Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 5 de 5
Filtrar
Mais filtros











Intervalo de ano de publicação
1.
Rev. méd. Chile ; 141(11): 1475-1479, nov. 2013. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-704574

RESUMO

Secondary hemophagocytic syndrome (HFS) is an uncommon entity with a high mortality rate in adults, if no therapy is given. It is characterized by a severehipercytokinemia due to a highly stimulated but ineffective immune system. Theprincipal causes are infections, malignancy or autoimmune diseases. It appears asa serious illness, similar to a multiorgan failure. Treatment is not well defined. Wereport five patients with HFS, aged 17 to 51 years (three females). The etiology wasonco-hematological in three patients. In two patients, the diagnosis was performedduring necropsy. One case was due to cytomegalovirus (CMV) infection in a hepatictransplant patient and the other, due to parenteral lipid administration. All presentedfever, cytopenia, hepatosplenomegaly and hemophagocytosis. Four of them requiredadmission in an Intensive Care Unit. All received different treatment modalities. Onlyone survived. Median survival time was 75 days. In conclusion, HFS has differentetiologies and a high mortality in adults.


Assuntos
Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Infecções por Citomegalovirus/complicações , Lipídeos/efeitos adversos , Linfo-Histiocitose Hemofagocítica/etiologia , Linfoma/complicações , Soluções de Nutrição Parenteral/efeitos adversos , Evolução Fatal , Unidades de Terapia Intensiva
2.
Rev Med Chil ; 141(11): 1475-9, 2013 Nov.
Artigo em Espanhol | MEDLINE | ID: mdl-24718476

RESUMO

Secondary hemophagocytic syndrome (HFS) is an uncommon entity with a high mortality rate in adults, if no therapy is given. It is characterized by a severe hipercytokinemia due to a highly stimulated but ineffective immune system. The principal causes are infections, malignancy or autoimmune diseases. It appears as a serious illness, similar to a multiorgan failure. Treatment is not well defined. We report five patients with HFS, aged 17 to 51 years (three females). The etiology was onco-hematological in three patients. In two patients, the diagnosis was performed during necropsy. One case was due to cytomegalovirus (CMV) infection in a hepatic transplant patient and the other, due to parenteral lipid administration. All presented fever, cytopenia, hepatosplenomegaly and hemophagocytosis. Four of them required admission in an Intensive Care Unit. All received different treatment modalities. Only one survived. Median survival time was 75 days. In conclusion, HFS has different etiologies and a high mortality in adults.


Assuntos
Infecções por Citomegalovirus/complicações , Lipídeos/efeitos adversos , Linfo-Histiocitose Hemofagocítica/etiologia , Linfoma/complicações , Soluções de Nutrição Parenteral/efeitos adversos , Adolescente , Adulto , Evolução Fatal , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Adulto Jovem
3.
Clin Nutr ; 31(5): 728-34, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22572624

RESUMO

BACKGROUND & AIMS: Parenteral nutrition is widely used in critically ill patients receiving nutritional support. Several previous studies associated the use of parenteral nutrition with the development of bloodstream infections. This study compared bloodstream infections in critical care patients receiving parenteral nutrition (PN) prepared via conventional compounding versus premixed multichamber bags. METHODS: Records in the Premier Perspective™ database for all in patients ≥ 18 years of age, with a minimum 3-day intensive care unit stay, who received PN between 2005 and 2007 were analyzed (n = 15,328). Statistical analysis of data, grouped according to preparation method, compared differences in both observed bloodstream infection rates and adjusted rates, using logistic regression to examine the impact of hospital and patient baseline characteristics. RESULTS: Patients receiving compounded parenteral nutrition had longer intensive care unit stays (11.3 vs. 9.1 days) and longer hospital stays (22.6 vs. 19.4 days); both P < .001. After adjusting for baseline differences, the probability for bloodstream infections was 19% higher when using compounded parenteral nutrition vs. multichamber bags (29.6 vs. 24.9%; odd ratio = 1.29; 95% confidence interval = 1.06-1.59). CONCLUSION: In this retrospective review of a large patient database the adjusted probability of bloodstream infection was significantly lower in patients receiving multichamber bags than compounded parenteral nutrition. These findings need to be investigated further in high quality observational studies and prospective clinical trials.


Assuntos
Bacteriemia/epidemiologia , Estado Terminal , Soluções de Nutrição Parenteral/administração & dosagem , Nutrição Parenteral/efeitos adversos , Adolescente , Adulto , Idoso , Feminino , Hospitalização , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Soluções de Nutrição Parenteral/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
4.
J Bras Nefrol ; 33(4): 467-71, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22189812

RESUMO

A previously healthy 19 year-old male presented to the hospital with anorexia, nausea, and vomiting. Laboratory studies were significant for hypercalcemia (peak calcium value of 14.8 mg/dL) and acute kidney injury (peak serum creatinine of 2.88 mg/dL). He admitted to using a parenteral formulation of vitamins A, D and E restricted for veterinary use containing 20,000,000 IU of vitamin A; 5,000,000 IU of vitamin D3; and 6,800 IU of vitamin E per 100 mL vial. The patient stated to have used close to 300 mL of the product over the preceding year. Interestingly, the young man was not interested in the massive amounts of vitamins that the product contained; he was only after the local effects of the oily vehicle. The swelling produced by the injection resulted in a silicone-like effect, which gave the impression of bigger muscles. Nevertheless, the product was absorbed and caused hypervitaminosis. The serum level of 25(OH) vitamin D was clearly elevated at 150 ng/mL (reference range from 30 to 60 ng/mL), but in most published cases of vitamin D toxicity, serum levels have been well above 200 ng/mL. His PTH level was undetectable and other potential causes of hypercalcemia were excluded. Therefore, we posit that the severity of the hypercalcemia observed in this case was the result of a synergistic effect of vitamins A and D. The patient was treated with normal saline, furosemide and zolendronic acid, with rapid normalization of calcium levels and renal function.


Assuntos
Injúria Renal Aguda/induzido quimicamente , Hipercalcemia/induzido quimicamente , Soluções de Nutrição Parenteral/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias/complicações , Vitamina A/efeitos adversos , Vitamina D/efeitos adversos , Vitamina E/efeitos adversos , Vitaminas/efeitos adversos , Overdose de Drogas , Humanos , Masculino , Drogas Veterinárias , Adulto Jovem
5.
J. bras. nefrol ; 33(4): 467-471, out.-nov.-dez. 2011. tab
Artigo em Inglês | LILACS | ID: lil-609061

RESUMO

Um rapaz de 19 anos, previamente hígido, procurou o hospital com queixas de anorexia, náuseas e vômitos. Exames laboratoriais revelaram hipercalcemia (valor máximo do cálcio de 14,8 mg/dL) e lesão renal aguda (valor máximo da creatinina de 2,88 mg/dL). O paciente admitiu utilizar uma formulação parenteral de vitaminas A, D e E de uso exclusivo veterinário, contendo 20.000.000 UI de vitamina A; 5.000.000 UI de vitamina D3 e 6.800 UI de vitamina E, por ampola de 100 mL. Ele refere ter usado cerca de 300 mL do produto no último ano. O jovem não estava interessado na quantidade maciça de vitaminas contida no produto, mas apenas no efeito local do veículo oleoso; o edema provocado pela injeção simulava um aumento de massa muscular. O produto, no entanto, foi absorvido e causou hipervitaminose. O nível sérico de 25(OH) vitamina D estava claramente elevado em 150 ng/mL (referência de 30 a 60 ng/mL), mas não tanto quanto em outros casos publicados de intoxicação por vitamina D. A maioria dos casos de hipercalcemia por hipervitaminose D se associa a níveis de 25 (OH)D bem maiores do que 200 ng/mL. O PTH estava indetectável, e outras causas de hipercalcemia foram excluídas. Deste modo, conclui-se que a gravidade da hipercalcemia encontrada neste caso foi resultado do efeito sinérgico da intoxicação pelas vitaminas A e D. O paciente foi tratado com soro fisiológico, furosemida e ácido zolendrônico e evoluiu com normalização rápida dos níveis séricos de cálcio e da função renal.


A previously healthy 19 year-old male presented to the hospital with anorexia, nausea, and vomiting. Laboratory studies were significant for hypercalcemia (peak calcium value of 14.8 mg/dL) and acute kidney injury (peak serum creatinine of 2.88 mg/dL). He admitted to using a parenteral formulation of vitamins A, D and E restricted for veterinary use containing 20,000,000 IU of vitamin A; 5,000,000 IU of vitamin D3; and 6,800 IU of vitamin E per 100 mL vial. The patient stated to have used close to 300 mL of the product over the preceding year. Interestingly, the young man was not interested in the massive amounts of vitamins that the product contained; he was only after the local effects of the oily vehicle. The swelling produced by the injection resulted in a silicone-like effect, which gave the impression of bigger muscles. Nevertheless, the product was absorbed and caused hypervitaminosis. The serum level of 25(OH) vitamin D was clearly elevated at 150 ng/mL (reference range from 30 to 60 ng/mL), but in most published cases of vitamin D toxicity, serum levels have been well above 200 ng/mL. His PTH level was undetectable and other potential causes of hypercalcemia were excluded. Therefore, we posit that the severity of the hypercalcemia observed in this case was the result of a synergistic effect of vitamins A and D. The patient was treated with normal saline, furosemide and zolendronic acid, with rapid normalization of calcium levels and renal function.


Assuntos
Humanos , Masculino , Adulto Jovem , Injúria Renal Aguda/induzido quimicamente , Hipercalcemia/induzido quimicamente , Soluções de Nutrição Parenteral/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias/complicações , Vitamina A/efeitos adversos , Vitamina D/efeitos adversos , Vitamina E/efeitos adversos , Vitaminas/efeitos adversos , Overdose de Drogas , Drogas Veterinárias
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA