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1.
Clin Nephrol ; 73(2): 147-52, 2010 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20129022

RESUMO

Malignant nephrosclerosis is acute renal failure in the setting of malignant hypertension and may be associated with thrombotic microangiopathy. Although the prognosis has improved considerably over the past decades, renal dysfunction remains an important cause of morbidity and mortality. Adequate control of blood pressure is crucial, allows gradual healing of the necrotizing vascular lesions and may induce stabilization and improvement of renal function in about 50 - 80% of involved patients. In addition, recent investigations have provided a better understanding of the pathophysiology of malignant hypertension and offer possibilities for identifying patients at risk. We report 3 patients who developed severe acute renal failure requiring dialysis initiation in the setting of malignant hypertension. All patients had kidney biopsy proven malignant nephrosclerosis and presented with symptoms of thrombotic microangiopathy. Despite adequate blood pressure control the prognosis of our patients varied.


Assuntos
Injúria Renal Aguda/terapia , Pressão Sanguínea/fisiologia , Hipertensão Renal/terapia , Diálise Renal/métodos , Injúria Renal Aguda/complicações , Injúria Renal Aguda/patologia , Adulto , Biópsia , Seguimentos , Humanos , Hipertensão Renal/etiologia , Hipertensão Renal/fisiopatologia , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença
2.
J Clin Pathol ; 59(6): 598-602, 2006 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-16469830

RESUMO

AIM: To evaluate the sources of fetal haemoglobin (HbF) as an indicator in cancer. An immunohistochemical study was carried out on some of the most common kinds of cancer. All of these cancers had serologically high levels of HbF as evaluated previously. METHODS: Immunoaffinity-purified anti-HbF was immunohistochemically used to study F cell distribution in the following cancers: colorectal adenocarcinoma, urinary bladder transitional cell carcinoma, brain tumours, lung carcinoma, breast adenocarcinoma, leukaemia, Burkitt's lymphoma and endometrial carcinoma. RESULTS: In colorectal adenocarcinoma, HbF-containing red blood cells (FRBC) were present within thin-walled vessels or were disposed in dense clusters within the tumour. Some of these cells were nucleated or binucleated HbF-erythroblasts or HbF-normoblasts (FNBS). In two cases, high levels of mitoses within HbF-erythroblasts were observed. In half of the cases with transitional cell carcinoma of the urinary bladder, regional intratumoral blood vessels were found to contain 5-50% FRBC. In the other tumours examined, F cells were not observed. FRBCs, however, were occasionally observed in the regional lymph nodes of some of these cancers. CONCLUSIONS: The evaluation of HbF as a potential plasma marker is suggested by the high concentration of FRBCs in colorectal tumours. The apparent development of FRBCs in colorectal tumour tissues is an interesting observation, as these cells were previously thought to develop in medullary or lymphoid tissues. It is thus suggested that the colonic microenvironment may stimulate extramedullary fetal-type haematopoiesis.


Assuntos
Adenocarcinoma/irrigação sanguínea , Neoplasias Colorretais/irrigação sanguínea , Hemoglobina Fetal/metabolismo , Neovascularização Patológica/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/metabolismo , Neoplasias Encefálicas/irrigação sanguínea , Neoplasias da Mama/irrigação sanguínea , Eritroblastos/metabolismo , Feminino , Humanos , Leucemia/sangue , Neoplasias Pulmonares/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Neoplasias da Bexiga Urinária/irrigação sanguínea
4.
J Lab Clin Med ; 139(1): 50-8, 2002 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-11873245

RESUMO

Although the beneficial effects of deferoxamine (DFO) on iron-associated morbidity and mortality are well documented, the role of deferiprone (L1) in the management of transfusional iron overload is controversial. This debate involves not only the question of efficacy but also of safety, with particular emphasis on the risk of a paradoxical aggravation of iron toxicity by L1. We used the iron-loaded gerbil model introduced by Carthew et al to compare the chelating efficacy of L1, DFO, or both in two gerbil strains treated by means of weekly iron-dextran injections: Psammomys obesus and pathogen-free Mongolian gerbils (Meriones unguiculatus). The difference between the high mortality and advanced hepatocellular necrosis observed in iron-loaded P obesus and the absence of mortality and limited morbidity encountered in pathogen-free Mongolian gerbils is most likely explained by the prevention of coincidental laboratory infections in the latter group. Iron-chelating treatment in all experimental groups resulted in a significant decrease in hepatic iron concentrations and normalization of mitochondrial respiratory enzyme activities, with combined L1 and DFO treatment being the most efficient, followed, in decreasing order, by DFO and L1 as single-drug treatments. Judged by tissue iron concentrations, mitochondrial enzyme activity, and hepatic histology, we could find no evidence of a paradoxical aggravation of iron toxicity by L1 in either of the two series of studies. Although these data appear to be reassuring, the present controversy related to the role of L1 in the development of hepatic cirrhosis should be eventually settled by clinical studies evaluating the effects of long-term iron-chelating treatment.


Assuntos
Desferroxamina/uso terapêutico , Modelos Animais de Doenças , Quelantes de Ferro/uso terapêutico , Sobrecarga de Ferro/tratamento farmacológico , Piridonas/uso terapêutico , Animais , Deferiprona , Feminino , Gerbillinae , Sobrecarga de Ferro/metabolismo , Sobrecarga de Ferro/patologia , Fígado/patologia , Miocárdio/patologia
7.
Cancer Detect Prev ; 22(5): 416-21, 1998.
Artigo em Inglês | MEDLINE | ID: mdl-9727622

RESUMO

Previously available serum tumor markers had a low clinical value in malignant pleural mesothelioma (MPM). The recently developed tissue polypeptide-specific antigen (TPS) and CYFRA 21-1 assays identify the soluble cytokeratin 18 and 19 fragments, respectively. In MPM these cytokeratins are expressed and may therefore be used as serum tumor markers. In this preliminary study, TPS and CYFRA 21-1 assays were evaluated to determine their potential for management of patients with MPM. Carcinoembryonic antigen (CEA) was evaluated as an additional marker. The study group consisted of 95 patients with benign lung and pleural diseases (BLPD), 14 patients with MPM, 41 patients with adenocarcinoma of lung (AC), and 40 patients with squamous cell carcinoma of lung (SQC). The utilized cutoff points corresponded to a 95% specificity for patients with BLPD. In MPM, TPS showed greater sensitivity (64.3%) than CYFRA 21-1 (50.0%), while CEA showed no sensitivity. In SQC, the marker CYFRA 21-1 had the highest sensitivity (52.5%), whereas in AC the most sensitive marker was CEA (56.1%). Significantly lower levels of CEA were found in MPM compared with BLPD (p < 0.001) or AC and SQC (p < 0.0001). Conversely, TPS levels in MPM were significantly higher than in SQC (p < 0.05). Close correlation of various individual pretreatment marker levels was observed only between TPS and CYFRA 21-1, both in MPM (r = 0.84; p < 0.001) and in non-small cell lung cancer (NSCLC) (r = 0.71; p < 0.001). In serial determinations of the markers during chemotherapy of MPM (n = 10), TPS and CYFRA 21-1 were shown to demonstrate more or less the same pattern of reactivity, although the changes in the TPS levels better reflected the clinical response to therapy. In conclusion, TPS seems to be a more sensitive marker than CYFRA 21-1.


Assuntos
Biomarcadores Tumorais/metabolismo , Queratinas/metabolismo , Mesotelioma/metabolismo , Neoplasias Pleurais/metabolismo , Antígenos de Neoplasias/metabolismo , Antígeno Carcinoembrionário/metabolismo , Carcinoma Pulmonar de Células não Pequenas/metabolismo , Humanos , Queratina-19 , Neoplasias Pulmonares/metabolismo , Peptídeos/metabolismo
9.
Obstet Gynecol ; 90(4 Pt 2): 653-4, 1997 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-11770581

RESUMO

BACKGROUND: Castleman disease, a rare disorder characterized by benign proliferation of lymphoid tissues, generally presents as a solitary mediastinal mass. We report the first case of this disease during pregnancy. CASE: A 32-year-old woman presented with a large abdominal mass and vaginal bleeding during the second trimester of pregnancy. Abdominal ultrasound demonstrated a large, retroperitoneal solid mass of mixed echogenicity and increased vascularity. The patient underwent explorative laparotomy that revealed a mesenteric mass, histologically consistent with Castleman disease of the hyaline-vascular type. The mass was excised completely, and the immediate postoperative course was uneventful, although the patient went into spontaneous preterm labor during the 29th week of pregnancy. CONCLUSION: Castleman disease should be considered one of the benign etiologies for an abdominal or retroperitoneal mass during pregnancy.


Assuntos
Hiperplasia do Linfonodo Gigante/epidemiologia , Complicações na Gravidez/epidemiologia , Adulto , Hiperplasia do Linfonodo Gigante/diagnóstico , Hiperplasia do Linfonodo Gigante/cirurgia , Feminino , Humanos , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/cirurgia
10.
Am J Gastroenterol ; 91(11): 2432-4, 1996 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-8931435

RESUMO

An 83-yr-old man was admitted to our hospital in a state of shock. Twenty four hours after his admission, he started to pass fresh blood from his nasogastric tube. Upper endoscopy revealed diffuse, confluent blackening of the esophageal mucosa. A repeated endoscopy, after hemodynamic stabilization, demonstrated a striking improvement with granulation tissue. Caustic injury and viral or fungal infections were ruled out by history, clinical features, and appropriate tests. We suggest that in this elderly patient, a state of shock resulted in ischemic infarction of the esophageal mucosa.


Assuntos
Esôfago/patologia , Infarto/etiologia , Choque/complicações , Idoso , Idoso de 80 Anos ou mais , Esôfago/irrigação sanguínea , Humanos , Masculino , Mucosa/irrigação sanguínea , Mucosa/patologia , Necrose
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