ABSTRACT
La osteomalacia oncogénica es una enfermedad rara. Existen descriptos alrededor de 337 casos. Es ocasionada por un tumor productor del factor de crecimiento fibroblástico 23 (FGF-23), hormona que disminuye la reabsorción tubular de fosfatos y altera la hidroxilación renal de la vitamina D, con hipofosfatemia, hiperfosfaturia y niveles bajos de calcitriol. Se presentan dos pacientes de 44 y 70 años, que consultaron por dolores óseos generalizados de aproximadamente un año de evolución en los que se hallaron alteraciones bioquímicas compatibles con osteomalacia hipofosfatémica. En el primer caso se realizó la resección de una tumoración en tejido celular subcutáneo del pie derecho, un año después del diagnóstico clínico. Luego de la exéresis, se disminuyó el aporte de fosfatos que recibía el paciente, pero reaparecieron los dolores al intentar suspenderlos. Ocho años más tarde, hubo recidiva local de la tumoración por lo que se efectuó resección completa. Después de la misma, se logró suspender el aporte de fosfatos. En el segundo caso, el paciente se estudió con tomografía por emisión de positrones con 18F-fluorodesoxiglucosa, hallando formación nodular hipermetabólica en partes blandas de antepie derecho, de 2.26 cm de diámetro. Luego de su escisión se pudo suspender el aporte de fosfatos. Ambos pacientes se encuentran asintomáticos con indicadores de metabolismo fosfocálcico normales. El diagnóstico anatomopatológico en ambos fue un tumor mesenquimático fosfatúrico, variante mixta del tejido conectivo, la entidad más frecuentemente asociada a la osteomalacia oncogénica.
Oncogenic osteomalacia is a rare disease. It is caused by a tumor that produces fibroblast growth factor 23, a hormone that decreases the tubular phosphate reabsorption and impairs renal hydroxylation of vitamin D. This leads to hyperphosphaturia with hypophosphatemia and low calcitriol levels. About 337 cases have been reported and we studied two cases; 44 and 70 year-old men who sought medical attention complaining of suffering diffuse bone pain over a period of approximately one year. In both cases, a laboratory test showed biochemical alterations compatible with a hypophosphatemic osteomalacia. In the first case, a soft tissue tumor of the right foot was removed, one year after the diagnosis. The patient was allowed to diminish the phosphate intake, but symptoms reappeared at this time. Eight years later, a local recurrence of the tumor was noted. A complete excision was now performed. The patient was able to finally interrupt the phosphate intake. In the second case, an F-18 fluorodeoxyglucose positron emission tomography, with computed tomography revealed a 2.26 cm diameter hypermetabolic nodule in the soft tissue of the right forefoot. After its removal, the patient discontinued the phosphate intake. Both patients are asymptomatic and show a regular phosphocalcic laboratory evaluation. The histopathological diagnosis was, in both cases, a phosphaturic mesenchymal tumor, a mixed connective tissue variant. This is the prototypical variant of these tumors.
Subject(s)
Adult , Aged , Humans , Male , Neoplasms, Connective Tissue , Rare Diseases , Follow-Up Studies , Fibroblast Growth Factors/isolation & purification , Forefoot, Human/surgery , Neoplasm Recurrence, Local , Neoplasms, Connective Tissue/drug therapy , Neoplasms, Connective Tissue/pathology , Neoplasms, Connective Tissue , Rare Diseases/drug therapy , Rare Diseases/pathology , Rare DiseasesABSTRACT
Reconstruction of traumatic as well as non-traumatic hind foot defects is always a challenging task. We share here a simple and practical protocol [working solution] to select the most suitable method for soft tissue coverage of hind foot defects, customizable for every patient. We carried out this study, in our department on 75 cases from March 2009 to May 2012. All cases with wound/defect in hind foot area were included. Majority of cases were traumatic rest included cases of malignancy, Trophic ulcers, infection. Patient's data including age, sex, site of injury, mode of injury, extent of injury [isolated or combined], if combined structures involved, type of wound, management of wound, wound healing time and complications were noted. Once optimal wound conditions were achieved the best possible reconstructive option was selected. The various reconstructive options include VAC therapy, Skin graft, local transposition flap, perforator based flapspedicled faciocutaneous/ muscle flaps, intrinsic foot muscles, Medial plantar artery flap and distant flaps like cross leg flap and micro vascular free flaps. All patients had satisfactory and stable reconstruction. They were ambulating freely by 4-6 weeks post operatively. There were few complications like patchy graft loss, peripheral flap necrosis, flap congestion, but none was serious and did not require repeat surgery. The simplified protocol followed by us is a practical customizable solution for difficult task of hind foot reconstruction. The choice of one or multiple techniques will vary from time to time from one surgeon to another depending upon his or her experience and liking
Subject(s)
Humans , Female , Male , Plastic Surgery Procedures/methods , Wound Healing , Orthopedic Procedures/methods , Forefoot, Human/surgery , Preoperative CareABSTRACT
Forefoot deformity in rheumatoid arthritis is a common occurrence leading to significant disability and impingement. Surgical options are frequently used to correct these deformities. The purpose of the present, retrospective study is to report our experience in surgical treatment of the rheumatoid forefoot: forefoot reconstruction with first metatarsophalangeal arthrodesis first metatarsal osteotomy and lesser metatarsal head resection performed on 18 patients. After surgery the results were good 14/17 patients were without pain during weight bearing and were able to wear casual shoes. Three patients were suffering from persistent pain. The average angle of the fused hallux was 19 2°. This surgical procedure is simple and efficient at the same time allowing a good correction of the rheumatoid deformity and respecting the concept of united family forefoot
Subject(s)
Humans , Male , Female , Forefoot, Human/surgery , Retrospective Studies , Arthrodesis , Metatarsophalangeal Joint , Hallux Valgus , Metatarsal Bones , OsteotomyABSTRACT
Se evaluaron un total de 50 pacientes con el Diagnóstico de Fractura de Bennett, pertenecientes a la consulta de cirugía de mano del Hospital "Dr. Patrocinio Peñuela Ruíz" del IVSS desde 1985-1994, con el objeto de demostrar la eficacia del tratamiento quirúrgico para la adecuada y recuperación. La mayor incidencia se ubicó en el sexo masculino, con edades comprendidas entre 15 y 45 años, obreros, presentandose la localización en miembros superior derecho como las más frecuente. La mayoría de los casos fueron intervenidos quirúrgicamente obtenido excelente resultados anatómicos; con secuelas pasajeras y que se resolvieron con tratamientos fisiátrico; conllevando esto a períodos cortos de recuperación