RESUMO
CASE: Three cases of inflammatory joint diseases (systemic lupus erythematosus and ongoing juvenile idiopathic arthritis) with painful flexible progressive collapsing foot deformity (PCFD) underwent flatfoot surgery. All cases maintained sufficient radiological correction and achieved good clinical condition at final follow-up. CONCLUSION: Although the prospect for recurrence of the deformity is not clear, even in inflammatory joint diseases, flat foot surgery such as flexor digitorum longs transfer, spring ligament reconstruction, and lateral column lengthening could have a possibility to be indicated against PCFD, as long as disease activity could be well suppressed by drug therapy, subsequently subtalar and talonavicular joints could be preserved.
Assuntos
Pé Chato , Humanos , Pé Chato/cirurgia , Pé Chato/diagnóstico por imagem , Pé Chato/etiologia , Feminino , Artrite Juvenil/complicações , Artrite Juvenil/cirurgia , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/cirurgia , Adolescente , Adulto , MasculinoAssuntos
Cirurgia Bariátrica , Lúpus Eritematoso Sistêmico , Obesidade Mórbida , Pontuação de Propensão , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/cirurgia , Cirurgia Bariátrica/estatística & dados numéricos , Estados Unidos/epidemiologia , Obesidade Mórbida/cirurgia , Obesidade Mórbida/epidemiologia , Obesidade Mórbida/complicações , Hospitalização/estatística & dados numéricos , FemininoRESUMO
We report a 58-year-old Asian woman who was diagnosed with systemic lupus erythematosus (SLE) and lupus nephritis, together with a mixed pulmonary bacterial and fungal infection including Aspergillus. The infection did not respond well to the routine administration of anti-bacterial and anti-fungal drugs, and the patient's creatinine levels continued to rise and protein remained in her urine. The patient's SLE persisted without going into remission. Finally, surgical resection of the pulmonary aspergilloma brought the SLE back under control.
Assuntos
Aspergilose , Lúpus Eritematoso Sistêmico , Nefrite Lúpica , Pneumonia , Aspergilose/complicações , Aspergilose/tratamento farmacológico , Aspergilose/cirurgia , Aspergillus , Feminino , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/cirurgia , Nefrite Lúpica/complicações , Nefrite Lúpica/diagnóstico , Nefrite Lúpica/cirurgia , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Osteonecrosis of the femoral head is one of the most severe complications in systemic lupus erythematosus (SLE) patients. Total hip arthroplasty (THA) is an effective treatment for femoral head necrosis. However, there is no consensus on the specific effect of THA on SLE patients. The objective of the present study was to review the current evidence regarding rates of THA complications and postoperative function in systemic lupus erythematosus. METHODS: Two independent reviewers searched PubMed, Cochrane Library, and EMBASE from January 1, 2000, to December 29, 2021. The primary outcomes were postoperative complications, including deep vein thrombosis (DVT), hematoma, wound infection, dislocation, periprosthetic fracture, revision, mortality. RESULTS: A total of 179 articles yielded 28 studies eligible for inclusion with 10 studies used for meta-analysis. This study found a statistically significant difference in DVT, dislocation, wound infection, periprosthetic fracture, and revision. CONCLUSIONS: This meta-analysis shows that SLE patients with THA are at an increased risk of DVT, wound infection, dislocation, periprosthetic fracture, revision, periprosthetic joint infection, following THA in comparison with non-SLE patients with THA. There was no adequate evidence to support the notion that the risk of seroma or hematoma following THA is increased in SLE. Also, there was no significant difference in HHS scores between SLE patients and non-SLE patients after THA.
Assuntos
Artroplastia de Quadril , Lúpus Eritematoso Sistêmico , Fraturas Periprotéticas , Infecção dos Ferimentos , Artroplastia de Quadril/efeitos adversos , Hematoma/etiologia , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/cirurgia , Fraturas Periprotéticas/etiologia , Fraturas Periprotéticas/cirurgia , Reoperação , Estudos Retrospectivos , Infecção dos Ferimentos/etiologiaRESUMO
Chronic hand ischemia causes cold intolerance, intractable pain, and digital ulceration. If ischemic symptoms persist despite pharmacologic treatments, surgical interventions should be considered. This retrospective study evaluated the long-term results after ulnar and radial reconstruction using an interpositional deep inferior epigastric artery (DIEA) graft combined with periarterial sympathectomy. Patients who underwent this surgery from March 2003 to February 2019 were included. To evaluate variables influencing recurrence after the procedure, patients were divided into the recurred and non-recurred groups and their data were compared. Overall, 62 cases involving 47 patients were analyzed (16 and 46 cases in the recurred and non-recurred groups, respectively). The median DIEA graft length was 8.5 cm. The rates of rheumatic disease and female patients were significantly higher in the recurred than in the non-recurred group, without significant between-group differences in postoperative complication rates. In the multivariate analysis, underlying rheumatic disease and graft length had significant effects on recurrence. In Kaplan-Meier analysis, the 5- and 10-year symptom-free rates were 81.3% and 68.0%, respectively, with lower rates for cases with rheumatic disease. Thus, arterial reconstruction using an interpositional DIEA graft provides long-term sustainable vascular supply in patients with chronic hand ischemia, especially in those without rheumatic disease.
Assuntos
Mãos/cirurgia , Isquemia/cirurgia , Artéria Radial/cirurgia , Simpatectomia/métodos , Artéria Ulnar/cirurgia , Enxerto Vascular/métodos , Procedimentos Cirúrgicos Vasculares/métodos , Adulto , Arteriopatias Oclusivas/complicações , Arteriopatias Oclusivas/cirurgia , Progressão da Doença , Artérias Epigástricas/cirurgia , Feminino , Seguimentos , Mãos/fisiopatologia , Humanos , Isquemia/fisiopatologia , Estimativa de Kaplan-Meier , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/cirurgia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Período Pós-Operatório , Modelos de Riscos Proporcionais , Artéria Radial/fisiopatologia , Estudos Retrospectivos , Doenças Reumáticas/cirurgia , Fatores de Risco , Escleroderma Sistêmico/complicações , Escleroderma Sistêmico/cirurgia , Fatores de Tempo , Artéria Ulnar/fisiopatologiaRESUMO
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease. Although previous studies have demonstrated that SLE is related to the imbalance of cells in the immune system, including B cells, T cells, and dendritic cells, etc., the mechanisms underlying SLE pathogenesis remain unclear. Therefore, effective and low side-effect therapies for SLE are lacking. Recently, mesenchymal stem cell (MSC) therapy for autoimmune diseases, particularly SLE, has gained increasing attention. This therapy can improve the signs and symptoms of refractory SLE by promoting the proliferation of Th2 and Treg cells and inhibiting the activity of Th1, Th17, and B cells, etc. However, MSC therapy is also reported ineffective in some patients with SLE, which may be related to MSC- or patient-derived factors. Therefore, the therapeutic effects of MSCs should be further confirmed. This review summarizes the status of MSC therapy in refractory SLE treatment and potential reasons for the ineffectiveness of MSC therapy from three perspectives. We propose various MSC modification methods that may be beneficial in enhancing the immunosuppression of MSCs in SLE. However, their safety and protective effects in patients with SLE still need to be confirmed by further experimental and clinical evidence.
Assuntos
Lúpus Eritematoso Sistêmico/cirurgia , Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais , Imunidade Adaptativa , Animais , Microambiente Celular , Humanos , Tolerância Imunológica , Imunidade Inata , Lúpus Eritematoso Sistêmico/imunologia , Lúpus Eritematoso Sistêmico/metabolismo , Transplante de Células-Tronco Mesenquimais/efeitos adversos , Células-Tronco Mesenquimais/imunologia , Células-Tronco Mesenquimais/metabolismo , Fenótipo , Resultado do TratamentoRESUMO
¼: Recent literature has shown that continued use rather than discontinuation of various antirheumatic agents throughout the perioperative period may present an opportunity to mitigate the risks of elective surgery. ¼: For patients with rheumatoid arthritis and systemic lupus erythematosus, perioperative management of medication weighs the risk of infection against the risk of disease flare when immunosuppressive medications are withheld. ¼: Broadly speaking, current evidence, although limited in quality, supports perioperative continuation of disease-modifying antirheumatic drugs, whereas biologic drugs should be withheld perioperatively, based on the dosing interval of the specific drug. ¼: For any withheld biologic drug, it is generally safe to restart these medications approximately 2 weeks after surgery, once the wound shows evidence of healing, all sutures and staples have been removed, and there is no clinical evidence of infection. The focus of this recommendation applies to the optimization of wound-healing, not bone-healing. ¼: In most cases, the usual daily dose of glucocorticoids is administered in the perioperative period rather than administering "stress-dose steroids" on the day of surgery.
Assuntos
Antirreumáticos , Artrite Reumatoide , Lúpus Eritematoso Sistêmico , Tornozelo/cirurgia , Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/cirurgia , Procedimentos Cirúrgicos Eletivos , Humanos , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Lúpus Eritematoso Sistêmico/cirurgiaRESUMO
BACKGROUND: With the advent of innovative therapies including biologics and Janus kinase inhibitors, children with rheumatic diseases are more likely to have improved outcomes. Despite these advances, some children do not respond, or they, or their parents fear adverse events and seek other alternatives. Increasingly, private companies are offering mesenchymal stem cells (MSC) as an alternative, which are described as natural therapies for rheumatic diseases, often insinuating them as a cure. MSC have immunomodulatory properties, and transplantation of these stem cells have been used to successfully treat immunologic conditions like graft-versus-host disease. Lately, MSC research in adult lupus has been encouraging, but the clinical trials are still underway and in most, MSC therapy is not a standalone treatment. This retrospective case series will highlight three cases of pediatric refractory autoimmune disease whose parents sought out and received MSC therapy as a self-decision without first seeking medical advice from our specialty. The three families felt that their children were improved and in two believed that their child was cured. MSC have the potential of beneficial immunomodulation and may be a powerful tool in the therapy of rheumatic disease, but well controlled clinical trials are necessary and should be designed and monitored by experts in childhood rheumatic disease. CASE PRESENTATION: Three children with three different rheumatic diseases; systemic lupus erythematosus, mixed connective tissue disease and juvenile idiopathic arthritis were under the care of pediatric rheumatology at a large, tertiary-care, teaching institution. Multiple non-biologic and biologic disease-modifying anti-rheumatic drugs failed to significantly decrease disease activity, and as a result, the families chose to undergo MSC therapy. After transplantation, all children improved per patient and parent report and tapered off conventional immunosuppressive drugs. No serious adverse events occurred in these three patients. CONCLUSION: The three cases presented in this report reflect comparable beneficial outcomes and minimal risks published in adult studies. These were not controlled studies, however, and benefit was reported rather than documented. These cases suggest that MSC transplantation may prove a promising adjunctive treatment option; however, further research, development of standardized infusion therapy protocols, and well-designed monitored clinical trials are essential.
Assuntos
Artrite Juvenil/cirurgia , Lúpus Eritematoso Sistêmico/cirurgia , Transplante de Células-Tronco Mesenquimais , Doença Mista do Tecido Conjuntivo/cirurgia , Adolescente , Criança , Feminino , Humanos , Estudos Retrospectivos , Adulto JovemRESUMO
INTRODUCTION: Sistemyc lupus erythematosus (SLE) is an autoinmune disease associated to severe organ damage and mortality. SLE patients have a higher surgical risk. The objective of this article is to review the systemic manifestations of SLE and how they can challenge the anesthetic management, so a safer and more tailored anesthesia can be provided. METHODS: A search was made on Pubmed, ProQuest, and EMBASE databases obtaining a total of 2,028 articles. The titles of articles found were reviewed, of which 88 merited greater review. The complete text of each article of this group was reviewed, references that were of greater interest were also reviewed. Finally, a total of 29 works to be included in this review were selected. RESULTS: Musculoskeletal, cardiac, renal and laringeal involvement are the most frequent and important complications to anesthetic management. It´s clinical manifestations must be assess in the preoperative evaluation as well as potential pharmacological interactions with regular medications that the patient might be taking. The need of antibiotic profilaxis and steroidal supplementation has to be addressed. The post operative management should be focused on assessment of frecuent complications as cardiovascular or thrombotic events. CONCLUSION: SLE is a complex disease that represent a challenge in surgical context. Its complications can affect the airway, ventilatory or hemodinamic management as well as renal function. That is why the multidisciplinary management of these patients and a complete preoperative evaluation are essentials so a risk estratification can be made and anesthesiologists can prepare correctly to handle potential complications.
INTRODUCCIÓN: El lupus eritematoso sistémico es una enfermedad autoinmune, asociada a complicaciones severas y mayor mortalidad. Por las complicaciones de la enfermedad estos pacientes son de alto riesgo quirúrgico. El objetivo de este trabajo es revisar las manifestaciones sistémicas y complicaciones del LES y como éstas pueden afectar el manejo anestésico, de manera de proporcionar una anestesia más segura y acorde a las necesidades de cada paciente. MATERIALES Y MÉTODOS: Se realizó una búsqueda en Pubmed, Embase y ProQuest, encontrándose un total de 2.028 trabajos. Se revisaron los títulos, encontrando 88 de interés para mayor revisión. Se revisaron los textos completos, incluyendo además referencias y sugerencias que parecieron pertinentes. Se seleccionaron, finalmente, 29 trabajos para ser incluidos en esta revisión. RESULTADOS: El compromiso musculoesquelético, cardiaco, renal y laríngeo son los más frecuentes e importantes en el manejo anestésico. Deben buscarse de manera dirigida en la evaluación preoperatoria, además de evaluar posibles interacciones farmacológicas entre anestésicos y medicamentos de uso habitual. Por el uso de corticoides e inmunosupresores, considerar el uso de profilaxis antibiótica y reemplazo esteroidal. El manejo posoperatorio debe enfocarse en la búsqueda de complicaciones más frecuentes como eventos cardiovasculares o trombóticos. DISCUSIÓN: El LES es una enfermedad compleja con desafíos en el contexto quirúrgico. Sus complicaciones afectan el manejo de vía aérea, terapia ventilatoria, manejo hemodinámico y mantención de la función renal. Es por ello que el manejo multidisciplinario y una buena evaluación preoperatoria son fundamentales, de manera de estratificar el riesgo y prepararse oportunamente.
Assuntos
Humanos , Anestesia , Lúpus Eritematoso Sistêmico/complicações , Medição de Risco , Assistência Perioperatória , Interações Medicamentosas , Lúpus Eritematoso Sistêmico/cirurgiaRESUMO
Placenta accreta (PA) is a life-threatening disorder associated with decidual maldevelopment and a thin endometrium. Few cases of systemic lupus erythematosus (SLE) pregnancy complicated by PA have been reported, and the background pathophysiology remains elusive. Here, we report a case of PA in SLE pregnancy treated with hydroxychloroquine. A nulligravida woman with SLE, aged 41 years, visited our hospital because of infertility problems. Her SLE was treated with prednisolone and tacrolimus. We conducted assisted reproductive technology and gained several embryos. An artificial cycle successfully prepared the endometrium for embryo transfer with sufficient thickness. Over time, her SLE exacerbated, and we started hydroxychloroquine administration. Consequently, the endometrium did not respond to hormonal supplementation and remained thin, but we transferred the embryo and managed to achieve pregnancy. On the 38th week of gestation, we conducted labor induction because of elevated blood pressure. Induction was not effective, so we performed cesarean section; PA was observed. We performed compression suturing and were able to stop the hemorrhage. Postoperative uterine infarction and pelvic infection were successfully managed with conservative treatment. The present case highlights the use of hydroxychloroquine during endometrial development and contributes evidence regarding the pathogenesis of PA in pregnancy complicated by SLE.
Assuntos
Transferência Embrionária , Hidroxicloroquina/uso terapêutico , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Placenta Acreta/etiologia , Complicações na Gravidez/tratamento farmacológico , Adulto , Blastocisto , Cesárea , Criopreservação , Transferência Embrionária/efeitos adversos , Transferência Embrionária/métodos , Feminino , Congelamento , Humanos , Recém-Nascido , Infertilidade Feminina/etiologia , Infertilidade Feminina/terapia , Japão , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/cirurgia , Placenta Acreta/diagnóstico , Placenta Acreta/cirurgia , Gravidez , Complicações na Gravidez/cirurgia , Resultado da Gravidez , Técnicas de Reprodução Assistida , Resultado do TratamentoRESUMO
BACKGROUND: Renal biopsy is the cornerstone of systemic lupus erythematosus (SLE) nephritis and antiphospholipid syndrome (APS) nephropathy management. However, transcutaneous renal biopsy (TCRB) is hampered by the antithrombotic treatment frequently prescribed for those diseases. Transjugular renal biopsy (TJRB) offers an attractive alternative for patients at increased risk of bleeding. The primary objective of the study was to describe the safety profile and diagnostic performance of TJRB in SLE and APS patients. METHODS: All SLE and/or APS patients who underwent a renal biopsy in our department (between January 2004 and October 2016) were retrospectively reviewed. Major complications were death, haemostasis nephrectomy, renal artery embolization, red blood cell transfusion, sepsis and vascular thrombosis; macroscopic haematuria, symptomatic perirenal/retroperitoneal bleeding and renal arteriovenous fistula without artery embolization were considered as minor complications. RESULTS: Two hundred and fifty-six TJRBs-119 without antithrombotics (untreated), 69 under aspirin and 68 on anticoagulants and 54 TCRBs without antithrombotics-were analysed. Their major and minor complication rates, respectively, did not differ significantly for the four groups: 0 and 8% for untreated TJRBs, 1 and 6% for aspirin-treated, 6 and 10% for anticoagulant-treated and 2 and 2% for TCRBs. The number of glomeruli sampled and the biopsy contribution to establishing a histological diagnosis was similar for the four groups. CONCLUSIONS: TJRBs obtained from SLE and APS patients taking antithrombotics had diagnostic yields and safety profiles similar to those of untreated TCRBs. Thus, TJRB should be considered for SLE and APS patients at risk of bleeding.
Assuntos
Síndrome Antifosfolipídica/patologia , Fibrinolíticos/uso terapêutico , Veias Jugulares/cirurgia , Lúpus Eritematoso Sistêmico/patologia , Nefrite Lúpica/tratamento farmacológico , Complicações Pós-Operatórias/prevenção & controle , Adulto , Síndrome Antifosfolipídica/tratamento farmacológico , Síndrome Antifosfolipídica/cirurgia , Biópsia , Feminino , Humanos , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Lúpus Eritematoso Sistêmico/cirurgia , Nefrite Lúpica/patologia , Nefrite Lúpica/cirurgia , Masculino , Prognóstico , Estudos RetrospectivosRESUMO
BACKGROUND: We compared pre-emptive transplant rates between SLE and non-SLE end-stage renal disease (ESRD) from the U.S. Renal Data System (USRDS) and investigated the potential influence of frequency matching and primary ESRD causes in the non-SLE group. METHODS: 4830 adult SLE patients with incident ESRD from USRDS 2005-2009 were frequency matched by age, sex and race to 4830 patients with incident non-SLE ESRD. Multivariable logistic regression models were used to estimate the odds of pre-emptive transplantation in SLE and non-SLE, and with the non-SLE subgroups by primary ESRD cause. RESULTS: The odds ratios (OR) of receiving a pre-emptive transplant were similar among non-SLE and SLE (referent group): ORâ¯=â¯1.18 (95% CI: 0.92, 1.50; pâ¯=â¯0.20). However, the ORs for receiving a pre-emptive transplant were 0.19 (95% CI: 0.08, 0.42) in type 2 diabetes ESRD, 0.42 (95% CI: 0.23, 0.75) for hypertension-associated ESRD, 1.67 (95% CI: 1.10, 2.54) in type 1 diabetes ESRD, and 2.06 (95% CI: 1.55, 2.73) for "other" ESRD. In contrast to non-SLE, younger SLE patients were less likely to receive a pre-emptive transplant than older SLE patients. CONCLUSION: The results of this study provide compelling evidence that major improvements need to be made in optimizing access to pre-emptive transplantation in SLE by addressing sociodemographic disparities and the unique challenges faced by SLE patients. Applying careful matching and selecting appropriate comparison groups in future studies may facilitate the development of effective strategies to address these barriers and to increase the number of pre-emptive renal transplants among SLE patients.
Assuntos
Falência Renal Crônica/cirurgia , Transplante de Rim , Lúpus Eritematoso Sistêmico/cirurgia , Adulto , Bases de Dados Factuais , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores de Tempo , Adulto JovemAssuntos
Reagentes de Ligações Cruzadas/uso terapêutico , Infecções Oculares Bacterianas/diagnóstico , Ceratite/diagnóstico , Ceratocone/terapia , Lúpus Eritematoso Sistêmico/complicações , Procedimentos Cirúrgicos Oftalmológicos/efeitos adversos , Abscesso/diagnóstico , Abscesso/etiologia , Adulto , Colágeno/química , Infecções Oculares Bacterianas/etiologia , Feminino , Humanos , Ceratite/etiologia , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Terapia UltravioletaRESUMO
Allogeneic mesenchymal stem/stromal cells (MSCs) have been widely studied as an alternative cell source for regenerative medicine. Here, we report a long-term follow-up study of allogeneic bone marrow and/or umbilical cord MSC transplantation (MSCT) in severe and drug-refractory systemic lupus erythematosus (SLE) patients. Eighty-one patients were enrolled, and the 5-year overall survival rate was 84% (68/81) after MSCT. At 5-year follow-up, 27% of patients (22/81) were in complete clinical remission and another 7% (6/81) were in partial clinical remission, with a 5-year disease remission rate of 34% (28/81). In total, 37 patients had achieved clinical remission and then 9 patients subsequently relapsed, with 5-year overall rate of relapse of 24% (9/37). SLE Disease Activity Index scores, serum albumin, complement C3, peripheral white blood cell, and platelet numbers, as well as proteinuria levels, continued to improve during the follow-up. Our results demonstrated that allogeneic MSCT is safe and resulted in long-term clinical remission in SLE patients.
Assuntos
Resistência a Medicamentos/fisiologia , Lúpus Eritematoso Sistêmico/patologia , Células-Tronco Mesenquimais/patologia , Adolescente , Adulto , Criança , Complemento C3/metabolismo , Transplante de Células-Tronco de Sangue do Cordão Umbilical/métodos , Feminino , Seguimentos , Transplante de Células-Tronco Hematopoéticas/métodos , Humanos , Lúpus Eritematoso Sistêmico/metabolismo , Lúpus Eritematoso Sistêmico/cirurgia , Masculino , Transplante de Células-Tronco Mesenquimais/métodos , Células-Tronco Mesenquimais/metabolismo , Pessoa de Meia-Idade , Transplante Homólogo/métodos , Adulto JovemRESUMO
The objective of the study is to analyze the efficacy and safety of splenectomy in the management of refractory autoimmune thrombocytopenia (AT)/autoimmune hemolytic anemia (AIHA) associated or not with systemic lupus erythematosus. Thirty-four patients after splenectomy due to severe AT and/or AIHA were divided into group 1 (G1) 18 SLE/APS patients: 9 AT/SLE patients, 6 SLE/antiphospholipid syndrome (APS), and 3 primary APS. Group 2 (G2): 16 patients without SLE/APS: 2 Fisher-Evans syndrome and 14 AIHA. Surgery approach when (1) platelets ≤ 50,000/ml despite 2 weeks on medical therapy, (2) medically dependent, and (3) medically intolerant or after two hemolytic crises in AIHA patients. Splenectomy response: (1) complete (CR): ≥ 150,000 platelets/ml, (2) partial: 50,000-149,000/ml, or (3) none: ≤ 50,000/ml. CR for AIHA: hemoglobin ≥9 g/dl. STATISTICAL ANALYSIS: descriptive statistics and chi-square test. The mean age was 34.6 years; mean follow-up: 28.5 months. Open splenectomy in 15/34 vs laparoscopy in 19/34 (p = NS). CR in 15/34, G1: 4/18, G2: 11/16, (p = 0.006). Complications in 6/34, 5 from G2 vs 1 from G1 (p = 0.05). Relapse in 7/18 patients in G1 and 3/16 in G2 (p = 0.05). Open and laparoscopic splenectomies in SLE and AT patients are as effective as in those without SLE; however, patients with SLE and APS had more relapses.
Assuntos
Anemia Hemolítica Autoimune/cirurgia , Lúpus Eritematoso Sistêmico/cirurgia , Púrpura Trombocitopênica Idiopática/cirurgia , Esplenectomia/métodos , Adulto , Anemia Hemolítica Autoimune/complicações , Feminino , Humanos , Laparoscopia/métodos , Lúpus Eritematoso Sistêmico/complicações , Masculino , Púrpura Trombocitopênica Idiopática/complicações , Resultado do TratamentoRESUMO
OBJECTIVES: To study the clinical characteristics and outcomes in systemic lupus erythematosus (SLE) patients who underwent cardiac surgery. METHODS: Retrospective analysis of 30 SLE patients who underwent cardiac surgery at a single center. Demographics, comorbidities, clinical and serologic characteristics, cardiovascular risk scores and treatment were recorded. Type of surgery, postoperative complications, mortality and histology were analyzed. RESULTS: Disease duration at surgery was 2 years. Valve replacement was the procedure most frequently performed (53%), followed by pericardial window (37%). At least one postoperative complication developed in 63% (mainly infections). An aortic cross-clamp time≥76minutes was associated with at least one postoperative complication (OR 6.4, 95% CI 1.1-35.4, p=.03). Early death occurred in 5 patients (17%) and late in 3 (10%); main causes were sepsis and heart failure. Disease activity was associated with pericardial window (OR 12.6, 95% CI 1.9-79, p=.007); lymphopenia≤1.200 (OR 10.1, 95% CI 1.05-97, p=.04); age≤30 years (OR 7.7, 95% CI 1.2-46.3, p=.02); and New York Heart Association class III (OR 7.0, 95% CI 1.1-42, p=.03). Postoperative infection was associated with length of hospital stay≥2 weeks (OR 54.9, 95% CI 5.0-602.1, p=.001); intensive care unit stay≥10 days (OR 20, 95% CI 1.6-171.7, p=.01); duration of mechanical ventilation≥5 days (OR 16.9, 95% CI 1.5-171.7, p=.01); and pulmonary artery systolic pressure≥50mmHg (OR 7.8, 95% CI 1.4-41.2, p=.01). CONCLUSIONS: Cardiac surgery in SLE confers high morbidity and mortality. SLE-specific preoperative risk scores should be designed to identify prognostic factors.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Lúpus Eritematoso Sistêmico/cirurgia , Adolescente , Adulto , Procedimentos Cirúrgicos Cardíacos/mortalidade , Feminino , Humanos , Lúpus Eritematoso Sistêmico/mortalidade , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Resultado do Tratamento , Adulto JovemRESUMO
PURPOSE OF REVIEW: In this review, we examine the central role of echocardiography in the diagnosis, prognosis, and management of infective endocarditis (IE). RECENT FINDINGS: 2D transthoracic echocardiography (TTE) and transesophageal echocardiography TEE have complementary roles and are unequivocally the mainstay of diagnostic imaging in IE. The advent of 3D and multiplanar imaging have greatly enhanced the ability of the imager to evaluate cardiac structure and function. Technologic advances in 3D imaging allow for the reconstruction of realistic anatomic images that in turn have positively impacted IE-related surgical planning and intervention. CT and metabolic imaging appear to be emerging as promising ancillary diagnostic tools that could be deployed in select scenarios to circumvent some of the limitations of echocardiography. Our review summarizes the indispensable and central role of various echocardiographic modalities in the management of infective endocarditis. The complementary role of 2D TTE and TEE are discussed and areas where 3D TEE offers incremental value highlighted. An algorithm summarizing a contemporary approach to the workup of endocarditis is provided and major societal guidelines for timing of surgery are reviewed.
Assuntos
Ecocardiografia/métodos , Endocardite/diagnóstico por imagem , Infecções Relacionadas à Prótese/diagnóstico por imagem , Abscesso/diagnóstico por imagem , Abscesso/cirurgia , Aneurisma/diagnóstico por imagem , Aneurisma/cirurgia , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Gerenciamento Clínico , Ecocardiografia Doppler/métodos , Ecocardiografia Tridimensional/métodos , Ecocardiografia Transesofagiana/métodos , Eletrodos Implantados , Endocardite/cirurgia , Endocardite não Infecciosa/diagnóstico por imagem , Endocardite não Infecciosa/cirurgia , Fístula/diagnóstico por imagem , Fístula/cirurgia , Cardiopatias/diagnóstico por imagem , Cardiopatias/cirurgia , Próteses Valvulares Cardíacas , Humanos , Lúpus Eritematoso Sistêmico/diagnóstico por imagem , Lúpus Eritematoso Sistêmico/cirurgia , Prognóstico , Infecções Relacionadas à Prótese/cirurgia , Dispositivo para Oclusão Septal , Fatores de TempoRESUMO
There is no consensus of treatments for acute acalculous cholecystitis with systemic lupus erythematosus (SLE). The study was aimed to investigate the effect of the corticosteroid for these patients.A series of patients who were diagnosed as acute acalculous cholecystitis with SLE in the period from January 2012 to December 2016 at our hospital were included. They accepted 2 different conservative treatment strategies initially: the treatment using moxifloxacin (the antibiotic group), and the treatment using corticosteroid combined moxifloxacin (the corticosteroid group). Then clinical manifestations, laboratory features, and outcomes were analyzed.The study identified 22 women Han Chinese patients with the SLE history of 2.8â±â1.4 year. There was no significant difference in SLE history, Systemic Lupus Erythematosus Disease Activity Index-2000 (SLEDAI-2000), Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index (SLICC/ACR), hematologic examination results, and corticosteroid dosage between 2 groups. And there was no significant difference in the symptom of acute cholecystitis, duration of the symptoms, white blood level, and the thickness of gallbladder wall between 2 groups either. However, the SLEDAI-2000 of the corticosteroid group was lower than that of the antibiotic group (7.3â±â1.4 vs 10.7â±â3.0, Pâ=â.03), so was the SLICC/ACR (0.1â±â0.3 vs 0.3â±â0.5, Pâ=â.01). Moreover, total 11 of 12 patients were successfully treated in the corticosteroid group, only 1 patient got cholecystectomy because no improvement after conservative treatment. While 4 of 10 patients were successfully treated by moxifloxacin alone, 6 patients had to accept cholecystectomy in the antibiotic group. The rate of successful conservative treatment in the corticosteroid group was higher than that of the antibiotic group (Pâ=â.02). All patients were followed up at least 6 months, there was no statistical difference in the rate of recurrence of abdominal pain between 2 groups (Pâ=â.37).The corticosteroid plays an important role in the management of the acalculous cholecystitis patient with SLE, and it should be considered as a first line of treatment.