Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.059
Filtrar
1.
Orv Hetil ; 161(3): 103-109, 2020 Jan.
Artículo en Húngaro | MEDLINE | ID: mdl-31928060

RESUMEN

Introduction: Autologous hemopoietic stem cell transplantation remains a promising therapy in certain malignant and non-malignant conditions. The procedure, however, will increase the risk of complications, most notably early and late infections. Aim: To analyze the frequency and spectrum of pathogens in early (<+100 days) post-transplant infections and to evaluate risk factors for mortality. Method: Prospectively collected data from 699 patients undergoing autologous hemopoietic stem cell transplantation between 2007 and 2014 at our center were retrospectively reviewed and analyzed. Results: The median age of 699 patients was 56 (interquartile range: 43-62) years, 54% (376) were male. 25 patients have been transferred to other centers and 19 patients were lost to follow up. Neutropenic fever occurred in 69.8% (488) of patients. In addition, 102 infectious episodes in 96 patients were identified. Most commonly bacteremia occurred (49 episodes) with a median onset of 7 (5-11) days. The majority (33/49) of bacteremias have been observed during the pre-engraftment period. Their incidence proved to be higher in patients with malignant lymphoma compared to individuals with plasma cell disorders (p = 0.0005, OR: 2.41, 95% CI: 1.49-3.99). 12 episodes of viral infections and 8 cases of proven or probable invasive mycoses have been identified. Among the 655 patients with complete follow up, 16 in-hospital deaths (2.4%) occurred, 8 of them were associated with infections. Survival was adversely affected by early infections (p = 0.0001). Conclusion: In autologous stem cell transplantation, microbiologically unconfirmed neutropenic fever is common. Documented early bacteremia, however, is infrequent. Lymphoma patients have a significantly higher chance to develop bloodstream infections compared to individuals with plasma cell disorders. Early infections decrease the chance of survival; thus, an effective prophylaxis and therapy remains of paramount importance. Orv Hetil. 2020; 161(3): 103-109.


Asunto(s)
Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/microbiología , Fiebre/etiología , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Neutropenia/microbiología , Trasplante Autólogo/efectos adversos , Adulto , Infecciones Bacterianas/mortalidad , Fiebre/epidemiología , Humanos , Hungría/epidemiología , Linfoma , Masculino , Persona de Mediana Edad , Neutropenia/epidemiología , Estudios Retrospectivos
2.
J Surg Res ; 245: 45-50, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31401246

RESUMEN

BACKGROUND: Dermatome-induced lacerations are a known complication; however, there is a paucity of literature discussing the incidence and predisposing factors. The aim of this study was to determine the incidence and risk factors to develop a preventive algorithm. METHODS: An 18-question survey was sent to all US and Canadian burn unit directors. Surgeons were queried about type and location of their practices, average annual caseload of skin graft harvesting, and number of dermatome-induced lacerations. The survey also asked about donor site location, harvesting technique and equipment, laceration severity, and causative factors. An algorithm was developed based on the results. RESULTS: Fifty-six responses (42% response rate) were received from the burn unit directors. They reported an estimated 133 lacerations over the past 5 y. The overall incidence of dermatome-induced lacerations was approximately 0.1% per year (1.3 per 1000 cases). The most commonly attributed causes were excessive pressure (25.0%) and patient factors (18.4%). Most lacerations occurred when using air dermatomes (73.0%) with a 4-inch guard (63.5%), 0.010- to 0.015-inch thickness (78.4%), and 30°-45° angulation (47.3%); the most common brand was Zimmer (71.6%). The dermatome was typically set up by a scrub tech or nurse (48.6%), whereas the skin harvesting was performed by residents (39.2%) or attendings (35.1%). Lacerations typically extended to subcutaneous tissue (70.3%), with no neurovascular injury (86.5%). CONCLUSIONS: Our study showed that dermatome-induced lacerations are rare events and that certain factors predispose patients to injury. An algorithm was developed to provide guidance on risk factor identification and the set up and use of dermatomes.


Asunto(s)
Quemaduras/cirugía , Laceraciones/epidemiología , Complicaciones Posoperatorias/epidemiología , Recolección de Tejidos y Órganos/instrumentación , Sitio Donante de Trasplante/patología , Unidades de Quemados/estadística & datos numéricos , Canadá/epidemiología , Estudios Transversales , Humanos , Incidencia , Laceraciones/etiología , Laceraciones/patología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/patología , Medición de Riesgo , Factores de Riesgo , Trasplante de Piel/efectos adversos , Trasplante de Piel/instrumentación , Trasplante de Piel/métodos , Encuestas y Cuestionarios/estadística & datos numéricos , Recolección de Tejidos y Órganos/efectos adversos , Trasplante Autólogo/efectos adversos , Trasplante Autólogo/instrumentación , Trasplante Autólogo/métodos , Estados Unidos/epidemiología , Cicatrización de Heridas
3.
Facial Plast Surg Clin North Am ; 27(4): 435-441, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31587763

RESUMEN

Fat grafting is effectively used in the lower eyelid and periorbital area for rejuvenation of the aging face. Several complications may occur with fat grafting, including volume undercorrection or overcorrection, contour irregularities, prolonged bruising and swelling, infection, granulomas and inflammation, and vascular embolization with visual loss or stroke. In many cases, complications can be effectively treated, although permanent and serious injury can occur. Appropriate surgical techniques help to prevent most of these complications. An understanding of how and why complications of fat grafting of the lower eyelid occur aids in the avoidance and treatment of these complications.


Asunto(s)
Tejido Adiposo/trasplante , Blefaroplastia/efectos adversos , Complicaciones Posoperatorias/cirugía , Trasplante Autólogo/efectos adversos , Blefaroplastia/métodos , Humanos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Rejuvenecimiento
4.
J Craniofac Surg ; 30(7): 2138-2143, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31478955

RESUMEN

OBJECTIVES: After reading this article, the participant should be able to: Understand the etiology of cranial defects. Understand the anatomy of the cranium. Understand the importance of the preoperative workup in the cranial reconstruction decision-making process. Describe the options available for calvarial reconstruction including autologous and alloplastic materials. Describe the basic differences between available alloplastic materials. Understand the intraoperative and postoperative complications that may arise during cranioplasty. SUMMARY: Cranial defects can arise from a variety of causes, yielding a diverse group of patients who require cranioplasty. The goals of calvarial reconstruction are to protect the underlying brain, to restore the aesthetic contour of the calvarium, and/or to treat postcraniectomy cerebrospinal fluid circulation abnormalities that may be symptomatic. Options for calvarial reconstruction include the autogenous bone flap that was removed for access, autologous bone grafting, and a variety of alloplastic materials such as titanium, hydroxyapatite, polymethylmethacrylate, polyether ether ketone, and high-density porous polyethylene. A detailed preoperative workup and discussion with the patient is important to choosing the appropriate reconstructive path.


Asunto(s)
Cráneo/cirugía , Trasplante Óseo/efectos adversos , Humanos , Polietileno , Complicaciones Posoperatorias/etiología , Colgajos Quirúrgicos/cirugía , Trasplante Autólogo/efectos adversos
5.
Bone Joint J ; 101-B(9): 1151-1159, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31474143

RESUMEN

AIMS: We analyzed the long-term outcomes of patients observed over ten years after resection en bloc and reconstruction with extracorporeal irradiated autografts. PATIENTS AND METHODS: This retrospective study included 27 patients who underwent resection en bloc and reimplantation of an extracorporeal irradiated autograft. The mean patient age and follow-up period were 31.7 years (9 to 59) and 16.6 years (10.3 to 24.3), respectively. The most common diagnosis was osteosarcoma (n = 10), followed by chondrosarcoma (n = 6). The femur (n = 13) was the most frequently involved site, followed by the tibia (n = 7). There were inlay grafts in five patients, intercalary grafts in 15 patients, and osteoarticular grafts in seven patients. Functional outcome was evaluated with the Musculoskeletal Tumor Society (MSTS) scoring system. RESULTS: There were no recurrences in the irradiated autograft and the autograft survived in 24 patients (88.9%). Major complications included nonunion (n = 9), subchondral bone collapse (n = 4), and deep infection (n = 4). Although 34 revision procedures were performed, 25 (73.5%) and four (11.8%) of these were performed less than five years and ten years after the initial surgery, respectively. The mean MSTS score at the last follow-up was 84.3% (33% to 100%). CONCLUSION: Considering long-term outcomes, extracorporeal irradiated autograft is an effective method of reconstruction for malignant musculoskeletal tumours Cite this article: Bone Joint J 2019;101-B:1151-1159.


Asunto(s)
Neoplasias Óseas/radioterapia , Neoplasias Óseas/cirugía , Huesos/cirugía , Recuperación del Miembro/métodos , Reimplantación , Trasplante Autólogo/métodos , Adolescente , Adulto , Autoinjertos/efectos de la radiación , Huesos/efectos de la radiación , Niño , Estudios de Seguimiento , Supervivencia de Injerto , Humanos , Persona de Mediana Edad , Radioterapia/métodos , Procedimientos Quirúrgicos Reconstructivos/métodos , Recuperación de la Función , Estudios Retrospectivos , Trasplante Autólogo/efectos adversos , Adulto Joven
6.
Rev. bras. cir. plást ; 34(3): 414-418, jul.-sep. 2019. ilus
Artículo en Inglés, Portugués | LILACS | ID: biblio-1047171

RESUMEN

O aumento do dorso nasal nas rinoplastias é foco de estudo de diversos trabalhos que buscam as melhores fontes de enxerto e técnicas cirúrgicas. A utilização de cartilagem já é consagrada para este fim, a partir do septo nasal, da concha auricular ou dos arcos costais. Nos últimos anos, têm-se buscado meios para reduzir a palpabilidade e dispersibilidade dos enxertos cartilaginosos. Assim, são descritos materiais sintéticos, como o SURGICEL®; e, autólogos, representados pelas fáscias. A fáscia temporal é mais amplamente utilizada, porém requer uma nova incisão cirúrgica, aumentando o tempo e a morbidade da cirurgia. É também descrito o uso de fáscia lata e fáscia reto abdominal, comparativamente mais espessas e menos flexíveis. Em muitos casos de rinoplastia fazse necessária a retirada da cartilagem costal, o que permite a coleta de fáscia do músculo peitoral maior pela mesma incisão cirúrgica. Dessa forma, descrevemos a utilização da fáscia do músculo peitoral maior envolvendo cartilagem costal picada, em uma rinoplastia estruturada com aumento do dorso.


Increasing the nasal dorsum in rhinoplasty is the focus of several studies that seek the best graft sources and surgical techniques. The use of cartilage from the nasal septum, ear shell, or costal arches is already established for this purpose. In recent years, methods have been sought to reduce the palpability and dispersibility of cartilaginous grafts. Thus, synthetic materials such as SURGICEL® and autologous materials such as fascia have been explored. Temporal fascia are more widely used but require a new surgical incision, increasing surgical time and morbidity. Also described is the use of fascia lata and rectus abdominis fascia, which are comparatively thicker and less flexible. In many rhinoplasty procedures, it is necessary to remove the costal cartilage, which allows the collection of fascia from the major chest muscles through the same surgical incision. Thus, we describe the use of major chest muscle fascia and chopped costal cartilage in structured rhinoplasty to increase the dorsum.


Asunto(s)
Humanos , Femenino , Adulto , Historia del Siglo XXI , Prótesis e Implantes , Rinoplastia , Trasplante Autólogo , Fascia , Cartílago Costal , Supervivencia de Injerto , Prótesis e Implantes/efectos adversos , Rinoplastia/efectos adversos , Rinoplastia/métodos , Trasplante Autólogo/efectos adversos , Trasplante Autólogo/métodos , Trasplantes/cirugía , Fascia/anatomía & histología , Fascia/trasplante , Cartílago Costal/cirugía , Cartílago Costal/citología
7.
Indian J Med Res ; 149(5): 650-655, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-31417033

RESUMEN

Background & objectives: Articular cartilage defects in the knee have a very poor capacity for repair due to avascularity. Autologous chondrocyte transplantation (ACT) is an established treatment for articular cartilage defects. Animal studies have shown promising results with allogenic chondrocyte transplantation since articular cartilage is non-immunogenic. In addition to being economical, allogenic transplantation has less morbidity compared to ACT. This study was undertaken to compare ACT with allogenic chondrocyte transplantation in the treatment of experimentally created articular cartilage defects in rabbit knee joints. Methods: Cartilage was harvested from the left knee joints of six New Zealand white rabbits (R1-R6). The harvested chondrocytes were cultured to confluence and transplanted onto a 3.5 mm chondral defect in the right knees of 12 rabbits [autologous in 6 rabbits (R1-R6) and allogenic in 6 rabbits (R7-R12)]. After 12 wk, the rabbits were euthanized and histological evaluation of the right knee joints were done with hematoxylin and eosin and safranin O staining. Quality of the repair tissue was assessed by the modified Wakitani histological grading scale. Results: Both autologous and allogenic chondrocyte transplantation resulted in the regeneration of hyaline/mixed hyaline cartilage. The total histological scores between the two groups showed no significant difference. Interpretation & conclusions: Allogenic chondrocyte transplantation seems to be as effective as ACT in cartilage regeneration, with the added advantages of increased cell availability and reduced morbidity of a single surgery.


Asunto(s)
Cartílago Articular/crecimiento & desarrollo , Regeneración/fisiología , Trasplante Autólogo/efectos adversos , Trasplante Homólogo/efectos adversos , Animales , Cartílago Articular/fisiopatología , Células Cultivadas , Condrocitos/metabolismo , Modelos Animales de Enfermedad , Eosina Amarillenta-(YS)/farmacología , Hematoxilina/farmacología , Humanos , Articulación de la Rodilla/crecimiento & desarrollo , Articulación de la Rodilla/patología , Conejos
8.
Plast Reconstr Surg ; 144(3): 369e-377e, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31461004

RESUMEN

BACKGROUND: As breast reconstructive microsurgeons increase their available flap techniques with experience, the need for stacked and multiple flaps may generate an improved aesthetic outcome. The authors present their institutional experience of using single versus stacked free flap breast reconstruction. METHODS: ONE THOUSAND SEVENTY: flaps were performed on 509 patients from 2010 to 2018 by two senior surgeons at a single university hospital. Three hundred eighty-eight flaps were either stacked profunda artery perforator (PAP) flaps, four-flap flaps [bilateral PAP plus bilateral deep inferior epigastric perforator (DIEP) flap], or double-pedicle DIEP/superficial inferior epigastric perforator flaps. Six hundred eighty-two flaps were either unilateral or bilateral DIEP or PAP flap (one flap per breast). Demographics, patient comorbidities, and flap complications were compared between the two groups. RESULTS: Of the 509 patients, 359 underwent single DIEP or PAP flap (one flap per breast) and 150 patients underwent stacked free flaps. The stacked flap group had statistically lower body mass index, higher rates of radiation therapy, longer procedure time, smaller flaps, higher deep venous thrombosis rates, and higher take-back rates compared with the single flap group. There were no statistical differences in the rates of flap loss (2.2 percent in stacked flaps versus 1.1 percent in single flaps), wound complication, hematoma, or pulmonary embolism. CONCLUSIONS: Autologous breast reconstruction is the gold standard for natural and durable breast reconstruction, often giving superior aesthetic outcomes and higher patient satisfaction. However, the true success of autologous breast reconstruction is limited to the amount of tissue available to provide total breast reconstruction. This study shows that stacked flap breast reconstruction is safe and has similar complication rates as single-flap breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Asunto(s)
Mamoplastia/métodos , Microcirugia/métodos , Satisfacción del Paciente , Colgajo Perforante/trasplante , Complicaciones Posoperatorias/epidemiología , Mama/cirugía , Neoplasias de la Mama/cirugía , Arterias Epigástricas/trasplante , Estética , Femenino , Humanos , Mamoplastia/efectos adversos , Mastectomía/efectos adversos , Persona de Mediana Edad , Tempo Operativo , Colgajo Perforante/irrigación sanguínea , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Trasplante Autólogo/efectos adversos , Trasplante Autólogo/métodos , Resultado del Tratamiento
9.
Plast Reconstr Surg ; 144(3): 433e-443e, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31461029

RESUMEN

BACKGROUND: Pediatric calvarial reconstruction is challenging because of the unique anatomical and growth considerations in this population. Comparative studies evaluating current cranioplasty materials are lacking. This review addresses the knowledge gap in pediatric cranioplasty outcomes with emphasis on current materials used. METHODS: A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Outcome data comparing fresh bone, banked bone, titanium, poly(methyl methacrylate), and polyetheretherketone were abstracted. RESULTS: Twenty studies met the authors' selection criteria. The mean patient age ranged from 4 to 17.4 years. Autologous cranioplasty was performed in 439 patients, and 201 patients underwent alloplastic reconstruction. Fresh bone grafts and titanium mesh were associated with the lowest infection rates (0.4 percent and 3.3 percent, respectively; p < 0.001), graft failures (2.9 percent and 3.3 percent, respectively; p < 0.001), and surgical-site occurrence rates (8.8 percent and 6.7 percent, respectively; p < 0.001). Banked bone flaps had the highest overall complication rates (51 percent; p < 0.001), bone resorption (39.7 percent; p < 0.001), and failure rates (40.2 percent; p < 0.001), whereas polyetherether ketone had the highest rates of infection (16.1 percent; p < 0.001). CONCLUSIONS: Based on the available evidence to date, fresh bone grafts and titanium mesh demonstrated the lowest surgical-site infection, surgical-site occurrence, and graft failure rates. Banked bone flaps had the highest overall surgical-site complications and graft failures. Pediatric cranioplasty outcomes studies are needed to evaluate current and novel cranioplasty materials.


Asunto(s)
Trasplante Óseo/efectos adversos , Complicaciones Posoperatorias/epidemiología , Prótesis e Implantes/efectos adversos , Procedimientos Quirúrgicos Reconstructivos/efectos adversos , Adolescente , Factores de Edad , Trasplante Óseo/métodos , Niño , Preescolar , Craneotomía , Humanos , Cetonas/efectos adversos , Polietilenglicoles/efectos adversos , Polimetil Metacrilato/efectos adversos , Complicaciones Posoperatorias/etiología , Procedimientos Quirúrgicos Reconstructivos/instrumentación , Procedimientos Quirúrgicos Reconstructivos/métodos , Colgajos Quirúrgicos , Titanio/efectos adversos , Trasplante Autólogo/efectos adversos , Trasplante Autólogo/métodos , Resultado del Tratamiento
10.
Mycoses ; 62(10): 954-960, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31332851

RESUMEN

BACKGROUND: Autologous hematopoietic stem cell transplantation (HSCT) carries risks of infectious morbidity. We analysed epidemiology and management burden associated with invasive fungal diseases (IFDs) in children and adolescents undergoing autologous HSCT. METHODS: In a retrospective, single-centre observational study, epidemiology and management burden associated with IFDs were analysed in all paediatric cancer patients who underwent autologous HSCT between 2005 and 2014. Clinical, radiographic and microbiological data were assessed up to 100 days post-transplant. The primary endpoint was the incidence of proven, probable and possible IFDs. Further endpoints included the use of systemic antifungal agents for prevention and management of IFDs; infectious and non-infectious comorbidities; and survival until day + 100. RESULTS: Of 95 patients (median age: 8 years; r, 0.75-20) underwent 103 HSCT procedures for solid tumours (92) or lymphoma (11). Primary antifungal prophylaxis was administered in 49 procedures (47.5%). No single case of proven/probable IFD was diagnosed. Nine cases (8.7%) fulfilled criteria of possible pulmonary mould infection and received treatment for a median of 14 days (r, 7-35). In an additional 12 procedures, empiric antifungal therapy with mould active agents was given for a median of 8 days (r, 3-105). Microbiologically documented non-fungal infections were observed in 17 procedures, and five patients were transferred to the ICU. There was one death from biopsy documented toxic endothelial damage at day 83 post-transplant. CONCLUSIONS: Autologous HSCT for solid tumours or lymphoma was associated with low morbidity from IFDs. However, utilisation of systemic antifungal agents for prevention and management of suspected IFDs was considerable.


Asunto(s)
Manejo de la Enfermedad , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Infecciones Fúngicas Invasoras/epidemiología , Neoplasias/complicaciones , Neoplasias/terapia , Trasplante Autólogo/efectos adversos , Adolescente , Antifúngicos/uso terapéutico , Quimioprevención/métodos , Niño , Preescolar , Femenino , Humanos , Incidencia , Lactante , Infecciones Fúngicas Invasoras/diagnóstico , Infecciones Fúngicas Invasoras/tratamiento farmacológico , Infecciones Fúngicas Invasoras/mortalidad , Masculino , Estudios Retrospectivos , Análisis de Supervivencia , Adulto Joven
11.
Acta Oncol ; 58(9): 1315-1322, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31286808

RESUMEN

Purpose: Lymphoma survivors after high dose therapy with autologous stem cell therapy (HD-ASCT) are at high risk for late adverse effects (AEs). Information patients receive and collect throughout their cancer trajectory about diagnosis, treatment schedule and risks of AEs may influence attitudes and health-related behavior in the years after treatment. The purpose of this study was to explore level of knowledge in lymphoma survivors after HD-ASCT at a median of 12 years after primary diagnosis. Material and methods: From a national study on the effects of HD-ASCT for lymphomas, 269 survivors met for an outpatient examination, including a structured interview addressing knowledge about diagnosis and treatment. Survivors were also asked whether they knew and/or had experienced certain common late AEs. Numbers of recognized and experienced late AEs were presented as sum scores. Factors associated with the level of knowledge of late AEs were analyzed by linear regression analysis. Results: Eighty-one percent of the survivors knew their diagnosis, 99% knew the components of HD-ASCT and 97% correctly recalled having had radiotherapy. Ninety percent reported awareness of late AEs, but the level of knowledge and personal experience with specified AEs varied. Thirty-five percent of survivors stated to have received follow-up for late AEs. In multivariable analysis younger age at diagnosis, having received mediastinal radiotherapy, higher mental health related quality of life, a higher number of self-experienced late AEs and having received follow-up care for late AEs were significantly associated with a higher level of knowledge of AEs. Conclusion: The majority of lymphoma survivors treated with HD-ASCT correctly recalled diagnosis and treatment, while knowledge of late AEs varied. Our findings point to information deficits in survivors at older age and with lower mental health related quality of life. They indicate benefit of follow-up to enhance education on late AEs in lymphoma survivors.


Asunto(s)
Supervivientes de Cáncer/psicología , Conocimientos, Actitudes y Práctica en Salud , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Linfoma/psicología , Adolescente , Adulto , Factores de Edad , Anciano , Supervivientes de Cáncer/estadística & datos numéricos , Niño , Femenino , Conductas Relacionadas con la Salud , Trasplante de Células Madre Hematopoyéticas/métodos , Humanos , Linfoma/diagnóstico , Linfoma/radioterapia , Linfoma/cirugía , Masculino , Recuerdo Mental , Persona de Mediana Edad , Noruega , Educación del Paciente como Asunto , Calidad de Vida , Análisis de Regresión , Encuestas y Cuestionarios , Factores de Tiempo , Acondicionamiento Pretrasplante/métodos , Acondicionamiento Pretrasplante/estadística & datos numéricos , Trasplante Autólogo/efectos adversos , Adulto Joven
12.
BioDrugs ; 33(4): 401-409, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31302863

RESUMEN

Three prospective controlled clinical trials and numerous small series and case reports have confirmed that durable, drug-free remission in systemic sclerosis is possible via an autologous hematopoietic stem cell transplantation. Similar results have been seen in other autoimmune diseases. The exact mechanism by which this immune "reset" was achieved in some but not all cases remains elusive, but includes major reduction of autoreactive immune competent cells, re-establishment of T- and B cell regulatory networks and normalization of tissue niche function, particularly vascular. Some aspects regarding mobilization, conditioning and graft manipulation still remain open, but clearly a significant toxicity is associated with all effective regimens at present, and therefore patient selection remains a key issue. In the hematology/oncology arena, major efforts are being made to reduce genotoxic and other collateral toxicity induced by current mobilization and conditioning protocols, which may also translate to autoimmune disease. These include developments in rapid mobilization and antibody drug conjugate conditioning technology. If effective, such low-toxicity regimens might be applied to autoimmune disease at an earlier stage before chronicity of autoimmunity has been established, thus changing the therapeutic paradigm.


Asunto(s)
Enfermedad Injerto contra Huésped/prevención & control , Trasplante de Células Madre Hematopoyéticas/métodos , Inmunoconjugados/uso terapéutico , Esclerodermia Sistémica/terapia , Acondicionamiento Pretrasplante/métodos , Ensayos Clínicos Controlados como Asunto , Enfermedad Injerto contra Huésped/inmunología , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Humanos , Estudios Prospectivos , Esclerodermia Sistémica/inmunología , Trasplante Autólogo/efectos adversos , Trasplante Autólogo/métodos , Trasplante Homólogo/efectos adversos , Trasplante Homólogo/métodos , Resultado del Tratamiento
13.
Int J Clin Oncol ; 24(12): 1515-1525, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31352632

RESUMEN

BACKGROUND: High-dose chemotherapy (HDC) and autologous stem-cell transplantation (auto-SCT) are used to improve the survival of children with high-risk brain tumors who have a poor outcome with the standard treatment. This study aims to evaluate the outcome of HDC/auto-SCT with topotecan-thiotepa-carboplatin and melphalan-etoposide-carboplatin (TTC/MEC) regimens in pediatric brain tumors. METHODS: We retrospectively analyzed the data of 33 children (median age 6 years) who underwent HDC/auto-SCT (18 tandem and 15 single) with uniform conditioning regimens. RESULTS: Eleven patients aged < 3 years at diagnosis were eligible for HDC/auto-SCT to avoid or defer radiotherapy. In addition, nine patients with high-risk medulloblastoma (presence of metastasis and/or postoperative residual tumor ≥ 1.5 cm2), eight with other high-risk brain tumor (six CNS primitive neuroectodermal tumor, one CNS atypical teratoid/rhabdoid tumor, and one pineoblastoma), and five with relapsed brain tumors were enrolled. There were three toxic deaths, and two of which were due to pulmonary complications. The main reason for not performing tandem auto-SCT was due to toxicities and patient refusal. The event-free survival (EFS) and overall survival (OS) rates of all patients were 59.4% and 80.0% at a median follow-up with 49.1 months from the first HDC/auto-SCT, respectively. The EFS/OS rates of patients aged < 3 years at diagnosis, high-risk medulloblastoma, other high-risk brain tumor, and relapsed tumors were 50.0/81.8%, 87.5/85.7%, 66.7/88.9%, and 20.0/60.0%, respectively. CONCLUSIONS: Although tandem HDC/auto-SCT with TTC/MEC regimens showed promising survival rates, treatment modifications are warranted to reduce toxicities. The survival rates with relapsed brain tumors were unsatisfactory despite HDC/auto-SCT, and further study is needed.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Encefálicas/terapia , Trasplante de Células Madre/métodos , Adolescente , Neoplasias Encefálicas/mortalidad , Neoplasias Encefálicas/patología , Carboplatino/administración & dosificación , Niño , Preescolar , Etopósido/administración & dosificación , Femenino , Humanos , Lactante , Masculino , Melfalán/administración & dosificación , Estudios Retrospectivos , Trasplante de Células Madre/efectos adversos , Trasplante de Células Madre/mortalidad , Tasa de Supervivencia , Tiotepa/administración & dosificación , Topotecan/administración & dosificación , Trasplante Autólogo/efectos adversos , Trasplante Autólogo/mortalidad , Resultado del Tratamiento
14.
J Urol ; 202(6): 1224-1229, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31251716

RESUMEN

PURPOSE: We report long-term outcomes in participants in the E-SISTEr (Extended Stress Incontinence Surgical Treatment Efficacy Trial) at 1 tertiary care center who underwent a Burch or a fascial sling procedure for stress urinary incontinence. MATERIALS AND METHODS: After receiving institutional review board approval E-SISTEr participants at 1 center who underwent midterm office evaluation in 2010 were further reevaluated at longer term followup by office visits and structured telephone interviews. The telephone interviews were performed by a third party not involved in patient care for those not seen in the last 2 years. Each group received validated questionnaires, including the UDI-6 (Urogenital Distress Inventory-Short Form), the IIQ-7 (Incontinence Impact Questionnaire-Short Form) and the visual analogue quality of life score questionnaire. Failure was measured by Kaplan-Meier curves using time to reoperation for stress urinary incontinence. RESULTS: Of the 29 eligible patients, including 14 treated with a Burch procedure and 15 treated with a sling procedure, 21 had long-term information available, including 11 and 10, respectively. Median followup was 15.1 years (range 11.2 to 16.0). One of the 8 patients was lost to followup, 1 died and 7 were unreachable by telephone. The UDI-6 question 3 score was lower for the 13 patients followed by telephone, including 13 and 7 with a Burch and a sling procedure compared to the 8 seen in clinic, including 5 and 3 with a Burch and a sling procedure, respectively (mean ± SD score 0.3 ± 0.6 vs 1.3 ± 1.1, p=0.0208). The UDI-6 scores were similar for the 2 procedures. Stress urinary incontinence reoperation was performed in 3 cases, including placement of a fascial sling in 1 Burch case. The other 2 cases in the Burch and sling groups received an injectable agent at 11.6 and 13.5 years, respectively. The overall Kaplan-Meier 15-year reoperation-free survival rate was 85.2% (95% CI 60.8-95). CONCLUSIONS: In this well characterized cohort with a median followup of 15.1 years there was sustained improvement in continence scores and quality of life related to stress urinary incontinence in each group and the reoperation rate was low.


Asunto(s)
Fascia/trasplante , Satisfacción del Paciente , Calidad de Vida , Incontinencia Urinaria de Esfuerzo/cirugía , Procedimientos Quirúrgicos Urológicos/métodos , Adulto , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Reoperación/estadística & datos numéricos , Factores de Tiempo , Trasplante Autólogo/efectos adversos , Trasplante Autólogo/métodos , Resultado del Tratamiento , Procedimientos Quirúrgicos Urológicos/efectos adversos
15.
Rev Esp Cir Ortop Traumatol ; 63(4): 253-260, 2019.
Artículo en Inglés, Español | MEDLINE | ID: mdl-31147299

RESUMEN

BACKGROUND: Recently, a new approach of autologous chondrocyte implantation technique (using as biomaterial a collagen type i/iii membrane) based on increasing cell density called HD-ACI (High Density Autologous Chondrocyte Implantation) has been described. The objective of this paper was to study the clinical outcome and incidence of subchondral bone oedema in patients with cartilage lesions in the knee treated with HD-ACI at 1-2 years of follow-up. METHODS: This is a retrospective study performed with forty patients with chondral injuries grade iii-iv. All patients were treated with HD-ACI with a cellular dose of 5×106 chondrocytes /cm2 of lesion. The subjective perception of improvement of symptoms and functionality was measured with the IKDC score (International Knee Documentation Committee). The presence of bone oedema was assessed at 6, 12 and 24 months of follow-up by magnetic resonance imaging. RESULTS: IKDC values showed a significant improvement at 12 and 24 months (P<.001). The mean difference of IKDC between the baseline visit and 12 months was 26.3 points, and 31.6 points at 24 months. Twenty-seven point five percent of the patients presented subchondral bone oedema at 2 years of follow-up. CONCLUSIONS: HD-ACI is an effective and safe treatment that improves pain, clinical perception and functionality of the joint. No correlation was found between the presence of bone oedema and the patients' clinical outcome.


Asunto(s)
Enfermedades Óseas/etiología , Condrocitos/trasplante , Edema/etiología , Articulación de la Rodilla/cirugía , Complicaciones Posoperatorias/etiología , Adulto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Estudios Retrospectivos , Factores de Tiempo , Trasplante Autólogo/efectos adversos , Trasplante Autólogo/métodos
16.
BMC Musculoskelet Disord ; 20(1): 274, 2019 Jun 04.
Artículo en Inglés | MEDLINE | ID: mdl-31159789

RESUMEN

BACKGROUND: Bone tunnel enlargement following primary anterior cruciate ligament (ACL) reconstruction with soft tissue graft might be a severe disadvantage for revision surgery. The postoperative rehabilitation protocol including the non-weight-bearing periods were different depending on the surgeon or institute. To determine the relationship between femoral bone tunnel enlargement and the postoperative non-weight-bearing period after double-bundle ACL reconstruction with hamstring grafts. METHODS: Forty-two patients who underwent primary double-bundle ACL reconstruction with hamstring grafts were divided into two postoperative non-weight-bearing protocol groups: 1-week non-weight-bearing postoperatively (group A, n = 19); and 2-week non-weight-bearing (group B, n = 18). Five cases were excluded due to additional knee injury, pregnancy, and lost to follow-up. Bone tunnel enlargement was evaluated by computed digital radiographs (anteroposterior (A-P) and lateral views) taken on the first postoperative day and at 12 months. Each tunnel diameter was shown as a percentage to the maximum joint width of the proximal tibia in the A-P view, or a percentage of the maximum diameter of the patella in the lateral view. To determine the incidence of tunnel enlargement, percentage diameter changes of more than 10% were defined as an enlarged tunnel. The magnitude of tunnel enlargement and the standard clinical evaluation were also evaluated. RESULTS: There were no significant differences between groups in the incidences of anteromedial and posterolateral bone tunnel enlargement, both in the A-P and lateral views (2 × 2 Chi-squared test). The magnitude of femoral posterolateral bone tunnel enlargement was significantly greater in group A in the A-P view (p = 0.01) and lateral view (p = 0.03) (Mann Whitney U-test). Twelve months after surgery, the Lysholm score and Tegner activity level scale were not significantly different between the groups. CONCLUSIONS: This prospective, clinical and radiographical study showed that early weight-bearing protocol after double-bundle ACL reconstruction with hamstring grafts might have the potential risk of significant postoperative femoral bone tunnel enlargement of the posterolateral bundle. There was no significant difference in clinical outcomes by postoperative non-weight-bearing period. To reduce and prevent the femoral bone tunnel enlargement, the comprehensive management could be considered and required to establish the suitable early stage rehabilitation protocol after surgery. TRIAL REGISTRATION: Trial registration number; UMIN000036212 . Scientific title: Prospective comparisons of femoral tunnel enlargement with two different postoperative non weight bearing periods after double-bundle anterior cruciate ligament reconstruction with hamstring grafts. Registered date: 15 Mar 2019 (retrospectively registered).


Asunto(s)
Lesiones del Ligamento Cruzado Anterior/cirugía , Reconstrucción del Ligamento Cruzado Anterior/efectos adversos , Complicaciones Posoperatorias/diagnóstico por imagen , Soporte de Peso , Adolescente , Adulto , Ligamento Cruzado Anterior/trasplante , Reconstrucción del Ligamento Cruzado Anterior/métodos , Reconstrucción del Ligamento Cruzado Anterior/rehabilitación , Autoinjertos/trasplante , Estudios de Casos y Controles , Femenino , Fémur/diagnóstico por imagen , Fémur/patología , Fémur/cirugía , Tendones Isquiotibiales/trasplante , Humanos , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/cirugía , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Periodo Posoperatorio , Estudios Prospectivos , Intensificación de Imagen Radiográfica , Factores de Tiempo , Trasplante Autólogo/efectos adversos , Trasplante Autólogo/métodos , Resultado del Tratamiento , Adulto Joven
17.
Transpl Infect Dis ; 21(4): e13114, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31102556

RESUMEN

BACKGROUND: The spectrum of infectious complications in autologous hematopoietic cell transplant recipients (AHCT) with multiple myeloma has not been well described in the recent era of novel agent induction and improved supportive care. METHODS: We conducted a retrospective cohort study of 413 adult myeloma AHCT recipients at our institution from 2007-2016 to describe the cumulative incidence and risk factors for various infections and FN occurring within the first 100 days after AHCT. Additionally, landmark analysis was done among 404 patients who survived at least 100 days after transplant admission to estimate the association of infections with subsequent non-relapse mortality (NRM), overall survival (OS), and relapse-free survival (RFS). RESULTS: Cumulative incidences (95% CI) of infection events by day 100 were: FN 43% (38-48), any infection 21% (17-25), bacterial 17% (14-21), viral 4% (3-7) and fungal 1% (0.5-3), central line-associated blood stream infection 3% (2-6), and Clostridium difficile colitis 6% (4-8). Patients with infection had a longer initial transplant hospitalization (median 17 vs 16 days, P < 0.01), more readmissions (31% vs 8%, P < 0.01), and spent more days in hospital in first 100 days (median 18 vs 16 days, P < 0.01). A 100-day mortality was low and similar between groups (2% vs 1%, P = 0.28). In landmark analysis of 404 100-day survivors, OS was worse among patients with early infections (hazard ratio 1.54 [1.03-2.30], P = 0.03), although there was no difference in NRM and RFS. CONCLUSIONS: Notwithstanding advances in supportive care, early infectious complications remain a relevant source of morbidity and require attention in myeloma AHCT recipients.


Asunto(s)
Trasplante de Células Madre Hematopoyéticas/efectos adversos , Mieloma Múltiple/complicaciones , Mieloma Múltiple/microbiología , Adulto , Factores de Edad , Anciano , Infecciones Bacterianas/complicaciones , Infecciones por Clostridium/complicaciones , Supervivencia sin Enfermedad , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Mieloma Múltiple/mortalidad , Micosis/complicaciones , Recurrencia Local de Neoplasia , Estudios Retrospectivos , Factores de Riesgo , Trasplante Autólogo/efectos adversos , Virosis/complicaciones , Adulto Joven
18.
J Foot Ankle Surg ; 58(4): 730-733, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31053381

RESUMEN

The purpose of this article is to examine complications in patients who underwent bone grafting from the calcaneus between December 2001 and June 2010. This retrospective, single-practice study included 247 procedures in 242 patients, including 200 (82.64%) female and 42 (17.36%) male patients, ranging in age from 13 to 89 (median 49) years. Overall, the incidence of experiencing any form of complication was 2.43% (6 of 247); these included 5 (2.02%) feet that displayed donor site sural neuritis and 1 (0.41) that displayed a painful, hypertrophic scar at the donor site. The only statistically significant risk factor associated with the development of a calcaneal donor site complication was white race (being African American was protective). These findings indicate that procurement of autogenous bone graft from the calcaneus, as described in this report, is safe and dependable with a low incidence of complications, and irritation of the sural nerve is the most common complication associated with the procedure. Further clinical and long-term follow-up studies controlling for confounding variables need to be performed to fully determine the overall safety and efficacy of this procedure.


Asunto(s)
Trasplante Óseo/efectos adversos , Calcáneo/trasplante , Complicaciones Posoperatorias , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Trasplante Óseo/métodos , Grupo de Ascendencia Continental Europea , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etnología , Estudios Retrospectivos , Factores de Riesgo , Recolección de Tejidos y Órganos , Trasplante Autólogo/efectos adversos , Adulto Joven
19.
Plast Reconstr Surg ; 143(6): 1625-1632, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-31136476

RESUMEN

Given the widespread utility and therapeutic potential of autogenous fat grafting, plastic surgeons should be familiar with its safety profile and associated adverse events. This article provides a critical review of the literature and delineates risk factors associated with various complications when grafting to the breast and gluteal regions. The majority of adverse events are related to fat necrosis and require minimal diagnostic or therapeutic intervention. Larger graft volumes, as in cosmetic augmentation, are associated with higher incidences of fatty necrosis. The oncologic safety of fat grafting is supported by multiple clinical studies with thousands of breast cancer patients, albeit predominantly retrospective in nature. Although less frequent, serious complications include fat emboli during gluteal augmentation. Identification of associated risk factors and implementation of proper surgical techniques may minimize the occurrence of life-threatening complications.


Asunto(s)
Tejido Adiposo/trasplante , Nalgas/cirugía , Embolia Grasa/prevención & control , Mamoplastia/métodos , Cirugía Plástica/métodos , Adulto , Contorneado Corporal/efectos adversos , Contorneado Corporal/métodos , Neoplasias de la Mama/cirugía , Embolia Grasa/mortalidad , Estética , Femenino , Humanos , Mastectomía/métodos , Persona de Mediana Edad , Complicaciones Posoperatorias/prevención & control , Medición de Riesgo , Cirugía Plástica/efectos adversos , Tasa de Supervivencia , Trasplante Autólogo/efectos adversos , Trasplante Autólogo/métodos , Resultado del Tratamiento
20.
World Neurosurg ; 127: e896-e900, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-30959259

RESUMEN

BACKGROUND: Dural repair during skull base approaches remains challenging, especially in the presence of significant defects. The autologous fat has become an alternative to various substitute materials being used previously. We report here our experience and technique for the repair of notable skull base dural defects using autologous fat as a dural substitute. METHODS: Over a period of 5 years, 71 consecutive patients operated on for skull base pathologies with an important intraoperative dural defect repaired using autologous fat tissue as replacement material were reviewed. The graft, withdrawn from the abdomen or thigh, was flattened and applied to the defect. The clinical findings and outcomes were assessed. RESULTS: Main pathologies included schwannomas (45%) and meningiomas (35.21%), with no side predilection. Surgical approaches such as transcondylar fossa, suboccipital, and frontotemporal approaches were used. Dural defects were mainly located in the posterior (73.2%) and middle cranial fossae (25.4%). No harvesting site-related complication occurred. In 7 cases, transitory subcutaneous fluid collection spontaneously resorbing after 8 days to 2 months was observed. No external cerebrospinal fluid leakage, infection, or other complication was noted during the following period. CONCLUSIONS: Dural repair can be effectively and durably achieved using autologous fat graft as a dural substitute during skull base approaches, even in cases of extended defects. The observed characteristics of the fat graft along with the achieved outcome make it an ideal dural substitute.


Asunto(s)
Pérdida de Líquido Cefalorraquídeo/cirugía , Neoplasias Meníngeas/cirugía , Meningioma/cirugía , Base del Cráneo/cirugía , Trasplante Autólogo/efectos adversos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Pérdida de Líquido Cefalorraquídeo/etiología , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos/métodos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Procedimientos Quirúrgicos Reconstructivos/métodos , Neoplasias de la Base del Cráneo/cirugía , Adulto Joven
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA