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21/841. Idiopathic pinealitis. Case report.

    This 63-year-old man presented with complaints of "having a feeling of falling backward" over a 3-month period. Results of his general physical examination, laboratory studies, and neurological examination were unremarkable. A magnetic resonance image revealed a 1.8 x 1.4 x 1.2-cm enhancing mass in the posterior third ventricle just above the corpora quadrigemina. The pineal gland was found to be diffusely enlarged at operation and separable from the posterior thalamus and was totally resected. The patient had an uneventful postoperative course but continues to be somewhat confused. The lesion consisted of a remarkable chronic inflammatory cell infiltrate permeating the pineal lobules and was composed of T and B lymphocytes, macrophages, eosinophils, and mast cells. Immunoperoxidase studies did not demonstrate langerhans cells, and a search for microorganisms was unrevealing. There was no evidence of neoplasia; results of immunostaining for germ cell markers and other tumor-associated antigens were negative.
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ranking = 1
keywords = macrophage
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22/841. Use of hydroxyapatite bone cement to prevent cerebrospinal fluid leakage through the frontal sinus: technical report.

    OBJECTIVE: To test the efficacy of a simple technique of frontal sinus obliteration during low frontal craniotomy using hydroxyapatite cement instead of more traditional methods, such as pericranial flaps, free muscle or adipose grafts, lumbar drainage, or fibrin glue. methods: Eight patients undergoing low frontal craniotomy for intradural surgery had the frontal sinus obliterated by careful removal of mucosa followed by filling of the sinus with hydroxyapatite bone cement. No other adjuncts for preventing cerebrospinal fluid leakage through the sinus were used. RESULTS: At an average follow-up of 9 months, there were no cerebrospinal fluid leaks, infections, instances of resorption, or cosmetic deformities. CONCLUSION: Hydroxyapatite bone cement seems to be a simple and effective method for frontal sinus obliteration and prevention of cerebrospinal fluid leakage.
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ranking = 2.7760748144599
keywords = bone
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23/841. Combined anti-fungal therapy and surgical resection as treatment of pulmonary zygomycosis in allogeneic bone marrow transplantation.

    Opportunistic fungal infection is a rare but severe complication in allogeneic bone marrow transplant (BMT) recipients. We report a 49-year-old patient who developed pneumonitis after BMT, due to a mucorales fungus (class Zygomycetes), absidia corymbifera. Infections due to mucormycosis are likely to become increasingly recognized even though the occurrence after BMT has only been described sporadically. We postulate that the patient was contaminated before BMT despite no intensive drug treatment or other iatrogenic features, related to his poor living conditions and developed the infection during aplasia. He immediately received i.v. liposomal amphotericin b (AmBisome) and GM-CSF. Because there was no response, the infected area and necrotic tissue were resected. Despite initial clinical and biological improvement and the absence of Mucor on mycological examination post-surgery, the patient died 3 weeks later from bilateral pulmonary infection and multiorgan failure.
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ranking = 2.3133956787166
keywords = bone
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24/841. Ultrastructural changes in peripheral blood neutrophils in a patient receiving ganciclovir for CMV pneumonitis following allogenic bone marrow transplantation.

    A 13-year-old splenectomized, multitransfused beta-thalassemia major, male patient received an allogenic BMT from his HLA-compatible brother after suffering grade III regimen-related pulmonary toxicity. He developed features of CMV pneumonitis with positive pp65 CMV antigenemia involving 2.5% peripheral blood neutrophils from day 46. The patient received intravenous immunoglobulin and ganciclovir 5 mg/kg intravenously twice daily. His neutrophil count was maintained above 1 x 10(9)/l by G-CSF 5 microg/kg subcutaneously as and when required. From day 7 onwards following twice daily ganciclovir his peripheral blood smear started showing isolated cytoplasmic inclusions, 1-3 per neutrophil, 3-5 mu in diameter, involving 2-3% of the neutrophils and occasional monocytes. Transmission election microscopy of peripheral blood neutrophils showed type I and type II intranuclear inclusions. These inclusions disappeared within 48 h of stopping ganciclovir. Inclusions were not seen in three patients who were given prophylactic ganciclovir 5 mg/kg once daily for 5 days every week following allogenic BMT after the same conditioning regimen. These patients were also negative for CMV antigenemia. Development of type I and type II intranuclear inclusions in blood neutrophils in patients receiving ganciclovir therapy has not been reported previously, and the striking light microscopic changes provide simple morphological evidence of the toxic effect of this drug on blood neutrophils.
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ranking = 1.8507165429733
keywords = bone
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25/841. Heterotopic ossification complicating total elbow replacement in a patient with rheumatoid arthritis.

    Heterotopic ossification after total elbow replacement is a new complication. In this particular case, it resulted in severe limitation of motion. Excision of the heterotopic bone resulted in an excellent functional outcome for the patient.
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ranking = 0.46267913574332
keywords = bone
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26/841. Encephalopathy associated with human herpesvirus 6 in a liver transplant recipient.

    Recent reports have documented human herpesvirus 6 (HHV-6) as a cause of high fever, bone marrow depression, and rash in liver transplant recipients in the absence of another known pathogen. We describe a 49-year-old liver transplant recipient who developed confusion, occipital headache, and involuntary movements of the limbs 3 weeks after orthotopic liver transplantation. HHV-6 was detected in the peripheral blood using a rapid culture assay. Examination of cerebrospinal fluid by polymerase chain reaction for HHV-6 was also positive. No other pathogens were identified. The patient improved after commencement of intravenous ganciclovir therapy. This case suggests HHV-6 needs to be considered in the differential diagnosis of unexplained confusion in liver transplant recipients.
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ranking = 0.46267913574332
keywords = bone
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27/841. Allogenic hair transplant in a bone marrow transplant recipient.

    BACKGROUND: Autotransplantation of hair normally provides satisfactory correction of baldness. The authors suggest that the allotransplantation of hair can aid patients who have undergone bone marrow transplantation as to correct hematologic disorders. In such patients, autotransplantation of hair may be unsatisfactory because of insufficient donor hair. OBJECTIVE: To determine whether allogeneic hair grafts from bone marrow donors can grow in the bone marrow transplant recipient. methods: The authors performed a standard hair transplant using minigrafts. The patient, who presented a large bald area, had undergone bone marrow transplant due to acute lymphoblastic leukemia. The authors transplanted the patient with hair taken from the same bone marrow donor. RESULTS: The hair had very good growth and the results, according to the authors, are comparable to those of hair autotransplantation. CONCLUSION: Chemotherapy and radiation treatments can often lead to widespread, permanent hair loss. Allotransplantation of hair usually proves unsatisfactory, because skin is strongly antigenic. Bone marrow transplant patients can undergo an allotransplant of hair from the same bone marrow donor if their own donor area is inadequate.
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ranking = 4.6267913574332
keywords = bone
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28/841. patella fracture and proximal patellar tendon rupture following arthroscopic anterior cruciate ligament reconstruction.

    The central one-third bone-patella tendon-bone graft is a popular choice for arthroscopic anterior cruciate ligament reconstruction. Complications following graft harvesting are unusual, but several reports have been published. We report an unusual case involving a simultaneous patella fracture and patellar tendon rupture that occurred 6 weeks postoperatively.
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ranking = 0.92535827148665
keywords = bone
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29/841. Adjuvant treatment of severe acute pancreatitis with C1 esterase inhibitor concentrate after haematopoietic stem cell transplantation.

    BACKGROUND: With an incidence of 4%, acute pancreatitis is a common complication of bone marrow or peripheral haematopoietic stem cell transplantation, which contributes significantly to morbidity and mortality in these patients. In most cases, the pathogenesis of acute pancreatitis cannot be attributed to a single pathogenetic factor, as treatment toxicity, acute graft versus host disease, infection, and cholestasis may all contribute. Acute pancreatitis is characterised by inflammation and activation of digestive proenzymes leading to autodigestive destruction of the pancreas and systemic activation of protease cascades including the complement system. AIM: To describe the effects of human C1 esterase inhibitor in two children, who developed severe acute pancreatitis with considerable complement activation after allogeneic haematopoietic stem cell transplantation. methods: Both children showed clinical features resembling those observed in capillary leakage syndrome. In both patients, treatment with C1 esterase inhibitor concentrate contributed to a rapid clinical stabilisation. CONCLUSIONS: These observations strongly support the proposed pathophysiological concept that early treatment with C1 esterase inhibitor interferes with the activation of the complement system in acute pancreatitis. Inhibition of complement activation prevents its adverse effects on vascular function and permeability, and thus stabilises intravascular fluid status and prevents multiorgan failure in acute pancreatitis.
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ranking = 0.46267913574332
keywords = bone
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30/841. Distraction of scarred soft tissue before secondary bone grafting. A case report.

    Mandibular distraction was performed to restore oral function in a 52-year-old man with tongue cancer, in whom a mandibular fracture developed after marginal resection of the mandible. The fracture caused the mandibular dental arch to be shorter than the maxillary arch. An external fixation device was attached to the collapsed mandible. The mandibular soft tissue was expanded by 32 mm. After gradual distraction, a vascularized iliac bone graft was transferred to the lengthened space. Subsequently, vestibuloplasty was performed and implants were inserted. A normal appearance, acceptable occlusion and satisfactory oral function were achieved.
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ranking = 2.3133956787166
keywords = bone
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