Termoablación por radiofrecuencia de osteomas osteoides del extremo proximal del fémur. Utilidad de la ecografía en casos seleccionados / Radiofrequency thermal ablation of osteoid osteomas of the proximal femur. Usefulness of ultrasound guidance in selected cases

Objetivo. Repasar la sintomatología y los hallazgos de imagen de los osteomas osteoides (OO) del extremo proximal del fémur, analizar los resultados de la técnica de la termoablación del nidus con ondas de radiofrecuencia en esa localización y describir la utilidad de la ecografía en la realización de la técnica en casos seleccionados. Material y método. Estudio descriptivo retrospectivo de una serie de 8 pacientes con OO del extremo proximal del fémur tratados mediante termoablación del nidus con ondas de radiofrecuencia desde 1998 hasta 2014. Resultados. El tiempo medio de evolución del dolor hasta la termoablación fue de 11,5 meses (rango: 5-18 meses). No hubo ninguna complicación y todos los pacientes refirieron la desaparición del dolor al día siguiente del procedimiento, con molestias que desaparecieron en la primera semana, salvo en uno, que se prolongaron más de un mes por la dificultad de la técnica. En la actualidad, con un seguimiento medio de 6 años y 2 meses (rango: 6-190 meses), todos los pacientes siguen asintomáticos y realizan una vida rigurosamente normal. Discusión. La termoablación con ondas de radiofrecuencia guiada por TC es un procedimiento seguro, eficaz y eficiente. Conclusiones. La presentación habitual de un OO del extremo proximal del fémur no difiere significativamente de la de un OO de otra localización y el diagnóstico es fácil cuando aquella se conoce. La termoablación del nidus con ondas de radiofrecuencia, que en casos seleccionados podría ayudarse de la ecografía para situar el electrodo en el centro del nidus, nos parece el tratamiento de elección por su eficacia y mínima morbilidad (AU)

Purpose. To review symptoms and imaging findings of proximal femoral osteoid osteomas (OO); to analyse the results of a thermal ablation technique for radiofrequency of the nidus in this location; and to describe usefulness of ultrasound guidance in selected cases. Material and method. Descriptive and retrospective study consisting of 8 patients with OO in the proximal epiphysis of the femur, which were treated by thermal ablation of the nidus with radiofrequency waves from 1998 to 2004. Results. The mean pain period until the performance of the thermal ablation was 11.5 months (range 5-18 months). There were no complications, and all patients stated that the pain was gone by the day following the procedure, with some discomfort during the first week, except for one where it lasted more than one month due to technique difficulties. At present, with a mean follow up of 6 years and 2 months (range 6-190 months), all patients remain asymptomatic and live a rigorous normal life. Discussion. Thermal ablation with CT-guided radiofrequency waves is a safe, effective and efficient procedure. Conclusion. Normal appearance of a proximal femoral OO does not differ significantly from other location osteomas and its diagnosis is easier with previous knowledge. Thermal ablation of the nidus with radiofrequency waves, that may be performed using ultrasound guidance, appears to be the elective treatment of choice due to its efficiency and minimum morbidity (AU)

Radiofrequency thermal ablation of osteoid osteomas of the proximal femur. Usefulness of ultrasound guidance in selected cases.

PURPOSE: To review symptoms and imaging findings of proximal femoral osteoid osteomas (OO); to analyse the results of a thermal ablation technique for radiofrequency of the nidus in this location; and to describe usefulness of ultrasound guidance in selected cases. MATERIAL AND METHOD: Descriptive and retrospective study consisting of 8 patients with OO in the proximal epiphysis of the femur, which were treated by thermal ablation of the nidus with radiofrequency waves from 1998 to 2004. RESULTS: The mean pain period until the performance of the thermal ablation was 11.5 months (range 5-18 months). There were no complications, and all patients stated that the pain was gone by the day following the procedure, with some discomfort during the first week, except for one where it lasted more than one month due to technique difficulties. At present, with a mean follow up of 6 years and 2 months (range 6-190 months), all patients remain asymptomatic and live a rigorous normal life. DISCUSSION: Thermal ablation with CT-guided radiofrequency waves is a safe, effective and efficient procedure. CONCLUSION: Normal appearance of a proximal femoral OO does not differ significantly from other location osteomas and its diagnosis is easier with previous knowledge. Thermal ablation of the nidus with radiofrequency waves, that may be performed using ultrasound guidance, appears to be the elective treatment of choice due to its efficiency and minimum morbidity.

[Lacunar infarcts. A comparative study of risk factors and carotid stenosis]. / Infartos lacunares. Estudio comparativo de factores de riesgo y estenosis carotídea.

OBJECTIVE: In order to evaluate the pathogenic role of carotid atheromatosis and risk factors for the lacunar type of cerebral ischaemia a comparative analysis was made between a group of patients with this type of stroke and other with non-lacunar infarctions. Unlike previous works, patients with clinical-radiological criteria for ischaemia in the carotid territory were included in both groups. METHODS: Ninety-eight patients with a first episode of stroke were selected prospectively. Strokes were classified as lacunar (52 patients) and non-lacunar (46 patients). The following risk factors were evaluated: age, sex, increased blood pressure, left ventricle enlargement, smoking, alcohol intake, lipid profile, history of previous transient stroke, arterial retinopathy, diabetes, ischaemic heart disease and presence of peripheral arteriopathy. The narrowing degree of the carotid artery was determined by means of Doppler ultrasonography. RESULTS: Significant differences were found for the presence of two variables: hypertensive retinopathy was more prevalent in the lacunar group (p = 0.003) and history of transient ischaemic stroke was recorded more frequently in association with non-lacunar infarction (p = 0.01). A 50%-70% degree of narrowing in the upper carotid artery was observed more frequently in association with non-lacunar infarctions (p < 0.001) in the ipsilateral artery to the symptomatic hemisphere. In the heterolateral artery the narrowing degree was similar for both groups (p = 0.87). CONCLUSIONS: Lacunar and non-lacunar infarctions share the same risk factors; nevertheless, the distribution of atheromatous lesions was different. The presence of hypertensive retinopathy is an excellent marker for perforant arterial disease. The carotid stenosis is an unusual pathogenic mechanism for the development of ischaemic lacunar syndrome with an appropriate injury visualized by CT.