RESUMO
Haemophilic arthropathy causes pain and a severely restricted range of motion, and results in a significant reduction in quality of life. When conservative treatments have failed, orthopaedic surgery is recommended for these patients with severe haemophilic arthropathy. However, surgery for haemophilia patients is challenging due to high complication rate such as infection, delayed wound healing and mortality. The aim of this study was to evaluate the incidence of early complications and identify preoperative risk factors of surgery for haemophilia patients. We report a series of haemophilia patients undergoing elective orthopaedic surgery between 2006 and 2012. During this period, 119 surgeries in 81 patients were prepared and 118 surgeries in 80 patients were actually performed. Four deep bacterial infections and four delayed wound healings occurred within 6 months postoperatively. One patient died preoperatively and four patients died postoperatively. Only the presence of inhibitor was a significant risk factor for infection. We found no risk factor related to delayed wound healing. Our data revealed alkaline phosphatase, albumin, platelet, alpha-fetoprotein, presence of ascites and child classification C as predictors of perioperative mortality following elective orthopaedic surgery. Our role is to identify potential patients who present with risk factors for complications and attempt to seek the best determination of treatment strategy for these people.
Assuntos
Transtornos Herdados da Coagulação Sanguínea/complicações , Artropatias/cirurgia , Adolescente , Adulto , Idoso , Infecções Bacterianas/etiologia , Transtornos Herdados da Coagulação Sanguínea/mortalidade , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Japão , Artropatias/complicações , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos , Complicações Pós-Operatórias , Fatores de Risco , Esplenomegalia/etiologia , Cicatrização , Adulto JovemRESUMO
A 33-year-old man who developed progressive multifocal leukoencephalopathy (PML) with HIV infection is reported. The patient exhibited rapid decline in neurological status after initiation of antiretroviral therapy (ART), which was attributed to the PML-immune re-constitution inflammatory syndrome. Following the administration of mefloquine in combination with ART, the patient's neurological status improved substantially. This case suggests that further investigation of the use of mefloquine might be warranted for treatment of PML in HIV-infected patients.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Fármacos Anti-HIV/uso terapêutico , Antivirais/uso terapêutico , Leucoencefalopatia Multifocal Progressiva/tratamento farmacológico , Mefloquina/uso terapêutico , Adulto , Fármacos Anti-HIV/administração & dosagem , Antivirais/administração & dosagem , Encéfalo/patologia , Encéfalo/virologia , Humanos , Vírus JC/efeitos dos fármacos , Leucoencefalopatia Multifocal Progressiva/patologia , Imageamento por Ressonância Magnética , Masculino , Mefloquina/administração & dosagem , NeuroimagemRESUMO
Hepatitis B virus (HBV) has seven genotypes, A to G. Previous studies have shown that genotype C is the most prevalent strain in chronic HBV carriers in East Asia. This study was undertaken to investigate the epidemiology of HBV genotypes among Japanese patients who are coinfected with human immunodeficiency virus type 1 (HIV-1). The sequences of the complete hepatitis B surface antifen (HBsAg) genes were obtained from 18 coinfected Japanese patients. Among the 18 patients, 12 of 13 men who had sex with men (MSM) had genotype A (92%), whereas only one of five heterosexual or hemophiliac patients had genotype A. The predominance of genotype A HBV in MSM showed a striking contrast to the current genotype prevalence in the Japanese population. Owing to the recent decrease in the rate of vertical transmission in Japan, the role of sexual behavior in the transmission of HBV cannot be overestimated. Thus, the relative proportion of genotype A may gradually increase in Japan.
Assuntos
Genes Virais , Infecções por HIV/complicações , HIV-1 , Vírus da Hepatite B/genética , Hepatite B Crônica/complicações , Adulto , Sequência de Bases , Feminino , Genótipo , Infecções por HIV/virologia , Antígenos de Superfície da Hepatite B/genética , Vírus da Hepatite B/classificação , Hepatite B Crônica/epidemiologia , Heterossexualidade , Homossexualidade Masculina , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Dados de Sequência Molecular , Fatores de RiscoRESUMO
We have recently encountered an outbreak of hepatitis A in Tokyo. Between July 1998 and November 1999, 21 patients were treated at our hospital. They were all male and 18 patients (86%) had had sex with men (MSM). About a half of the patients were seropositive for syphilis, hepatitis B and HIV. The VP1/2A region could be amplified by nested PCR in 6 of the 21 patients. They had the same sequences and were grouped into genotype IA. Homosexual activity should be kept in mind as a leading risk factor for hepatitis A in the recent Japanese population.