Treatment of a unique anemia in patients with IDDM with epoetin alfa.

OBJECTIVE: To identify and treat a unique form of anemia in patients with long-term IDDM. RESEARCH DESIGN AND METHODS: Patients with IDDM, unexplained symptomatic anemia, and serum creatinine levels of < 177 mumol/l (2.0 mg/dl) were treated with epoetin alfa (Procrit, Ortho Biotech, Raritan, NJ), 50 U/kg three times weekly, subcutaneously, to reach a target hematocrit of 38-40%. Baseline serum erythropoietin titers were measured before drug therapy. RESULTS: Six patients were treated with epoetin alfa. Median age of the group was 74 years, with IDDM being diagnosed for a median of > 20 years. All patients had symptoms of anemia with a median hematocrit of 28.9% (range 27-31). Compared with iron deficiency control patients, the group had a limited erythropoietin (EPO) response to the degree of anemia. All patients showed increases in hematocrit, median peak of 40.9%, with median time-to-peak response of 12 weeks. Baseline symptoms of anemia resolved in all patients. No adverse effects were noted during the treatment period. CONCLUSIONS: There is a unique form of anemia in patients with long-term IDDM and clinically normal renal function who respond to low-dose epoetin alfa therapy. The rapid response to therapy and depressed baseline erythropoietin titers suggest the anemia is due to a lack of endogenous EPO release.

[Acute and chronic diarrhea in AIDS: study of 435 (HIV+) patients, in Buenos Aires]. / Diarrea aguda y crónica en SIDA: estudio de 435 pacientes HIV(+), en Buenos Aires.

OBJECTIVE: Assessment of the rate of Diarrhoea in an infected HIV population of our medium. Assessment of its etiology, risk factors and response to treatment in both presentation of disease (Acute and chronic). DESIGN: This is a retrospective analysis of HIV and/or AIDS patients and diarrhea. The analytic points were: the clinical pattern of diarrhea (acute or chronic), risk factors, age, sex, etiology, stage of the disease, and response rate to treatment. PLACE: Hospital Prof. A. Posadas, that is situated in the greater Buenos Aires, and that functions as a referral centre for AIDS patients. PATIENTS AND METHODS: 435 case records that were followed up through June 1987/ March 1994 were reviewed; 109 of the total number suffered from diarrhea. RESULTS: The rate of diarrhoea in the studied population was 25% (109/435). This represented the first symptom of HIV infection in 18.3% of the patients (20/109), 49% had acute diarrhea and 51% had chronic diarrhea. An etiologic agent was established in 52.3% of the chronic diarrhoeas and in the 17.7% of the acute ones, with a 35.4% of a global isolation when basic stool test were made. Sixty three percent of the patients with chronic diarrhoea were in stage IV of HIV infection. The 78.3% of the acute diarrhoeas and 46% of the chronic ones were responsive to specific or symptomatic treatment. CONCLUSIONS: HIV antibodies determinations should be included in the study protocol of diarrhea, especially in young patients. Chronic diarrhea could be related to final stages of the disease, with lower response to treatment. Endoscopy studies should be useful when the stool tests are negative, specially in the Cytomegalovirus (CMV) and Mycobacterium complex avium intracellulare (MAI) search.

[Analysis of patients with acute pancreatitis (AP), (1984-1994) decade. Comparison with a past series]. / Análisis de pacientes con pancreatitis aguda (PA), Década (1984-1994). Comparación con serie anterior.

Between 1984-1994 records of 190 patients with acute pancreatitis (AP) were reviewed. Diagnosis was confirmed by surgery in 141, by necropsy 1 (75%), and for the remaining patients, by CT and clinical evaluation. Female 122 were female (64%), male 68 (36%), mean age 41 years (range 7-82 years). The etiologic factors were gallstones in 129 (68%) with 4 deaths (3%), alcoholic in 26 (14%) with 5 (19%) deaths, idiopathic in 24 (13%) and miscellaneous 11 (5%), the last 2 without mortality. The overall mortality was 5% (9/190). Surgical treatment was indicated in 141 (74%) and endoscopic treatment in 2 (1%), 47 patients (25%) received only medical treatment. One-hundred and fifty-four patients (81%) were mild forms with a Ranson mean score 2.2 without mortality. In this group, emergency surgery was indicated in 7 (6%), early in 3 (3%), late in 1 (0.9%) and elective in 99 (90%). In the severe group were 36 patients (19%) with a mean Ranson score of 4.2. Nine patients died (25%), 31 were surgically treated, by emergency surgery in 17 (47%), 1 (3%) early surgery and 13 (36%) late surgery. The mortality rate of this group was compared with previous series of the same hospital (1975-1984 series). The 1984-1994 group showed a significant overall mortality decrease 4.7% vs 12.7% (p = 0.0047); 3.1% vs 11.2% (p = 0.0087) for the gallstones group; without mortality in the idiopathic and miscellaneous form compared with 18.7% and 20% respectively of the previous series; no mortality was observed in the mild AP compared with 5% of the previous series. The mortality in the severe form was 25% vs 40.8% (1975-1984 group). We consider that the decreased mortality could be attributed to the improvement in the diagnosis, early recognition of the severe forms, systemic supportive care in the severe forms, the use of antibiotics with wide spectrum and deeper penetration in the pancreas and specially in the change of the surgical timing. Although, in the first period the option was the early pancreatic surgery, in the second this was indicated only in particular cases.