RESUMO
OBJECTIVE: To assess the effectiveness of apheresis therapy (AT) in treating the clinical manifestations of patients with complicated cryoglobulinemic vasculitis (CV). METHODS: A retrospective cohort study of 159 CV patients attending 22 Italian Centers who underwent at least one AT session between 2005 and 2015. The response to AT was evaluated on the basis of a defined grading system. RESULTS: Peripheral neuropathy was the most frequent clinical condition leading to AT. Therapeutic plasma exchange was used in 70.4% of cases. The outcome of AT was rated very good in 19 cases, good in 64, partial/transient in 40, and absent/not assessable in 36. Life-threatening CV-related emergencies and renal impairment independently correlated with failure to respond to AT. The independent variables associated with an increased risk of death were age at the time of the first AT session, multi-organ life-threatening CV, the presence of renal impairment and failure to respond to AT. The time-dependent probability of surviving until CV-related death in the second year was 84%, with an AHR in patients with absent/not assessable response to AT of 11.25. CONCLUSION: In this study AT is confirmed to be a safe procedure in patients with CV. Early AT should be considered in patients with severe CV, especially in cases with impending renal involvement, in order to prevent irreversible kidney damage. Although its efficacy in patients with multi-organ failure is limited, AT is the only treatment that can rapidly remove circulating cryoglobulins, and should be considered an emergency treatment.
Assuntos
Remoção de Componentes Sanguíneos/métodos , Crioglobulinemia/terapia , Troca Plasmática/métodos , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
OBJECTIVE: To investigate variations in bone mineral density during lactation and throughout the 12 months after scheduled cessation of lactation in relation to the resumption of ovarian function. METHODS: Three hundred eight mothers who decided to lactate were scheduled to fully breast-feed for 6 months, followed by a 1-month weaning period, and then suppress lactation with cabergoline. Their bone mineral density variations were compared with those of a control group of nonlactating mothers during the first 18 months postpartum. Half the lactating women were given daily oral calcium supplements of 1 g in an open design. RESULTS: There was a significant progressive decrease in bone mineral density in lactating women over the first 6 months, followed by recovery of bone mass up to levels that at 18 months were higher than baseline. In nonlactating women, bone mineral density increased progressively after delivery, and at 18 months postpartum had increased by 1.1-1.9% compared with baseline. Compared with lactating women who resumed menstruation within 5 months of delivery, breast-feeding mothers with longer amenorrhea initially lost more bone, but they also gained significantly more bone after resumption of menses, so there were no differences at 18 months postpartum. Oral calcium supplementation decreased bone loss, but had only a transient effect. CONCLUSION: A scheduled lactation period of 6 months, followed by a 1-month weaning period, allowed bone mineral density to reach higher values compared with early postpartum, regardless of calcium supplementation and duration of postpartum amenorrhea.
Assuntos
Densidade Óssea/fisiologia , Lactação/fisiologia , Adulto , Cálcio/uso terapêutico , Feminino , Humanos , MenstruaçãoRESUMO
OBJECTIVE: To study the sociodemographic risk factors and clinical features of Torulopsis glabrata vaginal infection. METHODS: We evaluated the sociodemographic and clinical characteristics of 86 consecutive symptomatic women attending a vaginitis clinic and isolated T glabrata. Case patients were compared with a control group of 174 asymptomatic women with negative vaginal cultures and an additional group of 625 symptomatic women with vaginal cultures positive for Candida albicans. In addition, the sensitivity of the isolates to the more common antimycotic agents used was tested by the modified Kirby-Bauer method. RESULTS: Patients with T glabrata vaginal infection were from lower socioeconomic backgrounds and had less education. They were more likely to use vaginal tampons and to be seropositive for human immunodeficiency virus than were negative controls. Compared with C albicans infection, T glabrata was more frequent among women over 38 years of age and in those with less education and of lower social class. In logistic regression analysis, T glabrata was associated more frequently with recurrent vaginal candidiasis than was C albicans (odds ratio 2.46, 95% confidence interval 1.33-4.54; P = .004). Six of the 86 (7%) T glabrata isolates and none of the C albicans isolates (P < .001 by Fisher exact test) were resistant to the imidazole derivatives tested. CONCLUSION: Torulopsis glabrata was isolated in 10% of women with vulvovaginal candidiasis attending a vaginitis clinic. This infection was associated with recurrent vaginitis in almost one-third of case patients presenting with symptoms.
Assuntos
Candidíase Vulvovaginal/epidemiologia , Vaginite/epidemiologia , Adulto , Estudos de Casos e Controles , Intervalos de Confiança , Feminino , Humanos , Modelos Logísticos , Razão de Chances , Fatores de Risco , Sensibilidade e Especificidade , Fatores Socioeconômicos , Vaginite/microbiologiaRESUMO
OBJECTIVE: To estimate the risk for cerebral palsy in preterm infants in relation to the presence of meconium in the amniotic fluid (AF). METHODS: A cohort study was conducted of 404 consecutive preterm infants delivered between 24 and 33 weeks' gestation at a single institution. Sociodemographic and clinical data were collected at birth. The diagnosis of cerebral palsy was made at 2 years' corrected age. Politomous logistic regression models were used to evaluate the odds for cerebral palsy while adjusting for potential confounders. RESULTS: The overall prevalence of cerebral palsy among survivors was 11.6% (40/345). The cerebral palsy rate was 41.2% (7/17) among infants who were meconium-stained at birth and 10% (33/328) among those who were not (P = .006 by Fisher exact test). After adjustment for potential confounders (gestational age and fetal gender), the odds ratio of cerebral palsy among infants delivered to women with meconium-stained AF was 6.9 (95% confidence interval 2.32, 20.81, P = .001) relative to those delivered to women with clear AF. CONCLUSION: The results of the present study support the view that the presence of meconium in the AF is a gestational age-independent risk factor for cerebral palsy among preterm infants.
Assuntos
Líquido Amniótico , Paralisia Cerebral/epidemiologia , Doenças do Prematuro/epidemiologia , Mecônio , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Modelos Logísticos , Prevalência , Fatores de Risco , Fatores SocioeconômicosRESUMO
The relation of maternal blood group to pre-eclampsia has not been adequately studied in previous research. To investigate this relation, we conducted a case-control study of primigravidae. Data on 204 consecutive severely pre-eclamptic patients delivered pre-term and 744 controls were analysed using multivariate methods. After adjustment for the confounding effects of maternal age, social class, origin, education, pre-pregnancy weight and body mass index, and weight gain in pregnancy, we found an increased risk of pre-eclampsia for mothers with blood type AB (adjusted odds ratio = 3.07; 95% confidence interval 1.48-6.36). With respect to blood group O, A, B and Rh type, no statistically significant correlation with severe pre-eclampsia was found. Although these results should be considered with caution, they support the hypothesis of a linkage mechanism involving blood group in the inheritance of susceptibility to pre-eclampsia.
Assuntos
Antígenos de Grupos Sanguíneos , Pré-Eclâmpsia/epidemiologia , Adulto , Distribuição por Idade , Estudos de Casos e Controles , Intervalos de Confiança , Feminino , Humanos , Modelos Logísticos , Análise Multivariada , Pré-Eclâmpsia/sangue , Pré-Eclâmpsia/fisiopatologia , Gravidez , Estudos Prospectivos , Fatores de Risco , Fatores SocioeconômicosRESUMO
The relationship between smoking in pregnancy and the development of pre-eclampsia has not been well studied. Smoking habits were prospectively evaluated in 117 patients with pre-eclampsia and 468 normotensive control pregnancies. Twenty cases (17.1%) and 120 controls (25.6%) reported smoking at any time during pregnancy. In stepwise multiple logistic regression analysis, smoking in pregnancy was a significant protective factor against the occurrence of pre-eclampsia (adjusted odds ratio = 0.50; 95% confidence interval 0.28-0.80, P = 0.018). On the other hand, a history of pre-eclampsia in previous pregnancies, low (< 6th grade) educational level, a body mass index > 24 and maternal blood group AB were factors independently associated with an increased risk of pre-eclampsia. In conclusion, this study confirms that smoking in pregnancy reduces the risk of pre-eclampsia. However, the harmful consequences of smoking on pregnancy outcome far outweigh this risk reduction.
Assuntos
Pré-Eclâmpsia/etiologia , Fumar/efeitos adversos , Adolescente , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Gravidez , Estudos Prospectivos , Fatores de RiscoRESUMO
To evaluate risk factors related to sociodemographic and clinical variables, oral contraception and sexual behavior of women with recurrent vulvovaginal candidiasis, we conducted a case-control study comparing 153 patients with recurrent vulvovaginal candidiasis with both asymptomatic women with negative vaginal cultures and patients with nonrecurrent symptomatic vulvovaginal candidiasis. In logistic regression analysis, patients with recurrent Candida vaginitis were more likely than negative controls to have used any contraceptive method in the year before evaluation, to have used antibiotics in the month preceding the visit, and to have a higher number of lifetime sex partners. Compared to patients with nonrecurrent Candida vaginitis, patients with recurrent infection were more likely to use oral contraception and to have a higher frequency of monthly intercourse. The proportion of recur rent disease attributable to the pill averages 11-12%. We conclude that oral contraceptives may influence the recurrence of symptomatic vulvovaginal candidiasis.
PIP: Researchers in Italy compared data on 153 patients with recurrent vulvovaginal candidiasis (cases) with data on 306 asymptomatic patients (control group A) and data on 306 patients with nonrecurrent symptomatic vulvovaginal candidiasis (control group B). They wanted to examine the sociodemographic and clinical characteristics, sexual habits, and contraceptive histories of women with recurrent vulvovaginal candidiasis. Cases were more likely than asymptomatic women to have previously used any contraceptive method (odds ratio [OR] = 2.08 for the pill, p = 0.0032; OR = 4.15 for the IUD, p = 0.0019; OR = 2.55 for barrier methods, p = 0.014). They were also more likely to have used antibiotics in the last month before the visit (OR = 2.1; p = 0.009) and to have more lifetime sexual partners than asymptomatic women (OR = 3.82 for 7 partners; p = 0.009). Patients with recurrent vulvovaginal candidiasis were more likely than those with nonrecurrent vulvovaginal candidiasis to have used low-dose oral contraceptives (OCs) (OR = 1.59; p = 0.036) and to have a higher rate of monthly intercourse in the last 6 months (OR = 2.51 for 10 times; p = 0.048). The attributable risk of OC use for recurrent vulvovaginal candidiasis was insignificant (11-12%). These results suggest that OCs may contribute to the recurrence of symptomatic vulvovaginal candidiasis.
Assuntos
Candidíase/etiologia , Anticoncepcionais Orais/efeitos adversos , Vulvovaginite/microbiologia , Adolescente , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Recidiva , Análise de Regressão , Fatores de Risco , Comportamento SexualRESUMO
This prospective observational study was designed to evaluate the magnitude of the corticosteroid-related reduction in the risk of respiratory distress syndrome (RDS), intraventricular hemorrhage and neonatal death according to different etiologic subgroups of preterm delivery. Of 380 patients delivered before 35 weeks' gestation, 155 received a complete course of dexamethasone or betamethasone to promote fetal lung maturation. In logistic models, the steroid-related reduction of RDS was greater among patients with intact membranes as opposed to patients with premature rupture of membranes (excess risk = 0.31; 95% confidence interval (C.I.) = 0.13-0.73; P = 0.007) and in patients with spontaneous preterm labor as compared with other etiologic groups (excess risk = 0.33; 95% C.I. = 0.11-0.98, P = 0.04). On the other hand, the steroid-related reduction of severe (grade III-IV) intraventricular hemorrhage was more marked in growth retarded as opposed to well-grown fetuses (excess risk = 0.15; 95% C.I. = 0.03-0.96, P = 0.04), and in planned as compared with spontaneous preterm deliveries (excess risk = 0.15; 95% C.I. = 0.03-0.96, P = 0.04). Results show that the greatest benefit from antenatal steroids appears to be in preterm deliveries with intact membranes and in planned preterm deliveries.
Assuntos
Corticosteroides/uso terapêutico , Doenças do Prematuro/prevenção & controle , Trabalho de Parto Prematuro/complicações , Corticosteroides/farmacologia , Adulto , Betametasona/farmacologia , Betametasona/uso terapêutico , Hemorragia Cerebral/epidemiologia , Hemorragia Cerebral/etiologia , Hemorragia Cerebral/prevenção & controle , Dexametasona/farmacologia , Dexametasona/uso terapêutico , Feminino , Retardo do Crescimento Fetal/tratamento farmacológico , Humanos , Mortalidade Infantil , Recém-Nascido , Doenças do Prematuro/epidemiologia , Doenças do Prematuro/etiologia , Pulmão/efeitos dos fármacos , Masculino , Modelos Teóricos , Pré-Eclâmpsia/tratamento farmacológico , Gravidez , Resultado da Gravidez/epidemiologia , Estudos Prospectivos , Síndrome do Desconforto Respiratório do Recém-Nascido/epidemiologia , Síndrome do Desconforto Respiratório do Recém-Nascido/etiologia , Síndrome do Desconforto Respiratório do Recém-Nascido/prevenção & controle , Fatores de RiscoRESUMO
The relationship between maternal risk factors and severity of fetal growth deficit was evaluated in a population of 613 small for gestational age (SGA) infants and 784 appropriately grown controls. The severity of growth deficit among SGA infants was expressed as 'fetal growth ratio' (observed/expected birthweight, where expected birthweight is the mean birthweight of the Italian population for a given gestational age). In multivariate models, preeclampsia was the only maternal high-risk factor positively correlated with a more severe growth deficit among SGA infants. Chronic cardiac or renal maternal diseases and female fetal sex were associated with mild forms of SGA, thus showing an inverse relationship with severity of growth deficit. Finally, the association between maternal smoking in pregnancy, low (< 0.2 kg/week) maternal weight gain, low (< 50 kg) pre-pregnancy weight, severe (Hb, < 8 g/dl) maternal anaemia, low education (< 6th grade), history of a previous low birthweight infant or recurrent spontaneous abortion, nulliparity and SGA was homogeneous across the severity strata of fetal growth deficit.
Assuntos
Retardo do Crescimento Fetal/etiologia , Recém-Nascido Pequeno para a Idade Gestacional , Anemia/complicações , Escolaridade , Feminino , Idade Gestacional , Cardiopatias/complicações , Humanos , Recém-Nascido , Itália , Nefropatias/complicações , Pré-Eclâmpsia/complicações , Gravidez , Complicações na Gravidez , Fatores de Risco , Fumar/efeitos adversos , Aumento de PesoRESUMO
To evaluate the simultaneous effects of antenatal and delivery risk factors on neonatal death and cerebral palsy in preterm infants, we conducted a cohort study of 363 singleton pregnancies delivered between 24 and 33 weeks gestation. Neurodevelopmental outcome of the infants was evaluated at 2 years of corrected age. Risk factors associated with death or cerebral palsy were analysed by politomous logistic regression. Overall, the mortality rate was 14.6% (53/363) and the prevalence of cerebral palsy among surviving infants was 12.3% (38/310). Decreasing gestation and meconium-stained amniotic fluid were the only antenatal factors associated with increased odds for both death and cerebral palsy. The effect magnitude and the predictive value of gestational age were greater for death than for cerebral palsy. After adjustment for confounders, prolonged (> or = 48 h) rupture of membranes (odds ratio 2.98, 95% confidence interval 1.12-7.96) and male sex of the infant (odds ratio 3.01, 95% confidence interval 1.32-6.71) were significantly associated only with cerebral palsy. We conclude that neonatal death and cerebral palsy share few common antenatal risk factors. The characteristics of antenatal risk factors for cerebral palsy suggest that bacterial infestation of the amniotic cavity may be implicated in the etiology of the cerebral impairment.
Assuntos
Paralisia Cerebral , Parto Obstétrico , Morte Fetal , Recém-Nascido Prematuro , Peso ao Nascer , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Modelos Logísticos , Masculino , Razão de Chances , Gravidez , Estudos Prospectivos , Fatores de Risco , Caracteres SexuaisRESUMO
OBJECTIVE: To evaluate the association between preeclampsia and cerebral palsy among preterm infants. STUDY DESIGN: A cohort study of 345 singleton preterm (24 to 33 weeks gestation) infants delivered at an institution where no mothers received magnesium sulphate. We investigated the relationship of preeclampsia to the development of infant cerebral palsy (spastic quadriplegia, hemiplegia or diplegia) at two years' corrected age. Potential confounders were controlled for by politomous logistic regression analysis. RESULTS: The prevalence of cerebral palsy in surviving infants from normotensive and preeclamptic pregnancies was 13.4% (38/284) and 3.3% (2/61), respectively (P=0.026 by Fisher exact test). After control for potential confounders (gestational age, infant gender, birthweight standard deviation score, mode of delivery), the likelihood of infant cerebral palsy was reduced by preeclampsia (odds ratio 0.16, 95% confidence interval=0.04-0.74 for infants from preeclamptic versus normotensive pregnancies being palsied). CONCLUSION: Among preterm infants, the protective effect of preeclampsia against cerebral palsy is manifest in the absence of magnesium sulphate utilization.
Assuntos
Paralisia Cerebral/epidemiologia , Trabalho de Parto Prematuro/epidemiologia , Pré-Eclâmpsia/epidemiologia , Adulto , Peso ao Nascer , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Mortalidade Infantil , Recém-Nascido , Sulfato de Magnésio/uso terapêutico , Masculino , Gravidez , Análise de Regressão , Fatores de Risco , Caracteres SexuaisRESUMO
OBJECTIVE: The purpose of the study was to evaluate the sociodemographic and clinical variables modifying the smoking-related risk of low birth weight (< 2500 g). METHOD: This case-control study included a population of 967 singleton low birth weight deliveries and 967 selected controls. Unconditional logistic regression analysis was used to test statistical significance of the interactions between smoking in pregnancy and other risk factors for low birth weight. RESULTS: Increasing maternal age and parity potentiate the smoking-related risk of a low birth weight infant. The effect of maternal smoking on the risk of low birth weight was significantly increased in patients with a history of previous spontaneous abortion (excess risk 2.30, 95% C.I. 1.24-4.27) and in patients of high compared with patients of intermediate or low social class (excess risk 1.97, 95% C.I. 1.1-3.57). Smokers with less than two prenatal visits per trimester were at significantly greater risk of delivering a low birth weight infant (excess risk 2.36, 95% C.I. 1.14-4.87) than their counterparts with more frequent prenatal visits. Among clinical variables, the effect of maternal smoking on the risk of low birth weight was significantly increased in women with a history of first trimester hemorrhage during the current pregnancy (excess risk 2.67, 95% C.I. 1.30-5.49). CONCLUSIONS: The smoking-related risk of low birth weight is very high in some subgroups of women. Identification of these subgroups could be important for prenatal counseling.
Assuntos
Recém-Nascido de Baixo Peso , Fumar/efeitos adversos , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Recém-Nascido , Idade Materna , Razão de Chances , Paridade , Gravidez , Cuidado Pré-Natal , Fatores de Risco , Fatores SocioeconômicosRESUMO
We evaluated the impact of the severity of intrauterine growth retardation (IUGR) measured as the proportion of expected birth weight (birth weight x 100/median birth weight) on short-term neonatal complications and two-year infant neurodevelopmental outcome. The study was carried out on 236 singleton pregnancies complicated by idiopathic IUGR. The rates of bradycardia, respiratory distress syndrome, hypocalcemia, ventilatory support, apneic crises, transient neurologic signs and poor neonatal outcome (neonatal death or cerebral palsy) significantly correlated with the increasing severity of IUGR. In logistic regression analysis more severely growth retarded infants (< 67.5% of expected birth weight) had higher rates of bradycardia, respiratory distress syndrome, hypocalcemia and bacterial sepsis when compared with those less severely affected (84-67.5% of expected birth weight). In pregnancies complicated by idiopathic IUGR, most short-term neonatal complications are inversely related to the severity of growth failure as evaluated by the proportion of expected birth weight.
Assuntos
Peso ao Nascer , Deficiências do Desenvolvimento/etiologia , Retardo do Crescimento Fetal/complicações , Adulto , Pré-Escolar , Feminino , Humanos , Recém-Nascido , Modelos Logísticos , Estudos Longitudinais , Masculino , Razão de Chances , Gravidez , Resultado da Gravidez , Prognóstico , Índice de Gravidade de DoençaRESUMO
The rate of spontaneous abortion from embryo-fetal infection is believed to range from 10 to 15%. This figure, however, is likely to be underestimated because of subclinical abortions occurring at the earliest stages of gestation that go undiagnosed. The actual frequency of infections resulting in 1st trimester spontaneous abortion is therefore unknown, whereas the impact of infectious agents in the TORCH group on the pathogenesis of such event is well known, although the pathogenetic mechanisms are not well understood. A wide range of microorganisms have been isolated by several investigators from the lower genital tract of women with 1st trimester spontaneous abortion. No causative relationship of HIV-1 infection to spontaneous abortion has been established yet. The diagnosis of abortion from infection can only be made retrospectively based on histologic examination of fetal and placental tissue and isolation on culture of the infectious agent assumed to have caused infection.
Assuntos
Aborto Espontâneo/etiologia , Doenças dos Genitais Femininos/complicações , Complicações Infecciosas na Gravidez/microbiologia , Aborto Espontâneo/microbiologia , Feminino , Doenças dos Genitais Femininos/microbiologia , Humanos , Gravidez , Primeiro Trimestre da GravidezAssuntos
Alanina Transaminase/sangue , Feminino , Humanos , Itália , Masculino , Valores de ReferênciaRESUMO
Up till the early 1970s, prenatal diagnosis of congenital anomalies was primarily aimed at detecting chromosomal abnormalities by amniocentesis.1. Over the last two decades, prenatal diagnosis has greatly benefited from advances in ultrasound technology and in our ability to detect microscopic and submicroscopic chromosome abnormalities as well as single gene disorders, leading to substantive improvements in detection of such congenital anomalies.2 At present, invasive prenatal diagnosis continues to be the gold standard for pregnancies at increased risk for chromosomal anomaly or other genetic disease, with chorionic villus sampling being the procedure of choice for the first trimester,3 whereas mid-trimester amniocentesis continues to be the most common form of invasive procedure for prenatal diagnosis.4 Still, invasive techniques are restricted to subgroups at risk for anomalies, for whom such time-consuming procedures are believed to be cost-effective, also accounting for procedure-related abortive risks. In the low-risk population prenatal diagnosis generally consists of screening procedures by means of ultrasound and maternal serum biochemistry.
RESUMO
OBJECTIVE: To evaluate the obstetric antecedents of cystic periventricular leukomalacia and transient echodense periventricular lesions among preterm infants. DESIGN: A cohort study of preterm singleton infants born between 25 and 33 weeks gestation. SETTING: Pavia, Italy. POPULATION: Three hundred and forty-nine infants admitted to a Division of Neonatal Intensive Care who were screened for periventricular leukomalacia. METHOD: The obstetric factors in infants with either cystic periventricular leukomalacia or transient echodense periventricular lesions were compared to those in infants with negative cranial ultrasonographic findings. Stepwise multiple logistic regression analysis was used to evaluate the association between risk factors and outcomes adjusting for confounders. RESULTS: The prevalence of cystic periventricular leukomalacia and transient echodense lesions was 5.7% (20/349) and 14% (49/349), respectively. The main risk factors for cystic leukomalacia were first trimester haemorrhage (OR 4.49; 95% CI 1.63-12.39), maternal urinary tract infection on admission (OR 5.71; 95% CI 1.91-17.07), and neonatal acidosis (pH < 7.2) at birth (OR 5.97; 95% CI 1.93-18.52). Meconium-stained amniotic fluid (OR 3.95; 95% CI 1.42-10.98) and long term (> 72 hours) ritodrine tocolysis (OR 2.54; 95% CI 1.28-5.05) were associated with an increased risk of echodense lesions. The likelihood of overall leukomalacia (cystic plus echodense periventricular lesions) was increased among cases with meconium-stained amniotic fluid (OR 4.06; 95% CI 1.65-10.0), long-term ritodrine tocolysis (OR 2.56; 95% CI 1.38-4.72), maternal infection (OR 1.73; 95% CI 1.0-3.0), and acidosis at birth (OR 1.98; 95% CI 1.0-3.98). CONCLUSIONS: This study confirms that maternal infection, acidosis at birth, and meconium-stained amniotic fluid increase the risk of periventricular leukomalacia in preterm infants. Long-term ritodrine use seems to increase the risk for transient echodense lesions.
Assuntos
Leucomalácia Periventricular/etiologia , Trabalho de Parto Prematuro/complicações , Acidose/complicações , Adulto , Hemorragia Cerebral/complicações , Paralisia Cerebral/complicações , Estudos de Coortes , Feminino , Ruptura Prematura de Membranas Fetais/complicações , Humanos , Recém-Nascido , Mecônio , Gravidez , Fatores de Risco , Ritodrina/efeitos adversos , Tocolíticos/efeitos adversos , Infecções Urinárias/complicaçõesRESUMO
Solid tumor bearing patients often show a large variety of immunologic alterations: increase in immune complexes number, reduced NK activity, decreased IL-2 production, T4/T8 reverse and s.o. Most literature data generally concern chemotherapy and/or radiotherapy pretreated patients, so it is difficult to relate the immunological alterations with either antineoplastic treatments or the disease itself. We tried to evaluate any possible alteration of immunological parameters in patients with solid neoplasms who underwent radiotherapy on mediastinum or pelvis. The aim was to detect any variation in peripheral lymphoid sub-populations (even per site of irradiation) and a possible activation of an immune therapy. The evaluable patients were 38 (12 treated with surgery). The minimum dose delivered was 5000 cGys through conventional fractionation. The immunological parameters (T, B, N, T4, T8, H/S) were evaluated before the treatment, at the end and every 2 months during follow-up. Cases were analyzed also per single irradiation volume. No statistically significant variation in immunological parameters was found, although suppressor activity was confirmed as prevailing in immune responsiveness of cancer patients. Thus any significant correlation between immunological state and disease evolution or response to treatment has still to be verified.