RESUMO
INTRODUCTION: Melanoma of the lower extremity with a positive sentinel lymph node biopsy (SLNB) mandates a groin dissection. This procedure has been associated with numerous complications; therefore we devised a modified approach. METHODS: All patients presenting with lower extremity melanomas that met criteria for SLNB had this procedure performed through an incision in the inguino-femoral region. In the event of a positive SLND, this same incision was used for the minimally invasive groin dissection (MIGD). A lighted retractor was used to improve visualization and a Ligasure (Valley-lab) was used to prevent seroma formation. RESULTS: Twenty patients met criteria for this investigation and five underwent MIGD. All patients tolerated the procedure well. There was no incidence of flap necrosis nor wound dehiscence. There was one case of seroma and cellulitis, one seroma, and one patient with lymphedema. All patients preferred the MIGD incision over traditional incisions. CONCLUSIONS: This new algorithm utilizing MIGD is well tolerated in patients. Complications appear to be minimal and patient satisfaction superior to traditional groin dissection.
Assuntos
Virilha/cirurgia , Excisão de Linfonodo , Melanoma/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Neoplasias Cutâneas/cirurgia , Feminino , Humanos , Metástase Linfática , Masculino , Melanoma/patologia , Projetos Piloto , Biópsia de Linfonodo Sentinela , Neoplasias Cutâneas/patologia , Resultado do TratamentoRESUMO
Tuberous sclerosis is a rare genetic disorder presenting clinically with multiple hamartomas in different organs including the skin. The cutaneous manifestations include facial angiofibromas, hypopigmented macules (ash leaves), connective tissue nevi (shagreen patches), and periungual fibromas (Koenen tumors). We present a case of facial angiofibromas in a mosaic pattern tuberous sclerosis in an 11-year-old boy.
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Angiofibroma/diagnóstico , Neoplasias Faciais/diagnóstico , Esclerose Tuberosa/diagnóstico , Angiofibroma/patologia , Criança , Neoplasias Faciais/patologia , Humanos , Masculino , Esclerose Tuberosa/patologiaRESUMO
Objective: MicroRNAs are short, noncoding RNA molecules that negatively regulate the stability and translational efficiency of target mRNAs. They are critical regulators of growth and development. Our aim was to identify microRNAs involved in the growth and regulation of infantile hemangiomas. In addition, we searched for the presence of Piwi-interacting RNAs in hemangioma tissue as another regulator of infantile hemangiomas. Methods: RNA was extracted from hemangioma specimens from 3 clinical, age-based categories: proliferative (N = 16), quiescent (N = 8), and involuting (N = 9). RNAs from human dermal microvascular endothelial cells were used as controls. MicroRNA microarray was performed, and the expression profiles of the hemangiomas and endothelial cells were compared using the t test. 5' End-labeling of RNA of our hemangioma specimens was performed for Piwi-interacting RNA detection. Results: Analysis confirmed statistically significant downregulated (N = 18) and upregulated (N = 15) microRNAs. Piwi-interacting RNA analysis did not detect Piwi-interacting RNA transcripts in the hemangioma specimens. Conclusions: The differential expression of microRNAs found in our hemangioma specimens provides insight into the regulation of hemangioma formation and proliferation, quiescence, and fibrofatty involution. Piwi-interacting RNA transcripts were not detected in the hemangioma specimens. These novel findings will help in establishing new therapeutic and diagnostic initiatives for these tumors.
RESUMO
A log splitter is a gasoline- or diesel-powered machine that uses a hydraulic-powered cutting wedge to do the work of an axe. Log-splitter injuries that do not result in amputation of digits or limbs are uncommon and not well described in the literature. We present a unique case of a patient who sustained a log-splitter injury that resulted in thrombosis of the radial artery and avulsion laceration of the ulnar artery leading to acute hand ischemia, in addition to scapholunate ligament disruption leading to a DISI deformity. In this case, thrombolytic therapy was contraindicated and surgical revascularization was the best possible treatment option. Our case illustrates the pitfalls of using this modality in a crush injury, since the use of thrombolytics in this instance would have resulted in severe hemorrhage. An important clinical caveat is the potentially misleading arteriographic diagnosis of thrombosis and/or spasm.
Assuntos
Traumatismo Múltiplo/diagnóstico , Traumatismo Múltiplo/cirurgia , Artéria Radial/cirurgia , Trombose/diagnóstico , Trombose/cirurgia , Artéria Ulnar/lesões , Artéria Ulnar/cirurgia , Acidentes de Trabalho , Adulto , Agricultura Florestal , Humanos , Masculino , Artéria Radial/lesões , Traumatismos do PunhoRESUMO
BACKGROUND: Microfracture is a frequently used technique for the repair of articular cartilage lesions of the knee. Despite the popularity of the technique, prospective information about the clinical results after microfracture is still limited. The purpose of our study was to identify the factors that affect the clinical outcome from this cartilage repair technique. METHODS: Forty-eight symptomatic patients with isolated full-thickness articular cartilage defects of the femur in a stable knee were treated with the microfracture technique. Prospective evaluation of patient outcome was performed for a minimum follow-up of twenty-four months with a combination of validated outcome scores, subjective clinical rating, and cartilage-sensitive magnetic resonance imaging. RESULTS: At the time of the latest follow-up, knee function was rated good to excellent for thirty-two patients (67%), fair for twelve patients (25%), and poor for four (8%). Significant increases in the activities of daily living scores, International Knee Documentation Committee scores, and the physical component score of the Short Form-36 were demonstrated after microfracture (p < 0.05). A lower body-mass index correlated with higher scores for the activities of daily living and SF-36 physical component, with the worst results for patients with a body-mass index of >30 kg/m(2). Significant improvement in the activities of daily living score was more frequent with a preoperative duration of symptoms of less than twelve months (p < 0.05). Magnetic resonance imaging in twenty-four knees demonstrated good repair-tissue fill in the defect in thirteen patients (54%), moderate fill in seven (29%), and poor fill in four patients (17%). The fill grade correlated with the knee function scores. All knees with good fill demonstrated improved knee function, whereas poor fill grade was associated with limited improvement and decreasing functional scores after twenty-four months. CONCLUSIONS: Microfracture repair of articular cartilage lesions in the knee results in significant functional improvement at a minimum follow-up of two years. The best short-term results are observed with good fill grade, low body-mass index, and a short duration of preoperative symptoms. A high body-mass index adversely affects short-term outcome, and a poor fill grade is associated with limited short-term durability.
Assuntos
Doenças das Cartilagens/cirurgia , Cartilagem Articular , Articulação do Joelho , Procedimentos Ortopédicos/métodos , Atividades Cotidianas , Adolescente , Adulto , Artroscopia , Índice de Massa Corporal , Doenças das Cartilagens/patologia , Doenças das Cartilagens/reabilitação , Feminino , Humanos , Modelos Lineares , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do TratamentoRESUMO
Cross-pin fixation of hamstring grafts for anterior cruciate ligament reconstruction was developed with hopes of improving on potential problems associated with interference screw and button fixation methods. However, cross-pins are a relatively new method of graft fixation and there are limited data on this technique. We report 2 cases in which reoperation was necessary after complications associated with cross-pin fixation. In one case, the cross-pin was left too proud and in the other it penetrated the medial side of the femur and was prominent. Surgeons who use cross-pin fixation should pay close attention so as not to leave the cross-pin proud laterally or medially to avoid the necessity of reoperation for hardware removal.
Assuntos
Ligamento Cruzado Anterior/cirurgia , Pinos Ortopédicos , Procedimentos de Cirurgia Plástica , Adulto , Desenho de Equipamento , Fixadores Externos , Feminino , Humanos , Articulação do Joelho/anatomia & histologia , Imageamento por Ressonância Magnética , Masculino , Dor Pós-Operatória/cirurgia , ReoperaçãoRESUMO
STUDY DESIGN: The study design consisted of a New Zealand white rabbit model of pseudarthrosis repair. Study groups consisting of no graft, autograft, or recombinant human bone morphogenetic protein-2 (rhBMP-2) with absorbable collagen sponge (ACS) or compression resistant matrix (CRM) were evaluated. OBJECTIVE: To evaluate the relative efficacy of bone graft materials (autograft, ACS, and CRM). SUMMARY OF BACKGROUND DATA: rhBMP-2 has been shown to have a 100% fusion rate in a primary rabbit fusion model, even in the presence of nicotine, which is known to inhibit fusion. METHODS: Seventy-two New Zealand white rabbits underwent posterolateral lumbar fusion with iliac crest autograft. To establish pseudarthroses, nicotine was administered to all animals. At 5 weeks, the spines were explored and all pseudarthroses were redecorticated and implanted with no graft, autograft, rhBMP-2/ACS, or rhBMP-2/CRM. At 10 weeks, fusions were assessed by manual palpation and histology. RESULTS: Eight rabbits (11%) were lost to complications. At 5 weeks, 66 (97%) had pseudarthroses. At 10 weeks, attempted pseudarthrosis repairs were fused in 1 of 16 of no graft rabbits (6%), 5 of 17 autograft rabbits (29%), and 31 of 31 rhBMP-2 rabbits (with ACS or CRM) (100%). Histologic analysis demonstrated more mature bone formation in the rhBMP-2 groups. CONCLUSIONS: The 2 rhBMP-2 formulations led to significantly higher fusion rates and histologic bone formation than no graft and autograft controls in this pseudarthrosis repair model.
Assuntos
Proteínas Morfogenéticas Ósseas/farmacologia , Vértebras Lombares/efeitos dos fármacos , Osseointegração/efeitos dos fármacos , Pseudoartrose/tratamento farmacológico , Proteínas Recombinantes/farmacologia , Fusão Vertebral/efeitos adversos , Fator de Crescimento Transformador beta/farmacologia , Animais , Proteína Morfogenética Óssea 2 , Proteínas Morfogenéticas Ósseas/química , Proteínas Morfogenéticas Ósseas/uso terapêutico , Substitutos Ósseos/química , Transplante Ósseo/efeitos adversos , Química Farmacêutica , Modelos Animais de Doenças , Portadores de Fármacos , Feminino , Humanos , Ílio/transplante , Vértebras Lombares/patologia , Vértebras Lombares/fisiopatologia , Vértebras Lombares/cirurgia , Nicotina , Pseudoartrose/induzido quimicamente , Pseudoartrose/fisiopatologia , Pseudoartrose/cirurgia , Coelhos , Proteínas Recombinantes/química , Proteínas Recombinantes/uso terapêutico , Fatores de Tempo , Tomografia Computadorizada por Raios X , Fator de Crescimento Transformador beta/química , Fator de Crescimento Transformador beta/uso terapêutico , Transplante AutólogoRESUMO
STUDY DESIGN: Case report of multifocal necrotizing fasciitis with lumbar involvement. OBJECTIVES: To raise awareness of an unusual, but potential, focus of a multifocal necrotizing infection in a diabetic patient. SUMMARY OF BACKGROUND DATA: Necrotizing fasciitis is a rapidly spreading infection of the soft tissue and fascia. These infections can be polymicrobial, are challenging to treat, and often have grave consequences. The spine may rarely be involved in such infections. METHODS: We describe a patient with long-standing diabetic foot ulcers, which evolved to a necrotizing infection. This infection spread hematogenously to several noncontiguous locations, including the lumbar spine, and was heralded by gas production at the sites of involvement. The spine was treated aggressively and infection eradicated at this site. RESULTS: Despite eradicating the spinal component of this infection, other sites were challenging to clear, and the patient went on to die of multisystem organ failure. CONCLUSIONS: Necrotizing infections rarely involve the spine. Heightened awareness of this potential focus of infection may facilitate its detection. As with other sites, aggressive surgical debridement of this potentially fatal condition is imperative.
Assuntos
Fasciite Necrosante/diagnóstico , Vértebras Lombares/patologia , Infecções dos Tecidos Moles/diagnóstico , Doenças da Medula Espinal/diagnóstico , Idoso , Angiopatias Diabéticas/diagnóstico , Angiopatias Diabéticas/terapia , Fasciite Necrosante/terapia , Evolução Fatal , Feminino , Humanos , Vértebras Lombares/microbiologia , Necrose , Infecções dos Tecidos Moles/terapia , Doenças da Medula Espinal/terapiaRESUMO
BACKGROUND: Microfracture is a frequently used technique for the repair of articular cartilage lesions of the knee. Despite the popularity of the technique, prospective information about the clinical results after microfracture is still limited. The purpose of our study was to identify the factors that affect the clinical outcome from this cartilage repair technique. METHODS: Forty-eight symptomatic patients with isolated full-thickness articular cartilage defects of the femur in a stable knee were treated with the microfracture technique. Prospective evaluation of patient outcome was performed for a minimum follow-up of twenty-four months with a combination of validated outcome scores, subjective clinical rating, and cartilage-sensitive magnetic resonance imaging. RESULTS: At the time of the latest follow-up, knee function was rated good to excellent for thirty-two patients (67%), fair for twelve patients (25%), and poor for four (8%). Significant increases in the activities of daily living scores, International Knee Documentation Committee scores, and the physical component score of the Short Form-36 were demonstrated after microfracture (p < 0.05). A lower body-mass index correlated with higher scores for the activities of daily living and SF-36 physical component, with the worst results for patients with a body-mass index of >30 kg/m(2). Significant improvement in the activities of daily living score was more frequent with a preoperative duration of symptoms of less than twelve months (p < 0.05). Magnetic resonance imaging in twenty-four knees demonstrated good repair-tissue fill in the defect in thirteen patients (54%), moderate fill in seven (29%), and poor fill in four patients (17%). The fill grade correlated with the knee function scores. All knees with good fill demonstrated improved knee function, whereas poor fill grade was associated with limited improvement and decreasing functional scores after twenty-four months. CONCLUSIONS: Microfracture repair of articular cartilage lesions in the knee results in significant functional improvement at a minimum follow-up of two years. The best short-term results are observed with good fill grade, low body-mass index, and a short duration of preoperative symptoms. A high body-mass index adversely affects short-term outcome, and a poor fill grade is associated with limited short-term durability.