RESUMO
The authors report a case of amiodaron-induced neuropathy in a seventy one years old man. First signs appeared seventeen months after the treatment was started with 400 mg/day for one year and continued with 200 mg/day. Examination on the 29th month disclosed a severe sensory and motor deficit of the limbs with distal predominancy. Motor nerve conduction velocity was strongly impaired without modification of distal latencies. Fundi were normal. The patient improved quickly after drug withdrawal. The authors review the rare similar cases reported in the literature and attempt to describe the clinical caracteristics of amiodaron neuropathy. Qualitative and quantitative light and electron microscopical studies of nerve, muscle and skin biopsies, including teased fibers preparations were performed and they disclosed a marked reduction of the number of myelinated fibers. Wallerian degeneration predominated (31 p. 100) other segmental demyalination (25 p. 100). Numerous polymorphous lipid-laden lysosomes were present in Schwann cells, fibrocytes, pericytes, endothelial and muscle cells. These previously undescribed morphological findings are similar to those present in perhexiline maleate intoxications. We believe amiodaron neuropathy is a new neuropathy with drug-induced lipidosis.
Assuntos
Amiodarona/efeitos adversos , Benzofuranos/efeitos adversos , Lipidoses/induzido quimicamente , Doenças do Sistema Nervoso/induzido quimicamente , Idoso , Humanos , Lipidoses/patologia , Lisossomos/ultraestrutura , Masculino , Músculos/patologia , Músculos/ultraestrutura , Nervo Musculocutâneo/patologia , Nervo Musculocutâneo/ultraestrutura , Doenças do Sistema Nervoso/patologiaAssuntos
Catecolaminas/uso terapêutico , Glicosídeos Digitálicos/uso terapêutico , Diuréticos/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Vasodilatadores/uso terapêutico , Débito Cardíaco/efeitos dos fármacos , Insuficiência Cardíaca/fisiopatologia , Hemodinâmica/efeitos dos fármacos , Humanos , Contração Miocárdica/efeitos dos fármacos , Equilíbrio Hidroeletrolítico/efeitos dos fármacosRESUMO
The effects of nitroglycerin on systemic vascular resistance and cardiac output are highly debated. This study demonstrates that these effects depend on the initial haemodynamic condition, and explains the conflicting results previously reported. 31 patients presenting initially with a fairly wide spectrum of various haemodynamic parameters underwent cardiac catheterisation with measures of parameters before and after nitroglycerin infusion. Multifactorial statistical analysis by correspondence analysis identifies 3 types of haemodynamic responses and demonstrates the association of each response with a particular haemodynamic profile. It is demonstrated that systemic vascular resistance is decreased only when it is initially elevated and cardiac output is increased only when initial pulmonary wedge pressure and systemic vascular resistance are elevated and cardiac output is low. The effects of nitroglycerin on cardiac output, systemic vascular resistance, heart rate and arterial pressure differ significantly according to the presence or not of cardiac insufficiency and depend mainly on the initial value of three parameters: systemic vascular resistance, pulmonary wedge pressure and cardiac output.
Assuntos
Insuficiência Cardíaca/tratamento farmacológico , Nitroglicerina/uso terapêutico , Adulto , Idoso , Débito Cardíaco/efeitos dos fármacos , Análise Fatorial , Hemodinâmica/efeitos dos fármacos , Humanos , Infusões Parenterais , Pessoa de Meia-Idade , Nitroglicerina/farmacologia , Resistência Vascular/efeitos dos fármacosAssuntos
Insuficiência Cardíaca/tratamento farmacológico , Hemodinâmica/efeitos dos fármacos , Insuficiência da Valva Mitral/tratamento farmacológico , Infarto do Miocárdio/tratamento farmacológico , Nitroglicerina/uso terapêutico , Adulto , Idoso , Pressão Sanguínea/efeitos dos fármacos , Débito Cardíaco/efeitos dos fármacos , Avaliação de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nitroglicerina/administração & dosagem , Nitroglicerina/efeitos adversos , Circulação Pulmonar/efeitos dos fármacos , Resistência Vascular/efeitos dos fármacosAssuntos
Antiarrítmicos/metabolismo , Antagonistas Adrenérgicos beta/metabolismo , Ajmalina/metabolismo , Amiodarona/metabolismo , Aprindina/metabolismo , Tosilato de Bretílio/metabolismo , Disopiramida/metabolismo , Humanos , Mexiletina/metabolismo , Fenitoína/metabolismo , Procainamida/metabolismo , Propranolol/metabolismo , Quinidina/metabolismoRESUMO
Seventy four clinically comparable cases of myocardial infarction, admitted on average at the 10th hour were divided at random in two groups: thirty nine were treated with a prolonged intravenous infusion of trinitrin lasting for 24 hours in 12 cases and during 5 at 7 days in 27 cases: 35 served as controls. The results showed the following: a) the good tolerance of the drug used in this way; b) on the basis of precordial cartography, a reduction of 56.2 +/- 14.5% to 30 +/- 7.3% in the index of secondary extension of necrosis; c) clinical signs of left ventricular failure developed in 60% of the controls as compared with 45.8% of the treated group; d) the prevalence of rhythm disturbances was also lower in those treated; e) overall mortality during the first 4 weeks was 8 amongst the 35 controls and 2 of the treated patients (p less than 0.05).