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1.
Oncotarget ; 11(21): 2002-2009, 2020 May 26.
Artigo em Inglês | MEDLINE | ID: mdl-32523654

RESUMO

PURPOSE: Experimental study aimed at evaluating whether pleural neoplastic disease is associated with the degree of pleural fibrosis over time caused by talc pleurodesis. The study describes changes in levels of inflammatory mediators and determines whether the course of time involved in progression of neoplastic pleural disease is the factor that influences safety of talc pleurodesis usage in mice. MATERIALS AND METHODS: Animals were randomized into two groups: Cancer group (CG) that received intrapleural injection of Lewis cells or Saline group (SG) that received saline injection. After, the animals were subdivided into Early (pleurodesis 3 days after pleural injection) and Late (pleurodesis 7 days after pleural injection) groups. Half of the animals in each group were euthanized 24 hours after pleurodesis (to obtain the inflammatory data); the remaining animals were killed after 8 days (to obtain the scores of pleural fibrosis). RESULTS: CGs had lower fibrosis scores than SGs comparing early phases to late phases. Inflammation scores were lower in CGs, particularly in Late group. In SGs the inflammation was intense in 100% of the animals. In Late CG group pleural adhesions had the lowest scores; we found intense fibrosis only in SGs. VEGF and LDH levels had increased in animals with cancer, particularly in Late group. Systemic distribution of talc occurred only in Late CG. CONCLUSIONS: The time for pleural neoplasia to evolve is inversely proportional to the degree of pleural fibrosis. Earlier pleurodesis yielded the best results related to fibrosis, with less systemic inflammation and is safer in mice.

4.
Eur J Cardiothorac Surg ; 51(4): 702-708, 2017 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-28082466

RESUMO

Objectives: Bronchopleural fistula (BPF) is an uncommon complication following a lung resection to address various conditions. BPFs are associated with high morbidity and mortality rates. This study evaluated the endoscopic treatment of 'total' BPFs using the Occlutech-Fígulla® cardiac device at a single centre. Methods: We selected nine patients with chronic and complete BPFs. Under direct bronchoscopic visualization, the BPFs were treated using the Occlutech-Fígulla device. The patients were followed up for 12 months to determine the treatment level and complications. Results: The procedure had a favourable outcome in three patients, resulting in complete fistula closure. Two patients had partial closure and showed improvements in their clinical conditions. In two other cases, closure of the bronchial stump was unsuccessful using this method. Two patients died from causes unrelated to the procedure or the device. During the follow-up period, no complications related to infection or device-related injuries were reported. Conclusions: In patients without clinical conditions that require surgical treatment, the Occlutech-Fígulla cardiac device can be a safe and effective method for the endoscopic treatment of large BPFs resulting from complete dehiscence of a bronchial stump. No severe events were reported.


Assuntos
Broncoscopia/métodos , Fístula do Sistema Respiratório/etiologia , Fístula do Sistema Respiratório/cirurgia , Deiscência da Ferida Operatória/complicações , Adulto , Idoso , Fístula Brônquica/etiologia , Fístula Brônquica/cirurgia , Broncoscopia/efeitos adversos , Doença Crônica , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Pleurais/etiologia , Doenças Pleurais/cirurgia , Pneumonectomia/efeitos adversos , Estudos Prospectivos , Dispositivo para Oclusão Septal/efeitos adversos , Resultado do Tratamento
10.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 26(1): 21-26, jan.-mar.2016. ilus, graf
Artigo em Português | LILACS | ID: lil-789772

RESUMO

A insuficiência cardíaca refratária e o choque cardiogênico estão relacionados aelevadas taxas de mortalidade e a baixa qualidade de vida. As estratégias de tratamento para esses pacientes foram limitadas, nos últimos anos, às terapias farmacológicas que pouco modificaram a evolução da doença. Entretanto, com o desenvolvimento tecnológico em dispositivos mecânicos de suporte circulatório, diversas modalidades terapêuticas utilizando diferentes tipos de tecnologia proporcionam melhor suporte hemodinâmico, diminuição e reversão de disfunções orgânicas causadas pela insuficiência cardíaca.Esses dispositivos quando indicados corretamente melhoram os desfechos clínicos de pacientes que aguardam transplante cardíaco e dos que não são candidatos a transplante. Atualmente, observam-se indicações cada vez mais precoces de dispositivos de suporte circulatório, tornando-os uma terapia essencial no manejo de pacientes cominsuficiência cardíaca refratária ou choque cardiogênico. Esta revisão abordará os principais tipos de dispositivos disponíveis em nosso país e suas indicações...


The refractory heart failure and cardiogenic shock are related to high rates of mortality and poor quality of life. Treatment strategies for these patients have been limited in the last yearsto pharmacological therapies that change only slightly the evolution of the disease. However, with technological advances in mechanical devices for circulatory assistance, various therapeutic modalities using different types of technology provide better hemodynamic support, reduction and reversal of organic dysfunction caused by heart failure. When properly indicated,these devices can provide better clinical outcomes of patients on heart transplantation waiting list and those who are not candidates for transplantation. Contemporarily, indications for mechanical support devices are occurring increasingly earlier, making them an essential therapy in the management of patients with refractory heart failure or cardiogenic shock.This review covers the different types of devices available in our country and its indications...


Assuntos
Humanos , Masculino , Feminino , Coração Auxiliar/tendências , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/diagnóstico , Prognóstico , Transplante de Coração , Choque Cardiogênico/complicações , Choque Cardiogênico/terapia , Circulação Assistida/métodos , Ecocardiografia/métodos , Fatores de Risco , Qualidade de Vida , Sobrevida , Ventrículos do Coração
11.
Ann Thorac Surg ; 91(2): 595-6, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21256324

RESUMO

An asymptomatic 48-year-old woman presented to our hospital with a tumor of the rib incidentally diagnosed on a chest roentgenogram. The patient was investigated and underwent tumor resection of the chest wall. The pathologic study revealed that it was cavernous hemangioma. This tumor of the bone is a distinctly uncommon benign vascular tumor, generally occurring in the spine or skull. Hemangiomas involving the rib are even more rare, with only 22 cases described in the literature. However, we suggest that this tumor of the rib should be considered in the differential diagnosis, principally in asymptomatic patients.


Assuntos
Neoplasias Ósseas/diagnóstico , Neoplasias Ósseas/cirurgia , Hemangioma/diagnóstico , Hemangioma/cirurgia , Costelas/cirurgia , Neoplasias Ósseas/patologia , Feminino , Hemangioma/patologia , Humanos , Pessoa de Meia-Idade
13.
Clinics (Sao Paulo) ; 64(2): 127-34, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19219318

RESUMO

OBJECTIVE: The aim of this study was to report a single center experience of organ and tissue transplantation INTRODUCTION: This is the first report of organ and tissue transplantation at the Hospital das Clínicas of the University of Sao Paulo Medical School. METHODS: We collected data from each type of organ transplantation from 2002 to 2007. The data collected were patient characteristics and actuarial survival Kaplan-Meier curves at 30 days, one year, and five years RESULTS: There were a total of 3,321 transplants at our institution and the 5-year survival curve ranged from 53% to 88%. CONCLUSION: This report shows that solid organ and tissue transplants are feasible within the institution and allow us to expect that the quality of transplantation will improve in the future.


Assuntos
Transplante de Órgãos/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Transplante de Tecidos/estatística & dados numéricos , Análise Atuarial , Adolescente , Adulto , Idoso , Brasil/epidemiologia , Criança , Pré-Escolar , Sobrevivência de Enxerto , Hospitais Estaduais/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Humanos , Lactente , Estimativa de Kaplan-Meier , Pessoa de Meia-Idade , Transplante de Órgãos/mortalidade , Transplante de Tecidos/mortalidade , Obtenção de Tecidos e Órgãos , Adulto Jovem
14.
J Bras Pneumol ; 34(5): 273-9, 2008 May.
Artigo em Inglês, Português | MEDLINE | ID: mdl-18545822

RESUMO

OBJECTIVE: To evaluate the effects of azathioprine on the mucociliary system in a model of bronchial section and anastomosis in rats. METHODS: Thirty-six male Wistar-Furth rats were submitted to left bronchial section and anastomosis and divided into two groups to receive either saline solution or azathioprine. After 7, 15 and 30 days of treatment, six animals from each group were killed, after which in situ mucociliary transport velocity, in vitro mucus transportability, and contact angle of mucus in the right (intact) and left (sectioned) bronchi were measured. RESULTS: In situ mucociliary transport velocity was significantly lower in the sectioned bronchi than in the intact bronchi (p < 0.001). In situ mucociliary transport velocity was lower in the intact bronchi of the animals treated with azathioprine for 7 days (p < 0.05), and those bronchi presented full recovery after 30 days of treatment. The contact angle was higher in the mucus samples collected from the sectioned bronchi of the animals treated with saline solution for 30 days (p < 0.001), which is in accordance with the decreased in vitro mucus transportability observed in the same animals (p < 0.001). CONCLUSIONS: We conclude that, in the sectioned bronchi of rats, treatment with azathioprine causes only transitory impairment of mucociliary transport, whereas administration of saline solution impairs mucociliary transport for up to 30 days. In addition, azathioprine protects against alterations in mucus surface properties.


Assuntos
Azatioprina/farmacologia , Imunossupressores/farmacologia , Depuração Mucociliar/efeitos dos fármacos , Anastomose Cirúrgica , Animais , Avaliação Pré-Clínica de Medicamentos , Transplante de Pulmão/imunologia , Masculino , Modelos Teóricos , Ratos , Ratos Wistar , Cloreto de Sódio
15.
J Bras Pneumol ; 34(7): 497-505, 2008 Jul.
Artigo em Português | MEDLINE | ID: mdl-18695795

RESUMO

OBJECTIVE: To analyze the rate at which lungs available for transplantation in the State of São Paulo in 2006 were utilized and to determine the lung donor profile in the same period. METHODS: A retrospective study of 497 clinical charts of lung tissue donors from January to December of 2006. RESULTS: According to the clinical charts, lungs were not offered for transplant in 149 cases (30%), which were therefore excluded from the study. Among the 348 lung donors eligible for inclusion in the study, the mean age was 37.4 +/- 16.1 years, and 56.9% were males. The main causes of brain death among the donors were stroke (in 40.5%), skull-brain trauma (in 34.2%) and subarachnoid hemorrhage (in 10.9%). The great majority of these lung donors (90.5%) received vasoactive agents, and 13.5% presented cardiopulmonary arrest. The mean donor leukocyte count was 15,008 +/- 6,467 cells/mm(3), 67.8% of the donors received anti-bacterial agents, and 26.1% presented lung infection. Nearly 40% of the lung donors presented chest X-ray abnormalities. Only 4.9% of the lung donors were accepted, representing 28 lungs (allograft utilization rate of 4%). The causes for donor exclusion were gas exchange alterations (in 30.1%), infection (in 23.7%) and distance (in 10.9%). CONCLUSIONS: The lung utilization rate in the State of São Paulo is low when compared to mean rates worldwide. In addition, more than half of the donor pool was excluded due to altered gas exchange or pulmonary infection. The combination of better care of the potential donor and more flexible selection criteria could increase allograft utilization.


Assuntos
Seleção do Doador/normas , Transplante de Pulmão/estatística & dados numéricos , Doadores de Tecidos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Causas de Morte , Criança , Pré-Escolar , Seleção do Doador/métodos , Feminino , Sobrevivência de Enxerto , Humanos , Lactente , Recém-Nascido , Pulmão , Transplante de Pulmão/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
17.
Arq Bras Cardiol ; 87(4): e108-11, 2006 Oct.
Artigo em Inglês, Português | MEDLINE | ID: mdl-17128294

RESUMO

Immunosuppressive therapy for transplanted patients exposes them to a high risk of developing posttransplantation lymphoproliferative disorders (PTLD). We report the case of a child undergoing heart transplantation at seven months of age who developed PTLD at nine years of age, diagnosed by resection of a pulmonary nodule.


Assuntos
Transplante de Coração/efeitos adversos , Imunossupressores/uso terapêutico , Transtornos Linfoproliferativos/etiologia , Cardiomiopatia Dilatada/cirurgia , Criança , Humanos , Transtornos Linfoproliferativos/diagnóstico , Transtornos Linfoproliferativos/tratamento farmacológico , Masculino , Resultado do Tratamento
18.
Clinics ; 64(2): 127-134, 2009. graf, tab
Artigo em Inglês | LILACS | ID: lil-505374

RESUMO

OBJECTIVE: The aim of this study was to report a single center experience of organ and tissue transplantation INTRODUCTION: This is the first report of organ and tissue transplantation at the Hospital das Clínicas of the University of Sao Paulo Medical School. METHODS: We collected data from each type of organ transplantation from 2002 to 2007. The data collected were patient characteristics and actuarial survival Kaplan-Meier curves at 30 days, one year, and five years RESULTS: There were a total of 3,321 transplants at our institution and the 5-year survival curve ranged from 53 percent to 88 percent. CONCLUSION: This report shows that solid organ and tissue transplants are feasible within the institution and allow us to expect that the quality of transplantation will improve in the future.


Assuntos
Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Humanos , Lactente , Pessoa de Meia-Idade , Adulto Jovem , Transplante de Órgãos/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Transplante de Tecidos/estatística & dados numéricos , Análise Atuarial , Brasil/epidemiologia , Sobrevivência de Enxerto , Hospitais Estaduais/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Estimativa de Kaplan-Meier , Transplante de Órgãos/mortalidade , Obtenção de Tecidos e Órgãos , Transplante de Tecidos/mortalidade , Adulto Jovem
19.
J. bras. pneumol ; 34(5): 273-279, maio 2008. ilus, graf
Artigo em Inglês, Português | LILACS | ID: lil-484207

RESUMO

OBJETIVO: Avaliar os efeitos da azatioprina sobre o sistema mucociliar em um modelo de secção e anastomose brônquica em ratos. MÉTODOS: Trinta e seis ratos machos da raça Wistar-Furth foram submetidos à secção e anastomose brônquica esquerda e separados aleatoriamente em dois grupos para receberem solução salina ou azatioprina. Após 7, 15 e 30 dias de terapia, seis animais de cada grupo foram sacrificados, e foram realizadas as medidas da velocidade de transporte mucociliar in situ, da transportabilidade do muco in vitro e do ângulo de contato do muco nos brônquios direito (intacto) e esquerdo (seccionado). RESULTADOS: A velocidade de transporte mucociliar in situ foi significativamente menor nos brônquios seccionados do que nos brônquios intactos (p < 0,001). Houve redução da velocidade de transporte mucociliar in situ nos brônquios intactos dos animais tratados com azatioprina por 7 dias (p < 0,05), havendo completa recuperação após 30 dias de terapia. O ângulo de contato do muco foi maior nos brônquios seccionados dos animais tratados com solução salina por 30 dias (p < 0,001), estando de acordo com a redução da transportabilidade do muco in vitro observada nos mesmos animais (p < 0,001). CONCLUSÕES: Concluímos que, nos brônquios seccionados de ratos, a terapia com azatioprina causa um prejuízo apenas transitório do transporte mucociliar, enquanto a administração de solução salina prejudica o transporte mucociliar por até 30 dias. Além disso, a azatioprina contribui para prevenir alterações nas propriedades da superfície do muco.


OBJECTIVE: To evaluate the effects of azathioprine on the mucociliary system in a model of bronchial section and anastomosis in rats. METHODS: Thirty-six male Wistar-Furth rats were submitted to left bronchial section and anastomosis and divided into two groups to receive either saline solution or azathioprine. After 7, 15 and 30 days of treatment, six animals from each group were killed, after which in situ mucociliary transport velocity, in vitro mucus transportability, and contact angle of mucus in the right (intact) and left (sectioned) bronchi were measured. RESULTS: In situ mucociliary transport velocity was significantly lower in the sectioned bronchi than in the intact bronchi (p < 0.001). In situ mucociliary transport velocity was lower in the intact bronchi of the animals treated with azathioprine for 7 days (p < 0.05), and those bronchi presented full recovery after 30 days of treatment. The contact angle was higher in the mucus samples collected from the sectioned bronchi of the animals treated with saline solution for 30 days (p < 0.001), which is in accordance with the decreased in vitro mucus transportability observed in the same animals (p < 0.001). CONCLUSIONS: We conclude that, in the sectioned bronchi of rats, treatment with azathioprine causes only transitory impairment of mucociliary transport, whereas administration of saline solution impairs mucociliary transport for up to 30 days. In addition, azathioprine protects against alterations in mucus surface properties.


Assuntos
Animais , Masculino , Ratos , Azatioprina/farmacologia , Imunossupressores/farmacologia , Depuração Mucociliar/efeitos dos fármacos , Anastomose Cirúrgica , Avaliação Pré-Clínica de Medicamentos , Transplante de Pulmão/imunologia , Modelos Teóricos , Ratos Wistar , Cloreto de Sódio
20.
J. bras. pneumol ; 34(7): 497-505, jul. 2008. ilus, tab
Artigo em Inglês, Português | LILACS | ID: lil-488276

RESUMO

OBJETIVO: Analisar a taxa de aproveitamento de pulmões disponibilizados em São Paulo no ano de 2006, bem como caracterizar o perfil dos doadores de pulmão deste período. MÉTODOS: Estudo retrospectivo de 497 prontuários de doadores de pulmão, no período de janeiro a dezembro de 2006. RESULTADOS: Não houve oferta de doação de pulmões para transplante em 149 (30 por cento) dos prontuários analisados, sendo excluídos do estudo. A idade média dos 348 doadores eleitos para o estudo foi de 37,4 ± 16,1 anos, e 56,9 por cento deles eram do sexo masculino. As principais causas da morte cerebral dos doadores foram: acidente vascular cerebral (40,5 por cento); trauma cranioencefálico (34,2 por cento); e hemorragia subaracnóidea (10,9 por cento). A grande maioria dos doadores recebia drogas vasoativas (90,5 por cento), sendo que 13,5 por cento haviam apresentado parada cárdio-respiratória. Do ponto de vista infeccioso, o leucograma médio foi de 15.008 ± 6.467 células/mm³, 67,8 por cento recebiam antibioticoterapia e 26,1 por cento apresentavam infecção pulmonar. Quase 40 por cento dos doadores apresentavam alterações radiográficas. Apenas 4,9 por cento dos doadores foram aceitos, representando 28 pulmões (taxa de aproveitamento de órgãos de 4 por cento). Os motivos de recusa foram: alteração gasométrica (30,1 por cento); infecção (23,7 por cento); e distância (10,9 por cento). CONCLUSÕES: A taxa de aproveitamento de pulmões em nosso meio é baixa quando comparada às taxas médias de aproveitamento mundial. Além disso, mais de 50 por cento das recusas deveram-se à gasometria arterial inadequada e infecção pulmonar. Aliar melhor cuidado ao potencial doador à menor rigidez nos critérios de seleção poderia aumentar a utilização dos órgãos doados.


OBJECTIVE: To analyze the rate at which lungs available for transplantation in the state of São Paulo in 2006 were utilized and to determine the lung donor profile in the same period. METHODS: A retrospective study of 497 clinical charts of lung tissue donors from January to December of 2006. RESULTS: According to the clinical charts, lungs were not offered for transplant in 149 cases (30 percent), which were therefore excluded from the study. Among the 348 lung donors eligible for inclusion in the study, the mean age was 37.4 ± 16.1 years, and 56.9 percent were males. The main causes of brain death among the donors were stroke (in 40.5 percent), skull-brain trauma (in 34.2 percent) and subarachnoid hemorrhage (in 10.9 percent). The great majority of these lung donors (90.5 percent) received vasoactive agents, and 13.5 percent presented cardiopulmonary arrest. The mean donor leukocyte count was 15,008 ± 6,467 cells/mm³, 67.8 percent of the donors received anti-bacterial agents, and 26.1 percent presented lung infection. Nearly 40 percent of the lung donors presented chest X-ray abnormalities. Only 4.9 percent of the lung donors were accepted, representing 28 lungs (allograft utilization rate of 4 percent). The causes for donor exclusion were gas exchange alterations (in 30.1 percent), infection (in 23.7 percent) and distance (in 10.9 percent). CONCLUSIONS: The lung utilization rate in the state of São Paulo is low when compared to mean rates worldwide. In addition, more than half of the donor pool was excluded due to altered gas exchange or pulmonary infection. The combination of better care of the potential donor and more flexible selection criteria could increase allograft utilization.


Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Seleção do Doador/normas , Transplante de Pulmão , Doadores de Tecidos , Brasil , Causas de Morte , Seleção do Doador/métodos , Sobrevivência de Enxerto , Pulmão , Transplante de Pulmão/métodos , Estudos Retrospectivos , Adulto Jovem
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