RESUMEN
Objetivo: Establecer la utilidad de la resonancia magnética (RM) en pacientes con reemplazo total de rodilla (RTR) dolorosa tras la aplicación de un protocolo optimizado y determinar en qué medida estos hallazgos modifican la conducta terapéutica. Materiales y métodos: Se analizaron con protocolo optimizado las RM de 15 pacientes con RTR dolorosa, realizadas entre marzo de 2013 y febrero de 2014. La evaluación fue hecha por un especialista en musculoesquelético y los hallazgos fueron registrados. Resultados: De nuestra población, el 74% eran mujeres y la media de edad fue de 74 +/ - 7 años. Se identificaron posibles causas de dolor en el 80% de los casos y se modificó la conducta médica en el 33%. Se encontró líquido articular en el 93% y signos de sinovitis en el 33%. Los tendones rotuliano, cuadricipital y poplíteo se vieron correctamente en el 77%, 92% y 69%, respectivamente; mientras que los ligamentos colaterales medial y lateral fueron visibles en el 46% y 54%, respectivamente. Discusión: Si bien hay publicaciones con diferentes prevalencias de sinovitis y demás hallazgos, la mayoría ha demostrado que la RM de rodilla con un protocolo optimizado permite generar cambios en la conducta terapéutica. A su vez, el método siempre ha visualizado los ligamentos y tendones de la rodilla con un éxito similar al de nuestro trabajo. Conclusión: Aun careciendo de softwares comerciales específicos que reduzcan el artificio metálico, la aplicación de un protocolo optimizado logra identificar hallazgos que guían el tratamiento y permite evaluar las estructuras ligamentarias.
Objective: To establish the usefulness of magnetic resonance (MR) in patients with total knee replacement (TKR) pain after applying an optimised protocol, and to determinate which of the findings influence medical decision. Materials and methods: Fifteen patients suffering knee pain after TKR were studied using an optimised MR examination protocol from March 2013 to February 2014. The MR was interpreted by a musculoskeletal radiologist and findings were registered. Results: Out of the 15 patients, 74% were female. Mean age was 74 +/ - 7 years. The cause of pain was identified in 80% of the cases, and the medical decision was changed in 33%. Increased intra-articular fluid was seen in 93%, and signs of synovitis in 33%. The patellar, quadricipital, and popliteal tendons were correctly assessed in 77%, 92%, and 69% of patients, respectively, while the tibial and the fibula collateral ligaments were correctly assessed in 46% and 54% of patients, respectively. Discussion: Despite other articles showing a different prevalence of synovitis and MR findings, most of them showed that an optimised protocol impacted on clinical care. Also, most of the adjacent anatomical structures were successfully observed, as in our case. Conclusion: Even in the absence of metal reduction tailored sequences, an optimised protocol manages to diagnose conditions that alter clinical decisions and allows the identification of adjacent anatomical structures.
Asunto(s)
Humanos , Masculino , Femenino , Espectroscopía de Resonancia Magnética , Artroplastia de Reemplazo de Rodilla , Prótesis de la Rodilla , Estudios Retrospectivos , Rodilla/diagnóstico por imagenAsunto(s)
Enfermedades de la Boca/diagnóstico , Enfermedad de Addison/patología , Candidiasis/patología , Enfermedad de Crohn/patología , Humanos , Liquen Plano/patología , Enfermedades de los Labios/etiología , Enfermedades de los Labios/patología , Enfermedades de la Boca/etiología , Pénfigo/patología , Estomatitis/patologíaRESUMEN
This study reveals that changes are occurring in the pattern of oral cancer. Despite decreases in the number of lip and salivary gland cases, intra-oral cancer is increasing. The number of new cases is rising, especially in females, and it is presenting at a younger age in males. Intra-oral cancer deaths have increased, with females showing a 40% rise. The mortality rate has deteriorated to 62%. It is possible that these increases could be attributed to continued lack of public awareness of the disease and a considerable rise in alcohol consumption per head of population in the UK.
Asunto(s)
Neoplasias de la Boca/epidemiología , Neoplasias Faríngeas/epidemiología , Adulto , Factores de Edad , Anciano , Consumo de Bebidas Alcohólicas/efectos adversos , Inglaterra/epidemiología , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Neoplasias de la Boca/mortalidad , Neoplasias Faríngeas/mortalidad , Gales/epidemiologíaAsunto(s)
Liquen Plano , Enfermedades de la Boca , Lesiones Precancerosas , Revelación de la Verdad , Humanos , Londres , Mala PraxisRESUMEN
One hundred and forty-five patients with paroxysmal trigeminal neuralgia were treated with cryotherapy and followed up from 1 month up to 6 years. The mean nerve relief pain period was 13 months for the long buccal, 17 months for the mental and 20 months for the infra-orbital nerves and patients regained normal sensation long before the return of pain.
Asunto(s)
Criocirugía , Neuralgia/cirugía , Nervio Trigémino/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Neuralgia/fisiopatología , Dolor/fisiopatología , Nervio Trigémino/fisiopatologíaRESUMEN
Paroxysmal trigeminal neuralgia still remains a difficult condition to treat. Carbamazepine (Tegretol) has been a first line treatment, failing this surgery becomes necessary. However, many surgical procedures result in permanent sensory loss. Peripheral cryotherapy, along with the recently described Jannetta (1976) and Hakanson (1981) techniques, attempt to preserve sensation. Cryotherapy to 53 branches of the trigeminal nerve in 39 patients, who were followed up for 4 years, resulted in pain relief out-lasting return of sensation. These cases show that cryotherapy applied to the correctly located affected nerve branches can produce results which are unobtainable by other methods of pain control in paroxysmal trigeminal neuralgia.
Asunto(s)
Criocirugía , Neuralgia del Trigémino/cirugía , Adolescente , Adulto , Anciano , Mejilla/inervación , Estudios de Seguimiento , Humanos , Nervio Mandibular/cirugía , Persona de Mediana Edad , Órbita/inervación , Neuralgia del Trigémino/fisiopatologíaAsunto(s)
Enfermedades de la Boca/patología , Sarcoidosis/patología , Adulto , Femenino , Humanos , MasculinoRESUMEN
The scope of this investigation included a comparative study of 211 patients with paroxysmal trigeminal neuralgia (PTN) seen over 22 years (from 1959 to 1981) and the use of an open-nerve freezing technique (cryotherapy) on peripheral branches of the trigeminal nerve in 42 of these patients over 3 years (from 1978 to 1981). The study was divided into three parts. Part I was an analysis of clinical findings in all patients. Part II dealt with 33 medically uncontrolled patients and was an assessment of cryotherapy under the most adverse conditions. Part III consisted of an unselected group of 16 patients whose pain could be controlled by chemotherapy but who were not in remission. It was an assessment of cryotherapy in 9 of them as a replacement or adjuvant to chemotherapy. A total of 62 operations were performed, resulting in immediate pain relief and the gradual return of sensation in the treated nerve in all patients. The procedure had to be repeated in 6 patients early in the study to achieve this; one probable reason was inadequate freezing. The longest period of relief has been 2 1/2 years so far; the first patient treated 3 years ago, failed to return and could not be traced. Migration of pain to smaller branches of the trigeminal nerve occurred in 16 patients from 3 to 9 months postoperatively. This was abolished by further cryotherapy in the areas of migration. It is postulated that cryotherapy acts both peripherally and centrally to produce pain relief; if the technique is correctly carried out, the results can be long lasting and may be permanent.(ABSTRACT TRUNCATED AT 250 WORDS)