Assuntos
Crise Blástica/patologia , Úlcera da Córnea/patologia , Infecções Oculares Bacterianas/patologia , Leucemia Mieloide Aguda/patologia , Infecções Pneumocócicas/patologia , Adulto , Córnea/patologia , Diagnóstico Diferencial , Evolução Fatal , Humanos , Masculino , Infecções Oportunistas/patologia , Choque Séptico/patologia , Supuração/patologia , Uveíte/patologiaRESUMO
Management of critically ill patients regularly involves the treatment of water and electrolyte disturbances. Moreover, critical care itself may contribute to volume overload and electrolyte abnormalities. Initial therapy should be followed by consequent diagnostic evaluation. The shift of volume and potassium in severe pancreatitis, for example, may lead to a life-threatening situation. In brain-dead patients, successful organ donation is facilitated by careful maintenance of water and electrolyte homeostasis.
Assuntos
Cuidados Críticos/métodos , Pancreatite/diagnóstico , Pancreatite/terapia , Desequilíbrio Hidroeletrolítico/diagnóstico , Desequilíbrio Hidroeletrolítico/terapia , Humanos , Pancreatite/complicações , Guias de Prática Clínica como Assunto , Padrões de Prática Médica , Desequilíbrio Hidroeletrolítico/etiologiaRESUMO
Functionally relevant damage caused by chronic systemic inflammatory disorders of autoimmune and/or unknown origin can be reduced or sometimes avoided by early initiation of treatment. This requires a correct diagnosis which makes treatment as early as possible. Due to the often uncharacteristic symptoms at the onset of disease, early diagnosis in systemic inflammatory disorders represents a diagnostic challenge. This review outlines current standards and limitations in the early diagnosis of rheumatoid arthritis, collagen vascular diseases and primary systemic vasculitides. Recent advances especially in serology and imaging techniques have improved early diagnosis of systemic inflammatory disorders.
Assuntos
Artrite Reumatoide/diagnóstico , Doenças do Colágeno/diagnóstico , Erros de Diagnóstico/prevenção & controle , Medição de Risco/métodos , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Vasculite/diagnóstico , Artrite Reumatoide/classificação , Artrite Reumatoide/epidemiologia , Artrite Reumatoide/terapia , Doença Crônica , Doenças do Colágeno/classificação , Doenças do Colágeno/epidemiologia , Doenças do Colágeno/terapia , Humanos , Guias de Prática Clínica como Assunto , Padrões de Prática Médica , Prognóstico , Fatores de Risco , Síndrome de Resposta Inflamatória Sistêmica/classificação , Síndrome de Resposta Inflamatória Sistêmica/epidemiologia , Síndrome de Resposta Inflamatória Sistêmica/terapia , Fatores de Tempo , Vasculite/classificação , Vasculite/epidemiologia , Vasculite/terapiaAssuntos
Transplante de Rim/métodos , Rim/anatomia & histologia , Doadores de Tecidos/estatística & dados numéricos , Adulto , Morte Encefálica , Pré-Escolar , Humanos , Lactente , Rim/anormalidades , Falência Renal Crônica/cirurgia , Transplante de Rim/fisiologia , Estudos Retrospectivos , Doadores de Tecidos/provisão & distribuiçãoRESUMO
The preparation for colonoscopy is essential for the results of the examination. The effectiveness of 3 commercially available Golytely solutions for colonoscopy (Original-Golytely-salt, Oralav and Delcoprep) were compared in a randomized prospective study. 310 outpatients were randomized into 3 groups. One of the above-mentioned solutions were used in these patients. Before the examination the patients were asked to drink 3 l of the given solution within 2 h. The colonoscopy was realized within 3-5 h after the end of preparation. Outcome criteria were the subjective acceptability of the solution for the patient, cleanness of the bowel and the formation of foam. In all 3 groups sufficient up to very good results could be achieved. There were no significant differences in the 3 groups. We conclude that the used procedure is absolutely sufficient to prepare for colonoscopy and that administration of liquids of more than 3 l or the use of enema or laxans on the previous day, are unnecessary. The suggested procedure can be used for children, too.
Assuntos
Colonoscopia , Eletrólitos/administração & dosagem , Polietilenoglicóis/administração & dosagem , Irrigação Terapêutica , Adulto , Idoso , Assistência Ambulatorial , Eletrólitos/química , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Polietilenoglicóis/química , Estudos Prospectivos , Método Simples-CegoAssuntos
Transplante de Rim/métodos , Rim/anatomia & histologia , Coleta de Tecidos e Órgãos/métodos , Adulto , Fatores Etários , Pré-Escolar , Feminino , Seguimentos , Rejeição de Enxerto/imunologia , Humanos , Lactente , Recém-Nascido , Rim/fisiologia , Transplante de Rim/imunologia , Transplante de Rim/fisiologia , Masculino , Resultado do TratamentoRESUMO
This study was performed to investigate the common characteristics of hemodialysis patients who need upper limb amputations. An index case was identified and involved questioning physicians and reviewing hospital and office records. Hemodialysis patients who have diabetes and leg amputations are at high risk for ischemic episodes that may lead to amputation of the arm, distal to the arteriovenous access site.
Assuntos
Amputação Cirúrgica/estatística & dados numéricos , Braço/cirurgia , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Isquemia/etiologia , Diálise Renal/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Braço/irrigação sanguínea , Chicago , Diabetes Mellitus , Feminino , Humanos , Perna (Membro)/cirurgia , Masculino , Pessoa de Meia-IdadeAssuntos
Neoplasias Esofágicas/terapia , Tumor de Células Granulares/terapia , Diagnóstico Diferencial , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/epidemiologia , Neoplasias Esofágicas/patologia , Tumor de Células Granulares/diagnóstico , Tumor de Células Granulares/epidemiologia , Tumor de Células Granulares/patologia , HumanosRESUMO
Summary : Renal disease is common in systemic lupus erythematosus (SLE) and significantly influences patient prognosis. Immunosuppressive therapy has markedly improved outcome, however, it increases the risk of infection and cancer induction. Although several therapeutic regimens have proved to be effective in controlling lupus nephritis (LN), optimal therapy is still a matter of discussion. The following review summarizes our current knowledge in treating LN and discusses new aspects in pathogenesis. Hopefully, continuing progress in uncovering details about the pathogenesis of SLE might lead to more disease-specific approaches to treat the underlying immunological disorder.
Assuntos
Carcinoma de Células Renais/cirurgia , Neoplasias Renais/cirurgia , Transplante de Rim , Nefrectomia/métodos , Adulto , Creatinina/sangue , Feminino , Taxa de Filtração Glomerular , Humanos , Soluções Hipertônicas , Transplante de Rim/fisiologia , Soluções para Preservação de Órgãos , Complicações Pós-OperatóriasAssuntos
Injúria Renal Aguda/etiologia , Sarampo/complicações , Rabdomiólise/etiologia , Injúria Renal Aguda/sangue , Injúria Renal Aguda/terapia , Adulto , Creatina Quinase/sangue , Humanos , Masculino , Vírus do Sarampo/patogenicidade , Mioglobina/sangue , Diálise Renal , Rabdomiólise/sangue , Rabdomiólise/complicaçõesAssuntos
Doença Antimembrana Basal Glomerular/cirurgia , Falência Renal Crônica/cirurgia , Transplante de Rim , Doença Antimembrana Basal Glomerular/etiologia , Doença Antimembrana Basal Glomerular/terapia , Autoanticorpos/metabolismo , Humanos , Terapia de Imunossupressão , Plasmaferese , Prognóstico , Recidiva , Sistema de RegistrosRESUMO
Systemic lupus erythematosus is a chronic disease with many clinical features, while Goodpasture's syndrome usually becomes manifest with progressive glomerulonephritis and pulmonary hemorrhage. Rapidly declining renal function and even pulmonary hemorrhage may be the common feature. Early and precise diagnosis is most important as it may provide general prognostic information and serve as a guideline for initial therapy. Immunosuppression with oral cyclophosphamide and high dose corticosteroids together with plasmapheresis is used in Goodpasture's syndrome. Progressive lupus nephritis requires high dose corticosteroids together with i.v. pulses of cyclophosphamide for at least six months, followed by maintenance immunosuppression. The benefits of therapy must always be weighed against the risks. Nevertheless, current therapy remains less than optimal. A better understanding of the pathogenesis of systemic lupus erythrematosis (SLE) and Goodpasture's syndrome may provide more specific information about the nature and the role of the immune response and thus lead to new treatment strategies.
Assuntos
Doença Antimembrana Basal Glomerular/terapia , Nefrite Lúpica/terapia , Doença Antimembrana Basal Glomerular/etiologia , Doença Antimembrana Basal Glomerular/patologia , Estado Terminal , Progressão da Doença , Humanos , Nefrite Lúpica/etiologia , Nefrite Lúpica/patologiaRESUMO
Goodpasture's syndrome is mediated by immunopathogenic autoantibodies to the alpha 3 NC1 domain of type IV collagen. It is not known whether collaborating T-cells participate in this autoreactive response. Here we describe the first T-cell clone isolated from a Goodpasture patient autoreactive to alpha 3 type IV collagen of glomerular basement membrane. To investigate cellular autoreactivity, T-cells from Goodpasture patients or controls were isolated and stimulated by purified native or recombinant type IV collagen proteins and synthetic oligopeptides. Cell surface markers, the T-cell receptor repertoire, and MHC-restriction were analyzed. T-cell clones specific for the alpha 3 (IV) NC1 domain were established in two Goodpasture patients, but not in controls. One of the three CD8+ T-cell clones was characterized further. It was MHC class I restricted (HLA-A11) and expressed the T-cell receptor V beta 5.1. chain. This clone specifically recognized a motif at the N-terminal area of the alpha 3 (IV) NC1 domain (AA 51 to 59: GSPATWTTR). We conclude that autoreactive T-cells exists in Goodpasture patients and may play a crucial role in the inflammatory process. T-cell clones are autoreactive to the alpha 3 (IV) NC1 domain. At least for one of the clones, the T-cell epitope is different from the putative antibody-binding site.
Assuntos
Doença Antimembrana Basal Glomerular/imunologia , Colágeno/imunologia , Linfócitos T/imunologia , Sequência de Aminoácidos , Autoantígenos/imunologia , Sequência de Bases , Células Clonais/química , Células Clonais/imunologia , Colágeno/química , Mapeamento de Epitopos , Humanos , Dados de Sequência Molecular , Estrutura Terciária de ProteínaRESUMO
The mechanisms of glomerular injury are multiple: one aspect is cell-mediated immunity in inflammatory kidney disease. Its fundamental role has been established within the last decade. T cells seem to play a regulatory role in the course of inflammation not only in the proliferative and crescentic disease, but also in nonproliferative glomerulonephritis. T cells become increasingly important in the pathogenesis of both glomerular and interstitial kidney diseases and seem to determine course and prognosis. The recent advances in understanding the mechanisms of T cell-mediated inflammation in kidney disease offer new approaches in therapy.