RESUMEN
Two chronic haemodialyzed patients with digitalis intoxication are reported. One of them took digoxin 0.25 mg three times daily for an unknown period and the other took digitoxin 0.1 mg twice daily for two weeks. The symptoms of intoxication were mainly concealed by uremic syndrome. The diagnosis was established by noticed sinus bradycardia, first- and second-degree atrioventricular block in ECG and the determination of sera levels of glycosides (serum digoxin concentration was 7.36 ng/ml, serum digitoxin concentration was 46.5 ng/ml) in both cases. Considering the probable long elimination period of digitalis and the potentially life-threatening situation the patients were given digoxin-specific antibody (Fab) fragments with potassium replacement therapy. The symptoms disappeared within a few hours after therapy, side effects and rebound toxicity did not develop. In connection with these cases the aim of this report is to publish a method which can reverse the life-threatening digitalis intoxication in patients suffering from renal failure as well. As to the above method, the authors have not found any similar case reports in the Hungarian medical literature.
Asunto(s)
Digoxina/administración & dosificación , Uremia/terapia , Anciano , Antídotos/administración & dosificación , Digoxina/inmunología , Digoxina/envenenamiento , Sobredosis de Droga , Femenino , Humanos , Fragmentos de Inmunoglobulinas/administración & dosificación , Potasio/administración & dosificación , Diálisis Renal , AutoadministraciónRESUMEN
The prevalence of IgE myeloma is 0.01% in all plasmocytomas. Although signs and symptoms are similar, it is generally accepted that IgE myeloma has a more malignant clinical course than other forms of plasmocytoma with monoclonal gammopathy. The disease has widely variable presentation. Most of the reported cases were accompanied by complications that are rarely seen with other types of myeloma. So far only one idiopathic (benign?) IgE monoclonal gammopathy has been reported. This case report is the first recorded IgE myeloma in Hungary with a rather unusual clinical presentation and diagnostic process. It is of particular interest that a monoclonal chain was detected in the urine of the patient several years prior to diagnosis.
Asunto(s)
Amiloidosis/inmunología , Inmunoglobulina E , Cadenas Ligeras de Inmunoglobulina , Paraproteinemias/inmunología , Diagnóstico Diferencial , Humanos , Inmunoglobulina E/sangre , Inmunoglobulina E/orina , Cadenas Ligeras de Inmunoglobulina/sangre , Cadenas Ligeras de Inmunoglobulina/orina , Masculino , Persona de Mediana Edad , Paraproteinemias/diagnóstico , Paraproteinemias/patologíaRESUMEN
Retrospective analysis has been carried out with the surgical material of 9 years in the wards of surgical character of a county hospital to determine the incidence and main clinical characteristics of perioperative myocardial infarction. Data of 61 patients were processed in order to answer the questions. Age, arteriosclerosis causing disturbance of organ perfusion and the change of blood pressure in the perioperative period play the main role in the development of this complication of high mortality. Detailed clarification of the coronary state before the elective operation, a possible aortocoronary bypass operation appear to prevent most effectively the pathological picture.