RESUMO
BACKGROUND: Breast carcinoma with extensive peritumoral vascular invasion (ePVI-BC) is a cancer with massive vascular invasion (>10) detected in more than one slide. This neoplasm shows clinic-pathological affinity with inflammatory breast carcinoma (IBC). In this paper we evaluate their biological relationship through the study of surrogate markers (ß-catenin and NFAT5) of Canonical (cWnt) and non-canonical (nWnt) Wnt pathways activation. METHODS: By immunoistochemistry, we investigate ß-catenin and NFAT5 in 39 IBC, 74 ePVI-BC and 84 control cases (CG-BC). RESULTS: cWnt was activated in 100 % of ePVI-BC, in 64 % of IBC and 10 % of CG-BC. nWnt was activated in 20 % of ePVI-BC, 50 % of IBC and 1% of CG-BC. The prognosis of carcinomas with nWnt activated was poor similar to IBC. The statistical analysis evidences as both the pathways are synergistic in malignant progression and survival time. ß-catenin show an important association with prognostic factors and NFAT5 shows a relevant prognostic role on OS (p = 1.5*10-6) and DFS (P = 1,2*10-4). nWnt is associated with a worse prognosis independently of cWnt. cWnt is associated with adverse prognosis (DFS p = 0.0469; OS p = 0.004891) but its prognostic role is indifferent in carcinoma with nWnt activated. CONCLUSIONS: Canonical Wnt pathway is involved in malignant progression with dominant role for vascular invasion whereas non canonical Wnt pathway plays an important role on survival time including the capacity to identify carcinomas with IBC-like prognosis. Furthermore ePVI may represent a "prodromal form of IBC" as demonstrated by its clinicopathological and biological similarity with IBC.
Assuntos
Neoplasias da Mama/metabolismo , Regulação Neoplásica da Expressão Gênica/fisiologia , Inflamação/metabolismo , Neoplasias Inflamatórias Mamárias/metabolismo , Via de Sinalização Wnt/fisiologia , Idoso , Mama/patologia , Neoplasias da Mama/mortalidade , Neoplasias da Mama/patologia , Feminino , Regulação Neoplásica da Expressão Gênica/genética , Humanos , Neoplasias Inflamatórias Mamárias/genética , Neoplasias Inflamatórias Mamárias/mortalidade , Masculino , Pessoa de Meia-Idade , Prognóstico , Receptor ErbB-2/metabolismoRESUMO
Dogs are the domestic reservoir of Leishmania infantum, a vector-borne intracellular protozoan agent of human visceral leishmaniasis. The role of polymorphonuclear leukocytes (PMNs) in the immune defence against this parasite has been poorly studied. We have investigated the function of peripheral blood PMNs in naive beagle dogs that have been naturally exposed to phlebotomine vectors in an area highly endemic for canine leishmaniasis, and found infected by Leishmania at the end of the transmission season. Whole blood phagocyte oxidative metabolism was assessed by a rapid method that determines a luminol-amplified chemiluminescence (CL) emission. This was evaluated using either a soluble stimulant, phorbol mirystate acetate (PMA), or phagocytic stimuli, such as zymosan unopsonized (ZYM) or opsonized with autologous serum (OPZ). In blood samples taken 2 months after exposure to Leishmania transmission, data on CL emission revealed a significant decrease of reactive oxygen intermediates (ROI) production in the presence of both PMA and ZYM, compared with blood samples obtained from dogs before exposure. On the contrary, no variations in CL emission were detected in presence of OPZ. Our data indicate that immunological changes occur early in canine leishmaniasis and confirm that the role of PMNs and their products need to be clarified.
Assuntos
Doenças do Cão/sangue , Leishmania infantum , Leishmaniose Visceral/veterinária , Fagócitos/fisiologia , Animais , Doenças do Cão/parasitologia , Cães , Humanos , Técnicas In Vitro , Leishmaniose Visceral/sangue , Medições Luminescentes , Luminol , Fagócitos/efeitos dos fármacos , Espécies Reativas de Oxigênio/metabolismo , Acetato de Tetradecanoilforbol/farmacologia , Zimosan/farmacologiaRESUMO
OBJECTIVE: The aim of this study was to examine whether delirium has specific clinical subtypes. METHOD: One hundred and eighty-three elderly subjects meeting DSM-IIIR criteria for delirium were evaluated using a 19-item symptom check-list assessing different dimensions of delirium symptomatology. Exploratory factor analysis was conducted in order to examine which symptoms clustered. RESULTS: Factor analysis confirmed the existence of two different clusters of symptoms: first, symptoms of hyperalert/hyperactive features (agitation, hyper-reactivity, aggressiveness, hallucinations, delusions); and second, symptoms of hypoalert/hypoactive features (decreased reactivity, motor and speech retardation, facial inexpressiveness). CONCLUSION: This preliminary study seems to support the evidence of hypoactive and hyperactive subtypes of delirium, even though their aetiology and prognostic values need to be further examined.
Assuntos
Delírio/classificação , Delírio/psicologia , Idoso , Idoso de 80 Anos ou mais , Nível de Alerta , Delírio/diagnóstico , Análise Fatorial , Feminino , Humanos , Masculino , Escalas de Graduação Psiquiátrica , Agitação Psicomotora/psicologiaRESUMO
The existence of hyperactive, hypoactive, or mixed clinical subtypes of delirium is widely accepted. But relationships between these motor profiles and etiology or outcome remain unclear. The aim of this study was to compare etiologic and outcome profiles in a case series of 183 elderly patients (mean age = 84.1 years, SD = 5.9) consecutively admitted into the geriatric wards of two French university hospitals or referred to a geriatric psychiatry consultation-liaison unit within a Swiss university hospital. All patients met DSM-III-R criteria for delirium and were classified into clinical subtypes according to the results of a previous factor analysis of scores on a 19-item checklist rating a wide range of delirium symptoms. The hyperactive subtype was more frequent (n = 85, 46.5%) than the unspecified (n = 50, 27.3%) and hypoactive subtypes (n = 48, 26.2%). There was no significant difference in terms of etiologic or outcome profile between clinical subtype groups. The presence of acute metabolic disorders, cardiovascular disease, and hyperthermia as etiologic factors was significantly associated with full recovery of the episode at 3 weeks follow-up, whereas probable preexisting dementia was significantly associated with partial recovery or failure to recover.
Assuntos
Doença de Alzheimer/etiologia , Delírio/etiologia , Atividade Motora , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/diagnóstico , Doença de Alzheimer/psicologia , Delírio/diagnóstico , Delírio/psicologia , Diagnóstico Diferencial , Feminino , Seguimentos , Avaliação Geriátrica , Humanos , MasculinoAssuntos
Idoso/psicologia , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/terapia , Medicina de Família e Comunidade , Psiquiatria Geriátrica , Antidepressivos/uso terapêutico , Transtorno Depressivo/classificação , Transtorno Depressivo/psicologia , Diagnóstico Diferencial , Humanos , PsicoterapiaRESUMO
This preliminary study evaluates the prevalence of personality disorders (PD) in a sample of 37 elderly recovered depressed and non-demented patients, using the French version of the Vragenlijst voor Kenmezken van de Persoonlijkheid (VKP) or Questionnaire on Personality Traits (QPT). The prevalence of definite personality disorder was 65% with predominance of Cluster C and particularly dependent and avoidant PD. The rate of PDs was higher in early onset (73%) than in late onset (45%) geriatric depression, even though there is only a trend towards statistical significance (Chi square = 2.588, p = 0.107). These results are consistent with those of previous reports using different PD assessment methods, supporting evidence that the QPT could be useful in PD assessment of elderly French speaking patients.
Assuntos
Transtorno Depressivo/diagnóstico , Transtornos da Personalidade/epidemiologia , Fatores Etários , Idade de Início , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Transtorno Depressivo/epidemiologia , Feminino , Avaliação Geriátrica , Hospitalização , Humanos , Masculino , Estado Civil , Pessoa de Meia-Idade , Transtornos da Personalidade/diagnóstico , Prevalência , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Fatores SexuaisRESUMO
O Serviço Universitário de Psicogeriatria de Lausanne, Suíça, vem desenvolvendo há mais de 30 anos programas de atendimento, de pesquisa e de ensino ligados à pessoa idosa sofrendo de transtornos psíquicos. Dirigido pelo Prof. J Wertheimer, o serviço ocupa um posto de liderança na Europa quanto a reflexão dos problemas de saúde mental da pessoa idosa. Este artigo desenvolve alguns pontos teóricos que servem de modelo para o tratamento de seus pacientes assim como descreve brevemente algumas atividades deste serviço
Assuntos
Humanos , Idoso , Idoso , Psiquiatria Geriátrica/tendênciasRESUMO
Using explicit criteria contained in the DSM III R, we collected in a prospective cohort study clinical features, outcome and risk factors from two cohorts of delirium in hospitalized elderly patients: 138 hospitalized in geriatric department and 45 patients admitted to an acute and comprehensive care hospital. The clinical features were assessed using a quantitative scale (developed by Derouesné). Delirium was unrecognized or misdiagnosed by physicians in 34% of the cases. The onset was known only two thirds of cases. The incidence of hyperactive type, prolonged hospital stay, poor outcomes (persistent delirium leading up to dementia) were highest in subjects admitted in comprehensive hospital. The etiology of delirium is complex and multifactorial. An underlying cause was identified in 80% of patients. The length or the worsening of delirium was significantly higher in patients with psychiatric or dementia comorbidity (OR: 0.2; IC 95%: 0.1-0.5). The prognosis was better in patients without psychoactive medications (OR: 0.2; IC 95%: 0.1-0.4) or with metabolic abnormalities or acute diseases and disorders (OR: 3.3; IC 95%: 1.5-7.6). The predisposing factors to the development of dementia were prior use of psychoactive medications and signs of prior cognitive impairment. This article suggests delirium in elderly patients is associated with several outcomes. The prognosis should be improved at admission by specific scale and an evaluation of predisposing and precipitating factors.
Assuntos
Idoso , Confusão/diagnóstico , Demência/complicações , Hospitalização , Idoso de 80 Anos ou mais , Confusão/classificação , Confusão/complicações , Demência/diagnóstico , Feminino , França , Humanos , Masculino , Estudos Prospectivos , Fatores de Risco , Suíça , Síndrome , Fatores de TempoRESUMO
Interviews with 32 widows have given a clearer picture of the different ways of adaptation to solitude. The following types are distinguished: 1. the tormented (6 cases), who are crushed by loneliness and depression, even though they have the support of friends and relations 2. the isolated (7 cases), who may go for several days without seeing anyone 3. the misanthropes (3 cases): 'The less I see of my friends, the better I feel' 4. those who have found the answer to the problem of solitude in outside activities and contacts (5 cases) 5. those who have found tranquility after a lifetime of struggle (4 cases) 6. those with a naturally harmonious temperament who have overcome solitude and demonstrate the way to face it with courage, good sense and optimism (7 cases). This attempt at typology, which describes six different ways of living with solitude, has made possible a better analysis of the problem, its causes and its effects. Though solitude is often considered a negative aspect of growing old, it can also be a source of happiness, even of fulfillment. The capacity to live alone is something that has to be learned.
Assuntos
Solidão , Pessoa Solteira/psicologia , Adaptação Psicológica , Idoso , Feminino , Humanos , Relações Interpessoais , Entrevistas como Assunto , Pessoa de Meia-Idade , Isolamento SocialRESUMO
For the aged, social isolation and loneliness are among the most frequent causes of hospitalization or placement in homes. A survey of 730 people over 65 shows that cohabitation becomes rarer with advancing age, a phenomenon that has grown increasingly important during the twentieth century. Social isolation, characterized by extremely infrequent contacts with other people, affects approximately one out of ten elderly people. Most at risk are those who retired from lower positions in employment, divorced people and widowers. The main causes are the absence of children and relatives in the immediate area, the fact of being divorced, the lack of professional apprenticeship and, above all, a psychological disposition to introversion. These concepts should form the basis for working out ways of preventing the generalization of a phenomenon which, in the absence of appropriate measures, might become a serious threat to the future of out society.
Assuntos
Idoso/psicologia , Pessoa Solteira/psicologia , Isolamento Social , Transtorno Depressivo/psicologia , Família , Feminino , Humanos , Relações Interpessoais , MasculinoRESUMO
Melanie Klein's therapy is comprised of elements likely to be transposed to senescence for a better understanding of certain disorders in pathological aging. To this day, several clinical states that appear for the first time at an advanced stage in life, such as certain forms of depression, deliria or intellectual deficiency, have not been satisfactorily explained psychodynamically. The author attempts to create a new approach with a Kleinien perspective.
Assuntos
Psiquiatria Geriátrica/métodos , Transtornos Mentais/psicologia , Idoso , Contratransferência , Humanos , Transtornos Mentais/etiologia , Transtornos Mentais/terapia , Teoria Psicológica , Psicoterapia/métodos , Autoimagem , Transferência PsicológicaRESUMO
The results of a survey conducted among 535 elderly people living in their own homes in urban areas make it possible to analyse the familiar and social relationship of this population. Cohabitation becomes rare as age increases and as most people, especially women, lose their spouses. More than half of the elderly people surveyed had good contacts with family and/or friends, but, for about a quarter of them, social relations were extremely rare. The authors of this article try to define the influence of age, sex, matrimonial status and the socio-professional milieu on the various forms of relationship. These data lead to the identification of a number of groups of people particularly exposed to the risk of isolation: former manual workers or persons having had very subordinate functions (this generally corresponds to a low level of schooling); people who were divorced or separated; men having lost their spouses (overall, men have somewhat fewer contacts than women with family and friends). Widows, though 25% of them were very isolated, generally had good family and social relationships; nevertheless, they often felt at a disadvantage in social life. Practically, the aim of the authors will not be to tackle isolation and solitude of the aged in general, but to design specific measures which will meet the real needs of the various groups at risk.