201 resultados para Vascular occlusion


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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

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Background: COX-2 is one of the most important prostaglandin involved in urologic cancer and seems to be associated with tumor progression, invasion, and metastasis. In addition, several effects have been reported for VEGF, including inducing angiogenesis, promoting cell migration, and inhibiting apoptosis. COX2 and VEGF up-regulation have been reported in human prostate cancer. Due to the importance of canine natural model for prostate cancer, the aim of this study was to evaluate COX-2 and VEGF protein expression in canine carcinogenic process. Material and Methods: Seventy-four prostatic tissues from dogs were selected to be evaluated for protein expression by immunohistochemistry (IHC), including: 10 normal prostatic tissues, 20 benign prostatic hyperplasias (BPH), 25 proliferative inflammatory atrophies (PIA) and 20 prostatic carcinomas (PCa). COX-2 and VEGF were detected using the monoclonal antibody CX-294 (1:50 dilution, Dako Cytomation and sc-53463 (1:100 dilution, Santa Cruz), respectively. The immunolabelling was performed by a polymer method (Histofine, Nichirei Biosciences). All reaction included negative controls by omitting the primary antibody. The percentage of C-MYC, E-cadherin, and p63- positive cells per lesion was evaluated according to Prowatke et al. (2007). The samples were scored separately according to staining intensity and graded semi-quantitatively as negative, weakly positive (1), moderately positive, and strongly positive. The score was done in one 400 magnification field, considering only the lesion, since this was done in a TMA core of 1 mm. For statistical analyses, the immunostaining classifications were reduced to two categories: negative and positive. The negative category included negative and weakly positive staining. Chi-square or Fisher exact test was used to determine the association between the categorical variables. Results: The COX-2 protein expression was elevated in the cytoplasm of the canine PCa and PIA compared to normal prostate (p=0.002). VEGF protein expression was increased in 94.75% of the PCa and 100% of the PIA compared with to normal prostate (p = 0.001). No difference was found when compared normal prostate with BPH. Conclusions: This study has demonstrated that the carcinogenesis of canine prostatic tissue may be related to gain of COX-2 and VEGF protein expression.

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Objective: To evaluate the effect of early fetoscopictracheal occlusion (FETO) (22–24 weeks’ gestation) onpulmonary response and neonatal survival in cases ofextremely severe isolated congenital diaphragmatic hernia(CDH). Methods: This was a multicenter study involving fetuseswith extremely severe CDH (lung-to-head ratio < 0.70,liver herniation into the thoracic cavity and no otherdetectable anomalies). Between August 2010 and December 2011, eight fetuses underwent early FETO. Datawere compared with nine fetuses that underwent standard FETO and 10 without fetoscopic procedure fromJanuary 2006 to July 2010. FETO was performed undermaternal epidural anesthesia, supplemented with fetalintramuscular anesthesia. Fetal lung size and vascularitywere evaluated by ultrasound before and every 2 weeksafter FETO. Postnatal therapy was equivalent for bothtreated fetuses and controls. Primary outcome was infantsurvival to 180 days and secondary outcome was fetalpulmonary response. Results: Maternal and fetal demographic characteristicsand obstetric complications were similar in the threegroups (P > 0.05). Infant survival rate was significantlyhigher in the early FETO group (62.5%) comparedwith the standard group (11.1%) and with controls(0%) (P < 0.01). Early FETO resulted in a significantimprovement in fetal lung size and pulmonary vascularitywhen compared with standard FETO (P < 0.01). Conclusions: Early FETO may improve infant survival byfurther increases of lung size and pulmonary vascularityin cases with extremely severe pulmonary hypoplasia inisolated CDH. This study supports formal testing of thehypothesis with a randomized controlled trial.

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Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

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Vascular lesions can be serious complications resulting of blunt or penetrating trauma(1,2). Internal carotid artery lesion is one of most serious and relatively frequent in all mechanisms of craniofacial trauma. Several clinical manifestations can occur as central neurologic and cranial nerves deficits as well as several degrees of bleeding (from mild symptomatic to fatal). Recurrent and massive epistaxis can occur after trauma due to pseudaoneurysms of the external and internal carotid artery (ICA)(3,4). Considering its life-threatening course, the assisting physician has a relatively narrow time to detect and treat these lesions.We present two cases of recurrent and massive epistaxis secondary to ICA pseudoaneurysm following blunt and perforating trauma. Evolution was fatal in the first case with delayed treatment and uneventfully in the second which was treated by occlusion of the pseudoaneurysm and ICA via endovascular intervention.

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Surgery on the head and neck region may be complicated by vascular trauma, caused by direct injury on the vascular wall. Lesions of the arteries are more dangerous than the venous one. The traumatic lesion may cause laceration of the artery wall, spasm, dissection, arteriovenous fistula, occlusion or pseudoaneurysm. We present a case of a child with a giant ICA pseudoaneurysm after tonsillectomy, manifested by pulsing mass and respiratory distress, which was treated by endovascular approach, occluding the lesion and the proximal artery with Histoacryl. We reinforce that the endovascular approach is the better way to treat most of the traumatic vascular lesions.

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Here, we present a case report on prosthetic reconstruction of posterior teeth and composite resin restoration of anterior teeth yielding considerable esthetic improvement, reestablishment of disocclusion guides and function.

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Pós-graduação em Fisiopatologia em Clínica Médica - FMB

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Thrombosis of tunneled central venous catheters (CVC) in hemodialysis (HD) patients is common and it can lead to the elimination of vascular sites. This study aimed to evaluate the incidence of thrombotic obstruction of tunneled CVC in HD patients and the efficacy of occlusion treatment with alteplase use, and identify factors associated with thrombotic occlusion. It was a prospective cohort study performed in two centers which evaluated the diagnosis and treatment of thrombotic occlusion of CVC in HD patients for 24 consecutive months. The catheter occlusion was defined as the difficulty infusing or withdrawing fluid from their paths. Alteplase dose was infused to fill the lumen of the occluded catheter and remained for 50 min. As there was no obstruction of the catheter, the procedure was repeated. Three hundred and thirty-nine CVC in 247 patients were evaluated and followed, totalling 67 244 CVC-days. One hundred fifty-seven patients had only one CVC, 88 patients had two CVC during the study, and two patients had three CVC. The median age was 58 (47–66) years, patients were predominantly men (54%), with diabetic nephropathy as the main cause of chronic kidney disease (44%), the internal jugular vein as the main site of implantation (82%), and duration of dialysis before CVC implantation of 119 (41.5 to 585.5) days. Eight hundred and fifteen occlusion episodes were diagnosed (12 episodes/1000 CVC-days), with primary success with alteplase in 596 episodes (77%) and secondary in 81 cases (10%). In 99 episodes (13%), success was not achieved after the second dose of alteplase. Two hundred and thirty CVC were removed during the study and the removal causes were arteriovenous fistula use in 88 patients (38.3%), infectious and mechanical complications in 89 (38.7%) and 21 (9.1%), respectively, and others (transplantation, transfer, or death) in 32 patients (13.9%). Adverse effects were also not observed. In the multivariate analysis, we identified the greatest number of days with CVC (OR = 1.02, CI = 1.01–1.04, P = 0.004), the presence of diabetes (OR = 1.560, CI = 1.351–1.894, P = 0.015), and exit site infection (ESI) (OR = 1.567 CI = 1347–1926, P = 0.023) as factors associated with obstruction. Thrombotic occlusion showed frequent mechanical complication in CVC of HD patients. We observed 12 episodes of obstruction per 1000 CVC-days, with a high success rate after alteplase use (87%). In the multivariate analysis, the time with CVC, the presence of diabetes, and ESI were identified as variables associated with thrombotic obstruction.