Subject(s)
Assisted Circulation/instrumentation , Assisted Circulation/standards , Extracorporeal Membrane Oxygenation/instrumentation , Extracorporeal Membrane Oxygenation/standards , Heart-Assist Devices , Assisted Circulation/methods , Brazil , Extracorporeal Membrane Oxygenation/methods , Heart Failure/therapy , Humans , Risk Factors , Societies, MedicalABSTRACT
BACKGROUND: Renal failure is the most important comorbidity in patients with heart transplantation, it is associated with increased mortality. The major cause of renal dysfunction is the toxic effects of calcineurin inhibitors (CNI). Sirolimus, a proliferation signal inhibitor, is an imunossupressant recently introduced in cardiac transplantation. Its nonnephrotoxic properties make it an attractive immunosuppressive agent for patients with renal dysfunction. In this study, we evaluated the improvement in renal function after switching the CNI to sirolimus among patients with new-onset kidney dysfunction after heart transplantation. METHODS: The study included orthotopic cardiac transplant (OHT) patients who required discontinuation of CNI due to worsening renal function (creatinine clearance < 50 mL/min). We excluded subjects who had another indication for initiation of sirolimus, that is, rejection, malignancy, or allograft vasculopathy. The patients were followed for 6 months. The creatinine clearance (CrCl) was estimated according to the Cockcroft-Gault equation using the baseline weight and the serum creatinine at the time of introduction of sirolimus and 6 months there after. Nine patients were included, 7 (78%) were males and the overall mean age was 60.1 +/- 12.3 years and time since transplantation 8.7 +/- 6.1 years. The allograft was beyond 1 year in all patients. There was a significant improvement in the serum creatinine (2.98 +/- 0.9 to 1.69 +/- 0.5 mg/dL, P = .01) and CrCl (24.9 +/- 6.5 to 45.7 +/- 17.2 mL/min, P = .005) at 6 months follow-up. CONCLUSION: The replacement of CNI by sirolimus for imunosuppressive therapy for patients with renal failure after OHT was associated with a significant improvement in renal function after 6 months.
Subject(s)
Heart Transplantation/physiology , Kidney Function Tests , Sirolimus/therapeutic use , Aged , Calcineurin Inhibitors , Creatinine/metabolism , Female , Follow-Up Studies , Heart Transplantation/adverse effects , Heart Transplantation/immunology , Humans , Immunosuppressive Agents/adverse effects , Immunosuppressive Agents/therapeutic use , Male , Middle Aged , Patient Selection , Renal Insufficiency/epidemiology , Renal Insufficiency/etiology , Renal Insufficiency/prevention & control , Reoperation/statistics & numerical data , Retrospective Studies , Sirolimus/adverse effects , Time FactorsABSTRACT
A Insuficiência Hepática Aguda é uma condição grave associada à coagulopatia e alteração mental em pacientes sem doença hepática prévia. Pode ser causada por diversos agentes, tais como, vírus, auto-imunidade e drogas. A Hepatite Aguda B pode se apresentar sob a forma de doença grave e a indicação de transplante hepático deve ser considerada
Subject(s)
Humans , Hepatic Insufficiency , Liver Failure, AcuteABSTRACT
A Insuficiência Hepática Aguda é uma condição grave associada à coagulopatia e alteração mental em pacientes sem doença hepática prévia. Pode ser causada por diversos agentes, tais como, vírus, auto-imunidade e drogas. A Hepatite Aguda B pode se apresentar sob a forma de doença grave e a indicação de transplante hepático deve ser considerada (AU)
Subject(s)
Humans , Hepatic Insufficiency , Liver Failure, AcuteABSTRACT
Five patients with breast myiasis underwent mammography, and three also underwent ultrasonography (US). Mammography revealed indistinct masses in all patients, with associated pairs of microcalcifications in three. US showed each larva as a fusiform hyperechoic mass surrounded by a hypoechoic halo, which included larval movement in one patient. These imaging features of breast myiasis facilitate correct diagnosis.
