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Gondim JA Ferraz T Mota I Studart D Almeida JP Gomes E Schops M 《Surgical neurology》2009,72(1):15-19
Background
Acromegaly is an excessive GH secretion, which in most cases, is caused by a pituitary GH-secreting adenoma. Traditional treatment of acromegaly consists of surgery, drug therapy, and eventually radiotherapy. The aim of this retrospective study is to evaluate the results of transsphenoidal endoscopic surgery in a group of patients with intrasellar GH adenoma who were operated by a pituitary specialist surgeon. We shall then argue about the economical advantages, for the NHS of a developing country, between surgical and medical treatment.Methods
We have analyzed data from 33 patients with intrasellar GH tumor who had been referred to the neuroendocrine department of the HGF, Brazil. The patients underwent a transsphenoidal endoscopic adenomectomy for acromegaly between 2000 and 2005. Their ages were between 20 and 67 years (mean, 44 years) at the moment of surgery. No cavernous sinus invasion was present. Follow-up was a median of 2 years (range, 12 months-6 years).Results
All 33 patients had intrasellar adenoma, 84.84% of patients achieved remission by surgery. One patient was operated twice and reached hormonal normalization. Five patients still had the disease and refused a second surgery. A treatment with octreotide was started for these 5 patients and resulted in an adequate control of GH and IGF-1 levels. No patients had radiotherapy.Conclusion
Our patients, with intrasellar GH tumor, operated by a pituitary specialist neurosurgeon had remission rates approaching those obtained by most specialized neurosurgical centers worldwide. For equal results, our study shows that the surgical treatment is the best issue for the patient and for the NHS. 相似文献3.
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E.S. Girão B.G. Rodrigues dos Santos E.S. do Amaral P.E.G. Costa K.B. Pereira A.H. de Araujo Filho E.B. Hyppolito M.U. Mota L.C.B.F. Marques C.M. Costa de Oliveira S.L. da Silva J.H.P. Garcia P.F.C.B.C. Fernandes 《Transplantation proceedings》2017,49(9):2076-2081
Background
Chikungunya virus (CHIKV) is an emerging mosquito-borne disease that causes acute febrile polyarthralgia and arthritis. CHIKV has spread rapidly to the Americas and, in Brazil, autochthonous cases are increasingly been reported. Solid organ transplant (SOT) recipients who travel to or live in CHIKV endemic areas are under high risk of acquiring the disease. Few data exist regarding the clinical characteristics of CHIKV infections in this population. We report the first case series of CHIKV infection in SOT recipients.Methods
We retrospectively evaluated 13 cases of CHIKV infection in SOT recipients between January 2016 and December 2016 confirmed by laboratory tests and transplanted in the Renal and Liver Transplant Units of Walter Cantídio University Hospital from Federal University of Ceará.Results
Positive CHIKV serology (enzyme-linked immunosorbent assay immunoglobulin M) was found in all patients (9 kidney and 4 liver transplant recipients). All of these patients had been living in endemic areas for dengue and CHIKV in the past months before the illness. The mean time between transplantation and CHIKV infection was of 7.2 years. Fever presented in 11 (84.6%) patients and 5 (38.5%) presented with a maculopapular rash. All cases had joint symptoms: 11 (84.6%) with symmetrical and peripheral polyarthralgia/polyarthritis and 2 (15.3%) with monoarthralgia/monoarthritis. Six (46%) patients had a joint complaint that lasted 3 months. Two patients had concomitant positive dengue serology (enzyme-linked immunosorbent assay immunoglobulin M). There were no cases of complications or deaths.Conclusion
SOT with CHIKV infection seems to have a clinical presentation and evolution similar to those seen in the general population, with no apparent damage to the graft. 相似文献5.
I.R.C. Brasil J. Custodio-Lima R.L. Sampaio A.M.M. Pierre T.M. Esmeraldo R.V.C. Lima L.F.A. Lima R.M. Esmeraldo 《Transplantation proceedings》2017,49(4):871-873
Intoduction
Infection by cytomegalovirus (CMV) is a major cause of morbidity among immunosuppressed patients, especially after solid organ transplantation. The risk of CMV after organ transplantation is strongly related to the serology of the donor and the recipient. The objective of this study was to analyze the outcomes and costs of pre-emptive therapy in patients after liver transplantation with donor-positive/recipient-negative (D+/R?) serostatus.Methods
This retrospective study analyzed all patients who underwent liver transplantation with CMV serostatus D+/R? between January 2012 and December 2015. The service protocol adopts pre-emptive therapy. The outcomes and costs of this therapy are described.Results
Of the 119 patients undergoing liver transplantation, 19 were D+/R? and entered the main analysis. Of these, 7 had positive polymerase chain reaction (PCR) results, and 1 developed CMV disease. Of the 6 patients who received no treatment, none developed CMV disease. Analyzing costs, pre-emptive therapy for these patients generated service savings of R$32,346.00.Conclusions
Although outcomes of universal prophylaxis and pre-emptive therapy are similar, pre-emptive therapy save on costs and have to be considered in patients with high-risk CMV disease after liver transplantation. 相似文献6.
2013年10月第64届世界医学大会对《赫尔辛基宣言》修订,改变的主要内容为便于阅读和把握宣言的体系增加了小标题,首次提出研究所致受试者伤害的赔偿规定,更注重保护弱势群体受试者,对试验完成后受试者权益保障更加明确具体,安慰剂使用(非干预措施)更加体系化且不弱化伦理要求等。 相似文献
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A. Gomes Neto A.S. Monteiro Nogueira I. Lopes De Medeiros R. Fernandes Viana De Araujo R. Carvalho Santos C.M. Sampaio Viana F. Moreira Batista Aguiar L. Gomes Catunda L. Araújo Aragão R. Fava Alencar 《Transplantation proceedings》2018,50(3):815-818
Introduction
The lung transplantation (LTx) program began in Ceará in 2011 and the first LTx was performed on June 11, 2011. The aim of this study was to present the initial results of the 6-year experience of our program.Methods
We retrospectively reviewed our experience on LTx from June 2011 to August 2017. Data on recipients and transoperative and postoperative outcomes were recorded in a database.Results
Twenty-two (56.4%) were single LTx, 15 (38.5%) were double, and 2 (5.1%) bilateral lobar. The mean age was 47.5 ± 15 years, and 26 (66.7%) were men. Twenty-eight (71.8%) had pulmonary fibrosis; 5 (12.8%) had pulmonary emphysema, 3 (7.7%) had bronchiectasis; 2 (5.1%) had pulmonary hypertension, and 1 (2.6%) had lymphangioleiomyomatosis. Complications occurred in 82% (32/39) and in-hospital mortality was 30.8% (single LTx = 27.8% and double LTx = 33.3%). The main complications were infection in 17 (43.5%) cases and primary graft dysfunction in 7 (17.9%). There was a significant improvement in pulmonary function in the first year of follow-up (forced expiratory volume pre-LTx = 37% ± 16% and 12 months post-LTx = 72% ± 22%, P = .001); and overall survival at 36 months was 59.0%, with no difference between single- and double-lung transplants.Conclusions
Idiopathic pulmonary fibrosis was the most common underlying disease and single LTx was the most commonly performed operation. There was a high incidence of postoperative complications and in-hospital mortality, but the 36-month follow-up showed a marked improvement in lung function and a global survival similar to the literature. 相似文献8.
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A.C. Teixeira C.C. Freire de Carvalho G.P. Mororó L.D.M. Pereira V.S. Lacerda R.M. Esmeraldo 《Transplantation proceedings》2017,49(10):2247-2250
The Maryland aggregate pathology index (MAPI) score is an important tool developed to help pathologists in evaluating potential organs for transplantation. It is based on analysis of five variables (present or absent): arteriolar hyalinosis (4 points), periglomerular fibrosis (2 points), arterial wall-lumen ratio superior to 0.5 (2 points), global glomerulosclerosis in more than 15% of glomeruli (2 points), and interstitial scar (3 points). Kidneys with a MAPI score >7 points are considered inadequate for donation. This study aimed to evaluate pathology agreement between frozen sections (FS) and paraffin sections (PS) using the MAPI score in a cohort of 262 biopsy specimens obtained at the General Hospital of Fortaleza, Brazil. We performed a retrospective review of pathological reports of FS (signed out by an on-call pathologist) and their corresponding PS (authorized by a specialist in renal pathology). Agreement was calculated using the Kappa test. Kappa values ranging from 0.29 to 0.51 were obtained when MAPI parameters were separately evaluated. When the score was used, the coefficient was 0.59. Fourteen of 262 kidneys were classified as inadequate for donation using PS and 8 cases were diagnosed using FS. There were no differences between wedge-shaped and filiform samples, apart from the mean number of glomeruli. Discordant cases had no statistical difference from concordant ones when clinical and macroscopic pathological parameters were analyzed. The MAPI score can be useful to minimize disagreements between FS and PS, but more effort should be made to standardize criteria and enable pathologists to recognize chronic lesions in FS samples. 相似文献
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Elizama S. Silveira Suzana B. Bezerra Kalyane S. Ávila Talita M. Rocha Romelia G. Pinheiro Maria Goretti R. de Queiroz Pedro Jorge Caldas Magalhães Flávia Almeida Santos Luzia Kalyne A.M. Leal 《Pathophysiology》2019,26(3-4):349-359
Arthur de Carvalho Drops® (ACD) is a traditional Brazilian herbal medicine used to treat functional gastrointestinal disorders (FGIDs). ACD is a formulation of herbal extracts from Matricaria recutita (chamomile), Foeniculum vulgare (fennel) and Gentiana lutea L. (gentian). Considering the popular use for FGIDs, the aim of this work was to investigate the ACD effect on gastric and intestinal parameters with emphasis in a mechanistic approach using isolated duodenal preparations of rodents. Analytical method was developed and validated for quantify three actives principles/markers (Apigenin-7-glucoside, gentiopicroside and anethole) in ACD. The treatment with ACD significantly reduced the emetogenic stimuli induced by cisplatin in rats, showed a laxative effect, reduced the bethanechol-enhanced gastrointestinal transit and completely reversed the contraction induced by carbachol in rat duodenum. However, ACD did not alter the secretory gastric volume or total gastric acidity. The ACD affect the contractions of duodenal smooth muscle mediated by Ca2+ channels and it is also able to inhibit the contractile response mediated by the release from its intracellular store. Furthermore, the relaxant effects of ACD appear independent of the nitric oxide pathway in rat duodenum. These results suggest that ACD could be beneficial for the treatment of disorders of the gastrointestinal tract. 相似文献