Ultrasound-guided biopsy of the equine forelimb proximal suspensory ligament by longitudinal access / [Biópsia guiada por ultrassom da origem do ligamento suspensor do boleto de equinos por acesso longitudinal]

A literatura atual discute múltiplas modalidades de imagem para acompanhar o processo de cicatrização da origem do ligamento suspensor do boleto (LSB) em equinos, mas nenhuma pode garantir que eles possuam fibras colágenas com calibre suficiente para suportar o retorno ao exercício. Já as técnicas morfológicas e bioquímicas, bem como a análise de birrefringência, podem ser mais apropriadas para caracterizar o processo de cicatrização e avaliar a eficiência do tratamento. O objetivo deste artigo é descrever procedimento simples que possibilita a coleta de amostras teciduais de boa qualidade e em sentido longitudinal, por biópsia em equinos em estação. Após antissepsia local, sedação e bloqueio do nervo palmar lateral no aspecto medial do osso acessório do carpo (OAC), o membro foi colocado em suspensão com o carpo flexionado em 90º; a agulha de biópsia guiada por ultrassom foi introduzida em sentido distoproximal, 11 a 13cm distal ao OAC, ângulo de 20º em relação ao LSB, até a região de sua origem. O equipamento foi disparado e coletou-se a amostra tecidual. Essa técnica possibilitou a coleta de fragmentos de boa qualidade para análise histológica e de birrefringência, sem reações adversas, podendo ser usada em modelos experimentais ou na prática clínica.(AU)

Metástasis poco frecuente del carcinoma renal de células claras / Unusual metastasis of clear cell renal cell carcinoma

El ligamento falciforme es una reflexión peritoneal abdominal relacionada con la superficie anterior del hígado, que en su borde inferior libre contiene el ligamento redondo (LR); las lesiones únicas en este son infrecuentes. Presentamos un caso de metástasis única en el ligamento redondo en un paciente con antecedente de carcinoma renal de células claras. Realizamos una búsqueda bibliográfica para identificar casos similares. Nuestro paciente es un varón de 71 años con antecedente de carcinoma renal de células tratado con nefrectomía radical izquierda laparoscópica (estadio pT3a). En tomografía computarizada (TC) control a los 5 años se evidencia lesión focal en la periferia del segmento IVa, ante la sospecha de malignidad, se realiza laparotomía exploradora revisando toda la cavidad abdominal sin evidenciar otros implantes peritoneales. Se halla un nódulo de 1 cm en el ligamento redondo y se realiza su exéresis completa, con diagnóstico anatomopatológico de metástasis de células claras. El LR generalmente está afectado en casos de carcinomatosis peritoneal y solo existen dos casos publicados de metástasis únicas.

The falciform ligament is a peritoneal reflection that attaches the liver to the anterior abdominal wall; its lower edge contains the round ligament (RL). Single lesions in the RL are rare and usually correspond to perivascular epithelioid cell tumors. We present a case report of a single metastasis in the RL in a patient with clear cell renal cell carcinoma who underwent surgery five years ago. We conducted a literature review to identify similar cases and we found two case reports of single metastasis in the RL. Our patient was a 71-year-old man with a history of renal cell carcinoma who underwent left laparoscopic radical nephrectomy (stage pT3a), laparoscopic right adrenalectomy and total thyroidectomy due to multinodular goiter. The pathological examination revealed metastases of renal cell carcinoma. A computed tomography (CT) scan performed at 5-year follow-up showed a focal lesion in segment IVa with no FDG uptake in the PET scan, but as malignancy was suspected, the patient underwent exploratory laparatomy with no evidence of peritoneal implants. A 1-cm node was found in the round ligament that was completely resected. The pathological examination revealed metastatic clear cell renal cell carcinoma. The RL is involved in cases of peritoneal carcinomatosis and only two cases of single metastasis have been reported: in one patient with papillary renal cell carcinoma pT1aN0 and another one with left breast adenocarcinoma.

Oophoropexy to the round ligament after recurrent adnexal torsion / Ooforopexia ao ligamento redondo em um caso de torção anexial recorrente

Abstract Recurrent adnexal torsion is a rare gynecological emergency. We report a case of recurrent ipsilateral adnexal torsion in a woman with polycystic ovaries, previously submitted to a laparoscopic plication of the utero-ovarian ligament. Due to the recurrence after the plication of the utero-ovarian ligament, the authors performed a laparoscopic oophoropexy to the round ligament, which is an underreported procedure. The patient was asymptomatic for 1 year, after which she had a new recurrence and needed a unilateral laparoscopic adnexectomy. Since then, she regained the quality of life without any gynecological symptoms. Oophoropexy to the round ligament may be considered when other techniques fail or, perhaps, as a first option in selected cases of adnexal torsion, as it may allow the prevention of recurrence without increasing morbidity while preserving the adnexa.

Resumo A torção anexial recorrente é uma emergência ginecológica rara. Os autores descrevem um caso de torsão anexial unilateral recorrente em uma paciente com síndrome de ovário policístico, previamente submetida a plicatura do ligamento utero-ovárico por laparoscopia. Nesta circunstância, os autores decidiram realizar uma ooforopexia laparoscópica ao ligamento redondo, uma técnica pouco descrita na literatura. A paciente manteve-se assintomática durante 1 ano, período após o qual teve nova recorrência, tendo-se decidido realizar uma anexectomia laparoscópica unilateral. Desde então, ela recuperou a qualidade de vida sem qualquer sintoma ginecológico. A ooforopexia ao ligamento redondo é uma técnica que deverá ser considerada quando outras falham e, em casos selecionados de torsão anexial recorrente, poderá ser considerada a primeira abordagem, para prevenir a recorrência e preservar o anexo.

Understanding the ligamentum teres of the hip: a histological study

Objective: To perform a histological study describing the microstructure of the ligamentum teres of the hip, with special emphasis on the presence of nerve bundles. Our study aims to correlate the microstructure of the ligamentum teres with its postulated functions, allowing greater understanding of its role within the hip joint. Methods: Fresh specimens excised intra-operatively in 11 patients undergoing open hip procedures were preserved in formalin and sent to the laboratory for histological analysis by our collaborating pathologist. The specimens were sectioned and stained, and examined under the microscope to look at their microstructure. In addition, a novel staining technique was employed to detect neural elements within the individual specimens . Results: The ligamentum teres is composed predominantly of a connective tissue matrix of collagen fibers, fibrous and adipose tissue, with an overlying layer of investing synovium. In addition, there are blood vessels of various sizes surrounded by a layer of encircling fat. In all specimens examined, there were nerve bundles of various shapes and sizes, regardless of the age of the patient. Conclusion: The ligamentum teres has both mechanical and biological functions within the hip joint and should no longer be considered a developmental vestige. Where possible, any surgical procedures around the hip joint should aim to limit damage to this structure to minimize any potential loss of function. Level of Evidence Basic Science Study.

Quiste de nuck asociado con hernia inguinal atascada en adolescente femenino / Nuck's cyst associated with incarcerated inguinal hernia in a female teenager

Objetivo: Presentar un caso de quiste de Nuck de la región inguinal. Métodos: Paciente adolescente de 16 años con aumento de volumen en región inguinal derecha y presencia de dolor, cuadro clínico de una hernia inguinal atascada. Resultados: El hallazgo quirúrgico de la intervención resultó ser un quiste de la región inguinal y cuyo resultado de anatomía patológica reporta ser un quiste de Nuck. Conclusión: Se define como quiste de Nuck, o quiste del ligamento redondo, un divertículo del peritoneo parietal en el canal inguinal que acompaña al ligamento redondo en la mujer encontrándose en condiciones fisiológicas obliterado. Este se manifiesta como un aumento de volumen en la región inguinal,irreductible, que puede ir acompañado o no de dolor; a veces puede presentarse simulando una hernia inguinocrural incarcelada y es frecuente en niños, siendo su presencia en adolescente y mujeres adultas y de avanzada edad una entidad muy rara(AU)

Objective: To present a case of Nuck's cyst in the inguinal region. Methods: A 16-year female teenager with an increase of volume in the right inguinal region and presence of pain. Clinical symptoms of an incarcerated inguinal hernia. Results: Surgical finding at the intervention turned out to bea cyst of the inguinal region and the result of pathology reported to be a cyst of Nuck. Conclusion: It is defined as cyst of Nuck, or cyst of the round ligament, a diverticulum of the peritoneum in the inguinal canal accompanying the round ligament in women being in physiological conditions obliterated. This is manifested as an increase in volume in the inguinal region, irreducible, that can go with or without pain, and sometimes mimicking a hernia can occurs inguinocrural incarcerated and is common in children being its presence in adolescent and adult women and elderly a very rare(AU)

Quiste del ligamento redondo, una lesión rara que simula una hernia inguinal: reporte de un caso / Round ligament cyst, a rare condition simulating inguinal hernia: case report

Cysts of the inguinal cord are disorders that simulate inguinal hernias and manifest as inguinal masses and, in some cases, are accompanied by pain that can simulate a complicated inguinal hernia. We report the third case of a round ligament cyst in a 21-year-old female with a mass in the right inguinal area with intermittent pain. The patient was subjected to surgical exploration of the right inguinal area where a round ligament cyst was found. The ligament was resected and reported as a serous cyst. The patient's outcome was excellent and she was discharged 24 h after surgery. She has been followed up for 3 months without recurrence. Round ligament cysts are very rare disorders, and the diagnosis is perioperative. Resection of the round ligament causes complete symptom relief, and every case requires inguinal hernioraphy.

Sarcoma no ligamento redondo do fígado / Sarcoma in the ligamentum teres of the liver

Leiomiossarcomas são tumores mesenquimais pouco comuns e tornam-se raros quando sua etiologia é de tecido estromal gastrintestinal ou de outra musculatura lisa. Objetivo - relatar um caso de tumor cístico de ligamento redondo de difícil diagnóstico clínico. Relato de caso - paciente de 31 anos com tumoração em hipocôndrio direito e epigástrio há aproximadamente três anos, sem perda de peso ou / Leiomyosarcomas are uncommon mesenchymal tumors and are even scarcer when they develop from gastrointestinal stromal tissue or some other smooth muscle. Aim - To report a case of cystic tumor from the round ligament, with difficult clinical diagnosis. Case report - 31 year-old patient presents with a lumping at the right hypochondrium and epigastrum for about 3 years, with no weight loss or any other complaints...