RESUMEN
OBJECTIVES: To describe the sonographic and clinical features of abdominal wall endometriosis (AWE), a frequently misdiagnosed condition. METHODS: This was a retrospective study of 21 consecutive women with pathologically proven endometriosis of the abdominal wall. Ultrasonographic and Doppler examinations were performed, before surgery, with a high-frequency linear transducer. The clinical data and the results of the sonographic examinations were reviewed and described. RESULTS: At ultrasound, all the nodules appeared as discrete solid masses that were less echogenic than the surrounding hyperechoic fat. The nodules had a median diameter of 20 (range, 5-50) mm and in 18/21 (86%) cases the nodules had a round/oval shape. In eight of 21 (38%) women the AWE was located at the umbilicus, in six of 21 (29%) it was between the transverse suprapubic line and the umbilicus, in five of 21 (24%) it was found along the scar of a previous Cesarean section and in two of 21 (9%) it was in the right inguinal canal. The content was homogeneously hypoechoic in 12/21 (57%) women and inhomogeneous in the other nine (43%). The outer borders were invariably ill defined. Scarce blood vessels were found by power Doppler. Cyclic or continuous spontaneous pain at the level of the AWE was present in 19/21 (91%) cases, and two (9%) patients were asymptomatic. CONCLUSIONS: Hypoechoic round/oval nodules with ill-defined borders and a hyperechoic rim should raise the suspicion of abdominal wall endometriosis, even in patients with no history of endometriosis or previous laparotomic surgery. Pressing the ultrasound probe against the nodule should reinforce a suspected diagnosis because of the pain it induces.
Asunto(s)
Pared Abdominal/diagnóstico por imagen , Cesárea/efectos adversos , Cicatriz/diagnóstico por imagen , Endometriosis/diagnóstico por imagen , Dolor/diagnóstico por imagen , Ultrasonografía Doppler , Pared Abdominal/patología , Pared Abdominal/cirugía , Adulto , Cicatriz/patología , Cicatriz/cirugía , Endometriosis/patología , Endometriosis/cirugía , Femenino , Humanos , Persona de Mediana Edad , Dolor/cirugía , Estudios RetrospectivosRESUMEN
AIM: Severe endometriosis represents one of the most challenging clinical and surgical cases in gynecology. Preoperative assessment of the extension of the disease is of key relevance to opt for medical or surgical therapy and, sometimes, to plan a multidisciplinary approach. METHODS: A systematic diagnostic approach is proposed and evaluated in a tertiary referral centre. It is based on an initial clinical evaluation and a second level ultrasound of the pelvis. Further exams, whenever required, have to be aimed at demonstrating specific involvements of organs other than ovaries and peritoneum such as bowel, urinary tract and nerves. RESULTS: The application of the proposed protocol has led to a reduction of the number of non-radical surgical procedures due to incomplete consent associated with missed diagnosis over the years (P<0.001). CONCLUSION: Our findings support the efficacy of a systematic diagnostic approach to endometriosis. This allows a correct planning of therapy with a multidisciplinary approach when necessary.
Asunto(s)
Endometriosis/diagnóstico , Pelvis , Cuidados Preoperatorios/métodos , Adulto , Femenino , HumanosRESUMEN
OBJECTIVE: The aim of our work was to assess the diagnostic accuracy of a scoring system versus subjective assessment of the risk of malignancy of pelvic masses achieved by gynecologist/sonologists in the preoperative triage of a busy gynecology department. METHODS: One hundred and eighty-two consecutive patients who underwent surgical removal of ovarian neoplasms were examined. In 39 patients pelvic masses were bilateral. The total number of neoplasms analyzed in this series was 221. Lesions were examined and scored according to the sonographic characteristics. Gynecologist/sonologists also recorded a subjective evaluation of the adnexal masses defining them as "probably benign", and "suspicious/probably malignant". Preoperative ultrasound risk assessment was compared to the final pathologic report and diagnostic accuracy was calculated. CA125 was obtained in all patients and its independent and combined accuracy was calculated. RESULTS: The sensitivity of the scoring system and subjective evaluation was 86% and 95% respectively, specificity was 79% and 91% with a positive predictive value of 41% and 53%. The frequency of positive diagnoses for CA125 was 44% due to the high prevalence of endometrosis in this series (48%). In premenopausal patients (75%) the specificity was 93% and 89% for scoring and subjective evaluation, respectively. The combined use of morphological scoring and CA125 achieved higher specificity and positive predictive values both for the whole series and in premenopausal patients. CONCLUSIONS: These results confirmed that the experience of gynecological surgeons with ultrasound skills, outperforms the morphological indexing assessment of ovarian masses. Nonetheless an easy sonographic descriptive scoring system is not significantly lower in accuracy than the expertise achieved by gynecologists with sonographic skills.
Asunto(s)
Quistes Ováricos/diagnóstico por imagen , Neoplasias Ováricas/diagnóstico por imagen , Proteínas/análisis , Adulto , Diagnóstico Diferencial , Femenino , Humanos , Péptidos y Proteínas de Señalización Intracelular , Quistes Ováricos/diagnóstico , Quistes Ováricos/patología , Neoplasias Ováricas/diagnóstico , Neoplasias Ováricas/patología , Cuidados Preoperatorios , Sensibilidad y Especificidad , Ultrasonografía/métodos , VaginaRESUMEN
We assessed peripheral nerve function during and after lower-limb lengthening by callotasis in 14 patients with short stature, using motor conduction studies. Four patients with short stature of varying aetiology showed unilateral and one showed bilateral weakness of foot dorsiflexion. Both clinical and electrophysiological abnormalities consistent with involvement of the peroneal nerve were observed early after starting tibial callotasis. There was some progressive electrophysiological improvement despite continued bone distraction, but two patients with Turner's syndrome had incomplete recovery. A greater percentage increase in tibial length did not correspond to a higher rate of peroneal nerve palsy. The function of the posterior leg muscles and the conduction velocity of the posterior tibial nerve were normal throughout the monitoring period. The F-wave response showed a longer latency at the end of the bone distraction than in basal conditions; this is probably related to the slowing of conduction throughout the entire length of the nerve.
Asunto(s)
Enanismo/cirugía , Electromiografía , Fémur/cirugía , Osteogénesis por Distracción , Nervio Peroneo/fisiología , Tibia/cirugía , Nervio Tibial/fisiología , Acondroplasia/complicaciones , Acondroplasia/fisiopatología , Adolescente , Adulto , Potenciales Evocados Motores/fisiología , Femenino , Enfermedades del Pie/etiología , Enfermedades del Pie/fisiopatología , Humanos , Pierna , Masculino , Monitoreo Fisiológico , Neuronas Motoras/fisiología , Debilidad Muscular/etiología , Debilidad Muscular/fisiopatología , Músculo Esquelético/inervación , Músculo Esquelético/fisiopatología , Conducción Nerviosa/fisiología , Osteogénesis por Distracción/efectos adversos , Parálisis/etiología , Parálisis/fisiopatología , Enfermedades del Sistema Nervioso Periférico/etiología , Enfermedades del Sistema Nervioso Periférico/fisiopatología , Tiempo de Reacción/fisiología , Síndrome de Turner/complicaciones , Síndrome de Turner/fisiopatologíaRESUMEN
We have reviewed 16 patients treated by leg lengthening for various forms of Turner dwarfism with regard to the long period of healing and the complications. We consider that Turner dwarfism is a suitable indication for leg lengthening because of the moderate length deficit and the morphological appearance of the patients, and have introduced an improved programme of management to deal with the problems encountered.
Asunto(s)
Alargamiento Óseo , Enanismo/cirugía , Síndrome de Turner/cirugía , Adolescente , Adulto , Estatura , Enanismo/etiología , Femenino , Humanos , Síndrome de Turner/complicaciones , Cicatrización de HeridasRESUMEN
Between 1979 and 1982, 80 patients with a variety of hip diseases were treated with articulated distraction of the hip. The patients ranged from nine to 69 years of age (mean, 34 years). The primary diagnoses were avascular necrosis, osteoarthrosis, and chondrolysis. A standard dynamic axial fixator with a single axis articulating unit was used to create a 5-mm joint space. The fixator allowed flexion and extension motion and remained in place for six to ten weeks. The follow-up period ranged from five to eight years. Assessment was performed by questionnaire, clinical, and radiographic review. The results were poor in 24 patients who were either older than 45 years of age or had a diagnosis of inflammatory arthropathy. Forty-two good results were found in the 59 patients younger than 45 years with osteoarthrosis, hip dysplasia, avascular necrosis, and chondrolysis. Only four patients older than 45 years of age had a good result. No serious complications occurred.
Asunto(s)
Contractura/cirugía , Fijadores Externos , Articulación de la Cadera/cirugía , Adolescente , Adulto , Anciano , Artroplastia/métodos , Enfermedades de los Cartílagos/cirugía , Niño , Femenino , Necrosis de la Cabeza Femoral/cirugía , Articulación de la Cadera/diagnóstico por imagen , Articulación de la Cadera/fisiología , Humanos , Artropatías/cirugía , Masculino , Persona de Mediana Edad , Osteoartritis de la Cadera/cirugía , Radiografía , Rango del Movimiento ArticularRESUMEN
Chondrodiatasis is a limb-lengthening technique involving slow, controlled, symmetric epiphyseal distraction. The clinical and histological differences between this technique and distraction epiphysiolysis are described. Results are given for the elongation of 170 bone segments in 75 children (41 with limb-length discrepancies and 34 with achondroplasia). All patients were operated upon while the growth plate was still open with maximum bone maturation corresponding to Risser 2.
Asunto(s)
Alargamiento Óseo/métodos , Epífisis/cirugía , Fémur/cirugía , Tibia/cirugía , Acondroplasia/cirugía , Adolescente , Alargamiento Óseo/efectos adversos , Alargamiento Óseo/instrumentación , Niño , Fémur/anatomía & histología , Humanos , Dispositivos de Fijación Ortopédica , Estrés Mecánico , Tibia/anatomía & histología , Factores de Tiempo , Tracción , Cicatrización de HeridasRESUMEN
Hemichondrodiatasis is a technique of closed, gradual, asymmetric distraction of the growth plate to correct angular deformities in growing children. This report describes the technique and the results achieved in 35 operated lower extremity segments, 14 involving the femur and 21 involving the tibia. The best results were achieved in posttraumatic deformities when the bone bridge occupied less than 20%-30% of the epiphyseal plate. The procedure is best performed toward the end of growth, or earlier if a progressive deformity exceeds 15 degrees - 20 degrees.
Asunto(s)
Alargamiento Óseo/métodos , Epífisis/cirugía , Fémur/cirugía , Placa de Crecimiento/cirugía , Tibia/cirugía , Adolescente , Alargamiento Óseo/efectos adversos , Alargamiento Óseo/instrumentación , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Masculino , Dispositivos de Fijación Ortopédica , Estrés Mecánico , TracciónRESUMEN
The aim of surgical orthopaedics in short stature is to increase overall height and improve body proportions. It is particularly applicable to lower limb lengthening in achondroplasia, hypochondroplasia, Turner's syndrome and Ellis-van Creveld syndrome. Two methods are routinely used in Verona: chondrodiatasis and callotasis. Although simultaneous lengthening of tibia and femur of the same limb have generally been employed, recent efforts have concentrated on simultaneous lengthening of one femur and the contralateral tibia. Lengthening of up to 20-25 cm can now be achieved, with a complication rate below 20%.
Asunto(s)
Estatura , Alargamiento Óseo/métodos , Acondroplasia/cirugía , Adolescente , Niño , Síndrome de Ellis-Van Creveld/cirugía , Femenino , Humanos , Masculino , Síndrome de Turner/cirugíaRESUMEN
We report our experience of lengthening by over 30% a total of 117 lower limbs in achondroplastic patients. We have compared four methods: transverse osteotomy, oblique osteotomy, callotasis of the shaft and chondrodiatasis of the epiphysis. Chrondrodiatasis of the femur and callotasis of the tibia are the techniques which gave fewest complications.
Asunto(s)
Acondroplasia/cirugía , Alargamiento Óseo/métodos , Fémur/cirugía , Osteotomía/métodos , Tibia/cirugía , Adolescente , Adulto , Alargamiento Óseo/efectos adversos , Niño , Epífisis/cirugía , Femenino , Humanos , Masculino , Osteotomía/efectos adversosRESUMEN
Limb lengthening of the left femur was performed in 12 sheep, 7-8 months of age. After weakening of the cortex by drill holes, a controlled fracture was created in the diaphysis. The bone segments were fixed in reduced position using a unilateral external fixation device. The fixator was left in neutral position for 10 days postoperatively when lengthening started. By means of daily distraction at a rate of 1.0 mm once a day for 3 weeks, an average lengthening of 1.9 cm (11.9%) was obtained. Two weeks after distraction had been discontinued, distinct callus bridging of the lengthening zone was confirmed radiographically in all animals. At this time the rigid state of fixation was converted to a system allowing axial compression by loading in half the animals. The other half of the animals served as controls with the fixator remaining unchanged. The external device was left on until 5 weeks after the end of distraction. At this time the animals were killed. Both femora of all animals were tested mechanically in torsion. The average ultimate torsional strength of the elongated femur compared with control was 71% in the group with dynamic axial fixation and 65% in the control group. No significant difference in relative strength of the tested bones in the two groups was found. We conclude that intermittent axial compression by loading during consolidation had no significant effect on the bone-healing process evaluated by radiography and mechanical testing.
Asunto(s)
Alargamiento Óseo/métodos , Fémur/cirugía , Animales , Alargamiento Óseo/instrumentación , Clavos Ortopédicos , Callo Óseo/diagnóstico por imagen , Femenino , Fracturas del Fémur/diagnóstico por imagen , Fracturas del Fémur/etiología , Fracturas del Fémur/cirugía , Fémur/diagnóstico por imagen , Fijación Interna de Fracturas , Masculino , Radiografía , Ovinos , Estrés MecánicoRESUMEN
Callotasis is a new technique of limb lengthening involving slow distraction of the callus formed in response to a proximal submetaphyseal corticotomy. Using a dynamic axial fixator with telescoping capabilities, distraction begins after 2 weeks. When the required length is attained, the fixator is held in the rigid mode until radiographic evidence of callus is observed. The locking screw is then released, and dynamic axial loading is instituted to promote corticalization. One hundred bony segments have been lengthened; 50 patients had limb length inequality, and 23 had achondroplasia. The mean lengthening achieved was 22% (maximum, 58%). There were 14 complications (14%).
Asunto(s)
Alargamiento Óseo/métodos , Callo Óseo , Acondroplasia/cirugía , Adolescente , Adulto , Alargamiento Óseo/efectos adversos , Alargamiento Óseo/instrumentación , Tornillos Óseos/efectos adversos , Niño , Fémur/cirugía , Humanos , Húmero/cirugía , Masculino , Osteólisis/etiología , Tibia/cirugíaRESUMEN
We have compared, in rabbits, two techniques of limb lengthening by distraction of the epiphyseal plate using a unilateral external fixation frame. In all cases, 14 mm of symmetrical lengthening without deviation was achieved. With rapid distraction at rates of 1 mm per day (distractional epiphyseolysis) separation of the epiphysis from the metaphysis occurred by day 7, and by day 70 almost complete ossification of the cartilage and the elongated segment was evident. In contrast, slow distraction at 0.25 mm every 12 hours (chondrodiatasis) produced hyperplasia of growth cartilage without any evidence of detachment at 28 days, the end of the distraction period. By day 70 the epiphyseal plate had returned to normal thickness with normal cellular morphology, while the lengthened segment was occupied by ossified tissue. The significance of these findings is discussed.
Asunto(s)
Alargamiento Óseo/métodos , Animales , Epífisis/patología , Placa de Crecimiento/patología , ConejosRESUMEN
We describe a technique for slow, progressive, symmetrical distraction of the growth plate using a lightweight dynamic axial fixation system. Results are given for the elongation of 40 bony segments in children with limb-length discrepancies and 60 segments in children with achondroplasia or hypochondroplasia. Increases in limb length of up to 36% were obtained in non-achondroplastic and up to 64.5% in achondroplastic patients. There were no nerve or vascular lesions or bony infections and no case required a bone graft. Pin-track complications occurred in only 1.5%.