ABSTRACT
Penetrating injuries caused by needlefish are very uncommon. Most of them have been reported in the Indo-Pacific region. We report a case of an occipito-cervical penetrating injury that occurred in the Mexican Tropical Pacific, and we describe the treatment of this injury.
Las heridas penetrantes por pez aguja son poco comunes. La mayor parte de los reportes han sido en la región Indo-Pacífico. Reportamos un caso de herida penetrante occipitocervical ocurrida en el Pacífico tropical mexicano y se describe el tratamiento de esta lesión.
Subject(s)
Beloniformes , Foreign Bodies , Wounds, Penetrating , Animals , Foreign Bodies/complications , Foreign Bodies/diagnostic imaging , Foreign Bodies/surgery , Humans , Neck , Wounds, Penetrating/etiology , Wounds, Penetrating/surgeryABSTRACT
BACKGROUND: sacral insufficiency fractures are a cause of debilitating pain in the elderly. These fractures were first described as a clinical entity in 1982. The bone in these patients is structurally weakened and often associated with diseases such as osteoporosis, cancer and immunological processes. This translates into back and pelvic pain unrelated to trauma. These fractures are usually caused by fatigue in most cases. Bone scans and MRI are the imaging studies with the most sensitivity for detecting sacral insufficiency. CLINICAL CASES: two patients with sacral insufficiency fractures who were studied by MRI and bone scan, in whom the diagnosis of sacral insufficiency was made, were treated by sacroplasty. CONCLUSIONS: sacral insufficiency is an underdiagnosed disease, caused by wide range of diseases, mainly osteoporosis. The studies of choice for diagnosis are MRI and bone scans. Techniques, such as percutaneous sacroplasty, produce significant improvements in pain scores and seem a suitable alternative for managing this disease.
Subject(s)
Fractures, Stress/complications , Low Back Pain/etiology , Sacrum/injuries , Spinal Fractures/complications , Accidental Falls , Aged , Bone Diseases, Metabolic/complications , Bone Diseases, Metabolic/diagnosis , Bone Diseases, Metabolic/diagnostic imaging , Female , Femur Head Necrosis/complications , Femur Head Necrosis/diagnosis , Femur Head Necrosis/surgery , Fractures, Spontaneous/complications , Fractures, Spontaneous/diagnosis , Fractures, Spontaneous/diagnostic imaging , Fractures, Stress/diagnosis , Fractures, Stress/diagnostic imaging , Fractures, Stress/surgery , Humans , Imaging, Three-Dimensional , Intervertebral Disc Displacement/complications , Intervertebral Disc Displacement/diagnosis , Lumbar Vertebrae/pathology , Magnetic Resonance Imaging , Positron-Emission Tomography , Sacrum/diagnostic imaging , Sacrum/surgery , Spinal Fractures/diagnosis , Spinal Fractures/diagnostic imaging , Spinal Fractures/surgery , Spinal Stenosis/complications , Spinal Stenosis/diagnosis , Spondylolisthesis/complications , Spondylolisthesis/diagnosis , Spondylolisthesis/diagnostic imaging , Tomography, X-Ray Computed , VertebroplastyABSTRACT
BACKGROUND: Idiopathic transdural spinal cord herniation (ISCH) is a rare entity with postsurgical and post-trauma forms. ISCH is often omited in the preoperative evaluation. It often affects the thoracic segment and presents clinically as a rare cause of progressive myelopathy or Brown-Séquard syndrome, whose diagnosis is established by magnetic resonance imaging (MRI). We report on this rare entity due to its difficult diagnosis, making optimal management difficult. CLINICAL CASE: We present the cases of two patients with ISCH who were misdiagnosed and operated on in other spinal segments without reaching an accurate diagnosis. In our institution, patients with clinical suspicion were evaluated by imaging studies in order to rule out other pathologies. Laminectomy was performed on the involved levels, reducing herniation and with the placement of a synthetic spinal patch to the duramater. CONCLUSIONS: ISCH has been attributed to congenital weakness of the duramater or the dural ventral duplication with herniation through the inner layer due to continuous pressure from cerebrospinal fluid that pushes the marrow out of the subdural space. It is estimated that presurgical diagnosis is done only in one third of the cases, confirmed by MRI. Surgery is performed on patients with symptom progression. Surveillance in those patients with mild symptoms is recommended. Treatment may allow recovery of the neurological deficit, improving motor affection in 80% of patients and sensory affection in 35%.
Subject(s)
Hernia , Spinal Cord Diseases , Adult , Dura Mater , Hernia/diagnosis , Herniorrhaphy , Humans , Male , Spinal Cord Diseases/diagnosis , Spinal Cord Diseases/surgeryABSTRACT
Introducción: La herniación medular transdural idiopática es una entidad rara cuyas formas son la postraumática y posquirúrgica; es omitida en la valoración preoperatoria y con frecuencia afecta al segmento torácico. Clínicamente puede causar mielopatía progresiva o síndrome de Brown-Séquard, cuyo diagnóstico se establece por resonancia magnética. La finalidad de informar esta entidad es su dificultad diagnóstica y, por lo tanto, para establecer un manejo óptimo. Casos clínicos: Dos pacientes mal diagnosticados al inicio e intervenidos en otros segmentos del raquis. Finalmente fueron valorados por sospecha clínica de herniación medular transdural idiopática y por exclusión de otras patologías. Se les realizó laminectomía en los niveles afectados, reducción de la hernia medular y colocación de parche sintético en duramadre. Conclusiones: La herniación medular transdural idiopática se ha atribuido a debilidad congénita de la duramadre o duplicación dural ventral con herniación a través de la capa interna debido a la presión continua del líquido cefalorraquídeo que empuja la médula fuera del espacio subdural. Se estima que el diagnóstico preoperatorio se realiza en una tercera parte de los casos, confirmándose con resonancia magnética. El tratamiento quirúrgico se efectúa en pacientes con progresión de los síntomas; los pacientes cuyos síntomas son leves o ausentes se mantienen bajo monitoreo. El tratamiento oportuno puede permitir la recuperación del déficit neurológico, mejorando la afección motora en 80% y la afección sensitiva en 35%.
BACKGROUND: Idiopathic transdural spinal cord herniation (ISCH) is a rare entity with postsurgical and post-trauma forms. ISCH is often omited in the preoperative evaluation. It often affects the thoracic segment and presents clinically as a rare cause of progressive myelopathy or Brown-Séquard syndrome, whose diagnosis is established by magnetic resonance imaging (MRI). We report on this rare entity due to its difficult diagnosis, making optimal management difficult. CLINICAL CASE: We present the cases of two patients with ISCH who were misdiagnosed and operated on in other spinal segments without reaching an accurate diagnosis. In our institution, patients with clinical suspicion were evaluated by imaging studies in order to rule out other pathologies. Laminectomy was performed on the involved levels, reducing herniation and with the placement of a synthetic spinal patch to the duramater. CONCLUSIONS: ISCH has been attributed to congenital weakness of the duramater or the dural ventral duplication with herniation through the inner layer due to continuous pressure from cerebrospinal fluid that pushes the marrow out of the subdural space. It is estimated that presurgical diagnosis is done only in one third of the cases, confirmed by MRI. Surgery is performed on patients with symptom progression. Surveillance in those patients with mild symptoms is recommended. Treatment may allow recovery of the neurological deficit, improving motor affection in 80% of patients and sensory affection in 35%.
Subject(s)
Humans , Male , Adult , Hernia , Spinal Cord Diseases , Dura Mater , Spinal Cord Diseases/diagnosis , Spinal Cord Diseases/surgery , Hernia/diagnosis , Hernia/surgeryABSTRACT
El sitio de presentación ósea más frecuente de los hemangiomas es la columna vertebral. Sin embargo, la mayoría son asintomáticos. Presentamos un paciente con hemangiomas múltiples de columna, uno de ellos sintomático en la vértebra torácica 6, con compresión de la raíz a ese nivel del lado izquierdo. Después de realizar varios estudios, se libera la misma mediante laminectomía y foraminotomía izquierda. Se discuten otras posibilidades de trataiento y su contraindicación en este caso
Subject(s)
Humans , Male , Aged , Hemangioma/diagnosis , Magnetic Resonance Spectroscopy , Spinal Neoplasms/diagnosis , Tomography, X-Ray Computed , Angiography , Hemangioma/surgeryABSTRACT
La patología del disco lumbar es rara en la población pediátrica. No existen reportes en la literatura de herniación de disco lumbar en preescolares. Se presenta el reporte de una niña de 2 años 6 meses de edad con prolapso discal postraumático L 3-4 quien requirió de tratamiento quirúrgico. Se analiza el cuadro clínico, los aspectos radiológicos, las alternativas de tratamiento y revisión de la literatura
Subject(s)
Humans , Female , Child, Preschool , Intervertebral Disc Displacement/diagnosis , Lumbar Vertebrae/pathology , Child, PreschoolABSTRACT
En el Hospital ABC de la Ciudad de México, del 3 de mayo de 1995 al 15 de noviembre de 1996 se practicaron 21 procedimientos estereotácticos en 20 pacientes con edades que iban de 12 a 81 años (promedio 51.5 años). No hubo errores en la localización de las lesiones. En un caso (6 por ciento) se obtuvo tejido no específicamente diagnóstico. Se presentó una complicación transitoria (5 por ciento). No se registraron defunciones relacionadas con los procedimientos. La cirugía estereotáctica ofrece seguridad y una precisión diagnóstica elevada
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Biopsy , General Surgery , Craniotomy/methods , Endoscopy , Psychotherapeutic ProcessesABSTRACT
Se presentan 26 pacientes con 28 ventriculostomías, en los que se encontró una frecuencia de cultivos positivos de 11 por ciento. Se discute sobre los factores de riesgo en este tipo de pacientes, así como los gérmenes aislados
