RESUMO
Intravenous IgG has been adopted as treatment for various immune-related diseases, including immune thrombocytopenic purpura, autoimmune neuropathies, systemic lupus erythematosus, Guillain-Barré syndrome, myasthenia gravis, Kawasaki disease, skin blistering diseases. The intravenous administration of exogenously pooled human immunoglobulin was originally licensed as antibody replacement therapy in patients with primary immunodeficiencies, but in the last thirty years, despite a current lack of institutional approval, off-label IVIgG treatment of a consistent number of disorders has shown to be a useful approach with good clinical results. The mechanism of action of IVIgG is complex and is not fully understood. The current understanding and development in the immune modulant action of IVIgG has three basic mechanisms: 1) F(ab')2 mediated actions; 2) interaction of IgGFc molecule with Fc receptors (FcgammaR); 3) actions mediated by complement fractions binding within the Fc molecular structure. The mode of action of IVIgG involves expression and function of Fc receptors, idiotype network, complement and cytokine network, T and B cell differentiation, modulation of antigen-presenting cells (APC). The therapeutic action of IVIgG is also related to natural antibodies in maintaining immune homeostasis. In addition, IVIgG interaction through V regions with complementary V regions of antibodies may provide a rational basis for selection of various immune repertoires. Since there is a significant gap between the institutional approval and the use of IVIgG in various clinical conditions, for which there is no adequate testing or for which a small number of records does not allow a rigorous statistical approach, several public and private institutions (mostly insurance companies) and research centres have developed guidelines for evaluating a rational and deontological approach in various pathological situations where IVIgG is used. Mathematical models based on non-linear differential equations may represent another potentially useful system to better understand an IVIgG targeted use in individual subjects.
Assuntos
Imunoglobulina G/imunologia , Imunoglobulinas Intravenosas/imunologia , Doenças Transmissíveis/imunologia , Humanos , Modelos BiológicosRESUMO
Fifty-seven highly recurrent unipolar patients, excluded from previous long-term studies with selective serotonin reuptake inhibitors (SSRIs) after they experienced a new recurrence, were acutely treated with the full dosage of the SSRIs they were on. Fifty-one of them (89.5%) had a sustained response and entered into the 4-month continuation therapy. During this phase, no relapse was observed. At the end of it, all patients gave their written informed consent to be enrolled in a 24-month long-term therapy, maintaining the same treatment dosage of fluvoxamine 300 mg/day, sertraline 150 mg/day, or paroxetine 40 mg/day. At the end of the study, 28 out of the 51 outpatients (54.9%) showed a further recurrence. Nevertheless, second recurrences observed during this second maintenance therapy were less severe than first recurrences, decreasing from 25.1+/-3.4 to 21.6+/-3.3 (P<0.0001), respectively. Considering the clinical characteristics of patients, we found that a high number of prior depressive episodes and an early age at onset of illness may predict a bad outcome. Moreover, patients with a longer duration of euthymia during a first maintenance period are less likely to have a new episode of depression.
Assuntos
Transtorno Depressivo/tratamento farmacológico , Transtorno Depressivo/prevenção & controle , Inibidores Seletivos de Recaptação de Serotonina/administração & dosagem , Adulto , Relação Dose-Resposta a Droga , Feminino , Fluvoxamina/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Paroxetina/administração & dosagem , Modelos de Riscos Proporcionais , Fatores de Risco , Prevenção Secundária , Sertralina/administração & dosagem , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
The rupture of pulmonary alveoli during the induction of general anesthesia is a significant complication of general anesthesia that has been seldom reported in our literature. This article documents this occurrence in a patient scheduled for elective orthognathic surgery. The diagnosis and treatment are discussed.
Assuntos
Anestesia Dentária/efeitos adversos , Pneumotórax/etiologia , Alvéolos Pulmonares/lesões , Adulto , Anestesia Geral/efeitos adversos , Feminino , Humanos , Pressão , RupturaAssuntos
Blastomicose/patologia , Dermatopatias Infecciosas/patologia , Anfotericina B/uso terapêutico , Blastomyces/isolamento & purificação , Blastomicose/tratamento farmacológico , Blastomicose/microbiologia , Ectrópio/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , América do Norte , Dermatopatias Infecciosas/complicações , Dermatopatias Infecciosas/tratamento farmacológico , Dermatopatias Infecciosas/microbiologia , Uveíte/tratamento farmacológico , Uveíte/etiologiaAssuntos
Aneurisma Aórtico/cirurgia , Arteriopatias Oclusivas/cirurgia , Prótese Vascular , Aorta Abdominal/cirurgia , Aneurisma Aórtico/mortalidade , Doenças da Aorta/mortalidade , Doenças da Aorta/cirurgia , Arteriopatias Oclusivas/mortalidade , Prótese Vascular/efeitos adversos , Prótese Vascular/mortalidade , Estudos de Avaliação como Assunto , Feminino , Artéria Femoral/cirurgia , Humanos , Artéria Ilíaca/cirurgia , Masculino , Polietilenotereftalatos , Artéria Poplítea/cirurgia , Complicações Pós-Operatórias/mortalidade , Obstrução da Artéria Renal/mortalidade , Obstrução da Artéria Renal/cirurgiaRESUMO
When mental retardation is complicated by mental illness, the clinical result is "dual diagnosis." Though recognized as such only since the 1970s, these patients have long been the subset of the developmentally disabled most resistant to integration into the community. The maladaptive behavior or mental illness often prevents training for the retardation or other developmental disability. Because these patients are no longer placed in the back wards of state institutions, the modern expectation is that even this most difficult group can be influenced by positive behavior support directed by a psychologist and medication treatment programs prescribed by a psychiatrist. In addition, program specialists structure the work, play, and learning environment of the patients. These activities, living conditions, and peer relationships will form a dynamic interaction with the behavior therapy and the medication. The challenge of adapting to this interaction is met by an interdisciplinary team. Subject to bizarre behavior and difficult to diagnose and treat, patients with both mental retardation and mental illness are best directed to providers trained for these patients.
Assuntos
Deficiências do Desenvolvimento/complicações , Deficiências do Desenvolvimento/diagnóstico , Transtornos Mentais/complicações , Transtornos Mentais/diagnóstico , Adulto , Criança , Pré-Escolar , Deficiências do Desenvolvimento/história , Deficiências do Desenvolvimento/terapia , História do Século XIX , História do Século XX , Humanos , Masculino , Transtornos Mentais/história , Transtornos Mentais/terapia , Modelos Psicológicos , Equipe de Assistência ao Paciente , Psicoterapia , Estados UnidosRESUMO
The Authors believe it erroneous to consider disc herniation as the only pathology responsible of sciatalgia. They emphasize the importance of proper diagnostic investigation prior to any operative intervention.