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PURPOSE: Hyponatremia occurs in about 30% of patients with pneumonia, including those with SARS-CoV-2 (COVID-19) infection. Hyponatremia predicts a worse outcome in several pathologic conditions and in COVID-19 has been associated with a higher risk of non-invasive ventilation, ICU transfer and death. The main objective of this study was to determine whether early hyponatremia is also a predictor of long-term sequelae at follow-up. METHODS: In this observational study, we collected 6-month follow-up data from 189 laboratory-confirmed COVID-19 patients previously admitted to a University Hospital. About 25% of the patients (n = 47) had hyponatremia at the time of hospital admission. RESULTS: Serum [Na+] was significantly increased in the whole group of 189 patients at 6 months, compared to the value at hospital admission (141.4 ± 2.2 vs 137 ± 3.5 mEq/L, p < 0.001). In addition, IL-6 levels decreased and the PaO2/FiO2 increased. Accordingly, pulmonary involvement, evaluated at the chest X-ray by the RALE score, decreased. However, in patients with hyponatremia at hospital admission, higher levels of LDH, fibrinogen, troponin T and NT-ProBNP were detected at follow-up, compared to patients with normonatremia at admission. In addition, hyponatremia at admission was associated with worse echocardiography parameters related to right ventricular function, together with a higher RALE score. CONCLUSION: These results suggest that early hyponatremia in COVID-19 patients is associated with the presence of laboratory and imaging parameters indicating a greater pulmonary and right-sided heart involvement at follow-up.
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COVID-19 , Hiponatremia , Humanos , COVID-19/complicações , SARS-CoV-2 , Hiponatremia/complicações , Seguimentos , Sons Respiratórios , Hospitais , Estudos RetrospectivosAssuntos
Infecções por Coronavirus/complicações , Hiponatremia/complicações , Interleucina-6/sangue , Pneumonia Viral/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19 , Infecções por Coronavirus/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/terapia , Estudos Retrospectivos , Sódio/sangue , Resultado do TratamentoRESUMO
The mercury (Hg) pollution of sediments is the main carrier of Hg for the biota and, subsequently, for the local fish consumers in Augusta Bay area (SE Sicily, Italy), a coastal marine system affected by relevant sewage from an important chlor-alkali factory. This relationship was revealed by the determination of Mass Dependent (MDF) and Mass Independent Fractionation (MIF) of Hg isotopes in sediment, fish and human hair samples. Sediments showed MDF but no MIF, while fish showed MIF, possibly due to photochemical reduction in the water column and depending on the feeding habitat of the species. Benthic and demersal fish exhibited MDF similar to that of sediments in which anthropogenic Hg was deposited, while pelagic organisms evidenced higher MDF and MIF due to photoreduction. Human hair showed high values of δ(202)Hg (offset of +2.2 with respect to the consumed fish) and Δ(199)Hg, both associated to fish consumption.
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Isótopos de Mercúrio/análise , Mercúrio/análise , Poluentes Químicos da Água/análise , Animais , Baías , Ecossistema , Monitoramento Ambiental , Poluição Ambiental , Peixes/metabolismo , Sedimentos Geológicos/química , Cabelo/química , Cabelo/metabolismo , Humanos , Itália , Carne/análise , Mercúrio/metabolismo , Isótopos de Mercúrio/metabolismo , Poluentes Químicos da Água/metabolismoRESUMO
In essential hypertension, increased renal resistive index (RRI) is associated to a reduction of renal function and microalbuminuria, and to renal tubulo-interstitial damage. A tubulo-interstitial inflammatory infiltration was found in experimental models of hypertension, and serum high-sensitive C-reactive protein (hsCRP) levels correlated with urinary markers of tubulo-interstitial damage in humans. We studied the relationship between RRI and serum hsCRP in hypertensives with preserved renal function, without microalbuminuria. We investigated hypertensive patients without diabetes, renal failure, microalbuminuria or major inflammatory disease. Serum levels of hsCRP were assayed. RRI was calculated by intrarenal Doppler ultrasound and considered pathologic when ≥0.70 or >95% of upper confidence limit expected for age decade. The renal volume-to-resistive index ratio (RV/RRI) was also calculated. We evaluated 85 patients (57±14 years, 61 males). Patients with pathologic RRI (n=21) were older and had significantly higher hsCRP levels (4.70±2.30 vs 2.93±2.09 mg l(-1), P<0.01) compared with patients with normal RRI, as well as patients with decreased RV/RRI (n=43). HsCRP was directly related with RRI (r=0.41, P<0.001) and inversely with RV/RRI (r=-0.35, P<0.001). HsCRP proved to be a significant predictor of both pathologic RRI and decreased RV/RRI, even after adjustment. In essential hypertension low-grade inflammation is associated with tubulo-interstitial damage evaluated by Doppler ultrasonography.
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Hipertensão/fisiopatologia , Inflamação/fisiopatologia , Túbulos Renais/fisiopatologia , Rim/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Proteína C-Reativa/metabolismo , Comorbidade , Estudos Transversais , Hipertensão Essencial , Feminino , Humanos , Hipertensão/sangue , Hipertensão/epidemiologia , Inflamação/sangue , Inflamação/epidemiologia , Rim/diagnóstico por imagem , Túbulos Renais/diagnóstico por imagem , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Ultrassonografia DopplerRESUMO
INTRODUCTION: Delays in the diagnosis of lung cancer are under debate and may affect outcome. The objectives of this study were to compare various delays in a rapid outpatient diagnostic program (RODP) for suspected lung cancer patients with those described in literature and with guideline recommendations, to investigate the effects of referral route and symptoms on delays, and to establish whether delays were related to disease stage and outcome. METHODS: A retrospective chart study was conducted of all patients with suspected lung cancer, referred to the RODP of our tertiary care university clinic between 1999 and 2009. Patient characteristics, tumor stage and different delays were analyzed. RESULTS: Medical charts of 565 patients were retrieved. 290 patients (51.3%) were diagnosed with lung cancer, 48 (8.5%) with another type of malignancy, and in 111 patients (19.6%) the radiological anomaly was diagnosed as non-malignant. In 112 (19.8%) no immediate definite diagnosis was obtained, however in 82 of these cases (73.2%) the proposed follow-up strategy confirmed a benign outcome. The median first line delay was 54 days, IQR (interquartile range) 20-104 days, median patient delay 19 days (IQR 4-52 days), median referral delay was 7 days (IQR 5-9 days), median diagnostic delay 2 days (IQR 1-19 days). In 87% a diagnosis was obtained within 3 weeks after visiting a chest physician and 52.5% started curative therapy within 2 weeks after diagnosis. Patients presenting with hemoptysis had shorter first line delays. The RODP care was generally far more timely compared to literature and published guidelines, except for both referral and palliative therapeutic delay. No specific delay was significantly related to disease stage or survival. CONCLUSIONS: An RODP results in a timely diagnosis well within guideline recommendations. Patient and first line delay account for most of total patient delay. Within the limitations of this retrospective study, we found no association with disease stage or survival.
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Neoplasias Pulmonares/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Idoso , Assistência Ambulatorial , Broncoscopia , Feminino , Fluordesoxiglucose F18 , Diretrizes para o Planejamento em Saúde , Compostos Heterocíclicos , Humanos , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/terapia , Masculino , Pessoa de Meia-Idade , Imagem Multimodal/métodos , Estadiamento de Neoplasias , Países Baixos , Compostos Organometálicos , Tomografia por Emissão de Pósitrons , Encaminhamento e Consulta , Estudos Retrospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: Non-recurrent inferior laryngeal nerve (NRILN) is usually discovered during thyroid surgery. It is often associated with vascular abnormalities that can be detected with magnetic resonance imaging (MRI) or duplex ultrasound scan. The aim of this study was to compare the diagnostic sensitivity of ultrasonography with MRI to identify the vascular abnormalities associated to NRILN. PATIENTS AND METHODS: We revised 2713 total thyroidectomies to select patients with NRILN. The NRILN was identified in 17 patients (0,6%). A postoperative ultrasonic duplex scanning and a MRI was performed in 15 cases as 2 patients refused to submit to the exams. RESULTS: At MRI an unique origin of common carotid trunk and a concomitant aberrant retroesophageal subclavian right artery was showed in 11 patients. In 2 cases vascular abnormality consisted in separated origin of supra-aortic arteries. At duplex ultrasound scan only in 2 patients was impossible to identify vascular abnormalities detected at MRI. Tthe diagnostic sensitivity of duplex ultrasound was 84,6%. CONCLUSIONS: Preoperative duplex ultrasound is a non invasive method with high diagnostic sensitivity that can easily complete the preoperative thyroid ultrasonography.
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Aorta Torácica/anatomia & histologia , Aorta Torácica/diagnóstico por imagem , Imageamento por Ressonância Magnética , Nervo Laríngeo Recorrente/anormalidades , Nervo Laríngeo Recorrente/diagnóstico por imagem , Ultrassonografia Doppler , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: The well established correlation between intima-media thickness (IMT) and the risk of cardiovascular and cerebrovascular events and death is usually measured in subjects with multiple vascular risk factors, which makes it difficult, after application of the usual analysis-of-variance linear combination of effects model, to establish whether each cardiovascular risk factor has, per se, an effect on IMT. METHOD AND RESULTS: In this study we investigated five "pure" groups of patients (865), i.e. each presenting only one of the following risk factors: hypertension, obesity, overweight, smoking, hypercholesterolaemia and a control group of 37 healthy subjects. We measured, both as discrete and as continuous variables, the following indices: intima-media thickening of the common carotid artery (IMT(C)) and of the common femoral artery (IMT(F)) and the ankle-brachial index (ABI). Descriptive statistics were used to analyse the prevalence of pathological values for the three indices in the different groups. Subsequently the entire group of 902 subjects was included in a correlation analysis in which the Pearson correlation coefficient for each pair of variables was computed. In order to assign the risk factors a continuous ranking, and obtain a more general idea of the correlation structure, principal component analysis (PCA) was used. The scores obtained from PCA made it possible to build a scale of severity of the vascular risk factors considered. All the risk factors considered were demonstrated to strongly affect the studied indices. Overweight was shown to be the least important risk factor with regard to intima-media thickening, followed by smoking, hypercholesterolaemia, hypertension and finally obesity, which emerged as the greatest risk factor. CONCLUSIONS: The strong correlation between the indices made it possible to compute a composite general score, which provides an univocal risk estimation at single-patient level. IMT(F) was demonstrated to be the most sensitive descriptor. The construction of this risk scale has implications for preventive treatment and the frequency of instrumental examinations, allowing clear quantitative definition of the extent of the damage.
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Doenças das Artérias Carótidas/etiologia , Artéria Carótida Primitiva/patologia , Artéria Femoral/patologia , Doença Arterial Periférica/etiologia , Túnica Íntima/patologia , Túnica Média/patologia , Adolescente , Adulto , Idoso , Índice Tornozelo-Braço , Doenças das Artérias Carótidas/patologia , Doenças das Artérias Carótidas/fisiopatologia , Feminino , Humanos , Hipercolesterolemia/complicações , Hipertensão/complicações , Itália , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Sobrepeso/complicações , Doença Arterial Periférica/patologia , Doença Arterial Periférica/fisiopatologia , Análise de Componente Principal , Medição de Risco , Fatores de Risco , Fumar/efeitos adversos , Adulto JovemRESUMO
Polycyclic aromatic hydrocarbons (PAH) such as dibenzo[a,l]pyrene (DBP) are wide-spread environmental pollutants most probably mutagenic and carcinogenic to humans. Detailed data on the cytogenetic effects of anti-11,12-dihydroxy-13,14-epoxy-11,12,13,14-tetrahydrodibenzo[a,l]pyrene (DBPDE) in mammalian cells are not available in the literature. The aim of this study is to elucidate the mechanisms involved in the induction of chromosomal aberrations and sister chromatid exchanges (SCEs) by DBPDE in mammalian cells. In order to achieve this a parental (AA8) and different DNA repair-deficient Chinese hamster ovary cell lines such as UV4, UV5, UV61 (nucleotide excision repair, NER), EM9 (base excision repair, BER), irs1SF (homologous recombination repair, HRR) and V3-3 (non-homologous end joining, NHEJ) were used. The most sensitive cell lines for DBPDE-induced chromosome aberrations were EM9 and irs1SF, while EM9 and V3-3 cell lines were the most sensitive in terms of SCEs induction. It can be suggested that the BER pathway plays an important role in the repair of lesions induced by DBPDE, affecting both chromosomal aberrations and SCEs induction. Moreover, the HRR pathway seems to play a role in cellular resistance to DBPDE mainly in terms of chromosomal aberration induction while the NHEJ pathway takes part affecting only the induction of SCEs.
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Benzopirenos/farmacologia , Dano ao DNA/efeitos dos fármacos , Reparo do DNA , Poluentes Ambientais/farmacologia , Compostos de Epóxi/farmacologia , Animais , Células CHO , Aberrações Cromossômicas , Cricetinae , CricetulusRESUMO
BACKGROUND: The aim of the present study was to evaluate the efficacy of different strategies of intermittent pneumatic compression (IPC) for the treatment of lower limb claudication. METHODS: Five study groups were prospectively studied. Group 1: 9 patients not undergoing IPC; Group 2; six patients undergoing IPC 1 hour/thrice-a-day/4 months; Group 3: six patients undergoing IPC 2 hours/once-a-day/4 months; Group 4; six patients undergoing IPC 1 hour/thrice-a-day/2 months; Group 5: six patients undergoing IPC 2 hours/once-a-day/2 months. RESULTS: All patients completed the planned treatment schedule and stated a compliance of 33% in group 2, 83% in group 3, 66% in group 4 and 100% in group 5. Peak systolic velocity of the popliteal artery blood flow increased over baseline values particularly when IPC lasted 4 months (group 2: 85%, group 3: 81% vs. group 4: 76%, group 5: 73%). These beneficial effects lasted 10 months and vanished 14 months after the end of IPC treatment. The absolute claudication distance increased at the end of the treatment of 101% in group 2, 94% in group 3, 86% in group 4, and 83% in group 5, and it was still increased over the baseline values 14 months after the end of the treatment. No differences have been observed whether the treatment was performed once- or thrice-a-day. CONCLUSIONS: ICP treatment performed two hours once-a-day for four months provide excellent results with satisfactory treatment compliance. However, these effects are not durable and vanish about one year after the end of IPC treatment.
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Claudicação Intermitente/terapia , Dispositivos de Compressão Pneumática Intermitente , Idoso , Feminino , Humanos , Perna (Membro) , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
OBJECTIVE: To obtain a "snapshot" view of access-specific percutaneous cardiovascular procedures outcomes in the real world. DESIGN: Multicentre, prospective study performed over a 30-day period. SETTING: Nine hospitals with invasive cardiology facilities, reflecting the contemporary state of healthcare. PATIENTS: Unselected consecutive sample of patients undergoing any percutaneous cardiovascular procedure requiring an arterial access. INTERVENTIONS: Percutaneous cardiovascular procedures by radial or femoral access MAIN OUTCOME MEASURES: The primary outcome was the combined incidence of in-hospital (a) major and minor haemorrhages; (b) peri-procedural stroke; and (c) entry-site vascular complications. The secondary outcome was the combined incidence of in-hospital death and myocardial infarction/reinfarction. For analysis purposes, outcomes were allocated to arterial access-determined study arms on an intention-to treat basis. Multivariable analysis adjusted using propensity score was performed to correct for selection bias related to arterial site. RESULTS: A total of 1052 patients were enrolled: 509 underwent radial access and 543 femoral access. In both groups, 40% underwent a coronary angioplasty. Relative to femoral access, radial access was associated with a lower incidence both of primary (4.2% vs 1.96%, p = 0.03, respectively) and secondary endpoints (3.1% vs 0.6%, p = 0.005, respectively). Multivariate analysis, adjusted for procedural and clinical confounders, confirmed that intention-to-access via the radial route was significantly and independently associated with a decreased risk both of primary (OR 0.37, 95% CI 0.16 to 0.84) and secondary endpoints (OR 0.14, 95% CI 0.03 to 0.62). CONCLUSIONS: Our study indicates strikingly better outcomes of percutaneous cardiovascular procedures with radial access versus femoral access in contemporary, real-world clinical settings.
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Angioplastia Coronária com Balão/efeitos adversos , Cateterismo Cardíaco/efeitos adversos , Isquemia Miocárdica/terapia , Artéria Radial , Idoso , Angioplastia Coronária com Balão/métodos , Cateterismo Cardíaco/métodos , Feminino , Artéria Femoral , Hemorragia/etiologia , Hemorragia/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Estudos Prospectivos , Resultado do TratamentoRESUMO
Castleman's disease (CD) is a rare lymphoproliferative disorder. Clinically CD has been subdivided in two forms: uni-centric and multicentric. The uni-centric type is limited to a single anatomic lymph-node-bearing region. The present report describes two cases of uni-centric CD: the first was an abdominal localization treated with a laparoscopic approach; the second was a submaxillary localization treated with a classical approach. In case 1 the laparoscopic approach permitted to reach diagnosis, not clear after diagnostic imaging procedures, and enabled a total and excellent resolution of the pathology because our patient, after eight months of follow up, has had no evidence of recurrence of the disease. In case 2 we want to highlight that CD should be considered in the differential diagnosis of a solitary neck mass and that the surgical treatment is diagnostic and curative at the same time.
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Abdome/cirurgia , Hiperplasia do Linfonodo Gigante/patologia , Hiperplasia do Linfonodo Gigante/cirurgia , Laparoscopia , Glândula Submandibular/cirurgia , Adulto , Hiperplasia do Linfonodo Gigante/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Retroperitoneais/cirurgia , Resultado do TratamentoRESUMO
The increasing trend in day-surgery procedures, resulting from continuous improvement in medical practice as well as cultural and economic factors, has profoundly changed the management of patient hospitalisation. Improvement in organizational and professional skills of health staff is essential for this procedure which allows mean hospitalisation time to be reduced. A retrospective study on personal experience of day-surgery procedures from 1st January 2002 to 31st December 2004 is herewith presented. The study comprises 1077 patients (74.2%) out of 1452 hospitalisations for programmed surgery in this period. Re-conversion rate of day-surgery hospitalisation reached 0.5%, while re-admissions within one month reached 2.5% and referred to late post-tonsillectomy haemorrhage in all 27 cases. The Authors highlight the importance of communication for an active and responsible involvement of the patients: the human factor is an indispensable quality for the good outcome of the procedure.
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Procedimentos Cirúrgicos Ambulatórios/estatística & dados numéricos , Unidades Hospitalares/estatística & dados numéricos , Otolaringologia/estatística & dados numéricos , Área Programática de Saúde , Hospitais com 100 a 299 Leitos , Humanos , Itália/epidemiologia , Tempo de Internação/estatística & dados numéricos , Estudos RetrospectivosRESUMO
PURPOSE: Research was focused on cerebral arterial flow in normal individuals and in patients suffering from short-term vertigo when sitting up rapidly from a lying position. PATIENTS AND METHODS: The research was performed in normal subjects and 46 patients affected by short term vertigo who underwent transcranial Doppler 32. In normal subjects (16 with an average age of 25 and 16 with an average age of 61) cerebral artery flow was recorded in a sitting and lying position, in Trendelenburg position and during transition from one position to another. In subjects suffering from short-term vertigo, arterial flow was recorded at baseline and during short-term vertigo. RESULTS: In normal subjects the flow remained unchanged in all body positions as well as during transition from one position to another. In subjects with short-term vertigo basilar artery flow increased with the onset of dizziness and returned to normal when dizziness ceased. CONCLUSIONS: In normal subjects cerebral self-regulation maintains constant flow in any body position. Increased basilar artery flow during short term vertigo is probably either due to altered self-regulation or its reduction in the carotid area with compensatory basilar artery hyperflow, or else to over-response in vertebro-basilar territory.
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Artéria Basilar/fisiopatologia , Circulação Cerebrovascular , Postura , Vertigem/fisiopatologia , Adulto , Tontura/fisiopatologia , Feminino , Decúbito Inclinado com Rebaixamento da Cabeça , Humanos , Masculino , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional , Decúbito DorsalRESUMO
BACKGROUND: The authors analyse the value of the exams preoperative for the identification of the pathological parathyroid glands. METHODS: The authors examined 58 patients affected by primitive hyperparathyroidism (HPTp) who had undergone surgical treatment for primary hyperparathyroidism at the Third Surgical Department of University "La Sapienza" of Rome, in 175 patients affected by primitive hyperparathyroidism observed between January 1970 and June 2000; all patients had undergone echotomography of the neck and 99mTc-MIBI scintigraphy in the diagnostic phase. The histological valuation confirmed the diagnosis by I.P. RESULTS: 99mTc-MIBI scintigraphy demonstrated the pathological glands in 56 cases (96.6%), the echography in 57 cases (98.2%). The comparison of the two exams demonstrated the pathological glands in 100% of the cases. In 45 cases the scintigraphy localized the side (77.6%), and the echography in 41 cases (70.7%). In one case demonstrated I.P. persistent (1.7%) and never one case demonstrated relapsed. CONCLUSIONS: The authors think that the scintigraphy together with the echography show high sensibility to identification the pathological glands. Neck surgical exploration can still give the side good when the diameter of the parathyroids is inferior to 5 mm.
Assuntos
Hiperparatireoidismo/diagnóstico por imagem , Compostos Radiofarmacêuticos , Tecnécio Tc 99m Sestamibi , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cintilografia , UltrassonografiaRESUMO
BACKGROUND: Tumor Necrosis Factor-alpha (TNF-alpha) has been implicated in the pathogenesis of insulin resistance and obesity. The increased expression of TNF-alpha in adipose tissue has been shown to induce insulin resistance, and a polymorphism at position -308 in the promoter region ofTNF-alpha has been shown to increase transcription of the gene in adipocytes. Aim of this study is to investigate the role of the G-308A TNFalpha variant in obesity and to study the possible influence of this mutation on body fat distribution and on measures of obesity (including Fat Free Mass, Fat Mass, basal metabolic rate), insulin resistance (measured as HOMAIR), and lipid abnormalities. The G-308A TNFalpha polymorphism has been studied in 115 patients with obesity (mean BMI 33.9 +/- 0.5) and in 79 normal lean subjects (mean BMI 24.3 +/- 0.3). METHODS: The G-308A variant, detected by PCR amplification and Nco-1 digestion, determines the loss of a restriction site resulting in a single band of 107 bp [the (A) allele]. RESULTS: The (A) allele frequencies of the G-308A TNFalpha polymorphism were 13.1% in the obese group and 14.6% in the lean subjects, with no significant difference between the two groups. Furthermore, no association was found with BMI classes, body fat distribution, HOMAIR, and metabolic abnormalities. CONCLUSIONS: Our study did not detect any significant association of the G-308A TNFalpha polymorphism with obesity or with its clinical and metabolic abnormalities in this population. Our data suggests that, in our population, the G-308A TNFalpha polymorphism is unlikely to play a major role in the pathogenesis of these conditions.
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UNLABELLED: A 3.5 y-old girl carrying a severe mutation of the LDL-receptor gene known as "FH Pavia", affected by homozygous familial hypercholesterolaemia (FH), and at high risk of developing coronary artery atherosclerosis was treated with selective dextran sulphate cellulose (DSC) column low-density lipoprotein apheresis (LDL-a). This is the youngest patient ever treated with LDL-a. Plasma total cholesterol (982 mg/dl) and LDL-cholesterol (939 mg/dl) (T-Chol, LDL-Chol) levels at baseline showed a transient decrease: -13.4%, and -16.8%, respectively, after 9 mo of combined treatment with a diet, cholestyramine (max. 12 g/d) and atorvastatin (max. 30 mg/d). However, the drugs were discontinued because of intolerance and an increase in aminotransferases and creatine phosphokinase in the plasma. Moreover, after 9 mo of this therapy, the mean plasma T-Chol and LDL-Chol levels were still high (930 mg/dl and 869.5 mg/dl, respectively). Therefore, 9 consecutive treatments with LDL-a were carried out every 15 d (plasma volumes treated: 1000-1700 ml). Mean plasma T-Chol, LDL-Chol, triglycerides (TG), and Lp(a) decreased significantly: -75.5%, -77.2%, -67.5% and -50.8%, respectively. HDL-cholesterol (HDL-Chol) concentration was considerably decreased immediately after apheresis because of haemodilution (X: -45.1%). CONCLUSION: LDL-a treatment improved the plasma apo B 100-containing lipoproteins--LDL, Lp(a)--profile in a homozygote with a severe inherited disorder in which coronary artery atherosclerosis frequently has its clinical onset before 10 y of age. At the time of this report, no significant side effects had been observed.
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Remoção de Componentes Sanguíneos , Hiperlipoproteinemia Tipo II/genética , Lipoproteínas LDL/sangue , Remoção de Componentes Sanguíneos/métodos , Pré-Escolar , HDL-Colesterol/sangue , Doença da Artéria Coronariana/prevenção & controle , Feminino , Homozigoto , Humanos , Hiperlipoproteinemia Tipo II/sangue , Hiperlipoproteinemia Tipo II/complicações , Hiperlipoproteinemia Tipo II/terapia , Mutação , Receptores de LDL/genéticaAssuntos
Angina Pectoris/terapia , Angioplastia Coronária com Balão , Oclusão de Enxerto Vascular/imunologia , Antígeno-1 Associado à Função Linfocitária/metabolismo , Infarto do Miocárdio/terapia , Stents , Linfócitos T/imunologia , Idoso , Angina Pectoris/imunologia , Feminino , Oclusão de Enxerto Vascular/diagnóstico , Humanos , Integrinas/sangue , Molécula 1 de Adesão Intercelular/sangue , Antígeno de Macrófago 1/sangue , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/imunologia , Receptores de Colágeno , Recidiva , Fatores de RiscoRESUMO
BACKGROUND: We evaluated the occurrence of a rapid process of restenosis after percutaneous mitral valvuloplasty (PMV), initiated by the recurrence of acute rheumatic fever. Restenosis after PMV has been mainly related to a high echocardiographic score (> or = 8) indicating a severely compromised mitral valve apparatus. METHODS: From 1986 to 1996, 120 patients underwent PMV by the transseptal approach at our Institution. The mean follow-up time was 58 +/- 32 months (range 3 months to 9 years). RESULTS: Restenosis occurred in 10 patients (8.3%): in 4 restenosis was found within a relatively short period of time (1 to 3 months) following a documented recurrence of acute rheumatic fever; in the other 6 patients there was a gradual loss of the initial gain in the mitral valve area. CONCLUSIONS: These data suggest two potential mechanisms of restenosis: 1) a more common slow process, due to turbulent flow-trauma on the mitral valve; 2) a rapid process that relates to valvulitis consequent to a recurrence of acute rheumatic fever. In consideration of the second possibility, after PMV prophylactic treatment may be warranted at least in those patients who are at high risk of streptococcal infection.