RESUMO
A glomus tumor is a rare and benign vascular tumor. It can originate in multiple locations on the body, although it has most frequently been found in subungeal areas of the hand. This two cases report describes a glomus tumor of the hallux, including a recurrence and a review of the related literature. We believe this case study might be of interest due to the unusual location of this tumor.
Assuntos
Doenças do Pé , Tumor Glômico , Hallux , Idoso , Feminino , Doenças do Pé/diagnóstico , Doenças do Pé/cirurgia , Tumor Glômico/diagnóstico , Tumor Glômico/cirurgia , Humanos , Pessoa de Meia-IdadeRESUMO
BACKGROUND: The administration of tranexamic acid (TA) is associated with a decrease in the number of red blood cell (RBC) units transfused. However, concerns about its safety have hindered its broader use. STUDY DESIGN AND METHODS: We evaluated the effect of TA on RBC transfusion and thromboembolic complications in total knee arthroplasty. We retrospectively studied 414 patients, 215 immediately before introducing TA treatment (control group) and after, in 199 patients without history of thromboembolic diseases (TA group). In a subgroup of patients, a lower extremities contrast venography was performed. RESULTS: Fifty-four per cent of control group patients were transfused with RBC while only 17.6% of TA group patients received RBCs. In the TA that group, those transfused received less units (2.83 vs. 1.89), showed smaller mean calculated perioperative blood loss and haemoglobin values at discharge were higher compared to control group (10.1 vs. 9.3 g/dl). Thromboembolic complications were diagnosed in 2.8% of the patients in the control group and in 1.5% in the TA group. Asymptomatic distal deep venous thrombosis was found in 54 (14.8%) of TA group patients and 54 (30.1%) of control patients. TA administration reduced the expenditure for RBC transfusion plus the cost of TA from 148.94 to 33.87 euro per patient. CONCLUSION: Routine administration of TA during total knee arthroplasty to patients without history of thromboembolic disease is associated with a 67% reduction in RBC transfusions and, in those transfused, with a reduction in the number of units administered. TA treatment was not associated with an increase in thromboembolic complications. Transfusion costs are significantly reduced.
Assuntos
Artroplastia do Joelho/efeitos adversos , Transfusão de Eritrócitos/métodos , Ácido Tranexâmico/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Antifibrinolíticos/uso terapêutico , Perda Sanguínea Cirúrgica , Estudos de Casos e Controles , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Transfusão de Eritrócitos/efeitos adversos , Transfusão de Eritrócitos/economia , Feminino , Hemoglobinas/análise , Humanos , Masculino , Pessoa de Meia-Idade , Flebografia , Estudos Retrospectivos , Tromboembolia/induzido quimicamente , Resultado do TratamentoRESUMO
INTRODUCTION: Diaphragmatic paralysis is a side-effect associated with interscalene block. Thickness index of the diaphragm muscle (inspiratory thickness/expiratory thickness) obtained by ultrasound has recently been introduced in clinical practice for diagnosis of diaphragm muscle atrophy. Our objective was to evaluate this index for the diagnosis of acute phrenic paresis associated with interscalene block. PATIENTS AND METHODS: We designed an observational study in 22 patients scheduled for shoulder arthroscopy. Spirometry was performed (criteria of phrenic paresis was a decrease in FVC and FEV1 ≥20%). Ultrasound apposition zone was assessed in anterior axillary line and diaphragmatic displacement was evaluated on inspiration and expiration (number of intercostal spaces; phrenic paresis considered a reduction ≥25%) and thickness of the diaphragm muscle (a phrenic paresis was considered an index <1.2). These determinations were performed before and at 20min after interscalene block at C5-C6 with 20ml of 0.5% ropivacaine. RESULTS: Twenty-one patients (95%) presented phrenic nerve block according to one or more of the methods used. One patient did not show any symptoms or signs suggestive of phrenic paralysis and was excluded. All the patients presented phrenic paresis based on the diaphragmatic thickness index, with the pre-block index being 1.8±0.5 and post-block of 1.05±0.06 (P<0.001). Ninety percent of the patients (19) presented phrenic paresis according to spirometry and all the patients had a reduction in diaphragmatic movement after the block (from 1.9±0.5 intercostal spaces to 0.5±0.3; P<0.001). CONCLUSION: The index of inspiratory / expiratory diaphragmatic thickness at cut-off <1.2 seems to be useful in the diagnosis of phrenic paresis associated with interscalene block. This index does not require a baseline pre-assessment.
Assuntos
Bloqueio do Plexo Braquial/efeitos adversos , Diafragma/diagnóstico por imagem , Nervo Frênico/fisiopatologia , Paralisia Respiratória/etiologia , Adulto , Idoso , Anestésicos Locais/efeitos adversos , Diafragma/patologia , Procedimentos Cirúrgicos Eletivos , Expiração , Feminino , Volume Expiratório Forçado , Humanos , Inalação , Masculino , Pessoa de Meia-Idade , Movimento , Atrofia Muscular/diagnóstico por imagem , Paralisia Respiratória/diagnóstico por imagem , Paralisia Respiratória/patologia , Paralisia Respiratória/fisiopatologia , Ombro/cirurgia , Ultrassonografia , Capacidade VitalRESUMO
Glenoid replacement is technically challenging. Removal of a cemented glenoid component often results in a large osseous defect which makes the immediate introduction of a revision prosthesis almost impossible. We describe a two-stage revision procedure using a reversed shoulder prosthesis. Freeze-dried allograft with platelet-derived growth factor was used to fill the glenoid defect. Radiological incorporation of the allograft was seen and its consistency allowed the placement of a screwed glenoid component. There were no signs of new mature bone formation on histological examination. The addition of platelet-derived growth factor to the allograft seems to contribute to an increase in incorporation and hardness, but does not promote the growth of new bone.
Assuntos
Artroplastia de Substituição/métodos , Transplante Ósseo/métodos , Liofilização/métodos , Fator de Crescimento Derivado de Plaquetas/uso terapêutico , Articulação do Ombro/cirurgia , Idoso , Humanos , Prótese Articular , Masculino , Radiografia , Reoperação , Articulação do Ombro/diagnóstico por imagem , Resultado do TratamentoRESUMO
A case of posttraumatic avascular necrosis of the humeral head in a young patient was detected 3 years after an anterior dislocation with a nondisplaced greater tuberosity fracture. The evolution to degenerative joint disease is described.
Assuntos
Osteonecrose/etiologia , Luxação do Ombro/complicações , Fraturas do Ombro/complicações , Adulto , Humanos , Úmero/irrigação sanguínea , Masculino , Osteoartrite/etiologia , Osteonecrose/complicações , Radiografia , Luxação do Ombro/diagnóstico por imagem , Fraturas do Ombro/diagnóstico por imagemRESUMO
The purpose of this paper is to develop a professional consensus that proposes, in the light of the current scientific evidence and the clinical experience of an expert panel, some clinical recommendations directed at the Orthopaedic and Trauma Surgery (OTS) specialist and with the aim of reducing the variability in the prophylactic management of venous thromboembolic disease in knee and hip arthroplasty in clinical practice. The Delphi method was used, which consisted of two rounds of an e-mail questionnaire. Of the 55 items considered, a consensus was reached in 37 (67.2%) of them. In 31 cases there was consensus with the formulation of the item, and in 6 cases there was no agreed consensus. It was observed that there was a consensus in multiple clinical recommendations that could help OTS specialists in the making of decisions in their clinical practice.
Assuntos
Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Tromboembolia/etiologia , Tromboembolia/prevenção & controle , Humanos , Guias de Prática Clínica como AssuntoRESUMO
We report a case of perioperative fracture-dislocation of the humeral head produced during the reaming for a resurfacing replacement hemiarthroplasty (RRH) in a 79-year old woman. This is a surgical complication not previously described in the literature for this type of prosthesis design. Resurfacing humeral head implant has been noted as a useful treatment for glenohumeral arthropathies, also in elderly people, with a very low incidence of complications. However, as we report, they are possible.It is advisable that conventional stemmed implants could be available when RRH is performed.
RESUMO
A 41-year-old man had typical symptoms and signs of carpal tunnel syndrome. At operation there were multiple large rice bodies along the flexor tendons with a great deal of adherent synovitis involving the index finger. Widespread surgical debridement with excision of involved synovium was done. Mycobacterium tuberculosis was cultured from the tenosynovium excised.
Assuntos
Síndrome do Túnel Carpal/diagnóstico , Tenossinovite/patologia , Tuberculose Osteoarticular/patologia , Adulto , Biópsia , Diagnóstico Diferencial , Humanos , Masculino , Tenossinovite/cirurgiaRESUMO
We report a case of periosteal chondroma of the clavicle. To our knowledge, this benign cartilaginous tumor has never been previously reported in this location. Clinical, radiographic and pathological investigations were necessary to establish the diagnosis. Marginal excision proved an effective treatment.