Parafoveal chondral lesion of the femoral head in patients with femoroacetabular impingement / Lesão condral parafoveal da cabeça femoral em pacientes com impacto femoroacetabular

Abstract Objective: To describe cases of parafoveal chondral lesion of the femoral head in patients with femoroacetabular impingement, correlating the clinical and imaging data. Materials and Methods: This was a retrospective descriptive case series of parafoveal chondral lesion of the femoral head in 21 patients who underwent computed tomography and magnetic resonance arthrography scans of the hip, having then received an imaging-based diagnosis of femoroacetabular impingement. Results: Of the 21 patients evaluated, 15 (71%) had cam-type femoroacetabular impingement, whereas five (24%) had mixed-type impingement, and one (5%) had pincer-type impingement. Twelve patients (57%) had a low frequency of physical activity, which was significantly associated with the presence of cam-type impingement (p = 0.015). Although the extent of the lesion correlated significantly with the acetabular coverage angle (p = 0.04), it did not correlate significantly with the alpha angle or femoral head-neck offset value (p = 0.08 and p = 0.06, respectively). We also found no correlation between the extent of the lesion and the other main parameters that define the femoroacetabular impingement types. Conclusion: This was one of the largest case series of parafoveal chondral lesion of the femoral head in patients with imaging findings of femoroacetabular impingement. The extent of such lesions does not appear to correlate with the parameters of femoroacetabular impingement, with the exception of the acetabular coverage angle.

Resumo Objetivo: Descrever casos de lesão condral parafoveal da cabeça femoral em pacientes com impacto femoroacetabular, correlacionando dados clínicos e de imagem. Materiais e Métodos: Esta foi uma série de casos descritiva retrospectiva de lesão condral parafoveal da cabeça femoral em 21 pacientes submetidos a tomografia computadorizada e artrorressonância magnética do quadril e que receberam diagnóstico por imagem de impacto femoroacetabular. Resultados: Dos 21 pacientes avaliados, 15 (71%) tiveram impacto femoroacetabular do tipo cam, enquanto cinco (24%) tiveram impacto do tipo misto e um (5%) teve impacto do tipo pincer. Doze pacientes (57%) apresentaram baixa frequência de atividade física, sendo esta significativamente associada a impacto do tipo cam (p = 0,015). Houve correlação significativa entre a extensão da lesão e o ângulo de cobertura acetabular (p = 0,04), porém, não se correlacionou significativamente com o ângulo alfa ou com o valor do deslocamento cabeça-colo femoral (p = 0,08 e p = 0,06, respectivamente). Também não encontramos correlação entre a extensão da lesão e os outros principais parâmetros que definem os tipos de impacto femoroacetabular. Conclusão: Esta foi uma das maiores casuísticas de lesão condral parafoveal da cabeça femoral em pacientes com achados de imagem de impacto femoroacetabular. A extensão dessas lesões não parece se correlacionar com os parâmetros do impacto femoroacetabular, com exceção do ângulo de cobertura acetabular.

Análise do tempo de maturação dos implantes de matriz de regeneração dérmica utilizando curativos sob pressão negativa / Maturation time analysis of dermal regeneration template using negative pressure wound therapy

Objetivo: Analisar a utilização do Curativo sob Pressão Negativa (CPN) como adjuvante no tratamento com Matriz de Regeneração Dérmica (MRD) no tratamento de feridas em geral, em crianças atendidas no Serviço de Cirurgia Pediátrica do Hospital Infantil Joana de Gusmão (HIJG). Método: Foram analisados todos os prontuários de crianças submetidas ao implante de MRD associada ao CPN, no período de janeiro de 2009 a março de 2010, totalizando 18 pacientes. Resultados: A idade pré-púbere (33,33%) e o sexo masculino (61,11%) predominaram. O trauma foi a indicação de uso de MRD e CPN mais frequente (44,44%). Os membros inferiores foram os principais locais de implante de MRD (77,78%). A complicação inicial mais comum foi o hematoma, e a média de pega da matriz foi de 90,56%. O tempo médio de maturação da MRD com a utilização do CPN foi de 15,88 dias. A quantidade de trocas de curativos foi, em média, de 3,06 procedimentos. Obteve-se como desfecho final o enxerto de pele em 100% dos casos, sendo a média de pega de 93,62%. Conclusões: O CPN oferece vantagens no tratamento adjuvante à MRD, como um menor número de trocas de curativos, redução no tempo maturação da MRD, e redução do tempo de internação hospitalar.

Purpose: To analyze the use of Negative Pressure Wound Therapy (NPWT) in the adjuvant treatment of Dermal Regeneration Template (DRT), in the treatment of wounds in general, in children treated in the Pediatric Surgery service, at Children's Hospital Joana de Gusmao. Methods: The medical files of all children submitted to DRT application with NPWT as adjuvant from January 2009 to March 2010 were accessed, in a total of 18 patients. Results: Most of the patients were preteenagers (33.33%) and males (61.11%). Trauma was the major indication for use of DRT and NPWT (44.44%). Lower limbs were the main sites of implantation of DRT (77.78%). The main early complication after DRT implantation and use of NPWT was the hematoma (50%), and the mean take rate of the DRT was 90.56%. On average, the maturation time of DRT using the NPWT was 15.88 days. The amount of dressing's changes was on average 3.06 procedures. The final outcome was skin grafting in 100% of cases. The epidermal graft achieved the average take rate of 93.62%. Conclusions: The NPWT offers advantages in the adjuvant treatment of DRT, as less frequent dressing changes, reduction of the maturation time of DRT, and shorter hospitalization.

Utilização da jejunostomia para extração endoscópica de Ascaris lumbricoides da via biliar principal em paciente com doença de Caroli / Use of visiting jejunostomy loopfor extracting Ascaris lumbricoides in the common bile ducts in patients with Caroli diseases

Grumbach-Auvert disease represents a type of Obstructive Disease of the Intrahepatic Biliary Tree. We presents a case report of a patient with hepatic abscess caused by Ascaris which ascended into hepatic parenquima through hepaticojejunostomy, resolved by endoscopic extraction of it after the jejunostomy of permanent access was opened.

Spontaneous splenic rupture due to dengue fever: report of two cases

Dengue is a febrile illness caused by Flavivírus and mainly transmitted by the mosquito Aedes aegypiti which have been a serious epidemic in Rio de Janeiro. In most of cases it was a self limited disease. We report two cases of a serious and rare complication of this viral infection.

Surgical management of the obstruction disease of the intrahepatic biliary tree: analysis of 51 patients

Background - Cholelithiasis is the commonest disease of the biliary tree. Eventually there are cases that escape from the habitual clinical profile. They suffer from the obstructive disease of the intrahepatic biliary tree. Both the high mortality and morbidity are sponsored by the hepatic lesion concomitant cholangitis that these patients...

Torção do grande omento / Torsion of greater omentum

We present two cases of greater omental torsion, a rare condition of acute abdominal pain, emphasizing the clinical manifestations and imaging findings, which can lead us to the difficult preoperative diagnosis of this entity.

Hematoma espontâneo do músculo reto abdominal / Spontaneous hematoma of the rectus sheath

Spontaneous hematoma of the rectus sheath is a rare entity, which may be confused with the surgical causes of acute abdomen. We present a well succeeded conservative therapy in a woman in the 7th decade of life.