RESUMO
One of the best procedures to prevent haemarthrosis in haemophilia has been radioactive synovectomy (radiosynoviorthesis). Since 1976 we have performed 119 radiosynoviortheses in 110 patients, aged from 3 to 40 years (mean 10), and of whom 71 were under 12 years of age. The knees were injected in 71, elbow in 29, ankles in 16, and shoulders in 3 cases. Clinical results of the procedure gave excellent results 80% of patients with no further bleeding. In the case of failure a reinjection can be given in the same joint at a 6 month interval. One of the criticisms against this method is possible chromosomal damage. In our centre, 4 studies have been made in order to see whether these changes are permanent, but all have demonstrated that chromosomal changes are reversible. Radioactive material used in 2 studies was Au-189. In 1978, 354 metaphases were studied with 61 ruptures, with 17.23% non-premalignant and 6 structural changes considered premalignant (1.69%). Further study was done in 1982, in the same group of patients with the result of 21 ruptures (3.34%) and no structural changes. The third study was performed in 13 patients that sustained radiosynoviorthesis with Re-186 in 1991. We compared the chromosomal study before and 6 months after the radioactive material injection and the results confirmed that changes appeared equally in non-irradiated and radiated patients and disappeared with time, never reaching the dangerous zone of 2%. In the group treated with Re-186 we studied an additional number of 130 metaphases with identical results and no structural changes. A study performed before and after radiosynoviorthesis with Y-90 revealed no premalignant changes. It seems than radiosynoviorthesis is safe and highly beneficial to haemophilic patients.
Assuntos
Hemartrose/radioterapia , Hemofilia A/complicações , Radioisótopos/administração & dosagem , Membrana Sinovial/efeitos da radiação , Adolescente , Adulto , Criança , Pré-Escolar , Aberrações Cromossômicas/efeitos da radiação , Hemartrose/etiologia , Humanos , Injeções Intra-Articulares , Radioisótopos/efeitos adversos , Adulto JovemRESUMO
In young patients with haemophilia, blood cysts in the finger bones may grow rapidly and imitate a malignant tumour (pseudo tumour). The condition must initially be treated with administration of factor VIII-IX. If this does not control the growth, surgical treatment is indicated. We have advised a percutaneous treatment with evacuation of the blood and injection of the cavity with fibrin seal.
Assuntos
Hematoma/tratamento farmacológico , Hematoma/cirurgia , Hemofilia A/complicações , Adolescente , Criança , Drenagem/métodos , Fator VIII/uso terapêutico , Adesivo Tecidual de Fibrina/administração & dosagem , Dedos , Hematoma/etiologia , Hemofilia A/tratamento farmacológico , Hemostáticos/administração & dosagem , Hemostáticos/uso terapêutico , Humanos , Injeções Intralesionais , Masculino , Cicatrização/efeitos dos fármacosRESUMO
Se realizó un estudio restrospectivo en el cual se revisaron las historias de 6 pacientes, todos con diagnóstico de osteomielitis y pseudoartrosis infectada de Tibia, que fueron operados en el Hospital San Juan de Dios de Caracas entre 1973 y 1983 según la técnica descrita por Huntington y modificada por Davis y Mich, que consiste en la transposición del Peroné ipsilateral para corregir el defecto en la diálisis tibial. Todos usaron inmovilización postoperatoria con yeso inguinopédico por un período que osciló entre las 12 y 32 semanas, todos con un seguimiento promedio de 6 años.En todos se logró consolidación satisfactoria de los fragmentos con hipertrofia del injerto de Peroné