RESUMO
BACKGROUND: Transplant recipients are at risk of developing progressive multifocal leukoencephalopathy (PML), an opportunistic infection due to reactivation of JC virus. Post-transplant lymphoproliferative disorders (PTLDs) represent a common malignancy in this population, and antiCD20-therapy has become an established component of its treatment. CASE PRESENTATION: We describe the first case of a renal allograft transplant recipient with PTLD who received rituximab-based immune-chemotherapy and developed PML shortly thereafter. Despite early suspicion and diagnosis, the disease ran a relentlessly progressive course, and the patient succumbed to his illness shortly thereafter. CONCLUSION: PML should be strongly suspected whenever unusual neurologic symptoms appear in the context of immunosuppression. Clinicians and patients should be aware of the potential for PML after rituximab therapy.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Hospedeiro Imunocomprometido , Transplante de Rim/efeitos adversos , Leucoencefalopatia Multifocal Progressiva/imunologia , Rituximab/efeitos adversos , Humanos , Vírus JC , Leucoencefalopatia Multifocal Progressiva/induzido quimicamente , Linfoma de Células B/tratamento farmacológico , Linfoma de Células B/imunologia , Masculino , Pessoa de Meia-IdadeRESUMO
We have carried out a prospective, randomised study of prophylaxis for heterotopic ossification (HO) comparing indomethacin for 7 and 14 days, acetylsalicylic acid, and fractional (4 x 3 Gy) or single exposure of 5 or 7 Gy irradiation after operation. We initially had 723 patients (733 hip replacements), but after withdrawals there were 685 hips of which 18.4% developed HO; 14% were grade I, 2.9% grade II and 1.5% grade III of the Brooker classification. We compared the results between these groups with those of a matched control series and found that indomethacin, 2 x 50 mg for 7 and 14 days, and postoperative irradiation of 4 x 3 Gy or 1 x 7 Gy, significantly reduced the development of HO compared with the control group. Patients in the acetylsalicylic acid group and those with a single irradiation of 5 Gy after operation developed significantly more ossification than those in the indomethacin and other irradiation groups. We suggest the use of 2 x 50 mg of indomethacin with mucoprotection for seven days as prophylaxis against HO after total hip replacement for all patients. A single irradiation of 7 Gy is recommended for patients who have developed HO after previous operations or to whom administration of indomethacin is contraindicated.
Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Aspirina/uso terapêutico , Prótese de Quadril , Indometacina/uso terapêutico , Ossificação Heterotópica/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ossificação Heterotópica/tratamento farmacológico , Ossificação Heterotópica/radioterapia , Período Pós-Operatório , Estudos Prospectivos , Dosagem RadioterapêuticaRESUMO
The technical equipment necessary for modern anaesthesia and intensive care medicine needs special and organized outfit control of the apparatus used and of their operation and proper function. Setting up of a centre for maintenance work on anaesthetic equipment is a possibility. Studies have shown that the necessary technical and hygienic maintenance work may be subdivided into 12 working phases each need special working sites and technical equipment corresonding to the requirements. The above systematic study is recommended to decrease risks assoicated which technique and hygiene.