RESUMO
Epidemiology and prognosis of complications related to allogeneic hematopoietic stem cell transplant (HSCT) recipients requiring admission to intensive care unit (ICU) have not been reassessed precisely in the past few years. We performed a retrospective single-center study on 318 consecutive HSCT patients (2009-2013), analyzing outcome and factors prognostic of ICU admission. Among these patients, 73 were admitted to the ICU. In all, 32 patients (40.3%) died in ICU, 46 at hospital discharge (63%) and 61 (83.6%) 1 year later. Survivors had a significantly lower sequential organ failure assessment (SOFA) score, serum lactate and bilirubin upon ICU admission. Catecholamine support, mechanical ventilation (MV) and/or renal replacement therapy during ICU stay, a delayed organ support and an active graft versus host disease (GvHD) significantly worsen the outcome. By multivariate analysis, the worsening of SOFA score from days 1 to 3, the need for MV and the occurrence of an active GvHD were predictive of mortality. In conclusion, the incidence of HSCT-related complications requiring an admission to an ICU was at 22%, with an ICU mortality rate of 44%, and 84% 1 year later. A degradation of SOFA score at day 3 of ICU, need of MV and occurrence of an active GvHD are main predictive factors of mortality.
Assuntos
Doença Enxerto-Hospedeiro , Transplante de Células-Tronco Hematopoéticas , Unidades de Terapia Intensiva , Adulto , Aloenxertos , Intervalo Livre de Doença , Feminino , Seguimentos , Doença Enxerto-Hospedeiro/mortalidade , Doença Enxerto-Hospedeiro/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Taxa de SobrevidaAssuntos
COVID-19 , Infecção Hospitalar , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Estudos Transversais , Pessoal de Saúde , Humanos , Controle de Infecções , Equipamento de Proteção Individual , Recursos Humanos em Hospital , Reação em Cadeia da Polimerase Via Transcriptase Reversa , SARS-CoV-2 , Estudos SoroepidemiológicosRESUMO
OBJECTIVES: The purpose of this study was to investigate the effects of a selective alpha2-adrenergic agonist, alpha-methylnorepinephrine (alphaMNE) as an alternative vasopressor agent during cardiopulmonary resuscitation (CPR). BACKGROUND: For more than 40 years, epinephrine has been the vasopressor agent of choice for CPR. Its beta- and alpha1-adrenergic effects increase myocardial oxygen consumption, magnify global myocardial ischemia and increase the severity of postresuscitation myocardial dysfunction. METHODS: Ventricular fibrillation (VF) was induced in 20 Sprague-Dawley rats. After 8 min of untreated VF, mechanical ventilation and precordial compression began. AlphaMNE, epinephrine or saline placebo was injected into the right atrium 2 min after the start of precordial compression. As an additional control, one group of animals was pretreated with alpha2-receptor blocker, yohimbine, before injection of alphaMNE. Defibrillation was attempted 4 min later. Left ventricular pressure, dP/dt40, negative dP/dt and cardiac index were measured for an interval of 240 min after resuscitation. RESULTS: Except for saline placebo and yohimbine-treated animals, comparable increases in coronary perfusion pressure were observed after each drug intervention. All animals were successfully resuscitated. Left ventricular diastolic pressure, cardiac index, dP/dt40 and negative dP/dt were more optimal after alphaMNE; this was associated with significantly better postresuscitation survival. Pretreatment with vohimbine abolished the beneficial effects of alphaMNE. CONCLUSIONS: The selective alpha2-adrenergic agonist, alphaMNE, was as effective as epinephrine for initial cardiac resuscitation but provided strikingly better postresuscitation myocardial function and survival.
Assuntos
Reanimação Cardiopulmonar , Parada Cardíaca/terapia , Nordefrin/uso terapêutico , Vasoconstritores/uso terapêutico , Antagonistas Adrenérgicos alfa/farmacologia , Animais , Masculino , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley , Pressão Ventricular/efeitos dos fármacos , Ioimbina/farmacologiaRESUMO
Sirolimus is a new potent immunosuppressive drug used in organ transplantation; its major advantage is the absence of deterioration in renal function. Documented adverse effects include myelosuppression and hyperlipidemia. Recently several cases of sirolimus-associated interstitial pneumonitis have been reported, usually of mild severity. We report a new case that was complicated by a severe acute respiratory distress syndrome, which required several days of mechanical ventilation. No infectious or cardiogenic etiology was documented. Low sirolimus blood levels and acute CD4 lymphocytic alveolitis suggested an immune-related mechanism rather than a direct toxic effect of the drug. The patient recovered after discontinuation of sirolimus and the administration of corticosteroids.
Assuntos
Transplante de Rim/imunologia , Síndrome do Desconforto Respiratório/induzido quimicamente , Sirolimo/efeitos adversos , Humanos , Imunossupressores/efeitos adversos , Masculino , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Respiração Artificial , Síndrome do Desconforto Respiratório/diagnóstico por imagem , Síndrome do Desconforto Respiratório/terapia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
STUDY OBJECTIVE: To compare the effects of biphasic defibrillation waveforms and conventional monophasic defibrillation waveforms on the success of initial defibrillation, postresuscitation myocardial function, and duration of survival after prolonged duration of untreated ventricular fibrillation (VF), including the effects of epinephrine. DESIGN: Prospective, randomized, animal study. SETTING: Animal laboratory and university-affiliated research and educational institute. PARTICIPANTS: Domestic pigs. INTERVENTIONS: VF was induced in 20 anesthetized domestic pigs receiving mechanical ventilation. After 10 min of untreated VF, the animals were randomized. Defibrillation was attempted with up to three 150-J biphasic waveform shocks or a conventional sequence of 200-J, 300-J, and 360-J monophasic waveform shocks. When reversal of VF was unsuccessful, precordial compression was performed for 1 min, with or without administration of epinephrine. The protocol was repeated until spontaneous circulation was restored or for a maximum of 15 min. MEASUREMENTS AND RESULTS: No significant differences in the success of initial resuscitation or in the duration of survival were observed. However, significantly less impairment of myocardial function followed biphasic shocks. Administration of epinephrine reduced the total electrical energy required for successful resuscitation with both biphasic and monophasic waveform shocks. CONCLUSIONS: Lower-energy biphasic waveform shocks were as effective as conventional higher-energy monophasic waveform shocks for restoration of spontaneous circulation after 10 min of untreated VF. Significantly better postresuscitation myocardial function was observed after biphasic waveform defibrillation. Administration of epinephrine after prolonged cardiac arrest decreased the total energy required for successful resuscitation.
Assuntos
Cardioversão Elétrica/métodos , Fibrilação Ventricular/terapia , Animais , Fenômenos Biofísicos , Biofísica , Masculino , Contração Miocárdica , Estudos Prospectivos , Distribuição Aleatória , Suínos , Fibrilação Ventricular/fisiopatologia , Função Ventricular EsquerdaRESUMO
OBJECTIVE: To compare values of SvO2 obtained by reflectance spectrophotometry continuous monitoring with those obtained from blood samples measurements by transmission spectrophotometry (Co-Oximetry). DESIGN: Values of SvO2 recorded by three pulmonary artery catheters for continuous monitoring, SAT1, SAT2 and Oximetrix3 (OX3), were compared in a prospective manner to those measured on blood samples by a Co-Oximeter, using the statistical analysis of Bland and Altman. SETTING: Adult intensive care unit in an University Hospital. PATIENTS: 37 patients admitted for acute respiratory failure and/or shock who required hemodynamic monitoring. MAIN RESULTS: The bias (average under- or overestimation) was small for all comparative measurements: +1.3, -0.2 and +1.0 sat% for SAT1, SAT2 and OX3, respectively. However, limits of agreement were only acceptable for SAT2 (-8.3 to +7.9 sat%) and OX3 (-6.7 to +8.6 sat%), but not for SAT1 (-23.3 to +25.9 sat%). No significant drift during 24 h was found with the three catheters. However, in vitro calibration was only found acceptable for SAT2 and OX3. The results were not influenced by the numbers of wavelengths of the device (2 for SAT1 and SAT2, and 3 for OX3) nor did they correlate with any of the hemodynamic and biochemical variables tested. CONCLUSION: For usual monitoring in the ICU, SAT2 and OX3, gave SvO2 values which are in acceptable agreement with SvO2 measured on blood samples by Co-Oximetry.
Assuntos
Cateterismo de Swan-Ganz/instrumentação , Oximetria/métodos , Oxigênio/sangue , Idoso , Viés , Índices de Eritrócitos , Tecnologia de Fibra Óptica , Hemodinâmica , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Espectrofotometria/métodosRESUMO
Temporary vascular access is an essential component to perform any extracorporeal renal replacement therapy (RRT) in the acute renal failure patient. RRT used in the acute setting may be categorized in two groups: intermittent (IRRT) and continuous (CRRT). Therapeutic indications are based on clinical and technical considerations. Continuous modalities are mainly utilized in intensive care units for hemodynamically compromised patient. Initially performed spontaneously via an arteriovenous circuit, CRRT modalities have progressively become venovenous with the circulatory assistance of a blood pump. Since both intermittent and continuous RRT modalities are now performed almost exclusively by venovenous modalities, this article deals exclusively with temporary venous catheters. At present, double-lumen catheters represent the most common vascular access for RRT modalities. Semi-rigid polyurethane catheters currently used in case of emergency are limited to short term use. Hemocompatible, flexible silicone catheters, less aggressive for the vessels, seem better suited for the medium and long term run. The tunneled silicone catheters (DualCath type) meet the short and long term needs, and allow for blood flow rates up to 400 ml/min. The internal jugular vein, particularly the right one, seems to warrant the proper functioning of catheters while reducing the risk of stenotic complications. Subclavian access should be limited in time and reserved for silicone catheters in order to limit the risk of stenosis and/or thrombosis. Femoral access, very useful in cases of emergency and respiratory problems, greatly impairs the patient's mobility and should be limited by time to prevent thrombosis and/or infection. Late and/or delayed dysfunctioning of catheters are indicative of a thrombosis. Performance standards of catheters are less of a limiting factor in continuous low flow RRT modalities than in the intermittent ones. Finally, careful handling of the catheter essential to prevent infectious complications.
Assuntos
Injúria Renal Aguda/terapia , Cateteres de Demora , Terapia de Substituição Renal/métodos , Injúria Renal Aguda/fisiopatologia , Pressão Sanguínea , Cateteres de Demora/efeitos adversos , Veia Femoral , Humanos , Veias Jugulares , Terapia de Substituição Renal/efeitos adversos , Terapia de Substituição Renal/instrumentação , Veia Subclávia , Pressão VenosaRESUMO
An 18-year-old woman presented with a large anterior myocardial infarction. Her cardiovascular risk factors were cigarette smoking in moderation and oral contraception with a synthetic oestroprogestative pill prescribed a few months previously. Coronary angiography showed occlusion of the left anterior descending artery but no other lesions. Biological investigations excluded an abnormality of coagulation. Antibodies to synthetic steroids (ethinylestradiol and progesterone) and circulating immune complexes were found in the serum. The role of antiethinylestradiol antibodies in the mechanism of myocardial infarction is discussed. These antibodies are present in 30 per cent of women taking oral contraceptives and their titres are significantly higher in 90 per cent of women who develop vascular thrombosis unrelated to atherosclerosis. The mechanism of the thrombogenic action of the antibodies and circulating immune complexes is also considered.
Assuntos
Anticorpos/análise , Anticoncepcionais Orais/efeitos adversos , Doença das Coronárias/etiologia , Trombose Coronária/etiologia , Etinilestradiol/imunologia , Infarto do Miocárdio/etiologia , Adolescente , Angiocardiografia , Angiografia Coronária , Eletrocardiografia , Feminino , Humanos , Fatores de Risco , FumarRESUMO
INTRODUCTION: During a pneumococcal septicemia, the direct revelation of bacteria on a blood smear is rare and has been mainly described in splenectomised patients. OBSERVATION: A 62 year-old non-splenectomised man suffering from myeloma died, a few hours after his admission to emergency department, from a fulminant pneumococcemia, the diagnosis of which had been rapidly evoked on the examination of a blood smear showing numerous Gram positive diplococci. COMMENTS: This observation highlights the potential severity of pneumococcal infections in patients suffering from altered humoral immunity and the diagnostic interest, in this case, of a systematic routine blood smear permitting rapid initiation of appropriate treatment.
Assuntos
Bacteriemia/diagnóstico , Bacteriemia/microbiologia , Técnicas Bacteriológicas/métodos , Hospedeiro Imunocomprometido , Mieloma Múltiplo/complicações , Infecções Pneumocócicas/diagnóstico , Infecções Pneumocócicas/etiologia , Coloração e Rotulagem/métodos , Antibacterianos/efeitos adversos , Formação de Anticorpos , Corantes Azur , Bacteriemia/sangue , Bacteriemia/tratamento farmacológico , Resistência a Medicamentos , Evolução Fatal , Violeta Genciana , Humanos , Macrolídeos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Mieloma Múltiplo/imunologia , Mieloma Múltiplo/terapia , Fenazinas , Infecções Pneumocócicas/sangue , Infecções Pneumocócicas/tratamento farmacológico , Índice de Gravidade de Doença , Irradiação Corporal Total/efeitos adversosRESUMO
OBJECTIVE: We studied elderly patients admitted for hyperosmolar state (HS) to evaluate current outcome of HS and identify prognosis factors associated with mortality. STUDY DESIGN: A clinical retrospective study in an eight bed ICU. PATIENTS AND METHODS: Eighteen over 65-year-old patients admitted with a serum osmolality greater than 325 mOsm/kg were reviewed. Age, sex, diabetes mellitus, underlying medical condition, presence of an acute precipitating factor, Apache II and Glasgow scores, systolic arterial pressure, state of hydration, core temperature, heart rate, serum osmolality, creatininemia, lactatemia, plasma urea and bicarbonate, and protidemia were collected at the admission. Amount of fluid, time course of osmolality correction, length of hospitalization and mortality were recorded. All data were analyzed to identify possible correlations with patient outcome. RESULTS: Mean age: 75 +/- 11 years; sex ratio 1/2; hyperosmolar hyperglycemic states: 13 patients; hyperosmolar hypernatremic states: five patients; mean Apache II score: 18 +/- 7; Glasgow coma score: 11 +/- 3; mean osmolality: 370 +/- 25 mOsm/kg. In nine patients, infection was the precipitating factor. Five patients died (28%). At the admission, low blood pressure and high heart rate were related to mortality. During hospitalization, the occurrence of an acute cardiocirculatory failure and/or the need of mechanical ventilation significantly worsens the outcome. CONCLUSION: Our results showed that ICU mortality of HS in the elderly was at 28%. Haemodynamic state was the only factor of prognosis at the admission. Deaths were mostly related to acute respiratory and circulatory failure.
Assuntos
Idoso/fisiologia , Desequilíbrio Hidroeletrolítico/epidemiologia , Desequilíbrio Hidroeletrolítico/terapia , APACHE , Feminino , Escala de Coma de Glasgow , Frequência Cardíaca/fisiologia , Humanos , Hiperglicemia/complicações , Hiperglicemia/fisiopatologia , Hipernatremia/complicações , Hipernatremia/fisiopatologia , Hipotensão/fisiopatologia , Infecções/complicações , Masculino , Prognóstico , Respiração Artificial , Estudos Retrospectivos , Fatores de Risco , Desequilíbrio Hidroeletrolítico/mortalidadeRESUMO
INTRODUCTION: Despite its rare occurrence in Caucasians, thyreotoxic periodic paralysis should be evoked in young male Caucasians presenting with episodes of pseudo-paralytic hypokalemia. OBSERVATION: A 37 year-old Caucasian was admitted in intensive care for an acute episode of hypotonic tetraplegia and hypokalemia during which laboratory tests revealed hyperthyroidism due to Basedow's disease. The clinical course was rapidly favourable after a small dose of intravenous potassium. Antithyroid treatment avoided any new occurrence of similar episodes. DISCUSSION: In Caucasians, sporadic acute paralysis with hypokalemia requires testing for hyperthyroidism. Though it is well know that hypokalemia results from potassium intracellular shift, the underlying mechanism remains poorly elucidated. Treatment includes potassium administration with caution and/or beta blockers but the specific treatment is that of hyperthyroidism.
Assuntos
Doença de Graves/complicações , Paralisia Periódica Hipopotassêmica/diagnóstico , Paralisias Periódicas Familiares/diagnóstico , Tireotoxicose/complicações , População Branca , Adulto , Diagnóstico Diferencial , Doença de Graves/tratamento farmacológico , Humanos , Infusões Intravenosas , Masculino , Potássio/administração & dosagem , Potássio/uso terapêuticoRESUMO
BACKGROUND: Acute kidney injury (AKI) is associated with unfavourable outcomes and higher mortality after trauma. Renal angioembolization (RAE) has proved efficiency in the management of high-grade renal trauma (HGRT), but inevitably expose to unavoidable ischaemic areas or contrast medium nephrotoxicity which may impair renal function in the following hours. The aim of this study was to assess the potential acute impact of RAE on renal function in a consecutive series of HGRTs treated nonoperatively. MATERIALS AND METHODS: Of 101 cases of renal trauma admitted to our Regional Trauma Center between January 2005 and January 2010, 52 cases of HGRT were treated nonoperatively; they were retrospectively classified into 2 groups according to whether RAE was used. Incidence and progression of AKI (RIFLE classification), maximum increase in serum creatinine (SCr), level since admission and recovery of renal function at discharge were compared between the groups. Multivariable analysis was performed to determine the role of RAE as an independent risk factor of AKI. RESULTS: RAE was performed in 10 patients within the first 48h. The RAE and no RAE groups were comparable in terms of severity score, renal injury grade, and level of SCr on admission. AKI incidence (RIFLE score Risk or worse) after 48 and 96h was 33% and 10%, respectively and did not differ significantly between groups at 48h (p=1.00) or 96h (p=1.00). The median maximum increase in SCr was significantly higher in no RAE than RAE group (30.4% vs. 6.9%, p=0.04). RAE was not found to be a significant variable in a multiple linear regression analysis predicting maximum SCr rise (p=0.34). SCr at discharge was >120% of baseline in only 5 patients, with no difference according to RAE (p=0.24). CONCLUSION: In a population of nonoperatively treated HGRT, the incidence of AKI decreased from almost 30% to 10% at 48h and 96h. RAE proceeding did not seem to affect significantly the occurrence and course of AKI or renal recovery. The decision to use RAE should probably not be restricted by fear of worsening renal function.
Assuntos
Traumatismos Abdominais/complicações , Injúria Renal Aguda/terapia , Embolização Terapêutica/métodos , Artéria Renal , Traumatismos Abdominais/mortalidade , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/mortalidade , Adulto , Creatinina/sangue , Embolização Terapêutica/efeitos adversos , Feminino , Mortalidade Hospitalar , Humanos , Incidência , Tempo de Internação , Masculino , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Índices de Gravidade do Trauma , Resultado do TratamentoAssuntos
Sulfato de Desidroepiandrosterona/sangue , Sistema Hipotálamo-Hipofisário/fisiopatologia , Sistema Hipófise-Suprarrenal/fisiopatologia , Sepse/sangue , Sepse/fisiopatologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estado Terminal , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
Amanita proxima is one species of white mushroom which can induce poisonings called in France "proximien" syndrome. The clinical feature of "proximien" syndrome is mainly characterized by early digestive troubles, mild hepatic cytolysis and late renal impairment. A cardiac insult has never been reported in such a circumstance. The authors describe herein two cases of white mushroom poisoning occurred in the Mediterranean French coast with a typical clinical feature of "proximien" syndrome plus secondary development of severe cardiac alterations. The outcome was good for the two patients thanks to symptomatic treatment. The cases reported here suggest that A. proxima have a potential severe cardiac toxicity leading to include early and precise cardiac examination in the management of patients poisoned by these mushrooms.
Assuntos
Amanita , Insuficiência Cardíaca/induzido quimicamente , Intoxicação Alimentar por Cogumelos/fisiopatologia , Agonistas Adrenérgicos beta/uso terapêutico , Adulto , Diuréticos , Dobutamina/uso terapêutico , Eletrocardiografia , Feminino , Furosemida/uso terapêutico , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/fisiopatologia , Hemodiafiltração , Hemodinâmica/fisiologia , Humanos , Síndrome do QT Longo/induzido quimicamente , Masculino , Pessoa de Meia-Idade , Intoxicação Alimentar por Cogumelos/diagnóstico por imagem , Náusea/induzido quimicamente , Ressuscitação , Choque Cardiogênico/induzido quimicamente , Choque Cardiogênico/terapia , Ultrassonografia , Disfunção Ventricular Esquerda/induzido quimicamente , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/fisiopatologiaAssuntos
Cardioversão Elétrica/métodos , Contração Miocárdica , Ressuscitação/métodos , Fibrilação Ventricular/fisiopatologia , Fibrilação Ventricular/terapia , Animais , Pressão Sanguínea , Débito Cardíaco , Modelos Animais de Doenças , Cardioversão Elétrica/efeitos adversos , Ressuscitação/efeitos adversos , Suínos , Resultado do Tratamento , Função Ventricular EsquerdaAssuntos
Anticestoides/efeitos adversos , Compostos de Cetrimônio/efeitos adversos , Coma/induzido quimicamente , Equinococose/tratamento farmacológico , Hemólise/efeitos dos fármacos , Doenças da Coluna Vertebral/tratamento farmacológico , Adulto , Cetrimônio , Espaço Epidural , Humanos , MasculinoRESUMO
To our knowledge Amanita proxima poisoning has never been reported. Amanita proxima is a mushroom seldomy encountered, similar to a common and edible species: Amanita ovoïdae. During October 1992, we had the opportunity to care for five cases of intoxications with Amanita proxima. In all cases early digestive disorders, cytolytic hepatitis and acute renal failure were noted. Outcome was favourable for all patients within three weeks with total recovery of both renal and hepatic functions with symptomatic treatment. Temporary dialysis was required in four patients.
Assuntos
Injúria Renal Aguda/etiologia , Intoxicação Alimentar por Cogumelos/complicações , Injúria Renal Aguda/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Amanita/classificação , Surtos de Doenças , Feminino , França/epidemiologia , Humanos , Hepatopatias/epidemiologia , Hepatopatias/etiologia , Pessoa de Meia-Idade , Intoxicação Alimentar por Cogumelos/epidemiologia , Especificidade da EspécieRESUMO
BACKGROUND: Heme protein toxicity, owing to generation of reactive oxygen species most likely by direct interaction between heme iron and hydrogen peroxide (H2O2), may be involved in various pathologies, including atherogenesis and pigmentary acute renal failure. The aim of this study was to investigate the mechanism of heme cytotoxicity and the effects of antioxidant therapies in an in vitro model of heme-induced low-density lipoprotein (LDL) oxidation. MATERIALS AND METHODS: Human LDLs were exposed to heme, iron (Fe), protoporphyrin (PPIX) and PPIX-Zinc (Zn) with or without H2O2. Lipid peroxidation was monitored by measurement of conjugated diene formation (at the 234-nm absorbance). The effect of various antioxidants, such as vitamin E and vitamin C, reduced glutathione (GSH), and oxidized glutathione (GSSG), mannitol and desferoxamine (DFO) was further investigated in the established in vitro model of LDL oxidation. RESULTS: Incubation of LDLs in the presence of heme/H2O2 induced lipid peroxidation with the optimal oxidation rate being at 5 microm heme/100 microm H2O2 doses. By contrast, incubation of LDL with H2O2, Fe, Fe/H2O2, PPIX, PPIX/H2O2, heme or PPIX-Zn did not initiate any LDL oxidation. In vitro, the vitamin E load protected native LDLs against heme/H2O2 oxidative modifications. Incubation of LDLs with increasing doses of vitamin C, GSH and DFO conferred a dose-dependent protection, while mannitol and GSSG had no effect. CONCLUSIONS: Initiation and propagation of heme-induced lipid peroxidation is not mediated by a Fenton reaction but depends on specific interactions between heme and H2O2. It may result from the generation of ferryl and perferryl radicals derived from hemic Fe and H2O2 interactions. A protective effect of vitamins E, C, GSH and DFO was demonstrated in this model.
Assuntos
Heme/farmacologia , Peroxidação de Lipídeos/efeitos dos fármacos , Lipoproteínas LDL/efeitos dos fármacos , Antioxidantes/farmacologia , Desferroxamina/farmacologia , Relação Dose-Resposta a Droga , Heme/metabolismo , Humanos , Peróxido de Hidrogênio/metabolismo , Quelantes de Ferro/farmacologia , Oxirredução/efeitos dos fármacos , Protoporfirinas/metabolismo , Vitaminas/farmacologiaRESUMO
OBJECTIVE: To report a case of fatal systemic reaction after intravesical administrations of bacillus Calmette-Guérin (BCG) for polyposis. CASE SUMMARY: A 72-year-old white man was treated by monthly injections of intravesical BCG immunotherapy for polyposis of the urinary bladder. He received a total of eight injections; four hours after the seventh injection, he presented with pyrexia associated with chills, sweating, headache, and vomiting, which quickly resolved. Four hours after the eighth injection, the patient presented with the same symptoms plus a left-hemisphere deficiency. Results of a cerebral scan performed at this time were normal. The clinical status of the patient quickly worsened, with the appearance of disseminated intravascular coagulation, acute anuric renal insufficiency, rhabdomyolysis, hemolysis, and cytolytic and cholestatic hepatitis. The patient required hemodialysis and symptomatic treatment. Lactic acidosis with hemolytic-uremic syndrome appeared, and he died as the result of a multivisceral (respiratory, renal, hepatic) deficiency. DISCUSSION: The patient presented with symptoms compatible with a severe systemic reaction to BCG therapy, a rare but possible adverse effect. CONCLUSIONS: BCG instillation is a valuable tool in the therapy of bladder carcinoma, but increasing reports of severe adverse reactions should continue to remind practicing urologists to be alert to the possibility of common and uncommon reactions after its use.