RESUMO
Macro-creatine kinase (macro-CK) is a neglected cause of raised CK. Over a 10-year period, we observed five cases. Three patients had macro-CK type 1. One patient with fibromyalgia underwent several explorations to find a muscular pathology; another, who had elevated CK-MB (muscle-brain fraction) activity, was referred to a cardiologist, and statin therapy was erroneously discontinued in two patients. Two patients had macro-CK type 2: a man with a neuroendocrine carcinoma and a woman with rheumatoid arthritis. Diagnosis of type 1 obviates the need to carry out pointless and expensive investigations seeking a neuromuscular or cardiac pathology, and also, the unwarranted discontinuation of statin therapy. Type 2 must prompt investigations for a neoplasm.
Assuntos
Creatina Quinase/análise , Creatina Quinase/metabolismo , Mialgia/diagnóstico , Mialgia/enzimologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: Surgical site infections (SSI) in orthognathic surgery are considered infrequent and without any important consequence for the final operative result. A procedure of epidemiological surveillance was implemented to determine the frequency of SSI in orthognathic surgery and to better document their risk factors. MATERIAL AND METHOD: This prospective study included all interventions in our orthognathic surgery department between September 1(st) 2006 and August 31(st) 2007. SSI and their risk factors were documented for up to one year of follow-up. Risk factors were correlated to SSI using monovariate and multivariate analyses. RESULTS: Ten (7%) out of 143 consecutive interventions in orthognathic surgery were complicated by a SSI. All the SSI were secondary to a mandibular ramus sagittal split osteotomy. The two significantly correlated risk factors with the SSI in multivariate analysis were the length of surgery and the type of antibiotic prophylaxis. DISCUSSION: This rate of SSI correlates to published data. To decrease this rate, it would be necessary, in association with the usual precautionary measures, to limit the operating time and to recommend an antibioprophylaxis combining amoxicillin plus clavulanic acid (Augmentin).
Assuntos
Procedimentos Cirúrgicos Ortognáticos/estatística & dados numéricos , Infecção da Ferida Cirúrgica/epidemiologia , Adolescente , Adulto , Amoxicilina/uso terapêutico , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Antibacterianos/uso terapêutico , Antibioticoprofilaxia/estatística & dados numéricos , Placas Ósseas/estatística & dados numéricos , Criança , Clindamicina/uso terapêutico , Feminino , Seguimentos , França/epidemiologia , Humanos , Incidência , Técnicas de Fixação da Arcada Osseodentária/estatística & dados numéricos , Masculino , Mandíbula/cirurgia , Maxila/cirurgia , Pessoa de Meia-Idade , Higiene Bucal , Osteotomia/estatística & dados numéricos , Osteotomia de Le Fort/estatística & dados numéricos , Estudos Prospectivos , Fatores de Risco , Fumar/epidemiologia , Fatores de Tempo , Adulto JovemRESUMO
OBJECTIVES: Increased incidence of cardiovascular disease (CVD) has been observed in AS. The reasons of this increase are not fully understood (greater prevalence of traditional cardiovascular risks, consequences of treatment (NSAID) or biological inflammation). The objectives of this study are to assess intima-media thickness (IMT) and arterial stiffness (i.e augmentation index AIx), markers of sub-clinical atherosclerosis in AS patients and to examine the effects of TNF-alpha inhibitors on arterial stiffness in active AS patients. METHODS: Sixty AS patients were enrolled with 60 healthy controls. Their BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) and BASFI (Bath Ankylosing Spondylitis Functional Index) scores, ESR and CRP levels were recorded. Subclinical atherosclerosis was assessed by measurement of AIx by pulse wave analysis and IMT by carotid echography. RESULTS: We found significantly increased IMT in the AS group compared with healthy controls. After adjustment for confounding factors, an underlying trend towards increased IMT was still present (P = 0.06). No difference was found in arterial stiffness between the two groups. AS patients, treated or not with anti-TNF-alpha at baseline, had significantly increased IMT and AIx or a trend towards increase. IMT was positively correlated with tobacco use, WHR and blood pressure but not correlated with CRP level. Despite improvement in markers of disease activity, arterial stiffness was unchanged after 14 weeks of treatment with TNF antagonists. CONCLUSION: This study shows a trend towards increased subclinical atherosclerosis in AS patients. TNF-alpha blockade does not seem to improve arterial stiffness in AS patients, but our results lack statistical power.
Assuntos
Espondilite Anquilosante/fisiopatologia , Túnica Íntima/patologia , Túnica Média/patologia , Resistência Vascular , Adulto , Anti-Inflamatórios não Esteroides/uso terapêutico , Antirreumáticos/uso terapêutico , Artérias/fisiopatologia , Aterosclerose/etiologia , Proteína C-Reativa/metabolismo , Artéria Carótida Primitiva/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Espondilite Anquilosante/complicações , Espondilite Anquilosante/tratamento farmacológico , Espondilite Anquilosante/patologia , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Resistência Vascular/efeitos dos fármacosRESUMO
Oseltamivir phosphate (OP) is an antiviral drug that is used in the treatment and prophylaxis of both influenza A and influenza B. It is effective against all known influenza viruses than can infect humans, including pandemic influenza viruses and may be the most appropriate antiviral option against avian influenza caused by H5N1 virus. Tamiflu, the registered trademark used under exclusive license by Roche laboratories with OP as active pharmaceutical ingredient, is considered the best treatment for the bird flu disease. A simple, selective, linear, accurate and precise HPLC method was developed and validated for rapid assay of OP aimed to the quality control of Tamiflu capsules and generic versions. Isocratic elution at a flow rate of 1.2 mL/min was employed on a Zorbax CN column (150 mm x 4.6mm; 5 microm) at ambient temperature. The mobile phase consisted of methanol and 0.04 M formic acid pH 3.0 (50:50, v/v). The UV detection wavelength was 226 nm and 20 microL of sample was injected. Sotalol hydrochloride was used as the internal standard (IS). The retention times for OP and IS were 3.40 and 2.25 min, respectively. The method was successfully applied to commercial pharmaceuticals, Tamiflu and generic versions. The proposed method could be applicable for routine analysis of OP and monitoring of the quality of marketed drugs as possibly counterfeit Tamiflu.
Assuntos
Antivirais/análise , Oseltamivir/análise , Cápsulas , Centrifugação , Cromatografia Líquida de Alta Pressão , Medicamentos Genéricos/análise , Concentração de Íons de Hidrogênio , Pós , Padrões de Referência , Reprodutibilidade dos TestesRESUMO
The diagnosis of transverse spinal fractures in patients with ankylosing spondylitis and Forestier's disease (DISH) may be difficult. The MRI features of 9 such fractures at the disk, vertebral body, spinal canal and posterior elements are presented. Fractures of the posterior elements (posterior arch fractures and/or rupture of interspinous or supraspinous ligaments and contiguous soft tissue structures) were present in all cases, underscoring the importance of MR signal abnormalities of posterior structures for diagnosis of these fractures. MR is advantageous due to its ability to demonstrate signal abnormalities of the posterior elements, which combined with disk and vertebral body abnormalities, play a major role for accurate diagnosis of this type of fracture.
Assuntos
Vértebras Cervicais/lesões , Hiperostose Esquelética Difusa Idiopática/complicações , Vértebras Lombares/lesões , Imageamento por Ressonância Magnética/métodos , Fraturas da Coluna Vertebral/diagnóstico , Fraturas da Coluna Vertebral/etiologia , Espondilite Anquilosante/complicações , Vértebras Torácicas/lesões , Idoso , Idoso de 80 Anos ou mais , Vértebras Cervicais/diagnóstico por imagem , Feminino , Humanos , Hiperostose Esquelética Difusa Idiopática/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Radiografia Torácica , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Espondilite Anquilosante/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
A simple, rapid and convenient analytical method without sample handling procedure is proposed for the determination of niflumic acid in a pharmaceutical gel with attenuated total reflectance/Fourier transform infrared spectroscopy (ATR/FTIR). A partial least square (PLS) calibration model for the prediction of niflumic acid contents was developed using 81 and 27 spectra of standard gels as training and validation sets, respectively. The used spectral range of niflumic acid for the establishment of this model was 2300-1100 cm(-1). All spectra were obtained in the transmittance mode, then normalized and first derivative transformed. The model yielded a regression coefficient R2 equal to 1 for the training set and a root mean square error of prediction (RMSEP) equal to 0.2 for the validation set. The percentage recoveries of the method for the analysis of Niflugel ranged from 96.60 to 101.02%.
Assuntos
Anti-Inflamatórios não Esteroides/análise , Ácido Niflúmico/análise , Preparações Farmacêuticas/química , Espectroscopia de Infravermelho com Transformada de Fourier/métodos , Géis , Análise dos Mínimos Quadrados , Controle de Qualidade , Reprodutibilidade dos TestesRESUMO
Twenty-five cases of polyarticular septic arthritis (PASA) were observed in our department over a 13-year period. They accounted for 16.6% of all septic arthritis (15% on average in the literature). A male predominance was noted in our patients, as well as in the literature. The knee was the most frequent location followed by the elbow, shoulder, and hip, in varying order depending on the series. An average of 4 joints was involved. The causative microorganism was Staphylococcus aureus in 20/25 of our patients and in about 50% of published cases. Other frequently causative organisms were streptococci and gram-negative bacteria. Blood cultures and joint aspirations were positive in 19/22 and 23/25 of our cases, respectively. Other septic lesions were noted in 10/25 of our cases. Fever and severe leukocytosis were absent at admission in 5/25 (literature, 37%) and 10/25 of our 25 patients, respectively. The underlying disease was rheumatoid arthritis in 13/25, while 9 of the other patients had immunodepression caused by drugs or by concurrent illness. Typically, rheumatoid arthritis was long-standing and erosive, patients having ulcerated calluses on the feet. This skin source was also noted in 23/36 published cases of PASA in rheumatoid arthritis. Systemic lupus erythematosus was an uncommon disease in PASA, but its presence promoted gram-negative infection. Despite effective therapy with 2 antibiotics, 8/25 patients died, a prognosis that is equally severe in cases reported in the literature (30%) and one that has remained surprisingly stable over the last 40 years. For comparison, the death rate was only 4% in our patients with MASA. Factors contributing to a poor prognosis were age greater than 50 years, rheumatoid arthritis as an underlying disease, and disease of staphylococcal origin. Septic polyarthritis should be considered even when the clinical picture is not florid--when patients have low fever and normal white blood cell counts. Nor should the simultaneous involvement of distant joints rule out infection. Indeed, the frequency of underlying rheumatic disease and its treatment may further confuse the clinical presentation. Joints suspected of harboring infection should be aspirated, including those previously affected by the concurrent rheumatism.
Assuntos
Artrite Infecciosa , Idoso , Idoso de 80 Anos ou mais , Artrite Infecciosa/complicações , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/microbiologia , Artrite Infecciosa/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , PrognósticoRESUMO
OBJECTIVE: To determine whether there are peculiarities of the POEMS syndrome (a multisystemic disorder associated with polyneuropathy, organomegaly, endocrinopathy of various forms, production of a monoclonal [M] component, and skin changes) in Caucasian patients, especially signs and symptoms absent in other series; and to attempt a reappraisal of the neuropathy and endocrinopathy to find a unifying mechanism. DESIGN: A retrospective, cooperative study compared 25 cases, observed over a 15-year period, with two published series of patients, one of Japanese patients and one of American patients, and with a review of the literature on non-Asian cases. Details were obtained of patients' medical history, physical examination, immunochemical and hormonal testing, roentgenographic examination, computed tomography imaging, and electromyography. RESULTS: The main features of the syndrome found in these patients were those first described in Japan: polyneuropathy, enlargement of the lymph nodes, liver, and spleen, endocrine disturbances, low concentration of the monoclonal component, hyperpigmentation, and hypertrichosis. Three other symptoms were found more frequently than previously reported: skin angiomas, scleroderma changes of the hands, and thrombocytosis. Electromyography and nerve biopsy showed a variety of abnormalities ranging from demyelination to axonal degeneration. Nerve deposits of immunoglobulin were absent. Organomegaly seemed to be heterogeneous. Pathologic findings in the enlarged lymph nodes and spleen were compatible with Castleman's disease. Liver biopsies were usually normal. The endocrine changes were surprisingly diverse, with some observations combining unrelated primary and secondary insufficiencies. No single hypothesis emerged regarding their mechanism. All M components had a lambda-light chain. An IgG M component was found more frequently in solitary lesions. An IgA M component was found more frequently in patients without bone lesions. Sedimentation rate was usually normal. Radiotherapy of solitary plasma-cytomas was followed by dramatic improvement of extramedullary signs and symptoms in all cases. CONCLUSIONS: The symptoms, clinical course, and management of the patients reported here were similar to those observed in the literature. This study confirms the existence of a close link between symptoms and lambda-light-chain production. There are indications that a plasma cell growth factor that does not cross-react with interleukin-6 (IL-6) may be involved.
Assuntos
Síndrome POEMS , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome POEMS/etnologia , Estudos RetrospectivosRESUMO
Whether patients with rheumatoid arthritis (RA) have an increased risk of developing non-Hodgkin lymphoma is controversial, and opinions differ on the possible role of methotrexate in the occurrence of lymphomas in patients with RA. We report 1 T-cell lymphoma and 1 B-cell lymphoma restricted to the skin associated with Epstein-Barr virus infection that healed completely and spontaneously after discontinuation of methotrexate in a man with RA and a woman with dermatomyositis. Cutaneous infiltrating cells were infected by a replicative form of Epstein-Barr virus. After discontinuation of methotrexate, the cutaneous lesions disappeared completely in 15 days without recurrence. Discontinuation of methotrexate is necessary in patients with RA or dermatomyositis who have a lymphoproliferative disorder, and a follow-up period of several weeks should be observed before specific therapy is initiated.
Assuntos
Antirreumáticos/efeitos adversos , Linfoma de Burkitt/virologia , Fármacos Dermatológicos/efeitos adversos , Infecções por Vírus Epstein-Barr/complicações , Herpesvirus Humano 4/isolamento & purificação , Imunossupressores/efeitos adversos , Linfoma Cutâneo de Células T/virologia , Metotrexato/efeitos adversos , Pele/patologia , Idoso , Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Linfoma de Burkitt/patologia , Fármacos Dermatológicos/uso terapêutico , Dermatomiosite/tratamento farmacológico , Infecções por Vírus Epstein-Barr/patologia , Feminino , Herpesvirus Humano 4/genética , Humanos , Imunossupressores/uso terapêutico , Hibridização In Situ , Linfoma Cutâneo de Células T/patologia , Masculino , Metotrexato/uso terapêutico , Pessoa de Meia-Idade , RNA Viral/isolamento & purificação , Pele/virologiaRESUMO
Cutaneous manifestations of POEMS (polyneuropathy, organomegaly, endocrinopathies, M-protein, and skin changes) syndrome in a 51-year-old white man included two types of hemangiomas, ie, cherry-type and subcutaneous hemangiomas. By light microscopy and immunohistochemistry, both types of tumors showed features of capillary hemangiomas. By electron microscopy, a peculiar finding of subcutaneous hemangiomas was the presence of slender abluminal processes of endothelial cells that were frequently anastomosing to form electron-lucent blebs. Although the precise etiopathogenesis of the vascular proliferations remains speculative, these lesions merit study since they constitute an easily recognizable marker of POEMS syndrome.
Assuntos
Hemangioma/ultraestrutura , Paraproteinemias/patologia , Neoplasias Cutâneas/ultraestrutura , Estrogênios/sangue , Imunofluorescência , Humanos , Masculino , Microscopia Eletrônica , Pessoa de Meia-Idade , SíndromeRESUMO
The mode of action of methotrexate (MTX) in rheumatoid arthritis (RA) is unknown. The hypothesis that its cytostatic effect may be involved has been questioned based on the evidence of several negative results, the most intriguing being its lack of effect on the Lymphoblastic Transformation Test (LTT) and other lymphoproliferations in cultures from patients' samples. Our study demonstrates that LTT evaluation by 3H-thymidine uptake, a standard method, is misleading when applied to MTX-treated cells. At in-vitro concentrations similar to those present in the red blood cells of RA patients, MTX produced an early block in the cell cycle without reducing the cellular uptake of 3H-thymidine. While the explanation of this discrepancy is still open to discussion, it is clear that future studies on the immunological status of RA patients on MTX should not use thymidine uptake for the measurement of the lymphocyte response to mitogens and various stimuli, but must rely on other methods for evaluating DNA synthesis.
Assuntos
Ativação Linfocitária/efeitos dos fármacos , Metotrexato/farmacologia , Timidina/metabolismo , Adulto , Ciclo Celular/efeitos dos fármacos , Células Cultivadas , Feminino , Humanos , Artropatias/metabolismo , Teste de Cultura Mista de Linfócitos , Masculino , Pessoa de Meia-Idade , Fito-Hemaglutininas/farmacologiaRESUMO
The dissociation constants of new 2-amino-2-oxazolines were determined by capillary electrophoresis (CE) as a new technique. A method based on a linear model has been used in the CE determination. A series of eight 2-amino-2-oxazolines are investigated to determine their ionization constant. Among them, three new oxazolines synthesized are presented. The Ka values were obtained from the plots of reciprocal effective mobility against inverse concentrations of protons. The potentiometric method (PM) was performed as a comparative method. No significant differences were observed between the determined dissociation constants using both methods. Thus, the pKa values have been found to vary between 8.55 and 8.68.
Assuntos
Eletroforese Capilar/métodos , Oxazóis/análise , Soluções Tampão , Concentração de Íons de Hidrogênio , Espectroscopia de Ressonância MagnéticaRESUMO
Selective serotonin reuptake inhibitors (SSRIs), serotonin noradrenergic reuptake inhibitors (SNaRIs) and noradrenergic and specific serotoninergic antidepressant (NaSSA) are widely used in the treatment of depression. An increase in antidepressant intoxications led to the development of reliable analytical methods for their analysis. A new determination procedure for these compounds (milnacipran, venlafaxine, desmethylvenlafaxine, mirtazapine, desmethylmirtazapine, citalopram, desmethylcitalopram, fluvoxamine, paroxetine, sertraline and fluoxetine) was developed by micellar electrokinetic capillary chromatography (MEKC) with diode array detection (DAD). Separation and determination were optimised on an uncoated fused-silica capillary (600 mm, 75 microm I.D.). The migration buffer consisted of 20 mM sodium borate, pH 8.55, with 20 mM SDS and 15% isopropanol, at an operating voltage of 25 kV. The column temperature was maintained at 40 degrees C. Injection in the capillary was performed in the hydrodynamic mode (0.5 p.s.i., 15 s). In these conditions, the migration time of the antidepressants was less than 11 min. In most cases, calibration curves were established for 30 - 2000 ng/ml (r > 0.995). The limit of detection and the limit of quantification were ranged between 10 and 20 and between 20 and 30 ng/ml, respectively, for all the molecules. This method allowed the determination of some of these compounds in biological fluids (blood, urine) in post-mortem cases. Samples (1 ml) were extracted with diethyl ether (5 ml) at pH 9.6 and reconstituted in diluted migration buffer. Similar results were obtained by a HPLC-DAD determination, performed as a reference method. These results suggest that this MEKC method can be useful for the determination of new antidepressants in post-mortem cases.
Assuntos
Antidepressivos/isolamento & purificação , Cromatografia Capilar Eletrocinética Micelar/métodos , Antidepressivos/classificação , Antidepressivos/metabolismo , Sensibilidade e EspecificidadeRESUMO
A high-performance liquid chromatographic method (HPLC) and a capillary zone electrophoresis method (CZE) have been developed for the analysis of methylparaben, ethylparaben, propylparaben and butylparaben in a commercial cosmetic product. A very simple extraction procedure with acidified diethylether was developed. The HPLC method involved a C18 reversed-phase column and a gradient of methanol and water-acetic acid (1%). Electrophoretic separation was performed on a fused-silica capillary with a mixed 15 mM tetraborate buffer (pH 9.2) and methanol (85:15, v/v). The calibration curves were linear from 1 to 40 microg/ml in HPLC and from 5 to 200 microg/ml in CZE. The limit of detection in CZE (0.21 microg/ml) was higher than in HPLC (0.05 microg/ml). Repeatability and intermediate precision were satisfactory for both methods (RSD values < 3.23% in HPLC and < 3.26%, in CZE). Only HPLC allowed the separation of butylparaben isomeric forms when CZE analysis was less time and reagents consuming. These results suggest that HPLC and CZE coupled with a simple extraction process are both suitable for parabens determination in cosmetic products.
Assuntos
Cosméticos/análise , Parabenos/análise , Conservantes Farmacêuticos/análise , Soluções Tampão , Cromatografia Líquida de Alta Pressão , Eletroforese Capilar , Indicadores e Reagentes , Controle de Qualidade , Reprodutibilidade dos TestesRESUMO
Four analytical methods have been developed for the quality control of tablets containing mirtazapine: spectrophotometry, spectrofluorimetry, high performance liquid chromatography (HPLC) and capillary zone electrophoresis (CZE). All the methods only require a simple extraction procedure of mirtazapine from the tablets before analysis. The concentration of mirtazapine in solutions was determined in the linearity range of 5-25 microg/ml at lambda=315 nm for spectrophotometry and at lambda=220 nm for HPLC and CZE. Spectrofluorimetric determinations were achieved at lambda(excitation)=328 nm and lambda(emission)=415 nm in the linearity range of 2-25 ng/ml. All the methods gave similar results and were validated for selectivity, linearity, precision and sensitivity. Spectrometric methods gave slightly higher RSD values (up to 2.54%). The four methods were directly and easily applied to the pharmaceutical preparation with accuracy, resulting from recovery experiments between 99.72% in HPLC and 101.47% in spectrofluorimetry.
Assuntos
Antidepressivos/análise , Mianserina/análogos & derivados , Mianserina/análise , Calibragem , Cromatografia Líquida de Alta Pressão , Eletroforese Capilar , Indicadores e Reagentes , Mirtazapina , Reprodutibilidade dos Testes , Soluções , Espectrometria de Fluorescência , Espectrofotometria Ultravioleta , ComprimidosRESUMO
Septic arthritis has shown no change in incidence, and despite advances in antimicrobial therapy is often responsible for residual functional impairment and for a high mortality rate among debilitated patients. Risk factors include older age, diabetes mellitus, rheumatoid arthritis, immunodeficiency, and a preexisting joint disease (e.g., rheumatoid arthritis) to which the symptoms of septic arthritis are sometimes ascribed. Staphylococcus aureus contributes over two-thirds of identified organisms; a range of streptococci and gram-negative bacilli are next in frequency. The most common site is the knee, followed by the hip and shoulder. Over 10% of patients have polyarticular involvement reflecting bacteremia and diminished resistance to infection; (over 50% of polyarticular forms occur in rheumatoid arthritis patients). Prosthetic joint infection is becoming increasingly common; chronic forms due to intraoperative contamination and resulting in septic loosening should be distinguished from acute hematogenous infection in which emergency treatment can allow to salvage the prosthesis. Demonstration of the organism in the joint is the key to the diagnosis. Joint aspiration should be performed on an emergency basis, if needed after identification of radiographic landmarks or under ultrasonographic guidance. Seeding the fluid on blood culture flasks immediately after aspiration increases the yield. Antibiotics should be started as soon as the microbiological specimens have been collected. When aspiration is difficult (hip) or inadequate, arthroscopic drainage usually makes arthrotomy unnecessary. Early antiinflammatory therapy (nonsteroidal antiinflammatory drugs, systemic or local glucocorticoids, anticytokines, and antiinflammatory cytokines) are being considered as tools for limiting joint damage; their efficacy and safety will first have to be established in animal studies.
Assuntos
Artrite Infecciosa , Articulações , Infecções Estafilocócicas , Adulto , Artrite Infecciosa/epidemiologia , Artrite Infecciosa/microbiologia , Artrite Infecciosa/fisiopatologia , Artrite Infecciosa/terapia , Feminino , França/epidemiologia , Humanos , Articulações/microbiologia , Articulações/fisiopatologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/fisiopatologia , Staphylococcus aureus/isolamento & purificaçãoRESUMO
A 41-year-old woman with systemic lupus erythematosus and lupus anticoagulant developed aortic thrombosis. The patient was receiving low dose aspirin. Aortography showed a complete obliteration of the infrarenal aorta. Computed tomography and magnetic resonance imaging showed no evidence of aortitis. The patient improved with medical treatment. Six other published cases are reviewed.
Assuntos
Síndrome Antifosfolipídica/diagnóstico por imagem , Doenças da Aorta/diagnóstico por imagem , Lúpus Eritematoso Sistêmico/diagnóstico por imagem , Trombose/diagnóstico por imagem , Adulto , Síndrome Antifosfolipídica/tratamento farmacológico , Aorta Abdominal/diagnóstico por imagem , Doenças da Aorta/tratamento farmacológico , Aortografia , Bloqueadores dos Canais de Cálcio/administração & dosagem , Quimioterapia Combinada , Feminino , Humanos , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Trombose/tratamento farmacológico , Tomografia Computadorizada por Raios X , Varfarina/administração & dosagemRESUMO
In 215 outpatients suffering from occlusive arterial disease of the lower limbs the authors compared the decrease in the ratio of ankle systolic pressure to brachial systolic pressure according to whether the treadmill exercise was limited to one minute or extended until pain forced the patient to stop. After a one-minute walk the pressure index always decreased significantly, especially when walking was restricted. The decrease in the pressure index was generally greater when the exercise was continued until the absolute walking distance, and the recovery time was usually twice as long. The fall in the pressure index was significantly greater for patients with single and multiple iliac stenoses than for those with stenoses at lower levels. In patients having a diastolic blood flow velocity on Doppler curves at rest, not modified by walking, a maximum drop in peripheral pressure was recorded after walking for one minute. In this instance there was no intensification of the decrease in peripheral pressure, unlike in patients without a diastolic blood flow velocity at rest. This one-minute test is not a maximal hemodynamic response, but it is sufficient for the appreciation of ischemia during exercise, according to the different parameters measured.
Assuntos
Arteriopatias Oclusivas/diagnóstico por imagem , Teste de Esforço/métodos , Claudicação Intermitente/diagnóstico por imagem , Perna (Membro)/irrigação sanguínea , Arteriopatias Oclusivas/patologia , Arteriopatias Oclusivas/fisiopatologia , Velocidade do Fluxo Sanguíneo , Diástole , Feminino , Artéria Femoral , Humanos , Artéria Ilíaca , Claudicação Intermitente/fisiopatologia , Masculino , Pessoa de Meia-Idade , Artéria Poplítea , Fatores de Tempo , Ultrassonografia , CaminhadaRESUMO
Diffuse sclerosing osteomyelitis of the mandible is characterized by bouts of intense pain, sometimes associated with trismus and paresthesia, and leads to progressive deformity. It is of unknown etiopathology, but it is suggested to be one manifestation of the synovitis, acne, pustulosis, hyperostosis, osteomyelitis syndrome, the other features of which may have been overlooked. Treatment results are disappointing, and decortication may be necessary to achieve an acceptable outcome. We report a case restricted to the mandible that responded favorably to treatment with pamidronate. Further trials of pamidronate in patients with diffuse sclerosing osteomyelitis of the mandible, even in those with the aforementioned syndrome, are needed to assess its effectiveness.
Assuntos
Anti-Inflamatórios/uso terapêutico , Difosfonatos/uso terapêutico , Doenças Mandibulares/tratamento farmacológico , Osteomielite/tratamento farmacológico , Idoso , Feminino , Humanos , PamidronatoRESUMO
A case of lingual necrosis in a patient irradiated 3 years earlier for a tonsillar tumor is presented. Imputability to a post-radiology bilateral external carotid thrombosis is evoked, where the diagnosis of tumoral recurrence and Horton's disease have been ruled out. Cervical peridural nerve block allowed successful treatment of this lesion.