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An. bras. dermatol ; 94(4): 470-472, July-Aug. 2019. graf
Article in English | LILACS | ID: biblio-1038288


Abstract: Paracoccidioidomycosis is a fungal infection that occurs in immunocompetent patients and are classified into two forms: the acute-subacute form, predominantly in young patients, and the chronic adult form that may present classic ulcerated lesions to rare sarcoid ones. We present the case of a boy whose infection began with sarcoid lesions but, after being mistakenly diagnosed with cutaneous sarcoidosis and treated (for three years) with prednisone, developed painful ulcerations throughout the body. After the correct diagnosis, with evidence of the fungus in histopathological and mycological examinations, the patient was properly treated with itraconazole for eight months and evolved with total remission of the disease.

Humans , Male , Adolescent , Paracoccidioidomycosis/etiology , Paracoccidioidomycosis/pathology , Glucocorticoids/adverse effects , Paracoccidioidomycosis/diagnosis , Paracoccidioidomycosis/drug therapy , Sarcoidosis/diagnosis , Sarcoidosis/pathology , Prednisone/adverse effects , Treatment Outcome , Itraconazole/therapeutic use , Antifungal Agents/therapeutic use
Rev. bras. reumatol ; 57(4): 294-298, July.-Aug. 2017. tab, graf
Article in English | LILACS | ID: biblio-899428


ABSTRACT Background: Sleep disturbances are common in rheumatoid arthritis (RA) patients and contribute to loss of life quality. Objective: To study associations of sleep quality with pain, depression and disease activity in RA. Methods: This is a transversal observational study of 112 RA patients submitted to measurement of DAS-28, Epworth scale for daily sleepiness, index of sleep quality by Pittsburg index, risk of sleep apnea by the Berlin questionnaire and degree of depression by the CES-D (Center for Epidemiologic Studies Depression scale) questionnaire. We also collected epidemiological, clinical, serological and treatment data. Results: Only 18.5% of RA patients had sleep of good quality. In univariate analysis a bad sleep measured by Pittsburg index was associated with daily doses of prednisone (p = 0.03), DAS-28 (p = 0.01), CES-D (p = 0.0005) and showed a tendency to be associated with Berlin sleep apnea questionnaire (p = 0.06). In multivariate analysis only depression (p = 0.008) and Berlin sleep apnea questionnaire (p = 0.004) kept this association. Conclusions: Most of RA patients do not have a good sleep quality. Depression and risk of sleep apnea are independently associated with sleep impairment.

RESUMO Antecedentes: Os distúrbios do sono são comuns em pacientes com artrite reumatoide (AR) e contribuem para a perda da qualidade de vida. Objetivo: Estudar as associações entre a qualidade do sono e a dor, depressão e atividade da doença na AR. Métodos: Estudo observacional transversal com 112 pacientes com AR submetidos à avaliação do DAS-28, escala de Epworth para sonolência diurna, qualidade do sono pelo índice de Pittsburg, risco de apneia do sono pelo questionário de Berlim e grau de depressão pelo questionário CES-D (Center for Epidemiologic Studies Depression). Também foram coletados dados epidemiológicos, clínicos, sorológicos e de tratamento. Resultados: Apenas 18,5% dos pacientes com AR tinham uma boa qualidade do sono. Na análise univariada, um sono ruim medido pelo índice de Pittsburg esteve associado à dose diária de prednisona (p = 0,03), DAS-28 (p = 0,01), CES-D (p = 0,0005) e mostrou uma tendência a estar associado à apneia do sono pelo questionário de Berlim (p = 0,06). Na análise multivariada, somente a depressão (p = 0,008) e a apneia do sono pelo questionário de Berlim (p = 0,004) mantiveram essa associação. Conclusões: A maior parte dos pacientes com AR não tem uma boa qualidade de sono. A depressão e o risco de apneia do sono estão independentemente associados ao comprometimento do sono.

Humans , Male , Female , Aged , Arthritis, Rheumatoid/complications , Sleep Wake Disorders/epidemiology , Sleep Apnea, Obstructive/epidemiology , Depression/epidemiology , Arthritis, Rheumatoid/drug therapy , Quality of Life , Prednisone/adverse effects , Surveys and Questionnaires , Risk Factors , Glucocorticoids/adverse effects , Middle Aged
Article in English | WPRIM | ID: wpr-111037


The radiologic findings of a single nodule from Pneumocystis jirovecii pneumonia (PJP) have been rarely reported. We described a case of granulomatous PJP manifesting as a solitary pulmonary nodule with a halo sign in a 69-year-old woman with diffuse large B cell lymphoma during chemotherapy. The radiologic appearance of the patient suggested an infectious lesion such as angioinvasive pulmonary aspergillosis or lymphoma involvement of the lung; however, clinical manifestations were not compatible with the diseases. The nodule was confirmed as granulomatous PJP by video-assisted thoracoscopic surgery biopsy.

Aged , Antibodies, Monoclonal, Murine-Derived/adverse effects , Antineoplastic Agents/adverse effects , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Biopsy/methods , Cyclophosphamide/adverse effects , Doxorubicin/adverse effects , Female , Humans , Lymphoma, Large B-Cell, Diffuse/drug therapy , Pneumocystis carinii/pathogenicity , Pneumonia, Pneumocystis/diagnosis , Positron-Emission Tomography , Prednisone/adverse effects , Solitary Pulmonary Nodule/microbiology , Thoracic Surgery, Video-Assisted , Tomography, X-Ray Computed , Vincristine/adverse effects
Article in Portuguese | LILACS | ID: lil-724264


Hemofilia adquirida A (HAA) é uma doença rara ? incidênciade 1/1.000.000 ao ano -, com maior prevalência em pessoas de65 a 85 anos. A doença caracteriza-se pela presença de autoanticorposcontra fator VIII (FVIII), o que induz a inibição daligação entre este com fator de Von Willebrand e consequenteinativação de sua função anticoagulante. O objetivo deste trabalhofoi apresentar um caso de Hemofilia adquirida A e destacar anecessidade do médico generalista para o reconhecimento destadoença, visto que sua alta taxa de mortalidade - aproximadamentemais de 20% - a torna um importante diagnóstico diferencialde coagulopatias graves. Paciente do sexo masculino, 59anos, com quadro de dor no ombro esquerdo e evolução parahematomas em diversas partes do corpo. Confirmado o diagnósticode hemofilia adquirida A, iniciou-se o tratamento suportivoe de supressão de inibidor de fator VIII, entretanto, houve novossangramentos. Após terapêutica com ciclofosfamida, foi obtidaa supressão das recorrências dos casos hemorrágicos. Devido aposterior desenvolvimento de anemia, o quimioterápico foi suspenso.Um mês após a retirada do fármaco, o paciente segue semreincidência do quadro. O diagnóstico de hemofilia adquirida Aé evidente caso haja o conhecimento prévio dos achados semiológicose sua rotina de investigação laboratorial, mas frequentementeé atrasado devido à falta de familiaridade com a doençapelos médicos generalistas, fator que interfere diretamente nocurso da Hemofilia adquirida A, pois o diagnóstico precoce éum fator determinante para a redução da taxa de mortalidade.(AU)

Acquired hemophilia A (AHA) is a rare disease ? incidence of1/1.000.000 per year - with a higher prevalence in the elderly.The condition is characterized by the presence of autoantibodiesagainst factor VIII, which induces inhibition of its binding tovon Willebrand factor and consequent inactivation of theiranticoagulant function. The objective of this paper was topresent a case of Acquired hemophilia A and emphasize theneed of primary care physicians to recognize this disease, animportant differential diagnosis of severe coagulopathy, withhigh mortality rate. A fifty-nine years old male patient, withleft shoulder pain and development of hematomas in severalareas of the body. The diagnosis of Acquired hemophilia Awas confirmed and supportive treatment and suppression offactor VIII inhibitor was initiated. However, there was furtherbleeding. After therapy with cyclophosphamide, suppressionof recurrent bleeding cases was obtained. Due to furtherdevelopment of anemia, chemotherapy was discontinued.One month after withdrawal of treatment the patient remainswithout recurrence. The diagnosis of Acquired hemophilia Acan be easier done if there is prior knowledge of the clinicalfindings and interpretation of laboratory investigation. Delayeddiagnosis due to lack of familiarity with the disease by generaldoctors directly interferes in the course of Acquired hemophiliaA, because the early diagnosis is a key factor in reducing themortality rate.(AU)

Humans , Male , Middle Aged , Factor VII/immunology , Hemophilia A/diagnosis , Prednisone/adverse effects , Cyclophosphamide/adverse effects , Early Diagnosis
An. bras. dermatol ; 88(3): 361-367, jun. 2013. tab, graf
Article in English | LILACS | ID: lil-676228


BACKGROUND: The increasing in the number of kidney transplant recipients has favored, more frequently than before, the emergence of dermatoses and warranted their study through subsequent publications. OBJECTIVES: to evaluate the frequency of dermatoses in kidney transplant recipients. METHODS: kidney transplant recipients with suspected dermatoses between March 1st 2009 and June 30th 2010. RESULTS: 53 patients (28 males and 25 females), aged between 22 and 69 (mean age = 45 years) were evaluated. Most of them came from the cities of Ceilândia, Samambaia and São Sebastião/DF, and had already been transplanted for 5 to 10 years before (37.7%); 62.3% were recipients of living donors and 83% were prednisone-treated. The most prevalent dermatoses were of fungal (45.3%) and viral (39.6%) etiologies. Among the non-melanoma malignant neoplasms, the basal cell carcinoma prevailed (six cases), in spite of the low incidence. Concerning fungal dermatoses, 12 cases of onychomycosis, five of pityriasis versicolor and four of pityrosporum folliculitis were reported. For diagnosis, in most cases (64.2%), laboratory examinations (mycological and histopathological) were performed. CONCLUSION: cutaneous manifestations in kidney transplant recipients are generally secondary to immunosuppression. The infectious dermatoses, especially those of fungal origin, are frequently found in kidney transplant recipients and their occurrence increases progressively according to the time elapsed from the transplantation, which makes follow-up important. .

FUNDAMENTOS: o crescente aumento do número dos transplantados renais tem favorecido o aparecimento mais frequente das dermatoses e permitido o estudo em sucessivos trabalhos. OBJETIVOS: avaliar a frequência das dermatoses em pacientes transplantados renais. MÉTODOS: captação de pacientes transplantados renais durante o período de 1° de março de 2009 a 30 de junho de 2010 com suspeita de dermatoses. RESULTADOS : foram avaliados 53 pacientes (28 homens e 25 mulheres), entre 22 e 69 anos (com uma média de 45 anos), a maioria procedente de Ceilândia, Samambaia e São Sebastião/DF, entre 5 e 10 anos de transplante renal (37,7%), sendo 62,3% receptor de doador vivo e 83% em uso de prednisona. As dermatoses mais prevalentes foram as de etiologia fúngica (45,3%) e viral (39,6%). Das neoplasias malignas não-melanoma, apesar da baixa incidência, predominou o carcinoma basocelular (seis casos). Com relação s dermatoses de origem fúngica, ocorreram 12 casos de onicomicoses, cinco casos de pitiríase versicolor e quatro casos de foliculite pitirospórica. Para realização do diagnóstico, na maioria dos casos (64,2%), foi utilizado os exames laboratoriais ( micológicos e histopatológicos). CONCLUSÃO: as manifestações cutâneas em pacientes transplantados renais são geralmente secundárias imunossupressão. As dermatoses infecciosas, principalmente as de etiologia fúngica, são frequentes em pacientes transplantados renais, e sua ocorrência aumenta progressivamente, conforme o tempo transcorrido, a partir do transplante, sendo importante o acompanhamento. .

Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Immunosuppression/adverse effects , Kidney Transplantation/adverse effects , Skin Diseases/etiology , Anti-Inflammatory Agents/adverse effects , Brazil/epidemiology , Cross-Sectional Studies , Dermatomycoses/epidemiology , Kidney Transplantation/statistics & numerical data , Prednisone/adverse effects , Socioeconomic Factors , Skin Diseases, Bacterial/epidemiology , Skin Diseases, Viral/epidemiology , Skin Diseases/epidemiology , Time Factors
Hematology, Oncology and Stem Cell Therapy. 2010; 3 (4): 167-173
in English | IMEMR | ID: emr-108570


The liposomal formulation of amphotericin B [LAmB] has been shown to cause few and mild infusion-related reactions, while achieving high plasma and tissue concentrations compared with conventional amphotericin B. We investigated the efficacy and safety of high-dose LAmB [7.5 mg/kg once weekly] prophylaxis of fungal infections in allogeneic stem-cell transplanted [allo-SCT] patients with graft-versus-host disease [GvHD]. Retrospective, comparative, single-center. Forty-two patients receiving high-dose prednisone for GvHD after allo-SCT had LAmB prophylaxis; 83 patients in the control group received other antifungal prophylaxis. In the LAmB prophylaxis group, the median duration of treatment was 7 weeks. The cumulative incidence of invasive fungal infection was 8% at 1 year after transplantation, 8% at 2 years and 16% at 3 years in the LAmB group vs. 36% at 1 year, 44% at 2 years and 49% at 3 years in the other prophylaxis group [P=.008]. Fungal infection-related mortality after transplantation was observed in none of the patients in the LAmB prophylaxis group vs. 12 patients [14%] at 1 year, 14 patients [17%] at 2 years and 16 patients [19%] at 3 years in the control group [P = .005]. The tolerance of the treatment was good with only 5 patients [12%] having a reversible nephrotoxicity leading to temporary treatment discontinuation. High-dose LAmB prophylaxis seems effective and well tolerated in this short series of allo-SCT patients with GvHD. Prospective clinical studies are required to confirm these results

Humans , Male , Female , Liposomes , Antifungal Agents , Mycoses/prevention & control , Graft vs Host Disease , Hematopoietic Stem Cell Transplantation , Retrospective Studies , Transplantation, Homologous , Prednisone , Prednisone/adverse effects
Arq. bras. med. vet. zootec ; 60(3): 641-650, jun. 2008. graf, tab
Article in Portuguese | LILACS | ID: lil-487909


Foram utilizados 25 ratos (Rattus novergicus) submetidos a trauma experimental da medula espinhal, empregando-se aparelho estereotáxico com um peso de 50,5g comprimindo a duramáter durante cinco minutos. Após o trauma, os animais foram divididos em cinco grupos de cinco. O grupo A (controle) recebeu placebo oito horas após o trauma; os grupos B, C, D e E receberam prednisona oito, 24, 48 e 120 horas após o trauma, respectivamente. A prednisona foi administrada na dose inicial de 2mg/kg, durante cinco dias, com diminuição progressiva até o 26º dia. Os animais foram avaliados conforme a capacidade motora, posicionamento proprioceptivo, reflexo de localização, plano inclinado e sensibilidade dolorosa. Após 33 dias da cirurgia, foram sacrificados para avaliação histológica das medulas espinhais. Observaram-se degeneração das raízes nervosas, necrose medular, inflamação local e reação glial, sem diferenças entre os grupos. Não houve correlação entre os testes neurológicos. A utilização da prednisona na lesão medular aguda não teve efeito diferenciado com o tempo e não foi prejudicial na recuperação neurológica, mesmo quando utilizada tardiamente.

Twent-five rats (Rattus novergicus) were submitted to an experimental spinal cord injury by using a 50.5g stereotaxic equipament to apply pressure on the duramater during five minutes. After the spinal cord injury, the animals were randomly distributed into five groups of five animals each: one group received placebo 8 hours after injury and the remaining four groups received prednisone at 8, 24, 48, and 120 hours after injury. Prednisone was applied at 2mg/kg dosage during five days and progressively reduced until the 26th day. Animals were evaluated by motor capacity, proprioceptive positioning, locating reflex, inclined plan, and sensibility to pain. The animals were sacrificed 33 days after surgery for histological study of the spinal cords that revealed degeneration of the rootlets, necrosis, inflammatory foci, and reactive gliosis, with no significant differences among the treated groups. The administration of high dosages of prednisone to animals with acute spinal cord injury had no deleterious effects on neurological recovery, even when used late.

Animals , Models, Animal , Prednisone/adverse effects , Rats , Spinal Cord Injuries/veterinary
Yonsei Medical Journal ; : 155-158, 2008.
Article in English | WPRIM | ID: wpr-158187


A 69-year-old male was diagnosed in February 2004 with stage IV extranodal marginal zone B cell lymphoma involving the mediastinal nodes, lung parenchyma and bone marrow with high LDH. Shortness of breath developed following the 5th course of Rituximab-CHOP chemotherapy (cyclophosphamide, Vincristine, Doxorubicin, Prednisolone). Bronchoscopy guided transbronchial lung biopsy revealed interstitial thickening and type II pneumocyte activation, compatible with interstitial pneumonitis. After treatment with prednisolone a complete resolution of the dyspnea was observed. The patient was well on routine follow-up at the outpatient clinic, with no progression of lymphoma or interstitial pneumonitis.

Aged , Antibodies, Monoclonal/adverse effects , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Biopsy , Cyclophosphamide/adverse effects , Doxorubicin/adverse effects , Humans , Lung Diseases, Interstitial/chemically induced , Lymphoma, B-Cell, Marginal Zone/drug therapy , Male , Prednisone/adverse effects , Tomography, X-Ray Computed , Vincristine/adverse effects
Indian J Cancer ; 2007 Jul-Sep; 44(3): 122-3
Article in English | IMSEAR | ID: sea-50991


We report a case of neutropenic enterocolitis diagnosed on computerized tomography abdomen in a 56-year-old man having high-grade non-Hodgkin's lymphoma. After appropriate management, the patient recovered completely.

Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Cyclophosphamide/adverse effects , Doxorubicin/adverse effects , Enterocolitis, Neutropenic/chemically induced , Humans , Lymphoma, Non-Hodgkin/drug therapy , Male , Middle Aged , Prednisone/adverse effects , Tomography, X-Ray Computed , Vincristine/adverse effects
Arq. bras. oftalmol ; 69(6): 811-816, nov.-dez. 2006. tab, graf
Article in English | LILACS | ID: lil-440416


PURPOSE: To investigate if colchicine is valuable in the treatment of Graves' ophthalmopathy (GO), we compared its effect with prednisone in 22 patients during the inflammatory phase of GO. METHODS: All patients, similar in age, sex and smoking habits, were euthyroid for at least 3 months and randomly divided into two groups, one treated with colchicine (1.5 mg/day) and the other treated with prednisone (0.75 mg/kg/day). They were monitored with ophthalmologic assessment (clinical activity score-CAS) and magnetic resonance imaging, using a signal intensity ratio (SIR) of the recti muscles in comparison to the cerebral substantia alba. RESULTS: Amelioration of CAS was seen in 68 percent of the orbits in both groups. SIR also had a significant reduction after treatment: the initial median of 1.14 in G1 and 1.27 in G2, evolved, after treatment, to 1.07 in G1 and 0.69 in G2. The variation between both groups after treatment was not significant (p=0.22). None of the patients treated with colchicine had side effects; on the other hand, side effects in G2 were weight gain, edema, gastric complaints, hirsutism, weakness, depression, and alterations in blood pressure. CONCLUSION: Colchicine had a beneficial effect on the inflammatory phase of GO without the side effects of prednisone.

OBJETIVO: Investigar se a colchicina é eficaz no tratamento da oftalmopatia de Graves, nós comparamos o seu efeito com a prednisona em 22 pacientes tratados na fase inflamatória da doença. MÉTODOS: Todos os pacientes, similares quanto à idade, sexo e hábitos de tabagismo, estavam em eutiroidismo por pelo menos três meses e foram randomizados em dois grupos. O grupo 1 (G1) recebeu colchicina (1,5 mg/dia) e o grupo 2 (G2) foi tratado com prednisona (0,75 mg/kg/dia). Os pacientes foram acompanhados com avaliação oftalmológica (escore de atividade clínica - CAS) e de imagem por meio da ressonância magnética, usando a relação da intensidade de sinal (SIR) dos músculos reto em comparação com a substância alba cerebral. RESULTADOS: Diminuição no CAS de 68 por cento foi notada em ambos os grupos. A SIR também apresentou redução significante após o tratamento: A mediana inicial do G1 de 1,14 e 1,27 do G2 diminui após o tratamento para 1,07 no G1 e 0,69 no G2. A variação entre os grupos após o tratamento não foi significante (p=0,22). Nenhum paciente tratado com colchicina apresentou efeito colateral; ao passo que os efeitos colaterais no G2 foram ganho de peso, edema, queixas gástricas, fraqueza, depressão e alteração na pressão arterial. CONCLUSÕES: A colchicina apresenta efeitos benéficos na fase inflamatória da oftalmopatia de Graves sem os efeitos colaterais da prednisona.

Humans , Male , Female , Adult , Middle Aged , Colchicine/therapeutic use , Glucocorticoids/therapeutic use , Graves Ophthalmopathy/drug therapy , Prednisone/therapeutic use , Body Weight/drug effects , Colchicine/adverse effects , Glucocorticoids/adverse effects , Graves Ophthalmopathy , Hypertension/etiology , Magnetic Resonance Imaging , Oculomotor Muscles , Prospective Studies , Prednisone/adverse effects , Severity of Illness Index , Smoking , Statistics, Nonparametric , Time Factors , Treatment Outcome
J. bras. pneumol ; 32(6): 592-595, nov.-dez. 2006. ilus
Article in Portuguese | LILACS | ID: lil-448730


Nocardiose é a infecção localizada ou disseminada causada por bactérias gram positivas do gênero Nocardia. Acomete mais freqüentemente pulmão, pele e sistema nervoso central. Ocorre principalmente em indivíduos com deficiência de imunidade celular e deve ser investigada principalmente quando se tem associação de manifestações respiratórias, cutâneas e neurológicas nesse grupo de pacientes. Relata-se um caso de nocardiose pulmonar e cutânea em paciente usuário de corticosteróide oral para tratamento de bronquiolite obliterante com pneumonia em organização idiopática, que evoluiu com melhora clínico-radiológica após tratamento prolongado com sulfametoxazol-trimetoprim.

Nocardiosis is a localized or disseminated infection caused by gram-positive bacteria of the genus Nocardia. The infection most commonly affects the lungs, skin and central nervous system. Nocardiosis principally occurs in individuals with cellular immunodeficiency and should be considered in the differential diagnosis when such individuals present respiratory, cutaneous or neurological alterations. Herein, we report a case of pulmonary and cutaneous nocardiosis in a patient receiving oral corticosteroids to treat bronchiolitis obliterans accompanied by organizing pneumonia of unknown origin. After long-term treatment with sulfamethoxazole-trimethoprim, the clinical and radiological profile improved.

Humans , Male , Middle Aged , Glucocorticoids/adverse effects , Immunocompromised Host , Lung Diseases/diagnosis , Nocardia Infections/diagnosis , Prednisone/adverse effects , Skin Diseases, Bacterial/diagnosis , Anti-Infective Agents/therapeutic use , Bronchiolitis Obliterans/drug therapy , Glucocorticoids/therapeutic use , Lung Diseases/drug therapy , Lung Diseases/microbiology , Nocardia Infections/drug therapy , Nocardia Infections/immunology , Nocardia asteroides/isolation & purification , Prednisone/therapeutic use , Skin Diseases, Bacterial/drug therapy , Skin Diseases, Bacterial/immunology , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use
Rev. méd. Chile ; 134(11): 1409-1416, nov. 2006. graf, tab
Article in Spanish | LILACS | ID: lil-439943


Background: Treatment of intermediate and high grade non-Hodgkin lymphoma (NHL) includes chemotherapy with or without radiotherapy, depending on the clinical stage. The standard treatment for advanced NHL is 8 cycles of combined chemotherapy, cyclophosphamide, adriamicin, vincristine and prednisone (CHOP). Patients presenting with localized disease are treated with fewer chemotherapy cycles and involved field radiotherapy, with good results. Aim: To evaluate the treatment results including overall survival (OS) and event-free survival (EFS) in localized aggressive NHL patients treated at the Pontificia Universidad Católica de Chile, Clinical Hospital. Patients and Methods: Retrospective analysis of all patients with Ann Arbor stages I and II referred to the hematology and radiotherapy clinic between 1998 and 2003. OS and EFS analysis was made according to the Kaplan and Meier method. Log-rank and Cox methods were used for univariate and multivariate analyses, respectively. Chemotherapy and radiotherapy toxicities were scored according to World Health Organization (WHO) and Radiation Therapy Oncology Group (RTOG) scales, respectively. Results: 39 patients (20 men), aged between 20 to 85 years, were the source for this study. The average follow-up was 51 months (range 6-115). The 5 years OS and EFS were 72,4 percent and 63,3 percent, respectively. On univariate analysis, age over 60 was the only variable that affected negatively OS and EFS. Acute toxicity caused by chemotherapy and radiotherapy was uncommon. Conclusions: Age over 60 was the only independent variable associated with poor prognosis. The number of chemotherapy cycles and the drug combination did not influence the results. These results support the usefullness of a shortened chemotherapy regimen plus involved field radiotherapy.

Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Lymphoma, Non-Hodgkin/drug therapy , Lymphoma, Non-Hodgkin/radiotherapy , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Combined Modality Therapy/methods , Cyclophosphamide/administration & dosage , Cyclophosphamide/adverse effects , Disease-Free Survival , Doxorubicin/administration & dosage , Doxorubicin/adverse effects , Etoposide/administration & dosage , Etoposide/adverse effects , Follow-Up Studies , Lymphoma, Non-Hodgkin/mortality , Neoplasm Staging , Prognosis , Prednisone/administration & dosage , Prednisone/adverse effects , Radiotherapy, Adjuvant , Recurrence , Retrospective Studies , Survival Analysis , Treatment Outcome , Vincristine/administration & dosage , Vincristine/adverse effects
Rev. Hosp. Clin. Fac. Med. Univ. Säo Paulo ; 59(5): 302-305, Oct. 2004. ilus
Article in English | LILACS | ID: lil-386566


Glicocorticóides são fármacos comumente usados no tratamento de pacientes lúpicos, porém apresentam efeitos adversos importantes, principalmente a osteoporose e fraturas. O tratamento da osteoporose em pacientes jovens deve ser eficaz e não prejudicial ao crescimento e remodelamento ósseo. Os bisfosfonatos são drogas que reduzem a incidência de fraturas, mas seu uso em crianças e adolescentes ainda é controverso, devido a seus possíveis efeitos adversos no esqueleto em crescimento. Estudos recentemente publicados demonstraram que o crescimento linear se manteve normal com o uso de bisfosfonatos, não havendo supressão excessiva do remodelamento ósseo ou defeitos de mineralização. O ácido zoledrônico é um novo bisfosfonato endovenoso aprovado pelo FDA para o uso na hipercalcemia das neoplasias e parece ser um tratamento eficaz para a osteoporose pós-menopáusica. Os autores descrevem um caso de uma adolescente lúpica que desenvolveu múltiplas fraturas vertebrais induzidas pelo glicocorticóide e obteve importante melhora clínica e densitométrica após o tratamento com o ácido zoledrônico.

Adolescent , Female , Humans , Bone Density Conservation Agents/therapeutic use , Diphosphonates/therapeutic use , Glucocorticoids/adverse effects , Imidazoles/therapeutic use , Lupus Erythematosus, Systemic/drug therapy , Osteoporosis/drug therapy , Spinal Fractures/chemically induced , Azathioprine/adverse effects , Bone Density/drug effects , Cervical Vertebrae/pathology , Osteoporosis/chemically induced , Prednisone/adverse effects
Rev. Inst. Med. Trop. Säo Paulo ; 43(1): 33-36, Jan.-Feb. 2001. tab
Article in English | LILACS | ID: lil-285675


Forty one cases of pemphigus vulgaris and thirty cases of pemphigus foliaceus were investigated at Hospital Universitário Clementino Fraga Filho from 1978 to 1999. They were divided into two treatment groups: one group received up to 100 mg of oral prednisone daily and the other group received >120 mg daily. The dose up to 100 mg provided good initial control of pemphigus vulgaris and pemphigus foliaceus and did not increase the mortality rate associated to disease. The dose >120 mg induced higher morbidity. These data allowed us to establish a regimen of oral prednisone (1-2 mg/kg/daily) with maximum of 120 mg daily in the treatment of pemphigus vulgaris and pemphigus foliaceus

Humans , Female , Child , Adolescent , Adult , Middle Aged , Pemphigus/drug therapy , Prednisone/administration & dosage , Aged, 80 and over , Dose-Response Relationship, Drug , Follow-Up Studies , Morbidity , Pemphigus/complications , Pemphigus/mortality , Prednisone/adverse effects , Retrospective Studies , Treatment Outcome
Bol. méd. Hosp. Infant. Méx ; 57(9): 512-6, sept. 2000. ilus
Article in Spanish | LILACS | ID: lil-286277


Introducción. El granuloma de Majocchi es una dermatofitosis profunda, generalmente causada por dermatófitos del género Trichophyton y asociada a padecimientos y procesos con inmunosupresión.Caso clínico. Se presenta un paciente del sexo femenino de 16 años de edad, con granuloma de Majocchi asociado a síndrome de Cushing medicamentoso (prednisona) y colangitis esclerosante primaria. El diagnóstico se realizó mediante pruebas micológicas: exámenes directos (KOH), y cultivo, aislándose Trichophyton rubrum, confirmado mediante histopatología. El tratamiento fue con terbinafina oral a dosis de 125 mg/día durante 30 días obteniéndose curación clínica y micológica.Conclusión. El granuloma de Majocchi es una tiña profunda, frecuentemente asociada a tratamientos con cortisona y sus derivados. Es un padecimiento raro en niños y adolescentes. Su confirmación es histopatológica y su tratamiento debe ser con antimicóticos sistémicos. Granuloma de Majocchi; granuloma dermatofítico; Trichophyton rubrum; inmunosupresión; terbinafina.

Humans , Female , Adolescent , Dermatomycoses/diagnosis , Granuloma/etiology , Cushing Syndrome/chemically induced , Cholangitis, Sclerosing/drug therapy , Prednisone/adverse effects
Rev. chil. pediatr ; 71(2): 128-35, mar.-abr. 2000. ilus, graf
Article in Spanish | LILACS | ID: lil-268230


La enfermedad de Crohn corresponde a un proceso inflamatorio crónico, de etiología desconocida, que puede afectar cualquier segmento del tubo digestivo. A diferencia de lo que ocurre en adultos, el diagnóstico de esta enfermedad en pediatría es a menudo tardío, debido al bajo índice de sospecha y las diversas formas de manifestación clínica, que dependen del segmento comprometido del tubo digestivo. Reportamos el caso de un paciente de 15 años de edad que consultó por talla baja y a quien se le detectó una masa abdominal palpable en uno de los controles médicos, motivando a un estudio que incluyó métodos de imágenes y endoscopia, y cuyos resultados fueron compatibles con enfermedad de Crohn. Se inició tratamiento con mesalamina y prednisona, siendo esta última reemplazada paulatinamente por azatioprina, debido a efectos adversos, con lo cual el paciente mejoró significativamente sus parámetros antropométricos, aunque la masa abdominal persistió a pesar de la mejoría sistémica

Humans , Male , Adolescent , Crohn Disease/complications , Failure to Thrive/etiology , Azathioprine/therapeutic use , Colitis/diagnosis , Crohn Disease/diagnosis , Crohn Disease/drug therapy , Ileitis/diagnosis , Mesalamine/therapeutic use , Prednisone/adverse effects , Prednisone/therapeutic use
Rev. Soc. Bras. Med. Trop ; 32(5): 475-82, set.-out. 1999. tab, graf
Article in Portuguese | LILACS | ID: lil-268911


Pacientes na fase crônica da doença de Chagas foram tratados com corticóide em virtude de afecçöes associadas e, a fim de tentar coibir reativaçäo da infecçäo pelo Trypanosoma cruzi, houve administraçäo o benznidazol, iniciada concomitantemente em um grupo de 12 pacientes, ou 15 dias após o começo do uso aquele medicamento em outro grupo de 6. Levando em conta o verificado em pesquisa anterior, quando corticóide de fato promoveu aumento da parasitemia, como ainda valorirando os resultados de xenodiagnóstico, pôde ser notado que o benznidazol mostrou-se apto a evitar a citada acentuaçäo parasitária, podendo tal constataçäo ser útil em procedimentos assistenciais, quando estiverem presentes doença de Chagas e imunodepressäo

Humans , Male , Adolescent , Adult , Middle Aged , Chagas Disease/prevention & control , Imidazoles/therapeutic use , Immunocompromised Host , Prednisone/adverse effects , Trypanosoma cruzi/drug effects , Chronic Disease , Control Groups , Drug Therapy, Combination , Imidazoles/administration & dosage , Nifurtimox/administration & dosage , Parasitemia/drug therapy , Prednisone/administration & dosage , Recurrence/prevention & control , Trypanocidal Agents/therapeutic use
Arch. med. res ; 29(3): 259-62, jul.-sept. 1998. tab
Article in English | LILACS | ID: lil-232643


Background. Steroid induced diabetes (SDM) has been known for a long time, but its pathophysiological mechanisms as well as its predisposing factors remain unknown. Method. In order to investigate the different factor related to the development of steroid diabetes (SDM) in patients with rheumatic diseases, we studied 27 patients with SDM, and 27 age-and sex-matched controls who also received therapy with glucocorticoids. In every case, family history of DM, body mass index, associated treatment, steroid dose and treatment duration were studied; fasting serum insulin, "C" peptide, growth hormone and glucagon levels were measured. Results. All of the patients received prednisone. Cumulated prednisone dose was the only factor significantly associated with the development of SDM. patients with SDM had a cumulated ose of 26.6 ñ 28 g (M ñ SD), while the control group received 11.6 ñ 11 g (p<0.02) (odds ratio, 6.35). Serum insulin levels were not significantly different, but insulin/glucose ratio was lower in SDM (0.104 ñ 0.05) than in the control group (0.163 ñ 0.07) (p<0.05). Conclusions. These findings suggest that high cumulated prednisone dose may induce DM regardless of another hereditary or personal predisposing factor

Humans , Male , Female , Adolescent , Adult , Middle Aged , Administration, Oral , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Anti-Inflammatory Agents/adverse effects , Diabetes Mellitus/chemically induced , Rheumatic Diseases/complications , Rheumatic Diseases/therapy , Glyburide/therapeutic use , Hypoglycemic Agents/therapeutic use , Insulin/therapeutic use , Prednisone/adverse effects , Risk Factors