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1.
Int J Radiat Oncol Biol Phys ; 106(3): 475-484, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31580930

RESUMO

PURPOSE: To estimate the overall rate, symptomatic proportion, and most common sites of pelvic insufficiency fracture (PIF) after external beam radiation therapy for gynecologic cancers based on posttreatment computed tomography, magnetic resonance imaging, positron emission tomography, or bone scintigraphy. METHODS AND MATERIALS: A systematic search of databases (PubMed and EMBASE) was performed (CRD42019125679). The pooled summary of overall PIF and the proportion of symptomatic cases were calculated using the random-effects model weighted by the inverse variance. A multivariate meta-regression was performed to evaluate potential sources of heterogeneity regarding PIF fractures. RESULTS: Twenty-one studies met the inclusion criteria (total 3929 patients). Five hundred four patients developed PIF, translating to an overall rate of 14% (95% confidence interval, 10%-18%, based on 21 studies). Among these cases with PIF, the proportion of symptomatic patients was 61% (95% confidence interval, 52%-69%, based on 14 studies). The total number of PIFs was 704 (mean, 1.72 PIFs per each patient to develop PIF, based on 14 studies). More recent series (P = .0074) and the use of intensity modulated radiation therapy (P = .0299) were associated with lower fracture rates. The most common fracture sites were sacroiliac joint (39.7%), body of the sacrum (33.9%), pubis (13%), lumbar vertebra (7%), iliac bone (2.8%), acetabulum (2.1%), and femoral head/neck (1.5%). The median time to fracture was 7.1 to 19 months after radiation therapy. CONCLUSIONS: The incidence of PIF after radiation therapy for gynecologic cancers is high (14%), with the majority affecting the sacral bone or joint (73.6%), although this risk appears to be lower with intensity modulated radiation therapy. Posttreatment bone surveillance is warranted in this population because nearly 40% of patients were asymptomatic at the time of PIF diagnosis.


Assuntos
Fraturas Ósseas/epidemiologia , Fraturas Espontâneas/epidemiologia , Neoplasias dos Genitais Femininos/radioterapia , Ossos Pélvicos/lesões , Intervalos de Confiança , Feminino , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/etiologia , Fraturas Espontâneas/diagnóstico por imagem , Fraturas Espontâneas/etiologia , Neoplasias dos Genitais Femininos/diagnóstico por imagem , Humanos , Ossos Pélvicos/efeitos da radiação , Radioterapia de Intensidade Modulada , Análise de Regressão
2.
J Pediatr Orthop ; 40(1): e68-e76, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30925579

RESUMO

BACKGROUND: A variety of treatment methods have so far been described for unicameral bone cysts (UBC). However, to the best of our knowledge, no particular consensus has yet been reached on when to operatively treat a patient with a humeral UBC. Therefore, members of the European Pediatric Orthopedic Society (EPOS) and Pediatric Orthopedic Society of North America (POSNA) were surveyed to characterize current treatment preferences. METHODS: An online electronic questionnaire was sent out to all registered EPOS and POSNA members. The survey comprised 45 questions related to the diagnosis, treatment, and follow-up characteristics of patients with UBCs of the humerus. Particular questions related to the nonoperative or surgical treatment of pathologic proximal humerus and humeral shaft fractures were also included. RESULTS: In total, 444 participants (132 EPOS and 292 POSNA members) responded, of whom 400 were actively involved in UBC treatment. The preferred diagnostic modalities to confirm the diagnosis of a UBC in the humerus were radiographs (88%), MRI in cases of questionable diagnosis (58%) or CT scan (8%). For painless UBCs 67% prefer no treatment at all except when the fracture risk is deemed high (then 53% recommend surgery); 71% of respondents would treat painful UBCs with surgery. Most common surgical techniques comprise curettage (45%), artificial bone substitutes (37%), corticosteroid injection (29%), or intramedullary stabilization (eg, rodding; 24%).Fractured, nondisplaced and mildly displaced proximal humerus UBCs and mildly displaced pathologic humerus shaft fractures are all preferably treated nonoperatively (94%, 91%, 83%, respectively). Severely displaced pathologic proximal humerus fractures are treated less often conservatively (36%) than surgically (40%), and severely displaced humerus shaft fractures are preferably treated surgically (63%) by intramedullary stabilization (60%). CONCLUSIONS: There is great variation among EPOS and POSNA members with regards to the diagnosis and treatment of UBCs in the humerus. Although some consensus on general treatment principles is seen, specific surgical treatment indications vary.Prospective randomized-controlled studies are needed to evaluate the outcomes of the different surgical approaches compared with nonoperative strategies. LEVEL OF EVIDENCE: Level V-expert opinion.


Assuntos
Cistos Ósseos/terapia , Fraturas Espontâneas/terapia , Fraturas do Úmero/terapia , Padrões de Prática Médica/tendências , Fraturas do Ombro/terapia , Cistos Ósseos/complicações , Cistos Ósseos/diagnóstico por imagem , Tratamento Conservador , Europa (Continente) , Fraturas Espontâneas/diagnóstico por imagem , Fraturas Espontâneas/etiologia , Humanos , Fraturas do Úmero/diagnóstico por imagem , Fraturas do Úmero/etiologia , Imagem por Ressonância Magnética , Dor Musculoesquelética/etiologia , América do Norte , Procedimentos Ortopédicos/métodos , Ortopedia , Pediatria , Estudos Prospectivos , Fraturas do Ombro/diagnóstico por imagem , Fraturas do Ombro/etiologia , Inquéritos e Questionários , Tomografia Computadorizada por Raios X
3.
BMC Musculoskelet Disord ; 20(1): 449, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615567

RESUMO

BACKGROUND: Simultaneous bilateral femoral neck fracture is a very rare condition, even in osteoporotic elderly individuals. We report an atypical case of a young male adult who developed simultaneous bilateral femoral neck fractures without previous trauma or overuse. CASE PRESENTATION: A 33-year-old man presented with discomfort in the bilateral groin, which had started 2 weeks previously. Bilateral femoral neck fractures were observed on a radiograph, and in addition, a fracture line was seen at the right subchondral region of the acetabulum using magnetic resonance imaging (MRI). Although the patient had no obvious risk factors associated with bone fragility, his bone mineral density measured using dual X-ray absorptiometry indicated severe osteoporosis (lumber spine: T score - 3.4 standard deviation [SD]; femoral neck: T score - 2.8 SD). Serum 25-hydroxyvitamin D level was deficient (19 ng/mL), which was considered to be partly due to non-sunlight exposure for 3 years owing to social withdrawal. Bilateral osteosynthesis was performed, considering his young age, although more than 2 weeks had passed since the onset of the fracture. Bone union and non-occurrence of osteonecrosis of the femoral head were confirmed via radiography and MRI 8 months after the surgery. CONCLUSIONS: Our case suggests that simultaneous non-traumatic bilateral femoral neck fractures can occur in healthy young men.


Assuntos
Fraturas do Colo Femoral/cirurgia , Fixação Interna de Fraturas/métodos , Fraturas Espontâneas/cirurgia , Osteoporose/diagnóstico , Absorciometria de Fóton , Adulto , Densidade Óssea , Fraturas do Colo Femoral/diagnóstico , Fraturas do Colo Femoral/etiologia , Colo do Fêmur/diagnóstico por imagem , Colo do Fêmur/lesões , Colo do Fêmur/cirurgia , Fraturas Espontâneas/diagnóstico , Fraturas Espontâneas/etiologia , Humanos , Imagem por Ressonância Magnética , Masculino , Osteoporose/sangue , Osteoporose/complicações , Tempo para o Tratamento , Vitamina D/análogos & derivados , Vitamina D/sangue
4.
Pediatrics ; 144(4)2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31537633

RESUMO

Congenital syphilis (CS) is a preventable infection, yet the incidence has surged to the highest rates in 20 years. Because 50% of live-born infants with CS are asymptomatic at birth, there is an increasing likelihood that pediatric providers will encounter older infants whose diagnoses were missed at birth, emphasizing the importance of timely prenatal screening and treatment. We present one such case of an infant admitted twice at 3 and 4 months of age with long bone fractures and suspected nonaccidental trauma. On her second presentation, several additional symptoms prompted evaluation for and eventual diagnosis of CS. In this case, it is demonstrated that an isolated long bone fracture can be a first presentation of CS, with other classic findings possibly appearing later. Pediatric providers should be familiar with the varied presentations of CS in older children, including the radiographic findings that we describe. The rising rates of CS reveal deficiencies in our current strategy to prevent CS and, thus, we recommend reconsideration of universal syphilis screening in the third trimester and at delivery, with timely treatment to prevent CS during pregnancy.


Assuntos
Sífilis Congênita/diagnóstico , Antibacterianos/uso terapêutico , Maus-Tratos Infantis/diagnóstico , Diagnóstico Diferencial , Erros de Diagnóstico , Feminino , Fraturas Espontâneas/etiologia , Humanos , Fraturas do Úmero/etiologia , Lactente , Penicilina G/uso terapêutico , Periostite/microbiologia , Úlcera Cutânea/microbiologia , Sífilis Congênita/tratamento farmacológico , Transaminases/sangue
5.
G Ital Nefrol ; 36(4)2019 Jul 24.
Artigo em Italiano | MEDLINE | ID: mdl-31373465

RESUMO

Osteoporosis affects a segment of the population in which Chronic Kidney Disease is also greatly represented. Nephropathic patients may present peculiar biochemical abnormalities related to Chronic Kidney Disease, defining the Mineral and Bone Disorder. This kind of anomalies, in the worst scenarios, configure the typical histomorphology patterns of Renal Osteodystrophy. Scientific Societies of Endocrinology have established therapy guidelines for patients with osteoporosis only based on the glomerular filtration rate and recommend avoiding the use of some drugs for the more advanced classes of nephropathy. However, there is no clear therapeutic approach for patients with advanced nephropathy and bone abnormalities. In this paper we propose a systematic review of the literature and present our proposal for managing patients with advanced nephropathy, based on eGFR and on presence of Mineral and Bone Disorder.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Distúrbio Mineral e Ósseo na Doença Renal Crônica/tratamento farmacológico , Difosfonatos/uso terapêutico , Osteoporose/tratamento farmacológico , Insuficiência Renal Crônica/complicações , Anticorpos Monoclonais/uso terapêutico , Conservadores da Densidade Óssea/efeitos adversos , Conservadores da Densidade Óssea/química , Distúrbio Mineral e Ósseo na Doença Renal Crônica/etiologia , Distúrbio Mineral e Ósseo na Doença Renal Crônica/fisiopatologia , Contraindicações , Denosumab/uso terapêutico , Difosfonatos/efeitos adversos , Difosfonatos/química , Feminino , Fraturas Espontâneas/tratamento farmacológico , Fraturas Espontâneas/etiologia , Fraturas Espontâneas/prevenção & controle , Taxa de Filtração Glomerular , Humanos , Masculino , Osteoporose/complicações , Osteoporose/diagnóstico , Proteína Relacionada ao Hormônio Paratireóideo/uso terapêutico , Guias de Prática Clínica como Assunto , Insuficiência Renal Crônica/fisiopatologia , Fatores de Risco , Teriparatida/uso terapêutico
6.
Cardiovasc Intervent Radiol ; 42(12): 1726-1737, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31444627

RESUMO

INTRODUCTION: To evaluate the long-term consolidation of vertebral metastases (VM) after preventive vertebroplasty (PV) and to report risk factors of pathological fracture despite PV. MATERIALS AND METHODS: Files of 100 consecutives cancer patients referred for PV of VM were retrospectively analyzed. We enumerated 215 VM at the time of the PV procedure (T0): 138 VM were considered at risk of pathological fracture and had PV (treated-VM), and 77 VM were not cemented. We compared the VM characteristics using the spine instability neoplastic score (SINS) at T0 and the rate of pathologic fracture between treated-VM and untreated-VM using Kaplan-Meier method. We analyzed risk factors of pathological fracture despite PV using treated-VM characteristics and quality of cement injection criteria. RESULTS: Despite a lower SINS value at T0 (p < 0.001), the rate of pathological fracture was significantly higher among untreated-VM compared to the treated-VM, (log-rank, p < 0.001). Major risk factors of fracture among treated-VM were: SINS value ≥ 8 (p < 0.012), mechanical pain (p = 0.001), osteolytic lesion (p = 0.033), metastatic vertebral body involvement > 50% with no collapse (p < 0.001) and unilateral posterior involvement by the vertebral metastasis (p = 0.024), Saliou score < 9 (p = 0.008), vertebral metastasis filling with cement < 50% (p = 0.007) and the absence of cement's contact with vertebral endplates (p = 0.014). CONCLUSION: PV is long-term effective for consolidation of VM and must be discussed at the early diagnosed. Quality of cement injection matters, suggesting that techniques that improve the quantity and the quality of cement diffusion into the VM must be developed.


Assuntos
Fraturas Espontâneas/etiologia , Fraturas Espontâneas/prevenção & controle , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/prevenção & controle , Neoplasias da Coluna Vertebral/complicações , Vertebroplastia/métodos , Cimentos para Ossos/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Traumatismos da Coluna Vertebral/prevenção & controle , Neoplasias da Coluna Vertebral/secundário , Coluna Vertebral/cirurgia , Resultado do Tratamento
9.
J Shoulder Elbow Surg ; 28(11): 2103-2112, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31272888

RESUMO

BACKGROUND: The incidence of giant cell tumors in the proximal humerus is low. We evaluated 2 surgical treatments for giant cell tumors of the proximal humerus and postoperative upper-extremity function. METHODS: This study retrospectively analyzed the clinical data of 27 cases of giant cell tumors of the proximal humerus at 4 Chinese medical centers specializing in bone oncology collected between January 2002 and June 2015. All patients were followed up for more than 2 years. The surgical procedures performed for treatment included curettage in 14 patients and segmental resection in 13. The Campanacci grade, occurrence of pathologic fracture, surgical method, complications, and Musculoskeletal Tumor Society score were recorded for each cohort. RESULTS: The recurrence rate was 7.1% in the curettage group and 15.4% in the segmental resection group. Other postoperative complications occurred in 4 patients with segmental resection, including resorption of the osteoarticular allograft in 2, subluxation of the glenohumeral joint in 1, and prosthetic loosening and exposure in 1. A significant difference in postoperative upper-extremity function was noted between the 2 groups (P < .001). CONCLUSIONS: Postoperative upper-extremity function in the curettage group was significantly better than that in the segmental resection group. Segmental resection and reconstruction with a large segmental osteoarticular allograft were considered unadvisable. We suggest that extensive curettage should be selected to treat proximal humerus giant cell tumors as much as possible.


Assuntos
Neoplasias Ósseas/cirurgia , Curetagem , Fraturas Espontâneas/etiologia , Tumores de Células Gigantes/cirurgia , Recidiva Local de Neoplasia/patologia , Adolescente , Adulto , Neoplasias Ósseas/complicações , Neoplasias Ósseas/patologia , Transplante Ósseo , Curetagem/efeitos adversos , Epífises , Feminino , Tumores de Células Gigantes/complicações , Tumores de Células Gigantes/patologia , Humanos , Cabeça do Úmero/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Luxação do Ombro/etiologia , Transplante Homólogo , Resultado do Tratamento , Extremidade Superior/fisiopatologia , Adulto Jovem
10.
BMJ Case Rep ; 12(7)2019 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-31331926

RESUMO

We report the management of a pathological fracture through a proximal tibial non-ossifying fibroma (NOF) in a 13-year-old girl with neurofibromatosis type 1 (NF1). The fracture was minimally displaced, and the lesion had clinical features of a NOF, and therefore biopsy was not required. Operative fixation has been the preferred method of treatment for pathological fractures through NOF associated with NF1. Multiple NOFs associated with NF1 are rare but can coalesce resulting in large lesions with an increased risk of pathological fracture. In cases which permit, non-operative treatment with cast immobilisation can yield satisfactory results.


Assuntos
Neoplasias Ósseas/diagnóstico por imagem , Moldes Cirúrgicos , Fraturas Espontâneas/terapia , Neurofibromatose 1/diagnóstico por imagem , Tíbia/lesões , Acidentes por Quedas , Adolescente , Neoplasias Ósseas/complicações , Tratamento Conservador , Feminino , Consolidação da Fratura , Fraturas Espontâneas/etiologia , Humanos , Neurofibromatose 1/complicações
11.
J Am Acad Orthop Surg ; 27(15): e709-e716, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31344005

RESUMO

INTRODUCTION: The goals of orthopaedic treatment for most patients with osseous metastases are to control pain, maintain function, and maximize quality of life and time at home. The aim of this study was to determine differences in 30-day postoperative morbidity and mortality between patients who underwent prophylactic versus postfracture stabilization for metastatic lesions of long bones. METHODS: The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients who underwent prophylactic fixation (n = 461) or postfracture stabilization (n = 856) for pathologic fractures because of metastatic lesions of long bones from 2006 to 2016. The groups were compared with respect to several potential confounders using Student t, Kruskal-Wallis, and χ tests. Logistic and Poisson regression models (inclusion threshold of P < 0.1) were used to assess the associations of functional status with outcomes. The alpha level was set at 0.05. RESULTS: Prophylactic fixation was associated with a lower risk of major medical complications (odds ratio = 0.64; 95% confidence interval [CI], 0.45 to 0.93; P = 0.02), discharge to a care facility rather than home (odds ratio = 0.48; 95% CI, 0.36 to 0.63; P < 0.01), and lower risk of a longer hospital stay (incidence risk ratio = 0.86; 95% CI, 0.74 to 0.96; P = 0.01) compared with postfracture stabilization. No significant difference was found in the risk of unplanned revision surgery or 30-day postoperative mortality between the two groups. CONCLUSION: Although prevention of pathologic fractures caused by metastatic disease may not always be possible, patients who underwent prophylactic stabilization had a lower risk of major complications within 30 days postoperatively and shorter hospital stays compared with patients who underwent postfracture stabilization. LEVEL OF EVIDENCE: Level IV, retrospective cohort.


Assuntos
Neoplasias Ósseas/mortalidade , Neoplasias Ósseas/secundário , Fixação Interna de Fraturas , Fraturas Espontâneas/mortalidade , Fraturas Espontâneas/cirurgia , Procedimentos Cirúrgicos Profiláticos , Idoso , Neoplasias Ósseas/complicações , Feminino , Fraturas Espontâneas/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
13.
Ortop Traumatol Rehabil ; 21(2): 107-115, 2019 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-31180032

RESUMO

BACKGROUND: A consequence of the progress in oncological treatment is an increasing number of bone complications asso-ciated with metastases. With appropriate choice of oncological treatment and appropriate surgical management, patients may recover their physical function and maintain the previous level of quality of life. Available surgical techniques include intrame-dullary nailing, stabilisation with plates and screws and the use of modular prostheses. AIM OF THE STUDY: to retrospectively assess the techniques and outcomes of surgical treatment of long bone metastases at the Oncology Orthopaedics Department of the Speciality Hospital in Brzozów, present the possibilities of surgical management and benefits of the chosen method and tentatively choose the most effective approach for restoring function. MATERIAL AND METHODS: Between 2013 and 2017, a total of 82 patients were treated for long bone metastases at the Depart-ment of Oncological Orthopaedics. The most common cancers causing bone metastases were breast cancer (37%), myeloma (16%), lung cancer (8%), kidney (15%), prostate (8%), thyroid 4%, colon 1%, uterus 1%, with other sites accounting for 10%. Pathological fractures were diagnosed in 68 patients. Before the surgical treatment, the patients' quality of life was assessed using the Karnofsky scale, Bollen prognostic scale, severity of pain in a VAS scale, and MSTS performance scale. Metastasis morpho-logy was evaluated with conventional radiographs, CT and PET-CT. Types of surgery comprised intramedullary nailing, the use of plates and screws and the placement of modular prostheses. Patients were divided into three groups with regard to the stabi-li-sation systems used and another three related to tumour location (humerus, femur or tibia). RESULTS: Post-operatively, there was a reduction of pain in the VAS scale. Function (MSTS) was best in patients treated with minimally invasive methods and modular prostheses (p <0.05). An improvement in quality of life in the Karnofsky scale was also noted. The complication rate was 7% and was related to wound healing and thromboembolic complications. CONCLUSIONS: 1. Patients with long-bone cancer metastases with pathological fractures or risk of fracture require surgical management. 2. Nailing or modular prosthesis produced the best functional result at 6 weeks post-operatively. 3. All methods of surgical treatment reduced pain and improved the quality of life.


Assuntos
Neoplasias Ósseas/secundário , Neoplasias Ósseas/cirurgia , Fraturas Espontâneas/etiologia , Fraturas Espontâneas/cirurgia , Procedimentos Ortopédicos/métodos , Terapia de Salvação , Adulto , Idoso , Idoso de 80 Anos ou mais , Placas Ósseas , Parafusos Ósseos , Feminino , Fixação Intramedular de Fraturas , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Polônia , Implantação de Prótese , Qualidade de Vida , Estudos Retrospectivos
14.
Am J Case Rep ; 20: 794-799, 2019 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-31168047

RESUMO

BACKGROUND Sacral stress fractures are rare complications of pregnancy and the early postpartum. Of these, few present with lumbosacral radiculopathy. We report the first Australian case of a young multiparous woman who sustained an atraumatic, fatigue sacral fracture with associated radiculopathy. We highlight the diagnostic process and chronic management of this case, particularly in relation to a future pregnancy. CASE REPORT A 26-year-old multiparous Caucasian female presented with worsening lumbosacral back pain and radicular symptoms following the rapid and spontaneous vaginal delivery of her second infant. Her pregnancy was unremarkable and she had no personal risk factors for osteoporosis. A magnetic resonance imaging (MRI) scan confirmed the diagnosis of a right S1 vertebral fracture. Bone densitometry and fasting bone metabolic testing excluded pregnancy-associated osteoporosis. She was managed conservatively with intermittent bed rest, regular physiotherapy and multimodal analgesia. During a future pregnancy, she experienced a severe exacerbation of her lumbosacral radiculopathy requiring hospital admission, up-titration of her analgesia and a right S1 epidural injection. She subsequently underwent an elective caesarean section and has since benefitted from regular hydrotherapy. CONCLUSIONS Lumbosacral radiculopathy in the absence of trauma during pregnancy or the early postpartum should prompt consideration of an underlying atraumatic, fatigue sacral fracture. Such fractures may result from the abnormal biomechanical loading of the sacrum during rapid vaginal deliveries and are most effectively diagnosed by MRI. Conservative management strategies involving physiotherapy and multimodal analgesia are recommended. Future pregnancies may exacerbate radicular symptoms. Such patients may subsequently benefit from elective caesarean section deliveries and hydrotherapy.


Assuntos
Fraturas Espontâneas/etiologia , Dor Lombar/fisiopatologia , Radiculopatia/diagnóstico por imagem , Fraturas da Coluna Vertebral/diagnóstico por imagem , Adulto , Austrália , Tratamento Conservador/métodos , Feminino , Fraturas Espontâneas/diagnóstico por imagem , Humanos , Dor Lombar/diagnóstico por imagem , Região Lombossacral , Imagem por Ressonância Magnética/métodos , Medição da Dor , Paridade , Período Pós-Parto , Gravidez , Prognóstico , Radiculopatia/complicações , Sacro/lesões , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/terapia
15.
Actas Dermosifiliogr ; 110(8): 642-652, 2019 Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31151668

RESUMO

Psoriasis is a chronic inflammatory disease associated with multiple comorbidities, particularly in patients with arthritis or more severe forms of the disease. The link between all these comorbidities is probably systemic inflammation. Several recent studies have indicated that patients with psoriasis may be at an increased risk of pathologic fractures and osteoporosis. Current guidelines on comorbidities in psoriasis do not recommend assessment of bone health. In this article, we review the available evidence on the association between psoriasis and osteoporosis. We first examine the concept of osteoporosis and the role of vitaminD in bone health and then propose an algorithm for managing and treating this condition in patients with psoriasis.


Assuntos
Osteoporose/etiologia , Psoríase/complicações , Vitamina D/fisiologia , Corticosteroides/efeitos adversos , Densidade Óssea/efeitos dos fármacos , Osso e Ossos/fisiologia , Densitometria/métodos , Feminino , Fraturas Espontâneas/etiologia , Fraturas Espontâneas/prevenção & controle , Humanos , Imunossupressores/efeitos adversos , Masculino , Metotrexato/efeitos adversos , Osteoporose/diagnóstico por imagem , Osteoporose/terapia , Psoríase/tratamento farmacológico , Fatores de Risco
16.
J S Afr Vet Assoc ; 90(0): e1-e5, 2019 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-31038324

RESUMO

Hepatoblastoma was diagnosed in a 3-year-old Thoroughbred gelding presented with forelimb lameness with bilateral fatigue fractures of the proximal third metacarpal bones. An abdominal mass was detected on ultrasound examination of the abdomen. Absolute erythrocytosis was diagnosed after clinical and haematological evaluation. The fractured metacarpal bones were surgically removed but complications after surgery were fatal. The liver mass was diagnosed as a hepatoblastoma based on histology and immunochemical staining. The combination of hepatoblastoma and fatigue fractures has not been described previously in horses. A potential link between the hepatic and orthopaedic pathologies is hypothesised.


Assuntos
Fraturas Espontâneas/veterinária , Hepatoblastoma/veterinária , Doenças dos Cavalos/patologia , Neoplasias Hepáticas/veterinária , Policitemia/veterinária , Animais , Evolução Fatal , Fraturas Espontâneas/etiologia , Fraturas Espontâneas/patologia , Hepatoblastoma/complicações , Hepatoblastoma/diagnóstico , Hepatoblastoma/patologia , Doenças dos Cavalos/diagnóstico , Doenças dos Cavalos/etiologia , Cavalos , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/patologia , Masculino , Ossos Metacarpais/patologia , Policitemia/etiologia
17.
Unfallchirurg ; 122(8): 604-611, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31098647

RESUMO

Pathological fractures of long tubular bones are stabilized with conventional implants. Essentially, plates and intramedullary nails are used for stabilization and are two different techniques, which compete with each other with respect to the surgical treatment. A large number of such means of osteosynthesis are commercially available but are primarily focused on acute fractures in otherwise biologically healthy bones. The pathological fracture or the treatment of impending pathological fractures due to metastatic osteolysis differs from the treatment of healthy bones in some fundamental aspects. The characteristics of pathological fractures make the development of new technologies that meet the specific needs of both the patient and the surgeon desirable. A new approach in treatment is stabilization of internal long bone fractures by the use of a cylindrical balloon implant, which is introduced into the bone via a small proximal or distal hole and then filled and expanded to a much larger diameter with a liquid monomer. The curing process is initiated with the application of blue light forming a rigid implant by polymerization (IlluminOss™). Many of the well-known disadvantages of conventional implants can be eliminated with this technology. Specifically, with respect to the irregular shape of the natural medullary canal it is possible to completely fill the medullary canal of the tubular bone. The filling of the canal provides torsional stability without the use of interlocking screws. Similarly, the use of the balloon technique enables minimally invasive surgery and furthermore permits the additive use of conventional metallic plates whenever necessary. The new balloon techniques show high primary stability in the treatment of pathological shaft fractures. In particular cases, the addition of a supplemental plate osteosynthesis is recommended.


Assuntos
Neoplasias Ósseas/cirurgia , Fixação Intramedular de Fraturas/métodos , Fraturas Espontâneas/cirurgia , Mieloma Múltiplo/cirurgia , Fototerapia/métodos , Pinos Ortopédicos , Neoplasias Ósseas/complicações , Placas Ósseas , Fixação Intramedular de Fraturas/instrumentação , Fraturas Espontâneas/etiologia , Humanos , Mieloma Múltiplo/complicações , Osteólise/etiologia , Osteólise/cirurgia , Fototerapia/instrumentação
18.
J Pediatr Orthop ; 39(4): e308-e311, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30839484

RESUMO

BACKGROUND: Pediatric Langerhans cell histiocytosis (LCH) often results in vertebral compression fracture. However, few reports have reported vertebral remodeling during the course of LCH. We aimed to investigate the longitudinal reconstitution and transformation of the affected vertebrae and the adjacent structures in young children with spinal LCH. METHODS: We recruited 13 patients, including 16 affected vertebrae, diagnosed with LCH via biopsy. The average age at first visit was 3.6 years. The average follow-up period was 10.2 years. Vertebral lesions involved L2 in 3 cases; T12, L1, or L5 in 2 cases; and C4, C5, C7, T5, T8, T9, or L3 in 1 case. We measured the ratios of the height of the affected vertebra and 1 vertebra above the affected one to that of the second vertebra above the affected one, local kyphotic angles, and the ratio of the height of the center of the adjacent disk to that of one disk above it. RESULTS: The collapse of the affected vertebra was most severe after 1 year of disease onset. The rate of reconstitution accelerated at 2 years or later of disease onset. The recovery speed of the anterior wall was faster than that of the center height. While the height of the affected vertebrae was restored, the thickness of the adjacent disk also increased. Further, the height of the adjacent vertebrae increased in a similar manner. The average local kyphosis angle shifted to lordosis within the first 3 years. CONCLUSIONS: The heights of not only the disk but also the adjacent vertebra increased during the vertebral collapse phase in pediatric spinal LCH patients. These transformations may affect the realignment of the sagittal spinal balance at the earlier stage of the disease. During the collapse phase, the heights of the adjacent vertebrae and disks increase but after the affected vertebrae reconstituted, the augmentation of adjacent vertebrae and disks diminished. LEVEL OF EVIDENCE: Level IV.


Assuntos
Previsões , Fraturas por Compressão/cirurgia , Fraturas Espontâneas/cirurgia , Histiocitose de Células de Langerhans/cirurgia , Procedimentos Ortopédicos/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Fraturas da Coluna Vertebral/cirurgia , Criança , Pré-Escolar , Feminino , Seguimentos , Fraturas por Compressão/diagnóstico , Fraturas por Compressão/etiologia , Fraturas Espontâneas/diagnóstico , Fraturas Espontâneas/etiologia , Histiocitose de Células de Langerhans/complicações , Histiocitose de Células de Langerhans/diagnóstico , Humanos , Lactente , Vértebras Lombares , Masculino , Radiografia , Fraturas da Coluna Vertebral/diagnóstico , Fraturas da Coluna Vertebral/etiologia , Vértebras Torácicas
19.
World Neurosurg ; 127: e124-e131, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30862584

RESUMO

BACKGROUND: Accurate survival estimate is necessary when determining the most appropriate treatment modality for metastatic spinal tumor. The main purpose of this study was to identify the prognostic factors of spinal metastasis and establish a decision tree model. METHODS: A consecutive cohort of 507 patients from 3 institutional clinical centers who were treated for metastatic spinal tumor between 2005 and 2015 were retrospectively reviewed. In total, 70% of the participants were randomly selected as a "training sample." The prognostic effect of preoperative factors was evaluated using the "training sample," and a decision tree model was established. Then, the accuracy of the new model, as well as the Tokuhashi and Tomita score, was tested by the "test sample," which consisted of the remaining 30% of participants. RESULTS: A decision tree model was generated based on the significant factors with an order of descending importance on predicting the prognosis. According to the new model, patients were classified into 3 groups, mean survival times of less than 6 months, 6-12 months, and more than 12 months, who were indicated for conservative therapy/palliative operation, palliative operation, and invasive excision, respectively. The newly established model was confirmed to be of high accuracy in predicting overall survival, whereas the Tokuhashi and Tomita scores were of modest accuracy and consistency. CONCLUSIONS: A new decision tree model for prognosis prediction in spinal metastasis was established with a satisfactory accuracy and consistency. However, the Tokuhashi and Tomita systems were presented to be less correlated between the scores and actual survival.


Assuntos
Tomada de Decisão Clínica/métodos , Índice de Gravidade de Doença , Neoplasias da Coluna Vertebral/mortalidade , Neoplasias da Coluna Vertebral/secundário , Idoso , Conservadores da Densidade Óssea/uso terapêutico , Quimioterapia Adjuvante , Terapia Combinada , Árvores de Decisões , Incontinência Fecal/epidemiologia , Incontinência Fecal/etiologia , Feminino , Fraturas Espontâneas/epidemiologia , Fraturas Espontâneas/etiologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Procedimentos Neurocirúrgicos , Cuidados Paliativos , Prognóstico , Radioterapia Adjuvante , Estudos Retrospectivos , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/terapia , Análise de Sobrevida , Tomografia Computadorizada por Raios X , Incontinência Urinária/epidemiologia , Incontinência Urinária/etiologia
20.
N Engl J Med ; 380(12): 1150-1157, 2019 03 21.
Artigo em Inglês | MEDLINE | ID: mdl-30893535

RESUMO

A 58-year-old woman with debilitating ankylosing spondylitis who was born to consanguineous parents was found to have an apparent severe vitamin D deficiency that did not respond to supplementation. Liquid chromatography-tandem mass spectrometry showed the absence of circulating vitamin D-binding protein, and chromosomal microarray confirmed a homozygous deletion of the group-specific component (GC) gene that encodes the protein. Congenital absence of vitamin D-binding protein resulted in normocalcemia and a relatively mild disruption of bone metabolism, in this case complicated by severe autoimmune disease. (Funded by the National Institutes of Health and the University of Washington.).


Assuntos
Doenças Autoimunes/complicações , Deleção de Genes , Hidroxicolecalciferóis/sangue , Espondilite Anquilosante/genética , Deficiência de Vitamina D/genética , Proteína de Ligação a Vitamina D/genética , Cálcio/sangue , Cromatografia Líquida , Feminino , Fraturas Espontâneas/etiologia , Expressão Gênica , Homozigoto , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Sequência com Séries de Oligonucleotídeos , Polimorfismo de Nucleotídeo Único , Irmãos , Espondilite Anquilosante/complicações , Espectrometria de Massas em Tandem , Vitamina D/metabolismo , Proteína de Ligação a Vitamina D/deficiência
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