RESUMO
Malnutrition in allogeneic stem cell transplant (allo-SCT) is associated with poor outcomes. Supplementation with Foods for Special Medical Purposes may be a valid alternative to enteral nutrition or total parental nutrition to reduce malnutrition in allo-SCT. In this study, 133 patients consecutively allo-transplanted were assessed for nutritional status by Patient- Generated Subjective Global Assessment (PG-SGA) and supplemented with TGF-beta enriched Food for Special Medical Purposes (TGF-FSMP). PG-SGA, gold standard for nutritional assessment in oncologic patients, was assessed at admission and on day 0, +7, +14, +21, and + 28 from transplant and categorized as follows: A = good nutritional status; B = moderate malnutrition; C = severe malnutrition. TGF-FSMP (Modulen-IBD) is currently used in Inflammatory Bowel Diseases (IBD) as primary nutritional support and in this study the dose was calculated according to BMI and total daily energy expenditure (TDEE). The patients assuming ≥50% of the prescribed TGF-FSMP dose were classified in Group A; the patients who received < 50% were included in Group B per protocol. The primary endpoint of the study was the assessment of the malnourished patients in Group A and B at day+28 after transplantation, according to the criteria of PG-SGA C categorization. At day +28 after transplant: i) patients in Group A were significantly less severely malnourished than patients in the Group B (21/76,28% vs 42/53, 79% respectively, OR 2.86 - CI 1.94-4.23 -, p = 0.000); ii) the incidence of severe (MAGIC II-IV) aGVHD and of any grade gastrointestinal (GI) aGVHD was higher in Group B than in Group A, (43% vs 21% p = 0.003) and (34.5% vs 9.2% p = 0.001); iii) Pneumonia was more frequent in the malnourished patients of Group B than in well/moderate nourished patients of Group A (52.7% vs 27.6% p = 0.002). In group A parenteral nutrition was avoided more frequently than in group B (67.5% vs 33.3% p = 0.000) and a median hospital stay of 27 days in comparison to 32 was reported (p = 0.006). The estimated median overall survival (OS) of the population was 33 months in Group A and 25.1 months in group B (p = 0.03). By multivariate and ANN analysis, TGF-FSMP TR < 50% assumption was significantly correlated with malnutrition, severe and GI aGVHD, pneumonia and reduced OS.
Assuntos
Doença Enxerto-Hospedeiro , Transplante de Células-Tronco Hematopoéticas , Doenças Inflamatórias Intestinais , Desnutrição , Pneumonia , Humanos , Fator de Crescimento Transformador beta , Alimentos Fortificados , Desnutrição/complicações , Desnutrição/epidemiologia , Doença Enxerto-Hospedeiro/etiologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Doenças Inflamatórias Intestinais/complicações , Pneumonia/complicaçõesRESUMO
Malnutrition is common after allogeneic Hematopoietic Stem Cell Transplantation (alloHSCT), and interventions directed to correct nutritional status are warranted to improve transplant outcomes. In this prospective study, an oral polymeric formulation enriched with TGF-ß2 (TE-OPF) was explored to correct malnutrition according to Patient-Generated Subjective Global Assessment (PG-SGA). TE-OPF was proposed to 51 consecutive patients who received transplants at our institution for hematological malignancies, and sufficient dose intake was established per protocol as at least 50% of the prescribed dose of TE-OPF: group A received adequate nutritional support; group B, inadequate. The study met the primary outcomes in terms of safety (no adverse events reported during TE-OPF intake except for its disgusting taste) and malnutrition (PG-SGA C 28 days after transplant): severely malnourished patients (PG-SGA C) accounted for 13% in group A and 88.9% in group B (p = 0.000). At the end of the study, after a median follow-up of 416 days, the estimated median Overall Survival (OS) was 734 days for well or moderately nourished patients (PG-SGA A/B) in comparison to 424 for malnourished patients (p = 0.03). Inadequate TE-OPF intake was associated with an increase in acute gastrointestinal Graft Versus Host Disease (GVHD) cumulative incidence (38% vs. 0% p = 0.006). A higher incidence of pneumonia was reported in group B (p = 0.006). IGF-1 levels at 14 and 28 days after transplant were significantly higher in group A and were associated with a lower incidence of acute GVHD (aGVHD). Higher subsets of B, T, and NK cells were found in group A, and a higher number of CD16+ NK cells was associated with a lower incidence of acute GVHD (p = 0.005) and increased survival at the end of the study (p = 0.023). Artificial neural network analysis suggested that inadequate TE-OPF intake, pneumonia, and sepsis significantly affected malnutrition 28 days after alloHSCT and survival 365 days after alloHSCT (normalized importance 100%, 82%, and 68%, respectively). In this exploratory and preliminary study, the use of TE-OPF appeared to reduce the incidence of malnutrition after alloHSCT, but larger and controlled studies are required.
Assuntos
Doença Enxerto-Hospedeiro , Transplante de Células-Tronco Hematopoéticas , Desnutrição , Doença Enxerto-Hospedeiro/etiologia , Doença Enxerto-Hospedeiro/prevenção & controle , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Humanos , Desnutrição/etiologia , Estudos Prospectivos , Fator de Crescimento Transformador beta2RESUMO
Malnutrition is a common problem after allogeneic hematopoietic stem cell transplantation (allo-HSCT) and could impair immune function. Immune dysfunction after allo-HSCT may be linked with infections, GVHD, and relapse and negatively affect the outcome. Aim of this review was to identify malnutrition biomarkers, potentially useful for immune-system monitoring, in the setting of allo-HSCT. After a systematic search, no satisfying biomarker was found, except for citrulline. Citrulline could be useful in monitoring gastrointestinal function after allo-HSCT and its role in the complex relationship with immune-system function ought to be better explored. A multi-omics approach, including biomarkers and PRO (patient reported outcomes) is, in our opinion, the optimal way to study the relationship between malnutrition and transplant outcomes.
Assuntos
Citrulina , Doença Enxerto-Hospedeiro , Transplante de Células-Tronco Hematopoéticas , Desnutrição , Biomarcadores/sangue , Citrulina/sangue , Citrulina/imunologia , Doença Enxerto-Hospedeiro/sangue , Doença Enxerto-Hospedeiro/imunologia , Humanos , Desnutrição/sangue , Desnutrição/imunologia , Transplante HomólogoRESUMO
OBJECTIVES: A cribriform architectural pattern has been reported in 9% of one unselected consecutively collected series of gastric carcinomas (GC) with unfavourable prognostic outcome. Taking into consideration the biological relevance of the human epidermal growth factor receptor 2 (HER2) status, we have analyzed a cohort of GC with a cribriform component more than 40% (CGC) to evaluate the HER2 amplification rate as a potential target for therapy with trastuzumab. RESULTS: HER2 overexpression was encountered in 21 of 100 (21%) GC; a progressive increase in HER2 amplification was appreciated moving from non-CGC (20.6%) towards CGC cases (21.6%), although this difference does not reach a statistical significance. Nevertheless, either in univariate or in multivariate analyses, stage and HER2 status showed a significant p value (<0.001) in CGC patients. CONCLUSIONS: Our data confirmed a worse prognosis in all CGC patients with HER2 amplification, resulting in a shorter survival time. We invite all pathologists in their daily practice to specify the occurrence of cribriform neoplastic component in GC, either in surgical or in bioptical samples, taking into practical assessment the high HER2 overexpression rate in order to correctly treat these patients with worse behavior.
Assuntos
Adenocarcinoma/genética , Biomarcadores Tumorais/genética , Receptor ErbB-2/genética , Neoplasias Gástricas/genética , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/metabolismo , Adenocarcinoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Biomarcadores Tumorais/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Receptor ErbB-2/metabolismo , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/metabolismo , Neoplasias Gástricas/patologia , Análise de Sobrevida , Trastuzumab/uso terapêuticoRESUMO
Fluoro-edenite is a natural mineral species initially isolated in Biancavilla, Sicily. The fibres are similar in size and morphology to certain amphibolic asbestos fibres, the inhalation of which may cause chronic inflammation and cancer. Occupational asbestos exposure is known to be associated with pleural and lung diseases, including pleural plaques. The aim of this study was to report the pleural and lung parenchymal lesions detected by high-resolution computed tomography (HRCT) in a group of construction workers exposed to fluoro-edenite. Information regarding life habits and occupational history was collected from 43 workers enrolled into the study. The participants underwent physical examination, blood analysis, search for uncoated fibres and ferruginous bodies in the sputum, pulmonary function tests, including diffusion capacity for carbon monoxide (TLCO), and HRCT chest imaging. A general descriptive outcome analysis was also conducted; a prevalence ratio (PR) with 95% confidence interval and a two-tailed test P-value were calculated for pleural plaques using log-binomial regression, measuring plaque size and thickness, and cumulative exposure index (CEI). The mean values of the functional respiratory tests were within the normal range for all participants. A restrictive ventilatory defect was identified in two (5%) subjects and an obstructive ventilatory defect in three (7%) subjects. TLCO was reduced in two additional participants. Fibres were detected in 19 (44%) of subjects. Pleural involvement was documented in 39 (91%) workers, of whom 31 (72%) had bilateral plaques. Calcifications were detected in 25 (58%) of these participants. PR indicated a progressive increase in the risk of developing pleural lesions with rising CEI, i.e. length of exposure. The present findings demonstrate for the first time the presence of pleural plaques in the lungs of subjects exposed to fluoro-edenite fibres, and not to asbestos, through residing in Biancavilla and through their occupation.
RESUMO
INTRODUCTION: The transumbilical laparoscopic-assisted appendectomy (TULAA) effects on the surgical stress response in children have not been studied. Our aim is to investigate the stress response in TULAA. METHODS: A total of 35 children underwent the appendectomy by open approach (OA) or TULAA approach. Interleukins (ILs)-6, -18, and -10 were measured before (T0), at the beginning (T1a), and at the end of surgery (T1b) and 24 hours after (T2). RESULTS: An increase in IL-6 levels at T1b and T2 and in IL-18 at T2 was observed after OA. A significant increase of both IL-6 and IL-18 were observed at T2 but values were less compared with OA (11.6 ± 4.4 vs. 31.9 ± 8.9 pg/mL for IL-6, p = 0.0006; 145.6 vs. 174.9 pg/mL for IL-18, p = NS). CONCLUSIONS: A significant reduction in the postoperative cytokines in TULAA group suggests that this approach causes less surgical trauma in children.
Assuntos
Apendicectomia/efeitos adversos , Apendicectomia/métodos , Apendicite/cirurgia , Laparoscopia/efeitos adversos , Estresse Fisiológico , Adolescente , Criança , Feminino , Humanos , Interleucina-10/sangue , Interleucina-18/sangue , Interleucina-6/sangue , Masculino , Estudos Prospectivos , Fatores de TempoRESUMO
OBJECTIVE: This study was designed to demonstrate the feasibility and the reliability of microwave ablation (MWA) of epiphyseal osteoid osteomas (OO). MATERIALS AND METHODS: From February to November 2012, 7 patients (4 males and 3 females; age range 16-30 years) with epiphyseal OOs were treated with MWA. The treatment was performed with 16 G antennas with a power of 20 W for 2 min. The OOs were approached by using coaxial needles inserted with hammer or with automatic drill. All patients underwent spinal anaesthesia, with posttreatment 6-8 h observation before discharging. We treated epiphyseal OOs placed away from nervous and vascular nontarget structures, located in: femoral head (n = 2), femoral lesser trochanter (n = 2), femoral neck (n = 2), and proximal tibial epiphysis (n = 1). CT was used to visualize the nidus and to insert the needle for thermal ablation and for postprocedure control. Technical success was considered the positioning of the antenna in the nidus, while the efficacy of treatment was clinically evaluated as the complete remission of pain after the procedure by using the visual analogue score (VAS). Follow-up was performed by using VAS score 1 day, 1 week, and 1, 3, and 6 months after the procedure, whereas MRI examination was performed immediately after the procedure, at 1 month, and in any case of recurrence. Complications were also recorded. RESULTS: All patients experienced resolution of the symptomatology (VAS = 0) in ~1 week until the last follow-up, with residual VAS < 2 points occurring only from 1 to 7 days after the procedure. No intraprocedural complication was noted, whereas one patient had back pain for 2 months after the procedure, likely due to spinal analgesic injection. CONCLUSIONS: In our experience, MWA can be safely performed with excellent results without complications in selected cases of epiphyseal OOs; however, the clinical significance of this report is limited because there were only few patients included in this study. Thus, these data must be confirmed by further and larger studies.
Assuntos
Neoplasias Ósseas/cirurgia , Ablação por Cateter/métodos , Epífises/patologia , Micro-Ondas/uso terapêutico , Osteoma Osteoide/cirurgia , Adolescente , Adulto , Estudos de Viabilidade , Feminino , Humanos , Imagem por Ressonância Magnética Intervencionista , Masculino , Medição da Dor , Radiografia Intervencionista , Reprodutibilidade dos Testes , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
INTRODUCTION: The thoracoscopic approach to esophageal atresia (EA) with tracheoesophageal fistula (TOF) represents a challenging procedure whose real benefits remains unclear. Our purpose is to identify, through a meta-analysis, clinical evidence of the reliability of the thoracoscopic repair (TR) for EA/TOF compared with the open repair. MATERIALS AND METHODS: Defined PubMed search, with analysis of intraoperative and postoperative complications after open or thoracoscopic primary anastomosis for EA/TOF. RESULTS: Five articles met the criteria of meta-analysis, being comparative studies between TR and conventional open repair (COR), although they were retrospective. One article was excluded because it was available only in Japanese. We observed a slight prevalence, statistically insignificant, of the intraoperative and postoperative complication rate for TR: odds ratio (OR) 1.29. Excluding the conversion rate, the meta-analysis between the complication rate for TR and COR did not show a significant difference (OR 0.64). Anastomosis's leaks and strictures considered together did not show a significant difference between the two techniques, p = not significant and OR of 0.56. Similar results were observed analyzing the single outcome of leaks and strictures; the meta-analysis did not show any significant differences with an OR, respectively, of 1.05 and 0.43. CONCLUSIONS: The effectiveness of the endoscopic technique for EA/TOF repair is indicated with outcomes not different from open surgery. A randomized controlled trial is needed in this field to indicate which procedure is superior, open or TR.
Assuntos
Atresia Esofágica/cirurgia , Toracoscopia , Toracotomia , Fístula Traqueoesofágica/cirurgia , Feminino , Humanos , Lactente , Complicações Intraoperatórias , Masculino , Complicações Pós-Operatórias , Fístula Traqueoesofágica/congênito , Resultado do TratamentoRESUMO
OBJECTIVE: Primary megaureter (PM) represents 6-10% of all antenatal displaced urinary malformations. Spontaneous resolution of PM is a well-known event. This long-term follow-up study evaluated the incidence and rate of resolution of PM. Some predictive factors were revised, based on morphological classification and scintigraphic pattern. MATERIAL AND METHODS: Sixty neonates with PM were followed. The diagnosis was confirmed by ultrasound examination and (99m)Tc-DTPA diuretic renal scan. All the observed patients underwent antibiotic prophylaxis. All conservatively treated children were followed from 6 months to 15 years. Follow-up consisted of monthly urine cultures, renal ultrasound and DTPA diuretic renography. Hydroureteronephrosis was considered to have resolved when a retrovesical cross-sectional diameter of ureter less than 6 mm was found. RESULTS: In total, 72 PM were identified in this series. At the end of the follow-up period, 38 PM (52.8%) had resolved, in 18 PM (25%) ureteral dilatation persisted and 16 PM (22.2%) required a surgical procedure. The median age at resolution was significantly affected by presenting hydronephrosis grade and cross-sectional diameter at diagnosis, but not by gender. The (99m)Tc-DTPA renogram results showed no functional impairment in resolved and persisting cases, even after long-term observation. CONCLUSIONS: The data show that 22% of neonatal PM require surgical treatment. Poor drainage on (99m)Tc-DTPA scan, grade IV-V hydronephrosis and ureteric diameter more than 15.0 mm were statistically significant and independent predictive factors for surgery. The time to spontaneous resolution in neonatally diagnosed PM may exceed 3.6 years, after which recovery is rare.
Assuntos
Hidronefrose/diagnóstico , Remissão Espontânea , Ureter/anormalidades , Ureter/cirurgia , Adolescente , Fatores Etários , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Hidronefrose/diagnóstico por imagem , Lactente , Recém-Nascido , Pelve Renal/anormalidades , Pelve Renal/diagnóstico por imagem , Masculino , Valor Preditivo dos Testes , Prognóstico , Renografia por Radioisótopo , Fatores Sexuais , Pentetato de Tecnécio Tc 99m , Ultrassonografia Pré-Natal , Ureter/diagnóstico por imagemRESUMO
BACKGROUND/PURPOSE: The stripping of benign ovarian cysts has been reported to be preferable to cyst wall ablation. The procedure can be performed via either an open or laparoscopic approach. The aim of our study was to evaluate the efficacy of the technique of stripping performed by laparoscopy and laparotomy in the treatment of benign ovarian masses in the pediatric age group with respect to healthy ovarian tissue. METHODS: This retrospective study evaluated all the pediatric or adolescent patients admitted during a 5-year period (2006-2010) for a suspected benign ovarian cyst treated with a laparoscopic technique or traditional open surgery to remove the cyst. The morphological characteristics of the tissue were graded on a semiquantitative scale from 0 to 4. RESULTS: Thirty patients were treated and divided in 2 groups: group A laparoscopy (18 patients) and group B open (12 patients). The median age was 9.1 years. No ovarian tissue could be observed in 26 cases (86.7%). In the 4 remaining (2 laparoscopic and 2 open) cases (13.3%), ovarian tissue was found, but never more than 1 mm in thickness. This finding was always in endometriotic cysts. CONCLUSIONS: We demonstrated that, in the pediatric population, no ovarian tissue is removed together with the cyst if this is nonendometriotic. The type of surgical procedure does not influence the removal of ovarian tissue. Laparoscopic stripping of ovarian cysts is the preferable surgical procedure in patients with prospective potential fertility because of their young age.
Assuntos
Procedimentos Cirúrgicos em Ginecologia/métodos , Laparoscopia , Laparotomia , Cistos Ovarianos/cirurgia , Ovário/patologia , Adolescente , Criança , Feminino , Seguimentos , Humanos , Cistos Ovarianos/patologia , Ovário/cirurgia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
INTRODUCTION: Bladder augmentation predisposes humans to many metabolic, renal and enteropatch changes. Our aim was to evaluate in a rat model of ileocystoplasty mid- and long-term urinary, metabolic, renal and graft changes. MATERIALS AND METHODS: We performed an ileocystoplasty and a sham operation in 30 rats. Seven augmented rats and 3 sham-operated animals were euthanized after 1, 3 and 6 months. We performed urinalysis, urine culture and blood sampling for serum electrolytes and urea. Histopathological changes of the ileal patch and kidneys were also evaluated. RESULTS: The urine cultures were positive in 14.3, 57 and 71%, respectively, 1, 3 and 6 months after surgery. Urinary pH, serum chloride and urea of the augmented group were significantly higher. Bladder calculi were formed in 23.8% of ileocystoplasty. Histopathological examination showed urothelialization of the graft with hyperplastic/metaplastic changes. The kidneys showed glomerular depletion and a marked distal tubular ectasia. CONCLUSIONS: Our data showed that, in a mid- and long-term follow-up, rat bladders subjected to ileocystoplasty displayed hyperchloremic metabolic acidosis, electrolyte imbalance, enhanced serum blood urea levels and glomerular/tubular changes. Hyperplastic and/or metaplastic changes at the junctional zone were observed. Our experimental results suggest that frequent monitoring of renal function and surveillance of humans who have undergone ileocystoplasty are recommended.
Assuntos
Íleo/cirurgia , Bexiga Urinária/cirurgia , Coletores de Urina , Acidose/etiologia , Acidose/metabolismo , Animais , Feminino , Concentração de Íons de Hidrogênio , Íleo/patologia , Glomérulos Renais/metabolismo , Glomérulos Renais/patologia , Túbulos Renais/metabolismo , Túbulos Renais/patologia , Masculino , Ratos , Ratos Wistar , Fatores de Tempo , Ureia/sangue , Urinálise , Bexiga Urinária/metabolismo , Bexiga Urinária/patologia , Coletores de Urina/efeitos adversos , Urina/química , Urina/microbiologia , Equilíbrio HidroeletrolíticoRESUMO
In rat experimental varicocele, polydeoxyribonucleotide (PDRN) induces vascular endothelial growth factor (VEGF) production, thereby enhancing testicular function. This may point to a new therapeutic approach in human varicocele.
Assuntos
Polidesoxirribonucleotídeos/farmacologia , Polidesoxirribonucleotídeos/uso terapêutico , Receptor A2A de Adenosina/metabolismo , Regulação para Cima/fisiologia , Varicocele/metabolismo , Varicocele/prevenção & controle , Fator A de Crescimento do Endotélio Vascular/biossíntese , Animais , Masculino , Substâncias Protetoras/farmacologia , Substâncias Protetoras/uso terapêutico , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley , Testículo/patologia , Varicocele/patologiaRESUMO
PURPOSE: Laparoscopic varicocelectomy has gained popularity in recent years. The aim of this study was to identify clinical evidence about the reliability of this technique in the recent literature. METHODS: We performed a Medline search for articles published during the last 10 years, using the key words "varicocele," "treatment," and "adolescent." As limits, we used last 10 years, adolescent, clinical trials, randomized controlled trials, meta-analysis, and multicenter retrospective and prospective studies. The results were investigated in recurrence and hydrocele formation. RESULTS: We pooled 37 studies, but 26 of these were excluded because they were neither relevant nor concerned an adolescent population. Meta-analysis showed that there was no statistical difference between laparoscopic surgery and open surgery in recurrence rate and postoperative hydrocele rate. In the laparoscopic group, the incidence of recurrence was higher in the patients undergoing artery ligation compared to patients undergoing artery and venous ligation. Furthermore, a lower rate of postoperative hydrocele was recorded in patients undergoing dye injections before laparoscopic ligation. CONCLUSIONS: Meta-analysis and literature analysis showed that the results after laparoscopic varicocelectomy are comparable to other surgical procedures. The laparoscopic approach has the advantage to treat simultaneously bilateral varicocele.
Assuntos
Laparoscopia/métodos , Varicocele/cirurgia , Adolescente , Artérias/cirurgia , Criança , Ensaios Clínicos como Assunto/estatística & dados numéricos , Corantes , Humanos , Laparotomia , Ligadura , Masculino , Metanálise como Assunto , Estudos Multicêntricos como Assunto/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Recidiva , Estudos Retrospectivos , Hidrocele Testicular/epidemiologia , Hidrocele Testicular/etiologia , Testículo/irrigação sanguínea , Resultado do Tratamento , Veias/cirurgiaRESUMO
INTRODUCTION: Wnt-1 is capable of inducing metanephric mesenchyme to undergo tubulogenesis. A relationship between the degree of cystogenesis and reduced E-cadherin (E-cad) expression was described. Syndecan-1 (Sdc-1) has a critical role in kidney development. MATERIALS AND METHODS: Ten multicystic dysplastic kidneys (MCDKs) were stained with hematoxylin and eosin and immunohistochemistry was performed using Wnt-1, E-cad and Sdc-1 antibodies. Eight unaffected kidneys were used as controls. RESULTS: Strong Wnt-1 immunostaining occurred inside cystic/tubular epithelial cells and in blastematous foci. An immunoreaction was observed in glomerular epithelial cells. In controls, just weak cytoplasmic Wnt-1 positivity was seen in tubular epithelial cells. E-cad reaction was negative in MCDKs while strong immunostaining was common in tubular cells of controls. A strong Sdc-1 immunoreaction depicted cystic, tubular and glomerular epithelial cells in MCDKs while Sdc-1 expression documented weak positivity in tubular epithelium alone. CONCLUSIONS: Our data are in accordance with an involvement of Wnt-1 in normal nephrogenesis and with its role in altered epithelial differentiation of metanephric mesenchyme in MCDKs. Wnt-1 signal may function to suppress E-cad expression, a predisposing event for cystogenesis. High expression of Sdc-1 in tubular/cystic epithelial cells of MCDKs might alter the normal transition of stages of the developmental process and modify the anion charge of the glomerular barrier.
Assuntos
Rim/química , Rim Displásico Multicístico/metabolismo , Antígenos CD , Caderinas/análise , Estudos de Casos e Controles , Humanos , Imuno-Histoquímica , Lactente , Rim/embriologia , Rim/crescimento & desenvolvimento , Morfogênese , Rim Displásico Multicístico/embriologia , Transdução de Sinais , Sindecana-1/análise , Proteína Wnt1/análiseRESUMO
INTRODUCTION: Testicular torsion may be an important cause of male infertility. We aimed to investigate the late hormonal function in patients with testicular ischemia/reperfusion injury of the testis after orchidectomy or detorsion. METHODS: Twenty patients (mean age, 13.6 years) were prospectively evaluated at a mean of 5 years after testicular torsion. The serum follicle-stimulating hormone, luteinizing hormone (before and after gonadotropin-releasing hormone stimulation), testosterone, and inhibin B were measured. Fifteen age-matched adolescents without evidence of endocrine disease were used as controls for inhibin B values. Data are quoted as mean +/- SEM. RESULTS: Twelve patients were treated with detorsion and orchidopexy, and 8 underwent orchidectomy. Serum follicle-stimulating hormone, luteinizing hormone, and testosterone were all within the reference range. Inhibin B levels were significantly reduced in the 2 groups compared with the controls (34.5 +/- 5.2 vs 63.9 +/- 12.8 pg/mL, P = .02), but were not significantly different between the orchidectomy group and the group that underwent detorsion (41.3 +/- 9.7 vs 30.4 +/- 5.9 pg/mL, P = .41). CONCLUSION: Hormonal testicular function can be compromised after testicular torsion, although the type of surgery (orchidectomy or orchidopexy) does not seem to change the effect of this ischemia/reperfusion injury.
Assuntos
Inibinas/sangue , Torção do Cordão Espermático/sangue , Torção do Cordão Espermático/cirurgia , Hormônios Testiculares/sangue , Adolescente , Hormônio Foliculoestimulante/sangue , Hormônio Liberador de Gonadotropina/farmacologia , Humanos , Estudos Longitudinais , Hormônio Luteinizante/sangue , Masculino , Orquiectomia/métodos , Orquidopexia/métodos , Complicações Pós-Operatórias/sangue , Estudos Prospectivos , Traumatismo por Reperfusão/sangue , Testículo/efeitos dos fármacos , Testículo/fisiopatologia , Testículo/cirurgia , Testosterona/sangueRESUMO
Torsion of an accessory spleen is an extremely rare condition. We describe an unusual case of acute abdomen caused by torsion of an accessory spleen in a 12-year-old boy. The patient underwent a laparotomy with splenectomy; the course was favorable. We discuss the clinical findings and values of preoperative instrumental diagnosis. The literature is also reviewed. This is the 11th case reported in the English literature. Torsion of an accessory spleen should be considered in the differential diagnosis of acute abdomen or subacute abdominal pain.
Assuntos
Abdome Agudo/etiologia , Baço/anormalidades , Esplenopatias/cirurgia , Anormalidade Torcional/cirurgia , Abdome Agudo/diagnóstico , Criança , Diagnóstico Diferencial , Diagnóstico por Imagem , Humanos , Masculino , Baço/irrigação sanguínea , Baço/cirurgia , Esplenectomia , Esplenopatias/diagnóstico , Anormalidade Torcional/diagnósticoRESUMO
The aim of this study was to evaluate the incidence and outcome of isolated moderate renal pelvis dilatation (RPD) [anterior-posterior diameter (APD) 10-15 mm] in an unselected population of 2-month-old infants prospectively followed for up to 12-14 months of life. Isolated moderate renal pelvis dilatation was detected in 282 of the 11,801 (2.4%), infants screened; 240 infants with normal renal ultrasound were enrolled as the control group. Resolution of RPD was considered when an APD Assuntos
Pelve Renal/diagnóstico por imagem
, Pelve Renal/patologia
, Dilatação Patológica/complicações
, Dilatação Patológica/diagnóstico por imagem
, Feminino
, Humanos
, Incidência
, Lactente
, Masculino
, Programas de Rastreamento
, Ultrassonografia
, Obstrução Ureteral/complicações
, Obstrução Ureteral/diagnóstico por imagem
, Obstrução Ureteral/epidemiologia
, Infecções Urinárias/diagnóstico por imagem
, Infecções Urinárias/epidemiologia
, Infecções Urinárias/etiologia
, Refluxo Vesicoureteral/complicações
, Refluxo Vesicoureteral/diagnóstico por imagem
, Refluxo Vesicoureteral/epidemiologia
RESUMO
INTRODUCTION: Anterior urethral valves (AUVs) are uncommon congenital anomalies causing urethral obstruction in boys. PATIENTS AND METHODS: Medical records of 13 children were reviewed retrospectively. Each patient (pt) was evaluated with voiding cysto-urethrogram (VCUG) and renal ultrasonography. Pts older than 5 years performed an uroflowmetry. Serum creatine was determined in all children. RESULTS: All pts had difficulty in voiding and eight had recurrent urinary tract infection. Renal function was normal in all pts. VCUG showed filling of Cowper's duct in a pt. In a case, a vesicoureteral reflux was discovered. Uroflowmetry showed a flat trace in all cases. Transurethral endoscopic resection of the valves was carried out in 11 children while open resection was necessary in two children. At serial follow-up, all pts remain symptom-free and uroflowmetry documented regular pattern. DISCUSSION: Anterior urethral valves are rare lesions that may create problems at different stages. Some AUVs may result from the obstruction distal lip of a ruptured syringocele. Improvements in endoscopic equipment allow for minimally invasive transurethral resection. Large diverticula are best managed with open diverticulectomy and reconstruction. In newborns with severe altered urinary tract drainage, particularly in low birth-weight infant, a vesicostomy may be necessary.
Assuntos
Uretra/anormalidades , Uretra/cirurgia , Obstrução Uretral/cirurgia , Criança , Pré-Escolar , Creatinina/sangue , Cistos/complicações , Cistos/cirurgia , Seguimentos , Humanos , Lactente , Recém-Nascido , Rim/diagnóstico por imagem , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Radiografia , Estudos Retrospectivos , Ultrassonografia , Uretra/diagnóstico por imagem , Obstrução Uretral/complicações , Obstrução Uretral/etiologia , Infecções Urinárias/etiologia , Procedimentos Cirúrgicos Urológicos/métodos , Refluxo Vesicoureteral/etiologia , Refluxo Vesicoureteral/cirurgiaRESUMO
PURPOSE: Dextranomer/hyaluronic acid implantation is associated with a granulomatous inflammatory reaction, replaced by fibrosis. Appearance of myofibroblasts is considered a crucial event in fibrosis, and CD68 positive cells and other factors are implied in their activation. Mast cells are a source of these factors and tryptase can induce fibroblast to express alpha-smooth muscle actin, which is characteristic of myofibroblasts. We evaluated histological changes in refluxing ureters treated with dextranomer/hyaluronic acid and immunolocalized CD68 positive cells, tryptase mast cells and myofibroblasts. MATERIALS AND METHODS: We performed histological, histochemical and immunohistochemical analyses in 22 refluxing ureters treated with dextranomer/hyaluronic acid in comparison with 17 refluxing ureters who underwent ureteral reimplantation but did not receive endoscopic bulking agent. We used CD68 antibody for monocytes/macrophages and epithelioid cells, mast cell tryptase mouse antibody for mast cells, and alpha-smooth muscle actin and vimentin antibodies for myofibroblasts. The area of the ureteral lumen in dextranomer/hyaluronic acid treated and untreated ureteral endings was measured. RESULTS: Sirius red documented a major grade of histological lesions in dextranomer/hyaluronic acid treated refluxing ureters. CD68 and tryptase mast cell staining showed a significant enhancement of positive cells in dextranomer/hyaluronic acid treated refluxing ureters. Immunostaining for alpha-smooth muscle actin and vimentin displayed a myofibroblastic invasion in dextranomer/hyaluronic acid. Measurement of surface in treated refluxing ureters was significantly less than in untreated refluxing ureters. CONCLUSIONS: Our data documented a recruitment of CD68 and tryptase positive cells, abnormal accumulation of collagenous stroma and successive extracellular matrix remodeling through differentiation of myofibroblasts. Myofibroblasts might provoke tissue contraction, decreasing the ureteral diameter and modifying the ureteral length-to-diameter ratio, preventing urine reflux.
Assuntos
Diferenciação Celular , Dextranos , Ácido Hialurônico , Mioblastos/citologia , Próteses e Implantes , Ureter/imunologia , Ureter/patologia , Refluxo Vesicoureteral/terapia , Antígenos CD/análise , Antígenos de Diferenciação Mielomonocítica/análise , Feminino , Fibroblastos , Humanos , Lactente , Masculino , Mastócitos/metabolismo , Estudos Retrospectivos , Triptases/biossínteseRESUMO
BACKGROUND: Stripping of the cystic wall is performed by gynecologists to treat large ovarian cysts. Information in the pediatric population is poor. We prospectively evaluated the pathologic specimens of large ovarian cyst to determine whether the stripping technique is a tissue-sparing procedure even in this age. METHODS: We evaluated 5 patients. Samples were taken from the intermediate part of the cystic wall and from the layer covering the cyst during excision. The presence of ovarian tissue adjacent to the cyst wall, and the morphological features of the surrounding tissue were both evaluated. Pelvic ultrasound follow-up was also performed. RESULTS: Patients' mean age was 4.5 years (7 days to 12 years). All cysts were removed because all were symptomatic. The mean diameter was 86.6 mm (74-100 mm). Cysts were follicular in 2 cases, serous in other two, and endometriotic in 1 case. Adjacent ovarian tissue was present in 1 of 5 specimens and was approximately 1 to 2 mm in thickness. The layer adjacent to the cystic wall always appeared as normal ovarian tissue. Ultrasound scans at follow-up revealed presence of ovarian tissue. CONCLUSION: The stripping procedure for large ovarian cyst excision allows to spare the adjacent normal ovarian tissue even in pediatric age because ovarian tissue is rarely excised with the cyst wall during the procedure.