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[PMID]:29269693
[Au] Autor:Yasuda K; Murase N; Ohtani R; Oka N; Nakamura M
[Ad] Endereço:Department of Neurology, National Hospital Organization Kyoto Medical Center.
[Ti] Título:[A case of chronic inflammatory demyelinating polyradiculoneuropathy, showing radicular pain due to tuberous hypertrophy of the spinal roots and plexuses after 20 years interval without relapsing sensorimotor symptoms].
[So] Source:Rinsho Shinkeigaku;58(1):21-24, 2018 Jan 26.
[Is] ISSN:1882-0654
[Cp] País de publicação:Japan
[La] Idioma:jpn
[Ab] Resumo:A 40-year-old man visited our department because of chest and back pain. He had a history of diagnosis of chronic inflammatory demyelinating polyneuropathy (CIDP) 20 years ago. He received immunosuppressive therapy and had no relapses after that. On Admission, MRI showed tuberous hypertrophy of the spinal roots, intercostal nerves, and brachial and lumbar plexuses. The genetic analysis showed no mutations in any of Charcot-Marie-Tooth related genes. He was finally diagnosed with CIDP and administration of high dose intravenous methylprednisolone relieved his chest and back pain within a few days. We present a rare case of CIDP in which showed marked enlarged spinal roots in long clinical course and have a relapse with radicular pain without sensorimotor symptoms.
[Mh] Termos MeSH primário: Dor nas Costas/etiologia
Plexo Braquial/patologia
Dor no Peito/etiologia
Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/complicações
Raízes Nervosas Espinhais/patologia
[Mh] Termos MeSH secundário: Adulto
Dor nas Costas/tratamento farmacológico
Plexo Braquial/diagnóstico por imagem
Dor no Peito/tratamento farmacológico
Seres Humanos
Hipertrofia
Infusões Intravenosas
Imagem por Ressonância Magnética
Masculino
Metilprednisolona/administração & dosagem
Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/diagnóstico por imagem
Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/tratamento farmacológico
Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/patologia
Pulsoterapia
Raízes Nervosas Espinhais/diagnóstico por imagem
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
X4W7ZR7023 (Methylprednisolone)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180227
[Lr] Data última revisão:
180227
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171223
[St] Status:MEDLINE
[do] DOI:10.5692/clinicalneurol.cn-001073


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[PMID]:28456770
[Au] Autor:Hirschmann S; Atreya R; Englbrecht M; Neurath MF
[Ad] Endereço:Medical Clinic 1, Department of Medicine, University Hospital Erlangen, University of Erlangen-Nurnberg, Germany.
[Ti] Título:Safety and efficacy of intravenous cyclophosphamide pulse therapy in therapy refractory Crohn's disease patients.
[So] Source:J Physiol Pharmacol;68(1):57-67, 2017 Feb.
[Is] ISSN:1899-1505
[Cp] País de publicação:Poland
[La] Idioma:eng
[Ab] Resumo:A major challenge in the management of persistently active Crohn's disease patient's refractory to treatment regimen following the current guidelines is the induction of remission, which is a prerequisite for subsequent maintenance therapy. The aim of this study was to evaluate both the clinical and endoscopic benefit of intravenous cyclophosphamide pulse therapy in patients with active and therapy refractory Crohn's disease. Nine patients with acute moderate to severe Crohn's disease, not responding to conventional as well as biological therapy regimen received 3 - 9 cycles of monthly treatments with intravenous cyclophosphamide (680 - 1000 mg) in an uncontrolled setting and were retrospectively analyzed. Eight of nine patients (88.9%) had a clinical response (measured by a decrease in the Harvey-Bradshaw index, HBI ≥ 3) and two of nine patients (22.2%) achieved clinical remission (HBI ≤ 4) at week 8 after two applications of intravenous cyclophosphamide therapy. These response and remission rates remained unchanged after individual completion of cyclophosphamide therapy. Median HBI decreased from 18 (7 - 25) at the beginning of therapy to 7 (3 - 18) at week 8. 5 of 9 patients (56%) showed endoscopic response (defined by a reduction of ulcers) and one patient (11%) reached endoscopic remission (defined by the absence of ulcers) after the last application of cyclophosphamide. Arthralgia, which was present in 4 of 9 (44%) patients, was unchanged in most patients after cyclophosphamide therapy, although one patient described a marked reduction in joint pain. Cyclophosphamide pulse therapy was well tolerated during the whole treatment course in all subjects. One patient with long-standing Crohn's disease was diagnosed with a high-grade intraepithelial neoplasia in the rectum and underwent surgical intervention, where the diagnosis of an early stage adenocarcinoma was made. We concluded that intravenous cyclophosphamide pulse therapy was well tolerated by most patients and effective for inducing clinical and endoscopic response and remission in patients with therapy refractory Crohn's disease. In patients who are unresponsive to available therapies, including available biological treatment options, cyclophosphamide therefore represents a potential option to induce therapeutic response, which must then be maintained by other treatment modalities.
[Mh] Termos MeSH primário: Doença de Crohn/tratamento farmacológico
Ciclofosfamida/administração & dosagem
Imunossupressores/administração & dosagem
[Mh] Termos MeSH secundário: Administração Intravenosa
Adulto
Proteína C-Reativa/análise
Doença de Crohn/sangue
Doença de Crohn/patologia
Ciclofosfamida/efeitos adversos
Ciclofosfamida/uso terapêutico
Resistência a Medicamentos
Endoscopia Gastrointestinal
Feminino
Seres Humanos
Imunossupressores/efeitos adversos
Imunossupressores/uso terapêutico
Masculino
Meia-Idade
Pulsoterapia
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Immunosuppressive Agents); 8N3DW7272P (Cyclophosphamide); 9007-41-4 (C-Reactive Protein)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180220
[Lr] Data última revisão:
180220
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170501
[St] Status:MEDLINE


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[PMID]:29390559
[Au] Autor:Tian M; Song X; Dong L; Xin X; Dong J
[Ad] Endereço:Department of Nephrology, Puai Hospital.
[Ti] Título:Systematic evaluation of different doses of cyclophosphamide induction therapy for lupus nephritis.
[So] Source:Medicine (Baltimore);96(51):e9408, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: This study systemically evaluated the efficacy and safety of intermittent intravenous pulse therapy with different doses of cyclophosphamide (CTX) for the treatment of lupus nephritis (LN). METHODS: We screened the Chinese Journal Full-text Database (CNKI, 1994-present), China Biology Medicine (CBMdisc, 1978-present), VIP Database for Chinese Technical Periodicals (1989-present), PubMed (1948-present), MEDLINE (Ovid SP, 1946-present), Embase (1947-present), and the Cochrane controlled trials register (13, 2017). Literature reports were selected according to the inclusion and exclusion criteria, effective data were extracted, research quality was evaluated, and RevMan5.2 was used for meta-analysis. RESULTS: Seven randomized controlled studies were included, consisting of 655 patients. The meta-analysis results showed no significant differences between the low- and high-dose cyclophosphamide groups in partial, complete, and total remission rates as well Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). Furthermore, there were no significant differences between the 2 groups in hematologic toxicity and gastrointestinal reaction, but the risk of infection (risk ratio [RR] = 0.74, 95% confidence interval [CI], 0.56-0.98, total effect inspection Z = 2.12, P = .03), and menstrual disorder (RR = 0.46, 95% CI, 0.31-0.69, total effect inspection Z = 3.83, P = .0001) decreased in the low-dose cyclophosphamide group. CONCLUSIONS: There was no obvious difference between the low- and high-dose cyclophosphamide groups in efficacy in the treatment of lupus nephritis, but the risk of infection and menstrual disorder significantly decreased in the low-dose group.
[Mh] Termos MeSH primário: Ciclofosfamida/administração & dosagem
Imunossupressores/administração & dosagem
Nefrite Lúpica/tratamento farmacológico
[Mh] Termos MeSH secundário: Ciclofosfamida/uso terapêutico
Seres Humanos
Imunossupressores/uso terapêutico
Infusões Intravenosas/métodos
Pulsoterapia/métodos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
0 (Immunosuppressive Agents); 8N3DW7272P (Cyclophosphamide)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180212
[Lr] Data última revisão:
180212
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009408


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[PMID]:29238021
[Au] Autor:Kiboshi T; Isoda K; Furukawa K; Wakahara T; Otani K; Ueda K; Konma J; Teramura K; Ueno N; Fujiwara H; Shoda T
[Ad] Endereço:Department of Rheumatology, Yodogawa Christian Hospital.
[Ti] Título:[Granulomatosis with Polyangiitis Complicated with Gastrointestinal Perforation: A Case Report and Review of Literature].
[So] Source:Nihon Rinsho Meneki Gakkai Kaishi;40(5):382-386, 2017.
[Is] ISSN:1349-7413
[Cp] País de publicação:Japan
[La] Idioma:jpn
[Ab] Resumo:  A 51-year-old man was detected nasal bleeding, multiple pulmonary nodule and mass, urinalysis abnormality, renal involvement and high titer of proteinase 3-anti-neutrophil cytoplasmic antibody (PR3-ANCA), and was suspected of granulomatosis with polyangiitis and initiated with steroid pulse therapy. On the day after the start of steroid pulse therapy, generalized peritonitis due to ileal perforation occurred, and emergency ileectomy and peritonitis surgery were performed. Induction therapy with steroid pulse therapy, plasma exchange and intravenous cyclophosphamide therapy (IVCY) and maintenance therapy with glucocorticoid and azathioprine led to good therapeutic outcomes. Gastrointestinal perforation in GPA is a rare complication, and we examined the clinical features, treatment contents, and prognosis of GPA with gastrointestinal perforation from this case and previous reports. Lung involvements were complicated in all reported cases. Gastrointestinal perforations in GPA were frequent in the small intestine, occurred just before and immediately after the start of treatment, and were severe involvement with poor prognosis because of the high mortality rate (46.7%). The frequency of ear, nose and upper respiratory tract lesions in the surviving group was significantly higher than in the dead group (survival 87.5%, death 28.3%, P = 0.041). IVCY were more frequently used in the surviving group (62.5%) than the death group (16.7%), but it was not significantly. GPA complicated with gastrointestinal perforation is a severe condition with poor prognosis, but there is a possibility to improve prognosis by early diagnosis and early initiation of strong treatment.
[Mh] Termos MeSH primário: Granulomatose com Poliangiite/complicações
Granulomatose com Poliangiite/terapia
Íleo
Perfuração Intestinal/etiologia
Troca Plasmática
[Mh] Termos MeSH secundário: Anticorpos Anticitoplasma de Neutrófilos/sangue
Azatioprina/administração & dosagem
Biomarcadores/sangue
Ciclofosfamida/administração & dosagem
Diagnóstico Precoce
Granulomatose com Poliangiite/diagnóstico
Seres Humanos
Perfuração Intestinal/cirurgia
Masculino
Metilprednisolona/administração & dosagem
Meia-Idade
Mieloblastina/imunologia
Prognóstico
Pulsoterapia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Antibodies, Antineutrophil Cytoplasmic); 0 (Biomarkers); 8N3DW7272P (Cyclophosphamide); EC 3.4.21.76 (Myeloblastin); MRK240IY2L (Azathioprine); X4W7ZR7023 (Methylprednisolone)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180112
[Lr] Data última revisão:
180112
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171215
[St] Status:MEDLINE
[do] DOI:10.2177/jsci.40.382


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[PMID]:29187683
[Au] Autor:Hoshino M; Suzuki Y; Akiyama H; Yamada K; Shima S; Mutoh T; Hasegawa Y
[Ad] Endereço:Department of Internal Medicine, Division of Neurology, St Marianna University School of Medicine.
[Ti] Título:[Efficacy of high-dose steroid pulse therapy for anti-galactocerebroside antibody-positive combined central and peripheral demyelination].
[So] Source:Rinsho Shinkeigaku;57(12):747-752, 2017 Dec 27.
[Is] ISSN:1882-0654
[Cp] País de publicação:Japan
[La] Idioma:jpn
[Ab] Resumo:A 59-year-old man had been admitted to another hospital because of diplopia and thirst at the beginning of March and was diagnosed with diabetic ketoacidosis. He was referred to our hospital because he had limb weakness, dysarthria, and bilateral sensory impairment of the upper limbs, which worsened rapidly from the middle of March, although plasma glucose had been well controlled after the initiation of insulin therapy in the previous hospital. Contrast spinal MRI in our hospital revealed hyperintense lesions at the level of C4 to C5 and T10. The level of myelin basic protein was high (1,260 pg/ml) in the cerebrospinal fluid and serum anti-neurofascin antibody was negative. Nerve conduction study showed typical findings of demyelination at least 2 regions. Although anti-neurofascin antibody was negative, he was diagnosed with combined central and peripheral demyelination (CCPD) based on these clinical findings. After the repeated methylprednisolone pulse therapy for five times, the hyperintense lesions of the spinal cord disappeared gradually. He was bedridden at the beginning of his hospitalization but could ambulate with a cane on discharge 2 months after the admission. Then we received the result of anti-galactocerebroside antibody test as positive. This case suggested that high-dose steroid pulse therapy is safe and may be effective for anti-galactocerebroside antibody-positive CCPD.
[Mh] Termos MeSH primário: Autoanticorpos/sangue
Doenças do Sistema Nervoso Central/diagnóstico
Doenças Desmielinizantes/diagnóstico
Galactosilceramidas/imunologia
Imunoglobulina G/sangue
Metilprednisolona/administração & dosagem
Doenças do Sistema Nervoso Periférico/diagnóstico por imagem
[Mh] Termos MeSH secundário: Biomarcadores/sangue
Moléculas de Adesão Celular/imunologia
Seres Humanos
Imagem por Ressonância Magnética
Masculino
Meia-Idade
Proteína Básica da Mielina/sangue
Fatores de Crescimento Neural/imunologia
Pulsoterapia
Resultado do Tratamento
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Autoantibodies); 0 (Biomarkers); 0 (Cell Adhesion Molecules); 0 (Galactosylceramides); 0 (Immunoglobulin G); 0 (Myelin Basic Protein); 0 (NFASC protein, human); 0 (Nerve Growth Factors); X4W7ZR7023 (Methylprednisolone)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180112
[Lr] Data última revisão:
180112
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171201
[St] Status:MEDLINE
[do] DOI:10.5692/clinicalneurol.cn-000977


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[PMID]:29228412
[Au] Autor:Ozawa H; Taoda A; Shinoda T; Yanagi H; Oki M; Takagi A
[Ad] Endereço:Department of General Internal Medicine, Tokai University School of Medicine, 143 Shimokasuya Isehara kanagawa 259-1193, Japan. hide1012@is.icc.u-toka.ac.jp.
[Ti] Título:A Case of Eosinophilic Myocarditis Associated with Cardiogenic Shock.
[So] Source:Tokai J Exp Clin Med;42(4):156-159, 2017 Dec 20.
[Is] ISSN:2185-2243
[Cp] País de publicação:Japan
[La] Idioma:eng
[Ab] Resumo:The patient was a 32-year-old man with a previous history of bronchial asthma. He was admitted with chief complaints of dyspnea and skin rash associated with itching of the palms and soles of the feet, which began 2 weeks earlier. Because of the presence of cardiac failure and increase in the peripheral blood eosinophil count, eosinophilic myocarditis (EM) was suspected. His blood pressure gradually decreased and the patient went into cardiogenic shock. Therefore, endomyocardial biopsy was performed and was immediately followed by corticosteroid therapy and intra-aortic balloon pump (IABP) placement. With the findings of eosinophil infiltration associated with myocardial interstitial edema on endomyocardial biopsy, EM was diagnosed. In this case, early therapeutic intervention led to resolution of shock resolved and improvement of the peripheral blood eosinophilia and cardiac function; the patient was discharged 33 days after the onset of symptoms. EM is a rare cardiomyopathy in which myocardial eosinophil infiltration is seen. Although it has been perceived as having a mild clinical course, this report described a severe case of EM associated with cardiogenic shock, which improved as a result of early diagnosis and therapeutic intervention.
[Mh] Termos MeSH primário: Eosinofilia/complicações
Miocardite/complicações
Choque Cardiogênico/etiologia
[Mh] Termos MeSH secundário: Adulto
Biópsia
Diagnóstico Precoce
Eosinofilia/diagnóstico
Eosinofilia/patologia
Eosinofilia/terapia
Seres Humanos
Balão Intra-Aórtico
Masculino
Metilprednisolona/administração & dosagem
Miocardite/diagnóstico
Miocardite/patologia
Miocardite/terapia
Miocárdio/patologia
Prednisona/administração & dosagem
Pulsoterapia
Índice de Gravidade de Doença
Choque Cardiogênico/terapia
Resultado do Tratamento
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
VB0R961HZT (Prednisone); X4W7ZR7023 (Methylprednisolone)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180108
[Lr] Data última revisão:
180108
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171212
[St] Status:MEDLINE


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[PMID]:28953662
[Au] Autor:Abramavicius S; Velickiene D; Kadusevicius E
[Ad] Endereço:aInstitute of Physiology and Pharmacology, Lithuanian University of Health Sciences bInstitute of Endocrinology, Lithuanian University of Health Sciences cInstitute of Physiology and Pharmacology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
[Ti] Título:Methimazole-induced liver injury overshadowed by methylprednisolone pulse therapy: Case report.
[So] Source:Medicine (Baltimore);96(39):e8159, 2017 Sep.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Treatment choices are limited, when deciding how to manage thyrotoxicosis and moderate to severe Graves ophthalmopathy (GO) with suspected optic nerve damage in patients with elevated liver transaminase levels. The situation become even more complicated, if methimazole induced hepatotoxicity is suspected and intravenous methylprednisolone is co-administrated. PATIENT CONCERNS: A 74-year-old woman presented with spontaneous retro-bulbar pain, eyelid swelling and inconstant diplopia. DIAGNOSES: Thyrotoxicosis and severe GO with suspected optic nerve damage and drug induced liver injury (DILI). INTERVENTIONS: Intravenous methylprednisolone pulse therapy was administered to treat GO and methimazole was continued for thyrotoxicosis. Dose of methimazole was reduced after exclusion of concurrent infection and active liver disease. OUTCOMES: The GO symptoms (eyelid swelling, sight loss, proptosis, retro-bulbar pain, diplopia) markedly decreased after the treatment course. Liver transaminases spontaneously returned to normal ranges and remained normal during the next 12 months until the Graves' disease until the treatment was completed. LESSONS: 1. The interaction of methimazole and methylprednisolone may result in DILI. 2. In a patient without concomitant liver diseases MP can be continued if the methimazole dose is reduced if no other treatment options are available.
[Mh] Termos MeSH primário: Doença Hepática Induzida por Substâncias e Drogas
Oftalmopatia de Graves
Metimazol
Metilprednisolona
Doenças do Nervo Óptico
Tireotoxicose
[Mh] Termos MeSH secundário: Administração Intravenosa
Idoso
Antitireóideos/administração & dosagem
Antitireóideos/efeitos adversos
Doença Hepática Induzida por Substâncias e Drogas/diagnóstico
Doença Hepática Induzida por Substâncias e Drogas/fisiopatologia
Doença Hepática Induzida por Substâncias e Drogas/terapia
Relação Dose-Resposta a Droga
Feminino
Glucocorticoides/administração & dosagem
Glucocorticoides/efeitos adversos
Oftalmopatia de Graves/diagnóstico
Oftalmopatia de Graves/tratamento farmacológico
Oftalmopatia de Graves/fisiopatologia
Seres Humanos
Testes de Função Hepática
Conduta do Tratamento Medicamentoso
Metimazol/administração & dosagem
Metimazol/efeitos adversos
Metilprednisolona/administração & dosagem
Metilprednisolona/efeitos adversos
Doenças do Nervo Óptico/complicações
Doenças do Nervo Óptico/diagnóstico
Doenças do Nervo Óptico/fisiopatologia
Pulsoterapia/métodos
Avaliação de Sintomas/métodos
Tireotoxicose/complicações
Tireotoxicose/diagnóstico
Tireotoxicose/fisiopatologia
Resultado do Tratamento
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antithyroid Agents); 0 (Glucocorticoids); 554Z48XN5E (Methimazole); X4W7ZR7023 (Methylprednisolone)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171016
[Lr] Data última revisão:
171016
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170928
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008159


  8 / 1478 MEDLINE  
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[PMID]:28871582
[Au] Autor:Suzuki Y; Yokoyama K; Terao M; Morioka T; Tsuda B; Niikura N; Okamura T; Yamada E; Imagawa K; Akamatsu T; Tokuda Y; Kumaki N
[Ad] Endereço:Division of Breast and Endocrine Surgery, Department of Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan. luke-szk@is.icc.u-tokai.ac.jp.
[Ti] Título:Pyoderma Gangrenosum after Breast Mastectomy and Primary Rectus Abdominis Flap Reconstruction.
[So] Source:Tokai J Exp Clin Med;42(3):133-138, 2017 Sep 20.
[Is] ISSN:2185-2243
[Cp] País de publicação:Japan
[La] Idioma:eng
[Ab] Resumo:Pyoderma gangrenosum is an intractable disease of unknown cause involving recurrent ulcerative lesions on the skin, and may accompany ulcerative colitis, rheumatoid arthritis, leukemia, systemic lupus erythematosus, and other conditions. Here, we report a rare case of pyoderma gangrenosum in the thoracic abdomen following post-mastectomy reconstructive surgery. A 39-year-old presented at the hospital with a complaint of left papilla erosion. Skin biopsy at the site revealed invasive skin cancer, with Paget-like progression in the cancerous nipple and suspected malignancy of skin appendages. After partial mastectomy including the areola, invasive ductal breast carcinoma was diagnosed. The patient underwent a subsequent full mastectomy with simultaneous sentinel lymph node biopsy and primary breast reconstructive surgery using a rectus abdominis myocutaneous flap. Two weeks post-surgery, healing of the abdominal surgical wound was found to be delayed, and suture abscess was suspected. Despite localized treatment, an ulcerative lesion developed in the thoracic region, and pyoderma gangrenosum was diagnosed following skin biopsy. After the introduction of steroid pulse therapy, no progression of the lesion was observed. This report describes the disease characteristics, diagnosis, and treatment of post-surgical pyoderma gangrenosum and discusses the case in the context of previous literature.
[Mh] Termos MeSH primário: Mamoplastia/efeitos adversos
Mamoplastia/métodos
Mastectomia/efeitos adversos
Complicações Pós-Operatórias/tratamento farmacológico
Pioderma Gangrenoso/tratamento farmacológico
Reto do Abdome/transplante
Retalhos Cirúrgicos
[Mh] Termos MeSH secundário: Adulto
Neoplasias da Mama/diagnóstico
Neoplasias da Mama/cirurgia
Carcinoma Ductal de Mama/diagnóstico
Carcinoma Ductal de Mama/cirurgia
Feminino
Seres Humanos
Complicações Pós-Operatórias/diagnóstico
Prednisolona/administração & dosagem
Pulsoterapia
Pioderma Gangrenoso/diagnóstico
Pioderma Gangrenoso/patologia
Resultado do Tratamento
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
9PHQ9Y1OLM (Prednisolone)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171016
[Lr] Data última revisão:
171016
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170906
[St] Status:MEDLINE


  9 / 1478 MEDLINE  
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[PMID]:28804113
[Au] Autor:Takahashi K; Sato H; Hattori H; Takao M; Takahashi S; Suzuki N
[Ad] Endereço:Department of Neurology, Saitama Municipal Hospital.
[Ti] Título:Case report of a 28-year-old male with the rapid progression of steroid-resistant central nervous system vasculitis diagnosed by a brain biopsy.
[So] Source:Rinsho Shinkeigaku;57(9):509-514, 2017 09 30.
[Is] ISSN:1882-0654
[Cp] País de publicação:Japan
[La] Idioma:jpn
[Ab] Resumo:A 28-year-old Japanese male without a significant past medical history presented with new-onset generalized clonic seizure and headache. A brain MRI revealed multiple enhanced lesions on both cerebral hemispheres. Laboratory exams showed no evidence of systemic inflammation or auto-immune antibodies such as ANCAs. Despite four courses of high-dose methylprednisolone pulse therapy and five treatments with plasmapheresis, his symptoms worsened and the MRI lesions progressed rapidly. During these treatments, we performed a targeted brain biopsy, that revealed histological findings consistent with a predominant angiitis of parenchymal and subdural small vessels. He was provided with diagnosis of central nervous system vasculitis (CNSV). Subsequent cyclophosphamide pulse therapy enabled a progressive successful improvement of his symptoms. While diagnostic methods for CNSV remain controversial, histological findings are thought to be more useful in obtaining a more definitive diagnosis than findings in image studies, such as MRI and angiography. We suggest that a brain biopsy should be considered during the early period of cases with suspected CNSV and rapid clinical deterioration. We also detected human herpesvirus 7 (HHV-7) using PCR technology in brain biopsy specimens, however the relationship between CNSV and HHV-7 infection is unknow.
[Mh] Termos MeSH primário: Biópsia
Encéfalo/patologia
Vasculite do Sistema Nervoso Central/diagnóstico
Vasculite do Sistema Nervoso Central/patologia
[Mh] Termos MeSH secundário: Adulto
Encéfalo/virologia
Ciclofosfamida/administração & dosagem
Imagem de Difusão por Ressonância Magnética
Progressão da Doença
Quimioterapia Combinada
Herpesvirus Humano 7/isolamento & purificação
Seres Humanos
Masculino
Metilprednisolona/administração & dosagem
Troca Plasmática
Prednisolona/administração & dosagem
Pulsoterapia
Resultado do Tratamento
Vasculite do Sistema Nervoso Central/terapia
Vasculite do Sistema Nervoso Central/virologia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
8N3DW7272P (Cyclophosphamide); 9PHQ9Y1OLM (Prednisolone); X4W7ZR7023 (Methylprednisolone)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171016
[Lr] Data última revisão:
171016
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170815
[St] Status:MEDLINE
[do] DOI:10.5692/clinicalneurol.cn-001034


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[PMID]:28804111
[Au] Autor:Shimozono K; Hayashi Y; Nishinaka T; Kobayashi S
[Ad] Endereço:Department of Internal Medicine, Otemachi Hospital.
[Ti] Título:An adult case of group A streptococcus meningitis associated with steroid-responsive meningoencephalitis.
[So] Source:Rinsho Shinkeigaku;57(9):499-503, 2017 09 30.
[Is] ISSN:1882-0654
[Cp] País de publicação:Japan
[La] Idioma:jpn
[Ab] Resumo:A previously healthy 80-year-old woman presented to our service in a comatose state. On examination the patient had fever and neck stiffness. Laboratory investigation showed polymorphonuclear pleocytosis in cerebro-spinal fluid (CSF). These findings prompted us to a diagnosis of bacterial or viral meningitis and combination therapy consisting of ceftriaxone, vancomycin and acyclovir was started immediately. Two days later, culture of blood yielded Streptococcus pyogenes (group A streptococcus; GAS). The antibiotic therapy was converted to intravenous ampicillin for 14 days. Fever resolved quickly, however, somnolence persisted. Fluid attenuated inversion recovery image of the brain, taken on the day 29, showed focal hyperintense lesions on the right subcortical area in the temporal and parietal lobes. Three times repeated intravenous steroid pulse therapy (methylprednisolone 1,000 mg/day, 3 days) resulted in complete improvement of her consciousness disturbance. We considered the present case to be a steroid-responsive meningoencephalitis caused by GAS infection.
[Mh] Termos MeSH primário: Ampicilina/administração & dosagem
Antibacterianos/administração & dosagem
Meningites Bacterianas/complicações
Meningites Bacterianas/tratamento farmacológico
Meningoencefalite/complicações
Meningoencefalite/tratamento farmacológico
Metilprednisolona/administração & dosagem
Infecções Estreptocócicas/complicações
Infecções Estreptocócicas/tratamento farmacológico
Streptococcus pyogenes/isolamento & purificação
[Mh] Termos MeSH secundário: Idoso de 80 Anos ou mais
Esquema de Medicação
Feminino
Seres Humanos
Imagem por Ressonância Magnética
Meningites Bacterianas/diagnóstico por imagem
Meningoencefalite/diagnóstico por imagem
Pulsoterapia
Infecções Estreptocócicas/diagnóstico por imagem
Resultado do Tratamento
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Bacterial Agents); 7C782967RD (Ampicillin); X4W7ZR7023 (Methylprednisolone)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171016
[Lr] Data última revisão:
171016
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170815
[St] Status:MEDLINE
[do] DOI:10.5692/clinicalneurol.cn-001022



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