Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Inhibidores de Puntos de Control Inmunológico/efectos adversos , Ipilimumab/efectos adversos , Melanoma/tratamiento farmacológico , Nivolumab/efectos adversos , Síndrome Uveomeningoencefálico/inducido químicamente , Femenino , Humanos , Persona de Mediana Edad , Síndrome Uveomeningoencefálico/patologíaRESUMEN
Laparoscopic colon and rectum operations expose peripheral nerves to risk due to extreme patient positions needed to achieve gravity displacement during the surgical procedures. The general incidence of position-caused nerve injuries in surgery is not well known and is estimated to be about 0.5â% in the literature. There are no current data concerning laparoscopic operations. This study assesses the incidence and outcome of surgery-associated neurological symptoms after laparoscopic colon and rectum surgical procedures. We analysed the number of position-caused nerve injuries and their outcome from 1992-2010 in a prospectively managed data base. Risk factors like age, BMI, procedure duration and abduction of the upper extremities were analysed. There were 19 (0.7â%) position-caused nerve injuries among 2698 laparoscopic operations on the colon and rectum. The incidence of surgery-associated neurological symptoms was 1.08â% after laparoscopic rectum and 0.54â% after laparoscopic colon surgical procedures. Both operation time (267 vs. 185 minutes) and BMI (27.93 vs. 25.79 kg/m(2)) were revealed as risk factors for position-caused nerve injuries. Adduction of the upper extremities reduced the incidence of positioning nerve injuries from 0.23â% to 0.1â%. Postoperative neurological symptoms were in most cases reversible (89.47â%). The incidence of postoperative nerve injuries since 2007 is low after laparoscopic rectum and colon operations and is mostly completely reversible. Both procedure duration and BMI are probable risk factors for surgery-associated nerve injuries. Adduction of the upper extremities provides an opportunity to reduce position-caused nerve injuries.
Asunto(s)
Enfermedades del Colon/cirugía , Laparoscopía/efectos adversos , Posicionamiento del Paciente/efectos adversos , Traumatismos de los Nervios Periféricos/etiología , Enfermedades del Recto/cirugía , Adulto , Anciano , Índice de Masa Corporal , Síndromes Compartimentales/diagnóstico , Síndromes Compartimentales/epidemiología , Síndromes Compartimentales/etiología , Síndromes Compartimentales/prevención & control , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Examen Neurológico , Posicionamiento del Paciente/instrumentación , Posicionamiento del Paciente/métodos , Traumatismos de los Nervios Periféricos/diagnóstico , Traumatismos de los Nervios Periféricos/epidemiología , Traumatismos de los Nervios Periféricos/prevención & control , Pronóstico , Factores de RiesgoRESUMEN
BACKGROUND: Pemphigus vulgaris (PV) and pemphigus foliaceus (PF) are potentially fatal blistering diseases caused by autoantibodies targeting desmoglein (Dsg) adhesion proteins. Previous studies have shown an IgG4 > IgG1 predominance of anti-Dsg antibodies in pemphigus; however, no studies have examined total serum IgG4 levels in pemphigus. IgG4 is induced by chronic antigen stimulation, which could occur with persistent skin blistering and potentially elevate the total serum IgG4 relative to other IgG subclasses in patients with pemphigus. OBJECTIVES: The primary aim of the study was to quantitate total and Dsg-specific IgG subclasses in patients with pemphigus. METHODS: IgG subclasses and Dsg-specific IgG1 and IgG4 were quantitated in patients with PV and PF, and in sera from age-matched controls using a subclass enzyme-linked immunosorbent assay. The effectiveness of IgG4 depletion in blocking IgG pathogenicity in PV was determined using a keratinocyte dissociation assay. RESULTS: Dsg-specific antibodies comprised a median of 7·1% and 4·2% of total IgG4 in patients with PV and PF, respectively, with eightfold and fourfold enrichment in IgG4 vs. IgG1. Total serum IgG4, but not other IgG subclasses, was enriched in patients with PV and PF compared with age-matched controls (P = 0·004 and P = 0·005, respectively). IgG4 depletion of PV sera reduced pathogenicity in a keratinocyte dissociation assay and showed that affinity-purified IgG4 is more pathogenic than other serum IgG fractions. CONCLUSIONS: Dsg-specific autoantibodies are significantly enriched in IgG4, which may explain the enrichment of total serum IgG4 in some patients with pemphigus. By preferentially targeting autoimmune rather than beneficial immune antibodies, IgG4-targeted therapies may offer safer treatment options for pemphigus.