RESUMO
BACKGROUND: Clinical practice requires an accurate psychological assessment of subjects with clinical history of alcohol abuse and/or substance abuse (abuse history [AH]) for therapeutic choice. This study aims to identify significant correlations between the Minnesota Multiphasic Personality Inventory (MMPI)-2 scales in patients awaiting liver transplantation. METHODS: We evaluated a personality questionnaire containing MMPI-2 scales in the sample of 308 patients (81.8% males and 18.2% females) awaiting liver transplantation. The AH group composed 44.49% of patients and in the abuse free (AF) group, 55.51%. Scales were compared using Shapiro-Wilk test and Mann-Whitney U test. Interrelationships were examined using Spearman's correlation. RESULTS: This analysis found 27 scales of the MMPI-2 that were statistically different between 2 groups (AF and AH). In the AH group, we found a significant correlation between the following pairs of scales: Schizophrenia Scale (Sc) with the Addictions Potential Scale, Social Introversion scale (Si) with the Psychopathic Deviate scale (Pd), and Social Discomfort scale with Pd; the ES scale was negatively correlated with the Sc and Si scales. This interim study showed that the understanding of these indicators is crucial both for the assessment accuracy and for a prediction of the degree of therapy compliance after the transplantation. CONCLUSIONS: The scales of the MMPI-2 indicated a marked tendency to emotional rigidity, a lack of self-esteem and susceptibility judgment. Social introversion and social discomfort trends lead to impulsive behavior and deviant actions that combine poorly with good compliance with treatment.
Assuntos
Alcoolismo/psicologia , Transplante de Fígado , Cooperação do Paciente/psicologia , Personalidade , Alcoolismo/terapia , Feminino , Humanos , MMPI , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Substâncias/psicologia , Transtornos Relacionados ao Uso de Substâncias/terapia , Inquéritos e Questionários , Listas de EsperaAssuntos
Adjuvantes Imunológicos/administração & dosagem , Anti-Inflamatórios/administração & dosagem , Ácido Hialurônico/administração & dosagem , Injeções Intra-Articulares/efeitos adversos , Metilprednisolona/administração & dosagem , Embolia Pulmonar/etiologia , Idoso , Artrite Reumatoide/tratamento farmacológico , Embolia Gordurosa/etiologia , Feminino , HumanosRESUMO
Ceftriaxone may precipitate in the bile leading to the formation of biliary sludge. Biliary complications, even serious ones, have rarely been described in patients treated with this antibiotic. A 71-year-old woman presented to the emergency room with biliary sludge complicated by acute cholecystitis and pancreatitis after 10 days of treatment with ceftriaxone (2 g, 40 mg/kg per day). There had been no evidence of sludge or gallstones on a transabdominal ultrasonography performed 6 months earlier. The patient underwent open cholecystectomy and recovered fully. Ceftriaxone should be kept in mind as a potential cause of biliary sludge. In most cases, resolution of sludge occurs after interruption of ceftriaxone. Young subjects, patients receiving a prolonged course and a daily dose > or = 40 mg/kg, and subjects with impaired gallbladder emptying have a greater risk of ceftriaxone-associated sludge. Cholecystectomy is the definitive therapy for severe complications.
Assuntos
Bile/efeitos dos fármacos , Ceftriaxona/efeitos adversos , Cefalosporinas/efeitos adversos , Colecistite/induzido quimicamente , Pancreatite/induzido quimicamente , Doença Aguda , Idoso , Precipitação Química , Colecistectomia , Colecistite/diagnóstico , Colecistite/cirurgia , Feminino , Humanos , Pancreatite/diagnóstico , Pancreatite/cirurgia , Fatores de TempoRESUMO
Thrombolysis has been shown to be an effective treatment for ischaemic stroke. The major obstacles to more widespread use of this therapy are lack of awareness that treatment is possible and the short, less than 3 hours, therapeutic window. Even though the use of this therapy can be burdened by the occurrence of intracerebral haemorrhages, there is tantalizing evidence that thrombolysis is the only approach that has been so far demonstrated to improve the outcome of these patients. Early recognition of the onset of stroke, the immediate transfer to a suitably equipped facility and careful screening of a computed tomographic scan of the head for signs of early infarction are necessary for the safe administration of intravenous thrombolysis. There is mounting evidence that intra-arterial thrombolysis in combination with transluminal angioplasty has even a greater potential than intravenous thrombolysis and, possibly, a lower rate of intracerebral haemorrhages. Despite doubts having been raised about the use of thrombolysis in routine clinical practice, it appears that this therapy is most effective in those patients treated with careful adherence to published guidelines.
Assuntos
Isquemia Encefálica/tratamento farmacológico , Tratamento de Emergência , Terapia Trombolítica , Ativador de Plasminogênio Tecidual/uso terapêutico , Doença Aguda , Humanos , Injeções Intra-Arteriais , Injeções Intravenosas , Proteínas Recombinantes/uso terapêutico , Fatores de TempoRESUMO
Goodpasture's disease is characterized by lung haemorrhage, associated with glomerulus basement membrane antibody glomerulonephritis, and circulating basement membrane antibody. Other diseases (Wegener, LES, arteritis) may have the same kidney and lung involvement. The Authors present a clinical case of rapidly progressive renal failure where renal biopsy showed an extensive extracapillary proliferative glomerulonephritis with linear deposits of antibody in the basement membrane, similar to Goodpasture's disease, with following lung involvement, but without hemoptysis and in absence of circulating antiglomerular basement membrane antibody. The Authors think it could be a case of Goodpasture's disease, even if it did not show the above-mentioned symptoms, whether out of the characteristic clinical course or the exclusion of all the other diseases. The Authors believe that the absence of circulating basement membrane antibody could be due to their sediment in the target organs and suggest a revision of the standards required for the Goodpasture's disease diagnosis.
Assuntos
Doença Antimembrana Basal Glomerular/diagnóstico , Doença Antimembrana Basal Glomerular/diagnóstico por imagem , Doença Antimembrana Basal Glomerular/imunologia , Autoanticorpos/análise , Membrana Basal/imunologia , Biópsia , Diagnóstico Diferencial , Técnica Direta de Fluorescência para Anticorpo , Humanos , Glomérulos Renais/patologia , Masculino , Pessoa de Meia-Idade , Radiografia TorácicaRESUMO
Ischemic stroke remains worldwide one of the leading causes of death and disability. Current therapeutic approach is focusing upon the protection of neuronal metabolism in ischemic areas and early thrombolysis in selected subgroups of patients. There is evidence that all subjects with ischemic stroke should undergo a cerebral CT as soon as possible after clinical presentation. Taken all into account, Emergency Physicians appear to have a central role in the management of ischemic stroke.