Introducción: El bloqueo en el plano del erector espinal (erector spinae plane [ESP]) a nivel torácico se ha introducido cómo método analgésico postoperatorio. Sin embargo, a pesar de que su empleo a nivel lumbar ha sido publicada, su distribución y su mecanismo de acción no han sido esclarecidos. Nos propusimos describir la técnica de punción del bloqueo ESP a nivel lumbar y evaluar la distribución de 20ml administrados a nivel de la transversa de L4 en un modelo cadavérico. Métodos: Estudio observacional tras 12bloqueos del ESP lumbar en L4, sobre un modelo de cadáver fresco (6 bilaterales). Se valoró la distribución de 20ml de solución inyectada contrastada mediante tomografía computarizada en las 6 muestras. Fueron evaluados mediante estudio anatómico 4 de las muestras, 2mediante disección por planos y otros 2fueron congelados y seccionados con cortes axiales de 2-2,5cm de grosor. Resultados: La distribución de la solución inyectada se distribuyó en el interior de la musculatura erectora espinal cráneo-caudal desde L2 a L5, con límite medial en la articulares interapofisarias y lateral en la fascia toracolumbar. El paso anterior a la transversa no se observó en el 33% de los casos, fue mínimo y sin afectación de los nervios espinales correspondientes en el 51%, siendo extenso en 2 muestras (16%) y con afectación del nervio espinal correspondiente. Conclusiones: El ESP lumbar a nivel de L4 tiene una acción constante sobre los ramos posteriores de los nervios espinales, siendo infrecuente su paso al espacio paravertebral y bloquear el nervio espinal
Introduction: Thoracic erector spinae plane (ESP) block is now used for postoperative analgesia. However, although reports of lumbar ESP have been published, the anesthetic spread and mechanism of action of this technique remains unclear. We describe the lumbar ESP block technique and evaluate the spread of 20ml of solution administered at the level of the transverse process of L4 in a cadaver model. Methods: Observational study after 12 lumbar ESP blocks at L4 on a fresh cadaver model (6 bilaterally). The spread of 20ml of injected contrast solution was assessed by computed tomography in all 6 samples. Four of the samples were evaluated by anatomical study, 2 by plane dissection, and 2 others were frozen and cut into 2-2.5cm axial slices. Results: The injected solution spread from L2 to L5 in a cranio-caudal direction in the erector spinae muscle, reaching the facet joints medially and the thoracolumbar fascia laterally. In 33% of cases the solution did not spread anterior to the transverse process; in 51%, spread was minimal and did not affect the corresponding spinal nerves, and in 2 samples (16%), spread was extensive and reached the corresponding spinal nerves. Conclusions: Lumbar ESP at L4 always acts on the posterior branches of the spinal nerves, but seldom spreads to the paravertebral space to block the spinal nerve
Humans , Nerve Block/methods , Lumbosacral Plexus/anatomy & histology , Spinal Nerves/anatomy & histology , Anesthetics, Local/administration & dosage , Cadaver , Anesthesia, Conduction/methods , Spinal Nerves/drug effects , Spinal Nerve Roots/drug effects
INTRODUCTION: Thoracic erector spinae plane (ESP) block is now used for postoperative analgesia. However, although reports of lumbar ESP have been published, the anesthetic spread and mechanism of action of this technique remains unclear. We describe the lumbar ESP block technique and evaluate the spread of 20ml of solution administered at the level of the transverse process of L4 in a cadaver model. METHODS: Observational study after 12 lumbar ESP blocks at L4 on a fresh cadaver model (6 bilaterally). The spread of 20ml of injected contrast solution was assessed by computed tomography in all 6 samples. Four of the samples were evaluated by anatomical study, 2 by plane dissection, and 2 others were frozen and cut into 2-2.5cm axial slices. RESULTS: The injected solution spread from L2 to L5 in a cranio-caudal direction in the erector spinae muscle, reaching the facet joints medially and the thoracolumbar fascia laterally. In 33% of cases the solution did not spread anterior to the transverse process; in 51%, spread was minimal and did not affect the corresponding spinal nerves, and in 2 samples (16%), spread was extensive and reached the corresponding spinal nerves. CONCLUSIONS: Lumbar ESP at L4 always acts on the posterior branches of the spinal nerves, but seldom spreads to the paravertebral space to block the spinal nerve.
Anesthetics/pharmacokinetics , Nerve Block/methods , Cadaver , Coloring Agents/pharmacokinetics , Diffusion , Fascia/diagnostic imaging , Humans , Imaging, Three-Dimensional , Injections , Lumbar Vertebrae/diagnostic imaging , Methylene Blue/pharmacokinetics , Muscle, Skeletal/diagnostic imaging , Pain, Postoperative/drug therapy , Spinal Nerves/diagnostic imaging , Spinal Nerves/drug effects , Thoracic Vertebrae/diagnostic imaging , Tomography, X-Ray Computed , Ultrasonography , Zygapophyseal Joint/diagnostic imaging
The fascia iliaca compartment is the compartment confined by the fascia iliaca (FI) and a muscular layer formed by the iliac- and psoas muscle. This compartment creates a virtual tunnel that contains the femoral nerve (FN), the obturator nerve (ON), and the lateral femoral cutaneous nerve (LFCN) of the lumbar plexus. In this pilot study, we aimed to determine the suggested volume needed to reach the three target nerves of the lumbar plexus (FN, ON, and LFCN) with a single-injection ultrasound-guided supra-inguinal fascia iliaca compartment (S-FICB). A computer tomography (CT scan)-guided step-up/step-down sequence was used to determine the suggested injection volume to target all three nerves. Subsequently, an anatomist blinded for the injected volume and CT findings, dissected the cadavers, and evaluated the spread of dye underneath the fascia iliaca. In total, seven pelvic areas of four cadavers were evaluated on CT scan and dissected. Distribution of dye underneath the FI in relation to the FN, ON, and the LFCN was recorded in all dissected cadavers. Combining CT and dissection findings, the suggested volume to reach the FN, ON, and LFCN with an S-FICB was 40 mL.
Fascia/metabolism , Lower Extremity , Nerve Block/methods , Aged , Aged, 80 and over , Cadaver , Female , Femoral Nerve , Humans , Injections , Male , Pilot Projects , Ultrasonography
Introducción. El bloqueo infraclavicular ecoguiado en el espacio costoclavicular, situado entre la clavícula y la segunda costilla, pretende acceder a los troncos secundarios del plexo braquial cuando se hallan agrupados y laterales a la arteria axilar. Habitualmente se realiza mediante abordaje lateral, con la dificultad de la interposición de la apófisis coracoides y la dirección de la aguja hacia los vasos y la pleura. Un abordaje medial, es decir de interno a externo, evita estas estructuras. Tradicionalmente evaluamos el resultado del bloqueo infraclavicular mediante la valoración sensitiva y motora; no obstante, el bloqueo de las fibras simpáticas podría evaluarse objetivamente a través de los cambios en el flujo arterial, la temperatura cutánea y/o el índice de perfusión de la extremidad. Objetivo. Describir el bloqueo costoclavicular ecoguiado con acceso medial, evaluando su desarrollo mediante la evaluación motora, sensitiva y simpática. Materiales y métodos. Descripción inicial de la técnica y punción ecoguiada con contraste en cadáver, evaluando la distribución de un volumen de 20ml mediante tomografía computarizada (TC) y secciones sagitales de la pieza anatómica. Posteriormente, una fase clínica con inclusión de 11 pacientes a quienes se evaluó la instauración del bloqueo motor, sensitivo y simpático. Este último a través de la medición del flujo humeral, el índice de perfusión digital y la temperatura cutánea distal. Resultados. En el cadáver se realizó el acceso sin dificultades y se evidenció una adecuada distribución periclavicular de medio de contraste en la TC y en las secciones, alcanzando desde el espacio interescalénico hasta los troncos secundarios. El 91% de los pacientes presentó bloqueo quirúrgico a los 25 min. Todos los parámetros de bloqueo simpático evaluados aumentaron significativamente. El flujo arterial humeral aumentó de 108±86 a 188±141ml/min (p=0,05). La temperatura cutánea de 32,1±2 a 32,8±9°C (p=0,03) y el índice de perfusión de 4±3 a 9±5 (p=0,003). Conclusiones. El abordaje medial del bloqueo costoclavicular ecoguiado fue anatómicamente factible y con elevada eficacia clínica tras 20ml de mepivacaína al 1,5%. El bloqueo simpático obtenido puede evaluarse mediante los 3 parámetros estudiados (AU)
Introduction. Ultrasound-guided infraclavicular block in the costoclavicular space located between the clavicle and the first rib, reaches the secondary trunks when they are clustered together and lateral to the axillary artery. This block is most often performed through a lateral approach, the difficulty being finding the coracoid process an obstacle and guiding the needle towards the vessels and pleura. A medial approach, meaning from inside to outside, will avoid these structures. Traditionally the assessment of a successful block is through motor or sensitive responses but a sympathetic fibre block can also be evaluated measuring the changes in humeral artery blood flow, skin temperature and/or perfusion index. Objective. To describe the medial approach of the ultrasound-guided costoclavicular block evaluating its development by motor and sensitive response and measurement of sympathetic changes. Materials and methods. Description of the technique and administration of 20ml of contrast in a fresh cadaver model, evaluating the distribution with CT-scan and sagittal sections of the anatomic piece. Subsequently in a clinical phase, including 11 patients, we evaluated the establishment of motor, sensitive and sympathetic blocks. We evaluated the sympathetic changes reflected by humeral artery blood flow, skin temperature and distal perfusion index. Results. In the anatomical model the block was conducted without difficulties, showing an adequate periclavicular distribution of the contrast in the CT-scan and in sagittal sections, reaching the interscalenic space as far as the secondary trunks. Successful blocks were observed in 91% of patients after 25minutes. All the parameters reflecting sympathetic block increased significantly. The humeral artery blood flow showed an increase from 108 ± 86 to 188±141ml/min (P=.05), skin temperature from 32.1±2 to 32.8±9°C (P=.03) and perfusion index from 4±3 to 9±5 (P=.003). Conclusions. The medial approach of the ultrasound-guided costoclavicular block is anatomically feasible, with high clinical effectiveness using 20ml of 1.5% mepivacaine. The sympathetic block can be evaluated with all three parameters studied (AU)
Humans , Male , Female , Adult , Middle Aged , Perfusion/methods , Brachial Plexus , Anesthesia, Conduction/methods , Anesthesia, Conduction , Skin Temperature , Brachial Plexus , Anesthetics/therapeutic use
INTRODUCTION: Ultrasound-guided infraclavicular block in the costoclavicular space located between the clavicle and the first rib, reaches the secondary trunks when they are clustered together and lateral to the axillary artery. This block is most often performed through a lateral approach, the difficulty being finding the coracoid process an obstacle and guiding the needle towards the vessels and pleura. A medial approach, meaning from inside to outside, will avoid these structures. Traditionally the assessment of a successful block is through motor or sensitive responses but a sympathetic fibre block can also be evaluated measuring the changes in humeral artery blood flow, skin temperature and/or perfusion index. OBJECTIVE: To describe the medial approach of the ultrasound-guided costoclavicular block evaluating its development by motor and sensitive response and measurement of sympathetic changes. MATERIALS AND METHODS: Description of the technique and administration of 20ml of contrast in a fresh cadaver model, evaluating the distribution with CT-scan and sagittal sections of the anatomic piece. Subsequently in a clinical phase, including 11 patients, we evaluated the establishment of motor, sensitive and sympathetic blocks. We evaluated the sympathetic changes reflected by humeral artery blood flow, skin temperature and distal perfusion index. RESULTS: In the anatomical model the block was conducted without difficulties, showing an adequate periclavicular distribution of the contrast in the CT-scan and in sagittal sections, reaching the interscalenic space as far as the secondary trunks. Successful blocks were observed in 91% of patients after 25minutes. All the parameters reflecting sympathetic block increased significantly. The humeral artery blood flow showed an increase from 108 ± 86 to 188±141ml/min (P=.05), skin temperature from 32.1±2 to 32.8±9°C (P=.03) and perfusion index from 4±3 to 9±5 (P=.003). CONCLUSIONS: The medial approach of the ultrasound-guided costoclavicular block is anatomically feasible, with high clinical effectiveness using 20ml of 1.5% mepivacaine. The sympathetic block can be evaluated with all three parameters studied.
Autonomic Nerve Block/methods , Ultrasonography, Interventional , Brachial Artery/physiology , Clavicle , Female , Humans , Male , Middle Aged , Regional Blood Flow
Describir los hallazgos en columna de la resonancia magnética (RM) en las espondiloartropatías seronegativas (ESN) y valorar la indicación de esta modalidad de imagen en el diagnóstico y seguimiento de este tipo de pacientes. Se describen los aspectos patológicos en 4 casos diagnosticados de ESN (Crohn, espondilitis anquilopoyética y psoriasis) con afectación espinal. Los hallazgos en RM en las ESN varían en función del tipo de enfermedad y del estadio en el que se encuentre. La osteítis anterior de los cuerpos vertebrales es el signo más precoz de la afectación espinal en este grupo de enfermedades. La afectación inflamatoria del complejo discovertebral con mayor o menor grado de afectación de los cuerpos vertebrales adyacentes se produce más tardíamente. La RM de columna vertebral permite valorar signos patológicos incipientes característicos por lo que representa una herramienta útil para el diagnóstico en las ESN (AU)
We describe the magnetic resonance imaging (MRI) findings for the spine in patients with seronegative spondyloarthropathy (SNS) and discuss the indications for MRI in the diagnosis and follow-up of this type of patients. We describe the pathological aspects of four patients diagnosed with SNS (Crohn's disease, ankylosing spondylitis, and psoriasis) with spinal involvement. The MRI findings in SNS vary in function of the type and stage of disease. Osteitis of the anterior vertebral bodies is a very early sign of spinal involvement in this group of diseases. Inflammatory involvement of the discovertebral complex that involves the adjacent vertebral bodies to a greater or lesser extent occurs later. MRI of the spine makes it possible to evaluate incipient signs of disease that are characteristic of these patients, so it is a useful tool for the diagnosis of SNS (AU)
Humans , Male , Female , Spondylarthropathies , Magnetic Resonance Imaging/instrumentation , Magnetic Resonance Imaging/methods , Magnetic Resonance Imaging , Magnetic Resonance Imaging/trends , Spine , Spondylitis, Ankylosing
We describe the magnetic resonance imaging (MRI) findings for the spine in patients with seronegative spondyloarthropathy (SNS) and discuss the indications for MRI in the diagnosis and follow-up of this type of patients. We describe the pathological aspects of four patients diagnosed with SNS (Crohn's disease, ankylosing spondylitis, and psoriasis) with spinal involvement. The MRI findings in SNS vary in function of the type and stage of disease. Osteitis of the anterior vertebral bodies is a very early sign of spinal involvement in this group of diseases. Inflammatory involvement of the discovertebral complex that involves the adjacent vertebral bodies to a greater or lesser extent occurs later. MRI of the spine makes it possible to evaluate incipient signs of disease that are characteristic of these patients, so it is a useful tool for the diagnosis of SNS.
Magnetic Resonance Imaging , Spondylarthropathies/diagnosis , Adult , Aged , False Negative Reactions , Female , Humans , Male , Middle Aged , Spondylarthropathies/blood
BACKGROUND: Exact location of the needle tip during nerve stimulation-guided peripheral nerve blocks is unknown. Using high-frequency ultrasound imaging, we tested the hypothesis that intraneural injection is common with nerve stimulator-guided sciatic nerve (SN) block in popliteal fossa. METHODS: Forty-two patients scheduled for hallux valgus repair were studied. Sciatic block at the popliteal fossa was accomplished using nerve stimulation. When a motor response was elicited at <0.5 mA (2 Hz, 0.1 ms), 40 ml of local anaesthetic (LA) was injected. Using ultrasound (Titan, Sonosite, 5-10 MHz), the diameters and area of the SN were measured before and after the injection. The presence of nerve swelling and proximal or distal diffusion of LA were also assessed. Intraneural injection was defined as nerve area (NA) increase of > OR =15% and one or more additional ultrasonographic markers (nerve swelling, proximal-distal diffusion within epineural tissue). Clinical neurological evaluation was performed 1 week after the block. RESULTS: Post-injection NA increase > OR =15% was seen in 32 (76%) patients [0.54 (SD 0.19) cm(-2) vs 0.76 (0.24) cm(-2); P<0.05]. Nerve swelling with fascicular separation was observed in 37 (88%) patients; proximal and distal diffusion of LA were present in six (14%) and 14 (38%) patients, respectively. Intraneural injection criteria were met in 28 (66%) patients. Greater NA increase was present in patients with fast block onset [61 (45) vs 25 (33)%; (Dif 35% 95% CI 61-9%); P<0.05]. No patient developed neurological complications. CONCLUSIONS: Intraneural (subepineural) injection is a common occurrence after nerve stimulator-guided SN block at the popliteal fossa, yet it may not inevitably lead to neurological complications.
Electric Stimulation/methods , Nerve Block/methods , Sciatic Nerve/physiology , Aged , Anesthetics, Local/administration & dosage , Anesthetics, Local/pharmacology , Female , Hallux Valgus/surgery , Humans , Knee Joint , Male , Middle Aged , Movement/drug effects , Nerve Block/adverse effects , Sciatic Nerve/anatomy & histology , Sciatic Nerve/diagnostic imaging , Sensation/drug effects , Ultrasonography, Interventional/methods
Benign osteoblastomas are infrequent tumors, representing less than 1% of all bone tumors. The spinal location accounts for 40-50% of all osteoblastomas from which only 20% are located in the cervical spine. The majority of the spinal osteoblastomas arise from the posterior elements: pedicles, laminas, transverse or spinous processes. We present a case report of a young male that due to the lack of specific symptoms was diagnosed of a cervical osteoblastoma 14 months after the first symptoms. The tumor was located in the right C7 pedicle. We then operated, resected the tumor and a posterior C6-T1 bilateral instrumentation was performed to stabilize the spine. Nowadays, this delay in diagnosis may be avoided by the routine use of MRI or CT for unspecific cervical symptoms. The treatment of this lesion is the complete surgical resection based on a correct preoperative planning with CT and MRI in order to define precisely the location, size and extension of the tumor. Currently, percutaneous or minimally invasive surgery is not commonly used in the treatment of this lesion.
Cervical Vertebrae , Osteoblastoma/diagnosis , Spinal Neoplasms/diagnosis , Adult , Cervical Vertebrae/surgery , Humans , Male , Osteoblastoma/surgery , Spinal Neoplasms/surgery , Treatment Outcome
Eleven AJCC stage IV melanoma patients with progressive disease after treatment with biochemotherapy were treated with autologous dendritic cells pulsed with heterologous tumor cell lysates. The vaccine used mature DCs (CD1a+++, CD40++, CD80++, CD83+, and CD86+++) generated from peripheral blood monocytes in the presence of GM-CSF and IL-4. After 7 days, DCs were matured with a defined cocktail of cytokines (IL-1+IL-6+TNF-alpha+PGE2) and simultaneously pulsed with lysates of heterologous melanoma cell lines, for 2 days. A total of 4 x 10(6) DCs was injected monthly under ultrasound control in an inguinal lymph node of normal appearance. The study was closed when all patients died as a consequence of tumor progression. No sign of toxicity was observed during the study. One patient experienced a partial response lasting 5 months, and two patients showed a mixed response which lasted 3 months. The median survival of the whole group was 7.3 months (range 3-14 months). This vaccination program had specific antitumoral activity in highly pretreated and large tumor burden stage IV melanoma patients and was well tolerated. The clinical responses and the median survival of the group of patients, together with the low toxicity of our DC vaccine, suggest that this approach could be applied to earlier AJCC stage IV melanoma patients.
Cancer Vaccines/therapeutic use , Dendritic Cells/immunology , Immunotherapy , Melanoma/therapy , Skin Neoplasms/therapy , Adult , Antineoplastic Agents/therapeutic use , Female , Granulocyte-Macrophage Colony-Stimulating Factor/metabolism , Humans , Interferon-gamma/blood , Interleukin-4/metabolism , Male , Melanoma/immunology , Melanoma/mortality , Melanoma/pathology , Middle Aged , Neoplasm Staging , Pilot Projects , Skin Neoplasms/immunology , Skin Neoplasms/mortality , Skin Neoplasms/pathology , Survival Rate , T-Lymphocytes, Cytotoxic/immunology , Tumor Cells, Cultured
Algunos pacientes con enfermedad ósea de Paget pueden desarrollar un osteosarcoma en la lesión pagética. Aunque se trata de una complicación infrecuente, el diagnóstico precoz de esta entidad es fundamental debido a su elevada mortalidad. Con el fin de analizar las características clínicas de estos pacientes y de valorar la utilidad de las pruebas de laboratorio en la sospecha diagnóstica de este proceso, se han revisado los pacientes con enfermedad ósea de Paget y osteosarcoma atendidos en nuestro centro en los últimos 12 años. Se describen 6 casos que corresponden a 3 varones y 3 mujeres, 5 de ellos con una enfermedad poliostótica, que desarrollaron dolor local intenso, en ocasiones asociado a sintomatología neurológica o a tumefacción de partes blandas. Tres pacientes seguían control por su enfermedad de Paget desde hacía más de 12 años, mientras que en 3 pacientes el diagnóstico del sarcoma óseo coincidió con el de la enfermedad de Paget. En ninguno de los pacientes de los que se disponía de seguimiento previo se observó un cambio significativo en las pruebas básicas de laboratorio (VSG, calcemia), ni en los valores de la fosfatasa alcalina, que alertaran al clínico de la posibilidad de una degeneración sarcomatosa. La sintomatología y las alteraciones radiológicas fueron las principales manifestaciones de este proceso (AU)
Aged , Female , Male , Middle Aged , Aged, 80 and over , Humans , Osteitis Deformans/complications , Osteosarcoma/etiology , Bone Neoplasms/etiology , Osteosarcoma , Bone Neoplasms
Bone Neoplasms/diagnosis , Histiocytosis, Langerhans-Cell/diagnosis , Low Back Pain/etiology , Adult , Bone Neoplasms/secondary , Diagnosis, Differential , Histiocytosis, Langerhans-Cell/pathology , Humans , Low Back Pain/complications , Male , Neoplasms, Unknown Primary/diagnosis , Osteolysis/complications , Osteolysis/etiology
The records of 144 patients of Child Psychiatry Units of Alsace (France), with childhood psychosis (CP) or pervasive developmental disorders (PDD) have been systematically screened for previous or associated pathological events. Half of the children studied have been or are still affected by severe somatic disorders, but none of the diagnostic subcategories (referring to DSM III or CFTMEA) appeared significantly more frequently affected. In our population, the severity of organic disorders was positively correlated with: the age of the mother: more severe cases were reported when the mother was younger than 20 or older than 40 at the moment of childbirth; pathological events during pregnancy; early mother-child separation during the first year of life. The most frequent associated disorders however (neonatal pathology 45% of the cases, epilepsy 17% of the cases, neurological or neurosensorial pathology 15% of the cases) were associated neither with a specific diagnostic nor with a clinical and social specific pattern. The only statistically significant correlation was found between neurological pathology and a relatively low level of cognitive and social functioning. All these results were confirmed by multivariate statistical analysis. A main component analysis integrating all quantified data concerning organic pathology was performed: it emphasizes the independence of the different pathological events reported. The factorial analysis including the clinical, diagnostical and somatic event-related data failed to show any statistical profile associating functional features of the children with any particular previous or existing somatic disorders. Our results suggest that a history of organic pathological events is frequent not only in autistic disorders but in any kind of PDD or early CP - associated with moderate to severe mental retardation, in most cases of our study. However, this does not demonstrate that this type of pathological events constitute the direct and unique cause of PDD and CP: the concept of the aetiology of these severe diseases must take account of other factors - such as relational disruption -, also frequently seen in these children.
Brain Damage, Chronic/diagnosis , Neurocognitive Disorders/diagnosis , Prenatal Exposure Delayed Effects , Adolescent , Autistic Disorder/diagnosis , Autistic Disorder/psychology , Brain Damage, Chronic/psychology , Child , Child Development Disorders, Pervasive/diagnosis , Child Development Disorders, Pervasive/psychology , Child, Preschool , Diagnosis, Differential , Epilepsy/diagnosis , Epilepsy/psychology , Female , Humans , Infant , Infant, Newborn , Intellectual Disability/diagnosis , Intellectual Disability/psychology , Male , Neurocognitive Disorders/psychology , Pregnancy , Psychiatric Status Rating Scales , Risk Factors
OBJECTIVE: CT findings of pneumatocyst of the sacrum have been evaluated. MATERIALS AND METHODS: Eight patients, six men and two women, with pneumatocysts of the sacrum were studied. Selective CT with 4 and 2 mm thickness was performed, and the intralesional attenuation coefficients were measured. RESULTS: All patients showed subchondral pneumatocysts of the sacrum with sclerotic margins related to the synovial portion of the sacroiliac joint. Intraarticular gas was found in six cases, and evidence of communication between the lesion and the joint was observed in two patients. Signs of bone degeneration were present in all cases. CONCLUSION: Pneumatocyst of the sacrum is a benign bone lesion associated with arthritic changes.
Bone Cysts/diagnostic imaging , Sacrum/diagnostic imaging , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Spinal Diseases/diagnostic imaging , Tomography, X-Ray Computed
BACKGROUND: Vertebral bone metastases represent the most frequently affected region within the skeleton. They are of important relevance because of the risk of medullar compression. The diagnosis of medullar canal invasion is of particular interest in order to prevent neurological dysfunction. A prospective study was carried out to detect the frequency and degree of invasion of the spine. METHODS: Twenty-eight patients were studied (13 males and 15 females), with a median age of 61 years (range 35-85), with cancer diagnosis and vertebral bone metastases, and local or radicular pain, without signs or symptoms suggesting myelopathy. Neurological, physical examination, radiological study (anteroposterior and lateral) and magnetic resonance imaging (MRI) study was performed in all patients to detect medullar canal invasion. RESULTS: Local pain was present in 43% of patients (n = 12), and radicular in 57.1% (n = 16). The most frequent radiologic vertebral involvement was thoracic (46.4%), with 71% of vertebral body collapse. MRI showed epidural space invasion in 75% of patients (n = 21), with a degree superior to 50% in 43%. CONCLUSIONS: The beginning of vertebral pain in a patient with cancer diagnosis, with evidence of bone invasion after radiological study, represents a major indicator to perform a MRI study to detect epidural involvement.
Magnetic Resonance Imaging , Spinal Neoplasms/diagnosis , Spinal Neoplasms/secondary , Adult , Aged , Aged, 80 and over , Epidural Space , Humans , Infant , Male , Middle Aged , Pain/etiology , Prospective Studies , Spinal Neoplasms/complications , Time Factors
Opportunistic Infections/diagnostic imaging , Pentamidine/administration & dosage , Pneumonia, Pneumocystis/diagnostic imaging , Administration, Inhalation , HIV Infections/complications , HIV Infections/diagnostic imaging , HIV Infections/drug therapy , HIV-1 , Humans , Lung/diagnostic imaging , Lung/drug effects , Opportunistic Infections/complications , Opportunistic Infections/drug therapy , Pneumonia, Pneumocystis/complications , Pneumonia, Pneumocystis/drug therapy , Radiography
The clinical, radiological and analytical aspects, and the complications observed in 16 cases of swallowing or insertion into the rectum of illicit drugs ("body-packing") are described. The drugs detected were heroin (6 cases), cocaine (5 cases) and cannabis (5 cases). In 15 cases abdominal plain X-rays were useful in the detection of the drug packages, their position and progression in the gastrointestinal tract and the presence of complications. The most valuable finding for radiologic diagnosis was the presence of a radiolucent halo surrounding the drug packages, or "double condom" sign, which was observed in 13/15 cases (87%). Urine analysis was positive for opiates or metabolites of cocaine in 7/9 cases (78%). One case presented acute heroin intoxication and three subjects gastric or intestinal obstruction requiring surgical treatment. In another case a packet, which had been retained in the stomach for five days, was extracted by upper gastrointestinal endoscopy using a Dormia basket with no complications.
Digestive System/diagnostic imaging , Foreign Bodies/diagnostic imaging , Illicit Drugs , Adult , Cannabis , Cocaine , Emergencies , Female , Foreign Bodies/complications , Foreign Bodies/etiology , Heroin , Humans , Intestinal Obstruction/diagnostic imaging , Intestinal Obstruction/etiology , Male , Radiography
