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1.
Medicine (Baltimore) ; 99(50): e23587, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327321

RESUMO

RATIONALE: Angiosarcoma is a rare malignant tumors. The objective of this study is to report a patient who suffered from a progressive low back pain and left lower extremities radiation pain for about 8 months, After diagnoses, this was identified as an extremely rare case of primary multiple angiosarcoma of vertebra. PATIENT CONCERNS: A 54-year-old man with a history of 2-year hypertension and 8-year diabetes, both of which were well controlled by drug management. Lately, he suffered from a progressive low back pain and left lower extremities radiation pain for about 8 months. DIAGNOSES: Magnetic resonance imaging of lumbar showed a clear pathological fracture and primary multiple angiosarcoma of all vertebra. Postoperative pathology and High-throughput sequencing confirmed the diagnosis of primary multiple angiosarcoma of vertebra. INTERVENTIONS: The patient underwent minimally invasive pedicle screw fixation combined with bone cement augmentation for the purpose of stabilizing the damaged vertebrae. Following operation, he received both radiotherapy and chemotherapy for a period of time. OUTCOMES: The operation has achieved positive results in relieving pain and stabilizing the spine. No wound problem or operative complications occurred after operation. The patient reported an obvious remission of low back pain and was only capable to perform restricted physiological activities. A long-term palliative radiotherapy and chemotherapy were performed after operation. Unfortunately, the patient died 18 months later. CONCLUSION: This article emphasizes primary multiple angiosarcoma of vertebra. Despite being rare, it should be part of the differential when the patient manifested back pain and radiculopathy. We recommended the minimally invasive pedicle screw fixation for angiosarcoma of vertebra. Osteoplasty by bone cement augmentation was also an ideal choice for surgical treatment. It also advocates the use of specific targeted radiotherapy drugs based on gene analysis of tumors.


Assuntos
Fraturas Espontâneas/diagnóstico , Hemangiossarcoma/diagnóstico , Vértebras Lombares , Neoplasias Primárias Múltiplas/diagnóstico , Neoplasias da Coluna Vertebral/diagnóstico , Terapia Combinada , Fraturas Espontâneas/complicações , Fraturas Espontâneas/diagnóstico por imagem , Fraturas Espontâneas/cirurgia , Hemangiossarcoma/complicações , Hemangiossarcoma/diagnóstico por imagem , Hemangiossarcoma/cirurgia , Humanos , Dor Lombar/etiologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/complicações , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Neoplasias Primárias Múltiplas/cirurgia , Parafusos Pediculares , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/cirurgia
2.
J Vasc Interv Radiol ; 31(10): 1683-1689.e1, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32921566

RESUMO

PURPOSE: To assess the safety and efficacy of multilevel thoracolumbar vertebroplasty in the simultaneous treatment of ≥ 6 painful pathologic compression fractures. MATERIALS AND METHODS: Retrospective review was conducted of 50 consecutive patients treated with vertebroplasty for ≥ 6 pathologic compression fractures in a single session for pain palliation at a tertiary single cancer center from 2015 to 2019. Outcomes measured included procedural safety according to Common Terminology Criteria for Adverse Events (CTCAE), change in 4-week postprocedure back pain by numeric rating scale (NRS), comparison of daily opioid medication consumption, and development of skeletal-related events. RESULTS: A total of 397 pathologic compression fractures were treated during 50 sessions (mean, 7.9 per patient ± 1.5). Mean procedure duration was 162 minutes ± 35, mean postoperative hospitalization duration was 1.6 days ± 0.9, and mean follow-up duration was 401 days ± 297. Seven complications were recorded, including 1 case of symptomatic polymethyl methacrylate pulmonary embolism. No major complications (CTCAE grade 4/5) were reported. NRS pain score was significantly decreased (5.0 ± 1.8 vs 1.7 ± 1.4; P < .0001), with a mean score decrease of 3.3 points (66%). Opioid agent use decreased significantly (76 mg/24 h ± 42 vs 45 mg/24 h ± 37; P = .0003), with a mean decrease of 30 mg/24 h (39%). Skeletal-related events occurred in 7 patients (14%). CONCLUSIONS: Multilevel vertebroplasty for ≥ 6 pathologic compression fractures is safe and provides significant palliative benefit when performed simultaneously.


Assuntos
Dor nas Costas/prevenção & controle , Fraturas por Compressão/terapia , Fraturas Múltiplas/terapia , Fraturas Espontâneas/terapia , Vértebras Lombares/lesões , Cuidados Paliativos , Fraturas da Coluna Vertebral/terapia , Vértebras Torácicas/lesões , Vertebroplastia , Idoso , Dor nas Costas/diagnóstico , Dor nas Costas/etiologia , Feminino , Fraturas por Compressão/complicações , Fraturas por Compressão/diagnóstico por imagem , Fraturas Múltiplas/complicações , Fraturas Múltiplas/diagnóstico por imagem , Fraturas Espontâneas/complicações , Fraturas Espontâneas/diagnóstico por imagem , Humanos , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Resultado do Tratamento , Vertebroplastia/efeitos adversos
4.
Arch Pediatr ; 27(2): 95-103, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31791829

RESUMO

BACKGROUND AND AIMS: Malnutrition is common in neurologically impaired (NI) children. It is, however, ill-defined and under-diagnosed. If not recognized and treated, it increases the burden of comorbidities and affects the quality of life of these children. The aim of this study was to characterize the nutritional status of a cohort of children followed up at a reference center for cerebral palsy (CP) in Brussels, Belgium, and to investigate possible links with the occurrence of comorbidities. MATERIAL AND METHODS: We conducted a single-center retrospective study including all the children followed up at the Inter-university Reference Center for Cerebral Palsy ULB-VUB-ULg. The data were obtained by reviewing medical files. Anthropometric measurements as well as the etiology of neurological impairment, comorbidities, feeding patterns, and laboratory test results were collected. The children were assigned a nutritional diagnosis according to the World Health Organization and Waterlow definitions. RESULTS: A total of 260 children with cerebral palsy were included, 148 males and 112 females. Their mean age was 10.9±4.3 years. The gross motor function classification system (GMFCS) level was I for 79 children, II for 63 children, III for 35 children, IV for 33 children, and V for 50 children. Of the children, 54% had a normal nutritional status, 34% showed malnutrition, and 8% were obese; 38% had oropharyngeal dysphagia. The sensitivity of mean upper arm circumference of

Assuntos
Paralisia Cerebral/complicações , Transtornos da Nutrição Infantil/complicações , Transtornos da Nutrição Infantil/diagnóstico , Transtornos de Deglutição/complicações , Obesidade Pediátrica/complicações , Adolescente , Bélgica , Criança , Pré-Escolar , Feminino , Fraturas Espontâneas/complicações , Gráficos de Crescimento , Humanos , Lactente , Masculino , Estado Nutricional , Obesidade Pediátrica/diagnóstico , Pneumonia/complicações , Lesão por Pressão/complicações , Estudos Retrospectivos , Extremidade Superior/anatomia & histologia
6.
BMC Surg ; 19(1): 35, 2019 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-30953554

RESUMO

BACKGROUND: Arteriovenous malformations (AVMs) are rare congenital vascular lesions associated with early quiescence, late expansion, and, ultimately, infiltration and destruction of local soft tissue and bone. The extremities are a common location. Incidence of bony involvement by AVM has been reported as high as 31%. However, there are few reports on management of pathologic fracture associated with AVM. Teriparatide is a recombinant parathyroid hormone (PTH) analogue consisting of the 1-34 fragment of PTH. Recently, some reports have shown the ability of teriparatide to improve fracture healing. Here, we present a case of pathologic femoral shaft fracture associated with large AVMs that was treated successfully by external fixation and teriparatide. CASE PRESENTATION: A 68-year-old Japanese woman, previously diagnosed as having large AVMs, sustained a right femoral shaft fracture due to a fall. At the time of admission, she presented with massive swelling and venous varicosities of the right thigh. Plain radiography of the right thigh revealed femoral shaft fracture with bony erosion and calcification of soft tissue. We planned closed reduction and intramedullary nailing with a unilateral external fixator following embolization of the feeding artery. However, closed reduction using the fracture table was difficult. When we attempted open reduction, massive bleeding (1000 mL) after incision of subcutaneous tissue occurred. Finally, we carefully applied a Taylor Spatial Frame. Fracture displacement was corrected successfully and bony union was obtained with administration of teriparatide 15 months after the initial surgery. The patient is able to walk using 1 cane. CONCLUSION: We present the first report of pathologic fracture associated with large AVMs that achieved bony union using a 3-dimensional external fixator and teriparatide.


Assuntos
Malformações Arteriovenosas/cirurgia , Conservadores da Densidade Óssea/uso terapêutico , Fraturas do Fêmur/terapia , Fixação de Fratura/métodos , Fraturas Espontâneas/terapia , Teriparatida/uso terapêutico , Idoso , Malformações Arteriovenosas/complicações , Malformações Arteriovenosas/diagnóstico por imagem , Diáfises/irrigação sanguínea , Diáfises/diagnóstico por imagem , Diáfises/efeitos dos fármacos , Diáfises/cirurgia , Fixadores Externos , Feminino , Artéria Femoral , Fraturas do Fêmur/complicações , Fraturas do Fêmur/diagnóstico por imagem , Fêmur/irrigação sanguínea , Fêmur/diagnóstico por imagem , Fêmur/efeitos dos fármacos , Fêmur/cirurgia , Fixação de Fratura/instrumentação , Fraturas Espontâneas/complicações , Fraturas Espontâneas/diagnóstico por imagem , Humanos
7.
World Neurosurg ; 123: 165-167, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30476663

RESUMO

BACKGROUND: Cranial pneumatization in humans is normally confined to the paranasal sinuses and the petrous and mastoid parts of the temporal bones. CASE DESCRIPTION: We present a case of left-sided fractures of the occipital condyle and lateral mass of the atlas in the setting of extensive craniocervical pneumatization but in the absence of trauma, with a resulting unilateral hypoglossal nerve palsy. CONCLUSIONS: We discussed the possible etiology of this rare disease, its management, and prognosis.


Assuntos
Doenças Ósseas/complicações , Atlas Cervical/lesões , Fraturas Espontâneas/complicações , Doenças Ósseas/diagnóstico por imagem , Atlas Cervical/diagnóstico por imagem , Fraturas Espontâneas/diagnóstico por imagem , Humanos , Doenças do Nervo Hipoglosso/diagnóstico por imagem , Doenças do Nervo Hipoglosso/etiologia , Masculino , Pessoa de Meia-Idade , Osso Occipital
8.
BMC Med Genet ; 19(1): 211, 2018 12 12.
Artigo em Inglês | MEDLINE | ID: mdl-30541476

RESUMO

BACKGROUND: Tricho-rhino-phalangeal syndrome (TRPS) is a rare autosomal dominant genetic disorder characterized by distinctive craniofacial and skeletal abnormalities, while non-ossifying fibroma (NOF) is a common benign bone tumour in children and adolescents. To date, no case of TRPS coexisting with NOF has been reported. This report presents a 12-year-old girl who had the characteristic features of tricho-rhino-phalangeal syndrome and non-ossifying fibroma with a fibula fracture. CASE PRESENTATION: A 12-year-old girl was admitted to the Department of Endocrinology and Diabetes for evaluation of brachydactyly and a right fibula fracture. Clinical examination revealed sparse scalp hair, a characteristic bulbous pear-shaped nose, and brachydactyly with significant shortening of the fourth metatarsal. Neither intellectual disability nor multiple exostoses were observed. Radiography of both hands showed brachydactyly and cone-shaped epiphyses of the middle phalanges of the digits of both hands with deviation of the phalangeal axis. Genetic analysis of TRPS1 identified a heterozygous germline sequence variant (p.Ala932Thr) in exon 6 in the girl and her father. Approximately 1 month before being admitted to our department, the girl experienced a minor fall and suffered a fracture of the proximal fibula in the right lower limb. The pathological cytological diagnosis of the osteolytic lesion was NOF. Ten months following the surgery, the lesion on the proximal fibula of the girl disappeared. CONCLUSIONS: In conclusion, the present study is the first to report a rare case of NOF with a pathologic fracture in the fibula of a girl with TRPS. The identification of a missense mutation, (p.Ala932Thr), in exon 6 of TRPS1 in this kindred further suggested that the patient had type I TRPS and indicated that mutations in this exon may be correlated with more pronounced features of the syndrome. Radiological techniques and genetic analysis played key roles in the definitive diagnosis.


Assuntos
Neoplasias Ósseas/genética , Braquidactilia/genética , Proteínas de Ligação a DNA/genética , Fibroma/genética , Dedos/anormalidades , Fraturas Espontâneas/genética , Doenças do Cabelo/genética , Síndrome de Langer-Giedion/genética , Neoplasias/genética , Nariz/anormalidades , Fatores de Transcrição/genética , Adulto , Sequência de Bases , Neoplasias Ósseas/complicações , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/patologia , Braquidactilia/complicações , Braquidactilia/diagnóstico por imagem , Braquidactilia/patologia , Criança , Éxons , Feminino , Fibroma/complicações , Fibroma/diagnóstico por imagem , Fibroma/patologia , Fíbula/lesões , Dedos/diagnóstico por imagem , Dedos/patologia , Fraturas Espontâneas/complicações , Fraturas Espontâneas/diagnóstico por imagem , Fraturas Espontâneas/patologia , Expressão Gênica , Doenças do Cabelo/complicações , Doenças do Cabelo/diagnóstico por imagem , Doenças do Cabelo/patologia , Humanos , Síndrome de Langer-Giedion/complicações , Síndrome de Langer-Giedion/diagnóstico por imagem , Síndrome de Langer-Giedion/patologia , Masculino , Mutação , Neoplasias/complicações , Neoplasias/diagnóstico por imagem , Neoplasias/patologia , Nariz/diagnóstico por imagem , Nariz/patologia , Herança Paterna , Radiografia , Proteínas Repressoras
9.
Dis Colon Rectum ; 61(6): 673-678, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29722726

RESUMO

BACKGROUND: Because bone metastasis from colorectal cancer is rare, there are little available data regarding such cases. OBJECTIVE: The study aim was to identify the prognostic factors and characteristics associated with survival in colorectal cancer patients with bone metastasis. DESIGN: This was a retrospective study from a prospectively collected database. SETTINGS: The study took place in a multidisciplinary, high-volume tertiary cancer center in Japan. PATIENTS: Examined were records from 104 consecutive patients treated between 2004 and 2015 for bone metastasis from colorectal cancer. MAIN OUTCOME MEASURES: The primary outcome measure was overall survival. RESULTS: The spine was the most common site of bone metastasis from colorectal cancer. Right colon cancer correlated significantly with long bone metastasis (p = 0.046), whereas left colon cancer correlated significantly with spinal bone metastasis (p = 0.034). Liver metastasis was also significantly correlated with spinal bone metastasis (p = 0.036). The median interval between the primary therapy for colorectal cancer and the metachronous diagnosis of bone metastasis was 20.0 months (quartile 1 to quartile 3, 9.0-46.5 mo). The median survival time from diagnosis of bone metastasis from colorectal cancer was 5.0 months (95% CI, 4.0-9.0 mo), and the 1-year survival rate was 30.0% (95% CI, 21.1%-39.4%). Multivariate analysis revealed that ≥2 extra-bone metastatic organs, hypercalcemia, and pathologic fractures were independent poor prognostic factors (p < 0.001, 0.001, and 0.033). The number of extra-bone metastatic organs correlated with prognosis. LIMITATIONS: This study was limited by its retrospective, nonrandomized design, as well as selection bias and performance at a single institute. CONCLUSIONS: The location of colorectal cancer correlates significantly with the site of bone metastasis; the prognosis of patients with bone metastasis from colorectal cancer is very poor, and the significant prognostic factors are number of extra-bone metastatic organs, hypercalcemia, and pathologic fractures. See Video Abstract at http://links.lww.com/DCR/A589.


Assuntos
Neoplasias Ósseas/secundário , Neoplasias Colorretais/patologia , Fraturas Espontâneas/complicações , Neoplasias Hepáticas/secundário , Idoso , Neoplasias Ósseas/mortalidade , Neoplasias Ósseas/patologia , Neoplasias Colorretais/mortalidade , Intervalo Livre de Doença , Feminino , Humanos , Hipercalcemia/etiologia , Japão/epidemiologia , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos
10.
J Foot Ankle Surg ; 57(4): 790-793, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29631970

RESUMO

Rupture of the peroneus longus tendon with or without an associated os peroneum fracture is rare and uncommonly encountered in the published data. Owing to the infrequent nature, a high index of suspicion is required. Otherwise, the opportunity for the injury to result in a delayed or missed diagnosis is increased. We report the case of a 39-year-old male with spontaneous rupture of the peroneus longus tendon and associated fracture of the os peroneum. The spontaneous rupture and fracture were diagnosed from the history, physical examination, and imaging findings. The patient elected to undergo operative repair, with excellent results, full recovery, and full return to normal function.


Assuntos
Traumatismos do Pé/diagnóstico por imagem , Fraturas Espontâneas/diagnóstico por imagem , Ossos Sesamoides/lesões , Traumatismos dos Tendões/diagnóstico por imagem , Adulto , Traumatismos do Pé/complicações , Traumatismos do Pé/cirurgia , Fraturas Espontâneas/complicações , Fraturas Espontâneas/cirurgia , Humanos , Masculino , Traumatismos dos Tendões/complicações , Traumatismos dos Tendões/cirurgia
11.
BMJ Case Rep ; 20172017 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-29066663

RESUMO

We present the case of a 56-year-old man who presented to our accident and emergency department 15 years after a work-based injury to his left thumb.In January 2017, the patient was woken up acutely with excruciating pain in his left thumb with no preceding trauma. On clinical examination, only a subungual haematoma was noted. Radiographs of the effected thumb demonstrated a round, lytic lesion with an accompanying hairline fracture on the distal phalanx of the left thumb. The radiologist suggested a differential diagnosis of enchondroma should be considered.The patient was referred for a routine plastic surgery outpatient appointment. Curettage sampling of the lesion was performed and a cement filler was used to prevent further pathological fractures.The biopsy report stated that the sample contained normal bone tissue with no evidence of enchondroma or other malignancy and the patient was discharged without any further complications.


Assuntos
Neoplasias Ósseas , Condroma , Fraturas Espontâneas/complicações , Fraturas Espontâneas/diagnóstico por imagem , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Cimentos para Ossos/uso terapêutico , Diagnóstico Diferencial , Fraturas Espontâneas/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Polegar
12.
Int Orthop ; 41(9): 1813-1824, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28733846

RESUMO

PURPOSE: The incidence of low energy pelvic fractures (FPFs) in the elderly is increasing. Comorbidities, decreased bone-quality, problematic fracture fixation and poor compliance represent some of their specific difficulties. In the absence of uniform management, a standard operating procedure (SOP) was introduced to our unit, aiming to improve the quality of services provided to these patients. METHODS: A cohort study was contacted to test the impact of (1) using a specific clinical algorithm and (2) using different antiosteoporotic drugs. Multivariate regression analysis was used to determine prognostic factors. Study endpoints were the time-to-healing, length-of-stay, return to pre-injury mobility, union status, mortality and complications. RESULTS: A total of 132 elderly patients (≥65 years) admitted during the period 2012-2014 with FPFs were enrolled. High-energy fractures, acetabular fractures, associated trauma affecting mobility, pathological pelvic lesions and operated FPFs were used as exclusion criteria. The majority of included patients were females (108/132; 81.8%), and the mean age was 85.8 years (range 67-108). Use of antiosteoporotics was associated with a shorter time of healing (p = 0.036). Patients treated according to the algorithm showed a significant protection against malunion (p < 0.001). Also, adherence to the algorithm allowed more patients to return to their pre-injury mobility status (p = 0.039). CONCLUSIONS: The use of antiosteoporotic medication in elderly patients with fragility pelvic fractures was associated with faster healing, whilst the adherence to a structured clinical pathway led to less malunions and non-unions and return to pre-injury mobility state.


Assuntos
Conservadores da Densidade Óssea/administração & dosagem , Tratamento Conservador/métodos , Fraturas Espontâneas/terapia , Ossos Pélvicos/lesões , Guias de Prática Clínica como Assunto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Estudos de Coortes , Feminino , Fixação de Fratura/métodos , Consolidação da Fratura/efeitos dos fármacos , Fraturas Espontâneas/complicações , Fraturas Espontâneas/mortalidade , Humanos , Incidência , Tempo de Internação/estatística & dados numéricos , Masculino , Qualidade da Assistência à Saúde , Recuperação de Função Fisiológica/efeitos dos fármacos , Taxa de Sobrevida
13.
J Shoulder Elbow Surg ; 26(3): e65-e70, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28341497

RESUMO

HYPOTHESIS: We aimed to report our experience in treating congenital pseudarthrosis of the clavicle (CPC). MATERIALS AND METHODS: A retrospective search of the archive of our institute was performed; 27 cases (12 male and 15 female patients) affected by CPC were recorded. Among these patients, 19 underwent surgical intervention for cosmetic appearance between 1960 and 2015. Of 19 patients, 18 were treated by pseudarthrosis resection and stabilization with a Kirschner wire, whereas in 1 case, the osteosynthesis was performed with a plate. Iliac crest bone autograft was used in 15 patients, whereas 4 patients were treated with a fibular allograft. RESULTS: The mean follow-up period was 36.3 ± 49.1 months. Bone healing was achieved in 14 of 19 operated cases (74%); none of the patients had complaints regarding cosmetic abnormalities or unesthetic appearance. All the operated patients were pain free, range of motion was complete, and no other subjective anomalies were found. No vascular or neurologic complications were observed. However, the use of allograft was associated with high rates of nonunion in this case series (P = .037). CONCLUSION: CPC can be satisfactorily treated by K-wire fixation and autologous iliac crest bone grafting, which showed better results in terms of functional and cosmetic outcome.


Assuntos
Clavícula/anormalidades , Clavícula/cirurgia , Pseudoartrose/congênito , Adolescente , Autoenxertos , Placas Ósseas , Fios Ortopédicos , Criança , Pré-Escolar , Clavícula/lesões , Feminino , Fixação de Fratura , Fraturas Espontâneas/complicações , Fraturas Espontâneas/cirurgia , Humanos , Ílio/transplante , Lactente , Masculino , Pessoa de Meia-Idade , Pseudoartrose/diagnóstico por imagem , Pseudoartrose/cirurgia , Estudos Retrospectivos
14.
Cir Cir ; 85(6): 529-534, 2017.
Artigo em Espanhol | MEDLINE | ID: mdl-27773365

RESUMO

BACKGROUND: Silent sinus or imploding antrum syndrome is a very rare condition, consisting of a usually asymptomatic spontaneous collapse of the sinus walls and floor of the orbit. It is associated with negative pressures, and when this occurs, it presents with manifestations such as enophthalmos, hypoglobus, and tilt flow orbital floor. As its incidence is very low, it is frequently missed as a diagnosis, and in fact there are currently fewer than 150 cases reported in the literature. CLINICAL CASES: Three patients have been identified in our practice over a period of two years, with different symptoms that influenced the decision of the treatment modality, which were: watch and wait, endoscopic sinus surgery, or endoscopic sinus surgery plus orbitoplasty. CONCLUSIONS: Despite being a rare entity, it stills catches the attention of the ENT, OMF surgery and Ophthalmologist. The diagnosis is mainly radiological, due to the late clinical manifestations and symptomatology. The treatment should be individualised and based on the symptoms and the individual decision of each patient, firstly by Functional Endoscopic sinus surgery, and once sinus permeability is restored, it may require augmentation surgery of the orbital floor, either with autologous bone implant, titanium or other material. It is important to be aware of this pathology, to know and to suspect it, avoiding misdiagnosis.


Assuntos
Diplopia/etiologia , Endoscopia/métodos , Enoftalmia/etiologia , Fixação Interna de Fraturas/métodos , Fraturas Espontâneas/complicações , Seio Maxilar/patologia , Fraturas Orbitárias/complicações , Doenças dos Seios Paranasais/etiologia , Adulto , Doenças Assintomáticas , Placas Ósseas , Feminino , Fraturas Espontâneas/diagnóstico por imagem , Fraturas Espontâneas/patologia , Fraturas Espontâneas/cirurgia , Humanos , Masculino , Seio Maxilar/diagnóstico por imagem , Seio Maxilar/cirurgia , Pessoa de Meia-Idade , Fraturas Orbitárias/diagnóstico por imagem , Fraturas Orbitárias/patologia , Fraturas Orbitárias/cirurgia , Doenças dos Seios Paranasais/diagnóstico por imagem , Doenças dos Seios Paranasais/patologia , Doenças dos Seios Paranasais/cirurgia , Pressão , Estudos Retrospectivos , Síndrome , Tomografia Computadorizada por Raios X , Conduta Expectante
15.
J Pediatr Orthop ; 37(4): e286-e291, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27824794

RESUMO

BACKGROUND: Vertebral compression fractures are a common result of osteoporosis and osteopenia secondary to steroid use and chemotherapy treatment. Balloon kyphoplasty is a treatment option with good to excellent results well described in adults. Although a few recent studies have been published regarding the use of kyphoplasty in children, no formal indication exists for the pediatric population. The purpose of this study is to describe the outcomes of 3 chronically ill children with intractable pain from vertebral compression fractures, managed with kyphoplasty. METHODS: We retrospectively reviewed 3 pediatric patients who underwent balloon kyphoplasty for vertebral compression fractures secondary to chronic illness. Patient variables included age, sex, primary diagnosis and treatments, levels of vertebral fracture, and time elapsed from initial therapy to fracture. A numeric rating scale of 0 to 10 was used for patient-reported pain, before and after kyphoplasty. Preoperative and postoperative analgesic use and physical function were also described. Surgical variables included levels of kyphoplasty, operative time, and procedure-related complications. RESULTS: The primary diagnoses were relapsed rhabdomyosarcoma, abdominal desmoplastic small round cell tumor, and IPEX-like (immune dysregulation, polyendrocrinopathy, enteropathy, X-linked) syndrome. All 3 patients were males, aged 12, 12, and 13, respectively, at the time of kyphoplasty. Pain scores were 8 to 9 preoperatively in 2 patients, severely affecting their physical function including independent walking. Excruciating back pain was a contributing factor to the respiratory distress of the third patient, who required elective intubation. All of the patients reported significant pain relief (range, 0 to 2) and improved physical function with kyphoplasty. The third patient was successfully extubated 1 week postoperatively and eventually returned to baseline activity. There were no complications related to kyphoplasty. CONCLUSIONS: Balloon kyphoplasty seems to be safe in terminally ill children and may be a useful tool for managing intractable pain due to vertebral compression fractures. LEVEL OF EVIDENCE: Level IV-retrospective case series.


Assuntos
Fraturas por Compressão/cirurgia , Fraturas Espontâneas/cirurgia , Cifoplastia/métodos , Dor Intratável/terapia , Fraturas da Coluna Vertebral/cirurgia , Adolescente , Doenças Ósseas Metabólicas/etiologia , Criança , Doença Crônica , Fraturas por Compressão/complicações , Fraturas Espontâneas/complicações , Humanos , Imagem por Ressonância Magnética , Masculino , Osteoporose/complicações , Manejo da Dor , Dor Intratável/etiologia , Estudos Retrospectivos , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/diagnóstico por imagem , Resultado do Tratamento
16.
J Oral Maxillofac Surg ; 74(12): 2403-2408, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27376180

RESUMO

PURPOSE: The risk of developing concomitant medication-related osteonecrosis of the jaw (MRONJ) in patients who have sustained an atypical femoral fracture (AFF) in association with parental administration of a bisphosphonate osteoclastic inhibitor medication for malignant disease is unclear. Published data were searched to determine the prevalence of these concomitant adverse medication events, if any. MATERIALS AND METHODS: A systematic review of published case series in the PubMed database was undertaken to ascertain the prevalence of patients having a concomitant history of AFF and MRONJ. The data were analyzed to provide prevalence rates of these events from the literature. RESULTS: Two case series were identified that delineated the risk (25 and 33%, respectively) of concomitant development of MRONJ and AFF in recipients of parenteral bisphosphonate medication administered for malignant disease. CONCLUSION: The published data suggest that approximately 30% of patients receiving parenteral bisphosphonates and having sustained an AFF could develop comorbid MRONJ.


Assuntos
Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/etiologia , Conservadores da Densidade Óssea/efeitos adversos , Neoplasias Ósseas/tratamento farmacológico , Difosfonatos/efeitos adversos , Fraturas do Fêmur/induzido quimicamente , Fraturas Espontâneas/induzido quimicamente , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/epidemiologia , Conservadores da Densidade Óssea/uso terapêutico , Difosfonatos/uso terapêutico , Fraturas do Fêmur/complicações , Fraturas Espontâneas/complicações , Humanos , Injeções Intravenosas , Prevalência , Fatores de Risco
18.
Support Care Cancer ; 24(3): 1327-37, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26329397

RESUMO

PURPOSE: Bone metastases secondary to solid tumors increase the risk of skeletal-related events (SREs), including the occurrence of pathological fracture (PF), radiation to bone (RB), surgery to bone (SB), and spinal cord compression (SCC). The aim of this study was to evaluate the impact of SREs on patients' pain, analgesic use, and pain interference with daily functioning. METHODS: Data were combined from patients with solid tumors and bone metastases who received denosumab or zoledronic acid across three identically designed phase 3 trials (N = 5543). Pain severity (worst pain) and pain interference were assessed using the Brief Pain Inventory at baseline and each monthly visit. Analgesic use was quantified using the Analgesic Quantification Algorithm. RESULTS: The proportion of patients with moderate/severe pain and strong opioid use generally increased in the 6 months preceding an SRE and remained elevated, while they remained relatively consistent over time in patients without an SRE. Regression analysis indicated that all SRE types were significantly associated with an increased risk of progression to moderate/severe pain and strong opioid use. PF, RB, and SCC were associated with significantly greater risk of pain interference overall. Results were similar for pain interference with emotional well-being. All SRE types were associated with significantly greater risk of pain interference with physical function. CONCLUSIONS: SREs are associated with increased pain and analgesic use in patients with bone metastases. Treatments that prevent SREs may decrease pain and the need for opioid analgesics and reduce the impact of pain on daily functioning.


Assuntos
Analgésicos/uso terapêutico , Neoplasias Ósseas/tratamento farmacológico , Neoplasias Ósseas/secundário , Denosumab/uso terapêutico , Difosfonatos/uso terapêutico , Imidazóis/uso terapêutico , Dor/etiologia , Analgésicos/administração & dosagem , Denosumab/administração & dosagem , Difosfonatos/administração & dosagem , Método Duplo-Cego , Feminino , Fraturas Espontâneas/complicações , Humanos , Imidazóis/administração & dosagem , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Ácido Zoledrônico
19.
Chir Main ; 34(4): 210-4, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26204827

RESUMO

We report an unusual case of avulsion of the flexor digitorum profundus tendon of the ring finger at its insertion, in combination with a pathological fracture of the distal phalanx due to enchondroma. The bone lesion was curetted and grafted using autogenous bone. The FDP tendon was reattached to the distal phalanx using the pullout technique. We describe this case in detail and discuss the surgical management through a review of literature.


Assuntos
Neoplasias Ósseas/complicações , Condroma/complicações , Falanges dos Dedos da Mão , Fraturas Espontâneas/complicações , Traumatismos dos Tendões/etiologia , Tendões , Feminino , Fraturas Espontâneas/etiologia , Humanos , Pessoa de Meia-Idade , Músculo Esquelético
20.
Eur J Trauma Emerg Surg ; 41(4): 363-7, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26037987

RESUMO

INTRODUCTION: Fragility fractures of the pelvis (FFP) are one of the most visible and debilitating consequences of osteoporosis. In contrast to pelvic ring fractures of the young, fragility fractures are caused by falls from a standing height or even by repetitive physiological loads. Even though haemorrhage is rarely found in fragility fractures of the pelvis, one must be aware of the potential risk. MATERIALS AND METHODS: In a computer literature search, we identified eight papers about patients with haemorrhage and/or haemodynamic instability as a complication of a low-velocity pelvic ring fracture, all of which were case reports. CONCLUSION: In our review, an overview of the case reports is provided, risk factors identified and a recommendation for the treatment and clinical observation given.


Assuntos
Embolização Terapêutica/métodos , Hemorragia/etiologia , Fraturas por Osteoporose/complicações , Ossos Pélvicos/lesões , Idoso , Idoso de 80 Anos ou mais , Angiografia/métodos , Transfusão de Sangue/métodos , Feminino , Fraturas Espontâneas/complicações , Fraturas Espontâneas/diagnóstico , Fraturas Espontâneas/cirurgia , Hemorragia/diagnóstico por imagem , Hemorragia/terapia , Humanos , Masculino , Fraturas por Osteoporose/diagnóstico , Fraturas por Osteoporose/cirurgia , Prognóstico , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento
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