RESUMO

BACKGROUND: This article describes and compares approved targeted therapies and the newer immunotherapy agents. MATERIALS AND METHODS: This article especially performs an in-depth review of currently available data for tivozanib, explaining its mechanism of action, its safety profile and its role as an efficacy drug in the management of renal cancer. RESULTS: Despite the fact that the treatment of advanced RCC has been dramatically modified in recent years, durable remissions are scarce and it remains a lethal disease. For first- and second-line therapy, there is now growing evidence to guide the selection of the appropriate treatment. CONCLUSIONS: Several TKIs are standard of care at different settings. Among those approved TKIs, tivozanib has similar efficacy than others with a better safety profile. The use of prognostic factors is critical to the selection of optimal therapy.

Assuntos

Carcinoma de Células Renais/tratamento farmacológico , Neoplasias Renais/tratamento farmacológico , Compostos de Fenilureia/uso terapêutico , Inibidores de Proteínas Quinases/uso terapêutico , Quinolinas/uso terapêutico , Receptores de Fatores de Crescimento do Endotélio Vascular/antagonistas & inibidores , Carcinoma de Células Renais/genética , Carcinoma de Células Renais/metabolismo , Carcinoma de Células Renais/patologia , Ensaios Clínicos como Assunto , Consenso , Humanos , Neoplasias Renais/genética , Neoplasias Renais/metabolismo , Neoplasias Renais/patologia , Metástase Neoplásica

RESUMO

Administration of chemotherapy in prostate cancer depends on patient fitness. In unfit patients, physiological impairment determines the optimum treatment. Although no consensus on assessing patient fitness currently exists, this article proposes an algorithm combining the available information for administering chemotherapy, and in particular docetaxel, in unfit patients. It was constructed by reviewing factors that can influence treatment, such as performance status, taxane-related comorbidities and nutritional status. Geriatric scales for prostate cancer patients and alternative treatment regimens for this population are also reviewed. In summary, patients require overall assessment to optimise treatment. Use of docetaxel should be restricted in unfit patients, and other options must be evaluated, because of high toxicity and low efficacy.

Assuntos

Algoritmos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias de Próstata Resistentes à Castração/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Fragilidade , Humanos , Avaliação de Estado de Karnofsky , Masculino , Aptidão Física

RESUMO

BACKGROUND: OM-85 is an immunostimulant bacterial lysate, which has been proven effective in reducing the number of lower airways infections. We investigated the efficacy of the bacterial lysate OM-85 in the primary prevention of a murine model of asthma. METHODS: In the first phase of our study the animals received doses of 0.5µg, 5µg and 50µg of OM-85 through gavage for five days (days -10 to -6 of the protocol), 10 days prior to starting the sensitisation with ovalbumin (OVA), in order to evaluate the results of dose-response protocols. A single dose (5µg) was then chosen in order to verify in detail the effect of OM-85 on the pulmonary allergic response. Total/differential cells count and cytokine levels (IL-4, IL-5, IL-13 and IFN-γ) from bronchoalveolar lavage fluid (BALF), OVA-specific IgE levels from serum, lung function and lung histopathological analysis were evaluated. RESULTS: OM-85 did not reduce pulmonary eosinophilic response, regardless of the dose used. In the phase protocol using 5µg/animal of OM-85, no difference was shown among the groups studied, including total cell and eosinophil counts in BALF, serum OVA-specific IgE, lung histopathologic findings and lung resistance. However, OM-85 decreased IL-5 and IL-13 levels in BALF. CONCLUSIONS: OM-85, administered in early life in mice in human-equivalent doses, does not inhibit the development of allergic pulmonary response in mice.

Assuntos

Asma/prevenção & controle , Extratos Celulares/administração & dosagem , Eosinófilos/efeitos dos fármacos , Animais , Asma/imunologia , Citocinas/metabolismo , Modelos Animais de Doenças , Eosinófilos/imunologia , Feminino , Humanos , Imunização , Imunoglobulina E/sangue , Camundongos , Camundongos Endogâmicos BALB C

RESUMO

BACKGROUND: The Institute of Nephrology and Urology (INU) has performed 75% of kidney transplantations (KT) in Uruguay during its 35 years of activity, with 90.6% from cadaveric donors. We investigated the risk factors (RF) for delayed graft function (DGF) and patient and graft survival (SV). METHODS: We analyzed retrospectively the characteristics and evolution of 1500 KT performed by INU until December 2014. The incidence of DGF and RF for patient and graft SV were analyzed in 4 eras, according to the year that KT was performed. RESULTS: The number of KT per year has progressively increased until reaching 40 KT per million population in 2006, with a decrease of the living donor KT (LDKT) rate. The age of the donors (D) and recipients (R) as well as the time on dialysis (TOD) have progressively increased over the different eras. Five hundred twenty-five R (35%) presented with DGF. The RF for DGF were the age of the R and the D, the TOD, the DDKT, and the warm ischemia time (WIT). In the DDKT group, the cold ischemia time and "died of stroke" were added factors. The death-censored graft SV at 1, 5, 10, and 15 years were 90%, 76%, 62%, and 49%, respectively. They improved as from era I, the patient SV being 92%, 83%, and 75% at 1, 5, and 10 years, in era I; 98%, 93%, and 86% in era II; 98%, 92%, and 83% in era III; and 95% and 90% at 1 and 5 years in era IV (P < .001). The graft SV over the same periods was 76%, 58%, and 40% in era I; 88%, 68%, and 52% in era II; 93%, 81%, and 70% in era III; and 93% and 85% at 1 and 5 years in era IV (P < .0001). The RF for patient SV were diabetes mellitus, era I, lower albuminemia, older age or TOD, and DGF. For kidney SV, the era, the age of the R, TOD, DGF, and D older than 60 years were RF associated with a worse evolution. In DDKT, the RF for the graft SV were the era, younger age of the R, and DGF. The group with the worst graft SV was the one made up of children and adolescents. CONCLUSIONS: Our results relating to patient and graft SV are acceptable and comparable to those mentioned on large records such as the OPNT/SRTR and the Collaborative Transplant Study. This has been the case, even though we have transplanted increasingly aged patients, with increasingly aged donors, or donors with associated pathology. The risk factors that we found both for DGF and SV have also been pointed out by other authors. The validity of some findings has the limitation of being from a retrospective analysis; hence, they should be corroborated by a prospective study.

Assuntos

Transplante de Rim/estatística & dados numéricos , Academias e Institutos/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Cadáver , Criança , Função Retardada do Enxerto/mortalidade , Feminino , Sobrevivência de Enxerto/fisiologia , Humanos , Incidência , Transplante de Rim/mortalidade , Masculino , Pessoa de Meia-Idade , Nefrologia/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Doadores de Tecidos/estatística & dados numéricos , Urologia/estatística & dados numéricos , Uruguai/epidemiologia , Adulto Jovem

RESUMO

Kidney transplantation is the best treatment for end-stage chronic renal disease. In Uruguay, the prevalence of patients on dialysis is 757 patients per millon inhabitants, plus 316 alive with a functioning renal graft. We install a preemptive renal transplantation program. Twenty-five patients received grafts without dialysis from 2004 to 2013, 5 receiving their 2nd transplantation and 17 from cadaveric donors, with 7.4 ± 7.7 months in the waiting list. At 24 months, patients' survival rate was 100% and the grafts' 97%, with a serum creatinine of 1.4 ± 0.6 mg%. The developed programs of dialysis and renal health care contributed install our preemptive kidney transplantation. Kidney transplantation should be proposed to selected patients with chronic renal failure as primary therapy of substitution of renal function.

Assuntos

Falência Renal Crônica/cirurgia , Transplante de Rim , Adolescente , Adulto , Criança , Feminino , Sobrevivência de Enxerto , Humanos , Falência Renal Crônica/mortalidade , Falência Renal Crônica/terapia , Transplante de Rim/mortalidade , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Diálise Renal , Taxa de Sobrevida , Resultado do Tratamento , Uruguai , Listas de Espera , Adulto Jovem

RESUMO

BACKGROUND: According to our experience, survival of cadaveric renal graft in 5 years increased from 63% as of the introduction of cyclosporine to 73% after azathioprine was substituted with mycophenolate mofetil (MMF) in 1997. Until 2003, the innovator mycophenolate mofetil (IMMF) (Cellcept; Roche) was used. In 2003, Laboratorios Clausen introduced in Uruguay a generic MMF (GMMF) (Suprimun/Micoflavin/Myclausen; Laboratorios Clausen) with previous bioequivalence studies. Since then, every health care provider administers one of these types of MMF available on the market to its renal transplant (RT) patients. METHODS: We compared the evolution of 2 groups of patients and their grafts, those treated with GMMF or with IMMF. This was a descriptive, retrospective, nonrandomized, comparative study that involved all transplant patients in a center from January 2005 to June 2010 from 2 different health care providers which administered GMMF or IMMF uninterruptedly. Patients were older than 18 years, underwent their first RT and received triple immunosuppressive regime with calcineurin inhibitor (CNI), corticoids, and MMF, and completed ≥6 months of post-RT evolution. RESULTS: The GMMF group included 29 patients and the IMMF group 23. Patients from both groups had no significant differences (NS) regarding age, sex, diabetes, hepatitis C virus (HCV), recipient hypertension, donor type (living or cadaveric, sex, age, cause of death), or mismatch degree. There were no material differences regarding antibody induction, CNI type, day of diuresis, or function recovery percentage. Statistically different results were reported for time in dialysis (6.1 ± 0.7 y in IMMF vs 3.8 ± 0.5 y in GMMF) and cadaveric donor cold ischemia time (989 ± 205 min vs 851 ± 219 min, respectively). For IMMF and GMMF, respectively, clinical acute rejection was 40.9% and 31% and creatinine over 3, 6, 12, 24, 36, and 48 months, respectively, was (mg%): 1.65 ± 0.12, 1.66 ± 0.15, 1.43 ± 0.10, 1.44 ± 0.12, 1.49 ± 0.18, and 1.41 ± 0.17 and 1.50 ± 0.08, 1.41 ± 0.07, 1.63 ± 0.26, 1.31 ± 0.08, 1.26 ± 0.09, and 1.21 ± 0.10, with 22/28, 22/28, 22/28, 22/26, 19/20, 17/11, and 15/9 patients under follow-up (NS). Patient survival over 3, 6, 12, and 18 months, respectively, was 94%, 94%, 94%, and 94% and 96%, 96%, 96%, and 96%, and graft survival was 94%, 89%, 89%, and 89% and 96%, 93%, 93%, and 93% for IMMF and GMMF, respectively (NS). Dosing adjustment frequency and substitution with mycophenolate sodium was similar for both groups. CONCLUSIONS: With the results of this preliminary study we can not reach any final conclusion regarding assistance practice. From both groups, which involved similar baseline variables except for time in dialysis and cold ischemia (both greater in IMMF), we could gather a similar graft and patient evolution. New prospective, randomized, double-blind studies involving an adequate number of patients will help to determine the efficacy of GMMF in renal transplantation.

Assuntos

Medicamentos Genéricos/uso terapêutico , Rejeição de Enxerto/prevenção & controle , Imunossupressores/uso terapêutico , Transplante de Rim , Ácido Micofenólico/análogos & derivados , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Sobrevivência de Enxerto , Humanos , Transplante de Rim/mortalidade , Masculino , Pessoa de Meia-Idade , Ácido Micofenólico/uso terapêutico , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento , Uruguai , Adulto Jovem

RESUMO

Asthma is associated with a loss of the structural integrity of airway epithelium and dysfunction of the physical barrier, which protects airways from external harmful factors. Granulocyte activation causes the formation of extracellular traps, releasing web-like structures of DNA and proteins, being important to kill pathogens extracellularly. We investigated whether eosinophils infiltrating airways in an experimental model of asthma would induce eosinophil extracellular traps (EETs) in bronchoalveolar lavage fluid and lung tissue. We showed that an ovalbumin (OVA) asthma protocol presented a significant increase in eosinophil counts with increased extracellular DNA in bronchoalveolar lavage fluid as well as in lung tissue, confirming the presence of DNA traps colocalized with eosinophil peroxidase. EETs formation was reversed by DNase treatment. With these approaches, we demonstrated for the first time that OVA-challenged mice release extracellular DNA traps, which could aggravate pulmonary dysfunction.

Assuntos

Líquido da Lavagem Broncoalveolar/imunologia , DNA/metabolismo , Armadilhas Extracelulares/imunologia , Armadilhas Extracelulares/metabolismo , Eosinofilia Pulmonar/imunologia , Eosinofilia Pulmonar/metabolismo , Animais , Asma/imunologia , Asma/patologia , Modelos Animais de Doenças , Inflamação/imunologia , Inflamação/metabolismo , Inflamação/patologia , Camundongos , Ovalbumina/efeitos adversos , Eosinofilia Pulmonar/patologia

Assuntos

Humanos , Adulto , Feminino , Acantose Nigricans/diagnóstico , Acantose Nigricans/etiologia , Hiperinsulinismo/complicações , Doenças Metabólicas/complicações

RESUMO

The role of innate cells and their receptors within the male genital tract remains poorly understood. Much less is known about the relative contribution of different genital tract cells such as epithelial/stromal cells and resident leucocytes. In this study, we examined innate immune responses to Chlamydia trachomatis by prostate epithelial/stromal cells and prostate resident leucocytes. Murine prostate primary cultures were performed and leucocyte and epithelial/stromal cells were sorted based on surface protein expression of CD45 by magnetism-activated cell sorting or fluorescence-activated cell sorting. Prostate derived CD45- and CD45+ cells were infected with C. trachomatis and chemokine secretion assayed by ELISA. Similar experiments were performed using prostate CD45+ and CD45- cells from myeloid differentiation factor 88 (Myd88(-/-)) mice or toll-like receptor (Tlr2(-/-)) and Tlr4(mutant) double-deficient mice. Moreover, a TLR-signalling pathway array was used to screen changes in different genes involved in TLR-signalling pathways by real-time PCR. Prostate derived CD45- and CD45+ cells responded to chlamydial infection with the production of different chemokines. Both populations expressed genes involved in TLR signalling and required to respond to pathogen-associated molecular patterns and to C. trachomatis infection. Both populations required the adaptor molecule MYD88 to elicit chemokine response against C. trachomatis. TLR2-TLR4 was essential for chemokine production by CD45+ prostate derived cells, but in their absence, CD45- cells still produced significant levels of chemokines. We demonstrate that C. trachomatis is differentially recognised by prostate derived CD45+ and CD45- cells and suggest that diverse strategies are taking place in the local microenvironment of the host in response to the infection.

Assuntos

Quimiocinas/metabolismo , Infecções por Chlamydia/patologia , Chlamydia trachomatis/fisiologia , Antígenos Comuns de Leucócito/metabolismo , Próstata/metabolismo , Próstata/patologia , Animais , Células Cultivadas , Quimiocina CXCL1/metabolismo , Infecções por Chlamydia/genética , Infecções por Chlamydia/metabolismo , Regulação da Expressão Gênica , Mediadores da Inflamação/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos C3H , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Fator 88 de Diferenciação Mieloide/genética , Fator 88 de Diferenciação Mieloide/fisiologia , Cultura Primária de Células , Próstata/microbiologia , Regulação para Cima

RESUMO

Arsenic is the most important contaminant of the environment in northern Chile. Soil samples and plant organs from three native plant species, Pluchea absinthioides, Atriplex atacamensis and Lupinus microcarpus, were collected from arid zones in order to determine the total and bioavailable arsenic concentrations in soils and to assess the bioconcentration factor (BCF) and transport index (Ti) of arsenic in the plants. Total arsenic concentrations in soils (pH 8.3-8.5) where A. atacamensis and P. absinthioides were collected, reached levels considered to be contaminated (54.3 ± 15.4 and 52.9 ± 9.9 mg kg⁻¹, respectively), and these values were approximately ten times higher than in soils (pH 7.6) where L. microcarpus was collected. Bioavailable arsenic ranged from 0.18 to 0.42% of total arsenic concentration. In the three plant species, arsenic concentration in leaves were significantly (p ≤ 0.05) higher than in roots. L. microcarpus showed the highest arsenic concentration in its leaves (9.7 ± 1.6 mg kg⁻¹) and higher values of BCF (1.8) and Ti (6.1), indicating that this species has a greater capacity to accumulate and translocate the metalloid to the leaf than do the other species.

Assuntos

Arsênio/análise , Gleiquênias/metabolismo , Poluentes do Solo/análise , Solo/química , Arsênio/metabolismo , Chile , Monitoramento Ambiental , Concentração de Íons de Hidrogênio , Folhas de Planta/metabolismo , Raízes de Plantas/metabolismo , Caules de Planta/metabolismo , Poluentes do Solo/metabolismo

RESUMO

Measurement of dynamic cerebral autoregulation (CA), the transient response of cerebral blood flow (CBF) to changes in arterial blood pressure (ABP), has been performed with an index of autoregulation (ARI), related to the parameters of a second-order differential equation model, namely gain (K), damping factor (D) and time constant (T). Limitations of the ARI were addressed by increasing its numerical resolution and generalizing the parameter space. In 16 healthy subjects, recordings of ABP (Finapres) and CBF velocity (ultrasound Doppler) were performed at rest, before, during and after 5% CO(2) breathing, and for six repeated thigh cuff maneuvers. The unconstrained model produced lower predictive error (p < 0.001) than the original model. Unconstrained parameters (K'-D'-T') were significantly different from K-D-T but were still sensitive to different measurement conditions, such as the under-regulation induced by hypercapnia. The intra-subject variability of K' was significantly lower than that of the ARI and this parameter did not show the unexpected occurrences of zero values as observed with the ARI and the classical value of K. These results suggest that K' could be considered as a more stable and reliable index of dynamic autoregulation than ARI. Further studies are needed to validate this new index under different clinical conditions.

Assuntos

Encéfalo/fisiologia , Homeostase/fisiologia , Adulto , Velocidade do Fluxo Sanguíneo/fisiologia , Pressão Sanguínea/fisiologia , Circulação Cerebrovascular/fisiologia , Humanos

RESUMO

In neuronal cultures it has been demonstrated that neurotrophins can elicit neuronal death through the p75 neurotrophic receptor (p75ntr) in the absence of concomitant Trk signaling. However, it was suggested that p75ntr induces neuronal death after status epilepticus (SE) in neuronal populations that express relatively high quantities of tropomyosin receptor kinase B (TrkB). Here, using Western blot and immunohistochemistry analyses in the hippocampus, we found that 3-h SE caused a remarkable decrease in TrkB expression and phosphorylation, and a significant increase in p75ntr. TrkB modification occurs before the overexpression of the tumor suppressor protein p53, accompanies the cell damage taking place in the dentate gyrus, and precedes the CA1 neuronal injury as assessed by Fluoro-Jade B and Nissl staining. Co-immunoprecipitation of brain-derived neurotrophic factor (BDNF) or its immature form proBDNF showed increased interaction with p75ntr after its binding to TrkB was reduced. Interestingly, proBDNF also increases its binding with p75ntr after seizures that do not cause neuronal death (animals injected with pilocarpine that fail to enter SE). However, in those animals, TrkB protein levels remained unchanged and its phosphorylation increased. Our results indicate an intrinsic capacity of neurons in vivo to modify final neurotrophin output by changing the proportion of their receptors' expression and the receptors' interaction with their ligands. These early events support the idea that neurotrophins may be involved in the induction of neuronal death in vivo under pathological conditions.

Assuntos

Fator Neurotrófico Derivado do Encéfalo/metabolismo , Neurônios/patologia , Receptor de Fator de Crescimento Neural/metabolismo , Receptor trkB/metabolismo , Estado Epiléptico/metabolismo , Estado Epiléptico/patologia , Animais , Benzoxazinas , Western Blotting , Corantes , Eletrochoque , Fluoresceínas , Imuno-Histoquímica , Imunoprecipitação , Marcação In Situ das Extremidades Cortadas , Masculino , Agonistas Muscarínicos , Compostos Orgânicos , Oxazinas , Pilocarpina , Ratos , Ratos Wistar , Estado Epiléptico/induzido quimicamente

RESUMO

Advanced renal disease is a formal contraindication to heart transplantation, and heart failure may make a patient ineligible for kidney transplantation. The International Society of Heart and Lung Transplantation has reported 336 simultaneous heart and kidney transplantations with a 70% rate of 5 year survival. Herein we have presented the first case of simultaneous heart plus kidney transplantation in Chile. The patient is a 62-year-old man with diabetes mellitus and arterial hypertension who in 1997 had a myocardial infarction with cardiogenic shock and acute renal failure. He underwent a coronary bypass but developed progressive heart failure, with an ejection fraction less than 20% and moderate mitral regurgitation. He required chronic hemodialysis and survived a cardiac arrest, receiving an implantable cardioverter defibrillator. Transplantation was performed in 2004 in 2 phases: initially a heart, followed by a kidney transplantation. Immunosuppression included Daclizumab, cyclosporine, mycophenolate mofetil (MMF) and steroids. He developed acute renal failure but did not receive dialysis. He left the hospital at 25 days posttransplantation. Two years following double transplantation, he has not shown acute rejection episodes of either the cardiac or the kidney graft. Both cardiac and renal functions are normal. In conclusion, simultaneous heart plus kidney transplantations offer a good alternative treatment for patients with advanced disease of both organs.

Assuntos

Injúria Renal Aguda/cirurgia , Angiopatias Diabéticas/cirurgia , Neuropatias Diabéticas/cirurgia , Transplante de Coração , Transplante de Rim , Infarto do Miocárdio/cirurgia , Quimioterapia Combinada , Seguimentos , Sobrevivência de Enxerto , Humanos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Diálise Renal , Resultado do Tratamento

RESUMO

La incidencia de cáncer infantil es de unos 120 casos anuales por cada millón de niños y conocer el diagnóstico oportuno mejora la sobrevida. Estudiar las concentraciones de la deshidrogenasa láctica (LDH) en niños con neoplasias que asisten a la consulta de Oncología Infantil del Hospital Central de San Cristóbal. Estudio prospectivo, descriptivo, longitudinal y observacional, diseño no experimental y longitudinal panel. 34 pacientes, 22 (65 por ciento) sexo masculino, 12 (5 por ciento) sexo femenino, preescolar 19 (56 por ciento), procedencia del medio urbano 23 (68 por ciento), 11 (32 por ciento) del medio rural, 17 (50 por ciento) leucemias, 5 (14,7 por ciento) tumor de wilms, 3 (8,82 por ciento) retinoblastoma, 3 (8,82 por ciento) linfoma no Hodgkin, 2 (5,88 por ciento) linfoma Hodgkin, 2 (5,88 por ciento) meduloblastoma, 1 (2,94 por ciento) sarcoma y 1 (2,94 por ciento) nueroblastoma. 9 (26 por ciento) consultan por tumoración abdominal y 28 (50 por ciento) tienen paraclínica de anemia. Leucemias en inicio y recaída la LDH elevada mayor de 285UI/L y normaliza en tratamiento, el tumor de wilms en tratamiento y seguimiento normal y en recaída elevada para luego normalizar, el retinoblastoma es normal en seguimiento y elevada en recaída y luego normaliza, el linfoma no Hodgkin elevada en inicio y luego normaliza y en tratamiento es normal, el linfoma Hodgkin normal en inicio, tratamiento y seguimiento, el meduloblastoma y neuroblastoma normal en seguimiento y el sarcoma normal en tratamiento. La LDH aumenta en fase de inicio y recaída y disminuye en fase de tratamiento y se normaliza en fase de seguimiento.

Assuntos

Humanos , Masculino , Feminino , Criança , L-Lactato Desidrogenase/análise , Biomarcadores Tumorais/análise , Neoplasias/diagnóstico , Neoplasias/patologia , Neoplasias/terapia , Doença de Hodgkin/patologia , Oncologia , Meduloblastoma/patologia , Neuroblastoma/patologia , Pediatria , Retinoblastoma/patologia , Sarcoma/patologia , Tumor de Wilms

Assuntos

Humanos , Masculino , Feminino , Criança , Linfócitos/imunologia , Biomarcadores Tumorais/química , Neoplasias Hematológicas/terapia , Neoplasias/patologia , Neoplasias/terapia , Oxirredutases , Leucemia/terapia , Linfoma não Hodgkin/terapia , Oncologia , Pediatria , Retinoblastoma/terapia , Sarcoma de Ewing/terapia

RESUMO

Lactante mayor femenina de 15 meses de edad, con clínica de dificultad para la marcha, paresia de hemicuerpo derecho, desviación de la comisura labial hacia lado izquierdo, ptosis palpebral parcial ipsilateral. En la Resonancia Magnética Computarizada de cráneo con contraste reporta lesión ocupante de espacio intraxial temporo-parietal de aspecto quistico, con masa mural compatible con ASTROCITOMA PILOCITICO, corroborado con estudios histopatológico. En el presente trabajo se destaca que los astrocitomas pilocíticos aparecen con mayor frecuencia en la infancia y cuya ubicación predilectoria se encuentra a nivel del Cerebelo, sin embargo nuestro caso clínico presenta una ubicación a nivel supratentorial, siendo esta mas frecuente en los adultos que en los infantes, por lo que no se correlaciona con las estadísticas establecidas a nivel mundial y de diversos estudios realizados para los tumores primarios benignos, específicamente, el astrocitoma pilocítico, por tal motivo quisimos traer a colación el presente estudio.

Assuntos

Humanos , Feminino , Lactente , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/patologia , Neuroglia/patologia , Sistema Nervoso Central/anatomia & histologia , Tomógrafos Computadorizados , Transtornos Neurológicos da Marcha/diagnóstico , Astrocitoma/diagnóstico , Astrocitoma/patologia , Biópsia/métodos , Lábio/lesões , Neurologia , Pediatria

RESUMO

Introducción: La obesidad es el principal problema nutricional en niños y su tratamiento es poco efectivo. Objetivo: Evaluar la adherencia y respuesta a mediano plazo del tratamiento médico convencional en un grupo de niños obesos. Sujetos y método: Se revisó retrospectivamente la evolución clínica de 120 pacientes obesos que consultaron por primera vez entre enero 2001 y enero 2002. Se consignó estado nutricional inicial y a los 2, 4, 6 y 12 meses de seguimiento, con indicación de medidas dietéticas y aumento de actividad física. Resultados: Su edad fue de 9,7 ± 3,3 años, 52,5 por ciento de sexo femenino, P/T: 147,6 ± 20 por ciento, e IMC z: 3,4 ± 1,5. El 30 por ciento de los pacientes acudió solamente a la primera consulta, con abandono de 23,3 por ciento, 10 por ciento y 18,3 por ciento después de 2, 4 y 6 meses. A los 12 meses sólo 18,3 por ciento seguía en control regular, habiendo disminuido su P/T en –20,8 ± 13,6 por ciento. Este grupo tenía un mayor grado de obesidad al ingreso (Anova, p < 0,05) y mayor baja ponderal inicial (Anova, p > 0,05), no se encontró diferencias en edad, sexo, maduración sexual, ni antecedente de obesidad familiar que permitieran predecir la adherencia ni la respuesta al tratamiento. Conclusión: Un alto porcentaje de los niños que consultan por obesidad presentan deserción al tratamiento médico convencional; solo 18,3 por ciento mantiene adherencia al año, todos ellos con mejoría significativa de su obesidad. Es necesario desarrollar estrategias para mejorar adhesividad y a través de ésta el rendimiento de la terapia.

Assuntos

Masculino , Adolescente , Humanos , Feminino , Pré-Escolar , Criança , Recusa do Paciente ao Tratamento/estatística & dados numéricos , Obesidade/terapia , Cooperação do Paciente , Análise de Variância , Chile , Evolução Clínica , Eficácia , Seguimentos , Comportamento Alimentar , Obesidade/dietoterapia , Estudos Retrospectivos

RESUMO

Kidney transplant programs nowadays increasingly use elderly, hypertensive and cardiac disease donors (expanded criteria donors). The impact of these donors on patient and graft outcome was investigated in our transplant population. Among 257 consecutive cadaveric kidney transplants, 56 were from expanded criteria donors. The frequency of anuria, delayed graft function, and the days of renal failure were higher using organs from the expanded criteria donor group. Serum creatinine was higher in this group, although the statistical significance disappeared at 36 months. There were no significant differences in graft or patient survival during the first 3 years. The use of expanded criteria donors should not be discouraged, but recipient selection and immunosuppression use should be adapted and cold ischemia minimized.

Assuntos

Doenças Cardiovasculares/epidemiologia , Transplante de Rim/efeitos adversos , Doadores de Tecidos/estatística & dados numéricos , Fatores Etários , Sobrevivência de Enxerto/fisiologia , Humanos , Transplante de Rim/fisiologia , Pessoa de Meia-Idade , Seleção de Pacientes , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento

RESUMO

Con el propósito de determinar los patrones de susceptibilidad antimicrobiana y producción de beta-lactaminasa, se estudiaron 60 pacientes procedentes del área de enfermedades de transmisión sexual del Hospital Universitario "Dr. Manuel Nuñez Tovar", estado Monagas. Se aislaron 35 cepas (58,30 por ciento) de N.gonorrhoeae, las cuales se agruparon de acuerdo a la susceptibilidad antimicrobiana y producción de beta-lactamasa, observándose una elevada tasa de resistencia a la penicilina (94,29 por ciento) y a la tetraciclina (97,14 por ciento). De las 33 cepas de N.gonorrhoeae resistentes a la penicilina, 15 (45,45 por ciento) fueron no productoras de beta-lactamasa. La sensibilidad in vitro de N. gonorrhoeae frente al cefepime, cefoxitin y ceftriaxone fue de 97,14 por ciento, 94,29 por ciento y 80,50 por ciento, respectivamente. Con relación a la susceptibilidad a la ofloxacina, se encontró que el 97,14 por ciento de las cepas de N.gonorrhoeae mostraron sensibilidad a este antimicrobiano

Assuntos

Humanos , Masculino , Feminino , beta-Lactamases , Suscetibilidade a Doenças , Resistência Microbiana a Medicamentos , Gonorreia , Neisseria gonorrhoeae , Medicina , Venezuela

RESUMO

Las heridas cardíacas que se acompañan de alojamiento intramiocárdico del proyectil son muy poco frecuentes. Se presentan dos casos de pacientes portadores de proyectiles intramiocárdicos, manejados ambos sin extracción del proyectil. Uno tratado en forma conservadora y el otro caso se manejó con esternotomía exploradora de urgencia. Se realizó revisión de la bibliografía y se analizan las conductas adoptadas en nuestros dos casos de proyectil intramiocárdico

Assuntos

Humanos , Masculino , Adulto , Traumatismos Cardíacos/cirurgia , Ferimentos Penetrantes , Esterno/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Radiografia Torácica , Traumatismos Cardíacos , Ferimentos por Arma de Fogo , Ferimentos Penetrantes