RESUMO
BACKGROUND: On-demand treatment may be an alternative in the long-term treatment of non-severe gastro-oesophageal reflux disease in patients with frequent symptomatic relapses. AIM: To compare the efficacy of on-demand treatment with rabeprazole 10 mg versus continuous treatment in the long-term treatment of patients with frequent symptomatic relapses of mild to moderate gastro-oesophageal reflux disease. METHODS: This randomized, open-label study enrolled patients diagnosed with non-erosive reflux disease or oesophagitis grade 1 or 2 (Savary-Miller classification) reporting frequent symptomatic relapses (requiring > or =2 courses of antisecretory therapy during the previous year), whose intensity is rated at least moderate (>2 on a 5-point Likert scale). After a 4-week selection phase with rabeprazole 10 mg once daily, patients reporting symptom relief (Likert score < or =2) were randomized to receive either rabeprazole 10 mg continuous treatment or on-demand treatment for 6 months. The main evaluation criterion was the rate of symptom relief (scored on the Likert scale) after 6 months. RESULTS: One hundred and seventy-six patients were enrolled in the 4-week selection phase (men, 53%; mean age, 49 years; non-erosive reflux disease, 36.4%; gastro-oesophageal reflux disease 1, 53.4%; gastro-oesophageal reflux disease 2, 10.2%). Rabeprazole relieved symptoms in 88.6% of patients. Of this group, 152 were randomized to the comparative phase to receive rabeprazole 10 mg continuous treatment (once daily) or on-demand treatment (continuous treatment, n = 81; on-demand treatment, n = 71). At month 6 (end point), the symptom relief rate was slightly higher for patients in the continuous treatment group compared with those in the on-demand treatment group: 86.4% versus 74.6%, respectively. This difference was not statistically significant (P = 0.065). For the overall quality of life score, there was no difference between the continuous treatment and on-demand treatment groups (86.25 and 84.94). Mean daily consumption of rabeprazole was significantly lower in the on-demand treatment group versus the continuous treatment group (0.31 tablets versus 0.96 tablets; P < 0.0001). CONCLUSION: On-demand therapy with rabeprazole 10 mg provides an alternative to continuous therapy in patients with mild to moderate gastro-oesophageal reflux disease suffering from frequent symptomatic relapses.
Assuntos
Antiulcerosos/administração & dosagem , Benzimidazóis/administração & dosagem , Omeprazol/análogos & derivados , Omeprazol/administração & dosagem , 2-Piridinilmetilsulfinilbenzimidazóis , Adulto , Idoso , Antiulcerosos/efeitos adversos , Benzimidazóis/efeitos adversos , Esquema de Medicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Omeprazol/efeitos adversos , Cooperação do Paciente , Rabeprazol , Prevenção Secundária , Resultado do TratamentoRESUMO
BACKGROUND: The treatment of acid-related symptoms requires rapid and consistent acid suppression, especially with on-demand regimens. AIM: To compare the antisecretory activity of low-dose rabeprazole and omeprazole in healthy, Helicobacter pylori-negative subjects. METHODS: In this randomized, double-blind, placebo-controlled, three-way crossover study, 27 volunteers were given rabeprazole 10 mg, omeprazole 10 mg, or placebo once daily for 7 days with a 10-14-day washout between treatments. Intragastric pH was monitored for 24-h on days 1 and 7 of each treatment. RESULTS: Median gastric pH was significantly higher with rabeprazole than with omeprazole or placebo: day 1: 2.3, 1.4 and 1.3, respectively (P = 0.0056, rabeprazole vs. omeprazole; P < 0.0001, rabeprazole vs. placebo); day 7: 3.7, 2.2 and 1.3, respectively (P = 0.0016 rabeprazole vs. omeprazole; P < 0.0001, rabeprazole vs. placebo). Time with gastric pH above 4 was significantly higher with rabeprazole than with omeprazole: day 1, 5.8 h vs. 3.7 h, respectively (P < 0.02); day 7, 10.5 h vs. 4.6 h, respectively (P = 0.0008). CONCLUSIONS: Rabeprazole 10 mg provides more rapid acid inhibition compared with omeprazole 10 mg. After 7 days, the time with pH above 4 is more than doubled with rabeprazole 10 mg vs. omeprazole 10 mg.
Assuntos
Antiulcerosos/administração & dosagem , Benzimidazóis/administração & dosagem , Ácido Gástrico/metabolismo , Omeprazol/análogos & derivados , Omeprazol/administração & dosagem , 2-Piridinilmetilsulfinilbenzimidazóis , Adulto , Antiulcerosos/farmacologia , Benzimidazóis/farmacologia , Estudos Cross-Over , Método Duplo-Cego , Feminino , Determinação da Acidez Gástrica , Humanos , Masculino , Omeprazol/farmacologia , RabeprazolAssuntos
Actinomicose/diagnóstico , Actinomicose/microbiologia , Doenças Ósseas Infecciosas/diagnóstico , Doenças Ósseas Infecciosas/microbiologia , Tíbia , Actinomyces/classificação , Actinomicose/complicações , Idoso , Idoso de 80 Anos ou mais , Doenças Ósseas Infecciosas/complicações , Diagnóstico Diferencial , Humanos , Imageamento por Ressonância Magnética , Masculino , Dor/etiologiaAssuntos
Artrite Reumatoide/complicações , Perna (Membro) , Linfoma de Células B/complicações , Linfoma de Células B/patologia , Linfoma Difuso de Grandes Células B/complicações , Linfoma Difuso de Grandes Células B/patologia , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/patologia , Idoso , Idoso de 80 Anos ou mais , Biópsia , Feminino , Humanos , Imuno-HistoquímicaAssuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções por Citomegalovirus/diagnóstico , Citomegalovirus/isolamento & purificação , Glândula Submandibular/patologia , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/patologia , Adulto , Antivirais/uso terapêutico , Infecções por Citomegalovirus/tratamento farmacológico , Infecções por Citomegalovirus/patologia , Quimioterapia Combinada , Humanos , Masculino , Glândula Submandibular/virologiaRESUMO
Although not considered as indicative of AIDS, leishmaniasis presents a number of epidemiologic and clinical features that promote opportunistic infection in HIV patients. Accurate assessment of the incidence of this type of co-infection is difficult due to underestimation in endemic areas such as Africa and Asia. In these areas the WHO estimates that 2 to 9 p. 100 of HIV patients will develop leishmaniasis/HIV co-infection which could become a major concern. The characteristics of this co-infection have been documented. It is observed in adults between 20 and 40 years of age with a strong male sex bias. The visceral form is most frequent. Manifestations are similar to those observed in immunocompetent subjects but with the possibility of asymptomatic and low-grade forms (10 p. 100) and unusual locations suggesting multiorgan spreading in absence of host immune response. In addition to the time-tested standard procedures for diagnosis of parasitic disease, new serologic tests and genomic amplification are now available. Pentavalent antimonials have long been considered as the treatment of choice but they are not always effective and can have untoward effects. Amphotericine B especially in the liposomal form is a good alternative. The particularly high incidence of recurrence suggests that follow-up may be indicated but the modalities of prophylaxis have yet to be defined.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Doenças Endêmicas/estatística & dados numéricos , Leishmaniose/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Adulto , África/epidemiologia , Distribuição por Idade , Idoso , Antiprotozoários/uso terapêutico , Ásia/epidemiologia , Comorbidade , Feminino , Saúde Global , Humanos , Incidência , Leishmaniose/classificação , Leishmaniose/diagnóstico , Leishmaniose/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Vigilância da População , Distribuição por SexoAssuntos
Antidepressivos de Segunda Geração/efeitos adversos , Fluoxetina/efeitos adversos , Hemorragia Gastrointestinal/induzido quimicamente , Hematoma/induzido quimicamente , Inibidores Seletivos de Recaptação de Serotonina/efeitos adversos , Dermatopatias/induzido quimicamente , Inibidores da Captação Adrenérgica/uso terapêutico , Idoso , Depressão/tratamento farmacológico , Feminino , Hemorragia/induzido quimicamente , Humanos , Doença Iatrogênica , Reto , Síndrome , Viloxazina/uso terapêuticoAssuntos
Artrite/etiologia , Febre de Causa Desconhecida/etiologia , Articulação do Joelho , Linfoma Anaplásico de Células Grandes/complicações , Doenças da Coluna Vertebral/etiologia , Adulto , Artrite/diagnóstico , Artrite Infecciosa/diagnóstico , Diagnóstico Diferencial , Evolução Fatal , Humanos , Linfoma Anaplásico de Células Grandes/diagnóstico , Masculino , Doenças da Coluna Vertebral/diagnóstico , Tuberculose Osteoarticular/diagnósticoRESUMO
BACKGROUND: We report two cases of rheumatism associated with hyperthyroidism. In both cases, arthralgia totally regressed after thyroid treatment. CASE REPORTS: Two 79-year-old and 59-year-old women developed manifestations of polymyalgia rheumatica and psoriasis arthritis respectively. Corticosteroid therapy was ineffective and followed by manifestations of hyperthyroidism. The first patient was treated with carbimazole and the second with thyroidectomy. Once the hyperthyroidism was controlled, both patients experienced a dramatically rapid cure of their arthralgias. DISCUSSION: Scalpulo-humeral periarthritis is the main articular complication of hyperthyroidism. True manifestations of "thyrotoxicosis rheumatism" are unusual and may be linked with a direct toxicity of the thyroid hormones on joint cartilage or with an autoimmune manifestation of hyperthyroidism.
Assuntos
Artralgia/etiologia , Hipertireoidismo/diagnóstico , Psoríase/etiologia , Doenças Reumáticas/etiologia , Corticosteroides/uso terapêutico , Idoso , Antitireóideos/uso terapêutico , Carbimazol/uso terapêutico , Feminino , Humanos , Hipertireoidismo/complicações , Hipertireoidismo/terapia , Pessoa de Meia-Idade , TireoidectomiaRESUMO
Cerebro-vascular complications of pheochromocytoma are now rare. The case reported here is a 47-year-old woman who presented with two cerebral hematomas and a pheochromocytoma. Abolition of a cutaneous abdominal reflex abolition can help the clinician to locate the adrenal tumor side.
Assuntos
Neoplasias das Glândulas Suprarrenais/diagnóstico , Encéfalo/diagnóstico por imagem , Hematoma/diagnóstico , Feocromocitoma/diagnóstico , Reflexo Abdominal/fisiologia , Reflexo Anormal/fisiologia , Neoplasias das Glândulas Suprarrenais/complicações , Feminino , Hematoma/etiologia , Humanos , Pessoa de Meia-Idade , Feocromocitoma/complicações , Tomografia Computadorizada por Raios XRESUMO
Superior vena cava syndromes are uncommon and usually caused by malignant diseases. In about 20% of the cases however, the cause is benign. Besides chronic mediastinitis, a growing number of cases are reported of thrombosis resulting from endovenous devices (central catheters, pacemaker leads...). Onset is often slow and insidious, good tolerance in the early stages being explained by the development of an effective collateral circulation. Bibrachial phlebography is still the reference exploration, but computed tomography and magnetic resonance imaging are contributive to diagnosis. Symptoms usually regress after medical treatment, sometimes requiring thrombolysis, however, in 10% of the patients, major functional impairment may require bypass surgery (autologous graft or endoprosthesis) or transluminal angioplasty. There is still some debate as to the precise indications for each method, but angioplasty, used recently, appears to be the most interesting technique for a disease in which prognosis is almost always favorable.