RESUMO
Malnutrition is a common complication in terminally ill situation. Artificial nutritional support in these patients create a host of ethical conflicts with difficult solutions. In this paper we give simple suggestions that might the help care provider in making a viable clinical decision. However, each case should be treated in an individualized manner taking into consideration the ratio between risks and benefits of this treatment. The patient's wishes should have the highest priority.
Assuntos
Ética Médica , Apoio Nutricional/ética , Assistência Terminal/ética , Doente Terminal , Humanos , Apoio Nutricional/normas , Assistência Terminal/normasRESUMO
BACKGROUND: To study the seroprevalence of hepatitis C virus in a cohort of six patients with a diagnosis of polyarteritis nodosa (PAN). METHODS: There have been included six patients with a diagnosis of PAN, carrying out a serodiagnosis of hepatitis B virus (VHB) and C (VHC) this last one by means of the following methods: ELISA, RIBA-II and PCR. RESULTS: These cases (50%) showed exclusive positivity to VHC by means of the three ways of diagnosis, two cases showed positivity to VHB (33.3%), one case (16.6%) showed positivity to both virus (VHB and (VHC) and one case didn't show positivity virus. CONCLUSIONS: It is probable a ethipatogenic relation between hepatitis C virus and polyarteritis nodosa, our sample doesn't show any difference from that written in the literature. The positive rheumatoid factors can give false positive for VHC by means of the technique ELISA because of this it is necessary to confirm the positive by means of the techniques RIBA-II and PCR.
Assuntos
Hepatite C/complicações , Poliarterite Nodosa/virologia , Idoso , Hepacivirus/isolamento & purificação , Humanos , Masculino , Pessoa de Meia-Idade , Testes SorológicosRESUMO
A 37 year old woman is presented with solitary splenic abscess, without involvement of other organs, in the context of septic abortion. Splenic abscess were effectively treated with 21 days of antibiotic administration, not was necessitated splenectomy and percutaneous drainage. Emphasis is laid on its rarity of solitary splenic abscess in the course of gynecologic infection, and complete response to antibiotic treatment.
Assuntos
Abscesso/tratamento farmacológico , Antibacterianos/uso terapêutico , Esplenopatias/tratamento farmacológico , Abscesso/etiologia , Adulto , Endometrite/complicações , Feminino , Humanos , Esplenopatias/etiologiaRESUMO
Suprarenal insufficiency is the systemic disease more frequent associated to auricular cartilage calcification. Physiopathologic mechanism of this phenomenon remain without elucidate, several hypothesis have been postulated. We introduce one patient male attached of Addison's disease with external ear bilateral calcification. We review 20 case related in literature, postulating that low levels of cortisone, established in acute or chronic form, can cause a maintained or transitory hypercalcemia, calcium deposit in predisposed physically-chemically tissue: deficient peripheral vascularization and susceptibility to external aggression like traumatisms or cold.
Assuntos
Doença de Addison/complicações , Calcinose/etiologia , Cartilagem da Orelha , Otopatias/etiologia , Doenças das Cartilagens/diagnóstico por imagem , Doenças das Cartilagens/etiologia , Cartilagem da Orelha/diagnóstico por imagem , Otopatias/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , RadiografiaAssuntos
Colite , Colágeno , Biópsia , Colite/patologia , Colo/patologia , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
The Neutrophilic dermatosis (ND) is considered as an independent entity with diverse clinical manifestations among which there are: gangrenous pyoderma, nodous erythema, Sweets Syndrome, vesiculopustula eruptions associated to ulcerous colitis and intestinal short circuit syndrome with or without short circuit. Histologically, they are characterized by infiltration of polymorphonuclear neutrophils, generally at the dermic level, but also at the epidermic. They are usually associated to systemic diseases, especially to chronic intestinal inflammatory disease. Our aim was to describe two forms of clinical presentation of neutrophilic dermatosis: gangrenous pyoderma and vesiculopustula eruption, associated to ulcerous colitis starting at advances ages.
Assuntos
Colite Ulcerativa/complicações , Neutrófilos , Dermatopatias/etiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Dermatopatias/patologiaRESUMO
We present the case of a patient under corticosteroid therapy (Deflazacort) developing a cutaneous Kaposi's Sarcoma. In a latter study performed due to the presence of digestive syndrome, a gastric Kaposi's sarcoma was detected. We review the cases published in the literature of patients with rheumatoid pathology under corticosteroid therapy.
Assuntos
Artrite Reumatoide/complicações , Sarcoma de Kaposi/complicações , Neoplasias Gástricas/complicações , Idoso , Anti-Inflamatórios/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Humanos , Masculino , Pregnenodionas/uso terapêuticoRESUMO
Schönlein-Henoch purpura is a vasculitis due to hypersensitivity characteristic of the infancy that affects preferably small vessels. The etiology is unknown, although it has been related to allergic reactions to drugs, infections, vaccines and insecta bites. An adult with a Schönlein-Henoch purpura after receiving spiramicin is presented, beginning with epigastric pain and vomiting and the purpura appearing subsequently.
Assuntos
Vasculite por IgA/induzido quimicamente , Espiramicina/efeitos adversos , Gastropatias/induzido quimicamente , Idoso , Humanos , Vasculite por IgA/complicações , MasculinoRESUMO
We present a case of mixed disease of the connective tissue in a 37-year-old woman previously healthy, whose first manifestations were ascites, facial edemas and tibiomalleolars, latter progressing with constitutional syndrome, myalgias, Raynaud's phenomenon and esophagic disorders. In the literature reviewed, we have not found any other case of this type of onset in mixed disease of the connective tissue.
Assuntos
Ascite/etiologia , Doença Mista do Tecido Conjuntivo/complicações , Doença Aguda , Adulto , Feminino , Humanos , Doença Mista do Tecido Conjuntivo/diagnósticoRESUMO
We present a case of nodose polyarteritis (NPA) in a 65-years-old man with clinical manifestations at the level of the peripherical nervous system (PNS) as a subacute sensorimotor polyneuropathy. We believe that this is an interesting case due to the outlined symptomatology and the first clinical signs, not as common as the multiple mononeuropathy. The diagnosis was established through biopsy of muscle-nerve, without observing aneurysms at the Divas and with negative results for the Hepatitis B markers. Response to corticoid and immunosuppressive therapy was positive.
Assuntos
Arterite/complicações , Doenças do Sistema Nervoso Periférico/etiologia , Idoso , Humanos , Masculino , Doenças do Sistema Nervoso Periférico/diagnósticoRESUMO
Two clinical cases of patients with rheumatoid arthritis (RA) and poor response to conventional treatment are described. Patients received immunosuppressor treatment with azathioprine (AZA) and developed hepatic hemangiomas without detectable hepatic pathology previous to the treatment with AZA. The hepatic iatrogenesis of AZA is discussed, as well as the etiopathogenic hypothesis regarding hepatic hemangioma.
Assuntos
Artrite Reumatoide/tratamento farmacológico , Azatioprina/efeitos adversos , Hemangioma/induzido quimicamente , Neoplasias Hepáticas/induzido quimicamente , Artrite Reumatoide/complicações , Azatioprina/uso terapêutico , Hemangioma/complicações , Humanos , Neoplasias Hepáticas/complicações , Masculino , Pessoa de Meia-IdadeRESUMO
We report a case of rheumatic polymyalgia associated with temporal arteritis, in which clinical-biological symptoms and evolution with steroid or immunosuppressive therapy were analyzed. We confirm the lack of effectiveness of the treatment with AINES, the low response to steroids and the high response to immunosuppressive therapy.
Assuntos
Arterite de Células Gigantes/tratamento farmacológico , Imunossupressores/uso terapêutico , Idoso , Anti-Inflamatórios não Esteroides/uso terapêutico , Azatioprina/administração & dosagem , Doença Crônica , Feminino , Arterite de Células Gigantes/diagnóstico , Humanos , Polimialgia Reumática/diagnóstico , Polimialgia Reumática/tratamento farmacológico , Prednisona/administração & dosagemRESUMO
A case of a patient with rheumatoid arthritis (RA) of long evolution associated to dry syndrome, who developed a dissociated cholestasis after parenteral administration of gold salts, is suppression of gold salts. We comment on the clinical, biochemical, and histological features of intrahepatic cholestasis related to gold salts, as well as the evolution and the necessary criteria in order to make the diagnosis. We highlight the normal level of bilirubin, comparing it to that described in the literature.