RESUMEN
PURPOSE: We compared the outcome of a 1-day and a 2-day sentinel node (SN) biopsy procedure, evaluated in terms of lymphoscintigraphic, surgical and pathological findings. METHODS: We studied 476 patients with melanoma from two melanoma centres using static scintigraphy and blue dye. A proportional odds model was used for statistical analysis. RESULTS: The number of SNs visualized at scintigraphy increased significantly with time from injection to scintigraphy and activity left in the patient at scintigraphy, and depended on the melanoma location. The number of SNs removed at surgery increased with the number of SNs visualized at scintigraphy and time from injection to surgery. The frequency of nodal metastasis increased with increasing thickness and Clark level of the melanoma, and was highest for two SNs visualized at scintigraphy. CONCLUSION: This study showed that early vs. late imaging and surgery do make a difference on the outcome of the SN procedure and confirmed the importance of the scintigraphic visualization of all true SNs.
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Melanoma/diagnóstico , Melanoma/cirugía , Biopsia del Ganglio Linfático Centinela/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Melanoma/diagnóstico por imagen , Melanoma/patología , Persona de Mediana Edad , Cintigrafía , Factores de TiempoRESUMEN
The aim of the current study was to describe the incidence of respiratory symptoms and allergic sensitisation and the sequence of events leading to respiratory symptoms among Danish baker apprentices (BA). A total of 114 BA were surveyed over a 20-month period. Questionnaires were completed along with spirometric analysis and skin-prick tests to common and work-related allergens. Bronchial hyperresponsiveness (BHR) was determined at baseline and at the end of the follow-up period. The incidences of work-related rhinitis and asthma-like symptoms were 22.1 and 10.0 cases.100 person-yrs(-1), respectively. At 20 months the cumulative incidence proportion was 40.2 and 20.5% for rhinitis and asthma-like symptoms, respectively. The cumulative incidence of occupational sensitisation was 6.1%. An increased risk of asthma-like symptoms was found in both atopic subjects and in females. In the BA with new onset respiratory symptoms, an increase in BHR from baseline was observed. Forced expiratory volume in one second and forced vital capacity did not change during the follow-up period. No relationship was observed between new sensitisation and new symptoms. In conclusion rhinitis- and asthma-like symptoms were found to develop commonly in Danish baker apprentices. The mechanism by which symptoms arose was perceived to reflect the development of an inflammation rather than the production of a specific immunoglobulin E pathway, as sensitisation to occupational allergens was rarely observed. Hence, respiratory symptoms and allergy may develop through separate pathways.
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Hiperreactividad Bronquial/epidemiología , Hiperreactividad Bronquial/etiología , Enfermedades Pulmonares/epidemiología , Enfermedades Pulmonares/etiología , Enfermedades Profesionales/epidemiología , Enfermedades Profesionales/etiología , Exposición Profesional , Rinitis/epidemiología , Rinitis/etiología , Adulto , Hiperreactividad Bronquial/diagnóstico , Culinaria , Dinamarca , Femenino , Humanos , Inmunoglobulina E/química , Incidencia , Enfermedades Pulmonares/diagnóstico , Masculino , Enfermedades Profesionales/diagnóstico , Rinitis/diagnóstico , Riesgo , Factores de TiempoRESUMEN
AIM: To define the clinical and histopathological characteristics of primary lacrimal sac lymphoma in a predominantly white population. METHODS: Specimens of lacrimal sac lymphoma and follow up data were solicited from members of the Ophthalmic Oncology Task Force of the European Organization for Research and Treatment of Cancer (EORTC) and the European Ophthalmic Pathology Society (EOPS). Specimens were stained with haematoxylin and eosin and an immunohistochemical panel against leucocyte antigens was applied. Diagnosis was reached by consensus of five experienced pathologists according to the World Health Organization classification system. The histopathological findings were correlated with the clinical data. RESULTS: Of 15 primary lacrimal sac lymphomas, five (33%) were diffuse large B cell lymphoma (DLBCL), five (33%) were extranodal marginal zone B cell lymphoma of mucosa associated lymphoid tissue (MALT lymphoma), three were classified as "transitional MALT lymphoma," being in transition from MALT lymphoma to DLBCL, and two were unclassified B cell lymphomas. Nine of the patients were female, and the median age at the time of diagnosis was 71 years (range 45-95 years). The most frequent presenting symptoms were epiphora (85%), swelling in the region of the lacrimal sac (79%), and dacryocystitis (21%). All but one patient presented in stage I. Systemic spread occurred in three of nine patients (33%). The 5 year overall survival was 65%. CONCLUSIONS: DLBCL and MALT lymphoma are equally common in the lacrimal sac in contrast with the remaining periorbital and/or orbital region where MALT lymphoma predominates.
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Enfermedades del Aparato Lagrimal/diagnóstico , Linfoma de Células B/diagnóstico , Anciano , Anciano de 80 o más Años , Antígenos CD/metabolismo , Antígenos de Neoplasias/metabolismo , Femenino , Humanos , Enfermedades del Aparato Lagrimal/patología , Enfermedades del Aparato Lagrimal/terapia , Linfoma de Células B/patología , Linfoma de Células B/terapia , Linfoma de Células B de la Zona Marginal/diagnóstico , Linfoma de Células B de la Zona Marginal/patología , Linfoma de Células B de la Zona Marginal/terapia , Linfoma de Células B Grandes Difuso/diagnóstico , Linfoma de Células B Grandes Difuso/patología , Linfoma de Células B Grandes Difuso/terapia , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
PURPOSE: To present two cases of rapidly growing tumors in the ocular adnexa. Both tumors were Epstein-Barr virus (EBV) positive peripheral T-cell lymphoma. METHODS: Case 1 was a 60-year-old man with a non-tender ulcerating tumor involving the lateral third of both upper and lower right eyelid. Case 2 was a 55-year-old man with a swelling of the left eyelid expanding cranially and dislocating the left eye, resulting in proptosis and diplopia. Both patients underwent incisional biopsy that did not disclose the malignant nature of the tumors. Clinical evaluation resulted in suspicion of malignancy and surgical excision was performed. RESULTS: The tumors were found to be consistent with EBV-positive peripheral T-cell lymphoma. CONCLUSIONS: Peripheral T-cell lymphoma is uncommon but a diagnosis to be considered in a patient with a tumorous lesion in the eye region. Furthermore, peripheral T-cell lymphoma may be EBV-positive.
Asunto(s)
Infecciones por Virus de Epstein-Barr/virología , Neoplasias de los Párpados/virología , Herpesvirus Humano 4/aislamiento & purificación , Linfoma de Células T/patología , Linfoma de Células T/virología , Antígenos Virales/análisis , Biomarcadores de Tumor/análisis , Infecciones por Virus de Epstein-Barr/patología , Infecciones por Virus de Epstein-Barr/cirugía , Neoplasias de los Párpados/patología , Neoplasias de los Párpados/cirugía , Herpesvirus Humano 4/química , Humanos , Linfoma de Células T/cirugía , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: To evaluate the relationship between renal function, ambulatory blood pressure (AMBP), and glycemic control in microalbuminuric IDDM patients compared with normoalbuminuric patients. RESEARCH DESIGN AND METHODS: Nineteen male patients (age 33 +/- 6 years) with slight microalbuminuria (UAE 20-70 micrograms/min) were compared with 19 normoalbuminuric (UAE < 15 micrograms/min) age-matched (33 +/- 6 years) male patients. Through constant infusion technique, 125I-iothalamate marked the glomerular filtration rate (GFR), and 131I-hippuran marked effective renal plasma flow (RPF). AMBP was measured by oscillometric technique (Spacelabs 90202). RESULTS: The microalbuminuric group had higher daytime systolic AMBP (132 +/- 11 vs. 125 +/- 7 mmHg, P < 0.05) and a poorer glycemic control (HbA1c 9.5 +/- 1.5 vs. 8.2 +/- 1.3%, P < 0.01). GFR (135 +/- 22 and 135 +/- 17 ml/min) and RPF (598 +/- 112 and 542 +/- 98 ml/min) were similar in the two groups. In the microalbuminuric group, daytime systolic AMBP was inversely correlated to both RPF (r = -0.77, P < 0.005) and GFR (r = -0.53, P = 0.02). HbA1c and GFR correlated positively in the microalbuminuric group (r = 0.47, P < 0.04). In contrast, the normoalbuminuric patients exhibited no such associations. CONCLUSIONS: IDDM patients with moderate microalbuminuria have elevated AMBP and a strong negative association between AMBP and RPF. This leaves several possibilities of interpretation. Primary blood pressure increase (of unknown origin) may induce morphological changes leading to reduction in renal function. Alternatively, blood pressure increase early in the course of incipient nephropathy may represent a compensatory mechanism, initially aiming at preservation of renal function, but later becoming maladaptive.
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Albuminuria/fisiopatología , Presión Sanguínea/fisiología , Diabetes Mellitus Tipo 1/fisiopatología , Nefropatías Diabéticas/fisiopatología , Flujo Plasmático Renal/fisiología , Adulto , Monitoreo Ambulatorio de la Presión Arterial , Diabetes Mellitus Tipo 1/complicaciones , Tasa de Filtración Glomerular , Hemodinámica , Humanos , MasculinoRESUMEN
OBJECTIVE: To evaluate the anatomical relationship between the esophagus and pulmonary artery including assessment of the correct transesophageal Doppler insonation angle into the mid-pulmonary artery trunk. METHODS: We evaluated the anatomical relationship between the esophagus and pulmonary artery (PA) from comparable magnetic resonance (MR) and transesophageal echocardiographic (TEE) multiple two-dimensional images (0 degree, 45 degrees, 90 degrees and 135 degrees clockwise rotation of the standard transverse scanning plane when seen bearfrom the esophagus) obtained in 10 healthy, young volunteers. RESULTS: The main PA could be visualized with both techniques in all 10 volunteers and provided highly identical images of good quality. A mean insonation angle of 35 degrees (range 26 degrees-46 degrees) for a fictive esophageal Doppler beam into the main PA was disclosed. The PA trunk was short with a mean length of 23.4 mm (range 17-30 mm). CONCLUSIONS: These anatomical data contradict the general assumption of alignment of the pulmonary artery and the transesophageal Doppler beam. Angle correction should be applied in the clinical setting using MTEE by rotation of the scanning plane to approximately 45 degrees. Ignoring the insonation angle of approximately 35 degrees may cause 20% underestimation of blood flow velocity and cardiac output in the PA.
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Ecocardiografía Transesofágica , Imagen por Resonancia Magnética , Arteria Pulmonar/anatomía & histología , Adulto , Esófago/anatomía & histología , Esófago/diagnóstico por imagen , Humanos , Arteria Pulmonar/diagnóstico por imagenRESUMEN
A study was undertaken to obtain baseline information for future studies of H-antigen expression in urothelial tumors. The influence of ABO- and Lewis genes on H-antigen expression in human ureters was investigated. Thirty two ureters of different ABO- and Lewis types were stained by the Tween 20-modified immunoperoxidase staining technique using Ulex europaeus agglutinin I (32 cases) and two monoclonal anti-H antibodies (10 cases). Ureters from A and AB individuals were also stained using monoclonal anti-A and Dolichos biflorus agglutinin (14 cases). The H-antigen expression in endothelium of all cases and in urothelium of Lea-b+ and Lea-b- individuals was correlated to ABO blood type. H antigen was never detected in urothelium of Lea+b- individuals. Endothelial H-antigen expression was not influenced by the Lewis types. In A and AB individuals, urothelial and endothelial H- and A-antigen and Dolichos biflorus reactivities were mainly insignificantly related, with correlation coefficients ranging numerically from 0.10 to 0.72. The study stresses the importance of relating blood group antigen H expression in urothelial tumors to the ABO-, Lewis, and secretors types of the individual.
Asunto(s)
Sistema del Grupo Sanguíneo ABO/inmunología , Antígenos del Grupo Sanguíneo de Lewis/inmunología , Uréter/inmunología , Histocitoquímica , Humanos , Técnicas para Inmunoenzimas , Métodos , FitohemaglutininasRESUMEN
In order to improve the accuracy and prognostic value of ABH blood group antigen loss in urothelial tumors, the effect of Lewis blood type and methodologic factors on detectability and distribution of blood group antigen A in human formalin-fixed, paraplast-embedded urothelium and endothelium was investigated by means of the Tween 20-modified indirect immunoperoxidase staining technique. Urothelium of Lea-b+ and Lea-b- individuals expressed significant higher amounts of blood group antigen A compared to urothelium of Lea+b- individuals. The expression on endothelial cells was related to vessel type and size, but not related to Lewis types. Compared to human anti-A, monoclonal anti-A demonstrated blood group antigen A with higher sensitivity and, due to reduced background staining, higher specificity. Consequently monoclonal anti-A detected blood group antigen A in the urothelium of Lea+b- individuals where human anti-A failed to stain, and different staining patterns became apparent. Both a two- to fourfold variation in the proportion between tissue section area and volume, and the volume of anti-A applied induced minor changes in sensitivity and specificity. The monoclonal anti-A method and knowledge about erythrocyte Lewis types might prove valuable in evaluating changes in blood group antigen-A expression in urothelial tumors.
Asunto(s)
Sistema del Grupo Sanguíneo ABO/genética , Uréter/inmunología , Anticuerpos Monoclonales , Membrana Celular/inmunología , Citoplasma/inmunología , Endotelio/inmunología , Epitelio/inmunología , Glicoproteínas/inmunología , Histocitoquímica/métodos , Humanos , Técnicas para Inmunoenzimas , Antígenos del Grupo Sanguíneo de Lewis/genética , Polisacáridos/inmunología , Pronóstico , Coloración y Etiquetado , Vejiga Urinaria/inmunología , Neoplasias Urológicas/inmunologíaRESUMEN
In order to obtain baseline information about Lewis antigen expression in human urothelium in order that changes during malignant transformation can be evaluated, urothelium from eight individuals of known erythrocyte Lewis types were stained by a Tween-modified indirect immunoperoxidase staining technique using goat antibodies directed toward the Lewis a and Lewis b determinants and mouse monoclonal antibodies directed toward the Lewis a determinant in serial dilutions. To evaluate the value of the method for tissue Lewis typing, eleven ureters from individuals of unknown erythrocyte Lewis types were stained using goat antibodies. The Lewis antigens were located on the cell membranes and in the cytoplasm of urothelial cells. Goat antibodies identified Lea-b-, Lea+b+, and Lea+b- urothelium. Monoclonal antibodies identified urothelium with both low and high Lewis a antigen expression as well as urothelium with no Lewis a antigen expression. Urothelial Lewis antigen expression correlated with erythrocyte Lewis types in Lea-b+ and Lea+b- individuals. In Lea-b- individuals Lewis determinants were either not detected or were expressed similarly to Lea-b+ individuals. Urothelial Lewis typing were doubtful in two out of the eleven ureters examined. The results imply that knowledge about erythrocyte Lewis type or normal tissue Lewis antigen expression is necessary for the immunohistochemical evaluation of changes in Lewis antigen expression in urothelial tumors.
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Epítopos/análisis , Antígenos del Grupo Sanguíneo de Lewis/inmunología , Vejiga Urinaria/inmunología , Epitelio/inmunología , Humanos , Técnicas para Inmunoenzimas , Técnicas In Vitro , Uréter/inmunologíaRESUMEN
The effect of the nonionic detergent Tween 20 on background staining, sensitivity, and specificity in the indirect immunoperoxidase staining for blood group antigen A was investigated histologically and spectrophotometrically. Pretreatment of dewaxed formalin-fixed Paraplast-embedded tissue sections from human ureters with 2% Tween 20 and dilution of the first and second layer antisera with 0.05 or 2% Tween 20 significantly reduced background staining of the urothelial cell cytoplasm, ureteral stroma, and musculature. Spectrophotometrical analysis of tissue sections from hypernephroma (rich in cytoplasm), cervix (fibrous stroma), and myometrium (musculature) underlined the histological results with a significant reduction of the maximum absorbance of Tween 20-modified indirect immunoperoxidase-stained tissue sections. Sensitivity, evaluated histologically by the endpoint titers of urothelial cell membrane staining, endothelial cell staining, and focal cytoplasmic staining of urothelial cells, was not influenced by the Tween 20 treatment. The specificity was improved as the staining was highly reduced or absent in control sections subjected to Tween 20.
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Sistema del Grupo Sanguíneo ABO , Uréter/inmunología , Detergentes , Endotelio/inmunología , Humanos , Técnicas para Inmunoenzimas , Polisorbatos , Espectrofotometría , Coloración y EtiquetadoRESUMEN
The influence of paracetamol on antroduodenal motility and gastric pH was studied in 11 healthy subjects and the relationship between gastroduodenal motility and gastric emptying rate time, tmax, to peak concentration of serum paracetamol, Cmax, was evaluated. The incidence of antral phase III activity and the duration of phase III was diminished with paracetamol (P less than 0.05). The other motility parameters assessed were unchanged. Three patterns of motility and absorption were observed. One group (n = 5) were fast absorbers with a tmax of 1 h and a motility pattern characterized by antral activity, a high motility index and a short duration of phase II (33-60 min); the phase IIIs were complete except in one case. The second group (n = 4) had tmax at 1.5 h and their phase II motility was characterized by a longer duration (80-133 min) (P less than 0.05), by antral activity, and by a high motility index; their phase IIIs were all incomplete. The last group (n = 2) were slow absorbers: Cmax was not reached in the investigation period, no antral contractions were seen, and the motility index was low. The area under the serum-concentration curve of paracetamol differed between the groups at 90 and 180 min (P less than 0.01).
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Acetaminofén/efectos adversos , Duodeno/efectos de los fármacos , Ácido Gástrico/metabolismo , Vaciamiento Gástrico/efectos de los fármacos , Motilidad Gastrointestinal/efectos de los fármacos , Antro Pilórico/efectos de los fármacos , Acetaminofén/farmacocinética , Adulto , Cromatografía Líquida de Alta Presión , Duodeno/fisiología , Femenino , Humanos , Concentración de Iones de Hidrógeno , Masculino , Antro Pilórico/fisiologíaRESUMEN
STUDY OBJECTIVES: The purpose was to investigate a possible relationship between different parameters of physical function, spirometric measurements, and the approaching need for mechanical ventilation. DESIGN: A nonrandomized, prospective, descriptive study of 11 patients with spinal muscular atrophy type II (SMA-II) and 14 patients with Duchenne muscular dystrophy (DMD). At a home visit, the anthropometric indices of age, height, and weight were recorded, the degree of disability was scored, and measurement of the strength of eight muscle groups and spirometry was performed. The interdependence of the variables was analyzed and the intergroup differences evaluated. Eighteen months later, it was found that one of the authors (B.J.), who was blind to the results of the first examination had instituted home mechanical ventilation on seven of the patients. The data were analyzed retrospectively for their predictive value as indicators of approaching ventilator dependency. RESULTS: The seven patients who needed mechanical ventilation were the patients with DMD with the highest disability score (Egen Klassifikation [EK] sum > 20) and the smallest values for FVC < 1.2 L (FVC% < 30). We found a significant correlation (p = 0.002) between FVC% and the EK sum at the first examination and between the FVC% and the time until treatment with mechanical ventilation was instituted (p = 0.023). Although 7 of the 11 patients with SMA type II had FVC below 1.2 L and some of them had an EK sum score higher (indicating more disability) than some patients with DMD who needed mechanical ventilation, none of them required mechanical ventilation. CONCLUSION: In this investigation, a combination of EK sum and FVC% provided a better indication of the approaching need for mechanical ventilation in the patients with DMD than the variables separately.
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Atrofia Muscular Espinal/terapia , Distrofias Musculares/terapia , Respiración Artificial , Adolescente , Adulto , Estudios de Casos y Controles , Evaluación de la Discapacidad , Femenino , Humanos , Masculino , Atrofia Muscular Espinal/diagnóstico , Atrofia Muscular Espinal/fisiopatología , Distrofias Musculares/diagnóstico , Distrofias Musculares/fisiopatología , Valor Predictivo de las Pruebas , Estudios Prospectivos , Mecánica Respiratoria/fisiología , Espirometría , Capacidad Vital/fisiologíaRESUMEN
Patients with imminent respiratory failure due to sputum retention were assessed for minitracheotomy (MT). MT was considered potentially useful in 79 patients but only attempted in 73, 54 men and 19 women, aged 23-81 years (median 65 years). Insertion of the cannula failed in 4 cases. Sputum retention and atelectasis were successfully treated in 87% (N = 60). Treatment by MT in medical and neurological patients seems as effective as in surgical patients (success rate 81% versus 90%). The frequency of complications was 16%. Most complications were insignificant and occurred during cannulation, but a few severe complications were seen. To minimize the number of these it is essential that MT is done only by doctors who are familiar with the procedure. MT can be recommended for treatment of sputum retention and atelectasis in surgical and medical/neurological intensive care patients with preserved cough function.
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Insuficiencia Respiratoria/terapia , Traqueotomía/normas , Adulto , Anciano , Anciano de 80 o más Años , Análisis de los Gases de la Sangre , Estudios de Evaluación como Asunto , Femenino , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Prospectivos , Insuficiencia Respiratoria/sangre , Insuficiencia Respiratoria/etiología , Traqueotomía/efectos adversos , Traqueotomía/métodosRESUMEN
We describe a case in which a repeat minitracheotomy (MT) could not be performed 2 months after the first. The cricothyroid membrane seemed calcified and histological examination showed scar formation with dystrophic calcification and heterotopic bone formation. Scar formation following MT may have caused these alterations making repeat access to the airway through the membrane impossible.
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Cartílago Cricoides , Cartílagos Laríngeos , Osificación Heterotópica/etiología , Traqueotomía/efectos adversos , Carcinoma de Células Escamosas/complicaciones , Carcinoma de Células Escamosas/terapia , Humanos , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/terapia , Masculino , Persona de Mediana Edad , Osificación Heterotópica/patologíaRESUMEN
Eight healthy, unsedated volunteers were studied to introduce a new non-invasive method for detailed blood velocity measurements and to evaluate flow patterns in the human pulmonary artery during end-expiratory apnea. With a multiplane transesophageal ultrasonic probe, spectral Doppler velocity registration was performed in nine different spatial locations across the vessel area. The pulmonary trunk could be visualized in all patients. The mean temporal velocity profile was virtually flat despite an instantaneous skewness that rotated counterclockwise up to 180 degrees. Furthermore, our data indicate that a good estimate of the temporal and spatial mean velocity can be obtained from velocity recordings based on centrally placed sample volumes. This makes the future application of Doppler-based measurement of cardiac output in the pulmonary artery hopeful. The ability of multiplane transesophageal echocardiography to estimate the area of the elastic human pulmonary artery, however, has to be evaluated more extensively before the clinical importance of this tool for measurement of cardiac output can be established.
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Ecocardiografía Doppler/métodos , Ecocardiografía Transesofágica/métodos , Procesamiento de Imagen Asistido por Computador , Arteria Pulmonar/diagnóstico por imagen , Adulto , Velocidad del Flujo Sanguíneo/fisiología , Humanos , Arteria Pulmonar/fisiologíaRESUMEN
Carcinomas arising in pre-existing sinonasal papillomas of the nasal septum are rare. To our knowledge only one case has been reported. We report two cases of carcinomas occurring in septal papillomas. In the first case a carcinoma developed in an exophytic papilloma 16 years after the first operation for a papilloma. In the second case a carcinoma was present at the first presentation within an inverted papilloma, and a metastasis had also developed. In the first case HPV type 6/11 was demonstrated by in-situ hybridisation and PCR in the original papilloma as well as in the recurrent papilloma and in the carcinoma. In the second case HPV type 18 was found in the nasal lesion as well as in the metastasis. All samples were examined for Epstein-Barr virus (EBV) by PCR, but with negative results. We believe that case one is the first reported case of carcinomatous transformation within an exophytic septal papilloma.
Asunto(s)
Carcinoma de Células Escamosas/patología , Tabique Nasal/patología , Neoplasias Primarias Múltiples/patología , Neoplasias Nasales/patología , Papiloma/patología , Adulto , Carcinoma de Células Escamosas/terapia , Carcinoma de Células Escamosas/virología , Femenino , Humanos , Masculino , Neoplasias Primarias Múltiples/terapia , Neoplasias Primarias Múltiples/virología , Neoplasias Nasales/terapia , Neoplasias Nasales/virología , Papiloma/terapia , Papillomaviridae , Reacción en Cadena de la Polimerasa , Tomografía Computarizada por Rayos XRESUMEN
Three cases of light chain kappa amyloidosis in multiple myeloma patients are described with remarkable involvement of the tongue and swelling of the sublingual and submandibular regions, and without signs of nephropathy despite Bence Jones kappa proteinuria. All three patients had carpal tunnel syndrome at the beginning of their disease course and only moderate gastrointestinal involvement. Primarily for prognostic reasons, amyloidosis should be suspected in such cases, even in the presence of these highly unusual manifestations, and the diagnosis should be confirmed by unambigously-positive biopsies.
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Amiloidosis/complicaciones , Amiloidosis/diagnóstico , Síndrome del Túnel Carpiano/complicaciones , Edema/complicaciones , Enfermedades Mandibulares/complicaciones , Mieloma Múltiple/complicaciones , Enfermedades de la Lengua/complicaciones , Anciano , Anciano de 80 o más Años , Biopsia , Síndrome del Túnel Carpiano/diagnóstico , Edema/diagnóstico , Resultado Fatal , Femenino , Humanos , Cadenas Ligeras de Inmunoglobulina/análisis , Masculino , Enfermedades Mandibulares/diagnóstico , Persona de Mediana Edad , Mieloma Múltiple/diagnóstico , Valor Predictivo de las Pruebas , Enfermedades de la Lengua/diagnósticoRESUMEN
In the period 1983 to 1992, 208 patients with bladder dysfunction were introduced to clean intermittent self-catheterization. Through questionnaires and retrospective study of patient records we found that 57% of the patients were very satisfied with this treatment modality. Seventy percent found it easy to learn to catheterize themselves and 39% experienced improval of everyday life. Thirty-five percent never had bacteriuria. No serious complications were seen. Conclusively we found that clean intermittent self-catheterization is a good treatment modality for patients with bladder dysfunction. It is easy to learn, easy to perform and is very well accepted by the patients.
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Autocuidado/métodos , Cateterismo Urinario/métodos , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Calidad de Vida , Estudios Retrospectivos , Autocuidado/psicología , Encuestas y Cuestionarios , Cateterismo Urinario/efectos adversos , Cateterismo Urinario/psicologíaRESUMEN
In 1990 we examined 25 patients with Duchenne Muscular Dystrophy (DMD) or Spinal Muscular Atrophy type II (SMA-II). The purpose was to elucidate their general physical capability and find indicators for future need of artificial ventilation. We used interviews and measurements. The interviews were based on classifications described as 1) EAMDA, 2) VIGNOS, 3) BROOKE for use with DMD patients. Our own classification (called EK) is described and used. Moreover, we measured five parameters for the mechanical lung function, the strength of eight great muscle groups, and anthropometrical data. In January 1992, between two and 18 months after our examination, seven of the patients (all DMD) required artificial ventilation. Among the patients who needed artificial ventilation, we found the DMDs to have the lowest physical capability, as measured by the interview (EK and EAMDA) and the smallest values for forced vital capacity (FVC) and peak expiratory flow rate (PEF). All 11 patients with SMA-II could administer their lives without ventilator. Comparing their values with the DMD group, we would expect that several would need artificial ventilation. The reason why the SMA-II patients can manage without artificial ventilation is not clarified. Combining our classification (EK) and the value for FVC, we can predict the need for artificial ventilation among the participating DMD patients.
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Atrofia Muscular Espinal/terapia , Distrofias Musculares/terapia , Respiración Artificial , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Atrofia Muscular Espinal/diagnóstico , Atrofia Muscular Espinal/fisiopatología , Distrofias Musculares/diagnóstico , Distrofias Musculares/fisiopatología , Ápice del Flujo Espiratorio , Capacidad VitalRESUMEN
Long-term respirator treatment in the patients' own home is instituted increasingly frequently in patients with neuromuscular diseases. Positive pressure ventilation via a permanent tracheostomy is employed. Treatment is frequently commenced electively during hospitalization in particularly interested departments. Discharge to the patients' home is undertaken after thorough instruction of the patient himself, the family and the persons who help the patient with his other daily needs. Possible guidelines for establishing this form of treatment are outlined on the basis of literature from abroad.