Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.215
Filtrar
1.
Medicine (Baltimore) ; 99(1): e18645, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895827

RESUMO

RATIONALE: Calcific tendinopathy is one of the most frequent causes of nontraumatic shoulder pain. However, intra-articular calcifications appear to be an infrequent condition. We herein report a rare case study of an intra-articular calcification of the acromioclavicular joint. PATIENT CONCERNS: A 46-year-old man presented with an acute pain in the anterior superior region of the left shoulder which also radiated to the left cervical region. The man during the physical evaluation also presented severe functional limitation of the shoulder movements in all planes of motion. DIAGNOSES: The diagnosis was carried out through a radiographic and an echotomographic examination, highlighting the intra-articular calcific formation associated to a reactive inflammatory reaction. INTERVENTIONS: An ultrasound-guided percutaneous treatment following the guidelines for calcific tendinopathy of the shoulder was carried out. OUTCOMES: The posttreatment was satisfactory with the disappearance of the pain and the recovery of the shoulder movements in all planes of motion. LESSONS: We can affirm that the ultrasound-guided percutaneous treatment in patients with calcification of the acromion-clavicular joint represents a valid and nonpainful therapeutic treatment.


Assuntos
Articulação Acromioclavicular/diagnóstico por imagem , Calcinose/terapia , Tendinopatia/terapia , Ultrassonografia de Intervenção , Calcinose/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Tendinopatia/diagnóstico por imagem
3.
Heart Lung Circ ; 28(9): 1310-1319, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31266725

RESUMO

Degenerative or fibrocalcific aortic stenosis (AS) is now the most common native valvular heart disease assessed and managed by cardiologists in developed countries. Transthoracic echocardiography remains the quintessential imaging modality for the non-invasive characterisation of AS due to its widespread availability, superior assessment of flow haemodynamics, and a wealth of prognostic data accumulated over decades of clinical utility and research applications. With expanding technologies and increasing availability of treatment options such as transcatheter aortic valve replacements, in addition to conventional surgical approaches, accurate and precise assessment of AS severity is critical to guide decisions for and timing of interventions. Despite clear guideline echocardiographic parameters demarcating severe AS, discrepancies between transvalvular velocities, gradients, and calculated valve areas are commonly encountered in clinical practice. This often results in diagnostically challenging cases with significant implications. Greater emphasis must be placed on the quality of performance of basic two dimensional (2D) and Doppler measurements (attention to detail ensuring accuracy and precision), incorporating ancillary haemodynamic surrogates, understanding study- or patient-specific confounders, and recognising the role and limitations of stress echocardiography in the subgroups of low-flow low-gradient AS. A multiparametric approach, along with the incorporation of multimodality imaging (cardiac computed tomography or magnetic resonance imaging) in certain scenarios, is now mandatory to avoid incorrect misclassification of severe AS. This is essential to ensure appropriate selection of patients who would most benefit from interventions on the aortic valve to relieve the afterload mismatch resulting from truly severe valvular stenosis.


Assuntos
Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/fisiopatologia , Valva Aórtica/patologia , Calcinose/diagnóstico por imagem , Calcinose/fisiopatologia , Ecocardiografia sob Estresse , Ecocardiografia , Hemodinâmica , Imagem Multimodal , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/prevenção & controle , Estenose da Valva Aórtica/terapia , Calcinose/prevenção & controle , Calcinose/terapia , Humanos , Substituição da Valva Aórtica Transcateter
5.
Medicine (Baltimore) ; 98(21): e15552, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31124934

RESUMO

BACKGROUND: Rotator cuff calcific tendinopathy (RCCT) is frequently diagnosed in patients with shoulder pain, but there is no consensus on its treatment such as rest, nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy, subacromial corticosteroid injection (SAI), extracorporeal shock wave therapy (ESWT), and ultrasound-guided percutaneous lavage (UGPL). The aim of the study was to compare the effectiveness of UGPL with other techniques in the treatment of RCCT. METHODS: Literature searches of PubMed, EMBASE, OVID, Cochrane Library, Web of Science, Chinese Biomedical Literature, Wanfang, Weipu Journal, and CNKI databases were performed up to August 2018. Only randomized controlled trials (RCTs) comparing UGPL vs other methods for RCCT were included. Data collection and extraction, quality assessment, and data analyses were performed according to the Cochrane standards. RESULTS: Eight RCTs were included with 617 cases in all. The result of meta-analysis showed that: there were significant differences between the UGPL and ESWT group in 12-month follow-up VAS, constant shoulder score (CSS), the average particle size of the calcium deposition, and the calcification disappearance rate. However, there was no significant difference in complication between 2 groups. CONCLUSION: The present meta-analysis indicates that UGPL has certain clinical effect for calcifying tendinitis of rotator cuff. Compared with ESWT, UGPL may be superior in clinical pain relief and calcification clearance. However, owing to the limited quality and quantity of the included studies, additional high-quality RCTs are needed to confirm these findings.


Assuntos
Calcinose/terapia , Lesões do Manguito Rotador/terapia , Dor de Ombro/terapia , Irrigação Terapêutica/métodos , Ultrassonografia de Intervenção/métodos , Corticosteroides/administração & dosagem , Adulto , Calcinose/complicações , Tratamento por Ondas de Choque Extracorpóreas , Feminino , Humanos , Injeções Intra-Articulares , Masculino , Pessoa de Meia-Idade , Modalidades de Fisioterapia , Lesões do Manguito Rotador/complicações , Dor de Ombro/etiologia , Resultado do Tratamento
7.
Ann Rheum Dis ; 78(6): 837-843, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30975645

RESUMO

OBJECTIVE: Steroid injections are common after an ultrasound-guided puncture and lavage (UGPL) of calcific tendonitis of the rotator cuff. However, steroids may prevent calcification resorption and negatively affect tendon healing. Our study was designed to determine whether saline solution was non-inferior to steroids in the prevention of acute pain reactions in the week following UGPL. METHODS: This was a randomised, double-blinded, controlled non-inferiority trial with 12-month follow-up. We included 132 patients (66 in each group) with symptomatic calcification measuring more than 5 mm. Patients received 1 mL of saline or steroid (methylprednisolone 40 mg) in the subacromial bursa at the end of UGPL. Primary outcome was the maximal pain during the week following the procedure with a prespecified non-inferiority margin of 10 mm (0-100 visual analogue scale). Secondary outcomes included pain at rest and during activity, function (disabilities of the arm, shoulder and hand score) and radiological evolution of the calcification over the 12-month follow-up. RESULTS: The estimated mean difference in the first week's maximal pain between these two groups was 11.76 (95% CI 3.78 to 19.75). Steroids significantly improved VAS pain at rest and during activities, as well as function at 7 days and 6 weeks. They did not change the rate of calcification resorption, which occurred in 83% and 74% of patients at 12 months in the saline and steroid groups. CONCLUSION: Non-inferiority of saline when compared with steroids could not be established. However, steroid injection improved pain in the 6 weeks following the procedure, and function in the 3 months after, with no significant effect on calcification resorption. TRIAL REGISTRATION NUMBER: NTC02403856.


Assuntos
Calcinose/terapia , Glucocorticoides/uso terapêutico , Metilprednisolona/uso terapêutico , Punções/métodos , Tendinopatia/terapia , Dor Aguda/etiologia , Dor Aguda/prevenção & controle , Adulto , Calcinose/diagnóstico por imagem , Método Duplo-Cego , Estudos de Equivalência como Asunto , Feminino , Seguimentos , Glucocorticoides/efeitos adversos , Humanos , Injeções Intra-Articulares , Masculino , Metilprednisolona/efeitos adversos , Pessoa de Meia-Idade , Medição da Dor/métodos , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Punções/efeitos adversos , Manguito Rotador , Solução Salina , Dor de Ombro/diagnóstico por imagem , Dor de Ombro/terapia , Tendinopatia/diagnóstico por imagem , Irrigação Terapêutica/métodos , Resultado do Tratamento , Ultrassonografia de Intervenção
9.
Medicine (Baltimore) ; 98(17): e15390, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31027134

RESUMO

RATIONALE: Fahr's syndrome (FS) is a rare neurological and psychiatric disorder characterized by bilateral brain calcifications when a secondary cause of the calcification is found. PATIENT CONCERNS: A 53-year-old female patient diagnosed with FS for laminectomy because of ossification of posterior longitudinal ligament. She had a history of generalized tonic-clonic (GTC) seizure and medication with anticonvulsant drugs. She had gait disturbance, spasticity, bradykinesia, and diffuse calcifications in the basal ganglia, thalamus, cerebellum, and cerebral hemispheres on the brain computed tomography. On the preoperative examination, the serum and ionized calcium (Ca) were decreased to 3.7 and 2.22 mg/dL. Hypomagnesemia is combined with hypocalcemia. Furthermore, the level of parathyroid hormone was decreased to 2.18 pg/mL. DIAGNOSES: Due to the radiologic findings and laboratory test results, she was diagnosed with FS with primary hypoparathyroidism. INTERVENTIONS: The Ca and magnesium (Mg) had been corrected before surgery but the electrolytes revealed low level at the intraoperative period. The 300 mg of calcium chloride was administered at 2 times and 1200 mg of it were infused for 1 hour during intraoperative periods. In addition, total 4 g of Mg sulfate intravenously administered. We used rocuronium as a neuromuscular block and checked neuromuscular function by train-of-four monitoring. OUTCOMES: Residual neuromuscular blockade was reversed with pyridostigmine and her muscle power completely recovered. The patient was extubated successfully and no unpredictable events occurred. On the day following transfer, serum electrolytes remained low, and although Ca was continuously supplied, serum Ca did not recover to a normal level. The patient was medicated with anticonvulsant drugs but experienced GTC seizure 2 weeks after surgery. LESSONS: We presume that the pathophysiology of FS was related to primary hypoparathyroidism and hypomagnesemia. FS raises concerns associated with neuromuscular problems, spasticity, and seizure, and concerns of hypotension, heart failure, cardiac arrhythmia, and cerebrovascular attack during perioperative periods, among anesthesiologists because of hypocalcemia and vessel calcification. During the perioperative period, Ca levels should be closely monitored, and titrated Ca replacement therapy is recommended. The simultaneous correction of hypomagnesemia is of considerable importance when correcting hypocalcemia.


Assuntos
Anestesia Geral , Encefalopatias/terapia , Calcinose/terapia , Encéfalo/diagnóstico por imagem , Encefalopatias/diagnóstico , Calcinose/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Hipoparatireoidismo/diagnóstico , Hipoparatireoidismo/terapia , Laminectomia , Pessoa de Meia-Idade , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Síndrome
10.
Trends Pharmacol Sci ; 40(3): 212-225, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30732864

RESUMO

Interest in lipoprotein (a) [Lp(a)] has exploded over the past decade with the emergence of genetic and epidemiological studies pinpointing elevated levels of this unique lipoprotein as a causal risk factor for atherosclerotic cardiovascular disease (ASCVD) and calcific aortic valve disease (CAVD). This review summarizes the most recent discoveries regarding therapeutic approaches to lower Lp(a) and presents these findings in the context of an emerging, although far from complete, understanding of the biosynthesis and catabolism of Lp(a). Application of Lp(a)-specific lowering agents to outcome trials will be the key to opening this new frontier in the battle against CVD.


Assuntos
Estenose da Valva Aórtica/sangue , Estenose da Valva Aórtica/terapia , Valva Aórtica/patologia , Aterosclerose/sangue , Aterosclerose/terapia , Calcinose/sangue , Calcinose/terapia , Lipoproteína(a)/sangue , Animais , Valva Aórtica/efeitos dos fármacos , Estenose da Valva Aórtica/genética , Aterosclerose/tratamento farmacológico , Aterosclerose/genética , Calcinose/genética , Humanos , Lipoproteína(a)/genética , Terapia de Alvo Molecular
11.
Circ Res ; 124(3): 405-415, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30702993

RESUMO

The prevalence of calcific aortic valve disease is increasing with aging of the population. Current treatment options for advanced or symptomatic aortic stenosis are limited to traditional surgical or percutaneous aortic valve replacement. Medical therapies that impact the progression of calcific aortic valve disease do not currently exist. New pathophysiological insights suggest that the processes leading to calcific aortic valve disease are metabolically active for many years before and during the clinical expression of disease. The identification of genetic and potentially causal mediators of calcific aortic valve disease allows opportunities for therapies that may slow progression to the point where aortic valve replacement can be avoided. Recent studies suggest that approximately one-third of aortic stenosis cases are associated with highly elevated lipoprotein(a) [Lp(a)] and pathways related to the metabolism of procalcifying oxidized phospholipids. Oxidized phospholipids can be carried by Lp(a) into valve leaflets but can also be formed in situ from cell membranes, lipoproteins, and apoptotic cells. This review will summarize the clinical data implicating the potential causality of Lp(a)/oxidized phospholipids, describe emerging therapeutic agents, and propose clinical trial designs to test the hypothesis that lowering Lp(a) will reduce progression aortic stenosis and the need for aortic valve replacement.


Assuntos
Estenose da Valva Aórtica/terapia , Calcinose/terapia , Hiperlipoproteinemias/complicações , Lipoproteína(a) , Fosfolipídeos/metabolismo , Estenose da Valva Aórtica/etiologia , Calcinose/etiologia , Causalidade , Ensaios Clínicos como Assunto , Implante de Prótese de Valva Cardíaca , Humanos , Oxirredução , Fatores de Risco
12.
World Neurosurg ; 125: 1-2, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30703602

RESUMO

Calcified disk herniation of the thoracic spine is by no means a rare clinical entity in neurosurgery. We present a 63-year-old woman with a long-standing giant calcified disk in the thoracic spine. Initial imaging studies indicated a differential diagnosis of calcified disk versus meningioma. Given her benign neurologic examination and the presumed morbidity of attempting to resect the lesion, we elected to follow her closely with serial imaging. Over 3 years of consistent follow-up, the lesion has not grown and she has remained free of neurologic changes.


Assuntos
Calcinose/diagnóstico , Deslocamento do Disco Intervertebral/diagnóstico , Vértebras Torácicas , Calcinose/terapia , Tratamento Conservador , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Degeneração do Disco Intervertebral/diagnóstico , Deslocamento do Disco Intervertebral/terapia , Dor Lombar/etiologia , Imagem por Ressonância Magnética , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Pessoa de Meia-Idade , Imagem Multimodal , Tomografia Computadorizada por Raios X
13.
Biomed Mater ; 14(3): 035014, 2019 04 05.
Artigo em Inglês | MEDLINE | ID: mdl-30769335

RESUMO

INTRODUCTION: Calcific aortic valve disease (CAVD) is the most common acquired heart valve disease with complex underlying pathomechanisms that are yet not fully understood. Three-dimensional (3D) cell culture models as opposed to conventional two-dimensional (2D) techniques may reveal new aspects of CAVD and serve as a transitional platform between conventional 2D cell culture and in vivo experiments. METHODS: Here we report on fabrication and characterization of a novel 3D hydrogel derived from cell-free native aortic valves. A detailed analysis containing protein composition, rheological behavior, cytotoxic and proliferative effects as well as results of 3D cell culture experiments are presented. Moreover, this aortic valve derived hydrogel (AVdH) is compared to commercially available biological extracellular matrix (ECM) components to evaluate and classify AVdH with respect to other currently used ECM solutions, i.e. Collagen type I and Matrigel®. RESULTS: On the biochemical level, a complex composition of native proteins was detected. Using different techniques, including mass spectrometry with Gene Ontology network and enrichment analysis, different fundamental biological functions of AVdH were identified, including peptidase-, peptidase inhibitor-, growth- and binding activity. No cytotoxic effects were detected and AVdH showed positive effects on cell growth and proliferation in vitro when compared to Collagen type I and Matrigel®. CONCLUSION: These results suggest AVdH as an organotypic ECM supporting sophisticated 3D cell culture model studies, while mimicking the native environment of the aortic valve to a greater level for enhanced in vitro analyses.


Assuntos
Valva Aórtica/fisiologia , Materiais Biomiméticos , Técnicas de Cultura de Células , Hidrogéis/química , Engenharia Tecidual/métodos , Animais , Valva Aórtica/patologia , Estenose da Valva Aórtica/terapia , Calcinose/terapia , Proliferação de Células , Sistema Livre de Células , Colágeno/química , Combinação de Medicamentos , Matriz Extracelular/química , Doenças das Valvas Cardíacas/terapia , Cinética , Laminina/química , Proteoglicanas/química , Reologia , Ovinos , Software
15.
Stroke ; 50(3): 745-749, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30661491

RESUMO

Background and Purpose- We try to evaluate whether plaque features and perforator stroke after intracranial stenting is associated with the arterial remodeling patterns in patients with severe basilar artery stenosis. Methods- We studied patients with symptomatic intracranial arterial stenosis who underwent high-resolution magnetic resonance imaging from September 2014 to January 2017. Among them, patients with basilar artery stenosis underwent angioplasty and stenting were recruited. Arterial remodeling patterns were divided into negative or nonnegative remodeling. Plaque features were investigated by high-resolution magnetic resonance imaging, which includes plaque distribution, intraplaque hemorrhage, calcification, as well as enhancement patterns. Incidence of perforator strokes after intracranial stenting was recorded. Plaque features and incidence of poststenting perforator stroke were compared between negative and nonnegative remodeling. Results- Two hundred ninety-eight consecutive patients were enrolled. Among them, 30 patients fulfilled the inclusion criteria. There were 11 patients (36.7%) with negative remodeling and 19 (63.3%) with nonnegative remodeling. Twenty-six patients (86.7%) had diffuse distribution, 5 patients (16.7%) had intraplaque hemorrhage, 2 patients (6.7%) had calcification, and 17 patients (65.4%) had enhancement. Three patients had perforator stroke after stenting. Plaque features were similar between negative and nonnegative remodeling groups. Patients with negative remodeling were more likely to have perforator stroke after stenting comparing with patients with nonnegative remodeling (27.3% versus 0%, P=0.041). Conclusions- Perforator stroke after basilar artery stenting may be related to negative remodeling on high-resolution magnetic resonance imaging. The finding needs to be confirmed in future studies. Clinical Trial Registration- URL: https://www.clinicaltrials.gov . Unique identifier: NCT02705599.


Assuntos
Artéria Basilar , Stents/efeitos adversos , Acidente Vascular Cerebral/etiologia , Insuficiência Vertebrobasilar/terapia , Idoso , Artéria Basilar/diagnóstico por imagem , Calcinose/etiologia , Calcinose/terapia , Feminino , Humanos , Arteriosclerose Intracraniana/terapia , Hemorragias Intracranianas/etiologia , Hemorragias Intracranianas/terapia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/terapia , Acidente Vascular Cerebral/diagnóstico por imagem , Resultado do Tratamento , Insuficiência Vertebrobasilar/diagnóstico por imagem
17.
Curr Probl Cardiol ; 44(1): 10-35, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29731112

RESUMO

Mitral stenosis (MS) is characterized by obstruction of left ventricular inflow as a result of narrowing of the mitral valve orifice. Although its prevalence has declined over the last decade, especially in developed countries, it remains an important cause of morbidity and mortality.  The most often cause of MS worldwide is still postrheumatic mitral valve disease. However, in developed countries, degenerative or calcific changes cause MS in a siginificant proportion of patients. Although the range of treatment for mitral valve disease has grown over the years in parallel with transcatheter therapies for aortic valve disease, these improvements in mitral valve disease therapy have experienced slower development. This is mainly due to the more complex anatomy of the mitral valve and entire mitral apparatus, and the interplay of the mitral valve with the left ventricle which hinders the development of effective implantable mitral valve devices. This is especially the case with degenerative MS where percutaneous or surgical comissurotomy is rarely employed due to the presence of extensive annular calcification and at the base of leaflets, without associated commissural fusion. However, the last few years have witnessed innovations in transcatheter interventional procedures for degenerative MS which consequently hinted that in the future, transcatheter mitral valve replacement could be the treatment of choice for these patients.


Assuntos
Calcinose/fisiopatologia , Estenose da Valva Mitral/fisiopatologia , Antiarrítmicos/uso terapêutico , Calcinose/epidemiologia , Calcinose/terapia , Cateterismo Cardíaco , Diuréticos/uso terapêutico , Doenças das Valvas Cardíacas/epidemiologia , Doenças das Valvas Cardíacas/fisiopatologia , Doenças das Valvas Cardíacas/terapia , Implante de Prótese de Valva Cardíaca , Humanos , Anuloplastia da Valva Mitral , Estenose da Valva Mitral/epidemiologia , Estenose da Valva Mitral/terapia , Índice de Gravidade de Doença
18.
Int J Cardiol ; 274: 326-330, 2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-30454723

RESUMO

BACKGROUND: Epicardial adipose tissue (EAT) thickness and pro-inflammatory status has been shown to be associated with several cardiac diseases, including aortic stenosis (AS). Thus, cardiac visceral fat could represent a potential new target for drugs. In the present study we evaluate the effect of statin therapy on EAT accumulation and inflammation. METHODS: Echocardiographic EAT thickness was assessed in 193 AS patients taking (n.87) and not taking (n.106) statins, undergoing cardiac surgery. To explore the association between statin therapy and EAT inflammation, EAT biopsies were obtained for cytokines immunoassay determination in EAT secretomes. An in vitro study was also conducted and the modulation of EAT and subcutaneous adipose tissue (SCAT) secretomes by atorvastatin was assessed in paired biopsies. RESULTS: Statin therapy was significantly associated with lower EAT thickness (p < 0.0001) and with lower levels of EAT-secreted inflammatory mediators (p < 0.0001). Of note, there was a significant correlation between EAT thickness and its pro-inflammatory status. In vitro, atorvastatin showed a direct anti-inflammatory effect on EAT which was significantly higher compared to the SCAT response to statin incubation (p < 0.0001). CONCLUSIONS: The present study indicates a robust association between statin therapy and reduced EAT accumulation in patients with AS. The present data also suggest a direct relationship between EAT thickness and its inflammatory status, both modulated by statin therapy. The in vitro results support the hypothesis of a direct action of statins on EAT secretory profile. Overall our data suggest EAT as a potential new therapeutic target for statin therapy.


Assuntos
Tecido Adiposo/diagnóstico por imagem , Atorvastatina/uso terapêutico , Doença da Artéria Coronariana/prevenção & controle , Inflamação/tratamento farmacológico , Pericárdio/diagnóstico por imagem , Idoso , Valva Aórtica/patologia , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/terapia , Biópsia , Calcinose/complicações , Calcinose/diagnóstico , Calcinose/terapia , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/etiologia , Citocinas/metabolismo , Ecocardiografia , Feminino , Seguimentos , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Inflamação/diagnóstico , Inflamação/metabolismo , Masculino , Estudos Retrospectivos
19.
J Pediatr ; 206: 212-216, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30466792

RESUMO

OBJECTIVE: To review pediatric idiopathic intervertebral disc calcification (PIIVDC) within a single center and within the literature to outline the disease course, management, and outcome. STUDY DESIGN: A retrospective chart review was performed spanning the period between January 2001 and February 2016 for diagnoses of PIIVDC. Patient age, sex, symptoms, and history and physical and neurologic findings were reviewed. Laboratory and imaging findings, management, follow-up, and outcome also were studied. RESULTS: Nine cases of PIIVDC were identified; they included 6 male and 3 female patients, with an age range of 23 months to 12 years. Two patients were asymptomatic, and PIIVDC was discovered incidentally. Of the remaining 7 patients, 5 presented with neck and/or back pain, 1 with painless torticollis, and 1 with painful torticollis. One patient reported neurologic symptoms of pain radiating along 1 dermatome. Disc spaces affected were 5 cervical, 4 thoracic, and 2 lumbar, with 2 patients having more than 1 space affected. All patients were managed conservatively. In 1 case, symptoms and lesions persisted after 5 years, but the remainder had complete symptom resolution, generally within 6 months. CONCLUSIONS: The etiology of PIIVDC remains unknown but appears to occur spontaneously, without preceding trauma or underlying medical condition. A conservative approach to patients without severe neurologic deficit with outpatient follow-up is supported.


Assuntos
Calcinose/diagnóstico , Calcinose/terapia , Degeneração do Disco Intervertebral/diagnóstico , Degeneração do Disco Intervertebral/terapia , Calcinose/complicações , Criança , Pré-Escolar , Diagnóstico Diferencial , Feminino , Humanos , Lactente , Recém-Nascido , Degeneração do Disco Intervertebral/complicações , Masculino , Estudos Retrospectivos , Fatores de Risco , Avaliação de Sintomas
20.
World Neurosurg ; 123: 23-28, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30521958

RESUMO

BACKGROUND: The endoscopic endonasal transpterygoid approach is emerging as a valid option for treating selected tumors in the infratemporal fossa. Compared with traditional open approaches, the endoscopic endonasal approach presents more difficulty in controlling bleeding and less choice in surgical instruments for endoscopic tumor dissection, which is often performed with bipolar forceps or steel dissectors. CASE DESCRIPTION: We describe the use of an ultrasonic scalpel device for performing endoscopic endonasal resection of 2 rare infratemporal fossa tumors (mature teratoma and hemangiopericytoma), which has not been reported in the literature so far. We also review the literature on endoscopic ultrasonic scalpel use. CONCLUSIONS: The ultrasonically activated scalpel is a safe, effective and simple to use device, which achieved excellent hemostasis and did not damage adjacent neurovascular structures.


Assuntos
Neoplasias Infratentoriais/terapia , Cirurgia Endoscópica por Orifício Natural/instrumentação , Procedimentos Cirúrgicos Ultrassônicos/instrumentação , Adulto , Calcinose/patologia , Calcinose/terapia , Diagnóstico Diferencial , Desenho de Equipamento , Feminino , Humanos , Neoplasias Infratentoriais/patologia , Imagem por Ressonância Magnética , Cirurgia Endoscópica por Orifício Natural/métodos , Instrumentos Cirúrgicos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA