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2.
Gastroenterol. latinoam ; 24(3): 135-142, 2013. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-763448

RESUMO

Introduction: Autoimmune pancreatitis (AIP) is one of the etiologies of chronic pancreatitis, which is classified in two subtypes: type 1 that is part of a fibroinflammatory systemic disease associated with IgG4; and type 2, confined to pancreatic tissue without IgG4 association. Both forms typically present as abdominal pain associated with obstructive jaundice. Radiologically it is characterized by diffuse or focal enlargement of the pancreas, becoming essential to differentiate from pancreatic cancer. Case report: We report the case of a 74 year-old patient who presented obstructive jaundice and abdominal pain, images with diffusely increased pancreatic volume and elevated serum IgG4. She was treated with prednisone with an excellent clinical and laboratory response. Conclusion: AIP is a disease with high clinical suspicion, well-established diagnostic criteria and standardized treatment, showing a high rate of response to treatment of first and second line. AIP pancreatitis diagnosis should be considered facing over patients with acute pancreatitis, chronic pancreatitis or pancreatic cancer.


Introducción: La pancreatitis autoinmune (PAI) es una causa de pancreatitis crónica que se clasifica en dos subtipos: la tipo 1, que es parte de una enfermedad fibroinflamatoria sistémica asociada a IgG4; y la tipo 2, limitada al tejido pancreático y sin asociación a IgG4. Ambas se presentan típicamente como un cuadro de dolor abdominal asociado a ictericia obstructiva. Imagenológicamente se caracteriza por aumento de volumen difuso o focal del páncreas, haciéndose indispensable hacer el diagnóstico diferencial con el cáncer de páncreas. Caso clínico: Presentamos el caso de una paciente de 74 años con ictericia obstructiva y dolor abdominal, imágenes con aumento difuso de volumen pancreático e IgG4 plasmática elevada. Se trata con prednisona con excelente respuesta clínica y de laboratorio. Conclusión: La PAI es un cuadro de alta sospecha clínica, con criterios diagnósticos bien establecidos y tratamiento estandarizado, presentando una alta tasa de respuesta a tratamiento de primera y segunda línea. El diagnóstico de PAI debe ser considerado al enfrentar un paciente con pancreatitis aguda, crónica o cáncer de páncreas.


Assuntos
Humanos , Feminino , Idoso , Doenças Autoimunes/diagnóstico , Doenças Autoimunes/imunologia , Imunoglobulina G , Pancreatite/diagnóstico , Pancreatite/imunologia , Doença Crônica
3.
Rev. Méd. Clín. Condes ; 21(2): 208-213, mar. 2010. tab, ilus
Artigo em Espanhol | LILACS | ID: biblio-869456

RESUMO

La insuficiencia intestinal se define como la pérdida de la autonomía nutricional debido a disfunción intestinal. Su única opción de tratamiento adecuado es la Nutrición Parenteral Total Central. El trasplante de intestino se presenta como una alternativa de tratamiento. Los resultados iniciales del trasplante de intestino evidenciaron una alta incidencia de rechazo, infección y complicaciones técnicas que frenaron el desarrollo de esta técnica, sin embargo con la disminución de los problemas técnicos por la experiencia acumulada y la mejoría de los tratamientos inmunosupresores los resultados mejoraron en forma importante. Si bien en Chile la experiencia es limitada la indicación para su realización existe y aumenta debido al interés creciente por los buenos resultados demostrados a nivel mundial. En este breve artículo se revisan las indicaciones y contraindicaciones del procedimiento, el estudio del receptor y del donante, la técnica de procuramiento y se analizan los resultados actuales y las perspectivas futuras.


Intestinal insufficiency is defined as the loss of nutricional autonomy as a result of intestinal malfunction. The only adequate treatment option is Total Central Parenteral Nutrition. Intestinal transplantation is proposed as a treatment alternative. Initial intestinal transplantation results showed a high incidence of rejection, infection and technical complications that stunted the development of this technique. Results have however greatly improved with the enhancement of immunosuppressive therapy and increased experience which has led to a subsequent decrease in technical problems. Even though Chile has limited experience, the demand for intestinal transplantation exists and increases due to a rising interest brought about by the good results presented worldwide. This short article addresses the indications and contraindications of this procedure, receptor and donor studies, the procurement technique and also analyzes current results and future prospects.


Assuntos
Humanos , Adulto , Seleção do Doador , Intestinos/transplante , Doadores de Tecidos , Transplantados , Chile , Seleção de Pacientes
4.
Rev. Méd. Clín. Condes ; 21(2): 273-277, mar. 2010. tab
Artigo em Espanhol | LILACS | ID: biblio-869464

RESUMO

El trasplante combinado páncreas-riñón (TPR) para pacientes portadores de Diabetes Mellitus 1 con insuficiencia renal crónica terminal, ha demostrado ser la única terapia que permite alcanzar el estado de normoglicemia de manera estable, situación que lleva a una disminución de las complicaciones crónicas de la DM y mejora la expectativa y calidad de vida. En nuestro país la tasa de realización de este trasplante es aún muy baja, lo que se debe a factores asociados a la donación y a una insuficiente divulgación de los resultados nacionales. Objetivo: Describir los resultados obtenidos por el equipo de trasplante de Clínica Las Condes en TPR desde el inicio del programa, en marzo 1994 a marzo 2009. Método: Se recopiló la información de los 12 pacientes sometidos a TPR en nuestro centro entre 1994 y marzo 2009, analizando las variables con estadística descriptiva y la sobrevida con curvas de Kaplan-Meier. Resultados: La sobrevida actuarial de pacientes a 5 y 10 años fue de 75 por ciento. La sobrevida actuarial de páncreas fue 83 por ciento a los 5 y 10 años, y la de riñón 74 por ciento en los mismos periodos. Nueve pacientes presentan injertos funcionantes a marzo 2009, todos los cuales realizan una vida normal. Discusión: Estos resultados son comparables a los presentados por centros extranjeros de prestigio internacional y se deben principalmente a avances en las técnicas quirúrgicas y de inmunosupresión. La baja tasa de complicaciones y alta sobrevida presentada refuerzan la necesidad de potenciar esta terapia en nuestro país.


Combined kidney-pancreas transplant (KPT) for patients with type 1 Diabetes Mellitus complicated with end stage renal disease has shown to be the best treatment to achieve a stable metabolic condition, which may lead to a decrease in chronic diabetes complications and improves quality of life and patient survival. In our country, the rate of this transplant is still very low, associated with donation issues and little knowledge of the results achieved by Chilean experience. Objective: describe the results obtained by Clínica Las Condes transplant team in KPT, from the beginning of the program in March 1994 to March 2009. Methods: Information of 12 patients undergoing KPT in our center from 1994 to march 2009, was collected and analyzed through descriptive statistics. Actuarial survival was calculated with Kaplan Meier formula. Results: Patient survival was 75 percent at 5 and 10 years. Kidney transplant survival was 74 percent and pancreas survival was 83 percent in the same periods. Nine patients have functioning grafts, all of them living a normal life. Discussion: These results are similar to those reported by foreign centers of international status and are due to advances in surgical techniques and immunosuppressive treatment. The low rate of complications and excellent survival presented in this article enforces the need to potentates this therapy in our country.


Assuntos
Humanos , Masculino , Adulto , Feminino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/cirurgia , Transplante de Pâncreas/estatística & dados numéricos , Transplante de Rim/estatística & dados numéricos , Chile , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/epidemiologia , Seguimentos , Insuficiência Renal Crônica/epidemiologia , Rejeição de Enxerto/epidemiologia , Análise de Sobrevida , Transplante de Pâncreas/efeitos adversos , Transplante de Rim/efeitos adversos
5.
Rev Chilena Infectol ; 26(4): 311-7, 2009 Aug.
Artigo em Espanhol | MEDLINE | ID: mdl-19802397

RESUMO

UNLABELLED: Cytomegalovirus (CMV) infection and disease in transplant (Tx) recipients may severely complicate the patients outcome. AIM: To determine the incidence, clinical characteristics and risk factors for CMV infection and disease in liver and kidney transplant recipients in a tertiary care children's hospital. METHOD: A clinical and laboratory evaluation was prospectively performed in 44 and 20 children receiving a renal and liver Tx respectively in the Hospital Luis Calvo Mackenna between 2004 and 2006. RESULTS: At the time of the organ Tx 20.3% (13/64) children were seronegative for CMV. Thirty six per cent (23/64) patients were infected with CMV, of whom 32% (14/44) received kidney Tx and 9/20 (45%) received liver Tx. CMV disease occurred in 52% (12/23) of infected patients. CMV disease was characterized by fever (100%), anemia (50%), leucopenia (16.6%) and specific organ involvement (renal graft 60% liver graft 57.1%, lung 25%, intestine 16.6%). Variables significantly associated with infection were a CMV seronegative status (p = 0.035) and lower age 5.5 + 3.7 years old vs 8.3 + 4.4 years old (p = 0.01). CONCLUSIONS: Incidence of CMV infection was high in children receiving a solid organ transplant in our institution and near half of infected children developed CMV-associated disease.


Assuntos
Infecções por Citomegalovirus/etiologia , Transplante de Rim , Transplante de Fígado , Adolescente , Antivirais/uso terapêutico , Criança , Pré-Escolar , Infecções por Citomegalovirus/tratamento farmacológico , Infecções por Citomegalovirus/imunologia , Ganciclovir/uso terapêutico , Humanos , Hospedeiro Imunocomprometido , Incidência , Lactente , Estudos Prospectivos , Fatores de Risco
6.
Rev. chil. infectol ; 26(4): 311-317, ago. 2009. tab
Artigo em Espanhol | LILACS | ID: lil-527873

RESUMO

Cytomegalovirus (CMV) infection and disease in transplant (Tx) recipients may severely complícate the patients outcome. Aim: To determine the incidence, clinical characteristics and risk factors for CMV infection and disease in liver and kidney transplant recipients in a tertiary care children's hospital. Method: A clinical and laboratory evaluation was prospectively performed in 44 and 20 children receiving a renal and liver Tx respectively in the Hospital Luis Calvo Mackenna between 2004 and 2006. Results: At the time of the organ Tx 20.3 percent (13/64) children were seronegative for CMV. Thirty six per cent (23/64) patients were infected with CMV, of whom 32 percent (14/44) received kidney Tx and 9/20 (45 percent) received liver Tx. CMV disease occurred in 52 percent (12/23) of infected patients. CMV disease was characterized by fever (100 percent), anemia (50 percent), leucopenia (16.6 percent) and specific organ involvement (renal graft 60 percent liver graft 57.1 percent, lung 25 percent, intestine 16.6 percent). Variables significantly associated with infection were a CMV seronegative status (p = 0.035) and lower age 5.5 + 3.7 years oíd vs 8.3 + 4.4 years oíd (p = 0.01). Conclusions: Incidence of CMV infection was high in children receiving a solid organ transplant in our institution and near half of infected children developed CMV-associated disease.


La infección y enfermedad por citomegalovirus (CMV) en pacientes sometidos a trasplantes (Tx) es una complicación que condiciona la evolución del injerto y la sobrevida del paciente. Objetivos: Determinar la incidencia de infección y enfermedad por CMV durante los primeros seis meses de efectuados Tx hepático y renal. Caracterizar la enfermedad, e identificar factores de riesgo asociados a infección. Metodología: Análisis prospectivo en 64 pacientes pediátricos sometidos a Tx renal (n: 44) o hepático (n: 20) en el Hospital Luis Calvo Mackenna entre 2004 y 2006. Resultados: Al trasplante, 23,1 por ciento (13/64) eran receptores IgG CMV (-). Cumplieron criterio de infección 36 por cientoo (23/64) de los pacientes, con Tx renal 32 por ciento (14/44) y con Tx hepático 45 por ciento (9/20). Desarrolló enfermedad el 52 por ciento) (12/23) la que se caracterizó porfiebre (100 por cientoo), anemia (50 por cientoo), leucopenia (16,6 por cientoo), disfunción del órgano trasplantado 60 por cientoo en Tx renal, hepático 57, l por cientoo, compromiso pulmonar en 25 por cientoo e intestinal en 16,6 por cientoo del total de pacientes. Variables asociadas a infección fueron: ser receptor IgG CMV (-)pre-Tx (p=0,035) y una menor edad del paciente 5,5 +3,7 vs 8,3 + 4,4 (p= 0,01). Conclusiones: Hay una elevada tasa de infección por CMV en la población de pacientes con Tx renal y hepática en nuestro medio, la mitad de ellos desarrolló enfermedad amenazando la función del injerto.


Assuntos
Adolescente , Criança , Pré-Escolar , Humanos , Lactente , Infecções por Citomegalovirus/etiologia , Transplante de Rim , Transplante de Fígado , Antivirais/uso terapêutico , Infecções por Citomegalovirus/tratamento farmacológico , Infecções por Citomegalovirus/imunologia , Ganciclovir/uso terapêutico , Hospedeiro Imunocomprometido , Incidência , Estudos Prospectivos , Fatores de Risco
7.
Rev Med Chil ; 137(2): 259-63, 2009 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-19543649

RESUMO

Small bowel transplantation is associated with a patient survival at one and five years, of 80% and 63%, respectively. We report a 36 year-old female with short bowel syndrome, subjected to the first small bowel transplantation performed in Chile. A cadaveric gran was used. Immunosuppression was achieved by means of alemtuzumab, tacrolimus, sirolimus, micofenolate mofetil and steroids. Serial endoscopies and biopsies were performed during seven months after transplantation. The most important late complications were a drug induced renal failure, infections caused by opportunistic agents and a gastrointestinal bleeding probably induced by drugs. After 29 months of follow up, the patient is ambulatory, on oral diet only and with no evidence of graft rejection.


Assuntos
Intestino Delgado/transplante , Síndrome do Intestino Curto/cirurgia , Adulto , Chile , Feminino , Rejeição de Enxerto/prevenção & controle , Humanos , Imunossupressores/uso terapêutico , Síndrome do Intestino Curto/imunologia , Tacrolimo/uso terapêutico
8.
Rev. méd. Chile ; 137(2): 259-263, feb. 2009. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-516092

RESUMO

Small bowel transplantation is associated with a patient survival atone and five years, of 80% and 63%, respectively. We report a 36 year-old female with short bowel syndrome, subjected to the first small bowel transplantation performed in Chile. A cadaveric graft was used. Immunosuppression was achieved by means of alemtuzumab, tacrolimus, sirolimus, micofenolate mofetil and steroids. Serial endoscopies and biopsies were performed during sevenmonths after transplantation. The most important late complications were a drug induced renal failure, infections caused by opportunistic agents and a gastrointestinal bleeding probably induced by drugs. After 29 months of follow up, the patient is ambulatory, on oral diet only, and with no evidence of graft rejection.


Assuntos
Adulto , Feminino , Humanos , Intestino Delgado/transplante , Síndrome do Intestino Curto/cirurgia , Chile , Rejeição de Enxerto/prevenção & controle , Imunossupressores/uso terapêutico , Síndrome do Intestino Curto/imunologia , Tacrolimo/uso terapêutico
9.
Rev. méd. Chile ; 134(11): 1393-1401, nov. 2006. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-439936

RESUMO

Background: Cardiovascular risk, growth failure and the new immunosuppressive drugs, have encouraged steroid withdrawal or total avoidance with promising results in renal transplant (Tx) immunosuppression. Aim: To evaluate a new immunosuppressor protocol with early withdrawal of steroids in pediatric kidney transplant. Patients and methods: Prospective study in pediatric patients older than 1 year and low immunological risk. Group A (n =28): steroids in decreasing doses until day 7 post Tx, tacrolimus (FK) and micophenolate mofetil (MMF). Group B (n =28) control: steroids, cyclosporine and azathioprine or steroids, FK and MMF. In both groups the induction therapy included basiliximab. Anthropometric and biochemical variables (renal function, lipid profile, hematological, blood glucose and acid-base equilibrium), acute rejection and CMV infection, were evaluated. Mean values and variations for continuous variables were calculated at months 1, 6, 12 and 18. Results: Two children were withdrawn before month 2, one had an untreatable diarrhea and the second died due to Aspergillus septicemia. Mean values at months 1, 6, 12 and 18 for groups A and B: Creatinine clearence (ml/min): 85.4 vs 89; 79.9 vs 83; 89 vs 80; 79.8 vs 80.6 (p: ns); hematocrit ( percent): 28.8 vs 30.4; 31.7 vs 34.4; 34.4; 32.4 vs 34.8; 34.4 vs 35.5 (p: ns). Total cholesterol (mg/dl): 151 vs 206; 139 vs 174; 138 vs 186; 140 vs 180 (p <0.05). Mean delta height/age Z score at the first year: 0.5 vs 0.15; 0.7 vs 0.22; 0.97 vs 0.25 (p <0.05). Mean systolic blood pressure Z score: 0.9 vs 1.5; 0.5 vs 0.9; -0.3 vs 0.8; 0.1 vs 1.0 (p <0.05). The height/age Z score was significantly superior in patients without steroids. A normalization of growth patterns at month 18 was observed (< 0.05). Both groups presented a negative variation of creatinine clearance during the follow-up, but it was minor in the study group (p <0.05). Two acute rejections were found in each group, and no difference in CMV infections...


Assuntos
Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Imunossupressores/administração & dosagem , Transplante de Rim/imunologia , Ácido Micofenólico/análogos & derivados , Esteroides/administração & dosagem , Tacrolimo/administração & dosagem , Anticorpos Monoclonais/administração & dosagem , Creatinina/sangue , Quimioterapia Combinada , Seguimentos , Rejeição de Enxerto/prevenção & controle , Transplante de Rim/efeitos adversos , Ácido Micofenólico/administração & dosagem , Estudos Prospectivos , Proteínas Recombinantes de Fusão/administração & dosagem
10.
Rev Med Chil ; 134(4): 469-74, 2006 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-16758083

RESUMO

BACKGROUND: Primary biliary cirrhosis (PBC) is a chronic cholestatic disease, which can progress to hepatic failure. AIM: To study the clinical presentation, pathological features, treatment and outcome of a group of patients with PBC. MATERIAL AND METHODS: Retrospective review of medical records of 115 patients (110 females, age range 30-76 years) with PBC. Clinical presentation, pathological stage, treatment, outcome and eventual use of liver transplantation, were recorded. RESULT: Seventy eight percent of patients were symptomatic at presentation (itching in 69% and malaise in 62%). Antimitochondrial antibodies were positive in 56%. No clinical or laboratory differences were observed between symptomatic patients or those with positive antimitochondrial antibodies and the rest of the study group. Sjögren syndrome was present in 38%, hypothyroidism in 13%, scleroderma in 7% and rheumatoid arthritis in 5%. Initially, 61% had fibrosis and/or cirrhosis, and ursodeoxycholic acid was indicated in 94% of the patients. Fifteen patients underwent liver transplantation due to upper digestive bleeding or itching. Survival has been 67% at 36 months after transplantation. In one transplanted liver, PBC recurred. CONCLUSIONS: An early diagnosis and treatment of a progressive disease such as PBC will reduce the incidence of complications and the use of costly treatments.


Assuntos
Cirrose Hepática Biliar/diagnóstico , Adulto , Idoso , Colagogos e Coleréticos/uso terapêutico , Feminino , Seguimentos , Humanos , Hipotireoidismo/complicações , Fígado/patologia , Cirrose Hepática Biliar/patologia , Cirrose Hepática Biliar/terapia , Transplante de Fígado , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Síndrome de Sjogren/complicações , Taxa de Sobrevida , Fatores de Tempo , Resultado do Tratamento , Ácido Ursodesoxicólico/uso terapêutico
11.
Rev. méd. Chile ; 134(4): 469-474, abr. 2006. tab
Artigo em Espanhol | LILACS | ID: lil-428547

RESUMO

Background: Primary biliary cirrhosis (PBC) is a chronic cholestatic disease, which can progress to hepatic failure. Aim: To study the clinical presentation, pathological features, treatment and outcome of a group of patients with PBC. Material and methods: Retrospective review of medical records of 115 patients (110 females, age range 30-76 years) with PBC. Clinical presentation, pathological stage, treatment, outcome and eventual use of liver transplantation, were recorded. Result: Seventy eight percent of patients were symptomatic at presentation (itching in 69% and malaise in 62%). Antimitochondrial antibodies were positive in 56%. No clinical or laboratory differences were observed between symptomatic patients or those with positive antimitochondrial antibodies and the rest of the study group. Sjögren syndrome was present in 38%, hypothyroidism in 13%, scleroderma in 7% and rheumatoid arthritis in 5%. Initially, 61% had fibrosis and/or cirrhosis, and ursodeoxycholic acid was indicated in 94% of the patients. Fifteen patients underwent liver transplantation due to upper digestive bleeding or itching. Survival has been 67% at 36 months after transplantation. In one transplanted liver, PBC recurred. Conclusions: An early diagnosis and treatment of a progressive disease such as PBC will reduce the incidence of complications and the use of costly treatments.


Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cirrose Hepática Biliar/diagnóstico , Colagogos e Coleréticos/uso terapêutico , Seguimentos , Hipotireoidismo/complicações , Cirrose Hepática Biliar/patologia , Cirrose Hepática Biliar/terapia , Transplante de Fígado , Fígado/patologia , Estudos Retrospectivos , Síndrome de Sjogren/complicações , Taxa de Sobrevida , Fatores de Tempo , Resultado do Tratamento , Ácido Ursodesoxicólico/uso terapêutico
12.
Rev Med Chil ; 134(11): 1393-401, 2006 Nov.
Artigo em Espanhol | MEDLINE | ID: mdl-17277852

RESUMO

BACKGROUND: Cardiovascular risk, growth failure and the new immunosuppressive drugs, have encouraged steroid withdrawal or total avoidance with promising results in renal transplant (Tx) immunosuppression. AIM: To evaluate a new immunosuppressor protocol with early withdrawal of steroids in pediatric kidney transplant. PATIENTS AND METHODS: Prospective study in pediatric patients older than 1 year and low immunological risk. Group A (n =28): steroids in decreasing doses until day 7 post Tx, tacrolimus (FK) and mycophenolate mofetil (MMF). Group B (n =28) control: steroids, cyclosporine and azathioprine or steroids, FK and MMF. In both groups the induction therapy included basiliximab. Anthropometric and biochemical variables (renal function, lipid profile, hematological, blood glucose and acid-base equilibrium), acute rejection and CMV infection, were evaluated. Mean values and variations for continuous variables were calculated at months 1, 6, 12 and 18. RESULTS: Two children were withdrawn before month 2, one had an untreatable diarrhea and the second died due to Aspergillus septicemia. Mean values at months 1, 6, 12 and 18 for groups A and B: Creatinine clearance (ml/min): 85.4 vs 89; 79.9 vs 83; 89 vs 80; 79.8 vs 80.6 (p: ns); hematocrit (%): 28.8 vs 30.4; 31.7 vs 34.4; 34.4; 32.4 vs 34.8; 34.4 vs 35.5 (p: ns). Total cholesterol (mg/dl): 151 vs 206; 139 vs 174; 138 vs 186; 140 vs 180 (p <0.05). Mean delta height/age Z score at the first year: 0.5 vs 0.15; 0.7 vs 0.22; 0.97 vs 0.25 (p <0.05). Mean systolic blood pressure Z score: 0.9 vs 1.5; 0.5 vs 0.9; -0.3 vs 0.8; 0.1 vs 1.0 (p <0.05). The height/age Z score was significantly superior in patients without steroids. A normalization of growth patterns at month 18 was observed (< 0.05). Both groups presented a negative variation of creatinine clearance during the follow-up, but it was minor in the study group (p <0.05). Two acute rejections were found in each group, and no difference in CMV infections was observed. CONCLUSIONS: Early steroid withdrawal in pediatric renal transplant recipients was effective and safe and did not increase the risk of rejection.


Assuntos
Imunossupressores/administração & dosagem , Transplante de Rim/imunologia , Ácido Micofenólico/análogos & derivados , Esteroides/administração & dosagem , Tacrolimo/administração & dosagem , Adolescente , Adulto , Anticorpos Monoclonais/administração & dosagem , Basiliximab , Criança , Pré-Escolar , Creatinina/sangue , Quimioterapia Combinada , Feminino , Seguimentos , Rejeição de Enxerto/prevenção & controle , Humanos , Lactente , Transplante de Rim/efeitos adversos , Masculino , Pessoa de Meia-Idade , Ácido Micofenólico/administração & dosagem , Estudos Prospectivos , Proteínas Recombinantes de Fusão/administração & dosagem
13.
Gastroenterol. latinoam ; 16(1): 12-17, ene.-mar. 2005. tab, graf
Artigo em Espanhol | LILACS | ID: lil-418316

RESUMO

Antecedentes/objetivos: En pacientes sometidos a trasplante hepático ortotópico (TH), el rechazo celular agudo (RCA) constituye una de sus principales complicaciones, a pesar del mayor desarrollo de drogas inmunosupresoras. Por otra parte, el ácido ursodeoxicólico (AUC) es capaz de reducir la hiperexpresión de antígenos del complejo de histocompatibilidad mayor tipo I en hepatocitos, en la cirrosis biliar primaria. A su vez, reduce la producción periférica de interleukinas 2 y 4. Estos hallazgos podrían sugerir un eventual efecto beneficioso al AUC en reducir la injuria inmunológica, sin embargo, diversos estudios evidencian resultados contradictorios en la reducción de la incidencia de RCA. Pacientes y métodos: Entre noviembre 1993 y diciembre 2002 se evaluaron retrospectivamente a 58 pacientes sometidos a TH. Veinticinco de ellos recibieron AUC (15 mg/Kg) además de la inmunosupresión estándar, a lo menos por 1 año. El grupo control (n = 33), recibió el mismo tratamiento inmunosupresor, excepto AUC. El diagnóstico de RCA se fundamentó histológicamente. Resultados: No hubo diferencias en el número total de RCA en los dos grupos de pacientes; tampoco en la severidad o recurrencia. Ni la frecuencia de rechazo crónico como tampoco la de retrasplante hepático, fueron diferentes en ambos grupos de pacientes. Conclusiones: El presente estudio no mostró que la incidencia de RCA mejorara por la asociación de AUC a la triple terapia inmunosupresora estándar.


Assuntos
Humanos , Fígado , Transplante de Fígado/reabilitação , Ácido Ursodesoxicólico/administração & dosagem , Ácido Ursodesoxicólico/efeitos adversos , Rejeição de Enxerto
14.
Rev. méd. Chile ; 132(4): 479-484, abr. 2004. ilus, graf
Artigo em Espanhol | LILACS | ID: lil-362913

RESUMO

We report a girl with a chronic hepatitis caused by C virus diagnosed at the age of nine, unsuccessfully treated with interferon and ribavirine. Two years later, she was subjected to a liver transplantation. She maintained elevated viral loads with a normal pathological study of the liver until 22 months after transplantation. She was treated again with combined antiviral therapy, for 6 months, without response and experienced a progressive deterioration liver function, dying three years after transplantation.


Assuntos
Humanos , Feminino , Criança , Cirrose Hepática/cirurgia , Hepatite C/cirurgia , Hepatite C/complicações , Transplante de Fígado/imunologia , Antivirais/uso terapêutico , Interferons/uso terapêutico , Ribavirina/uso terapêutico , Transplante de Fígado
15.
Rev. chil. cir ; 51(4): 347-50, ago. 1999. ilus
Artigo em Espanhol | LILACS | ID: lil-245512

RESUMO

Uno de nuestros enfermos presentó ictericia en el postoperatorio y la ERCP demostró un clip en el colédoco. Esto motivó la búsqueda en la literatura si existía un tiempo, después de producido el accidente, en el cual se podía retirar el clip o ligadura, sin que existiera daño o reacción importante del colédoco. Al no encontrarlo, diseñamos un modelo experimental el cual desarrollamos en nuestro laboratorio de cirugía e investigación experimental. El objetivo de esta investigación fue determinar la cuantía y el momento en que se producen las alteraciones anatómicas (principalmente la fibrosis), que van a llevar, eventualmente, a una estenosis futura (aunque el clip se haya retirado). Se planifica una serie de 10 perros que se operaron bajo anestesia general, en forma consecutiva, a los cuales se les coloca un clip en el colédoco, el que fue retirado en días sucesivos (del 1 al 10). El colédoco fue extirpado y la muestra analizada en anatomía patológica posteriormente. Se observó una fibrosis leve a moderada, con inflamación rica en linfocitos y células plasmáticas. El sitio del clip presentó necrosis focal de tipo isquémica. Estos hallazgos pueden constituir una línea interesante de investigación en el estudio de los mecanismos que llevan a la estenosis de la vía biliar, y definir el momento en que se producen alteraciones probablemente irreversibles en el colédoco


Assuntos
Animais , Cães , Atresia Biliar/fisiopatologia , Colecistectomia Laparoscópica/efeitos adversos , Fibrose/fisiopatologia , Ducto Colédoco/fisiopatologia , Instrumentos Cirúrgicos/efeitos adversos
16.
Rev. chil. obstet. ginecol ; 62(3): 185-91, 1997. graf
Artigo em Espanhol | LILACS | ID: lil-207176

RESUMO

Se presentan dos casos clínicos, el primero corresponde a una rotura espontánea de hígado asociada a gestación de 25 semanas con hipertensión arterial crónica y preeclampsia severa sobreagregada y el segundo a quiste hidatídico hepático complicado, roto a vía biliar concomitante con gestación de 36 semanas. Se revisa la literatura y se discute el manejo quirúrgico en ambos casos


Assuntos
Humanos , Feminino , Adulto , Gravidez , Equinococose Hepática/complicações , Pré-Eclâmpsia/complicações , Ruptura Espontânea/complicações , Complicações Parasitárias na Gravidez/diagnóstico , Complicações Parasitárias na Gravidez/cirurgia
18.
Rev. chil. cir ; 46(4): 377-84, ago. 1994. tab
Artigo em Espanhol | LILACS | ID: lil-137937

RESUMO

En nuestro medio el cáncer esofágico sigue diagnosticándose tardíamente, por lo cual el tratamiento quirúrgico con intención resectiva no excede el 30 por ciento. Al resto de los pacientes sólo se les puede ofrecer tratamientos paliativos. De un total de 224 enfermos portadores de esta localización de cáncer, 170 accedieron a esta última alternativa de tratamiento. Dilataciones periódicas, gastrostomías, prótesis endoluminales o puentes con ascenso de estómago o de un segmento de intestino grueso fueron los procedimientos terapéuticos utilizados en esta serie, motivo de este estudio. De ellos, la dilatación periódica es el que presenta menor morbimortalidad, y los procedimientos de puente están indicados cuando los pacientes en buenas condiciones generales presentan intensa disfagia, y la operación les permite una mejor calidad de vida en el corto o mediano plazo de sobrevida


Assuntos
Masculino , Feminino , Neoplasias Esofágicas/cirurgia , Cuidados Paliativos , Dilatação , Seguimentos , Gastrostomia , Complicações Pós-Operatórias/classificação , Próteses e Implantes
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