RESUMEN
We report the 6-year radiographic follow-up of a phalangeal brown tumor in a patient with severe hyperparathyroidism secondary to chronic renal failure treated with hemodialysis. The phalangeal lesion increased in size during the first 3 years, until the patient finally accepted to undergo parathyroidectomy. The initial radiographic change was a small intracortical lytic area. Two years later, an expansile cystic lesion was visible in the phalanx, and computed tomography showed a cortical defect. Ossification of the lesion occurred over the 2.5 years following parathyroidectomy. The epidemiology, radiographic changes and post-treatment evolution of brown tumor in dialysed patients is reviewed. Surgical parathyroidectomy is the standard treatment for brown tumor complicating secondary hyperparathyroidism. The usefulness and limitations of treatment with vitamin D analogs, recently reported in a few case reports, are discussed.
Asunto(s)
Dedos/patología , Hiperparatiroidismo Secundario , Osteítis Fibrosa Quística/diagnóstico por imagen , Dedos/diagnóstico por imagen , Estudios de Seguimiento , Humanos , Hiperparatiroidismo Secundario/complicaciones , Hiperparatiroidismo Secundario/cirugía , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Osteítis Fibrosa Quística/etiología , Osteítis Fibrosa Quística/cirugía , Paratiroidectomía , Diálisis Renal , Tomografía Computarizada por Rayos XRESUMEN
Soft tissue calcification are common in chronic hemodialysis patients and often affect the periarticular tissues, where they occasionally form tumoral masses. In a retrospective study of 254 hemodialysis patients we identified three such cases. Affected sites were the wrist, shoulder, and chest wall. None of the patients had secondary hyperparathyroidism. A discussion is provided of the roentgenographic and clinical features of tumoral calcinosis, of current pathogenic hypotheses, and of available treatments.
Asunto(s)
Calcinosis/etiología , Fallo Renal Crónico/terapia , Diálisis Renal/efectos adversos , Articulación del Hombro , Articulación de la Muñeca , Adulto , Anciano , Calcinosis/diagnóstico por imagen , Calcinosis/fisiopatología , Calcinosis/terapia , Femenino , Humanos , Artropatías/diagnóstico por imagen , Artropatías/etiología , Artropatías/fisiopatología , Artropatías/terapia , Masculino , Persona de Mediana Edad , Radiografía , Estudios RetrospectivosRESUMEN
Cerebral embolism from cardiac, aortic or carotid cause can be detected by Doppler examination of carotid arteries or transcranial Doppler with long-duration recordings. The signals detected called HITS (high intensity transient signals), which have been described in vitro and in vivo, have specific physical characteristics. This novel technique is considered promising in establishing the relationship between the discovery of embolic heart disease and its clinical neurological manifestations. In the evaluation of a stroke, the detection of HITS could provide evidence in support of an embolic cause. The areas of application of this new technique are many: screening for asymptomatic embolism in patients with an embolic cardiac disorder, and effects of antiplatelet and anticoagulant medications or surgical treatments.
Asunto(s)
Embolia y Trombosis Intracraneal/diagnóstico por imagen , Ultrasonografía Doppler/métodos , Enfermedades Cardiovasculares/complicaciones , Enfermedades Cardiovasculares/diagnóstico por imagen , Arterias Carótidas/diagnóstico por imagen , Prótesis Valvulares Cardíacas/efectos adversos , Humanos , Embolia y Trombosis Intracraneal/etiología , Ultrasonografía Doppler TranscranealRESUMEN
Although carnitine levels and carnitine therapy have been extensively studied in dialysis patients, the pathophysiology of L-carnitine is poorly understood. The usual therapeutic dose is 20-30 mg/kg, resulting in dramatic increases of circulating levels above the normal values. Guided by studies on its lipidic effect and by our experience of its action on haematocrit, we propose the use of 2-3 mg/kg of L-carnitine in future prospective studies.
Asunto(s)
Carnitina/uso terapéutico , Fallo Renal Crónico/complicaciones , Diálisis Renal/efectos adversos , Carnitina/administración & dosificación , Carnitina/metabolismo , Humanos , Fallo Renal Crónico/terapiaAsunto(s)
Carnitina/uso terapéutico , Fragilidad Osmótica/efectos de los fármacos , Diálisis Renal , Adulto , Anciano , Anciano de 80 o más Años , Relación Dosis-Respuesta a Droga , Membrana Eritrocítica/efectos de los fármacos , Eritropoyetina/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Antígenos CD/metabolismo , Antígenos de Diferenciación de Linfocitos T/metabolismo , Suero Antilinfocítico/uso terapéutico , Moléculas de Adhesión Celular/metabolismo , Trasplante de Riñón/inmunología , Glicoproteínas de Membrana/metabolismo , Receptores Inmunológicos/metabolismo , Formación de Roseta , Linfocitos T/inmunología , Antígeno 12E7 , Animales , Antígenos CD/análisis , Antígenos de Diferenciación de Linfocitos T/análisis , Azatioprina/uso terapéutico , Antígenos CD2 , Células CHO , Moléculas de Adhesión Celular/análisis , Cricetinae , Ciclosporina/uso terapéutico , Quimioterapia Combinada , Humanos , Glicoproteínas de Membrana/análisis , Metilprednisolona/uso terapéutico , Receptores Inmunológicos/análisis , Linfocitos T/efectos de los fármacos , Factores de Tiempo , TransfecciónAsunto(s)
Mononucleosis Infecciosa/diagnóstico , Pruebas de Función Renal , Adulto , Humanos , MasculinoRESUMEN
The prevalence of renal lithiasis and the rate of recurrences in affected patients raises the problem of the minimum number of investigations really needed to arrive at an accurate diagnosis and establish a potentially effective treatment. Stone recuperation is very important as it allows to carry out an accurate analysis of its constituent(s) (frequently heterogenous). Such analysis already brings forth accurate indications as to the etiology. Other biological investigations should be limited after a first episode of kidney stone disease, but recurring lithiasis will necessitate a much more thorough work-up. Recurrences in certain lithiases, such as those caused by urate calculi, are readily prevented by conventional therapy (uricosuric agents, alkalinization of urine). Withdrawal of certain medicines is paramount in iatrogenic lithiasis. Regarding calcium stones associated with hypercalciuria, results from dynamic tests and their pertinence for differentiating between hypercalciuria due to abnormally high digestive absorption and that due to excessive elimination are currently strongly contested. The role of alimentary factors seems extremely important and prescription of adapted diets appears to be quite effective in view of the present lack of crystal formation inhibitors.