Bilateral Digital Ischemia
A 69-year-old woman presented with bilateral digital necrosis, which had developed over a period of 2 months (Panels A and B). One year earlier, new-onset Sjögren's syndrome and painful Raynaud's phenomenon had developed. Nifedipine and topical nitroglycerin failed to improve symptoms. The patient did not smoke. Her family history was notable for Waldenström's macroglobulinemia. Laboratory studies were positive for cryoglobulins, and serum protein electrophoresis with the use of immunofixation revealed a monoclonal IgM spike at 345 mg per deciliter with kappa light-chain restriction. Tests for hepatitis C virus, serum viscosity, and lymphocyte counts were normal. The patient received a diagnosis of cryoglobulinemia with an IgM monoclonal gammopathy of unknown significance. To treat the cryoglobulinemia, two courses of chemotherapy with dexamethasone, cyclophosphamide, and rituximab were administered over a period of 2 weeks. After 1 month without clinical improvement, video-assisted thoracic sympathectomy was performed to increase perfusion. After the sympathectomy, the patient's hands became warm and moist. One year after presentation, cryoglobulins were undetectable, the patient's fingers had gradually improved, and there had been no amputations.
Abdominal aortic aneurysmEar injury Cuts, fractures and blunt force trauma can cause ear injury. If damage is severe, surgery may be necessary to address the problem. This may include surgery to preserve hearing or cosmetic surgery to improve the appearance of your ear.Ear tumors Ear tumors may be benign (noncancerous) or malignant (cancerous). Types of noncancerous ear tumors include keloids, sebaceous cysts, osteomas and exostoses (bone growths). Noncancerous ear tumors usually require surgical removal. Cancers that can affect your ears include melanoma, basal cell carcinoma and squamous cell carcinoma. Treatment for these conditions depends on several factors, including the type and stage of cancer, and whether or not it has spread to other parts of your body.First Sickle Cell Gene TherapyMental and physical health are interconnected. We, as a society, need to work on emphasizing the importance of the two. This would prevent people developing physical and mental diseases at earlier and earlier ages.