Subcutaneous immunotherapy induces alterations in monocytes and dendritic cells homeostasis in allergic rhinitis patients.

BACKGROUND: Specific subcutaneous immunotherapy (SCIT) can achieve long-term remission in patients with allergic rhinitis (AR) through complex and still unknown mechanisms. The aim of this study is to evaluate the effect of SCIT over CD16+ and CD16- monocytes, myeloid (mDCs) and plasmacytoid dendritic cells (pDCs) in patients with AR, comparatively to pharmacological standard treatment (non-SIT). METHODS: The relative frequency and absolute number of monocytes and DC subsets, the frequency of these cells producing TNFα after in vitro stimulation with Dermatophagoides pteronyssinus (Dpt) extract, and the expression levels of receptor-bound IgE or IgG were assessed by flow cytometry, in peripheral blood samples from 23 healthy individuals (HG) and 43 participants with AR mono-sensitized to Dpt; 10 with non-SIT treatment and 33 under SCIT, just before (SCIT-T0) and 4 h after administration (SCIT-T4). Moreover, IFNα mRNA expression was evaluated in purified pDCs, by qRT-PCR. RESULTS: After SCIT administration we observed a strong decrease of circulating pDCs, although accompanied by higher levels of IFNα mRNA expression, and an increase of circulating CD16+ monocytes. AR participants under SCIT exhibited a higher expression of receptor-bound IgE in all cell populations that expressed the high affinity receptor for IgE (FcεRI) and a higher frequency of CD16+ monocytes producing TNFα. Conversely, we observed a decrease in the frequency of mDCs producing TNFα in AR under SCIT, similar to the observed in the control group. CONCLUSIONS: SCIT seems to induce numeric, phenotypic, and functional changes in circulating monocytes and dendritic cells, contributing at least in part to the well described immunological alterations induced by this type of immunotherapy.

Timothy grass pollen therapeutic vaccine: optimal dose for subcutaneous immunotherapy.

AIMS: To establish the optimal dose of Phleum pratense subcutaneous immunotherapy (SCIT) in patients with allergic rhinoconjunctivitis with/without asthma. MATERIALS & METHODS: One hundred and fifty-one patients were randomized to receive SCIT 0.25, 0.5, 1.0, 2.0 or 4.0 skin-prick test units (SPT) or placebo. The primary end point was the variation in the concentration of Phleum pratense extract needed to produce a positive nasal provocation test from baseline (V0) to final visit (FV). RESULTS: After 17 weeks, a dose-dependent trend was apparent in the concentration of P. pratense extract needed to produce a positive nasal provocation response. Systemic adverse reactions occurred with 3.2% of administered doses. Grade III (n = 2) and IV (n = 2) events were observed only at the two highest doses. CONCLUSION: P. pratense depot SCIT showed signs of clinical and immunological efficacy by dose-dependently decreasing the allergen sensitization rate. Risk-benefit favored doses below 1.0 SPT units for confirmatory trials.

Alterations on peripheral blood B cell subsets induced by allergic rhinitis.

OBJECTIVES AND DESIGN: Here we evaluated whether allergic rhinitis to Dermatophagoides pteronyssinus induces alterations on circulating B cell subsets. MATERIALS AND METHODS: Circulating B cell subsets and isotype expression on antigen-experienced B cells from allergic patients under conventional pharmacological treatment (NO-SIT, n = 15) and under subcutaneous immunotherapy (SCIT, n = 33), and non-allergic subjects (NC, n = 25) were analyzed by flow cytometry. RESULTS: In allergic patients, we found a significant decrease in IgM(+) and IgG(+) memory B cells and an increase in IgA(+) memory B cells. Additionally, the numbers of circulating IgA(+) plasmablasts in allergic patients were also increased, while those cells expressing IgM were reduced. CONCLUSIONS: Allergic patients have a disturbed B cell subsets distribution which seems to underlie rhinitis pathogenesis and remain unchanged after SCIT.

[Approach and Registry of Anaphylaxis in Portugal]. / Abordagem e Registo da Anafilaxia em Portugal.

Anaphylaxis has a growing incidence, especially in children. It represents a medical emergency and its successful therapy depends on early and proper intervention. Intramuscular epinephrine, with dose adjustment according to weight and age, is the drug of choice for anaphylaxis treatment. After resolution of the acute reaction, the patient should be kept under clinical surveillance for 6 to 24 hours, due to possible biphasic reactions. Prescription of an epinephrine auto injectable device should be considered in all patients with diagnosed or suspected anaphylaxis; additionally these patients should always be referred to an Immunoallergy consultation, to perform adequate investigation and management in order to reduce future risk. All anaphylaxis episodes must be recorded in The Portuguese Catalogue of Allergies and other Adverse Reactions (Catálogo Português de Alergias e outras Reações Adversas, CPARA), which represents a fundamental tool to share clinical information within the Health System. The present manuscript intends to disclose the most recent Portuguese guidelines for the diagnosis and treatment of anaphylaxis, making its clinical approach more effective and homogeneous, and to promote the use of The Portuguese Catalogue of Allergies and other Adverse Reactions as an essential tool to register and share information on anaphylaxis in Portugal.

A anafilaxia apresenta uma incidência crescente, particularmente em idade pediátrica. Constituindo uma emergência Médica, o sucesso terapêutico depende de uma intervenção precoce e adequada. A adrenalina por via intramuscular constitui o fármaco de eleição para o seu tratamento, devendo a dose ser ajustada ao peso e à idade. Resolvida a reação aguda, o doente deve ser mantido sob vigil'ncia Médica por um período de 6 a 24 horas, pelo risco de ocorrência de reações bifásicas. Deverá ser considerada a prescrição de um dispositivo de autoadministração de adrenalina em todos os doentes com diagnóstico ou suspeita de anafilaxia; adicionalmente estes doentes têm indicação formal para estudo em consulta de imunoalergologia, de modo a permitir uma adequada intervenção diagnóstica e terapêutica que reduzirá o risco futuro. Todos os episódios de anafilaxia devem ser registados no Catálogo Português de Alergias e outras Reações Adversas (CPARA), constituindo este um instrumento fundamental de partilha de informação clínica dentro do Sistema de Saúde. Este manuscrito pretende divulgar as orientações para o diagnóstico e tratamento da anafilaxia, tornando a sua abordagem clínica mais eficiente e consertada a nível nacional, e promover a adesão ao Catálogo Português de Alergias e outras Reações Adversas como um instrumento essencial de registo e partilha de informação dos episódios de anafilaxia ocorridos em Portugal.

Different frequencies of Tc17/Tc1 and Th17/Th1 cells in chronic spontaneous urticaria.

BACKGROUND: Chronic urticaria is associated with an immune dysregulation usually mediated by T lymphocytes. Recently, Th17 and Tc17 have been implicated in autoimmune diseases; however, their role in urticaria is not clear yet. METHODS: For the study we recruited 20 patients [10 of them had autoreactive chronic spontaneous urticaria (positive autologous intradermal serum test response, ASST+), and the other 10 were nonautoreactive chronic spontaneous urticaria patients (ASST-)] and 17 healthy age- and gender-matched controls (HG). The frequency and functional activity of Th17/Tc17 and Th1/Tc1 cells were evaluated by flow cytometry and type 2 cytokine mRNA by real-time PCR. RESULTS: Our results demonstrated a significant decrease in Th17 frequency in both chronic urticaria groups compared to HG; regarding the amount of IL-17, at the single cell level, it was reduced in ASST- compared to HG. Concerning the Th1 and Th17 cells producing IFN-γ, IL-2, and TNF-α, a lower frequency was noted in chronic urticaria patients compared to HG. In contrast, a significantly increased frequency of Tc1 cells producing these cytokines was noted in ASST+ compared to HG and ASST-. Also, the frequency of Tc17 cells producing TNF-α was increased in ASST+ compared to HG; however, with respect to the amount of TNF-α, at the single cell level, we found a decrease in ASST+ compared to HG. Regarding type 2 cytokine mRNA, a higher expression was verified in ASST+ compared to HG. CONCLUSION: Our data suggest a probable involvement of cytotoxic T cells, mainly the Tc1 and Tc17 subsets, in chronic urticaria, particularly in the ASST+ group.

Impact of allergic rhinitis and specific subcutaneous immunotherapy on peripheral blood basophils of patients sensitized to Dermatophagoides pteronyssinus.

BACKGROUND: Basophils are important effectors cells in allergic rhinitis (AR) since they are involved in immunoglobulin (Ig) E - mediated inflammation and in the release of pro-inflammatory mediators. Specific subcutaneous immunotherapy (SCIT) provides clear immunologic modulation in some immune cells, however its systemic effects on basophils are not well known. METHODS: Peripheral blood (PB) samples from 43 patients with allergic rhinitis mono-sensitized to Dermatophagoides pteronyssinus (Dpt) [33 of them under SCIT with allergoid Dpt extract, in maintenance dose (SCIT), with evaluation just before SCIT injection (SCIT-T0) and 4 hours later (SCIT-T4) and the other 10 Dpt allergic patients never having, in the past, undergone specific immunotherapy treatment (NSIT)], and 15 healthy age- and gender-matched controls (HG), were analyzed. For each sample, the total (t-IgE) and specific IgE (s-IgE) was performed, as well as, the relative frequency and absolute number of PB basophils and receptor-bound IgE and IgG expression were evaluated by flow cytometry and the Histamine N-methyltransferase (HNMT) and tryptase α/ß1 (TPSAB1) gene expression was assessed by real-time PCR. RESULTS: Higher levels of receptor-bound IgE were observed in SCIT patients, which are correlated with the levels of serum t-IgE and s-IgE, whereas no significant differences were observed for receptor-bound IgG. Regarding HNMT mRNA expression, significantly lower expression levels were detected in AR patients compared to HG, independently of type of therapy. Moreover a negative correlation was found between HNMT gene expression and time under SCIT. Conversely, tryptase gene expression was significantly up-regulated in NSIT when compared to HG; however in SCIT patients, tryptase gene expression was significantly decreased than in NSIT patients. No differences were found for any parameter between SCIT-T0 and SCIT-T4 with exception of a transient increased expression of tryptase in SCIT-T4. CONCLUSION: PB basophils from patients with AR show altered functional features, which seems to be influenced by SCIT, suggesting that these cells could be useful to clarify the SCIT triggered mechanisms at a systemic level.

Specific sublingual immunotherapy with peach LTP (Pru p 3). One year treatment: a case report.

INTRODUCTION: Food allergy is an increasing problem with limited therapeutic approaches apart from to the eviction diet. CASE PRESENTATION: A 40-year-old female patient with food allergy symptoms was polysensitized to almost all vegetable food since the age of 36; the onset of symptoms was during pregnancy. The allergological study demonstrated positive skin prick tests (SPT) to nuts, legumes, cereals, spices, several fresh fruits including peach, and other groups of vegetable foods however, it was negative to common aeroallergens. Serum specific IgE levels were negative (<0.35 kU/L) to profilin and carbohydrate determinants, but positive to Pru p 3 (3.5 kU/L). Positive double-blind placebo-controlled food challenge to peach confirmed the allergic disease. She received specific sublingual immunotherapy with native Pru p 3 at a concentration of 40 mug/ml with 5 administrations per week and a cumulative dose of 200 mug of nPru p 3 per month. After an ultra-rush build-up phase concluded in one day she continued therapy during a year with 5 administrations per week. The clinical evolution and laboratory studies demonstrated an early reduction on SPT reactions with no relevant changes on serum specific IgE, IgG, IgG(1) and IgG(4) to Pru p 3 during the immunotherapy period. The challenge test was negative 4 months after the beginning of the SLIT. Regarding clinical response she markedly improved after the first month of treatment, and by the 3th month she had no major vegetable dietary restrictions, except for nuts and pepper. CONCLUSION: These results demonstrate the excellent efficacy and safety of sublingual specific protein immunotherapy developed according to the patient specific sensitivity profile to Pru p3.

Dynamics of CD86 expression on allergic inflammation--new insights.

CD86 is a well-known costimulatory molecule in its interaction with CD28 and/or CTLA present on T cells, and is essential for full activation of naïve T-cell and subsequent differentiation. Usually the B7 molecules are expressed mainly on APCs and B cells and in specific conditions on other activated cells. These costimulatory molecules are involved in the development of allergic inflammation and airways hyperreactivity (AHR) in allergen-challenged mice. Activated T cells, CD4(+)CD25(+), express CD86 in the first 60 minutes after the specific inhalatory exposure. These T cells can be relevant in IgE mediated allergic reaction possibly by an autocrine costimulation via CD28/CTLA activation pathway. The blockage of the expression of CD86 could be a potential therapeutical target to reduce the magnitude or the progression of the allergic reaction. The review article also discussed relevant patents.

Increased prevalence of allergic sensitisation in rheumatoid arthritis patients treated with anti-TNFalpha.

INTRODUCTION: Tumour necrosis factor alpha (TNFalpha) has emerged as a therapeutic target in chronic inflammatory disorders characterised by a Th1 type immune response, such as rheumatoid arthritis (RA). The presence of allergic disease in these patients could be influenced both by the presence of RA and anti-TNFalpha therapy. Our aim was to evaluate the prevalence of sensitisation to airborne allergens and allergic disease in RA patients, with and without anti-TNFalpha treatment. METHODS: RA patients with (N=20) and without (N=20) anti-TNFalpha therapy (groups T and R) were enrolled. Healthy controls (N=60, group C) were randomly selected from the general population. All participants answered a standardised questionnaire to assess the prevalence of allergic disease and had skin prick tests (SPT) with a standard panel of airborne allergen extracts. RESULTS: Significant differences were found in the prevalence of positive SPT between groups T and R (70% vs 35%, p=0.027) and groups T and C (70% vs 36.7%, p=0.009), but not between groups R and C. The prevalence of allergic disease was similar in the three groups. Groups T and R had similar gender and age distribution, disease duration, disease activity score (DAS28), erythrocyte sedimentation rate and serum C-reactive protein. CONCLUSIONS: Increased prevalence of sensitisation to airborne allergens in RA patients treated with anti-TNFalpha was found. The clinical impact of the positive SPT following anti-TNFalpha initiation has now to be assessed.

Sensitization to profilin in the Central region of Portugal.

BACKGROUND: Profilin is a panallergen found in pollens and fruits. Sensitization to this protein may explain some sensitization to multiple pollen species. We aimed to evaluate sensitization to profilin in patients suffering from respiratory allergy sensitized to pollens, in the Central region of Portugal. METHODS: Patients were evaluated for asthma symptoms, rhinitis, conjunctivitis and food allergy. Skin prick tests (SPT) to aeroallergens including 12 different pollens and profilin (nPho d 2) were performed. The patients were divided into two study groups according to the region of residence: A--inland region and B--coastal region. RESULTS: A total of 370 patients were evaluated (277-group A; 93-group B). 65.9% showed positive skin prick tests and 76.2% were positive to pollens (87.1%-group A; 42.85%-group B; p<0.0001). All the patients sensitized to pollens had rhinitis (p=0.001). Sensitization to profilin was associated with pollen sensitization (p=0.014). 43 patients were sensitized to profilin (40-group A; 3-group B; p=0.006). 21.0% of patients sensitized to pollens, were also sensitized to profilin. 39 patients were sensitized to at least two pollens (p<0.0001). Four profilin and pollen sensitized patients had oral allergy syndrome complaints to melon. This syndrome was related with profilin sensitization (p=0.001). CONCLUSIONS: It is advisable to perform SPT to profilin, particularly in the Inland region, for a better differential diagnosis between cross-reactivity and true sensitization to pollens. The results together with the medical history may support the choice for a specific immunotherapy option.

Effect of Dermatophagoides specific immunotherapy on cutaneous reactivity.

BACKGROUND: There are several immunological and clinical effects induced by specific immunotherapy (SIT). A reduction of reactivity to allergen is the final propose of this therapy. The aim of this study was to evaluate the specific cutaneous reactivity, two years after beginning SIT. METHODS: We included 95 patients with bronchial asthma (BA) and/or allergic rhinitis (AR) to house dust mites (HDM). 74 patients were submitted to subcutaneous SIT with commercial extracts of Dermatophagoides. The control group included the 21 patients without SIT. After a two years period, the cutaneous reactivity was reassessed, by skin prick tests (SPT). The effect of SIT in the cutaneous response was evaluated by calculating the difference between the wheal diameter of the SPT before and after treatment. A positive difference indicated a cutaneous reactivity reduction. RESULTS: The patients submitted to SIT included 52.7% males and 47.3% females, with a mean age of 18.4 +/- 13.9 years old. The cutaneous reactivity to D. pteronyssinus, before and two years after the beginning of SIT, were 6.9 +/- 3 mm and 5.1 +/- 2.9 mm, respectively, with 1.87 of difference (p = 0.0001). The cutaneous reactivity to D. farinae, before and two years after the beginning of SIT, were 6.2 +/- 2.4 mm and 5.0 +/- 3.7 mm, respectively, with 0.93 of difference (p = 0.0790). In the control group, the cutaneous reactivity to D. pteronyssinus was 4.4 +/- 2.1 mm and two years later it was 8.2 +/- 3.7 mm. The difference was -1.53 (p = 0.1590). The cutaneous reactivity to D. farinae was 4.6 +/- 2.2 mm in the first evaluation and 8.3 +/- 4.7 mm two years later. The difference was -2.63 (p = 0.0470). CONCLUSIONS: This study showed a significant reduction of specific cutaneous reactivity induced by Dermatophagoides SIT. In the control group the cutaneous reactivity to Dermatophagoides revealed an increment.

Home gardening may be a risk factor for contact dermatitis to Alstroemeria.

BACKGROUND: Occupational allergy among florists and people who work in cut flower production of Alstroemeria cultivars (Peruvian lily or Inca lily) has been previously reported. The allergen involved in sensitization is tulipalin A (alpha-methylene-gamma-butyrolactone). CASE REPORT: We describe the case of a 65-year-old woman who developed severe dermatitis on her right thumb, index and middle fingers and less severe dermatitis on her left palm and front of forearm with occasional itching of the neck and face after taking up home gardening activities, including cutting flowers such as Alstroemeria. METHODS: The patient and three healthy individuals were submitted to epicutaneous tests with the European standard series, the plant series, and stem portions of three suspected ornamental plants (Alstroemeria, Lilium and Zantedeschia), garlic, and onion. RESULTS: Patch tests performed in our patient, revealed an extreme reaction (+ + +) to Alstroemeria and alpha-methylene-gamma-butyrolactone, a strong reaction (+ +) to propolis and wood tar mix, a weak reaction (+) to balsam of Peru, an irritant reaction to garlic and negative results to diallyl disulfide and the other components investigated. Patch tests performed in the healthy individuals revealed negative. CONCLUSIONS: We stress the importance of Alstroemeria as a cause of allergic contact dermatitis not only in workers involved in the flower trade, but also in other people that come into contact with this plant in their leisure activities.

Home gardening may be a risk factor for contact dermatitis to Alstroemeria / La jardinería puede ser un factor de riesgo de dermatitis de contacto por alstroemeria

Background: Occupational allergy among florists and people who work in cut flower production of Alstroemeria cultivars (Peruvian lily or Inca lily) has been previously reported. The allergen involved in sensitization is tulipalin A (alpha-methylene-gamma-butyrolactone). Case report: We describe the case of a 65-year-old woman who developed severe dermatitis on her right thumb, index and middle fingers and less severe dermatitis on her left palm and front of forearm with occasional itching of the neck and face after taking up home gardening activities, including cutting flowers such as Alstroemeria. Methods: The patient and three healthy individuals were submitted to epicutaneous tests with the European standard series, the plant series, and stem portions of three suspected ornamental plants (Alstroemeria, Lilium and Zantedeschia), garlic, and onion. Results: Patch tests performed in our patient, revealed an extreme reaction (+ + +) to Alstroemeria and alpha-methylene-gamma-butyrolactone, a strong reaction (+ +) to propolis and wood tar mix, a weak reaction (+) to balsam of Peru, an irritant reaction to garlic and negative results to diallyl disulfide and the other components investigated. Patch tests performed in the healthy individuals revealed negative. Conclusions: We stress the importance of Alstroemeria as a cause of allergic contact dermatitis not only in workers involved in the flower trade, but also in other people that come into contact with this plant in their leisure activities

Antecedentes: La alergia ocupacional entre las floristas y en los trabajadores de producción de flores de corte de cultivos de Alstroemeria (lirio Peruano o lirio Inca) fue ya objeto de descripción. La Tulipalina A (alfa-metileno-gama-butirolactona) es lo alergeno involucrado en la sensibilización. Caso clínico: se presenta un caso de una paciente de 65 años que ha iniciado una dermatitis grave en los 1º, 2º y 3º dedos de la mano derecha, bien como una dermatitis de intensidad moderada en la área palmar izquierda y vista anterior de lo antebrazo homolateral. Ocasionalmente, los síntomas se acompañan de prurito de la cara y cuello, en el decurso de actividades de jardinaje en su casa, incluyendo el corte de flores de Alstroemeria. Métodos: Fueron realizadas pruebas epicutáneas con la serie estándar europea, la serie de plantas, y porciones de tallo de tres plantas sospechas (Alstroemeria, Lilium y Zantedeschia), ajo y cebolla. Resultados: Las pruebas revelaron una reacción severa (+++) a Alstroemeria y alfa-metileno-gama-butirolactona, una reacción intensa (++) a propolis y mixtura de alquitranes de la madera, una reacción ligera (+) a bálsamo Perú, una reacción irritativa a ajo y resultados negativos a dialil disulfido, bien como a todos los demás estudiados. Conclusiones: Este caso clínico reporta la importancia de la Alstroemeria como inductor de dermatitis de contacto alérgica, non solo en trabajadores de floricultura, pero también en individuos comunes que puedan contactar con esta planta en sus actividades de tiempos libres

Imunoterapia específica - avaliação dinâmica e cinética in vivo do extrato terapêutico em doentes alérgicos / Specific immunotherapy - in vivo dinamic and kinetic evaluation of a therapeutic extract in allergic patients

Introdução: A imunoterapia específica (IT) é uma forma comum de tratamento da doença alérgica. O mecanismo preciso desta terapêutica não é conhecido, embora a eficácia clínica esteja plenamente documentada. O objetivo deste estudo foi avaliar a cinética da IT , aplicando uma técnica de Medicina Nuclear, marcação de leucócitos com 99mTc-HMPAO, em doentes em fase de manutenção e com excelente eficácia clínica à terapêutica.Pacientes e métodos: Foram estudados 14 doentes alérgicos agrupados de acordo com o tipo de extrato e via de administração: extratos aquosos subcutâneos (látex= 4 doentes; veneno de abelha= 2 doentes), extrato depot subcutâneo (ácaros= 2 doentes; gramíneas= 2 doentes); extrato modificado subcutâneo (gramíneas= 1 doente; Parietária= 1 doente) extrato sublingual (ácaros= 2 doentes). O grupo controle foi constituído por dois doentes alérgicos a ácaros, submetidos respectivamente a: injecção subcutânea de soluto salino e injecção de extrato bacteriano por via subcutânea (controle positivo).Simultaneamente à administração do extrato alergênico terapêutico, procedeu-se à re-injecção de leucócitos marcados com 99mTc-HMPAO, em veia periférica contralateral. A aquisição dinâmica decorreu durante 60 minutos, com matriz de 64x64, 2 imagens/ minuto em projeção torácica anterior. As aquisições estáticas, com matrizes 256x256, durante 5 minutos cada foram adquiridas aos 60, 90, 120, 180, 240, 300 e 360 minutos, em projeção torácica (anterior e posterior) e abdominal (anterior).Resultados: A atividade inflamatória no ocal de administração da IT para os extratos subcutâneos aquosos e depot iniciou-se na primeira hora e manteve um aumento ao longo do tempo de estudo. Para os extratos sublinguais a atividade inflamatória foi observada logo nos primeiros minutos. Todos os estratos subcutâneos condicionaram dreanagem linfática ascendente para áreas axilares homolaterais nos primeiros minutos após a adminstração do extrato e, posteriormente, para tecido linfóide do mediastino superior e anterior, e áreas cervicais. As focalizações torácicas estiveram presentes em todos os doentes estudados, o mesmo não acontecendo para a atividade de intestinal. A via sublingual não induziu focalizações axilares ou instetinais, mesmo tendo havido deglutição do alérgeno. Foram calculados coeficientes corrigidos de captação em áreas individualizadas (ROIs- region of interest) em relação aos coeficientes de captação das áreas de background.

Oftalmia simpática após traumatismo ocular contuso / Simpathetic ophthalmia

Os autores descrevem um caso de Oftalmia Simpática (OS) sem perfuraçäo ou rotura ocular evidente, com excelente evoluçäo com a corticoterapia. Discutem, com base na observaçäo do caso e na revisäo de literatura, a excepcionalidade da enucleaçäo nesta patologia

Retinopexia pneumática: análise de 101 casos / Pneumatic retinopexy: analysis of 101 cases

Apresentada casuística de 101 pacientes operados no Hospital dos Servidores-RJ pela técnica de retinopexia pneumática, entre 1986 e 1991. Setenta e cinco olhos em 75 pacientes tiveram sua retina reaplicada (74,25 por cento) por no mínimo 6 meses. Foram incluídos pacientes (n=29) com roturas múltiplas, roturas maiores que 1 h, portadores de PVR até C3, afásicos e pseudofásicos, e previamente operados pela técnica de introflexäo escleral. Neste grupo, o índice de cura atingiu 62,07 por cento. Naqueles com roturas até 30º de extensäo ou múltiplas retidas neste intervalo, PVR até C1 e localizadas entre 9 e 3 hs., a retina foi reaplicada em 78,26 por cento. A retinopexia pneumática mostrou-se eficiente, de baixo custo e fácil realizaçäo, devendo ser considerada, frente às dificuldades estruturais da saúde pública no Brasil, como de primeira escolha para casos selecionados.

Hipertensäo ocular após retinopexias / Ocular hypertension after retinopexy

Os autores analisaram, prospectivamente, a ocorrência de hipertensäo ocular no período pós-operatório imediato (primeira semana), em 47 olhos submetidos à retinopexia com introflexäo escleral, drenagem de líquido sub-retiniano e colocaçäo de elemento circular. Encontraram elevada incidência de níveis acima de 22 mmHg tanto no primeiro dia de pós operatório - 27 casos (57,45//) - como após uma semana - 11 casos (23,40//). Sugerem que maior atençäo seja dada à tonometria após as retinopexias, em razäo das possíveis complicaçöes relacionadas aos elevados níveis tensionais

Candidemia com endoftalmite / Candidemia with choroidoretinitis

Um paciente com 43 anos, de cor negra, é internado com quadro de íleo e submetido a laparotomia exploradora. A oclusäo intestinal era conseqüente a bridas. Durante o ato cirúrgico, houve lesäo de intestino delgado, fazendo-se necessária a ileostomia. No pós-operatório apresentou abscesso de parede e fístula enterocutânea, precedidos de quadro febril. Iniciado gentamicina, cloranfenicol e hiperalimentaçäo parenteral. O cuadro febril, que fora debelado, reinstalou-se com calafrios e sem resposta ao novo esquema antimicrobiano. Quatro hemoculturas deram crescimento a Candida albicans e a imunodifusäo foi fortemente positiva. Iniciou-se ketoconazol, tendo sido sustada, em seguida, a hiperalimentaçäo parenteral. No olho esquerdo, apresentou turvaçäo vítrea e na coriorretina, lesöes metastáticas de candidemia. A seguir, foram constatadas sinéquias posteriores. Queixava-se, nesta fase, de turvaçäo visual intensa. Hemoculturas negativas. Continuava febril. Surgiram novas lesöes de coriorretinite, a despeito de utilizaçäo de anfotericina B. A melhor clínica, no entanto, foi acentuada neste curto espaço de tempo. Tomou apenas 125mg de anfotericina B que, por falta absoluta de veias, foi interrompida. Continuou a terapêutica com 5-fluorocitosina, tendo obtido plena recuperaçäo clínica e oftálmica. Säo revistos os aspectos gerais da candidemia com endoftalmite. Considerando a seriedade com que deve ser hoje encarado o envolvimento das estruturas oculares nesta patologia, lançamos um alerta para seu alto índice de mortalidade assim como para a possibilidade de cegueira definitiva

Métodos e resultados iniciais dos enxertos arteriais com a veia safena "in situ" / Methods and initial results of the in situ saphenous vein arterial bypase

A utilizaçäo da veia safena "in situ" nas restauraçöes arteriais abaixo do ligamento inguinal, é técnica particularmente atrativa considerando tratar-se de substituto arterial autólogo, linear e com endotélio conservado, ser morfologicamente crônico e apresentar ótima capacidade hemodinâmica de adaptaçäo ao fluxo arterial, mesmo quando apresenta pequeno calibre ou quando parcialmente varicosada. A casuística consta de 7 pacientes, todos com isquemia grave e importante comprometimento do estado geral. A anastomose distal foi realizada acima do joelho em 4 casos e em 3 abaixo do joelho. O sistema vascular foi previamente avaliado por flebografia e, intra-operatoriamente, submetido a devalvulaçäo ou secçäo valvular. Somente em um caso foi necessáia a ressecçäo valvular. Num segmento médio de 10 meses, houve uma complicaçäo imediata por hemorragia, um óbito por infarto do miocárdio e uma amputaçäo com prótese pérvia