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1.
Ann Chir Plast Esthet ; 68(4): 333-338, 2023 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-35853759

RESUMEN

Total hip arthroplasty is a very common procedure to treat osteoarthritis. One of the complication is the infection which occurs in about 1% of the cases. The manifestation of infection can be poor wound healing with dehiscence and exposition of bone or prosthetic components. Hip arthroplasty infections are difficult to treat. It required an associated multidisciplinary approach with infectiology, orthopedic and plastic surgeries. The study included five patients with hip wound dehiscence after total hip arthroplasty. Coverage after orthopedic surgery was provided by local cutaneous flap. These cutaneous flaps were either a deep inferior epigastric perforator flap (DIEP) or a transposition flap. The orthopedic and the plastic treatment were done at the same time. Two deep inferior epigastric flaps were performed for patients with a deep defect with bone or prosthesis exposure. Four transposition flaps were done in three patients with wound dehiscence but without direct contact with the prosthesis. Three transposition flaps were done from the abdominal wall and one from the posterior thigh. The mean follow up was 18 months, ranging from 10 to 24months. After healing, there was no recurrence of the infection. In all cases, the coverage was obtained. The prosthesis was salvage and the gait was possible. Cutaneous flaps are easy and safe to cover the hip. They are reliable flaps even in patients with multiple co-morbidities. They do not cause sequelae on the recipient site. This study is the first about cutaneous flap for covering hip defects in hip arthroplasty infections.


Asunto(s)
Artroplastia de Reemplazo de Cadera , Mamoplastia , Infección de Heridas , Humanos , Artroplastia de Reemplazo de Cadera/efectos adversos , Colgajos Quirúrgicos , Piel , Complicaciones Posoperatorias , Mamoplastia/métodos
2.
Ann Chir Plast Esthet ; 67(2): 101-104, 2022 Mar.
Artículo en Francés | MEDLINE | ID: mdl-34949489

RESUMEN

The deep inferior epigastric perforator (DIEP) flap is a reliable flap mostly used in skin resurfacing after signifiant resection for sarcoma or correction contour deformities. This case is about a pedicled DIEP flap covering the trochanteric region after a total hip arthroplasty infection. A 62years old woman with a BMI at 42kg/m2 presents an infected total hip arthroplasty with a cutaneous defect. The hip prosthesis is changed and covered with a pedicled DIEP flap. This original case reports the used of pedicled DIEP flap in hip coverage. This local fasciocutaneous flap covered the hip osteoarticular infection. The limb is salved and the patient can walked again. The success of this surgery is the collaboration between infectious disease specialist, orthopedic surgeon and plastic surgeon.


Asunto(s)
Artroplastia de Reemplazo de Cadera , Mamoplastia , Colgajo Perforante , Neoplasias de los Tejidos Blandos , Arterias Epigástricas/cirugía , Femenino , Humanos , Colgajo Perforante/cirugía , Neoplasias de los Tejidos Blandos/cirugía
3.
Orthop Traumatol Surg Res ; 103(2): 301-305, 2017 04.
Artículo en Inglés | MEDLINE | ID: mdl-28167248

RESUMEN

BACKGROUND: Whether pre-operative microbiological sampling contributes to the management of chronic peri-prosthetic infection remains controversial. We assessed agreement between the results of pre-operative and intra-operative samples in patients undergoing single-stage prosthesis exchange to treat chronic peri-prosthetic infection. HYPOTHESIS: Agreement between pre-operative and intra-operative samples exceeds 75% in patients undergoing single-stage exchange of a hip or knee prosthesis to treat chronic peri-prosthetic infection. MATERIAL AND METHODS: This single-centre retrospective study included 85 single-stage prosthesis exchange procedures in 82 patients with chronic peri-prosthetic infection at the hip or knee. Agreement between pre-operative and intra-operative sample results was evaluated. Changes to the initial antibiotic regimen made based on the intra-operative sample results were recorded. RESULTS: Of 149 pre-operative samples, 109 yielded positive cultures, in 75/85 cases. Of 452 intra-operative samples, 354 yielded positive cultures, in 85/85 cases. Agreement was complete in 54 (63%) cases and partial in 9 (11%) cases; there was no agreement in the remaining 22 (26%) cases. The complete agreement rate was significantly lower than 75% (P=0.01). The initial antibiotic regimen was inadequate in a single case. DISCUSSION: Pre-operative sampling may contribute to the diagnosis of peri-prosthetic infection but is neither necessary nor sufficient to confirm the diagnosis and identify the causative agent. The spectrum of the initial antibiotic regimen cannot be safely narrowed based on the pre-operative sample results. We suggest the routine prescription of a probabilistic broad-spectrum antibiotic regimen immediately after the prosthesis exchange, even when a pathogen was identified before surgery. LEVEL OF EVIDENCE: IV, retrospective study.


Asunto(s)
Prótesis de la Rodilla/microbiología , Infecciones Relacionadas con Prótesis/microbiología , Infecciones Relacionadas con Prótesis/cirugía , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Rodilla/efectos adversos , Enfermedad Crónica , Femenino , Humanos , Periodo Intraoperatorio , Masculino , Persona de Mediana Edad , Periodo Preoperatorio , Infecciones Relacionadas con Prótesis/diagnóstico , Estudios Retrospectivos
4.
Eur J Surg Oncol ; 43(4): 680-682, 2017 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-27567098

RESUMEN

The importance of preoperative histological diagnosis in the assessment of breast lesions in women is widely established, but in men with breast lesions histological diagnosis is obtained in a limited number of cases. The aim of this study was to report our single-center experience in a large series of 131 CNB performed for suspicious male breast lesions. Our data confirmed that CNB is an effective method in distinguishing between benign and neoplastic lesions in the male breast, thus validating the few published data. CNB should be a routine part of the unilateral male breast swelling diagnostic assessment, being precious tool for the clinicians for surgery planning or avoidance.


Asunto(s)
Neoplasias de la Mama Masculina/patología , Carcinoma Ductal de Mama/patología , Carcinoma Lobular/patología , Carcinoma Papilar/patología , Ginecomastia/patología , Mastitis/patología , Neoplasias de Mama Unilaterales/patología , Adulto , Anciano , Anciano de 80 o más Años , Biopsia con Aguja Fina , Biopsia con Aguja Gruesa , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto Joven
5.
Eur J Surg Oncol ; 43(4): 642-648, 2017 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-27889196

RESUMEN

BACKGROUND: Core needle biopsy (CNB) plays a crucial role as diagnostic tool for breast cancer (BC). The characterization of biomarkers status before surgical treatment is crucial when primary systemic therapy is a therapeutic option. The aim of this analysis was to report concordance between preoperative CNB and surgical specimen (SS) in evaluating biomarkers and molecular subtypes. METHODS: Data have been collected from a cohort of 101 patients affected by early BC treated at Careggi Florence University Hospital, between January 2014 and March 2015. The conformity between molecular subtype classification was tested using kappa (κ) test. RESULTS: Mean age was 57.5 years (range 29-86). There was concordance between the estrogen receptor (ER) assessment on CNB and SS in 95 cases (94.1%). Concordance of the progesterone receptor (PgR) assessment was observed in 89 cases (88.1%). Concordance for detecting immunohistochemistry-assessed BC molecular subtypes was 87.1% (κ = 0.78). Concerning Ki-67 evaluation, we report a concordance rate of 88.1% (κ = 0.68). The evaluation of luminal A plus luminal B/HER negative subgroup showed a κ-value of 0.65. CONCLUSIONS: CNB showed good accuracy in evaluating hormonal receptors status, HER2, and BC molecular subtypes. Evaluation of Ki67 status was less accurate than other biomarkers; therefore, we recommend that it should be detected both on CNB and SS samples, especially in hormonal positive HER2 negative tumors, in order to avoid a misclassification of tumor subtypes that could lead to an omission of potential effective systemic therapy.


Asunto(s)
Biomarcadores de Tumor/metabolismo , Neoplasias de la Mama/metabolismo , Carcinoma Ductal de Mama/metabolismo , Carcinoma Lobular/metabolismo , Receptor ErbB-2/metabolismo , Receptores de Estrógenos/metabolismo , Receptores de Progesterona/metabolismo , Neoplasias de la Mama Triple Negativas/metabolismo , Adulto , Anciano , Anciano de 80 o más Años , Biopsia con Aguja Gruesa , Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/patología , Neoplasias de la Mama/terapia , Carcinoma Ductal de Mama/diagnóstico por imagen , Carcinoma Ductal de Mama/patología , Carcinoma Ductal de Mama/terapia , Carcinoma Lobular/diagnóstico por imagen , Carcinoma Lobular/patología , Carcinoma Lobular/terapia , Manejo de la Enfermedad , Femenino , Humanos , Biopsia Guiada por Imagen , Inmunohistoquímica , Antígeno Ki-67/metabolismo , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias de la Mama Triple Negativas/diagnóstico por imagen , Neoplasias de la Mama Triple Negativas/patología , Neoplasias de la Mama Triple Negativas/terapia , Ultrasonografía Mamaria
6.
Orthop Traumatol Surg Res ; 102(1): 127-9, 2016 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-26611716

RESUMEN

UNLABELLED: Fungal infection of a total joint arthroplasty has a low incidence but is generally considered as more difficult to cure than bacterial infection. As for bacterial infection, two-stage exchange is considered as the gold standard of treatment. We report two cases of one-stage total joint exchange for fungal peri-prosthetic infection with Candida albicans, where the responsible pathogens was only identified on intraoperative samples. This situation can be considered as a one-stage exchange for fungal peri-prosthetic infection without preoperative identification of the responsible organism, which is considered as having a poor prognosis. Both cases were free of infection after two years. One-stage revision has several potential advantages over two-stage revision, including shorter hospital stay and rehabilitation, no interim period with significant functional impairment, shorter antibiotic treatment, better functional outcome and probably lower costs. We suggest that one-stage revision for C. albicans peri-prosthetic infection may be successful even without preoperative fungal identification. LEVEL OF EVIDENCE: Level IV-Historical cases.


Asunto(s)
Artroplastia de Reemplazo de Cadera/métodos , Candidiasis/cirugía , Prótesis de Cadera/efectos adversos , Infecciones Relacionadas con Prótesis/cirugía , Anciano , Antifúngicos/uso terapéutico , Candida albicans , Candidiasis/tratamiento farmacológico , Femenino , Prótesis de Cadera/microbiología , Humanos , Persona de Mediana Edad , Reoperación
7.
Rev Chir Orthop Reparatrice Appar Mot ; 91(7): 658-63, 2005 Nov.
Artículo en Francés | MEDLINE | ID: mdl-16327671

RESUMEN

PURPOSE OF THE STUDY: The angle between the anatomic axis of the tibia and the tangent to the superior borders of the tibial plateaus is, on average, tilted 3 degrees in the varus position. If there is no bone wear, this angle measures the constitutional epiphyseal axis of the proximal tibia. When degenerative joint disease modifies the aspect of the tibial plateaus, this angle measures the sum of the constitutional varus and the bone wear, without distinguishing between the two. It is known however that the respective contribution of these two deformations can have therapeutic implications, particularly when tibial osteotomy for valgus correction or implantation of a unicompartmental prosthesis is proposed. Lévigne proposed a radiographic measurement of the proximal tibial axis to distinguish between these two sources of tibial deformation. We studied the intra- and interobserver reproducibility of these measurements. MATERIAL AND METHODS: Fifty volunteers free of knee disease were chosen at random among a population of patients undergoing upper limb surgery. All patients provided their informed consent for participation in the study. Full-limb radiographs of one lower limb (chosen at random) were obtained using a standardized technique. The proximal tibial axis was measured according to the Lévigne technique using a manual goniometer graduated in degrees. One operator performed two series of measures independently on the same films. Two other operators performed a series of measurements on each film. The intra- and inter-observer reproducibility was determined with the interclass coefficient of correlation (rho). RESULTS: The proximal epiphyseal axis of the tibia could not be determined on 7 to 18 films, depending on the operator. All three operators were able to make the all measurements (four per film) for only 25 patients. The mean epiphyseal axis varied from 2.5 degrees to 4.7 degrees for the four series of measurements. Intra-observer reproducibility was considered good (rho=0.62). Inter-observer reproducibility was considered moderate (rho=0.41). DISCUSSION: The Lévigne technique is to our knowledge the only method described in the literature distinguishing the relative contribution of constitutional varus and bone wear of the proximal tibia. According to the advocates of this method, the angle between the epiphyseal axis linking the center of the tibial plateaus and the center of the proximal growth cartilage scare, and the anatomic axis of the tibia is a measurement of constitutional varus. The average is 3 degrees . The angle between a line perpendicular to the epiphyseal axis and the tangent of the superior borders of the tibial plateaus measures the deformation related to bone wear. In the present work, we found that this technique enables acceptable intra-observer reproducibility but that inter-observer reproducibility is low. The differences observed are certainly related to uncertain identification of the growth cartilage scar. This illustrates the difficulty in generalizing this technique for measuring healthy knees. Such difficulties would be even greater for degenerative knees. CONCLUSION: The Lévigne technique does not appear to be a reliable method for defining indications for different surgical procedures according to the morphology of the proximal tibia.


Asunto(s)
Tibia/anatomía & histología , Tibia/diagnóstico por imagen , Antropometría/métodos , Epífisis/anatomía & histología , Epífisis/diagnóstico por imagen , Humanos , Variaciones Dependientes del Observador , Radiografía , Reproducibilidad de los Resultados
8.
Comput Aided Surg ; 6(4): 217-20, 2001.
Artículo en Inglés | MEDLINE | ID: mdl-11835617

RESUMEN

A navigation system should improve the quality of a total knee prosthesis implantation in comparison to that obtained with the classical, surgeon-controlled operative technique. The authors implanted 30 total knee prostheses with an infrared navigation system (Orthopilot, Aesculap, Tuttlingen, Germany). The quality of implantation was studied on postoperative long-leg coronal and lateral X-rays, and compared to a control group of 30 matched-paired total knee prostheses of the same type (Search prosthesis, Aesculap, Tuttlingen, Germany) implanted with a classical, surgeon-controlled technique. An optimal mechanical femorotibial angle (177 to 183 degrees) was obtained in 25 cases in the study group and 21 cases in the control group (p > 0.05). Similar differences were seen for the coronal and sagittal orientations of both tibial and femoral components. Globally, 23 cases in the study group and 8 cases in the control group were implanted in an optimal manner for all studied criteria (p < 0.001). The navigation system used allows a significant improvement in the quality of implantation of a total knee prosthesis in comparison to that obtained with a classical, surgeon-controlled instrumentation, and long-term outcome could consequently be improved.


Asunto(s)
Artroplastia de Reemplazo de Rodilla , Cirugía Asistida por Computador , Anciano , Estudios de Casos y Controles , Femenino , Humanos , Prótesis de la Rodilla , Masculino , Cirugía Asistida por Computador/instrumentación
9.
Rev Chir Orthop Reparatrice Appar Mot ; 87(7): 645-52, 2001 Nov.
Artículo en Francés | MEDLINE | ID: mdl-11845067

RESUMEN

PURPOSE OF THE STUDY: The quality of total knee arthroplasty (TKA) implantation is an essential factor determining long-term outcome. Computer-assisted implantation could improve quality compared with conventional manual instrumentation. MATERIAL AND METHODS: We studied the radiographic quality of TKA implantation in 100 patients with primary degenerative knee disease who underwent a computer-assisted procedure guided by an informatic navigation system without imagery (group A) or a conventional manual procedure (group B). The two groups were matched for age, sex, initial frontal mechanical tibiofemoral angle and severity of the degenerative lesions. Postoperative telemetry was used in accordance with the Knee Society guidelines to measure the frontal mechanical tibiofemoral angle and the frontal and sagittal tilt of the tibial and femoral components. The number of optimal implantations for the five measured criteria was chosen as the main study criterion. The two groups were compared using the chi-squared test with statistical significance set at 5% and power at 80%. RESULTS: Globally, implantation of the prosthesis was considered to be optimal in 33 patients in group A and in 15 in group B (p<0.001). Mean angles were not different between the two groups, except for sagittal tilt of the femoral piece. The frontal mechanical tibiofemoral angle was considered optimal in 47 patients in group A and in 39 in group B (p<0.05). A significant improvement in the quality of the implantation was also found in group A for frontal tilt of the femoral piece (p=0.05), frontal tilt of the tibial piece (p<0.05) and sagittal tilt of the tibial piece (p<0.001). No particular peroperative difficulty or complication was related to the navigation system. DISCUSSION AND CONCLUSION: The navigation system allowed a significant improvement in the quality of implantation of TKA compared with conventional instrumentation controlled by the surgeon's hand and eye. Only minimal changes in the operative technique are necessary and standard preoperative investigations remain unchanged. Long-term survival of prostheses implanted with this system could thus be improved compared with manually implanted TKA. The system used here does not involve preoperative imaging and allows a precision to the order of 1 degree for angles and 1 mm for lengths.


Asunto(s)
Artroplastia de Reemplazo de Rodilla , Cirugía Asistida por Computador , Adulto , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Rodilla/instrumentación , Artroplastia de Reemplazo de Rodilla/métodos , Estudios de Casos y Controles , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Factores de Tiempo
10.
Rev Chir Orthop Reparatrice Appar Mot ; 89(2): 163-6, 2003 Apr.
Artículo en Francés | MEDLINE | ID: mdl-12844061

RESUMEN

We examined the diagnostic and therapeutic approaches used for two patients with loosened total hip prostheses who developed Mycobacterium tuberculosis infection. Revision total hip arthroplasty (THA) was performed in one patient. The prosthesis was left in situ in the second patient due to lack of sufficient bone stock. Medical treatment was given. The diagnosis was established on direct examination of bacteriological samples and culture on specific media. Polymerase chain reaction identified the Mycobacterium tuberculosis complex. Non-specific granulomas were observed on the histology sections. For us, management of overt tuberculosis involving a THA depends on the quality of the fixation. If the prosthesis remains stable, medical treatment can be sufficient. If the prosthesis loosens, definitive ablation must be considered with possible revision THA later. Exceptionally, a loosened implant may be left in situ if the remaining bone stock is insufficient. Minimal duration of anti-tuberulosis treatment is six months.


Asunto(s)
Artroplastia de Reemplazo de Cadera/efectos adversos , Infecciones Relacionadas con Prótesis/etiología , Tuberculosis/etiología , Antituberculosos/uso terapéutico , Biopsia , Terapia Combinada , ADN Bacteriano/análisis , ADN Bacteriano/genética , Femenino , Humanos , Persona de Mediana Edad , Mycobacterium tuberculosis/genética , Reacción en Cadena de la Polimerasa , Falla de Prótesis , Infecciones Relacionadas con Prótesis/diagnóstico , Infecciones Relacionadas con Prótesis/terapia , Reoperación , Factores de Tiempo , Tuberculosis/diagnóstico , Tuberculosis/terapia
11.
Rev Chir Orthop Reparatrice Appar Mot ; 85(3): 293-6, 1999 Jun.
Artículo en Francés | MEDLINE | ID: mdl-10422135

RESUMEN

PURPOSE OF THE STUDY: Giant-cell tumor are known for local recurrence. Metastases are rare (2 p. 100), and generally located in the lung. We present a case with multiple bone metastases and rapid course. MATERIAL, METHODS AND RESULTS: A 45-year-old man presented a 5 cm giant-cell tumor of his right distal tibia and two other localisation in the fifth and sixth cervical vertebral bodies. He underwent a resection of the distal tibia and reconstruction with a controlateral free vascularized fibula. The bodies of the fifth and sixth cervical vertebral were resected and replaced by an iliac crest graft. Other localisations appeared in iliac right crest, in the posterior wall of the cotyle and in the second, third and fourth cervical vertebral bodies. Chemotherapy was administered and clinical signs regressed but eight months later the patient presented a recurrence of his tumor in the distal tibia with new localisation in the left fifth rib, in the right clavicle, in the frontal bone, in right ischio-pubal branch and in the right proximal femur. A new chemotherapy was performed but had little effect and probably hasved dubic death 13 month after the first symptom. DISCUSSION: The present observation is characterised by the large number of localisations (13; the highest number found in the literature was 11 localisations) and by the rapidity of the clinical course. Low grade giant-cell tumors generally give benign metastase with a course lasting several years. The chemotherapy helpt us to slow the progression of the lesions but was unable to prevent the development of new localisation and the recurrence in the distal tibia. More over, its toxicity could have caused the death of the patient. CONCLUSION: We present the case of one patient who presented a giant-cell tumor with unusual presentation: multiple bony metastases with rapidly fatal outcome.


Asunto(s)
Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/cirugía , Vértebras Cervicales , Tumor Óseo de Células Gigantes/diagnóstico por imagen , Tumor Óseo de Células Gigantes/cirugía , Recurrencia Local de Neoplasia/diagnóstico por imagen , Recurrencia Local de Neoplasia/cirugía , Neoplasias de la Columna Vertebral/diagnóstico por imagen , Neoplasias de la Columna Vertebral/cirugía , Tibia , Antineoplásicos/uso terapéutico , Biopsia con Aguja , Quimioterapia Adyuvante , Resultado Fatal , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X
12.
Chir Main ; 20(1): 71-4, 2001 Feb.
Artículo en Francés | MEDLINE | ID: mdl-11291323

RESUMEN

We describe a new procedure of trapeziometacarpal ligamentoplasty. This ligamentoplasty is both passive and active. The operation is performed in three stages: (1) Transfert of part of the abductor pollicis longus in a posterior and distal direction; (2) Transfert of the radial part of the extensor carpi radialis longus into the proximal first metacarpal; (3) Forming a loop around the flexor carpi radialis tendon with a distally inserted slip of abductor pollicis longus.


Asunto(s)
Huesos del Carpo , Inestabilidad de la Articulación/cirugía , Ligamentos Articulares/cirugía , Articulación Metacarpofalángica/cirugía , Pulgar , Adulto , Estudios de Seguimiento , Humanos , Inestabilidad de la Articulación/etiología , Inestabilidad de la Articulación/fisiopatología , Masculino , Articulación Metacarpofalángica/lesiones , Persona de Mediana Edad , Rango del Movimiento Articular , Resultado del Tratamiento
13.
Eur J Surg Oncol ; 40(7): 859-64, 2014 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-24612651

RESUMEN

AIMS: Image-guided 14-gauge (G) core biopsy (CB) has been shown to be an accurate method providing histological diagnosis of breast lesions. The purpose of this study was to evaluate the reliability of image-guided 14-G CB in the diagnosis of phyllodes tumours (PT) reported as B3 category and its accuracy in distinguishing this lesion from fibroadenomas (FA). MATERIALS AND METHODS: The records of 10 000 image-guided 14-G CB of the breast performed from January 2001 to August 2011 at the Diagnostic Senology Unit of Careggi University Hospital were reviewed; 2554 (25.5%) were fibroepithelial lesions: 56 of them (2%) were diagnosed as PT and reported as B3 category. The database of the Pathological Anatomy Unit of Careggi University Hospital was then searched to verify the histological diagnosis after surgical excision. Fifty-one cases of PT diagnosed as B3 category in 51 women were included in the present study. RESULTS: Of the 51 cases of PT diagnosed as B3 category on 14-G CB, 39 (76.5%) lesions were confirmed as PT on SE (30, 4 and 5 as benign, borderline and malignant PT respectively) with a PPV of 76.5%. Twelve lesions (23.5%) were diagnosed as FA after surgical excision. CONCLUSIONS: Our study shows that 14-G CB is a valuable tool, in a preoperative setting, in diagnosing PT.


Asunto(s)
Biopsia con Aguja Gruesa , Neoplasias de la Mama/patología , Fibroadenoma/patología , Biopsia Guiada por Imagen/métodos , Tumor Filoide/patología , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/cirugía , Estudios de Cohortes , Diagnóstico Diferencial , Femenino , Fibroadenoma/diagnóstico , Fibroadenoma/cirugía , Hospitales Universitarios , Humanos , Inmunohistoquímica , Italia , Mastectomía/métodos , Invasividad Neoplásica/patología , Estadificación de Neoplasias , Tumor Filoide/diagnóstico , Tumor Filoide/cirugía , Cuidados Preoperatorios/métodos , Reproducibilidad de los Resultados , Estudios Retrospectivos
14.
Orthop Traumatol Surg Res ; 100(2): 217-20, 2014 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-24582652

RESUMEN

BACKGROUND: Periprosthetic joint infection often raises diagnostic challenges, as the published criteria are heterogeneous. New markers for predicting periprosthetic infection have been evaluated. Here, we assessed one of these markers, C-reactive protein (CRP), in joint fluid. HYPOTHESIS: We hypothesised that intra-articular CRP levels would perform better than serum CRP concentrations in diagnosing knee prosthesis infection. PATIENTS AND METHODS: We prospectively included 30 patients including 10 with native-knee effusions, 11 with prosthetic-knee aseptic effusions, and 11 with prosthetic-knee infection defined using 2011 Musculoskeletal Society criteria. Serum CRP was assayed using turbidimetry or nephelometry and intra-articular CRP using nephelometry. Appropriate statistical tests were performed to compare the three groups; P values < 0.05 were considered significant. RESULTS: Serum and intra-articular CRP levels were 5- to 16-fold higher in the group with periprosthetic infection than in the other two groups. Although the areas under the ROC curves were not significantly different, the likelihood ratios associated with the selected cut-offs suggested superiority of intra-articular CRP: a value > 2.78 mg/L suggested possible infection (100% sensitivity and 82% specificity) and a value > 5.37 mg/L probable infection (90% sensitivity and 91% specificity). DISCUSSION: Our findings suggest a possible role for intra-articular CRP assay in diagnosing knee prosthesis infection and perhaps periprosthetic infection at any site. LEVEL OF EVIDENCE: Level III, diagnostic study, development of a diagnostic criterion in consecutive patients comparatively to a reference standard.


Asunto(s)
Proteína C-Reactiva/análisis , Prótesis de la Rodilla/efectos adversos , Infecciones Relacionadas con Prótesis/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Rodilla , Biomarcadores/sangre , Femenino , Humanos , Masculino , Estudios Prospectivos , Infecciones Relacionadas con Prótesis/sangre , Sensibilidad y Especificidad
15.
Breast ; 21(2): 159-64, 2012 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-21944431

RESUMEN

The purpose of this study was to evaluate the reliability of image-guided 14-gauge needle core biopsy in the diagnosis of radial scar without associated atypical epithelial proliferation, by comparison with definitive histological diagnosis on surgical excision. The records of 8792 consecutive image-guided 14-gauge needle core biopsy of the breast performed from January 1996 to December 2009 were reviewed. Forty-nine cases of radial scar without associated atypical epithelial proliferation were identified and compared with definitive histological diagnosis on surgical excision. The definitive histological diagnosis on surgical excision confirmed the results of image-guided 14-gauge needle core biopsy in 36 of 49 cases (73.5%), in 9 cases (18.3%) radial scar was associated with atypical epithelial proliferation, while 4 cases out of 49 cases were upgraded to carcinoma (3 cases of ductal carcinoma in situ and one case of invasive lobular carcinoma), with an underestimation rate of 8.2%. A diagnosis of radial scar without associated atypical epithelial proliferation on image-guided 14-gauge needle core biopsy does not exclude a malignancy on surgical excision; consequently during the multidisciplinary discussion further assessment by surgical excision or vacuum-assisted excision, as recently reported, needs to be considered to obtain a definitive histological diagnosis.


Asunto(s)
Enfermedades de la Mama/diagnóstico , Neoplasias de la Mama/patología , Mama/patología , Carcinoma in Situ/patología , Cicatriz/diagnóstico , Adulto , Anciano , Biopsia con Aguja , Enfermedades de la Mama/patología , Proliferación Celular , Cicatriz/patología , Células Epiteliales , Femenino , Humanos , Persona de Mediana Edad , Reproducibilidad de los Resultados , Estudios Retrospectivos
16.
Diabet Med ; 23(1): 99-102, 2006 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-16409574

RESUMEN

AIM: To study prospectively two methods for the bacteriological diagnosis of osteomyelitis related to diabetic foot ulcer: needle puncture performed across normal skin surrounding the foot ulcer and superficial swabbing of the ulcer. PATIENTS AND METHODS: Diabetic patients with a foot ulcer complicated by bone or joint infection, as detected by X-ray imaging, were included in the study. Ulcer swabbing and needle puncture were performed in each patient. To reach the tissue nearest the bone surface, needle puncture was guided by X-ray imaging and the drop of fluid obtained by aspiration was used for both aerobic and anaerobic bacterial culture. RESULTS: Twenty-one diabetic patients were included. The mean number of microorganisms isolated by needle puncture was significantly lower compared with that obtained by superficial swabbing: 1.09 vs. 2.04 (P < 0.02). Three bacterial species were isolated by needle puncture only in one patient while three or more bacterial isolates were obtained by superficial swabbing in six patients. No bacterial isolate was detected in five patients by needle puncture and in two patients by superficial swabbing. Staphylococcus aureus accounted for 70% of cases (seven patients) when a single bacterial species was obtained by needle puncture. After needle puncture, no wound complication or infection was observed. CONCLUSION: Culture of samples obtained by needle puncture revealed one or two bacterial isolates in two-thirds of diabetic patients with osteomyelitis following foot ulcer. Given the lack of complications, this invasive diagnostic technique should be considered for deep direct sampling in diabetic patients with osteomyelitis related to foot ulcer when surgical debridement is contraindicated or delayed.


Asunto(s)
Pie Diabético/microbiología , Osteomielitis/microbiología , Adulto , Anciano , Técnicas Bacteriológicas/métodos , Biopsia con Aguja/métodos , Pie Diabético/complicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteomielitis/complicaciones , Osteomielitis/diagnóstico , Estudios Prospectivos , Infecciones Estafilocócicas/complicaciones , Infecciones Estafilocócicas/diagnóstico , Staphylococcus aureus/aislamiento & purificación , Streptococcus/aislamiento & purificación
17.
Z Orthop Ihre Grenzgeb ; 139(2): 117-9, 2001.
Artículo en Alemán | MEDLINE | ID: mdl-11386099

RESUMEN

OBJECTIVE: A navigation system should improve the quality of a total knee prosthesis implantation in comparison to the classical, surgeon-controlled operative technique. METHODS: The authors have implanted 40 knee total prostheses with an optical infrared navigation system (Orthopilot AESCULAP, Tuttlingen--group A). The quality of implantation was studied on postoperative long leg AP and lateral X-rays, and compared to a control group of 40 computer-paired total knee prostheses o the same model (Search Prosthesis, AESCULAP, Tuttlingen) implanted with a classical, surgeon-controlled technique (group B). RESULTS: An optimal mechanical femorotibial angle (3 degrees valgus to 3 degrees varus) was obtained by 33 cases in group A and 31 cases in group B (p > 0.05). Better results were seen for the coronal and sagittal orientation of both tibial and femoral components in group A. Globally, 26 cases of the group A and 12 cases of the group B were implanted in an optimal manner for all studied criteria (p < 0.01). CONCLUSIONS: The used navigation system allows a significant improvement of the quality of implantation of a knee total prosthesis in comparison to a classical, surgeon-controlled instrumentation. Long-term outcome could be consequently improved.


Asunto(s)
Artroplastia de Reemplazo de Rodilla/instrumentación , Procesamiento de Imagen Asistido por Computador/instrumentación , Microcomputadores , Osteoartritis de la Rodilla/cirugía , Complicaciones Posoperatorias/diagnóstico por imagen , Periféricos de Computador , Humanos , Osteoartritis de la Rodilla/diagnóstico por imagen , Radiografía , Equipo Quirúrgico , Resultado del Tratamiento
18.
Knee Surg Sports Traumatol Arthrosc ; 9(5): 299-301, 2001 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-11685362

RESUMEN

Sixty patients were operated on for primary gonarthrosis by means of a cemented, posterior cruciate preserving total knee and were randomly allocated to postoperative drainage or nondrainage. The primary criterion was duration of hospital stay. Secondary criteria included serial evaluation of knee pain, knee flexion, knee circumference, calculated blood loss after 7 days, complications, reoperations, and the need for blood transfusions. There was no difference between the two groups in any of the criteria during the entire follow-up. There was a nonsignificant trend to a decreased calculated blood loss in the nondrained group and significantly less transfused blood units in the nondrained group. Lack of drainage does not increase complication risk after total knee prosthesis implantation. We therefore recommend using no routine drainage after this procedure.


Asunto(s)
Artroplastia de Reemplazo de Rodilla , Drenaje , Complicaciones Posoperatorias , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Prótesis de la Rodilla , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo
19.
Radiol Med ; 99(6): 438-42, 2000 Jun.
Artículo en Italiano | MEDLINE | ID: mdl-11262820

RESUMEN

INTRODUCTION: Mammography is the only technique of proven efficacy in the early diagnosis of breast cancer, even though its sensitivity is much lower in breasts that are dense or with a high parenchymal-stromal component. In the past malignant breast nodules detected at US in patients with negative mammographic and physical findings were considered incidental findings, but more recent papers report increasing numbers of breast cancers detected only at US. PURPOSE: We investigated the yield of US performed as a diagnostic complement in asymptomatic women with mammographic findings that were either negative or poorly readable because of dense breast. MATERIAL AND METHODS: We examined 13 women 37 to 55 years old (mean 47): 9 of them were asymptomatic and 4 had poorly specific physical findings. The patients underwent physical examination, mammography, US, microhistologic biopsy with 14G needles under US guidance and surgery. RESULTS: Fourteen breast lesions 7.0-15 mm in diameter were detected only by US. Mammography (2 or 3 standard views) was negative in all cases. The lesions detected only by US (10% of all carcinomas) were typified with US-guided needle biopsy and finally confirmed surgically. DISCUSSION AND CONCLUSIONS: Though obtained in a small series, our results seem to suggest that US should be included in the diagnostic work-up, especially of women with dense breast. Also, any hypoechoic lesion detected at breast US in clinically asymptomatic women with negative mammographic findings should be further investigated with US, needle aspiration or core biopsy to make the final diagnosis.


Asunto(s)
Neoplasias de la Mama/diagnóstico por imagen , Adulto , Femenino , Humanos , Persona de Mediana Edad , Ultrasonografía
20.
Radiol Med ; 95(6): 630-4, 1998 Jun.
Artículo en Italiano | MEDLINE | ID: mdl-9717547

RESUMEN

INTRODUCTION: Any breast lesion/abnormality detected at mammography must be characterized as (non)-neoplastic before surgery. Fine needle aspiration cytology (FNAC) permits a precise diagnosis in over 70% of cases but exhibits many inadequate, false negatives or questionable findings. This makes surgical biopsy mandatory in many cases. An alternative is offered by fine needle biopsy (FNB: 16-18 G needles) or by large core biopsy (LCB: 14 G needles), which procedures can reduce the number of questionable diagnoses with no major discomfort or side-effects for the patient. MATERIAL AND METHODS: January, 1996, to October, 1997, we performed 422 microhistologic biopsies on breast lesions at the Unità Integrata di Senologia, Azienda Ospedaliera Careggi, Florence, Italy. 383 of these lesions were nonpalpable. FNB was performed in 221 cases and LCB in 201. Most biopsies (65%) were carried out under US guidance and some others (25%) under stereotactic guidance. RESULTS: Microhistologic biopsy allowed accurate lesion characterization in most cases, even though LCB obviously performed much better. Samples were inadequate in 5.88% of cases with FNB and only in 2.98% of cases with LCB. The false negative rate was 1.92% for FNB and 0.99% for LCB. Surgical biopsy was needed for an unquestionable diagnosis only in 9.5% of FNB and 3.9% of LCB cases. CONCLUSIONS: Our results confirm the literature data on how LCB can be considered a valid alternative to surgical biopsy (and, to some extent, to FNAC); in particular, its advantages are: moderate invasiveness, little patient discomfort and high diagnostic accuracy. Moreover, the procedure is short (5-10 minutes) and costs much less than surgical biopsies (1/2 to 1/4).


Asunto(s)
Biopsia con Aguja/instrumentación , Mama/patología , Agujas , Adulto , Anciano , Anestesia Local , Enfermedades de la Mama/patología , Neoplasias de la Mama/patología , Calcinosis/patología , Reacciones Falso Negativas , Femenino , Humanos , Mamografía , Persona de Mediana Edad , Ultrasonografía Intervencional , Ultrasonografía Mamaria
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