ABSTRACT
We experienced a 22-year old patient with a documented history of minimal change nephrotic syndrome (MCNS), and a diagnosis of acute lymphoblastic leukemia (ALL) was then made for this patient. The patient received standard daily steroid therapy for the treatment of nephrotic syndrome. Cyclosporin A was administered because there was no clinical improvement with steroid therapy. Six years after the diagnosis of nephrotic syndrome, the patient was diagnosed with ALL. After chemotherapy for ALL, the patient was in complete remission and he showed clinical improvement of nephrotic syndrome. The hematological malignancies associated with nephrotic syndrome are mainly lymphoma and chronic lymphocytic leukemia. ALL has rarely been described in combination with nephrotic syndrome. Although the exact mechanism for development of ALL after nephrotic syndrome is unknown, at least two possibilities exist. First, the incidence of leukemia may be increased after immunosuppressive therapy, which may include cyclosporin A. Second, the underlying defect in T-lymphocyte function could account for both nephrotic syndrome and ALL. The possible mechanisms for such a relationship are discussed here along with a review of the relevant literature.
Subject(s)
Humans , Young Adult , Cyclosporine , Diagnosis , Drug Therapy , Hematologic Neoplasms , Incidence , Leukemia , Leukemia, Lymphocytic, Chronic, B-Cell , Lymphoma , Nephrosis, Lipoid , Nephrotic Syndrome , Precursor Cell Lymphoblastic Leukemia-Lymphoma , T-LymphocytesABSTRACT
Mycobacterium marinum is a nontuberculous mycobacterium responsible for skin infection. Risk factors include a history of trauma and water/fish-related hobbies or occupations. This infection is characteristically limited to the skin but deep soft tissue may be involved. We report a case of M. marinum infection in a 51-year-old man with ulcer and erythematous nodules on his right hand. The patient owned a tropical fish tank and remembered having previous hand trauma. The lesions extended to his forearm and formed sporotrichoid appearance. M. marinum was isolated from tissue specimens. The patient was treated with rifampin, etambutol and clarithromycin for 5 months, then the skin lesions were cured. The key to the diagnosis of this case are clinical awareness and a detailed history. M. marinum infection should be considered in chronic sporotrichoid skin lesions, particularly when there is a clinical suspicion on an infectious cause, and it could lead to successful treatment.
Subject(s)
Humans , Middle Aged , Clarithromycin , Diagnosis , Forearm , Hand , Hobbies , Mycobacterium marinum , Mycobacterium , Nontuberculous Mycobacteria , Occupations , Rifampin , Risk Factors , Skin , UlcerABSTRACT
Mycobacterium marinum is a nontuberculous mycobacterium responsible for skin infection. Risk factors include a history of trauma and water/fish-related hobbies or occupations. This infection is characteristically limited to the skin but deep soft tissue may be involved. We report a case of M. marinum infection in a 51-year-old man with ulcer and erythematous nodules on his right hand. The patient owned a tropical fish tank and remembered having previous hand trauma. The lesions extended to his forearm and formed sporotrichoid appearance. M. marinum was isolated from tissue specimens. The patient was treated with rifampin, etambutol and clarithromycin for 5 months, then the skin lesions were cured. The key to the diagnosis of this case are clinical awareness and a detailed history. M. marinum infection should be considered in chronic sporotrichoid skin lesions, particularly when there is a clinical suspicion on an infectious cause, and it could lead to successful treatment.
Subject(s)
Humans , Middle Aged , Clarithromycin , Diagnosis , Forearm , Hand , Hobbies , Mycobacterium marinum , Mycobacterium , Nontuberculous Mycobacteria , Occupations , Rifampin , Risk Factors , Skin , UlcerABSTRACT
Rituximab is a chimeric monoclonal antibody for human B lymphocyte subset CD20 and has recently been used for treatment of autoimmune disease such as rheumatoid arthritis and systemic lupus erythematosus (SLE). We report the experiences of rituximab treatment in two patients with severe SLE. The first case is 16-year-old female patient with hemolytic anemia, thrombocytopenia and acute renal failure due to aggravation of lupus nephritis, and the second case is 30-year-old female pregnant patient with diffuse alveolar hemorrhage after preterm premature rupture of fetal membranes. All two patients responded to rituximab and maintained symptom free state.
Subject(s)
Adolescent , Adult , Female , Humans , Pregnancy , Acute Kidney Injury , Anemia, Hemolytic , Arthritis, Rheumatoid , Autoimmune Diseases , Fetal Membranes, Premature Rupture , Hemorrhage , Lupus Erythematosus, Systemic , Lupus Nephritis , Lymphocyte Subsets , Rituximab , ThrombocytopeniaABSTRACT
Dieulafoy's lesion is a rare cause of massive gastrointestinal bleeding. It is usually identified within the proximal stomach but has been reported in the esophagus, duodenum, small intestine, colon and rectum. Surgery was originally the treatment of choice for this lesion. However, recently, most case can be treated using endoscopic techniques including an injection of a sclerosing agent, clipping, band ligation, heater probe, and bipolar coagulation. We report 2 cases of a rectal Dieulafoy's lesion that were treated sucessfully by endoscopic clipping without complications.
Subject(s)
Colon , Duodenum , Esophagus , Hemorrhage , Intestine, Small , Ligation , Rectum , StomachABSTRACT
Massive hydrothorax is uncommon but well recognized complication of peritoneal dialysis. Possible mechanisms include a disorder of lymphatic drainage, pleuro-peritoneal pressure gradient, and congenital diaphragmatic defects. Hydrothorax in a CAPD patient caused by infiltrative disease or malignancy is very rare. Recently, two cases of hydrothorax in CAPD patients caused by systemic amyloidosis involving diaphragm were reported. However, no case of pleuro-peritoneal communication secondary to HCC infiltrating diaphragm was reported. This case was of a hydrothorax due to HCC in a CAPD patient. We performed video-assited thoracoscopic resection of diaphragmatic mass, diaphragmatic repair and thoracoscopic talc pleurodesis. This case showed that malignancy might be considered as a cause of a hydrothorax in a CAPD patient.
Subject(s)
Carcinoma, HepatocellularABSTRACT
Twelve cases with paralytic elbow due to a traumatic lesion of the brachial plexus (eleven cases) and to poliomyelitis (one case) were treated by elbow flexorplasty from April, 1978 to February, 1984 Seven cases with available muscle for transfer were treated by muscle transfer, three cases withwhole arm type brachial plexus injury were treated by gracilis muscle transplantation, and two relatively fresh cases by neurotization. The three operated groups were assessed in range of active elbow motion, muscle power testing, and electromyography at final follow-up. In eight cases, the elbow flexorplasty were augmented by shoulder arthrodesis. The mean length of follow-up was twenty two months. The mean arc of restored active elbow motion was 93 degrees following muscle transfer, 100 degrees following gracilis muscle transplatation, and 35 degrees following neurotization. The overall mean arc of active elbow motion was 77.5 degrees. In the muscle testing, the mean scores of the elbow flexor power were 3+, 4−, and 3− following muscle transfer, grcilis muscle transplantation, and neurotization respectively. The overall mean score of restored elbow flexor power was 3− . The electromyographic findings also revealed corresponding restoration of the action potential in the flexor muscle in the three groups. One case of the transfer group failed after sternocleidomastiod muscle transfer, who subsequently received gracilis muscle transplantation with satisfactory result.
Subject(s)
Action Potentials , Arm , Arthrodesis , Brachial Plexus , Elbow , Electromyography , Follow-Up Studies , Nerve Transfer , Poliomyelitis , ShoulderABSTRACT
From May, 1971 to June, 1984, we performed extensive saucerization on the chronic osteomyelitis of long bones eradicating all pathologic foci; not only sequestra but sclerotic involocurum and necrotic original cortex embeded by new bone, which was different from the conventional methods such as sequestrectomy or guttering in its extensiveness. Clinical analysis on the base of radiologic evaluation after saucerization was done on the 16 patients; for average 5 years of follow-up. The results obtained were as follows; 1. The angulatory deformity of the long bones after pathologic fracture complicated by the chronic osteomyelitis was not corrected satisfactorily due to the bony sclerosis or hyperostosis at the fracture site, especially in cases of posterior or medial angulation. 2. The recurrence was closely related to the persisting non-sequestered original cortical lesion after incomplete saucerization, which was embeded by the new bone. So to prevent the recurrence the non-sequestered original cortical lesion must be removed completely. 3. The cortical defect after saucerization was restored completely in patients under the age of 14, but which was not the way in patients over the age of 16.
Subject(s)
Humans , Congenital Abnormalities , Follow-Up Studies , Fractures, Spontaneous , Hyperostosis , Osteomyelitis , Recurrence , SclerosisABSTRACT
We performed a clinical study of the effect of electrical current on the congenital pseudarthrosis of the tibia from May, 1980 to January, 1984. Eight congenital pseudarthrosis were treated with direct current stimulation, six of which had received previous treatment at least more than one time in any manner and two had none. Four were failures in previous treatment with vascularized fibular graft due to the non-uoion at the proximal or distal sites of grafted bones. Six of eight congenital pseudarthrosis were treated with invasive type electrical stimulators, and the remaining two were treated with semi-invasive type. The average follow-up period was 26 months (range from 8 to 39 months). As a result satisfactory union has occured in seven out of eight cases. The mean time for union was 27 weeks (range from 15 weeks to 48 weeks). No serious complication was observed, but in our experience, the semi-invasive type, comparing to invasive type, was handicaped with minor complications such as pin tract infection and skin sloughing due to the irritation by anode pad, and needed frequent recharging to maintain adequate voltage. With above result, we think that the electrical stimulation has revealed to be one of the reliable methods in the treatment of surgery-resistant congenital pseudarthrosis.