RESUMO
BACKGROUND/AIMS: The onset of multiple sclerosis (MS) in Greece has not been systematically studied. We sought to provide data on the onset of MS in Greece with detailed information regarding initial symptoms, and to confirm the prognostic significance of demographic and clinical factors at onset. METHODS: We studied 1,034 consecutive patients with MS and independently assessed 265 patients 'seen at onset'. We used the MS severity score and survival analysis (time to reach an Expanded Disability Status Scale score of 4.0) to evaluate the prognostic significance of factors at onset. RESULTS: Female-to-male ratio was 1.9:1 and mean age at onset was 30.7 +/- 9.9 years. MS was primary progressive in 9.6%. Initial symptoms were optic neuritis in 20.1%, brainstem dysfunction in 14.7%, dysfunction of long tracts in 49.3%, cerebral dysfunction in 1% and a combination of symptoms in 14.9%. In 'seen at onset' patients, detailed data on initial symptoms are presented. Female gender, earlier age at onset, 'bout onset' and onset with optic neuritis were associated with less severe disease and longer time to disability. CONCLUSION: The onset of MS in Greece is similar to Western populations. Initial symptoms are within the expected spectrum. Prognostic significance of factors at onset is as previously identified.
Assuntos
Esclerose Múltipla , Adulto , Idade de Início , Feminino , Grécia/epidemiologia , Humanos , Estimativa de Kaplan-Meier , Masculino , Esclerose Múltipla/diagnóstico , Esclerose Múltipla/epidemiologia , Esclerose Múltipla/fisiopatologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Adulto JovemRESUMO
Subacute thyroiditis is a painful, inflammatory disease of the thyroid gland, probably of viral origin. It is an uncommon but important cause of fever of unknown origin (FUO). We report a case of a 72-year-old man who presented with a 1 month history of fever, headache and weakness, and in whom extensive evaluation only revealed subacute thyroiditis. He was treated with low-dose steroids and became asymptomatic after 2 weeks. In conclusion, when a patient presents with FUO, subacute thyroiditis should be considered as a possible cause even if classic features are absent.
Assuntos
Febre de Causa Desconhecida/etiologia , Tireoidite Subaguda/complicações , Idoso , Humanos , MasculinoRESUMO
Neurologic involvement in patients with familial Mediterranean fever is relatively uncommon, and rarely described in the literature. Although headache occurs frequently, meningitis and convulsions are rare. We describe the case of a 30-year-old man with attacks of meningitis. After colchicine therapy, no further recurrence of fever and meningitis were observed. These findings suggest that meningitis should be considered as an unusual manifestation of familial Mediterranean fever.
Assuntos
Febre Familiar do Mediterrâneo/complicações , Meningite/etiologia , Adulto , Colchicina/uso terapêutico , Febre Familiar do Mediterrâneo/tratamento farmacológico , Humanos , Masculino , Meningite/tratamento farmacológicoRESUMO
Creatine kinase (CK) activity is found in high concentrations in skeletal muscle, cardiac muscle and brain. Here, we describe a 64-year-old woman with acute pancreatitis and elevated serum CK activity. This association is extraordinarily rare. In particular, laboratory findings which were found to be abnormal were serum CK 4.150 U/l (peaked 1 day after admission) with the CK-MB fraction being less than 5%, lactate dehydrogenase (LDH) 424 U/l, serum lipase 1.265 U/I and serum amylase 1.105 U/l. Some data regarding the phenomenon of acute pancreatitis and elevated serum CK activity are given.
Assuntos
Creatina Quinase/sangue , Pancreatite/enzimologia , Doença Aguda , Biomarcadores/sangue , Ensaios Enzimáticos Clínicos , Feminino , Humanos , Isoenzimas/sangue , Pessoa de Meia-IdadeRESUMO
Piroxicam is a nonsteroidal anti-inflammatory drug currently available for the treatment of various rheumatic diseases. Twenty-eight patients with acute gouty arthritis were treated with a single daily dose of 40 mg piroxicam for a period of 5 days. The majority of patients showed rapid improvement with analgesic effectiveness demonstrated 3 hours after first dose administration. No significant side affects were observed. On the basis of this study, piroxicam was found to be an effective medication for the treatment of acute gouty arthritis.
Assuntos
Artrite/tratamento farmacológico , Gota/tratamento farmacológico , Tiazinas/uso terapêutico , Doença Aguda , Idoso , Ensaios Clínicos como Assunto , Feminino , Gastroenteropatias/induzido quimicamente , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos , Piroxicam , Tiazinas/efeitos adversosRESUMO
The combination of penicillin with an aminoglycoside has been recommended as an initial treatment of choice for patients with acute infections of the biliary tract. However, many patients have incidence of renal problems and for this reason aminoglycosides must be avoided. Newer antimicrobial agents with lesser nephrotoxic effects will be tried. We, therefore, performed a prospective, randomized trial of ofloxacin, a new quinolone and ceftriaxone in patients with acute biliary tract infections. Fifty-two patients with severe biliary tract infections (cholecystitis and cholangitis) were randomly assigned to receive either ofloxacin (n = 28) or ceftriaxone (n = 24). The 2 groups receiving antibiotics were similar with respect to all clinical and laboratory parameters. Bacteria were documented in 48% of patients in the ofloxacin group and in 46% in the ceftriaxone group. The percentage of patients with a clinical cure or significant improvement was the same in the 2 groups. No significant difference was noted between the 2 treatment groups with respect to drug toxicity. These data suggest that intravenous ofloxacin followed by oral administration is an effective and safe single drug for the therapy of patients with acute biliary tract infections.
Assuntos
Anti-Infecciosos/uso terapêutico , Colangite/tratamento farmacológico , Colecistite/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Ofloxacino/uso terapêutico , Anti-Infecciosos/efeitos adversos , Bacteriemia/tratamento farmacológico , Ceftriaxona/efeitos adversos , Ceftriaxona/uso terapêutico , Cefalosporinas/efeitos adversos , Cefalosporinas/uso terapêutico , Infecções por Escherichia coli/tratamento farmacológico , Feminino , Humanos , Infecções por Klebsiella/tratamento farmacológico , Klebsiella pneumoniae , Masculino , Pessoa de Meia-Idade , Ofloxacino/efeitos adversos , Flebite/induzido quimicamenteRESUMO
The efficacy and safety of amikacin administered once-daily versus twice-daily was evaluated in adult patients with systemic infections. Patients over 23 years of age with suspected or documented systemic infections were randomly divided into two groups: one group received amikacin intravenously 15 mg/kg once-daily, and the other group received amikacin 15 mg/kg divided into 2 doses. The efficacy of both dosage regimens was very good with a satisfactory clinical response in 90.2% and 89%, respectively. The bacteriological cure rate was 82.2% and 76%, respectively. There were no significant differences between the 2 regimens as far as what efficacy and safety are concerned. Nephrotoxicity appeared in 2 patients of the first group and 3 patients of the second, but did not lead to discontinuation of amikacin. No significant differences between the regimens with regard to hearing loss or prodromal signs of ototoxicity. We concluded that amikacin administered once-daily appears to be as effective and safe as the twice-daily dosing. However, the once-daily administration is more convenient and less costly.
Assuntos
Amicacina/administração & dosagem , Amicacina/uso terapêutico , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Amicacina/efeitos adversos , Antibacterianos/efeitos adversos , Infecções Bacterianas/microbiologia , Feminino , Transtornos da Audição/induzido quimicamente , Humanos , Nefropatias/induzido quimicamente , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
Single-dose antibiotic therapy for uncomplicated infection of the lower urinary tract (UTI) in women has resulted in high success rates. Ciprofloxacin, like other new quinolones, has shown good in vitro activity against the pathogens most frequently encountered in UTI, high concentrations in the urine and is well tolerated. The present report describes a randomized, double-blind, controlled trial of two single-dose regimens of ciprofloxacin in women with lower UTI. Thirty-six women received 250 mg and forty-two received 500 mg of ciprofloxacin as a single dose. Escherichia coli was the most frequently isolated pathogen in both groups (forty-eight patients). Clinical and bacteriological cures were attained in 81% and 93% of the 250 mg and 500 mg dose groups, respectively, 7 days after treatment. Follow-up at 4 weeks after completion of treatment disclosed that the clinical cure rate was 62% and 79% respectively. Ciprofloxacin was well tolerated. This study shows that a single dose of ciprofloxacin is an effective and safe treatment of uncomplicated UTI. Although the cure rates were higher with a single dose of 500 mg, further studies are needed for assessment to determine the optimal dose.
Assuntos
Ciprofloxacina/administração & dosagem , Infecções Urinárias/tratamento farmacológico , Doença Aguda , Adolescente , Adulto , Ciprofloxacina/uso terapêutico , Método Duplo-Cego , Esquema de Medicação , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
A study was carried out in 40 patients with mild to moderate essential hypertension. The treatment administered was a fixed drug combination of oxprenolol (160 mg) and chlorthalidone (20 mg) in a single morning dose for 16 weeks. As a result, resting and standing blood pressure decreased significantly) (p less than 0.001). As regards clinical tolerance, this was adequate although treatment had to be discontinued in three patients. The minor side effects observed in other patients did not necessitate withdrawal of therapy. Only minor changes of the biochemical parameters were observed. It may be concluded that some patients with mild to moderate hypertension can be adequately treated with a single daily dose of a fixed drug combination of oxprenolol and chlorthalidone.
Assuntos
Clortalidona/uso terapêutico , Hipertensão/tratamento farmacológico , Oxprenolol/uso terapêutico , Adulto , Pressão Sanguínea/efeitos dos fármacos , Clortalidona/efeitos adversos , Combinação de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oxprenolol/efeitos adversosRESUMO
Sulindac is a new non-steroidal drug which is currently available for the treatment of rheumatoid arthritis, osteo-arthritis and ankylosing spondylitis throughout the world. We have recently assessed on open trial of this drug in acute gout arthritis of 26 patients (16 men and ten women). Their ages ranged from 40 to 62 years. All the patients entered in the study provided the fulfilled rigid criteria. Patients received 400 mg in two separate doses in the morning and evening for seven days. There was a dramatic improvement in the joint pain in 15 patients in the first 24 hours and only one after 48 hours, swelling and tenderness improved after four days. No significant side-effects and no significant changes in any of the laboratory tests were observed. Our conclusion is that sulindac is a very useful drug in the treatment of acute gout arthritis.
Assuntos
Artrite/tratamento farmacológico , Gota/tratamento farmacológico , Indenos/uso terapêutico , Sulindaco/uso terapêutico , Doença Aguda , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sulindaco/efeitos adversosRESUMO
Fractures of the medial and lateral malleoli are frequently associated with fractures of the posterior malleolus, comprising trimalleolar fractures. The posterior fragment may be posteromedial or posterolateral and its size determines the necessity for surgical or non-surgical treatment. The authors describe a case of trimalleolar fracture with double involvement of the posterior malleolus, both a posteromedial and posterolateral fragment. A modified transmalleolar operative approach for internal fixation is recommended when dealing with such complex trimalleolar fractures of the ankle.
Assuntos
Traumatismos do Tornozelo/cirurgia , Articulação do Tornozelo/cirurgia , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Fraturas Cominutivas/cirurgia , Traumatismos do Tornozelo/classificação , Traumatismos do Tornozelo/complicações , Emergências , Feminino , Fraturas Ósseas/classificação , Fraturas Ósseas/complicações , Fraturas Cominutivas/complicações , Humanos , Fixadores Internos , Pessoa de Meia-IdadeRESUMO
Complete dislocation of the talus is an extremely rare injury. We report on a case that was treated according to a surgical technique described by Günal et al. According to this technique, a pseudarthrosis is created between the tibia and the calcaneus by transposing and fixing the medial malleolus laterally and displacing the entire foot anteriorly. The result was considered to be initially unsatisfactory. At the 2-year follow-up examination, the outcome was considered to be satisfactory. This was attributed to preservation of motion and stability in the new mortise.
Assuntos
Fraturas Ósseas/cirurgia , Tálus/lesões , Adulto , Fraturas Ósseas/classificação , Humanos , Masculino , Osteotomia/métodos , Tálus/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
Between 1983 and 1994, 15 patients (range 18 to 62 years) with acute traumatic Achilles tendon rupture, were treated surgically in our Department. We employed a modified Bosworth technique. The modifications were the use of a shorter strip of tendon and more secure fixation of the proximal and distal stump, than the original Bosworth technique. Postoperatively an above - knee plaster cast was applied with the knee flexed 30°-40° and the foot in a relaxed equinus position. The plaster cast was changed to a below - knee after 4 weeks and the foot gradually dorsiflexed to a neutral position until the 8th week, and then the plaster cast was removed. No patient had wound separation, infection or skin sloughs. After an average follow-up of 9 years, no rerupture has been reported and all the patients have returned to their pre injury activities.
Assuntos
Programas de Rastreamento/organização & administração , Serviços de Saúde Escolar , Escoliose/diagnóstico , Adolescente , Criança , Feminino , Grécia/epidemiologia , Humanos , Masculino , Prevalência , Avaliação de Programas e Projetos de Saúde , Fatores de Risco , Escoliose/epidemiologia , Escoliose/terapiaRESUMO
In the recent past, pathological gambling has been increasingly reported to be related with dopamine agonist application in patients with Parkinson's disease. We present the case of a female patient whose gambling behavior occurred shortly after reaching the final dose of a combined levodopa and pramipexole therapy and resolved completely after stopping pramipexole. Pathological gambling seems to be a rare and serious but reversible adverse reaction to treatment with dopamine agonists of which clinicians should be aware in patients with Parkinson's disease.
Assuntos
Comportamento Aditivo/induzido quimicamente , Comportamento Aditivo/prevenção & controle , Benzotiazóis/efeitos adversos , Jogo de Azar , Antiparkinsonianos/efeitos adversos , Comportamento Aditivo/diagnóstico , Feminino , Humanos , Pessoa de Meia-Idade , PramipexolRESUMO
Cat scratch disease (CSD), due to Bartonella henselae, is a self-limited chronic lymphadenopathy. A previously healthy 22-year-old woman presented with a palpable painful swelling in the right submandibular region accompanied by enlarged cervical lymph nodes. A diagnosis of B. henselae infection was made according to her personal history that divulged frequent contacts with cats and to a high titre of immunoglobulin G (IgG) and IgM antibodies for this agent. The patient improved within 1 month without the requirement of antibiotic treatment or surgery. The CSD should always be included in the differential diagnosis of all equivocal masses in the neck, especially in young individuals. In addition, it is important that a meticulous personal history is obtained.
Assuntos
Doença da Arranhadura de Gato/complicações , Edema/etiologia , Doenças Parotídeas/etiologia , Adulto , Animais , Gatos , Feminino , HumanosRESUMO
Hypertension is probably the most important public health problem in developed countries. Over the last 40 years, an increasing number of hypertensive patients have been treated with various antihypertensive drugs. If the blood pressure (BP) is controlled, the discontinuation of the antihypertensive drug may result either in a relapse of the disease or in the maintenance of normal BP for a long time. In this study, we discuss the available data regarding the consequences of antihypertensive drug withdrawal in successfully treated patients and we suggest guidelines for the application in clinical practice.
Assuntos
Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Hipertensão/tratamento farmacológico , Guias de Prática Clínica como Assunto , Esquema de Medicação , Medicina de Família e Comunidade , Feminino , Humanos , Hipertensão/fisiopatologia , Masculino , Prevalência , Atenção Primária à Saúde , RecidivaRESUMO
In this study, a review of the available information concerning abrupt withdrawal of antihypertensive drug therapy is presented. Abrupt withdrawal of these drugs can produce a syndrome of sympathetic overactivity that includes nervousness, tachycardia, headache, agitation and nausea 36-72 h after cessation of the drug. A withdrawal syndrome may occur after discontinuation of almost all types of antihypertensive drugs, but mostly occurs with clonidine, beta-blockers, methyldopa and guanabenz. Less commonly can produce a rapid increase of the blood pressure to pre-treatment levels or above, or both and/or myocardial ischaemia. Although the exact incidence of the syndrome is not known, it appears to be rare, at least in patients receiving standard doses of the above antihypertensive drugs. The best treatment is prevention. In this study regarding the withdrawal syndrome that follows cessation of antihypertensive drugs therapy, a reference to the abrupt discontinuation of the main categories of antihypertensive drugs is also attempted.