RESUMO
PURPOSE: Compartment syndrome is a surgical emergency that can occur in any part of the body and can cause cell necrosis when maintained over time. The resulting defects can affect the nerves, muscle cells, bone tissue, and other connective tissues inside the compartment, and fasciotomy has to be performed. The anatomical and histological characteristics of the leg make acute, chronic, and exertional compartment syndrome more likely in this limb. For these reasons, knowledge of the ultrasound, anatomical, and histological features of the crural fascia can help in the treatment of leg compartment syndrome. METHODS: Twenty-one cryopreserved lower limbs from adult cadavers and from one 29-week-old fetus were obtained from the dissection room. They were examined by ultrasound and a subsequent anatomical dissection and microscopy to study the crural fascia and its relationship with the different muscles. Anthropometric measurements were taken of the distances from the head of the fibula and lateral malleolus to the origin of the tibialis anterior muscle in the crural fascia, the exit of the superficial fibular nerve, and the fascia covering the deep posterior muscles of the leg. RESULTS: The crural fascia has very important clinical relationships, which can be identified by ultrasound, as the origin of the tibialis anterior muscle at 16.25 cm from the head of the fibula and the exit of the superficial fibular nerve that crosses this fascia at 21.25 cm from the head of the fibula. Furthermore, the presence of a septum that fixes the deep posterior muscles of the leg and the vessels and nerve can be seen by ultrasound and can explain the possible development of a posterior compartmental syndrome of the leg. Awareness of these features will help to keep these structures safe during the surgical treatment of compartment syndrome. CONCLUSION: The ultrasound study allows identification of anatomical structures in the leg and, thus, avoids damage to them during surgery for compartmental syndromes.
Assuntos
Síndromes Compartimentais , Perna (Membro) , Adulto , Humanos , Perna (Membro)/inervação , Fáscia/diagnóstico por imagem , Fáscia/fisiologia , Fíbula , Músculo Esquelético/diagnóstico por imagem , Músculo Esquelético/fisiologia , CadáverRESUMO
PURPOSE: Acute compartment syndrome is defined as a limb-threatening condition caused by bleeding or oedema in a closed muscle compartment surrounded by fascia or bone. It is most commonly encountered in the forearm, which has three compartments: posterior, anterior and lateral. These are surrounded and closed in by the antebrachial fascia, formed by dense connective tissue that facilities their study on ultrasound and is key to fasciotomy treatment. The purpose of this study was to broaden existing ultrasound, anatomical and histological knowledge of the fascia of the forearm to facilitate their identification on ultrasound, with possible clinical and therapeutic applications. METHODS: The study was performed in 50 cryopreserved upper limbs from adult cadavers from the dissection room of the Faculty of Medicine and Health Sciences. They were examined on ultrasound and subsequent anatomical dissection and microscopy to study the fascia and its relationship with different muscles of the forearm compartments. RESULTS: Distinct anatomical relationships were observed on ultrasound and dissection between the fascia and the extensor carpi ulnaris, extensor digiti minimi, and anconeus muscle in the posterior compartment, and the flexor carpi radialis and flexor carpi ulnaris in the anterior compartment. They were isolated by the antebrachial fascia and had distinct relationships with the neurovascular structures. CONCLUSION: These results demonstrate that high-definition ultrasound enables us to locate the antebrachial fascia and particular muscles with a distinct relationship with neurovascular structures. This helps better identify these structures, facilitating diagnosis of any pathology in the area, with potential therapeutic and clinical applications.
Assuntos
Fáscia/anatomia & histologia , Antebraço/anatomia & histologia , Antebraço/irrigação sanguínea , Ultrassonografia/métodos , Adulto , Cadáver , HumanosRESUMO
OBJECTIVES: A role for microorganisms in aseptic prosthetic loosening (AL) is postulated. We analyse the microbiological and clinical findings of patients with suspected AL, and compare them with patients with chronic prosthetic joint infection (PJI). METHODS: Prospective study (2011-2012) of patients with presumed AL. Evaluation of tissue samples (≥5; TS) at the time of surgery and sonication fluid (SF) of prosthesis. RESULTS: According to positive culture in TS/SF, 89 patients were divided into: Group1: (≥2 positive-TS; n = 12); Group2: single positive-TS and concordant SF (n = 10); Group3: one positive or non-concordant TS or SF (n = 38); and Group4: cultures negative (n = 29). Positive-SF was always concordant with TS in Group 1 (75%); it was positive in 74% in Group 3. Median months (prosthesis-age: implantation to revision arthroplasty) for PJI and Group 1-4 was 21, 46, 65, 63 and 81, respectively (P < 0.001); they also had a different dynamic trend in prosthesis failure (P < 0.001). CONCLUSIONS: Several patients with suspected AL are misdiagnosed PJI. Results from SF correlated well with TS in Group 1, led us to consider single positive-TS as significant (Group 2) and to suggest that microorganisms were on the prosthesis (Group 3). We observed a correlation between microbiology and prosthesis-age, which supports that early loosening is more often caused by hidden PJI than late loosening.
Assuntos
Articulação do Quadril/microbiologia , Prótese de Quadril/efeitos adversos , Articulação do Joelho/microbiologia , Prótese do Joelho/efeitos adversos , Falha de Prótese/etiologia , Infecções Relacionadas à Prótese/microbiologia , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril , Artroplastia do Joelho , Osso e Ossos/microbiologia , Análise de Falha de Equipamento , Feminino , Prótese de Quadril/microbiologia , Humanos , Prótese do Joelho/microbiologia , Masculino , Estudos Prospectivos , Infecções Relacionadas à Prótese/complicações , Infecções Relacionadas à Prótese/diagnóstico , Reoperação , Sonicação , Membrana Sinovial/microbiologia , Fatores de TempoRESUMO
The diagnosis of tumors and pseudotumors depends on three pillars: the clinician, the radiologist, and the pathologist. The first two can establish a presumptive diagnosis on the basis of the clinical presentation and findings on complementary tests, whereas the pathologist will have to reach the definitive diagnosis after analyzing the biopsy specimens. Obviously, the clinician and radiologist should reach a consensus regarding the diagnostic orientation; however, for this to happen there must be a relationship between the two professionals and they must work together for the benefit of the patient. Orthopedic surgeons, like any other group of specialists, would like to have radiologists working in their own center who are dedicated to the organ/system they treat, in this case the locomotor apparatus, and who can provide them with their opinion about the different images obtained. This point is very important and especially so for tumors, because this type of disease is uncommon and few specialists are dedicated to it. For this reason, when faced with a lesion that has the characteristics of a tumor, orthopedic surgeons would like radiologists to give the most accurate description of the images as possible, defining the characteristics of benignity or malignancy of the process as well as indicating the risk of fracture in a metastatic lesion. On the other hand, orthopedic surgeons would ask for a clear and comprehensible description of the images obtained in complementary tests, because orthopedic surgeons have less experience in this type of images and they are often difficult to interpret. Another aspect that is often mentioned in discussions among orthopedic surgeons is the importance of having a radiology department that performs interventional procedures. Radiologists that perform interventional procedures can facilitate our work very much, both in the diagnosis and in the treatment of certain bone tumors. Finally, we would like to stress the importance of having a radiologist who collaborates with us and is interested in our work, supporting us without being overly critical. This is also important for our relations with patients; radiologists, like all professionals, must know their responsibilities and limitations in aspects related to intervention and in elaborating the corresponding reports.
Assuntos
Comunicação Interdisciplinar , Ortopedia , RadiologiaRESUMO
OBJECTIVE: To study whether any relationship exists between the C282Y and H63D mutations of the HFE gene, iron liver content, and the severity of histological damage in patients with hepatitis C virus (HCV)-induced chronic hepatitis. MATERIAL AND METHODS: In 72 patients diagnosed with HCV-chronic infection, naïve for antiviral therapy, and undergoing liver biopsy, the Knodell index was established, a morphometric evaluation of hepatic hemosiderin deposits was performed by using a semiautomatic method of image analysis, and mutations of the HFE gene were identified through a polymerase chain reaction on leukocyte genomic DNA by using specific restriction enzymes. The control group for the distribution of HFE genetic variants was composed of 181 healthy individuals with the same ethnic and geographical (white Spaniards) origin. RESULTS: (Cases/controls): 1. Genotype distribution: a) mutation C282Y: no homozygotes, 6/23 heterozygotes, 66/158 without the mutation (not significant, n.s.); b) mutation H63D: 2/5 homozygotes, 26/52 heterozygotes, 44/124 without the mutation (n.s.). compound heterozygotes 2/6. 2. Allele frequencies: a) mutation C282Y: 0.042/0.064 (n.s.); b) mutation H63D: 0.208/0.171 (n.s.). Four C282Y heterozygous patients had stainable liver iron (p=0.015 vs patients without mutations). Sixty-six patients were not carriers of the C282Y mutation; among them, 26.9% of 26 carriers and 15% of 40 non-carriers of the H63D mutation had liver stainable iron (n.s.). Knodell index score, gender, age at diagnosis, mode of transmission, and serum and liver iron values were not related to the HFE genotype. CONCLUSIONS: our results suggest that the C282Y mutation, but not the H63D mutation, of the HFE gene is frequently associated with stainable iron in the liver in HCV-related chronic hepatitis. The HFE genotype is not related to the histological severity of the disease.
Assuntos
Hepatite C Crônica/patologia , Antígenos de Histocompatibilidade Classe I/genética , Proteínas de Membrana/genética , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Proteína da Hemocromatose , Humanos , Ferro/análise , Fígado/química , Masculino , Pessoa de Meia-Idade , Mutação , Índice de Gravidade de DoençaRESUMO
We report the case of thyroid dysfunction that developed in a 36-year-old female patient who required combination therapy with interferon and ribavirine for chronic hepatitis C. Firstly, she suffered a hyperthyroidism followed by a hypothyroidism stage requiring thyroxine replacement therapy. Nevertheless, combination treatment was not discontinued, reaching a sustained biochemical and virological response. The pathogenesis of autoimmune diseases in patients with Hepatitis C virus infection and interferon therapy is not clear, but usually these disorders are reversible and only require supervision and treatment if clinical or laboratory abnormalities are present.
Assuntos
Antivirais/efeitos adversos , Hepatite C/complicações , Interferon-alfa/efeitos adversos , Doenças da Glândula Tireoide/induzido quimicamente , Antivirais/uso terapêutico , Feminino , Hepatite C/tratamento farmacológico , Humanos , Interferon alfa-2 , Interferon-alfa/uso terapêutico , Pessoa de Meia-Idade , Proteínas Recombinantes , Doenças da Glândula Tireoide/complicaçõesRESUMO
AIMS/BACKGROUND: To establish the rate of infection with a newly discovered Flaviviridae family member hepatitis G virus (HGV) -- in Spanish patients with hepatocellular carcinoma (HCC), chronic alcoholic liver disease (CALD) with cirrhosis, or hepatitis C virus (HCV)-induced chronic hepatitis (CH). METHODS: The presence of HGV-RNA was assessed in sera of 117 patients divided in three groups: group 1: 40 patients with HCC (35 men, mean age 62.7 years, SD 10.9 years); group 2: 41 patients with chronic alcoholic liver disease (CALD) (36 men, mean age 52.5 years, SD 9.8 years); group 3: 36 patients with HCV-induced CH (27 men, mean age 35.8 years, SD 8.5 years). Serum samples were tested for HGV-RNA by specific reverse transcriptase-polymerase chain reaction (RT-PCR). Serological markers of hepatitis B virus (HBV) and HCV were investigated in all patients and were negative in CALD patients, as a prerequisite for their inclusion in the study. All patients in group 1 were also tested for HBV-DNA. RESULTS: Rates of HGV-RNA positivity were, respectively, 47%, 10% and 28% in groups 1, 2 and 3. Differences were significant between groups 1 and 2 (p=0.00017) and groups 2 and 3 (p= 0.042), but not between groups 1 and 3 (p=0.079). CONCLUSIONS: HGV infection is common in HCC patients, but usually in association with HCV, indicating that both agents share common routes of infection. HGV was the only hepatitis virus detected in 12% of HCC patients, but its possible role in the pathogenesis of HCC remains unclear.
Assuntos
Carcinoma Hepatocelular/virologia , Flaviviridae/isolamento & purificação , Hepatite Viral Humana/patologia , Neoplasias Hepáticas/virologia , Adulto , Idoso , Carcinoma Hepatocelular/epidemiologia , Carcinoma Hepatocelular/patologia , Feminino , Hepatite C/epidemiologia , Hepatite C/patologia , Hepatite C/virologia , Hepatite Viral Humana/epidemiologia , Humanos , Hepatopatias Alcoólicas/epidemiologia , Hepatopatias Alcoólicas/patologia , Hepatopatias Alcoólicas/virologia , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Espanha/epidemiologiaAssuntos
Hipertensão Portal/cirurgia , Derivação Portossistêmica Cirúrgica , Derivação Esplenorrenal Cirúrgica , Adolescente , Adulto , Idoso , Feminino , Hemorragia Gastrointestinal/etiologia , Encefalopatia Hepática/etiologia , Humanos , Circulação Hepática , Masculino , Pessoa de Meia-Idade , Derivação Portossistêmica Cirúrgica/efeitos adversos , Portografia , Complicações Pós-Operatórias , Derivação Esplenorrenal Cirúrgica/efeitos adversosRESUMO
In 26 interposition mesocaval shunts using an internal jugular vein autograft which has been performed since 1970, four patients had important abnormalities in the superior mesenteric vein, making impossible the usual subduodenal position of the jugular vein graft. In these four patients, a small pancreatectomy was performed between the transverse portion of the duodenum and the right aspect of the superior mesenteric vein, placing the interposition mesocaval shunt in a transduodenopancreatic position. No patient has had any bleeding after the operation nor have esophageal varices been found at the time of the last examination. During this period, all patients showed a remarkable tolerance to proteins, so that no patient has been on a low protein diet.