RESUMO
A 46-year old man with X-linked chronic granulomatous disease (CGD) being followed at the National Institute of Health with uncontrolled CGD colitis who developed chronic colovesical fistula, and end-stage renal disease (ESRD). Despite aggressive medical management of symptoms with immunomodulators and antibiotic prophylaxis, the chronic colovesical fistula led to chronic pyelonephritis, recurrent urinary tract infections, persistent air in the collecting system and bladder, and post-renal obstruction resulting in renal failure. Patient is now hemodialysis dependent and required diverting loop ileostomy placement. This report highlights multiple potential etiologies of rising serum creatinine in patients with CGD.
RESUMO
SETTING: Tertiary referral center, National Institutes of Health (NIH), USA. OBJECTIVE: To estimate the mortality rate and its correlates among persons with pulmonary non-tuberculous mycobacteria (PNTM) disease. DESIGN: A retrospective review of 106 patients who were treated at the NIH Clinical Center and met American Thoracic Society/Infectious Diseases Society of America criteria for PNTM. Eligible patients were aged ⩾18 years and did not have cystic fibrosis or human immunodeficiency virus (HIV) infection. RESULTS: Of 106 patients followed for a median of 4.9 years, 27 (25%) died during follow-up, for a mortality rate of 4.2 per 100 person-years. The population was predominantly female (88%) and White (88%), with infrequent comorbidities. Fibrocavitary disease (adjusted hazard ratio [aHR] 3.3, 95% confidence interval [CI] 1.3-8.3) and pulmonary hypertension (aHR 2.1, 95%CI 0.9-5.1) were associated with a significantly elevated risk of mortality in survival analysis. CONCLUSIONS: PNTM remains a serious public health concern, with a consistently elevated mortality rate across multiple populations. Significant risk factors for death include fibrocavitary disease and pulmonary hypertension. Further research is needed to more specifically identify clinical and microbiologic factors that jointly influence disease outcome.
Assuntos
Pulmão/microbiologia , Infecções por Mycobacterium não Tuberculosas/mortalidade , Micobactérias não Tuberculosas/isolamento & purificação , Infecções Respiratórias/mortalidade , Feminino , Humanos , Hipertensão Pulmonar/microbiologia , Hipertensão Pulmonar/mortalidade , Estimativa de Kaplan-Meier , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Infecções por Mycobacterium não Tuberculosas/diagnóstico por imagem , Infecções por Mycobacterium não Tuberculosas/microbiologia , National Institutes of Health (U.S.) , Micobactérias não Tuberculosas/classificação , Modelos de Riscos Proporcionais , Fibrose Pulmonar/microbiologia , Fibrose Pulmonar/mortalidade , Infecções Respiratórias/diagnóstico por imagem , Infecções Respiratórias/microbiologia , Estudos Retrospectivos , Fatores de Risco , Centros de Atenção Terciária , Fatores de Tempo , Tomografia Computadorizada por Raios X , Estados Unidos/epidemiologiaAssuntos
Ligamentos Articulares/diagnóstico por imagem , Ligamentos Articulares/lesões , Articulação Metacarpofalângica/diagnóstico por imagem , Articulação Metacarpofalângica/lesões , Entorses e Distensões/diagnóstico por imagem , Polegar/diagnóstico por imagem , Polegar/lesões , Humanos , Radiografia , Esqui/lesões , Entorses e Distensões/etiologia , Estatísticas não ParamétricasRESUMO
A device for easing retrieval of wire from acute angles of holes drilled in base wedge osteotomies, or any other osteotomy requiring wire fixation, is a Folio Ianiro Retriever. The Folio Ianiro Retriever modifies the way the wire is guided while reducing microtrauma to the bone and expediting the procedure. The use of the device is described with a discussion of the surgical procedure.