RESUMO
INTRODUCTION AND AIMS: Malignant dysphagia is difficulty swallowing resulting from esophageal obstruction due to cancer. The goal of palliative treatment is to reduce the dysphagia and improve oral dietary intake. Self-expandable metallic stents are the current treatment of choice, given that they enable the immediate restoration of oral intake. The aim of the present study was to describe the results of using totally covered and partially covered esophageal stents for palliating esophageal cancer. MATERIALS AND METHODS: A retrospective study was conducted on patients with inoperable esophageal cancer treated with self-expandable metallic stents. The 2 groups formed were: group A, which consisted of patients with a fully covered self-expandable stent (SX-ELLA®), and group B, which was made up of patients with a partially covered self-expandable stent (Ultraflex®). RESULTS: Of the 69-patient total, 50 were included in the study. Group A had 19 men and 2 women and their mean age was 63.6 years (range 41-84). Technical success was achieved in 100% (n=21) of the cases and clinical success in 90.4% (n=19). Group B had 24 men and 5 women and their mean age was 67.5 years (range 43-92). Technical success was achieved in 100% (n=29) of the cases and clinical success in 89.6% (n=26). Complications were similar in both groups (33.3 vs. 51.7%). CONCLUSION: There was no difference between the 2 types of stent for the palliative treatment of esophageal cancer with respect to technical success, clinical success, or complications.
Assuntos
Neoplasias Esofágicas/terapia , Cuidados Paliativos/métodos , Stents , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtornos de Deglutição/etiologia , Neoplasias Esofágicas/complicações , Estenose Esofágica/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents/efeitos adversosRESUMO
Genetic polymorphism studies of cytokines may provide an insight into the understanding of acute kidney injury (AKI) and death in intensive care unit (ICU) patients. The aim of this study was to investigate whether the genetic polymorphisms of -308 G < A tumour necrosis factor (TNF)-α, -174 G > C interleukin (IL)-6 and -1082 G > A IL-10 may predispose ICU patients to the development of AKI and/or death. In a prospective nested case-control study, 303 ICU patients and 244 healthy individuals were evaluated. The study group included ICU patients who developed AKI (n = 139) and 164 ICU patients without AKI. The GG genotype of TNF-α (low producer phenotype) was significantly lower in the with AKI than without AKI groups and healthy individuals (55 versus 62 versus 73%, respectively; P = 0·01). When genotypes were stratified into four categories of TNF-α/IL-10 combinations, it was observed that low TNF-α plus low IL-10 producer phenotypes were more prevalent in patients with AKI, renal replacement therapy and death (P < 0·05). In logistic regression analysis, low TNF-α producer plus low IL-10 producer phenotypes remained as independent risk factors for AKI and/or death [odds ratio (OR) = 2·37, 95% confidence interval (CI): 1·16-4·84; P = 0·02] and for renal replacement therapy (RRT) and/or death (OR = 3·82, 95% CI: 1·19-12·23; P = 0·02). In this study, the combination of low TNF-α plus low IL-10 producer phenotypes was an independent risk factor to AKI and/or death and RRT and/or death in critically ill patients. Our results should be validated in a larger prospective study with long-term follow-up to emphasize the combination of these genotypes as potential risk factors to AKI in critically ill patients.
Assuntos
Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/imunologia , Interleucina-10/metabolismo , Fator de Necrose Tumoral alfa/metabolismo , Injúria Renal Aguda/genética , Injúria Renal Aguda/mortalidade , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Análise Mutacional de DNA , Feminino , Predisposição Genética para Doença , Humanos , Unidades de Terapia Intensiva , Interleucina-10/genética , Interleucina-6/genética , Interleucina-6/metabolismo , Masculino , Pessoa de Meia-Idade , Polimorfismo Genético , Prognóstico , Estudos Prospectivos , Análise de Sobrevida , Fator de Necrose Tumoral alfa/genéticaRESUMO
Nas últimas três décadas, os avanços tecnológicos permitiram a disponibilização de diversas modalidades dialíticas, as quais oferecem vantagens e desvantagens, que devem ser levadas em conta quando da prescrição e escolha da modalidade para determinado paciente. Isso é particularmente importante nos pacientes que apresentam instabilidade hemodinâmica. Na sepse, discute-se hoje a dose de diálise e o uso de terapias contínuas de reposição da função renal. Grandes progressos têm sido feitos nessa área nos últimos anos. Dados recentes sugerem que a diálise peritoneal e a ultrafiltração lenta podem beneficiar pacientes com insuficiência cardíaca terminal. Nesta revisão, abordaremos os aspectos básicos e técnicos, e a aplicação clínica dos métodos dialíticos no paciente criticamente enfermo, particularmente na sepse e na insuficiência cardíaca.