RESUMEN
We here report a patient who developed a high titer antibody to factor VIII (FVIII) during gram-negative urosepsis caused by enterobacter cloacae after complete resection of rectal cancer. The patient initially presented with a life threatening spontaneous hematothorax and multiple large haematomas. Coagulation studies revealed a severe FVIII deficiency <1% with a high FVIII antibody titer of 64 BU. The bleeding responded rapidly to infusions of recombinant factor VIIa. After achievement of a partial remission (FVIII activity 28%) by combined immunosuppressive therapy (prednisone, cyclophosphamide, plasmapheresis and immunoadsorption), subsequently, two relapses occurred following steroid tapering. Resumption of prednisone and cyclophosphamide treatment combined with immunoadsorption induced a second and third remission, respectively. After resection of a papillary carcinoma of the bladder 6 months later and continuous immunosuppressive therapy with cyclophosphamide, FVIII levels remained stable within normal ranges. This clinical course suggests that the cause of inhibitor formation against FVIII resulting in severe acquired haemophilia was multifactorial and was initiated by the gram-negative urosepsis and probably by the underlying malignancies.
Asunto(s)
Carcinoma Papilar/complicaciones , Infecciones por Enterobacteriaceae/complicaciones , Hemofilia A/complicaciones , Sepsis/complicaciones , Neoplasias de la Vejiga Urinaria/complicaciones , Anciano , Enterobacter cloacae/aislamiento & purificación , Factor VIII/análisis , Humanos , MasculinoRESUMEN
AIM: To determine whether the forearm vasodilatory response to reactive hyperaemia (RH) is reduced in normoalbuminuric subjects with Type 1 diabetes mellitus and retinopathy compared with subjects with no retinopathy. METHODS: Forearm RH, an indicator of endothelial function, was measured, using strain-gauge plethysmography, in 39 normoalbuminuric subjects (22 with retinopathy) with long-standing Type 1 diabetes mellitus. RESULTS: were evaluated in relation to conventional risk factors for atherosclerosis, and C-reactive protein (CRP), which we have recently determined to be an independent correlate of forearm RH. RESULTS: Forearm RH was decreased in subjects with retinopathy compared with those with no retinopathy (219 +/- 182 vs. 473 +/- 355, P < 0.01). Both retinopathy and CRP proved to be independent and negative predictors, and explain 27% of the variance, in forearm RH. CONCLUSION: Retinopathy in subjects with Type 1 diabetes mellitus may reflect a generalized process of endothelial dysfunction, even in the absence of microalbuminuria.
Asunto(s)
Albuminuria/sangre , Diabetes Mellitus Tipo 1/sangre , Retinopatía Diabética/sangre , Antebrazo/irrigación sanguínea , Hiperemia/etiología , Factores de Edad , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores SexualesRESUMEN
We assessed clinical and biochemical predictors of death and/or cardiovascular disease in 147 type 1 diabetes mellitus (DM) patients followed-up for 14 years. At follow-up, 28 of patients (19%) had died, and 25 patients (18%) had developed or died of coronary artery disease (CAD). At baseline, those who died had significantly higher serum creatinine (p=0.001) and urine albumin/creatinine ratio (p=0.016), greater prevalence of retinopathy (p=0.006), lower serum apolipoprotein A1 (p=0.046), and lower daily insulin dose (p=0.024) than those who survived. CAD patients had a longer duration of diabetes (p<0.001), were older at the onset of diabetes and at presentation (p=0.001), and had higher prevalences of retinopathy (p=0.005) and neuropathy (p=0.016). The CAD group also had higher baseline serum creatinine (p=0.02), lower HDL cholesterol (p=0.004) and apolipoprotein A1 (p=0.007) and higher LDL cholesterol (p=0.028) and apolipoprotein B concentrations (p=0.027). Under logistic regression analysis (adjusted for age and sex), baseline urine albumin/creatinine ratio (p=0.003), presence of retinopathy (p=0.004), serum creatinine (p=0.028), and serum urea (p=0.034) were the most powerful predictors of mortality, while duration of diabetes (p<0.0001), baseline HDL cholesterol (p=0.012), serum creatinine (p=0.02), apolipoprotein B (p=0.038), LDL cholesterol (p=0.039), and systolic blood pressure (p=0.055) were the strongest predictors of CAD. These findings emphasize the role of abnormal lipoprotein metabolism in the development of CAD in type 1 DM. Indicators of renal impairment and the presence of retinopathy seem to be of greater importance in predicting overall mortality.
Asunto(s)
Enfermedad Coronaria/mortalidad , Diabetes Mellitus Tipo 1/mortalidad , Angiopatías Diabéticas/mortalidad , Adulto , Biomarcadores/análisis , Estudios de Cohortes , Estudios Transversales , Diabetes Mellitus Tipo 1/complicaciones , Femenino , Estudios de Seguimiento , Humanos , Modelos Logísticos , Masculino , Estudios Prospectivos , Análisis de Regresión , Australia Occidental/epidemiologíaRESUMEN
A retrospective review of adolescent admissions (12 to 18 years) to the Queen Elizabeth Hospital (QEH) and the Psychiatric Hospital for the period of October, 1991 to September, 1992 was undertaken to determine the causes of hospitalization. There were 725 admissions consisting of 297 males and 428 females. The majority of the patients (535, i.e. 74 percent) spent between 1 and 5 days, while only 55 patients (7.6 percent) spent more than 14 days in hospital. The three most frequent causes of hospitalization were trauma (165), abortions (153), drug abuse/overdose (53). Psychiatric conditions accounted for 38 admissions. Based on our data, we estimated that a 15-bed adolescent unit set up at the QEH can serve the in-patient needs of the adolescent population in Barbados. This can be speedily achieved by restructuring the existing paediatric unit (AU)