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1.
Front Immunol ; 8: 111, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28243232

RESUMEN

INTRODUCTION: Microscopic polyangiitis (MPA) is one of the causes of the pulmonary-renal syndrome associated with elevated non-specific markers of inflammation and antineutrophil cytoplasmic autoantibody (ANCA) positivity in 50-75%. De novo occurrence of the disease in patients on chronic hemodialysis (HD) has not been described. CASE PRESENTATION: We presented patient who developed MPO-ANCA-associated MPA with lung and musculoskeletal involvement after 4 years on regular HD due to bilateral nephrectomy. After excluding the other causes of MPO-ANCA positivity, diagnosis was confirmed even without renal biopsy. Patient received standard immunosuppression therapy and he is still in remission after 27 months. CONCLUSION: The onset of immune-mediated disease could be observed even after introduction of renal replacement therapy, which may be a diagnostic problem. Early recognition and traditional immunosuppressive regiment may provide successful outcome.

2.
Med Pregl ; 66(3-4): 185-8, 2013.
Artículo en Serbio | MEDLINE | ID: mdl-23653999

RESUMEN

INTRODUCTION: Encapsulating peritoneal sclerosis is a possible, serious, life-threatening complication of peritoneal dialysis therapy. CASE 1: A female patient was hospitalized for clinical signs of encapsulating peritoneal sclerosis in the inflammatory stage with fever, intestinal occlusion, positive inflammatory syndrome (Le 20 K/microL,.CRP 217 mg/L) and highly turbid peritoneal effluent (Le 3.3 K/microL) with sterile culture. Risk factors for the development of encapsulating peritoneal sclerosis were nine previous episodes of peritonitis and long-term use of high osmolality dialysis solution. The diagnosis was confirmed by computed tomography findings. During the course of therapy, the patient had a good response to Tamoxifen and prednisone. Although encapsulating peritoneal sclerosis was well controlled, the patient died after eight months due to tuberculosis of the lungs with signs of heart failure. CASE 2: The clinical presentation also corresponded to encapsulating peritoneal sclerosis in the inflammation stage, and the identified risk factors were the long-term treatment with peritoneal dialysis (100 months) and an episode of peritonitis with tunnel infection. The first sign of encapsulating peritoneal sclerosis was hemorrhagic ascites, which was observed when the peritoneal catheter was being replaced. The diagnosis was confirmed by computed tomography findings. He was treated with Tamoxifen (10 mg 2x2 tbl). Except anemia, poor appetite and fatigue, the patient denied any other symptoms after 14 months of therapy. CONCLUSION: During peritoneal dialysis, one should always think about encapsulating peritoneal sclerosis which is not always easy to recognize. Timely diagnosis with the use of corticosteroids and Tamoxifen in the first and Tamoxifen in the second case were effective in controlling and preventing dise- ase progression.


Asunto(s)
Fibrosis Peritoneal/diagnóstico , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fibrosis Peritoneal/terapia
3.
Vojnosanit Pregl ; 69(2): 209-13, 2012 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-22500379

RESUMEN

INTRODUCTION: Multiple myeloma (MM) is characterized by the presence of neoplastic proliferating plasma cells. The tumor is generally restricted to the bone marrow. The most common complications include renal insufficiency, hypercalcemia, anemia and reccurent infections. The spectrum of MM neurological complications is diverse, however, involvement of MM in the cerebrospinal fluid (CSF) and leptomeningeal infiltration are rare considered. In about 1% of the cases, the disease affects the central nervous system (CNS) and presents itself in the form of localized intraparenchymal lesions, solitary cerebral plasmocytoma or CNS myelomatosis (LMM). CASE REPORT: We presented the clinical course of a 55-year-old man with MM and LMM proven by malignant plasma cells in the CSF, hospitalized with the pain in the thoracic spine. His medical history was uneventful. There had been no evidence of mental or neurological impairment prior to the seizures. Physical examination showed no abnormalities. After a complete staging, the diagnosis of MM type biclonal gammopathia IgG lambda and free lambda light chains in the stage III was confirmed. The treatment started with systemic chemotherapy (with vincristine, doxorubicin plus high-dose dexamethasone--VAD protocol), radiotherapy and bisphosphonate. The patient developed weakness, nausea, febrility, dispnea, bilateral bronchopneumonia, acute renal insufficiency, confusions, headaches and soon thereafter sensomotor aphasias and right hemiparesis. The patient was treated with the adequate therapy including one hemodyalisis. His neurological status was deteriorated, so Multislice Computed Tomography (MSCT) of the head was performed and the findings were normal. Analysis of CSF showed pleocytosis, 26 elements/mL and increased concentrations of proteins. Cytological analysis revealed an increased number of plasma cells (29%). Electrophoretic analysis of proteins disclosed the existance of monoclonal components in the serum, urine and CSF. Immunofixation electrophoretic and quantitative nephelometric tests confirmed Biclonal multiple myeloma of IgG lambda and light chain lambda isotypes. Analysis of neurothropic viruses with ELISA methods was negative. Once the presence of LMM was confirmed, the patient received intrathecal chemotherapy with methotrexate, cytosine arabinoside, dexamethasone three times a week, and systemic high doses of dexamethasone iv like a single agent without craniospinale irradiations. Despite the treatment, the patient died one month after the diagnosis. Autopsy was not performed. CONCLUSION: Presented patient, as well as most other patients with MM progressing to CN Sinfiltration was in the stage III. In addition to the detailed clinical examination, and all investigations required for MM diagnosis and staging of the disease, we introduced the additional CSF examination and calculation of kappa lambda ratio, that helped us make an early diagnosis and prognosis of MM with LMM. Although LMM had a low prevalence, it could be more frequent than expected especially in patients with high risk. CSF examination with positive plasma cells and abnormal morphology remains the hallmark for diag nosing CNS infiltration.


Asunto(s)
Neoplasias Meníngeas/diagnóstico , Mieloma Múltiple/diagnóstico , Humanos , Masculino , Neoplasias Meníngeas/secundario , Persona de Mediana Edad , Mieloma Múltiple/patología
4.
Med Pregl ; 64(1-2): 55-60, 2011.
Artículo en Serbio | MEDLINE | ID: mdl-21548270

RESUMEN

INTRODUCTION: According to the convincing evidence, a decline in mortality rate has been achieved with beta-blockers in patients with an acute myocardial infarction and in post-infarction follow-up. In fact, there has been a clear reduction of sudden coronary death. The necessary condition for the efficiency of beta-blockers is an early use. They are also a medication of choice for angina after an infarction. The objective of this work was to evaluate the use of beta-blockers after a myocardial infarction in various clinical states and to eliminate doubts concerning their prescription. BETA BLOCKERS: Even in conditions considered contraindications for administration of beta blockers such as old age, diabetes, non-Q-wave myocardial infarction, peripheral vascular disease, arterial disease, heart insufficiency; ventricular arrhythmias, renal disease, chronic obstructive pulmonary disease, asthma and depression, patients benefit from beta blockers when they are given along with a right choice of the medication and a regular followup of the patient. Preference is given to cardioselective beta blockers in patients with diabetes or lung disease. Beta-blockers do not cause long-term lipid alterations. Therefore, the matter of clinically significant alterations of lipids or blood glucose levels should not need further consideration as a problem of the treatment of diabetics. DISCUSSION AND CONCLUSION: Investigations have proved that the use of beta-blockers reduces the development of cerebrovascular accidents, heart insufficiency and hypertension. Despite strong arguments and numerous recommendations, beta-blockers have not been accepted to a sufficient extent as an integral part of treatment of acute coronary syndrome and related diseases, to the detriment of many lost lives and in spite of favourable pharmaco-economic aspect.


Asunto(s)
Antagonistas Adrenérgicos beta/uso terapéutico , Infarto del Miocardio/complicaciones , Antagonistas Adrenérgicos beta/farmacología , Humanos , Infarto del Miocardio/tratamiento farmacológico
5.
Med Pregl ; 63(9-10): 662-7, 2010.
Artículo en Serbio | MEDLINE | ID: mdl-21446096

RESUMEN

INTRODUCTION: Biochemical cardiac markers play an important role in diagnosing and treatment of patients with acute coronary syndrome. Markers of myocytes necrosis, troponins, have been recommended for diagnosing and treatment of myocardial infarction with ST segment elevation, myocardial infarction without ST segment elevation and unstable angina pectoris. Two more groups of cardiac markers have been gaining in importance: inflammation markers and cardiac function markers.The objective of this study was the risk stratification and identification of patients with coronary syndrome, who could take advantage from evolutionary, changes of serum cardiac markers. MATERIAL AND METHODS: The method of the analysis sums up the results of independently published studies and literature and data base review, such as MEDLINE, PubMed and KOBSON. INFLAMMATION MARKERS: Systemic and localized inflammation plays an important role in the development of acute coronary syndrome. The following inflammation markers are available: C-reactive protein. IL-2, sedimentation of erythrocytes and fibrinogen; as well as myocardial necrosis markers: creatine kinase MB, myoglobin and cardiac troponins. CONCLUSION: Tropinins are ideal markers which enable early detection of patients with acute coronary syndrome, whereas inflammation markers are helpful in diagnosing and assessing the severity of inflammation.


Asunto(s)
Síndrome Coronario Agudo/diagnóstico , Biomarcadores/sangre , Miocardio/patología , Sedimentación Sanguínea , Proteína C-Reactiva/análisis , Creatina Quinasa/sangre , Fibrinógeno/análisis , Humanos , Inflamación , Interleucina-6/sangre , Necrosis , Valor Predictivo de las Pruebas , Factores de Riesgo , Troponina/sangre
6.
Med Pregl ; 62(9-10): 450-5, 2009.
Artículo en Serbio | MEDLINE | ID: mdl-20391741

RESUMEN

Convincing evidence of the decline of mortality has been achieved with beta-blockers in patients with an acute myocardial infarction and in post-infarction follow-up. The beta-blockers are also the most efficient antianginal medications for the decrease of ischemia in outpatients. They are highly efficient as a monotherapy for angina and are also a medication of choice for angina after the coronary. The objective of this work was an estimate of the use of beta-blockers in secondary prevention of the ischemic heart disease and eliminating doubts concerning their prescription. The method of the analysis sums up the results of a twenty-five-year study on of the outcome of the treatment with beta-blockers in secondary prevention of the ischemic heart disease. The method of the work implies an examination of the professional literature and the data-bases, such as MEDLINE, Pub-Med and KOBSON. The first studies concerned non-selective beta-blockers, used orally. The following studies concerned cardioselective beta-blockers, metoprolol and atenolol. Several studies followed also the effect of beta-blockers and heparin, or beta-blockers and antagonists of calcium towards placebo, in patients with an unstable angina pectoris. Beta-blockers are an essential drug in secondary prevention of the myocardial infarction and in chronic heart failure. The necessary condition for the efficiency of beta-blockers is an early use. Beta-blockers should be given within 12 hours after the appearance of pain. The continuation of the therapy with beta-blockers after the acute phase is considered to be important in the decrease of the infarction zone expansion. Prophylactic use of beta-blockers after the coronary has an excellent effect, above all in patients with a minor, uncomplicated coronary. Though certain groups of beta-blockers have some special characteristics, when it comes to the treatment of angina pectoris, all beta-blockers are efficient. Generally, patients react well to them. Preference is given to cardioselective remedies, in patients with diabetes or lung disease. Exhaustive controlled clinical studies affirm beta-blockers as drugs that reduce mortality in secondary prevention of the ischemic heart disease.


Asunto(s)
Antagonistas Adrenérgicos beta/administración & dosificación , Isquemia Miocárdica/prevención & control , Prevención Secundaria , Angina de Pecho/tratamiento farmacológico , Humanos , Infarto del Miocardio/prevención & control
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