RESUMO
Introducción: La Suprarrenalectomía quirúrgica es el tratamiento de elección en lesiones tumorales de la glándula suprarrenal mayores de 4 cm o aquellos que resulten funcionales. La técnica laparoscópica esta asociada a menor sangrado, morbilidad perioperatoria y estadía hospitalaria. El apoyo del abordaje single-port (LESS) se asocia además a menor dolor y mejores resultados estéticos, pero conlleva a una mayor complejidad técnica, sin embargo esta dificultad puede ser eliminada con el apoyo robótico, conservando los beneficios de la técnica single port.(AU)
Introduction: Surgical adrenalectomy is the treatment of choice in tumors of the adrenal gland larger than 4 cm or those that are functional. The laparoscopic technique is associated with less bleeding, perioperative morbidity and hospital stay. The support of the single-port approach (LESS) is also associated with less pain and better aesthetic results, but it leads to greater technical complexity, however this difficulty can be eliminated with robotic support, while retaining the benefits of the single port technique.
Assuntos
Feminino , Laparoscopia , Adenoma Adrenocortical , Filme e Vídeo EducativoRESUMO
A commercially available multi-antigen lateral flow assay (LFA) for detection of antibodies to Mycobacterium bovis was evaluated by testing dairy cattle in Baja California, México. Sera and tissue samples were obtained from 268 dairy cattle at a slaughterhouse and were tested by LFA, bacteriological culture, and polymerase chain reaction (PCR). Of 107 culture positive samples, 70 (65.4%) were positive by PCR and 49 (45.8%) were positive by LFA. The PCR and LFA gave positive results with an additional 59 (36.6%) and 77 (47.8%) of the 161 culture negative samples, respectively. The false negative rate for the PCR was 34.6% and 54.2% for the LFA. Due to the high false positive rate for both PCR and LFA observed in this study, the LFA cannot be a useful test, even in combination with PCR.
Assuntos
Anticorpos Antibacterianos/análise , Imunoensaio/métodos , Tuberculose Bovina/diagnóstico , Animais , Anticorpos Antibacterianos/sangue , Anticorpos Antibacterianos/imunologia , Bovinos , Indústria de Laticínios , Mycobacterium bovis/genética , Mycobacterium bovis/imunologia , Reação em Cadeia da Polimerase , Tuberculose Bovina/sangue , Tuberculose Bovina/imunologia , Tuberculose Bovina/microbiologiaRESUMO
Schistosoma mansoni cathepsin B (Sm31) is a major antigen from adult worms that circulates in the blood of infected patients (Li et al., Parasitol Res 1996; 82: 14-18). An analysis of the Sm31 sequence (Klinkert et al., Mol Biochem Parasitol 1989; 33: 113-122) allowed the prediction of seven hydrophilic regions that were confirmed to be exposed on the surface of a 3D model of Sm31; the species specificity of these regions was checked using BLAST analysis. The corresponding peptides were chemically synthesized in polymerazible forms using the t-Boc technique. Rabbits developed a high humoral response against these peptides as tested by a multiple antigen blot assay; it recognized native Sm31 in crude S. mansoni extracts and as circulating antigen in sera of S. mansoni-infected patients by western blot. Relevant antigenic determinants were located at the N- and C-terminus sequences. Antibodies against these regions recognized the native enzyme in an ELISA-like assay called cysteine protease immuno assay in which the immunocaptured enzyme was revealed by the intrinsic cathepsin B hydrolytic activity of Sm31. The method successfully and specifically detected Sm31 in sera of infected individuals, most of them (83.3%) with light infections, offering a rationale for the development of parasite enzyme capture assays using anti-synthetic peptide antibodies for possible use in the diagnosis of schistoso,iasis.
Assuntos
Antígenos de Helmintos/sangue , Cisteína Endopeptidases/sangue , Doenças Endêmicas , Proteínas de Helminto/sangue , Schistosoma mansoni/isolamento & purificação , Esquistossomose mansoni/diagnóstico , Esquistossomose mansoni/epidemiologia , Sequência de Aminoácidos , Animais , Anticorpos Anti-Helmínticos/imunologia , Antígenos de Helmintos/imunologia , Cisteína Endopeptidases/síntese química , Cisteína Endopeptidases/imunologia , Proteínas de Helminto/síntese química , Proteínas de Helminto/imunologia , Humanos , Imunoensaio , Dados de Sequência Molecular , Estrutura Terciária de Proteína , Coelhos , Schistosoma mansoni/imunologia , Schistosoma mansoni/metabolismo , Esquistossomose mansoni/sangue , Esquistossomose mansoni/imunologia , Sensibilidade e Especificidade , Especificidade da Espécie , Venezuela/epidemiologiaRESUMO
Este trabajo tiene como objetivo analizar cómo el consumo cultural se convierte en un elemento fundamental en el proceso de construcción de identidades y diferencias de algunos grupos de jóvenes en un contexto urbano y en espacios de intercambio de bienes materiales y simbólicos globalizados, como es el caso de los malls en Maracaibo. En función de este objetivo se tomaron, como categorías centrales de análisis, los conceptos de consumo cultural y representaciones de identidades. La metodología utilizada es de tipo cualitativo, privilegiando para la producción de la información el uso de técnicas etnográficas tales como la observación y las entrevistas en profundidad. Se concluye que en los procesos de construcción de representaciones de identidades de los jóvenes y las jóvenes en estudio, los objetos se tornan valiosos y adquieren centralidad en sus adscripciones identitarias, en la medida en que se convierten en el medio más importante para construir la imagen que desean comunicar para identificarse y diferenciarse de los otros jóvenes y de las otras jóvenes. Asimismo, que existen diferentes maneras de ser joven y que estas identidades se construyen en el entrecruzamiento de espacios y símbolos globales y locales.
Este trabalho tem como objetivo analisar como o consumo cultural se torna num elemento fundamental no processo de construção de identidades e diferenças de alguns grupos de jovens num contexto urbano e em espaços de troca de bens materiais e simbólicos globalizados, como é o caso dos malls da cidade de Maracaibo, Venezuela. Baseado neste objetivo, se tomaram como categorias centrais da análise, os conceitos de consumo cultural e representações de identidades. A metodologia utilizada é do tipo qualitativo, privilegiando o uso de técnicas etnográficas, tais como a observação e as entrevistas de profundidade, para a produção de informação. Se conclui que nos processos de construção de representações de identidades dos jovens e das jovens neste estudo, os objetos se tornam valiosos e adquirem centralidade nas suas adscrições identitárias, na medida em que se tornam no meio mais importante para construir a imagem que desejam comunicar para se identificar e para se diferenciar dos outros jovens e das outras jovens. Igualmente se conclui que há maneiras diferentes de ser jovem e que estas identidades se construem no cruzamento de espaços e símbolos globais e locais.
This paper has as its goal to analyze how cultural consumerism turns out to be a fundamental element in the process of construction of identites and differences in some youth groups in an urban context and in those spaces where globalized material and symbolic goods are interchanged, as it is the case of the malls of Maracaibo. To reach this goal, the concepts of cultural consumerism and identities representations were taken as central analytic categories. The methodology used in this study was qualitative, foregrounding ethnographic techiques for the collection of information, like observation and in-depth interviews. The conclusion is that in the proceses of identities representation construction in those youths under scrutiny, objects become valuable and acquire centrality in their identitary adscriptions in as much as they become the most important means to construct that image they wish to communicate in order to identfiy with, and differentiate themselves from other youths. It is also concluded that there are different ways of being young, and that those identites are constructed in the crossing of spaces and symbols that are both local and global.
Assuntos
Humanos , Adolescente , Cultura , VenezuelaRESUMO
Human cutaneous leishmaniasis (CL) and mucous leishmaniasis (ML) are highly endemic in Isiboro Secure Park, which lies in the Bolivian department of Cochabamba--an area where branded meglumine antimoniate (Glucantime) is expensive and poorly distributed. The safety and efficacy of generic sodium stibogluconate (SSG), from Albert David Ltd, was therefore explored, in CL and ML cases from the park, who were treated with 20 mg/kg.day for 20 and 30 days, respectively. A questionnaire recording adverse effects was completed by a physician in each treatment centre. Efficacy of treatment was assessed at the end of treatment and at follow-ups 1 month and 3, 6 and 12 months later. Overall, 146 patients completed treatment with SSG in 2003-2004. No fatalities or severe adverse effects were reported but mild to moderate adverse effects were noted in 41 (28%) of the patients. The incidence of adverse effects was significantly higher among the cases of ML than among the cases of CL. Of the 86 patients with CL who completed 6 months of follow-up, 81 (94.2%) were considered to have been clinically cured; a comparable cohort of 69 CL cases who had been treated with Glucantime in 2001-2002 showed a similar frequency of clinical cure (90%). Generic SSG was shown to be safe and efficacious for the treatment of tegumentary leishmaniasis in Bolivia. Being several times cheaper than Glucantime, it could contribute to improving the access of CL and ML patients to treatment, not only in Bolivia but also in other countries of Latin America.
Assuntos
Gluconato de Antimônio e Sódio/administração & dosagem , Antiprotozoários/administração & dosagem , Medicamentos Genéricos/administração & dosagem , Leishmaniose Cutânea/tratamento farmacológico , Meglumina/administração & dosagem , Compostos Organometálicos/administração & dosagem , Adulto , Gluconato de Antimônio e Sódio/efeitos adversos , Antiprotozoários/efeitos adversos , Bolívia/epidemiologia , Medicamentos Genéricos/efeitos adversos , Feminino , Humanos , Injeções Intramusculares , Injeções Intravenosas , Leishmaniose Cutânea/epidemiologia , Leishmaniose Cutânea/parasitologia , Leishmaniose Mucocutânea/tratamento farmacológico , Leishmaniose Mucocutânea/epidemiologia , Leishmaniose Mucocutânea/parasitologia , Masculino , Meglumina/efeitos adversos , Antimoniato de Meglumina , Compostos Organometálicos/efeitos adversos , Resultado do TratamentoRESUMO
It is not unusual to find common molecules among different species of the genus Schistosoma. When those molecules are antigenic, they may be used in immunodiagnosis and vaccines, but they could also be applied to taxonomic and evolutionary studies. To study cross-reactivity and antigenic community among different species of schistosomes, plasmas from laboratory animals infected with Schistosoma bovis, S. guineensis, S. rodhaini, S. haematobium, and four strains of S. mansoni were evaluated with a crude extract of adult worms of S. mansoni by Western blot. Using the multiple antigen blot assay, plasmas from these infected animals were exposed to a selected group of synthetic peptides from Sm28GST, Sm28TPI, Sm elastase, Sm97, Sm32, Sm31, and Sm Cathepsin L. The results presented herein demonstrate differential cross-reactivity and antigenic community among the Mansoni and Haematobium groups of schistosomes, which is of relevance as an additional new tool for phylogenetic studies of schistosomes as well as for diagnosis and vaccine purposes.
Assuntos
Antígenos de Helmintos/imunologia , Schistosoma/imunologia , Esquistossomose/parasitologia , Animais , Antígenos de Helmintos/análise , Western Blotting , Reações Cruzadas , Eletroforese em Gel de Poliacrilamida , Gerbillinae , Humanos , Immunoblotting , Peptídeos/análise , Peptídeos/imunologia , Schistosoma/classificação , Esquistossomose/imunologiaRESUMO
Multi-locus enzyme electrophoresis is the current gold standard for the genetic characterisation of Leishmania. However, this method is time-consuming and, more importantly, cannot be directly applied to parasites present in host tissue. PCR-based methods represent an ideal alternative but, to date, a multi-locus analysis has not been applied to the same sample. This has now been achieved with a sample of 55 neotropical isolates (Leishmania (Viannia) braziliensis, L. (V.) peruviana, L. (V.) guyanensis, L. (V.) lainsoni and L. (L.) amazonensis), using five different genes as targets, four of which encoded major Leishmania antigens (gp63, Hsp70, H2B and Cpb). Our multi-locus approach strongly supports the current taxonomy and demonstrates a highly robust method of distinguishing different strains. Within L. (V.) braziliensis, we did not encounter so far specific genetic differences between parasites isolated from cutaneous and mucosal lesions. Interestingly, results provided by each of the different antigen-genes in the species considered, were different, suggesting different selective pressures. Our work emphasises the need for a multi-disciplinary approach to study the clinical pleomorphism of leishmaniasis.
Assuntos
Antígenos de Protozoários/genética , Leishmania/genética , Leishmaniose Cutânea/parasitologia , Reação em Cadeia da Polimerase/métodos , Polimorfismo Genético/genética , Animais , Humanos , Leishmania/classificação , Leishmaniose Mucocutânea/parasitologia , Filogenia , Polimorfismo de Fragmento de RestriçãoRESUMO
La prostatectomía radical laparoscópica (PRL) es una nueva técnica quirúrgica que surge como alternativaa la prostatectomía radical abierta con el fin de reducir su morbilidad. Presentamos nuestra experienciainicial en PRL.Revisión retrospectiva de 17 pacientes operados entre marzo 2002 y agosto 2003 por PRL, por cáncer depróstata localizado, en 3 centros hospitalarios. Nueve pacientes fueron operados por vía transperitonealy 8 por vía extraperitoneal, sin conservación de bandeletas. Dos pacientes fueron sometidos alinfadenectomía íleo obturatriz. PSA preoperatorio promedio fue 9,5 ng/ml (rango 5,5-16,8).El tiempo operatorio promedio fue 5,1 h (rango 2,5-7), la mediana de sangrado estimado fue 500 cc(rango 100-2000 cc), con 2 transfusiones. Hubo 3 conversiones, una por tiempo prolongado de cirugía,otra por lesión de arteria epigástrica con hemorragia profusa y otra por imposibilidad de encontrar elcuello vesical. Hubo 3 complicaciones intraoperatorias resueltas por vía laparoscópica, lesión de arteriaepigástrica, perforación de vejiga, lesión de recto. La mediana de hospitalización fue 5 días (rango 4-19).La mediana de tiempo de catéter vesical fue de 6 días (rango 4 a 24). Hubo una fístula urinaria. Laetapificación patológica fue T2a (12 porciento), T2b (70 porciento), T3a (18 porciento), con 1 margen positivo en un pacienteT3a. La mediana de seguimiento fue de 3 meses (rango 1-15), con una sobrevida libre de tumor a 3 mesesde 95 porciento. Una continencia nocturna de 100 porciento y una continencia diurna de 85 porciento sin paños y de 15 porciento usando un paño.La prostatectomía radical laparoscópica es una técnica factible de realizar, que requiere una larga curvade aprendizaje para reducir los prolongados tiempos operatorios y la morbilidad perioperatoria. Se requierede un buen material laparoscópico y de un equipo quirúrgico afiatado y motivado (cirujanos,anestesista, arsenalera y personal de pabellón) para lograr resultados comparables a la técnica abierta.
Assuntos
Humanos , Masculino , Laparoscopia , Prostatectomia/instrumentação , Prostatectomia/métodos , Prostatectomia/tendências , ChileRESUMO
The asparaginyl endopeptidase (Sm32) is expressed in the gastrodermal cells of the schistosome gut and in the head glands of the cercariae. Possibly, Sm32 hydrolyzes pro-proteins involved in the degradation of host hemoglobin [Parasitol. Today 12 (1996) 125]. Preliminary evidences using an Sj32/Sm32 murine vaccine have shown a profound effect on oviposition and worm burden [Chin. J. Schist. Control. 7 (1995) 72; Bull. Human Med. Univ. 24 (1999) 225; Vaccine 20 (2002) 439]. The importance of Sm32 as a novel vaccine candidate is based on the possibility of preventing the maturation of other cathepsins and/or preventing schistosome skin invasion. We studied the immunogenicity of polymerizable peptides derived from Sm32 to select potential protective epitopes. Sm32 prediction of T and B epitopes and homology studies with human legumain were performed. Among the variety of factors that influence the antibody response, we specifically examined the effect of: (i) genetic background of mouse strain, inbred (C57BL/6) versus outbred (Swiss) mice; and (ii) vaccination with a single peptide versus pool of peptides. Swiss mice raised antibodies to three different regions of the Sm32, as tested by the Multiple Antigen Blot Assay (MABA): 182-215 (peptides IMT-70 and 72), 244-273 (IMT-64) and 336-355 (IMT-66). None of these regions were immunogenic for C57BL/6. On the contrary, other peptides, IMT-4 (21-40), IMT-12 (101-120) and IMT-26 (292-313) were highly immunogenic for this inbred strain. Only Swiss mice immunized with a single peptide (IMT-64 and 72) or with three different pools of IMT-peptides (Pool A-II: 14, 16, 18, 70, 72, 89; pool A-III: 22, 64, 24, 26, 28 and pool A-V: 64, 66, 28, 70, 72) recognized the original protein in a crude extract of the worm antigen by Western blot. Peptides IMT-64, 14 and 26 were responsible for this recognition. In general, the vaccination with pool of peptides was more immunogenic for both mouse strains. Predicted B cell epitopes, with hydrophilicity scores over +10 (IMT-12, 64, 26) were always immunogenic after either single or combined peptide vaccination. Sm32 sequences 41-80 (IMT-6 and 8), 141-160 (IMT-16) and 182-215 (IMT-70 and 72) were nearly identical to the corresponding human legumain regions and should be excluded from the human vaccine. We can conclude that the regions of Sm32 that were recognized by antibodies of mice immunized with polymerizable peptides depended on the mice strain and on the hydrophilicity score of the peptides.
Assuntos
Cisteína Endopeptidases/química , Cisteína Endopeptidases/imunologia , Esquistossomose/imunologia , Vacinas de Subunidades Antigênicas/química , Vacinas de Subunidades Antigênicas/imunologia , Sequência de Aminoácidos , Animais , Reações Cruzadas/imunologia , Epitopos de Linfócito B/imunologia , Humanos , Camundongos , Dados de Sequência Molecular , Schistosoma mansoni/enzimologia , Schistosoma mansoni/imunologia , Esquistossomose/parasitologia , Alinhamento de Sequência , Linfócitos T/imunologia , Vacinas de Subunidades Antigênicas/síntese químicaRESUMO
Spectroscopic techniques have been used to study the conformations of several synthetic peptides with sequences corresponding to the repeat regions of the circumsporozoite proteins of Plasmodium vivax, variants vk-210 and vk-247. As has previously been shown for P. falciparum, turn-like folded conformations are observed, in rapid dynamic equilibrium with extended-chain forms. These results are consistent with the known similarity of the structural, biosynthetic and immunological properties of the circumsporozoite proteins of different plasmodial species. Additionally, the observation of folded conformers provides a rationale for the effectiveness of these peptides as immunogens and potential vaccines.
Assuntos
Peptídeos/química , Plasmodium vivax/química , Proteínas de Protozoários/química , Sequência de Aminoácidos , Animais , Dicroísmo Circular , Ressonância Magnética Nuclear Biomolecular , Conformação Proteica , SoluçõesRESUMO
After 57 years of successful control of schistosomiasis in Venezuela, the prevalence and intensity of infection have declined. Approximately 80% of the individuals eliminate less than 100 eggs/g of stools, therefore morbidity is mild and the majority are asymptomatic. The sensitivity of Kato-Katz decreases to approximately 60%. Available serological methods for the detection of circulating antigens only reach a 70% of sensitivity. Tests based on the detection of antibodies by immunoenzymatic assays have been improved. The circumoval precipitine test has shown a high sensitivity (97%), specificity (100%), and correlation with oviposition, being considered the best confirmatory diagnostic test. Additionally to the classical immunoenzymatic assays, the development of the alkaline phosphatase immunoassay, allowed to reach a 100% specificity with an 89% sensitivity. Recently, we have developed a modified ELISA in which the soluble egg antigen is treated with sodium metaperiodate (SMP-ELISA) in order to eliminate the glycosilated epitopes responsible for the false positive reactions. The specificity and sensitivity reaches 97% and 99%, respectively. Synthetic peptides from the excretory-secretory enzymes, cathepsin B (Sm31) legumain (Sm32) and cathepsin D (Sm45), have been synthesized. The combination of two peptides derived from the Sm31 have been evaluated, reaching a sensitivity of 96% when analyzed independently and with a 100% specificity. Antibodies raised in rabbits against peptides derived from the Sm31 and Sm32 are currently evaluated in two different antigen-capture-based assays. The development of a simple, cheap and reliable test that correlates with parasite activity is a major goal.
Assuntos
Antígenos de Helmintos/imunologia , Ensaio de Imunoadsorção Enzimática/métodos , Esquistossomose/diagnóstico , Animais , Reações Falso-Positivas , Fezes/parasitologia , Humanos , Schistosoma mansoni/imunologia , Sensibilidade e Especificidade , Testes Sorológicos , VenezuelaRESUMO
After 57 years of successful control of schistosomiasis in Venezuela, the prevalence and intensity of infection have declined. Approximately 80 percent of the individuals eliminate less than 100 eggs/g of stools, therefore morbidity is mild and the majority are asymptomatic. The sensitivity of Kato-Katz decreases to approximately 60 percent. Available serological methods for the detection of circulating antigens only reach a 70 percent of sensitivity. Tests based on the detection of antibodies by immunoenzymatic assays have been improved. The circumoval precipitine test has shown a high sensitivity (97 percent), specificity (100 percent), and correlation with oviposition, being considered the best confirmatory diagnostic test. Additionally to the classical immunoenzymatic assays, the development of the alkaline phosphatase immunoassay, allowed to reach a 100 percent specificity with an 89 percent sensitivity. Recently, we have developed a modified ELISA in which the soluble egg antigen is treated with sodium metaperiodate (SMP-ELISA) in order to eliminate the glycosilated epitopes responsible for the false positive reactions. The specificity and sensitivity reaches 97 percent and 99 percent, respectively. Synthetic peptides from the excretory-secretory enzymes, cathepsin B (Sm31) legumain (Sm32) and cathepsin D (Sm45), have been synthesized. The combination of two peptides derived from the Sm31 have been evaluated, reaching a sensitivity of 96 percent when analyzed independently and with a 100 percent specificity. Antibodies raised in rabbits against peptides derived from the Sm31 and Sm32 are currently evaluated in two different antigen-capture-based assays. The development of a simple, cheap and reliable test that correlates with parasite activity is a major goal
Assuntos
Animais , Humanos , Antígenos de Helmintos , Ensaio de Imunoadsorção Enzimática , Esquistossomose , Reações Falso-Positivas , Fezes , Schistosoma mansoni , Sensibilidade e Especificidade , Testes Sorológicos , VenezuelaRESUMO
The chemical synthesis of peptides may simplify the production of molecules for diagnosis of Schistosoma mansoni. Seventeen polymeric, 20-amino acids long, peptides comprising the entire Sm31 molecule of the adult worm, were synthesized under the t-boc strategy and their immunogenicity was evaluated. Of these, 10 peptides were immunogenic in rabbits. The peptides containing the sequence Gly74-Ser93 (peptide IMT-172) and the sequence Val154-Ala173 (peptide IMT-180) were responsible for the recognition of the Sm31 molecule by Western blot. This was confirmed by the specific inhibition of recognition of each molecule with the homologous peptide. Additionally, antibodies against these peptides strongly fixed to the adult worm gut. The present results, together with the strong immunogenicity shown for the adult worm 31 kDa antigen, establish the basis for the development of an immunodiagnostic method using synthetic peptides.
Assuntos
Antígenos de Helmintos/imunologia , Cisteína Endopeptidases , Proteínas de Helminto/imunologia , Fragmentos de Peptídeos/imunologia , Schistosoma mansoni/imunologia , Sequência de Aminoácidos , Animais , Anticorpos Anti-Helmínticos/imunologia , Antígenos de Helmintos/isolamento & purificação , Western Blotting , Proteínas de Helminto/síntese química , Proteínas de Helminto/isolamento & purificação , Imuno-Histoquímica , Dados de Sequência Molecular , Fragmentos de Peptídeos/síntese químicaRESUMO
Los cambios estructurales iniciados en Bolivia a partir del año 1993 concuerdan con la mayoría de las recomendaciones de los organismos internacionales para acelerar la implementación de la Atención Primaria de Salud y así alcanzar la meta social de Salud para Todos con equidad, eficiencia, eficacia y calidad, con solidaridad y universalidad. Se cumplen seis años de un proceso de cambio estructural, que se condiera todavía breve para medir los impactos en las condiciones de vida de la población. Es evidente el cambio importante en el desarrollo y fortalecimiento de los servicios de primer nivel aumentando de esta forma la accesibilidad geográfica de los sectores más marginados. Otro logro importante en este proceso es la implementación del seguro básico de salud que permite romper las barreras económicas para la gran mayoría de la población y de esta forma aumentar la cobertura en salud particularmente de los grupos vulnerables. Por último es innegable, el valor de la incorporación de la comunidad, dentro de este proceso de cambio al asumir con responsabilidad la toma de decisiones y control de las acciones de salud
Assuntos
Reforma dos Serviços de Saúde , BolíviaRESUMO
Presentamos nuestra experiencia de 406 trasplantes realizados por el Servicio de Urología y Nefrología del Hospital del Salvador entre los años 1975 y 1999, se analizaron en forma retrospectiva las complicaciones de 384 transplantes, realizados a 352 pacientes. La distribución de los transplantes fue de un 57,3 por ciento a pacientes de sexo masculino y 42,7 por ciento a pacientes de sexo femenino, con un promedio de edad de 38,1 años. La mayor parte de los órganos transplantados provinieron de donante cadáver (57,8 por ciento). La anastomosis venosa se realizó a la cava inferior en 41 por ciento de los casos, y a la ilíaca en un 59 por ciento. La anastomosis arterial fue de tipo término-terminal a la hipogástrica en un 63 por ciento y término lateral a la ilíaca en 37 por ciento de las unidades renales trasplantadas. En la mayor parte de los implantes ureterales se utilizó la técnica de Gregoire (92 por ciento) y en el resto Leadbetter-Politano al inicio del programa. Se presentaron 110 complicaciones de origen quirúrgico: las complicaciones urológicas (14,6 por ciento) fueron las de mayor frecuencia y dentro de ellas, la más importante fue la obstrucción ureteral. La incidencia de complicaciones vasculares fue de 5,7 por ciento, siendo la más frecuente la estenosis de la arteria renal. El linfocele que requirió tratamiento se presentó sólo en 12 pacientes (3,2 por ciento). A julio de 1999 el 77,8 por ciento de los riñones trasplantados están funcionantes. La causa más importante de perdida del injerto, fue la inmunológica (63 casos). Se analizan casuística y sus resultados
Assuntos
Humanos , Masculino , Adulto , Feminino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/cirurgia , Transplante de Rim/tendências , Causas de Morte , Complicações Intraoperatórias , Complicações Pós-OperatóriasRESUMO
Las complicaciones urológicas del trasplante renal son causa de morbilidad importante y potencialmente pueden afectar la viabilidad del órgano trasplantado. El objetivo de éste trabajo es determinar la existencia de relación entre complicaciones urológicas y el tipo de anastomosis venosa del trasplante renal. De un total de 386 trasplantes renales realizados entre 1975-1999, se analizaron en forma retrospectiva las fichas clínicas de 259 pacientes que cumplieron con los criterios de inclusión del estudio. Se correlacionó la incidencia de complicaciones urológicas y sitio de anastomosis venosa. Para el análisis estadístico se utilizó la prueba de Mantel-Haenszel y odds ratio, con un valor de p<0,05. Se observaron 32 complicaciones urológicas (12,3 por ciento): necrosis, filtración y obstrucción. Las complicaciones que afectaron a uréter y vejiga se presentaron en 25,5 por ciento de los trasplantes con anastomosis a la vena cava y en un 6 por ciento, en los que tenían anastomosis a venas ilíaca común, externa e interna. Esta diferencia es estadísticamente significativa. (Odds ratio 3,61 y Mantel Haenszel p=0.00097). Las complicaciones urológicas del trasplante renal han sido más frecuentes cuando la anastomosis venosa se realiza a la vena cava. Interpretamos esta diferencia como consecuencia de la mayor distancia existente al sitio del neoimplante y por lo tanto, a una mayor longitud del uréter, lo que se asociará a una peor irrigación de este último. En consecuencia, consideramos que la anastomosis venosa no debiera realizarse en la cava, a menos que sea estrictamente necesario, lo cual nos ha hecho cambiar la estrategia quirúrgica con que comenzamos nuestro programa de trasplantes
Assuntos
Humanos , Masculino , Feminino , Anastomose Cirúrgica/efeitos adversos , Transplante de Rim/efeitos adversos , Manifestações Urológicas , Complicações Pós-OperatóriasRESUMO
El objetivo de este tratamiento es demostrar que la estenosis pieloureteral congénita por medio de técnica quirúrgica abierta permanece como una alternativa válida de tratamiento. Se revisaron en forma retrospectiva las fichas clínicas de 82 pacientes sometidos a pieloplastía abierta en los últimos 20 años, seleccionando a 58 pacientes que cumplieron con criterio de inclusión y seguimiento. Se analizó forma de presentación, diagnóstico y tratamiento de la estenosis pieloureteral. Se evaluaron resultados y complicaciones a largo plazo. El promedio de edad fue de 35,8 años, siendo el motivo de consulta más frecuente el dolor (79 por ciento). El diagnóstico se realizó principalmente con pielografía de eliminación (94 por ciento) y el tipo de tratamiento más utilizado fue pieloplastía desmembrada (78 por ciento). Los procedimientos quirúrgicos fueron realizados principalmente por médicos en entrenamiento, con una tasa libre de complicaciones de 74 por ciento. La reestenosis de la unión pieloureteral se produjo en 3 pacientes (5,1 por ciento) en un plazo promedio de 4,8 meses post cirugía. El tiempo promedio de seguimiento fue de 33 meses (0,5-139 meses). En conclusión el tratamiento quirúrgico de la estenosis pieloureteral con técnica abierta, evaluado a largo plazo, presenta una baja incidencia de complicaciones y reestenosis y no requiere gran experiencia del cirujano, lo que la mantiene como una alternativa vigente para el tratamiento de esta patología
Assuntos
Humanos , Masculino , Adolescente , Adulto , Feminino , Pessoa de Meia-Idade , Obstrução Ureteral/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Obstrução Ureteral/congênito , Complicações Pós-Operatórias , Estudos RetrospectivosRESUMO
El carcinoma de células renales (CaR) es un tumor relativamente raro que se presenta en un 3 por ciento de las neoplasias malignas del adulto. La nefrectomía radical (NR) sigue siendo el único método efectivo de tratamiento. Nos propusimos ver la sobrevida de los pacientes con CaR sometidos a NR. Se revisaron 170 pacientes sometidos a NR desde noviembre de 1976 a marzo de 1996. Se recuperaron 90 pacientes con CaR, edad promedio de 60,7 años (rango de 34 a 79 años), 53,1 por ciento de hombres y 46,9 por ciento de mujeres, con una mediana de seguimiento de 81 meses. Motivo de consulta principal fue hematuria (44,9 por ciento), dolor 27,5 por ciento, incidental en 22,4 por ciento. Un 57,8 por ciento son tumores renales derechos y 2,1 por ciento bilaterales. La sobrevida global es de 69 por ciento a 5 años y 60 por ciento a 10 años. Según clasificación TNM la sobrevida estadío I fue 83 por ciento (med 88 meses), II 77 por ciento (med 89 meses), III 62 por ciento (med 78 meses), IV 10 por ciento (med 12 meses), estos últimos no sometidos a NR. El carcinoma de células renales en etapas precoces (I y II) tiene un muy buen pronóstico a largo plazo, no así las etapas más avanzadas. Como aún no existen tratamientos eficaces para estos últimos, se enfatiza la importancia de un diagnóstico precoz