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1.
Int J Surg Case Rep ; 110: 108706, 2023 Sep.
Article in English | MEDLINE | ID: mdl-37603914

ABSTRACT

INTRODUCTION: Bronchogenic cysts (BCs) are rare congenital lesions that originate from the tracheobronchial bud and can be found in any organ derived from the embryonic foregut. Complete surgical excision is the treatment of choice, and the definitive diagnosis is established by histopathological examination. PRESENTATION OF THE CASE: 41-year-old female with diastolic arterial hypertension and a heterogeneous mass, with multiple calcifications and a solid component with well-defined regular contours. A biochemical study revealed no functionality. Intraoperatively we noticed an adrenal gland-dependent mass with a cystic component and an area of sebaceous content and histological examination confirmed a bronchogenic cyst. DISCUSSION: The majority of cases of BCs are asymptomatic. They can be intrapulmonary, mediastinal or ectopic, being the left adrenal region the most common retroperitoneal location. Symptomatic cysts should always be surgically resected either by thoracotomy or a minimally invasive technique, which has been shown to improve postoperative discomfort and shorten hospital stay with reliable postoperative outcomes. CONCLUSION: Despite their low incidence, it is important to consider BCs in the differential diagnosis of retroperitoneal masses, particularly in the left para-adrenal region.

2.
J Soc Social Work Res ; 14(2): 411-429, 2023.
Article in English | MEDLINE | ID: mdl-37441191

ABSTRACT

Objective: To explore the relationships between social and environmental factors and parenting self-efficacy (PSE) among mothers of preterm infants hospitalized in neonatal intensive care units (NICUs) using a social determinants of health (SDoH) framework. Method: We analyzed data from a prospective cohort study that included 187 mother-infant dyads admitted to four NICUs in the Mountain West region between June 2017 and December 2019. We used multivariable linear regression models to assess the independent associations between maternal and infant characteristics and PSE. Results: Our final multiple linear regression model predicting the efficacy score including maternal race/ethnicity, age, insurance, employment status before giving birth, gestational age, depression, and having other children was significant (F(12,160) = 3.17, p = .0004, adjusted R¬2 = .131). Significant predictors of PSE were race/ethnicity (ß= 3.3, p = .022), having another child/children (ß= 4.2, p = .005), and depression (ß= -4.2, p = .004). Conclusions: Findings suggest that social workers and medical practitioners should consider SDoH, such as insurance type, household income, and employment, along with traditional clinical indicators when assessing families' infant care needs. Social workers, medical practitioners, and researchers should be mindful of how implicit bias may influence the allocation of care and parental supports.

3.
Ear Nose Throat J ; : 1455613231177193, 2023 May 24.
Article in English | MEDLINE | ID: mdl-37222131

ABSTRACT

Primary hyperparathyroidism (PHPT) is a common endocrine disorder characterized by hypercalcemia and elevated or abnormally normal parathyroid hormone (PTH) levels, due to excessive secretion of PTH by 1 or more parathyroid glands. In this report, we discuss the diagnostic and therapeutic challenges posed by ectopic parathyroid adenomas, a rare but atypical presentation of PHPT. We present the case of a 36-year-old female with PHPT due to an ectopic parathyroid adenoma located in the submandibular region. The patient presented with bone pain and was initially evaluated with routine imaging studies, which were negative. [18F] F-choline positron emission tomography (PET)/Computed tomography revealed the ectopic adenoma, leading to successful surgical management. Ectopic parathyroid adenomas are rare but can occur in various locations, and functional imaging modalities such as choline PET can aid in their detection. Surgical resection remains the definitive treatment for parathyroid adenomas, with intraoperative PTH monitoring guiding the extent of resection. Proper evaluation and management of PHPT is essential to avoid significant morbidity. Our case adds to the growing body of literature on the importance of considering ectopic locations of parathyroid adenomas in patients with PHPT.

4.
Adv Neonatal Care ; 23(4): 365-376, 2023 Aug 01.
Article in English | MEDLINE | ID: mdl-37036938

ABSTRACT

BACKGROUND: Sleep-associated infant death is the leading cause of postneonatal mortality in the United States. Preterm infants are at higher risk for sleep-associated death, but maternal adherence to safe sleep practices is lower than for mothers of full-term infants. Data are lacking on whether maternal neonatal intensive care unit (NICU) visitation time impacts safe sleep compliance after hospital discharge. PURPOSE: For mothers of preterm infants, to investigate the association of time days per week spent in the NICU and adherence to safe sleep practices after discharge. METHODS: A prospective observational study of 109 mothers with infants born at less than 32 weeks from 4 Colorado NICUs who completed a survey at 6 weeks after discharge about infant sleep practices. Maternal time spent in the NICU was defined as the average number of days spent in the NICU per week of infant hospitalization, as documented in the electronic medical record. Multivariable logistic regression models assessed the relationship between time in the NICU and safe sleep adherence. Covariates included maternal/infant characteristics significant at P < .2 level in bivariate analysis. RESULTS: Predictors of compliance with all safe infant sleep practices included public/no insurance compared with private insurance (adjusted odds ratio [AOR] 0.29; 95% confidence interval [CI] 0.09-0.96), some college/associate-level education versus bachelor's degree (AOR 5.88; 95% CI 1.21-28.67), and depression/anxiety symptoms (AOR 0.37; 95% CI 0.14-0.97). NICU visitation days was not associated with adherence to safe sleep practices. IMPLICATIONS FOR PRACTICE AND RESEARCH: Maternal visitation days was not associated with adherence to safe infant sleep practices after discharge, highlighting the need to identify barriers and facilitators to engaging families about SUID risk-reducing behaviors.


Subject(s)
Mothers , Sudden Infant Death , Infant , Female , Infant, Newborn , Humans , Intensive Care Units, Neonatal , Infant, Premature , Sleep
5.
Nurs Res ; 71(3): 241-249, 2022.
Article in English | MEDLINE | ID: mdl-35149629

ABSTRACT

BACKGROUND: Mothers' engagement with their hospitalized preterm infant(s) is recognized as an important aspect of treatment in neonatal intensive care units (NICUs). However, no gold standard exists for measuring maternal engagement, and the various methods used to measure mothers' time have documented limitations. OBJECTIVES: This study sought to compare three measurement methods of maternal engagement (a five-item maternal cross-sectional survey, time use diaries, and electronic health records [EHRs]) to identify whether these methods capture consistent data and patterns in detected differences in measures of engagement. METHODS: Maternal engagement was defined as time spent visiting the infant in the NICU (presence), holding (blanket holding in the mother's arms or by kangaroo care [KC]), and caregiving (e.g., bathing and changing diapers). The survey estimating daily maternal engagement was administered in two Level III NICUs and one Level IV NICU at study enrollment, at least 2 weeks after admission. Mothers then completed the daily time use diaries until infant discharge. Data were also collected from participants' EHRs, charted by nursing staff. Wilcoxon signed-rank tests were used for pairwise analysis of the three measures for maternal engagement activities. RESULTS: A total of 146 participants had data across all three measurement types and were included in the analysis. In the Level III NICUs (n = 101), EHR data showed significantly more time spent with all engagement activities than the diary data. In the Level IV data, only differences in time holding were significant when comparing EHR data with survey data, with mothers reporting more time doing KC and less time blanket holding. Comparison of EHR data with diary data showed more time in all activities except KC. DISCUSSION: In most cases, time spent in engagement activities measured in the EHR was higher than in the surveys or time use diaries. Accuracy of measurements could not be determined because of limitations in data collection, and there is no gold standard for comparison. Nevertheless, findings contribute to ongoing efforts to develop the most valuable and accurate strategies for measuring maternal engagement-a significant predictor of maternal and infant health.


Subject(s)
Infant, Premature , Intensive Care Units, Neonatal , Child , Cross-Sectional Studies , Female , Humans , Infant Care , Infant, Newborn , Mothers
6.
Hosp Pediatr ; 11(11): 1190-1198, 2021 11.
Article in English | MEDLINE | ID: mdl-34649934

ABSTRACT

OBJECTIVES: Investigate disparities by Hispanic ethnicity in the care of opioid exposed newborns (OENs) in Colorado birthing hospitals within a statewide quality improvement collaborative. METHODS: This study is a secondary analysis of a quality improvement initiative aimed at standardizing hospital-based care of OENs through implementation of the Eat, Sleep, Console Model. We used statistical process control charts to compare time to special cause variation by Hispanic ethnicity for outcomes including infant length of stay, use of pharmacologic therapy, and breastfeeding eligibility and receipt. Only hospitals that delivered both Hispanic and non-Hispanic OENs during the study period were included, documented maternal ethnicity was required for inclusion. We investigated hospital variation in these outcomes among 4 hospitals that cared for Hispanic OENs for most of the study period. RESULTS: We analyzed 799 mother-OEN dyads, 241 Hispanic and 558 non-Hispanic. Both Hispanic and non-Hispanic OENs experienced decreases in length of stay overall and among those who received postnatal opioids, although Hispanic OENs achieved these decreases 3 annual quarters after non-Hispanic OENs. Pharmacologic therapy use decreased by 55% for Hispanic OENs and 60% for non-Hispanic OENs. Hispanic OENs experienced a 1-quarter delay for this decrease. CONCLUSIONS: Although this quality improvement initiative resulted in positive outcomes for Hispanic and non-Hispanic OENs, improvement was delayed among Hispanic infants, indicating a need to explore and address care practices of Hispanic mothers and infants affected by opioid use disorders.


Subject(s)
Analgesics, Opioid , Ethnicity , Analgesics, Opioid/therapeutic use , Colorado , Female , Hospitals , Humans , Infant , Infant, Newborn , Mothers
7.
Hosp Pediatr ; 11(9): 988-996, 2021 09.
Article in English | MEDLINE | ID: mdl-34426486

ABSTRACT

OBJECTIVES: Evaluate the association between maternal social factors and maternal time spent in the NICU for very preterm infants admitted to 4 level III and IV NICUs. METHODS: In this prospective observational cohort study, we enrolled mother-infant dyads whose infants were born <32 weeks' gestation. Enrollment occurred after 2 weeks of NICU exposure, when maternal social factors and demographic information was collected. Maternal time spent in the NICU was abstracted from the electronic medical record and was dichotomized into 0 to 6 days and ≥6 days per week. Demographic differences between the 2 groups were compared by using χ2 tests. Logistic regression was used to assess the independent association between maternal social factors and the average number of days per week spent in the NICU. RESULTS: A total of 169 mother-infant dyads were analyzed. Maternal social factors associated with more time spent in the NICU included an annual household income of >$100 000, compared with those with an annual household income of <$50 000 (adjusted odds ratio [aOR]: 5.68; 95% confidence interval [CI] 1.77-18.19), a travel time <30 minutes to the NICU (compared with those who traveled >60 minutes [aOR: 7.85; 95% CI 2.81-21.96]), and the lack of other children in the household, compared with women with other children (aOR: 3.15; 95% CI 1.39-7.11). CONCLUSIONS: Maternal time spent in the NICU during a prolonged birth hospitalization of a very preterm infant differed by socioeconomic status, travel time, and presence of other dependents. Strategies to better identify and reduce these disparities to optimize engagement and, subsequently, improve infant health outcomes is needed.


Subject(s)
Intensive Care Units, Neonatal , Mothers , Child , Female , Humans , Infant , Infant, Newborn , Infant, Premature , Prospective Studies , Social Factors
9.
Pediatrics ; 147(2)2021 02.
Article in English | MEDLINE | ID: mdl-33504611

ABSTRACT

Serotonergic medications are used for the prevention and treatment of depression during pregnancy. Selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors (SNRIs) can cause poor neonatal adaptation, which has been attributed to withdrawal versus toxicity. Bupropion, a norepinephrine-dopamine reuptake inhibitor, is often used as an adjunctive agent to selective serotonin reuptake inhibitors or SNRIs for refractory depression. Quetiapine, an atypical antipsychotic, may also be used in more complex cases. When combined with serotonergic drugs, bupropion and quetiapine are associated with increased risk of serotonin syndrome in adults. We describe a neonate exposed to venlafaxine (an SNRI), bupropion, and quetiapine in utero who presented nearly immediately after birth with encephalopathy and abnormal movements. The severity and rapidity of symptoms may be attributable to potentiation of venlafaxine's serotonergic effects by bupropion and quetiapine. Neonatal providers should be aware of maternal medications and prepare for possible adverse effects, particularly from common psychotropic exposures.


Subject(s)
Antidepressive Agents/adverse effects , Bipolar Disorder/drug therapy , Brain Diseases/chemically induced , Dyskinesia, Drug-Induced/etiology , Neurotransmitter Uptake Inhibitors/adverse effects , Pregnancy Complications/drug therapy , Stress Disorders, Post-Traumatic/drug therapy , Antidepressive Agents/therapeutic use , Brain Diseases/congenital , Brain Diseases/diagnosis , Bupropion/adverse effects , Bupropion/therapeutic use , Drug Therapy, Combination , Dyskinesia, Drug-Induced/congenital , Dyskinesia, Drug-Induced/diagnosis , Female , Humans , Infant, Newborn , Male , Neurotransmitter Uptake Inhibitors/therapeutic use , Pregnancy , Quetiapine Fumarate/adverse effects , Quetiapine Fumarate/therapeutic use , Venlafaxine Hydrochloride/adverse effects , Venlafaxine Hydrochloride/therapeutic use
10.
J Perinatol ; 39(2): 307-313, 2019 02.
Article in English | MEDLINE | ID: mdl-30531932

ABSTRACT

OBJECTIVE: Language barriers contribute to suboptimal healthcare delivery. We sought to explore disparities in communication between English and Spanish-speaking parents and their neonatal intensive care unit (NICU) providers. STUDY DESIGN: We compared English-speaking versus Spanish-speaking parents' understanding of their infant's diagnosis through a structured interview. RESULTS: Spanish-speaking parents were four times (RR 4.0, 95% CI: 1.5, 11.0; p = 0.004) more likely to incorrectly identify their child's diagnosis than English-speaking parents. Spanish speakers also self-reported lower understanding of NICU interventions. Physicians provided updates to Spanish-speaking parents in their native language only 39% of the time. CONCLUSIONS: Spanish-speaking NICU parents more commonly misunderstood aspects of their child's care than did English-speaking parents. Providers' failed to communicate with Spanish-speaking families in their native language the majority of the time. Additional research is needed to assess the barriers to effective communication between NICU providers and Spanish-speaking parents.


Subject(s)
Communication Barriers , Hispanic or Latino/psychology , Intensive Care, Neonatal/standards , Parents , Adult , Colorado , Female , Humans , Infant, Newborn , Intensive Care Units, Neonatal , Intensive Care, Neonatal/statistics & numerical data , Language , Male , Prospective Studies , Young Adult
11.
Int. braz. j. urol ; 44(4): 688-696, July-Aug. 2018. tab, graf
Article in English | LILACS | ID: biblio-954075

ABSTRACT

ABSTRACT Objectives: To evaluate the diagnostic performance of preoperative multiparametric magnetic resonance imaging (mp-MRI) as a predictor of extracapsular extension (ECE) and unfavorable Gleason score (GS) in patients with intermediate and high-risk prostate cancer (PCa). Materials and Methods: Patients with clinically localized PCa who underwent radical prostatectomy (RP) and had preoperative mp-MRI between May-2011 and December-2013. Mp-MRI was evaluated according to the European Society of Urogenital Radiology MRI prostate guidelines by two different readers. Histopathological RP results were the standard reference. Results: 79 patients were included; mean age was 61 and median preoperative prostate-specific antigen (PSA) 7.0. On MRI, 28% patients had ECE evidenced in the mp-MRI, 5% seminal vesicle invasion (SVI) and 4% lymph node involvement (LNI). At RP, 39.2% had ECE, 26.6% SVI and 12.8% LNI. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of mp-MRI for ECE were 54.9%, 90.9%, 76%, 81% and 74.1% respectively; for SVI values were 19.1%, 100%, 77.3%, 100% and 76.1% respectively and for LNI 20%, 98.4%, 86.7%, 66.7% and 88.7%. Conclusions: Major surgical decisions are made with digital rectal exam (DRE) and ultrasound studies before the use of Mp-MRI. This imaging study contributes to rule out gross extraprostatic extension (ECE, SVI, LNI) without competing with pathological studies. The specificity and NPV are reasonable to decide surgical approach. A highly experienced radiology team is needed to provide accurate estimations of tumor extension and aggressiveness.


Subject(s)
Humans , Male , Adult , Aged , Prostatic Neoplasms/pathology , Prostatic Neoplasms/diagnostic imaging , Magnetic Resonance Imaging/methods , Prostatectomy/methods , Prostatic Neoplasms/surgery , Seminal Vesicles/pathology , Seminal Vesicles/diagnostic imaging , Biopsy , Reproducibility of Results , Sensitivity and Specificity , Prostate-Specific Antigen/blood , Risk Assessment/methods , Neoplasm Grading , Lymph Nodes/pathology , Lymph Nodes/diagnostic imaging , Middle Aged , Neoplasm Invasiveness/pathology , Neoplasm Staging
12.
Int Braz J Urol ; 44(4): 688-696, 2018.
Article in English | MEDLINE | ID: mdl-29570254

ABSTRACT

OBJECTIVES: To evaluate the diagnostic performance of preoperative multiparametric magnetic resonance imaging (mp-MRI) as a predictor of extracapsular extension (ECE) and unfavorable Gleason score (GS) in patients with intermediate and high-risk prostate cancer (PCa). MATERIALS AND METHODS: Patients with clinically localized PCa who underwent radical prostatectomy (RP) and had preoperative mp-MRI between May-2011 and December-2013. Mp-MRI was evaluated according to the European Society of Urogenital Radiology MRI prostate guidelines by two different readers. Histopathological RP results were the standard reference. RESULTS: 79 patients were included; mean age was 61 and median preoperative prostate-specific antigen (PSA) 7.0. On MRI, 28% patients had ECE evidenced in the mp-MRI, 5% seminal vesicle invasion (SVI) and 4% lymph node involvement (LNI). At RP, 39.2% had ECE, 26.6% SVI and 12.8% LNI. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of mp-MRI for ECE were 54.9%, 90.9%, 76%, 81% and 74.1% respectively; for SVI values were 19.1%, 100%, 77.3%, 100% and 76.1% respectively and for LNI 20%, 98.4%, 86.7%, 66.7% and 88.7%. CONCLUSIONS: Major surgical decisions are made with digital rectal exam (DRE) and ultrasound studies before the use of Mp-MRI. This imaging study contributes to rule out gross extraprostatic extension (ECE, SVI, LNI) without competing with pathological studies. The specificity and NPV are reasonable to decide surgical approach. A highly experienced radiology team is needed to provide accurate estimations of tumor extension and aggressiveness.


Subject(s)
Magnetic Resonance Imaging/methods , Prostatic Neoplasms/diagnostic imaging , Prostatic Neoplasms/pathology , Adult , Aged , Biopsy , Humans , Lymph Nodes/diagnostic imaging , Lymph Nodes/pathology , Male , Middle Aged , Neoplasm Grading , Neoplasm Invasiveness/pathology , Neoplasm Staging , Prostate-Specific Antigen/blood , Prostatectomy/methods , Prostatic Neoplasms/surgery , Reproducibility of Results , Risk Assessment/methods , Seminal Vesicles/diagnostic imaging , Seminal Vesicles/pathology , Sensitivity and Specificity
13.
Case Rep Pediatr ; 2017: 7628946, 2017.
Article in English | MEDLINE | ID: mdl-28280644

ABSTRACT

We report a case of a 1-month-old infant with spontaneous thymic hemorrhage secondary to severe vitamin K deficiency. He was brought to medical attention due to scrotal bruising and during evaluation was noted to be tachypneic and hypoxemic. Chest X-ray revealed an enlarged cardiothymic silhouette, and a follow-up echocardiogram revealed a mass in the anterior mediastinum. Routine laboratory work-up revealed severe coagulopathy. Further questioning revealed the patient had not received prophylactic vitamin K at birth. The coagulopathy resolved with administration of vitamin K, and a biopsy confirmed the anterior mediastinal mass was due to spontaneous thymic hemorrhage.

14.
Rev. colomb. radiol ; 28(3): 4486-4488, 2017. ilus
Article in Spanish | LILACS, COLNAL | ID: biblio-986742

ABSTRACT

El tumor de células gigantes de la vaina tendinosa es, después del ganglión, la masa más común en la mano; se ha descrito su localización en articulaciones de mayor tamaño como el tobillo y el pie. La rodilla es la localización menos frecuente y suele presentarse en niños. En la rodilla la forma de presentación usual es intraarticular y la localización más frecuente es infrapatelar, seguido de la suprapatelar y en menor frecuencia la región posterior intercondilar. Se expone el caso de una mujer sana de 26 años de edad con dolor en la fosa poplítea izquierda asociado a aumento de volumen. La resonancia magnética (RM) mostró una masa sólida, heterogénea, intraarticular, localizada en la región posteromedial de la rodilla, con realce difuso con el medio de contraste. Se consideró como primera posibilidad diagnóstica una sinovitis vellonudar pigmentada. El estudio histopatológico mostró un tumor de células gigantes de la vaina tendinosa de la cápsula articular. El objetivo de esta presentación de caso es demostrar las características en RM de un tumor de células gigantes de la vaina tendinosa de la cápsula de la rodilla, una de las localizaciones menos frecuentes de esta lesión.


The giant cell tumor of the tendon sheath, after the ganglion cyst, is the most common mass in the hand; followed by the ankle and the foot. The knee represents a less common location and it usually occurs in children. In the knee, the usual presentation is intrarticular, and the most frequent location is in the infrapatellar region, followed by the suprapatellar region, and less frequently the posterior intercondylar region. A case of a healthy 26-year-old woman with pain in the right popliteal fossa associated with increased volume is presented. The MRI showed an intra articular heterogeneous solid mass, centrally located in the posterior intercondylar region, with heterogeneous enhancement. Pigmented villonodular synovitis was considered as the first possible differential diagnoses. Histopathological analysis demonstrated a giant cell tumor of the tendon sheath of the joint capsule. The objective of this case report is to show the magnetic resonance (MR) characteristics of a giant cell tumor of the tendon sheath arising from the joint capsule, an uncommon location of this type of lesion.


Subject(s)
Humans , Giant Cell Tumors , Magnetic Resonance Imaging , Knee
15.
J Cytol ; 32(1): 46-9, 2015.
Article in English | MEDLINE | ID: mdl-25948947

ABSTRACT

Desmoplastic small round cell tumor (DSRCT) is a malignant neoplasm that most often presents in male adolescents as an abdominal mass. Cytological features have been previously described, but only two reports noted post chemotherapy changes on effusions. We report a case of a 15-year-old male with DSRCT status postchemotherapy that presented with ascitis. Unusual morphology was seen: Numerous malignant large and single cells with prominent nucleoli and abundant cytoplasm in a background without the stroma, occasional mitosis, and the abundant apoptosis. Cell block immunocytochemistry was confirmatory. Awareness of the postchemotherapy changes in this tumor will allow us to diagnose recurrence.

16.
Rev. colomb. gastroenterol ; 24(1): 72-78, ene.-mar. 2009. ilus
Article in Spanish | LILACS | ID: lil-523337

ABSTRACT

Presentamos el caso de una mujer de 78 años, que presentaba importante pérdida de peso y su endoscopia digestiva alta demostró pliegues gástricos gigantes. Se realizaron biopsias con asa de polipectomía en busca del diagnóstico y posible enfermedad neoplásica. La histopatología documentó gastropatía hipertrófica. La ecoendoscopia gástrica demostró una pared muy gruesa y aunque se sospechó neoplasia no podía ser conclusiva, solamente después de realizada la gastrectomía total se diagnosticó linitis plástica. Presentamos la revisión de pliegues gástricos gigantes así como las causas y clasificación de la gastropatía hipertrófica.


We present 78 year old Colombian lady who had lost weight and had giant gastric folds in her upper endoscopy. Intensive work up was done including extra large biopsies done with polipectomy snares. The pathology diagnosed hypertrophic gastropathy. Endoscopic ultrasound of the stomach diagnosed a very thick gastric wall. Only after total gastrectomy was done, Linitis Plastica was diagnosed. We review giant gastric folds as well as causes and classification of the hypertrophic gastropathy.


Subject(s)
Humans , Female , Aged , Linitis Plastica , Stomach Diseases
17.
J Clin Pharmacol ; 47(8): 970-7, 2007 Aug.
Article in English | MEDLINE | ID: mdl-17615254

ABSTRACT

The aim of this study was to determine the impact of sex on the pharmacokinetics of lopinavir/ritonavir. Interaction between lopinavir/ritonavir and tenofovir was also evaluated. Steady-state plasma samples were obtained from virologically suppressed HIV-infected patients on lopinavir/ritonavir 800/200-mg soft gel capsule taken once daily. Drug assays were performed by high-performance liquid chromatography. Pharmacokinetic parameters estimated by noncompartmental method were reported as 90% confidence intervals (CIs) about the geometric mean ratio (GMR). There were 9 males and 11 females. No sex differences were observed in lopinavir/ritonavir pharmacokinetics profile. The GMR(sex) (women compared with men) for lopinavir area under the concentration-time curve (AUC(24)), maximum concentration (C(max)), and minimum concentration (C(min)) was 0.95 (90% CI, 0.70-1.29), 0.88 (90% CI, 0.67-1.15), and 1.27 (90% CI, 0.60-2.66), respectively. Similarly, the GMR(sex) for ritonavir AUC(24), C(max), and C(min) was 0.84 (90% CI, 0.57-1.24), 0.79 (90% CI, 0.50-1.22), and 1.02 (90% CI, 0.58-1.80), respectively. Tenofovir coadministration led to a reduction in lopinavir/ritonavir plasma exposure, giving a lopinavir GMR(tenofovir) for C(max) of 0.72 (90% CI, 0.57-0.93) and AUC(24) of 0.74 (90% CI, 0.56-0.98), respectively. No difference in lopinavir/ritonavir plasma concentrations between sexes was demonstrated in this study. However, tenofovir coadministration lowered lopinavir/ritonavir plasma exposure.


Subject(s)
Adenine/analogs & derivatives , HIV Protease Inhibitors/pharmacokinetics , Organophosphonates/administration & dosage , Pyrimidinones/pharmacokinetics , Reverse Transcriptase Inhibitors/administration & dosage , Ritonavir/pharmacokinetics , Adenine/administration & dosage , Adult , Area Under Curve , Capsules , Chromatography, High Pressure Liquid , Drug Administration Schedule , Drug Combinations , Drug Interactions , Female , HIV Infections/drug therapy , HIV Protease Inhibitors/administration & dosage , HIV Protease Inhibitors/therapeutic use , Humans , Lopinavir , Male , Pyrimidinones/administration & dosage , Pyrimidinones/therapeutic use , Ritonavir/administration & dosage , Ritonavir/therapeutic use , Sex Factors , Tenofovir
18.
Hum Pathol ; 38(9): 1345-50, 2007 Sep.
Article in English | MEDLINE | ID: mdl-17509660

ABSTRACT

Fluorescence in situ hybridization, loss of heterozygosity testing, and comparative genomic hybridization have been used to detect NF2 gene alterations in both sporadic and neurofibromatosis type 2 (NF2)-associated central nervous system tumors. In this study, we performed chromogenic in situ hybridization (CISH) and immunohistochemistry to evaluate for NF2 gene deletion in a group of sporadic meningiomas, schwannomas, and ependymomas. Twenty-two sporadic tumors, including 9 ependymomas, 10 meningiomas, and 3 schwannomas, were studied. CISH and immunohistochemistry were performed using the NF2 gene deletion probe and NF2 polyclonal antibody. Deletion of the NF2 gene was identified in 11 (50%) tumors, including 60% (6/10) of meningiomas, 33% (3/9) of ependymomas, and 67% (2/3) of schwannomas. The remaining 11 (50%) cases were diploid. Overall, immunoexpression of NF2 protein was observed in 50% (11/22) tumors, and concordance between CISH and immunohistochemistry was observed in 73% of cases. Our results support previous observations that schwannomas and meningiomas, and to a lesser degree, ependymomas, express a high incidence of NF2 gene deletion, which supports the hypothesis that NF2 gene plays an important role in their tumorigenesis. In addition, we have validated CISH as an efficient, economic, and reliable method for routinely assessing NF2 gene deletion in these tumors.


Subject(s)
Ependymoma/pathology , Gene Deletion , Genes, Neurofibromatosis 2 , Meningioma/pathology , Neurilemmoma/pathology , Chromosome Painting , Ependymoma/genetics , Humans , Immunohistochemistry , In Situ Hybridization, Fluorescence , Meningioma/genetics , Neurilemmoma/genetics , Referral and Consultation , Reproducibility of Results , Retrospective Studies
19.
Hum Pathol ; 37(5): 623-6, 2006 May.
Article in English | MEDLINE | ID: mdl-16647961

ABSTRACT

Gangliocytic paraganglioma (GP) is an unusual tumor in the wide spectrum of neuroendocrine neoplasms. The biologic behavior and histogenesis of this tumor is uncertain because, despite its benign histologic features, there have been reports of metastases to regional lymph nodes and distant metastases. Although most of these tumors have been reported in the duodenum, examples of GP arising in extra-ampullary sites have been well documented. Herein, we report the case of a lung GP corticotropin producing and presenting as Cushing's syndrome. After removal of the tumor, there was a significant drop in cortisol and corticotropin levels. To our knowledge, this is the first report of a GP causing Cushing's syndrome.


Subject(s)
Adrenocorticotropic Hormone/metabolism , Cushing Syndrome/pathology , Lung Neoplasms/pathology , Paraganglioma/pathology , Cushing Syndrome/complications , Humans , Lung Neoplasms/complications , Lung Neoplasms/metabolism , Male , Middle Aged , Paraganglioma/complications , Paraganglioma/metabolism
20.
Rev. Fac. Med. (Bogotá) ; 49(2): 63-69, abr.-jun. 2001. tab
Article in Spanish | LILACS | ID: lil-424595

ABSTRACT

Se revisaron 9.349 informes de estudios de especímenes quirúrgicos del archivo del Departamento de Patología del Hospital San Juan de Dios y la Clínica Carlos Lleras Restrepo de Bogotá en el tiempo comprendido entre enero 1 de 1999 y mayo 31 de 2000. Se seleccionaron los especímenes con diagnóstico de tumores gástricos que correspondieron al 8,61 por ciento de los casos; 2,41 por ciento fueron tumores benignos y 6,2 por ciento malignos De éstos 91,67 por ciento fueron adenocarcinomas, 2,78 por ciento linfomas, 1,85 por ciento tumores carcinoides y 1,85 por ciento leiomiosarcomas. Hubo predominio de los adenocarcinomas, los cuales se subclasificaron como de tipo intestinal diruso. Los adenocarcinomas se presentaron más frecuentemente en la sexta y séptima décadas, predominando en el género masculino. El adenocarcinoma de tipo intestinal prevaleció sobre el difuso, presentándose más frecuentemente en hombres, en la sexta y séptima década, encontrándose una estrecha relación de éste con la gastritis crónica atrófica multifocal


Subject(s)
Stomach Neoplasms
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