RESUMO
Hypertrophic pulmonary osteoarthropathy( HPO) is a rare paraneoplastic manifestation of lung cancer that causes joint pain, joint swelling, and limited range of motion. Two surgical cases of lung cancer with HPO are presented. Case1:A 43-year-old female was referred to our department with a diagnosis of cStage â ¡B left hilar lung cancer. She had difficulty in walking due to arthralgia caused by HPO. Left pneumonectomy was performed and the arthralgia disappeared on the first postoperative day. The patient is being well after surgery without relapse of joint symptoms. Case2:The patient was a 65-year-old male with cStage â ¡A right lung cancer. The symptoms of HPO appeared after he was found to have lung cancer. After right upper lobectomy, the arthralgia disappeared on the first postoperative day. Currently, he is receiving adjuvant chemotherapy, without relapse of joint symptoms.
Assuntos
Neoplasias Pulmonares , Osteoartropatia Hipertrófica Secundária , Adulto , Idoso , Artralgia/complicações , Artralgia/cirurgia , Feminino , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , Masculino , Recidiva Local de Neoplasia/cirurgia , Osteoartropatia Hipertrófica Secundária/diagnóstico por imagem , Osteoartropatia Hipertrófica Secundária/etiologia , Osteoartropatia Hipertrófica Secundária/cirurgia , Pneumonectomia/efeitos adversosRESUMO
Hypertrophic pulmonary osteoarthropathy(HPO)is a tumor-associated syndrome that features the triad of clubbed fingers, periosteal bone growth in long bones, and arthritis, and is often associated with an adenocarcinoma or squamous cell carcinoma. This report presents details of a case of HPO associated with pleomorphic carcinoma, which was relieved by treatment. A 47-year-old woman was presented with a complaint of generalized arthralgia. A physical examination showed swollen joints in the body and clubbed fingers. Chest CT revealed a mass shadow in the left upper lobe and ultrasound- guided biopsy findings led to a diagnosis of non-small cell lung cancer. Furthermore, bone scintigraphy indicated symmetrical accumulation in bones and joints throughout the body. A right upper lobectomy was performed along with combined chest wall resection and mediastinal lymph node dissection with an open chest, and the presence of lung cancer complicated with HPO was indicated. Pathological examination results revealed a diagnosis of pleomorphic carcinoma(pT4N0M0, Stage â ¢A). Systemic arthralgia was resolved on the first postoperative day. One year after surgery, a solitary brain metastasis developed and was removed, with no recurrence at the time of writing. Joint symptoms related to HPO can be expected to improve with treatment of pulmonary lesions, thus aggressive procedures for diagnosis and treatment are desirable.
Assuntos
Carcinoma Pulmonar de Células não Pequenas , Carcinoma de Células Escamosas , Neoplasias Pulmonares , Osteoartropatia Hipertrófica Secundária , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/cirurgia , Neoplasias Pulmonares/patologia , Carcinoma Pulmonar de Células não Pequenas/complicações , Osteoartropatia Hipertrófica Secundária/cirurgia , Osteoartropatia Hipertrófica Secundária/complicações , Carcinoma de Células Escamosas/complicações , Artralgia/complicaçõesRESUMO
BACKGROUND: Pulmonary hypertrophic osteoarthropathy (PHO) is a rare paraneoplastic syndrome that mainly occurs in patients with lung cancer. Most symptoms occur symmetrically, and unilateral symptoms without clubbing are infrequent. This report presents the case of a rare atypical symptom that was highly suspected of being PHO. CASE PRESENTATION: A 77-year-old woman with swelling and severe pain in the left femur for 2 months was referred to our hospital. Radiography revealed a remarkably osteogenic thickening and sclerotic lesion in her distal femur. Preliminary diagnoses of malignant bone tumor and hematological tumor were made based on laboratory test results, radiological examination, and clinical manifestation. A needle biopsy was performed, which ruled out the diagnosis of malignant bone tumors. A low-grade bone tumor was still suspected. After that, en bloc resection was performed, followed by replacement of the femur with a mega-prosthesis. Pathological analysis revealed no malignant tumor cells, and immunohistochemical staining for CDK4 and MDM2 yielded negative results. Meanwhile, pulmonary large cell carcinoma was identified on biopsy. Based on published studies, a diagnosis of atypical PHO was made according to clinical and imaging manifestations. CONCLUSIONS: This is an infrequent case of PHO with unilateral symptoms in the left femur. When clinical manifestations and radiological findings are inconsistent with the pathological results, the possibility of benign lesions with malignant clinical manifestations or imaging features should be carefully considered.
Assuntos
Carcinoma de Células Grandes , Fêmur/diagnóstico por imagem , Neoplasias Pulmonares , Osteoartropatia Hipertrófica Secundária , Síndromes Paraneoplásicas , Idoso , Carcinoma de Células Grandes/complicações , Carcinoma de Células Grandes/diagnóstico , Feminino , Fêmur/patologia , Fêmur/cirurgia , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/diagnóstico , Osteoartropatia Hipertrófica Secundária/diagnóstico , Osteoartropatia Hipertrófica Secundária/etiologia , Osteoartropatia Hipertrófica Secundária/cirurgia , Síndromes Paraneoplásicas/diagnóstico , Síndromes Paraneoplásicas/etiologia , Síndromes Paraneoplásicas/cirurgiaRESUMO
Osteoid osteoma of the distal phalanx is very rare. We describe a case of osteoid osteoma of the distal phalanx of the ring finger with clubbed finger deformity that improved after tumour removal. A 50-year-old left-handed man presented with a history of right ring finger pain without any trauma. The distal phalanx of the ring finger had tender, redness, and a clubbed finger deformity. Plain radiography indicated a circular radiolucent area in the centre of the lesion. Computed tomography and gadolinium enhanced magnetic resonance imaging indicated presence of a nidus. The lesion was removed via the transungual approach. Histopathological examination confirmed the presence of an osteoid osteoma. His pain was immediately relieved after surgery. At the 2-year followup, he had no pain and the clubbed finger deformity had improved. In cases where clubbed finger deformity involves only one finger, the possibility of chronic osteomyelitis or osteoid osteoma should be considered.
Assuntos
Neoplasias Ósseas/diagnóstico , Neoplasias Ósseas/cirurgia , Falanges dos Dedos da Mão , Osteoartropatia Hipertrófica Secundária/etiologia , Osteoma Osteoide/diagnóstico , Osteoma Osteoide/cirurgia , Neoplasias Ósseas/complicações , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Osteoartropatia Hipertrófica Secundária/diagnóstico , Osteoartropatia Hipertrófica Secundária/cirurgia , Osteoma Osteoide/complicações , Radiografia , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Prosthetic vascular graft procedures are a common treatment modality for peripheral vascular disease. A relatively common complication is graft infection, occurring at a rate of 0.5-5%. When they occur, graft infections are associated with significant morbidity and mortality. Vascular graft infections also represent a diagnostic and therapeutic challenge for the physician METHODS: Here, we report a case where the rare finding of secondary hypertrophic osteoarthropathy was an important indication of underlying aortic graft infection that was initially misdiagnosed. A review of the literature revealed 34 cases of vascular graft infection associated with hypertrophic osteoarthropathy. RESULTS: The mean interval from surgery to time of infection was approximately 5 years. Mortality was 35%. When combined with hypertrophic osteoarthropathy, vascular graft infection was complicated by an aortoenteric fistula in 53% of the cases. CONCLUSION: The complexity of this case highlights the challenges physicians face in order to diagnose and treat this condition.
Assuntos
Aorta/cirurgia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Prótese Vascular/efeitos adversos , Artéria Femoral/cirurgia , Osteoartropatia Hipertrófica Secundária/diagnóstico , Doença Arterial Periférica/cirurgia , Infecções Relacionadas à Prótese/diagnóstico , Adolescente , Adulto , Idoso , Remoção de Dispositivo , Erros de Diagnóstico , Evolução Fatal , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Osteoartropatia Hipertrófica Secundária/diagnóstico por imagem , Osteoartropatia Hipertrófica Secundária/microbiologia , Osteoartropatia Hipertrófica Secundária/cirurgia , Valor Preditivo dos Testes , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/cirurgia , Resultado do TratamentoRESUMO
Secondary hypertrophic osteoarthropathy (HOA), also known as Marie-Bamberger syndrome, is a rare neoplastic syndrome featuring clubbing of the tips of the digits, periosteal proliferation and synovial effusion of adjacent joints. We report a case where a patient without any other known medical condition developed persistent arthralgia and mobility restriction after bruising the left knee. As the initial X-ray examination of the knee showed a distinct periosteal proliferation of the left femoral bone, extended diagnostics were initiated during which a bronchial carcinoma was identified. After surgical removal of the primary tumor the symptoms of irritation in the knee joint recovered totally.
Assuntos
Adenocarcinoma/secundário , Adenocarcinoma/cirurgia , Artralgia/etiologia , Artralgia/prevenção & controle , Carcinoma Broncogênico/secundário , Carcinoma Broncogênico/cirurgia , Osteoartropatia Hipertrófica Secundária/complicações , Osteoartropatia Hipertrófica Secundária/cirurgia , Adenocarcinoma/complicações , Artralgia/diagnóstico , Carcinoma Broncogênico/complicações , Feminino , Fêmur/cirurgia , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/patologia , Articulação do Joelho/cirurgia , Pessoa de Meia-Idade , Osteoartropatia Hipertrófica Secundária/diagnóstico , Radiografia , Resultado do TratamentoRESUMO
Single clubbed finger is an extremely rare condition that may show the presence of an underlying neoplasm of the distal phalanx. We describe a case of clubbing in a young adult patient with an enchondroma of the ring finger distal phalanx. The patient had a history of antecedent trauma to the left ring finger, suggesting the diagnosis of intraosseous epidermoid cyst rather than enchondroma. The lesion was successfully treated by curettage and packing of the bony defect with a synthetic bone substitute. Histologically, the tumour consisted of small, uniform chondrocytes without cytologic atypia. At the seven months follow-up, the patient had no evidence of recurrence, with a nearly normal-looking finger. We suggest that enchondroma should be considered in the differential diagnosis of clubbing in a single digit.
Assuntos
Neoplasias Ósseas/complicações , Condroma/complicações , Falanges dos Dedos da Mão/cirurgia , Procedimentos Ortopédicos/métodos , Osteoartropatia Hipertrófica Secundária/etiologia , Biópsia , Neoplasias Ósseas/diagnóstico , Neoplasias Ósseas/cirurgia , Condroma/diagnóstico , Condroma/cirurgia , Diagnóstico Diferencial , Feminino , Falanges dos Dedos da Mão/patologia , Humanos , Imageamento por Ressonância Magnética , Osteoartropatia Hipertrófica Secundária/diagnóstico , Osteoartropatia Hipertrófica Secundária/cirurgia , Adulto JovemRESUMO
Hypertrophic osteoarthropathy is a syndrome frequently described in intrathoracic diseases, especially malignant ones. The association with lung tuberculosis is rarely reported. The authors describe the case of a 35-year-old patient, a smoker, hospitalised for lung cavitation associated with hypertrophic osteoarthropathy. The assessment of the aetiology was negative and the patient underwent lung surgery. The histopathological examination concluded as to chronic pulmonary tuberculosis. This report aims at alerting physicians about the possibility of hypertrophic osteoarthropathy in non malignant diseases, especially pulmonary tuberculosis which is still endemic in our country.
Assuntos
Osteoartropatia Hipertrófica Secundária/diagnóstico , Tuberculose Pulmonar/diagnóstico , Adulto , Antituberculosos/uso terapêutico , Bronquiectasia/diagnóstico , Bronquiectasia/patologia , Bronquiectasia/cirurgia , Broncoscopia , Terapia Combinada , Diagnóstico Diferencial , Quimioterapia Combinada , Humanos , Processamento de Imagem Assistida por Computador , Pulmão/patologia , Masculino , Osteoartropatia Hipertrófica Secundária/patologia , Osteoartropatia Hipertrófica Secundária/cirurgia , Pneumonectomia , Tomografia Computadorizada por Raios X , Teste Tuberculínico , Tuberculose Pulmonar/patologia , Tuberculose Pulmonar/cirurgia , TunísiaAssuntos
Adenocarcinoma/diagnóstico , Neoplasias Pulmonares/diagnóstico , Osteoartropatia Hipertrófica Secundária/diagnóstico , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/cirurgia , Feminino , Febre , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/cirurgia , Pessoa de Meia-Idade , Osteoartropatia Hipertrófica Secundária/tratamento farmacológico , Osteoartropatia Hipertrófica Secundária/cirurgia , Medicina TropicalRESUMO
The association of paraneoplastic hypoglycemia [Doege-Potter syndrome] and finger clubbing [Pierre-Marie-Bamberg syndrome] with pleural solitary fibrous tumour is rare. We present a previously unpublished but typical example of this rare occurrence together with a detailed updated literature review of previously published cases of pleural SFT discussing the histopathology of SFT; pathophysiology of the hypoglycemia and finger clubbing; treatment and outcome of pleural SFT. The patient, a 57-year-old African male was admitted at our hospital with recurrent episodes of hypoglycemia. He was found to have digital clubbing and decreased breath sounds in the right lower chest but no other significant clinical findings. His insulin level measured during an episode of hypoglycemia was undetectable. Chest radiograph and CT-scan revealed a lobulated mass in the right chest which was diagnosed to be SFT on histology. Surgical excision of the mass resulted in cure of the hypoglycemic episodes and rapid regression of the clubbing. Less than 65 cases of pleural SFT manifesting with hypoglycemia with or without finger-clubbing have been published in the English literature. The mean diameter of these tumours manifesting with hypoglycemia is 20 cm, 54% being benign while 42% were malignant. They predominantly present in the 6th-8th decade, average age of 64 years and a slight male preponderance at 58%. Complete surgical resection remains the most important predictor of clinical outcome in terms of recurrence and metastases, while providing instant cure for the hypoglycemia and rapid resolution of the finger clubbing.
Assuntos
Hipoglicemia/cirurgia , Osteoartropatia Hipertrófica Secundária/cirurgia , Síndromes Paraneoplásicas/cirurgia , Tumor Fibroso Solitário Pleural/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Glicemia/análise , Peptídeo C/análise , Feminino , Humanos , Hipoglicemia/etiologia , Insulina/análise , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Osteoartropatia Hipertrófica Secundária/diagnóstico , Síndromes Paraneoplásicas/etiologia , Tumor Fibroso Solitário Pleural/complicações , Tumor Fibroso Solitário Pleural/diagnóstico , Resultado do TratamentoRESUMO
OBJECTIVE: To objectively evaluate the reversal of digital clubbing (DC) in a series of surgically treated lung cancer patients, and to review the literature on the subject. METHODS: Sixty-one patients with non-small cell lung cancer--40 with and 21 without DC--were treated by pulmonary resection. Eleven (18%) received additional postoperative radiation therapy. Preoperatively, as well as on postoperative days 7, 18, and 90, the hyponychial angle (HA) and the distal phalangeal depth/interphalangeal depth (DPD/IPD) ratio were determined on profile shadow projections of the index fingers. A review of the literature on reversal of DC (1954-2007) was also performed. RESULTS: From the preoperative period to postoperative day 90, HA decreased from 200.5 +/- 5.0 masculine to 193.3 +/- 6.8 masculine (p < 0.001), and the DPD/IPD ratio decreased from 1.014 +/- 0.051 mm to 0.956 +/- 0.045 mm (p < 0.001) in the group of 40 patients with DC. The HA and the DPD/IPD ratio decreased in 33 (82.5%) but remained the same in 7 (1.7%), 6 with unfavorable evolution. In the 21 patients without DC, HA (184.5 +/- 5.5 masculine) and the DPD/IPD ratio (0.937 +/- 0.046 mm) remained unchanged after surgery. In the literature (1954-2007), we found 52 cases, 5 of which were lung cancer cases, in which reversal of DC, observed in several clinical conditions, was explicitly reported. CONCLUSION: In most lung cancer patients, DC resolves after effective surgical treatment of the tumor, as can occur in patients with other conditions.
Assuntos
Carcinoma de Células Escamosas/cirurgia , Neoplasias Pulmonares/cirurgia , Osteoartropatia Hipertrófica Secundária/cirurgia , Adulto , Distribuição por Idade , Idoso , Carcinoma de Células Escamosas/radioterapia , Feminino , Humanos , Neoplasias Pulmonares/etiologia , Neoplasias Pulmonares/radioterapia , Masculino , Pessoa de Meia-Idade , Osteoartropatia Hipertrófica Secundária/radioterapia , Período Pós-Operatório , Cuidados Pré-Operatórios , Distribuição por Sexo , Fumar/efeitos adversos , Resultado do TratamentoRESUMO
OBJETIVO: Estudar, por meio de avaliações objetivas, a ocorrência de regressão do hipocratismo digital (HD) em pacientes com câncer de pulmão, tratados cirurgicamente, e revisar a literatura sobre o assunto. MÉTODOS: Sessenta e um pacientes com câncer de pulmão não-pequenas células-40 com e 21 sem HD-foram tratados por cirurgia de ressecção pulmonar. Onze deles (18 por cento) também receberam radioterapia pós-operatória. No período pré-operatório e no 7º, no 18º e no 90º dia pós-operatório, o ângulo hiponiquial (AH) e a relação entre as espessuras falangeana distal e interfalangeana (EFD/EIF) foram determinados sobre imagens da sombra dos dedos indicadores em perfil. Uma revisão da literatura sobre regressão do HD (1954-2007) também foi efetuada. RESULTADOS: Do período pré-operatório ao 90º dia pós-operatório, o AH diminuiu de 200,5 ± 5,0º para 193,3 ± 6,8º (p < 0,001), e a relação EFD/EIF, de 1,014 ± 0,051 mm para 0,956 ± 0,045 mm (p < 0,001) no grupo de 40 pacientes com HD. Em 33 (82,5 por cento), o AH e a relação EFD/EIF diminuíram, mas, em 7 (1,7 por cento), 6 com evolução desfavorável, esses valores não se reduziram. Nos 21 pacientes sem HD, tanto o AH (184,5 ± 5,5º) como a relação EFD/EIF (0,937 ± 0,046 mm) permaneceram inalterados após a cirurgia. Na literatura (1954-2007) foram encontrados 52 casos em que a regressão do HD, observada em diversas condições clínicas, foi explicitamente referida, 5 dos quais eram casos de câncer de pulmão. CONCLUSÕES: O HD em pacientes com câncer de pulmão regride na maioria dos casos após tratamento cirúrgico efetivo do tumor, o que pode também ocorrer em pacientes com outras condições.
OBJECTIVE: To objectively evaluate the reversal of digital clubbing (DC) in a series of surgically treated lung cancer patients, and to review the literature on the subject. METHODS: Sixty-one patients with non-small cell lung cancer-40 with and 21 without DC-were treated by pulmonary resection. Eleven (18 percent) received additional postoperative radiation therapy. Preoperatively, as well as on postoperative days 7, 18, and 90, the hyponychial angle (HA) and the distal phalangeal depth/interphalangeal depth (DPD/IPD) ratio were determined on profile shadow projections of the index fingers. A review of the literature on reversal of DC (1954-2007) was also performed. RESULTS: From the preoperative period to postoperative day 90, HA decreased from 200.5 ± 5.0º to 193.3 ± 6.8º (p < 0.001), and the DPD/IPD ratio decreased from 1.014 ± 0.051 mm to 0.956 ± 0.045 mm (p < 0.001) in the group of 40 patients with DC. The HA and the DPD/IPD ratio decreased in 33 (82.5 percent) but remained the same in 7 (1.7 percent), 6 with unfavorable evolution. In the 21 patients without DC, HA (184.5 ± 5.5º) and the DPD/IPD ratio (0.937 ± 0.046 mm) remained unchanged after surgery. In the literature (1954-2007), we found 52 cases, 5 of which were lung cancer cases, in which reversal of DC, observed in several clinical conditions, was explicitly reported. CONCLUSION: In most lung cancer patients, DC resolves after effective surgical treatment of the tumor, as can occur in patients with other conditions.
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Carcinoma de Células Escamosas/cirurgia , Neoplasias Pulmonares/cirurgia , Osteoartropatia Hipertrófica Secundária/cirurgia , Distribuição por Idade , Carcinoma de Células Escamosas/radioterapia , Neoplasias Pulmonares/etiologia , Neoplasias Pulmonares/radioterapia , Osteoartropatia Hipertrófica Secundária/radioterapia , Período Pós-Operatório , Cuidados Pré-Operatórios , Distribuição por Sexo , Fumar/efeitos adversos , Resultado do TratamentoRESUMO
Finger clubbing can be a single physical finding. In Touraine-Solente-Gole syndrome, the primary form of hypertrophic osteoarthropathy, it is mostly associated with bone pain, hyperhydrosis, pachydermy and wrinkling of the forehead. In other cases, the presence of clubbing is associated with neoplastic, pulmonary, cardiac or other diseases and is then called Bamberger-Pierre-Marie syndrome, the secondary type of hypertrophic osteoarthropathy. The patient's history and careful physical examination, sometimes accompanied by laboratory and imaging studies, leads to the diagnosis. A patient with hereditary hypertrophic osteoarthropathy and its clinical symptoms is presented. Surgical correction of the clubbing fingers is demonstrated in the paper with bilateral resection and shortening of the nail bed, nail matrix and resection of soft tissue. Clubbing fingers are rare, but they might be part of a syndrome or a symptom of other diseases. Reconstructive surgery for aesthetic reasons can be performed.
Assuntos
Osteoartropatia Hipertrófica Primária/cirurgia , Osteoartropatia Hipertrófica Secundária/cirurgia , Adulto , Fatores Etários , Diagnóstico Diferencial , Estética , Dedos/patologia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartropatia Hipertrófica Primária/diagnóstico , Osteoartropatia Hipertrófica Primária/diagnóstico por imagem , Osteoartropatia Hipertrófica Primária/patologia , Osteoartropatia Hipertrófica Secundária/diagnóstico , Osteoartropatia Hipertrófica Secundária/diagnóstico por imagem , Osteoartropatia Hipertrófica Secundária/patologia , Qualidade de Vida , Radiografia , Fatores de Tempo , Resultado do TratamentoRESUMO
Various modalities for the treatment of hypertrophic pulmonary osteoarthropathy (HPOA) associated with lung cancer have been suggested since 1958. Although the etiology remains speculative, unilateral vagotomy on the side of the lung cancer achieves symptomatic relief. We report a case of a 50-year-old woman with disabling HPOA and inoperable lung cancer who experienced effective pain relief and regained full mobility after video-assisted thoracoscopic surgery was used to perform truncal vagotomy. This relatively safe and simple procedure should be considered for terminal lung cancer patients with intractable HPOA.
Assuntos
Adenocarcinoma/complicações , Neoplasias Pulmonares/complicações , Osteoartropatia Hipertrófica Secundária/etiologia , Osteoartropatia Hipertrófica Secundária/cirurgia , Cuidados Paliativos , Cirurgia Torácica Vídeoassistida , Vagotomia , Feminino , Dedos/patologia , Humanos , Pessoa de Meia-Idade , Movimento , Osteoartropatia Hipertrófica Secundária/patologia , Osteoartropatia Hipertrófica Secundária/fisiopatologia , Resultado do TratamentoAssuntos
Antebraço/anormalidades , Predisposição Genética para Doença , Deformidades Congênitas da Mão , Polidactilia , Sindactilia , Diagnóstico Diferencial , Deformidades Congênitas da Mão/epidemiologia , Deformidades Congênitas da Mão/patologia , Deformidades Congênitas da Mão/cirurgia , Humanos , Incidência , Osteoartropatia Hipertrófica Secundária/epidemiologia , Osteoartropatia Hipertrófica Secundária/patologia , Osteoartropatia Hipertrófica Secundária/cirurgia , Polidactilia/epidemiologia , Polidactilia/patologia , Polidactilia/cirurgia , Sindactilia/epidemiologia , Sindactilia/patologia , Sindactilia/cirurgia , Polegar/anormalidades , Ulna/anormalidadesRESUMO
Along with angiopathy, neuropathy and osteoarthropathy are the most important effects of diabetes mellitus with regard to the foot. Because diagnosis in cases of these two consequences are very frequently wrong and too late, the diagnostic procedure and differential diagnosis will be discussed first. The goal of surgical and conservative treatment is a functioning foot and not amputation and provision of a prosthesis. The five types of osteoarthropathy together with the operative procedure for each are introduced: at the forefoot, resection of from one to all metatarsal radii whilst sparing the toes; at the metatarsus, the removal of projecting fragments; at the dorsal foot, resectioning arthroplasty. The operative procedures usual in traumatology cannot simply be transferred to osteoarthropathy. Arthrodeses and spongiosa grafting are doomed to failure in the neuropathic area, or at least carry the onus of a much longer period of convalescence. Resectioning arthroplasty for constructing a stiff pseudarthrosis is an alternative. The results are, however, only lasting if perfect orthopedic care and regular care and checking of the feet are guaranteed thereafter.
Assuntos
Artropatia Neurogênica/cirurgia , Pé Diabético/cirurgia , Neuropatias Diabéticas/cirurgia , Osteoartropatia Hipertrófica Secundária/cirurgia , Artropatia Neurogênica/diagnóstico , Artropatia Neurogênica/etiologia , Pé Diabético/diagnóstico , Pé Diabético/etiologia , Neuropatias Diabéticas/diagnóstico , Neuropatias Diabéticas/etiologia , Diagnóstico Diferencial , Humanos , Procedimentos Ortopédicos , Osteoartropatia Hipertrófica Secundária/diagnóstico , Osteoartropatia Hipertrófica Secundária/etiologia , PrognósticoAssuntos
Anormalidades Múltiplas/classificação , Anormalidades Múltiplas/cirurgia , Braço/anormalidades , Rádio (Anatomia)/anormalidades , Ulna/anormalidades , Animais , Braço/embriologia , Humanos , Recém-Nascido , Osteoartropatia Hipertrófica Secundária/classificação , Osteoartropatia Hipertrófica Secundária/cirurgia , Polidactilia/classificação , Polidactilia/etiologia , Rádio (Anatomia)/embriologia , Rádio (Anatomia)/cirurgia , Cirurgia Plástica/métodos , Sindactilia/classificação , Sindactilia/etiologia , Ulna/cirurgiaRESUMO
We report on a 39-year-old female who had been operated on for an atrial septal defect at the age of 14 years. On operation the inferior vena cava was iatrogenically misdirected into the left atrium. The cyanotic patient, in functional group IV of the NYHA classification, with polyglobulia and clubbing of the fingers was successfully reoperated after 25 years.
Assuntos
Comunicação Interatrial/cirurgia , Osteoartropatia Hipertrófica Secundária/cirurgia , Complicações Pós-Operatórias/cirurgia , Adulto , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/cirurgia , Comunicação Interatrial/diagnóstico por imagem , Hemodinâmica/fisiologia , Humanos , Doença Iatrogênica , Osteoartropatia Hipertrófica Secundária/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Radiografia , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/cirurgiaRESUMO
A case of hypertrophic pulmonary osteoarthropathy (HPOA) in a HIV-infected patient with granulomatous Pneumocystis carinii pneumonia is described. This is the third case of HPOA associated with AIDS reported in the literature. Granulomatous P. carinii pneumonia is an unusual manifestation of P. carinii infection. Surgical treatment of this condition may lead to the dramatic spread of P. carinii causing a fulminant course with fatal outcome.