RESUMO
The age-related course of blood pressure and its gender-related difference, as well as the incidence of hypertension, have been the subject of multiple experimental, clinical and epidemiological studies over the past decades. The role of the sex hormones estradiol and testosterone within this gender dimorphism has been investigated without conclusive results. In this review, we provide background information on the gender difference in blood pressure, describe the impact of progesterone and aldosterone, and discuss the pathophysiology of aldosteronism as well as the potential role of drospirenone as a gender-specific agent for the prevention and treatment of hypertension and for cardiovascular protection.
Assuntos
Aldosterona/fisiologia , Hipertensão , Progesterona/fisiologia , Idoso , Aldosterona/efeitos adversos , Androstenos/administração & dosagem , Androstenos/uso terapêutico , Animais , Doenças Cardiovasculares/etiologia , Dieta Hipossódica , Estradiol/administração & dosagem , Estrogênios/efeitos adversos , Estrogênios/farmacologia , Estrogênios/fisiologia , Feminino , Humanos , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Hipertensão/prevenção & controle , Pessoa de Meia-Idade , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Natriurese , Congêneres da Progesterona/efeitos adversos , Congêneres da Progesterona/farmacologia , Sistema Renina-Angiotensina/efeitos dos fármacos , Sistema Renina-Angiotensina/fisiologia , Fatores de Risco , Caracteres SexuaisRESUMO
OBJECTIVE: The aim of this study was to evaluate the behavior of endometrial stromal sarcomas (ESS) in relation to their clinical and pathologic features and to identify possible prognostic factors. METHODS: Thirty-one patients with histologically proven ESS were included in the analysis. Endometrial stromal sarcoma is characterized by proliferations composed of cells with endometrial stromal cell differentiation. A breakpoint of 10 mitoses per 10 high-power fields was used in the statistical analysis to distinguish between low-grade and high-grade endometrial stromal sarcoma and to evaluate the prognostic value of mitotic count in patients with ESS. RESULTS: The median follow-up time was 72 months (range 34-110). The median overall survival of the 31 patients was 127 months, resulting in a 5-year overall survival rate of 62%. Adjuvant therapy was administered to 25 patients; among those, 20 patients received postoperative radiotherapy and 5 patients received chemotherapy. Ten of the irradiated patients and 3 patients undergoing chemotherapy developed disease recurrence. Concerning the response rate to adjuvant chemotherapy, 1 patient showed a complete response, 1 patient a partial response, 1 patient stable disease, and 2 patients progressive disease. Altogether, 14 patients developed recurrent disease with a median disease-free survival of 11 months (range 5-60). Twelve patients died of the disease. A univariate model revealed that early tumor stage (P < 0.0007), low myometrial invasion (P < 0.008), and low mitotic count (P < 0.005) were associated with a lengthened overall survival in patients with endometrial stromal sarcoma. Age and adjuvant therapy did not influence overall survival of patients with ESS. CONCLUSION: Early tumor stage, low myometrial invasion, and low mitotic count are associated with a lengthened overall survival in patients with ESS.
Assuntos
Neoplasias do Endométrio/patologia , Sarcoma do Estroma Endometrial/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Quimioterapia Adjuvante , Neoplasias do Endométrio/terapia , Feminino , Seguimentos , Humanos , Histerectomia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Ovariectomia , Prognóstico , Radioterapia Adjuvante , Estudos Retrospectivos , Salpingostomia , Sarcoma do Estroma Endometrial/terapia , Análise de SobrevidaRESUMO
Candida sepsis during pregnancy is a rare but life-threatening complication of infection with Candida albicans. In contrast to the situation with other antimicrobial agents, there exists only limited experience with systemic antifungal therapy during pregnancy. A recent report focuses on amphotericin B treatment in systemic fungal infection during pregnancy. The present report discusses a pregnant patient with Candida albicans sepsis and endophthalmitis as well as candida infection of the oral and genital mucous membranes, after hyperalimentation and broad spectrum antibiotic therapy via a central venous catheter. The patient was treated with 10 mg/kg fluconazole from week 16 of gestation for a total duration of 50 days. Adverse effects did not occur and the rest of the pregnancy proceeded favourably for both the mother and the baby.
Assuntos
Aborto Séptico/complicações , Antifúngicos/uso terapêutico , Candida albicans/isolamento & purificação , Candidíase/tratamento farmacológico , Endoftalmite/complicações , Fluconazol/uso terapêutico , Sepse/tratamento farmacológico , Adulto , Candidíase/complicações , Candidíase/microbiologia , Feminino , Humanos , Recém-Nascido , Gravidez , Literatura de Revisão como Assunto , Sepse/complicações , Sepse/microbiologiaRESUMO
Reports available on the extent and incidence of cognitive deficits in human immunodeficiency virus (HIV-1) patients are variable. To assess the influence of drug abuse and psychiatric symptoms on the extent of the cognitive deficit, we examined 42 drug-addicted HIV-1 patients and compared them with a group of seronegative drug addicts (n = 31) as well as with a group of healthy controls (n = 50), using a psychometric test battery and standardized psychiatric scales. We found no significant difference in the extent and incidence of cognitive deficits in the group of HIV-1 patients as compared with the seronegative drug addicts. Both groups, however, differed from the normal population group. Remarkable depressive symptoms were found in the HIV-1 infected patient group. We assume that long-term drug abuse contributes markedly to the cognitive deficit of HIV-1 patients, which is further influenced by depressive symptoms.
Assuntos
Complexo AIDS Demência/diagnóstico , HIV-1 , Testes Neuropsicológicos , Transtornos Relacionados ao Uso de Opioides/complicações , Abuso de Substâncias por Via Intravenosa/complicações , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Complexo AIDS Demência/psicologia , Adulto , Nível de Alerta/efeitos dos fármacos , Feminino , Humanos , Inteligência/efeitos dos fármacos , MMPI , Masculino , Rememoração Mental/efeitos dos fármacos , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/psicologia , Abuso de Substâncias por Via Intravenosa/psicologia , Transtornos Relacionados ao Uso de Substâncias/psicologiaRESUMO
Reports on neuropsychological assessment and psychopathological symptoms in HIV-1 patients are rather different. The aim of the study was to assess frequency and extent of noopsychic changes and psychopathological symptoms in HIV-1 patients of different risk groups. Of the 77 patients being included in the study 35 patients belonged to risk group 1, 42 to risk group 2. The patient groups were compared to a control-group of healthy volunteers (n = 50) and to a control-group of HIV-negative i.v. drug-addicts (n = 31). The psychometric test battery included Raven and MWT Test, Benton Test, numerical memory Test, ARG Test. Personality variables were assessed by MMPI, Psychopathology by AMDP-System, Hamilton Depression Scale, Wellbeing Scale (von Zerssen), STAI 1 and 2 and BPRS. Patients of risk group 1 showed significantly less impairment of noopsychic performance than patients of risk group 2. Risk group 1 showed only in the Benton Test significant impairment compared to healthy volunteers while risk group 2 in most of the tests was impaired. Risk group 2 did not show impairment compared to the control-group of seronegative drug users. Depressive syndromes mainly in risk group 2 showed a significant influence on the noopsychic performance.
Assuntos
Complexo AIDS Demência/diagnóstico , HIV-1 , Testes Neuropsicológicos , Complexo AIDS Demência/psicologia , Adolescente , Adulto , Feminino , Homossexualidade/psicologia , Humanos , Testes de Inteligência , MMPI , Masculino , Pessoa de Meia-Idade , Transtornos Neurocognitivos/diagnóstico , Transtornos Neurocognitivos/psicologia , Fatores de Risco , Abuso de Substâncias por Via Intravenosa/complicações , Abuso de Substâncias por Via Intravenosa/psicologiaRESUMO
Twenty-one immunodeficiency virus 1 (HIV 1)-positive hemophilic patients were treated with Azidothymidine (AZT) for symptomatic HIV infection. The median observation period was 20.5 months. At 25 months the probability of survival was 82%, the probability of progression of disease from CDC III or IV C2 to IV C1 (AIDS) was 20% in patients on continuous AZT treatment and 50% in patients with interruption of treatment. Three patients developed severe leukopenia and 3 patients severe anemia during AZT treatment. In 1 patient a dose-dependent striking increase of transaminases during AZT treatment was observed. In 7 patients treatment was interrupted, in 1 patient because of anemia, in 1 because of pruritus and in 5 patients because of non-compliance. No significant changes in the consumption of clotting factor concentrates and number of bleeding episodes before and during AZT treatment were noted. We conclude, that both hematological and non-hematological side effects of AZT in HIV 1-infected hemophilic patients are comparable to those seen in other risk groups. AZT does not increase the bleeding tendency in this patient group.
Assuntos
Infecções por HIV/tratamento farmacológico , HIV-1 , Hemofilia A/complicações , Zidovudina/efeitos adversos , Zidovudina/uso terapêutico , Adolescente , Adulto , Idoso , Contagem de Células Sanguíneas/efeitos dos fármacos , Fatores de Coagulação Sanguínea/uso terapêutico , Linfócitos T CD4-Positivos/efeitos dos fármacos , Ensaio de Imunoadsorção Enzimática , Seguimentos , Infecções por HIV/etiologia , Infecções por HIV/mortalidade , Humanos , Imunofenotipagem , Fígado/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Taxa de Sobrevida , Reação TransfusionalRESUMO
Antacids are used in the treatment of upper gastrointestinal side-effects during therapy with nonsteroidal anti-inflammatory drugs (NSAIDs). Since pharmacokinetic interactions between antacids and NSAIDs have been reported, it was investigated whether aluminium and magnesium hydroxide (Maalox as oral suspension) or aluminium hydroxide and calcium carbonate (Solugastril as oral gel) influenced the bioavailability of Lornoxicam (rINN), a new potent NSAID from the chemical group of the oxicams. Eighteen male volunteers were given 4 mg of Lornoxicam as a film-coated tablet either alone or together with 10 ml of Maalox or 10 g of Solugastril in an open, randomized, three-way cross-over study. The levels of Lornoxicam in plasma were determined by HPLC following solid-phase extraction. It was found that none of the antacids changed significantly any of the following pharmacokinetic parameters: elimination half-life (t1/2 beta), concentration at peak time (Cmax), time to reach the peak (tmax) and area under the curve to infinity (AUCo-infinity). The results indicate that the concomitant administration of antacids did not influence the pharmacokinetic profile of Lornoxicam. Furthermore they confirm the short elimination half-life of Lornoxicam in man, which is markedly shorter than that of other oxicam-type compounds.
Assuntos
Antiácidos/farmacologia , Piroxicam/análogos & derivados , Adulto , Hidróxido de Alumínio/farmacologia , Disponibilidade Biológica , Carbonato de Cálcio/farmacologia , Quimioterapia Combinada , Humanos , Hidróxido de Magnésio/farmacologia , Masculino , Piroxicam/sangue , Piroxicam/farmacocinéticaRESUMO
A group of 90 hemophiliacs who had been regularly treated with non virus-inactivated factor VIII or IX concentrates were studied in 1983. At that time 50 patients were HIV-1-antibody positive, 6 additional seroconversions occurred until 1985. 26 of the 50 patients seropositive in 1983 are currently asymptomatic. 4 patients have developed the lymphadenopathy syndrome, 9 patients AIDS and 11 patients ARC (CDC IV C 2). 6/9 cases of AIDS and 10/11 cases of ARC have occurred only after 1985. Patients, who subsequently became symptomatic, had significantly higher IgG levels in 1983, otherwise no predictive laboratory tests were identified. Patients with T4 counts above 500/microliters became symptomatic later, but after 5 years the incidence of AIDS was comparable in patients with original T4 counts of more than or below 500/microliters.
Assuntos
Complexo Relacionado com a AIDS/etiologia , Síndrome da Imunodeficiência Adquirida/etiologia , Soropositividade para HIV/epidemiologia , Hemofilia A/complicações , Complexo Relacionado com a AIDS/epidemiologia , Síndrome da Imunodeficiência Adquirida/epidemiologia , Adolescente , Adulto , Áustria , Criança , Pré-Escolar , Estudos de Coortes , Seguimentos , Hemofilia A/epidemiologia , Hemofilia A/terapia , Humanos , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco , Reação TransfusionalRESUMO
A case of primary pulmonary lymphoma presenting as a nodular lesion on the chest radiograph in a patient with the acquired immune deficiency syndrome is described.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Neoplasias Pulmonares/etiologia , Linfoma não Hodgkin/etiologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
This study presents a report on the first clinical experiences gained in 68 hospitalized HIV antibody-positive patients from Austria, covering a period of twelve months. 36 patients (52.9%) belonged to risk group I or Ib (homo- or bisexual), whereas 26 (38.2%) patients were i.v. drug abusers (risk group II). 5 (7.4%) patients fulfilled the criteria of stage II of the CDC classification of HIV-associated clinical symptoms, 10 (14.7%) were classified as stage III and the remaining 53 patients (78%) as stage IV. The most frequent and also the most serious problem was the development of opportunistic infections. Multiple infections were found in 45.7% of all cases. Kaposi's sarcoma was found in 9 patients who all belonged to risk group I. During the entire observation period 10 patients died as a consequence of HIV-1-induced immunodeficiency and the resulting opportunistic infections and/or neoplasms.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Infecções Oportunistas/complicações , Síndrome da Imunodeficiência Adquirida/imunologia , Adolescente , Adulto , Anticorpos Antibacterianos/análise , Anticorpos Antivirais/análise , Áustria , Citomegalovirus/imunologia , Feminino , HIV/imunologia , Anticorpos Anti-HIV/análise , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Oportunistas/imunologia , Fatores de RiscoRESUMO
The therapeutic effect of selective calcium entry blockers in the treatment of chronic occlusive diseases of peripheral and cerebral arteries is well documented. Experimental studies in acute cerebral ischaemia and cerebral infarction allow to anticipate positive results in clinical studies. The number of clinical studies so far available is to small for final assessment at the present time.