RESUMO
INTRODUCTION: The case of 14-year-old male with low-energy tibia fracture, treated by osteosynthesis with LCP plate placement, is present. Picnodisostosis is a rare autosomal recessive lysosomal disease (1.7/million inhabitants) characterized by osteosclerosis, short stature and bone fragility and evidenced radiologically by increased bone density with permeable medular canal persistence. Due to a mutation in the gene encoding for catepsin K (1q21), enzyme responsible for the division of proteins in the bone matrix (type 1 collagen, osteonectin and osteopontin), presenting bone fragility with increased consolidation time. Diagnosis of picnodystosis was made clinically by the presence of Wormian bones in the skull, micrognathia, clavicular hypoplasia, acroosteolysis, osteosclerosis and increased bone density in long bones. Open reduction and internal fixation with tibia LCP plate was carried out, with surveillance for three months with monthly radiographic controls. The healing of the fracture was achieved within 3 months of the surgical event with reintegration into its normal activities at the same time. Picnodisostosis is a rare disease with special bone characteristics that merits treatment with special plate for osteoporotic bones obtaining good results in an acceptable time.
INTRODUCCIÓN: Masculino de 14 años de edad con fractura de tibia de baja energía, tratada mediante osteosíntesis con colocación de placa LCP. La picnodisostosis es una enfermedad lisosomal autosómica recesiva rara (1.7/millón de habitantes) caracterizada por osteoesclerosis, estatura baja y fragilidad ósea, se evidencia radiológicamente por aumento de la densidad ósea con persistencia del canal medular permeable. Esta enfermedad se debe a una mutación en el gen que codifica para la catepsina K (1q21), enzima encargada de la división de las proteínas de la matriz ósea (colágeno tipo 1, osteonectina y osteopontina), presentando fragilidad ósea con aumento en el tiempo de consolidación. Se corroboró el diagnóstico de picnodisostosis clínicamente por la presencia de huesos wormianos en cráneo, micrognatia, hipoplasia clavicular, acroosteólisis de falanges distales, osteoesclerosis y aumento de la densidad ósea en huesos largos, con facies característica y talla baja. Se realizó reducción abierta y fijación interna con placa LCP a tibia, con vigilancia por tres meses con controles radiográficos mensuales. La consolidación del trazo de fractura se logró a los tres meses posteriores al evento quirúrgico con reinserción a sus actividades normales en el mismo tiempo. La picnodisostosis es una enfermedad rara, de características óseas especiales que amerita tratamiento con placa especial para huesos osteoporóticos obteniéndose buenos resultados en un tiempo aceptable.
Assuntos
Tíbia , Fraturas da Tíbia , Adolescente , Placas Ósseas , Fixação Interna de Fraturas , Consolidação da Fratura , Humanos , MasculinoRESUMO
OBJECTIVE: To compare the different diagnostic techniques of Helicobacter Pylori infection, confronting the bacteriological culture to other faster, less expensive and easier techniques, such as the urease test, methylen blue and Gram stained smears, the histopathologic examination of biopsies specimens, and the detection of IgG antibodies anti Helicobacter Pylori. MATERIAL AND METHODS: 43 patients with gastroduodenal symptoms who had not taken NSAIDs and who presented endoscopic signs of inlammation and/or gastroduodenal ulcer were prospectively studied. Biopsies specimens of antrum, gastric fundus and duodenal bulb were taken and processed in the following way: methylen blue and Gram stained smears and Hematoxylin and eosin stained section. Studies were performed in to all the 43 patients. Urease test was performed in the antrum specimens of 37 patients, and inmunologic test by inmunoenzimatic technique (ELISA) in 40 of them. RESULTS: Methylen blue and Gram stained smears: sensitivity (S): 100% and specificity (E): 76% Histopathologic examination (S): 86% (E): 61%, urease test (S) 100% (E) 62.5%, antibodies anti H.P. not possible to calculate. DISCUSSION: The authors have taken the microbiological culture as a reference technique because the isolation and identification of the bacteria are the most important signs of its presence and vitality. Stained smears, histopathologic examination and the urease test are fast, inexpensive techniques with high sensitivity for diagnosis. However, the inmunologic test is reveals better to the prevalence of the infection.
Assuntos
Infecções por Helicobacter/diagnóstico , Helicobacter pylori/isolamento & purificação , Adulto , Idoso , Feminino , Infecções por Helicobacter/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e EspecificidadeRESUMO
OBJECTIVE: To compare the different diagnostic techniques of Helicobacter Pylori infection, confronting the bacteriological culture to other faster, less expensive and easier techniques, such as the urease test, methylen blue and Gram stained smears, the histopathologic examination of biopsies specimens, and the detection of IgG antibodies anti Helicobacter Pylori. MATERIAL AND METHODS: 43 patients with gastroduodenal symptoms who had not taken NSAIDs and who presented endoscopic signs of inlammation and/or gastroduodenal ulcer were prospectively studied. Biopsies specimens of antrum, gastric fundus and duodenal bulb were taken and processed in the following way: methylen blue and Gram stained smears and Hematoxylin and eosin stained section. Studies were performed in to all the 43 patients. Urease test was performed in the antrum specimens of 37 patients, and inmunologic test by inmunoenzimatic technique (ELISA) in 40 of them. RESULTS: Methylen blue and Gram stained smears: sensitivity (S): 100
and specificity (E): 76
Histopathologic examination (S): 86
(E): 61
, urease test (S) 100
(E) 62.5
, antibodies anti H.P. not possible to calculate. DISCUSSION: The authors have taken the microbiological culture as a reference technique because the isolation and identification of the bacteria are the most important signs of its presence and vitality. Stained smears, histopathologic examination and the urease test are fast, inexpensive techniques with high sensitivity for diagnosis. However, the inmunologic test is reveals better to the prevalence of the infection.