RESUMEN
We describe a patient with refractory systemic lupus erythematosus (SLE) who demonstrated complete resolution of all SLE symptoms. He was subsequently found to be infected with the human immunodeficiency virus (HIV-1) and had marked depletion of peripheral CD4 positive T lymphocytes. In addition, while his SLE remained completely inactive, the course of HIV was rapidly progressive, suggesting that retroviral replication may have been enhanced by the underlying state of T cell transactivation characteristic of SLE.
Asunto(s)
Infecciones por VIH/inmunología , VIH-1 , Tolerancia Inmunológica/inmunología , Lupus Eritematoso Sistémico/inmunología , Lupus Eritematoso Sistémico/virología , Adulto , Progresión de la Enfermedad , Humanos , Masculino , Linfocitos T/fisiología , Linfocitos T/virologíaAsunto(s)
Mamoplastia , Prótesis e Implantes/efectos adversos , Enfermedades Reumáticas/etiología , Siliconas/efectos adversos , Animales , Enfermedades del Tejido Conjuntivo/epidemiología , Enfermedades del Tejido Conjuntivo/etiología , Femenino , Humanos , Sistema Inmunológico/efectos de los fármacos , Incidencia , Factores de RiesgoAsunto(s)
Anticuerpos Anticardiolipina/análisis , Aspirina/uso terapéutico , Trastornos de la Coagulación Sanguínea/tratamiento farmacológico , Trastornos de la Coagulación Sanguínea/inmunología , Prednisona/uso terapéutico , Circulación Renal , Trombocitopenia/tratamiento farmacológico , Adolescente , Humanos , Masculino , Warfarina/uso terapéuticoRESUMEN
This article describes the development and implementation of a six-month pilot clinical ethics program at Saint Thomas Hospital (Nashville, Tenn). To assess the impact of this program, baseline data were gathered from a self-selected sample of critical and special care unit nurses and physicians about the "most troublesome" ethical dilemmas in their practices. Nurses and physicians reported facing similar dilemmas in practice. Nurses believed that chaplains and peers were most "beneficial" in resolving their "most troublesome" cases; physicians did not deem one particular individual or service to be of any greater benefit than any other in dilemma resolution. Nurses and physicians indicated that in many cases patients and families did not appear involved in the process. In a posttest survey following the pilot program, nurses rated the beneficial role of chaplains somewhat lower and agreed that the clinical ethics service was beneficial. As with the pretest sample, the posttest nurses evaluated the role of the attending physician as "detrimental" to resolving their ethical conflicts. In the posttest, physicians ranked the role of the clinical ethicist as comparable to that of chaplains and social workers.
Asunto(s)
Eticistas , Comités de Ética/normas , Ética Clínica , Hospitales Comunitarios/normas , Evaluación de Programas y Proyectos de Salud/métodos , Derivación y Consulta/normas , Actitud del Personal de Salud , Discusiones Bioéticas , Recolección de Datos , Comités de Ética/organización & administración , Comités de Ética/estadística & datos numéricos , Comités de Ética Clínica , Consultoría Ética , Ética Institucional , Hospitales con más de 500 Camas , Hospitales Comunitarios/organización & administración , Comunicación Interdisciplinaria , Proyectos Piloto , Desarrollo de Personal , Tennessee , Privación de TratamientoAsunto(s)
Enfermedades del Sistema Nervioso Central/diagnóstico , Hemangioendotelioma/diagnóstico , Lupus Eritematoso Sistémico/diagnóstico , Linfoma/diagnóstico , Anciano , Enfermedades del Sistema Nervioso Central/etiología , Diagnóstico Diferencial , Femenino , Humanos , Lupus Eritematoso Sistémico/complicacionesRESUMEN
A funny thing has happened on our way to the elimination of rheumatic fever from the United States. It is quite clear that, at least in some areas, rheumatic fever has made a dramatic resurgence. Although all the factors accounting for this are not clearly understood, there are several obvious conclusions that must be drawn: 1. Rheumatic fever is no longer the province of the poor and overcrowded. 2. Clinical manifestations, as embodied in the Jones criteria, may have changed somewhat over the years. 3. New insights into the genetics and immunology of rheumatic fever may lead to a vaccine and/or effective therapy in the future. 4. Rheumatic fever will continue to occur unless and until we resume an aggressive approach to the treatment and prophylaxis of pharyngitis, probably utilizing benzathine penicillin as our primary drug.
Asunto(s)
Brotes de Enfermedades , Fiebre Reumática/epidemiología , Enfermedad Aguda , Adolescente , Adulto , Artritis Infecciosa/etiología , Niño , Preescolar , Humanos , Inmunogenética , Penicilina G Benzatina/farmacología , Fiebre Reumática/etiología , Fiebre Reumática/prevención & control , Estados Unidos/epidemiologíaRESUMEN
Giant cell (temporal) arteritis is a serious inflammatory condition that can lead to blindness, stroke, or other adverse sequelae if not properly treated. An elevated erythrocyte sedimentation rate has traditionally been emphasized as a criterion for making this diagnosis. Delays in diagnosis and unnecessary testing may occur when a patient presents with a normal erythrocyte sedimentation rate and a clinical history consistent with this condition. We describe a patient with giant cell arteritis who presented with a normal erythrocyte sedimentation rate and who subsequently developed devastating central nervous system complications.
Asunto(s)
Arteritis de Células Gigantes/diagnóstico , Anciano , Sedimentación Sanguínea , Encefalopatías/etiología , Diagnóstico Diferencial , Femenino , Arteritis de Células Gigantes/sangre , Arteritis de Células Gigantes/complicaciones , Humanos , Enfermedades del Sistema Nervioso/etiología , Neuritis Óptica/diagnósticoRESUMEN
Three patients with severe, deforming, and long-standing rheumatoid arthritis developed pure red cell aplasia that did not remit after withdrawal of medications, ran a chronic course, and in two patients remitted only after cytotoxic immunosuppressive treatment. An IgG inhibitor of autologous erythroid colony-forming and burst-forming unit growth in vitro was found in the serum of one patient. This specific erythropoietic inhibitor persisted in lower titer in the patient's serum even after an azathioprine-induced remission of pure red cell aplasia, indicating the possible need for maintenance immunosuppressive therapy. Chronic pure red cell aplasia may be another extra-articular manifestation of rheumatoid arthritis and should be considered when severe anemia develops in the absence of blood loss or hemolysis.
Asunto(s)
Anemia Aplásica/etiología , Artritis Reumatoide/complicaciones , Anciano , Anemia Aplásica/inmunología , Artritis Reumatoide/sangre , Artritis Reumatoide/inmunología , Examen de la Médula Ósea , Ensayo de Unidades Formadoras de Colonias , Eritropoyesis , Femenino , Humanos , Inmunoglobulina G , Persona de Mediana EdadRESUMEN
Thirteen reports of patients who developed polymyositis or dermatomyositis during treatment with D-penicillamine are reviewed and a fourteenth case is described. Twelve of the fourteen patients recovered after D-penicillamine was withdrawn; two patients died from cardiac involvement. Proximal muscle weakness was present in 13 patients and dermatomyositis in 4 patients. Dysphagia was the presenting symptom in 6 patients. Although D-penicillamine is useful in the management of rheumatoid arthritis, this drug should be used with caution and patients monitored closely for evidence of polymyositis or dermatomyositis.