Assuntos
Hematoma/patologia , Vasculite por IgA/diagnóstico , Imunoglobulina A/metabolismo , Vasculite Leucocitoclástica Cutânea/diagnóstico , Idoso , Biópsia , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/terapia , Diagnóstico Diferencial , Imunofluorescência , Humanos , Vasculite por IgA/sangue , Vasculite por IgA/patologia , Imunoglobulina A/análise , Masculino , Anamnese , Exame Físico , Vasculite Leucocitoclástica Cutânea/imunologia , Vasculite Leucocitoclástica Cutânea/patologiaAssuntos
Hipotireoidismo/metabolismo , Proteinúria/urina , Tiroxina/urina , Idoso , Feminino , Humanos , Hipotireoidismo/complicações , Hipotireoidismo/tratamento farmacológico , Pessoa de Meia-Idade , Síndrome Nefrótica/complicações , Síndrome Nefrótica/tratamento farmacológico , Proteinúria/complicações , Tiroxina/administração & dosagemRESUMO
A 30-year-old patient treated with CCPD presented with genital ulcers and a culture-negative peritonitis. Herpes simplex virus type 2 (HSV-2) was cultured from the effluent and the genital lesions. Primary HSV-2 infection was diagnosed by serology. This is the first documented case of PD peritonitis caused by HSV-2. We speculate that cases of culture-negative PD peritonitis may be due to recurrences of genital herpes.
Assuntos
Herpes Genital/complicações , Herpes Simples/etiologia , Diálise Peritoneal Ambulatorial Contínua/efeitos adversos , Peritonite/etiologia , Adulto , Feminino , Herpes Genital/virologia , Herpes Simples/virologia , Herpesvirus Humano 2/isolamento & purificação , Humanos , Peritonite/virologia , RecidivaAssuntos
Meios de Contraste/efeitos adversos , Metformina , Soluções para Reidratação/uso terapêutico , Insuficiência Renal/prevenção & controle , Cloreto de Sódio/uso terapêutico , Acidose Láctica/induzido quimicamente , Humanos , Metformina/administração & dosagem , Metformina/efeitos adversos , Países Baixos , Insuficiência Renal/induzido quimicamenteAssuntos
Artrite Reumatoide/complicações , Artrite Reumatoide/tratamento farmacológico , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Isoxazóis/efeitos adversos , Glomérulos Renais/imunologia , Insuficiência Renal/etiologia , Artrite Reumatoide/patologia , Membrana Basal/imunologia , Feminino , Humanos , Leflunomida , Pessoa de Meia-IdadeRESUMO
A 19-year-old woman is presented with high-spiking fever, pericardial tamponade and respiratory failure. A diagnosis of adult onset Still's disease was made. This is a rare inflammatory disease with an unknown aetiology. The diagnosis is made by exclusion and with the help of diagnostic criteria. Treatment with corticosteroids met with a good response.
Assuntos
Febre/diagnóstico , Derrame Pericárdico/diagnóstico , Corticosteroides/uso terapêutico , Adulto , Diagnóstico Diferencial , Feminino , Febre/tratamento farmacológico , Humanos , Derrame Pericárdico/tratamento farmacológico , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/tratamento farmacológico , Doença de Still de Início Tardio/diagnóstico , Doença de Still de Início Tardio/tratamento farmacológicoAssuntos
Glomerulonefrite/virologia , Infecções por Parvoviridae/virologia , Parvovirus B19 Humano/isolamento & purificação , Adulto , Idoso , Antígenos Virais/sangue , Feminino , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Masculino , Parvovirus B19 Humano/imunologia , Remissão Espontânea , Resultado do TratamentoRESUMO
Beer drinker's hyponatraemia, also called beer potomania, is a syndrome of hyponatraemia in patients who consume excessive amounts of beer and have a poor dietary intake. We describe a patient with chronic asymptomatic hyponatraemia due to beer potomania. The pathophysiology of this syndrome, the treatment and prevention are reviewed.
Assuntos
Alcoolismo/complicações , Cerveja , Hiponatremia/etiologia , Idoso , Doença Crônica , Humanos , Hiponatremia/diagnóstico , Hiponatremia/metabolismo , Masculino , Distúrbios Nutricionais/complicaçõesRESUMO
Splenomegaly is a common problem. In the absence of systemic illness or malignancy splenic cysts must be considered, especially the epithelial variety. For large cysts total splenectomy has long been recommended. Recognition of the risk of an overwhelming postsplenectomy infection (OPSI), especially in children, has led to spleen conserving surgery. We describe the use of an absorbable Vicryl net after partial splenectomy with total cystectomy in the management of splenic epithelial cysts.
Assuntos
Cistos/diagnóstico , Cistos/cirurgia , Esplenomegalia/diagnóstico , Esplenomegalia/cirurgia , Adolescente , Adulto , Cistos/patologia , Intervalo Livre de Doença , Epitélio/patologia , Epitélio/cirurgia , Humanos , Imageamento por Ressonância Magnética , Masculino , Esplenectomia/métodos , Esplenomegalia/patologia , Telas Cirúrgicas , Resultado do TratamentoRESUMO
In a 75-year-old man treated for cerebral oedema with mannitol, anuria developed after two days' treatment. Within a few hours after haemodialysis renal function returned. High doses of mannitol can cause acute renal failure, especially in patients with pre-existing renal impairment. Lowering of the concentration of mannitol in plasma by haemodialysis will rapidly restore renal function.
Assuntos
Edema Encefálico/tratamento farmacológico , Diuréticos Osmóticos/intoxicação , Manitol/intoxicação , Doença Aguda , Idoso , Anuria/induzido quimicamente , Anuria/terapia , Humanos , Masculino , Manitol/uso terapêutico , Diálise RenalRESUMO
In a 61-year-old man, who had undergone left-sided nephrectomy in the past, and who came with anuria and recurrent pulmonary oedema, complete obstruction of the right renal artery was diagnosed. Recurrent pulmonary oedema may be a manifestation of ischaemic renal disease. This clinical entity is not rare and may lead to terminal renal insufficiency. Both surgery and angioplasty can preserve or improve renal function and make dialysis therapy unnecessary. In the patient described, the stenotic part of the renal artery was resected and the vessel connected to the aorta end to side; the patient recovered.
Assuntos
Anuria/etiologia , Edema Pulmonar/etiologia , Obstrução da Artéria Renal/cirurgia , Angiografia Digital , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Renal/diagnóstico por imagem , Artéria Renal/cirurgia , Obstrução da Artéria Renal/complicações , Procedimentos Cirúrgicos Vasculares/métodosRESUMO
Complement and erythrocyte complement receptors CR1 (CD35) play an important role in the clearance of immune complexes. We studied the elimination of soluble 123I-labelled aggregates of human immunoglobulin G (123I-AIgG), used as a model for immune complexes, in two patients with a congenital and two patients with an acquired deficiency of complement component C3, and compared these with 10 healthy controls. The first disappearance halflife of 123I-AIgG was shorter (3.3 +/- 0.4 versus 7.0 +/- 0.4 min in the controls, P = 0.005) and maximal hepatic uptake of aggregates was increased in the C3 deficient patients (maximal liver/background ratio 3.6 +/- 0.4 versus 2.7 +/- 0.2 in controls, P = 0.04). Apparently, in the absence of C3, removal of circulating immune complexes by the liver is accelerated, probably through Fc receptor-dependent mechanisms.
Assuntos
Complemento C3/deficiência , Imunoglobulina G/sangue , Radioisótopos do Iodo , Adulto , Complexo Antígeno-Anticorpo , Eritrócitos/metabolismo , Eritrócitos/ultraestrutura , Feminino , Humanos , Imunoglobulina G/metabolismo , Masculino , Oxigênio/metabolismo , Ligação Proteica , Receptores de Complemento 3b/imunologia , Receptores de Complemento 3b/fisiologiaRESUMO
The mononuclear phagocyte system (MPS) is responsible for the elimination of foreign material, effete autologous material and immune complexes. To study the relationship between MPS function and human disease, several test substances have been developed, and used to determine the clearance capacity of the MPS in human subjects in vivo. These test substances and the multitude of factors that influence the elimination of these substances (and complicate the interpretation of the test results) are discussed. Use of these probes has provided important new insights, that may lead to the development of treatment modalities by which MPS function is modified in order to influence disease processes more effectively.
Assuntos
Técnicas Imunológicas , Sistema Fagocitário Mononuclear/fisiologia , Fagocitose/fisiologia , História do Século XX , Humanos , Técnicas Imunológicas/históriaRESUMO
The prevalence of antibodies against the collagen-like region of the subcomponent of the first component of complement, C1q, was investigated in 11 patients with anti-glomerular basement membrane (GBM) nephritis. Anti-C1q antibodies (anti-C1qAb) were detected in seven patients. IgG anti-C1qAb were found in four and IgA anti-C1qAb in five patients. During follow up of the patients a relationship was observed between the levels of IgG anti-C1qAb and the levels of anti-GBM antibodies (anti-GBMAb). Gelfiltration experiments indicated that both IgG anti-C1qAb as well as IgG anti-GBMAb were monomeric and that binding also occurred with the F(ab')2 fragments of the antibodies. Although anti-C1qAb and anti-GBMAb are both directed against a collagen-like structure, it was demonstrated by means of inhibition experiments that anti-C1qAb and anti-GBMAb are directed against different antigenic sites. Comparison of patients with anti-GBM nephritis with and without anti-C1qAb revealed that there were no differences in disease activity or disease severity. Therefore, the results of this study suggest that anti-C1qAb do not play a direct pathogenetic role in anti-GBM nephritis.
Assuntos
Autoanticorpos/imunologia , Membrana Basal/imunologia , Complemento C1q/imunologia , Glomerulonefrite/imunologia , Adulto , Idoso , Humanos , Glomérulos Renais/imunologia , Pessoa de Meia-IdadeRESUMO
Patients treated with chronic haemodialysis are at risk of infections, possibly because of impaired function of macrophage Fc receptors. Using [123I]-labelled aggregates of human IgG ([123I]-AIgG) as a probe of Fc-receptor-mediated function, we examined eight patients treated with chronic intermittent haemodialysis (HD), eight patients treated with CAPD, eight patients with preterminal renal failure who had not yet received renal replacement therapy, and eight healthy controls. In all three patient groups the first elimination half-life of [123I]-AIgG was decreased, suggesting accelerated binding of the probe. In the HD group overall clearance of [123I]-AIgG was similar to the value found in healthy controls. In the CAPD and preterminal renal failure group clearance was decreased as compared with the HD patients. Uptake of [123I]-AIgG by liver and spleen was quantitatively similar in patients and controls, but hepatic uptake of [123I]-AIgG reached its maximum earlier in the patients treated with HD. These results suggest that Fc receptor function is not impaired in patients who undergo chronic haemodialysis.
Assuntos
Macrófagos/imunologia , Receptores Fc/fisiologia , Diálise Renal/efeitos adversos , Adulto , Idoso , Feminino , Humanos , Imunoglobulina G/metabolismo , Masculino , Pessoa de Meia-Idade , Diálise Peritoneal Ambulatorial Contínua/efeitos adversosRESUMO
Antibodies to the collagen-like region of C1q have been described in patients with SLE and rheumatoid vasculitis. In this study the prevalence of both IgG and IgA C1qAb was assessed in serum samples of 385 patients with different systemic and renal diseases. The results demonstrate that the prevalence of IgG and IgA C1qAb is not restricted to the diseases in which they were originally described. C1qAb can also be demonstrated in patients with MCTD, Felty's syndrome, ankylosing spondylitis, polyarteritis nodosa, mixed cryoglobulinaemia, membranoproliferative glomerulonephritis, glomerulosclerosis, and patients with anti-glomerular basement membrane nephritis. The widespread occurrence of C1qAb of both immunoglobulin classes in systemic and renal diseases may provide insight into the mechanisms that lead to C1qAb formation.
Assuntos
Autoanticorpos/análise , Complemento C1q/imunologia , Imunoglobulina A/análise , Imunoglobulina G/análise , Nefropatias/imunologia , Lúpus Eritematoso Sistêmico/imunologia , Artrite Reumatoide/sangue , Artrite Reumatoide/imunologia , Autoanticorpos/imunologia , Síndrome de Felty/sangue , Síndrome de Felty/imunologia , Humanos , Imunoglobulina A/imunologia , Imunoglobulina G/imunologia , Nefropatias/sangue , Lúpus Eritematoso Sistêmico/sangue , Doença Mista do Tecido Conjuntivo/sangue , Doença Mista do Tecido Conjuntivo/imunologia , Poliarterite Nodosa/sangue , Poliarterite Nodosa/imunologia , Espondilite Anquilosante/sangue , Espondilite Anquilosante/imunologiaRESUMO
It is thought that glucocorticosteroids impair the clearance of immune complexes by the mononuclear phagocyte system (MPS). We studied the effect of a five day course of prednisone (1 mg/kg body weight per day) on MPS function in 10 healthy volunteers, using soluble radiolabeled aggregates of human immunoglobulin G as a probe. MPS function was assessed before steroid treatment, and again 24 hours after the last dose of prednisone. Elimination kinetics and the uptake of the immunoglobulin aggregates by liver and spleen did not change after prednisone treatment. This suggests that, in contrast to general belief, high doses of glucocorticosteroids have no direct, acute effect on MPS function.
Assuntos
Corticosteroides/farmacologia , Imunoglobulina G/análise , Corticosteroides/administração & dosagem , Adulto , Complexo Antígeno-Anticorpo/análise , Complexo Antígeno-Anticorpo/metabolismo , Relação Dose-Resposta a Droga , Humanos , Imunoglobulina G/sangue , Radioisótopos do Iodo , Fígado/citologia , Fígado/efeitos dos fármacos , Fígado/metabolismo , Masculino , Taxa de Depuração Metabólica/efeitos dos fármacos , Fagócitos/efeitos dos fármacos , Fagócitos/metabolismo , Fagócitos/fisiologia , Prednisona/farmacologia , Baço/citologia , Baço/efeitos dos fármacos , Baço/metabolismo , Fatores de TempoRESUMO
Serum concentrations of IgG may influence Fc receptor-mediated clearance of immune complexes. For instance, when 123I-labeled aggregates of human IgG (123I-AIgG), used as a model for soluble immune complexes, are administered to patients with systemic lupus erythematosus (SLE), there is an inverse correlation between the serum concentrations of IgG and the clearance and volume of distribution in steady state (Vss) of 123I-AIgG. To answer the question whether IgG has a direct effect on the clearance of immune complexes, we measured the elimination of 123I-AIgG in eight patients with hypogammaglobulinemia, before and after substitution with intravenous gammaglobulin (IVIG). As expected, raising IgG concentrations in these patients (by 6 g/l) caused a significant decrease of the Vss of 123I-AIgG. However, clearance of 123I-AIgG remained unchanged by IVIG. Thus, the results of this study offer no experimental evidence that raising concentrations of IgG influences the clearance of soluble immune complexes.