Extensive emphysematous pyelonephritis in a renal allograft: case report and review of literature.

Emphysematous pyelonephritis (EPN) is an acute, severe necrotizing infection of the renal parenchyma and perirenal tissue, which results in the presence of gas within the renal parenchyma, collecting system, or perinephric tissue. EPN of renal allograft is rare, with only 23 cases reported in Western literature. Here, we report a patient treated successfully with surgery. We also review the literature, focusing on old and new suggested classification systems for EPN.

Two auricular epithesis surgical cases retained by a custom titanium implant: result at four years.

INTRODUCTION: This article aims at describing the four-year outcome of a surgical procedure implanting a patient specific epithesis system in two patients. TECHNICAL NOTE: After virtual 3D reconstruction of the anatomy and mirroring of the healthy ear, the position of the three Locator® attachments were optimized in the software to embed them as accurately as possible in the planned episthesis antihelix. The personalized plate bearing the three Locator® implants was then manufactured. Ten osteosynthesis screws were placed around the abutments to ensure bone anchorage. Post-operative antibiotic therapy was prescribed for the duration of ten days. The episthesis was placed two months post-operatively. The follow-up for each patient was 65 and 57 months respectively with no complications to report. CONCLUSION: 3D planning assists the surgeon and eliminates several constraints related to the placement of bone implants. It assists the surgical procedure and improves both the aesthetics and functional result of the surgery.

Avascular necrosis of the femoral head in patients treated for leukaemia. Assessment of the need for a diagnostic protocol. / Necrosis avascular de cabeza femoral en pacientes tratados de leucemia. Evaluación de la necesidad de un protocolo diagnóstico.

OBJECTIVE: To evaluate the incidence of avascular necrosis of the hip in leukaemia patients treated in our hospital with high doses of corticosteroids in order to evaluate the necessity for an early detection protocol. MATERIAL AND METHODS: Observational-descriptive and retrospective study from 2005 to 2016 of 253 patients diagnosed with paediatric leukaemia. Patients with musculoskeletal pathology were identified and patients with avascular necrosis were analysed. RESULTS: A total of 26 patients (10%) had musculoskeletal symptoms. Three patients with avascular necrosis (1.2%) were analysed. One girl, 7 years old, was treated conservatively with traction - suspension and discharge. Two boys, an 11 and a 15.4 year-old,who developed graft-versus-host disease secondary to bone marrow transplantation, and whose treatment included high doses of corticosteroids, developed avascular necrosis of the hip. One was treated with bisphosphonates and forage and the other ended up with a total hip arthroplasty. DISCUSSION: The occurrence of musculoskeletal symptoms during the treatment of leukaemia is different according to the bibliographic series (0.43 -12.6%). Some authors observe an increased risk in female patients between the ages of 10 and 17. A retrospective study reveals that there is a delay of 3.9 months in the diagnosis of CAP since the onset of pain. Other authors relate NAV to loading joints, age and high doses of corticosteroids. CONCLUSION: Based on the low incidence of avascular necrosis of the hip in our 14-year-old population treated for leukaemia, the creation of diagnostic protocols seems not to be necessary. However, close monitoring of patients with potential risk factors recognized in the literature, is advisable.

Neurotrophic keratopathy in a patient with familial amyloidosis. / Queratopatía neurotrófica corneal bilateral en paciente con amiloidosis familiar bilateral.

INTRODUCTION: Familial amyloidotic polyneuropathy is a disease related to amyloid material deposits in the extracellular matrix that can affect many tissues, including the eye. CASE REPORT: This case includes clinical data, a full corneal study report, and histopathological findings, as well as the treatment and follow up of bilateral neurotrophic keratopathy in a 33 year-old patient with familial amyloidotic polyneuropathy. DISCUSSION: Although amyloidotic deposits were also found in the conjunctival tissue, this is not a typical form of ophthalmic amyloidosis. The corneal wound in this case is a result of a corneal anaesthesia due to the systemic polyneuropathy.

[Study of immutable variables determining rHuEPO dose requirements on hemodialysis patients]. / Estudio de causas no modificables de pobre respuesta al tratamiento con eritropoyetina en pacientes en hemodiálisis.

Patients receiving recombinant human erythropoietin (rHuEPO) therapy show wide variability in their responsiveness to the drug. Variables that affect rHuEPO dose requirements can be broadly divided into modificable and immutable characteristics. Most of the scientific research on rHuEPO hyporesponsiveness has focused on modificable variables (iron status, dialysis adequacy), while immutable variables such as gender, etiology of chronic renal failure (CRF) and age have been insufficiently explored. A cross sectional study was performed in order to evaluate if immutable patient characteristics determine rHuEPO dose requirements among 215 patients (52% males; mean age 66 +/- 14 years) on hemodialysis (HD) for more than twelve months. Data were collected at 10 hemodialysis units in Aragon. Patients were divided into three groups according to their gender, their cause of CRF (diabetic nephropathy, vascular nephropathy, tubulointerstitial nephropathy and primary glomerulonephritis) and their age (younger than 60 years, from 60 to 75 years, older than 75 years). Despite a similar dose of rHuEPO, women had lower mean hemoglobin (11.1 +/- 1.5 versus 11.6 +/- 1.7 g/dl; p = 0.0258) than men. The greater hemoglobin in men than women may be attributed to greater serum albumin in men (3.5 +/- 0.3 versus 3.7 +/- 0.3 mg/dl; p = 0.0001). Requirements of rHuEPO were higher in the patients with etiology of primary glomerulonephritis compared with those with the other etiologies, even those with diabetic nephropathy (p = 0.0374). The rHuE-PO doses required to obtain similar hemoglobin levels were higher in patients younger than 60 years (p = 0.0249). We conclude that women, patients with primary glomerulonephritis as cause of CRF, and patients younger than 60 years showed the highest requirements of rHuEPO doses.

The effect of pentoxifylline on red cell deformability in cerebrovascular accidents.

A study was carried out in 49 recent cerebrovascular accident (CVA) patients to compare red cell deformability in this group with that in 65 healthy controls. Deformability was determined using a standard technique for measuring blood filtration time through a micropore filter. Filtration time was shown to be significantly reduced in the CVA patients. All patients had ACTH treatment, 28 of them receiving in addition 600 mg pentoxifylline per day, either by intravenous infusion or by intramuscular injection. After 2-weeks' treatment, red cell deformability was increased in the patients treated with pentoxifylline and ACTH and was unchanged in the 21 patients receiving only ACTH (p less than 0.001). The authors discuss the role of increased red cell deformability in the clinical prognosis of the patients.

[Diagnosis and prevention of tuberculosis in hemodialysis patients. a new old problem?]. / Detección y prevención del desarrollo de tuberculosis en pacientes en hemodiálisis. Un antiguo problema actual?

Patients with chronic renal failure undergoing hemodialysis are at increased risk of developing tuberculosis because of impaired cellular immunity. Most cases are due to reactivation of disease and are known to develop the complication of extrapulmonary tuberculosis more frequently than the general population, and this makes the disease difficult to diagnose, delaying the establishment of appropiate therapy. We evaluated 39 patients undergoing hemodialysis treatment in the course of a 3 year period, therewere. Tuberculosis control program was developed to evaluate all patients newly admitted to the renal dialysis program. All of the patients were skin-tested initially with use 2 U.I. tuberculin PPD RT23, and 16 patients had positive results. Three cases of tuberculosis -registered that developed in patients, and in exposed patients, 3 patients with negative test result 2 months later had positive test. No relationship was found between the results of the tests and age, sex, renal disease, other pathologies or previous tuberculosis and albumin figures. However, positive patients had higher levels of total leukocytes. The period from undergoing hemodialysis until mantoux testing was performed was lower in those patients who resulted positive: 9.4+/-13.6 months versus 32.9+/-39 months in negative patients. The use of mantoux testing is important as a sieve system in hemodialysis patients as long as is associated with other diagnosis techniques, detecting that way those cases at risk of developing tuberculosis and latting perform further studies and isoniacida prophylaxis. Establishing isoniacida prevention in hemodialysis patients can avoid the development of tuberculosis in patients at risk as well as prompt detection makes easier the establishment of right therapy.

[Tuberculosis in hemodialysis patients and evaluation of exposures]. / Tuberculosis en hemodiálisis: casos coincidentes en el tiempo y valoración de contactos.

Three cases of tuberculosis in hemodialysis patients are described. All of them had an insidious presentation: a pulmonary form, a pleural form and a lymphadenitis form of the disease. The three cases presented risk factors associated and in two out of the three the detection of the team was achieved during the first three months of hemodialysis therapy (one had to undertake hemodialysis again, after disfunction of renal transplant). The three teams happened within two months. Owing to this, an evaluation of exposure was carried out in patients, staff and collective transport personnel making tuberculin test conversion clear in all three groups and establishing chemoprophylaxis afterward. Isoniacide prophylaxis eliminates a possible need for multidrug therapy for active tuberculosis at a future date, but decisions to institute preventive therapy are always difficult. To successfully combat the spread of tuberculosis, timely identification and treatment of high-risk populations is essential.

[Fractures of the base of the first metacarpus]. / Fractures de la base du premier métacarpien.

The authors report a group of 73 cases of fractures of the base of the first metacarpal treated between 1974 and 1989. Fifty-three articular fractures (73%) and 20 non-articular fractures are described. Sixty-eight patients were treated surgically: 49 diverging pin insertions were used, 15 Lars Thoren technique, 5 rigid osteosyntheses with AO miniaturized material. Forty-two patients were seen again after one year or more. We classify the results as follows: very good: 29 (69%), good: 10 (24%), bad: 3 (7%). The relative simplicity, the reliability and the good results of the double diverging pin insertion lead the authors to apply this method in most fractures of the base of the first metacarpal, either articular or extra-articular.

[Fracture-luxation of the Lisfranc joint. Apropos of 39 cases]. / Les fractures-luxations de l'interligne de Lisfranc. A propos de trente-neuf observations.

Lisfranc fracture-dislocations are relatively rare (two per thousand). They generally occur in multiple trauma victims and may pass unnoticed. Open reduction followed by pinned osteosynthesis and plaster immobilisation ensures a good anatomical and functional result.

[Metatarsalgia and modified Helal's operation. Apropos of a series of 40 cases]. / Métatarsalgies et intervention de Helal modifiée. A propos d'une série de quarante cas.

The authors report a series of 40 cases of metatarsalgia operated according to a modified Helal technique. The mid-diaphyseal osteotomy was situated obliquely inferoanteriorly at an angle of 45 degrees on the metatarsal diaphysis. Twenty cases of hallux valgus were operated during the same procedure Surgery allowed a reduction in pain and hyperkeratosis in 67.5% of patients. Comparison of the results obtained with those reported in the literature confirms that the osteotomy must be metaphyseal and that weight bearing must be early and effective.

[Bony metastases of the fingers. Apropos of 3 cases. Review of the literature]. / Les métastases osseuses des doigts. A propos de 3 observations. Revue de la littérature.

Bone metastases of fingers are rare, are of highest incidence in men 40 to 60 years, and may reveal the presence of a primary cancer. Radiologic imaging shows almost constant osteolytic lesions, the primary usually being located in the bronchi. Short-term prognosis is poor, with a mean survival of three and a half months. Bone biopsy should be conducted routinely to determine nature of lesion in fingers.

[Diagnostic difficulties of Parker-Jackson sarcoma. Apropos of 2 cases]. / Difficultés diagnostiques du sarcome de Parker et Jackson. A propos de deux observations.

The sarcoma of Parker and Jackson is a rarely tumor. It is a malign lymphoma primitive of the bone. His diagnostic is difficult. The only treatment is chemotherapy-radiotherapy association.

[The course of a case of Maffucci's syndrome]. / Evolution d'un cas de syndrome de Maffucci.

The syndrome of Maffucci is characterized by angioma association of the enchondromatose. It is a relatively rare syndrome. The lesions are evolutived. The treatment is surgical. His pronostic is marqued by high percentage of malign degenerescence.

[10-year radiologic results of a cemented stem in close contact with the bone]. / Résultats radiologiques à 10 ans d'une tige cimentée au contact de l'os.

The femoral stem "Contact", conceived in 1981, provides an excellent contact with metaphyseal-diaphyseal bone, on the medial and lateral cortices. The stress on the cement is not high; the cement fills the medulla in the anteroposterior direction. Five-year results in 92 prostheses were published at the annual meeting of the SO.F.C.O.T. in 1986. The follow-up after 10 years of 76 prostheses with a complete radiological evaluation showed neither loosening, nor space between cortex and prosthesis. The calcar remained unchanged after 5 years in 60 cases; in 11 patients the density was diminished and in 5 hips, a cavitation was seen. Around the top of the stem, 11 partial or total "wall-forming" deposits were seen. On 42 lateral x rays the bone cement interface was satisfactory. Cortical resorption, which was not seen before, is now apparent on the most recent controls. The cortical index (Hoffman), measured on 49 prostheses, was unchanged in 15 cases (30%). The narrowing of the cortex increases with age, being more frequent and significant and occurring earlier in women. This process was seen from the age of 65 years in females and about 75 in males. This natural increase in the size of the medulla induces a loosening of the stem. Loosening may be limited by the use of a snugly fitting cemented stem, with limited stress on the cement.

[Chondrosarcoma of the foot. Apropos of a case--literature review]. / Chondrosarcome du pied. A propos d'un cas--revue de la littérature.

Primitive chondrosarcoma of the foot is rare. About 50 cases have been reported. It often poses diagnostic problems, and the confirmation of malignancy necessitates a broad resection. The tumor is radioresistant and chemotherapy is minimally effective, as illustrated by the present report.

[Mri and surgical indications in perforating ulcer in diabetic patients]. / IRM et indications chirurgicales, dans le mal performant chez le diabétique.

The authors report a series of thirty-six perforating ulcers of the foot in diabetic patients, evaluated using M.R.I. M.R.I. showed osteomyelitis in 16 cases, cellulitis in 15 cases, osteoarthropathies in 21 cases, tenosynovitis of flexor tendons in 2 cases, oedema in 2 cases and abscess in one case. In 19 cases, M.R.I. was used to improve diagnostic accuracy. The medical treatment made use of thermo-moulded soles allowing for the recovery of walking, with a hole facing the perforating ulcer of the foot. The application of insulin-soaked sponges in the event of clean perforating ulcer of the foot and iodized solution in the event of infected perforating ulcer of the foot promoted healing. The treatment was only conservative, when the lesions were limited to the soft tissues. Surgical treatment was performed in 19 cases due to a global involvement of soft and osteoarticular tissues. In fourteen cases the surgical treatment was limited and was performed through the perforating ulcer. Resection of metatarsal heads or metatarso-phalangeal joints was performed in 10 cases, with resection of surrounding pathologic tissue. The surgical treatment was limited to the soft tissues in 6 cases. In 4 cases, M.R.I. findings resulted into a transmetatarsal amputation because the vascular plexus was of poor quality and infection spread from the perforating ulcer to the dorsal aspect of the foot. In our opinion, dorsal infectious involvement in a perforating ulcer of the foot, is a factor of poor prognosis. A below-knee amputation has been performed in one patient.

[A defective callus of the trapezoid bone diagnosed by 3-dimensional scanner]. / Cal vicieux du trapézoïde diagnostiqué par scanner tridimensionnel.

The authors report a case of a trapezoid fracture which was diagnosed only when it was malunited. This malunion was shown only by 3-dimensional C.T. imaging.

[Gauthier's subcapital osteotomy in the treatment of metatarsophalangeal luxation of the 2nd ray. Apropos of 44 cases with 5 year followup]. / L'ostéotomie sous-capitale selon Gauthier dans le traitement de la luxation métatarsophalangienne du deuxième rayon. A propos de 44 cas avec un recul de 5 ans.

The authors report on a series of 44 metatarsophalangeal dislocations of the second ray which were treated surgically using Gauthier's technique. The patients were 44 middle-aged women. The surgical indication was a dislocation of the 2nd metatarsophalangeal joint with hallux valgus. There was excess length of the second metatarsal ray or acquired shortness of the first metatarsal. The treatment always included an osteotomy of the neck maintained by a transosseous pin. The average follow-up was 8 years and 3 months (minimum 5 years). Postoperative results were evaluated using clinical and radiological criteria. Surgical treatment gave 68.2% very good and good results and 4 recurrences of dislocation. The results in this series are identical with those in other series reported, but the backward displacement of the head of second metatarsal was found to be limited. Weil's osteotomy seems to provide better results because it better restores the relative lengths of the metatarsals and often makes interphalangeal arthroplasty unnecessary. Gauthier's metatarsal osteotomy is an easy procedure which effectively improves static metatarsalgia, but it provides limited metatarsal shortening. Weil's osteotomy is preferable in cases with long lateral metatarsals.