ABSTRACT
Abstract Schwannomas are benign slow-growing tumors that constitute 8% of all soft-tissue tumors. The clinical signs and symptoms are often misinterpreted because of the low incidence, and these tumors are often misdiagnosed. A 39-year-old male patient presented with non-traumatic solitary swelling in the posteromedial aspect of the right ankle that gradually increased in size and was associated with pain. Clinically, the swelling was firm, non-fluctuant, and was not associated with sensorimotor impairment. Surgical excision of the swelling was performed without damaging the surrounding vessels and nerves. The histopathological examination of the excised tumor revealed a schwannoma.
Resumo Schwannomas são tumores benignos de crescimento lento, e constituem 8% de todos os tumores de tecido mole. Os sinais clínicos e sintomas são muitas vezes mal interpretados por causa da baixa incidência, e, muitas vezes, esses tumores são mal diagnosticados. Um paciente do sexo masculino de 39 anos apresentou um inchaço solitário não traumático sobre o aspecto posteromedial do tornozelo direito, que aumentou gradualmente de tamanho e estava associado a dor. O inchaço era clinicamente firme, não flutuante, e não associado a qualquer comprometimento sensório-motor. A excisão cirúrgica do inchaço foi feita sem danificar os vasos e os nervos circundantes. O exame histopatológico do tumor excisado revelou schwannoma.
Subject(s)
Humans , Male , Adult , Pain , Signs and Symptoms , Ankle/pathology , NeurilemmomaSubject(s)
Humans , Male , Adult , Bone Diseases/surgery , Bone Diseases/diagnosis , Echinococcosis/surgery , Echinococcosis/diagnosis , Ankle/surgery , Ankle/pathology , Treatment OutcomeABSTRACT
BACKGROUND: The purpose of this study was to report findings of exploratory arthroscopic assessment performed in conjunction with removal of internal fixation device placed in the initial surgery for rotational ankle fracture. METHODS: A total of 53 patients (33 male, 20 female) who underwent surgery for rotational ankle fracture between November 2002 and February 2008 were retrospectively reviewed. All patients gave consent to the exploratory arthroscopic surgery for the removal of internal fixation devices placed in the initial surgery. Lauge-Hansen classification system of ankle fractures was assessed for all patients. Intra-articular lesions (osteochondral lesion, loose body, and fibrosis) were evaluated via ankle arthroscopy. Comparative analysis was then performed between radiological classification of ankle fracture/patient's symptoms and arthroscopic findings. RESULTS: Lauge-Hansen classification system of ankle fractures included supination-external rotation type (n = 35), pronation-external rotation type (n = 9), and pronation-abduction type (n = 9). A total of 33 patients exhibited symptoms of pain or discomfort while walking whereas 20 exhibited no symptoms. Arthroscopic findings included abnormal findings around the syndesmosis area (n = 35), intra-articular fibrosis (n = 51), osteochondral lesions of the talus (n = 33), loose bodies (n = 6), synovitis (n = 13), and anterior bony impingement syndrome (n = 3). Intra-articular fibrosis was seen in 31 of symptomatic patients (93.9%). Pain or discomfort with activity caused by soft tissue impingement with meniscus-like intra-articular fibrosis were found in 19 patients. There was statistical significance (p = 0.02) between symptoms (pain and discomfort) and the findings of meniscus-like fibrosis compared to the group without any symptom. CONCLUSIONS: Arthroscopic examination combined with treatment of intra-articular fibrosis arising from ankle fracture surgery may help improve surgical outcomes.
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Ankle/pathology , Ankle Fractures/pathology , Arthralgia , Arthroscopy/methods , Fibrosis , Retrospective Studies , Treatment OutcomeABSTRACT
Introducción: Presentamos nuestra casuística sobre 94 artroscopías de tobillo y retropié, realizadas entre 2008 y 2011; evaluando las complicaciones inherentes al procedimiento quirúrgico, en nuestra curva de aprendizaje. Material y Métodos: Todas fueron realizadas por el mismo cirujano. El promedio de edad 35,30 años; 75 hombres, 19 mujeres. Seguimiento, entre 1 mes y 3 años con un promedio de 10,77 meses. Las indicaciones en nuestra muestra fueron: lesiones osteocondrales (LOC): 42 pacientes (44,68 por ciento); de las cuales 3 fueron subastragalinas (7,14 por ciento del total de LOC), 5 tibiales (11,9 por ciento del total de LOC), el resto del astrágalo. Síndrome friccional posterior (SFP) 6 casos (6,38 por ciento). Síndrome friccional anterior (SFA) 44 casos (46,8 por ciento), que incluyeron: fibrosis anterolaterales, hipertrofias del ligamento tibio-peróneo inferior, bandas fibrosas intraarticulares y 4 artrofibrosis severas (4,25 por ciento del total de pacientes y 9 por ciento del total de SFA). Tenosinovitis crónicas: 7 pacientes (7,44 por ciento), 3 fueron de tendones peroneos y cuatro del tibial posterior. Resultados: Tuvimos un 10,63 por ciento (10 casos) de complicaciones inherentes al procedimiento quirúrgico artroscópico. El 60 por ciento fueron neurológicas, 2 infecciones superficiales, una de cada portal (anterolateral y anteromedial), 1 caso de sangrado intraarticular y 1 distrofia simpático-refleja. Conclusión: El tratamiento artroscópico de las lesiones mencionadas es el de elección, pero no está exento de complicaciones. Debe ser realizado por cirujanos experimentados ya que la curva de aprendizaje no es tan corta como a veces suponemos, al pensar en la artroscopía, como un procedimiento simple y sin complicaciones. Diseno del estudio: Retrospectivo. Nivel de evidencia: IV.
Subject(s)
Adolescent , Adult , Middle Aged , Young Adult , Ankle Joint/surgery , Arthroscopy/methods , Postoperative Complications , Retrospective Studies , Treatment Outcome , Ankle/pathologyABSTRACT
Esse relato apresenta o caso de uma paciente com quarta recidiva de sinoviosarcoma, um sarcoma de partes moles que possui estreita relação com bainhas tendinosas, bursas e cápsulas articulares. A paciente apresentou uma quarta recidiva, sendo necessária a realização da amputação de perna, visto que as cirurgias conservadoras já não aliviam o sofrimento da paciente. O principal objetivo deste relato de caso é apresentar um caso clássico de neoplasia rara, expondo a doença e fazer uma breve revisão da literatura e mostrar sua importância, visto que corresponde a apenas 5% das neoplasias de partes moles.
This report presents the case of a female patient with fourth synoviosarcoma recurrence, a sarcoma of soft parts that have close relationship with tendom sheaths, bursas and articular capsule.The patient present her fourth recurrence, in wich the perfomance of amputation was required, since the conservative surgeriesno longer relieved the patient suffering. The main objective of this case report is to present a classic case of a rare cancer, exposing the disease, and to make a brief review of the literature to show its importance, since it corresponds to only five percent of the cancers of soft parts.
Subject(s)
Humans , Female , Adult , Sarcoma, Synovial/diagnosis , Sarcoma, Synovial/therapy , Ankle/pathology , Amputation, Surgical , Soft Tissue Neoplasms/diagnosis , Soft Tissue Neoplasms/therapy , Prognosis , Neoplasm Recurrence, Local , Treatment OutcomeABSTRACT
La amiloidosis constituye un grupo de enfermedades caracterizadas por el depósito extracelular de material proteico autólogo, fibrilar e insoluble. Existe una variedad que se asocia a enfermedades inflamatorias crónicas mal controladas que presentan manifestaciones orientadoras al diagnóstico, lo que es importante de conocer, ya que hace variar el pronóstico de la enfermedad de base. A continuación se presenta un caso clínico de amiloidosis secundaria a artropatía psoriásica, discutiendo su diagnóstico y posibilidades terapéuticas tanto para la enfermedad de base como para su asociación y complicación por amiloidosis.
Amyloidosis is a group of diseases characterized by the extracellular deposition of protein material autologous fibrillar insoluble. There is a variety that is associated with poorly controlled chronic inflammatory diseases that have manifestations in the diagnosis. Below we present a clinical case of secondary amyloidosis in psoriatic arthropathy and discuss its diagnosis and further management.
Subject(s)
Humans , Male , Middle Aged , Amyloidosis/diagnosis , Amyloidosis/etiology , Arthritis, Psoriatic/complications , Antirheumatic Agents/therapeutic use , Amyloidosis/classification , Amyloidosis/drug therapy , Arthritis, Psoriatic/drug therapy , Methotrexate/therapeutic use , Knee/pathology , Ankle/pathologyABSTRACT
To determine the outcome of heel and ankle reconstruction with distally-based sural island flap. Case series. The study was carried out in Plastic Surgery Department, Chittagong Medical College Hospital, from January 2007 to April 2009. Twenty two subjects with soft tissue defect of heel and ankle requiring coverage were included in the study. The flap was first outlined on the posterior aspect of leg at the junction of upper and middle-third. Having incision made over the designed flap and along the line of the fascial pedicle, the vessels and the nerve were ligated at the proximal margin and severed. The skin island was elevated with the deep fascia. The sub-cutaneous fascial pedicle was then raised, with a width of 2.5 cm to include the sural nerve and vessels. The recipient defect was covered after tunneling the island flap. The donor site was closed directly when the wound was less wide and with a split skin graft when the wound was large. Results were analyzed in terms of graft acceptance and complications determined as percentage frequencies. Of the 22 patients, 15 had uneventful recovery with almost complete take of flaps. Although 5 patients showed marginal necrosis initially, they later on healed by secondary intention without requiring any secondary graft coverage. The rest two had a marked loss of flap in the peripheral part and required secondary graft coverage. Immediate venous congestion was commonly encountered which disappeared within a few days. There were no delayed complaints regarding sensation of the flaps. Distally-based sural island flap can be performed as a one-step procedure without sacrifice of any major artery. It is reliable, safe and should be the choice for reconstruction of ankle and heel defects
Subject(s)
Humans , Male , Female , Ankle/pathology , Ankle/surgery , Heel/pathology , Heel/surgery , Sural NerveABSTRACT
The accessory soleus muscle is an uncommon anatomical variant. We report an accessory soleus muscle in a 18-years-old female and we make a review of the literature. The clinical presentation wass of tissue swelling with mi Id pain in the posteromedial region of the anckle. Ultrasonography shows homogeneous echogenicity consistent with normal-appearing muscle bundles in the appropriate anatomic location. MRI showed a mass with signal characteristics of normal muscle, but in an abnormal location. Awareness of this entity can help the radiologist contribute significantly to the patient's care, because accurate radiographic diagnosis can spare the patient more invasive tests such as exploration and biopsy
El músculo soleo accesorio es una variante anatómica rara. Presentamos un caso, en una mujer de 18 años y hacemos una revisión de la bibliografía. Clínicamente aparecía como una tumefacción levemente dolorosa en la región posteromedial del tobillo izquierdo. En la ultrasonografia presentaba un aspecto homogéneo, de apariencia muscular normal, en la localización anatómica precisa. La resonancia magnética mostraba una masa con señal característica del músculo normal, pero en localización atípica. El conocimiento de esta entidad puede ayudar al radiólogo a contribuir significativamente en el manejo de los pacientes, con un diagnóstico radiológico exacto que evite procedimientos invasivos como biopsia o exploración quirúrgica
Subject(s)
Humans , Adolescent , Female , Muscle, Skeletal/abnormalities , Ankle/pathology , Magnetic Resonance Imaging , AnkleABSTRACT
Método de tratamento pelo punho-tornozelo. Localização e técnica de inserção de agulhas. Técnica Punho-tornozelo - posições dos pontos do punho. Técnica Punho-tornozelo - posições dos pontos do tornozelo. Indicação do método Punho-tornozelo. Aplicação clínica do método punho-tornozelo. Estudo de casos
Subject(s)
Male , Female , Humans , Acupuncture/methods , Ankle/pathology , Medicine, East Asian Traditional , Wrist/pathologyABSTRACT
Método de tratamento pelo punho-tornozelo. Localização e técnica de inserção de agulhas. Técnica Punho-tornozelo - posições dos pontos do punho. Técnica Punho-tornozelo - posições dos pontos do tornozelo. Indicação do método Punho-tornozelo. Aplicação clínica do método punho-tornozelo. Estudo de casos
Subject(s)
Humans , Male , Female , Acupuncture/methods , Medicine, East Asian Traditional , Wrist/pathology , Ankle/pathologyABSTRACT
Se presenta un paciente con sinovitis villonodular pigmentada del seno del tarso (SVP). Se analizaron retrospectivamente imágenes radiográficas, de TC y RM. En las radiografías se observó una erosión del sinus tarsi condicionada por una masa palpable firme, elástica en la porción lateral del tobillo. La TC confirmó la erosión evidenciando una masa ovoide densa en la porción lateral del tobillo con un pedículo que la conectaba con el sinus tarsi. Dicha masa alcanzaba una alta densidad (86,9 UH). Las imágenes de RM confirmaron la presencia de dicha masa que reveló en las series con SPIN ECO hipointensidad de señal tanto en la ponderación T1 cuanto en T2 tisulares. La RM posibilitó la detección de la SVP del tobillo con extensión al sinus tarsi, sinovitis villonodular, TC, RM
Subject(s)
Humans , Male , Adult , Ankle/pathology , Synovitis, Pigmented Villonodular/diagnosis , Ankle , Magnetic Resonance Imaging/standards , Synovitis, Pigmented Villonodular , Synovitis, Pigmented Villonodular/pathology , Tomography, X-Ray ComputedABSTRACT
Os autores apresentam caso de displasia epifisária hemimélica, contribuindo assim para enriquecer a literatura nacional. Trata-se de patologia rara, sendo o diagnóstico essencialmente clínico e radiológico, sem características bem definidas quanto aos aspectos histológicos.
Subject(s)
Humans , Male , Adolescent , Ankle/pathology , Osteochondrodysplasias , Osteochondroma , Ankle , Ankle/surgery , Osteochondrodysplasias/surgery , Osteochondroma/surgeryABSTRACT
Os autores relatam um caso de sinovite vilonodular pigmentada (SVP) do tornozelo em um paciente do sexo masculino, 19 anos, acometendo o lado esquerdo e invadindo a articulaçäo subastragalina e tíbio-társica. A sintomatologia iniciou-se após prática de esportes. O diagnóstico constituiu-se de achados clínicos e radiológicos, incluindo tomografia computadorizada, sendo confirmado pelos achados histopatológicos. O tratamento realizado constou de sinovectomia ampla, com ressecçäo de toda a massa tumoral, como também do músculo tibial posterior, que estava comprometido, seguido de radioterapia. Por se tratar de um caso raro, visto que a literatura apresenta poucos relatos desta entidade patológica, os autores chamam a atençäo para o melhor diagnóstico e conduta terapêutica
Subject(s)
Humans , Male , Adult , Ankle/pathology , Synovitis, Pigmented Villonodular/diagnosis , Ankle/surgery , Synovitis, Pigmented Villonodular/surgery , Tomography, X-Ray ComputedABSTRACT
Lateral instability of the ankle joint is a disabling condition especially when walking on uneven surfaces or participating in a sports activity. Various surgical procedures have been described to correct this disabling condition by using the tendon of the peroneus brevis muscle. In doing so they create a tenodesis effect at the vector direction of the lateral band complex, resulting in some degree of stiffness of both the tibio talar compartment and the talo - calcanal compartment of the ankle, subtalar articulation complex. In the procedure advocated by this paper both the anterior talo - fibular ligament function and the calcaneo - fibular ligament function are corrected restoring stability to the ankle region without inducing stiffness
Subject(s)
Humans , Male , Female , Ankle Injuries/surgery , Ankle Joint/surgery , Ankle/pathologyABSTRACT
A finalidade da apresentaçäo deste trabalho é a de contribuir com mais um caso de displasia epifisária hemimélica para a literatura nacional. Enumeramos as principais característiticas desta entidade rara, chamando a atençäo para o diagnóstico, que é clínico-radiológico, näo havendo lesäo característica pelo qual o diagnóstico possa ser feito ou confirmado através do exame histopatológico