RESUMO
BACKGROUND: Cirrhotic patients with spontaneous bacterial peritonitis (SBP) have elevated rates of renal impairment and mortality. It has been shown that cefotaxime plus albumin infusion decrease renal impairment compared with antibiotic treatment alone, in patients with serum bilirubin >4 mg/dL or creatinine >1 mg/dL. AIM: To assess clinical outcomes of high-risk cirrhotic patients with SBP who were treated with antibiotics associated with Gelafundin (polygeline) 4%. METHODS: Twenty nine cirrhotic patients with SBP and serum bilirubin >4 mg/dL or creatinine >1 mg/dL were enrolled. Ceftriaxone was administered in doses of 2 g/day and Gelafundin 4% was given intravenously at 1.5 g/kg of body weight at the time of the diagnosis, followed by 1 g/kg on day 3. Renal impairment was defined as nonreversible deterioration of renal function during hospitalization. RESULTS: Eight patients (27.5%) had basal renal failure. Infection resolved in 28 (96.6%) patients. Renal impairment occurred in four patients (13.8%), and three patients (10.4%) died during hospitalization. Mortality within 90 days after discharge was 34.5% (10 patients). CONCLUSION: The rates of renal impairment and mortality in high-risk patients with SBP suggest that Gelafundin 4% administration given with ceftriaxone may be a less expensive therapeutic alternative to albumin.
Assuntos
Antibacterianos/administração & dosagem , Infecções Bacterianas/tratamento farmacológico , Ceftriaxona/administração & dosagem , Cirrose Hepática/tratamento farmacológico , Peritonite/tratamento farmacológico , Substitutos do Plasma/administração & dosagem , Poligelina/administração & dosagem , Infecções Bacterianas/mortalidade , Quimioterapia Combinada , Feminino , Humanos , Cirrose Hepática/mortalidade , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Peritonite/mortalidade , Projetos Piloto , Medição de Risco , Resultado do TratamentoRESUMO
OBJECTIVE: To study the efficacy of oral fluorescein angiography compared to intravenous (IV) fluorescein angiography in several retinal diseases. PATIENTS AND METHODS: We performed oral fluorescein angiography with a confocal SLO (Heidelberg Retina Angiograph-HRA) in fourteen psychologically challenged individuals and children, all of whom explicitly refused venipuncture. Patient's diagnosis included diabetes, central serous choroidopathy, toxoplasmosis and choroidal neovascularization. A dose of 30 mg/kg body weight of fluorescein was given. RESULTS: We obtained images of adequate quality to allow interpretation in all cases. CONCLUSIONS: Even though the images were not nearly as good as when obtained after IV injection, we conclude that oral fluorescein angiography with SLO is an appropriate alternative in those cases where a venipuncture is contraindicated by medical or psychological reasons.
Assuntos
Angiofluoresceinografia/métodos , Fluoresceína/administração & dosagem , Oftalmoscópios , Doenças Retinianas/diagnóstico , Vasos Retinianos/patologia , Administração Oral , Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Injeções Intravenosas , Lasers , Masculino , Pessoa de Meia-IdadeRESUMO
PURPOSE: To determine whether there are angiographic differences among normal, preperimetric and advanced glaucoma eyes using indocyanine green angiography with SLO. This method was chosen because of its sensibility to detect peripapillary capillary vessels. METHODS: Scanning laser opthalmoscopy was preformed on normal eyes, preperimetric glaucomas and advanced glaucomas. MATERIAL: The authors used a confocal SLO (Heidelberg Retina Angiograph-HRA) CONCLUSION: Several changes may be seen on peripapillary capillary vessels at the different glaucomatous stages. DISCUSSION: In normal subjects HRT shows preservation of the disc/cup area ratio; indocyanine green angiography shows normal prepapillary plexus pattern on the neuroretinal rim and cup. Subjects on glaucomatous preperimetric stage reveal a decrease in the disc/cup area ratio as a result of an increase of the cup area secondary to a reduction of the neuroretinal rim area. ICG at this hipertensive stage shows an increase in prepapillary plexus visualization, which may be a consequence of increased blood flow while autoregulation is still operative. Subjects with advanced glaucoma show prominent decrease in the disc/cup area ratio as well as marked capillary droupout in ICG angiography.
Assuntos
Corantes , Angiofluoresceinografia/métodos , Glaucoma/fisiopatologia , Verde de Indocianina , Oftalmoscopia/métodos , Disco Óptico/irrigação sanguínea , Humanos , Pressão Intraocular , Lasers , Hipertensão Ocular/fisiopatologiaRESUMO
PURPOSE: To describe the angiographic signs found using scanning laser ophthalmoscopy for the early diagnosis of vitreoretinal interface syndrome. This method is useful to visualize the inner retinal layers, being more sensitive than fundus biomicroscopy. MATERIAL: 61 patients with vitreoretinal interfase syndrome were evaluated. All of them had evidence of this disease using scanning laser ophthalmoscopy but four patients were referred without diagnosis of vitreoretinal interfase syndrome. These patients showed no biomicroscopic signs and diagnosis was made with SLO. METHODS: Confocal scanning infrared laser ophthalmoscope (Heidelberg Retinal Angiograph assembled by Heidelberg Engineering). This SLO uses an infrared diode laser source of 795 nm. CONCLUSION: Patients included were referred with another diagnosis and with this method the correct diagnosis was made. In conclusion scanning laser ophthalmoscopy allows early diagnosis of this pathology for follow-up and treatment.