Search

Aim: To determine the perfusion reserve of the lower limbs using the method 99m Tc-MIBI (rest-dipyridamole) perfusion scintigraphy (one-day protocol) in the diagnostic evaluation of peripheral artery disease (PAD) in patients with and without diabetes mellitus (DM)., Material and Methods: We performed tissue-muscle perfusion scintigraphy (TMPS) of the lower limbs, through one-day rest-dipyridamole protocol with 99m Tc-MIBI in 24 patients, divided in two groups according to the presence of diabetes - patients with DM (Dp) 13/24 (54%), 2 males and 9 female patients, age 63±13 years and patients without DM (NDp) 11/24 (46%), 3 males and 10 females, age 61±14 years., Results: In the dynamic phase of the rest study, the time of maximum activity (Tmax), in the early arterial phase, of the calf region was significantly prolonged in Dp compared to NDp, with lower accumulation of the radiotracer in the 1st minute (85%/87% in Dp vs. 89%/90% in NDp, ns). 4/11 of NDp (36.4%) and 7/13 of Dp (53.8%) registered pathological value of the inter-extremity index of the calves in the stress study. Perfusion reserve (PR) of the thighs (LT, RT) and calves (LC, RC) calculated with the formula "(ROI stress-ROI rest)×100%/ROI rest", was significantly lower in Dp: LT: 28±19% vs. 43±24% in NDp, p<0.05; RT: 27±17% vs. 40±25% in NDp, p<0.05; LC: 22±15% vs. 36±15% in NDp, p<0.01; RC: 25±15% vs. 38±14% in NDp, p<0.01., Conclusion: This one-day protocol (rest-dipyridamole with 99m Tc-MIBI) of perfusion scintigraphy of lower limbs is considered as a useful procedure in PAD assessment, especially the asymptomatic form. TMPS of the lower limbs in our study indicated that perfusion reserve in patients with DM was significantly lower, compared to the patients without diabetes., (Copyright © 2017. Publicado por Elsevier España, S.L.U.)

Background: The structural characteristics of the fibula, strength, shape, length and limited donor site morbidity make it more suitable for reconstructing long bone defects larger than 6cm in the limbs., Material and Methods: A descriptive study was conducted using a non-probabilistic sample of consecutive cases undergoing on limb reconstruction with free fibular flap in the period from January 2010 to January 2015 in the Mexican Institute of Social Security No. 21, Monterrey Nuevo Leon., Results: The mean age of the ten cases included was 25 years, with the most common diagnosis being trauma in 4 patients, osteosarcoma in 2, followed by one congenital pseudoarthrosis of the tibia, one non-union fracture, and one gunshot wounds, respectively. The most common location was tibia, followed by humerus, radius, ulna and femur., Conclusions: This study has shown that the fibular free flap can be an excellent option for management of long bone defects, regardless of cause of the injury. One or more skin islands can be added for coverage in exposure of deep tissue and osteosynthesis material, thus preserving the septocutaneous perforators., (Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.)

There are common, specific noninvasive and invasive tests for the diagnosis of pulmonary embolism (PE). Arterial blood gases, lung radiography and electrocardiography belong to the first group and should be performed in patients with suspected PE. Among the second group, D-dimer determination is essential. Ventilation-perfusion scintigraphy was formerly the most frequently used test but has been relegated to a second-line position by the development of multislice computed tomography (CT) angiography, which provides the possibility of simultaneously studying the lower limbs to detect deep venous thrombosis (DVT). SPECT and magnetic resonance imaging can be used as an alternative to multislice CT angiography, but there is less experience with these techniques. Transthoracic echocardiography has, above all, predictive value and lower limb ultrasonography is the most common non-invasive method to detect DVT. Invasive tests, the gold standard, are often unavailable and their use is therefore limited to selected patients. In conclusion, noninvasive management (clinical probability, D-dimer and multislice CT) is feasible in most patients with suspected PE.

Objective: To evaluate the diagnostic efficacy of multidetector computed tomography angiography (MDCTA) in lower limb arteriopathy (LLA) by comparing it with digital subtraction angiography (DSA)., Material and Methods: Twenty-four patients with LLA were studied. All patients underwent MDCTA (four detectors) and DSA, with double reading between the two techniques. Vascular territories were divided to facilitate analysis. Sensitivity (S), specificity (Sp), prevalence, positive and negative predictive values (PPV, PNV), and concordance (Kappa test) were evaluated. In third-portion arteries, the diagnostic performance of MDCTA was evaluated using an ROC curve., Results: MDCTA study to evaluate arterial pathology showed: Lower sensitivity in the study of the internal iliac artery (S: 0.65 and 0.71) with Sp 0.94 and 1. In the other vascular territories, S approached 1, with a slight decrease in Sp. Concordance with DSA was very high (kappa between 0.62 and 1) in all of the territories studied. MDCTA showed greater vessel longitude than DSA. In the third portion, the best diagnostic performance (ROC) was obtained in the reading of pathological vessels., Conclusion: MDCTA was highly reliable in the study of LLA, with high concordance with DSA. In tortuous vessels, MDCTA depicted the lesions poorly; however, in straight vessels and third-portion vessels, MDCTA showed more vascular segments.

Case report of a 32 month old boy with Gaucher's disease. He had an evolution of 22 months with neurological symptoms. The spleen was removed and was studied with light and electron microscopy. The study disclosed the typical morphological features of Gaucher's cells. A correlation was established between symptomatology, radiological findings and anatomic alterations in post mortem studies. An interesting fact is the absence of the disease in other family members and therefore this case may represent an example of a recent mutation. General considerations on the current concept of this disease are also discussed.

The present paper describes a case with clinical and radiological characteristics of Apert's syndrome. He was the first offspring from second cousins marriage. We considered that in this case, consanguinity is an associated feature. Perhaps this case may be the third one reported in the literature with consanguineous parents. We comment the different classifications of the acrocephalosyndactylias for genetic counseling purposes.

The present paper describes a case with clinical and radiological characteristics of Ellis-van Creveld syndrome. He was the first offspring from non-consanguineous parents. We comment the differential diagnosis between chondroectodermal dysplasia with types of dwarfism for genetic conseling purposes.

Two patients with Osgood-Schlatter's disease studied at the Unidad de Pediatría Hospital General de México are reported. Both with the same ago, sex and clinical symptoms. No surgery was performed. Several considerations are made on etiology, clinical, radiologic and histopathological aspects. Treatment is discussed and a complete review of medical literature is made.