RESUMO
BACKGROUND: Carotid artery stenting (CAS) is an alternative to carotid endarterectomy for the prevention of stroke and transient ischemic attack (TIA). The high long-term mortality among patients who underwent CAS seems to be related to the high comorbidity burden, including coronary and peripheral artery disease. However, limited data on very long-term mortality (over four years) and predictors of death are available. AIM: We sought to investigate the very long-term survival after CAS and the impact of comorbidities on mortality at follow-up. METHODS: Data of 194 symptomatic and asymptomatic patients who underwent CAS with cerebral protection systems from December 2002 to March 2014 were analyzed. All cause mortality during long-term follow-up was assessed. Univariate and multivariate Cox regression analysis was used to find independent predictors of death. RESULTS: The median age of patients was 66 [interquartile range (IQR): 60-73] years and 78.9 % of patients were male. The median follow-up was 7.6 (IQR: 4.4-10.2) years. The all-cause mortality rate after 30 days, one year, four years, and at maximum follow-up was 0 %, 5.1 %, 17.5 % and 31.4 %, respectively. Out of 61 deaths, 37 (60 %) were cardio-cerebral vascular related deaths, 15 (25 %) non-cardiovascular deaths, and 9 (15 %) due to unknown reasons. Among cardio-cerebral vascular deaths, there were 12 fatal strokes, 18 fatal myocardial infarctions and seven other cardiac related deaths. Non-cardiac deaths were due mainly to cancer (9/15). Age and diabetes mellitus were independent predictors of all-cause death during long-term follow-up. CONCLUSIONS: The mortality rate during short and long-term follow-up after CAS was lower than reported in the literature. Age and diabetes mellitus were independent predictors of all-cause death. Further research is needed to confirm the potential association between those risk factors and decreased survival. Hippokratia 2016, 20(3): 204-208.
RESUMO
Altered hypothalamo-pituitary-adrenal axis was reported in stroke patients; however, mechanisms responsible for this phenomenon are barely understood. Acute cerebral ischemia triggers interleukin-6 (IL-6) release into blood. Circulating IL-6 can stimulate hypothalamo-pituitary-adrenal axis. The goal of our study was to assess a relationship between serum IL-6 and cortisol in acute ischemic stroke. Twenty two patients with ischemic stroke and 17 controls were included. Serum samples were collected on the 2nd day of stroke at 6:00, 10:00 18:00, 22:00 h and at the same time points in control group. Cytokines and cortisol levels were measured using ELISA method. Serum IL-6 and cortisol levels were higher in stroke patients than in controls. Cortisol displayed diurnal variations in both stroke patients and controls. In contrast with control subjects, serum IL-6 levels did not display diurnal variations in stroke patients. In stroke patients, but not in controls, IL-6 level correlated significantly with cortisol level and morning serum IL-6 level independently predicted evening/night cortisol level. In conclusion, brain ischemia could stimulate IL-6 release in blood and in this way modulate hypothalamo-pituitary-adrenal axis.
Assuntos
Isquemia Encefálica/sangue , Ritmo Circadiano , Hidrocortisona/sangue , Interleucina-6/sangue , Acidente Vascular Cerebral/sangue , Doença Aguda , Idoso , Feminino , Humanos , Hidrocortisona/metabolismo , Sistema Hipotálamo-Hipofisário/fisiologia , Masculino , Análise por Pareamento , Pessoa de Meia-Idade , Sistema Hipófise-Suprarrenal/fisiologia , Valor Preditivo dos TestesRESUMO
BACKGROUND: Deterioration of left ventricular function during follow-up was reported in some patients with syndrome X and concomitant left bundle branch block. The patients with syndrome X and left bundle branch block has been frequently presented with elevated Endothelin-1 (ET-1) level while brain natriuretic peptide (BNP) (a sensitive marker of left ventricular dysfunction) has not been measured in patients with syndrome X. METHODS: The purpose of the present study was to assess left ventricular diastolic function, levels of N-terminal Brain Natriuretic Peptide (NT-proBNP) precursor and biochemical parameters of endothelial function in patients with syndrome X complicated by left bundle branch block but preserved left ventricular systolic function (group A, n=8). The echocardiographic and neurohormonal measures in these patients were compared to those in patients with syndrome X without left bundle branch block (group B, n=13), and controls (group C, n=15). RESULTS: At rest and after exercise the serum concentration of NT-proBNP was significantly higher in group A than in the controls (at rest: 232+/-96 vs. 133+/-23 fmol/ml, P=0.03; after exercise: 313+/-96 vs. 180+/-33 fmol/ml, P=0.02). The highest concentration of endothelin-1 was also found in group A, being significantly higher than in the controls (6.81 vs. 4.52 pg/ml, P<0.05). Mitral flow abnormalities were detected in left bundle branch block patients. Accordingly, the lowest E/A ratio was in group A and it differed significantly from that in group C (0.85 vs. 1.1, P<0.05). E/A ratio inversely correlated with plasma NT-proBNP concentration in patients with left bundle branch block (r=-0.48, P=0.02). CONCLUSIONS: Elevated NT-proBNP and endothelin-1 plasma concentrations were demonstrated in patients with syndrome X complicated by left bundle branch block even when left ventricular systolic function was still preserved. In this subgroup the magnitude of left ventricular diastolic dysfunction correlated with the increase of BNP level which reflects neurohormonal activation.
Assuntos
Bloqueio de Ramo/sangue , Bloqueio de Ramo/fisiopatologia , Endotelinas/sangue , Angina Microvascular/sangue , Angina Microvascular/fisiopatologia , Peptídeo Natriurético Encefálico/sangue , Precursores de Proteínas/sangue , Sístole/fisiologia , Função Ventricular Esquerda/fisiologia , Bloqueio de Ramo/diagnóstico por imagem , Feminino , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Angina Microvascular/diagnóstico por imagem , Pessoa de Meia-Idade , UltrassonografiaRESUMO
BACKGROUND: Administration of enoxaparin to patients with acute coronary syndromes can result in better outcomes in comparison to patients treated with unfractionated heparin. Use of enoxaparin during percutaneous coronary interventions (PCI) can also improve the outcome. Administration of ticlopidine and aspirin for a few days before PCI decreases frequency of ischaemic complications. There is lack of data about safety and efficacy of combined administration of enoxaparin, ticlo-pidine and aspirin during PCI. METHODS: 61 patients with coronary artery disease were involved in the study. All patients were pretreated with aspirin (75-325 mg/d) and ticlopidine (2 x 250 mg) for at least 3 days before PCI. PCI procedures were conducted after i.v. administration of 1 mg/kg of enoxaparin. After PCI bleeding and ischaemic complications were monitored. RESULTS: In the treated group, no major bleeding occurred, while minor bleeding was noted in 6.5% of patients. No periprocedural major adverse cardiac events (death, Q wave infarction, urgent revascularisation) were observed. Microembolisation was present in 4.9% patients (expressed as CK-MB > 3 times the reference level). CONCLUSIONS: Intravenous administration of enoxaparin 1 mg/kg during PCI in patients pretreated with aspirin and ticlopidine for at least 3 days before intervention appears to be safe. Safety and high efficacy of enoxapirine in this pilot trial justify initiating the randomized, multicenter trial comparing use of low molecular weight heparin to unfractionated heparin during PCI.
Assuntos
Angioplastia Coronária com Balão/métodos , Anti-Inflamatórios/uso terapêutico , Anticoagulantes/uso terapêutico , Doença da Artéria Coronariana/terapia , Fibrinolíticos/uso terapêutico , Ácido Glicirretínico/uso terapêutico , Heparina de Baixo Peso Molecular/uso terapêutico , Cuidados Pré-Operatórios , Ticlopidina/uso terapêutico , Administração Tópica , Anti-Inflamatórios/efeitos adversos , Anticoagulantes/administração & dosagem , Doença da Artéria Coronariana/tratamento farmacológico , Quimioterapia Combinada , Feminino , Ácido Glicirretínico/efeitos adversos , Heparina de Baixo Peso Molecular/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Projetos PilotoRESUMO
In several renal diseases such as nephrotic syndrome or terminal renal insufficiency changes in lipids metabolism may lead to increase of cholesterol level or changes in its fractions proportions. There are many clinical and experimental observations demonstrating direct toxic effect of lipids on endothelium leading to impairment of endothelial function what can increase damage of glomeruli. It is associated with passive filtration of lipoprotein to mesangium and active fagocytosis by mesangial cells and infiltrating macrophages, which release cytokines and growth factors increasing mesangial proliferation. There are first publications suggesting possibility of application LDL-apheresis-radical cholesterol removing procedure in renal disease. Periodical cholesterol lowering in the blood reduces proteinuria in patients with resistant for pharmacotherapy nephrotic syndrome, especially with focal glomerulonephritis.
Assuntos
Hipercolesterolemia/terapia , Nefropatias/complicações , Plasmaferese , LDL-Colesterol/sangue , Mesângio Glomerular/metabolismo , Humanos , Hipercolesterolemia/etiologia , Hipercolesterolemia/metabolismo , Nefropatias/metabolismoRESUMO
Since a number of pathological processes such as septic shock, inflammation, graft rejection, diabetes, etc. are associated with a release of nitric oxide (NO), rapid and accurate methods of monitoring of NO concentration are of interest. Various methods for measurement of nitrite and nitrate (NO2-, NO3- ) -- the stable metabolites of NO -- are commonly used for this purpose. In this paper we have shown that the proper Griess procedure for nitrite determination significantly increases the sensitivity of this method. This procedure, supplemented with deproteinization and reduction of nitrates to nitrites in the presence of NADPH-sensitive reductase, can be successfully applied for measurement of NOx levels in human body fluids (serum, urine and CSF). Deproteinization of samples with methanol/diethylether is required and does not influence the sensitivity of detection of NO metabolites. The recovery of the method is 88%+/-6% (n = 30). The NOx concentrations measured by this procedure ranged from 25.0 to 39.0 micromol/l in blood, 4.6 to 14.6 micromol/l in CSF and 0.37 to 2.52 mmol/l (adjusted to creatinine concentration) in urine. The coefficient of variation for this method was between 1.3-2.2%. This method can also be recommended for measurement of NOx produced by cells in tissue cell culture.
Assuntos
Sequestradores de Radicais Livres , Nitratos/análise , Nitritos/análise , Animais , Células Cultivadas , Etilenodiaminas , Humanos , Masculino , Músculo Liso Vascular/química , Ratos , Ratos Wistar , SulfanilamidasAssuntos
Angioplastia com Balão , Fatores de Crescimento Endotelial/biossíntese , Endotélio Vascular/metabolismo , Regulação da Expressão Gênica , Linfocinas/biossíntese , Infarto do Miocárdio/metabolismo , Isquemia Miocárdica/metabolismo , Óxido Nítrico Sintase/biossíntese , Animais , Artérias Carótidas , Endotélio Vascular/lesões , Indução Enzimática , Ratos , Ratos Wistar , Fator A de Crescimento do Endotélio Vascular , Fatores de Crescimento do Endotélio VascularRESUMO
Over 1,243 organ transplants have been performed at the Hartford Transplant Center over the past two decades. Survival in kidney, heart, liver, and pancreas patients is at or above the national average. Hartford was one of the first centers to use triple immunosuppression, which significantly improved survival in kidney transplantation. For recipients of kidneys from living related donors and cadaveric kidneys, two-year actuarial graft survival has been 98% and 83%, respectively, over the last five years. For heart and liver transplants, two-year survival has been 79% and 67%, respectively. Despite high success rates at most transplant centers, donor organs remain scarce. This problem needs to be addressed through increased cooperative efforts in the health-care community and the general public.
Assuntos
Transplante de Órgãos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Connecticut , Estudos de Avaliação como Assunto , Sobrevivência de Enxerto , Transplante de Coração/estatística & dados numéricos , Humanos , Transplante de Rim/estatística & dados numéricos , Transplante de Fígado/estatística & dados numéricos , Pessoa de Meia-Idade , Transplante de Órgãos/estatística & dados numéricos , Transplante de Pâncreas/estatística & dados numéricosRESUMO
1. BSA-containing solutions improve islet yields using standard collagenase digestion techniques. 2. The BSA effect on islet isolation is independent of source and lot of collagenase. 3. The BSA effect on islet isolation is not due solely to its colloid action, as HES failed to achieve the same level of improvement seen with albumin. 4. BSA can protect islets from warm ischemic injury, and the protective action appears to be unique to albumin, as HES was not as effective.
Assuntos
Separação Celular/métodos , Ilhotas Pancreáticas/citologia , Soroalbumina Bovina , Animais , Colagenases , Coloides , Estudos de Avaliação como Assunto , Técnicas In Vitro , Isquemia/prevenção & controle , Ilhotas Pancreáticas/irrigação sanguínea , Ilhotas Pancreáticas/lesões , Transplante das Ilhotas Pancreáticas , Soluções Isotônicas , Ratos , Ratos Endogâmicos LewAssuntos
Rejeição de Enxerto/terapia , Transplante de Rim/imunologia , Muromonab-CD3/uso terapêutico , Ciclosporina/uso terapêutico , Relação Dose-Resposta a Droga , Esquema de Medicação , Quimioterapia Combinada , Sobrevivência de Enxerto , Humanos , Metilprednisolona/uso terapêutico , Taxa de Sobrevida , Fatores de TempoRESUMO
The purpose of this study was to determine the incidence of cholelithiasis among heart and kidney transplant recipients. Since recommendations for cholecystectomy in transplant recipients varies widely, we discuss guidelines for surgery including laparoscopic techniques. We reviewed the records of 114 patients who underwent heart transplantation from 1984 to 1993 and 539 kidney transplant patients from 1972 to 1993. Recipients of heart and kidney transplants were found to have an incidence of cholelithiasis of 12% and 3% respectively. Pretransplantation ultrasound surveillance was used in heart transplant recipients and 64% of these with asymptomatic cholelithiasis have not required surgery with close follow-up from six months to six years. Thirty-six percent of the heart patients underwent cholecystectomy. All symptomatic renal transplant patients undergoing ultrasound with the findings of cholelithiasis underwent cholecystectomy. Open cholecystectomies were performed prior to the advent of laparoscopic surgery in six of the first seven attempts. Laparoscopic cholecystectomy on heart and kidney transplant recipients was well tolerated with admission the same day of surgery, a one to two day hospital stay and maintenance of oral immunosuppression. There was a single complication of leg thrombophlebitis, no mortality, and allograft rejection did not occur.
Assuntos
Colelitíase/cirurgia , Transplante de Coração , Transplante de Rim , Adulto , Colecistectomia Laparoscópica/métodos , Colelitíase/diagnóstico por imagem , Colelitíase/epidemiologia , Colelitíase/prevenção & controle , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , UltrassonografiaAssuntos
Adenoma de Células das Ilhotas Pancreáticas/cirurgia , Tumor Carcinoide/cirurgia , Neoplasias Hepáticas/secundário , Transplante de Fígado , Neoplasias Pancreáticas/cirurgia , Feminino , Seguimentos , Humanos , Neoplasias Hepáticas/cirurgia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Pancreatectomia , EsplenectomiaAssuntos
Transplante de Rim/fisiologia , Corticosteroides/uso terapêutico , Adulto , Azatioprina/uso terapêutico , Cadáver , Ciclosporina/uso terapêutico , Feminino , Seguimentos , Humanos , Transplante de Rim/imunologia , Masculino , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Doadores de Tecidos , Resultado do TratamentoAssuntos
Rejeição de Enxerto/prevenção & controle , Sobrevivência de Enxerto/efeitos dos fármacos , Transplante de Rim/imunologia , Muromonab-CD3/administração & dosagem , Cadáver , Ciclosporina/administração & dosagem , Relação Dose-Resposta a Droga , Esquema de Medicação , Rejeição de Enxerto/imunologia , Sobrevivência de Enxerto/imunologia , Humanos , Metilprednisolona/administração & dosagem , Muromonab-CD3/efeitos adversos , Complicações Pós-Operatórias/imunologia , Complicações Pós-Operatórias/prevenção & controleAssuntos
Azatioprina/administração & dosagem , Ciclosporina/administração & dosagem , Rejeição de Enxerto/prevenção & controle , Sobrevivência de Enxerto/efeitos dos fármacos , Antígenos HLA/imunologia , Teste de Histocompatibilidade , Transplante de Rim/imunologia , Complicações Pós-Operatórias/prevenção & controle , Prednisona/administração & dosagem , Transfusão de Sangue , Relação Dose-Resposta a Droga , Esquema de Medicação , Quimioterapia Combinada , Rejeição de Enxerto/imunologia , Sobrevivência de Enxerto/imunologia , Humanos , Complicações Pós-Operatórias/imunologiaAssuntos
Corticosteroides/administração & dosagem , Azatioprina/administração & dosagem , Ciclosporina/administração & dosagem , Rejeição de Enxerto/mortalidade , Transplante de Rim/mortalidade , Complicações Pós-Operatórias/mortalidade , Adulto , Causas de Morte , Quimioterapia Combinada , Feminino , Seguimentos , Rejeição de Enxerto/patologia , Teste de Histocompatibilidade , Humanos , Transplante de Rim/patologia , Masculino , Complicações Pós-Operatórias/patologia , ReoperaçãoAssuntos
Rejeição de Enxerto/economia , Hospitalização/economia , Transplante de Rim/economia , Complicações Pós-Operatórias/economia , Recusa do Paciente ao Tratamento , Assistência Ambulatorial/economia , Análise Custo-Benefício , Nefropatias Diabéticas/economia , Nefropatias Diabéticas/cirurgia , Seguimentos , Humanos , Imunossupressores/economia , Diálise Renal/economiaAssuntos
Rejeição de Enxerto/imunologia , Imunossupressores/administração & dosagem , Testes de Função Renal , Transplante de Rim/imunologia , Complicações Pós-Operatórias/imunologia , Aciclovir/administração & dosagem , Soro Antilinfocitário/administração & dosagem , Soro Antilinfocitário/efeitos adversos , Causas de Morte , Clotrimazol/administração & dosagem , Terapia Combinada , Relação Dose-Resposta a Droga , Esquema de Medicação , Seguimentos , Rejeição de Enxerto/tratamento farmacológico , Rejeição de Enxerto/mortalidade , Humanos , Transplante de Rim/mortalidade , Muromonab-CD3/administração & dosagem , Muromonab-CD3/efeitos adversos , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/mortalidade , Pentamidina/administração & dosagem , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/mortalidade , Análise de Sobrevida , Taxa de Sobrevida , Combinação Trimetoprima e Sulfametoxazol/administração & dosagemRESUMO
Orthotopic liver transplantation (OLT) remains the only option for progressive acute fulminant hepatic failure (FHF). The overall one-year survival is approximately 58% versus 75% for all patients undergoing OLT. Nevertheless, this is superior to the results obtained with medical management alone, which carries a mortality of approximately 60-85%. Seven of 32 patients at Hartford Hospital (22%) received liver transplants for acute FHF; the one-year survival was 57%. Four of seven patients are alive with complete neurologic recovery. One case is presented in detail.