骨科医生使用金属假体实施人工髋、膝关节置换术的历史已经超过40年。全髋关节置换术(total hip arthroplasy,THA)及全膝关节表面置换术(total knee arthroplasty,TKA)是治疗终末期髋膝疾病极为有效的方法,但术后在部分患者中会出现不...骨科医生使用金属假体实施人工髋、膝关节置换术的历史已经超过40年。全髋关节置换术(total hip arthroplasy,THA)及全膝关节表面置换术(total knee arthroplasty,TKA)是治疗终末期髋膝疾病极为有效的方法,但术后在部分患者中会出现不明原因的皮肤红斑、湿疹、关节疼痛、活动度受限的症状,甚至需要再次手术。20年前,Merritt针对这种表现提出了假体金属过敏的解释,但到目前为止,假体金属过敏的话题仍具有争议。主要原因是其发病率低,临床表现不特异,缺乏较特异的实验室检查,且难以与其他TKA术后并发症相鉴别。因此,TKA术后金属过敏的诊断仍需在除外其他诊断以后做出。斑贴试验虽是诊断Ⅳ型超敏反应的金标准,但目前共识并不推荐术前常规筛查。在治疗上,局部激素治疗皮炎反应被认为是有效的[1],但若出现严重滑膜炎、关节功能障碍时,保守治疗往往没有效果,最终需要使用不含过敏原的假体或涂层假体进行翻修手术,通常会得到疼痛缓解、活动度提升的结果。展开更多
Introduction. We report a cutaneous ulceration which occurred following a BCG revaccination. Observation. A 17 year old man, without previous history, presented a large and slow progressive ulceration of the left delt...Introduction. We report a cutaneous ulceration which occurred following a BCG revaccination. Observation. A 17 year old man, without previous history, presented a large and slow progressive ulceration of the left deltoid area following a fortuitous BCG revaccination. He did not complain of any other symptom. The swab culture from the exudate isolated Mycobacterium boviswhereasthedirectanalysisbyZiehlstainingwasnegative. The ulceration healed in four months with local and systemic treatment with isoniazid. Discussion. BCG vaccination side effects are largely described and can be either nonspecific, like with all vaccinations, or specific and due to the infection with Mycobacterium bovis. It can behave like an infectious agent or an immunogenic agent. The BCG revaccination complications are much less known because there are only few publications in the literature. In our case, the mechanism may have been infectious or imply immune reaction with Arthus’type-phenomenon and/or a type IV hypersensitivity. Conclusion. Adverse reactions due to revaccination are rarely described should became lessfrequentwhentheBCGrevaccinationisabandonedfollowing the decision of French regulatory authorities. Nevertheless, such complications can occur by accident, as the case in our patient.展开更多
文摘骨科医生使用金属假体实施人工髋、膝关节置换术的历史已经超过40年。全髋关节置换术(total hip arthroplasy,THA)及全膝关节表面置换术(total knee arthroplasty,TKA)是治疗终末期髋膝疾病极为有效的方法,但术后在部分患者中会出现不明原因的皮肤红斑、湿疹、关节疼痛、活动度受限的症状,甚至需要再次手术。20年前,Merritt针对这种表现提出了假体金属过敏的解释,但到目前为止,假体金属过敏的话题仍具有争议。主要原因是其发病率低,临床表现不特异,缺乏较特异的实验室检查,且难以与其他TKA术后并发症相鉴别。因此,TKA术后金属过敏的诊断仍需在除外其他诊断以后做出。斑贴试验虽是诊断Ⅳ型超敏反应的金标准,但目前共识并不推荐术前常规筛查。在治疗上,局部激素治疗皮炎反应被认为是有效的[1],但若出现严重滑膜炎、关节功能障碍时,保守治疗往往没有效果,最终需要使用不含过敏原的假体或涂层假体进行翻修手术,通常会得到疼痛缓解、活动度提升的结果。
文摘Introduction. We report a cutaneous ulceration which occurred following a BCG revaccination. Observation. A 17 year old man, without previous history, presented a large and slow progressive ulceration of the left deltoid area following a fortuitous BCG revaccination. He did not complain of any other symptom. The swab culture from the exudate isolated Mycobacterium boviswhereasthedirectanalysisbyZiehlstainingwasnegative. The ulceration healed in four months with local and systemic treatment with isoniazid. Discussion. BCG vaccination side effects are largely described and can be either nonspecific, like with all vaccinations, or specific and due to the infection with Mycobacterium bovis. It can behave like an infectious agent or an immunogenic agent. The BCG revaccination complications are much less known because there are only few publications in the literature. In our case, the mechanism may have been infectious or imply immune reaction with Arthus’type-phenomenon and/or a type IV hypersensitivity. Conclusion. Adverse reactions due to revaccination are rarely described should became lessfrequentwhentheBCGrevaccinationisabandonedfollowing the decision of French regulatory authorities. Nevertheless, such complications can occur by accident, as the case in our patient.
