RESUMEN
Imaging with biomechanical analysis augments the clinical examination and improves outcomes by correlating imaging findings with the examination. Plain film radiographs are the gold standard to assess osseous alignment. The biomechanical examination provides information to formulate an accurate assessment. Weightbearing computed tomography scanning is a potentially valuable for functional information about joint biomechanics. True alignment of the lower extremity can be appreciated on weightbearing computed tomography scanning. Soft tissue structures can be assessed with diagnostic ultrasound examination. Acute and chronic injuries that compromise joint stability can be identified.
Asunto(s)
Deformidades del Pie/diagnóstico por imagen , Deformidades del Pie/fisiopatología , Humanos , Imagen por Resonancia Magnética , Radiografía , Rango del Movimiento Articular/fisiología , Ultrasonografía , Soporte de Peso/fisiologíaRESUMEN
Necrotizing fasciitis is a rare and potentially fatal infection, with mortality of up to 30%. This case report describes a patient recovering from a laryngectomy for laryngeal squamous cell cancer who developed nosocomial necrotizing fasciitis of the lower extremity due to Serratia marcescens . Only eight cases of necrotizing fasciitis exclusive to the lower extremity due to S marcescens have been previously reported. Patients with S marcescens necrotizing fasciitis of the lower extremity often have multiple comorbidities, are frequently immunosuppressed, and have a strikingly high mortality rate.
Asunto(s)
Infección Hospitalaria/diagnóstico , Fascitis Necrotizante/etiología , Infecciones por Serratia/complicaciones , Serratia marcescens/aislamiento & purificación , Infección Hospitalaria/microbiología , Diagnóstico Diferencial , Fascitis Necrotizante/diagnóstico , Humanos , Extremidad Inferior , Masculino , Persona de Mediana Edad , Infecciones por Serratia/diagnóstico , Infecciones por Serratia/microbiologíaRESUMEN
BACKGROUND: Persons with intellectual disabilities frequently have podiatric conditions. Limited information exists on their prevalence in international cohorts of Special Olympics (SO) athletes. Findings from multiple United States (US) venues are compared to those from athletes screened at the 2011 Special Olympics World Summer Games in Athens, Greece (ATHENS). METHODS: Data from Fit Feet screenings from 2096 ATHENS participants was compared to 7192 US participants. RESULTS: Frequently noted in the ATHENS population were motion restriction in both the ankle and the first metatarsal phalangeal joint (1st MTPJ), pes planus, metatarsus adductus, brachymetatarsia, hallux abducto valgus (HAV), onychomycosis, onychocryptosis, and tinea pedis. ATHENS differed from the US cohort as HAV and restricted ankle joint and 1st MTPJ joint motion was less frequent. Significantly more tinea pedis, xerosis, and hyperhidrosis were present in the ATHENS population. DISCUSSION/CONCLUSION: SO athletes have a higher prevalence of podiatric structural conditions compared to the general population, and some vary between ATHENS versus US. Less prevalent in ATHENS was HAV, and restricted motion in both the ankle and 1st MTPJ. This may reflect differences due to varied clinical observers. The higher rates of several dermatological conditions in ATHENS may reflect venue seasonal climate, or social factors.
Asunto(s)
Atletas/estadística & datos numéricos , Personas con Discapacidad/estadística & datos numéricos , Deformidades del Pie/epidemiología , Enfermedades del Pie/epidemiología , Internacionalidad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Estudios de Cohortes , Femenino , Deformidades del Pie/diagnóstico , Deformidades del Pie/fisiopatología , Enfermedades del Pie/diagnóstico , Enfermedades del Pie/fisiopatología , Articulaciones del Pie , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Rango del Movimiento Articular , Estados Unidos , Adulto JovenRESUMEN
AIM: To study the demographic and endoscopic characteristics of patients with sessile serrated adenoma (SSA) in a single center. METHODS: Patients with SSA were identified by review of the pathology database of Mayo Clinic Arizona from 2005 to 2007. A retrospective chart review was performed to extract data on demographics, polyp characteristics, presence of synchronous adenomatous polyps or cancer, polypectomy methods, and related complications. RESULTS: One hundred and seventy-one (2.9%) of all patients undergoing colonoscopy had a total of 226 SSAs. The mean (SE) size of the SSAs was 8.1 (0.4) mm; 42% of SSAs were < or = 5 mm, and 69% were < or = 9 mm. Fifty-one per cent of SSAs were located in the cecum or ascending colon. Approximately half of the patients had synchronous polyps of other histological types, including hyperplastic and adenomatous polyps. Synchronous adenocarcinoma was present in seven (4%) cases. Ninety-seven percent of polyps were removed by colonoscopy. CONCLUSION: Among patients with colon polyps, 2.9% were found to have SSAs. Most of the SSAs were located in the right side and were safely managed by colonoscopy.
Asunto(s)
Adenoma/patología , Neoplasias Colorrectales/patología , Pólipos/patología , Adenoma/epidemiología , Colonoscopía , Neoplasias Colorrectales/epidemiología , Bases de Datos Factuales , Endoscopía , Humanos , Pólipos/epidemiologíaRESUMEN
BACKGROUND: Safe and effective colonoscopy is aided by the use of endoscopic techniques and maneuvers (ETM) during the examination including patient repositioning, stiffening of the endoscope and abdominal pressure. AIM: To better understand the use and value of ETM during colonoscopy by using a device that allows real-time imaging of the colonoscope insertion shaft. METHODS: The use of ETM during colonoscopy and their success was recorded. Experienced colonoscopists and endoscopy assistants used a commercially available electromagnetic (EM) transmitter and a special adult variable stiffness instrument with 12 embedded sensors to examine 46 patients. In 5 of these a special EM probe passed through the instrument channel of a standard pediatric variable stiffness colonoscope was used instead of the EM colonoscope. RESULTS: Thirty-nine men and 7 women with a mean age of 64 years (range 33-90) were studied. The cecum was intubated in 93.5% (43/46). The mean time to reach the cecum was 10.6 minutes (range 3-25). ETM were used a total of 174 times in 41 of the patients to assist with cecal intubation. When ETM were required to reach the cecum, and the cecum was intubated, an average of 3.82 ETM/patient was used. While ETM were used most often when the tip of the colonoscope was in the left side of the colon (rectum 5.0%, sigmoid colon 20.7%, descending colon 5.0%, and splenic flexure 11.6%), when the instrument was in the transverse colon (14.8%), hepatic flexure (20.7%) and ascending colon (19.8%) the use of ETM was also required. When the colonoscope tip was in the transverse colon, hepatic flexure and ascending colon, ETM success rates were less (61.1%, 52.0%, and 41.7% respectively) compared to the left colon success rates (rectum 83.3%, sigmoid colon 84.0%, descending colon 100%, and splenic flexure 85.7%). CONCLUSION: The EM colonoscope allows imaging of the insertion shaft without fluoroscopy and is a useful device for evaluating the efficacy of ETM. ETM are important tools of the colonoscopist and are used most often in the left colon where they are most effective.