ABSTRACT
Two cases of cerebral involvement in Wegener's granulomatosis (WG) are described. The course of the disease in both patients was characterized by sudden onset and fatal outcome, despite maximum immunosuppressive therapy. Cerebral involvement is a rare complication of WG. Over the past two decades, only a small number of case-reports appeared of patients with WG who showed this complication. Since the era of cyclophosphamide therapy, it is commonly assumed that cerebral involvement in WG has no influence on patient survival. However, the two patients described here both died shortly after the occurrence of central neurological symptoms.
Subject(s)
Brain Diseases/etiology , Granulomatosis with Polyangiitis/complications , Aged , Brain/pathology , Brain Diseases/diagnosis , Brain Diseases/mortality , Female , Granulomatosis with Polyangiitis/mortality , Humans , Male , Middle Aged , Vasculitis/diagnosis , Vasculitis/etiology , Vasculitis/mortalityABSTRACT
Several groups have reported that recipients of a simultaneous pancreas-kidney transplantation suffer from more kidney rejection episodes than do recipients of a kidney transplantation (1-6). However, it is not known whether this is interstitial rejection, vascular rejection, or both. In this study, the renal biopsies and transplantectomies of 45 pancreas-kidney and 48 kidney transplant recipients were evaluated for the presence of interstitial and vascular rejection. Furthermore, the influence of OKT3 induction therapy on rejection after pancreas-kidney transplantation was studied. Of the 45 pancreas-kidney recipients. 4 patients did not suffer from rejection during follow-up, 28 suffered only from interstitial rejection, and 13 suffered from vascular (with or without interstitial) rejection, whereas 12, 19, and 14 of the 48 kidney transplant patients had no rejection, interstitial rejection, or vascular (with or without interstitial) rejection, respectively. Three patients with a kidney transplant were treated for rejection although no biopsy was taken. In the pancreas-kidney group, 38 of the total of 149 biopsies and transplantectomies taken contained no rejection, 92 had interstitial rejection, and 19 had vascular rejection. In the kidney group, these values were 13, 41, and 25, respectively, of 79 biopsies and transplantectomies taken (P = 0.002). Five-year renal graft survival was 79% in the kidney group and 60% in the pancreas-kidney group. Renal graft survival rates differed significantly (P = 0.02). Renal graft survival and occurrence of rejection did not reach significance between pancreas-kidney recipients treated with OKT3 induction therapy and pancreas-kidney recipients receiving conventional triple therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Graft Rejection/pathology , Immunosuppressive Agents/therapeutic use , Kidney Transplantation , Muromonab-CD3/therapeutic use , Pancreas Transplantation , Adult , Azathioprine/therapeutic use , Case-Control Studies , Cyclosporine/therapeutic use , Diabetic Nephropathies/complications , Female , Graft Rejection/prevention & control , Graft Survival , Humans , Kidney Failure, Chronic/surgery , Male , Matched-Pair Analysis , Middle Aged , Prednisone/therapeutic useSubject(s)
Mycoses/etiology , Peritoneal Dialysis, Continuous Ambulatory/adverse effects , Peritonitis/etiology , Trichoderma/isolation & purification , Amphotericin B/therapeutic use , Fatal Outcome , Humans , Male , Middle Aged , Mycoses/drug therapy , Mycoses/pathology , Peritoneum/microbiology , Peritoneum/pathology , Peritonitis/drug therapy , Peritonitis/pathologySubject(s)
Acyclovir/adverse effects , Brain Diseases/chemically induced , Acyclovir/blood , Acyclovir/cerebrospinal fluid , Adult , Brain Diseases/diagnosis , Brain Diseases/metabolism , Diagnosis, Differential , Herpes Zoster/complications , Herpes Zoster/diagnosis , Herpes Zoster/drug therapy , Humans , Kidney Failure, Chronic/complications , Male , Meningoencephalitis/complications , Meningoencephalitis/diagnosis , Meningoencephalitis/drug therapyABSTRACT
OBJECTIVE: To determine the complication rate of a totally implantable central venous access device [Port-A-Cath (PAC)] in AIDS patients, used mainly for home infusion therapy. DESIGN: A retrospective study. SETTING: The study was performed at the AIDS Unit of the Department of Internal Medicine, Academic Medical Centre, University of Amsterdam, The Netherlands. PATIENTS, PARTICIPANTS: Forty-seven consecutive AIDS patients who had a PAC device implanted to receive either drug maintenance therapy (42 patients) or total parenteral nutrition (TPN; five patients). RESULTS: Fifty-one devices were implanted between June 1987 and October 1990. Mean puncture frequency was five times per week. The total number of catheter days was 9069. The total complication rate was 0.43 per 100 catheter days. Complications occurred in 17 (36%) patients: three implantation-related bleedings (0.03 per 100 catheter days), three puncture-related bleedings (0.03 per 100), two infections (0.17 per 100), seven occlusions (0.08 per 100), four flow problems (0.04 per 100) and one central vein thrombosis (0.011 per 100). Imminent skin necrosis at puncture site occurred in one case (0.01 per 100) and drug extravasation in two cases (0.02 per 100). Eight devices (17%) had to be removed. Primary septicaemias were resolved using antibiotics in three out of six patients in whom they occurred. Occlusions were almost exclusively caused by TPN. CONCLUSION: A totally implantable venous access device appears to be safe and convenient in (home) infusion therapy in AIDS patients, without risk of additional infection.
