RESUMO
Atrial fibrillation is the most frequent cardiac arrhythmia in adults. Its frequency increases with age, being its incidence 1.5% in individuals 50 to 59 years old and 8-10% from 80 to 89 years. Atrial fibrillation increases 5 fold the risk of suffering stroke and actually causes 15% of all strokes. Its management focuses primary in the prevention of thromboembolic phenomena, heart rate and rhythm control. Anticoagulation, when indicated, has demonstrated to be the main tool in the prevention of these thromboembolic events. Although the bleeding complication is frequent in this population and increases with age, anticoagulation benefits are greater than the risks of bleeding. Due to the clinically heterogeneous nature of this arrythmia and the difficulty of establishing appropriate treatment for each particular case, the American College of Cardiology, the American Heart Association, European Society of Cardiology and American College of Chest Physicians have established guidelines to improve the management of these patients. The review of this condition and the proposed directives can notably facilitate and improve the management of the patients with atrial fibrillation.
Assuntos
Anticoagulantes/uso terapêutico , Fibrilação Atrial/complicações , Tromboembolia/prevenção & controle , Adulto , Idoso de 80 Anos ou mais , Humanos , Pessoa de Meia-Idade , Tromboembolia/etiologiaRESUMO
La fibrilación auricular es la taquiarritmia cardíaca más frecuente. Su incidencia aumenta con la edad, presentándose en un 1.5% entre los 50 a 59 años, y en un 8-10% entre los 80 a 89 años. Esta arritmia incrementa en cinco veces el riesgo de sufrir un evento cerebrovascular isquémico cardioembólico y causa el 15% de todos los accidentes cerebrovasculares isquémicos. Su manejo se enfoca en la prevención de los fenómenos tromboembólicos y el control de la frecuencia y ritmo cardíaco. El tratamiento anticoagulante ha demostrado ser la principal herramienta en la prevención de eventos cardioembólicos. Aunque las complicaciones hemorrágicas por el tratamiento son esperables y aumentan con la edad, el beneficio de usar anticoagulación sobrepasa por mucho al riesgo de sangrado. Precisamente debido a la heterogeneidad clínica de esta arritmia y a la dificultad de establecer un tratamiento adecuado para cada caso en particular, el American College of Cardiology, la American Heart Association, la European Society of Cardiology y el American College of Chest Physicians han establecido guías para mejorar el tratamiento de estos pacientes. La revisión de esta enfermedad y de las directrices propuestas puede facilitar y mejorar notablemente el tratamiento de los pacientes con fibrilación auricular.
Atrial fibrillation is the most frequent cardiac arrhythmia in adults. Its frequency increases with age, being its incidence 1.5% in individuals 50 to 59 years old and 8-10% from 80 to 89 years. Atrial fibrillation increases 5 fold the risk of suffering stroke and actually causes 15% of all strokes. Its management focuses primary in the prevention of thromboembolic phenomena, heart rate and rhythm control. Anticoagulation, when indicated, has demonstrated to be the main tool in the prevention of these thromboembolic events. Although the bleeding complication is frequent in this population and increases with age, anticoagulation benefits are greater than the risks of bleeding. Due to the clinically heterogeneous nature of this arrythmia and the difficulty of establishing appropriate treatment for each particular case, the American College of Cardiology, the American Heart Association, European Society of Cardiology and American College of Chest Physicians have established guidelines to improve the management of these patients. The review of this condition and the proposed directives can notably facilitate and improve the management of the patients with atrial fibrillation.
Assuntos
Adulto , Idoso de 80 Anos ou mais , Humanos , Pessoa de Meia-Idade , Anticoagulantes/uso terapêutico , Fibrilação Atrial/complicações , Tromboembolia/prevenção & controle , Tromboembolia/etiologiaRESUMO
Until the 1990 s, the treatment of chronic myeloid leukemia (CML) recognized hematopoietic stem cell transplantation as the best treatment for those patients with an available donor. With the advent of imatinib in 2001, this paradigm changed dramatically as this drug provided outstanding and durable rates of hematologic, cytogenetic, and molecular responses. As a consequence it became the gold standard first-line treatment for most patients. However, after almost a decade of its use, it is clear that although very effective, imatinib cannot cure CML as transplantation has already proven so. Furthermore, the new non-myeloablative regimens and the improvements in survival after allogeneic transplant, especially in the field of unrelated transplants, offer this option to a broader population of patients with CML. This adds to the old question of whom to transplant, when and how to proceed with the allograft. This article reviews the current role of transplantation in the era of tyrosine kinase inhibitors and will try to elucidate its role in the frontline setting as well as after first- and second-line kinase inhibitors failure.
Assuntos
Transplante de Células-Tronco Hematopoéticas/tendências , Inibidores de Proteínas Quinases/uso terapêutico , Proteínas Tirosina Quinases/antagonistas & inibidores , Antineoplásicos/uso terapêutico , Benzamidas , Terapia Combinada , Resistencia a Medicamentos Antineoplásicos/fisiologia , Diretrizes para o Planejamento em Saúde , Transplante de Células-Tronco Hematopoéticas/métodos , Humanos , Mesilato de Imatinib , Terapia Neoadjuvante , Piperazinas/uso terapêutico , Pirimidinas/uso terapêuticoRESUMO
BACKGROUND: Bone marrow (BM) is an important tissue in the generation of immunocompetent and peripheral blood cells. The precursors of hematopoietic cells in BM undergo continuous proliferation and differentiation and are highly vulnerable to acute and chronic oxidative stress. Little is known about the oxidant and antioxidant status in the BM of untreated patients with nonhematologic tumors. In this study, oxidative stress was evaluated in peripheral blood plasma (PBP) and BM plasma (BMP) from lung carcinoma (LC) and breast carcinoma (BC) patients. METHODS: The sample included 13 consecutive untreated LC patients, 15 BC patients, and 11 healthy controls. Luminol-dependent chemiluminescence was used to evaluate oxygen radical generation by peripheral blood neutrophils. Lipid oxidation, assessed by 2-thiobarbituric acid-reactive substances (TBARS), and alpha-tocopherol, beta-carotene, and total ubiquinol-10 levels were determined in PBP and BMP. RESULTS: In LC and BC patients, neutrophil chemiluminescence was higher (128% and 264%, respectively) than in controls (P < 0.05). In cancer patients, TBARS levels were higher in both PBP (51% and 243% for LC and BC patients, respectively) and BMP (66% and 305% for LC and BC patients, respectively) than in plasma from controls (P < 0.01). alpha-Tocopherol and total ubiquinol-10 levels were significantly lower in BMP from BC patients compared with controls. In BC patients, alpha-tocopherol content in PBP was significantly lower than in controls. CONCLUSIONS: Untreated cancer patients presented an imbalance between oxidant generation and lipid-soluble antioxidant levels in favor of the former.
Assuntos
Antioxidantes/análise , Medula Óssea/química , Neoplasias/metabolismo , Adulto , Humanos , Peroxidação de Lipídeos , Medições Luminescentes , Pessoa de Meia-Idade , Neutrófilos/metabolismo , OxirreduçãoRESUMO
La anemia aplástica severa (AAS) es una grave enfermedad hematológica en que el transplante de médula ósea (TMO) es el tratamiento de elección en pacientes pediátricos y adultos jóvenes, siendo el número de transfusiones pre-TMO el factor más importnate para determinar la incidencia de rechazos de injerto. Veinte pacientes com AAS, en sua mayoría politransfundidos, fueron sometidos a TMO utilizando la asociación ciclofosfamida (CFM) + globulina antilinfocitaria (GAL) como régimen condicionante. Todos los pacientes evaluables tuvieron injerto funcionante ("engraftment") y no se observó rechazo de injerto en ninguno de ellos. Tres pacientes fallecieron, y los 17 restantes (85 por ciento) están vivos y con reconstitución hematopoyética completa, con una mediana de seguimiento de 27.7 meses. EL TMO demostró ser una excelente opción terapéutica en esta serie de pacientes con AAS, y el régimen condicionante fue adecuado para una adecuada mieloablación e inmunosupresión pré-TMO sin rechazos tempranos o tardíos del injerto.
Assuntos
Adulto , Pré-Escolar , Criança , Feminino , Humanos , Adolescente , Anemia Aplástica/terapia , Soro Antilinfocitário/uso terapêutico , Transplante de Medula Óssea , Ciclofosfamida/uso terapêutico , Imunossupressores/uso terapêutico , Condicionamento Pré-Transplante , Intervalo Livre de Doença , Quimioterapia Combinada , Doença Enxerto-Hospedeiro , Doença Enxerto-Hospedeiro/tratamento farmacológicoRESUMO
La anemia aplástica severa (AAS) es una grave enfermedad hematológica en que el transplante de médula ósea (TMO) es el tratamiento de elección en pacientes pediátricos y adultos jóvenes, siendo el número de transfusiones pre-TMO el factor más importnate para determinar la incidencia de rechazos de injerto. Veinte pacientes com AAS, en sua mayoría politransfundidos, fueron sometidos a TMO utilizando la asociación ciclofosfamida (CFM) + globulina antilinfocitaria (GAL) como régimen condicionante. Todos los pacientes evaluables tuvieron injerto funcionante ("engraftment") y no se observó rechazo de injerto en ninguno de ellos. Tres pacientes fallecieron, y los 17 restantes (85 por ciento) están vivos y con reconstitución hematopoyética completa, con una mediana de seguimiento de 27.7 meses. EL TMO demostró ser una excelente opción terapéutica en esta serie de pacientes con AAS, y el régimen condicionante fue adecuado para una adecuada mieloablación e inmunosupresión pré-TMO sin rechazos tempranos o tardíos del injerto. (AU)