ABSTRACT
Se presenta el caso de un niño de 11 años de edad, diagnosticado un año antes de enfermedad de Gorham con afectación ósea múltiple a nivel de tórax y columna dorsal. En el curso de la enfermedad apareció daño medular secundario. Fue intervenido quirúrgicamente realizándose una fusión vertebral para detener la progresión del cuadro clínico y la deformidad de columna. En el postoperatorio inmediato se evidenció cuadro de lesión medular completa motora e incompleta sensitiva precisando tratamiento rehabilitador precoz. En el síndrome de Gorham-Stout la afectación vertebral es infrecuente, siendo la mielopatía una grave complicación. La recuperación de las secuelas neurológicas precisa un programa de rehabilitación adecuado a la gravedad de las mismas. El síndrome de Gorham-Stout es un trastorno esquelético raro de etiología y patogénesis desconocidas. Puede afectar a cualquier hueso del esqueleto, siendo la afectación de la columna vertebral un hallazgo raro. Cuando aparece como complicación una mielopatía, esta se considera una complicación grave (AU)
Gorham-Stout syndrome is a rare skeletal disorder of unknown etiology and pathogenesis. It can affect any bone of the skeleton, involvement of the spine being a rare finding. Myelopathy, when it appears, is considered a serious complication. The case is presented of an 11- year old boy who had been diagnosed 1 year earlier of Gorham disease with multiple bone involvement on the chest and spine level. Secondary bone marrow damage appeared during the course of the disease. He was referred to our hospital where was underwent surgery, performing spinal fusion to halt the spinal deformity progression and the clinical course. In the immediate postoperative period, a complete motor and incomplete sensory spinal cord injury was observed, which required early rehabilitation treatment. In Gorham-Stout syndrome, vertebral involvement is uncommon, myelopathy being a serious complication. Neurologic recovery requires a comprehensive rehabilitation program adapted to its severity (AU)
Subject(s)
Humans , Male , Child , Osteolysis, Essential/rehabilitation , Myelitis/diagnosis , Myelitis/rehabilitation , Spinal Cord Diseases/rehabilitation , Bone Diseases, Metabolic/rehabilitation , Spinal Cord Compression/complications , Spinal Cord Compression/diagnosis , Muscle Spasticity/rehabilitation , Chylothorax/complications , Chylothorax/rehabilitation , Osteolysis, Essential/complications , Osteolysis, Essential/therapy , Osteolysis, Essential , Bone Diseases, Metabolic , Thorax/abnormalities , Myelitis/complications , ThoraxABSTRACT
Congenital chylothorax, an uncommon cause of respiratory distress in the neonate, is diagnosed initially by prenatal ultrasound or postnatal x-ray and definitively by evaluation of the fluid in the pleural space. The etiology is not well understood, and reaccumulation of fluid can occur. Thoracentesis and chest tube placement may be required to support respiratory status. Conservative treatment, which may be tried for up to five weeks, includes diet and should be attempted before surgical intervention. Nutritional status, along with fluids and electrolytes, needs to be monitored closely.
Subject(s)
Chylothorax/congenital , Infant, Premature , Chylothorax/diagnosis , Chylothorax/physiopathology , Chylothorax/rehabilitation , Disease Progression , Humans , Infant, Newborn , Lymphatic System/anatomy & histology , Lymphatic System/embryology , Male , Pleural Effusion/etiology , Pleural Effusion/physiopathologyABSTRACT
Chylothorax is a rare but serious complication of coronary artery bypass grafting. We describe a case of double myocardial revascularization with the internal mammary artery developing the complication ten weeks after cardiac surgery. The reasons for late symptomatology of lymphatic injury are analyzed. Conservative treatment with low-fat diet, total parenteral nutrition and pleural drainage was attempted unsuccessfully; chyle leakage of around 500 ml/day and onset of nutritional deficiency made it advisable to seal the thoracic duct surgically.
