Annali italiani di medicina interna : organo ufficiale della Società italiana di medicina interna
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Ann. Ital. Med. Int. · Jul 2002
Case ReportsThree cases of severe acute hepatitis after parenteral administration of amiodarone: the active ingredient is not the only agent responsible for hepatotoxicity.
Amiodarone is one of the most effective antiarrhythmic drugs available and is widely prescribed despite several potentially life-threatening side-effects. Hepatotoxicity is the most frequent one during long-term oral therapy: occasionally acute hepatitis necessitates the suspension of treatment but monitoring of a transient increase in serum aminotransferases is usually sufficient; the clinical-morphological pictures of liver cirrhosis have also been reported. Fulminant hepatitis soon after a parenteral load of the drug is far less well described in the literature. ⋯ Because of the rarity of this diagnosis, we report 3 cases of short-term hepatotoxicity secondary to amiodarone treatment for supraventricular tachyarrhythmias: in 2 male patients with dilated cardiomyopathy and in a female with liver disease. The diagnosis was presumptive and based on a thorough drug history, the temporal relationship, the time-course of liver dysfunction, the exclusion of other causes and on the rapid improvement observed after parenteral amiodarone withdrawal in 2 cases; in no case could we find any other explanation for the liver damage. Since amiodarone is sometimes still an irreplaceable antiarrhythmic drug, we raise the question of whether careful and continuous vigilance should be mandatory in patients receiving the drug or whether it is possible to introduce a pharmaceutical preparation not containing the vehicle that induces acute liver toxicity.
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Hyperkalemia may occur in many clinical settings and lead to serious events. Heparin-induced hyperkalemia is presumably less well recognized than other untoward effects of heparin treatment and more frequent than commonly perceived. ⋯ Heparin-induced hyperkalemia is mediated by an enzymatic block in the synthesis of aldosterone; however, in most cases severe hyperkalemia occurs in the presence of additional factors influencing potassium homeostasis. Patients treated with heparin should be stratified and adequately monitored according to the outlined risk profile.
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Ann. Ital. Med. Int. · Oct 2000
[3-year-survival and quality of life after out-of-hospital heart arrest].
Although the long- and short-term aspects of the outcome of advanced cardiopulmonary resuscitation on patients have been studied to evaluate the percentage of survival up to the moment of discharge from hospital, little information has been published concerning the patients' long-term quality of life. In order to verify the efficiency of our group we retrospectively evaluated 468 subjects admitted to the Emergency Room of Rho Hospital (Milan, Italy) for out-of-hospital cardiac arrest that had occurred over a 90-month period. ⋯ Our data show that: a) 10.25% of the patients were discharged alive; b) younger men (< 65 years old) admitted with a ventricular fibrillation (p = 0.01) and those who had undergone advanced cardiopulmonary resuscitation for less than 25 min (p = 0.001) had a better survival rate at 3 years from discharge; c) 64% of the survivors have a satisfactory quality of life; d) younger age (p = 0.01) and cardiac left ventricular ejection fraction (> 40%) (p = 0.05) are positive predictors for future work capacity. In conclusion, we believe that the critical moment following advanced cardiopulmonary resuscitation is hospitalization because after discharge survival percentage abruptly increased from 10.25 to 65%.
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Ann. Ital. Med. Int. · Jul 1999
Review Case ReportsKikuchi's disease: an uncommon cause of fever of unknown origin.
Kikuchi's disease or histiocytic necrotizing lymphadenitis is an uncommon clinical condition that causes diagnostic difficulties because of its lack of specific signs, symptoms and serological markers. Diagnosis is based on histopathological findings, but overlapping of the histological features requires a differential diagnosis among histiocytic necrotizing lymphadenitis and a number of infectious, autoimmune and lymphoproliferative lymphadenopathies. We report a case of Kikuchi's disease in a 19-year-old woman presenting with generalized lymphadenopathy and persistent fever.
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Ann. Ital. Med. Int. · Jul 1999
Review Historical Article[The homeopathy problem in contemporary medicine].
The aim of this study is to explain homeopathy, and make a critical evaluation of the doctrine and its clinical practice. The discipline of homeopathy, a medical doctrine advanced by Samuel Hahnemann in the late eighteenth and the early nineteenth centuries, is based on a physiological theory according to which a "vital force dominates the human body in an unopposed and dynamic way"; disease processes are considered the consequence of a disturbance of this vital force. According to this doctrine, there are only three diseases: psora, sycosis and lues. ⋯ Second, despite the fact that homeopathic specialists claim many therapeutic successes, the small number of rigorous studies conducted have not as yet provided convincing evidence that homeopathic treatment is effective against particular disease processes. Third, from a methodological standpoint, homeopathy has a number of serious flaws: above all, it violates both the principle of falsifiability enunciated by Karl Popper as a criterion for the demarcation between science and pseudo-science, and the principle of operative definition. Homeopathy cannot therefore be considered a scientific discipline.