ABSTRACT
Pain in terminally ill patients with cancer can be often hard to manage, due to the unpredictable kinetics of drugs caused by progressive kidney and liver dysfunction. Plasma concentrations of active metabolites-also a cause of dangerous side effects--could be difficult to estimate. This case report holds the idea that buprenorphine, a partial agonist of m-receptors, even at high dosage, may be effective and safe to use in terminally ill patients with significant liver and kidney impairment.
Subject(s)
Analgesics, Opioid/therapeutic use , Buprenorphine/therapeutic use , Liver Failure/physiopathology , Pain/drug therapy , Analgesics, Opioid/adverse effects , Buprenorphine/adverse effects , Dose-Response Relationship, Drug , Humans , Kidney/physiopathology , Liver/physiopathology , Liver Failure/complications , Male , Middle Aged , Pain/etiology , Pain/physiopathology , Pain Measurement/methods , Pancreatic Neoplasms/complications , Pancreatic Neoplasms/physiopathology , Terminally IllABSTRACT
The authors evaluated the performance of the MycArray™ Yeast ID (Myconostica Ltd, UK) assay in the identification of a total of 88 yeast isolates recovered in culture as compared to that obtained through routine methods. The turn-around time for species identification directly from cultures by the MycArray was 6 hours, much quicker than classical methods and all yeasts were correctly identified. In two cases a double identification including Saccharomyces cerevisiae was noted, but it was not confirmed by culture. The results show that MycArray Yeast ID can be a potential tool for rapid detection and identification of Candida species.
Subject(s)
Blood/microbiology , Fungemia/microbiology , Oligonucleotide Array Sequence Analysis/methods , Yeasts/classification , Yeasts/isolation & purification , Candida/classification , Candida/genetics , Candida/isolation & purification , Culture Media , Hospitals , Humans , Italy , Mycological Typing Techniques/instrumentation , Mycological Typing Techniques/methods , Oligonucleotide Array Sequence Analysis/instrumentation , Saccharomyces cerevisiae/classification , Saccharomyces cerevisiae/genetics , Saccharomyces cerevisiae/isolation & purification , Yeasts/geneticsSubject(s)
Buprenorphine/administration & dosage , Cholestasis/drug therapy , Naloxone/administration & dosage , Neoplasms/complications , Pain/etiology , Pain/prevention & control , Pruritus/drug therapy , Administration, Topical , Aged , Analgesics, Opioid/administration & dosage , Cholestasis/etiology , Chronic Disease , Drug Combinations , Female , Humans , Injections, Intravenous , Narcotic Antagonists/administration & dosage , Neoplasms/nursing , Pain Measurement/drug effects , Palliative Care/methods , Pruritus/etiology , Treatment OutcomeABSTRACT
A 9-year-old female, domestic short hair cat was presented with sudden onset of polyuria/polydipsia, and hundreds of cutaneous nodules. Prior to referral, the cat had had four skin nodules that were treated with steroids. The four skin nodules then multiplied to form more than 100 ulcerated and nonulcerated nodules located all over the trunk. Clinical evaluation revealed hypothermia and respiratory distress. Cytology from both skin nodules and bronchoalveolar lavage showed macrophages and small organisms whose shape and size were indicative of Toxoplasma spp., or similar organisms. Feline immunodeficiency virus (FIV) and feline leukaemia virus (FeLV) serology results were negative. The cat was seropositive for Toxoplasma (IgG 1 : 640) and Neospora (1 : 80) infections. The cat died soon after referral. Necropsy revealed pyothorax, necrotic/purulent pneumonia, haemorrhagic spots on kidneys and mesentery. Histopathology from skin nodules showed diffuse, deep necrotic dermatitis/panniculitis, vasculitis and disseminated free and grouped protozoa. The parasites were found in lungs, spleen, kidneys and liver. Immunohistochemistry on skin tissue with anti-Toxoplasma gondii and Neospora caninum antibodies gave positive results with both. Electron microscopy showed single and grouped tachyzoites with morphological features of T. gondii, often within macrophages. Samples of cutaneous nodules and bronchoalveolar fluid were examined by a polymerase chain reaction (PCR) assay for detecting apicomplexa coccidia. PCR results were consistent only with T. gondii infection. Therefore, immunohistochemistry positivity for N. caninum was considered a cross-reaction and a diagnosis of cutaneous and visceral toxoplasmosis was made.
