RESUMO
BACKGROUND: Intravenous immunoglobulins (IVIg) are the first-choice drugs for the treatment of certain neuroimmune diseases. The aim of this study was to evaluate the efficacy and safety of IVIg in patients with selected nervous system diseases. METHODS: The study enrolled patients who received IVIg in programmes financed by the National Health Fund in Poland. The status of patients upon inclusion and during treatment was assessed using scales dedicated to specific neurological diseases. RESULTS: The study enrolled 141 patients aged 56.28 ± 14.72 (51.77% female): 21 patients with myasthenia gravis (MG), 65 with chronic inflammatory demyelinating polyneuropathy (CIDP), 30 with Guillain-Barré syndrome (GBS), 12 with neuromyelitis optica spectrum disorder (NMOSD) and 13 patients with autoimmune encephalitis (AE). Neurological improvement was found in 14 (66.66%) MG patients (with a reduction of at least three points on the Quantitative Myasthenia Gravis Score (QMGS) within 14 days from the completion of the cycle), and in 34 (52.3%) GBS patients (with a reduction of at least one point on the Medical Research Council Scale within 14 days from the completion of the cycle). The parameters with the strongest effect on clinical improvement in MG patients were age [OR 1.033, CI 95% [0.09-1.09], p = 0.049] and baseline QMGS [OR 0.505; CI 95% [0.24-0.87], p = 0.038]. In the majority of CIDP patients (27, 97%) and NMOSD patients (6, 50%), neurological stabilisation was observed (without clinical improvement, defined for CIDP patients as an increase of at least two points on the Lovett Scale after three courses of IVIg were administered, and for NMOSD patients as an increase of at least one point on the Medical Research Council Scale and/or a shift of at least 0.3 logMAR after three courses of treatment). Deep-vein thrombosis was only one serious adverse event in the total group of patients treated with IVIg. CONCLUSIONS: The use of IVIg in patients with MG and GBS mostly results in neurological improvement, while in patients with NMOSD and CIDP, it mostly results in disease stabilisation. This could indicate the predominant anti-idiotypic antibody activity of IVIg in acute neuroimmune diseases or during exacerbations in chronic autoimmune diseases. The therapy of AE in comorbid neoplastic disease is burdened with an elevated risk of failure for IVIg. The results of our study confirm the improved safety of IVIg for selected neurological diseases.
RESUMO
PURPOSE: Surgical stone treatment induces oxidative stress in kidney tissue. We hypothesized that tubeless percutaneous nephrolithotomy (tPCNL) may induce less oxidative stress than classic percutaneous nephrolithotomy (cPCNL) with nephrostomy tube. METHODS: Seventy-two consecutive patients with kidney stones qualified for PCNL were enrolled in the study. Patients were assigned to one of two groups (first group 33 patients-cPCNL and second group 39 patients-tPCNL). Four urine samples were collected in four consecutive days, starting the day before operation. Four oxidative stress markers were analyzed in each sample: catalase (CAT), protein sulfhydryl group (SH), total antioxidant capacity (TAC) and superoxide dismutase (SOD). RESULTS: Baseline mean levels of CAT (IU/l), SH (µmol/l), TAC (mmol/l) and SOD (NU/ml) were 19.4 versus 11.7; 18 versus 58.7; 2.02 versus 1.99; 20.5 versus 22.6 in cPCNL and tPCNL group, respectively. On day two, the levels were 89 versus 104.9; 334.7 versus 518.9; 1.87 versus 1.79; 33.7 versus 41.4, respectively. On the third day, the levels were: 67.4 versus 28.3; 206.8 versus 306.9; 2.01 versus 2.06; 38.2 versus 36.6, respectively. On the fourth day, the concentrations were 47.4 versus 18.5; 129.3 versus 208.7; 2 versus 2.06; 35 versus 45.2, respectively. Significant differences were observed only for CAT and TAC concentrations in days 3 (p = 0.04 and 0.04) and 4 (p = 0.02 and < 0.001) in favor of tPCNL. CONCLUSIONS: CAT, SH and SOD significantly rise after operation. TAC represents the inversion of other parameters. CAT is significantly lower, and TAC is significantly higher in tPCNL postoperatively favoring this method.