Assuntos
Hemangioma/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Infecções por HIV/complicações , Hemangioma/etiologia , Humanos , Neoplasias Hepáticas/etiologia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada de Emissão de Fóton Único , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: To provide a concise review of the current approach to the clinical use of the available drugs for HIV infection. DATA SOURCES: Recent "state of the art" publications and key reference articles. CONCLUSIONS: Prognostic and monitoring parameters for HIV infection have been established based on new insights into the life-cycle of HIV and novel virologic techniques. Three groups of antiretrovirals are now available for general use. Familiarity with these drugs, their pharmacokinetics, side effects, and drug-drug interactions, as well as with the specific milieu of each individual patient is crucial for the successful management of HIV infection.
Assuntos
Fármacos Anti-HIV/farmacologia , Infecções por HIV/tratamento farmacológico , Adulto , Fármacos Anti-HIV/efeitos adversos , HIV/fisiologia , Infecções por HIV/virologia , Humanos , RNA Viral/sangue , Replicação Viral/efeitos dos fármacosRESUMO
OBJECTIVES: The passage of immunoglobulin G (IgG) across the placenta is thought to involve Fc' receptors on the syncytiotrophoblast. To confirm the receptor dependency of this process we have studied the changes in the tissue content and transfer kinetics of immunoglobulins and hyperimmune serum to HIV (HIVIG) during in vitro dual placental perfusion. METHODS: Isolated lobules of term placentae from normal pregnancies were perfused in a model of maternal and fetal circulation. The perfused tissue was compared to fresh tissue samples from the same placenta for the content of IgG, IgG subclasses, IgM, cytokeratin, human placental lactogen and SP1 antigen by immunohistochemistry and by protein elution. RESULTS: The immunoglobulin staining faded by an average of 40% during the 1st hour of perfusion. In contrast, staining for cytokeratin, human placental lactogen and SP1 remained unchanged. During a 4-hour recycling of endogenous immunoglobulins in the maternal circulation, IgG and HIVIG crossed to the fetal side in a steady rate. The transport of HIVIG could be inhibited by preperfusion with an intravenous gammaglobulin preparation (IVIG). DISCUSSION: The transfer of IgG across the placenta occurs in a steady state rate consistent with a receptor-mediated mechanism. Furthermore, inhibition of HIVIG maternofetal transfer by IVIG further establishes the receptor-mediated transfer of immunoglobulins through the placenta.
Assuntos
Imunidade Materno-Adquirida/imunologia , Imunoglobulinas Intravenosas/metabolismo , Placenta/imunologia , Placenta/metabolismo , Receptores Fc/metabolismo , Feminino , Humanos , Imunoglobulina G/imunologia , Imunoglobulina G/metabolismo , Imunoglobulina M/imunologia , Imunoglobulina M/metabolismo , Imunoglobulinas/metabolismo , Imunoglobulinas Intravenosas/imunologia , Imuno-Histoquímica , Técnicas In Vitro , Queratinas/metabolismo , Lactogênio Placentário/metabolismo , Gravidez , Receptores Fc/imunologiaAssuntos
Dor Abdominal/etiologia , Febre de Causa Desconhecida/etiologia , Soropositividade para HIV/diagnóstico , Hepatite Alcoólica/diagnóstico , Linfoma Relacionado a AIDS/diagnóstico , Linfoma não Hodgkin/diagnóstico , Sorodiagnóstico da AIDS , Dor Abdominal/complicações , Adulto , Técnicas de Laboratório Clínico , Diagnóstico por Imagem , Febre de Causa Desconhecida/complicações , Soropositividade para HIV/complicações , Hepatite Alcoólica/complicações , Humanos , Linfoma Relacionado a AIDS/complicações , Linfoma não Hodgkin/complicações , Masculino , Cooperação do PacienteAssuntos
Hipersensibilidade a Drogas/etiologia , Quinolonas/efeitos adversos , Biópsia , Ciprofloxacina/efeitos adversos , Dermatite Herpetiforme/induzido quimicamente , Dermatite Herpetiforme/diagnóstico , Diagnóstico Diferencial , Toxidermias/classificação , Toxidermias/diagnóstico , Eritema Multiforme/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Penfigoide Bolhoso/induzido quimicamente , Penfigoide Bolhoso/diagnóstico , Penfigoide Bolhoso/patologia , Pele/patologiaRESUMO
OBJECTIVE: The goal of this review is to summarize the current knowledge about the transfer of immunoglobulins from the mother to the fetus. Data obtained experimentally and clinically will be discussed, and intervention trials and options will be examined. DATA SOURCE: References are limited to the English language and to human data. Sources include computerized databases and bibliographies of recent articles and books. RESULTS: Electronmicroscopic studies have unveiled the passage route of IgG through the placenta. The placental in vitro perfusion system has become a valuable experimental model, with a crucial role in the preclinical evaluation of trials to manipulate the maternal-fetal passage of immunoglobulins. CONCLUSIONS: Immunoglobulins are transferred through the placenta in an active, selective and affinity-restricted process, which is Fc-gamma receptor mediated and intracellular. Much work is still required to improve our ability to control the rate and the efficiency of this process, but the results of pioneering attempts have been encouraging.
Assuntos
Imunoglobulinas/imunologia , Troca Materno-Fetal/imunologia , Feminino , Humanos , Imunidade Materno-Adquirida , Placenta/imunologia , GravidezAssuntos
Lúpus Eritematoso Sistêmico/complicações , Dermatopatias Vesiculobolhosas/complicações , Adulto , Dermatite Herpetiforme/diagnóstico , Diagnóstico Diferencial , Hipersensibilidade a Drogas/etiologia , Feminino , Furosemida/efeitos adversos , Glibureto/efeitos adversos , Humanos , Imunoglobulinas/análise , Lúpus Eritematoso Cutâneo/diagnóstico , Penfigoide Bolhoso/diagnóstico , Plasmaferese , Dermatopatias Vesiculobolhosas/diagnóstico , Dermatopatias Vesiculobolhosas/terapia , Sulfonamidas/efeitos adversosRESUMO
Given the variability of patient problems, it is difficult to construct a single drug therapy regimen for treatment of chronic urticaria. However, the following regimen should prove to be a useful outline to follow for most cases. The first line of therapy will usually be antihistamines. In general, antihistamines should be always used on a regular basis and not only after hives occur. If drowsiness or anticholinergic adverse symptoms limit the use of one drug in effective doses, other H1-blockers should be tried. For day-time use, the newer, less sedating antihistamines are preferred. If antihistamines fail to control symptoms when used at full doses, addition of glucocorticosteroids can be tried for short periods. Most patients respond to doses equivalent to 40 mg of prednisone daily. The end point of use of corticosteroids is to reach quickly an effective low, alternate-day dose followed by their discontinuation.
Assuntos
Antagonistas dos Receptores Histamínicos H1/uso terapêutico , Urticária/tratamento farmacológico , Doença Crônica , Antagonistas dos Receptores Histamínicos H1/efeitos adversos , Antagonistas dos Receptores Histamínicos H1/química , Antagonistas dos Receptores H2 da Histamina/uso terapêutico , HumanosRESUMO
A 38-year-old man with AIDS and intractable large-volume diarrhea due to a cryptosporidial infection was successfully treated with intravenous octreotide, a somatostatin analogue. The volume of diarrhea, 10-12 liters with 8-13 movements per day, was reduced to three to four semi-formed to formed stools per day when the patient was treated with 400 micrograms intravenous octreotide daily. The patient's intravenous hyperalimentation was discontinued and he returned to oral feeding. He quickly regained his normal weight and has now resumed his normal activities. For those patients who cannot tolerate subcutaneous administration, intravenous octreotide therapy may not only be life-saving but may also markedly increase the quality of life. Roxithromycin, a macrolide antibiotic, was also administered to this patient with cryptosporidiosis but efficacy was not demonstrated.