RESUMO
Incidence rates for varicella and herpes zoster were similar in patients with juvenile idiopathic arthritis receiving etanercept/methotrexate (n = 85, 184.9 patient-years [PY]) or methotrexate alone (n = 71, 199.4 PY); no complicated varicella or herpes zoster cases were reported; herpes labialis incidence was higher in patients receiving etanercept/methotrexate versus methotrexate alone (0.38 vs. 0.24 PY).
Assuntos
Antirreumáticos/uso terapêutico , Artrite Juvenil/tratamento farmacológico , Varicela/epidemiologia , Etanercepte/uso terapêutico , Herpes Labial/epidemiologia , Herpes Zoster/epidemiologia , Metotrexato/uso terapêutico , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Criança , Pré-Escolar , Quimioterapia Combinada , Feminino , Humanos , Incidência , Masculino , Cidade de Roma/epidemiologiaAssuntos
Aorta/patologia , Insuficiência da Valva Aórtica/diagnóstico , Guias de Prática Clínica como Assunto , Arterite de Takayasu/diagnóstico , Adolescente , Anticorpos Monoclonais/uso terapêutico , Aorta/fisiopatologia , Insuficiência da Valva Aórtica/tratamento farmacológico , Insuficiência da Valva Aórtica/fisiopatologia , Quimioterapia Combinada , Diagnóstico Precoce , Feminino , Humanos , Imunossupressores/uso terapêutico , Infliximab , Angiografia por Ressonância Magnética , Metotrexato/uso terapêutico , Prednisona/uso terapêutico , Recidiva , Indução de Remissão , Arterite de Takayasu/tratamento farmacológico , Arterite de Takayasu/fisiopatologiaRESUMO
Personal experience of 31 patients suffering from intractable ascites due to advanced liver cirrhosis between 1978 and 1987 is reported. Seventeen patients were selected for a peritoneojugular shunt: in 3 patients the Le Veen shunt was performed and in 14 the Denver shunt was preferred. The high postoperative morbidity and mortality due to liver failure, DIC, hepatorenal syndrome, bleeding, sepsis and cerebral thrombosis is pointed out. Careful selection of patients to be submitted to this surgical procedure is essential because of the high morbidity due to ascites reinfusion. DIC has to be diagnosed as soon as possible and, when severe, the prompt interruption of the peritoneojugular shunt is mandatory.
Assuntos
Derivação Peritoneovenosa/métodos , Adulto , Idoso , Ascite/complicações , Ascite/mortalidade , Ascite/cirurgia , Feminino , Humanos , Cirrose Hepática/complicações , Cirrose Hepática/mortalidade , Cirrose Hepática/cirurgia , Masculino , Pessoa de Meia-Idade , Derivação Peritoneovenosa/efeitos adversos , Derivação Peritoneovenosa/instrumentação , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/prevenção & controleRESUMO
The authors dealt with 37 patients suffering from advanced liver cirrhosis with ascites. Eighteen patients out of them underwent Denver peritoneum-jugular shunt as a first choice procedure, the other 19 patients underwent lymphovenous anastomosis. The extremely advanced hepatic damage and the general conditions of these patients discouraged us to perform a portocaval shunt. In the 19 patients who underwent lymphovenous anastomosis we had no mortality rate. Two patients showed post-operative complications: 1 patient complained which hoarseness regressed in 5 months and the other patient suffered from a spleno-mesenteric-portal thrombosis with digestive hemorrhage from gastro-esophageal varices. In 6 patients out of 19 who underwent lymphovenous anastomosis, we did not obtain any immediate positive effects on ascites. In 4 patients, after 3 months, the ascites came back ingravescent and in the other 9 patients the positive effects on ascites were still evident after 1 year. Despite failure to obtain very comforting results, they suggest to employ this technique at any rate, as the first procedure, to make ascites more "manageable", because of its safety.
Assuntos
Ascite/cirurgia , Veias Jugulares/cirurgia , Ducto Torácico/cirurgia , Anastomose Cirúrgica , Ascite/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
A 12-year-old girl presented at the Oncoemato-logic Department with an acute onset of generalized lymphadenopathy. Lymphoproliferative disorders were highly suspected. Biopsied cervical and inguinal lymph node disclosed neither malignant cells nor monoclonal proliferation of lymphocytes. Revaluating the diagnosis, anamnestic data revealed multiple episodes of bilateral parotid swelling since age one, without systemic symptoms. Laboratory investigations, parotid ecography, Schirmer test revealed Sjogren's syndrome without associated disease. Sjogren syndrome (SS) in childhood is a rare and possibly underdiagnosed condition.