Quiste hidático primario músculo-esquelético: revisión de la literatura a propósito de un caso / Primary hydatid cyst of skeletal muscle: a literature review based on a case / Cisto hidático primário músculo esquelético: revisão da literatura a propósito de um caso

Resumen: Introducción: la equinococosis quística músculo-esquelética es poco frecuente, pudiendo determinar retrasos diagnósticos y errores terapéuticos. Reporte de caso: presentamos el caso de un paciente con un quiste hidático primario único a nivel de la región femoral posterior derecha, infectado. Discusión: se realizó una revisión en las bases de datos PubMed y LILACS sobre el diagnóstico y manejo terapéutico de los quistes hidáticos músculo-esqueléticos primarios. Conclusiones: la equinococosis quística músculo-esquelética debe ser tenida en cuenta dentro de los diagnósticos diferenciales de tumoraciones de partes blandas en pacientes provenientes de zonas endémicas. La tomografía computada y/o resonancia magnética cumplen un rol diagnóstico y de planificación terapéutica. El tratamiento es quirúrgico, a medida del paciente y del quiste, en función de su topografía, tamaño y fundamentalmente relaciones vasculo nerviosas y musculares. Otros factores a tener en cuenta son las futuras secuelas funcionales y resultados estéticos.

Summary: Introduction: musculoskeletal cystic echinococcosis is rather an unusual condition, what may result in delayed diagnosis and therapeutic mistakes. Case report: the study presents the case of a patient with a single primary hydatid cyst in the right posterior femoral region, which is infected. Discussion: a review of PubMed and LILACS was performed to learn about diagnosis and therapeutic handling of the primary musculoskeletal hydatid cysts. Conclusions: musculoskeletal cystic echinococcosis needs to be considered among differential diagnosis of soft tissues tumors in patients coming from endemic areas. A CT scan and RMI play an important role in diagnosis and the planning of treatment. Treatment involves surgery that must be adapted to the patient and the cyst, considering its topography and size, and in particular in view of muscular and nervous vessels relationship. Other factors to bear in mind are renal sequels and esthetic aspects.

Resumo: Introdução: a equinococose cística musculoesquelética é rara e pode determinar atrasos em seu diagnóstico e erros terapêuticos. Relato do caso: apresentamos o caso de uma paciente com cisto hidrático primário único ao nível da região femoral posterior direita, infectado. Discussão: foi realizada uma revisão nas bases de dados PubMed e LILACS sobre o diagnóstico e manejo terapêutico dos cistos hidráticos osteomusculares primários. Conclusões: a equinococose cística musculoesquelética deve ser considerada no diagnóstico diferencial de tumores de partes moles em pacientes de áreas endêmicas. A tomografia computadorizada e / ou a ressonância magnética desempenham um papel no planejamento diagnóstico e terapêutico. O tratamento é cirúrgico, adaptado ao paciente e ao cisto, dependendo de sua topografia, tamanho e, fundamentalmente, das relações vascular-nervosas e musculares. Outros fatores a serem considerados são as sequelas funcionais futuras e os resultados estéticos.

Tibial tunnel enlargement and joint instability after anterior cruciate ligament reconstruction. A prospective comparison between autograft and allograft

Abstract Purpose: To investigate tibial tunnel widening and knee instability after ACL reconstruction with hamstring autograft or irradiated soft tissue allograft. Methods: Eight-two patients were divided into two groups: autograft group and allograft group. Radiographic and clinical evaluations were performed. Results: Seventy patients were followed up with median of 36.3 months (range 36-38 months). Tibial tunnel widening was at or greater than 30% for nine patients in the autograft group and 15 patients in the allograft group (P = 0.0417). The average percentage of tibial tunnel widening was 26.7 ± 4.0 % and 29.7 ± 5.3 % in autograft and allograft groups, respectively (P = 0.0090). Knee range of motion was not affected by the reconstruction operation or different grafts. Thigh atrophy improved significantly within 24 months after ACL reconstructions in both groups. ACL reconstruction with the allograft leaded to less knee stability than that with the autograft from one year after operation (P = 0.0023). There was no significant difference between two groups with respect to Lysholm score (P = 0.1925) and Tegner score (P =0 .0918) at the final follow-up. Conclusion: The allograft group reported significantly more tibial tunnel widening and knee instability compared with the autograft group.

Post-traumatic left thigh seroma

A forty-seven-year-old male had a left-thigh trauma after a vehicular accident. The patient developed a left-thigh swelling which was managed by aspiration of a hematoma on admission and was performed twice within 3 months. Large seroma recollected and evacuation of the seroma and excision of the well-formed fibrous capsule was performed. We present this case to increase the awareness of physicians for better prevention and treatment of post-traumatic or postoperative seromas

Does hypericin boost the efficacy of high-power laser? A preliminary experimental study on rats / A hipericina aumenta a eficácia do laser de alta potência? Um estudo preliminar e experimental em ratos

CONTEXT AND OBJECTIVE: Lasers are widely used in treating symptomatic benign prostatic hyperplasia. In current practice, potassium titanyl phosphate (KTP) lasers are the most common type of laser systems used. The aim here was to evaluate the rapid effect of high-power laser systems after application of hypericin. DESIGN AND SETTING: Experimental animal study conducted in the Department of Urology, Gülhane Military Medical Academy, Ankara, Turkey, in 2012. METHODS: Sixteen rats were randomized into four groups: 120 W KTP laser + hypericin; 120 W KTP laser alone; 80 W KTP laser + hypericin; and 80 W KTP laser alone. Hypericin was given intraperitoneally two hours prior to laser applications. The laser incisions were made through the quadriceps muscle of the rats. The depth and the width of the laser incisions were evaluated histologically and recorded. RESULTS: To standardize the effects of the laser, we used the ratio of depth to width. These new values showed us the depth of the laser application per unit width. The new values acquired were evaluated statistically. Mean depth/width values were 231.6, 173.6, 214.1 and 178.9 in groups 1, 2, 3 and 4, respectively. The most notable result was that higher degrees of tissue penetration were achieved in the groups with hypericin (P < 0.05). CONCLUSIONS: The encouraging results from our preliminary study demonstrated that hypericin may improve the effects of KTP laser applications. .

CONTEXTO E OBJETIVO: Lasers são amplamente utilizados no tratamento de hiperplasia benigna de próstata sintomática. Na prática atual, lasers de fosfato de titanilo de potássio (KTP) são os tipos mais comuns usados dos sistemas. O objetivo foi avaliar o efeito rápido do sistema laser de alta potência após a aplicação de hipericina. TIPO DE ESTUDO E LOCAL: Estudo experimental animal, realizado no Departamento de Urologia, Academia de Medicina Militar de Gülhane, Ancara, Turquia, em 2012. MÉTODOS: 16 ratos foram divididos aleatoriamente em 4 grupos: 120W KTP laser + hipericina; 120W KTP laser somente; 80W KTP laser + hipericina; 80W KTP laser somente. Hipericina foi dada intraperitonealmente duas horas antes da aplicação do laser. As incisões a laser foram feitas através do músculo quadríceps dos ratos. A profundidade e a largura das incisões a laser foram avaliadas histologicamente e registradas. RESULTADOS: Para padronizar o efeito do laser foi utilizada a razão entre profundidade e largura. Estes novos valores nos mostraram a profundidade da aplicação do laser de largura por unidade. Os novos valores adquiridos foram avaliados estatisticamente. Os valores da média de profundidade/largura foram 231,6, 173,6, 214,1 e 178,9 nos grupos 1, 2, 3 e 4, respectivamente. O resultado mais notável foi atingir altos graus de penetração tecidual nos grupos com hipericina (P < 0,05). CONCLUSÕES: Os resultados promissores do nosso estudo preliminar mostraram que hipericina pode melhorar os efeitos das aplicações do laser KTP. .

Tumor mioepitelial mixto (paracordoma) / Myoepithelial mixed tumor (parachordoma)

Estudio de caso: Paciente de sexo masculino, de 38 años de edad,con tumor ación indolor a en muslo izquierdo de 3 años de evolución. Esta neoplasia corresponde típicamente a nódulos compuestos por células epiteloides poligonales, claras, que recuerdan a las de la notocorda y una segunda población de células e osinofílicas organizadas en cordones y nidos separados por estroma mixoide, con fenómenos de vacuolización citoplasmática similar a las del cordoma (células tipo fisalíferas).

Case Study: Male patient, 38 years old, with painless swelling in left thigh 3 years evolution. This neoplasm typicall y corresponds tonodules composed of polygonal epithelioid cells, clear, reminiscent of the notochord and a second population of eosinophilic cells arranged incords and nests separated by myxoid stroma with phenomena similar to cytoplasmic vacuolization the chordoma (physaliphorous type cells).

Low Grade Fibromyxoid Sarcoma in Thigh

A low grade fibromyxoid sarcoma is a rare soft tissue tumor that has a tendency to develop in the deep soft tissue of young adults and the potential for local recurrence or distant metastasis. There have been several case reports and sporadic reports in the literature. However, only 1 case has been reported in Korea but without a follow-up result. We describe a 54-year-old female patient with a low-grade fibromyxoid sarcoma of the thigh that had been growing slowly for 34 years. A marginal resection of this tumor was performed. Currently, the patient is doing well without evidence of local recurrence or distant metastasis at 5 years after surgery.

Utilización de RNM de cuerpo completo como complemento de PET-FDG de cuerpo completo: a propósito de un caso / Whole-body magnetic resonance like complement of imaging whole-body FDG-PET: case report

Exponemos el caso de una mujer de 55 años, con antecedentes de melanoma en cara interna de pierna izquierda, años atrás. Tras golpe en dicha zona, aparece nodulación que se biopsia e identifica como metástasis de melanoma. Para valorar la extensión de la enfermedad, se realiza PET-FDG, donde se identifican tres hallazgos patológicos; dos de ellos sugestivos de malignidad y un tercero de posible origen osteoarticular. Para su exacta localización y complementar imágenes PET-FDG, se realiza RNM de cuerpo completo. Sus hallazgos son coincidentes con los del estudio PET, permitiéndonos determinar que el foco hipermetabólico PET, probablemente osteoarticular, no se corresponde con alteración articular alguna, sino en porción inferior del tejido infra-rotuliano. Resaltamos la importancia de complementar la PET-FDG con RNM de cuerpo completo frente a complementar con TAC, cuando las localizaciones de focos patológicos PET se sitúen en zonas donde la RNM presente mayor sensibilidad que la TAC.

We present a case of 55 years old woman with antecedents of left leg melanoma, several years ago. After a strike in that area, a node appeared; this one was biopsed and identified as melanoma metastasis. To value the bodily extension of the disease, a PET-FDG was performed. There were three pathologic findings; two were suggestive of malignancy and the third one had a possible ostheoarticular origin. In order to have an exact localization of the lesions and to complement PET-FDG images, a whole body MRI was performed. Its findings coincide with PET findings, allowing determine that the hypermetabolic focus from PET, probably ostheoarticular, doesn´t correspond with articular alteration, but it was in lower infrapatellar tissue. We emphasize the importance of PET-FDG complement with whole-body MRI in front of to complement with CT, when the pathologic focus localizations in PET are in areas where MRI presents upper sensibility than CT.

Extraskeletal osteogenic sarcoma: a rare entity.

A 25-year-old female presented with a rapidly increasing painful swelling around right lower thigh and knee for the last 5 months with distant metastasis in the form of lung involvement. X-ray of the part showed only soft tissue swelling without any bony involvement. A diagnosis of extraskeletal osteosarcoma was made which was confirmed by immunohistochemistry.

An unusual presentation of myxoid liposarcoma: a case report.

A 50 year old female had a myxoid liposarcoma of left thigh that was widely excised. After three years, she presented with a soft tissue mass in right hypochondriac region, which was diagnosed as myxoid liposarcoma on fine needle aspiration cytology (FNAC) and was confirmed histologically.

Role of descending venography and endovenous embolization in treatment of females with lower extremity varicose veins, vulvar and posterior thigh varices

To evaluate the prevalence of refluxing pelvic veins among female patients with lower extremity varicose veins and the role of embolization treatment in these cases. Of 158 female patients suffering from primary varicose veins of the lower extremities presented to the Venous Disease Clinic at Dhahran Health Center between January 2002 and December 2004, 25 patients [15.8%] were noted to have vulvar or postero-medial thigh varices or both. Those were referred for trans-jugular descending pelvic venography with or without subsequent embolization of the contributing refluxing veins. Venous reflux contributing to the vulvoperineal or posterior thigh varices was detected in 23 patients [92%] on catheter venography. Left ovarian venous reflux was responsible for 60% of all cases. Embolization, using multiple coils, was successful in 18 patients with positive reflux [78.3%]. One patient had primary vulvar venous malformation that required additional percutaneous sclerotherapy using dehydrated ethanol. Four patients had femoro-saphenous reflux contributing to the varices and required subsequent surgical ligation excision. All treated cases showed significant improvement of their symptoms without any procedure related complications. In patients with vulvar or postero-medial thigh varicose veins, radiological study of ovarian and hypogastric venous reflux should be considered. Trans-jugular descending venography and embolization is a feasible, effective and safe diagnostic and therapeutic modality

MR Imaging in a Child with Scurvy: a Case Report

Scurvy is very rare disease in industrialized societies. Nevertheless, it still exists in higher risk groups including economically disadvantaged populations with poor nutrition, such as the elderly and chronic alcoholics. The incidence of scurvy in the pediatric population is very low. This study reports a case of scurvy in a 5-year-old girl with cerebral palsy and developmental delay based on MRI findings.

Painless angioleiomyoma: a case report with review of literature.

A 55 year old male, who presented with a painless swelling of six months duration on his thigh, was clinically diagnosed to have a benign soft tissue neoplasm. Histological examination of the excision biopsy specimen revealed a benign tumour of the vascular smooth muscle, which was diagnosed as angioleiomyoma. Angioleiomyomas are painful lesions that can occur anywhere in the body. We present this case for its atypical clinical presentation and discuss its histologic features with a review of literature.

Fine needle aspiration cytology [FNAC] in diagnosis of tumoral calcinosis, a report of three cases

Tumoral calcinosis [T.C.] is very rare and generally of unknown aetiology characterized by calcific deposits in the soft tissues. Commonly seen in the second decade of life [reported age range 15 months to 83 years]. We are reporting 3 cases of T. C. who were initially diagnosed by FNAC. Two of the 3 cases were female siblings who were referred to us as possible cases of recurrent fibrosarcomas following surgical excision. [1] Two female siblings aged 17 and 14 years - complaining of large swelling in the upper outer right thigh and the left outer upper thigh around the hip joints respectively. There was no limitation of movement. The masses recurred within a short period after total excision. Neither specimen was subjected to histopathology. Clinical examination showed two masses each approximately 30cm maximum diameter and 10 cm width. In addition the younger sister showed an additional mass 4.5 cm in the outer aspect of her right elbow. [2] 18 months old female child, unrelated to the above two cases, presented with an egg-sized mass in the mid-lateral aspect of her right thigh - cystic and mobile. There is a history of quinine injection in the same area. No positive family history of a similar condition. All three cases showed normocalcaemia and hyperphosphataemia with specks of calcification on x - ray and cysts in ultrasound. FNAC showed structureless gung, calcium granules and inflammatory cells including foreign body type multinucleated giant cells. Histopathology confirmed the diagnosis of T. C. Described the three types of T. C. [familial, idiopathic, and that in patients of chronic renal failure on dialysis]. The differential diagnoses were also discussed as well as lines of management such as Ca[++] supplementation, phosphate restriction, acetazolamide, parathyroidectomy and the treatment of choice is total surgical excision. To our best knowledge this is the first time to report the use of fine needle aspiration cytology in the diagnosis of T. C. in Sudan

Transluminal Removal of a Fractured and Embolized Indwelling Central Venous Catheter in the Pulmonary Artery

Vascular catheters are associated with complications such as infection, thrombosis and stenosis. The embolization of a venous catheter fragment is a rare complication. A 39-year-old woman underwent placement of a totally implantable venous access device for chemotherapy to treat a recurrent liposarcoma of the left thigh. The "pinch-off sign" was noted on a routine chest X-ray but that was ignored. Three-months after implantation of the intravenous access device, the indwelling central catheter was fractured and embolized to the pulmonary trunk. The catheter in the pulmonary trunk was successfully removed through a percutaneous femoral vein approach using a pigtail catheter and goose neck snare.

Nueva alternativa terapéutica en NEVIL: a propósito de un caso / New therapeutic options in inflammatory linear verrucous epidermal nevus (ILVEN): a case report

El nevo epidérmico verrucoso inflamatorio lineal (NEVIL) es un hamartoma cutáneo poco frecuente, caracterizado por placas pruriginosas, eritematosas, de aspecto verrucoso y de distribución lineal. Múltiples esquemas terapéuticos han sido descritos en la literatura, predominando en ellos una respuesta parcial y la recurrencia de la lesión. Presentamos el casos de una paciente con un NEVIL tratado tópicamente mediante la combinación de 5-Fluorouracilo y ácido retinoico, con una resolución casi completa y mantenida de la lesión cutánea. Se hace una revisión, además de los principales aspectos clínicos del NEVIL junto con las modalidades terapéuticas descritas hasta ahora en la literatura.

Infected primary intramuscular echinococcosis of thigh.

An unusual case of infected primary echinococcosis involving quadriceps muscles of the thigh and presenting as a cystic mass in a child is being reported. The diagnosis was made preoperatively with ultrasound examination and serology. After a cover of medical treatment the cyst was excised. Various clinical possibilities and management strategies are discussed.