RESUMO
The median nerve entrapment after elbow-dislocation is rare. We report two cases of fracture dislocation elbow completed by entrapment of median nerve occurred after reduction in two children. For both cases, the diagnosis of entrapment was made some months later after injury. Median nerve graft was performed after nerve resection. The nerve recovery was satisfactory at the final follow-up. This nerve complication should be suspected systematically before and after reduction of all dislocation of the elbow in the children. The indication of nerve release or nerve graft depends on the entrapment and the delay of the palsy.
Assuntos
Lesões no Cotovelo , Fraturas Ósseas/complicações , Luxações Articulares/complicações , Neuropatia Mediana/etiologia , Síndromes de Compressão Nervosa/etiologia , Criança , Articulação do Cotovelo/cirurgia , Feminino , Fraturas Ósseas/terapia , Humanos , Luxações Articulares/terapia , Masculino , Neuropatia Mediana/diagnóstico , Neuropatia Mediana/cirurgia , Síndromes de Compressão Nervosa/diagnóstico , Síndromes de Compressão Nervosa/cirurgia , Nervo Sural/transplanteRESUMO
Chondromyxoid Fibroma is a rare benign osseous tumor especially in the hand, because the hand represents less than 3% of all osseous locations. It can causes problems of differential diagnosis with several types of tumors and in particular with chondrosarcoma, for which the management is totally different. We report a case of location of a chondromyxoid fibroma in a phalanx of the thumb, which caused problems of differential diagnosis with chondroma and chondrosarcoma. There were 2 recurrences after local excision. A wide resection with massive cancellous aotograft prevented further recurrence and the patient is disease free with a follow up of 7.5 years.
Assuntos
Neoplasias Ósseas/patologia , Condroblastoma/patologia , Fibroma/patologia , Polegar/patologia , Neoplasias Ósseas/cirurgia , Criança , Condroblastoma/cirurgia , Fibroma/cirurgia , Humanos , Masculino , Polegar/cirurgiaAssuntos
Doença de Hodgkin/diagnóstico , Neoplasias Pulmonares/diagnóstico , Tosse/diagnóstico , Tosse/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Doença de Hodgkin/diagnóstico por imagem , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Radiografia Torácica , Adulto JovemRESUMO
INTRODUCTION: A chylothorax can occur following any intrathoracic procedure. It is generally straightforward to make the diagnosis but optimal management can be problematic. METHODS: Between 1995 and 2002, three women and one man aged from 13 to 58 years were treated for chylothorax after thoracic surgery. Their initial illnesses were a right pulmonary hydatid cyst associated with hepatic disease, a tumour of the posterior mediastinum, an oesophageal carcinoma and metastases in the left lung. RESULTS: These patients had: a pulmonary and hepatic cystectomies, a resection of the mediastinal tumor, an Akyama oesophagectomy and a resection of four left pulmonary metastases. Chylothorax became apparent post operatively between the 1st and the 4th day. All patients were treated with a medium-chain triglyceride diet. Two patients were re-explored with ligation of lymphatic vessels. One woman who did not have further surgery was treated with etilefrine. In the patient who had had an oesophagectomy, chylothorax persisted after re-operation. He was successfully treated by talc pleurodesis via a chest drain, which prevented further recurrence. CONCLUSIONS: In the management of postoperative chylothorax, medical treatment must be started early but surgery should not be delayed as operative risk is increased by the development of malnutrition and immune deficiency.
Assuntos
Agonistas Adrenérgicos/uso terapêutico , Administração de Caso , Quilotórax/terapia , Gorduras na Dieta/administração & dosagem , Drenagem , Etilefrina/uso terapêutico , Complicações Pós-Operatórias/terapia , Ducto Torácico/cirurgia , Procedimentos Cirúrgicos Torácicos , Triglicerídeos/administração & dosagem , Adolescente , Adulto , Carcinoma de Células Escamosas/secundário , Carcinoma de Células Escamosas/cirurgia , Quilotórax/dietoterapia , Quilotórax/tratamento farmacológico , Quilotórax/cirurgia , Terapia Combinada , Proteínas Alimentares/administração & dosagem , Equinococose Hepática/cirurgia , Equinococose Pulmonar/cirurgia , Ingestão de Energia , Neoplasias Esofágicas/cirurgia , Esofagectomia , Feminino , Ganglioneuroma/cirurgia , Hepatectomia , Humanos , Ligadura , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/cirurgia , Masculino , Neoplasias do Mediastino/cirurgia , Pessoa de Meia-Idade , Pneumonectomia , Complicações Pós-Operatórias/dietoterapia , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/cirurgia , Reoperação , Cirurgia Torácica VídeoassistidaRESUMO
The authors report their experience of digital lengthening and analyze the indications and results of 12 cases performed over 13 years in the plastic and reconstructive surgery service of the Kassab institute. Distraction was performed using a mini-orthofix device. In majority of cases, the procedure was performed on young people, manual workers and victims of industrial accidents. The lengthened osseous segment was the 1st metacarpal in 7 cases, the proximal phalanx of the index in 3 cases, the 3rd metacarpal once and the proximal phalanx of the middle finger in one case. Gradual distraction at the rate of 0.25 to 0.5 mm/day was carried out in 10 cases using the procedure of "callotasis". In 2 cases the distraction was performed at a rate of 1 mm/day followed by bone graft. Callotasis allowed us to obtain an average lengthening of 17 mm (61.5%) in distraction of the phalanx, and 26 mm (63.3%) in distraction of the first metacarpal. This technique avoids the spontaneous shortening observed after the use of bone graft alone. Complications are relatively frequent but had little influence on the final result.
Assuntos
Dedos/patologia , Traumatismos da Mão/terapia , Osteogênese por Distração/métodos , Adolescente , Adulto , Transplante Ósseo , Feminino , Traumatismos da Mão/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
The authors report 5 cases of chondrosarcoma of the hand brought together over a period of 20 years. The series comprises 3 men and 2 woman of average age 42 years. In two cases the tumour arose from degeneration in a preexisting lesion of Ollier's disease. Diagnosis was made on clinical and radiological criteria. Confirmation of the diagnosis by histological examination proved to be difficult in 2 cases. The treatment was surgical, with ray amputation in 3 cases and curettage with bone graft in the other 2. None of the patients had a recurrence at 4.5 years mean follow-up.
Assuntos
Neoplasias Ósseas/cirurgia , Condrossarcoma/cirurgia , Adolescente , Adulto , Idoso , Amputação Cirúrgica , Neoplasias Ósseas/diagnóstico por imagem , Transplante Ósseo , Condrossarcoma/diagnóstico por imagem , Curetagem , Diagnóstico Diferencial , Encondromatose/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , RadiografiaRESUMO
UNLABELLED: Pulmonary sclerosing hemangioma is a rare, slow-growing, benign tumor. Its potential for progression and its histiogenesis remains controversial. CASE REPORT: A routine chest X-ray revealed a right abdominal mass in 41-year-old woman. Search for a cause was negative. The patient underwent posterolateral thoracotomy for tumorectomy. Intraoperative pathology analysis revealed the benign nature of the tumor. No complication was observed postoperatively. The final pathological conclusion was sclerosing hemangioma of the lung. Pulmonary sclerosing hemangioma is a parenchymal tumor of the lung. The latest immunohistochemical studies of this lesion suggest a pneumocyte origin. Prognosis is good, but extension to lymph nodes may occur. Surgery is always required for cure, and must be associated with lymph node dissection for large tumors.
Assuntos
Hemangioma Esclerosante Pulmonar/cirurgia , Fumar/efeitos adversos , Adulto , Feminino , Humanos , Prognóstico , Hemangioma Esclerosante Pulmonar/patologia , Radiografia Torácica , ToracotomiaRESUMO
BACKGROUND: Osteoid osteoma (OO) is a slowly progressing benign osteoblastic tumour. In the hand, this tumour is rare. We propose a review of seventeen cases of OO of the phalanx and metacarpal bone. PATIENTS AND METHODS: During the period, between 1998 and 2011, a total of seventeen OO in the hand were confirmed by the pathological examination. They were 10 women and 7 men with an average age of 29 years (age range 17-76). The most common site of the tumour was the proximal phalanx in ten cases, followed by middle phalanx in four cases and metacarpal bone in three cases. The diagnosis of OO was highly required by clinical history. Standard radiographs showed variable images, but computed tomography, and it was useful to facilitate diagnosis and pre-operative planning. All patients underwent surgery (the tumour resection and autogenous bone grafting). In post-operative, there was an immediate pain relief with complete resolution of all symptoms. No recurrence was observed during the last follow-up period of 4 years and 2 months. CONCLUSION: The diagnosis of OO of the hand can be difficult, and it should be considered with bony pain or bony swelling, especially when the history is a chronic one. The CT scan allows visualisation and precise localisation of such benign tumour of the hand. The care should be taken to make the excision complete in order to avoid recurrence.
Assuntos
Neoplasias Ósseas/diagnóstico , Neoplasias Ósseas/cirurgia , Falanges dos Dedos da Mão , Ossos Metacarpais , Osteoma Osteoide/diagnóstico , Osteoma Osteoide/cirurgia , Adolescente , Adulto , Idoso , Feminino , Falanges dos Dedos da Mão/cirurgia , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Masculino , Ossos Metacarpais/patologia , Ossos Metacarpais/cirurgia , Pessoa de Meia-Idade , Procedimentos Ortopédicos/métodos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
From 1985 to 1997, 74 patients was operated of scaphoid non union at the Kassab Institute by a percutaneous pinning as described by Galluccio. The average age is 30 years with an extreme from 17 to 48 years. Union was obtained after an average of two years and six months. In 12 cases the delay was superior than three years. Functionally, pain is a constant cause of consultations and the majority of patients presented a reduction of the mobility sector (80%) and the strength of grasp (70%). Anatomically, it is particularly a pseudarthrosis stage II a of Alnot, and type I b of our classification. An immobilisation post-operative during one month is the rule. The analysis of results at an average of four years, revealed 91% of clinical recovery. Radiographically, the union is obtained in 89% of cases. Our fails (11%), are explained by an inadequate mounting and particularly by the length of pseudarthrosis. Compared to other means of synthesis, the percutaneous pinning of Galluccio, is an inexpensive technique, easily and rapid, which permit to obtain an interesting results particularly in the recent pseudarthrosis (evolution delay below three years).
Assuntos
Pinos Ortopédicos , Ossos do Carpo/cirurgia , Pseudoartrose/cirurgia , Adolescente , Adulto , Artralgia/fisiopatologia , Ossos do Carpo/lesões , Moldes Cirúrgicos , Feminino , Seguimentos , Fixação Interna de Fraturas/métodos , Consolidação da Fratura , Força da Mão/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pseudoartrose/classificação , Pseudoartrose/fisiopatologia , Amplitude de Movimento Articular/fisiologia , Resultado do Tratamento , Articulação do Punho/fisiopatologiaRESUMO
INTRODUCTION: In this study, the authors have described an original technique for the two-stage treatment of trans-scaphoid perilunar dislocation. PATIENTS AND METHODS: In this study, the first step consisted of reducing the extent of the perilunar displacement, followed one month later by percutaneous pinning of the scaphoid as described by Galluccio. A series of 20 cases was treated in this manner, with positive results regarding scaphoid stabilization, joint mobility and the state of the median nerve. CONCLUSION: The advantage of this technique is that it avoids emergency stabilization of the scaphoid, a procedure which may be complicated by accompanying carpal injuries.
Assuntos
Pinos Ortopédicos , Luxações Articulares/cirurgia , Osso Semilunar , Manipulação Ortopédica/métodos , Articulação do Punho , Adulto , Fenômenos Biomecânicos , Seguimentos , Força da Mão , Humanos , Luxações Articulares/classificação , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/etiologia , Luxações Articulares/fisiopatologia , Masculino , Manipulação Ortopédica/instrumentação , Radiografia , Amplitude de Movimento Articular , Resultado do TratamentoRESUMO
We have analysed 283 patient studies operated of ambulatory during the last two years. These patients represent only 12% of the patient group. It's especially a matter of patients operated urgently. The local anaesthesia in the regional local was practised in terms of 90% of cases. The complications where exceptional. We wanted to insist on the necessary guidelines and pitfalls to forget during the practice of that surgery and we wanted to focus on its advantages.
Assuntos
Procedimentos Cirúrgicos Ambulatórios/estatística & dados numéricos , Cirurgia Plástica/organização & administração , Procedimentos Cirúrgicos Ambulatórios/economia , Procedimentos Cirúrgicos Ambulatórios/métodos , Anestesia/economia , Anestesia/métodos , Anestesia/estatística & dados numéricos , Custos Hospitalares/estatística & dados numéricos , Humanos , Guias de Prática Clínica como Assunto , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , TunísiaRESUMO
The strange body at the hand level is frequent consultation pattern. Its extraction seems easy, however it's not. The authors reported one observation of the hand which is penetrated by a ig strange body. It's ablation is performed in a surgical room under anaesthesia, respecting the tension lines at the hand level and avoiding the nerves ramification of the cubital nerve that was hung by the harpoon.
Assuntos
Corpos Estranhos/cirurgia , Mãos , Idoso , Dissecação/métodos , Corpos Estranhos/etiologia , Mãos/inervação , Humanos , Masculino , Encaminhamento e Consulta/estatística & dados numéricosRESUMO
UNLABELLED: Immediate postoperative arrhythmias after pneumonectomy for non small cell lung cancer is a serious complication. Frequency is estimated 10 to 28% of all patients. The goal of this study is to evaluate the incidence of this complication in our experience, preoperative risk factors, therapeutic implications and short outcome. 132 consecutive patients underwent pneumonectomy for lung cancer. We retrospectively studied this series of which 29 patients developed arrhythmias postoperatively. Mean age was 58 years (48 to 79), 16 patients were older than 65 years. Seven patients had medical history of either myocardial infarction or hypertension. Arrhythmias appeared post-operatively on days 1 and 2 six times, days 3 ans 4 ten times, days 5 to 6 six times and days 7 to 10 twice. The trouble consisted in atrial fibrillation in 18 patients, atrial associated with ventricular premature beats in 11 patients. Antiarrhythmic medication (amiodarone) was started as soon as the trouble was confirmed by EKG in all cases. Normalization was obtained in 27 patients (95%). One patient remained dysrrhythmic in spite of treatment. One death occurred on day 4 postoperatively. The mean hospitalisation stay was 10 days. CONCLUSION: Cardiac arrhythmia in the immediate postoperative course is not rare. Early diagnosis in patients at risk followed by adequat treatment is necessary to avoid haemodynamic storm in these quite fragile patients. Amiodarone is the treatment of choice.
Assuntos
Arritmias Cardíacas/etiologia , Neoplasias Pulmonares/cirurgia , Pneumonectomia/efeitos adversos , Complicações Pós-Operatórias , Idoso , Antiarrítmicos/uso terapêutico , Arritmias Cardíacas/tratamento farmacológico , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de RiscoRESUMO
Chest X-ray in a 46-year-old woman with a history of hysterectomy for a uterine mass revealed a nodular opacity measuring 3 cm. Computed tomography identified 3 other nodules. Histology examination of the lung lesions identified the same configuration as that of the hysterectomy specimen performed two years earlier: benign metastatic leiomyoma. Approximately 40 cases have been reported in the literature.
Assuntos
Leiomioma/diagnóstico por imagem , Neoplasias Pulmonares/secundário , Neoplasias Uterinas/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Humanos , Leiomioma/patologia , Pulmão/patologia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Neoplasias Uterinas/patologia , Útero/patologiaRESUMO
Thymolipoma is an uncommon benign tumor of the thymus. Asymptomatic, it is an incidental discovery. Pathogenesis remains controversial. We report a new case in a 36-year-old woman that was discovered on a chest x-ray ordered for pneumonia. The MRI findings suggested the diagnosis which was confirmed at the pathology examination of the surgical specimen.
Assuntos
Lipoma/patologia , Neoplasias do Timo/patologia , Adulto , Biópsia , Feminino , Humanos , Lipoma/diagnóstico por imagem , Lipoma/cirurgia , Prognóstico , Radiografia , Neoplasias do Timo/diagnóstico por imagem , Neoplasias do Timo/cirurgiaRESUMO
Ewing's sarcoma of the finger is extremely rare. Pain and swelling of the affected finger are the most frequent presenting features. We report two cases of Ewing's sarcoma located at ring finger and the thumb in two children aged 14 and 10 years. The first patient died of generalised metastases despite surgery, chemotherapy and radiation therapy. The second had no localised recurrence or metastases after surgery and chemotherapy at last follow-up of 4.5 years after tumour resection. The tumour's surgical accessibility, chemotherapy, and radiation therapy improve the prognosis of this tumour.
Assuntos
Amputação Cirúrgica/métodos , Antineoplásicos/uso terapêutico , Neoplasias Ósseas/terapia , Dedos/cirurgia , Sarcoma de Ewing/terapia , Adolescente , Neoplasias Ósseas/diagnóstico , Criança , Evolução Fatal , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Masculino , Recidiva Local de Neoplasia , Radioterapia Adjuvante , Sarcoma de Ewing/diagnósticoRESUMO
The intraosseous capillary haemangioma is classified as a benign vascular bone tumor. It is extremely rare in the hand. We present the case of a carpometacarpal capillary haemangioma involving the capitate and the bases of third and fourth metacarpals. To our knowledge it is the first case reported at this site.
Assuntos
Neoplasias Ósseas/cirurgia , Capitato , Hemangioma Capilar/cirurgia , Ossos Metacarpais , Adulto , Neoplasias Ósseas/diagnóstico , Capitato/cirurgia , Seguimentos , Hemangioma Capilar/diagnóstico , Humanos , Masculino , Ossos Metacarpais/cirurgia , Doenças Raras , Resultado do TratamentoRESUMO
INTRODUCTION: Knee arthrodesis is one of the reconstruction options for limb preservation after malignant tumor resection. Vascularised rotatory fibular transfer allows biological and, thus,definitive reconstruction. The goal of this work was to analyse the results of knee arthrodesis with vascularised fibular graft after tumor resection and to discuss the reliability of this technique. PATIENTS AND METHODS: We report a retrospective series of 13 patients with an average age of 29.6 years. The pathological diagnosis was bone sarcoma in 12 cases and synovial chondrosarcoma in one case. Resection/arthrodesis was undertaken as the primary procedure in 11 cases.In two cases, arthrodesis was indicated after failure of an endoprosthesis. Reconstruction was achieved with a vascularised fibular rotatory transfer in all cases. For stabilisation, an external fixator was utilised in eight cases, a femorotibial nail in three cases, and a plate in two cases.Mean follow-up was 6 years. RESULTS: We encountered infection in 53% of cases, mechanical complications in 53% of cases,and nerve palsy in 23% of cases. Four patients died from metastases (only one had arthrodesis complete union). In the nine surviving patients, arthrodesis was fully united in seven cases,after an average period of 36 months. The functional score average (Enneking classification)was 20 points. DISCUSSION: Knee arthrodesis after tumor resection is a complex technique. Septic complications and mechanical failure are frequent regardless of the technique employed. They are related to the extent of bone sacrifice but also to that of soft tissues. The use of vascularised fibula alone and stabilisation by external fixation were the main shortcomings in this series. TYPE OF STUDY RETROSPECTIVE: Level IV.