ABSTRACT
La amigdalectomía es la intervención quirúrgica más frecuente en otorrinolaringología y sus indicaciones son ampliamente conocidas en la especialidad. El avance en el conocimiento de sus funciones inmunológicas ha determinado su uso en el tratamiento de otras enfermedades tales como la nefropatía por IgA, síndromes neuropsiquiátricos, el síndrome de fiebre recurrente, algunas entidades dermatológicas, entre otras. Pretendemos así, revisar la literatura para evaluar la evidencia disponible que sustente lo que denominamos indicaciones no tradicionales. Al parecer, la evidencia a favor del uso de amigdalectomía en el tratamiento de algunas de estas enfermedades es sólido, mientras que para otras aún no supera la suposición teórica, pues sólo se cuenta con casos aislados. Consideramos necesario estudios más extensos, con mayor calidad metodológica para definir mejor la indicación de amigdalectomía. Esto, más la evaluación multidisciplinaria de cada caso nos debiera conducirá la mejor decisión.
Tonsillectomy is the most common surgical procedure in otorhinolaryngology and their indications are well known in the field. The advance in knowledge of their immune function has determined its use in the treatment of other diseases such as IgA nephropathy neuropsychiatric syndromes, periodic fever syndrome, some dermatologic entities, and others. We review the literature to evaluate the available evidence that supports what we cali nontraditional indications. Apparently the evidence for the use of tonsillectomy in the treatment of some diseases is solid, while others still not overcome the theoretical assumption, since there are only isolated cases. Larger studies are needed to consider, with higher methodological quality, to better define the indication for tonsillectomy. This and the multidisciplinary assessment of each case should lead us to the best decision.
Subject(s)
Humans , Stomatitis, Aphthous/surgery , Pharyngitis/surgery , Glomerulonephritis, IGA/surgery , Tonsillectomy , Autoimmune Diseases of the Nervous System/surgery , Skin Diseases/surgery , Fever , Streptococcal Infections , Periodicity , Patient Selection , Decision MakingABSTRACT
BACKGROUND: There is a paucity of data on the course of renal transplant in patients with immunoglobulin A (IgA) nephropathy (IgAN) from India. While the natural history of IgAN in the Indian context is rapidly progressive, the post-transplant course remains speculative. AIM: To study the graft survival in renal transplant recipients whose native kidney disease was IgAN and the incidence and correlates of recurrent disease. SETTINGS AND DESIGNS: Retrospective case control study from a Nephrology unit of a large tertiary care center. MATERIALS AND METHODS: The outcomes of 56 transplant patients (58 grafts) with biopsy-proven IgAN and of 116 patients without IgAN or diabetic nephropathy, transplanted during the same period were analyzed. Correlates of biopsy-confirmed recurrent disease were determined. STATISTICAL ANALYSIS: Means were analyzed by Student's t test and Mann-Whitney test; proportions were determined by Chi-square analysis and graft survival curves were generated using the Kaplan-Meier. RESULTS: Five-year graft survival for IgA patients was not significantly different from that in the reference group (90% and 79%, P = 0.6). During a mean follow-up of 42 months (range, 1-144), 28 event graft biopsies were required in 20 grafts of IgAN. Histological recurrence was diagnosed in five of the 20 available biopsies (25%) after a mean duration of 28 months. Recurrence did not correlate with donor status, HLA B35 and A2, recipient age, gender or immunosuppression. CONCLUSIONS: Renal transplantation is an appropriate treatment modality for IgA nephropathy patients with end-stage renal disease in India, despite the potential for recurrent disease. The posttransplant course is an indolent one when compared to the malignant pretransplant phase.
Subject(s)
Adult , Female , Glomerulonephritis, IGA/surgery , Graft Survival , Humans , Kidney Transplantation , Male , RecurrenceABSTRACT
This is a review of two children who developed acute glomerulonephritis (AGN) following acute gangrenous appendicitis (AGA) with periappendicular collections. The first patient presented with AGN during the course of appendicitis. The second patient developed AGN after appendectomy. Both patients did not have any other predisposing factors. AGN resolved in both patients after massive intravenous antibiotics. This is the first report of acute appendicitis as a predisposing factor for AGN