RESUMO
The efficacy and toxicity (specially hepatic) of methotrexate in low doses (7.5 mg/week) was prospectively assessed in 21 patients with rheumatoid arthritis refractory to treatment with gold or penicillamine, during two years. Three patients were prematurely withdrawn from the protocol. A fast and significant improvement of RA was observed during the first six months, which tapered thereafter. Erythrocyte sedimentation rate decreased from 51.5 +/- 20.1 to 27.7 +/- 11.5 mm/h (p < 0.05). A rise in serum transaminases, always raising to less than twice the normal value, was observed in 75% of patients in some moment of the follow up. Hepatic scintigraphy did not show significant changes. Hepatic histological alterations were mild and no changes were observed after two years of treatment. The main secondary effects were moderate and transitory gastrointestinal and hematological disturbances. The prednisone dose was decreased from 6.8 +/- 2.6 to 4.8 +/- 1.9 mg/day at twelve months. There were no withdrawals due to drug toxicity. It is concluded that methotrexate proved to be efficacious in the treatment of rheumatoid arthritis refractory to conventional treatments. Its secondary effects, although frequent, were discrete and transitory and there were no changes in liver histology.
Assuntos
Artrite Reumatoide/tratamento farmacológico , Fígado/efeitos dos fármacos , Metotrexato/uso terapêutico , Adulto , Idoso , Análise de Variância , Artrite Reumatoide/fisiopatologia , Biópsia , Feminino , Humanos , Fígado/patologia , Masculino , Metotrexato/efeitos adversos , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
Twenty patients, 6 months to 11 year old, with clinically recognized acute pyelonephritis, were evaluated with Tc99m DMSA renal scintigraphy in the first 15 days of their illness to validate this method in the detection of the acute renal inflammatory disease. In 85% of Tc99m DMSA scintigraphies some kind of abnormality (focal or diffuse, unilateral or bilateral) was observed. Second renal images obtained at an average 8.5 months later, showed total disappearance of abnormal findings in 42%; partial regression in 50% and no changes in 8% of these cases. Tc99m DMSA scintigraphy seems to be a good diagnostic tool to confirm acute renal compromise in urinary tract infections. Besides follow up examinations, at least three months later with this same method, were able to confirm sustained renal lesions.
Assuntos
Compostos de Organotecnécio , Pielonefrite/diagnóstico por imagem , Succímero , Doença Aguda , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Cintilografia , Ácido Dimercaptossuccínico Tecnécio Tc 99mRESUMO
The hypotensive effect of enalapril, a converting enzyme inhibitor, given as a single agent once daily, was evaluated prospectively over a 16 week period in 20 subjects. One patient abandoned therapy and 2 were withdrawn (increased creatinine levels in one and the need for associated therapy in the other). Side effects developed in 3 patients: creatinine elevation, skin rush and a "salty taste", respectively. A significant decrease in blood pressure (p less than 0.01) attaining normal levels in 6 out of 17 patients was observed. Normal blood pressure levels were not reached in severe hypertension; the association of hydrochlorothyazide was effective in 5 of 11 such subjects. Thus, enalapril may be safely used as a first stage single therapy in mild or moderate hypertension.