ABSTRACT
Hepatitis C virus infection plays a major role in the pathogenesis of mixed cryoglobulinemia, promoting activation and expansion of B cells. These molecular rearrangements induce synthesis of cryoglobulins and the appearance of cryoglobulinemic vasculitis. Clearance of the virus promotes resolution of the clinical manifestations and immunological disorders seen in mixed cryoglobulinemia in a large percentage of patients, but not in all. In some cases, cryoglobulinemia could appear after sustained response. Several steps in the pathogenesis of mixed cryoglobulinemia are strongly related to HCV infection and when the virus is eliminated, the disease course improves. However, independent steps related to other factors do not improve following viral clearance. In some types of low-grade non-Hodgkin lymphoma (lymphomoplasmocytic lymphoma, marginal zone lymphoma) sustained response following antiviral treatment induces remission of the neoplasm. HCV has a minor role in aggressive lymphomas and clearance of the virus may not induce remission, but could decrease the hepatotoxicity associated with the chemotherapy.Therefore, in chronic hepatitis C, the combination of peginterferon + ribavirin is strongly recommended in treating symptomatic mixed cryoglobulinemia and HCV-related non-Hodgkin lymphomas.
Subject(s)
Cryoglobulinemia/etiology , Hepatitis C/complications , Lymphoma, Non-Hodgkin/etiology , HumansABSTRACT
La infección por el virus de la hepatitis C juega un papel principalen la patogénesis de la crioglobulinemia mixta, promoviendola activación y expansión de las células B. Estos reajustes molecularesinducen la síntesis de crioglobulinas y la aparición de la vasculitiscrioglobulinémica. El aclaramiento del virus provoca la resoluciónde las manifestaciones clínicas y de las alteracionesinmunológicas observados en la crioglobulinemia mixta en un altoporcentaje de los pacientes, pero no en todos. En algunos casos,la crioglobulinemia puede aparecer tras la respuesta virológicasostenida. Muchos mecanismos de la patogénesis de la crioglobulinemiamixta están fuertemente relacionados con la infección porVHC y, cuando el virus es eliminado, hay una mejoría en el cursode la enfermedad. Aun así, los pasos independientes relacionadoscon otros factores no mejoran tras la erradicación del virus.En algunos tipos de linfomas no-Hodgkin de bajo grado (linfomalinfoplasmocítico y linfoma de la zona marginal) la respuestasostenida tras el aclaramiento viral induce una remisión de la neoplasia.El VHC tiene un papel secundario en los linfomas agresivosy el aclaramiento del virus puede no inducir la remisión, peropuede disminuir la hepatotoxicidad asociada a la quimioterapia.Por tanto, en la hepatitis C crónica, la combinación de interferónpegilado y ribavirina es altamente recomendable en el tratamientode la crioglobulinemia mixta sintomática y los linfomas no-Hodgkin asociados al VHC
Hepatitis C virus infection plays a major role in the pathogenesisof mixed cryoglobulinemia, promoting activation and expansionof B cells. These molecular rearrangements induce synthesisof cryoglobulins and the appearance of cryoglobulinemic vasculitis.Clearance of the virus promotes resolution of the clinical manifestationsand immunological disorders seen in mixed cryoglobulinemiain a large percentage of patients, but not in all. In somecases, cryoglobulinemia could appear after sustained response.Several steps in the pathogenesis of mixed cryoglobulinemia arestrongly related to HCV infection and when the virus is eliminated,the disease course improves. However, independent steps relatedto other factors do not improve following viral clearance.In some types of low-grade non-Hodgkin lymphoma (lymphomoplasmocyticlymphoma, marginal zone lymphoma) sustainedresponse following antiviral treatment induces remission of theneoplasm. HCV has a minor role in aggressive lymphomas andclearance of the virus may not induce remission, but could decreasethe hepatotoxicity associated with the chemotherapy.Therefore, in chronic hepatitis C, the combination of peginterferon+ ribavirin is strongly recommended in treating symptomaticmixed cryoglobulinemia and HCV-related non-Hodgkinlymphomas
Subject(s)
Humans , Cryoglobulinemia/etiology , Hepatitis C/complications , Lymphoma, Non-Hodgkin/etiologySubject(s)
Antibodies, Monoclonal/therapeutic use , Colitis, Ulcerative/complications , Colitis, Ulcerative/drug therapy , Megacolon, Toxic/complications , Megacolon, Toxic/drug therapy , Tumor Necrosis Factor-alpha , Humans , Infliximab , Male , Middle Aged , Remission Induction , Severity of Illness IndexSubject(s)
Adenocarcinoma/diagnosis , Cecal Diseases/etiology , Cecal Neoplasms/diagnosis , Emergencies , Intestinal Perforation/etiology , Pneumoperitoneum/etiology , Sigmoidoscopy/adverse effects , Adenocarcinoma/surgery , Aged, 80 and over , Cecal Diseases/surgery , Cecal Neoplasms/surgery , Cecum/injuries , Cecum/surgery , Colectomy , Humans , Intestinal Perforation/surgery , Male , Pneumoperitoneum/surgery , RuptureABSTRACT
No disponible
Subject(s)
Male , Middle Aged , Humans , Megacolon, Toxic/complications , Colitis, Ulcerative/complications , Antibodies, Monoclonal/pharmacokinetics , Colectomy , Megacolon, Toxic/drug therapy , Colitis, Ulcerative/drug therapy , Tumor Necrosis Factor-alpha/antagonists & inhibitorsABSTRACT
No disponible
Subject(s)
Male , Infant, Newborn , Humans , Scabies/complications , Scabies/diagnosis , Scabies/drug therapy , Permethrin/therapeutic use , Pruritus/complications , Staphylococcus aureus/isolation & purification , Streptococcus pyogenes/isolation & purification , Polymerase Chain Reaction/methods , Mite Infestations/diagnosis , Mite Infestations/drug therapy , Scabies/physiopathology , Permethrin/pharmacokinetics , Hyperkeratosis, Epidermolytic/complications , Hyperkeratosis, Epidermolytic/drug therapy , Keratoderma, Palmoplantar/diagnosis , Scabies/epidemiology , Scabies/historyABSTRACT
Follicular keratosis may be a rare paraneoplastic disease having unknown etiopathogeny that is sometimes associated to myeloma whose diagnosis and evolution follow a parallel course. We describe the case of a 57-year-old female patient diagnosed of multiple myeloma 8 years ago. She developed generalized follicular hyperkeratotic spicules coinciding with leukemization of the myeloma.
Subject(s)
Keratosis/complications , Multiple Myeloma/complications , Antineoplastic Agents/therapeutic use , Boronic Acids/therapeutic use , Bortezomib , Fatal Outcome , Female , Humans , Keratolytic Agents/therapeutic use , Keratosis/drug therapy , Keratosis/pathology , Middle Aged , Multiple Myeloma/drug therapy , Multiple Myeloma/pathology , Pyrazines/therapeutic use , Skin/pathologyABSTRACT
La queratosis folicular puede ser una rara enfermedad paraneoplásica de etiopatogenia desconocida, a veces asociada a mieloma, cuyo diagnóstico y evolución siguen un curso paralelo. Describimos el caso de una paciente de 57 años diagnosticada de mieloma múltiple 8 años antes, que desarrolló espículas hiperqueratósicas foliculares generalizadas coincidiendo con la leucemización del mieloma
Follicular keratosis may be a rare paraneoplastic disease having unknown etiopathogeny that is sometimes associated to myeloma whose diagnosis and evolution follow a parallel course. We describe the case of a 57-year-old female patient diagnosed of multiple myeloma 8 years ago. She developed generalized follicular hyperkeratotic spicules coinciding with leukemization of the myeloma
Subject(s)
Female , Middle Aged , Humans , Darier Disease/complications , Darier Disease/diagnosis , Darier Disease/drug therapy , Multiple Myeloma/complications , Multiple Myeloma/diagnosis , Hyperkeratosis, Epidermolytic/complications , Hyperkeratosis, Epidermolytic/diagnosis , Hyperkeratosis, Epidermolytic/drug therapy , Hyperkeratosis, Epidermolytic/pathology , Hyperkeratosis, Epidermolytic/physiopathology , Hyperkeratosis, Epidermolytic/therapyABSTRACT
OBJECTIVE: To estimate the prevalence and characteristics of geographic isolation in the elder people from Alora (Málaga). DESIGN: A transversal observational study. SETTING: Town of Alora. PATIENTS OR OTHER PARTICIPANTS: Elder people of both sexes, who lives habitually in Alora and born in 1927 or before. Home interview in a 153 individuals random sample proceeding from actual census during june to september 1992. MEASUREMENTS AND MAIN RESULTS: We found 25 individuals with the isolation conditions being the 16.34% (IC 95%: 10.48-22.20). In the 24% of them (IC 95%: 11.5-43.4) we found dependence of other person for two and more basic functions in the current life. Half of them this deficits are cover by the couple, the rest depends on their sons. We didn't found significative differences in none variables with the urban group. CONCLUSIONS: The geographic isolation affect to an important proportion of elder people in rural areas and must be used in the designs of care elderly programs.
