Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 23
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
Eur Urol ; 2019 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-31537406

RESUMO

BACKGROUND: Mutations in BRCA2 cause a higher risk of early-onset aggressive prostate cancer (PrCa). The IMPACT study is evaluating targeted PrCa screening using prostate-specific-antigen (PSA) in men with germline BRCA1/2 mutations. OBJECTIVE: To report the utility of PSA screening, PrCa incidence, positive predictive value of PSA, biopsy, and tumour characteristics after 3 yr of screening, by BRCA status. DESIGN, SETTING, AND PARTICIPANTS: Men aged 40-69 yr with a germline pathogenic BRCA1/2 mutation and male controls testing negative for a familial BRCA1/2 mutation were recruited. Participants underwent PSA screening for 3 yr, and if PSA > 3.0 ng/ml, men were offered prostate biopsy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: PSA levels, PrCa incidence, and tumour characteristics were evaluated. Statistical analyses included Poisson regression offset by person-year follow-up, chi-square tests for proportion t tests for means, and Kruskal-Wallis for medians. RESULTS AND LIMITATIONS: A total of 3027 patients (2932 unique individuals) were recruited (919 BRCA1 carriers, 709 BRCA1 noncarriers, 902 BRCA2 carriers, and 497 BRCA2 noncarriers). After 3 yr of screening, 527 men had PSA > 3.0 ng/ml, 357 biopsies were performed, and 112 PrCa cases were diagnosed (31 BRCA1 carriers, 19 BRCA1 noncarriers, 47 BRCA2 carriers, and 15 BRCA2 noncarriers). Higher compliance with biopsy was observed in BRCA2 carriers compared with noncarriers (73% vs 60%). Cancer incidence rate per 1000 person years was higher in BRCA2 carriers than in noncarriers (19.4 vs 12.0; p = 0.03); BRCA2 carriers were diagnosed at a younger age (61 vs 64 yr; p = 0.04) and were more likely to have clinically significant disease than BRCA2 noncarriers (77% vs 40%; p = 0.01). No differences in age or tumour characteristics were detected between BRCA1 carriers and BRCA1 noncarriers. The 4 kallikrein marker model discriminated better (area under the curve [AUC] = 0.73) for clinically significant cancer at biopsy than PSA alone (AUC = 0.65). CONCLUSIONS: After 3 yr of screening, compared with noncarriers, BRCA2 mutation carriers were associated with a higher incidence of PrCa, younger age of diagnosis, and clinically significant tumours. Therefore, systematic PSA screening is indicated for men with a BRCA2 mutation. Further follow-up is required to assess the role of screening in BRCA1 mutation carriers. PATIENT SUMMARY: We demonstrate that after 3 yr of prostate-specific antigen (PSA) testing, we detect more serious prostate cancers in men with BRCA2 mutations than in those without these mutations. We recommend that male BRCA2 carriers are offered systematic PSA screening.

2.
Paediatr Anaesth ; 28(9): 788-794, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30175433

RESUMO

BACKGROUND: Positive-pressure ventilation in critically ill patients is commonly administered via a manual resuscitation device or a mechanical ventilator during transport. Our group previously compared delivered ventilation parameters between a self-inflating resuscitator and a flow-inflating resuscitator during simulated in-hospital pediatric transport. However, unequal group access to inline pressure manometry may have biased our results. In this study, we examined the performance of the self-inflating resuscitator and the flow-inflating resuscitator, both equipped with inline manometry, and several mechanical ventilators to deliver prescribed ventilation parameters during simulated pediatric transport. METHODS: Thirty anesthesia providers were randomized to initial resuscitator device used to hand ventilate a test lung. The resuscitators studied were a Jackson-Rees circuit (flow-inflating resuscitator) or a Laerdal pediatric silicone resuscitator (self-inflating resuscitator), both employing manometers. The scenario was repeated using several mechanical transport ventilators (Hamilton-T1, LTV® 1000, and LTV® 1200). The primary outcome was the proportion of total breaths delivered within the predefined target PIP/PEEP range (30 ± 3, 10 ± 3 cm H2 O). RESULTS: The Hamilton-T1 outperformed the other ventilators for breaths in the recommended range (χ2  = 2284, df = 2, P < .001) and with no breaths in the unacceptable range (χ2  = 2333, df = 2, P < .001). Hamilton-T1 also outperformed all human providers in proportion of delivered acceptable and unacceptable breaths (χ2  = 4540, df = 3, P < .001 and χ2  = 639, df = 3, P < .001, respectively). Compared with the flow-inflating resuscitator, the self-inflating resuscitator was associated with greater odds of breaths falling outside the recommended range (Odds ratio (95% CI): 1.81 (1.51-2.17)) or unacceptable (Odds ratio (95% CI): 1.63 (1.48-1.81)). CONCLUSION: This study demonstrates that a majority of breaths delivered by manual resuscitation device fall outside of target range regardless of provider experience or device type. The mechanical ventilator (Hamilton-T1) outperforms the other positive-pressure ventilation methods with respect to delivery of important ventilation parameters. In contrast, 100% of breaths delivered by the LTV 1200 were deemed unacceptable.

4.
Br J Cancer ; 118(2): 266-276, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29301143

RESUMO

BACKGROUND: Prostate-specific antigen (PSA) and PSA-velocity (PSAV) have been used to identify men at risk of prostate cancer (PrCa). The IMPACT study is evaluating PSA screening in men with a known genetic predisposition to PrCa due to BRCA1/2 mutations. This analysis evaluates the utility of PSA and PSAV for identifying PrCa and high-grade disease in this cohort. METHODS: PSAV was calculated using logistic regression to determine if PSA or PSAV predicted the result of prostate biopsy (PB) in men with elevated PSA values. Cox regression was used to determine whether PSA or PSAV predicted PSA elevation in men with low PSAs. Interaction terms were included in the models to determine whether BRCA status influenced the predictiveness of PSA or PSAV. RESULTS: 1634 participants had ⩾3 PSA readings of whom 174 underwent PB and 45 PrCas diagnosed. In men with PSA >3.0 ng ml-l, PSAV was not significantly associated with presence of cancer or high-grade disease. PSAV did not add to PSA for predicting time to an elevated PSA. When comparing BRCA1/2 carriers to non-carriers, we found a significant interaction between BRCA status and last PSA before biopsy (P=0.031) and BRCA2 status and PSAV (P=0.024). However, PSAV was not predictive of biopsy outcome in BRCA2 carriers. CONCLUSIONS: PSA is more strongly predictive of PrCa in BRCA carriers than non-carriers. We did not find evidence that PSAV aids decision-making for BRCA carriers over absolute PSA value alone.

5.
Immunology ; 154(1): 104-121, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29164596

RESUMO

Dermal blood vessels and regional lymph nodes are innervated by sympathetic nerves and, under stress, sympathetic nerves release norepinephrine (NE). Exposure of primary murine dermal microvascular endothelial cells (pDMECs) to NE followed by co-culture with Langerhans cells (LCs), responsive CD4+ T-cells and antigen resulted in modulation of CD4+ T-cell responses. NE-treatment of pDMECs induced increased production of interleukin (IL)-6 and IL-17A while down-regulating interferon (IFN)-γ and IL-22 release. This effect did not require contact between pDMECs and LCs or T-cells and depended upon pDMEC production of IL-6. The presence of NE-treated pDMECs increased the proportion of CD4+ T-cells expressing intracellular IL-17A and increased IL-17A mRNA while decreasing the proportion of IFN-γ- or IL-22-expressing CD4+ T-cells and mRNA levels for those cytokines. Retinoic acid receptor-related orphan receptor gamma (ROR-γt) mRNA was significantly increased in CD4+ T-cells while T-box transcription factor (T-bet) mRNA was decreased. Intradermal administration of NE prior to hapten immunization at the injection site produced a similar bias in draining lymph node CD4+ T-cells towards IL-17A and away from IFN-γ and IL-22 production. Under stress, release of NE may have significant regulatory effects on the outcome of antigen presentation through actions on ECs with enhancement of inflammatory skin disorders involving IL-17/T helper type 17 (Th17) cells.


Assuntos
Apresentação do Antígeno , Comunicação Celular , Citocinas/imunologia , Células Endoteliais/efeitos dos fármacos , Células de Langerhans/imunologia , Norepinefrina/farmacologia , Linfócitos T Auxiliares-Indutores/imunologia , Animais , Células Cultivadas , Microambiente Celular , Técnicas de Cocultura , Citocinas/genética , Citocinas/metabolismo , Células Endoteliais/imunologia , Células Endoteliais/metabolismo , Feminino , Genes Codificadores dos Receptores de Linfócitos T , Interleucina-17/imunologia , Interleucina-17/metabolismo , Interleucina-6/imunologia , Interleucina-6/metabolismo , Interleucinas/imunologia , Interleucinas/metabolismo , Células de Langerhans/metabolismo , Linfonodos/efeitos dos fármacos , Linfonodos/imunologia , Linfonodos/metabolismo , Camundongos Endogâmicos BALB C , Camundongos Transgênicos , Fenótipo , Linfócitos T Auxiliares-Indutores/metabolismo
6.
Am J Otolaryngol ; 38(2): 204-207, 2017 Mar - Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28139320

RESUMO

PURPOSE: Many head and neck surgical procedures are considered clean-contaminated wounds and antibiotic prophylaxis is recommended. Despite prophylaxis, the incidence of surgical site infections remains significant - especially in the setting of free tissue transfer. The antibiotic course is often of a longer duration after free tissue transfer than the recommended 24hour post-operatively. Currently, there is no consensus on appropriate antibiotic regimen or duration at this time. This study investigates the outcomes of a 7-day perioperative antibiotic regimen after microvascular reconstruction of the head and neck at our institution. MATERIALS AND METHODS: A retrospective review was performed of 72 patients undergoing microvascular free tissue at our institution between 09/2011 and 03/2014. The antibiotic regimen, post-operative surgical (including surgical site infections) and medical complications were noted. Our rates of complications and adverse events were compared to all surgical patients, as well as all inpatients hospital-wide with use of the University Health System Consortium database. RESULTS: Seventy-two subjects met inclusion criteria for this study. The majority of subjects received cefazolin/metronidazole (69.4%). Subjects with beta-lactam allergy received clindamycin (12.5%). The remainder received an alternative regimen (18.1%). All received at least 7days of antibiotics. The rate of hospital acquired C. difficile diarrhea was 0.57% hospital-wide, 1.13% in Otolaryngology patients, and 1.4% in this study. There were no instances of a multi-drug resistant infection or any adverse reactions to the administration of antibiotics. When compared with other antibiotic regimens, clindamycin was associated with a significantly increased rate of either medical or surgical infections (OR 14.38, p=0.02) and longer hospital stay (average=18days, p<0.05). CONCLUSION: The use of a 7-day prophylactic antibiotic regimen is not associated with an increased risk of antibiotic-associated infections, multi-drug resistant infections, or antibiotic-associated complications. The use of clindamycin is associated with increased risk of medical and surgical infections post-operatively and should be avoided in the prophylactic perioperative phase after free tissue transfer of the head and neck.


Assuntos
Antibioticoprofilaxia , Neoplasias de Cabeça e Pescoço/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Infecção da Ferida Cirúrgica/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Retalhos de Tecido Biológico , Humanos , Masculino , Microcirurgia , Pessoa de Meia-Idade , Estudos Retrospectivos
7.
Dermatol Online J ; 23(10)2017 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-29469794

RESUMO

Eruptive actinic keratosis (AK) consequent to systemic chemotherapy can be confused with drug allergies. We present the first case of inflamed AKs in one patient after receiving combination therapy with pemetrexed and carboplatin.A 68-year-old woman with non-small cell lung adenocarcinoma (NSCLC) presented with numerous pruritic ill-defined, gritty, erythematous papules consistent with AKs on her upper chest, upper back, and arms two weeks after completing the first cycle of combination therapy with carboplatin and pemetrexed. The care team managed her with topical steroids and the lesions resolved within one month. The patient resumed the second cycle of chemotherapy and reported the occurrence of a similar but milder eruption.This case illustrates that eruptive AKs should be considered in the differential diagnosis of drug-related rashes, especially if the physical exam is suggestive. The mainstay of treatment should be directed at symptomatic improvement, and chemotherapy may be continued.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Carboplatina/efeitos adversos , Erupção por Droga/diagnóstico , Ceratose Actínica/induzido quimicamente , Pemetrexede/efeitos adversos , Idoso , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Diagnóstico Diferencial , Erupção por Droga/etiologia , Feminino , Humanos , Ceratose Actínica/diagnóstico , Neoplasias Pulmonares/tratamento farmacológico
9.
Int J Syst Evol Microbiol ; 66(10): 3942-3950, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27406710

RESUMO

Two bacterial strains, HKU50T and HKU46, were isolated in Hong Kong from the blood culture and the peritoneal dialysis effluent of two patients. The strains are Gram-stain-positive, acid-fast, non-motile, non-sporulating bacilli. They grow on Columbia agar with 5 % defibrinated sheep blood and brain-heart infusion agar under aerobic conditions with 5 % CO2 at 37 °C as pink-to-orange, non-haemolytic colonies. The strains are catalase-positive and oxidase-negative, and have a unique biochemical profile distinguishable from other closely related species. DNA sequencing revealed that both isolates possessed multiple intra-genomic 16S rRNA gene copies (99.8-100 % sequence identities to Gordonia lacunae NRRL B-24551T and Gordonia terrae NRRL B-16283T). Phylogenetic analysis of the 16S rRNA gene, secA1 and gyrB showed that the two isolates formed a distinct branch within the genus Gordonia and were most closely related to G. lacunae and G. terrae. DNA-DNA hybridization demonstrated ≤53.7 % and ≤49.4 % DNA relatedness between the two isolates and G. lacunae, and between the two isolates and G. terrae, respectively. Hierarchical cluster analysis of MALDI-TOF MS main spectrum profiles showed that strains HKU50T and HKU46 were closely related to each other, but were distinct from G. lacunae, G. terrae, or any other species of the genus Gordonia in the Bruker database. The chemotaxonomic traits of the two strains were highly similar, and the major fatty acids were summed feature 4 (iso-C15 : 0 2-OH/C16 : 1trans-9), C16 : 0, C18 : 1cis-9, and tuberculostearic acid. A novel species named Gordonia hongkongensis sp. nov. is proposed to accommodate strains HKU50T and HKU46, with strain HKU50T (=CCOS 955T=CIP 111027T=NBRC 111234T=NCCP 16210T) as the type strain.


Assuntos
Hemocultura , Gordonia (Bactéria)/classificação , Diálise Peritoneal , Filogenia , Técnicas de Tipagem Bacteriana , Análise por Conglomerados , DNA Bacteriano/genética , Ácidos Graxos/química , Genes Bacterianos , Gordonia (Bactéria)/genética , Gordonia (Bactéria)/isolamento & purificação , Hong Kong , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Hibridização de Ácido Nucleico , Pigmentação , RNA Ribossômico 16S/genética , Análise de Sequência de DNA
10.
PLoS One ; 11(2): e0148304, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26862894

RESUMO

BACKGROUND: Surgical interventions are being increasingly recognized as cost-effective global priorities, the utility of which are frequently measured using either quality-adjusted (QALY) or disability-adjusted (DALY) life years. The objectives of this study were to: (1) identify surgical cost-effectiveness studies that utilized a formulation of the QALY or DALY as a summary measure, (2) report on global patterns of QALY and DALY use in surgery and the income characteristics of the countries and/or regions involved, and (3) assess for possible associations between national/regional-income levels and the relative prominence of either measure. STUDY DESIGN: PRISMA-guided systematic review of surgical cost-effectiveness studies indexed in PubMed or EMBASE prior to December 15, 2014, that used the DALY and/or QALY as a summary measure. National locations were used to classify publications based on the 2014 World Bank income stratification scheme into: low-, lower-middle-, upper-middle-, or high-income countries. Differences in QALY/DALY use were considered by income level as well as for differences in geographic location and year using descriptive statistics (two-sided Chi-squared tests, Fischer's exact tests in cell counts <5). RESULTS: A total of 540 publications from 128 countries met inclusion criteria, representing 825 "national studies" (regional publications included data from multiple countries). Data for 69.0% (569/825) were reported using QALYs (2.1% low-, 1.2% lower-middle-, 4.4% upper-middle-, and 92.3% high-income countries), compared to 31.0% (256/825) reported using DALYs (46.9% low-, 31.6% lower-middle-, 16.8% upper-middle-, and 4.7% high-income countries) (p<0.001). Studies from the US and the UK dominated the total number of QALY studies (49.9%) and were themselves almost exclusively QALY-based. DALY use, in contrast, was the most common in Africa and Asia. While prominent published use of QALYs (1990s) in surgical cost-effectiveness studies began approximately 10 years earlier than DALYs (2000s), the use of both measures continues to increase. CONCLUSION: As global prioritization of surgical interventions gains prominence, it will be important to consider the comparative implications of summary measure use. The results of this study demonstrate significant income- and geographic-based differences in the preferential utilization of the QALY and DALY for surgical cost-effectiveness studies. Such regional variation holds important implications for efforts to interpret and utilize global health policy research. PROSPERO registration number: CRD42015015991.


Assuntos
Análise Custo-Benefício , Anos de Vida Ajustados por Qualidade de Vida , Procedimentos Cirúrgicos Operatórios/economia , África , Ásia , Países em Desenvolvimento , Pessoas com Deficiência , Geografia , Humanos , Renda , Modelos Estatísticos , Qualidade de Vida , Reino Unido , Estados Unidos
11.
BMC Infect Dis ; 16: 74, 2016 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-26861696

RESUMO

BACKGROUND: Long-term outcomes in non-HIV immunocompromised patients with disseminated Mycobacterium avium complex (dMAC) infections are unknown and the need for post-treatment secondary prophylaxis against MAC is uncertain in this setting. The objective of this study was to determine the need of continuing secondary anti-MAC prophylaxis in non-HIV patients after completing treatment of the primary dMAC episode. METHODS: We conducted a ten-year multi-center analysis of non-HIV immunosuppressed patients with dMAC infections in Hong Kong. RESULTS: We observed sixteen patients with dMAC during the study period of which five (31 %) were non-HIV immunosuppressed patients. In the non-HIV immunosuppressed group, three patients completed a treatment course without secondary prophylaxis, one patient received azithromycin-based secondary prophylaxis and one patient was still receiving therapy for the first dMAC episode. All the three patients who completed treatment without being given secondary prophylaxis developed recurrent dMAC infection requiring retreatment. CONCLUSIONS: In view of the high rate of dMAC infection recurrence in non-HIV immunocompromised patients following treatment completion, our data support long-term anti-MAC suppression therapy after treatment of the first dMAC infection episode in immunocompromised non-HIV patients, as is recommended for patients with advanced HIV. Tests of cell mediated immune function need to be evaluated to guide prophylaxis discontinuation in non-HIV patients.


Assuntos
Antibacterianos/uso terapêutico , Antibioticoprofilaxia , Azitromicina/uso terapêutico , Hospedeiro Imunocomprometido , Complexo Mycobacterium avium , Infecção por Mycobacterium avium-intracellulare/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Infecções por HIV , Hong Kong , Humanos , Masculino , Infecção por Mycobacterium avium-intracellulare/prevenção & controle , Recidiva
12.
J Clin Microbiol ; 53(2): 671-6, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25428146
13.
Eur Urol ; 66(3): 489-99, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24484606

RESUMO

BACKGROUND: Men with germline breast cancer 1, early onset (BRCA1) or breast cancer 2, early onset (BRCA2) gene mutations have a higher risk of developing prostate cancer (PCa) than noncarriers. IMPACT (Identification of Men with a genetic predisposition to ProstAte Cancer: Targeted screening in BRCA1/2 mutation carriers and controls) is an international consortium of 62 centres in 20 countries evaluating the use of targeted PCa screening in men with BRCA1/2 mutations. OBJECTIVE: To report the first year's screening results for all men at enrollment in the study. DESIGN, SETTING AND PARTICIPANTS: We recruited men aged 40-69 yr with germline BRCA1/2 mutations and a control group of men who have tested negative for a pathogenic BRCA1 or BRCA2 mutation known to be present in their families. All men underwent prostate-specific antigen (PSA) testing at enrollment, and those men with PSA >3 ng/ml were offered prostate biopsy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: PSA levels, PCa incidence, and tumour characteristics were evaluated. The Fisher exact test was used to compare the number of PCa cases among groups and the differences among disease types. RESULTS AND LIMITATIONS: We recruited 2481 men (791 BRCA1 carriers, 531 BRCA1 controls; 731 BRCA2 carriers, 428 BRCA2 controls). A total of 199 men (8%) presented with PSA >3.0 ng/ml, 162 biopsies were performed, and 59 PCas were diagnosed (18 BRCA1 carriers, 10 BRCA1 controls; 24 BRCA2 carriers, 7 BRCA2 controls); 66% of the tumours were classified as intermediate- or high-risk disease. The positive predictive value (PPV) for biopsy using a PSA threshold of 3.0 ng/ml in BRCA2 mutation carriers was 48%-double the PPV reported in population screening studies. A significant difference in detecting intermediate- or high-risk disease was observed in BRCA2 carriers. Ninety-five percent of the men were white, thus the results cannot be generalised to all ethnic groups. CONCLUSIONS: The IMPACT screening network will be useful for targeted PCa screening studies in men with germline genetic risk variants as they are discovered. These preliminary results support the use of targeted PSA screening based on BRCA genotype and show that this screening yields a high proportion of aggressive disease. PATIENT SUMMARY: In this report, we demonstrate that germline genetic markers can be used to identify men at higher risk of prostate cancer. Targeting screening at these men resulted in the identification of tumours that were more likely to require treatment.


Assuntos
Detecção Precoce de Câncer , Genes BRCA1 , Genes BRCA2 , Predisposição Genética para Doença/genética , Mutação , Antígeno Prostático Específico/sangue , Próstata/patologia , Neoplasias da Próstata/genética , Neoplasias da Próstata/patologia , Adulto , Idoso , Biópsia , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Valor Preditivo dos Testes , Neoplasias da Próstata/sangue
14.
Sci Rep ; 3: 2059, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23792811

RESUMO

Controversy surrounds the use of PSA as a biomarker for prostate cancer detection, leaving an unmet need for a novel biomarker in this setting; urinary EN2 may identify individuals with clinically relevant prostate cancer. Male BRCA1 and BRCA2 mutation carriers are at increased risk of clinically significant prostate cancer and may benefit from screening. Urine samples from 413 BRCA1 and BRCA2 mutation carriers and controls were evaluated. Subjects underwent annual PSA screening with diagnostic biopsy triggered by PSA > 3.0 ng/ml; 21 men were diagnosed with prostate cancer. Urinary EN2 levels were measured by ELISA and had a sensitivity of 66.7% and specificity of 89.3% for cancer detection. There was no statistically significant difference in EN2 levels according to genetic status or Gleason score. Urinary EN2 may be useful as a non-invasive early biomarker for prostate cancer detection in genetically high-risk individuals.


Assuntos
Biomarcadores Tumorais/urina , Proteínas de Homeodomínio/urina , Proteínas do Tecido Nervoso/urina , Neoplasias da Próstata/diagnóstico , Adulto , Idoso , Genes BRCA1 , Genes BRCA2 , Humanos , Masculino , Pessoa de Meia-Idade , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/genética
15.
J Pediatr Surg ; 48(5): E1-3, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23701800
16.
J Laparoendosc Adv Surg Tech A ; 23(1): 78-80, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23151113

RESUMO

BACKGROUND: Improved cosmesis is widely recognized as the main benefit of single-port laparoscopy (SPL). Recently, some centers have started to perform SPL in infants and neonates. However, in our experience, the cosmetic result following traditional laparoscopic surgery in this age range is excellent. This study assessed infants' postoperative scars following traditional laparoscopic surgery. SUBJECTS AND METHODS: Ten successive patients who previously underwent transperitoneal dismembered pyeloplasty were invited to attend for photographs of their abdominal wounds. All patients had had a 5-mm infra-umbilical port and two 3.5-mm ports (epigastrium and iliac fossa). Photographs were all taken in the hospital's medical photography studio by the same medical photographer. Life-size photographs were then shown to 10 junior doctors who were asked to identify any visible scars and rate the cosmetic result. RESULTS: Six patients with a median age at surgery of 8 months (range, 4-15 months) attended for photographs a median of 13 months postoperatively (range, 8-19 months). None of the junior doctors was able to identify all three scars on any photo. No individual scar was identifiable by all reviewers. No scars were identified in over half (31) of the total of 60 photograph reviews. Of 180 scar reviews, only 37 (21%) were identified. The umbilical scars were least noticeable (3/60), followed by iliac fossa scars (11/60) and epigastric scars (23/60). Where any scars were correctly identified, the cosmetic result was always rated good (44%) or excellent (56%). CONCLUSIONS: Traditional laparoscopic surgery in infants can have an excellent cosmetic result with "invisible" scars. The cosmetic benefit and thus the role of SPL in infants are therefore questionable.


Assuntos
Cicatriz/etiologia , Laparoscopia/efeitos adversos , Humanos , Lactente
17.
ANZ J Surg ; 82(5): 334-7, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22507245

RESUMO

INTRODUCTION: Photoselective vaporization of the prostate (PVP) is widely used to treat benign prostatic obstruction (BPO), but there is little experience reported on the new more powerful 180W lithium triborate (LBO) laser. This study evaluates the safety and efficacy of using the 180W LBO laser to treat BPO by examining a multicentre Australian experience. METHODS: Retrospective review of prospectively collected data on all men treated by 180W LBO laser PVP by eight urologists across six Australian hospitals, from July 2011 to August 2011, was performed. Perioperative and functional outcomes were examined at baseline and 3 months. RESULTS: Of the 85 men (median age 70 years, prostate volume 51 cm(3)) identified, 27% (23/85) were in urinary retention and 44% (37/85) were taking antiplatelet/anticoagulant medication. Median operating time was 46 min, laser time 27 min, energy use 211 kJ, post-operative duration of catheterization 15 h and hospitalization 22 h. Functional outcomes from baseline to 3 months, respectively, were for IPSS 25-7; QoL 5-2; Qmax 7.7-18.4; and PVR 147-38. All improvements were statistically significant (P < 0.01). Thirty-eight percent (32/85) of patients experienced at least one adverse event. Most adverse events were low Clavien-Dindo grade I-II. There were five grade III, two grade IV and no grade V adverse events. Sixty per cent (51/85) of men were able to be discharged home voiding successfully without a catheter within 24-h post-PVP. CONCLUSIONS: Our early multicentre Australian experience indicates the 180W LBO laser PVP is an efficacious and safe treatment for BPO.


Assuntos
Terapia a Laser/métodos , Próstata/cirurgia , Prostatectomia/instrumentação , Hiperplasia Prostática/cirurgia , Idoso , Boratos , Humanos , Compostos de Lítio , Masculino , Estudos Retrospectivos , Volatilização
18.
J Pediatr Surg ; 47(2): 371-4, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22325393

RESUMO

BACKGROUND: The association of urogenital (UG) anomalies and sacrococcygeal teratoma (SCT) has not been widely reported. Our aim was to look at the national incidence and presentation of this anomaly in patients with SCT and to provide the first report of a clear anatomical description of this commonly missed association. METHODS: Sacrococcygeal teratoma cases in Scotland during the last 30 years were identified. Patients with associated UG anomalies were reviewed in detail to identify their presentation, anatomy, and management. RESULTS: Fifty-three patients with SCT were identified, including 41 girls. Five girls (12%) subsequently had a UG anomaly diagnosed, which was not apparent at the initial surgery. Two patients presented with retention, and their anomaly was diagnosed at 6 weeks and 7 months of age. The other 3 presented with incontinence, and despite thorough assessment, including cystoscopy, their UG anomalies were not recognized until the ages of 7, 9, and 13 years. CONCLUSIONS: Urogenital anomalies are surprisingly common in girls with SCT. The reason for this association is unclear. None of these cases were diagnosed initially, which means that it was either missed or acquired. Urogenital anomalies should be suspected in girls with SCT and actively excluded in those with voiding difficulties.


Assuntos
Teratoma/epidemiologia , Anormalidades Urogenitais/epidemiologia , Adolescente , Criança , Comorbidade , Cistoscopia , Diagnóstico Tardio , Feminino , Humanos , Hidropisia Fetal/epidemiologia , Incidência , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/epidemiologia , Imagem por Ressonância Magnética , Recidiva Local de Neoplasia , Estudos Retrospectivos , Região Sacrococcígea , Escócia/epidemiologia , Teratoma/cirurgia , Uretra/anormalidades , Doenças Uretrais/epidemiologia , Bexiga Urinária/anormalidades , Bexiga Urinária/cirurgia , Derivação Urinária , Fístula Urinária/epidemiologia , Transtornos Urinários/etiologia , Anormalidades Urogenitais/diagnóstico , Fístula Vaginal/epidemiologia
19.
Am J Physiol Endocrinol Metab ; 301(4): E668-84, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21693692

RESUMO

Cysteine homeostasis is dependent on the regulation of cysteine dioxygenase (CDO) in response to changes in sulfur amino acid intake. CDO oxidizes cysteine to cysteinesulfinate, which is further metabolized to either taurine or to pyruvate plus sulfate. To gain insight into the physiological function of CDO and the consequence of a loss of CDO activity, mice carrying a null CDO allele (CDO(+/-) mice) were crossed to generate CDO(-/-), CDO(+/-), and CDO(+/+) mice. CDO(-/-) mice exhibited postnatal mortality, growth deficit, and connective tissue pathology. CDO(-/-) mice had extremely low taurine levels and somewhat elevated cysteine levels, consistent with the lack of flux through CDO-dependent catabolic pathways. However, plasma sulfate levels were slightly higher in CDO(-/-) mice than in CDO(+/-) or CDO(+/+) mice, and tissue levels of acid-labile sulfide were elevated, indicating an increase in cysteine catabolism by cysteine desulfhydration pathways. Null mice had lower hepatic cytochrome c oxidase levels, suggesting impaired electron transport capacity. Supplementation of mice with taurine improved survival of male pups but otherwise had little effect on the phenotype of the CDO(-/-) mice. H(2)S has been identified as an important gaseous signaling molecule as well as a toxicant, and pathology may be due to dysregulation of H(2)S production. Control of cysteine levels by regulation of CDO may be necessary to maintain low H(2)S/sulfane sulfur levels and facilitate the use of H(2)S as a signaling molecule.


Assuntos
Cisteína Dioxigenase/fisiologia , Cisteína/metabolismo , Sulfeto de Hidrogênio/metabolismo , Taurina/biossíntese , Animais , Cisteína Dioxigenase/genética , Transporte de Elétrons/fisiologia , Complexo IV da Cadeia de Transporte de Elétrons/metabolismo , Feminino , Fígado/metabolismo , Masculino , Camundongos , Camundongos Knockout
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA