RESUMEN
In non-endemic countries, leprosy, or Hansen's disease (HD), remains rare and is often underrecognized. Consequently, the literature is currently lacking in clinical descriptions of leprosy complications in the United States. Immune-mediated inflammatory states known as reactions are common complications of HD. Type 1 reactions are typical of borderline cases and occur in 30% of patients and present as swelling and inflammation of existing skin lesions, neuritis, and nerve dysfunction. Type 2 reactions are systemic events that occur at the lepromatous end of the disease spectrum, and typical symptoms include fever, arthralgias, neuritis, and classic painful erythematous skin nodules known as erythema nodosum leprosum. We report three patients with lepromatous leprosy seen at a U.S. HD clinic with complicated type 2 reactions. The differences in presentations and clinical courses highlight the complexity of the disease and the need for increased awareness of unique manifestations of lepromatous leprosy in non-endemic areas.
Asunto(s)
Antiinflamatorios/uso terapéutico , Eritema Nudoso/complicaciones , Hipersensibilidad/complicaciones , Leprostáticos/uso terapéutico , Lepra Lepromatosa/complicaciones , Neuritis/complicaciones , Adulto , Anciano , Asia Sudoriental/etnología , Bangladesh/etnología , Eritema Nudoso/diagnóstico , Eritema Nudoso/tratamiento farmacológico , Femenino , Georgia/epidemiología , Humanos , Hipersensibilidad/diagnóstico , Hipersensibilidad/tratamiento farmacológico , Lepra Lepromatosa/diagnóstico , Lepra Lepromatosa/tratamiento farmacológico , Masculino , Neuritis/diagnóstico , Neuritis/tratamiento farmacológico , Prednisona/uso terapéutico , Talidomida/uso terapéuticoRESUMEN
This case report describes a man with intractable hiccups probably caused by donepezil. The patient's symptoms were not responsive to commonly used medications for hiccups, but they were improved and completely relieved upon donepezil dose deescalation and discontinuation. We report two occasions in which the discontinuation of donepezil resulted in hiccup resolution and three occasions in which initiation of donepezil was associated with the onset of hiccups. This report contributes to the growing body of literature that describes an association between centrally acting medications and intractable hiccups.
Asunto(s)
Hipo/inducido químicamente , Hipo/diagnóstico , Indanos/efectos adversos , Nootrópicos/efectos adversos , Piperidinas/efectos adversos , Anciano , Donepezilo , Resultado Fatal , Humanos , MasculinoRESUMEN
We review the new technology and methods available for support of intraoperative and intraprocedural imaging in the catheterization laboratory for surgical and interventional catheterization procedures in the treatment of congenital heart disease. The methods reviewed include miniaturized probes and new ways of using them perioperatively for cardiac imaging from transesophageal, substernal, and intracardiac imaging locations. The smaller and more versatile the probes, the better adapted they will be in providing methods to improve the outcomes in babies born with serious forms of congenital heart disease.