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1.
Clin Exp Med ; 20(1): 87-95, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31853669

RESUMO

One of the most common mechanisms of immune evasion in MSI colorectal cancers (CRCs) is loss of HLA class I expression due to mutations in B2M gene which can become a negative predictor for checkpoint blockade therapy. The aim of this study was the determination of prevalence of B2M somatic mutations in MSI CRC patients and relationship between B2M mutations and lymphocytes infiltration and other clinicopathological features as well as detection of methylation changes in B2M promoter region which can be another mechanism of immune escape. In our study, 37 MSI-H and 5 MSI-L patients were selected for screening of B2M mutational and methylation status. The characterization of patients was based on standard histopathological diagnosis and TNM classification; BRAF, KRAS mutations, tumor-infiltrating lymphocytes and peritumoral lymphoid reaction were also determined. MSI analysis was performed using fragment analysis. B2M mutations were identified by Sanger sequencing, and methylation of CpG islands in promoter region was detected by methylation-specific PCR. Heterozygous mutations in the B2M gene were detected in five MSI-H patients (13.5%), while the mutation c.45_48delTTCT was determined in four patients and mutation c.276delC was found in two patients. One of these five patients was compound heterozygote harboring both mutations. Methylation of the promoter region of the B2M gene was observed in one patient with MSI-H colorectal cancer. Detection of genetic and epigenetic changes in B2M gene could be important in personalized therapy for CRC patients as these changes may be one of the mechanisms of secondary resistance of MSI positive tumors to immunotherapy.

2.
Transplant Proc ; 51(10): 3259-3264, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31732198

RESUMO

Practically all kidney allograft recipients require immunosuppressive therapy to prevent rejection and loss of the allograft. The aim of this study was to determine the occurrence of biopsy-proven acute rejection in low-immunologic risk kidney transplant recipients according to the type of induction (basiliximab vs low-dose of rabbit antithymocyte globulin [rATG], 3.5 mg/kg). MATERIALS AND METHODS: A total of 125 patients after primary kidney transplant were included in the retrospective analysis with 6-month follow-up. The immunosuppression regimen included tacrolimus, mycophenolic acid, and corticoids. RESULTS: We did not find any significant difference in the occurrence of acute rejection or difference in the occurrence of infection complications. Patients in the rATG group had a significantly longer period of cold ischemia, more frequently received kidney transplants from expanded criteria donors, and had significantly more mismatches in HLA-DR. Delayed graft function (DGF) was identified as an independent risk factor for biopsy-proven acute rejection (hazard ratio, 3.4859; P = .003). There was comparable incidence of DGF between the 2 groups despite that there were several factors that are more commonly associated with DGF in the rATG group. CONCLUSION: Patients with low immunologic risk and high risk of DGF benefit from the rATG induction in dose of 3.5 mg/kg without the increased risk of infection complications with the assumption of good graft function in long-term post-transplant period.

3.
BMC Nephrol ; 20(1): 272, 2019 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-31319808

RESUMO

BACKGROUND: Acute kidney injury (AKI) affects approximately 13% of patients undergoing major abdominal surgery, and is a common and important clinical sign of perioperative injury. The aim of our analysis was to identify risk factors for AKI in elderly patients with no known kidney disease at the time of surgery, and to evaluate their 30-day, 12-month and 5-year survival. METHODS: We performed a retrospective analysis on a group of 785 patients after liver resection to determine the incidence of complications (AKI - according to KDIGO classification, sepsis, cardiovascular and surgical complications). All patients had normal kidney function prior to surgery. We determined risk factors for the development of AKI for two groups of patients, stratified for age: patients younger than 65 years, and patients older than 65 years. RESULTS: The incidence of complications was significantly higher in the group of patients older than 65 years (n = 76) than in younger patients (n = 119) (P = 0.0496). In the group of younger patients, significantly worse 30-day survival was observed for patients who developed AKI (P = 0.0004). We identified the following independent risk factors for AKI: male gender (HR 10,3834; P = 0,0238), histological identification of colorectal carcinoma metastases (HR 2,8651; P = 0,0499), surgery duration longer than 300 min (HR 6,0096; P < 0,0001), blood loss of more than 500 ml (HR 10,5857; P = 0,0012), and the need for more than 500 ml of fresh frozen plasma during surgery ml (HR 2,4878; P < 0,0317). Age was not confirmed to be an independent risk factor for AKI in our study. CONCLUSION: Approaches to treatment should be highly individualized, with assessment of several variables. According to our findings, age should not present a contraindication for the indication of a patient for surgery.

4.
J Diabetes Complications ; 33(4): 315-322, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30755355

RESUMO

INTRODUCTION: Sex differences are defined as biology-linked differences between women and men that occur through the sex chromosomes and their effects on organ systems. MATERIAL AND METHODS: The objective of this prospective study was to determine risk factors for post-transplant diabetes mellitus (PTDM) in men and women. RESULTS: A total of 417 patients (271 men and 146 women) were included in the monitored group. Age at the time of kidney transplantation (KT) >60 years and hypovitaminosis D at the time of KT (<20 µg/l) were identified as independent risk factors for PTDM in both men and women. It was further confirmed as an independent risk factor for men a waist circumference at the time of KT >94 cm, C-peptide at the time of KT >5 ng/ml, HOMA-IR >2 and triacylglycerols at the time of KT >1.7 mmol/l. In case of women, the dominant factor was BMI at the time of KT >30 kg/m2 and menopause at the time of KT. A significant decrease in C-peptide was recorded in women with PTDM. CONCLUSION: It was confirmed that there are gender differences with regard to the development of PTDM after KT. Women show pancreas ß cell dysfunction, whereas insulin resistance and metabolic syndrome are dominant in men.

5.
Ann Surg Oncol ; 26(1): 291, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30374922

RESUMO

BACKGROUND: A laparoscopic approach for associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) would have the potential to decrease morbidity and mortality rates,1 as similarly observed with laparoscopic liver surgery.2 METHODS: A 54-year-old woman with stage IV rectal cancer (cT3dN1M1) was indicated for the 'liver-first' approach. The patient presented with a massive bilobar metastatic liver involvement, including S4. Five lesions were localized in a small left liver lobe (future liver remnant < 25%). During the first stage of ALPPS, the liver parenchyma was transected with preservation of the central part of the middle hepatic vein, followed by a non-anatomical resection of S3 and a metastasectomy in S2. The procedure was completed by radiofrequency ablation of S2 lesions close to the S2 portobiliary triad, to spare venous drainage for S3. The second stage of ALPPS was performed 8 days later. RESULTS: Operative time was 300 min for the first stage of ALPPS and 200 min for the second stage. Peroperative blood loss did not exceed 50 mL per operation, and no postoperative complications were observed. The patient was discharged 7 days after the second surgery. One month later, a laparoscopic uncomplicated low anterior resection with tumor-free resection margins was performed. Five months after surgery, no disease progression was detected. CONCLUSION: A laparoscopic ALPPS procedure with preservation of one portobiliary triad in the left lobe would be feasible in selected patients. The laparoscopic approach would be very important for patients waiting for a final primary tumor surgery.


Assuntos
Hepatectomia/métodos , Neoplasias Renais/cirurgia , Laparoscopia/métodos , Tempo de Internação/estatística & dados numéricos , Neoplasias Hepáticas/cirurgia , Veia Porta/cirurgia , Complicações Pós-Operatórias , Feminino , Humanos , Neoplasias Renais/patologia , Ligadura , Neoplasias Hepáticas/secundário , Pessoa de Meia-Idade , Duração da Cirurgia , Prognóstico
6.
J Diabetes Complications ; 32(9): 863-869, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30049444

RESUMO

INTRODUCTION: Obese patients have increased leptin production and selective resistance to its central anti-adipogenic effects, yet its pro-inflammatory immunostimulating effects persist. MATERIAL AND METHODS: In a group of 70 patients who underwent primary kidney transplantation (KT) we examined adiponectin and leptin levels at the time of KT and 6 months post-transplantation. Patients with diabetes mellitus type 1 or type 2 at the time of KT were excluded from the study. RESULTS: We found that leptin levels significantly increased during the post-transplant period (P = 0.0065). Overall, leptin levels were positively correlated with the level of triacylglycerols, post-transplant diabetes mellitus (PTDM) development and acute rejection (AR). We discovered that, in particular, high leptin levels were associated with AR [OR 2.1273; 95% CI 1.0130-4.4671 (P = 0.0461)] and PTDM development [OR 7.200; 95% CI 1.0310-50.2836 (P = 0.0465)], whereas, low adiponectin levels represent a risk factor for the development of insulin resistance [HR 38.6135; 95% CI 13.3844-67.7699 (P < 0.0001)] and obesity [HR 3.0821; 95% CI 0.8700-10.9192 (P = 0.0053)]. CONCLUSION: We found that a high serum concentration of leptin before KT is associated with both PTDM development and AR and merits further investigation in relation to KT.


Assuntos
Biomarcadores , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/etiologia , Transplante de Rim/efeitos adversos , Leptina/fisiologia , Complicações Pós-Operatórias/diagnóstico , Doença Aguda , Adiponectina/sangue , Adulto , Biomarcadores/sangue , Diabetes Mellitus/sangue , Feminino , Seguimentos , Rejeição de Enxerto/sangue , Rejeição de Enxerto/diagnóstico , Humanos , Resistência à Insulina/fisiologia , Leptina/sangue , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/sangue , Valor Preditivo dos Testes , Sensibilidade e Especificidade
7.
Am Surg ; 84(6): 1058-1063, 2018 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-29981649

RESUMO

Sepsis, severe sepsis, and septic shock represent a serious medicinal and general social problem and still maintain an important position among the present issues in the basic and clinical research. In the prospective analysis of patients satisfying the criteria of septic condition, we determined serum levels of bioparameters in three consecutive days from the first signs of sepsis depending on the stage or advancement of the septic condition. We determined the most significant parameter/parameters which are able to determine the stage of sepsis or to predict patient's death. In the group of 68 patients, all monitored biomarkers showed significant difference in serum concentrations versus the control group (P = 0.001). The strongest positive connection between the seriousness of sepsis and serum level is in case of procalcitonin. Predictor of mortality (r = -0.468; P = 0.001), transferrin (r = -0.506; P = 0.003), and tumor necrosis factor-α (r = 0.939; P = 0.001). Our results show that the monitored parameters (procalcitonin, C-reactive protein, tumor necrosis factor-α, and interleukin 6) have strong correlations between the serum levels and the stage of disease. Examination of at least one cytokine in normal clinical practice might lead to better interpretation of the patient's condition, determining the risk of death.


Assuntos
Biomarcadores/sangue , Sepse/sangue , Sepse/diagnóstico , Adulto , Idoso , Proteína C-Reativa/metabolismo , Calcitonina/sangue , Estudos de Casos e Controles , Feminino , Humanos , Interleucina-6/sangue , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Sepse/mortalidade , Transferrina/metabolismo , Fator de Necrose Tumoral alfa/sangue
8.
Prog Transplant ; 28(1): 87-90, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29402156

RESUMO

Delayed graft function continues to pose a significant challenge to clinicians in the context of kidney transplantation. The objective of this retrospective, 5-year analysis is to identify the parameters of beating heart donors and those of recipients that affect the delayed development of graft function. The monitored group was composed of 152 beating heart donors and 179 recipients. Delayed graft function was identified in 32 (17%) patients. The predictor for development of delayed graft function was the body mass index of the donor (odds ratio: 1.1473; 95% confidence interval [CI]: 1.0017-1.3140; P = .0472), and the independent risk factors were donor body mass index 30 to 34.9 kg/m2 (hazard ratio [HR]: 6.0215; 95% CI: 1.4188-25.556; P = .0149), donor body mass index ≥35 kg/m2 (HR: 13.5484; 95% CI: 1.4575-125.938; P = .0220), and abuse of alcohol in the donor's history (HR: 1.779; 95% CI: 1.0679-2.964; P = .0270).


Assuntos
Índice de Massa Corporal , Função Retardada do Enxerto/etiologia , Rejeição de Enxerto/etiologia , Transplante de Rim/efeitos adversos , Doadores Vivos/estatística & dados numéricos , Transplantados/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco
9.
Iran J Kidney Dis ; 11(6): 461-466, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29190607

RESUMO

INTRODUCTION: The Kidney Disease: Improving Global Outcomes Clinical Practice Guidelines on the management of bone disease in patients with chronic kidney disease recommend periodic measurement of serum calcium, phosphorus, vitamin D, and parathyroid hormone levels after kidney transplantation, with the frequencies that will vary according to the severity of bone disease and graft function. Paricalcitol, a selective vitamin D receptor activator, is indicated in the prevention and treatment of secondary hyperparathyroidism. MATERIALS AND METHODS: We retrospectively evaluated the effect of treatment with paricalcitol among our kidney transplant recipients. We monitored the effect of paricalcitol on bone density; the plasma levels of parathyroid hormone, calcium, and phosphorus; and proteinuria and calciuria. Comparisons were made between these parameters before treatment and 12 months after treatment. RESULTS: Eighty-eight kidney transplant recipients with a mean age at the time of transplantation of 47.1 ± 10.5 years were receiving paricalcitol. On average, paricalcitol was included into the treatment for 48 months from transplantation (median, 27 months). The patients had significantly improved bone density (P < .001), significantly lower parathyroid hormone levels (P < .001), and significantly decreased proteinuria (P = .02) after 12 months of treatment. During the treatment with paricalcitol, the immunosuppressive therapy, dose of prednisone, body mass index, and vitamin D levels had not significantly changed. Nor had any significant change occurred to graft function. CONCLUSIONS: Paricalcitol is an effective therapy for secondary hyperparathyroidism in kidney transplant recipients.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Densidade Óssea/efeitos dos fármacos , Ergocalciferóis/uso terapêutico , Hiperparatireoidismo Secundário/tratamento farmacológico , Transplante de Rim/efeitos adversos , Adulto , Biomarcadores/sangue , Conservadores da Densidade Óssea/efeitos adversos , Ergocalciferóis/efeitos adversos , Feminino , Humanos , Hiperparatireoidismo Secundário/sangue , Hiperparatireoidismo Secundário/diagnóstico , Hiperparatireoidismo Secundário/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Eslováquia , Fatores de Tempo , Resultado do Tratamento
10.
Neuro Endocrinol Lett ; 38(5): 325-328, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29106786

RESUMO

The authors present a case report of severe descending necrotizing mediastinitis (DNM) etiologically of unrecognized traumatic endotracheal intubation with hypopharynx-esophageal junction perforation. Patient was treated inadequately for seven days in local hospital what was the cause of sepsis progression into the septic shock with multiorgan dysfunction syndrome. Patient was transferred to specialized hospital and was immediately operated in general anaesthesia - combined transcervical approach and lateral thoracotomy was used for mediastinal drainage and debridement. Combination of appropriate conventional and surgical therapy led to reversing of the unfavorable situation.


Assuntos
Hipofaringe/lesões , Intubação Intratraqueal/efeitos adversos , Mediastinite/etiologia , Sepse/etiologia , Drenagem , Feminino , Humanos , Doença Iatrogênica , Mediastinite/cirurgia , Pessoa de Meia-Idade , Sepse/cirurgia , Toracotomia , Resultado do Tratamento
11.
Vector Borne Zoonotic Dis ; 17(4): 225-228, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28051760

RESUMO

Echinococcosis is a serious parasitic disease that ends lethally in 95% of untreated infected patients. It was first diagnosed in Slovakia in the year 2000. It is caused by the larval stage of a tapeworm belonging to the genus Echinococcus, which was assigned to the group "A" of zoonoses in the year 2004. The number of new infections is rising because of increasing percentage of infected red foxes (Vulpes vulpes). Early and accurate diagnosis of infections with this parasite is essential for proper initiation of adequate therapy. Thanks to professional multidisciplinary efforts and new laboratory procedures, the number of correctly diagnosed cases has increased. Antimicrobial therapeutic approaches can lead to improved quality of life and better prognosis even if radical surgery is refused by the patient.


Assuntos
Equinococose Hepática/diagnóstico , Echinococcus multilocularis/fisiologia , Animais , Anti-Helmínticos/uso terapêutico , Equinococose Hepática/tratamento farmacológico , Equinococose Hepática/patologia , Humanos , Masculino , Mebendazol/uso terapêutico , Pessoa de Meia-Idade , Eslováquia/epidemiologia , Zoonoses
12.
Ann Hepatol ; 16(1): 149-156, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28051804

RESUMO

Introduction and aims. Liver resection is the treatment of choice for many primary and secondary liver diseases. Most studies in the elderly have reported resection of primary and secondary liver tumors, especially hepatocellular carcinoma and colorectal metastatic cancer. However, over the last two decades, hepatectomy has become safe and is now performed in the older population, implying a paradigm shift in the approach to these patients. MATERIAL AND METHODS: We retrospectively evaluated the risk factors for postoperative complications in patients over 65 years of age in comparison with those under 65 years of age after liver resection (n = 360). The set comprised 127 patients older than 65 years (35%) and 233 patients younger than 65 years (65%). RESULTS: In patients younger than 65 years, there was a significantly higher incidence of benign liver tumors (P = 0.0073); in those older than 65 years, there was a significantly higher incidence of metastasis of colorectal carcinoma to the liver (0.0058). In patients older than 65 years, there were significantly more postoperative cardiovascular complications (P = 0.0028). Applying multivariate analysis, we did not identify any independent risk factors for postoperative complications. The 12-month survival was not significantly different (younger versus older patients), and the 5-year survival was significantly worse in older patients (P = 0.0454). CONCLUSION: In the case of liver resection, age should not be a contraindication. An individualized approach to the patient and multidisciplinary postoperative care are the important issues.


Assuntos
Ablação por Cateter/efeitos adversos , Hepatectomia/efeitos adversos , Neoplasias Hepáticas/cirurgia , Complicações Pós-Operatórias/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Ablação por Cateter/mortalidade , Distribuição de Qui-Quadrado , Feminino , Hepatectomia/métodos , Hepatectomia/mortalidade , Humanos , Incidência , Estimativa de Kaplan-Meier , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Seleção de Pacientes , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/mortalidade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Eslováquia , Fatores de Tempo , Resultado do Tratamento
13.
Ann Hepatol ; 16(1): 149-156, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-31155096

RESUMO

INTRODUCTION AND AIMS: Liver resection is the treatment of choice for many primary and secondary liver diseases. Most studies in the elderly have reported resection of primary and secondary liver tumors, especially hepatocellular carcinoma and colorectal meta-static cancer. However, over the last two decades, hepatectomy has become safe and is now performed in the older population, implying a paradigm shift in the approach to these patients. MATERIAL AND METHODS: We retrospectively evaluated the risk factors for postoperative complications in patients over 65 years of age in comparison with those under 65 years of age after liver resection (n = 360). The set comprised 127 patients older than 65 years (35%) and 233 patients younger than 65 years (65%). RESULTS: In patients younger than 65 years, there was a significantly higher incidence of benign liver tumors (P = 0.0073); in those older than 65 years, there was a significantly higher incidence of metastasis of colorectal carcinoma to the liver (0.0058). In patients older than 65 years, there were significantly more postoperative cardiovascular complications (P = 0.0028). Applying multivariate analysis, we did not identify any independent risk factors for postoperative complications. The 12-month survival was not significantly different (younger versus older patients), and the 5-year survival was significantly worse in older patients (P = 0.0454). CONCLUSION: In the case of liver resection, age should not be a contraindication. An individualized approach to the patient and multidisciplinary postoperative care are the important issues.

14.
Iran J Kidney Dis ; 10(5): 332-335, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27721233

RESUMO

Treatment of retroperitoneal fibrosis usually involves corticosteroids with or without other immunomodulating medications or tamoxifen.  Rituximab, a monoclonal antibody that specifically targets CD20 on the surface of B-cells, is effective in achieving complete remission of proteinuria in patients with idiopathic membranous nephropathy. We describe a case of a 45 years old man with idiopathic membranous glomerulonephritis (with proteinuria of more than 30 grams/24 hours) and simultaneously with idiopathic retroperitoneal fibrosis (with large number of cells CD20 in the histologic image). The patient did not tolerate the treatment by cyclophosphamide, and as rescue therapy, administration of rituximab was indicated with excellent effect. We recorded promptreduction of proteinuria and significant reduction of retroperitoneal fibrosis. Rituximab is effective in treatment of idiopathic retroperitonea lfibrosis with positivity of CD20 cells, as well as in treatment of idiopathic membranous glomerulonephritis.


Assuntos
Glomerulonefrite Membranosa/tratamento farmacológico , Fatores Imunológicos/uso terapêutico , Proteinúria/tratamento farmacológico , Fibrose Retroperitoneal/tratamento farmacológico , Rituximab/uso terapêutico , Glomerulonefrite Membranosa/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Proteinúria/etiologia , Fibrose Retroperitoneal/complicações , Fibrose Retroperitoneal/diagnóstico por imagem , Fibrose Retroperitoneal/patologia , Resultado do Tratamento
15.
Ann Transplant ; 20: 154-9, 2015 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-25791039

RESUMO

BACKGROUND: New-onset diabetes mellitus after transplantation (NODAT) is a serious and frequent complication of solid organ transplantations. NODAT leads to 2-3 times higher cardiovascular morbidity and mortality. Visceral obesity is a key factor for diabetes mellitus type 2 and metabolic syndrome development, and is an independent risk factor for cardiovascular diseases. MATERIAL AND METHODS: The series consisted of 167 patients after primary kidney transplantation from a dead donor (64 patients had developed NODAT), average age of the series was 46.1±11.6 years. We retrospectively examined waist circumference, body mass index, and weight gain in the 12th month after transplantation. We examined average level of triglycerides, cholesterol, and immunosuppression throughout the 12 monitored months. RESULTS: Patients with NODAT were significantly older (P=0.004) and had greater waist circumference (P<0.0001) and higher average sirolimus level (P=0.0262). We identified the following independent risk factors for NODAT by using multivariate analysis: age at the time of transplantation above 50 years (HR=2.5038, [95% CI: 1.7179 to 3.6492], P<0.0001), waist circumference in men greater than 94 cm (HR=1.9492, [95% CI: 1.1697 to 3.2480], P=0.0104) and in women greater than 80 cm (HR=4.5018, [95% CI: 1.8669 to 10.8553], P=0.009). By using correlation coefficient we have proved that greater waist circumference was related to higher incidence of NODAT (r=0.1935, [95% CI: 0.01156 to 0.3630], P=0.0374). Graft survival (death censored) 12 months after kidney transplantation was 97.1% in the control group and 95.3% in the NODAT group (P=0.5381). Patient survival 12 months after kidney transplantation in the control group was 98.1% and in the NODAT group it was 96.9% (P=0.6113). CONCLUSIONS: We identified waist circumference as an independent risk factor for NODAT in our analysis.


Assuntos
Diabetes Mellitus Tipo 2/etiologia , Transplante de Rim/efeitos adversos , Insuficiência Renal Crônica/cirurgia , Circunferência da Cintura , Adulto , Índice de Massa Corporal , Diabetes Mellitus Tipo 2/mortalidade , Feminino , Rejeição de Enxerto/mortalidade , Humanos , Imunossupressores/uso terapêutico , Transplante de Rim/métodos , Transplante de Rim/mortalidade , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/mortalidade , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Tacrolimo/uso terapêutico
16.
Platelets ; 25(2): 132-4, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-23534936

RESUMO

Platelets are required for the recruitment of bone marrow-derived mononuclear cells (BMMNC) into ischemia-induced vasculature, which underlines their key role in angiogenesis. The difference in platelet immunophenotype between healthy controls and patients with critical limb ischemia (CLI) treated with therapeutic angiogenesis (TA) using BMMNC was assessed. The impact of TA on the expression of platelet membrane markers was studied as well. CLI patients (N = 26) and blood donors as controls (N = 21) were enrolled. Bone marrow (600 ± 50 ml) was centrifuged (3200 g, 20 min, 22 °C). BMMNC (100-120 ml) were separated by Optipress I and implanted to the ischemic limb using deep intramuscular injections. Flow cytometry was employed for the peripheral blood platelets immunophenotyping. CD41FITC, CD62PE, CD36FITC, CD29FITC antibodies were used. Patients were followed up prior to the procedure and at months 1, 3 and 6. The expression of CD41 was lower in CLI patients than in the controls. P-selectin (CD62P) was higher in CLI patients than in controls at the baseline and at month 6. It was significantly down-regulated at month 3, however not at months 1 and 6 compared to baseline. Platelet GPIV (CD36) was higher at the baseline, but not during the follow-up compared to the controls. ß1-integrin (CD29) progressively decreased during the follow-up as compared to the baseline value. Platelets in CLI express P-selectin, GPIV and ß1-integrin more abundantly than platelets of healthy subjects. TA down-regulates the expression of the respective markers. Possible mechanism could be higher clearance of the activated platelets in the ischemic tissues during angiogenesis.


Assuntos
Plaquetas/metabolismo , Transplante de Medula Óssea , Extremidades/irrigação sanguínea , Isquemia/metabolismo , Isquemia/terapia , Ativação Plaquetária , Adulto , Antígenos de Superfície/metabolismo , Feminino , Seguimentos , Humanos , Imunofenotipagem , Masculino , Pessoa de Meia-Idade , Fenótipo , Resultado do Tratamento
17.
Vasa ; 41(5): 380-2, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22915537

RESUMO

Hemorrhagic complications are usually manifestations of the progress of severe pancreatitis. In major arterial hemorrhage resulting from pancreatic inflammatory disease, visceral angiography is valuable in localizing the site of bleeding, and hemostasis can be achieved by transcatheter arterial embolization. Successful transcatheter embolization of bleeding in the anterior superior pancreaticoduodenal artery using ethylene-vinyl alcohol copolymer (Onyx) was performed in a 38-year-old woman with acute biliary necrotic-hemorrhagic pancreatitis.


Assuntos
Embolização Terapêutica/métodos , Hemorragia/terapia , Pancreatite Necrosante Aguda/complicações , Polivinil , Adulto , Angiografia , Feminino , Hemorragia/diagnóstico por imagem , Artéria Hepática/diagnóstico por imagem , Humanos , Pancreatite Necrosante Aguda/diagnóstico por imagem , Tomografia Computadorizada por Raios X
18.
Ann Transplant ; 7(4): 52-4, 2002.
Artigo em Inglês | MEDLINE | ID: mdl-12854349

RESUMO

We present a case report of a 30-year-old man, who hyperacutely rejected a blood group identical, HLA-haploidentical living related kidney graft in spite of the fact that he had never been immunized. Anti-endothelial IgG antibodies that did not react with monocytes were detected with flow cytometry, on a panel of human umbilical cord cells in his serum retrospectively. On the basis of this experience we put for consideration the possibility of regular examination of non-HLA antibodies in potential living graft recipients.


Assuntos
Anticorpos/imunologia , Endotélio Vascular/imunologia , Rejeição de Enxerto/imunologia , Imunoglobulina G/imunologia , Transplante de Rim/imunologia , Doadores Vivos , Monócitos/imunologia , Doença Aguda , Adulto , Especificidade de Anticorpos , Teste de Histocompatibilidade , Humanos , Masculino
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