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Humanos , Masculino , Anciano , Neoplasias Gástricas/patología , Fibrosis/complicaciones , Adenocarcinoma , AutopsiaRESUMEN
Background and objectives: Cardiac remodeling in pregnancy and postpartum is poorly understood. The aim of this study was to evaluate changes in cardiac fibrosis (pericardial, perivascular, and interstitial), as well as the expression of matrix metalloproteinases (MMP-1, MMP-2, and MMP-9) and their inhibitors (Tissue inhibitors of metalloproteinases, TIMP-1 and TIMP-4) during late pregnancy and postpartum in rat left ventricle. Materials and Methods: Female Sprague-Dawley rats were used for this study. Rats were divided three groups: non-pregnant, late pregnancy, and postpartum. The heart was weighed and cardiac fibrosis was studied by conventional histological procedures. The expression and transcript level of target proteins were evaluated using immunoblot techniques and quantitative PCR. Results: The experiments showed an increase of perivascular, pericardial, and interstitial fibrosis in heart during pregnancy and its reversion in postpartum. Moreover, in late pregnancy, MMP-1, MMP-2, and MMP-9 metalloproteinases were downregulated and TIMP-1 and TIMP-4 were upregulated in left ventricle. Conclusions: Our data suggest that the metalloproteinases system is involved in the cardiac extracellular matrix remodeling during pregnancy and its reversion in postpartum, this improves the knowledge of the adaptive cardiac remodeling in response to a blood volume overload present during pregnancy.
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Fibrosis/complicaciones , Ventrículos Cardíacos/fisiopatología , Metaloproteinasas de la Matriz/metabolismo , Animales , Modelos Animales de Enfermedad , Femenino , Fibrosis/fisiopatología , Ventrículos Cardíacos/enzimología , Metaloproteinasa 1 de la Matriz/metabolismo , Metaloproteinasa 1 de la Matriz/fisiología , Metaloproteinasa 2 de la Matriz/metabolismo , Metaloproteinasa 2 de la Matriz/fisiología , Metaloproteinasa 9 de la Matriz/metabolismo , Metaloproteinasa 9 de la Matriz/fisiología , Metaloproteinasas de la Matriz/fisiología , Periodo Posparto , Embarazo , Ratas , Ratas Sprague-Dawley , Inhibidor Tisular de Metaloproteinasa-1/metabolismo , Inhibidor Tisular de Metaloproteinasa-1/fisiología , Inhibidor Tisular de Metaloproteinasa-2/metabolismo , Inhibidor Tisular de Metaloproteinasa-2/fisiologíaRESUMEN
Introdução: A fibrose, o edema intenso e a equimose são as intercorrências que representam um grande desafio ao fisioterapeuta dermatofuncional no pós-operatório de cirurgia plástica de lipoaspiração e abdominoplastia. O objetivo é propor uma abordagem inédita desde o pré, trans e pós-operatório para prevenir e minimizar as fibroses, edema intenso e equimoses, acelerando a recuperação do paciente e reduzindo o número de sessões. Método: Ensaio clínico controlado, composto por 20 pacientes do sexo feminino, com idade entre 18 e 56 anos, divididos em dois grupos: 10 no grupo controle (GC) e 10 no grupo experimental (GE), que apresentavam indicação cirúrgica de abdominoplastia ou lipoaspiração abdominal, associadas ou não, e que se encontravam com no mínimo 7 dias de pré-operatório. Os dois grupos foram avaliados no pré-operatório. O GC recebeu atendimento somente a partir do 4º dia de pós-operatório, enquanto que o grupo GE recebeu atendimento durante o pré, trans e pós-operatório. Resultados: O grupo experimental apresentou uma média menor do número de sessões (p = 0,0032), perimetria menor no 4º dia de pós-operatório (p < 0,05) nos pontos antômicos: sulco inframamário e crista ilíaca, média menor na resolução da fibrose (p = 0,0058) e média menor na resolução da equimose (p = 0,0002) em relação ao grupo controle. Conclusão: Pode-se concluir com este estudo inédito que o tratamento no pré, trans e pós-operatório reduz o edema, a formação de equimose e principalmente a formação de fibrose no pós-operatório. Também diminui o número de sessões fisioterapêuticas e acelera o restabelecimento do paciente no pós-operatório das cirurgias abdominais.
Introduction: Fibrosis, intense edema, and ecchymosis are complications that represent a great challenge to dermatofunctional physiotherapists in the postoperative period of liposuction and abdominoplasty. Here we aimed to propose a new approach in the pre-, trans-, and postoperative periods to prevent and minimize fibrosis, intense edema, and ecchymosis, thereby expediting the patient's recovery and reducing the number of required physiotherapy sessions. Method: This controlled clinical trial included 20 female patients aged 18-56 years who were divided into the control group (CG; n = 10) and experimental group (EG; n = 10). All were scheduled to undergo abdominoplasty or abdominal liposuction at least 7 days after enrollment. The two groups were evaluated preoperatively. The CG received care only from the 4th postoperative day, while the EG received care during the pre-, trans-, and postoperative periods. Results: The EG required fewer mean physiotherapy sessions (p = 0.0032) and had lower perimetry values on the 4th postoperative day (p < 0.05) in the inframammary groove and iliac crest, lower mean resolution of fibrosis (p = 0.0058), and lower mean resolution of ecchymosis (p = 0.0002) compared to the CG. Conclusion: The findings of this unprecedented study indicate that treatment in the pre-, trans-, and postoperative periods reduces edema, ecchymosis, and fibrosis formation in the postoperative period. It also decreases the number of required physiotherapy sessions and accelerates patient recovery from abdominal plastic surgery.
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Humanos , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Fibrosis/cirugía , Fibrosis/complicaciones , Lipectomía/métodos , Procedimientos de Cirugía Plástica/métodos , Equimosis/cirugía , Equimosis/complicaciones , Edema/cirugía , Edema/complicaciones , Pacientes , Complicaciones Posoperatorias , Fibrosis , Lipectomía , Modalidades de Fisioterapia , Equimosis , Edema , Complicaciones IntraoperatoriasRESUMEN
OBJECTIVE: To assess sublingual microcirculation in cirrhotic patients and its relationship to spider angiomas, complications, and outcome. METHODS: Thirty-one cirrhotic patients were prospectively compared to 31 matched controls. Sublingual microcirculation was evaluated by videomicroscopy. We specifically looked for capillaries with increased RBCV, which was defined as a velocity higher than the percentile 100th of controls. RESULTS: Compared to controls, cirrhotic patients showed decreased total and PVD (14.4 ± 2.2 vs 16.0 ± 1.3 and 14.1 ± 2.3 vs 15.9 ± 1.6 mm/mm2 , respectively, P < .001 for both) and increased HFI (0.64 ± 0.39 vs 0.36 ± 0.21, P = .001). They also exhibited high RBCV in 2% of the microvessels (P < .0001). Patients with MELD score ≥10 had higher RBCV than patients with score <10 (1414 ± 290 vs 1206 ± 239 µm/s, P < .05). Patients with spider angiomas showed lower vascular densities. Microcirculation did not differ between survivors and nonsurvivors. CONCLUSIONS: Cirrhosis is associated with microcirculatory alterations that can be easily monitored in the sublingual mucosa. Alterations included decreased density and PPV and hyperdynamic microvessels. The most striking finding, however, was the microvascular heterogeneity. Patients with spider angiomas had more severe alterations. Larger studies should clarify the relationship between microcirculatory abnormalities and outcome.
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Fibrosis/fisiopatología , Microcirculación , Suelo de la Boca/irrigación sanguínea , Adulto , Velocidad del Flujo Sanguíneo , Estudios de Casos y Controles , Femenino , Fibrosis/complicaciones , Hemangioma , Humanos , Masculino , Microscopía por Video , Microvasos/fisiopatología , Persona de Mediana Edad , Suelo de la Boca/patología , Estudios ProspectivosRESUMEN
Purpose: To describe a new model of actinic enteritis that does not use radiotherapy machines. Methods: Sixteen Wistar rats were divided into four groups, consisting of four animals each: control (group A), two weeks after irradiation (group B), five weeks after irradiation (group C) and eight weeks after irradiation (group D). Animals were given a 10Gy radiation from a Cobalt-60 natural source in a nuclear technology research center. Protections of the surrounding tissues were obtained through the usage of plumb devices with a hole in the center, which served as a collimator. We obtained irradiated and non-irradiated colons from each animal. Results: In group B we found an important inflammatory response in the irradiated colon, which appeared in a reduced way in group C and was minimal in group D, in which we found a relevant collagen submucosal deposition/fibrosis. In all groups, the non-irradiated colon had a lower pathological damage in comparison with the irradiated colon. Conclusion: We thus described an efficient and feasible technique for obtaining an animal model of actinic enteritis.(AU)
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Animales , Femenino , Ratas , Modelos Animales , Radioisótopos de Cobalto/administración & dosificación , Radioisótopos de Cobalto/efectos de la radiación , Radioisótopos de Cobalto/uso terapéutico , Colon/efectos de la radiación , Enteritis/radioterapia , Fibrosis/inducido químicamente , Fibrosis/complicacionesRESUMEN
BACKGROUND: Cancer cachexia is a multifactorial syndrome that dramatically decreases survival. Loss of white adipose tissue (WAT) is one of the key characteristics of cachexia. WAT wasting is paralleled by microarchitectural remodeling in cachectic cancer patients. Fibrosis results from uncontrolled ECM synthesis, a process in which, transforming growth factor-beta (TGFß) plays a pivotal role. So far, the mechanisms involved in adipose tissue (AT) re-arrangement, and the role of TGFß in inducing AT remodeling in weight-losing cancer patients are poorly understood. This study examined the modulation of ECM components mediated by TGFß pathway in fibrotic AT obtained from cachectic gastrointestinal cancer patients. METHODS: After signing the informed consent form, patients were enrolled into the following groups: cancer cachexia (CC, n = 21), weight-stable cancer (WSC, n = 17), and control (n = 21). The total amount of collagen and elastic fibers in the subcutaneous AT was assessed by histological analysis and by immunohistochemistry. TGFß isoforms expression was analyzed by Multiplex assay and by immunohistochemistry. Alpha-smooth muscle actin (αSMA), fibroblast-specific protein (FSP1), Smad3 and 4 were quantified by qPCR and/or by immunohistochemistry. Interleukin (IL) 2, IL5, IL8, IL13 and IL17 content, cytokines known to be associated with fibrosis, was measured by Multiplex assay. RESULTS: There was an accumulation of collagen and elastic fibers in the AT of CC, as compared with WSC and controls. Collagens type I, III, VI, and fibronectin expression was enhanced in the tissue of CC, compared with both WSC and control. The pronounced expression of αSMA in the surrounding of adipocytes, and the increased mRNA content for FSP1 (20-fold) indicate the presence of activated myofibroblasts; particularly in CC. TGFß1 and TGFß3 levels were up-regulated by cachexia in AT, as well in the isolated adipocytes. Smad3 and Smad4 labeling was found to be more evident in the fibrotic areas of CC adipose tissue. CONCLUSIONS: Cancer cachexia promotes the development of AT fibrosis, in association with altered TGFß signaling, compromising AT organization and function.
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Tejido Adiposo/patología , Caquexia/metabolismo , Neoplasias/metabolismo , Transducción de Señal , Factor de Crecimiento Transformador beta/metabolismo , Actinas/genética , Actinas/metabolismo , Adulto , Anciano , Caquexia/complicaciones , Proteínas de Unión al Calcio/genética , Proteínas de Unión al Calcio/metabolismo , Femenino , Fibrosis/complicaciones , Expresión Génica , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/complicaciones , Neoplasias/patología , Isoformas de Proteínas/metabolismo , Proteína de Unión al Calcio S100A4 , Proteínas Smad/genética , Proteínas Smad/metabolismoRESUMEN
Fundamentos: Disfunção do ventrículo direito (VD) é observada em 30-50% dos pacientes com infarto do miocárdio na parede inferior (IM-I) e é fator preditor de mortalidade precoce. A fibrose miocárdica está associada com disfunção ventricular progressiva e prognóstico grave. Nesses pacientes, a ressonância magnética cardíaca (RMC) é um importante método de estratificação de risco. Objetivos: Avaliar a associação entre disfunção do VD e fibrose miocárdica em pacientes com IM-I por RMC. Métodos: Estudo coorte realizado em um centro de cardiologia de referência. Quarenta indivíduos com IM-I foram incluídos no estudo. RMC foi realizada durante a internação para estimar função do VD e quantificar fibrose miocárdica pela técnica de realce tardio com gadolínio (TRT). Os pacientes foram estratificados quanto à função ventricular, e características clínicas foram comparadas entre os grupos. Resultados: Quarenta pacientes foram incluídos no estudo, 75% eram homens e 43% idosos (idade ≥ 60 anos). Entre os fatores de risco cardiovasculares, hipertensão (45%) e tabagismo (33%) foram os mais prevalentes. A disfunção do VD estava presente em 33% dos pacientes. A massa de fibrose média foi 22 ± 12g nos pacientes com disfunção do VD e 15 ± 8 g nos pacientes com função ventricular preservada (p = 0,051). Conclusões: Os resultados deste estudo indicam uma possível associação entre disfunção do VD e fibrose miocárdica nos pacientes com IM-I. No entanto, outros estudos envolvendo um maior número de pacientes são necessários para confirmar nossos achados
Background: Right ventricular dysfunction (RVD) can be found in 30-50% of patients with inferior wall myocardial infarction (I-MI) and predicts early mortality. Myocardial fibrosis is associated with progressive ventricular dysfunction and severe prognosis. In these patients, cardiovascular magnetic resonance (CMR) is an important risk stratification method. Objectives: This study sought to evaluate the association between RVD and myocardial fibrosis in patients with I-MI, using CMR. Methods: Cohort study conducted in a prominent center of cardiology. Forty individuals with I-MI were included in the study. CMR was performed during hospitalization to estimate parameters of right ventricle function and to quantify myocardial fibrosis through late gadolinium enhancement (LGE) technique. Patients were stratified by ventricular function, and clinical characteristics were compared between study groups. Results: Forty patients were included in the study, 75% were male and 43% elderly (age ≥ 60 years). Hypertension (45%) and smoking (33%) were the most prevalent cardiovascular risk factors. RVD was found in 33% of patients. Mean fibrosis mass was 22 ± 12 g in patients with RVD compared with 15 ± 8 g in patients with preserved ventricular function (p = 0.051). Conclusions: The findings of our study indicate a possible association between RVD and myocardial fibrosis in patients with I-MI. However, further studies with larger series are needed to confirm our findings
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Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Fibrosis/complicaciones , Fibrosis/diagnóstico , Espectroscopía de Resonancia Magnética/métodos , Infarto del Miocardio/fisiopatología , Infarto del Miocardio/terapia , Disfunción Ventricular Derecha/complicaciones , Disfunción Ventricular Derecha/diagnóstico , Enfermedades Cardiovasculares/fisiopatología , Diabetes Mellitus , Ventrículos Cardíacos , Hipertensión , Prevalencia , Factores de Riesgo , Interpretación Estadística de Datos , Volumen SistólicoRESUMEN
BACKGROUND: Wave reflections, which are increased in patients with heart failure with preserved ejection fraction, impair diastolic function and promote pathologic myocardial remodeling. Organic nitrates reduce wave reflections acutely, but whether this is sustained chronically or affected by hydralazine coadministration is unknown. METHODS AND RESULTS: We randomized 44 patients with heart failure with preserved ejection fraction in a double-blinded fashion to isosorbide dinitrate (ISDN; n=13), ISDN+hydralazine (ISDN+hydral; n=15), or placebo (n=16) for 6 months. The primary end point was the change in reflection magnitude (RM; assessed with arterial tonometry and Doppler echocardiography). Secondary end points included change in left ventricular mass and fibrosis, measured with cardiac magnetic resonance imaging, and the 6-minute walk distance. ISDN reduced aortic characteristic impedance (mean baseline=0.15 [95% CI, 0.14-0.17], 3 months=0.11 [95% CI, 0.10-0.13], 6 months=0.10 [95% CI, 0.08-0.12] mm Hg/mL per second; P=0.003) and forward wave amplitude (Pf, mean baseline=54.8 [95% CI, 47.6-62.0], 3 months=42.2 [95% CI, 33.2-51.3]; 6 months=37.0 [95% CI, 27.2-46.8] mm Hg, P=0.04), but had no effect on RM (P=0.64), left ventricular mass (P=0.33), or fibrosis (P=0.63). ISDN+hydral increased RM (mean baseline=0.39 [95% CI, 0.35-0.43]; 3 months=0.31 [95% CI, 0.25-0.36]; 6 months=0.44 [95% CI, 0.37-0.51], P=0.03), reduced 6-minute walk distance (mean baseline=343.3 [95% CI, 319.2-367.4]; 6 months=277.0 [95% CI, 242.7-311.4] meters, P=0.022), and increased native myocardial T1 (mean baseline=1016.2 [95% CI, 1002.7-1029.7]; 6 months=1054.5 [95% CI, 1036.5-1072.3], P=0.021). A high proportion of patients experienced adverse events with active therapy (ISDN=61.5%, ISDN+hydral=60.0%; placebo=12.5%; P=0.007). CONCLUSIONS: ISDN, with or without hydralazine, does not exert beneficial effects on RM, left ventricular remodeling, or submaximal exercise and is poorly tolerated. ISDN+hydral appears to have deleterious effects on RM, myocardial remodeling, and submaximal exercise. Our findings do not support the routine use of these vasodilators in patients with heart failure with preserved ejection fraction. CLINICAL TRIAL REGISTRATION: URL: www.clinicaltrials.gov. Unique identifier: NCT01516346.
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Insuficiencia Cardíaca/tratamiento farmacológico , Hidralazina/administración & dosificación , Hipertrofia Ventricular Izquierda/tratamiento farmacológico , Dinitrato de Isosorbide/administración & dosificación , Miocardio/patología , Volumen Sistólico/fisiología , Remodelación Ventricular/efectos de los fármacos , Anciano , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Quimioterapia Combinada , Ecocardiografía Doppler , Femenino , Fibrosis/complicaciones , Fibrosis/tratamiento farmacológico , Fibrosis/fisiopatología , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/fisiopatología , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/fisiopatología , Humanos , Hipertrofia Ventricular Izquierda/complicaciones , Hipertrofia Ventricular Izquierda/fisiopatología , Imagen por Resonancia Cinemagnética , Masculino , Persona de Mediana Edad , Proyectos Piloto , Vasodilatadores/administración & dosificación , Función Ventricular Izquierda/fisiologíaRESUMEN
Breast augmentation with silicone implants is one of the most common procedures performed by plastic surgeons around the world. Capsular contracture is a frequent complication in breast augmentation and reconstructive surgery, that requires invasive intervention. The inflammatory response to implanted mammary prostheses appears to be directly associated to capsular contracture. This review discusses the evidences from rat models studies, on the role of inflammation and fibrosis in capsular contraction and its relation to silicone breast implants surface.
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Implantes de Mama , Contractura Capsular en Implantes/etiología , Geles de Silicona , Animales , Mama/patología , Fibrosis/complicaciones , Inflamación/complicaciones , Modelos Animales , RatasRESUMEN
Because Model for End-Stage Liver Disease (MELD) scores at the time of liver transplantation (LT) increase nationwide, patients are at an increased risk for delisting by becoming too sick or dying while awaiting transplantation. We quantified the risk and defined the predictors of delisting or death in patients with cirrhosis hospitalized with an infection. North American Consortium for the Study of End-Stage Liver Disease (NACSELD) is a 15-center consortium of tertiary-care hepatology centers that prospectively enroll and collect data on infected patients with cirrhosis. Of the 413 patients evaluated, 136 were listed for LT. The listed patients' median age was 55.18 years, 58% were male, and 47% were hepatitis C virus infected, with a mean MELD score of 2303. At 6-month follow-up, 42% (57/136) of patients were delisted/died, 35% (47/136) underwent transplantation, and 24% (32/136) remained listed for transplant. The frequency and types of infection were similar among all 3 groups. MELD scores were highest in those who were delisted/died and were lowest in those remaining listed (25.07, 24.26, 17.59, respectively; P < 0.001). Those who were delisted or died, rather than those who underwent transplantation or were awaiting transplantation, had the highest proportion of 3 or 4 organ failures at hospitalization versus those transplanted or those continuing to await LT (38%, 11%, and 3%, respectively; P = 0.004). For those who were delisted or died, underwent transplantation, or were awaiting transplantation, organ failures were dominated by respiratory (41%, 17%, and 3%, respectively; P < 0.001) and circulatory failures (42%, 16%, and 3%, respectively; P < 0.001). LT-listed patients with end-stage liver disease and infection have a 42% risk of delisting/death within a 6-month period following an admission. The number of organ failures was highly predictive of the risk for delisting/death. Strategies focusing on prevention of infections and extrahepatic organ failure in listed patients with cirrhosis are required.
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Enfermedad Hepática en Estado Terminal/mortalidad , Enfermedad Hepática en Estado Terminal/cirugía , Fibrosis/cirugía , Infecciones/complicaciones , Listas de Espera , Adulto , Anciano , Enfermedad Hepática en Estado Terminal/complicaciones , Femenino , Fibrosis/complicaciones , Hepatitis C/complicaciones , Humanos , Relación Normalizada Internacional , Estimación de Kaplan-Meier , Trasplante de Hígado , Masculino , Persona de Mediana Edad , América del Norte , Estudios Prospectivos , Análisis de Regresión , Riesgo , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
Objetivo: Determinar las características clínico- epidemiológicas de la Peritonitis bacteriana espontánea (PBE) en el Hospital Nacional Arzobispo Loayza (HNAL) el 2014. Métodos: Estudio descriptivo, retrospectivo en 43 casos. Se revisaron las historias clínicas y se elaboró una hoja de datos en SPSS.21 para el análisis descriptivo con nivel de significancia p<0.05. Resultados: La edad mediana fue 59±14 años, el grupo etario más frecuente fue de 50-59 años (34.9 por ciento), sexo masculino (65.1 por ciento. p<0.05), instrucción primaria y secundaria (32.6 por ciento respectivamente) y nivel socio-económico medio (60.5 por ciento, p<0.05). La etiología más frecuente de cirrosis hepática fue el alcohol (46.5 por ciento), se obtuvo pacientes con antecedentes de PBE previa (32.6 por ciento) y hospitalizaciones previas (76.5 por ciento). El estadio clínico por Score Child Pugh fue estadio B en el 48.8 por ciento y C en el 37.2 por ciento. El 90.7 por ciento cursaba con hipoalbuminemia, 72.1 por ciento leucocitosis, 72.1 por ciento anemia y 69.8 por ciento hiponatremia. Una mortalidad de 23.3 por ciento asociada a encefalopatía hepática (p<0.014), ascitis refractaria (p<0.035), insuficiencia renal aguda (p<0.004) y antecedentes de diabetes mellitus 2 (p<0.022). Los gérmenes con significancia para mortalidad fueron S. pneumoniae, S. aureus y Klepsiella pneumoniae (p<0.05). Conclusiones: Las características que tuvieron significancia con PBE fueron: sexo masculino, nivel socio-económico medio, antecedente de PBE y hospitalizaciones previas, estadio clínico, ascitis, fiebre, ascitis refractaria, insuficiencia renal aguda, hipoalbuminemia, leucocitosis, anemia, hiponatremia. La mortalidad por PBE se asoció significativamente con encefalopatía hepática, ascitis refractaria, insuficiencia renal aguda, diabetes mellitus e infección del líquido ascítico por S. pneumoniae.
Objective: To determine the clinical and epidemiological characteristics of spontaneous bacterial peritonitis (SBP) in the Archbishop Loayza (HNAL) 2014 National Hospital. Methods: A retrospective study in 43 cases. The medical records were reviewed and a data sheet was prepared in SPSS.21 tor descriptive analysis with significance level of p<0.05. Results: The median age was 59 ± 14 years, the most common age group was 50-59 years (34.9 per cent), males (65.1 per cent, p<0.05), primary and secondary education (32.6 per cent respectively) and socio-economic level average (60.5 per cent, P<0.05) (60.5 per cent P<0.05). The most common etiology of liver cirrhosis was alcohol (46.5 per cent), previous history of SBP (32.6 per cent) and previous hospitalizations (76.5 per cent). The clinical stage by Score Child Pugh was 48.8 per cent (stage B) and 37.2 per cent (stage C). 90.7 per cent with hypoalbuminemia. 72.1 per cent leukocytosis, anemia 72.1 per cent and 69.8 per cent hyponatremia. A 23.3 per cent mortality associated with hepatic encephalopathy (p<0.014), refractory ascites (p<0.035). acute renal failure (p<0.004) and a history of diabetes mellitus type 2 (p<0.022). Germs with significance for mortality were S. pneumonia, S. aureus and Klepsiella pneumoniae (p<0.05). Conclusions: The characteristics that had significance with SBP were male, middle socio-economic status, history of PBE and previous hospitalizations, clinical stage, refractory ascites, acute renal failure, fever, hypoalbuminemia, leukocytosis, anemia, hyponatremia. PBE mortality was significantly associated with hepatic encephalopathy, refractory ascites, acute renal failure, diabetes mellitus and infection of ascites S. pneumoniae.
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Masculino , Femenino , Humanos , Adulto , Persona de Mediana Edad , Anciano , Fibrosis/complicaciones , Peritonitis/epidemiología , Estudios Observacionales como Asunto , Estudios Retrospectivos , Estudios TransversalesRESUMEN
INTRODUÇÃO: Com base na grande variedade de possíveis sequelas e intercorrências de cirurgias estéticas e no papel da nutrição no processo de recuperação dessas, percebe-se a necessidade de práticas terapêuticas que garantam eficácia do resultado estético final. MÉTODO: O presente estudo caracteriza-se como uma revisão não sistemática que associou possíveis nutrientes, compostos bioativos e fitoterápicos que previnam ou amenizem seroma e fibrose no pós operatório. Para tanto, foram utilizados artigos de revistas científicas do meio eletrônico, legislações nacionais e livros didáticos, publicados entre os anos de 2002 e 2012. RESULTADOS: Demonstrou-se que as principais causas de seroma e fibrose são cicatrização alterada, inflamação, estresse oxidativo e edema. Dessa forma, foi elaborado um guia prático com os nutrientes, compostos bioativos e fitoterápicos que podem ser utilizados a fim de prevenir, controlar ou amenizar as complicações no pós-cirúrgico de procedimentos estéticos. CONCLUSÃO: Salientou-se que para o tratamento das condições abordadas é fundamental que haja um trabalho multiprofissional, enfatizando um acompanhamento médico, nutricional e fisioterápico que abranja as alterações conhecidas na fisiopatologia de seroma e fibrose.
INTRODUCTION: Based on the wide range of possible consequences and complications of plastic surgery and the role of nutrition in the recovery process of these, we see the need for therapeutic practices to ensure effectiveness of the final aesthetic result. METHOD: This study is characterized as a non-systematic review of the possible associated nutrients, bioactive compounds and herbal medicines to prevent seroma and fibrosis. Thus, we used scientific journal articles from electronic media, national laws and textbooks published between 2002 and 2012. RESULTS: We demonstrated that the main causes of seroma and fibrosis are changed healing, inflammation, oxidative stress and edema. Thus, we designed a practical guide with nutrients, bioactive compounds and herbal medicines that can be used to prevent, control or mitigate the complications after plastic surgery. CONCLUSION: It was emphasized that for the treatment of covered conditions is essential that there is a multidisciplinary approach, emphasizing a medical, nutritional and therapeutic monitoring covering the known changes in the pathophysiology of seroma and fibrosis.
Asunto(s)
Humanos , Complicaciones Posoperatorias , Fibrosis , Nutrientes , Revisión , Artículo de Revista , Seroma , Publicación Periódica , Portales de Acceso a Revistas Científicas , Ciencias de la Nutrición , Fitoterapia , Complicaciones Posoperatorias/cirugía , Fibrosis/cirugía , Fibrosis/complicaciones , Fibrosis/patología , Nutrientes/análisis , Nutrientes/uso terapéutico , Seroma/cirugía , Seroma/complicaciones , Alimentos Funcionales , Alimentos Funcionales/análisis , Alimentos Funcionales/normas , Ciencias de la Nutrición/métodos , Ciencias de la Nutrición/normas , Fitoterapia/métodos , Fitoterapia/normasRESUMEN
Objetivo: Demostrar que la DM es un factor de riesgo para infecciones en pacientes cirróticos atendidos en el Hospital Nacional PNP Luis N. Sáenz entre Enero del 2010 a Diciembre del 2011. Metodología: Estudio de diseño retrospectivo y metodología observacional, analística y comparativa. Muestra de estudio: Lo conformaron 262 pacientes cirróticos distribuidos en dos grupos (2010-2011): Grupo Casos (cirróticos diabéticos = 68 pacientes). Grupo Control (cirróticos no diabéticos = 194 pacientes). Total Población de comparación = 262 pacientes. Ficha de datos: Instrumento principal de estudio que incluyó en su contenido todas las variables comprometidas con los objetivos del estudio, que previamente fue revisado y validado por la Jefatura del Servicio de Gastroenterología en presencia de 03 miembros del staff y del tutor de la investigación para su autorización y ejecución del estudio. Resultados: La edad promedio fue de 65.2 años, predominando el sexo masculino (59 por ciento). La etiología más frecuente fue el alcohol (32.10 por ciento) en el 26.70 por ciento la causa no fue precisada. La severidad de la cirrosis (Child Pugh) en estadio C fue la más frecuente (64.10 por ciento). El 25.95 por ciento de cirróticos cumplían con los criterios de Mellitus. La prevalencia de infecciones en la población general fue de 57.65 por ciento (151 casos) y fue más frecuente la infección urinaria (62.1 por ciento), seguida de la neumonía (19.4 por ciento). En los resultados de la población diabética versus no diabéticos no se aprecia diferencias significativas, lo que permite la comparación entre estos dos grupos. Al asociar la diabetes con las infecciones en los pacientes cirróticos, se halló mayor porcentaje en la población diabética comparada con la no diabética (p<0.0001). La neumonía fue la infección que se encuentra en la población cirrótica diabética con diferencias significativas entre los grupos comparados. Conclusiones: Uno de cada 6 pacientes tiene criterios...
Objective: To demonstrate that DM is a risk factor for infections in cirrhotic patients treated at the National Hospital PNP Luis N. Saenz from January 2010 to December 2011. Methodology: A retrospective observational design and methodology, and comparative annals. Study Shows: The formed 262 cirrhotic patients divided into two groups (2010-2011): Studies Group (diabetic cirrhotic patients = 68). Control group (non-diabetic cirrhotic patients = 194). Total Population = 262 comparison patients. Data Sheet: Main Instrument study including its content all the variables involved with the objectives of the study, which was previously reviewed and validated by the Chief of Gastroenterology in the presence of 03 staff members and the tutor of research for authorization and execution of the study. Results: Mean age was 65.2 years, predominantly male (59 per cent). The most common etiology was alcohol (32.10 per cent) 26.70 per cent in the case was not specified. The severity of cirrhosis (Child Pugh) stage C was the most frequent (64.10 per cent). The cirrhotic 25.95 met the criteria Mellitus. The prevalence of infection in the general population was 57.65 per cent (151 cases) and was more frequent urinary tract infection (62.1 per cent), followed by pneumonia (19.4). The results of the non-diabetic vs. diabetic population no significant differences were observed, allowing the comparison between these two groups. By associating diabetes with infections in cirrhotic patients, a higher percentage was found in the diabetic population compared with non-diabetic (p<0.0001). Pneumocystis infection was found in cirrhotic diabetic population with significant differences between the groups compared. Conclusions: One in 6 patients has diagnostic criteria for DM. Cirrhotic patients with DM had 85.30 per cent of infections compared with 48.5 per cent of non-diabetics. The most common infections were UTI, pneumonia and cellulitis. Pneumonia was the only infection significantly...
Asunto(s)
Masculino , Femenino , Humanos , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Complicaciones de la Diabetes , Diabetes Mellitus , Factores de Riesgo , Fibrosis/complicaciones , Infecciones , Estudios Observacionales como Asunto , Estudios Retrospectivos , Informes de CasosRESUMEN
Introdução: A desnutrição é um importante fator que interfere no prognóstico de crianças e adolescentes com cirrose. Este estudo tem como objetivo avaliar o estado nutricional e a adequação da ingesta alimentar de crianças e adolescente com cirrose. Métodos: Estudo transversal, realizado com 39 crianças e adolescentes cirróticos com idade entre 0-15 anos. A gravidade da doença hepática foi avaliada pelo critério de Child-Pugh e escores Pediatric End-Stage Liver Disease e/ou Model for End-Stage Liver Disease. A classificação do estado nutricional foi determinada de acordo com os padrões WHO (2009) e Frisancho (2008). A avaliação da ingesta alimentar foi realizada a partir de um registro alimentar de três dias. Resultados: As médias e desvios padrão dos escores z para os parâmetros Peso/Idade (P/I), Índice de Massa Corporal/Idade (IMC/I), Estatura/Idade (E/I), Circunferência do Braço/Idade (CB/I) e Dobra Cutânea Tricipital/Idade (DCT/I) foram respectivamente -0,53 (±1,17), 16,8 (±2,53), -1,22 (±1,20), -1,04 (±1,61) e -0,99 (±1,67), caracterizando cerca de 44% como desnutridos; sendo que 69% destes eram desnutridos graves (abaixo do escore-z -3,00). A ingesta alimentar média dos cirróticos (33/39), excluindo aqueles em aleitamento materno, dieta enteral e/ou restrição dietética, comparada com a RDI para idade foi de 112% (±36), sendo que a maioria 78,4% (26/33) apresentou uma ingesta maior ou igual a 80% da recomendação para a idade. Conclusão: A associação de parâmetros antropométricos, clínicos e dietéticos deve ser utilizada para que se possa chegar a um diagnóstico nutricional coerente e intervenção nutricional efetiva.
Introduction: Malnutrition is an important factor affecting the prognosis of children and teenagers with cirrhosis. This study aims to evaluate the nutritional status and adequacy of food intake by children and adolescents with cirrhosis. Methods: Cross-sectional study of 39 cirrhotic children and adolescents aged 0-15 years. The severity of liver disease was evaluated by Child-Pugh scores and Pediatric End-Stage Liver Disease and/or Model for End-Stage Liver Disease. The nutritional status was determined according to WHO standards (2009) and Frisancho (2008). The evaluation of food intake was made by recording food intake for three days. Results: The means and standard deviations of z scores for the parameters weight/age (W/A), body mass index/age (BMI/A), Height/Age (H/A), arm circumference/age (A /I), and triceps skinfold/Age (TS/A) were respectively -0.53 (± 1.17), 16.8 (± 2.53), -1.22 (± 1.20), -1.04 (± 1.61), and -0.99 (± 1.67), characterizing about 44% as malnourished, 69% of whom as severely malnourished (z-score <3.00). The mean dietary intake of cirrhotic patients (33/39), excluding those in breast-feeding, enteral feeding and/or dietary restriction, as compared with the RDI for age was 112% (± 36), most of which (78.4% , 26/33) with an intake > 80% as recommended for their age. Conclusion: A combination of anthropometric, clinical and dietary factors should be used so that a coherent nutritional diagnosis and effective nutritional intervention can be made.
Asunto(s)
Humanos , Masculino , Femenino , Niño , Adolescente , Evaluación Nutricional , Desnutrición , Fibrosis/complicaciones , Ingestión de Alimentos , Estado Nutricional , Estudios Transversales/métodosRESUMEN
Hunter syndrome (MPSII) is a rare X-linked lysosomal storage disorder that can affect multiple systems but primarily affects the heart. We report the case of a previously asymptomatic 23-year-old patient who had an attenuated form of MPSII and presented with refractory heart failure that required a heart transplant. The diagnosis was confirmed by detection of an increase in urinary excretion of glycosaminoglycans, a deficiency in enzymatic activity, and molecular analysis. A myocardial biopsy revealed hypertrophic cardiomyocytes, mild fibrosis, and lysosomal storage in interstitial cells. Molecular analysis identified a novel mutation in the iduronate-2-sulfatase gene. Although the clinical outcome was not favorable, we believe that this approach may be valid in end-stage heart failure.
Asunto(s)
Insuficiencia Cardíaca/cirugía , Mucopolisacaridosis II/cirugía , Ecocardiografía Doppler , Salud de la Familia , Resultado Fatal , Femenino , Fibrosis/complicaciones , Fibrosis/patología , Insuficiencia Cardíaca/etiología , Trasplante de Corazón , Humanos , Hipertrofia , Lisosomas/patología , Masculino , Mucopolisacaridosis II/complicaciones , Mucopolisacaridosis II/diagnóstico , Mutación , Miocitos Cardíacos/patología , Sulfatasas , Sulfotransferasas/genética , Adulto JovenRESUMEN
PURPOSE: To evaluate the donor site of adipocytes as well as histopathological alterations secondary to liposuction. METHODS: All animals underwent liposuction with a syringe on the right side of the back. While the left side of the back was used as control and did not undergo intervention. The 10 rabbits were divided into two groups A and B according the postoperative day which were submitted to euthanasia: 90 and 120 days. All adipose tissue from the donor site was analyzed and compared with the control macroscopic and light microscopy. Tissues were weighed and analyzed searching for histological changes and late inflammatory response to trauma such as fibrosis, fat necrosis and inflammation and macrophage infiltration. RESULTS: There was wide variation in adipose tissue volume between the experimental and the control on macroscopic analysis. The presence of histopathological changes was found in two samples at 90 days. CONCLUSIONS: There was a relationship between the presence of fibrosis with the weight and number of days after liposuction surgery in rabbits. The study show macroscopic difference between control and experiment sides in all rabbits.(AU)
OBJETIVO: Avaliar a zona doadora de adipócitos bem como as alterações histopatológicas secundárias a lipoaspiração. MÉTODOS: Todos os animais foram submetidos à lipoaspiração com seringa no lado direito do dorso. Enquanto o lado esquerdo do dorso foi usado como controle, não sofrendo intervenção. Os 10 coelhos foram divididos em dois grupos A e B conforme o dia pós-operatório (DPO) os quais foram submetidos à eutanásia: 90 DPO e 120 DPO. Todo tecido adiposo da zona doadora foi analisado e comparados com o controle macroscopicamente e à microscopia óptica. Os tecidos foram pesados e foram analisadas as variações histológicas em busca de uma resposta inflamatória tardia ao trauma como fibrose, inflamação, necrose gordurosa e infiltrado macrofágico. RESULTADOS: Foi observada grande variação de volume de tecido adiposo entre o experimento e o controle do dorso a macroscópica e a presença de alteração histopatológica em duas amostras aos 90 dias. CONCLUSÕES: Houve relação entre a presença de fibrose com o peso e numero de dias pós-operatório na lipoaspiração de coelhos. O estudo mostrou diferença entre os lados experimento e controle em todos os coelhos.(AU)
Asunto(s)
Animales , Lipectomía/veterinaria , Conejos/clasificación , Tejido Adiposo/anatomía & histología , Fibrosis/complicacionesRESUMEN
Los departamentos de ginecología oncológica y educación al usuario encontró una incidencia de cáncer de cérvix en un período de un año de un 30.2% del total de las pacientes que acuden a la institución, de los cuales el 45% estaba entre los 30-49 años de edad al momento del diagnóstico. Como parte de su tratamiento los pacientes recibieron radioterapia externa y braquiterapia por encontrarse en un estadio avanzado y presentar estenosis vaginal como uno de los efectos secundarios más conocidos...
Asunto(s)
Femenino , Braquiterapia/métodos , Fibrosis/complicaciones , Neoplasias Abdominales/diagnóstico , Neoplasias Abdominales/radioterapiaRESUMEN
En tiempos recientes, la miocardiopatía cirrótica ha pasado a ser considerada una nueva entidad clínica. El reconocimiento de cambios leves en la estructura cardíaca que pueden ser detectados incluso en las etapas iniciales de la cirrosis preascítica ha contribuido a una mejor comprensión de los trastornos cardiovasculares que se observan a medida que progresa la enfermedad. Se han categorizado cambios cardíacos estructurales y se diagnóstica, con frecuencia, la disfunción diastólica. La cirrosis descompensada se caracteriza por una disminución de la presión sanguínea y de la resistencia vascular periférica, y un aumento del gasto cardíaco y de la frecuencia cardíaca, los cuales se producen en un escenario de circulación hiperdinámica favorecida por la expansión del volumen total sanguíneo, la sobrecarga circulatoria y la hiperactividad de los sistemas endógenos vasoactivos. La vasodilatación periférica evita la insuficiencia cardíaca. Recientemente se ha reconocido la existencia de una menor respuesta cardíaca en situaciones de estrés como son los cambios en las condiciones de la carga cardíaca en presencia de un mayor deterioro de la función hepática, tales como la ascitis refractaria, el síndrome hepatorrenal, la peritonitis bacteriana espontánea y la hemorragia de várices esofágicas. Ante la disponibilidad de intervenciones terapéuticas (paracentesis, comunicación portosistémica intrahepática transyugular, comunicación venosa peritoneal, trasplante hepático) utilizadas actualmente para manejar las complicaciones potencialmente mortalesen las formas más avanzadas de cirrosis, el conocimiento del impacto que tienen en la función cardiovascular es de suma importancia. Se encuentran en progreso las intervenciones terapéuticas dirigidas a prevenir y manejar el deterioro cardiovascular.(AU)
Asunto(s)
Fibrosis/complicaciones , Fibrosis/terapia , Cardiomiopatías/diagnóstico , Cardiomiopatías/etiología , Cardiomiopatías/terapia , Ascitis/terapiaRESUMEN
En tiempos recientes, la miocardiopatía cirrótica ha pasado a ser considerada una nueva entidad clínica. El reconocimiento de cambios leves en la estructura cardíaca que pueden ser detectados incluso en las etapas iniciales de la cirrosis preascítica ha contribuido a una mejor comprensión de los trastornos cardiovasculares que se observan a medida que progresa la enfermedad. Se han categorizado cambios cardíacos estructurales y se diagnóstica, con frecuencia, la disfunción diastólica. La cirrosis descompensada se caracteriza por una disminución de la presión sanguínea y de la resistencia vascular periférica, y un aumento del gasto cardíaco y de la frecuencia cardíaca, los cuales se producen en un escenario de circulación hiperdinámica favorecida por la expansión del volumen total sanguíneo, la sobrecarga circulatoria y la hiperactividad de los sistemas endógenos vasoactivos. La vasodilatación periférica evita la insuficiencia cardíaca. Recientemente se ha reconocido la existencia de una menor respuesta cardíaca en situaciones de estrés como son los cambios en las condiciones de la carga cardíaca en presencia de un mayor deterioro de la función hepática, tales como la ascitis refractaria, el síndrome hepatorrenal, la peritonitis bacteriana espontánea y la hemorragia de várices esofágicas. Ante la disponibilidad de intervenciones terapéuticas (paracentesis, comunicación portosistémica intrahepática transyugular, comunicación venosa peritoneal, trasplante hepático) utilizadas actualmente para manejar las complicaciones potencialmente mortalesen las formas más avanzadas de cirrosis, el conocimiento del impacto que tienen en la función cardiovascular es de suma importancia. Se encuentran en progreso las intervenciones terapéuticas dirigidas a prevenir y manejar el deterioro cardiovascular.
Asunto(s)
Ascitis/terapia , Cardiomiopatías/diagnóstico , Cardiomiopatías/etiología , Cardiomiopatías/terapia , Fibrosis/complicaciones , Fibrosis/terapiaRESUMEN
Introdução: Diversos índices têm sido propostos na avaliação da gravidade da doença hepática. Objetivo: Analisar os escores de Child-Turcote- Pugh (CTP), APACHE II, MELD e SOFA como índices prognósticos de mortalidade hospitalar em pacientes cirróticos. Metodologia: Foram avaliados prospectivamente todos os cirróticos que se internaram em enfermaria provenientes da emergência de um Hosputal Geral de Porto Alegre, em um período de 6 meses. Os escores CTP, MELD, APACHE II e SOFA foram registrados, bem como o desfecho (alta ou óbito). O nível de significância adotado foi de 5%. Resultados: Foram avaliados 61 cirróticos. Quarenta e três eram homens (70%). A média de idade foi de 54,7±11,7 anos. Álcool e/ou o vírus da hepatite C (HCV) foram responsáveis pela etiologia de 50 (82%) casos. Quanto ao CTP, houve 7 (32%) mortes naqueles CTP A ou B, e 11 (38%) naqueles C (p=0,27). A mediana do escore MELD foi de 15, sendo que houve 3 (11%) mortes naqueles com MELD < 15 e 15 (45%) naqueles com MELD ≥15 (p=0,02). A mediana do escore APACHE II foi de 9, sendo que houve 0 morte naqueles com índice < 9 e 18 (41%) naqueles com índice ≥9 (p<00,1). Em relação ao SOFA, a média foi de 3,6±1,8 naqueles vivos versus 5,6±2,6 naqueles que foram a óbito durante a internação (p=0,005). A mortalidade hospitalar foi de 29% (18 casos). Conclusões: Os escores MELD, APACHE II e SOFA se mostraram bons preditores de mortalidade em cirróticos hospitalizados, mas não a classificação de CTP.
Introduction: A number of indexes have historically been proposed to assess the severity of liver disease. Aim: To evaluate the Child-Turcote-Pugh (CTP), APACHE II, MELD and SOFA scores as prognostic indexes of in-hospital mortality among cirrhotic patients. Methods: This is a prospective analysis of all cirrhotic patients who were admitted to a general hospital of Porto Alegre in a period of 6 months. CTP, MELD, APACHE II and SOFA scores were analyzed, as well as the outcome (discharge or death). The level of significance was 5%. Results: A total of 61 cirrhotic patients were evaluated. Forty-three patients were males (70%) and the mean age was 54.7±11.7 years. Alcohol and/or hepatitis C virus (HCV) were the ethiological agents in 50 (82%) cases. Concerning CTP scores, there were 7 (32%) deaths among CTP A or B and 11 (38%) deaths among CTP C (p=0.27). The median for the MELD scores was 15, and there were 3 (11%) deaths among those with MELD < 15 and 15 (45%) deaths among those with MELD ≥15 (p=0.02). The median for the APACHE II scores was 9, and there were no deaths (0) among patients with indexes ≥9 (p<00.1). Concerning the SOFA, the mean was 3.6±1.8 among living patients versus 5.6±2.6 among those who progressed to death during the hospitalization (p=0.005). The overall in-hospital mortality rate was 29% (18 cases). Conclusions: MELD, APACHE II, and SOFA scores proved to be good predictors of mortality of hospitalized cirrhotic patients, but the CTP did not.