RESUMEN
A 55-year-old man presented with a history of asymptomatic, bilateral, figurate dermatosis consisting of erythematous, annular, linear, andarciform, indurated nodules and plaques on the lateral walls of thorax, flanks, and hypogastrium. His medical history was positive for chronic hepatitis C. Skin biopsy was compatible with the diagnosisof interstitial granulomatous dermatitis. Additionalinvestigation revealed positive rheumatoid factor, antinuclear antibodies, and cryoglobulins. Thepatient started treatment with high-potency topical corticosteroid. After 12 weeks of treatment there was a partial clinical improvement of thedermatosis. Interstitial granulomatous dermatitis exhibits a distinct histopathological pattern with a diverse clinical appearance, which can be associated with autoimmune systemic diseases, neoplasms, several drugs, and infections. Optimal therapy for this condition is yet to be established, but topical corticosteroids have been a mainstay of treatment.
Asunto(s)
Crioglobulinemia/complicaciones , Dermatitis/etiología , Granuloma/etiología , Hepatitis C Crónica/complicaciones , Anticuerpos Antinucleares/sangre , Biopsia , Dermatitis/patología , Granuloma/patología , Humanos , Masculino , Persona de Mediana Edad , Factor Reumatoide/sangre , Piel/patologíaAsunto(s)
Quiste Epidérmico/veterinaria , Enfermedades de los Peces/patología , Enfermedades del Ovario/veterinaria , Animales , Quiste Epidérmico/diagnóstico , Quiste Epidérmico/patología , Femenino , Enfermedades de los Peces/diagnóstico , Inmunohistoquímica , Enfermedades del Ovario/diagnóstico , Enfermedades del Ovario/patologíaRESUMEN
Trials have demonstrated that high-dose escalation followed by autologous transplantation can promote better long-term survival as salvage treatment in malignant lymphomas. The aim of the present nonrandomized clinical trial was to demonstrate the role of high-dose cyclophosphamide (HDCY) in reducing tumor burden and also to determine the effectiveness of HDCY followed by etoposide (VP-16) and methotrexate (MTX) in Hodgkin's disease plus high-dose therapy with peripheral blood progenitor cell (PBPC) transplantation as salvage treatment. From 1998 to 2000, 33 patients with a median age of 33 years (13-65) affected by aggressive non-Hodgkin's lymphoma (NHL) (60.6%) or persistent or relapsed Hodgkin's disease (39.4%) were enrolled and treated using high dose escalation (HDCY + HDVP-16 plus HDMTX in Hodgkin's disease) followed by autologous PBPC transplantation. On an "intention to treat" basis, 33 patients with malignant lymphomas were evaluated. The overall median follow-up was 400 days (40-1233). Thirty-one patients underwent autografting and received a median of 6.19 x 10(6)/kg (1.07-29.3) CD34+ cells. Patients who were chemosensitive to HDCY (N = 22) and patients who were chemoresistant (N = 11) presented an overall survival of 96 and 15%, respectively (P<0.0001). Overall survival was 92% for chemosensitive patients and 0% for patients who were still chemoresistant before transplantation (P<0.0001). Toxicity-related mortality was 12% (four patients), related to HDCY in two cases and to transplant in the other two. HDCY + HDVP-16 plus HDMTX in only Hodgkin's disease followed by autologous PBPC proved to be effective and safe as salvage treatment for chemosensitive patients affected by aggressive NHL and Hodgkin's disease, with acceptable mortality rates related to sequential treatment.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Trasplante de Células Madre Hematopoyéticas , Enfermedad de Hodgkin/tratamiento farmacológico , Linfoma no Hodgkin/tratamiento farmacológico , Terapia Recuperativa , Adolescente , Adulto , Anciano , Ciclofosfamida/administración & dosificación , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Recurrencia , Trasplante AutólogoRESUMEN
We report an unusual case of a 39-years-old male patient, with previous inferior and anterior non Q wave myocardial infarctions, in whom the coronary arteriography showed an arteriovenous fistula between the left anterior descending coronary artery and the pulmonary artery, without any other coronary lesions. We make a revision of this disease and discuss the mechanisms of ischemia.
Asunto(s)
Fístula Arterio-Arterial/diagnóstico , Enfermedad Coronaria/diagnóstico , Infarto del Miocardio/diagnóstico , Arteria Pulmonar , Adulto , Angiografía Coronaria , Ecocardiografía , Electrocardiografía , Humanos , Masculino , Arteria Pulmonar/diagnóstico por imagenRESUMEN
UNLABELLED: The aim of the present study was to evaluate, in patients with hypertrophic cardiomyopathy (HCM): 1. The relation of rate corrected QT interval (QTc) and of QTc interlead variability (QTc dispersion) to complex ventricular arrhythmias (CVA); 2. The effects of amiodarone (Am), beta-blockers (beta B) and calcium antagonists (CA) on QTc and on QTc dispersion. Surface 12 leads ECG was analysed in 55 patients with HCM (39 +/- 12 years, 32 males). All patients were in sinus rhythm, without bundle branch block. Maximum (max), minimum (min) and mean QTc values were considered. QTc dispersion was calculated as: a) max QTc - min QTc (max-min); b) dispersion index (DI) = standard deviation of QTc/mean QTcx100. Patients groups were defined accordingly to: 1--the absence (group A1-35 patients) or the presence (group A2-20 patients) of CVA on 24 hours Holter monitoring; II--absence of cardioactive medication (group B1-20 patients) versus monotherapy with Am (group B3-10 patients), or beta B (group B4-15 patients), or CA (group B5-10 patients). Age, gender, type of HCM (asymmetric versus concentric) and echocardiographic fractional shortening were not different in the studied groups. RESULTS: [table: see text] CONCLUSIONS: 1. Maximum QTc interlead QTc dispersion are increased in patients with HCM that show CVA on Holter monitoring; 2. Amiodarone prolongs QTc but reduces QTc dispersion, while beta-blockers and calcium antagonists do not significantly change neither the duration nor the dispersion of ventricular repolarization.
Asunto(s)
Antiarrítmicos/uso terapéutico , Arritmias Cardíacas/tratamiento farmacológico , Cardiomiopatía Hipertrófica/tratamiento farmacológico , Electrocardiografía/efectos de los fármacos , Antagonistas Adrenérgicos beta/uso terapéutico , Adulto , Anciano , Arritmias Cardíacas/diagnóstico , Bloqueadores de los Canales de Calcio/uso terapéutico , Cardiomiopatía Hipertrófica/diagnóstico , Distribución de Chi-Cuadrado , Electrocardiografía/métodos , Electrocardiografía/estadística & datos numéricos , Femenino , Ventrículos Cardíacos , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
The option for revascularization and the choice of intervention in isolated left anterior descending artery disease may be controversial. We decided to study retrospectively a group of revascularized patients (PTCA or surgery), with previous isolated LAD disease, to evaluate the angiographic features of LAD lesion, its contribution to the persistence of symptoms after revascularization and also to compare the occurrence of cardiac events in the two subgroups (PTCA and surgery). We studied 87 patients (mean age 57 +/- 10 years) submitted to myocardial revascularization (68 PTCA; 19 surgery), whose clinical evolution was followed for a mean period of 49 +/- 10 months (cardiac events: death, myocardial infarction, angina, heart failure, PTCA, surgery). We evaluated in cineangiography angiographic features of LAD lesions (degree of stenosis, lesion length and diameter, ectasia, luminal irregularity, ulcerated plaque, eccentricity, thrombus, calcification, type of lesion). On comparing angiographic features, we noted coronary lesions were longer in operated patients (p < 0.05) and a tendency for more complex lesions in this group (p = 0.08). After revascularization, 65% of PTCA patients and 26% of operated patients maintained angina (p < 0.01). The frequency of events was significantly higher in patients submitted to PTCA (84%) due to the greater occurrence of angina (65%). Sixteen percent PTCA were redilated and 6% operated whereas 11% of the surgical group were reoperated, without statistical difference regarding reintervention between the two groups. In the PTCA group, the greater frequency of angina and the necessity of a new PTCA could reflect restenosis. The disappearance of angina in operated patients may reflect probable patency of coronary bypass.
Asunto(s)
Angioplastia Coronaria con Balón , Puente de Arteria Coronaria , Enfermedad Coronaria/cirugía , Anciano , Angiocardiografía , Cineangiografía , Vasos Coronarios/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: Menopause is associated with a decrease in fat-free mass and an increase in fat mass. Sarcopenic obesity is more strongly associated with physical limitations than either obesity or sarcopenia and their effect in plantar pressure is not known. Consequently, the scope of the present study was to examine the effect of obesity and sarcopenic obesity on plantar pressure of postmenopausal women, during walking. METHODS: Body composition and biomechanics parameters of plantar pressure were assessed in 239 postmenopausal women. FINDINGS: Compared to non-obese and non-sarcopenic women, obese postmenopausal women have higher peak pressure in the metatarsal areas 1, 4, 5, midfoot and lateral heel and higher absolute impulses in all metatarsal and heel areas. On the other hand, sarcopenic obese postmenopausal women presented higher peak pressure and absolute impulses under all metatarsal areas, midfoot and heels. When the absolute values of maximal peak pressures and absolute impulses were normalised to body mass, pressure increases were only perceived for midfoot. INTERPRETATION: The pressure increase found in different foot areas of obese and particularly in sarcopenic obese could cause discomfort and pain in the foot. Sarcopenic obese postmenopausal women also present a higher loading during the stance phase comparing with non-sarcopenic non-obese, fact that might limit their basic daily activity tasks, such as walking.
Asunto(s)
Pie/fisiología , Obesidad/fisiopatología , Posmenopausia , Sarcopenia/fisiopatología , Caminata/fisiología , Tejido Adiposo/fisiopatología , Análisis de Varianza , Fenómenos Biomecánicos , Composición Corporal , Impedancia Eléctrica , Femenino , Humanos , Persona de Mediana Edad , Músculo Esquelético/fisiología , Presión , Estadísticas no ParamétricasAsunto(s)
Angina de Pecho/epidemiología , Angiografía Coronaria , Enfermedad Coronaria/diagnóstico por imagen , Revascularización Miocárdica , Complicaciones Posoperatorias/epidemiología , Anciano , Enfermedad Coronaria/complicaciones , Enfermedad Coronaria/terapia , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Revascularización Miocárdica/métodos , Revascularización Miocárdica/estadística & datos numéricos , Recurrencia , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Very few data are available on the comparison of infectious complications in peripheral blood stem cell transplantation (PBSCT) and bone marrow transplant (BMT). The objective of this study was to evaluate the severity and frequency of infectious complications in patients randomized to receive PBSCT or BMT. We retrospectively reviewed the charts of all patients included in a randomized clinical trial comparing PBSCT (27 patients) and BMT (29 patients). We analyzed two periods: pre-engraftment and post-engraftment. In the pre-engraftment period, we compared the two groups with respect to the duration of neutropenia, antibiotic use and hospitalization, and documentation of infection. In the post-engraftment period, we analyzed the occurrence and severity of graft-versus-host disease (GVHD), duration of cyclosporine, corticosteroids, antibiotic, antiviral and antifungal prophylaxis, number of episodes of infection, and death rates. Patients receiving PBSCT had shorter duration of neutropenia, but there were no differences in the incidence of infections or duration of antibiotic therapy. Patients receiving PBSCT had a higher incidence of extensive chronic GVHD (65% vs. 39%, P=0.08), longer duration of cyclosporine use (risk ratio [RR] 1.97), corticosteroids (RR 1.66), antibacterial (RR 2.60), antifungal (RR 2.50), anti-Pneumocystis carinii (RR 2.06) and anti-cytomegalovirus (RR 1.44) prophylaxis, and more infectious episodes (3.65 vs. 2.32 per 1000 days at risk, RR 1.57). There were no differences in death rates. Multivariate analysis identified the use of steroids as the most significant variable associated with infectious episodes. PBSCT was associated with more infections in the post-engraftment period.
Asunto(s)
Trasplante de Médula Ósea/efectos adversos , Infecciones/etiología , Trasplante de Células Madre de Sangre Periférica/efectos adversos , Adolescente , Adulto , Niño , Femenino , Enfermedad Injerto contra Huésped/etiología , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Trasplante HomólogoRESUMEN
O líquen estriado é uma dermatose inflamatória auto-limitada, idiopática, comum na infância e raro no adulto. Manifesta-se por pápulas violáceas, dedistribuição linear, limitadas habitualmente ao membro inferior. Apresenta-se o caso de um homem de 30 anos, caucasiano, observado por dermatose pruriginosa com 14 dias de evolução, caracterizado por erupção papulosa de distribuição linear ao longo da nádega e membro inferior direito. O exame histológico revelou líquen estriado. Fez tratamento comcorticoide tópico, tendo-se verificado resolução completa das lesõe
Lichen striatus is an uncommon inflammatory skin eruption of unknown etiology, being frequent in childhood and rare in the adult. The main manifestation are violaceous papules with linear distribution, generally limited to the lower limb. We present a case of a Caucasian male patient, aged 30, presented with a 14-days history of itching dermatosis characterized by papular eruption linearly distributed along the buttock and right lower limb. Histological examination revealed lichen striatus. He received topical steroids, with complete resolution of the lesions (AU)
Asunto(s)
Humanos , Masculino , Adulto , Erupciones Liquenoides/diagnóstico , Enfermedades Cutáneas Papuloescamosas/diagnóstico , Corticoesteroides/uso terapéuticoAsunto(s)
Frutas , Obstrucción Intestinal , Síndromes Posgastrectomía , Adulto , Femenino , Humanos , Intestino Delgado , Masculino , Persona de Mediana EdadRESUMEN
Trials have demonstrated that high-dose escalation followed by autologous transplantation can promote better long-term survival as salvage treatment in malignant lymphomas. The aim of the present nonrandomized clinical trial was to demonstrate the role of high-dose cyclophosphamide (HDCY) in reducing tumor burden and also to determine the effectiveness of HDCY followed by etoposide (VP-16) and methotrexate (MTX) in Hodgkin's disease plus high-dose therapy with peripheral blood progenitor cell (PBPC) transplantation as salvage treatment. From 1998 to 2000, 33 patients with a median age of 33 years (13-65) affected by aggressive non-Hodgkin's lymphoma (NHL) (60.6 percent) or persistent or relapsed Hodgkin's disease (39.4 percent) were enrolled and treated using high dose escalation (HDCY + HDVP-16 plus HDMTX in Hodgkin's disease) followed by autologous PBPC transplantation. On an "intention to treat" basis, 33 patients with malignant lymphomas were evaluated. The overall median follow-up was 400 days (40-1233). Thirty-one patients underwent autografting and received a median of 6.19 x 10(6)/kg (1.07-29.3) CD34+ cells. Patients who were chemosensitive to HDCY (N = 22) and patients who were chemoresistant (N = 11) presented an overall survival of 96 and 15 percent, respectively (P<0.0001). Overall survival was 92 percent for chemosensitive patients and 0 percent for patients who were still chemoresistant before transplantation (P<0.0001). Toxicity-related mortality was 12 percent (four patients), related to HDCY in two cases and to transplant in the other two. HDCY + HDVP-16 plus HDMTX in only Hodgkin's disease followed by autologous PBPC proved to be effective and safe as salvage treatment for chemosensitive patients affected by aggressive NHL and Hodgkin's disease, with acceptable mortality rates related to sequential treatment