RESUMO
La nitrofurantoína es un antimicrobiano ampliamente utilizado en el tratamiento y profilaxis de infecciones urinarias no complicadas, su eficacia clínica parece equivalente a la de otros antibióticos. Su toxicidad pulmonar se conoce desde 1962. Presentamos el caso de una paciente de 82 años que se diagnosticó en agosto de 2009 y que refería dos cuadros pulmo nares previos ese mismo año, compatibles con toxicidad por nitrofurantoína y que en los 12 años siguientes no ha presentado cuadros similares. Se exponen las formas clínicas de presentación, la dificultad diagnóstica y las dudas sobre el tratamiento adecuado (AU)
Nitrofurantoin is an antimicrobial widely used in the treatment and prophylaxis of uncomplicated urinary tract infections, its clinical efficacy seems equivalent to that of other antibiotics. Its pulmonary toxicity has been known since 1962. We present the case of an 82-year-old patient who was diagnosed in August 2006 and who reported two previous pulmo nary symptoms that same year, compatible with nitrofurantoin toxicity and who in the following 12 years had not presented similar symptoms. The clinical forms of presentation, the diagnostic difficulty and the doubts about the appropriate treatment are exposed (AU)
Assuntos
Humanos , Feminino , Idoso de 80 Anos ou mais , Pneumonia/induzido quimicamente , Pneumonia/diagnóstico por imagem , Nitrofurantoína/uso terapêutico , Antibacterianos/uso terapêuticoRESUMO
El trasplante pulmonar es un procedimiento terapéutico, médico-quirúrgico, indicado en enfermedades pulmonares terminales e irreversibles con los tratamientos médicos actuales, excepto el carcinoma pulmonar. Es un tratamiento emergente en atención médica. En esta revisión se analizan las complicaciones más frecuentes del trasplante pulmonar relacionadas con: el injerto (rechazo y disfunción crónica); la inmunosupresión (infecciones, hipertensión arterial, diabetes, etc.); otras especialmente frecuentes (gastrointestinales, osteoporosis, etc.) y la actitud terapéutica más razonable. Se especifican los controles a realizar para vigilar la evolución del injerto y del paciente, las recomendaciones generales para la consecución de un estilo de vida saludable y de la mayor calidad posible y la supervivencia tanto del registro español como del registro internacional, su evolución histórica y las causas más frecuentes de muerte, para poder así analizar la utilidad real del trasplante (AU)
The lung transplantation is a therapeutic procedure indicated for lung diseases that are terminal and irreversible (except lung cancer) despite the best medical current treatment. It is an emergent procedure in medical care. In this review, an analyse is made of the most frequent complications of lung transplant related to the graft (rejection and chronic graft dysfunction), immunosuppression (infections, arterial hypertension, renal dysfunction, and diabetes), as well as others such as gastrointestinal complications, osteoporosis. The most advisable therapeutic options are also included. pecific mention is made of the reviews and follow-up for monitoring the graft and the patients, as well as the lifestyle recommended to improve the prognosis and quality of life. An analysis is also made on the outcomes in the Spanish and international registries, their historical evolution and the most frequent causes of death, in order to objectively analyse the usefulness of the transplant (AU)
Assuntos
Humanos , Transplante de Pulmão , Rejeição de Enxerto , Imunossupressores/administração & dosagem , Infecções por Citomegalovirus/epidemiologia , Atenção Primária à Saúde/métodos , Padrões de Prática Médica , Complicações Pós-Operatórias/epidemiologia , Osteoporose/epidemiologiaRESUMO
El trasplante pulmonar es un procedimiento terapéutico, médico-quirúrgico, indicado en enfermedades pulmonares terminales e irreversibles con los tratamientos médicos actuales, excepto el carcinoma pulmonar. En España se llevan realizados más de 3.500 trasplantes, con una tasa superior a 6 pacientes por millón de habitantes y en expansión. En esta revisión se analizan los tipos de trasplantes, sus indicaciones y contraindicaciones, la estrategia del trasplante, el tratamiento inmunosupresor con sus efectos secundarios e interacciones medicamentosas, la profilaxis habitual. Se incluyen unas referencias bibliográficas, la mayoría de autores nacionales, de fácil acceso para facilitar una profundización en temas seleccionados (AU)
Lung transplant is a therapeutic, medical-surgical procedure indicated for pulmonary diseases (except lung cancer), that are terminal and irreversible with current medical treatment. More than 3,500 lung transplants have been performed in Spain, with a rate of over 6 per million and increasing. In this review, an analysis is made of the types of transplants, their indications and contraindications, the procedures, immunosuppressive treatments, their side effects and medical interactions, current prophylaxis. A list of easily accessible literature references is also include, the majority being by national authors (AU)
Assuntos
Humanos , Transplante de Pulmão/educação , Medicina de Família e Comunidade , Medicina de Família e Comunidade/organização & administração , Conhecimentos, Atitudes e Prática em Saúde , Terapia de Imunossupressão/métodos , Fibrose Cística/complicações , Hipertensão/complicações , Hipertensão Pulmonar/complicações , Ciclosporina/uso terapêutico , Tacrolimo/uso terapêuticoRESUMO
Lung transplant is a therapeutic, medical-surgical procedure indicated for pulmonary diseases (except lung cancer), that are terminal and irreversible with current medical treatment. More than 3,500 lung transplants have been performed in Spain, with a rate of over 6 per million and increasing. In this review, an analysis is made of the types of transplants, their indications and contraindications, the procedures, immunosuppressive treatments, their side effects and medical interactions, current prophylaxis. A list of easily accessible literature references is also include, the majority being by national authors.
Assuntos
Imunossupressores/administração & dosagem , Pneumopatias/cirurgia , Transplante de Pulmão/métodos , Humanos , Imunossupressores/efeitos adversos , Médicos de Família , EspanhaRESUMO
The lung transplantation is a therapeutic procedure indicated for lung diseases that are terminal and irreversible (except lung cancer) despite the best medical current treatment. It is an emergent procedure in medical care. In this review, an analyse is made of the most frequent complications of lung transplant related to the graft (rejection and chronic graft dysfunction), immunosuppression (infections, arterial hypertension, renal dysfunction, and diabetes), as well as others such as gastrointestinal complications, osteoporosis. The most advisable therapeutic options are also included. Specific mention is made of the reviews and follow-up for monitoring the graft and the patients, as well as the lifestyle recommended to improve the prognosis and quality of life. An analysis is also made on the outcomes in the Spanish and international registries, their historical evolution and the most frequent causes of death, in order to objectively analyse the usefulness of the transplant.
