Asunto(s)
Dolor en el Flanco/inducido químicamente , Hematoma/inducido químicamente , Enfermedades Renales/inducido químicamente , Linfoma de Células del Manto/tratamiento farmacológico , Pirazoles/uso terapéutico , Pirimidinas/uso terapéutico , Enfermedad Aguda , Adenina/análogos & derivados , Femenino , Dolor en el Flanco/diagnóstico , Dolor en el Flanco/etiología , Hematoma/complicaciones , Hematoma/diagnóstico , Humanos , Enfermedades Renales/complicaciones , Enfermedades Renales/diagnóstico , Persona de Mediana Edad , Perinefritis/inducido químicamente , Perinefritis/complicaciones , Perinefritis/diagnóstico , Piperidinas , Trombocitopenia/inducido químicamente , Trombocitopenia/complicaciones , Trombocitopenia/diagnósticoRESUMEN
Varenicline (Champix®, Chantix®) is a partial agonist of the α4ß2 nicotinic acetylcholine receptor (nAChR) and a full agonist of the α7 nAChR. It has been used for smoking cessation since 2006. Varenicline has been associated with adverse cardiovascular (CV) events, including myocardial infarction, which may be caused by activation of the α7 nAChR receptor that in turn stimulates parasympathetic output from the brainstem to the heart, release of catecholamines, and has a prothrombotic effect. However, among the adverse CV events, the issue related to the varenicline-induced pulmonary thromboembolism (PTE) has not being addressed. We report a case of PTE with pulmonary infarction presenting as right flank pain that resulted from the use of varenicline (the total score of adverse drug reaction probability scale, 6; probable association between varenicline and pulmonary PTE) in a patient without underlying CV disease and in whom low probability of PTE (Wells score was zero) was identified.
Asunto(s)
Dolor en el Flanco/inducido químicamente , Infarto/inducido químicamente , Agonistas Nicotínicos/efectos adversos , Embolia Pulmonar/diagnóstico , Cese del Hábito de Fumar , Vareniclina/efectos adversos , Heparina/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Oxígeno/uso terapéutico , Embolia Pulmonar/inducido químicamente , Embolia Pulmonar/terapia , Receptores Nicotínicos , Resultado del TratamientoAsunto(s)
Dolor en el Flanco/inducido químicamente , Inhibidores de la Proteasa del VIH/efectos adversos , Lopinavir/efectos adversos , Lesiones por Pinchazo de Aguja/virología , Nefritis Intersticial/inducido químicamente , Enfermedades Profesionales/tratamiento farmacológico , Ritonavir/efectos adversos , Dolor en el Flanco/etiología , Inhibidores de la Proteasa del VIH/administración & dosificación , Humanos , Lopinavir/administración & dosificación , Masculino , Persona de Mediana Edad , Nefritis Intersticial/etiología , Enfermedades Profesionales/virología , Profilaxis Posexposición , Ritonavir/administración & dosificación , CirujanosRESUMEN
PURPOSE: To evaluate the effectiveness and safety of single dose 0.2 % povidone iodine renal pelvic instillation sclerotherapy for the treatment for chyluria. METHODS: In a prospective study from August 2010 till July 2013, 41 patients presenting with milky urine were included. Apart from ether test, the presence of lymphocytes in urine and urine triglycerides levels were also done to confirm chyluria. On a day care basis under local anesthesia, 5F open-ended ureteric catheter was introduced in the ureteric orifice of affected side. Freshly prepared 7-10 ml of 0.2 % povidone iodine solution was instilled with the patient in Trendelenburg position. RESULTS: Total of 41 patients were enrolled (27 males and 14 females; mean age 40 years, SD 8.9, range 19-61) with a mean follow-up of 20 months. Immediate clearance was seen in all patients and recurrence in 7 (17 %). Mean disease-free duration was 18 months. Two patients had moderate to severe flank pain. CONCLUSION: Single dose 0.2 % povidone iodine sclerotherapy is safe and effective treatment for chyluria. As it offers treatment on a day care basis, continuous ureteral and urethral catheterizations can be avoided.
Asunto(s)
Antiinfecciosos Locales/administración & dosificación , Quilo , Povidona Yodada/administración & dosificación , Escleroterapia/métodos , Adulto , Antiinfecciosos Locales/efectos adversos , Supervivencia sin Enfermedad , Femenino , Dolor en el Flanco/inducido químicamente , Humanos , Instilación de Medicamentos , Pelvis Renal , Masculino , Persona de Mediana Edad , Povidona Yodada/efectos adversos , Estudios Prospectivos , Recurrencia , Escleroterapia/efectos adversos , Orina , Adulto JovenRESUMEN
Warfarin is a widely used anticoagulant. Interindividual differences in drug response, a narrow therapeutic range and the risk of bleeding render warfarin difficult to use clinically. An 18-year-old woman with antiphospholipid syndrome received long-term warfarin therapy for a recurrent deep vein thrombosis. Six years later, she developed right flank pain. We diagnosed intrahepatic and subgaleal hemorrhages secondary to anticoagulation therapy. After stopping oral anticoagulation, a follow-up computed tomography showed improvement in the hemorrhage. After restarting warfarin because of a recurrent thrombosis, the intrahepatic hemorrhage recurred. We decided to start clopidogrel and hydroxychloroquine instead of warfarin. The patient has not developed further recurrent thrombotic or bleeding episodes. Intrahepatic hemorrhage is a very rare complication of warfarin, and our patient experienced intrahepatic and subgaleal hemorrhage although she did not have any risk factors for bleeding or instability of the international normalized ratio control.
Asunto(s)
Anticoagulantes/efectos adversos , Síndrome Antifosfolípido/tratamiento farmacológico , Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Hemorragia/inducido químicamente , Cuero Cabelludo , Enfermedades de la Piel/inducido químicamente , Trombosis de la Vena/tratamiento farmacológico , Adolescente , Síndrome Antifosfolípido/sangre , Síndrome Antifosfolípido/complicaciones , Síndrome Antifosfolípido/diagnóstico , Enfermedad Hepática Inducida por Sustancias y Drogas/diagnóstico , Enfermedad Hepática Inducida por Sustancias y Drogas/prevención & control , Clopidogrel , Sustitución de Medicamentos , Quimioterapia Combinada , Femenino , Dolor en el Flanco/inducido químicamente , Hemorragia/diagnóstico , Hemorragia/prevención & control , Humanos , Hidroxicloroquina/uso terapéutico , Relación Normalizada Internacional , Imagen por Resonancia Magnética , Inhibidores de Agregación Plaquetaria/uso terapéutico , Recurrencia , Factores de Riesgo , Enfermedades de la Piel/diagnóstico , Enfermedades de la Piel/prevención & control , Ticlopidina/análogos & derivados , Ticlopidina/uso terapéutico , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Trombosis de la Vena/sangre , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/etiologíaRESUMEN
BACKGROUND: Opioids are a potential new treatment for severe restless legs syndrome. We investigated the efficacy and safety of a fixed-dose combination of prolonged release oxycodone-naloxone for patients with severe restless legs syndrome inadequately controlled by previous, mainly dopaminergic, treatment. METHODS: This multicentre study consisted of a 12-week randomised, double-blind, placebo-controlled trial and 40-week open-label extension phase done at 55 sites in Austria, Germany, Spain, and Sweden. Patients had symptoms for at least 6 months and an International RLS Study Group severity rating scale sum score of at least 15; patients with severe chronic obstructive pulmonary disease or a history of sleep apnoea syndrome were excluded. Patients were randomly assigned (1:1) to either study drug or matched placebo with a validated interactive response technology system in block sizes of four. Study drug was oxycodone 5·0 mg, naloxone 2·5 mg, twice per day, which was up-titrated according to investigator's opinion to a maximum of oxycodone 40 mg, naloxone 20 mg, twice per day; in the extension, all patients started on oxycodone 5·0 mg, naloxone 2·5 mg, twice per day, which was up-titrated to a maximum of oxycodone 40 mg, naloxone 20 mg, twice per day. The primary outcome was mean change in severity of symptoms according to the International RLS Study Group severity rating scale sum score at 12 weeks. This study is registered with ClinicalTrials.gov (number NCT01112644) and with EudraCT (number 2009-011107-23). FINDINGS: We screened 495 patients, of whom 306 were randomly assigned and 276 included in the primary analysis (132 to prolonged release oxycodone-naloxone vs 144 to placebo). 197 patients participated in the open-label extension. Mean International RLS Study Group rating scale sum score at randomisation was 31·6 (SD 4·5); mean change after 12 weeks was -16·5 (SD 11·3) in the prolonged release oxycodone-naloxone group and -9·4 (SD 10·9) in the placebo group (mean difference between groups at 12 weeks 8·15, 95% CI 5·46-10·85; p<0·0001). After the extension phase, mean sum score was 9·7 (SD 7·8). Treatment-related adverse events occurred in 109 of 150 (73%) patients in the prolonged release oxycodone-naloxone group and 66 of 154 (43%) in the placebo group during the double-blind phase; during the extension phase, 112 of 197 (57%) had treatment-related adverse events. Five of 306 (2%) patients had serious treatment-related adverse events when taking prolonged release oxycodone-naloxone (vomiting with concurrent duodenal ulcer, constipation, subileus, ileus, acute flank pain). INTERPRETATION: Prolonged release oxycodone-naloxone was efficacious for short-term treatment of patients with severe restless legs syndrome inadequately controlled with previous treatment and the safety profile was as expected. Our study also provides evidence of open-label long-term efficacy of this treatment. Opioids can be used to treat patients with severe restless legs syndrome who have had no benefit with first-line drugs. FUNDING: Mundipharma Research.
Asunto(s)
Naloxona/uso terapéutico , Oxicodona/uso terapéutico , Síndrome de las Piernas Inquietas/tratamiento farmacológico , Anciano , Preparaciones de Acción Retardada , Trastornos de Somnolencia Excesiva/etiología , Agonistas de Dopamina/uso terapéutico , Método Doble Ciego , Femenino , Dolor en el Flanco/inducido químicamente , Enfermedades Gastrointestinales/inducido químicamente , Humanos , Masculino , Persona de Mediana Edad , Naloxona/administración & dosificación , Naloxona/efectos adversos , Oxicodona/administración & dosificación , Oxicodona/efectos adversos , Selección de Paciente , Calidad de Vida , Terapia Recuperativa , Índice de Severidad de la Enfermedad , Sueño , Resultado del TratamientoRESUMEN
BACKGROUND: The etiology of flank pain sometimes experienced during the administration of ultrasound contrast agents is unknown. The aim of this study was to investigate whether microbubble ultrasound contrast agents are retained within the renal microcirculation, which could lead to either flow disturbance or local release of vasoactive and pain mediators downstream from complement activation. METHODS: Retention of lipid-shelled microbubbles in the renal microcirculation of mice was assessed by confocal fluorescent microscopy and contrast-enhanced ultrasound imaging with dose-escalating intravenous injection. Studies were performed with size-segregated microbubbles to investigate physical entrapment, after glycocalyx degradation and in wild-type and C3-deficient mice to investigate complement-mediated retention. Urinary bradykinin was measured before and after microbubble administrations. Renal contrast-enhanced ultrasound in human subjects (n = 13) was performed 7 to 10 min after the completion of lipid microbubble administration. RESULTS: In both mice and humans, microbubble retention was detected in the renal cortex by persistent contrast-enhanced ultrasound signal enhancement. Microbubble retention in mice was linearly related to dose and occurred almost exclusively in cortical glomerular microvessels. Microbubble retention did not affect microsphere-derived renal blood flow. Microbubble retention was not influenced by glycocalyx degradation or by microbubble size, thereby excluding lodging, but was reduced by 90% (P < .01) in C3-deficient mice. Urinary bradykinin increased by 65% 5 min after microbubble injection. CONCLUSIONS: Lipid-shelled microbubbles are retained in the renal cortex because of complement-mediated interactions with glomerular microvascular endothelium. Microbubble retention does not adversely affect renal perfusion but does generate complement-related intermediates that are known to mediate nociception and could be responsible for flank pain.
Asunto(s)
Medios de Contraste/farmacocinética , Dolor en el Flanco/inducido químicamente , Fluorocarburos/efectos adversos , Fluorocarburos/farmacocinética , Riñón/diagnóstico por imagen , Riñón/metabolismo , Ultrasonografía/efectos adversos , Animales , Medios de Contraste/efectos adversos , Estudios de Factibilidad , Dolor en el Flanco/diagnóstico , Humanos , Masculino , Tasa de Depuración Metabólica , Ratones , Ratones Endogámicos C57BL , Circulación Renal , Distribución TisularRESUMEN
We report an unusual renal complication of cocaine abuse in a young man who developed loin pain, renal vein thrombosis, and acute renal failure. Cocaine abuse should be considered in the differential diagnosis of renal vein thrombosis in young adults.