RESUMEN
A 66-year-old man was hospitalized for asthenia, weight loss, fever and chills. A polyarteritis nodosa associated with hepatitis B virus infection in a replicative phase was diagnosed. Etiology, physiopathology, and clinical characteristics of hepatitis B virus-related polyarteritis nodosa will be reviewed, as well as the effectiveness of therapy combining corticosteroïds, interferon alpha and plasma exchanges.
Asunto(s)
Hepatitis B/complicaciones , Poliarteritis Nudosa/etiología , Anciano , Virus de la Hepatitis B/patogenicidad , Humanos , Interferón-alfa/uso terapéutico , Masculino , Plasmaféresis , Poliarteritis Nudosa/tratamiento farmacológico , Poliarteritis Nudosa/patologíaRESUMEN
We report a case of hepatoportal sclerosis in a renal transplant patient treated with azathioprine. The initial symptom was ascites. On the biochemical level, there were cholestasis without cytolysis or hepatocellular insufficiency. A presinusoidal portal hypertension was found on haemodynamic studies, without portal thrombosis at CT-scan. A diagnosis of hepatoportal sclerosis was evoked on histology and attributed to azathioprine. This case gives an illustration of a classical albeit rare complication of azathioprine. The indolent pattern of the disease and the risk of variceal bleeding point out the need for a hepatic follow-up during the treatment.
Asunto(s)
Azatioprina/efectos adversos , Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Hipertensión Portal/inducido químicamente , Inmunosupresores/efectos adversos , Trasplante de Riñón , Cirrosis Hepática/inducido químicamente , Adulto , Ascitis/inducido químicamente , Enfermedad Hepática Inducida por Sustancias y Drogas/diagnóstico , Colestasis/inducido químicamente , Diagnóstico Diferencial , Humanos , Hipertensión Portal/diagnóstico , Cirrosis Hepática/diagnóstico , MasculinoAsunto(s)
Anciano , Vestuario , Anciano/psicología , Anciano de 80 o más Años , Comercio , Difusión de Innovaciones , Humanos , Ropa de Protección , Industria TextilRESUMEN
In the present work, we demonstrate in the serum of patients with progressive exophthalmos, the presence of circulating immunoglobulin which is able to induce an experimental exophthalmos in goldfish. This immunoglobulin disappears when exophthalmos becomes residual. In parallel, we describe an easy technique for the measurement of delayed hypersensitivity which is positive for thyroid or retroorbital antigens in progressive exophthalmos but negative in residual exophthalmos. We also demonstrate in patients with exophthalmos an increase in urinary glycosaminoglycans. We propose a new therapeutic approach in treatment of acute exophthalmos which consists of intensive plasma exchange followed during a few months, by the administration of small amounts of corticosteroids. The plasma exchange mechanism consists of the extraction of the antibody directed against retroorbital eye muscle antigen. In addition, plasma exchange produces the extraction of glycosaminoglycans from retroorbital tissue. These hygroscopic molecules are responsible for the marked oedema in retroorbital tissue.
Asunto(s)
Enfermedades del Sistema Endocrino/complicaciones , Exoftalmia/etiología , Adulto , Anciano , Autoanticuerpos/análisis , Enfermedades del Sistema Endocrino/inmunología , Enfermedades del Sistema Endocrino/terapia , Exoftalmia/inmunología , Exoftalmia/terapia , Femenino , Estudios de Seguimiento , Glicosaminoglicanos/orina , Enfermedad de Graves/fisiopatología , Enfermedad de Graves/terapia , Enfermedad de Graves/orina , Humanos , Inmunidad Celular , Inmunosupresores/uso terapéutico , Persona de Mediana Edad , Intercambio PlasmáticoRESUMEN
In former investigations on human focal epilepsy and on experimental epilepsy by cobalt implantation, the authors have demonstrated the signaletic importance of "activated astrocytes": cortical astrocytes endowed with a modified metabolism and an accelerated turnover. The present study concerns the results of the intra-amygdaloid injections of kainic acid, a strong excitatory and neurotoxic amino acid. Injections in semi-chronic conditions in the rat lead to electrical and motor seizures and to the production of activated astrocytes not only in regions that might trigger off epileptic seizures (cerebral cortex, amygdala, possibly hippocampus), but also in the neostriatum. Stimulation of this last region results in a Huntington chorea-like syndrome. Thus, the importance of activated astrocytes must be extended to include other conditions of intense hyperactivity of neurons than epilepsy.