RESUMO
Invasive fungal disease (IFD) shows distinct regional incidence patterns and epidemiological features depending on the geographic region. We conducted a prospective survey in eight centres in Brazil from May 2007 to July 2009. All haematopoietic cell transplant (HCT) recipients and patients with acute myeloid leukaemia (AML) or myelodysplasia (MDS) were followed from admission until 1 year (HCT) or end of consolidation therapy (AML/MDS). The 12-month cumulative incidence (CI) of proven or probable IFD was calculated, and curves were compared using the Grey test. Among 237 AML/MDS patients and 700 HCT recipients (378 allogeneic, 322 autologous), the 1-year CI of IFD in AML/MDS, allogeneic HCT and autologous HCT was 18.7%, 11.3% and 1.9% (p <0.001), respectively. Fusariosis (23 episodes), aspergillosis (20 episodes) and candidiasis (11 episodes) were the most frequent IFD. The 1-year CI of aspergillosis and fusariosis in AML/MDS, allogeneic HCT and autologous HCT were 13.4%, 2.3% and 0% (p <0.001), and 5.2%, 3.8% and 0.6% (p 0.01), respectively. The 6-week probability of survival was 53%, and was lower in cases of fusariosis (41%). We observed a high burden of IFD and a high incidence and mortality for fusariosis in this first multicentre epidemiological study of IFD in haematological patients in Brazil.
Assuntos
Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Hospedeiro Imunocomprometido , Leucemia Mieloide Aguda/complicações , Micoses/epidemiologia , Síndromes Mielodisplásicas/complicações , Transplante , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Aspergillus/isolamento & purificação , Brasil/epidemiologia , Candida/isolamento & purificação , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Fusarium/isolamento & purificação , Humanos , Incidência , Lactente , Recém-Nascido , Leucemia Mieloide Aguda/terapia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Micoses/microbiologia , Síndromes Mielodisplásicas/terapia , Adulto JovemRESUMO
BACKGROUND: Several studies have found a reduction in hippocampal volume in borderline personality disorder (BPD) patients. METHODS: In order to investigate the degree to which comorbid posttraumatic stress disorder (PTSD) could account for reduction in hippocampal volume in these patients, we conducted a systematic review and meta-analysis of studies that compared hippocampal volume in BPD patients with and without PTSD relative to healthy controls. RESULTS: Seven articles, involving 124 patients and 147 controls, were included. We found a statistically significant reduction for the left and right hippocampus. Data from the four studies that discriminated BPD patients with and without PTSD indicate that hippocampal volumes were reduced bilaterally in BPD patients with PTSD, relative to healthy controls, but that results were mixed for BPD patients without PTSD, relative to healthy controls. CONCLUSIONS: Results from this meta-analysis suggest that hippocampal volumes are reduced in patients with BPD, relative to healthy controls, but particularly in cases in which patients are diagnosed with comorbid PTSD.
Assuntos
Transtorno da Personalidade Borderline/patologia , Hipocampo/patologia , Transtornos de Estresse Pós-Traumáticos/patologia , Adulto , Transtorno da Personalidade Borderline/epidemiologia , Transtorno da Personalidade Borderline/psicologia , Comorbidade , Interpretação Estatística de Dados , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Testes Neuropsicológicos , Tamanho do Órgão , Escalas de Graduação Psiquiátrica , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/psicologiaRESUMO
PURPOSE: To test a circulatory assist device (CAD) developed in the University of São Paulo. Heart Institute, Bioengineering Division. It is a valveless chamber working through the counterpulsation principle, aiming at assistance to temporary the left ventricle. PATIENTS AND METHODS: The CAD consists of a rigid polycarbonate shell, which houses in its interior a polyurethane bag with a maximum volume of 110 cm3, driven alternately by pressure and vacuum from an external electropneumatic device synchronized with the ECG. The device worked for 300 hours in a test bench simulating the cardiovascular system in order to verify its resistance to wear and fatigue. The CAD was implanted near the aortic root of five dogs, in whom cardiac failure was induced through the use of propranolol and plasma expanders. The CAD was driven for five periods of 2 minutes separated by pauses of equal duration. The hemodynamic parameters were measured during the mentioned periods. RESULTS: "In vitro" testing resulted in no wear or fatigue. No leakage was observed. In the "in vivo" testing the averages obtained during the on and off periods of the device showed for the on periods; a) lowering of the systolic pressures of both the aorta (17.5%) and the left ventricle (LV) 15.1%), lowering of the final diastolic pressure of the LV (15.4%) and lowering of the diastolic pressure of the aorta (27.4%); b) increase in cardiac output (45.5%); c) increase of the endocardial viability ratio by 37.5%. CONCLUSION: The tested device represents a therapeutic option in cases of acute left ventricle failure, since with it an improved cardiac performance was measured and an increased coronary perfusion can be presumed.
Assuntos
Contrapulsação , Coração Auxiliar , Animais , Cães , Insuficiência Cardíaca/induzido quimicamente , Insuficiência Cardíaca/terapia , Hemodinâmica , Masculino , Substitutos do Plasma/farmacologia , Propranolol/farmacologiaRESUMO
We analyzed the different effects of CO2, Nd-YAG, and argon lasers on aorta by using a Thermovision infrared system that registered the laser interaction with mongrel dog aorta. The images (thermograms) obtained were processed by a computer, which associated each area of the same temperature with a determined color. These thermograms were compared to histological analysis of the respective samples and the following results were obtained: (1) After the application of each laser there is very little propagation of heat in tissue. (2) The CO2 laser makes tissue reach 100 degrees C in less than 0.05 seconds. (3) The heat dissipation time was higher with the Nd-YAG laser due to higher scattering on tissue. Based on this research we conclude that the CO2 laser was best absorbed, the Nd-YAG laser penetrated human tissue with the best results, and the argon laser had the most significant backscattering.
Assuntos
Aorta/lesões , Temperatura Alta , Lasers , Termografia , Animais , Aorta/patologia , Argônio , Dióxido de Carbono , Cães , Temperatura Alta/efeitos adversos , Processamento de Imagem Assistida por Computador , NeodímioRESUMO
The principal techiniques for experimental obstruction of the coronary flow are described, emphasyzing the use of the metalic mercury embolization as proved by the experience of the Experimental Division of the Heart Institute of the Säo Paulo Medical School, as well as the anterior descending coronary artery ligation through left sided thoracotomy in rats during chronic investigations
Assuntos
Cães , Coelhos , Ratos , Animais , Doença das Coronárias/etiologia , Embolia/complicações , Doença da Artéria Coronariana/complicações , Trombose Coronária/complicaçõesRESUMO
Foram estudados oito cäes mestiços, com pesos variáveis entre 12 e 15 Kg, submetidos à anestesia geral, toracotomia lateral e pericardiotomia longitudinal. Após ligadura da veia ázigos, as veias cavas anterior e posterior foram isoladas por cadarços de algodäo em torniquetes. Com técnica de bloqueio do retorno venoso, a artéria pulmonar foi aberta e as comissuras de sua valva suturadas, produzindo estenose pulmonar. A artéria pulmonar fou suturada e o retorno venoso liberado, assumindo os animais novo equilibrio hemodinâmico. Um cateter especial de angiocardiografia para aplicaçäo endocavitária de Laser (modelo Armelin e col.) foi introduzido na via de saida do ventrículo direto (por via transparietal em quatro casos e por cateterismo transvenoso-femoral nos demais). O laser foi aplicado na valva pulmonar obstruída até o desaparecimiento do gradiente pressórico estabelecido com à estenose pulmonar. Estudos hemodinâmicos e anatomopatológicos confirmaram a eficiência do método na desobstruçäo da estenose pulmonar
Assuntos
Estenose da Valva Pulmonar/cirurgia , Terapia a Laser , Cateterismo CardíacoRESUMO
Foi o raio laser aplicado em caes, em quatro tipos de experiencia: 1)lesao da intima e media das arterias, provando-se a inexistencia de estenose e formacao de trombos ate com 20 dias de evolucao; 2) "sutura" arterial ou arteriopatia, demonstrando-se a completa hemostasia e a alta resistencia a rotura, em experiencias agudas e cronicas de ate 17 dias; 3) anastomoses arterio-arteriais e arterio-venosas, mostrando-se a permeabilidade da luz dos vasos, a nao producao de estenose e trombos; 4) a - possibilidade de usar o laser, conduzido por cateter, sem necessidades de interromper a circulacao no sistema cardiovascular; b - eliminacao da estenose pulmonar, atraves do cateterismo cardiaco. Com estes resultados, acreditam os autores que o uso do laser em Cardiologia-Clinica possa ser iniciado
Assuntos
Animais , Cães , Artéria Femoral , Lasers , Artérias CarótidasRESUMO
Foram estudados 24 caes mesticos, com pesos variaveis entre 13 e 14 kg, distribuidos nos seguintes grupos: Grupo I - oito caes submetidos a derivacao intercarotidea, com interposicao de segmento de veia safena. Grupo II - oito caes submetidos a anastomose entre arteria mamaria interna esquerda e arteria coronaria descendente anterior. Grupo III - oito caes com anastomose venovenosa. Em todos os grupos, 0,8 a 1,5 watts de Laser de Argonio foram aplicados durante tempo total de 90 a 300 segundos. A menor intensidade para as anastomoses venosas e a maior para as arterias. No pos-operatorio imediato as anastomoses com Laser mostraram resistencia pressorica media de 730 mmHg. Apos 30 dias de seguimento a resistencia foi superior a 2.500 mmHg. Os estudos anatomo-patologicos e angiograficos revelaram sempre anastomoses pervias e ausencia de fenomenos tromboticos
Assuntos
Animais , Cães , Anastomose Arteriovenosa , Lasers , Procedimentos Cirúrgicos VascularesRESUMO
O efeito de nova solucao cardioplegica foi estudado experimentalmente em caes, submetidos a toracotomia e circulacao extracorporea.Foram controladas as variacoes pressoricas em ventriculo esquerdo, modificacao da forca e do deslocamento miocardio bem como estudada a dinamica do ventriculo esquerdo por cineangiocardiografia. A solucao cardioplegica foi infundida em volumes correspondentes a 6 ml/ kg, repetido a intervalos de 40 minutos de anoxia. Os resultados obtidos demonstram protecao miocardica eficaz com normalizacao dos parametros controlados apos o reinicio da circulacao coronaria normal