1/157. Lymphocyte transformation test for the evaluation of adverse effects of antituberculous drugs.The usefulness of the lymphocyte transformation test (LTT) for the analysis of adverse reactions to antituberculous drugs was evaluated. - The LTT was performed with isoniazid and rifampicin in 15 tuberculosis and 2 MOTT (Mycobacteria other than tuberculosis)-infection patients who suffered drug reactions, in 23 patients without any adverse reactions, in 7 controls previously exposed to antituberculous drugs, and in 14 controls who had never been exposed. 4/15 of the hepatotoxic reactions only showed a positive LTT with rifampicin, 3/15 only with isoniazid, and in 8/15 the LTT was negative. In an anaphylactoid shock reaction the LTT was extremely exaggerated for both rifampicin and isoniazid. In patients without any side effects only one slightly increased LTT due to isoniazid was observed. Two healthy controls with previous contact to these drugs showed a positive LTT for isoniazid, one of those with both rifampicin and isoniazid. The LTT was negative in all control persons without any former contact to antituberculous medications. In most cases hepatotoxicity seems to be a pure toxic reaction without the participation of cellular immune mechanisms. LTT can be useful for identifying the drug responsible for immunological side effects.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
2/157. Remission of the nephrotic syndrome in a patient with renal amyloidosis due to rheumatoid arthritis treated with prednisolone and methotrexate.A 46-year-old woman developed nephrotic syndrome secondary to rheumatoid arthritis (RA). A renal biopsy showed deposition of amyloid fibrils in the subendothelial space of the glomerular capillary walls. After treatment with prednisolone (PSL, 40 mg/day), the levels of c-reactive protein (CRP) and serum amyloid A decreased to within normal limits for 2 weeks. However, the nephrotic syndrome persisted for 6 months after the therapy. To maintain the suppression of disease activity and to reduce PSL, methotrexate (5 mg/week) was added. The nephrotic syndrome resolved gradually, and the level of serum albumin returned to normal. Although renal prognosis of patients with nephrotic syndrome due to amyloidosis caused by RA has been considered poor, adequate and long-term treatment of RA with antiinflammatory drugs, including PSL and methotrexate, is useful for patients with secondary amyloidosis complicated by RA.- - - - - - - - - - ranking = 0.11111111111111keywords = drug (Clic here for more details about this article) |
3/157. Isolated renal aspergillus abscess in an AIDS patient with a normal CD4 cell count on highly active antiretroviral therapy.Isolated renal aspergillus abscess is a very rare complication of hiv infection. It usually occurs in patients with severe immune deficiency. The case of a 29-year-old hiv-infected homosexual male, a nonintravenous drug abuser, who developed a right renal aspergillus abscess despite normalization of the CD4 cell count after highly active antiretroviral treatment is described. When antimicrobial treatment failed (amphotericin b followed by itraconazole), he was cured by right nephrectomy and remains in good health 3 months later with no recurrence. In cases of aspergillus renal abscess in hiv-infected patients, surgery is the treatment of choice, especially in the current era of highly active antiretroviral therapy.- - - - - - - - - - ranking = 0.11111111111111keywords = drug (Clic here for more details about this article) |
4/157. Irreversible glomerular lesions induced by crystal precipitation in a renal transplant after foscarnet therapy for cytomegalovirus infection.AIMS: foscarnet is an antiviral agent used to treat cytomegalovirus infection in AIDS patients and in transplant recipients. In most cases, foscarnet induces reversible tubulo-interstitial lesions which can be avoided by correct hydration. We report the first case of crystal foscarnet precipitation within glomerular capillaries in a renal transplant. methods AND RESULTS: The recipient, a 49-year-old man, developed a nephrotic syndrome with haematuria and an acute renal failure after foscarnet therapy for cytomegalovirus (CMV) infection. The polarization examination of the first graft biopsy revealed the presence of birefringent crystals within glomeruli and tubules. Infrared analysis attested to the presence of trisodium foscarnet salts and mixed sodium calcium salts coloured by Von Kossa's reaction. A second biopsy showed glomerular sclerosis, interstitial fibrosis, tubular atrophy and crystal vanishing. polymerase chain reaction (PCR) in situ applied to this biopsy confirmed the diagnosis of cytomegalovirus infection. CONCLUSIONS: These adverse effects might be the result of a toxic synergy between foscarnet and other drugs. In cases with crystalline precipitation, graft biopsy remains the best mean of diagnosis and follow-up of glomerular damage.- - - - - - - - - - ranking = 0.11111111111111keywords = drug (Clic here for more details about this article) |
5/157. Seat-belt transection of the pararenal vena cava in a 5-year-old child: survival with caval ligation.Blunt traumatic disruption of the inferior vena cava is associated with high mortality and is rare in children. A seat-belted 5-year-old girl sustained, in a motor vehicle accident, pararenal caval transection, right renal vein transection, laceration of the right kidney, duodenal injury, and a second lumbar vertebral fracture. Damage-control surgery consisted of inferior vena caval and right renal vein ligation and temporary abdominal wall silo closure. She is alive and well 10 months after the accident, with no sequelae of caval ligation and with normal right renal function.- - - - - - - - - - ranking = 0.00082900349033117keywords = closure (Clic here for more details about this article) |
6/157. CT appearance of a renal aspergilloma in a patient with the acquired immunodeficiency syndrome.The appearance of a unilateral renal aspergilloma on computed tomography is described in a 32-year-old man with acquired immunodeficiency syndrome (AIDS). aspergillus infections are uncommon in the AIDS population. Only 9 cases of renal aspergilloma have been described in AIDS. The treatment performed was percutaneous drainage followed by antifungal drug administration and unilateral nephrectomy. This case report emphasizes the fact that renal fungal infections need to be considered in differential diagnosis of kidney infections in AIDS patients.- - - - - - - - - - ranking = 0.11111111111111keywords = drug (Clic here for more details about this article) |
7/157. Nephrobronchial fistula secondary to xantogranulomatous pyelonephritis.We report a case of staghorn nephrolithiasis that evolved into xanthogranulomatous pyelonephritis with perinephric abscess, nephrobronchial fistula, and lung abscess. The patient was an intravenous drug abuser who tested positive for human immunodeficiency virus, without evidence of acquired immunodeficiency syndrome. He presented with a 2-month history of untreated repeated episodes of left flank pain and hyperpyrexia. Treatment involved left nephrectomy, debridement of abscess, tube drainage, and intravenous antibiotics. The patient illustrates the need to consider untreated nephrolitiasis as a predisposing factor for pulmonary complications.- - - - - - - - - - ranking = 0.11111111111111keywords = drug (Clic here for more details about this article) |
8/157. Medically resistant neonatal hypertension: revisiting the surgical causes.OBJECTIVE: To present the importance of searching for the surgical causes of pharmacologically resistant hypertension in the neonatal population. STUDY DESIGN: A case report and discussion are provided. RESULTS: Severe hypertension in the neonatal period is uncommon and almost always has a secondary cause. Although a majority of hypertensive neonates can be successfully managed with medical therapy, some cases are resistant to pharmacological treatment. We report three hypertensive neonates who failed to respond to intensive multidrug therapy. This led to further evaluation and identification of obstructive uropathies in two neonates and renovascular disease that necessitated surgical intervention. Subsequently, all patients had prompt resolution of hypertension and normalization of renal function. All are now off antihypertensive medications and have normal renal function at 12 months of follow-up. CONCLUSION: Our report exemplifies the importance of the consideration of surgical etiologies for differential diagnosis in neonates with severe hypertension that is unresponsive to pharmacological therapy. early diagnosis and prudent management of these etiologies reduce morbidity and mortality and preserve of renal function.- - - - - - - - - - ranking = 0.11111111111111keywords = drug (Clic here for more details about this article) |
9/157. spironolactone-associated aggravation of renal functional impairment.Five patients in whom deterioration in renal function was associated with the use of the aldosterone antagonist, spironolactone, are reported. Care in the use of this drug is urged, especially in the elderly. patients with known renal functional impairment should not receive this agent.- - - - - - - - - - ranking = 0.11111111111111keywords = drug (Clic here for more details about this article) |
10/157. Leukocytoclastic vasculitis in a child with epidermolysis bullosa simplex.A 10-year-old boy with epidermolysis bullosa simplex (Weber-Cockayne variant) together with leukocytoclastic vasculitis is presented. He was admitted to the hospital with the provisional diagnoses of infected epidermolysis bullosa simplex or drug eruption. On the sixth day of hospitalization he developed palpable purpura, abdominal pain and bloody diarrhea, together with hematuria and proteinuria. A generalized tonic-clonic convulsion, changes in mental status, fluctuations in arterial blood pressure and intractable pain in his extremities occurred during the course of hospitalization. Systemic pulse steroid therapy, antibiotics, and antihypertensive and anticonvulsive drugs were given. On the 30th day of hospitalization, a skin graft was performed to replace a large tissue defect on his left hand. Despite high dose steroid therapy, his hematuria, proteinuria and hypertension continued after his discharge, suggesting a steroid-resistant renal pathology, such as focal glomerulosclerosis, that occurred secondary to leukocytoclastic vasculitis.- - - - - - - - - - ranking = 0.22222222222222keywords = drug (Clic here for more details about this article) |
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