RESUMO
To establish the safety and efficacy of low-dose oral methotrexate in treating refractory interstitial cystitis, 9 women who fulfilled internationally accepted criteria for the diagnosis of interstitial cystitis were enrolled in a prospective study. All had proven unresponsive to conventional treatment modalities. Assessment by pain score and frequency volume charts was performed pretreatment and up to 6 months during therapy. No significant adverse side effects were noted. At the end of follow-up, 4 women had noted a subjective improvement in bladder pain and wished to continue on methotrexate, 4 women noted little change and 1 woman reported a worsening of symptoms. Overall there was a significant reduction in pain score (p = 0.047) posttreatment. However, there was no significant difference in urinary frequency per 24 hours (p = 0.40), maximum voided volume (p = 0.089) or mean voided volume (p = 0.59). Methotrexate significantly improved bladder pain in women with interstitial cystitis, although no significant change was found in voiding pattern.
Assuntos
Cistite Intersticial/tratamento farmacológico , Imunossupressores/uso terapêutico , Metotrexato/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Cistite Intersticial/fisiopatologia , Feminino , Humanos , Pessoa de Meia-Idade , Medição da Dor , Estudos Prospectivos , UrodinâmicaRESUMO
The clinical record of a patient who suffered a mid-trimester missed abortion during an acute febrile illness is presented. Campylobacter jejuni was isolated from her blood cultures. Complete clinical recovery followed evacuation of the uterus and antibiotic therapy. Evidence of placental infection was found on histological examination. The possible role of campylobacter and other infections in fetal and perinatal death is discussed.
PIP: This case report of a 23-year-old woman who suffered a midtrimester missed abortion during an acute febrile illness shows the possible systemic effects of infection with Campylobacter jejuni. This "vibrio" was found in blood samples; products of conception were found intact; and evacuation of the uterus led to complete resolution of the infection. Histological examination of the placenta showed that as the infected site, rather than an ascending infection in the maternal genital tract. Pregnancy seems to be a predisposing factor in the occurrence of systemic campylobacter infection.
