RESUMO
The incidence of heterotopic ossification (HO) was reported to be higher in combat-injured patients than in civilian trauma patients. HO is often considered a possible cause of residual limbs pain in amputee. Here, we report the case of a 21-year-old male, who underwent a traumatic right transfemoral and left transtibial amputation with two segments of painful HO around his left amputation site. We report the effect of extracorporeal shock wave therapy (ESWT) on size and pain associated with HO. After ESWT, the visual analog scale score decreased from 5∼6 to 0∼1 and the size of two masses decreased from 13.1 × 6.7 mm and 12.5 mm to 11.9 × 4.7 mm and 12.2 mm, respectively. To the best of our knowledge, this is the first case that has reported on the treatment of HO using ESWT for a traumatic transtibial amputation patient. The case suggests that ESWT could serve as a complementary treatment for HO in traumatic amputation patient.
RESUMO
The incidence of heterotopic ossification (HO) was reported to be higher in combat-injured patients than in civilian trauma patients. HO is often considered a possible cause of residual limbs pain in amputee. Here, we report the case of a 21-year-old male, who underwent a traumatic right transfemoral and left transtibial amputation with two segments of painful HO around his left amputation site. We report the effect of extracorporeal shock wave therapy (ESWT) on size and pain associated with HO. After ESWT, the visual analog scale score decreased from 5∼6 to 0∼1 and the size of two masses decreased from 13.1 × 6.7 mm and 12.5 mm to 11.9 × 4.7 mm and 12.2 mm, respectively. To the best of our knowledge, this is the first case that has reported on the treatment of HO using ESWT for a traumatic transtibial amputation patient. The case suggests that ESWT could serve as a complementary treatment for HO in traumatic amputation patient.
RESUMO
PURPOSE: Studies on the relationship between appendiceal inflammation and bedside ultrasonographic findings are lacking. The purpose of this study was to determine statistically significant parameters to diagnose appendicitis earlier by comparing ultrasonographic findings and clinical features between early and late appendicitis. METHODS: A registry of right lower quadrant (RLQ) pain ultrasound from December 2011 to December 2012 was reviewed. Among these cohorts, patients pathologically proven to have appendicitis were selected and divided into two groups: an early appendicitis group, patients who complained of a diffuse abdominal pain, and a late appendicitis group, patients who complained of a localized right lower quadrant pain. The two groups were compared according to gender, age, bedside ultrasonographic findings, inflammatory markers, clinical features, and postoperative pathological findings. RESULTS: A total of 102 patients were enrolled in this study. Among them, 42 patients (41.2%) were in the early appendicitis group and 60(58.8%) were in the late appendicitis group. Appendiceal diameter and noncompressibility did not differ between the groups. However, periappendiceal fat infiltration and fluid were less prevalent in the early group (p=0.031 vs. p=0.022, respectively). CONCLUSION: Appendiceal diameter and non-compressibility were the only bedside ultrasound findings found in early appendicitis patients. Emergency physicians can detect early appendicitis and prevent complications before the migration of abdominal pain to the RLQ by bedside ultrasonography.
Assuntos
Humanos , Dor Abdominal , Apendicite , Biomarcadores , Estudos de Coortes , Emergências , Inflamação , UltrassonografiaRESUMO
PURPOSE: Studies on the relationship between appendiceal inflammation and bedside ultrasonographic findings are lacking. The purpose of this study was to determine statistically significant parameters to diagnose appendicitis earlier by comparing ultrasonographic findings and clinical features between early and late appendicitis. METHODS: A registry of right lower quadrant (RLQ) pain ultrasound from December 2011 to December 2012 was reviewed. Among these cohorts, patients pathologically proven to have appendicitis were selected and divided into two groups: an early appendicitis group, patients who complained of a diffuse abdominal pain, and a late appendicitis group, patients who complained of a localized right lower quadrant pain. The two groups were compared according to gender, age, bedside ultrasonographic findings, inflammatory markers, clinical features, and postoperative pathological findings. RESULTS: A total of 102 patients were enrolled in this study. Among them, 42 patients (41.2%) were in the early appendicitis group and 60(58.8%) were in the late appendicitis group. Appendiceal diameter and noncompressibility did not differ between the groups. However, periappendiceal fat infiltration and fluid were less prevalent in the early group (p=0.031 vs. p=0.022, respectively). CONCLUSION: Appendiceal diameter and non-compressibility were the only bedside ultrasound findings found in early appendicitis patients. Emergency physicians can detect early appendicitis and prevent complications before the migration of abdominal pain to the RLQ by bedside ultrasonography.