Subject(s)
Adolescent , Adult , Middle Aged , Humans , Male , Female , Acetyltransferases , Antitubercular Agents/adverse effects , Phenotype , Acetylation , Aspartate Aminotransferases/genetics , Aspartate Aminotransferases/metabolism , Acetyltransferases/genetics , Acetyltransferases/metabolism , Chile , Prospective Studies , Alkaline Phosphatase/genetics , Alkaline Phosphatase/metabolism , Isoniazid/metabolism , Liver/drug effects , Liver/enzymology , Antitubercular Agents/metabolismSubject(s)
Humans , Phenelzine/pharmacokinetics , Procainamide/pharmacokinetics , Sulfasalazine/pharmacokinetics , Dapsone/pharmacokinetics , Hydrazines/pharmacokinetics , Isoniazid/pharmacokinetics , Phenelzine/adverse effects , Procainamide/adverse effects , Sulfasalazine/adverse effects , Dapsone/adverse effects , Hydrazines/adverse effects , Isoniazid/adverse effects , Drug Evaluation , Genetic MarkersABSTRACT
Se presenta el caso de un hombre de 53 años con tuberculosis miliar asociada a distress respiratorio del adulto y a hemorragia digestiva. El paciente tenía una historia de 2 meses de evolución con pérdida de peso (10 Kg), fiebre y sudoración nocturna. En el examen físico se encontraron múltiples adenopatías y hepato-esplenomegalia. La radiología de tórax reveló masas redondeadas en el mediastino superior y en el hilio derecho. 11 día después de su ingreso el paciente presentó insuficiencia respiratoria aguda (PaO2=50 mmHg, FlO2=1, 0: PaCO2 34 mmHg y melena. La radiografía de tórax demostró edema pulmonar bilateral. Se instauró ventilación mecánica com 15 cm H2O de PEEP. Una biopsia de ganglio supraclavicular demostró lesiones tuberculosas de tipo caseoso. Una laparatomía exploradora efectuada el noveno día de la hemorragia digestiva demostró una úlcera gástrica penetrada al pancreas y múltiples nódulos peritoneales y retroperitoneales. La lesión gástrica se suturó. El paciente se trató con nutrición parenteral, transfusiones de sangre total, antibióticos (amikacina y cefuoroxima), dopamina, metilprednisolona y con drogas anti TBC (isoniazida, rifampicina y pirazinamida). Evolucionó agravándose y falleciendo al 21o dá de su admisión al hospital. La necropsia demostró tuberculosis miliar mezclada con lesiones cavitarias y caseosas del pulmón. Además se encontró membrana hialina y focos neumónicos. Las lesiones tuberculosas tenían escaso infiltrado celular linfocítico y de células de Langhans sugiriendo un proceso hiporreactivo
Subject(s)
Middle Aged , Humans , Male , Tuberculosis, Miliary , Gastrointestinal Hemorrhage , Respiratory Distress Syndrome, NewbornABSTRACT
We analyzed the type and dosage of opiates used for pain in a large general hospital from April to September 1985. Information was obtained from the computerized data base in 234 patients with a mean age of 49 years. Most patients came from the surgical service. The route of administration was intramuscular in 64% and not specified in 10% of patients. The most common drug was meperidine, the dose being 65 ñ 26 mg intramuscular and 39 ñ 26 intravenously. Methadone and morphine were used with less frequency. Good analgesic effect was recorded in 42 of 71 (59%) of patients, but the effect was not written down in the majority of subjects (70%). Other analgesics were associated in 73% of cases, most commonly a pyrazolone derivative. Nausea or vomiting was observed in only 12 patients; there were no instances of respiratory depression. We conclude that the dose of opiate used was frequently low and the associated drugs were not the best to obtain increased analgesic effect. Better recording of clinical effect of analgesics is needed in medical practice