RESUMEN
OBJECTIVE: There is controversy regarding the importance of psychological/psychiatric factors in the development of the Complex Regional Pain Syndrome (CRPS). Our objective was to determine whether CRPS type I patients were psychiatrically different from other chronic pain patients, with particular attention to personality pathology. DESIGN: A standardized clinical assessment of all major psychiatric categories, including personality disorders, was performed on 25 CRPS type I patients and a control group of 25 patients with chronic low back pain from disc-related radiculopathy. MEASURES: Both sections of the Structured Clinical Interview for the Diagnostic and Statistical Manual (3rd ed., rev.) and the visual analog scale. RESULTS: Both groups were similar in terms of pain intensity and duration. Statistical analysis showed both groups to have a significant amount of major psychiatric comorbidity, in particular major depressive disorder, and a high incidence of personality disorders. Therefore, intense chronic pain was associated with significant psychiatric comorbidity in both groups and in similar proportions. CONCLUSION: The high incidence of personality pathology in both groups may represent an exaggeration of maladaptive personality traits and coping styles as a result of a chronic, intense, state of pain.
Asunto(s)
Determinación de la Personalidad , Distrofia Simpática Refleja/psicología , Adulto , Trastorno Depresivo Mayor/etiología , Femenino , Humanos , Desplazamiento del Disco Intervertebral/complicaciones , Entrevista Psicológica , Dolor de la Región Lumbar/etiología , Dolor de la Región Lumbar/fisiopatología , Dolor de la Región Lumbar/psicología , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Enfermedades del Sistema Nervioso Periférico/complicaciones , Trastornos de la Personalidad/etiología , Distrofia Simpática Refleja/fisiopatología , Raíces Nerviosas Espinales/fisiopatologíaRESUMEN
The records of 15 patients with metastatic carcinoma to skeletal muscle treated between 1979 and the present were reviewed. Fourteen patients were referred with a diagnosis of soft tissue sarcoma and one with suspected infection. There was a previous diagnosis of carcinoma in eight patients but seven patients had no prior diagnosis of a known malignancy. Primary tumors were lung (eight), melanoma (two), gastrointestinal (one), kidney (one), and bladder (one). No primary tumor could be identified in two patients. Local control of metastatic lesions was achieved by radiotherapy in 11 patients as an initial measure. Two patients underwent wide excision and one declined treatment for local tumor control. Eight patients died within 12 months of presentation and survival analysis indicated a 25% overall survival at 60 months. Two patients remained free of disease at 132 months and 72 months. From this study and a review of 52 cases reported in the literature, the authors are unable to find any clinical or radiographic characteristics that distinguish metastatic carcinoma to muscle from soft tissue sarcomas. Surgical resection can be reserved for cases in which radiation does not provide local control.
Asunto(s)
Neoplasias de los Músculos/diagnóstico , Neoplasias de los Músculos/secundario , Músculo Esquelético , Adulto , Anciano , Biopsia , Terapia Combinada , Diagnóstico Diferencial , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Neoplasias de los Músculos/radioterapia , Neoplasias de los Músculos/cirugía , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Análisis de Supervivencia , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Infrequently, prior reports have described the use of the ipsilateral proximal fibula to replace an absent distal fibula caused by either trauma, infection, or resection for tumor. This is a 27-year follow-up of a 12-year-old patient who lost the distal 7.5 cm of her fibula secondary to trauma. The soft tissue defect was replaced early by an abdominal flap and the bone defect was eventually replaced with 7.5 cm of proximal fibula. The lateral ankle ligaments were reconstructed with the peroneus brevis, and the ankle joint has remained stable. Although traumatic arthrosis has progressed slowly, the patient at age 39 has a relatively painless, mobile ankle joint.
Asunto(s)
Articulación del Tobillo/cirugía , Trasplante Óseo/métodos , Peroné/cirugía , Adulto , Traumatismos del Tobillo/rehabilitación , Traumatismos del Tobillo/cirugía , Tirantes , Calcáneo/lesiones , Calcáneo/patología , Moldes Quirúrgicos , Niño , Progresión de la Enfermedad , Femenino , Peroné/lesiones , Estudios de Seguimiento , Marcha , Humanos , Artropatías/fisiopatología , Ligamentos Articulares/cirugía , Músculo Esquelético/trasplante , Osteotomía , Rango del Movimiento Articular , Colgajos Quirúrgicos/métodos , Astrágalo/lesiones , Astrágalo/patología , Tibia/lesiones , Tibia/patología , Tibia/cirugíaRESUMEN
Internal rotation of the shoulder is frequently measured by noting the maximal vertebral level reached by the patient's thumb, but it is not at all certain that this maneuver is strictly measuring internal rotation. We analyzed this maneuver with computed tomographic scans of the shoulder in differing positions. We also analyzed extension of the glenohumeral joint and scapulothoracic articulation with scapular lateral radiographs. Finally, we used posteroanterior radiographs to analyze elbow flexion at the limits of internal rotation behind the back. We found that maximal internal rotation behind the back occurs in approximately a 2 : 1 ratio between the glenohumeral joint and the scapulothoracic articulation. However, the scapulothoracic articulation was more significant in placing the arm behind the back, whereas the glenohumeral joint performed most of the internal rotation in front of the body. The scapulothoracic articulation assists in this motion by both extension and internal rotation of the scapula on the thorax. The limits of internal rotation behind the back are reached with a significant contribution from elbow flexion. We conclude that measuring shoulder internal rotation by the maximal vertebral level reached by the patient's thumb greatly oversimplifies the concept of internal rotation and that limitations in this motion may not be strictly due to a loss of internal rotation at the glenohumeral joint.