RESUMEN
In Brazil, around 80% of snakebites are caused by snakes of the genus Bothrops. A three-dimensional culture model was standardized and used to perform treatments with Bothrops erythromelas venom (BeV) and its antivenom (AV). The MRC-5 and L929 cell lines were cultured at increasing cell densities. Morphometric parameters were evaluated through images obtained from an inverted microscope: solidity, circularity, and Feret diameter. L929 microtissues (MT) showed better morphometric data, and thus they were used for further analysis. MT viability was assessed using the acridine orange and ethidium bromide staining method, which showed viable cells in the MT on days 5, 7, and 10 of cultivation. Histochemical and histological analyses were performed, including hematoxylin/eosin staining, which showed a good structure of the spheroids. Alcian blue staining revealed the presence of acid proteoglycans. Immunohistochemical analysis with ki-67 showed different patterns of cell proliferation. The MT were also subjected to pharmacological tests using the BeV, in the presence or absence of its AV. The results showed that the venom was not cytotoxic, but it caused morphological changes. The MT showed cell detachment, losing their structure. The antivenom was able to partially prevent the venom activities.
Asunto(s)
Antivenenos , Bothrops , Supervivencia Celular , Venenos de Crotálidos , Fibroblastos , Animales , Venenos de Crotálidos/toxicidad , Antivenenos/farmacología , Supervivencia Celular/efectos de los fármacos , Línea Celular , Fibroblastos/efectos de los fármacos , Proliferación Celular/efectos de los fármacos , Ratones , Humanos , Técnicas de Cultivo de Célula , Serpientes VenenosasRESUMEN
BACKGROUND: The attitude toward cytoreductive surgery with HIPEC in peritoneal carcinomatosis from colorectal cancer is unclear. The aim of this study is to report the perioperative outcomes after cytoreductive surgery with HIPEC in patients ≥ 75 years. METHODS: This retrospective multicenter study collected the data the Spanish Group of Peritoneal Cancer Surgery. Thirty-six patients with peritoneal carcinomatosis from colorectal cancer met the selection criteria for the study. Morbidity, mortality, disease-free and overall survival were analyzed. RESULTS: Morbidity (grade III-IV) was 17% and 2 patients died of complications related to the procedure (5.4%). Median disease-free survival (DFS) was 16 months. DFS at 1 and 3 years was 81% and 42%, respectively. Overall survival at 1 and 3 years was 96% and 75%. In the univariate analysis, preoperative comorbidities (p = 0.01), liver metastases (p = 0.02), blood transfusion (p = 0.001) and postoperative complications (p = 0.001); and in the multivariate analysis, perioperative blood transfusion (OR 2.56, 95% CI 1.95-6.24, p = 0.03) and postoperative complications (OR 3.25, 95% CI 2.35-7.56, p = 0.02) were associated with a lower overall survival. CONCLUSIONS: Age is not an absolute contraindication to perform cytoreduction surgery with HIPEC in highly selected elderly patients with colorectal peritoneal carcinomatosis.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Quimioterapia del Cáncer por Perfusión Regional/mortalidad , Neoplasias Colorrectales/mortalidad , Procedimientos Quirúrgicos de Citorreducción/mortalidad , Hipertermia Inducida/mortalidad , Neoplasias Peritoneales/mortalidad , Anciano , Anciano de 80 o más Años , Neoplasias Colorrectales/patología , Neoplasias Colorrectales/terapia , Terapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Masculino , Neoplasias Peritoneales/secundario , Neoplasias Peritoneales/terapia , Pronóstico , Estudios Retrospectivos , España , Tasa de SupervivenciaRESUMEN
BACKGROUND: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) for pseudomyxoma peritonei and appendix tumours are widespread in the world. It is unclear what should be the attitude in elderly patients. METHODS: This retrospective multicenter study collected the database from ten Spanish centers from Spanish Group of Peritoneal Cancer Surgery. The study period was between November 2002 and March 2014. Seventeen patients with age greater than or equal to 75 years with peritoneal carcinomatosis from pseudomyxoma peritonei and appendix tumours met the selection criteria for the study. Outcomes in terms of morbidity and mortality such as disease-free and overall survival were analyzed. RESULTS: Median PCI was 16 (range 6-39). Ten postoperative adverse events were detected in nine patients (44.4%). 28% were grade I-II and 17% were grade III-IV. Disease-free survival at 1 and 3 years was 67 and 44%, respectively. Overall survival at 1 and 3 years was 100 and 88%, respectively. Only cytoreduction was related to worst disease free survival after univariate (p = 0.007) and multivariate (OR 11.639, 95% CI 1.24-109.74, p = 0.03) analyses. Cytoreduction was related to the worst overall survival after univariate analysis (p = 0.046). CONCLUSION: Cytoreductive surgery and HIPEC for pseudomyxoma peritonei and appendix tumours in elderly patients it is a procedure with feasible postoperative morbi-mortality and survival outcomes. TRIAL REGISTRATION: researchregistry1587 (retrospectively registered).
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias del Apéndice/terapia , Quimioterapia del Cáncer por Perfusión Regional/mortalidad , Procedimientos Quirúrgicos de Citorreducción/mortalidad , Hipertermia Inducida/mortalidad , Neoplasias Peritoneales/terapia , Seudomixoma Peritoneal/terapia , Anciano , Anciano de 80 o más Años , Neoplasias del Apéndice/patología , Terapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Masculino , Neoplasias Peritoneales/secundario , Pronóstico , Seudomixoma Peritoneal/patología , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
PURPOSE: To evaluate the efficacy of extracorporeal shock wave lithotripsy (SWL) on lower calyceal calculi in relation to the renal anatomical factors and determine which of these factors can be used to select patients who will benefit from SWL. MATERIALS AND METHODS: We analyzed retrospectively 78 patients with single radiopaque lower calyceal stones treated with SWL. The patients were evaluated 3 months after lithotripsy with a simple abdominal X-ray and a kidney ultrasound scan. The success of the treatment, removal of all fragments, was correlated with renal anatomical factors measured in the pre-treatment intravenous urography: infundibulopelvic angle, lower infundibulum width, lower infundibulum length, ratio length/width, infundibulum height, and number of minor calyces in the lower calyceal group. RESULTS: Three months after SWL treatment, 39 patients were stone-free (NR group) and 39 had residual fragments (R group). Both groups presented no differences in relation to infundibulopelvic angle, width and length of the lower calyceal infundibulum, length/width ratio of the lower infundibulum or number of lower calyces. Height of the infundibulum, described as the distance between the line passing through the lowest part of the calyx containing the calculus and the highest point of the lower lip of renal pelvis, was the only parameter in which significant differences (p = 0.002) were found between the NR and R groups. CONCLUSIONS: Lower Infundibular height could be a good measurement tool for deciding which patients with lower calyceal lithiasis would benefit from SWL treatment. Height of less than 22 mm suggests a good outcome from lithotripsy.
Asunto(s)
Cálculos Renales/terapia , Cálices Renales/anatomía & histología , Litotricia , Femenino , Humanos , Litotricia/normas , Modelos Logísticos , Masculino , Persona de Mediana Edad , Curva ROC , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
PURPOSE: To evaluate the efficacy of extracorporeal shock wave lithotripsy (SWL) on lower calyceal calculi in relation to the renal anatomical factors and determine which of these factors can be used to select patients who will benefit from SWL. MATERIAL AND METHODS: We analyzed retrospectively 78 patients with single radiopaque lower calyceal stones treated with SWL. The patients were evaluated 3 months after lithotripsy with a simple abdominal X-ray and a kidney ultrasound scan. The success of the treatment, removal of all fragments, was correlated with renal anatomical factors measured in the pre-treatment intravenous urography: infundibulopelvic angle, lower infundibulum width, lower infundibulum length, ratio length/width, infundibulum height, and number of minor calyces in the lower calyceal group. RESULTS: Three months after SWL treatment, 39 patients were stone-free (NR group) and 39 had residual fragments (R group). Both groups presented no differences in relation to infundibulopelvic angle, width and length of the lower calyceal infundibulum, length/width ratio of the lower infundibulum or number of lower calyces. Height of the infundibulum, described as the distance between the line passing through the lowest part of the calyx containing the calculus and the highest point of the lower lip of renal pelvis, was the only parameter in which significant differences (p = 0.002) were found between the NR and R groups. CONCLUSIONS: Lower Infundibular height could be a good measurement tool for deciding which patients with lower calyceal lithiasis would benefit from SWL treatment. Height of less than 22 mm suggests a good outcome from lithotripsy.
Asunto(s)
Femenino , Humanos , Masculino , Persona de Mediana Edad , Cálculos Renales/terapia , Cálices Renales/anatomía & histología , Litotricia , Modelos Logísticos , Litotricia/normas , Estudios Retrospectivos , Curva ROC , Resultado del TratamientoRESUMEN
Peritoneal carcinomatosis, considered years ago as a final stage of unresectable cancer, can now be managed with curative intention by means of a radical cytoreductive surgical procedure with associated peritonectomy and intraperitoneal chemotherapy, as described by Sugarbaker. Malignant neoplasms such as mesothelioma and pseudomyxoma peritonei, ovarian and colon cancer nowadays are experiencing some new therapeutical approaches. Higher survival rates can be reached in ovarian cancer, which is commonly diagnosed in the presence of peritoneal carcinomatosis, using an optimal cytoreductive radical surgery with intraperitoneal chemotherapy. An actualised review of the treatment of advanced ovarian cancer and a proposal of a national multicentre protocol for the treatment of peritoneal carcinomatosis from ovarian cancer has been performed by a group of Spanish surgeons and oncologists dedicated to a therapeutical approach to this pathology.
Asunto(s)
Carcinoma/terapia , Neoplasias Ováricas/terapia , Neoplasias Peritoneales/terapia , Carcinoma/tratamiento farmacológico , Carcinoma/secundario , Terapia Combinada , Femenino , Humanos , Neoplasias Ováricas/tratamiento farmacológico , Neoplasias Ováricas/patología , Selección de Paciente , Neoplasias Peritoneales/tratamiento farmacológico , Neoplasias Peritoneales/secundario , Análisis de SupervivenciaRESUMEN
INTRODUCTION AND OBJECTIVE: The endocranial hypertension syndrome is one of the commonest and most feared neurological complications in clinical practice. This encourages its continued study, and is the subject of this review. DEVELOPMENT: Endocranial hypertension is the common pathway for the presentation of many neurological and non neurological disorders. An increase in the volume of one or more intracranial structures causes secondary lesions of the brain and even the death of the patient, although this may frequently be avoided by prompt recognition and suitable action by the doctor involved. General, non specific therapeutic measures should be instituted to achieve a normal endocranial pressure. The clinical presentation and complementary investigations should be correctly interpreted to determine the aetiology of the condition so that specific treatment may be given. Continuous monitoring of the intracranial pressure and other neuromonitorization techniques are essential for correct decisions as to treatment. CONCLUSIONS: Understanding the physiopathology, diagnosis and treatment of the syndrome of endocranial hypertension are still essential in modern medicine. In recent years there have been advances in the use of well known treatments and new drugs have been introduced. Use of the different neuromonitoring techniques permits optimum use of the treatment available.
Asunto(s)
Hipertensión Intracraneal , Edema Encefálico/complicaciones , Edema Encefálico/fisiopatología , Líquido Cefalorraquídeo/metabolismo , Circulación Cerebrovascular , Humanos , Hipertensión Intracraneal/diagnóstico , Hipertensión Intracraneal/etiología , Hipertensión Intracraneal/fisiopatología , Hipertensión Intracraneal/terapia , Presión Intracraneal , Monitoreo FisiológicoRESUMEN
Se informan algunos hallazgos durante y después de la talamotomía subventrolateral en pacientes parkinsonianos. En nuestros pacientes la simetría del trazado no se altera ni por la introducción del electrodo de coagulación, ni por las estimulaciones del VL o su coagulación. La estimulación a baja frecuencia da lugar a pontenciales evocados de superficie (no estudiados aquí y en algunos pacientes tardíamente, mucho después de cesar la estimulación) y a una actividad lenta hipersincrónica de la misma cadencia que la estimulación. Inmediatamente después de la coagulación del VL pueden verse algunos trenes theta generalizados de bajo o moderado voltaje. Se da a conocer una curiosa "crisis reclutante" en regiones frontocentrales de ambos lados, provocada sin estimulación eléctrica, por el solo cambio de posición de la aguja-electrodo (AU)