RESUMO
Background: Malignant Superior Vena Cava Syndrome (SVCS) corresponds to the clinical manifestations due to the restriction of venous return to the right atrium secondary to obstruction of the superior vena cava and/or its main tributaries for a tumor. Endovascular management has proven to be safe, effective and cause a fast symptomatic relief in patients with SVCS. There is limited evidence in factors associated with outcomes in malignant setting for this procedure. Materials and methods: An analytical retrospective study was conducted and included patients that underwent endovascular management for malignant SVCS at the National Cancer Institute of Colombia between May 2016 and May 2021. Clinical and technical variables were analyzed to found associations with outcomes in these patients. Results: 54 patients were analyzed. Successful procedure rate was 94.4 %. At 10 months, the OS of the entire cohort of patients was 25 %. Patients with breast or lung cancer (P = 0.031), unsuccessful procedure (P = 0.011), and also with short time of symptoms to the date of the endovascular procedure (P = 0.027) had worse OS. Multivariate analysis showed that lung cancer [HR = 2.55, 95%IC:(1.21-5.36)] and left internal jugular vein or left Innominate vein distal stent attachment [HR = 3.27, 95%IC:(1.31-8.15)] were independent factors for worst OS. Conclusions: Based in the high success rate of the endovascular management and the better outcome in patients with early and successful procedure, this procedure should be considered as part of the multimodal treatment in patients with SVCS independent of the clinical scenario and the oncological diagnosis.
RESUMO
End-stage renal disease (ESRD) requires for its treatment permanent dialysis or kidney transplantation (KT). KT is the best clinical treatment, however, the early function of the allograft varies depending on multiple factors associated with cold ischemia time (CIT) and the allograft rejection process. It is known that serum creatinine is an insensitive and late marker for predicting graft recovery after KT, mainly in patients with delayed graft function (DGF). Neutrophil gelatinase-associated lipocalin (NGAL) is produced in the distal nephron and it is one of the most promising novel biomarkers for acute kidney injury (AKI) and chronic kidney disease (CKD). NGAL has been proposed to be a predictor of organ recovery from DGF after KT from donors after cardiac death. Because nonrenal diseases can also induce NGAL, more information is necessary to validate the sensitivity and specificity of urine and plasma NGAL in clinical samples. The exosomes are vesicles released into the urine from the kidney epithelium and they have been proposed as better source to explore as biomarker of renal dysfunction. The molecular composition of the urinary exosomes could be representative of the physiological or physiopathologic condition of the urinary system. We propose that determination of NGAL in urinary exosomes is a better predictor of kidney dysfunction after KT than other urinary fractions. We analyzed 15 kidney allograft recipients, with a mean age of 36 years (range, 16-60 years) and 75% were male: 11 living donors (LD) and 4 deceased donors (DD). The average length of CIT was 14 hours in DD and less than 1 hour in LD. Three patient developed DGF. Using Western blot analysis, NGAL was detectable in the cellular and exosomal fraction of the urine. The exosomes expressed higher levels of NGAL than the cellular fraction. The expression of NGAL was observed from the first day after transplantation. In the cellular fraction of the urine, no significant differences of NGAL were observed between the patients. However, the median of NGAL expression in the exosomes fraction was significantly higher in DD patient, from the first day after KT (P < .05). Moreover, we noticed that NGAL expression in exosomes remained elevated in the patients with DGF compared with non-DGF patients (P < .05). Considering the highest abundance of NGAL in the urinary exosomes and its correlation with DGF patients, we suggest the exosomal fraction as a more sensitive substrate to evaluate early biomarkers of DGF after KT.
Assuntos
Proteínas de Fase Aguda/urina , Função Retardada do Enxerto/etiologia , Exossomos/enzimologia , Falência Renal Crônica/cirurgia , Transplante de Rim/efeitos adversos , Rim/enzimologia , Rim/cirurgia , Lipocalinas/urina , Proteínas Proto-Oncogênicas/urina , Adolescente , Adulto , Biomarcadores/urina , Western Blotting , Cadáver , Função Retardada do Enxerto/diagnóstico , Função Retardada do Enxerto/enzimologia , Função Retardada do Enxerto/fisiopatologia , Função Retardada do Enxerto/urina , Feminino , Humanos , Rim/fisiopatologia , Lipocalina-2 , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Fatores de Tempo , Resultado do Tratamento , Regulação para Cima , Adulto JovemRESUMO
Twenty-one consecutive cases of esophageal fistulae (EF), were studied to assess their etiology, the associated thoracopulmonary pathology and evaluate the usefulness of simultaneous partial exclusion of the esophagus and treatment of the present thoracopulmonary complications. EF were 6 cervical, 13 thoracic and 2 abdominal. The different types were: esophagopleural 8, esophagotracheal 7, esophagobronchial 1, congenital 1 and diverse type 4. Tracheal manipulation was the cause in 6, mistaken surgical procedures were an important etiologic factor in 9, improper use of dilators in 3 and different causes in 3. Esophageal reflux was the common antecedent, but 9 cases had normal esophagus before the EF. Pleural empyema, mediastinitis and aspiration pneumonia were major complications, two cases had subphrenic abscess. Treatment was based on partial exclusion of the esophagus, drainage of pleural and mediastinal infections, proper antimicrobial therapy and nutritional support. Four required thoracotomy. Eighteen patients were cured and 3 died.
Assuntos
Fístula Esofágica/cirurgia , Adolescente , Adulto , Criança , Empiema Pleural/complicações , Fístula Esofágica/complicações , Fístula Esofágica/diagnóstico por imagem , Fístula Esofágica/etiologia , Feminino , Gastrostomia , Humanos , Jejunostomia , Masculino , Pessoa de Meia-Idade , Pneumonia/complicações , Radiografia , Resultado do TratamentoRESUMO
Existe escasa información en nuestro medio respecto de la eficiencia y los costos de la administración de oxígeno por vía nasal en lactantes con enfermedad pulmonar crónica (EPOC). Por esta razón se estudiaron comparativamente dos métodos de administración de oxígeno en 10 lactantes con EPOC: 1- "bigotera" versus "prongs" nasales midiendo la Fi02 en la hipofaringe (FhO2) con flujos de oxígenos preestablecidos; 2-Flujímetro "1" calibrado en alícuotas pequeñas de 0.125 litros/minuto versus flujímetro "2" graduado en alícuotas de 1 litro/minuto. Además se realizó una encuesta en 32 niños con EPOC a fin de analizar la calidad y adecuación de la administración de oxígeno por vía nasal. Se comprobó que no hubo diferencia en la eficacia terapéutica y en los valores de la FhO2 observados con ambos tipos diferentes de dispositivos nasales. El flujímetro "1" permitió disminuir la dosis de oxígeno administrada en 0.625 litros/minuto manteniendo la misma eficiencia terapéutica. Los costos mayores del flujímetro "1" son superados por el ahorro de oxígeno posible de obtener con este equipo. Este ahorro se incrementa con su aplicación a más pacientes y por períodos más prolongados. Se observaron frecuentes deficiencias en la indicación, control y suspensión del oxígeno. (AU)
Assuntos
Humanos , Masculino , Feminino , Lactente , Pneumopatias Obstrutivas/terapia , Oxigenoterapia/métodos , ArgentinaRESUMO
Existe escasa información en nuestro medio respecto de la eficiencia y los costos de la administración de oxígeno por vía nasal en lactantes con enfermedad pulmonar crónica (EPOC). Por esta razón se estudiaron comparativamente dos métodos de administración de oxígeno en 10 lactantes con EPOC: 1- "bigotera" versus "prongs" nasales midiendo la Fi02 en la hipofaringe (FhO2) con flujos de oxígenos preestablecidos; 2-Flujímetro "1" calibrado en alícuotas pequeñas de 0.125 litros/minuto versus flujímetro "2" graduado en alícuotas de 1 litro/minuto. Además se realizó una encuesta en 32 niños con EPOC a fin de analizar la calidad y adecuación de la administración de oxígeno por vía nasal. Se comprobó que no hubo diferencia en la eficacia terapéutica y en los valores de la FhO2 observados con ambos tipos diferentes de dispositivos nasales. El flujímetro "1" permitió disminuir la dosis de oxígeno administrada en 0.625 litros/minuto manteniendo la misma eficiencia terapéutica. Los costos mayores del flujímetro "1" son superados por el ahorro de oxígeno posible de obtener con este equipo. Este ahorro se incrementa con su aplicación a más pacientes y por períodos más prolongados. Se observaron frecuentes deficiencias en la indicación, control y suspensión del oxígeno.
Assuntos
Humanos , Masculino , Feminino , Lactente , Pneumopatias Obstrutivas/terapia , Oxigenoterapia/métodos , ArgentinaRESUMO
Comparamos en un estudio randomizado la efectividad en el tratamiento de enfermedades cutáneas superficiales con mupirocine tópico y cloxacilina oral. Los resultados demostraron un a mejor respuesta con mupirocine, con 85,7 por ciento de eliminación bacteriana a la semana post-tratamiento versus un 54,5 por ciento con cloxacilina. No se reportaron efectos sistémicos colaterales con mupirocine excepto prurito y sensación de ardor