RESUMEN
PURPOSE: Study of negative pressure wound therapy (NPWT) safety for patients with intraoperative exposure of the dura. METHODS: We analyzed the literature on the NPWT usage after spinal surgery in patients with exposure of the dura. We also described our experience of NPWT in 3 pediatric patients with spinal dysraphism. Due to the peculiarities of the anatomy (spina bifida), all of these patients had dural sac exposure during spinal surgery. RESULTS: The reasons for NPWT in all three cases were different. In the first patient with segmental spinal dysgenesis, surgery was complicated by extensive postoperative wound necrosis and the formation of soft tissue deficiency. The second patient with post-myelomeningocele kyphosis had a deficiency of soft tissues during spinal surgery due to a large bedsore at the apex of the deformity. And in the third patient also with post-myelomeningocele kyphosis, NPWT was applied with surgical site infection. In all three cases, NPWT was used when the dura was exposed, without complications and with satisfactory results. The observation period for the patients was 3 years, 2.5 years, and 2 years, respectively. CONCLUSIONS: The usage of NPWT in cases of wound complications in the spinal surgery may be a useful option, which allows saving implants. NPWT is not contraindicated in cases of intraoperative dural exposure if there are no signs of cerebrospinal fluid (CSF) leak.
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Cifosis , Terapia de Presión Negativa para Heridas , Niño , Duramadre/cirugía , Humanos , Procedimientos Neuroquirúrgicos , Infección de la Herida Quirúrgica/etiologíaRESUMEN
Impacted common bile duct (CBD) lithiasis poses therapeutical challenges and repeated attempts of removal may result in life-threatening complications. CASE REPORT. A 45 year-old female patient was admitted in emergency for right upper quadrant abdominal pain and jaundice. Clinical, lab data, abdominal ultrasound (US) and cholangio-MRI established the diagnosis of acute cholecystitis and obstructive jaundice due to distal CBD lithiasis. Endoscopic retrograde colangiopancreatography (ERCP) confirmed the presence of a distal CBD stone but extraction failed. The patient was operated on and surgical procedure consisted of cholecistectomy, intraoperative cholangiography and a side-to-side choledocho-duodenal anastomosis was performed because all attempts to extract the stone through choledocotomy or duodenotomy and enlargement of endoscopic shincterotomy failed. The postoperative course was endangered by a severe pancreatitis, a massive upper digestive bleeding and portal vein thrombosis that responded to conservative management in the intensive care unit. The patient was discharged after 34 days in good clinical condition and approximately 9 months later was readmitted electively for an incisional hernia. Apart from this, physical examination, lab tests and imagistic studies were normal; the patient was operated and rapidly discharged in good condition. In conclusion, the management of CBD lithiasis may be a serious challenge both for interventional endoscopists and surgeons and require a concerted team effort.
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Colecistectomía/efectos adversos , Coledocolitiasis/diagnóstico , Coledocolitiasis/cirugía , Hemorragia Gastrointestinal/etiología , Pancreatitis/etiología , Vena Porta , Trombosis de la Vena/etiología , Colangiopancreatografia Retrógrada Endoscópica , Urgencias Médicas , Femenino , Hemorragia Gastrointestinal/terapia , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Pancreatitis/terapia , Vena Porta/patología , Resultado del Tratamiento , Trombosis de la Vena/terapiaRESUMEN
Replacing toxic, wild-type Neotyphodium coenophialum-infected tall fescue (E+) with nontoxic, N. coenophialum-infected tall fescue (NE+) has improved cow performance, but producer acceptance of NE+ has been slow. The objective was to compare performance by spring- and fall-calving cows grazing either E+ or NE+ at different percentages of the total pasture area. Gelbvieh×Angus crossbred cows (n=178) were stratified by BW and age within calving season and allocated randomly to 1 of 14 groups representing 5 treatments for a 3-yr study: i) Fall-calving on 100% E+ (F100); ii) Spring-calving on 100% E+ (S100); iii) Fall-calving on 75% E+ and 25% NE+ (F75); iv) Spring-calving on 75% E+ and 25% NE+ (S75); and v) Spring-calving on 100% NE+ (SNE100). Groups allocated to F75 and S75 grazed E+ until approximately 28 d before breeding and weaning, then were then moved to their respective NE+ pasture area for 4 to 6 wk; those allocated to F100, S100, and SNE100 grazed their pastures throughout the entire year. Samples of tall fescue were gathered from specific cells within each pasture at the time cows were moved into that particular cell (â¼1 sample/mo). Blood samples were collected from the cows at the start and end of the breeding season. Stocking rate for each treatment was 1 cow/ha. Forage IVDMD, CP, and total ergot alkaloid concentrations were affected (P<0.05) by the treatment×sampling date interaction. Hay offered, cow BW, and BCS at breeding, end of breeding, and at weaning were greater (P<0.05) from fall-calving vs. spring-calving. Cow BW at weaning was greater (P<0.05) from F75 and S75 vs. F100 and S100. The calving season×NE+ % interaction affected (P<0.05) calving rates. Preweaning calf BW gain, actual and adjusted weaning BW, ADG, sale price, and calf value at weaning were greater (P<0.05) from fall-calving vs. spring-calving and from SNE100 vs. S75 except for sale price which was greater (P<0.05) from S75 vs. SNE100. Cow concentrations of serum prolactin at breeding and serum NEFA at the end of breeding were affected (P<0.05) by the calving season×NE+ % interaction. Serum Zn and Cu concentrations from cows were affected (P<0.05) by calving season. A fall-calving season may be more desirable for cows grazing E+, resulting in greater calving rates, cow performance, and calf BW at weaning, whereas limited access to NE+ may increase calving rates, serum prolactin, and NEFA concentrations during certain times in the production cycle, particularly in spring-calving cows.
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Alimentación Animal/análisis , Bovinos/fisiología , Dieta/veterinaria , Neotyphodium/aislamiento & purificación , Parto/fisiología , Poaceae/microbiología , Estaciones del Año , Fenómenos Fisiológicos Nutricionales de los Animales , Animales , Femenino , Embarazo , Factores de TiempoRESUMEN
Adequate antithyroid drug treatment or surgery usually generates remission of myasthenia gravis (MG) in patients with thymus hyperplasia associated with Graves' hyperthyroidism. The case of a 46-year-old woman diagnosed with MG based on the clinical picture, anticholinesterase drug test and positive electromyography (EMG) is presented. The cervico-thoracic computer tomography revealed a compressive nodular goiter and normal antero-superior mediastinum and led to the diagnosis of MG secondary to the hyperthyroidism. An uneventful total thyroidectomy was performed, but postoperatively the MG symptoms worsened. TC99m tetrofosmin scintigraphy revealed an area of hyperfixation in the antero-inferior mediastinum, suggestive for thymoma, as confirmed by a repeated thoracic CT scan. Following a longitudinal sternotomy, a well incapsulated tumor of approximately 6/5 cm located in the antero-inferior mediastinum was found and an extensive thymomectomy was performed. The postoperative course was uneventful and the patient was discharged 9 days later with complete remission of myasthenia. The pathology report of the specimen revealed a mixt thymoma or AB thymoma after Muller-Hermelink and WHO classification, with invasive capsular foci corresponding to Masaoka II stadium. In conclusion, scintigraphy proved to be useful in the diagnosis and decision making of a thymoma.
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Bocio Nodular/complicaciones , Miastenia Gravis/complicaciones , Timoma/complicaciones , Neoplasias del Timo/complicaciones , Tirotoxicosis/complicaciones , Electromiografía , Femenino , Bocio Nodular/diagnóstico , Bocio Nodular/cirugía , Humanos , Persona de Mediana Edad , Compuestos Organofosforados , Compuestos de Organotecnecio , Cintigrafía , Radiofármacos , Timectomía , Timoma/diagnóstico , Timoma/cirugía , Neoplasias del Timo/diagnóstico , Neoplasias del Timo/cirugía , Tiroidectomía , Tirotoxicosis/diagnóstico , Tirotoxicosis/cirugía , Resultado del TratamientoRESUMEN
PURPOSE: To determine survivin expression patterns in Wilms tumor (WT) and compare it with the expression in normal renal tissue. Also, to analyse cytoplasmic and nuclear survivin expression in relation to histological type, prognostic group and tumor stage. METHODS: Immunohistochemical expression of survivin was analysed in 59 cases of primary WT and in 10 normal kidney specimens, taken from the same patients, but distant from the tumor. RESULTS: 51 out of 59 cases of WT (86.44%) showed decreased cytoplasmic survivin expression and 4 out of 59 cases of WT (6.78%) showed nuclear overexpression of survivin. There was statistically significant difference in the frequency of decreased cytoplasmic expression of survivin in individual components of WT (p=0.005). Decreased cytoplasmic expression of survivin in epithelial, blastemal and stromal component was found significantly more often in low stage WT compared to high stage WT (Fisher exact test, p=0.0002, p=0.002, p=0.002, respectively). There was no statistically significant difference in the frequency of survivin nuclear overexpression between different stages of WT (Fisher exact test, p=0.564), histological types (Fisher exact test, p=0.915), or between different prognostic groups (Fisher exact test, p=1). CONCLUSION: Decreased survivin cytoplasmic expression or nuclear overexpression may be related to favorable prognosis of WT.
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Proteínas Inhibidoras de la Apoptosis/análisis , Neoplasias Renales/química , Tumor de Wilms/química , Núcleo Celular/química , Niño , Preescolar , Citoplasma/química , Femenino , Humanos , Inmunohistoquímica , Lactante , Neoplasias Renales/mortalidad , Neoplasias Renales/patología , Masculino , Estadificación de Neoplasias , Pronóstico , Survivin , Tumor de Wilms/mortalidad , Tumor de Wilms/patologíaRESUMEN
Bacteria and phytoplankton dynamics are thought to be closely linked in coastal marine environments, with correlations frequently observed between bacterial and phytoplankton biomass. In contrast, little is known about how these communities interact with each other at the species composition level. The purpose of the current study was to analyze bacterial community dynamics in a productive, coastal ecosystem and to determine whether they were related to phytoplankton community dynamics. Near-surface seawater samples were collected in February, May, July, and September 2000 from several stations in the Bay of Fundy. Savin et al. (M.C. Savin et al., Microb Ecol 48: 51-65) analyzed the phytoplankton community in simultaneously collected samples. The attached and free-living bacterial communities were collected by successive filtration onto 5 microm and 0.22 microm pore-size filters, respectively. DNA was extracted from filters and bacterial 16S rRNA gene fragments were amplified and analyzed by denaturing gradient gel electrophoresis (DGGE). DGGE revealed that diversity and temporal variability were lower in the free-living than the attached bacterial community. Both attached and free-living communities were dominated by members of the Roseobacter and Cytophaga groups. Correspondence analysis (CA) ordination diagrams showed similar patterns for the phytoplankton and attached bacterial communities, indicating that shifts in the species composition of these communities were linked. Similarly, canonical CA revealed that the diversity, abundance, and percentage of diatoms in the phytoplankton community accounted for a significant amount of the variability in the attached bacterial community composition. In contrast, ordination analyses did not reveal an association between free-living bacteria and phytoplankton. These results suggest that there are specific interactions between phytoplankton and the bacteria attached to them, and that these interactions influence the composition of both communities.
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Fenómenos Fisiológicos Bacterianos , Diatomeas/fisiología , Ecosistema , Biología Marina , Filogenia , Fitoplancton/fisiología , Microbiología del Agua , Océano Atlántico , Bacterias/genética , Secuencia de Bases , Diatomeas/genética , Electroforesis , Funciones de Verosimilitud , Modelos Genéticos , Datos de Secuencia Molecular , Nuevo Brunswick , Fitoplancton/genética , Dinámica Poblacional , ARN Ribosómico 16S/genética , Análisis de Secuencia de ADNRESUMEN
Phytoplankton have traditionally been identified based on morphological characteristics. However, identifications based on morphology are time-consuming, require expertise in taxonomy, and often fail to distinguish differences among the multitudes of minute, nondescript planktonic organisms. Molecular techniques, which have revealed new insights into bacterial and picoplankton communities, may also enhance our knowledge of the diversity among communities of larger plankton. We compared plankton identifications and community assessments based on the two types of techniques (morphological vs molecular) for surface seawater samples collected on 2 May, 31 July and 25 September 2000 from several sampling stations in the Bay of Fundy. Phytoplankton captured in surface bucket samples were quantified and identified based on morphology. DNA was extracted from plankton communities (5-100 microm in diameter) collected by filtration, and 18S rRNA gene fragments were amplified with primers specific for eukaryotes. Denaturing gradient gel electrophoresis (DGGE) was used to develop DNA profiles of eukaryotic phylogenetic diversity and to select cloned 18S rDNA fragments for sequencing. Both morphological and molecular methods showed great community diversity. However, the communities identified with the two different types of techniques were starkly different. Morphological abundances and taxon richness were lowest in the May samples, whereas the number of DGGE bands was highest in May and July. Morphological identifications showed a succession of dominant organisms through time. Whereas neither diatoms nor dinoflagellates were dominant in May, diatoms and a few dinoflagellates were dominant in July and September. In contrast, few 18S rDNA sequences were related to rDNA sequences of known identity, and furthermore, few diatoms were identified in the molecular analyses. Molecular phylogenetic analysis indicated the presence of many novel organisms, several of which were most closely related to other unidentified sequences from diverse marine environments representing new lineages. Our results support the ideas that we are just beginning to uncover the diversity of eukaryotic marine organisms and that there may be many more ubiquitous, microeukaryotic plankton than previously realized. Our results suggest that both types of methods capture only a portion of the community. Morphological methods may be more adept at capturing the phototrophic organisms within the community. However, just as for bacteria and picoplankton, molecular techniques can enhance our understanding of plankton diversity, particularly by detecting previously unidentified organisms.
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Biodiversidad , Filogenia , Plancton/citología , Plancton/genética , Océano Atlántico , Secuencia de Bases , Electroforesis , Datos de Secuencia Molecular , Nuevo Brunswick , ARN Ribosómico 18S/genética , Estaciones del Año , Análisis de Secuencia de ADNRESUMEN
BACKGROUND: Neutropenia is common in patients receiving myelotoxic chemotherapy. Pegfilgrastim, a sustained-duration filgrastim is a once-per-cycle therapy for prophylactic neutrophil support. PATIENTS AND METHODS: Women, treated with four cycles of doxorubicin/docetaxel chemotherapy every 21 days, received pegfilgrastim or filgrastim 24 h after chemotherapy as a single subcutaneous injection per chemotherapy cycle (pegfilgrastim 30, 60 or 100 microg/kg) or daily subcutaneous injections (filgrastim 5 microg/kg/day). Safety, efficacy and pharmacokinetics were analyzed. RESULTS: The incidence of grade 4 neutropenia in cycle 1 was 95, 90 and 74%, in patients who received pegfilgrastim 30, 60 and 100 microg/kg, respectively, and 76% in patients who received filgrastim. Mean duration of grade 4 neutropenia in cycle 1 was 2.7,2 and 1.3 days for doses of pegfilgrastim, and 1.6 days for filgrastim. The pharmacokinetics of pegfilgrastim were non-linear and dependent on both dose and neutrophil count. Pegfilgrastim serum concentration was sustained until the neutrophil nadir occurred then declined rapidly as neutrophils started to recover, consistent with a self-regulating neutrophil-mediated clearance mechanism. The safety profiles of pegfilgrastim and filgrastim were similar. CONCLUSIONS: A single subcutaneous injection of pegfilgrastim 100 microg/kg provided neutrophil support and a safety profile comparable to daily subcutaneous injections of filgrastim during multiple chemotherapy cycles.
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Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Neoplasias de la Mama/tratamiento farmacológico , Factor Estimulante de Colonias de Granulocitos/análogos & derivados , Factor Estimulante de Colonias de Granulocitos/administración & dosificación , Neutropenia/inducido químicamente , Neutropenia/tratamiento farmacológico , Paclitaxel/análogos & derivados , Taxoides , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Neoplasias de la Mama/patología , Intervalos de Confianza , Docetaxel , Relación Dosis-Respuesta a Droga , Doxorrubicina/administración & dosificación , Doxorrubicina/efectos adversos , Esquema de Medicación , Quimioterapia Combinada , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Femenino , Filgrastim , Estudios de Seguimiento , Humanos , Inyecciones Subcutáneas , Persona de Mediana Edad , Paclitaxel/administración & dosificación , Paclitaxel/efectos adversos , Polietilenglicoles , Probabilidad , Proteínas Recombinantes , Valores de Referencia , Resultado del TratamientoRESUMEN
PURPOSE: This multicenter, randomized, double-blind, active-control study was designed to determine whether a single subcutaneous injection of pegfilgrastim (SD/01, sustained-duration filgrastim; 100 microg/kg) is as safe and effective as daily filgrastim (5 microg/kg/d) for reducing neutropenia in patients who received four cycles of myelosuppressive chemotherapy. PATIENTS AND METHODS: Sixty-two centers enrolled 310 patients who received chemotherapy with docetaxel 75 mg/m(2) and doxorubicin 60 mg/m(2) on day 1 of each cycle for a maximum of four cycles. Patients were randomized to receive on day 2 either a single subcutaneous injection of pegfilgrastim 100 microg/kg per chemotherapy cycle (154 patients) or daily subcutaneous injections of filgrastim 5 microg/kg/d (156 patients). Absolute neutrophil count (ANC), duration of grade 4 neutropenia, and safety parameters were monitored. RESULTS: One dose of pegfilgrastim per chemotherapy cycle was comparable to daily subcutaneous injections of filgrastim with regard to all efficacy end points, including the duration of severe neutropenia and the depth of ANC nadir in all cycles. Febrile neutropenia across all cycles occurred less often in patients who received pegfilgrastim. The difference in the mean duration of severe neutropenia between the pegfilgrastim and filgrastim treatment groups was less than 1 day. Pegfilgrastim was safe and well tolerated, and it was similar to filgrastim. Adverse event profiles in the pegfilgrastim and filgrastim groups were similar. CONCLUSION: A single injection of pegfilgrastim 100 microg/kg per cycle was as safe and effective as daily injections of filgrastim 5 microg/kg/d in reducing neutropenia and its complications in patients who received four cycles of doxorubicin 60 mg/m(2) and docetaxel 75 mg/m(2).
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Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Neoplasias de la Mama/tratamiento farmacológico , Factor Estimulante de Colonias de Granulocitos/administración & dosificación , Paclitaxel/análogos & derivados , Taxoides , Anciano , Neoplasias de la Mama/patología , Preparaciones de Acción Retardada , Docetaxel , Método Doble Ciego , Doxorrubicina/administración & dosificación , Femenino , Filgrastim , Factor Estimulante de Colonias de Granulocitos/efectos adversos , Humanos , Inyecciones Subcutáneas , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Neutropenia/prevención & control , Paclitaxel/administración & dosificación , Proteínas RecombinantesRESUMEN
This study was designed to compare outcome in terms of disease-free survival (DFS) in women with histologically negative axillary lymph nodes and documented low proliferative rate cancer to other well-defined prognostic factors including type of adjuvant treatment. Between 1988 and 1998, we studied 669 patients with invasive node-negative breast cancer up to 5 cm in size and low proliferative rate measured by flow cytometry to determine S-phase fraction (SPF) or by histochemistry (Ki67/MIB1). At a median follow-up of 53 months, 5-year DFS for the entire group was 94% and did not differ significantly by type of systemic adjuvant treatment: none (133 patients, 95% DFS), tamoxifen (441 patients, 94% DFS), or chemotherapy with doxorubicin and cyclophosphamide (95 patients, 92% DFS). In a multivariate prognostic factor analysis, only tumor size was significant; 5-year DFS was 96% for T1N0 cancer versus 89% for T2N0 cancer (P = 0.01). We have prospectively confirmed that a low rate of proliferation as measured by SPF or MIB1 determination confers an excellent prognosis in invasive node-negative breast cancer up to 5 cm in size, regardless of adjuvant treatment.
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Neoplasias de la Mama/patología , Adulto , Antibióticos Antineoplásicos/uso terapéutico , Antígenos Nucleares , Antineoplásicos Alquilantes/uso terapéutico , Antineoplásicos Hormonales/uso terapéutico , Axila , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/metabolismo , Neoplasias de la Mama/mortalidad , Ciclofosfamida/uso terapéutico , Supervivencia sin Enfermedad , Doxorrubicina/uso terapéutico , Femenino , Humanos , Antígeno Ki-67/metabolismo , Ganglios Linfáticos , Metástasis Linfática , Persona de Mediana Edad , Invasividad Neoplásica , Proteínas Nucleares/metabolismo , Estudios Prospectivos , Fase S , Tasa de Supervivencia , Tamoxifeno/uso terapéuticoRESUMEN
BACKGROUND: Preclinical studies in animal models have demonstrated tumor regression following intratumoral administration of an adenovirus vector containing wild-type p53 complementary DNA (Ad-p53). Therefore, in a phase I clinical trial, we administered Ad-p53 to 28 patients with non-small-cell lung cancer (NSCLC) whose cancers had progressed on conventional treatments. METHODS: Patients received up to six, monthly intratumoral injections of Ad-p53 by use of computed tomography-guided percutaneous fine-needle injection (23 patients) or bronchoscopy (five patients). The doses ranged from 10(6) plaque-forming units (PFU) to 10(11) PFU. RESULTS: Polymerase chain reaction (PCR) analysis showed the presence of adenovirus vector DNA in 18 (86%) of 21 patients with evaluable posttreatment biopsy specimens; vector-specific p53 messenger RNA was detected by means of reverse transcription-PCR analysis in 12 (46%) of 26 patients. Apoptosis (programmed cell death) was demonstrated by increased terminal deoxynucleotide transferase-mediated biotin uridine triphosphate nick-end labeling (TUNEL) staining in posttreatment biopsy specimens from 11 patients. Vector-related toxicity was minimal (National Cancer Institute's Common Toxicity Criteria: grade 3 = one patient; grade 4 = no patients) in 84 courses of treatment, despite repeated injections (up to six) in 23 patients. Therapeutic activity in 25 evaluable patients included partial responses in two patients (8%) and disease stabilization (range, 2-14 months) in 16 patients (64%); the remaining seven patients (28%) exhibited disease progression. CONCLUSIONS: Repeated intratumoral injections of Ad-p53 appear to be well tolerated, result in transgene expression of wild-type p53, and seem to mediate antitumor activity in a subset of patients with advanced NSCLC.
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Adenoviridae , Carcinoma de Pulmón de Células no Pequeñas/terapia , Técnicas de Transferencia de Gen , Genes p53 , Terapia Genética/métodos , Neoplasias Pulmonares/terapia , Adenoviridae/genética , Adulto , Anciano , Broncoscopía , Carcinoma de Pulmón de Células no Pequeñas/diagnóstico por imagen , Carcinoma de Pulmón de Células no Pequeñas/genética , Carcinoma de Pulmón de Células no Pequeñas/patología , ADN Viral/aislamiento & purificación , Progresión de la Enfermedad , Femenino , Genes p53/genética , Vectores Genéticos/efectos adversos , Humanos , Etiquetado Corte-Fin in Situ , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Selección de Paciente , Análisis de Supervivencia , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
In chronic renal insufficiency resulting from destruction of the vast majority of nephrons, the surviving nephrons adapt their functions to the conditions of vigorous haemodynamic and osmolar overloads. They acquire an appropriate behaviour to preserve the principal renal functions and to achieve the balance of inner space. In the long period of time, similarly as in healthy people. Glomerulotubular balance as well as tubuloglomerular balance distinguish the remaining nephron function, while autoregulation of perfusion pressure along the glomerulus rapidly vanishes. All three regulation mechanisms are characteristic of the nephron function under physiologic conditions. Intense work of the remaining nephrons in chronic renal failure is under the high level controls of the group of hormones, among them are rennin-angiotensin system, arginine-vasopressin and atrial natriuretic peptide playing very important and particular roles. Comparison of different published studies emerge the idea that chronically increased arginine-vasopressin levels in chronic renal failure could block the autoregulation of blood flow and hydraulic pressure in glomeruli, which together with other mediator actions give high and fluctuating tense within remaining glomeruli, during every single cardiac cycle. It is probably the main event in the further course of kidney disease progression resulting in definite damage of the overloaded nephrons. Angiotensin II is one of reliably recognised mediators of unfavourable outcome in the process of nephron adaptation in chronic renal failure. Knowing the pathophysiologic processes in the remaining functionally adapted nephrons in chronic renal insufficiency determines a more adequate therapeutic approach in these patients.
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Adaptación Fisiológica , Fallo Renal Crónico/fisiopatología , Nefronas/fisiopatología , Animales , Arginina Vasopresina/fisiología , Progresión de la Enfermedad , HumanosRESUMEN
PURPOSE: It is generally thought that the Greenfield filter should not be placed in inferior venae cavae (IVCs) that are larger than 28 mm in diameter because of its base diameter. However, the newer versions have larger base diameters. The purpose of this study was to evaluate fixation of the three currently available Greenfield filters in large IVCs. MATERIALS AND METHODS: Filter fixation was tested in an ex vivo perfusion system with a 34-mm-diameter equine IVC. Greenfield filters with base diameters of 30 mm (original 24-F version [24-F GF]), 38 mm (percutaneous titanium [TGF]), and 32 mm (percutaneous stainless steel [SGF]) were deployed. Increasing force was then applied in a cephalic direction and the resultant movement was measured. RESULTS: In a 34-mm-diameter IVC, the TGF and SGF demonstrated significantly less movement than did the 24-F GF (P < .001). None of the TGFs or SGFs moved above the renal veins with a 480-g pull. Three of the seven 24-F GFs moved above the renal veins at 30 g. No significant difference in fixation was demonstrated between the TGF and the SGF (P = .6). CONCLUSIONS: In a 34-mm-diameter IVC, fixation of the TGF and SGF was significantly better than the 24-F GF. The TGF and SGF may not be subject to the same 28-mm-diameter IVC size limitation as the 24-F GF.
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Procedimientos Quirúrgicos Vasculares/métodos , Filtros de Vena Cava , Vena Cava Inferior/cirugía , Animales , Diseño de Equipo , Migración de Cuerpo Extraño , Caballos , Acero Inoxidable , Titanio , Procedimientos Quirúrgicos Vasculares/efectos adversosAsunto(s)
Ciclosporina/uso terapéutico , Rechazo de Injerto/epidemiología , Inmunosupresores/uso terapéutico , Trasplante de Riñón/inmunología , Trasplante de Riñón/patología , Adulto , Anciano , Cadáver , Creatinina/sangre , Ciclosporina/administración & dosificación , Ciclosporina/sangre , Relación Dosis-Respuesta a Droga , Quimioterapia Combinada , Femenino , Estudios de Seguimiento , Rechazo de Injerto/inmunología , Rechazo de Injerto/patología , Humanos , Inmunosupresores/administración & dosificación , Inmunosupresores/sangre , Glomérulos Renales/patología , Trasplante de Riñón/fisiología , Donadores Vivos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Tiempo , Donantes de Tejidos , Trasplante HomólogoRESUMEN
Rapidly progressive glomerulonephritis is a kidney disease leading to sudden and definitive damages of the renal parenchyma and progressive impairment of its function until the complete failure. Histological findings of the changes are characterized with dominant glomerular lesions with crescentic formations. Early and intensive immunosuppressive therapy with pulse doses of steroids (Solumedrol 1.5 to 2.5 g), followed by Prednisolone 1 mg/kg every other day and cytostatic drugs (cyclophosphamide 1-2 mg-kg/every other day) discontinues the processes of specific and non-specific inflammation in the kidney and could enable regeneration of the kidney tissues with favorable outcome of the disease. Immunosuppressive therapy should be gradually lowered after two months, and applied for at least three to six months.
Asunto(s)
Glomerulonefritis/tratamiento farmacológico , Inmunosupresores/uso terapéutico , Lesión Renal Aguda/etiología , Adolescente , Adulto , Femenino , Glomerulonefritis/complicaciones , Glomerulonefritis/patología , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The use of preoperative and intraoperative irradiation as surgical adjuncts in cancer management has led to concerns regarding post-operative wound healing. The optimum time to construct an intestinal anastomosis after irradiation has not been determined. The aim of this study was to evaluate anastomotic wound healing at varying times after irradiation. One hundred eighty-seven male Sprague-Dawley rats were randomized into seven experimental groups. Group I (control) had a sutured anastomosis and no irradiation. Groups II-VII received a single dose of 20 Gy intraoperatively. In group II, a sutured anastomosis incorporating irradiated bowel was performed immediately after irradiation. Groups III-VII underwent a second laparotomy to undergo a sutured anastomosis with irradiated bowel at 2 days, 1 week, 2 weeks, 3 weeks, and 4 weeks after irradiation. The rats were sacrificed 7 days after the anastomosis was created and the segment of terminal ileum containing the anastomosis was harvested. Tensile strength, hydroxyproline content, and modified Black irradiation damage scores were determined: [table: see text] The increasing modified Black scores reflect the progressive nature of irradiation damage over time. Increasing hydroxyproline content is seen after irradiation but this does not imply increasing wound strength. There was a return of tensile strength to normal levels by 2 weeks. These findings suggest that normal wound healing can be expected if a minimum of 2 weeks elapses between irradiation and intestinal anastomosis.