A case of a 23-year-old woman with a paraovarian tumor is presented. The patient complained of pelvic pain and abdominal swelling. Cystectomy was the initial surgical treatment, but after the histological diagnosis, a staging surgery was carried out. The clinical aspects and subsequent management of related cases are discussed, and a literature review is made.
Chemokines are involved in the control of dendritic cell (DC) trafficking, which is critical for the immune response, namely in allergic contact dermatitis (ACD). In this work, we investigated by flow cytometry the effect of the contact sensitizers 2,4-dinitrofluorobenzene (DNFB), 1,4-phenylenediamine (PPD) and nickel sulfate (NiSO(4)), on the surface expression of the chemokine receptors CCR6 and CXCR4 in DC. As an experimental model of a DC we used a fetal skin-derived dendritic cell line (FSDC), which has morphological, phenotypical and functional characteristics of skin DC. Our results show that all the skin sensitizers studied decreased the membrane expression of the chemokine receptors CCR6 and CXCR4. In contrast, 2,4-dichloronitrobenzene (DCNB), the inactive analogue of DNFB without contact sensitizing properties, was without effect on the surface expression of these receptors. Lipopolysaccharide (LPS), which induces the maturation of DC, also reduced surface CCR6 and CXCR4 expression.
Despite the generally accepted use of cardioplegia for myocardial protection during cardiac revascularization and other operations, non-cardioplegic methods have been used by many surgeons throughout the world. We have prospectively studied 229 patients consecutively subjected to isolated coronary artery bypass surgery from March 1990 to February 1991 by a single surgeon who used intermittent aortic cross-clamping for construction of the distal anastomoses. The mean age of the patients was 58.9 +/- 8.9 years. One hundred and nine patients (47.6%) with unstable angina were subjected to urgent or emergent surgery and 129 (56.3%) had a previous myocardial infarction. The mean number of grafts per patient was 3.0. The ischaemic time per graft was 6.5 +/- 1.4 min. At least one internal mammary artery was used in 98% of the cases (1.4 internal mammary artery grafts/patient). Hospital mortality was 0.9% (two patients, in neither case related to the procedure). Only nine patients (3.9%) required inotropes and none needed intra-aortic counterpulsation. The analysis of serum enzymes specific of myocardial lesion showed a CPK-MB/CPK ratio of 10.5 +/- 10.2 after surgery, 6.4 +/- 6.6% at 24 h after surgery, and 6.9 +/- 2.6% by the 5th day. Only four patients (1.7%) had ECG criteria of myocardial infarction. These results were compared retrospectively with those of the 40 immediately preceding patients (December 1989 to February 1990)...
INTRODUÇÃO: Os doentes com cirrose hepática admitidos em Unidades de Cuidados Intensivos (UCI) têm um prognóstico particularmente reservado. O prognóstico destes doentes pode ser avaliado com scores gerais (SOFA, APACHE, SAPS) ou com scores específicos de cirrose hepática (MELD, Child-Pugh). OBJECTIVOS: Avaliar o valor prognóstico dos scores gerais (SOFA, APACHE e SAPS) e dos scores específicos de cirrose hepática (MELD e Child-Pugh) em doentes com cirrose hepática admitidos em UCI polivalentes ou em Unidades de Cuidados Intensivos de Gastrenterologia (UCIGE). MATERIAL E MÉTODOS: Os autores fazem uma revisão da literatura sobre a avaliação do prognóstico de doentes com cirrose hepática admitidos em ICUs e relatam também a sua experiência sobre esta temática no contexto duma UCIGE incluindo a análise de 124 internamentos. RESULTADOS: Nos diversos estudos efectuados em doentes com cirrose hepática admitidos em UCI polivalentes, os diferentes scores gerais e específicos revelaram um bom poder discriminativo, ou seja, com uma área sob a curva ROC (AUC) > 0,7. Considerando os seis estudos mais representativos, o valor médio da AUC dos scores SOFA, APACHE II, APACHE III, MELD e Child-Pugh foi 0,86, 0,74, 0,81, 0...
Introduction: In patients with morbid obesity the intragastric balloon (IGB) can be a “bridge” to surgery or a temporary treatment in patients who are not candidates for surgery.
Objective: Evaluate IGB efficacy in morbidly obese patients.
Patients and Methods: In 2003/2004 seventeen IGB Bioenterics ® filled with normal saline and methylene blue were placed in 17 patients [11 women, median age was 49.2 (27-69 years); median body mass index was 55.6 (40.2-74.2 Kg/m2)], followed by nutritionists and/or endocrinologists. They had previously tried dietetic and/or pharmacological measures with limited results. Co-morbidities were present in 13 (76.5%).
Results: Eight (47%) patients presented nausea/vomiting in the first 24-72h that persisted in 4 (23.5%) leading to dehydration and pre-renal insufficiency and forcing premature removal of the balloon (0.5 to 4 months). In the other patients, the device was removed at 6 months treatment (in 1 patient at 10 months). All patients suffered weight loss (5-70 Kg); median loss-19.6 Kg (p
The weak central coherence hypothesis represents one of the current explanatory models in Autism Spectrum Disorders (ASD). Several experimental paradigms based on hierarchical figures have been used to test this controversial account. We addressed this hypothesis by testing central coherence in ASD (n = 19 with intellectual disability and n = 20 without intellectual disability), Williams syndrome (WS, n = 18), matched controls with intellectual disability (n = 20) and chronological age-matched controls (n = 20). We predicted that central coherence should be most impaired in ASD for the weak central coherence account to hold true. An alternative account includes dorsal stream dysfunction which dominates in WS. Central coherence was first measured by requiring subjects to perform local/global preference judgments using hierarchical figures under 6 different experimental settings (memory and perception tasks with 3 distinct geometries with and without local/global manipulations). We replicated these experiments under 4 additional conditions (memory/perception*local/global) in which subjects reported the correct local or global configurations. Finally, we used a visuoconstructive task to measure local/global perceptual interference. WS participants were the most impaired in central coherence whereas ASD participants showed a pattern of coherence loss found in other studies only in four task conditions favoring local analysis but it tended to disappear when matching for intellectual disability. We conclude that abnormal central coherence does not provide a comprehensive explanation of ASD deficits and is more prominent in populations...
INTRODUCTION: The wrist arthrodesis has become a well-established procedure on the treatment of various diseases that affect the radiocarpal joint with the objective of pain relief and restoration of joint stability, allowing a recovery of gripping function and lifestyle. OBJECTIVES: Evaluate the functional outcomes of wrist arthrodesis in patients with advanced symptomatic inflammatory or degenerative arthritis and evaluate the residual synovitis by ultrasonography. METHODS: Review the patients who underwent a total wrist arthrodesis in our Hospital between 1999 and 2009, by a comparative and functional study. The study population was divided into two groups: Inflammatory Rheumatic Disease (IRD group) and another that included the remaining cases (RC group). For functional evaluation we used the Buck-Gramcko&Lohman (BGL) Evaluation for Total Wrist Function and the Disabilities of the Arm, Shoulder and Hand (DASH) Score. Pain levels were measured pre- and postoperatively according to the Visual Analogue Scale (VAS). A General Electric P5 Power Doppler Ultrasound with a high-resolution linear 7-12 MHz array was used to identify local synovitis. Mann-Whitney, Wilcoxon and Chi-Square tests were applied for statistical evaluation. p
The clinical efficacy of continuous infusion of piperacillin/tazobactam in critically ill patients with microbiologically documented infections is currently unknown. We conducted a retrospective multicenter cohort study in 7 Portuguese intensive care units (ICU). We included 569 critically ill adult patients with a documented infection and treated with piperacillin/tazobactam admitted to one of the participating ICU between 2006 and 2010. We successfully matched 173 pairs of patients according to whether they received continuous or conventional intermittent dosing of piperacillin/tazobactam, using a propensity score to adjust for confounding variables. The majority of patients received 16g/day of piperacillin plus 2g/day of tazobactam. The 28-day mortality rate was 28.3% in both groups (p = 1.0). The ICU and in-hospital mortality were also similar either in those receiving continuous infusion or intermittent dosing (23.7% vs. 20.2%, p = 0.512 and 41.6% vs. 40.5%, p = 0.913, respectively). In the subgroup of patients with a Simplified Acute Physiology Score (SAPS) II>42, the 28-day mortality rate was lower in the continuous infusion group (31.4% vs. 35.2%) although not reaching significance (p = 0.66). We concluded that the clinical efficacy of piperacillin/tazobactam in this heterogeneous group of critically ill patients infected with susceptible bacteria was independent of its mode of administration...
Transplant glomerulopathy is a sign of chronic kidney allograft damage. It has a distinct morphology and is
associated with poor allograft survival. We aimed to assess the prevalence and clinic-pathologic features of
transplant glomerulopathy, as well as determine the functional and histological implications of its severity. We
performed a single-centre retrospective observational study during an eight-year period. Kidney allograft biopsies
were diagnosed and scored according to the Banff classification, coupled with immunofluorescence studies. The
epidemiology, clinical presentation, outcomes (patient and graft survival) and anti-HLA alloantibodies were evaluated.
Transplant glomerulopathy was diagnosed in 60 kidney transplant biopsies performed for clinical reasons
in 49 patients with ABO compatible renal transplant and a negative T-cell complement dependent cytotoxicity
crossmatch at transplantation. The estimated prevalence of transplant glomerulopathy was 7.4% and its cumulative
prevalence increased over time. C4d staining in peritubular capillaries (27.6%) was lower than the frequency
of anti-HLA antibodies (72.5%), the majority against both classes I and II. Transplant glomerulopathy was associated
with both acute (mainly glomerulitis and peritubular capillaritis) and chronic histologic abnormalities. At