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- ItemAcesso aberto (Open Access)Análise da recorrência de fibrilação atrial durante terapia com sotalol ou quinidina(Sociedade Brasileira de Cardiologia - SBC, 1998-01-01) Veloso, Henrique Horta [UNIFESP]; De Paola, Angelo Amato Vincenzo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)PURPOSE: To analyze the recurrences of atrial fibrillation in patients treated with sotalol or quinidine. METHODS: After conversion to sinus rhythm, 121 patients with paroxysmal atrial fibrillation were randomized to sotalol (58 patients) or quinidine (63 patients) and followed-up during 6 months. Symptoms and ventricular rates on the 12 lead electrocardiogram of the arrhythmic events were compared between the two groups. Clinical and echocardiographic characteristics were analyzed as predictors of atrial fibrillation recurrence. RESULTS: Seventeen (14%) patients relapsed into atrial fibrillation; 7 (12%) were treated with sotalol and 10 (16%) with quinidine. Recurrence occurred later in the sotalol group (median 69 days) in comparison with the quinidine group (median 10 days) (p=0.04). Symptoms were present in 14 (82%) patients during the initial crisis and in 10 (47%) during recurrence. Recurrence was less symptomatic during antiarrhythmic therapy (p<0.04), with no statistical differences between the two groups. Only patients treated with sotalol had ventricular rates during the recurrences lower than during initial crisis (p<0.02). All variables failed to predict recurrence of atrial fibrillation. CONCLUSIONS: evention of atrial fibrillation. Recurrence was less symptomatic during antiarrhythmic therapy. Patients treated with sotalol relapsed to atrial fibrillation later and had ventricular rates during recurrences significantly lower than during the initial crisis.
- ItemSomente MetadadadosGlomeruloesclerose segmentar e focal após-transplante renal: evolução clínica e fatores de progressão(Universidade Federal de São Paulo (UNIFESP), 2016-12-31) Mata, Gustavo Ferreira da [UNIFESP]; Kirsztajn, Gianna Mastroianni Kirsztajn [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Background: In spite of advances in dialysis therapies, renal transplantation is the best therapy for the treatment of end stage renal disease (ESRD). However, graft survival depends on varied factors: graft age, cold ischemia time, occurrence of rejections, adherence to treatment, immunosuppressive drugs, compatibility, donor type, recipient disease, others. Among glomerular diseases that progress to ESRD, focal segmental glomerulosclerosis (FSGS) occupies a prominent position due to its prevalence and its high recurrence after renal transplantation. After transplantation, the disease can recur in 15-52% of cases and, if left untreated, leads to early graft loss in more than 50% of cases. Objective: To perform a descriptive analysis of a cohort of patients with post-transplant FSGS in terms of recipient and donor demographic characteristics, clinical course, response to treatment and progression of glomerular disease to "graft loss". Material and Methods: This is a retrospective cohort study, including adolescent and adult patients, submitted to renal transplantation with live and deceased donors between January 1999 and September 2014 in the Transplant Section (Division of Nephrology) of the Federal University of São Paulo/Hospital do Rim, São Paulo (SP), Brazil. Results: 88 patients with post-transplant FSGS were identified along the period of this study. The mean age of the patients in this sample was 29.1 ± 13.3 years at the time of transplantation, with predominance of male and white patients. Transplants with deceased donors predominated (60.9%). Of these, 25.6% were performed with an expanded criterion donor. Delay graft function occurred in 47.6% of recipients. The mean time to onset of proteinuria greater than 0.5 g / g was 20.51 ± 20.88 days. The indication of biopsy of the renal graft due to the suspicion of FSGS occurred with a median of 79 days, and histological characteristics of the FSGS were verified, in most cases, only in the subsequent biopsies, with a mean time of appearance of the histological changes of 164.56 ± 375.89 days. Only 21.5% of the patients had histological characteristics of FSGS in the first graft biopsy. The vast majority of patients (90.80%) underwent pulse therapy with methylprednisolone associated with plasmapheresis (70.10%). Taking a period of 60 months after kidney transplantation, 44.16% of the patients had partial remission, 25.97% complete remission and 29.87% had no remission. However, 50.60% of the patients evolved with graft loss (77.27% secondary to FSGS). After 12 months of transplantation, mean serum creatinine was 1.94 ± 1.02 mg/dL. The main complication of the treatment was infection/sepsis (67.5%). Eight patients (9.4%) died in the 60-month period, five (62.5%) deaths were attributed to infection. Conclusion: FSGS after renal transplantation presented a high rate of recurrence, usually early in the course of the disease. The histological changes in light microscopy were not simultaneous to the appearance of proteinuria. The infection rate during follow-up was high and related to mortality. The graft loss rate attributed to the post-transplant FSGS was elevated throughout the follow-up and corresponded to half of the individuals affected. Plasmapheresis therapy was an effective measure for the treatment of post-transplant FSGS and was able to contribute to partial or total response in more than 70% of the patients.
- ItemAcesso aberto (Open Access)Glossopharyngeal neuralgia with syncope as a sign of neck cancer recurrence(Academia Brasileira de Neurologia - ABNEURO, 2007-12-01) Ribeiro, Reinaldo Teixeira [UNIFESP]; Souza, Nilton Amorim de [UNIFESP]; Carvalho, Deusvenir de Souza [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Glossopharyngeal neuralgia with syncope as a sign of neck cancer is a very rare condition. A review of the literature revealed only 29 cases formerly reported. We present the first Brazilian case of such association. A 68-year-old man presented with paroxysmal excruciating pain over the right side of the neck, sometimes followed by syncope. Given the suspicion of recurrent tumor from a previously treated neck malignancy, a computed tomography scan was performed and a right parapharyngeal tumor was shown. Pain and syncope were successfully controlled with carbamazepine and the patient underwent palliative radiotherapy.
- ItemSomente MetadadadosLipid levels and risk of recurrent venous thrombosis: results from the MEGA follow-up study(Wiley, 2017) Morelli, V. M. [UNIFESP]; Lijfering, W. M.; Rosendaal, F. R.; Cannegieter, S. C.Background Knowledge of risk factors for recurrent venous thrombosis may guide decisions on duration of anticoagulation. The association between lipid levels and first venous thrombosis has been studied extensively. However, data on the role of lipids in the risk of recurrence are scarce. Objective To assess the association between lipid levels and recurrent venous thrombosis. Patients/Methods Patients with a first venous thrombosis from the MEGA study were included. Follow-up started at the date of end of anticoagulant treatment. Percentile categories of total/low-density lipoprotein/high-density lipoprotein cholesterol, triglycerides and apolipoproteins B and A1 were established (< 10th, 10th-25th, 25th-75th [reference], 75th-90th, > 90th percentile). Lipids were measured at least 3 months after discontinuing anticoagulation. Results Of 2106 patients followed for a median of 6.9 years, 326 developed recurrence (incidence rate, 2.7/100 patient-years
- ItemSomente MetadadadosPostoperative subconjunctival corticosteroid injection to prevent pterygium recurrence(Lippincott Williams & Wilkins, 2008-05-01) Paris, Fabiana dos Santos [UNIFESP]; Farias, Charles Costa de [UNIFESP]; Melo, Gustavo Barreto de [UNIFESP]; Santos, Myrna Serapião dos [UNIFESP]; Batista, Jefferson Luiz Alves [UNIFESP]; Gomes, José Álvaro Pereira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Purpose: To report the outcome of postoperative subconjunctival injection of triamcinolone in eyes that underwent pterygium surgery and were at risk for recurrence.Methods: Twelve eyes of 11 patients with primary (7 eyes) or recurrent (5 eyes) pterygia underwent excision and conjunctival autografting (4 eyes, 33.3%), an-miotic membrane grafting (6 eyes, 50%), or both (2 eyes, 16.6%). All of these eyes had signs that were considered to be risk factors for recurrence (conjunctival inflammation, hemorrhage, granuloma, and fibrovascular proliferation); accordingly, they also underwent subconjunctival injection of triamcinolone.Results: Among the 11 patients, there were 8 (72.7%) men and 3 (27.3%) women; the mean age was 41 years (range, 20 - 56 years). In 5 (41.7%) eyes, the pterygium was graded as T2 (intermediate) and in 7 (58.3%) eyes was graded as T3 (fleshy). The time between surgery and the first injection ranged from 2 to 5 weeks (mean, 3.4 weeks), and 1 - 3 injections were necessary (mean, 1.7) to achieve the desired effect. After injection, 1 (8.3%) eye developed inflammation, and 2 (16.7%) eyes from another patient developed intraocular hypertension that was controlled with a topical P-blocker. The follow-up after the last injection ranged from 8 to 36 months (mean, 14.5 months); only 1 recurrence (grade 3) occurred during this period.Conclusions: The postoperative use of subconjunctival triamcinclone seems to benefit patients at increased risk of pterygium recurrence. It is relatively safe and is accompanied by few complications, but controlled and prospective studies are necessary to confirm its efficacy.
- ItemSomente MetadadadosPrognostic scores after surgical treatment for cervical intraepithelial neoplasia: a proposed model and possible implications for post-operative follow-up(Wiley-Blackwell, 2014-09-01) Andrade, Carlos E. M. C.; Scapulatempo-Neto, Cristovam; Longatto-Filho, Adhemar; Vieira, Marcelo A.; Tsunoda, Audrey T.; Silva, Ismael D. C. G. da [UNIFESP]; Fregnani, Jose Humberto T. G.; Barretos Canc Hosp Pio XII Fdn; Universidade Federal de São Paulo (UNIFESP)Objective. To develop a prognostic model for women who underwent surgical treatment for cervical intraepithelial neoplasia. Design. Cohort study. Patient inclusion and follow-up occurred retrospectively and prospectively. Setting. Barretos Cancer Hospital, Barretos, São Paulo, Brazil. Population. Women (n = 242) diagnosed with cervical intraepithelial neoplasia who were submitted to conization. Methods. Immediately prior to surgical treatment, a cervical cytology sample was collected from each individual included in the study by endocervical brushing and stored in a preservative solution with methanol. A human papilloma virus-DNA test was conducted using an aliquot of the endocervical brushings. the surgical specimens were subjected to immunohistochemical analysis of p16 (immunohistochemical analysis 4a) protein expression. Main outcome measures. Two-year disease-free survival rates calculated for each study variable. Identified variables in the multivariate Cox model were used for elaboration of prognostic scores. Results. Variables associated with outcome included age (p = 0.033), tobacco use (p < 0.001), final histopathological diagnosis (p = 0.007), surgical margins (p < 0.001), high-risk human papilloma virus status (p = 0.008), human papilloma virus-16 status (p < 0.001) and immunoexpression of p16 in the cytoplasm (p = 0.049). By the Cox model, independent risk factors for disease recurrence/persistence were: tobacco use (hazard risk = 3.0; 95% confidence interval 1.6-5.6), positive surgical margins (hazard risk = 3.2; 95% confidence interval 1.6-6.1), human papilloma virus-16 (hazard risk = 3.3; 95% confidence interval 1.6-6.9) and age over 45 years (hazard risk = 2.7; 95% confidence interval 1.1-6.6). Conclusions. Establishment of a prognostic score can represent a valuable tool for determining the risk of cervical intraepithelial neoplasia recurrence after conization. the use of clinical (age and tobacco use), pathological (surgical margins) and molecular (human papilloma virus-16 genotyping) factors can facilitate more appropriate patient follow up according to risk stratification.