Assuntos
Neuropatias do Plexo Braquial , Hanseníase , Abscesso/diagnóstico , Abscesso/diagnóstico por imagem , Neuropatias do Plexo Braquial/complicações , Neuropatias do Plexo Braquial/diagnóstico , Humanos , Hanseníase/complicações , Hanseníase/diagnóstico , Imageamento por Ressonância Magnética/métodos , Espectroscopia de Ressonância Magnética , Nervo Ulnar/diagnóstico por imagem , Nervo Ulnar/patologiaRESUMO
Leprosy is a chronic infectious disease that presents with varied manifestations. Pure neuritic leprosy is one of the rarest forms of the disease which is characterized by nerve involvement without the characteristic cutaneous stigmata. Eleven year old, healthy male presented with progressively increasing painful swelling at the medial aspect of the arm near to the right elbow joint with difficulty in extending right ring and little fingers at interphalangeal joint and numbness in the same region for last 1 year with no cutaneous abnormalities. Physical examination revealed 6x3 cm firm, tender lesion 3 cm proximal to the right elbow joint with positive tinel's sign, without signs of inflammation, along with characteristic claw hand deformity of right hand and atrophy of hypothenar and interossei muscle. Electro-diagnostic testing revealed findings consistent with a right ulnar axonal neuropathy above the elbow. Magnetic resonance imaging revealed well defined heterogeneously hyper intense linear lesion along the course of thickened ulnar nerve in the distal arm extending posterior to the medial condyle. It also showed an oval shaped lesion (2.1x1.0 cm) arising from the same segment of the nerve, without any bony or muscular involvement of that area. The patient underwent surgical exploration and ulnar nerve decompression with biopsy. Pathology revealed necrotizing granulomatous inflammatory acid fast bacilli stain negative lesion, which was histologically consistent with caseous abscess caused by tuberculoid leprosy, pathognomonic for Hansen's disease. He has been started on antibiotic therapy and is referred to leprosy center for further course of management. Pure neuritic leprosy, though rare, should be considered as differential diagnosis in cases presenting with peripheral neuropathy at leprosy-endemic areas. Prompt diagnosis and treatment is imperative to prevent permanent neurological injury.
Assuntos
Hanseníase Tuberculoide/diagnóstico , Nervo Ulnar/diagnóstico por imagem , Abscesso/diagnóstico , Antibacterianos/uso terapêutico , Biópsia , Criança , Diagnóstico Diferencial , Cotovelo , Humanos , Hanseníase Tuberculoide/tratamento farmacológico , Hanseníase Tuberculoide/patologia , Imageamento por Ressonância Magnética , Masculino , Nervo Ulnar/patologiaAssuntos
Abscesso/diagnóstico , Erros de Diagnóstico , Hanseníase/diagnóstico , Neuroma/diagnóstico , Doenças do Sistema Nervoso Periférico/diagnóstico , Tuberculose dos Linfonodos/diagnóstico , Abscesso/microbiologia , Abscesso/patologia , Humanos , Índia , Hanseníase/patologia , Masculino , Neuroma/microbiologia , Neuroma/patologia , Doenças do Sistema Nervoso Periférico/microbiologia , Doenças do Sistema Nervoso Periférico/patologia , Tuberculose dos Linfonodos/patologia , Adulto JovemRESUMO
The treatment in acute diverticulitis has undergone a considerable shift from an offensive to a more restrictive and individual indication for surgery. This review of the very recent literature with special regard to long-term observation of conservatively treated patients clearly shows that surgery is not required in any case of a first episode of severe diverticulitis, but should be recommended in high-risk patients under immunosuppression or chronic renal failure. In all other groups of patients the indication for surgery should be weighed on an individual basis after each episode, again aiming for the laparoscopic procedure. A therapeutic algorithm is proposed according to the Hansen-Stock classification.
Assuntos
Colectomia , Doença Diverticular do Colo/cirurgia , Abscesso/diagnóstico , Abscesso/cirurgia , Doença Aguda , Algoritmos , Colonoscopia , Doença Diverticular do Colo/diagnóstico , Medicina Baseada em Evidências , Seguimentos , Fidelidade a Diretrizes , Humanos , Enteropatias/diagnóstico , Enteropatias/cirurgia , Perfuração Intestinal/diagnóstico , Perfuração Intestinal/cirurgia , Fatores de RiscoAssuntos
Abscesso/diagnóstico , Hanseníase Paucibacilar/complicações , Lipoma/diagnóstico , Doenças do Sistema Nervoso Periférico/diagnóstico , Neoplasias Cutâneas/diagnóstico , Abscesso/tratamento farmacológico , Abscesso/microbiologia , Diagnóstico Diferencial , Humanos , Hanseníase Paucibacilar/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso Periférico/tratamento farmacológico , Doenças do Sistema Nervoso Periférico/microbiologiaRESUMO
INTRODUCTION: It is often postulated that younger patients with acute sigmoid diverticulitis (SD) have an increased risk of perforation which constitutes an indication for early surgery. The aim of this study was to correlate the severity of sigmoid diverticulitis with patient age in order to check the surgical indication in younger patients. PATIENTS AND METHODS: Patients with acute SD from January 1998 to June 2009 were included. Two age groups were distinguished: group I (GI) ≤40 years in age and group II (GII) >40 years. The perforation risk associated with first episode SD was determined by multivariate analysis. SD was classified according to Hansen and Stock (H/S). RESULTS: In the total cohort of 959 patients, including 86 in GI (8.9%) and 873 in GII (91.1%) 468 had a first episode, with 64 in GI (13.7%) and 404 in GII (86.3%). The proportion of first episodes was 74.4% in GI and 46.3% in GII (p<0.001). The perforation risk did not differ (H/S IIb: 29.7% in GI vs. 29.2% in GII, p=0.938; H/S IIc: 25% in GI vs. 25% in GII, p=1). Treatment regimes were (GI vs. GII) emergency operations 25% vs. 25% (p=1), elective operations 17.2% vs. 10% (p=0.096) and conservative treatment 57.8% vs. 64.9% (p=0.276). CONCLUSION: First episodes of SD were more frequent in younger patients (≤40) and did not involve a higher risk of perforation. The indication for treatment of acute SD should not be based on age but on the severity of inflammation and the individual situation of patients.
Assuntos
Doença Diverticular do Colo/epidemiologia , Perfuração Intestinal/epidemiologia , Doenças do Colo Sigmoide/epidemiologia , Abscesso/diagnóstico , Abscesso/epidemiologia , Abscesso/cirurgia , Doença Aguda , Adulto , Fatores Etários , Berlim , Estudos de Coortes , Doença Diverticular do Colo/diagnóstico , Doença Diverticular do Colo/cirurgia , Emergências , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Perfuração Intestinal/diagnóstico , Perfuração Intestinal/cirurgia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Recidiva , Fatores de Risco , Doenças do Colo Sigmoide/diagnóstico , Doenças do Colo Sigmoide/cirurgia , Tomografia Computadorizada por Raios XAssuntos
Humanos , Masculino , Adulto , Hanseníase Tuberculoide/cirurgia , Hanseníase Tuberculoide/complicações , Hanseníase Tuberculoide/diagnóstico , Hanseníase Tuberculoide/fisiopatologia , Hanseníase Tuberculoide/reabilitação , Hanseníase Tuberculoide/terapia , Abscesso/complicações , Abscesso/diagnóstico , Abscesso/fisiopatologiaAssuntos
Abscesso/tratamento farmacológico , Hanseníase/complicações , Doenças do Sistema Nervoso Periférico/tratamento farmacológico , Esteroides/uso terapêutico , Nervo Ulnar , Abscesso/diagnóstico , Abscesso/etiologia , Diagnóstico Diferencial , Quimioterapia Combinada , Edema/diagnóstico , Seguimentos , Humanos , Hansenostáticos/administração & dosagem , Hanseníase/tratamento farmacológico , Doenças do Sistema Nervoso Periférico/diagnóstico , Doenças do Sistema Nervoso Periférico/etiologia , Resultado do TratamentoRESUMO
A case of suspected giant nerve abscess near the radial nerve in the upper arm of a patient with borderline leprosy is reported. On exploration, it turned out to be a deep seated lipoma. Consideration should be given to exploring nerve masses in leprosy.