Myelitis

Hepatitis A Virus

Hepatitis A virus (HAV) infection is the most frequent cause of viral hepatitis worldwide. HAV belongs to the Picornaviridae family in the genus Hepatovirus. The genome of HAV is a positive-sense single-stranded RNA that is approximately 7.5 kb in length. In fact, HAV is classified into six genotypes: three isolated from humans (I–III) and three of simian origin (IV–VI). Worldwide, genotype I is the most prevalent, particularly subgenotype IA. A diagnosis of hepatitis A can be performed by detection of anti-HAV IgM and IgG antibodies by enzyme immunoassay or HAV RNA detection by nested-PCR. Hepatitis A is transmitted principally via the fecal-oral route, including person-to-person contact and the ingestion of water or food that is contaminated by the feces of infected individuals. HAV infection is usually selflimited and benign, with no symptoms, but a severe form of the disease, fulminant hepatitis, affects approximately 1% of the patients who are hospitalized for hepatitis A. In Latin America, several seroprevalence studies have demonstrated an epidemiological shift in HAV infection from high towards intermediate endemicity levels. In Brazil, a large number of children under five years of age (74.1-90%) have been found to be susceptible to HAV infection in 3 capitals of the North, Midwest and Southeast region of Brazil. There is no specific treatment for hepatitis A. Therapy should be supportive and aimed at maintaining an adequate nutritional balance.

Radiation-Induced Lesions

This chapter includes general aspects regarding the mechanisms of radiation-induced lesions and specific organ-related effects of radiotherapy, from the cardiovascular system to bone marrow. For oncologists, understanding the mechanisms of radiation-induced carcinogenesis and knowing the estimated time taken for postradiotherapy occurrence of metachronous tumors is mandatory for proper patient follow-up. We here analyze all lesions of the skin and internal organs, leaving aside tumors for this chapter. The acute and chronic effects of radiotherapy are presented in detail, and the grading system of oral mucositis is also outlined.

Eosinophilic Pancreatitis with Psoriasis Vulgaris

Eosinophilic pancreatitis (EP) is a rare disease characterized by eosinophilic infiltration of pancreatic parenchyma. Although the etiology of EP is not fully understood, there may be some allergic mechanisms related to the disease. Here we report on an EP patient with psoriasis vulgaris.

A 47-year-old man was admitted with cardiac space pain and a feeling of abdominal compression. He had a history of psoriasis vulgaris treated with steroid ointment for the past 30 years. Laboratory findings revealed elevated serum titers amylase. An abdominopelvic computed tomography scan showed a cystic lesion 45 mm in diameter localized in the pancreatic tail. He was diagnosed with pancreatic pseudocyst and conservative medical treatment was initiated with antimicrobial drugs and gabexate mesilate. Whenever meals were taken, pancreatitis aggravation returned. Eosinophilic leukocytosis occurred during steroid administration. Pseudoaneurysm in the splenic artery solution part occurred and a splenic artery embolism was performed in interventinal radiology. The patient underwent distal pancreatectomy. The operation specimen revealed eosinophilic infiltration.

Despite the unusual occurrence of EP, it should be considered in the differential diagnosis of patients with allergic disease or with an eosinophillia group presenting pancreatitis. In such cases, EUS-FNA or laparoscopic biopsy should be mandatory to avoid unnecessary surgical operation.

Hyperbaric Oxygen Therapy for Salvage of Flaps with Unstable Blood Flow

In plastic surgery, hyperbaric oxygen therapy is used to promote healing of intractable ulcers caused by severe diabetes mellitus, peripheral circulatory disorders, and severe scald burns. We performed hyperbaric oxygen therapy to improve blood flow disorders of transferred flaps and reported the utility of and problems with this method.

We performed hyperbaric oxygen therapy for 10 patients with postoperative blood flow disorder after flap transfer. All cases were reconstruction using pedicled flaps. Subject disorders were intractable ulcers with myelitis in three cases, decubitus ulcers in three cases, gas gangrene in one case, injury in one case, hair loss in one case, and defect after tumor resection in one case. Among the 10 patients for whom we performed hyperbaric oxygen therapy, eight experienced local chronic inflammation or systemic wound healing protraction factors.

The transferred flaps in 4 of 10 patients treated with hyperbaric oxygen therapy were salvaged, and the diseases were cured. In one patient, the flap was saved; however, myelitis symptoms were caused by an intramedullary bone screw. The other five patients showed epidermal or adiposal partial necrosis of the transferred flap and closed wounded area.

We performed hyperbaric oxygen therapy for 10 patients with unstable flap blood flow.

A therapy effect was apparent in all cases, and supplemental surgical procedures were not required in five cases. Hyperbaric oxygen therapy is a useful flap salvation method for institutions that have access to hyperbaric oxygen devices.