Dermatomiositis. Aportación de un caso de afectación leve-moderada y disfagia precoz / Dermatomyositis. Presentation of a mild to moderate case with early dysphagia

Presentamos el caso de una paciente de 12 años de edad afectada de dermatomiositis juvenil, que fue diagnosticada en nuestra unidad a los pocos días de presentar debilidad muscular proximal y rash cutáneo. Inició tratamiento con la combinación de corticoides por vía oral y metotrexato, con mejoría inicial de la afectación cutánea, sin modificarse la debilidad muscular. La aparición de disfagia a los pocos días de iniciado el tratamiento nos llevó a cambiar la estrategia terapéutica inicial, añadiendo pulsos de metilprednisolona parenteral. Aportamos el caso como ilustrativo de la dificultad en la toma de decisiones sobre la opción de tratamiento inicial

We report the case of a twelve year old female patient with juvenile dermatomyositis. The diagnosis was made in our unit a few days after starting with proximal muscular weakness and a skin rash. A combination of oral corticosteroids and methotrexate was administered. There was an initial improvent in the skin lesions, but with no changes in the muscle weakness. The appearance of dysphagia a few days after starting the treatment led us to add three pulses of parenteral methylprednisolone to her initial treatment. We report the case to illustrate the difficulties in deciding initial treatment options

Imaging of gaps in digital joints by measurement of ultrasound transmission using a linear array.

In orthodontic dentistry for young subjects, it is important to assess the degree of growth of the jaw bones to determine the optimum time for treatment. The structure of the digital joint changes with age, with such changes correlating to the degree of bone growth (including jaw bones). There are two gaps in the digital joint of a young subject, one of which disappears with aging. In the present study, a method for noninvasive assessment of such change in the structure of a digital joint was examined, in which continuous-wave ultrasound is radiated to a digital joint by a single-element ultrasonic transducer. This continuous ultrasound, which passes through the digital joint, is received by a linear array ultrasonic probe situated opposite the transducer. The probe simultaneously realizes pulse-echo imaging and imaging of transmission ultrasound, which passes through the joint. Using this experimental apparatus, the existence and position of a gap can be detected clearly by imaging the transmission ultrasound on a pulse-echo image. In basic experiments, continuous-wave ultrasound generated by a planar or focused transducer was radiated to a gap between two acrylic bars, which simulated that in a digital joint; transmission ultrasound, which passed through the gap, was measured with a linear array probe. The basic experimental results showed that a gap with a width >0.4 mm is detectable and that the width at half maximum of the amplitude profile of the received transmission ultrasound that passed through the gap correlated with the width of the gap. Furthermore, in the preliminary in vivo experiments, transmission ultrasound that passed through two gaps in the case of a child was clearly imaged by the proposed method, and that which passed through only one gap in the case of an adult was also imaged. These results show the possibility for the use of the proposed method to noninvasively assess the change in the structure of a joint as a result of aging.

The potential of tissue engineering in orthopedics.

This article presents models of human phalanges and small joints developed by tissue engineering. Biodegradable polymer scaffolds support growth of osteoblasts, chondrocytes, and tenocytes after implantation of the models in athymic mice. The cell-polymer constructs are vascularized by the host mice, form new bone, cartilage, and tendon with characteristic gene expression and protein synthesis and secretion, and maintain the shape of human phalanges with joints. The study demonstrates critical progress in the design and fabrication of bone, cartilage, and tendon by tissue engineering and the potential of this field for human clinical orthopedic applications.

Epiphyseal injuries in the small joints of the hand.

The principles followed in treatment of epiphyseal injuries of the hand are essentially the same as those used in treating epiphyseal injuries elsewhere in the child. Special patience is required in treating the patients, and methods of immobilization must be modified appropriately for the active child. A knowledge of the mechanism of injury and potential effects on the growth potential of the digit are important in determining treatment and counseling parents on possible growth disturbance and later deformity. The epiphyses of the proximal phalanges of the fingers and the thumb metacarpal are the most frequently injured. Salter Type I and II fractures frequently demonstrate remarkable remodeling potential, whereas intra-articular Salter III and IV fractures often require surgical repair and may be more frequently associated with later problems of growth and post-traumatic arthritis. The physician should establish a trusting relationship with the child and his or her parents in order to provide comforting reassurance, facilitate treatment and compliance, and promote an understanding of the possible outcomes associated with injuries of the vulnerable growth plate. When these principles are followed appropriately, the long-term follow-up of these children provides for a very satisfying and rewarding experience for the physician and family.