ABSTRACT
Rapidly destructive coxopathy (RDC) is a disease that is sometimes seen in geriatric patients. A total hip arthroplasty (THA) is mostly chosen to treat the RDC, but few cases are known that received THAs due to RDC associated with dialysis amyloidosis. We report a case of RDC due to dialysis amyloidosis with special references to its pathophysiology. The case involved a 61-year-old male who had been on dialysis for seven years due to diabetic nephropathy. At his first visit, the radiographs showed collapse and flattening of the femoral head, which progressed within a month. Magnetic resonance imaging for the hip disclosed bone marrow edoema of the acetabulum and sclerosis of the subchondral bone of the femoral head. Biochemical analyses for the blood revealed high inflammatory reactions with elevated C-reactive protein and white blood cell count, but the joint fluid cultures were negative for general bacteria, tubercle bacillus, and nontuberculous mycobacteria. As he did not have gastrointestinal disorders or inflammatory arthritis other than the left hip and no disease that caused elevated inflammatory reactions was observed, we diagnosed the patient with RDC due to dialysis amyloidosis, and a THA was performed. Pathological findings for the synovium collected during surgery showed infiltration of the inflammatory mononuclear cells and vascular hyperplasia. The synovial tissues were extensively stained with an antibody to ß2-microglobulin. Many tartrate-resistant acid phosphatase-positive multinucleated cells were also observed in the synovium. One year after surgery, his left hip pain disappeared and he returned to work.
Subject(s)
Amyloidosis , Bone Diseases , Renal Dialysis , Amyloidosis/complications , Amyloidosis/etiology , Arthroplasty, Replacement, Hip , Bone Diseases/diagnosis , Bone Diseases/surgery , Diabetic Nephropathies/therapy , Femur Head/pathology , Humans , Male , Middle Aged , Renal Dialysis/adverse effectsABSTRACT
Breath-holding spells (BHS) are commonly seen in childhood. However, there are no case reports of BHS occurring in adolescents or young adults. We report two young adult cases and discuss the pathogensis, both physically and psychologically. BHS occurred for 1-2 minutes after hyperventilation accompanied by cyanosis in both cases. Oxygen saturation was markedly decreased. Each patient had shown distress and a regressed state psychologically. These cyanotic BHS occurred after hyperventilation, and we considered that a complex interplay of hyperventilation followed by expiratory apnea increased intrathoracic pressure and respiratory spasm. Breath-holding spells can occur beyond childhood.
Subject(s)
Apnea/psychology , Hyperventilation/psychology , Somatoform Disorders/diagnosis , Adolescent , Adult , Chronic Disease , Combined Modality Therapy , Cyanosis/psychology , Diagnosis, Differential , Family Therapy , Female , Hand/surgery , Humans , Male , Oxygen/blood , Pain, Postoperative/psychology , Regression, Psychology , Somatoform Disorders/psychology , Somatoform Disorders/rehabilitationABSTRACT
BACKGROUND: Elevations of plasma inflammatory cytokines are related to the surgical intervention. We have examined the circulating interleukin 6, 8 (IL-6, IL-8) and CRP responses in patients older than 80 years during orthopedic hip arthroplasty. METHODS: After taking the signed informed consent, 8 patients were enrolled in this study. All patients received standard spinal anesthesia combined with epidural catheterization. Samples were collected just before and after the surgery, and on 1st, 2nd and 7th day after the operation. RESULTS: Plasma IL-6 levels showed a significant increase on the day after surgery (5.6 +/- 3.7 vs. 52.2 +/- 24.1 pg.ml-1, mean +/- SD, P < 0.05), whereas although the levels of IL-8, increased (minimum 7.9 +/- 3.2 to maximum 70.3 +/- 80.2 pg.ml-1, mean +/- SD), the change was not significant. CRP levels were slightly elevated in the preoperative examination (2.8 +/- 3.5 mg.dl-1) and further increased on the 2nd day of surgery (8.3 +/- 5.4 mg.dl-1), but returned to a normal level on the 7th day. CONCLUSIONS: From the viewpoint of cytokines, this study showed that, although IL-8 level did not return to the preoperative value, the surgical stress of orthopedic hip arthroplasty in patients older than 80 years was almost of the same level as reported previously.
Subject(s)
Arthroplasty, Replacement, Hip/adverse effects , Cytokines/blood , Inflammation Mediators/blood , Stress, Physiological/diagnosis , Aged , Aged, 80 and over , Anesthesia, Epidural , Anesthesia, Spinal , Biomarkers/blood , C-Reactive Protein/analysis , Humans , Interleukin-6/blood , Interleukin-8/blood , Stress, Physiological/etiologyABSTRACT
BACKGROUND: Hepatic resection is prone to significant blood loss. Adverse effects of blood loss and transfusion mandate improvements in surgical techniques to reduce blood loss and transfusion. METHODS: We retrospectively analyzed the present status of intraoperative blood transfusion practice of 42 hepatic resections in National Kure Medical Center for the year of 2000. RESULTS: Median values for blood loss were 1355, 1708, 1415, and 2298 ml for nonanatomic, subsegmental, segmental and extended right resections, respectively. Crossmatched to transfused blood (C/T) ratios were 1.76, 1.19, 2.31, and 0.90 for nonanatomic, subsegmental, segmental and extended right resections, respectively. CONCLUSION: In general, C/T ratio of 1.5 to 2.5 has been recommended but own C/T ratios are 1.19 and 0.9 for subsegmental and extended right hepatic resection, which are lower than recommended values. It was estimated that inappropriate prediction of blood loss by several surgeons and unused maximum surgical blood order schedule (MSBOS) or type and screen (T&S) decreased these values of C/T ratio in the present analysis. We therefore conclude that MSBOS and T&S could be improved by avoiding such in appropriate prediction.
