RESUMO
AIM: To estimate the prevalence of gingival overgrowth in kidney allograft recipients in southern Switzerland and to determine the factors associated with it. We hypothesized that poor oral hygiene was a risk factor. METHODS: We assessed the level of oral hygiene among renal transplant patients and determined whether a good level of information and regular dental checkups in addition to good oral hygiene could prevent gingival hyperplasia. Seventy-six adults who had undergone kidney transplantation were examined. The level of oral hygiene, gender, age, time elapsed from transplantation, medication and dose were recorded. RESULTS: In general the level of oral hygiene was average. We found a significant association between the severity of gingival overgrowth and the level of oral hygiene. No statistical relationship between gingival hyperplasia and the other recorded variables was detected. Patients on tacrolimus had a tendency to have less gingival hyperplasia. Patient education, along with regular dental checkups and a good level of oral hygiene, should prevent gingival hyperplasia or maintain it at an acceptable level. CONCLUSION: Intensive motivation of patients to maintain good oral hygiene is necessary to reduce the incidence of gingival hyperplasia.
Assuntos
Hiperplasia Gengival/prevenção & controle , Imunossupressores/efeitos adversos , Transplante de Rim , Higiene Bucal , Adulto , Idoso , Inibidores de Calcineurina , Estudos Transversais , Ciclosporina/efeitos adversos , Ciclosporina/farmacologia , Ciclosporina/uso terapêutico , Feminino , Hiperplasia Gengival/induzido quimicamente , Hiperplasia Gengival/epidemiologia , Humanos , Imunossupressores/farmacologia , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Fatores de Risco , Índice de Gravidade de Doença , Suíça/epidemiologia , Tacrolimo/efeitos adversos , Tacrolimo/farmacologia , Tacrolimo/uso terapêuticoRESUMO
BACKGROUND: Symptomatic intradialytic hypotension (IDH) associated with increased mortality in hemodialysis patients is difficult to predict and hence prevent. Artificial Neural Networks (ANNs) are promising tools to solve multidimensional non-linear problems. The aim of the study was to verify in which way mathematical models, statistics or knowledge of patients influence the ability of the nephrologists to predict IDH. METHODS: The performance of ANNs was compared with that of independent nephrologists supported by a logistic regression giving odds ratio for each studied variable (NEPHiS) or of nephrologists in charge of the patients without (NEPHc) or with statistical support as for NEPHiS (NEPHcS). Data from 98 hemodialysis patients were analysed in order to select patients with frequent IDH (>10% of the dialysis sessions). Complete data on 1979 dialysis sessions from 7 patients were retrieved. The ability to predict the occurrence of hypotension episodes was compared (ROC curves) between ANNs, NEPHc/S (N=7) in Switzerland and NEPHiS from independent dialysis centers in Western Australia (N=10). RESULTS: ANN gave the most accurate correlation between estimated and observed IHD episodes compared to NEPHc (p<0.001), but a similar performance was attained by NEPHcS (p<0.001). NEPHiS were superior to NEPHc (P<0.05), but inferior to ANN (P<0.01). For a sensitivity of 80%, specificity was 44% for ANNs, 33% for NEPHcS and 20% for NEPHc. CONCLUSIONS: ANNs are superior to nephrologists in predicting IDH episodes; however when supported by a statistical analysis, nephrologists reach ANNs in their prediction ability. IDH still remains difficult to predict even with mathematical models.
Assuntos
Hipotensão/diagnóstico , Hipotensão/epidemiologia , Modelos Estatísticos , Redes Neurais de Computação , Diálise Renal , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Hipotensão/etiologia , Incidência , Masculino , Pessoa de Meia-Idade , Razão de Chances , Valor Preditivo dos Testes , Diálise Renal/efeitos adversos , Diálise Renal/estatística & dados numéricos , Estudos Retrospectivos , Suíça/epidemiologiaRESUMO
PURPOSE: To evaluate the feasibility and clinical effects of increasing doses of amifostine administered four times in 1 day with high-dose (HD) cyclophosphamide (CTX). METHODS: A group of 16 patients with a diagnosis of lymphoma were treated with HD-CTX given at a total dose of 7 g/m2 subdivided into four doses, each preceded by increasing doses of amifostine. A group of 12 lymphoma patients previously treated with the same HD-CTX regimen was used as historical controls. RESULTS: The dose of amifostine was escalated in cohorts of three patients each from 4x570 mg/m2 to 4x910 mg/m2 without severe toxic effects. Further patients were treated at the highest dose level. Side effects included a fall in blood pressure (always less than 20% of baseline value), asymptomatic hypocalcemia (from a median value of 2.4 to 1.7 mmol/l) and a decrease in creatinine clearance (from a median value of 102 to 85 ml/min). The parameters of hematotoxicity for patients treated in the study were not significantly different from those of the historical control patients. CONCLUSIONS: Amifostine can be given safely at a dose of 910 mg/m2 four times in 1 day in combination with HD-CTX. With this schedule amifostine did not show a myeloprotective effect.
Assuntos
Amifostina/administração & dosagem , Antineoplásicos Alquilantes/efeitos adversos , Medula Óssea/efeitos dos fármacos , Ciclofosfamida/efeitos adversos , Doença de Hodgkin/tratamento farmacológico , Linfoma não Hodgkin/tratamento farmacológico , Pró-Fármacos/administração & dosagem , Adolescente , Adulto , Idoso , Antineoplásicos Alquilantes/uso terapêutico , Ciclofosfamida/uso terapêutico , Esquema de Medicação , Quimioterapia Combinada , Estudos de Viabilidade , Humanos , Pessoa de Meia-IdadeRESUMO
A case report is presented, which describes a patient with a long history of stable but mild renal insufficiency for several years, who presented with end-stage stage renal disease following a rapid decline of renal function and accelerated hypertension. A renal work-up disclosed severe bilateral renal artery stenoses. A percutaneous transluminal renal angioplasty (PTRA) with stent significantly improved both renal function and hypertension and the patient was still not on dialysis twelve months after the procedure. The epidemiology, prognosis, diagnosis and treatment of the atherosclerotic renovascular disease are discussed. Treatment consists in the revascularization, this can improve not only the hypertension but also the renal function. In patients with end-stage renal disease PTRA can postpone for several months the need for dialysis.
Assuntos
Hipertensão Renovascular/diagnóstico , Falência Renal Crônica/diagnóstico , Obstrução da Artéria Renal/diagnóstico , Angioplastia com Balão , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Hipertensão Renovascular/terapia , Falência Renal Crônica/terapia , Pessoa de Meia-Idade , Obstrução da Artéria Renal/terapia , StentsRESUMO
Tendinopathies as a result of fluoroquinolone therapy represent a new clinical entity. We report on tendinitis and tendon rupture in six fluoroquinolone treated patients of our outpatient and dialysis service between 1995 and 1997. The most important risk factors for tendinopathies were renal failure in all cases, glucocorticosteroid therapy in five patients, secondary hyperparathyroidism in three patients, advanced age in two patients, and diabetes mellitus in another patient. Latency periods of 2 to 60 days between onset of fluoroquinolone therapy and emergence of symptoms suggest significant involvement of these agents and are compatible with previously published case reports. Therefore, care should be used in prescribing fluoroquinolones to older renal transplant or hemodialysis patients with additional risk factors for tendinopathies. These drugs should be stopped when symptoms of tendinitis occur, particularly to prevent tendon rupture. The incidence of fluoroquinolone induced tendinopathies in patients without renal diseases is unknown.
Assuntos
Anti-Infecciosos/efeitos adversos , Ciprofloxacina/efeitos adversos , Fleroxacino/efeitos adversos , Tendinopatia/induzido quimicamente , Traumatismos dos Tendões/induzido quimicamente , Adulto , Idoso , Anti-Infecciosos/administração & dosagem , Ciprofloxacina/administração & dosagem , Feminino , Fleroxacino/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Ruptura EspontâneaRESUMO
Long-term therapy with lithium may be associated with a broad spectrum of functional and structural side-effects in the kidney. Among these features, nephrogenic diabetes insipidus is the most frequent and it can be expected to occur in 20-70% of the patients. Diabetes insipidus is the result of a lithium induced resistance of collecting ducts to antidiuretic hormone. Additional functional disturbances are represented by renal tubular acidosis and consequences of hypercalcemia. Structural alterations of the kidney have a rare occurrence. In the literature, there are accounts of chronic tubulo-interstitial nephritis, acute tubular necrosis and few cases of glomerulopathies. Our report of a patient with chronic interstital nephritis is supplemented by a brief discussion of the diverse picture of the nephrotoxicity of lithium.
Assuntos
Antimaníacos/efeitos adversos , Transtorno Bipolar/tratamento farmacológico , Falência Renal Crônica/induzido quimicamente , Carbonato de Lítio/efeitos adversos , Nefrite Intersticial/induzido quimicamente , Antimaníacos/uso terapêutico , Biópsia , Feminino , Humanos , Rim/efeitos dos fármacos , Rim/patologia , Falência Renal Crônica/patologia , Carbonato de Lítio/uso terapêutico , Pessoa de Meia-Idade , Nefrite Intersticial/patologiaRESUMO
OBJECTIVE: The purpose of the present study was to investigate whether the clearance of ceftriaxone during haemodialysis is influenced by the type of membrane used (cuprophane, haemophane or polysulphone). METHODS: After administration of a single 2-g dose of ceftriaxone, the half-life of the drug during haemodialysis and the clearance of the dialyser were measured. RESULTS: The mean dialysis clearance normalised for square metre of membrane surface was significantly different for the three dialysers (haemophane 24 ml.min-1.m-2; cuprophane 32 ml.min-1.m-2; polysulphone 42 ml.min-1.m-2). CONCLUSIONS: Polysulphone membranes are more permeable and increase the extraction of ceftriaxone more than the other dialysers studied (haemophane and cuprophane membranes). These results, taken together with previous data, show that an increase of the dose in dialysis patients treated with large surface (> 0.8 m2) and high permeability membranes might be necessary.
Assuntos
Ceftriaxona/farmacocinética , Cefalosporinas/farmacocinética , Membranas Artificiais , Diálise Renal/instrumentação , Adulto , Idoso , Materiais Biocompatíveis , Ceftriaxona/sangue , Celulose/análogos & derivados , Cefalosporinas/sangue , Cromatografia Líquida de Alta Pressão , Feminino , Meia-Vida , Humanos , Masculino , Taxa de Depuração Metabólica , Pessoa de Meia-Idade , Polímeros , SulfonasRESUMO
This retrospective study analyzes and compares the incidence of admissions for alcohol and drug (i.e.: heroin and cocaine) induced diseases to the internal medicine service of Locarno Regional Hospital (61 beds plus intensive care unit) between January 1, 1993 and December 31, 1994. Of 4038 admissions, 298 (7.4%) were related to alcoholism and drug addiction. 4.2% of all hospital days were due to alcohol abuse, whereas 3.2% were related to drug abuse (of these 1.8% were for HIV-associated diseases and 0.9% for withdrawal treatment). The male/female ratio was 3:1 in both groups, the average age of women being significantly lower in the alcoholic group (50.5 +/- 14.4 years vs. 58.1 +/- 12.9; p = 0.003). Over 90% of the patients with alcohol-induced conditions continued to consume alcohol. On the contrary, only 16% of the HIV-positive patients were still drug-addicted. The in-hospital mortality was 6% (5% in the alcoholic group; 1.6% and 12%, respectively, in the HIV-negative and HIV-positive groups of drug addicts). This study confirms the high prevalence of diseases related to alcohol and drug abuse. Women are less affected, but show complications of alcohol abuse earlier. Despite the HIV epidemic in our area, the admissions of alcoholics to the hospital are more frequent than those of drug addicts. Most of the drug addicts with an HIV-associated condition are in remission, whereas alcoholics with alcohol-induced diseases continue, for the most part, to be alcohol-dependent.