Avascular necrosis of bone: a common serious complication of allogeneic bone marrow transplantation

Article Abstract:

Avascular necrosis of the bone is a bone disease characterized by areas of tissue death in the bone and bone marrow of the long bones, such as those in the leg and arm. The development of lesions in the joints can result in several joint disorders, including degenerative forms of arthritis. Avascular necrosis has been associated with: systemic lupus erythematosus, a chronic inflammatory disease of connective tissue; decompression sickness, the formation of nitrogen bubbles in the tissue spaces; Cushing's disease, a condition involving excessive release of glucocorticoids from the adrenal gland; and various blood disorders. Steroid treatment after kidney, bone marrow, or heart transplantation may also be complicated by avascular necrosis of bone. The incidence of avascular necrosis of the bone was assessed in 902 patients undergoing bone marrow transplantation. The factors that may influence the development and outcome of this bone disorder were also examined. Avascular necrosis developed in 28 of 642 allogeneic transplant recipients, or patients receiving bone marrow from donors, and in none of 260 autologous transplant recipients, or patients receiving their own bone marrow tissue. Symptoms of avascular necrosis developed an average of one year after transplantation. The 28 patients had avascular necrosis of a total of 91 joints, including the hip joint in 64 percent of patients, the knee joint in 61 percent, the ankle joint in 29 percent, the shoulder joint in 21 percent and the elbow joint in 7 percent. Certain imaging techniques were more effective than X-rays in revealing changes associated with avascular necrosis of bone. Steroid therapy and increasing age increased the risk of avascular necrosis. Surgery to correct avascular necrosis was required by 14 patients, including joint replacement in 11 patients. Thus, bone marrow transplantation may be complicated by the later development of avascular necrosis, which may be difficult to detect by conventional imaging methods and often requires surgical treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Bones, Bone marrow, Bone marrow transplantation, Osteonecrosis

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Combined hepatic and renal transplantation in primary hyperoxaluria type I: clinical report of nine cases

Article Abstract:

Primary hyperoxaluria type I (PHI) is a genetic disorder characterized by a deficiency of the enzyme alanine:glyoxylate aminotransferase in the liver. The disease is associated with increased production and excretion of oxalate and glycolate, the formation of urinary stones composed on calcium oxalate, and calcium formation within the kidney, leading to kidney failure. In addition, a process referred to as oxalosis develops in which calcium oxalate is deposited throughout the body, resulting in elevated levels of oxalate ions, or charged oxalate molecules. PHI may be managed by vitamin therapy, or combined liver and kidney transplantation. The deficient enzyme is replaced by new liver graft, whereas the function of the kidney is restored by new kidney graft. Nine cases of PHI treated by combined liver and kidney transplantation are reviewed. One patient with oxalosis died shortly after surgery, while another patient died of infection by cytomegalovirus eight weeks after transplantation. A patient with osteodystrophy, or abnormal bone development, died nine months after surgery, whereas another patient with osteodystrophy died 14 months after surgery due to failure of the transplanted kidney, formation of blood clots, and oxalosis. A fifth patient experienced rejection of the kidney graft and died of gastrointestinal bleeding. Four patients who survived 22 to 38 months after their transplants remained free of kidney disease and recovered from oxalosis. These findings show that combined kidney and liver transplantation may be beneficial for patients with PHI, particularly before the development of advanced kidney failure. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Chronic kidney failure, Oxaluria, Hyperoxaluria

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Ecthyma gangrenosum in the absence of pseudomonas bacteremia in a bone marrow transplant recipient

Article Abstract:

Patients with systemic pseudomonas infections frequently develop ecthyma gangrenosum, a pseudomonas disorder that produces skin lesions. Ecthyma gangrenosum frequently occurs in a hospital setting and most often affects patients with leukemia, severe burns, low white blood cell counts, recipients of organ transplants and patients who are receiving immunosuppressive therapy. However, recent evidence has shown that this disorder can occur even in the absence of systemic infection; a classic case of ecthyma gangrenosum in a patient with no apparent systemic disease is described. The patient was admitted to the hospital suffering from chills and fever. He had crusting scabs on his forehead and groin which were diagnosed by a dermatologist as impetigo. However, after seven days in the hospital, the lesions worsened and took on the characteristics of classic ecthyma gangrenosum. The skin lesions were distributed over the anogenital region and thighs, and cultured positively for pseudomonas bacteria. There was no white blood cell deficiency. The patient had been treated with cyclosporin A, which produces a suppression of immune factors. Although he might have had a low-level pseudomonas infection that was not diagnosed, it is the authors's opinion that the patient's ecthyma gangrenosum was caused by contamination of the impetigo lesions with pseudomonas bacteria from the hospital environment. They urge care on the part of hospital staff to prevent the spread of this bacteria.

Case studies, Nosocomial infections, Cross infection, Pseudomonas infections, Impetigo

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