RESUMO
Liver transplantation [LT] increases the risk of de novo malignancies including skin cancers. However, risk factors for this type of cancers have not been well studied. To determine the incidence of skin cancer in LT recipients, and to identify the risk factors of this type of cancer. We identified all adult patients who underwent LT and developed de novo skin cancer post-LT at our institution between 1996 and 2009. We excluded the patients with history of skin cancer prior to LT. We also studied a control group of patients who underwent LT during the same period but did not develop skin cancer; the control group was matched [1:2] for age, gender and geographical place of residence. Over a median [IQR] follow-up of 41.5 [18.0, 98.6] months, 23 [2.3%] of 998 patients developed skin cancer post-LT, of whom 10 were identified with squamous cell carcinoma, 9 with basal cell carcinoma and 4 with melanoma. After adjusting the confounding variables, subjects who had combined liver/ kidney transplant had 22 [95% CI: 5.1-99] times higher hazard of skin cancer compared to subjects with LT alone. Furthermore, patients who had non-skin cancer prior to LT had 23 [95% CI: 8.6-60] times higher hazard developing skin cancer after the transplant. Patients with history of alcohol consumption, as the underlying etiology of liver disease, had 4 [95% CI: 1.2-12.9] times higher hazard of developing skin cancer after transplantation. Type or duration of immunosuppression was not associated with increased risk of skin cancer post-LT. The post-LT survival outcome was not affected by the development of de novo skin cancer post-LT. Skin cancer is relatively common in LT recipients and should be monitored, particularly in patients with a history of pretransplant malignancy, recipients of combined liver and kidney transplant or having alcoholic cirrhosis as the underlying cause of liver disease
RESUMO
The relationship between depression and coronary artery disease is well established; however assessment of this relationship using functional and semi-quantitative imaging [myocardial perfusion scintigraphy] was lacking. The aim of this study was to assess the relationship between the severity of depression and the severity of myocardial perfusion abnormality. Patients were assessed with rest/stress 99mTc-MIBI myocardial perfusion scintigraphy using Single Photon Emission Computed Tomography [SPECT] and Beck Depression Inventory [BDI-II]. Visual and semi-quantitative assessment of myocardial perfusion score [MPS] in a five-scale measurement for standard 20-segment-model were used. When all patients [n=167] were evaluated, no correlation was found between MPS and BDI-score. Considering only those with significant perfusion abnormality [MPS<90, n=38], negative correlation was found between MPS and BDI score [r= -0.641, p=0.017]. Also higher BDI scores were recorded for patients with inferior wall infarction when compared with those with normal or near-normal MPS [MPS>95] [p=0.097], but other myocardial walls failed to show such association. In patients with significant perfusion abnormality, the greater is this abnormality the more severe is the depression. Also patients with inferior wall infarction, have a higher BDI-score as compared with normal subjects