ABSTRACT
Pneumatoceles and bronchiectasis are secondary complications of respiratory infections in patients with hyper IgE syndrome (HIgES). We report on a patient with HIgES and recurrent pneumonias since 1 year of age, with progression to pneumatoceles and bronchiectasis and fatal outcome, with disseminated infection and suspected allergic bronchopulmonary aspergillosis, who was subjected to sequential spirometric assessment. We describe the early beginning of respiratory infections, difficulties in the management of pulmonary sequelae and the impact of an early functional diagnosis and follow-up of the patient regarding a disease for which lung function has not been fully described.
Subject(s)
Job Syndrome/complications , Job Syndrome/physiopathology , Lung/physiopathology , Adolescent , Fatal Outcome , Humans , Male , SpirometryABSTRACT
Invertase was covalently immobilized on polyurethane (PU), inox plate covered with plast-film layer and ferromagnetic azide-Dacron. The immobilization processes, physico-chemical parameters and a model for coupling reactions were studied. The preliminary studies for selection of the support showed that the best activity was obtained for PU treated with HCl, polyethylenimine and glutaraldehyde (156.7+/-4.9 U/g support). All plast-film-invertase derivatives did not show activity and the Dacron-invertase derivative showed an activity of 105.39 U/g support. The invertase immobilized in presence of substrate (10% w/v sucrose) was the most efficient (832.74+/-1.48 U/g support). The optimal pH was shifted from 4.5 (free enzyme) to 5.0 (immobilized derivative) and optimal temperature was not affected. Activation energy values of free enzyme, Dacron-invertase and PU-invertase were 32.4+/-0.34 kJ/mol, 33.4+/-0.36 kJ/mol and 44.0+/-0.67 kJ/mol, respectively. The PU-invertase could be used over 2 months without considerable activity loss (68.5% activity retention) and retained 12.6% (287.97+/-27.9U/g support) of the activity after five cycles.
Subject(s)
Biotechnology/methods , Enzymes, Immobilized/chemistry , Polyethylene Terephthalates/chemistry , Polyurethanes/chemistry , beta-Fructofuranosidase/chemistry , Azides/chemistry , Carbohydrates/chemistry , Glutaral/chemistry , Hydrazines/chemistry , Hydrogen-Ion Concentration , Magnetics , Materials Testing , Polyethyleneimine/chemistry , Proteins/chemistry , Sucrose/chemistryABSTRACT
Os autores relatam o caso em que uma criança de 48 horas de vida, portadora de bloqueio atrioventricular (BAV) de grau avançado, bradicardia acentuada e insuficiência cardíaca importante foi submetida com sucesso a um implante de marcapasso endocárdico. Como via de acesso foi utilizada a veia jugular interna, o cabo-eletrodo de fixaçäo passiva foi posicionado no ventrículo direito e uma alça foi efetuada no interior do átrio direito. Com o crescimento da criança, observou-se o progressivo desenrolar do cabo-eletrodo. A freqüência inicial do marcapasso com que se obteve melhor débito cardíaco foi de 120 ppm, valor definido através de ecocardiograma bidimensional. Após 28 meses a criança vem apresentando ótima evoluçäo clínica. O marcapasso atualmente demonstra bom funcionamento, tanto no comando como na sensibilidade, e o cabo-eletrodo apresenta desenrolar suave, acompanhando o crescimento da criança.
Subject(s)
Infant, Newborn , Male , Humans , Heart Block/pathology , Bradycardia/diagnosis , Thoracic Surgery/instrumentation , Infant, Newborn , Heart Block/surgeryABSTRACT
BACKGROUND AND STUDY AIMS: The endoscopic treatment of symptomatic pharyngoesophageal diverticula (PED) with rigid instruments involves the incision of the septum between the diverticulum and the esophageal lumen, within which the cricopharyngeal muscle is present. The aim of this study is to report on the feasibility and efficacy of our method using flexible endoscopy and an electro-surgery system with minimal trauma to the patients. PATIENTS AND METHODS: Forty-two patients (13 female, 29 male) with symptomatic pharyngoesophageal diverticula underwent endoscopic treatment. The average age of the patients was 68.4 years (range 46 to 102 years) and 26 of them (61%) had concomitant cardiopulmonary diseases. The procedure consisted of endoscopic incision of the septum with a needle knife, using cutting/coagulation current. It was performed under preparation for routine endoscopic examination. All patients were clinically and endoscopically evaluated at two and four weeks, and afterwards followed clinically at 12, 24, and 60 months after the procedure. RESULTS: The endoscopic incision was performed in one to live sessions (mean of 1.8 session per patient). Two complications (one cervical emphysema, and one hemorrhage) were managed clinically. Dysphagia disappeared in all patients soon after the treatment, although the post-operative radiological and endoscopic controls revealed the presence of a remaining diverticulum. Manometric findings disclosed a significant reduction in upper esophageal sphincter pressures in all five patients after endoscopic incision. Mean follow-up was 38 months. There was recurrence of dysphagia in three patients (7.1%) at 12, 22, and 60 months after the procedure. They experienced relief of dysphagia after a repeated endoscopic incision. CONCLUSIONS: Endoscopic incision of PED using flexible equipment proved to be a highly efficient and safe method of treating symptomatic disease. It should be considered as an alternative therapy for Zenker's diverticula, especially for patients at a high surgical risk.
Subject(s)
Electrocoagulation/instrumentation , Endoscopes , Esophagoscopes , Zenker Diverticulum/surgery , Adult , Aged , Aged, 80 and over , Feasibility Studies , Female , Follow-Up Studies , Humans , Male , Middle Aged , Postoperative Complications/etiology , Treatment Outcome , Zenker Diverticulum/pathologyABSTRACT
A obra que temos hoje em mãos é, indiscutivelmente, superior àquela que imaginávamos inicialmente produzir. O DEF é, pois, a resultante do trabalho equilibrado de uma equipe de profissionais do melhor nível, que tem se esforçado sempre no aperfeiçoamento de novos métodos e técnicas, visando melhor servir aos nossos usuários (AU)
