Recenti progressi in medicina
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Case Reports
[Rhabdomyolysis and acute renal failure caused by haloperidol-decanoate (neuroleptic malignant syndrome)].
A case of rhabomyolysis with attendant severe acute renal failure, arisen in a 59-year-old male treated with haloperidol-decanoate, is presented. The patient has been affected by paranoia schizophrenia since childhood, and he was treated with electroshock and successively with neuroleptics p.o. Four years before our observation, a therapy with haloperidol decanoate (50 mg i.m. monthly) was started. ⋯ After that haloperidol decanoate was stopped and rehydration and intensive diuretic therapy was started, the clinical and laboratory pattern went normal, persisting however a light creatinine increase. Probably the rhabdomyolysis was induced by the haloperidol decanoate, and renal failure by secondary severe hyvolemia. This case comes into the so-called neuroleptic malignant syndrome which can rarely arise in patients treated with antipsycotic agents and which causes high mortality, particularly when there are rhabdomyolysis and acute renal failure.
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Case Reports
[Pheochromocytoma-gastric leiomyoblastoma association. A possible expression of Carney's triad. A case report].
The case of a 28 yrs old female patient affected by pheochromocytoma and gastric leiomyoblastoma was described. The simultaneous presence of these neoplasms in a young woman supported the diagnosis of the clinical syndrome known as "Carney's triad".
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Editorial Comparative Study
[What is the real prevalence of hypertension in obesity?].
Many confounding variables (age, sex, race, income level) may contribute to an incorrect estimate of the prevalence of hypertension in the obese population. Furthermore, as far as methodology is concerned, both casual morning BP measurement and, the use, in the obese patient, of inappropriate cuffs both also contribute significantly to the overestimation with the inclusion of false positives even in relevant percentages. ⋯ At last and overall, universally recognized cutoff-points for obesity and hypertension should always be used when studying prevalence of hypertension among general population and/or among obese patients. When such conditions are not taken into account, inaccurate and misleading conclusions on the real prevalence of hypertension in obesity may result.
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A case of acute inflammatory myopathy associated with the use of pravastatin, a new hydrophilic 3-hydroxy-3 methylglutaril coenzyme A reductase inhibitor, is reported. The patient, a 69-year-old man was affected by non-insulin-dependent diabetes mellitus and hypertension. He assumed pravastatin (20 mg/day) because of hypercholesterolemia. ⋯ A previously unknown hypothyroidism, probably due to chronic autoimmune thyroiditis, was evidenced. Muscle biopsy (left gastrocnemius) revealed a perimysial and endomysial inflammatory infiltrate with a prevalence of CD4+ lymphocytes. While lovastatin and simvastatin have been associated with toxic myopathy, pravastatin-associated myopathy could represent a distinct, inflammatory entity.
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Multiple organ system failure (MOSF) is a severe clinical process that causes progressive renal and liver failure. Acute pancreatitis (AP) can cause MOSF. Several series document high mortality rate from necrotizing forms is associated with MOSF. ⋯ So it is important to provide prophylactic use of antibiotics that are effective against expected bacteria and also achieve a therapeutic concentration in pancreatic tissue and juice. Fluid replacement, nutritional support and other therapeutic strategies must be employed to prevent MOSF. When the MOSF is clearly developed, medical and surgical measures are unuseful and the mortality rate is very high also in an intensive care unit.