RESUMEN
La sinovitis villonodular pigmentada es un tumor benigno del tejido sinovial de muy baja incidencia. El compromiso de tobillo es aún menos frecuente. Se requiere diagnóstico y manejo precoz para evitar secuelas funcionales y mecánicas irreversibles. Se manifiesta inicialmente con aumento de volumen de partes blandas, edema o derrame articular y puede evolucionar con dolor progresivo y daño articular avanzado. Existe una forma focal y una difusa, siendo esta última la de peor pronóstico. El examen diagnóstico de elección es la resonancia magnética, confirmándose por biopsia en la que se observa tejido sinovial inflamatorio con depósitos de hemosiderina. El tratamiento es quirúrgico y consiste en sinovectomía abierta o artroscópica. La recurrencia es de hasta un 40%, por lo que están descritas terapias coadyuvantes biológicas y radioterapia. Este artículo expone el caso de un hombre de 30 años que consulta por dolor y claudicación del tobillo izquierdo, encontrándose en el estudio imagenológico (resonancia magnética) hallazgos compatibles con sinovitis villonodular pigmentada difusa del tobillo, con extensión a la articulación subtalar, por lo que se realiza artroscopía para tratamiento y biopsia. En este reporte de caso se ilustran los resultados con este paciente y una revisión bibliográfica del tema.
Pigmented villonodular synovitis is a benign tumor of synovial tissue with a very low incidence. Ankle location is even less frequent. Early diagnosis and management are required to avoid irreversible functional and mechanical sequelae. The clinical presentation starts with edema or joint effusion and may progress with pain and advanced joint degenerative changes. Pigmented villonodular synovitis can be focal or diffuse, the latter being the type with the worst prognosis. When suspected, magnetic resonance imaging is performed, and the diagnosis confirmed with a biopsy in which synovial inflammatory tissue with hemosiderin deposits is observed. An open or arthroscopic synovectomy is preferred over surgical management. Recurrence is up to 40%, which is why biological coadjutant therapies and radiotherapy are described. This article presents the case of a 30-year-old man who presented with pain and claudication of the left ankle; the imaging study findings were compatible with diffuse pigmented villonodular synovitis of the ankle with extension to the subtalar joint, leading to arthroscopy for treatment and biopsy. This case report illustrates the results with this patient and a literature review of the subject.
Asunto(s)
Humanos , Masculino , Adulto , Artroscopía/métodos , Sinovitis Pigmentada Vellonodular/cirugía , Articulación del Tobillo/cirugía , Dolor/etiología , Sinovitis Pigmentada Vellonodular/diagnóstico , Biopsia , Imagen por Resonancia Magnética , Sinovectomía/métodos , Articulación del Tobillo/patologíaRESUMEN
The aim of this study was to determine whether the degree of purity achieved in conventional vaccines against the foot and mouth disease virus in Argentina interferes with the interpretation of seroepidemiological surveys for confirming the absence of viral activity, which are performed to support the recognition of free zones practising vaccination. The evaluation of 168 vaccine series due to be marketed in Argentina (2006-2012) and subjected to official control testing in cattle, as well as repeated vaccination of cattle and other species using vaccines with high antigen concentrations, demonstrated that they did not induce antibodies to non-structural proteins (NSPs). The results show clearly that vaccines with satisfactory potency do not induce a response to NSPs, even by forcing the immune response through more concentrated doses with multiple valences and revaccination protocols at shorter irtervals than in vaccination campaigns. These results confirm that the vaccines used in routine vaccination programmes have a degree of antigen purification consistent with the needs observed on the basis of sampling for serological surveillance. Moreover, serological surveys conducted in 2006-2011 by Argentina's official Veterinary Services--the National Health and Agrifood Quality Service (SENASA)--on more than 23,000 sera per year from cattle included in the vaccination programme, in order to confirm the absence of virus circulation, revealed an average 0.05% of reactive results, consistent with the specificity of the tests. In conclusion, the vaccines produced by conventional methods and with proven potencythat are available in Argentina are sufficiently purified to ensure thatthey do not interfere with the interpretation of sampling for serological surveillance performed to support the recognition of FMD-free zones practising vaccination.