RESUMO
Acquired haemophilia is a rare, but often life-threatening bleeding disorder caused by autoantibodies, mostly directed against factor VIII (FVIII inhibitor). The incidence of acquired haemophilia, which most commonly affects patients over 50 years of age, is estimated between 0.2 and 1 million per year. Although its aetiology remains obscure, 40-50% of cases are associated with other conditions, such as pregnancy, malignancies, drugs and autoimmune disorders as rheumatoid arthritis, systemic lupus erythematosus and Sjögren's disease. We report the case of a 69-year-old patient with spontaneously acquired FVIII inhibitor secondary to polymyalgia rheumatica (PMR)/arteritis temporalis (AT). Our case illustrates that PMR/AT can be added to the list of autoimmune disorders associated with acquired haemophilia due to FVIII inhibitor.
Assuntos
Arterite de Células Gigantes/imunologia , Hemofilia A/tratamento farmacológico , Hemofilia A/imunologia , Imunossupressores/uso terapêutico , Polimialgia Reumática/imunologia , Idoso , Autoanticorpos/imunologia , Feminino , Arterite de Células Gigantes/complicações , Hematoma/etiologia , Hemofilia A/etiologia , Humanos , Tempo de Tromboplastina Parcial , Polimialgia Reumática/complicaçõesRESUMO
OBJECTIVE: Peritoneal dialysis (PD) patients frequently suffer from dyspeptic complaints such as nausea, vomiting, abdominal distension, early satiety, and anorexia. Gastroparesis might be, at least partially, a source of dyspeptic complaints in PD patients. The aim of the present study was to determine the influence of the presence and composition of dialysate on gastric emptying in PD patients. DESIGN: Prospective study. SETTING: Renal Division, Department of Internal Medicine, Ghent University Hospital, Belgium. PATIENTS: Sixty-one PD patients using different dialysate solutions, and 27 healthy volunteers. MAIN OUTCOME MEASURE: Gastric emptying of solids was assessed by the 13C-octanoic acid breath test. RESULTS: Gastric emptying was impaired in PD patients, regardless of the composition of dialysate and even if tested with an empty peritoneal cavity. Gastric emptying was significantly slower when glucose-containing dialysate was compared to an empty peritoneal cavity, or when glucose-containing dialysate was compared to icodextrin dialysate. No difference in gastric emptying could be demonstrated between glucose-containing dialysate and dialysate containing a mixture of glycerol and amino acids as osmotic agent. CONCLUSIONS: These findings suggest that the delay in gastric emptying demonstrated in the presence of peritoneal dialysate is not the consequence of a mere volume or pressure effect, but of the absorption of substrate substances with caloric and/or metabolic activity, such as glucose or glycerol and amino acids.