RESUMEN
Lumbosacral dislocation is uncommon. We report a case of traumatic lumbosacral dislocation which occurred in a 33-year-old pedestrian traffic accident victim. The posterior impact produced lumbar injury with diffuse pain exacerbated at the lumbosacral junction. Ecchymotic diffusion involving the entire lumbar region fluctuated due to the presence of a subcutaneous hematoma. The neurological examination revealed incomplete L5 paraplegia. Standard x-rays revealed L5-S1 spondylolisthesis and fracture of the L5 spinous process as well as fractures of the L3, L4, and L5 transverse processes. Computed tomography disclosed biarticular L5-S1 fracture dislocation and a voluminous herniation of the L5-S1 disc. Emergency surgery was performed and revealed subaponeurotic detachment from T4 to S1 and bald iliac pyramids. After L5 laminectomy and extraction of the voluminous herniation of the L5-S1 disc, a short L5-S1 posteriolateral fusion was achieved using pedicular screws and two rods on either side as well as a posterolateral iliac autograft. The clinical course was satisfactory with nearly complete neurological recovery (persistent levator ani paresis). This clinical case and a review of the literature illustrate the pathogenic, clinical, radiological and therapeutic aspects of lumbosacral fracture dislocation.
Asunto(s)
Luxaciones Articulares/diagnóstico , Vértebras Lumbares/lesiones , Sacro/lesiones , Accidentes de Tránsito , Adulto , Tornillos Óseos , Trasplante Óseo , Equimosis/diagnóstico , Femenino , Hematoma/diagnóstico , Humanos , Desplazamiento del Disco Intervertebral/diagnóstico , Paraplejía/diagnóstico , Fracturas de la Columna Vertebral/diagnóstico , Fusión Vertebral , Espondilolistesis/diagnóstico , Tomografía Computarizada por Rayos XRESUMEN
Central chondrosarcoma of the tibia is exceptional, particularly in young patients. Low-grade tumors raise difficult problems for histological distinction with enchondroma. We report a case of grade 1 chondrosarcoma located in the upper portion of the tibia in a 17-year-old girl. After radical surgery, outcome was favorable with no recurrence or metastasis at three years follow-up. The distinction between low-grade central chondrosarcoma and enchondroma is one of the most difficult challenges in bone pathology. Clinical, radiographic and pathological data must be considered together to reach certain diagnosis.
Asunto(s)
Neoplasias Óseas/diagnóstico , Neoplasias Óseas/cirugía , Condrosarcoma/diagnóstico , Condrosarcoma/cirugía , Tibia/patología , Adolescente , Diagnóstico Diferencial , Femenino , Humanos , Resultado del TratamientoRESUMEN
Transverse fractures of the sacrum with major displacement are rare and often misdiagnosed. A case of transverse fracture of the sacrum with cauda equina injury is reported. The diagnosis was not recognized initially. Conventional radiographs of the pelvis failed to demonstrate the fracture. True lateral sacral views and CT scan with reconstructions allowed analysis of the different sagittal fracture lines to facilitate surgical planning. These examinations should be considered in all patients with history of high energy trauma and clinical signs indicating lumbosacral injury.
Asunto(s)
Sacro/lesiones , Fracturas de la Columna Vertebral/diagnóstico , Adolescente , Femenino , HumanosRESUMEN
AIMS: Construction and characterization of a new cloning shuttle vector for gene transfer and expression in Bacillus thuringiensis. METHODS AND RESULTS: A novel short and high-copy number shuttle vector called pHBLBIV, was constructed for gene transfer and expression in Bacillus thuringiensis. A 1.6-kbp replicon of a relatively high-copy number endogenous plasmid of a selected B. thuringiensis strain was ligated to Escherichia coli pUC18 replicon containing the ampicillin and the erythromycin resistance genes used for the selection of respectively E. coli and B. thuringiensis transformants. The constructed vector was shown to have a high copy number compared with the conventional B. thuringiensis vectors, and used successfully for the transfer of vegetative insecticidal protein-encoding gene (vip) in between B. thuringiensis strains. CONCLUSIONS: A new shuttle vector of B. thuringiensis-E. coli named pHBLBIV was constructed. It was characterized by its high copy number, small size and segregational stability. This vector was successfully used for vip gene cloning and transfer in B. thuringiensis. SIGNIFICANCE AND IMPACT OF THE STUDY: A novel shuttle vector has been constructed, which has demonstrated potential for the cloning and expression of genes in B. thuringiensis.
Asunto(s)
Bacillus thuringiensis/genética , Dosificación de Gen , Vectores Genéticos/genética , Plásmidos/genética , Animales , Bacillus thuringiensis/crecimiento & desarrollo , Bacillus thuringiensis/metabolismo , Proteínas Bacterianas/genética , Proteínas Bacterianas/farmacología , Escherichia coli/genética , Transferencia de Gen Horizontal , Lepidópteros/efectos de los fármacos , Transformación BacterianaRESUMEN
We describe the case of a 38-year-old woman with breast tuberculosis associated with a second localization in the lumber spine. These features simulated breast cancer with vertebral metastasis. Clinical and imaging findings are described herein.
Asunto(s)
Enfermedades de la Mama/diagnóstico , Vértebras Lumbares , Tuberculosis de la Columna Vertebral/diagnóstico , Tuberculosis/diagnóstico , Adulto , Antituberculosos/uso terapéutico , Enfermedades de la Mama/diagnóstico por imagen , Enfermedades de la Mama/patología , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/patología , Diagnóstico Diferencial , Femenino , Humanos , Imagen por Resonancia Magnética , Mamografía , Neoplasias de la Columna Vertebral/diagnóstico , Neoplasias de la Columna Vertebral/diagnóstico por imagen , Neoplasias de la Columna Vertebral/patología , Neoplasias de la Columna Vertebral/secundario , Tuberculosis/diagnóstico por imagen , Tuberculosis/patología , Tuberculosis de la Columna Vertebral/diagnóstico por imagen , Tuberculosis de la Columna Vertebral/patología , Ultrasonografía MamariaRESUMEN
Osseous hydatidosis is a rare occurrence of hydatid disease. Anatomoclinical changes are, however, peculiar to this localization. From the anatomopathologic standpoint, this localization marks the torpid, insidious progression of the parasite into bone tissue, leading to an immediate diffuse, extensive, invasion process, so complete surgical eradication is rarely possible. From the clinical standpoint, whatever the localization may be, we are surprised by the latency of this affection, the patient being treated at an advanced stage, when radiologic lesions are already extensive, and the complications, especially in the spinal area, are severe. Owing to the poor biologic findings, the diagnosis of osseous hydatidosis is still primarily based on roentgenographic findings. Sometimes, however, the diagnosis is established only after surgery. Treatment of osseous hydatidosis is closer to oncologic therapy than to the usual surgical treatment of visceral hydatid cysts. Because of the poor results with medical treatment, osseous hydatidosis must be treated by a radical operation with wide excision, adapted to each localization. In the main, the prognosis of osseous hydatidosis remains poor, especially with spinal and pelvic localizations, which are the most frequent ones. The prognosis and treatment of osseous hydatidosis belong in the same category as a locally malignant lesion.
Asunto(s)
Enfermedades Óseas/diagnóstico por imagen , Enfermedades Óseas/terapia , Equinococosis/diagnóstico por imagen , Equinococosis/terapia , Enfermedades Óseas/parasitología , Terapia Combinada , Diagnóstico Diferencial , Equinococosis/parasitología , Humanos , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVES: The objective of this study was to analyse the results of percutaneous nephrolithotomy (PCNL), which was recently introduced into Tunisia, in order to determine its place among the treatment options for renal stones. MATERIAL AND METHODS: Our retrospective study was based on 115 consecutive PCNL procedures performed between April 1994 and November 1997. The stone was a single pelvic stone in 13 cases, lower caliceal in 15 cases, lower pyelocaliceal in 28 cases, partial staghorn in 20 cases, total staghorn in 16 cases and multiple pyelocaliceal in 23 cases. In our series, ultrasound lithotripsy constitutes the procedure of choice for renal stone fragmentation. RESULTS: A good result was obtained immediately in 67% of cases. This figure is lower than that published in the literature because of the complexity of the stones and the high failure rate due to the learning curve, involving 6 members of the team. In the case of failure, the procedure was converted to conventional surgery under the same anaesthetic in 20 patients. Residual stones, observed in 23 patients, were successfully treated by extracorporeal shock-wave lithotripsy (ESWL) in 79% of cases. By combining PCNL and ESWL, the good result rate was 80%. The mortality rate of this series was 0.8% and the morbidity rate was 7.5%. Complications were generally rare and often minor. CONCLUSION: PCNL occupies an important place in the treatment of renal stones. The results depend on the site, size and number of stones and on the operator's experience.
Asunto(s)
Cálculos Renales/cirugía , Cálculos Renales/terapia , Litotricia , Nefrostomía Percutánea , Adolescente , Adulto , Factores de Edad , Anciano , Estudios de Evaluación como Asunto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nefrostomía Percutánea/métodos , Estudios Retrospectivos , Factores SexualesRESUMEN
The authors report two cases of bladder leiomyosarcoma, an extremely rare invasive bladder tumour, with a very poor prognosis due to very early local invasion. The definitive diagnosis can only be established by histological examination. The treatment modalities for this histological type of bladder tumour have not been standardized and remain controversial. However, the treatment of choice appears to be radical prostatocystectomy preceded by neoadjuvant chemotherapy when compatible with the patient's general state.
Asunto(s)
Leiomiosarcoma/diagnóstico , Neoplasias de la Vejiga Urinaria/diagnóstico , Adulto , Anciano , Cistectomía , Humanos , Leiomiosarcoma/patología , Leiomiosarcoma/cirugía , Masculino , Prostatectomía , Tomografía Computarizada por Rayos X , Vejiga Urinaria/patología , Neoplasias de la Vejiga Urinaria/patología , Neoplasias de la Vejiga Urinaria/cirugía , UrografíaRESUMEN
An avascular necrosis of the femoral head occurred after intra-medullary nailing of a femoral diaphyseal fracture. This complication may be related to the posterior situation of the proximal insertion hole just posterior to the trochanteric notch and piriformis fossa as demonstrated by the CT scan. This situation of the nail may cause injury to posterior branch of the circonflex artery at the time of rod insertion. Even if it appears exceptional in adult patients with intra-medullary nailing, this potential complication and the anatomy of the superior extremity of the femur should be known.
Asunto(s)
Fracturas del Fémur/cirugía , Necrosis de la Cabeza Femoral/etiología , Fijación Intramedular de Fracturas/efectos adversos , Adulto , Arterias/lesiones , Cabeza Femoral/irrigación sanguínea , Necrosis de la Cabeza Femoral/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , RadiografíaRESUMEN
The authors present a case of fracture dislocation of the ankle joint with the proximal part of the fibula entrapped behind the tibia ; Bosworth's fracture. This fracture was described for the first time in 1848 by Hugier, and classified by Bosworth in 1947. In our case, diagnosis was not done in a first time, and closed reduction failed. This fracture was operated on and open reduction was performed. At the present time, the functional result is good.
Asunto(s)
Traumatismos del Tobillo/cirugía , Peroné/lesiones , Fijación Interna de Fracturas/métodos , Fracturas Cerradas/complicaciones , Luxaciones Articulares/diagnóstico , Clavos Ortopédicos , Moldes Quirúrgicos , Diagnóstico Diferencial , Peroné/cirugía , Estudios de Seguimiento , Humanos , Luxaciones Articulares/complicaciones , Luxaciones Articulares/cirugía , Masculino , Persona de Mediana Edad , Rango del Movimiento ArticularAsunto(s)
Quemaduras Químicas/complicaciones , Cáusticos/efectos adversos , Esofagitis/inducido químicamente , Esófago/lesiones , Quemaduras Químicas/diagnóstico , Quemaduras Químicas/epidemiología , Quemaduras Químicas/terapia , Niño , Preescolar , Esofagitis/diagnóstico , Esofagitis/epidemiología , Esofagitis/terapia , Femenino , Humanos , Lactante , Masculino , Estudios RetrospectivosRESUMEN
This paper presents a short study of 17 cases of tuberculosis of the greater trochanter seen during a period of 19 years at the National Orthopaedic Institute in Tunis. The onset of the infection is slow with patients presenting at a mean of 7 years after initial symptoms. The diagnosis is confirmed by biopsy and culture of the organism. Management is based on treatment with antituberculous drugs, although surgical excision of the lesion is sometimes required. Successful resolution of the symptoms is usually achieved unless the hip joint becomes involved. Our patients showed good results at a mean follow up of 5 1/2 years.
Asunto(s)
Antituberculosos/uso terapéutico , Fémur , Tuberculosis Osteoarticular/tratamiento farmacológico , Adolescente , Adulto , Femenino , Fémur/diagnóstico por imagen , Fémur/microbiología , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Resultado del Tratamiento , Tuberculosis Osteoarticular/diagnóstico por imagen , Tuberculosis Osteoarticular/microbiologíaRESUMEN
The authors report a case of spontaneous bilateral subcapsular haematoma of the kidney in a patient with polyarteritis nodosa. Although often easy to diagnose, the aetiology of these spontaneous subcapsular haematomas is sometimes difficult to establish despite ultrasonography and computed tomography. The authors emphasise the value of arteriography in these cases, which may reveal pathognomonic signs of polyarteritis nodosa. In this case, the diagnosis was established on the basis of arteriographic findings and the American College of Rheumatology criteria and not on histological criteria.
Asunto(s)
Hematoma/etiología , Enfermedades Renales/etiología , Poliarteritis Nudosa/complicaciones , Adulto , Diagnóstico Diferencial , Hematoma/diagnóstico por imagen , Humanos , Enfermedades Renales/diagnóstico por imagen , Masculino , Poliarteritis Nudosa/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
An exceptional case of vertebral hydatidosis with involvement of the cervical, dorsal, lumbar and sacral segments of the spine is presented. Vertebral hydatidosis is a rare form of hydatid disease. It is found in less than 2% of all cases in echinococcosis. The initial parasite localization is usually univertebral. Extensive primary lesions were related to massive infestation by tapeworm ova at multivertebral levels. At this stage, the disease presents as a malignant tumor resistant to all surgical procedures. The prognosis is poor because of severe neurological complications and inexorable spinal destruction. The hope remains that in the future an effective medical parasiticidal treatment will be available.
Asunto(s)
Equinococosis/diagnóstico , Enfermedades de la Columna Vertebral/parasitología , Adulto , Diagnóstico Diferencial , Equinococosis/complicaciones , Femenino , Humanos , Osteólisis/etiología , Neoplasias de la Columna Vertebral/diagnóstico , Tomografía Computarizada por Rayos XRESUMEN
Osteoid osteoma of the acetabulum can be expected to cause nonspecific symptoms of hip inflammation. In a sixteen year old girl, investigation by routine radiographs and a bone scan suggested a focus of inflammation with a nidus and sclerosis of the acetabulum and overgrowth of the head and neck of the femur. Removal of the lesion by an anterior approach with dislocation of the hip gave excellent results when seen after three years with a normal gait and normal hip motion.
Asunto(s)
Acetábulo , Neoplasias Óseas/diagnóstico , Osteoma Osteoide/diagnóstico , Adolescente , Neoplasias Óseas/cirugía , Femenino , Humanos , Osteoma Osteoide/cirugíaRESUMEN
The authors report about one rare case of renal tuberculosis in a pseudo-tumoral form, which had radiologic appearances compatible with a kidney cancer invading soft tissue. The fast spontaneous evolution towards fistulization allowed confirming the diagnosis of urinary tuberculosis. The outcome with treatment was favorable. The authors recommend that needle biopsy should be made in cases of doubtful kidney tumors to provide an exact diagnosis.