ABSTRACT
La osteonecrosis del semilunar o enfermedad de Kienböck es una entidad de baja prevalencia, más frecuente en varones jóvenes entre 20 y 40 años. Todavía más exclusiva en pacientes en edad infantil. De etiología variable, se baraja la teoría traumática vascular y la teoría no traumática causada por otros diversos mecanismos. La afectación del semilunar puede presentarse con edema óseo, fragmentación, desalineación escafo-lunar y progresar hacia el colapso. Presentamos el caso de un adolescente con enfermedad de Kienböck, sin antecedente traumático atribuible que desarrolló una lesión de compleja clasificación en la escala de Litchman. Se consiguió mejoría parcial de la clínica con tratamiento conservador, pero sin eliminar el dolor de forma definitiva. El planteamiento quirúrgico se debate actualmente teniendo en cuenta su madurez esquelética y evolución fisiopatológica de la lesión (AU)
Semilunar osteonecrosis or Kienböck's disease has a low prevalence, usually occurring in young men aged between 20 and 40 years. This disease is even less common in childhood. The aetiology varies, with postulation of the vascular trauma theory and the non-traumatic theory, in which the disease is caused by various other mechanisms. Semilunar involvement can occur with bone oedema, fragmentation, and scapholunate misalignment and progresses towards collapse. We present the case of an adolescent boy with Kienböck's disease, with no attributable traumatic antecedent, who developed a complex classification injury on the Litchman scale. Partial improvement of symptoms was achieved with conservative treatment but without definitive pain elimination. Future surgery for this patient is currently being discussed, bearing in mind his skeletal maturity and the pathophysiological progression of the injury (AU)
Subject(s)
Humans , Male , Child , Adolescent , Young Adult , Adult , Lunate Bone/diagnostic imaging , Lunate Bone/surgery , Osteonecrosis/etiology , Vascular System Injuries , Conservative TreatmentABSTRACT
Semilunar osteonecrosis or Kienböck's disease has a low prevalence, usually occurring in young men aged between 20 and 40 years. This disease is even less common in childhood. The aetiology varies, with postulation of the vascular trauma theory and the non-traumatic theory, in which the disease is caused by various other mechanisms. Semilunar involvement can occur with bone oedema, fragmentation, and scapholunate misalignment and progresses towards collapse. We present the case of an adolescent boy with Kienböck's disease, with no attributable traumatic antecedent, who developed a complex classification injury on the Litchman scale. Partial improvement of symptoms was achieved with conservative treatment but without definitive pain elimination. Future surgery for this patient is currently being discussed, bearing in mind his skeletal maturity and the pathophysiological progression of the injury.
Subject(s)
Lunate Bone , Osteonecrosis , Vascular System Injuries , Adolescent , Adult , Bone and Bones , Child , Family , Humans , Lunate Bone/diagnostic imaging , Lunate Bone/surgery , Male , Osteonecrosis/etiology , Young AdultABSTRACT
A 48-year-old patient with IgA k multiple myeloma received a BMT from his HLA-matched sibling. After transplantation, the disease relapsed. Melphalan therapy followed by reinfusion of haemopoietic blood stem cells collected from the patient led to the improvement of the clinical status, although mixed chimerism and an elevated serum IgA persisted. Successful donor immunisation against an immunogenic preparation of the recipient monoclonal protein was performed before the infusion of donor T lymphocytes (DLI) into the patient. Ten weeks after the lymphocyte infusions, no monoclonal band was evidenced and donor complete chimerism was detected. The patient did not develop GVHD. Once complete remission was achieved, the idiotype vaccine was administered to the patient. Nineteen months after DLI, the patient remains in remission. Bone Marrow Transplantation (2000).
Subject(s)
Blood Donors , Immunization , Immunoglobulin A/immunology , Immunoglobulin Idiotypes/immunology , Immunoglobulin kappa-Chains/immunology , Immunotherapy, Adoptive , Lymphocyte Transfusion , Multiple Myeloma/therapy , Myeloma Proteins/immunology , Salvage Therapy , T-Lymphocytes/transplantation , Antineoplastic Agents, Alkylating/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Bone Marrow Transplantation , Chimera , Combined Modality Therapy , Dexamethasone/administration & dosage , Doxorubicin/administration & dosage , Graft Survival , Humans , Male , Melphalan/therapeutic use , Middle Aged , Multiple Myeloma/drug therapy , Multiple Myeloma/immunology , Remission Induction , Vincristine/administration & dosageSubject(s)
Brain Ischemia/diagnosis , Leukemia, Myeloid/diagnosis , Chronic Disease , Diagnosis, Differential , Female , Humans , Middle AgedABSTRACT
A 24-year-old male developed cytogenetic relapse of chronic myeloid leukemia (CML) four years after allogeneic BMT. After a year of treatment with IFN-alpha, he achieved a partial cytogenetic response. Treatment with donor leukocyte infusions (DLI) was given (total dose 1 x 10(8) T lymphocytes/kg). Two months later, he developed acute GVHD (skin and liver), that improved with CsA and methylprednisolone and resulted in cytogenetic remission with complete donor chimerism. One month later he developed rhinocerebral mucormycosis and was successfully treated with surgical debridement and liposomal amphotericin B (total dose 12 g). This is the first case of mucormycosis described after DLI.
Subject(s)
Amphotericin B/therapeutic use , Antifungal Agents/therapeutic use , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy , Leukocyte Transfusion/adverse effects , Mucormycosis , Adult , Brain Diseases/drug therapy , Brain Diseases/etiology , Brain Diseases/microbiology , Brain Diseases/surgery , Drug Carriers , Humans , Liposomes , Male , Mucormycosis/drug therapy , Mucormycosis/etiology , Mucormycosis/surgery , Transplantation, HomologousABSTRACT
Mucormycosis is becoming recognized as a serious complication in patients undergoing hemopoietic transplantation (HT), because it is a major cause of morbidity and mortality. In our institution 4 cases of mucormycosis in post-HT period among 345 patients undergoing HT were diagnosed between 1984 and 1997. We studies the clinical characteristics of these cases and we conclude that mucormycosis is not a common infection in patients undergoing HT but that it is followed by a high morbidity and mortality. Maintained neutropenia is the most important risk factor.
Subject(s)
Hematologic Diseases/therapy , Hematopoietic Stem Cell Transplantation/adverse effects , Mucorales/isolation & purification , Mucormycosis/etiology , Mucormycosis/physiopathology , Adult , Female , Humans , Immunosuppression Therapy , MaleABSTRACT
AIM: Analysis of how the prior appointment system affects various indicators of attendance. DESIGN: A multi-centered intervention study. SITE. Faculty of Medicine. Department of Social-Health Sciences. PATIENTS AND OTHER PARTICIPANTS: Patients seen in the general consulting-rooms of urban and rural Health Centres during the same months in two successive years, i.e. before and after setting up the prior appointment system. INTERVENTIONS: Introduction of the prior appointment programme (a consultation, with the hour and date arranged beforehand). Questionnaire given to the patient at the end of the consultation. MEASUREMENTS AND MAIN FINDINGS: The personal variations of age and sex, and also of those relating to the medical side were compared by means of the questionnaire, before and after the introduction of the prior appointment system. Significant differences were only seen in relation to hospital referral, which tripled; and to the number of prescriptions per person, which increased. CONCLUSIONS: The prior appointment system has meant less waiting-time for patients and a rationalisation of consultation time; but it has not substantially altered the content of the consultation.
