Osteochondroma: ignore or investigate? / Osteocondroma: ignorar ou investigar?

Osteochondromas are bone protuberances surrounded by a cartilage layer. They generally affect the extremities of the longbones in an immature skeleton and deform them. They usually occur singly, but a multiple form of presentation may be found. They have a very characteristic appearance and are easily diagnosed. However, an atypical site (in the axial skeleton) and/or malignant transformation of the lesion may sometimes make it difficult to identify osteochondromas immediately by means of radiographic examination. In these cases, imaging examinations that are more refined are necessary. Although osteochondromas do not directly affect these patients' life expectancy, certain complications may occur, with varying degrees of severity...

Osteocondromas são protuberâncias ósseas envolvidas por uma camada de cartilagem. Atingem, habitualmente, as extremidades dos ossos longos no esqueleto imaturo e os deformam. Em geral são únicos, mas a forma de apresentação múltipla pode ser encontrada. De aspecto bastante característico, são de fácil diagnóstico. Contudo, por vezes, a localização atípica (esqueleto axial) e/ou a malignização da lesão podem dificultar a sua pronta identificacão por exames radiográficos. Nesses casos, exames de imagem mais apurados são necessários. Apesar de não afetarem diretamente a expectativa de vida do portador, algumas complições, com variados graus de gravidade, podem ocorrer...

Bone mineral content reduction in youth with surgical form of Schistosomiasis mansoni: factors involved in the pathogenesis

Thirty two children and adolescents from 14 to 20 years of age, suffering from hepatosplenic schistosomiasis mansoni and bleeding esophageal varicose veins, were evaluated for bone mineral density (BMD), before undergoing medical and surgical treatment. The surgical protocol was splenectomy, autoimplantation of spleen tissue into a pouch of the major omentum and ligature of the left gastric vein. Follow up of these patients'ranges from one to ten years with a mean of five years. The BMD was measured at the lumbar spine (L2 - L4) through the dual energy absorptionmetry X-ray (DEXA), using a LUNAR DPX-L densitometer. The degree of Symmers'fibrosis was assessed by semiautomatic hystomorphometry. In eleven patients, the serum magnesium was measured before an intravenous overload of this ion and subsequently after eight and twenty four hours. Urine was collected 24 hours before and 24 hours after the magnesium overload. Deficiency of magnesium was considered when the uptake of this ion was greater than 40 por cento. There was a significant trend of association between the status of bone mineral content and the Symmers'fibrosis degree (chi² = 6.606 R = 0.01017). There was also a moderate agreement between the greater fibrosis densities ( > the mean percentage) and bone mineral deficits. Although the normal bone mineral content was more found among the patients with better hepatic functional reserve, the results did not reach statistical significance. There was a marked magnesium retention (>95 por cento) in one patient who had severe osteoporosis and a slight depletion (<5 por cento) in another patient, who presented no bone mineral deficit. It was concluded that the patients included in this series, showed an important BMD deficit, specially among the females which has had a significant improvement after medical and surgical treatment. Bone mineral deficit was associated with the degree of Symmers'fibrosis. Magnesium depletion was present in two out of eleven patients. It is speculated that magnesium supplementation may be warranted to forestall the progression of bone mineral deficit in patients with more impaired hepatic functional reserve.

Bone mineral density in children and adolescents with hepatosplenic mansonic schistosomiasis and esophageal varices who underwent splenectomy and ligature of the left gastric vein

Twenty eight children and adolescents from 7 to 19 years of age, suffering from hepatosplenic mansonic schistosomiasis and bleeding esophageal varices were evaluated for bone mineral density (BMD), before undergoing medical and surgical treatment. The surgical protocol was splenectomy, autoimplantation of spleen tissue into a pouch of the greater omentum and ligature of the left gastric vein. Twenty one patients were evaluated after a follow up from two to nine years post surgical treatment. The BMD was measured at the lumbar spine (L2 - L4) through the dual energy absorptionmetry X-ray (DEXA), using a LUNAR DPX-L densitometer. Preoperatively, all patients showed deficit of the BMD varying from 1 to 7.07 standard deviations (Mean +/- SEM - 2.64 +/- 0.28), considering the mean line of the control curve for healthy children accepted as normal. The BMD deficit was more evident among the females than the males. After treatment there was a significant increment (C2 = 9.19 - p =0.01) of the BMD and 29 percent of the patients (six out of twenty one) were considered without bone mineral deficit. It was concluded that the patients included in this series, who suffer from hepatosplenic mansonic schistosomiasis, showed an important BMD deficit, specially among the females which has had a significant improvement after medical and surgical treatment

Enxerto pediculado "clavicula pro humero": nova técnica cirúrgica para tumores malignos do terço proximal do úmero: relato de caso / Pedicled bone graft \"clavicula pro humero\": new surgical technique for proximal humerus malignant tumors: case report

Os autores descrevem caso de sarcoma osteogênico de úmero submetido a ressecçao e substituiçao por enxerto pediculado da clavícula homolateral. Nos casos de resposta favorável ao tratamento quimioterápico, a maioria dos tumores malignos do terço proximal do úmero é passível de ressecçao oncológica. A reconstruçao do defeito remanescente faz-se necessária para manter o comprimento do braço, estabilidade do ombro e a flexo-extensao do cotovelo. Diversos métodos de reconstruçao estao descritos na literatura, tais como: substituiçao por próteses, enxerto livre e/ou vascularizado do perônio, enxerto de banco com ou sem artrodese do ombro e a coaptaçao do restante da diáfise umeral na clavícula ou cavidade glenóide. Este trabalho descreve uma nova técnica cirúrgica em que a vascularizaçao da clavícula é preservada, permitindo soluçao biológica e funcional adequada para estes casos.

Ressecçäo total do calcâneo: apresentaçäo de quatro pacientes operados / Total resection of the calcaneous: presentation of four operated patients

Os autores analisaram os resultados cirúrgicos de quatro pacientes submetidos a ressecçäo total do calcâneo. A indicaçäo teve como base o exame físico, o exame radiológico e histopatológico nos três pacientes portadores de tumores ósseos e o exame físico e radiológico no caso do paciente portador de osteomielite crônica. Todos os pacientes foram submetidos a tratamento prévio em outros serviços, tendo sido submetidos a mais de uma intervençäo cirúrgica. Todos os pacientes apresentaram recuperaçäo parcial da funçäo do pé e tornozelo, com marcha sem uso de tutor e até o último exame clínico se encontravam curados da patologia que determinou a indicaçäo de ressecçäo do calcâneo e satisfeitos com o resultado obtido. O objetivo do presente trabalho é apresentar uma técnica de rara indicaçäo.

Densidade mineral óssea (BMD) em crianças esquistossómoticas na forma hepatoesplênica com indicaçäo cirúrgica / Bone mineral density (BMD) in children with hepatosplenic shistosomiasis with surgical indication

Onze crianças do sexo feminino e dez do sexo masculino, de idades ente sete e 16 anos, portadoras de hepato-esplenomegalia esquistossomótica, com indicaçäo cirurgica, foram avaliadas quanto a densidade mineral óssea (BMD), antes de serem submetidas a esplenectomia e ligadura da veia gástrica esquerda. O BMD foi obitido na coluna lombar (L2,L4) pela metodologia de absorçäo de duplo fóton através de um denitômetro modelo LUNAR-DPX-L. Todos os pacientes apresentaram déficit do BMD variando de um a 65 por cento(20 +-19por cento) do limite inferior da curva aceita como referênciade normalidade para criançass. O déficit foi mais evidente no sexo feminino, variando de um a 65 por cento(26 +- 25 por cento). Nas crianças do sexo masculino o déficit variou de seis a 18 por cento (14 +- 8 por cento). O estudo permide concluir que as crianças esquistossomóticos, forma hepatoesplênica, apresentaram déficit importante do BMD, sendo mais significativo no sexo feminino