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Embj

Embj (159)

Systemic lupus erythematosus (SLE) is associated with a high prevalence of atherosclero-sis and an enhanced cardiovascular mortality. In adult subjects, several studies have shown the coexistence of SLE and renal artery stenosis, most of them with unilateral in-volvement or with renal dysfunction.
We observed a 62-year-old man with SLE and a 10-year history of moderate-to-severe hy-pertension who was admitted to our hospital because of uncontrolled blood pressure val-ues (152/95 mmHg), despite drug therapy. No signs of renal impairment were evident.
After an initial physical examination, which presented a periumbilical bruit, a renal ultra-sound was performed with evidence of bilateral renal artery stenosis. An angio-MR study also confirmed the diagnosis and showed a double renal artery on the right side.
Many different factors can contribute to the bilateral renal artery stenosis in this patient. Chronic inflammatory state associated to SLE, metabolic alterations with dyslipidemia and steroid therapy may all be involved in the development of the renal atherosclerotic le-sions.
Method of work: During the Bosnian (1992-1995), 2,195 wounded people underwent primary surgical treatment for their wounded extremities. Tibia wounds were dominant in 695 (31.66%) of the cases, and 59 (8.48%) of which developed chronic osteomyelitis. The Gustilo’s Classification score was IIIB and the Cierny-Mader’s Classification score was IIIB. The average age of the patients was 38.2 years, sex representation: 57 (97%) males and 2 (3%) females. Cause of fracture: bullets 18 (31%), shell pieces 39 (66%), and combined 2 (3%), with polytrauma in 31 (52.54%). The most dominant infective agent was Staphylococcus aureus 31 (52%). We used Papineau’s method in 5 (8.50%), sequestration in 28 (47.45%), fenestration and sequestration in 17 (29%), only Forage of the tibia in 3 (5%), and decortication and resection in 6 (10%). We used the instantaneous vacuum for 36 (61%) patients. The aim of this work is to evaluate some perceptions in the therapy of the chronic fistulous war osteomyelitis tibia in a decade-long work. The study is retrospective and analyzes the use of surgical methods in the treatment of chronic osteomyelitis tibia caused by the high kinetic energy projectiles.
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