RESUMEN
BCG immunotherapy for bladder carcinoma has been a long-standing treatment modality that has proved itself efficient and safe. Most of the side-effects of this treatment are minor and of short duration. There have been, nevertheless, several reports regarding more severe and long-term complications of BCG therapy-namely inflammatory arthritis, and occasionally systemic autoimmune manifestations. Here, we present four cases of patients who received intravesical instillation with BCG for bladder carcinoma and developed long-standing inflammatory arthritis. One of these patients developed Reiter's syndrome. We also refer to the possible immune mechanisms by which BCG can trigger arthritis, as well as to the link between mycobacterial infection, BCG immunotherapy and autoimmunity.
Asunto(s)
Autoinmunidad/inmunología , Vacuna BCG/efectos adversos , Neoplasias de la Vejiga Urinaria/inmunología , Anciano , Vacuna BCG/administración & dosificación , Vacuna BCG/inmunología , Vacuna BCG/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de la Vejiga Urinaria/terapiaRESUMEN
Four patients with hypersensitivity reaction to carboplatin of variable severity, after previous uneventful cisplatin and carboplatin treatment, are described. Skin testing performed in two of the patients suggests a cross-reaction with cisplatin but was negative with carboplatin in one of them. The mechanism of hypersensitivity reaction to carboplatin is poorly understood and the issue of retreatment with carboplatin is controversial. Physicians should be aware of the possible hypersensitivity reaction to carboplatin and appropriate precautions should be taken.
Asunto(s)
Antineoplásicos/efectos adversos , Carboplatino/efectos adversos , Hipersensibilidad a las Drogas/etiología , Adulto , Anciano , Femenino , Humanos , Persona de Mediana Edad , Pruebas CutáneasRESUMEN
The penetration of oral cefixime into the synovial fluids of 16 patients (mean age, 50.6 years) who underwent joint taps for rheumatic noninfectious disorders was examined. The patients were each given a single dose (400 mg) 2 to 24 h prior to the tap. Cefixime concentrations in serum and joint fluid samples were measured by high-performance liquid chromatography, and the bactericidal activities of these fluids against three isolates each of Haemophilus influenzae and Escherichia coli were examined. The highest concentrations in serum and synovial fluid were achieved 4 h following drug intake, the mean values being 2.8 and 2.03 micrograms/ml, respectively. Effective bactericidal activities (bactericidal titer, > 1:2) against E. coli and H. influenzae were demonstrated in serum and joint fluid up to 10 h following oral intake of cefixime. These results suggest that cefixime penetrates well into joint fluid, achieving levels above the MIC for E. coli lasting as long as 10 h and levels above the MIC for H. influenzae lasting up to 24 h after administration. Good bactericidal activity against susceptible bacterial isolates was observed for at least 10 h after dosing.
Asunto(s)
Cefotaxima/análogos & derivados , Cefalosporinas/uso terapéutico , Artropatías/tratamiento farmacológico , Enfermedades Reumáticas/tratamiento farmacológico , Líquido Sinovial/química , Adulto , Anciano , Cefixima , Cefotaxima/análisis , Cefotaxima/sangre , Cefotaxima/uso terapéutico , Escherichia coli/efectos de los fármacos , Femenino , Haemophilus influenzae/efectos de los fármacos , Humanos , Masculino , Persona de Mediana Edad , Líquido Sinovial/microbiología , Factores de TiempoRESUMEN
An atypical clinical presentation, the diagnostic procedures and a novel surgical approach are described in a 67-year-old woman with a patent ductus arteriosus.