Steroid induced aseptic necrosis

Persons who are on drugs which suppress the immune system are more susceptible to infections than healthy individuals. Chicken pox and measles , for example, can have a more serious or even fatal course in non-immune children or adults on corticosteroids. In such children or adults who have not had these diseases particular care should be taken to avoid exposure. How the dose, route and duration of corticosteroid administration affects the risk of developing a disseminated infection is not known. The contribution of the underlying disease and/or prior corticosteroid treatment to the risk is also not known. If exposed, to chicken pox, prophylaxis with varicella zoster immune globulin (VZIG) may be indicated. If exposed to measles, prophylaxis with pooled intramuscular immunoglobulin (IG) may be indicated. (See the respective package inserts for complete VZIG and IG prescribing information.) If chicken pox develops, treatment with antiviral agents may be considered. Similarly, corticosteroids should be used with great care in patients with known or suspected Strongyloides (threadworm) infestation. In such patients, corticosteroid-induced immunosuppression may lead to Strongyloides hyperinfection and dissemination with widespread larval migration, often accompanied by severe enterocolitis and potentially fatal gram-negative septicemia .

For younger patients, typically under the age of 50 and depending on the area and extent of involvement, various surgical procedures may be indicated. Among these are arthroscopic removal of damaged cartilage and/or drilling (to reduce pressure in the bone and reestablish blood supply), and realignment procedures and osteotomies to shift load bearing away from the damaged surface of the knee. There are also surgical procedures to replace or help regenerate involved bone and cartilage. For the older age population, full or partial knee replacement is the usual surgical treatment.

The radiograph demonstrates AVN of the humeral head and early collapse of the articular surface. Patients with radiographic evidence of proximal humerus AVN should also have hip radiographs performed as part of their evaluation.

Cruess reviews 95 patients with steroid-induced AVN of the humeral head reporting success with both conservative and arthroplasty treatment.

L'insalata et al reviews 65 shoulders with AVN of the humeral head reporting mixed results with 35 shoulders requiring arthroplasty after failure of conservative therapies. Surgical drilling and decompression did not alter the progression of disease.

Incorrect Answers:
Answers 1, 2, 3, and 5 describe rheumatoid arthritis, Reiter's Syndrome, gout, and septic arthritis respectively.

Conditions of the human integumentary system constitute a broad spectrum of diseases, also known as dermatoses , as well as many nonpathologic states (like, in certain circumstances, melanonychia and racquet nails ). [15] [16] While only a small number of skin diseases account for most visits to the physician , thousands of skin conditions have been described. [14] Classification of these conditions often presents many nosological challenges, since underlying etiologies and pathogenetics are often not known. [17] [18] Therefore, most current textbooks present a classification based on location (for example, conditions of the mucous membrane ), morphology ( chronic blistering conditions ), etiology ( skin conditions resulting from physical factors ), and so on. [19] [20] Clinically, the diagnosis of any particular skin condition is made by gathering pertinent information regarding the presenting skin lesion (s), including the location (such as arms, head, legs), symptoms ( pruritus , pain), duration (acute or chronic), arrangement (solitary, generalized, annular, linear), morphology ( macules , papules , vesicles ), and color (red, blue, brown, black, white, yellow). [21] Diagnosis of many conditions often also requires a skin biopsy which yields histologic information [22] [23] that can be correlated with the clinical presentation and any laboratory data. [24] [25] [26]

Steroid induced aseptic necrosis

steroid induced aseptic necrosis

Conditions of the human integumentary system constitute a broad spectrum of diseases, also known as dermatoses , as well as many nonpathologic states (like, in certain circumstances, melanonychia and racquet nails ). [15] [16] While only a small number of skin diseases account for most visits to the physician , thousands of skin conditions have been described. [14] Classification of these conditions often presents many nosological challenges, since underlying etiologies and pathogenetics are often not known. [17] [18] Therefore, most current textbooks present a classification based on location (for example, conditions of the mucous membrane ), morphology ( chronic blistering conditions ), etiology ( skin conditions resulting from physical factors ), and so on. [19] [20] Clinically, the diagnosis of any particular skin condition is made by gathering pertinent information regarding the presenting skin lesion (s), including the location (such as arms, head, legs), symptoms ( pruritus , pain), duration (acute or chronic), arrangement (solitary, generalized, annular, linear), morphology ( macules , papules , vesicles ), and color (red, blue, brown, black, white, yellow). [21] Diagnosis of many conditions often also requires a skin biopsy which yields histologic information [22] [23] that can be correlated with the clinical presentation and any laboratory data. [24] [25] [26]

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