ABSTRACT
The purpose of this review is to describe the anatomy and lesions affecting the peripheral portion of posterior horn of medial menisci (ramp lesions), along with illustrations and MRI cases. We will correlate imaging features with arthroscopic classification of ramp lesions. Also, postoperative and chronic changes related to meniscocapsular tears will be presented, as well as biomechanical consequences and treatment approach.
ABSTRACT
OBJECTIVE:: To report a case of successful limb-salvage staged treatment in the treatment of an infected diabetic Charcot foot. CASE SUMMARY:: A 45-year-old male with long-term, uncontrolled type 2 diabetes, six months' history of progressive deformity on the right foot and 45 days of purulent drainage in the lateral aspect of the foot. Patient was diagnosed with an infected Charcot foot with extensive midfoot bone involvement as shown by radiographic and MRI images. We used a multidisciplinary approach to treatment with early antibiotic therapy, tight glycaemic control and staged surgical treatment. Initial treatment was adequate irrigation and debridement, bone-void filling with bioactive glass, external fixation and provisional negative pressure wound therapy (NPWT). Later progressed to total contact casting and progressive protect weight bearing. At final follow-up, patient was full weight-bearing in stiff soled footwear, with no clinical signs of infection, no gross alteration of gait pattern and demonstrating complete bone healing and integration of the bioactive glass. CONCLUSION:: The bioactive glass S53P4 was successfully used in the limb-salvage staged treatment of a patient with an infected Charcot foot. Here, full integration with the surrounding bone and its supportive action in the combat of bone infection was demonstrated.
Subject(s)
Bone Substitutes , Diabetes Mellitus, Type 2 , Diabetic Foot/therapy , Glass , Debridement , Diabetic Foot/diagnostic imaging , Humans , Limb Salvage , Male , Middle Aged , Negative-Pressure Wound Therapy , Wound HealingABSTRACT
Magnetic resonance neurography is a high-resolution imaging technique that allows evaluating different neurological pathologies in correlation to clinical and the electrophysiological data. The aim of this article is to present a review on the anatomy of the lumbosacral plexus nerves, along with imaging protocols, interpretation pitfalls, and most common pathologies that should be recognized by the radiologist: traumatic, iatrogenic, entrapment, tumoral, infectious, and inflammatory conditions. An extensive series of clinical and imaging cases is presented to illustrate key-points throughout the article.
Subject(s)
Lumbosacral Plexus/diagnostic imaging , Lumbosacral Plexus/pathology , Magnetic Resonance Imaging , Humans , Muscle DenervationABSTRACT
INTRODUCTION: Low back pain and vertebral endplate abnormalities are common conditions within the population. Subclinical infection caused by indolent pathogens can potentially lead to these findings, with differentiation between them notably challenging from a clinical perspective. Progressive infection of the intervertebral disc has been extensively associated with increasing low back pain, with Propionibacterium acnes specifically implicated with in relation to sciatica. The main purpose of this study is to identify if the presence of an infective pathogen within the intervertebral disc is primary or is a result of intraoperative contamination, and whether this correlates to low back pain. METHODS AND ANALYSIS: An open prospective cohort study will be performed. Subjects included within the study will be between the ages of 18 and 65 years and have a diagnosis of lumbar disc herniation requiring open decompression surgery. Excised herniated disc fragments, muscle and ligamentum flavum samples will be collected during surgery and sent to microbiology for tissue culture and pathogen identification. Score questionnaires for pain, functionality and quality of life will be given preoperatively and at 1, 3, 6 and 12 months postoperatively. A MRI will be performed 12 months after surgery for analysis of Modic changes and baseline comparison. The primary endpoint is the rate of disc infection in patients with symptomatic degenerative disc disease. The secondary endpoints will be performance scores, Modic incidence and volume. ETHICS AND DISSEMINATION: This study was approved by our Institutional Review Board and was only initiated after it (CAAE 65102617.2.0000.0071). Patients agreeing to participate will sign an informed consent form before entering the study. Results will be published in a peer reviewed medical journal irrespective of study findings. If shown to be the case, this would have profound effects on the way physicians treat chronic low back pain, even impacting health costs. TRIALS REGISTRATION NUMBER: NCT0315876; Pre-results.
Subject(s)
Gram-Positive Bacterial Infections/epidemiology , Gram-Positive Bacterial Infections/microbiology , Intervertebral Disc Displacement/microbiology , Lumbar Vertebrae , Propionibacterium acnes/isolation & purification , Adult , Aged , Chronic Disease , Disability Evaluation , Female , Humans , Incidence , Intervertebral Disc/microbiology , Low Back Pain/microbiology , Male , Middle Aged , Prospective Studies , Quality of Life , Young AdultABSTRACT
As apófises são núcleos de ossificação secundários que se desenvolvem com o crescimento. Estão sujeitas a forças de tração porque servem para inserção de músculos e ligamentos. Se a força de tração torna-se maior em magnitude e freqüência, pode ocorrer irritação da fase, resultando na apofisite. As lesões apofisárias ocorrem em adolescentes, geralmente presentes com dor articu-lar, associadas com o crescimento, imaturidade esquelética, microtraumas repetidos e imaturidade músculo-tendínea. As apofisites e as suas localizações principais são: doença de Osgood-Schlatter (tuberosidade tibial), apofisites do quadril (crista ilíaca e tuberosidade isquiática), doença de Sever (calcâneo posterior), apofisite do navicular, síndrome de Sindig-Larsen-Johans-son (patela inferior) e doença de lselin (tuberosidade da base do quinto metatarsal). 0 principal objetivo será demonstrar os principais achados de imagem destas afecções pela ressonância magnética e raios-X, bem como discutir os principais diagnósticos diferenciais.
Subject(s)
Humans , Male , Female , Child , Adolescent , Bone Diseases/diagnosis , Bone Diseases , Magnetic Resonance Spectroscopy , Lower Extremity/pathology , Diagnosis, DifferentialABSTRACT
Estudo retrospectivo de nove pacientes que sofreram lesao traumática da placa de crescimento foi realizado através da análise de seus prontuários, com o objetivo de determinar o valor da ressonância magnética no diagnóstico precoce das lesoes pós-traumáticas da placa de crescimento e também na capacidade de identificar o tipo, localizaçao e extensao da lesao, para melhor planejar o tratamento. As ressonâncias magnéticas foram realizadas com séries pesadas em T1, T2 e T2* (gradiente eco), nos planos coronais e sagitais. Em dois casos de lesao traumática aguda sem desvio da placa de crescimento, foi possível sua identificaçao. Nos casos em que havia ponte através da placa de crescimento, foi possível identificar sua localizaçao, sua extensao e ainda diferenciar entre ponte óssea ou fibrosa, com exceçao de um caso. Os resultados mostraram que a RM é um eficiente método na detecçao precoce das alteraçoes pós-traumáticas da placa de crescimento, assim como na determinaçao da localizaçao e extensao dessas, contribuindo muito para o planejamento terapêutico.
Subject(s)
Humans , Male , Female , Child , Adolescent , Epiphyses/injuries , Wounds and Injuries/diagnosis , Growth Plate/injuries , Magnetic Resonance Imaging , Retrospective StudiesABSTRACT
Os autores analisam as várias causas de dor em um paciente em crescimento. Chamam a atençäo para os aspectos clínicos, do diagnóstico e do tratamento das afecçöes mais comuns que causam dor na coluna nesse grupo etário.
Subject(s)
Humans , Child , Adolescent , Back Pain/etiology , Tomography, X-Ray ComputedABSTRACT
The authors review eight cases of lumbar intervertebral disk herniation in adolescents aged less than 16 years, with a minimun follow-up treatment of 2 years, during an 18-year period. All patients presented lower back and sciatic pain, antalgic scoliosis, and a positive Lasègue sign. Nerve compression signs present in 25+ of the cases. Seventy-five percent of the cases underwent myelography and 25% underwent computerized axial tomography. Results were good in all cases
Subject(s)
Humans , Male , Adolescent , Intervertebral Disc Displacement/surgery , Lumbar Vertebrae/surgery , Myelography , Tomography, X-Ray Computed , Follow-Up Studies , Intervertebral Disc Displacement , Laminectomy , Lumbar VertebraeABSTRACT
Os autores avaliam as várias modalidades de diagnóstico empregadas nas lombalgias. Analisam as modalidades de diagnóstico em relaçäo ao quadro clínico. Apresentam um algoritmo baseado na idade dos pacientes
Subject(s)
Humans , Child , Adolescent , Adult , Middle Aged , Diagnostic Imaging , Low Back Pain/diagnosis , Algorithms , Low Back Pain , Low Back Pain , Magnetic Resonance Spectroscopy , Tomography, X-Ray ComputedABSTRACT
Os autores apresentarm um caso de osteoma osteoide vertebral, localizado na coluna toracica, no qual foi feita ressonancia magnetica. Abordam os aspectos de imagem da ressonancia magnetica da lesao. Chamam atencao para a necessidade da precisa localizacao do osteoma osteoide vertebral, para seu correto tratamento cirurgico.