RESUMO
BACKGROUND: Achieving adequate fixation strength in osteoporotic bone is a challenge. In this study, we examined the use of hydroxyapatite-coated tapered external-fixation pins for the fixation of wrist fractures in patients with osteoporosis. METHODS: Twenty female patients with osteoporosis and a fracture of the wrist were divided into two paired groups and randomized to receive either standard tapered pins or hydroxyapatite-coated tapered pins. Two pins were inserted in the distal part of the radius, two pins were inserted in the second metacarpal, and an external fixation device was mounted. All fixation devices were removed six weeks after surgery. RESULTS: The mean pin-insertion torque (and standard deviation) was 461 +/- 254 Nmm in the group managed with standard pins and 332 +/- 176 Nmm in the group managed with hydroxyapatite-coated pins (p = 0.01). The mean pin-extraction torque was 191 +/- 155 Nmm in the group managed with standard pins and 600 +/- 214 Nmm in the group managed with hydroxyapatite-coated pins (p < 0.0001, power 95%). The mean extraction torque was lower than the corresponding insertion torque at each pin position in the group managed with standard pins (p < 0.05), whereas the mean extraction torque was higher than the corresponding insertion torque at each pin position in the group managed with hydroxyapatite-coated pins (p = 0.001). Two patients managed with standard pins and no patient managed with hydroxyapatite-coated pins had a pin-track infection. Pain during pin removal did not differ between the two groups. CONCLUSIONS: The present study showed that hydroxyapatite-coated tapered external-fixation pins provided improved fixation in the treatment of wrist fractures in patients with osteoporosis.
Assuntos
Pinos Ortopédicos , Durapatita , Fixação de Fratura/instrumentação , Fraturas Ósseas/cirurgia , Osteoporose/complicações , Traumatismos do Punho/cirurgia , Idoso , Fenômenos Biomecânicos , Feminino , Fixação de Fratura/métodos , Humanos , Estudos Prospectivos , Desenho de Prótese , Resultado do TratamentoRESUMO
Aneurysms of the distal posterior inferior cerebellar artery are rare comprising less than 0.5 to 3% of all aneurysms. The authors report two cases of distal PICA aneurysms: a case of a ruptured saccular aneurysm arising on the tonsillomedullary segment of the PICA and a case of a giant aneurysm arising on junctional site of lateral-medullary and tonsillo-medullary segments. In the first case subarachnoid and intraventricular hemorrhage was diagnosed by CT and four vessel-angiography visualized the aneurysm which was clipped successfully. In the second case MRI was suggestive for posterior fossa giant aneurysm; four vessel angiography confirmed the suspicion, detected distal PICA origin of the giant aneurysm and disclosed the association with a middle cerebral artery saccular aneurysm. Because of lacking of a clippable neck and important perforating vessels to brainstem, the aneurysm was trapped and excised successfully. The literature is exhaustively reviewed. Discussion regarding to distal PICA aneurysm distribution (location, age, sex, multiplicity and associated vascular anomalies), pathophysiology, clinical presentation, neuroradiological findings, surgery and outcome is presented.
Assuntos
Cerebelo/irrigação sanguínea , Aneurisma Intracraniano , Adolescente , Adulto , Idoso , Aneurisma Roto/complicações , Angiografia Cerebral , Hemorragia Cerebral/etiologia , Ventrículos Cerebrais , Pré-Escolar , Feminino , Soluço/etiologia , Humanos , Hidrocefalia/etiologia , Lactente , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico , Aneurisma Intracraniano/cirurgia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Ruptura Espontânea , Hemorragia Subaracnóidea/etiologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Distúrbios da Voz/etiologiaRESUMO
Computed tomography was performed in a patient with a median nerve tumor at the arm, histologically confirmed as neurilemmoma. Neurilemmoma was a slightly hypodense, solid tumor with no vascular contrast enhancement. To our knowledge this is the first CT description of a median nerve neurilemmoma at the arm. According to our experience and to previous literature, CT gives useful information regarding extent, anatomic location, size and relationship of peripheral nerve neoplasm to surrounding structures and may be an useful tool for evaluation arm nerve mass and for appropriate planning of surgical therapy.
Assuntos
Nervo Mediano/diagnóstico por imagem , Neurilemoma/diagnóstico por imagem , Neoplasias do Sistema Nervoso Periférico/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Braço , Humanos , Masculino , Neoplasias Primárias Múltiplas , NeurofibromaRESUMO
A case is reported of persistent primitive trigeminal artery associated with recurrent facial pain and noncomitant strabismus by partial ipsilateral oculomotor palsy. Transcranial Doppler disclosed indirectly persistent carotid-basilar anastomosis. CT and angiography allowed complete diagnosis excluding a posterior communicating artery aneurysm, a Tolosa-Hunt syndrome and an ophthalmoplegic migraine. Steroid therapy is recommended treatment. Surgery should be considered when symptoms are intractable to medical therapy.
Assuntos
Artérias Cerebrais/anormalidades , Dor Facial/etiologia , Doenças do Nervo Oculomotor/etiologia , Cefaleias Vasculares/etiologia , Adulto , Fístula Artério-Arterial/diagnóstico por imagem , Artéria Basilar/anormalidades , Artéria Carótida Interna/anormalidades , Diagnóstico Diferencial , Dor Facial/diagnóstico por imagem , Feminino , Humanos , Doenças do Nervo Oculomotor/diagnóstico por imagem , Radiografia , Cefaleias Vasculares/diagnóstico por imagemRESUMO
The authors report 2 cases of colloid cyst of the 3(rd) ventricle (both patients previously asymptomatic) diagnosed after head trauma. Neurological deterioration due to biventricular hydrocephalus, rendering necessary an urgent bilateral CSF shunting, was observed. The possible relationship between clinical deterioration and head injury in these cases is discussed.
Assuntos
Traumatismos Craniocerebrais/fisiopatologia , Cistos/fisiopatologia , Hidrocefalia/fisiopatologia , Terceiro Ventrículo/patologia , Adulto , Coloides , Traumatismos Craniocerebrais/complicações , Traumatismos Craniocerebrais/patologia , Cistos/complicações , Cistos/patologia , Humanos , Hidrocefalia/etiologia , Hidrocefalia/patologia , Masculino , Tomografia Computadorizada por Raios XRESUMO
The treatment of intrathoracic lesions invading the spine has two main issues: the surgical route to be preferred and the incidence of complications following the operation. As a matter of fact surgical treatment, performed in two stages, has a higher risk of cord accidents. Some authors have proposed a combined thoraco-vertebral surgical route which allows the exposition of both the spine and the chest. We experienced the utility of such a surgical approach in the treatment of two endothoracic lesions invading the thoracic spine and requiring the stabilization of the rachis. Satisfactory results were achieved without morbidity.
Assuntos
Neoplasias Ósseas/cirurgia , Condroma/cirurgia , Equinococose Pulmonar/cirurgia , Costelas/cirurgia , Compressão da Medula Espinal/cirurgia , Neoplasias Torácicas/cirurgia , Neoplasias Ósseas/diagnóstico , Condroma/diagnóstico , Diagnóstico Diferencial , Equinococose Pulmonar/diagnóstico , Humanos , Laminectomia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Costelas/patologia , Compressão da Medula Espinal/diagnóstico , Neoplasias Torácicas/diagnóstico , Tomografia Computadorizada por Raios XAssuntos
Ácido 4-Aminobenzoico/uso terapêutico , Aminobenzoatos/uso terapêutico , Hemostáticos/uso terapêutico , Inflamação/tratamento farmacológico , Adulto , Idoso , Avaliação de Medicamentos , Quimioterapia Combinada , Feminino , Humanos , Inflamação/etiologia , Masculino , Pessoa de Meia-Idade , Ferimentos e Lesões/complicações , para-AminobenzoatosRESUMO
The authors report the result of the review of fractures of the growth plate of the distal humeral epiphysis treated at the Orthopaedic Clinic of the University of Pisa. They examine the varieties of lesions which may occur at that site and report the results after a follow-up of 5 to 15 years.
Assuntos
Fraturas do Úmero/diagnóstico por imagem , Fraturas Salter-Harris , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Fixação de Fratura , Lâmina de Crescimento/diagnóstico por imagem , Humanos , Fraturas do Úmero/classificação , Fraturas do Úmero/epidemiologia , Fraturas do Úmero/terapia , Úmero/diagnóstico por imagem , Masculino , RadiografiaRESUMO
A case of traumatic orbital encephalocele following a "blow-in" fracture is presented. Computed tomography (CT) and magnetic resonance imaging (MRI) findings are shown. Although CT was useful for identifying the orbital roof fracture, bone fragments and soft tissue abnormalities, MRI was more sensitive to brain herniation and an intraorbital haematoma.
Assuntos
Encefalocele/etiologia , Fraturas Orbitárias/diagnóstico , Adulto , Encefalocele/diagnóstico , Humanos , Imageamento por Ressonância Magnética , Masculino , Fraturas Orbitárias/complicações , Tomografia Computadorizada por Raios XRESUMO
A 22-year-old female patient with a swelling in the right forearm near the elbow underwent a 67Ga-citrate scan because of paraesthesia on the ulnar side of the right hand. The 67Ga total body scan showed intense focal uptake on the forearm in the same position as the swelling. At surgery a histological diagnosis of alveolar rhabdomyosarcoma was made. Five months later, a repeat 67Ga scan was normal. Eight months after the diagnosis, the patient complained of pain in the left lumbar region extending to the hypogastric area. A third 67Ga scan showed intense uptake near the spinal column which at surgery was found to be a metastasis of the primary tumor.
Assuntos
Neoplasias Ósseas/diagnóstico por imagem , Citratos , Radioisótopos de Gálio , Rabdomiossarcoma/diagnóstico por imagem , Adulto , Neoplasias Ósseas/patologia , Ácido Cítrico , Feminino , Humanos , Prognóstico , Cintilografia , Rabdomiossarcoma/patologiaRESUMO
We report here the results of a validation study of the avidin/indium-111 biotin approach in patients with skeletal lesions. This study involved 54 patients with orthopaedic conditions: 20 patients with intermediate suspected osteomyelitis of the trunk, 19 patients with infection/inflammation of prosthetic joint replacements, and 15 patients with suspected osteomyelitis of appendicular bones. Avidin (3 mg) was injected as an i.v. bolus, followed 4 h later by 111In-biotin; imaging was acquired 30 min and 16-18 h after administration of 111In-biotin. Technetium-99m hexamethylpropylene amine oxime (99mTc-HMPAO)-labelled leucocyte scintigraphy was performed in 39/54 patients. The overall sensitivity of the avidin/111In-biotin scan was 97.7% (versus 88.9% for 99mTc-HMPAO leucocyte scintigraphy). While the diagnostic performance of avidin/111In-biotin scintigraphy was similar to that of 99mTc-HMPAO leucocyte scintigraphy in patients with prosthetic joint replacements or osteomyelitis of appendicular bones, the avidin/111In-biotin approach clearly performed better than 99mTc-HMPAO leucocyte scintigraphy in patients with suspected osteomyelitis of the trunk (100% sensitivity, specificity and accuracy versus 50% sensitivity, 100% specificity and 66.7% accuracy for 99mTc-HMPAO-leucocyte scintigraphy). These results demonstrate the feasibility of the avidin/111In-biotin approach for imaging sites of infection/inflammation in the clinical setting. Although no systematic advantages of avidin/111In-biotin scintigraphy were found versus 99mTc-HMPAO leucocyte scintigraphy, the newer scintigraphic method is more practicable and involves lower biological risk for the operators.