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1.
Bone Joint J ; 101-B(9): 1151-1159, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31474143

RESUMO

AIMS: We analyzed the long-term outcomes of patients observed over ten years after resection en bloc and reconstruction with extracorporeal irradiated autografts. PATIENTS AND METHODS: This retrospective study included 27 patients who underwent resection en bloc and reimplantation of an extracorporeal irradiated autograft. The mean patient age and follow-up period were 31.7 years (9 to 59) and 16.6 years (10.3 to 24.3), respectively. The most common diagnosis was osteosarcoma (n = 10), followed by chondrosarcoma (n = 6). The femur (n = 13) was the most frequently involved site, followed by the tibia (n = 7). There were inlay grafts in five patients, intercalary grafts in 15 patients, and osteoarticular grafts in seven patients. Functional outcome was evaluated with the Musculoskeletal Tumor Society (MSTS) scoring system. RESULTS: There were no recurrences in the irradiated autograft and the autograft survived in 24 patients (88.9%). Major complications included nonunion (n = 9), subchondral bone collapse (n = 4), and deep infection (n = 4). Although 34 revision procedures were performed, 25 (73.5%) and four (11.8%) of these were performed less than five years and ten years after the initial surgery, respectively. The mean MSTS score at the last follow-up was 84.3% (33% to 100%). CONCLUSION: Considering long-term outcomes, extracorporeal irradiated autograft is an effective method of reconstruction for malignant musculoskeletal tumours Cite this article: Bone Joint J 2019;101-B:1151-1159.


Assuntos
Neoplasias Ósseas/radioterapia , Neoplasias Ósseas/cirurgia , Osso e Ossos/cirurgia , Salvamento de Membro/métodos , Reimplante , Transplante Autólogo/métodos , Adolescente , Adulto , Autoenxertos/efeitos da radiação , Osso e Ossos/efeitos da radiação , Criança , Seguimentos , Sobrevivência de Enxerto , Humanos , Pessoa de Meia-Idade , Radioterapia/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Recuperação de Função Fisiológica , Estudos Retrospectivos , Transplante Autólogo/efeitos adversos , Adulto Jovem
2.
Plast Reconstr Surg ; 143(6): 1625-1632, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31136476

RESUMO

Given the widespread utility and therapeutic potential of autogenous fat grafting, plastic surgeons should be familiar with its safety profile and associated adverse events. This article provides a critical review of the literature and delineates risk factors associated with various complications when grafting to the breast and gluteal regions. The majority of adverse events are related to fat necrosis and require minimal diagnostic or therapeutic intervention. Larger graft volumes, as in cosmetic augmentation, are associated with higher incidences of fatty necrosis. The oncologic safety of fat grafting is supported by multiple clinical studies with thousands of breast cancer patients, albeit predominantly retrospective in nature. Although less frequent, serious complications include fat emboli during gluteal augmentation. Identification of associated risk factors and implementation of proper surgical techniques may minimize the occurrence of life-threatening complications.


Assuntos
Tecido Adiposo/transplante , Nádegas/cirurgia , Embolia Gordurosa/prevenção & controle , Mamoplastia/métodos , Cirurgia Plástica/métodos , Adulto , Contorno Corporal/efeitos adversos , Contorno Corporal/métodos , Neoplasias da Mama/cirurgia , Embolia Gordurosa/mortalidade , Estética , Feminino , Humanos , Mastectomia/métodos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Medição de Risco , Cirurgia Plástica/efeitos adversos , Taxa de Sobrevida , Transplante Autólogo/efeitos adversos , Transplante Autólogo/métodos , Resultado do Tratamento
3.
BMC Musculoskelet Disord ; 20(1): 138, 2019 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-30927929

RESUMO

BACKGROUND: The gracilis tendon is commonly used as an autograft to reconstruct torn tendons or ligaments in many parts of the body. Little is known about the subjective and functional outcome after gracilis tendon harvest. The aim of this study was to evaluate the outcome of the donor leg in patients undergoing such surgery. METHODS: Patients with chronic acromioclavicular joint dislocations undergoing coracoclavicular ligament reconstructions using autogenous gracilis tendon grafts were eligible for this study. The graft harvesting procedure was carried out in a standard fashion using a tendon stripper. Knee injury and Osteoarthritis Outcome Score (KOOS) were collected preoperatively and after 12 months. The first 5 patients were included retrospectively and lacked preoperative data, for these patients age- and gender matched normative KOOS scores were used as baseline values. Isometric knee flexor strength in 60° and 90° degrees of flexion was measured at final follow up at a median of 26 (14-56) months postoperatively with the non-operated leg used as reference. RESULTS: Twenty four patients were eligible for the study and 2 were excluded. The 22 patients available for analysis had a mean age of 44 (22-62) years at the time of surgery and 4 were women. There was no statistically significant change in KOOS 12 months postoperatively compared to baseline values but the patients were weaker in knee flexion in the operated leg compared to the non-operated one. CONCLUSIONS: Gracilis tendon harvesting results in a weakness of knee flexion but does not impair subjective knee function and is a procedure that can be recommended when an autogenous tendon graft is needed.


Assuntos
Autoenxertos/transplante , Músculo Grácil/cirurgia , Ligamentos Articulares/cirurgia , Procedimentos Ortopédicos/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Tendões/transplante , Articulação Acromioclavicular/cirurgia , Adulto , Feminino , Seguimentos , Músculo Grácil/fisiologia , Humanos , Luxações Articulares/complicações , Luxações Articulares/cirurgia , Articulação do Joelho/fisiologia , Ligamentos Articulares/lesões , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/efeitos adversos , Estudos Prospectivos , Amplitude de Movimento Articular , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Estudos Retrospectivos , Sítio Doador de Transplante/fisiologia , Transplante Autólogo/efeitos adversos , Transplante Autólogo/métodos , Resultado do Tratamento , Adulto Jovem
4.
Plast Reconstr Surg ; 143(3): 488e-494e, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30817640

RESUMO

BACKGROUND: Recently, the profunda artery perforator flap has become one of the popular flap choices for patients who desire autologous breast reconstruction but are not optimal candidates for deep inferior epigastric perforator (DIEP) flap surgery. These patients are not ideal patients for DIEP flap surgery because of having poor perforators, previous abdominal operations, low body mass index, or previously used/failed DIEP flap. In their institution, the authors have performed stacked profunda artery perforator flaps for these patients to provide full volumetric and aesthetic reconstruction. METHODS: A retrospective review of 20 patients (40 flaps) who underwent stacked profunda artery perforator flap surgery from 2014 to 2018 was performed. Patient characteristics, demographics, and flap data were collected. RESULTS: Forty flaps were used to reconstruct 20 breasts in 20 patients. The mean age of patients was 51.5 years (range, 38 to 74 years), the average body mass index was 27.3 kg/m(2) (range, 21.0 to 34.4 kg/m(2)), and the mean flap weight was 398.5 g (range, 170 to 600 g). The majority of anastomoses were performed in internal mammary vessels (60 percent), followed by thoracodorsal (10 percent), serratus (10 percent), and side branch of profunda artery perforator vessels (20 percent). There were no flap losses, and two patients experienced donor-site wound dehiscence. CONCLUSIONS: Stacking profunda artery perforator flaps is an innovative yet technically challenging choice of flap for autologous breast reconstruction. It can provide an aesthetically pleasing result in the appropriately selected patient, and we recommend this technique in patients who are not optimal candidates for DIEP flap surgery because of previous flap failure or unavailable donor site. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Neoplasias da Mama/cirurgia , Artérias Epigástricas/transplante , Mamoplastia/efeitos adversos , Retalho Perfurante/transplante , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Mama/cirurgia , Estética , Feminino , Humanos , Mamoplastia/métodos , Mastectomia/efeitos adversos , Pessoa de Meia-Idade , Seleção de Pacientes , Retalho Perfurante/efeitos adversos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Estudos Retrospectivos , Sítio Doador de Transplante/patologia , Sítio Doador de Transplante/cirurgia , Transplante Autólogo/efeitos adversos , Transplante Autólogo/métodos , Resultado do Tratamento
5.
BMC Cancer ; 19(1): 287, 2019 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-30925912

RESUMO

BACKGROUND: Primary central nervous system lymphoma (PCNSL) is a diffuse large B-cell lymphoma (DLBCL) confined to the central nervous system (CNS) with rising incidence among patients > 65 years. Although elderly patients are able to tolerate aggressive systemic chemotherapy, previous studies have demonstrated inferior outcomes for patients who present with a poor performance status (PS) and older age. Usually, intensive treatment approaches including high-dose chemotherapy followed by autologous stem cell transplantation (HDT-ASCT) are only offered to patients younger than 65-70 years of age. METHODS: This is an open-label, multicentric, non-randomized, single arm phase II trial. We will recruit 51 immuno-competent patients with newly diagnosed PCNSL from 12 German centers. The objective is to investigate the efficacy of age-adapted induction treatment followed by HDT-ASCT. All enrolled patients will undergo induction chemotherapy consisting of 2 cycles of rituximab 375 mg/m2/d (days 0 & 4), methotrexate 3.5 g/m2 (d1), and cytarabine 2 × 2 g/m2/d (d2-3) every 21 days. After 2 cycles of induction chemotherapy, patients achieving at least stable disease will undergo HDT-ASCT with busulfan 3.2 mg/kg/d (days - 7-(- 6)) and thiotepa 5 mg/kg/d (days - 5-(- 4)) followed by autologous stem cell transplantation. The primary endpoint of this study is 1-year progression-free survival (PFS). Secondary endpoints include PFS, overall survival, treatment response and treatment-related morbidities. Minimal follow-up after treatment completion is 12 months. DISCUSSION: Current treatment options for PCNSL have improved over the last years, resulting in the potential to achieve durable remission or cure in patients < 70 years. Age alone may not be the only criterion to select patients for this effective treatment approach and probably many elderly patients are undertreated just because of advanced age. There have been no multicentre trials investigating this curative treatment concept in elderly and fit PCNSL patients so far. We aim to answer whether HDT-ASCT is feasible and effective in fit patients > 65 years with newly-diagnosed PCNSL. TRIAL REGISTRATION: German clinical trials registry DRKS00011932 registered 18 August 2017.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias do Sistema Nervoso Central/tratamento farmacológico , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Quimioterapia de Indução/efeitos adversos , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Transplante Autólogo/efeitos adversos , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos Antineoplásicos , Neoplasias do Sistema Nervoso Central/terapia , Terapia Combinada/efeitos adversos , Citarabina/efeitos adversos , Citarabina/uso terapêutico , Humanos , Linfoma Difuso de Grandes Células B/terapia , Metotrexato/efeitos adversos , Metotrexato/uso terapêutico , Intervalo Livre de Progressão , Rituximab/efeitos adversos , Rituximab/uso terapêutico , Tiotepa/efeitos adversos , Tiotepa/uso terapêutico
6.
Int J Mol Sci ; 20(6)2019 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-30893777

RESUMO

Unlike allogeneic transplant, autologous stem cell transplantation (ASCT) represents a procedure with a low-risk of cytomegalovirus (CMV) symptomatic reactivation-infection/end-organ disease (CMV complications) and invasive fungal disease (IFD). However, novel drugs for the treatment of lymphoproliferative malignancies could cause an increase of such opportunistic infections, even after ASCT. To the best of our knowledge, there are no published data demonstrating an association between CMV and IFD in the autologous setting, while this association has been widely reported in allogeneic transplantation. We have reviewed our series of 347 ASCT in myeloma and lymphoma patients performed over a period of 14 years with the aim of investigating the descriptive and analytical epidemiology of bacterial, CMV and IFD complications, focusing on the association between CMV and IFD. Patients with myeloma have significantly fewer bacterial infections and IFD than patients with lymphoma, but a similar rate of CMV complications. Descriptive epidemiological data are consistent with the literature, indicating an overall incidence of 36%, 3.5% and 15.5% for bacterial infections, IFD and CMV complications, with a case mortality rate of 4%, 16.7% and 3.7%, respectively. A strong correlation between CMV and IFD exists, with 8 cases of IFD out of a total of 12 presenting a CMV complication. At multivariate analysis, a diagnosis of lymphoma, ≥3 previous treatment lines and age ≥60 years were found to be independent risk factors for IFD. Duration of neutropenia (ANC < 500/mm³) ≥7 days represents an independent risk factor for CMV complications, where neutropenia most likely represents a crude surrogate biomarker indicating a deeper and longer state of overall immunosuppression. From our data we conclude that (1) myeloma patients are at lower risk of bacterial infections and IFD as compared with lymphoma patients but are at equal risk of CMV complications, most likely as a consequence of a selective impact of bortezomib on Herpes Viruses infection control; (2) a significant association exists between CMV and IFD, although a possible cause-effect relationship remains to be determined; (3) IFD is a rare complication after ASCT but burdened by a mortality rate of about 17%, with peak rates in older lymphoma patients who underwent more intensive therapeutic regimens.


Assuntos
Infecções por Citomegalovirus/complicações , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Infecções Fúngicas Invasivas/complicações , Transtornos Linfoproliferativos/microbiologia , Transtornos Linfoproliferativos/virologia , Infecções Oportunistas/complicações , Adolescente , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Fatores de Risco , Transplante Autólogo/efeitos adversos , Adulto Jovem
7.
J Craniofac Surg ; 30(3): e278-e281, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30817542

RESUMO

INTRODUCTION: Published data on procalcitonin (PCT) levels after microsurgical interventions are very scarce, although infection within these patients is not only associated with severe morbidity but also significantly higher mortality rates. MATERIAL AND METHODS: Retrospective study on 20 patients, who were operated on by a single experienced plastic and reconstructive surgeon within one year (June 2017-June 2018). The authors included all patients, who received microvascular transplants for reconstruction of soft tissue defects. Furthermore, age above 18 years and appropriate documentation allowing sufficient data collection were defined as inclusion criteria. The authors excluded all patients with perioperative systemic inflammation and transplant loss, as our aim was to solely determine and evaluate potential alterations of serological PCT levels after microsurgical interventions. RESULTS: The PCT cutoff level to differentiate physiological and pathological levels was defined as 0.1 µg/L. There was no detectable increase in procalcitonin in all of our 20 patients, for whom the authors performed microvascular transplantation to reconstruct soft tissue defects. CONCLUSION: Serological PCT levels remain stable after the considered surgical interventions and therefore PCT levels might be utilized to identify systemic inflammation, thus helping to reduce severe complications by early individualized antiinfective treatment strategies.


Assuntos
Microcirurgia/efeitos adversos , Complicações Pós-Operatórias , Pró-Calcitonina/sangue , Transplante Autólogo/efeitos adversos , Enxerto Vascular/efeitos adversos , Humanos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/prevenção & controle , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Estudos Retrospectivos
8.
J Craniofac Surg ; 30(3): 682-685, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30817527

RESUMO

Autologous fat transfer (AFT) is a well-established and safe surgical technique in which autologous fat tissue is injected at a defective site directly after its harvesting and centrifugation. Initially used as an excellent filler for facial enhancement and rejuvenation, AFT has evolved over the years into more complex reconstructive procedures. Autologous fat transfer is now additionally used for correcting and restoring cranial and maxillofacial volume defects resulting from traumas, tumors, or congenital disorders. Apart from being a natural filler, human adipose tissue represents a rich source of mesenchymal stem cells, called adipose-derived stem cells, that exhibit multilineage differentiation potential and secrete several angiogenic and antiapoptotic factors.In this work, the authors will discuss different aspects influencing the final outcome of AFT, on the basis of the major clinical outcomes obtained using this surgical procedure. Starting from preoperative evaluation and planning, donor-recipient sites, and type of anesthesia and infiltration, the discussion will continue by analyzing the methods of adipose tissue harvesting, purification, and processing. Finally, an overview of the type of placement, clinical application, postoperative care, possible complications, fat graft take, longevity, volume maintenance, and future perspectives will be provided.


Assuntos
Tecido Adiposo/transplante , Face/cirurgia , Regeneração/fisiologia , Rejuvenescimento/fisiologia , Adipócitos/transplante , Contraindicações de Procedimentos , Face/fisiologia , Humanos , Cuidados Pós-Operatórios/métodos , Cuidados Pré-Operatórios/métodos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Coleta de Tecidos e Órgãos/métodos , Sítio Doador de Transplante , Transplante Autólogo/efeitos adversos , Transplante Autólogo/métodos , Resultado do Tratamento
9.
In Vivo ; 33(2): 515-521, 2019 Mar-Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30804135

RESUMO

BACKGROUND/AIM: Patients diagnosed with chronic endometritis (CE) may fail to respond to standard antibiotic treatment. The driver behind the approach reported here was the imperative need for alternative therapeutic solutions. CASE REPORT: This case report presents a woman with CE and premature ovarian insufficiency having experienced repeated implantation failures following donated embryo transfers. The patient was diagnosed with CE through hysteroscopy, microbiological analysis and scanning electron microscopy. Following the suggested antibiotic treatment, she underwent a new embryo transfer, but with subsequent pregnancy loss. Following a second antibiotic scheme, all diagnostic procedures certified the persistence of CE. The patient underwent autologous, intrauterine platelet-rich plasma treatment and a subsequent embryo transfer. The diagnostic procedures indicated no signs of CE, while the embryo transfer resulted in a twin pregnancy and birth. CONCLUSION: Platelet-rich plasma may be employed as a first-line CE treatment, especially for patients who fail to respond to conventional antibiotic schemes.


Assuntos
Endometrite/terapia , Fertilização In Vitro , Infertilidade Feminina/veterinária , Nascimento Vivo , Plasma Rico em Plaquetas , Adulto , Implantação do Embrião/fisiologia , Transferência Embrionária , Endometrite/fisiopatologia , Endométrio/fisiopatologia , Feminino , Humanos , Infertilidade Feminina/fisiopatologia , Infertilidade Feminina/terapia , Gravidez , Resultado da Gravidez , Taxa de Gravidez , Transplante Autólogo/efeitos adversos
10.
Pediatr Cardiol ; 40(4): 776-783, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30734094

RESUMO

Progressive dilatation of the pulmonary autograft is one of the greatest concerns after the Ross procedure. Increased stress in the arterial wall may cause changes in the elastic properties of the pulmonary autograft, and thus lead to pathological dilatation. The present study aimed to investigate the changes in the autograft diameter and stiffness during follow-up after the Ross procedure. A total of ten patients underwent the Ross procedure at our institution between 2003 and 2011. Echocardiography was used to measure the diameters of the pulmonary autograft at the level of the annulus, sinus of Valsalva, and sinotubular junction. The stiffness index was calculated from the angiographic data, and compared with that of 16 age-matched control children. The diameters of the pulmonary autograft increased throughout the follow-up period, particularly at the level of the sinus of Valsalva and at the sinotubular junction. The aortic root was stiffer in Ross patients compared with control children (7.9 ± 1.8 vs. 3.9 ± 0.7 immediately postoperatively, p < 0.01; 10.1 ± 2.8 vs. 4.2 ± 1.4 at 5 years postoperatively, p < 0.01). Although no significant relationship was found between the stiffness index and the autograft diameter, the stiffness index tended to increase over time. Dilatation of the pulmonary autograft was accompanied by progressive change in aortic stiffness. Longer follow-up is warranted to clarify the impact of this change in aortic stiffness on autograft failure.


Assuntos
Valva Aórtica/cirurgia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Doenças das Valvas Cardíacas/cirurgia , Valva Pulmonar/transplante , Adolescente , Angiografia/métodos , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/patologia , Autoenxertos/patologia , Procedimentos Cirúrgicos Cardíacos/métodos , Criança , Pré-Escolar , Dilatação Patológica/complicações , Ecocardiografia/métodos , Feminino , Seguimentos , Humanos , Masculino , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Transplante Autólogo/efeitos adversos
11.
Transpl Infect Dis ; 21(2): e13052, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30689291

RESUMO

BACKGROUND: Autologous stem cell transplantation (ASCT) is a commonly used treatment for multiple myeloma (MM). This retrospective cohort study characterizes the risk factors and outcomes associated with bacteremia following ASCT at a single center. METHODS: We conducted a retrospective analysis in subjects who underwent ASCT for multiple myeloma and other malignancies from May 2014 to March 2015 at a single center. The control cohort included all subjects undergoing ASCT in the same time period who did not develop bacteremia. RESULTS: During the study period, 363 ASCTs were completed in 282 discrete patients. Bacteremia was documented in 13% of all transplants. Enterococcus faecium was the most frequent species overall (14/62, 23%). Vancomycin resistance was present in 93% of E faecium isolates. Bacteremia was associated with a significantly decreased survival in patients who received their transplant after the first year of myeloma treatment. Overall survival (OS) was not significantly different in the two cohorts among patients undergoing ASCT within the first year of myeloma treatment. Survival analysis showed a significantly decreased OS in patients who developed Enterococcus bacteremia as compared to the non-bacteremia cohort. Enterococcal bacteremia was associated with significantly longer duration of neutropenia (mean 14 vs 9.7 days, P = 0.01), hospitalization (mean 61.7 vs 20.4 days, P = 0.0006), and higher mortality (69% vs 25%, P = 0.01) as compared to other bacteremias. CONCLUSION: We found a high incidence of E faecium and a low incidence of MRSA and Pseudomonas bacteremias following ASCT in our patient population. Survival analysis in our cohort suggests that the effect of underlying disease status and cumulative chemotherapy is critically important in determining outcomes related to bacteremia. Enterococcal bacteremias following ASCT were associated with significantly higher morbidity and mortality than non-enterococcal bacteremias.


Assuntos
Bacteriemia/etiologia , Mieloma Múltiplo/terapia , Transplante de Células-Tronco/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/epidemiologia , Intervalo Livre de Doença , Feminino , Infecções por Bactérias Gram-Positivas/epidemiologia , Infecções por Bactérias Gram-Positivas/mortalidade , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/complicações , Infecções por Pseudomonas/epidemiologia , Infecções por Pseudomonas/mortalidade , Estudos Retrospectivos , Fatores de Risco , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/mortalidade , Análise de Sobrevida , Transplante Autólogo/efeitos adversos
12.
J Infect Chemother ; 25(5): 371-375, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30642772

RESUMO

BACKGROUND: Disseminated adenovirus (ADV) infection is a fatal complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT), however, it is rare following autologous peripheral blood stem cell transplantation (auto-PBSCT) or chemotherapy alone. CASE: A 66-year-old Japanese female with relapsed and refractory multiple myeloma (RRMM) received auto-PBSCT, achieving partial response. To obtain a greater response, pomalidomide/dexamethasone was started on day 28 after auto-PBSCT, but was stopped on day 41 due to thrombocytopenia, fever, and gross hematuria. Additionally, she complained of abdominal pain on day 46. Blood tests revealed elevation of transaminases and alkaline phosphatase. There was no evidence of bacterial or fungal infections or progression of MM. ADV titer in urine and serum were 3.41 × 105 copies/mL and 6.76 × 103 copies/mL, respectively. CT scans revealed cystitis, urethritis, and peritonitis. Since more than two organs were infected with ADV, she was diagnosed with disseminated ADV disease. After 5 weeks of supportive care, all symptoms resolved. ADV titer decreased to 5.90 × 102 copies/mL in urine and became negative in serum on day 80. However, she succumbed to the MM a little more than a month later. CONCLUSION: Disseminated ADV infection can occur even in non-allogeneic transplant settings, such as in severely immunocompromised patients with MM who receive auto-PBSCT and repeated salvage therapies. Although it is a rare event, the mortality rate of this disease is very high, and hence, early diagnosis and interventions are needed in suspected cases.


Assuntos
Infecções por Adenoviridae/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Mieloma Múltiplo/terapia , Recidiva Local de Neoplasia/terapia , Transplante de Células-Tronco de Sangue Periférico/efeitos adversos , Terapia de Salvação/métodos , Adenoviridae/isolamento & purificação , Infecções por Adenoviridae/diagnóstico , Infecções por Adenoviridae/etiologia , Idoso , Dexametasona/uso terapêutico , Resistencia a Medicamentos Antineoplásicos , Evolução Fatal , Feminino , Humanos , Mieloma Múltiplo/patologia , Recidiva Local de Neoplasia/patologia , Talidomida/análogos & derivados , Talidomida/uso terapêutico , Transplante Autólogo/efeitos adversos
13.
J Craniofac Surg ; 30(3): 808-810, 2019 May/Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30615002

RESUMO

A 45-year-old female came to the clinic complaining of periorbital swelling and ptosis on the left upper eyelid that had started 6 months previously. She had received an autologous fat injection in the forehead 6 months prior, and there was no other ophthalmologic history. There were no abnormal findings, including pupil, extraocular movement, or fundus examination. There was eyebrow elevation of the left upper eyelid, and the marginal reflex distance 1 was 1 mm on the left eye compared to 4 mm on the right eye. There were a 2-cm-sized round and firm mass on the left upper eyelid that was not accompanied by tenderness. Orbital computed tomography showed heterogeneous infiltration with an ill-defined margin. Excisional biopsy and levator advancement were performed on the left upper eyelid, and histological findings showed chronic granulomatous inflammation with foreign body reaction and fat necrosis.A complete history for patient presentation with autologous fat injection is important when a periorbital mass is encountered clinically because granulomatous inflammation of the eyelid may occur after autologous fat injection in the forehead and can be related to migration of the injected fat.


Assuntos
Tecido Adiposo/transplante , Doenças Palpebrais/etiologia , Granuloma de Corpo Estranho/etiologia , Inflamação/etiologia , Doenças Palpebrais/patologia , Feminino , Granuloma de Corpo Estranho/patologia , Humanos , Inflamação/patologia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Transplante Autólogo/efeitos adversos
14.
Anticancer Res ; 39(1): 67-72, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30591441

RESUMO

BACKGROUND/AIM: SLC7A5 is recognized as the major mediator of melphalan uptake into multiple myeloma (MM) cells; however, its contribution to the inter-patient variability of melphalan efficacy and toxicity is yet to be well elucidated. This study aimed to investigate the impact of a single nucleotide polymorphism (SNP) rs4240803 in SLC7A5 on the gene expression, ex vivo sensitivity to melphalan, and clinical outcomes in MM patients who were undergoing autologous stem cell transplantation with high-dose melphalan. MATERIALS AND METHODS: Peripheral blood mononuclear cells (PBMC) were collected from 108 MM patients prior to melphalan therapy. Clinical data were also collected from these patients following melphalan therapy. RESULTS: rs4240803 was associated with elevated expression of SLC7A5 mRNA, higher ex vivo sensitivity to melphalan in PBMCs, and positive 90-day response in these patients (p=0.047, 0.10, 0.049, respectively). CONCLUSION: rs4240803 impacted the expression of SLC7A5, thus contributing to the clinical response of MM patients to melphalan therapy.


Assuntos
Transportador 1 de Aminoácidos Neutros Grandes/genética , Melfalan/administração & dosagem , Mieloma Múltiplo/tratamento farmacológico , Adulto , Idoso , Terapia Combinada , Feminino , Regulação Neoplásica da Expressão Gênica , Estudos de Associação Genética , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Humanos , Leucócitos Mononucleares/efeitos dos fármacos , Masculino , Melfalan/efeitos adversos , Pessoa de Meia-Idade , Mieloma Múltiplo/genética , Mieloma Múltiplo/patologia , Polimorfismo de Nucleotídeo Único , Transplante Autólogo/efeitos adversos , Resultado do Tratamento
15.
Int J Pediatr Otorhinolaryngol ; 116: 1-6, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30554677

RESUMO

BACKGROUND: The Brent or Nagata techniques of microtia reconstruction and their modifications involve complicated frameworks; therefore, complications are inevitable. The authors aimed to provide comprehensive knowledge regarding the occurrence, development, prognosis, risk factors, and treatment of complications. METHODS: This study was a retrospective review of patients who underwent autologous cartilage microtia reconstruction at a single auricular plastic and reconstructive center between March 2005 and June 2016. Custom database software was used to process data from patients with microtia. Details of postoperative complications were collected during follow-up for analysis. RESULTS: A total of 470 procedures (stage I) were performed on 429 patients. The mean (±SD) age at surgery was 12.27 ±â€¯5.01 years (range, 6-32 years). The mean time to follow-up was 3.67 ±â€¯2.45 years (range, 1-11 years). The complication rate was 2.98% (4/134) with the Brent technique and 12.2% (38/311) with the Nagata technique. A multivariate logistic regression analysis of complications of microtia reconstruction revealed that age, sex, and laterality were not associated with postoperative complications (p > 0.05). Surgical technique affected the incidence of complications. The Nagata technique resulted in a higher risk for complications (OR 6.14 [95% CI 1.63-23.19]; p < 0.01). CONCLUSION: The development of complications was a dynamic process. There was a learning curve associated with autologous cartilage microtia reconstruction. Orthopedists or otologists aspiring to master microtia reconstruction should have a fundamental understanding of the procedure and be aware of possible complications.


Assuntos
Cartilagem/transplante , Microtia Congênita/cirurgia , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adolescente , Adulto , Criança , Cartilagem da Orelha/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Transplante Autólogo/efeitos adversos , Transplante Autólogo/métodos , Adulto Jovem
16.
Plast Reconstr Surg ; 143(3): 667-677, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30589826

RESUMO

BACKGROUND: This study aimed to identify differences in patient-reported abdominal well-being, satisfaction, and quality of life in women with muscle-preserving free abdominal versus pedicle transverse rectus abdominis musculocutaneous (TRAM) flap for breast reconstruction. METHODS: Women with a history of breast cancer surgery were recruited from the Army of Women foundation to take the BREAST-Q and a background questionnaire. Descriptive statistics and regression analyses were used to compare abdominal physical well-being, breast satisfaction, chest physical, psychosocial well-being, and sexual well-being in women undergoing free versus pedicle TRAM flaps. RESULTS: Of 657 women, 273 (41 percent) underwent free flap surgery and 384 (58 percent) underwent pedicle TRAM flap surgery. Compared with unilateral pedicle TRAM flaps, those with unilateral free flaps scored an average of 9.5 points higher (95 percent CI, 5.4 to 13.6; p < 0.0001) and those with bilateral free flaps reported no difference in physical well-being of the abdomen. Compared with bilateral pedicle TRAM flaps, the following groups scored higher in physical well-being of the abdomen: unilateral free flaps, an average of 17.4 (95 percent CI, 11.5 to 23.3; p < 0.0001); bilateral free flaps, an average of 6.8 (95 percent CI, 0.3 to 13.3; p = 0.04); and unilateral pedicle TRAM flaps, an average of 7.9 (95 percent CI, 2.4 to 13.4; p = 0.005) higher. Women with bilateral pedicle flaps reported sexual well-being scores 7.4 (95 percent CI, 0.6 to 14.3; p = 0.03) and 6.8 (95 percent CI, 0.3 to 13.2; p = 0.04) points lower than those with unilateral free and unilateral pedicle flaps. CONCLUSIONS: Muscle-preserving techniques result in improved abdominal wall function and decreased morbidity compared with pedicle TRAM flap reconstruction. These data highlight the importance of offering patients the option of microsurgical techniques.


Assuntos
Retalhos de Tecido Biológico/transplante , Mamoplastia/métodos , Retalho Miocutâneo/transplante , Medidas de Resultados Relatados pelo Paciente , Sítio Doador de Transplante/fisiopatologia , Parede Abdominal/fisiopatologia , Parede Abdominal/cirurgia , Idoso , Neoplasias da Mama/cirurgia , Estudos de Coortes , Feminino , Retalhos de Tecido Biológico/efeitos adversos , Humanos , Mamoplastia/efeitos adversos , Mastectomia/efeitos adversos , Microcirurgia/efeitos adversos , Microcirurgia/métodos , Pessoa de Meia-Idade , Retalho Miocutâneo/efeitos adversos , Tratamentos com Preservação do Órgão/efeitos adversos , Tratamentos com Preservação do Órgão/métodos , Seleção de Pacientes , Qualidade de Vida , Reto do Abdome/transplante , Transplante Autólogo/efeitos adversos , Transplante Autólogo/métodos
17.
Medicine (Baltimore) ; 97(44): e13050, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30383676

RESUMO

This study was designed to compare postoperative complications and postoperative discomfort when using glue combined with nasal margin suture fixation versus fibrin glue or sutures alone to attach conjunctival autografts among Chinese patients during pterygium excisions.We analyzed the medical records of 150 eyes of 150 patients with primary pterygium, in which the autografts were secured by 3 different methods after pterygium excision: 50 eyes were secured with fibrin glue, 50 eyes were secured with glue + nasal sutures, and 50 eyes were secured with sutures. The more than 6 months of follow-up observation data included postoperative complications (graft loss/displacement, dehiscence, proliferative granuloma, inflammation, and hemorrhage), recurrence, and postoperative discomfort. A logistic regression procedure was conducted to evaluate the relationship between graft complications and the pterygium grade.Graft loss/displacement occurred in 3 patients (6%) in the glue group. Graft dehiscence occurred in 8 patients (16%) in the glue group (P < .001), with 2 developing into proliferative granuloma, compared with none in the glue + nasal sutures group and the sutures group at the 3-month postoperative follow-up. Pterygium recurrence occurred in 1 patient (2.2%) in the glue group and 2 patients (4.4%) in the sutures group, compared with none in the glue + nasal sutures group at the 6 to 9 month postoperative follow-up (P = .315). There were fewer postoperative symptoms (pain, foreign body sensation, and tearing) at days 1 and 7 in the fibrin glue and glue + nasal sutures groups than in the sutures group (P < .01). The pterygium grade was a significant risk factor for graft complications (Odd ratio, OR: 5.98, Confidence interval, CI: 1.193-29.992, P = .03) in the glue group.The modified conjunctival autograft fixation with glue + sutures on the nasal margin resulted in more stable grafts and less graft-associated complications. There was a low level of postoperative patient discomfort in the glue + sutures group. A higher grade of pterygium led to an increased rate of complications in the glue group.


Assuntos
Túnica Conjuntiva/cirurgia , Adesivo Tecidual de Fibrina/uso terapêutico , Nariz/cirurgia , Pterígio/cirurgia , Técnicas de Sutura/efeitos adversos , Adulto , Idoso , Grupo com Ancestrais do Continente Asiático , Autoenxertos , Terapia Combinada , Feminino , Adesivo Tecidual de Fibrina/efeitos adversos , Seguimentos , Sobrevivência de Enxerto , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Recidiva , Estudos Retrospectivos , Suturas/efeitos adversos , Transplante Autólogo/efeitos adversos
18.
Thorac Surg Clin ; 28(3): 347-355, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30054072

RESUMO

Finding a good and durable substitute to trachea and proximal airways has remained the holy grail for thoracic surgeons for many decades. Autologous tracheal reconstruction using armed forearm free flap with rib cartilage achieved satisfactory results in managing extended tracheal lesions without the need for synthetic materials or immunosuppression. This well-vascularized and rigid neo trachea limits postoperative airway collapse, mediastinal infection, and ischemic airway issues, and achieves long-term functional benefit and prolonged survival. Further improvement is needed to deal with the lack of mucociliary clearance for longer airway replacement involving trachea and bronchial bifurcation.


Assuntos
Retalhos de Tecido Biológico , Procedimentos Cirúrgicos Reconstrutivos/métodos , Traqueia/cirurgia , Autoenxertos , Antebraço , Humanos , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Síndrome do Desconforto Respiratório do Adulto/etiologia , Transplante Autólogo/efeitos adversos , Transplante Autólogo/métodos
19.
Can J Physiol Pharmacol ; 96(9): 886-892, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29975111

RESUMO

This study aimed to investigate the protective effects of ketamine against hepatic ischemia-reperfusion (I/R) injury by suppressing activation of Kupffer cells (KCs) in rat liver autotransplantation. Male Sprague-Dawley rats were randomized into 3 groups (n = 10 each). Group I, the sham group, received saline. Group II received saline and underwent orthotopic liver autotransplantation (OLAT). Group III received 10 mg/kg ketamine and underwent OLAT. Blood samples were obtained at 3, 6, 12, and 24 h after I/R, and following ALT, AST, LDH, IL-6, TNF-α, IL-1ß, and IL-10 in serum were detected. Model rats were sacrificed at the indicated time points and the graft liver tissues were evaluated histologically. KCs were isolated from rat liver tissues, and inflammatory products and proteins of NF-κB signaling pathway were detected using quantitative RT-PCR and Western blotting. Our results showed that ketamine significantly decreased ALT, AST, LDH, IL-6, TNF-α, and IL-1ß levels and increased IL-10 level. Furthermore, ketamine alleviated the histopathology changes, by less KC infiltration and lower hepatocyte apoptosis. Moreover, activity of NF-κB signaling pathway in KCs was suppressed. In addition, production of pro- and anti-inflammatory factors is consistent with the results in tissues. Ketamine ameliorated I/R injury after liver transplantation by suppressing activation of KCs in rats.


Assuntos
Ketamina/farmacologia , Macrófagos do Fígado/efeitos dos fármacos , Transplante de Fígado/efeitos adversos , Traumatismo por Reperfusão/etiologia , Traumatismo por Reperfusão/patologia , Animais , Apoptose/efeitos dos fármacos , Citoproteção/efeitos dos fármacos , Hepatócitos/efeitos dos fármacos , Hepatócitos/metabolismo , Hepatócitos/patologia , Ketamina/uso terapêutico , Macrófagos do Fígado/metabolismo , Masculino , NF-kappa B/metabolismo , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Ratos , Ratos Sprague-Dawley , Traumatismo por Reperfusão/genética , Traumatismo por Reperfusão/metabolismo , Transdução de Sinais/efeitos dos fármacos , Transplante Autólogo/efeitos adversos
20.
Braz Oral Res ; 32: e31, 2018 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-29898018

RESUMO

Polymethyl methacrylate (PMMA) has been considered a suitable material for cranioplasty. However, no consensus has been reached concerning the best material for cranioplasty with regard to minimizing complications. Thus, this systematic review and meta-analysis aimed to compare the complication rates of PMMA with those of autologous bone and titanium mesh. This review was registered with PROSPERO (CRD42016042725). Systematic searches were conducted on PubMed/MEDLINE, Scopus, and Web of Science. The focus question was, "Do PMMA prostheses used in cranioplasty have complications rates similar to those of autologous bone and titanium mesh?" A meta-analysis of complication rates was performed on the basis of dichotomous outcomes assessed by risk ratio (RR) with corresponding 95% confidence intervals (CI). From 1014 data sources, 11 articles were selected according to eligibility criteria. These articles involved 1,256 individuals and 1,278 cranioplasties using autologous bone (n = 408), PMMA (n = 379), or titanium (n = 151). The follow-up period ranged from 63 days to 54.3 months. No difference was observed between the complication rates of PMMA and autologous bone (p = 0.94; RR, 0.98; 95%CI, 0.54-1.75) or between PMMA and titanium (p = 0.38; RR, 1.59; 95%CI, 0.57-4.48). Sub-analysis of the reasons for craniotomy (trauma/non-trauma) was conducted, which revealed no significant difference (p = 0.91; RR, 0.95; 95%CI, 0.37-2.42). The meta-analysis indicated that the use of PMMA yields complication rates that are near those of autologous bone and titanium mesh.


Assuntos
Substitutos Ósseos/efeitos adversos , Transplante Ósseo/efeitos adversos , Polimetil Metacrilato/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Crânio/cirurgia , Resinas Acrílicas/efeitos adversos , Materiais Biocompatíveis , Humanos , Fatores de Risco , Titânio/efeitos adversos , Transplante Autólogo/efeitos adversos
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