RESUMO
Los tumores de la fosa isquiorrectal son poco frecuentes, habitualmente descritos en reportes o series de casos. Estas lesiones son un reto terapéutico, requiriendo un estudio preoperatorio apropiado, además de discusión y manejo guiado por un comité multidisciplinario, que permiten lograr resultados óptimos tanto oncológicos como funcionales. Presentamos un caso de un hombre de 73 años con antecedentes de resección de un tumor glúteo izquierdo en otro centro 5 años antes. La biopsia fue compatible con un sarcoma epiteloideo (SE) de alto grado, con margen quirúrgico < 0,5 mm que requirió ampliación de los márgenes posteriormente. Además, se realizó radioterapia adyuvante. Al cuarto año de seguimiento el paciente desarrolla dolor e induración con retracción en relación a cicatriz quirúrgica, siendo objetivada una recidiva tumoral local. Luego de una discusión multidisciplinaria, se realizó una desfuncionalización con ileostomía en asa laparoscópica y resección tumoral con preservación del ano y del piso pélvico. El defecto fue cubierto por el equipo de cirugía plástica utilizando un colgajo perforante de la arteria glútea superior. La biopsia confirmó la recidiva tumoral y los márgenes quirúrgicos fueron negativos. El paciente es dado de alta a los 25 días postoperatorios por cuidados del colgajo, sin complicaciones. Al año de seguimiento el paciente no presenta recidiva tumoral, la ileostomía fue cerrada, y sus resultados funcionales en términos defecatorios y de la herida son buenos.
Ischiorectal fossa tumors are rare lesions, mostly described in case reports or case series. These lesions represent a diagnostic and therapeutic challenge. Hence, an appropriate preoperative study and multidisciplinary discussion are essential to achieve good oncologic and functional results. We report a case of a 73-year-old male operated on five years before in another health center due to the diagnosis of a left gluteal tumor. The lesion was excised, and biopsies confirmed a high-grade epithelioid sarcoma with a close margin, requiring a subsequent wider excision of the surgical margins. The patient received adjuvant radiotherapy. After four years of follow-up, the patient developed mild pain with skin retraction around the former incision. A local recurrence was diagnosed by imaging. In a multidisciplinary team meeting, a decision to resect the lesion with preservation of the anus and the pelvic floor was taken. The patient underwent a laparoscopic defunctioning loop ileostomy and a resection of the recurrent tumor in the ischiorectal fossa with preservation of the anal sphincter. The defect was covered utilizing a superior gluteal artery perforator flap and a partial gluteus maximus muscle rotation. The tumor was completely excised with negative margins. The patient was discharged without complications after 25 days due to flap management. After one year of follow-up, the patient is recurrence-free, and the ileostomy was closed.
Assuntos
Humanos , Masculino , Idoso , Sarcoma/cirurgia , Recidiva Local de Neoplasia/cirurgia , Neoplasias Retais/cirurgia , Neoplasias Retais/patologia , Nádegas/cirurgia , Resultado do Tratamento , Ísquio/cirurgia , Ísquio/patologia , Ísquio/diagnóstico por imagemRESUMO
Ischiorectal fossa tumors are rare lesions, mostly described in case reports or case series. These lesions represent a diagnostic and therapeutic challenge. Hence, an appropriate preoperative study and multidisciplinary discussion are essential to achieve good oncologic and functional results. We report a case of a 73-year-old male operated on five years before in another health center due to the diagnosis of a left gluteal tumor. The lesion was excised, and biopsies confirmed a high-grade epithelioid sarcoma with a close margin, requiring a subsequent wider excision of the surgical margins. The patient received adjuvant radiotherapy. After four years of follow-up, the patient developed mild pain with skin retraction around the former incision. A local recurrence was diagnosed by imaging. In a multidisciplinary team meeting, a decision to resect the lesion with preservation of the anus and the pelvic floor was taken. The patient underwent a laparoscopic defunctioning loop ileostomy and a resection of the recurrent tumor in the ischiorectal fossa with preservation of the anal sphincter. The defect was covered utilizing a superior gluteal artery perforator flap and a partial gluteus maximus muscle rotation. The tumor was completely excised with negative margins. The patient was discharged without complications after 25 days due to flap management. After one year of follow-up, the patient is recurrence-free, and the ileostomy was closed.
Assuntos
Recidiva Local de Neoplasia , Sarcoma , Humanos , Masculino , Idoso , Recidiva Local de Neoplasia/cirurgia , Sarcoma/cirurgia , Nádegas/cirurgia , Resultado do Tratamento , Neoplasias Retais/cirurgia , Neoplasias Retais/patologia , Ísquio/cirurgia , Ísquio/diagnóstico por imagem , Ísquio/patologiaAssuntos
Ísquio , Osteocondrose/diagnóstico por imagem , Osso Púbico , Adolescente , Humanos , MasculinoAssuntos
Adenocarcinoma/secundário , Calcinose/patologia , Neoplasias Pulmonares/secundário , Tomografia Computadorizada por Raios X , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/cirurgia , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/secundário , Feminino , Humanos , Ísquio/diagnóstico por imagem , Ísquio/patologia , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/secundário , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Metástase Linfática , Pessoa de Meia-Idade , Osteólise/etiologia , Osso Púbico/diagnóstico por imagem , Osso Púbico/patologia , Neoplasias Retais/patologia , Neoplasias Retais/cirurgiaRESUMO
Los osteocondromas constituyen el grupo de tumores óseos benignos más frecuentes en cadera, solitarios o como parte de una enfermedad exostosante múltiple; pueden ser asintomáticos o sintomáticos. Se tratan para evitar el riesgo de una degeneración sarcomatosa relativamente frecuente en este sitio. El propósito del estudio es revisar la entidad a partir de experiencia hospitalaria con énfasis en las manifestaciones clínicas y tratamiento. Se reporta el caso de un paciente masculino de 22 años e historia de hemofilia, que presentó una tumoración ósea a nivel de cadera derecha que los limita rangos de movilidad
Osteochondromas constitute the group of benign bone tumors most frequent in the hip, solitary or as part of a multiple exostosante disease; They can be asymptomatic or symptomatic. They are treated to avoid the risk of a relatively frequent sarcomatous degeneration at this site. The purpose of the study is to review the entity based on hospital experience with emphasis on clinical manifestations and treatment. The case of a 22-year-old male patient and a history of hemophilia is reported, who presented a bone tumor at the right hip level that limits mobility ranges.
Assuntos
Humanos , Masculino , Adulto , Osteocondroma , Osteocondroma/cirurgia , Fêmur , Transtornos Herdados da Coagulação Sanguínea , Quadril , Luxação do Quadril , ÍsquioRESUMO
Background: Fractures and dislocations are common orthopedic conditions arising from traumas from anthropic interaction on wild species, such as those caused by road trampling. Among the treatments, osteosynthesis is considered the method of choice in the treatment of fractures, such as ilium body fractures and femoral fractures. Based on this context, with regard to the incidence of auto accidents and few studies describing osteosynthesis techniques for crab-eating fox, the present study aimed to report the osteosynthesis performed on the body of the ileum and femur of a wild specimen of Cerdocyon thous. Case: A female, adult, crab-eating fox (Cerdocyon thous), coming from wild life was referred to hospital care with a history of run over. After specific examinations, it was diagnosed a complete transverse femoral shaft fracture, an oblique ilium body fracture, a pubic and ischial fracture, and pelvic canal narrowing. The treatment instituted was osteosynthesis of the femoral and ilium body fractures through the use of a 2.7 mm locking plate and screws. In the postoperative period, radiographic examination was performed, where bone callus formation was observed in the 5th week and bone remodeling and consolidation in the 11th week. After 140 days of rehabilitation, the animal was able to be released in the wild, with effective return of function of the pelvic limbs. The release was performed by environmental agencies in a national natural reserve, using radio necklace monitoring.Discussion: Osteosynthesis techniques and preoperative and postoperative management proved to be effective for the return of adequate function of the pelvic limbs in Cerdocyon thous. For wild animals, the use of internal orthopedic implants (plate and screws, for example) become the most suitable for osteosynthesis...(AU)
Assuntos
Animais , Fixação Interna de Fraturas/veterinária , Ílio/cirurgia , Fraturas do Fêmur/cirurgia , Animais Selvagens/cirurgia , Ísquio/lesões , Osso Púbico/lesõesRESUMO
Background: Fractures and dislocations are common orthopedic conditions arising from traumas from anthropic interaction on wild species, such as those caused by road trampling. Among the treatments, osteosynthesis is considered the method of choice in the treatment of fractures, such as ilium body fractures and femoral fractures. Based on this context, with regard to the incidence of auto accidents and few studies describing osteosynthesis techniques for crab-eating fox, the present study aimed to report the osteosynthesis performed on the body of the ileum and femur of a wild specimen of Cerdocyon thous. Case: A female, adult, crab-eating fox (Cerdocyon thous), coming from wild life was referred to hospital care with a history of run over. After specific examinations, it was diagnosed a complete transverse femoral shaft fracture, an oblique ilium body fracture, a pubic and ischial fracture, and pelvic canal narrowing. The treatment instituted was osteosynthesis of the femoral and ilium body fractures through the use of a 2.7 mm locking plate and screws. In the postoperative period, radiographic examination was performed, where bone callus formation was observed in the 5th week and bone remodeling and consolidation in the 11th week. After 140 days of rehabilitation, the animal was able to be released in the wild, with effective return of function of the pelvic limbs. The release was performed by environmental agencies in a national natural reserve, using radio necklace monitoring.Discussion: Osteosynthesis techniques and preoperative and postoperative management proved to be effective for the return of adequate function of the pelvic limbs in Cerdocyon thous. For wild animals, the use of internal orthopedic implants (plate and screws, for example) become the most suitable for osteosynthesis...
Assuntos
Animais , Animais Selvagens/cirurgia , Fixação Interna de Fraturas/veterinária , Fraturas do Fêmur/cirurgia , Ílio/cirurgia , Osso Púbico/lesões , Ísquio/lesõesRESUMO
Las úlceras por presión son las complicaciones secundarias más comunes a una lesión medular, las cuales ponen en riesgo tanto la salud como la vida de quienes las padecen. Las úlceras por presión más comunes en lesionados medulares aparecen en la región pélvica, principalmente en las tuberosidades isquiáticas (TI's). Una estrategia usada en la clínica es medir la presión generada entre el paciente y la superficie donde se encuentra para evaluar el riesgo que representa dicha superficie para el desarrollo de úlceras por presión sin embargo, este tipo de mediciones superficiales no garantizan que la presión en los tejidos internos subyacentes a prominencias óseas sea inocua. Con el fin de estudiar los mecanismos de formación de úlceras por presión, se realizó el análisis de un modelo de pelvis y tejido subyacente por medio del Método de los Elementos Finitos (MEF). De esta manera se puede estudiar el comportamiento de las TI's sobre su tejido circundante, así como analizar los efectos biomecánicos que provocan las úlceras. Se construyó el modelo computacional por medio de un software de CAD (Computing Aided Design) de la pelvis a partir de cortes tomográficos. El modelo fue exportado al software COMSOL y se analizaron seis casos de estudio: un análisis de la pelvis sobre bloques de tejido sano y cinco casos más, los cuales simulan lesiones en el tejido con distintas profundidades, representando úlceras superficiales e internas. Los resultados mostraron que los puntos de máximo esfuerzo, en todas las pruebas, se localizan justo debajo de la TIs además se encontró que las lesiones internas presentan mayores esfuerzos y deformaciones, los cuales pueden ser precursores de daño en el tejido.
Pressure ulcers are the most common secondary complication to a spinal cord injury, which endanger both health and life of the patients who suffer them. The most common pressure ulcers in spinal cord injuries occur in the pelvic region, mainly in the ischial tuberosities (ITs). A strategy used in clinic is to quantify the pressure generated between the patient and the surface, in order to assess the risk posed by that surface for developing pressure ulcers. Despite this, this type of surface measurements does not guarantee that pressure in the internal tissues underlying to bony prominences, to be safe. In order to study the mechanisms of formation of pressure ulcers, an analysis of a model of the pelvis and its underlying tissue was performed using the Finite Element Method (FEM). By this means we can study the behavior of ITs on its surrounding tissue, and at the same time, we analyze the biomechanical effects those cause ulcers. The computational model of the pelvis was built from tomographic slices using CAD software (Computing Aided Design). The model was exported to the finite element software COMSOL and six study cases were analyzed: an analysis of the pelvis on healthy tissue blocks and five more cases, which simulate tissue injury with different depths, representing surface and internal ulcers. The results showed that the maximum stress points in all tests are located just below the ITs it was also found that internal injuries present higher stresses and strains, which can be precursors of tissue damage.
Assuntos
Humanos , Fenômenos Biomecânicos/fisiologia , Análise de Elementos Finitos , Úlcera por Pressão/fisiopatologia , Imageamento Tridimensional , Ísquio/fisiopatologiaRESUMO
Brown tumors result from excess osteoclast activity and consist of collections of osteoclasts intermixed with fibrous tissue and poorly mineralized woven bone. They are secondary to hyperparathyroidism (HPT). Their incidence is higher in primary than in secondary hyperparathyroidism. We report a 69 years-old male, admitted in a state of confusion, lethargy and bedridden, with a pathological fracture of the femur caused by a brown tumor. The laboratory examination revealed a hypercalcemia (8.85 mEq/L), with high levels of ionized Ca (5.48 mEq/L), serum alkaline phosphatases (416 U/L) and serum parathormone (120 pg/mL). Ultrasound examination of the neck showed a large parathyroid tumor, probably corresponding to a carcinoma. A primary HPT was diagnosed. The patient was hydrated and high doses of diuretics and bisphosphonates were administered. After correction of serum calcium and neurologic symptoms, the patient was operated, performing an extensive resection of the tumor. The pathology report confirmed the diagnosis of parathyroid carcinoma.
Assuntos
Neoplasias Ósseas/complicações , Carcinoma/etiologia , Fraturas do Fêmur/etiologia , Fraturas Espontâneas/etiologia , Hiperparatireoidismo Primário/complicações , Neoplasias das Paratireoides/etiologia , Idoso , Carcinoma/diagnóstico , Neoplasias Femorais/etiologia , Humanos , Ísquio , Masculino , Neoplasias das Paratireoides/diagnósticoRESUMO
Brown tumors result from excess osteoclast activity and consist of collections of osteoclasts intermixed with fibrous tissue and poorly mineralized woven bone. They are secondary to hyperparathyroidism (HPT). Their incidence is higher in primary than in secondary hyperparathyroidism. We report a 69 years-old male, admitted in a state of confusion, lethargy and bedridden, with a pathological fracture of the femur caused by a brown tumor. The laboratory examination revealed a hypercalcemia (8.85 mEq/L), with high levels of ionized Ca (5.48mEq/L), serum alkaline phosphatases (416 U/L) and serum parathormone (120 pg/mL). Ultrasound examination of the neck showed a large parathyroid tumor, probably corresponding to a carcinoma. A primary HPT was diagnosed. The patient was hydrated and high doses of diuretics and bisphosphonates were administered. After correction of serum calcium and neurologic symptoms, the patient was operated, performing an extensive resection of the tumor. The pathology report confirmed the diagnosis of parathyroid carcinoma.
Los tumores pardos son una consecuencia de una actividad osteoclástica excesiva y consisten en osteoclastos mezclados con tejido fibroso y tejido óseo mal mineralizado. Son secundarios a hiperparatiroidismo y más comunes en hiperparatiroidismo primario. Informamos de un hombre de 69 años que ingresa confuso y letárgico con una fractura patológica del fémur causada por un tumor pardo. El laboratorio mostró hipercalcemia de 8,85 mEq/L, fosfatasas alcalinas de 416 U/L y parathormona de 120 pg/mL. La ecografía del cuello mostró un tumor paratiroideo sospechoso de carcinoma. Se diagnosticó un hiperparatiroidismo primario. El paciente se hidrató y estabilizó con diuréticos y bifosfonatos. Una vez estabilizado, se operó efectuando una extensa resección del tumor. El estudio anatomopatológico confirmó el diagnóstico de cáncer de paratiroides.
Assuntos
Idoso , Humanos , Masculino , Neoplasias Ósseas/complicações , Carcinoma/etiologia , Fraturas do Fêmur/etiologia , Fraturas Espontâneas/etiologia , Hiperparatireoidismo Primário/complicações , Neoplasias das Paratireoides/etiologia , Carcinoma/diagnóstico , Neoplasias Femorais/etiologia , Ísquio , Neoplasias das Paratireoides/diagnósticoRESUMO
UNLABELLED: Ischial osteomyelitis is a bone infection that is very infrequent during childhood and is diagnosed by excluding other more frequent conditions. The definitive diagnosis is made with puncture biopsy, which allows instituting targeted antibiotic therapy. We present herein two clinical cases of two children who had a favorable course. In both cases the findings of the initial X-rays were unremarkable. The physical exam did not show total limitation of the coxofemoral joint but it did show ischial tenderness. The MRI showed images compatible with ischial osteitis. The ischial puncture biopsy was diagnostic in both cases. At the 24-month follow-up both children are leading a normal life. CONCLUSIONS: Ischial osteomyelitis is an entity to consider in children with coxalgia once other more frequent conditions have been ruled out. The diagnosis is possible with a thorough iconographic study toget.
Assuntos
Ísquio/patologia , Osteomielite/diagnóstico , Infecções Estafilocócicas/diagnóstico , Infecções Estreptocócicas/diagnóstico , Adolescente , Antibacterianos/uso terapêutico , Artralgia/etiologia , Bacteriemia/complicações , Bacteriemia/microbiologia , Criança , Fístula Cutânea/etiologia , Febre/etiologia , Humanos , Ísquio/diagnóstico por imagem , Ísquio/microbiologia , Imageamento por Ressonância Magnética , Osteomielite/complicações , Osteomielite/diagnóstico por imagem , Osteomielite/tratamento farmacológico , Osteomielite/microbiologia , Osteomielite/patologia , Tomografia por Emissão de Pósitrons , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/patologia , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/patologia , Streptococcus pyogenes/isolamento & purificaçãoRESUMO
El objetivo de este estudio fue determinar la influencia de la extensibilidad isquiosural en la morfología sagital del raquis e inclinación pélvica en deportistas jóvenes. Métodos. Un total de 152 deportistas (media de edad: 16,22 +/- 0,80 años) participaron voluntariamente en este estudio. La morfología sagital de las curvas torácica y lumbar, así como la inclinación pélvica, fueron evaluadas con un Spinal Mouse al realizar los test sit-and-reach, toe-touch y McRae & Wright. La extensibilidad isquiosural fue determinada mediante el test de elevación de la pierna recta (EPR). En base al valor obtenido en el test EPR, la muestra fue dividida en tres grupos (Grupo A: EPR < 76, n=49; Grupo B, EPR entre 76-88, n=45; y Grupo C, EPR > 88, n=50). Resultados. Los deportistas con menor extensibilidad isquiosural adoptaron posturas de mayor cifosis torácica y una mayor retroversión pélvica en los test sit-and-reach y toe-touch. No obstante, no se encontraron diferencias significativas entre grupos en el test McRae & Wright. Además, la extensibilidad isquiosural no tuvo influencia alguna en la morfología sagital del raquis lumbar. Conclusiones. Una menor extensibilidad isquiosural está relacionada con una mayor cifosis torácica y una mayor retroversión pélvica cuando se realizan movimientos de flexión máxima del tronco con rodillas extendidas. La extensibilidad isquiosural no afecta a la disposición sagital del raquis lumbar en movimientos de flexión máxima del tronco.
The objective of this study was to determine the influence of hamstring extensibility in sagittal spinal curvatures and pelvic inclination on young athletes. Methods: A hundred and fifty-two young athletes (mean age: 16.22 +/- 0.80 years) were recruited. Thoracic and lumbar curvatures and pelvic inclination were evaluated with a Spinal Mouse system in the sit-and-reach test, toe-touch test and McRae & Wright test. Hamstring muscle extensibility was determined by passive straight leg raise test (PSLR). The sample was divided into three groups with regard to straight leg raise angle (Group A: PSLR < 76, n=49; Group B, PSLR between 76-88, n=45; and Group C, PSLR > 88, n=50). Results. Athletes with lower extensibility presented higher thoracic angle and a more posterior pelvic tilt in the sit-and-reach and toe-touch tests. However, no significant differences were found between groups when maximal trunk flexion with knees flexed was performed (McRae & Wright test). The lumbar curve was not affected by hamstring extensibility in any position. Conclusions: Lower hamstring extensibility is related to increased thoracic curve and more posterior pelvic tilt when maximal trunk flexion with knees extended is performed. Hamstring extensibility has not any influence in sagittal lumbar morphology when trunk flexion is performed.
Assuntos
Adulto Jovem , Ossos Pélvicos/anatomia & histologia , Ísquio/anatomia & histologia , Ísquio/lesões , Nervo Sural/lesões , Canal Medular , Atletas , Ossos Pélvicos/lesões , PosturaRESUMO
This project, developed by the Design Studies Research Group at the Universidad Pontificia Bolivariana (UPB), presents a design proposal focused on human factors for ischial support for the stations of the Medellín Metro. An initial pilot scheme was developed on Platform 'A' of San Antonio - the most important transfer station. The methodology of the Ergonomics Research Division at UPB constituted the basis of the project. This methodology observes, analyses and draws conclusions of the conditions that optimize the User-Product-Context nexus, and in doing so defines design requirements which, in this proposal, centered on the needs of the users of the Medellín Metro. The Experimental Morphology Research Division provided technical support in the form of modelling, production and structural testing of the object. The proposal includes thematic units, themes and priority components for analysis and application in the design process. In addition, the project generates certain activities and moments that future designers can develop in a parallel manner, coherent with the vision of ergonomics. The methodology focused on the requirements of the users and took into account the existing space (the Metro System), thus establishing relationships of use that were coherent with the principles of ergonomics and design.
Assuntos
Desenho de Equipamento , Ergonomia , Ísquio/fisiologia , Postura/fisiologia , Colômbia , Comportamento do Consumidor , Qualidade de Produtos para o Consumidor , Humanos , Projetos Piloto , FerroviasRESUMO
A associação entre dor no quadril, anormalidade do músculo quadrado femoral na ressonância magnética (RM) e estreitamento do espaço isquiofemoral tem sido relatada na literatura atual, levantando a possibilidade de que essa lesão muscular seja causada pelo impacto isquiofemoral. Tal diagnóstico foi observado em algumas mulheres de meia-idade com ou sem história de trauma ou cirurgia. Os autores relatam aqui uma mulher de 31 anos de idade, que apresentava dor no quadril sem história de trauma, com evidência de estreitamento do espaço isquiofemoral e edema no músculo quadrado femoral. Foi realizado tratamento não cirúrgico com alívio dos sintomas. O diagnóstico de impacto isquiofemoral deve ser considerado em pacientes do sexo feminino com queixa de dor no quadril sem outra causa evidente.
An association between hip pain and quadratus femoris muscle abnormality on magnetic resonance imaging (MRI) with concurrent narrowing of the ischiofemoral space has been reported in the recent literature. This raises the possibility that the muscle damage observed is due to ischiofemoral impingement. This diagnosis has been noted in middle-aged females either with or without a history of trauma or surgery, is a rarely described feature. We report here on a 31-year-old woman who presented with non-traumatic hip pain and evidence of narrowing of the ischiofemoral space and edema in the quadratus femoris. Nonsurgical treatment was administered, which relieved her hip pain. The diagnosis of ischiofemoral impingement should be considered in female patients complaining of hip pain without any other evident cause.
Assuntos
Adulto , Ísquio/patologia , Nervo Isquiático/fisiopatologia , Nervo Isquiático/patologia , Dor , Quadril/patologiaRESUMO
Introdução: Úlceras por pressão isquiáticas são lesões de difícil tratamento e altas taxas de recidivas, principalmente quando associadas à osteomielite. Para o seu adequado manejo, impõe-se a necessidade de equipe multidisciplinar, apoiada no reconhecimento clínico e radiológico do comprometimento ósseo, antibioticoterapia adequada, suporte nutricional, terapia hiperbárica e tratamento cirúrgico com amplo debridamento e cobertura de partes moles, com técnicas de reconstrução. Método: O presente trabalho foi baseado em 18 pacientes cadeirantes e portadores de úlceras por pressão com osteomielite associada, todos submetidos a tratamento cirúrgico e acompanhados por um período de pós-operatório de 6 meses a 5 anos e 4 meses, no período de fevereiro de 2004 a junho de 2009. Estes pacientes foram submetidos à técnica de isquiectomia modificada, com preservação da inserção do músculo gracilis, e subsequente cobertura cutânea com variadas técnicas isoladas ou associadas de retalhos cutâneos, fasciocutâneos, musculares, e miocutâneos. Resultados: O trabalho demonstra que a ampla isquiectomia é o ponto crucial para a resolução do processo infeccioso ósseo, e a possibilidade da utilização do retalho muscular do músculo gracilis, associado ou não a outras técnicas de reconstrução, é uma opção técnica, no sentido de ocluir a lacuna óssea e proporcionar a entrada da antibioticoterapia adjuvante.
Introduction: Ischiatic pressure ulcers are lesions of difficult treatment and high relapse rates, especially when associated with osteomyelitis. For their adequate handling, the need of a multidisciplinary team is essential, based on the clinical and radiological recognition of the osseous jeopardy, adequate antibiotic therapy, nutritional support, hyperbaric therapy and surgical treatment comprising a wide range debridement and coverage of the soft parts, using reconstructive techniques. Methods: The present work is based on 18 handcaps patients who are wheel chair users and have ischial pressure ulcers associated with osteomyelitis, all of them submitted to surgical treatment and a post-surgical follow upperiod from 6 months to 5 years and 4 months, during the period from February, 2004 to June, 2009. These patients were submitted to the modified ischiectomy technique, with preservation of the insertion of the gracilis muscle, and subsequent cutaneous coverage with varied techniques, isolated or associated with cutaneous, fasciocutaneous, muscularisand, myocutaneous flaps. Results: The present work states that extended ischiectomy is the most important point for the resolution of the osseous infective process, and the possibility of using the gracile muscle muscularis flap, associated or not with other reconstruction techniques is a technical option, in the sense of occluding the osseous lacuna and allowing the use of adjuvant antibiotic therapy.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Complicações Intraoperatórias , Ísquio/cirurgia , Osteomielite/cirurgia , Complicações Pós-Operatórias , Úlcera Cutânea , Retalhos Cirúrgicos , Procedimentos Cirúrgicos Operatórios , Tomografia Computadorizada por Raios X , Úlcera por Pressão/cirurgia , Ferimentos e Lesões , Técnicas e Procedimentos Diagnósticos , Métodos , PacientesRESUMO
A hernia esquiática é a mais rara entre todas as hérnias. A sintomalogia é escassa, exceto quando evolui com complicações. O diagnóstico pré-operatório é difícil o tratamento cirúrgico é indicado devido ao risco de estrangulamento visceral. Os autores relatamo caso de jovem do sexo masculino com massa na região glutea direita indolorà palpação com diagnóstico de hérnia isquiática.
Assuntos
Humanos , Masculino , Adolescente , Hérnia/cirurgia , Ísquio/patologia , Cirurgia Geral/métodos , Diagnóstico Diferencial , Diafragma da Pelve , Tomografia Computadorizada de EmissãoAssuntos
Angiografia , Cuidados Pré-Operatórios , Gêmeos Unidos/cirurgia , Feminino , Humanos , Lactente , ÍsquioAssuntos
Humanos , Feminino , Lactente , Angiografia , Gêmeos Unidos/cirurgia , Cuidados Pré-Operatórios , ÍsquioRESUMO
A fin de comprobar la eficacia de la Centellografía con leucocitos marcados con TC99m para detectar infecciones en huesos, articulaciones y partes blandas se realizaron 41 exploraciones utilizando Cámara Gamma SPECT y planar Elscint y Technicare. Se realizaron 17 diagnósticos positivos de infección, resultando uno de ellos falso positivo y 24 diagnósticos negativos, con un falso negativo. Todos los pacientes fueron revisados por dos especialistas en Medicina Nuclear por separado, con interrupción del tratamiento antibiótico 24-48 horas antes del estudio. El estudio reveló alta sensibilidad diagnóstica con valores relevantes para el tratamiento y evolución clínica de los pacientes por lo que concluimos que los leucocitos marcados constituyen un método muy útil en el diagnóstico de las patologías infecciosas