Acrometástasis óseas, serie de casos y revisión de la literatura / Bone acrometástasis, case series and literature review

Resumen: Las acrometástasis se definen como metástasis óseas localizadas distales al codo y la rodilla. Su prevalencia es muy baja, aproximadamente el 0,1% de todas las metástasis óseas y se presentan en pacientes con enfermedad avanzada y son indicador de mal pronóstico. Hasta en el 10% de los casos se presentan como el primer signo de neoplasia oculta. Su forma de presentación clínica y radiológica es inespecífica, lo que genera retraso en su diagnóstico y tratamiento. La resonancia magnética es la imagen de elección para el diagnóstico. El tratamiento en la mayoría de los casos es paliativo. Presentamos cuatro pacientes con acrometástasis y una revisión de la literatura.

Abtract: Acrometastasis are defined as localized bone metastases distal to the elbow and knee. Its prevalence is very low, approximately 0.1% of all bone metastases and they present in patients with advanced disease and are considered indicators of poor prognosis. In up to 10% of cases are the first sign of undiagnosed neoplasia. Its clinical and radiological presentation is non-specific which generates delays in its diagnosis and treatment. Magnetic resonance is the image of choice for diagnosis. The treatment in most cases is palliative. We present four patients with acrometastasis and a review of the literature.

Comparison study of combined CT pulmonary angiography and venography with bilateral leg sonography in thromboembolic disease

The purpose of this study was to compare combined CT pulmonary angiography and venography with leg sonography for accuracy and relative efficacy in diagnosis of deep venous thrombosis from the popliteal vein to the common femoral vein. Seventy consecutive patients with clinically suspected pulmonary embolism underwent both combined CT pulmonary angiography and venography and bilateral leg sonography within 24 hr. CT venograms were analyzed independently in a blinded fashion for quality of venous opacification and patency by two observers. CT venography was compared with sonography for femoropopliteal vein thrombosis, and the final assessment based on multiple subjective and objective clinical and imaging criteria was recorded in three categories: 1, CT venography better than sonography; 2, CT venography equivalent to sonography; and 3, sonography better than CT venography. Sixty-eight patients [97%] had a satisfactory or good quality CT venography examination. Two CT venography studies had false-positive findings due to flow artifacts. Both CT venography and sonography had positive findings for deep venous thrombosis in five patients, and both had negative findings in 63 patients [100% sensitivity, 97% specificity, 100% negative predictive value, and 71% positive predictive value]. CT venography was better and more efficacious than sonography [category I] in 25 patients [36%]. CT venography was equivalent to sonography [category 2] in 26 patients [3 7%], and sonography was better than CT venography [category 3] in 19 patients [27%]. Compared with sonography, CT venography in addition to CT pulmonary angiography is a relatively accurate method for evaluation of femoropopliteal venous thrombosis. Combined CT pulmonary angiography and CT venography may be more efficacious than sonography or two separate examinations in selected patients

Hydrocortisone effects on composition of rat bone

Hydrocortisone is sometimes used as a necessary treatment for many diseases. But unfortunately, it usually causes osteoporosis when used for long periods of administration even with normal doses. It produces variations in calcium and phosphate contents in bones. The aim of the present work is to study the effects of long period hydrocortisone treatment on the bone composition of rat hind-leg. Three techniques were used in this study: X-ray imaging to analyze the bone density, molecular spectrophotometer for determining bone composition and histological study to clear the bone structure. The obtained data showed variations in calcium and phosphate contents during the hydrocortisone treatment periods which reached maximum changes after three weeks of treatment. The obtained results by X-ray images indicated changes in the bone density which were supported and found in good agreement with that obtained by both spectrophotometric analysis and structural changes

Diagnostic yield of color doppler ultrasonography in deep vein thrombosis

To see the diagnostic yield of color Doppler ultrasonography in patients who presented with clinical symptoms and signs of acute deep vein thrombosis of lower limb. Descriptive study. The study was carried out in Bolan Medical Complex Hospital, Quetta from January 2002 to December 2002. Twenty five patients, who presented with clinical symptoms and signs of acute deep venous thrombosis of lower limb, were selected. In all patients color Doppler ultrasound and venography was performed to compare the results. The age of the patients ranged from 16-82 +/- 20.33 years. The mean was 49.16, median 50.00 and mode 60.00 There were 15 females [60.00%] and 10 males [40.00%]. Left lower limb involvement was seen in 12 patients [48.00% +/- 0.51], right lower limb involvement in 10 patients [40.00% +/- 0.50] and both limbs involvement in 3.0 patients [12.00% +/- 0.33]. Color Doppler ultrasound was positive in 16 patients [64.00% +/- 0.48] while venography was positive in 21 patients [84.00% +/- 0.37%]. Doppler ultrasonography and venography showed that 11 patients [52.38%] had distal DVT, while 10 patients [47.62%] had distal as well as proximal DVT. Ten patients [100.00%] of proximal as well as distal DVT were diagnosed by CDU and later confirmed by venography. Eleven patients [100.00%] of distal DVT only in whom 6 patients [54.54%] were diagnosed by CDU, while 5 patients [45.46%] had inconclusive findings, which were confirmed by venography. Doppler ultrasonography compared venography showed sensitivity 76.1%, specificity 100%, positive predictive value 100%, negative predictive value 44.45% and accuracy 80.00%. Color Doppler ultrasonography is a non-invasive, safe, efficient and cost-effective method in diagnosing acute deep venous thrombosis of lower limb but still it has not 100% accuracy. It is better for diagnosing proximal DVT than distal DVT. 7

Rotational malalignment in osteoarthritic knees

To study the rotational alignment of lower limbs in patients with osteoarthritis of the knees, measuring two of its components, knee rotation and tibial torsion, by computer tomography. Material and Method: 46 subjects [36 patients with osteoarthritis of the knees and 10 age- and sex-matched asymptomatic volunteers] were included in the study. Cases were required to be "knee pain positive", ascertained using a previously standardized questionnaire and to have at least grade 3 radiographic changes using Kellgren and Lawrence criteria. All 92 limbs were scanned at the level of distal femoral condyle, proximal tibial condyles and ankle joint. Rotation of the knee joint was measured as an angle between the tangent to the dorsal aspect of femoral condyles [pro x i m a l reference line] and the dorsal tangent to the tibial condyles. Tibial torsion was measured as an inclination between the dorsal tangent to the tibial condyles and the tangent to the distal tibia at the level of the medial malleolus. The mean values of the two variables were reduced in patients with osteoarthritis of the knee. The decrease of tibial torsion [28.3° +/- 5.1°] in the osteoarthritic patients compared to the control group [35.4° +/- 6.2°] showed significance. Rotational malalignment may have some implications in the genesis of osteoarthritis of the rotationally intolerant knee joint

role of MR imaging in the diagnosis of swollen lower extremities

In this study, MR imaging of swollen extremity was performed on 20 patients using T1 and T2-weighted spin-echo and short inversion time inversion recovery sequences. Thickness and signal intensity of the cutis, subcutis and subfascia were evaluated in the images. In all cases with lymphatic edema, trabecular structures suggesting dilated collateral lymphatic vessels were observed in the swollen subcutis. Regarding the non-lymphatic patients, one case of nephrotic syndrome showed similar findings. In four cases with venous edema, fatty intensity was found in the subfascia. In the remaining three cases, the subcutis exhibited only water intensity

Value of colour-duplex scanning compared with arteriography for assessment of lower extrimity arterial diseases

This study aimed to emphasize the role of colored duplex ultrasound and its capabilities in detecting normal lower limb arterial tree and different morphological alterations caused by arterial diseases using contrast arteriography as the standard test to evaluate the results. Using it, atherosclerotic lesions, hemodynamically significant stenosis [>50% diameter reduction] and occlusions of the arteries both in the pelvic region and in the thigh-knee regions were detected. The study revealed that its high sensitivity [91%] and specificity [74%] for diagnosis and quantifying lower limb arterial diseases. It is more sensitive for femoropopliteal segments diseases [95%] than aortoiliac inflow system [85%]. Also, it is more sensitive to occlusion [95%] than stenosis [84%]. Aneurysms of the arterial tree, aortoiliac or peripheral were accurately diagnosed and assessed with 100% accuracy. It demonstrated the flow pattern inside it, thrombosis within it and its relation to important visceral arteries [renal and mesenteric arteries]