RESUMO
BACKGROUND: There are rare reports of broken surgical blades occurring during lumbar discectomy, and even fewer that discuss their retrieval. CASE DESCRIPTION: While a 54-year-old male was undergoing a lumbar discectomy, the knife blade was broken. As it was difficult to retrieve the fragment through the original incision, the patient was closed, and a postoperative angio-computerized tomography (CT) was obtained. When the CT angiogram (CTA) documented the retained fragment had become lodged near the iliac vein within the psoas muscle, a second operation for blade retrieval, consisting of a paravertebral, lateral transpsoas approach, was successfully performed. CONCLUSION: In some cases, it is difficult to retrieve a broken scalpel blade during the index surgery. When this occurs, we would recommend closing the patient, and obtaining a CTA to better document the location of the retained foreign body. Based upon these findings, a safer second stage procedure may be performed (e.g., as in this case using a paravertebral lateral transpsoas approach) to avoid undue sequelae/morbidity.
RESUMO
El Pott's puffy tumor (PPT) es una rara entidad que en la actualidad representa un abombamiento del cuero cabelludo asociado a un absceso subperióstico y a una osteomielitis craneal, pudiendo acompañarse o no de infección intracraneal. Suele asociarse a la sinusitis frontal, tratándose de una complicación típica, aunque poco frecuente de la misma. Por su parte las osteomielitis causadas por Actinomyces son raras y suelen tener lugar a nivel mandibular, no encontrándose apenas casos de osteomielitis craneal causada por este género bacteriano, en especial tras traumatismo craneoencefálico. Presentamos un caso especialmente poco usual al tratarse de un PPT frontal tras traumatismo cerrado, con componente intracraneal y en el que tras cirugía se aisló Actinomyces como copartícipe de dicha infección, junto con Fusobacterium y Propionibacterium
Pott's puffy tumour (PPT) is a rare entity that involves scalp swelling associated with subperiosteal abscess and cranial osteomyelitis, occasionally accompanied by intracranial infection. It is usually affiliated with frontal sinusitis, which is a typical but infrequent complication. On the contrary, Osteomyelitis by Actinomyces is rare and usually occurs at the mandibular level, with very few cases of cranial osteomyelitis caused by this bacterial specie, especially after traumatic brain injury. We report an exceptionally unusual case of a PPT frontal tumor after blunt trauma (closed head injury), with an intracranial lesion whereby Actinomyces was isolated after surgery, as a co-participant of the mentioned infection besides Fusobacterium and Propionibacterium
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos Craniocerebrais/complicações , Traumatismos Craniocerebrais/cirurgia , Osteomielite/complicações , Actinomyces/patogenicidade , Actinomyces/isolamento & purificação , Osso Frontal/diagnóstico por imagem , Osso Frontal/lesões , Dura-Máter/diagnóstico por imagem , Dura-Máter/cirurgia , Crânio/diagnóstico por imagem , Crânio/cirurgia , Antibacterianos/administração & dosagemRESUMO
Pott's puffy tumour (PPT) is a rare entity that involves scalp swelling associated with subperiosteal abscess and cranial osteomyelitis, occasionally accompanied by intracranial infection. It is usually affiliated with frontal sinusitis, which is a typical but infrequent complication. On the contrary, Osteomyelitis by Actinomyces is rare and usually occurs at the mandibular level, with very few cases of cranial osteomyelitis caused by this bacterial specie, especially after traumatic brain injury. We report an exceptionally unusual case of a PPT frontal tumor after blunt trauma (closed head injury), with an intracranial lesion whereby Actinomyces was isolated after surgery, as a co-participant of the mentioned infection besides Fusobacterium and Propionibacterium.
Assuntos
Actinomyces/isolamento & purificação , Traumatismos Craniocerebrais/complicações , Fusobacterium/isolamento & purificação , Tumor de Pott/microbiologia , Propionibacterium/isolamento & purificação , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tumor de Pott/diagnóstico por imagem , Tumor de Pott/cirurgia , Tomografia Computadorizada por Raios XRESUMO
El cordoma condroide de localización vertebral torácica es un tipo de tumor que constituye una auténtica rareza. La incidencia anual del cordoma condroide se cifra en 0,1/100.000 habitantes, y la afectación torácica se aprecia en el 2 al 5% de los casos. Su diagnóstico definitivo se ve complicado por su semejanza con otros tumores como los condrosarcomas, por lo que es preciso acudir al estudio inmunohistoquímico.Su capacidad de recidiva y la tendencia a la malignización a pesar de su naturaleza de lento crecimiento provocan que su tratamiento, predominantemente quirúrgico, sea de una complejidad nada desdeñable. Su comportamiento evolutivo tan agresivo está siendo motivo de estudio a nivel molecular y genético para la elaboración de nuevas terapias oncológicas médicas con el fin de complementar la cirugía y la radioterapia, cuando estas sean aplicables. Se presenta un caso de localización torácica vertebral e intrapleural, así como el tratamiento practicado (AU)
Chondroid chordoma is an extremely rare tumour with an annual incidence of around 0.1 cases per 100 000 population. Involvement of the thoracic vertebrae may be present in 2%5% of cases. Definitive diagnosis usually requires a suitable distinction between this and other mesenchymal tumours such as chondrosarcomas, so immunohistochemical analysis is virtually mandatory. In spite of its slow-growing nature, chondroid chordoma tends to relapse, and it may eventually become malignant, often jeopardising the patient's prognosis. Although surgery remains the main therapeutic approach, research into the molecular and genetic aspects of this tumour is ongoing. These new advances are likely to improve future oncology therapies by complementing surgery and radiotherapy, changing the currently poor prognosis.We report the case of a patient with a chondroid chordoma involving the thoracic vertebrae and pleural cavity, and the treatment performed (AU)
Assuntos
Humanos , Cordoma/patologia , Neoplasias da Coluna Vertebral/patologia , Neoplasias Torácicas/patologia , Neoplasias Pleurais/patologiaRESUMO
La hernia medular idiopática es una causa muy poco frecuente de mielopatía, siendo todavía más rara la existencia de una recidiva tras un correcto tratamiento. La herniación se produce a través de un defecto dural en la cara anterior de la duramadre a nivel de la columna torácica, por causas no bien establecidas. La cirugía debe liberar la médula, corrigiendo la alineación de la médula e intentando prevenir la recidiva de este cuadro. Presentamos el caso de una mujer con clínica de síndrome de Brown-Séquard consecuencia de una herniación medular a nivel D5, y que tras una primera cirugía exitosa presentó una recidiva de la herniación tras un traumatismo mínimo (AU)
Idiopathic spinal cord herniation is a rare cause of thoracic myelopathy and its recurrence is even more infrequent. Cord herniation is through an anterior dural defect in thoracic spine with unknown causes. Symptomatic cases must be surgically treated to reduce the hernia and seal the defect to prevent recurrences. We report a patient presenting a Brown-Séquard syndrome secondary to a D5 spinal cord herniation treated successfully and its posterior traumatic recurrence (AU)
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Síndrome de Brown-Séquard/etiologia , Herniorrafia/métodos , Hérnia/complicações , Recidiva , Dura-Máter/anormalidades , Doenças da Medula Espinal/etiologiaAssuntos
Vértebras Cervicais/efeitos dos fármacos , Fraturas da Coluna Vertebral/tratamento farmacológico , Espondilite Anquilosante/tratamento farmacológico , Teriparatida/uso terapêutico , Vértebras Cervicais/lesões , Vértebras Cervicais/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas da Coluna Vertebral/cirurgia , Espondilite Anquilosante/cirurgia , Resultado do TratamentoRESUMO
Chondroid chordoma is an extremely rare tumour with an annual incidence of around 0.1 cases per 100,000population. Involvement of the thoracic vertebrae may be present in 2-5% of cases. Definitive diagnosis usually requires a suitable distinction between this and other mesenchymal tumours such as chondrosarcomas, so immunohistochemical analysis is virtually mandatory. In spite of its slow-growing nature, chondroid chordoma tends to relapse, and it may eventually become malignant, often jeopardising the patient's prognosis. Although surgery remains the main therapeutic approach, research into the molecular and genetic aspects of this tumour is ongoing. These new advances are likely to improve future oncology therapies by complementing surgery and radiotherapy, changing the currently poor prognosis. We report the case of a patient with a chondroid chordoma involving the thoracic vertebrae and pleural cavity, and the treatment performed.
Assuntos
Cordoma/diagnóstico , Cavidade Pleural/patologia , Neoplasias Torácicas/diagnóstico , Vértebras Torácicas/patologia , Antineoplásicos/uso terapêutico , Cordoma/diagnóstico por imagem , Cordoma/patologia , Cordoma/secundário , Cordoma/terapia , Terapia Combinada , Curetagem , Erros de Diagnóstico , Diafragma/patologia , Equinococose/diagnóstico , Receptores ErbB/antagonistas & inibidores , Humanos , Laminectomia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias Musculares/secundário , Invasividade Neoplásica , Proteínas de Neoplasias/antagonistas & inibidores , Cavidade Pleural/diagnóstico por imagem , Neoplasias Pleurais/secundário , Próteses e Implantes , Inibidores de Proteínas Quinases/uso terapêutico , Radioterapia Adjuvante , Indução de Remissão , Sarcoma/diagnóstico , Neoplasias Torácicas/diagnóstico por imagem , Neoplasias Torácicas/patologia , Neoplasias Torácicas/terapia , Vértebras Torácicas/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
Idiopathic spinal cord herniation is a rare cause of thoracic myelopathy and its recurrence is even more infrequent. Cord herniation is through an anterior dural defect in thoracic spine with unknown causes. Symptomatic cases must be surgically treated to reduce the hernia and seal the defect to prevent recurrences. We report a patient presenting a Brown-Séquard syndrome secondary to a D5 spinal cord herniation treated successfully and its posterior traumatic recurrence.
Assuntos
Deslocamento do Disco Intervertebral/etiologia , Traumatismos da Medula Espinal/complicações , Feminino , Humanos , Pessoa de Meia-Idade , RecidivaRESUMO
Anomalous branches from the internal carotid artery (ICA) have been reported rarely in the literature. We report three cases of ascending pharyngeal arising from the ICA. It is essential to be aware of these variations in carotid artery surgery.
Assuntos
Artéria Carótida Interna/anormalidades , Faringe/irrigação sanguínea , Malformações Vasculares/diagnóstico , Idoso , Artéria Carótida Interna/cirurgia , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico , Estenose das Carótidas/cirurgia , Endarterectomia das Carótidas/efeitos adversos , Feminino , Humanos , Angiografia por Ressonância Magnética , Masculino , Valor Preditivo dos Testes , Resultado do Tratamento , Malformações Vasculares/complicações , Lesões do Sistema Vascular/etiologia , Lesões do Sistema Vascular/prevenção & controleAssuntos
Hematoma Subdural Crônico/complicações , Doenças do Nervo Oculomotor/etiologia , Drenagem , Hematoma Subdural Crônico/diagnóstico por imagem , Hematoma Subdural Crônico/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Nervo Oculomotor/diagnóstico , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
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