RESUMO
BACKGROUND & AIMS: Budesonide is a highly potent topical glucocorticosteroid that is characterized by low systemic availability as a result of high first-pass hepatic metabolism. The aim of this study was to evaluate the efficacy and safety of three doses of an enema preparation of budesonide in patients with active distal ulcerative colitis/proctitis. METHODS: In a double-blind multicenter trial, 233 patients were randomized to receive either a placebo enema or budesonide enema at a dose of 0.5 mg/100 mL, 2.0 mg/100 mL, or 8.0 mg/100 mL. The primary efficacy variables were an improvement of sigmoidoscopic inflammation grade, total histopathology score, and remission rates. Effects on cortisol concentrations were also assessed. RESULTS: After 6 weeks of treatment, there was significant improvement in sigmoidoscopy and histopathology scores in the budesonide 2.0-mg and 8.0-mg dose groups compared with placebo. Remission was achieved in 19% of patients in the 2.0-mg budesonide group (P = 0.050) and 27% of patients in the 8.0-mg budesonide group (P = 0.001) compared with 4% in the placebo group. More than 90% of all budesonide patients had a normal adrenocorticotropin (ACTH)-stimulated cortisol response at the last visit. The budesonide enemas were well tolerated. CONCLUSIONS: Budesonide enema is both effective and safe for the treatment of active distal ulcerative colitis/proctitis. A dose of 2. 0 mg/100 mL budesonide is the lowest effective dose.
Assuntos
Anti-Inflamatórios/uso terapêutico , Budesonida/uso terapêutico , Colite Ulcerativa/tratamento farmacológico , Enema , Proctite/tratamento farmacológico , Adulto , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/efeitos adversos , Budesonida/administração & dosagem , Budesonida/efeitos adversos , Colite Ulcerativa/patologia , Relação Dose-Resposta a Droga , Método Duplo-Cego , Enema/efeitos adversos , Feminino , Humanos , Inflamação , Masculino , Proctite/patologia , Sigmoidoscopia , Resultado do TratamentoRESUMO
We describe a patient with hematuria, pyuria, eosinophiluria, decreased renal function, and severe anemia that developed while she was receiving chronic therapy with griseofulvin for onychomycosis. We offer evidence that griseofulvin can cause an isolated erythroid hypoplasia and possibly an allergic interstitial nephritis. This is the first documented case of the above entities induced by the agent. We would recommend, based on our report, that otherwise healthy patients, when maintained on the drug for extended periods of time, have periodic determinations of renal function and hematologic status. As drug-induced erythroid hypoplasia typically occurs after a relatively long period of dosing, it may be prudent in certain individuals to monitor the CBC at approximately bimonthly intervals after initiation of therapy. Recommendations regarding monitoring of renal function are more difficult, as acute allergic interstitial nephritis can occur after either short- or long-term exposure to certain drugs.
Assuntos
Anemia Hipocrômica/induzido quimicamente , Células Precursoras Eritroides/patologia , Griseofulvina/efeitos adversos , Nefrite Intersticial/induzido quimicamente , Doença Aguda , Administração Oral , Adulto , Anemia Hipocrômica/patologia , Exame de Medula Óssea , Esquema de Medicação , Feminino , Griseofulvina/administração & dosagem , Humanos , Nefrite Intersticial/patologia , Fatores de TempoAssuntos
Adenocarcinoma/imunologia , Glomerulonefrite/imunologia , Neoplasias da Próstata/imunologia , Fosfatase Ácida/análise , Adenocarcinoma/complicações , Idoso , Idoso de 80 Anos ou mais , Antígenos de Neoplasias/análise , Biomarcadores Tumorais/análise , Glomerulonefrite/etiologia , Humanos , Técnicas Imunoenzimáticas , Masculino , Próstata/enzimologia , Próstata/imunologia , Antígeno Prostático Específico , Neoplasias da Próstata/complicações , Coloração e RotulagemRESUMO
Heroin-associated nephropathy (HAN) occurs almost exclusively in black heroin abusers, suggesting a genetic link to the disease. To further study this possibility, the frequencies of HLA-A, B, C, and DR antigens were determined in a group of 47 black patients with HAN. Included in the analyses is a subgroup of 16 patients with biopsy-proven focal glomerulosclerosis. Patient frequencies were compared with three separate control populations, the first a normal black population from New York City, the second from a national registry, and the third a group of blacks with idiopathic focal glomerulosclerosis. Only the frequency of HLA-BW53 was consistently increased significantly in the patients as compared with the control groups. This finding supports the notion that a genetic predisposition may exist in the addicted population for the development of renal disease.
Assuntos
Antígenos HLA/genética , Antígenos HLA-B , Dependência de Heroína/complicações , Falência Renal Crônica/genética , Adulto , Negro ou Afro-Americano , População Negra , Feminino , Glomerulosclerose Segmentar e Focal/etiologia , Glomerulosclerose Segmentar e Focal/genética , Antígenos HLA-DR/genética , Dependência de Heroína/etnologia , Dependência de Heroína/genética , Humanos , Nefropatias/etiologia , Nefropatias/genética , Falência Renal Crônica/etnologia , Falência Renal Crônica/etiologia , Masculino , Pessoa de Meia-Idade , FenótipoAssuntos
Injúria Renal Aguda/induzido quimicamente , Anuria/urina , Derivados de Hidroxietil Amido/efeitos adversos , Necrose Tubular Aguda/induzido quimicamente , Oligúria/urina , Substitutos do Plasma/efeitos adversos , Amido/análogos & derivados , Idoso , Humanos , Necrose Tubular Aguda/urina , Masculino , Pessoa de Meia-Idade , Concentração Osmolar , Gravidade EspecíficaRESUMO
Tuberculosis (TB) is a relatively common infectious complication in the dialysis population. Most cases are extrapulmonary and pose a diagnostic dilemma for the clinician. Tuberculous arthritis is a rare form of extrapulmonary TB occurring in approximately 1% of cases in nonuremics. Only 1 case in a dialysis patient (not proven by positive synovial fluid culture) has been reported. We report here a culture-proven case of tuberculous arthritis in a hemodialysis patient which masqueraded as an acute septic arthritis. TB should be considered early as an etiologic agent along with synovial biopsy when the exact cause of a monoarthritis has not been discovered, thus avoiding delay in initiation of appropriate therapy.
Assuntos
Diálise Renal/efeitos adversos , Tuberculose Osteoarticular/etiologia , Nefropatias Diabéticas/terapia , Feminino , Humanos , Falência Renal Crônica/terapia , Pessoa de Meia-Idade , Líquido Sinovial/análise , Líquido Sinovial/citologia , Tuberculose Osteoarticular/fisiopatologiaRESUMO
To determine the relative effects of systemic pH, PCO2, and bicarbonate concentration on colonic electrolyte transport, states of acute metabolic acidosis and alkalosis were created in Sprague-Dawley rats by gavage feeding (NH4)2SO4 and NaHCO3, respectively. During in situ perfusion of the distal colon in pentobarbital-anesthetized animals, electrolyte transport was measured before and after respiratory compensation of the systemic pH. Acute respiratory acidosis and alkalosis also were studied by ventilating animals with 0, 3, or 8% CO2. When animals in all groups were considered, net sodium absorption correlated well with blood PCO2 (r = 0.99) but not with blood pH. Net bicarbonate secretion correlated with the plasma (r = 0.95) and luminal (r = -0.63) bicarbonate concentrations but not with blood pH or PCO2. Net chloride absorption correlated with both blood PCO2 (r = 0.92) and the plasma bicarbonate concentration (r = 0.80). These results suggest that systemic PCO2 affects a sodium chloride absorptive process and that the plasma bicarbonate concentration affects a chloride absorptive-bicarbonate secretory exchange process in the rat colon.
Assuntos
Acidose/fisiopatologia , Alcalose/fisiopatologia , Bicarbonatos/metabolismo , Colo/fisiologia , Animais , Transporte Biológico Ativo , Dióxido de Carbono/sangue , Concentração de Íons de Hidrogênio , Absorção Intestinal , Canais Iônicos/metabolismo , Masculino , Perfusão , Ratos , Ratos Endogâmicos , Cloreto de Sódio/metabolismo , Equilíbrio HidroeletrolíticoRESUMO
To determine the relative effects of systemic pH, CO2 tension (PCO2), and bicarbonate concentration on ileal electrolyte transport, states of acute metabolic acidosis and alkalosis were created in Sprague-Dawley rats by gavage feeding (NH4)2SO4 and NaHCO3, respectively. During in situ perfusion of the ileum in anesthetized animals, electrolyte transport was measured before and after respiratory compensation of the systemic pH. Acute respiratory acidosis and alkalosis also were studied by ventilating animals with 0, 3, or 8% CO2. When animals in all groups were considered, net sodium absorption correlated very well with blood pH (r = -0.97). Net bicarbonate secretion correlated with the plasma bicarbonate concentration (r = 0.91) independently of blood pH and PCO2. Net chloride absorption correlated with blood PCO2 (r = 0.92) and was altered when systemic pH and bicarbonate concentration changed in opposite directions. Alterations in luminal pH and PCO2 did not affect electrolyte transport. These results suggest that systemic pH affects a sodium chloride absorptive process and that the plasma bicarbonate concentration affects a chloride absorptive-bicarbonate secretory exchange process in the rat ileum.