Use of cuff tear arthroplasty head prosthesis for rotator cuff arthropathy treatment in elderly patients with comorbidities / Utilização de prótese do tipo cabeça cuff tear arthroplasty para o tratamento de artropatia do manguito rotador em pacientes idosos e com comorbidades

ABSTRACT Objective To evaluate the clinical and functional behavior of patients undergoing cuff tear arthroplasty at different stages of the disease. Methods Cuff tear arthroplasty hemiarthroplasties were performed in 34 patients with rotator cuff arthropathy and associated comorbidities, classified according to Seebauer. The mean age was 76.3 years, and the sample comprised 23 females (67.6%) and 11 males (32.4%). The mean follow-up period was 21.7 months, and evaluations were performed using the Visual Analog Scale for pain and the Constant scale. Results There were no statistically significant differences in the mean reduction in the Visual Analog Scale or in the Constant scale increase between the female and male groups. The variation between the pre- and postoperative Visual Analog Scale and Constant scale evaluations was significant. There was also no statistically significant difference between the Seebauer classification groups regarding the mean Visual Analog Scale reduction, or the mean Constant scale increase. Conclusion Cuff tear arthroplasty shoulder hemiarthroplasty is a good option for rotator cuff arthropathy in patients with comorbidities.

RESUMO Objetivo Avaliar o comportamento clínico e funcional dos pacientes submetidos à artroplastia do tipo cuff tear arthroplasty para o tratamento da artropatia do manguito rotador em diferentes estágios da afecção. Métodos Foram realizadas 34 hemiartroplastias do tipo cuff tear arthroplasty em 34 pacientes com artropatia do manguito rotador e comorbidades associadas, classificadas de acordo com Seebauer. A média de idade foi de 76,3 anos, sendo 23 pacientes do sexo feminino (67,6%) e 11 do sexo masculino (32,4%). O seguimento médio foi de 21,7 meses e a avaliação foi realizada por meio da Escala Visual Analógica da dor e pela escala de Constant. Resultados Não houve diferença estatisticamente significante entre os grupos feminino e masculino, tanto nas médias de redução na Escala Visual Analógica quanto nas de aumento na escala de Constant. A variação entre as avaliações da Escala Visual Analógica e da escala de Constant pré e pós-operatórias foi significante. Não houve diferença estatisticamente significante entre os grupos de classificação de Seebauer quanto às médias de redução na Escala Visual Analógica e nem quanto às médias de aumento na escala de Constant, e não houve casos de infecção. Conclusão A hemiartroplastia do ombro tipo cuff tear arthroplasty é boa uma opção nos pacientes com artropatia do manguito rotador, especialmente em pacientes com comorbidades.

Levator Resection in the Management of Myopathic Ptosis

PURPOSE: To evaluate the results of levator resection in patients with myopathic ptosis. METHODS: The medical records of consecutive patients who underwent levator resection surgery performed for myopathic ptosis between October 2009 and March 2013 were reviewed. Indications for surgery were ptosis obscuring the visual axis and margin-reflex distance or =3 mm. We analyzed the effect of levator function and Bell's phenomenon on the rates of success and corneal complication. RESULTS: This series included six male and six female patients. Levator function was between 4 and 12 mm. We performed bilateral levator resection surgery in all patients. The mean follow-up time was 14.8 months (range, 6 to 36 months). No patient was overcorrected. Adequate lid elevation was achieved after the operation in 20 eyes. Ptosis recurred in three out of 20 eyes after adequate lid elevation was achieved. Our overall success rate was 70.8%. In three eyes with poor Bell's phenomenon, corneal irritation and punctate epitheliopathy that required artificial eye drops and ointments developed in the early postoperative period, although symptoms resolved completely within 2 months of the resection surgery. No patients required levator recession or any other revision surgery for lagophthalmos or corneal exposure after levator resection. CONCLUSIONS: Levator resection seems to be a safe and effective procedure in myopathic patients with moderate or good Bell's phenomenon and levator function greater than 5 mm.

Imaging in the Diagnosis of Symptomatic Forearm Muscle Herniation.

Symptomatic muscle herniations are an unusual cause of upper extremity pain that is rarely reported in the literature. Out of 18 reported cases of upper extremity herniations, only 3 were caused by strenuous exertion6. Dynamic ultrasound and Dynamic MRI test are the very good tool for diagnosis of muscle herniation, FNAC and biopsy are rarely needed. This article describes a successful repair of a 22yr old manual worker’s ventral forearm herniation with polypropylene mesh. Prevalence Muscle herniation in an extremity is a well-known cause of pain, even though there have been extremely few documented cases. In a 2009 report published by the “Journal of Hand and Microsurgery,” only 200 cases of herniated muscles of the extremities had been reported since the mid-1800s, and only 17 cases of muscle herniation in the upper limb have been described10. Characteristics A herniated muscle in the forearm can cause mild to severe localized pain, affect grip, cause nerve pain or have no physical symptoms at all. Causes of documented cases include sporting or occupational activities, or an unrelated primary medical condition. Patients usually have a swollen mass that increases in size when the affected muscle is engaged and decreases when the muscles are relaxed. One differential diagnosis for a herniated forearm muscle is a tumor. Muscle herniation in the forearm typically affects males in their adolescent or young-adult years1. We report a case of a disappearing forearm nodule that appeared with muscle contraction. This is characteristic of a transfascial muscle hernia. Ultrasound and MRI are the key to identifying an area of fascial alteration. Treatment alternatives of this unusual condition are discussed.

Hidatidosis primaria de la musculatura de la pierna que simula un caso de fasceítis eosinofílica: reporte de un caso / Hydatid cyst of the soleus muscle: report of one case

Hydatid cysts may occasionally be confused with soft tissue tumors such as sarcomas. We report a 43 years oíd female living in a rural zone, presenting with a painful tumor in her left leg. A CAT sean showed the presence of a solid-eystic lesion in the left soleus muscle. A biopsy of the zone was informed as eosinophilic fasceitis and steroids were indicated. Two months later a new CAT sean showed that the lesion was increasing in size. An IgG for hydatidosis was positive. The patient was subjected to a cystectomy and the pathology report informed a hydatid cyst.

En nuestro país la hidatidosis sigue siendo un importante problema de salud pública. Generalmente compromete el hígado y el pulmón, sin embargo, se han reportado casos con compromiso de diversos órganos, como bazo, peritoneo y otras ubicaciones. Excepcionalmente puede presentarse como un tumor de partes blandas simulando un sarcoma u otro tumor. Presentamos un caso clínico de una paciente con hidatidosis de la musculatura de la pierna derecha tratado en el Hospital Base Osorno, que simuló una fasceítis eosinofílica; además se revisa el estado del arte de la hidatidosis muscular.

Hidatidosis muscular: 2 casos clínicos / Muscle hydatidosis: two clinical cases

La hidatidosis por equinococcus granolossus es una parasitosis que afecta principalmente a hígado y pulmón y que en una mínima proporción implica de forma primaria al músculo. Presentamos 2 casos de pacientes intervenidos por una masa quística muscular que tras llegar al diagnóstico de hidatidosis fue tratada con antihelmínticos. Se practicó intervención radical resecando en bloque la periquística. en el seguimiento postoperatorio no se apreciaron imágenes quísticas no siendo necesarias nuevas intervenciones. El tratamiento de elección de la hidatidosis en cualquier localización es la resección quirúrgica radical (quistoperiquistectomía), lo que requiere un diagnóstico previo adecuado. Ante una masa quística muscular no se debe olvidar esta lozalización de la hidatidosis, ya que el primer tratamiento que se realice determinará la evolución de una patología benigna que, como en nuestro caso, puede evolucionar con recurrencias múltiples, muy invalidantes y de difícil resolución. La rareza de un caso de hidatosis muscular primaria, incluso en un país endémico como el nuestro, junto con la evolución peculiar, que puede recordar ciertas premisas básicas en el tratamiento de la enfermedad hidatídica, sea cual sea su localización, han motivado la comunicación de estos casos.

Quantitative and Qualitative Muscular Changes after Selective Neurotomy

Disfigurement of body contour, caused by excessive muscular hypertrophy, can seldom be effectively and safely corrected by lipectomy, liposuction or combined partial myomectomy. This study was conducted to obtain basic knowledge for the development of a safe and effective method of treating patients with excessive and unwelcome muscle hypertrophy. Accordingly, we developed a new experimental rat model, consisting of the peroneal nerve and its target muscles - the anterolateral crural muscle group. After severance of 1/4, 1/2, and 1/1 of the peroneal nerve, functional parameters based on gross movement and electrophysiologic data were monitored. Changes in the external circumference and weight of the anterolateral crural muscle were documented and compared with control sides. Histologic and histomorphometric parameters of the muscle were also documented. Average takeoff latency in 1/4 and 1/2 neurotomy groups was increased to 130% and 154% of the control at 3 months, and 156% and 149% of control at 6months, respectively. Similarly, average peak-to-peak compound action potentials were 72% and 59% of the control at 3months and 57% and 50% of control at 6months. No definite gait disturbances were evident in the partial neurotomy groups. Maximal circumferences of the anterolateral crural muscle group were significantly reduced to 86%, 71% and 66% of the control in the 1/4, 1/2 and 1/1 neurotomy groups at 3 months (p < 0.001), and to 74%, 68% and 64% of the control at 6 months, respectively (p < 0.001). The corresponding weights were 76%, 62%, and 50% of the control sides at 3 months, and 70%, 56%, and 48% at 6 months in 1/4, 1/2 and 1/1 neurotomy groups. Histograms drawn showing the number of muscle fibers per mm2 in cross-sections, showed a total number of 239 +/- 52 in the control group; the size of muscle fibers was mainly medium to large. The more extensive the neurotomy, the greater the was the number of small angulated muscle fibers, up to a total of 1,564 +/- 211. Although more research work and clinical trials are required, we believe that selective neurotomy has the potential of being an effective tool for reducing muscle bulk, and avoiding apparent muscular dysfunction and complications.

Ausência congênita de reto inferior / Congenital absence of inferior rectus

Os autores apresentam dois casos de ausência congênita do reto inferior, tratados pelo deslocamento vertical dos retos horizontais (cirurgia de Knapp invertida).

Torcicolo muscular congênito: resultado do tratamento cirúrgico / Congenital torticollis: results of surgical management

Sao apresentados três casos de uma mesma família. portadores de osteólise idiopática com padrao de herança do tipo dominante autossômico e expressividade variável. Fazem-se comentários sobre os vários tipos de osteólises conhecidos e de outras afecçoes do esqueleto que devem entrar no diganóstico diferencial. Um dos pacientes. devido à gravidade do acomentimento nos quadris, necessitou de ressecçao das cabeças femorais. É descrito o resultado anatomopatológico das peças removidas.

Artrodese tríplice do pé: revisäo de 117 casos / Triple arthrodesis of the foot: review of 117 cases

No período de 1977 a 1990, foram operados 117 pés em 109 pacientes portadores de doenças neuromusculares, através da tríplice artrodose modelante do pé. Obteve-se o apoio plantígrado com correçäo total da deformidade em 94,8% dos casos, proporcionando, conseqüentemente, melhora da marcha, da dor e da estética nos pacientes