RESUMO
BACKGROUND: Acute gastrointestinal bleeding (AGIB) is common in older patients but the use of iron in this context remains understudied. AIMS: This study aimed to evaluate prospectively the efficacy of ferric carboxymaltose to treat anaemia in older patients after AGIB. METHODS: This randomised double-blinded placebo-controlled clinical trial was conducted in 10 French centres. Eligible patients were 65 years or more, had controlled upper or lower gastrointestinal bleeding and a haemoglobin level of 9-11 g/dl. Patients were randomly assigned, in a 1:1 ratio, to receive either one intravenous iron injection of ferric carboxymaltose or one injection of saline solution. The primary endpoint was the difference in haemoglobin level between day 0 and day 42. Secondary endpoints were treatment-emergent adverse events, serious adverse events, rehospitalisation and improvement of quality of life (QOL) at day 180. RESULTS: From January 2013 to January 2017, 59 patients were included. The median age of patients was 81.9 [75.8, 87.3] years. At day 42, a significant difference in haemoglobin level increase was observed (2.49 g/dl in the ferric carboxymaltose group vs. 1.56 g/dl in the placebo group, P = 0.02). At day 180, QOL, measured on European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30, improved by 10.5 points in the ferric carboxymaltose group and by 8.2 points in the placebo group (P = 0.56). Rates of adverse events and rehospitalisation were similar in the two groups. CONCLUSIONS: Intravenous iron seems safe and effective to treat anaemia in older patients after AGIB and should be considered as a standard-of-care treatment. ClinicalTrials.gov (NCT01690585).
Assuntos
Compostos Férricos , Hemorragia Gastrointestinal , Hemoglobinas , Maltose , Maltose/análogos & derivados , Qualidade de Vida , Humanos , Compostos Férricos/efeitos adversos , Compostos Férricos/administração & dosagem , Compostos Férricos/uso terapêutico , Masculino , Maltose/administração & dosagem , Maltose/efeitos adversos , Maltose/uso terapêutico , Feminino , Idoso , Hemoglobinas/metabolismo , Hemoglobinas/análise , Hemorragia Gastrointestinal/tratamento farmacológico , Idoso de 80 Anos ou mais , Método Duplo-Cego , Resultado do Tratamento , Estudos Prospectivos , Hematínicos/efeitos adversos , Hematínicos/administração & dosagem , Hematínicos/uso terapêutico , França , Injeções Intravenosas , Fatores EtáriosAssuntos
Anticorpos Monoclonais Humanizados/efeitos adversos , Antirreumáticos/efeitos adversos , Disfonia/induzido quimicamente , Laringite/induzido quimicamente , Faringite/induzido quimicamente , Adalimumab , Adulto , Candidíase Bucal/diagnóstico , Doença de Crohn/complicações , Doença de Crohn/tratamento farmacológico , Diagnóstico Diferencial , Disfonia/etiologia , Endoscopia do Sistema Digestório , Feminino , Refluxo Gastroesofágico/diagnóstico , Humanos , Hipertrofia , Laringite/complicações , Leucoplasia/diagnóstico , Tonsila Palatina/patologia , Faringite/complicações , Recidiva , Língua , Prega Vocal/patologiaRESUMO
INTRODUCTION: Autoimmune pancreatitis is an idiopathic inflammatory disease that produces pancreatic masses and ductal strictures. This benign disease can be associated with extrapancreatic manifestations including cholangitis, sialadenitis, inflammatory bowel disease or retroperitoneal fibrosis, mediastinal adenopathy, interstitial nephritis mainly due to immunoglobulin G4 (Ig G4), and occasional association with other auto-immune diseases. OBSERVATION: We report a 57-year-old woman who developed thrombotic thrombocytopenic purpura (TTP) and pseudo-tumour's seronegative autoimmune pancreatitis (AIP) type 1. The patient was initially treated with pulse corticosteroids and plasmapheresis; afterwards two cures of i.v. Vincristin with inadequate response and subsequently with four weekly pulses dose of i.v. Rituximab, leading to full remission. CONCLUSION: This case represents the first report of TTP associated to pseudo-tumour's seronegative AIP type 1 successfully treat by Rituximab.
Assuntos
Doenças Autoimunes/etiologia , Pancreatite/etiologia , Púrpura Trombocitopênica Trombótica/complicações , Anti-Inflamatórios/uso terapêutico , Anticorpos Monoclonais Murinos/uso terapêutico , Doenças Autoimunes/tratamento farmacológico , Feminino , Humanos , Pessoa de Meia-Idade , Pancreatite/tratamento farmacológico , RituximabRESUMO
We report the case of a 77 year old man treated with a distal pancreatectomy for rectal metastatic cancer. Diagnosis was made based on increased CEA levels following excision of the rectal tumor discovered during treatment follow up of liver and pulmonary metastases. Eight months after pancreatectomy the patient was asymptomatic and CEA levels were normal. Pancreatic resection for metastatic colonic adenocarcinoma of the pancreas may be considered in selected patients without extrapancreatic disease. Long-term survival or good palliation may be achieved after surgery.