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1.
Cancer Med ; 13(4): e6839, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38457231

RESUMO

BACKGROUND: Mannitol is exclusively recommended in the National Comprehensive Cancer Network guidelines for diuresis in cisplatin (CDDP)-based chemotherapy. The utility of furosemide, a widely used and convenient diuretic, thus requires clarification. METHODS: This is a prospective, single-centered, open-label, noninferiority phase II study. Patients with thoracic malignancies who planned to receive CDDP-based chemotherapy were randomly assigned to receive either mannitol (arm A) or furosemide (arm B). The primary end point was set as the proportion of patients who experienced any grade of "creatinine (Cr) increased" based on the upper limit of the normal range (ULN) during the first cycle as assessed by Common Terminology Criteria for Adverse Events Version 4.0. Secondary end points were Cr increased based on the baseline value during the first cycle, Cr increased after the completion of CDDP, and the proportion of patients with phlebitis. RESULTS: Between April 2018 and March 2022, 115 patients were enrolled and 106 were analyzed. Any grade of Cr increased based on the ULN during the first cycle was 17.3% (arm A) and 24.1% (arm B), respectively (p = 0.34). Therefore, the primary end point was not met. After completion of chemotherapy, any grade of Cr increased was observed in 23.1% (arm A) and 31.5% (arm B), respectively. However, the actual serum Cr level and Cr clearance during the courses were not different between the arms. Phlebitis occurred more frequently in arm A (28.8%) than arm B (16.7%). CONCLUSIONS: Mannitol should remain the standard diuresis in CDDP-based chemotherapy assessed by conventional CTCAE grading, but furosemide can be room for consideration when assessed by actual serum Cr level and Cr clearance.


Assuntos
Flebite , Neoplasias Torácicas , Humanos , Furosemida/efeitos adversos , Cisplatino/efeitos adversos , Manitol/efeitos adversos , Estudos Prospectivos , Flebite/induzido quimicamente , Flebite/tratamento farmacológico
2.
J Infus Nurs ; 47(2): 132-141, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38422406

RESUMO

The most commonly used vascular access is the peripheral intravenous catheter (PIVC). However, it can trigger complications and the occurrence of adverse events, such as phlebitis. This study evaluated the variables that are associated with the occurrence of phlebitis in medical and surgical inpatient units. This is an observational, retrospective, case-control study in medical and surgical hospitalization units of a private general hospital in the city of São Paulo. Participants were an average age of 66.3 years, and 71% were hospitalized in medical units. The risk variables associated with phlebitis were medical hospitalization (odds ratio [OR] = 4.36; P = .002), presence of comorbidity (OR = 10.73; P < .001), and having 5 or more PIVCs (OR = 53.79; P = .001). Regarding intravenous therapy, the use of contrast was a risk variable (OR = 2.23; P = .072). On the other hand, patient education regarding PIVCs was a protective measure against the development of phlebitis. The nursing team plays an essential role in the care of patients with PIVCs, inpatient guidance, planning, and device choice, taking into account the risk factors for phlebitis to maintain the preservation of vascular health and reduce adverse events.


Assuntos
Flebite , Humanos , Idoso , Estudos de Casos e Controles , Estudos Retrospectivos , Brasil , Flebite/epidemiologia , Flebite/etiologia , Hospitais
3.
Drug Discov Ther ; 18(1): 71-74, 2024 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-38382993

RESUMO

In Japan, the switch from branded to generic infusion fluids has been promoted as a national policy. Recently, as generic products have been in short supply, the switch from generic to branded infusion fluids has increased. However, certain additives for injectable infusion fluids, such as nonvolatile acids like acetic acid and hydrochloric acid, are not required to be listed in the package insert. We hypothesized that the addition of nonvolatile acids may be one of the reasons for the differences in physicochemical properties between the branded and generic infusion fluids. We have previously reported that in other types of electrolyte infusion fluids, a variation in pH can cause incompatibility with other drugs, and variation in titratable acidity and osmolality can lead to phlebitis. Glucose-added maintenance hypotonic infusion fluid (listed as type-3G) is commonly used as a maintenance solution when energy support is needed. However, nonvolatile acid is added to prevent the caramelization of glucose, resulting in higher osmolality and titratable acidity and lower pH. Therefore, we hypothesized that both phlebitis and incompatibility with other drugs are likely to occur; hence, we measured and evaluated the physicochemical properties of branded and generic type-3G infusion fluids. We show that the osmolality, pH, and titratable acidity of all evaluated branded and generic products differed significantly and that these properties should be evaluated together to avoid phlebitis and incompatibility with other drugs when switching between branded and generic type-3G infusion fluids.


Assuntos
Flebite , Humanos , Flebite/etiologia , Flebite/prevenção & controle , Glucose , Medicamentos Genéricos , Japão
4.
Int J Nurs Stud ; 151: 104676, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38241817

RESUMO

BACKGROUND: Central venous catheters are widely used in clinical practice, and the incidence of central venous catheter occlusion is between 25 % and 38 %. The turbulence caused by the pulsatile flushing technique is harmful to the vascular endothelium and may lead to phlebitis. The low-speed continuous infusion catheter technique is a new type of continuous infusion that ensures that the catheter is always in a keep-vein-open state by continuous low-speed flushing; hence, avoiding the problem of catheter occlusion. OBJECTIVE: To investigate the effectiveness of the low-speed continuous infusion catheter technique and the routine care of double-lumen central venous catheters. DESIGN: This was a prospective, randomized, controlled, open-label trial. SETTING: Patients were recruited from 14 medical institutions in China between February and June 2023. PARTICIPANTS: In total, 251 patients were recruited, with 125 in the intervention group and 126 in the control group. METHODS: Patients who used double-lumen central venous catheters for infusion treatment were selected, and those who met the sampling criteria were randomly divided into intervention and control groups using the random envelope method. The intervention group used the low-speed continuous infusion catheter technique to maintain catheter patency, whereas the control group used routine care with a trial period of 7 days. The primary outcome was the occlusion rate. The secondary outcomes included nursing satisfaction and complication rates of the two groups. RESULTS: After 7 days, the rate of catheter occlusion was 28.0 % (35/125, 95 % confidence interval (CI):0.203, 0.367) in the intervention group and 53.97 % (68/126, 95 % CI: 0.449-0.629) in the control group, with a statistically significant difference (χ2 = 17.488, p < 0.001); at 3 days of intervention, the rate of catheter blockage was 8.0 % (10/125, 95 % CI: 0.039-0.142) in the intervention group and 23.8 % (30/126, 0.167-0.322) in the control group, with a statistically significant difference (χ2 = 11.707, p < 0.001). Nurse satisfaction was significantly higher in the intervention group (115/125, 92.0 %, 95 % CI: 0.858-0.961) than in the control group (104/126, 82.54 %, 95 % CI: 0.748-0.887) (χ2 = 5.049, p = 0.025). There were no statistically significant complication rates in either group (p = 0.622). CONCLUSION: The low-speed continuous infusion catheter technique helps maintain catheter patency, improves nurse satisfaction, and provides a high level of safety. REGISTRATION: Chinese Clinical Trial Registry (ChiCTR2200064007, www.chictr.org.cn). The first recruitment was conducted in February. https://www.chictr.org.cn/showproj.html?proj=177311.


Assuntos
Cateterismo Venoso Central , Cateteres Venosos Centrais , Flebite , Humanos , Estudos Prospectivos , Cateterismo Venoso Central/efeitos adversos , Incidência
6.
Pathol Int ; 74(3): 146-153, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38240415

RESUMO

A woman in her 60s with rheumatoid arthritis was admitted with fever and abdominal pain. Laparoscopic examination with the differential diagnosis of peritoneal neoplasm and infection revealed granulomatous phlebitis in the resected greater omentum. Amorphous eosinophilic deposits observed in the resected tissue exhibited focal, weak positivity for Congo red but were strongly positive for thioflavin S, confirming their focal amyloid properties. Marked degeneration of elastic fibers was also evident. Electron microscopy revealed deposits around the affected elastic fibers. Immunohistochemistry revealed the deposition of epidermal growth factor-containing fibulin-like extracellular matrix protein 1 (EFEMP1) along with T-cell-predominant lymphocytic inflammation. The definitive diagnosis was granulomatous enterocolic lymphocytic phlebitis (ELP) associated with EFEMP1 deposition exhibiting focal amyloid properties (EFEMP1/AEFEMP1), supported by proteomics analysis. This type of vasculitis is similar to amyloid-ß-related angiitis of the central nervous system. Thus, we speculate that granulomatous ELP also results from an immune response that recognizes EFEMP1/AEFEMP1 deposits as foreign material and attempts to remove them. Confirmation of EFEMP1/AEFEMP1 deposition with Congo red staining is challenging, particularly in the presence of inflammation, and warrants comprehensive evaluation.


Assuntos
Proteínas de Ligação ao Cálcio , Fator de Crescimento Epidérmico , Flebite , Humanos , Feminino , Vermelho Congo , Inflamação , Proteínas da Matriz Extracelular/metabolismo
7.
Br J Nurs ; 33(2): S12-S19, 2024 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-38271042

RESUMO

Vascular access continues to be a key factor for the reliable and safe delivery of intravenous (IV) therapy to patients in any healthcare setting. Clinical guidelines advocate for the right vascular access device selection, in order to reduce avoidable complications, eg multiple stabs, phlebitis, thrombophlebitis, insertion site infection, and blood stream infection, while improving efficiency and reducing costs. Peripheral intravenous catheters or cannulas (PIVCs) remain widely used for gaining vascular access in all clinical settings, with both adults and children, because they provide a relatively cheap and simple way to provide blood sampling and the prompt administration of IV medications. Although safe and easy to insert, PIVCs present with associated risks that can be costly to the organisation. The case studies included with this article introduce Nipro's Safetouch Cath Winged with Injection Port as a new cost-effective choice of PIVC, which is now available from NHS Supply Chain.


Assuntos
Cateterismo Periférico , Flebite , Dispositivos de Acesso Vascular , Adulto , Criança , Humanos , Cânula/efeitos adversos , Cateterismo Periférico/efeitos adversos , Flebite/etiologia , Dispositivos de Acesso Vascular/efeitos adversos , Remoção de Dispositivo
8.
J Am Vet Med Assoc ; 262(1): 1-7, 2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-37918104

RESUMO

OBJECTIVE: To identify risk factors associated with peripheral intravenous catheter (PIVC) complications in dogs hospitalized in the critical care unit (CCU). ANIMALS: 107 dogs admitted to the CCU between October 2022 and March 2023. METHODS: This prospective, observational clinical trial was performed at a single veterinary teaching hospital. Dogs hospitalized in the CCU for at least 24 hours were evaluated for enrollment. PIVC were placed following a standardized protocol and monitored for complications. PIVC complications were classified as extravasation, phlebitis, dislodgement, occlusion, line breakage, or patient removal. RESULTS: Median PIVC dwell time was 46.50 hours (range, 24.25 to 159.25 hours). Overall PIVC complication rate was 12.1% (13/107), with phlebitis (4/107 [3.7%]) and extravasation (4/107 [3.7%]) being the most frequently recorded complications. Multivariable analysis identified increasing length of hospitalization (LOH; OR, 1.43; 95% CI, 1.04 to 1.97; P = .029), an acute patient physiologic and laboratory evaluation full (APPLEFULL) score > 35 (OR, 4.66; 95% CI, 1.09 to 19.90; P = .038), and having 2 PIVCs placed at admission (OR, 10.92; 95% CI, 1.96 to 60.73; P = .006) as risk factors for PIVC complication. CLINICAL RELEVANCE: Increasing LOH, an APPLEFULL score > 35 and having 2 PIVCs placed at admission were associated with increased odds for PIVC complication in this study. Although these are independent risk factors for PIVC complication, the combination of increasing LOH, an APPLEFULL score > 35, and having 2 PIVCs placed at admission may represent a more severely ill population, drawing attention to a vulnerable group of dogs at risk for PIVC complication.


Assuntos
Cateterismo Periférico , Doenças do Cão , Flebite , Animais , Cães , Cateterismo Periférico/efeitos adversos , Cateterismo Periférico/veterinária , Cateterismo Periférico/métodos , Cateteres/efeitos adversos , Doenças do Cão/etiologia , Hospitalização , Hospitais Veterinários , Hospitais de Ensino , Flebite/epidemiologia , Flebite/etiologia , Flebite/veterinária , Estudos Prospectivos
9.
Int J Rheum Dis ; 27(1): e14762, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37270684

RESUMO

Takayasu arteritis (TAK) is the main type of large vessel arteritis in young adults, which mainly affects the aorta and its main branches, leading to clinical manifestations such as syncope, intermittent limb claudication, hypertension, and abdominal pain. Among them, venous involvement is rarely reported. Here we show a case of TAK presenting as phlebitis. This was a 27-year-old woman, who initially admitted to our hospital with myalgia of the upper and lower extremities and night sweats. She was diagnosed as TAK according to the 1990 American College of Rheumatology TAK criteria. Surprisingly, vascular ultrasonography revealed wall thickening as indicated by macaroni sign of the multiple veins. TAK phlebitis appeared at the active phase, while disappearing rapidly at remission. Phlebitis might have a close relationship with disease activity. By retrospective study in our department, the estimated incidence rate of phlebitis might be 9.1% in TAK. With the literature review, it revealed that phlebitis might be an ignored manifestation in active TAK. However, due to the smaller sample size, it should be noted that a direct cause-effect relationship cannot be established.


Assuntos
Hipertensão , Flebite , Arterite de Takayasu , Feminino , Adulto Jovem , Humanos , Adulto , Arterite de Takayasu/diagnóstico , Arterite de Takayasu/diagnóstico por imagem , Estudos Retrospectivos , Aorta , Flebite/diagnóstico por imagem , Flebite/etiologia
10.
Int J Nurs Stud ; 151: 104673, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38142634

RESUMO

BACKGROUND: Peripheral intravenous catheters are the most frequently used invasive device in nursing practice, yet are commonly associated with complications. We performed a systematic review to determine the prevalence of peripheral intravenous catheter infection and all-cause failure. METHODS: The Cochrane Library, PubMed, CINAHL, and EMBASE were searched for observational studies and randomised controlled trials that reported peripheral intravenous catheter related infections or failure. The review was limited to English language and articles published from the year 2000. Pooled estimates were calculated with random-effects models. Meta-analysis of observation studies in epidemiology guidelines and the Cochrane process for randomised controlled trials were used to guide the review. Prospero registration number: CRD42022349956. FINDINGS: Our search retrieved 34,725 studies. Of these, 41 observational studies and 28 randomised controlled trials (478,586 peripheral intravenous catheters) met inclusion criteria. The pooled proportion of catheter-associated bloodstream infections was 0.028 % (95 % confidence interval (CI): 0.009-0.081; 38 studies), or 4.40 catheter-associated bloodstream infections per 100,000 catheter-days (20 studies, 95 % CI: 3.47-5.58). Local infection was reported in 0.150 % of peripheral intravenous catheters (95 % CI: 0.047-0.479, 30 studies) with an incidence rate of 65.1 per 100,000 catheter-days (16 studies; 95 % CI: 49.2-86.2). All cause peripheral intravenous catheter failure before treatment completion occurred in 36.4 % of catheters (95 % CI: 31.7-41.3, 53 studies) with an overall incidence rate of 4.42 per 100 catheter days (78,891 catheter days; 19 studies; 95 % CI: 4.27-4.57). INTERPRETATION: Peripheral intravenous catheter failure is a significant worldwide problem, affecting one in three catheters. Per peripheral intravenous catheter, infection occurrence was low, however, with over two billion catheters used globally each year, the absolute number of infections and associated burden remains high. Substantial and systemwide efforts are needed to address peripheral intravenous catheter infection and failure and the sequelae of treatment disruption, increased health costs and poor patient outcomes.


Assuntos
Infecções Relacionadas a Cateter , Cateterismo Periférico , Flebite , Sepse , Humanos , Flebite/etiologia , Infecções Relacionadas a Cateter/epidemiologia , Cateteres , Cateterismo Periférico/efeitos adversos , Sepse/complicações
11.
Mayo Clin Proc ; 98(12): 1831-1832, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38043999
12.
BMJ Open ; 13(12): e073557, 2023 12 07.
Artigo em Inglês | MEDLINE | ID: mdl-38149412

RESUMO

OBJECTIVES: Whether the glucose-insulin-potassium (GIK) should be used as an adjuvant therapy for ischaemic myocardial disease remains controversial nowadays reperfusion era. This meta-analysis aimed to assess the effects of preinitiated GIK for patients undergoing planned percutaneous coronary intervention (PCI). DESIGN: Systematic review and meta-analysis. DATA SOURCES: PubMed, Web of science, MEDLINE, Embase, Cochrane Library and ClinicalTrials.gov were searched through 27 November 2022. ELIGIBILITY CRITERIA: Only randomised controlled trials involving participants preinitiated with GIK or placebo before planned PCI were included. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers used standardised methods to search, screen and code included trials. Risk of bias was assessed with the Cochrane tool. Pooled analysis was conducted using random or effects models according to the heterogeneity. Subgroup analyses were carried out for dosage of GIK and if with ongoing myocardial ischaemia. RESULTS: 13 randomised controlled trials (RCTs) including 3754 participants were evaluated. We found patients preconditioned with GIK before PCI showed a significant increase in Thrombolysis in Myocardial Infarction 3 flow events after angioplasty (OR 1.59, 95% CI 1.03 to 2.46, p=0.04), also revealed improved in-hospital left ventricular ejection fraction (weighed mean difference, WMD 1.62, 95% CI 0.21 to 3.03, p=0.02) and myocardial salvage index (WMD 0.09, 95% CI 0.01 to 0.16, p=0.03). Nevertheless, no benefit was observed in all-cause mortality neither on 30-day (OR 0.81, 95% CI 0.59 to 1.11, p=0.18) nor 6 months (OR 1.02, 95% CI 0.42 to 2.46, p=0.97). Furthermore, GIK intervention was associated with higher occurrences of complications such as phlebitis (OR 10.13, 95% CI 1.74 to 59.00, p=0.01) and hypoglycaemia (OR 10.43, 95% CI 1.32 to 82.29, p=0.03), but not hyperkalaemia (OR 9.36, 95% CI 0.50 to 175.27, p=0.13), liquid overload (OR 1.02, 95% CI 0.25 to 4.13, p=0.98) or in-hospital heart failure (OR 0.42, 95% CI 0.06 to 2.96, p=0.39). CONCLUSIONS: Our study shows preconditioning GIK exhibits myocardial reperfusion and cardiac function benefits for patients planning to receive PCI intervention, while also some complications such as phlebitis and hypoglycaemia accompany. PROSPERO REGISTRATION NUMBER: CRD42022326334.


Assuntos
Hipoglicemia , Insulinas , Intervenção Coronária Percutânea , Flebite , Humanos , Potássio/uso terapêutico , Glucose/uso terapêutico , Hipoglicemia/tratamento farmacológico , Flebite/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto
13.
Eur J Oncol Nurs ; 67: 102438, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37913684

RESUMO

PURPOSE: Phlebitis is a common complication in palliative patients. There are limited nursing practices in phlebitis care. The study was conducted to determine the effect of warm moist compresses in patients with peripheral intravenous catheter-related phlebitis. METHODS: 70 patients (35 control and 35 experimental) with phlebitis symptoms who were hospitalized in the palliative clinic of a training and research hospital were recruited for the study. The phlebitis site of the patients in the control and experimental groups were followed for three days. While the control group received routine nursing care, the experimental group received a warm moist compresses at 28 °C for 15 min three times a day for three days in addition to routine nursing care. RESULTS: According to the results, there was a decrease in the initial and final phlebitis grades between the control and experimental groups, but the difference was not statistically significant (p = 0.957, p = 0.078). In the final evaluation of the phlebitis site, a statistically significant difference was observed in redness, edema width, and pain intensity between the control and experimental groups in favor of the experimental group (p˂0.001, p = 0.006, p˂0.001, respectively). CONCLUSIONS: It was determined that applying warm water compresses three times a day in phlebitis care had a positive effect on healing.


Assuntos
Cateterismo Periférico , Flebite , Humanos , Flebite/etiologia , Flebite/prevenção & controle , Cateterismo Periférico/efeitos adversos , Hospitais , Medição da Dor , Cateteres/efeitos adversos
14.
Immun Inflamm Dis ; 11(11): e1094, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-38018585

RESUMO

OBJECTIVE: Amiodarone (AM) is a drug commonly used in patients with ventricular arrhythmias. It can damage vascular endothelial cells and easily cause phlebitis. At present, the prevention and treatment of phlebitis induced by the use of AM is not clear due to the lack of corresponding primary research. Isoliquiritigenin (ISL) has an anti-inflammatory effect, but until now, has not been explored much in the field of research in primary care nursing. The purpose of this study is to investigate the efficacy and mechanism of action of ISL in treating phlebitis induced by AM. METHODS: In our study, we used human umbilical vein endothelial cells (HUVECs) that were divided into three groups: the NC group (normal), the AM group (AM 30 µmol/L for 24 h), and the ISL pretreatment group (isoliquiritigenin 10 µmol/L after 1 h of pretreatment with amiodarone for 24 h). We used CCK-8 to detect cell proliferation, cell scratch assay to detect the migration capability of cells, flow cytometry to measure apoptosis, angiogenesis assay to check the total length and total branches of angiogenesis, and PCR and WB to detect the expression of PCNA, casepase-3, and VEGFA. WB was used to detect NF-κBp65 and p-NF-κBp65 expression. RESULTS: Compared with the AM group, the ISL pretreatment promoted cell proliferation and migration, inhibited cell apoptosis, increased the total length and total branches of angiogenesis, and downregulated p-NF-κBp65 expression. CONCLUSION: ISL shows promise in the prevention and treatment of clinical phlebitis and can be used as a potential therapeutic drug to prevent phlebitis.


Assuntos
Amiodarona , Chalconas , Flebite , Humanos , Células Endoteliais da Veia Umbilical Humana , Amiodarona/toxicidade , Chalconas/farmacologia
15.
BMJ Case Rep ; 16(10)2023 Oct 03.
Artigo em Inglês | MEDLINE | ID: mdl-37788914

RESUMO

Transient reactive phlebitis (TRP) is a rare adverse event seen with intravenous infusion of medications. It is characterised by the appearance of erythematous cord-like lesions along the superficial veins proximal to the site of infusion. It is rarely seen with drugs such as morphine, rocuronium, eptifibatide, propofol and vancomycin. The exact pathogenesis is not clear; however, certain proposed mechanisms are due to the direct activation of C-nociceptors, activation of the kallikrein-kinin system with bradykinin release, local mediator release or histamine release. Here, we report a case of TRP due to ciprofloxacin infusion.


Assuntos
Flebite , Propofol , Humanos , Flebite/induzido quimicamente , Bradicinina , Veias , Infusões Intravenosas
16.
Zhonghua Kou Qiang Yi Xue Za Zhi ; 58(8): 815-820, 2023 Aug 09.
Artigo em Chinês | MEDLINE | ID: mdl-37550042

RESUMO

Objective: To analyze the clinicopathological characteristics of IgG4-related sialadenitis (IgG4-RS). Methods: A total of 40 cases diagnosed with IgG4-RS were collected from the Department of Oral Pathology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from January 2019 to December 2022. Among them, there were 26 males and 14 females. The age range was 29-77 years old [(59.4±11.8) years old], with 23 patients being older than 60 years. The lesion site, imaging manifestations, histopathological features, serological test and treatment information of patients were collected. The expression of IgG4 and IgG proteins was detected by immunohistochemistry. Results: Submandibular region swelling was the most common initial symptom of IgG4-RS (38/40, 95.0%). All the patients having serum IgG4 levels> 1.35 g/L. Serum IgG4 levels were significantly increased in patients aged>60 years (Z=-2.45, P=0.014) and those involving multiple glands (Z=-2.04, P=0.042). Thirty six cases received major salivary gland biopsy, and all the cases showed dense lymphocyte and plasma cell infiltration. Lymphoid follicle, storiform fibrosis and obliterative phlebitis were seen in 88.9% (32/36), 63.9% (23/36), 30.6% (11/36) of the cases, respectively. Twenty one cases received labial salivary gland biopsy, 66.7% (14/21) showed lymphocyte and plasma cell infiltration, 19.0% (4/21) had lymphoid follicle structures, and 33.3% (7/21) showed no obvious histological abnormalities. No signs of fibrosis or obliterative phlebitis were observed in all labial salivary gland biopsies. And 95.0% (38/40) of cases had IgG4 positive plasma cell>10/HPF, 82.5% (33/40) of cases had IgG4/IgG positive plasma cell ratio>40%. All the patients had a decrease in serum IgG4 levels after glucocorticoid treatment, but only 21.4% (6/28) of cases had reduced to normal levels (≤1.35 g/L), and there were still significant fluctuations in serum IgG4 levels thereafter. Conclusions: IgG4-RS has a predilection for middle-aged and elderly male patients, and serum IgG4 levels are significantly related to the patient's age and whether multiple glands are involved. Labial salivary gland biopsy cannot replace submandibular gland for histopathological evaluation. It is a common phenomenon that serum IgG4 levels cannot restored to normal levels after glucocorticoid treatment. This study provides certain assistance for clinical and pathological diagnosis of IgG4-RS. This study is beneficial for further understanding IgG4-RS and improving the clinical and pathological diagnosis of the disease.


Assuntos
Flebite , Sialadenite , Pessoa de Meia-Idade , Idoso , Feminino , Humanos , Masculino , Adulto , Glucocorticoides , Imunoglobulina G/uso terapêutico , China , Sialadenite/diagnóstico , Sialadenite/patologia , Inflamação/tratamento farmacológico , Fibrose , Flebite/tratamento farmacológico
17.
J Med Case Rep ; 17(1): 309, 2023 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-37408048

RESUMO

BACKGROUND: Eales' disease is an idiopathic peripheral retinal vasculopathy characterized by retinal phlebitis, ischemia, retinal neovascularization, and recurrent vitreous hemorrhages. But CRAO is an unusual presentation. CASE PRESENTATION: A 27-year-old healthy female nurse of Indian descent presented with sudden vision loss in her right eye upon awakening. Central retinal artery occlusion (CRAO), combined with mild central retinal vein occlusion (CRVO), was diagnosed. During the second of three consecutive sessions of hyperbaric oxygen treatments, her vision rapidly improved. One week later, she developed peripheral phlebitis in the same eye. Infectious, inflammatory, and hematologic etiologies were excluded. The systemic evaluation was normal except for a positive Mantoux tuberculin skin test. Following systemic steroidal treatment, she experienced gradual improvement of her vasculitis. Two weeks later, mild retinal phlebitis appeared in her left eye. Eales' disease was diagnosed after the exclusion of other diseases. CONCLUSION: This is an unusual Eales' disease case, which presented as combined CRAO with mild CRVO. The association of CRAO and Eales' disease is reported here for the first time, to our best knowledge.


Assuntos
Flebite , Oclusão da Artéria Retiniana , Vasculite Retiniana , Humanos , Feminino , Adulto , Vasculite Retiniana/diagnóstico , Vasculite Retiniana/etiologia , Neovascularização Patológica , Flebite/diagnóstico , Oclusão da Artéria Retiniana/diagnóstico , Oclusão da Artéria Retiniana/etiologia
19.
Clin Nutr ESPEN ; 56: 215-221, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-37344076

RESUMO

BACKGROUND AND AIMS: Malnutrition is a common challenge among hospitalised patients and its associatiation with poor patient health-related outcomes places a significant financial burden on the healthcare system. Total parenteral nutrition (TPN) is the primary means for providing nutrition to individuals in whom enteral feeding is not possible but is costly and requires invasive central venous access. Peripheral parenteral nutrition (PPN) provides a suitable option for early nutrition provision in select patients; however, its routine use has been limited by safety and tolerability concerns, with high rates of phlebitis reported in previous studies. The objectives of this study were to review the use, safety, and costs of PPN in an Australian tertiary hospital. METHODS: A single-site, prospective observational study was conducted over 15 months in a tertiary hospital. 139 participants (87 male and 52 female) were enrolled in the study. Data collected assessed the indication for PPN initiation, compliance with the hospital's protocols for PPN, total fasting days, the proportion of the patient's total energy and protein requirements provided by PPN, the incidence of phlebitis and potential cost implications associated with the use of PPN. RESULTS: 139 patients (62.6% male), median age 62 years (IQR (interquartile range) 48-74) were enrolled. Most patients had an emergency admission (80.6%) under a general surgical team (84.2%). Forty-eight patients (34.5%) were malnourished, as assessed by the Subjective Global Assessment tool (SGA). Patients fasted for a median of 3 days (IQR 2-5) before PPN commencement, with a median duration of PPN use of 3 days (IQR 2-4). PPN provided an average of 61.6% of the patients' required caloric intake and 46.4% of protein requirements. Progression to TPN was observed in 34.5% of patients. There were low rates of complications with phlebitis observed in 3.7%, extravasation in 1.1%, and no patients developed septicaemia, despite suboptimal compliance with the recommended cannula management guidelines for PPN (66.4% compliant). The cost of PPN was estimated to be AUD$187 per patient day. CONCLUSION: PPN is an effective short-term nutrient delivery solution to facilitate early feeding with small numbers of patients requiring transition to TPN. PPN was safe with low rates of cannula complications. Costs were favourable, with potentially significant cost savings as compared with TPN.


Assuntos
Desnutrição , Flebite , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Centros de Atenção Terciária , Austrália/epidemiologia , Nutrição Parenteral/efeitos adversos , Nutrição Parenteral/métodos , Nutrição Parenteral Total/efeitos adversos , Desnutrição/complicações , Flebite/etiologia
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