RESUMO
BACKGROUND: Adverse reactions to drugs have increased in the last years, about 15% of all side effects are thought to be immune mediated according to the Coombs and Gell classification they can be type I (immediate) hypersensitivity, type II (cytotoxic) type III (immune complex mediated) or type IV (delay). Allergy to insulin is defined as an immunological response type I, and type II or III to exogenous insulin solutions occurring the 0.1% and 0.2% of the patients. PATIENTS: A 13 year old female with a 4-year history of insulin-dependent diabetes mellitus who presented hypersensitivity against recombinant DNA (rDNA) insulin manifested with urticaria and itching. We used a premedication therapy without good response and impossibility to use alternative therapy for her metabolic control, so she needed desensitization with insulin. METHODS: Skin prick testing with rapid insulin preparations 1:10 W/V dilution were positive. IgE antibodies to insulin weren't presented. IgE serum values were normal. We began the desensitization with a rapid 1:1000 UI insulin solution by intradermal route, than by subcutaneous route until reaching the accumulated doses necessary per day. During the process it appeared a papular rash and itching which were treated with an intravenous antihistaminic without troubles. RESULTS: The patient tolerated the desensitization procedure very well. For the past 14 months she has been treated uneventfully by subcutaneous administration of rDNA insulin. DISCUSSION: The desensitization against drugs is not a frequently process it only has to be used when it is impossible to substitute the treatment. Our patient showed probably hypersensitivity type 1 to insulin. However, we have to take into account the cytotoxic reaction caused by IgG or IgM antibodies or by immune complex. The desensitization finally was tolerated, 14 months after our patient accepts correctly her daily dose of human recombinant insulin.
Assuntos
Dessensibilização Imunológica , Diabetes Mellitus Tipo 1/tratamento farmacológico , Insulina/imunologia , Adolescente , Diabetes Mellitus Tipo 1/imunologia , Toxidermias/etiologia , Toxidermias/terapia , Feminino , Humanos , Insulina/administração & dosagem , Insulina/efeitos adversos , Insulina/genética , Insulina/uso terapêutico , Prurido/induzido quimicamente , Prurido/terapia , Proteínas Recombinantes/administração & dosagem , Proteínas Recombinantes/efeitos adversos , Proteínas Recombinantes/imunologia , Proteínas Recombinantes/uso terapêutico , Testes Cutâneos , Urticária/induzido quimicamente , Urticária/terapiaAssuntos
Imunossupressores/uso terapêutico , Transplante de Rim/fisiologia , Transplante de Rim/psicologia , Prednisona/uso terapêutico , Pregnenodionas/uso terapêutico , Qualidade de Vida , Adolescente , Adulto , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Transplante de Rim/imunologia , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Perfil de Impacto da DoençaAssuntos
Nefropatias Diabéticas/cirurgia , Falência Renal Crônica/cirurgia , Transplante de Rim , Doença Aguda , Adulto , Doença Crônica , Diabetes Mellitus Tipo 1 , Diabetes Mellitus Tipo 2 , Seguimentos , Rejeição de Enxerto/epidemiologia , Humanos , Transplante de Rim/fisiologia , Transplante de Rim/tendências , Necrose Tubular Aguda/epidemiologia , Complicações Pós-Operatórias , Estudos Retrospectivos , Fatores de TempoRESUMO
We undertook a study of cardiac function in 13 patients with end-stage renal disease with conventional echocardiography. Measurements in systolic and diastolic function were assessed before and after renal transplantation. Improvement in left ventricular mass was observed (mu +/- SD) from 362.4 +/- 150.2 to 178.4 +/- 62.4 (p less than 0.001), also in left ventricular mass index (left ventricular mass/body surface) from 229 +/- 86.3 to 115.6 +/- 41.3 (p less than 0.001), ejection fraction from 0.44 +/- .196 to 0.64 +/- .165 (p less than 0.01) and velocity of circumferential fiber shortening (mu +/- SD) from 19.5 +/- 11.04 to 31 +/- 11.6. Renal transplantation procedure induce favorable modifications in left ventricular functions. If cardiac dysfunction is present in a end stage renal disease patient, it should be not considered a contraindication for transplantation. We were unable to demonstrate that hemoglobin values play an important role in the development or maintenance left ventricular dysfunction. A prospective, larger and longer trails are needed to clarify the risk factors associated with cardiovascular morbid event.
Assuntos
Transplante de Rim , Função Ventricular , Adolescente , Adulto , Ecocardiografia , Feminino , Ventrículos do Coração/fisiopatologia , Humanos , Falência Renal Crônica/fisiopatologia , Falência Renal Crônica/cirurgia , Masculino , Pessoa de Meia-Idade , Fatores de TempoRESUMO
Hereditary thrombocytopathic thrombocytopenia is reported in a family (mother and son) and is transmitted with dominant character of moderate to severe intensity (platelets fluctuated from less than 5,000 per mm-3 to 20,000 with sporadic higher rises), normal survivorhship, larger than normal diameter and abnormal platelet 3 factor. Comments are made on its resemblance to idiopathic thrombocytopenic purpura and stress is placed on the importance of its identification through the decision of splenectomy with negative results in these patients.