-) rats contained encephalitogenic T cells and/or their precursor cells as revealed by adoptive transfer experiments. Taken together, these findings suggest that suppression of IL-10 by PT administration is the major factor contributing to the exacerbation of EAE in PT(+) rats.
Assuntos
Encefalomielite Autoimune Experimental/imunologia , Toxina Pertussis , Fatores de Virulência de Bordetella/imunologia , Animais , Divisão Celular , Sistema Nervoso Central/metabolismo , Sistema Nervoso Central/patologia , Citocinas/metabolismo , Encefalomielite Autoimune Experimental/metabolismo , Encefalomielite Autoimune Experimental/patologia , Cobaias , Imunização , Imuno-Histoquímica , Mediadores da Inflamação/metabolismo , Proteína Básica da Mielina/imunologia , Reação em Cadeia da Polimerase , Ratos , Ratos Endogâmicos F344 , Linfócitos T/patologiaRESUMO
[formula: see text] A triply convergent, highly efficient second-generation synthesis of the potent antimitotic agent (+)-discodermolide (1) has been achieved on a 1-g scale.
Assuntos
Alcanos , Antineoplásicos/síntese química , Carbamatos , Lactonas/síntese química , Animais , Indicadores e Reagentes , Poríferos/química , Pironas , EstereoisomerismoRESUMO
To evaluate the protective activity of fruits against liver injury, 22 different fruits were fed to rats with liver damage caused by D-galactosamine, a powerful liver toxin. As measured by changes in the levels of plasma alanine aminotransferase (ALT) and aspartate aminotransferase (AST), avocado showed extraordinarily potent liver injury suppressing activity. Five active compounds were isolated and their structures determined. These were all fatty acid derivatives, of which three, namely, (2E,5E,12Z,15Z)-1-hydroxyheneicosa-2,5,12,15-tetraen-4-one, (2E,12Z,15Z)-1-hydroxyheneicosa-2,12,15-trien-4-one, and (5E,12Z)-2-hydroxy-4-oxoheneicosa-5,12-dien-1-yl acetate, were novel.
Assuntos
Galactosamina/antagonistas & inibidores , Hepatopatias/prevenção & controle , Fígado/lesões , Persea/uso terapêutico , Fitoterapia , Alanina Transaminase/sangue , Animais , Aspartato Aminotransferases/sangue , Doença Hepática Induzida por Substâncias e Drogas , Persea/química , RatosRESUMO
The summation and classification of patients registered for planned radiation therapy in the 24-year period from 1962 to 1986, in the Department of Radiation Therapy, National Cancer Center Hospital, are reported. Patients numbered 16,471, and total sessions of treatment were 26,175. The ratio of the two figures, 1.58, is the average number of treatment sessions per patient. Peak age was 61-65 years' old and 56-60 years old, respectively for males and females. The most frequent primary site of disease for radiation therapy was the head and neck, followed by trachea, bronchus and lung, crevix uteri, breast, and esophagus. Frequency of squamous cell carcinoma was 38.0%; that of adenocarcinoma was 20.9%. Radical treatment was performed in 32.0% of patients in the first session, but this figure decreased to 24.7% for all sessions. There were many cases of secondary and primary palliative treatment, i.e., 31.8%. Radiotherapy was done in 70% of patients by megavoltage X-ray, with 9.4% treated by electron beam. Crude 5-year survival rates for each classification of malignant disease respective to the category of treatment policy from 1962 to 1978 were obtained. Among the radical treatment group, head and neck tumors, skin cancer, and Hodgkin's disease showed 5-year survival rates greater than 50%.
Assuntos
Neoplasias/radioterapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Braquiterapia , Institutos de Câncer , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Sistemas de Informação , Japão , Masculino , Pessoa de Meia-Idade , Neoplasias/classificação , Neoplasias/mortalidade , Sistema de RegistrosRESUMO
A 59-year-old female presented with a very rare case of primary malignant lymphoma of the cavernous sinus manifesting as diplopia and right facial hypesthesia. Magnetic resonance (MR) imaging showed the tumor located in the right cavernous sinus as low intensity with marked enhancement by gadolinium. The tumor was partially removed by the transzygomatic extradural approach. The histological diagnosis was malignant lymphoma. Chest and abdominal computed tomography and gallium-67 scintigraphy revealed no other lesions in the body. The patient received conventional radiotherapy and her diplopia and right facial hypesthesia gradually improved. At 1 month after radiotherapy, MR imaging showed no evidence of residual tumor. Primary cavernous sinus malignant lymphoma is extremely rare, but should be considered in the differential diagnosis of cavernous sinus lesions. Histological confirmation of tumors in this region is essential for choosing the most appropriate treatment to achieve a better outcome.
Assuntos
Neoplasias Encefálicas/cirurgia , Seio Cavernoso/cirurgia , Leucemia Linfocítica Crônica de Células B/cirurgia , Linfoma de Células B/cirurgia , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/patologia , Seio Cavernoso/patologia , Diagnóstico Diferencial , Feminino , Humanos , Leucemia Linfocítica Crônica de Células B/diagnóstico , Leucemia Linfocítica Crônica de Células B/patologia , Linfoma de Células B/diagnóstico , Linfoma de Células B/patologia , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Invasividade Neoplásica , Gânglio Trigeminal/patologiaRESUMO
A 48-year-old woman admitted with progressive dyspnea had previously been diagnosed with systemic lupus erythematosus, antiphospholipid syndrome, and chronic renal failure, and had undergone mitral valve replacement with a Carpentier-Edwards pericardial bioprosthesis for mitral insufficiency 9 years before. She suffered a cerebral infarction 5 years earlier, despite appropriate anticoagulant therapy. On admission, echocardiography showed severe bioprosthetic stenosis. Repeat mitral valve replacement was conducted using a Mosaic bioprosthesis. On postoperative day 2, when heparinization was commenced, she suddenly had an epileptic fit. She also developed ischemic necrosis of the fingers and toes, considered secondary to microthrombosis. Aspirin was administered and heparin replaced by warfarin sodium. Necrosis gradually disappeared, and she was discharged 3 months after surgery. The original bioprosthesis showed degenerative changes with significant thrombus formation on cusps, thought to be mainly due to her hypercoagulable state. Considering the thrombophilic tendency in patients with antiphospholipid syndrome, strict management of anticoagulant therapy is required.
Assuntos
Síndrome Antifosfolipídica/complicações , Implante de Prótese de Valva Cardíaca , Falência Renal Crônica/complicações , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Adulto , Bioprótese , Feminino , Próteses Valvulares Cardíacas , Humanos , Pessoa de Meia-Idade , Falha de Prótese , ReoperaçãoRESUMO
OBJECTIVE: Prosthetic valve endocarditis remains a challenging complication after heart valve replacement. To identify predictive risk factors, we have reviewed 30 patients who underwent surgery for prosthetic valve endocarditis between March 1986 and May 1999. METHODS: There were 15 men and 15 women (mean age 51 years). Prosthetic valve endocarditis was classified as early (< or = 1 year after operation) in 10 cases, and as late in the other 20 cases. The most common indication for surgery was moderate to severe congestive heart failure due to prosthetic valve dysfunction in 21 (70%) patients. The average follow-up period was 6.5 years, with a range of 0.3 to 14.1 years. RESULTS: The most common microorganism was Staphylococcus epidermidis in both patients with early (50%) and late prosthetic valve endocarditis (25%). The in-hospital mortality was 13.3% (4/30). There were six late deaths. The actuarial survival at 5 years was 78% and 66% at 10 years. An early onset of prosthetic valve endocarditis was the only significant determinant of both in-hospital mortality (p = 0.005) and overall mortality (p = 0.021). Emergency surgery had a statistically significant relationship with in-hospital mortality (p = 0.045). No significant influence on mortality after reoperation for prosthetic valve endocarditis was found in age, sex, valve position, antecedent native valve endocarditis, or in the type of pathological findings (ring abscess, valve dehiscence, and vegetation). CONCLUSION: Early onset of prosthetic valve endocarditis and emergency surgery were important risk factors for mortality due to prosthetic valve endocarditis.
Assuntos
Endocardite Bacteriana/cirurgia , Próteses Valvulares Cardíacas/efeitos adversos , Infecções Relacionadas à Prótese/cirurgia , Adulto , Idoso , Endocardite Bacteriana/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/mortalidade , Reoperação , Estudos Retrospectivos , Infecções Estafilocócicas/cirurgia , Staphylococcus epidermidis , Resultado do TratamentoRESUMO
We report a case of rapidly progressive varicella zoster virus retinitis, which is distinct from acute retinal necrosis syndrome. The patient was a 52-year-old male and suffered acquired immunodeficiency syndrome. Two months after the varicella zoster dermatitis in the distribution of the first division of the left trigeminal nerve, pseudodendritic keratitis and iridocyclitis were observed in the left eye. After 5 weeks, multifocal and patchy white exudates were observed in the peripheral deeper layer of the retina in the left eye, but retinal vasculitis in the exudative lesions was slight. Despite systemic administration of acyclovir, white exudates progressed confluently from the periphery to the post pole of the retina and reached the macula in 10 weeks. Eight weeks after the observation of lesions in the left eye, we found the same lesions in the right eye. After the white exudative lesions disappeared, the retina became atrophic and the retinal vessels were narrowed, but no retinal detachment was observed. Recently, Foster and associates described the rapidly progressive outer retinal necrosis as a new entity of varicella zoster virus retinitis in AIDS patients. We think our case was very similar to the rapidly progressive outer retinal necrosis. This case shows that we must carefully follow up the rapidly progressive outer retinal necrosis in the AIDS patients with a varicella zoster dermatitis.