Base de dados : MEDLINE
Pesquisa : D06.472.040 [Categoria DeCS]
Referências encontradas : 47937 [refinar]
Mostrando: 1 .. 10   no formato [Detalhado]

página 1 de 4794 ir para página                         

  1 / 47937 MEDLINE  
              next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:29332223
[Au] Autor:Togasaki E; Shimizu N; Nagao Y; Kawajiri-Manako C; Shimizu R; Oshima-Hasegawa N; Muto T; Tsukamoto S; Mitsukawa S; Takeda Y; Mimura N; Ohwada C; Takeuchi M; Sakaida E; Iseki T; Yoshitomi H; Ohtsuka M; Miyazaki M; Nakaseko C
[Ad] Endereço:Department of Hematology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan.
[Ti] Título:Long-term efficacy of partial splenic embolization for the treatment of steroid-resistant chronic immune thrombocytopenia.
[So] Source:Ann Hematol;97(4):655-662, 2018 Apr.
[Is] ISSN:1432-0584
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:Thrombopoietin-receptor agonists have been recently introduced for a second-line treatment of immune thrombocytopenia (ITP). Splenectomy has tended to be avoided because of its complications, but the response rate of splenectomy is 60-80% and it has still been considered for steroid-refractory ITP. We performed partial splenic embolization (PSE) as an alternative to splenectomy. Between 1988 and 2013, 91 patients with steroid-resistant ITP underwent PSE at our hospital, and we retrospectively analyzed the efficacy and long-term outcomes of PSE. The complete response rate (CR, platelets > 100 × 10 /L) was 51% (n = 46), and the overall response rate (CR plus response (R), > 30 × 10 /L) was 84% (n = 76). One year after PSE, 70% of patients remained CR and R. The group with peak platelet count after PSE ≥ 300 × 10 /L (n = 29) exhibited a significantly higher platelet count than the group with platelet count < 300 × 10 /L (n = 40) at any time point after PSE. The failure-free survival (FFS) rates at 1, 5, and 10 years were 78, 56, and 52%, respectively. Second PSE was performed in 20 patients who relapsed (n = 14) or had no response to the initial PSE (n = 6), and the overall response was achieved in 63% patients. There were no PSE-related deaths. These results indicate that PSE is a safe and effective alternative therapy to splenectomy for patients with steroid-resistant ITP as it generates long-term, durable responses.
[Mh] Termos MeSH primário: Embolização Terapêutica
Púrpura Trombocitopênica Idiopática/terapia
Baço/irrigação sanguínea
[Mh] Termos MeSH secundário: Adolescente
Corticosteroides/uso terapêutico
Adulto
Idoso
Idoso de 80 Anos ou mais
Intervalo Livre de Doença
Resistência a Medicamentos
Resistência a Múltiplos Medicamentos
Embolização Terapêutica/efeitos adversos
Feminino
Seguimentos
Hospitais Universitários
Seres Humanos
Japão
Masculino
Meia-Idade
Tamanho do Órgão
Púrpura Trombocitopênica Idiopática/diagnóstico por imagem
Púrpura Trombocitopênica Idiopática/tratamento farmacológico
Púrpura Trombocitopênica Idiopática/patologia
Estudos Retrospectivos
Baço/diagnóstico por imagem
Baço/efeitos dos fármacos
Baço/patologia
Esteroides/uso terapêutico
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Adrenal Cortex Hormones); 0 (Steroids)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180115
[St] Status:MEDLINE
[do] DOI:10.1007/s00277-018-3232-x


  2 / 47937 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo SciELO Brasil
[PMID]:29267659
[Au] Autor:Jana A; Thomas J; Ghosh P
[Ad] Endereço:PMS College of Dental Science & Research, Department of Physiology, Kerala, India.
[Ti] Título:P-glycoprotein expression in oral lichen planus.
[So] Source:Braz Oral Res;31:e95, 2017 Dec 18.
[Is] ISSN:1807-3107
[Cp] País de publicação:Brazil
[La] Idioma:eng
[Ab] Resumo:Oral lichen planus (OLP) is a stress induced inflammatory condition with malignant potency. The mdr1 (multidrug resistance) is a stress gene overexpressed in cancerous conditions and its translated form, the p-glycoprotein efflux transporter is usually overexpressed with chemotherapy, leading to chemoresistance. OLP, a lesion with carcinogenic potency, is broadly classified into the asymptomatic reticular form and the aggressive erosive form. The objective of the study was to verify the expression level of p-glycoprotein in antifungal-treated and untreated reticular OLP, in untreated erosive OLP and erosive OLP patients treated with corticosteroid. Semi-quantitative reverse transcriptase polymerase chain reaction (SQ-RTPCR) and ELISA were performed on biopsy tissue samples to evaluate the mdr1 mRNA and protein expression of p-glycoprotein, respectively. The present study shows for the first time that mdr1 mRNA as well as its translated form p-glycoprotein are overexpressed in OLP subjects compared to healthy individuals. This overexpression is significantly higher in erosive than in reticular OLP patients, further confirming that the erosive form has higher risk for multidrug resistance. A higher expression is also observed in corticosteroid-treated erosive cases than similar untreated ones. The gradation of expression is in conformity with severity of the disease.
[Mh] Termos MeSH primário: Subfamília B de Transportador de Cassetes de Ligação de ATP/metabolismo
Corticosteroides/uso terapêutico
Antifúngicos/uso terapêutico
Líquen Plano Bucal/tratamento farmacológico
Líquen Plano Bucal/metabolismo
[Mh] Termos MeSH secundário: Adulto
Análise de Variância
Biópsia
Farmacorresistência Fúngica Múltipla
Ensaio de Imunoadsorção Enzimática
Feminino
Seres Humanos
Líquen Plano Bucal/patologia
Masculino
Meia-Idade
Reação em Cadeia da Polimerase Via Transcriptase Reversa
Índice de Gravidade de Doença
Pele/patologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (ATP Binding Cassette Transporter, Sub-Family B); 0 (Adrenal Cortex Hormones); 0 (Antifungal Agents)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:D; IM
[Da] Data de entrada para processamento:171222
[St] Status:MEDLINE


  3 / 47937 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:29351562
[Au] Autor:Calvet J; Orellana C; Galisteo C; García-Manrique M; Navarro N; Caixàs A; Larrosa M; Gratacós J
[Ad] Endereço:Rheumatology Department, Parc Taulí Sabadell University Hospital. I3PT Research Institute (UAB), Sabadell, Barcelona, Spain.
[Ti] Título:Clinical and ultrasonographic features associated to response to intraarticular corticosteroid injection. A one year follow up prospective cohort study in knee osteoarthritis patient with joint effusion.
[So] Source:PLoS One;13(1):e0191342, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: Intraarticular injection is used for pain relief in knee osteoarthritis (OA), but there is not a well defined profile of patient who could get more benefit from it. The purpose of this study was to evaluate the frequency of pain relief at one year after corticosteroids intraarticular injection and to identify clinical factors associated to response in patients with knee osteoarthritis with joint effusion. METHODS: One-year prospective cohort study of patients with knee OA with joint effusion confirmed by ultrasound. An intraarticular injection was performed following a clinical protocol. Anthropometric measurements, laboratory parameters, clinical severity, ultrasound parameters and radiological severity were collected. Response regarding pain and presence of synovial fluid on ultrasound at one month and at one year were evaluated. Clinical responder were consider in subjects with enough improvement to carry out normal daily activities with pain VAS<40mm. RESULTS: One hundred and thirty-two patients were included.A significant number of patients (61.4%) improved pain at one year following the protocol established in this study. Pain and ultrasound synovial fluid at one month appeared to predict the response at one year. The Lequesne index and the percentage of body fat were independently associated to pain at one year while the Lequesne index and ultrasound synovial hypertrophy were independently related to the presence of synovial fluid at one year. CONCLUSIONS: The status regarding pain or ultrasound synovial fluid at one month after an intraarticular joint injection appeared to predict the status at one year in patients with knee osteoarthritis and synovial effusion.
[Mh] Termos MeSH primário: Corticosteroides/administração & dosagem
Osteoartrite do Joelho/tratamento farmacológico
[Mh] Termos MeSH secundário: Idoso
Estudos de Coortes
Feminino
Seguimentos
Seres Humanos
Injeções Intra-Articulares
Masculino
Meia-Idade
Osteoartrite do Joelho/diagnóstico por imagem
Osteoartrite do Joelho/fisiopatologia
Dor/tratamento farmacológico
Manejo da Dor
Medição da Dor
Estudos Prospectivos
Líquido Sinovial/diagnóstico por imagem
Líquido Sinovial/efeitos dos fármacos
Ultrassonografia
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Adrenal Cortex Hormones)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180120
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0191342


  4 / 47937 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:29317387
[Au] Autor:Keeley D; Baxter N
[Ad] Endereço:Primary Care Respiratory Society UK, Solihull, UK duncan.keeley@nhs.net.
[Ti] Título:Conflicting asthma guidelines cause confusion in primary care.
[So] Source:BMJ;360:k29, 2018 01 09.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Asma/diagnóstico
Asma/terapia
Guias de Prática Clínica como Assunto
Atenção Primária à Saúde/normas
[Mh] Termos MeSH secundário: Administração por Inalação
Corticosteroides/administração & dosagem
Corticosteroides/uso terapêutico
Asma/economia
Asma/epidemiologia
Inglaterra/epidemiologia
Seres Humanos
Antagonistas de Leucotrienos/uso terapêutico
Espirometria
[Pt] Tipo de publicação:EDITORIAL
[Nm] Nome de substância:
0 (Adrenal Cortex Hormones); 0 (Leukotriene Antagonists)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180111
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.k29


  5 / 47937 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:29301743
[Au] Autor:Dowlatshahi EA; Diercks G; van Doorn M
[Ad] Endereço:Erasmus Medical Centre, Rotterdam, Netherlands emmilia.dowlat@gmail.com.
[Ti] Título:Blisters in disguise.
[So] Source:BMJ;360:j5364, 2018 01 04.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Vesícula/imunologia
Vesícula/patologia
Pênfigo/imunologia
Pênfigo/patologia
Pele/patologia
[Mh] Termos MeSH secundário: Corticosteroides/administração & dosagem
Corticosteroides/uso terapêutico
Idoso
Vesícula/tratamento farmacológico
Vesícula/epidemiologia
Desmogleínas/imunologia
Diagnóstico Diferencial
Ensaio de Imunoadsorção Enzimática/métodos
Técnica Direta de Fluorescência para Anticorpo/métodos
Seres Humanos
Fatores Imunológicos/administração & dosagem
Fatores Imunológicos/uso terapêutico
Imunossupressores/administração & dosagem
Imunossupressores/uso terapêutico
Incidência
Masculino
Pênfigo/tratamento farmacológico
Pênfigo/epidemiologia
Rituximab/administração & dosagem
Rituximab/uso terapêutico
Pele/imunologia
Resultado do Tratamento
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Adrenal Cortex Hormones); 0 (Desmogleins); 0 (Immunologic Factors); 0 (Immunosuppressive Agents); 4F4X42SYQ6 (Rituximab)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180106
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.j5364


  6 / 47937 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:29452655
[Au] Autor:Amici JM; Chaussade V
[Ad] Endereço:Service de dermatologie, hôpital Saint-André, Bordeaux, France. Electronic address: jmamici@gmail.com.
[Ti] Título:[How to optimize scarring in dermatologic surgery?]
[Ti] Título:Optimisation de la cicatrisation en chirurgie dermatologique et gestions des aléas..
[So] Source:Ann Dermatol Venereol;143 Suppl 2:S20-S25, 2016 Dec.
[Is] ISSN:0151-9638
[Cp] País de publicação:France
[La] Idioma:fre
[Ab] Resumo:Scarring is the response elicited by the skin surface to injury and loss of tissue material. Wound healing takes place through a complex natural repair system consisting of vascular, inflammatory and proliferative phenomena, followed by a remodelling and cell apoptosis phase. This incredible repair system is inevitable, but sometimes unpredictable due to individual differences based on multiple factors. The scar is the objective criterion of a skin surgery, both for the patient and the dermsurgeon. It is therefore crucial to establish with the patient during the preoperative consultation, the size and positioning of the expected scar, taking into account the oncologic, anatomic and surgical constraints. Scars can ideally blend into normal skin, but may also give rise to various abnormalities. We can manage and prevent these abnormalities by mastering initial inflammation, that may induce hyperpigmentation and hypertrophy. Early massage using cortocosteroid topic or anti-inflammatory moisturizers may be effective. Random individual scarring may be minimized by a dynamic personalized accompanying scarring.
[Mh] Termos MeSH primário: Cicatriz/fisiopatologia
Procedimentos Cirúrgicos Dermatológicos/efeitos adversos
[Mh] Termos MeSH secundário: Corticosteroides/administração & dosagem
Anti-Inflamatórios/administração & dosagem
Cicatriz/prevenção & controle
Cicatriz Hipertrófica/fisiopatologia
Cicatriz Hipertrófica/prevenção & controle
Terapia Combinada
Eritema/fisiopatologia
Eritema/prevenção & controle
Hiperpigmentação/fisiopatologia
Hiperpigmentação/prevenção & controle
Queloide/fisiopatologia
Massagem
Educação de Pacientes como Assunto
Fatores de Risco
Pele/fisiopatologia
Transplante de Pele
Protetores Solares/administração & dosagem
Telangiectasia/fisiopatologia
Telangiectasia/prevenção & controle
Cicatrização/fisiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Adrenal Cortex Hormones); 0 (Anti-Inflammatory Agents); 0 (Sunscreening Agents)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180302
[Lr] Data última revisão:
180302
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180218
[St] Status:MEDLINE


  7 / 47937 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:29452653
[Au] Autor:Passeron T
[Ad] Endereço:Service de dermatologie, CHU Nice, France; INSERM U1065, équipe 12, C3M, Nice, France. Electronic address: thierry.passeron@unice.fr.
[Ti] Título:[Post-inflammatory hyperpigmentation].
[Ti] Título:L'hyperpigmentation post-inflammatoire..
[So] Source:Ann Dermatol Venereol;143 Suppl 2:S15-S19, 2016 Dec.
[Is] ISSN:0151-9638
[Cp] País de publicação:France
[La] Idioma:fre
[Ab] Resumo:Post-inflammatory hyperpigmentation (PIH) is a hyperpigmentation of the skin occurring after and sometimes during an inflammatory process. Although more frequent in dark skinned individuals, PIH can be observed in any type of skin and at all ages. In most case a strong impact on the quality of life of affected individuals is observed. The pathophysiology of PIH remains largely unknown. The activation of the melanocytes occurs in the first week following the inflammation emphasizing the crucial role of early preventive measures. Photoprotection with balanced UVA and UVB protection is required. Visible light could also play a role in PIH but this remains to be demonstrated. Healing topics with anti-inflammatory properties are of interest after a skin procedure. When the risk of PIH is high or when PIH occurs, topical steroids remains the gold standard approach.
[Mh] Termos MeSH primário: Dermatite/fisiopatologia
Hiperpigmentação/fisiopatologia
[Mh] Termos MeSH secundário: Corticosteroides/administração & dosagem
Dermatite/prevenção & controle
Seres Humanos
Hiperpigmentação/prevenção & controle
Melanócitos/efeitos dos fármacos
Melanócitos/fisiologia
Pigmentação da Pele/efeitos dos fármacos
Pigmentação da Pele/fisiologia
Protetores Solares/administração & dosagem
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Adrenal Cortex Hormones); 0 (Sunscreening Agents)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180302
[Lr] Data última revisão:
180302
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180218
[St] Status:MEDLINE


  8 / 47937 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:29387946
[Au] Autor:Sánchez-González B; Planillo A; Navarro-Castilla Á; Barja I
[Ad] Endereço:Department of Biology, Zoology Unit, Universidad Autónoma de Madrid, Madrid, Spain.
[Ti] Título:The concentration of fear: mice's behavioural and physiological stress responses to different degrees of predation risk.
[So] Source:Naturwissenschaften;105(1-2):16, 2018 Jan 31.
[Is] ISSN:1432-1904
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:Predation is an unavoidable and dangerous fact in the lifetime of prey animals and some sign of the proximity of a predator may be enough to trigger a response in the prey. We investigated whether different degrees of predation risk by red foxes (Vulpes vulpes) evoke behavioural and physiological stress responses in wood mice (Apodemus sylvaticus). We examined the variation in mice responses due to individual factors (sex and reproductive status) and related them to the concentration of the volatile compounds from fox faeces over time. In our experiment, we introduced predation cues into four plots, each subjected to a different concentration treatment (0, 10, 50 and 100% concentration of fresh faeces of red fox), based on the following outline: initial odourless phase 0, phase1 in which predation treatment was renewed daily, and phase 2 in which we renewed the treatment only on the first day. Wood mice were live trapped during all three phases and the physiological response was measured non-invasively by analysing faecal corticosterone metabolites (FCM) in freshly collected faeces. Data were analysed by Generalized Linear Mixed Models. Overall, males were trapped less often than females, and reproductively active individuals from both sexes avoided traps more than non-reproductively active individuals, especially in medium- and high- concentration plots. Variations in FCM concentrations were explained by plot, the interaction between plot and treatment phase, and the interaction between the treatment phase and the reproductive status. During phase 1, we detected a significant rise in FCM levels that increased with predator faecal odour concentration. Additionally, reproductively active individuals showed a strong physiological response during both phases 1 and 2 in all plots, except the control plot. Our results indicated that wood mice are able to discriminate different degrees of predation risk, which allows them to trigger gradual changes in their behavioural and physiological stress responses.
[Mh] Termos MeSH primário: Medo/fisiologia
Murinae/fisiologia
Estresse Fisiológico/fisiologia
[Mh] Termos MeSH secundário: Corticosteroides/análise
Animais
Comportamento Animal
Fezes/química
Feminino
Cadeia Alimentar
Raposas/fisiologia
Masculino
Murinae/psicologia
Odorantes
Reprodução
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Adrenal Cortex Hormones)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180302
[Lr] Data última revisão:
180302
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180202
[St] Status:MEDLINE
[do] DOI:10.1007/s00114-018-1540-6


  9 / 47937 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:29334287
[Au] Autor:Sridharan K; Sivaramakrishnan G
[Ad] Endereço:a Associate Professor, Department of Pharmacology and Therapeutics , College of Medicine and Medical Sciences, Arabian Gulf University , Manama , Bahrain.
[Ti] Título:Efficacy and safety of alpha blockers in medical expulsive therapy for ureteral stones: a mixed treatment network meta-analysis and trial sequential analysis of randomized controlled clinical trials.
[So] Source:Expert Rev Clin Pharmacol;11(3):291-307, 2018 Mar.
[Is] ISSN:1751-2441
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Alpha blockers (AB) are the main group of drugs used for medical expulsive therapy (MET) in patients with ureteral stones. However, there is no consensus on the relative efficacy and safety of individual AB in MET. Areas covered: The present work is a network meta-analysis of randomized controlled trials comparing AB with either placebo or standard of care in patients with ureteral stones. Electronic databases of Medline, Cochrane CENTRAL and Google Scholar were searched for eligible clinical studies. Inverse variance heterogeneity model was used for mixed treatment comparisons. Stone expulsion rate (SER) and stone expulsion time (SET) were the primary outcomes. Sub-group analyses for the following sub-groups were carried out: children; after shockwave lithotripsy; stone size of ≤5 mm; >5 mm; proximal and distal ureteral stones. Expert review: AB, phosphodiesterase inhibitors and combined AB with corticosteroids were observed with significant stone expulsion rate compared to control group in a recent network meta-analysis. Due to lack of head-to-head clinical trials within AB, only tamsulosin has been widely recommended by various urological guidelines. The results of this network meta-analysis will guide the future researchers in evaluating other promising ABs as agents for MET.
[Mh] Termos MeSH primário: Antagonistas Adrenérgicos alfa/administração & dosagem
Sulfonamidas/administração & dosagem
Cálculos Ureterais/tratamento farmacológico
[Mh] Termos MeSH secundário: Corticosteroides/administração & dosagem
Antagonistas Adrenérgicos alfa/efeitos adversos
Adulto
Criança
Quimioterapia Combinada
Seres Humanos
Inibidores de Fosfodiesterase/administração & dosagem
Guias de Prática Clínica como Assunto
Ensaios Clínicos Controlados Aleatórios como Assunto
Sulfonamidas/efeitos adversos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
0 (Adrenal Cortex Hormones); 0 (Adrenergic alpha-Antagonists); 0 (Phosphodiesterase Inhibitors); 0 (Sulfonamides); G3P28OML5I (tamsulosin)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180116
[St] Status:MEDLINE
[do] DOI:10.1080/17512433.2018.1424537


  10 / 47937 MEDLINE  
              first record previous record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:29390386
[Au] Autor:Nusshag C; Morath C; Zeier M; Weigand MA; Merle U; Brenner T
[Ad] Endereço:Department of Nephrology.
[Ti] Título:Hemophagocytic lymphohistiocytosis in an adult kidney transplant recipient successfully treated by plasmapheresis: A case report and review of the literature.
[So] Source:Medicine (Baltimore);96(50):e9283, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening disease entity primarily described in children, but not less relevant in adults. It is characterized by a misdirected activation of the immune system, resulting in an uncontrolled cytokine release from macrophages and cytotoxic T-cells (CTLs). Primary HLH relies on a genetic predisposition, whereas secondary HLH develops in the context of infections, malignancies or autoimmune diseases. However, the awareness and therapeutic knowledge for HLH in adulthood is limited. Most therapy protocols are almost exclusively validated in pediatric cohorts and for primary HLH. Their transferability to adult individuals with mostly secondary HLH is doubtful. Especially the high liver and bone marrow toxicity of applied etoposide-based protocols is discussed controversially and connected to overwhelming infections and death. PATIENT CONCERN: A 51-year old, male, kidney transplant recipient was admitted to our center suffering from diarrhea, fever, nausea, hyponatremia, kidney graft failure, disorientation, progressive hemodynamic instability, and multiorgan failure. DIAGNOSES: Clinical and laboratory findings resembled those of a septic shock. Ferritin and soluble interleukin-2 receptor (sCD25) levels were disproportionally elevated. Only a mild hepatosplenomegaly was diagnosed in a CT scan. A T2-weighted, fluid-attenuated inversion recovery MRI showed marked, bilateral and periventricular white matter hyperintensities. The cerebrospinal fluid (CSF) analysis showed a moderately elevated protein content and cell count. There was no evidence of any bacterial, viral, or parasitic infection. The diagnosis of HLH was made. INTERVENTIONS & OUTCOMES: The patient was successfully treated by a combined approach consisting of plasma exchange (PE), corticosteroids, anakinra, and cyclosporine (CsA). LESSONS: HLH is an important differential diagnosis in critically ill patients. Its unspecific clinical picture complicates an early diagnosis and may be misclassified as sepsis. A combination of plasma exchange (PE), corticosteroids, anakinra, and cyclosporine (CsA) may be a promising and less toxic approach for HLH therapy in adults.
[Mh] Termos MeSH primário: Transplante de Rim
Linfo-Histiocitose Hemofagocítica/terapia
Plasmaferese
[Mh] Termos MeSH secundário: Corticosteroides/uso terapêutico
Antirreumáticos/uso terapêutico
Terapia Combinada
Ciclosporina/uso terapêutico
Diagnóstico Diferencial
Diagnóstico por Imagem
Seres Humanos
Imunossupressores/uso terapêutico
Proteína Antagonista do Receptor de Interleucina 1/uso terapêutico
Linfo-Histiocitose Hemofagocítica/etiologia
Masculino
Meia-Idade
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Adrenal Cortex Hormones); 0 (Antirheumatic Agents); 0 (Immunosuppressive Agents); 0 (Interleukin 1 Receptor Antagonist Protein); 83HN0GTJ6D (Cyclosporine)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009283



página 1 de 4794 ir para página                         
   


Refinar a pesquisa
  Base de dados : MEDLINE Formulário avançado   

    Pesquisar no campo  
1  
2
3
 
           



Search engine: iAH v2.6 powered by WWWISIS

BIREME/OPAS/OMS - Centro Latino-Americano e do Caribe de Informação em Ciências da Saúde