RESUMEN
BACKGROUND: Leprosy is a chronic granulomatous disease and affects many internal organs in addition to the skin and peripheral nerves. Endocrine dysfunction is often silent and is often missed in patients of leprosy leading to significant morbidity. We studied the presence of occult endocrine disorders in leprosy patients and compared the same with disease parameters. MATERIALS AND METHODS: We evaluated 40 patients of leprosy (aged 18-70 years, any duration) in this cross-sectional, observational study. All subjects were assessed for pituitary, thyroid, adrenal, gonadal function, and dynamic testing was done when deemed necessary. The participants were divided into two groups: Group 1 (Leprosy, n = 40) and Group 2 (Controls, n = 20) and the data were analyzed with appropriate statistical tests. RESULTS: The study participants (35 males, 5 females) had a mean age of 36.4 ± 11.3 years, and duration of the disease was 2.5 ± 5.5 years. Eleven out of 40 patients showed results consistent with an endocrine disorder, including subclinical hypothyroidism (n = 4), sick euthyroid syndrome (n = 3), growth hormone (GH) deficiency (n = 2), primary hypogonadism (n = 2) and secondary hypogonadism in one patient. One patient had partial hypopituitarism (GH deficiency and secondary hypogonadism) and none of the controls showed any hormonal dysfunction. Testosterone levels showed inverse correlation with the number of skin patches (P = 0.0006). CONCLUSION: Occult endocrine dysfunction is seen in a quarter of patients with leprosy. Thyroid and gonadal axes abnormalities are common, and the severity is more in lepromatous forms of the disease. Further large studies are required to confirm the findings observed in our study.
RESUMEN
BACKGROUND: Refractory intracranial hypertension often is treated with craniectomy to prevent herniation and irreversible neurologic decline in those with salvageable brain injuries. OBJECTIVE: We report 3 cases of iatrogenic abdominal hematoma at the site of craniectomy implantation secondary to abdominal subcutaneous deep vein thrombosis (DVT) prophylaxis. METHODS: A retrospective chart review of patients with abdominal wound complications after craniectomy and abdominal bone flap implantation at the University of Florida from 2004 to 2008 was performed. RESULTS: Three patients receiving subcutaneous DVT prophylaxis via abdominal injections developed hematomas at the site of abdominal implantation. The hematomas occurred 17 days, 20 days, and 6 weeks postoperatively. All required urgent hematoma evacuation. All had evidence of needle sticks overlying the implantation site. CONCLUSION: To reduce the potential risk of wound hematoma, DVT prophylaxis injections should be performed remote to the surgical site in craniectomized patients with abdominal bone flap implantation.