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1.
Artigo em Inglês | MEDLINE | ID: mdl-32278676

RESUMO

BACKGROUND: Clinicopathologic characteristics and prognostic and predictive factors offer valuable guidance when selecting optimal first-line treatment in patients with metastatic colorectal cancer (CRC). The association between baseline circulating tumor cell (bCTC) count, molecular tumor profile, and clinicopathologic features was analyzed in a chemo-naïve metastatic CRC population. PATIENTS AND METHODS: A total of 1202 patients from the Spanish VISNÚ-1 (FOLFIRINOX/bevacizumab vs. FOLFOX/bevacizumab) and VISNÚ-2 (FOLFIRI/bevacizumab vs. FOLFIRI/cetuximab; RAS-wildtype) studies were analyzed for mutational status and bCTC count. The association between clinicopathologic characteristics and bCTC count, mutational status, and microsatellite instability (MSI) was analyzed in 589 eligible patients. RESULTS: Interestingly, 41% of the population studied presented ≥3 bCTC count. bCTC count ≥3 was associated with worse performance status (according Eastern Cooperative Oncology Group scale), stage IV at diagnosis, at least 3 metastatic sites, and elevated carcinoembryonic antigen (CEA) levels; but not with RAS or BRAF mutations or high MSI. BRAFmut (BRAF mutated) tumors were associated with right-sided primary tumors, peritoneum, distant lymph node metastasis, and less frequent liver involvement. RASmut (RAS mutated) was associated with worse performance status; stage IV at diagnosis; right-sided primary tumors; liver, lung, and bone metastases; at least 3 metastatic sites; and elevated CEA, whereas PIK3CAmut (PIK3CA mutated) tumors were associated with right-sided primary tumors, high CEA serum levels, and older age. High MSI was associated with right-sided primary tumors, distant lymph nodes metastasis, and lower CEA levels. CONCLUSIONS: In our study, elevated bCTCs and RASmut were associated with clinicopathologic features known to be associated with poor prognosis; whereas the poor prognosis of BRAFmut tumors in chemo-naïve metastatic CRC is not explained by associations with poor clinicopathologic prognostic factors, except right-sided primary tumors. TRIAL REGISTRATION NUMBER: VISNU 1 ClinicalTrials.gov ID: NCT01640405/ VISNU 2 ClinicalTrials.gov ID: NCT01640444.

2.
Am J Cardiol ; 125(8): 1142-1147, 2020 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-32087994

RESUMO

Bleeding risk stratification is an unresolved issue in older adults. Anemia may reflect subclinical blood losses that can be exacerbated after percutaneous coronary intervention . We sought to prospectively determine the contribution of anemia to the risk of bleeding in 448 consecutive patients aged 75 or more years, treated by percutaneous coronary interventions without concomitant indication for oral anticoagulation. We evaluated the effect of WHO-defined anemia on the incidence of 1-year nonaccess site-related major bleeding. The prevalence of anemia was 39%, and 13.1% of anemic and 5.2% of nonanemic patients suffered a bleeding event (hazard ratio 2.75, 95% confidence interval 1.37 to 5.54, p = 0.004). Neither PRECISE-DAPT nor CRUSADE scores were superior to hemoglobin for the prediction of bleeding. In conclusion, anemia is a powerful predictor of bleeding with potential utility for simplifying tailoring therapies.

3.
Obes Surg ; 29(10): 3348-3356, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31209830

RESUMO

INTRODUCTION/PURPOSE: The assessment of the patients' motivation as a predictor of behavioral change via five stages (pre-contemplation, contemplation, preparation, action, and maintenance) and four processes (emotional re-evaluation, weight management actions, environmental restructuring, and weight consequences evaluation) of change. MATERIALS/METHODS: A total of 542 participants (251 waiting for bariatric surgery (BS), 90 undergoing BS, and 201 controls) completed the Stages (S-Weight) and Processes (P-Weight) of Change in Overweight and Obese People questionnaires in a multicenter cross-sectional study. RESULTS: A higher percentage of subjects seeking BS (31.7%) were in the action stage (16.7% of post-BS patients, p < 0.001; 14.9% of controls, p < 0.001). The referred body mass index (BMI) reduction was higher in subjects in active stages (3.6 ± 4.4 kg/m2 in maintenance versus 1.4 ± 1.4 kg/m2 in contemplation, p < 0.001). In the P-Weight questionnaire, patients looking for BS scored significant higher in the four processes of change than controls. In addition, a positive and significantly correlation between BMI and the four processes was observed. In the stepwise multivariate analysis, BMI and the S-Weight allocation were constantly associated with the four processes of change. CONCLUSION: Obesity is accompanied by a modifying behavioral stage, suggesting that subjects before BS are seriously thinking about overcoming excess weight. To identify subjects on the waiting list for BS who will be more receptive to weight lost interventions remains a challenge.

4.
Foot Ankle Surg ; 24(5): 411-416, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29409208

RESUMO

BACKGROUND: Akin osteotomy is a well-known surgical procedure in forefoot surgery. When performing percutaneously, we have found a lot of delayed unions on follow up X-rays. The objective of this study was to assess the incidence of delayed union when performing a percutaneous Akin osteotomy. METHODS: We report a series of 26 cases who underwent minimally invasive (percutaneous) Akin osteotomy. The mean follow-up duration was 17.6 (range 12 to 24) months. We analys-24) months. We analyzed the time to fusion using standard weight bearing radiographs. All the procedures were uneventful and we had only two skin burns that healed without sequelae. RESULTS: All the procedures were uneventful and we had only two skin burns that healed without sequelae. The average time to fusion in our series was 4.69 months (2-11): seventeen of the 26 osteotomies (65.4%) were considered radiographically healed at an average time of 2,94 months (2-5), whereas 9 patients (34.6%) sustained a delayed-union and healed at an average of 8 months (7-11). CONCLUSIONS: Despite few intraoperative complications and satisfactory clinical and radiological outcomes, our data suggest that a delayed union after Akin osteotomy is very common in the daily practice when performing it through a minimally invasive technique.


Assuntos
Hallux Valgus/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Osteotomia/efeitos adversos , Falanges dos Dedos do Pé/cirurgia , Cicatrização , Adulto , Idoso , Feminino , Seguimentos , Hallux Valgus/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Osteotomia/métodos , Radiografia , Fatores de Tempo , Falanges dos Dedos do Pé/diagnóstico por imagem , Resultado do Tratamento
5.
Eur Urol Focus ; 3(4-5): 430-436, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28753791

RESUMO

BACKGROUND: Markers able to predict the response to antiangiogenics in metastatic clear cell renal cell carcinoma (ccRCC) are not available. The development of new treatment options like immunotherapy are reaching the clinic; therefore, predictors of benefit from these different available treatments are increasingly needed. OBJECTIVE: In this study, we prospectively assessed the association of circulating endothelial cells (CECs) in peripheral blood with long-term benefit from first-line treatment in ccRCC. DESIGN, SETTING, AND PARTICIPANTS: A prospective observational study was designed involving 13 institutions of the Spanish Oncology Genitourinary Group. Adult patients diagnosed with advanced ccRCC who had achieved response or disease stabilization after 3 mo on first-line therapy were eligible. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: CECs were isolated from peripheral blood, captured with ferrofluids coated with monoclonal antibodies directed against the CD146 antigen, and assessed centrally with an automated standardized system. CECs were defined as 4',6-diamidino-2-phenylindole+, CD105+, and CD45-. Blood samples were systematically taken every 6 wk for 15 mo or until tumor progression, whichever occurred first. Clinical data were externally monitored at all centers. RESULTS AND LIMITATIONS: From August 9, 2011, to January 17, 2013, 75 patients were enrolled in the study. Patients with baseline CECs above the median showed a significantly longer progression-free survival than those with low CECs (22.2 mo vs 12.2 mo) with a hazard ratio of 2.5 (95% confidence interval: 1.2-5.3, p=0.016). There was no difference between CEC levels at baseline and at tumor progression (medians of 50 CECs/4ml and 52 CECs/4ml, respectively). CONCLUSIONS: Under antiangiogenic treatment, the detection of higher CEC levels is associated with clinical benefit in terms of progression-free survival in ccRCC. PATIENT SUMMARY: Antiangiogenics are the cornerstone of treatment in kidney cancer. Since they target endothelial rather than tumor cells, we studied the correlation between levels of circulating endothelial cells in peripheral blood and long-term benefit in patients on antiangiogenic therapy. Higher levels were associated with long-term benefit, suggesting that this determination could help to separate best responders from those who could require a more intensive approach.


Assuntos
Biomarcadores Tumorais/sangue , Carcinoma de Células Renais/tratamento farmacológico , Carcinoma de Células Renais/patologia , Células Endoteliais/citologia , Células Endoteliais/efeitos dos fármacos , Adulto , Idoso , Idoso de 80 Anos ou mais , Inibidores da Angiogênese/efeitos adversos , Antígeno CD146/metabolismo , Contagem de Células/métodos , Endoglina/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
6.
Arch. venez. pueric. pediatr ; 80(2): 47-51, jun. 2017. tab
Artigo em Espanhol | LILACS-Express | ID: biblio-887824

RESUMO

La Purpura de Henoch Schonlein (PHS) es la vasculitis mas frecuente en pediatría. Su análisis epidemiológico, clínico y evolución, son importantes en el manejo de los pacientes. Objetivo general: Revisar unas serie de pacientes con PHS de un hospital de referencia comarcal. Método: Se recogió información de las historias clínicas y se analizaron los datos de acuerdo a parámetros definidos. Resultados: 17 pacientes menores de 15 años fueron evaluados; esta cifra corresponde a 29 casos/año/100.000 habitantes <15años edad promedio 6.12±4.9 años; predominio del sexo masculino; la mayoría de los casos se presentó en otoño e invierno. Se detectó antecedente infeccioso previo o concomitante en 47% de los casos, predominantemente infecciones del tracto respiratorio superior y, la forma de presentación mas frecuente fue la tríada: purpura cutánea palpable, manifestaciones gastrointestinales y articulares. Se encontró que 53% de los pacientes presentaron manifestación nefrológica inicial, predominando hematuria y proteinuria. Todos los casos mantuvieron función de filtración renal normal. Estreptococo beta hemolítico fue aislado en un tercio de los casos. Todos los pacientes han evolucionado satisfactoriamente después de 11±7 meses de seguimiento ambulatorio. Conclusiones: La casuística de PHS en este hospital muestra que la incidencia es mayor al promedio reportado en la mayoría de las casuísticas internacionales y es mayor en otoño, distinto a lo habitualmente reportado. Esto sugiere la probable existencia de factores ambientales, microbiológicos, o de otra índole, no precisados, lo cual ameritaría estudios pertinentes en materia de salud publica.


Background: Henoch Schonlein Purpura (HSP) is the commonest vasculitis in children. To perform epidemiological analysis and to evaluate clinic features and results of follow up are important for the adequate management of patients. Objectives: To review epidemiologic characteristics of HSP in a series of patients attended in a referral hospital in Spain and to analyze clinical, laboratory results and evolution of patients. Methods: Data from the clinical records was collected and analyzed according to defined parameters. Results: 17 patients under 15 years of age were evaluated; it corresponds to 29 cases/year/100.000 IH <15 years. Mean age 6.12±4.9 years. The majority of cases presented in autumn and winter. Infectious antecedent or simultaneous infection with the onset was detected in 47% of cases mainly in upper respiratory tract. Clinical presentation was the classical triad of palpable cutaneous purpura, gastrointestinal and joints manifestations. Initial nephrologic manifestations were found in 53% of cases, predominantly hematuria and proteinuria, with normal glomerular filtration ratio. Beta hemolytic streptococcus was isolated in one third of cases. After ambulatory follow up of 11±7 months all patients have had uneventful recovery. Conclusions: this casuistic of PHS shows that the incidence in this geographic area is higher compared with the majority of international and national series and it is more frequent in autumn, which is different to the reported in other series. This suggests the probable presence of environmental, microbiologic or another features, no clearly known, which requires analysis from the public health point of view.

8.
Obes Facts ; 9(1): 41-51, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26901345

RESUMO

BACKGROUND: Severe postprandial hypoglycemia after bariatric surgery is a rare but invalidating complication. Our aim was to describe the different tests performed for its diagnosis and their outcomes as well as the response to the prescribed pharmacological and surgical treatments. METHODS: Multicenter, retrospective systematic review of cases with recurrent severe postprandial hypoglycemia. RESULTS: Over 11 years of follow-up, 22 patients were identified. The test most used to provoke hypoglycemia was the oral glucose load test followed by the mixed meal test which was the least standardized test. With pharmacological treatment, 3 patients were symptom-free (with octreotide) and in 12 patients hypoglycemic episodes were attenuated. Seven patients had persistent hypoglycemic episodes and underwent surgery. Partial pancreatectomy was performed in 3 patients who had positive selective arterial calcium stimulation, and nesidioblastosis was confirmed in 2 patients. Reconversion to normal anatomy was performed in 3 patients, and 1 patient underwent a resection of the 'candy cane' roux limb, with resolution of hypoglycemia in all cases. CONCLUSIONS: There is high heterogeneity in the evaluation and treatment options for postoperative hypoglycemia. In patients that do not respond to pharmacological treatment, reconstruction of gastrojejunal continuity may be the safest and most successful procedure.


Assuntos
Cirurgia Bariátrica/efeitos adversos , Hiperinsulinismo/etiologia , Hipoglicemia/etiologia , Adulto , Feminino , Teste de Tolerância a Glucose , Humanos , Hiperinsulinismo/sangue , Hipoglicemia/diagnóstico , Hipoglicemia/epidemiologia , Hipoglicemia/terapia , Incidência , Jejuno/cirurgia , Masculino , Pessoa de Meia-Idade , Nesidioblastose/complicações , Nesidioblastose/diagnóstico , Nesidioblastose/epidemiologia , Octreotida/uso terapêutico , Pancreatectomia , Sistema de Registros , Estudos Retrospectivos , Espanha/epidemiologia , Estômago/cirurgia
9.
Obes Surg ; 26(8): 1836-42, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-26661106

RESUMO

BACKGROUND: Specific data is needed to safely expand bariatric surgery and to preserve good surgical outcomes in response to the non-stop increase in obesity prevalence worldwide. OBJECTIVE: The aims of this study are to provide an overview of the baseline characteristics, type of surgery, and 30-day postoperative morbidity and mortality in patients undergoing bariatric surgery in Spanish public hospitals, and evaluate changes throughout the 2000-2014 period. MATERIAL AND METHODS: This is a descriptive study using data from the RICIBA, a computerized multicenter and multidisciplinary registry created by the Obesity Group of the Endocrinology and Nutrition Spanish Society. Three periods according to the date of surgery were created: January 2000 to December 2004 (G1), January 2005 to December 2009 (G2), and January 2010 to December 2014 (G3). RESULTS: Data from 3843 patients were available (44.8 ± 10.5 years, a 3:1 female-to-male ratio, 46.9 ± 8.2 kg/m(2)). Throughout the 15-year period assessed, candidate patients for bariatric surgery were progressively older and less obese, with an increase in associated comorbidities and in the prevalence of men. The global trend also showed a progressive decrease in Roux-en-Y gastric bypass, the most performed bariatric procedure (75.1 % in G1, 69.3 % in G2, and 42.6 % in G3; p < 0.001), associated with a parallel increase in sleeve gastrectomy (0.8 % in G1, 18.1 % in G2, and 39.6 % in G3; p < 0.001). An overall mortality rate of 0.3 % was reported. CONCLUSIONS: Data from Spain is similar to data observed worldwide. Information recorded in the National Registries like RICIBA is necessary in order to safely expand bariatric surgery in response to increasing demand.


Assuntos
Cirurgia Bariátrica/estatística & dados numéricos , Obesidade Mórbida/cirurgia , Cirurgia Bariátrica/métodos , Cirurgia Bariátrica/tendências , Comorbidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/mortalidade , Período Pós-Operatório , Prevalência , Sistema de Registros , Espanha/epidemiologia
10.
Rev Esp Enferm Dig ; 105(9): 529-36, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24467497

RESUMO

INTRODUCTION: intragastric balloons provide early satiety and thereby induce short-term weight loss. The aim of this study was to evaluate safety and short and medium-term effectiveness of gastric balloons associated to hypocaloric diet in obesity. MATERIAL AND METHODS: from May 2004 to June 2011 91 obese patients, body mass index (BMI) 45.2 +/- 7.2 kg/m2 were prospectively followed after endoscopic implantation of a gastric balloon associated to restricted diet. Successful therapy was defined as percent loss of total weight (%LTW) > or = 5 % at six months after balloon placement and 6 and 12 months after their withdrawal. All analyses followed intention-to treat principles considering significant p-values < 0.05. RESULTS: we placed 73 fluid-filled balloons (80.2 %) and 18 air-filled ones (19.8 %). Compared to baseline values, at 6-month 73.7 % subjects succeeded, showing significant reductions in weight (13.3 +/- 8.8 kg), BMI (5 +/- 3.4 kg/m2) (p < 0.0001), with % LTW 11 +/- 7 %. Six and twelve months after retrieval 45.1 % and 28.6 % patients reached % LTW > or = 5 %. Short-term and medium-term effectiveness was negatively associated to obesity in first-grade relatives (p = 0.003 and p = 0.04). Higher weight loss 6 months after balloon placement independently predicted medium-term effectiveness (p = 0.0001). Mortality was absent but there were two spontaneous deflations of air-filled balloons and severe withdrawal difficulties in 8 patients, leading to surgery in one case. Retrieval complications associated to air-filled balloons (p = 0.0005). CONCLUSIONS: in obesity, effectiveness of gastric balloons associated to hypocaloric diet decreases over time.Complications occurred mainly in the retrieval endoscopic procedure and related to air-filled balloons.


Assuntos
Dieta Redutora , Balão Gástrico , Obesidade/terapia , Adolescente , Adulto , Idoso , Estudos de Coortes , Dieta Redutora/efeitos adversos , Feminino , Balão Gástrico/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/dietoterapia , Estudos Prospectivos , Segurança , Resultado do Tratamento , Adulto Jovem
11.
Obes Surg ; 23(4): 509-14, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23090430

RESUMO

BACKGROUND: Obesity impairs quality of life, but the perception of the impairment could be different from one country to another. The purpose was to compare weight-related quality of life (QOL) between cohorts from Spain and North America. METHODS: A cross-sectional case-control study was performed between two populations. Four hundred Spanish and 400 North American obese subjects suitable for bariatric surgery closely matched for race, gender, age, and body mass index (BMI) were included. Two non-obese control groups matched for gender, age, and BMI from each population were also evaluated (n = 400 in each group). The participants completed the Impact of Weight on Quality of Life-Lite (IWQOL-Lite) questionnaire, a measure of weight-related QOL. RESULTS: Spanish morbidly obese patients showed poorer QOL than their North American counterparts in physical function, sexual life, work, and total score. By contrast, Spanish non-obese control subjects reported better QOL in all domains than their North American counterparts. Women, both in Spain and North America, reported reduced QOL compared to men on the domain of self-esteem. In addition, North American women reported reduced QOL on the sexual life domain compared to men. BMI correlated negatively with all domains of QOL except for self-esteem in both national groups. CONCLUSIONS: Spanish obese subjects suitable for bariatric surgery report poorer weight-related quality of life than their North American counterparts, and obese women, regardless of nationality, perceive a reduced quality of life compared to men.


Assuntos
Cirurgia Bariátrica , Índice de Massa Corporal , Obesidade Mórbida/psicologia , Qualidade de Vida , Autoimagem , Adulto , Cirurgia Bariátrica/psicologia , Estudos de Casos e Controles , Comparação Transcultural , Estudos Transversais , Emprego/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , América do Norte/epidemiologia , Obesidade Mórbida/epidemiologia , Obesidade Mórbida/cirurgia , Comportamento Sexual/psicologia , Espanha/epidemiologia , Inquéritos e Questionários
16.
Rev. Soc. Venez. Microbiol ; 30(1): 29-36, jun. 2010. ilus, tab
Artigo em Espanhol | LILACS-Express | ID: lil-631696

RESUMO

El objetivo de este trabajo fue caracterizar una muestra de suelo proveniente de un sistema de biorremediación en actividad y determinar la capacidad de la comunidad bacteriana de biodegradar petróleo y sus destilados, e identificar los principales microorganismos involucrados en el proceso. Para esto se tomó una muestra de suelo por la técnica de lanfarming y se caracterizaron sus propiedades físicas, químicas y microbiológicas; así como el tipo de hidrocarburos que contenía por extracción con Soxhlet y cromatografía en columna de sílica gel. A partir de la muestra se extrajo la comunidad bacteriana, y se determinó su potencial para biodegradar petróleo, sus diferentes fracciones y los destilados comerciales que se obtienen a partir de él. Se utilizaron métodos indirectos de medición del crecimiento bacteriano por conteo de microorganismos y medición de densidad óptica. A partir de estos sistemas se aislaron 41 cepas y se identificaron por FAME. Los principales resultados indicaron que la comunidad bacteriana del suelo posee la capacidad de biodegradar los hidrocarburos existentes en el mismo, principalmente la fracción alifática, así como los destilados gasoil, kerosén y aceite lubricante, siendo la fracción aromática, la polar y el destilado nafta no degradados. Está comunidad está constituida principalmente por Rhodococcus erythropolis, Achromobacter xylosoxidans y Brevundimonas diminuta, mostrando la mayor biodiversidad cuando los hidrocarburos utilizados como fuente de carbono pertenecen al grupo de los alifáticos. Las características físicas, químicas y microbiológicas del suelo indicaron que es factible que se realice una biorremediación eficiente de los hidrocarburos presentes.


The purpose of this study was to characterize a soil sample obtained from an active bioremediation system and determine the capacity of the bacterial community for biodegrading petroleum and its distilled products, and identify the main microorganisms involved in the process. For this object a soil sample was taken with the lanfarming technique and its physical chemical and microbiological characteristics were characterized, as well as the type of hydrocarbons it contained by Soxhlet extraction and silica gel column chromatography. From this sample we also extracted the bacterial community and determined its potential for degrading petroleum, its different fractions and the commercial distilled products obtained from it. We used indirect measurement methods for determining bacterial growth by counting the microorganisms and measuring optical densities. Through these methods we isolated 42 strains and identified them by FAME. The principal results indicated that the soil bacterial community has the capacity for degrading the hydrocarbons in it, mainly the aliphatic fraction as well as the distilled products such as gasoil, kerosene and lubricant oil, while the aromatic and polar fractions and the naphtha distilled product are non degradable. This community is mainly constituted by Rhodococcus erythropolis, Achromobacter xylosoxidans and Brevundimonas diminuta, showing the greatest diversity when the hydrocarbons used as carbon source belong to the aliphatic group. The physical, chemical and microbiological characteristics of the soil indicated that it is possible that an efficient bioremediation of the hydrocarbons present occurs.

17.
Obes Surg ; 20(12): 1642-6, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-20390374

RESUMO

The intragastric balloon is a temporary treatment for obese patients. Fluid-filled devices have shown efficacy and safety, and are widely used. Recently, although there are no comparative studies between them, an air-filled balloon, Heliosphere® bag, has been proposed. Prospective, double-blind study in 33 patients with morbid and type 2 obesity: 23 female, 43.9±10 years, 120.3±17 kg, and body mass index (BMI) of 44.2±5 kg/m2, placing 18 gastric balloons filled with 960 cm3 of air (Heliosphere® bag) or 15 balloons filled with 700 ml of saline (Bioenterics-BIB®). Both balloons were placed with conscious sedation and removed under general anesthesia 6 months later. Intravenous drugs were given to control symptoms for 48 h. Patients were sent home on a 1000-kcal diet, multivitamin supplements, and oral proton pump inhibitors, and were followed monthly. Complications, symptoms, weight, and quality of life evaluated by the Gastrointestinal Quality of Life Index (GIQLI) scale were recorded. At 6 months, mean weight loss (12.8±8 vs 14.1±8 kg), BMI loss (4.6±3 vs 5.5±3 kg/m2) and percent excess weight loss (27±16 vs.30.2±17) showed no significant differences between both groups. At removal, two Heliosphere® bags were not found in the stomach, and four patients required extraction of the balloon by rigid esophagoscopy or surgery (p=0.02). Tolerance was good in both groups, but early removal occurred in three BIB® (20%) due to vomits and dehydration. The GIQLI total scores remained unchanged. Both balloons achieve a significant weight loss with good tolerance in obese patients. Nevertheless, Heliosphere® bag has severe technical problems that need to be solved before recommending it.


Assuntos
Balão Gástrico , Obesidade Mórbida/terapia , Perda de Peso , Adulto , Índice de Massa Corporal , Método Duplo-Cego , Feminino , Seguimentos , Balão Gástrico/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Segurança , Resultado do Tratamento
18.
J Clin Endocrinol Metab ; 92(6): 2370-3, 2007 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17405843

RESUMO

CONTEXT: Several endocrine disorders that share resistance to PTH are grouped under the term pseudohypoparathyroidism (PHP). PHP type I, associated with blunted PTH-induced nephrogenous cAMP formation and phosphate excretion, is subdivided according to the presence or absence of additional endocrine abnormalities, Albright's hereditary osteodystrophy (AHO), and reduced Gsalpha activity caused by GNAS mutations. OBJECTIVE: We sought to identify the molecular defect in four unrelated patients who were thought to have PHP-Ia because of PTH and TSH resistance and mild AHO features. METHODS: Gsalpha activity and mutation analysis, and assessment of GNAS haplotype, methylation, and gene expression were performed for probands and family members. RESULTS: Two patients showed modest decreases in erythrocyte Gsalpha activity. Instead of Gsalpha point mutations, however, all four patients showed methylation defects of the GNAS locus, a feature previously described only for PHP-Ib. Furthermore, one patient with an isolated loss of GNAS exon A/B methylation had the 3-kb STX16 deletion frequently identified in PHP-Ib patients. In all but one of the remaining patients, haplotype analysis excluded large deletions or uniparental disomy as the cause of the observed methylation changes. CONCLUSIONS: Our investigations indicate that an overlap may exist between molecular and clinical features of PHP-Ia and PHP-Ib. No current mechanisms can explain the AHO-like features of our patients, some of which may not be linked to GNAS. Therefore, patients with hormone resistance and AHO-like features in whom coding Gsalpha mutations have been excluded should be evaluated for epigenetic alterations within GNAS.


Assuntos
Displasia Fibrosa Poliostótica/diagnóstico por imagem , Displasia Fibrosa Poliostótica/genética , Subunidades alfa Gs de Proteínas de Ligação ao GTP/genética , Pseudo-Hipoparatireoidismo/diagnóstico por imagem , Pseudo-Hipoparatireoidismo/genética , Adulto , Cromograninas , Epigênese Genética/fisiologia , Feminino , Displasia Fibrosa Poliostótica/fisiopatologia , Subunidades alfa Gs de Proteínas de Ligação ao GTP/metabolismo , Humanos , Lactente , Ossos Metacarpais/diagnóstico por imagem , Fenótipo , Pseudo-Hipoparatireoidismo/fisiopatologia , Radiografia , Índice de Gravidade de Doença
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