RESUMO
Thromboembolic complications constitute an important risk in renal transplant patients, in whom a hypercoagulable state is associated with immunosuppressive treatment, and the presence of hypercoagulability and hypofibrinolysis specifically with cyclosporine. Hypercorticism secondary to steroid treatment has been associated with a thrombophilic state and the presence of a reduced fibrinolytic potential in particular. The aims of this study were to first evaluate the fibrinolytic potential by the venous occlusion (VO) test in 19 renal transplant (RT) patients, and then compare these findings with those obtained in similar groups of normal subjects and patients with Cushing's disease. The following tests were carried out before and after the VO test: euglobulin lysis time and t-PA and PAI-1 activities and antigen. Compared with normal controls, RT and Cushing's patients both showed a similar significant increase in PAI-1 activity and concentration. The VO test revealed a similar impairment in fibrinolytic potential in both the RT and Cushing groups. High and pathological PAI-1 levels before and after the VO test were consistent with a defective fibrinolytic potential due to the inhibitory effect of PAI-1 on plasminogen activation. A hypofibrinolytic state was found in 68.4% of RT patients. Our results suggest that an imbalance in the fibrinolytic system is a typical feature of RT patients one year after transplantation. Steroids appear to be the immunosuppressive drug mainly involved in determining thromboembolic risk after renal transplantation.
Assuntos
Fibrinolíticos/sangue , Transplante de Rim/fisiologia , Adulto , Síndrome de Cushing/sangue , Ciclosporina/efeitos adversos , Feminino , Humanos , Transplante de Rim/efeitos adversos , Masculino , Pessoa de Meia-Idade , Inibidor 1 de Ativador de Plasminogênio/sangue , Prednisolona/efeitos adversos , Tromboembolia/induzido quimicamente , Tromboembolia/etiologia , Fatores de Tempo , Ativador de Plasminogênio Tecidual/sangueRESUMO
Adrenal location of a hydatic cyst is a clinical occurrence of exceptional rarity, especially in its primitive form and it could be evaluated, on the operative and autoptic comparison, not to exceed overall 0.5% of all the possible locations. Moreover, among all the cystic formations of the adrenal glands, parasitic ones are only 7%. Our observation of a case of adrenal hydatidosis, initially suspected as hepatic mass, was casually discovered by means of abdominal ultrasonography and later confirmed with the operation. This work contributes to the knowledge of this pathology, emphasizing diagnostic difficulties, and, considering the exiguous literature, helping us in supplying real indications to the surgical treatment.
RESUMO
The authors report a case of intrabiliary rupture of some recurrent hepatic hydatid cysts. The biliary drainage was performed endoscopically during ERCP. The results of treatment were satisfactory. The value of total cystopericystectomy and external biliary drainage on prevention of cyst-biliary fistulas is underlined.
Assuntos
Doenças Biliares/etiologia , Equinococose Hepática/complicações , Idoso , Doenças Biliares/diagnóstico por imagem , Doenças Biliares/cirurgia , Equinococose Hepática/diagnóstico por imagem , Equinococose Hepática/cirurgia , Humanos , Masculino , Radiografia , Recidiva , Ruptura EspontâneaRESUMO
The authors report their experience relative to 8 patients who underwent IMA revascularization during infrarenal AAA repair. The Carrel patch technique was employed in all cases operated. With this procedure no ischemic intestinal complication occurred. Two cases of ischemic colitis were observed in a second group of 40 patients operated for AAA in whom the IMA wasn't reimplanted into the aortic graft. The overall incidence of acute intestinal ischemia was 4%.
Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Prótese Vascular , Artérias Mesentéricas/transplante , Adulto , Idoso , Colite/etiologia , Feminino , Humanos , Isquemia/etiologia , Masculino , Pessoa de Meia-IdadeRESUMO
The authors report their experience relative to 102 patients evaluated with carotid duplex-scanner. Ultrasonographic data of atherosclerotic carotid changes have been correlated with the outcome of the tested series. In fact, echographic images of vascular changes with high thromboembolic risk (ulcerated plaque) have been associated with cerebrovascular injuries in 25% of the cases. Furthermore, the duplex-scanner showed the need for surgical treatment (TEA) in 32 patients with asymptomatic carotid stenosis. Therefore, this noninvasive diagnostic tool seems to play an essential role in the prevention of cerebrovascular ischemia.
Assuntos
Arteriosclerose/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico por imagem , Trombose das Artérias Carótidas/prevenção & controle , Humanos , Valor Preditivo dos Testes , Prognóstico , UltrassonografiaRESUMO
BACKGROUND: Personal experience concerning the treatment of 8 patients with infrarenal aortic aneurysms associated with extravascular non-neoplastic abdominal diseases is presented. METHODS AND RESULTS: In all 7 cases which underwent combined surgical procedures (aneury-smectomy + cholecystectomy in 4 patients and aneurysmectomy + groin hernia repair in 3 patients) early and late postoperative complications were not recorded. CONCLUSIONS: The main therapeutic guidelines concerning the pathologic association of infrarenal aortic aneurysms associated with extravascular non-neoplastic abdominal diseases are discussed on the basis of a literature review and of personal experience.
Assuntos
Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/diagnóstico , Protocolos Clínicos , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The latest developments in the understanding of the etiopathogenesis of bronchial asthma in childhood are briefly described. The Authors emphasize the central role of inflammation and different cell types recruitment and distinguish three phases: early, late and chronic inflammation. Current views on bronchial hyperreactivity and the vicious circle represented by causative allergic and extra-allergic factors are discussed. Clinically, the role of respiratory infections, sinusitis, gastroesophageal reflux, and so-called asthma-equivalent symptoms (recurrent laryngospasm, asthma-equivalent chronic cough) are also discussed. Lastly, the pharmacologic activity of the main classes of drugs on the various stages of asthmatic response are reviewed and the rationale for appropriate use is presented.
Assuntos
Asma , Adolescente , Asma/complicações , Asma/tratamento farmacológico , Asma/etiologia , Criança , Pré-Escolar , Humanos , Hipersensibilidade , Lactente , Recém-NascidoAssuntos
Amilases/urina , Diabetes Mellitus Tipo 1/cirurgia , Duodeno/transplante , Rejeição de Enxerto , Transplante de Rim/imunologia , Lipase/urina , Transplante de Pâncreas/imunologia , Receptores de Interleucina-2/análise , Biomarcadores/sangue , Biomarcadores/urina , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/urina , Seguimentos , Humanos , Transplante de Rim/fisiologia , Transplante de Pâncreas/fisiologia , Transplante Homólogo/imunologia , Bexiga Urinária/cirurgiaAssuntos
Sobrevivência de Enxerto , Transplante de Rim/fisiologia , Doadores de Tecidos/classificação , Adolescente , Adulto , Fatores Etários , Idoso , Criança , Pré-Escolar , Dopamina , Feminino , Humanos , Hipertensão , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Seleção de Pacientes , Estudos Retrospectivos , Análise de Sobrevida , Doadores de Tecidos/provisão & distribuição , Resultado do TratamentoAssuntos
Fígado , Transplante de Pâncreas , Pâncreas , Doadores de Tecidos , Humanos , Resultado do TratamentoAssuntos
Transplante de Rim , Transplante de Pâncreas , Complicações Pós-Operatórias , Sepse/etiologia , Infecções Bacterianas/etiologia , Infecções Bacterianas/imunologia , Candidíase/etiologia , Candidíase/imunologia , Diabetes Mellitus Tipo 1/cirurgia , Nefropatias Diabéticas/cirurgia , Rejeição de Enxerto , Humanos , Imunossupressores/uso terapêutico , Transplante de Pâncreas/métodos , Transplante de Pâncreas/fisiologia , Estudos Retrospectivos , Sepse/imunologiaAssuntos
Soluções Hipertônicas , Isquemia , Transplante de Rim/fisiologia , Rim , Soluções para Preservação de Órgãos , Preservação de Órgãos/métodos , Adenosina , Alopurinol , Animais , Nitrogênio da Ureia Sanguínea , Creatinina/sangue , Glutationa , Insulina , Rim/irrigação sanguínea , Transplante de Rim/patologia , Necrose Tubular Aguda/patologia , Túbulos Renais Proximais/patologia , Túbulos Renais Proximais/ultraestrutura , Microscopia Eletrônica , Microvilosidades/ultraestrutura , Rafinose , Suínos , Transplante AutólogoAssuntos
Transplante de Rim/fisiologia , Animais , Cadáver , Humanos , Transplante de Rim/patologia , Suínos , Doadores de TecidosAssuntos
Ciclosporina/uso terapêutico , Transplante de Rim/fisiologia , Resistência Vascular/fisiologia , Adolescente , Adulto , Pressão Sanguínea/efeitos dos fármacos , Ciclosporina/administração & dosagem , Humanos , Infusões Intravenosas , Rim/diagnóstico por imagem , Transplante de Rim/imunologia , Masculino , Pessoa de Meia-Idade , Núcleo Familiar , Doadores de Tecidos , Transplante Homólogo , Ultrassonografia , Resistência Vascular/efeitos dos fármacosRESUMO
The effect of anthracycline antibiotics on the activity of the partially purified and reconstituted tricarboxylate carrier system of the rat liver mitochondria was studied. It was found that the citrate/citrate exchange activity is inhibited by Br-daunomycin and with less potency by doxorubicin, daunomycin, epirubicin and idarubicin. The inhibition of the citrate transport activity is concentration and time-dependent. Cardiolipin protects against the inhibition by Br-daunomycin and the reconstituted citrate transport activity depends upon the ratio of cardiolipin/Br-daunomycin.
Assuntos
Antibióticos Antineoplásicos/farmacologia , Proteínas de Transporte/metabolismo , Mitocôndrias Hepáticas/metabolismo , Animais , Citratos/metabolismo , Daunorrubicina/análogos & derivados , Daunorrubicina/farmacologia , Doxorrubicina/farmacologia , Epirubicina/farmacologia , Idarubicina/farmacologia , Cinética , RatosRESUMO
Volunteer cuddler programs have the potential to enhance the human caring aspects of complex technological nursing care provided premature infants. Nurse researchers have identified the value of human touch and stimulation to the development of premature infants. Although the fragile premature infant may not always appear to respond overtly, the weight gain, and social and mental development of the cuddled babies give testimony to the effectiveness of human attention. The infants' improved well-being and subsequent earlier hospital discharge as a result of cuddling are convincing rationale to implement a cuddler program. A well administered hospital volunteer program is an excellent resource for cuddlers. Volunteers tend to be readily attracted to a neonatal nursery and their services have proven to be safe and therapeutic. After determining the type of service needed, nurse administrators and directors of volunteer programs may team together to develop their strategy. A literature review about cuddler programs and the development of the premature infant contain valuable information of research findings and experience of other nurses. Staff nurse and physician involvement in the program are essential for overall success as well as identifying an effective person to coordinate the plan. The team of planners need a program development and implementation schedule, a volunteer job description and a training plan. Orientation of all nursing staff to the program may occur simultaneously with volunteer recruitment. Evaluation of a cuddler program utilizing predetermined criteria should occur at scheduled intervals.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Cuidado do Lactente , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal , Voluntários , Humanos , Recém-Nascido , Voluntários/educaçãoRESUMO
We studied the prevalence of long-term responders to interferon-alpha (IFN-alpha) treatment (undetectable levels of serum IgM anti-HBc, HBV-DNA and normal ALT values for 3 years) in 53 anti-HBe-positive chronic hepatitis B patients. Forty-two of them were treated with (6-18 MU) alpha-2a-recombinant-IFN t.w. for 4-6 months, and the remaining 11 with 10 MU of lymphoblastoid-IFN thrice weekly for 6 months. At the end of treatment, HBV-DNA levels were undetectable and ALT values within the normal range in 34 of 53 patients (60%); IgM anti-HBc levels decreased in all the 34 patients, falling below 10 PEI U in 2/34 (6%). Response to treatment was maintained throughout the follow-up (mean 3 years, range 2-7 years) in five patients (9.4%). The remaining 29 patients experienced HBV reactivation within median follow-up of 6 months (range 1-22 months; 90% of cases within 12 months). Overall 4/9 long-term responders (44.4%) cleared serum HBsAg. In conclusion, chronic anti-HBe-positive hepatitis B has a lower IFN treatment response rate than the HBeAg-positive form; however, among long-term responders, the incidence of serum HBsAg clearance is comparable in the two forms. Because of the high rate of relapses, stringent monitoring criteria (HBV-DNA, IgM anti-HBc and ALT monthly tested for at least 12 months) are mandatory.
Assuntos
Antígenos E da Hepatite B/sangue , Hepatite B/terapia , Interferon-alfa/uso terapêutico , Adolescente , Adulto , Criança , Pré-Escolar , Doença Crônica , Códon , DNA Viral/análise , Feminino , Regulação Viral da Expressão Gênica , Hepatite B/imunologia , Hepatite B/virologia , Antígenos E da Hepatite B/genética , Vírus da Hepatite B/genética , Humanos , Interferon alfa-2 , Masculino , Pessoa de Meia-Idade , Proteínas Recombinantes , Resultado do TratamentoRESUMO
A randomized controlled multicentre trial was undertaken to assess the effectiveness of natural IFN beta (Frone) administered by intramuscular injection to chronic hepatitis B patients. Sixty-five HBsAg and HBeAg carriers with chronic hepatitis and intrahepatic HBcAg histologically proven by immunohistochemistry were included in the study. Fifty-nine patients completed the study: 30 of them (mean age 27 years, range 14-55 years, 16M/14F) were treated with 5 Million Units (MU)/m2 of Frone three times weekly for six months and 29 (mean age 28 years, range 14-59 years, 18M/11F) were not treated. The 2 groups of patients were similar in their clinical and histological (CAH/CPH ratio 25/5 and 20/9) characteristics. In the treated patients, a significant reduction in viremia was observed starting from the 6th month of the follow-up (p < 0.01), accompanied by a significant reduction of serum aminotransferase levels (p < 0.005). At the end of therapy serum HBeAg was undetectable in 7 of 30 (23%) treated patients and in 1 of 29 (3%) controls. Six months after the end of treatment 8 of 30 (26%) treated patients and 5 of 29 (17%) controls were HBeAg negative. A significant difference (p < 0.05) was observed in the rate of anti-HBe seroconversion between the 2 groups starting from the 8th month of follow-up. Mild side effects, namely fever < 38 degrees C and asthenia were observed in 20% and 37% of treated patients. In conclusion natural beta interferon given intramuscularly is effective in HBeAg positive patients suffering from chronic hepatitis B with optimal compliance.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Hepatite B/terapia , Hepatite Crônica/terapia , Interferon beta/uso terapêutico , Viremia/terapia , Adulto , Esquema de Medicação , Feminino , Seguimentos , Antígenos de Superfície da Hepatite B/análise , Antígenos E da Hepatite B/análise , Humanos , Injeções Intramusculares , Interferon beta/administração & dosagem , Masculino , Fatores de TempoRESUMO
BACKGROUND: Platelet and white blood cell counts decrease in chronic viral hepatitis patients treated with alpha interferon. AIM: To analyse whether delta negative variations in platelets and white blood cells are influenced by type, dose and duration of alpha interferon treatment, we studied 340 consecutive patients (mean treatment 8 months, range 4-18 months). PATIENTS AND METHODS: A total of 204 (60%) patients were treated with recombinant alpha interferons (30% alpha-2a and 30% alpha-2b), 64 (19%) with N3.leukocytic and 72 (21%) N1.lymphoblastoid natural interferons. Median age and male/female ratios were comparable in the 3 groups (41, 41 and 43 years and 2.3, 2.6 and 2.5, respectively). The lowest platelets and white blood cells counts were observed between the 2nd and the 4th month of therapy in all patients. Age, sex, aetiology and duration of interferon therapy did nor influence the platelets and white blood cells reduction rates. The decrease was lower for patients treated with N3.leukocytic interferon than for the other interferons. A significant difference was observed between interferon doses when the groups treated with 3 or 9-10 MIU were compared. However, dose or cirrhosis-related bias are ruled out by similar proportions of cirrhosis and patients treated with 3 MIU in the 3 groups of patients treated with different types of interferon. CONCLUSIONS: The type of interferon appears to represent a major cause of the different haemopoietic toxicity. The lowest toxicity of N3.leukocytic interferon may have clinical implications for the choice of interferon in patients with low baseline platelets and white blood cells counts. These findings prompt prospective studies on larger series of patients.