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Rev. guatemalteca cir ; 23(1): [56-66], ene-dic,2017.
Artigo em Espanhol | LILACS | ID: biblio-884888


Introducción: Los tumores del cuerpo carotideo son tumores infrecuentes, generalmente benignos y muy vascularizados, por lo que su resección es un reto para el cirujano. El objetivo de este estudio es realizar una caracterización epidemiológica de los pacientes con glomus carotideo operados en la Unidad de Cirugía Cardiovascular de Guatemala (UNICAR) Metodología: El estudio fue descriptvo retrospectivo analizando los registros clínicos de todos los pacientes sometidos a resección de glomus carotideo en UNICAR de enero de 2,002 a diciembre de 2,015. Resultados: Se documentaron 17 pacientes a quienes se les realizo resección de glomus en la unidad, de los cuales 1 expediente no fue posible analizar porque no se encontró en el archivo. El 93% de los pacientes fueron de sexo femenino lo cual está descrito que es el género más afectado. La altitud es característica de esta patología ya que el 93%, 15 de los 16 venían de una altura mayor de los 1,500 mts sobre el nivel del mar. No se pudo determinar la etnia como factor de riesgo ya que el 50% de los pacientes fueron de etnia indígena y el 50% de etnia ladina. Se obtuvo un caso de herencia familiar ya que tanto la abuela como la nieta presentaron glomus carotideo. Las biopsias que se documentaron fueron solamente en 5 pero pensamos que hay un subregistro ya que consultando con los especialistas estás pudieron haber sido más. Conclusiones: El Glomus Carotideo es una patología poco frecuente, sin embargo, debe ser tratado en unidades especializadas vasculares debido a su compleja resección y el importante riesgo de sangrado. En este estudio se logró caracterizar epidemiológicamente a los pacientes, coincidiendo con lo reportado en la literatura mundial.

Background: Carotid body tumors are uncommon, generally benign, hypervascular turmors; resection is a challenge for surgeons. The aim of this study is to characterize patents with carotid body tumors who underwent resection at the Cardiovascular Surgical Unit in Guatemala (UNICAR) Methods and Results: There were a total of 17 patents in this descriptve and retrospectve trial who underwent resection of carotid body tumor during 2002 to 2015, but we only had access to 16 of the patents clinical records. 93% were female patents, this is the same as reported in other trials being women more affected than men. Altitude of more than 1,500 m from sea level was present in 93% of the patents. This is remarkable due to the country's geography where there can be in some department's altitudes from 0 m at sea level to as high as 2,800 m. Their background in race speaking isn't related to the presence of this pathology, 50% were indigenous and 50% were ladinos. There was only one case of family related heritage where grandmother and granddaughter had a carotid body tumor resection. Previous biopsy was only recorded in 5 clinical records but we think this can be a sub registry due to the experience of some of the surgeons who said most of them had previous scars and it made the resection more difficult. Conclusions: Carotid body tumors are rare in presentation and they must be treated in a specialized vascular unit due to its complex resection and hemorrhage risk.

Humanos , Masculino , Feminino , Tumor do Corpo Carotídeo/cirurgia , Corpo Carotídeo/patologia , Estudos Epidemiológicos , Paragânglios Cromafins
PLoS Med ; 1(1): e8, 2004 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-15526056


BACKGROUND: Chronic obstructive pulmonary disease and emphysema are a frequent result of long-term smoking, but the exact mechanisms, specifically which types of cells are associated with the lung destruction, are unclear. METHODS AND FINDINGS: We studied different subsets of lymphocytes taken from portions of human lungs removed surgically to find out which lymphocytes were the most frequent, which cell-surface markers these lymphocytes expressed, and whether the lymphocytes secreted any specific factors that could be associated with disease. We found that loss of lung function in patients with chronic obstructive pulmonary disease and emphysema was associated with a high percentage of CD4+ and CD8+ T lymphocytes that expressed chemokine receptors CCR5 and CXCR3 (both markers of T helper 1 cells), but not CCR3 or CCR4 (markers of T helper 2 cells). Lung lymphocytes in patients with chronic obstructive pulmonary disease and emphysema secrete more interferon gamma--often associated with T helper 1 cells--and interferon-inducible protein 10 and monokine induced by interferon, both of which bind to CXCR3 and are involved in attracting T helper 1 cells. In response to interferon-inducible protein 10 and monokine induced by interferon, but not interferon gamma, lung macrophages secreted macrophage metalloelastase (matrix metalloproteinase-12), a potent elastin-degrading enzyme that causes tissue destruction and which has been linked to emphysema. CONCLUSIONS: These data suggest that Th1 lymphoctytes in the lungs of people with smoking-related damage drive progression of emphysema through CXCR3 ligands, interferon-inducible protein 10, and monokine induced by interferon.

Macrófagos Alveolares/imunologia , Doença Pulmonar Obstrutiva Crônica/imunologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Enfisema Pulmonar/imunologia , Enfisema Pulmonar/fisiopatologia , Células Th1/imunologia , Idoso , Quimiocina CXCL10 , Quimiocinas CXC/fisiologia , Citocinas/fisiologia , Progressão da Doença , Feminino , Humanos , Subpopulações de Linfócitos , Masculino , Pessoa de Meia-Idade , Receptores CXCR3 , Receptores de Quimiocinas/fisiologia , Fumar/efeitos adversos , Tomografia Computadorizada por Raios X
Am J Surg ; 186(6): 641-7; discussion 647, 2003 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-14672772


BACKGROUND: We present a large, single institution experience with adult cardiac tumors and address factors affecting outcome. METHODS: A retrospective review was made of all patients who underwent surgery for primary cardiac tumors from April 1975 through August 2002. RESULTS: Eighty-five patients (33 male and 52 female) with a mean age of 54 years were identified with follow-up available for 80 (94%) patients. There were 68 (80%) benign tumors and 17 (20%) malignant tumors. Three tumors recurred and were resected giving a total of 88 surgeries. All benign tumors were grossly resected and the extent of resection for malignant disease ranged from 14 (78%) gross resections and 3 (17%) debulkings to 1 (5%) biopsy. There were 4 (5%) early hospital deaths. Median survival was 9.6 months and 322 months for patients with malignant and benign diseases, respectively. Significant predictors of long-term mortality were malignant disease (P <0.0001) and New York Heart Association class (P <0.03). CONCLUSIONS: Surgical resection provides excellent outcome in patients with benign cardiac tumors. Malignant tumors continue to pose a challenge with good local tumor control but limited survival owing to metastatic disease.

Neoplasias Cardíacas/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Complicações Pós-Operatórias , Estudos Retrospectivos , Taxa de Sobrevida
Chest ; 123(5): 1718-25, 2003 May.
Artigo em Inglês | MEDLINE | ID: mdl-12740292


Non-small cell lung cancer (NSCLC) in the United States will continue to be a major public health issue, particularly as our elderly population grows. As surgery offers the best hope of cure for NSCLC, staging of NSCLC is critical because it directly impacts on the management of lung cancer. Cost, quality of life, safety, and accuracy of various staging methods all influence the clinical outcome. Staging of NSCLC is evolving due to the emergence of new and improved technologies. The objective of this article is to review the current methods used in staging of NSCLC. Currently, positron emission tomography and endoscopic ultrasound (EUS) show promise in identifying patients that may benefit from surgery. Histologic confirmation via EUS-guided fine-needle aspiration, however, may still be necessary to accurately stage the mediastinum.

Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Endossonografia , Neoplasias Pulmonares/diagnóstico por imagem , Linfonodos/diagnóstico por imagem , Biópsia , Biópsia por Agulha , Carcinoma Pulmonar de Células não Pequenas/patologia , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Neoplasias Pulmonares/patologia , Linfonodos/patologia , Metástase Linfática , Mediastinoscopia , Estadiamento de Neoplasias , Sensibilidade e Especificidade , Tomografia Computadorizada de Emissão , Tomografia Computadorizada por Raios X
Circulation ; 107(4): 538-44, 2003 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-12566363


BACKGROUND: There are currently no data on the accuracy of intravenous myocardial contrast echocardiography (MCE) in detecting myocardial hibernation in man and its comparative accuracy to dobutamine echocardiography (DE) or thallium 201 (Tl(201)) scintigraphy. METHODS AND RESULTS: Twenty patients with coronary artery disease and ventricular dysfunction underwent MCE 1 to 5 days before bypass surgery and repeat echocardiography at 3 to 4 months. Patients also underwent DE (n=18) and rest-redistribution Tl(201) tomography (n=16) before revascularization. MCE was performed using continuous Optison infusion (12 to 16 cc/h) with intermittent pulse inversion harmonics and incremental triggering (1:1 to 1:8). Myocardial contrast intensity (MCI) replenishment curves were constructed to derive quantitative MCE indices of blood velocity and flow. Recovery of function occurred in 38% of dysfunctional segments. MCE parameters of perfusion in hibernating myocardium were similar to segments with normal function and higher than dysfunctional myocardium without recovery of function (P<0.001). The best MCE parameter for predicting functional recovery was Peak MCIxbeta, an index of myocardial blood flow (area under the curve, 0.83). MCE parameters were higher in segments with contractile reserve and Tl(201) uptake > or =60% (P<0.05) and identified viable segments without contractile reserve by DE. The sensitivity of Peak MCIxbeta >1.5 dB/s for recovery of function was 90% and was similar to Tl(201) scintigraphy (92%) and any contractile reserve (80%); specificity was higher than for Tl(201) and DE (63%, 45%, and 54%, respectively; P<0.05). CONCLUSIONS: MCE with intravenous contrast identifies myocardial hibernation in humans. Prediction of viable myocardium with MCE is best using quantification of myocardial blood flow and provides improved accuracy compared with DE and Tl(201) scintigraphy.

Meios de Contraste/administração & dosagem , Dobutamina , Ecocardiografia , Miocárdio Atordoado/diagnóstico , Radioisótopos de Tálio , Idoso , Velocidade do Fluxo Sanguíneo , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/cirurgia , Circulação Coronária , Feminino , Humanos , Injeções Intravenosas , Masculino , Pessoa de Meia-Idade , Contração Miocárdica , Miocárdio Atordoado/diagnóstico por imagem , Variações Dependentes do Observador , Valor Preditivo dos Testes , Curva ROC , Cintilografia , Recuperação de Função Fisiológica , Sensibilidade e Especificidade , Disfunção Ventricular/diagnóstico , Disfunção Ventricular/etiologia
Rev. costarric. cardiol ; 4(3): 11-13, sept.-dic. 2002. ilus
Artigo em Espanhol | LILACS | ID: lil-325292


Introducción: Se trata de un procedimiento diferente al tradicional, el cirujano no usa la máquina Corazón-Pulmón, o de circulación extracorpórea durante el mismo, en su lugar se usan instrumentos para estabilizar el área destinada para colocar el injerto coronario. Esto permite continuar con el flujo de sangre coronario natural, sin interrupción. Material y métodos: En la Unidad de Cirugía Cardiovascular de Guatemala "UNICAR" de agosto de 1999 a setiembre 2002, 71 pacientes fueron operados de revascularización coronaria con éste método con edades comprendidas entre 35 y 80 años, siendo más frecuente el grupo de 51 a 55 años. Resultados: El porcentaje de Hemoductos realizados por paciente fue de 1.7 por ciento, utilizándose en todos Arteria Mamaria Interna para revascularizar la arteria descendente anterior. Se utilizó Arteria Radial en 4 casos. El promedio de estancia en cuidado intensivo fue de 24 horas en el 72 por ciento. En el 82 no hubo ninguna complicación, 2 pacientes presentaron derrame pleural (2.81 por ciento). Siete pacientes (9.85 por ciento) presentaron fallo cardiaco que resolvió en las primeras 48 horas. Un paciente desarrolló Infarto de Miocardio trans-operatorio sin ninguna repercusión hemodinámica (1.4 por ciento). La mortalidad fue del 2.85 por ciento (2 pacientes) que desarrollaron uno neumonía postoperatoria y el segundo hizo fallo multisistémico por sepsis de causas no cardíacas. Conclusiones: La Revascularización Coronaria sin Circulación Estracorpórea reduce el trauma del músculo cardíaco y órganos blandos. La recupeación es rápida y disminuye la estadía hospitalaria. Reduce el riesgo de sangrado, accidente cerebrovascular y fallo renal. Reduce los problemas psicomotores y cognositivos que se presentan en el método tradicional, la morbi-mortalidad es baja. Palabras claves: injerto coronario, cirugía sin circulación extracorpórea.

Humanos , Adulto , Pessoa de Meia-Idade , Circulação Coronária , Doença das Coronárias , Revascularização Miocárdica/métodos , Revascularização Miocárdica , Cirurgia Torácica , Transplantes , Guatemala
Circulation ; 106(8): 950-6, 2002 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-12186799


BACKGROUND: Myocardial contrast echocardiography (MCE) has been used to evaluate myocardial viability. There are no data, however, on the pathological determinants of myocardial perfusion by MCE in humans and the implications of such determinants. METHODS AND RESULTS: MCE was performed in 20 patients with coronary artery disease and ventricular dysfunction within 24 hours before myocardial biopsy at surgery using a continuous Optison infusion (12 to 16 cc/h), with intermittent pulse inversion harmonics and incremental triggering. Peak myocardial contrast intensity (MCI) and the rate of increase in MCI (beta) were quantitated. Thirty-six transmural myocardial biopsies (2 per patient) were obtained by transesophageal echocardiography. Total microvascular (<100 microm) density, capillary density and area, arteriolar and venular density, and percent collagen content were quantitated with immunohistochemistry. Peak MCI correlated with microvascular density (r=0.59, P<0.001) and capillary area (r=0.64, P<0.001) and inversely correlated with percent collagen content (r=-0.45, P=<0.01). The best relation was observed when the ratio of peak MCI in the 2 biopsied segments in each patient was compared with the ratio of microvascular density and capillary area (r=0.84 and 0.87, respectively; P<0.001). A significant overlap in microvascular density was seen between segments with and without recovery of function. The new MCE indices of blood velocity (beta) and flow (peak MCIxbeta) better identified recovery of function compared with microvascular density and the sole use of peak MCI. CONCLUSIONS: Microvascular integrity is a significant determinant of maximal MCI in humans. MCE indices of blood velocity and flow are important parameters that predict recovery of function after revascularization.

Doença da Artéria Coronariana/diagnóstico , Ecocardiografia Transesofagiana/métodos , Miocárdio Atordoado/diagnóstico , Disfunção Ventricular Esquerda/diagnóstico , Idoso , Biópsia , Capilares/patologia , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/patologia , Doença da Artéria Coronariana/cirurgia , Circulação Coronária , Vasos Coronários/patologia , Feminino , Fibrose , Coração/fisiopatologia , Humanos , Masculino , Microcirculação/patologia , Pessoa de Meia-Idade , Miocárdio Atordoado/diagnóstico por imagem , Miocárdio Atordoado/patologia , Miocárdio Atordoado/cirurgia , Miocárdio/patologia , Variações Dependentes do Observador , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/patologia , Disfunção Ventricular Esquerda/cirurgia
J Am Coll Cardiol ; 39(9): 1468-74, 2002 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-11985909


OBJECTIVES: The purpose of this study is to investigate the morphologic characteristics of the cardiac interstitium in the hibernating human myocardium and evaluate whether active remodeling is present and is an important determinant of functional recovery. BACKGROUND: Myocardial hibernation is associated with structural myocardial changes, which involve both the cardiomyocytes and the cardiac interstitium. METHODS: We evaluated 15 patients with coronary disease with two-dimensional echocardiography and thallium-201 ((201)Tl) tomography before coronary bypass surgery. During surgery, transmural myocardial biopsies were performed guided by transesophageal echocardiography. Myocardial biopsies were stained immunohistochemically to investigate fibroblast phenotype and examine evidence of active remodeling in the heart. RESULTS: Among the 29 biopsied segments included in the study, 24 showed evidence of systolic dysfunction. The majority of dysfunctional segments (86.4%) were viable ((201)Tl uptake > or = 60%). After revascularization, 12 dysfunctional segments recovered function as assessed with an echocardiogram three months after bypass surgery. Interstitial fibroblasts expressing the embryonal isoform of smooth muscle myosin heavy chain (SMemb) were noted in dysfunctional segments, predominantly located in border areas adjacent to viable myocardial tissue. Segments with recovery had higher SMemb expression (0.46 +/- 0.16% [n = 12] vs. 0.10 +/- 0.02% [n = 12]; p < 0.05) and a higher ratio of alpha-smooth muscle actin to collagen (0.14 +/- 0.026 [n = 12] vs. 0.07 +/- 0.01 [n = 12]; p < 0.05) compared with segments without recovery, indicating fibroblast activation and higher cellularity of the fibrotic areas. In addition, interstitial deposition of the matricellular protein tenascin, a marker of active remodeling, was higher in hibernating segments than in segments with persistent dysfunction (p < 0.05), suggesting an active continuous fibrotic process. Multiple logistic regression demonstrated a significant independent association between SMemb expression and functional recovery (p < 0.01). CONCLUSIONS: Fibroblast activation and expression of SMemb and tenascin provide evidence of continuous remodeling in the cardiac interstitium of the hibernating myocardium, an important predictor of recovery of function after revascularization.

Miocárdio Atordoado/patologia , Miocárdio/patologia , Cadeias Pesadas de Miosina/metabolismo , Tenascina/metabolismo , Idoso , Feminino , Fibroblastos/ultraestrutura , Humanos , Imuno-Histoquímica , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Revascularização Miocárdica , Miocárdio Atordoado/metabolismo , Cadeias Pesadas de Miosina/ultraestrutura , Miosina não Muscular Tipo IIB , Recuperação de Função Fisiológica , Tenascina/ultraestrutura
Am J Pathol ; 160(4): 1425-33, 2002 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-11943726


Myocardial hibernation refers to a state of prolonged impairment of left ventricular function in the presence of coronary artery disease, which may be reversed by revascularization. In this study we present evidence for a local inflammatory reaction in hibernating myocardial segments from patients undergoing coronary revascularization. We obtained transmural myocardial biopsies guided by transesophageal echocardiography from patients with ischemic ventricular dysfunction undergoing bypass surgery. Among the 28 biopsied segments included in the study, 23 showed evidence of systolic dysfunction. The majority of dysfunctional segments (85.7%) were viable ((201)Tl uptake >/= 60%). The samples were stained with markers for mast cells, mature resident macrophages, and the monoclonal antibody Mac387 that labels newly recruited myeloid cells. Dysfunctional segments showed more extensive fibrosis and higher macrophage density than normal segments. Among the 23 dysfunctional segments, 12 recovered function as assessed with echocardiograms 3 months after revascularization. Segments with postoperative functional recovery had comparable macrophage and mast cell density with those showing persistent dysfunction. However, biopsied segments that subsequently recovered function contained significantly higher numbers of newly recruited Mac387-positive leukocytes (18.7 +/- 3.1 cells/mm(2), n = 12 versus 8.6 +/- 0.9 cells/mm(2), n = 11; P = 0.009). In addition, monocyte chemotactic protein-1, a potent mononuclear cell chemoattractant, was predominantly expressed in segments with recovery of function. Myocardial hibernation is associated with an inflammatory response leading to active leukocyte recruitment. Dysfunctional myocardial segments that show an active inflammatory reaction have a greater potential for recovery of function after revascularization. We postulate that revascularization may promote resolution of the ongoing inflammation, preventing further tissue injury and fibrosis.

Miocárdio Atordoado/patologia , Miocardite/patologia , Idoso , Anticorpos Monoclonais , Contagem de Células , Colágeno/metabolismo , Feminino , Coração/fisiopatologia , Humanos , Imuno-Histoquímica , Macrófagos/patologia , Mastócitos/patologia , Pessoa de Meia-Idade , Monócitos/fisiologia , Miocárdio Atordoado/fisiopatologia , Miocardite/fisiopatologia , Recuperação de Função Fisiológica , Coloração e Rotulagem