Use of cryopreserved human amniotic membrane in the treatment of skin ulcers secondary to calciphylaxis.

Calciphylaxis is a rare condition characterized by skin ulceration and necrosis as a result of vascular calcification of the small and medium blood vessels of skin and subcutaneous tissues. It mainly occurs in patients with advanced chronic kidney disease and sometimes leads to complications with a fatal outcome. In this report, we describe the case of a 67-year-old male patient with end stage renal disease presenting painful skin ulcers on his lower limbs. The lesions had progressively grown and were associated to severe pain and decreased quality of life. The ulcers did not respond to conventional treatments and the patient underwent skin biopsy of these lesions obtaining anatomopathological findings compatible with calciphylaxis. In this report, we present an innovative treatment for skin ulcers secondary to calciphylaxis using cryopreserved amniotic membrane (AM) as a dressing in order to promote epithelialization of the wounds. After four applications, healing of the main ulcer and reduction in pain was achieved. In summary, applying cryopreserved AM probed to be a promising strategy to reduce pain and to enhance epithelialization and healing of chronic non-responsive ulcers in calciphylaxis.

[Algological treatment of trigeminal neuralgia. Experience of 15 years]. / Tratamiento algológico de neuralgia del trigémino. Experiencia de 15 años.

BACKGROUND: We present the experience in the treatment of trigeminal neuralgia (TN) during 15 years in one institute, evaluating epidemiological variables and clinical presentation, and comparing the results obtained with different treatments available. METHODS: A retrospective, descriptive study was carried out by reviewing cases diagnosed by the Neurology Service, such as TN, and treated by the Pain Medicine and Palliative Care Unit of the Insituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubíran," from January 1, 1998 to December 31, 2003. Age, sex, type of neuralgia, anatomical site affected and intensity of pain were evaluated by means of the Analogue Visual Scale (AVS). The following treatments were evaluated (pharmacologic, surgical, and blockade of Gasser ganglion). Descriptive statistics, linear regression and bivariate correlation were used (statistical package SPSS). RESULTS: Fifty two cases were studied with a female predominance (2:1). Average age was 60 years. Clinical presentation most frequently was typical neuralgia (51.9%), right predominance (59.6%) and affected branch V2 (50%). In 88%, pharmacological treatment was used. The reduction of pain was 74% in all cases, with r-.765 for the pharmacological treatment, r-.715 in the blockade of the Gasser ganglion, and r-.901 for surgical treatment (p < 0.01). CONCLUSIONS: In the experience of the INCMNSZ, treatment of choice in most cases of TN is pharmacological, with surgical treatment useful in cases where vascular alterations were identified.

[Bouveret's syndrome. Case report]. / Síndrome de Bouveret. Reporte de un caso.

INTRODUCTION: Bouveret's syndrome is characterized by piloro-duodenal obstruction following the implant of a giant gallstone with gallstone ileus origin. It constitutes the less common variety of gallstone ileus (1-3%), mainly affecting elderly patients with chronic degenerative illnesses, possibly with high mortality. OBJECTIVE: We report the case of a patient with a less common variety of gallstone ileus. The patient was treated at a third-level care hospital. CLINIC CASE: Patient is a 52-year-old male with gastric obstruction and secondary dehydration. Studies were supported by a series of esophagus-gastric-duodenal and broad endoscopy. Piloro-duodenal obstruction by a giant gallstone was reported which could not be extracted by endoscopy. The patient was taken to surgery where a giant gallstone lying in the duodenal site was found and biliary vesicular scleroatrophic. Gastrotomy is effected with the extraction of the gallstone and gastrography. Gallstone duodenal fistula is then identified with support analysis. CONCLUSIONS: Bouveret's syndrome is a rare entity whose diagnosis has a high sensitivity and specificity with a supported radiographic diagnosis. Endoscopy is difficult in the case of a giant impacted gallstone, making surgery the best therapeutic choice.