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1.
Actas Urol Esp (Engl Ed) ; 48(3): 218-227, 2024 Apr.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-37574011

RESUMO

INTRODUCTION: The management of patients with prostate cancer (PCa) is established in clinical practice guidelines, which are based on randomized studies according to the level of evidence. In Spain, the degree of compliance with these guidelines in clinical practice is unknown. OBJECTIVES: To describe the profiles of PCa patients at the time of diagnosis and the management of patients with localized PCa and those with BCR in Spain. MATERIALS & METHODS: A medical survey was conducted in specialized care (85 urologists [UROs], 64 radiation oncologists [ROs], and 21 medical oncologists [MOs]). Three questionnaires were developed for this study with 22 (UROs and ROs) or 21 questions (MOs). RESULTS: The annual incidence of PCa was 24,057 in participating hospitals (N = 131). The extrapolated annual incidence in Spain is 40,531 cases. The estimated prevalence of PCa in Spain is 221,689. Of note, 79% and 80% of patients seen by UROs and ROs, respectively had localized PCa at diagnosis. Biopsy was the most used diagnostic test among the three specialties, followed by abdominopelvic computer tomography. More than 90% of patients with BCR underwent standard tests. Next generation imaging tests and PET-choline/PSMA are still used residually. Most patients with localized PCa are currently treated with either surgery or radiotherapy, while for BCR patients, UROs and ROs prefer radiotherapy and MOs androgen deprivation therapy alone or in combination. CONCLUSION: This study describes patient profiles at the time of diagnosis and provides an overview of the current therapeutic management of localized PCa and BCR in clinical practice in Spain.


Assuntos
Neoplasias da Próstata , Masculino , Humanos , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/epidemiologia , Neoplasias da Próstata/terapia , Espanha/epidemiologia , Antagonistas de Androgênios , Espécies Reativas de Oxigênio , Inquéritos e Questionários
2.
Artigo em Inglês | MEDLINE | ID: mdl-37813239

RESUMO

INTRODUCTION: Amino acid PET is a tool recommended by the main neuroimaging societies in the differential diagnosis between radionecrosis (RNC) and umour recurrence (TR) in brain tumours, but its use in our country is still limited. The aim of this work is to present our experience with 6-[18F]FDOPA PET/CT (FDOPA) in brain tumours (primary and M1), comparing these results with other published results. MATERIAL AND METHODS: Retrospective study of 62 patients with suspected tumour recurrence (TR): 42 brain metastases (M1) and 20 primary, who underwent FDOPA. Images were analysed visually and semi-quantitatively, obtaining SUVmax and SUVmaxlesion/SUVmaxstriatum (L/S) and SUVmaxlesion/SUVmaxcortex (L/C) ratios. The diagnostic validity of PET was analysed and the best performing cut-off points were calculated. PET results were compared with clinical-radiological follow-up and/or histopathology. RESULTS: TR was identified in 49% of M1 and 76% of brain primaries. The best performing FDOPA interpretation was visual and semi-quantitative, with a sensitivity and specificity in primaries of 94% and 80% and in M1s of 96% and 72% respectively. The cut-off points with the best diagnostic performance were L/C1.44 in M1 and L/C1.55 in primaries. There are discrepant results with other published results. CONCLUSION: FDOPA PET/CT is a useful tool in the differential diagnosis between recurrence and RNC in brain tumours. It is needed a standardization to contribute to homogenise FDOPA results a inter-centre level.


Assuntos
Neoplasias Encefálicas , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Humanos , Recidiva Local de Neoplasia/diagnóstico por imagem , Estudos Retrospectivos , Tomografia por Emissão de Pósitrons/métodos , Di-Hidroxifenilalanina , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/radioterapia
3.
Arch Dermatol Res ; 315(9): 2721-2724, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37477680

RESUMO

An inflammatory microenvironment has been shown to increase risk for malignant melanoma, suggesting that melanoma may be related to a pro-inflammatory state. Though Hashimoto's thyroiditis is one of the most common autoimmune diseases, there are no investigations of its relationship with melanoma. We aim to determine if Hashimoto's increases risk of developing melanoma. A retrospective, validated cohort of patients with a diagnosis of Hashimoto's between 2005 and 2020 were identified using the Olmsted County database. Patients were age and sex matched to controls without a Hashimoto's diagnosis. The primary outcomes were development of melanoma and time to first melanoma diagnosis. 4805 patients were included in the study, with 1726 (36%) having a diagnosis of Hashimoto's. Hashimoto's patients had no significant difference in risk of melanoma (relative risk 0.96, 95% CI 0.78-1.17) or nonmelanoma skin cancer (relative risk 0.95, 95% CI 0.86-1.06) compared with matched controls. This suggests that the local proinflammatory environment present in Hashimoto's does not contribute significantly to melanoma risk. Larger studies may be needed to further characterize the relationship between these diseases.


Assuntos
Doença de Hashimoto , Melanoma , Humanos , Estudos Retrospectivos , Estudos de Coortes , Doença de Hashimoto/epidemiologia , Risco , Melanoma/epidemiologia , Microambiente Tumoral
4.
AJNR Am J Neuroradiol ; 44(4): 358-366, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-36822829

RESUMO

Lymphomas of the CNS are the second most frequent primary brain malignancy in adults after gliomas. Presurgical suspicion of lymphoma greatly impacts patient management. The radiologic features of this tumor have been widely covered in the literature for decades, but under current classifications, mainly corresponding to the most common presentations of the most frequent type: primary diffuse large B-cell lymphoma of the CNS. Nevertheless, rarer presentations of this specific lymphoma and of other World Health Organization lymphoma subtypes with different imaging features are rarely treated. Moreover, important advances in imaging techniques, changing epidemiologic factors with relevant impact on these tumors (eg, immunodeficiency/dysregulation), and recent updates of the World Health Organization Classification of CNS Tumors 2021 and Hematolymphoid Tumors 2022 may have rendered some accepted concepts outdated. In this article, the authors aim to fulfill a critical need by providing a complete update-review, emphasizing the latest clinical-radiologic features of the full spectrum of lymphomas involving the CNS.


Assuntos
Neoplasias Encefálicas , Neoplasias do Sistema Nervoso Central , Linfoma , Segunda Neoplasia Primária , Adulto , Humanos , Linfoma/diagnóstico por imagem , Linfoma/patologia , Neoplasias do Sistema Nervoso Central/diagnóstico por imagem , Neoplasias do Sistema Nervoso Central/patologia , Diagnóstico por Imagem , Organização Mundial da Saúde
5.
AJNR Am J Neuroradiol ; 43(11): 1567-1574, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36202547

RESUMO

BACKGROUND AND PURPOSE: Immunodeficiency-associated CNS lymphoma may occur in different clinical scenarios beyond AIDS. This subtype of CNS lymphoma is diffuse large B-cell and Epstein-Barr virus-positive. Its accurate presurgical diagnosis is often unfeasible because it appears as ring-enhancing lesions mimicking glioblastoma or metastasis. In this article, we describe clinicoradiologic features and test the performance of DSC-PWI metrics for presurgical identification. MATERIALS AND METHODS: Patients without AIDS with histologically confirmed diffuse large B-cell Epstein-Barr virus-positive primary CNS lymphoma (December 2010 to January 2022) and diagnostic MR imaging without onco-specific treatment were retrospectively studied. Clinical, demographic, and conventional imaging data were reviewed. Previously published DSC-PWI time-intensity curve analysis methodology, to presurgically identify primary CNS lymphoma, was used in this particular lymphoma subtype and compared with a prior cohort of 33 patients with Epstein-Barr virus-negative CNS lymphoma, 35 with glioblastoma, and 36 with metastasis data. Normalized curves were analyzed and compared on a point-by-point basis, and previously published classifiers were tested. The standard percentage of signal recovery and CBV values were also evaluated. RESULTS: Seven patients with Epstein-Barr virus-positive primary CNS lymphoma were included in the study. DSC-PWI normalized time-intensity curve analysis performed the best for presurgical identification of Epstein-Barr virus-positive CNS lymphoma (area under the receiver operating characteristic curve of 0.984 for glioblastoma and 0.898 for metastasis), followed by the percentage of signal recovery (0.833 and 0.873) and CBV (0.855 and 0.687). CONCLUSIONS: When a necrotic tumor is found in a potentially immunocompromised host, neuroradiologists should consider Epstein-Barr virus-positive CNS lymphoma. DSC-PWI could be very useful for presurgical characterization, with especially strong performance of normalized time-intensity curves.


Assuntos
Infecções por Vírus Epstein-Barr , Glioblastoma , Linfoma Difuso de Grandes Células B , Humanos , Herpesvirus Humano 4 , Infecções por Vírus Epstein-Barr/complicações , Infecções por Vírus Epstein-Barr/diagnóstico por imagem , Estudos Retrospectivos , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Linfoma Difuso de Grandes Células B/patologia , Perfusão
6.
Rev. cir. (Impr.) ; 74(1): 61-72, feb. 2022. tab, ilus
Artigo em Espanhol | LILACS | ID: biblio-1388920

RESUMO

Resumen Introducción: Los aloinjerto cutáneos (AC) son excelentes sustitutos cutáneos temporales, sin embargo, la donación y procura de piel cadavérica, fuente habitual de AC, es baja. Objetivo: Evaluar la factibilidad de utilizar la piel proveniente de abdominoplastías como fuente de AC y su eficacia clínica. Materiales y Método: Entre el 17 de agosto de 2020 al 28 de febrero de 2021 se analizó una cohorte prospectiva de 14 pacientes femeninas sometidas a abdominoplastía por motivos estéticos, que aceptaron donar la piel del colgajo cutáneo abdominal redundante, la cual fue criopreservada. Se utilizaron los AC de piel total criopreservados (ACPTC) en 10 pacientes con diagnósticos de: pie diabético (4), laparostomía contenida (2) herida compleja extremidad inferior (2), sarcoma de cuero cabelludo recidivado (1) y melanoma (1). Resultados: Se obtuvieron 14 colgajos de piel total, los cuales fueron procesados obteniendo una superficie promedio de 302 cm2 y 8,3 láminas de distintos tamaños de utilidad clínica por paciente. En todos los pacientes en que se utilizó ACPTC hubo un prendimiento inicial del AC para posteriormente, en promedio 21 días, presentar una escara necrótica que al ser retirada presentaba un tejido vital adherido al receptor rico en fibroblastos, siendo algunos pacientes auto injertados y otros manejados con cicatrización por segunda intención como tratamiento definitivo. Discusión: Los ACPTC proporcionan una cobertura intermedia, pues una parte se integra en forma definitiva, actuando como un andamiaje biológico para la formación de una interfase sobre la cual se puede autoinjertar o dejar evolucionar con cicatrización por segunda intención y una parte es rechazada. Conclusión: La procura de piel de donante vivo, en pacientes sometidos a cirugías de contorno corporal es un proceso factible, fuente de ACPTC, los cuales permiten una nueva cobertura intermedia con múltiples aplicaciones clínicas.


Introduction: Skin allografts (SA) are outstanding temporary skin substitutes; however, cadaveric skin donation and procurement, a common source of SA, remains low. Aim: To evaluate the feasibility and clinical efficacy of using skin from abdominoplasties as a source of SA. Materials and Method: A prospective cohort was analyzed from August 17th, 2020 and February 28th, 2021, with 14 female patients submitted to abdominoplasty surgeries for aesthetic motives, who authorized skin donation from the redundant abdominal flap which was posteriorly cryopreserved. Cryopreserved total skin allografts (CTSA) was used in 10 patients with the following diagnoses: diabetic foot (4), contained laparostomy (2) complex wound of the lower limb (2), relapsing sarcoma of the scalp (1), and melanoma (1). Results: 14 CTSA were obtained, which were processed, obtaining an average area of 302 cm2 and 8.3 sheets of different sizes and clinical applications from each patient. In all patients who received CTSA, an initial attachment was observed, followed by the appearance of a necrotic scar in an average of21 days. The peeling of the latter revealed a vital tissue tightly adhered to the receptor and rich in fibroblasts. Some of the patients received autografts, and others were managed with secondary intention scarring as a definite treatment. Discussion: CTSA provide an intermediate coverage since one part is definitely adhered to, acting as a biologic scaffolding for the formation of an interface that can be autografted or left for a secondary intention scarring, and the host rejects the other portion. Conclusión: skin procurement from a living donor in patients submitted to body contour surgeries is a feasible process and significant source of CTSA, which permits a new intermediate coverage with multiple clinical uses.


Assuntos
Humanos , Feminino , Criopreservação , Abdominoplastia/métodos , Aloenxertos/cirurgia , Pele , Exames Médicos , Inquéritos e Questionários , Consentimento Livre e Esclarecido
7.
AJNR Am J Neuroradiol ; 41(10): 1816-1824, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32943424

RESUMO

BACKGROUND AND PURPOSE: DSC-PWI has demonstrated promising results in the presurgical diagnosis of brain tumors. While most studies analyze specific parameters derived from time-intensity curves, very few have directly analyzed the whole curves. The aims of this study were the following: 1) to design a new method of postprocessing time-intensity curves, which renders normalized curves, and 2) to test its feasibility and performance on the diagnosis of primary central nervous system lymphoma. MATERIALS AND METHODS: Diagnostic MR imaging of patients with histologically confirmed primary central nervous system lymphoma were retrospectively reviewed. Correlative cases of glioblastoma, anaplastic astrocytoma, metastasis, and meningioma, matched by date and number, were retrieved for comparison. Time-intensity curves of enhancing tumor and normal-appearing white matter were obtained for each case. Enhancing tumor curves were normalized relative to normal-appearing white matter. We performed pair-wise comparisons for primary central nervous system lymphoma against the other tumor type. The best discriminatory time points of the curves were obtained through a stepwise selection. Logistic binary regression was applied to obtain prediction models. The generated algorithms were applied in a test subset. RESULTS: A total of 233 patients were included in the study: 47 primary central nervous system lymphomas, 48 glioblastomas, 39 anaplastic astrocytomas, 49 metastases, and 50 meningiomas. The classifiers satisfactorily performed all bilateral comparisons in the test subset (primary central nervous system lymphoma versus glioblastoma, area under the curve = 0.96 and accuracy = 93%; versus anaplastic astrocytoma, 0.83 and 71%; versus metastases, 0.95 and 93%; versus meningioma, 0.93 and 96%). CONCLUSIONS: The proposed method for DSC-PWI time-intensity curve normalization renders comparable curves beyond technical and patient variability. Normalized time-intensity curves performed satisfactorily for the presurgical identification of primary central nervous system lymphoma.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias do Sistema Nervoso Central/diagnóstico por imagem , Interpretação de Imagem Assistida por Computador/métodos , Neuroimagem/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Neoplasias Encefálicas/patologia , Neoplasias do Sistema Nervoso Central/patologia , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Retrospectivos , Adulto Jovem
8.
J Neurooncol ; 148(3): 545-554, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32524392

RESUMO

INTRODUCTION: To assess the management of immunocompetent patients with primary central nervous system lymphomas (PCNSL) in Spain. METHODS: Retrospective analysis of 327 immunocompetent patients with histologically confirmed PCNSL diagnosed between 2005 and 2014 in 27 Spanish hospitals. RESULTS: Median age was 64 years (range: 19-84; 33% ≥ 70 years), 54% were men, and 59% had a performance status (PS) ≥ 2 at diagnosis. Median delay to diagnosis was 47 days (IQR 24-81). Diagnostic delay > 47 days was associated with PS ≥ 2 (OR 1.99; 95% CI 1.13-3.50; p = 0.016) and treatment with corticosteroids (OR 2.47; 95% CI 1.14-5.40; p = 0.023), and it did not improve over the years. Patients treated with corticosteroids (62%) had a higher risk of additional biopsies (11.7% vs 4.0%, p = 0.04) but corticosteroids withdrawal before surgery did not reduce this risk and increased the diagnostic delay (64 vs 40 days, p = 0.04). Median overall survival (OS) was 8.9 months [95% CI 5.9-11.7] for the whole series, including 52 (16%) patients that were not treated, and 14.1 months (95%CI 7.7-20.5) for the 240 (73.4%) patients that received high-dose methotrexate (HD-MTX)-based chemotherapy. Median OS was shorter in patients ≥ 70 years (4.1 vs. 13.4 months; p < 0.0001). Multivariate analysis identified age ≥ 65 years, PS ≥ 2, no treatment, and cognitive/psychiatric symptoms at diagnosis as independent predictors of short survival. CONCLUSIONS: Corticosteroids withdrawal before surgery does not decrease the risk of a negative biopsy but delays diagnosis. In this community-based study, only 73.4% of patients could receive HD-MTX-based chemotherapy and OS remains poor, particularly in elderly patients ≥ 70 years.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias do Sistema Nervoso Central/mortalidade , Quimiorradioterapia/mortalidade , Irradiação Craniana/mortalidade , Diagnóstico Tardio/estatística & dados numéricos , Imunocompetência , Linfoma não Hodgkin/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Carmustina/administração & dosagem , Neoplasias do Sistema Nervoso Central/diagnóstico , Neoplasias do Sistema Nervoso Central/imunologia , Neoplasias do Sistema Nervoso Central/terapia , Citarabina/administração & dosagem , Feminino , Seguimentos , Humanos , Linfoma não Hodgkin/diagnóstico , Linfoma não Hodgkin/imunologia , Linfoma não Hodgkin/terapia , Masculino , Metotrexato/administração & dosagem , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Adulto Jovem
9.
Int. j. morphol ; 38(3): 787-792, June 2020. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1098320

RESUMO

El bazo se localiza en el cuadrante superior izquierdo del abdomen, relacionándose posteriormente con la 9a a 11a costilla, de las que se separa por el diafragma y el receso costodiafragmático, se localiza por detrás del estómago y lateralmente al riñón izquierdo. Por alteraciones en su desarrollo pueden generarse bazos accesorios (BA), considerándose un tejido ectópico del bazo. Se consideran tejido normal, con los mismos procesos fisiológicos que el bazo principal. Con el propósito de localizar y determinar aspectos biométricos de los mismos, se realizó un estudio de corte transversal y de carácter descriptivo, sobre una muestra de 220 exámenes de TC pertenecientes a pacientes mayores de 18 años del Hospital Regional Hernán Henríquez Aravena, Temuco, Chile. Para este estudio se excluyeron toda aquellas TC con antecedentes de esplenectomía y lesiones de Bazo o peri-esplénicas. El análisis de los datos mostró una prevalencia de 32,3 % de BA, pudiendo ser de una única presencia, dos e incluso tres BA por paciente.De un total de 71 personas que tienen al menos un BA, 34 (47,89 %) fueron de sexo femenino y 37 (52,11 %) de sexo masculino. Hubo 56 pacientes (78,9 %) con un BA, 29 (40,85 %) del sexo femenino y 27 (38,03 %) del masculino; 15 (21,1 %) presentaron más de un BA, 5 (7,04 %) de sexo femenino y 10 (14,08 %) de sexo masculino, si bien se puede observar variación en la cantidad de BA según sexo, no existe una relación estadísticamente significativa entre dichas variables. La ubicación más frecuente encontrada en el plano axial fue la zona antero-medial con 59 casos (66,29 %); asimismo, en el plano sagital, la localización más frecuente fue en el polo inferior con 40 casos (44,44 %). Datos biométricos de estos BA son mostrados en Tablas. Esta información será de gran valor morfológico y médico debido a la escasa literatura existente sobre esta materia en individuos chilenos.


The spleen is located in the upper left quadrant of the abdomen, subsequently related to the 9th to 11th rib, from which it is separated by the diaphragm and the cost-diaphragmatic recess, it is located behind the stomach and laterally to the left kidney. Due to alterations in its development, accessory spleens (AS) can be generated, being considered an ectopic tissue of the spleen. The AS are considered normal tissue, with the same physiological processes as the main spleen. With the purpose of locating and determining biometric aspects of them, a cross-sectional and descriptive study was carried out on a sample of 220 CT scans belonging to patients over 18 years of age at the Hernán Henríquez Aravena Regional Hospital, Temuco, Chile. For this study, all CT scans with a history of splenectomy and spleen or peri-splenic lesions were excluded. The analysis of the data showed a prevalence of 32.3 % of AS, being able to be of a single presence, two and even three AS per patient. Of a total of 71 people who have at least one AS, 34 (47.89 %) were female and 37 (52.11 %) male. There were 56 patients (78.9 %) with a one AS, 29 (40.85 %) of the female sex and 27 (38.03 %) of the male; 15 (21.1 %) presented more than one AS, 5 (7.04 %) female and 10 (14.08 %) male, although variation in the amount of AS according to sex can be observed, no there is a statistically significant relationship between these variables. The most frequent location found in the axial plane was the anteromedial zone with 59 cases (66.29 %); also, in the sagittal plane, the most frequent location was in the lower pole with 40 cases (44.44 %). Biometric data of these AS are shown in tables. This information will be of great morphological and medical value due to the limited existing literature on this subject in Chilean individuals.


Assuntos
Humanos , Masculino , Feminino , Adulto , Baço/anormalidades , Baço/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Baço/anatomia & histologia , Chile , Fatores Sexuais , Prevalência , Estudos Transversais
10.
AAPS PharmSciTech ; 20(8): 318, 2019 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-31620905

RESUMO

Praziquantel is a broad spectrum antihelmintic agent and represents the drug of choice for the treatment of schistosomiasis. However, its low aqueous solubility and strong bitter taste highly affect the bioavailability and compliance in pediatric patients. Thus, the purpose of this study was to develop a dry nanosuspension, by a combination of high-pressure homogenization and spray drying, intended for redispersion in a pleasant taste vehicle for extemporaneous use. Three formulations, varying stabilizers to drug ratio, were developed and characterized in terms of particle size distribution, crystallinity, morphology, in vitro dissolution, and sedimentation-redispersibility behavior. A significant reduction in particle size was achieved after the high-pressure homogenization process, and the nanoparticles were further microencapsulated by spray drying technique. The redispersed dried powders exhibited a conserved particle size distribution (in the nanometric range) and certain crystallinity extent, with satisfactory redispersion ability. Besides, the enhancement of the dissolution performance obtained after comminution was conserved, even after drying and redispersion of the extemporaneous powdered formulation. In conclusion, the developed nanoparticle-loaded powders comprise an interesting tool for the administration of praziquantel to preschool-age children.


Assuntos
Anti-Helmínticos/administração & dosagem , Nanopartículas/administração & dosagem , Praziquantel/administração & dosagem , Esquistossomose/tratamento farmacológico , Criança , Composição de Medicamentos/métodos , Humanos , Tamanho da Partícula , Pós , Praziquantel/química
11.
Rev. chil. neuro-psiquiatr ; 57(3): 283-294, 2019. tab
Artigo em Espanhol | LILACS | ID: biblio-1058124

RESUMO

Resumen La polineuropatía desmielinizante inflamatoria crónica (CIDP por sus siglas en inglés) corresponde a un espectro de diferentes fenotipos clínicos caracterizados por lesiones de naturaleza autoinmune, inflamatoria y desmielinizante, que afectan primariamente nervios periféricos y raíces nerviosas. Generalmente, los pacientes con CIDP presentan un curso crónico de discapacidad neurológica, pero hasta un tercio de los casos puede exhibir un curso remitente-recidivante. El fenotipo clásico involucra compromiso simétrico de la fuerza muscular y la sensibilidad proximal y distal, asociado a arreflexia generalizada. El diagnóstico requiere la demostración de la desmielinización de nervios mediante electromiografía o biopsia de nervios. Debido a la afectación de personas relativamente jóvenes, laboralmente activos, y a la gran discapacidad neurológica que puede generar, el tratamiento debiera ser iniciado precozmente. Los pilares de la terapia en su fase inicial son los corticoides intravenosos en altas dosis, inmunoglobulina intravenosa y la plasmaféresis, mientras que la terapia de mantención se basa, principalmente, en el uso de corticoides orales a bajas dosis. Este artículo presenta el caso de un paciente evaluado en nuestro hospital y diagnosticado con CIDP, y expone una revisión bibliográfica actualizada de la enfermedad.


Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) can be defined as a spectrum of different clinical phenotypes which are characterized by autoimmune, inflammatory and demyelinating injuries, primarily affecting the peripheral nerves and nerve roots. Most patients with CIDP have a chronic course of neurological disability, but about a third of cases exhibit a relapsing-remitting course. Classic phenotype of CIDP involves symmetric compromise of proximal and distal muscle strength and sensitivity, associated with generalized areflexia. For an accurate diagnosis, demonstration of nerve demyelination by electromyography or nerve biopsy is required. Due to the affectation of relatively young, labor-active people and the high risk for neurological disability by the disease, treatment should be initiated early. The predominant lines of therapy, in its initial phase, are high-dose intravenous corticosteroids, intravenous immunoglobulin and plasmapheresis, while the maintenance therapy is mainly based on low-dose oral corticosteroids. This article presents a case report of a patient evaluated in our hospital and diagnosed with CIDP and exposes an updated literature review about this disease.


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Nervos Periféricos , Polineuropatias , Doenças Autoimunes , Doenças Desmielinizantes
12.
Mater Sci Eng C Mater Biol Appl ; 93: 28-35, 2018 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-30274060

RESUMO

Praziquantel (PZQ), an antihelmintic agent commonly administered to humans and cattle, has low aqueous solubility, which compromises its bioavailability and efficacy. The purpose of this study was to develop a new formulation, in order to improve PZQ dissolution rate. PZQ dispersions have been developed by high-pressure homogenization (HPH) using different stabilizers, selected upon PZQ saturation solubility. After the screening, two promising formulations were developed, combining poloxamer 188 with polyvinylpyrrolidone or maltodextrin. Characterization studies including particle size distribution, crystallinity, morphology, drug content, and in vitro dissolution profiles, were performed over selected formulations. The scanning electronic micrographs revealed that the morphology of suspended particles corresponded to elongated shapes, with an average particle size close to the micron range. X-ray powder diffractometry and differential scanning calorimetry results confirmed the drug crystallinity, before and after the HPH process. Besides, differential scanning calorimetry revealed the absence of interactions between PZQ and excipients. The dissolution rate of PZQ dispersions was significantly enhanced compared with raw PZQ, either in phosphate buffer or hydrochloric acid, mainly due to particle size reduction, thus improved saturation solubility.


Assuntos
Anti-Helmínticos/química , Poloxâmero/química , Polissacarídeos/química , Povidona/química , Praziquantel/química , Pressão
13.
Eur J Neurol ; 25(2): 387-394, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29115706

RESUMO

BACKGROUND AND PURPOSE: The main aim of this study was to identify which patients with glioblastoma multiforme (GBM) have a higher risk of presenting seizures during follow-up. METHODS: Patients with newly diagnosed GBM were reviewed (n = 306) and classified as patients with (Group 1) and without (Group 2) seizures at onset. Group 2 was split into patients with seizures during follow-up (Group 2A) and patients who never had seizures (Group 2B). The anatomical location of GBM was identified and compared by voxel-based lesion symptom mapping (discovery set). Seizure-susceptible brain regions obtained were assessed visually and automatically in external GBM validation series (n = 85). RESULTS: In patients with GBM who had no seizures at onset, an increased risk of presenting seizures during follow-up was identified in the superior frontal and inferior occipital lobe, as well as in inferoposterior regions of the temporal lobe. Conversely, those patients with GBM located in medial and inferoanterior temporal areas had a significantly lower risk of suffering from seizures during follow-up. Additionally, the seizure-susceptible brain region maps obtained classified patients in the validation set with high positive and negative predictive values. CONCLUSIONS: Tumor location is a useful marker to identify patients with GBM who are at risk of suffering from seizures during follow-up. These results may help to support the use of antiepileptic prophylaxis in a selected GBM population and to improve stratification in antiepileptic clinical trials.


Assuntos
Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/patologia , Córtex Cerebral/patologia , Glioblastoma/complicações , Glioblastoma/patologia , Convulsões/etiologia , Adulto , Idoso , Anticonvulsivantes/uso terapêutico , Neoplasias Encefálicas/diagnóstico por imagem , Córtex Cerebral/diagnóstico por imagem , Feminino , Seguimentos , Glioblastoma/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Convulsões/prevenção & controle
14.
Redox Biol ; 2: 590-8, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24688895

RESUMO

Many carbonyl species from either lipid peroxidation or glycoxidation are extremely reactive and can disrupt the function of proteins and enzymes. 4-hydroxynonenal and methylglyoxal are the most abundant and toxic lipid-derived reactive carbonyl species. The presence of these toxics leads to carbonyl stress and cause a significant amount of macromolecular damages in several diseases. Much evidence indicates trapping of reactive carbonyl intermediates may be a useful strategy for inhibiting or decreasing carbonyl stress-associated pathologies. There is no rapid and convenient analytical method available for the assessment of direct carbonyl scavenging capacity, and a very limited number of carbonyl scavengers have been identified to date, their therapeutic potential being highlighted only recently. In this context, we have developed a new and rapid sensitive fluorimetric method for the assessment of reactive carbonyl scavengers without involvement glycoxidation systems. Efficacy of various thiol- and non-thiol-carbonyl scavenger pharmacophores was tested both using this screening assay adapted to 96-well microplates and in cultured cells. The scavenging effects on the formation of Advanced Glycation End-product of Bovine Serum Albumin formed with methylglyoxal, 4-hydroxynonenal and glucose-glycated as molecular models were also examined. Low molecular mass thiols with an α-amino-ß-mercaptoethane structure showed the highest degree of inhibitory activity toward both α,ß-unsaturated aldehydes and dicarbonyls. Cysteine and cysteamine have the best scavenging ability toward methylglyoxal. WR-1065 which is currently approved for clinical use as a protective agent against radiation and renal toxicity was identified as the best inhibitor of 4-hydroxynonenal.


Assuntos
Aldeídos/farmacologia , Cisteamina/farmacologia , Cisteína/farmacologia , Ensaios de Triagem em Larga Escala/métodos , Aldeído Pirúvico/farmacologia , Aldeídos/antagonistas & inibidores , Animais , Células CACO-2 , Linhagem Celular Tumoral , Produtos Finais de Glicação Avançada/metabolismo , Humanos , Mercaptoetilaminas/farmacologia , Camundongos , Aldeído Pirúvico/antagonistas & inibidores , Sensibilidade e Especificidade , Soroalbumina Bovina/metabolismo
15.
Rev Stomatol Chir Maxillofac Chir Orale ; 114(5): 287-91, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24176690

RESUMO

INTRODUCTION: Bifocal fractures of the mandible often associate the angle and condyle or symphysis. Little data is available on biangular fractures. The authors had for aim to study their characteristics and to suggest an adapted management. MATERIAL AND METHODS: We retrospectively reviewed the records of patients operated on for a biangular fracture from January 2005 to December 2009. The impact of a third molar was evaluated using Pell and Gregory's and Shiller's classifications. RESULTS: Six hundred and forty patients underwent surgery for a mandibular fracture, seven of whom (1.1%) for biangular fractures. The patients' mean age was 27.6 years. Patients were predominantly men (85.7%). Assaults or brawls were the most frequent etiology (85.7%). The mechanism was direct impact in every case. The inferior alveolar nerve was injured in 57.1% of cases. There was an impacted third molar in 71.4% of cases. Most of the time, a single miniplate was sufficient for each angle. Two cases of postoperative infection were noted. The mean follow-up was 52.2months. The occlusion was restored in every case. Three patients presented with neurological sequels in the V3 area. DISCUSSION: Biangular fractures are rare and present a high risk of infection and neurological sequels. The presence of a mesioangular impacted third molar seems to be a predisposing factor. The risk of neurological sequels requires performing surgery rapidly.


Assuntos
Fraturas Mandibulares/epidemiologia , Fraturas Mandibulares/cirurgia , Adolescente , Adulto , Feminino , Humanos , Masculino , Fraturas Mandibulares/classificação , Fraturas Mandibulares/complicações , Nervo Mandibular/cirurgia , Pessoa de Meia-Idade , Dente Serotino/cirurgia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Dente Impactado/complicações , Dente Impactado/epidemiologia , Dente Impactado/cirurgia , Traumatismos do Nervo Trigêmeo/complicações , Traumatismos do Nervo Trigêmeo/epidemiologia , Traumatismos do Nervo Trigêmeo/cirurgia , Adulto Jovem
16.
Biochem Biophys Res Commun ; 439(1): 137-41, 2013 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-23942115

RESUMO

We reported, in previous experiments, that AA is a global regulator of cAMP pools. In this study, we demonstrate that K873, an analog of AA we synthesized and presenting antiproliferative properties, has also an impact on cAMP production. However, K873 has no antioxidant activity, at the contrary of AA. It definitively demonstrates that action of AA on the cAMP production is not linked to antioxidant activity. These data suggest that AA, and derivatives of this molecule, could be promising drug acting on biological processes that are under the control of cAMP dependent pathway.


Assuntos
Ácido Ascórbico/análogos & derivados , Ácido Ascórbico/química , AMP Cíclico/metabolismo , Organofosfatos/farmacologia , Animais , Antioxidantes/metabolismo , Ácido Ascórbico/farmacologia , Linhagem Celular , Proliferação de Células , Relação Dose-Resposta a Droga , Camundongos , Proteínas da Mielina/metabolismo , Técnicas de Cultura de Órgãos/métodos , Ratos , Células de Schwann/citologia , Nervo Isquiático/metabolismo , beta Caroteno/metabolismo
18.
Rev. MVZ Córdoba ; 17(2): 10-20, mayo-ago. 2012. ilus, graf, tab
Artigo em Espanhol | LILACS, COLNAL | ID: lil-657092

RESUMO

Objetivo. El objetivo de este trabajo fue comparar los índices espontáneos e inducidos en ratones de ambos sexos de las líneas Balb/c, NMRI, OF-1 y C57BL/6/cenp, mediante el ensayo de aberraciones cromosómicas en células de la médula ósea. Materiales y métodos. Con este fin se determinó la línea más eficiente, sobre la base de la aparición significativa de índices espontáneos más bajos e índices inducidos altos a sustancias mutagénicas como la ciclofosfamida (CF). Resultados. Se obtuvo como resultado que la línea Balb/c en ambos sexos difiere significativamente de las demás líneas evaluadas. En esta línea se encontró el menor número de células totales con aberraciones estructurales y un mayor número de inducción de aberraciones cromosómicas cuando es utilizada la CF como mutágeno. Conclusiones. Este trabajo permitirá utilizar la mejor línea de ratones como biomodelo en este ensayo de genotoxicidad, además que le confiere a esta técnica citogenética mayor veracidad y robustez.


Objective. The aim of this study was to compare spontaneous and induced rates in mice of both sexes of lines BALB / c, NMRI, OF-1 and C57BL/6/ cenp, by testing chromosomal aberrations in bone marrow cells. Materials and methods. For this purpose, the most efficient line was determined, based on the significant appearance of lower spontaneous rates and higher induced rates to mutagen substances such as cyclophosphamide (CP). Results. The result obtained was that line Balb / c, in both sexes, differs significantly from the other lines tested. The lesser total number of cells with structural aberrations was found in this line and a greater number of induction of chromosomal aberrations when CP was used as a mutagen. Conclusions. This work will give way to the use of the best line of mice as bio model in this genotoxicity test, and will also give this cytogenetic technique greater veracity and robustness.


Assuntos
Medula Óssea , Aberrações Cromossômicas , Camundongos
19.
Rev Med Interne ; 31(3): 188-93, 2010 Mar.
Artigo em Francês | MEDLINE | ID: mdl-20053487

RESUMO

PURPOSE: Misuse of high-dose buprenorphine (HDB), mainly by injection, is responsible of frequent infectious adverse events. METHODS: This is a retrospective study of infectious complications occurring in patients using HDB by injection. Forty-two cases were identified (29 men and ten women) and the data were collected between March 1999 and December 2008. RESULTS: The infectious complications included cutaneous infections (27 cases), endocarditis (nine cases), osteoarticular infections (four spondylodiscitis and one sacroiliitis), and a vascular embolism with decrease in visual acuity. CONCLUSION: The results of HDB maintenance treatment must be improved, both from the point of view of substitution and to limit its misuse by intravenous route injection. Health professionals have to play an important role in drug addict patients' education and supervision, to prevent buprenorphine injection and related infectious complications.


Assuntos
Infecções Bacterianas/etiologia , Buprenorfina/administração & dosagem , Injeções Intravenosas/efeitos adversos , Injeções Subcutâneas/efeitos adversos , Antagonistas de Entorpecentes/administração & dosagem , Abscesso/etiologia , Adulto , Discite/etiologia , Relação Dose-Resposta a Droga , Endocardite Bacteriana/etiologia , Feminino , Dependência de Heroína/reabilitação , Humanos , Masculino , Estudos Retrospectivos
20.
Rev Stomatol Chir Maxillofac ; 110(6): 329-34, 2009 Dec.
Artigo em Francês | MEDLINE | ID: mdl-19863983

RESUMO

The aneurysmal bone cyst is a rare, expansive, osteolytic, pseudocystic lesion with an unknown etiology. It usually affects long bones and the spine. Two to 5 % of cases have mandibular localization (between 75 and 100 % present on the mandible) accounting for 1 % of all mandibular cysts. Less than 200 cases have been reported in English and French literature.


Assuntos
Cistos Ósseos Aneurismáticos/diagnóstico , Doenças Mandibulares/diagnóstico , Cistos Ósseos Aneurismáticos/cirurgia , Diagnóstico Diferencial , Diagnóstico por Imagem , Humanos , Doenças Mandibulares/cirurgia
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