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Sample records for corticoids

  1. Corticoids: 60 Years Later a Pending Subject

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    Silvia Gómez Ordóñez

    2007-12-01

    Full Text Available The objective of this article is to make a brief compilation of the physiology of the hypothalamic-pituitary-adrenal axis in order to understandthe role of the exogenous corticoids as therapeutic tools in innumerable pathologies, but when used inappropriately, it can produce important deleterious effects. The history of the corticoids began 164 years ago in 1843 when Thomas Addison described the symptoms of the adrenal gland insufficiency. On September 21st 1948, almost one hundred years after, Dr. Hench injected cortisone for the first time in a patient with arthritis. In 1950 Hench, Kendall and Reichsteinreceived the Nobel Prize in Medicine and Physiology. In the cortex of the adrenal glands, three different hormones are synthesized from cholesterol, and these hormones produce diverseeffects on the homeostasis of the body. The synthetic glucocorticoids are classified by their anti-inflammatory power, half life, and mineralocorticoideffect; they operate in almost every cell through genomic and non genomic mechanismsof action producing different responses. This is the reason of their wide therapeutic effect in respiratory diseases like asthma and COPD,multiple sclerosis, rejection of transplants, among others.

  2. Fecal corticoid monitoring in whooping cranes (Grus americana) undergoing reintroduction

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    Hartup, Barry K.; Olsen, Glenn H.; Czekala, Nancy M.

    2005-01-01

    We used radioimmunoassay to determine fecal corticoid concentrations and assess potential stress in 10 endangered whooping cranes (Grus americana) undergoing reintroduction to the wild. Fecal samples were collected shortly after hatching at a captive facility in Maryland, during field training in Wisconsin, and throughout a human-led migration to Florida. After a 14-day decline following hatching, fecal corticoid concentrations stabilized at baseline levels for the duration of the captive period, despite exposure to potentially stressful stimuli. Shipment of the cranes to the field training site was correlated with an eight- to 34-fold increase in fecal corticoid concentrations, which returned to baseline levels within 1 week. Increases were positively correlated with age but not body weight at the time of shipping. Fecal corticoid concentrations during the training period increased slightly and exhibited greater variation than levels observed at the captive facility, but were well within expected norms based on previous studies. Fecal corticoid concentrations increased twofold following premigration physical examinations and placement of radiotransmitters, and persisted for up to 4 days before they returned to baseline levels. Though fecal corticoid concentrations and variation during the migration period were similar to training levels, there was an overall decline in fecal corticoid concentrations during the artificial migration. Acute stressors, such as capture, restraint, and severe storms, were associated with stress responses by the cranes that varied in accordance with lasting physical or psychological stimuli. The overall reintroduction process of costume-rearing, ultralight aircraft habituation, training, and artificial migration was not associated with elevations in fecal corticoid concentrations suggestive of chronic stress.

  3. Role and physiological actions of the mineralo-corticoids; Role et actions physiologiques des mineralo-corticoides

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    Morel, F. [Commissariat a l' Energie Atomique, Saclay (France). Centre d' Etudes Nucleaires

    1958-07-01

    This review recalls first of all the history of the discovery of aldosterone; it then defines the concept of mineralo-corticoid on the biological level; the physiological effects of aldosterone are compared with those of desoxycorticosterone, which have been known for a long time. The part played by the mineralo-corticoids in maintaining the hydro-mineral balance is then discussed, particularly in the light of information provided by acute deficiency or primitive hyperaldosteronism; the importance of the correlations linking the post-hypophysis and suprarenal is underlined. The possible mechanisms of the action of mineralo-corticoids on the kidney are discussed in greater detail and a general plan of action is proposed. The physiological regulation of the secretion of mineralo-corticoids is then described, and the respective roles played in this secretion by different factors are discussed (ante-hypophysis, corticoids, plasmatic concentration of electrolytes, volume of extracellular liquids, etc...). Finally, the whole problem investigated is placed within the field of homeostasis (377 bibliographical references). (author) [French] Cette revue de la question rappelle d'abord l'historique de la decouverte de l'aldosterone; elle definit ensuite le concept de mineralo-corticoide sur le plan biologique; les effets physiologiques de l'aldosterone sont compares a ceux connus depuis longtemps de la desoxycorticosterone. Le role joue par les mineralo-corticoides dans le maintien de la balance hydrominerale est ensuite discute, notamment a la lumiere des informations fournies par l'insuffisance aigue ou l'hyperaldosteronisme primitif; l'importance des correlations liant posthypophyse et surrenale est soulignee. Les mecanismes possibles de l'action des mineralo-corticoides sur le rein sont discutes avec davantage de details et un schema general d'action est propose. La regulation physiologique de la secretion des mineralo-corticoides

  4. 21 CFR 862.1195 - Corticoids test system.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Corticoids test system. 862.1195 Section 862.1195 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CLINICAL CHEMISTRY AND CLINICAL TOXICOLOGY DEVICES Clinical Chemistry Test Systems §...

  5. Idiopathic sudden hearing loss: Oxidative status before and after corticoid treatment

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    Cavaleriu Bogdan D.

    2015-01-01

    Full Text Available The aim of this study was to investigate antioxidant enzyme activities and lipid peroxidation levels after systemic corticoid therapy (Solu-Medrol, 250mg/day, for 7 days. The effects of corticoid treatment on superoxide dismutase (SOD and glutathione peroxidase (GPX activity were investigated. Fifteen patients diagnosed with sudden sensorineural hearing loss were enrolled. Serum markers of oxidative stress were measured using spectrophotometric methods. In ten cases, the SOD and GPX activities and malondialdehyde (MDA serum levels before and after corticoid treatment were investigated. Corticoid treatment enhanced antioxidant activity by increasing SOD and GPX activities and decreasing MDA serum levels.

  6. Los corticoides epidurales en el tratamiento de la hernia discal

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    Arenas Planelles, Antonio; Pampliega Martínez, T.; Moros García, J.S.; Cisneros Lanuza, María Teresa; Zabalza Hermoso de Mendoza, N.

    1997-01-01

    Se presenta una serie de 233 pacientes diagnosticados de hernia discal lumbar y tratados mediante infiltraciones epidurales de corticoides, asociadas a un programa de rehabilitación realizado a continuación de las inyecciones. Los resultados con dicho tratamiento fueron satisfactorios en un 75% de los casos. Se observó una mejor evolución en pacientes varones, en pacientes cuya profesión conlleva esfuerzo físico, en hernias discales L5-S1, y en aquellos que han seguido un progr...

  7. Uso de Corticoides en Laringitis Obstructiva en nuestro medio.

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    María Corfio P.1.2 3 4 5; Isolda Budnik O.; Sabina Ojeda W.; Constanza Damm A.; Manuel Fernández V.

    2008-01-01

    La laringitis obstructiva (croup) es la inflamación aguda de la laringe y la gravedad está dada por el grado de obstrucción de la vía aérea. Existe consenso mundial, que establece dar dexametasonavía oral en dosis única de 0,15 a 0,6 mg/kg para el tratamientodel croup moderado y severo. El objetivo de nuestro estudiofue describir cuál es el manejo del croup en nuestro medio y saber cuándo y cuáles corticoides se utilizan. Se encuestó a un total de 72 pediatras, de los cuales, ante un croup le...

  8. Fecal corticoid monitoring in whooping cranes trained to follow ultralight aircraft

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    Hartup, B.K.; Czekala, Nancy M.; Olsen, G.H.; Langenberg, J.A.; Chavez-Ramirez, Felipe

    2005-01-01

    The use of fecal corticoid assays to measure stress in North American cranes has been limited to laboratory validation and a single field project involving reintroduced sandhill cranes (Ludders et aI., 1998, 2001; Hartup et aI., 2004). In 2001, we documented trends in corticoid concentrations among a cohort of ten costume-reared whooping cranes subjected to ultralight aircraft training and migration. All samples were analyzed by a validated corticosterone 1251 radioimmunoassay for determination of corticoid levels. Fecal corticoid concentrations in chicks exhibited a logarithmic decline over the first 14 days after hatching (r = 0.86, p cranes increased 8-34 fold during shipment in crates to Wisconsin for field training. Increases in fecal corticoid concentrations were positively correlated with age (r = 0.81, p = 0.01), but not body weight (r = 0.44, P = 0.28) at the time of shipping. Fecal corticoid concentrations returned to baseline levels within seven days, and were sustained throughout the remainder of the training period (median 77 ng/g, range 22- 292 ng/g, n=190). Elevations in fecal corticoid concentrations were observed one (p = 0.035) and four days (p = 0.003) following physical examination and placement of leg bands compared to three days prior to the procedures (median 176 ng/g, range 116 - 553 ng/g, n = 19). Fecal corticoid concentrations decreased to pre-procedure levels within seven days. Fecal corticoid concentrations and variation during the 50 day migration period were similar to training levels in Wisconsin, except for a one day increase observed following a violent storm and escape from the temporary holding pen the preceding night (median 243 ng/g, range 228 - 280 ng/g, n = 7). There was an overall decline in fecal corticoid concentrations from the cranes during the migration (r= 0.42, p cranes that varied in accordance with lasting physical or psychological stimuli. The overall process of costume-rearing, ultralight aircraft habituation

  9. Corticoides intralesionales en lesiones a células gigantes

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    J.P. Crestanello Nese

    2003-12-01

    Full Text Available Desde su descripción original, las lesiones de células gigantes (LCG han sido entidades controvertidas, desde el punto de vista de su origen, de su comportamiento clínico, de sus características radiográficas e histológicas, así como de su tratamiento. Para su tratamiento se han considerado alternativas quirúrgicas y no quirúrgicas. En este trabajo, se presentan tres nuevos casos de LCG, en los cuales se realizó infiltración intralesional con corticoides como una maniobra previa y complementaria a la quirúrgica. Luego de la infiltración, se observó una disminución del tamaño de las lesiones y un cambio en sus características macroscópicas, se trato por enucleación un caso y por remodelación quirúrgica los dos restantes.Giant cell lesions (GCL have been controversial entities since its original description. Its origin, clinical behavior, radiographic and histological features and also its treatment are polemical. The therapeutic possibilities are surgical or non surgical. In this paper, the intralesional infiltration with steroids is presented like a previous and complementary therapy to surgery alone. Three new cases of GCL are presented. All of them were first treated with intralesional infiltration with steroids. After that,a partial remission and a change of the macroscopic characteristics were observed and one of the lesion was then enucleated while for the others two surgical remodelation were necessary to do.

  10. Prematuridad extrema y uso materno de corticoides antenatal

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    Ramón Acosta Díaz

    2000-12-01

    Full Text Available Con el objetivo de evaluar el uso de corticoides antenatal en las madres con amenaza de parto pretérmino y el efecto sobre los recién nacidos prematuros extremos, se realizó un estudio prospectivo, longitudinal, y analítico entre todos los niños nacidos vivos con edad gestacional menor de 31 semanas y peso inferior a 1 500 g, ocurridos en el Hospital Ginecoobstétrico Provincial Docente "Justo Legón Padilla" de Pinar del Río, desde enero de 1997 hasta julio de 1998. Se estudiaron los 53 niños con estas características. Los datos que se obtuvieron se depositaron en base de datos; para el procesamiento estadístico, se aplicó la prueba de chi cuadrado, con un nivel de significación de p In order to evaluate the antenatal use of adrenal cortex hormones in mothers with preterm delivery threat and its effect on extreme premature infants, it was conducted a prospective, longitudinal and analytical study among the live births with gestational age under 31 weeks and a weight lower than 1 500 g registered at "Justo Legón Padilla" Provincial Gynecoobstetric Teaching Hospital, in Pinar del Río, from January, 1997, to July, 1998. 53 children with these characteristics were studied. The collected data were entered in databases. The chi square test with a level of significance of p<0.05 was used for the statistical processing. Steroids were administered to 32 mothers. A statistically significant reduction of the hyaline membrane disease, the use of ventilation, the complications and mortality was observed with the antenatal use of maternal adrenal cortex hormones. There were no statistically significant differences between the study and the control group as regards sex, mean gestational age (29.0/28.9 weeks and weights (1207.9/1180.0 g.

  11. Corticoides : 60 años después, una asignatura pendiente

    OpenAIRE

    2008-01-01

    El objetivo de este artículo es hacer una breve recopilación de la fisiología del eje hipotálamo-hipofisiario-suprarrenal, para comprender el papel de los corticoides exógenos como herramientas terapéuticas en innumerables patologías, que, utilizados de manera inapropiada, pueden causar efectos deletéreos importantes. La historia de los corticoides empezó hace 164 años, en 1843, cuando Thomas Addison describió los síntomas de la insuficiencia suprarrenal. Casi 100 años después,...

  12. Corticoides: 60 años después, una asignatura pendiente

    OpenAIRE

    2010-01-01

    El objetivo de este artículo es hacer una breve recopilación de la fisiología del eje hipotálamo-hipofisiario-suprarrenal, para comprender el papelde los corticoides exógenos como herramientas terapéuticas en innumerables patologías,que, utilizados de manera inapropiada, pueden causar efectos deletéreos importantes. La historia de los corticoides empezó hace 164 años, en 1843, cuando Thomas Addison describió los síntomas de la insuficiencia suprarrenal. Casi 100 años después, el 21 de septiem...

  13. Corticoides intratimpánicos: una revisión sistemática

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    González, Rubén; Caro, Jorge

    2007-01-01

    Muchas patologías otológicas como la hipoacusia súbita y la enfermedad de Maniere han sido tratadas con corticoides sistémlcos, los que tienen diversos efectos secundarios potencia/mente graves. Los corticoides intratimpánicos son una alternativa en el tratamiento para estas enfermedades del oído interno, con lo que se podría aumentar su efecto al mejorar el perfil farmacocinético de la droga disminuyendo los efectos adversos sistémicos. Para evaluar la evidencia disponible con respecto a la ...

  14. Corticoides intratimpánicos: una revisión sistemática

    OpenAIRE

    González, Rubén; Caro, Jorge

    2007-01-01

    Muchas patologías otológicas como la hipoacusia súbita y la enfermedad de Maniere han sido tratadas con corticoides sistémlcos, los que tienen diversos efectos secundarios potencia/mente graves. Los corticoides intratimpánicos son una alternativa en el tratamiento para estas enfermedades del oído interno, con lo que se podría aumentar su efecto al mejorar el perfil farmacocinético de la droga disminuyendo los efectos adversos sistémicos. Para evaluar la evidencia disponible con respecto a la ...

  15. Detection and characterization of differences in plasma corticoid response to treatments.

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    Adkinson, R W; Thatcher, W W; Wilcox, C J; Gwazdauskas, F C; Head, H H

    1976-04-01

    Ten experiments involving 3013 observations and 103 animals were studied to characterize variation associated with bovine plasma corticoid concentrations (ng/ml). Total corticoids, corticosterone, or cortisol were measured by competitve protein binding assay. Animals were noncystic or cystic, and measurements were made to establish basal concentrations or to estimate response to stimulation by adrenocorticotrophic hormone injection. Data were analyzed by least squares with the nested model: treatment regimen, animal in treatment, sample in animal in treatment, and sampling time to the highest order of regression (up to seventh) which was statistically significant (P less than .05). Estimates of error variances ranged from .31 for basal cortisol in cystic animals to 233.27 for total corticoids in noncystic, stimulated animals. Coefficients of variation among experiments ranged from 33 to 87% with mean 61%. In most analyses, estimates of experimental error were large indicating need for careful attention to experimental design to insure efficient least-cost experimentation. Use of the power function for nested analysis of variance to accomplish this is demonstrated.

  16. Influence of corticoids on healing of the rotator cuff of rats – biomechanical study

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    Leonardo Dau

    2014-08-01

    Full Text Available Objective:To compare healing strength of the infraspinatus tendon of rats with corticoid inoculation, regarding maximum tension, maximum force and rupture force, after injury and experimental repair.Methods:A total of 60 Wistar rats were subjected to tenotomy of the infraspinatus tendon, which was then sutured. Before the surgery, they were divided into a control group (C inoculated with serum and a study group (S inoculated with corticoids over the tendon. After repair, the rats were sacrificed in groups of 10 individuals in the control group and 10 in the study group at the times of one week (C1 and S1, three weeks (C3 and S3 and five weeks (C5 and S5. The rats were dissected, separating out the infraspinatus tendon with the humerus. The study specimens were subjected to a traction test, with evaluation of the maximum tension (kgf/cm2, maximum force (kgf and rupture force (kgf, comparing the study group with the respective control groups.Results:Among the rats sacrificed one week after the procedure, we observed greater maximum tension in group C1 than in group S1. The variables of maximum force (kgf and rupture force did not differ statistically between the groups investigated. In the same way, among the rats sacrificed three weeks after the procedure, group C3 only showed greater maximum tension than group S3 (p = 0.007, and the other variables did not present differences. Among the rats sacrificed five weeks after the procedure (C5 and S5, none of the parameters studied presented statistical differences.Conclusion:We concluded that corticoid diminished the resistance to maximum tension in the groups sacrificed one and three weeks after the procedure, in comparison with the respective control groups. The other parameters did not show differences between the study and control groups.

  17. Possible effect of corticoids on hemiplegic attacks in severe hemiplegic migraine.

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    Sánchez-Albisua, Iciar; Schöning, Martin; Jurkat-Rott, Karin; Lerche, Holger

    2013-10-01

    Sporadic and familial hemiplegic migraines are rare paroxysmal disorders characterized by transient hemiparesis and headache. The distinction is based on whether other family members are affected. In 50% of cases, these migraines are caused by CACNA1 A missense mutations. We describe a boy with a particularly severe phenotype and a de novo R1349Q mutation of the CACNA1 A gene. The patient suffered from early-onset profound mental retardation, epileptic seizures, cerebellar ataxia, and progressive cerebellar atrophy. He experienced prolonged attacks of migraine with hemiparesis, seizures, altered consciousness, and fever resulting from minor head traumas. A prolonged hemiplegic attack improved following a 5-day treatment of 100 mg/d methylprednisolone. R1349Q mutation of the CACN1 A gene may be associated with a severe phenotype. Corticoids might be beneficial in prolonged hemiplegic attacks. Copyright © 2013 Elsevier Inc. All rights reserved.

  18. ¿Afecta el tratamiento con corticoides en los periodos prenatal y posnatal el neurodesarrollo del recién nacido prematuro?

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    Marita Lardón

    2017-04-01

    Conclusión. Los resultados de este estudio no pudieron demostrar que el tratamiento perinatal con corticoides se asociara con peores resultados en el neurodesarrollo en recién nacidos de muy bajo peso.

  19. Corticoide oral e inalatório para tratamento de sibilância no primeiro ano de vida

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    Cristina Gonçalves Alvim

    2011-08-01

    Full Text Available OBJETIVO: Avaliar a frequência e os fatores associados ao uso de corticoides para o tratamento de sibilância em lactentes no 1º ano de vida. MÉTODOS: Estudo transversal, realizado com o questionário validado do Estudio Internacional de Sibilancias en Lactantes, com 1.261 lactentes entre 12 e 15 meses em Belo Horizonte (MG. Foi realizado o cálculo das proporções e intervalo de confiança de 95% e teste de qui-quadrado para estudo da associação entre as variáveis. RESULTADOS: Seiscentos e cinquenta e seis (52% manifestaram sibilância no 1º ano de vida, sendo 53% do sexo masculino e 48,2% brancos. A média de idade do primeiro episódio foi 5,11±2,89 meses. Verificou-se elevada morbidade, com frequentes idas à emergência (71% e hospitalizações (27,8%. Foram frequentes a história familiar de asma e atopia (32,2 a 71%, exposição a tabagismo passivo (41,5% e mofo (47,3%. As prevalências da utilização de corticoides, tanto por via oral (48,7% quanto inalatória (51,3%, foram elevadas e maiores no grupo com três ou mais episódios. Crianças com maior morbidade tiveram maior chance de receber uma prescrição de corticoide (p < 0,05. CONCLUSÃO: A elevada frequência de utilização de corticoides aponta para a necessidade de estabelecerem-se critérios específicos para o tratamento da sibilância nos primeiro anos de vida, para evitar a extrapolação do tratamento da asma para outras condições transitórias e autolimitadas, em que o uso do corticoide pode representar mais um risco do que um benefício.

  20. Fatigue favors in vitro Th1 and Th17-like cell expansion and reduces corticoid sensitivity in MS patients.

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    Alvarenga-Filho, Hélcio; Salles, Marisa; Hygino, Joana; Ferreira, Thais B; Sacramento, Priscila M; Monteiro, Clarice; Vasconcelos, Claudia Cristina F; Alvarenga, Regina Maria Papais; Bento, Cleonice A M

    2017-02-15

    Fatigue is a common "ghost" symptom in patients with multiple sclerosis (MS), an autoimmune disease mediated by T cells that target myelin antigens of the central nervous system. As fatigue has been associated with inflammatory states, its occurrence may negatively impact MS progression. The aim of this study was to evaluate the impact of fatigue on the cytokine profile of patients with relapsing-remitting (RR) MS. For our study, blood were collected from MS patients in clinical remission phase with (n=15) and without (n=15) fatigue. Cytokines were detected by ELISA in the plasma and supernatant collected from anti-CD3/anti-CD28-activated T cells or LPS-stimulated monocytes. In some wells, different doses of hydrocortisone (HC) were added at the beginning of the culture. Here, peripheral levels of IL-6 and TNF-α, as well as in vitro production of cytokines related to Th17 (IL-6, IL-17, IL-22, and GM-CSF) or Th1 (IFN-γ) phenotypes, were elevated in fatigued patients and their levels were associated with fatigue severity. The same phenomenon was observed between the production of IL-6, TNF-α, IL-1β, and IL-23 by monocytes and fatigue. Moreover, HC was less efficient in inhibiting in vitro inflammatory cytokine production in patients with fatigue, mainly those produced by both CD8(+) T cells and monocytes. Our data, although preliminary, suggests that the occurrence of fatigue, by favoring the in vitro production of Th1/Th17-related cytokines and corticoid resistance, may negatively impact the course of MS.

  1. Endogenous interleukin-6 amplifies interleukin-17 production and corticoid-resistance in peripheral T cells from patients with multiple sclerosis.

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    Ferreira, Thais B; Hygino, Joana; Barros, Priscila O; Teixeira, Bruna; Kasahara, Taissa M; Linhares, Ulisses C; Lopes, Lana Márcia F; Vasconcelos, Claudia Cristina F; Alvarenga, Regina; Wing, Ana Cristina; Andrade, Regis M; Andrade, Arnaldo F B; Bento, Cleonice A M

    2014-12-01

    Interleukin-6 (IL-6) has been implicated in the induction of pathogenic IL-17-producing T cells in autoimmune diseases, and studies evaluating the role of this cytokine in T-cell function in patients with multiple sclerosis (MS) are lacking. Our objective was to evaluate the role of IL-6 receptor (IL-6R) signalling on in vitro functional status of T cells from patients with relapsing-remitting MS during clinical remission. Our results demonstrated that, even during the remission phase, activated T cells from patients produce higher levels of IL-17, and this cytokine was positively correlated with disease severity, as determined by Expanded Disability Status Scale score. In the MS group, the blockade of IL-6R signalling by anti-IL-6R monoclonal antibody reduced IL-17 production and elevated IL-10 release by activated CD4(+) T cells, but it did not alter the production of these cytokines by activated CD8(+) T cells. Blockade of IL-6R signalling also reduced the ability of monocytes to up-regulate T helper type 17 phenotype in patients with MS. Finally, both cell proliferation and IL-17 release by CD4(+) and, mainly, CD8(+) T cells from patients with MS were less sensitive to hydrocortisone inhibition than control group. Interestingly, IL-6R signalling blockade restored the ability of hydrocortisone to inhibit both T-cell proliferation and IL-17 production. Collectively, these results suggest that IL-6 might be involved in MS pathogenesis by enhancing IL-17 production and reducing corticoid inhibitory effects on activated T cells.

  2. Tratamiento de la hepatitis alcohólica grave corticoides frente a nutrición enteral : efectos a corto y largo plazo /

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    Rodríguez Iglesias, Pilar

    2002-01-01

    Antecedentes: El espectro clínico de la hepatitis alcohólica es muy variable, desde formas leves, que se recuperan fácilmente con la abstinencia enólica, hasta formas graves, en las que la tasa de mortalidad puede llegar hasta el 40%. En las últimas tres décadas se han ensayado numerosas estrategias terapéuticas, y los corticosteroides se han investigado ampliamente. A pesar de que algunos estudios no observan un efecto beneficioso, los corticoides continúan siendo el único tratamiento recome...

  3. Corticoides versus Placebo o tratamiento conservador en Cefalea post punción dural. Revisión sistemática y metaanálisis

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    Roncancio Arias, Gildardo; Robayo Conde, Omar Andrés

    2016-01-01

    Introducción Se realizó una revisión sistemática de la literatura y metaanálisis para determinar la utilidad, en términos de reducción de la intensidad y la prevención de la cefalea post-punción dural, de los corticoides endovenosos. Materiales y métodos Revisión sistemática y metaanálisis, dos revisores seleccionaron y analizaron los artículos definidos en los términos de entrada, extrajeron características generales de los estudios incluidos, describieron los principale...

  4. Comparação do corticoide inalatório e oral no tratamento da disfonia aguda Use of inhaled versus oral steroids for acute dysphonia

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    Andréa Moreira Veiga de Souza

    2013-04-01

    Full Text Available A disfonia aguda é um quadro comum na prática clínica. Seu tratamento, principalmente em adultos, não é bem definido na literatura. O corticoide é o tratamento medicamentoso mais recomendado. Os estudos existentes, entretanto, não são suficientes para a determinação da superioridade entre diferentes corticoides e a melhor forma de administração. OBJETIVO: Este estudo clínico prospectivo teve como objetivo comparar o efeito do corticoide inalatório na forma de pó seco com o efeito do corticoide oral, no tratamento da disfonia aguda. MÉTODO: Foram avaliados 32 pacientes adultos, divididos em dois grupos de 16 pacientes para cada um dos tratamentos, antes e após sete dias do uso da medicação. Os pacientes foram submetidos à videolaringosocpia e avaliação perceptiva e acústica da voz. RESULTADOS: O tratamento inalatório e oral reduziram significativamente a hiperemia, o edema e melhorou o movimento muco-ondulatório; entretanto, a redução do edema foi estatisticamente mais significativa (p = 0,012 nos pacientes tratados com a forma inalatória. A comparação dos valores da análise perceptiva auditiva e das medidas acústicas após tratamento entre os grupos, entretanto, não apresentou significância estatística. CONCLUSÃO: Houve melhora significativa da laringite aguda nas avaliações realizadas, em todos os pacientes estudados, com os dois tratamentos. O tratamento com corticoide inalatório foi significativamente mais efetivo na redução do edema.Acute dysphonia is a frequent condition in clinical practice. Its treatment, especially in adults, is not well established in the literature. Steroids are the most recommended drug treatment. However, the existing studies are not enough to establish superiority among the different steroids and the best route of administration. OBJECTIVE: This prospective clinical study aimed at comparing the effect of inhaling steroids as a dry powder with the effect of oral steroids to

  5. Corticoides transforaminales en la radiculopatía lumbosacra: valoración del dolor y la discapacidad

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    P. Papa de la Rosa

    2014-08-01

    Full Text Available Objetivo: el objetivo del trabajo fue determinar la efectividad clínica de una inyección epidural transforaminal de corticoides en una población de pacientes con lumbociatalgia por compresión radicular y escasa respuesta al tratamiento previo. Teniendo en cuenta que el dolor es un síntoma multidimensional cuya expresión final dependerá de factores afectivos, cognitivos, emocionales, y socio-culturales, la evaluación de la eficacia del tratamiento se realizó por medio de la forma abreviada del Cuestionario de Mc Gill y en lo funcional utilizando el Índice de Discapacidad de Oswestry efectuados pre y postratamiento. Método: se realizó un estudio prospectivo, no randomizado, comparativo pre y post-prueba con seguimiento longitudinal a los 15 y 30 días de 20 pacientes, que consultaron en un periodo de 6 meses. Se incluyeron pacientes con lumbociatalgia y radiculopatía lumbar secundaria a hernia discal o estenosis neuroforaminal. Se evaluó el dolor con la forma abreviada del Cuestionario de Mc Gill. La elección del Cuestionario de Mc Gill se basó en que permite la cuantificación de los distintos componentes de la experiencia dolorosa: sensorial-discriminativo, afectivo y cognitivo-evaluativo. La discapacidad, evaluada por la Escala de Discapacidad de Oswestry, se basa en que nuestra meta en estos pacientes no es sólo controlar el dolor sino también mantener la función, continuando con una vida de relación activa para lograr finalmente la reinserción laboral. Para la búsqueda de diferencias entre tiempos para las variables estudiadas se utilizó test de Wilcoxon para medidas apareadas, fijándose un nivel de significación de α = 0,05. Resultados: la mejoría clínica se acompañó de disminución de los puntajes sensorial-discriminativo, cognitivo-evaluativo y afectivo del Cuestionario de Mc Gill (forma corta que resultó significativa para las primeras dos dimensiones del dolor a los 30 días. La discapacidad evolucion

  6. Interleukin-17- and interleukin-22-secreting myelin-specific CD4(+) T cells resistant to corticoids are related with active brain lesions in multiple sclerosis patients.

    Science.gov (United States)

    Wing, Ana Cristina; Hygino, Joana; Ferreira, Thais B; Kasahara, Taissa M; Barros, Priscila O; Sacramento, Priscila M; Andrade, Regis M; Camargo, Solange; Rueda, Fernanda; Alves-Leon, Soniza V; Vasconcelos, Claudia Cristina; Alvarenga, Regina; Bento, Cleonice A M

    2016-02-01

    Multiple sclerosis (MS) is thought to be an autoimmune disorder. It is believed that immunological events in the early stages have great impact on the disease course. Therefore, we aimed to evaluate the cytokine profile of myelin basic protein (MBP)-specific T cells from MS patients in the early phase of the disease and correlate it to clinical parameters, as well as to the effect of in vitro corticoid treatment. Peripheral T cells from MS patients were stimulated with MBP with our without hydrocortisone for 5 days. The cytokines level were determined by ELISA. The number of active brain lesions was determined by MRI scans, and the neurological disabilities were assessed by Expanded Disability Status Scale scores. Our results demonstrated that MS-derived T cells responded to MBP by producing high levels of T helper type 1 (Th1) and Th17 cytokines. Although the production of interleukin-6 (IL-6), granulocyte-macrophage colony-stimulating factor, IL-17 and IL-22 was less sensitive to hydrocortisone inhibition, only IL-17 and IL-22 levels correlated with active brain lesions. The ability of hydrocortisone to inhibit IL-17 and IL-22 production by MBP-specific CD4(+) T cells was inversely related to the number of active brain lesions. Finally, the production of both cytokines was significantly higher in cell cultures from Afrodescendant patients and it was less sensitive to hydrocortisone inhibition. In summary, our data suggest that IL-17- and IL-22-secreting CD4(+) T cells resistant to corticoids are associated with radiological activity of the MS in early stages of the disease, mainly among Afrodescendant patients who, normally, have worse prognosis.

  7. Tratamiento con altas dosis de corticoides de Púrpura Trombocitopénica Inmune en paciente con Diabetes Mellitus y Obesidad Mórbida, un desafio metabólico

    OpenAIRE

    Juan Pedro Andreu Cuello; Juan Pablo Gatica Araneda; Patricio Alfaro-Toloza; Romina Olmos-de-Aguilera

    2012-01-01

    El manejo de la púrpura trombocitopénica inmune con altas dosis de corticoides en pacientes con diabetes mellitus y obesidad mórbida no está definido. Mujer de 64 años con obesidad mórbida, diabetes mellitus 2 y púrpura trombocitopénico inmune presenta trombocitopenia severa de 2 000 plaquetas asociada a equimosis extensas en ambas extremidades inferiores y glicemia descompensada. Se inició tratamiento con Metilprednisolona 500mg por tres días y luego Prednisona 60mg/día, al quinto día se aum...

  8. Tratamiento con altas dosis de corticoides de Púrpura Trombocitopénica Inmune en paciente con Diabetes Mellitus y Obesidad Mórbida, un desafio metabólico

    Directory of Open Access Journals (Sweden)

    Juan Pedro Andreu Cuello

    2012-06-01

    Full Text Available El manejo de la púrpura trombocitopénica inmune con altas dosis de corticoides en pacientes con diabetes mellitus y obesidad mórbida no está definido. Mujer de 64 años con obesidad mórbida, diabetes mellitus 2 y púrpura trombocitopénico inmune presenta trombocitopenia severa de 2 000 plaquetas asociada a equimosis extensas en ambas extremidades inferiores y glicemia descompensada. Se inició tratamiento con Metilprednisolona 500mg por tres días y luego Prednisona 60mg/día, al quinto día se aumentó dosis a 110mg/día. Se usó Metformina (850mg, tres veces al día, insulina NPH e insulina cristalina, logrando pasar de una glicemia capilar promedio de 322mg/dl (primer día a 122mg/dl (decimotercer día. Al decimocuarto día, con 86 000 plaquetas, fue dada de alta con tratamiento vía oral y control en policlínico. Se logró compensación metabólica con altas dosis de insulina NPH y Metformina. Es posible usar altas dosis de corticoides en pacientes con diabetes mellitus 2 y obesidad mórbida

  9. Revisión del tratamiento con corticoides en el dolor de espalda según la medicina basada en la evidencia Evidence-based review of steroid therapy for back pain

    Directory of Open Access Journals (Sweden)

    F. Neira

    2009-09-01

    Full Text Available Objetivo: Evaluar la efectividad de la infiltración con corticoides asociados o no a los anestésicos locales por vía epidural cervical, torácica, lumbar, caudal, en las facetas y ramas espinales cervicales, torácicas, lumbares y sacras, así como en la articulación sacroilíaca, en el tratamiento del dolor de espalda, y extremidades superiores e inferiores. Material y métodos: Los términos que se utilizaron para la búsqueda de la información fueron: "epidural steroid injections o blocks", "caudal injections o blocks", "selective nerve root injections o blocks", "transforaminal injections o blocks", "facet injections o blocks", "medial nerve blocks" y "low back pain". Se realizó una búsqueda en: Trip Database, SUMSearch, National Guidelines Clearinghouse, Cochrane y centros elaboradores de guías de práctica clínica. Se aceptaron guías de práctica clínica con niveles de evidencia, revisiones sistemáticas, estudios metaanálisis y referencias cruzadas entre las publicaciones revisadas en español e inglés desde 1979 hasta 2009. Resultados: En la revisión se seleccionaron 5 guías de práctica clínica y 9 revisiones sistemáticas. De su análisis se desprende la recomendación de no realizar la infiltración intradiscal en el tratamiento de la lumbalgia crónica. La evidencia de la infiltración de la rama medial lumbar, cervical y torácica en el tratamiento de la lumbalgia, cervicalgia y dorsalgia es moderada a corto y a largo plazo. La evidencia de la infiltración intraarticular sacroilíaca es limitada. La infiltración epidural interlaminar cervical tiene un efecto significativo en el alivio del dolor crónico intratable de origen cervical y proporciona un alivio prolongado. La infiltración epidural lumbar interlaminar con corticoides, sin fluoroscopia, tienen un nivel de evidencia (NE II-2 y un NE II en el alivio a largo plazo. La infiltración epidural transforaminal con corticoides es eficaz en el s

  10. Baja frecuencia de prescripción de profilaxis para osteoporosis en pacientes en tratamiento crónico con corticoides en Colombia Low frequency of prophylaxis prescription for osteoporosis in patients receiving chronic treatment with corticosteroids in Colombia

    Directory of Open Access Journals (Sweden)

    Jorge Machado-Alba

    2013-03-01

    Full Text Available Objetivos. Identificar la frecuencia de uso de medicamentos para prevención de osteoporosis inducida por corticoides (OIC en pacientes que reciben corticoides por un periodo mayor a tres meses y que son afiliados al Sistema General de Seguridad Social en Salud de Colombia. Materiales y métodos. Estudio de tipo transversal. Se utilizó información sobre, las personas afiliadas al Sistema General de Seguridad Social en Salud de Colombia (3,7 millones. Se incluyeron en el trabajo los usuarios de todas las edades y sexos a los cuales se les indicó algún glucocorticoide entre el 1 de agosto y 30 de noviembre de 2011.Se identificaron variables sociodemográficas y las características de prescripción de glucocorticoides y medicamentos para profilaxis de OIC con dosis expresadas en dosis diarias definidas (DDD. Resultados. Se obtuvo una base de datos de 255 568 prescripciones de glucocorticoides, de los cuales 1837 pacientes recibían algún glucocorticoide de manera crónica. Predominaron pacientes de sexo femenino (60,2%, edad promedio de 55,2± 16,9 años distribuidos en 65 ciudades del país. El glucocorticoide más utilizado fue prednisolona en 1546 (84,1%, mientras que el medicamento para profilaxis más prescrito fue calcitriol (67,1%. Se encontraron 994 casos (54,2% que no estaban recibiendo profilaxis para osteoporosis a pesar de requerirlo. Conclusiones. Existe un bajo empleo de profilaxis para OIC. Se recomienda implementar acciones de farmacovigilancia que permitan identificar problemas relacionados con medicamentos para prevenir eventos adversos y optimizar recursos, anticipándose a la aparición de complicaciones para el pacienteObjective. To identify the frequency of drug use for the prevention of corticosteroid induced osteoporosis (CIO among patients using corticosteroids for more than three months affiliated to the General Social Health Security System of Colombia. Materials and methods. Cross-sectional study. Information about

  11. Leishmaniosis laríngea recidivante: un caso inusual en un paciente inmunocompetente tratado con corticoides Recidivant laryngeal leishmaniosis: an unusual case in an immunocompetent patient treated with corticosteroids

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    R. Casero

    2010-06-01

    Full Text Available La leishmaniosis es una parasitosis de evolución crónica; en Argentina, sus agentes etiológicos principales pertenecen al complejo Leishmania (Viannia braziliensis, habitualmente asociado a lesiones cutáneas y mucocutáneas. Informamos en este trabajo un caso de leishmaniosis laríngea en un hombre de 29 años procedente de Jujuy, quien a raíz de múltiples subdiagnósticos portaba esta parasitosis desde hacía 20 años. En el año 2008 este paciente consulta por disfonía crónica y trastornos en las vías aéreas superiores, refiere que fue sometido a terapias con tuberculostáticos, antifúngicos y corticoides desde 2002. Diferentes biopsias y fibroscopías revelaron los siguientes diagnósticos: laringitis granulomatosa inespecífica, laringitis compatible con tuberculosis, laringitis compatible con histoplasmosis, linfoma Natural Killer extraganglionar a células pequeñas. Finalmente, estudios realizados en nuestro hospital demostraron la presencia de una laringe granulomatosa en toda su extensión, amastigotes intra y extracelulares de Leishmania spp., ausencia de formas compatibles con Micobacterias e Histoplasma, y laringitis crónica vinculable a Leishmania spp. El paciente realizó tratamiento con antimoniato de N-metil-glucamina y demostró una muy buena evolución clínica tras ser examinado 2 meses después. Si bien la leishmaniosis laríngea como lesión única no es la presentación prevalente de esta zoonosis, su estudio amerita especial atención en pacientes tratados con corticoides, pues esto evitará un diagnóstico tardío y las mayores consecuencias asociadas a la morbimortalidad propia de esta parasitosis.Leishmaniosis is a chronic parasitic disease, which in Argentina is mainly caused by protozoa belonging to the Leishmania (Viannia braziliensis complex, leading to cutaneous and mucosal pathologies. We report a rare case of laryngeal leishmaniosis in a 29 year-old man from Jujuy province, Argentina, who had been

  12. Uso de corticóide como inibidor da resposta inflamatória sistêmica induzida pela circulação extracorpórea Corticoid as an inhibitor of systemic inflammatory response, induced by cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Luiz Antonio BRASIL

    1999-07-01

    diferença estatisticamente significativa entre os dois grupos. CONCLUSÕES: A metilprednisolona inibiu significantemente a liberação de citocinas pró-inflamatórias principalmente o TNFa. Os efeitos sistêmicos adversos decorrentes da reação inflamatória pós-CEC foram atenuados com o uso do corticóide.Cardiopulmonary bypass (CPB induces the development of a systemic inflammatory response syndrome, with the release of cytokines that are responsible for many clinical manifestations. PURPOSE: The purpose of the study was to observe the release of the cytokines - tumor necrosis factor alpha (TNFa and Interleukine-6 (IL-6, and to verify the clinical alterations produced in patients undergoing myocardial revascularization with CPB, with or without corticoids. MATERIAL AND METHODS: Thirty patients were studied - 15 used corticoid (methylprednisolone, 30 mg/kg -Group I and 15 did not (Group II. Serial blood samples were collected and the TNFa and IL-6 release were analyzed, as well as the leukocyte count, erythrocyte sedimentation rate and glycemia. The blood pressure, cardiac rate, temperature, postoperative bleeding, orotracheal tubing time and inotropic drug requirement were also compared. Statistical significance was assumed when p £ 0.05. RESULTS: In Group I TNFa was not detected and IL-6 was detected in 13 patients, with levels ranging from 8.6 to 101.8 pg/ml. In Group II TNFa was detected in 13 patients, with levels between 5.4 and 231.0 pg/ml. The IL-6 in this group was detected in 15 patients, with higher levels than those in Group I, varying between 5.5 and 2569.0 pg/ml. The Group I patients had higher medium blood pressure (7.9 ± 0.5 vs 7.3 ± 0.4 mmHg and lower inotropic drug requirement (5 vs 11. They evolved with less tachycardia (105.6 ± 5.9 vs 109.3 ± 7.2 bpm, lower temperature (36.5 ± 0.2 vs 37.3 ± 0.2°C, lower postoperative bleeding, (576.6 ± 119.5 vs 810.0 ± 176.2 ml, shorter orotracheal tubing time (11.0 ± 2.0 vs 14.6 ± 2.9 hs and lower

  13. Corticoide sistêmico como tratamento de primeira linha da hipertensão pulmonar secundária a síndrome POEMS Systemic corticosteroids as first-line treatment in pulmonary hypertension associated with POEMS syndrome

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    Samia Rached

    2009-08-01

    Full Text Available A síndrome POEMS é uma rara doença de plasmócitos. A ocorrência de hipertensão pulmonar como complicação respiratória da síndrome é pouco frequente e pode estar ligada ao aumento de várias citocinas, quimiocinas e fatores de crescimento como parte dos fenômenos inflamatórios que cercam a fisiopatologia da síndrome POEMS. Descrevemos o caso de uma mulher de 54 anos com síndrome POEMS e hipertensão pulmonar, que foi tratada com corticoide como terapia de primeira linha. Tratava-se de uma paciente com clássicos sintomas dessa síndrome: polineuropatia (confirmada por eletroneuromiografia, organomegalia, hipotireoidismo subclínico, gamopatia monoclonal em dosagem urinária e alterações cutâneas. A cateterização cardíaca direita revelou pressão arterial pulmonar média de 48 mmHg, débito cardíaco de 4,1 L/min e resistência vascular pulmonar de 8,05 Woods. O nível sérico de brain natriuretic peptide (BNP foi de 150 pg/mL. Nenhuma outra doença foi encontrada durante investigação. Prednisona (1 mg/kg por três meses foi iniciada, com dramática melhora clínica e funcional, além de normalização dos níveis dos hormônios tireoidianos e de proteína em urina por eletroforese. A pressão arterial pulmonar média caiu para 26 mmHg, o débito cardíaco para 3,8 L/min e a resistência vascular pulmonar para 2,89 Woods. O nível sérico de BNP caiu para 8pg/mL. Nossos achados indicam o potencial papel da corticoterapia como primeira linha de tratamento na hipertensão pulmonar associada à síndrome POEMS. Diante da raridade dessa apresentação, um registro multicêntrico deveria ser desenvolvido para permitir a aquisição de mais dados que suportem essa conduta.The POEMS syndrome is a rare plasma cell disease. Pulmonary hypertension is an infrequent respiratory complication of this syndrome and might be associated with increased levels of various cytokines, chemokines and growth factors as part of the inflammatory

  14. Necrosis avascular de ambas caderas y rodillas en una paciente con colitis ulcerosa tratada prolongadamente con corticoides a dosis altas A vascular necrosis of both hips and knees in a patient with ulcerative colitis treated for a long term with high-dose corticosteroids

    Directory of Open Access Journals (Sweden)

    A. Vidal Casariego

    2006-02-01

    Full Text Available INTRODUCCIÓN: La necrosis avascular representa la muerte del tejido óseo por fallo de su vascularización, y se asocia principalmente al uso de corticoides a dosis elevadas durante tiempo prolongado. CASO CLÍNICO: Una paciente de 25 años tratada con glucocorticoides a altas dosis durante 7 meses por colitis ulcerosa presenta dolor en ambas rodillas y movilidad limitada de caderas y rodillas. En la radiografía simple y la resonancia nuclear magnética (RNM se observó necrosis avascular en dichas articulaciones; la densitometría ósea demostró osteopenia en cabeza femoral y osteoporosis lumbar. DISCUSIÓN: Presentamos un caso llamativo por la amplia afectación articular (ambas caderas y rodillas con presencia simultánea de osteoporosis y osteopenia en una paciente joven tratada con corticoides por colitis ulcerosa. Es necesario recomendar el uso prudente de los glucocorticoides, prescribiendo la dosis mínima necesaria y durante el menor tiempo que sea posible para controlar la enfermedad de base.INTRODUCTION. Avascular necrosis represents the bone tissue death from vascularization failure, and it is mainly associated with the use of high-dose corticosteroids for a long time. CLINICAL CASE. A 25 years old female patient treated with high-dose corticosteroids for 7 months for ulcerative colitis presents with both knees pain and limited hip and knee motility. In a plain X-ray and in nuclear magnetic resonance imaging (MRI avascular necrosis was observed at these joints. Bone densitometry showed osteopenia at the femoral head and lumbar osteoporosis. DISCUSSION. We present a striking case for its large involvement of the joints (both knees and hips with simultaneous osteoporosis and osteopenia in a young patient treated with corticosteroids for ulcerative colitis. It is necessary to recommend the judicious use of glucocorticoids, prescribing the minimal necessary dose and for the least amount of time necessary to control the underlying

  15. [Recurrent acute pericarditis and corticoid dependence. Apropos of 10 cases].

    Science.gov (United States)

    Godeau, P; Derrida, J P; Bletry, O; Herreman, G

    1975-10-09

    The authors report ten cases of acute recurrent pericarditis observed over a period of 5 years and emphasize the frequency of these relapses involving 15 to 20% of cases of acute pericarditis. Usually, no cause is found and, althrough an immunological mechanism has been suggested, there is no common test which may confirm or disprove this theory. The risk of ultimate constrictive pericarditis is minimal and this risk is thus not taken into consideration in deciding on treatment. On the other hand, the undesirable effects of corticosteroids which favour relapses, seem to be demonstrated. The use of corticosteroids in cases of acute pericarditis should thus be exceptional and one should prefer non-steroid anti-inflammatory drugs. Immunosuppressors and pericardectomy should be reserved for the rare forms where the disease progresses and relapses continue after cortisone has been stopped.

  16. Salmon calcitonin in the therapy of corticoid-induced osteoporosis.

    Science.gov (United States)

    Ringe, J D; Welzel, D

    1987-01-01

    There is uncertainty about the best treatment for steroid-induced osteoporosis. Thirty-six patients with steroid-dependent, chronic obstructive lung disease and associated steroid osteoporosis have been studied, of whom 18 were treated with salmon calcitonin and the other 18 served as controls. Treatment lasted for 6 months and consisted of 100 I.U.s.c. every other day. In the controls there were significant decrements of 1.4% and 3.5%, respectively, in cortical and cortical and trabecular bone mineral content, whereas in subjects on calcitonin there were increments of 2.6% and 2.7%, respectively. Additional evidence of positive effect of calcitonin was derived from the reduced incidence of new fractures occurring during the observation period. A significant reduction in back pain was a further consequence of the hormone therapy.

  17. [The high pressure liquid chromatography of corticoids. II. Analysis of synthetic corticoids in blood and urine (author's transl)].

    Science.gov (United States)

    Saito, Z; Amatsu, E; Ono, T; Hihumi, S; Mimou, T; Hashiba, T; Sakato, S; Miyamoto, M; Takeda, R

    1979-10-20

    The high pressure liquid chromatographic (HPLC) technique was developed to separate and quantitate the synthetic corticosteroids (s-CS) which are widely used clinically. 1) 12 kinds of s-CS in alcoholic solvent and 2) some of their metabolites in the plasma and urine of healthy subjects with oral administration of s-CS were investigated for the preliminary work. The results are summarized as follows: 1) Cortisol sodium phosphate, Dexamethasone 21, disodium phosphate, Paramethasone acetate, Cortisol acetate, Cortisone acetate, Methylprednisolone acetate, Prednisone, Dexamethasone, 9 alpha-fluorocortisol, Betamethasone, Triamcinolone, and Prednisolone in ethanol were clearly separated by HPLC from Cortisol (F). In the suitable condition of the HPLC (LC-2 type) with a Zorbax SIL column, organic solvent (cyclohexane:dichloromethane:ethanol = 9:4:1)-carrier mobile phases and UV detector, the retention time of each s-CS was obviously different from that of F. The calibration curve was obtained in a linear line with regards to each s-CS. The mean recovery was 97.6% and the coefficient of variation were 1.6 (intraassay) and 7.2 (interassay)%. The sensitivity of the steroid determination was 200pg order. 2) The serial changes in plasma concentrations of s-CS; CS-metabolites and endogenous F were shown in 3 healthy males and 2 females following oral administration of the s-CS. The separated metabolites in number and quality depended on the kind of s-CS. Prednisone and other kinds of the acidified products were separated from prednisolone in the plasma and urinary samples of the healthy subjects as well as Addisonian patients. In conclusion, the HPLC method is useful for the separation and quantitation of the UV-absorbing CS of human plasma and urine. The obtained chromatograms may be an indication of the metabolic state of the subject with treatment of s-CS.

  18. Avaliação do uso de corticoide no tratamento da dengue

    Directory of Open Access Journals (Sweden)

    Avelino José da Silva Freitas Júnior

    2016-09-01

    Full Text Available A Dengue é uma doença febril causada por quatro sorotipos de um vírus do gênero Flavivirus. Ocorre em praticamente todas as regiões tropicais e subtropicais do planeta, atingindo cerca de 100 milhões de casos todos os anos. Sua apresentação clínica se divide em dengue clássica e dengue hemorrágica, sendo esta uma importante causa de óbitos. O uso de corticóide em seu tratamento é freqüentemente estudado, tendo em vista seu efeito antiinflamatório e imunossupressor, o que agiria exatamente na fisiopatogenia da doença. O presente estudo revisou a literatura acerca dos reais benefícios em incluir essa droga no manejo da fase aguda da dengue. Ao término, concluiu-se a partir da literatura, que não houve melhora significativa quando do uso de corticóides, e que seu uso não deve ser rotineiro.

  19. Corticoid therapy for overlapping syndromes in an HIV-positive patient.

    Science.gov (United States)

    Kaku, Yu; Kodama, Shoko; Higuchi, Makiko; Nakamura, Akihiro; Nakamura, Masataka; Kaieda, Tomoe; Takahama, Soichiro; Minami, Rumi; Miyamura, Tomoya; Suematsu, Eiichi; Yamamoto, Masahiro

    2015-01-01

    Human immunodeficiency virus (HIV) infection disturbs the host's immune function and often coexists with various autoimmune and/or systemic rheumatic diseases with manifestations that sometimes overlap with each other. We herein present the case of a 43-year-old Japanese man infected with HIV who exhibited elevated serum creatine kinase and transaminases levels without any symptoms. He was diagnosed with autoimmune hepatitis, polymyositis and Sjögren's syndrome and received combined antiretroviral therapy (cART); however, the laboratory abnormalities persisted. We successfully administered cART with the addition of oral prednisolone, and the patient's condition recovered without side effects related to the metabolic or immunosuppressive effects of these drugs.

  20. Intrathecal corticoids in permanent focal cerebral ischemia in rats. Part I: a new therapeutic approach in the acute phase.

    Science.gov (United States)

    Goericke, Sophia L; Engelhorn, Tobias; Forsting, Michael; Speck, Ulrich; Maderwald, Stefan; Ladd, Mark E; Doerfler, Arnd

    2010-04-01

    Intrathecally, triamcinolone acetonide (TCA) was suggested to have neuroprotective efficacy on infarction volume in acute focal cerebral ischemia in rats. In the first dose-finding study, TCA in five different doses or saline was administered into the cisterna magna of 12 rats, each 30 mins after endovascular occlusion of the middle cerebral artery (MCAO). In the second magnet resonance controlled confirmation study, the most neuroprotective dose was compared with controls in each of the 15 rats. Infarction volume was calculated at 24 h by 2.3.5 triphenyl-tetrazolium-chloride staining. Compared with controls (18.2%), infarction volume was significantly reduced using TCA at a dose of 0.012 mg/kg body weight (BW) (13.4%, P=0.04). TCA at doses of 0.03 (17.7%, P=0.84), 0.006 (15.9%, P=0.24), and 0.003 mg/kg BW (14.5%, P=0.11) did not significantly reduce infarction size. TCA 0.3 mg/kg BW resulted in bilateral infarction with increased infarction volume (19.8%, P=0.49). Magnetic resonance imaging confirmed successful MCAO and intrathecal administration. In experiment 2 compared with controls (20.0%), infarction volume was significantly reduced using TCA 0.012 mg/kg (13.4%, P=0.02). Intrathecally, TCA may significantly reduce infarction volume in acute focal cerebral ischemia in rats. Further studies are necessary to define the value of this therapy.

  1. Neuropatía óptica por radiación: tratamiento combinado con corticoides y anti-VEGF.

    Directory of Open Access Journals (Sweden)

    Vanesa Rivero Gutiérrez

    2015-08-01

    Full Text Available Caso Clínico: Varón 71 años diabético y fumador, tratado con braquiterapia por melanoma coroideo. A los dos años presenta una neuropatía óptica por radiación y trombosis venosa contralateral. Se trata con corticodes subtenonianos y posteriormente, se interviene de cataratas y se introduce antiangiogénico intravitreo, con buen resultado. Discusión: La neuropatía óptica por radiación  es una vasculopatía progresiva y crónica secundaria a una radiación ionizante supraumbral. Ocurre cuando la dosis total recibida excede de 50 Gy o la dosis diaria de 1,8 Gy .La trombosis venosa podría estar relaciona con los factores de riesgo existentes. Diferentes tratamientos han sido propuestos para la papilopatía por radiación.

  2. 猎豹粪样皮质醇代谢研究%Fecal Corticoid Metabolire Measurement in Cheetah

    Institute of Scientific and Technical Information of China (English)

    吴锋; 孙强; 许建中; 吴昆; 金晓军; 蒋论; 周永晓

    2008-01-01

    采用放射性免疫法测量猎豹粪样中皮质醇代谢的含量,通过不同时间点的动态采样分析皮质醇含量的变化.在研究的6个雌性猎豹中,粪样皮质醇含量显示它们能够分成3个不同的组,高皮质醇含量的雌性猎豹组(~295.22 ng/g粪样,n=2)、中等皮质醇含量雌性猎豹组(~152.29 ng/g粪样,n=2)、偏低的皮质醇含量的雌性猎豹组(~94.14 ng/g粪样,n=2).外源压力影响了猎豹的繁殖性能,而皮质醇的代谢水平是反映猎豹来自外源压力的一个重要指标.本研究拟通过猎豹粪样中皮质醇的含鼍评估动物所处的环境压力水平,为饲养管理水平和饲养环境的改善提供有益的借鉴,进而为解决动物的繁殖问题提供新的思路和方法.

  3. Efecto broncodilatador de fenoterol y salbutamol asociados a un corticoide en niños con crisis de asma.

    Directory of Open Access Journals (Sweden)

    Raúl Huaman

    1996-01-01

    Full Text Available RESUMEN Objetivo: Evaluar los efectos clínicos y colaterales de Fenoterol 100 ug/inh en microdosificador inhalatorio (MDI con aerocámara y salbutamol 100 ug/inh en MDI con aerocámara ambos asociados a dexametasona endovenosa (0.3 mg/kg en bolo. Material y métodos: En un estudio prospectivo, randomizado, multicéntrico se incluyó 60 niños con crisis asmática leve-moderada (30 para cada grupo. Ambos grupos fueron comparables en la evaluación inicial. Resultados: Fenoterol - Dexametasona dio mayor reducción del puntaje clínico (p<0.05 que Salbutamol - Dexametasona al minuto 120 (-2.86 vs -1.25 respectivamente. Asimismo un mayor aumento del Pico Espiratorio Forzado (PEF (p<0.05 al minuto 60 en comparación a Salbutamol - Dexametasona (135 vs 54 respectivamente. Tanto para frecuencia respiratoria como para presencia de tremor los 2 grupos fueron comparables en todos los momentos de la evaluación. No se encontró diferencia significativa entre ambos grupos en la cantidad de altas al final del estudio (4 horas. Conclusiones: Concluímos que las combinaciones Fenoterol - Dexametasona y Salbutamol - Dexametasona son igualmente efectivas en el manejo de crisis asmática leves a moderadas en niños. (Rev Med Hered 1996; 7: 4-10.

  4. Corticotropin-releasing hormone-mediated metamorphosis in the neotenic axolotl Ambystoma mexicanum: synergistic involvement of thyroxine and corticoids on brain type II deiodinase.

    Science.gov (United States)

    Kühn, Eduard R; De Groef, Bert; Van der Geyten, Serge; Darras, Veerle M

    2005-08-01

    In the present study, morphological changes leading to complete metamorphosis have been induced in the neotenic axolotl Ambystoma mexicanum using a submetamorphic dose of T(4) together with an injection of corticotropin-releasing hormone (CRH). An injection of CRH alone is ineffective in this regard presumably due to a lack of thyrotropic stimulation. Using this low hormone profile for induction of metamorphosis, the deiodinating enzymes D2 and D3 known to be present in amphibians were measured in liver and brain 24h following an intraperitoneal injection. An injection of T(4) alone did not influence liver nor brain D2 and D3, but dexamethasone (DEX) or CRH alone or in combination with T(4) decreased liver D2 and D3. Brain D2 activity was slightly increased with a higher dose of DEX, though CRH did not have this effect. A profound synergistic effect occurred when T(4) and DEX or CRH were injected together, in the dose range leading to metamorphosis, increasing brain D2 activity more than fivefold. This synergistic effect was not found in the liver. It is concluded that brain T(3) availability may play an important role for the onset of metamorphosis in the neotenic axolotl.

  5. Insights from the predicted interactions of plant derived compounds to the gluco-corticoid receptor as an alternative to dexa-methasone.

    Science.gov (United States)

    Sarmah, Rajeev

    2012-01-01

    Dexamethasone (DEX) an anti-inflamatory 9-fluoro-glucocorticoid, activates the cytosolic glucocorticoid receptor (GR) binding to its Ligand Binding Domain (LBD). The GR-ligand complex then translocates to the nucleus and binds to the Glucocorticoid Response Element (GRE) resulting up-regulation of target gene expression of anti-inflamatory proteins. DEX is one of the most effective ligand for GR activation but comply to side effects. Therefore, alternative for DEX - plant metabolites of Calotropis sp and Swertia chirata were screened using docking appraoch. These plants compounds were selected because; parts of these plants are widely used againsts inflamation, allergy, asthma etc. Three metabolites of Swertia chirata namely Gentianine (GENT), Xanthone (XANT) and Swerchirin (SWER) are found to be occupying the same binding pocket in the LBD of the GR (PDB ID 1M2Z). The binding affinity as reflected by binding energies of GENT-1M2Z, XANT-1M2Z and SWER-1M2Z are -5.6, -6.7 and -6.7, and all the output parameter of the respective compounds positively correlates with that of DEX-1M2Z with r = 0.9, 0.6 and 0.6 respectively indicating similar GR activation function. Visualization analysis of the models clearly indicates that GENT and SWER may be GR activators. Rest of the compounds mostly docked onto the surface of the receptor molecule.

  6. Laboratorial and physiological validation of comercial kits for quantification of fecal corticoids of captive chimpanzees (Pan troglodytes and orangutangs (Pongo pygmaeus under environmental enriched conditions

    Directory of Open Access Journals (Sweden)

    Cristiane Schilbach Pizzutto

    2008-12-01

    Full Text Available Neste trabalho foi realizado estudo comparativo dos níveis de corticóides fecais (CF de chimpanzé (Pan troglodytes e orangotango (Pongo pygmaeus. Foram analisadas amostras coletadas em duas fases distintas, relacionadas com a introdução de técnicas de enriquecimento ambiental, a saber: Base (antes da introdução e Habituação (imediatamente após. Realizamos as validações do conjunto comercial para radioimunoensaio ImmunuChemTM Double Antibody Corticosterone da MP Biomedicals, para mensuração de CF. A validação laboratorial dos conjuntos diagnósticos para uso em extrato fecal de primatas foi realizada pelo método de paralelismo, no qual, para cada espécie, concentrações conhecidas de corticosterona foram adicionadas a um pool de extratos fecais, sendo estas amostras analisadas em seguida. As inclinações das curvas obtidas nestes ensaios e da curva padrão do ensaio foram então comparadas. Os resultados obtidos para chimpanzé e orangotango, foram respectivamente, Y= 17,23+1,31*X;R^2=0,98 e Y=11,14+1,29*X; R^2=0,99. Para a validação fisiológica, foi utilizada a introdução de técnicas de enriquecimento ambiental como causador de aumento dos níveis de CF, conseqüentes à indução de resposta do tipo estresse. Os resultados foram expressos em médias e erros-padrão da média. As concentrações médias destes corticóides foram: chimpanzés: Base (5,90 +/-2,41x10³ ng/g de fezes, Habituação (14,92 +/- 4,66x10³ ng/g de fezes e para o orangotango: Base (91,1 +/- 30,0x10³ ng/g de fezes, Habituação (185,1 +/- 57x10³ng/g de fezes. Houve diferença significativa (P<0,05 para os valores destes CF para ambas as espécies entre as duas fases estudadas.

  7. Reproducibility of O-(2-{sup 18}F-fluoroethyl)-L-tyrosine uptake kinetics in brain tumors and influence of corticoid therapy: an experimental study in rat gliomas

    Energy Technology Data Exchange (ETDEWEB)

    Stegmayr, Carina; Schoeneck, Michael; Oliveira, Dennis; Willuweit, Antje [Institute of Neuroscience and Medicine, Research Center Juelich, Juelich (Germany); Filss, Christian; Coenen, Heinz H.; Langen, Karl-Josef [Institute of Neuroscience and Medicine, Research Center Juelich, Juelich (Germany); University of Aachen, Department of Nuclear Medicine and Neurology, Aachen (Germany); Galldiks, Norbert [Institute of Neuroscience and Medicine, Research Center Juelich, Juelich (Germany); University of Cologne, Department of Neurology, Cologne (Germany); Shah, N. Jon [Institute of Neuroscience and Medicine, Research Center Juelich, Juelich (Germany); University of Aachen, Department of Nuclear Medicine and Neurology, Aachen (Germany); Juelich-Aachen Research Alliance (JARA) - Section JARA-Brain, Juelich (Germany)

    2016-06-15

    Positron emission tomography (PET) using O-(2-{sup 18}F-fluoroethyl)-L-tyrosine ({sup 18}F-FET) is a well-established method for the diagnostics of brain tumors. This study investigates reproducibility of {sup 18}F-FET uptake kinetics in rat gliomas and the influence of the frequently used dexamethasone (Dex) therapy. F98 glioma or 9L gliosarcoma cells were implanted into the striatum of 31 Fischer rats. After 10-11 days of tumor growth, the animals underwent dynamic PET after injection of {sup 18}F-FET (baseline). Thereafter, animals were divided into a control group and a group receiving Dex injections, and all animals were reinvestigated 2 days later. Tumor-to-brain ratios (TBR) of {sup 18}F-FET uptake (18-61 min p.i.) and the slope of the time-activity-curves (TAC) (18-61 min p.i.) were evaluated using a Volume-of-Interest (VOI) analysis. Data were analyzed by two-way repeated measures ANOVA and reproducibility by the intraclass correlation coefficient (ICC). The slope of the tumor TACs showed high reproducibility with an ICC of 0.93. A systematic increase of the TBR in the repeated scans was noted (3.7 ± 2.8 %; p < 0.01), and appeared to be related to tumor growth as indicated by a significant correlation of TBR and tumor volume (r = 0.77; p < 0.0001). After correction for tumor growth TBR showed high longitudinal stability with an ICC of 0.84. Dex treatment induced a significant decrease of the TBR (-8.2 ± 6.1 %; p < 0.03), but did not influence the slope of the tumor TAC. TBR of {sup 18}F-FET uptake and tracer kinetics in brain tumors showed high longitudinal stability. Dex therapy may induce a minor decrease of the TBR; this needs further investigation. (orig.)

  8. Polimorfismos genéticos y respuesta a corticoides en pacientes de artritis reumatoide. Efecto sobre citocinas y células T reguladoras

    OpenAIRE

    Paz Cazón, Banesa de

    2016-01-01

    La artritis reumatoide (AR) es una enfermedad autoinmune sistémica caracterizada por una inflamación persistente de las articulaciones, que deriva en una destrucción progresiva, generando distintos grados de deformidad e incapacidad funcional. Caracterizada por un exceso de mediadores inflamatorios, están bien documentadas las alteraciones en los niveles de IL-10 y el TNFα, dos citocinas involucradas en la respuesta inflamatoria. Dado que la producción de estas moléculas está genéticamente ...

  9. Síndrome de Distrés Respiratorio Agudo: Utilidad de los Corticoides Acute respiratory distress syndrome: Role of steroids

    OpenAIRE

    Célica L. Irrazábal; Abelardo A. Capdevila; Carlos Sosa; Marina C. Khoury; Miguel A. Jorge; Carlos R. Gherardi

    2004-01-01

    En Argentina, el síndrome de distrés respiratorio agudo (SDRA) representa el 7.7% de las admisiones en terapia intensiva y está asociado con una alta morbilidad y mortalidad (58%). Con frecuencia la muerte puede ser atribuida a más de una causa. La hipoxemia refractaria es una causa de muerte poco frecuente (15%) y en muchos casos puede coexistir con disfunción multiorgánica, sepsis o shock séptico. La utilidad de los esteroides como parte del tratamiento es aún motivo de debate a pesar de la...

  10. Síndrome de Distrés Respiratorio Agudo: Utilidad de los Corticoides Acute respiratory distress syndrome: Role of steroids

    Directory of Open Access Journals (Sweden)

    Célica L. Irrazábal

    2004-06-01

    Full Text Available En Argentina, el síndrome de distrés respiratorio agudo (SDRA representa el 7.7% de las admisiones en terapia intensiva y está asociado con una alta morbilidad y mortalidad (58%. Con frecuencia la muerte puede ser atribuida a más de una causa. La hipoxemia refractaria es una causa de muerte poco frecuente (15% y en muchos casos puede coexistir con disfunción multiorgánica, sepsis o shock séptico. La utilidad de los esteroides como parte del tratamiento es aún motivo de debate a pesar de las múltiples series de casos y estudios clínicos publicados. En el artículo se evalúa la utilidad de los esteroides en el SDRA a través de la revisión de la bibliografía disponible. Se concluye que los esteroides estarían indicados en un pequeño subgrupo de pacientes con SDRA no resuelto o tardío, después de descartar o controlar una infección activa.The acute respiratory distress syndrome (ARDS represents 7.7% of the intensive care population, and is associated with great morbidity and mortality (58%. Frequently, the mortality can be attributed to more than one cause. Refractory hypoxemia is uncommon (15% and most of the patients also have multiple organic dysfunction, sepsis or septic shock. Although there are many publications concerning series of cases and clinical trials using steroids as a part of the treatment of ARDS, this issue remains controversial. In this article the role of steroids in the ARDS is evaluated by analysis of the available literature. We conclude that steroids are useful in a subgroup of patients with unresolving ARDS, after ruling out an active infection or after treatment with antibiotics.

  11. Adrenalectomy promotes a permanent decrease of plasma corticoid levels and a transient increase of apoptosis and the expression of Transforming Growth Factor β1 (TGF-β1 in hippocampus: effect of a TGF-β1 oligo-antisense

    Directory of Open Access Journals (Sweden)

    Lara Hernán E

    2006-05-01

    Full Text Available Abstract Background Corticosterone reduction produced by adrenalectomy (ADX induces apoptosis in dentate gyrus (DG of the hippocampus, an effect related to an increase in the expression of the pro-apoptotic gene bax. However it has been reported that there is also an increase of the anti-apoptotic gene bcl-2, suggesting the promotion of a neuroprotective phenomenon, perhaps related to the expression of transforming growth factor β1 (TGF-β1. Thus, we have investigated whether TGF-β1 levels are induced by ADX, and whether apoptosis is increased by blocking the expression of TGF-β1 with an antisense oligonucleotide (ASO administered intracerebrally in corticosterone depleted rats. Results It was observed an increase of apoptosis in DG, 2 and 5 days after ADX, in agreement with a reduction of corticosterone levels. However, the effect of ADX on the number of apoptotic positive cells in DG was decreased 5 days after the lesion. In CA1–CA3 regions, the effect was only observed 2 days after ADX. TGF-β1 mRNA levels were increased 2 days after ADX. The sustained intracerebro-ventricular administration of a TGF-β1 ASO via an osmotic mini pump increased apoptosis levels in CA and DG regions 5 days after ADX as well as sham-operated control animals. No significant effect was observed following a scrambled-oligodeoxynucleotide treatment. Conclusion The changes in both the pattern and the magnitude of apoptotic-cell morphology observed 2 and 5 days after ADX suggest that, as a consequence of the reduction of corticosteroids, some trophic mechanisms restricting cell death to a particular time window are elicited. Sustained intracerebral administration of TGF-β1 ASO increased the apoptosis promoted by ADX, suggesting that TGF-β1 plays an anti-apoptotic role in vivo in hippocampus.

  12. Caracterización de la respuesta inflamatoria en la neumonía comunitaria grave. Efecto de los corticoides en la contención de dicha respuesta y en el curso evolutivo de la infección

    OpenAIRE

    Fernández Serrano, Silvia

    2012-01-01

    [spa] La neumonía adquirida en la comunidad (NAC) continúa siendo en la actualidad una enfermedad potencialmente grave, que con frecuencia presenta una evolución desfavorable, a pesar del tratamiento antibiótico adecuado. La hipótesis de la tesis plantea que es posible monitorizar la respuesta inflamatoria que tiene lugar durante la NAC y, que dicha respuesta, puede ser influenciada por los antibióticos utilizados en su tratamiento, así como modulada mediante una terapia adyuvante con co...

  13. Leishmaniosis laríngea recidivante: un caso inusual en un paciente inmunocompetente tratado con corticoides Recidivant laryngeal leishmaniosis: an unusual case in an immunocompetent patient treated with corticosteroids

    OpenAIRE

    Casero, R.; L. Laconte; L. Fraenza; N; Iglesias; C. Quinteros Greco; ML. Villablanca

    2010-01-01

    La leishmaniosis es una parasitosis de evolución crónica; en Argentina, sus agentes etiológicos principales pertenecen al complejo Leishmania (Viannia) braziliensis, habitualmente asociado a lesiones cutáneas y mucocutáneas. Informamos en este trabajo un caso de leishmaniosis laríngea en un hombre de 29 años procedente de Jujuy, quien a raíz de múltiples subdiagnósticos portaba esta parasitosis desde hacía 20 años. En el año 2008 este paciente consulta por disfonía crónica y trastornos en las...

  14. Therapeutic usage of omeprazole and corticoid in a dog with hydrocephalus unresponsive to conventional therapyUso terapêutico da associação do omeprazol com corticóide em um cão com hidrocefalia não-responsiva ao tratamento convencional

    Directory of Open Access Journals (Sweden)

    Alexandre Mendes Amude

    2013-05-01

    Full Text Available Medical therapy for hydrocephalus includes the administration of medications to limit the production of the cerebrospinal fluid (CSF resulting in reduced intracranial pressure (ICP. This report describes the clinical findings in one dog with congenital hydrocephalus that was unresponsive to conventional medical treatment with steroids, but demonstrated good response to omeprazole when this drug was added to the steroid. Omeprazole might decrease the CSF production by about 26% according to experimental studies with healthy dogs, but the usage of the omeprazole in clinical trials with affected dogs such as hydrocephalic animals is lacking. The results of this report might suggest that omeprazole can be used added to steroids to ameliorate the neurological status in dogs with increased ICP by hydrocephalus.O tratamento médico para a hidrocefalia inclui a administração de medicamentos para limitar a produção do fluido cerebroespinhal (FCE, resultando em redução da pressão intracraniana (PIC. Este trabalho descreve os achados clínicos em um cão com hidrocefalia congênita não responsiva ao tratamento médico convencional com esteróides mas que apresentou boa resposta à associação omeprazolesteróides. O omeprazol pode diminuir a produção de FCE em cerca de 26% de acordo com estudos experimentais realizados com cães saudáveis. Porém, o uso do omeprazol em ensaios clínicos com cães enfermos, como os animais hidrocefálicos, não é descrito. Os resultados deste trabalho sugerem que o omeprazol pode ser empregado em associação ao corticóide para melhorar o estado neurológico em cães com aumento da PIC devido à hidrocefalia.

  15. The stress response to environmental change in captive cheetahs (Acinonyx jubatus).

    Science.gov (United States)

    Wells, Amy; Terio, Karen A; Ziccardi, Michael H; Munson, Linda

    2004-03-01

    The captive North American cheetah (Acinonyx jubatus) population is not self-sustaining because of high prevalences of unusual diseases and poor reproductive success. Cheetahs are commonly moved between zoos for breeding purposes to maintain genetic diversity within the captive population, and movement may exacerbate infertility and disease. Fecal corticoids were analyzed by radioimmunoassay to measure the stress response of cheetahs to movement between facilities. Fecal samples were collected from 15 cheetahs for 14 days before movement and for at least 30 days after movement. For each cheetah, premovement fecal corticoid concentrations were used to determine baseline and then compared with trends in postmovement concentrations. In general, postmovement corticoid concentrations either increased (n = 8), did not change (n = 2), or decreased (n = 5). Although individual animal differences occurred, corticoid concentrations increased for most animals moved on-exhibit and decreased in animals moved off-exhibit. Animals moving on-exhibit had an 18-times greater risk of having corticoids elevated more than two standard deviations above baseline for 30 days after movement compared with animals that moved off-exhibit. In addition, greater day-to-day variation in corticoids occurred in animals moved on-exhibit. In general, animals with initially low baseline corticoid concentrations had a greater postmovement corticoid response than cheetahs with initially high baseline levels. These results indicate that some cheetahs have a prolonged stress response when moved between facilities, and the magnitude and character of this response is influenced by the exhibit environment.

  16. Celulitis por Microascus trigonosporus(anamorfo Scopulariopsis trigonospora)

    National Research Council Canada - National Science Library

    DELIA CANLE CORTIÑAS; RICARDO FERNÁNDEZ RODRÍGUEZ; ANA CID LAMA; MARIA DOLORES DÍAZ LÓPEZ

    2013-01-01

    ... régimen de tratamiento para las infecciones por Scopulariopsis spp. Presentamos un caso excepcional de celulitis por Microascus trigonosporus en un paciente con tratamiento prolongado con corticoides. Abstract...

  17. [Management of severe ulcerative colitis: An up-to-date].

    Science.gov (United States)

    Hernández-Rocha, Cristian; Ibáñez, Patricio; Molina, María Elena; Klaassen, Julieta; Valenzuela, Andrea; Candia, Roberto; Bellolio, Felipe; Zúñiga, Álvaro; Miguieles, Rodrigo; Miquel, Juan Francisco; Chianale, José; Álvarez-Lobos, Manuel

    2017-01-01

    Ulcerative Colitis (UC) is a chronic inflammatory disease involving the colon, with alternating periods of remission and activity. Exacerbations can be severe and associated with complications and mortality. Diagnosis of severe UC is based on clinical, biochemical and endoscopic variables. Patients with severe UC must be hospitalized. First line therapy is the use of intravenous corticoids which achieve clinical remission in most patients. However, 25% of patients will be refractory to corticoids, situation that should be evaluated at the third day of therapy. In patients without response, cytomegalovirus infection must be quickly ruled out to escalate to second line therapy with biological drugs or cyclosporine. Total colectomy must not be delayed if there is no response to second line therapy, if there is a contraindication for second line therapies or there are complications such as: megacolon, perforation or massive bleeding. An active management with quick escalation on therapy allows to decrease the prolonged exposure to corticoids, reduce colectomy rates and its perioperative complications.

  18. What are the effects of adding azathioprine to corticosteroids in polymyositis?

    OpenAIRE

    Cristina Meneses; Gabriel Rada

    2015-01-01

    El tratamiento de la polimiositis se basa en el uso de corticoides, con adición de azatioprina en casos de difícil manejo o como medida para disminuir la dosis de corticoides, si bien no existe evidencia clara de su beneficio en el control de síntomas. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos 1 revisión sistemática que incluye sólo un estudio controlado aleatorizado pertinente. Realizamos una tabla de resumen de los...

  19. Inyecciones locales multipuntuales con corticosteroide para el síndrome de estrés tibial medial: un nuevo enfoque.

    OpenAIRE

    I. Medina; Jurado, A; Magee, D.J.; Vas, J

    2013-01-01

    El síndrome de estrés medial de la tibia (SEMT) constituye una de las afecciones más comunes del miembro inferior. Los resultados obtenidos con terapias convencionales en esta patología son dispares. La infiltración local de corticoides ha mostrado producir efectos favorables en el tratamiento de diversos problemas musculoesqueléticos. Elefecto de la infiltración local multipuntual de un corticoide encombinación con un anestésico se estudió en 47 pacientes (29 hombres y 18 mujeres, con una ed...

  20. Repeated blockade of mineralocorticoid receptors, but not of glucocorticoid receptors impairs food rewarded spatial learning

    NARCIS (Netherlands)

    Douma, BRK; Korte, SM; Buwalda, B; la Fleur, SE; Bohus, B; Luiten, PGM

    1998-01-01

    Corticosteroids from the adrenal cortex influence a variety of behaviours including cognition, learning and memory. These hormones act via two intracellular receptors, the mineralo-corticoid receptor (MR) and the glucocorticoid receptor (GR). These two receptor types display a high concentration and

  1. 3.TRADITIONAL CHINESE MEDICINE

    Institute of Scientific and Technical Information of China (English)

    1992-01-01

    920220 Studies on plasma cortisol concen-tration and blood leukocyte content of gluco-corticoid receptors in patients with asthenia-cold asthenia-heat syndrome.ZHANG Guan-gyu (张广宇),XLE Zhufar (谢竹藩).Tradit & West

  2. Stress and innate immunity in carp: corticosteroid receptors and pro-inflammatory cytokines

    NARCIS (Netherlands)

    Stolte, H.H.; Nabuurs, S.B.; Bury, N.R.; Sturm, A.; Flik, G.; Savelkoul, H.F.J.; Verburg-van Kemenade, B.M.L.

    2008-01-01

    The stress hormone cortisol is deeply involved in immune regulation in all vertebrates. Common carp (Cyprinus carpio L.) express four corticoid receptors that may modulate immune responses: three glucocorticoid receptors (GR); GR1, with two splice variants (GR1a and GR1b), GR2 and a single mineraloc

  3. Repeated blockade of mineralocorticoid receptors, but not of glucocorticoid receptors impairs food rewarded spatial learning

    NARCIS (Netherlands)

    Douma, B.R.; Korte, S.M.; Buwalda, B.; Fleur, la S.E.; Bohus, B.; Luiten, P.G.

    1998-01-01

    Corticosteroids from the adrenal cortex influence a variety of behaviours including cognition, learning and memory. These hormones act via two intracellular receptors, the mineralo-corticoid receptor (MR) and the glucocorticoid receptor (GR). These two receptor types display a high concentration and

  4. Creatinine Ratios in Dogs with Pituitary-Dependent Hypercortisolism during Trilostane Treatment

    NARCIS (Netherlands)

    Galac, S.; Buijtels, J.J.C.W.M.; Kooistra, H.S.

    2009-01-01

    J Vet Intern Med. 2009 Nov-Dec;23(6):1214-9. Epub 2009 Aug 26. Urinary Corticoid : Creatinine Ratios in Dogs with Pituitary-Dependent Hypercortisolism during Trilostane Treatment. Galac S, Buijtels JJ, Kooistra HS. Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine,

  5. First trimester exposure to corticosteroids and oral clefts

    NARCIS (Netherlands)

    Pradat, P; Robert-Gnansia, E; Di Tanna, GL; Rosano, A; Lisi, A; Mastroiacovo, P

    2003-01-01

    BACKGROUND: The possible association between oral cleft in the newborn and maternal exposure to corticoids during pregnancy is still controversial. The aim of this study was to test this association by a case-control analysis using the large multicentric MADRE database. METHODS: The MADRE database i

  6. LIQUEN SIMPLE CRÓNICO VULVAR UNILATERAL

    OpenAIRE

    Lema C,Rodrigo; Ricci A,Paolo; Solà D,Vicente; Contreras M,Luis

    2006-01-01

    Presentamos un caso de liquen simple crónico vulvar izquierdo, en una paciente con diagnóstico psiquiátrico de trastorno bipolar, tratado repetidamente como micosis. Se realizó biopsia que confirmó el diagnóstico y se trató exitosamente con antihistamínicos orales y corticoides tópicos

  7. Fiebre y placas dolorosas en manos. ¿Cuál es el diagnóstico?

    Directory of Open Access Journals (Sweden)

    Juan Manuel Barja López

    2013-12-01

    Full Text Available Presentamos un caso de Síndrome de Sweet con lesiones cutáneas características, precipitado posiblemente por una infección respiratoria, que respondió satisfactoriamente a corticoides orales. Se realiza una brevísima descripción del síndrome basada en la literatura médica.

  8. Synthesis of 7. cap alpha. -chloro-16. cap alpha. -methylprednisolone 17. cap alpha. ,21-dipropionate-4-/sup 14/C (alclometasone dipropionate-4-/sup 14/C). [Antiinflammatory Agent

    Energy Technology Data Exchange (ETDEWEB)

    Terasawa, Tadao; Atsumi, Kazunori; Yokoshima, Tetsuyoshi; Ohyabu, Shintaro; Fukasaku, Noboru

    1986-09-01

    In order to study the bioavailability, metabolism and protein-binding effects of the new antiinflammatory corticoid, alclometasone dipropionate, it was required to obtain the biochemically stable /sup 14/C-labelled substrate. In the present publication we describe an efficient synthesis of the title compound.

  9. Linfoma angioinmunoblástico de células T

    Directory of Open Access Journals (Sweden)

    Gargantilla P

    2016-09-01

    Full Text Available Se trata de un linfoma muy agresivo, con una mediana de supervivencia en torno a los 3 años. En cuanto al tratamiento, se han ensayado varias modalidades terapéuticas entre las cuales se encuentran los corticoides, los fármacos citotóxicos (vorinostat, romidepsin, panbinostat y belinostat y los inmunomoduladores (rituximab, lenalidomide.

  10. [Treatment outcome using prednisone in corticosteroid-responsive primary nephrotic syndrome in children].

    Science.gov (United States)

    Brumariu, O; Cucer, Florentina; Munteanu, Mihaela; Haliţchi, Codruţa; Müller, R; Russu, R

    2005-01-01

    In children, the nephrotic syndrome is usually corticoid-responsive; approximately 70% of patients experience relapses, frequently triggered by infections. Our paper presents the results obtained using a 4 month prednisone regimen. This retrospective study included 83 children afflicted with nephrotic syndrome over a 10 year span. We analyzed: age at diagnosis, boys/girls ratio, response to corticoid treatment - after one month of prednisone and at the completion of the treatment course, number of relapses and their frequency, complications of prednisone treatment. The median age at diagnosis was 4.8 years, males predominating M:F = 1.5:1. Complete response after 4 weeks of prednisone therapy was noted in 98.79% of cases. We had 116 episodes of relapses during the first year of follow-up, occurring in 67.4% of children (27.9% were frequent relapsers, 11.62% subsequently became corticoid-dependent). Late relapses, after the first year, occurred in 32.55% of cases. We noted mostly mild adverse effects of the prednisone treatment: occurrence of infections during therapy (16.27%), cushingoid facies (37.2%), hirsutism (4.6%), high blood pressure (4.65%), stretch marks (2.32%). In conclusion, the 4 month prednisone treatment regimen is efficient in inducing and maintaining a remission. The incidence of relapses is 32.55%, comparable to the figure cited in larger studies. Serious adverse effects are significantly lower with this regimen compared to other corticoid treatment schemes. Key wo

  11. The Stomatological Complications of Diamond-Blackfan Anemia: A Case Report

    Science.gov (United States)

    Gomes, Rita Fabiane Teixeira; Munerato, Maria Cristina

    2016-01-01

    Diamond-Blackfan Anemia (DBA) is a rare heterogeneous genetic disease characterized by severe anemia, reduction or absence of erythroid progenitors, and pro-apoptoptic hematopoiesis, which culminates in bone marrow failure. The disease generally manifests in infancy, as craniofacial, cardiac, genitourinary, and upper limb congenital anomalies. Therapy with corticoids is the treatment of choice, while blood transfusion is adopted during diagnosis and as a chronic approach if the patient does not respond to corticoids. This case report describes DBA in a patient that presented with lesions on the oral mucosa caused by secondary neutropenia. The stomatologist plays an important role in a transdisciplinary team and must remain attentive to the general health conditions of patients, since some oral lesions may be associated with systemic events. PMID:26864506

  12. What are the effects of adding azathioprine to corticosteroids in polymyositis?

    Directory of Open Access Journals (Sweden)

    Cristina Meneses

    2015-07-01

    Full Text Available El tratamiento de la polimiositis se basa en el uso de corticoides, con adición de azatioprina en casos de difícil manejo o como medida para disminuir la dosis de corticoides, si bien no existe evidencia clara de su beneficio en el control de síntomas. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos 1 revisión sistemática que incluye sólo un estudio controlado aleatorizado pertinente. Realizamos una tabla de resumen de los resultados utilizando el método GRADE. Se concluye que existe incertidumbre sobre si agregar azatioprina mejora o no la fuerza muscular en la polimiositis porque la certeza de la evidencia es muy baja.

  13. Non habitual microscopic forms of Histoplasma capsulatum in disseminated disease

    Institute of Scientific and Technical Information of China (English)

    Bava AJ; Garro S; Troncoso A

    2008-01-01

    This paper communicates the presence of aberrant microscopic forms of Histoplasma capsulatum in a sample ob-tained by scrapping of the skin lesion and stained with a rapid modification of the Grocott technique.The AIDS patient was treated with cream contained corticoids and antifungal and antibacterial antibiotics by an erroneous diagnosis.Once the etiologic diagnosis was achieved,oral itraconazol was administrated at the daily dose of 400 mg during at least six months.These non habitual forms described in the literature as"aberrant variants", can be interpreted as an"adaptive phenomenon"of this termodimorphic fungal specie,as response of the eco-logic alterations produced by antibiotic on the local antagonic bacterial microbiota,the deleterous activity of antifungal on the fungal cells and the local inmunodepression produced by the corticoids.

  14. High-dose inhaled corticosteroids or addition of theophylline in patients with poorly controlled asthma?

    Directory of Open Access Journals (Sweden)

    Pilar Celis

    2015-08-01

    Full Text Available Existen varias estrategias para el manejo de los pacientes asmáticos con mal control a pesar del tratamiento habitual. Dentro de las alternativas terapéuticas se encuentra aumentar las dosis de corticoides inhalados o utilizar teofilina. Sin embargo, esta última se asocia a importantes efectos adversos. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos una revisión sistemática que incluye cuatro estudios aleatorizados. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Concluimos que no está claro si teofilina o el uso de dosis altas de corticoides inhalados logran un mejor control sintomático o reducción de las exacerbaciones en pacientes asmáticos no controlados porque la certeza de la evidencia es muy baja.

  15. Lesões bolhosas palmo-plantares pós-quimioterapia

    Directory of Open Access Journals (Sweden)

    Mário Pires

    2013-09-01

    Full Text Available Apresentamos um caso de um doente com o diagnóstico de sarcoma pulmonar que, após o 3º ciclo de tratamento com doxorrubicina lipossómica pegilada (DLP (50mg/m2 cada 4 semanas, desenvolveu exuberantes lesões bolhosas, descamativas, nas palmas das mãos, (Figuras 1 e 2, e plantas dos pés, com impotência funcional total. Efetuouse tratamento com corticoide sistémico e aplicação tópica de antibiótico, corticoide e hidratantes. Após duas semanas a melhoria em termos de dor e capacidade funcional foram substanciais (Figuras 3 e 4. Devido à severidade deste episódio, nos tratamentos subsequentes a DLP foi substituída por trabectidina.

  16. Pemphigus vulgaris. A presentation of 14 cases and review of the literature.

    Science.gov (United States)

    Camacho-Alonso, Fabio; López-Jornet, Pía; Bermejo-Fenoll, Ambrosio

    2005-01-01

    Pemphigus vulgaris (PV) is a chronic vesicular-ampullar mucocutaneous disease that almost always produces oral manifestations. The fact that blisters on the oral mucosa are sometimes the first manifestation of the disease implies that dental professionals must be sufficiently familiarized with the clinical manifestations of PV to ensure early diagnosis and treatment. We present a series of 14 patients with clinically and histologically diagnosed PV seen in the Teaching Unit of Oral Medicine of the University of Murcia (Spain) between 1981 and 2001. A thorough evaluation was made, recording patient age and sex, the location and extent of the lesions, and the signs and symptoms of the disease. Complementary studies were also carried out, with the evaluation of hematological parameters (including blood chemistry), the histology and immunohistochemical characteristics (direct immunofluorescence in 2 cases). Treatment comprised topical corticoids, in 12 cases combined with systemic corticoids, and associated to intralesional corticotherapy in one patient. A good response to treatment was observed in all cases.

  17. Is epidural steroid injection effective for degenerative lumbar spinal stenosis?

    Directory of Open Access Journals (Sweden)

    Sebastián Flores

    2015-12-01

    Full Text Available Existe una variada cantidad de alternativas no quirúrgicas para tratar el dolor radicular producido por la raquiestenosis lumbar degenerativa. Los corticoides epidurales se utilizan desde hace varias décadas, sin embargo la eficacia reportada en la literatura es muy variable. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos nueve revisiones sistemáticas que en conjunto incluyen siete estudios aleatorizados. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Concluimos que la inyección de corticoides epidurales probablemente tiene poco o nulo efecto en reducir el dolor radicular por estenorraquis.

  18. Newly Reported Hypertension After Military Combat Deployment in a Large Population-Based Study

    Science.gov (United States)

    2009-01-01

    conditions? . . . Hypertension ( high blood pressure ).” At follow-up, participants were asked the same question, but in the context of the last 3 years...factor for hypertension . Although stress is postulated to increase blood pressure , the underlying role of stress on hypertension is not well established...related violence on hypertension is not well established. Stress is postulated to increase blood pressure through the release of corticoids and

  19. Ocular toxocariasis. A case presentation

    Directory of Open Access Journals (Sweden)

    Mariela Julia Curbelo Gómez

    2008-12-01

    Full Text Available A clinical case on ocular toxocariasis is presented. The clinical manifestations were pain and red eye in a four year-old child. A prior acute uveitis in the LE was found in the physical ocular exam. Vitrea band that was out of the superior edge of papila and a marginal granuloma were found in the eyes fundus. The patient was admitted and treated with oral corticoids and oral antihelmintics

  20. Ocular toxocariasis: radiological findings - a case report and review of the literature; Toxocariase ocular - relato de um caso por ressonancia magnetica e revisao da literatura

    Energy Technology Data Exchange (ETDEWEB)

    Abbehusen, Cristiane; Jesus, Paulo Eduardo Marinho de; Rodrigues, Waldinei Merces; Wolosker, Angela Maria Borri; Lederman, Henrique Manoel; Yamashita, Helio Kiitiro [Escola Paulista de Medicina, Sao Paulo, SP (Brazil). Dept. de Diagnostico por Imagem

    1998-10-01

    The authors report a case of a 4-year-old girl patient complaining of leukokoria on the right eye 15 days ago. The ophthalmologic exam was not possible to do because of catarata. So, a magnetic resonance imaging (MRI) examination was performed, which revealed hyperintense vitreous camera and enhancing intraocular mass. Diagnosis of ocular toxocariasis was based on MRI findings and laboratorial examinations. The corticoids treatment was performed and the child had a good evolution. (author) 7 refs., 6 figs.

  1. Proinflammatory cytokines differentially influence adult hippocampal cell proliferation depending upon the route and chronicity of administration

    OpenAIRE

    Julie Anne Seguin; Jordan Brennan; Emily Mangano; Shawn Hayley

    2009-01-01

    Julie Anne Seguin, Jordan Brennan, Emily Mangano, Shawn HayleyInstitute of Neuroscience, Carleton University, Ottawa, Ontario, CanadaAbstract: Disturbances of hippocampal plasticity, including impaired dendritic branching and reductions of neurogenesis, are provoked by stressful insults and may occur in depression. Although corticoids likely contribute to stressor-induced reductions of neurogenesis, other signaling messengers, including pro-inflammatory cytokines might also be involved. Accor...

  2. Proinflammatory cytokines differentially influence adult hippocampal cell proliferation depending upon the route and chronicity of administration

    OpenAIRE

    Hayley, Shawn

    2008-01-01

    Julie Anne Seguin, Jordan Brennan, Emily Mangano, Shawn HayleyInstitute of Neuroscience, Carleton University, Ottawa, Ontario, CanadaAbstract: Disturbances of hippocampal plasticity, including impaired dendritic branching and reductions of neurogenesis, are provoked by stressful insults and may occur in depression. Although corticoids likely contribute to stressor-induced reductions of neurogenesis, other signaling messengers, including pro-inflammatory cytokines might also be involved. Accor...

  3. Montmorillonite Clay-Based Polyurethane Nanocomposite As Local Triamcinolone Acetonide Delivery System

    OpenAIRE

    Flávia Carmo Horta Pinto; Armando Silva-Cunha; Gerson Antônio Pianetti; Eliane Ayres; Rodrigo Lambert Oréfice; Gisele Rodrigues Da Silva

    2011-01-01

    Biodegradable polyurethane was synthesized by preparing aqueous polyurethane dispersion having poly(caprolactone) and poly(ethylene glycol) as soft segments. Montmorillonite particles were delaminated within the waterborne polyurethane to produce a nanocomposite. The triamcinolone acetonide (TA), an important corticoid drug, was dispersed into the nanocomposite followed by a drying step to produce an implantable drug delivery system. Infrared (FTIR) results demonstrated that the original chem...

  4. Lumbar spine joint synovial cysts of intraspinal development. CT scan imaging

    Energy Technology Data Exchange (ETDEWEB)

    Vallee, C.; Chevrot, A.; Benhamouda, M. and others

    CT scan imaging findings are described in 22 patients with lumbar spine joint synovial cysts, of intraspinal development, provoking sciatica or lumbosciatica from nerve compression in spinal canal. Diagnosis was suggested by a mass at the posterior joint level, of variable density, sometimes with peripheral calcification, presenting a vacuum appearance on occasions, and with enhanced image with contrast. Differential diagnosis is from excluded hernia and postoperative fibrosis. Posterior intra-articular arthrography can confirm diagnosis and allow treatment with prolonged action corticoid infiltrations.

  5. [2 cases of acute disseminated intravascular coagulation in normal pregnancy and as the first symptom of acute promyelocytic leukemia].

    Science.gov (United States)

    Kardaszewicz, E; Bujak, M; Spychałowicz, W; Siudyka, A; Harbut-Gryłka, A

    Two cases of the acute disseminated intravascular coagulation (DIC) are presented. DIC in the first case was diagnosed in healthy pregnant woman without any obstetric pathology. This patient recovered completely. The acute DIC in another patient preceded the acute promyelocytic leukemia. The patient died despite a control of DIC. DIC therapy included antifibrinolytic agents and additionally corticoids in pregnant patient. Heparin was not administered because of post partum period and foreseen cytostatic therapy in the leukemic patient.

  6. Síndrome CLIPPERS con distribución atípica de las lesiones en la resonancia magnética cerebral

    OpenAIRE

    Canneti Heredia, Beatrice; Mosqueira, Antonio J.; Gilo, Francisco; Carreras, Teresa; Barbosa, Antonio; Meca-Lallana, Virginia; Vivancos, José

    2013-01-01

    Introducción. El síndrome CLIPPERS (chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids) es un proceso inflamatorio del sistema nervioso central cuyo rasgo distintivo son las lesiones puntiformes en el troncoencéfalo captantes en los estudios de resonancia magnética. Clínicamente, cursa con disartria, ataxia y diplopía, y suele responder a corticoides. Anatomopatológicamente, aparecen infiltrados de linfocitos T en los espacios perivasculares...

  7. Rotura del tendón del cuádriceps en paciente con lupus eritematoso sistémico

    National Research Council Canada - National Science Library

    Sancho-Loras, R; García-Delgado, I; Echeverría-Ulloa, M; Úbeda-Tikkanen, A

    2009-01-01

    ... y degenerativos que sufren los ligamentos y tendones tras largos años de evolución de la enfermedad y al uso prolongado de corticoides 4 . En aquellos pacientes en los que ha sido posible realizar biopsia, se han encontrado anomalías estructurales consistentes en cambios histológicos tales como la disminución del número de células sinoviales, la inf...

  8. First report of multinodular pulmonary fibrosis associated with equine herpesvirus 5 in Belgium

    OpenAIRE

    Verryken, Kirsten; Saey, Veronique; S.; Maes; Borchers, K; Van de Walle, Gerlinde; Ducatelle, Richard; Deprez, Piet

    2010-01-01

    A 20-year-old horse was evaluated for symptoms of weight loss, anorexia, fever and lethargy. Clinical examination revealed tachypnea, poor body condition and increased breath sounds on auscultation. Ultrasound showed multiple consolidations on the lungs. Thoracic radiography revealed a severe nodular pattern. The horse was treated with antibiotics, corticoids and supportive medication. Since no improvement was observed, the horse was euthanized. At necropsy, numerous coalescing fibrous nod...

  9. Síndrome de DRESS asociado a Levetiracetam

    Directory of Open Access Journals (Sweden)

    Moreno Díaz J

    2016-09-01

    Full Text Available El síndrome de DRESS es una toxicodermia asociada a eosinofilia con síntomas sistémicos. Presentamos un caso de dicho síndrome tras inicio de Levetiracetam con buena evolución tras inicio de corticoides y retirada del fármaco. Este síndrome, poco conocido y probablemente infradiagnosticado, puede ser potencialmente letal si no se trata de forma precoz.

  10. Pharmacological Prevention and Reversion of Erectile Dysfunction after Radical Prostatectomy, By Modulation of Nitric Oxide/Cgmp Pathways

    Science.gov (United States)

    2008-03-01

    sparing quality with potency following laparoscopic radical prostatectomy. J Urol. 2008 Apr;179(4):1510-4. 2: Madeb R, Golijanin D, Knopf J, Vicente I...222–227. 23 Perez -Sala D, Cernuda-Morollon E, Diaz-Cazorla M, Rodriguez- Pascual F, Lamas S. Posttranscriptional regulation of human iNOS by the NO...De Nicola AF (1990) Estrogens down-regulate type I but not type II adrenal corticoids receptors in rat anterior pituitary. J Steroid Biochem Mol

  11. Present Concepts in Internal Medicine. Volume 13, Number 1. Endocrinology Research Symposium,

    Science.gov (United States)

    1980-01-01

    have caused overt hyperthyroidism , 14 most have been reported in hypothyroid patients. 15 Presumably long-standing primary hypothyroidism results in...experience (in the absence of conditions causing false positive responses) the presence of elevated urine free cortisol (> 100 Vg/24 h) and lack of...corticoids with normal or subnormal levels of urine 17- ketosteroids. Since adrenal tumors causing Cushing’s syndrome are usually greater than 2 cm in

  12. Tinea incognito due to Trichophyton mentagrophytes: case report

    Directory of Open Access Journals (Sweden)

    Walter Gubelin

    2016-11-01

    Full Text Available Resumen Las tiñas son infecciones frecuentes causadas por dermatofitos, capaces de invadir tejido queratinizado, produciendo placas anulares, eritematosas y descamativas. Sin embargo, en la tiña incógnita esta clínica es modificada por el uso inapropiado de corticoides o inhibidores de calcineurina tópicos, dificultando su diagnóstico. Presentamos el caso de un paciente masculino de 12 años, con lesiones eritematosas localizadas en la región ciliar derecha. Se interpretó como una dermatitis de contacto y se indicaron corticoides tópicos, pero evolucionó con lesiones más inflamatorias. Se obtuvo un cultivo de hongos positivo para Tricophyton mentagrophytes. De este reporte se concluye que las tiñas pueden imitar otras condiciones dermatológicas. Por ende, se debe tener precaución al indicar corticoides o inhibidores de calcineurina tópicos sin una certeza diagnóstica. Ello, debido a que en el caso de corresponder a una tiña, se alteran las características clínicas, dificultando el diagnóstico y manejo.

  13. Co-administration of deflazacort and doxycycline: a potential pharmacotherapy for Duchenne muscular dystrophy.

    Science.gov (United States)

    Pereira, Juliano Alves; Marques, Maria Julia; Santo Neto, Humberto

    2015-07-01

    The standard therapy used in the treatment of Duchenne muscle dystrophy (DMD) is corticoids, such as deflazacort and prednisone. However, they have limited therapeutic value, and their combination with drugs already in use to treat other human diseases could potentially increase corticoid outcomes in DMD. In the present study, we evaluated whether a combined therapy of the corticoid deflazacort with doxycycline could result in greater improvement in mdx dystrophy than deflazacort alone. Deflazacort alone or deflazacort/doxycycline were administered for 36 days (starting on postnatal day 0) in drinking water. Histopathological, biochemical (creatine kinase), functional (forelimb muscle grip strength and fatigue) parameters and inflammatory markers (MMP-9, TNF-α, NF-kB) were evaluated in biceps brachii and diaphragm muscles of the mdx mice. The combined therapy was superior in improving the dystrophic phenotype compared to monotherapy. The primary results were observed in attenuating muscle fatigue, decreasing muscle total calcium and inflammatory markers and increasing β-dystroglycan, a main component of the dystrophin-protein complex. Furthermore, the combined therapy was effective in preventing the loss of body mass observed with deflazacort alone at this very early stage of therapy. The present study offers preclinical data to support further studies with deflazacort/doxycycline combined therapy in DMD clinical trials.

  14. Oxigenoterapia hiperbárica como tratamento adjuvante do pioderma gangrenoso Hyperbaric oxygen therapy as an adjuvant treatment for pyoderma gangrenosum

    Directory of Open Access Journals (Sweden)

    Wilson Albieri Vieira

    2011-12-01

    Full Text Available O pioderma gangrenoso é uma dermatose neutrofílica, rara da pele e do tecido subcutâneo, caracterizada por um processo necrosante progressivo e doloroso. A conduta no Pioderma gangrenoso requer, com frequência, o uso de drogas sistêmicas, tais como: corticoides, sulfonas e imunossupressoras, seja de maneira isolada, seja em combinação. Muitos relatos, na literatura, documentam o tratamento com êxito do Pioderma gangrenoso, com a oxigenoterapia hiperbárica. No nosso caso, uma jovem com lesões extensas e muito dolorosas, o tratamento com oxigenoterapia hiperbárica associado ao corticoide e imunossupressor promoveu cicatrização, com excelente resultado, com fechamento rápido da lesão e diminuição do desconforto.Pyoderma Gangrenosum is a rare neutrophilic dermatosis of skin and subcutaneous tissue characterized by a painful and progressive necrotizing process. The management of pyoderma gangrenosum often requires systemic drug therapy, such as corticosteroids, sulfones or immunosuppressants, either alone or in combination. Several reports in the literature document the successful treatment of pyoderma gangrenosum with hyperbaric oxygen therapy. In our case, hyperbaric oxygen therapy associated with corticoids and immunosuppressants promoted healing of large and very painful lesions in an adolescent girl with an excellent outcome, including rapid wound closure and decreased discomfort.

  15. Evidence for chronic stress in captive but not free-ranging cheetahs (Acinonyx jubatus) based on adrenal morphology and function.

    Science.gov (United States)

    Terio, Karen A; Marker, Laurie; Munson, Linda

    2004-04-01

    The cheetah (Acinonyx jubatus) is highly endangered because of loss of habitat in the wild and failure to thrive in captivity. Cheetahs in zoos reproduce poorly and have high prevalences of unusual diseases that cause morbidity and mortality. These diseases are rarely observed in free-ranging cheetahs but have been documented in cheetahs that have been captured and held in captive settings either temporarily or permanently. Because captivity may be stressful for this species and stress is suspected as contributing to poor health and reproduction, this study aimed to measure chronic stress by comparing baseline concentrations of fecal corticoid metabolites and adrenal gland morphology between captive and free-ranging cheetahs. Additionally, concentrations of estradiol and testosterone metabolites were quantified to determine whether concentrations of gonadal steroids correlated with corticoid concentration and to assure that corticosteroids in the free-ranging samples were not altered by environmental conditions. Concetntrations of fecal corticoids, estradiol, and testosterone were quantified by radioimmunoassay in 20 free-ranging and 20 captive cheetahs from samples collected between 1994 and 1999. Concentrations of baseline fecal corticoids were significantly higher (p = 0.005) in captive cheetahs (196.08 +/- 36.20 ng/g dry feces) than free-ranging cheetahs (71.40 +/- 14.35 ng/g dry feces). Testosterone concentrations were lower in captive male cheetahs (9.09 +/- 2.84 ng/g dry feces) than in free-ranging cheetahs (34.52 +/- 12.11 ng/g dry feces), which suggests suppression by elevated corticoids in the captive males. Evidence for similar sulppression of estradiol concentrations in females was not present. Adrenal corticomedullary ratios were determined on midsagittal sections of adrenal glands from 13 free-ranging and 13 captive cheetahs obtained between 1991 and 2002. The degree of vacuolation of cortical cells in the zona fasciculata was graded for each animal

  16. Intoxicación aguda en perro por toxinas de sapo (Bufo bufo) - Acute intoxication in a dog by toxins of a toad (Bufo bufo)

    OpenAIRE

    2009-01-01

    ResumenLas intoxicaciones por toxinas de sapo no son frecuentes en España y su incidencia es mayor en primavera y verano. En este trabajo describimos un caso de intoxicación aguda de una perra de 4 años de edad tras la aprehensión de un sapo (Bufo bufo) en la zona de Huelva. Los signos de una intoxicación comenzaron a los 15 minutos de entrar en contacto con el sapo muriendo a las 3 horas sin responder al tratamiento suministrado (corticoides, atropina, fluidoterapia y acepromazina). Aunque e...

  17. Dispositivos inhaladores en la EPOC: ¿Cuál utilizar?

    Directory of Open Access Journals (Sweden)

    2015-06-01

    Full Text Available El tratamiento de la EPOC ha experimentado un avance muy notable en los últimos años debido a la aparición de nuevos broncodilatadores. Actualmente se dispone de broncodilatadores y corticoides inhalados que se pueden administrar una sola vez al día y cada 12 horas, con lo que las combinaciones pueden ser múltiples (Tabla 1. Por tanto, somos capaces de individualizar el tratamiento de los pacientes con EPOC de la misma forma que se hace en otras enfermedades crónicas, como la hipertensión arterial o la diabetes mellitus

  18. Factors de risc de mortalitat en la diarrea associada a Clostridium difficile

    OpenAIRE

    Franco Arenaz, María

    2012-01-01

    Identificar els possibles factors de risc de mortalitat en els pacients amb un primer episodi de diarrea associada a Clostridium difficile (DACD) mitjançant un estudi observacional retrospectiu. Després d'una anàlisi uni i multivariant amb les següents variables (sexe, edat, índex de Charlson, número d'antibiòtics previs i la seva retirada, ús de corticoids, inhibidors de la bomba de protons o antihistamínics antiH2, antiàcids, procedència de residència geriàtrica, dies de tractament per a la...

  19. Atlantoaxial joint synovial cyst: diagnosis and percutaneous treatment.

    Science.gov (United States)

    Velán, Osvaldo; Rabadán, Alejandra; Paganini, Lisandro; Langhi, Luciano

    2008-01-01

    Synovial cysts at the atlantoaxial level are found uncommonly. Lumbar symptomatic cases are treated by percutaneous cyst aspiration with or without corticoid injection or by surgical resection, but synovial cysts at the C1-C2 level are usually treated by surgery. We report here a 92-year-old woman with a retro-odontoid synovial cyst producing spinal cord compression that was treated by percutaneous aspiration of the cyst under CT guidance. To our knowledge, this is the first reported case of an atlantoaxial synovial cyst successfully treated with a minimally invasive procedure.

  20. Do antenatal corticosteroids in term elective cesarean sections reduce neonatal respiratory morbidity?

    Directory of Open Access Journals (Sweden)

    Felipe Petour Gazitúa

    2015-10-01

    Full Text Available INTRODUCCIÓN El síndrome de distrés respiratorio neonatal se relaciona con la edad gestacional y vía de parto. Menor edad gestacional y parto vía cesárea se asocian a mayor riesgo. Con lo anterior, surge la necesidad de evaluar estrategias que reduzcan su incidencia. El uso de corticoides antenatales en la inducción de maduración pulmonar en partos prematuros, podría ser beneficioso en fetos de término en que se programe cesárea. OBJETIVO Buscar evidencia bibliográfica que determine si el uso de corticoides antenatales disminuyen la incidencia de síndrome de distrés respiratorio en cesáreas electivas de término. MÉTODOS Se realizó búsqueda de literatura médica en PubMed, LILACS, UpToDate, Trip, SciELO y Cochrane. Se incluyeron estudios terapéuticos aleatorizados y controlados, en humanos, cuya intervención fuera con corticoides en cesáreas electivas de término. RESULTADOS Se seleccionaron dos estudios cuya intervención fueron dos dosis de 12 mg de dexametasona previas a la cesárea. El objetivo primario de ambos estudios fue analizar la incidencia de síndrome de distrés respiratorio y el ingreso a unidad de cuidados intensivos. En ambos hubo menor incidencia de síndrome de distrés respiratorio en el grupo tratado, con resultados estadísticamente significativos. CONCLUSIÓN Se concluye que el uso de corticoides en cesáreas electivas de término disminuye la incidencia de distrés respiratorio e ingreso a unidad de cuidados intensivos. Sin embargo, evidenciamos debilidades que afectan la validez interna de ambos estudios, por lo que es necesario el desarrollo de nuevos estudios que avalen los resultados encontrados para poder cambiar las conductas clínicas en este grupo de estudio.

  1. Acute coronary syndrome after infliximab therapy in a patient with Crohn's disease

    Institute of Scientific and Technical Information of China (English)

    Vasilios Panteris; Anna Perdiou; Vasilios Tsirimpis; Demetrios Georgios Karamanolis

    2006-01-01

    Infliximab is a potent anti-TNF antibody, which is used with great success in Crohn's disease patients. Since its release in clinical practice, several adverse reactions have been observed. The interest in possible consequences of its administration is still high because of the recent introduction of the drug for the long-term maintenance therapy of refractory luminal and fistulizing Crohn's disease. We present a case of acute coronary syndrome (non-STEMI) in a patient with corticoid resistant Crohn's disease after his first dose of infliximab. By reviewing the scant articles that exist in the literature on this topic we made an effort to delineate the possible mechanisms of this phenomenon.

  2. Effectiveness of infliximab in the treatment of perianal fistulas in ulcerative colitis: report of two cases.

    Science.gov (United States)

    de la Piscina, Patricia Ramírez; Duca, Ileana; Estrada, Silvia; Spicakova, Katerina; Calderón, Rosario; Urtasun, Leire; Marra-López, Carlos; Salvador, Marta; Delgado, Elvira; Campos, Francisco García

    2013-01-01

    Ulcerative colitis is a chronic inflammatory bowel disease of unknown etiopathogenesis and increasing incidence in recent years. Perianal complications of ulcerative colitis are rare and seem to be associated with higher extent of inflammation and a more severe course of the disease. The cases of two male patients with severe corticoid-dependent ulcerative colitis of protracted clinical course who developed perianal fistulas and abscesses successfully treated with infliximab are reported. Treatment with infliximab was followed by perianal fistula closure with marked improvement in the quality of life over 2-year follow-up period.

  3. [Corticosteroids and septic shock].

    Science.gov (United States)

    Bouletreau, P; Petit, P; Latarjet, J

    1976-01-01

    According to the data in the literature, the authors attempted to sum-up present attitudes on the value of corticoids in the treatment of septic shock. If their cardiovascular effects after a period of enthusiasm, are presently rather controversial, their cellular and sub-cellular actions, on the lysosomal membranes, capillary permeability and perhaps the intimate mechanisms of cellular oxygenation seem to be more real. However, the contra-indications which persist in the results of clinical works have resulted in the fact that the exact place of cortico-steroids in the therapeutic arsenal of septic shock still remains to be specified.

  4. Púrpura Schönlein Henoch con compromiso renal. Reporte de un caso

    Directory of Open Access Journals (Sweden)

    Cynthia Aguilera M.

    2013-04-01

    Full Text Available INTRODUCCIÓN: El Púrpura Schönlein Henoch es una vasculitis sistémica que afecta principalmente a la piel, articulaciones, sistema gastrointestinal y renal. Es una de las vasculitis más comunes en la infancia. El compromiso renal se da en aproximadamente el 40% de los casos, y en la mayoría se presenta con hematuria, sin embargo, también puede manifestarse como proteinuria, síndrome nefrótico y nefrítico. PRESENTACIÓN DEL CASO: Se presenta el caso de una paciente de 6 años que consulta en Servicio de Urgencia por dolor en el tarso del pie izquierdo de 4 días de evolución, sin antecedentes de trauma, acompañándose de dolor en rodilla izquierda con limitación a la movilización, y lesiones purpúricas en extremidades inferiores. Durante la hospitalización, la paciente presentó al inicio presiones arteriales altas y oliguria, manejándose con antihipertensivos, además del inicio del tratamiento con corticoides. Luego de la mejoría del compromiso articular y cutáneo, se evidenció compromiso renal con proteinuria, que al persistir se aumentó las dosis de corticoides, teniendo favorable respuesta al disminuir sus niveles. Al encontrarse en mejores condiciones, se decidió manejo ambulatorio manteniendo tratamiento corticoidal y antihipertensivo, controlándose en Nefrología y Reumatología Infantil. DISCUSIÓN: Se concluye de este trabajo que la corticoterapia y el manejo de la presión arterial fueron pilares fundamentales para el tratamiento en este caso, mejorando su evolución clínica y principalmente la disminución de la proteinuria con el uso de los corticoides, evitando un compromiso mayor a pesar de que no esté comprobado su beneficio en la literatura.

  5. Asma de difícil control en niños y adolescentes: Estrategias diagnóstico-terapéuticas

    OpenAIRE

    Hugo Neffen; Santiago Vidaurreta; Ana Balanzat; Mónica Silvia De Gennaro; Verónica Giubergia; Maspero, Jorge F; Ricardo J Saranz; Alejandro M Teper

    2012-01-01

    El asma es una de las enfermedades crónicas más frecuentes en los niños. Si bien la mayoría de los niños con asma responden a bajas dosis de corticoides inhalados y/o antagonistas del receptor de leucotrienos, algunos de ellos permanecen sintomáticos independientemente de cualquier esfuerzo terapéutico, presentando una elevada morbilidad e inclusive mortalidad. Aunque la mayoría de los pacientes controlan los síntomas de forma adecuada, existe un grupo importante que presenta síntomas graves ...

  6. Asma de difícil control en niños y adolescentes: Estrategias diagnóstico-terapéuticas Poorly controlled asthma: diagnosis and therapeutics in children and adolescents

    OpenAIRE

    Hugo Neffen; Santiago Vidaurreta; Ana Balanzat; Mónica Silvia De Gennaro; Verónica Giubergia; Maspero, Jorge F; Ricardo J Saranz; Alejandro M Teper

    2012-01-01

    El asma es una de las enfermedades crónicas más frecuentes en los niños. Si bien la mayoría de los niños con asma responden a bajas dosis de corticoides inhalados y/o antagonistas del receptor de leucotrienos, algunos de ellos permanecen sintomáticos independientemente de cualquier esfuerzo terapéutico, presentando una elevada morbilidad e inclusive mortalidad. Aunque la mayoría de los pacientes controlan los síntomas de forma adecuada, existe un grupo importante que presenta síntomas graves ...

  7. Terapia médica actual en reumatología

    Directory of Open Access Journals (Sweden)

    N. María Ángela Carreño, Dra.

    2012-07-01

    Full Text Available El tratamiento médico de las enfermedades reumatológicas ha cambiado en forma importante en las últimas décadas. La aparición de los corticoides en 1948, la incorporación del metotrexato en la década del 90 y últimamente la utilización de medicamentos biológicos, han marcado los hitos más importantes en la historia de la especialidad. En este artículo se revisan los fármacos que actualmente se usan de manera regular en la práctica diaria.

  8. Eficacia de la suplementación con calcifediol en el control del asma en pacientes asmáticos con déficit de vitamina D

    OpenAIRE

    Salinero González, Lourdes

    2016-01-01

    Introducción: Existen numerosos estudios transversales en niños y adultos que indican que los niveles bajos de vitamina D en los pacientes asmáticos se correlacionan con un peor control, una peor función pulmonar, una disminución de la respuesta a glucocorticoides y más frecuentes exacerbaciones. Por otra parte, existe un grupo importante de pacientes asmáticos que presentan un control insuficiente a pesar de altas dosis de corticoides inhalados, ante lo que se han investigado nuevas alternat...

  9. Biomarcadores metabólicos y de inflamación en la obesidad canina y felina en enfermedades asociadas

    OpenAIRE

    Tvarijonaviciute, Asta

    2012-01-01

    En esta Tesis los principales 5 avances que se aportan sobre obesidad en perros y gatos son: 1) Los ensayos comercialmente disponibles para la adiponectina y la IGF-1 funcionan para estas especies. 2) La adiponectina y IGF-1 no están influenciadas por los ciclos de alimentación/ayuno o por corticoides. La adiponectina no se afecta por orquidectomia, mientras que la IGF-1 baja. La inflamación disminuye la adiponectina y la IGF-1. 3) La adiponectina baja en la obesidad, aunque no se aprecia un ...

  10. Tratamiento conservador versus quirurgico de la paraplejia traumática por fracturas torácicas y lumbares.

    OpenAIRE

    Forner Cordero, Isabel

    2005-01-01

    RESUMEN Objetivos: Comparar los resultados del tratamiento conservador y quirúrgico de la paraplejia traumática en cuanto a recuperación neurológica, frecuencia de complicaciones médicas y postoperatorias, los periodos de hospitalización y la cifosis y el dolor a largo plazo. Como objetivos secundarios, intentamos identificar otros factores clínicos relacionados con los resultados y evaluar los beneficios de los corticoides según NASCIS. Material y Método: Estudio de observación anal...

  11. Uso de metilprednisolona versus diclofenaco en el control de la inflamación y el trismo tras la cirugía del tercer molar inferior

    OpenAIRE

    López Carriches, M.C.; Martínez González, José María; Donado Rodríguez, Manuel

    2006-01-01

    Objetivo: Comparar el efecto sobre la inflamación y el trismo de la metilprednisolona (corticoide) versus diclofenaco (antiinflamatorio no esteroideo-AINE-) tras la cirugía del tercer molar inferior. Diseño del estudio: Estudio prospectivo sobre 73 pacientes sometidos a la extracción quirúrgica de los terceros molares inferiores. Fueron divididos de forma aleatoria en dos grupos: De diclofenaco y de metilprednisolona. Se cumplimentó una ficha donde se hizo constar los datos epidemiológicos...

  12. [PFAPA syndrome].

    Science.gov (United States)

    André, Suzete Costa Anjos; Vales, Fernando; Cardoso, Eduardo; Santos, Margarida

    2009-01-01

    PFAPA syndrome is characterized by periodic fever, pharyngitis, cervical adenitis and aphthous stomatitis. The bouts of fever can last for days or even weeks. Between crises, patients remain asymptomatic for variable periods. It appears before the age of five and has limited duration (4-8 years). Its aetiopathogeny is unknown. Corticoids are the treatment of choice. Tonsillectomy has been proposed as a solution but remains controversial. We present the case of a 4-year-old girl with PFAPA syndrome who underwent tonsillectomy in January, 2008, and we review the literature.

  13. Desorientación y cirrosis. No siempre encefalopatía hepática

    OpenAIRE

    Sergio Vázquez Rodríguez; Verónica Lázaro González

    2012-01-01

    Mujer de 49 años de edad, con antecedente de hepatopatía crónica de origen alcohólico e ingreso reciente en nuestro servicio por cuadro clínico compatible con hepatitis alcohólica aguda con criterios de gravedad según índice de Maddrey. Una vez descartada infección concomitante, insuficiencia renal y hemorragia digestiva activa, se inició tratamiento con corticoides a dosis habituales, manteniendo posteriormente dicho tratamiento por mejoría analítica según criterios de Lille.

  14. [Cogan síndrome. Audio-vestibular findings in a patient and literature review].

    Science.gov (United States)

    Pino Rivero, V; Marcos García, M; Trinidad Ruiz, G; González Palomino, A; Pardo Romero, G; Trinidad Ramos, G; Blasco Huelva, A

    2004-01-01

    Cogan Sindrome is described as the association of non-syphilic interstitial keratitis with vestibulo-auditory symptoms in its typical form. We are reporting a case corresponding to a 32 years old male who consulted at first place for ophthalmic clinic and, two months later, affected of bilateral neurosensorial hearing loss with tinnitus and vestibular dysfunction. In spite of the corticoid treatment our patient has not improved. His hearing disorder was even worse after one year-follow up. A bibliographic review has been performed related to this pathology whose etiology is still unknown.

  15. Tratamiento de epicondilitis refractaria con neurotoxina botulínica tipo A libre de complejo proteínico Treament of refractory epicondilitis with botulin neurotoxin type A free of protein complex

    OpenAIRE

    B. Santos; E. Calderón; P. Ordóñez; R. García-Hernández; L. M. Torres

    2013-01-01

    Introducción: La epicondilitis o "codo de tenista" es un cuadro que se caracteriza por dolor en la inserción proximal del músculo extensor radial corto del carpo. El tratamiento de este cuadro clásicamente se ha basado en fisioterapia e infiltración con corticoides, así como el uso de ortesis. La cirugía se recomienda cuando las estrategias conservadoras no controlan los síntomas después de 6-12 meses de tratamiento. La toxina botulínica es una opción terapéutica cuando fracasan medidas conse...

  16. Is there benefit adding antivirals to corticosteroids for Bell’s palsy in adults?

    OpenAIRE

    Benjamín Walbaum; Gabriel Rada

    2015-01-01

    La parálisis de Bell es la primera causa de parálisis facial unilateral. El mecanismo etiológico más probable es una inflamación del nervio facial, probablemente por reactivación viral de la familia herpes simplex y varicela zóster. Los corticoides se consideran el pilar del tratamiento, sin embargo no está claro si la adición de antivirales ofrecería un beneficio adicional. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos ...

  17. Kwashiorkor and coagulation disturbance: atypical presentation of cystic fibrosis

    OpenAIRE

    Sundell,Michelle de Oliveira T.; Daniela Góis Meneses; Antônio Fernando Ribeiro; Elizete Aparecida L. C. Pinto; Gabriel Hessel

    2012-01-01

    OBJETIVO: Enfatizar a apresentação clínica precoce da fibrose cística (FC) em lactente com Kwashiorkor e distúrbio de coagulação, decorrente de hipovitaminose K. DESCRIÇÃO DO CASO: Paciente com três meses e meio, sexo feminino, nascida a termo, peso de 2655g, estatura de 46cm, foi encaminhada para investigação de lesões perineais associadas à monilíase de difícil controle, refratária a diversos antifúngicos e corticoides. Quadro geral caracterizado por baixo ganho ponderal, edema e diarreia. ...

  18. Lengua plicata: debut del síndrome de Melkersson-Rosenthal

    OpenAIRE

    Crespo Escudero, P.; Ibáñez Muñoz, Cristina; Tejero Cavero, M.; Salcedo de la Cruz, W.; Escobar Martínez, M.

    2011-01-01

    [ES] Introducción: De las múltiples causas de parálisis faciales, uni o bilaterales, la gran dominadora es la parálisis de Bell o idiopática (40-75%). Melkersson (1928) y Rosenthal (1930) describieron este síndrome, todavía de etiopatogenia desconocida; algunos autores defienden la hipótesis autoinmune (mejora con corticoides), la infecciosa, o la genética (alteraciones en el brazo corto del cromosoma 9). Se estima una prevalencia entre la población general del 0,08%, sin objetiva...

  19. ¿Hipoacusia súbita?

    OpenAIRE

    Cornejo Sch,Santiago; García M,Raimundo; San Martín P,José

    2010-01-01

    Se presenta un caso de paciente mujer sin antecedentes mórbidos que consulta a nuestro servicio por síntomas sugerentes de hipoacusia súbita. La evaluación audiométrica y prueba calórica era compatible con una parálisis cocleovestibular y dado que no presentaba contraindicaciones, se decide iniciar tratamiento con corticoides y antiviral oral. La evolución inicial fue favorable sin embargo al control del mes presentó un nuevo deterioro audiométrico. Esto motivó mayor estudio con el cual se pu...

  20. EPA protects against muscle damage in the mdx mouse model of Duchenne muscular dystrophy by promoting a shift from the M1 to M2 macrophage phenotype.

    Science.gov (United States)

    Carvalho, Samara Camaçari de; Apolinário, Leticia Montanholi; Matheus, Selma Maria Michelin; Santo Neto, Humberto; Marques, Maria Julia

    2013-11-15

    In dystrophic mdx mice and in Duchenne muscular dystrophy, inflammation contributes to myonecrosis. Previously, we demonstrated that eicosapentaenoic acid (EPA) decreased inflammation and necrosis in dystrophic muscle. In the present study, we examined the effects of EPA and the corticoid deflazacort (DFZ) as modulators of M1 (iNOS-expressing cells) and M2 (CD206-expressing cells) macrophages. Mdx mice (14 days old) received EPA or DFZ for 16 days. The diaphragm, biceps brachii and quadriceps muscles were studied. Immunofluorescence, immunoblotting and ELISA assays showed that EPA increased interleucin-10, reduced interferon-γ and was more effective than DFZ in promoting a shift from M1 to M2.

  1. Intra-Articular Osteoid Osteoma Mimicking Juvenile Arthritis

    Directory of Open Access Journals (Sweden)

    Sidi Yaya Traore

    2014-01-01

    Full Text Available In case of intra-articular osteoid osteoma, misdiagnosis as juvenile arthritis may occur, delaying adequate treatment. We report cases of intra-articular osteoid osteomas in children that were misdiagnosed and initially inappropriately treated with intra-articular corticoid injection. Diagnosis of osteoid osteoma was finally given by CT-scan and appropriate treatment by radiofrequency ablation or surgical ablation was performed. Clinicians and radiologists should be aware of the potentially confusing clinical and imaging findings associated with intra-articular osteoid osteoma.

  2. Moléculas de adhesión endotelial: nuevas dianas terapéuticas en la enfermedad inflamatoria intestinal

    OpenAIRE

    Soriano Izquierdo, Antonio

    2004-01-01

    INTRODUCCIÓN: El tratamiento de la enfermedad inflamatoria intestinal se ha basado en el uso de aminosalicilatos corticoides e inmunosupresores, que ayudan a controlar los brotes de la enfermedad, aunque no consiguen su curación. El bloqueo de las moléculas de adhesión endotelial, que permiten el reclutamiento de leucocitos desde el lecho vascular hacia el área inflamada, podría ser una diana terapéutica útil en esta enfermedad.OBJETIVOS: 1. Determinar el valor de las moléculas de adhesión en...

  3. Chronic unpredictable stress during adolescence causes long-term anxiety.

    Science.gov (United States)

    Chaby, L E; Cavigelli, S A; Hirrlinger, A M; Caruso, M J; Braithwaite, V A

    2015-02-01

    Exposure to stress during adolescence can cause long-term changes in behavior and cognition. Anxiety diagnoses rise during adolescence and are increased by adverse experiences. Currently, it is unknown how long stress during adolescence alters anxiety in adulthood. We found that rats exposed to chronic unpredictable stress during adolescence expressed altered behavior 6.5 months later; showing increased anxiety in a feeding test in a novel environment. Although behavioral changes indicative of anxiety were detected in late adulthood, the basal levels of fecal corticoid metabolites in prior-stressed rats did not differ from unstressed, control rats.

  4. Penfigoide cicatricial, causa poco común de estenosis supraglótica

    OpenAIRE

    Bahamonde, Héctor; Délano R,Paúl H; Albertz A,Nicolás; Valdés P,Constanza

    2008-01-01

    El penfigoide cicatricial o de mucosas es una patología que afecta principalmente a la mucosa oral y ocular. Sólo en 25% de los pacientes afecta también la piel y en alrededor de 10% de los pacientes compromete a la mucosa faringo-laríngea, produciendo en los casos severos disnea que incluso puede requerir traqueostomía. En el tratamiento del penfigoide cicatricial habitualmente se utilizan corticoides e inmunosupresores. En este artículo presentamos un caso de una mujer de 69 años con diagnó...

  5. Evaluación de un modelo experimental de inmunosupresión química en ratones N: NIH-Swiss

    OpenAIRE

    Córdoba, María Alejandra; Del Coco, V.; Sparo, Mónica; Basualdo Farjat, Juan Ángel

    2010-01-01

    La evaluación de infecciones oportunistas de etiología microbiana o parasitaria en animales de laboratorio en calidad de huésped alternativo, exige que éstos se encuentren en condición de inmunosupresión genética o química. Entre los distintos modelos murinos de inmunosupresión química, existen aquellos que utilizan glucocorticoides inoculados oral o intragástricamente. Los corticoides tienen la capacidad de reducir la proliferación y aumentar la apoptosis de células T mediante mecanismos que...

  6. Cerebral salt wasting syndrome: review.

    Science.gov (United States)

    Cerdà-Esteve, M; Cuadrado-Godia, E; Chillaron, J J; Pont-Sunyer, C; Cucurella, G; Fernández, M; Goday, A; Cano-Pérez, J F; Rodríguez-Campello, A; Roquer, J

    2008-06-01

    Hyponatremia is the most frequent electrolyte disorder in critically neurological patients. Cerebral salt wasting syndrome (CSW) is defined as a renal loss of sodium during intracranial disease leading to hyponatremia and a decrease in extracellular fluid volume. The pathogenesis of this disorder is still not completely understood. Sympathetic responses as well as some natriuretic factors play a role in this syndrome. Distinction between SIADH and CSW might be difficult. The essential point is the volemic state. It is necessary to rule out other intermediate causes. Treatment requires volume replacement and maintenance of a positive salt balance. Mineral corticoids may be useful in complicated cases.

  7. [Pediatric emergency: adrenal insufficiency and adrenal crisis].

    Science.gov (United States)

    Martínez, Alicia; Pasqualini, Titania; Stivel, Mirta; Heinrich, Juan Jorge

    2010-04-01

    Adrenal insufficiency is defined by impaired secretion of adrenocortical hormones. It is classified upon the etiology in primary and secondary. Rapid recognition and therapy of adrenocortical crisis are critical to survival. Patients often have nonspecific symptoms: anorexia, vomiting, weakness, fatigue and lethargy. They are followed by hypotension, shock, hypoglicemia, hyponatremia and hyperkalemia. All patients with adrenal insufficiency require urgent fluid reposition, correction of hypoglycemia and glucocorticoid replacement, in order to avoid serious consequences of adrenal crisis. After initial crisis treatment, maintenance dose of corticoids should be indicated. Mineralocorticoids replacement, if necessary, should also be initiated.

  8. Desorientación y cirrosis. No siempre encefalopatía hepática

    Directory of Open Access Journals (Sweden)

    Sergio Vázquez Rodríguez

    2012-09-01

    Full Text Available Mujer de 49 años de edad, con antecedente de hepatopatía crónica de origen alcohólico e ingreso reciente en nuestro servicio por cuadro clínico compatible con hepatitis alcohólica aguda con criterios de gravedad según índice de Maddrey. Una vez descartada infección concomitante, insuficiencia renal y hemorragia digestiva activa, se inició tratamiento con corticoides a dosis habituales, manteniendo posteriormente dicho tratamiento por mejoría analítica según criterios de Lille.

  9. ¿Hipoacusia súbita?

    OpenAIRE

    Cornejo Sch,Santiago; García M,Raimundo; San Martín P,José

    2010-01-01

    Se presenta un caso de paciente mujer sin antecedentes mórbidos que consulta a nuestro servicio por síntomas sugerentes de hipoacusia súbita. La evaluación audiométrica y prueba calórica era compatible con una parálisis cocleovestibular y dado que no presentaba contraindicaciones, se decide iniciar tratamiento con corticoides y antiviral oral. La evolución inicial fue favorable sin embargo al control del mes presentó un nuevo deterioro audiométrico. Esto motivó mayor estudio con el cual se pu...

  10. [Vitamin D. A geriatric updated perspective].

    Science.gov (United States)

    Ribera Casado, José Manuel

    2012-01-01

    The aim of this review is to offer an updated survey about the relationship between old age, vitamin D and different clinical conditions. Two third of people over 65 years has insufficient serum levels of vitamin D (macular degeneration or periodontitis. Also with muscle strength, mobility and physical performance. Vitamin D supplementation has beneficial clinical effects, with a significant reduction of risks, specially in subjects living in nursing-homes and in those treated with corticoids or antireabsortive drugs. These effects are doses dependent. Risk of intoxication is minimal, even with high doses of vitamin.

  11. Síndrome de Tolosa-Hunt

    OpenAIRE

    2016-01-01

    RESUMO A Síndrome de Tolosa Hunt é uma doença rara, cuja etiopatogenia é desconhecida. Apresenta-se como uma oftalmoplegia dolorosa de um ou mais nervos cranianos oculomotores, que regride espontaneamente e responde bem ao tratamento com corticoides. O presente estudo trata-se de um relato de caso de um paciente que apresentou seguidos casos de oftalmoplegias dolorosas, envolvendo o nervo oculomotor e o abducente sendo tratado com corticoesteroides obteve uma resposta dramática. Objetiva-se a...

  12. Estudio de los factores pronósticos en la sarcoidosis: análisis de la persistencia de actividad mediante técnicas multivariantes

    OpenAIRE

    Mañá Rey, Joan Mª

    1990-01-01

    a) INTRODUCCIÓN.La sarcoidosis es una enfermedad cuya evolución puede oscilar desde formas asintomáticas o con eritema nudoso con remisión espontánea, hasta cuadros progresivamente incapacitantes a pesar de un tratamiento con corticoides. La dificultad fundamental se plantea en poder identificar, en la presentación inicial de la enfermedad, aquellos datos que ayuden a establecer un pronóstico y, en consecuencia, a indicar un tratamiento. En la literatura médica sobre el pronóstico se han anal...

  13. Micosis fungoide liquenoide atípica Unusual lichenoid mycosis fungoides

    Directory of Open Access Journals (Sweden)

    F Pulgar

    2011-06-01

    Full Text Available Presentamos un caso de micosis fungoide liquenoide. La paciente presentó prurito intenso, pero con una buena evolución hasta el momento. Tanto clínica como histológicamente se correspondía con un patrón liquenoide, hecho de excepcional frecuencia. Respondió al tratamiento esteroideo tópico de alta potencia.A 53-years-old woman with a lichenoid mycoses fungoides is reported. Both clinical and histological lichenoid pattern was finding, which is unusual. The treatment with high potency corticoids was successfully and the outcome is favorable up to now.

  14. Pancreatitis autoinmune: a propósito de un caso

    Directory of Open Access Journals (Sweden)

    E. Valdivielso Cortázar

    2016-01-01

    Full Text Available La pancreatitis autoinmune (PAI es una patología poco frecuente, aunque con una creciente incidencia en países orientales, si bien esto podría deberse a una mayor tasa de detección. Puede asociarse a otras patologías autoinmunes, y se ha descrito su asociación con la enfermedad sistémica por IgG4. La clínica es variada y el tratamiento habitualmente es médico, mediante corticoides. Se describe un caso clínico diagnosticado.

  15. Luteinizing hormone-dependent Cushing's syndrome in a pet ferret (Mustela putorius furo).

    Science.gov (United States)

    Schoemaker, N J; Kuijten, A M; Galac, S

    2008-04-01

    Hyperadrenocorticism in ferrets is associated with increased circulating concentrations of adrenal androgens, whereas plasma concentrations of cortisol and ACTH are usually not affected. Here, we report on a 5-year-old castrated male pet ferret (Mustela putorius furo) in which the major presenting signs were polyuria and polyphagia. Routine biochemistry values were within their reference ranges. The urinary corticoid:creatinine ratio (UCCR) was increased and the plasma ACTH concentration was suppressed. Abdominal ultrasonography revealed an enlarged right adrenal gland and atrophy of the left adrenal gland. Administration of hCG resulted in an increase of plasma cortisol and androstenedione concentrations. Based on these findings LH/hCG-dependent hypercortisolism and hyperandrogenism were suspected and treatment was started with a depot GnRH-agonist implant containing 9.4mg deslorelin. Within 3 weeks after placement of the implant all clinical signs had disappeared. Three months later the endocrine parameters had normalized, while abdominal ultrasonography revealed that the right adrenal gland had diminished in size and the left adrenal gland was considered of normal size. No recurrences of clinical signs were seen within 2 years after placement of the deslorelin implant. At that time urinary corticoid and plasma hormone concentrations were within their reference ranges, and no further change in the size of the adrenal glands was seen. In conclusion, this is the first confirmed case of LH-dependent hypercortisolism in a ferret that was treated successfully with a depot GnRH-agonist.

  16. Are steroids effective in toxic epidermal necrolysis and Stevens-Johnson syndrome?

    Directory of Open Access Journals (Sweden)

    Rodrigo Meza

    2017-06-01

    Full Text Available Resumen La necrólisis epidérmica tóxica y el síndrome de Stevens-Johnson son reacciones cutáneas adversas graves a medicamentos e infecciones. Los corticoides se describen como una alternativa terapéutica, sin embargo, su uso es aún controvertido. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en múltiples bases de datos, identificamos cuatro revisiones sistemáticas que en conjunto incluyen once estudios primarios que responden la pregunta de interés. Extrajimos los datos y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Concluimos que no está claro si los corticoides disminuyen la mortalidad o la estadía hospitalaria en la necrólisis epidérmica tóxica y el síndrome de Stevens-Johnson porque la certeza de la evidencia es muy baja.

  17. What is the role of corticosteroids in the management of sepsis?

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    Joaquín Jerez

    2016-09-01

    Full Text Available Resumen Durante un episodio de sepsis, el fenómeno de respuesta inflamatoria sistémica desencadena un déficit en la acción y/o secreción de cortisol. Se ha planteado que el uso de corticoides podría tener un rol en el manejo de la sepsis, pero no existe consenso al respecto. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos 16 revisiones sistemáticas que en conjunto incluyen 64 estudios aleatorizados que responden esta pregunta. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Concluimos que el uso de corticoides en cuadros sépticos probablemente favorece la reversión del shock, acorta brevemente la estadía en unidades de cuidado intensivo, y podría disminuir la mortalidad, con escasos efectos adversos clínicamente relevantes.

  18. Impaired up-regulation of type II corticosteroid receptors in hippocampus of aged rats.

    Science.gov (United States)

    Eldridge, J C; Fleenor, D G; Kerr, D S; Landfield, P W

    1989-01-30

    Several recent investigations have reported a decline of rat hippocampal corticosteroid-binding receptors (CSRs) with aging. This decline has been proposed to be an initial cause (through disinhibition) of the elevated adrenal steroid secretion that apparently occurs with aging; however, it could instead be an effect of corticoid elevation (through down-regulation). In order to assess the effects of age on CSR biosynthetic capacity in the absence of down-regulatory influences of endogenous corticoids, as well as to study aging changes in CSR plasticity, we examined the up-regulation of hippocampal CSR that follows adrenalectomy (ADX). The rat hippocampus contains at least two types of CSR binding and differential analysis of types I and II CSR was accomplished by selective displacement of [3H]corticosterone with RU-28362, a specific type II agonist. In young (3 months old) Fischer-344 rat hippocampus, up-regulation of type II binding above 2-day ADX baseline was present by 3-7 days and increased still further by 8-10 days post-ADX; type I CSR density did not change significantly between 1 and 10 days post-ADX. However, in aged (24-26 months old) rats, type II CSR up-regulation did not occur over the 10 day post-ADX period. Thus, the age-related impairment of type II up-regulation may reflect an intrinsic deficit in CSR biosynthesis or lability that is independent of the acute endogenous adrenal steroid environment.

  19. Intoxicación aguda en perro por toxinas de sapo (Bufo bufo - Acute intoxication in a dog by toxins of a toad (Bufo bufo

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    Fernández-Palacios, O´Connor, Rocío

    2009-04-01

    Full Text Available ResumenLas intoxicaciones por toxinas de sapo no son frecuentes en España y su incidencia es mayor en primavera y verano. En este trabajo describimos un caso de intoxicación aguda de una perra de 4 años de edad tras la aprehensión de un sapo (Bufo bufo en la zona de Huelva. Los signos de una intoxicación comenzaron a los 15 minutos de entrar en contacto con el sapo muriendo a las 3 horas sin responder al tratamiento suministrado (corticoides, atropina, fluidoterapia y acepromazina. Aunque el diagnóstico fue precoz, a pesar del tratamiento se produjo la muerte en 3 horas.SummaryIntoxications by toad toxins are not frequent in Spain, and its incidence is greater in spring and summer. In this work it is described a case of an acute intoxication of a dog of 4 years old by toad toxins (Bufo bufo in the area of Huelva. The animal began to show signs of intoxication 15 minutes after the contact with the toad, dying 3 hours later without any response to the provided treatment (corticoids, atropine, fluidotherapy and acepromazine. Although the diagnosis was precocious and the treatment was administrated, after 3 hours the animal died.

  20. Evidence and recommendation. Is intratympanic corticosteroid treatment of sudden hearing loss effective?

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    José Luis PARDAL-REFOYO

    2016-03-01

    Full Text Available Introduction and objective: It is considered that treatment with systemic corticosteroid (SC orally is preferred in sudden deafness and intratympanic injection of corticosteroid (ITC can be used as an alternative. PICO question: In an adult with no improvement sudden deafness or partial hearing improvement [patient], does treatment with intratympanic corticoid [intervention] compared with conventional treatment [compared] improve hearing? [result]. Material and Methods: Literature search in PubMed, Scopus and Cochrane meta-analysis of published data including descriptors: deafness, hearing loss, steroids, corticoids, intratympanic. Selected studies in adult humans, in Spanish or English that included meta-analysis. Results: Level of evidence: Evidence is high for the use of ITC as rescue therapy in patients undergoing SC without response or partial response. The evidence is moderate for the use of ITC as initial therapy given the poor quality of published studies. What is more, the evidence is high against the use of ITC as initial therapy. Conclusions: Recommendation: The recommendation is strongly in favor of ITC as rescue therapy in patients with little or no response to SC treatment. The recommendation is weak against ITC perform as first-line treatment.

  1. [Anti-NMDA receptor encephalitis: two paediatric cases].

    Science.gov (United States)

    González-Toro, M Cristina; Jadraque-Rodríguez, Rocío; Sempere-Pérez, Ángela; Martínez-Pastor, Pedro; Jover-Cerdá, Jenaro; Gómez-Gosálvez, Francisco

    2013-12-01

    Introduccion. La encefalitis asociada a anticuerpos antirreceptores de N-metil-D-aspartato (NMDA) es una patologia neurologica autoinmune documentada en la poblacion pediatrica de manera creciente en los ultimos años. Se presentan dos casos de nuestra experiencia con clinica similar. Casos clinicos. Caso 1: niña de 5 años que inicia un cuadro de convulsiones y alteracion de conciencia, asociando trastornos del movimiento y regresion de habilidades previamente adquiridas que evoluciona a autismo. Caso 2: niña de 13 años que presenta hemiparesia izquierda, movimientos anomalos, trastorno de conducta y disautonomia. En ambos casos se obtienen anticuerpos antirreceptores de NMDA positivos en el liquido cefalorraquideo y se diagnostican de encefalitis antirreceptor de NMDA. En el primer caso se inicia el tratamiento con perfusion intravenosa de corticoides e inmunoglobulinas y es necesario asociar rituximab. En el segundo, corticoides e inmunoglobulinas. La evolucion fue favorable en ambas pacientes, con una leve alteracion del lenguaje como secuela en el primer caso y una recaida en el segundo caso, con resolucion completa. Conclusion. La encefalitis antirreceptor de NMDA es un trastorno tratable y es importante el diagnostico y tratamiento precoz, ya que mejora el pronostico y disminuye las recaidas.

  2. Cytochrome P450-mediated metabolic alterations in preeclampsia evaluated by quantitative steroid signatures.

    Science.gov (United States)

    Moon, Ju-Yeon; Moon, Myeong Hee; Kim, Ki Tae; Jeong, Dae Hoon; Kim, Young Nam; Chung, Bong Chul; Choi, Man Ho

    2014-01-01

    Although preeclampsia has been suggested potential risk factors including placental and systemic inflammation, oxidative stress, and abnormal steroid metabolism during pregnancy, the pathogenesis of preeclampsia has not fully been elucidated, particularly in steroid metabolism. The association between various cytochrome P450 (CYP)-mediated steroid metabolic markers and preeclampsia risk was therefore investigated. The serum levels of 54 CYP-mediated regioselective hydroxysteroids and their substrates were quantitatively evaluated from both pregnant women with preeclampsia (n=30; age, 30.8±4.5 years) and normotensive controls (n=30; age, 31.0±3.5 years), who were similar with respect to maternal age, gestational age, and body mass index. The levels of 6ß-, 7a-, and 11ß-hydroxymetabolites of androgens and corticoids were significantly increased in women with preeclampsia. In addition, the levels of oxysterols, including 7a-, 7ß-, 4ß-, 20a-, 24S-, and 27-hydroxycholesterol, were markedly higher, while the levels of 16a-OH-DHEA, 16a-OH-androstenedione, and cholesterol were significantly decreased in patients. The 6ß-hydroxylation of androgens and corticoids by CYP3A4 (P2.0-fold) were positively correlated with the conditions of preeclampsia. Our metabolic profiling suggests the CYP-mediated alterations in steroid metabolism and hydroxylation in pregnancy-induced hypertension. These multiple markers could serve as background information for improved clinical diagnosis and management during pregnancy. This article is part of a Special Issue entitled "Pregnancy and Steroids".

  3. Síndrome de Melkersson Rosenthal: reporte de un caso y revisión de la literatura Melkersson-Rosenthal syndrome: case report and literature review

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    R. Cosmelli Maturana

    2008-10-01

    Full Text Available El Síndrome de Melkersson Rosenthal se describe como la asociación de edema labial (queilitis granulomatosa de Miescher y/o facial recurrente, parálisis facial recidivante y lengua fisurada. El edema labial recurrente se presenta en uno o ambos labios, el cual puede llegar a ser persistente. Cuando se presenta en forma aislada se considera como una forma monosintomatica de este síndrome. El objetivo de esta revisión es mostrar el seguimiento de un caso clínico atendido en nuestro servicio con el diagnóstico síndrome de Melkersson Rosenthal que presenta una gran queilitis granulomatosa asociada a lengua fisurada, cuyo tratamiento consistió en la infiltración de corticoides intralesionales y una posterior queiloplastía.Melkersson-Rosenthal syndrome is described as the association of recurrent lip edema (Miescher’s cheilitis granulomatosa and/or facial edema, recurrent facial paralysis, and plicated tongue. Recurrent edema occurs in one or both lips, and can be persistent. When lip edema alone occurs, the case is considered a monosymptomatic form of this syndrome. The aim of this review was to discuss the follow-up of a patient seen in our department with the diagnosis of Melkersson-Rosenthal syndrome who presented intense cheilitis granulomatosa associated with plicated tongue. The patient was treated with infiltration of intralesional corticoids and later cheiloplasty.

  4. Osteoporosis grave con aplastamientos vertebrales en dermatomiositis juvenil: Efecto del tratamiento con alendronato oral Severe osteoporosis with vertebral crushes in juvenile dermatomyositis: Effect of oral alendronate therapy

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    Cristina Tau

    2007-02-01

    Full Text Available Los glucocorticoides son usados comúnmente para el tratamiento de enfermedades inflamatorias, autoinmunes, enfermedades malignas, y en la prevención de rechazo de órganos trasplantados. Un efecto secundario frecuente del tratamiento prolongado es la pérdida de masa ósea que se produce por varios mecanismos y es causa de osteoporosis y fracturas vertebrales. El tratamiento con disfosfonatos ha sido propuesto para esta situación. Presentamos un caso clínico de osteoporosis grave en una niña con dermatomiositis juvenil, que respondió favorablemente al tratamiento con disfosfonatos orales.Glucocorticoids are used for the treatment of inflammatory and autoimmune diseases, cancer, and in prevention of organ rejects. A frequent secondary effect of longterm treatment with corticoids is the loss of bone mass, caused by several mechanisms: decrease in the intestinal calcium absorption, increase of the renal calcium excretion at the distal renal tubule, suppressive effect on the osteoblast and also in apoptosis of osteoclasts, inhibition in local production of IGF I (Insulin-like growth factor and IGFBPs (binding IGF I proteins necessary for bone metabolism, and decrease on osteocalcin production. Longterm treatment with corticoids is associated with osteoporosis and vertebral fractures. To improve this condition, treatment with bisphosphonates has been proposed. We present here a clinical case of a girl with dermatomyositis and severe osteoporosis with vertebral crushes, who responded well to oral bisphophonate treatment.

  5. Testicular adrenal rest tumor in infertile man with congenital adrenal hyperplasia: case report and literature review

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    Giovanni Scala Marchini

    Full Text Available CONTEXT: Synthesis of cortisol and aldosterone is impaired in patients with congenital adrenal hyperplasia (CAH because of 21-hydroxylase deficiency. Men with CAH have low fertility rates compared with the normal population, and this is related to testicular adrenal rest tumors. Findings of azoospermia in combination with a testicular tumor on ultrasound are likely to have a mechanical cause, especially when in the testicular mediastinum. The preferred treatment method consists of intensive corticoid therapy. However, when the tumor is unresponsive to steroid therapy, surgical treatment should be considered. CASE REPORT: We present the case of a male patient with CAH due to 21-hydroxylase deficiency who presented a testicular tumor and azoospermia. Treatment with low daily corticoid doses had previously been started by an endocrinologist, but after 12 months, no significant change in sperm count was found. Although the adrenocorticotrophic hormone and 17-hydroxyprogesterone levels returned to normal values, the follicle-stimulating hormone (FSH, luteinizing hormone and testosterone levels remained unchanged. Ultrasound examination confirmed that the testicles were small and heterogenous bilaterally, and revealed a mosaic area at the projection of the testis network bilaterally. Magnetic resonance imaging confirmed the finding. Testicular biopsy revealed the presence of preserved spermatogenesis and spermiogenesis in 20% of the seminiferous tubules in the right testicle. The patient underwent testis-sparing tumor resection. After 12 months of follow-up, there was no tumor recurrence but the patient still presented azoospermia and joined an intracytoplasmic sperm injection program.

  6. [Castleman disease].

    Science.gov (United States)

    Belletti, Gerardo A; Savio, Verónica; Minoldo, Daniel; Caminos, Susana; Yorio, Marcelo A

    2004-01-01

    A 66 years female, who was since last year under astenia, arthralgias, pimply lesions in spread plates and tests showing eritrosedimentation over 100 mm, anemi, leucocitosis with neutrofilia, policlonal hypergammaglobulinemia, slight proteinuria and IgE on 900. This patient was sporadically treated with corticoids. When made the medical consult had lost 34lb., was under anorexy, as well as dyspepsia. Hemoglobyn 6.9 gr/dl, leucocytes 20000/mm3, neutrofils at 90%, proteinogram the same as former, with hypoalbuminemia. She was taking prednisona, 16 mg/day. When examined showed depress of conscience, astenia, and dermic lesions already quoted. 4 cm nonpainful right axillary adenopaty adhered to deep planes. Medulogram with increased iron, hyperegenerative. Ganglionar biopsia: linfoid hyperplasic process linked to inmune response. Toracoabdominal tomography with adenomegalia in torax and retroperitoneo. Skin biopsia: neutrofilic vasculitis. The patient suspends the 16 mg of prednisona and fever as well as generalized adenopatias come up. After laying aside other ethiologies, and understanding as Castleman Multicentric disease, it is started to supply prednisona 1 mg/kg of weight with a clinical and biochemical fast and outstanding response. After 7 months it was progressively suspended the esteroids and 60 days later, the process fall back; for that, corticoids are restarted, with a good evolution. The illness of Castleman although it is not very frequent, it should be considered as differential diagnosis in those clinical cases that are accompanied with important general commitment, linphadenopaties and respons to steroid therapy.

  7. Implementation of anaphylaxis management guidelines: a register-based study.

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    Linus Grabenhenrich

    Full Text Available BACKGROUND: Anaphylaxis management guidelines recommend the use of intramuscular adrenaline in severe reactions, complemented by antihistamines and corticoids; secondary prevention includes allergen avoidance and provision of self-applicable first aid drugs. Gaps between recommendations and their implementation have been reported, but only in confined settings. Hence, we analysed nation-wide data on the management of anaphylaxis, evaluating the implementation of guidelines. METHODS: Within the anaphylaxis registry, allergy referral centres across Germany, Austria and Switzerland provided data on severe anaphylaxis cases. Based on patient records, details on reaction circumstances, diagnostic workup and treatment were collected via online questionnaire. Report of anaphylaxis through emergency physicians allowed for validation of registry data. RESULTS: 2114 severe anaphylaxis patients from 58 centres were included. 8% received adrenaline intravenously, 4% intramuscularly; 50% antihistamines, and 51% corticoids. Validation data indicated moderate underreporting of first aid drugs in the Registry. 20% received specific instructions at the time of the reaction; 81% were provided with prophylactic first aid drugs at any time. CONCLUSION: There is a distinct discrepancy between current anaphylaxis management guidelines and their implementation. To improve patient care, a revised approach for medical education and training on the management of severe anaphylaxis is warranted.

  8. Are intraarticular steroids effective for knee osteoarthritis?

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    Jorge Faúndez

    2016-12-01

    Full Text Available Resumen La artrosis de rodilla es una enfermedad crónica, invalidante, de evolución progresiva e irreversible. Los corticoides intraarticulares han sido comúnmente utilizados con el fin de disminuir sus síntomas y retrasar la resolución quirúrgica. Sin embargo, hasta el día de hoy, existe debate sobre su eficacia y seguridad. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, se identificaron 12 revisiones sistemáticas que en conjunto incluyen 41 estudios que contestan la pregunta de interés, entre los cuales se cuentan 40 estudios aleatorizados. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Concluimos que los corticoides intraarticulares probablemente llevan a una leve disminución del dolor a corto plazo, hacen poca o ninguna diferencia a mediano plazo y podrían no tener ningún efecto a largo plazo.

  9. Progresión a necrólisis epidérmica tóxica por uso de lamotrigina: A propósito de un caso Progression to toxic epidermal necrolysis by using lamotrigina: In connection of a case

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    M X Andreoli

    2008-09-01

    Full Text Available El Síndrome de Stevens Johnson (SSJ, el Síndrome de Superposición (SSJ/ NET y la Necrólisis Epidérmica Tóxica (NET son formas clínicas cutáneo-mucosas graves, desencadenadas por fármacos y muy frecuentemente por anticonvulsivantes. Comunicamos el caso de una paciente medicada por su epilepsia, quién presentó un cuadro incipiente de SSJ empeorando rápidamente hasta derivar en la NET. A pesar de la gravedad, la paciente respondió satisfactoriamente a altas dosis de corticoides sistémicos desde el comienzo y por las medidas de soporte del equipo médico multidisciplinario del hospital.The Stevens Johnson Syndrome, the Overlape Syndrome (SSJ / NET, and the Toxic Epidermal Necrolysis are clinical cutaneous mucouse forms due to drugs administration and most frequently due caused by antiepileptic. We communicate the case of a patient treated with lamotrigina for epilepsy, who presented an incipient case of Stevens Johnson Syndrome, worsened rapidly causing a Toxic Epidermal Necrolysis. Nevertheless, the patient gained a satisfactory answer due to high doses of corticoids, which were given from the beginning as well as the measures and the support of the whole medical team of the hospital.

  10. What is the effectiveness of systemic corticosteroids in children with croup?

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    Elizabeth Muñoz-Osores

    2017-06-01

    Full Text Available Resumen Los corticoides sistémicos constituyen un tratamiento habitual en los niños con laringitis aguda obstructiva (croup, sin embargo, no se conoce exactamente cuál es la magnitud de los beneficios y riesgos asociados a su uso. Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud a nivel mundial, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Identificamos seis revisiones sistemáticas que en conjunto incluyen 25 estudios aleatorizados pertinentes. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos tablas de resumen de los resultados utilizando el método GRADE. Concluimos que el uso de corticoides sistémicos aumenta la cantidad de pacientes con mejoría clínica a las 12 horas y disminuye el riesgo de readmisión.

  11. Is there benefit adding antivirals to corticosteroids for Bell’s palsy in adults?

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    Benjamín Walbaum

    2015-08-01

    Full Text Available La parálisis de Bell es la primera causa de parálisis facial unilateral. El mecanismo etiológico más probable es una inflamación del nervio facial, probablemente por reactivación viral de la familia herpes simplex y varicela zóster. Los corticoides se consideran el pilar del tratamiento, sin embargo no está claro si la adición de antivirales ofrecería un beneficio adicional. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos 10 revisiones sistemáticas que en conjunto incluyen 16 estudios controlados aleatorizados. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Concluimos que la adición de antivirales al tratamiento con corticoides probablemente reduce el riesgo de recuperación incompleta en pacientes con parálisis de Bell.

  12. [Pharmacotherapy for tinnitus: much ado about nothing].

    Science.gov (United States)

    Espinosa-Sánchez, Juan M; Heitzmann-Hernández, Teresa; López-Escámez, José A

    2014-08-16

    Introduccion. El 5-15% de la poblacion general presenta acufenos cronicos, que afectan de manera grave a la calidad de vida del 1% de los casos. El tratamiento farmacologico es una de las opciones terapeuticas en el abordaje de pacientes con acufenos, aunque su eficacia es controvertida. Objetivo. Evaluar el nivel de evidencia que sustenta el uso de diferentes farmacos para reducir la intensidad de los acufenos. Desarrollo. Se han revisado varios grupos farmacologicos incluyendo anestesicos, antiepilepticos, antidepresivos, antihistaminicos, benzodiacepinas, diureticos, corticoides y otras sustancias. La lidocaina intravenosa parece ser eficaz aunque la breve duracion de su efecto y la aparicion de reacciones adversas han llevado a descartarla. La carbamacepina y la gabapentina no han mostrado eficacia frente a placebo, si bien podrian ser eficaces en algunos pacientes con compresion neurovascular o mioclonias. Los antidepresivos triciclicos no son mas eficaces que el placebo aunque pueden mejorar una depresion coexistente. La evidencia es insuficiente para evaluar la eficacia de los inhibidores selectivos de la recaptacion de serotonina y las benzodiacepinas. El acamprosato podria reducir la intensidad de los acufenos, aunque el nivel de evidencia es bajo. No disponemos de resultados consistentes para el tratamiento de los acufenos de la enfermedad de Meniere empleando gentamicina intratimpanica o corticoides. Conclusiones. La utilizacion de medicamentos para reducir la intensidad de los acufenos no esta bien apoyada por ensayos clinicos controlados, aleatorizados y prospectivos. Algunos farmacos son eficaces en algunos estudios, pero la evidencia es limitada. Se necesitan ensayos clinicos aleatorizados mas amplios.

  13. Miescher's cheilitis granulomatosa. A presentation of five cases.

    Science.gov (United States)

    Camacho-Alonso, Favio; Bermejo-Fenoll, Ambrosio; López-Jornet, Pía

    2004-01-01

    Miescher's cheilitis granulomatosa (CG) consists of the appearance of recurrent labial edema on one or both lips, which can become persistent. It has traditionally been considered as a monosymptomatic form of the Melkersson-Rosenthal syndrome, described as the association of recurrent labial and/or recurrent facial edema, relapsing facial paralysis and fissured tongue. The aim of this study is to present a series of five clinically and histopathologically diagnosed cases of CG that came to our clinic at the Teaching Unit of Oral Medicine, Faculty of Medicine and Odontology, University of Murcia. A complete study of these patients evaluated the age, sex, family history, and location and course of the signs and symptoms. Various complementary examinations were carried out, studying the hematic characteristics (hemogram, erythrocyte sedimentation rate, leukocyte count), including immunological and histopathological studies. The treatment consisted of intralesional corticoids, combined in some cases with anti-leprous drugs or systemic corticoids. A good response to treatment was obtained in all cases.

  14. Prevalência e gravidade da sibilância no primeiro ano de vida no município de Santo André

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    Isabel Cristina C. Ferreira

    2014-09-01

    Full Text Available Objetivo: Verificar a prevalência e a gravidade da sibilância no primeiro ano de vida em lactentes no município de Santo André. Métodos: Estudo transversal com aplicação de questionário escrito, padronizado e validado do estudo EISL (do espanhol: Estudio Internacional de Sibilancias en Lactantes aos pais e/ou responsáveis por lactentes de 12 a 24 meses de idade, em unidades básicas de saúde, durante campanhas de vacinação em creches e escolas maternais. O questionário consiste de questões sobre características demográficas, presença de sibilância, infecções respiratórias e fatores de risco. Os dados obtidos foram analisados com o Statistical Package for the Social Sciences for Windows, versão 20.0 (SPSS inc., Chicago, Il, EUA. A regressão logística foi aplicada para analisar as variáveis associadas à presença de sibilos recorrentes. Resultados: Do total de 1.028 lactentes estudados, 48,5% apresentaram um ou mais episódios de sibilância nos primeiros 12 meses de vida (sibilância alguma vez e 23,9%, três ou mais episódios (sibilância recorrente. Sintomas noturnos, dificuldade intensa para respirar e visitas à emergência estiveram presentes em 67,3%, 42,4% e 60,7% dos lactentes, respectivamente, sendo que 19,4% foram hospitalizados e 11,0% tiveram diagnóstico médico de asma. O uso de β2-agonistas, corticoides inalatórios, corticoides orais e antagonistas do receptor de leucotrienos foram observados em 88,8%, 21,0%, 54,9% e 3,2% das crianças com sibilância, respectivamente. Uso de corticoide oral, percepção de falta de ar pelos pais, diagnóstico de asma, pneumonia e hospitalização por pneumonia foram mais frequentes entre os sibilantes recorrentes (p<0,001. Conclusões: No município de Santo André, cerca da metade dos lactentes estudados apresentava pelo menos um episódio de sibilância no primeiro ano de vida, e metade deles apresentou sibilância recorrente, com início precoce e alta morbidade.

  15. Radiolytic degradation scheme for 60Co-irradiated corticosteroids

    Energy Technology Data Exchange (ETDEWEB)

    Kane, M.P.; Tsuji, K.

    1983-01-01

    The cobalt 60 radiolytic degradation products have been identified in the following corticosteroids: cortisone, cortisone acetate, hydrocortisone, hydrocortisone acetate, hydrocortisone sodium succinate, isoflupredone acetate, methylprednisolone, methylprednisolone acetate, prednisolone, prednisolone acetate, and prednisone. Two major types of degradation processes have been identified: loss of the corticoid side chain on the D-ring to produce the C-17 ketone and conversion of the C-11 alcohol, if present, to the C-11 ketone. Minor degradation products derived from other changes affecting the side chain are also identified in several corticosteroids. These compounds are frequently associated in corticosteroids as process impurities or degradation compounds. No new radiolytic compounds unique to 60Co-irradiation have been found. The majority of corticosteroids have been shown to be stable to 60Co-irradiation. The rates of radiolytic degradation ranged from 0.2 to 1.4%/Mrad.

  16. Miliary tuberculosis in the XXI century - a case report

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    Liliana Pinho

    2016-03-01

    Full Text Available Introduction: Tuberculosis is still a serious public health problem. Young age and HIV infection are important risk factors for severe or disseminated disease. Case report: We report the case of a three-year-old girl who presented a prolonged fever without a source on physical examination. Initial laboratory fi ndings were suggestive of urinary tract infection and empirical antibiotic therapy was started. Urine culture confi rmed that diagnosis, but fever had persisted. On complementary investigation, chest X-ray revealed an< infiltrate with a miliary pattern. Mycobacterium tuberculosis was isolated on gastric aspirate, cerebrospinal fluid and urine. Antituberculous therapy and corticoid were initiated with signifi cant clinical improvement. Conclusions: Even in this era of advanced medical technology, tuberculosis is still a diagnostic challenge, especially when the presentation is atypical and extra-pulmonary. A high index of suspicion by the physician is required because prompt institution of adequate treatment is decisive for fi nal outcome.

  17. [Treatment with montelukast in children with asthma. Test trial].

    Science.gov (United States)

    Pérez, O

    2000-01-01

    To study of antileukotrienes with participation in the genesis of the asthma appeared in the last years. 17 children with a mean age of 10.29 years, male seven and ten girls. They were tried with montelukast 5 mg/day the 12-year-old smellers and with 10 mg/day the such age greats, during a period middle to 5.7 months. Ten of they had a concomitant treatment fluticasona, budesonide, salmeterol or formoterol. Was valued the clinic improvement, the saving in medication and the sound effects. a) Clinic improvement in 82.3%; b) elimination of medication associated in 90% and c) sound effects: in a case drowsiness and in other abdominal pain. Montelukast seems be a very useful product in the treatment of the bronchial asthma in children since generates a saving of corticoids and longtime beta 2 in the mild or moderate asthma, associate or not with the inmunoterapia.

  18. CASE-CONTROL STUDY FOR HOSPITAL INFECTIONS CAUSED BY GRAM-NEGATIVE BACILLI IN EMERGENCY INTENSIVE CARE UNIT

    Institute of Scientific and Technical Information of China (English)

    伍育旗; 余旻; 单红卫; 钱民; 张新黎; 吕晓玲; 程群霞; 杨兴易

    2013-01-01

    <正>Objective To evaluate the potential patient factors associated with hospital infections caused by gram-negative bacilli in Emergency Intensive Care Unit(EICU).Methods A total of 146 patients with hospital infections were investigated.The method of retrospective case-control study and multivariable logistic regression analysis were adopted.Results Univariate analysis revealed relationship among numerous patient factors,and multivariate analysis revealed four factors to be associated independently with hospital infections caused by gram-negative bacilli:mechanical ventilation,corticoid use, length of stay,and coma.Conclusion The comprehensive preventive measures should be taken to deal with the risk factor of hospital infections in EICU.

  19. A Rare Case of Isolated Cerebral Sarcoidosis Presenting as Suprasellar Mass Lesion with Salt-Wasting Hypopituitarism.

    Science.gov (United States)

    Krenzlin, H; Jussen, D; Musahl, C; Scheil-Bertram, S; Wernecke, K; Horn, P

    2015-07-01

    Background Sarcoidosis is a systemic disorder of unknown origin characterized by noncaseating granulomas. Clinical symptoms due to central nervous system (CNS) involvement occur in 5 to 7% of all cases; subclinical involvement is more frequent. Sole CNS involvement is very rare. Case Report A 25-year-old man presented with increasing polyuria and polydipsia over 8 weeks. Magnetic resonance imaging (MRI) revealed a supra- and infra-chiasmatic pre-thalamic mass lesion 1.0 × 1.4 × 1.4cm in diameter. Microsurgical biopsy verified a necrotizing noncaseating epithelioid cell tumor indicative for neurosarcoidosis. All symptoms dissolved within 3 months under stringent corticoid therapy. Conclusion Intracranial mass lesions as the primary and only manifestation of neuronal sarcoidosis are rare. Because conservative treatment is safe and effective, surgery is limited to biopsy and the alleviation of pressure-related symptoms to preserve neurologic function.

  20. Insuficiencia renal crónica y crecimiento

    Directory of Open Access Journals (Sweden)

    T. Pasqualini

    2003-12-01

    Full Text Available El retardo de crecimiento es uno de los mayores problemas de los niños con insuficiencia renal crónica (IRC. En 77% de los varones y 71% de las mujeres con IRC diagnosticada durante la niñez, la altura adulta se halla por debajo del percentilo 3. Los factores que influencian el crecimiento antes del trasplante (Tx son las alteraciones nutricionales, metabólicas y endocrinas; post Tx: la terapia corticoidea inmunosupresora y la alteración de la función del injerto. Sesenta a 64% de los niños llegan al Tx renal con gran deterioro de talla (mediana de talla -2.5 desvíos estándar, DS, no existiendo diferencia entre el DS de talla en el momento del Tx y el DS de talla adulta. Para mejorar el crecimiento post Tx renal, se ha intentado disminuir la dosis de corticoides, administrarlos en días alternos o utilizar corticoides con menos efectos sobre el crecimiento como el deflazacort. Varios estudios demostraron que el tratamiento con hormona de crecimiento (GH es efectivo y esto condujo a que el FDA (Food and Drug Administration lo aprobara como tratamiento de los niños, antes de ser sometidos al Tx renal. La magnitud del aumento de la velocidad de crecimiento es mayor durante el tratamiento conservador, post Tx algo menor, observándose la menor respuesta durante la diálisis. Asimismo, la ganancia de talla se correlaciona con mayor duración del tratamiento con GH durante la etapa prepuberal. Como conclusión, si el deterioro de talla es importante, lo ideal es comenzar el tratamiento a edades tempranas, en la etapa del tratamiento conservador, tratar de acortar el tiempo de diálisis, lograr una talla mejor al momento del Tx, teniendo en cuenta que la talla final está fuertemente relacionada con la talla alcanzada al momento del primer Tx.Many children with chronic renal insufficiency (CRI show growth retardation. Our objective is to describe the natural history of growth in patients with CRI, its pathogenesis and its optimization. Final

  1. [Leading symptom shoulder pain].

    Science.gov (United States)

    Wittke, R

    2003-09-25

    Pain in the shoulder should prompt a systematic clinical examination that adheres closely to the functional anatomy. The basic examination of the shoulder joint comprises active and passive movements and isometric resistance tests with the aid of which external and internal rotation and abduction/adduction can be investigated. The results of these tests provide the physician with a "pattern of findings" which unequivocally identifies the pain-triggering structure. Accordingly, shoulder pain can be classified into four categories as proposed by Cyriax. As treatment, intra-articular injections of corticoids or local anesthetics as determined by findings, where necessary supported by physiotherapeutic measures. Rupture of a tendon, in particular in the case of an active patient, is an indication for surgery.

  2. Policondrite recidivante: relato de caso Relapsing polichondritis: a case report

    Directory of Open Access Journals (Sweden)

    Emerson M. Rodrigues

    2003-01-01

    Full Text Available A policondrite recidivante é uma doença inflamatória sistêmica, que causa destruição dos tecidos cartilaginosos, cuja etiologia acredita-se ser de natureza auto-imune. Acomete, principalmente, cartilagem auricular, nasal e articular. O diagnóstico pode ser confirmado por biópsia. Os autores fazem uma revisão da literatura e relatam o caso de um paciente portador de policondrite recidivante que respondeu ao uso de corticoterapia.Relapsing polychondritis is an inflammatory systemic disease leading to cartilage destruction. It is thought to be an auto-immune pathology. The auricular, nasal and articular chondrous tissues are the most affected ones. Biopsy can confirm the diagnosis. The authors review the literature and describe one case that was well controlled with corticoid therapy.

  3. Montmorillonite Clay-Based Polyurethane Nanocomposite As Local Triamcinolone Acetonide Delivery System

    Directory of Open Access Journals (Sweden)

    Flávia Carmo Horta Pinto

    2011-01-01

    Full Text Available Biodegradable polyurethane was synthesized by preparing aqueous polyurethane dispersion having poly(caprolactone and poly(ethylene glycol as soft segments. Montmorillonite particles were delaminated within the waterborne polyurethane to produce a nanocomposite. The triamcinolone acetonide (TA, an important corticoid drug, was dispersed into the nanocomposite followed by a drying step to produce an implantable drug delivery system. Infrared (FTIR results demonstrated that the original chemical structure of the TA was preserved after incorporation into the nanocomposite. Wide angle (WAXS and small angle X-ray scattering (SAXS results suggested that TA and clay do not dramatically change the morphology phase of the polymer although they can interact with each other. The presence of montmorillonite particles in the nanocomposite reduced the rate of TA release as compared to the pure polyurethane and enhanced the mechanical properties of the polymer. The overall results indicate that montmorillonite clay-based polyurethane nanocomposite could be potentially applied as local TA delivery system.

  4. 'Femoral head necrosis' in metabolic and hormonal osteopathies

    Energy Technology Data Exchange (ETDEWEB)

    Heuck, F.H.W.; Treugut, H.

    1984-07-01

    The pathogenesis of bone necrosis is discussed with special attention and with respect to metabolic, hormonal, and vascular factors. The influence of statics and dynamics of the hip joint bones for the development of aseptic necrosis are discussed. 45 patients with ''idiopathic femoral head necroses'' were observed, including 6 cases of renal osteopathy following renal transplantation and immune suppression therapy, 14 cases of long term corticoid therapy, and 11 cases of liver diseases of different genesis. The femoral head necrosis understood as complication of an osteopathy. In our patients there were 31 males and 14 females - which means higher involvement of males. Plain radiological findings and CT-findings of changes of the femoral heat structure in different stages of the disease are described. Early diagnosis of metabolic and hormonal osteopathies is demanded for a joint keeping therapy of the beginning femoral head necrosis. 90 refs.

  5. Expression, purification and crystallization of the ancestral androgen receptor-DHT complex.

    Science.gov (United States)

    Colucci, Jennifer K; Ortlund, Eric A

    2013-09-01

    Steroid receptors (SRs) are a closely related family of ligand-dependent nuclear receptors that mediate the transcription of genes critical for development, reproduction and immunity. SR dysregulation has been implicated in cancer, inflammatory diseases and metabolic disorders. SRs bind their cognate hormone ligand with exquisite specificity, offering a unique system to study the evolution of molecular recognition. The SR family evolved from an estrogen-sensitive ancestor and diverged to become sensitive to progestagens, corticoids and, most recently, androgens. To understand the structural mechanisms driving the evolution of androgen responsiveness, the ancestral androgen receptor (ancAR1) was crystallized in complex with 5α-dihydrotestosterone (DHT) and a fragment of the transcriptional mediator/intermediary factor 2 (Tif2). Crystals diffracted to 2.1 Å resolution and the resulting structure will permit a direct comparison with its progestagen-sensitive ancestor, ancestral steroid receptor 2 (AncSR2).

  6. [An unusual cause of acute respiratory distress: obstructive bronchial aspergillosis].

    Science.gov (United States)

    Margery, J; Perez, J-P; Vaylet, F; Bordier, E; Dot, J-M; Saint-Blancard, P; Bonnichon, A; Guigay, J; Pats, B; L'Her, P

    2004-06-01

    We report the case of a 77-Year-old immunocompetent woman who required intensive care for acute dyspnea revealing complete atelectasia of the left lung related to an aspergillus mycelium plug blocking the principal bronchus. The clinical course was favorable after deobstruction by thermocoagulation and oral itraconazole given for six Months. The patient was free of parenchymatous or endobronchial sequelae. Adjuvant oral corticoid therapy was given temporarily during the second Month of treatment when signs of transition towards allergic aspergillosis developed. Four Months after discontinuing the antifungal treatment, the patient developed a new episode of acute dyspnea caused by atelectasia limited to the right lower lobe. Treatment by itraconazole was resumed and continued as long-term therapy. No recurrence has been observed for eighteen Months. The diagnostic and therapeutic problems raised by Aspergillus fumigatus are well known in the immunocompromised subject, but can also be encountered in the immunocompetent subject.

  7. Beneficios de la hidrocortisona agregada al tratamiento estándar de neumonías en niños de 1 a 5 años, ingresados al Hospital Vicente Corral Moscoso, Cuenca 2014-2015

    OpenAIRE

    Espinoza Cisneros, Michel Viviana

    2016-01-01

    Introducción: La neumonía adquirida en la comunidad permanece como la causa más común de muerte por infección y la octava causa de muerte en los Estados Unidos. La literatura disponible no ha demostrado un beneficio claro del uso de los corticoides en la neumonía. Objetivo: Determinar los beneficios de la Hidrocortisona vía venosa agregada al tratamiento estándar de neumonías en niños de 1 a 5años, ingresados al Hospital Vicente Corral Moscoso. Cuenca 2014. Material y métodos: Se r...

  8. Carpal tunnel syndrome - Part II (treatment,

    Directory of Open Access Journals (Sweden)

    Michel Chammas

    2014-10-01

    Full Text Available The treatments for non-deficit forms of carpal tunnel syndrome (CTS are corticoid infiltration and/or a nighttime immobilization brace. Surgical treatment, which includes sectioning the retinaculum of the flexors (retinaculotomy, is indicated in cases of resistance to conservative treatment in deficit forms or, more frequently, in acute forms. In minimally invasive techniques (endoscopy and mini-open, and even though the learning curve is longer, it seems that functional recovery occurs earlier than in the classical surgery, but with identical long-term results. The choice depends on the surgeon, patient, severity, etiology and availability of material. The results are satisfactory in close to 90% of the cases. Recovery of strength requires four to six months after regression of the pain of pillar pain type. This surgery has the reputation of being benign and has a complication rate of 0.2–0.5%.

  9. Síndrome poslesión cardíaca. Pericarditis postraumática a propósito de un caso / Post-cardiac injury syndrome. Post-traumatic pericarditis apropos of a case

    Directory of Open Access Journals (Sweden)

    Jara Gayán Ordás

    2015-08-01

    Full Text Available La pericarditis postraumática se incluye dentro de los síndromes poslesión cardíaca. Este síndrome es un proceso inflamatorio que afecta al pericardio, la pleura, o ambos, secundario a un infarto de miocardio, a un traumatismo torácico o a una cirugía cardíaca. Las características clínicas incluyen el dolor torácico de perfil pericardítico, fiebre y elevación de los reactantes de fase aguda. Generalmente responde de manera satisfactoria al tratamiento con antiinflamatorios no esteroideos y corticoides, pero la falta de pruebas diagnósticas puede llevar a estudios innecesarios o tratamientos inadecuados con posibles efectos secundarios. Se presenta el caso de un hombre joven que evolucionó favorablemente tras la instauración del tratamiento apropiado.

  10. Glomerulopatía membranosa secundaria a infección por Citomegalovirus. Reporte de un caso.

    OpenAIRE

    Loza-Munarriz, Reyner; Enriquez, María; Departamento de Pediatría, Unidad de Nefrología pediátrica, Hospital Nacional Cayetano Heredia. Lima.; Apaza, Fernando; Departamento de Pediatría, Unidad de Nefrología pediátrica, Hospital Nacional Cayetano Heredia. Lima.; Mayo, Nancy; Departamento de Patología. Hospital Nacional Cayetano Heredia, Lima.; Miyahira, Juan; Departamento de Medicina, Servicio de Nefrología. Hospital Nacional Cayetano Heredia. Lima.

    2012-01-01

    Las causas más frecuentes de síndrome nefrótico en niños son la nefropatía de cambios mínimos y laglomeruloesclerosis focal y segmentaria; las formas secundarias son poco frecuentes. Se presenta el caso de unniño de 5 años y 7 meses de edad, con síndrome nefrótico resistente a corticoides, en quién la biopsia renal mostrónefropatía membranosa con cambios citopáticos focales en las células tubulares, compatibles con citomegalovirus.La inmunofluorescencia mostró depósitos de IgM y C3 en el mesa...

  11. Aminaphtone in the control of Schamberg's disease

    Directory of Open Access Journals (Sweden)

    de Godoy José

    2009-06-01

    Full Text Available Abstract The aim of this case report is to describe control of Schamberg's disease using aminaphtone. We report on the case of a 28-year-old patient who presented with multiple purpuric lesions of the lower extremities which had appeared spontaneously. A biopsy of the skin was performed that showed a perivascular T-cell lymphocytic infiltrate centered on the small superficial blood vessels of the skin and so a diagnosis of Schamberg's disease was reached. The patient was prescribed corticoids and the lesions disappeared however on suspension of the medication the lesions re-emerged within three to seven days. This treatment was unsuccessfully continued for more than one year. Thus another therapeutic option was attempted: 75 mg of aminaphtone was prescribed twice daily for one month and the purpuric lesions disappeared within about one week. One year after suspending the medication no relapse of the purpura was observed.

  12. Localized Langerhans` cell histiocytosis of bone: treatment and follow-up in children

    Energy Technology Data Exchange (ETDEWEB)

    Libicher, M. [Dept. of Diagnostic Radiology, Univ. Heidelberg (Germany); Roeren, T. [Dept. of Diagnostic Radiology, Univ. Heidelberg (Germany); Troeger, J. [Dept. of Pediatric Radiology, Univ. Heidelberg (Germany)

    1995-11-01

    We report a case of Langerhans` cell histiocytosis (LCH) involving the right scapula in a 4-year-old child. Because of progressive shoulder pain and immobility methylprednisolone was injected directly into the lesion under computed tomography (CT) guidance. Follow-up studies with magnetic resonance imaging (MRI) and ultrasound (US) revealed continuous ossification of the osteolytic lesion with healing after 6 months. Plain films and CT confirmed the healing process. We consider intralesional corticoid instillation a safe method when performed under CT guidance. For initial evaluation and follow-up, MRI and US yielded reliable results in comparison to plain films and CT, thus helping to reduce the radiation dosage in children. (orig.)

  13. Endurance exercise after orange ingestion anaphylaxis

    Directory of Open Access Journals (Sweden)

    Manu Gupta

    2016-01-01

    Full Text Available Endurance exercise after orange ingestion cause anaphylaxis which is food-dependent exercise-induced anaphylaxis (FDEIA which is a form of exercise-induced anaphylaxis. In this article, an individual develops symptoms such as flushing, itching, urticaria, angioedema, and wheezing after eating a food allergen and proceeds to exercise. Neither the food alone nor exercise alone is sufficient to induce a reaction. This case report describes a 36-year-old asthmatic male athlete who experienced nausea, vomiting, flushing, urticaria, and facial swelling while exercising in a gymnasium after eating oranges. Neither oranges alone nor exercise alone induced the reaction. Total avoidance of suspected food allergens would be ideal. Persons with FDEIA should keep at hand an emergency kit with antihistamines, injectable rapid action corticoids, and adrenaline.

  14. Artrosis de muñeca, estudio y opciones de tratamiento

    Directory of Open Access Journals (Sweden)

    Dr. G. Francisco Andrade

    2014-09-01

    Full Text Available La artrosis de muñeca es una patología que se origina generalmente tras una lesión ligamentosa intraósea del carpo, debido a una no unión de fractura de escafoides o después de una fractura articular del radio. Se sabe que la artrosis no mejora ni retrocede, por lo que se debe tener el tratamiento ideal para cada paciente según sus propias necesidades, que van desde el manejo médico (cambios de actividad, inmovilización, AINES o infiltración con corticoides. Cuando falla el tratamiento médico, se pueden realizar procedimientos poco invasivos como la denervación, carpectomía proximal o una artrodesis de cuatro esquinas. En estadios avanzados, sólo se puede proponer una artroplastia o artrodesis total de la muñeca.

  15. [Hypersensitivity Pneumonitis (extrinsic allergic alveolitis)].

    Science.gov (United States)

    Cebollero, P; Echechipía, S; Echegoyen, A; Lorente, M P; Fanlo, P

    2005-01-01

    Farmer's lung was first described in 1932. We can define hypersensitivity pneumonitis as a pulmonary and systemic disease that is accompanied by dyspnoea and coughing; it is caused by an immunological type of inflammation of the alveolar walls and the terminal airways and it is secondary to the repeated inhalation of a variety of antigens by a susceptible host. It can be said that it is an underdiagnosed disease and only a high degree of clinical manifestations and a detailed history of exposure can lead to an early diagnosis and satisfactory treatment. A combination among clinical-radiological, functional, cytological or pathological findings leads in some cases to a diagnosis. Treatment is based on avoiding further exposure to the causal agent and in the more serious cases the administration of systemic corticoid treatment.

  16. Radiological abnormalities of the skeleton in patients with sickle-cell anemia. A study of 222 cases in Tunisia

    Energy Technology Data Exchange (ETDEWEB)

    Ben Dridi, M.F.; Oumaya, A.; Gastli, H.; Doggaz, C.; Bousnina, S.; Fattoum, S.; Ben Osman, R.; Gharbi, H.A.

    1987-05-01

    The way in which bones are affected in cases of sickle-cell anemia is well known. Nevertheless, advances in treatment and in methods of transfusion mean that we are increasingly seeing cases of older patients with this disease. A retrospective analysis of 222 cases of sickle-cell anemia demonstrates the radiological appearance of the skeleton in the disease and reveals the various bone segments which are particularly vulnerable at certain periods of life. Correlation of X-rays permits the discovery of lesions which are not clinically apparent. The frequency and characteristics of epiphyseal osteonecrosis and osteitis are studied. Aggravation of the bone lesions when corticoids are administered poses the problem of differential diagnosis of the disease, especially in comparison with rheumatic fever.

  17. Childhood adversity and allostatic overload of the hypothalamic-pituitary-adrenal axis: a vulnerability model for depressive disorders.

    Science.gov (United States)

    Wilkinson, Paul O; Goodyer, Ian M

    2011-11-01

    Childhood adversity is associated with increased risk for onset of depressive episodes. This review will present evidence that allostatic overload of the hypothalamic-pituitary-adrenal axis (HPAA) partially mediates this association. The HPAA is the physiological system that regulates levels of the stress hormone cortisol. First, data from animals and humans has shown that early environmental adversity is associated with long-term dysregulation of the HPAA. This may occur due to permanent epigenetic modification of the glucocorticoid receptor. Second, data from humans has demonstrated that HPAA dysregulation is associated with increased risk of future depression onset in healthy individuals, and pharmacological correction of HPAA dysregulation reduces depressive symptoms. HPAA dysregulation may result in corticoid-mediated abnormalities in neurogenesis in early life and/or neurotoxicity on neural systems that subserve emotion and cognition.

  18. New Immunosuppressive Therapies in Uveitis Treatment

    Directory of Open Access Journals (Sweden)

    Salvador Mérida

    2015-08-01

    Full Text Available Uveitis is an inflammatory process that initially starts in the uvea, but can also affect other adjacent eye structures, and is currently the fourth cause of blindness in developed countries. Corticoids are probably the most widespread treatment, but resorting to other immunosuppressive treatments is a frequent practice. Since the implication of different cytokines in uveitis has been well demonstrated, the majority of recent treatments for this disease include inhibitors or antibodies against these. Nevertheless, adequate treatment for each uveitis type entails a difficult therapeutic decision as no clear recommendations are found in the literature, despite the few protocolized clinical assays and many case-control studies done. This review aims to present, in order, the mechanisms and main indications of the most modern immunosuppressive drugs against cytokines.

  19. Micosis fungoide: reporte de un caso clínico

    Directory of Open Access Journals (Sweden)

    Gabriel Abudinén A

    2010-01-01

    Full Text Available La micosis fungoide es una neoplasia maligna originada en los linfocitos T que compromete la piel pudiendo extenderse a médula ósea, linfocitos sanguíneos, ganglios linfáticos y diversos órganos internos. Se presenta el caso de un paciente de 32 años de edad, sexo masculino, que desde hace aproximadamente 1 año presenta lesiones eritematodescamativas pruriginosas inicialmente localizadas en extremidades inferiores y que luego se generalizan, asociándose a baja de peso de aproximadamente 20 Kg. Ha usado corticoides y antihistamínicos, con regular respuesta. Se inicia su estudio por eritrodermia confirmándose por biopsia el diagnóstico de micosis fungoide. Se deriva para iniciar tratamiento específico con Fototerapia con Luz Ultravioleta A (PUVA.

  20. [Tracheal resection for post-intubation subglottic stenosis in a patient with granulomatosis with polyangiitis (Wegener)].

    Science.gov (United States)

    Stoica, Radu; Negru, Irina; Matache, Radu; MirunaTodor

    2014-01-01

    Granulomatosis with polyangiitis (GPA or Wegener) is a systemic autoimmune disease with inflammation of small- and medium-size vessels. It can affect practically any organ or system, but renal, respiratory andjoint systems are most frequently damaged. Positive pANCA antibodies can raise the suspicion of diagnosis. Subglottic stenosis is relatively frequent, in a quarter of patients, especially in the third decade women. The case presented is of an 80-year-old woman, recently diagnosed with pulmonary, renal and systemic manifestations of GPA and with a subglottic stenosis rapidly evolving towards endotracheal intubation, tracheostomy with mechanical ventilation and renal failure. Further evolution has been favorable under corticoid therapy. After weaning from the mechanical ventilation and30 days after the suppression of the tracheostomy, the patient developed a tracheal stenosis with mixed etiology, secondary to vasculitis and prolonged intubation with tracheostomy. Tracheal resection with termino-terminal anastomosis was performed in emergency with simple post-operative evolution and without late complications.

  1. [Tracheal resection for post-intubation subglottic stenosis in a patient with granulomatosis with polyanaiitis (Wegener)].

    Science.gov (United States)

    Stoica, Radu; Negru, Irina; Matache, Radu; MirunaTodor

    2014-01-01

    Granulomatosis with polyangiitis (GPA or Wegener) is a systemic autoimmune disease with inflammation of small- and medium-size vessels. It can affect practically any organ or system, but renal, respiratory andjoint systems are most frequently damaged. Positive pANCA antibodies can raise the suspicion of diagnosis. Subglottic stenosis is relatively frequent, in a quarter of patients, especially in the third decade women. The case presented is of an 80-year-old woman, recently diagnosed with pulmonary, renal and systemic manifestations of GPA and with a subglottic stenosis rapidly evolving towards endotracheal intubation, tracheostomy with mechanical ventilation and renal failure. Further evolution has been favorable under corticoid therapy. After weaning from the mechanical ventilation and30 days after the suppression of the tracheostomy, the patient developed a tracheal stenosis with mixed etiology, secondary to vasculitis and prolonged intubation with tracheostomy. Tracheal resection with termino-terminal anastomosis was performed in emergency with simple post-operative evolution and without late complications.

  2. Presentación de un caso de Pénfigo Vulgar

    Directory of Open Access Journals (Sweden)

    Zully Ballesteros Zárate

    2012-12-01

    Full Text Available El pénfigo es una enfermedad vesículo-ampollosa autoinmune de la piel y mucosas, que puede comprometer grandes extensiones; los tipos vulgar y foliáceo son los más frecuentes, con diferencias inmunopatológicas entre ellas. El pénfigo es tratado con corticoides y Azatioprina pero en los últimos años se incluyeron nuevos medicamentos como inmunoglobulinas, Rituximab (anticuerpo monoclonal quimérico anti-CD20 entre otros, Mostramos un caso de pénfigo hiperpigmentado atípico, y revisamos el tema en especial sobre el tratamiento. Salud UIS 2012; 44 (3: 49-55

  3. A strange case of Evans syndrome

    Directory of Open Access Journals (Sweden)

    Manuel Monti

    2013-12-01

    Full Text Available Evans syndrome is a rare autoimmune disease presenting hemolytic anemia, thrombocytopenia and/or neutropenia. It may be associated with other autoimmune or lymphoproliferative diseases. It can have an extremely serious disease course and, in rare cases, this can even be life-threatening. First-line treatment consists of steroids and/or immunoglobulin. Further therapy with rituximab, vincristine, cyclophosphamide and other immunosuppressive drugs can be considered in unresponsive patients. We report a case of Evans syndrome in a 54-year old woman admitted to the Emergency Department (ED for asthenia. Etiopathogenic, clinical, therapeutic and evolutive aspects are discussed. In contrast to many cases described in the literature, our patient had a satisfactory response to corticoids. We also discuss how to make a specific diagnosis, even in a suburban ED with limited resources, in order to admit patients to the appropriate hospital department and allow the correct therapy to be started as early as possible.

  4. Sepsis por shigella flexneri

    Directory of Open Access Journals (Sweden)

    César Cabrera C

    2005-04-01

    Full Text Available Se presenta un caso raro de sepsis por Shigella flexneri en una paciente de 45 años de edad quien estando hospitalizada para el estudio de un tumor cerebral, requirió el uso de manitol y dosis altas de corticoides; luego de ello presenta deposiciones líquidas con moco y sangre, desarrolla síndrome de respuesta inflamatoria sistémica, luego se aísla Shigella flexneri en el hemocultivo; recibió tratamiento antibiótico con ciprofloxacina. Se describen las características del caso y se comenta de acuerdo con la revisión de literatura.

  5. Experiencia con rituximab en miopatía inflamatoria idiopática refractaria

    Directory of Open Access Journals (Sweden)

    Elmer R. García-Salazar

    2013-10-01

    Full Text Available Se describe las características clínicas y de laboratorio de dos pacientes que recibieron rituximab por miopatía inflamatoria idiopática (MII. Ellas eran refractarias a tratamiento convencional con DARMES, por lo que recibieron rituximab 1 gramo cada 14 días, en dos infusiones en ciclo semestral. En las historias clínicas se obtuvo los datos clínicos de fuerza muscular proximal, lesiones cutáneas patognomónicas, elevación de CPK, TGO, DHL y VSG, resultados de electromiografía, biopsia muscular y de piel. Ninguno de los dos casos presentó reacción medicamentosa ni infecciones durante y posterior a las infusiones. Rituximab mostró efectividad en la respuesta clínica y enzimática en estas pacientes con dermatomiositis refractarias a corticoides y DARMES tradicionales.

  6. Incidencia y características de la esofagitis eosinofílica (EE en adultos Incidence and characteristics of eosinophilic esophagitis in adults

    Directory of Open Access Journals (Sweden)

    O. Nantes

    2009-08-01

    Full Text Available La esofagitis eosinofílica (EE es una enfermedad caracterizada por la infiltración de la mucosa del esófago por eosinófilos, cuya incidencia en adultos parece estar aumentando en los últimos años, de forma similar a lo que ocurre en otras enfermedades de probable etiología inmunoalérgica. Predomina en varones jóvenes y se manifiesta principalmente por disfagia e impactación alimentaria. Su tratamiento se basa en eliminar el alérgeno potencialmente implicado y la administración de corticoides. En el presente trabajo se revisan retrospectivamente los casos de EE diagnosticados en el Hospital de Navarra entre enero de 2002 y agosto de 2008, encontrándose 25 pacientes, lo que supone una incidencia de 2,13 casos/10(5 habitantes/año. Un 72% de nuestros pacientes presentaban disfagia y un 52% historia de impactación del bolo alimentario, encontrándose alteraciones endoscópicas en 23 de los 25 casos. De 24 pacientes estudiados, un 76% manifestaban alergia alimentaria o a neumoalérgenos, lo que apoya el fondo inmunoalérgico de la enfermedad y la necesidad de un estudio alergológico en todos las pacientes con EE. La mayoría de nuestros pacientes (22 de 24 valorados presentaron buena respuesta clínica al tratamiento, que se basó en evitar la exposición al alergeno potencialmente implicado y/o la administración de corticoides (tópicos o sistémicos y/o la administración de inhibidores de la bomba de protones.Eosinophilic esophagitis (EE is a disease characterised by the infiltration of esophageal mucosa by eosinophils, whose incidence in adults seems to have been increasing in recent years, in a way that is similar to what is occurring with other diseases of a probable immunoallergic aetiology. It predominates in young adults and is mainly expressed by dysphagia and esophageal food impactation. Treatment is based on eliminating the allergen that is potentially involved and the administration of corticoids. This article offers a

  7. Update on hypertrophic scar treatment

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    Felipe Bettini Rabello

    2014-08-01

    Full Text Available Scar formation is a consequence of the wound healing process that occurs when body tissues are damaged by a physical injury. Hypertrophic scars and keloids are pathological scars resulting from abnormal responses to trauma and can be itchy and painful, causing serious functional and cosmetic disability. The current review will focus on the definition of hypertrophic scars, distinguishing them from keloids and on the various methods for treating hypertrophic scarring that have been described in the literature, including treatments with clearly proven efficiency and therapies with doubtful benefits. Numerous methods have been described for the treatment of abnormal scars, but to date, the optimal treatment method has not been established. This review will explore the differences between different types of nonsurgical management of hypertrophic scars, focusing on the indications, uses, mechanisms of action, associations and efficacies of the following therapies: silicone, pressure garments, onion extract, intralesional corticoid injections and bleomycin.

  8. Lichen sclerosus of the oral mucosa: a case report.

    Science.gov (United States)

    Jiménez, Yolanda; Gavaldá, Carmen; Carbonell, Enrique; Margaix, María; Sarrión, Gracia

    2008-07-01

    Lichen sclerosus or lichen sclerosus et atrophicus is a chronic inflammatory disease predominantly affecting the genital mucosa and skin. Clinically, it is characterized by white atrophic plaques in the anogenital region. The lesions are generally asymptomatic, but may cause discomfort with itching and pain. Extragenital mucosal involvement is very unusual, and lesions limited to the oral mucosa are even less frequent. Knowledge of such lesions is important in order to establish a differential diagnosis with other white oral lesions, and histological confirmation is required. We present the case of a 31-year-old woman with a well delimited, pearly white lesion located in the upper gingival mucosa, lip mucosa and adjacent skin. The lesion had led to loss of periodontal attachment of the affected tooth, causing pain in response to tooth brushing. The biopsy confirmed lichen sclerosus, and treatment was provided in the form of intralesional corticoid injections, followed by improvement of the mucosal lesion, though without recovery of the periodontal loss.

  9. Radioimmunological analysis of plasma cortisole levels and daily plasma cortisole variation following triamcinolone acetonide therapy

    Energy Technology Data Exchange (ETDEWEB)

    Hartmann, F.; Schuster, E.

    1980-08-01

    Plasma cortisol levels in a four-point daily profile were measured by radioimmunoassay before and during treatment with corticoid-containing ointments (triamcinolone acetonide) in 21 patients with psoriasis, who had no endocrine disorders. In the pretreatment phase there were typical circadian fluctuations of the plasma cortisol concentrations. Already after two days of treatment a significant suppression of adrenal function could be detected. This disfunction increased during continuous treatment. In comparison with a fluorimetric method, the radioimmunoassay allowed a better differentiation. This could be due to a lack of specificity and to susceptibility to erroneous measurement of the fluorimetric method. We could also confirm that the distribution of plasma cortisol levels is not a linear but a logarithmic one. Considering the log-normal distribution different mean values and variances are obtained.

  10. High rate of strongyloidosis infection, out of endemic area, in patients with eosinophilia and without risk of exogenous reinfections.

    Science.gov (United States)

    Repetto, Silvia A; Durán, Pablo A; Lasala, María B; González-Cappa, Stella M

    2010-06-01

    Strongyloides stercoralis chronic infections are usually asymptomatic and underestimated. We used direct fresh stool examination, Ritchie's method, and agar plate culture for diagnosis in patients with eosinophilia and previous residence in endemic areas. The frequency of strongyloidosis detected among these patients was high: 21 of 42 were positive. Among them, 10 were positive only by agar plate culture. After ivermectin treatment, patients resulted negative for parasitological tests and reduced their eosinophil counts. Half of the submitted patients that were followed 4-12 months after treatment remained negative without eosinophilia, except one who showed an eosinophil ascending curve before reappearance of larvae in stools. The high frequency of strongyloidosis found in this group emphasizes the relevance of including this parasitosis among differential diagnosis in patients with eosinophilia and past risk of S. stercoralis infection to prevent disseminated infections secondary to corticoid therapy.

  11. New Immunosuppressive Therapies in Uveitis Treatment

    Science.gov (United States)

    Mérida, Salvador; Palacios, Elena; Navea, Amparo; Bosch-Morell, Francisco

    2015-01-01

    Uveitis is an inflammatory process that initially starts in the uvea, but can also affect other adjacent eye structures, and is currently the fourth cause of blindness in developed countries. Corticoids are probably the most widespread treatment, but resorting to other immunosuppressive treatments is a frequent practice. Since the implication of different cytokines in uveitis has been well demonstrated, the majority of recent treatments for this disease include inhibitors or antibodies against these. Nevertheless, adequate treatment for each uveitis type entails a difficult therapeutic decision as no clear recommendations are found in the literature, despite the few protocolized clinical assays and many case-control studies done. This review aims to present, in order, the mechanisms and main indications of the most modern immunosuppressive drugs against cytokines. PMID:26270662

  12. Cardiomyopathie hypertrophique neonatale de diagnostic etiologique difficile

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    Rania Hammami

    2011-12-01

    Full Text Available La cardiomyopathie hypertrophique neonatale est une entite rare, heterogene regroupant plusieurs formes cliniques et donc de diagnostic etiologique difficile. Nous rapportons l�observation d�un nouveau ne issu d�une grossesse gemellaire, ayant presente a la naissance un tableau d�insuffisance cardiaque, l�echocardiographie avait conclut a une cardiomyopathie hypertrophique obstructive. Le bilan etiologique etait negatif notamment une mere non diabetique. L�evolution etait favorable avec regression de l�hypertrophie 2 semaines apres la naissance. L�etiologie finalement suggeree etait une cardiomyopathie secondaire a l�injection antenatale de corticoides dans le but d�accelerer la maturation pulmonaire. L�etablissement par les societes savantes d�un consensus de bilan etiologique minimal standard selon une chronologie bien determinee serait d�un grand apport dans la prise en charge de cette anomalie.

  13. OSTEOPOROSIS IN SYSTEMIC LUPUS ERYTHEMATOSUS

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    N V Seredavkina

    2009-01-01

    Full Text Available Patients with systemic lupus erythematosus (SLE form a high risk group osteoporosis (OP. Its main causes are autoimmune inflammation, concomitant pathology, and their treatment. When OP occurs in SLE, bone mass loss is shown to occur early and is associated with the use of glucocorticosteroids (GC. To prevent OP, all patients with SLE should modify their lifestyle. To verify bone changes, densitometry is performed in patients who have risk factors of OP and/or a menopause. Calcium preparations and vitamin D are used to prevent OP; bisphosphonates that significantly reduce the risk of fractures of the vertebral column and femoral neck are employed for therapy of OP. A SLE patient with gluco-corticoid-induced OP and a good effect of bisphophonate treatment is described.

  14. Loxoscelismo en Chile: estudios epidemiológicos, clínicos y experimentales Loxoscelism in Chile: epidemiological, clinical and experimental studies

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    Hugo Schenone

    1989-12-01

    Full Text Available Se presenta un enfoque panorámico de estudios epidemiológicos, clínicos y experimentales referentes a Loxosceles laeta y loxoscelismo efectuados en 1955-1988 en Santiago, Chile. Se estudiaron 216 casos de loxoscelismo. Los hechos más relevantes fueron: 52,8% correspondió a mujeres; edad entre 7 meses y 78 años; 84,3% fué loxoscelismo cutáneo (LO y 15,7% loxoscelismo cutáneo-visceral (LCV; 73,6% sucedió en época calurosa; en 86,6% el accidente ocurrió en la vivienda, especialmente en dormitorios, mientras la persona dormía o se vestía. La araña fué vista en 60,2% de los casos e identificada en laboratorio como L. laeta en 17,7% (10,6% de los 216 casos. Los sitios más frecuen temente afectados fueron las extremidades con 67,6%, lancetazo urente fué el síntoma inicial más frecuente. Dolor, edema y placa livedoide, la cual posteriormente se transformaría en escara necrótica, fueron las manifestaciones locales predominantes. En LCV hematuria y hemoglobinuria fueron constantes, ictericia, fiebre y compromiso de conciencia se presentaron en la mayoría de los casos. Tratamiento: LC con antihistamínicos o corticoides inyectables, LCV con corti-coides inyectables. La condición de los pacientes en el último control fué: curación completa en 75,5%, curación con secuela cicatrizal en 8,3%, muerte en 3,7% (todos con LCV y abandono en 12,5%. Adicionalmente, se ha efectuado una serie de estudios experimentales, tanto in vivo como in vitro para esclarecer aspectos básicos sobre el veneno de L. laeta y el tratamiento del loxoscelismo.A panoramic sight of epidemiological, clinical and experimental studies, referring to Loxosceles laeta and loxoscelism, carried out in 1955-1988, in Santiago, Chile is presented. Two-hundred and sixteen cases of loxosce lism were studied. The most relevant features were: 84.3% corresponded to cutaneous loxosce lism (CD and 15.7% to viscerocutaneous loxos celism (VCD; 73.6% ocurred in hot season; in 86

  15. Eficácia da associação de dexametasona à antibioticoterapia em pacientes pediátricos com meningite bacteriana Effectiveness of the association of dexamethasone with antibiotic therapy in pediatric patients with bacterial meningitis

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    Wanderley Marques Bernardo

    2012-06-01

    Full Text Available OBJETIVO: Avaliar a eficácia da associação de corticoide ao tratamento padrão da meningite bacteriana em pacientes pediátricos. MÉTODOS: Realizou-se revisão sistemática da literatura através da base de dados MEDLINE. Foram incluídos apenas ensaios clínicos controlados e randomizados que comparassem a dexametasona ao placebo no tratamento de pacientes pediátricos com meningite bacteriana. RESULTADOS: Oito artigos preencheram os critérios de inclusão e foram selecionados para análise. Não houve diferença nas taxas de mortalidade (p = 0,86 ou de incidências de sequelas neurológicas (p = 0,41 e audiológicas (p = 0,48 entre os grupos. CONCLUSÃO: Não existem benefícios na associação de corticoide ao tratamento da meningite bacteriana em pacientes pediátricos.OBJECTIVE: To evaluate the efficacy of the association of corticosteroids and the standard treatment of bacterial meningitis in pediatric patients. METHODS: A systematic review of the literature was conducted through the MEDLINE database. Only randomized controlled trials comparing dexamethasone with placebo in the treatment of pediatric patients with bacterial meningitis were included. RESULTS: Eight articles met the inclusion criteria and were selected for analysis. There were no difference in mortality (p = 0.86, and incidence of neurological (p = 0.41 and auditory (p = 0.48 sequelae between the groups. CONCLUSION: There are no benefits in associating corticosteroids with the standard treatment of bacterial meningitis in pediatric patients.

  16. Cortisol affects metabolic and ionoregulatory responses to a different extent depending on feeding ration in common carp, Cyprinus carpio.

    Science.gov (United States)

    Liew, Hon Jung; Fazio, Angela; Faggio, Caterina; Blust, Ronny; De Boeck, Gudrun

    2015-11-01

    Interacting effects of feeding and stress on corticoid responses in fish were investigated in common carp fed 3.0% or 0.5% body mass (BM) which received no implant, a sham or a cortisol implant (250 mg/kg BM) throughout a 168 hour post-implant period (168 h-PI). At 12h-PI, cortisol implants elevated plasma cortisol, glucose and lactate. Plasma osmolality and ions remained stable, but cortisol increased gill and kidney Na(+)/K(+) ATPase (NKA) and H(+) ATPase activities. Gill NKA activities were higher at 3%-BM, whereas kidney H(+) ATPase activity was greater at 0.5%-BM. Cortisol induced liver protein mobilization and repartitioned liver and muscle glycogen. At 3%-BM, this did not increase plasma ammonia, reflecting improved excretion efficiency concomitant with upregulation of Rhesus glycoprotein Rhcg-1 in gill. Responses in glucocorticoid receptors (GR1/GR2) and mineralocorticoid receptor (MR) to cortisol elevation were most prominent in kidney with increased expression of all receptors at 24 h-PI at 0.5%-BM, but only GR2 and MR at 0.5%-BM. In the liver, upregulation of all receptors occurred at 24 h-PI at 3%-BM, whilst only GR2 and MR were upregulated at 0.5%-BM. In the gill, there was a limited upregulation: GR2 and MR at 72 h-PI and GR1 at 168 h-PI at 3%-BM but only GR2 at 72 h-PI at 0.5%-BM. Thus cortisol elevation led to similar expression patterns of cortisol receptors in both feeding regimes, while feeding affected the type of receptor that was induced. Induction of corticoid receptors occurred simultaneously with increases in Rhcg-1 mRNA expression (gill) but well after NKA and H(+) ATPase activities increased (gill/kidney).

  17. Cure of Psoriasis and Arthritis when Addison's Disease Was Detected.

    Science.gov (United States)

    Lind, Marcus

    2010-06-01

    INTRODUCTION: Corticoid therapy is well-known to improve the symptoms of psoriasis. Addison's disease is an autoimmune disease which leads to a loss of cortisol production in the adrenal glands. This case report describes a patient with wide-spread psoriasis for 34 years who was cured when Addison's disease was detected and substitution to reach normal biological cortisol levels was introduced. CASE REPORT: A 59-year-old man was diagnosed with Addison's disease. He had been tired for several years and had had difficulties in continuing his work. His brother had Addison's disease and recommended him to make a screen for the disease. Synacthen test diagnosed Addison's disease with a clear deficiency of cortisol production. After substitution with hydrocortisone the patient's constitution improved rapidly and he felt no longer tired during work. At the same time, all skin lesions of psoriasis disappeared as well as aches in several joints, both symptoms having been present for a couple of decades. Previously, salves of cortisol had been used to reduce the symptoms of psoriasis, but now, 1-2 years later, after the treatment of Addison's disease, no symptoms in the skin or joints have reoccurred. CONCLUSIONS: This report illustrates that Addison's disease, although a rare condition, should be kept in mind before treatment of psoriasis is started. Especially if other symptoms such as fatigue are present, a screening test of serum cortisol in the morning should be liberally made. The report also illustrates a need of examining corticoid levels in patients with psoriasis compared to the general population.

  18. Recomendaciones de vacunación en pacientes con enfermedad inflamatoria intestinal (EII

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    C. Rodríguez

    2013-04-01

    Full Text Available El concepto de enfermedad inflamatoria intestinal (EII engloba tres entidades: la colitis ulcerosa (CU, la enfermedad de Crohn (EC y la colitis inclasificable (CI. Estas enfermedades tienen en común el curso crónico y recidivante, alternando épocas de marcada actividad inflamatoria con otras quiescentes, en las que el paciente permanece asintomático. Durante muchos años la base del tratamiento, sobre todo en las fases agudas, se basó en el uso de corticoides. Sin embargo, a lo largo de las últimas décadas hemos asistido a avances importantes desde el punto de vista terapéutico. Así se estima que, a lo largo de la evolución de la enfermedad, el 80% de los pacientes van a precisar corticoides, el 40% inmunomoduladores (IMM y hasta un 20% necesitará un fármaco biológico para el control de su enfermedad. Si bien todo ello se acompaña de una mejora en la calidad de vida, disminuyendo la necesidad de ingresos e intervenciones quirúrgicas, su uso implica también un incremento en el riesgo de sufrir infecciones, bien por gérmenes habituales en la comunidad o por gérmenes oportunistas. Las infecciones, además, son causa de morbimortalidad asociada a EII y algunas de ellas son prevenibles con vacunas, de ahí la importancia que los programas de vacunación están adquiriendo en este grupo de pacientes. Presentamos una revisión de la literatura al respecto y proponemos unas recomendaciones de vacunación para los pacientes diagnosticados de EII.

  19. Antenatal corticosteroid treatment for the prevention of peri-intraventricular haemorrhage in preterm newborns: a retrospective cohort study using transfontanelle ultrasonography

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    Bianca A. Almeida

    2017-06-01

    Full Text Available Objective: The objective of this study was to assess the correlation between antenatal corticosteroids and peri-intraventricular haemorrhage (PIVH using transfontanelle ultrasonography, as well as to evaluate the risk factors for its incidence. Methods: We performed a retrospective cohort study using medical records of preterm newborns. The protocol for maternal corticoid administration for foetal lung maturation included dexamethasone 4 mg (intramuscular 8/8 hours per 48 hours, with one cycle per week. The diagnosis of periintraventricular haemorrhage was based on transfontanelle ultrasonography, using the Papile’s classification. The following risk factors for peri-intraventricular haemorrhage were assessed: birth weight, gestational age at delivery, type of delivery, newborn’s sex, surfactant administration, premature rupture of membranes and previous history of infection during the current pregnancy. The student’s t-test and chi-square test were used for statistical analysis. Results: Our sample population included 184 preterm newborns. Transfontanelle ultrasonography revealed peri-intraventricular haemorrhage in 32 (74.4% and periventricular leukomalacia in 11 (25.6% newborns. Grade I haemorrhage was found in 20 (62.5%, grade II in five (15.6%, and grade III in seven (21.8% newborns, as in accordance with Papile’s classification. Vaginal delivery (p = 0.010, birth weight <1500 g (p = 0.024, gestational age at delivery ≤32 weeks (p = 0.018, and previous history of infection during pregnancy (p = 0.013 were considered risk factors for peri-intraventricular haemorrhage in preterm newborns. Conclusion: Maternal corticoid administration for foetal lung maturation showed a protective effect against peri-intraventricular haemorrhage in preterm newborns. The risk factors for peri-intraventricular haemorrhage were determined.

  20. Noninvasive monitoring of adrenocortical function in captive jaguars (Panthera onca).

    Science.gov (United States)

    Conforti, Valéria A; Morato, Ronaldo G; Augusto, Anderson M; de Oliveira e Sousa, Lúcio; de Avila, David M; Brown, Janine L; Reeves, Jerry J

    2012-01-01

    Jaguars are threatened with extinction throughout their range. A sustainable captive population can serve as a hedge against extinction, but only if they are healthy and reproduce. Understanding how jaguars respond to stressors may help improve the captive environment and enhance their wellbeing. Thus, our objectives were to: (1) conduct an adrenocorticotrophic hormone (ACTH) challenge to validate a cortisol radioimmunoassay (RIA) for noninvasive monitoring of adrenocortical function in jaguars; (2) investigate the relationship between fecal corticoid (FCM) and androgen metabolite (FAM) concentrations in males during the ACTH challenge; and (3) establish a range of physiological concentrations of FCMs for the proposed protocol. Seven jaguars (3 M, 4 F) received 500 IU/animal of ACTH. Pre- and post-ACTH fecal samples were assayed for corticoid (M and F) and androgen metabolites (M) by RIA. Concentrations of FCMs increased (P80.01) after ACTH injection (pre-ACTH: 0.90 ± 0.12 µg/g dry feces; post-ACTH: 2.55 ± 0.25 µg/g). Considering pre- and post-ACTH samples, FCM concentrations were higher (P80.01) in males (2.15 ± 0.20 µg/g) than in females (1.30 ± 0.20 µg/g), but the magnitude of the response to ACTH was comparable (P>0.05) between genders. After ACTH injection, FAMs increased in two (of 3) males; in one male, FCMs and FAMs were positively correlated (0.60; P80.01). Excretion of FCMs was assessed in 16 jaguars (7 M, 9 F) and found to be highly variable (range, 80.11-1.56 µg/g). In conclusion, this study presents a cortisol RIA for monitoring adrenocortical function in jaguars noninvasively. © 2011 Wiley Periodicals, Inc.

  1. Endocrine control of active sodium transport across frog skin; Le controle endocrinien du transport actif de sodium a travers la peau de grenouille

    Energy Technology Data Exchange (ETDEWEB)

    Maetz, J. [Commissariat a l' Energie Atomique, Saclay (France).Centre d' Etudes Nucleaires

    1959-07-01

    I. Action of the neurohypophyseal peptides on sodium transport. 1) On Rana Esculenta, oxytocin alone is active on the sodium transport (not vaso pressin). 2) The post hypophysis of R.e. contains an hormonal factor even more specific on Na transport (12 times more active than oxytocin). 3) This new factor must be closely related to oxytocin. II. Action of the adrenal corticoids. 1) The skin of frogs adapted to a salt-rich external medium, shows a considerable diminution in sodium uptake. 2) This decreased sodium uptake is brought back to normal by the injections of aldosterone. 3) This suggests that salt loading of amphibians (as well as mammals) inhibits the mineralocorticoid activity of the adrenals. (author) [French] I. Action des peptides neurohypophysaires chez Rana esculenta. 1) Le transport actif de Na est sensible a l'action de l'ocytocine mais non a l'hormone antidiuretique. 2) La posthypophyse de ces grenouilles contient un facteur plus specifique encore, puisque 12 fois plus actif que l'ocytocine. 3) Ce facteur est cependant tres voisin de l'ocytocine au point de vue chimique. lI. Action des corticoides surrenaliens chez Rana Esculenta. 1) L'adaptation des grenouilles a un milieu riche en sel a pour effet une diminution considerable du transport actif de sodium, visible in vivo et in vitro. 2) L'injection d'aldosterone a des grenouilles adaptees dans ces conditions restaure le transport actif a un niveau comparable a celui que l'on observe chez les animaux conserves dans de l'eau courante. 3) Ces faits suggerent que la surcharge en NaCI produirait chez les amphibiens, comme chez les mammiferes, une mise au repos de la fonction mineralotrope de la surrenale. (auteur)

  2. [Analysis of a series of cases with an initial diagnosis of acute disseminated encephalomyelitis over the period 2000-2010].

    Science.gov (United States)

    Rodríguez-Fernández, Cristina; López-Marín, Laura; López-Pino, Miguel Ángel; Gutiérrez-Solana, Luis G; Soto-Insuga, Víctor; Conejo-Moreno, David

    2013-10-01

    Introduccion. La encefalomielitis aguda diseminada (EMAD) es una enfermedad desmielinizante que afecta fundamentalmente a la sustancia blanca del sistema nervioso central. El diagnostico se basa en hallazgos clinicorradiologicos y evolutivos. La resonancia magnetica cerebral es la herramienta diagnostica mas util. El curso suele ser monofasico y el tratamiento inicial de eleccion, los corticoides. Pacientes y metodos. Estudio retrospectivo de 18 pacientes con diagnostico de sospecha inicial de EMAD. Se analizo la sintomatologia, los hallazgos radiologicos, la evolucion y el tratamiento. El diagnostico definitivo se establecio en 12 pacientes, excluyendo un paciente con reaccion en cadena de la polimerasa positiva para el virus herpes simple en el liquido cefalorraquideo, uno con clinica compatible pero resonancia magnetica cerebral normal, y cuatro con inicio similar a EMAD cuyos diagnosticos definitivos fueron: sindrome de Rassmusen, sindrome hemofagocitico, tumor cerebral y MELAS (encefalomiopatia mitocondrial con acidosis lactica y accidentes cerebrovasculares). Resultados. La mediana de edad fue de 31 meses, sin predominio de sexo. La infeccion de la via respiratoria superior fue la causa mas frecuente en niños mayores y la gastrointestinal, en menores de 2 años. Todos presentaron alteracion en el nivel de conciencia y deficits neurologicos multifocales. El hallazgo radiologico mas frecuente fue la alteracion multifocal bihemisferica de la sustancia blanca. Los corticoides fueron el tratamiento de eleccion en la mayoria. La evolucion fue favorable en casi todos los pacientes excepto en dos, que tuvieron secuelas importantes. Conclusiones. La EMAD puede presentarse a cualquier edad, incluyendo lactantes. Hay multiples entidades que pueden simular una EMAD en un inicio.

  3. Alveolitis: Revisión de la literatura y actualización

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    Odalys Martín Reyes

    2001-12-01

    Full Text Available La alveolitis es la complicación más frecuente de la extracción dentaria. Su frecuencia varía del 1 al 4 % y puede llegar del 20 al 30 % en extracciones de terceros molares mandibulares. Se describen algunos factores de riesgo que aumentan su incidencia, aunque se habla de un origen multifactorial. La clínica y los síntomas subjetivos nos permiten su diagnóstico y clasificación. Para tratar las alveolitis se han utilizado localmente distintos productos para inducir la formación del coágulo: antibióticos, anestésicos, analgésicos y antiinflamatorios, asociados o no con corticoides, analgésicos y antibióticos sistémicos. También la medicina natural y tradicional ocupa un lugar importante en el tratamiento de esta urgencia estomatológica, y se destacan terapéuticas como: la apiterapia, la acupuntura y la ozonoterapia, además tecnologías de avanzada como los soft láser.Alveolitis is the most frequent complication of tooth extraction. Its frequency varies from 1 to 4 % and may reach 20 to 30 % in extractions of mandibular third molars. Some risk factors increasing its incidence are described, although reference is made to a multifactorial origin. The clinic and the subjective symptoms allow us to make its diagnosis and to classify it. Different products have been used in the treatment of alveolitis to induce clot formation: antibiotics, anesthesics, analgesics and anti-inflammatories associated or not with corticoids, analgesics and systemic antibiotics. Natural and traditional medicine also play an important role in the treatment of this stomatological emergency and therepeutics such as the apiotherapy, the acupuncture, the ozone therapy and state-of-the art technologies as the soft laser are stressed.

  4. Factores de riesgo asociados a osteopenia del prematuro en una terapia intensiva neonatal de referencia

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    MP Ríos-Moreno

    2016-03-01

    Full Text Available INTRODUCCIÓN: la enfermedad ósea metabólica del prematuro resulta de la desmineralización ósea. Existen factores que deben vigilarse con la finalidad de realizar diagnóstico y tratamiento temprano. OBJETIVO: determinar los factores de riesgo asociados a osteopenia en prematuros. MATERIALES Y MÉTODOS: estudio transversal comparativo de octubre del 2011 a octubre del 2013. Se incluyeron 120 prematuros 900 UI/L. Factores de riesgo determinados con razón de momios (OR. Estadística inferencial con c2 y t de Student. RESULTADOS: se diagnosticó enfermedad ósea metabólica en 58 prematuros (48%, peso 1067 ± 216 gramos, edad gestacional 28 ± 1.6 semanas, edad postnatal 41 ± 15.5 días. Género masculino 32 (55%. Factores de riesgo: peso < 1,000 gramos OR 4.64, (2.13-10.10, displasia broncopulmonar moderada o severa OR 3.13 (1.44-6.81, tres o más eventos de sepsis OR 3.43 (1.62 7.28, sedación prolongada OR 4.09 (1.06-15.73 y corticoide prolongado OR 9.54 (2.06-44.16.  CONCLUSIONES: nuestros resultados muestran que los factores de riesgo para enfermedad ósea metabólica del prematuro fueron peso al nacer menor de 1,000 gramos, displasia broncopulmonar moderada o severa, tres o más eventos de sepsis, sedación y corticoides durante tiempo prolongado.

  5. [Lymphocytic hypophysitis and hypertrophic pachymeningitis: description of a possible case associated to IgG4 pathologies].

    Science.gov (United States)

    Blanco-Cantó, M Empar; Dávila-González, Pablo; López de Silanes, Carlos; Cuadrado-Pérez, M Luz; Ortega, Gloria; Porta-Etessam, Jesús

    2015-06-01

    Introduccion. Las patologias relacionadas con la infiltracion de linfocitos y celulas inflamatorias se clasifican, segun su topografia, en patologia orbitaria idiopatica, paquimeningitis hipertrofica idiopatica, sindrome de Tolosa-Hunt e hipofisitis linfocitaria. Presentamos a una paciente que comenzo con una hipofisitis linfocitaria hace ocho años y ha presentado varios episodios de paquimeningitis hipertrofica variables en su localizacion. Caso clinico. Mujer de 55 años, en seguimiento por cefalea de dos meses de evolucion, que ingreso por empeoramiento clinico con paralisis del III par derecho completo, lagrimeo y rinorrea. Se realizo una resonancia magnetica cerebral que demostro la presencia de una lesion sellar compatible con hipofisitis linfocitaria. Se inicio tratamiento con corticoides con mejoria inicial, pero, tras dos años, la paciente presento empeoramiento clinico con cefalea y parestesias perioculares derechas. Se repitio la resonancia, donde se observaron varias lesiones extraaxiales, siendo el resto de estudios normales, por lo que se diagnostico paquimeningitis hipertrofica idiopatica y se inicio tratamiento de nuevo con corticoides. En el seguimiento posterior, la paciente presento nuevas lesiones en diferentes localizaciones y mal control algico, por lo que se añadio tratamiento inmunomodulador. Ante la asociacion de hipofisitis linfocitaria y paquimeningitis hipertrofica, se completo el estudio con determinacion de la IgG4 en el suero, que resulto negativa. Conclusiones. La asociacion de hipofisitis linfocitaria y paquimeningitis hipertrofica con las patologias relacionadas con la IgG4 se ha descrito recientemente. A pesar de que en nuestra paciente no se ha confirmado el diagnostico, se debe considerar esta relacion en aquellos casos idiopaticos y, sobre todo, si se asocian otras manifestaciones sistemicas.

  6. Oral gavage in rats: animal welfare evaluation.

    Science.gov (United States)

    Turner, Patricia V; Vaughn, Elizabeth; Sunohara-Neilson, Janet; Ovari, Jelena; Leri, Francesco

    2012-01-01

    The effect of chronic daily orogastric gavage with water (5 mL/kg) on behavior and physiology was evaluated in male Sprague-Dawley rats. Treatment groups included: unmanipulated control, restraint control, dry gavage, and gavage, with all rats singly housed (n = 9 or 10 per group). In addition, a group of pair-housed rats (n = 18) was included to determine whether social housing affected response to gavage. Weekly body weights and food consumption were recorded as well as use of a nylon chew toy for enrichment. Feces were collected biweekly at the end of the light and dark phases for fecal corticoid metabolite determinations. After 28 d of treatment, animals underwent conditioned place preference testing to evaluate sensitivity to motivational properties of the anxiolytic drug chlordiazepoxide (5.6 mg/kg SC). Brain and paired adrenal gland weights were collected at necropsy. Week 2 total fecal corticosterone levels were elevated in all groups and attributed to a fire alarm accidentally tripped during building renovations. No differences occurred in body weight or food consumption between any groups. All groups used a nylon chew toy given for enrichment and demonstrated mild preference for the drug-associated chamber. Fecal weights and corticoid metabolite levels were similar between all groups at week 4 and showed normal diurnal variation. No biologically significant variations were noted in brain or paired adrenal gland to body weight ratios. We conclude that orogastric gavage of aqueous solutions at 5 mL/kg does not negatively affect the welfare of laboratory rats acclimated to handling.

  7. Mastitis crónica granulomatosa idiopática: reporte de un caso Idiopathic chronic granulomatous mastitis: a case report

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    Juan Takano

    2010-12-01

    Full Text Available La mastitis cónica granulomatosa idiopática es una enfermedad rara que se presenta en mujeres, preferentemente en edad reproductiva, con características clínicas, mamográficas, ecográficas y citológicas sugestivas de cáncer mamario. Se informa un caso de patología mamaria en paciente mujer de 35 años de edad, portadora de tumoración eritematosa, sensible, localizada en mama izquierda. La lesión fue tratada como "mastitis" con antibióticos y corticoides durante dos semanas. La persistencia de tumoración y sensibilidad, así como los controles mamográficos y ecográficos sugestivos de neoplasia, decidieron la extirpación quirúrgica. El diagnóstico histopatológico fue de mastitis crónica granulomatosa idiopática.Idiopathic chronic granulomatous mastitis is a rare disease in women at the reproductive life with clinic, mammographic, echographic and cytological characteristics suggestive of breast cancer. We report a case of breast pathology in a 35 years old woman who had a sensitiveness and eritematous tumor localized in the left breast. With the diagnosis of "mastitis", she was treated with antibiotics and corticoids for two weeks. Because the lesion and the sensitiveness persist and the mammographic and ecographic controls were suggestive of malignancy, the tumor was surgically removing. The histopathological diagnosis was idiopatic chronic granulomatous mastitis.

  8. [Etanercept on steroid-refractary acute graft-versus-host disease].

    Science.gov (United States)

    González Munguía, Silvia; Pérez León, Moisés; Piñero González, Marta; Díaz Pestano, Marina Magnolia; Molero Gómez, Rafael; Luzardo Henríquez, Hugo Daniel

    2015-05-01

    Objetivo: Describir el uso y la efectividad de etanercept como terapia en la enfermedad de injerto contra huésped refractaria a corticoides tras el trasplante alogénico de progenitores hematopoyéticos. Método: Se seleccionaron los pacientes en los que se utilizó etanercept fuera de indicación para el tratamiento de la enfermedad de injerto contra huésped y se revisaron retrospectivamente sus historias clínicas para evaluar la respuesta al tratamiento. Resultados: De un total fueron cinco pacientes tratados cuatro presentaban enfermedad con afectación digestiva y otro con manifestación pulmonar y hepática. En el 80% de los casos se alcanzó alguna respuesta clínica: 60% respuesta parcial y 20% respuesta completa. En cuatro pacientes se utilizo etanecept 25mg dos veces por semana con duración variable, obteniendo una respuesta nula en uno (3 semanas), parcial en dos (4 y 8 semanas) y total en otro (8 semanas). Sólo en un caso se usó etanercept 50mg dos veces en semana durante 5 semanas con respuesta parcial. Conclusiones: Los resultados obtenidos de respuesta clínica son coherentes con los publicados previamente y vienen a incrementar la escasa bibliografía sobre la utilidad de etanercept en el tratamiento en la enfermedad de injerto contra huésped aguda y refractaria a corticoides. Dadas las limitaciones del diseño y el reducido número de pacientes, estudios controlados deberán evaluar en el futuro la eficacia y la seguridad de etanercept en estos pacientes.

  9. Bases biológicas do transtorno de estresse pós-traumático Biological basis of posttraumatic stress disorder

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    Frederico G Graeff

    2003-06-01

    Full Text Available A pesquisa neuroendocrinológica dos sistemas fisiológicos envolvidos no estresse evidencia hiper função do eixo simpato-adrenal em conjunto com uma redução da atividade do eixo hipotálamo-hipófise-adrenal (HHA em pacientes com estresse pós-traumático (TEPT. Uma resposta prejudicada do cortisol aos estressores parece estar associada com um aumento da vulnerabilidade ao desenvolvimento do TEPT. O excesso de catecolaminas, sem o pareamento do aumento dos corticóides promoveria uma consolidação excessiva das memórias traumáticas e a indevida generalização para outras situações estressantes. Sintomas como o entorpecimento e flashbacks têm sido relacionados com o aumento de opióides endógenos. Estudos de neuroimagem evidenciam uma redução do volume hipocampal no TEPT, que tem sido relacionada a alterações cognitivas e anormalidades do eixo HHA encontrados no TEPT.Neuroendocrinological research on the physiological systems involved in stress evidenced hyper functioning of the sympatho-adrenal axis together with reduced activity of the hypothalamic-pituitary-adrenal axis in patients with posttraumatic stress disorder (PTSD. An impaired corticoid response to stressors seems to be associated with enhanced vulnerability to PTSD. Excess catecholamines, unchecked by corticoids would promote over consolidation of traumatic memories and undue generalization to other stressful situations. Symptoms such as numbing and flashbacks have been related to endogenous opioids. Neuroimaging studies evidenced a reduction of hippocampal volume in PTSD patients, which has been related to both cognitive changes and abnormalities of the HPA axis that are found in PTSD.

  10. Seguimiento multidisciplinario en el control del penfigoide de membranas mucosas

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    Fabiano Jeremias

    2011-06-01

    Full Text Available El término penfigoide de membranas mucosas designa un grupo de enfermedades vesículo-bulosas autoinmunes crónicas, que afectan predominantemente mucosas. El presente artículo describe dos casos clínicos de penfigoide de membranas mucosas con compromiso gingival y tuvo como objetivo resaltar la importancia de un correcto diagnóstico de la lesión y discutir la conducta terapéutica. Fueron realizados diversos exámenes complementares como, examen de Nikolsky, biopsia incisional, investigación de células LE y de anticuerpos antinucleares, además de la evaluación de médicos especializados en dermatología y oftalmología. Fue fundamental la substitución de dentífricos, la orientación nutricional y psicológica, el cuidado con la higiene, además del uso de corticoides tópicos. Hubo periodos de remisión y exacerbación del cuadro clínico durante el seguimiento, fue necesario el ajuste en la terapéutica y refuerzo en los cuidados con la higiene bucal. Es muy importante la interacción multidisciplinaria en la atención de estos casos para el control del tratamiento y seguimiento, además de reforzar todas las orientaciones y cuidados en lo que se refiere a la salud bucal y cautela en el uso de corticoides.

  11. [Electrical status epilepticus during sleep: a retrospective multi-centre study of 29 cases].

    Science.gov (United States)

    Lorenzo-Ruiz, María; Miguel-Martin, Beatriz; García-Pérez, Asunción; Martínez-Granero, Miguel A; Aguilera-Albesa, Sergio; Yoldi-Petri, M Eugenia; Sánchez-Ruiz de Gordoa, Javier; Castro-De Castro, Pedro; Sánchez-Carpintero, Rocío

    2015-02-01

    Introduccion. El estado epileptico electrico durante el sueño (ESES) es un sindrome epileptico caracterizado por la presencia de descargas epilepticas tipo punta-onda lenta de manera muy persistente durante el sueño no REM. En la actualidad, el manejo de esta patologia es heterogeneo y no hay estudios controlados con los tratamientos utilizados, ni se ha comprobado si estos mejoran la evolucion cognitiva de los pacientes. Pacientes y metodos. Se revisan los pacientes diagnosticados de ESES durante 15 años en cuatro centros hospitalarios, se recoge la presentacion clinica, el manejo terapeutico y la evolucion clinica, y se compara con la bibliografia. Resultados. Se seleccionaron 29 pacientes con ESES, 20 de ellos idiopatico y 26 de ellos generalizado. Los farmacos con los que se consiguio mayor control de la actividad electrica fueron los corticoides/hormona adrenocorticotropa (ACTH), el clobazam y el levetiracetam. La mediana de duracion del ESES en los casos primarios fue de seis meses, y en los secundarios, el doble. El 45% de los pacientes mantuvo un cociente intelectual normal y un 40% presento en la evolucion discapacidad cognitiva de diferente grado. Conclusiones. El pronostico neuropsicologico evolutivo suele ser desfavorable y la evolucion cognitiva parece estar en relacion con la duracion del ESES y el area donde este concentrada la actividad epileptica, lo que sugiere que el mal pronostico, si se trata precozmente, se puede evitar. Los antiepilepticos mas frecuentemente utilizados son el acido valproico, la etosuximida y el levetiracetam, y en nuestra muestra tambien se utilizaron con frecuencia el clobazam y la lamotrigina. Los farmacos mas eficaces para el control del ESES fueron los corticoides/ACTH, el clobazam y el levetiracetam.

  12. Cure of Psoriasis and Arthritis when Addison’s Disease Was Detected

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    Marcus Lind

    2010-06-01

    Full Text Available Introduction: Corticoid therapy is well-known to improve the symptoms of psoriasis. Addison’s disease is an autoimmune disease which leads to a loss of cortisol production in the adrenal glands. This case report describes a patient with wide-spread psoriasis for 34 years who was cured when Addison’s disease was detected and substitution to reach normal biological cortisol levels was introduced. Case Report: A 59-year-old man was diagnosed with Addison’s disease. He had been tired for several years and had had difficulties in continuing his work. His brother had Addison’s disease and recommended him to make a screen for the disease. Synacthen test diagnosed Addison’s disease with a clear deficiency of cortisol production. After substitution with hydrocortisone the patient’s constitution improved rapidly and he felt no longer tired during work. At the same time, all skin lesions of psoriasis disappeared as well as aches in several joints, both symptoms having been present for a couple of decades. Previously, salves of cortisol had been used to reduce the symptoms of psoriasis, but now, 1–2 years later, after the treatment of Addison’s disease, no symptoms in the skin or joints have reoccurred. Conclusions: This report illustrates that Addison’s disease, although a rare condition, should be kept in mind before treatment of psoriasis is started. Especially if other symptoms such as fatigue are present, a screening test of serum cortisol in the morning should be liberally made. The report also illustrates a need of examining corticoid levels in patients with psoriasis compared to the general population.

  13. Evolución clínica y radiológica de una mujer con histiocitosis pulmonar de células de Langerhans durante 18 años Clinical and radiological evolution of a woman with pulmonary Langerhans cell histiocytosis during 18 years

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    XIMENA CEA B

    2008-01-01

    Full Text Available La histiocitosis pulmonar de células de Langerhans (HPCL es una enfermedad pulmonar difusa quística poco frecuente. En esta revisión, presentamos un caso de HPCL diagnosticada en una adolescente, no fumadora, que consultó por disnea rápidamente progresiva asociada a dolor pleurítico izquierdo, debido a un neumotorax bilateral. El diagnóstico se confirmó por biopsia quirúrgica. Se indicó tratamiento con corticoides (prednisona durante el primer año. Tras 18 años de seguimiento destaca una importante mejoría clínica, con una evolución radiológica y espirométrica favorable, pero no completa. Los casos que se presentan con neumotorax espontáneo recurrente son raros. La evolución natural de esta enfermedad es variable y su tratamiento aún es controversial, siendo la terapia con inmunosupresores, tal como corticoesteroides y agentes citotóxicos de valor limitado, ya que son escasos los estudios que avalan su eficaciaThe Pulmonary Langerhans cell histiocytosis (PLCH is an uncommon pulmonary diffuse cystic disease. This review presents one case of PLCH diagnosed in a non-smoker female adolescent, who consulted for rapidly progressive dyspnea associated to left pleuritic pain that corresponded to a bilateral pneumothorax. The diagnosis was confirmed by surgical biopsy of the lung. Treatment with corticoids (prednisone was indicated during the first year. After 18 years from diagnosis she presented an important clinical improvement, with a favourable but not complete radiological and spirometric improvement. The cases that make their debut with recurrent spontaneous pneumothorax are infrequent. The natural evolution of this disease is variable and the treatment is still controversial, been the immunosuppressive therapy, as corticoesteroids and cytotoxic agents of limited value, since are few studies that confirm their effectiveness

  14. Paniculitis mesentérica: A propósito de un caso A case of mesenteric panniculitis

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    C.I. González

    2008-04-01

    Full Text Available La paniculitis mesentérica puede ser considerada como un estadio evolutivo de una enfermedad mesentérica, con una primera fase de lipodistrofia mesentérica sin signos inflamatorios, seguida de una segunda fase de paniculitis, para finalizar en fibrosis, denominándose entonces mesenteritis retráctil, que afecta principalmente a varones con más de 50 años. La etiología es desconocida, habiéndose descrito diferentes factores asociados, y la presentación clínica es variable, en función del estadio de la enfermedad. Para su diagnóstico la TAC es la prueba de imagen indicada, siendo el estudio histopatológico el que arrojará el diagnóstico definitivo. Existen diferentes fármacos y pautas terapéuticas, si bien se carecen de estudios donde se establezca el tratamiento idóneo. Presentamos el caso de un paciente diagnosticado de paniculitis mesentérica que ha evolucionado satisfactoriamente tras haber sido tratado con ciclofosfamida asociada a corticoides.Mesenteric panniculitis can be considered as an evolved state of a mesenteric disease, with a first phase of mesenteric lipodystrophy without inflammatory signs, followed by a second phase of panniculitis, ending in fibrosis, at which point it is denominated retractile mesentiritis, which principally affects males over the age of 50. Its aetiology is unknown, with a description made of different associated factors, and its clinical presentation is variable, depending on the stage of the disease. The image test indicated for its diagnosis is the TAC, while an histopathological study provides the definitive diagnosis. There are different medicines and therapeutic guidelines, although studies establishing the ideal treatment are lacking. We present the case of a patient diagnosed with mesenteric panniculitis who evolved favourably followed treatment with cyclophosphamide associated with corticoids.

  15. Treatment of retroauricular keloids: Revision of cases treated at the ENT service of HC/UFPR.

    Science.gov (United States)

    Carvalho, Bettina; Ballin, Annelyse Cristine; Becker, Renata Vecentin; Ribeiro, Talita Beithum; Cavichiolo, Juliana Benthien; Ballin, Carlos Roberto; Mocellin, Marcos

    2012-04-01

    Introdução: Queloides são tumores benignos resultantes de cicatrização anômala da pele, sendo que existem diversos procedimentos disponíveis para o seu tratamento.Objetivo: O objetivo deste trabalho é avaliar os resultados de pacientes submetidos a tratamento de queloides retroauriculares após cirurgias otorrinológicas em nosso serviço.Método: Estudo retrospectivo e prospectivo, através de análise de prontuários, dos pacientes submetidos a tratamento de queloides retroauriculares em nosso serviço.Resultados: Nove pacientes foram avaliados, sendo que 6 foram submetidos a ressecção e betaterapia adjuvante, 2 foram submetidos a ressecção mais aplicação de corticoide local, 1 foi submetido apenas a ressecção sem terapia adjuvante. Não houve recidiva nos casos tratados com betaterapia no pós-operatório precoce, 1 paciente apresentou recidiva mesmo com corticoterapia e betaterapia tardia.Discussão: diversas técnicas tem sido utilizadas para tratamento dos queloides retroauriculares, sendo que a betaterapia é considerada a com melhores resultados, seguida pela utilização de corticoides intralesionais.Conclusão: o tratamento dos queloides retroauriculares continua um desafio. Enquanto novas técnicas não são desenvolvidas, a ressecção seguida de betaterapia precoce ainda é a melhor opção.

  16. Mortalidad en recién nacidos de extremo bajo peso al nacer en la unidad de neonatología del Hospital Nacional Cayetano Heredia entre enero 2000 y diciembre 2004.: January 2000 to December 2004

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    Pablo Lohmann Gandini-Billinghurst

    2006-07-01

    Full Text Available Objetivos: Identificar los factores demográficos y clínicos más frecuentes en recién nacidos con peso menor a 1 000g al nacimiento (extremo bajo peso fallecidos en la unidad de neonatología del Hospital Nacional Cayetano Heredia. Material y métodos: El estudio diseñado es una serie de casos. Se evaluaron las epicrisis y la base de datos NEOCOSUR de los pacientes con estas características, fallecidos durante la hospitalización, de enero 2000 a diciembre 2004. Resultados: Se encontraron 99 pacientes, con registros completos en 87 de ellos (88% de la muestra. La mortalidad en esta población fluctuó entre 70 y 85%, siendo las siguientes condiciones clínicas más frecuentes: control prenatal inadecuado, edad gestacional menor a 27 semanas, uso de corticoides prenatales, empleo de surfactante, enfermedad de membrana hialina-síndrome de distrés respiratorio y hemorragia intraventricular. Conclusiones: Los cuidados prenatales, el uso de corticoides prenatales y surfactante son factores modificables que tendrían impacto en la mortalidad. Síndrome de Distrés Respiratorio-membrana hialina, sepsis y hemorragia intraventricular, constituyen las entidades de morbilidad más frecuentes. El alcance de este estudio permite formular estas hipótesis. La evaluación de las mismas requiere estudios tipo observacionales y analíticos posteriores. (Rev Med Hered 2006;17:141-147.

  17. [Latin-American Consensus on Difficult-to-Control Asthma. 2008 Update].

    Science.gov (United States)

    2008-06-01

    Asthma, which is more of a syndrome than a disease, usually responds to inhaled corticosteroid treatment, with or without the addition of long-acting beta-agonists. However, in a certain group of patients asthma cannot be controlled despite administering appropriate drugs at high doses. Difficult-to-control asthma cases are the target of this consensus meeting. Clinical practice guidelines and consensus on this subject already exist, so we must emphasize that the objective of this document is to review said guidelines and adapt them to regional situations. It is also necessary to update the guidelines, as new treatment alternatives have appeared in our countries. Difficult-to-control asthma has many different names, such as severe, serious, difficult, refractory, unstable, life-threatening, corticoid-resistant, and corticoid-dependent asthma, among others. The prevalence of difficult-to-control asthma has not clearly been established, but several publications estimate it to represent 5% of the asthma population. However, the significant impact on asthma-related direct and indirect costs and the quality of life impairment in this patient population have been clearly shown. The Latin American Consensus on Difficult-to-Control Asthma submits the following definition: "Inadequately-controlled asthma existing despite appropriate treatment strategy adjusted to the clinical severity level (level 4 or higher of the Global Initiative for Asthma [GINA]), indicated by a physician and administered for at least six months". The correct diagnosis of difficult-to-control asthma usually is made when there is no response to adequate treatment adjusted to the clinical severity level. However, many conditions can mimic difficult-to-control asthma, while others can exacerbate it. Therefore, in order to ensure a correct diagnosis, certain requirements - systematic assessments - must be met which confirm the asthma diagnosis and rule out other conditions. The therapeutic approach to

  18. Response of first attack of inflammatory bowel disease requiring hospital admission to steroid therapy Respuesta al tratamiento esteroideo del primer brote de enfermedad inflamatoria intestinal que requiere ingreso hospitalario

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    M. Abu-Suboh Abadía

    2004-08-01

    Full Text Available Introduction: corticoid administration is the usual treatment of Crohn' disease (CD and ulcerative colitis (UC attacks. How-ever, information available on response rates and their predictive factors is scarce. Objective: to establish response to steroidal treatment in an homogeneous group of patients with CD or UC during their first admission to hospital. Methods: restrospective analysis of 86 patients who received systemic steroidal treatment for a severe flare-up during their first hospital admission between 1995 and 2000. Patients were treated per protocol with fluid therapy, absolute diet, IV 6-methyl-prednisolone 1 mg/kg/day, and enoxaparin at prophylactic doses. Clinical response at 30 days was considered good in case of complete remission, and poor in case of partial or absent remission. Univariate and multivariate analyses according to non-parametric statistics were performed for sociodemographic and biologic variables. Results: 45 patients with CD and 41 with UC were included. Good response rates were 64.4% for CD and 60.9% for UC. The univariate analysis showed that patients with good response have shorter evolution times and fewer previous flare-ups (p Introducción: la administración de corticoides constituye el tratamiento habitual de los brotes de enfermedad de Crohn (EC y colitis ulcerosa (CU. Sin embargo, existe poca información sobre las tasas de respuesta y los factores que puedan predecirla. Objetivo: determinar la respuesta al tratamiento esteroideo en un grupo homogéneo de pacientes de EC y CU que ingresan por primera vez en el hospital. Métodos: análisis retrospectivo de 86 pacientes que en su primer ingreso hospitalario recibieron tratamiento esteroideo sistémico por brote grave de EC o CU entre 1995 y 2000. Fueron tratados de forma protocolizada con sueroterapia, dieta absoluta, 6-metil-prednisolona 1 mg/kg/día IV y enoxaparina a dosis profilácticas. Se ha considerado la respuesta clínica a los 30 días como

  19. Recomendaciones para la prevención, diagnóstico y tratamiento de LA EPOC en la Argentina

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    Juan Carlos Figueroa Casas

    2012-08-01

    Full Text Available La enfermedad pulmonar obstructiva crónica (EPOC está aumentando marcadamente su morbimortalidad, costos e indicadores epidemiológicos. Por ello la Asociación Argentina de Medicina Respiratoria (AAMR convocó a un grupo de especialistas para actualizar conocimientos básicos y efectuar recomendaciones para su diagnóstico, prevención y tratamiento. Se revisan definición, avances en fisiopatología, presentación clínica, diagnóstico por imágenes y evaluación funcional. Se enfatiza su diagnóstico temprano mediante exploración funcional -esencialmente espirometría- y la prevención a través de la cesación del tabaquismo. Se describen estrategias para dejar de fumar, tratamiento farmacológico y no farmacológico. La administración de broncodilatadores, preferentemente de acción prolongada, es la primera opción de tratamiento farmacológico. Los corticoides inhalados se indican en combinación con los broncodilatadores en pacientes con obstrucción al flujo aéreo persistente asociada con exacerbaciones frecuentes, si bien se requieren estudios que confirmen su relación costo/beneficio. La vacuna antigripal es recomendada en todos los pacientes. Con respecto a las intervenciones no farmacológicas, la cirugía del enfisema solo se recomienda en circunstancias especiales. La rehabilitación respiratoria es una herramienta útil en pacientes con limitación en la actividad física habitual. La oxígenoterapia crónica domiciliaria mejora la supervivencia en pacientes con hipoxemia crónica grave. La ventilación no invasiva domiciliaria fuera de las exacerbaciones, tiene indicaciones en pacientes seleccionados. Las exacerbaciones agudas deben tratarse con broncodilatadores, oxígeno, corticoides, antibióticos y, bajo ciertas circunstancias, asistencia respiratoria mecánica tanto no invasiva como invasiva. El papel de la educación pública, del paciente y su familia, es considerada esencial en la prevención y tratamiento.

  20. Tratamiento farmacológico de las alteraciones neuromusculares en el paciente crítico Pharmacological treatment neuromuscular impairments in critically ill patients

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    C. Ortiz Leyba

    2006-05-01

    Full Text Available El empleo de fármacos para tratamiento de las alteraciones neuromusculares que se presentan en el enfermo ingresado en una Unidad de Cuidados Intensivos es prácticamente inexistente. El empleo de inmunoglobulinas por vía venosa para el tratamiento de la polineuropatía del paciente crítico (PPC no aporta ninguna evidencia para su uso. Más importancia tiene el tratamiento profiláctico, como es el caso de la administración de una perfusión de insulina para prevenir la hiperglucemias que seasocian a un mayor desarrollo de la PPC. Nuevos datos inducen a pensar que el mecanismo protector de esta perfusión, normalizando los niveles de glucosa se hacen modulando una disfunción endotelial y a unos menores niveles de dimetilarginina asimétrica (ADMA. Con respecto a la miopatía del paciente crítico o a los cuadros de bloqueo neuromuscular prolongado, el tratamiento consiste en evitar el empleo de diversos fármacos que se sabe se asocian al desarrollo de estas entidades como son los corticoides, los relajantes musculares y los aminoglucósidos. Por lo que respecta a la parálisis aguda flácida -infección por el virus del oeste del nilo se han comunicado casos anecdóticos de mejoría con el empleo de corticoides o de interferón, pero su tratamiento rutinario queda aún por establecer.The use of drugs for treating neuromuscular impairments that present in the patient admitted to the Intensive Care Unit is virtually inexistent. The use of intravenous immunoglobulins for managing polyneuropathy of the critically ill patient (PCIP is supported by no evidence. More important is prophylactic therapy, as is the administration of insulin perfusion to prevent hyperglycemia that is associated to increased development of PCIP. New data suggest that the protective mechanism of this perfusion, which normalizes glucose levels, is achieved through the modulation of endothelial dysfunction and lowering levels of asymmetrical di-methyl arginine (ADMA. As

  1. Nefropatía por Inmunoglobulina A: Guía de práctica clínica

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    Alicia Fayad

    2011-05-01

    Full Text Available La nefropatía por Inmunoglobulina A (N.IgA es la causa más frecuente de enfermedad glomerular a nivel mundial, 15-50% de los pacientes presentan pérdida progresiva de la función renal en 10-20 años; el resto remisión clínica o hematuria/ proteinuria persistente. Su tratamiento óptimo es incierto. Nuestro objetivo fue desarrollar recomendaciones basadas en la evidencia a través de búsqueda en bases de datos Medline, Embase, Lilacs, Cochrane Trials Register. Los investigadores analizaron la calidad de los estudios independientemente, usando la Cochrane Renal Group checklist: aleatorización, carácter ciego, intención de tratar y pérdidas en el seguimiento. La evidencia se clasificó en niveles y la recomendación en grados, según el Centre for Evidence-Based Medicine, Oxford, con dos enfoques principales: Terapia inmunosupresora (corticoides, citostáticos, ciclosporina A y micofenolato mofetilo: Nivel I a, grado A. Terapia combinada con inmunosupresores en adultos: Nivel II b, grado B. Corticoides más ciclofosfamida o azatioprina en niños: Nivel II b, grado C. Ciclosporina y micofenolato-mofetilo: Nivel II b, grado B. Terapia no inmunosupresora: inhibidores del sistema renina-angiotensina (IEAC y/o bloqueantes del receptor de angiotensina II (BRAII, aceite de pescado, estatinas, antiplaquetarios y tonsilectomía: Nivel I a, grado A. Niños: IECA y BRAII con monitoreo de función renal y de nivel sérico de potasio: Nivel I b, grado B. En nefropatía progresiva, antiplaquetarios como tratamiento coadyuvante: Nivel I, grado C. Aceite de pescado como soporte adicionado de BRAII e IECA en pacientes con lesiones histológicas leves y baja reducción de la filtración glomerular: Nivel II b, grado B (no en niños. No hay evidencias para recomendar estatinas en niños; en mayores de 5 años con síndrome nefrótico e hipercolesterolemia usar sólo con monitoreo de fosfocreatin-kinasa sérica. No hay evidencias para recomendar la

  2. Estrategia de atención de niños hospitalizados por infecciones respiratorias agudas bajas

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    Ferrari Ana M

    2002-01-01

    Full Text Available OBJETIVO: Mejorar la calidad de la atención hospitalaria de los niños con infecciones respiratorias agudas bajas, aumentar los conocimientos sobre esa patología y mejorar la eficiencia en el uso de los recursos asistenciales, por medio de una estrategia que se denominó Plan de Invierno.MÉTODOS: La estrategia se basó en la utilización de protocolos de diagnóstico y tratamiento, internación por cuidados progresivos y por enfermedad, adecuación de los recursos asistenciales y creación de un sistema de registro permanente, informatizado. Se incorporó la investigación sistemática de la etiología viral para racionalizar el uso de la medicación y reducir las infecciones intrahospitalarias. RESULTADOS: Durante la aplicación del Plan (19/V-19/IX/99 ingresaron 3.317 niños; 1.347 (40.61% presentaban infecciones respiratorias agudas bajas. Se captaron 1.096 (81%, de los cuales 71% eran menores de un año. Predominaron las infecciones respiratorias virales (68%. Los criterios de ingreso fueron saturación de oxígeno <95%, polipnea, tiraje o derrame pleural en el 92.4% de los niños. La magnitud de la demanda impidió que las pautas de aislamiento individual o en grupo se cumplieran en todos los casos. El uso de la medicación se ajustó a lo recomendado en un elevado porcentaje: no recibieron antibióticos 73% de las bronquiolitis ni 72% de las neumonías virales, y 96% de las neumonias bacterianas los recibieron según pauta; se redujo el uso de broncodilatadores y de corticoides. El gasto en medicamentos disminuyó fundamentalmente en el grupo de los corticoides y tuvo el mayor impacto en el costo por día/cama de antibióticos. CONCLUSIONES: Disminuir la morbimortalidad por infecciones respiratorias agudas bajas requiere continuar mejorando la calidad de la atención hospitalaria y fortalecer los programas de promoción de salud y de control de las enfermedades prevalentes, en el primer nivel de atención.

  3. Análisis retrospectivo de 23 años de necrólisis epidérmica tóxica en la Unidad de Quemados de Alicante, España

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    F.I. Castillo-Muñoz

    2014-09-01

    Full Text Available El Síndrome de Lyell o Necrólisis Epidérmica Tóxica (NET se encuadra dentro del espectro de reacciones cutáneas adversas graves y se caracteriza por presentar una baja incidencia pero una elevada mortalidad. La mayoría de los casos de NET se relacionan con una reacción medicamentosa idiosincrática. El objetivo de este trabajo es reflejar la experiencia clínica con esta entidad en la Unidad de Quemados del Hospital General Universitario de Alicante, España, durante los últimos 23 años. Realizamos un estudio retrospectivo recogiendo los datos epidemiológicos, agentes causales probables, pruebas complementarias, patologías concomitantes, tratamiento y evolución clínica. En total recogimos 16 pacientes con una media de edad de 53,19 años, 68,75% mujeres y 31,25% varones. Los antibióticos fueron los fármacos más comúnmente implicados (31,25%, seguidos de los AINES (25%. Durante el ingreso hospitalario, el 43,75% de los pacientes recibió corticoides sistémicos, el 37,5% exclusivamente tratamiento de soporte y el 25% inmunoglobulinas intravenosas. El 56,25% sufrió algún tipo de secuela, siendo la afectación ocular la más frecuente (18,75%. Calculamos el SCORTEN (Severity of illness score for toxic epidermal necrolisys para todos los pacientes en las primeras 24 horas de ingreso, siendo la suma de las probabilidades predichas de morir por NET de un 32%, cifra superior a los datos reales (mortalidad del 25%. La utilización de corticoides sistémicos sigue siendo controvertida, apareciendo en nuestro estudio un mayor número de infecciones y una mayor mortalidad asociada a dicho tratamiento. La retirada inmediata del fármaco sospechoso, el ingreso precoz en una Unidad de Quemados o de Cuidados Intensivos, el tratamiento de soporte y la reposición hidroelectrolítica, siguen siendo medidas cruciales y de primera línea en el tratamiento de estos pacientes. A pesar de que están descritos diferentes tipos de tratamiento

  4. Notalgia parestésica: relato de caso

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    José Otávio Alquezar Gozzano

    2016-10-01

    Full Text Available Introdução: Notalgia parestésica (NP é uma condição neurocutânea, caracterizada por crises pruriginosas, hiperpigmentação e neuropatia sensorial. Apesar de pouco descrita em literatura, a doença é mais frequente do que se imagina, sendo subdiagnosticada em muitos casos. NP pode afetar qualquer idade e sexo, mas acomete principalmente pessoas de média idade e mulheres. Sua etiologia inclui alterações degenerativas vertebrais, trauma vertebral e predisposição genética. NP envolve o trajeto anatômico dos nervos espinhais e está relacionada com o comprometimento de neuropeptídios, dando origem a marcapassos neurais ectópicos, responsáveis pela clínica da NP. O diagnóstico é clínico, a partir da identificação de máculas hiperpigmentadas unilaterais em zona escapular, sem eritema ou descamação, com piora ao estresse. Deve-se diferenciar de líquen simples, amiloidose macular e hanseníase. Na anatomopatologia observa-se acantose focal e queratinócitos necróticos; a derme papilar mostra depósito de substância amiloide. Com sintomas leves o tratamento medicamentoso nem sempre é necessário, se mais severa utiliza-se capsaicina tópica, gabapentina, oxicarba-mazepina, corticoides e toxina botulínica. Objetivo: Relatar caso de NP. Material e métodos: Paciente atendida ambulatorialmente com revisão de literatura. Relato de Caso: Feminina, 50 anos, com queixa de mancha em dorso há 2 anos; refere dor na coluna torácica. Ao exame: presença de mácula hipercrômica. Hipótese diagnóstica: NP. Foi prescrito corticoide tópico para alívio de sintomas. Conclusão: Por tratar-se de uma doença subdiagnosticada, o conhecimento médico da clínica de NP é fundamental para o diagnóstico precoce, permitindo a escolha do tratamento específico, o que melhora a evolução dos pacientes e evita o uso de fármacos ineficazes.

  5. Diagnóstico clínico-radiológico de neurocisticercosis: a propósito de un caso Clinical and radiological diagnosis of neurocysticercosis: A case report

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    D. Navarro

    2009-08-01

    Full Text Available Introducción. La neurocisticercosis es la enfermedad parasitaria más frecuente del sistema nervioso central y la primera causa de epilepsia de inicio tardío en las áreas endémicas. Nuestro objetivo con este trabajo es orientar a través de los criterios clínicos y radiológicos el diagnóstico de sospecha de esta enfermedad, presentando un caso clínico. Materiales y métodos. Presentamos el caso de una mujer de 43 años, natural de Bolivia, que acudió al Servicio de Urgencias tras presentar una crisis convulsiva generalizada, presenciada por familiares de la paciente. Resultados. Se realizó una tomografía axial computarizada craneal, que permitió junto con su historia clínica sospechar una neurocisticercosis. Se ingresó en neurocirugía para completar el estudio, que confirmó el diagnóstico de sospecha, y recibió tratamiento con albendazol y corticoides, con buena evolución. Conclusiones. La neurocisticercosis es una patología emergente en países desarrollados, debido al aumento de la inmigración desde áreas endémicas, principalmente de América Latina. La epilepsia es la expresión clínica más frecuente, pero la presentación es muy variable. Un alto grado de sospecha es necesario para poder diagnosticar esta enfermedad.Background. Neurocysticercosis is the most frequent parasitic disease of the central nervous system and the first cause of acquired epilepsy in endemic areas. Our aim with this paper is to use clinical and radiological criteria to orientate diagnosis where there is suspicion of neurocysticercosis, presenting a clinical case as an example. Materials and methods. We present the case of a 43 year old woman of Bolivian origin, who came to accidents and emergencies after suffering a generalized convulsive crisis, witnessed by relatives of the patient. Results. A cranial computerized axial tomography was taken, which together with her clinical history led to suspicion of neurocysticercosis. She was admitted to

  6. Prevalencia de los factores de riesgo de fractura por fragilidad en varones de 40 a 90 años de una zona básica de salud rural

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    Rafael Gómez Navarro

    2011-01-01

    Full Text Available Fundamento: La osteoporosis, y como consecuencia de ella las fracturas por fragilidad, se han convertido en los últimos años en un importante problema de salud pública en los países desarrollados. Aunque es bien conocida su epidemiología y factores de riesgo en la mujer postmenopáusica son escasos los trabajos centrados en analizar esta patología en los hombres. El objetivo es determinar la prevalencia de los factores de riesgo de fractura por fragilidad en los varones y calcular su riesgo absoluto de fractura osteoporótica mayor y de fractura de cadera. Métodos: Estudio descriptivo transversal realizado en una zona de salud rural. La población de estudio fueron los varones de entre 40 y 90 años. No se contemplaron causas de exclusión. Se realizó entrevista personal recogiendo los siguientes datos: edad, peso, talla, índice de masa corporal (IMC, antecedente de fractura previa, antecedente de fractura de cadera en progenitores, habito tabáquico, consumo de corticoides, antecedente de artritis reumatoide, osteoporosis secundaria, consumo de alcohol y densidad mineral ósea (DMO. Con estos datos se calculó el riesgo absoluto de fractura y el riesgo de fractura de cadera mediante la aplicación de la herramienta FRAX®. Resultados: Se estudió a 431 hombres. Media de edad 65,8 ± 13,9 años e IMC de 28,4 ± 4,3 Kg/m². A ninguno se le había determinado DMO. Prevalencia de los factores de riesgo: fractura previa 3,7%; progenitores con fractura de cadera 10,4%; fumadores 21,1%; corticoides 2,8%; artritis reumatoide 0,9%; osteoporosis secundaria 2,3%; alcohol 30,9%. Riesgo absoluto de fractura del 3,7 ± 3,1 IC al 95% (3,43-4,02 y riesgo de fractura de cadera del 1,7 ± 2,5 IC al 95% (1,51-1,98. Conclusiones: Especialmente importante en el varón sería supresión del alcohol y del tabaco.

  7. Intoxicación por cáusticos

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    E. Mencías

    Full Text Available A la hora de valorar a un paciente que ha ingerido un cáustico existen guías o protocolos de tratamiento discordantes. Diversas ideas o tendencias hablan a favor de diluir, neutralizar, provocar el vómito, realizar lavado gástrico, etc., dependiendo del medio en que se haga la encuesta: domicilio, centro de salud, servicio de urgencias u hospital. Lo mismo sucede con el tipo de diluyente o neutralizante a usar, cómo y cuándo iniciar pauta de tratamiento con corticoides y/o antibióticos y antisecretores, y eso si es que hay que hacerlo. Se ha realizado una revisión bibliográfica exhaustiva, un trabajo experimental y el estudio de diversas guías o protocolos de diagnóstico y tratamiento que se siguen en diversos hospitales españoles. A escala experimental se evidencia que existen marcadores histopatológicos que desaconsejan la utilización de sustancias diluyentes tras la ingestión de álcalis cáusticos. Salvo en los casos de ingesta de sustancias cáusticas sólidas -cristalinas o granulosas- se contraindica, de forma absoluta, la dilución. Los corticoides no son eficaces cuando se ingiere un ácido cáustico; su uso es más que cuestionable tras la ingesta de álcalis cáusticos. El diagnóstico y calidad de tratamiento se apoya en la endoscopia. No existe un criterio único que defina en qué momento (tiempo post-ingesta es más conveniente llevarla a cabo, aunque el periodo comprendido entre las primeras 6-12 horas es el más adecuado. Se presenta un protocolo independiente de diagnóstico y tratamiento -en forma de algoritmos- que debe seguirse tras la ingesta de ácidos cáusticos o álcalis cáusticos.

  8. Comparative study of ophthalmological and serological manifestations and the therapeutic response of patients with isolated scleritis and scleritis associated with systemic diseases

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    Jacqueline Martins de Sousa

    2011-12-01

    Full Text Available INTRODUCTION: Scleritis is a rare, progressive and serious disease, the signs of which are inflammation and edema of episcleral and scleral tissues and is greatly associated with systemic rheumatoid diseases. PURPOSE: To perform a prospective and comparative study between ophthalmologic manifestations, serologic findings and therapeutic response of patients with isolated scleritis and scleritis associated with systemic rheumatoid disease. METHODS: Thirty-two outpatients with non-infectious scleritis were studied, from March 2006 to March 2008. The treatment was corticoid eye drops associated with anti-inflammatory agents, followed by systemic corticoids and immunosuppressive drugs if necessary, was considered successful after six months without scleritis recurrence. RESULTS: Fourteen of 32 patients had scleritis associated with systemic rheumatoid disease, of which nine had rheumatoid arthritis, two systemic lupus erythematosus, one Crohn's disease, one Behçet's disease and one gout. There were no difference in relation to involvement and ocular complications, there was predominance of nodular anterior scleritis and scleral thinning was the most frequent complication. The scleritis associated with systemic rheumatoid disease group had 64.3% of autoantibodies, versus 27.8% among those with isolated scleritis and this difference was statistically significant. In the isolated scleritis group 16.7% used anti-inflammatory, 33.3% corticosteroids, 27.8% corticosteroids with one immunosuppressive drug, 5.5% two immunosuppressive drugs, 16.7% corticosteroids with two immunosuppressive drugs and 33.3% pulse of immunosuppressive drugs, there was remission in 88.9%. In the scleritis associated with systemic rheumatoid disease group 7.1% used anti-inflammatory, 7.1% corticosteroids, 50% corticosteroids with one immunosuppressive drug, 7.1% two immunosuppressive drugs and 22.2% pulse of immunosuppressive drugs, 100% had treatment success. CONCLUSION

  9. Estrategia de atención de niños hospitalizados por infecciones respiratorias agudas bajas

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    Ana M Ferrari

    2002-06-01

    Full Text Available OBJETIVO: Mejorar la calidad de la atención hospitalaria de los niños con infecciones respiratorias agudas bajas, aumentar los conocimientos sobre esa patología y mejorar la eficiencia en el uso de los recursos asistenciales, por medio de una estrategia que se denominó Plan de Invierno.MÉTODOS: La estrategia se basó en la utilización de protocolos de diagnóstico y tratamiento, internación por cuidados progresivos y por enfermedad, adecuación de los recursos asistenciales y creación de un sistema de registro permanente, informatizado. Se incorporó la investigación sistemática de la etiología viral para racionalizar el uso de la medicación y reducir las infecciones intrahospitalarias. RESULTADOS: Durante la aplicación del Plan (19/V-19/IX/99 ingresaron 3.317 niños; 1.347 (40.61% presentaban infecciones respiratorias agudas bajas. Se captaron 1.096 (81%, de los cuales 71% eran menores de un año. Predominaron las infecciones respiratorias virales (68%. Los criterios de ingreso fueron saturación de oxígeno <95%, polipnea, tiraje o derrame pleural en el 92.4% de los niños. La magnitud de la demanda impidió que las pautas de aislamiento individual o en grupo se cumplieran en todos los casos. El uso de la medicación se ajustó a lo recomendado en un elevado porcentaje: no recibieron antibióticos 73% de las bronquiolitis ni 72% de las neumonías virales, y 96% de las neumonias bacterianas los recibieron según pauta; se redujo el uso de broncodilatadores y de corticoides. El gasto en medicamentos disminuyó fundamentalmente en el grupo de los corticoides y tuvo el mayor impacto en el costo por día/cama de antibióticos. CONCLUSIONES: Disminuir la morbimortalidad por infecciones respiratorias agudas bajas requiere continuar mejorando la calidad de la atención hospitalaria y fortalecer los programas de promoción de salud y de control de las enfermedades prevalentes, en el primer nivel de atención.

  10. Trends in Infant mortality rate and mortality for neonates born at less than 32 weeks and with very low birth weight Tendencia de la mortalidad infantil y de neonatos menores de 32 semanas y de muy bajo peso Tendência da mortalidade infantil e dos neonatos menores de 32 semanas e de muito baixo peso

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    René Mauricio Barría-Pailaquilén

    2011-08-01

    Full Text Available The aim of the study was to assess the trend of the infant mortality rate between 1990-2004 and the neonatal mortality between 2000-2005 in infants born at less than 32 weeks of gestational age or with very low birth-weight. Based on secondary data, infant mortality rate and by its component for Valdivia city were compared with national indicators. Mortality at Para evaluar la tendencia de la mortalidad infantil entre 1990-2004 y la mortalidad de prematuros menores de 32 semanas de edad de gestación y niños de muy bajo peso al nacer, entre 2000-2005, se compararon los datos secundarios globales por componentes del Servicio de Salud Valdivia con los totales del país, en Chile. Se calculó la mortalidad específica, por mil nacidos vivos, para los Para avaliar a tendência da mortalidade infantil, entre 1990 e 2004, a mortalidade de prematuros <32 semanas de idade gestacional e crianças de muito baixo peso ao nascer, entre 2000 e 2005, compararam-se dados secundários globais e por componentes do Serviço de Saúde Valdivia, e do total do país (Chile. Calculou-se a mortalidade específica em <32 semanas e <1.500g, por mil nascidos vivos, estabelecendo causas de óbito e avaliando sua relação com intervenções específicas, como uso de surfactante e corticoides pré-natais. A mortalidade infantil deteve sua queda a partir do ano 2000, com referência à década precedente, e a brecha que existia, entre os valores nacionais e locais antes de 2000, reduziu drasticamente. A mortalidade em <32 semanas e <1.500g variou entre 88 e 200‰ nascidos vivos, destacando a síndrome da angústia respiratória como principal causa de morte. O uso de corticoides e surfactante coincidiu com reduções da mortalidade.

  11. Adesão dos profissionais de saúde a práticas pré- e neonatais de redução da mortalidade neonatal: 2004 versus 2012

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    Renata Jaccottet Freitas

    Full Text Available RESUMO: Objetivo: Avaliar a adesão dos profissionais de saúde a práticas de assistência pré-natal e neonatal para reduzir a mortalidade neonatal. Métodos: Estudo não controlado, do tipo antes-e-depois, que avaliou a mudança ocorrida entre os anos 2004 e 2012, após as intervenções propostas pelo Comitê Municipal de Investigação de Óbitos Infantis, Fetais e de Morte Materna (COMAI na cidade de Pelotas, Rio Grande do Sul, na frequência de indicadores de processo de melhoria na assistência perinatal. Foram estudados 254 pacientes no ano de 2004 e 259 no ano de 2012. Resultados: Foi observado aumento de 65% na frequência do uso de corticoide pré-natal entre gestantes em trabalho de parto prematuro com idade gestacional ≤ 34 semanas (frequência de uso de 38,0 e 62,8% em 2004 e 2012, respectivamente; p < 0,001 e de 35% no uso de surfactante entre recém-nascidos ≤ 34 semanas de idade gestacional (41,3 e 55,6% em 2004 e 2012, respectivamente; p = 0,025, assim como uma redução de 16% na presença de hipotermia (70,8 e 59,4% em 2004 e 2012, respectivamente; p = 0,009 na admissão à unidade de terapia intensiva neonatal. Conclusão: Houve melhora em algumas das práticas de assistência pré-natal e neonatal. Ao final do período estudado, as frequências de uso de corticoide pré-natal e de surfactante foram menores do que as relatadas internacionalmente. No mesmo sentido, a frequência de hipotermia na admissão à unidade de terapia intensiva neonatal foi maior do que a observada em países desenvolvidos.

  12. Ofidismo en la provincia de Chanchamayo, Junín: revisión de 170 casos consecutivos en el Hospital de Apoyo de La Merced

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    Miguel Villanueva Forero

    2004-04-01

    Full Text Available Objetivo: Describir las características clínico-epidemiológicas del ofidismo en la provincia de Chanchamayo, Junín, Perú. Materiales y métodos: Se revisaron todas las historias clínicas de pacientes con diagnóstico de ofidismo en el "Hospital de Apoyo de La Merced" (HALM, Junín, Perú entre enero de 1998 y diciembre del 2000. Se recogieron datos de demográficos y clínico-epidemiológicos. Resultados: Las historias clínicas revisadas fueron 195, de estas, 170 fueron incluidas en el análisis. La media edad fue 26.2 años (rango: 1-76 años. La mayoría (62.4% era de sexo masculino. El 43.5% provenía del distrito de La Merced. Los casos de ofidismo ocurrieron con mayor frecuencia (67% durante los meses de lluvia (de diciembre a mayo. La localización más frecuente de la mordedura fue en los miembros inferiores (67.7%. El tiempo entre el accidente y la atención médica fue en promedio de 5 hrs. 43 min. (± 5 hrs. 56 min.. El animal agresor se identificó en 37.6% de las veces, siendo el más frecuente el Bothrops atrox (36.5%. Los síntomas más comunes que acompañaron el cuadro clínico fueron dolor, edema, eritema (80%. La mayoría (78.3% recibió suero antiofídico, de estos, 18.8% presentaron reacciones anafilactoides o urticariformes luego de la administración. La complicación más frecuente fue celulitis, presentándose mas comúnmente en pacientes que recibieron corticoides por más de 5 días (p=0.024. Ningún paciente falleció. Conclusiones: La mayoría de accidentes ofídicos en esta región ocurren en el ámbito rural. La utilización de corticoides por más de 5 días se asoció con una mayor frecuencia de celulitis. Las reacciones de hipersensibilidad hacia el suero antiofídico no son raras, siendo recomendable realizar la prueba intradérmica antes de su administración. (Rev Med Hered 2004; 15: 82-87.

  13. Eritema multiforme mayor desencadenado por antimicrobianos Big multiform erythema triggered by antimicrobials

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    Ronaldo de Carvalho Raimundo

    2010-03-01

    Full Text Available El eritema multiforme, aparece como una enfermedad sistémica con la participación de la piel y las membranas mucosas en relación con varios factores como las infecciones bacterianas o virales, y en particular la administración de drogas, analgésicos y antibióticos en general. Se presenta un paciente masculino de 29 años de edad con eritema multiforme mayor desencadenado por antimicrobianos con la aparición de lesiones vesiculares-bulloso-ulcerosas en las regiones de los labios, encías, la lengua y la mucosa genital en tratamiento de una infección del tracto urinario con norfloxacino 400 mg por una semana. Fue realizado un tratamiento de soporte con el uso de colutorios para la higienización bucal y pomada a base de corticoide para protección de las úlceras, antihistamínicos y orientación nutricional de dieta líquida hipercalórica e hiperproteica. Este síndrome está caracterizado como un proceso eruptivo buloso agudo que compromete la calidad de vida del paciente y no hay pruebas de laboratorio específicas por lo que su diagnóstico debe estar basado en la revisión minuciosa de la anamnesis y en los hallazgos clínicos.The multiform erythema appears as a systemic disease where skin and the mucous membranes have participation in relation to some factors such as bacterial or viral infections and in particular the drugs administration, analgesics and antibiotics in general. The aim of present paper was the presentation of case of big multiform erythema triggering by antimicrobials. Authors present the case of a male patient aged 29 with appearance of ulcerous bullous-vesicular lesions in lips, gums, tongue and genital mucosa under treatment with 400 mg norfloxacin due to urinary tract infection for a week. We made support treatment using mouthwashes for oral hygiene and corticoids ointment for ulcer protection, antihistaminics and nutritional guiding of a hypercaloric and hyperprotein liquid diet. This syndrome is characterized

  14. Effect of 131-iodine therapy on Grave ophthalmopathy: How to prevent?; Risque d'ophtalmopathie et iode 131: comment preparer les patients?

    Energy Technology Data Exchange (ETDEWEB)

    Duron, F. [Service d' endocrinologie, hopital Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, (France)

    2009-05-15

    The propositions to prepare the patients to ira-therapy are as follow: to try to get the smokers to stop tobacco; to get euthyroidism before the treatment; to avoid ira-therapy for the patients bearers of high title of antibodies ( but often, they are in failure of medical treatment and these ones to who it is proposed a radical treatment; to avoid hypothyroidism by quick establishment (possible choice of two weeks) of a treatment by thyroxine; to counter to ira-therapy for patients reached by severe Basedow orbitopathy; to treat preventively the patients bearers of moderated basedow orbitopathy by corticoids, according to the scheme proposed by Bartalena and al. (0.5 mg/kg of prednisone 48 hours before the treatment and the first following month, then at graduated dose on two months) or an other one; however, these propositions must be validated by prospective studies made on a large scale and including reproducible and homogeneous criteria of evaluation like these ones proposed by the European group 'European group on graves orbitopathy' (E.U.G.O.G.O). (N.C.)

  15. Anti-inflammatory activity of Mitraphylline isolated from Uncaria tomentosa bark.

    Science.gov (United States)

    Rojas-Duran, R; González-Aspajo, G; Ruiz-Martel, C; Bourdy, G; Doroteo-Ortega, V H; Alban-Castillo, J; Robert, G; Auberger, P; Deharo, E

    2012-10-11

    Uncaria tomentosa (Willd. ex Roem. & Schult.) DC. (Rubiaceae) is widely used by populations living in South America to treat many ailments associated with inflammatory disorders. Mitraphylline was shown to be the major pentacyclic oxindolic alkaloid present in the bark chloroformic extract of this plant. Its activity against cytokines involved in inflammation process was tested in a murine model in vivo. Mice received mitraphylline once a day for 3 days at 30 mg/kg/day by oral route. Then, they were subjected to bacterial lipopolysaccharide (LPS) endotoxin (15 mg/kg) and the LPS-induced production of 16 different cytokines was determined by Elisa multiplex. Control group received dexamethasone orally at 2mg/kg/day. Toxicity on K565 cells and murine peritoneal macrophages, in vitro, at doses up to 100 μM was monitored by XTT-colorimetric assay. For the first time mitraphylline was tested in vivo against a large range of cytokines that play a crucial role in inflammation. Mitraphylline inhibited around 50% of the release of interleukins 1α, 1β, 17, and TNF-α. This activity was similar to dexamethasone. It also reduced almost 40% of the production of interleukin 4 (IL-4) while the corticoid did not. Lastly it did not show any toxicity on K565 cells nor murine macrophages at doses up to 100 μM. Copyright © 2012. Published by Elsevier Ireland Ltd.

  16. Inactivation of corticosteroids in intestinal mucosa by 11 beta-hydroxysteroid: NADP oxidoreductase (EC 1. 1. 1. 146)

    Energy Technology Data Exchange (ETDEWEB)

    Burton, A.F.; Anderson, F.H.

    1983-10-01

    Activity of the enzyme 11 beta-hydroxysteroid:NADP oxidoreductase (EC 1.1.1.146) in human intestinal mucosa was determined by incubating scraped mucosa with /sup 3/H-cortisone and /sup 14/C-cortisol; these steroids were then extracted, separated chromatographically, and the radioactivity assayed to determine simultaneously both reductase and dehydrogenase activities. This was the only significant metabolic alteration which the substrate underwent. Only two cases had slight (5 and 13%) reductase activity. In 35 patients, 16 male and 19 female, including seven cases of Crohn's disease, three ulcerative colitis, five diverticulitis, two undergoing surgery for repair of injuries and 18 for carcinoma of colon or rectum, cortisol was converted to cortisone in 15 min with a wide range of values distributed uniformly up to 85% dehydrogenation, with a mean of 42%. When tissue homogenates were fortified with coenzymes, excess NADPH lowered dehydrogenase activity 81%; excess NADP increased dehydrogenase activity 2-fold in three cases. It is possible that a value is characteristic of an individual but perhaps more likely enzyme activity varies with metabolic events involving changes in the coenzyme levels in mucosa, and a random sampling might be expected to yield such a distribution of values. In any event, where activity is high most of the cortisol is inactivated within minutes. It is suggested that synthetic corticoids which escape such metabolic alteration might, except during pregnancy, prove superior in the treatment of conditions such as inflammatory bowel disease.

  17. Plasma cortisol and cortisone in pregnancies with normal and anencephalic fetuses.

    Science.gov (United States)

    Fencl, M D; Osathanondh, R; Tulchinsky, D

    1976-07-01

    Plasma cortisol (F), cortisone (E), and progesterone (P), were measured in the umbilical vein (UV), umiblical artery (UA), and maternal peripheral vein (MPV) of 17 normal patients, and of 8 patients carying anencephalic fetuses. The plasma F in MPV of patients undergoing vaginal delivery after labor of spontaneous onset was significantly higher than that of patients delivered by elective cesarean section, whereas the plasma F concentrations in the UA or UV of the 2 groups were not statistically different from each other. The anencephalic fetuses had UA plasma F and E concentrations which were significantly lower than those of normal fetuses, suggesting that a main portion of UA cortisol and cortisone originates in the fetal adrenal. The UV and MPV plasma F and E concentrations of patients carrying anencephalic fetuses did not differ, however, from those of normal patients, suggesting that these UV corticoids are derived mainly from maternal sources. The amniotic fluid cortisol levels of the patients carying anencephalic fetuses were lower than those observed in the normal pregnancies, suggesting that amniotic fluid cortisol is derived mainly from fetal sources.

  18. Analysis of diversity of wood-inhabiting fungi retrieved from a Mediterranean forest dominated by Pinus pinaster Aiton

    Directory of Open Access Journals (Sweden)

    Maria D'Aguanno

    2016-04-01

    Full Text Available The present paper is focused on the diversity of wood-inhabiting fungi in a poorly investigated habitat: a Mediterranean forest dominated by maritime pine. The sampling area lies in Tocchi biogenetic Reserve, located in the province of Siena (Tuscany, Italy. The monitoring campaign was carried out in 10 permanents plots, taking note of all the fungal species found on each piece of dead wood, irrespective of size and stage of decay. Over one year of surveys, 56 taxa of wood-inhabiting fungi were recorded, among which 39 are corticoids species, 16 polypores and 1 Heterobasidiomycetes. The fungal community seems to be dominated by a small number of species, which are more abundant than the others. Moreover, there are some specific features of deadwood influencing the species composition, such as the presence of coarse woody debris at the first decay stage and fine woody debris at the late decay stages. The results allowed characterizing the wood-inhabiting fungal community in this forest reserve, broadening our knowledge on several species and providing a preliminary database for further studies in Mediterranean areas.

  19. Miopatía inflamatoria con compromiso inicial de músculos respiratorios y artritis reumatoidea

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    Martín Hunter

    2014-10-01

    Full Text Available Las miopatías inflamatorias constituyen un grupo heterogéneo de enfermedades musculares adquiridas de presentación subaguda, crónica y a veces aguda. Las entidades clínicas más frecuentes son la dermatomiositis, la polimiositis, la miositis necrotizante autoinmune y la miositis por cuerpos de inclusión. Suelen presentarse con debilidad muscular con predominio proximal y simétrica, pero rara vez comprometen los músculos respiratorios. Presentamos el caso de una mujer de 39 años con miopatía inflamatoria inespecífica que presentó insuficiencia respiratoria secundaria a hipoventilación alveolar por debilidad muscular y requirió asistencia respiratoria mecánica. Respondió favorablemente y de forma rápida tras el tratamiento instaurado con inmunosupresores (corticoides y metotrexato e inmunoglobulina humana endovenosa. Se utilizó ventilación no invasiva como alternativa a la intubación orotraqueal con adecuada tolerancia.

  20. Effect of the macromolecular architecture of biodegradable polyurethanes on the controlled delivery of ocular drugs.

    Science.gov (United States)

    da Silva, Gisele Rodrigues; da Silva Cunha, Armando; Ayres, Eliane; Oréfice, Rodrigo L

    2009-02-01

    Controlled delivery of drugs is a major issue in the treatment of ocular diseases, such as in the treatment of uveitis. In this study, dexamethasone acetate, an important type of corticoid used in the treatment of some uveitis, was incorporated into biodegradable polyurethanes (PU) having different macromolecular architectures. The biodegradable polyurethanes were obtained by preparing PU aqueous dispersions having poly(caprolactone) and/or poly(ethylene glycol) as soft segments. The drug was incorporated into the polymer by dissolving it in the PU aqueous dispersion. FTIR results showed the presence of the drug in the polymer with its original chemical structure. Small angle X-ray scattering (SAXS) results were explored to show that the incorporation of dexamethasone acetate led to the modification of the nanostructure of the polyurethane having only poly(caprolactone) as the soft segment, while the drug did not change significantly the microphase separated structure of PU having both poly(caprolactone) and poly(ethylene glycol) as soft segments. The evaluation of the release of the drug in vitro demonstrated that the obtained biodegradable polyurethanes were well succeeded in delivering dexamethasone acetate at an almost constant rate for 53 weeks. The presence of poly(ethylene glycol) together with poly(caprolactone) as soft segment in biodegradable PU was able to increase the rate of dexamethasone acetate release when compared to the rate of drug release from PU having only poly(caprolactone).

  1. Celulitis por Microascus trigonosporus(anamorfo Scopulariopsis trigonospora

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    DELIA CANLE CORTIÑAS

    2013-06-01

    Full Text Available Resumen: Microascus trigonosporus ( anamorfo Scopulariopsis trigonospora es un hongo filamentoso ubicuo que se encuentra en el suelo , plumas de aves, material vegetal e insectos. Aunque Scopulariopsis spp se consideran comúnmente hongos contaminantes , pueden causar ocasionalmente infecciones en humanos, en especial onicomicosis . Excepcionalmente se han descrito infecciones de piel, abscesos cerebrales, endocarditis ,sinusitis e infecciones diseminadas por Scopulariopsis spp , casi siempre en pacientes inmunodeprimidos . En los últimos años se han publicado un mayor número de casos de infecciones oportunistas por Scopulariopsis spp y otros hialohifomicetos multiresistentes. Todavía no está establecido cuál es el mejor régimen de tratamiento para las infecciones por Scopulariopsis spp. Presentamos un caso excepcional de celulitis por Microascus trigonosporus en un paciente con tratamiento prolongado con corticoides. Abstract: Microascus trigonosporus ( Anamorph Scopulariopsis trigonospora is a cosmopolitan filamentous fungus that inhabits soil, feathers ,plant material and insects. While Scopulariopsis is commonly considered as a contaminat fungus it may cause occasionally infections in humans ,especially onychomycosis .Skin lesions, brain abscess , endocarditis, sinusitis and disseminated infections due to Scopulariopsis species have been rarely reported , usually in immunocompromised patients . Over the last few years opportunistic infections by Scopulariopsis species and others multi-resistant hyalohyphomycetes have been increasingly reported . No clear treatment regimen for Scopulariopsis species infections has been established yet. We present a exceptional case of cellulitis due to Microascus trigonosporus in a patient with prolonged steroid therapy.

  2. Neumonía por virus parainfluenza 3 en paciente inmunocomprometido PARAINFLUENZA 3 PNEUMONIA IN AN IMMUNOCOMPROMISED PATIENT

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    MARÍA CRISTINA AJENJO H

    2004-01-01

    Full Text Available Un paciente de 45 años bajo tratamiento corticoidal por una probable sarcoidosis y una pancitopenia moderada ingresa por una neumonía que no responde a antibióticos ni a tratamiento antimicótico indicado a raíz del aislamiento de Aspergillus fumigatus en expectoración. Desarrolla una insuficiencia respiratoria progresiva e hipotensión y una inmunofluorescencia para virus parainfluenza 3 resulta positiva. Fallece al séptimo día y la necropsia muestra una neumonía necrotizante, daño alveolar difuso y abundantes partículas viralesA 45 years old patient under corticosteroid treatment for a probable sarcoidosis and a moderate pancytopenia, presents a pneumonia which did not respond to antibiotics nor to antifungal treatment indicated after isolation of aspergillus fumigatus in sputum. He progressively develops respiratory insufficiency and arterial hypotension. Immunofluorescense for parainfluenza 3 is positive. He dies after seven days and the necropsy shows a necrotizing pneumonia, diffuse alveolar damage and abundant viral particles

  3. Is pentoxifylline effective in alcoholic hepatitis? –First update

    Directory of Open Access Journals (Sweden)

    Gabriel Rada

    2016-07-01

    Full Text Available ACERCA DE LA ACTUALIZACIÓN: Este resumen Epistemonikos (Living FRISBEE: Living FRIendly Summary of the Body of Evidence using Epistemonikos es una actualización del resumen publicado en Junio de 2014. Incorpora una nueva revisión sistemática que identificó un estudio no incluido en las revisiones previas. La incorporación de esta nueva evidencia lleva a cambios sustantivos en la evidencia existente. RESUMEN: La pentoxifilina, un inhibidor del factor de necrosis tumoral oral, se ha planteado como un posible tratamiento para la hepatitis alcohólica. Sin embargo, no está claro si es efectiva o si su adición al tratamiento con corticoides agrega beneficios. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos tres revisiones sistemáticas que en conjunto incluyen ocho estudios aleatorizados. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Concluimos que la pentoxifilina probablemente no disminuye la mortalidad en pacientes con hepatitis alcohólica.

  4. [New food allergies].

    Science.gov (United States)

    Dutau, G; Rittié, J L; Rancé, F; Juchet, A; Brémont, F

    1999-09-25

    RISING INCIDENCE OF FOOD ALLERGIES: Food allergies are becoming more and more common, concerning 3 to 4% of the general population. One out of four persons allergic to nuts, the most frequent food allergen, have severe signs and symptoms. A CLASSICAL DIAGNOSIS: Certain diagnosis of food allergy is established on the basis of labial and oral tests. The dose required to induce a reaction is established by the oral test, giving information about the severity of the allergy and its progression. OTHER ALLERGENS: "Emerging" food allergens include spices and condiments, exotic fruits (kiwi, avocado, cashew and pecan nuts, Brazil nuts), sesame seeds, psyllium, sunflower seeds. Endurance exercise following ingestion of a food allergen can lead to severe anaphylactic reactions. Allergen associations "food-pollen", "latex-food", "mitessnails" have been described. INDISPENSABLE PREVENTION: Avoiding contact is essential. Many allergens are "masked" within prepared foods. Precise labeling, with particular attention to nut content, must be reinforced. Individualized counseling on food allergies should be available for school children. Persons with severe allergies should keep at hand an emergency kit with antihistamines, injectable rapid action corticoids and adrenalin (1 mg/ml).

  5. Is rituximab effective for induction of remission in ANCA-associated vasculitis?

    Directory of Open Access Journals (Sweden)

    Carmen Rain

    2015-08-01

    Full Text Available La adición de rituximab al tratamiento con corticoides se ha planteado como alternativa terapéutica para inducir remisión en las vasculitis asociadas a anticuerpos anticitoplasma de neutrófilos (ANCA, especialmente en pacientes con deseo de preservar fertilidad que persisten activos después del tratamiento estándar, o en aquellos que tienen contraindicación o mala tolerancia a ciclofosfamida. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos solo una revisión sistemática que incluye tres estudios aleatorizados. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Concluimos que el uso de rituximab podría resultar en poca o nula diferencia en mortalidad, mientras que existe incertidumbre sobre si disminuye las recaídas o aumenta los efectos adversos serios, como infecciones o neoplasias.

  6. Tratamiento sistémico del penfigoide cicatrizal ocular

    Directory of Open Access Journals (Sweden)

    María Cecilia Juri

    2012-04-01

    Full Text Available El penfigoide cicatrizal ocular (PCO es una enfermedad ampollar autoinmune que produce daño conjuntival grave. Se conoce poco acerca de la respuesta del PCO al tratamiento inmunosupresor. Describimos un grupo de 76 pacientes con PCO, 62 mujeres y 14 hombres. La edad media al diagnóstico fue de 67 ± 14 años, con un retraso de 7.5 ± 10 años. Sesenta se siguieron en nuestro servicio por 19 ± 21 meses. De 51 en quienes se describe la gravedad de la enfermedad al inicio del tratamiento, fue leve en 19 pacientes, moderada en 19, grave en cinco y muy grave en ocho. Las drogas mayormente prescriptas fueron dapsona en 35 pacientes, de los que 23 la discontinuaron por efectos adversos, y metotrexate en 42, de los que nueve lo suspendieron. Otros recibieron azatioprina, ciclofosfamida y ciclosporina. A 17 se les indicaron corticoides orales, además del inmunosupresor. Cuatro combinaron dos drogas para controlar la enfermedad. Tres pacientes refractarios recibieron gammaglobulina EV con buena respuesta. De 48 evaluados, 39 mostraron mejoría, ocho no tuvieron cambios y uno progresó. En nuestra experiencia, metotrexate y azatioprina son efectivos, con baja toxicidad. Dapsona es útil en casos leves, con efectos adversos frecuentes. La gammaglobulina EV fue efectiva en casos refractarios.

  7. Proinflammatory cytokines differentially influence adult hippocampal cell proliferation depending upon the route and chronicity of administration

    Directory of Open Access Journals (Sweden)

    Julie Anne Seguin

    2008-12-01

    Full Text Available Julie Anne Seguin, Jordan Brennan, Emily Mangano, Shawn HayleyInstitute of Neuroscience, Carleton University, Ottawa, Ontario, CanadaAbstract: Disturbances of hippocampal plasticity, including impaired dendritic branching and reductions of neurogenesis, are provoked by stressful insults and may occur in depression. Although corticoids likely contribute to stressor-induced reductions of neurogenesis, other signaling messengers, including pro-inflammatory cytokines might also be involved. Accordingly, the present investigation assessed whether three proinflammatory cytokines, namely interleukin-1β (IL-1β, IL-6, and tumor necrosis factor-α (TNF-α (associated with depression influenced cellular proliferation within the hippocampus. In this regard, systemic administration of TNF-α reduced 5-bromo-2-deoxyuridine (BrdU labeling within the hippocampus, whereas IL-1β and IL-6 had no such effect. However, repeated but not a single intra-hippocampal infusion of IL-6 and IL-1β actually increased cellular proliferation and IL-6 infusion also enhanced microglial staining within the hippocampus. Yet, no changes in doublecortin expression were apparent, suggesting that the cytokine did not influence the birth of cells destined to become neurons. Essentially, the route of administration and chronicity of cytokine administration had a marked influence upon the nature of hippocampal alterations provoked, suggesting that cytokines may differentially regulate hippocampal plasticity in neuropsychiatric conditions.Keywords: cytokine, depression, neuroplasticity, hippocampus, stressor

  8. Proinflammatory cytokines differentially influence adult hippocampal cell proliferation depending upon the route and chronicity of administration.

    Science.gov (United States)

    Seguin, Julie Anne; Brennan, Jordan; Mangano, Emily; Hayley, Shawn

    2009-01-01

    Disturbances of hippocampal plasticity, including impaired dendritic branching and reductions of neurogenesis, are provoked by stressful insults and may occur in depression. Although corticoids likely contribute to stressor-induced reductions of neurogenesis, other signaling messengers, including pro-inflammatory cytokines might also be involved. Accordingly, the present investigation assessed whether three proinflammatory cytokines, namely interleukin-1beta (IL-1beta), IL-6, and tumor necrosis factor-alpha (TNF-alpha) (associated with depression) influenced cellular proliferation within the hippocampus. In this regard, systemic administration of TNF-alpha reduced 5-bromo-2-deoxyuridine (BrdU) labeling within the hippocampus, whereas IL-1beta and IL-6 had no such effect. However, repeated but not a single intra-hippocampal infusion of IL-6 and IL-1beta actually increased cellular proliferation and IL-6 infusion also enhanced microglial staining within the hippocampus. Yet, no changes in doublecortin expression were apparent, suggesting that the cytokine did not influence the birth of cells destined to become neurons. Essentially, the route of administration and chronicity of cytokine administration had a marked influence upon the nature of hippocampal alterations provoked, suggesting that cytokines may differentially regulate hippocampal plasticity in neuropsychiatric conditions.

  9. Coma mixedematoso y midazolam: Reporte de caso.

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    Miguel Pinto Valdivia

    2008-10-01

    Full Text Available Se reporta el caso de un paciente varón sin antecedente previo de patología tiroidea que ingresó por coma mixedematoso y desarrolló insuficiencia respiratoria después de la administración endovenosa de midazolam. Tenía 55 años de edad, y una enfermedad de dos semanas caracterizado por letargia, debilidad, hiporexia y cefalea. Los análisis de laboratorio mostraron anemia, hiponatremia severa y niveles elevados de transaminasas y creatinquinasa. TSH elevada y T4 y T3 en niveles muy bajos. Se inició tratamiento con levotiroxina, corticoides endovenosos y solución hipertónica de cloruro de sodio. La evolución fue mala, se colocó un catéter venoso central bajo sedación con midazolam endovenoso para monitoreo hemodinámico, luego del cual, el paciente desarrolló insuficiencia respiratoria, mayor compromiso del sensorio y falleció. En pacientes con hipotiroidismo, el metabolismo del midazolam esta alterado y puede causar insuficiencia respiratoria. (Rev Med Hered 2008; 19:171-174.

  10. Increased demand for steroid therapy in hyperprolactinemic patients with rheumatoid arthritis.

    Science.gov (United States)

    Rovenský, J; Bakosová, J; Payer, J; Lukác, J; Raffayová, H; Vigas, M

    2001-01-01

    The role of increased plasma prolactin (PRL) in rheumatoid arthritis (RA) is not fully explained. The aim of this study was to compare the clinical features and the treatment administered in RA patients with normal and elevated plasma PRL concentrations. Forty-nine patients with rheumatoid arthritis and 16 healthy subjects were included in this study In healthy controls, PRL concentrations were 7.6 micro/l (median), in 34 patients plasma PRL was less than 20 micro/l (9.9 micro/l) and in 15 patients it was elevated, with a median of 26.7 micro/l. No differences in clinical features were found compared with normal or increased plasma PRL. The introduction of corticoid therapy produced a significant difference. Steroid therapy was administered to 93% of the patients with hyperprolactinemia, compared with 59% of those with normal PRL concentrations. Daily prednisone doses higher than 5 mg were administered to 43% of the patients with elevated PRL, compared with 25% of patients with normal prolactin concentrations. In conclusion, the clinical feature of patients with rheumatoid arthritis did not differ in subjects with elevated PRL concentrations and in those with normal concentrations. The difference between these two groups was in the higher demand for steroid therapy in patients with hyperprolactinemia.

  11. Septic thrombophlebitis of the superior mesenteric vein and multiple liver abscesses in a patient with Crohn's disease at onset

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    Grueso Jose

    2007-06-01

    Full Text Available Abstract Background Portal-mesenteric vein thrombosis, pylephlebitis and liver abscesses are rare complications of inflammatory bowel disease (IBD. The purpose of this case report is to relate an unusual presentation of CD in order to show how conservative treatment could be an appropriate option as a bridge to the surgery, in patients with septic thrombophlebitis and multiple liver abscesses with CD. Case presentation We report a case of a 25-year-old man with Crohn's disease (CD who developed a superior mesenteric venous thrombosis, multiple liver abscesses and pylephlebitis, diagnosed through abdominal ultrasound and an abdominal computed tomography (CT scan. The patient was successfully treated with conservative treatment consisting of intravenous antibiotics, subcutaneous anticoagulation and percutaneous catheter drainage of liver abscesses. Conclusion We reported an unnusual case of pylephlebitis in CD. Until now this association has not been reported in adult patients at onset. We hypothesise that the infection developed as a result of mucosal disease and predisposed by corticoid therapy. Adequated management was discussed.

  12. [IgG4- and MPO-ANCA-associated hypertrophic pachymeningitis].

    Science.gov (United States)

    Aragonès, Josep M; Arias-Rivero, Montserrat; García-Barrionuevo, Joan M; Lucchetti, Gianni

    2015-11-16

    Introduccion. La paquimeningitis hipertrofica idiopatica es una enfermedad fibroinflamatoria de la duramadre. Su diagnostico requiere la exclusion de enfermedades infecciosas, tumorales y otras enfermedades inflamatorias. En los ultimos años se han descrito nuevas entidades que pueden presentarse con paquimeningitis hipertrofica: la enfermedad relacionada con IgG4 y la paquimeningitis MPO-ANCA+ como forma de vasculitis limitada al sistema nervioso central. Caso clinico. Varon de 64 años con cefalea y cervicalgia de predominio nocturno y clinica de compresion medular. Tras el diagnostico de paquimeningitis hipertrofica craneocervical facilitado por el estudio de resonancia magnetica, se realizo un estudio etiologico. Se descartaron enfermedades infecciosas y tumorales. La clinica no mostraba afectacion sistemica y en la analitica presentaba IgG4 elevada y MPO-ANCA+. Tras tratamiento con corticoides presento una rapida mejoria de la clinica. Conclusiones. La enfermedad relacionada con IgG4 y la vasculitis asociada a MPO-ANCA limitada al sistema nervioso central pueden representar un alto porcentaje de las paquimeningitis hipertroficas que se consideraban idiopaticas, y su diagnostico requiere biopsia y estudio histologico.

  13. Consenso 2012 da Sociedade Brasileira de Reumatologia sobre o manejo de comorbidades em pacientes com artrite reumatoide 2012 Brazilian Society of Rheumatology Consensus on the management of comorbidities in patients with rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    Ivânio Alves Pereira

    2012-08-01

    Full Text Available OBJETIVO: Elaborar recomendações da Comissão de Artrite Reumatoide da Sociedade Brasileira de Reumatologia (SBR para o manuseio das comorbidades em artrite reumatoide (AR. MÉTODOS: Revisão da literatura e opinião de especialistas da Comissão de AR da SBR. RESULTADOS E CONCLUSÕES: Recomendações: 1 Diagnosticar e tratar precoce e adequadamente as comorbidades; 2 O tratamento específico da AR deve ser adaptado às comorbidades; 3 Inibidores da enzima conversora da angiotensina (IECA ou bloqueadores dos receptores de angiotensina II (BRA são preferidos no tratamento da hipertensão arterial sistêmica; 4 Em pacientes com AR e diabetes mellitus, deve-se evitar o uso contínuo de dose cumulativa alta de corticoides; 5 Sugere-se o uso de estatinas para manter níveis de LDL menor que 100 mg/dL e índice aterosclerótico menor que 3,5 em pacientes com AR e comorbidades; 6 A síndrome metabólica deve ser tratada; 7 Recomenda-se a realização de exames para a investigação de aterosclerose subclínica; 8 Maior vigilância para um diagnóstico precoce de neoplasia oculta; 9 Medidas de prevenção para trombose venosa são sugeridas; 10 Recomenda-se a realização de densitometria óssea em pacientes com AR acima de 50 anos, e naqueles com idade menor com corticoide maior que 7,5 mg por mais de três meses; 11 Pacientes com AR e osteoporose devem evitar quedas, e devem ser aconselhados a aumentarem a ingestão de cálcio, aumentarem a exposição solar e fazerem atividade física; 12 Suplementação de cálcio e vitamina D é sugerida.Autilização de bisfosfonatos é sugerida para pacientes com escore T menor que -2,5 na densidade mineral óssea; 13 Recomenda-se equipe multidisciplinar, com participação ativa do médico reumatologista no tratamento das comorbidades.OBJECTIVE: To elaborate recommendations of the Rheumatoid Arthritis Committee of the Brazilian Society of Rheumatology (SBR to manage comorbidities in rheumatoid arthritis (RA

  14. Acquired haemophilia A in a patient with chronic hepatitis C virus infection receiving treatment with pegylated interferon plus ribarivin: role of rituximab.

    Science.gov (United States)

    Fernández de Palencia Espinosa, M Á; Arocas Casañ, V; Garrido Corro, B; de la Rubia Nieto, A

    2013-01-01

    Antecedentes: la hemofilia adquirida es un trastorno infrecuente causado por el desarrollo de inhibidores del factor de coagulación. Para eliminarlos, se requiere tratamiento con corticoides y fármacos citotóxicos. Métodos: describimos el caso del uso de rituximab en hemofilia adquirida refractaria al tratamiento convencional en un hombre de 63 años con infección crónica por el virus de la hepatitis C y que estaba recibiendo tratamiento con interferón pegilado a-2a y ribarivina. Resultados: tras 21 semanas de tratamiento antivírico, el paciente fue ingresado en el hospital por un gran hematoma en la musculatura abdominal. La concentración de factor VIII era nula y el título de inhibidor fue de 345 unidades Bethesda. Se administró tratamiento inmunosupresor oral con metilprednisolona y ciclofosfamida durante 1 mes, con escasa mejoría. Así pues, se sustituyó la ciclofosfamida por una dosis semanal de rituximab intravenoso. Dos meses después, la concentración de factor VIII se normalizó y el título de inhibidor era indetectable. Conclusión: Rituximab puede ser útil en el tratamiento de la hemofilia adquirida resistente al tratamiento estándar.

  15. Profilaxia e tratamento do edema macular cistoide após cirurgia de catarata

    Directory of Open Access Journals (Sweden)

    Pedro C. Carricondo

    2015-04-01

    Full Text Available O edema macular cistoide é uma das principais causas de baixa de visão após cirurgia de catarata. O processo inflamatório parece ser o principal fator causal do edema. São considerados fatores de risco complicações cirúrgicas, doenças retinianas prévias, diabetes, uveítes e uso de colírios de prostaglandinas. O diagnóstico é feito clinicamente, mas a angiografia fluoresceínica e a tomografia de coerência óptica também são ferramentas importantes para detectar o edema e auxiliar no diagnóstico diferencial. Apesar da profilaxia pré-operatória não ter evidência científica, ela é preconizada especialmente nos casos com fatores de risco. O tratamento inicial é realizado com associação de corticoide e anti-inflamatório não hormonais tópicos. Os casos crônicos e refratários têm diversas alternativas de tratamento, sendo o uso de triancinolona e antiangiogênicos intravítreos as mais utilizadas. Este artigo se propõe a discutir diversos aspectos do edema macular cistoide pseudofácico.

  16. PREMATURITY, NEONATAL HEALTH STATUS, AND LATER CHILD BEHAVIORAL/EMOTIONAL PROBLEMS: A SYSTEMATIC REVIEW.

    Science.gov (United States)

    Cassiano, Rafaela G M; Gaspardo, Claudia M; Linhares, Maria Beatriz M

    2016-05-01

    Preterm birth can impact on child development. As seen previously, children born preterm present more behavioral and/or emotional problems than do full-term counterparts. In addition to gestational age, neonatal clinical status should be examined to better understand the differential impact of premature birth on later developmental outcomes. The aim of the present study was to systematically review empirical studies on the relationship between prematurity, neonatal health status, and behavioral and/or emotional problems in children. A systematic search of the PubMed, PsycINFO, Web of Science, and LILACS databases for articles published from 2009 to 2014 was performed. The inclusion criteria were empirical studies that evaluated behavioral and/or emotional problems that are related to clinical neonatal variables in children born preterm. Twenty-seven studies were reviewed. Results showed that the degree of prematurity and birth weight were associated with emotional and/or behavioral problems in children at different ages. Prematurity that was associated with neonatal clinical conditions (e.g., sepsis, bronchopulmonary dysplasia, and hemorrhage) and such treatments as corticoids and steroids increased the risk for these problems. The volume and abnormalities of specific brain structures also were associated with these outcomes. In conclusion, the neonatal health problems associated with prematurity present a negative impact on later child emotional and adapted behavior. © 2016 Michigan Association for Infant Mental Health.

  17. Mielitis transversa relacionada con vacunación anti-influenza A(H1N1

    Directory of Open Access Journals (Sweden)

    María Florencia Arcondo

    2011-04-01

    Full Text Available La mielitis transversa es una enfermedad inflamatoria que se caracteriza por disfunción de la médula espinal. Las causas reconocidas de mielitis transversa son autoinmunes, enfermedades desmielinizantes, post infecciosas y post vacunales, aunque hasta el 50% de los casos son idiopáticas. Las vacunas contra la rubéola, paperas, rabia y gripe estacional han sido asociadas a diversos trastornos neurológicos, como el Síndrome de Guillain Barré, la encefalomielitis diseminada aguda (ADEM y la mielitis transversa. Como mecanismo preventivo luego de la pandemia de 2009, en febrero del año 2010 se inició en nuestro país la campaña de vacunación contra la Influenza A (H1N1. Se presenta el caso de una paciente con hipoestesias que aparecieron cuatro días después de haber recibido la vacuna monovalente anti-influenza A (H1N1 y progresaron con evidente nivel sensitivo. La paciente cumplía criterios diagnósticos de mielitis transversa, según el Transverse Myelitis Consortium Working Group. Tuvo remisión de las imágenes de la resonancia magnética y estabilidad clínica sin tratamiento con corticoides. Se discuten aspectos diagnósticos, pronósticos y terapéuticos de esta entidad clínica.

  18. Atlas of tissue renin-angiotensin-aldosterone system in human: A transcriptomic meta-analysis.

    Science.gov (United States)

    Nehme, Ali; Cerutti, Catherine; Dhaouadi, Nedra; Gustin, Marie Paule; Courand, Pierre-Yves; Zibara, Kazem; Bricca, Giampiero

    2015-05-20

    Tissue renin-angiotensin-aldosterone system (RAAS) has attracted much attention because of its physiological and pharmacological implications; however, a clear definition of tissue RAAS is still missing. We aimed to establish a preliminary atlas for the organization of RAAS across 23 different normal human tissues. A set of 37 genes encoding classical and novel RAAS participants including gluco- and mineralo-corticoids were defined as extended RAAS (extRAAS) system. Microarray data sets containing more than 10 normal tissues were downloaded from the GEO database. R software was used to extract expression levels and construct dendrograms of extRAAS genes within each data set. Tissue co-expression modules were then extracted from reproducible gene clusters across data sets. An atlas of the maps of tissue-specific organization of extRAAS was constructed from gene expression and coordination data. Our analysis included 143 data sets containing 4933 samples representing 23 different tissues. Expression data provided an insight on the favored pathways in a given tissue. Gene coordination indicated the existence of tissue-specific modules organized or not around conserved core groups of transcripts. The atlas of tissue-specific organization of extRAAS will help better understand tissue-specific effects of RAAS. This will provide a frame for developing more effective and selective pharmaceuticals targeting extRAAS.

  19. Absceso subperióstico de la órbita de foco dentario: reporte de un caso

    Directory of Open Access Journals (Sweden)

    Félix Antonio Torres Cotrina

    2005-01-01

    Full Text Available Un paciente varón de 35 años fue admitido en el Servicio de Oftalmología del Hospital Nacional Arzobispo Loayza con una historia de 15 días de proptosis, diplopía, limitación de la motilidad ocular, dolor y agudeza visual de cuenta dedos a 40 cm en su ojo izquierdo. No hubo antecedentes de fiebre, trauma, sinusitis, ni evidencia de medicación previa. Tuvo caries dentales sin tratamiento. Se instaló terapia con corticoide pensando en un síndrome inflamatorio inespecífico de la órbita. Una semana después se obtuvo material purulento después de una aspiración con aguja fina, por lo que se inició terapia antibiótica. Luego de la punción-aspiración los signos orbitarios empeoraron pero a los pocos días se obtuvo buena respuesta. Se discute el caso y se revisa la literatura pertinente.

  20. Study of Therapeutic Mechanism of Acupuncture in Treating Bronchial Asthma

    Institute of Scientific and Technical Information of China (English)

    LI; Ji

    2001-01-01

    It has been considered by modern medicine that bronchial asthma is a chronic airway allergic inflammation (AAI) which is the major factor that induces reversible airway ventilating disturbance and bronchial hyper-responsiveness (BHR) in asthmatic patients, as well as a correlation between the delayed-phase onset of asthma and AAI is more significant than immediate-phase onset of asthma in its pathogenesis. Anti-inflammatory therapy as a fundamental principle of treatment for bronchial asthma has been brought forward during the interval phase so that a large number of anti-AAI drugs to significantly enhance the curative effect such as inhalant corticoid, disodium cromoglycate, and leukotriene receptors antagonist, etc., has been rapidly developed. Additionally, traditional Chinese medicine (TCM) and integration of TCM and western medicine (WM) therapies, including acupuncture, are gradually taken into account by the medical circle as a characteristic in our country for treatment of bronchial asthma. It is worthy of being pointed out that the curative effect of acupuncture and moxibustion in treating asthma is evident, and that its therapeutic mechanism has to a certain extent, been found along with the recent deep-going acupunctural research.……

  1. Study of Therapeutic Mechanism of Acupuncture in Treating Bronchial Asthma

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    @@  It has been considered by modern medicine that bronchial asthma is a chronic airway allergic inflammation (AAI) which is the major factor that induces reversible airway ventilating disturbance and bronchial hyper-responsiveness (BHR) in asthmatic patients, as well as a correlation between the delayed-phase onset of asthma and AAI is more significant than immediate-phase onset of asthma in its pathogenesis. Anti-inflammatory therapy as a fundamental principle of treatment for bronchial asthma has been brought forward during the interval phase so that a large number of anti-AAI drugs to significantly enhance the curative effect such as inhalant corticoid, disodium cromoglycate, and leukotriene receptors antagonist, etc., has been rapidly developed. Additionally, traditional Chinese medicine (TCM) and integration of TCM and western medicine (WM) therapies, including acupuncture, are gradually taken into account by the medical circle as a characteristic in our country for treatment of bronchial asthma. It is worthy of being pointed out that the curative effect of acupuncture and moxibustion in treating asthma is evident, and that its therapeutic mechanism has to a certain extent, been found along with the recent deep-going acupunctural research.

  2. An Overlap Syndrome involving systemic lupus erythematosus and autoimmune hepatitis in an adolescent girl.

    Science.gov (United States)

    Battagliotti, Cristina; Rispolo Klubek, Daniela; Karakachoff, Mario; Costaguta, Alejandro

    2016-06-01

    La superposición del lupus eritematoso sistémico y la hepatitis autoinmune se describe ocasionalmente. Aunque ambas enfermedades pueden compartir ciertos hallazgos, como poliartralgias, hipergammaglobulinemia y anticuerpo antinúcleo positivo, son consideradas dos diferentes. Se presenta a una paciente de 14 años con lupus eritematoso sistémico, que, luego de dos años, consultó por ictericia. Sin antecedentes de ingesta de drogas, alcohol o exposición a virus hepatotropos. Tenia un aumento de las enzimas hepáticas con anticuerpos antinúcleo, anti-ADN de doble cadena y LKM 1 positivos. La biopsia hepática mostró una hepatitis de interfase con infiltrado linfoplasmocitario. De esta manera, cumplia con los criterios diagnósticos tanto para lupus eritematoso sistémico como para hepatitis autoinmune. Tratada con corticoides y micofenolato mofetil, mejoró su clinica y laboratorio. Conclusión. La hepatitis autoinmune puede ocurrir en el curso del lupus eritematoso sistémico. Un diagnóstico temprano es importante para prevenir el avance de la enfermedad; es obligatoria la realización de la biopsia hepática.

  3. Meningitis granulomatosa, glomerulonefritis rápidamente progresiva y vasculitis

    Directory of Open Access Journals (Sweden)

    Ana Ludueña

    2011-08-01

    Full Text Available El compromiso meníngeo es una manifestación infrecuente de la granulomatosis de Wegener. Puede manifestarse como cefalea con hiperproteinorraquia y engrosamiento de la duramadre con aspecto granulomatoso, que se observa en la resonancia magnética. Presentamos un varón de 57 años con granulomatosis de Wegener que debutó con compromiso de vías aéreas superiores, oídos, órbitas y meningitis granulomatosa asintomática y que posteriormente evolucionó con mononeuritis múltiple y glomerulonefritis crescéntica ANCA positiva. La presencia de ANCA y el compromiso sistémico (vías aéreas superiores, oído, órbitas, nervios periféricos, duramadre y glomerulonefritis rápidamente progresiva permitieron en este caso llegar a un diagnóstico de certeza e iniciar el tratamiento inmunosupresor combinado (corticoides y ciclofosfamida. Evolucionó con remisión clínica y serológica (negativización de ANCA, pero persistiendo leve deterioro secuelar auditivo y de la función renal, sin recidiva de la enfermedad de base.

  4. Estado epiléptico, consideraciones sobre manejo y tratamiento

    Directory of Open Access Journals (Sweden)

    Solari B. Francesca, Dra.

    2013-11-01

    Full Text Available El estado epiléptico es una emergencia médica. Existen diversas definiciones de estado epiléptico y clasificaciones según etiología, tipo de crisis y respuesta a terapia. En esta revisión, se adopta la variable tiempo como fundamental en el manejo del paciente. Otro concepto que se resalta, es la sospecha frente a pacientes graves o con ciertas patologías, la posibilidad de presentar estado epiléptico no convulsivo, ya que la identificación de este, podría mejorar el manejo del paciente grave. Las benzodiacepinas siguen siendo la terapia de primera línea, con una muy buena tasa de respuesta, cuanto más precoz se adopte la terapia. Se discuten diferentes terapias de segunda línea (fenitoína, fenobarbital, valproato, levetiracetam y midazolam y se mencionan aquellas de tercera línea, tanto farmacológicas como otras (dieta cetogénica, inmunosupresores, corticoides y cirugía.

  5. Láser de diodo; opción terapéutica para liquen plano erosivo resistente a corticoterapia: reporte de caso

    Directory of Open Access Journals (Sweden)

    Sandra Milena Espitia-Nieto

    2016-02-01

    Full Text Available Laser therapy is a new treatment option for its analgesic, anti-inflammatory and bio-stimulants properties and without significant adverse effects, for diseases such as oral Lichen Planus in its erosive form, characterized by chronic and painful ulcers with possibility of malignization, which obliges an adequate therapy. This article reports the clinical case taking into account ethical considerations framed in law 008430 of 1993 of a female patient 50 years old, with clinical and histopathological diagnosis of oral erosive Lichen Planus, who received initial treatment with corticoids local and systemic without improvement in 7 months; reason why is opted biostimulation with 980nm diode laser therapy, showing a significant reduction in the severity of injuries and decrease of pain from the first cycle of irradiation. Diode laser is safe and effective in this type of diseases treatment because it promotes healing, therefore it can be considered as an excellent alternative in cases of oral Lichen Planus resistant to corticotherapy.

  6. In vivo multiphoton imaging of human skin: assessment of topical corticosteroid-induced epidermis atrophy and depigmentation

    Science.gov (United States)

    Ait El Madani, Hassan; Tancrède-Bohin, Emmanuelle; Bensussan, Armand; Colonna, Anne; Dupuy, Alain; Bagot, Martine; Pena, Ana-Maria

    2012-02-01

    Multiphoton microscopy has emerged in the past decade as a promising tool for noninvasive skin imaging. Our aim was to evaluate the potential of multiphoton microscopy to detect topical corticosteroids side effects within the epidermis and to provide new insights into their dynamics. Healthy volunteers were topically treated with clobetasol propionate on a small region of their forearms under overnight occlusion for three weeks. The treated region of each patient was investigated at D0, D7, D15, D22 (end of the treatment), and D60. Our study shows that multiphoton microscopy allows for the detection of corticoid-induced epidermis modifications: thinning of stratum corneum compactum and epidermis, decrease of keratinocytes size, and changes in their morphology from D7 to D22. We also show that multiphoton microscopy enables in vivo three-dimensional (3-D) quantitative assessment of melanin content. We observe that melanin density decreases during treatment and almost completely disappears at D22. Moreover, these alterations are reversible as they are no longer present at D60. Our study demonstrates that multiphoton microscopy is a convenient and powerful tool for noninvasive 3-D dynamical studies of skin integrity and pigmentation.

  7. Artritis reumatoide como forma de presentación de un timoma

    Directory of Open Access Journals (Sweden)

    Juan Antonio Velasco Franco

    2016-12-01

    Full Text Available El timo juega un importante papel en la maduración de los linfocitos T y en la tolerancia inmune, una alteración a dicho nivel podría desencadenar una reacción de linfocitos contra antígenos propios, dando lugar a reacciones autoinmunes. Presentamos el caso de un paciente de 65 años diagnosticado hacía 4 años de artritis reumatoide seropositiva controlada con bajas dosis de corticoide que ingresó en el servicio de Medicina Interna por cuadro sincopal situacional (defecatorio con recuperación espontánea. En las exploraciones complementarias destacaba la presencia en la radiografía de tórax de una masa mediastínica confirmada en TAC y con biopsia compatible con timoma. Tras el hallazgo casual del timoma y 2 años después de la extirpación del mismo el paciente se encuentra asintomático sin tratamiento corticoideo en lo que respecta a artritis y con negativización en controles posteriores a la cirugía de factor reumatoide y anticuerpos anticitrulinados en descenso.

  8. Riding out the storm: sympathetic storming after traumatic brain injury.

    Science.gov (United States)

    Lemke, Denise M

    2004-02-01

    Following acute multiple trauma, hypothalamic stimulation of the sympathetic nervous system and adrenal glands causes an increase in circulating corticoids and catecholamines, or a stress response. In individuals with severe traumatic brain injury or a Glasgow Coma Scale score of 3-8, this response can be exaggerated and episodic. A term commonly used by nurses caring for these individuals to describe this phenomenon is storming. Symptoms can include alterations in level of consciousness, increased posturing, dystonia, hypertension, hyperthermia, tachycardia, tachypnea, diaphoresis, and agitation. These individuals generally are at a low level of neurological activity with minimal alertness, minimal awareness, and reflexive motor response to stimulation, and the storming can take a seemingly peaceful individual into a state of chaos. Diagnosis is commonly made solely on clinical assessment, and treatment is aimed at controlling the duration and severity of the symptoms and preventing additional brain injury. Storming can pose a challenge for the nurse, from providing daily care for the individual in the height of the storming episode and treating the symptoms, to educating the family. Careful assessment of the individual leads the nurse to the diagnosis and places the nurse in the role of moderator of the storming episode, including providing treatment and evaluating outcomes.

  9. Pseudotumor pulmonar como apresentação inicial de granulomatose de Wegener Lung pseudotumor as the initial presentation of Wegener's granulomatosis

    Directory of Open Access Journals (Sweden)

    Marcelo Fouad Rabahi

    2009-04-01

    Full Text Available A granulomatose de Wegener é uma doença inflamatória multissistêmica de etiologia desconhecida, que se caracteriza por vasculite de pequeno e médio calibre. As manifestações clínicas mais comuns envolvem o trato respiratório superior, pulmões e rins e as alterações encontradas nos exames de imagem são geralmente opacidades pulmonares ou nódulos múltiplos, bilaterais e, em 50% dos casos, cavitações. O tratamento é feito com corticoides e imunossupressores. Descreve-se um caso atípico de um homem de 61 anos cuja investigação inicial de um tumor pulmonar unilateral evidenciou, na verdade, Granulomatose de Wegener.Wegener's granulomatosis is a multisystemic inflammatory illness of unknown etiology, characterized by vasculitis of small and medium caliber vessels. The most common clinical manifestations involve the upper respiratory tract, lungs and kidneys. Common alterations in imaging studies include pulmonary opacities and bilateral multiple nodules, cavitations occurring in 50% of the cases. Treatment includes corticosteroids and immunosuppressants. We describe an atypical case of a 61-year-old man initially investigated due to suspicion of a unilateral lung tumor, which proved to be, in fact, a case of Wegener's granulomatosis.

  10. [Viper (Vipera berus) snake bites].

    Science.gov (United States)

    Valenta, J; Kornalík, F

    2000-07-19

    Cases of snake bites (Vipera berus) have as compared with past years a rising trend in the Czech Republic. This ensues among other factors from a higher prevalence of snakes due to the improving ecological situation. The morbidity of snake bites is of no epidemiological importance, the frequency of snake bites amounts to several tens per year and in some clinically manifest intoxication does not develop. Nevertheless in individual cases, in children weakened subjects, a viper bite may be manifested by a serious and in exceptional instances fatal affection. Within the framework of first aid the authors do not recommend application of a tourniquet or dissecting of the wound because of undesirable potentiation of tissue traumatization. Non-specific treatment involves the administration of corticoids and antihistaminics. Specific immunotherapy, administration of horse antiserum (Ipser Europe, Pasteur Mérieux, France) is indicated only in case of systemic or very severe local symptoms and is associated with the risk of a severe allergic reaction. In case of severe systemic symptoms, symptomatic treatment in a health institution of the appropriate type is of fundamental importance. In all cases observation of the affected subject is recommended to rule out intoxication or the development of possible complications.

  11. Infliximab en pacientes con enfermedad ocular inflamatoria, refractarios a DARMES

    Directory of Open Access Journals (Sweden)

    Elmer R. García-Salazar

    2013-07-01

    Full Text Available Se describe la experiencia con infliximab (anticuerpo monoclonal con una potente acción antiinflamatoria en el tratamiento de enfermedades oculares inflamatorias secundarias a patologías reumáticas y refractarias a drogas antirreumáticas modificadoras de la enfermedad (DARMES. Se evaluó el caso de una paciente de 50 años con artritis reumatoide (AR de fondo activo y una paciente de 37 años con vasculitis anticuerpos anticitoplasma de neutrófilos especifico para mieloperoxidasa (ANCA MPO sin compromiso de órgano noble, ambas con escleritis bilateral y perforación con prolapso de iris del ojo izquierdo. Ellas recibieron infliximab EV en dosis de 3 a 5 mg/kg/dosis, según el esquema, a las 0, 2, 6 y 8 semanas. Infliximab resultó eficaz y seguro para el tratamiento de escleritis asociada a AR y vasculitis ANCA MPO positivo, refractaria a tratamiento con DARMES y corticoides en dosis altas. Los injertos de tejido esclerocorneal evolucionaron favorablemente con infliximab.

  12. Retrospective survey of Chikungunya disease in Réunion Island hospital staff

    Science.gov (United States)

    STAIKOWSKY, F.; Le ROUX, K.; SCHUFFENECKER, I.; LAURENT, P.; GRIVARD, P.; DEVELAY, A.; MICHAULT, A.

    2008-01-01

    SUMMARY Réunion Island (Indian Ocean) has been suffering from its first known Chikungunya virus (CHIKV) epidemic since February 2005. To achieve a better understanding of the disease, a questionnaire was drawn up for hospital staff members and their household. CHIKV infected about one-third of the studied population, the proportion increasing with age and being higher in women. Presence of a garden was associated with CHIKV infection. The geographical distribution of cases was concordant with insect vector Aedes albopictus distribution. The main clinical signs were arthralgia and fever. The disease evolved towards full recovery in 34·4% of cases, a relapse in 55·6%, or a chronic form in 10%. Paracetamol was used as a painkiller in 95% of cases, sometimes associated with non-steroidal anti-inflammatory drugs, corticoids, or traditional herbal medicine. The survey provided valuable information on the factors that favour transmission, the clinical signs, the importance of relapses and the therapies used. PMID:17433130

  13. Síndrome de Tolosa-Hunt

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    Eduardo Scaldini Buscacio

    2016-02-01

    Full Text Available RESUMO A Síndrome de Tolosa Hunt é uma doença rara, cuja etiopatogenia é desconhecida. Apresenta-se como uma oftalmoplegia dolorosa de um ou mais nervos cranianos oculomotores, que regride espontaneamente e responde bem ao tratamento com corticoides. O presente estudo trata-se de um relato de caso de um paciente que apresentou seguidos casos de oftalmoplegias dolorosas, envolvendo o nervo oculomotor e o abducente sendo tratado com corticoesteroides obteve uma resposta dramática. Objetiva-se ainda descrever as características fisiopatológicas, clínicas, o diagnóstico diferencial, visto que é um diagnóstico de exclusão, e medidas terapêuticas instituídas de acordo com o International Headache Society 2004 (ISH-2004 através da apresentação do caso clínico conduzido com as normas do estudo supracitado.

  14. Síndrome DRESS inducido por fármacos antituberculosos en un paciente con diabetes mellitus tipo 2

    Directory of Open Access Journals (Sweden)

    Antonio Salas

    2012-04-01

    Full Text Available Presentamos el caso de un paciente varón de 48 años de edad, con diagnóstico de diabetes mellitus tipo 2, no controlada, de diez años de evolución, a quien se le diagnosticó tuberculosis pulmonar mediante signos clínicos, radiográficos y cultivo en esputo positivo para Mycobacterium tuberculosis, sensible a drogas antituberculosas de primera línea. Recibió isoniacida, rifampicina, etambutol y pirazinamida. Dos meses después de iniciado el tratamiento presentó hipersensibilidad a medicamentos, con los siguientes signos y síntomas: rash dérmico generalizado, prurito generalizado, anemia Coombs positiva, eosinofilia y síntomas sistémicos, compatibles con el síndrome DRESS (drug rash with eosinophilia and systemic symptoms. Ante ello, se suspendió la medicación antituberculosa y se instaló tratamiento con antihistamínicos y corticoides sistémicos, con remisión y mejoría de síntomas. Posteriormente, recibió un esquema individualizado de tratamiento para tuberculosis consistente en medicamentos mínimamente hemato-hepatotóxicos, similar al indicado en pacientes inmunosuprimidos. Desde entonces presenta baciloscopias negativas.

  15. Challenges for lupus management in emerging countries.

    Science.gov (United States)

    Tazi Mezalek, Zoubida; Bono, Wafaa

    2014-06-01

    In emerging countries, systemic lupus erythematosus (SLE) has been associated with several unfavorable outcomes including disease activity, damage accrual, work disability and mortality. Poor socioeconomic status (SES) and lack of access to healthcare, especially in medically underserved communities, may be responsible for many of the observed disparities. Diagnostic delay of SLE or for severe organ damages (renal involvement) have a negative impact on those adverse outcomes in lupus patients who either belong to minority groups or live in emerging countries. Longitudinal and observational prospective studies and registries may help to identify the factors that influence poor SLE outcomes in emerging countries. Infection is an important cause of mortality and morbidity in SLE, particularly in low SES patients and tuberculosis appears to be frequent in SLE patients living in endemic areas (mainly emerging countries). Thus, tuberculosis screening should be systematically performed and prophylaxis discussed for patients from these areas. SLE treatment in the developing world is restricted by the availability and cost of some immunosuppressive drugs. Moreover, poor adherence has been associated to bad outcomes in lupus patients with a higher risk of flares, morbidity, hospitalization, and poor renal prognosis. Low education and the lack of money are identified as the main barrier to improve lupus prognosis. Newer therapeutic agents and new protocols had contributed to improve survival in SLE. The use of corticoid-sparing agents (hydroxychloroquine, methotrexate, azathioprine and mycophenolate mofetif) is one of the most useful strategy; availability of inexpensive generics may help to optimize access to these medications.

  16. Adult female of strongyloides stercoralis in respiratory secretions

    Institute of Scientific and Technical Information of China (English)

    Bava; Amadeo; Javier; Bava; Domínguez; Cecilia; Troncoso; Alcides

    2013-01-01

    Objective:To communicate the presence of adult females,rabditoid larvae and eggs of Strongyloides stercoralis(S.stercoralis)in the respiratory secretions obtained by tracheal aspirate from a HIV-negative patient who was suffering from polymyositis,and treated with corticoids and amethopterin and assisted by pneumonia.Methods:The respiratory secretions submitted to the Parasitology Laboratory of the Mu(?)iz Hospital were made more concentrated by centrifugation(1 500 r/min for 15 seconds).Wet mount microscopy was performed with the pellet.Results:It revealed adult females,rabditoid larvae and eggs of S.stercoralis.Further parasitological studies performed after the start of the treatment with ivermectin on fresh fecal samples,gastric lavages and tracheal aspirates showed scanty mobile filariform and rabditoid larvae of the same parasite.Conclusions:The presence of adult female S.stercoralis which has never been observed before in the clinical samples submitted to our Laboratory for investigation can be considered as an indirect marker of the severe immunosupression of the patient.

  17. Adult female of Strongyloides stercoralis in respiratory secretions

    Institute of Scientific and Technical Information of China (English)

    Bava Amadeo Javier Bava; Domnguez Cecilia; Troncoso Alcides

    2013-01-01

    Objective: To communicate the presence of adult females, rabditoid larvae and eggs of Strongyloides stercoralis (S. stercoralis) in the respiratory secretions obtained by tracheal aspirate from a HIV-negative patient who was suffering from polymyositis, and treated with corticoids and amethopterin and assisted by pneumonia. Methods: The respiratory secretions submitted to the Parasitology Laboratory of the Muñiz Hospital were made more concentrated by centrifugation (1 500 r/min for 15 seconds). Wet mount microscopy was performed with the pellet. Results: It revealed adult females, rabditoid larvae and eggs of S. stercoralis. Further parasitological studies performed after the start of the treatment with ivermectin on fresh fecal samples, gastric lavages and tracheal aspirates showed scanty mobile filariform and rabditoid larvae of the same parasite. Conclusions: The presence of adult female S. stercoralis which has never been observed before in the clinical samples submitted to our Laboratory for investigation can be considered as an indirect marker of the severe immunosupression of the patient.

  18. Molecular Pathways: Immune Checkpoint Antibodies and their Toxicities.

    Science.gov (United States)

    Cousin, Sophie; Italiano, Antoine

    2016-09-15

    The emergence of immune checkpoint inhibitors for solid tumor treatments represents a major oncologic advance. Since the approval of ipilimumab, a cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) antibody, for the treatment of metastatic melanoma, many drugs, especially those targeting PD-1/PD-L1, have demonstrated promising antitumor effects in many types of cancer. By reactivating the immune system, these immunotherapies have led to the development of new toxicity profiles, also called immune-related adverse events (irAE). IrAEs can involve many organ systems, and their management is radically different from that of cytotoxic drugs; irAEs require immunosuppressive treatments, such as corticoids or TNFα antibody. In addition, the occurrence of irAEs has raised significant questions. Here, we summarize progress that has been made toward answering these questions, focusing on (i) the impact of immunotherapy dose on irAE occurrence, (ii) the correlation between irAE and patient outcome, (iii) the safety of immune checkpoint inhibitors in patients already treated for autoimmune disease, and (iv) the suspected effect on tumor growth of steroids used for the management of irAEs. Clin Cancer Res; 22(18); 4550-5. ©2016 AACR.

  19. Cisticercosis diseminada: reporte de un caso en Perú

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    Julio Maquera-Afaray

    Full Text Available La cisticercosis es una enfermedad desatendida y endémica en el Perú que afecta comúnmente al sistema nervioso central (SNC, causando la neurocisticercosis (NCC. Sin embargo, son pocos los reportes de cisticercosis diseminada (CCD en el mundo. Se reporta el caso de un paciente varón de 82 años, natural del departamento de Junín, que presenta pérdida brusca del nivel de conciencia asociada a convulsiones tónico-clónicas generalizadas. La tomografía axial computarizada y la resonancia magnética nuclear cerebral mostraron múltiples lesiones de aspecto quístico con presencia de escólex en su interior y compatibles con NCC masiva; la resonancia magnética nuclear torácica, abdominal y pélvica permitieron evidenciar la diseminación multiorgánica de cisticercos. Aunque es poca la casuística y experiencia terapéutica en los casos de CCD, el paciente recibió tratamiento antiparasitario con albendazol y corticoides, logrando una evolución clínica favorable y sin complicaciones durante la hospitalización

  20. The infiltration of the AC joint performed by one specialist: Ultrasound versus palpation a prospective randomized pilot study

    Energy Technology Data Exchange (ETDEWEB)

    Sabeti-Aschraf, M., E-mail: manuel.sabeti-aschraf@meduniwien.ac.a [Vienna Medical School, Department for Orthopaedics and Orthopaedic Surgery, AKH-Wien, Waehringer Guertel18-20, 1090 Vienna (Austria); Ochsner, A. [Vienna Medical School, Department for Orthopaedics and Orthopaedic Surgery, AKH-Wien, Waehringer Guertel18-20, 1090 Vienna (Austria); Schueller-Weidekamm, C. [Vienna Medical School, Department for Radiology, AKH-Wien, Waehringer Guertel 18-20, 1090 Vienna (Austria); Schmidt, M. [Vienna Medical School, Department for Orthopaedics and Orthopaedic Surgery, AKH-Wien, Waehringer Guertel18-20, 1090 Vienna (Austria); Funovics, Ph.T. [Vienna Medical School, Department for Radiology, AKH-Wien, Waehringer Guertel 18-20, 1090 Vienna (Austria); Skrbensky, G. von [Vienna Medical School, Department for Orthopaedics and Orthopaedic Surgery, AKH-Wien, Waehringer Guertel18-20, 1090 Vienna (Austria); Goll, A. [Vienna Medical School, Core Unit for Medical Statistics and Wien, Waehringer Guertel18-20, 1090 Vienna (Austria); Schatz, K.D. [Vienna Medical School, Department for Orthopaedics and Orthopaedic Surgery, AKH-Wien, Waehringer Guertel18-20, 1090 Vienna (Austria)

    2010-07-15

    Introduction: The acromio-clavicular (AC) joint is very susceptible to degenerative processes that result in pain and functional impairment. One common modality of treatment has been local infiltration of the joint space. Although this procedure has produced notable positive results, needle misplacement occurs frequently. The aim of this investigation is to evaluate the effects of an intra articular infiltration by comparing precise needle placement into the joint space using high-resolution-ultrasound with the conventional palpation technique. Methods: This prospective and randomized pilot study analysed 20 patients who were assigned either to the 'ultrasound' or the 'palpation' group. Clinical examinations were performed before treatment and at 1 h, 1 week and 3 weeks after a single infiltration of local anaesthetic and corticoid carried out by one specialist. Results: In both groups significant improvement in pain and function was obtained up to one-week post injection. Function remained significantly improved until the last follow-up and did not differ between the two groups. The agent was administered in all patients into the joint space in the ultrasound group. Conclusion: Ultrasound guided infiltration of the AC joint is an easily achieved procedure without any complications. However, clinical follow-up did not differ between free-hand and ultrasound-guided AC joint space infiltration.

  1. Enfermedad cardíaca grave en la esclerosis sistémica Severe cardiac disease in scleroderma

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    Alejandro R. Grinberg

    2004-10-01

    Full Text Available Una mujer de 36 años de edad con diagnóstico de esclerosis sistémica (ES desarrolló un cuadro agudo de miositis esquelética e insuficiencia cardíaca grave. Evolucionó con shock cardiogénico y a pesar del tratamiento con drogas inotrópicas y altas dosis de corticoides falleció a los cinco días de haber ingresado. La autopsia reveló áreas de necrosis coagulativa miocárdicas con miocitolisis y necrosis en banda de contracción. Son muy pocos los casos comunicados de insuficiencia cardíaca grave asociada a la ES.A 36 year-old female with a diagnosis of systemic sclerosis suffered from an acute episode of skeletal myositis and refractory heart failure with cardiogenic shock. Despite immunosuppressive treatment with high doses of corticosteroids and hemodynamic support she died five days after admission. The autopsy showed cardiac myocytolysis, myocyte necrosis and contraction band necrosis. There are very few reported cases of severe heart failure associated to systemic sclerosis.

  2. General Stress Responses in the Honey Bee

    Science.gov (United States)

    Even, Naïla; Devaud, Jean-Marc; Barron, Andrew B.

    2012-01-01

    The biological concept of stress originated in mammals, where a “General Adaptation Syndrome” describes a set of common integrated physiological responses to diverse noxious agents. Physiological mechanisms of stress in mammals have been extensively investigated through diverse behavioral and physiological studies. One of the main elements of the stress response pathway is the endocrine hypothalamo-pituitary-adrenal (HPA) axis, which underlies the “fight-or-flight” response via a hormonal cascade of catecholamines and corticoid hormones. Physiological responses to stress have been studied more recently in insects: they involve biogenic amines (octopamine, dopamine), neuropeptides (allatostatin, corazonin) and metabolic hormones (adipokinetic hormone, diuretic hormone). Here, we review elements of the physiological stress response that are or may be specific to honey bees, given the economical and ecological impact of this species. This review proposes a hypothetical integrated honey bee stress pathway somewhat analogous to the mammalian HPA, involving the brain and, particularly, the neurohemal organ corpora cardiaca and peripheral targets, including energy storage organs (fat body and crop). We discuss how this system can organize rapid coordinated changes in metabolic activity and arousal, in response to adverse environmental stimuli. We highlight physiological elements of the general stress responses that are specific to honey bees, and the areas in which we lack information to stimulate more research into how this fascinating and vital insect responds to stress. PMID:26466739

  3. Treatment of glucocorticoid-induced osteoporosis with alfacalcidol/calcium versus vitamin D/calcium.

    Science.gov (United States)

    Ringe, J D; Cöster, A; Meng, T; Schacht, E; Umbach, R

    1999-10-01

    Vitamin D/calcium substitution is generally regarded as an effective first step treatment for glucocorticoid-induced osteoporosis (GIOP). The aim of our study was to evaluate the efficacy of the active vitamin D metabolite alfacalcidol (1alpha) compared with the native vitamin D(3) in patients with established GIOP with or without vertebral fractures. Patients on long-term corticoid therapy were given either 1 microg alfacalcidol plus 500 mg calcium per day (group A, n = 43) or 1000 IU vitamin D(3) plus 500 mg calcium (group B, n = 42). The two groups were alike in age range, sex ratio, percentages of underlying diseases, average initial bone density values (lumbar spine: mean T-score -3.28 and -3.25, respectively), and rates of vertebral and nonvertebral fractures. During the 3-year study we found a small but significant increase of lumbar spine density in group 1alpha (+2.0%, P back pain (P vitamin D group. We conclude that with the doses used in this trial, alfacalcidol is superior to vitamin D in the treatment of established GIOP.

  4. Tratamento da doença de Hailey-Hailey com toxina botulínica tipo A Hailey-Hailey disease treatment with Botulinum toxin type A

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    Giancarlo Rezende Bessa

    2010-10-01

    Full Text Available Duas irmãs com doença de Hailey-Hailey, com lesões recorrentes - uma em axilas e outra em região inguinal -, e resposta limitada aos tratamentos clássicos. Elas foram tratadas com aplicação de toxina botulínica tipo A. Observamos que houve importante melhora na paciente tratada na região inguinal e remissão completa na paciente em cujas axilas sofreram tratamento. Além disso, foi possível poupar uso de antibióticos sistêmicos e corticoides tópicos. O alto custo é um fator restritivo para uso rotineiro e estudos maiores são necessários para definir eficácia e relação custo-benefício dessa intervenção.Two sisters with recurrent lesions, one on axillae and other on the groin, and with limited response to classical treatments were treated with injections botulinum toxin type A. We observed marked improvement in the patient treated in the groin and complete remission in the patient treated in the axillae. It was possible to spare the use of systemic antibiotics and topical corticosteroids. The high cost is a restrictive factor to routine use and large studies are necessary to access efficacy and cost benefit profile.

  5. Meningitis bacteriana aguda

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    D. Rodrigo Blamey, Dr.

    2014-05-01

    Full Text Available La Meningitis Bacteriana Aguda (MBA de adquisición comunitaria es una enfermedad prevalente en todo el mundo; constituye siempre una emergencia médica y se asocia a una alta morbimortalidad. Su epidemiología es variable y los principales agentes en adultos son S. pneumoniae, N. meningitidis, H. influenzae y L. monocitogenes. En Chile existe un sistema de vigilancia recientemente implementado que permitirá un mejor diagnóstico epidemiológico. Las manifestaciones clínicas clásicas no siempre están presentes principalmente en adultos mayores. El diagnóstico requiere del estudio de líquido cefalorraquídeo, y las técnicas de biología molecular han significado un aporte relevante en los últimos años. El tratamiento antibiótico debe ser instaurado rápidamente para mejorar el pronóstico, mientras que la terapia coadyuvante con corticoides en adultos tiene sólo beneficios en etiología neumocócica. Se requieren mejores estrategias de prevención frente a una entidad que no ha cambiado su mortalidad a pesar del progreso de la medicina moderna.

  6. Atopic dermatitis in adults: clinical and epidemiological considerations

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    Raquel Leão Orfali

    2013-06-01

    Full Text Available OBJECTIVE: Atopic dermatitis (AD is a chronic inflammatory disease causing intense pruritus, and with typical clinical features. There are few epidemiological studies concerning AD in adults, as well as little information about its prognostic. The aim of this study was to evaluate the clinical and epidemiological course of adults with AD. METHODS: 80 patients aged above 18 years (mean age = 29 years were selected (30 males and 50 females and interviewed about hospitalization, systemic corticoid usage, age of AD onset, and personal and/or familial history of atopy. Disease severity was evaluated through the Scoring Atopic Dermatitis (SCORAD tool. Laboratory examination included IgE serum levels and eosinophil blood count. RESULTS: 71 out of 80 patients referred association with respiratory symptoms (18 had asthma, 17 had rhinitis, and 36 had both conditions; nine out of 80 patients denied any respiratory disease. AD patients were divided in mild (n = 25, moderate (n = 30, and severe (n = 25; 56% had one or more hospitalizations due to AD. A positive association was found between IgE serum levels, eosinophil blood count, and disease severity. CONCLUSION: Adult AD represents a clinical challenge that needs to be better characterized, since it can be misdiagnosed and interferes with the patient's social and personal life. The association of skin and respiratory atopic disease is frequent, and laboratory parameters such as circulating IgE levels and eosinophil blood count may be helpful to assess disease severity.

  7. Effect of methylprednisolone use on the rotator cuff in rats: biomechanical and histological study

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    Gustavo Vinícius Ghellioni

    2015-06-01

    Full Text Available OBJECTIVE: To evaluate the influence of treatment with different doses of methylprednisolone on the mechanical resistance and possible histological alterations of the rotator cuff tendon in rats.METHODS: Male Wistar rats were divided randomly into four treatment groups: sham, vehicle or 0.6 mg/kg or 6.0 mg/kg of methylprednisolone. Changes to mechanical resistance (in N and histological parameters (fibrillar appearance, presence of collagen, edema and vascular proliferation of the rotator cuff tendon were evaluated. The analyses were conducted after administration of one treatment (24 h afterwards, two treatments (7 days afterward or three treatments (14 days afterwards, into the subacromial space.RESULTS: Seven and fourteen days after the treatments were started, it was found that in a dose-dependent manner, methylprednisolone reduced the mechanical resistance of the rotator cuff tendon (p < 0.05 in relation to the vehicle group. Modifications to the histological parameters were observed on the 7th and 14th days after the first infiltration, especially regarding the presence of collagen and vascular proliferation, for the dose of 0.6 mg/kg of methylprednisolone, and also regarding the presence of collagen, edema and vascular proliferation for the dose of 6.0 mg/kg of corticoid.CONCLUSION: The results obtained demonstrated a relationship between methylprednisolone use through infiltration into the subacromial space and reduction of the mechanical resistance of and histological modifications to the rotator cuff tendon in rats.

  8. Prediction of disease severity in neuromyelitis optica by the levels of interleukin (IL)-6 produced during remission phase.

    Science.gov (United States)

    Barros, P O; Cassano, T; Hygino, J; Ferreira, T B; Centurião, N; Kasahara, T M; Andrade, R M; Linhares, U C; Andrade, A F B; Vasconcelos, C C F; Alvarenga, R; Marignier, R; Bento, C A M

    2016-03-01

    T helper type 17 (Th17) cytokines have been implicated in the pathogenesis of neuromyelitis optica (NMO). As humanized anti-interleukin (IL)-6R (tocilizumab) immunoglobulin (Ig)G has been used as disease-modifying therapy for NMO, the objective of our study was to investigate the role of endogenous IL-6 on NMO-derived CD4(+) T cell behaviour. High production of IL-6, IL-17 and IL-21 by CD4(+) T-cells was detected in NMO patients. Further, IL-21 and IL-6 levels were related directly to the level of neurological disabilities. The addition of anti-IL-6R IgG not only reduced directly the production of these cytokines, but also almost abolished the ability of activated autologous monocytes in enhancing IL-6, IL-17 and IL-21 release by CD4(+) T cells. In contrast, the production of IL-10 was amplified in those cell cultures. Further, anti-IL-6R monoclonal antibodies (mAb) also potentiated the ability of glucocorticoid in reducing Th17 cytokines. Finally, the in-vivo and in-vitro IL-6 levels were significantly higher among those patients who experienced clinical relapse during 2-year follow-up. In summary, our results suggest a deleterious role of IL-6 in NMO by favouring, at least in part, the expansion of corticoid-resistant Th17 cells.

  9. Update on Eosinophilic Meningoencephalitis and Its Clinical Relevance

    Science.gov (United States)

    Graeff-Teixeira, Carlos; da Silva, Ana Cristina Arámburu; Yoshimura, Kentaro

    2009-01-01

    Summary: Eosinophilic meningoencephalitis is caused by a variety of helminthic infections. These worm-specific infections are named after the causative worm genera, the most common being angiostrongyliasis, gnathostomiasis, toxocariasis, cysticercosis, schistosomiasis, baylisascariasis, and paragonimiasis. Worm parasites enter an organism through ingestion of contaminated water or an intermediate host and can eventually affect the central nervous system (CNS). These infections are potentially serious events leading to sequelae or death, and diagnosis depends on currently limited molecular methods. Identification of parasites in fluids and tissues is rarely possible, while images and clinical examinations do not lead to a definitive diagnosis. Treatment usually requires the concomitant administration of corticoids and anthelminthic drugs, yet new compounds and their extensive and detailed clinical evaluation are much needed. Eosinophilia in fluids may be detected in other infectious and noninfectious conditions, such as neoplastic disease, drug use, and prosthesis reactions. Thus, distinctive identification of eosinophils in fluids is a necessary component in the etiologic diagnosis of CNS infections. PMID:19366917

  10. Physiological and pathological implications of cholesterol.

    Science.gov (United States)

    Cortes, Victor A; Busso, Dolores; Maiz, Alberto; Arteaga, Antonio; Nervi, Flavio; Rigotti, Attilio

    2014-01-01

    Cholesterol has evolved to fulfill sophisticated biophysical, cell signaling and endocrine requirements of animal systems. At a cellular level, cholesterol is found in membranes, where it increases both bilayer stiffness and impermeability to water and ions. Furthermore, cholesterol is integrated into specialized lipid-protein membrane microdomains with critical topographical and signaling functions. At an organismal level, cholesterol is the precursor for all steroid hormones, including gluco- and mineralo-corticoids, sex hormones and vitamin D, all of which regulate carbohydrate, sodium, reproductive and bone homeostasis, respectively. This sterol is also the precursor for bile acids, which are important for intestinal absorption of dietary lipids as well as energy and glucose metabolic regulation. Importantly, complex mechanisms maintain cholesterol within physiological ranges and the disregulation of these mechanisms results in embryonic or adult diseases, caused by either excessive or reduced tissue cholesterol levels. The causative role of cholesterol in these diseases has been demonstrated by diverse genetic and pharmacologic animal models that are commented in this review.

  11. Retracted: Advances in the physiological and pathological implications of cholesterol.

    Science.gov (United States)

    Cortes, Victor A; Busso, Dolores; Mardones, Pablo; Maiz, Alberto; Arteaga, Antonio; Nervi, Flavio; Rigotti, Attilio

    2013-11-01

    Cholesterol has evolved to fulfill sophisticated biophysical, cell signalling, and endocrine functions in animal systems. At the cellular level, cholesterol is found in membranes where it increases both bilayer stiffness and impermeability to water and ions. Furthermore, cholesterol is integrated into specialized lipid-protein membrane microdomains with critical topographical and signalling functions. At the organismal level, cholesterol is the precursor of all steroid hormones, including gluco- and mineralo-corticoids, sex hormones, and vitamin D, which regulate carbohydrate, sodium, reproductive, and bone homeostasis, respectively. This sterol is also the immediate precursor of bile acids, which are important for intestinal absorption of dietary lipids as well as energy homeostasis and glucose regulation. Complex mechanisms maintain cholesterol within physiological ranges and the dysregulation of these mechanisms results in embryonic or adult diseases, caused by either excessive or reduced tissue cholesterol levels. The causative role of cholesterol in these conditions has been demonstrated by genetic and pharmacological manipulations in animal models of human disease that are discussed herein. Importantly, the understanding of basic aspects of cholesterol biology has led to the development of high-impact pharmaceutical therapies during the past century. The continuing effort to offer successful treatments for prevalent cholesterol-related diseases, such as atherosclerosis and neurodegenerative disorders, warrants further interdisciplinary research in the coming decades. © 2013 The Authors. Biological Reviews © 2013 Cambridge Philosophical Society.

  12. A case of human intramuscular adrenal gland transplantation as a cure for chronic adrenal insufficiency.

    Science.gov (United States)

    Grodstein, E; Hardy, M A; Goldstein, M J

    2010-02-01

    Intramuscular endocrine gland transplantation has been well described as it pertains to parathyroid autotransplantation; however, transplantation of the adrenal gland is less well characterized. While adrenal autotransplantation in the setting of Cushing's disease has been described, intramuscular adrenal allotransplantation as a cure for adrenal insufficiency to our knowledge has not been previously carried out. Current treatment for adrenal insufficiency leaves patients without diurnal variation in cortisol release and susceptible to the detrimental effects of chronic hypercortisolism. We describe here the case of a 5-year-old girl with renal failure who had adrenal insufficiency following fulminant meningococcemia that led to requirements for both stress-dose steroid and mineralocorticoid replacement. Ten months after the onset of her disease, she received a simultaneous renal and adrenal gland transplant from her mother. The adrenal gland allograft was morselized into 1 mm(3) segments and implanted into three 2 cm pockets created in her rectus abdominis muscle. Three years after surgery, her allograft remains fully functional, responding well to adrenocorticotropin hormone stimulation and the patient does not require any steroid or mineral-corticoid supplementation. We believe this case represents the first description of successful functional intramuscular adrenal allograft transplantation with long-term follow up as a cure for adrenal insufficiency.

  13. Acute diplopia posterior to chemical laberinthectomy

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    Santos-Gorjón P

    2012-04-01

    Full Text Available SummaryIntroduction: Chemical laberinthectomy with gentamicin is an ambulatory procedure with a low rate of iatrogenical effects. We present a case with a rare complication and review the especifical literature. Clinical repport: We present a women with a left Meniere´s syndrome. A corticoid intratimpanic threathment was done and we don’t get control of symptoms. A gentamicin laberinthectomy was done, and an accute diplopia with no other clinical manifestations appears. Discussion: 95% of Ménière´s symptoms gets control with medical theathments. Security of gentamicin is accepted since 80`s decade. Susceptibility of action in inner ear is variable. We have to use minimal dosis of gentamicin to have control of the disease. Monitoring with VHIT is a new diagnosys arm to avoid complications. No references of diplopia postlaberintectomy was collected on medical literature. It´s very important control ocular movements by a recording metod or Frenzel glasses. Conclussion: Intratimpanic therapy is a secure metod. A diplopia postlaberinthectomy is undiagnosed. Usually no speciffic treathment is required. We have to use all recurses to detect a earl abolition of vestible and use minimal dose of gentamicin as possible.

  14. Síndrome de Hughes-Stovin

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    Sonia Pankl

    2015-04-01

    Full Text Available El síndrome de Hughes-Stovin es una entidad infrecuente caracterizada por trombosis venosa profunda y aneurismas de la arteria pulmonar, siendo su etiología y patogenia desconocida. Algunos autores la consideran una variante de la enfermedad de Behcet. Su curso natural es generalmente fatal. Se presenta con tos, disnea, hemoptisis, dolor torácico y fiebre. El tratamiento es con esteroides y agentes citotóxicos hasta la cirugía. Presentamos el caso de un hombre de 41 años que consultó por disnea, hemoptisis y dolor torácico, llegándose al diagnóstico de trombosis venosa profunda de miembro inferior derecho, trombo-embolismo de pulmón y aneurismas de arterias pulmonares. Recibió tratamiento con corticoides en altas dosis y 6 pulsos de ciclofosfamida de 1 gramo durante 6 meses, con regresión completa de los aneurismas y de la sintomatología.

  15. Fênomeno de Raynaud grave associado a terapia com interferon-beta para esclerose múltipla: relato de caso Severe Raynaud's phenomenon associated with interferon-beta therapy for multiple sclerosis: case report

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    BORIS AFONSO CRUZ

    2000-06-01

    Full Text Available Interferon-B (IFN-beta é usado no tratamento de esclerose múltipla (EM. Descrevemos o caso de uma mulher com EM que apresentou fenômeno de Raynaud grave, livedo reticular e necrose digital duas semanas após tratamento com IFN-beta. Os sintomas melhoraram após suspensão do IFN-beta e início de anticoagulação associada a ciclofosfamida e corticóide. Fenômeno de Raynaud é um efeito colateral provável da terapia com IFN-beta para EM.Interferon-beta (IFN-beta is administered for treatment of multiple sclerosis (MS. We report on a woman with MS who presented with severe Raynaud's phenomenon, livedo-reticularis and digital necrosis two weeks after beginning therapy with IFN-beta. Symptoms improved after the IFN-beta was discontinued and anticoagulation associated with cyclophosphamide and corticoid were introduced. Raynaud's phenomenon is probably a side effect of IFN-beta therapy for multiple sclerosis.

  16. Efferent and afferent connections of the olfactory bulb and prepiriform cortex in the pigeon (Columba livia).

    Science.gov (United States)

    Atoji, Yasuro; Wild, J Martin

    2014-06-01

    Although olfaction in birds is known to be involved in a variety of behaviors, there is comparatively little detailed information on the olfactory brain. In the pigeon brain, the olfactory bulb (OB) is known to project to the prepiriform cortex (CPP), piriform cortex (CPi), and dorsolateral corticoid area (CDL), which together are called the olfactory pallium, but centrifugal pathways to the OB have not been fully explored. Fiber connections of CPi and CDL have been reported, but those of other olfactory pallial nuclei remain unknown. The present study examines the fiber connections of OB and CPP in pigeons to provide a more detailed picture of their connections using tract-tracing methods. When anterograde and retrograde tracers were injected in OB, projections to a more extensive olfactory pallium were revealed, including the anterior olfactory nucleus, CPP, densocellular part of the hyperpallium, tenia tecta, hippocampal continuation, CPi, and CDL. OB projected commissural fibers to the contralateral OB but did not receive afferents from the contralateral olfactory pallium. When tracers were injected in CPP, reciprocal ipsilateral connections with OB and nuclei of the olfactory pallium were observed, and CPP projected to the caudolateral nidopallium and the limbic system, including the hippocampal formation, septum, lateral hypothalamic nucleus, and lateral mammillary nucleus. These results show that the connections of OB have a wider distribution throughout the olfactory pallium than previously thought and that CPP provides a centrifugal projection to the OB and acts as a relay station to the limbic system.

  17. Effects on hippocampus of lifelong absence of glucocorticoids in the pro-opiomelanocortin null mutant mouse reveal complex relationship between glucocorticoids and hippocampal structure and function.

    Science.gov (United States)

    Ostwald, Dirk; Karpac, Jason; Hochgeschwender, Ute

    2006-01-01

    In humans changes in serum cortisol levels have been observed with aging, stress, and with affective disorders such as major depression and post-traumatic stress disorder. Corticosteroids are known to influence hippocampal structure and function; specifically, plasma corticosteroid levels have been inversely correlated with hippocampal cell proliferation, cell death, and impaired memory function. The relationship between corticosteroids and structure and function of the hippocampus has been studied in experimental systems in adult animals by increasing or decreasing corticosterone levels through pharmacological supplementation and through surgical removal of the adrenal gland. Here, we utilized the genetically engineered pro-opiomelanocortin (POMC) null mutant mouse, which because of the lack of all POMC peptides has no corticosterone from birth throughout life. The effect of this lifelong absence of corticosterone on the dentate gyrus of the hippocampus is a decrease in granule cell density, which correlated with a decrease in cell proliferation but not an increase in cell degeneration. Fine morphology of granule cells was unaltered. Analyses of gene expression revealed no changes in POMC null mutant vs wild-type hippocampus with respect to levels of expression of corticoid receptor genes or genes known to be regulated by corticosterone. Spatial learning as tested by the Morris water maze was not altered in the POMC null mutant mouse. Taken together with findings from other studies of the effects of altered levels of corticosteroids on the hippocampus, our results argue for a complex homeostasis in which disturbances of any one factor can offset the system in varying ways.

  18. Influencia del estrógeno en la enfermedad periodontal: revisión de literatura

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    V.F.C. Pazmino

    2015-08-01

    Full Text Available La etiología de la enfermedad periodontal está bien definida, dentro de los agentes etiológicos que la causan podemos citar algunos microorganismos subgingivales como: Porphyromonas gingivalis, Prevotella intermedia, Bacteroides forsythus, Actinobacillus actinomycetemcomitans y espiroquetas. La susceptibilidad del huésped a estos agentes bacterianos también tiene un papel importante dentro del progreso y prevalencia de la enfermedad periodontal. Dentro de los factores de riesgo asociados con la enfermedad periodontal tenemos: el aumento de edad, presencia de biofilm dental o placa bacteriana patogénica, alteración del estado inmunológico, deficiencia nutricional, el uso de medicamentos como corticoides, género, estrés, tabaco, factores genéticos y condiciones sistémicas, dentro de estas se incluyen alteraciones de neutrófilos, diabetes, embarazo, osteoporosis y hormonales. La enfermedad periodontal puede ser exacerbada por determinados factores sistémicos como la deficiencia o aumento de hormonas como estrógeno y progesterona. La presente revisión de literatura tiene por objeto dilucidar la influencia del estrógeno en la enfermedad periodontal.

  19. Hipertensión arterial mineralocorticoidea

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    Carlos E. Fardella B., Dr.

    2013-09-01

    Full Text Available La hipertensión arterial (HTA dependiente de mineralocorticoides representa actualmente una de las formas secundarias de hipertensión más prevalentes. Entre las causas más conocidas está el hiperaldosteronismo primario (HAP. A nivel renal, la aldosterona reabsorbe sodio y agua aumentando el volumen intravascular y la presión arterial. Actualmente la prevalencia de HAP, detectada por la razón aldosterona/actividad renina plasmática (ARR que es considerado el mejor test de screening, es cercana al 10% en población hipertensa. Por otra parte, defectos congénitos o adquiridos en la enzima 11β-Hidroxiesteroide deshidrogenasa tipo 2 (11β-HSD2 resultan en una ineficiente inactivación de cortisol a cortisona favoreciendo la aparición de hipertensión por activación del receptor mineralocorticoideo. La actividad de esta enzima se evalúa midiendo la razón cortisol/cortisona en suero o en orina de 24 horas. Recientemente, hemos observado déficit parciales de la actividad de la enzima 11β-HSD-2 en alrededor del 15% de los pacientes hipertensos esenciales los que podrían ser tratados con bloqueadores específicos del receptor mineralocorticoide y/o con corticoides de acción prolongada sin actividad mineralocorticoide como dexametasona o betametasona.

  20. Cisticercosis diseminada: reporte de un caso en Perú

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    Julio Maquera-Afaray

    2014-04-01

    Full Text Available La cisticercosis es una enfermedad desatendida y endémica en el Perú que afecta comúnmente al sistema nervioso central (SNC, causando la neurocisticercosis (NCC. Sin embargo, son pocos los reportes de cisticercosis diseminada (CCD en el mundo. Se reporta el caso de un paciente varón de 82 años, natural del departamento de Junín, que presenta pérdida brusca del nivel de conciencia asociada a convulsiones tónico-clónicas generalizadas. La tomografía axial computarizada y la resonancia magnética nuclear cerebral mostraron múltiples lesiones de aspecto quístico con presencia de escólex en su interior y compatibles con NCC masiva; la resonancia magnética nuclear torácica, abdominal y pélvica permitieron evidenciar la diseminación multiorgánica de cisticercos. Aunque es poca la casuística y experiencia terapéutica en los casos de CCD, el paciente recibió tratamiento antiparasitario con albendazol y corticoides, logrando una evolución clínica favorable y sin complicaciones durante la hospitalización

  1. Is dexamethasone as effective as other corticosteroids for acute asthma exacerbation in children?

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    Gonzalo A. Bravo-Soto

    2017-06-01

    Full Text Available Resumen La dexametasona se ha planteado como una opción en el tratamiento de exacerbación asmática en niños, acortando el tratamiento, lo que además de ventajas prácticas, podría reducir costos y potenciales efectos adversos. No está claro, sin embargo, si su eficacia es similar al esquema esteroidal tradicional. Para responder esta interrogante utilizamos la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en múltiples fuentes de información. Identificamos seis revisiones sistemáticas que en conjunto incluyen diez ensayos controlados aleatorizados. Extrajimos los datos, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Concluimos que la dexametasona, en comparación con otros corticoides, probablemente tiene menos efectos adversos, y podría ser igual de efectiva en reducir hospitalizaciones y reconsulta.

  2. Micosis fungoide: reporte de un caso clínico

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    Gabriel Abudinén A

    2011-02-01

    Full Text Available La micosis fungoide es una neoplasia maligna originada en los linfocitos T que compromete la piel pudiendo extenderse a médula ósea, linfocitos sanguíneos, ganglios linfáticos y diversos órganos internos. Se presenta el caso de un paciente de 32 años de edad, sexo masculino, que desde hace aproximadamente 1 año presenta lesiones eritematodescamativas pruriginosas inicialmente localizadas en extremidades inferiores y que luego se generalizan, asociándose a baja de peso de aproximadamente 20 Kg. Ha usado corticoides y antihistamínicos, con regular respuesta. Se inicia su estudio por eritrodermia confirmándose por biopsia el diagnóstico de micosis fungoide. Se deriva para iniciar tratamiento específico con Fototerapia con Luz Ultravioleta A (PUVA. Palabras Clave: linfoma cutáneo de células T, micosis fungoide, neoplasias cutáneas

  3. Etiopathological mechanisms and clinical characteristics of hyperhemolysis syndrome in Spanish patients with thalassemia.

    Science.gov (United States)

    Vagace, Jose Manuel; Cardesa, Rocío; Corbacho, Antonio; Vázquez, Teresa; de la Maya, Maria Dolores; Gonzalez, Fernando Ataulfo; Nieto, José Bartolomé; Urrutia, Emilia; Gómez, María Jesus; Pascual, Teresa; Aguinaco, Maria Reyes; Gervasini, Guillermo

    2016-09-01

    Hyperhemolysis syndrome (HHS) is characterized by severe intravascular hemolysis with a decrease in the reticulocyte count, which is triggered and aggravated by transfusion and cannot be explained by standard immunohematological studies. A nationwide study was conducted in order to retrospectively identify thalassemia patients with HHS in Spain in order to assess pre-disposing mechanisms for this syndrome. For this, the expression of adhesion (CD49, CD36) and complement-related molecules (C3a, CD59) and the levels of reticulocyte apoptosis and macrophage activation were measured in 4 thalassemia patients with HHS, 14 patients without HHS, and 10 healthy subjects. Five of the six thalassemia patients had δβ-thalassemia. The patients were not alloimmunized prior to the syndrome, which was developed after the first transfusion in all but one case. Patients with δβ-thalassemia did not respond to corticoids or immunoglobulins; only splenectomy was successful. The expression of CD49 (α4β1 integrin) was far higher in patients who had experienced HHS (85.07 ± 18.46 vs. 46.28 ± 24.31; p thalassemia was the most common hemoglobinopathy in patients with HHS. Furthermore, the risk to develop this syndrome may be associated with an increased expression of α4β1 integrin.

  4. Ocular complication of malar fracture and its handling. Case report

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    León Miguel E.

    2004-09-01

    Full Text Available Antecedents: The superior orbital fissure syndrome (SOFS is a rare complication in patient with maxillofacial fractures, that consists of a direct compression or hematoma of the structures related to the SOFS. The characteristic clinics are: gross and persistent edema of the periorbital tissues; proptosis and subconjuntival echyimosis; ptosis and ophtalmoplegia; dilatation of the pupil; direct light, reflex absent, inderect reflex (consensual present; loss of the accommodation reflex; loss of corneal reflex; anesthesia of the eyelid and the front; radiological evidence of reduction in the dimensions of the SOF. Objetive: The objective of this report is to present a clinical case of a patient who underwent the syndrome of the superior orbitaria fissure, its the pos surgery handling and results. Materials: It is presented a clinical case of a 20-year-old age patient, who in his postoperatorio immediate of fracture reduction malar presented the characteristic clinics and radiological of the SOFS. An updated revision of the subject and the different options from treatment appears. Results: This case was handled quickly with megadosis of corticoides and the patient recovered totally his normal visual function. Conclusions: The conducted treatment was successful.

  5. Queratopatía cristalina en EL-DSEK

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    Taimí Cárdenas Díaz

    Full Text Available La queratopatía cristalina es una manifestación poco frecuente y característica, aunque no exclusiva, de queratitis infecciosa por Streptococcus mitis. Provoca un infiltrado intraestromal blanco, con aspecto de cristales de morfología arboriforme, con una mínima respuesta inflamatoria. Se ha relacionado con el uso prolongado de corticoides tópicos, tras queratoplastia penetrante, y presenta una mala respuesta al tratamiento con antibiótico. se presentan dos mujeres de más de 65 años, con antecedentes de endoqueratoplastia (EL-DSEK por queratopatía bullosa pseudofáquica realizada por cirujanos diferentes, quienes desarrollan un infiltrado intraestromal blanco, con aspecto de cristales de morfología arboriforme, con mínima respuesta inflamatoria. Ante la sospecha de una infección cristalina se instaura tratamiento antibiótico tópico frecuente sin franca mejoría, que requiere queratoplastia penetrante.

  6. Biodegradable polyurethane nanocomposites containing dexamethasone for ocular route

    Energy Technology Data Exchange (ETDEWEB)

    Rodrigues da Silva, Gisele [Federal University of Sao Joao Del Rei, School of Pharmacy, Divinopolis, Minas Gerais (Brazil); Silva-Cunha, Armando da [Federal University of Minas Gerais, School of Pharmacy, Belo Horizonte, Minas Gerais (Brazil); Behar-Cohen, Francine [INSERM, Physiopathology of ocular diseases: Therapeutic innovations, Institut des Cordeliers, Paris (France); Laboratoire d' Innovations Therapeutiques, Fondation Rothschild, Paris (France); Universite Rene Descartes, Hotel Dieu University Hospital, Paris (France); Ayres, Eliane [Federal University of Minas Gerais, Department of Metallurgical and Materials Engineering, Belo Horizonte, Minas Gerais (Brazil); Orefice, Rodrigo L., E-mail: rorefice@demet.ufmg.br [Federal University of Minas Gerais, Department of Metallurgical and Materials Engineering, Belo Horizonte, Minas Gerais (Brazil)

    2011-03-12

    The treatment of posterior segment ocular diseases, such as uveitis, by using eye drops and oral drugs is usually not effective due to the body's natural barriers to drug penetration. In this study, ocular implants to treat uveitis were synthesized by incorporating dexamethasone acetate, an important type of corticoid used in the treatment of some uveitis, into a biodegradable polyurethane containi clay nanoparticles. Biodegradable polyurethane nanocomposites having poly(caprolactone) oligomers as soft segments were obtained by delaminating clay particles within a polyurethane aqueous dispersion. The drug was incorporated into the polymer by dispersing it in the waterborne polyurethane followed by a drying step. Nanoparticles derived from clay were demonstrated to be able to tailor the mechanical properties of polyurethanes to achieve values that can match the properties of ocular soft tissues. Infrared spectra (FTIR) showed that the presence of clay particles was able to change the microphase separation process typical of polyurethanes. X-ray diffraction and small angle x-ray scattering (SAXS) results were explored to show that the incorporation of both dexamethasone acetate and nanocomponents derived from clay led to a less defined two-phase polyurethane. The presence of clay nanoparticles increased the rate of drug release measured in vitro. Human retinal pigment epithelial cells (ARPE-19) were cultured in contact with polyurethanes and polyurethane nanocomposites, and the viability of them (evaluated by using MTT assay after 7 days) showed that no toxic components were released from polyurethanes containing no drugs during the test.

  7. Development of Cryptosporidium parvum-Induced Gastrointestinal Neoplasia in Severe Combined Immunodeficiency (SCID) Mice: Severity of Lesions Is Correlated with Infection Intensity

    Science.gov (United States)

    Certad, Gabriela; Creusy, Colette; Ngouanesavanh, Tramy; Guyot, Karine; Gantois, Nausicaa; Mouray, Anthony; Chassat, Thierry; Flament, Nicolas; Fleurisse, Laurence; Pinon, Anthony; Delhaes, Laurence; Dei-Cas, Eduardo

    2010-01-01

    We reported previously that Cryptosporidium parvum was able to induce intestinal tumors in severe combined immunodeficiency (SCID) mice treated with corticoids. To further characterize this Cryptosporidium-induced cell transformation, SCID mice treated with dexamethasone were challenged with C. parvum oocysts, and euthanatized sequentially after infection for histologic examination. Ki-67 was used as a marker of cellular proliferation. Our previous results were confirmed, and it was also found that mice receiving higher inocula (106–107) experienced more severe neoplastic development. Additionally, neoplastic changes were observed not only in the caecum but also in the stomach and duodenum of some animals. Interestingly, SCID mice (6/6) inoculated with 105–107 oocysts showed high grade intraepithelial neoplasia or adenomas with high grade dysplasia in the caecum after Day 46 post-infection (PI). Immunohistochemistry for Ki-67 staining indicated the neoplastic process associated to cryptosporidiosis, and evidenced the first immunohistochemical alterations at early stages of the process, even at 3 weeks PI. PMID:20134002

  8. Eritema multiforme mayor desencadenado por antimicrobianos

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    Ronaldo de Carvalho Raimundo

    2010-03-01

    Full Text Available El eritema multiforme, aparece como una enfermedad sistémica con la participación de la piel y las membranas mucosas en relación con varios factores como las infecciones bacterianas o virales, y en particular la administración de drogas, analgésicos y antibióticos en general. Se presenta un paciente masculino de 29 años de edad con eritema multiforme mayor desencadenado por antimicrobianos con la aparición de lesiones vesiculares-bulloso-ulcerosas en las regiones de los labios, encías, la lengua y la mucosa genital en tratamiento de una infección del tracto urinario con norfloxacino 400 mg por una semana. Fue realizado un tratamiento de soporte con el uso de colutorios para la higienización bucal y pomada a base de corticoide para protección de las úlceras, antihistamínicos y orientación nutricional de dieta líquida hipercalórica e hiperproteica. Este síndrome está caracterizado como un proceso eruptivo buloso agudo que compromete la calidad de vida del paciente y no hay pruebas de laboratorio específicas por lo que su diagnóstico debe estar basado en la revisión minuciosa de la anamnesis y en los hallazgos clínicos.

  9. Variations in the size of focal nodular hyperplasia on magnetic resonance imaging.

    Science.gov (United States)

    Ramírez-Fuentes, C; Martí-Bonmatí, L; Torregrosa, A; Del Val, A; Martínez, C

    2013-01-01

    To evaluate the changes in the size of focal nodular hyperplasia (FNH) during long-term magnetic resonance imaging (MRI) follow-up. We reviewed 44 FNHs in 30 patients studied with MRI with at least two MRI studies at least 12 months apart. We measured the largest diameter of the lesion (inmm) in contrast-enhanced axial images and calculated the percentage of variation as the difference between the maximum diameter in the follow-up and the maximum diameter in the initial study. We defined significant variation in size as variation greater than 20%. We also analyzed predisposing hormonal factors. The mean interval between the two imaging studies was 35±2 months (range: 12-94). Most lesions (80%) remained stable during follow-up. Only 9 of the 44 lesions (20%) showed a significant variation in diameter: 7 (16%) decreased in size and 2 (4%) increased, with variations that reached the double of the initial size. The change in size was not related to pregnancy, menopause, or the use of birth control pills or corticoids. Changes in the size of FNHs during follow-up are relatively common and should not lead to a change in the diagnosis. These variations in size seem to be independent of hormonal factors that are considered to predispose. Copyright © 2011 SERAM. Published by Elsevier Espana. All rights reserved.

  10. Unmasked renal impairment and prolonged hyperkalemia after unilateral adrenalectomy for primary aldosteronism coexisting with primary hyperparathyroidism: report of a case.

    Science.gov (United States)

    Hibi, Yatsuka; Hayakawa, Nobuki; Hasegawa, Midori; Ogawa, Kimio; Shimizu, Yoshimi; Shibata, Masahiro; Kagawa, Chikara; Mizuno, Yutaka; Yuzawa, Yukio; Itoh, Mitsuyasu; Iwase, Katsumi

    2015-02-01

    We herein report the case of a patient with critical hyperkalemia after unilateral adrenalectomy (ADX) for aldosterone-producing adenomas, which were coexisting with primary hyperparathyroidism. A right adrenal tumor oversecreting mineral corticoid was identified in a 62-year-old female whose kidney function had been impaired due to primary hyperaldosteronism and hyperparathyroidism. The ADX improved her hypertension with normalization of the plasma aldosterone concentration, but without adequately increasing her plasma renin activity. Her eGFR further decreased postoperatively, hyperkalemia appeared and the serum potassium level rose to 6.3 mEq/L at 3 months after ADX. Then, treatment with calcium polystyrene sulfonate jelly was started. Eight months after ADX, a left lower parathyroidectomy was performed, and the serum calcium and intact parathyroid hormone levels decreased to the normal range. The hyperkalemia was difficult to control within 20 months postoperatively without treatment with calcium polystyrene sulfonate jelly or hydrocortisone. This suggests that unmasking the renal impairment and relative hypoaldosteronism after ADX might induce critical hyperkalemia.

  11. Asma de difícil control en niños y adolescentes: Estrategias diagnóstico-terapéuticas

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    Hugo Neffen

    2012-10-01

    Full Text Available El asma es una de las enfermedades crónicas más frecuentes en los niños. Si bien la mayoría de los niños con asma responden a bajas dosis de corticoides inhalados y/o antagonistas del receptor de leucotrienos, algunos de ellos permanecen sintomáticos independientemente de cualquier esfuerzo terapéutico, presentando una elevada morbilidad e inclusive mortalidad. Aunque la mayoría de los pacientes controlan los síntomas de forma adecuada, existe un grupo importante que presenta síntomas graves de la enfermedad difíciles de controlar (ADC. El objetivo de la presente revisión es discutir los aspectos clínicos, diagnósticos y terapéuticos del ACD en los menores de 18 años y su implicancia en la práctica clínica diaria.

  12. ASMA DEL LACTANTE: ACTUALIZACIÓN

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    Prof. Dr. Javier Mallol

    2017-01-01

    Full Text Available El asma del lactante en los dos primeros años de vida, es la forma de presentación más frecuente, además de episodios recurrentes de sibilancias y tos, es una condición de alta prevalencia; sin embargo, es frecuentemente sub-diagnosticada y sub-tratada. Una elevada proporción de estos lactantes sufren episodios severos, visitas a servicios de urgencia y hospitalizaciones, lo cual altera profundamente su calidad de vida y la de sus padres. El diagnóstico de asma en el lactante es clínico y se basa en la presencia de tos y sibilancias recurrentes, presencia de factores de riesgo para asma, y la respuesta al tratamiento. Los corticoides inhalados son el tratamiento de primera línea y tanto su efecto como la adherencia, deben ser monitoreados. Actualmente, no hay razones científicas ni clínicas para posponer el diagnóstico y tratamiento en lactantes con síntomas de asma, especialmente si la frecuencia y severidad de los episodios alteran la calidad de vida del niño y de su familia.

  13. [Pulmonary nocardiosis. A case report (author's transl)].

    Science.gov (United States)

    García Rodríguez, J A; Martín Luengo, F; Villar Galán, J L

    1979-06-25

    Within the genus Nocardia three species are at present considered to have human pathologic interest: N. asteroides, N. brasiliensis, and N. caviae. These species are usually the etiologic agents of at least two clinical pictures: nocardiosis and actinomycetoma. A case of pulmonar nocardiosis in a 62-year-old male is reported. The patient had asthmatic episodes and on several occasions received treatment with corticoids. The clinical picture basically consisted of an impairment of the general condition with respiratory symptomatology and fever of 38 to 39 degrees C. An opaque pleuropulmonary image was observed on the chest X-ray film, and the diagnosis of tuberculosis was initially established. The correct diagnosis was confirmed through the bacteriological examination of the transtracheal aspirate with the isolation of N. asteroides. Treatment with streptomycin, sulfamethoxazole and trimethoprim achieved the clinical and roentgenologic cure of the patient. After 2 months of treatment the clinical manifestations had disappeared and after 5 months the chest X-ray was normal. Some epidemiologic data are reviewed.

  14. Importance of local skin treatments during radiotherapy for prevention and treatment of radio-induced epithelitis; Interet des applications cutanees en cours de radiotherapie pour la prevention et le traitement des epitheliites radio-induites

    Energy Technology Data Exchange (ETDEWEB)

    Chargari, C.; Fromantin, I.; Kirova, Y.M. [Institut Curie, Dept. de Radiotherapie Oncologique, 75 - Paris (France); Chargari, C. [Hopital d' Instruction des Armees du Val-de-Grace, Service d' Oncologie Radiotherapie, 75 - Paris (France)

    2009-07-15

    Radio-epithelitis represents a common problem, for which treatments are characterized by a great heterogeneity. The present review of literature focuses on data referenced in Pub med/Medline and published in French/English. Despite a real preclinical rationale, aloe vera and trolamine failed to demonstrate any benefit in the prophylactic settings. In a prospective assessment phase III assessment, Calendula officinalis was shown to be superior to trolamine for the prevention of radio-epithelitis. In the curative settings, sucrafalte failed to demonstrate any benefit. The benefit of dermo-corticoids was suggested in terms of erythema and itching. Promising clinical results are available with hyaluronic acid (M.A. S065D and Ialugen) and silver leaf may reduce the intensity of cutaneous radio-induced side effects. Data from the literature are conflicting, making real the difficulty to adopt from clinical trials any proof-of-principle strategy. Considering these uncertainties, several strategies are allowed. New topics are under investigation. Present data from the literature highlight the need for further trials, in order to propose evidence-based treatments and to harmonize clinical practice. (authors)

  15. Severe acute respiratory syndrome, a pathological immune response to the new coronavirus--implications for understanding of pathogenesis, therapy, design of vaccines, and epidemiology.

    Science.gov (United States)

    Bermejo, Jesus F; Muñoz-Fernandez, M Angeles

    2004-01-01

    Findings coming from autopsies and serum of SARS patients suggest an important immune-inflammatory implication in the evolution to respiratory distress. Conditions such as HIV infection or treatment with immunosuppressors (in cancer or autoimmune diseases) are not among the bad prognosis factors for development of distress. To date, there have been no reported case fatalities in children, probably due to their more immature immune system. Our conclusions follow: (1) The milder form of SARS in children and the apparent protective factor that immunosupression represent rules out a significant viral cytopathic effect (they would be the most affected). (2) The evidence for immune implication in distress strongly supports immunomodulators for therapy: phosphodiesterase inhibitors (due to their down-modulating activity on proinflammatory cytokines); inhaled corticoids (aimed at producing a local immunomodulation); teophylline or nedocromil sodium (which prevents inflammatory cell recruitment into the airway wall). (3) An early immunomodulatory therapy, based on the levels of proinflammatory cytokines and clinical parameters to evaluate the respiratory function such as arterial oxygen saturation, could prevent the occurrence of distress. (4) Vaccine design should consider the immune origin of distress. (5) Physicians should be aware of mildly symptomatic patients (children, immuno-compromised hosts) to avoid transmission to immunocompetent adults.

  16. Is rituximab effective for induction of remission in lupus nephritis?

    Directory of Open Access Journals (Sweden)

    Macarena Mac-Namara

    2014-08-01

    Full Text Available La combinación de ciclofosfamida y corticoides constituye el tratamiento estándar en pacientes con nefritis lúpica con indicación de terapia inmunosupresora mayor. Sin embargo, se asocia a importantes efectos adversos, por lo que existe interés en otros inmunosupresores como rituximab. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 19 bases de datos, identificamos 5 revisiones sistemáticas que en conjunto incluyen 24 estudios. Realizamos una síntesis mediante tablas de resumen de los resultados utilizando el método GRADE y concluimos que existe incertidumbre sobre la eficacia de rituximab en nefritis lúpica porque la certeza de la evidencia es muy baja, se asocia a efectos adversos importantes, y tiene alto costo. Rituximab no debiera utilizarse fuera de un estudio clínico, o sólo en casos en que otras alternativas han fracasado si es que no existen limitaciones de recursos.

  17. Endoftalmitis endógena por Nocardia asteroides en un paciente con lupus eritematoso sistémico Endogenous Nocardia asteroides endophthalmitis in a patient with systemic lupus erythematosus

    Directory of Open Access Journals (Sweden)

    David E. Pelayes

    2004-04-01

    Full Text Available Se describe un caso de endoftalmitis endógena por nocardia en un varón de 32 años con diagnóstico de lupus eritematoso sistémico. El paciente desarrolló compromiso pulmonar y ocular luego de meses de tratamiento con corticoides y ciclofosfamida. La infección intraocular, de rápida evolución a fístula escleral, recibió tratamiento con vitrectomía, lensectomía y terapia antibacteriana intravítrea y endovenosa. Se aislaron colonias de Nocardia asteroides a partir de material vítreo y aspirado bronquioloalveolar. El ojo afectado evolucionó a ptisis bulbi y fue posteriormente eviscerado, y se realizó el estudio histopatológico.We report a case of endogenous nocardial endophthalmitis in a 32-year-old man with systemic lupus erythematosus. The patient developed pulmonary and ocular disease while on systemic corticosteroid and cyclophosphamide treatment. The intraocular infection progressed to a scleral fistula, and was treatead with pars plana vitrectomy, lensectomy, intravitreous and intravenous antibacterial therapy. The diagnosis of Nocardia asteroides was made by isolation and growth of colonies from samples of a vitreous specimen and bronchioloalveolar aspirates. The eye became phthisical, it was eviscerated, and histopathogical examination was carried out.

  18. [Nosocomial infection due to Trichosporon asahii: clinical revision of 22 cases].

    Science.gov (United States)

    Rodrigues, Gustavo da Silva; de Faria, Rodrigo Rosa Ubatuba; Guazzelli, Lucina Silva; Oliveira, Flávio de Mattos; Severo, Luiz Carlos

    2006-06-01

    Twenty two cases of nosocomial infection caused by Trichosporon asahii, detected during a period of six years (1999-2005) is described. The patients were predominantly males with an average age of 47.3 years-old. The predominant diseases in the study group were respiratory insufficiency, cancer, diabetes, chronic renal insufficiency, cirrhosis and AIDS. The main predisposing conditions were antibiotic therapy, mechanical ventilation, urethral catheterization, catheter, corticoids, transplant, immunosuppressive therapy, chemotherapy, granulocytopenia, surgical procedures and continuous ambulatory peritoneal dialysis. The most used antifungal drugs were fluconazole and amphotericin B. In some cases several antifungals were administered. Five patients did not receive antifungal treatment, and one patient received granulocyte colony stimulating factor (G-CSF). Nine patients showed clinical improvement, nine died and the progress of four patients is unknown. T. asahii is an emergent pathogen in patients with immunodeficiency and its presence in these type hosts can not be considered colonization, as there is an important risk of invasive infection. So, in susceptible patients to develop trichosporonosis it is advisable to take into consideration this disease especially in intensive clinical care units.

  19. Grape polyphenols and propolis mixture inhibits inflammatory mediator release from human leukocytes and reduces clinical scores in experimental arthritis.

    Science.gov (United States)

    Mossalayi, M D; Rambert, J; Renouf, E; Micouleau, M; Mérillon, J M

    2014-02-15

    Polyphenols from red fruits and bee-derived propolis (PR) are bioactive natural products in various in vitro and in vivo models. The present study shows that hematotoxicity-free doses of grape polyphenols (GPE) and PR differentially decreased the secretion of pro-inflammatory cytokines from activated human peripheral blood leucocytes. While GPE inhibited the monocytes/macrophage response, propolis decreased both monokines and interferon γ (IFNγ) production. When used together, their distinct effects lead to the attenuation of all inflammatory mediators, as supported by a significant modulation of the transcriptomic profile of pro-inflammatory genes in human leukocytes. To enforce in vitro data, GPE+PR were tested for their ability to improve clinical scores and cachexia in chronic rat adjuvant-induced arthritis (AA). Extracts significantly reduced arthritis scores and cachexia, and this effect was more significant in animals receiving continuous low doses compared to those receiving five different high doses. Animals treated daily had significantly better clinical scores than corticoid-treated rats. Together, these findings indicate that the GPE+PR combination induces potent anti-inflammatory activity due to their complementary immune cell modulation. Copyright © 2013 Elsevier GmbH. All rights reserved.

  20. Demodicidosis en pacientes con rosácea

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    Edhizon Trejo Mucha

    2007-01-01

    Full Text Available Objetivo: Determinar la frecuencia de demodicidosis y sus características clínicas en pacientes con rosácea. Materiales y métodos: Estudio de casos y controles en 42 pacientes con rosácea y 42 controles para describir la presencia y densidad de D. folliculorum. El estudio se realizó en el Hospital Nacional Cayetano Heredia entre marzo y setiembre del 2004, utilizándose la técnica de Tello. Resultados: Demodex folliculorum fue encontrado en los 42 pacientes con rosácea (100% y en 13 (31,0% del grupo control, (p= 0,000. La exposición a gatos, la crianza de roedores y cerdos, la seborrea y el uso de corticoides tópicos fueron mas frecuentes en los pacientes con rosácea. Conclusiones: La presencia de Demodex folliculorum fue más frecuente en los pacientes con rosácea. (Rev Med Hered 2007;18:15-21.

  1. Thirty-eight-year follow-up of two sibling Lipoid Congenital Adrenal Hyperplasia patients due to homozygous Steroidogenic Acute Regulatory (STARD1 protein Mutation. Molecular structure and modeling of the STARD1 L275P mutation.

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    Jean-Guy Lehoux

    2016-11-01

    Full Text Available Objective: Review the impact of StAR (STARD1 mutations on steroidogenesis and fertility in LCAH patients. Examine the endocrine mechanisms underlying the pathology of the disorder and the appropriate therapy for promoting fertility and pregnancies.Design: Published data in the literature and a detailed 38-year follow-up of two sibling LCAH patients. Molecular structure and modeling of the STARD1 L275P mutation.Setting : University hospital.Patients: Patient A (46,XY female phenotype and patient B (46,XX female with LCAH bearing the L275P mutation in STARD1.Interventions : Since early-age diagnosis, both patients underwent corticoid replacement therapy. Patient A received estrogen therapy at pubertal age. Clomiphene therapy was given to Patient B to induce ovulation. Pregnancies were protected with progesterone administration.Main Outcome Measures : Clinical and molecular assessment of adrenal and gonadal functions.Results: Both patients have classic manifestations of corticosteroid deficiency observed in LCAH. Time of onset and severity were different. Patient A developed into a female phenotype due to early and severe damage of Leydig cells. Patient B started a progressive pubertal development, menarche and regular non-ovulatory cycle. She was able to have successful pregnancies.Conclusions: Understanding the molecular structure and function of STARD1 in all steroidogenic tissues is the key for comprehending the heterogeneous clinical manifestations of LCAH, and the development of an appropriate strategy for the induction of ovulation and protecting pregnancies in this disease.

  2. Biopsia de la arteria temporal: revisión de indicaciones y técnica quirúrgica para cirujanos plásticos Temporal artery biopsy: review of indications and surgical technique for plastic surgeons

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    A. Rodríguez Lorenzo

    2007-06-01

    Full Text Available La arteritis de células gigantes (ACG es una vasculitis que presenta complicaciones graves si no es diagnosticada y tratada precozmente con corticoides a altas dosis. La biopsia de la arteria temporal (BAT es la técnica diagnóstica estandarizada utilizada para confirmar la enfermedad. Se trata de una técnica sencilla y con poca morbilidad. No obstante, en la actualidad existe una controversia sobre su indicación en pacientes con sospecha clínica de arteritis sin síntomas craneales debido a la baja tasa de positividad de la biopsia. Presentamos en este trabajo una serie de 28 pacientes en los que se realizaron 30 BAT con el objetivo de revisar las indicaciones y describir la técnica quirúrgica utilizada.Giant cell arteritis is a vasculitis that presents serious complications if it is not diagnosed and treated prematurely with corticosteroids to high dose. The temporal artery biopsy is the gold estandar technique of diagnosis used to confirm the disease. It is a simple technique with little morbidity. Nevertheless, currently there is a controversy on its indication in patients with clinical suspicion of arteritis without craneal symptoms because of the downward rate of positiveness of the biopsy. We present in this work a serie of 28 patients in which 30 biopsies were carried out with the objective to review the indications and to describe the surgical technique utilized.

  3. The antiglucocorticoid action of mifepristone.

    Science.gov (United States)

    Agarwai, M K

    1996-01-01

    Glucocorticoid hormones influence the physiological activity of almost all cell types in the mammal. This is accomplished via a soluble receptor that, in the presence of an appropriate steroid, modifies the activity of RNA polymerase by binding to the site where different factors assemble for the initiation of cell transcription. The development of antiglucocorticoids has permitted the molecular elucidation of a number of underlying events. Contrary to the classical view, it is now clear that the affinity, stability and activability of the glucocorticoid receptor in the presence of a steroid are cell- and/or tissue-dependent events. The antiglucocorticoid RU 38486 can even activate transcription by binding to sites distinct from those that process transactivation by the agonist. Furthermore, glucocorticoids can sometimes activate the mineralocorticoid receptor, whereas mineralocorticoids can bind the glucocorticoid receptor. Since mifepristone is devoid of adverse toxicity, it has been used for the paraclinical diagnosis of the hypothalamus-pituitary-adrenal axis in normal volunteers, subjects with disorders of the behaviour, and the treatment of Cushing's disease. However, the whole spectrum of cell-specific processes that are antagonized by RU 38486 suggests wide ranging possibilities in the eventual application of antigluco-corticoids.

  4. Recomendaciones para la prevención, diagnóstico y tratamiento de LA EPOC en la Argentina Guidelines for COPD prevention, diagnosis and treatment in Argentina

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    Juan Carlos Figueroa Casas

    2012-08-01

    Full Text Available La enfermedad pulmonar obstructiva crónica (EPOC está aumentando marcadamente su morbimortalidad, costos e indicadores epidemiológicos. Por ello la Asociación Argentina de Medicina Respiratoria (AAMR convocó a un grupo de especialistas para actualizar conocimientos básicos y efectuar recomendaciones para su diagnóstico, prevención y tratamiento. Se revisan definición, avances en fisiopatología, presentación clínica, diagnóstico por imágenes y evaluación funcional. Se enfatiza su diagnóstico temprano mediante exploración funcional -esencialmente espirometría- y la prevención a través de la cesación del tabaquismo. Se describen estrategias para dejar de fumar, tratamiento farmacológico y no farmacológico. La administración de broncodilatadores, preferentemente de acción prolongada, es la primera opción de tratamiento farmacológico. Los corticoides inhalados se indican en combinación con los broncodilatadores en pacientes con obstrucción al flujo aéreo persistente asociada con exacerbaciones frecuentes, si bien se requieren estudios que confirmen su relación costo/beneficio. La vacuna antigripal es recomendada en todos los pacientes. Con respecto a las intervenciones no farmacológicas, la cirugía del enfisema solo se recomienda en circunstancias especiales. La rehabilitación respiratoria es una herramienta útil en pacientes con limitación en la actividad física habitual. La oxígenoterapia crónica domiciliaria mejora la supervivencia en pacientes con hipoxemia crónica grave. La ventilación no invasiva domiciliaria fuera de las exacerbaciones, tiene indicaciones en pacientes seleccionados. Las exacerbaciones agudas deben tratarse con broncodilatadores, oxígeno, corticoides, antibióticos y, bajo ciertas circunstancias, asistencia respiratoria mecánica tanto no invasiva como invasiva. El papel de la educación pública, del paciente y su familia, es considerada esencial en la prevención y tratamiento

  5. Avaliação do grau de controle clínico, espirométrico e da intensidade do processo inflamatório na asma Assessing clinical and spirometric control and the intensity of the inflammatory process in asthma

    Directory of Open Access Journals (Sweden)

    Cláudia R. de Andrade

    2010-04-01

    Full Text Available OBJETIVOS: Revisar o papel da avaliação clínica, da qualidade de vida, da espirometria, do teste de broncoprovocação e dos marcadores inflamatórios na avaliação da asma. FONTES DOS DADOS: Pesquisa nas bases MEDLINE e LILACS. SÍNTESE DOS DADOS: A avaliação clínica auxilia na avaliação do controle da asma e é amplamente preconizada. No entanto, os pacientes podem apresentar obstrução e inflamação das vias aéreas a despeito da normalidade clínica. A espirometria quantifica o grau de obstrução das vias aéreas e auxilia no diagnóstico, enquanto a broncoprovocação pode ser indicada na suspeita de asma com espirometria normal. Já os marcadores inflamatórios do condensado do ar exalado, do escarro induzido e do lavado broncoalveolar, além dos fragmentos da biópsia brônquica, encontram-se alterados na asma e são métodos complexos, quase sempre restritos às pesquisas. A fração exalada de óxido nítrico (FeNO é elevada nos pacientes com asma, reprodutível e não invasiva, reduzindo-se com o tratamento. O uso da FeNO como auxiliar no ajuste de doses do corticoide inalatório tem sido estudado, mas as vantagens ainda não estão claras. CONCLUSÕES: Vários métodos são necessários para avaliar de forma acurada o controle da asma, e todos têm vantagens e limitações. A avaliação clínico-funcional é útil para o diagnóstico de asma, porém limitada para avaliar de forma precisa a intensidade do processo inflamatório nas vias aéreas. É necessário que mais estudos controlados, randomizados, com adequado poder estatístico sobre a utilidade dos marcadores inflamatórios não invasivos, especialmente a FeNO, no manejo da asma, sejam realizados para determinar sua utilidade clínica.OBJECTIVES: To review the role of clinical assessment, quality of life assessment, spirometry, bronchial responsiveness test and inflammatory markers for asthma assessment. SOURCES: Search run on MEDLINE and LILACS. SUMMARY OF THE

  6. Metilprednisolona intratimpânica como terapia de resgate na surdez neurossensorial súbita Intratympanic methylprednisolone as rescue therapy in sudden sensorineural hearing loss

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    Igor Teixeira Raymundo

    2010-08-01

    Full Text Available O tratamento da surdez súbita é uma das questões mais controversas da Otologia. No entanto, os corticoides sistêmicos têm sido a opção mais escolhida por referidos autores como padrão ouro de tratamento. O uso de corticoide intratimpânico como terapia de segunda linha para tratamento de casos refratários de surdez súbita tem sido relatado e os resultados promissores têm feito alguns autores promoverem o seu uso como terapia de primeira linha, indicando-a para todos os casos de surdez súbita. OBJETIVOS: Descrever essa nova modalidade de tratamento e avaliar a sua segurança e eficácia em quatorze pacientes tratados após falha da corticoterapia oral. MATERIAIS E MÉTODOS: Trata-se de estudo analítico prospectivo em que quatorze pacientes portadores de surdez súbita neurossensorial foram tratados com metilprednisolona intratimpânica após falha da corticoterapia oral. Limiares tonais e o índice de reconhecimento de fala pré-tratamento e pós-tratamento foram analisados. RESULTADOS: Dez dos quatorze pacientes tratados com metilprednisolona intratimpânica apresentaram recuperação da audição superior a 20 dB nos limiares tonais ou 20% no IRF. CONCLUSÃO: Três injeções intratimpânicas de metilprednisolona aumentaram os limiares tonais e índices de reconhecimento da fala em um grupo de pacientes portadores de surdez súbita neurossensorial que não obtiveram benefício após corticoterapia oral.Treatment in sudden sensorineural hearing loss is a contentious issue, today, oral steroids are the most common choice and considered the best treatment option, but the use of intratympanic steroids has become an attractive alternative, especially in cases when systemic therapy fails, or to avoid the side effects of the systemic use of steroids. AIM: To describe the results of intratympanic methylprednisolone in idiopathic sudden sensorineural hearing loss after failure of oral prednisolone. METHODS: In a prospective study fourteen

  7. Alopecia areata ofiásia na infância: do diagnóstico ao tratamento

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    José Otávio Alquezar Gozzano

    2016-10-01

    Full Text Available Introdução: Entre as alopecias mais comuns na infância está a alopecia areata (AA, uma afecção crônica dos folículos pilosos, de etiologia auto-imune e genética. Apresenta-se pela queda de pelos, devido a interrupção de sua síntese, sem a atrofia dos folículos, por isso é reversível. AA afeta ambos os sexos e inicia- se em qualquer idade; porém, 60% dos primeiros episódios ocorrem entre 5 e 20 anos. AA manifesta-se por placas de alopecia assintomáticas, arredondadas, sem inflamação, podendo afetar qualquer área com folículos pilosos, frequentemente o couro cabeludo. Sinal de tração positivo, pelos cadavéricos e penugem branca no exame físico da fase aguda auxiliam o diagnóstico. AA é classificada como atípica e clássica, esta última pode ser: placa única, placas múltiplas, AA total, ou AA ofiásica (AAO. AAO consiste na perda de cabelos na linha de implantação temporooccipital, atingindo as bordas inferiores do couro cabeludo; seu diagnóstico é clinico devendo ser diferenciado de Tinha do couro cabeludo, pseudopelada de Brocq e tricotilomania. O tratamento para AAO é sintomático e não altera o prognóstico, sendo utilizados principalmente corticoides tópicos, infiltrações intralesionais, antralina e minoxidil. Objetivo: Relatar caso de AAO na infância. Relato do caso: Feminina, 13 anos, com perda de cabelos há 4 anos e piora há 6 meses. Ao exame: área extensa de alopecia em região temporoocciptal até margem inferior de implantação do couro cabeludo. Sinal de tração positivo na periferia da área de alopecia. Hipótese diagnóstica: AAO. Terapia: infiltração de corticoide. Metodologia: Paciente atendida em ambulatório e revisão de literatura. Conclusão: Por acometer sobretudo os cabelos, AA afeta a autoestima e os aspectos psicológicos, principalmente das crianças, que crescem em meio propício a julgamentos e rejeição social. Assim, é importante a intervenção terapêutica precoce

  8. Avaliação do crescimento, do controle laboratorial e da corticoterapia em um grupo de pacientes com a forma clássica da deficiência da 21-hidroxilase Evaluation of growth, laboratorial control and corticotherapy in a sample of patients with the classical form of 21-hydroxylase deficiency

    Directory of Open Access Journals (Sweden)

    Clarissa Cerchi A. Ramos

    2007-12-01

    Full Text Available OBJETIVO: Avaliar o padrão de crescimento de pacientes com hiperplasia adrenal congênita com a forma clássica da deficiência da 21-hidroxilase (21-OH, em relação ao controle hormonal e ao uso de corticóide no tratamento. MÉTODOS: Análise retrospectiva dos prontuários de 45 pacientes. Como padrão de crescimento, foi utilizado o ganho ou não de altura, avaliando-se a diferença entre o escore Z da estatura na última consulta (para idade óssea em relação ao escore Z da estatura no início do tratamento (para a idade cronológica. Foram avaliadas todas as concentrações de 17-OH progesterona (17-OHP, androstenediona e renina, sendo considerados bem controlados os pacientes com 50% ou mais das dosagens normais. Em relação ao corticóide, foram analisados o tipo e a dose. RESULTADOS: A idade na última consulta variou de 2,8 a 26,6 anos (12,6+5,8 anos, sendo 31 do sexo feminino, 30 com a forma perdedora de sal; 62% foram considerados bem controlados para 17-OHP, 75% para androstenediona e 78% para renina. A hidrocortisona foi usada por 41 pacientes (20,2+2,6 mg/m²/dia e, por 40, em associação com a 9a-fludrocortisona. Encontrou-se 14 pacientes com ganho, 20 com manutenção e 11 com perda estatural. Os pacientes perdedores de sal (p=0,01 e os bem controlados (p=0,0005 para 17-OHP e androstenediona apresentaram associação significativa com o ganho de estatura. CONCLUSÕES: Nesta amostra de pacientes com a forma clássica da deficiência da 21-OHD, o melhor crescimento apresentou associação com o bom controle laboratorial da 17-OHP e da androstenediona e com a forma perdedora de sal.OBJECTIVE: To verify the growth pattern of patients with congenital adrenal hyperplasia (CAH due to classical 21hydroxylase (21-OH deficiency in relation to hormonal control and use of corticoid during the treatment. METHODS: Retrospective analysis of data from 45 patients. The growth pattern was analyzed according to height gain or not, using the

  9. Fibrodisplasia ossificante progressiva: diagnóstico em atenção primária Fibrodisplasia osificante progresiva: diagnostico desde la atención primaria Fibrodysplasia ossificans progressiva: diagnosis in primary care

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    Jesus Garcia-Pinzas

    2013-03-01

    Full Text Available OBJETIVO: Buscou-se demonstrar ser possível diagnosticar a fibrodisplasia ossificante progressiva na atenção primária à saúde. DESCRIÇÃO DO CASO: Paciente de dez anos que, desde os quatro anos, mostrava rigidez progressiva nas articulações e na coluna vertebral, além de ossificações de partes moles, muitas vezes associadas a traumatismos. Havia desvio de hálux valgo dos primeiros artelhos de ambos os pés, presente desde o nascimento. Por meio de radiografias, demonstrou-se a presença de ossificações heterotópicas. COMENTÁRIOS: É possível realizar o diagnóstico desta doença com recursos disponíveis em atenção primária à saúde, uma vez que se baseia fundamentalmente em critérios clínicos. Atualmente, não existe cura para a doença, mas é possível limitar o desenvolvimento de novas calcificações, assim como mitigar a dor causada pelos recrudescimentos da doença, melhorando a qualidade de vida dos pacientes. Para isso, são utilizadas altas doses de corticoides e anti-inflamatórios não esteroides, disponíveis nos níveis primários de atenção.OBJETIVO: Se buscó demostrar que es posible diagnosticar la Fibrodisplasia Osificante Progresiva (FOP desde la atención primaria de Salud. DESCRIPCIÓN DEL CASO: Se describe el caso de una paciente de 10 años que desde los 4 años, desarrolla rigidez progresiva en las articulaciones y en la columna vertebral, además de osificaciones de partes blandas, muchas veces asociada con traumatismos; un rasgo importante fue la desviación en Hallux Valgus de los primeros dedos de ambos pies, presente desde su nacimiento; por medio de radiografías se demostró la presencia de osificaciones heterotópicas. COMENTARIOS: el diagnóstico de esta enfermedad es factible de realizarse con recursos disponibles en la Atención Primaria de Salud ya que se basa fundamentalmente en criterios clínicos. Actualmente no existe cura para esta enfermedad, pero es posible limitar el

  10. [Clinical and Epidemiological Study of Complicated Infection by Varicella-Zoster Virus in the Pediatric Age].

    Science.gov (United States)

    Maia, Catarina; Fonseca, Jacinta; Carvalho, Isabel; Santos, Helena; Moreira, Diana

    2015-01-01

    Introdução: Em Portugal, a incidência da infeção complicada por vírus varicela-zoster e respetivos custos é desconhecida. O objetivo deste estudo foi descrever as características clinico-epidemiológicas dos doentes em idade pediátrica internados com o diagnóstico de infeção complicada por vírus varicela-zoster. Material e Métodos: Estudo descritivo, baseado na análise dos processos clínicos dos doentes internados entre janeiro de 1999 e julho de 2013, com diagnóstico de infeção complicada por vírus varicela-zoster. Resultados: Foram internados 94 doentes por infeção complicada a vírus varicela-zoster, dois por reativação de infeção latente. A mediana da idade foi 38 (IQR 18 - 65) meses. As complicações mais frequentes foram as infeciosas (70,2%), destacando-se a sobreinfeção bacteriana da pele/tecido celular subcut'neo (37,2%) e as complicações respiratórias (24,5%). Seguiram-se as complicações neurológicas (19,1%), gastrointestinais (9,6%), hematológicas (5,3%) e osteoarticulares (4,3%). Diagnosticaram-se 38 (40,4%) infeções bacterianas invasivas, seis com bacteriemia. A mediana da idade na admissão foi mais elevada nas complicações imunológicas relativamente às complicações infeciosas. As complicações neurológicas ocorreram preferencialmente em crianças saudáveis, enquanto as complicações infeciosas, nomeadamente as infeções bacterianas invasivas foram mais frequentes nos doentes medicados com ibuprofeno e/ou corticoide. A evolução foi favorável na maioria dos casos. Discussão: As complicações da infeção pelo vírus varicela-zoster ocorreram preferencialmente em idade pré-escolar e doentes saudáveis. As complicações infeciosas, nomeadamente as dermatológicas e respiratórias, foram as mais frequentes, tendo sido verificada associação com a terapêutica prévia com ibuprofeno e /ou corticoide.Conclusão: Estudos multicêntricos deverão ser planeados com o intuito de otimizar e ajustar as

  11. 血浆置换联合药物治疗儿童重症系统性红斑狼疮的临床疗效%Clinical Efficacy of Plasma Exchange Combined with Drugs for the Treatment of Severe Systemic Lupus Erythematosus in Children

    Institute of Scientific and Technical Information of China (English)

    简讯; 罗晓英; 马懿; 胡诗德; 肖胜; 杨乔岚

    2013-01-01

    [目的]观察血浆置换联合激素、霉酚酸酯(MMF)治疗儿童重症系统性红斑狼疮(SLE)的临床疗效。[方法]回顾性分析入住本院的18例重症S L E患儿的临床资料,观察治疗前后患儿症状、体征(发热、关节疼痛、皮疹、水肿)缓解情况及抗SM抗体、抗ds-DNA抗体、抗RNP抗体、血沉(ESR)、24h尿蛋白、肌酐(SCr)及补体C3的变化。[结果]18例患儿经治疗后症状全部得到好转,其中12例面部红斑消失,2例患儿皮肤表面溃疡愈合,13例患儿雷诺现象消失,发热及关节疼痛明显缓解。ESR由治疗前的(92±24)mm/h降到(27±15)mm/h ,24 h尿蛋白由治疗前的(8.12±4.76)g降到(1.83±1.55)g ,抗SM抗体、抗ds-DNA抗体转阴率明显下降。[结论]血浆置换联合激素、MMF可降低血清自身抗体,有效控制儿童重症SLE ,值得临床推广应用。%[Objective] To observe the clinical efficacy of plasma exchange combined with corticoids and myco-phenolate mofetil(MMF) for the treatment of severe systemic lupus erythematosus (SLE) in children .[Methods]Clinical data of 18 children with severe SLE in our hospital were analyzed retrospectively .The improvement of symptoms and signs(fever ,joint pain ,rash ,edema) and anti-SM antibody ,anti-ds-DNA antibody ,anti-RNP anti-bodies ,blood sedimentation(ESR) ,24h urine protein ,serum creatinine(Scr) and complement C3 before and after treatment were observed .[Results]Symptoms of all the 18 patients got better after treatment .Facial erythema of 12 patients disappeared .Skin surface ulcer of 2 patients was healed .Raynaud phenomenon of 13 patients disap-peared ,and fever and joint pain were alleviated significantly .ESR reduced from (92 ± 24)mm/h to (27 ± 15)mm/h ,and 24h urinary protein reduced from (8 .12 ± 4 .76)g to (1 .83 ± 1 .55)g .The negative conversion rate of anti-SM antibody and anti-ds-DNA antibody decreased obviously .[Conclusion

  12. Relevancia de la farmacovigilancia hospitalaria en la práctica médica actual Importance of pharmacovigilance in current medical practice

    Directory of Open Access Journals (Sweden)

    Marcelo L. Ponte

    2013-02-01

    Full Text Available Las reacciones adversas medicamentosas (RAM generan actualmente una notable morbimortalidad, llegando a representar entre la cuarta y sexta causa de muerte y hasta un 12% de las hospitalizaciones en países desarrollados. Este es, además, un problema creciente. El objetivo del trabajo fue revisar la incidencia de RAM en un hospital de alta complejidad. Se revisó la base de datos del sistema de farmacovigilancia, desde junio de 2008 hasta febrero de 2012. Para determinar la causabilidad de una droga en un evento médico se aplicó el índice de Naranjo de efectos indeseables medicamentosos. Se consideró RAM grave a aquella que provoca la internación, la prolonga, compromete seriamente la vida, genera discapacidad permanente o teratogénesis o induce la muerte. Se detectaron 2420 RAM en este período. 469 (19.38%; IC 95%: 17.80-20.95 fueron serias, principalmente debido a que fueron causa de hospitalización (n = 287. Hubo 14 muertes atribuibles a RAM. Los grupos farmacológicos más frecuentemente asociados a toxicidad fueron drogas cardiovasculares, antibióticos, neuropsiquiátricas y corticoides. Las RAM más frecuentes afectaron al sistema endocrinometabólico, causaron hepatotoxicidad, nefrotoxicidad y farmacodermias. Las causas más frecuentes de hospitalización por RAM fueron infecciones graves asociadas a tratamiento inmunosupresor y hemorragia digestiva por anticoagulación y antiinflamatorios no esteroides. La incidencia de RAM en pacientes hospitalizados y el número de hospitalizaciones por este motivo fue elevado. Las drogas involucradas fueron similares a las comunicadas en la bibliografía internacional, salvo la alta incidencia de RAM relacionadas a inmunosupresores.Adverse drug reactions (ADRs are cause of significant morbi-mortality They are between the fourth and sixth cause of mortality in developed countries and cause nearly 12% of hospitalizations. The objective of this publication was to analyze the incidence of ADRs

  13. Cefalea cervicogénica: Diagnóstico, diagnóstico diferencial y principios generales del tratamiento Cervicogenic headache: Differential diagnosis and general therapeutic principles

    Directory of Open Access Journals (Sweden)

    I. O'Mullony

    2005-02-01

    Full Text Available La cefalea cervicogénica es un síndrome, una vía final común, o un patrón de reacción frente a estímulos nociceptivos generados por lesiones en una o varias estructuras anatómicas del cuello, inervadas por nervios cervicales. Este concepto admite la posibilidad de etiologías diversas y mecanismos multifactoriales. La cefalea cervicogénica es frecuente, y afecta preferentemente a mujeres en la edad media de la vida. El dolor es estrictamente unilateral, con predominio en la región occipital pero con afectación también de la región frontal. La cefalea es moderada en general, no pulsátil y puede acompañarse de náuseas, vómitos y fotoaudiofobia pero con intensidad mucho menor que en la migraña. El patrón temporal es remitente o crónico. Los signos y síntomas de afectación cervical son constantes: antecedentes de traumatismo cervical directo o indirecto, limitación de la motilidad cervical hacia el lado sintomático, hipersensibilidad y/o precipitación del dolor por presión sobre determinadas zonas occipitales o cervicales, y alivio completo (aunque transitorio, tras la anestesia local del nervio occipital mayor y/o la raíz C2 ipsilateral. Ocasionalmente es preciso anestesiar raíces más bajas o realizar bloqueos anestésicos articulares cervicales. Las formas episódicas pueden tratarse de forma sintomática con ciclos cortos de AINE o infiltración local con anestésico y corticoide de la zona hipersensible. Las formas crónicas requieren tratamiento preventivo con amitriptilina o fármacos antineurálgicos. Diversos procedimientos lesivos, fundamentalmente con radiofrecuencia, pueden ser necesarios para erradicar el dolor. Previamente debe identificarse la diana terapéutica y estimar la respuesta a los bloqueos anestésicos locales.Cervicogenic headache is either a syndrome, a common final route or a reaction pattern against nociceptive stimulus caused by lesions in one or several anatomical neck structures innervated

  14. Reacções cutâneas adversas aos inibidores do receptor do factor de crescimento epidérmico: estudo de 14 doentes Adverse cutaneous reactions to epidermal growth factor receptor inhibitors: a study of 14 patients

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    Felicidade Santiago

    2011-06-01

    Full Text Available FUNDAMENTOS: O cetuximab e o erlotinib, inibidores do receptor do factor de crescimento epidérmico, provocam frequentemente reacções cutâneas adversas peculiares. OBJETIVOS: Caracterizar do ponto de vista clínico-evolutivo as reacções cutâneas adversas e avaliar a sua abordagem terapêutica. METODOLOGIA: Entre março/2005 e setembro/2009 foram seguidos 14 doentes com idade média de 59,6 anos, em tratamento com cetuximab (7 ou erlotinib (7, por neoplasia pulmonar (10 ou colorrectal (4. Retrospectivamente foi avaliado o padrão clínico evolutivo de reacção cutânea, o intervalo entre a introdução do fármaco e o início dos sintomas e a resposta ao tratamento. RESULTADOS: Doze doentes apresentaram erupção papulopustulosa predominantemente na face, decote e dorso, em média 13,5 dias após o início do fármaco. Efectuaram tratamento oral com minociclina ou doxiciclina e tópico com metronidazol, peróxido de benzoílo e/ou corticoide. Ocorreu melhoria das lesões em todos os doentes. Cinco doentes, em média oito semanas após o início da terapia, apresentaram granulomas piogénicos periungueais, em quatro casos associados a paroníquia, melhorados com tratamento tópico (antibióticos, corticoides e antissépticos. Observou-se xerose em alguns doentes e, de forma isolada, outros efeitos adversos, como telangiectasias e angiomas, alterações dos cabelos e cílios e nevos melanocíticos eruptivos. Na maioria dos doentes, a terapêutica com o inibidor do receptor do factor de crescimento epidérmico foi mantida. CONCLUSÃO: Com o crescente uso destas terapêuticas-alvo, torna-se obrigatório reconhecer e tratar os seus efeitos cutâneos adversos, assegurando uma intervenção atempada de forma a permitir a manutenção desta terapêuticaBACKGROUND: Cetuximab and erlotinib, epidermal growth factor receptor inhibitors, often cause peculiar adverse cutaneous reactions. OBJECTIVES: Our aim was to evaluate adverse cutaneous reactions

  15. Fatores associados à amnésia pós-traumática de longa duração Fatores asociados a la amnesia post-traumática de larga duración Factors associated with long-term post-traumatic amnesia

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    Silvia Cristina Fürbringer e Silva

    2011-01-01

    Full Text Available OBJETIVO: Identificar fatores relacionados à amnésia pós-traumática de longa duração. MÉTODO: Estudo prospectivo, longitudinal, com 187 vítimas de trauma cranioencefálico contuso, idade >14 anos, atendidos em hospital de referência para trauma. As variáveis independentes foram: idade, sexo, gravidade do trauma cranioencefálico, local e tipo de lesão, número de lesões encefálicas e uso de medicação com atividade em sistema nervoso central ou corticoides. RESULTADO: O modelo de regressão logística múltipla ajustado pela variável área de lesão (intra/extra axial evidenciou: Escala de Coma de Glasgow inicial 3 (OR=2,80 e uso de Fenitoína (OR=2,60, Midazolan (OR=2,83 ou ambas as drogas (OR=3,83. CONCLUSÃO: O uso do Midazolan e da Fenitoína, além da gravidade do trauma cranioencefálico, destacaram-se como fatores relacionados à amnésia de longa duração.OBJETIVO: Identificar factores relacionados a la amnesia post-traumática de larga duración. MÉTODO: Estudio prospectivo, longitudinal, realizado con 187 víctimas de trauma craneoencefálico contuso, edad >14 años, atendidos en un hospital de referencia para trauma. Las variables independientes fueron: edad, sexo, gravedad del trauma craneoencefálico, local y tipo de lesión, número de lesiones encefálicas y uso de medicación con actividad en el sistema nervioso central o corticoides. RESULTADO: El modelo de regresión logística múltiple ajustado por la variable área de lesión (intra/extra axial evidenció: Escala de Coma de Glasgow inicial 3 (OR=2,80 y uso de Fenitoína (OR=2,60, Midazolan (OR=2,83 o ambas drogas (OR=3,83. CONCLUSIÓN: El uso del Midazolan y de Fenitoína, además de la gravedad del trauma craneoencefálico, se destacaron como factores relacionados a la amnesia de larga duración.OBJECTIVE: To identify factors related to post-traumatic amnesia of long duration. METHOD: A prospective, longitudinal study, with 187 victims of blunt head trauma

  16. Osteoporosis inducida por glucocorticoides Glucocorticoid induced osteoporosis

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    R. Gutiérrez-Polo

    2003-01-01

    . Corticoid-induced osteoporosis is the main adverse event deriving from their systemic and long-term administration, being the most frequent cause of secondary osteoporosis. This implies an important health and socio-economic repercussion due to the complications it causes, such as fragility fractures, above all of vertebral origin, and the resultant functional incapacity. The bone loss is produced early, being greatest in the first few months of glucocorticoid use, in relation fundamentally to daily dose. The pathogenesis of this type of osteoporosis is multifactorial, but the inhibitory effect of corticoids on bone formation can be emphasised. The adequate management of this serious health problem requires an active attitude that is currently suboptimal. It involves similar diagnostic, preventive and therapeutic recommendations available for other, different causes of bone loss, but with certain particularities, especially including those referring to the self-management of corticosteroids. A multidisciplinary strategy is advisable, which has shown its effectiveness, mainly if it is carried out early, from the start of glucocorticoid therapy. Nevertheless, there are many questions to be clarified about aspects relating to therapy with corticosteroids in general, and to the osteoporosis caused by them in particular. What is needed is the evaluation and investigation of new treatments that will improve the effectiveness obtained with those in current use, in order to minimize the adverse consequences that glucocorticoid use has for the health of patients.

  17. USO DE MEDICAMENTOS INMUNOSUPRESORES EN PACIENTES CON TRASPLANTE RENAL, HEPÁTICO Y DE MÉDULA ÓSEA, EN UNA CLÍNICA DE NIVEL III DE BOGOTÁ Use of immunosuppressive drugs in patients with kidney, liver or bone marrow transplant in a high complexity clinic in Bogotá, Colombia

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    Jorge J López G

    2009-01-01

    Full Text Available Antecedentes. El trasplante de órganos en la actualidad es una opción terapéutica para los pacientes que cursan estadíos terminales de ciertas patologías; el uso de inmunosupresores contribuye en gran medida a la efectividad de este tipo de tratamientos, ya que es fundamental para evitar el rechazo. El no seguimiento del consumo de medicamentos nuevos, como es el caso de los inmunosupresores que suelen tener precios relativamente elevados, junto con la ampliación injustificada de indicaciones, puede ocasionar un aumento de los costos de la terapia farmacológica y, lo más importante, causar riesgos en el paciente trasplantado. Objetivos. Describir y caracterizar el uso de medicamentos inmunosupresores en pacientes con trasplante renal, de médula ósea alogénico y hepático. Material y métodos. Estudio observacional-descriptivo de corte transversal con recolección retrospectiva de la información a un año. Se trata de un estudio de utilización de medicamentos sobre hábitos de prescripción. Resultados. El desenlace global de la terapia del trasplante produce resultados satisfactorios en un 92,5 por ciento (49 pacientes, 5,7 por ciento (3 pacientes presentan rechazo con retiro del injerto, mientras que un paciente fallece después de ser sometido al trasplante. El medicamento más prescrito es el micofenolato de mofetil, con 41 prescripciones (28%, mientras que el más consumido es la prednisona con 2,38 dosis diaria definidas /100 pacientes/día. Conclusiones. Se evidencia la presencia de micofenolato, ciclosporina y corticoides en la mayoría de los esquemas con algunas prescripciones de anticuerpos monoclonales y globulina antitimocítica.Background. Organ transplantation is currently a therapeutic option for patients at the terminal stages of diverse pathologies. The use of immunosuppressants greatly contributes to the efficacy of these treatments by preventing organ rejection. The lack of follow-up to the use of new medications

  18. Study of hyperglycemia in non critically-ill patients receiving parenteral nutrition: incidence and risk factors Estudio de hiperglicemia en pacientes no críticos tratados con nutrición parenteral: incidencia y factores de riesgo

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    J. M. Llop

    2012-10-01

    Full Text Available Background: The objectives of our study on non-critically ill patients receiving parenteral nutrition (PN are to assess the incidence of hyperglycemia, the risk factors associated to its development and its influence in patient's evolution. Methods: A multicentric prospective observational study was performed in 9 hospitals. Four multivariate studies were developed to study the temporal risk in the occurrence of hyperglycemia (endpoint, intensive care unit (ICU admission, length of stay (LOS and death. Demographics, nutrients, drugs and clinical variables were collected. Independent variables studied as a possible risk factors were: sex, diabetes mellitus 2, baseline glycemia, albuminemia, pancreatitis, surgery in the 7 days prior to the end point, infection, insulin/somatostatin/corticoids administration during the study, glomerular filtration rate (GFR, and difference in the amount of glucose administration between the endpoint and one day before. Results: 119 patients were enrolled in the study, 25 cases of hyperglycemia were detected. In the clinical factors associated with PN hyperglycemia, significant variables were: surgery in the 7 days before the end point, GFR, glucose load in the 24 hours previous to the end point insulin administration and somatostatine/octreotide administration during the study. Hyperglycemia was significantly associated with ICU admission and increased LOS. Conclusions: Glucose administration in non-critically ill patients receiving PN should be reassessed downwards, especially in the immediate postsurgery, renal impairment and in patients treated with somatostatin analogues. It should be taken into account that an increase in glucose dose may lead to hyperglycemia in these patients and hyperglycemia correlates with longer hospital stay and increased frequency of ICU admissions.Antecedentes y objetivo: El estudio está dirigido a pacientes no críticos tratados con nutrición parenteral (NP y tiene como objetivo

  19. Effects of TLC-Ag dressings on skin inflammation.

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    Bisson, Jean-François; Hidalgo-Lucas, Sophie; Bouschbacher, Marielle; Thomassin, Laetitia

    2013-06-01

    The TLC-Ag dressings, a combination of technology lipido-colloid and silver salts, are used to promote healing in wounds with risks or signs of local infection, thanks to the antimicrobial properties of the silver salts. Nanocrystalline silver dressings containing nanocrystalline silver, also used to improve wound healing, present both antimicrobial and anti-inflammatory effects. The aim of this study was to investigate the anti-inflammatory effects of TLC-Ag dressings in a model of chronic skin inflammation induced by repeated application of 12-O-tetradecanoylphorbol-13-acetate to the skin of hairless mice, in comparison with TLC dressing, Silcryst nanocrystalline dressing, desonide cream 0.05%, a corticoid cream used as positive control, and gauze. Daily treatments of the mice began 7 days after the start of induction of chronic skin inflammation and lasted for 7 days. A macroscopic score was performed daily during the treatment period until the mice killing on day 15 and skin samples were taken for histopathological analysis. TLC-Ag reduced significantly the macroscopic score of chronic skin inflammation from day 10 in comparison with gauze and TLC dressing, similarly to Silcryst nanocrystalline dressing and desonide cream, which presented the best anti-inflammatory effects. No significant differences were observed between TLC dressing and gauze. TLC-Ag reduced significantly the microscopic score of chronic skin inflammation in comparison with TLC dressing and gauze, similarly to Silcryst nanocrystalline dressing but significantly less than desonide cream. These results demonstrate that TLC-Ag dressings present significant anti-inflammatory effects on chronic skin inflammation. They can improve wound healing, due to both the antimicrobial and anti-inflammatory properties. © 2013 Japanese Dermatological Association.

  20. VASCULITIS DE CHURG-STRAUSS: PRESENTACIÓN CLÍNICA COMO GLOMERULONEFRITIS EXTRACAPILAR NECROTIZANTE PAUCI-INMUNE CON NEFRITIS TUBULO-INTERSTICIAL EOSINOFÍLICA.

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    Fernanda da Cunha

    2004-01-01

    Full Text Available RESUMEN: Se presenta el caso clínico de una mujer de 81 años con antecedentes patología pulmonar obstructiva crónica "idiopática" que desarrolló un cuadro de insuficiencia renal aguda aparentemente prerrenal, con posterior oliguria y eosinofilia simulando una nefropatía túbulo-intersticial alérgica. La evolución atípica y la presencia de p-ANCA, sugerían una vasculitis, patología que se confirmó con la biopsia renal. Los resultados anatomopatológicos revelaron la existencia de una glomerulonefritis necrotizante con semilunas e infiltrado eosinófilo. Estos datos y el historial de la paciente llevaron al diagnóstico de vasculitis de Churg-Strauss. El tratamiento inicial con corticoides y ciclofosfamida y posteriormente con Azatioprina mostró excelentes resultados con mejoría de la función renal, de los parámetros inflamatorios y de la clínica sistémica, que la paciente mantuvo posteriormente. ABSTRACT: We report a case of a 81 year-old woman with idiopathic chronic obstructive pulmonary disease, who developed a functional acute renal failure with delayed oliguria and eosinophily, simulating an acute interstitial nephropathy. The unusual clinical course and the presence of antimyeloperoxidase antibodies (p-ANCA suggested a vasculitis; the renal biopsy confirmed this diagnosis. The histology revealed a crescentic glomerulonephritis with eosinophilic infiltration. With these data and the pulmonary history of the patient, a diagnosis of Churg-Struss Vasculitis was made. The initial treatment with steroids and ciclophosphamide switched later to azatioprine, was succeeded with a sustained improvement in renal function, inflammatory markers and clinical course.

  1. Tumores malignos de novo en el trasplante hepático experiencia de un centro en la Argentina

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    Florencia Antinucci

    2015-02-01

    Full Text Available El objetivo del presente trabajo ha sido evaluar la incidencia y las características clínicas de los tumores aparecidos de novo en los pacientes sometidos a trasplante hepático, como así también su supervivencia. Para ello, analizamos en forma retrospectiva los 168 trasplantes hepáticos realizados en 159 pacientes adultos en el período mayo 2006 hasta mayo 2014, encontrando una incidencia de neoplasia de novo de 7.5% (n = 12. La edad media en el momento del diagnóstico fue de 63 ± 7 años. Las neoplasias más frecuentes fueron las de piel no melanoma y adenocarcinomas. El 50% de las neoplasias se desarrollaron en el segundo y tercer año postrasplante. El tipo de inmunosupresión no influyó en el tipo de tumor; sin embargo, debemos destacar que la mayor parte de los pacientes recibieron tacrolimus, micofenolato y/o corticoides. El tiempo medio de seguimiento tras el diagnóstico del tumor fue 25 ± 29 meses (0-76, y la tasa de mortalidad fue de un 41% (5/12 pacientes IC95%,15-72.La supervivencia global luego del trasplante a 1 y 5 años, calculada por análisis de Kaplan-Meier, fue de 83 y 55%, respectivamente. Los tumores de novo son frecuentes luego del trasplante hepático y presentan un patrón evolutivo diferente al de la población general. Teniendo en cuenta esta evolución más agresiva, es fundamental el seguimiento periódico en estos pacientes para realizar un diagnóstico lo más precoz posible.

  2. Determination of free cortisol and free cortisone in human urine by on-line turbulent flow chromatography coupled to fused-core chromatography-tandem mass spectrometry (TFC-HPLC-MS/MS).

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    Sánchez-Guijo, Alberto; Hartmann, Michaela F; Shi, Lijie; Remer, Thomas; Wudy, Stefan A

    2014-01-01

    Urinary free cortisol and urinary free cortisone are decisive markers for the diagnosis of syndromes related to the dysfunction of the adrenal gland or to evaluate certain enzymatic disorders. Here, we present a new method, designed for routine laboratory use, which enables quick determination of these analytes with minor sample workup. Turbulent flow chromatography shortens sample preparation, and connection to a fused-core particle-packed column (rugged amide-embedded C18 phase) permits a rapid and effective separation of the analytes, as well as additional separation from other related and isobaric compounds present in urine. Urinary isobaric compounds were successfully identified. The method requires only 100 μl of urine supernatant per sample. The total time between injections is 9.5 min. The solvents used for both turbulent and analytical chromatography are water and methanol, and the relatively low flows needed during the method resulted in an extended life of the columns. Linearity showed a R (2) > 0.994. Limit of detection and limit of quantification are 0.5 and 1.0 ng/ml for cortisone and 1.0 and 2.0 ng/ml for cortisol. Recoveries ranged from 99.7 to 109.1 % for cortisone and from 98.7 to 102.9 % for cortisol. Accuracy values (relative errors) for intra- and inter-assay experiments were always below 8 %, whereas precision (percent CV) ranged from 3.7 to 10.7 %. No matrix effects were detected during the validation process. The reproducibility for each analyte's retention time was excellent, with a coefficient of variation always below 0.2 %. The final validation step included the study of urine samples from healthy children and from children previously diagnosed with corticoidal disorders. The high selectivity achieved enables quick data handling.

  3. Registro de um caso de paracoccidioidomicose no Japão Paracoccidioidomycosis in Japan report of a case

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    Taishiro Chikamori

    1984-10-01

    Full Text Available Os Autores descrevem um caso de paracoccidioidomicose em Tóquio, o segundo observado no Japão. A paciente residiu cerca de cinco anos na zona urbana de São Paulo, onde provavelmente adquiriu a primo-infecção. Não tomou corticóides, nem teve história de outras afecções que justificassem a paracoccidioidomicose. Após três anos do retorno ao Japão apresentou linfadenopatia, comprometimento hepatesplênico e ausência de lesões pulmonares. O presente caso, com exame histopatoló-gico e cultivo positivos para Paracoccidioides brasiliensis também apresentou quadro soroló-gico compatível. O aspecto blástico das lesões ósseas, raro em arcos costáis nesta micose, bem como a linfadenopatia generalizada são discutidos. Tratamento à base de anfotericina B e ketoconazol ofereceu resultados favoráveis. Neste trabalho os Autores discutem o problema de "patologia de importação", com suas implicações.The Authors report a non-autochthonous case of paracoccidioidomycosis in Tokyo, the second related in Japan. The patient lived for nearly five years in the urban area of São Paulo, where probably she acquired the primary infection. There was no history of corticoid therapy or other diseases that could explain paracoccidioidomycosis. Three years after her return to Japan, she presented lymphadenopathy, hepatosplenic involvement and absence of pulmonary lesions. The present case, with histopathological examination and culture positive to Paracoccidioides brasiliensis also showed compatible serological results. The blastic feature of bone lesions, rare in ribs in this mycosis, as well as the generalized lymphadenopathy are discussed. Treatment with amphotericin B and ketoconazole offered good results. In this paper the Authors discuss the problem of the "pathology of importation" with its implications.

  4. Daño pulmonar agudo relacionado con la transfusión (Trali y Bartonelosis aguda

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    Douglas López de Guimaraes

    2006-07-01

    Full Text Available Se presenta el caso de un varón de 22 años procedente de la periferia de la ciudad de Huaraz, Perú, que acude al Hospital "Victor Ramos Guardia" de Huaraz con un tiempo de enfermedad de 14 días, febril, pálido e ictérico, en el frotis de sangre periférica se encuentran formas bacilares de Bartonella bacilliformis en 99% de la lámina; se inicia tratamiento antibiótico con ceftriaxona y ciprofloxacino. Al día siguiente se le indica transfusión de dos paquetes globulares (puesto que tenía 6,2 g/dL de Hb, dos horas después presenta dolor toráxico, tos seca exigente, vómitos, dificultad respiratoria y cianosis, en la auscultación se encuentran roncantes y crepitantes, la radiografía de tórax muestra infiltrado alveolar difuso a predominio derecho. Es trasladado a la UCI donde recibe oxígeno con máscara de reservorio, dopamina, corticoides y se inicia el monitoreo hemodinámico; responde en forma satisfactoria, sale de alta con frotis negativo a Bartonella bacilliformis. Es el primer caso de daño pulmonar agudo relacionado con la transfusión (TRALI asociado con Bartonelosis aguda con cuadro clínico - radiológico y evolución compatible, es importante distinguir entre la complicación pulmonar debido a la sepsis grave por Bartonelosis aguda, que puede producir un cuadro clínico similar y el TRALI.

  5. Contribution of glucocorticoid-mineralocorticoid receptor pathway on the obesity-related adipocyte dysfunction.

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    Hirata, Ayumu; Maeda, Norikazu; Nakatsuji, Hideaki; Hiuge-Shimizu, Aki; Okada, Takuya; Funahashi, Tohru; Shimomura, Iichiro

    2012-03-09

    Mineralocorticoid receptor (MR) blockade ameliorated insulin resistance with improvements in adipocytokine dysregulation, inflammation, and excess of reactive oxygen species (ROS) in obese adipose tissue and adipocytes, but its mechanism has not been clarified. The 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1), producing active glucocorticoids, is highly expressed in adipocytes and glucocorticoids bind to MR with higher affinity than to glucocorticoid receptor (GR). We investigated whether glucocorticoids effect on adipocytokines and ROS through MR in adipocytes. In addition, fat distributions of MR and GR were investigated in human subjects. Corticoid receptors and their target genes were examined in adipose tissue of obese db/db mice. 3T3-L1 adipocytes were treated with glucocorticoids, H(2)O(2), MR antagonist eplerenone (EP), GR antagonist RU486 (RU), MR-siRNA, and/or N-acetylcysteine. Human adipose tissues were obtained from seven patients who underwent abdominal surgery. The mRNA levels of MR and its target gene were higher in db/db mice than in control db/m+mice. In 3T3-L1 adipocytes, glucocorticoids, similar to H(2)O(2), caused the dysregulation of mRNA levels of various genes related to adipocytokines and the increase of intracellular ROS. Such changes were rectified by MR blockade, not by GR antagonist. In human fat, MR mRNA level was increased in parallel with the increase of body mass index (BMI) and its increase was more significant in visceral fat, while there were no apparent correlations of GR mRNA level to BMI or fat distribution. Glucocorticoid-MR pathway may contribute to the obesity-related adipocytokine dysregulation and adipose ROS. Copyright © 2012 Elsevier Inc. All rights reserved.

  6. Vertebral fractures in patients with inflammatory bowel disease COMPARED with a healthy population: a prospective case-control study

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    Vázquez Ma

    2012-05-01

    Full Text Available Abstract Background A prospective study was performed to compare the prevalence of morphometric vertebral fractures (MVF between patients with inflammatory bowel disease (IBD and healthy subjects and to identify predictive factors of fracture. Methods A total of 107 patients with IBD (53 with Crohn’s disease and 54 with ulcerative colitis and 51 healthy subjects participated in the study. Information about anthropometric parameters, toxins, previous fractures, and parameters related to this disease were evaluated. The index of vertebral deformity, bone mass density (BMD, and biochemical parameters were calculated. Results A total of 72 fractures were detected in 38.32% of patients with IBD, and 10 fractures were detected in 13.73% of healthy subjects; the risk of fracture in patients with IBD was higher than that in control subjects (OR, 4.03; 95% CI, 1.652–9.847; p p = 0.17 and femoral neck, r = −0.138, p = 0.07. Corticosteroid treatment was not associated with prevalent vertebral fractures nor with taking corticosteroids (r = 0.135, p = 0.14 or the duration for which they were taken (r = 0.08, p = 0.38, whereas this relationship was present in the controls (r = −0.365, p = 0.01. In the multivariate analysis, none of the measured parameters were significantly predictive of fracture, only to manifested IBD. Hypovitaminosis D was observed in 55.14% of patients with IBD. Conclusions The prevalence of morphometric vertebral fractures is higher in patients with IBD than in the healthy population, without association with BMD or corticoid treatment. Simply having IBD was proven to be a predictive factor of fracture. We observed a high incidence of hypovitaminosis D in patients with IBD.

  7. Longitudinal monitoring of endogenous steroids in human serum by UHPLC-MS/MS as a tool to detect testosterone abuse in sports.

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    Ponzetto, Federico; Mehl, Florence; Boccard, Julien; Baume, Norbert; Rudaz, Serge; Saugy, Martial; Nicoli, Raul

    2016-01-01

    The detection of testosterone abuse in sports is routinely achieved through the 'steroidal module' of the Athlete Biological Passport by GC-MS(/MS) quantification of selected endogenous anabolic androgenic steroids (EAAS) from athletes' urines. To overcome some limitations of the "urinary steroid profile" such as the presence of confounding factors (ethnicity, enzyme polymorphism, bacterial contamination, and ethanol), ultrahigh performance liquid chromatography (UHPLC) measurements of blood concentrations of testosterone, its major metabolites, and precursors could represent an interesting and complementary strategy. In this work, two UHPLC-MS/MS methods were developed for the quantification of testosterone and related compounds in human serum, including major progestogens, corticoids, and estrogens. The validated methods were then used for the analyses of serum samples collected from 19 healthy male volunteers after oral and transdermal testosterone administration. Results from unsupervised multiway analysis allowed variations of target analytes to be assessed simultaneously over a 96-h time period. Except for alteration of concentration values due to the circadian rhythm, which concerns mainly corticosteroids, DHEA, and progesterone, significant variations linked to the oral and transdermal testosterone administration were observed for testosterone, DHT, and androstenedione. As a second step of analysis, the longitudinal monitoring of these biomarkers using intra-individual thresholds showed, in comparison to urine, significant improvements in the detection of testosterone administration, especially for volunteers with del/del genotype for phase II UGT2B17 enzyme, not sensitive to the main urinary marker, T/E ratio. A substantial extension of the detection window after transdermal testosterone administration was also observed in serum matrix. The longitudinal follow-up proposed in this study represents a first example of 'blood steroid profile' in doping control

  8. Effect of several intracanal medicaments on the push-out bond strength of ProRoot MTA and Biodentine.

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    Nagas, E; Cehreli, Z C; Uyanik, M O; Vallittu, P K; Lassila, L V J

    2016-02-01

    To evaluate the effect of prior application of several intracanal medicaments on the push-out bond strength of ProRoot MTA and Biodentine. Sixty freshly extracted maxillary anterior teeth were sectioned below the cementoenamel junction, and the root canals instrumented using rotary files. Thereafter, a parallel post drill was used to obtain a standardized root canal dimension. The roots were randomly assigned into one of the following groups with respect to the intracanal medicament applied: group 1: calcium hydroxide (CH) powder (Merck, Darmstadt, Germany) mixed with distilled water; group 2: a mixture of metronidazole, ciprofloxacin and minocycline (triple antibiotic paste); group 3: a combination of amoxicillin and clavulanic acid (Augmentin; Champs Pharmacy, San Antonio, TX, USA); group 4: an antibiotic-corticoid compound paste (Ledermix; Riemser, Greifswald, Germany); and group 5: no medicament (control). Following removal of medicaments with instrumentation and irrigation, the roots were cut into 1-mm-thick parallel transverse sections in a coronal-to-apical direction (5 slices/tooth). Thereafter, the specimens were divided into two subgroups according to the calcium silicate cement applied (n = 30/group): (i) ProRoot MTA (Dentsply Tulsa Dental, Tulsa, OK, USA) and (ii) Biodentine (Septodont, Saint-Maur-des-Fosses, France). A push-out test was performed, and the data were analysed statistically using two-way anova and Tukey's post hoc test. Regardless of the type of intracanal medicament used, Biodentine had significantly higher bond strength than MTA (P MTA and Biodentine groups, pairwise comparisons between other medicaments showed similar debonding values (P > 0.05). Biodentine had a higher bond strength to root canal dentine than ProRoot MTA. Prior CH in distilled water intracanal placement increased the dislodgment resistance of both calcium silicate cements. © 2015 International Endodontic Journal. Published by John Wiley & Sons Ltd.

  9. Arthroscopic treatment for chronic lateral epicondylitis

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    Bernardo Barcellos Terra

    2015-08-01

    Full Text Available ABSTRACTOBJECTIVE: To report the clinical and functional results from arthroscopic release of the short radial extensor of the carpus (SREC in patients with chronic lateral epicondylitis that was refractory to conservative treatment. METHODS: Over the period from January 2012 to November 2013, 15 patients underwent arthroscopic treatment. The surgical technique used was the one described by Romeo and Cohen, based on anatomical studies on cadavers. The inclusion criteria were that the patients needed to present lateral epicondylitis and that conservative treatment (analgesics, anti-inflammatory agents, corticoid infiltration or physiotherapy had failed over a period of more than six months. The patients were evaluated based on the elbow functional score of the Mayo Clinic, Nirschl's staging system and a visual analog scale (VAS for pain. RESULTS: A total of 15 patients (9 men and 6 women were included. The mean Mayo elbow functional score after the operation was 95 (ranging from 90 to 100. The pain VAS improved from a mean of 9.2 before the operation to 0.64 after the operation. On Nirschl's scale, the patients presented an improvement from a mean of 6.5 before the operation to approximately one. There were significant differences from before to after the surgery for the three functional scores used ( p 0.05. CONCLUSION: Arthroscopic treatment for lateral epicondylitis was shown to be a safe and effective therapeutic option when appropriately indicated and performed, in refractory cases of chronic lateral epicondylitis. It also allowed excellent viewing of the joint space for diagnosing and treating associated pathological conditions, with a minimally invasive procedure.

  10. Mometasone furoate-loaded cold processed oil-in-water emulsions: in vitro and in vivo studies.

    Science.gov (United States)

    Raposo, Sara; Tavares, Rita; Gonçalves, Lídia; Simões, Sandra; Urbano, Manuela; Ribeiro, Helena M

    2015-01-01

    Over the years, research has focused on strategies to increase benefit/risk ratio of corticoids. However, vehicles intended for topical glucocorticoids delivery with an improved benefit/risk ratio are still on demand. The aim of this work was the in vitro and in vivo characterization of cold processed oil-in-water (o/w) emulsions intended for mometasone furoate (MF) delivery to induce drug targeting to upper skin strata, decreasing adverse effects. Two o/w emulsions, containing 0.1% of MF, were developed differing in the glycol used (2-methyl-2,4-pentanediol - PT and ethoxydiglycol - TC emulsions). In vitro permeation studies revealed that these emulsions are suitable vehicles for the delivery of MF containing ingredients which are responsible for a drastically increased on the permeability coefficients of MF from a theoretical value of 1.18 × 10(-4 )cm/h to 5.20 × 10(-4) ± 2.05 × 10(-4 )cm/h and 6.30 × 10(-4) ± 2.94 × 10(-4 )cm/h, for PT and TC, respectively. The tape stripping results showed that the amount of drug that reached the viable skin layers was very low (1.99 %) and the amount that remained in the stratum corneum (SC) was 10.61%. The in vivo studies showed that the developed formulations decreased the edema and erythema in mice skin in more that 90%, assuring, at least, the same anti-inflammatory effect compared with the commercial cream. PT placebo demonstrated to contribute to restore the skin barrier by increasing the amount of lipids within the human skin.

  11. [Encephalopathy and neuromyelitis optica: the importance of recognising atypical symptoms].

    Science.gov (United States)

    Hervás-García, José V; Grau-López, Laia; Doménech-Puigcerver, Sira; Ramo-Tello, Cristina

    2014-01-01

    Introduccion. La neuromielitis optica (NMO) o enfermedad de Devic es un trastorno autoinmune, inflamatorio y desmielinizante del sistema nervioso central, que afecta principal y caracteristicamente al nervio optico y a la medula espinal. Los anticuerpos antiacuaporina-4 (AQ-4) son un biomarcador especifico de esta entidad y, desde su descubrimiento, se ha ampliado el numero de sintomas y datos radiologicos de la enfermedad y se ha definido el concepto de espectro clinico de NMO. Caso clinico. Mujer de 66 años diagnosticada de NMO por haber sufrido brotes de neuritis optica y mielitis de repeticion junto con anticuerpos AQ-4 positivos. Presento un cuadro de disminucion del nivel de conciencia, con resonancia magnetica cerebral que mostro multiples lesiones en la sustancia blanca, sin realce de contraste, que se resolvio sin tratamiento. Un mes despues, sufrio empeoramiento del estado general, sindrome confusional y ceguera. En la resonancia magnetica cerebral se observaron nuevas lesiones en la sustancia blanca y aumento del tamaño de otras ya existentes. Se emitio el diagnostico de encefalopatia en el contexto de NMO y se trato a la paciente con corticoides e inmunoglobulinas intravenosas, con lo que se produjo mejoria clinica y radiologica. Conclusiones. Desde el descubrimiento de los anticuerpos AQ-4, ha aumentado el numero de manifestaciones clinicas y radiologicas de la NMO mas alla de la afectacion del nervio optico y de la medula espinal, entre ellas las manifestaciones cerebrales. Reconocerlas es muy importante para hacer un diagnostico precoz, evitar pruebas complementarias no necesarias e instaurar el tratamiento adecuado.

  12. Cryptosporidium parvum, a potential cause of colic adenocarcinoma

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    Pinon Anthony

    2007-11-01

    cryptosporidiosis using SCID mice treated with corticoids. This reproducible model has facilitated the evaluation of clinical signs, oocyst shedding, location of the infection, pathogenicity, and histopathological changes in the gastrointestinal tract, indicating divergent effects of Dex according to Cryptosporidium species causing infection.

  13. Diagnóstico do parto pré-termo pela medida ultrassonográfica do comprimento do colo uterino Preterm labor diagnosis by sonographic measurement of the uterine cervical length

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    Carlos Eduardo Ferreira Novaes

    2009-10-01

    Full Text Available OBJETIVO: Medir o comprimento do colo uterino, utilizando a ultrassonografia transvaginal, em pacientes com quadro clínico compatível com ameaça de parto pré-termo, e correlacionar a medida do colo uterino, em cada caso, com a interrupção espontânea da gravidez dentro de sete dias. MATERIAIS E MÉTODOS: Foram realizados exames ultrassonográficos em 72 pacientes com quadro clínico compatível com ameaça de parto pré-termo. RESULTADOS: A sensibilidade do exame foi de 90,5%, a especificidade, de 98%, o valor preditivo positivo, de 95%, e o valor preditivo negativo, de 96%. A análise foi realizada utilizando-se a medida de 15 mm de comprimento do colo uterino como valor preditivo do parto pré-termo. CONCLUSÃO: Parece ser possível prever o parto pré-termo em pacientes com colo uterino menor que 15 mm. Tal observação poderá trazer contribuição para a administração mais oportuna de corticoides, com o intuito de acelerar a maturidade pulmonar fetal.OBJECTIVE: To measure the uterine cervical length by using transvaginal ultrasonography in patients with clinical signs compatible with preterm labor threat, and correlating each individual measurement with spontaneous pregnancy interruption within seven days. MATERIALS AND METHODS: Sonographic examinations were performed in 72 patients with clinical signs compatible with preterm labor threat. RESULTS: Sensitivity was 90.5%, specificity, 98%, positive predictive value, 95%, and negative predictive value, 96%. A standard uterine cervix length of 15 mm was considered as a predictive value for preterm labor. CONCLUSION: It seems to be possible to foresee preterm delivery in patients whose cervical length is < 15 mm. Such observation could contribute to a timely corticosteroid administration to accelerate fetal lung maturity.

  14. Relevancia de la farmacovigilancia hospitalaria en la práctica médica actual

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    Marcelo L. Ponte

    2013-02-01

    Full Text Available Las reacciones adversas medicamentosas (RAM generan actualmente una notable morbimortalidad, llegando a representar entre la cuarta y sexta causa de muerte y hasta un 12% de las hospitalizaciones en países desarrollados. Este es, además, un problema creciente. El objetivo del trabajo fue revisar la incidencia de RAM en un hospital de alta complejidad. Se revisó la base de datos del sistema de farmacovigilancia, desde junio de 2008 hasta febrero de 2012. Para determinar la causabilidad de una droga en un evento médico se aplicó el índice de Naranjo de efectos indeseables medicamentosos. Se consideró RAM grave a aquella que provoca la internación, la prolonga, compromete seriamente la vida, genera discapacidad permanente o teratogénesis o induce la muerte. Se detectaron 2420 RAM en este período. 469 (19.38%; IC 95%: 17.80-20.95 fueron serias, principalmente debido a que fueron causa de hospitalización (n = 287. Hubo 14 muertes atribuibles a RAM. Los grupos farmacológicos más frecuentemente asociados a toxicidad fueron drogas cardiovasculares, antibióticos, neuropsiquiátricas y corticoides. Las RAM más frecuentes afectaron al sistema endocrinometabólico, causaron hepatotoxicidad, nefrotoxicidad y farmacodermias. Las causas más frecuentes de hospitalización por RAM fueron infecciones graves asociadas a tratamiento inmunosupresor y hemorragia digestiva por anticoagulación y antiinflamatorios no esteroides. La incidencia de RAM en pacientes hospitalizados y el número de hospitalizaciones por este motivo fue elevado. Las drogas involucradas fueron similares a las comunicadas en la bibliografía internacional, salvo la alta incidencia de RAM relacionadas a inmunosupresores.

  15. Angioedema por rellenos faciales: Descripción de cinco casos

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    Micaela A. Cosatti

    2010-12-01

    Full Text Available En los últimos años se ha incrementado la utilización de sustancias de relleno facial con fines estéticos. Estos productos, originalmente considerados inertes, se asocian con diversos efectos adversos localizados alrededor del sitio de la aplicación. Describimos a 5 mujeres con antecedentes de inyecciones de sustancia de relleno facial que presentaron como síntoma inicial angioedema facial duro y persistente seguido por la aparición de nódulos subcutáneos. Todas las pacientes fueron derivadas al servicio de alergia por sospecha de angioedema de causa alérgica sin respuesta al tratamiento con antihistamínicos. El angioedema inició 27.6 meses (1 a 48 luego de la inyección del producto, y las pacientes evolucionaron con brotes y remisiones que fueron tratados con corticoides orales y en 2 oportunidades con inyecciones locales. El tiempo medio desde el inicio de los síntomas hasta la remisión del angioedema fue 8.75 meses (1 a 24. A octubre de 2009 cuatro pacientes se mantuvieron en remisión persistente, luego de un seguimiento clínico de 24.5 meses (7 a 36. Una paciente continúa con exacerbaciones luego de 11 meses de iniciados los síntomas. Las sustancias de relleno facial pueden producir angioedema como evento adverso y deben ser consideradas en el diagnóstico diferencial del angioedema persistente. Sólo responden al tratamiento con esteroides y en algunos casos esteroides dependientes, con ciclosporina. La frecuencia de angioedema por rellenos faciales entre pacientes con angioedema asistidos en la Unidad de Asma, Alergia e Inmunología Clínica fue del 0.5%.

  16. Manifestaciones clínicas y complicaciones de la fase aguda de bartonelosis o Fiebre de la Oroya en pacientes atendidos en el Hospital Nacional Cayetano Heredia.

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    Ciro Peregrino Maguiña Vargas

    2008-07-01

    Full Text Available Objetivos: Determinar las características clínicas, epidemiológicas y de laboratorio de la bartonelosis aguda, así como las complicaciones en una serie de pacientes atendidos en el Hospital Nacional Cayetano Heredia. Material y métodos: Estudio descriptivo de tipo serie de casos de pacientes mayores de 15 años con bartonelosis aguda hospitalizados en el Hospital Nacional Cayetano Heredia entre 1993 y 2006. Resultados: La edad promedio fue 27,8 años, 72,7% fueron varones, 51,5% procedía de Lima y 33,3% de Ancash. Los síntomas principales fueron: fiebre 90,9%, cefalea 87,9%, hiporexia 75,5%, baja de peso 63,6%, e ictericia 57,6%. Dos pacientes presentaron alteraciones en el fondo de ojo: retinitis exudativa y retinopatía hemorrágica. El hematocrito promedio fue 20,8% y 63,6% cursaron hematocrito £20%. Hubo desviación izquierda en 24,2%, hiperbilirrubinemia a predominio indirecto 62,5% e hipoalbuminemia (< 3mg/dl 56,5%. Se presentaron complicaciones en 84,8%, el 27,2% requirió internamiento en UCI. Las complicaciones no infecciosas ocurrieron en 84,8%, hematológicas 81,8% y gastrointestinales 78,7%. Las complicaciones infecciosas se presentaron en 12,1%. Los antibióticos más utilizados fueron ciprofloxacina 66,6% y cloranfenicol 42,4%, se administró corticoides en 9,1% y se transfundió paquete globular en 42,4%. Conclusiones: Los pacientes de UCI tuvieron más complicaciones cardiovasculares, trombocitopenia y mayor severidad de la anemia. No se registró mortalidad. (Rev. Med Hered 2008;19:87-95

  17. Mouse social stress induces increased fear conditioning, helplessness and fatigue to physical challenge together with markers of altered immune and dopamine function.

    Science.gov (United States)

    Azzinnari, Damiano; Sigrist, Hannes; Staehli, Simon; Palme, Rupert; Hildebrandt, Tobias; Leparc, German; Hengerer, Bastian; Seifritz, Erich; Pryce, Christopher R

    2014-10-01

    In neuropsychiatry, animal studies demonstrating causal effects of environmental manipulations relevant to human aetiology on behaviours relevant to human psychopathologies are valuable. Such valid models can improve understanding of aetio-pathophysiology and preclinical discovery and development of new treatments. In depression, specific uncontrollable stressful life events are major aetiological factors, and subsequent generalized increases in fearfulness, helplessness and fatigue are core symptoms or features. Here we exposed adult male C57BL/6 mice to 15-day psychosocial stress with loss of social control but minimal physical wounding. One cohort was assessed in a 3-day test paradigm of motor activity, fear conditioning and 2-way avoid-escape behaviour on days 16-18, and a second cohort was assessed in a treadmill fatigue paradigm on days 19 and 29, followed by the 3-day paradigm on days 30-32. All tests used a physical aversive stimulus, namely mild, brief electroshocks. Socially stressed mice displayed decreased motor activity, increased fear acquisition, decreased 2-way avoid-escape responding (increased helplessness) and increased fatigue. They also displayed increased plasma TNF and spleen hypertrophy, and adrenal hypertrophy without hyper-corticoidism. In a third cohort, psychosocial stress effects on brain gene expression were assessed using next generation sequencing. Gene expression was altered in pathways of inflammation and G-protein coupled receptors in prefrontal cortex and amygdala; in the latter, expression of genes important in dopamine function were de-regulated including down-regulated Drd2, Adora2a and Darpp-32. This model can be applied to identify targets for treating psychopathologies such as helplessness or fatigue, and to screen compounds/biologics developed to act at these targets. Copyright © 2014 Elsevier Ltd. All rights reserved.

  18. Promotion of Wound Healing by an Agonist of Adenosine A2A Receptor Is Dependent on Tissue Plasminogen Activator.

    Science.gov (United States)

    Montesinos, M Carmen; Desai-Merchant, Avani; Cronstein, Bruce N

    2015-12-01

    Impaired wound healing, as it occurs in diabetes mellitus or long-term corticoid treatment, is commonly associated with disability, diminished quality of life, and high economic costs. Selective agonists of the A2A receptor subtype of adenosine, an endogenous regulator of inflammation, promote tissue repair in animal models, both healthy and with impaired healing. Plasmin-mediated proteolysis of fibrin and other matrix proteins is essential for cell migration at sites of injury. Since adenosine A2A receptor activation increases plasminogen activator release from macrophages and mast cells, we studied the effect of a selective agonist, CGS-21680, on full-thickness excisional wound closure in wild-type, urokinase plasminogen activator (uPA)-deficient, and tissue plasminogen activator (tPA)-deficient mice. Wound closure was impaired in tPA- and uPA-deficient mice as compared with wild-type mice, and topical application of CGS-21680 significantly increased the rate at which wounds closed in wild-type mice and uPA-deficient mice, but not in tPA-deficient mice. Immunostaining of tissue sections showed that tPA was present in endothelial cells and histiocytes by day 3 post-wound and also by day 6. In contrast, uPA was more prominent in these cell types only by day 6 post-wound. Our results confirm that plasminogen activation contributes to wound repair and are consistent with the hypothesis that adenosine A2A receptor activation promotes wound closure by a mechanism that depends upon tPA, but not uPA. Moreover, our results suggest that topical adenosine A2A receptor agonists may be useful in promotion of wound closure in patients with impaired wound healing.

  19. Generalized systemic cryptococcosis in a dog after immunosuppressive corticotherapy Criptococose sistêmica generalizada em cão após corticoterapia imunossupressora

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    C.S. Honsho

    2003-04-01

    Full Text Available A male Boxer dog aged 2 years and 11 months was referred to the veterinary hospital with a history of a gastrointestinal disorder of two months duration, with apathy, hyporexia, progressive weight loss and visual deficit. Ataxia and vocalization were observed during hospitalization. The animal had been treated previously with antibiotics and immunosuppressive doses of corticoids to control chronic inflammatory bowel disease. The dog died five days later. Gross and microscopic observations indicated systemic cryptococcosis. The alimentary tract, eyes, brain, kidneys, pancreas and lymph nodes were involved.Um cão da raça Boxer, macho, com 2 anos e 11 meses de idade foi encaminhado ao hospital veterinário com histórico de distúrbio gastroentérico de dois meses de duração, apatia, hiporexia, emagrecimento progressivo e deficiência visual. Ataxia e vocalização foram observadas posteriormente. O animal estava sendo tratado em outra clínica veterinária com antibióticos e doses imunossupressoras de corticóides, direcionados ao controle de provável enterite alimentar. A morte ocorreu após cinco dias. As observações macro e microscópica revelaram tratar-se de criptococose sistêmica, atingindo trato digestório, olhos, SNC, rins, pâncreas e linfonodos. O presente relato enfatiza a infecção fúngica criptocócica quanto aos seus aspectos grastrointestinais iniciais a serem considerados no diagnóstico clínico, ressaltando a imunossupressão induzida pela corticoterapia.

  20. Metabolic alteration of urinary steroids in pre- and post-menopausal women, and men with papillary thyroid carcinoma

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    Chung Bong

    2011-08-01

    Full Text Available Abstract Background To evaluate the metabolic changes in urinary steroids in pre- and post-menopausal women and men with papillary thyroid carcinoma (PTC. Methods Quantitative steroid profiling combined with gas chromatography-mass spectrometry was used to measure the urinary concentrations of 84 steroids in both pre- (n = 21, age: 36.95 ± 7.19 yr and post-menopausal female (n = 19, age: 52.79 ± 7.66 yr, and male (n = 16, age: 41.88 ± 8.48 yr patients with PTC. After comparing the quantitative data of the patients with their corresponding controls (pre-menopause women: n = 24, age: 33.21 ± 10.48 yr, post-menopause women: n = 16, age: 49.67 ± 8.94 yr, male: n = 20, age: 42.75 ± 4.22 yr, the levels of steroids in the patients were normalized to the mean concentration of the controls to exclude gender and menopausal variations. Results Many urinary steroids were up-regulated in all PTC patients compared to the controls. Among them, the levels of three active androgens, androstenedione, androstenediol and 16α-hydroxy DHEA, were significantly higher in the pre-menopausal women and men with PTC. The corticoid levels were increased slightly in the PTC men, while progestins were not altered in the post-menopausal PTC women. Estrogens were up-regulated in all PTC patients but 2-hydroxyestrone and 2-hydroxy-17β-estradiol were remarkably changed in both pre-menopausal women and men with PTC. For both menopausal and gender differences, the 2-hydroxylation, 4-hydroxylation, 2-methoxylation, and 4-methoxylation of estrogens and 16α-hydroxylation of DHEA were differentiated between pre- and post-menopausal PTC women (P P -7. Conclusions These results are expected be helpful for better understanding the pathogenic differences in PTC according to gender and menopausal conditions.

  1. EPIGENETIC EFFECTS OF SHIFTWORK ON BLOOD DNA METHYLATION

    Science.gov (United States)

    Bollati, Valentina; Baccarelli, Andrea; Sartori, Samantha; Tarantini, Letizia; Motta, Valeria; Rota, Federica; Costa, Giovanni

    2012-01-01

    In the present study, the authors investigated the effects of shiftwork exposure on DNA methylation using peripheral blood DNA from subjects working in two chemical plants in Northern Italy. The investigation was designed to evaluate (a) DNA methyl- ation changes in Alu and long interspersed nuclear element-1 (LINE-1) repetitive elements as a surrogate of global methylation and (b) promoter methylation of gluco- corticoid receptor (GCR), tumor necrosis factor alpha (TNF-α), and interferon- gamma (IFN-γ). One hundred and fifty white male workers (mean ± SD: 41.0 ± 9 yrs of age) were examined: 100 3 × 8 rotating shiftworkers (40.4 ± 8.7 yrs of age) and 50 day workers (42.2 ± 9.4 yrs of age). The authors used bisulfite-pyrosequencing to esti- mate repetitive elements and gene-specific methylation. Multiple regression analysis, adjusted for age, body mass index (BMI), and job seniority, did not show any signifi- cant association between the five DNA methylation markers and shiftwork. However, job seniority, in all subjects, was significantly associated with Alu (β = −0.019, p = .033) and IFN-γ (β = −0.224, p 15 yrs) was associated with significantly lower Alu (β = −0.86, p = .006) and IFN-γ methylation (β = −6.50, p = .007) after adjust- ment for age, BMI, and morningness/eveningness. In addition, GCR significantly increased with length of shiftwork (β = 3.33, p = .05). The data showed alterations in blood DNA methylation in a group of shiftworkers, including changes in Alu repeti- tive elements methylation and gene-specific methylation of IFN-γ and TNF-α promoters. Further studies are required to determine the role of such alterations in mediating the effects of shiftwork on human health. PMID:20636218

  2. Graham-Little Piccardi Lassueur Syndrome: case report Síndrome de Graham-Little Piccardi Lassueur: relato de caso

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    Raquel Bissacotti Steglich

    2012-10-01

    Full Text Available A 33-year-old woman presented with a 3-year history of progressive alopecia of the scalp. Past treatment with hydroxicloroquine did not show improvement. Physical examination revealed multiple areas of alopecia with atrophic aspect of the scalp, and axillary and pubic hypotrichosis. Dermoscopy showed hyperkeratosis and accentuation of follicular ostia. Anatomopathological examination revealed decrease in the number of hair follicles, upper perifollicular infiltrate and areas with fibrosis. The Piccardi-Lassueur-Graham-Little syndrome is a rare disorder, characterized by the triad of multifocal scarring alopecia of the scalp, keratotic follicular eruption and hypotrichosis of axillary and pubic regions. Management is a challenge and many medications tried have controversial results. We report a case of this rare syndrome which improved with corticoids.Mulher, 33 anos, apresenta quadro de alopecia progressiva do couro cabeludo há 3 anos. Tratamento com hidroxicloroquina há 12 meses, sem apresentar melhora. Ao exame físico exibe múltiplas áreas de alopecia cicatricial no couro cabeludo, além de hipotricose axilar e pubiana. A dermatoscopia evidencia hipercetose folicular e acentuação dos óstios foliculares. O exame anatomopatológico revela diminuição do número de folículos pilosos, infiltrado perifolicular e fibrose. A síndrome de Graham-Little Piccardi Lassueur é uma dermatose rara, caracterizada pela tríade de alopecia cicatricial multifocal do couro cabeludo, ceratose folicular disseminada e hipotricose das regiões axilares e pubianas. A terapêutica desta dermatose é um desafio, muitas medicações relatadas tem resultados controversos. Relatamos o caso desta síndrome rara que apresentou melhora com corticoterapia.

  3. Crisis de esclerodermia renal normotensiva

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    M. Villaverde

    2003-01-01

    Full Text Available Paciente de sexo masculino de 60 años con esclerosis sistémica que evolucionó con crisis de esclerodermia renal normotensiva. Tenía compromiso poliarticular, esofágico, pulmonar y cutáneo. Antes de internarse en nuestro hospital recibió tratamiento con altas dosis de corticoides, lo que probablemente precipitó el daño renal que presentó en su evolución, caracterizado por falla renal, anemia hemolítica microangiopática sin elevación de la presión arterial. La ausencia de hipertensión se observa sólo en el 10% de los casos de esclerodermia renal. Recibió tratamiento con enalapril y hemodiálisis. Evolucionó en forma desfavorable, sin respuesta a la terapeútica y falleció a los siete días de internado.A 60 year old male patient having systemic scleroderma and normotensive scleroderma renal crisis was admitted in our hospital. He presented polyarticular, esophagic, lung and skin compromise. Before admission he had been treated with high doses of corticosteroids. We believe corticosteroids led to the worsening of renal damage with renal failure, microangiopathic hemolytic anemia without high blood pressure. The 10% of these cases have normal blood pressure. The patient was treated with enalapril and hemodyalisis. There was no favourable response to this treatment and he died seven days after admission.

  4. Post traumatic retroperitoneal fibrosis as a cause of low-back pain Fibrosis retroperitoneal postraumática como causa de dolor lumbar

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    A.M. Hidalgo-Ovejero

    2011-12-01

    Full Text Available We present the case of a male patient with post traumatic retroperitoneal fibrosis whose main clinical expression was low-back pain. Diagnosis was established using CAT-scan and MRI, which revealed a large mass of soft tissue that almost entirely enveloped the abdominal aorta. Treatment with 40 mg of prednisone every 24 hours was established. This dose was reduced gradually, and progressive remission of clinical signs and symptoms was achieved, with a significant improvement of subsequent imaging-test results. Treatment was continued for one year. Two and a half years later the patient remains symptom-free, with no recurrence of his condition.Se presenta el caso de un paciente varón afecto de una fibrosis retroperitoneal postraumática, a cuyo diagnóstico se llegó a partir de dolor lumbar como síntoma principal. El diagnóstico se efectuó en base a los estudios mediante CT y RM, los cuales demostraron una gran masa de tejido de partes blandas que rodeaban la aorta. El tratamiento consistió en dosis de prednisona que inicialmente se instauró a 40 mg cada 24 horas, y posteriormente se fue reduciendo de forma gradual hasta la remisión de los signos y síntomas, y consecuentemente de los estudios de imagen. El tratamiento con corticoides se mantuvo durante un año. Dos años y medio el paciente está libre de síntomas sin recidiva de su proceso.

  5. Study Of Topical Anti-Inflammatory Potency And Clinical Efficacy Of Formulations Of Mometasone And Betamethasone By Cutaneous Blood Flow Measurements In Psoriatic Patients Using Laser Doppler Velocimetry

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    Mulekar S. V

    1997-01-01

    Full Text Available Laser Doppier Velocimetry (LDV was used to measure cutaneous blood flow (CBF in psoriatic skin lesions to assess the effect of once daily application of Mometasone furoate (MF in a base claimed to possess a “reservoir” effect, as against Betamethasone-17-valarate (BV in a conventional cream base, applied twice daily, for 4 weeks. Bilaterally symmetrical active lesions were studied in 10 psoriatics, at baseline and at the end of 2 and 4 weeks’ treatment. The formulations were also evaluated for topical anti-inflammatory potency in terms of their ability to inhibit the Post-Ischaemic-Reactive-Hyperaemic-Response (PIRHR induced on normal uninvolved skin treated under occlusion. The lesions were also assessed subjectively for clinical Psoriatic Hyperaemia Index (PHI = CBF on lesions/CBF on uninvolved skin: 8.42 + 1.74 & 10.13 + 1.70 correlating with high CPI (9 + 0.50 & 9.1 + 0.51. During treatment with MF or BV, the lesions resolved rapidly, with a concomitant decrease in PHI and CPI (Week 2 : PHI = 3.40 + 0.46 & 5.19 + 1.65, CPI = 4.15 + 0.86& 5.20 + 0.87 and Week 4 : PHI = 1.99 + 0.23 & 2.81 + 0.74 CPI = 2.00 + 0.50 & 2.88 + 0.72 respectively. The two formulations Inhibited PIRHR to same extent (auc/min: Control = 1871 + 399.22, MF = 536.11 + 153.34 & BV = 567.5 + 110.76, indicating equal potency. The results show that pharmaceutical factor such as vehicle can significantly influence the clinical efficacy of corticoids.

  6. [Status epilepticus in paediatrics: a retrospective study and review of the literature].

    Science.gov (United States)

    Moreno-Medinilla, Esther E; Negrillo-Ruano, Rocío; Calvo-Medina, Rocío; Mora-Ramírez, M Dolores; Martínez-Antón, Jacinto L

    2015-05-01

    Introduccion. El estado epileptico (EE) es la emergencia neurologica mas frecuente en pediatria. Dada la posibilidad de secuelas neurologicas y mortalidad asociadas, requiere un tratamiento agresivo precoz. Pacientes y metodos. Estudio descriptivo retrospectivo a traves de la revision de historias clinicas de pacientes ingresados en nuestro hospital entre 2010-2013 con diagnostico de EE. El objetivo fue describir las caracteristicas epidemiologicas y el manejo de estos pacientes, asi como revisar la bibliografia disponible sobre este tema. Resultados. Hemos recogido 39 pacientes (25 varones) y 51 episodios de EE. Edad media: 4,8 años. Tenian enfermedad de base 22 pacientes. Dieciocho eran epilepticos conocidos y cinco tuvieron un EE previo. De los 51 episodios de EE, 33 fueron sintomaticos, 15 febriles y tres criptogenicos. Los tipos de EE fueron: 25 parciales (de ellos, 16 complejos) y 26 generalizados. El tratamiento de primera eleccion fue benzodiacepinas en 47 pacientes (40, diacepam), fenitoina en tres y acido valproico en uno. Veintisiete pacientes precisaron farmacos de segunda linea: 16, acido valproico; ocho, fenitoina; dos, fenobarbital; y uno, levetiracetam. Diez pacientes precisaron farmacos de tercera linea para la induccion del coma: el midazolam fue el mas utilizado en nuestro centro, seguido del tiopental y el propofol. Dos EE superrefractarios requirieron inmunoglobulinas y corticoides sistemicos por presentarse en el curso de encefalitis autoinmunes. Conclusiones. Debe plantearse el esquema terapeutico del EE desde el inicio de cualquier crisis convulsiva. El tratamiento es escalonado, con benzodiacepinas en la primera etapa, antiepilepticos de amplio espectro y disponibilidad intravenosa en la segunda (acido valproico, levetiracetam en el EE generalizado y fenitoina en el EE focal), mientras que el tercer nivel varia en funcion de la experiencia de cada equipo.

  7. Retinite por citomegalovirus (CMV após terapia imunossupressora para vasculite leucocitoclástica Cytomegalovirus (CMV retinitis after immunossupressive therapy for leukocytoclastic vasculitis

    Directory of Open Access Journals (Sweden)

    Carlos Ewerton Maia Rodrigues

    2009-02-01

    Full Text Available A retinite por citomegalovírus (CMV é uma doença rara que acomete principalmente pacientes com a síndrome da imunodeficiência adquirida (AIDS. No entanto, outros pacientes imunossuprimidos, como os transplantados, os que estão em uso de quimioterápicos, pacientes com lúpus eritematoso sistêmico (LES ou em tratamento com drogas imunossupressoras também podem ser acometidos. O quadro clínico caracteriza-se por visão turva, diminuição da acuidade ou alterações de campo visual, geralmente unilateral, podendo ocorrer deslocamento de retina. A perda visual é progressiva, evolui em ritmo variável até a completa amaurose do olho acometido. O presente relato de caso descreve um paciente com vasculite leucocitoclástica grave submetido à terapia com corticoide em dose imunossupressora que evoluiu com glaucoma, panuveíte por CMV, perda da acuidade visual e infecção bacteriana secundária.Cytomegalovirus (CMV retinitis is a rare disease which mainly affects patients with acquired immunodeficiency syndrome (AIDS. Nevertheless, other immunosuppressed patients, such as the organ transplant recipients, the ones using chemotherapy, patients with systemic lupus erythematosus (SLE or in treatment with immunosuppressive drugs can also be attacked. The clinical characteristics are blurred vision, decrease of the visual acuity or visual field alterations, generally unilateral, with the possibility of retinal detachment. The visual loss is progressive, evolving in a variable rate until complete amaurosis of the attacked eye. The present case report describes a patient with severe leukocytoclastic vasculitis, submitted to corticosteroid therapy in immunosuppressive doses that evolved with glaucoma, panuveitis by CMV, loss of visual acuity and secondary bacterial infection.

  8. Fecal cortisol metabolite analysis for noninvasive monitoring of adrenocortical function in the cheetah (Acinonyx jubatus).

    Science.gov (United States)

    Terio, K A; Citino, S B; Brown, J L

    1999-12-01

    A radioimmunoassay was validated for quantifying excreted cortisol metabolites in cheetah (Acinonyx jubatus) feces. High-performance liquid chromatography analysis indicated that immunoreactivity was associated with a water-soluble metabolite in fecal extracts from males and females. None of the immunoreactivity corresponded with free cortisol or corticosterone but rather was associated with a more polar, unidentified metabolite. To determine the biologic relevance of excreted immunoreactive cortisol metabolites, cheetahs were exposed to a variety of situations anticipated to increase cortisol secretion. First, to assess acute changes in adrenal activity, adrenocorticotropic hormone (ACTH; 400 IU i.m.) was administered to two adult males and two adult females. Pre-ACTH baseline serum cortisol and fecal cortisol metabolite concentrations varied among individuals. Serum cortisol concentrations were elevated above baseline within 10 min of ACTH injection, followed by corresponding increases in fecal cortisol metabolite concentrations (690-4,194% above baseline) 48 hr later in three of four cheetahs. In the fourth cheetah, a smaller increase (334% above baseline) in fecal cortisol metabolite excretion was observed 96 hr after ACTH injection. Seven cheetah females also were subjected to a variety of potentially stressful manipulations, including immobilization, translocation, and introduction to a male to assess the ability of this technique to detect physiologic changes in adrenal activity. Increased fecal corticoid metabolite excretion was observed 24-72 hr after exposure to these exogenous stressors. Results indicate that adrenocortical activity can be monitored noninvasively in the cheetah through analysis of these metabolites. This technique could be valuable for evaluating, and thus optimizing, environmental and management conditions and for investigating the role of stress in disease pathogenesis and the usually poor reproductive performance of this species in

  9. On the development of markers for pathological TDP-43 in amyotrophic lateral sclerosis with and without dementia.

    Science.gov (United States)

    Geser, F; Prvulovic, D; O'Dwyer, L; Hardiman, O; Bede, P; Bokde, A L W; Trojanowski, J Q; Hampel, H

    2011-12-01

    Pathological 43-kDa transactive response sequence DNA-binding protein (TDP-43) has been recognized as the major disease protein in amyotrophic lateral sclerosis (ALS), frontotemporal lobar degeneration with ubiquitin positive, tau and α-synuclein negative inclusions (FTLD-U) and the transitional forms between these multisystem conditions. In order to develop TDP-43 into a successful ALS biomarker, the natural history of TDP-43 pathology needs to be characterized and the underlying pathophysiology established. Here we propose a spatial and temporal "two-axes" model of central nervous system vulnerability for TDP-43 linked degeneration and review recent studies on potential biomarkers related to pathological TDP-43 in the cerebrospinal fluid (CSF), blood, and skeletal muscle. The model includes the following two arms: Firstly, a "motor neuron disease" or "spinal cord/brainstem to motor cortex" axis (with degeneration possibly ascending from the lower motor neurons to the upper motor neurons); and secondly, a "dementia" or "corticoid/allocortex to neocortex" axis (with a probable spread of TDP-43 linked degeneration from the mediotemporal lobe to wider mesocortical and neocortical brain areas). At the cellular level, there is a gradual disappearance of normal TDP-43 in the nucleus in combination with the formation of pathological aggregates in the cell body and cellular processes, which can also be used to identify the stage of the disease process. Moreover, TDP-43 lesions in subpial/subependymal or perivascular localizations have been noted, and this might account for increased CSF and blood TDP-43 levels through mechanisms that remain to be elucidated.

  10. Periinterventional prophylactic antibiotics in radiological port catheter implantation; Periinterventionelle prophylaktische Antibiotikagabe bei der radiologischen Portkatheterimplantation

    Energy Technology Data Exchange (ETDEWEB)

    Gebauer, B.; Teichgraeber, U.; Werk, M. [Charite, Universitaetsmedizin Berlin (Germany). Klinik fuer Strahlenheilkunde; Wagner, H.J. [Vivantes Klinikum im Friedrichshain und am Urban (Germany). Inst. fuer Radiologie

    2007-08-15

    Purpose: To evaluate whether catheter-related infections after radiologically placed port catheters can be reduced by single-shot periinterventional antibiosis. Materials and Method: Between January and September 2002, 164 consecutive patients with indication for central venous port catheter implantation were included in the present study. During implantation the interventional radiologist was responsible for deciding whether to administer a prophylactic single-shot antibiosis. The prophylactic antibiosis entailed intravenous administration of ampicillin and sulbactam (3 g Unacid, Pfizer) or 100 mg ciprofloxacine (Ciprobay, Bayer) in the case of an allergy history to penicillins. Catheter-related infection was defined as a local or systemic infection necessitating port catheter extraction. Results: Indication for port catheter implantation was a malignant disease requiring chemotherapy in 158 cases. The port catheter (Chemosite [Tyco Healthcare] [n = 123], low-profile [Arrow International] [n = 35], other port system [n = 6]) was implanted via sonographically guided puncture of the right jugular vein in 139 patients, via the left jugular vein in 24 cases and via the right subclavian vein in one patient. 75 patients received periinterventional prophylactic antibiosis (Unacid [n = 63] Ciprobay [n = 12]) and 89 patients did not receive antibiosis. The prophylactic antibiosis caused a minor allergic reaction in one patient that improved with antihistamic and corticoid medication. A total of 7 ports, 6 without prophylactic antibiosis versus one with periinterventional prophylaxis, were extracted due to infectious complications. Conclusion: Single-shot periinterventional prophylactic antibiosis can reduce early and late infectious complications after radiological-interventional placement of central venous port catheters. (orig.)

  11. Urinary lithiasis and idiopathic hypercalciuria: the importance of dietary intake evaluation

    Directory of Open Access Journals (Sweden)

    Patricia C. G. Damasio

    2010-10-01

    Full Text Available PUSPOSE: To evaluate food intake of patients with urinary lithiasis and idiopathic hypercalciuria (IH. MATERIALS AND METHODS: Between August 2007 and June 2008, 105 patients with lithiasis were distributed into 2 groups: Group 1 (n = 55 - patients with IH (urinary calcium excretion > 250 mg in women and 300 mg in men with normal serum calcium; Group 2 (n = 50 - normocalciuria (NC patients . Inclusion criteria were: age over 18, normal renal function (creatinine clearance = 60 mL/min, absent proteinuria and negative urinary culture. Pregnant women, patients with some intestinal pathology, chronic diarrhea or using corticoids were excluded. The protocol of metabolic investigation was based on non-consecutive collection of two 24-hour samples for dosages of: calcium, sodium, uric acid, citrate, oxalate, magnesium and urinary volume. Food intake was evaluated through the quantitative method of Dietary Register of three days. RESULTS: Urinary excretion of calcium (433.33 ± 141.92 vs. 188.93 ± 53.09, sodium (280.08 ± 100.94 vs. 200.44.93 ± 65.81, uric acid (880.63 ± 281.50 vs. 646.74 ± 182.76 and magnesium (88.78 ± 37.53 vs. 64.34 ± 31.84 was significantly higher in the IH group in comparison to the NC group (p < 0.05. As regards the nutritional composition of food intake of IH and NC groups, there was no statistical significant difference in any nutrient evaluated. CONCLUSION: In our study, no difference was observed in the food intake of patients with urinary lithiasis and IH or NC.

  12. Clinical and serological characterization of autoimmune hemolytic anemia after allogeneic hematopoietic stem cell transplantation

    Institute of Scientific and Technical Information of China (English)

    Yang Zhen; Wu Bangzhao; Zhou Youning; Wang Wenjuan; Chen Suning; Sun Aining; Wu Depei

    2014-01-01

    Background Autoimmune hemolytic anemia (AIHA) is an uncommon complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT) which has only been reported in a few cases.We here aimed to explore its mechanism.Methods We retrospectively analyzed 296 patients who underwent allo-HSCT in our center from July 2010 to July 2012.Clinical manifestations were carefully reviewed and the response to currently available treatment approaches were evaluated.The survival and risk factors of AIHA patients after allo-HSCT were further analyzed.Results Twelve patients were diagnosed with AIHA at a median time of 100 days (15-720 days) after allo-HSCT.The incidence of AIHA after allo-HSCT was 4.1%.IgG antibody were detected in ten patients and IgM antibody in two patients.The two cold antibody AIHA patients had a better response to steroid corticoid only treatment and the ten warm antibody AIHA patients responded to corticosteroid treatment and adjustment of immunosuppressant therapy.Rituximab was shown to be effective for AIHA patients who failed conventional therapy.Survival analysis showed that the combination of AIHA in allo-HSCT patients hinted at poor survival.Cytomegalovirus (CMV) infection,graft-versus-host disease (GVHD) and histocompatibility leukocyte antigen (HLA) mismatch seemed to increase the risk of developing AIHA.Conclusions Patients who develop AIHA after allo-HSCT have poor survival compared to non-AIHA patients.Possible risk factors of AIHA are CMV infection,GVHD,and HLA mismatch.Rituximab is likely to be the effective treatment choice for the refractory patients.

  13. [Tropical spastic paraparesis in a non tropical region].

    Science.gov (United States)

    Pias-Peleteiro, L; Pias-Peleteiro, J M; Arias, M

    2015-10-16

    Introduccion. El virus linfotropo humano de celulas T tipo 1 (HTLV-1) es el agente causal de la paraparesia espastica tropical. Su prevalencia, elevada en determinadas areas tropicales, es baja en Europa y Norteamerica. Casos clinicos. Se describen dos casos de paraparesia espastica tropical en varones naturales y residentes en Galicia. Se realizaron estudios analiticos en la sangre y el liquido cefalorraquideo (LCR), examenes neurofisiologicos y resonancia magnetica craneal y medular. En ambos pacientes, la presentacion clinica fue la de una mielopatia cronica, con cuadro torpido y progresivo que evoluciono a paraparesia espastica. Un paciente desarrollo uveitis antes de la clinica neurologica. En los dos casos, el estudio del LCR demostro leve pleocitosis linfoide, ligera hiperproteinorraquia, bandas oligoclonales negativas y anticuerpos anti-HTLV-1 positivos. La reaccion en cadena de la polimerasa para HTLV-1 resulto positiva en ambos casos. La resonancia magnetica raquidea resulto normal en un paciente y mostro en el otro hiperseñal medular dorsal, que desaparecio tras el tratamiento. No se demostraron datos de polineuropatia periferica. Recibieron corticoides e interferon alfa, con leve mejoria y estabilizacion del cuadro clinico. La anamnesis dirigida revelo antecedentes de contactos sexuales de riesgo en regiones endemicas de HTLV-1. Conclusiones. La uveitis asociada a HTLV-1 podria ser predictora de paraparesia espastica tropical. Esta es probablemente una entidad infradiagnosticada (alto porcentaje de portadores asintomaticos, clinica insidiosa y bajo indice de sospecha en areas no endemicas). Debe considerarse su diagnostico en zonas no tropicales que reciben inmigrantes de areas endemicas y tambien en regiones con una tradicional emigracion a regiones tropicales.

  14. Ten-year study of species distribution and antifungal susceptibilities of Candida bloodstream isolates at a Brazilian tertiary hospital.

    Science.gov (United States)

    Bonfietti, L X; Szeszs, M W; Chang, M R; Martins, M A; Pukinskas, S R B S; Nunes, M O; Pereira, G H; Paniago, A M M; Purisco, S U; Melhem, M S C

    2012-12-01

    To describe the incidence and susceptibility profile of Candida bloodstream infections in a tertiary-care hospital, we performed a retrospective observational study from 1998 to 2007. Comorbidities and risk factors were compiled from all cases. In vitro susceptibility testing to fluconazole, itraconazole, voriconazole, and amphotericin B was performed for 100 isolates, and caspofungin was tested for C. parapsilosis complex. In a ten-year evaluation of candidemias, 44 % were caused by C. albicans, and species of the C. parapsilosis complex were the second most frequent agents (37 %). Other species presented lower incidences (C. tropicalis, 13 %, C. glabrata, 5 %, and C. krusei, 1 %). Neither C. dubliniensis nor C. metapsilosis were observed in this study. C. orthopsilosis (3 %) and C. parapsilosis stricto sensu (34 %) were also found. Species distribution was independent of catheterization, mechanical ventilation, or previous use of antifungals or corticoids. Parenteral nutrition administration was strongly related to C. glabrata infection, and the highest mortality (80 %) was observed in patients infected by this species. All C. albicans isolates showed high susceptibility to all tested drugs. However, two C. parapsilosis stricto sensu isolates presented high minimum inhibitory concentration (MIC) (4 mg/L each) to fluconazole, and one exhibited voriconazole MIC of 0.25 mg/L, highlighting the cross-resistance to these azoles. All isolates of C. tropicalis and C. glabrata showed no resistance to any drug tested. No difference was noted between C. parapsilosis and C. orthopsilosis susceptibilities to caspofungin. Our results suggest that resistance to amphotericin B, fluconazole, voriconazole, itraconazole, and caspofungin in Brazilian Candida bloodstream isolates is still uncommon.

  15. Successful application of extracorporeal membrane oxygenation due to pulmonary hemorrhage secondary to granulomatosis with polyangiitis

    Directory of Open Access Journals (Sweden)

    Hohenforst-Schmidt W

    2013-07-01

    Full Text Available Wolfgang Hohenforst-Schmidt,1 Arndt Petermann,2 Aikaterini Visouli,3 Paul Zarogoulidis,4 Kaid Darwiche,5 Ioanna Kougioumtzi,6 Kosmas Tsakiridis,3 Nikolaos Machairiotis,6 Markus Ketteler,2 Konstantinos Zarogoulidis,4 Johannes Brachmann11II Medical Clinic, Coburg Clinic, University of Wuerzburg, Coburg, Germany; 2Division of Nephrology, Coburg Clinic, University of Wuerzburg, Coburg, Germany; 3Cardiothoracic Surgery Department, “Saint Luke” Private Hospital, Thessaloniki, Greece; 4Pulmonary Department, “G Papanikolaou” General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; 5Department of Interventional Pneumology, Ruhrlandklinik, West German Lung Center, University Hospital, University of Duisburg-Essen, Essen, Germany; 6Surgery Department (National Health System, University General Hospital of Alexandroupolis, Alexandroupolis, GreeceAbstract: Extracorporeal membrane oxygenation (ECMO is increasingly applied in adults with acute refractory respiratory failure that is deemed reversible. Bleeding is the most frequent complication during ECMO support. Severe pre-existing bleeding has been considered a contraindication to ECMO application. Nevertheless, there are cases of successful ECMO application in patients with multiple trauma and hemorrhagic shock or head trauma and intracranial hemorrhage. ECMO has proved to be life-saving in several cases of life-threatening respiratory failure associated with pulmonary hemorrhage of various causes, including granulomatosis with polyangiitis (Wegener’s disease. We successfully applied ECMO in a 65-year-old woman with acute life-threatening respiratory failure due to diffuse massive pulmonary hemorrhage secondary to granulomatosis with polyangiitis, manifested as severe pulmonary-renal syndrome. ECMO sustained life and allowed disease control, together with plasmapheresis, cyclophosphamide, corticoids, and renal replacement therapy. The patient was successfully weaned from ECMO

  16. Effect of acupuncture on TNF-alpha, IL-1b and IL-10 concentrations in the peritoneal exudates of carrageenan-induced peritonitis in rats Efeito da acupuntura sobre a concentração de TNF-alfa, IL-1b e IL-10 no exsudato peritoneal de ratos com peritonite induzida por carragenina

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    Márcia Valéria Rizzo Scognamillo-Szabó

    2005-02-01

    Full Text Available Acupuncture is an ancient and empirical therapeutic procedure known by its efficacy in the treatment of pain. However, the influence of acupuncture on inflammatory process is still poorly understood and additional research is needed. In this work, we investigated the mechanism of action of manual acupuncture on the inhibition of neutrophil migration to the peritoneal cavity induced by the inflammatory stimulus carrageenan in Wistar rats. Previous results from our laboratory showed that this anti-inflammatory effect is not due to endogenous corticoid release. Furthermore, the concentration of IL-1b, but not of TNF-alpha or IL-10 in the carrageenan-induced exudates was reduced in the acupuncture group. Further research will be needed to elucidate the mechanisms involved in the anti-inflammatory action of acupuncture as described here.A acupuntura é método terapêutico milenar reconhecido por sua eficácia no tratamento da dor, porém seu efeito sobre processos inflamatórios é ainda pouco conhecido e maiores estudos são necessários. Neste trabalho, é investigado o mecanismo de ação da acupuntura manual sobre a inibição na migração de neutrófilos para a cavidade peritoneal induzida por carragenina em ratos Wistar. Resultados prévios indicam que esse efeito antiinflamatório não depende de hormônios corticóides. Entretanto, as concentrações de IL-1b no exsudato induzido por carragenina foram reduzidas pelo tratamento com acupuntura. Por outro lado os níveis de TNF-alfa e IL-10 não foram afetados pelo tratamento. Mais pesquisas poderão elucidar os mecanismos envolvidos na ação antiinflamatória da acupuntura.

  17. Artrosis de cadera: tratamiento no protésico y alternativas de manejo con células madres mesenquimáticas

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    Dr. P. Rodrigo Mardones

    2014-09-01

    Full Text Available La artrosis de cadera, ya sea focal o generalizada, constituye una patología frecuente y de difícil manejo, que genera dolor y discapacidad. El tratamiento médico está basado en el uso de analgésicos y antiinflamatorios, incluyendo aquellos de origen natural. Sin embargo, además de las complicaciones asociadas a su uso prolongado, a medida que la enfermedad avanza se van haciendo menos efectivos. En este punto cobra importancia las alternativas intervencionales de diferente grado. El tratamiento se dificulta debido a la localización y esfericidad de la articulación y generalmente está limitado a la artroplastia total de cadera en artrosis generalizada. Previo a ésta, existen alternativas para el tratamiento de lesiones condrales profundas o artrosis focal que incluyen la resección, debridamiento, condroplastía térmica y/o microfracturas con o sin coadyudancia biológica (Ácido Hialurónico, Plasma Rico en Plaquetas (PRP y Células Madre Mesenquimáticas (CMM. Esta revisión se enfoca en el uso de nuevas tecnologías que pudieran mejorar los resultados obtenidos con las técnicas convencionales, incluyendo las infiltraciones (Corticoides/Ácido Hialurónico/PRP/CMM. Se detalla el uso de terapias biológicas en base al uso de CMM, correspondientes a las inyecciones intraarticulares de CMM expandidas, concentrado de células mononucleares en una matriz de PRP y CMM expandidas sembradas en una membrana de colágeno.

  18. Impact of rituximab therapy on response to tetanus toxoid vaccination in kidney-transplant patients.

    Science.gov (United States)

    Puissant-Lubrano, Benedicte; Rostaing, Lionel; Kamar, Nassim; Abbal, Michel; Fort, Marylise; Blancher, Antoine

    2010-03-01

    Rituximab is used after kidney transplant to prevention or treat kidney-allograft rejection. However, the impact of rituximab on the ability of patients to respond to tetanus toxoid vaccination has not yet been studied. The response to tetanus toxoid vaccination was analyzed in 39 kidney transplant recipients immunosuppressed by corticoids, antiproliferative agents, and/or calcineurin inhibitors. Thirteen patients had previously received rituximab (group 1), 26 patients had not (group 2). Response to control bacterial antigens and immunologic parameters (lymphocyte count, B-cell subsets, serum immunoglobulin level) were analyzed before and at 1 month after vaccination. Thirty healthy blood donors were used as controls for the before-vaccination immunologic parameters. Before vaccination, neither patient group differed from controls in serum levels of immunoglobulins and antibodies against bacterial antigens, but they did display lower levels of CD4 T cells and B cells compared with controls. Responders to the tetanus toxoid vaccination were slightly fewer in group 1 (4/13) than in group 2 (16/26), but the intensity of the anti-tetanus toxoid response was not significantly different between these 2 groups. None of the parameters studied at the time of vaccination (anti-tetanus toxoid level, peripheral B or CD4 T-cell count, memory B-cell subsets, treatment with rituximab, time since transplant) were associated with an ability to respond to vaccination. The ability to respond to vaccination and graft outcomes were not correlated in each patient group. Rituximab impaired the secondary immune response after tetanus toxoid vaccination, but did not abolish it in all patients.

  19. Association of genetic variations of genes encoding thrombospondin, type 1, domain-containing 4 and 7A with low bone mineral density in Japanese women with osteoporosis.

    Science.gov (United States)

    Mori, Seijiro; Kou, Ikuyo; Sato, Hidenori; Emi, Mitsuru; Ito, Hideki; Hosoi, Takayuki; Ikegawa, Shiro

    2008-01-01

    Twins and family studies have shown that genetic factors are important determinants of bone mass. Important aspects of bone mineral density (BMD) regulation are endocrine systems, notably hormonal regulation of adrenal corticoids, as indicated by clinical knowledge of glucocorticoid-induced osteoporosis. Glucocorticoid is known to negatively regulate bone mass in vivo, and glucocorticoid increases thrombospondin messenger ribonucleic acid (mRNA) levels. We studied single nucleotide polymorphisms (SNPs) in genes encoding thrombospondin, type 1, domain-containing 4 and 7A (THSD4 and THSD7A) for possible association with lumbar and femoral BMD among 337 Japanese women with osteoporosis who participated in the BioBank Japan project. Genetic variations of THSD4 and THSD7A loci displayed significant association with lumbar and femoral BMD. Most significant correlation was observed for THSD7A SNP rs12673692 with lumbar BMD (P = 0.00017). Homozygous carriers of the major (G) allele had the highest BMD [0.886 +/- 0.011 g/cm2, mean +/- standard deviation (SD)], whereas heterozygous carriers were intermediate (0.872 +/- 0.013 g/cm2) and homozygous A-allele carriers had the lowest (0.753 +/- 0.023 g/cm2). THSD4 SNP rs10851839 also displayed strong association with lumbar BMD (P = 0.0092). In addition, both THSD7A and THSD4 displayed significant association with femoral BMD in a recessive model (P = 0.036 and P = 0.0046, respectively). Results suggest that variations of THSD7A and THSD4 loci may be important determinants of osteoporosis in Japanese women.

  20. [Surgical treatment of the rheumatoid hand].

    Science.gov (United States)

    Kénési, C

    1996-10-01

    In rheumatoid arthritis, involvement of the hand is serious, frequent and occurs early. It reaches synovial sheets, articular or tendinous, and causes painful and invalidating deformities. Our experience, based on 537 operations of the hand, indicates that reconstructive surgery can be practised at all levels. For the wrist, inferior radio ulnar arthrodesis strengthens the articulation and eradicates pain when performed in the early stage. Segmentar resection of ulnar diaphysis ensures the conservation of "prono- supination". In the case of destruction or luxation of the wrist, a choice has to be made between prosthesis and arthrodesis. We tend to prefer the latter which confers a strong, painless and definitive articulation. Ulnar deviation of metacarpo-phalangeal articulations of long fingers can be corrected by ligamentar or tendinous plasties. But the results are not always durable and they cannot be used when the articulations are destroyed. In that case prostheses have to be implanted. Swanson's silastic implants enable to straighten the fingers and to suppress pain but ensure a limited mobility. Likewise, interphalangeal deviations generally call for implants or arthrodeses. Trapezo-metacarpal or phalangeo-metacarpal deformities of the thumb are stabilised by arthrodeses, ensuring a strong and painless prehension. In conclusion, reconstructive surgery allows many possibilities but its results are often incomplete. It is therefore advisable to perform synovectomy as early as possible before the occurrence of deformities. Surgical synovectomy competes with isotopic, chemical or corticoid synoviosthesis. But at tendinous level, synovectomy alone should be used, since it gives excellent results. Even though rehabilitation after synovectomies is not always easy, we hope that it will prevent the occurrence of articular or tendinous destruction for many years.

  1. [CLIPPERS syndrome with atypical distribution of lesions in magnetic resonance imaging of the brain].

    Science.gov (United States)

    Canneti, Beatrice; Mosqueira, Antonio J; Gilo, Francisco; Carreras, Teresa; Barbosa, Antonio; Meca-Lallana, Virginia; Vivancos, José

    2013-10-16

    Introduccion. El sindrome CLIPPERS (chronic lymphocytic in?ammation with pontine perivascular enhancement responsive to steroids) es un proceso inflamatorio del sistema nervioso central cuyo rasgo distintivo son las lesiones puntiformes en el troncoencefalo captantes en los estudios de resonancia magnetica. Clinicamente, cursa con disartria, ataxia y diplopia, y suele responder a corticoides. Anatomopatologicamente, aparecen infiltrados de linfocitos T en los espacios perivasculares troncoencefalicos. Caso clinico. Mujer de 40 años con cuadro de instauracion subaguda de diplopia binocular, ataxia y disartria. En la resonancia magnetica cerebral presento lesiones puntiformes hipertintensas en secuencia T2 en el tronco, cerebelo, diencefalo y areas cortico-subcorticales bihemisfericas, que realzaron con contraste. Se realizo un estudio etiologico para descartar un origen infeccioso, neoplasico o inflamatorio subyacente, que resulto negativo. La paciente recibio tratamiento en dos ocasiones con metilprednisolona, con descenso progresivo de la dosis, con buena respuesta. Conclusiones. La diplopia y la ataxia, como en nuestro caso, estan presentes practicamente siempre. Los hallazgos en la RM consisten en lesiones captantes puntiformes localizadas en la protuberancia con extension hacia el cerebelo, ganglios basales y cuerpo calloso, con gradiente de captacion menor conforme se alejan rostralmente hacia la corteza, y caudalmente hacia la medula. En el caso de nuestra paciente, este gradiente no se respeta, encontrandose una densidad similar de las lesiones a nivel supratentorial. El diagnostico diferencial es amplio y justifica un estudio diagnostico extenso, y en casos seleccionados la biopsia cerebral. El curso de la enfermedad es remitente-recurrente, y el pronostico mejora cuanto mas precoz y prolongado es el tiempo de corticoterapia.

  2. Fatores associados ao obito neonatal de recem-nascidos de alto risco: estudo multicentrico em Unidades Neonatais de Alto Risco no Nordeste brasileiro

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    Cristiana Ferreira da Silva

    2014-02-01

    Full Text Available Este estudo pretendeu determinar os fatores associados à mortalidade intra-hospitalar, utilizando como variáveis explicativas as características individuais da mãe, da assistência ao pré-natal, parto e período neonatal e dos recém-nascidos internados em Unidades Neonatais de Alto Risco (UTIN integrantes da Rede Norte-Nordeste de Saúde Perinatal no Nordeste do Brasil. Foi realizado estudo longitudinal, multicêntrico de base hospitalar. A população do estudo compreendeu 3.623 nascidos vivos internados em 34 UTIN. Após o ajuste para os três níveis hierárquicos do modelo de determinação do óbito em UTIN até o 27 o dia de vida, associaram-se: tipo de parto – cesariana (OR = 0,72; IC95%: 0,56-0,95; não uso de corticoide antenatal (OR = 1,51; IC95%: 1,01-2,25; pré-eclâmpsia (OR = 0,73; IC95%: 0,56-0,95; oligodramnia (OR = 1,57; IC95%: 1,17-2,10; peso ao nascer < 2.500g (OR = 1,40; IC95%: 1,03-1,90; escore de Apgar 5 o minuto < 7 (OR = 2,63; IC95%: 2,21-3,14; uso de tubo endotraqueal (OR = 1,95; IC95%: 1,31-2,91; não uso de surfactante (OR = 0,54; IC95%: 0,43-0,69. O óbito em UTIN é determinado pelas condições assistenciais à gestação, parto e recém-nato.

  3. Safety, pharmacokinetics and pharmacodynamics of BI 135585, a selective 11β-hydroxysteroid dehydrogenase-1 (HSD1) inhibitor in humans: liver and adipose tissue 11β-HSD1 inhibition after acute and multiple administrations over 2 weeks.

    Science.gov (United States)

    Freude, S; Heise, T; Woerle, H-J; Jungnik, A; Rauch, T; Hamilton, B; Schölch, C; Huang, F; Graefe-Mody, U

    2016-05-01

    To assess the safety and pharmacokinetic and pharmacodynamic characteristics of BI 135585, a selective 11β-hydroxysteroid dehydrogenase-1 (11β-HSD1) inhibitor, after single- and repeated-dose administration. The single-dose study included open-label administration of 200 mg BI 135585 in healthy volunteers, while in the multiple-dose study, we carried out randomized, double-blind administration of 5-200 mg BI 135585 or placebo once daily over 14 days in patients with type 2 diabetes (T2DM). Assessments included 11β-HSD1 inhibition in the liver (urinary tetrahydrocortisol (THF)/tetrahydrocotisone (THE) ratio) and in subcutaneous adipose tissue (AT) ex vivo and determination of hypothalamus-pituitary-adrenal (HPA) axis hormone levels. No major safety issues occurred with BI 135585 administration. The HPA axis was mildly activated with slightly increased, but still normal adrenocorticotropic hormone levels, increased total urinary corticoid excretion but unchanged plasma cortisol levels. After multiple doses of 5-200 mg BI 135585, exposure (area under the curve) increased dose-proportionally and half-life was 55-65 h. The urinary THF/THE ratio decreased, indicating liver 11β-HSD1 inhibition. Median 11β-HSD1 enzyme inhibition in the AT reached 90% after a single dose of BI 135585, but was low (31% or lower) after 14 days of continuous treatment. BI 135585 was safe and well tolerated over 14 days and can be dosed once daily. Future studies are required to clarify the therapeutic potential of BI 135585 in view of its effects on 11β-HSD1 inhibition in AT after single and multiple doses. Enzyme inhibition in the AT was not adequately predicted by the urinary THF/THE ratio. © 2016 John Wiley & Sons Ltd.

  4. Practical aspects of the use of intrathecal chemotherapy

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    Raquel Olmos-Jiménez

    2017-01-01

    Full Text Available Introduction: Intrathecal chemotherapy is frequently used in clinical practice for treatment and prevention of neoplastic meningitis. Despite its widespread use, there is little information about practical aspects such as the volume of drug to be administered or its preparation and administration. Objective: To conduct a literature review about practical aspects of the use of intrathecal chemotherapy. Materials: Search in PubMed/ Medline using the terms chemotherapy AND intrathecal”, analysis of secondary and tertiary information sources. Results: The most widely used drugs in intrathecal therapy are methotrexate and cytarabine, at variable doses. One of the aspects with higher variability among different studies is their potential combination with a glucocorticoid, the specific corticoid selected and its dose. The efficacy and toxicity of the different combinations have not been compared. Regarding preparation, it is worth highlighting the recommendation to adjust pH and osmolarity to the physiological range, with the aim of improving tolerability. The volume of administration can influence distribution, and recommendated range is between 5 and 12 mL. Overall, it is recommended to extract a similar volume of cerebrospinal fluid before administration. The position of the patient during and after administration can have an impact on distribution and toxicity; lateral decubitus or sitting position is recommended in the first case, and prone and/ or supine position in the second one. Most publications don’t explain how the treatment has been prepared or administered, and the lack of standardization could affect results. Conclusions: There is a great variability in practice when using intrathecal chemotherapy, despite being an effective therapy, accepted by all international groups. This uncertainty is not li mited to the drugs and doses administered, but it also includes the manner of preparation and the administration technique. The

  5. Dexamethasone Regulates Macrophage and Cd4+Cd25+ Cell Numbers in the Chicken Spleen

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    AS Calefi

    2016-03-01

    Full Text Available Abstract Dexamethasone (DEX is a corticoid hormone that is experimentally used to mimic the effects of increased levels of endogenous corticosterone observed during the stress response. Currently, stress is considered one of the major predisposing factors for diseases in the poultry industry. The aim of this study was to analyze the effects of DEX and/or of a 20-fold coccidial vaccine dose on leukocyte phenotypes in the spleen and cecal tonsils of chickens. Twenty specific-pathogen-free (SPF Leghorn chickens were divided into four groups: a non-treated group (NT, a DEX-treated group (Dex, a vaccinated group (V and a DEX-treated+vaccinated group (Dex+V. On experimental day (ED 42, each bird in the vaccinated groups received a anti-coccidial vaccine. DEX was injected in the birds of the Dex and Dex+V groups (0.9 mg/kg onED42 and ED45. The immunophenotyping was performed by flow cytometry analysis of splenocytes and cecal tonsils cells onED48. DEX treatment per se was unable to change CD4+CD8+, CD4+CD8+ and CD4-CD8+ populations with TCRgd or CD28 in the spleen, or macrophages and T lymphocytes in the cecal tonsils. V group birds presented higher numbers of splenic macrophages compared with those measured in the Dex+V group. The number of CD4+CD25+ cells in the spleen of birds of the V group was higher than those measured in the other experimental groups. Our data suggest that CD4+CD25+ cells and macrophages might be influenced by DEX treatment in spleen, but not in the cecal tonsils of chickens inoculated with Eimeria.

  6. Brain radionecrosis in patients irradiated for nasopharyngeal carcinoma: about nine cases; Radionecrose cerebrale chez les patients irradies pour cancer du nasopharynx: a propos de neuf cas

    Energy Technology Data Exchange (ETDEWEB)

    Nasr Ben Ammar, C.; Chaari, N.; Kochbati, L.; Besbes, M.; Maalej, M. [Institut Salah-Azaiz, Service de Carcinologie-Radiotherapie, Tunis (Tunisia); Attia, I.; Ben Hamadi, D.; Chebbi, A.; Saadi, A. [Institut Salah-Azaiz, Service de radiologie, Tunis (Tunisia)

    2007-09-15

    Purpose To study the clinical, radiological, therapeutic and progressive aspects of brain radio necrosis after treatment for nasopharyngeal carcinoma. Patients and methods Nine patients (seven men and two women) of mean age 47.7 years old (extremes: 18-57 years old) were treated for UCNT (undifferentiated carcinoma of the nasopharynx) between 1989 and 2003 and developed cerebral radio necrosis. All patients were treated with radical radiotherapy. The mean total dose was 73.5 Gy (70-75 Gy). Dose per fraction was 2 to 2.5 Gy, one fraction daily. One patient received adjuvant brachytherapy to the dose of 8 Gy and four patients also received chemotherapy. Results Brain radio necrosis was authenticated by brain imaging (CT scan {+-} MRI): the imaging was ordered in seven cases to elucidate non-specific neurological signs and two cases were discovered fortuitously. The time to the appearance of neurological signs was 40.3 months (10 to 108 months). The localization was temporal in six cases, parieto-occipital (one case) and bulbo-medullar (two cases). After a mean follow-up period of 30.6 months (12-84 months), clinical outcomes were favorable in all cases receiving medical treatment (corticoids), with a stabilization of the radiological lesions in eight cases and complete radiological regression in one patient. Conclusion Brain radio necrosis is a late complication rarely occurring in patients irradiated for UCNT. Imaging techniques (CT scan but more so MRI) play a major role in the diagnosis. Cortico therapy resulted in a durable objective response in all patients and, in most cases, resulted in radiological stabilization. (authors)

  7. Líquen plano hipertrófico disseminado: relevante resposta à acitretina Disseminated hypertrophic lichen planus: relevant response to acitretin

    Directory of Open Access Journals (Sweden)

    Thais Jerez Jaime

    2011-08-01

    Full Text Available O líquen plano hipertrófico é uma variante do líquen plano, com pronunciada hiperplasia epidérmica em resposta à coçadura persistente. Clinicamente, caracterizam-se por placas hiperceratósicas, simétricas, de coloração cinza-violácea, com predileção pela região pré-tibial. O prurido intenso, a refratariedade aos tratamentos convencionais e a possibilidade de associação de um carcinoma epidermoide às lesões de longa duração impõem um tratamento eficaz. Os corticoides são considerados o tratamento de primeira linha e podem ser aplicados topicamente ou empregados de forma sistêmica. Outras modalidades terapêuticas propostas são a fototerapia com UVB-NB ou PUVA, imunossupressores e retinoides sistêmicos, com destaque para a acitretina. Relatamos um caso com apresentação clínica exuberante e excelente resposta à acitretin, totalizando um seguimento de nove mesesHyperthrofic lichen planus is considered a variant of lichen planus with marked epidermal hyperplasia in response to persistent itch. It is clinically, characterized by symmetric hyperkeratotic plaques, of purplish-grey color, often located in the pretibial region. Intense pruritus, refractoriness to conventional treatments and the possibility of association of the long-term injuries with squamous cell carcinoma requires an effective treatment. The first-line treatment is corticosteroids which can be applied either topically or systemically. Other therapeutic modalities proposed are: NB-UVB phototherapy or PUVA, immunosuppressive drugs and systemic retinoids, notably acitretin. We report a case with exuberant clinical presentation of hyperthrofic lichen planus with excellent response to acitretin after nine months of treatment

  8. Pathways involved in gut mucosal barrier dysfunction induced in adult rats by maternal deprivation: corticotrophin-releasing factor and nerve growth factor interplay.

    Science.gov (United States)

    Barreau, Frederick; Cartier, Christel; Leveque, Mathilde; Ferrier, Laurent; Moriez, Raphael; Laroute, Valerie; Rosztoczy, Andras; Fioramonti, Jean; Bueno, Lionel

    2007-04-01

    Neonatal maternal deprivation (NMD) increases gut paracellular permeability (GPP) through mast cells and nerve growth factor (NGF), and modifies corticotrophin-releasing factor (CRF) and corticosterone levels. CRF, corticosterone and mast cells are involved in stress-induced mucosal barrier impairment. Consequently, this study aimed to specify whether corticosteronaemia and colonic expression of both preproCRF and CRF are modified by NMD, and to determine if altered expression may participate in the elevated GPP in connection with NGF and mast cells. Male Wistar rat pups were either separated from postnatal days 2-14, or left undisturbed with their dam. At 12 weeks of age, adult rats were treated with mifepristone (an antagonist of corticoid receptors), alpha-helical CRF((9-41)) (a non-specific CRF receptor antagonist), or SSR-125543 (CRF-R(1) receptor antagonist). We also determined corticosteronaemia and both colonic preproCRF and CRF expression. Then, control rats were treated by CRF, doxantrazole (mast cell stabilizer), BRX-537A (a mast cell activator) and anti-NGF antibody. NMD did not modify colonic CRF level but increased colonic preproCRF expression and corticosteronaemia. Peripheral CRF, via CRF-R(1) receptor, but not corticosterone, was involved in the elevated GPP observed in these rats, through a mast-cell-mediated mechanism, since the increase of GPP induced by exogenous CRF was abolished by doxantrazole. Anti-NGF antibody treatment also reduced the elevated GPP induced by CRF or BRX-537A. CRF acts through CRF-R(1) receptors to stimulate NGF release from mast cells, which participates in the elevated GPP observed in NMD adult rats. This suggests that early traumatic experience induced neuro-endocrine dysfunction, involved in alterations of gut mucosal barrier.

  9. Asma de difícil control en niños y adolescentes: Estrategias diagnóstico-terapéuticas Poorly controlled asthma: diagnosis and therapeutics in children and adolescents

    Directory of Open Access Journals (Sweden)

    Hugo Neffen

    2012-10-01

    Full Text Available El asma es una de las enfermedades crónicas más frecuentes en los niños. Si bien la mayoría de los niños con asma responden a bajas dosis de corticoides inhalados y/o antagonistas del receptor de leucotrienos, algunos de ellos permanecen sintomáticos independientemente de cualquier esfuerzo terapéutico, presentando una elevada morbilidad e inclusive mortalidad. Aunque la mayoría de los pacientes controlan los síntomas de forma adecuada, existe un grupo importante que presenta síntomas graves de la enfermedad difíciles de controlar (ADC. El objetivo de la presente revisión es discutir los aspectos clínicos, diagnósticos y terapéuticos del ACD en los menores de 18 años y su implicancia en la práctica clínica diaria.Asthma is one of the most common chronic diseases in children. While most children with asthma respond to low doses of inhaled corticosteroids and /or leukotriene receptor antagonists, some of them remain symptomatic regardless of any therapeutic effort, showing a high morbidity and even mortality. While most of the patients control symptoms adequately, there is a large group with severe symptoms of the disease and difficult to control. The aim of this review is to discuss the clinical aspects, diagnosis and treatment of poorly controlled asthma in children and adolescents and its implications in daily clinical practice.

  10. Síndrome pulmón-riñón Pulmonary-renal syndrome

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    Jorge A. Risso

    2009-12-01

    Full Text Available El síndrome pulmón-riñón se define como una combinación de hemorragia alveolar difusa y glomerulonefritis. La coexistencia de estas dos afecciones clínicas se produce por enfermedades con distintos mecanismos patogénicos. Las vasculitis sistémicas primarias y el síndrome de Goodpasture son las etiologías más frecuentes. El lupus eritematoso sistémico, otras colagenopatías, las vasculitis con anticuerpos anticitoplasma de los neutrófilos negativos y las secundarias a drogas son causas mucho menos comunes. El diagnóstico temprano basado en criterios clínicos, radiológicos, de laboratorio e histológicos, permite iniciar el tratamiento disminuyendo su elevada morbi-mortalidad. La terapéutica se basa en altas dosis de corticoides, inmunosupresores, inhibidores del factor de necrosis tumoral y plasmaféresis.The pulmonary-renal syndrome is defined as a combination of diffuse alveolar hemorrhage and glomerulonephritis. The coexistence of these two clinical conditions is due to diseases with different pathogenic mechanisms. Primary systemic vasculitis and Goodpasture syndrome are the most frequent etiologies. Systemic lupus erythematosus, connective tissue diseases, negative anti neutrophil cytoplasmic antibody vasculitis and those secondary to drugs are far less common causes. An early diagnosis based on clinical, radiologic, laboratory and histologic criteria enables early treatment, thus diminishing its high morbility-mortality rate. Therapy is based on high doses of corticosteroids, immunosuppressants, tumor necrosis factor inhibitors and plasmapheresis.

  11. Limitaciones de los tratamientos conductuales: A propósito de un caso con Encefalitis por herpes simple

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    Modesto Jesús Romero-López

    2011-07-01

    Full Text Available Introducción. El tratamiento precoz con aciclovir limita el área de afectación por el virus del herpes simple (HSV al hipocampo y parahipocampo. Afecta principalmente a la memoria, aunque también puede provocar otras secuelas emocionales y conductuales. Se presenta el caso clínico de un paciente con encefalitis vírica por HSV al que se le realiza una evaluación neuropsicológica un año después del inicio de la infección. Caso clínico. Varón, de 63 años diagnosticado de encefalopatía por HSV. La resonancia magnética cerebral muestra hiperdensidad en la región medial del lóbulo temporal derecho, especialmente en hipocampo y parahipocampo. Siguió tratamiento con aciclovir y corticoides. Al año, la evaluación neuropsicológica muestra trastornos de la memoria episódica, rendimiento normal en el resto de las pruebas cognitivas, apatía y conducta tipo agresivo. Discusión. El tratamiento precoz limita la afectación del virus a la memoria, pero no exclusivamente. Las secuelas más importantes son las conductuales, dependientes de la integridad funcional de las áreas cerebrales afectadas. Esto implica directamente al diagnóstico diferencial y a los tratamientos psicológicos

  12. Avances en el tratamiento de las ataxias crónicas

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    María Celeste Buompadre

    2013-09-01

    Full Text Available Las ataxias crónicas cerebelosas autosómicas recesivas constituyen el grupo más amplio de ataxias hereditarias, con presentación principalmente en la edad pediátrica, se caracterizan por degeneración o desarrollo anormal del cerebelo y de la médula espinal. Hasta el momento el tratamiento etiológico está disponible sólo para algunas formas: aquellas con defecto metabólico conocido como la abetalipoproteinemia, la ataxia con deficiencia de vitamina E y la xantomatosis cerebrotendinosa. En estas entidades la modificación de la dieta, el suplemento con vitaminas E y A principalmente y la administración de ácido quenodexocicólico pueden cambiar el curso de la enfermedad. En la mayoría de los otros tipos de ataxia el tratamiento es solo de soporte, como por ejemplo el uso de antioxidantes y quelantes del hierro en la ataxia de Friederich con el objetivo de disminuir los depósitos de hierro mitocondriales, de corticoides en la ataxia telangiectasia y de ubiquinona /coenzima Q10 en la ataxia por deficiencia de coenzima Q-10. Si bien hasta el momento ningún tratamiento es curativo para la mayoría de las ataxias crónicas autosómico recesivas, el diagnóstico precoz de estas entidades se asocia con una mejor respuesta a las diferentes drogas.

  13. Anestesia em pacientes com teste de coombs direto positivo: relato de três casos Anestesia en pacientes con test de combs directo positivo: relato de tres casos Anesthesia in patients with positive direct coombs test: report of three cases

    Directory of Open Access Journals (Sweden)

    Joana Patrícia dos Santos Carvalho

    2010-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Existe associação entre anemias hemolíticas autoimunes (AHA e doença neoplásica, com consequente incompatibilidade sanguínea que dificulta a transfusão destes pacientes. Os autores descrevem e discutem a conduta em três casos com Teste de Coombs Direto (TCD positivo e impossibilidade de determinação de grupo sanguíneo propostos para intervenção cirúrgica por doença neoplásica. RELATO DOS CASOS: 1º caso: paciente do sexo masculino, 87 anos, ASA III, para intervenção cirúrgica por neoplasia do cólon. Apresentou TCD positivo, foi tratado com corticoide, imunoglobulina (Ig e eritropoietina, tendo-se conseguido tipar. No intraoperatório, administrou-se uma unidade de concentrado eritrocitário (UCE sem incidentes. Faleceu 24 horas depois por acidente vascular encefálico isquêmico. 2º caso: paciente do sexo masculino, 77 anos, ASA III, para intervenção cirúrgica de carcinoma gástrico. Apresentou TCD positivo, realizou tratamento com corticoide e Ig, não se conseguindo tipar. A intervenção cirúrgica decorreu sem incidentes. Faleceu ao 18º dia pós-operatório após parada cardiorrespiratória. 3º caso: paciente do sexo feminino, 80 anos, ASA IV, para laparotomia exploradora de urgência. Apresentou também TCD positivo. A intervenção cirúrgica (hemicolectomia decorreu sem incidentes. Faleceu às 48 horas do pós-operatório com acidente vascular encefálico isquêmico. CONCLUSÕES: Os autoanticorpos (Ac circulantes nas AHA podem impossibilitar tipagem sanguínea e disponibilidade de sangue compatível para transfusão. O tratamento correto da AHA visa à remissão dos Ac e ao tratamento da anemia. Na urgência em transfundir sem possibilidade de tipagem, a transfusão sanguínea surge como medida life-saving.JUSTIFICATIVA Y OBJETIVOS: Existe una asociación entre las anemias hemolíticas autoinmunes (AHA y la enfermedad neoplásica, con la consecuente incompatibilidad sanguínea que

  14. Complicación ocular de fractura malar y su manejo. Informe de caso.

    Directory of Open Access Journals (Sweden)

    Miguel E. León

    2009-11-01

    Full Text Available Antecedentes: El síndrome de la fisura orbitaria superior (SFOS es una complicación rara en pacientes con traumatismo maxilofacial, que consiste en una compresión directa o hematoma de las estructuras relacionadas con la FOS. Las características clínicas son: severo y persistente edema de los tejidos periorbitarios; proptosis y equimosis subconjuntival; ptosis y oftalmoplegia; dilatación de la pupila; ausencia del reflejo a la luz directa, reflejo consensual conservado; pérdida del reflejo de acomodación; pérdida del reflejo corneal; anestesia del párpado y la frente; reducción radiológica evidente de la dimensión de la FOS. Objetivo: El objetivo de este informe es presentar un caso clínico de un paciente que sufrió el síndrome de la fisura orbitaria superior, su manejo y los resultados postoperatorios. Materiales y métodos: Se presenta un caso clínico de un paciente de 20 años de edad, quien en su postoperatorio inmediato de reducción de fractura malar presentó las características clínicas y radiológicas del SFOS. Se hace una revisión actualizada del tema y las diferentes opciones de tratamiento. Este caso se manejó rápidamente con megadosis de corticoides. Resultados: El paciente recuperó totalmente su función ocular normal, respondiendo satisfactoriamente al manejo farmacológico. Conclusiones: Se concluye que el tratamiento efectuado fue exitoso.

  15. A validated analytical method to study the long-term stability of natural and synthetic glucocorticoids in livestock urine using ultra-high performance liquid chromatography coupled to Orbitrap-high resolution mass spectrometry.

    Science.gov (United States)

    De Clercq, Nathalie; Julie, Vanden Bussche; Croubels, Siska; Delahaut, Philippe; Vanhaecke, Lynn

    2013-08-01

    Due to their growth-promoting effects, the use of synthetic glucocorticoids is strictly regulated in the European Union (Council Directive 2003/74/EC). In the frame of the national control plans, which should ensure the absence of residues in food products of animal origin, in recent years, a higher frequency of prednisolone positive bovine urines has been observed. This has raised questions with respect to the stability of natural corticoids in the respective urine samples and their potential to be transformed into synthetic analogs. In this study, a ultra high performance liquid chromatography-high resolution mass spectrometry (UHPLC-HRMS) methodology was developed to examine the stability of glucocorticoids in bovine urine under various storage conditions (up to 20 weeks) and to define suitable conditions for sample handling and storage, using an Orbitrap Exactive™. To this end, an extraction procedure was optimized using a Plackett-Burman experimental design to determine the key conditions for optimal extraction of glucocorticoids from urine. Next, the analytical method was successfully validated according to the guidelines of CD 2002/657/EC. Decision limits and detection capabilities for prednisolone, prednisone and methylprednisolone ranged, respectively, from 0.1 to 0.5μgL(-1) and from 0.3 to 0.8μgL(-1). For the natural glucocorticoids limits of detection and limits of quantification for dihydrocortisone, cortisol and cortisone ranged, respectively, from 0.1 to 0.2μgL(-1) and from 0.3 to 0.8μgL(-1). The stability study demonstrated that filter-sterilization of urine, storage at -80°C, and acidic conditions (pH 3) were optimal for preservation of glucocorticoids in urine and able to significantly limit degradation up to 20 weeks.

  16. Relation of rheumatoid factor and anti-cyclic citrullinated peptide antibody with disease activity in rheumatoid arthritis: cross-sectional study.

    Science.gov (United States)

    Choe, Jung-Yoon; Bae, Jisuk; Lee, Hwajeong; Bae, Sang-Cheol; Kim, Seong-Kyu

    2013-09-01

    To analyze the association of rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibody (anti-CCP) with non-remission and with disease activity measures in rheumatoid arthritis (RA). Cross-sectional study of consecutive RA patients. Non-remission was defined as a disease activity score (DAS28) ≥ 2.6 at study enrollment. The Simplified Disease Activity Index (SDAI) and the Clinical Disease Activity Index (CDAI) were additionally measured. Serum titers of RF and anti-CCP were transformed into incremental levels (100/units) and log-transformed levels. Analysis of association with non-remission was done with logistic regression models, with and without adjustment for age, sex, disease duration, and corticoid use. Multiple regression models, raw and similarly adjusted, were used to measure the association of RF and anti-CCP with the disease activity measures. A total of 385 patients were included, of whom 286 (74 %) were not in remission. Log-transformed RF level was associated with an increased risk of non-remission after adjustment (OR = 1.32, 95 % CI 1.04-1.67). This association was especially evident in patients with less than 10 years of disease duration (OR = 1.51, 95 % CI 1.15-1.99) and in those using steroids (OR = 2.06, 95 % CI 1.22-3.48). Serum RF titers and log-transformed RF levels showed a small but significant association with DAS28 score (adjusted beta coefficients 0.002 and 0.18, respectively; both p ≤ 0.01), but neither with SDAI or CDAI nor with anti-CCP antibody. : Log-transformed RF levels might be associated with non-remission in RA, especially in patients with short disease duration or on steroids.

  17. On the development of markers for pathological TDP-43 in amyotrophic lateral sclerosis with and without dementia.

    LENUS (Irish Health Repository)

    Geser, F

    2011-12-01

    Pathological 43-kDa transactive response sequence DNA-binding protein (TDP-43) has been recognized as the major disease protein in amyotrophic lateral sclerosis (ALS), frontotemporal lobar degeneration with ubiquitin positive, tau and α-synuclein negative inclusions (FTLD-U) and the transitional forms between these multisystem conditions. In order to develop TDP-43 into a successful ALS biomarker, the natural history of TDP-43 pathology needs to be characterized and the underlying pathophysiology established. Here we propose a spatial and temporal "two-axes" model of central nervous system vulnerability for TDP-43 linked degeneration and review recent studies on potential biomarkers related to pathological TDP-43 in the cerebrospinal fluid (CSF), blood, and skeletal muscle. The model includes the following two arms: Firstly, a "motor neuron disease" or "spinal cord\\/brainstem to motor cortex" axis (with degeneration possibly ascending from the lower motor neurons to the upper motor neurons); and secondly, a "dementia" or "corticoid\\/allocortex to neocortex" axis (with a probable spread of TDP-43 linked degeneration from the mediotemporal lobe to wider mesocortical and neocortical brain areas). At the cellular level, there is a gradual disappearance of normal TDP-43 in the nucleus in combination with the formation of pathological aggregates in the cell body and cellular processes, which can also be used to identify the stage of the disease process. Moreover, TDP-43 lesions in subpial\\/subependymal or perivascular localizations have been noted, and this might account for increased CSF and blood TDP-43 levels through mechanisms that remain to be elucidated.

  18. Mucormycosis and chromoblastomycosis occurring in a patient with leprosy type 2 reaction under prolonged corticosteroid and thalidomide therapy Mucormicose e cromoblastomicose em um paciente com reação hansênica tipo II sob terapia prolongada com corticosteróide e talidomida

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    Flávia Machado Alves Basílio

    2012-10-01

    Full Text Available Mucormycosis is an uncommon fungal infection caused by Mucorales. It frequently occurs in patients with neutropenia, diabetes, malignancy and on corticoid therapy. However, it is rare in patients with AIDS. Clinical disease can be manifested in several forms. The case reported illustrates the rare occurrence of chromoblastomycosis and mucormycosis in an immunosuppressed patient with multibacillary leprosy, under prolonged corticosteroid and thalidomide therapy to control leprosy type 2 reaction. Neutrophil dysfunction, thalidomide therapy and work activities are some of the risk factors in this case. Chromoblastomycosis was treated by surgical excision and mucormycosis with amphotericin B. Although the prognosis of mucormycosis is generally poor, in the reported case the patient recovered successfully. This case should alert dermatologists to possible opportunistic infections in immunosuppressed patients.Mucormicose é uma infecção fúngica incomum causada por Mucorales. Ocorre frequentemente em pacientes com neutropenia, diabetes, corticoterapia e condições malignas. Porém, é rara em pacientes com AIDS. A doença pode apresentar-se em diferentes formas. Este caso ilustra a rara ocorrência de mucormicose e cromoblastomicose em um paciente com hanseníase multibacilar, que estava sendo tratado com prednisona e talidomida devido a eritema nodoso (reação hansênica tipo II. Disfunção de neutrófilos, uso de talidomida e atividades profissionais são alguns fatores de risco neste caso. A cromoblastomicose foi tratada por excisão cirúrgica e a mucormicose com anfotericina B. Embora o prognóstico da mucormicose seja ruim, neste caso o tratamento foi bem sucedido. Este caso alerta dermatologistas para a possibilidade de infecções oportunistas em pacientes imunossuprimidos.

  19. Eosinophilic esophagitis in adults, an emerging cause of dysphagia: Description of 9 cases Esofagitis eosinofílica del adulto, causa emergente de disfagia: Presentación de 9 casos

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    A. J. Lucendo Villarín

    2005-04-01

    Full Text Available Background: eosinophilic esophagitis is a rare condition mainly affecting children, although the number of cases reported in adults is on the increase. It is characterized by intense infiltration of eosinophilic leukocytes in the esophageal mucosa, without involvement of other sections of the alimentary canal. Material and methods: over the past year, following the performance of endoscopies and biopsies, our service identified nine patients who were diagnosed with suffering from this disorder. Each patient sought medical help for episodes of long-term, self-limited dysphagia or food impaction in the alimentary canal. Results: endoscopy revealed esophageal stenosis in the form of simultaneous contraction rings or regular stenosis. In six cases, the manometric study showed a nonspecific motor disorder of severe intensity affecting the esophageal body, and another patient had a disorder characterized by the presence of simultaneous waves and secondary peristaltic waves in the three thirds of the organ. These disorders are presumably due to eosinophilic infiltration of the muscular layer or ganglionar cells of the esophagus, and account for symptoms in these patients. Although the etiopathogenesis of this illness is uncertain, it is clearly an immunoallergic manifestation. Conclusions: as the number of diagnosed cases is on the increase, eosinophilic esophagitis is in adults a specific entity within the differential diagnosis of dysphagia in young males with a history of allergies. Eosiniphilic esophagitis responds in a different number of ways to therapies used. We successfully used fluticasone propionate, a synthetic corticoid applied topically, which proved to be efficient in the treatment of this illness by acting on the pathophysiological basis of the process. It does not have any adverse effects, thus offering advantages over other therapies such as systematic corticoids or endoscopic dilations.Introducción: la esofagitis eosinofílica es

  20. Nuevo consenso argentino de la enfermedad pulmonar obstructiva crónica

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    R. J. Gene

    2003-10-01

    Full Text Available Debido al aumento de la morbi-mortalidad de la enfermedad pulmonar obstructiva crónica (EPOC, especialistas en medicina respiratoria actualizan los conocimientos básicos acerca de esta enfermedad desde el último Consenso llevado a cabo en 1994 para efectuar recomendaciones para su diagnóstico, prevención y tratamiento. Los autores revisan la definición de EPOC, conjuntamente con los últimos conocimientos de la fisiopatología de la enfermedad. Se resume la presentación clínica, diagnóstico por imágenes y evaluación funcional. Se enfatiza la importancia del diagnóstico precoz mediante la exploración funcional y la prevención a través de la cesación del tabaquismo, única medida capaz de alterar la evolución. Se describen las estrategias para dejar de fumar, así como el tratamiento farmacológico y no farmacológico. En el primero, la administración de broncodilatadores inhalados -anticolinérgicos, beta 2 agonistas adrenérgicos o ambos- son la primera opción. Los broncodilatadores de acción prolongada mejoran la adherencia al tratamiento y su efectividad. Los corticoides inhalados se indican en pacientes con marcada obstrucción al flujo aéreo y respuesta conocida a corticoides. Su uso disminuye la frecuencia de las exacerbaciones. La vacunación antigripal anual está recomendada en todos los pacientes. Con respecto a las intervenciones no farmacológicas, la cirugía del enfisema se recomienda en especiales circunstancias. La rehabilitación que incluya ejercicios, kinesioterapia y nutrición, es una herramienta útil en pacientes con limitación en la actividad física habitual. La oxigenoterapia domiciliaria prolongada mejora la sobrevida de pacientes con hipoxemia crónica severa. Otras intervenciones terapéuticas como la ventilación no invasiva domiciliaria tienen indicación muy específica. Las exacerbaciones agudas deben ser tratadas agresivamente con oxígeno, corticoides, antibióticos, asociación de

  1. Femoral head necrosis after renal transplantation%肾移植后的股骨头坏死★

    Institute of Scientific and Technical Information of China (English)

    王晓勃; 王跃; 丰贵文; 李金锋; 尚文俊; 庞新路

    2013-01-01

    University from January 2008 to July 2012. The dialysis method and duration before transplantation, dose and duration of corticoid administration after transplantation, changes of body mass of the patients, lipids situation, and the time from transplantation to onset of femoral head necrosis were observed. RESULTS AND CONCLUSION:454 out of 486 patients were fol owed-up (averaged for 22.7 months) and four patients were diagnosed with femoral head necrosis. The incidence rate was 0.8%, and the mean duration of occurrence was 8.25 months. The mean dose of methylprednisolone for 5 days after transplantation was (2 707.5±154.45) mg, and the mean dose of prednisone for the first month after transplantation was (617.5± 180.76) mg. Al the four patients above received hemodialysis, and the lipids and body mass were increased after renal transplantation;the amount of corticoid was decreased or stopped after diagnosis and then treated with blood circulation drugs and conservative treatment. Three cases were improved, and the other one case was newly diagnosed with femoral head necrosis. Application of corticoid is the main reason for femoral head necrosis after renal transplantation, while to stop hormone therapy and give the blood circulation drugs after the onset can get better effect.

  2. Tratamiento médico de los hemangiomas Medical treatment of haemangiomas

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    P. Lloret

    2004-01-01

    Full Text Available En el tratamiento de los hemangiomas, existen dos actitudes claramente diferentes, la actitud expectante y la actitud terapéutica médica o quirúrgica. La actitud expectante podría indicarse en hemangiomas pequeños, lejos de zonas con posible daño funcional, y con un lento crecimiento, aunque debe considerarse que después de llegar a su máxima involución, alrededor de un 25% de los hemangiomas presentan una deformidad significativa. Deben ser sometidos a tratamiento aquellos hemangiomas que obstruyan el eje visual, la vía aérea, el canal auditivo, (con alteración de funciones como la visión, respiración, deglución, y funciones intestinal o urinaria, aquellos con crecimiento rápido que produzcan o puedan producir una destrucción tisular o desfiguración importante, lesiones ulceradas, y lesiones con gran extensión cutánea o con afectación visceral que puedan desembocar en insuficiencia cardíaca congestiva, o alteraciones hematológicas. Los corticosteroides sistémicos son el tratamiento de elección a dosis inicial de 2 a 3 mg/kg/día de prednisona o prednisolona, administrada una vez al día, por la mañana. Lo más frecuente es conseguir una detención del crecimiento, mientras que la disminución de tamaño se observa en menos de la mitad de los casos. La administración intralesional de corticoides a intervalos de entre 4 y 8 semanas es un tratamiento efectivo que consigue evitar los efectos adversos de los corticoides sistémicos. La indicación del interferón por los efectos adversos neurológicos está limitada a lesiones con riesgo vital o funcional severo que no respondan a corticoides. Otro grupo de tratamiento son los citotóxicos: bleomicina intralesional, vincristina, ciclofosfamida y la pingiangmicina. Finalmente, otras modalidades a caballo entre el tratamiento médico y quirúrgico, como son la compresión intermitente, la radioterapia, la crioterapia, la escleroterapia o la implantación de metales

  3. Abordagem terapêutica dos hemangiomas cutâneos na infância Therapeutic management of skin hemangiomas in children

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    Adriana Maria da Silva Serra

    2010-06-01

    Full Text Available FUNDAMENTOS: Hemangioma é um tumor benigno de células endoteliais comum na infância e de involução espontânea. OBJETIVO: Avaliar os tratamentos utilizados em 122 pacientes com hemangiomas cutâneos, tratados no Hospital Universitário de Brasília, de março de 2000 a dezembro de 2006. MÉTODOS: Utilizou-se coleta de dados em prontuários e aplicação de questionários aos pais. Foram analisados gênero, fatores pré-natais e perinatais, características clínicas, tipo de tratamento e resultados. RESULTADOS: A razão de sexo (F: M foi de 1,5:1. 42, em pacientes que apresentavam hemangiomas superficiais, 13 profundos e 67 mistos; em 7 pacientes, havia associação com síndromes. Em 79 pacientes, localizavam-se no polo cefálico. Já em 98/122 dos pacientes, foram submetidos a tratamento único e 24/122 a múltiplos. No primeiro grupo, foi utilizada conduta expectante em 38 pacientes, compressão em 3, corticoide sistêmico em 18, corticoide intralesional em 13, corticoide tópico em 4, cirurgia convencional em 12, criocirurgia em 7, luz pulsada em 1 e imiquimod em 2. No segundo grupo, 15 fizeram 2 tipos de tratamentos e 9 necessitaram de 3 ou mais tratamentos. CONCLUSÃO: Os dados obtidos concordam com a literatura mundial, quanto a sexo e localização da lesão. A incidência de hemangiomas presentes ao nascimento foi maior que em outras publicações. Os resultados terapêuticos obtidos foram comparáveis aos publicados na literatura. A identificação dos hemangiomas que necessitam de tratamento, em que momento adequado para intervenção e a melhor opção terapêutica devem ser considerados.BACKGROUND: Hemangiomas are benign, self-involuting tumors of endothelial cells that are common in childhood. OBJECTIVES: To evaluate the treatment of 122 patients with skin hemangiomas treated at a teaching hospital in Brasilia, Brazil between March 2000 and December 2006. MATERIAL AND METHODS: Data were collected from the patients' medical

  4. Granulocitoaféresis en la enfermedad inflamatoria intestinal: Eficacia a 32 semanas con protocolo de inducción y sesiones de mantenimiento Granulocytapheresis in inflamatory bowel disease: Efficacy of an induction plus maintenance sessions protocol at 32 weeks

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    F. J. Fernández Pérez

    2007-11-01

    Full Text Available Introducción: la granulocitoaféresis (GCAF retira de la circulación granulocitos-monocitos activados, modificando el pool circulante e induciendo una reducción en la inflamación intestinal. Objetivo: valorar la eficacia de la GCAF en la enfermedad inflamatoria intestinal (EII mediante sesiones de inducción y mantenimiento. Material y método: análisis retrospectivo en pacientes con EII activa corticodependiente y corticorrefractaria. Aplicamos 5 sesiones de inducción en colitis ulcerosa (CU y 7 en enfermedad de Crohn (EC y 1 sesión mensual hasta semana 32. Evaluamos indices clínicos de actividad y empleo de corticoides. Resultados: incluimos a 18 pacientes (10 CU, 8 EC, 10 de ellos corticodependientes y 8 corticorrefractarios. Catorce pacientes eran refractarios y 4 intolerantes a inmunosupresores (IS. No completaron la inducción 2-CU (brotes graves y 1-EC (secundarismos. Abandonaron el mantenimiento 1-CU y 3-EC. De aquellos que completaron inducción alcanzaron respuesta o remisión el 87,5% de las CU (2 y 5 pacientes, y el 71,4% de EC (1 y 4 pacientes respectivamente. Estos resultados a 32 semanas eran del 75% en CU (3 y 3 pacientes y del 42,8% en EC (1 y 2 pacientes respectivamente. De los que completaron la inducción, suprimieron corticoides el 14,2% de EC por el 62,5% de CU (25% de estas en remisión y 37,5% en respuesta. Registramos 2 secundarismos graves (tromboflebitis y síncope. Ninguna CU que completó inducción sufrió colectomía tras 97,6 (72-128 semanas de seguimiento. Conclusiones: tanto CU como EC responden bien a inducción con GCAF pero mientras la CU mantiene tras 32 semanas tasas similares de respuesta-remisión (87,5 vs. 75% casi 1/3 de los pacientes con EC recaen tras alcanzar respuesta. La granulocitoaféresis es una alternativa de tratamiento para inducir y mantener remision en CU, ahorrando corticoides, pero en la EC se precisa una adecuada selección de pacientes y un esquema de mantenimiento aún por

  5. Condutas usuais entre os reumatologistas brasileiros: levantamento nacional Routine clinical practices of Brazilian rheumatologists: national overview

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    Marta M. C. Medeiros

    2006-04-01

    antirheumatic drugs were methotrexate (84,2% and chloroquine (63.8%. Four rheumatologists (2.8% indicated biological agents (infliximab and etanercept as their initial choice of treatment. Prophylaxis for corticoid-induced osteoporosis and calcium and vitamin D supplementation were recommended by only 61.2% and 46.5% of the respondents, respectively. In a clinical scenario describing systemic lupus erythematosus, almost all doctors prescribed oral corticoids (93.7%, chloroquine (92.5% and photoprotection (93.7%. In the presence of lupus nephritis with unimpaired renal function and normal blood pressure levels, the most frequently adopted management was pulse therapy with corticoids (47.7% or high doses of oral prednisone. Pulsetherapy with cyclophosphamide was indicated by 34.6% of the respondents. In a clinical scenario describing acute mechanical back pain without alarming signs, 55.4% stated that they would request no laboratory examinations on the first encounter and the main treatments of choice were non-hormonal antiinflammatory drugs (89.3%, muscle relaxant drugs (72.9% and physical therapy (33.3%. Bed rest was recommended by 31.6% of the respondents. In a clinical scenario describing chronic back pain with recent X-ray showing first degree spondylolisthesis and disc arthrosis, 39.6% of the rheumatologists stated that they would not request additional examinations, while 26.2% and 24.4% would request computer tomography scans and magnetic resonance scans, respectively. The most frequently prescribed treatments were physical therapy (75.1%, muscle relaxant drugs (48.5%, RPG (45.6%, physical exercise (41%, Cox-2-selective non-hormonal antiinflammatory drugs (40.5%, amitriptyline (35.3% and opioid analgesics (34.7%. The questionnaire also included scenarios describing knee arthrosis and shoulder pain. CONCLUSION: The low rate of response from rheumatologists may be associated with aspects of Brazilian culture. In fact, respondents displayed a very similar profile throughout

  6. Active site proton delivery and the lyase activity of human CYP17A1

    Energy Technology Data Exchange (ETDEWEB)

    Khatri, Yogan; Gregory, Michael C.; Grinkova, Yelena V.; Denisov, Ilia G.; Sligar, Stephen G., E-mail: s-sligar@illinois.edu

    2014-01-03

    Highlights: •The disruption of PREG/PROG hydroxylation activity by T306A showed the participation of Cpd I. •T306A supports the involvement of a nucleophilic peroxo-anion during lyase activity. •The presence of cytochrome b{sub 5} augments C–C lyase activity. •Δ5-Steroids are preferred substrates for CYP17 catalysis. -- Abstract: Cytochrome P450 CYP17A1 catalyzes a series of reactions that lie at the intersection of corticoid and androgen biosynthesis and thus occupies an essential role in steroid hormone metabolism. This multifunctional enzyme catalyzes the 17α-hydroxylation of Δ4- and Δ5-steroids progesterone and pregnenolone to form the corresponding 17α-hydroxy products through its hydroxylase activity, and a subsequent 17,20-carbon–carbon scission of pregnene-side chain produce the androgens androstenedione (AD) and dehydroepiandrosterone (DHEA). While the former hydroxylation reaction is believed to proceed through a conventional “Compound I” rebound mechanism, it has been suggested that the latter carbon cleavage is initiated by an iron-peroxy intermediate. We report on the role of Thr306 in CYP17 catalysis. Thr306 is a member of the conserved acid/alcohol pair thought to be essential for the efficient delivery of protons required for hydroperoxoanion heterolysis and formation of Compound I in the cytochromes P450. Wild type and T306A CYP17A1 self-assembled in Nanodiscs were used to quantitate turnover and coupling efficiencies of CYP17’s physiological Δ4- and Δ5-substrates. We observed that T306A co-incorporated in Nanodiscs with its redox partner cytochrome P450 oxidoreductase, coupled NADPH only by 0.9% and 0.7% compared to the wild type (97% and 22%) during the conversion of pregnenolone and progesterone, respectively, to the corresponding 17-OH products. Despite increased oxidation of pyridine nucleotide, hydroxylase activity was drastically diminished in the T306A mutant, suggesting a high degree of uncoupling in which reducing

  7. Pancreatitis autoinmune asociada a fibrosis retroperitoneal: evolución tras dos años de seguimiento Autoimmune pancreatitis associated with retroperitoneal fibrosis: outcome after 24 months of follow-up

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    M. Romero

    2008-10-01

    Full Text Available Introducción: la pancreatitis autoinmune es un tipo de pancreatitis crónica caracterizado por un infiltrado linfoplasmocitario y una elevación de IgG e IgG4, que se ha descrito asociada a diversas manifestaciones extrapancreáticas y enfermedades autoinmunes, lo cual apoya la teoría de un mecanismo autoinmune fisiopatólogico de base. Caso clínico: presentamos el caso de un varón que debutó simultáneamente con una pancreatitis autoinmune asociada a fibrosis retroperitoneal y lesión de la vía biliar extrapancreática, con respuesta total tras tratamiento con corticoides durante 4 meses y ausencia de recurrencia tras 24 meses de seguimiento. Discusión: la pancreatitis autoinmune es un tipo de pancreatitis crónica que probablemente forme parte de un proceso sistémico autoinmune, cuyas manifestaciones extrapancreáticas más frecuentes son la fibrosis retroperitoneal y las lesiones de la vía biliar extrapancreática. Su correcto diagnóstico e inicio precoz del tratamiento puede favorecer la resolución completa de las lesiones, principalmente en los casos de bajo grado de actividad, con menor probabilidad de recurrencia.Introduction: autoimmune pancreatitis is a kind of chronic pancreatitis characterized by the presence of lymphoplasmacytic infiltration and severely elevated serum IgG and IgG4, which has been associated to many extrapancreatic lesions and other autoimmune disorders, leading to the theory of an autoimmune mechanism involved in the pathogenesis of this disease. Case report: we report the case of a man who simultaneously presented with autoimmune pancreatitis associated with retroperitonal fibrosis, and a lesion of the extrapancreatic bile duct, with total response to corticosteroid treatment for 4 moths and absence of recurrence after 24 months of follow-up. Discussion: autoimmune pancreatitis is a kind of chronic pancreatitis that is probably a part of a systemic autoinmune disease, with retroperitoneal fibrosis and

  8. Doença de Castleman associada a sarcoma de células dendríticas foliculares e miastenia gravis Castleman's disease associated with follicular dendritic cell sarcoma and myasthenia gravis

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    Fernando Luiz Westphal

    2010-12-01

    Full Text Available A doença de Castleman é um distúrbio linfoproliferativo atípico, de etiologia desconhecida, que pode estar associada a uma série de condições clínicas, inclusive doenças de caráter autoimune e neoplasias malignas. No presente relato, uma paciente de 72 anos foi encaminhada ao serviço de cirurgia torácica do Hospital Universitário Getúlio Vargas, localizado na cidade de Manaus (AM para a ressecção de um tumor de mediastino posterior. Três meses antes, havia sido internada em UTI com um quadro de dispneia intensa, ocasião na qual foi diagnosticada miastenia gravis. Após a ressecção da massa mediastinal, a análise histopatológica revelou doença de Castleman hialino-vascular complicada por sarcoma de células dendríticas foliculares. Até o momento da redação deste estudo, a paciente utilizava um anticolinesterásico e corticoides para o controle da miastenia gravis.Castleman's disease is an atypical lymphoproliferative disorder of unknown etiology, which might be associated with various clinical conditions, including autoimmune diseases and malignant neoplasms. We report the case of a 72-year-old female patient who was referred to the thoracic surgery department of Getúlio Vargas University Hospital, in the city of Manaus, Brazil, for the resection of a posterior mediastinal tumor. Three months prior, the patient had been admitted to the ICU with signs of severe dyspnea, at which time she was diagnosed with myasthenia gravis. After the resection of the mediastinal tumor, the histopathological examination revealed hyaline vascular-type Castleman's disease, complicated by follicular dendritic cell sarcoma. At this writing, the patient was being treated with an anticholinesterase agent and corticosteroids for the control of myasthenia gravis.

  9. Mid- and long-term clinical results of surgical therapy in unicameral bone cysts

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    Hagmann Sébastien

    2011-12-01

    Full Text Available Abstract Background Unicameral (or simple bone cysts (UBC are benign tumours most often located in long bones of children and adolescents. Pathological fractures are common, and due to high recurrence rates, these lesions remain a challenge to treat. Numerous surgical procedures have been proposed, but there is no general consensus of the ideal treatment. The aim of this investigation therefore was to study the long-term outcome after surgical treatment in UBC. Methods A retrospective analysis of 46 patients surgically treated for UBC was performed for short and mid-term outcome. Clinical and radiological outcome parameters were studied according to a modified Neer classification system. Long-term clinical information was retrieved via a questionnaire at a minimum follow-up of 10 years after surgery. Results Forty-six patients (17 female, 29 male with a mean age of 10.0 ± 4.8 years and with histopathologically confirmed diagnosis of UBC were included. Pathological fractures were observed in 21 cases (46%. All patients underwent surgery for UBC (35 patients underwent curettage and bone grafting as a primary therapy, 4 curettage alone, 3 received corticoid instillation and 4 decompression by cannulated screws. Overall recurrence rate after the first surgical treatment was 39% (18/46, second (17.4% of all patients and third recurrence (4.3% were frequently observed and were addressed by revision surgery. Recurrence was significantly higher in young and in male patients as well as in active cysts. After a mean of 52 months, 40 out of 46 cysts were considered healed. Prognosis was significantly better when recurrence was observed later than 30 months after therapy. After a mean follow-up of 15.5 ± 6.2 years, 40 patients acknowledged clinically excellent results, while five reported mild and casual pain. Only one patient reported a mild limitation of range of motion. Conclusions Our results suggest satisfactory overall long-term outcome for the

  10. Nefritis tubulo intersticial asociada a parvovirus b19 Tubulointerstitial nephritis associated with parvovirus b19 infection

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    José A. Ramírez

    2005-08-01

    Full Text Available Paciente de 9 años, previamente sana, que ingresa en anasarca con síndrome nefrótico clínico y humoral, asociado a hipertensión arterial y microhematuria, con función renal normal y se comporta como corticorresistente. Se realiza 1° biopsia renal que informa glomerulonefritis proliferativa mesangial difusa con esclerosis focal y segmentaria. En tratamiento con ciclofosfamida y corticoides, presenta síndrome febril prolongado con anemia secundaria a crisis aplásica de la serie roja, asociada con una infección aguda por parvovirus B19, e insuficiencia renal aguda secundaria a nefritis tubulointersticial severa. La PCR para parvovirus B19 DNA fue positiva en tejido renal y médula ósea. La paciente evoluciona a insuficiencia renal crónica terminal. No se puede descartar que desde su inicio, el síndrome nefrótico estuviera asociado al daño glomerular por la infección viral, que comenzó como síndrome nefrótico con componentes nefríticos y que evoluciona inesperadamente a una nefritis tubulointersticial. Este sería el primer caso en el que se documenta como causa de insuficiencia renal crónica terminal, un daño tubulointersticial secundario a parvovirus B19.A previously healthy 9 year old girl developed nephrotic syndrome with hypertension, microhematuria and normal renal function. The patient evolved as steroid resistant nephrotic syndrome whose initial renal biopsy was consistent with diffuse proliferative mesangial glomerulonephritis with focal segmental glomerulosclerosis. At the time of cyclophosphamide and prednisone treatment, she developed a prolonged febrile syndrome. She also had severe anemia following an aplastic crisis induced by human parvovirus B19 infection and acute renal failure secondary to a severe tubulointersticial disease. Bone marrow and renal tissue, tested by polimerase chain reaction were positive for parvovirus, while the patient’s blood was negative. The renal involvement did not improve requiring

  11. Anemia hemolítica autoinmune postinfección por virus de la hepatitis A. Informe de caso; Autoimmune haemolytic anaemia associated to hepatitis A. Case report

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    Claudia Lucía Sossa Melo, MD

    2010-01-01

    Full Text Available La anemia hemolítica autoinmune se asocia con una variedad de virus hepatotrópicos, en particular citomegalovirus (CMV, virus del Epstein-Barr y de la hepatitis B. No es frecuente dentro de la historia natural de la hepatitis A, la aparición de anemia hemolítica, y cuando se presenta, generalmente se asocia a deficiencia de glucosa-6-fosfato deshidrogenasa. Presentamos el caso de un paciente de sexo masculino sin hemólisis previa, con astenia e ictericia de dos meses de evolución y hepatomegalia 14 cm por debajo del reborde costal derecho. Los hallazgos en los exámenes de laboratorios mostraron anemia hemolítica con Coombs directo positivo, anticuerpos tipo inmunoglobulina M contra el virus de la hepatitis A positivos, niveles de bilirrubinas 20 veces y aminotrasferasas cuatro veces por arriba del rango normal; con estos datos el paciente fue diagnosticado como hepatitis A complicada con anemia hemolítica y probable hepatitis autoinmune asociada, por lo que se inició manejo con corticoides, alcanzándose mejoría clínica. Resaltamos la importancia de descartar la infección por el virus de la hepatitis A como posible etiología de anemia hemolítica autoinmune.______________________________________________________________________ Acute auto inmune haemolytic anaemia is associated with a variety of hepatotropic viruses, in particular cytomegalovirus, Epstein Barr virus and hepatitis B. The typical course of hepatitis A is rarely complicated with glucose-6-phosphate dehydrogenase deficiency. Wepresent the case of a man without previous haemolysis, he had been unwell for two months with fatigue and jaundice, the liver edge was palpable and tender 14 cm below the costal margin. Clinical chemistry showed haemolytic anaemia with positive direct coombs test, immunoglobulin M antibodies to hepatitis A virus were detected, the total bilirrubin concentration 20 times the upper and transaminase 4 times upper limit for normal levels; with this

  12. Herpes zoster: Epidemiología y clínica Clinical and epidemiological aspects of Herpes zoster

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    Claudia Vujacich

    2008-04-01

    Full Text Available El herpes zoster (HZ constituye una enfermedad de distribución mundial; sin embargo, existen es casos datos comunicados sobre la misma en países de Latinoamérica. Con el objetivo de evaluar aspectos clínicos y epidemiológicos de esta enfermedad en nuestra población, realizamos un análisis retrospectivo de historias clínicas de un centro privado de referencia en enfermedades infecciosas en Buenos Aires, Argentina (período: 2000-2005. Se realizó un análisis estadístico univariado para evaluar los factores asociados a neuralgia posherpética en este grupo de pacientes. Sobre un total de 302 casos evaluables, el 62% correspondieron a mujeres. La mediana de edad fue de 57 años. El 16.1% de los pacientes presentó condiciones predisponentes al desarrollo de zoster. Las localizaciones más frecuentes fueron la torácica, oftálmica y lumbosacra. El 7.75% presentó compromiso de más de dos metámeras. El 94% de los pacientes recibió medicación antiviral, siendo el aciclovir la droga más utilizada. El 94% recibió alguna medicación coadyuvante (antiinflamatorios no esteroideos, antineuríticos, corticoides. La complicación más frecuente fue la neuralgia posherpética (12% y se encontró estadísticamente asociada a edad mayor de 50 años.Herpes zoster (HZ is a public health problem worldwide. Although, there is paucity of data of this disease from South American countries. The objective of this study was to evaluate clinical and epidemiological aspects of HZ in a population of patients from South America. We underwent a retrospective analysis of clinical charts of an infectious diseases reference center (period: 2000-2005. Univariate analysis was performed to assess variables related to post herpetic neuralgia (PHN. From a total of 302 cases, 62% were in women. The median age was 57 years; 16.1% of the patients had a predisposing condition for the development of HZ. Most frequent dermatomes involved were: thoracic, ophthalmic and

  13. Implante coclear en enfermedad de Ménière bilateral. Descripción de un caso

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    Ainhoa MORENO-BRAVO

    2017-03-01

    Full Text Available Introducción: La enfermedad de Ménière se caracteriza por síntomas cocleares y vestibulares. Puede ser unilateral o bilateral. Cuando la pérdida de audición asociada es severa-profunda de forma bilateral o unilateral pero con problemas de audición en el otro oído, dicha audición puede beneficiarse de un implante coclear. Si además, presenta crisis de vértigo y Tumarkin refractarias al tratamiento médico, se puede plantear la realización simultánea de una laberintectomía quirúrgica y colocación de un implante coclear. Descripción: Se describe el caso de un paciente con enfermedad de Ménière bilateral con hipoacusia neurosensorial profunda de oído derecho con fluctuaciones auditivas izquierdas que asocia crisis vertiginosas y de Tumarkin sin respuesta a corticoides orales e intratimpánicos ni a gentamicina intratimpánica. Se le realizó una laberintectomía quirúrgica con implante coclear en el mismo acto quirúrgico anticipándonos al probable deterioro auditivo contralateral. Posteriormente presenta buen rendimiento del implante y desaparición de las crisis del oído intervenido. Discusión: El objetivo del tratamiento es controlar las crisis preservando la función, pero en pacientes en los que las medidas conservadoras fallan, se han de considerar otras más destructivas como es la laberintectomía química, que consigue altas tasas de control de las crisis, y el implante coclear, indicado para restaurar la audición en el oído afectado por enfermedad de Ménière. Si ambas se realizan en un mismo tiempo quirúrgico, se consigue reducir riesgos asociados con otros procedimientos quirúrgicos y anestésicos y evitar las modificaciones histológicas tras una laberintectomía química que dificultarían la posterior colocación del implante colear.

  14. Uso de everolimo de novo em receptores de transplante renal com doador vivo HLA idêntico

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    Marina Pontello Cristelli

    2016-06-01

    Full Text Available Resumo Introdução: Receptores de rim de doadores vivos HLA-idêntico apresentam menor risco para rejeição aguda e maior sobrevida do enxerto, quando comparado a outros tipos de transplante. Um regime imunossupressor sem inibidor de calcineurina (ICN pode melhorar ainda mais esses resultados, através da redução de eventos cardiovasculares, metabólicos e tóxicos secundários a esse fármaco. Objetivo: Avaliar eficácia e segurança do novo tratamento imunossupressor com suspensão planejada do ICN. Métodos: Estudo prospectivo, aberto, braço único de tratamento em único centro para avaliar resultados do transplante renal HLA-idêntico em pacientes que recebem everolimo (EVR, tacrolimo (TAC e corticoide, seguido da descontinuação do TAC 30 dias pós-transplante. Após análise interina de eficácia, a descontinuação do TAC foi postergada para o terceiro mês pós-transplante, através de emenda ao protocolo. Resultados: Trinta e nove pacientes foram incluídos. Apesar de as médias das concentrações de TAC e EVR terem respeitado os intervalos propostos, cinco pacientes tiveram rejeição aguda comprovada por biópsia e um paciente apresentou um episódio de glomerulite com depósitos de C4D. Esse resultado demandou o fim das inclusões. A proporção de pacientes com proteinúria > 0.5g/L não atingiu mais que 22% dos pacientes em nenhuma visita. Os eventos adversos mais frequentes foram relacionados ao uso de EVR: úlceras orais, dislipidemia e edema periférico. Conclusão: O regime proposto não foi eficaz para essa população, principalmente pela alta incidência de rejeição aguda. O perfil de segurança mostrou que a exposição prolongada a altas concentrações sanguíneas de EVR aumenta a incidência dos eventos adversos relacionados ao fármaco.

  15. Rosácea fulminante: relato de caso

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    José Otávio Alquezar Gozzano

    2016-10-01

    Full Text Available Introdução: Rosácea fulminante (RF ou pioderma facial é uma doença rara, descrita em 1940 por Kierland e O’Leary. É considerada uma variante extrema de rosácea conglobata, esta, consiste em formação de placas e abscessos hemorrágicos na pele. A RF tem sua etiologia desconhecida, porém há teorias que relacionam seu acometimento com a variação de hormônios femininos e a ingestão de vitamina B12. A RF é frequente em mulheres, principalmente pós- adolescentes. Apresenta-se abruptamente na face, amiúde na região mento- mandibular, através de pápulas inflamatórias, pústulas, cistos e nódulos com comedões escassos ou inexistentes, além de abcessos, sem manifestações sistêmicas e com a recidiva rara. Seu diagnóstico é fundamentalmente clínico, apenas com a história do paciente, sem necessidade de exames complementares. Para o tratamento, são utilizados corticoides orais, isotretinoína oral e antibióticos a fim de minimizar as sequelas físicas e psicológicas. Objetivo: Relatar caso de paciente com diagnóstico de rosácea fulminante. Metodologia: Paciente diagnosticada com rosácea fulminante atendida em serviço ambulatorial e revisão de literatura. Relato de caso: Paciente do sexo feminino, 19 anos, refere lesões súbitas em face há uma semana. Nega quadro acneico anterior, histórias de alergias e outras comorbidades. Relata ausência de uso de anticoncepcionais orais há 5 meses e data de última menstruação há 3 semanas, sem atraso menstrual. Ao exame: pápulas eritematosas e pústulas, além de pequenos nódulos inflamatórios na face. Hipótese diagnóstica: RF. Como conduta, foi prescrito tetraciclina. Conclusões: A RF é uma forma infrequente de rosácea, sendo importante o diagnóstico precoce e tratamento eficaz, a fim de melhorar a qualidade de vida do paciente.

  16. [Doctors belonging to the Senegalese Association of Sport Medicine and doping in sports: survey on knowledge and attitudes].

    Science.gov (United States)

    Dièye, Amadou Moctar; Diallo, Boubacar; Fall, Assane; Ndiaye, Mamadou; Cissè, Fallou; Faye, Babacar

    2005-01-01

    Doping in sports is as old as sports, but it grew considerably during the 20th century with the arrival in stadiums during the 1990s of amphetamines and anabolic steroids as well as such peptide hormones as erythropoietin. The international fight against doping took a giant step forward in 1999 with the creation of the world antidoping agency (WADA). This study is part of that fight. It follows an earlier survey of retail pharmacists in Senegal and aims to evaluate the knowledge about doping of doctors belonging to the Senegalese Association of Sports Medicine and to assess their attitude towards this phenomenon. Its goal is to determine how best to involve them in preventive actions. We conducted a survey in 2001 and randomly selected and interviewed 60 of the 92 doctors in the association. The questionnaire focused on three areas: their knowledge of doping, their attitudes to it, and the means of prevention that they proposed. The results showed that only 11 of the 60 doctors knew the definition of doping and 15% of doctors could not cite any family of doping products. They were aware mainly of testosterone and other anabolic steroids (84.3%), then amphetamines and other stimulants (64.7%), and finally peptide hormones (58.8%). The subjects mentioned blood doping and pharmacological manipulations as forbidden methods. They considered that the four groups of drugs most often used by athletes for doping were, in descending order, anabolic steroids, stimulants, peptide hormones and corticoids. Eighty per cent of doctors think that Senegalese athletes use doping products and that the sports most involved are football, wrestling, track and field and basketball. They also think that doping is a form of drug addiction and a public health problem. Eleven doctors (18%) said they had been contacted for information on use of doping products. The interviewees consider that the three best methods of prevention include information about side effects, unannounced urine and

  17. Toxicidad hepática recurrente secundaria a metilprednisolona intravenosa Recurrent acute liver toxicity from intravenous methyprednisolone

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    M. Rivero Fernández

    2008-11-01

    after corticoid administration. In the third episode a liver biopsy was performed, which showed acute hepatitis with bridging necrosis; such histological picture has not been described before in patients treated with intravenous steroids.

  18. Clinical predictors of abnormal esophageal pH monitoring in preterm infants Preditores clínicos para pHmetria esofágica anormal em prematuros

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    Maria Aparecida Mezzacappa

    2008-09-01

    Full Text Available BACKGROUND: Risk factors for gastroesophageal reflux disease in preterm neonates have not been yet clearly defined. AIM: To identify factors associated with increased esophageal acid exposition in preterm infants during the stay in the neonatal unit. METHODS: A case-control study in preterm infants who had undergone prolonged monitoring of distal esophageal pH, following clinical indication. Eighty-seven preterms with reflux index (percentage of total time of esophageal pHmetry >10% (cases and 87 unpaired preterms were selected with reflux index 10% in preterms were: vomiting, regurgitation, Apnea, female gender. The variables that were associated with a lower frequency of increased reflux index were: volume of enteral intake at the onset of symptoms >147 mL/kg/day, and postnatal corticoid use. CONCLUSIONS: Vomiting, regurgitation, apnea, female gender and acute respiratory distress during the first week of life were variables predictive of increased esophageal acid exposition in preterm infants with birthweight 10%.RACIONAL: Os fatores de risco para a doença pelo refluxo gastroesofágico em recém-nascidos prematuros não foram, até momento, claramente estabelecidos. OBJETIVO: Identificar fatores associados ao aumento da exposição ácida intra-esofágica em prematuros durante o período de internação em unidade neonatal. MÉTODOS: Realizou-se estudo de caso controle com prematuros que realizaram monitorização prolongada do pH esofágico por suspeita clínica de doença do refluxo. Foram selecionados 87 recém-nascidos com valor do índice de refluxo (percentual do tempo total do exame com pH abaixo de 4 >10% (casos e 87 recém-nascidos com índice de refluxo 10% foram: vômitos, regurgitações, apnéia, sexo feminino e insuficiência respiratória na 1ª semana de vida. As variáveis que se associaram a menor freqüência de índice de refluxo 147mL/kg/d e uso de corticóide pós-natal. CONCLUSÕES: Vômitos, regurgitações, apn

  19. Study progress of sequelaes and risk factors of bacterial meningitis in children%儿童细菌性脑膜炎的后遗症及其危险因素研究进展

    Institute of Scientific and Technical Information of China (English)

    张金晶; 王亚娟

    2013-01-01

    儿童细菌性脑膜炎仍是导致儿童死亡的重要原因,而细菌性脑膜炎所致后遗症也并不少见,细菌性脑膜炎患者出院后至少发生1种后遗症的平均概率为19.9%,包括听力障碍、认知障碍、运动障碍、癫(癎)、视力障碍等,其中听力障碍是最常见的后遗症,多种后遗症可同时存在.入院时患儿的意识水平、惊厥、起病时间>48 h、外周循环衰竭、致病菌为肺炎链球菌是细菌性脑膜炎发生后遗症的公认危险因素.外周血白细胞计数、脑脊液糖及蛋白水平亦与细菌性脑膜炎预后密切相关.入院时低钠血症提示预后不良.男童及激素的应用对细菌性脑膜炎后遗症影响尚无定论.%Bacterial meningitis in children is still a life-threatening disease which causes a serious of sequelaes,the median risk of at least 1 major or minor sequelae after hospital discharge is 19.9%,including hearing impairment,cognitive impairment,motor disorders,seizures,visual impairment and so on.Of all these sequelaes,hearing impairment is the most common type.Multiple sequelae is recognized.Prognostic factors are found to be statistically significant:coma/impaired consciousness,complaints > 48 hours before admission,seizures at admission,peripheral circulatory failure,respiratory distress,Streptococcus pneumonia as causative pathogen were recognized as the risk factors for sequeales.And cerebrospinal fluid parameters and white blood cell count were closely related to sequelaes.Hypokaliemia at admission also indicate poor prognosis,but need independent validation in clinical works.Male gender and corticoids were still in discussion.

  20. Circuits regulating pleasure and happiness: the evolution of the amygdalar-hippocampal-habenular connectivity in vertebrates.

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    Anton J.M. Loonen

    2016-11-01

    Full Text Available Appetitive-searching (reward-seeking and distress-avoiding (misery-fleeing behavior are essential for all free moving animals to stay alive and to have offspring. Therefore, even the oldest ocean-dwelling animal creatures, living about 560 million years ago and human ancestors, must have been capable of generating these behaviors. The current article describes the evolution of the forebrain with special reference to the development of the misery-fleeing system. Although the earliest vertebrate ancestor already possessed a dorsal pallium, which corresponds to the human neocortex, the structure and function of the neocortex was acquired quite recently within the mammalian evolutionary line. Up to, and including, amphibians, the dorsal pallium can be considered to be an extension of the medial pallium, which later develops into the hippocampus. The ventral and lateral pallium largely go up into the corticoid part of the amygdala. The striatopallidum of these early vertebrates becomes extended amygdala, consisting of centromedial amygdala (striatum connected with the bed nucleus of the stria terminalis (pallidum. This amygdaloid system gives output to hypothalamus and brainstem, but also a connection with the cerebral cortex exists, which in part was created after the development of the more recent cerebral neocortex. Apart from bidirectional connectivity with the hippocampal complex, this route can also be considered to be an output channel as the fornix connects the hippocampus with the medial septum, which is the most important input structure of the medial habenula. The medial habenula regulates the activity of midbrain structures adjusting the intensity of the misery-fleeing response. Within the bed nucleus of the stria terminalis the human homologue of the ancient lateral habenula-projecting globus pallidus may exist; this structure is important for the evaluation of efficacy of the reward-seeking response. The described organization offers a

  1. Reacciones por lepra en un centro de referencia nacional en Colombia

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    John Nova

    2013-03-01

    Full Text Available Introducción. Colombia es el país de América con mayor proporción de casos nuevos de lepra con discapacidad grave. Para disminuir tal discapacidad se requiere el control de las reacciones, principal causa del daño neural en esta enfermedad. Objetivo. Describir las características clínicas y epidemiológicas y el tratamiento de los pacientes con reacciones de tipo 1 y 2 que consultaron al Centro Dermatológico Federico Lleras Acosta. Materiales y métodos. Se trata de un estudio descriptivo que incluyó la población de pacientes con diagnóstico clínico de reacciones de tipo 1 y de tipo 2 por lepra, que acudieron al centro entre los años 2003 y 2009. Resultados. Se estudiaron 96 reacciones, 35 del tipo 1 y 61 del tipo 2. El 75 % de los pacientes provenía de los departamentos de Tolima, Cundinamarca, Santander y Boyacá. El 56 % de las reacciones de tipo 1 se presentaron antes de iniciar la poliquimioterapia para la lepra; el dermatólogo tratante consideró que las reacciones que se presentaron después de suspender la poliquimioterapia eran recaídas. El 94 % de las reacciones de tipo 1 se trataron con corticoides orales. El 97 % de los pacientes con reacciones de tipo 2 presentaron eritema nudoso, y todos se trataron con talidomida. Conclusiones. La clínica de la reacción de tipo 1 puede orientar al diagnóstico de la lepra en un paciente sin el antecedente de esta enfermedad (56 %. La reacción de tipo 1 que se inicia después de suspender la poliquimioterapia para la lepra, podría ser una manifestación de recaída de la enfermedad. La reacción de tipo 2 es más frecuente en hombres, con una relación hombre a mujer de 4:1. El 97 % de los pacientes con reacción de tipo 2 presentó eritema nudoso.   doi: http://dx.doi.org/10.7705/biomedica.v33i1.582

  2. Osteonecrosis de los maxilares asociada a bifosfonatos: revisión sistemática Osteonecrosis of the jaws associated to biphosphonates: systematical review

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    EA Escobar López

    2007-04-01

    Full Text Available En los últimos años se ha descrito una nueva complicación en la terapia con bifosfonatos: la osteonecrosis de los maxilares. Esta complicación no había sido detectada en los ensayos clínicos previos. En esta revisión sistemática de 340 casos, los pacientes afectados presentan como diagnóstico primario principalmente: mieloma múltiple (51,2%, cáncer de mama (31,4%, cáncer de próstata (7,1% y osteoporosis (4,1%. La mandíbula resulta más afectada que el maxilar, con el 59,1%. La relación entre género femenino y masculino es de 2:2,6. El pamidronato es el bifosfonato más asociado a los casos de osteonecrosis (35,3%. Los factores de riesgos desencadenantes incluyen: exposición a bifosfonatos, infecciones orales, traumas, procedimientos quirúrgicos orales previos y terapias contra el cáncer (quimioterapia, corticoides y otros agentes citostáticos. La alteración en el equilibrio óseo, factores antiangiogénicos, inhibición en el ciclo celular de los queratinocitos y mecanismos osteolíticos generados en la infección podrían explicar la etiopatogenia en el desarrollo de esta complicación.In the last years a new complication has been described in the therapy with biphosphonates: biphosphonate-associated osteonecrosis of the jaws. This complication had not been detected in previous clinical tests. In this systematic review of 340 cases, the patients had as primary diagnosis principally: multiple myeloma (51.2%, breast cancer (31.4%, prostate cancer (7.1% and osteoporosis (4.1%. The mandible is more affected than the maxilla, with 59.1%. The relationship between femenine and masculine gender was 2:2.6. The pamidronate was the biphosphonate more associated to the cases of osteonecrosis (35.3%. The risk factors associated include: use of biphosphonates, presence of oral infections, trauma, oral surgical procedures and therapies against cancer (chemoterapy, corticosteroids and other cytostatics agents. Effects on bone turnover

  3. Foliculite queloidiana

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    Maria Carolina Coelho Gozzano

    2015-10-01

    Full Text Available Introdução: Foliculite queloidiana (FQ é uma doença crônica com presença de inflamação,  cicatriz de folículo piloso e posterior desenvolvimento de pápulas, placas queloidianas e alopecia cicatricial; com episódios de agravamento da inflamação. Afeta principalmente couro cabeludo e nuca. Normalmente acomete homens de ascendência africana e fototipos elevados (Fitzpatrick IV-VI na adolescência e é rara após os 50 anos. Sua causa não é definida; aponta-se a irritação crônica ou oclusão dos folículos  -  devido a práticas de corte de cabelo  -, trauma, fricção, predisposição e fator agravante. A inflamação ativa é manifestada por pápulas, pústulas e eritema; acompanhada de prurido ou dor. A inflamação tende a ser menos ativa, mas as pápulas queloidianas e as placas podem persistir se não tratadas. Achados histológicos: infiltrado inflamatório neutrofílico ou linfoplasmocitário perifolicular e intrafolicular, fibrose cutânea, folículos capilares quebrados cercados por inflamação granulomatosa, formação de abscesso perifolicular e dérmica fibrose. Tratamento é difícil, podendo ser utilizados antibióticos e corticoides intralesionais.  Objetivo:  Relatar caso de FQ.  Metodologia:  Paciente diagnosticada com FQ atendido em serviço ambulatorial.  Relato de caso: Masculino, 33 anos, Fitzpatrick III, com lesões em couro cabeludo e nuca há 2 anos, sem atendimento médico anterior. Exame físico: presença de pápulas e placas queloidianas na nuca, substituindo o folículo piloso, com consequente alopecia cicatricial. Sem queixas de dores ou prurido. Hipótese diagnóstica: FQ Conclusão: É uma doença crônica, de diagnóstico clínico e difícil tratamento. Assim, é importante o diagnóstico precoce para um tratamento adequado e acompanhamento regular da doença, visando a melhor qualidade de vida para o paciente.

  4. Mielitis transversa relacionada con vacunación anti-influenza A(H1N1 Transverse myelitis associated with anti-influenza A (H1N1 vaccination

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    María Florencia Arcondo

    2011-04-01

    Full Text Available La mielitis transversa es una enfermedad inflamatoria que se caracteriza por disfunción de la médula espinal. Las causas reconocidas de mielitis transversa son autoinmunes, enfermedades desmielinizantes, post infecciosas y post vacunales, aunque hasta el 50% de los casos son idiopáticas. Las vacunas contra la rubéola, paperas, rabia y gripe estacional han sido asociadas a diversos trastornos neurológicos, como el Síndrome de Guillain Barré, la encefalomielitis diseminada aguda (ADEM y la mielitis transversa. Como mecanismo preventivo luego de la pandemia de 2009, en febrero del año 2010 se inició en nuestro país la campaña de vacunación contra la Influenza A (H1N1. Se presenta el caso de una paciente con hipoestesias que aparecieron cuatro días después de haber recibido la vacuna monovalente anti-influenza A (H1N1 y progresaron con evidente nivel sensitivo. La paciente cumplía criterios diagnósticos de mielitis transversa, según el Transverse Myelitis Consortium Working Group. Tuvo remisión de las imágenes de la resonancia magnética y estabilidad clínica sin tratamiento con corticoides. Se discuten aspectos diagnósticos, pronósticos y terapéuticos de esta entidad clínica.Transverse myelitis is an inflammatory disorder characterized by spinal cord dysfunction. Infectious, autoimmune, postinfectious and postvaccination diseases are the most common recognized causes of transverse myelitis, but near 50% of the cases are finally assumed as idiopathic. Rubeolla, mumps, rabies and influenza vaccines were associated with many neurologic complications, such as Guillain Barré Syndrome, acute disseminated encephalomyelitis (ADEM and transverse myelitis. As a prevention measure after the 2009 pandemia, in February 2010 a National Campaigne of Vaccination against the Influenza A (H1N1 was started in our country. We report a case of a woman who received a monovalent Influenza A (H1N1 vaccine and four days after, began with sensory

  5. Homeopathy as an alternative for asthma treatment

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    Andreas Sebastian Loureiro Mendez

    2011-09-01

    Full Text Available Background: Asthma is a chronic inflammatory disease characterized by a reversible obstruction and hyperactivity of inferior aerial treat [1]. It is responsible for lifestyle modification and, considering its high frequency, it became an important issue in the budget of health services around the world. Aspects like the lack of definitive results and presence of adverse effects, observed for traditional therapy, as well as the search for better quality of life have increased patients’ interest for complementary and alternative medicines (CAM, being homeopathy one of the most cited [2]. In 2001, asthma was between the 10 diagnostics most treated by homeopaths in USA [3]. Aims: In this work, a qualitative research was made focusing the evaluation of the real contribution that homeopathy can represent for asthma patients and the role of pharmacist in this therapy. Methodology: databases such as Medline, Sciencedirect and Bireme were used to find scientific articles, applying the expressions “asthma”, “homeopathy” and “complementary and alternative medicine”. Results: At least six works demonstrate successful applications of homeopathic treatment in children or adults with asthma. The main benefits cited are the decrease of frequency and gravity of the crises, besides of some cure cases. Conclusions: Data available are still scanty about asthma homeopathic treatment. The few works found showed this kind of therapy is very adequate, mainly because of the emotional component of the disease, but also because it represents to be away from the adverse effects commonly related to the traditional therapy (e. g. corticoids. To ensure a correct therapy is being made, the pharmacist must be present and active in the patients’ identification and documentation, giving them right orientations about the use and storage of homeopathic medicines

  6. Expandindo a aplicação de questionário padronizado para sibilância recorrente no lactente Expanding the application of a standardized questionnaire on recurrent wheezing in infancy

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    Herberto José Chong Neto

    2009-04-01

    Full Text Available OBJETIVO: Estender a aplicação de um instrumento para avaliar a prevalência e as características clínicas da sibilância em lactentes. MÉTODOS: Estudo transversal, como parte do projeto Estudio Internacional de Sibilancias en Lactantes (EISL, aplicando questionário aos pais de lactentes entre 12 e 15 meses (grupo I e 16 e 24 meses de vida (grupo II. RESULTADOS: Mil trezentos e sessenta e quatro lactentes (45,4% do grupo I e 250 (46,7% do grupo II apresentaram pelo menos um episódio de sibilância (p = 0,58. O uso de β2-agonistas inalados, corticoides inalatórios ou orais e modificadores de leucotrienos foi semelhante entre os grupos (p = 0,52, 0,12, 0,06 e 0,75. Sintomas noturnos, dificuldade para respirar, visitas à emergência, hospitalização por sibilância e diagnóstico médico de asma não foram diferentes nos grupos (p = 0,09, 0,28, 0,69, 0,54 e 0,45. CONCLUSÃO: A aplicação do questionário pode ser estendida aos lactentes com até 24 meses de vida.OBJECTIVE: To verify the possibility of extending the application of an instrument to investigate the prevalence and clinical characteristics of wheezing in infants. METHODS: A cross-sectional study conducted as part of the International Study on Wheezing in Infants (EISL, Estudio Internacional de Sibilancias en Lactantes. A questionnaire was administered to parents of infants aged 12 to 15 months (group I and 16 to 24 months (group II infants. RESULTS: One thousand, three hundred and sixty-four infants (45.4% in group I and 250 (46.7% in group II had had at least one episode (p = 0.58. The numbers of patients on inhaled β2-agonists, inhaled or oral steroids and/or leukotriene modifiers were similar in both groups (p = 0.52, 0.12, 0.06, and 0.75. There were no differences between the groups in terms of night-time symptoms, shortness of breath, emergency room visits, asthma hospitalization or asthma diagnosed by a doctor (p = 0.09, 0.28, 0.54, and 0.45. CONCLUSION: The

  7. Mujer joven con hipertiroidismo asociado a insuficiencia tricuspídea grave Young woman with hyperthyroidism associated with severe tricuspid regurgitation

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    Ariel K. Saad

    2008-02-01

    Full Text Available Las manifestaciones cardiovasculares del hipertiroidismo son frecuentes, y en ocasiones dominan el cuadro clínico. Con frecuencia, la enfermedad se manifiesta por un estado circulatorio hiperdinámico, con disminución de la resistencia vascular periférica, aumento de la volemia y del volumen minuto cardíaco. La dilatación de las cavidades cardíacas con insuficiencia tricuspídea grave e insuficiencia cardíaca derecha sin hipertensión pulmonar constituye una forma inusual de presentación. Se presenta el caso de una joven paciente, portadora de enfermedad de Graves Basedow, sin antecedentes cardiovasculares, que evoluciona en el transcurso de un mes con edema de miembros inferiores, palpitaciones, diarrea, pérdida de peso y fiebre. Al examen clínico se evidencian taquicardia con pulso irregular, signos de insuficiencia cardíaca derecha acompañado de un intenso soplo regurgitante que aumentaba con la inspiración. Por radiografía de tórax y ecocardiograma se constata cardiomegalia e insuficiencia tricuspídea grave sin hipertensión pulmonar. El cuadro se resuelve en forma rápida luego del tratamiento con propranolol, corticoides y diuréticos, con reversión de la arritmia y franca mejoría de los signos y síntomas. Se analizan en forma breve los efectos de las hormonas tiroideas en el aparato cardiovascular y se postulan probables mecanismos fisiopatológicos de la insuficiencia cardíaca en el hipertiroidismo.Cardiovascular manifestations of hyperthyroidism are frequent and sometimes are relevant in the clinical picture. Usually an hyperdynamic circulatory state hallmarks the disease with low peripheral resistance, increased intravascular volume and cardiac output. However, right chamber dilatation with tricuspid valve regurgitation and cardiac failure are unusual. We present the case of a young woman with Graves-Basedow disease without cardiovascular history who complained about palpitations, peripheral edemas, weight loss and

  8. Neurocisticercosis en niños: Hospital Universitario San Vicente de Paúl, Medellín 1989-1996 Neurocysticercosis in children: experience in Medellín, Colombia 1989-1996

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    José William Cornejo Ochoa

    1997-03-01

    Full Text Available Se hace un estudio retrospectivo de las historias cínicas de los menores de 18 años con diagnóstico de egreso de neurocisticercosis, del Hospital Universitario San Vicente de Paúl, de Medellín (HUSVP durante el período 1989 a 1996. Se encontraron 16 pacientes: Trece mujeres y 3 hombres, con un promedio de edad de 11 años. Los motivos de consulta mas frecuentes fueron convulsiones (68.8%, cefalea (62.5% y alteraciones visuales (37.5%. La evolución de los síntomas fue menor de tres meses en el 81% de los casos. Los diagnósticos sindromáticos mas frecuentes fueron los síndromes convulsivo (68.8% y de hipertensión endocraneana (43.8%. La tomografía computarizada mostró lesiones parenquimatosas múltiples en 8 casos y únicas en 4. El tratamiento con albendazol (10 mg/kg/dla mejor6 la sintomatología en todos los casos; se emplearon corticoides en todos los pacientes que recibieron tratamiento antiparasitario. Las convulsiones se controlaron fácilmente con difenilhidantolna o carbamazepina. Neurocysticercosis in children. Experience in Medellín, Colombia, 1989-1996 This is a retrospective clinical study of neurocisticercosis in patients aged 18 years or less, at Hospital Universitario San Vicente de Paul, in Medellln, Colombia, during the period 1989-1996. There were 16 patients, 13 girls and 3 boys; average age was 11 years. The main complaints were: Seizures (68.8%, headache (62.5% and visual disturbances (37.5%. Evolution of symptoms was less than three months in 81% of the patients. The most frequent syndromatic diagnoses were: Convulsive (68.8% and intracraneal hypertension syndromes (43.8%. Computed tomography revealed intraparenchimal multiple lesions in 8 cases and solitary lesions in 4 cases. Treatment with albendazole (10 mg/kg/day improved symptoms in every patient; children treated with antiparasitic drugs also received corticosteroids for 7 to 14 days. Seizures were easily controlled with anticonvulsivants such as

  9. Hepatitis fulminante en la Sierra Nevada: Una forma de superinfección del virus delta con el virus de la hepatitis B.

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    Alvaro Villanueva

    1992-06-01

    Full Text Available Durante septiembre de 1980 a octubre de 1983, se realizó un estudio seroepidemiológico para hepatitis A y B, en 258 personas en una ciudad (Santa Marta población de 250.000 y tres pequeños municipios (Santa Rosalía, Julio Zawady y Aracataca, poblaciones de 768, 800 y 5.000 habitantes respectivamente. La presencia de hepatitis A se encontró en un 77 a 93% (IgG Hepatitis A. Hbs Ag o Anti-Hbs Ag en 30.5% de la población en dos municipios (Santa Rosalía y Julio Zawady, en 2.5% en el municipio de Aracataca y 48.5% en la ciudad de Santa Marta. La presencia del Agente Delta (Anti-delta en el suero se determinó también en estas mismas poblaciones, encontrándose ausente en la ciudad y uno de los municipios (Aracataca, en contraste con una prevalencia de 13.7% y 22% en Julio Zawady y Santa Rosalía (P: 0.0001. Se excluyeron por historia clínica, antecedentes de drogadicción, transfusiones, o prácticas homosexuales, como mecanismos de transmisión de los virus B y delta. En veinte pacientes con diagnóstico histopalógico de hepatitis fulminante y en quienes se descartaron otras etiologías se demostró la presencia serológica de los virus de la hepatitis By Delta. De estos veinte, diez provenían de Julio Zawady y los otros diez de Santa Rosalía. La evolución clínica de esta enfermedad fue indistinguible de otras causas de falla hepática aguda. La mortalidad de estas formas fulminantes de hepatitis alcanzaron hasta un 65%. Los corticoides no modificaron el curso de esta enfermedad. La población joven mostró mayor compromiso y peor diagnóstico (P:0.033. La hepatitis fulminante de la Sierra Nevada de Santa Marta es el resultado de la superinfección con el virus Delta sobre la infección virus B. La aparición simultánea de casos intrafamiliares sugiere una relación importante entre los grupos comprometidos, aunque la forma exacta de transmisión permanece aún desconocida.

  10. 克罗恩病患者合并院内感染的危险因素分析%Risk factors for nosocomial infections in patients with Crohn’s disease

    Institute of Scientific and Technical Information of China (English)

    杨少武; 吴刚

    2015-01-01

    Objective To explore the risk factors for Crohn’s disease (CD) patients with nosocomial infection, and to provide guidance for the clinical diagnosis and treatment. Methods The clinical data of 120 cases of CD were analyzed by using comparative analysis, retrospectively. The signiifcantly related factors with nosocomial infection were analyzed by a multivariable Logistic regression. Results The incidence rate with nosocomial infection was 38.3%, there was 32.6% (15/46) CD patient with hospital acquired pneumonia. The disease behavior, Crohn’s disease activity index (CDAI), malnutrition, the use of corticoid and the use of immunosuppressive agents were the risk factors of CD patient with nosocomial infection (P all<0.05), and the OR values were 2.25, 3.62, 2.82, 2.18 and 2.58, respectively. Conclusions It is necessary for the medical staff to comprehensively consider these risk factors and take effective prevention, treatment and nursing measures.%目的:探讨克罗恩病(CD)患者并发医院感染相关因素,为临床诊疗工作提供参考。方法对住院治疗的120例CD患者的临床资料进行比较分析;与医院感染有显著差异的因素再进行多元Logistic回归分析。结果 CD患者医院感染率为38.3%(46/120),医院获得性肺炎为32.6%(15/46);疾病行为、活动指数(CDAI)、营养不良、使用激素或免疫抑制剂等均是并发院内感染的危险因素(P均<0.05),其OR值分别为2.25、3.62、2.82、2.18和2.58。结论对于克罗恩病,临床中应综合考虑上述危险因素,做好感染的预防、治疗和护理工作。

  11. The role of salt abuse on risk for hypercalciuria

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    Padovani Carlos R

    2011-01-01

    Full Text Available Abstract Background Elevated sodium excretion in urine resulting from excessive sodium intake can lead to hypercalciuria and contribute to the formation of urinary stones. The aim of this study was to evaluate salt intake in patients with urinary lithiasis and idiopathic hypercalciuria (IH. Methods Between August 2007 and June 2008, 105 lithiasic patients were distributed into 2 groups: Group 1 (n = 55: patients with IH (urinary calcium excretion > 250 mg in women and 300 mg in men with normal serum calcium; Group 2 (n = 50: normocalciuric patients (NC. Inclusion criteria were: age over 18 years, normal renal function (creatinine clearance ≥ 60 ml/min, absent proteinuria and negative urinary culture. Pregnant women, patients with intestinal pathologies, chronic diarrhea or using corticoids were excluded. The protocol of metabolic investigation was based on non-consecutive collection of two 24-hour samples for dosages of: calcium, sodium, uric acid, citrate, oxalate, magnesium and urinary volume. Food intake was evaluated by the three-day dietary record quantitative method, and the Body Mass Index (BMI was calculated and classified according to the World Health Organization (WHO. Sodium intake was evaluated based on 24-hour urinary sodium excretion. Results The distribution in both groups as regards mean age (42.11 ± 10.61 vs. 46.14 ± 11.52, weight (77.14 ± 16.03 vs. 75.99 ± 15.80, height (1.64 ± 0.10 vs. 1.64 ± plusorminus 0.08 and BMI (28.78 ± 5.81 vs. 28.07 ± 5.27 was homogeneous. Urinary excretion of calcium (433.33 ± 141.92 vs. 188.93 ± 53.09, sodium (280.08 ± 100.94 vs. 200.44.93 ± 65.81, uric acid (880.63 ± 281.50 vs. 646.74 ± 182.76 and magnesium (88.78 ± 37.53 vs. 64.34 ± 31.84 was significantly higher in the IH group (p Conclusions This study showed that salt intake was higher in patients with IH as compared to NC.

  12. Formulation factors affecting the isomerization rate of betamethasone-17-valerate in a developmental hydrophilic cream - a HPLC and microscopy based stability study.

    Science.gov (United States)

    Byrne, Jonathan; Wyraz, Anke; Velasco-Torrijos, Trinidad; Reinhardt, Robert

    2016-02-19

    independent of the pH value of the aqueous phase of the cream. These findings have not been reported in previous literature reports on this topic, which have tended to focus on the influence of pH. The results are likely to be of interest to pharmaceutical chemists working on the formulation of glucocorticoids as well as to local- and hospital pharmacists who carry out the practice of dilution of proprietary corticoid preparations, where the choice of diluent is likely to be critical for ensuring the stability of the diluted product.

  13. Terapia celular para el tratamiento de la diabetes: Más allá de las células madre

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    María Laura Gimeno

    2011-06-01

    Full Text Available La diabetes tipo 1 es una enfermedad de etiología autoinmune que se caracteriza por la destrucción de las células ß pancreáticas, produciendo un déficit absoluto de insulina. El tratamiento clínico estándar consiste en la aplicación de insulina. Sin embargo, en un número importante de pacientes y debido a la dificultad en lograr un control metabólico preciso, generalmente se asocia con complicaciones graves a nivel vascular con repercusión renal y ocular entre otras. Por otra parte, un estricto control metabólio, a menudo se asocia con hipoglucemias con riesgo de muerte. Esto motivó la investigación y el desarrollo de alternativas de tratamiento. Una de ellas es el trasplante de células productoras de insulina, las células ß, obtenidas por medio del aislamiento y trasplante de islotes de un páncreas cadavérico. Los mejores resultados con esta modalidad de trasplante se obtuvieron con la inyección sucesiva de islotes pancreáticos de diferentes donantes y terapia inmunosupresora exenta de corticoides. Sin embargo, la escasez de órganos por un lado, y el hecho de que cada implante de islotes de otro páncreas aumenta las posibilidades de rechazo inmunológico, hace que este tratamiento se vea limitado a centros de alta experiencia y pacientes muy seleccionados. Asimismo, las drogas inmunosupresoras que deben administrarse de por vida, pueden producir efectos no deseados en el organismo. La medicina regenerativa abre la posibilidad de utilizar células madre con capacidad de diferenciarse en células productoras de insulina, utilizando de manera conjunta factores tróficos que serían capaces de estimular a las propias células madre de cada parénquima.

  14. Detecting Adreno-Cortical Activity in Gorillas: A Comparison of Faecal Glucocorticoid Measures Using RIA Versus EIA

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    J.B. Nizeyi

    2011-04-01

    Full Text Available The conservation community is concerned that the remnants of highly endangered Mountain gorilla are being exposed to enormous stressors in their habitat but no assay has been validated to monitor stress markers in their fecal medium. Non specific ICN Corticosterone RIA and Munro Cortisol EIA were validated for measurement of free-ranging Mountain gorilla Faecal Glucocorticoids Metabolites (FGM to non-invasively detect effect of environmental stressors on the adrenocortical activity in gorillas. Parallelism and quantitative recovery of FGM showed that the RIA and EIA can reliably measure corticoid metabolites in this medium. High Performance Liquid Chromatography confirmed presence of FGM in faecal extracts. Peak immunoreactive metabolites constituting 35.43% of FGM measured by the RIA co-eluted with maximum corticosterone radioactivity, the EIA measured multiple immunoreactive peak metabolites which were less polar than the cortisol, corticosterone and DOC standard hormones. For Lowland gorilla, peak FGM eluted at fractions 27 and 53 under the 100% Isocratic gradient (San Diago protocol, and 20-80% Methanol gradient (National Zoo protocol respectively; while peak FGM eluted at fraction 8 and 47 in Mountain gorilla under 100% Isocratic and 20-80% Methanol gradients respectively. After injection of Lowland gorilla with long acting Adrenal Cortico-trophic Hormone (ACTH gel (150U Acthar Gel, urinary cortisol increased by 5-fold (p<0.05 within the first 6 h and then decreased to original values by 24 h. FGM were significantly elevated (p<0.05 between 72 and 96 h (RIA and between 48 and 120 h (EIA and there after decreased towards the pre-ACTH levels. Both assays detected a 2-fold increase in FGM 48 h post ACTH. Mean pre-ACTH and post- ACTH FGM amounts measured by RIA were 36 times (p<0.05 more than those measured by the EIA. For field application FGM were measure from three free-ranging Mountain gorilla individuals before and after chasing the

  15. Enfermedad injerto vs hospedero postransfusional en un paciente con leucemia linfoblástica aguda Graft vs host disease after transfusion in a patient with acute linfoblastic leukemia

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    TR Nijamin

    Full Text Available La enfermedad injerto vs hospedero (EICH es un proceso inmunológico, desencadenado por linfocitos T de un donante inmunocompetente, que reaccionan contra los tejidos de un receptor inmunocomprometido. Esto origina daño multiorgánico severo en el agente receptor. Las manifestaciones cutáneas son un signo clínico relevante en períodos tempranos. La EICH postranfusional (EICH-PT es una entidad poco frecuente y con alta tasa de mortalidad, que se observa en pacientes luego de transfusiones con hemoderivados no irradiados. Los corticoides son el pilar fundamental del tratamiento, una vez instalado el cuadro. La prevención con leucorreducción e irradiación de los componentes sanguíneos, constituye el sustento primordial para evitar su desarrollo. Presentamos un paciente de 5 años de edad, con un diagnóstico de leucemia linfoblástica aguda de alto riesgo, de múltiples transfusiones de glóbulos rojos sin tratamiento radiante previo, a quien se le realiza el diagnóstico dermatológico e histopatológico de EICH aguda postransfusional.Graft vs host disease (GVHD is a process triggered by immune T cells, that react immunocompetent donor tissue against a recipient immunocompromised. This causes severe multiorgan damage in the receiving agent. Cutaneous manifestations are an important clinical sign in early periods. Postranfusional GVHD (GVHD-PT is a rare entity with high mortality rate, observed in patients after transfusion with blood products not previously irradiated. Corticosteroids are the mainstay of treatment after installation of the box, however prevention with leukoreduction and irradiation of blood components remains the mainstay to prevent its development. We present a patient 5 years of age, diagnosed with acute lymphoblastic leukemia at high risk with a history of multiple transfusions of red blood cells without prior radiation treatment, who is performed dermatological and histopathological diagnosis posttransfusion acute GVHD.

  16. Short term administration of glucocorticoids in patients with protracted and chronic gout arthritis. Part III – frequency of adverse events

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    A A Fedorova

    2009-01-01

    Full Text Available Objective. To assess frequency of adverse events during short term administration of gluco- corticoid (GC in protracted and chronic gout arthritis. Material and methods. 59 pts with tophaceous gout (crystal-verified diagnosis and arthritis of three and more joints lasting more than a months in spite of treatment with sufficient doses of nonsteroidal anti-inflammatory drugs were included. Median age of pts was 56 [48;63], median disease duration – 15,2 years [7,4;20], median swollen joint count at the examination – 8 [5;11]. The patients were randomized into 2 groups. Methylprednisolone (MP 500 mg/day iv during 2 days and placebo im once was administered in one of them, betamethasone (BM 7 mg im once and placebo iv twice – in the other. Clinical evaluation of inflamed joints was performed every day. Standard laboratory examination and ECG were done before drug administration, at 3rd, 7th, and 14th day of follow up. Immunoreactive insulin level was evaluated before drug administration and at day 14. Blood pressure (BP was measured every day. Results. After first GC administration BP elevated in 28 (47% pts. In pts not having appropriate BP values BP elevated in 73% of cases. Pts with appropriate BP values showed less frequent BP elevation – 38% (p=0,02. In 8 (13% pts at day 3 after GC administration ECG signs of myocardial blood supply deterioration were revealed. Glucose level elevated in 10 (17% pts and after the second BM administration – in 5 (8% pts. Cholesterol level did not significantly change after 14 days of follow up but in 28 (47% pts it increased in comparison with baseline. Trigliceride level significantly decreased at day 14 from 149 [106; 187] to 108 [66,5; 172] mg/dl (p=0,02. 26 (44% pts had face hyperemia, 4 (7% –42 palpitation and 2 (3,4% – bitter taste. Conclusion. Administration of short course of GC in pts with gout requires monitoring of possible adverse events. Antihypertensive therapy providing appropriate BP

  17. A síndrome anserina Anserine syndrome

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    Milton Helfenstein Jr

    2010-06-01

    Full Text Available Dor no joelho é uma condição comum na clínica diária e a patologia anserina, também conhecida como pata de ganso, tem sido considerada uma das principais causas. O diagnóstico tem sido realizado de maneira eminentemente clínica, o que tem gerado equívocos. Os pacientes queixam-se tipicamente de dor na parte medial do joelho, com sensibilidade na porção ínferomedial. Estudos de imagem têm sido realizados para esclarecer se tais pacientes possuem bursite, tendinite ou ambos os distúrbios na região conhecida como pata de ganso. Entretanto, o defeito estrutural responsável pelos sintomas permanece desconhecido, motivo pelo qual preferimos intitular como "Síndrome Anserina". O diabetes mellitus é um fator predisponente bem reconhecido. O sobrepeso e a osteoartrite de joelho parecem ser fatores adicionais de risco, contudo, seus papéis na gênese da moléstia ainda não são bem entendidos. O tratamento atual inclui anti-inflamatório, fisioterapia e infiltração de corticoide, com evolução muito variável, que oscila entre 10 dias e 36 meses. A falta de conhecimento sobre a etiofisiopatologia e dados epidemiológicos exige futuros estudos para esse frequente e intrigante distúrbio.Knee pain is a common complaint in clinical practice, and pes anserinus tendino-bursitis syndrome (PATB has been frequently diagnosed based only on clinical features that may cause equivocal interpretations. Patients complain of characteristic spontaneous medial knee pain with tenderness in the inferomedial aspect of the joint. Studies with different imaging modalities have been undertaken during the last years to identify whether these patients suffer from bursitis, tendinitis, or both. Nevertheless, little is known regarding the structural defect responsible for this disturbance. Due to these problems and some controversies, we suggest the term "anserine syndrome" for this condition. Diabetes Mellitus is a known predisposing factor for this syndrome

  18. Treatment and prevention of paronychia using a new combination of topicals: report of 30 cases.

    Science.gov (United States)

    Gianni, C

    2015-08-01

    Moderate and chronic paronychia is a common disease affecting the hand. Treatment can be effective but the affection is often recurrent, especially as an occupational disease. Moreover, this condition may be complicated by a Candida spp or by bacterial infections. Therefore, general preventive measures can be useful in maintaining health. The aim of this study was to investigate the efficacy and tolerability of a new combination of topical medications in the treatment and prevention of moderate and chronic paronychia. This formulation includes an insulating polymer (Syn-cell barrier), two topical antifungals (octopirox and climbazole) and a molecule with anti-inflammatory activity (corticoid-like repair). Thirty adult subjects (age, 16-78 years; 24 females and 6 males) affected by moderate or chronic paronychia, with or without nail alterations, were evaluated. Included in the study were patients with allergic contact dermatitis (8), irritant contact dermatitis (19), psoriatic paronychia (2 patients), lichen planus of the nails (1 patient). Sometimes Candida spp or bacteria overlapped with paronychia (16 patients positive for Candida spp and 4 patients with bacterial paronychia), sometimes infectious paronychia was not associated with dermatitis of the hands. All 30 subjects were treated with a new cream formulation, three applications per day for 2 months. In 8 patients with proven and severe candidiasis of the nails, oral fluconazole 100 mg was added for 20 days. All patients with bacterial perionyxis took clarithromycin 500 mg twice daily for six days. Patients were then followed for 8 weeks. After two months of treatment, 26 patients responded to therapy. In particular, the treatment evaluation at the end of the follow-up period showed a clinical cure in 46.6% (14 patients), improvement in 40% (12 patients), and failure in 13.4% (4 patients). There was a side effect (moderate skin irritation) in 2 patients, but the drug was not discontinued. Results of the

  19. Unpredictable chronic stress decreases inhibitory avoidance learning in Tuebingen long-fin zebrafish: stronger effects in the resting phase than in the active phase.

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    Manuel, Remy; Gorissen, Marnix; Zethof, Jan; Ebbesson, Lars O E; van de Vis, Hans; Flik, Gert; van den Bos, Ruud

    2014-11-01

    Zebrafish (Danio rerio Hamilton) are increasingly used as a model to study the effects of chronic stress on brain and behaviour. In rodents, unpredictable chronic stress (UCS) has a stronger effect on physiology and behaviour during the active phase than during the resting phase. Here, we applied UCS during the daytime (active phase) for 7 and 14 days or during the night-time (resting phase) for 7 nights in an in-house-reared Tuebingen long-fin (TLF) zebrafish strain. Following UCS, inhibitory avoidance learning was assessed using a 3 day protocol where fish learn to avoid swimming from a white to a black compartment where they will receive a 3 V shock. Latencies of entering the black compartment were recorded before training (day 1; first shock) and after training on day 2 (second shock) and day 3 (no shock, tissue sampling). Fish whole-body cortisol content and expression levels of genes related to stress, fear and anxiety in the telencephalon were quantified. Following 14 days of UCS during the day, inhibitory avoidance learning decreased (lower latencies on days 2 and 3); minor effects were found following 7 days of UCS. Following 7 nights of UCS, inhibitory avoidance learning decreased (lower latency on day 3). Whole-body cortisol levels showed a steady increase compared with controls (100%) from 7 days of UCS (139%), to 14 days of UCS (174%) to 7 nights of UCS (231%), suggestive of an increasing stress load. Only in the 7 nights of UCS group did expression levels of corticoid receptor genes (mr, grα, grβ) and of bdnf increase. These changes are discussed as adaptive mechanisms to maintain neuronal integrity and prevent overload, and as being indicative of a state of high stress load. Overall, our data suggest that stressors during the resting phase have a stronger impact than during the active phase. Our data warrant further studies on the effect of UCS on stress axis-related genes, especially grβ; in mammals this receptor has been implicated in

  20. Neumonitis por hipersensibilidad (alveolitis alérgica extrínseca Hypersensitivity Pneumonitis (extrinsic allergic alveolitis

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    P. Cebollero

    2005-01-01

    Full Text Available El pulmón del granjero se describió por primera vez en 1932. Podemos definir la neumonitis por hipersensibilidad como una enfermedad pulmonar y sistémica que cursa con disnea y tos, y que se produce por la inflamación de tipo inmunológico de las paredes alveolares y vías aéreas terminales y que es secundaria a la inhalación repetida de una variedad de antígenos por un huésped susceptible. Puede decirse que es una enfermedad infradiagnosticada y sólo un alto grado de sospecha clínica y una historia detallada de la exposición pueden llevar a un diagnóstico precoz y un tratamiento satisfactorio. Una combinación entre los hallazgos clínico-radiológicos, funcionales, citológicos o anatonomopatológicos, en algunos casos, nos llevarán al diagnóstico. El tratamiento se funda en la evitación del agente causal y, en los casos más graves, la administración de tratamiento corticoideo sistémico.Farmer’s lung was first described in 1932. We can define hypersensitivity pneumonitis as a pulmonary and systemic disease that is accompanied by dyspnoea and coughing; it is caused by an immunological type of inflammation of the alveolar walls and the terminal airways and it is secondary to the repeated inhalation of a variety of antigens by a susceptible host. It can be said that it is an underdiagnosed disease and only a high degree of clinical manifestations and a detailed history of exposure can lead to an early diagnosis and satisfactory treatment. A combination among clinical-radiological, functional, cytological or pathological findings leads in some cases to a diagnosis. Treatment is based on avoiding further exposure to the causal agent and in the more serious cases the administration of systemic corticoid treatment.

  1. [Etiological factors of acute pancreatitis].

    Science.gov (United States)

    Spicák, J

    2002-09-01

    , pancreatitis develops in the Ist, IVth and Vth type of Frederikson's classification, in rare recessive disorders and other conditions such as hypothyroidism, renal insufficiency, oestrogen substitution and others. In pancreas divisum chronic pancreatitis is more likely to develop. In exotic countries tropical pancreatitis is most frequent. It is however similarly as alcoholic pancreatitis primarily chronic. A very serious course is usual in traumatic pancreatitis. Risk factors of pancreatitis after ERCP are in particular undilated biliary pathways, dysfunction of the sphincter of Oddi and the use of a needle knife (bistoury). Medicamentous prevention is not substantiated. Drug induced pancreatic damage is much rarer than hepatotoxicity. Pancreatitis is caused most frequently by immunosuppressives, methyldopa, corticoids and oestrogens. The question remains to what extent the course of pancreatitis is influenced by its etiology. Biliary, alcoholic, traumatic and postoperative pancreatitis is usually severe, pancreatitis associated with viroses and induced by drugs is usually mild.

  2. Protocolo para la micropropagación de Furcraea macrophylla Baker

    Directory of Open Access Journals (Sweden)

    Martínez María A.

    2006-12-01

    Full Text Available

    Del género Furcraea hacen parte especies textiles de gran importancia en los mercados nacionales e internacionales, tanto por las características de la fibra como por el contenido de precursores de hormonas, corticoides, azúcares, ácidos grasos y biopesticidas que se encuentran en sus jugos. En esta investigación se desarrolló un protocolo para la micropropagación de Furcraea macrophylla B. a partir de ápices caulinares procedentes de bulbillos. Los cultivos in vitro se realizaron en medio MS modificado y suplementado con BA, TDZ, KIN y 2-IP en forma individual o en combinación con 2,69 μM de ANA. Después de 12 semanas de iniciados los cultivos, en la mayoría de los tratamientos ensayados los explantes desarrollaron brotes axilares. 100% de los brotes producidos enraizaron después de 30 d en medio MS modificado suplementado con  11,42 μM de AIA, con 2,46 μM de AIB o en ausencia de reguladores de crecimiento. Después de la etapa de endurecimiento, 94% de las plántulas sobrevivieron en condiciones ex vitro. El protocolo establecido para la  micropropagación de F. macrophylla es un procedimiento efectivo con el que se podría suplir la demanda comercial de material vegetal seleccionado, en óptimo estado fitosanitario, en periodos relativamente  cortos y a bajos costos.

  3. Therapy and prophylaxis of acute and late radiation-induced sequelae of the esophagus

    Energy Technology Data Exchange (ETDEWEB)

    Zimmermann, F.B.; Geinitz, H.; Feldmann, H.J. [Klinik und Poliklinik fuer Strahlentherapie und Radiologische Onkologie, Klinikum rechts der Isar, Muenchen (Germany)

    1998-11-01

    symptomatische Linderung der Beschwerden im Vordergrund, allen voran die der Dysphagie. Eine Besserung wird mit topischen und systemischen Schmerzmitteln erreicht. Finden sich Zeichen eines muskulaeren oesophagealen Spasmus, koennen Calciumantagonisten eingesetzt werden, bei der Refluxoesophagitis Protonenpumpenhemmer. Eine sinnvolle prophylaktische Medikation steht nicht zur Verfuegung. Spaete oesophageale Nebenwirkungen der Strahlenbehandlung mit klinischer Relevanz sind sehr selten. Zumeist finden sich chronische Ulzera, Fisteln und narbige Stenosen. Vor dem Einsatz einer Therapie sollte in jedem Fall eine tumoroese Infiltration der Speiseroehre bioptisch ausgeschlossen werden, da sie deutlich haeufiger als die eigentliche Strahlenbehandlung zu diesen Komplikationen fuehrt. Therapeutisch steht wieder die Sicherung der Ernaehrung durch endoskopische Dilatation, Stentimplantation oder PEG im Vordergrund. Zur Vermeidung einer fruehen Restenosierung koennen Corticoide lokal injiziert werden. Schlussfolgerung: Eine intensive symptomatische Therapie der akuten Oesophagitis ist sinnvoll. Wirksame prophylaktische Therapien existieren nicht. Da spaete radiogene Schaeden des Oesophagus selten sind, sollte im Falle einer Dysphagie ein Tumorrezidiv ausgeschlossen werden. Therapeutisch steht die Sicherung der Ernaehrung ueber PEG, Stent oder Port im Vordergrund. (orig.)

  4. Aspergilosis cervical con diseminación al sistema nervioso central. Presentación de un caso y revisión de bibliografía

    Science.gov (United States)

    Vergara, Guillermo Enrique; Roura, Natalia; del Castillo, Marcelo; Mora, Andrea; Alcorta, Santiago Condomi; Mormandi, Rubén; Cervio, Andrés; Salvat, Jorge

    2015-01-01

    Introducción: la Aspergilosis Invasiva (AI) del Sistema Nervioso Central (SNC) es infrecuente y ocurre generalmente en pacientes inmunocomprometidos. Puede presentarse con cuadros de meningitis, aneurismas micóticos, infartos o abscesos. Es una infección con pronóstico reservado y puede afectar el SNC de forma primaria o secundaria a partir de un foco que se disemina por vía hematógena. Presentamos el caso de un paciente con AI con invasión primaria a nivel óseo y diseminación posterior al cerebro. Caso clínico: Paciente masculino de 25 años con diagnóstico de leucemia linfática aguda en tratamiento quimioterápico que presentó neumonitis por metotrexate por lo que inicia tratamiento con corticoides. Posteriormente agregó cervicalgia y con el diagnóstico de osteomielitis cervical se realiza punción bajo tomografía computada (TC) sin aislarse gérmenes. Se colocó Halo Vest e inició tratamiento antibiótico empírico. Posteriormente presentó afasia de expresión secundaria a lesión frontal izquierda. Se realizó evacuación de absceso cerebral aislando A. fumigatus. El tratamiento antibiótico específico posterior permitió una buena respuesta clínica y radiológica. Conclusión: La presencia de lesiones en el SNC de pacientes inmunocomprometidos debe incluir a las micosis como diagnóstico diferencial. La evacuación quirúrgica permite llegar rápidamente al diagnóstico mejorando la respuesta posterior al tratamiento antibiótico. Para evaluar la respuesta terapéutica y posibles recaídas se debe realizar un seguimiento periódico clínico radiológico. Palabras clave: Aspergilosis cerebral; Aspergilosis cervical; Aspergilosis invasiva; Voriconazol. PMID:26600985

  5. Tratamiento sistémico del penfigoide cicatrizal ocular Systemic treatment of ocular cicatricial pemphigoid

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    María Cecilia Juri

    2012-04-01

    Full Text Available El penfigoide cicatrizal ocular (PCO es una enfermedad ampollar autoinmune que produce daño conjuntival grave. Se conoce poco acerca de la respuesta del PCO al tratamiento inmunosupresor. Describimos un grupo de 76 pacientes con PCO, 62 mujeres y 14 hombres. La edad media al diagnóstico fue de 67 ± 14 años, con un retraso de 7.5 ± 10 años. Sesenta se siguieron en nuestro servicio por 19 ± 21 meses. De 51 en quienes se describe la gravedad de la enfermedad al inicio del tratamiento, fue leve en 19 pacientes, moderada en 19, grave en cinco y muy grave en ocho. Las drogas mayormente prescriptas fueron dapsona en 35 pacientes, de los que 23 la discontinuaron por efectos adversos, y metotrexate en 42, de los que nueve lo suspendieron. Otros recibieron azatioprina, ciclofosfamida y ciclosporina. A 17 se les indicaron corticoides orales, además del inmunosupresor. Cuatro combinaron dos drogas para controlar la enfermedad. Tres pacientes refractarios recibieron gammaglobulina EV con buena respuesta. De 48 evaluados, 39 mostraron mejoría, ocho no tuvieron cambios y uno progresó. En nuestra experiencia, metotrexate y azatioprina son efectivos, con baja toxicidad. Dapsona es útil en casos leves, con efectos adversos frecuentes. La gammaglobulina EV fue efectiva en casos refractarios.Ocular cicatricial pemphigoid (OCP is a blistering autoimmune disease that can produce severe conjunctival damage. Its response to immunosuppressive treatment is poorly known. We describe a group of 76 patients, 62 women and 14 men. Mean age at diagnosis was 67±14 years old, with a delay to diagnosis of 7.5±10 years. Sixty patients continued their follow up in our services for 19±21 months. Nineteen out of 51 had mild disease, 19 moderate, 5 severe and 8 very severe at onset of treatment. The more frequently prescribed drugs were dapsone, in 35 (23 discontinued it because of adverse effects, and methotrexate in 42 patients, nine of them stopped it. Other patients

  6. Circuits Regulating Pleasure and Happiness: The Evolution of the Amygdalar-Hippocampal-Habenular Connectivity in Vertebrates

    Science.gov (United States)

    Loonen, Anton J. M.; Ivanova, Svetlana A.

    2016-01-01

    Appetitive-searching (reward-seeking) and distress-avoiding (misery-fleeing) behavior are essential for all free moving animals to stay alive and to have offspring. Therefore, even the oldest ocean-dwelling animal creatures, living about 560 million years ago and human ancestors, must have been capable of generating these behaviors. The current article describes the evolution of the forebrain with special reference to the development of the misery-fleeing system. Although, the earliest vertebrate ancestor already possessed a dorsal pallium, which corresponds to the human neocortex, the structure and function of the neocortex was acquired quite recently within the mammalian evolutionary line. Up to, and including, amphibians, the dorsal pallium can be considered to be an extension of the medial pallium, which later develops into the hippocampus. The ventral and lateral pallium largely go up into the corticoid part of the amygdala. The striatopallidum of these early vertebrates becomes extended amygdala, consisting of centromedial amygdala (striatum) connected with the bed nucleus of the stria terminalis (pallidum). This amygdaloid system gives output to hypothalamus and brainstem, but also a connection with the cerebral cortex exists, which in part was created after the development of the more recent cerebral neocortex. Apart from bidirectional connectivity with the hippocampal complex, this route can also be considered to be an output channel as the fornix connects the hippocampus with the medial septum, which is the most important input structure of the medial habenula. The medial habenula regulates the activity of midbrain structures adjusting the intensity of the misery-fleeing response. Within the bed nucleus of the stria terminalis the human homolog of the ancient lateral habenula-projecting globus pallidus may exist; this structure is important for the evaluation of efficacy of the reward-seeking response. The described organization offers a framework for the

  7. [Sacral hitch vesical pexy: a new ancillary technique for ureteroneocystostomy].

    Science.gov (United States)

    Pini, Giovannalberto; Leoni, Sergio

    2011-01-01

    To describe the Sacral Hitch, vesical pexys to sacral promontory, an alternative technique to the Psoas Hitch when this is impossible to perform. We report intraoperative complications, and long-term functional results. From 1989 to date we performed 66 ureteroneocystostomies (UNCS) (transbladder technique and Politano-Leadbetter antireflux plasty): 51 with ancillary "Psoas Hitch" (11 Casati-Boari); 15 with "Sacral Hitch" because of the intraoperative finding of deficiency or lack of psoas tendon. Note of technique. Ureter and bladder are dissected as usual. Sacral Hitch: left lateralization of sigmoid and exposition of sacral promontory; longitudinal incision and divarication of peritoneum; smooth dissection of fat tissue, displacement of medium sacral vessels and visualization of neurovascular bundles. Direct fixation of the dome/posterior aspect of bladder to anterior longitudinal ligament above promontory. Among the patients who underwent the Psoas Hitch technique, 3 (5.4%) showed hypoesthesia, acute pain and impossible flexion of the thigh on hip with EMG positive for femoral (1) and genito-femoral (2) neuropathy. The re-operation in 2 cases solved the symptoms. One case resolved conservatively with corticoids, tricyclic antidepressants (Amitriptyline) and antiepileptics (gabapentin). Mean follow-up was 115 months (8-252); two stenosis of anastomosis. Sacral Hitch: (15 pts), mean follow-up: 47 months (range 4-110), no stenosis of anastomosis 0%; transfusion rate 0%. The psoas tendon deficiency or its congenital absence (children or women) requires the direct fixation to the muscle, an inadequate and weak target and housing of important sensitive-motor nerves (Genito-femoral, femoral and latero-cutaneous). A "Psoas-Syndrome" could be present in 5.1% and a re-operation could be necessary. The sacral promontory represents an affixation target already successfully adopted in other surgery specialties (Gynaecology, Orthopaedic and General Surgery) and gives to UNCS

  8. Estudo comparativo entre as alterações histológicas na região do cateter intravascular com e sem o uso de corticosteróide local

    Directory of Open Access Journals (Sweden)

    Maíra Stathourakis Sampaio Amaral

    2015-10-01

    Full Text Available O acesso venoso central é um dos procedimentos cirúrgicos mais comuns na cirúrgica pediátrica em todo mundo, pois frequentemente são utilizados para tratamentos com antibióticos, fluidos com eletrólitos, quimioterapia, nutrição parenteral total, etc. As complicações loco-regionais decorrentes da permanência de cateteres venosos são descritas mais frequentemente como: trombose, infecção, edema e celulites locais, mobilização e perda do cateter. Estas complicações levam também à sua retirada precoce e à necessidade de novas cateterizações para administração dos medicamentos. Se houver possibilidade de minimizar os efeitos inflamatórios locais do vaso e nos tecidos adjacentes com o uso de costicosteróide local, será uma alternativa para a manutenção mais prolongada do cateter, evitando novos procedimentos. O objetivo do presente estudo foi o de analisar as diferenças entre as alterações inflamatórias vasculares e perivasculares nas flebotomias com catéteres de politetrafluoretileno (Intracath®, com e sem o uso de Corticosteroide local (Betametasona, comparando os resultados dessas alterações por meio de análise histológica do vaso sanguíneo com 15 (quinze e 30 (trinta dias e permanência do cateter. O uso de corticoide não impediu o processo inflamatório. Não parece existir diferença entre o processo inflamatório observado com 15 e 30 dias. A grande maioria das amostras no grupo controle não apresentou infiltrado linfoplasmocitário garantindo que os coelhos não apresentavam processo inflamatório antes da colocação do cateter.

  9. [Reminiscences on the occasion of the Whipple's disease centenary: a summary paper].

    Science.gov (United States)

    Kojecký, Z; Benýsek, L; Krc, I; Ehrmann, J; Kod'ousek, R; Malínský, J

    2008-03-01

    The disease referred to eponymically as Whipple's disease (WD) in medical literature was thoroughly described by the American physician and pathologist George Hoyot Whipple (1878-1976) in 1907 and given a temporary denomination of "intestinal lipodystrophy". According to literature, WD is rare, but its precise incidence has not yet been established. Familial incidence of the disease is acknowledged, and its immunogenetic pathogenesis is assumed. The incidence ofWD is prevailingly observed in middle-aged men (mean age 55), exceptionally at child age - the ratio being 3 to 6 for men and women, respectively. 1. Clinical diagnosis is based on symptoms in the GIT region and, in rare cases, on extraintestinal symptoms. Clinical symptomatology includes: abdominal pain with persistent diarrhoea (steatorrhoea), symptoms typical of malabsorption connected with weight loss, fevers, polyarthritic symptoms, swollen lymph nodes and, in part of patients, skin hyperpigmentation. Anaemia and hypoalbuminaemia (reduced IgA) are typically detected in laboratory tests. Rarer extraintestinal symptoms of the disease are of a diverse nature: cardiac lesions, cerebral lesions, ocular symptoms, conspicuous or even tumour-like enlargement of lymph nodes, lesions of the hemopoietic system. The clinical course ofWD is of progressive or remittent nature and the disease is fatal without treatment. Long-term therapy with antibiotics, especially a combination oftetracyclines (doxycyclin) and corticoids (dexametazone), or chloramphenicol in case of cerebral lesion, have a significantly positive effect on the course and prognosis of WD. From the point of view of pathology, WD is a multisystem infectious disease (Tropheryma whipplei) primarily affecting the GIT (39, 47, 52, 103) or different extraintestinal locations. Due to the known diversity of clinical symptoms, no clinical-diagnostic standard has been established for WD. Differential diagnosis includes different multisystem diseases, primarily

  10. Hyperparasitaemia during bouts of malaria in French Guiana

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    Carme Bernard

    2013-01-01

    Full Text Available Abstract Background High circulating parasite load is one of the WHO criteria for severe falciparum malaria. During a period of 11 years (2000–2010, the frequency of hyperparasitaemia (HP (≥4% infected erythrocytes during bouts of malaria due to Plasmodium falciparum, Plasmodium vivax and Plasmodium malariae in patients referred to Cayenne General Hospital (CGH in French Guiana and the frequency of their admission to the Intensive Care Unit (ICU were evaluated. Methods A mean of 1,150 malaria cases were referred to the Parasitology Laboratory of CGH each year over the last decade. During this period, malaria diagnostic (microscopy and parasitaemia evaluation have remained unchanged: determination of the parasitized erythrocytes percentage with asexual forms on thin blood smears for all cases of parasitaemia exceeding 0.1%. Patients admitted to the ICU can be counted by origin of the request for malaria testing. All the data collected retrospectively were anonymized in a standardized case report form and in database. Results Between 2000 and 2010, 12,254 bouts of malaria were confirmed at the Parasitology Laboratory of CHG: P. vivax: 56.2%, P. falciparum: 39.5%, co-infection with both species: 3.4%, P. malariae: 0.9%. HP was observed in 262 cases, at a frequency of 4.9% for P. falciparum and only 0.041% for P. vivax, with no recorded cases for P. malariae. The need for intensive care was correlated with P. falciparum parasite load: 12.3% of cases for parasitaemia of 4-9%, 21.2% for parasitaemia 10-19%, 50% for parasitaemia 20-29% and 77.8% for parasitaemia ≥30% (n=9. The patient with the highest parasitaemia (75% infected erythrocytes with asexual form presented a major concomitant lupus flare-up treated with corticoids. He survived without obvious sequelae. Conclusions In French Guiana during bouts of malaria, HP was observed at a frequency of ~ 5% for P. falciparum and two orders of magnitude less frequent for P. vivax. HP is a severity

  11. Doenças pulmonares obstrutivas crônicas na criança

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    Jose Dirceu Ribeiro

    2015-12-01

    Full Text Available Resumo Objetivos: Verificar e descrever os principais eventos relacionados ao diagnóstico e manejo das doenças pulmonares obstrutivas crônicas em crianças (DPOCC e adolescentes, tendo em vista a fisiopatologia e as características genéticas e ambientais inter-relacionadas. Fonte dos dados: Revisão na base de dados Pubmed com seleção de referências relevantes. Síntese dos dados: As DPOCC têm origem ambiental e/ou genética e se manifestam com diversos genótipos, fenótipos e endótipos e, embora possam ser controladas, não têm cura. O principal sintoma é a tosse crônica e muitas cursam com bronquiectasia. O manejo tem maior eficácia se baseado em guidelines e se a adesão ao regime terapêutico for estimulada e comprovada. Corticoides orais e inalatórios, broncodilatadores, antibióticos inalados e tratamento das exacerbações pulmonares (EP são vigas mestras do manejo e devem ser individualizados para cada DPOCC. Conclusões: Nas DPOCC é fundamental o diagnóstico correto, conhecer os fatores de risco e as comorbidades. Os procedimentos e os medicamentos devem ser baseados em guidelines específicos para cada DPOCC. Adesão ao tratamento é fundamental para obter os benefícios do manejo. O controle deve ser avaliado pela diminuição das EP, melhoria na qualidade de vida e redução da evolução da perda da função e do dano estrutural pulmonar. Para a maioria das DPOCC, o acompanhamento por equipes interdisciplinares em centros de referência especializados, com estratégias de vigilância e acolhimento contínuos, conduz a melhores desfechos, que devem ser avaliados pela diminuição da deterioração do dano e da função pulmonar, pelo melhor prognóstico, melhor qualidade de vida e aumento da expectativa de vida.

  12. Bronquiolite obliterante pós-infecciosa em crianças

    Directory of Open Access Journals (Sweden)

    Natália da Silva Champs

    2011-06-01

    Full Text Available OBJETIVOS: Revisar os trabalhos publicados sobre os principais aspectos da bronquiolite obliterante pós-infecciosa, relacionados com sua história, etiologia, epidemiologia, fatores de risco, patogenia, alterações histológicas, manifestações clínicas, exames complementares, critérios diagnósticos, diagnóstico diferencial, tratamento e prognóstico. FONTES DOS DADOS: Realizou-se uma revisão não sistemática nas bases de dados MEDLINE e LILACS, selecionando-se 66 referências mais relevantes. SÍNTESE DOS DADOS: Na bronquiolite obliterante pós-infecciosa ocorre lesão do epitélio respiratório, e a gravidade clínica está relacionada aos diferentes graus de lesão e ao processo inflamatório. O diagnóstico baseia-se no quadro clínico, na exclusão dos principais diagnósticos diferenciais e no auxílio dos exames complementares. A tomografia computadorizada de alta resolução, principalmente com imagens em inspiração e expiração, possibilta a avaliação das pequenas vias aéreas. As provas de função pulmonar caracterizam-se por padrão obstrutivo fixo com redução acentuada do FEF25-75%. O tratamento não está bem estabelecido, e o uso de corticoides tem sido preconizado em forma de pulsoterapia ou por via inalatória em elevadas doses, no entanto, os dados da literatura a respeito de sua eficácia ainda são escassos. O prognóstico a longo prazo é variável, podendo haver melhora clínica ou evolução para insuficiência respiratória crônica e óbito. CONCLUSÃO: A bronquiolite obliterante pós-infecciosa é uma doença que cursa com elevada morbidade e deve ser abordada por equipe multidisciplinar com acompanhamento em longo prazo.

  13. Interações fármaco-alimento/nutriente potenciais em pacientes pediátricos hospitalizados

    Directory of Open Access Journals (Sweden)

    Everton Moraes Lopes

    2013-01-01

    Full Text Available A alimentação e a administração de medicamentos são indispensáveis na rotina hospitalar, porém sua interação pode acarretar prejuízos ao estado nutricional ou ao tratamento farmacológico, principalmente em crianças, uma vez que possuem certas particularidades. Por isso, profissionais da saúde devem aumentar a atenção durante a administração de fármacos, sobretudo os enfermeiros, por estarem envolvidos diretamente nesse processo. O objetivo desse estudo foi investigar as possíveis interações entre medicamentos e alimentos/nutrientes na unidade de pediatria em um hospital piauiense. Tratou-se de um estudo descritivo, transversal, com abordagem quantitativa, realizado com 90 pacientes hospitalizados. A amostra apresentou prevalência do sexo masculino (55,6% e uma média de idade de 62,76 meses (± 44,101. Os antimicrobianos tiveram uma frequência significativa, com 79 interações entre os medicamentos estudados, seguidos pelos corticoides com 22 ocorrências. Foram encontrados ainda, nove episódios de interações envolvendo os antiulcerosos. Entre os nutrientes, a vitamina B12 teve sua biodisponibilidade reduzida por muitos fármacos. Em suma, pode ser observado que as interações estão presentes na clínica pediátrica, e só o conhecimento pode minimizar prejuízos e/ou multiplicar os benefícios decorrentes das associações de medicamentos com alimentos. Assim, esse trabalho surge como um indicador de segurança do paciente, uma vez que identifica erros de medicação (interações entre prescrições médicas e a da equipe de nutrição.

  14. Avaliação clínica da infiltração facetaria no tratamento da dor lombar crônica por síndrome facetaria: estudo prospectivo Evaluación clínica de la infiltración de las facetas en el tratamiento del dolor crónico de espalda baja por el síndrome de faceta síndrome: estudio prospectivo Clinical evaluation of the lumbar facet joint blocks in treatment of chronic low back pain: a prospective study

    Directory of Open Access Journals (Sweden)

    Thiago Miller Santana Silva

    2011-01-01

    Full Text Available OBJETIVO: Avaliar os resultados do bloqueio facetário lombar com anestésico local e corticóide em pacientes com lombalgia crônica por síndrome facetária. MÉTODOS: Realizou-se um estudo prospectivo em 30 pacientes com lombalgia crônica por síndrome facetária, os quais foram submetidos à infiltração facetária com bupivacaína a 0,25% e acetato de metilpredinisolona sob controle radioscópico, e foram seguidos e avaliados seguindo as escalas Visual Analógica da Dor, Oswestry Disability Index e os Critérios de MacNab nos quais 17 foram do sexo feminino e 13 do sexo masculino. RESULTADOS: Foi observada diminuição significativa (pOBJETIVO: Evaluar los resultados del bloqueo facetario lumbar, con anestésico local y corticoide, en pacientes con dorsalgia crónica por síndrome facetario. MÉTODOS: Se realizó un estudio prospectivo en 30 pacientes, 17 del sexo femenino y 13 del sexo masculino, con dorsalgia crónica por síndrome facetario, quienes fueron sometidos a la infiltración facetaria con bupivacaína a 0,25% y acetato de metilpredinisolona bajo control radioscópico, y fueron acompañados y evaluados siguiendo las escalas Visual Analógica del Dolor, Oswestry Disability Index y los Criterios de MacNab. RESULTADOS: Se observó una disminución significativa (pOBJECTIVE: To evaluate the lumbar facet block with local anesthetics and corticosteroids in patients with chronic low back pain of facet joint origin. METHODS: We conducted a prospective study on 30 patients with chronic low back pain in facet syndrome who underwent facet infiltration with bupivacaine 0.25% and methylprednisolone acetate under radioscopic control; the subjects were followed and evaluated following the Visual Analogue Scale of Pain , Oswestry Disability Index and MacNab criteria; 17 of them were female and 13 male. RESULTS: Reduction of pain was found by Visual Analogue Scale significant (p <0.05. We obtained 73.3% of satisfactory results in the first

  15. Consenso 2012 da Sociedade Brasileira de Reumatologia para o tratamento da artrite reumatoide 2012 Brazilian Society of Rheumatology Consensus for the treatment of rheumatoid arthritis

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    Licia Maria Henrique da Mota

    2012-04-01

    Full Text Available OBJETIVO: Elaborar recomendações para o tratamento da artrite reumatoide no Brasil. MÉTODO: Revisão da literatura com seleção de artigos baseados em evidência e opinião de especialistas da Comissão de Artrite Reumatoide da Sociedade Brasileira de Reumatologia. RESULTADOS E CONCLUSÕES: 1 A decisão terapêutica deve ser compartilhada com o paciente; 2 imediatamente após o diagnóstico, uma droga modificadora do curso da doença (DMCD deve ser prescrita e o tratamento ajustado para atingir remissão; 3 o tratamento deverá ser conduzido por reumatologista; 4 o tratamento inicial inclui DMCD sintéticas; 5 o metotrexato é a droga de escolha; 6 pacientes que não alcançaram resposta após a utilização de dois esquemas de DMCD sintéticas devem ser avaliados para DMCD biológicas; 7 excepcionalmente, DMCD biológicas poderão ser consideradas mais precocemente; 8 recomenda-se preferencialmente o uso de agentes anti-TNF como terapia biológica inicial; 9 após falha terapêutica a uma primeira DMCD biológica, outros biológicos poderão ser utilizados; 10 ciclofosfamida e azatioprina podem ser consideradas em manifestações extra-articulares graves; 11 recomenda-se a utilização de corticoide oral em baixas doses e por curtos períodos; 12 os anti-inflamatórios não hormonais devem sempre ser prescritos em associação à DMCD; 13 avaliações clínicas devem ser mensais no início do tratamento; 14 terapia física, reabilitação e terapia ocupacional são indicadas; 15 deve-se recomendar tratamento cirúrgico para correção de sequelas; 16 métodos de terapia alternativa não substituem a terapia tradicional; 17 deve-se orientar planejamento familiar; 18 orienta-se a busca ativa e o manejo de comorbidades; 19 atualizar e documentar a vacinação do paciente; 20 doenças transmissíveis endêmico-epidêmicas devem ser investigadas e tratadas.OBJECTIVE: To elaborate recommendations for the treatment of rheumatoid arthritis in

  16. Encuesta a neumonólogos sobre el diagnóstico y tratamiento de EPOC Survey of chest physicians regarding copd diagnosis and treatment

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    Martín L. Sívori

    2004-04-01

    Full Text Available Se realizó una encuesta acerca de diagnóstico y tratamiento de EPOC a un grupo de 517 especialistas en neumonología, seleccionados al azar entre los 1121 integrantes de la Asociación Argentina de Medicina Respiratoria. Se obtuvieron 187 respuestas (36.2%. Atienden en promedio 53.3 pacientes con EPOC/mes, a los cuáles definen como leves el 24.2%, moderados el 41.8% y severos el 33.8% (criterios normativos GOLD. El criterio utilizado para el diagnóstico de EPOC fue sólo clínico en el 2.9%, clínico y espirometría (ESP en el 23.4% y clínico, ESP y por imágenes en el 73.7%. El 70.1% de los encuestados incluye dentro de la definición de EPOC al asma crónico de escasa respuesta a broncodilatadores. Sólo el 14.1% manifiesta realizar espirometría en cada consulta. La evaluación de la función cardíaca la realizan en EPOC severa por examen clínico (90.6%, electrocardiograma (80.6% y ecocardiograma (73.8%. El 98.3% de los encuestados afirma que la mayoría de los pacientes son instruidos en la realización de maniobras de inhalación de medicamentos. Eligieron como primera opción para administrar broncodilatadores en aerosol (64.8%, nebulización (16.5%, polvo (13.7% y vía oral (4.8%. El 65.5% eligió como primera opción de tratamiento crónico a los anticolinérgicos (AC + b2-agonistas de acción corta (BAAC, 18.8% AC solos, 9.7% b2-agonistas de acción larga (BAAL, 3.5% corticoides inhalados (CI y 2.8% BAAC solos. Los corticoides sistémicos y los antibióticos fueron utilizados en las reagudizaciones severas por el 92.5% y el 70% de los encuestados, respectivamente. En esa situación, como antibióticos de primera elección, fueron elegidos los beta lactámicos + inhibidores de beta-lactamasa por el 39.1% de los encuestados, fluorquinolonas (23.7%, macrólidos (17.4% y beta-lactámicos (12.5%. El 12.7% de los pacientes con EPOC realiza oxigenoterapia crónica domiciliaria y el 59.3% rehabilitación respiratoria. El 94.1% de los

  17. Urgencias metabólicas en el paciente oncológico Metabolic emergencies in the oncology patient

    Directory of Open Access Journals (Sweden)

    J.L. Elejalde

    2004-01-01

    Full Text Available Entre las principales situaciones metabólicas que pueden precisar atención urgente en el paciente oncológico se encuentran: hipercalcemia, hiponatremia, síndrome de lisis tumoral, acidosis láctica, hiperuricemia, insuficiencia renal, hiperamonemia, hiperpotasemia, etc. La hipercalcemia es la complicación metabólica más frecuente en oncología apareciendo en el 10-30% de estos pacientes. Sus principales mecanismos son dos, la lisis tumoral y la hipercalcemia humoral mediada por la PTHrP (proteína relacionada con la parathormona. Para su diagnóstico lo principal es su sospecha ya que algunos síntomas son inespecíficos y atribuibles a otras causas como somnolencia, estreñimiento, etc. El tratamiento estará basado en la intensidad y se inicia con medidas calciuréticas con una intensa hidratación con suero fisiológico y en algunas ocasiones furosemida. Las medidas antirreabsortivas incluyen la calcitonina, bifosfonatos, mitramicina, nitrato de galio y en ocasiones corticoides. Bifosfonatos como el pamidronato y el zolendronato parecen ser muy útiles en estos casos. La hiponatremia se clasifica en función de la osmolaridad plasmática; cuando ésta es baja nos encontramos ante la verdadera hiponatremia que puede cursar con volumen extracelular elevado (insuficiencia cardíaca, cirrosis, síndrome nefrótico e insuficiencia renal, disminuido (pérdidas renales y extrarrenales de sodio y normal (SIADH principalmente, relacionado con una eliminación alta de sodio en orina con alta osmolaridad urinaria a pesar de ser ésta baja en sangre. Varios tipos de tumor y diversos fármacos quimioterápicos pueden producir este SIADH. El tratamiento variará según el tipo y la intensidad pero, en general, éste se basa en una restricción hídrica y la reposición del sodio deficitario bien a través de suero fisiológico o de sueros salinos hipertónicos según el caso y en ocasiones furosemida para la eliminación del exceso de agua

  18. Trastornos tiroideos por amiodarona The effects of amiodarone on the thyroid

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    M. Toni

    2009-12-01

    Full Text Available Fundamento. Muchos pacientes reciben tratamiento con amiodarona por su eficacia como antiarrítmico. Aproximadamente el 16% desarrollan alteraciones de la función tiroidea. El objetivo de este estudio es valorar la relevancia de dichas alteraciones en la población navarra, estudiada entre 2001 y 2007. Material y métodos. Se trata de un estudio retrospectivo, en el que se han analizado las características de 182 pacientes remitidos a la consulta de endocrinología, por desarrollar disfunción tiroidea mientras se encontraban en tratamiento con amiodarona. Para ello se han medido en plasma los niveles de hormonas tiroideas y anticuerpos antitiroideos y, cuando ha sido necesario, se ha realizado estudio tiroideo de imagen, ya sea mediante gammagrafía con tecnecio 99 o ecografía. Resultados. El screening de la función tiroidea, recomendado previamente al inicio de tratamiento con amiodarona, se efectúo solamente en el 20,9% de los pacientes estudiados. El 41% presentaban hipotiroidismo; de éstos, en el 76% se suspendió el tratamiento con amiodarona. El tiempo medio de aparición del mismo fue de 21 ±12 meses desde el inicio de la toma del fármaco. El 48,6% desarrolló hipotiroidismo permanente. Este grupo presentaba niveles de TSH (tirotropina mayores y llevaban menos tiempo de tratamiento con amiodarona. El 59% presentaban tirotoxicosis: el 59,4% presentó una tirotoxicosis inducida por amiodarona (TIA tipo 1, el 30,6% una TIA tipo 2 y el 10% restante fue etiquetada de tiroxicosis mixta. El tiempo medio de aparición de la tirotoxicosis fue de 29,5 meses desde el inicio del tratamiento. Los niveles de T4 libre eran significativamente mayores en la TIA tipo 2. Todos los pacientes fueron tratados con antitiroideos y/o corticoides, llegando a precisar en alguna ocasión ingreso hospitalario debido a la severidad del cuadro. Conclusiones. En nuestra serie son más frecuentes las tirotoxicosis que el hipotiroidismo inducido por amiodarona

  19. Nefropatía por Inmunoglobulina A: Guía de práctica clínica Immunoglobulin A nephropathy: Clinical Practice Guidelines

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    Alicia Fayad

    2011-05-01

    Full Text Available La nefropatía por Inmunoglobulina A (N.IgA es la causa más frecuente de enfermedad glomerular a nivel mundial, 15-50% de los pacientes presentan pérdida progresiva de la función renal en 10-20 años; el resto remisión clínica o hematuria/ proteinuria persistente. Su tratamiento óptimo es incierto. Nuestro objetivo fue desarrollar recomendaciones basadas en la evidencia a través de búsqueda en bases de datos Medline, Embase, Lilacs, Cochrane Trials Register. Los investigadores analizaron la calidad de los estudios independientemente, usando la Cochrane Renal Group checklist: aleatorización, carácter ciego, intención de tratar y pérdidas en el seguimiento. La evidencia se clasificó en niveles y la recomendación en grados, según el Centre for Evidence-Based Medicine, Oxford, con dos enfoques principales: Terapia inmunosupresora (corticoides, citostáticos, ciclosporina A y micofenolato mofetilo: Nivel I a, grado A. Terapia combinada con inmunosupresores en adultos: Nivel II b, grado B. Corticoides más ciclofosfamida o azatioprina en niños: Nivel II b, grado C. Ciclosporina y micofenolato-mofetilo: Nivel II b, grado B. Terapia no inmunosupresora: inhibidores del sistema renina-angiotensina (IEAC y/o bloqueantes del receptor de angiotensina II (BRAII, aceite de pescado, estatinas, antiplaquetarios y tonsilectomía: Nivel I a, grado A. Niños: IECA y BRAII con monitoreo de función renal y de nivel sérico de potasio: Nivel I b, grado B. En nefropatía progresiva, antiplaquetarios como tratamiento coadyuvante: Nivel I, grado C. Aceite de pescado como soporte adicionado de BRAII e IECA en pacientes con lesiones histológicas leves y baja reducción de la filtración glomerular: Nivel II b, grado B (no en niños. No hay evidencias para recomendar estatinas en niños; en mayores de 5 años con síndrome nefrótico e hipercolesterolemia usar sólo con monitoreo de fosfocreatin-kinasa sérica. No hay evidencias para recomendar la

  20. Encuesta sobre cambios en el manejo y tratamiento del asma bronchial Survey on changes in asthma treatment and management

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    Guillermo A. Raimondi

    2004-06-01

    Full Text Available Se realizó una encuesta a 518 especialistas de enfermedades respiratorias de un listado de la totalidad del país. Esta se refería al manejo y al tratamiento del acceso agudo y especialmente al asma estable, en adultos y en niños mayores de 6 años. Se obtuvieron 198 respuestas (38.2% de los cuestionarios enviados. Se compararon los resultados con los obtenidos en una encuesta realizada en 1994. Las respuestas se evaluaron como 0 (nunca, 1 (algunas veces, 2 (a menudo, 3 (siempre. Con estos valores se calculó un puntaje medio. Respecto a 1994 se encontró una buena tendencia referente al enfoque diagnóstico con más utilización de la prueba de reversibilidad a los broncodilatadores (2.74 ±2.3 vs 2.30±1.05 y la prueba terapéutica con corticoides (1.26±0.96 vs 0.98±0.84 y menor utilización de las pruebas cutáneas (0.50±0.83 vs 0.88±1.08. Referente al consejo de utilizar la sintomatología o el descenso del pico flujo espiratorio para reconocer el ataque del asma, ambos mejoraron significativamente (2.65±0.66 vs 2.29±0.90 y 1.93±1.05 vs 1.51±1.20, respectivamente. Criterios objetivos para evaluar el ataque de asma no siempre son utilizados por parte del médico y no mejoraron respecto a 1994 (2.14±1.04 vs 2.13±0.70. Referente al tratamiento en agudo, este enfoque mejoró notablemente con la casi totalidad de los encuestados que recomiendan b2 agonistas inhalados tanto en adultos como en niños (primera opción de tratamiento 85.3 vs 57.5% y 81.0 vs 63.4%, respectivamente. En el tratamiento de mantenimiento, se observó una mayor utilización de corticoides inhalados, sobre todo en los niños (2.09±1.01 vs 1.61±1.00, con dosis ahora correctas. Se observó menor utilización de b2 agonistas de acción corta en el tratamiento continuo, 0.40±0.78 vs 1.23±1.10 y 0.21±0.58 vs 1.23±1.00 en adultos y niños, respectivamente. A pesar de esta tendencia positiva en el manejo y tratamiento de asma bronquial no todo está de acuerdo

  1. Alogenosis iatrogénica: Una nueva enfermedad A new desease: Iatrogenic allogenosis

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    F. Coiffman

    2008-03-01

    ático. Las resecciones quirúrgicas solo deben hacerse en zonas muy limitadas, pues producen depresiones cutáneas y cicatrices retráctiles. Las masas muy grandes no se deben resecar debido a las deformaciones consecuentes. Se debe proteger la piel con sustancias emolientes. El aspecto más importante de este estudio es lo que no debe hacerse: los corticoides locales o generales no sirven y aumentan la atrofia de la piel; las punciones y la liposucción no ayudan, pues las masas son sólidas y fibróticas; los masajes, el ultrasonido y el láser no ayudan y a veces empeoran la situación. En todos los países se deben realizar campañas oficiales de prevención contra estas sustancias.The need to replenish wrinkles and depressions has enticed the creation of multiple solid or semi-solid injectable substances. The disastrous results of some of these have led me to create the term "Iatrogenic Allogenosis": "Allogenosis", because it is produced by allogenic (foreign substances. "Iatrogenic", because we, the physicians or persons injecting these substances, have caused this disease. Over one million persons in Latin-America have become victims of these substances. Our objective is to learn how to treat these cases. We have studied 358 cases in a 10-year time span. We have grouped them and tried to reach conclusions. Mostly used substances are: liquid silicon, paraffin, liquid petrolatum, Vaseline, mineral oil, animal fat, etc. We have not included in this study some substances that have been fairly accepted by surgeons: autogenous fat, bovine collagen, hydroxyapatite, acrylic, hyaluronic acid, etc. Reactions are local and general. The latency period varies from 6 hours to 25 years. Local reactions are: pain, erhytema, edema, pigmentations, swelling, fibrosis, keloids, infection, fistulas, necrosis, gravity displacement, etc. The general ones are: fever, arthralgia, general discomfort, we have no find relations with autoimmune diseases (dermatomyositis, scleroderma, etc

  2. 四逆汤对脓毒症患者下丘脑-垂体-肾上腺轴的影响%Effect of Sini decoction on function of hypothalamic-pituitary-adrenal axis in patients with sepsis

    Institute of Scientific and Technical Information of China (English)

    黄若兰; 张忠; 徐慕娟; 常晓; 乔秋杰; 王玲; 孟新科

    2014-01-01

    Objective To investigate the effects of Sini decoction on function of hypothalamic-pituitary-adrenal axis in patients with sepsis.Methods A prospective single-blind randomized controlled trial was conducted.60 septic patients were divided into three groups with the method of random number table,20 cases in the control group,20 in the Chinese herb group,and 20 in corticoid group.All of them received routine treatment.Patients in Chinese herb group were given Sini decoction in addition (decoction of monkshood 15 g,dried ginger 15 g,honey-fried licorice 10 g) 100 mL/d orally or by nasal feeding,while patients in corticoid group were given hydrocortisone 200 mg/d intravenously instead,both for 7 days.Before the treatment,3 days and 14 days after treatment,blood was collected to determine the levels of adrenocorticotropic hormone (ACTH) and cortisol,and the result of ACTH stimulating test was observed.At the same time,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score was recorded,and 3-day shock recovery rate and 28-day death rate were also compared among these groups.Results None of the three groups showed different result in ACTH stimulating test (x2=1.101,P=0.605).ACTH in three groups was gradually decreased.Compared with that before treatment,ACTH in Chinese herb group and corticoid groups began to decrease obviously on day 3 (ng/L:29.90 ± 3.31 vs.33.10 ±.3.31,28.20 ±.2.45 vs.33.30 ± 3.84,both P<0.01),while in control group declined ACTH appeared later (on day 14) compared with before treatment (ng/L:29.40 ±5.63 vs.33.50 ±4.89,P<0.05).No obvious difference in ACTH level was showed between the Chinese herb group and the cortical group (both P>0.05).Cortisol level in both Chinese herb and cortical groups showed a raise-fall biphase trend while there was no change in the control.The cortical levels on day 3 in Chinese herb and cortical groups were much higher than that before treatment (μg/L:343.04 ± 31.20 vs.294.70 ±42.10,331.25 ±42

  3. Análise de prevalência e evolução das manifestações neuropsiquiátricas moderadas e graves em pacientes com lúpus eritematoso sistêmico internados no serviço de reumatologia do Hospital Geral de Fortaleza Prevalence and follow-up analysis of evolution of severe and moderate neuropsychiatric manifestations in hospitalized systemic lupus erythematosus in the rheumatology service of the Hospital General de Fortaleza

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    Walber Pinto Vieira

    2008-06-01

    in these patients: cause of admission, presence of auto-antibodies, cerebral spinal fluid, radiological imaging, retrospective study of medical records and treatment. RESULTS: The prevalence of NPM was 16.4% (18/110, being seventeen women and one man; the mean age was 29 years; during the hospitalization term, only 33% (6/18 of the patients had an NPM. The occurrence of the first NPM was in 11% (2/18 of the cases before diagnosis, in 33% (6/18 during diagnosis and in 56% (10/18 after diagnosis. The mortality rate was 11% (2/18. The most common NPM's were: seizures and headache (50%, psychosis (22%, cerebrovascular disease (17%, syncope and major depression (11%. Treatment outcome: 28% (5/18 of the patients responded to oral corticoids, 17% (3/18 had a pulse of methylprednisolone and 56% (10/18 were treated with cyclophosphamide. CONCLUSION: The prevalence of NPM in the patients of this study was on the lowest limit reported by the related literature. With no controlled clinical trials, the approach to these patients is based on case reports and the professional experience of the service.

  4. [The Omega "Omega" pulley plasty: a new technique for the surgical management of the De Quervain's disease].

    Science.gov (United States)

    Bakhach, J; Sentucq-Rigal, J; Mouton, P; Boileau, R; Panconi, B; Guimberteau, J-C

    2006-02-01

    The Omega "Omega" pulley plasty: a new technique for the surgical management of the De Quervain's disease. The De Quervain tenosynovitis is an inadequacy into the first extensor compartment between the osteo-fibrous tunnel and the tendons. This mechanical conflict generates a tenosynovitis of the extensor pollicis brevis and the abductor pollicis longus tendons. This is generally expressed by a tenderness on the radial side of the wrist over the radial styloid process. The medical management consists on corticoids infiltrations of the first extensor compartment, the avoidance of repetitive and stress movements of the first ray with the use of a rest splint. The surgical approach is considered with the recurrence of the painful symptoms. This well-known pathology is reputated to require a simple section of the pulley. Our post-operative complications have been reported in the literature of this classical surgical solution. These complications concern an incomplete release of the extensor pollicis brevis and the abductor pollicis longus tendons particularly when an extensor sub-compartment exists and was overlooked, an irritation of the collateral branches of the sensitive radial nerve or the occurrence of a nevroma after a nerve injury and the most serious complication is a palmar subluxation of the extensor tendons which can occur with the thumb extended and the wrist flexed. In rare cases, this subluxation can be really painful and requires a surgical management with secondary reconstruction of the pulley. This reconstruction necessitates distal pedicle flaps from the dorsal retinaculum or the brachioradialis tendon. To prevent these complications, Codega and Kapandji described techniques of reconstruction of the pulley after its release. More recently, Le Viet reported a procedure using the anterior flap of the pulley; fixed to the dermis it will work as a barrier and maintain the tendons sliding on the radial styloid groove. These techniques require to divide

  5. Terapia celular para el tratamiento de la diabetes: Más allá de las células madre Cell therapy for diabetes mellitus: Beyond stem cells

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    María Laura Gimeno

    2011-06-01

    Full Text Available La diabetes tipo 1 es una enfermedad de etiología autoinmune que se caracteriza por la destrucción de las células ß pancreáticas, produciendo un déficit absoluto de insulina. El tratamiento clínico estándar consiste en la aplicación de insulina. Sin embargo, en un número importante de pacientes y debido a la dificultad en lograr un control metabólico preciso, generalmente se asocia con complicaciones graves a nivel vascular con repercusión renal y ocular entre otras. Por otra parte, un estricto control metabólio, a menudo se asocia con hipoglucemias con riesgo de muerte. Esto motivó la investigación y el desarrollo de alternativas de tratamiento. Una de ellas es el trasplante de células productoras de insulina, las células ß, obtenidas por medio del aislamiento y trasplante de islotes de un páncreas cadavérico. Los mejores resultados con esta modalidad de trasplante se obtuvieron con la inyección sucesiva de islotes pancreáticos de diferentes donantes y terapia inmunosupresora exenta de corticoides. Sin embargo, la escasez de órganos por un lado, y el hecho de que cada implante de islotes de otro páncreas aumenta las posibilidades de rechazo inmunológico, hace que este tratamiento se vea limitado a centros de alta experiencia y pacientes muy seleccionados. Asimismo, las drogas inmunosupresoras que deben administrarse de por vida, pueden producir efectos no deseados en el organismo. La medicina regenerativa abre la posibilidad de utilizar células madre con capacidad de diferenciarse en células productoras de insulina, utilizando de manera conjunta factores tróficos que serían capaces de estimular a las propias células madre de cada parénquima.Type 1 diabetes is an autoimmune disease of unknown etiology characterized by destruction of pancreatic beta cells, leading to absolute insulin deficiency. Standard therapy includes the use of exogenous insulin. However, due to the difficulty to achieve a tight metabolic

  6. Avaliação da densidade mineral óssea em pacientes com doença inflamatória intestinal Bone mineral density evaluation in inflammatory bowel disease patients

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    Fabiana Lígia Lora

    2005-12-01

    patients from 20 to 50 years old, of the Inflammatory Bowel Disease Ambulatory of the Gastroenterology Service of the Clinics Hospital, Curitiba, PR, Brazil, were selected for the evaluation. From those, 76 completed all the stages of the evaluation. The densitometry was made from lumbar column and right femur with a dual-energy x-ray absortiometry (Hologyc QDR 1000/W device. RESULTS: The inflammatory bowel disease patients had a significant reduction of the bone mineral density in all the evaluated parts, femur neck, total femur and lumbar column. The analysed variables, disease activity index, usage of corticoids, the lack of physical activities, the index body mass and previous surgeries did not have influence in the results. CONCLUSION: Reduced bone mineral density was founded in inflammatory bowel disease patients of the Clinics Hospital, mainly in the Crohn's disease patients, as described in literature. None analyzed variables had significant correlation to the bone mineral density.

  7. Tratamiento de epicondilitis refractaria con neurotoxina botulínica tipo A libre de complejo proteínico Treament of refractory epicondilitis with botulin neurotoxin type A free of protein complex

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    B. Santos

    2013-02-01

    Full Text Available Introducción: La epicondilitis o "codo de tenista" es un cuadro que se caracteriza por dolor en la inserción proximal del músculo extensor radial corto del carpo. El tratamiento de este cuadro clásicamente se ha basado en fisioterapia e infiltración con corticoides, así como el uso de ortesis. La cirugía se recomienda cuando las estrategias conservadoras no controlan los síntomas después de 6-12 meses de tratamiento. La toxina botulínica es una opción terapéutica cuando fracasan medidas conservadoras. Material y métodos: Presentamos 3 pacientes diagnosticados previamente de epicondilitis de más de 6 meses de evolución y que habían sido sometidos de forma ambulatoria a los tratamiento habituales sin éxito, a los cuales se les administró toxina botulínica A libre de complejo proteico (50 UI en un solo punto de aplicación. Se evaluó la intensidad del dolor en ambos pacientes usando una escala analógica visual (EVA, en la que el 0 representa ningún dolor y 10 significa el dolor más intenso que han experimentado tanto a la palpación como con la maniobra de extensión resistida de la muñeca. Resultados: Se obtuvo una reducción importante del dolor en los 3 pacientes tratados al primer mes de su administración, con resolución total del mismo a los 3 meses. Este beneficio se mantuvo al menos durante los 6 meses de estudio. Conclusiones: La epicondilitis refractaria a tratamientos conservadores puede ser tratada eficazmente con toxina botulínica A libre de complejo proteínico.Introduction: Epicondylitis or "tennis elbow" is a condition characterized by pain in the proximal insertion of the extensor Carpi radialis brevis muscle. Treatment of this condition has classically been based on physiotherapy and infiltration with corticosteroids, as well as the use of orthoses. Surgery is recommended when the conservative strategies do not control symptoms after 6-12 months of treatment. Botulin toxin is a therapeutic option when

  8. Brote epidémico de dermatitis por la oruga procesionaria del pino (Thaumetopoea pityocampa en escolares Outbreak of dermatitis caused by pine processionary caterpillar (Thaumetopoea pityocampa in schoolchildren

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    F. Artola-Bordás

    2008-12-01

    Full Text Available Fundamento. Describir un brote de dermatitis por exposición a las orugas procesionarias del pino (Thaumetopoea pityocampa ocurrido el 15 de marzo del 2006 en escolares, que realizaron una estancia vacacional en una masía rural a 2 Km de Villahermosa del Río (Castellón. Métodos. Se realizó un estudio epidemiológico transversal que incluyó a los setenta escolares, de 10 años de edad, y a 3 profesores procedentes de Castellón. Se empleó un cuestionario específico para ser cumplimentado por los escolares. Resultados. Seis casos de dermatitis (tasa de ataque 8,6%: 6/70 ocurrieron después del baño en la piscina climatizada de la masía al secarse con toallas, que habían dejado fuera del recinto de la piscina, y la Thaumetopoea pityocampa se deslizó sobre ellas. Los casos precisaron atención médica con administración de antihistamínicos, corticoides y duchas de agua fría. El riesgo de sufrir el cuadro por contacto con la Thaumetopoea pityocampa fue muy alto (Odds Ratio = 157,2; Intervalo de confianza del 95% 18,4-∞. Se recogieron Thaumetopoea pityocampa en las inmediaciones de la piscina y se observaron sus nidos en pinos próximos. Conclusiones. La presencia de Thaumetopoea pityocampa en zonas próximas a albergues rurales puede ser causa de brotes epidémicos y se requiere educación sanitaria de los escolares y eliminación de los nidos de Thaumetopoea pityocampa en las inmediaciones de estos albergues.Background. To describe a dermatitis outbreak caused by exposure to pine processionary caterpillar (Thaumetopoea pityocampa that took place on March 15th, 2006, in schoolchildren during their stay at a rural farm holiday centre in Villahermosa del Río (Castellón. Methods. A cross sectional epidemiological study was carried out on seventy schoolchildren, average age 10 years, and 3 teachers from Castellón. A specific questionnaire was used to be filled in by the schoolchildren. Results. Six cases of dermatitis (attack rate 8

  9. Estudo controlado do uso endovenoso de sulfato de magnésio ou de salbutamol no tratamento precoce da crise de asma aguda grave em crianças Randomized clinical trial of intravenous magnesium sulfate versus salbutamol in the early management of severe acute asthma in children

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    João Carlos Santana

    2001-08-01

    Full Text Available OBJETIVOS: estudar os efeitos da administração endovenosa de sulfato de magnésio (MgEV ou de salbutamol (SalbEV em crianças com crise de asma aguda. MÉTODOS: estudo randomizado, duplo-cego e controlado por placebo. Incluídas crianças maiores de 2 anos admitidas em sala de observação com crise de asma aguda grave (refratária a três nebulizações com beta-adrenérgicos. Após a admissão, recebiam tratamento convencional (oxigênio, corticóides, nebulizações com beta-adrenérgicos e eram alocadas a receber uma de três soluções indistinguíveis entre si: a MgEV (50 mg/kg; b SalbEV (20 µg/kg; ou c solução salina, que eram administradas em 20 minutos (1ml/kg/hora. Avaliações clínicas, dosagens de eletrólitos e gases arteriais foram registrados antes e 1 hora após a infusão das drogas. RESULTADOS: foram estudados 50 pacientes (+ 4,5 anos e 53% de meninas, sem diferenças significativas entre os 3 grupos. No grupo MgEV, observou-se redução da pressão arterial durante a infusão, que retornou ao normal 1 hora após, associado com aumento (p OBJECTIVE: To study the efficacy of intravenous magnesium sulfate and intravenous salbutamol in the treatment of severe asthma in children. METHODS: Randomized, double-blind, placebo-controlled clinical trial, including children above 2 years of age with severe acute asthma admitted to the observation ward of the Pediatric Intensive Care Unit of Hospital São Lucas. All patients received conventional treatment (oxygen, corticoids, beta-adrenergics on admission, and later received one of the following solutions: a IVMg (50 mg/kg; b intravenous salbutamol (20 µg/kg; c saline solution (1 ml/kg/min. Clinical assessments, electrolyte concentration, and arterial blood gas analyses were recorded before intravenous infusion and one hour after that. RESULTS: Fifty patients participated in this study (of whom 53% were females, mean age = 4.5 years. There were no significant differences among the

  10. Consecuencias clínicas de la disfunción muscular en la enfermedad pulmonar obstructiva crónica Clinic consequences of the muscle dysfunction in chronic obstructive pulmonary disease

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    J. Sauleda Roig

    2006-05-01

    Full Text Available La función de los músculos respiratorios, y principalmente los inspiratorios, está alterada en pacientes con EPOC. La mayoría de estas alteraciones se deben fundamentalmente a la hiperinsuflación pulmonar que deja en situación desventajosa a estos músculos. La principal consecuencia de esta disfunción es la fatiga muscular respiratoria que puede provocar disnea, intolerancia al ejercicio, hipoventilación con aparición de insuficiencia respiratoria hipercápnica. Dicha función puede medirse en el laboratorio de función pulmonar a través de pruebas inespecíficas (espirometría, volúmenes pulmonares y específicas (presiones respiratorias máximas [PIM-PEM], presión transdiafragmática, índice tensión tiempo del diafragma, electromiografía o pruebas de resistencia. El tratamiento debe ir encaminado principalmente a mejorar la hiperinsuflación con tratamiento broncodilatador, mejorar la fuerza muscular con rehabilitación y en casos graves se requiere reposo muscular con ventilación mecánica. La disfunción muscular periférica es una complicación frecuente en la EPOC moderada-severa y puede ser consecuencia de la inactividad crónica, hipoxemia, alteraciones electrolíticas, desnutrición, corticoides, estrés oxidativo e inflamación sistémica. Además, puede contribuir a que estos pacientes asocien empeoramiento en su calidad de vida, discapacidad e incluso a un aumento en la morbi-mortalidad. Se puede evaluar con impedanciometría, pruebas de fuerza muscular (dinamometría, pruebas de imagen e incluso con biopsia muscular en estudios de investigación. La disfunción muscular periférica es potencialmente tratable con rehabilitación, suplementos nutricionales y fármacos anabolizantes. No obstante, a menudo el éxito terapéutico es incompleto por lo que es necesario desarrollar nuevos estudios con nuevas estrategias terapéuticas.The function of respiratory muscles, and mainly inspiratorymuscles, is impaired in COPD

  11. Impacto de la nutrición en la evolución de la enfermedad inflamatoria intestinal Impact of nutritional treatment in the evolution of inflammatory bowel disease

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    M.ª D. Ballesteros Pomar

    2010-04-01

    Full Text Available La enfermedad inflamatoria intestinal es una entidad de etiopatogenia aún no bien conocida, con importantes implicaciones nutricionales y metabólicas, por la alta prevalencia de malnutrición que conlleva; por la posible implicación de factores dietéticos en su patogenia; y por la hipótesis de que la intervención nutricional pudiera ser un tratamiento primario de la enfermedad. Algunos nutrientes, además de su función exclusivamente nutricional, podrían inducir un bajo estímulo antigénico, regular respuestas inflamatorias e inmunológicas y estimular el trofismo de la mucosa intestinal. La evidencia disponible actual apoya el empleo de nutrición enteral en enfermedad de Crohn como terapia primaria en adultos si el tratamiento con corticoides no es posible (fracaso o contraindicación (grado de recomendación A o bien en terapia combinada con fármacos en pacientes malnutridos y estenosis inflamatoria del intestino. En los pacientes en remisión clínica duradera no se ha demostrado beneficio de la nutrición enteral o suplementos en ausencia de déficits nutricionales. No se recomienda el uso de fórmulas elementales ni modificadas (glutamina, ácidos grasos omega 3. En colitis ulcerosa, no se ha demostrado la influencia de la nutrición sobre la actividad de la enfermedad, aunque disponemos de datos prometedores sobre el papel de los ácidos grasos w3 con cubierta entérica y de un posible papel de los probióticos. En el tratamiento y profilaxis de la pouchitis crónica, el empleo de probióticos puede tener un papel (VSL#3. La nutrición debe considerarse un componente integral en el manejo de los pacientes con EII.Inflammatory bowel disease is an entity with not wellknown pathogenesis, and important nutritional and metabolic implications because of the high prevalence of malnutrition, the possible implication of dietary factors in its pathogenesis and because of the hypothesis that nutritional intervention could be a primary

  12. Predictive factors of poor response to intravenous cyclosporine in steroid-refractory ulcerative colitis Factores predictivos de mala respuesta precoz a la ciclosporina endovenosa en la colitis ulcerosa grave corticorrefractaria

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    J. W. Huamán Ríos

    2009-03-01

    Full Text Available Background: the treatment of severe ulcerative colitis (UC flares includes measures such as hospitalization and intravenous steroids. Despite this, a quarter of patients are refractory to treatment. Given the availability of new therapeutic strategies in patients with steroid-refractory UC (cyclosporine, infliximab, apheresis, surgery it is necessary to predict which treatment will be most effective for each patient. Objectives: to determine which clinical or biological factors discriminate the lack of response to cyclosporine in steroid-refractory UC. Methods: forty one flares of steroid-refractory UC in 35 patients treated with intravenous cyclosporine have been included. The response to cyclosporine was assessed at day 10 of treatment by using the modified Truelove and Witts disease activity score. Variables with prognostic significance were determined by a univariate analysis comparing groups with complete response and no-response, and an analysis of multiple linear regression. Results: complete response was obtained in 41 flares (48%, partial response in 22%, and lack of response in 29%. The univariate analysis showed a significant difference in four predictive factors: higher age (p = 0.008, thrombocytosis (p = 0.01, disease extent (pancolitis vs. left-sided disease (p = 0.04, and having received cyclosporine previously (p = 0.01. A multiple linear regression analysis confirmed the significance of higher age, thrombocytosis, and having received cyclosporine previously as predictive factors of poor response. Conclusion: higher age, thrombocytosis and previous use of cyclosporine predispose to poor response to intravenous cyclosporine in severe flares of steroid-refractory UC.Introducción: el tratamiento de los brotes graves de colitis ulcerosa (CU incluye medidas como la hospitalización y corticoides e.v., a pesar de ello, en una cuarta parte de los pacientes no se consigue inducir la remisión. Dada la disponibilidad de diferentes

  13. Angioedema por rellenos faciales: Descripción de cinco casos Facial angioedema after filler injections: Description of five cases

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    Micaela A. Cosatti

    2010-12-01

    Full Text Available En los últimos años se ha incrementado la utilización de sustancias de relleno facial con fines estéticos. Estos productos, originalmente considerados inertes, se asocian con diversos efectos adversos localizados alrededor del sitio de la aplicación. Describimos a 5 mujeres con antecedentes de inyecciones de sustancia de relleno facial que presentaron como síntoma inicial angioedema facial duro y persistente seguido por la aparición de nódulos subcutáneos. Todas las pacientes fueron derivadas al servicio de alergia por sospecha de angioedema de causa alérgica sin respuesta al tratamiento con antihistamínicos. El angioedema inició 27.6 meses (1 a 48 luego de la inyección del producto, y las pacientes evolucionaron con brotes y remisiones que fueron tratados con corticoides orales y en 2 oportunidades con inyecciones locales. El tiempo medio desde el inicio de los síntomas hasta la remisión del angioedema fue 8.75 meses (1 a 24. A octubre de 2009 cuatro pacientes se mantuvieron en remisión persistente, luego de un seguimiento clínico de 24.5 meses (7 a 36. Una paciente continúa con exacerbaciones luego de 11 meses de iniciados los síntomas. Las sustancias de relleno facial pueden producir angioedema como evento adverso y deben ser consideradas en el diagnóstico diferencial del angioedema persistente. Sólo responden al tratamiento con esteroides y en algunos casos esteroides dependientes, con ciclosporina. La frecuencia de angioedema por rellenos faciales entre pacientes con angioedema asistidos en la Unidad de Asma, Alergia e Inmunología Clínica fue del 0.5%.The use of fillers for cosmetic purposes is becoming increasingly frequent. Although initially considered inert, these products produce adverse reactions around the injection site. We present 5 cases of women with a history of filler injections who presented a hard and persistent angioedema followed by local subcutaneous nodules . They were referred to the allergist for

  14. 纤支镜下支气管肺泡灌洗在多发伤并肺挫伤中的应用%Application of Bronchoalveolar Lavage by Fibrobronchoscopy in Multiple Injury with Pulmonary Contusion

    Institute of Scientific and Technical Information of China (English)

    边革元; 郝江; 罗积慎; 张萍; 杨明浩; 刘军

    2011-01-01

    [Objective]To explore the efficacy of bronchoalveolar lavage by fibrobronchoscopy for the examination and treatment of multiple injury patients with pulmonary contusion. [Methods] Multiple injury patients with pulmonary contusion who needed invasive ventilation were randomly divided into control group and fibrobronchoscopy treatment group. Beside antibiotics, circulatory and respiratory support and corticoids,bronchoalveolar lavage was used in the treatment group. Bronchoalveolar lavage fluid included normal saline 100ml and ambroxol hydrochloride injection 150mg. Bronchoalveolar lavage at bedside was performed for 3times with once a day. Meanwhile sputum smear was performed. The efficacy was compared between two groups. [Results] Compared with the control group, the oxygenation index(PaO2/FiO2) target reaching (≥300mmHg) time, chest-X ray shadow fade time and invasive mechanical ventilation time in the fibrobronchoscopy treatment group decreased, and there were significant differences between two groups( P >0.05). Fibrobronchoscopy could promptly find mucosal injury and airway obstruction, and timely take local irrigate and medication for removing the obstruction. [Conclusion] Mechanical ventilation combined with bronchoalveolar lavage is a safe and effective measure for the treatment of multiple injury complicated with pulmonary contusion.%[目的]探讨纤支镜下支气管肺泡灌洗(BAL)对多发伤并肺挫伤患者的检查与治疗效果.[方法]将多发伤并肺挫伤且需使用有创机械通气患者分为对照与纤支镜治疗组,除抗感染、循环呼吸支持、皮质激素等治疗外,治疗组病程中均采用纤支镜,以生理盐水100 mL+盐酸氨溴索注射液150 mg作为灌洗液,床旁行BAL灌洗3次,每2天1次,并行痰检,比较两组的治疗效果.[结果]经纤支镜治疗组氧合指数(PaO2/FiO2)改善(≥300 mmHg)时间、胸片阴影消退时间、有创机械通气时间三项指标均较对照组有所

  15. Avaliação da mucosa sinusal do coelho à presença de implante biodegradável Assessing the maxillary sinus mucosa of rabbits in the presence of biodegradable implants

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    André Coura Perez

    2012-12-01

    Full Text Available Pensando em melhorar a qualidade de vida dos pacientes com doenças do humor vítreo, os oftalmologistas começaram a utilizar recentemente implantes biodegradáveis com corticoide. Estes mesmos implantes podem ser uma alternativa no tratamento da RSC e, para isso, realizamos um estudo experimental em seios maxilares de coelhos. OBJETIVO: Avaliar histologicamente a mucosa de seio maxilar de coelhos após a colocação de implante biodegradável de prednisolona. MÉTODO: Dezoito coelhos foram divididos aleatoriamente em dois grupos: Grupo 1: no seio maxilar esquerdo foi inserido um implante biodegradável com prednisolona; Grupo 2: No seio maxilar esquerdo foi inserido um implante biodegradável sem medicação. Os seios maxilares do lado direito serviram como controle. Após 7, 14 e 28 dias foram escolhidos aleatoriamente três coelhos de cada grupo e a resposta tecidual inflamatória foi avaliada. RESULTADOS: Foi encontrada diferença não significativa de inflamação na mucosa, quando comparamos o grupo de coelhos que receberam implantes com e sem medicação com o grupo controle; ou quando comparamos o grupo que recebeu implante com prednisolona com o grupo que recebeu implante sem medicação. CONCLUSÃO: Não foram observados sinais de toxicidade ou inflamação na mucosa do seio maxilar do coelho à presença do implante com ou sem prednisolona.In an attempt to improve the quality of life of patients with vitreous humor disease, ophthalmologists began offering steroid-eluting biodegradable implants to their patients. These implants can be used as an alternative treatment for CRS and this is why this experimental study was carried out on rabbit maxillary sinuses. OBJECTIVE: This study aims to assess the histology of the mucosa of the maxillary sinuses of rabbits after the placement of a prednisolone-eluting biodegradable implant. METHOD: Eighteen rabbits were randomly divided into two groups: group 1 - subjects had drug-eluting implants

  16. Tratamiento etiológico de la Enfermedad de Chagas

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    Roberto Montoya Araujo

    2000-08-01

    Full Text Available

    En la enfermedad de Chagas el tratamiento etiológico hace referencia al empleo de quimio-terapia específica para combatir al Trypanosoma cruzi en el organismo, con el objetivo de erradicar la infección y de esta forma curar o detener el curso progresivo de la enfermedad.

    Cuando comenzó a conocerse la magnitud del problema de la enfermedad de Chagas y a medida que fueron apareciendo medicamentos eficaces contra otras enfermedades infecciosas, una gran variedad de sustancias comenzaron a ser experimentadas para eliminar al T. cruzi en las infecciones humanas [1]. Los resultados obtenidos especialmente en animales de laboratorio y en casos agudos con el uso de arsenicales, antimoniales, derivados quinoleínicos, corticoides, sulfonamidas hipoglicemiantes y antibióticos, entre otros, no mostraron que ninguna de estas sustancias fuera capaz de eliminar la infección [1].

    Después de que Packchanian sugiriera el uso del nitrofurazona en el hombre advirtiendo sobre la no desaparición de la infección, Brener [2] a comienzos de la década del 60, experimentó prolongando el tratamiento en ratones durante 53 días, logrando la cura parasitológica con lo que planteó la posibilidad de exaustación parasitaria de las formas tisulares por el mantenimiento de una concentración sanguínea de droga prolongada y letal para las formas flageladas que circularían en la sangre antes de nuevas localizaciones.

    En 1961 Ferreira obtuvo excelentes resultados con el uso de la nitrofurazona en casos agudos [3], observando una regresión rápida de las manifestaciones clínicas y negativización parasitológica. Admi-tiendo los planteamientos de Brener, Coura et al. [3] utilizaron dicha droga en 10 chagásicos crónicos llamando la atención sobre la negativización serológica en dos individuos, la persistencia del xenodiagnóstico positivo en otro que no recibió el esquema terapéutico prolongado y sobre la toxicidad de la sustancia, con

  17. Influência de fatores maternos e neonatais no desenvolvimento da displasia broncopulmonar Influence of maternal and neonatal factors on bronchopulmonary dysplasia development

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    Marcela Raquel de Oliveira Lima

    2011-08-01

    Full Text Available OBJETIVO: Analisar as características epidemiológicas da displasia broncopulmonar (DBP e suas relações com condições maternas e neonatais em uma unidade neonatal. MÉTODOS: Estudo transversal, descritivo e analítico, sendo os dados coletados através da análise de prontuários envolvendo recém-nascidos (RNs pré-termo com peso ao nascimento inferior a 1.500 g e idade gestacional abaixo de 37 semanas internados em uma unidade neonatal. RESULTADOS: Foram estudados 323 recém-nascidos com média do peso ao nascimento de 1.161 g (± 231 g, idade gestacional entre 24 e 36,5 semanas com incidência da DBP de 17,6%. Entre os RNs que desenvolveram DBP, a média de dias de uso de assistência ventilatória mecânica invasiva (AVMI, ventilação não invasiva (VNI e oxigênio foi, respectivamente, 17,6 dias, 16,2 dias e 46,1 dias, sendo significativamente maior naqueles RNs que desenvolveram a DBP (p < 0,001. A ocorrência da DBP foi significativamente maior nos RNs com diagnóstico de persistência do canal arterial (PCA. CONCLUSÃO: A incidência da DBP neste estudo foi semelhante à encontrada na literatura mundial. Não houve associação entre a presença de infecção materna e o uso de corticoide antenatal com a DBP. Os RNs que fizeram uso de surfactante tiveram maior incidência da DBP porque tinham menor PN e menor IG. A ocorrência da PCA e DBP simultaneamente está associada ao maior tempo de uso de AVMI, VNI e oxigênioOBJECTIVE: To review epidemiological features of bronchopulmonary dysplasia (BPD and its relationship with maternal and neonatal conditions in a neonatal unit. METHODS: Cross-sectional, descriptive and analytical study involving preterm newborns (NBs with a birth weight lower than 1,500 g and gestational age under 37 weeks. Data was collected through a review of medical records of these newborns admitted to a neonatal unit. RESULTS: The study included 323 newborns with a mean birth weight of 1,161 g (± 231 g

  18. Uso do sulfato de magnésio por via venosa e nebulização para o tratamento da asma aguda na emergência Use of the intravenous and nebulized magnesium sulfate for the treatment of the acute asthma in the emergence

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    Fabiano Timbó Barbosa

    2007-09-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Tem sido mostrado que o sulfato de magnésio apresenta benefícios em adultos e crianças asmáticos, com fraca resposta aos agentes beta-agonistas e corticóides sistêmicos no departamento de emergência. O objetivo deste estudo foi realizar uma revisão não sistemática acerca do tratamento da asma aguda com sulfato de magnésio por via venosa e nebulização na emergência. CONTEÚDO: As primeiras investigações que demonstraram benefício no uso do sulfato de magnésio na asma são de 1938. Os efeitos do sulfato de magnésio podem ser mediados através da ação antagonista do cálcio ou através da função de co-fator em sistemas enzimáticos envolvendo o fluxo iônico através da membrana celular. Foi realizada uma revisão de literatura através da base de dados MedLine nos últimos seis anos (2000 a 2006 e incluídos os artigos publicados na língua inglesa, através do cruzamento dos unitermos asma e sulfato de magnésio. CONCLUSÕES: A administração de rotina do sulfato de magnésio por via venosa e nebulização em pacientes com asma aguda grave que se apresentam no serviço de emergência não é recomendado; entretanto, como um tratamento adjuvante obtém-se algum benefício.BACKGROUND AND OBJECTIVES: Magnesium sulfate has been shown to benefit asthmatic children and adults with poor responses to initial beta-agonist therapy and systemic corticoids in the emergency department. The aim of this study was to realize a no systematic review about the treatment of the acute asthma with intravenous and nebulized magnesium sulfate in the emergence. CONTENTS: The first investigations that demonstrate the benefit in the use of the magnesium sulfate in asthma date to 1938. The effects of magnesium sulfate may be mediated through its action as a calcium antagonist or through its function as a cofactor in enzyme systems involving ion flux across cell membranes. We realized a literature review using Med

  19. Corticosteróides inalatórios e crescimento em crianças asmáticas ambulatoriais Inhaled corticosteroid treatment and growth of asthmatic children seen at outpatient clinics

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    Elisete E. Arend

    2006-06-01

    Full Text Available OBJETIVO: Verificar o efeito do uso de corticosteróides inalatórios no aumento estatural e ponderal de crianças asmáticas tratadas ambulatorialmente MÉTODOS: Foi realizado um estudo de coorte prospectivo de 1 ano, no qual 124 crianças asmáticas com 3 a 16 anos de idade que haviam recebido prescrição para uso de corticosteróides inalatórios há pelo menos 12 meses foram avaliadas quanto aos escore z altura/idade, peso/idade, índice de massa corporal e altura alvo parental estimada para a idade atual. Os critérios de exclusão foram: peso de nascimento menor que 2.500 g, desnutrição, doenças crônicas e uso de corticóide sistêmico por mais de 7 dias consecutivos. RESULTADOS: A média ± desvio padrão dos escores z altura/idade inicial e final foi, respectivamente, de 0,06±1,2 e 0,01±1,2, (IC95% 0,05-0,11; dos escores z peso/idade inicial e final foi de 0,6±1,5 e 0,5±1,5, respectivamente (IC95% 1,84-6,6. Esses valores não diferiram significativamente (p = 0,199 e p = 0,808. Quando estratificados em grupos bem e mal controlados da asma, púberes e não-púberes, também não houve perda estatural. CONCLUSÃO: Em relação às curvas NCHS (National Center for Health Statistics, não houve prejuízo na estatura e peso corporal de crianças/adolescentes que utilizaram corticosteróides inalatórios por mais de 1 ano nas doses preconizadas para prevenir asma.OBJECTIVE: To ascertain the effect of inhaled corticosteroid use on gain in height and weight of asthmatic pediatric outpatients. METHODS: A one-year prospective cohort study was carried out with 124 asthmatic children aged 3 to 16 years who were prescribed inhaled corticosteroids for at least 12 months, evaluating z-scores for height/age, weight/age, body mass index and parental target height for current age. Exclusion criteria were: birth weight less than 2,500 g, malnutrition, chronic diseases and systemic corticoid use for more than 7 consecutive days. RESULTS: The mean

  20. Polirradiculoneuropatia desmielinizante inflamatória crônica: estudo de 18 pacientes Chronic inflammatory demyelinating polyradiculoneuropathy: study of 18 patients

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    Leandro C. Calia

    1997-01-01

    , and therapeutic response. Male patients outnumbered female patients in a proporction of 1.25:1. Symptoms first appeared at an age ranging from 6 to 85. Most of the patients denied the occurrence of preceding events and a progressive evolution prevailed over relapsing evolution. All patients had both motor and sensory dysfunction associated with loss of tendon reflexes, and only three patients (16.7% had cranial nerve involvement. The cerebrospinal fluid protein levels were increased in 88.9% of the patients and mean level was 203.4 mg/dl. Electrophysiological studies revealed demyelination in all patients and axonal damage in 94.4%. Preponderant characteristics in the sural nerve biopsy of seven patients showed demyelination and remyelination, and changes indicative of axonal damage were often present. The anti-HLA Dr antibodies were found in the sural nerve of one patient and anti-CD