RESUMO
OBJECTIVES: The aim of this study was to evaluate the effect of STS resection in the thigh on MS and the HRQoL. METHODS: Fourteen adults patients with STS in the thigh who underwent wide resection and limb preservation were evaluated. The patients were submitted to the Mini-Mental State Examination (MMSE). A hand-held dynamometer was used to measure the MS the flexors, adductors, abductors, and extensors muscles of the operated and non-operated thighs and between the dominant and non-dominant operated sides. The Musculoskeletal Tumor Society (MSTS) and Short Form Health Survey-36 (SF-36) questionnaires were applied to quantify the psychometric properties of the HRQoL. The data were submitted to statistical analysis using the Wilcoxon test (MS), and Mann-Whitney and Spearman correlation (MSTS and SF-36) (α = 0.05). RESULTS: There was no significant difference in MS between the operated side and the non-operated side, and between the dominant and non-dominant operated side (ρ > 0.05). The MSTS presented a significant difference in the emotional acceptance for patients submitted to radiotherapy (ρ = 0.029). The SF-36 showed significant differences in the emotional aspect for patients submitted to chemotherapy (ρ = 0.027) and in the social aspect between the dominant and non-dominant operated side (ρ = 0.024). CONCLUSIONS: The HRQoL of adult patients is hampered after the treatment of STS even when MS is maintained.
Assuntos
Sarcoma , Neoplasias de Tecidos Moles , Adulto , Humanos , Coxa da Perna/patologia , Qualidade de Vida , Psicometria , Sarcoma/cirurgia , Sarcoma/patologia , Neoplasias de Tecidos Moles/cirurgia , Neoplasias de Tecidos Moles/patologia , Força MuscularRESUMO
Resumen: Introducción: la equinococosis quística músculo-esquelética es poco frecuente, pudiendo determinar retrasos diagnósticos y errores terapéuticos. Reporte de caso: presentamos el caso de un paciente con un quiste hidático primario único a nivel de la región femoral posterior derecha, infectado. Discusión: se realizó una revisión en las bases de datos PubMed y LILACS sobre el diagnóstico y manejo terapéutico de los quistes hidáticos músculo-esqueléticos primarios. Conclusiones: la equinococosis quística músculo-esquelética debe ser tenida en cuenta dentro de los diagnósticos diferenciales de tumoraciones de partes blandas en pacientes provenientes de zonas endémicas. La tomografía computada y/o resonancia magnética cumplen un rol diagnóstico y de planificación terapéutica. El tratamiento es quirúrgico, a medida del paciente y del quiste, en función de su topografía, tamaño y fundamentalmente relaciones vasculo nerviosas y musculares. Otros factores a tener en cuenta son las futuras secuelas funcionales y resultados estéticos.
Summary: Introduction: musculoskeletal cystic echinococcosis is rather an unusual condition, what may result in delayed diagnosis and therapeutic mistakes. Case report: the study presents the case of a patient with a single primary hydatid cyst in the right posterior femoral region, which is infected. Discussion: a review of PubMed and LILACS was performed to learn about diagnosis and therapeutic handling of the primary musculoskeletal hydatid cysts. Conclusions: musculoskeletal cystic echinococcosis needs to be considered among differential diagnosis of soft tissues tumors in patients coming from endemic areas. A CT scan and RMI play an important role in diagnosis and the planning of treatment. Treatment involves surgery that must be adapted to the patient and the cyst, considering its topography and size, and in particular in view of muscular and nervous vessels relationship. Other factors to bear in mind are renal sequels and esthetic aspects.
Resumo: Introdução: a equinococose cística musculoesquelética é rara e pode determinar atrasos em seu diagnóstico e erros terapêuticos. Relato do caso: apresentamos o caso de uma paciente com cisto hidrático primário único ao nível da região femoral posterior direita, infectado. Discussão: foi realizada uma revisão nas bases de dados PubMed e LILACS sobre o diagnóstico e manejo terapêutico dos cistos hidráticos osteomusculares primários. Conclusões: a equinococose cística musculoesquelética deve ser considerada no diagnóstico diferencial de tumores de partes moles em pacientes de áreas endêmicas. A tomografia computadorizada e / ou a ressonância magnética desempenham um papel no planejamento diagnóstico e terapêutico. O tratamento é cirúrgico, adaptado ao paciente e ao cisto, dependendo de sua topografia, tamanho e, fundamentalmente, das relações vascular-nervosas e musculares. Outros fatores a serem considerados são as sequelas funcionais futuras e os resultados estéticos.
Assuntos
Humanos , Feminino , Coxa da Perna/patologia , Equinococose/cirurgia , Equinococose/tratamento farmacológico , Equinococose/diagnóstico por imagem , Músculo EsqueléticoRESUMO
BACKGROUND: Multiple primary malignant neoplasms are not frequent but are increasing in incidence. Some of them are associated with genetic syndromes such as von Hippel-Lindau syndrome and Li-Fraumeni syndrome. Dedifferentiated liposarcoma is one of the rarest soft tissue tumors, and clear cell renal carcinoma is the most frequent kidney cancer. The concomitant presence of these tumors is extremely rare; however, some cases have been reported, none of them presenting with liposarcoma of the limbs. We report an interesting case of a patient with synchronous multiple primary tumors presenting with a very rare liposarcoma associated with renal cell carcinoma (a very rare association). A review of the literature and a collection of similar cases published previously are also provided. CASE PRESENTATION: We report a case of a 62-year-old Hispanic man who presented to our institution with a left thigh mass compatible with dedifferentiated liposarcoma synchronous with metastatic clear cell renal carcinoma. Multiple treatment lines were provided with no response, with a further metastatic transformation. Genetic analysis by liquid biopsy showed some mutations that were not susceptible to targeted therapy. At the time of this report, the patient is undergoing palliative care because his nonresponsive metastatic disease persists. CONCLUSIONS: We present the first reported case of clear cell renal carcinoma synchronous with dedifferentiated liposarcoma of a limb. The association between renal cell carcinoma and dedifferentiated liposarcoma is unusual, and there are few reports of this presentation in the literature. More research about these tumors along with genetic tests needs to be performed to seek a better understanding of the fundamental basis of this rare association.
Assuntos
Carcinoma de Células Renais/complicações , Neoplasias Renais/complicações , Lipossarcoma/complicações , Neoplasias Primárias Múltiplas , Neoplasias de Tecidos Moles/complicações , Carcinoma de Células Renais/genética , Humanos , Neoplasias Renais/genética , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica/terapia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Coxa da Perna/diagnóstico por imagem , Coxa da Perna/patologiaAssuntos
Linfedema/etiologia , Obesidade Mórbida/complicações , Adulto , Humanos , Masculino , Coxa da Perna/patologiaRESUMO
Bothrops lanceolatus is an endemic Crotalidae species in Martinique, where approximately 30 cases of envenoming are managed yearly. Envenoming characteristics from Bothrops species include local tissue damage, systemic bleeding, and hemodynamic alterations. We hereby report a case of severe envenomation following B. lanceolatus snakebite to the right calf. Severe local manifestations developed progressively up to the lower limb despite adequate antivenom therapy. Systemic manifestations of venom also occurred, resulting in intensive care therapy. Surgery exploration revealed soft tissue necrosis, friability of the deep fascia, and myonecrosis. The patient needed multiple debridement procedures and fasciotomy of all leg compartments and anterior compartment of the thigh. Diagnosis of necrotizing fasciitis was confirmed by positive Aeromonas hydrophila blood cultures. This clinical case illustrates that major soft tissue infection, including necrotizing fasciitis may occur after snakebite. Abnormal coagulation tests should not delay surgical management, as severe envenoming is a life-threatening condition.
Assuntos
Bothrops , Gerenciamento Clínico , Fasciite Necrosante/etiologia , Fasciotomia , Mordeduras de Serpentes/cirurgia , Adulto , Aeromonas hydrophila/isolamento & purificação , Animais , Venenos de Crotalídeos/efeitos adversos , Desbridamento , Fasciite Necrosante/diagnóstico , Fasciite Necrosante/microbiologia , Feminino , Infecções por Bactérias Gram-Negativas/sangue , Humanos , Martinica , Coxa da Perna/patologia , Coxa da Perna/cirurgiaRESUMO
Abstract Purpose: To investigate tibial tunnel widening and knee instability after ACL reconstruction with hamstring autograft or irradiated soft tissue allograft. Methods: Eight-two patients were divided into two groups: autograft group and allograft group. Radiographic and clinical evaluations were performed. Results: Seventy patients were followed up with median of 36.3 months (range 36-38 months). Tibial tunnel widening was at or greater than 30% for nine patients in the autograft group and 15 patients in the allograft group (P = 0.0417). The average percentage of tibial tunnel widening was 26.7 ± 4.0 % and 29.7 ± 5.3 % in autograft and allograft groups, respectively (P = 0.0090). Knee range of motion was not affected by the reconstruction operation or different grafts. Thigh atrophy improved significantly within 24 months after ACL reconstructions in both groups. ACL reconstruction with the allograft leaded to less knee stability than that with the autograft from one year after operation (P = 0.0023). There was no significant difference between two groups with respect to Lysholm score (P = 0.1925) and Tegner score (P =0 .0918) at the final follow-up. Conclusion: The allograft group reported significantly more tibial tunnel widening and knee instability compared with the autograft group.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Adulto Jovem , Tíbia/cirurgia , Reconstrução do Ligamento Cruzado Anterior/métodos , Lesões do Ligamento Cruzado Anterior/cirurgia , Instabilidade Articular/cirurgia , Osteotomia/métodos , Período Pós-Operatório , Coxa da Perna/patologia , Estudos Prospectivos , Seguimentos , Resultado do Tratamento , Período Pré-Operatório , Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Reconstrução do Ligamento Cruzado Anterior/reabilitação , Duração da Cirurgia , Aloenxertos/transplante , Autoenxertos/transplante , Tendões dos Músculos Isquiotibiais/transplanteRESUMO
PURPOSE: To investigate tibial tunnel widening and knee instability after ACL reconstruction with hamstring autograft or irradiated soft tissue allograft. METHODS: Eight-two patients were divided into two groups: autograft group and allograft group. Radiographic and clinical evaluations were performed. RESULTS: Seventy patients were followed up with median of 36.3 months (range 36-38 months). Tibial tunnel widening was at or greater than 30% for nine patients in the autograft group and 15 patients in the allograft group (P = 0.0417). The average percentage of tibial tunnel widening was 26.7 ± 4.0 % and 29.7 ± 5.3 % in autograft and allograft groups, respectively (P = 0.0090). Knee range of motion was not affected by the reconstruction operation or different grafts. Thigh atrophy improved significantly within 24 months after ACL reconstructions in both groups. ACL reconstruction with the allograft leaded to less knee stability than that with the autograft from one year after operation (P = 0.0023). There was no significant difference between two groups with respect to Lysholm score (P = 0.1925) and Tegner score (P =0 .0918) at the final follow-up. CONCLUSION: The allograft group reported significantly more tibial tunnel widening and knee instability compared with the autograft group.
Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/métodos , Instabilidade Articular/cirurgia , Tíbia/cirurgia , Adolescente , Adulto , Aloenxertos/transplante , Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Reconstrução do Ligamento Cruzado Anterior/reabilitação , Autoenxertos/transplante , Feminino , Seguimentos , Tendões dos Músculos Isquiotibiais/transplante , Humanos , Masculino , Duração da Cirurgia , Osteotomia/métodos , Período Pós-Operatório , Período Pré-Operatório , Estudos Prospectivos , Coxa da Perna/patologia , Resultado do Tratamento , Adulto JovemRESUMO
CONTEXT AND OBJECTIVE: Lasers are widely used in treating symptomatic benign prostatic hyperplasia. In current practice, potassium titanyl phosphate (KTP) lasers are the most common type of laser systems used. The aim here was to evaluate the rapid effect of high-power laser systems after application of hypericin. DESIGN AND SETTING: Experimental animal study conducted in the Department of Urology, Gülhane Military Medical Academy, Ankara, Turkey, in 2012. METHODS: Sixteen rats were randomized into four groups: 120 W KTP laser + hypericin; 120 W KTP laser alone; 80 W KTP laser + hypericin; and 80 W KTP laser alone. Hypericin was given intraperitoneally two hours prior to laser applications. The laser incisions were made through the quadriceps muscle of the rats. The depth and the width of the laser incisions were evaluated histologically and recorded. RESULTS: To standardize the effects of the laser, we used the ratio of depth to width. These new values showed us the depth of the laser application per unit width. The new values acquired were evaluated statistically. Mean depth/width values were 231.6, 173.6, 214.1 and 178.9 in groups 1, 2, 3 and 4, respectively. The most notable result was that higher degrees of tissue penetration were achieved in the groups with hypericin (P < 0.05). CONCLUSIONS: The encouraging results from our preliminary study demonstrated that hypericin may improve the effects of KTP laser applications. .
CONTEXTO E OBJETIVO: Lasers são amplamente utilizados no tratamento de hiperplasia benigna de próstata sintomática. Na prática atual, lasers de fosfato de titanilo de potássio (KTP) são os tipos mais comuns usados dos sistemas. O objetivo foi avaliar o efeito rápido do sistema laser de alta potência após a aplicação de hipericina. TIPO DE ESTUDO E LOCAL: Estudo experimental animal, realizado no Departamento de Urologia, Academia de Medicina Militar de Gülhane, Ancara, Turquia, em 2012. MÉTODOS: 16 ratos foram divididos aleatoriamente em 4 grupos: 120W KTP laser + hipericina; 120W KTP laser somente; 80W KTP laser + hipericina; 80W KTP laser somente. Hipericina foi dada intraperitonealmente duas horas antes da aplicação do laser. As incisões a laser foram feitas através do músculo quadríceps dos ratos. A profundidade e a largura das incisões a laser foram avaliadas histologicamente e registradas. RESULTADOS: Para padronizar o efeito do laser foi utilizada a razão entre profundidade e largura. Estes novos valores nos mostraram a profundidade da aplicação do laser de largura por unidade. Os novos valores adquiridos foram avaliados estatisticamente. Os valores da média de profundidade/largura foram 231,6, 173,6, 214,1 e 178,9 nos grupos 1, 2, 3 e 4, respectivamente. O resultado mais notável foi atingir altos graus de penetração tecidual nos grupos com hipericina (P < 0,05). CONCLUSÕES: Os resultados promissores do nosso estudo preliminar mostraram que hipericina pode melhorar os efeitos das aplicações do laser KTP. .