RESUMO
Liposomal doxorubicin is used for the treatment of various cancers like epithelial ovarian cancers, multiple myeloma and sarcomas. We report the first case of anaphylaxis to pegylated liposomal doxorubicin.
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Port-a-cath is commonly used in patients who require frequent administration of intravenous medications. We describe a rare case of port-a-cath migration into the mediastinum 16 months after its insertion.
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We report the case of a 26-year-old woman with a 19 cm malignant hepatic neoplasm with morphological features that closely resembled a follicular thyroid carcinoma. Despite this, it was interpreted as a cholangiocarcinoma due to the absence of a primary thyroid tumor and the lack of thyroglobulin and TTF-1 immunoreactivity by the hepatic tumor. The left hepatic lobectomy specimen showed an encapsulated and multinodular gray-white mass with cystic and hemorrhagic areas. Microscopically, it displayed predominant macro and microfolicullar patterns with focal solid, trabecular and insular areas. The small and distended follicles contained a colloid-like secretion and were lined by low cuboidal cells with scant cytoplasm, round or oval hyperchromatic nuclei with fine chromatin. The solid areas, trabecular and insular structures were similar to those of follicular or papillary thyroid carcinomas. In addition, some of the neoplastic cells had clear nuclei with occasional grooves. The tumor was positive for cytokeratin (CK) 7, CK 19 and CD138, and negative for TTF-1, thyroglobulin, Hepar-1, Glypican-3, alpha-fetoprotein and neuroendocrine markers. A thyroid neoplasm was excluded clinically and by ultrasound and computed tomography. Although, the residual hepatic parenchyma was initially not cirrhotic, the patient eventually developed cryptogenic cirrhosis. The patient received adjuvant chemotherapy and died of metastatic disease 18 months after surgery. The thyroid-like pattern broadens the morphologic spectrum of cholangiocarcinoma.
Assuntos
Adenocarcinoma Folicular/patologia , Carcinoma/patologia , Colangiocarcinoma/patologia , Neoplasias Hepáticas/patologia , Neoplasias da Glândula Tireoide/patologia , Adulto , Neoplasias dos Ductos Biliares , Ductos Biliares Intra-Hepáticos , Biomarcadores Tumorais/análise , Carcinoma Papilar , Quimioterapia Adjuvante , Colangiocarcinoma/química , Colangiocarcinoma/tratamento farmacológico , Colangiocarcinoma/cirurgia , Evolução Fatal , Feminino , Hepatectomia , Humanos , Neoplasias Hepáticas/química , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/cirurgia , Imageamento por Ressonância Magnética , Câncer Papilífero da Tireoide , Resultado do Tratamento , Carga TumoralRESUMO
We describe a case of Clostridium septicum enterocolitis in a patient with pre-B acute lymphoblastic leukaemia undergoing autologous stem cell transplant. In the setting of neutropenia, Clostridium septicum should be suspected in patients who develop signs and symptoms of acute abdomen.
Assuntos
Infecções por Clostridium/complicações , Enterocolite/microbiologia , Neutropenia/microbiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras B/complicações , Abdome Agudo , Adulto , Infecções por Clostridium/diagnóstico por imagem , Enterocolite/diagnóstico por imagem , Evolução Fatal , Humanos , Hospedeiro Imunocomprometido , Masculino , Leucemia-Linfoma Linfoblástico de Células Precursoras B/terapia , Transplante de Células-Tronco , Tomografia Computadorizada por Raios X , Transplante AutólogoRESUMO
OBJECTIVE: We tested the hypothesis that inhaled beclomethasone therapy for prevention of bronchopulmonary dysplasia does not cause adrenal suppression. STUDY DESIGN: Infants receiving ventilatory support with birth weights
Assuntos
Glândulas Suprarrenais/efeitos dos fármacos , Beclometasona/farmacologia , Displasia Broncopulmonar/prevenção & controle , Glucocorticoides/farmacologia , Recém-Nascido Prematuro/fisiologia , Administração por Inalação , Insuficiência Adrenal/induzido quimicamente , Método Duplo-Cego , Feminino , Humanos , Hidrocortisona/sangue , Recém-Nascido , Masculino , Estatísticas não ParamétricasRESUMO
OBJECTIVES: Very low birth weight (< 1500 g) infants frequently require packed red blood cell transfusions, and transfusion rates vary among neonatal intensive care units (NICUs). We analyzed transfusions and compared outcomes among NICUs. STUDY DESIGN: In a 6-site prospective study, we abstracted all newborns weighing < 1500 g (total = 825) born between October 1994 and September 1995. Transfusion frequency and volume and phlebotomy number were analyzed by site and adjusted for birth weight and illness severity. We compared rates of intraventricular hemorrhage, necrotizing enterocolitis, bronchopulmonary dysplasia, growth, and length of stay between the high and low transfuser NICUs. RESULTS: Sites differed significantly in mean birth weight, illness severity, number of transfusions, pretransfusion hematocrit, blood draws, and donor number. Multivariate adjustment for these risks showed that the highest transfusing NICU transfused an additional 24 cc/kg per baby during the first 14 days and 47 cc/kg per baby after 15 days, relative to the lowest transfusing NICU. The presence of arterial catheters increased the frequency of blood transfusions. The rates of intraventricular hemorrhage, necrotizing enterocolitis, and bronchopulmonary dysplasia were not higher in the 2 lowest transfusing NICUs, nor were there differences in 28-day weight gain or length of stay. CONCLUSIONS: Major differences in transfusion practices for very low birth weight infants exist among NICUs. Because clinical outcomes were no different in lower transfuser NICUs, it is likely that transfusion and phlebotomy guidelines could result in fewer transfusions, fewer complications, and reduced cost.
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Anemia Neonatal/terapia , Transfusão de Eritrócitos/estatística & dados numéricos , Doenças do Prematuro/terapia , Anemia Neonatal/sangue , Anemia Neonatal/mortalidade , Feminino , Humanos , Recém-Nascido , Doenças do Prematuro/sangue , Doenças do Prematuro/mortalidade , Recém-Nascido de muito Baixo Peso , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Estudos Prospectivos , Medição de Risco , Taxa de Sobrevida , Aumento de PesoRESUMO
Sera from infants aged 5 to 11 months and from their mothers were used to investigate the level and duration of transplacentally derived measles antibody. The infants of foreign-born, inner-city mothers were more likely to have measles antibody and were less likely to get measles. Infants of foreign-born mothers, because they are less likely to respond to measles vaccine, may require different vaccine strategies than infants of mothers born in the United States.
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Anticorpos Antivirais/sangue , Vírus do Sarampo/imunologia , Sarampo/etnologia , Feminino , Georgia , Humanos , Lactente , Sarampo/imunologia , Mães , Saúde da População UrbanaRESUMO
A single-day large dose of vitamin D (stosstherapy) was given to 42 patients with nutritional vitamin D-deficiency rickets. Stosstherapy is safe and effective, obviates problems with compliance, and, by evoking a response in 4 to 7 days in nutritional rickets, becomes a valuable diagnostic aid for patients in whom initial findings do not clearly distinguish nutritional rickets from familial hypophosphatemic rickets.
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Raquitismo/tratamento farmacológico , Deficiência de Vitamina D/tratamento farmacológico , Vitamina D/uso terapêutico , Administração Oral , Cálcio/administração & dosagem , Cálcio/sangue , Cálcio/uso terapêutico , Cápsulas , Criança , Pré-Escolar , Esquema de Medicação , Ergocalciferóis/administração & dosagem , Ergocalciferóis/uso terapêutico , Humanos , Hiperparatireoidismo Secundário/etiologia , Hipocalcemia/etiologia , Hipofosfatemia Familiar/diagnóstico , Hipofosfatemia Familiar/tratamento farmacológico , Lactente , Fosfatos/sangue , Raquitismo/sangue , Raquitismo/complicações , Vitamina D/administração & dosagem , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/complicaçõesRESUMO
The effect of butylated hydroxytoluene (BHT), butylated hydroxy anisole (BHA) and tocopherol acetate on photooxidation of the fatty acids was studied. A marked increase in the photooxidation was observed in the presence of BHT, and this effect was further potentiated by hexabromobiphenyls. Conversely, BHA and tocopherol acetate as such did not show any significant effect, but greatly enhanced the photooxidation when hexabromobiphenyls were also present. Hexabromobiphenyls by themselves did not show any notable effect on the photooxidation.
RESUMO
Sodium balance was studied in 17 consecutively admitted neonates weighing less than 1,200 gm at birth. Infants whose gestation was less than or equal to 30 weeks were sicker and were in markedly negative sodium balance on day 3 (-9.25 mEq/kg day), despite a high sodium intake (7.22 mEq/kg/day). This negative balance was the result of a high fractional sodium excretion and resulted in hyponatremia in six (50%) of the patients. By day 8 these immature infants were in positive sodium balance, although fractional sodium excretion and daily sodium requirements remained high. More mature infants (greater than 30 weeks gestational age) were in positive sodium balance on both days 3 and 8. Creatinine clearance did not differ significantly between groups on either day 3 or 8 but increased within each group during the study period. These data suggest that the daily sodium requirement of immature sick infants may be much higher than was previously suggested.