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Triagem para o tratamento ambulatorial da neutropenia febril
Bellesso, Marcelo;Costa, Silvia Figueiredo;Chamone, Dalton Alencar Fischer;Llacer, Pedro Enrique Dorlhiac;
Revista Brasileira de Hematologia e Hemoterapia , 2010, DOI: 10.1590/S1516-84842010000500014
Abstract: febrile neutropenia is a frequent and potentially fatal adverse event of chemotherapy. nowadays, febrile neutropenia is considered an emergency and it is known that prompt infusion of antibiotics decreases mortality. several studies demonstrated that febrile neutropenia is a heterogeneous group of diseases and that factors such as outpatient status, no hypotension, no dehydration, no chronic obstructive pulmonary disease, no symptoms, no previous fungal infection and age < 60 years are protective factors against serious complications as demonstrated by the multinational association for supportive care in cancer (mascc). these data show that outpatient treatment and early discharge is safer and much research has shown lower costs for outpatient treatment in low-risk patients with febrile neutropenia. the aim of this work is to review and discuss tools (in particular the mascc index) for safe screening of febrile neutropenia for outpatient treatment in addition to demonstrate results of research.
Linfoma primário do sistema nervoso central
Bellesso, Marcelo;Bizzetto, Renata;Pereira, Juliana;Beitler, Beatriz;Pracchia, Luis Fernando;Chamone, Dalton A. S.;
Revista Brasileira de Hematologia e Hemoterapia , 2008, DOI: 10.1590/S1516-84842008000100013
Abstract: primary central nervous system lymphoma (pcnsl) is an extranodal non-hodgkin lymphoma in the brain, leptomeninges, spinal cord or eyes. the incidence of pcnsl increased approximately three-fold in the last decades. nowadays, it represents 0.4 case per 100,000 people and accounts for 4% of all primary brain tumors. although individuals infected with hiv have a 3,600-fold increased risk of developing pcnsl compared with the general population, the incidence has not increased only in aids group. recent data suggest that the incidence of pcnsl declined in the aids group after the introduction of anti-retroviral drugs. around 90% of pcnsl cases are classified as diffuse large b-cell lymphoma, 10% involve the eyes and 10% of patients are hiv positive. the clinical presentation depends on the location of the tumor with neurological rather than systemic symptoms. computed tomography (ct) and magnetic resonance imaging (rmi) are essential in diagnosis, however the gold standard is tumor biopsy. staging should be made with imaging and bilateral biopsy of bone marrow. the main poor prognosic parameters are performance status greater than 1, age older than 60 years, elevated dhl, high liquor protein concentration and tumor located within the deep regions of the brain. bcl-6 expression identified in the tumor confers a better prognosis. currently, a combined therapy with high doses of methotrexate and whole-brain radiotherapy is the therapy of choice. nowever, whole-brain radiotherapy should be carefully analyzed because neurotoxity is a frequent problem in the elderly and in relapsed and refractory patients.
Associa??o do polimorfismo do gene da enzima conversora da angiotensina com dados ecocardiográficos em jovens normotensos filhos de hipertensos
Franken, Roberto Alexandre;Bellesso, Marcelo;Cavazin, Adriana M.;Pol?nio, Igor Bastos;Mattheucci, Euclides;Varga, José;
Revista da Associa??o Médica Brasileira , 2004, DOI: 10.1590/S0104-42302004000100037
Abstract: objectives: to evaluate angiotensin converting enzyme gene (ace) polymorphism with transthoracic bidimensional ecocardiogram of normotensive young medical students, siblings of hypertensive parents comparing them with those with normotensive parents. method: we had studied 80 normotensive youngs divided in two groups: hypertensive parents' normotensive young medical students 40 x normotensive parents'and normotensive medical students. exclusion criteria were hypertension, obesity, smoke, use of oral contraceptives, as well as those who use chronically drugs or the presence of any disease. the group has been enrolled between 1994 to 1996. 50 students made transthoracic bidimensional echocardiogram. the statistical analysis was done by ''t-student'' test. the evaluation of polymorphism ace gene was studied in 80 people in each step: 1) 5ml of blood in edta tube; 2) extraction of dna; 3) evaluation of dna concentration by eletrophoresis analyses; 4) polymerase chain reaction with primer of ace gene; 5) analysis of polymorphism ace gene by electrophoresis 6) statiscal analysis by chi-square test. results: the group of students with hypertesive parents presented thicker interventricular septum (7.82mm ± 0.69 against 7.38 mm ± 0,8, p < 0,05). on the other hand, we didn't find differences between the groups concerning ace gene genotype: students with hypertensive parents dd:42.5%, di: 37.5%, ii: 20% against students with normotensive parents : dd: 37.5%, di: 32.5%, ii: 30%, (p=0,58), in addition we also did not find differences concerning the alleles group of hypertensive parents: d: 61.25%, i: 38.75% versus normotensive parents: d: 53.75% , i: 46.25%, p=0,33. we divided these groups into two in relation to the mean thickness of interventricular septum and left ventricular mass and we did not find any difference: in students with hypertensive parents group septum > 7,82 mm: dd: 32%, di: 24%, ii: 20% x septum < 7,82 mm: dd: 8%, di: 12 %, ii: 4%, p=0,7) in normotensive paren
Associa o do polimorfismo do gene da enzima conversora da angiotensina com dados ecocardiográficos em jovens normotensos filhos de hipertensos
Franken Roberto Alexandre,Bellesso Marcelo,Cavazin Adriana M.,Pol?nio Igor Bastos
Revista da Associa??o Médica Brasileira , 2004,
Abstract: OBJETIVOS: Os autores objetivaram no presente estudo avaliar o polimorfismo da enzima conversora da angiotensina com dados do ecocardiograma de jovens estudantes de Medicina, filhos de hipertensos, comparados com jovens filhos de normotensos. MéTODOS: Foram estudados 80 jovens normotensos divididos em dois grupos: 40 filhos normotensos de pais hipertensos e 40 filhos normotensos de pais hipertensos. Critérios de exclus o foram hipertens o arterial, fumo, obesidade, uso de contraceptivos orais. Uso cr nico de medicamentos e presen a de qualquer doen a. Os alunos foram incluídos entre 1994 e 1996. Cinqüenta alunos foram submetidos a ecocardiograma transtoráxico. A análise estatística foi feita através do teste T de Student. A avalia o do polimorfismo do gene da enzima conversora da angiotensina foi feita nos 80 alunos conforme segue: 1) 5 ml de sangue em tubo contendo EDTA, 2) extra o do DNA, 3) medida da concentra o do DNA por eletroforese, 4) rea o em cadeia de polimerase com ''primer'' do gene da enzima conversora da angiotensina, 5) análise do polimorfismo do gene da enzima conversora da angiotensina através da eletroforese e 6) análise estatística através do teste do Qui-quadrado. RESULTADOS: O grupo de estudantes filhos de hipertensos mostraram maior espessura do septo interventricular (7,82mm+/-0,69 contra 7,38 +/- 0,8, p<0,05). Por outro lado n o encontramos diferen as entre os grupos em rela o ao genótipo do gene da enzima conversora. Filhos de hipertensos DD 42,5%, DI 37,5%, II 20% contra filhos de normotensos: DD 37,5%, DI 32,5%, II 30%, (p=0,58). N o encontramos mesmo diferen as quando considerados os alelos. O grupo com pais hipertensos D 61,25%, I 38,75%, contra grupo com pais normotensos D 53,75%, I 46,25% (p=0,33). Dividimos o grupo em dois, considerando a média da espessura do septo interventricular e a massa do ventrículo esquerdo e também n o encontramos diferen as: estudantes com pais hipertensos com septo > 7,82mm; DD 32%, DI 24%, II 20% contra septo < 7,82mm; DD 86%, DI 12%, II 4% (p=0,7). Naqueles com pais normotensos septo > 7,38mm: DD28%, DI12%, II 12%, contra septo < 7,38mm: DD16%, DI6%, II 16% (p=0,59). Em rela o à massa ventricular em filhos de pais hipertensos: massa > 131,52g: DD 20,69% DI 13,79%, II 6,9% contra massa < 131,52g: DD 24,24%, DI 17,24%, II 17,24% (p=0,72). No grupo de alunos filhos de pais normotensos massa > 117,11g: DD 30,43%, DI 8,7%, II 8,7% contra massa < 117,11g: DD 13,04%, DI 21,74%, II 17,39% (p=0,17) CONCLUS O: Encontramos diferen as entre a espessura do septo interventricular de estudantes normot
é necessária a realiza??o de biópsia de medula óssea bilateral para o estadiamento do linfoma difuso de grandes células B?
Bellesso, Marcelo;Velasques, Rodrigo Dolphini;Pracchia, Luis Fernando;Beitler, Beatriz;Aldred, Vera Lúcia;Chamone, Dalton Alencar Fisher;Pereira, Juliana;
Jornal Brasileiro de Patologia e Medicina Laboratorial , 2009, DOI: 10.1590/S1676-24442009000200004
Abstract: this retrospective study aims to analyze the usefulness of bilateral bone marrow biopsy in bone marrow infiltration by diffuse large b-cell lymphoma (dlbcl). our objectives were to assess the incidence of unilateral bm involvement by dlbcl and compare fragment length obtained from positive and negative samples for infiltration. furthermore, we compared the differences between unilateral and bilateral infiltration correlating with lactic dehydrogenase (ldh) and computerized tomography (ct) staging. we evaluated 268 cases of dlbcl and observed medullary infiltration in 34 cases (13%). it was not possible to evaluate 6 out of 34 cases. 70 bm fragments were reviewed as to the presence or absence of infiltration and length. the mean number of fragments per case was 2.5; the mean bm fragment length was 11.01 mm (± 5.12 mm) and the mean bm fragment length per case was 27.53 mm. there was unilateral bm infiltration in six cases (21.4%). there were no differences in the mean fragment length as to the presence/absence of infiltration 10.95 mm (± 5.2 mm) versus 11.57 mm, p > 0.05, respectively. there were no differences in 23 cases between the comparison of unilateral medullary infiltration versus bilateral with lactic dehydrogenase and ct staging. we concluded that bilateral bone marrow biopsy was superior to unilateral because it may increase by 21.4% the detection of bm involvement by dlbcl.
Disease progression after R-CHOP treatment associated with the loss of CD20 antigen expression
Bellesso, Marcelo;Xavier, Flavia Dias;Costa, Renata Oliveira;Pereira, Juliana;Siqueira, Sheila Aparecida Coelho;Chamone, Dalton Alencar Fischer;
Revista Brasileira de Hematologia e Hemoterapia , 2011, DOI: 10.5581/1516-8484.20110036
Abstract: a case of a follicular lymphoma transformed into a cd20+ is described which progressed with the loss of cd20 expression after 8 cycles of r-chop. this phenomenon is not a rare event and has shown poor prognosis. our purposes are to describe this event and suggest biopsy in relapsed or progressive disease.
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