RESUMO
Recent advances in machine learning research, combined with the reduced sequencing costs enabled by modern next-generation sequencing, paved the way to the implementation of precision medicine through routine multi-omics molecular profiling of tumours. Thus, there is an emerging need of reliable models exploiting such data to retrieve clinically useful information. Here, we introduce an original consensus clustering approach, overcoming the intrinsic instability of common clustering methods based on molecular data. This approach is applied to the case of non-small cell lung cancer (NSCLC), integrating data of an ongoing clinical study (PROMOLE) with those made available by The Cancer Genome Atlas, to define a molecular-based stratification of the patients beyond, but still preserving, histological subtyping. The resulting subgroups are biologically characterized by well-defined mutational and gene-expression profiles and are significantly related to disease-free survival (DFS). Interestingly, it was observed that (1) cluster B, characterized by a short DFS, is enriched in KEAP1 and SKP2 mutations, that makes it an ideal candidate for further studies with inhibitors, and (2) over- and under-representation of inflammation and immune systems pathways in squamous-cell carcinomas subgroups could be potentially exploited to stratify patients treated with immunotherapy.
Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Humanos , Carcinoma Pulmonar de Células não Pequenas/patologia , Neoplasias Pulmonares/patologia , Proteína 1 Associada a ECH Semelhante a Kelch , Consenso , Fator 2 Relacionado a NF-E2 , Análise por ConglomeradosRESUMO
We present a case of a patient with a three-month history of peripheral blood cytopenia without a confirmed diagnosis of myelodysplastic syndrome, who developed a favourable-risk acute myeloid leukemia (AML), according to the European Leukemia Net (ELN) criteria. The patient achieved a complete remission with incomplete platelet recovery (CRi) after induction. The patient achieved the morphological CR after the first consolidation and completed the first-line treatment with a syngeneic stem cell transplantation (SCT). A disease relapse occurred after one year of CR (blast cell count in the bone marrow 15%), and the patient was offered a haplo-SCT, which he refused due to personal reasons. In this paper, we discuss the interplay between clinical and biological risk factors in non-high-risk AML patients and speculate that some old clinical risk factors (e.g., age of the patient, achievement of CR after induction, and previous history of myelodysplastic syndrome) may still impact on the treatment decision algorithm of some of these patients.
RESUMO
An update at 7 years was conceived for our multicenter phase II study in which 55 elderly high-risk untreated diffuse large B-cell lymphoma patients were treated with (90)Y-ibritumomab tiuxetan after a short course of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone (R-CHOP) as long-term follow-up analyses of this combined therapeutic modality are lacking. The overall response rate to the entire regimen was 80%, including 73% (40/55) of complete response (CR) rate and 7% (4/55) of partial response rate. At the time of writing, 24/55 (43.6%) patients experienced a progression disease and 20 of 40 (50%) patients who obtained a CR are still alive in continuous CR. With a median follow-up of 7 years, the disease-free survival was 43.3% and the progression-free survival was 36.1%. The overall survival at 7.9 years was 38.9% (27 deaths mainly because of lymphoma). Two patients developed secondary hematological malignancies, an acute myeloid leukemia and a myelodysplastic syndrome, at 4 and 3 years from radioimmunotherapy, respectively. Our data confirm the feasibility, efficacy and safety of four cycles of R-CHOP followed by radioimmunotherapy consolidation even in the long term: this combination allows dispensing less chemotherapy in a frail group of patients without invalidating response quality and duration.
Assuntos
Anticorpos Monoclonais/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Linfoma Difuso de Grandes Células B/terapia , Radioisótopos de Ítrio/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais Murinos/efeitos adversos , Anticorpos Monoclonais Murinos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Terapia Combinada , Ciclofosfamida/efeitos adversos , Ciclofosfamida/uso terapêutico , Doxorrubicina/efeitos adversos , Doxorrubicina/uso terapêutico , Feminino , Seguimentos , Humanos , Linfoma Difuso de Grandes Células B/diagnóstico , Linfoma Difuso de Grandes Células B/mortalidade , Masculino , Pessoa de Meia-Idade , Prednisona/efeitos adversos , Prednisona/uso terapêutico , Radioimunoterapia , Rituximab , Análise de Sobrevida , Resultado do Tratamento , Vincristina/efeitos adversos , Vincristina/uso terapêutico , Radioisótopos de Ítrio/administração & dosagemAssuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Linfoma Folicular/tratamento farmacológico , Linfoma Folicular/radioterapia , Radioimunoterapia/métodos , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais/efeitos adversos , Intervalo Livre de Doença , Humanos , Linfoma Folicular/mortalidade , Mitoxantrona/administração & dosagem , Mitoxantrona/efeitos adversos , Vidarabina/administração & dosagem , Vidarabina/efeitos adversos , Vidarabina/análogos & derivadosRESUMO
BACKGROUND: A prospective, single-arm, open-label, multicenter, nonrandomised phase II trial to evaluate efficacy and safety of short fludarabine, mitoxantrone, and rituximab (FMR) induction followed by radioimmunotherapy, in untreated, intermediate/high-risk follicular non-Hodgkin's lymphoma (NHL) patients. PATIENTS AND METHODS: Fifty-five patients were treated using a sequential treatment schedule of four induction cycles of FMR chemoimmunotherapy, and a subsequent consolidating single administration of (90)Y-ibritumomab tiuxetan ((90)Y-IT), 8-14 weeks later. Patients were eligible for radioimmunotherapy if at least in partial response (PR) after induction, with normal platelet and granulocyte counts and a bone marrow infiltration ≤ 25%. Primary study end points were response rate and hematologic toxic effects; secondary end points were overall survival (OS) and progression-free survival (PFS). RESULTS: All the 55 patients received four induction cycles with an overall response rate of 96% (38 complete responses [CR] and 15 PR). Fifty-one patients (38 in CR and 13 in PR) received (90)Y-IT. By the end of the treatment, 49/55 patients achieved a CR. With a median follow-up of 21 months, the estimated 3-year PFS was 81% and the 3-year OS 100%. CONCLUSIONS: This study has established feasibility, tolerability, and efficacy of a regimen composed by short FMR induction with (90)Y-IT consolidation in untreated intermediate/high-risk follicular NHL patients.
Assuntos
Anticorpos Monoclonais/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Linfoma Folicular/tratamento farmacológico , Linfoma Folicular/radioterapia , Radioisótopos de Ítrio/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Monoclonais Murinos/administração & dosagem , Feminino , Humanos , Quimioterapia de Indução , Masculino , Pessoa de Meia-Idade , Mitoxantrona/administração & dosagem , Estudos Prospectivos , Radioimunoterapia , Rituximab , Resultado do Tratamento , Vidarabina/administração & dosagem , Vidarabina/análogos & derivadosRESUMO
BACKGROUND: Adult Langerhans cell histiocytosis (LCH) is a rare disease. The combination of vinblastine and prednisone, given in a 6-month course, is the standard of care but prospective randomized trials are lacking. PATIENTS AND METHODS: We report our monocentric experience in the treatment of seven adult patients with multisystem (MS) LCH (n = 3) or single-system multifocal (SS-m) LCH (n = 4) with the short-course intensive chemotherapy regimen methotrexate, doxorubicin, cyclophosphamide, vincristine, prednisone and bleomicin (MACOP-B). RESULTS: The overall response rate was 100% [five complete response (CR), two partial response (PR)]. After a median follow-up of 6.5 years, four patients are in first continuous CR and three patients relapsed after 5, 8 and 62 months, respectively. Four patients were evaluated with positron emission tomography (PET) scan: all three PET-negative patients at the end of treatment had a long-lasting response with only one patient relapsing after 5 years. PET scan detected additional bone lesions at diagnosis in two of four patients, changing the treatment program in one of them. CONCLUSIONS: MACOP-B regimen seems to be very active in the treatment of adult MS or SS-m LCH, with long-lasting responses in five of seven patients. PET scan merits further evaluation in the initial staging and in the evaluation of the response to chemotherapy.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Histiocitose de Células de Langerhans/tratamento farmacológico , Adolescente , Adulto , Bleomicina/uso terapêutico , Ciclofosfamida/uso terapêutico , Progressão da Doença , Doxorrubicina/uso terapêutico , Feminino , Fluordesoxiglucose F18 , Seguimentos , Histiocitose de Células de Langerhans/diagnóstico por imagem , Humanos , Leucovorina/uso terapêutico , Masculino , Metotrexato/uso terapêutico , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons , Prednisona/uso terapêutico , Indução de Remissão , Estudos Retrospectivos , Vincristina/uso terapêutico , Adulto JovemRESUMO
BACKGROUND: Peripheral T-cell lymphoma unspecified (PTCLU) and mycosis fungoides (MF) often show resistance to conventional chemotherapy. Gemcitabine should be considered a suitable option. We report the long-term update of 39 pretreated T-cell lymphoma patients treated with gemcitabine. PATIENTS AND METHODS: From May 1997 to September 2007, 39 pretreated MF and PTCLU patients received gemcitabine. Inclusion criteria were as follows: histologic diagnosis of MF or PTCLU; relapsed/refractory disease; age > or =18 years; and World Health Organization performance status of two or less. Nineteen patients had MF and 20 PTCLU. All patients with MF had a T3-T4, N0, and M0 disease and patients with PTCLU had stage III-IV disease. Gemcitabine was given on days 1, 8, and 15 on a 28-day schedule (1200 mg/m(2)/day) for a total of three to six cycles. RESULTS: Overall response rate was 51% (20 of 39 patients); complete response (CR) and partial response (PR) rates were 23% (9 of 39 patients) and 28% (11 of 39 patients), respectively. Patients with MF had a CR rate of 16% and a PR rate of 32% compared with a CR rate of 30% and a PR rate of 25% of PTCLU patients. Among the CR patients, 7 of 9 are in continuous complete response with a variable disease-free interval (15-120 months). CONCLUSION: In our experience, gemcitabine proved to be effective in pretreated MF and PTCLU patients, even in the long term.
Assuntos
Desoxicitidina/análogos & derivados , Resistencia a Medicamentos Antineoplásicos , Linfoma de Células T/tratamento farmacológico , Adulto , Idoso , Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , Quimioterapia Adjuvante , Desoxicitidina/efeitos adversos , Desoxicitidina/uso terapêutico , Feminino , Seguimentos , Humanos , Linfoma de Células T/complicações , Linfoma de Células T/radioterapia , Masculino , Pessoa de Meia-Idade , Micose Fungoide/complicações , Micose Fungoide/tratamento farmacológico , Recidiva , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/tratamento farmacológico , Fatores de Tempo , Resultado do Tratamento , GencitabinaRESUMO
We report the case of a child with difficulties to control epilepsy and celiac disease, diagnosed soon after the onset of the seizure disorder. Seizure frequency and pattern, in addition to electroencephalogram record were suggestive of Lennox-Gastaut syndrome. Diagnosis of celiac disease was determined by positive anti-endomysium and anti-transglutaminase tests, and abnormal jejunal biopsy. Gluten-free diet, started soon after the diagnosis, led to progressive seizure control, allowing significant decrease in dosage of anti-epileptic drugs. This case corroborates the importance of serological screening tests for celiac disease, at least in patients with difficult to control epilepsy.
Assuntos
Doença Celíaca/complicações , Doença Celíaca/terapia , Epilepsia/etiologia , Epilepsia/terapia , Avaliação de Resultados em Cuidados de Saúde , Doença Celíaca/diagnóstico , Pré-Escolar , Epilepsia/diagnóstico , Humanos , MasculinoRESUMO
BACKGROUND: The aims of this work were (a) to evaluate the prevalence of coeliac disease (CD) in a large sample of the Brazilian general population and (b) to compare CD prevalence between children and adults. METHODS: The study group comprised 4405 subjects (2629 F and 1776 M). Age distributions were 2034 (1-14 years), 848 (15-29), 584 (30-44), 667 (45-59) and 272 above 60. The immunoglobulin A antiendomysial antibody (IgA-EMA) test was used as the serological screening tool. All sera were submitted to turbidimetric measurement of IgA levels and those with IgA deficiency to the IgG antigliadin (IgG-AGA) test. The small intestinal biopsy was recommended for subjects showing either (a) IgA-EMA positivity or (b) selective IgA deficiency (SigAD) and IgG-AGA positivity. RESULTS: There were 16 EMA positive out of 4405 sera tested. SigAD was found in five cases (one adult and four children). Two of these children tested positive for IgG-AGA and underwent jejunal biopsy that, in both cases, disclosed a normal mucosa. Overall, 17 out of 18 eligible subjects performed the small intestinal biopsy. The prevalence of biopsy-proven CD in this study group was 3.41 per 1000 individuals. If all 18 EMA-positive patients were included, the overall prevalence would become 3.63 per 1000. The prevalence in adults and children was 2.11 per 1000 and 5.44 per 1000, respectively. CONCLUSION: This work supports previous findings showing that CD is not a rare disorder in Brazil and that there is an unexplained difference in the prevalence of CD between adults and children.
Assuntos
Doença Celíaca/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Fatores Etários , Assistência Ambulatorial , Brasil/epidemiologia , Doença Celíaca/diagnóstico , Doença Celíaca/etiologia , Criança , Pré-Escolar , Feminino , Gliadina/imunologia , Hospitais Universitários , Humanos , Imunoglobulina A/sangue , Imunoglobulina G/sangue , Lactente , Masculino , Pessoa de Meia-Idade , Miofibrilas/imunologia , PrevalênciaRESUMO
BACKGROUND: The aim of this study was to evaluate the specificity of the immunoglobulin A (IgA) antiendomysial antibody test in the diagnosis of celiac disease in a group of malnourished children with acute diarrhea, chronic diarrhea, or parasitosis, because the reliability of this test has been questioned when applied to this specific group of patients. METHODS: Serum IgA level, IgA antiendomysial antibody (EMA) test, and stool examination were performed in 315 children, ranging in age 6 months to 13 years (range, 41 +/- 2.9 months), affected by malnutrition, isolated or in association with diarrhea or parasitosis. Independent of results, 33 children with a strong suspicion of celiac disease, also underwent IgA antitransglutaminase antibody test and jejunal biopsy. RESULTS: The EMA test was negative in 313 children, including the 43 with parasitosis, being positive in two patients in whom biopsy disclosed typical celiac mucosal abnormalities (1:157). The 31 children with negative EMA test who underwent biopsy also showed negative antitransglutaminase antibody results. Their biopsies disclosed normal mucosa in 1 patient, variable degree of jejunal atrophy (grade 1 and 2) in 27 patients, and grade 3 abnormalities in 3 patients. One of these three children, showing severe jejunal atrophy, died. The diagnosis of celiac disease was apparently not confirmed by a protracted gluten challenge in the other two children. CONCLUSIONS: The specificity of the EMA test seems to be high also in children with chronic malnutrition and diarrhea. However, the possibility of false-negative tests among immunologically compromised children cannot be excluded. In doubtful cases, the gluten challenge is required in malnourished children with clinical picture, biopsy finding, and evolution suggestive of celiac disease.
Assuntos
Doença Celíaca/diagnóstico , Transtornos da Nutrição Infantil/complicações , Diarreia/complicações , Imunoglobulina A/sangue , Adolescente , Animais , Atrofia , Autoanticorpos/sangue , Biomarcadores/sangue , Cebus , Doença Celíaca/sangue , Doença Celíaca/imunologia , Criança , Pré-Escolar , Esôfago/imunologia , Reações Falso-Positivas , Feminino , Técnica Indireta de Fluorescência para Anticorpo , Humanos , Imunoglobulina A/imunologia , Lactente , Jejuno/patologia , Masculino , Programas de Rastreamento , Transglutaminases/imunologiaRESUMO
OBJECTIVE: There are no studies on the prevalence of celiac disease (CD) in either Brazil or, as far as we know, South America. The aim of this study was to determine the prevalence of CD in healthy blood donors in the city of Brasilia, Brazil. METHODS: Sera were obtained, independently of age and gender, from an unselected group of 2045 blood donors attending the Hematological Center of Brasilia. An IgG antigliadin antibody (AGA) test was used as a first-level screening step, followed by IgA-AGA test, serum IgA antiendomysium (EMA), and total serum IgA determination performed in all sera showing abnormally high IgG-AGA results. Jejunal biopsy was suggested for all subjects showing at least one of the following: IgA-EMA positivity; IgG-AGA and IgA-AGA positivity; IgG-AGA positivity and selective IgA deficiency. AGA was determined by an enzyme-linked immunosorbent assay (ELISA) technique and IgA-EMA was ascertained by indirect immunofluorescence on cryostat sections of monkey esophagus. Jejunal mucosa samples were obtained with a Watson capsule. RESULTS: Sixty-two (3.03%) blood donors had IgG-AGA above the cut-off values. Fifty-eight individuals showed isolated high values of IgG-AGA, whereas four had simultaneously increased IgG and IgA-AGA. Three patients had positive IgA-EMA test (one with both IgG- and IgA-AGA and two with only IgG-AGA) and underwent jejunal biopsies that disclosed complete villous atrophy associated with an increased number of intraepithelial lymphocytes and hypertrophic criptae. In this study group, the prevalence of biopsy-proven celiac disease was 1.47 +/- 1.66 in 1000 subjects. CONCLUSIONS: We found a prevalence of undiagnosed CD of 1:681 among apparently healthy blood donors. These preliminary results support the view that CD is not a rare disease in Brazil.
Assuntos
Doadores de Sangue/estatística & dados numéricos , Doença Celíaca/epidemiologia , Comparação Transcultural , Adolescente , Adulto , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , América do Sul/epidemiologiaRESUMO
The prevalence of antiendomysial antibody (AEA) in 989 Saharawi children was 5.6%. Intestinal biopsies in a subsample confirmed that AEA is a marker of coellac disease in people living in a developing country.
Assuntos
Doença Celíaca/epidemiologia , Doenças Endêmicas , Adolescente , África do Norte/epidemiologia , Autoanticorpos/análise , Biópsia , Doença Celíaca/diagnóstico , Doença Celíaca/patologia , Criança , Pré-Escolar , Feminino , Humanos , Imunoglobulina A/análise , Lactente , Intestinos/patologia , Masculino , Músculo Liso/imunologiaRESUMO
BACKGROUND: Our objective was to determine the possible presence of IgA antibodies directed against human central nervous system (CNS) structures in sera from coeliac disease (CD) patients. METHODS: Serum samples were collected from 4 patients with active CD on a gluten-containing diet, 11 biopsy-proven CD patients on a gluten-free diet (GFD), and 52 non-coeliac gastrointestinal controls. In all patients IgA antigliadin antibody (AGA) titres were determined with enzyme-linked immunoassay (ELISA), and IgA antiendomysium antibodies (EMA) with indirect immunofluorescence on human umbilical cord. Cryostat sections of human brain occipital cortex were incubated with the patients' sera and subsequently labelled with anti-human IgA fluorescein conjugate. RESULTS: All sera from patients with active CD on a gluten-containing diet yielded positive results in both the IgG-AGA and EMA test and in indirect immunofluorescence on brain tissue, disclosing a strong fluorescence over blood-vessels structures. All sera from CD patients on a GFD and from non-coeliac gastrointestinal controls gave a negative result on both the EMA test and the immunofluorescence reaction on human brain. CONCLUSIONS: Sera from patients with active CD contain IgA antibodies that react with human brain vessel structures, giving intense fluorescence. These antibodies are not present in sera from coeliac patients on a GFD or non-coeliac controls. This finding might be involved in the abnormal nervous system manifestations frequently described in association with coeliac disease.
Assuntos
Autoanticorpos/sangue , Encéfalo/irrigação sanguínea , Encéfalo/imunologia , Doença Celíaca/imunologia , Imunoglobulina A/sangue , Adulto , Idoso , Estudos de Casos e Controles , Pré-Escolar , Ensaio de Imunoadsorção Enzimática , Feminino , Sangue Fetal/imunologia , Técnica Indireta de Fluorescência para Anticorpo , Gliadina/imunologia , Humanos , Lactente , Masculino , Pessoa de Meia-IdadeRESUMO
Biliary changes secondary to portal hypertension are uncommon. These patients do not usually present clinical or biochemical evidence of cholestasis. This report describes one case of obstructive jaundice due to portal cavernoma. The obstructive jaundice appeared in adulthood in a patient who had developed the portal cavernoma during childhood. Endoscopic retrograde cholangiography allowed both the diagnosis and the palliative treatment of the stenosis of the common bile duct, avoiding risky surgical treatment.
Assuntos
Neoplasias do Sistema Biliar/complicações , Colangiopancreatografia Retrógrada Endoscópica/métodos , Colestase/terapia , Hemangioma Cavernoso/complicações , Adulto , Neoplasias do Sistema Biliar/diagnóstico , Neoplasias do Sistema Biliar/terapia , Colangiopancreatografia Retrógrada Endoscópica/instrumentação , Colangite/diagnóstico , Colangite/etiologia , Colangite/terapia , Colestase/diagnóstico , Colestase/etiologia , Ducto Colédoco/patologia , Intervalo Livre de Doença , Hemangioma Cavernoso/diagnóstico , Humanos , Masculino , StentsRESUMO
The present paper reports data regarding the influence of aluminum, at micromolar concentrations, on intracellular calcium homeostasis. Al3+ modifies Ca2+ uptake in the endoplasmic reticulum (ER), accelerates Ca2+ release from mitochondria and strongly inhibits Ca2+-ATPase activity with a consequent high-level calcium accumulation inside the cell. These results suggest that Al3+ neurotoxicity may be related to an alteration of the intracellular calcium regulatory system.
Assuntos
Alumínio/química , Cálcio/metabolismo , Líquido Intracelular/metabolismo , Alumínio/metabolismo , Animais , Transporte Biológico Ativo , ATPases Transportadoras de Cálcio/antagonistas & inibidores , ATPases Transportadoras de Cálcio/metabolismo , Retículo Endoplasmático/enzimologia , Retículo Endoplasmático/metabolismo , Inibidores Enzimáticos/química , Corantes Fluorescentes/metabolismo , Homeostase , Líquido Intracelular/enzimologia , Mitocôndrias Hepáticas/enzimologia , Mitocôndrias Hepáticas/metabolismo , Compostos Orgânicos , Ratos , Ratos Wistar , Tapsigargina/químicaRESUMO
BACKGROUND AND AIMS: Intrahepatic stones are a frequent disease in the Eastern world but rare in Western countries. Treatment is complex and often requires surgical intervention. Extracorporeal shock wave lithotripsy is a relatively recent technique, widely used in the treatment of stones in the gallbladder and common bile duct. It can also be used in the treatment of intrahepatic stones. The present study analyses the efficacy of extracorporeal shock wave lithotripsy in intrahepatic stones. PATIENTS AND METHODS: In our study, we used extracorporeal lithotripsy in six cases of intrahepatic stones (mean age 53 years). In five of these cases deformities of the intrahepatic bile ducts were also present: stenoses and angulated strictures. The stones were in the right lobe of the liver in 5 patients, and in both lobes in 1 patient. Four patients had multiple stones and 2 a single stone, all varying in diameter from 6 to 25 mm. The stones were localized radiologically with contrast medium through a drainage tube. The technique does not require anaesthesia. An average of three lithotripsy sessions were necessary, with a mean total of 8050 shock waves per patient. RESULTS: Successful fragmentation was obtained in 5 out of 6 patients, while the remaining subsequently underwent surgery. No complications were observed. CONCLUSIONS: Extracorporeal shock wave lithotripsy proved to be effective, easy to perform and safe for the treatment of intrahepatic stones.
Assuntos
Ductos Biliares Intra-Hepáticos , Colelitíase/terapia , Litotripsia , Adulto , Idoso , Colangiografia , Colelitíase/complicações , Colestase Intra-Hepática/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoAssuntos
Anticorpos Antibacterianos/análise , Endoscopia Gastrointestinal/efeitos adversos , Infecções por Helicobacter/transmissão , Helicobacter pylori/imunologia , Imunoglobulina G/análise , Transmissão de Doença Infecciosa do Paciente para o Profissional , Adulto , Idoso , Ensaio de Imunoadsorção Enzimática , Feminino , Infecções por Helicobacter/epidemiologia , Infecções por Helicobacter/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Taiwan/epidemiologiaRESUMO
During recent decades, acute bacterial parotitis has progressively changed its etiological and clinical spectrum. New risk factors and causative agents are emerging, while the associated rates of complications and mortality may remain still significant. A rare case of concurrent bilateral suppurative parotitis caused by Staphylococcus aureus has been observed in a patient hospitalized for prior abdominal surgery and multiple underlying illnesses. The disease had a complicated and ultimately fatal outcome, despite a timely diagnosis being made and a specific treatment started. A literature review dealing with risk factors, microbiology, clinical picture, complications, differential diagnosis, treatment and outcome of suppurative parotitis is presented.
Assuntos
Parotidite/etiologia , Infecções Estafilocócicas/etiologia , Doença Aguda , Idoso , Evolução Fatal , Humanos , Masculino , Parotidite/diagnóstico , Staphylococcus aureus/isolamento & purificação , Supuração/etiologiaRESUMO
OBJECTIVE: To evaluate the usefulness of a series of ultrasound parameters in the differential diagnosis between serous and mucinous forms of cystic tumours of the pancreas. SETTING: Retrospective comparative study between the histological analysis of surgical specimens from cystic tumours of the pancreas (4 serous cystadenomas, 6 mucinous cystadenomas and 11 mucinous cystadenocarcinomas) and ultrasound evaluation. METHODS: The ultrasound images of the 21 tumours were analysed by an operator who did not know the result of the histological diagnosis and were divided according to Johnson's criteria (number of cysts > 6 and diameter < 2 cm for serous tumours; number of cysts <6 and diameter >2cm for mucinous tumours) and according to other anatomicopathological parameters such as the presence of septae, endocystic projections, central scar, central calcification and/or in the tumour wall. RESULTS: The ultrasound study gave a correct diagnosis in two out of the four (50%) serous cystic tumours. A central scar and internal calcification was present in one of them. Fifteen (88.2%) of the 17 mucinous tumours were correctly diagnosed; one presented peripheral calcifications and three endocystic projections. CONCLUSION: Ultrasound has a high degree of sensitivity in the differential diagnosis of serous and mucinous cystic tumours of the pancreas if the ultrasound aspects corresponding to the anatomicopathological structure of the neoplasms are correctly evaluated.