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1.
Cancer Control ; 26(1): 1073274819865281, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31331197

RESUMO

The aim of the study was to evaluate the usefulness of computed tomography (CT) and magnetic resonance imaging (MRI) for differentiating thymoma from nonthymoma abnormalities in patients with myasthenia gravis (MG). A cross-sectional study of 53 patients with MG, who had undergone surgical thymectomy, was conducted at 103 Hospital (Hanoi, Vietnam) and Cho Ray Hospital (Ho Chi Minh City, Vietnam) during August 2014 and January 2017. The CT and MRI images of patients with MG were qualitatively and quantitatively (radiodensity and chemical shift ratio [CSR]) analyzed to determine and compare their ability to distinguish thymoma from nonthymoma abnormalities. Logistic regression was used to identify the association between imaging parameters (eg, CSR) and the thymoma status. The receiver operating curve (ROC) analysis was used to determine the differentiating ability of CSR and radiodensity. As results, of the 53 patients with MG, 33 were with thymoma and 20 were with nonthymoma abnormalities. At qualitative assessment, MRI had significantly higher accuracy than did CT in differentiating thymoma from nonthymoma abnormalities (94.3% vs 83%). At quantitative assessment, both the radiodensity and CSR were significantly higher for thymoma compared with nonthymoma groups (P < .001). The ROC analysis showed that CSR had significantly higher sensitivity (Se) and specificity (Sp) than radiodensity in discriminating between the 2 groups (CSR: Se 100%, Sp 95% vs radiodensity: Se 90.9%, Sp 70%). When combining both qualitative and quantitative parameters, MRI had even higher accuracy than did CT in thymoma diagnosis (P = .031). In conclusion, chemical shift MRI was more accurate than CT for differentiating thymoma from nonthymoma in patients with MG.


Assuntos
Miastenia Gravis/etiologia , Timoma/diagnóstico , Timo/diagnóstico por imagem , Neoplasias do Timo/diagnóstico , Adulto , Estudos Transversais , Diagnóstico Diferencial , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Curva ROC , Timectomia , Timoma/complicações , Timoma/cirurgia , Timo/cirurgia , Neoplasias do Timo/complicações , Neoplasias do Timo/cirurgia , Tomografia Computadorizada por Raios X , Adulto Jovem
2.
Nat Commun ; 10(1): 2244, 2019 05 21.
Artigo em Inglês | MEDLINE | ID: mdl-31113942

RESUMO

Before they are used in the clinical setting, the effectiveness of artificially produced human-derived tissue-engineered medical products should be verified in an immunodeficient animal model, such as severe combined immunodeficient mice. However, small animal models are not sufficient to evaluate large-sized products for human use. Thus, an immunodeficient large animal model is necessary in order to properly evaluate the clinical efficacy of human-derived tissue-engineered products, such as artificial grafts. Here we report the development of an immunodeficient pig model, the operational immunodeficient pig (OIDP), by surgically removing the thymus and spleen, and creating a controlled immunosuppressive protocol using a combination of drugs commonly used in the clinical setting. We find that this model allows the long-term accommodation of artificial human vascular grafts. The development of the OIDP is an essential step towards a comprehensive and clinically relevant evaluation of human cell regeneration strategies at the preclinical stage.


Assuntos
Órgãos Bioartificiais , Prótese Vascular , Hospedeiro Imunocomprometido , Modelos Animais , Engenharia Tecidual , Animais , Implante de Prótese Vascular/métodos , Linhagem Celular , Fibroblastos , Humanos , Masculino , Impressão Tridimensional , Baço/imunologia , Baço/cirurgia , Suínos , Porco Miniatura/imunologia , Porco Miniatura/cirurgia , Timo/imunologia , Timo/cirurgia , Fatores de Tempo
3.
Thorac Surg Clin ; 29(2): 159-164, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30927997

RESUMO

The effectiveness of thymectomy for nonthymomatous myasthenia gravis is analyzed with regard to extensiveness of removal of the adipose tissue of the mediastinum and the lower neck region with various techniques of thymectomy. The approach necessary to achieve maximal radicality must include access to both pleural cavity and the lower neck area up to the thyroid gland. Surgical techniques include extended transsternal approach, which might be combined with separate transcervical incision, bilateral videothoracoscopic (VATS) approach combined with transcervical incision, and extended subxiphoid approach, either uniportal or combined with bilateral VATS. Anatomic aspects of maximally extensive thymectomy are described in detail.


Assuntos
Miastenia Gravis/cirurgia , Timectomia , Tecido Adiposo/cirurgia , Humanos , Cirurgia Torácica Vídeoassistida , Timectomia/métodos , Timo/anatomia & histologia , Timo/cirurgia
4.
Allergol. immunopatol ; 47(2): 141-151, mar.-abr. 2019. tab
Artigo em Inglês | IBECS | ID: ibc-180802

RESUMO

Background: The del22q11 syndrome patients present immunological abnormalities associated to thymus alterations. Up to 75% of them present cardiopathies and thymus is frequently removed during surgery. The thymectomy per se has a deleterious effect concerning lymphocyte subpopulations, and T cell function. When compared to healthy controls, these patients have higher infections propensity of variable severity. The factors behind these variations are unknown. We compared immunological profiles of del22q11.2 Syndrome patients with and without thymectomy to establish its effect in the immune profile. Methods: Forty-six del22q11.2 syndrome patients from 1 to 16 years old, 19 of them with partial or total thymectomy were included. Heart disease type, heart surgery, infections events and thymus resection were identified. Immunoglobulin levels, flow cytometry for lymphocytes subpopulations and TREC levels were determined, and statistical analyses were performed. Results: The thymectomy group had a lower lymphocyte index, both regarding total cell count and when comparing age-adjusted Z scores. Also, CD3+, CD4+ and CD8+ lower levels were observed in this group, the lowest count in those patients who had undergone thymus resection during the first year of life. Their TREC level median was 23.6/μL vs 16.1 miL in the non-thymus group (p = 0.22). No differences were identified regarding immunoglobulin levels or infection events frequencies over the previous year. Conclusion: Patients with del22q11.2 syndrome subjected to thymus resection present lower lymphocyte and TREC indexes when compared to patients without thymectomy. This situation may be influenced by the age at the surgery and the time elapsed since the procedure


No disponible


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Linfócitos T/fisiologia , Subpopulações de Linfócitos T/fisiologia , Timectomia/métodos , Timo/cirurgia , Cromossomos Humanos Par 22/imunologia , Deleção Cromossômica , Citometria de Fluxo , Receptores de Antígenos de Linfócitos T/genética
5.
Int J Surg ; 65: 1-6, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30818068

RESUMO

BACKGROUND: The clinical value of thymus preservation during thyroid carcinoma surgery remains unclear. The aim of this study is to explore the role of bilateral thymus preservation in parathyroid glands (PGs) function and surgical completeness in total thyroidectomy (TT) with bilateral central lymph node dissection (CLND). MATERIALS AND METHODS: Fifty-four consecutive patients who underwent TT and bilateral CLND were assigned to the thymus preservation (TP) group (n = 27) and the bilateral thymectomy (BT) group (n = 27). Surgical completeness was evaluated by the number of lymph nodes dissected, serum Tg level and ultrasound findings postoperatively. RESULTS: Incidental parathyroidectomy was more common in the BT group (29.6% vs 7.4%, p = 0.038). Patients in the BT group had higher risks of neuromuscular symptoms (63.0% vs 29.6%, P = 0.014) and transient hypoparathyroidism (70.4% vs 25.9%, P = 0.001). The incidence of persistent hypoparathyroidism failed to show a significant difference between the TP and BT groups (0 vs 14.8%, P = 0.111). However, those with transient hypoparathyroidism in the BT group had a lower level of serum PTH at 3 weeks postoperatively (p = 0.001). There was no significant difference in the number of lymph nodes dissected (5.89 ±â€¯3.12 vs 8.56 ±â€¯6.93, P = 0.077) and preablation sTg level (1.82 ±â€¯2.18 vs 1.42 ±â€¯1.56 ng/ml, P = 0.775) between the TP and BT groups. No metastatic lymph nodes were found on sonography at 3 months postoperatively in both groups. CONCLUSION: Thymus preservation had benefits on protecting PGs and promoting rapid clinical resolution of hypoparathyroidism. It had no effects on oncologic completeness of TT with bilateral CLND.


Assuntos
Excisão de Linfonodo , Glândulas Paratireoides/fisiopatologia , Timo/cirurgia , Câncer Papilífero da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Adulto , Feminino , Humanos , Hipoparatireoidismo/etiologia , Excisão de Linfonodo/efeitos adversos , Masculino , Pessoa de Meia-Idade , Timo/fisiopatologia , Câncer Papilífero da Tireoide/fisiopatologia , Neoplasias da Glândula Tireoide/fisiopatologia
6.
Oncol Rep ; 41(5): 2762-2774, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30816514

RESUMO

The aim of the present study was to examine the whole­genome DNA methylation status of thymomas and identify differences in thymoma DNA methylation profiles. DNA methylation profiles of tissues (n=12) were studied using the Infinium MethylationEPIC BeadChip microarray (850K) and analyzed in relation to gene expression data. Functional annotation analysis of DNA methylation between the different groups was performed using the online tool GeneCodis3. In order to assess the diagnostic value of candidate DNA methylation markers, receiver operation characteristic (ROC) analysis was performed using the pROC package. A total of 10,014 CpGs were found to be differentially methylated (Δß>0.2) between two thymoma types (type A and B). Combination analysis showed that 36 genes had differentially methylated CpG sites in their promoter region. 'Pathways in cancer', 'focal adhesion' and 'regulation of actin cytoskeleton' were the most enriched KEGG pathways of differentially methylated genes between tumor and controls. Among the 29 genes that were hypomethylated with a high expression, zinc finger protein 396 and Fraser extracellular matrix complex subunit 1 had the largest area under the curve. The present results may provide useful insights into the tumorigenesis of thymomas and a strong basis for future research on the molecular subtyping of epigenetic regulation in thymomas.


Assuntos
Metilação de DNA/genética , Epigênese Genética , Regulação Neoplásica da Expressão Gênica , Timoma/genética , Neoplasias do Timo/genética , Adulto , Idoso de 80 Anos ou mais , Carcinogênese/genética , Ilhas de CpG/genética , Feminino , Genoma Humano/genética , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Sequência com Séries de Oligonucleotídeos , Regiões Promotoras Genéticas/genética , Timectomia , Timoma/patologia , Timoma/cirurgia , Timo/patologia , Timo/cirurgia , Neoplasias do Timo/patologia , Neoplasias do Timo/cirurgia
7.
Allergol Immunopathol (Madr) ; 47(2): 141-151, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30292446

RESUMO

BACKGROUND: The del22q11 syndrome patients present immunological abnormalities associated to thymus alterations. Up to 75% of them present cardiopathies and thymus is frequently removed during surgery. The thymectomy per se has a deleterious effect concerning lymphocyte subpopulations, and T cell function. When compared to healthy controls, these patients have higher infections propensity of variable severity. The factors behind these variations are unknown. We compared immunological profiles of del22q11.2 Syndrome patients with and without thymectomy to establish its effect in the immune profile. METHODS: Forty-six del22q11.2 syndrome patients from 1 to 16 years old, 19 of them with partial or total thymectomy were included. Heart disease type, heart surgery, infections events and thymus resection were identified. Immunoglobulin levels, flow cytometry for lymphocytes subpopulations and TREC levels were determined, and statistical analyses were performed. RESULTS: The thymectomy group had a lower lymphocyte index, both regarding total cell count and when comparing age-adjusted Z scores. Also, CD3+, CD4+ and CD8+ lower levels were observed in this group, the lowest count in those patients who had undergone thymus resection during the first year of life. Their TREC level median was 23.6/µL vs 16.1µL in the non-thymus group (p=0.22). No differences were identified regarding immunoglobulin levels or infection events frequencies over the previous year. CONCLUSION: Patients with del22q11.2 syndrome subjected to thymus resection present lower lymphocyte and TREC indexes when compared to patients without thymectomy. This situation may be influenced by the age at the surgery and the time elapsed since the procedure.


Assuntos
Subpopulações de Linfócitos T/fisiologia , Linfócitos T/fisiologia , Timectomia , Timo/cirurgia , Adolescente , Criança , Pré-Escolar , Deleção Cromossômica , Cromossomos Humanos Par 22/imunologia , Feminino , Citometria de Fluxo , Humanos , Lactente , Contagem de Linfócitos , Masculino , Receptores de Antígenos de Linfócitos T/genética
8.
Neurol Res ; 41(3): 275-281, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30574849

RESUMO

OBJECTIVE: To evaluate transcervical and transsternal thymectomy benefits in large myasthenia gravis (MG) cohort. METHOD: We retrospectively evaluated MG patients (n = 184) who had undergone thymectomy between 2004 and 2015 at National Institute of Mental Health and Neurosciences, Bangalore (India). Myasthenia gravis foundation of America guidelines were followed to assess clinical outcome. Anti-acetylcholine receptors (AChR) antibodies, repetitive nerve stimulation (RNS) and Neostigmine tests were performed at pre and post-thymectomy stage. RESULTS: Most of the patients were fell under MG grade IIA (82 of 184, 44.56%) and grade IIB (61 of 184, 33.15%). Thymoma and thymic hyperplasia was established in 64 (34.78%) and 89 (48.37%) patients respectively. Other thymic abnormalities such thymic atrophy, cysts and lipoma were established in 31 (16.85%) patients. MG patients were treated either with transcervical (n = 79) or (n = 105) transsternal thymectomy. At the pre-thymectomy stage, the majority of the patients were positive for anti-AChR antibodies (179 of 184, 97.28%), RNS (170 of 184, 92.4%), and Neostigmine (175 of 184, 95.11%). At the post-thymectomy stage, a significant reduction observed in anti-AChR antibodies positivity (p < 0.022) and RNS positivity (p < 0.015). Overall, benefits were observed in 61.41% (113 of 184) of patients. Clinical benefits (complete stable remission, pharmacological remission, minimal manifestation, and improvement) of transcervical and transsternal thymectomy observed in 69.62% (55 of 79) and 55.24% (58 of 105) of patients respectively. MG patients with thymoma showed the least improvement compared to thymic hyperplasia. DISCUSSION: Transcervical and transsternal thymectomy showed clinical benefits, however, there was no significant difference between them.


Assuntos
Miastenia Gravis/cirurgia , Timectomia , Adulto , Autoanticorpos/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Miastenia Gravis/imunologia , Miastenia Gravis/patologia , Receptores Nicotínicos/imunologia , Estudos Retrospectivos , Timectomia/métodos , Timo/patologia , Timo/cirurgia , Resultado do Tratamento
11.
Medicine (Baltimore) ; 97(38): e12499, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30235757

RESUMO

INTRODUCTION: While thymectomy is a recommended therapy for patients with Myasthenia Gravis (MG), there is insufficient evidence of its benefits over other therapies in patients in China, specifically, or of the most optimal timing for the procedure. Thus, there remains a clinical need for the investigation of these questions. Therefore, it is important to compare the clinical efficacy of thymectomy plus oral prednisone, an immunosuppressant protocol with prednisone, or immunosuppressants alone. CONCLUSION: We propose here to prospectively assess 822 cases of MG and 1886 medical records from individuals hospitalized at the First Affiliated Hospital of Guangzhou University of Chinese Medicine and follow them for 3 years. Inclusion criteria will include the following: a Myasthenia Gravis Foundation of America (MGFA) clinical classification between I and IV while on optimal anticholinesterase therapy with or without oral prednisone or immunosuppressive therapy, an MG history of longer than 3 years, being 18 to 60 years of age, and positive testing for serum acetylcholine receptor antibodies (AchR-Ab). Both thymomatous-naïve and non-naïve participants will be included. The primary outcomes will be: mortality, frequency of myasthenic crises, MGFA classification, and changes to the required dose of prednisone and immunosuppressants. Based on these outcomes, we will evaluate the efficacy of thymectomy as well as oral drugs in managing patients with nonthymomatous MG. As of September 2017, this study has been approved by the ethics committee of the First Affiliated Hospital of Guangzhou University of Chinese Medicine and the Registration number is ChiCTR1800017564(Version1.0, September 8,2017).


Assuntos
Miastenia Gravis/cirurgia , Timectomia/métodos , Adolescente , Adulto , China , Protocolos Clínicos , Terapia Combinada , Feminino , Humanos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Miastenia Gravis/patologia , Prednisona/uso terapêutico , Estudos Prospectivos , Timo/patologia , Timo/cirurgia , Tempo , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
12.
Acta Oncol ; 57(12): 1713-1720, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30264630

RESUMO

BACKGROUND: The purpose of this study was to compare dosimetric differences related to target volume and organs-at-risk (OAR) using 3D-conformal radiotherapy (3DCRT), volumetric modulated arc therapy (VMAT), TomoTherapy (Tomo), proton radiotherapy (PRT), and carbon ion radiotherapy (CIRT) as part of postoperative thymoma irradiation. MATERIAL AND METHODS: This single-institutional analysis included 10 consecutive patients treated with adjuvant radiotherapy between December 2013 and September 2016. CT-datasets and respective RT-structures were anonymized and plans for all investigated RT modalities (3DCRT, VMAT, Tomo, PRT, CIRT) were optimized for a total dose of 50 Gy in 25 fractions. Comparisons between target volume and OAR dosimetric parameters were performed using the Wilcoxon rank-sum test. RESULTS: The best target volume coverage (mean PTV V95% for all patients) was observed for Tomo (97.9%), PRT (97.6%), and CIRT (96.6%) followed by VMAT (85.4%) and 3DCRT (74.7%). PRT and CIRT both significantly reduced mean doses to the lungs, breasts, heart, and esophagus, as well as the spinal cord maximum dose compared with photon modalities. Among photon-based techniques, VMAT showed improved OAR sparing over 3DCRT. Tomo was associated with considerable low-dose exposure to the lungs, breasts, and heart. CONCLUSIONS: Particle radiotherapy (PRT, CIRT) showed superior OAR sparing and optimal target volume coverage. The observed dosimetric advantages are expected to reduce toxicity rates. However, their clinical impact must be investigated prospectively.


Assuntos
Tratamentos com Preservação do Órgão/métodos , Órgãos em Risco/efeitos da radiação , Fótons/efeitos adversos , Terapia com Prótons/efeitos adversos , Timoma/terapia , Neoplasias do Timo/terapia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tratamentos com Preservação do Órgão/efeitos adversos , Fótons/uso terapêutico , Período Pós-Operatório , Terapia com Prótons/métodos , Lesões por Radiação/prevenção & controle , Radiometria , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia Adjuvante/efeitos adversos , Radioterapia Adjuvante/métodos , Radioterapia Conformacional/efeitos adversos , Radioterapia Conformacional/métodos , Radioterapia de Intensidade Modulada/efeitos adversos , Radioterapia de Intensidade Modulada/métodos , Timectomia , Timo/patologia , Timo/cirurgia , Neoplasias do Timo/patologia , Adulto Jovem
13.
Arterioscler Thromb Vasc Biol ; 38(7): 1519-1527, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29853568

RESUMO

OBJECTIVE: Androgen deprivation therapy has been associated with increased cardiovascular risk in men. Experimental studies support that testosterone protects against atherosclerosis, but the target cell remains unclear. T cells are important modulators of atherosclerosis, and deficiency of testosterone or its receptor, the AR (androgen receptor), induces a prominent increase in thymus size. Here, we tested the hypothesis that atherosclerosis induced by testosterone deficiency in male mice is T-cell dependent. Further, given the important role of the thymic epithelium for T-cell homeostasis and development, we hypothesized that depletion of the AR in thymic epithelial cells will result in increased atherosclerosis. APPROACH AND RESULTS: Prepubertal castration of male atherosclerosis-prone apoE-/- mice increased atherosclerotic lesion area. Depletion of T cells using an anti-CD3 antibody abolished castration-induced atherogenesis, demonstrating a role of T cells. Male mice with depletion of the AR specifically in epithelial cells (E-ARKO [epithelial cell-specific AR knockout] mice) showed increased thymus weight, comparable with that of castrated mice. E-ARKO mice on an apoE-/- background displayed significantly increased atherosclerosis and increased infiltration of T cells in the vascular adventitia, supporting a T-cell-driven mechanism. Consistent with a role of the thymus, E-ARKO apoE-/- males subjected to prepubertal thymectomy showed no atherosclerosis phenotype. CONCLUSIONS: We show that atherogenesis induced by testosterone/AR deficiency is thymus- and T-cell dependent in male mice and that the thymic epithelial cell is a likely target cell for the antiatherogenic actions of testosterone. These insights may pave the way for new therapeutic strategies for safer endocrine treatment of prostate cancer.


Assuntos
Aorta/metabolismo , Doenças da Aorta/prevenção & controle , Aterosclerose/prevenção & controle , Células Epiteliais/metabolismo , Linfócitos T/metabolismo , Testosterona/metabolismo , Timo/metabolismo , Animais , Aorta/patologia , Doenças da Aorta/genética , Doenças da Aorta/metabolismo , Doenças da Aorta/patologia , Aterosclerose/genética , Aterosclerose/metabolismo , Aterosclerose/patologia , Modelos Animais de Doenças , Células Epiteliais/patologia , Masculino , Camundongos Endogâmicos C57BL , Camundongos Knockout para ApoE , Orquiectomia , Receptores Androgênicos/deficiência , Receptores Androgênicos/genética , Testosterona/deficiência , Timectomia , Timo/patologia , Timo/cirurgia
14.
Geroscience ; 40(3): 279-291, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29804201

RESUMO

Calorie restriction (CR) without malnutrition increases life span and health span in multiple model organisms. In non-human and human primates, CR causes changes that protect against several age-related pathologies, reduces inflammation, and preserves or improves cell-mediated immunity. However, CR has also been shown to exhibit adverse effects on certain organs and systems, including the immune system, and to impact genetically different organisms of the same species differentially. Alternately, short periods of fasting followed by refeeding may result in the proliferation of bone marrow stem cells, suggesting a potential rejuvenation effect that could impact the hematopoietic compartment. However, the global consequences of CR followed by refeeding on the immune system have not been carefully investigated. Here, we show that individuals practicing long-term CR with adequate nutrition have markedly lower circulating levels of total leukocytes, neutrophils, lymphocytes, and monocytes. In 10-month-old mice, short-term CR lowered lymphocyte cellularity in multiple lymphoid tissues, but not in bone marrow, which appears to be a site of influx, or a "safe haven" for B, NK, and T cells during CR. Cellular loss and redistribution was reversed within the first week of refeeding. Based on BrdU incorporation and Ki67 expression assays, repopulating T cells exhibited high proliferation in the refeeding group following CR. Finally, we demonstrated that the thymus was not essential for T cell repopulation following refeeding. These findings are of potential relevance to strategies to rejuvenate the immune system in mammals and warrant further investigation.


Assuntos
Restrição Calórica , Movimento Celular/fisiologia , Tecido Linfoide/patologia , Linfopenia/prevenção & controle , Linfócitos T/fisiologia , Adulto , Animais , Atrofia/prevenção & controle , Feminino , Humanos , Contagem de Leucócitos , Linfopenia/sangue , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Modelos Animais , Timo/patologia , Timo/cirurgia , Perda de Peso
15.
Khirurgiia (Mosk) ; (3. Vyp. 2): 15-21, 2018.
Artigo em Russo | MEDLINE | ID: mdl-29652317

RESUMO

AIM: To present possibility and technical aspects of anesthetic management during video-assisted thoracoscopic thymectomy in patients with myasthenia gravis. MATERIAL AND METHODS: The article describes the proposed modified anesthetic method that is suitable for video-assisted thoracoscopic thymectomy in patients with myasthenia gravis. Nine patients with myasthenia underwent VATS-thymectomy. Anesthesia was performed with artificial airway and auxiliary ventilation without muscle relaxants administration.


Assuntos
Miastenia Gravis/cirurgia , Cirurgia Torácica Vídeoassistida , Timectomia/instrumentação , Humanos , Timectomia/métodos , Timo/cirurgia , Resultado do Tratamento
16.
Ann Diagn Pathol ; 34: 135-141, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29661720

RESUMO

BACKGROUND AND AIMS: Programmed death ligand 1 (PD-L1), an immune check point inhibitor, is known to be expressed in several malignancies and is being considered as a prognostic factor and a potential immunotherapeutic target. The aim of this study was to characterize PD-L1 expression in thymomas and to determine correlation with clinicopathological features and previously published studies in the literature. METHODS: Tissue microarrays were prepared from selected blocks of thymomas and immunohistochemistry (IHC) for PD-L1 was performed. Cases were considered as PD-L1 positive or negative depending on whether the percentage of stained thymic epithelial cells were <25 or >25%. Results were compared clinically and with previously published studies using Google and Pubmed search engines. RESULTS: Of 84 cases of thymoma, 69 (82.1%) revealed PD-L1 positivity in >25% cells. 94.23% of type B thymoma subtypes (B1/B2/B3) were PD-L1 positive (P < 0.001). There was no correlation of PD-L1 with age, gender, myasthenia gravis, the tumor size or stage of disease. Nine studies were available in the literature; most of which showed PD-L1 expression in higher stage and B subtype however percentage positivity varied from 53.7% to over 90%. CONCLUSIONS: PD-L1 expression is frequent in type B (B1/B2/B3) thymomas. It can be easily evaluated by IHC even on small biopsies in unresectable cases, thereby enabling improved clinical evaluation as well as prognostic stratification of patients. It will serve as a potential indicator for benefit from anti-PD-L1 antibody immunotherapy in thymomas.


Assuntos
Antígeno B7-H1/metabolismo , Timoma/metabolismo , Neoplasias do Timo/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Imuno-Histoquímica , Imunoterapia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Timoma/diagnóstico , Timoma/patologia , Timoma/terapia , Timo/patologia , Timo/cirurgia , Neoplasias do Timo/diagnóstico , Neoplasias do Timo/terapia , Adulto Jovem
17.
Eur J Cardiothorac Surg ; 54(3): 579-584, 2018 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-29547970

RESUMO

OBJECTIVES: Minimally invasive techniques seem to be promising alternatives to open approaches in the surgical treatment of early-stage thymoma, although there are controversies because of lack of data on long-term results. The aim of the study was to evaluate the surgical and oncological results after robotic thymectomy for early-stage thymoma compared to median sternotomy. METHODS: Between 1982 and 2017, 164 patients with early-stage thymoma (Masaoka I and II) were operated on by median sternotomy (108 patients) or the robotic approach (56 patients). Duration of surgery, amount of blood loss, complications, duration of chest drainage, postoperative hospital stay, oncological results and total costs were retrospectively evaluated. Data were analysed also after propensity score matching. RESULTS: Compared to the trans-sternal group, robotic thymectomy had significantly longer average operative times (P < 0.001) but less intraoperative blood loss (P = 0.01), less perioperative complications (P = 0.03), shorter time to chest drainage removal and hospital discharge (P < 0.001). The median expense for the trans-sternal approach was significantly higher than the cost of the robotic procedure (P < 0.001), mainly due to longer hospitalization. From an oncological point of view, there were no differences in thymoma recurrence, although follow-up of the trans-sternal group was significantly longer (P < 0.001). Data were confirmed after propensity score matching. CONCLUSIONS: Robotic thymectomy for early-stage thymoma is a technically safe and feasible procedure with low complication rate and shorter hospital stay compared to the trans-sternal approach. Cost analysis revealed lower expenses for the robotic procedure due to the reduced hospital stay. The oncological outcomes seemed comparable, but longer follow-up is needed.


Assuntos
Procedimentos Cirúrgicos Robóticos , Esternotomia , Timectomia , Timoma/cirurgia , Timo/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Esternotomia/efeitos adversos , Esternotomia/métodos , Esternotomia/estatística & dados numéricos , Esterno/cirurgia , Timectomia/efeitos adversos , Timectomia/métodos , Timectomia/estatística & dados numéricos
18.
Lung Cancer ; 118: 161-170, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29571996

RESUMO

Until recently, the surgical approach to thymic tumors has remained basically unchanged. The collaborative effort led by ITMIG with the collaboration of regional and society-based interest groups (ESTS, JART) produced an enthusiastic surge of interest in testing the new technological advances in thoracic surgery and many historical dogmas in thymic surgery have been questioned and challenged. The present review addresses the new trends in the optimal surgical management of thymic tumors based on the review of the current literature. 1. Minimally-invasive techniques (MIT) including video-assisted thoracic surgery (VATS) and robotic-assisted thoracic Surgery (RATS) are now to be considered the standard of care in early-stage thymic tumors. MIT are no inferior to open approaches in terms of postoperative complications, loco-regional recurrence rates and survival. MIT are associated with a shorter length of stay, reduced intraoperative blood loss and better cosmetic results. 2. The adoption of the ITMIG/IASLC TNM staging system for thymic tumors requires a paradigm shift among thoracic surgeons to include regional lymphadenectomy according to the IASLC/ITMIG nodal map in the surgical management of thymic tumors. 3. A limited thymectomy instead of total thymectomy along with the removal of the thymic tumor in nonmyasthenic Stage I-II tumors has been proposed by some authors, although the results are not uniform. Until more mature data is available, adherence to the current guidelines recommending total thymectomy in addition to thymomectomy is always indicated. 4. In locally-advanced Stage IVa patients with pleural involvement, major pleural resections, including pleurectomy/decortication or extrapleural pneumonectomy are indicated, provided a complete resection of the pleural deposits is anticipated, usually in a multidisciplinary setting, with excellent long-term results. The incorporation of these new concepts and techniques in the surgical armamentarium of the thoracic surgeons dealing with thymic malignancies will certainly be of help in the optimal management of these patients.


Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos , Cirurgia Torácica Vídeoassistida , Timectomia , Timo/cirurgia , Neoplasias do Timo/cirurgia , Humanos , Excisão de Linfonodo , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Complicações Pós-Operatórias , Timo/patologia
19.
Interact Cardiovasc Thorac Surg ; 27(2): 290-294, 2018 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-29554262

RESUMO

OBJECTIVES: To evaluate the predictive value of the intraoperative thymofatty specimen weight (TFSW) index on predicting the prognosis of extended thymectomy (ET) for non-thymomatous myasthenia gravis. METHODS: This is a prospective non-interventional study in which patients who underwent ET between January 2012 and June 2015 were enrolled. Resected thymus and surrounding adipose tissues were weighed using an electronic scale intraoperatively and adjusted to the body surface area (BSA) to calculate the TFSW index. The primary end point was defined as complete stable remission (CSR) according to the Myasthenia Gravis Foundation of America (MGFA) guidelines. RESULTS: One hundred and eighteen patients who completed postoperative follow-up were included in this study. After a mean follow-up period of 44 months, 68 (57.6%) patients reached clinical CSR. The MGFA class, histopathology and TFSW index were associated with a postoperative CSR in univariate analysis. When the Cox hazard multiple regression model was used, the TFSW index was found to be an independent predictor for CSR (hazard ratio 2.056; 95% confidence interval 1.182-3.576). Based on ROC analysis, an optimal TFSW index cut-off value (35.9 g/m2) with the highest sensitivity and specificity was determined. CONCLUSIONS: The TFSW index is an important independent predictor for mid-term CSR after ET in non-thymomatous myasthenia gravis patients. During the ET surgery, every effort should be made to take a tissue specimen with a TFSW index more than 35.9 g/m2.


Assuntos
Miastenia Gravis/cirurgia , Timectomia/métodos , Timo/patologia , Adulto , Feminino , Humanos , Masculino , Tamanho do Órgão , Período Pós-Operatório , Valor Preditivo dos Testes , Estudos Prospectivos , Timo/cirurgia , Resultado do Tratamento
20.
J Perioper Pract ; 28(1-2): 33-34, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29376777
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