scar Contreras O

Enfermedad de Paget en Chile: una serie de 15 pacientes

Background: Paget disease of bone (PD) is a localized disorder of bone remodeling, which leads to bone fragility and deformity. In Chile PD is uncommon. Aim: To study clinical and demographic characteristics of patients with PD seen in the Clinical Hospital of the Catholic University. Patients and methods: Patients with typical radiological and clinical features of PD referred to our institution during the last decade were included in this review. Results: We obtained data from 15 patients with PD (ten males, eight Chilean, six European and one Asian), eleven of them were diagnosed during the last 3 years. The mean age at diagnosis was 68,7±11,1 years old. No one had first degree relatives with PD. Bone pain was the main complaint in 13 patients and elevated total alkaline phosphatases in the other two. The average duration of the symptoms prior to diagnosis was 38,8 months. Eight patients had monostotic lesions; the most commonly involved sites were the pelvis, spine and femur. Radiological evaluation disclosed sclerotic changes in all patients as well as bone deformity and osteoarthritis in eight patients. Total alkaline phosphatases were elevated in 14 cases (mean: 4 times over the upper normal limit). Conclusions: When compared to series of the Northern hemisphere, PD in Chile is characterized by an older age at diagnosis, a higher frequency of symptomatic presentation, advanced radiological involvement and greater proportion of complications. PD should be suspected in every patient, Chilean or foreigner, with bone pain or elevated alkaline phosphatases (Rev Med Chile 2003; 131: 491-7).

Síndrome de Parsonage-Turner o neuritis braquial: a propósito de dos casos clínicos

Tw o cases of Parsonage-Turner syndrome are presented. The clinical presentation and MRI characteristics are discussed.

Neoplasia colorrectal.: Tratamiento de la obstrucción con endoprótesis metálicas autoexpandibles

Background: Expandable metal stents can be used as a palliative or pre surgical method to decompress obstructing colonic carcinomas. Aim: To assess the effectiveness of these stents in the treatment of obstructive colonic carcinoma. Patients and methods: Expandable metal stents were placed in nine patients with the diagnosis of colorectal carcinoma and with clinical and radiographic signs of intestinal obstruction. Stents were placed under fluoroscopic guidance in nine patients and with endoscopic help in 2. The indications were palliative treatment in 7 and pre surgical decompression in 2 patients. Results: Stent placement was successful in all patients. One patient presented a self limited rectal bleeding after the procedure. Obstruction was relieved in less than 24 hours after the procedure. Conclusion: Expandable metal stent placement is an effective means of relieving intestinal obstruction caused by colorectal carcinoma.

Diagnóstico de lesiones óseas con biopsia percutánea guiada por imágenes

Background: Percutaneous biopsies have a good sensitivity and specificity for the diagnosis of bone lesions. Aim: To report the experience with 270 percutaneous bone lesions biopsies guided with fluoroscopy or computed tomography. Material and Methods: Retrospective review of the medical records of 270 patients (mean age 53.4 years, range 4 to 95 years; 134 female) subjected to a percutaneous biopsy of a bone lesion, guided either by computed tomography or fluoroscopy. The final analysis included the tumor type, tumor malignancy, tumor grade and complications of the procedure. Results: One hundred seventy nine lesions were malignant and 91 benign. Of the malignant lesions, 95 were metastatic and 84 were primary. In 3 cases, the initial diagnosis was a false negative (1.1%). Only one patient had a local hematoma after the procedure. Conclusions: Image guided percutaneous biopsy of bone lesions is a safe, effective, fast and economic procedure to obtain a pathological diagnosis of bone lesions (Rev Med Chile 2006; 134: 1283-87). (Key words: Biopsy, needle; Bone and bones; Neoplasms by site; Neoplasms, second primary)

VERTEBROPLASTIA PERCUTANEA: NUEVA ALTERNATIVA EN EL TRATAMIENTO DEL DOLOR DE ORIGEN VERTEBRAL

Resumen: Con el aumento de la expectativa de vida y el avance en la terapia oncologica enfrentamos una poblacion que presenta una mayor frecuencia de dolor vertebral originado en fracturas osteoporoticas o lesiones vertebrales neoplasicas. En este escenario y en conjunto con el desarrollo de las terapias minimamente invasivas aparece la vertebroplastia percutanea, que ha demostrado ser una excelente alternativa en el tratamiento del dolor de origen vertebral. Presentamos nuestra experiencia con esta nueva tecnica, que incluye 32 procedimientos en 21 pacientes, con resultados satisfactorios, observandose un 15.6% de complicaciones menores sin significado clinico.

Quiste hidatídico retro-peritoneal: Una enfermedad frecuente en una ubicación inusual

La hidatidosis sigue siendo un problema prevalente en areas endemicas. Presentamos el caso de un quiste hidatidico primario ubicado en el espacio retro-peritoneal. Mujer de 54 anos, procedente de area rural del sur de Chile, hospitalizada por cuadro de coxalgia derecha y aumento de volumen gluteo, con tres meses de evolucion. Se realizo el diagnostico de hidatidosis complicada por medio de examenes de imagenes, tests serologicos y anatomia patologica. No se demostraron quistes hidatidicos en otras ubicaciones. Se realizo un drenaje percutaneo del quiste infectado y se administraron antihelminticos durante 12 semanas y actualmente permanece en seguimiento cercano con buena respuesta al tratamiento. El quiste hidatidico debe ser considerado en el diagnostico diferencial de masas quisticas retro-peritoneales, especialmente en areas endemicas.

Proyección de Rosenberg en la evaluación radiológica de la osteoartrosis de rodilla

Knee osteoarthritis is highly prevalent in our country. An early diagnosis is very important to provide an accurate and early treatment, and eventually delay its progression. Aim: To compare the diagnostic yield for osteoarthritis of two projections in knee Xray examination. Material and Methods: We evaluated 44 knees with conventional (AP weight-bearing, in full extension) and Rosenberg (PA weight-bearing in 45 degrees of flexion) X ray projections in 32 patients (24 women and 8 men), aged 26 to 78 years. All patients were symptomatic at the time of evaluation, with a suspicion of knee osteoarthritis. Both projections were analyzed and compared. Results: Joint space in the lateral compartment with conventional AP weight-bearing and Rosenberg projections were 8.6±11.5 mm and 7.8±10.9 mm, respectively (NS). The joint space for the medial compartment were 8.2±10.9 mm and 6.7±8.6 mm, respectively (p <0.05). Conclusions: Rosenberg prqjection is more sensitive to detect knee joint space narrowing as compared with conventional AP weight-bearing prqjection, at least in the medial compartment ofthe knee. Therefore, Rosenberg prqjection should be included in the initial study of any patient with suspicion ofknee osteoarthritis

Radiosinovectomía de muñeca guiada por ultrasonido: Experiencia de un caso clínico y revisión del tema

Radiosynovectomy is a local form of radiotherapy used as second-line treatment in the management of inflammatory and non-inflammatory arthropathies with unsatisfactory response to local or systemic corticos - teroid therapy. Its efficacy is similar to that of surgical synovectomy, with the advantages of being a low-cost and minimally- invasive treatment that requires a shorter recovery time. Its efficacy is greater in the treatment of inflammatory arthritis characterized by synovitis, such as rheumatoid arthritis and juvenile chronic arthritis with mono/ oligoarticular involvement, especially in upper extremity joints. A number of isotopes can be used in colloidal suspensions. Rhenium-186-sulphide colloid is currently indicated for the treatment of medium-sized joints. The ultrasound-guided injection is suitable for small joints, such as wrist. For proper and safe use and administration of this technique the collaboration of a trained and experienced radiologist is critical to successful treatment.

Síndrome de edema de la médula ósea de cadera

Two men and two women (one of them pregnant) aged 42, 48, 36 and26 years old, fulfilled criteria. Treatment included limited weight bearing, non steroidal antiin-flammatory drugs, intranasal calcitonin and physical therapy. Complete remission of symptomswas observed within five to seven months. At an average follow up of 36 months, all patientspresented complete function of the hip, returning to their previous activity levels, with no newepisodes of BMES.

VALOR DE LA RESONANCIA MAGNETICA PRECOZ EN EL DIAGNOSTICO DE FRACTURAS DE ESCAFOIDES

Introduction: In cases of clinically suspected scaphoid fracture, without radiographic evidence, immobilization and symptomatic treatment is recommended. The use of MRI would define how many of this cases actually present scaphoid fracture, modifying treatment. Materials and methods: In 15 patients with clinically suspected scaphoid fracture and negative radiograph, MRI exams were done 9 days or earlier after trauma. The study included coronal turbo-spin-echo (TSE) T1 weighted images and coronal short tau inversion recovery (STIR) sequences. Results: MRI showed occult scaphoid fractures in 5 patients (33%), with the combination of T1 and STIR sequences. Patients with negative radiograph and MRI studies reintegrated to normal activities in a period shorter than 2 weeks after trauma. As a consequence there was a reduction in economic costs of at least 50% considering only radiologic studies, and decreased number of medical consultation. Discussion: MRI early after trauma show a high sensitivity detecting scaphoid fractures radiographically occult, allowing early diagnosis and treatment, avoiding unnecessary immobilization and reducing costs in those patients without fracture.