RESUMO
Neurogenic claudication is most frequently observed in patients with degenerative lumbar spinal stenosis. We describe a patient with lumbar epidural varices secondary to obstruction of the inferior vena cava by pathological lymph nodes presenting with this syndrome. Following a diagnosis of follicular lymphoma, successful chemotherapy led to the resolution of the varices and the symptoms of neurogenic claudication. The lumbar epidural venous plexus may have an important role in the pathogenesis of spinal stenosis. Although rare, epidural venous engorgement can induce neurogenic claudication without spinal stenosis. Further investigations should be directed at identifying an underlying cause.
Assuntos
Espaço Epidural/irrigação sanguínea , Claudicação Intermitente/etiologia , Região Lombossacral/irrigação sanguínea , Linfoma Folicular/diagnóstico , Varizes/diagnóstico , Varizes/etiologia , Biópsia , Humanos , Linfoma Folicular/complicações , Linfoma Folicular/tratamento farmacológico , Linfoma Folicular/patologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estenose Espinal/diagnóstico , Estenose Espinal/etiologiaRESUMO
A 66-year-old man presented with an infected resurfacing hip replacement in the immediate post-operative period following an uneventful transurethral resection of the prostate. Prophylactic antibiotics had been administered on induction of anaesthesia. The hip prosthesis had been inserted seven years previously and had been hitherto asymptomatic. The hip was washed out and microbiological examination identified Enterococcus faecalis as the infecting micro-organism. Despite current recommendations, clinicians undertaking invasive procedures which can lead to bacteraemia in patients with prosthetic joint replacements should be aware of the risk of haematogenous seeding in such prostheses, which although low, has potentially disastrous consequences.
Assuntos
Artroplastia de Quadril/efeitos adversos , Enterococcus faecalis/isolamento & purificação , Infecções por Bactérias Gram-Positivas/microbiologia , Prótese de Quadril/microbiologia , Infecções Relacionadas à Prótese/microbiologia , Ressecção Transuretral da Próstata/efeitos adversos , Idoso , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , Masculino , Infecções Relacionadas à Prótese/tratamento farmacológico , Resultado do TratamentoRESUMO
It is generally accepted that antiphospholipid syndrome remains a major medical problem characterised by hypercoagulability, arterial and venous thrombosis and thrombocytopenia. It is unclear how best to treat these patients should they require emergency surgery. If a lupus anticoagulant is present, hypercoagulability may occur de novo but surgical interventions along with sepsis are two important predisposing factors. We describe three patients with primary antiphospholipid syndrome and discuss the implications for surgery.
