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INTRODUCTION: No therapy has yet proven effective in COVID-19. Tocilizumab (TCZ) in patients with severe COVID-19 could be an effective treatment. METHOD: We conducted a retrospective case-control study in the Nord Franche-Comté Hospital, France. We compared the outcome of patients treated with TCZ and patients without TCZ considering a combined primary endpoint: death and/or ICU admissions. RESULTS: Patients with TCZ (n=20) had a higher Charlson comorbidity index (5.3 [±2.4] vs 3.4 [±2.6], P=0.014), presented with more severe forms (higher level of oxygen therapy at 13L/min vs 6L/min, P<0.001), and had poorer biological findings (severe lymphopenia: 676/mm3 vs 914/mm3, P=0.037 and higher CRP level: 158mg/L vs 105mg/L, P=0.017) than patients without TCZ (n=25). However, death and/or ICU admissions were higher in patients without TCZ than in the TCZ group (72% vs 25%, P=0.002). CONCLUSION: Despite the small sample size and retrospective nature of the work, this result strongly suggests that TCZ may reduce the number of ICU admissions and/or mortality in patients with severe SARS-CoV-2 pneumonia.
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Anticuerpos Monoclonales Humanizados/uso terapéutico , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/mortalidad , Unidades de Cuidados Intensivos/estadística & datos numéricos , Admisión del Paciente/estadística & datos numéricos , Neumonía Viral/tratamiento farmacológico , Neumonía Viral/epidemiología , Neumonía Viral/mortalidad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Betacoronavirus/efectos de los fármacos , Betacoronavirus/inmunología , COVID-19 , Estudios de Casos y Controles , Comorbilidad , Infecciones por Coronavirus/patología , Enfermedad Crítica/epidemiología , Enfermedad Crítica/mortalidad , Femenino , Francia/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Mortalidad , Pandemias , Neumonía Viral/patología , Estudios Retrospectivos , SARS-CoV-2 , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Adulto JovenRESUMEN
INTRODUCTION: Adherence to (or compliance with) a medication is one of the foremost issues in the assumption of patients with psychiatric illness and, in particular, in schizophrenia. Adherence to medication is generally defined as the extent to which patients take medications as prescribed by their health care providers. There is no consensus to define an acceptable compliance. LITERATURE FINDINGS: The methods available for measuring adherence can be broken down into direct and indirect methods of measurement, each one having advantages and disadvantages. Clinical summations of studies were realized, the problem of poor adherence to medication concerned 25% of patients with schizophrenia and 74% of the 1493 schizophrenia patients recruited for the Catie study discontinued their assigned study medication before 18 months, a rate that was considered to be very high in a study in which the primary outcome measure was discontinuation of the study drug for any cause and approximately 30% stopped the treatment of their own motivation. In two thirds of cases, rehospitalisation is the result of complete or partial non-compliance. One year after first hospitalsation, 40% of relapse results from non-adherence to medication. DISCUSSION: Medication adherence problems increase hospitalisation, morbidity and mortality. Social consequences, professional and family problems linked to hospitalisations lead to low quality of life for patients and high cost for society. Indicators of poor adherence to a medication regimen are a useful resource for physicians to help identify patients who are most in need of interventions to improve adherence. It is usual to identify quatre categories of factors causing disparity: 1: factors due to psychiatric disorders; 2: factors due to medication; 3: factors linked to patients; 4: factors depending on the therapeutic relationship with the clinician. Patients with psychiatric illness typically have great difficulty following a medication regimen, but they also have the greatest potential for benefiting from adherence. Some effective actions to improve compliance are described in reply to the factors influencing the adherence. The communication attitude of the clinician, therapeutic relationship and prescription use are main points of alliance. Information and communication with the patient, simplification of the therapeutic plan, consultation planning and account of side effect are simple and effective actions. Social support is very important for improvement of therapeutic alliance. Poor therapeutic alliance is common, contributing to substantial worsening of disease and more research on compliance and therapeutic alliance evaluation is needed. Information and tools must be proposed to practitioners.
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Antipsicóticos/uso terapéutico , Cumplimiento de la Medicación/psicología , Esquizofrenia/tratamiento farmacológico , Psicología del Esquizofrénico , Antipsicóticos/efectos adversos , Enfermedad Crónica , Estudios Transversales , Francia , Humanos , Cuidados a Largo Plazo , Cumplimiento de la Medicación/estadística & datos numéricos , Readmisión del Paciente , Recurrencia , Esquizofrenia/epidemiologíaRESUMEN
Grazing management has an important impact on dairy ruminants' performance. References on the intake and milk yield of dairy goats under strip-grazing systems in temperate regions are scarce. In order to study the effect of pasture allowance on pasture intake (PI), milk yield and grazing behaviour, a trial was carried out in spring with 36 Alpine goats in mid-lactation. Three daily pasture allowances (PA=1.7, 2.6 and 3.5 kg dry matter (DM)/day, namely Low, Medium and High, respectively) were compared in a 3 × 3 Latin square design replicated six times during three successive 14-day periods. Goats individually received 268 g DM of concentrate twice daily at each milking and had access 11 h/day to pasture (from 0830 to 1600 h and from 1730 to 2100 h). Pasture intake increased with PA, and more so between Low and Medium than between Medium and High (+216 v. +101 g DM/kg DM of PA). Milk yield was lower on Low than on Medium and High (2.79 v. 3.13 kg/day), as were milk fat and protein yields. Grazing time averaged 476 min/day and was lowest on Low and greatest on Medium. Pasture intake rate was 30 g DM/h lower on Low and Medium than on High. It is concluded that under temperate conditions, when goats are supplemented with 536 g DM of concentrate and have enough access time to pasture (11 h/day), a medium pasture allowance close to 2.6 kg DM/day may be sufficient to maximise milk yield.
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Suplementos Dietéticos/análisis , Conducta Alimentaria , Cabras/fisiología , Leche/metabolismo , Animales , Dieta/veterinaria , Femenino , Lactancia , Estaciones del AñoRESUMEN
INTRODUCTION: Ear involvement by non-Hodgkin lymphoma is quite rare and can be mistaken for other common lesions encountered in otolaryngology. The literature on this subject is also limited. CASE SUMMARY: A 45-year-old man with bilateral ear nodules that progressed over two years. Biopsy of the right ear revealed a B-cell small lymphocytic lymphoma (SLL). The patient responded to radiotherapy well. He received an additional dose two months after the initial treatment because of a remaining nodularity on the right earlobe. After several months, he presented a new lesion on his nasal tip, for which a biopsy confirmed a lymphoma relapse. The patient was managed with oral prednisone and low-dose radiation with a favourable response. DISCUSSION: This case highlights the importance of including lymphoma in the differential diagnosis of ear lesions from an otolaryngology perspective. A biopsy of any lesion or nodule with an atypical course should be considered for appropriate diagnosis and management.
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Pabellón Auricular , Neoplasias del Oído , Leucemia Linfocítica Crónica de Células B , Neoplasias Primarias Múltiples , Neoplasias del Oído/tratamiento farmacológico , Neoplasias del Oído/patología , Neoplasias del Oído/radioterapia , Humanos , Leucemia Linfocítica Crónica de Células B/tratamiento farmacológico , Leucemia Linfocítica Crónica de Células B/patología , Leucemia Linfocítica Crónica de Células B/radioterapia , Masculino , Persona de Mediana Edad , Neoplasias Primarias Múltiples/tratamiento farmacológico , Neoplasias Primarias Múltiples/patología , Neoplasias Primarias Múltiples/radioterapia , Neoplasias Nasales/secundario , Dosis de RadiaciónRESUMEN
The important role played by the sex hormone estrogen in disease and physiological processes has been well documented. However, the mechanisms by which this hormone elicits many of its normal as well as pathological effects are unclear. To identify both known and unknown genes that are regulated by or associated with estrogen action, we performed serial analysis of gene expression on estrogen-responsive breast cancer cells after exposure to this hormone. We examined approximately 190,000 mRNA transcripts and monitored the expression behavior of 12,550 genes. Expression levels for the vast majority of those transcripts were observed to remain constant upon 17beta estradiol (E2) treatment. Only approximately 0.4% of the genes showed an increase in expression of > or =3-fold by 3 h post-E2 treatment. We cloned five novel genes (E2IG1-5), which were observed up-regulated by the hormonal treatment. Of these the most highly induced transcript, E2IG1, appears to be a novel member of the family of small heat shock proteins. The E2IG4 gene is a new member of the large family of leucine-rich repeat-containing proteins. On the basis of architectural and domain homology, this gene appears to be a good candidate for secretion in the extracellular environment and, therefore, may play a role in breast tissue remodeling and/or epithelium-stroma interactions. Several interesting genes with a potential role in the regulation of cell cycle progression were also identified to increase in expression, including Pescadillo and chaperonin CCT2. Two putative paracrine/autocrine factors of potential importance in the regulation of the growth of breast cancer cells were identified to be highly up-regulated by E2: stanniocalcin 2, a calcium/phosphate homeostatic hormone; and inhibin-beta B, a TGF-beta-like factor. Interestingly, we also determined that E2IG1 and stanniocalcin 2 were exclusively overexpressed in estrogen-receptor-positive breast cancer lines, and thus they have the potential to serve as breast cancer biomarkers. This data provides a comprehensive view of the changes induced by E2 on the transcriptional program of human E2-responsive cells, and it also identifies novel and previously unsuspected gene targets whose expression is affected by this hormone.
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Estradiol/farmacología , Expresión Génica/efectos de los fármacos , Secuencia de Aminoácidos , Secuencia de Bases , Mama/efectos de los fármacos , Mama/metabolismo , Neoplasias de la Mama/genética , Neoplasias de la Mama/metabolismo , Clonación Molecular , Femenino , Perfilación de la Expresión Génica/métodos , Regulación Neoplásica de la Expresión Génica/efectos de los fármacos , Genes cdc/efectos de los fármacos , Humanos , Chaperonas Moleculares/genética , Datos de Secuencia Molecular , Proteínas de Neoplasias/biosíntesis , Proteínas de Neoplasias/genética , ARN Mensajero/análisis , ARN Mensajero/genética , Receptores de Estrógenos/biosíntesis , Receptores de Estrógenos/genética , Reproducibilidad de los Resultados , Células Tumorales CultivadasRESUMEN
OBJECTIVES: This study sought to define the ultrastructural characteristics of skeletal muscle in heart transplant recipients (HTRs) in relation to exercise capacity compared with that in age-matched control subjects. BACKGROUND: Muscle structural features seem to play an important role in the limitation of exercise capacity of HTRs long after transplantation. METHODS: The structure of the vastus lateralis muscle was analyzed by ultrastructural morphometry in 16 HTRs and 20 healthy control subjects. Maximal oxygen consumption (peak Vo2) was determined by an incremental exercise test. RESULTS: Peak Vo2 was significantly lower (by 35%) in HTRs. Fiber size, volume density of mitochondria and intramyocellular lipid deposits were not significantly different between HTRs and control subjects. In contrast, the capillary density and the capillary/fiber ratio were both significantly reduced in HTRs (by 24% and 27%, respectively). CONCLUSIONS: A normal volume density of mitochondria and a reduced capillary network are the main characteristics of muscle ultrastructure in HTRs by 10 months after transplantation. The muscle structural abnormalities and reduced exercise capacity might be related to immunosuppressive therapy with cyclosporine and corticosteroids as well as deconditioning.
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Trasplante de Corazón/patología , Músculo Esquelético/ultraestructura , Adulto , Biopsia , Prueba de Esfuerzo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mitocondrias Musculares/ultraestructura , Músculo Esquelético/irrigación sanguínea , Consumo de OxígenoRESUMEN
OBJECTIVES: We sought to examine the effects of endurance training on the ultrastructural characteristics of skeletal muscle in heart transplant recipients (HTRs) and age-matched control subjects (C). BACKGROUND: Deconditioning is one of the factors involved in the peripheral limitation of exercise capacity of HTRs, and training has proven to be beneficial. METHODS: Biopsies of the vastus lateralis muscle, analyzed by ultrastructural morphometry, and quadriceps muscle cross-sectional area, assessed by computed tomography (CT), were performed in 12 HTRs and 7 age-matched C before and 6 weeks after an endurance training program. Maximal oxygen uptake (peak VO2) was determined by an incremental exercise test. Additionally muscle biopsies were performed before and after a 6-week control period in four HTRs to check for spontaneous improvement. RESULTS: Training resulted in similar increases in peak VO2 (11% in HTRs, 8.5% in C), ventilatory threshold (23% in HTRs, 32% in C) and total endurance work (54% in HTRs, 31% in C). Volume density of total mitochondria increased significantly (26% in HTRs, 33% in C) with a predominant increase of subsarcolemmal mitochondrial volume density (74% in HTRs, 70% in C). The capillary/fiber ratio increased by 19% in C only. In the nontrained group, none of the structural markers was spontaneously modified. CONCLUSIONS: Six weeks of endurance training in HTRs and C led to similar improvements of aerobic work capacity. However, the decreased muscular capillary network in HTRs remained unchanged with training. Immunosuppressive therapy might be responsible for the discrepancy between the normal mitochondrial content and the reduced capillary supply of these patients.
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Terapia por Ejercicio , Trasplante de Corazón/rehabilitación , Músculo Esquelético/anatomía & histología , Resistencia Física/fisiología , Adulto , Umbral Anaerobio/fisiología , Anatomía Transversal , Biopsia , Capilares/ultraestructura , Estudios de Casos y Controles , Prueba de Esfuerzo , Tolerancia al Ejercicio , Femenino , Trasplante de Corazón/fisiología , Humanos , Inmunosupresores/uso terapéutico , Masculino , Persona de Mediana Edad , Mitocondrias Musculares/ultraestructura , Fibras Musculares Esqueléticas/ultraestructura , Músculo Esquelético/diagnóstico por imagen , Músculo Esquelético/fisiología , Músculo Esquelético/ultraestructura , Consumo de Oxígeno/fisiología , Respiración/fisiología , Tomografía Computarizada por Rayos X , Evaluación de Capacidad de TrabajoRESUMEN
Mutations within the rosy locus of Drosophila were mapped using blots of genomic DNA fragments separated on denaturing gradient gels. DNA sequence differences between otherwise identical small rosy DNA fragments were detected among the mutants as mobility shifts on the blots. Mutations were mapped to within a few hundred base pairs of rosy sequence in 100 of 130 mutants tested--a 77% detection rate. The sequence changes in 43 rosy mutations are presented; all but six of these were single base changes. Thirty-four of 36 sequenced mutations induced by the alkylating agents N-ethyl-N-nitrosourea and ethyl methanesulfonate were transitions. All of the mutations mapped in the rosy transcription unit. Twenty-three of the 43 sequenced mutations change the predicted rosy gene polypeptide sequence; the remainder would interrupt protein translation (17), or disrupt mRNA processing (3).
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Mapeo Cromosómico , Mutación/genética , Xantina Deshidrogenasa/genética , Animales , Secuencia de Bases , Southern Blotting , Clonación Molecular , ADN/aislamiento & purificación , Análisis Mutacional de ADN , Drosophila melanogaster/genética , Electroforesis en Gel de Poliacrilamida/métodos , Expresión Génica/genética , Datos de Secuencia Molecular , Mutágenos , Desnaturalización de Ácido Nucleico , Hibridación de Ácido Nucleico , Biosíntesis de Proteínas/genética , Procesamiento Postranscripcional del ARN/genética , Xantina Deshidrogenasa/deficienciaRESUMEN
OBJECTIVE: For 3 years we have used extracorporeal assistance in intensive care frequently. This study evaluates our results. METHOD: We studied the patient records for those treated between January 2002 and January 2005. The method used, indications and morbidity/mortality were analysed. RESULTS: We performed 24 circulatory assistance procedures in 20 patients (median age: 5 months), arterio-venous with oxygenation (n=18), veino-venous with oxygenation (n=3) or biventricular (n=3). The indications were post cardiotomy cardio-respiratory failure (Group I; n=20, 16 patients), pure respiratory failure (Group II: n=1), or pre-transplant/recovery (Group III: n=3). Five procedures (4 from group I and 1 from group III) required cardiac massage (no fatalities). The average duration of assistance was 7 +/- 6 days (2 to 20 days). Treatment was successfully discontinued in sixteen patients 80%), one of them thanks to heart transplant. Four (20%) died during assistance. The morbidity essentially consisted of further surgery for haemostasis, multiple transfusions, and infections. Three patients (15%) died later (1 at 17 months after discontinuation) from complications unrelated to the assistance. No neurological sequelae were noted in the survivors. CONCLUSION: These results confirm the usefulness of circulatory assistance when medical treatment has failed, particularly in the post-operative period of paediatric cardiac surgery or while awaiting transplantation.
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Procedimientos Quirúrgicos Cardiovasculares , Circulación Extracorporea/métodos , Unidades de Cuidado Intensivo Pediátrico/estadística & datos numéricos , Adolescente , Adulto , Niño , Preescolar , Femenino , Trasplante de Corazón , Humanos , Lactante , Recién Nacido , Masculino , Morbilidad , Periodo Posoperatorio , Estudios Retrospectivos , Factores de Tiempo , Resultado del TratamientoRESUMEN
INTRODUCTION: Myelolipomas and extramedullary hematopoietic tumors are uncommon benign tumors. They are variably composed of mature adipose tissue and hematopoietic tissue. Myelolipoma is usually observed in the adrenal gland and extramedullary hematopoietic tumors in the liver and spleen but may occasionally be found within solid tumors. CASE REPORT: A 62-year-old man without previous haematological history presented with a voluminous solitary bilateral renal tumor. Contrast-enhanced ultrasound CT-scan and scintigraphy with technetium-99m-nanocolloid and indium-111-chloride bone marrow were highly suggestive of extramedullary hematopoietic tumor. CT-guided biopsy suggested a diagnosis of myelolipoma. An atypical hereditary spherocytosis, undiagnosed until now, was demonstrated. CONCLUSION: We report, for the first time to our knowledge, a border form between extramedullary hematopoiesis tumor and myelolipoma of renal localisation revealing a hereditary spherocytosis in an adult patient.
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Hematopoyesis Extramedular , Neoplasias Renales/complicaciones , Mielolipoma/complicaciones , Esferocitosis Hereditaria/complicaciones , Humanos , Riñón/fisiología , Masculino , Persona de Mediana Edad , Esferocitosis Hereditaria/diagnósticoRESUMEN
RATIONALE AND OBJECTIVES: The response of osteosarcoma to preoperative chemotherapy was assessed using dynamic magnetic resonance imaging (MRI) processed by factor analysis of medical image sequences (FAMIS). METHODS: Forty-nine dynamic image sequences, acquired after a bolus injection of gadolinium in 10 patients, were processed by FAMIS: FAMIS is a means whereby physiologic contrast enhancement kinetics, called factors, and their spatial distribution, termed factor images, are estimated. Tumor volumes were measured on static MRIs, and factor images were compared with histologic maps of the resected specimens. RESULTS: A substantial increase in tumor volume reflected a poor response to chemotherapy. Viable tumor was precisely depicted by the early vascular factor image, reflecting rapid uptake by tumor vessels. This early uptake disappeared in all five patients who responded to chemotherapy, whereas it persisted in four of five nonresponders. CONCLUSION: FAMIS of dynamic MRI is proposed as a possible means of predicting the response of osteosarcoma to chemotherapy.
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Neoplasias Óseas/diagnóstico , Neoplasias Óseas/tratamiento farmacológico , Imagen por Resonancia Magnética , Osteosarcoma/diagnóstico , Osteosarcoma/tratamiento farmacológico , Adolescente , Adulto , Neoplasias Óseas/patología , Niño , Femenino , Humanos , Masculino , Osteosarcoma/patologíaRESUMEN
INTRODUCTION: Transforming Growth Factor-beta1 is known to maintain primitive human hematopoietic stem/progenitor cells in a quiescent state. However, its specific role in the control of distinct progenitor cell types needs to be further elucidated. In this study, we have investigated the dose-response effect of TGF-beta1 on progenitors ranging from primitive high proliferative potential (HPP)-Mix, -GM or -BFU-E to later BFU-E, CFU-G or CFU-M. MATERIALS AND METHODS: A clonal semi-solid assay has been used to analyze the effects of a TGF-beta1 blocking antibody (anti-TGF-beta1) or that of active TGF-beta1 added to the medium at concentrations from 10-3000 pg/ml, on these different hematopoietic stem/progenitor cell types. RESULTS AND CONCLUSION: A preferential growth inhibitory effect on the earlier progenitors was observed when low concentrations of TGF-beta1 (10-300 pg/ml) were used. Concentrations of 10-30 pg/ml TGF-beta1 were sufficient to inhibit 90% of the primitive multipotent HPP-Mix, while 100-300 pg/ml TGF-beta1 were required to inhibit 70% of the bipotent HPP-GM and early HPP-BFU-E. TGF-beta1 did not significantly inhibit or activate the growth of later CFU-G and CFU-M, even when added at concentrations 10-100 fold higher. In contrast, a significant growth-inducing effect of very low TGF-beta1 concentrations (< or =30 pg/ml) on a subset of later BFU-E was observed and cannot be explained by a switch of early into later BFU-E. These results emphasize the polyfunctional role of TGF-beta1 in the regulation of hematopoiesis and the need for low, physiological concentrations of TGF-beta1, when studying both the stem cell compartment and more mature progenitor cell subpopulations.
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Sangre Fetal/citología , Células Madre Hematopoyéticas/efectos de los fármacos , Factor de Crecimiento Transformador beta/farmacología , Técnicas de Cultivo de Célula , Ciclo Celular/efectos de los fármacos , Ensayo de Unidades Formadoras de Colonias , Parto Obstétrico , Femenino , Sustancias de Crecimiento/farmacología , Células Madre Hematopoyéticas/citología , Humanos , Recién Nacido , Proteínas Recombinantes/farmacología , Factor de Crecimiento Transformador beta1RESUMEN
BACKGROUND: Hemodynamic improvement after heart transplantation is expected to normalize the neuroendocrine balance, but circulating atrial natriuretic peptide (ANP) remains elevated. Endothelin stimulates ANP secretion and its concentration increases after heart transplantation, suggesting a role for this peptide in the cardiovascular adaptative response to heart transplantation. METHODS: To investigate whether endothelin may induce ANP increase in heart transplant recipients, we monitored daily ANP, endothelin, and related hormonal, biologic, and hemodynamic parameters before and during the first week after either heart transplantation (n = 15) or coronary artery bypass grafting (n = 10). RESULTS: Surgery induced a transient secretory peak of arginine vasopressin and endothelin in both groups at day 1. Bypass grafting did not modify normal ANP (11.8 +/- 2.1 pmol/L), endothelin (2.4 +/- 0.3 pmol/L), renin activity (0.11 +/- 0.04 pmol/L/sec), or aldosterone (492 +/- 122 pmol/L) values. Heart transplantation normalized the renin-aldosterone axis, but the early decrease observed for ANP (from 27.2 +/- 4.8 to 21.14 +/- 1.4 pmol/L) was only partial and transient. Endothelin further increased (from 4.4 +/- 0.8 to 9.14 +/- 1.8 pmol/L; p < 0.01) after transplantation. Positive correlations were observed between endothelin, isoproterenol dose, creatinine, right atrial pressure, and ANP, but multiple correlation analysis showed the important role of endothelin (r = 0.69, p < 0.001). Cyclic guanosine monophosphate correlated with ANP (r = 0.65, p < 0.001). CONCLUSIONS: Elevated endothelin, suggesting vascular dysfunction, likely contributes to the ANP increase observed early after heart transplantation. Furthermore, ANP, through a cardiac endothelium feedback, may act in the maintenance of circulatory homeostasis in heart transplant recipients.
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Factor Natriurético Atrial/metabolismo , Endotelinas/fisiología , Trasplante de Corazón , Adulto , Factor Natriurético Atrial/sangre , Puente de Arteria Coronaria , Endotelinas/sangre , Femenino , Hemodinámica , Humanos , Masculino , Persona de Mediana Edad , Factores de TiempoRESUMEN
BACKGROUND: The breakdown of blood pressure and body fluid homeostasis observed in heart transplant (Htx) recipients may partly be due, as in heart failure, to a blunted renal response to elevated atrial natriuretic peptide (ANP). METHOD: This possibility was addressed through determination of the relationship between ANP, the urinary cyclic guanosine monophosphate (cGMP), a biologic marker of ANP renal activity, and the early renal responses to 10 mL/kg isotonic saline infusion over 30 minutes in 8 control subjects and 8 matched Htx recipients. RESULTS: Urine flow, natriuresis, and urinary cGMP excretion increased similarly in both groups, resulting in elimination of, respectively, 1/2 and 2/3 of the sodium and the water load during the experiment that lasted 4 hours and 30 minutes. Plasma renin and aldosterone decreases were similar in both groups. Elevated ANP further increased in Htx after saline infusion (from 19.5 +/- 3.7 to 33.8 +/- 5.6 pmol/L, P < .001). Plasma cGMP paralleled ANP in both groups (r = 0.81; P < .001). Significant correlations were observed between plasma ANP and urinary cGMP excretion (r = 0.48, P < .025 and r = 0.43, P < .05 in Htx recipients and control subjects) and between plasma ANP and urinary sodium excretion (r = 0.64, P < .001 in Htx recipients). CONCLUSION: In spite of a relative renal hyporesponsiveness to the cardiac hormone, with higher plasma ANP being not associated with increased renal excretions in Htx recipients, ANP is likely to participate in the appropriate short-term renal response to acute volume expansion in Htx recipients.
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Factor Natriurético Atrial/fisiología , Trasplante de Corazón/fisiología , Riñón/fisiopatología , Equilibrio Hidroelectrolítico/fisiología , Aldosterona/sangre , GMP Cíclico/fisiología , GMP Cíclico/orina , Diuresis , Humanos , Masculino , Persona de Mediana Edad , Natriuresis , Renina/sangre , Sodio/orina , Cloruro de Sodio/administración & dosificación , OrinaRESUMEN
The standard approach (right ventriculotomy and atriotomy) for surgical repair of double-outlet right ventricle with subaortic ventricular septal defect and pulmonary stenosis may not give an adequate view of the intracardiac defect due-to the presence of anomalous coronary artery anatomy or unusual cavity spacial relationship. Thus, a transverse aortotomy was performed and the left ventricular outflow tract was well visualized through the aortic valve and could be reconstructed precisely. Therefore, the transaortic approach also should be considered for systemic route reconstruction in this group.
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Aorta/cirugía , Ventrículo Derecho con Doble Salida/cirugía , Defectos del Tabique Interventricular/cirugía , Válvula Aórtica/patología , Niño , Preescolar , Anomalías de los Vasos Coronarios/patología , Ventrículo Derecho con Doble Salida/patología , Femenino , Atrios Cardíacos/patología , Atrios Cardíacos/cirugía , Defectos del Tabique Interventricular/patología , Ventrículos Cardíacos/patología , Ventrículos Cardíacos/cirugía , Humanos , Politetrafluoroetileno , Prótesis e Implantes , Arteria Pulmonar/cirugía , Estenosis de la Válvula Pulmonar/cirugía , Situs Inversus/cirugíaRESUMEN
We report the case of a malignant primary cardiac pheochromocytoma treated by adjuvant cytotoxic chemotherapy after surgical resection, with a 5-year survival. There is no specific chemotherapy for malignant pheochromocytoma, but because it has the same embryologic origin as neuroblastoma, we used similar chemotherapy. Because of unexpected malignancy potential, we think that total and meticulous resection of the tumor must be done.
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Neoplasias Cardíacas/cirugía , Feocromocitoma/cirugía , Adulto , Quimioterapia Adyuvante , Atrios Cardíacos/patología , Atrios Cardíacos/cirugía , Neoplasias Cardíacas/tratamiento farmacológico , Neoplasias Cardíacas/patología , Humanos , Ganglios Linfáticos/patología , Metástasis Linfática , Masculino , Microcirugia , Feocromocitoma/tratamiento farmacológico , Feocromocitoma/patologíaRESUMEN
STUDY OBJECTIVE: To investigate potential vascular and neuroendocrine determinants of altered blood pressure (BP) regulation in patients previously operated on for aortic coarctation. DESIGN, SETTING AND PATIENTS: We prospectively re-evaluated 45 patients operated on for aortic coarctation at Strasbourg University Hospital over a 13-year period. Four of these patients were less than 2 years old at the time of the operation and four were older than 20 years. Patient age and time since the operation were on average 21+/-13 years and 8+/-3 years, respectively. Surgery consisted of a resection with end-to-end anastomosis for 18 patients, angioplasty (8), prosthesis (4) or sub-clavian flap (15). RESULTS: Despite repair of the coarctation, about 40% of the patients showed an abnormal BP status at rest. The majority of these patients had uncomplicated borderline hypertension. The orthostasis test as well as the BP circadian rhythm were frequently abnormal. While the ankle/arm systolic pressure index measured at rest was generally within the normal range, diminished carotid-femoral pulse wave velocity was observed. Plasma adrenaline and aldosterone levels were elevated in about 50% of the patients examined. CONCLUSIONS: These new findings suggest that there are 'cause and effect' relationships between aortic structural and functional vascular abnormalities, and augmented plasma adrenaline and aldosterone in some patients after coarctation repair. These phenomena are likely to be involved in altered BP regulation and might result in recurrent hypertension.
Asunto(s)
Coartación Aórtica/fisiopatología , Presión Sanguínea/fisiología , Sistemas Neurosecretores/fisiopatología , Adolescente , Adulto , Aldosterona/sangre , Coartación Aórtica/sangre , Coartación Aórtica/cirugía , Velocidad del Flujo Sanguíneo , Niño , Preescolar , Ritmo Circadiano , Epinefrina/sangre , Femenino , Humanos , Hipertensión/fisiopatología , Lactante , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVE: It is a common statement that every mitral repair should be stabilized by some type of prosthetic mitral ring. In the very specific situation of isolated prolapse of the posterior leaflet (PPL), this statement may be enhanced by the possible anatomically discontinuity of the mitral annulus. This article concerns 96 patients with 'isolated' PPL (IPPL) who were operated upon without ring insertion. Long-term follow-up was obtained in order to ascertain the survival, stability of the repair and the need for reoperation, thus justifying or not the lack of use of a ring. METHODS: A total of 96 patients, 70 male and 26 female, underwent mitral repair for mitral insufficiency (MI) almost exclusively caused by PPL. Age ranged from 33 to 81 years (mean 60.7+/-11.3). All underwent quadrangular resection of the prolapsed portion and plication of the annulus. In 69 cases local stabilization was achieved by four U stitches, two on each side of the plication, passed through and sutured on some flexible material, 2-3 cm in length. Twenty seven patients had no such local reinforcement. RESULTS: There was one case of early death (1%) caused by refractory hypoxemia in a patient with long lasting pre-operative pulmonary edema. Two patients were lost for follow-up after 2 months. Follow-up was from 0.2 to 14.7 years (mean 4.5), for a total of 422.7 patient-years. There were four late deaths at a mean of 6-year follow-up (0.9-10 years). Actuarial survival was 95.5 and 90.5% at 5 and 8 years, respectively. Event-free for recurrence of significant mitral insufficiency (MI) was 96 and 92% at 5 and 8 years. Event-free of thromboembolic or hemorrhagic events was 84.3 and 72.3% at 5 and 8 years. Event-free from reoperation was 97.8 and 94% at 5 and 8 years. CONCLUSION: One can conclude that (a) IPPL repair without insertion of a ring is safe and long-lasting (b) the incidence of late death, recurrence of MI, thromboembolic/hemorrhagic events, need for reoperation, is not higher in this subset of patients than in conventional repair (c) such repair might work better and for a longer time, as reaction and sclerosis resulting from ring insertion are avoided (d) minor advantages could be due to an easier surgical procedure, especially through a minimally invasive approach.
Asunto(s)
Prótesis Valvulares Cardíacas , Insuficiencia de la Válvula Mitral/etiología , Insuficiencia de la Válvula Mitral/cirugía , Prolapso de la Válvula Mitral/complicaciones , Válvula Mitral/cirugía , Análisis Actuarial , Femenino , Estudios de Seguimiento , Prótesis Valvulares Cardíacas/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Insuficiencia de la Válvula Mitral/epidemiología , Análisis Multivariante , Recurrencia , Factores de Tiempo , Resultado del TratamientoRESUMEN
Adult T-cell leukemia/lymphoma is a monoclonal T-cell neoplasm associated with human T-cell lymphotropic virus-1 (HTLV-1) that occurs almost exclusively in adults. This report concerns a Romanian girl who had recurrent skin eruptions since infancy, subcutaneous tumors in childhood, and peripheral blood lymphocytosis, which initially developed at the age of 12 years. The circulating lymphocytes were of helper T-cell immunophenotype. Serologic studies demonstrated a number of HTLV-1 antigens in the child and her mother, and molecular analyses revealed monoclonal T-cell-receptor gamma gene rearrangement and detectable HTLV-1 proviral DNA. Conventional cytogenetic studies revealed a t(3;6)(q23;q27) chromosome translocation in most of the neoplastic cells. The patient initially responded well to interferon alfa therapy and showed regression of skin lesions and diminished lymphocytosis, but 4 years later, she developed massive lymphadenopathy and leukemic infiltration of the breast. At last clinical follow-up, at the age of 17 years, the patient had stable low-level peripheral lymphocytosis and subcutaneous tumors while being continuously treated with interferon alfa. Our review of the literature revealed six additional children with HTLV-1-associated T-cell leukemia/lymphoma, including one case with a similar clinical presentation and ethnic background. To our knowledge, the t(3;6)(q23;q27) translocation identified in this patient's neoplasm has not been previously reported in adult T-cell leukemia/lymphoma cases and may explain the early onset of disease. Although adult T-cell leukemia/lymphoma is rare in Romania, the identification of healthy carriers and vertical transmission raise the possibility that Romania might be an endemic region for HTLV-1 infection.