A 39-year-old man with hypertension, a renal-artery aneurysm, and eosinophiluria

Article Abstract:

A 39-year-old construction worker with a long history of cigarette smoking had been in excellent health until the onset of acute pain about a month prior to his admission to the hospital. The pain was in his abdomen on the left side and disappeared after three hours, returned a few days later, then resolved again. He had received a urologic examination which showed signs of abnormality in the left kidney. Over the next two weeks, the man felt nauseated and lost weight, with pain in both shoulders. His urine tested positive for protein and physical examination showed an enlarged lymph node in his neck. The patient developed a pulsating headache. He finally entered Massachusetts General Hospital after additional tests and a brief stay in another hospital. At this point he had abnormal protein and blood cells in his urine, a severe headache with confusion, abnormal findings on eye exam (papilledema), high blood pressure, and, on X-ray examination (angiography), signs of delayed excretion by the left kidney, a constricted left renal artery, and an aneurysm of that artery. More than 80 percent of the blood cells in his urine were eosinophils, a type of white blood cell. After taking medication to reduce his hypertension and help in diagnosis, he appeared better except for a mild headache and anxiety. Biopsy of the left kidney showed areas of injury to the tubules and signs of necrosis. A muscle biopsy showed no muscle cell abnormalities. The differential diagnosis should rule out polyarteritis nodosa and various other forms of arteritis and tuberculosis. The clinical diagnosis was fibromuscular dysplasia of the renal artery (abnormal development of fibrous tissue in the artery's wall) with a dissecting aneurysm (dilatation of the artery in which the tissue layers in the artery's wall separate, dramatically affecting the passage of blood through the vessel). An additional diagnosis was giant-cell arteritis (a type of blood vessel inflammation), with dissecting aneurysm of the renal artery and renal infarction. The anatomical diagnosis was renal-artery dysplasia with dissecting aneurysm, and ischemic nephropathy, with hyperplasia of juxtaglomerular apparatus (kidney damage due to reduced blood flow, affecting the cells that regulate sodium concentration and, hence, blood pressure). The clinical picture was not typical of any one disease. Surgery to attempt to repair the aneurysm was not successful since the dissection had proceeded well into the kidney and so the left kidney was removed. The patient did well following his hospitalization and his blood pressure returned to normal. (Consumer Summary produced by Reliance Medical Information, Inc.)

Hypertension, Diagnosis, Physiological aspects, Kidney diseases, Fibromuscular dysplasia, Periarteritis nodosa, Polyarteritis nodosa, Renal artery

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A 74-year-old man with a failed right-hip replacement, constant pain centered in the right hip, an osteolytic lesion in the right acetabulum

Article Abstract:

A 74-year-old man was admitted to a hospital with pain in his hip associated with a failed hip replacement. On X-ray, the surgical appliance was seen to be associated with a destructive lesion of the hip bone. The possibility of various malignant tumors was considered and ruled out. A needle biopsy was done, and no tumor was found. The patient underwent a revision of the original hip surgery, at which time particulate debris, presumably from surgical glue (used to attach the hip prosthesis) was found surrounded by diseased tissue. Tissue samples were taken for routine microscopic examination. The loss of bone from the hip was found to be a foreign-body reaction associated with the cement which was used. Although there was concern that the replacement operation (which uses a related cement) might fail in a similar manner, there was no substitute for the gluing procedure. However, during the 10 years since the original operation there have been considerable advances in the surgical method. This has resulted in a decrease in the loosening of glued parts from a range of 30 to 40 percent to the current rate of 3 percent. This has been achieved by improving the design of the implants and preparing the cement in a better way. The patient has been seen approximately six months after the operation and is well with good hip function. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Methods, Bones, Artificial hip joints, Hip prostheses, Bone cements

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