ABSTRACT
Ultrasound examination of the breast and its lymphatic drainage was undertaken in 78 patients who--after mammoplasty with silicone implants--had palpable lymph nodes, pain and sensation of tension in the area surrounding the implant. Five patients had space-occupying echo-dense inner structures and dense echos from structures dorsal to the space-occupying ones. In this way silicone granuloma could be demonstrated even preoperatively in tissues, musculature or lymph nodes, although the changes were palpable in only two of the five patients. Ultrasonography can thus be of great importance not only in the diagnosis but also in the preoperative localization of silicone-induced granulomas.
Subject(s)
Breast Diseases/diagnosis , Breast/pathology , Granuloma/diagnosis , Lymphatic Diseases/diagnosis , Postoperative Complications/diagnosis , Prostheses and Implants/adverse effects , Silicone Elastomers/adverse effects , Ultrasonography , Adult , Breast/surgery , Breast Diseases/etiology , Female , Granuloma/etiology , Humans , Lymph Nodes/pathology , Lymphatic Diseases/etiology , Middle Aged , Postoperative Complications/etiology , Prospective StudiesABSTRACT
A case of mucormycosis in a 45 year-old woman with uncontrolled diabetes is reported. Following dental extractions, the patient presented with total ophthalmoplegia, chemosis and complete sensory loss of the right fifth cranial nerve. Exophthalmus was not present. Although a fungal infection was suspected, administration of Amphotericin B was avoided because of renal insufficiency. After temporary clinical improvement with high doses of antibiotics, signs of right seventh and eighth cranial nerve paralysis and of thrombosis of the right ophthalmic artery developed. The patient expired after six days. Autopsy disclosed extensive mucormycosis with involvement of the nasal cavity and paranasal sinuses, soft tissues and bones of face and orbit, cranial nerves, meninges and base of the brain, as well as mycotic thrombosis of the right cavernous sinus and the internal carotid, ophthalmic and maxillary arteries. The spread of infection is detailed, and the importance of an early diagnosis is stressed.
Subject(s)
Cavernous Sinus , Intracranial Embolism and Thrombosis/etiology , Meningoencephalitis/etiology , Mucormycosis/complications , Carotid Artery Diseases/etiology , Carotid Artery, Internal , Female , Humans , Maxillary Artery , Meningoencephalitis/complications , Middle Aged , Mucormycosis/etiology , Ophthalmic Artery , Thrombosis/etiology , Tooth Extraction/adverse effectsABSTRACT
Bone histology (iliac crest biopsies; undecalcified sections; micromorphometry) was studied by repeated biopsies in 19 patients on maintenance hemodialysis. Sampling error was assessed by taking two biopsies at one time. After an initial biopsy, patients were dialyzed either against 3.6 mEq Ca/l dialyzate or 3.9 mEq Ca/l dialyzate for 9-16 months before a second biopsy was taken. Bone histology failed to normalize irrespective of the dialyzate Ca concentration. Surface density of endosteal fibrosis diminished in a considerable proportion of the patients (9/19). Volumetric density of osteoid fell in 5 and rose in 4 of the patients.
Subject(s)
Bone and Bones/pathology , Calcium/administration & dosage , Ilium/pathology , Renal Dialysis/methods , Adolescent , Adult , Bone Matrix/pathology , Bone Resorption , Calcium/analysis , Calcium/blood , Chronic Kidney Disease-Mineral and Bone Disorder/blood , Chronic Kidney Disease-Mineral and Bone Disorder/pathology , Densitometry , Female , Fibrous Dysplasia of Bone/pathology , Humans , Male , Middle Aged , Osteolysis/pathology , Osteosclerosis/pathology , Parathyroid Hormone/bloodABSTRACT
The change of bone mass during maintenance haemodialysis was studied in 20 patients. Iliac crest biopsies were obtained at a 9 - 16 months interval. Two biopsies were taken in order to give an independent estimate of the sampling error. 22 individuals in the same age group without skeletal disease who died from traffic accidents or from violent deaths were used as controls. Undecalcified sections of bone (Masson-Goldner-stain) were evaluated by micromorphometry. At the beginning of the study osteosclerosis (i.e. volumetric density of bone above x +/- 2 SD in control patients) was found in 14 out of 20 patients. Volumetric density of bone only increased in one of the patients during the observation period. A significant decrease of volumetric density of bone was found in 5 out of 20 patients. This could be attributed to prolonged immobilisation in two cases and to inadequate protein- and calorie-intake in two cases. No predisposing factor could be found in the fifth case. It is concluded that loss of spongy bone mass (osteopenia) is not an invariable result of haemodialysis.
Subject(s)
Chronic Kidney Disease-Mineral and Bone Disorder/etiology , Renal Dialysis/adverse effects , Adult , Bone and Bones/pathology , Chronic Kidney Disease-Mineral and Bone Disorder/pathology , Female , Humans , Hyperparathyroidism, Secondary , Immobilization , Male , Middle Aged , Osteosclerosis/etiologyABSTRACT
Quantitative bone histology (micromorphometry of undecalcified sections, analysis under polarized light; fluorescence microscopy with tetracycline double labelling) as well as serum and urinary chemistry (creatinine clearance, parathyroid hormone, ionized Ca, bone phosphatase, pH), were studied in 50 patients with incipient to advanced (glomerular filtration rate, 80 to 6 ml/min x 1.73 m2 renal insufficiency. In incipient renal failure, indirect evidence of parathyroid hormone excess was found in the skeleton (empty osteoclastic lacunae, woven osteoid). Osteoclastic surface resorption was abnormally high when GFR fell below 50ml/min x 1.73 m2. With the tetracycline double-labelling technique, a mineralization defect was demonstrable in many but not all patients.
