ABSTRACT
Background: Among males, osteoporosis is less common than in women, but can also be a health issue. Aim: To report the frequency and clinical manifestations of osteoporosis among males referred to perform a bone densitometry. Material and Methods: All densitometries performed during one year at a clinical institution were analyzed and those corresponding to males aged over 18 years were selected to review the clinical record of the patient. Osteoporosis was defined as a bone mineral density T score < -2.5 among males aged over 50 years or a Z score below -2.0 and a history of osteoporotic fracture among males aged less than 50 years. Results: Of 5792 densitometries performed, 439 (8 percent) corresponded to males aged more than 18 years. Among these 156 (82 percent aged more than 50 years) had an abnormal densitometry. Seventy patients had osteoporosis, (67 percent only by DXA) and the rest had an osteoporotic fracture. Mean age and body mass index of the latter was 62 +/- 15 years and 25.9+/- 3 kg/m2, respectively. Forty two percent had osteoporosis in the spine, 35 percent in the hip and 23 percent in both sites. Thirty six of the 70 patients with osteoporosis (51 percent) had a history of osteoporotic fracture in column, hip, wrist and other sites in 55, 11, 8 and 26 percent respectively. Seventy eight percent of these patients were aged more than 50 years. The most common causes of osteoporosis were idiopathic in21 percent, induced by glucocorticoids in 20 percent, associated with vitamin D deficiency in 16 percent and associated to chronic renal failure in 14 percent. Conclusions: One of six male referred for bone densitometry have osteoporosis, usually associated with other underlying diseases. In half of these patients, osteoporosisis severe.
Subject(s)
Humans , Male , Adult , Middle Aged , Bone Density , Densitometry/methods , Osteoporosis/diagnosis , Osteoporosis/epidemiology , Osteoporosis/etiologyABSTRACT
Radiosynovectomy is a local form of radiotherapy used as second-line treatment in the management of inflammatory and non-inflammatory arthropathies with unsatisfactory response to local or systemic corticosteroid therapy. Its efficacy is similar to that of surgical synovectomy, with the advantages of being a low-cost and minimally- invasive treatment that requires a shorter recovery time. Its efficacy is greater in the treatment of inflammatory arthritis characterized by synovitis, such as rheumatoid arthritis and juvenile chronic arthritis with mono/oligoarticular involvement, especially in upper extremity joints. A number of isotopes can be used in colloidal suspensions. Rhenium-186-sulphide colloid is currently indicated for the treatment of medium-sized joints. The ultrasound-guided injection is suitable for small joints, such as wrist. For proper and safe use and administration of this technique the collaboration of a trained and experienced radiologist is critical to successful treatment.
La radiosinovectomía es una forma local de radioterapia utilizada como tratamiento de segunda línea en el manejo de artropatías inflamatorias y no inflamatorias con respuesta insatisfactoria a la terapia sistémica o local con corticoesteroides. Tiene una eficacia similar a la sinovectomía quirúrgica, con las ventajas de ser un tratamiento de menor costo, menos cruento y con menor tiempo de convalecencia. Su eficacia es mayor en artropatías inflamatorias caracterizadas por sinovitis, como la artritis reumatoide y artritis crónica juvenil, con compromiso mono u oligoarticular y en articulaciones de extremidades superiores. Existen múltiples isótopos que se pueden utilizar en suspensiones coloidales, siendo el sulfuro coloidal de renio-186 el utilizado para la articulación radiocarpiana. Una técnica de administración adecuada es fundamental para el éxito del tratamiento, siendo la inyección con guía ultrasonográfica adecuada para articulaciones de volumen pequeño, instancia en la que la colaboración del médico radiólogo entrenado es fundamental.
Subject(s)
Female , Arthritis, Juvenile/therapy , Rhenium/therapeutic use , Synovitis/therapy , Ultrasonics/methods , Arthritis, Juvenile/complications , Injections, Intra-Articular , Wrist , Radiopharmaceuticals/therapeutic use , Patient Selection , Synovitis/etiology , Combined Modality TherapyABSTRACT
Echinococcal disease remains a major problem within some endemic areas. We report a case of a single primary echinococcal cyst located in the retroperitoneal space. A 54-year-old woman, born in a rural area of southern Chile, was admitted with a 3-month history of right hip pain and painful swelling of the gluteal region. Hidatid disease was confirmed with serologic test, radiological examinations and histo-pathology. There were no cysts in any other location. A percutaneous drainage was performed and antihelminthics were administered for 12 weeks and is now being closely followed up, with good response to therapy. Especially in the endemic areas hydatid cyst should be considered when evaluating retroperitoneal cystic masses.
La hidatidosis sigue siendo un problema prevalente en áreas endémicas. Presentamos el caso de un quiste hidatídico primario ubicado en el espacio retro-peritoneal. Mujer de 54 años, procedente de área rural del sur de Chile, hospitalizada por cuadro de coxalgia derecha y aumento de volumen glúteo, con tres meses de evolución. Se realizó el diagnóstico de hidatidosis complicada por medio de exámenes de imágenes, tests serológicos y anatomía patológica. No se demostraron quistes hidatídicos en otras ubicaciones. Se realizó un drenaje percutáneo del quiste infectado y se administraron antihelmínticos durante 12 semanas y actualmente permanece en seguimiento cercano con buena respuesta al tratamiento. El quiste hidatídico debe ser considerado en el diagnóstico diferencial de masas quísticas retro-peritoneales, especialmente en áreas endémicas.
Subject(s)
Female , Humans , Middle Aged , Echinococcosis/diagnosis , Retroperitoneal Space/parasitology , Anthelmintics/therapeutic use , Drainage , Echinococcosis/therapy , Magnetic Resonance Imaging , Tomography, X-Ray ComputedABSTRACT
La artrosis de cadera es una patología de múltiples etiologías. Los principios biomecánicos implicados en el desarrollo de la artrosis se basan en la transmisión de fuerzas a través de la superficie articular, iniciándose la degeneración cartilaginosa por sobrecarga. Existe un grupo de pacientes jóvenes que presentan artrosis cuya causa ha sido históricamente catalogada como idiopática o primaria. El advenimiento de nuevos conocimientos de la anatomía normal y patológica de la cadera ha permitido detectar alteraciones más sutiles. El pellizcamiento fémoroacetabular (PFA) aparece entonces como una nueva causa mecánica de dolor de cadera (1). Esto, en el tiempo llevaría a una lesión del labrum acetabular y/o el cartílago adyacente (2, 3, 22) y finalmente, a una artrosis precoz. Esta patología es de consulta frecuente en pacientes jóvenes con coxalgia no diagnosticada. Puede comprometer a diversas especialidades de la medicina durante su consulta primaria con distintas formas de presentación, hallazgos semiológicos e imaginológicos.
Hip osteoarthritis is pathology with multiple etiologies. The biomechanical principles involved in the development of hip osteoarthritis are based on force transmission through the articular surface, initiating carthilage degeneration due to overload. There is a group of young patients who present hip osteoarthritis that have been historically classified as idiopathic or primary. The progress in knowledge of normal anatomy and pathologies of the hip has made it possible to detect more subtle alterations. The femoroacetabular impingement (FAI) appears as a new mechanical cause for hip osteoarthritis (1). This, in time, would lead to acetabular labral and/or carthilage lesions (2, 3, 22) and eventually, early onset osteoarthritis. This pathology is frequent in young patients with an undiagnosed hip pain. It can involve multiple medical specialties in its initial consult due to different forms of early presentation, findings during physical exam and image studies.
Subject(s)
Humans , Acetabulum/pathology , Joint Diseases/diagnosis , Osteoarthritis, Hip/diagnosis , Femur/pathologyABSTRACT
Background: Knee osteoarthritis is highly prevalent in our country. An early diagnosis is very important to provide an accurate and early treatment, and eventually delay its progression. Aim: To compare the diagnostic yield for osteoarthritis of two projections in knee Xray examination. Material and Methods: We evaluated 44 knees with conventional (AP weight-bearing, in full extension) and Rosenberg (PA weight-bearing in 45 degrees of flexion) X ray projections in 32 patients (24 women and 8 men), aged 26 to 78 years. All patients were symptomatic at the time of evaluation, with a suspicion of knee osteoarthritis. Both projections were analyzed and compared. Results: Joint space in the lateral compartment with conventional AP weight-bearing and Rosenberg projections were 8.6±11.5 mm and 7.8±10.9 mm, respectively (NS). The joint space for the medial compartment were 8.2±10.9 mm and 6.7±8.6 mm, respectively (p <0.05). Conclusions: Rosenberg projection is more sensitive to detect knee joint space narrowing as compared with conventional AP weight-bearing prqjection, at least in the medial compartment ofthe knee. Therefore, Rosenberg prqjection should be included in the initial study of any patient with suspicion ofknee osteoarthritis.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Arthrography/methods , Knee Joint , Osteoarthritis, Knee , Analysis of Variance , Biomechanical Phenomena , Cartilage, Articular , Chi-Square Distribution , Knee Joint/physiology , Osteoarthritis, Knee/physiopathology , Weight-BearingABSTRACT
La osteoartrosis de rodilla es una patología con una elevada prevalencia en nuestro medio cuyo diagnóstico precoz es fundamental para un adecuado y oportuno tratamiento, y eventualmente, retrasar su progresión. En población deportista de la vida media, su detección precoz puede ser muy importante para el consejo médico de una práctica deportiva que no agrave su progresión. Evaluamos las radiografías de 44 rodillas en 32 pacientes (24 mujeres y 8 hombres), entre 26 y 78 años. Todos los pacientes eran sintomáticos y con un diagnóstico presuntivo de gonartrosis. Las proyecciones radiológicas empleadas fueron: convencional (anteroposterior (AP) en extensión, con carga) y Rosenberg (posteroanterior (PA) con carga y flexión de 45 grados). Al analizar y comparar ambas proyecciones se encontró una mayor capacidad de la proyección de Rosenberg para detectar la disminución del espacio articular en la articulación femorotibial, comparado con las proyecciones convencionales AP. Dicha diferencia fue estadísticamente significativa en nuestro estudio. Se concluye que la proyección de Rosenberg debería ser la proyección de elección en el estudio radiológico inicial de todo paciente con sospecha de gonartrosis.
Subject(s)
Adult , Middle Aged , Cartilage, Articular/injuries , Cartilage, Articular , Osteoarthritis, Knee/diagnosis , Osteoarthritis, Knee , Knee Joint , Early Diagnosis , Reproducibility of Results , Radiography/methods , Weight-BearingABSTRACT
Background: Percutaneous biopsies have a good sensitivity and specificity for the diagnosis of bone lesions. Aim: To report the experience with 270 percutaneous bone lesions biopsies guided with fluoroscopy or computed tomography. Material and Methods: Retrospective review of the medical records of 270 patients (mean age 53.4 years, range 4 to 95 years; 134 female) subjected to a percutaneous biopsy of a bone lesion, guided either by computed tomography or fluoroscopy. The final analysis included the tumor type, tumor malignancy, tumor grade and complications of the procedure. Results: One hundred seventy nine lesions were malignant and 91 benign. Of the malignant lesions, 95 were metastatic and 84 were primary. In 3 cases, the initial diagnosis was a false negative (1.1 percent). Only one patient had a local hematoma after the procedure. Conclusions: Image guided percutaneous biopsy of bone lesions is a safe, effective, fast and economic procedure to obtain a pathological diagnosis of bone lesions.
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Biopsy, Needle/methods , Bone Neoplasms/pathology , Bone and Bones/pathology , Radiography, Interventional , Spinal Injuries , Bone Neoplasms , Bone Neoplasms/secondary , Bone and Bones , False Negative Reactions , Fluoroscopy , Neoplasms, Second Primary/pathology , Neoplasms, Second Primary , Retrospective Studies , Sensitivity and Specificity , Tomography, X-Ray ComputedABSTRACT
Background: Bone marrow edema syndrome (BMES) is a rare clinical condition. Its etiology is unknown and it can be seen in different locations. In the case of the hip, avascular necrosis is the main differential diagnosis. Aim: To present our experience of BMES of the hip and a review of the literature. Patients and methods: Retrospective analysis of clinical records of patients with hip pain that met clinical, radiological, and magnetic resonance imaging criteria for BMES. Clinical outcome and clinical and radiological follow up are presented. Results: Two men and two women (one of them pregnant) aged 42, 48, 36 and 26 years old, fulfilled criteria. Treatment included limited weight bearing, non steroidal antiinflammatory drugs, intranasal calcitonin and physical therapy. Complete remission of symptoms was observed within five to seven months. At an average follow up of 36 months, all patients presented complete function of the hip, returning to their previous activity levels, with no new episodes of BMES. Conclusions: It is important to be aware of this condition as part of the differential diagnosis of hip pain to avoid aggressive and unnecessary diagnostic and therapeutic procedures (Rev Méd Chile 2004; 132: 947-54).
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Pregnancy , Bone Marrow Diseases/diagnosis , Edema/diagnosis , Hip Joint , Bone Diseases, Metabolic/diagnosis , Diagnosis, Differential , Femur Head Necrosis/diagnosis , Magnetic Resonance Imaging , SyndromeSubject(s)
Humans , Male , Aged , Low Back Pain/diagnosis , Hematopoiesis, Extramedullary , Tomography, Emission-ComputedABSTRACT
Introducción: La sospecha clinica de fractura de escafoides sin confirmación radiografica, habitualmente lleva a inmovilización y tratamiento sintomático. La resonancia magnetica (RM) precoz permite definir cuales casos presentan realmente fractura, modificando la conducta terapeutica. Material y metodos: En 15 pacientes con sospecha clinica de fractura de escafoides y radiografia normal, se realizó RM dentro de un plazo no mayor a 9 dias despues del trauma. Se utilizaron secuencias T1 turbo-spin-echo (TSE) coronal y short-tau-inversion recovery (STIR) coronal. Resultados: La RM demostró fracturas ocultas de escafoides en 5 pacientes (33 por ciento), todas ellas fueron detectadas con una combinación de secuencias STIR y T1. Los pacientes con radiografia y RM negativos para fractura se reintegraron a sus actividades habituales en un plazo menor a dos semanas. Esto se tradujo en reducción de al menos 50 por ciento de costos en examenes radiológicos, ademas de disminuir el número de consultas de control y ausentismo laboral. Conclusión: La RM precoz tiene alta sensibilidad para la detección de fracturas de escafoides radiograficamente ocultas y permite un diagnóstico definitivo y tratamiento oportuno, evitando inmovilización innecesaria en pacientes sin fractura, llevando a una significativa reducción de costos.
Subject(s)
Humans , Magnetic Resonance Spectroscopy , Scaphoid Bone/injuries , Scaphoid Bone , Diagnostic Techniques and ProceduresABSTRACT
La condromatosis sonovial es un proceso beningo infrecuente que afecta las articulacione y otras estructuras que contienen tejido sinovial. Se presenta el caso de una mujer de 46 años con condromatosis sinovial sintomática de cadera derecha, en etapa inicial, localizada en la fosa acetabular. El tratamiento fue la resección abierta de la lesión mediante luxación quirúrgica de la cadera. No hubo complicaciones intra o postoperatorias y la osteotomía consolidó adecuadamente. Al último seguimiento, la paciente no tiene dolor y realiza una vida normal.
Subject(s)
Humans , Adult , Female , Middle Aged , Chondromatosis, Synovial/surgery , Hip Dislocation/surgeryABSTRACT
Se presentan dos casos clínicos de neuritis braquial (síndrome de Parsonage-Turner). Se discuten los aspectos clínicos y los hallazgos en resonancia magnética destacando el valor de ésta en su diagnóstico.
Subject(s)
Humans , Male , Adult , Middle Aged , Brachial Plexus Neuritis/diagnosis , Diagnosis, Differential , Shoulder Pain/etiology , Magnetic Resonance Imaging , Brachial Plexus Neuritis/physiopathology , Paresis/etiologyABSTRACT
Se presenta una serie de 18 pacientes sometidos a pancreatoduodenectomía por cáncer de ampolla de Vater, entre febrero de 1983 y marzo de 1994, 10 hombres y 8 mujeres con una edad promedio de 57 años. Los síntomas más frecuentes de presentación fueron ictericia en 17 enfermos (94.4 por ciento9 y baja de peso en 11 (61.1 por ciento). La complicación quirúrgica más frecuente fue la fístula pancreática en 4 pacientes (22 por ciento). Falleció un enfermo (5.5 por ciento), lográndose una sobrevida actuarial de 38 por ciento a 5 años, para la serie global