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Rev Med Liege ; 76(7-8): 614-619, 2021 Jul.
Artigo em Francês | MEDLINE | ID: mdl-34357714


Intracerebroventricular (ICV) infusion of morphine is a well-known technique to relieve intractable neoplasic pain when conventional analgesic strategies reach their limits. Through this case report, we present indications, assets, and drawbacks of this procedure in such conditions. We also describe the adaptation of the systemic analgesic treatment to allow discharge from the hospital to home settings. Thanks to the ICV infusion of a mixture of morphine, bupivacaine and clonidine, the patient was weaned from oral opioid medications and reached an acceptable level of comfort. This allowed him to be discharged from the hospital to go back home with a specific setting of mobile palliative care structure. The patient's family followed training about the device to prevent any technical trouble and to react in case of unwanted events.

Clonidina , Dor Intratável , Analgésicos Opioides/uso terapêutico , Bupivacaína/uso terapêutico , Clonidina/uso terapêutico , Humanos , Infusões Intraventriculares , Masculino , Morfina/uso terapêutico , Dor Intratável/tratamento farmacológico , Dor Pós-Operatória , Cuidados Paliativos
Acta Anaesthesiol Belg ; 67(3): 143-147, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-29873470


We report the case of a 70-year-old man, with increased anesthetic risk, who beneficiated from a lumbar laminarthrectomy from lumbar vertebra 4 (L4) to sacral 1 (S1). A dural tear facing L5-S 1 levels occurred during surgery and was repaired intra-operatively. Postoperatively, back and radicular pain symptoms appeared along with a pseudo-meningocele. Successful treatment was only achieved after performing an epidural blood patch and closed subarachnoid drainage. This well-known but infrequent management was undertaken after a first epidural blood patch attempt, and after two unsuccessful surgical choking procedures. Management is here described, and discussed at the light of existing literature.

Repouso em Cama , Placa de Sangue Epidural , Dura-Máter/lesões , Dura-Máter/cirurgia , Complicações Intraoperatórias/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Coluna Vertebral/cirurgia , Idoso , Vazamento de Líquido Cefalorraquidiano , Descompressão Cirúrgica , Dura-Máter/diagnóstico por imagem , Humanos , Complicações Intraoperatórias/líquido cefalorraquidiano , Complicações Intraoperatórias/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Estenose Espinal/cirurgia , Espaço Subaracnóideo/cirurgia , Sucção
Am J Nephrol ; 32(2): 156-62, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20606419


BACKGROUND/AIMS: Some studies suggest that polymorphisms in angiotensin-converting enzyme (ACE), angiotensinogen (AGT), angiotensin II type I receptor (AGTR1) and angiotensin II type II receptor (AGTR2) genes may contribute to renal function variation. METHODS: Genotyping for single nucleotide polymorphisms (SNPs) in these candidate genes was performed in 2,847 participants from four racial/ethnic groups (African American, Chinese, White and Hispanic) without known cardiovascular disease in the Multi-Ethnic Study of Atherosclerosis. SNP and haplotype analyses were performed to determine associations between genotypes and cross-sectional renal function measurements, including urine albumin excretion (UAE) and estimated glomerular filtration rate (eGFR) using serum creatinine and cystatin C. RESULTS: Twenty-four ACE SNPs, 10 AGT SNPs, 15 AGTR1 SNPs and 6 AGTR2 SNPs were typed successfully. After adjusting for ancestry, age and gender, 3 SNPs (AGT M235T, AGT rs2148582 and AGTR1 rs2131127) showed associations with an empiric p value <0.05 with the same phenotype in multiple racial/ethnic groups, suggesting replication. The AGT M235T SNP has been shown previously to be associated with diabetic and hypertensive nephropathy. CONCLUSIONS: These data suggest that genetic polymorphisms in the renin-angiotensin system are associated with renal phenotypes in the general population, but that many associations differ across racial/ethnic groups.

Angiotensinogênio/genética , Aterosclerose/etnologia , Grupos Étnicos/genética , Nefropatias/etnologia , Nefropatias/genética , Peptidil Dipeptidase A/genética , Polimorfismo de Nucleotídeo Único , Receptor Tipo 1 de Angiotensina/genética , Receptor Tipo 2 de Angiotensina/genética , Sistema Renina-Angiotensina/genética , Idoso , Aterosclerose/genética , Estudos de Coortes , Feminino , Variação Genética , Humanos , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Fenótipo
Int J Antimicrob Agents ; 23 Suppl 1: S41-53, 2004 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-15037328


The efficacy and safety of two oral dosing regimens of gatifloxacin were compared to ciprofloxacin in the treatment of complicated urinary tract infection in a randomised, double-blind multi-centre trial. One thousand one hundred and twenty-three adult patients with complicated urinary tract infection (70%) or pyelonephritis (30%) were initially enrolled, 1122 were treated. Of these, 824 were included in a modified ITT population: gatifloxacin 200 mg (274 patients) or 400 mg (280 patients) once daily or ciprofloxacin 500 mg twice daily for 5-14 days (269 patients). Bacteriological and clinical responses were assessed 7-9 days after the end of treatment (EOT) and 4-6 weeks post-treatment (end of study visit, EOS). The bacteriological response rates per patient at EOT in the gatifloxacin 400 mg, gatifloxacin 200 mg and ciprofloxacin groups were 77% (207/269), 78% (208/268) and 73% (190/259), respectively. At EOS they were slightly lower: 70% (184/262), 71% (176/248) and 69% (174/252), respectively. The clinical responses at EOT were 69% (190/277), 70% (190/273) and 65% (174/266). At EOS they were 71% (193/273), 70% (182/259) and 74% (190/258). The overall eradication rates of initial pathogens at EOT and EOS were 85.3% and 88.4% in the gatifloxacin 400 mg group; 84.1 and 90.1% in the gatifloxacin 200 mg group and 85.1 and 91.4% in the ciprofloxacin group. Both oral regimens of gatifloxacin were as effective as that of ciprofloxacin. All treatment groups showed a similar safety profile, nausea being the most frequently reported adverse event.

Infecções Bacterianas/tratamento farmacológico , Ciprofloxacina/uso terapêutico , Fluoroquinolonas/uso terapêutico , Pielonefrite/tratamento farmacológico , Infecções Urinárias/tratamento farmacológico , Infecções Bacterianas/classificação , Ciprofloxacina/administração & dosagem , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Fluoroquinolonas/administração & dosagem , Gatifloxacina , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
Neurochirurgie ; 48(1): 30-4, 2002 Feb.
Artigo em Francês | MEDLINE | ID: mdl-11972148


A middle cerebral artery aneurysm, completely enclosed in a large frontotemporal anaplastic astrocytoma, is demonstrated in a 11-month-old girl admitted for intracranial hypertension. Clipping of the aneurysm along with radical resection was successfully performed. Five years later, follow-up neurological examination is normal, aneurysm occlusion and no evidence of tumor recurrence are demonstrated by angiogram and MRI. The association of brain tumor and aneurysm is discussed, and documented with the only two cases of a neoplasm surrounding on aneurysm reported in the literature.

Astrocitoma/complicações , Lobo Frontal , Aneurisma Intracraniano/complicações , Artéria Cerebral Média/patologia , Neoplasias Supratentoriais/complicações , Lobo Temporal , Astrocitoma/irrigação sanguínea , Astrocitoma/diagnóstico por imagem , Astrocitoma/patologia , Astrocitoma/cirurgia , Calcinose/etiologia , Angiografia Cerebral , Transtornos da Consciência/etiologia , Constrição , Feminino , Lobo Frontal/irrigação sanguínea , Lobo Frontal/diagnóstico por imagem , Lobo Frontal/patologia , Lobo Frontal/cirurgia , Humanos , Lactente , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/patologia , Aneurisma Intracraniano/cirurgia , Imageamento por Ressonância Magnética , Artéria Cerebral Média/diagnóstico por imagem , Artéria Cerebral Média/cirurgia , Neoplasias Supratentoriais/irrigação sanguínea , Neoplasias Supratentoriais/diagnóstico por imagem , Neoplasias Supratentoriais/patologia , Neoplasias Supratentoriais/cirurgia , Lobo Temporal/irrigação sanguínea , Lobo Temporal/diagnóstico por imagem , Lobo Temporal/patologia , Lobo Temporal/cirurgia , Vômito/etiologia