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1.
Invest Ophthalmol Vis Sci ; 60(13): 4285-4291, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31618765

RESUMO

Purpose: The optic nerve becomes tethered in adduction in most people, which deforms the disc. We investigated the effect of horizontal ocular duction and subject age on choroidal volume at the macular side of the optic disc. Methods: In 25 younger (18-33 years) and 15 older (50-73 years) normal subjects, the disc and the peripapillary choroid were imaged with optical coherence tomography (OCT) in central gaze and 35° adduction and abduction. The choroid temporal to the optic disc underlying the region between the Bruch's membrane opening and fovea was segmented into regions that were multiples of the disc radius for determination of local choroidal thickness. Regional volume changes from central gaze were determined in adduction and abduction. Results: In adduction, regional choroidal volume decreased by 42.4 ± 3.4 nanoliters (nL) (standard error of the mean) in younger (P < 0.0001) and 6.2 ± 2.6 nL in older (P < 0.02) subjects. Relative volume reduction in adduction was 7.5% ± 0.6% in younger (P < 0.001) and 1.3% ± 0.6% in older (P < 0.02) subjects. Volume reduction was greatest near the disc and significant up to three disc radii from it in younger and 1 radius in older subjects but was insignificant in abduction. Conclusions: Horizontal duction compresses the temporal peripapillary choroid, more in adduction than in abduction and more in younger than older subjects. This reflects duction-related peripapillary tissue deformation probably related, at least in part, to optic nerve tethering in adduction.


Assuntos
Envelhecimento/fisiologia , Corioide/patologia , Síndromes de Compressão Nervosa/etiologia , Transtornos da Motilidade Ocular/complicações , Disco Óptico/patologia , Doenças do Nervo Óptico/etiologia , Adolescente , Adulto , Idoso , Corioide/diagnóstico por imagem , Feminino , Fixação Ocular , Humanos , Masculino , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/diagnóstico por imagem , Disco Óptico/diagnóstico por imagem , Doenças do Nervo Óptico/diagnóstico por imagem , Tomografia de Coerência Óptica , Adulto Jovem
3.
Muscle Nerve ; 60(4): 428-433, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31325324

RESUMO

BACKGROUND: Muscle herniation is a muscle protrusion through a fascial defect. It is a rarely reported cause of nerve entrapment. METHODS: We present a case of superficial fibular (peroneal) neuropathy associated with a fibularis (peroneus) brevis muscle herniation and a review of the literature on nerve entrapments secondary to muscle herniation unrelated to compartment syndrome. RESULTS: Eleven cases of nerve entrapments secondary to muscle herniation were identified. The superficial fibular nerve (SFN) was the most commonly entrapped nerve by fibularis muscle herniation. Patients presented with pain, numbness, or paresthesias, and an often tender, small palpable mass with a Tinel sign. Muscle MRI or ultrasound identified the lesion, and patients responded well to fasciotomy. CONCLUSIONS: The most commonly reported nerve entrapped by muscle herniation is the SFN secondary to fibularis muscle herniation. Characteristic clinical and imaging (MRI or ultrasound) features are diagnostic, and there is a salutary response to fasciotomy.


Assuntos
Hérnia/diagnóstico por imagem , Músculo Esquelético/diagnóstico por imagem , Síndromes de Compressão Nervosa/diagnóstico por imagem , Neuropatias Fibulares/diagnóstico , Adulto , Eletromiografia , Fasciotomia , Feminino , Hérnia/complicações , Humanos , Imagem por Ressonância Magnética , Síndromes de Compressão Nervosa/etiologia , Síndromes de Compressão Nervosa/cirurgia , Condução Nervosa , Neuropatias Fibulares/etiologia , Ultrassonografia
5.
World Neurosurg ; 128: 1-3, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31051308

RESUMO

BACKGROUND: Melorheostosis is a bone hyperostosis disorder characterized by flowing bone thought to occur in a sclerodermal distribution. These bony lesions often arise in soft tissues adjacent to joints. Pain arises from joint limitations and impingements, but diffuse pain can also occur. CASE DESCRIPTION: We present a case of a patient with symptomatic compression of the common peroneal nerve by an extraosseous hyperostotic tissue island in a patient with melorheostosis. CONCLUSIONS: Melorheostosis is a rare bone overgrowth syndrome that can lead to joint mobility limitations and pain. In specific locations, it can also lead to tethering and symptomatic compression of the peripheral nerves.


Assuntos
Melorreostose/complicações , Síndromes de Compressão Nervosa/etiologia , Adulto , Diagnóstico Diferencial , Feminino , Fíbula , Humanos , Melorreostose/diagnóstico por imagem , Melorreostose/cirurgia , Síndromes de Compressão Nervosa/diagnóstico , Síndromes de Compressão Nervosa/cirurgia , Nervo Fibular
6.
World Neurosurg ; 128: e752-e759, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31077893

RESUMO

BACKGROUND: The availability of magnetic resonance imaging (MRI) has led to an increase in the detection of pituitary incidentaloma (PI). However, there are no robust data on surgical treatment of PI on which to base therapeutic recommendations. This study was performed to investigate the significance of surgery for asymptomatic nonfunctioning pituitary adenoma (NFPA) among PIs. METHODS: A total of 180 patients that underwent tumor resection of pituitary adenoma via the transsphenoidal approach between 2005 and 2017 were reviewed. Thirty-three consecutive patients with subjectively asymptomatic NFPA were included in this study. Our surgical indications for asymptomatic NFPAs were categorized as follows: macroadenoma with optic chiasma compression (group A, n = 14), solid tumor ≥2 cm in size (group B, n = 7), and tumor growth on follow-up MRI (group C, n = 12). The clinical outcomes were analyzed accordingly. RESULTS: Seven patients (50%) in group A showed subjective improvement of visual function after tumor resection even though they had no complaints preoperatively. On the other hand, no changes occurred in any cases in group B or group C. Although there were no critical complications in this series, the incidence of nonnegligible nasal complications was relatively high (24.2%) and may decrease the patient's quality of life. CONCLUSIONS: Surgery should be recommended for asymptomatic NFPA with optic chiasma compression to improve visual outcome. On the other hand, immediate intervention for other asymptomatic NFPA to reduce the likelihood of the appearance of tumor-related symptoms remains questionable considering its invasiveness to the nose.


Assuntos
Adenoma/cirurgia , Neoplasias Hipofisárias/cirurgia , Adenoma/complicações , Adenoma/diagnóstico por imagem , Adulto , Idoso , Feminino , Seguimentos , Humanos , Achados Incidentais , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/etiologia , Síndromes de Compressão Nervosa/cirurgia , Procedimentos Neurocirúrgicos , Quiasma Óptico , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/diagnóstico por imagem , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Osso Esfenoide/cirurgia , Resultado do Tratamento , Transtornos da Visão/etiologia , Adulto Jovem
7.
BMJ Case Rep ; 12(5)2019 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-31092495

RESUMO

This is a rare case of an anterior interosseous nerve (AIN) palsy in a patient as a result of a prolonged period of shoulder immobilisation. The patient had an open reduction internal fixation of a midshaft clavicle fracture. They subsequently underwent removal of metal due to symptomatic prominence of the metal work. The patient was in a shoulder immobiliser for a period of 5 months in total. They developed progressive AIN palsy as a result of a positional compression due to prolonged wearing of a shoulder immobiliser. This resolved with conservative management and careful observation.


Assuntos
Imobilização/efeitos adversos , Síndromes de Compressão Nervosa/etiologia , Articulação do Ombro/inervação , Clavícula/lesões , Tratamento Conservador , Humanos , Masculino , Síndromes de Compressão Nervosa/terapia , Redução Aberta/efeitos adversos , Adulto Jovem
8.
World Neurosurg ; 127: 464-468, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31009779

RESUMO

BACKGROUND: Several authors have reported the occurrence of extraforaminal L5 nerve root compression between lumbosacral transitional vertebrae (LSTV) and sacral ala, but reports on a lesion caused by an intervertebral osteophyte on the ventral and contralateral side of a unilateral abnormality by LSTV are hardly available. CASE DESCRIPTION: A 67-year-old woman presented with pain along the distribution of the L5 nerve root; straight leg raise test, femoral nerve stretch test, and Kemp test were positive on the left. Following plain radiographs, computerized tomography, magnetic resonance imaging, and selective nerve root block, an osteophyte bridging the L5 and S1 vertebral bodies in the ventral side was identified compressing the L5 nerve root. On account of resistance to conservative therapy and the delicate position of the lesion, surgical treatment was performed by an anterior decompression. Subsequently, the patient attained adequate relief from pain and could walk normally. CONCLUSION: We herein present a very rare case of extraforaminal L5 nerve root compression caused by an intervertebral osteophyte on the ventral and contralateral side of a unilateral abnormality by LSTV, which was managed by anterior decompression.


Assuntos
Vértebras Lombares/cirurgia , Síndromes de Compressão Nervosa/etiologia , Osteófito/complicações , Sacro/cirurgia , Raízes Nervosas Espinhais/cirurgia , Idoso , Descompressão Cirúrgica/métodos , Feminino , Humanos , Dor Musculoesquelética/etiologia , Dor Musculoesquelética/cirurgia , Síndromes de Compressão Nervosa/cirurgia , Osteófito/cirurgia
9.
J Clin Neurosci ; 64: 35-37, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30967313

RESUMO

Alcohol consumption and subsequent sleeping in unusual positions often causes compression neuropathies. In this case, we experienced a unique case of bilateral leg palsy after sleeping in a forward bending position that was photographed by his colleague. We expected that prolonged blockage of the circulation of the femoral arteries resulted in bilateral thigh compartment syndromes (TCSs), leading to sciatic nerve damage. The muscle MRI and needle EMG support this hypothesis. A couple of similar cases have been reported, but the causes of TCS was undetermined due to lack of medical history. This case illustrates that atraumatic compartment syndrome with sciatic nerve palsy can be occurred by prolonged unusual positions.


Assuntos
Síndromes Compartimentais/etiologia , Neuropatia Ciática/etiologia , Postura Sentada , Coxa da Perna , Adulto , Humanos , Masculino , Necrose/etiologia , Síndromes de Compressão Nervosa/etiologia , Coxa da Perna/irrigação sanguínea , Coxa da Perna/patologia
11.
Orthop Surg ; 11(1): 3-9, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30834704

RESUMO

Bowstring disease (BSD) is a new classification of spine disease caused by axial stretched lesion on nerve roots and the spinal cord, which is differentiated from disc herniation and canal stenosis in that it is caused by nerve compression lesions. BSD could be caused by mismatched growth rates between the spine and nerve roots (the juvenile type), or by imbalanced degenerative rates between the spine column and nerve roots (degenerative type). Here, we propose that there are several self-adjust mechanisms to relieve axial nerve tension: (i) nerve growth; (ii) posture adjustment and low back pain; (iii) autogenous degeneration of intervertebral disc; and (iv) idiopathic and degenerative scoliosis. Iatrogenic lesions could also result in BSD, which could be presented as adjacent segment degeneration, leading to adding-on effects and other neurological symptoms. The diagnosis criteria are proposed based on symptoms, physical examination, and radiological presentations. To remove axial tension on nerve roots, lumbar surgery should aim to restore the coordination of spine and cord units. Capsule surgery, shortening the spine column, could decompress cord and nerve roots 3-dimensionally.


Assuntos
Vértebras Lombares/cirurgia , Síndromes de Compressão Nervosa/diagnóstico , Síndromes de Compressão Nervosa/cirurgia , Compressão da Medula Espinal/diagnóstico , Compressão da Medula Espinal/cirurgia , Humanos , Degeneração do Disco Intervertebral/etiologia , Deslocamento do Disco Intervertebral/etiologia , Dor Lombar/etiologia , Síndromes de Compressão Nervosa/etiologia , Escoliose/etiologia , Compressão da Medula Espinal/etiologia , Raízes Nervosas Espinhais/fisiopatologia
12.
World Neurosurg ; 127: e69-e75, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30857995

RESUMO

OBJECTIVE AND BACKGROUND: To study the efficacy of lumbar (AL) magnetic resonance imaging (MRI) in patients with suspected lumbar spinal stenosis (LSS), with and without AL compression. Supine MRI is used in the assessment of patients with LSS. However, MRI findings may poorly correlate with neurologic findings because of the morphologic changes of the lumbar spinal canal between upright standing and supine positions. In patients without significant stenosis in routine lumbar MRI, by applying AL, MRI can show significant LSS. METHODS: This study included 103 consecutive patients (188 disc levels) who presented with neurogenic claudication with and without low back pain. AL was performed using a nonmagnetic compression device for 5 minutes. T1- and T2-weighted axial and sagittal sequences were obtained during AL applied to the spine. The dural sac cross-sectional area (DSCA) appeared to be narrow at each disc level of L4-5 to L5-S1 in all patients and was measured using T2-weighted images in routine supine and AL images. RESULTS: The groups included patients with a reduction in the DSCA (>15 mm2) according to patient age and DSCA in routine spine MRI. The mean DSCA of the disc levels without and with AL were 138 mm2 and 123 mm2, with a mean difference of 15 mm2 at L4-5, 134 mm2 and 125 mm2 and a mean difference of 9 mm2 at L5-S1, respectively. CONCLUSIONS: The use of AL MRI in patients with clinically suspected LSS could reduce the risk of misdiagnosis of stenosis, leading to inappropriate treatment.


Assuntos
Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Posicionamento do Paciente , Canal Vertebral/diagnóstico por imagem , Estenose Espinal/diagnóstico por imagem , Adulto , Idoso , Dura-Máter/diagnóstico por imagem , Desenho de Equipamento , Feminino , Humanos , Disco Intervertebral/diagnóstico por imagem , Dor Lombar/etiologia , Imagem por Ressonância Magnética/instrumentação , Masculino , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/diagnóstico por imagem , Síndromes de Compressão Nervosa/etiologia , Pressão , Estenose Espinal/complicações , Estenose Espinal/fisiopatologia , Decúbito Dorsal , Suporte de Carga , Adulto Jovem
13.
Am J Surg ; 217(5): 873-877, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30878217

RESUMO

INTRODUCTION: Enlargement of the ilioinguinal nerve distal to the inguinal ring is common in primary open inguinal herniorrhaphy and is histologically consistent with compression neuropathy. However, the origin of this neuropathy has not been thoroughly studied in primary inguinal hernia. METHODS: In this prospective study, 143 primary inguinal herniorrhaphies were performed. Prior to surgery, all patients completed a preoperative pain questionnaire from the Carolina Comfort Scale and Visual Analog Scale-evaluating pain with various activities. Pain scores were statistically compared with several different anatomical surgical observations. RESULTS: When each variable is individually compared with pain scores, a significant positive correlation exists between nerve enlargement and increased pain compared to those without enlargement for preoperative "most of the time pain" (P < 0.0017). There is also a statistically significant positive correlation between nerve enlargement and external ring fibrosis (P < 0.001). 81% of patients with enlargement have histological abnormalities. CONCLUSION: Preoperative pain in primary inguinal hernia is correlated with ilioinguinal nerve enlargement, which is also correlated with fibrosis of the external oblique fascia at the external ring.


Assuntos
Hérnia Inguinal/cirurgia , Síndromes de Compressão Nervosa/etiologia , Medição da Dor , Nervos Periféricos/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Fáscia/patologia , Fibrose , Virilha/patologia , Hérnia Inguinal/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/cirurgia , Dor/etiologia , Nervos Periféricos/cirurgia , Período Pré-Operatório , Estudos Prospectivos , Adulto Jovem
14.
World Neurosurg ; 127: e288-e298, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30902779

RESUMO

OBJECTIVE: This retrospective cohort study aimed to investigate the change of spinal cord displacements and the occurrence of C5 palsy between anterior controllable antedisplacement and fusion (ACAF) (group A) and single open-door laminoplasty (group L). METHODS: From January 2016 to December 2017, a total of 80 patients with cervical ossification of the posterior longitudinal ligament (OPLL) were enrolled. All patients underwent computed tomography and magnetic resonance imaging. The types and extent of OPLL, spinal cord rotation, deviation angle, and distance between the vertebral arteries line and spinal cord (DVS) were measured. Patients with postoperative C5 palsy were recorded. Neurologic function was evaluated by Japanese Orthopaedic Association (JOA) score. RESULTS: Three days after surgery, patients in group A had better recovery (6.7° ± 2.4°) of spinal cord rotation than group L (3.1° ± 0.8°; P < 0.05). Deviation angle showed similar changes to spinal cord rotation. At the final follow-up, patients in group A had decreased DVS (11.0 ± 0.7 mm), whereas patients in group L had increased DVS (15.1 ± 0.8 mm) compared with preoperation (P < 0.05). Five patients (1 in group A and 4 in group L) developed postoperative C5 palsy (P > 0.05). Patients in group A had a higher JOA score at the final follow-up than those in group L (P < 0.05). CONCLUSIONS: ACAF could achieve in situ decompression in terms of spinal cord rotation, deviation angle, and spinal cord shift with better clinical outcomes and relatively lower incidence of C5 palsy compared with single open-door laminoplasty.


Assuntos
Laminoplastia/métodos , Imagem por Ressonância Magnética/métodos , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Medula Espinal/patologia , Fusão Vertebral/métodos , Adulto , Idoso , Antropometria , Vértebras Cervicais , Descompressão Cirúrgica/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/etiologia , Síndromes de Compressão Nervosa/reabilitação , Neuroimagem , Ossificação do Ligamento Longitudinal Posterior/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/reabilitação , Período Pós-Operatório , Medula Espinal/diagnóstico por imagem , Raízes Nervosas Espinhais/diagnóstico por imagem , Raízes Nervosas Espinhais/fisiopatologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
15.
Neurol Sci ; 40(7): 1371-1375, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30903414

RESUMO

INTRODUCTION: Leprosy is nowaday increasingly encountered in non-endemic countries. Nerve involvement is common. Swelling of the nerves may lead to entrapment neuropathy causing pain and neurological deficits. Delay in diagnosis and treatment may lead to loss of chance of improvement. Surgical decompression in conjunction with medical therapy allows relief of symptoms. METHODS: We present a retrospective series of 21 patients surgically treated in our center for leprosy entrapment neuropathy. We report presentation, treatment, and outcome at follow-up including a brief literature review. RESULTS: Twenty-one patients were treated for nerve entrapments in four different anatomical districts. We reported good clinical outcomes mainly in motor deficits but also in improvement of sensitive deficits and pain symptoms. We did not experience surgical complications. DISCUSSION: Although there is a lack of high-quality prospective studies comparing medical and surgical treatment of leprosy neuropathy, benefits of surgery are widely reported in series and case reports from endemic countries. There is scant literature from low-incidence countries even if leprosy incidence is nowaday increasing in these countries and will likelihood further increase in the future. Our results are in line with the literature presenting good outcomes after surgery. CONCLUSION: We believe that a precise knowledge of the pathology and its management is crucial also for physicians who work in low-incidence countries to maximize healing chances with timely diagnosis and treatment.


Assuntos
Hanseníase/complicações , Hanseníase/cirurgia , Síndromes de Compressão Nervosa/etiologia , Síndromes de Compressão Nervosa/cirurgia , Descompressão Cirúrgica , Feminino , Seguimentos , Humanos , Incidência , Itália/epidemiologia , Hanseníase/tratamento farmacológico , Hanseníase/epidemiologia , Masculino , Síndromes de Compressão Nervosa/tratamento farmacológico , Síndromes de Compressão Nervosa/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento
16.
World Neurosurg ; 126: 79-82, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30831302

RESUMO

BACKGROUND: There have been a few previous reports of trigeminal neuralgia caused by bony structures. We report a rare case of trigeminal neuralgia caused by petrous bone deformity. CASE DESCRIPTION: A-43-year-old man with facial pain in the left maxillary and mandibular divisions of the trigeminal nerve was referred to our hospital. Computed tomography showed bone hyperplasia protruding into the left cerebellopontine cistern, compressing the left trigeminal nerve. Administration of carbamazepine ameliorated facial pain, but the effect was unsatisfactory, and microvascular decompression was performed through the anterior transpetrosal approach. The protruding petrous bone was drilled out to release compression of the trigeminal nerve, thus straightening the deviated trajectory of the nerve. The superior cerebellar artery adjacent to the thickened petrosal bone seemed to have compressed the trigeminal nerve and was also transposed. The facial pain disappeared completely after microvascular decompression surgery. CONCLUSIONS: The anterior transpetrosal approach is an appropriate and essential strategy for trigeminal neuralgia caused by petrous bone deformity of the petrous apex.


Assuntos
Osso Petroso/anormalidades , Neuralgia do Trigêmeo/etiologia , Adulto , Dor Facial/etiologia , Humanos , Masculino , Cirurgia de Descompressão Microvascular/métodos , Síndromes de Compressão Nervosa/etiologia , Osso Petroso/diagnóstico por imagem , Osso Petroso/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Neuralgia do Trigêmeo/diagnóstico por imagem , Neuralgia do Trigêmeo/cirurgia
17.
Ann Vasc Surg ; 57: 275.e9-275.e12, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30711499

RESUMO

We present the case of an 89-year-old man with 3-month history of hoarseness and no other significant clinical manifestations. Flexible laryngoscopy revealed a paralyzed left vocal cord, and contrast-enhanced computed tomography showed a thoracic dissecting aortic aneurysm of the distal aortic arch and proximal descending aorta. The aortic aneurysm was repaired through implantation of an endovascular stent graft, and the patient was discharged uneventfully after a week. The false lumen was completely thrombosed, and the patient had a partial resolution of hoarseness at the 1-year follow-up.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Rouquidão/etiologia , Síndromes de Compressão Nervosa/etiologia , Nervo Laríngeo Recorrente/fisiopatologia , Prega Vocal/inervação , Idoso de 80 Anos ou mais , Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aortografia/métodos , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/instrumentação , Rouquidão/fisiopatologia , Humanos , Laringoscopia , Masculino , Síndromes de Compressão Nervosa/diagnóstico , Síndromes de Compressão Nervosa/fisiopatologia , Desenho de Prótese , Recuperação de Função Fisiológica , Stents , Síndrome , Resultado do Tratamento , Voz
18.
Medicine (Baltimore) ; 98(3): e14162, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30653159

RESUMO

In this study, we try to explore the effect of orbital decompression treatment on severe dysthyroid optic neuropathy.We retrospectively collected demographic and clinical characteristics of thyroid eye disease patients who performed orbital decompression. Then we analyzed the change of best-corrected visual acuity and exophthalmometry after surgery and the correlations among clinical parameters.A total of 22 cases (30 eyes) were included in the study. After orbital decompression, visual acuities improved in 16 eyes, declined in 8 eyes, and had no change in 5 eyes. Best-corrected visual acuity was significantly improved (0.1 vs 0.4, P = .039) and exophthalmometry was significantly declined (22.0 mm vs 16.5 mm, P = .001) after orbital decompression. Better postoperative best-corrected visual acuity was significantly correlated with better preoperative best-corrected visual acuity (r = 0.718, P < .05), and with normal optic disc (r = 0.568, P < .05), but not with age, exophthalmometry, keratopathy, and clinical activity score.These results showed that orbital decompression is a useful approach to manage dysthyroid optic neuropathy. The optimal time for surgery should be chosen based on clinical parameters, such as visual acuity and degree of crowding of orbital apex.


Assuntos
Descompressão Cirúrgica/métodos , Oftalmopatia de Graves/complicações , Síndromes de Compressão Nervosa/cirurgia , Doenças do Nervo Óptico/cirurgia , Órbita/cirurgia , Adulto , Feminino , Oftalmopatia de Graves/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/etiologia , Doenças do Nervo Óptico/etiologia , Estudos Retrospectivos , Resultado do Tratamento , Acuidade Visual
19.
JAMA Netw Open ; 2(1): e187053, 2019 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-30657531

RESUMO

Importance: Complications affect treatment outcomes and quality of life in addition to increasing treatment costs. Objectives: To evaluate complication rates after the treatment of a distal radius fracture, to determine whether the rate or complication type is associated with treatment method, and to determine predictors of complications. Design, Setting, and Participants: The multicenter Wrist and Radius Injury Surgical Trial (WRIST), a randomized clinical trial, enrolled participants from April 10, 2012, to December 31, 2016. The study included 304 adults 60 years or older with isolated unstable distal radius fractures; 187 were randomized and 117 opted for casting. The study was conducted at 24 health systems in the United States, Canada, and Singapore. Data for this secondary analysis were collected from April 24, 2012, to February 28, 2018. Interventions: Participants opting for surgery were randomized to receive the volar locking plate system (n = 65), percutaneous pinning (n = 58), or bridging external fixation with or without supplemental pinning (n = 64). Patients who chose not to have surgery (n = 117) were not randomized and were enrolled for casting. Main Outcomes and Measures: Complication rate. Results: The WRIST enrolled a total of 304 participants, of whom 8 casting group participants were later found to be ineligible and were excluded from the analysis, leaving 296 participants. Randomized participants' mean (SD) age was 68 (7.2) years, 163 (87%) were female, and 165 (88%) were white. Casting participants' mean (SD) age was 75.6 (9.6) years, 93 (84%) were female, and 85 (85%) were white. The most common type of complications varied by treatment. Twelve of 65 participants (18.5%) in the internal fixation group reported a median nerve compression, while 16 of 26 participants (25.8%) who received external fixation and 13 of 56 participants (23.2%) who received pinning sustained pin site infections. Compared with the internal fixation group, complication rate for any severity complication was higher in participants who initially received casting (adjusted rate ratio, 1.88; 95% CI, 1.22-2.88), whereas the rate for moderate complications was higher in the external fixation group (adjusted rate ratio, 2.52; 95% CI, 1.25-5.09). Conclusions and Relevance: The distal radius fracture treatment decision-making process for older patients should incorporate a complication profile for each treatment type. For example, external fixation and pinning could be used for patients after apprising them of pin site infection risk. Internal fixation can be done in patients with high functional demands who are willing to receive surgery. Internal fixation use should be substantiated owing to the time and cost involved. Trial Registration: ClinicalTrials.gov Identifier: NCT01589692.


Assuntos
Fraturas do Rádio/complicações , Fraturas do Rádio/terapia , Idoso , Pinos Ortopédicos , Placas Ósseas , Moldes Cirúrgicos/efeitos adversos , Feminino , Seguimentos , Fixação de Fratura/efeitos adversos , Fixação de Fratura/métodos , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/métodos , Humanos , Masculino , Neuropatia Mediana/etiologia , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/etiologia , Complicações Pós-Operatórias , Qualidade de Vida , Infecção da Ferida Cirúrgica
20.
J Foot Ankle Surg ; 58(2): 377-380, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30612871

RESUMO

Soft tissue ganglion cysts are a well-known cause of tibial nerve compression in the tarsal tunnel. We describe a patient who presented with tibial nerve symptoms and was found to have an adventitial cyst of the tibial vein arising from the subtalar joint, with the joint connection confirmed both on imaging and at surgery. Surgical decompression of the cyst with transection of the vascular pedicle arising from the subtalar joint improved her symptoms at 6 months, and postoperative magnetic resonance imaging showed resolution of the cyst. Cystic adventitial disease is a rare, poorly understood condition in which a cyst is identified in the adventitia of a vessel, usually an artery. Only 3 cases of adventitial cysts have been reported in the foot and ankle region, 2 in the lesser and 1 in the greater saphenous vein. None of the previous cases have been recognized to be joint connected. This case provides additional evidence for an articular origin for adventitial cysts and helps guide management strategies for these joint-connected cysts.


Assuntos
Descompressão Cirúrgica/métodos , Cistos Glanglionares/cirurgia , Veia Safena/cirurgia , Articulação Talocalcânea/cirurgia , Adulto , Biópsia por Agulha , Progressão da Doença , Feminino , Cistos Glanglionares/diagnóstico por imagem , Cistos Glanglionares/patologia , Humanos , Imuno-Histoquímica , Imagem por Ressonância Magnética/métodos , Síndromes de Compressão Nervosa/diagnóstico , Síndromes de Compressão Nervosa/etiologia , Medição da Dor , Doenças Raras , Medição de Risco , Veia Safena/patologia , Articulação Talocalcânea/diagnóstico por imagem , Resultado do Tratamento
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