RESUMO
PURPOSE: To show the results of a trocar spacer for pediatric vitreoretinal surgery with a 3D printed trocar spacer in 2 cases. METHODS: We used standard 27 gauge (ga) and 25 ga trocars and cannulae, and prototyped 1.5â¯mmâ¯×â¯3â¯mm spacers with a Prusa MK3 3D printer (0.4â¯mm nozzle) with Fuse deposition melting (FDM) technology. Parts were printed with a 50⯵m layer height in polylactic acid or polylactide (PLA). The spacer was placed in two places: between the blade's base and the trocar, and between the trocar and the sclera depending on the desired amount of shortening. This prototype was used in 2 vitrectomy cases in pediatric patients. RESULTS: We used this trocar spacer in 2 cases with positive results. CONCLUSIONS: This 3D printed spacer has proved to effectively shorten the introduced trocar into two different small eyes. More studies are needed to validate the efficacy and safety of this spacer in clinical practice.
Assuntos
Cirurgia Vitreorretiniana , Criança , Humanos , Impressão Tridimensional , Esclera , Instrumentos Cirúrgicos , VitrectomiaRESUMO
AIMS: To generate a murine experimental model of colonization by Campylobacter coli DSPV458. METHODS AND RESULTS: Twelve adult Balb/cCmedc female mice were housed in a treated group (T-G) and a control group (C-G) for 4 weeks. Both experimental groups received antibiotics for 5 days during the first week. The T-G was administered with 6.68log10 CFU of C. coli DSPV458 by oesophageal gavage. Necropsies were performed weekly to evaluate translocation and intestinal colonization in the spleen and liver and in the ileum and cecum respectively. Samples were cultured to quantify intestinal microbiota members. Faeces were cultured weekly for a C. coli DSPV458 count. Campylobacter coli DSPV458 was isolated from all the inoculated mice. The recovered level of C. coli DSPV458 was, on average, 6.9 log10 CFUg-1 , 8.0 log10 CFUg-1 and 1.6 log10 CFUg-1 in faeces, cecum and ileum respectively. Colonization by C. coli DSPV458 does not alter the normal clinical and physiological status. CONCLUSIONS: Campylobacter coli DSPV458 does not have an invasive capacity, and the model is suitable for evaluating strategies to reduce intestinal loads. SIGNIFICANCE AND IMPACT OF STUDY: Farm animals have an important impact on thermotolerant Campylobacter transmission to humans. Extremely few colonization models by C. coli have been reported to date. In food-producing animals, infection is mild or absent and thermotolerant Campylobacter colonize the intestines of animals. Colonization models are specific models that do not cause infection as they do not generally result in diarrhoea or other signs of disease. Therefore, this model will allow to evaluate the evolution of colonization by thermotolerant Campylobacter and the alternative tools development to antibiotics that limit their colonization in food-producing animals.
Assuntos
Infecções por Campylobacter , Campylobacter coli , Campylobacter jejuni , Campylobacter , Animais , Campylobacter/genética , Infecções por Campylobacter/veterinária , Campylobacter coli/genética , Ceco , Fezes , Feminino , Intestinos , CamundongosRESUMO
BACKGROUND: Everolimus (EVL)-based immunosuppressive strategies may permit the reduction of calcineurin inhibitors (CNI) and their side effects, while offering a safe and efficient treatment. Our aim was to describe our experience with EVL in everyday practice and provide information for its optimal utilization. METHODS: Prospective, multicenter study of 181 kidney transplant recipients treated with EVL as part of their immunosuppressive regimen, with a follow-up of 24 months. We studied demographic data, transplant characteristics, clinical information, drugs used, serum creatinine, estimated glomerular filtration rate (eGFR), rejection episodes, and adverse events. RESULTS: In total, 181 renal transplant recipients were included. Of these, 30 (16.6%) received EVL de novo and 151 (83.4%) were converted; median time from transplantation to conversion was 10 (range, 1-312) months. Main reasons for conversion were prevention of interstitial fibrosis and tubular atrophy (23.9%), intolerance to immunosuppressants (11.1%), neoplasia (13.9%), nephrotoxicity (8.9%), and cytomegalovirus infections (8.3%). The eGFR values at baseline, months 12, and 24 were 46.4 ± 27.4 mL/min, 54.8 ± 22.9 mL/min, and 55.9 ± 26.5 ml/min, respectively. Two of 181 (1.1%) patients died, 5 of 181 (2.8%) lost their grafts, 12 of 181 (6.6%) had an episode of acute rejection, 13 of 181 (7.2%) had ≥1 serious event and infection, and 85 of 181 (49.9%) had ≥1 nonserious adverse event or infection. Multivariate analysis showed that increased eGFR at month 24 was associated with lower donor age, shorter time from transplant to EVL introduction, and a baseline eGFR ≥40 mL/min. CONCLUSION: Through different strategies among centers, the inclusion of EVL improved renal function during the first 12 months.
Assuntos
Everolimo/uso terapêutico , Imunossupressores/uso terapêutico , Transplante de Rim , Argentina , Feminino , Seguimentos , Taxa de Filtração Glomerular , Rejeição de Enxerto , Sobrevivência de Enxerto , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sistema de RegistrosRESUMO
Staphylococcus aureus es un microorganismo con habilidad de infectar diferentes tejidos celulares, por portar genes que le confieren resistencia a antibióticos, factores de virulencia y su plasticidad genética, que podrían contribuir a una progresión rápida y complicada de la enfermedad. El Paraguay no cuenta con datos epidemiológicos que indiquen los factores de virulencia que presentan las cepas de S. aureus, por lo que el objetivo del trabajo fue determinar un perfil de virulencia detectando los genes codificantes de: hemolisinas α y β,enterotoxinas A, B, C, D, H y toxinas exfoliativas A y B. Este estudio observacional descriptivo de corte transverso, con muestreo no probabilístico de casos consecutivos, incluyó 50 aislados de S. aureus obtenidos a partir de muestras clínicas de secreciones de piel, partes blandas o líquidos corporales de pacientes menores de 17 años que concurrieron al Hospital General Pediátrico Niños de Acosta Ñú durante el año 2.010. Las reacciones de PCR incluyeron la detección de los genes: sea+seb+sec+ADNr16S, hlA+hlB, eta+etb, sed y seh. El 82% de los aislados provenía de niños que presentaron cuadros clínicos compatibles con infecciones de piel y partes blandas y el 18% de cuadros clínicos graves como sepsis, osteomielitis y neumonías. Los aislados contaban con datos de portación de Leucocidina de Panton-Valentine, el cual fue el factor de virulencia más frecuentemente detectado (58%), seguido de las hemolisinas alfa (16%) y beta (8%). Las enterotoxinas y las toxinas exfoliativas fueron menos frecuentes (0-2%), y no se detectaron genes codificantes de las enterotoxinas C y D.
Staphylococcus aureus is a pathogen that has the ability to successfully infect differenttissues, because it carries genes that confer antibiotic resistance, virulence factors and itshigh genetic plasticity, that could contribute to a quick and complicated diseaseprogression. Paraguay does not have epidemiological data indicating the virulence factorspresented in S. aureus strains. Therefore, the aim of this study was to determine thevirulence profile by molecular methods detecting the codifying genes of: α and β hemolysin, enterotoxins A, B, C, D, H and exfoliative toxins A and B. This descriptiveobservational study with non-probability sampling of consecutives cases, included 50 S.aureus isolates obtained from clinical specimens from skin secretions, soft tissue or bodyfluids of patients younger than 17 years who attended the Niños de Acosta Ñú PediatricGeneral Hospital in 2010. The PCR reactions included the detection of the followinggenes: sea+seb+sec+ADNr16S, hlA+hlB, eta+etb, sed and seh. The 82% of the isolatescame from children skin and soft tissue infections and 18% came from invasive diseasessuch as sepsis, osteomyelitis and pneumonia. The Panton Valentine leukocidin, whichdata was previously obtained, was the most frequently virulence factor detected (58%),followed by alpha (16%) and beta (8%) hemolysins. Enterotoxins and exfoliative toxinswere less frequent (0-2%) and the enterotoxins C and D genes were not detected.
Assuntos
Humanos , Masculino , Adolescente , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Fatores de Virulência , Staphylococcus aureus/isolamento & purificação , Reação em Cadeia da PolimeraseRESUMO
Proliferation signal inhibitors, such as everolimus, offer immunosuppression without the toxicity of calcineurin inhibitors. This descriptive and prospective study reports outcomes at 1 year and predictors of improved estimated glomerular filtration rate (eGFR) in 174 renal transplant recipients from a national registry of the use of everolimus. At 1 year after conversion, 48.85% of patients had improved eGFR compared with baseline. The mean time from transplantation to initiation of treatment with everolimus was 47.97 months, the median 22 (range, 0-312) months. The kidneys were from deceased donors in 120 patients (68.79%) and from living donors in 54 (31.21%); 35 (20.83%) were expanded-criteria donors. When comparing the baseline versus 12-month values of laboratory results, total cholesterol levels and platelet counts differed significantly-191.55 ± 43.92 mg/dL versus 204.52 ± 41.29 mg/dL (P < .05) and 213,411 ± 63,231/mm(3) vs 255,571 ± 59,153/mm(3), respectively (P < .05)-but remained within clinically controllable ranges. Glycemia, triglycerides, hematocrit, hemoglobin, and leukocytes remained stable. Logistic regression analysis of baseline variables showed that the only independent prognostic factor for improved eGFR at 1 year was the conversion of patients to everolimus within the first 12 months after transplantation (odds ratio, 2.17; 95% confidence interval, 1.15-4.10). In conclusion, regarding the effectiveness of everolimus in our subjects, the only predictor of improved eGFR identified at 1 year was conversion within 12 months after transplantation.
Assuntos
Rejeição de Enxerto/prevenção & controle , Imunossupressores/uso terapêutico , Transplante de Rim , Sirolimo/análogos & derivados , Adulto , Everolimo , Feminino , Seguimentos , Taxa de Filtração Glomerular , Rejeição de Enxerto/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sistema de Registros , Sirolimo/uso terapêutico , Resultado do TratamentoRESUMO
BACKGROUND: The worldwide seroprevalence of human BK polyomavirus (BKV) in adults is 80%. About 10%-60% of renal transplant recipients experience BKV infection, nephropathy of the graft may occur in 5% of the cases, and up to 45% lose the graft. The aim of this work was to describe the prevalence of BK viruria during the 1st year after transplantation. METHODS: An epidemiologic multicenter cross-sectional study was carried out in consecutive patients at each site with kidney transplantation from August 2011 to July 2012. Clinically significant viruria was defined as >10(7) copies/mL. Viral DNA was extracted with the use of silica columns. Quantification was performed with the use of real-time polymerase chain reaction with primers that amplify a fragment of the large T-antigen gene and with a specific Taqman-MGB probe for BKV. For each assay, a standard curve with a quantified plasmid was included. RESULTS: Of 402 renal transplant recipients at 18 renal transplant sites, we analyzed 382; median age was 46.33 years, and 46.40% were female. The median of the temporal distribution for urine samples was 153 days. BK virus was detected in 50/382 samples (13%), 18 with values >10(7) copies/mL (4.7%). The median of the distribution of positive values was 123 days and the highest frequency of positive values was in months 3-7. The conditions of recipient older than 34 years and donor older than 41 years were the only ones that showed statistically significant association with BK viruria. No association with any specific immunosuppressive drug was observed. CONCLUSIONS: This is the first multicenter study conducted in Argentina to determine the prevalence of BK viruria in renal transplant recipients. Because of the growing number of the population susceptible to this infection, it is important to register and describe data about its epidemiology and associated risk factors.
Assuntos
Vírus BK/isolamento & purificação , Transplante de Rim , Infecções Oportunistas/epidemiologia , Infecções por Polyomavirus/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Infecções Tumorais por Vírus/epidemiologia , Adulto , Argentina , Vírus BK/genética , Estudos Transversais , DNA Viral/análise , Feminino , Humanos , Imunossupressores/efeitos adversos , Masculino , Pessoa de Meia-Idade , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/etiologia , Infecções por Polyomavirus/diagnóstico , Infecções por Polyomavirus/etiologia , Complicações Pós-Operatórias/diagnóstico , Prevalência , Reação em Cadeia da Polimerase em Tempo Real , Fatores de Risco , Infecções Tumorais por Vírus/diagnóstico , Infecções Tumorais por Vírus/etiologiaRESUMO
The production of anti-snake venom from large mammal's blood has been found to be low-yielding and arduous, consequently, antivenom immunoglobulins for treatment are achieved regularly as polyvalent serum. We have standardized an undemanding technique for making purified immunoglobulin IgY antivenom consisting of polyclonal antibodies against coral snake venom in the egg yolk of immunized hens. We have adapted a reported process of antibody purification from egg yolks, and achieved 90% antibody purity. The customized technique consisted of the removal of lipids from distilled water-diluted egg yolks by a freeze-thaw sequence. The specific immunoglobulins were present in the egg yolk for up to 180 days postimmunization. Therefore, by means of small venom quantities, a significant amount of immunoglobulins were found in an adequately purified state (The obtained material contained about 90% pure IgY). The antigen binding of the immunoglobulins was detected by a double immunodiffusion test. Titers of antibodies in the yolk were estimated with a serum protection assay (Median effective dose = ED50) (ED50= 477 mg/kg). Given that breeding hens is economically feasible, egg gathering is noninvasive and the purification of IgY antibodies is quick and easy, chicken immunization is an excellent alternative for the production of polyclonal antibodies. To the best of our knowledge, this is the first coral snake antivenom prepared in birds.
Assuntos
Antivenenos/biossíntese , Gema de Ovo/imunologia , Elapidae , Imunização/métodos , Imunoglobulinas/biossíntese , Animais , Antivenenos/isolamento & purificação , Galinhas , Eletroforese em Gel de Poliacrilamida , Feminino , Imunoglobulinas/isolamento & purificação , Dose Letal Mediana , Camundongos , Testes de NeutralizaçãoRESUMO
The production of anti-snake venom from large mammal's blood has been found to be low-yielding and arduous, consequently, antivenom immunoglobulins for treatment are achieved regularly as polyvalent serum. We have standardized an undemanding technique for making purified immunoglobulin IgY antivenom consisting of polyclonal antibodies against coral snake venom in the egg yolk of immunized hens. We have adapted a reported process of antibody purification from egg yolks, and achieved 90% antibody purity. The customized technique consisted of the removal of lipids from distilled water-diluted egg yolks by a freeze–thaw sequence. The specific immunoglobulins were present in the egg yolk for up to 180 days postimmunization. Therefore, by means of small venom quantities, a significant amount of immunoglobulins were found in an adequately purified state (The obtained material contained about 90% pure IgY). The antigen binding of the immunoglobulins was detected by a double immunodiffusion test. Titers of antibodies in the yolk were estimated with a serum protection assay (Median effective dose = ED50) (ED50= 477 mg/kg). Given that breeding hens is economically feasible, egg gathering is noninvasive and the purification of IgY antibodies is quick and easy, chicken immunization is an excellent alternative for the production of polyclonal antibodies. To the best of our knowledge, this is the first coral snake antivenom prepared in birds.
La producción de antiveneno de serpiente usando sangre de grandes mamíferos se ha encontrado que es de bajo rendimiento y de trabajo arduo, en consecuencia, las inmunoglobulinas antiveneno para el tratamiento se obtienen generalmente, como suero polivalente. Hemos estandarizado una técnica poco exigente para la fabricación de inmunoglobulina purificada IgY, que consistió en generar anticuerpos policlonales contra el veneno de la serpiente coral en huevos de gallinas inmunizadas. La técnica consistió en la eliminación de lípidos de las yemas del huevo, diluidas en agua y en una secuencia de congelación-descongelación. Las inmunoglobulinas específicas estuvieron presentes en la yema de huevo hasta 180 días después de la inmunización. La unión del antígeno a las inmunoglobulinas se detectó mediante un ensayo de inmunodifusión doble. Los títulos de anticuerpos en la yema fueron estimados con un ensayo de protección (dosis efectiva media = ED50). Dado que las gallinas reproductoras son económicamente viables, la recolección de huevos es no invasiva y la purificación de anticuerpos IgY es rápida y fácil, la inmunización de la gallina es una excelente alternativa para la producción de anticuerpos policlonales. A nuestro entender, esta es el primer anti-veneno contra serpiente de coral preparado en aves.
Assuntos
Animais , Feminino , Camundongos , Antivenenos/biossíntese , Elapidae , Gema de Ovo/imunologia , Imunização/métodos , Imunoglobulinas/biossíntese , Antivenenos/isolamento & purificação , Galinhas , Eletroforese em Gel de Poliacrilamida , Imunoglobulinas/isolamento & purificação , Testes de NeutralizaçãoRESUMO
A pesar de los avances científicos y las numerosas reuniones de expertos en todo el mundo y quizás por su presentación poco frecuente, aún existen dudas en el manejo de los pacientes con carcinoma oculto de la mama (COM). Algunos autores señalan que su comportamiento es similar a los carcinomas estadio II/III. Métodos: Retrospectivamente estudiamos en la base de datos del Centro Clínico de Estereotaxia CECLINES en Caracas, 841 pacientes, de las cuales el grupo de COM representa el 0.71% (6/841) y pacientes con St II el 16.52% (139/841). Resultados: Para COM el seguimiento promedio fue de 4.33 años (0.08 a 10.25, DS 4.04). En el estudio definitivo de la disección axilar las pacientes COM presentaron promedio de 2.17 ganglios (1-6 + 0.83) positivos y el grupo ST II un promedio de 2.72 ganglios (0-9 + 0.26) (p>0.05). La tasa de recaída para COM fue de 16.7% (1/6) y para ST II fue 15.1% (21/139)(p=0.089). La sobrevida a los 5 años, para COM fue 83.2% y para ST II 80.4% (p=0.630). Conclusión: La sobrevida de pacientes con COM es discretamente mejor que la de STII. El esquema propuesto parece ser factible en el manejo de pacientes con COM, ya que ha arrojado cifras de recaídas y sobrevida similar a lo reportado a nivel internacional(AU)
Despite scientific advances and the numerous meetings of experts around the world and perhaps it´s rare presentation, there are still doubts in the management of patients with occult breast carcinoma (OBC). Some authors suggest that it´s behavior is similar to those breast cancer stage (ST) II/III. Methods: Retrospectively we studied in the database of Centro Clínico de Estereotaxia CECLINES at Caracas, 841 patients, in which OBC represents 0.71% (6/841) and ST II breast cancer 16.52% (139/841). Results: For OBC the median follow up was 4.33 years (0.08-10.25, SD 4.04). In the definitive study of the axillary disecction of OBC there was a median of 2.17 (1-6 + 0.83) positie nodes and for the grup ST II a median of 2.72 (0-9 + 0.26) positive nodes (p>0.05). The recurrence rate for OBC was 16.7% (1/6) and for St II 15.1% (21/139)(p=0.089). The 5y survival for OBC was 83.2% y and for ST II 80.4% (p=0.630). Conclusion: The 5y survival for OBC patients was quietly better than that of ST II. The algorithm proposed seems to be feasible for the management of patients with OBC because it has produce results such as recurrence and survival similar as those reported internationaly(AU)
Assuntos
Humanos , Feminino , Recidiva , Algoritmos , Mama , Carcinoma/patologia , Axila , Sobrevida , Neoplasias da Mama , Mamografia , Biomarcadores , Taxa de Sobrevida , MastectomiaRESUMO
OBJETIVO : analizar el impacto de la implementación y operación del Seguro Popular en las condiciones psicosociales de trabajo y la exposición a situaciones y comportamientos de violencia de un grupo de trabajadores que laboran en una institución de salud. METODOLOGIA: se realizó un estudio cualitativo bajo el marco de la sociología fenomenológica. Se aplicó una encuesta a 206 trabajadores para valorar las condiciones psicosociales negativas en el entorno laboral. Posteriormente, se identificaron 18 sujetos caso por haber obtenido puntajes negativos altos en la encuesta y haber estado expuestos o haber participado en situaciones y comportamientos de violencia en el trabajo. RESULTADOS Y DISCUSIÓN :la implementación y operación del Seguro Popular provocó un deterioro y precarización de las condiciones psicosociales y del proceso de trabajo. La exposición a situaciones y comportamientos de violencia se manifestó como estrés , desgaste emocional, pérdida de la motivación, minusvalía y depresión. CONCLUSIONES : las reformas laborales y de la administración pública, expresadas en un nuevo modelo de gestión organizacional orientado a la eficiencia y reducción de costos prioriza los criterios administrativos y desestima la satisfacción y bienestar de los trabajadores.
OBJECTIVE: to analyze the impact of the implementation and operation of the Popular Health Insurance underwork psychosocial conditions and violence of a group of workers from a health institution. METHODOLOGY a qualitative study was realized under the framework of the phenomenological sociology. A survey was applied to two hundred six workers for the evaluation of the negative psychosocial conditions in the work environment. Later, it was identified to eighteen individual «cases¼for having obtained high negatives scores in the survey and having been exposed or for having taken part in situations and behaviors of violence at workplace. RESULTS AND DISCUSSION:the implementation and operation of the Popular Health Insurance provoked deterioration and precarious psychosocial conditions and work process alterations. Violence at workplace expressed like distress, emotional exhaustion, loss of motivation, disability and depression. CONCLUSIONS : labor and public administration, reforms in a new model of organizational management oriented to efficiency and cost reductions, prioritizes the administrative criteria and rejects the satisfaction and subjective well-being of workers.
RESUMO
Mujer de 80 años con síntomas dispépticos a quien se le realizó endoscopia de vías digestivas altas que mostró lesiones polipoides confluentes en la segunda porción del duodeno, cuyo estudio histológico indicó un linfoma no Hodgkin B folicular primario, neoplasia duodenal infrecuente de bajo grado, la cual debe diferenciarse de hiperplasia linfoide folicular reactiva y de otros linfomas
Patient was an 80 year old woman with dyspepsia. An upper endoscopy showed confluent polypoid lesions in the second portion of the duodenum. A histological study showed a follicular B-cell lymphoma. This is a rare low grade neoplasm of duodenum which must be differentiated from follicular reactive hyperplasia and other lymphomas
Assuntos
Humanos , Feminino , Idoso de 80 Anos ou mais , Linfoma Folicular , Linfoma não HodgkinRESUMO
Comparar carcinoma lobulillar infiltrante y carcinoma ductal infiltrante a largo plazo según estadio, tratamiento quirúrgico, terapia neoadyuvante, adyuvante. Estudiamos en la base de datos de CECLINES 841 pacientes, el lobulillar representa 7,25% (61) y ductal 51,24% (431). El seguimiento global 22 años con promedio de 5 años. La sobrevida global: lobulillar 68,1% vs. 60,9% ductal (P=0,772), por estadio fue: I lobulillar 96,3% ductal 90,5 II 94,4% y 88,4% III 90,5% 83,2% (P=0,023). La expresión de receptores de estrógenos positivos en comparación a los CDI fue 87,7% vs. 74,7%,(P=0,031) sobrevida 96,9% vs. 94,0% (P=0,033). El tratamiento preservador del lobulillar en comparación aductal 57,4% vs. 63,2% (P=0,949) y la sobrevida 85,4% vs. 82,9% (P=0,001). La sobrevida de lobulillar sometidos a quimioterapia primaria, quimioterapia adyuvante, radioterapia y hormonoterapia adyuvante en relación al grupo ductal fue 93,4% vs. 91,3%, 91,5% vs. 89,7%, 92,5% vs. 89,8% 92,5% vs. 88,4%, respectivamente (P<0,05). La sobrevida global es igual, la sobrevida por estadio favorece al lobulillar estos presentan más receptores positivos y sobrevida mejor. La tendencia a tratamiento preservador en lobulillar es mayor encontrando excelentes cifras de sobrevida. Dado el perfil hormonal y sobrevida según receptores las pacientes con lobulillar infiltrante son candidatas a participar en protocolos de hormonoterapia primaria. Generalmente el tratamiento para ambos grupos es similar.
Compare infiltrante lobulillar carcinoma and ductal carcinoma in long-term follow up as stage surgical treatment, neoadyuvante, adjuvant therapy. We studied in CECLINES data base 841 patients; lobulillar represents 7.25% (61) and 51.24% ductal (431). The overall followup was up to twenty two years with an average of five years. The overall survival for lobulillar was 68.1%and for ductal 60.9% (P=0.772), the survival according to state was: I lobulillar 96.3% ductal 90.5, II 94.4% vs. 88.4 III 90.5 and 83.2 respectively (P=0.023). Estrogen receptors positive expression for lobulillar compared to ductal was 87.7% vs. 74.7%, (P=0.031) and its survival 96.9% vs. 94.0% (P=0.033). The breast conserving surgery for lobulillar compared to ductal was 57.4% vs. 63.2% (P=0.949) survival 85.4% vs. 82.9% (P=0.001). The survival reported for patients with lobulillar who received neoadyuvante chemotherapy adjuvant chemotherapy radiotherapy and adjuvant hormonotherapy compared to ductal was 93.4% 91.3%, 91.5% 89.7%, 92.5% 89.8% 92.5% 88.4%, respectively P<0.05. The overall survival is equal, survival favors. The lobulillar have more positive receptors and survival is better. The tendency to conservative treatment in lobulillar is increasingly. Given the hormonal profile and survival according to estrogen receptors patients with ILC, are probably good candidates to participate in neoadyuvante hormone therapy protocols. Usually the treatment is the same or similar for both groups.
Assuntos
Humanos , Adulto , Feminino , Pessoa de Meia-Idade , Mastectomia Segmentar/métodos , Neoplasias da Mama/cirurgia , Neoplasias da Mama/patologia , Quimioterapia Adjuvante/métodos , Receptores de Progesterona/administração & dosagem , Biópsia/métodos , Carcinoma Ductal de Mama/patologia , Carcinoma Ductal de Mama/tratamento farmacológico , Carcinoma Lobular/patologia , Carcinoma Lobular/tratamento farmacológicoRESUMO
Describir los primeros 100 casos de carcinoma ductal in situ en nuestra institución. 100 casos tratados adoptamos la definición de mic de Silver y Tavassoli: 77 fueron puros y 23 mic. En 69 por ciento se practicó cirugía preservadora, 31 por ciento mastectomía, 24 por ciento con reconstrucción, una bilateral y 7 por ciento sin reconstrucción. 64 por ciento recibió radioterapia complementaria. 36 por ciento el tratamiento fue cirugía sola. 77 por ciento recibieron terapia hormonal adyuvante. En 46 por ciento practicamos biopsia de ganglio centinela: 25 por ciento in situ puros y 21 por ciento mic. En 83 por ciento la presentación fue micro calcificaciones. El patrón histológico cribiforme y mixtos, los más frecuentes, 75 por ciento. El tamaño mamográfico e histológico coincidieron, 20 mm, promedio. El 87 por ciento grado nuclear II o III actividad mitótica 82 por ciento fue baja o moderada sólo 4 por ciento alta. El 78 por ciento presentó necrosis. De 25 pacientes con in situ puro, que se les practicó ganglio centinela ninguna presentó enfermedad ganglionar y los 21 con in situ mic, 9,52 por ciento presentaron metástasis. 2 por ciento recaídas locales, con enfermedad infiltrante; una a 52 meses, los otros a 58 meses. Una sin radioterapia, se trataron con mastectomía de rescate. No ocurrieron muertes por enfermedad. El buen manejo de los casos, traduce satisfactorios resultados de sobre vida libre de enfermedad y sobrevida global. Podemos seleccionar un sub-grupo de pacientes a quienes les pueda omitir la radioterapia sin aumentar el riesgo de mortalidad.
Describe first 100 cases of ductal carcinoma in situ in our institution. 100 cases treated adopted the definition of mic by Silver and Tavassoli: 77 pure and 23 mic. 69 percent we performed breast conserving surgery 31 percent total mastectomy 24 percent reconstruction, 1 was bilateral, 7 percent without reconstruction. 64 percent received complementary radiotherapy. 36 percent treatment was surgery alone. 77 percent recieved hormonal adjuvant therapy. 46 percent we performed sentinel lymph node biopsy: 25 percent were pure and 21 percent mic. 83 percent initial form of presentation was micro calcifications. The histological type was cribiform and mixed (75 percent). The mammographic and histological size matched 20 mm average. 87 percent were nuclear grade II and III, 82 percent of the mitotic activity was moderate or low only 4 percent were high. 78 percent had necrosis. Out of the 25 patients with pure in which we practice none presented ganglion disease and out of the 21 patients with mic, 9.52 percent presented ganglion metastasis. 2 percent had local recurrence, both of them with invasive disease, one 52 months the other one at 58 month from surgery. One didn´t received radiation. Both were treated with rescue mastectomy. There was no death diseases related. Adequate and good management of cases results related to disease free survival and overall survival. We can classify sub group of patients in which may avoid radiation without increasing the risk of mortality.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Fatores de Necrose Tumoral/efeitos adversos , Mastectomia Radical/métodos , Neoplasias da Mama/cirurgia , Neoplasias da Mama/radioterapia , Biópsia de Linfonodo Sentinela/métodos , Carcinoma Intraductal não Infiltrante/fisiopatologia , Carcinoma Intraductal não Infiltrante/terapiaRESUMO
OBJECTIVE: There is a lack of information regarding overactive bladder (OAB) in South America. Our aim in this study was to estimate the prevalence of overactive bladder (OAB) in Venezuela based on the 2002 International Continence Society (ICS) consensus criteria and also to verify its demographic distribution in this country. SUBJECTS AND METHODS: We performed a multicentric prospective evaluation of patients from 2003 to 2007 in different cities in Venezuela. A number 3.407 adults (M:38%, F:62%) between 18 and 75 years of age (mean age 54 years) completed a physician guided questionnaire (V8) of urinary symptoms, bladder function, diet, general habits and general medical condition. Statistical procedures were carried out using software based on R programming for computational statistics. RESULTS: The overall prevalence of OAB in Venezuela was determined as 21%. Female were more affected as compared to male (25.6% vs. 13.7% in men, p < 0.005) OAB was detected at early age (18 yrs) maintaining higher prevalence in women (M: 9%, F: 14%). In the studied cohort OAB shows its highest prevalence between the subgroup of 65 to 69 years of age. In all statistical tests the level of significance was defined as p < 0.005, with a confidence interval of 95%. CONCLUSION: The OAB-V8 questionnaire aids to clearly identify patients with OAB symptoms. The overall prevalence of OAB in Venezuela is 21%. It is present in both genders, predominantly women and can be detected at early age.
Assuntos
Bexiga Urinária Hiperativa/epidemiologia , Adolescente , Adulto , Fatores Etários , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Fatores Sexuais , Inquéritos e Questionários , Venezuela/epidemiologia , Adulto JovemRESUMO
Management of posttransplantation malignancies should include control of the neoplasia and preservation of renal function. Conversion to everolimus (EVL) would potentially have both effects. Twenty-one patients were converted to EVL due to posttransplantation neoplasms. We have presented herein descriptive data and postconversion (PC) outcomes among subjects of mean age 53.6 +/- 10.1 years (range, 36-69), 57.1% were males, undergoing conversion at 108.2 +/- 74.7 (range, 5-316) months after transplantation. All patients received standard immunosuppressive therapy and 9.5% had been induced with thymoglobulin. Malignant neoplasms were as follows: skin (n = 7), gynecological (n = 3), gastrointestinal (n = 3), PTLD (n = 2), renal (n = 2), CNS (n = 1), seminoma (n = 1), Kaposi's sarcoma (n = 1), and prostate cancer (n = 1). PC to EVL, calcineurin inhibitors (CNIs) were discontinued in 18 of 19 patients, mycophenolate in 9/12, and azathioprine in 5/7; all patients continued to receive steroids. In 16 patients (79%) tumors were removed. Chemotherapy was performed in 2 patients with PTLD and radiotherapy was performed in 1 patient with prostate cancer. Mean follow-up was 505 days (range, 59-1151); baseline glomerular filtration rate (GFR) was 53.5 +/- 21.6 mL/min versus 48.5 +/- 25.7 mL/min (P = not significant [NS]) at the last control. One patient experienced graft loss at day 744 after conversion due to chronic rejection. Adverse events were observed in 57% of patients and 28% displayed infections; no patient discontinued EVL. There were 2 deaths: 1 due to an infection and the other due to postsurgical complication. No deaths due to cancer progression were observed. The results observed in this series suggested that conversion to EVL for a posttransplantation neoplasm is a valid therapeutic alternative to preserve graft function and control disease progression.
Assuntos
Imunossupressores/uso terapêutico , Transplante de Rim/imunologia , Neoplasias/imunologia , Complicações Pós-Operatórias/imunologia , Sirolimo/análogos & derivados , Adulto , Idoso , Soro Antilinfocitário/uso terapêutico , Colesterol/sangue , Everolimo , Feminino , Seguimentos , Taxa de Filtração Glomerular , Humanos , Imunossupressores/efeitos adversos , Masculino , Pessoa de Meia-Idade , Neoplasias/tratamento farmacológico , Neoplasias/radioterapia , Neoplasias/cirurgia , Contagem de Plaquetas , Neoplasias da Próstata/radioterapia , Proteinúria , Sirolimo/uso terapêutico , Fatores de Tempo , Triglicerídeos/sangueAssuntos
Humanos , Masculino , Feminino , Seguimentos , Guias como Assunto/normas , Neoplasias da Mama/patologia , Neoplasias da Mama/prevenção & controle , Neoplasias da Mama/secundário , Revisão por Pares/métodos , Carcinoma/patologia , Carcinoma/prevenção & controle , Dissidências e Disputas , OncologiaRESUMO
Masculino de 36 años, con trauma generalizado causado por accidente de tránsito ocurrido de 18 de septiembre de 1977, presenta fracturas conminuta a nivel de tercio medio de femúr izquierdo cerrada; fragmento en mariposa. Se coloca tracción esquelética, con posterior tratamiento quirúrgico abierto, colocación de clavo endo medular no convencional, tornillo de Sherman para fragmento de mariposa. Evolución tórpida proceso infeccioso supurativo severo, posterior a 2 meses se raliza limpieza quirúrgica y colocación de injerto de ternera (xenoinjerto), persiste proceso infeccioso. Compromiso del foco de fractura. Se decide practicar limpieza quirúrgica y diafisectomía (15 cm), se mantiene espacio con tutor externo. Primer tutor externo usado en Mérida. Curas planas sucesivas bajo anestesia general inhalatoria. En mayo 1978 se presenta paciente con fracturas conminuta a nivel de tercio medio femúr izquierdo y fractura intercondilea antes tratada. Se practica amputación a nivel de muslo, se preparó la tibia 19 centímetros lineales, remodelada dando aspecto cilíndrico en los extremos, se coloca injerto en espacio correspondiente a femúr. Se mantiene con clavo de Kunther N° 12 X 42 de acorde a la longuitud de los segmentos óseos. Injerto de esponjosa a nivel de los expertos. Después de treinta años de intervenido, el paciente se encuentra en buenas condiciones con acortamiento compensado con realce en el calzado y limitación de la flexo-extensión de la articulación de la rodilla izquierda.
Assuntos
Humanos , Masculino , Adulto , Pinos Ortopédicos , Fraturas do Fêmur/diagnóstico , Transplante , Transplante Heterólogo , Transplante Ósseo/métodos , OrtopediaRESUMO
Presentamos el caso de un quiste óseo aneurismático en la columna cervical que se manejó con embolización intravascular con partículas. Se obtuvo una muy buena respuesta y una marcada disminución de su tamaño, por lo que no se llevó a resección quirúrgica.
A case of aneurysmal bone cyst of the cervical spine treated with particulate embolization with a very good answer and marked involution of the mass, for which it doesnt lead to surgical resection.
Assuntos
Neoplasias Ósseas , Cistos Ósseos/terapiaRESUMO
OBJECTIVE: Apoptosis appears to be the mode of cell death by which damaged cells are removed from the lesional tissue. The aim of this study was to examine keratinocyte apoptosis and caspase-3 (CPP32) expression in oral lichen planus (OLP). MATERIALS AND METHODS: Paraffin-embedded samples of OLP (n = 30) and normal oral mucosa (NOM; n = 5) were prepared for haematoxylin-eosin (H & E), immunohistochemistry and electron microscopy. The number of apoptotic cells and the proportion of total cells that were either apoptotic (apoptotic index; AI) or mitotic (mitotic index; MI) were assessed in H & E stained sections. An immunostaining-intensity-distribution index (IIDI; proportion of stained cells x staining intensity) was used to assess CPP32 immunoreactivity. RESULTS: Results showed a significant increase in the number of apoptotic cells in OLP (P < 0.001). In OLP, all apoptotic bodies were found in the basal and prickle epithelial layers. Compared with NOM, the AI was significantly greater in atrophic (P < 0.05), reticular (P < 0.001) and plaque-like (P < 0.01) OLP. The MI was significantly greater in plaque-like OLP (P < 0.01). The proportion of CPP32-positive cells and the IIDI were significantly greater in all forms of OLP compared with NOM (P < 0.05). No difference in CPP32 expression was evident between clinical forms of OLP. Electron microscopy confirmed the light microscopic finding of apoptosis. CONCLUSION: Keratinocyte apoptosis and caspase-3 expression co-localized to the basal and parabasal epithelial layers, suggesting that proliferating epithelial cells may be targeted for destruction in OLP. Differences in epithelial AI and MI may underlie the various clinical and histological appearances of OLP.