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1.
Eur J Endocrinol ; 184(3): 437-444, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33449911

RESUMO

Objective: Atrial fibrillation (AF) may be triggered by intravenous bisphosphonates (IVBPs) such as zoledronic acid or pamidronic acid. Our objective was to confirm the association between AF and IVBPs in a real-life large pharmacovigilance database. Design: A systematic analysis of VigiBase, the World Health Organization's pharmacovigilance database. Methods: Analysis of adverse events reported as 'atrial fibrillation' (according to the Medical Dictionary for Drug Regulatory Activities) associated with the use of zoledronic acid or pamidronic acid, in VigiBase, the World Health Organization's global Individual Case Safety Report (ICSR) database. All ICSRs reporting AF associated with zoledronic acid or pamidronic acid were included in a disproportionality analysis determining the lower end of the 95% credibility interval for the information component (IC025), showing a statistical association when >0. Results: 530 ICSRs reporting on the association between AF and IVBPs were extracted. Bayesian disproportionality analysis detected a significant association between AF and use of zoledronic acid (IC025 = 1.83) and pamidronic acid (IC025 = 2.16). Further analysis of these ICSRs determined that AF was severe in 85.0% of cases and with a mortality of 17.7%. The risk of severe AF was increased (OR: 2.98 (95% CI: 1.17-7.57), P = 0.02) following zoledronic acid vs pamidronic acid, after adjustment for age and gender. Conclusions: This is the first VigiBase pharmacoepidemiological study confirming the association between IVBPs and AF. Most AF were severe, with a high frequency of lethal outcome. The risk of severe AF was increased following zoledronic acid use compared to pamidronic acid, advocating for a cautious use of IVBPs.


Assuntos
Fibrilação Atrial/induzido quimicamente , Fibrilação Atrial/epidemiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Pamidronato/efeitos adversos , Ácido Zoledrônico/efeitos adversos , Administração Intravenosa , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , América do Norte/epidemiologia , Pamidronato/administração & dosagem , Farmacoepidemiologia , Farmacovigilância , Organização Mundial da Saúde , Ácido Zoledrônico/administração & dosagem
2.
BMJ Case Rep ; 12(10)2019 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-31666255

RESUMO

We report the case of a 59-year-old man with a history of type 2 diabetes, hypertension and chronic kidney disease who presented with symptomatic severe hypercalcaemia (calcium 15.8 mg/dL) and acute kidney injury. Evaluation revealed that the hypercalcaemia was not mediated by parathyroid hormone (PTH), PTH-related peptide or 1,25-hydroxyvitamin D. Adrenal insufficiency was subsequently diagnosed and was initially thought to be the aetiology of the hypercalcaemia. He was treated with intravenous fluid, pamidronate and started on hydrocortisone with resolution of his hypercalcaemia. Over the next several months, despite adherence to hydrocortisone therapy, the patient continued to have recurrent severe hypercalcaemia requiring hospitalisation. Additional laboratory evaluation showed similar results to the initial evaluation. On further questioning, the patient admitted to routinely ingesting the household cleaning product Comet, which contains a large amount of calcium. Psychiatric assessment confirmed the diagnosis of pica. The patient eventually discontinued ingestion of Comet with resolution of his hypercalcaemia.


Assuntos
Ingestão de Alimentos/psicologia , Produtos Domésticos/efeitos adversos , Hipercalcemia/etiologia , Pica/psicologia , Lesão Renal Aguda , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/uso terapêutico , Conservadores da Densidade Óssea/administração & dosagem , Conservadores da Densidade Óssea/uso terapêutico , Produtos Domésticos/toxicidade , Humanos , Hidrocortisona/administração & dosagem , Hidrocortisona/uso terapêutico , Hipercalcemia/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Pamidronato/administração & dosagem , Pamidronato/uso terapêutico , Pica/diagnóstico , Recidiva , Índice de Gravidade de Doença , Resultado do Tratamento
3.
G Ital Nefrol ; 36(5)2019 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-31580546

RESUMO

Calcific uremic arteriolopathy (CUA) is a highly morbid condition usually found in ESRD patients that has rarely been reported after renal transplantation and renal function restoration. Furthermore, little is known about the optimal management of CUA in this setting. Herein, we report on the clinical case of AB, a 70-year-old woman who developed CUA after renal transplantation and renal function restoration. However, other risk factors for CUA such as diabetes and warfarin treatment, due to mechanical aortic valve implantation, were present. Thirty-eight months after renal transplantation she developed erythema and livedo reticularis in both legs and a gradually enlarging skin ulcer in the right leg. A skin biopsy of the ulcer showed features compatible with the CUA, such as sub-intimal calcification and luminal obstruction of the small dermal arterioles, tissue ischemia and signs of adipocytes degeneration. A multidisciplinary approach was adopted, including medical and non-medical treatments such as surgical debridement and vacuum-assisted closure therapy. Medical treatments included a five weeks course of once a week intravenous infusion of pamidronate and intravenous sodium thiosulfate (STS) at increasing doses. Four months after beginning the therapy with STS, a complete healing of the ulcer on the right leg and the disappearance of the livedo reticularis on the left leg was noted. In conclusion, although rare CUA may develop also in renal transplanted patients, a timely and combined therapeutic approach is essential for its resolutive treatment. Sodium thiosulfate therapy has proven to be effective and tolerated.


Assuntos
Calciofilaxia/terapia , Transplante de Rim/efeitos adversos , Úlcera da Perna/terapia , Doenças Raras/terapia , Idoso , Anticoagulantes/uso terapêutico , Conservadores da Densidade Óssea/administração & dosagem , Calciofilaxia/etiologia , Quelantes/administração & dosagem , Terapia Combinada/métodos , Diabetes Mellitus , Feminino , Humanos , Úlcera da Perna/etiologia , Livedo Reticular/etiologia , Livedo Reticular/terapia , Pamidronato/administração & dosagem , Doenças Raras/etiologia , Fatores de Risco , Tiossulfatos/administração & dosagem , Varfarina/uso terapêutico
4.
BMJ Case Rep ; 12(9)2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31537587

RESUMO

We describe an 11-year prospective clinical and radiologic course of a 6-year-old boy with bilateral Legg-Calvé-Perthes disease, who was treated with intravenous pamidronate (IV-PAM). His baseline radiographs showed grade IV avascular necrosis/Catterall stage IV, and at worst he progressed to lateral pillar/Herring stage C bilaterally. His disease initially was extremely functionally limiting with expected poor outcome with eventual joint replacement. Because IV-PAM stops bone breakdown and allows for ongoing bone formation while revascularisation of bone occurs, we hypothesised that IV-PAM could act as an adjunct to traditional treatment to help heal the femoral heads. Our patient received nine once monthly doses of IV-PAM (1 mg/kg/dose) over 13 months, along with Petrie/broomstick casts and physiotherapy. Remarkably, over time, his femoral heads healed. Now, at 11-year follow-up, he has excellent functional and radiologic outcome with congruence between femoral head and acetabulum, no residual osteonecrosis and minimal loss of femoral head sphericity.


Assuntos
Conservadores da Densidade Óssea/administração & dosagem , Necrose da Cabeça do Fêmur/tratamento farmacológico , Doença de Legg-Calve-Perthes/tratamento farmacológico , Pamidronato/uso terapêutico , Conservadores da Densidade Óssea/uso terapêutico , Moldes Cirúrgicos , Criança , Cabeça do Fêmur/efeitos dos fármacos , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/patologia , Humanos , Doença de Legg-Calve-Perthes/reabilitação , Doença de Legg-Calve-Perthes/cirurgia , Masculino , Pamidronato/administração & dosagem , Tenotomia/métodos , Resultado do Tratamento
5.
Joint Bone Spine ; 86(6): 783-788, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31216487

RESUMO

OBJECTIVES: Assessment of bisphosphonates efficiency in the therapy of NSAIDs-refractory Chronic Recurrent Multifocal Osteomyelitis. METHODS: Retrospective analysis of records of patients treated for Chronic Recurrent Multifocal Osteomyelitis between 2012 and 2018. RESULTS: Between 2012 and 2018, 76 children and adolescents were diagnosed with Chronic Recurrent Multifocal Osteomyelitis in our department. All patients underwent an initial course of NSAIDs therapy that provided a remission in 46% of cases. Of 41 NSAIDs-resistant cases, 7 patients were male and 34 were female. Disease started meanly in the age of 10. Most frequently pain localised in foot, clavicle and hip. In presented group, pamidronate was administered intravenously in the dose of 1mg/kg/day for 3 days. Patients received 6 series (1-17 series) on average with mean interval of 10 weeks (4-14 weeks). Our observations demonstrated rapid decrease of symptoms intensity after first dose of pamidronate with relapse of pain after 3-4 weeks. The frequency of pamidronate dosage was dependent of patient's symptoms. No serious adverse effects were reported. We finished the therapy after complete remission of symptoms and complete bone remodelling in imaging. Of 41 patients, 32 achieved remission and 9 continue their therapy. In remission group patients received 7 series of pamidronate on average and their treatment lasted meanly 20 months. CONCLUSIONS: Pamidronate is a safe and efficient method of CRMO therapy, particularly in cases refractory to NSAIDs treatment. Treatment with pamidronate provides both symptomatic relief as well as normalisation of bone morphology.


Assuntos
Difosfonatos/administração & dosagem , Osteomielite/diagnóstico por imagem , Osteomielite/tratamento farmacológico , Pamidronato/administração & dosagem , Adolescente , Anti-Inflamatórios não Esteroides/administração & dosagem , Criança , Estudos de Coortes , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Seguimentos , Humanos , Masculino , Radiografia/métodos , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
6.
Biomed Mater Eng ; 30(3): 323-331, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31006658

RESUMO

Calcium phosphate cement (CPC) has been studied extensively due to its bioactivity and biodegradability. CPC is typically made by a combination of multiple calcium phosphates that form a paste that sets and hardens in the body after being combined with either water or an aqueous solution. It is highly moldable and easily manipulated, and CPCs possess osteoconductive properties. Due to these characteristics, CPCs offer great promise in bone grafting applications. CPC combined with drugs has a great potential as drug delivery system and has been studied extensively. In this review we have focused on Bisphosphonate-CPC drug delivery system. In addition, we introduce and discuss the potential of studying other bisphosphonates.


Assuntos
Conservadores da Densidade Óssea/administração & dosagem , Fosfatos de Cálcio/química , Difosfonatos/química , Portadores de Fármacos/química , Alendronato/administração & dosagem , Animais , Materiais Biocompatíveis/química , Sistemas de Liberação de Medicamentos/métodos , Ácido Etidrônico/administração & dosagem , Humanos , Pamidronato/administração & dosagem , Ácido Zoledrônico/administração & dosagem
7.
J Hum Genet ; 64(4): 291-296, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30692598

RESUMO

A rare form of osteogenesis imperfecta (OI) caused by Wingless-type MMTV integration site family 1 (WNT1) mutations combines central nervous system (CNS) anomalies with the characteristic increased susceptibility to fractures. We report an additional case where arachnoid cysts extend the phenotype, and that also confirms the association of intellectual disabilities with asymmetric cerebellar hypoplasia here. Interestingly, if the cerebellum is normal in this disorder, intelligence is as well, analogous to an association with similar delays in a subset of patients with sporadic unilateral cerebellar hypoplasia. Those cases typically appear to represent vascular disruptions, and we suggest that most brain anomalies in WNT1-associated OI have vascular origins related to a role for WNT1 in CNS angiogenesis. This unusual combination of benign cerebellar findings with effects on higher functions in these two situations raises the possibility that WNT1 is involved in the pathogenesis of the associated sporadic cases as well. Finally, our patient reacted poorly to pamidronate, which appears ineffective with this form of OI, so that a lack of improvement is an indication for molecular testing that includes WNT1.


Assuntos
Sistema Nervoso Central/fisiopatologia , Deficiência Intelectual/genética , Osteogênese Imperfeita/genética , Proteína Wnt1/genética , Cistos Aracnóideos/diagnóstico por imagem , Cistos Aracnóideos/fisiopatologia , Sistema Nervoso Central/anormalidades , Sistema Nervoso Central/diagnóstico por imagem , Cerebelo/anormalidades , Cerebelo/diagnóstico por imagem , Cerebelo/fisiopatologia , Deficiências do Desenvolvimento/diagnóstico por imagem , Deficiências do Desenvolvimento/genética , Deficiências do Desenvolvimento/fisiopatologia , Lobo Frontal/diagnóstico por imagem , Lobo Frontal/fisiopatologia , Humanos , Deficiência Intelectual/diagnóstico por imagem , Deficiência Intelectual/tratamento farmacológico , Deficiência Intelectual/fisiopatologia , Mutação , Malformações do Sistema Nervoso/diagnóstico por imagem , Malformações do Sistema Nervoso/genética , Malformações do Sistema Nervoso/fisiopatologia , Osteogênese Imperfeita/diagnóstico por imagem , Osteogênese Imperfeita/tratamento farmacológico , Osteogênese Imperfeita/fisiopatologia , Pamidronato/administração & dosagem , Pamidronato/efeitos adversos
8.
BMJ Case Rep ; 12(1)2019 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-30674496

RESUMO

This is a case of a 67-year-old woman, known to have multiple medical problems, mainly papillary thyroid cancer status post-total thyroidectomy and cervical neck dissection in addition to radioactive iodine currently in remission for 1 year, who presented to the hospital with severe weakness and fatigue. The initial workup showed significant hypercalcaemia and suppressed Parathyroid hormone (PTH). The patient was treated with hydration and pamidronate and her hypercalcaemia and symptoms improved. The differential was wide, however, a CT scan of the chest, abdomen and pelvis did show multiple liver and splenic nodular lesions; therefore, malignancy was the highest possible diagnosis. Biopsy of the splenic lesion confirmed the diagnosis of sarcoidosis. Therefore, the patient was diagnosed with primary isolated nodular hepatosplenic sarcoidosis mimicking malignancy and causing significant symptomatic hypercalcaemia.


Assuntos
Hipercalcemia/etiologia , Neoplasias/diagnóstico por imagem , Sarcoidose/complicações , Assistência ao Convalescente , Idoso , Conservadores da Densidade Óssea/uso terapêutico , Diagnóstico Diferencial , Feminino , Humanos , Hipercalcemia/diagnóstico , Hipercalcemia/tratamento farmacológico , Hepatopatias/complicações , Hepatopatias/diagnóstico por imagem , Hepatopatias/patologia , Pamidronato/administração & dosagem , Pamidronato/uso terapêutico , Sarcoidose/diagnóstico por imagem , Sarcoidose/patologia , Sarcoidose/terapia , Esplenopatias/complicações , Esplenopatias/diagnóstico por imagem , Esplenopatias/patologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
9.
Calcif Tissue Int ; 104(2): 182-192, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30302533

RESUMO

Duchenne muscular dystrophy (DMD) is an X-linked disease of progressive muscle deterioration and weakness. Patients with DMD have poor bone health which is partly due to treatment with glucocorticoids, a standard therapy to prolong muscle function that also induces bone loss. Bisphosphonates are used to treat adults at risk of glucocorticoid-induced osteoporosis but are not currently used in DMD patients until after they sustain fractures. In this study, C57BL/10ScSn-mdx mice, a commonly used DMD animal model, received continuous glucocorticoid, prednisone treatment (0.083 mg/day) from 5 to 10 weeks of age. Pre-treatment with the bisphosphonate pamidronate started at 4 weeks of age over a period of 2 weeks or 6 weeks (cumulative dose 8 mg/kg for both) to assess the effectiveness of the two dosing regimens in ameliorating glucocorticoid-induced bone loss. Mdx mice treated with prednisone had improved muscle function that was not changed by pamidronate treatment. Glucocorticoid treatment caused cortical bone loss and decreased cortical bone strength. Both 2 and 6 week pamidronate treatment increased cortical thickness and bone area compared to prednisone-treated Mdx mice, however, only 2 week pamidronate treatment improved the strength of cortical bone compared to that of glucocorticoid-treated Mdx mice. In the trabecular bone, both pamidronate treatments significantly increased the amount of bone, and increased the ultimate load but not the energy to fail. These results highlight the importance of when and how much bisphosphonate is administered prior to glucocorticoid exposure.


Assuntos
Fenômenos Biomecânicos/efeitos dos fármacos , Osso e Ossos/efeitos dos fármacos , Glucocorticoides/uso terapêutico , Distrofia Muscular de Duchenne/tratamento farmacológico , Pamidronato/administração & dosagem , Animais , Doenças Ósseas Metabólicas/induzido quimicamente , Doenças Ósseas Metabólicas/prevenção & controle , Osso e Ossos/fisiologia , Osso Esponjoso/efeitos dos fármacos , Osso Cortical/efeitos dos fármacos , Modelos Animais de Doenças , Esquema de Medicação , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Endogâmicos mdx , Camundongos Transgênicos , Força Muscular/efeitos dos fármacos , Força Muscular/fisiologia , Distrofia Muscular de Duchenne/patologia
10.
Int Wound J ; 16(1): 250-255, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30393969

RESUMO

Calciphylaxis is a rare and potentially fatal disease that affects the subcutaneous layer of the skin. It is a calcific vasculopathy induced by a systemic process that causes occlusion of small blood vessels. The mortality rate for individuals diagnosed with calciphylaxis is estimated between 52% and 81% with sepsis being the leading cause of death. Uraemic calciphylaxis and its known effective treatments are well documented in the literature. Unfortunately, there is no known effective treatment for non-uraemic calciphylaxis. Most of the current treatments for non-uraemic calciphylaxis are derived from uraemic calciphylaxis treatment protocols. We report a case of a 75-year-old female with calciphylaxis on the right lower extremity who was successfully treated with four pamidronate infusions in addition to local wound care. This case represents a non-uraemic calciphylaxis wound successfully treated with pamidronate infusions and standard wound care, and suggests that IV pamidronate can be an effective treatment option.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Calciofilaxia/diagnóstico , Calciofilaxia/tratamento farmacológico , Pamidronato/administração & dosagem , Pamidronato/uso terapêutico , Administração Intravenosa , Idoso , Feminino , Humanos , Resultado do Tratamento
11.
J Oncol Pharm Pract ; 25(7): 1787-1793, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30419769

RESUMO

This is a case report of a patient who developed severe, irreversible hypocalcemia after receiving one dose of pamidronate 90 mg for hypercalcemia of malignancy. Hypocalcemia is a known risk of bisphosphonate treatments, but the incidence of severe hypocalcemia is rare, and the risk factors are well established. However, in the treatment of hypercalcemia of malignancy, the treatment objective is to reduce the elevated serum calcium level, and the bisphosphonate is usually given as one time dose only. The potential for developing severe hypocalcemia may not be considered a significant concern in this setting compared to the setting of the treatment of bone metastasis, where the baseline serum calcium level is not elevated and the bisphosphonate is administered at a regular interval of every three to four weeks. Furthermore, there is unawareness of prevalence of vitamin D deficiency in cancer patients, especially in those with advanced cancer, which may lead to inadvertent, severe hypocalcemia from bisphosphonate treatment. The objective of this case report is to bring awareness to the risk of severe hypocalcemia in patients with hypercalcemia of malignancy and the high prevalence of unrecognized vitamin D deficiency in cancer patients.


Assuntos
Hipercalcemia/tratamento farmacológico , Hipocalcemia/induzido quimicamente , Pamidronato/efeitos adversos , Neoplasias Ósseas/tratamento farmacológico , Cálcio/metabolismo , Humanos , Hipercalcemia/etiologia , Masculino , Pessoa de Meia-Idade , Pamidronato/administração & dosagem , Fatores de Risco
12.
Actual. osteol ; 14(2): 148-150, Mayo - Ago. 2018. ilus
Artigo em Espanhol | LILACS | ID: biblio-1116417

RESUMO

El término "distrofia ósea esclerosante mixta" describe la combinación de las características radiológicas correspondientes a melorreostosis, osteopoiquilosis y osteopatía estriada, como entidades individuales, que ocurren en un mismo paciente. El objetivo de esta comunicación es presentar el caso clínico de una paciente con diagnóstico de distrofia ósea esclerosante mixta y, a partir de este caso, realizar una revisión sobre el tema. (AU)


The term "mixed-sclerosing-bone-dystrophy" describes the combination of the radiological characteristics corresponding to melorheostosis, osteopoikilosis and osteopathia striata, as individual conditions, ocurring in the same patient. The aim of this communication is to present the clinical case of a patient diagnosed with mixed-sclerosing-bone-dystrophy and, based on this case, to undertake a review of this condition. (AU)


Assuntos
Humanos , Feminino , Adulto , Osteopecilose/diagnóstico , Doenças Ósseas Metabólicas/diagnóstico , Melorreostose/diagnóstico , Osteíte Deformante/diagnóstico , Osteíte Deformante/tratamento farmacológico , Osteíte Deformante/sangue , Osteopecilose/sangue , Radiologia , Tíbia/diagnóstico por imagem , Doenças Ósseas Metabólicas/sangue , Menopausa Precoce/metabolismo , Fêmur/diagnóstico por imagem , Pamidronato/administração & dosagem , Melorreostose/sangue
13.
J Prosthodont ; 27(3): 240-249, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27870311

RESUMO

PURPOSE: To our knowledge from indexed literature, the present study is the first one to systematically review the influence of local delivery of pamidronate (PAM) and/or ibandronate (IBA) on osseointegration enhancement. The aim of the present systematic review was to assess the efficacy of IBA and/or PAM local delivery (topically or coating on implants surfaces) in promoting osseointegration. MATERIALS AND METHODS: To address the focused question, "Does local IBA and/or PAM delivery enhances osseointegration?," indexed databases were searched without time or language restrictions up to and including May 2016 using various combinations of the following keywords: "pamidronate," "ibandronate," "bisphosphonates," "osseointegration," and "topical administration." Letters to the Editor, historic reviews, commentaries, case series, and case reports were excluded. RESULTS: Fifteen studies were included. Fourteen studies were performed in animals and 2 were clinical trials. One study reported an experimental model and a clinical trial in the same publication. Results from 12 experimental studies and 2 clinical studies reported improved biomechanical properties and/or osseointegration around implants with PAM and/or IBA. Two experimental studies showed that PAM and/or IBA did not improve osseointegration. CONCLUSIONS: On experimental grounds, local IBA and/or PAM delivery seems to enhance osseointegration; however, from a clinical perspective, further randomized control trials are needed to assess the effectiveness of IBA and PAM in promoting osseointegration around dental implants.


Assuntos
Conservadores da Densidade Óssea/administração & dosagem , Ácido Ibandrônico/administração & dosagem , Osseointegração/efeitos dos fármacos , Pamidronato/administração & dosagem , Administração Tópica , Humanos
14.
Colomb Med (Cali) ; 49(4): 288-291, 2018 Dec 30.
Artigo em Inglês | MEDLINE | ID: mdl-30700922

RESUMO

Introduction: Calciphylaxis is an infrequent disease that almost exclusively affects patients with chronic kidney disease, although cases have been observed in patients without renal function impairment. The diagnosis is mainly made by clinical manifestations and subsequently confirmed by radiological and histological study. The optimal treatment is not known, although there is a consensus that a multifactorial approach is required. Clinical Case: A 68-year-old woman on hemodialysis for 2 years, who presented a painful nodular lesion in the left thigh, a skin biopsy was performed resulting in a diagnosis of calciphylaxis. Treatment and Outcome: Treatment was started with intravenous sodium thiosulfate. Pamidronate is added intravenously, three months later, due to an unfavorable evolution. After 6 months of treatment, improvement in nodular lesions and healing of the ulcerated lesion was observed to be generally well tolerated treatment. Conclusion: The combined treatment of sodium thiosulfate, pamidronate and calcitomimetics has been effectiveand safe for the treatment of calciphylaxis, inducing complete remission.


Assuntos
Calciofilaxia/tratamento farmacológico , Falência Renal Crônica/complicações , Pamidronato/administração & dosagem , Tiossulfatos/administração & dosagem , Administração Intravenosa , Idoso , Calciofilaxia/etiologia , Calciofilaxia/patologia , Quelantes/administração & dosagem , Quimioterapia Combinada , Feminino , Humanos , Falência Renal Crônica/terapia , Diálise Renal/métodos , Resultado do Tratamento
15.
Actual. osteol ; 13(3): 243-250, Sept - DIc. 2017. ilus, tab
Artigo em Espanhol | LILACS | ID: biblio-1117571

RESUMO

La hipercalcemia es un trastorno común que representa aproximadamente el 0,6% de todas las admisiones médicas agudas. El hiperparatiroidismo primario (HPTP) y las neoplasias malignas son las dos causas más comunes de elevación de los niveles séricos de calcio; constituyen, en conjunto, alrededor del 90% de todos los casos. La presentación sintomática clásica de la hipercalcemia se observa con relativa poca frecuencia en el mundo desarrollado; la presentación más común es la detección asintomática en las pruebas bioquímicas. Sin embargo, en casos raros, el HPTP puede desarrollar hipercalcemia aguda, grave y sintomática, llamada crisis hipercalcémica (CH). Esta condición se asocia a alteraciones profundas en el estado mental y las funciones cardíaca, renal y gastrointestinal en presencia de concentraciones marcadamente elevadas de calcio sérico y paratohormona (PTH). Mientras que algunas elevaciones en el calcio sérico pueden ser bien toleradas, los síntomas de la CH son severos. Si el tratamiento se retrasa, la CH puede provocar la muerte. Describimos el caso de un paciente masculino que ingresa en la unidad de cuidados críticos por una CH secundaria a un HPTP por adenoma paratiroideo. (AU)


Hypercalcaemia is a most common disorder, accounting for approximately 0,6% of all acute medical admissions. Primary hyperparathyroidism (PHPT) and malignancy are the two most common causes of increased serum calcium levels, together accounting for about 90% of all cases. The classical symptomatic presentation of hypercalcaemia is seen relatively rarely in the developed world, the most common presentation being asymptomatic and detected following on biochemical testing. However, in rare cases HPTP can result in acute, severe and symptomatic hypercalcemia, called hypercalcemic crisis (HC). This condition is associated with profound disturbances in mental status, and cardiac, renal, and gastrointestinal function in the presence of markedly increased serum calcium and parathyroid hormone (PTH) concentrations. While some elevations in serum calcium can be well tolerated, symptoms of HC are severe. If treatment is delayed, HC can result in death. We describe herein a case of a male patient who was admitted to the intensive care unit as a consequence of HC resulting from elevated PTH, secondary to a parathyroid adenoma. We describe the case of a male patient who was admitted to the critical care unit for a HC mediated by PTH secondary to a parathyroid adenoma. (AU)


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias das Paratireoides/complicações , Glândulas Paratireoides/patologia , Hiperparatireoidismo Primário/complicações , Hipercalcemia/induzido quimicamente , Hormônio Paratireóideo/metabolismo , Hormônio Paratireóideo/sangue , Neoplasias das Paratireoides/cirurgia , Neoplasias das Paratireoides/diagnóstico por imagem , Glândulas Paratireoides/cirurgia , Deficiência de Vitamina D/sangue , Calcitriol/administração & dosagem , Gluconato de Cálcio/administração & dosagem , Perda de Peso , Anti-Inflamatórios não Esteroides/uso terapêutico , Cálcio/administração & dosagem , Cálcio/sangue , Diálise Renal , Colecalciferol/administração & dosagem , Desidratação , Diuréticos/administração & dosagem , Hiperparatireoidismo Primário/cirurgia , Hiperparatireoidismo Primário/diagnóstico , Cinacalcete/administração & dosagem , Pamidronato/administração & dosagem , Soluções Cristaloides/administração & dosagem , Hipercalcemia/diagnóstico , Hipercalcemia/tratamento farmacológico , Hipercalcemia/sangue
16.
Rev. bras. reumatol ; 57(6): 514-520, Nov.-Dec. 2017. tab, graf
Artigo em Inglês | LILACS | ID: biblio-899474

RESUMO

Abstract Purpose: The use of bisphosphonates for osteoporosis is effective in reducing the risk of fractures. However, oral formulations are sometimes not well tolerated or are contraindicated. Due to its availability in Brazilian public health system, pamidronate is frequently prescribed for osteoporosis, despite the lack of studies demonstrating its anti-fracture efficacy and the absence of FDA or EMEA approval for this purpose. The aim of this study was to evaluate the bone mineral density (BMD) response to pamidronate in a group of women with osteoporosis in a tertiary care hospital. Patients and methods: The medical records of women with osteoporosis who received pamidronate for up to two years of treatment were reviewed. Patients were stratified at high or intermediate risk of fracture. Results: A total of 70 women were in treatment with pamidronate. Among them, 74% were at high risk of fracture. A significant gain in spine BMD after 24 months of treatment was observed (p = 0.012). There was no difference between the groups of high and not high risk of fracture. At the femur, no significant increase in BMD was present, though, a strong negative correlation with high PTH levels (r = −0.61; p = 0.003) was seen. In the multivariate analysis BMI at 12 months had impact in the response to the treatment. Conclusion The intravenous pamidronate in a group of postmenopausal women with predominant high risk of fracture promoted an isolated gain in the spine BMD, even though, clinical randomized trials are needed to confirm its anti-fracture efficacy.


Resumo Justificativa: O uso de bisfosfonatos para a osteoporose é eficaz na redução do risco de fraturas. No entanto, as formulações orais às vezes não são bem toleradas ou são contraindicadas. Em razão da sua disponibilidade no sistema público de saúde brasileiro, o pamidronato é frequentemente prescrito para a osteoporose, apesar da falta de estudos que demonstrem a sua eficácia antifratura e da ausência de aprovação da Food and Drug Administration (FDA) ou da European Medicine Agency (Emea) para essa finalidade. O objetivo deste estudo foi avaliar a resposta da densidade mineral óssea (DMO) ao pamidronato em um grupo de mulheres com osteoporose em um hospital terciário. Pacientes e métodos: Revisaram-se os prontuários médicos de mulheres com osteoporose que receberam pamidronato por até dois anos de tratamento. As pacientes foram estratificadas em risco alto ou intermediário de fratura. Resultados: Estavam em tratamento com pamidronato 70 mulheres. Entre elas, 74% tinham alto risco de fratura. Observou-se um ganho significativo na DMO da coluna vertebral após 24 meses de tratamento (p = 0,012). Não houve diferença entre os grupos de risco de fratura alto e não alto. No fêmur, não foi encontrado aumento significativo na massa óssea; contudo, observou-se uma forte correlação negativa com altos níveis de PTH (r = −0,61; p = 0,003). Na análise multivariada, o IMC aos 12 meses tinha impacto na resposta ao tratamento. Conclusão O pamidronato intravenoso em um grupo de mulheres na pós-menopausa predominantemente com alto risco de fratura promoveu um ganho isolado na DMO da coluna vertebral, embora sejam necessários ensaios clínicos randomizados para confirmar sua eficácia antifratura.


Assuntos
Humanos , Feminino , Idoso , Idoso de 80 Anos ou mais , Densidade Óssea/efeitos dos fármacos , Osteoporose Pós-Menopausa/tratamento farmacológico , Conservadores da Densidade Óssea/administração & dosagem , Pamidronato/administração & dosagem , Brasil , Modelos Logísticos , Estudos Retrospectivos , Conservadores da Densidade Óssea/farmacologia , Administração Intravenosa , Pamidronato/farmacologia , Pessoa de Meia-Idade
17.
Rev Bras Reumatol Engl Ed ; 57(6): 514-520, 2017.
Artigo em Inglês, Português | MEDLINE | ID: mdl-29173688

RESUMO

PURPOSE: The use of bisphosphonates for osteoporosis is effective in reducing the risk of fractures. However, oral formulations are sometimes not well tolerated or are contraindicated. Due to its availability in Brazilian public health system, pamidronate is frequently prescribed for osteoporosis, despite the lack of studies demonstrating its anti-fracture efficacy and the absence of FDA or EMEA approval for this purpose. The aim of this study was to evaluate the bone mineral density (BMD) response to pamidronate in a group of women with osteoporosis in a tertiary care hospital. PATIENTS AND METHODS: The medical records of women with osteoporosis who received pamidronate for up to two years of treatment were reviewed. Patients were stratified at high or intermediate risk of fracture. RESULTS: A total of 70 women were in treatment with pamidronate. Among them, 74% were at high risk of fracture. A significant gain in spine BMD after 24 months of treatment was observed (p=0.012). There was no difference between the groups of high and not high risk of fracture. At the femur, no significant increase in BMD was present, though, a strong negative correlation with high PTH levels (r=-0.61; p=0.003) was seen. In the multivariate analysis BMI at 12 months had impact in the response to the treatment. CONCLUSION: The intravenous pamidronate in a group of postmenopausal women with predominant high risk of fracture promoted an isolated gain in the spine BMD, even though, clinical randomized trials are needed to confirm its anti-fracture efficacy.


Assuntos
Conservadores da Densidade Óssea/administração & dosagem , Densidade Óssea/efeitos dos fármacos , Osteoporose Pós-Menopausa/tratamento farmacológico , Pamidronato/administração & dosagem , Administração Intravenosa , Idoso , Idoso de 80 Anos ou mais , Conservadores da Densidade Óssea/farmacologia , Brasil , Feminino , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Pamidronato/farmacologia , Estudos Retrospectivos
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