RESUMO
Ten (1.8%) out of 558 patients with end-stage chronic renal failure on program hemodialysis developed infective endocarditis (IE). The average length of hemodialysis before IE was 17.0 +/- 14.5 months. The main cause of IE was infection of the site of vascular approaches. The diagnosis was difficult; Duke criteria modified by J. Li et al. (2000) allowed evidenced diagnosis of IE only in 30% of cases, while modified criteria offered by the authors did it in 50% of cases. The article discusses rational antibacterial therapy. Hospital lethality in IE is as high as 50%.
Assuntos
Endocardite Bacteriana/microbiologia , Diálise Renal , Adolescente , Adulto , Idoso , Antibacterianos/uso terapêutico , Neuropatias Diabéticas/epidemiologia , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/epidemiologia , Feminino , Glomerulonefrite/epidemiologia , Glomerulonefrite/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Diálise Renal/métodosRESUMO
Diagnostics of primary (AL) amyloidosis is difficult enough; treatment of this disease in not less difficult or more adequate. Because of similarity of the pathogenesis of AL-amyloidosis and that of multiple myeloma, similar therapeutic regimens, directed towards depression of plasma cell dyscrasia, are used in both cases: administration of melphalan in various doses together with prednisolone, administration of vincristine, adriablastine and dexamethasone, as well as high-dose chemotherapy with melphalan and autologic stem cell transplantation. This therapeutic approach makes it possible to reach clinico-laboratory remission and prolong the life of patients with AL-amyloidosis. The article contains a case description of a patient with AL-amyloidosis, who underwent a successful high-dose melphalan therapy with subsequent autologic stem cell transplantation.
Assuntos
Amiloidose/diagnóstico , Amiloidose/patologia , Antineoplásicos Alquilantes/uso terapêutico , Melfalan/uso terapêutico , Amiloidose/imunologia , Diagnóstico Diferencial , Quimioterapia Combinada , Humanos , Imunoglobulina G/imunologia , Masculino , Pessoa de Meia-Idade , Prednisolona/uso terapêuticoRESUMO
Hormono-metabolic status was assayed before and after month 6, 12, 24, 36, 48, 54 and 60 of therapy in 72 patients with receptor-positive tumors of the breast who completed 5 years of adjuvant tamoxifen (20 mg/24 hrs) or letrozole (2.5 mg/24 hrs). Eleven patients were not followed up, 11 relapsed and had metastases while 50 completed therapy. Significant fall in body mass (Ketle's index), in C-peptide concentration after an insignificant rise and C-peptide/insulin ratio 129 min after glucose loading, low basal blood level of estradiol as well as stable estradiolemia throughout treatment were characteristic of cases of pre-treatment recurrence and metastastic spread. Insulin resistance status, basal serum-estradiol level and fasting its course of development during hormonotherapy should be the subject of further research in criteria for adjuvant hormonotherapy efficacy.