Biomedical subjects
Publications and source records attributed to R Ramón.
Primary small cell cutaneous neuroendocrine carcinoma (Merkel cell carcinoma) is an uncommon, highly malignant, primary cutaneous neuroendocrine carcinoma. Clinically it is seen as a 0.5- to 5.0-cm pinkish purple papule or nodule, usually not ulcerated, on the head, neck, or, less frequently, the roots of the limbs. We present the case of a woman with an atypical clinical presentation of a Merkel cell tumor.
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The implant of a proximal femoral structural allograft is one of the possibilities to restore circumferential defects of multiply revised total hip arthroplasties. A review of 7 patients who underwent proximal femoral reconstruction with an allograft-prosthesis composite to restore bone loss in revision hip replacements is presented. The average follow-up period was 50.2 months. Two patients developed an infection and in one case an instability of the prosthesis appeared. Incorporation in the remaining 5 cases was/achieved in an average period of 8.2 months. Neither fractures nor high rate of resorption appeared in our series. The majority of patients have improved in the functional assessment. Despite the rate of complications, structural femoral allografts can be used with success in this difficult challenge of reconstructing major segmental bone loss of the proximal femur in revision hip surgery.
We describe the case of a 70-year-old woman with chronic renal failure on haemodialysis presenting with an ulnar nerve compression in Guyon's canal secondary to uremic tumoral calcinosis. Excision of calcium deposits and external neurolysis of the ulnar nerve were successfully performed. Simultaneously, the hyperphosphatemia and hypercalcemia were corrected. The pathogenesis of this condition is different from primary tumoral calcinosis. Clinical and radiological features and therapy are discussed. Uremic tumoral calcinosis is an unusual etiology of ulnar nerve compression in Guyon's canal not previously reported in dialysis patients.
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Tuberous sclerosis has many forms of clinical presentation. Rarely, multiple facial angiofibromas of unilateral distribution have been reported. We describe 2 patients with such a presentation and hypothesize that this is a mosaic form of tuberous sclerosis.
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BACKGROUND: To quantify short-term benefits of total hip replacement, prognostic factors of the outcome, and to assess hospital costs of this surgical procedure in Catalonia, Spain. PATIENTS AND METHODS: Multicentric prospective study in seven hospitals in Catalonia. All patients undergoing this procedure in one year were included. They were evaluated prior to the operation, and six months later. This evaluation involved: clinical assessment, the Hip Pain and Function Scale, the Nottingham Health Profile (NHP), and the EuroQol (EQ-5D), in order to measure cost-utility. Hospital costs were estimated by means of a specific questionnaire. RESULTS: Information was obtained for 332 patients. The mean age was 65 years (range: 27-89 years); 58% were women; the most common diagnosis was arthritis; 59% of patients had associated pathology and 13% presented some type of postoperative complication. The improvement in health status was important according to all instruments. An outcome of "excellent" or "good" was achieved by 70.8% of the patients, in terms of hip function and pain. The factors associated with not achieving an outcome of this level were: associated pathology, complications, diagnoses other than arthritis, and operation carried out in a tertiary hospital. The total cost of the procedure was 838,480 pesetas. This average varied significantly with the cost of the prosthesis, and as a function of the length of stay. The three-year cost-utility of the procedure was estimated as 507,500 pesetas. CONCLUSIONS: Total hip replacement greatly improves the pain, hip function and overall perceived health of the patient. This improvement is greater among patients with a diagnosis of arthritis, with good overall health, operated on by a surgeon experienced in this procedure. The benefit is high in relation to the cost, although there is a margin for improvement, reducing complications, shortening length of stay, and controlling the price of implants.
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OBJECTIVE: To analyze a series of uremic tumoral calcinosis (UTC) in patients receiving longterm dialysis therapy. METHODS: Twelve patients receiving longterm hemodialysis affected by tumoral calcinosis were analyzed. Clinical, radiological, and pathological features were evaluated and pathogenic factors were reviewed. RESULTS: The most common sites for UTC were the elbow, hip, hand, and wrist. The lesions were multiple (67%, n = 8), of large size, and symptomatic with joint mobility impairment (75%, n = 9) as well as nerve compression (33%, n = 4). High serum calcium and phosphate concentrations were detected in 50% (n = 6) and 100% of the patients, respectively. An increased calcium-phosphorus product (Ca x P) was observed in all patients, either due to overt secondary hyperparathyroidism (42%, n = 5), or secondary to iatrogenic hypercalcemia and/or severe hyperphosphoremia of multifactorial etiology (i.e., prolonged and excessive administration of calcitriol and calcium carbonate, insufficient dialysis and inadequate phosphorus chelating therapy, etc.) (58%, n = 7). Several treatment strategies were followed (surgical excision, parathyroidectomy, renal transplant) in combination with aggressive medical therapy to decrease Ca x P product, achieving complete remission in 83% of the patients. CONCLUSION: UTC lesions show clinical and pathogenic features that differ from those of idiopathic tumoral calcinosis. The most important pathogenic factor involved in UTC is an increase in Ca x P, not necessarily related to hyperparathyroidism. Combined treatment strategies allow complete remission in a high proportion of patients. A low Ca x P is necessary to prevent development of UTC.
To determine the behaviour of bone allografts in the treatment of tibial plateau fractures, 20 recipients of frozen bone allograft for a depressed tibial plateau fracture were studied. Incorporation of grafts took place in all cases, and no complication secondary to the allograft use has been detected. To avoid donor site morbidity associated with harvesting iliac crest, the use of frozen bone allograft is a good alternative in the treatment of depressed tibial plateau fractures.
Multiorgan and tissue donors offer a larger quantity and high quality of bone allograft that cannot be obtained from living donors. The risk of bone contamination must be borne in mind if secondary sterilization is not performed. The bacteriological cultures of 270 bone segments obtained from 53 multiorgan or tissue donors were analysed to study the relationship between previous organ and tissue procurements and bone retrieval contamination. We concluded that no significant differences in bacterial contamination percentage were found for each type of previous organ and tissue procurement, nor in the number of teams per donor.
Mucinous syringometaplasia is a rare condition characterized by the presence of mucinous cells lining eccrine ducts. Because most occurrences are on the palms and soles, the disorder is generally considered to be the result of chronic trauma or pressure. We describe an example of mucinous metaplasia involving an apocrine duct on the left arm of a 57-year-old woman. Histopathologic study demonstrated that in deeper areas of the invagination, the lining of the lumen consisted of columnar cells showing decapitation secretion and that the invagination was connected to a rudimentary hair follicle. These histopathologic features support the possibility that the involved duct was an apocrine one. We discuss the differential diagnosis with those cutaneous adnexal neoplasms in which the presence of mucinous cells has been described.
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