Cyclophosphamide (CY) is an alkylating agent used to treat a variety of autoimmune disorders. Water intoxication is a well-known complication of high-dose intravenous (i.v.) CY, but is rare in patients treated with low dose i.v. CY. We describe two patients with lupus nephritis and water intoxication following low dose i.v. CY. The first patient was treated with oral prednisolone and azathioprine for eight weeks with inadequate response and persistent renal inflammatory activity. Eight hours after the first i.v. CY pulse she had a grand mal seizure. The second patient had WHO class III lupus nephritis, and after a single i.v. CY pulse developed vomiting, diarrhoea and grand mal seizures. They were both fluid-restricted and their serum sodium levels returned to normal. In conclusion, even at low doses i.v. CY may induce hyponatremia related to inappropriate antidiuretic hormone secretion. This potentially life-threatening complication of i.v. CY could be minimized by avoidance of overhydration following pulse i.v. CY.
presidential address (Weinblatt ME. ACR presidential address: the best of times, the worst of times, rheumatology 2001. Arthritis Rheum 2002;46:567-73) with great interest as soon as it arrived, I regret that its Tale of Two Cities metaphor inspired not only juxtaposition, but also a conflicting emotional response quite separate from its intended message. Although the address triumphantly chronicled many accomplishments and described our new challenges, I felt belittled by the comments regarding fibromyalgia. Rheumatologists have a proud tradition of walking where others fear to tread. Our participation in investigating the enigmas of breast implants, Lyme disease, tryptophan, and myriad other puzzles only hastened the eventual understanding of these problems. Who is better qualified than rheumatologists to finally unravel the daunting mystery of fibromyalgia? I believe that Dr. Weinblatt may be inaccurate when he suggests that rheumatologists provide "little value" to patients with fibromyalgia. The comments regarding Mary Betty Stevens personified my hopes and aspirations as well. While each specialty seems to be trying to discard their most emotionally challenging disorders to primary care physicians and psychiatrists, I doubt that those inspiring pioneers ever took the easy road by "restricting followup visits." We will overcome this daunting adversary called fibromyalgia. And, as with previous challenges, we will eventually be just as proud of that effort and determination. We are all committed to caring for patients with inflammatory diseases, but our past success should inspire us to conquer all of our challenges, not just to enjoy the fruits of our recent advances for a portion of our patients.
Livro resenhado: Garrido, Carlos. Dicionário de zoologia e sistemática dos invertebrados: português, espanhol, inglês, alemão. São Paulo: Editora da Universidade de São Paulo, 2019, 592 pp.
Neste artigo apresentam-se umas notas sobre a história da língua portuguesa no século XVII e sobre a biografia do lexicógrafo Bento Pereira. Da sua obra selecionamos o “appendiz”, Florilegio dos modos de fallar, e adagios da lingoa Portuguesa, dividido em duas partes: a Primeira das frases portuguezas, a que correspondem as mais puras, é elegantes Latinas, como tiradas de Marco Tullio, & outros Authores de primeira classe e a Segunda onde recolhem os principaes adagios portugueses, com seu latim prouerbial correspondente, pera se aiuntar a Prosodia, & Thesouro portugues, como appendiz, ou complemento (1655). Analisam-se exemplos dos verbos parassintéticos, explicam-se os esquemas morfológicos constituídos pelas preposições a-, des-, en-/em- e os sufixos –ar, -ecer, com especial referência ao substantivo ou adjetivo que constitui a base da derivação e a partir da qual se elabora a definição lexicográfica. Incorpora-se informação sobre as palavras com que se combinam, usadas nos exemplos escolhidos neste apêndice da principal obra do lexicógrafo jesuíta, autoridade indiscutível na dicionarística bilingue e metaortográfica. A seguir às Referências junta-se um Anexo, a modo de vocabulário sintético dos verbetes e artigos tirados da obra, com detalhes de sinonímia e outras informações complementares.
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