Elevated reticulocyte count – a clue to the diagnosis of haemolytic-uraemic syndrome (HUS) associated with gemcitabine therapy for metastatic duodenal papillary carcinoma: a case report

In adults, the haemolytic-uraemic syndrome (HUS) is associated with probable causative factors in the minority of all cases. Cytotoxic drugs are one of these potential causative agents. Although metastatic cancer by itself is a recognized risk-factor for the development of HUS, therapy with mitomycin-C, with cis-platinum, and with bleomycin carries a significant, albeit extremely small, risk for the development of HUS, compared with all other cytotoxic drugs. Gemcitabine is a novel cytotoxic drug with promising activity against pancreatic adenocarcinoma. We are reporting on one patient with metastatic duodenal papillary carcinoma developing HUS while on weekly gemcitabine therapy. The presenting features in this patient were non-cardiac pulmonary oedema, renal failure, thrombocytopenia and haemolytic anaemia. The diagnosis of HUS was made on the day of admission of the patient to this institution. Upon aggressive therapy, including one single haemodialysis and five plasmaphereses, the patient recovered uneventfully, with modestly elevated creatinine-values as a remnant of the acute illness. Re-exposure to gemcitabine 6 months after the episode of HUS instituted for progressive carcinoma, thus far has not caused another episode of HUS. © 1999 Cancer Research Campaig

Efeito do treinamento funcional do assoalho pélvico associado ou não à eletroestimulação na incontinência urinária após prostatectomia radical Effect of functional training for the pelvic floor muscles with or without electrical stimulation in cases of urinary incontinence following radical prostatectomy

INTRODUÇÃO: A literatura sobre fisioterapia do assoalho pélvico no tratamento da incontinência urinária após prostatectomia radical é escassa e relata técnicas diferentes de tratamento fisioterapêutico. OBJETIVO: Avaliar o efeito do tratamento fisioterapêutico na recuperação da continência urinária de pacientes submetidos a prostatectomia radical utilizando treinamento funcional do assoalho pélvico acompanhado ou não da eletroestimulação. MÉTODO: Foram selecionados 20 pacientes com incontinência urinária pós-prostatectomia radical. Os pacientes foram distribuídos ao acaso em grupos controle e de investigação. O grupo de investigação, composto por 10 pacientes, recebeu como tratamento fisioterapêutico o treinamento funcional do assoalho pélvico e a eletroestimulação. O grupo controle, composto por 10 pacientes, recebeu como tratamento fisioterapêutico o treinamento funcional do assoalho pélvico. Todos os pacientes foram reavaliados 3 meses, 6 meses e 12 meses após o início do tratamento por meio de "pad test", Escala Visual Análoga (EVA) da incontinência, Escala Visual Análoga (EVA) do problema e número de fraldas utilizadas. RESULTADOS: Houve diminuição estatisticamente significante entre a avaliação inicial e o 12º mês do "pad test", da EVA incontinência, da EVA problema e do número de fraldas no grupo controle e no grupo de investigação. Entretanto, não foi encontrada diferença estatisticamente significante quando comparadas as mesmas variáveis entre os dois grupos. DISCUSSÃO E CONCLUSÃO: Não houve melhora adicional no tratamento com treinamento funcional do assoalho pélvico associado à eletroestimulação quando comparado com o tratamento apenas com treinamento funcional do assoalho pélvico. Entretanto, nos dois grupos, houve melhora significante da incontinência urinária.<br>INTRODUCTION: Literature on physical therapy for the pelvic floor muscles to treat urinary incontinence following radical prostatectomy is scarce, with descriptions of differing techniques for physical therapy treatment. OBJECTIVE: To evaluate the effect of physical therapy treatment for recovering urinary continence among patients who had undergone radical prostatectomy, by using functional training of the pelvic floor muscles with or without electrical stimulation. METHOD: Twenty patients with urinary incontinence following radical prostatectomy were selected. The patients were randomly allocated to a control or to an experimental group. The experimental group was composed of ten patients who received physical therapy treatment consisting of functional training of the pelvic floor muscles and electrical stimulation. The control group was composed of ten patients who received physical therapy treatment consisting only of functional training of the pelvic floor. All of the patients were reevaluated three, six and twelve months after beginning treatment, by using the pad test, visual analog scale (VAS) for incontinence, VAS for the problem and counting the number of diapers (nappies) used. RESULTS: There was a statistically significant decrease between the initial and 12th month evaluations of the pad test, VAS for incontinence, VAS for the problem and numbers of diapers of the control group and experimental group. However, no statistically significant difference was found when the same variable was compared between the two groups. CONCLUSION: There was no additional improvement from treatment with functional training of the pelvic floor muscles associated with electrical stimulation, in relation to treatment only using functional pelvic floor training. However, there was a significant improvement in urinary incontinence in both groups

Paulista registry of glomerulonephritis: 5-year data report

Background. The Paulista Registry of Glomerulopathies was created in May 1999 and comprises several centres of Sao Paulo, the most populous Brazilian State, that concentrates people from all regions of the country who look for health care. Methods. This report includes data from 2086 patients from Brazil submitted to renal biopsy due to the presumed diagnosis of glomerular diseases, registered prospectively since May 1999 until January 2005. Data were collected by the integrants of the 11 centres involved, utilizing a standardized questionnaire. Results. The mean age of the patients was 34.5 +/- 14.6 years. Primary glomerular diseases were more frequent in males (55.1%) than in females; on the other hand, secondary glomerular diseases were more frequent in females (71.8%). The most common clinical presentation was nephrotic syndrome and the frequency of hypertension, at this time, was 55.5%. There was a predominance of indication of biopsies in the third, fourth and fifth decades of life. The most common primary glomerular diseases were focal and segmental glomerulosclerosis (29.7%), followed by membranous nephropathy (20.7%), IgA nephropathy (17.8%), minimal change disease (9.1%), membranoproliferative glomerulonephritis (7%), crescentic glomerulonephritis (4.1%), advanced chronic glomerulopathy (4%), non-IgA mesangial glomerulonephritis (3.8%), diffuse proliferative glomerulonephritis (2.5%), focal segmental proliferative glomerulonephritis (1%) and others (0.3%). The most frequent secondary glomerular disease was lupus nephritis, corresponding to 66.2% of the cases, followed by post-infectious glomerulonephritis (12.5%), diabetic nephropathy (6.2%), diseases associated to paraproteinaemia (4.9%), hereditary diseases (4.6%), vasculitis (3.2%), malignancies (0.9.%), secondary focal segmental glomerulosclerosis (0.6%) and others (0.9%). Conclusion. Focal segmental glomerulosclerosis was the most frequent primary glomerular disease, followed by membranous nephropathy and IgA nephropathy. Lupus nephritis predominated over all the other secondary glomerular diseases.21113098310