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Condroma/diagnóstico , Unhas Malformadas/etiologia , Neoplasias Cutâneas/diagnóstico , Condroma/complicações , Condroma/patologia , Condroma/cirurgia , Dedos , Humanos , Masculino , Pessoa de Meia-Idade , Unhas/diagnóstico por imagem , Unhas/patologia , Unhas/cirurgia , Unhas Malformadas/diagnóstico , Unhas Malformadas/patologia , Unhas Malformadas/cirurgia , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgia , Resultado do TratamentoRESUMO
BACKGROUND: Slipped capital femoral epiphysis (SCFE) is a hip disorder frequently occurring in adolescence. In adults it is rare and so far very few cases have been documented. CASE PRESENTATION: This report presents a 25-year-old patient diagnosed with an anterior fossa giant chondroma, hypogonadotropic hypogonadism, and SCFE. The patient underwent surgical and hormonal therapy. His symptoms revealed, and he became a father. CONCLUSIONS: Every patient diagnosed with SCFE in adulthood should undergo endocrinological assessment based on physical examination and laboratory tests.
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Condroma/patologia , Hipogonadismo/patologia , Neoplasias Cranianas/patologia , Escorregamento das Epífises Proximais do Fêmur/patologia , Adulto , Condroma/complicações , Condroma/terapia , Humanos , Hipogonadismo/complicações , Hipogonadismo/terapia , Masculino , Prognóstico , Neoplasias Cranianas/complicações , Neoplasias Cranianas/terapia , Escorregamento das Epífises Proximais do Fêmur/complicações , Escorregamento das Epífises Proximais do Fêmur/terapiaRESUMO
Chondroma in the area of the spheno-ethmoidal junction is very rare. A 29-year-old male patient with chronic rhinosinusitis with nasal polyps was arranged for a preoperative computed tomography scan, and a lesion was accidentally found in his spheno-ethmoidal junction and involved the skull base. Combined with MRI, the lesion was misdiagnosed as fungal sinusitis. However, no fungal lesions were found during the operation, and cartilage tissue was confirmed only after some bone was ground away under the guidance of a surgical navigation system. Our case indicates that chondroma is easily misdiagnosed as fungal sinusitis when it appears in the sinuses and should be carefully distinguished from fungal sinusitis. Moreover, when lesions involve the skull base, surgical navigation systems are useful in accurately locating lesions.
Assuntos
Condroma/diagnóstico por imagem , Osso Etmoide/diagnóstico por imagem , Seios Paranasais/diagnóstico por imagem , Adulto , Condroma/complicações , Condroma/cirurgia , Osso Etmoide/patologia , Humanos , Masculino , Micoses , Pólipos Nasais/etiologia , Pólipos Nasais/cirurgia , Seios Paranasais/patologia , Seios Paranasais/cirurgia , Sinusite/etiologia , Tomografia Computadorizada por Raios XRESUMO
INTRODUCTION: Enchondromas arise from cartilaginous cells derived from the physis that persists throughout development. They are difficult to diagnose and are often discovered on radiographs after a trauma. PATIENT CONCERNS: We discuss the case of a 32-year-old woman with a pathologic mallet fracture of the distal phalanx that was initially misdiagnosed as common mallet fracture. DIAGNOSIS: Magnetic resonance imaging revealed an eccentrically located lesion expanding to the cortex, with a high signal intensity at T2 weighted image, suggesting pathologic fracture. INTERVENTIONS: We performed a operation, involving curettage and bone grafting. Complete removal of the lesion was confirmed intraoperatively with the image intensifier, and the cavity was irrigated and subsequently filled with allogenous bone and demineralized bone matrix. OUTCOMES: With an uneventful recovery, she gradually return to normal function within 3 months. Her symptoms improved and nearly full range of motion of the finger was seen at 1-year follow-up. CONCLUSION: Our case of pathologic mallet fracture was misdiagnosed as a simple fracture, suggesting that the mechanism of fracture and radiological diagnosis should be carefully considered.
Assuntos
Condroma/complicações , Condroma/diagnóstico por imagem , Erros de Diagnóstico , Falanges dos Dedos da Mão/diagnóstico por imagem , Fraturas Espontâneas/diagnóstico por imagem , Fraturas Espontâneas/etiologia , Adulto , Feminino , Falanges dos Dedos da Mão/lesões , Humanos , Imageamento por Ressonância MagnéticaRESUMO
Endobronchial hamartochondroma is a rare benign tumor which differs from the parenchymal form in its symptomatology and also by its treatment which should be as conservative as possible. The endobronchial location is exceptional. Here we present the cases of two patients with endobronchial hamartochondroma associated with clinical manifestation, chest pain and repeated pulmonary infections, respectively. The diagnosis was made after performing a CT-scan, a PET-SCAN and histological analysis. After discussion in a multidisciplinary staff meeting, conservative treatment was chosen in both cases.
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Obstrução das Vias Respiratórias/etiologia , Neoplasias Brônquicas/complicações , Condroma/complicações , Hamartoma/complicações , Fumar Tabaco/efeitos adversos , Idoso , Obstrução das Vias Respiratórias/diagnóstico , Obstrução das Vias Respiratórias/patologia , Obstrução das Vias Respiratórias/cirurgia , Neoplasias Brônquicas/diagnóstico , Neoplasias Brônquicas/patologia , Neoplasias Brônquicas/cirurgia , Broncoscopia/métodos , Condroma/diagnóstico , Condroma/patologia , Condroma/cirurgia , Feminino , Hamartoma/diagnóstico , Hamartoma/patologia , Hamartoma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons , Fumar Tabaco/patologia , Tomografia Computadorizada por Raios XRESUMO
Flexor Digitorum Profundus avulsion injury associated with an enchondroma at the level of the distal phalanx is extremely rare. There have been few cases reported to date and most have been surgically managed using a screw and/or Bunnell pull-out wire technique with or without bone grafting. We describe the first case using a simple interosseus fixation technique for the reattachment of FDP tendon without bone grafting. The patient made an excellent post-operative recovery. This technique is a simple, effective, patient-friendly and internalised solution which, in addition, may prevent the need for bone grafting.
Assuntos
Condroma/complicações , Condroma/cirurgia , Traumatismos dos Dedos/cirurgia , Traumatismos dos Tendões/cirurgia , Condroma/diagnóstico , Traumatismos dos Dedos/diagnóstico , Traumatismos dos Dedos/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos dos Tendões/diagnóstico , Traumatismos dos Tendões/etiologiaRESUMO
RATIONALE: Chondromyxoid fibroma (CMF) is a rare form of benign bone tumor and easily misdiagnosed as fibrosarcoma. Hence, to explore the clinical manifestations, diagnostic tests, and therapeutic procedures for temporal bone cartilage myxoid fibroma, it is important to optimize patient treatment and avoid overtreatment. Previous research has discussed cases of CMF, but this paper presents a systematic, complete, and comprehensive introduction of this disease based on this case and related literature. PATIENT CONCERNS: A 52-year-old male patient presented with pain in his right ear for 2 years and hearing loss in his right ear with tinnitus for 1 year. The patient had a history of hypertension for 9 years and it was well-controlled. DIAGNOSIS: A computed tomography (CT) scan of the temporal bone showed an expansive growth on the right temporal bone plate and tympanic plate, presenting as a cloud-like ground glass opaque shadow involving the temporom and ibular joint, middle skull base, and small auditory bones. A magnetic resonance imaging (MRI) of the temporal bone showed a large and irregular soft tissue mass shadow on the right temporal bone plate. The right temporal bone plate was occupied by the lesion, consistent with a bone origin. From the results of the imaging examination of the patient, a lesion occupying the temporal bone in the right ear and mastoiditis in the right middle ear was initially diagnosed. INTERVENTIONS: Right ear temporal bone tumor resection and abdominal fat extraction were conducted. OUTCOMES: Postoperative pathological results demonstrated myxoid fibroma of the temporal bone cartilage. No recurrence or severe complications were observed in 8 months of follow-up. LESSONS: A finding of myxoid fibroma of the temporal bone cartilage is rare in the clinic. The growth of such tumors is slow. The temporal bone CT and inner ear MRI were helpful in diagnosis. Surgery was the principal treatment.
Assuntos
Condroma/diagnóstico por imagem , Neoplasias Cranianas/diagnóstico por imagem , Osso Temporal/diagnóstico por imagem , Condroma/complicações , Condroma/cirurgia , Diagnóstico Diferencial , Perda Auditiva/etiologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias Cranianas/complicações , Neoplasias Cranianas/cirurgia , Zumbido/etiologia , Tomografia Computadorizada por Raios XRESUMO
Chondromas rarely occur in the nasal area and are usually found in the metaphyseal area of the phalanges and metacarpals of the hands, as well as the pelvis, sternum and scapula. The authors present an unusual case of dysphagia induced by histologically confirmed chondroma arising from the nasal septum. Treatment is to completely remove the mass with adequate margins of normal tissues to prevent recurrence and malignancy. Intranasal endoscopic removal of tumor with an adequate margin of normal tissue. After one year of treatment, there was no evidence of recurrence. We present a case of nasal septal chondroma in 18-year-old male. Keywords: chondroma; dysphagia; septum.
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Condroma/diagnóstico , Transtornos de Deglutição/etiologia , Septo Nasal/patologia , Neoplasias Nasais/diagnóstico , Adolescente , Condroma/complicações , Condroma/cirurgia , Humanos , Masculino , Septo Nasal/cirurgia , Neoplasias Nasais/complicações , Neoplasias Nasais/cirurgiaRESUMO
BACKGROUND: Maffucci syndrome (MS) and Ollier disease (OD) are rare diseases characterized by multiple benign enchondromas. The incidence of skull base (SB) enchondromas and the risk of malignant transformation remain unknown. Most SB lesions are asymptomatic, and surgical resection carries significant morbidity. Observation may be a reasonable strategy. We report our experience with observation of probable SB enchondromas in MS/OD patients. METHODS: Retrospective review of OD/MS patients with cranial imaging between 1995 and 2018 at 1 institution. RESULTS: 14 patients were included: 3 with MS (21.4%) and 11 with OD (78.6%). The median age was 28 years (range, 11-74 years) and 57.1% were female. Extracranial chondrosarcoma was reported in 3 (21.4%) patients. Seven (50%) patients with SB enchondroma or chondrosarcoma were identified on initial imaging. In patients with SB lesions, the indications for imaging were headache (n=3), seizure (n=1), and diplopia (n=1); 2 cases were incidental findings. The most commonly involved structures were petroclival fissure (86%) and clivus (71%). Treatment included observation (6/7) and resection (1/7). Follow-up imaging was available for all SB lesions, with a mean interval of 50.7 months (range, 5-225 months) and was negative for progression in all patients. CONCLUSIONS: Primary SB lesions in OD/MS patients frequently present in the petroclival junction. Cranial screening and close observation should be considered in MS/OD patients, given the increased risk of intra-axial intracranial tumors, de novo chondrosarcomas, or malignant degeneration of previously known lesions. In asymptomatic patients, observation appears to be a safe strategy in this cohort. Further case accumulation and follow-up are required to better understand the long-term outcomes.
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Neoplasias Ósseas/epidemiologia , Condroma/epidemiologia , Condrossarcoma/epidemiologia , Encondromatose/epidemiologia , Neoplasias da Base do Crânio/epidemiologia , Adolescente , Adulto , Idoso , Neoplasias Ósseas/complicações , Neoplasias Ósseas/patologia , Criança , Condroma/complicações , Condroma/patologia , Condrossarcoma/complicações , Condrossarcoma/patologia , Encondromatose/complicações , Encondromatose/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias da Base do Crânio/complicações , Neoplasias da Base do Crânio/patologia , Adulto JovemAssuntos
Condroma/patologia , Condrossarcoma/tratamento farmacológico , Condrossarcoma/patologia , Parede Torácica/patologia , Idoso , Antibióticos Antineoplásicos/uso terapêutico , Anticorpos Monoclonais Humanizados/administração & dosagem , Anticorpos Monoclonais Humanizados/uso terapêutico , Antineoplásicos Imunológicos/uso terapêutico , Neoplasias Ósseas/patologia , Condroma/complicações , Condrossarcoma/complicações , Condrossarcoma/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Doxorrubicina/administração & dosagem , Doxorrubicina/uso terapêutico , Evolução Fatal , Humanos , Masculino , Atelectasia Pulmonar/complicações , Atelectasia Pulmonar/diagnóstico por imagem , Neoplasias Torácicas/patologia , Parede Torácica/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Pediatric intracavernous sinus tumors are exceedingly rare and thus poorly characterized. Their neurosurgical management is challenging and diagnostic, and management guidelines are limited. OBJECTIVE: To report our institutional experience with the surgical resection of pediatric intracavernous sinus tumors. We also compare and contrast our results with the 14 cases of pediatric intracavernous sinus lesions in the current literature. METHODS: A retrospective descriptive analysis of consecutive pediatric patients (ages 0-18 yr) presenting to our institution with a diagnosis of an intracavernous sinus lesion was performed. From January 2012 to January 2017, 5 cases were identified. Eleven patients with secondary invasion of the cavernous sinus (2 meningiomas, 7 pituitary adenomas) or dermoid tumors involving the cavernous sinus (2) were not included in our review. RESULTS: Surgical resection via a frontotemporal orbitozygomatic approach was performed in all cases by a single senior neurosurgeon (M.L.). There were no perioperative or postoperative complications attributable to the surgery or approach. Four of 5 patients remained neurologically stable throughout the perioperative and postoperative period. The fifth patient had a complete resolution of their cranial neuropathies postoperatively. A pathological diagnosis that guided long-term management was obtained in all cases. CONCLUSION: Neurosurgical management of pediatric cavernous sinus lesions can be safely performed and critically guide future therapies. Surgeon familiarity with cavernous sinus and skull-base anatomy is critical to the successful management of these patients. The benefits of surgery should be balanced against the potential complications and need for a tissue diagnosis in children. The senior author had a significant experience with cavernous sinus approaches in adults prior to initiating use of the approach in the pediatric population.
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Seio Cavernoso/cirurgia , Condroma/cirurgia , Hemangioma/cirurgia , Linfoma de Células B/cirurgia , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Neoplasias Vasculares/cirurgia , Adolescente , Criança , Condroma/complicações , Condroma/diagnóstico por imagem , Doenças dos Nervos Cranianos/etiologia , Feminino , Hemangioendotelioma , Hemangioma/complicações , Hemangioma/diagnóstico por imagem , Humanos , Linfoma de Células B/complicações , Linfoma de Células B/diagnóstico por imagem , Masculino , Neoplasias Meníngeas/complicações , Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/complicações , Meningioma/diagnóstico por imagem , Estudos Retrospectivos , Neoplasias Vasculares/complicações , Neoplasias Vasculares/diagnóstico por imagemRESUMO
BACKGROUND: Intracranial chondromas are extremely rare and represent only 0.2% of all intracranial primary neoplasms. The histologic appearance lacks nuclear atypism and mitoses, and it usually shows low growth potential, although these benign features do not necessarily imply a good prognosis. CASE DESCRIPTION: A 44-year-old man was referred to our institution with a subarachnoid hemorrhage (SAH). He had a history of SAH 5 years previously that was diagnosed as unknown etiology at another hospital. Head magnetic resonance imaging showed a large tumor located in the prepontine cistern and extending up to the interpeduncular cistern, and the tumor was irregularly enhanced with contrast medium. Retrospective analysis of the original computed tomography of 5 years earlier identified a small contrast enhancing defect behind the dorsum sellae. Tumor removal was planned to prevent repeated SAH and control the apparently growing tumor. An extended transsphenoidal approach was performed. The pituitary gland was dissected from the bottom of the sellar floor and transposed forward to the prechiasmatic cistern with preservation of the pituitary stalk and its blood supply, and subtotal removal of the tumor was achieved. Postoperative diabetes insipidus disappeared within a few days, and the patient was discharged without neurologic or endocrinologic deficits. Histologic examination established the diagnosis as chondroma without a sarcomatous component. Follow-up examination 3 months after surgery showed a re-enlargement of the residual tumor, and gamma knife surgery was performed. CONCLUSIONS: Intracranial chondroma sometimes manifests as intracranial hemorrhage and grows comparatively rapidly in a short period despite the benign histologic features. A long and careful follow-up period is essential.
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Neoplasias Encefálicas/cirurgia , Encéfalo/cirurgia , Condroma/cirurgia , Hemorragia Subaracnóidea/cirurgia , Adulto , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/patologia , Condroma/complicações , Condroma/diagnóstico por imagem , Condroma/patologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Período Pós-Operatório , Estudos Retrospectivos , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/etiologia , Hemorragia Subaracnóidea/patologia , Espaço Subaracnóideo/diagnóstico por imagem , Espaço Subaracnóideo/patologia , Espaço Subaracnóideo/cirurgia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
An extraosseous or soft tissue chondroma is a rare, benign cartilaginous tumour characterised by the formation of mature hyaline cartilage. The majority of osseous chondromas are located within the medullary cavity of long bones. Soft tissue chondromas are extremely rare with only five cases affecting the bladder being reported in the literature. Soft tissue chondroma of the bladder is a rare cause of lower urinary tract symptoms and abdominopelvic pain. All reported cases of soft tissue chondromas of the bladder have occurred in women in their fifth to seventh decades of life. We describe the case of a 65-year-old woman diagnosed with a soft tissue chondroma of her bladder while being investigated for lower urinary tract symptoms.
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Condroma/cirurgia , Cistoscopia/efeitos adversos , Sintomas do Trato Urinário Inferior/etiologia , Neoplasias da Bexiga Urinária/cirurgia , Idoso , Antibacterianos/uso terapêutico , Condroma/complicações , Condroma/diagnóstico por imagem , Feminino , Humanos , Osteomielite/tratamento farmacológico , Osteomielite/etiologia , Resultado do Tratamento , Neoplasias da Bexiga Urinária/complicações , Neoplasias da Bexiga Urinária/diagnóstico por imagem , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/etiologiaRESUMO
INTRODUCTION: Periprosthetic femoral fractures (PFF) around tumor prosthesis of knee are stubborn problems for surgeons, huge bone defect and inappropriate biomechanics of the revision implant design can be disaster for reconstruction. With the development of three-dimensional (3D) printing technology, surgeons participate more in precise preoperative design and simulation for treatment of such fractures. In this study we explored an accurate and feasible way to restore normal anatomy and function of the knee joint with 3D printing technology. CASE PRESENTATION: Rationale: This report explored an accurate and feasible way to treat PFF around tumor knee prosthesis in a 32 years old women with 3D printing technology, which restored normal anatomy and function of the knee joint. Patient concerns: Pain in left thigh lasted for 10 months after resection of left femoral chondroma and knee joint replacement four years ago. Diagnoses: periprosthetic femoral fractures (PFF) around tumor knee prosthesis. INTERVENTIONS: CT images of the patient were collected and reconstructed. Parameters of bilateral femurs were virtually sliced and measured. Novel femoral stem and nail paths were specially designed by doctors according to these parameters. The prosthetic femoral stem components and navigator were customized by engineers according to the doctor's design. The residual femoral resin model, customized components and navigator were printed with Stereo Lithography Apparatus 3D printer. The shape-preconcerted allograft bone was selected as patch for the bone defect before operation with the printed bone model. All the steps were simulated preoperatively with the models printed, and then the operation was carried out. OUTCOMES: The operation was successfully performed. The postoperative x-ray image, MSTS93 scores were examined and the function restoration sustained well in the follow-up period from 1 month to 27 months. LESSONS: 3D printing and medical interaction are key points in complex PFF cases. CONCLUSION: As for PFF of the complex tumor of knee, preoperative design and simulation with 3D printing technology may provide more accurate and effective operative outcome than traditional methods, which might be considered as a method suitable for popularization in complex and severe cases.
Assuntos
Condroma/cirurgia , Fraturas do Fêmur/cirurgia , Fixação Intramedular de Fraturas/métodos , Prótese do Joelho/efeitos adversos , Fraturas Periprotéticas/cirurgia , Adulto , Artroplastia do Joelho/efeitos adversos , Condroma/complicações , Feminino , Fraturas do Fêmur/etiologia , Fêmur/patologia , Fêmur/cirurgia , Humanos , Articulação do Joelho/cirurgia , Impressão Tridimensional , Desenho de PróteseRESUMO
BACKGROUND: Chondroma is a slowly growing, benign cartilaginous tumor which predominantly occurs in long bones of the hands and feet. Primary mediastinal chondroma is rare, especially with Horner's syndrome. CASE PRESENTATION: We reported the case of a 31-year-old woman with a posterior mediastinum mass associated with Horner's syndrome. After complete dissection of the mass, a pathological diagnosis of the primary mediastinal chondroma was rendered. The patient has shown no local recurrence or distal disease in a 3.5-year follow-up period. CONCLUSIONS: The preoperative diagnosis of chondroma should combine various examinations for comprehensive evaluation. Complete surgical resection should be the first choice of the treatment due to the risk of malignancy.
Assuntos
Condroma/patologia , Síndrome de Horner/patologia , Neoplasias do Mediastino/patologia , Adulto , Condroma/complicações , Condroma/cirurgia , Feminino , Síndrome de Horner/complicações , Síndrome de Horner/cirurgia , Humanos , Neoplasias do Mediastino/complicações , Neoplasias do Mediastino/cirurgia , PrognósticoRESUMO
BACKGROUND: Chondroma is a rare benign cartilaginous tumor that originates in chondrocytes and is commonly seen in the long bones; however, it infrequently occurs in the cervical spine. CASE DESCRIPTIONS: We report 2 patients with cervical periosteal chondroma that originated in the C2 vertebral body and C1 lamina as extramedullary tumors. The first patient was a 28-year-old man who presented with right upper extremity weakness and numbness. Cervical radiography revealed a bony tumor with evidence of severe spinal cord compression. The second patient was a 26-year-old woman with left occipital neuralgia. Cervical radiography demonstrated a bony tumor arising from the left C1 lateral mass that compressed the C2 nerve root. Both patients underwent surgical removal of the bony tumors, which were diagnosed as periosteal chondroma. CONCLUSIONS: The authors herein summarized 16 previous reports of cervical chondroma and compared the clinical courses and treatments. Recommended treatment included maximal surgical resection, especially when significant compression of the cervical cord and signal abnormality within the cord was observed. Annual postoperative follow-up is mandatory to ensure proper neurologic improvement.
Assuntos
Vértebras Cervicais/diagnóstico por imagem , Condroma/diagnóstico por imagem , Síndromes de Compressão Nervosa/diagnóstico por imagem , Compressão da Medula Espinal/diagnóstico por imagem , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Adulto , Vértebras Cervicais/cirurgia , Condroma/complicações , Condroma/cirurgia , Feminino , Humanos , Masculino , Cervicalgia/diagnóstico por imagem , Cervicalgia/etiologia , Cervicalgia/cirurgia , Síndromes de Compressão Nervosa/etiologia , Síndromes de Compressão Nervosa/cirurgia , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/cirurgia , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/cirurgiaRESUMO
We present two cases of pathologic fractures extended to the metacarpal head related with enchondromas at the metacarpal neck treated by surgery. The timing of surgery varied between the two cases. The first was operated without delay, using tumor curettage and ß-TCP (tricalcium phosphate) packing in the cavity, followed by internal fixation of the fracture using a screw and Kirshner wires. In the second case, tumor curettage and ß-TCP packing was performed after fracture union. Favorable clinical outcomes were obtained for both cases.