1/14. Therapeutic plasma exchange for the acute management of the catastrophic antiphospholipid syndrome: beta(2)-glycoprotein I antibodies as a marker of response to therapy.We describe two patients with the catastrophic antiphospholipid syndrome associated with elevation of beta(2)-glycoprotein I antibodies and fulminant thrombotic diatheses. Both patients were treated with therapeutic plasma exchange (TPE), which resulted in a marked decrease in antibody titer accompanied by an improved clinical outcome in one patient (IgG antibody). In the second patient, the outcome was poor despite TPE (IgA antibody). There were no significant complications of TPE in either case. Because of the fulminant nature of the catastrophic antiphospholipid syndrome, we conclude that a trial of TPE is warranted for the acute management. Further studies are needed to clarify which patients may benefit from this treatment.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/14. amputation-sparing treatment by nature: "surgical" maggots revisited.Maggots were used as adjunct treatment for infected wounds that showed no response to the classical approach of wound debridement and antibiotic therapy. We summarize findings for 11 patients with necrotic wounds who received treatment with "surgical" maggots (100-2900 applied in 3-10 changes of dressing) for 11-34 days, which apparently aided in tissue remodeling and cure, and describe 2 typical patients in detail.- - - - - - - - - - ranking = 4keywords = nature (Clic here for more details about this article) |
3/14. Idiopathic purpura fulminans and varicella gangrenosa of both hands, toes and integument in a child.Chicken pox is a common childhood illness and, though a vaccine is readily available, it is not routinely included in the vaccination schedule of most countries owing to its mild clinical nature. However, varicella gangrenosa is a rare complication of this disease, infrequently reported in the literature. We report the case of a child who developed purpura fulminans in the convalescent phase of chicken pox and subsequently presented with peripheral gangrene of both hands and the toes of the right foot, and skin gangrene. To our knowledge, bilateral gangrene of the hands has rarely been reported, and we present this case to highlight the serious nature of complications following varicella infection.- - - - - - - - - - ranking = 2keywords = nature (Clic here for more details about this article) |
4/14. Fatal pyoderma gangrenosum in association with C7 deficiency.Although pyoderma gangrenosum (PG) is often associated with systemic diseases, it has not been reported in association with congenital complement deficiencies. We describe an aggressive and ultimately fatal case of PG in a patient with a congenital C7 deficiency. Deficiencies of C7 can be associated with decreased neutrophil chemotaxis, phagocytosis, and opsonization, similar to the immunologic abnormalities described in patients with PG. Our patient's decreased complement level, if not directly related to the development of PG, may have contributed to the aggressive nature of her disease.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/14. Limb gangrene following treatment of limb injury by traditional bone setter (Tbs): a report of 15 consecutive cases.This study is done to evaluate cases of limb gangrene resulting from treatment of limb injury by traditional bonesetter. METHOD: This is a prospective study in which patients with limb gangrene are evaluated as each presents. Data extracted for evaluation include history of having been to a traditional bonesetter, the original injury, type of treatment given by the traditional healer, progression of condition while on treatment and reason for not coming to orthodox orthopaedic centre ab initio for treatment. RESULTS: 15 cases were seen during the 5-year of study spanning June 1997 to May 2002. Upper limbs were involved in 4 cases while 11 involved the lower limbs. The original injuries were 3 cases of soft tissue injury to the joints, 7 closed fractures and 5 open fractures of type I and II. There was associated sepsis and toxemia in all except one. All the cases were treated by amputation. There were 4 deaths. CONCLUSION: Limb gangrene was not a justifiable end-result of treatment in all the cases judging by the nature of the original injury. Reasons for this end result were adduced. The need to avert unnecessary limb loss from mismanagement of limb injury by education of public in general and enlightenment of the traditional bonesetters of the harmful procedures in their practice is highlighted.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/14. Cryofibrinogenemia: report of a case.Cryofibrinogenemia, a rare disease, is diagnosed by the presence of reversible cryoprecipitate in plasma, which may cause various clinical manifestations of thromboembolic or hemorrhagic disorders. A 66-year-old female patient suffered from recurrent reticulate erythema, purpura and gangrene on the distal portion of the extremities and face during the winter for 5 years. Cryofibrinogenemia was proven with the following evidences: (1) Histopathologic findings revealed many eosinophilic cylinders, about 6-9 microns in diameter, deposited within the lumen of the blood vessels in the dermis and subcutaneous tissue. There was no evidence of vasculitis. These cylinders were fibrinogen in nature, as proven by direct immunofluorescence. (2) Cryofibrinogen was detected in the citrated plasma, which was confirmed by double immunodiffusion, the presence of an IgG-kappa M protein was also revealed by immunofixation. debridement and skin grafts were performed, and prednisolone combined with cyclophosphamide were given. skin lesions improved without recurrence, and the "cryocrit" decreased from 13.6% to less than 2% during the follow up. We conclude that if there is any case with the similar cutaneous manifestations, cryofibrinogenemia should be considered.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/14. Peripheral embolization complicating bilateral renal infarction with gelfoam.Selective arterial embolization is a technique with wide therapeutic applicability. However, regardless of the nature of the embolic particles, reflux into the aorta with peripheral embolization is a serious potential complication. A case is described in which this complication occurred. We recommend that all such embolizations be performed with a balloon catheter occluding the target artery.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/14. Congenital constriction band associated with pseudarthrosis and impending gangrene. A case report.A newborn baby with a severe congenital constriction band associated with pseudarthrosis and impending gangrene of the foot is described. Early one-stage circumferential excision of the band with immediate wound closure by multiple Z-plasties salvaged the compromised foot. The pseudarthrosis indicated the severely compressive nature of the fibrous band. The uneventful healing of the pseudarthrosis and the full recovery of neurovascular function points to essential normal tissue underlying the constricting band.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/14. Post-surgical pyoderma gangrenosum of the vaginal vault associated with ulcerative colitis and Behcet's disease; a case report.A case is described in which a patient with ulcerative colitis developed chronic vaginal ulceration around the incision lines after cone biopsy. The ulcers persisted at the vaginal vault after abdominal hysterectomy and removal of a cuff of vagina. Non-specific histological features compatible with pyoderma gangrenosum were found on biopsy. The auto-immune nature of this chronic ulcer is further supported by its rapid response to steroid therapy and the subsequent development of Behcet's syndrome.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/14. pyoderma gangrenosum. A possible cause of wound necrosis.pyoderma gangrenosum is a destructive cutaneous disorder characterized by painful, rapidly enlarging ulcers with under-mined bluish and purplish red margins. This disease is most frequently found in association with ulcerative colitis. However, in the last three years, four cases of pyoderma gangrenosum precipitated by surgical procedures have occurred, and only one of these patients had ulcerative colitis. All four patients responded to steroid therapy and local wound care. pyoderma gangrenosum can first be suspected by recognition of the previously described classic lesion. In addition, the absence of significant microbial growth and the lack of a specific etiology ascertained on routine and special staining of biopsy material is suggestive of the diagnosis. Histologic characteristics are entirely nonspecific but can be helpful in ruling out other specific entities. The progressively destructive nature of this process in the face of what would seem to be appropriate therapy for bacterial wound infection requires that pyoderma gangrenosum, as well as other aspects of the differential diagnosis of a persistent ulcerative lesion, such as fungal infection, factitious ulcer, or vasculitis, be considered.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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