RESUMEN
OBJECTIVES: Many studies show that a large portion of medical prescriptions for diagnostic examinations may be not useful for patient's management or unnecessary. Rapid technological advancement has made it possible for magnetic resonance imaging (MRI) to be increasingly used all over the world, particularly for musculoskeletal disorders. The aim of this study was to assess the appropriateness of the knee MRI prescriptions. MATERIALS AND METHODS: A panel of experts found standard clinical practice guidelines in the management of knee disorders. Secondly, the finalized set of guidelines chosen was compared with the data of 400 patients who underwent previous knee MRIs, which were then reported in a specific questionnaire prepared by the authors. The rate of appropriateness of knee MRI prescriptions was then calculated. RESULTS: Almost 21% of prescriptions were totally inappropriate, 18.8% were uncertain, and 60.2% could be considered totally appropriate. The most frequent prescription indication was for meniscal disorders that account for 26.8% of the total indications. CONCLUSIONS: Our results demonstrate that approximately 40% of the total prescriptions were totally inappropriate or uncertain and that most of these were made by general practitioners. In light of these results, the economic impact of inappropriate prescriptions on the Italian healthcare system has to be seriously considered.
Asunto(s)
Artropatías/patología , Articulación de la Rodilla/patología , Imagen por Resonancia Magnética , Prescripciones , Adolescente , Adulto , Anciano , Femenino , Humanos , Imagen por Resonancia Magnética/economía , Masculino , Persona de Mediana Edad , Prescripciones/economía , Estudios Retrospectivos , Encuestas y Cuestionarios , Adulto JovenAsunto(s)
Condrosarcoma/etiología , Exostosis Múltiple Hereditaria/complicaciones , Neoplasias Primarias Múltiples/etiología , Osteosarcoma/etiología , Sacro , Neoplasias de la Columna Vertebral/etiología , Vértebras Torácicas , Femenino , Humanos , Persona de Mediana Edad , Clasificación del Tumor , Neoplasias Primarias Múltiples/patología , Osteosarcoma/patologíaRESUMEN
Peripheral chondrosarcoma is a rare tumor particularly insidious when arising from the pelvis, becoming symptomatic later in time when surgery may be too difficult and dangerous due to this complex area. In the present case, the tumor arose from an exostosis located on the medial surface of the left iliac wing. Its diameter was 25 cm × 20 cm × 15 cm, adhering to the last three vertebrae, involving the left iliac vein and artery, displacing the left ureter. In a similar case, a hindquarter amputation is indicated but, if the patient refuses, a resection remains possible. In this paper, we describe a multistage technique consisting of an extra-anatomic vascular bypass, a lumbar stabilization, a neurovascular bundles anterior isolation and a postero-lateral resection of this mass. After a five-year follow-up, the patient is alive and able to stand and walk with support, after undergoing twice lung metastasis removal.
Asunto(s)
Neoplasias Óseas/cirugía , Tornillos Óseos , Condrosarcoma/cirugía , Vértebras Lumbares/cirugía , Huesos Pélvicos , Sacro/cirugía , Fusión Vertebral/métodos , Angiografía , Biopsia con Aguja , Neoplasias Óseas/irrigación sanguínea , Neoplasias Óseas/diagnóstico , Condrosarcoma/irrigación sanguínea , Condrosarcoma/diagnóstico , Arteria Femoral/diagnóstico por imagen , Estudios de Seguimiento , Humanos , Arteria Ilíaca/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
Infection in prosthesis surgery is very dangerous because it changes the patient's prognosis. Differential diagnosis between septic and aseptic loosening is fundamental in order to apply the correct treatment. The correct diagnostic approach is still debated in literature. The aim of this study was to perform a review of literature evaluating positron emission tomography (PET) capacity to distinguish between septic and aseptic loosening in hip prosthesis. Research was done principally among medical archives. Five studies were selected which satisfied the required characteristics, and a weighted average of sensitivity and specificity of the different studies was determined. The fluorodeoxyglucose positron emission tomography (FDG-PET) sensitivity in individuating hip prosthesis infections was 82.8% and specificity was 87.3%. Positron emission tomography based on 2-fluoro-2-deoxy-D-glucose could be a valid option if research is able to find an uptake pattern specific for septic and aseptic loosening.
Asunto(s)
Prótesis de Cadera/microbiología , Falla de Prótesis , Infecciones Relacionadas con Prótesis/diagnóstico por imagen , Artroplastia de Reemplazo de Cadera/efectos adversos , Diagnóstico Diferencial , Femenino , Fluorodesoxiglucosa F18 , Humanos , Masculino , Tomografía de Emisión de Positrones/métodos , Infecciones Relacionadas con Prótesis/etiologíaRESUMEN
The authors describe a variation in the method of vertebral hemi-resection used for the treatment of neoplasms that present a wide invasion of the vertebral canal. This is followed by a review of the literature on the subject.
Asunto(s)
Neoplasias de la Columna Vertebral/patología , Neoplasias de la Columna Vertebral/cirugía , Columna Vertebral/cirugía , Humanos , Laminectomía , Invasividad Neoplásica , Procedimientos de Cirugía PlásticaRESUMEN
The authors discuss the reconstructive methods used after curettage and/or vertebral resection possibly associated with removal of surrounding muscular, visceral and nervous structures.
Asunto(s)
Procedimientos Ortopédicos/métodos , Procedimientos de Cirugía Plástica/métodos , Columna Vertebral/cirugía , Adolescente , Diseño de Equipo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Ortopédicos/instrumentaciónRESUMEN
The authors discuss the criteria of differential diagnosis between primary and secondary tumors, emphasizing the role played by biopsy.