ABSTRACT
BACKGROUND: Idiopathic granulomatous mastitis (IGM) is a rare benign inflammatory disease of the breast. It is related to various etiological factors. The treatment of IGM is challenging as there is a lack of consensus in the literature and treatment options vary widely. Conservative treatment with antibiotics, glucocorticoids and immunosuppressive drugs, and surgery are used in the management of the disease. In this article we report our experience with IGM patients receiving immunosuppressive treatment. PATIENTS AND METHODS: The medical records of patients with IGM receiving systemic therapy at the Hacettepe University Hospital between October 2007 and May 2010 were reviewed. 15 cases of histopathologically proven IGM were identified. The data was examined for risk factors and success of treatment. RESULTS: 14 patients were given prednisolone together with azathioprine, and 1 patient who was pregnant at the time of diagnosis received only prednisolone (30 mg/day). 11 (73%) patients had a complete response to systemic therapy. 2 patients had a relapse, of whom 1 required surgical drainage and 1 was treated with a higher dose of glucocorticoids. CONCLUSION: Systemic therapy is a safe and effective treatment for IGM. The addition of azathioprine to glucocorticoid therapy permits quick tapering of the steroid doses and increases the treatment success.
ABSTRACT
BACKGROUND: Intra-abdominal organs, most commonly the spleen and liver, are injured in 40-50% of polytraumatized patients. Because of its important immunological functions, preservation of the injured spleen is of paramount importance. METHODS: There are both conservative and surgical approaches to preservation of the spleen in trauma cases. Of the techniques available for this purpose, tissue adhesives, coagulation, partial resection, and mesh splenorrhapy are the most suitable. RESULTS: Nonoperative management is a worthwhile option in hemodynamically stable patients. The decisive factor for successful conservative management is the degree of injury. We find that the manner in which heparin is administered plays an important role. Tissue adhesives are commonly used with good success with superficial lacerations. Coagulation techniques are also suitable for organ conservation with grade I and II injuries. Splenorraphy with resorbablemesh is the method of choice with the deep lacerations as it permits rapid and permanenthemostasis. If an injury only involves one pole or one half of the spleen, resection of that part of the organ is an option. Partial resection with a stapler is advisable for speed and effectiveness. Total fragmentation or separation of the hilus is treated with an immediate splenectomy, saving the tail of the pancreas. CONCLUSION: In trauma cases, every attempt should be made to save the spleen. If splenectomy cannot be avoided, the splenectomized patient should be immunized against pneumococcus and be informed of his/ her resultant immune deficiency.
ABSTRACT
Human granulocyte colony-stimulating factor (G-CSF) is a hematopoietic hormone promoting the growth, proliferation, differentiation and maturation of myeloid and leukocytic lineages. G-csfs have been used to improve granulocyte count in neutropenic patients, reduce the incidence and duration of neutropenia in patients receiving cytotoxic chemotherapy and to mobilize peripheral blood stem cells prior to leukapheresis for using in both autologous and allogeneic hematopoietic cell transplantation. In general, side-effects are mild to moderate and life threatening side-effects like splenic rupture are very rare. We herein, report a case of spontaneous splenic rupture secondary to high-dose G-CSF use (20 mcg/kg/day), in a healthy female allogeneic donor of peripheral-blood stem cell (PBSC) .
