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1.
Br J Radiol ; 93(1112): 20190725, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32516546

RESUMO

OBJECTIVE: To compare htree-dimensional CAIPIRINHA SPACE and two-dimensional turbo spin echo (2D TSE) MRI in the diagnosis of knee pathology in symptomatic adult patients. METHODS: From February to September in 2018, 120 patients who underwent a knee MRI using both 3D CAIPIRINHA SPACE and 2D TSE MRI were enrolled. The signal-to-noise ratios (SNRs) and contrast-to-noise ratio (CNR) of the 2D and 3D MRI were compared using a paired t-test. Two radiologists independently evaluated both 2D and 3D MRI images using scoring systems for the menisci, ligaments, and cartilage. Intermethod, inter- and intrareader agreements were determined using an intraclass correlation coefficient (ICC). The diagnostic performance of both methods was measured in 44 patients with arthroscopy. RESULTS: The mean scan time of 3D CAIPIRINHA SPACE MRI (4' 43") was shorter than that of 2D TSE MRI (17' 27"). The mean SNR and CNR of 3D CAIPIRINHA SPACE was higher than those of 2D TSE MRI (mean difference, 3.97 of SNR and 1.58 of CNR; p < 0.001 and p = .038, respectively). Intermethod (ICC, 0.84-1.0) and inter-reader (ICC, 0.75-0.97), and intra-reader agreements (ICC, 0.87-1.0) were good or excellent. The diagnostic accuracy of 3D CAIPIRINHA SPACE sequence was equal for ligament (95.5%) and better for meniscal and cartilage evaluation (84.1% each), compared to 2D TSE MRI (79.5% each). CONCLUSION: The fat-suppressed 3D CAIPIRINHA SPACE MRI maybe useful in clinical practice for the evaluation of the knee in place of the 2D conventional MRI protocol. ADVANCES IN KNOWLEDGE: 1. The 3D CAIPIRINHA SPACE MRI of the knee joint may be acceptable to be used in clinical practice showing comparable imaging quality compared to conventional 2D TSE MRI.2. Compared with arthroscopic findings as the gold-standard, the diagnostic performance of 3D CAIPIRINHA SPACE MRI was equal or better for knee joint evaluation than that of 2D TSE MRI, as well as with shorter scan time.


Assuntos
Joelho/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste , Feminino , Humanos , Aumento da Imagem/métodos , Imageamento Tridimensional , Joelho/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Razão Sinal-Ruído , Adulto Jovem
2.
Medicine (Baltimore) ; 99(16): e19856, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32312009

RESUMO

RATIONALE: Pigmented villonodular synovitis is a rare disease which may involve any joints. It has localized and diffuse forms, and the latter is more aggressive with a higher recurrence rate. Different treatments are applied to each form of the disease, but there is no standard surgical procedure or any consensus on whether adjuvant therapy should be used. Many factors may lead to recurrence of the disease; however, there is no reliable way to predict the recurrence. PATIENT CONCERNS: A 21-year-old female patient presented with a one-year history of progressive pain of the right knee. DIAGNOSES: Pigmented villonodular synovitis. INTERVENTIONS: We performed an anterior approach arthroscopic synovectomy and a posterior approach open synovectomy in the popliteal fossa, but the patient declined to take radiotherapy as a post-surgical adjuvant therapy. Then, she received a repeat arthroscopic synovectomy 20 months later because of the recurrent lesions, and a radiotherapy was performed 6 weeks after the second surgery. OUTCOMES: There were no abnormal signs in the right knee on magnetic resonance imaging scanning 6 months after the second surgery. The range of motion of her right knee was normal. LESSONS: Pigmented villonodular synovitis is a rare disease which may involve any joints. Surgical resection plus adjuvant therapy is recommended for patients with risk factors of recurrence.


Assuntos
Joelho/patologia , Imagem por Ressonância Magnética/métodos , Sinovite Pigmentada Vilonodular/diagnóstico por imagem , Sinovite Pigmentada Vilonodular/cirurgia , Artroscopia/métodos , Feminino , Humanos , Joelho/diagnóstico por imagem , Dor/diagnóstico , Dor/etiologia , Radioterapia/métodos , Amplitude de Movimento Articular/fisiologia , Recidiva , Fatores de Risco , Sinovectomia/métodos , Sinovite Pigmentada Vilonodular/patologia , Sinovite Pigmentada Vilonodular/radioterapia , Resultado do Tratamento , Adulto Jovem
3.
Medicine (Baltimore) ; 99(12): e19541, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32195960

RESUMO

BACKGROUND: Knee osteoarthritis (KOA) is a common degenerative joint disorder that affects 250 million people globally. KOA can lead to disability and is often associated with cardiovascular disease, poor quality of life, and mortality. The most common treatment for KOA is non-steroidal anti-inflammatory drug administration. However, the analgesic effect is limited and often accompanied by multiple side effects. Hence, many KOA patients opt for complementary and alternative medicine. Acupuncture is one of the most popular complementary treatments with great analgesic effect and minimal side effect. Electroacupuncture (EA) and laser acupuncture (LA) have been known to reduce pain in KOA patients. However, to date, no study has assessed the benefits of combining these two therapies. METHODS: Fifty participants diagnosed with KOA, aged 50 years or older, and with consistent knee pain for more than 3 months were recruited and randomly assigned to the treatment group (EA plus LA) or control group (EA plus sham LA without laser output). All subjects in the treatment group will undergo a combined EA and LA treatment thrice a week for 4 weeks. The acupuncture will be performed on GB33, GB34, SP9, SP10, and ST36 sites. The treatment group will receive acupuncture with a transcutaneous electrical nerve stimulator at GB33, GB34, SP9, and SP10 sites and with LA at EX-LE5, ST35, and BL40 sites. The subjects in the control group will undergo the same treatment modality as the treatment group, except these subjects will not be exposed to laser output. Outcome measurements will include visual analog scale, Western Ontario McMaster Universities Osteoarthritis Index, Knee injury and osteoarthritis outcome, body composition analysis, knee range of motion, quadriceps muscle stiffness, one-leg standing with eyes open test, and the 30-s chair stand test before and after 4 weeks of intervention. OBJECTIVES: This protocol aims to investigate the combined effect of EA and LA in KOA patients.


Assuntos
Terapia por Acupuntura/métodos , Eletroacupuntura/métodos , Terapia a Laser/métodos , Osteoartrite do Joelho/terapia , Estimulação Elétrica Nervosa Transcutânea/instrumentação , Terapia por Acupuntura/tendências , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Humanos , Joelho/patologia , Terapia com Luz de Baixa Intensidade , Pessoa de Meia-Idade , Osteoartrite do Joelho/radioterapia , Avaliação de Resultados em Cuidados de Saúde , Dor , Manejo da Dor/métodos , Amplitude de Movimento Articular/fisiologia , Taiwan/epidemiologia , Escala Visual Analógica
4.
Am J Phys Med Rehabil ; 99(1): 7-12, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31335340

RESUMO

PURPOSE: The aim of the study was to compare the clinical, radiographic, and ultrasound findings between simple and complicated Baker's cysts. METHODS: Forty-seven knees with Baker's cysts in 45 patients with knee pain were identified from a chart review. Baker's cysts were classified as simple or complicated according to ultrasound findings. Clinical data, including duration of knee pain, visual analog scale score, Kellgren-Lawrence grade, ultrasound findings, including the size and sonomorphology of the BC, severity of osteophytosis, thickness of joint effusion, meniscal tear, and synovial proliferation of the two types of BC, were compared. RESULTS: There were 22 knees with a simple cyst and 25 knees with a complicated cyst. The thickness of the suprapatellar effusion in complicated Baker's cysts (5.7 ± 3.0 mm) was significantly greater than that in simple Baker's cysts (3.8 ± 3.2 mm), and the presence of synovial proliferation in the suprapatellar recess was significantly higher in complicated Baker's cysts (22 knees, 88.0%) than in the simple Baker's cysts (12 knees, 54.5%). However, there were no significant differences in demographic, radiographic, and other ultrasound parameters between the two types of BC. CONCLUSIONS: Synovial proliferation with larger effusion in the suprapatellar recess was more associated with complicated BC than simple BC.


Assuntos
Cisto Popliteal/diagnóstico por imagem , Cisto Popliteal/patologia , Radiografia , Ultrassonografia , Adulto , Idoso , Idoso de 80 Anos ou mais , Proliferação de Células , Estudos Transversais , Feminino , Humanos , Joelho/diagnóstico por imagem , Joelho/patologia , Masculino , Pessoa de Meia-Idade , Patela/diagnóstico por imagem , Patela/patologia , Estudos Retrospectivos , Líquido Sinovial/citologia
9.
BMC Public Health ; 19(1): 1375, 2019 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-31655569

RESUMO

BACKGROUND: An increasing amount of evidence supports an association between sedentary behaviors and chronic knee pain. However, the association between the total daily duration of sedentary behavior and chronic knee pain in the general population remains unclear. We aimed to analyze the association between sedentary behavior and chronic knee pain in a study population representative of the general Korean population aged > 50 years while also considering the physical activity or body mass index (BMI). METHODS: This cross-sectional study used data from the 6th Korean National Health and Nutrition Examination Survey (KNHANES VI) of 2013-2015, which was completed by 22,948 Korean adult participants aged > 50 years. The participants were divided into two groups based on the status of the chronic knee pain. Data were analyzed using multivariable logistic regression after adjustment for age, sex, and individual factors. RESULTS: Longer sedentary behavior was correlated with chronic knee pain (p for trend = 0.02). Sedentary behavior exceeding 10 h/day was significantly associated with chronic knee pain (adjusted odds ratio, 1.28; p = 0.03). Participants with high levels of physical activity were less likely to suffer from chronic knee pain (adjusted odds ratio, 0.78; p = 0.00), and women with over 10 daily hours of sedentary behavior with high levels of physical activity were more likely to have chronic knee pain. A significant association was noted between chronic knee pain and obesity (≥30.0 kg/m2) individuals (adjusted odds ratio, 3.48; p = 0.04). CONCLUSIONS: Longer duration of sedentary behaviors was correlated with chronic knee pain. Our study suggests the need to encourage reductions in overall sedentary behavior to < 10 h daily. A high physical activity level is recommended, particularly for women > 50 years and those with obesity.


Assuntos
Dor Crônica/epidemiologia , Joelho/patologia , Comportamento Sedentário , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , República da Coreia/epidemiologia , Fatores de Risco , Autorrelato , Fatores de Tempo
11.
Int. j. morphol ; 37(3): 1089-1094, Sept. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1012401

RESUMO

Knee osteoarthritis (OA) is a common disabling disease. Epidemiological studies have revealed various risk factors for OA, including sex, aging, obesity, occupational illnesses, and chronic diseases. Here we evaluate the clinical, pathological, and radiological findings of knee OA in a subset of Saudi patients who were subjected to total knee replacement (TKA). The study population included 30 Saudi patients with knee OA who were operated by TKA (from June 2014 to December 2015) in the Department of Orthopedics, Faculty of Medicine, King Abdulaziz University, Saudi Arabia. Patient's clinical and radiological data were collected from the hospital files. Pathological examination of the excised superior articular surface of tibia and femoral condyles were done. Pearson Chi-squared analysis was used to test for differences between the variables in associated risk factors. There were more women than men. Sixty per cent of patients were older than 60 years [mean age, 59.2 (females) and 61.7 (men) years-old]. All patients exceeded obesity class 1, with females being more obese than males. Pathological examination of the superior articular surface of tibia and femoral condyles showed high score lesions, which was more apparent in females than in males. Radiological findings showed that most lesions were high grade. The findings of this study will help to understand the pathogenesis of OA and improve treatment decision making relevant to TKA in knee OA in Saudi Arabia and elsewhere.


La artrosis de rodilla (OA, por sus siglas en inglés) es una enfermedad invalidante común. Los estudios epidemiológicos han revelado diversos factores de riesgo para la OA, que incluyen el sexo, el envejecimiento, la obesidad, las enfermedades profesionales y las enfermedades crónicas. Aquí evaluamos los hallazgos clínicos, patológicos y radiológicos de la OA de rodilla en un subconjunto de pacientes sauditas que fueron sometidos a reemplazo total de rodilla (RTR). La población de estudio incluyó a 30 pacientes saudíes con OA de rodilla que fueron operados por RTR (desde junio de 2014 hasta diciembre de 2015) en el Departamento de Ortopedia, Facultad de Medicina, King Abdulaziz University, Arabia Saudita. Los datos clínicos y radiológicos de los pacientes se obtuvieron de las fichas hospitalarias. Se realizó examen patológico de la superficie articular superior de la tibia extirpada y cóndilos femorales. Se utilizó el análisis Chi-cuadrado de Pearson para probar las diferencias entre las variables en los factores de riesgo asociados. El número de mujeres era mayor que los hombres. El 60 % de los pacientes eran mayores de 60 años [edad media, 59,2 (mujeres) y 61,7 (hombres) años]. Todos los pacientes superaron la obesidad clase 1, siendo las mujeres más obesas que los hombres. El examen patológico de la superficie articular superior de la tibia y los cóndilos femorales mostraron lesiones con puntaje alto, que fue más evidente en mujeres que en hombres. Los hallazgos radiológicos mostraron que la mayoría de las lesiones eran de alto grado. Los hallazgos de este estudio ayudarán a comprender la patogenia de la OA y mejorarán la toma de decisiones sobre el tratamiento relevante para el RTR en la OA de rodilla en Arabia Saudita y en otros lugares.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Osteoartrite do Joelho/patologia , Joelho/patologia , Joelho/diagnóstico por imagem , Arábia Saudita , Índice de Massa Corporal , Distribuição de Qui-Quadrado , Fatores de Risco , Artroplastia do Joelho , Osteoartrite do Joelho/cirurgia
13.
Biomed Res Int ; 2019: 8491301, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31467914

RESUMO

Objectives: To examine the metabolic profiles alterations of synovial fluids from anterior cruciate ligament- (ACL-) injured rabbit knees at early stage and analyze the correlation with T2 relaxation times of cartilage and meniscus. Methods: The right knees of 15 rabbits were selected for the construction of ACL injury models, whereas the contralateral knees served as control group. After 4 weeks, both knees were examined by MRI with quantitative T2 mapping sequence, and the T2 relaxation times of cartilage and meniscus were measured. Then, the synovial fluids were obtained from both knee capsules and performed liquid chromatography-mass spectrometry analysis (LC-MS). Results: The T2 relaxation times of cartilage and meniscus in ACL-injured knees were significantly higher than those in control knees (Cartilage: 41.52 ± 2.98 ms vs 36.02 ± 2.71 ms, P < 0.001; Meniscus: 33.35 ± 3.57 ms vs 27.27 ± 2.10 ms, P < 0.001). Twenty-eight differential metabolites were identified based on a total of 1569 detected signatures between ACL-injured knees and control knees. These differential metabolites primarily implied perturbations in the fluxes of lipids and steroid-based compounds. The Linear regression analysis demonstrated satisfactory correlations between glycerophospholipid metabolism and T2 relaxation times of both cartilage and meniscus in ACL-injured knees (R2 = 0.8204 and 0.8197, respectively). Conclusion: ACL injury of rabbit knees resulted in elevated T2 relaxation times of cartilage and meniscus and perturbed metabolism of various lipids and steroids in synovial fluids, particularly glycerophospholipids. Glycerophospholipid metabolism related compounds could serve as potential biomarkers for early degenerative changes of cartilage and meniscus after ACL injury.


Assuntos
Lesões do Ligamento Cruzado Anterior/metabolismo , Cartilagem Articular/metabolismo , Traumatismos do Joelho/metabolismo , Líquido Sinovial/metabolismo , Animais , Ligamento Cruzado Anterior/diagnóstico por imagem , Ligamento Cruzado Anterior/metabolismo , Ligamento Cruzado Anterior/patologia , Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Lesões do Ligamento Cruzado Anterior/patologia , Reconstrução do Ligamento Cruzado Anterior/métodos , Cartilagem Articular/diagnóstico por imagem , Cartilagem Articular/patologia , Modelos Animais de Doenças , Humanos , Joelho/diagnóstico por imagem , Joelho/patologia , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/patologia , Imagem por Ressonância Magnética , Meniscos Tibiais/metabolismo , Menisco/metabolismo , Menisco/patologia , Metaboloma , Coelhos , Líquido Sinovial/diagnóstico por imagem
14.
BMC Infect Dis ; 19(1): 631, 2019 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-31315565

RESUMO

BACKGROUND: Candida arthritis is extremely rare and also represents a major challenge of diagnosis and treatment. Here we reported a rare case of recurrent arthritis caused by Candida parapsilosis. CASE PRESENTATION: A 56-year-old Chinese male suffered from recurrent pain and swelling in his right knee after several times of "small needle-knife" acupuncture and corticosteroid injection of the joint. Candida parapsilosis was cultured in his synovial fluid and identified by sequencing of its Internal Transcribed Spacer (ITS) gene. Here we present the radiological characteristics, arthroscopic pictures, and synovium pathology of this patient. Also, blood test and chemical analysis of his synovial fluid were listed as well as the ITS sequence of this Candida species identified. The patient underwent thorough arthroscopic debridement and then set on fluconazole 400 mg daily for 12 months. His symptoms resolved and no relapse was observed on the last follow-up. Additionally, a brief but comprehensive review of C. parapsilosis arthritis episodes from past to now were studied. CONCLUSION: With the detailed clinical information reported in this case and our literature review, we hope they would add to our knowledge of C. parapsilosis arthritis - its clinical settings, laboratory features, radiological characteristics, arthroscopic findings and experience of management.


Assuntos
Artrite/microbiologia , Candida parapsilosis/patogenicidade , Candidíase/tratamento farmacológico , Antifúngicos/uso terapêutico , Artrite/tratamento farmacológico , Artrite/cirurgia , Candida parapsilosis/isolamento & purificação , Desbridamento , Fluconazol/uso terapêutico , Humanos , Joelho/microbiologia , Joelho/patologia , Masculino , Pessoa de Meia-Idade , Líquido Sinovial/microbiologia
16.
Acta Orthop Traumatol Turc ; 53(4): 272-277, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31103417

RESUMO

OBJECTIVE: The aim of this study was to compare ultrasonographically measured quadriceps and patellar tendon thicknesses between Patellofemoral Pain Syndrome (PFPS) patients and age- and gender-matched healthy controls. METHODS: Among patients who presented to physical therapy and rehabilitation outpatient clinic in January-December 2016, 61 volunteers (28 men and 33 women; mean age: 30.79 ± 6.55 years) who were eligible considering the inclusion and exclusion criteria were enrolled. 30 were diagnosed with PFPS, and the remaining were age- and gender-matched healthy volunteers. Mean age was 30.03 ± 5.67 years in healthy subjects and 45.2% were of male gender. The patient group had mean age of 31.57 ± 7.37 years and 46.7% of the patients were male. Q angles were measured at standing, supine and sitting positions. Patellar and femoral tendon thicknesses and areas were measured ultrasonographically. Kujala questionnaire were used to evaluate the functional status of the participants. RESULTS: No significant difference was detected between groups regarding profession, educational background, and body mass indices (BMI) (p > 0.05). Q angle values were significantly higher in the patient group when compared to controls at standing (17.03 ± 3.84 vs. 13.87 ± 1.75°, p < 0.001), supine (16.20 ± 3.74 vs. 13.45 ± 1.79°, p = 0.001) and sitting (16.50 ± 3.28 vs. 13.71 ± 1.72°, p < 0.001) positions. Kujala score was significantly lower in the PFPS group when compared to controls (70.57 ± 8.37 vs. 98.58 ± 2.05, p < 0.001). Patellar (0.39 ± 0.08 vs. 0.32 ± 0.05 cm, p < 0.001) and quadriceps (0.64 ± 0.10 vs. 0.52 ± 0.09 cm, p < 0.001) tendon thicknesses were significantly higher in the PFPS group when compared to controls. There was no significant difference between groups regarding patellar tendon areas (p > 0.05). Patellar tendon thickness values of ≥0.35 cm were found to have 66.7% sensitivity and 67.7% specificity for PFPS diagnosis in the ROC curve analysis (area under curve: 0.771, 95% confidence interval: 0.655-0.887, p < 0.001). Quadriceps tendon thickness values of ≥0.54 cm were found to have 80% sensitivity and 71% specificity for PFPS diagnosis in the ROC curve analysis (area under curve: 0.824, 95% confidence interval: 0.710-0.939, p < 0.001). In PFPS patients, quadriceps tendon thickness had significant positive correlation with age (r = 0.405, p = 0.027) and BMI (r = 0.450, p = 0.013); and significant negative correlation with Kujala score (r = -0.441, p = 0.015). In the multivariate regression analysis, quadriceps tendon thickness was independently associated with the presence of PFPS (Exp (B): 3.089, 95% confidence interval: 1.344-7.100, p = 0.008). CONCLUSION: Our study demonstrates that ultrasonographically measured patellar and quadriceps tendon thicknesses are significantly higher in subjects with PFPS and particularly, quadriceps tendon thickness may be used for the diagnosis. LEVEL OF EVIDENCE: Level III, Therapeutic Study.


Assuntos
Joelho , Ligamento Patelar , Síndrome da Dor Patelofemoral/diagnóstico , Tendões , Ultrassonografia/métodos , Adulto , Feminino , Humanos , Joelho/diagnóstico por imagem , Joelho/patologia , Joelho/fisiopatologia , Masculino , Tamanho do Órgão , Ligamento Patelar/diagnóstico por imagem , Ligamento Patelar/patologia , Reprodutibilidade dos Testes , Tendões/diagnóstico por imagem , Tendões/patologia
17.
Clin Radiol ; 74(7): 517-526, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30827492

RESUMO

Central cartilage tumours of bone range from the benign enchondroma to the malignant chondrosarcoma. They are an incidental finding in up to 2.8% of routine magnetic resonance imaging (MRI) examinations performed of the shoulder and knee. The purpose of this review is to provide a current appraisal of the imaging and histological challenges of distinguishing enchondroma from low-grade chondrosarcoma. The general radiologist, encountering these lesions in the proximal humerus and around the knee, is introduced to the Birmingham Atypical Cartilage Tumour Imaging Protocol (BACTIP). This provides a guide to the initial assessment and diagnosis, a stepwise imaging follow-up plan, and the indications for onward specialist orthopaedic oncology referral or discharge from follow-up.


Assuntos
Neoplasias Ósseas/diagnóstico por imagem , Condroma/diagnóstico por imagem , Condrossarcoma/diagnóstico por imagem , Diagnóstico por Imagem/métodos , Joelho/diagnóstico por imagem , Neoplasias Ósseas/patologia , Cartilagem/diagnóstico por imagem , Cartilagem/patologia , Condroma/patologia , Condrossarcoma/patologia , Seguimentos , Humanos , Úmero/diagnóstico por imagem , Úmero/patologia , Joelho/patologia , Imagem por Ressonância Magnética , Tomografia por Emissão de Pósitrons , Radiografia , Ombro/diagnóstico por imagem , Ombro/patologia
18.
Clin Imaging ; 56: 13-16, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30831532

RESUMO

A 54-year old woman with primary osteoarthritis and a tibial bone marrow lesion underwent subchondroplasty with injectable calcium phosphate. Post-operatively, the patient's symptoms worsened, and she lost the ability to bear weight. Follow-up MRI revealed previously absent, diffuse STIR hyperintensity in the tibia extending far beyond the surgical site. Twelve months post-operatively, symptoms spontaneously resolved. As the prevalence of subchondroplasty grows it will be important to recognize potential complications. To the authors' best knowledge this is the first report of significantly worsening pain and difficulty bearing weight corresponding with diffuse hyperintense T2 signal in the tibia after a calcium phosphate subchondroplasty.


Assuntos
Artroplastia de Substituição/métodos , Artroplastia Subcondral/métodos , Doenças das Cartilagens/cirurgia , Meniscectomia , Meniscos Tibiais/cirurgia , Osteoartrite do Joelho/cirurgia , Tíbia/patologia , Artroplastia de Substituição/efeitos adversos , Artroplastia Subcondral/efeitos adversos , Medula Óssea/patologia , Doenças da Medula Óssea/complicações , Fosfatos de Cálcio , Doenças das Cartilagens/patologia , Feminino , Humanos , Joelho/patologia , Joelho/cirurgia , Imagem por Ressonância Magnética/métodos , Meniscectomia/efeitos adversos , Meniscos Tibiais/patologia , Pessoa de Meia-Idade , Osteoartrite do Joelho/patologia , Dor/etiologia , Complicações Pós-Operatórias , Período Pós-Operatório
20.
BMJ Case Rep ; 12(2)2019 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-30796073

RESUMO

The authors present the case of a woman in the seventh decade of life with medical history of: left nephrectomy for renal tuberculosis and non-Hodgkin's lymphoma treated with chemotherapy (QT) and radiotherapy. She presented with a 2-month history of non-tender, left inguinal lymph node enlargement. Positron Emission Tomography (PET)-CT -scanshowed hypermetabolic inguinal and retroperitoneal lymphadenopathies, no primary tumour. On the second dermatological examination a pink, 2 cm plaque on the anterior left knee was noted. The histopathological analysis revealed Merkel cell carcinoma. The patient underwent two lines of systemic QT, with life-threatening toxicities limiting treatment. Followed overwhelming disease progression with lymphoedema and numerous skin metastases in the left lower limb. The patient received palliative care until death. The rare incidence of such neoplasia and its uncommon clinical presentation justifies reporting this case and highlights the importance of multidisciplinary teams in the management of cancer patients.


Assuntos
Carcinoma de Célula de Merkel/patologia , Joelho/patologia , Neoplasias Primárias Desconhecidas/patologia , Neoplasias Cutâneas/secundário , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica , Carcinoma de Célula de Merkel/diagnóstico por imagem , Carcinoma de Célula de Merkel/fisiopatologia , Terapia Combinada , Progressão da Doença , Evolução Fatal , Feminino , Humanos , Neoplasias Primárias Desconhecidas/diagnóstico por imagem , Neoplasias Primárias Desconhecidas/fisiopatologia , Cuidados Paliativos , Tomografia por Emissão de Pósitrons , Radioterapia Adjuvante , Neoplasias Cutâneas/diagnóstico por imagem , Neoplasias Cutâneas/fisiopatologia
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