Assuntos
Dermatologia , Consulta Remota , Redução de Custos , Humanos , Pacientes Internados , Encaminhamento e ConsultaRESUMO
A 29-year-old woman with hepatitis C presented 2 years after an orthotopic liver transplant with several weeks of fevers, abdominal pain, nausea, and a painful ulcerated nodular eruption on her abdomen and lower extremities. The patient was evaluated, and her case is presented and the differential discussed.
Assuntos
Abdome/patologia , Cryptococcus neoformans/isolamento & purificação , Dermatomicoses/diagnóstico , Exantema/patologia , Perna (Membro)/patologia , Transplante de Fígado/efeitos adversos , Dor Abdominal , Adulto , Antígenos de Fungos/isolamento & purificação , Criptococose/diagnóstico , Criptococose/microbiologia , Criptococose/patologia , Cryptococcus neoformans/imunologia , Dermatomicoses/microbiologia , Dermatomicoses/patologia , Evolução Fatal , Feminino , Humanos , Pele/microbiologia , Pele/patologiaAssuntos
Doença Enxerto-Hospedeiro/etiologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Mieloma Múltiplo/terapia , Ciclosporina/uso terapêutico , Evolução Fatal , Feminino , Gastroenteropatias/etiologia , Humanos , Hepatopatias/etiologia , Pessoa de Meia-Idade , Dermatopatias/etiologia , Transplante AutólogoAssuntos
Neoplasias do Ânus/etiologia , Carcinoma de Células Escamosas/etiologia , Doença de Crohn/complicações , Fístula Retal/complicações , Idoso , Antibacterianos/uso terapêutico , Neoplasias do Ânus/patologia , Carcinoma de Células Escamosas/patologia , Doença Crônica , Feminino , Humanos , PeríneoRESUMO
Cyclophosphamide is a potent immunosuppressive agent that has an important role in the treatment of autoimmune, neoplastic, granulomatous, and neutrophilic disorders. Pulse intravenous cyclophosphamide has been shown to be efficacious for several dermatologic disorders, particularly pemphigus vulgaris, with a low incidence of toxicity reported. As reported earlier, studies performed on the use of pulse intravenous cyclophosphamide in the treatment of a variety of dermatology-related diseases strongly suggest that the toxicities frequently noted with the use of oral cyclophosphamide therapy may be significantly less common with pulse intravenous administration of cyclophosphamide. The short follow-up period of patients treated with this modality so far, however, requires constant vigilance for the development of side effects, particularly secondary malignancy. At this time, pulse intravenous cyclophosphamide is a promising treatment modality with an acceptable risk profile for moderate-to-severe dermatologic diseases recalcitrant to standard therapy. Prospective comparative trials are needed to assess further the efficacy and toxicity of this therapy.
Assuntos
Antineoplásicos Alquilantes/administração & dosagem , Ciclofosfamida/administração & dosagem , Imunossupressores/administração & dosagem , Dermatopatias/tratamento farmacológico , Antineoplásicos Alquilantes/efeitos adversos , Antineoplásicos Alquilantes/farmacocinética , Ciclofosfamida/efeitos adversos , Ciclofosfamida/farmacocinética , Humanos , Imunossupressores/efeitos adversos , Imunossupressores/farmacocinética , Infusões Intravenosas , Pênfigo/tratamento farmacológico , Pênfigo/patologia , Pulsoterapia , Dermatopatias/patologiaRESUMO
The authors present three cases of extensive squamous cell carcinoma of the conjunctiva invading the orbit and masquerading as orbital cellulitis. All cases were in elderly alcoholic men living in relative social isolation. Total exenteration of the orbit was required in all three cases. Only one patient has had long-term follow-up; he was well 5 years after presentation. The other two patients were well 15 and 5 months after surgery.
Assuntos
Carcinoma de Células Escamosas/diagnóstico , Celulite (Flegmão)/diagnóstico , Neoplasias da Túnica Conjuntiva/diagnóstico , Doenças Orbitárias/diagnóstico , Isolamento Social , Idoso , Idoso de 80 Anos ou mais , Alcoolismo/complicações , Carcinoma de Células Escamosas/complicações , Carcinoma de Células Escamosas/patologia , Neoplasias da Túnica Conjuntiva/complicações , Neoplasias da Túnica Conjuntiva/patologia , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , SíndromeRESUMO
This report reviews the experience of the Santa Clara County Maternal Mortality Study Committee, which continued its local activity after the termination of California state-supported study groups in 1970. A study of 36 maternal deaths among approximately 262,000 live births was compiled over a 13-year period, between 1971 and 1983, in a population group representative of much of California. Although based on a small population sample, the results indicate an imperative need for such reviews to improve the quality of clinical care and to develop significant statistical information on the incidence and causes of maternal mortality. The historical development of study committees throughout the United States illustrates the necessity of standardized definitions and uniform methodology among study groups in all states and territories. A nationwide study is proposed to obtain a broad-based, cumulative maternal mortality series, directed toward the eventual elimination of preventable maternal deaths. The current effort by a special interest group in the American College of Obstetricians and Gynecologists is commended for beginning this task.
Assuntos
Mortalidade Materna , Adolescente , Adulto , California , Parto Obstétrico , Etnicidade , Feminino , Humanos , Hemorragia Pós-Parto/mortalidade , Gravidez , Complicações na Gravidez/mortalidade , Sistema de RegistrosRESUMO
A moderately severe thermal injury of the central cornea of 48 Dutch-belted rabbit eyes was produced with a carbon (CO2) laser. The lesions were photographed with a slit lamp (SL) camera immediately following the injury and at 1, 2, 4, 7, 14, 21, 30 and 60 days after the exposure. Lesion size, opaqueness, and depth were graded clinically by SL biomicroscopy at the same intervals. No significant differences were found (p less than or equal to 0.05) between groups of eyes treated with flurbiprofen (0.03%), prednisolone acetate (1%), and vehicle control four-times-a-day for three weeks following injury. Additionally, eyes were studied histopathologically at 3 and 60 days following injury by light and transmission electron microscopy, and clinically at 30 and 60 days by endothelial specular microscopy. Important clinical and histopathological findings included coagulative necrosis of the corneal epithelium, epithelial sloughing, fusion of stromal collagen, stromal edema and inflammatory cell infiltration, stromal scar formation, corneal thinning, endothelial hyperplasia and metaplasia, fibrinous anterior chamber reaction with hypopyon, and retrocorneal fibrous membrane formation.
Assuntos
Anti-Inflamatórios/uso terapêutico , Lesões da Córnea , Lasers/efeitos adversos , Administração Tópica , Animais , Córnea/patologia , Avaliação Pré-Clínica de Medicamentos , Flurbiprofeno/uso terapêutico , Prednisolona/análogos & derivados , Prednisolona/uso terapêutico , CoelhosAssuntos
Linfoma não Hodgkin , Neoplasias Pélvicas , Neoplasias Retroperitoneais , Doença Aguda , Feminino , Granulócitos/patologia , Humanos , Linfoma não Hodgkin/diagnóstico , Linfoma não Hodgkin/terapia , Pessoa de Meia-Idade , Neoplasias Pélvicas/diagnóstico , Neoplasias Pélvicas/terapia , Neoplasias Retroperitoneais/diagnóstico , Neoplasias Retroperitoneais/terapiaRESUMO
The development of a program to provide complete anesthesia coverage for obstetrics in a community hospital was undertaken as a prospective project which emphasized continuous caudal techniques. Mutually acceptable guidelines were formulated by a group of anesthesiologists and the Department of Obstetrics and Gynecology. A computerized study involving 3,500 labor patients was carried out to thoroughly evaluate the experience over 16 months. The data confirmed the feasibility, safety and wide acceptance of the program. Major complications were few and the anesthesia service to patients was excellent.
Assuntos
Anestesia Epidural/efeitos adversos , Anestesia Obstétrica , Hospitais Comunitários , Anestesiologia , Computadores , Feminino , Departamentos Hospitalares , Humanos , GravidezAssuntos
Candidíase/etiologia , Doenças dos Genitais Femininos/cirurgia , Aborto Séptico/cirurgia , Adulto , Anfotericina B/uso terapêutico , Antibacterianos/efeitos adversos , Candida , Candidíase/diagnóstico , Candidíase/tratamento farmacológico , Candidíase/mortalidade , Carcinoma de Células Escamosas/cirurgia , Feminino , Humanos , Imunossupressores/efeitos adversos , Pessoa de Meia-Idade , Nistatina/uso terapêutico , Complicações Pós-Operatórias , Gravidez , Neoplasias do Colo do Útero/cirurgiaAssuntos
Neoplasias das Glândulas Suprarrenais/terapia , Feocromocitoma/terapia , Complicações na Gravidez/terapia , Neoplasias das Glândulas Suprarrenais/diagnóstico , Neoplasias das Glândulas Suprarrenais/patologia , Neoplasias das Glândulas Suprarrenais/cirurgia , Adulto , Anestesia Intravenosa , Feminino , Morte Fetal/etiologia , Humanos , Hipertensão/etiologia , Relações Interprofissionais , Sulfato de Magnésio/uso terapêutico , Fenobarbital/uso terapêutico , Feocromocitoma/diagnóstico , Feocromocitoma/patologia , Feocromocitoma/cirurgia , Cuidados Pós-Operatórios , Gravidez , Complicações na Gravidez/cirurgia , Reserpina/uso terapêuticoRESUMO
Specialists are having many difficulties defining and developing more effective methods in the area of continuing medical education. Present unorganized multifaceted mechanisms are too little utilized by the majority to be acceptable. A cooperative effort by parent specialty organizations, accredited hospital staffs and the State Board of Medical Examiners could explore the possibility of establishing standards by which a qualitative and quantitative review of the level of performance of physicians could be done. The initiative must be exercised by these groups to forestall governmental intervention.