Dexmedetomidina para sedación durante intubación difícil con Fibrobroncoscopia / Dexmedetomidina for sedation during intubación difficult with Fibrobroncoscopia

Paciente de 48 años de sexo femenino, con diagnóstico de bocio gigante, valorada en consulta preanestésica que presenta una gran masa en cuello que ya había sido operada previamente y que se extendía al pulmón derecho. Al evaluar la vía aérea se encontró una desviación traqueal importante, con Mallampati III y se programó como intubación difícil con fibrobroncoscopia. El día de la cirugía, se decidió colocar un tubo doble lumen No. 37, previa anestesia tópica con lidocaina spray, 2 mg de midazolam y un bolo de Dexmedetomidina (DXM) 0,7 microgr/kg en 10 minutos, seguido por una infusión continua de 0,25-0,3 microgr/Kg. Se midió el nivel de sedacion mediante la escala de Ramsay, considerando adecuado un nivel 2 y 3 y se procedió a la intubación nasotraqueal con fibrobroncoscopia. Una vez confirmada se le colocó tiopental sódico 3 mg/kg más Rocuronio 0,5 mg/kg y Fentanyl 2 microgr/kg IV. Se continúo con DXM durante todo el procedimiento y se adicionó Isorane a 1 MAC. Se realizó cervicotomía y esternotomía para extraer la masa, se suspendió la DXM 15 minutos antes de finalizar el procedimiento y se extubó a la paciente despierta; hemodinámicamente estable, se llevó a UCI donde evolucionó satisfactoriamente y fue dada de alta a los 3 días...

Injectable gold-induced hepatitis and neutropenia in rheumatoid arthritis

Gold salts have been used for many years in the treatment of rheumatoid arthritis. The common side effects are mucocutaneous reactions, but hepatotoxic reaction and isolated neutropenia are rare complications. We report a 62-year-old woman with rheumatoid arthritis who had developed hepatitis and neutropenia simultaneously after receiving 137.5 mg of sodium aurothiomalate.

Nitric Oxide(NO) in Inflammatory Arthritis / 대한내과학회지

OBJECTIVES:Nitric Oxide(NO) is a toxic, inorganic, gaseous free radical produced during the metabolism of L-Arginine by NO synthase(NOS). It has been implicated in a rapidly growing number of physiological and pathophysiological processes such as cytotoxic effects against microbes and tumor cells, blood vessel dilation and neurotransmitter. Recently there is growing evidence implicating NO in immune regulation, inflammation, autoimmunity, and arthritis. We performed this study to determine a role for nitric oxide in inflammatory arthritis especially rheumatoid arthritis(RA). METHODS: We measured (1) the concentrations of nitrite, a breakdown product of nitric oxide, in serum and synovial fluid from patients with RA and osteoarthritis(OA) and in the serum of controls (2) the concentrations of nitrite in the supernatant of cultured synovial tissue with RA and OA and (3) determined whether human chondrocytes and synoviocytes can synthesize nitric oxide and if so, how production is regulated by cytokines and antirheumatic drugs. RESULTS: 1) Serum nitrite concentrations in patients with RA and OA were higher than in controls. In both disease groups synovial fluid nitrite was higher than serum nitrite. Serum and synovial fluid nitrite concenrations in RA were higher than those in OA. However, those findings are not statistically significant. 2) Although these findings are not statistically significant, the concentration of nitrite in the supernatant of cultured synavial tissue with RA was higher than that in OA. 3) IL-1beta and TNF-alpah induced the biosynthesis of NO by chondrocytes and synoviocytes. IGF-1 and TGF-beta failed to provoke the production of NO. The biosynthesis of NO required an induction period of approximately 6 hours and was inhibited by L-NMMA and cycloheximide. Dexamethasone, indomethacin, gold sodium thiomalate and methotrexate had no effect on the induction of NO biosynthesis. CONCLUSION: These results suggest a role for nitric oxide as an inflommatory mediator in inflammatory arthritis.

A Case of Remission of Systemic Juvenile Rheumatoid Arthritis(Still's Disease) Treated with High-dose Intravenous Gammaglobulin

High dose intravenous gammaglobuline (IVLG) therapy is effective in some of the autoimmune diseases. Although the exact mechanism of action of IVIG is uncertain, the action as a neutralizing antibody against unknown etiologic agents, the action of blocking of Fc receptors of effector cells, or the action as a antiidiotypic antibody are suggested. We report a case of 12 year old girl with systemic juvenile rheumatoid arthritis who was treated with high dose IVIG and got a remission. In August 1990 she was admitted to our hospital. because of intermittent fever, transient rash and multiple arthralgia. Under the diagnosis of systemic juvenile rheumatoid arthritis, aspirin (4.0g/day) had been given with symptom improvement. She was readmitted in October 1990 because of aspirin intoxication and acute fulminant hepatitis. She was discharged after recovery and any medicine was not prescribed. In November 1990 she was admitted because of epigastric pain, vomiting, intermittent fever, multiple arthritis, and mild hepatomegaly. Total parenteral alimentation had been given under the diagnosis of superior mesenteric artery syndrome and gold sodium thiomalate (Myochrysine, 5 and 10 mg, two weekly IM injection) was given in conjunction with prednisolone (30 mg/day) and naproxen (375 mg/day). She was admitted again in February 1991 due to the fever, coughing, rash, and hepatosplenomegaly. Pneumonia and leukopenia (2100/mm(3)) were found and gold sodium thiomalate injection was discontinued. Gammaglobulin 1 g/kg/day was given intravenously for 2 consecutive days with dramatic symptom improvement. Five more monthly IV gammaglobulin had been given and the side reaction of injection were nausia, fever, and headache which were controlled by the decrease of infusion rate. Four months after the last IVIG injection she had no symtom of arthritis and the hepatosplenomegaly was decreased. Hemoglobin level was increase to 12.2 mg/dL form 6.2mg/dL and ESR was decrease to 15mm/h. The oral prednisolne and ibuprofen were stopped one year after th last IVIG injection. All the laboratory parameters of arthritis and physical examinations had been normal for more than two year after the stop of all the medications until March of 1994. We suggest that high dose intravenous gammaglobulin can be one of treatments for severe systemic juvenile rheumatoid arthritis.

Effect of Gold Sodium Thiomalate for Rheumatoid arthritis / 대한정형외과학회잡지

Gold Sodium Thiomalate (Myochrysine) used for rheumatoid arthritis has been known that it can cause the long term remission by its antimicrobial action, cell metabolism, complement activation and by activating the cell related to immunologic response. Accordingly the effect and side effect of gold theraphy has long been an object of concern. Authors clinically analyzed cases of 49 rheumatoid arthritis patients who were treated with gold and the mean duration of follow-up was 2.7 years. 50mg of Gold Sodium Thiomalate was injected intramuscularly in accordance with weekly based check up of symptom improvement & side effect. The interval of injection was prolonged and maintained to 4 weeks or 6 weeks when the total amount of injected gold was reached to 1gm or 1.2gm. The over-all symptom remission was forty (82%) and twenty five (51%) showed symptom remission and its maintenance. In symptom remission group, the change of laboratory findings was the reduction of erythrocyte sedimentation rate (ESR) from 59.7 to 32.3. As for side effects, dermatitis found in 16 cases was the most common and stomatitis found in 8 cases. There were others such as irritation symptom of gastrointestinal system & nephritis and 7 cases where the injection was stopped because of side effects was found out. Considering the above results, Gold Sodium Thiomalate is regarded as one of the effective methods for the treatment of rheumatoid arthritis when it is used electively paying heed to side effect.

Lesäo pulmonar pelo ouro / Lung injuries by gold

Os autores relatam um caso de lesäo pulmonar secundária a tratamento com sal de ouro, em pacientes com artrite reumatóide. Chamam atençäo para a possibilidade diagnóstica desta complicaçäo pulmonar e fazem revisäo bibliográfica do tema, que demonstra a extrema raridade da entidade, visto que até 1990 somente 38 casos foram descritos na literatura mundial.

Auroterapia precoce na artrite reumatóide juvenil / Early aurotherapy in youth rheumatoid arthritis

Estuda o presente trabalho o resultado do tratamentoa áurico precoce em onze pacietnes portadores de artrite reumatóide juvenil. Avalia a evoluçäo clínica e laboratorial dos doentes observados ao longo de oito anos e conclui que a precocidade do tratamento modifica a evoluçäo natural da artrite reumatóide. Ressalta a importância da história psicossomática das crianças observadas e o trauma familiar conseqüente desempenhando papel de relevo na gênese e na evoluçäo da artrite reumatóide

Effect of gold thiomalate on cell proliferation and collagen synthesis of synovial cells in culture.

Human synovial cells from cases of rheumatoid and osteoarthritis were cultured and at their 3-5 passages, were treated with gold thiomalate. At early-log phase gold thiomalate arrested the proliferation of cells. However, at confluent state shere was a slight proliferation of synovial cells. This was followed by an increase in prolyl hydroxylase, collagen and protein synthesis, indicating that gold salts directly stimulate the synovial cells.

Doença reumatóida: avaliaçäo da terapêutica áurica em 30 pacientes / Rheumatoid disease: therapeutic evaluation of 30 patients treated with gold salts

O emprego do aurotiomalato de sódio mostrou-se efetivo em 80% dos pacientes, com apreciável efeito córtico-economizador. Os paraefeitos ocorreram em percentagem insignificante. A terapia remissiva deve ser utilizada em estágios precoces da enfermidade, associada aos antiinflamatórios e medidas físico e psicoterápicas

Tratamento da artrite reumatóide com sal de ouro (aurotiomalato de sódio aquoso) por 20 semanas em 19 casos / Treatment of rheumatoid arthritis with gold sodium thiomalate (aqueous solution) during 20 weeks in 19 cases

Os autores apresentam os resultados e efeitos colaterais observados com o uso de sal de ouro (aurotiomalato de sódio aquoso) durante 20 semanas em 19 pacientes com artrite reumatóide de mais de 6 meses de duraçäo. Quinze (78,9%) pacientes toleraram e responderam à terapia com ouro. As respostas foram ótimas, boas e regulares em 10,5%, 36,8% e 31,6% dos pacientes, respectivamente. Um caso (5,3%) tolerou mas näo reagiu ao ouro. Em 3 casos e terapia foi suspensa por causa de "anafilaxia cutânea". Outros efeitos colaterais säo apresentados. Os autores também tecem comentários sobre o uso e controle a longo prazo

Gold Sodium Thiomalate Therapy on Rheumatoid Arthritis: Clinical Experience / 대한정형외과학회잡지

Seventeen patients with classical rheumatoid arthritis have been treated with gold sodium thiomalate(G.S.T) injection and followed up for 1.7 years on average. The results obtained are as follows: 1. Clinical improvement was obtained in 12(70.3%) out of 17 cases, but only in 5 cases(29.3%) marked and persisting improvement was obtained. Such improvement was first noticed when the total dose of the gold sodium thiomalate reached 500mg or more, and also noticed about 10 weeks after initiation of G.S.T therapy. 2. Changes in laboratory parameters such as hemoglobin, hematocrit, eosinophilia, titers of rheumatoid factor and C-reactive protein, and proteinuria began to appear at the time of the clinical improvement. 3. Adverse reaction consisted mostly of mucocutaneous lesions. The main causes of drop-out during therapy also are severe skin rashes and pruritus. Most of the adverse reactions appeared when the total dose of G.S.T. administered reached over 500mg. In two severe cases skin rashes terminated the gold therapy. Our findings suggest, because of high incidence of adverse reaction during G.S.T therapy, repeated careful clinical and laboratory examination of the patient are mandatory especially when the total dose of G.S.T is reached 500mg. In spite of the well documented reports of the maintenance gold therapy for rheumatoid arthritis it is felt that the maintenance gold therapy should be studied further before it can be safely used as a routine in daily rheumatology practice because of its toxicity.

Hepatite toxica colestatica induzida pelos sais de ouro. / Hepatotoxicity induced by gold slats

Uma paciente portadora de artrite reumatoide desenvolveu hepatite toxica com colestase intra-hepatica apos uso de 250mg de aurotiomalato de sodio. Hepatotoxicidade e uma complicacao incomum na terapeutica com sais de ouro.A recuperacao e geralmente completa, mas anormalidades nas provas de funcoes hepaticas podem persistir por varios meses