Assuntos
COVID-19/terapia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Pneumonia/terapia , Traqueostomia/métodos , COVID-19/complicações , Sedação Consciente , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Segurança do Paciente , Equipamento de Proteção Individual , Pneumonia/etiologia , Tempo para o Tratamento , Traqueostomia/efeitos adversos , VasoconstritoresRESUMO
We describe the case of a 44-year-old man who developed sub-acute cerebellar ataxia due to AIDS-related progressive multifocal leucoencephalopathy (PML) caused by JC virus. Following treatment with highly active anti-retroviral therapy (HAART) and cidofovir, he made a marked neurological improvement and is leading an independent life 18 months after the diagnosis of PML. Early recognition of AIDS-related PML and treatment with HAART improves prognosis. Cidofovir, an inhibitor of viral DNA polymerase, appears to have an additive beneficial effect and should be considered especially in patients who fail to improve despite treatment with HAART and in patients who have a high JC virus load in CSF.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Antivirais/uso terapêutico , Citosina/análogos & derivados , Citosina/uso terapêutico , Vírus JC/isolamento & purificação , Leucoencefalopatia Multifocal Progressiva/tratamento farmacológico , Organofosfonatos , Compostos Organofosforados/uso terapêutico , Infecções Oportunistas Relacionadas com a AIDS/virologia , Adulto , Terapia Antirretroviral de Alta Atividade , Líquido Cefalorraquidiano/virologia , Cidofovir , Humanos , Leucoencefalopatia Multifocal Progressiva/virologia , Masculino , Prognóstico , Taxa de Sobrevida , Resultado do TratamentoRESUMO
In a prospective randomized multi-centre study, the mortality following internal fixation surgery for fracture of the upper femur was investigated in 538 elderly patients allocated to receive subarachnoid blockade or general (narcotic-relaxant) anaesthesia. The 28-day mortality was 6.6% with subarachnoid, and 5.9% with general, anaesthesia. The difference was not significant (95% confidence limits: -3.5 to +4.8). At 1 year following surgery, the mortality was 20.4%. Increasing age, ischaemic heart disease, cardiac failure, preoperative arrhythmias and poor ASA status were all associated with increases in early and long term mortality. A delay to surgery of more than 24 h from admission was also associated with an increased 28-day mortality. Senile dementia and admission other than from the patient's own home, were factors associated with a poorer long term outcome. From the point of view of mortality, subarachnoid anaesthesia did not appear to confer any advantages over general anaesthesia in non-prosthetic surgery for hip fracture in the elderly.
Assuntos
Anestesia Geral/mortalidade , Raquianestesia/mortalidade , Fraturas do Quadril/cirurgia , Idoso , Idoso de 80 Anos ou mais , Ensaios Clínicos como Assunto , Emergências , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/mortalidade , Estudos Prospectivos , Distribuição AleatóriaRESUMO
Trans-sphenoidal injection of 95 percent dehydrated alcohol into the pituitary fossa was attempted in 10 patients to control pain associated with widely disseminated metastatic cancer. Significant pain relief was obtained in eight patients, some of whom had tumours not recognised as being hormone sensitive. Effects of pituitary destruction were easily managed, and there were few complications. There was no mortality directly attributable to the injection.