Biomedical-TeMU/CodiEsp_corpus · Datasets at Hugging Face

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The hip joint balance is of flexion 110o bilateral, internal rotation of 10o right, 40o left and external rotation of 30o right, 40o left.
The muscle balance in Daniels scale is 5/5 global bilateral.
There is no Valley pain, but the voiding score and the maneuvers ofix, Fabere, Lasegue and Bragard are negative.
Nor does it present pain related to palpation of the iliac crest and the Ober test is negative.
On gait examination, we observed absence of claudication and the right-to-left alternate monopodal support was stable, with negative Trendelenburg results.
You have gait pain with forced flexion of the hip and knee
Anteroposterior plain radiography (AP) showed a joroba-shaped deformity in the right cervical-cef femoral neck region.
Blood count, biochemistry, thyroid hormones, antibodies and acute phase reactants were normal.
1.
Associated findings were magnetic resonance imaging of the hip, which showed mild subchondral alteration, edema in the right hip, cortical irregularity and mild synovitis in the joint, with osseus gap between the hips.
The femoral head has a small bone islet and the alpha angle is greater than 50o.
Arthrography showed an anterior superior-anterior joint interline anterior and inferior anterolateral ligament, an incipient femoral osteophytic collar with small anterosuperior subchondral lesions of the femoral head edema and small foci.
No avascular necrosis or labrum lesions were observed.
A cystic juxtaarticular lesion in relation to the greater trochanter is also visualized.
1.
With the diagnosis of femoroacetabular impingement syndrome type VLE (also known as CAM), the patient is prescribed magnetotherapy (15), for clinical pain and improvement of bone voiding.
Pharmacological treatment was prescribed with the combination of glucosamine sulfate and oral chondroitin sulfate 400 mg every 12 hours for 3 months and nonsteroidal anti-inflammatory drugs on demand if the patient experienced pain.
Sports rest is indicated to avoid shock in the joint, with controlled active physical activity, recommending not to exceed 90 degrees of hip flexion and avoid rotations.
She was referred to the arthroscopic unit of the traumatology service for evaluation of arthroscopic surgery.
Male patient in 2009 for control of Bone Metabolic Unit (BMU) with 36 years and diagnosed in a private center of monostotic Paget disease of the left radius.
The patient reported biopsy and scintigraphy in 2007.
She was treated with risedronate at the dose used for osteoporosis.
Riseddronate was discontinued in 2009 due to the good result in P1NP levels (amino-terminal propeptide type 1).
Since then and until November 2014, it was periodically monitored with serum levels of bone markers indicating a new low-dose risedronate cycle for a few months, when they increased.
Also in this time interval a gammagraphy was performed without finding significant changes compared to the previous one.
When the treatment was administered, the patient improved his local pain clinic, but in November 2014 he went spontaneously to the consultation with the arm in a sling indicating that two days ago he suffered a casual fall and experienced intense pain in the left area.
Physical examination revealed a hematoma on the dorsum of the hand and distal third of the forearm, edema, blurred tendon grooves on the back of the hand, functional impotence and increased local wrist temperature.
a The patient was suspected of having a fracture since the Metabolic Unit was referred to the emergency department where X-rays were performed; he was discharged with the diagnosis of contusion because there was no evidence of any fracture, but a new lesion
Although the X-rays did not show evidence of malignancy, an urgent computed tomography (CAT) and nuclear magnetic resonance (NMR) were requested for the study of fracture in hyperosteum.
The CT scan showed a fracture in the hamate bone and sickle cell disease.
The limb was immobilized with a posterior splint.
Once the trauma emergency was resolved, the radiological lesion of the radius was re-evaluated in subsequent days, identifying the so-called “slip-off ulcer” sign.
The possibility of presenting meloretosis was commented on this option to the services of Radiology and Nuclear Medicine to submit it to its consideration.
Finally, it was accepted as an alternative diagnosis to Paget's disease of bone, being indistinguishable scintigraphically.
Once confirmed and agreed upon the new diagnosis of meloreostosis, we resumed the anamnesis, which highlights the report of a fall at 14 years while practicing sports.
The patient reported having suffered severe pain in the radius, but did not go to any health center and was referred to her parents with a deformity since then.
The pain subsided weeks after that fall.
We deduced that the patient fractured the radius and, as the fracture was not immobilized or reduced, he remained with this deformity, which can be seen in Figure 1, but which is not directly related to hyperostosis.
In addition to the striking central image, there are other areas of hyperostosis inside the distal extremity of the radius and in the proximal third.
We describe the case of a 47-year-old female patient with psoriatic spondyloarthritis and fibromyalgia under regular treatment with menstrual leflux, celecoxib and gabapentin, with no relevant history and cycles.
She did not report toxic habits and her body mass index (BMI) was normal.
In a routine revision, the patient complained of pain in the feet and ankles, with no history of trauma, of mechanical rhythm, which was progressively increasing until claudication at gait, with modification of foot statics due to pain.
On examination, inflammation of ankles and feet stood out, with pressure pain and bilateral fovea.
An ultrasound was performed in the office, which showed a marked inflammation of subcutaneous cellular tissue (SCT) without signs of synovitis or Doppler signal.
An X-ray of the feet was requested, which showed no pathological findings.
Due to the significant SCT edema, the patient was referred to Angiology for evaluation.
From this service, a lymphography was requested that confirmed severe bilateral lymphocytic insufficiency.
In left foot with severe pain, MRI of the right foot showed callus fracture at 3rd and 4th MTT; and edema at 2nd MTT;
Given the MRI findings, the patient was assessed by the Traumatology Department, indicating conservative treatment with discharge and rehabilitation (magnet therapy).
Due to the finding of multiple stress fractures, we proceeded to study in our consultations, performing analysis with renal function, serum and urinary calcium, ionized calcium, magnesium and PTH, which were normal.
Only 19.5 ng/ml of vitamin D was found, so supplementation was indicated.
1.
Evaluating the case of this patient as a whole, we propose, as a predisposing factor for the appearance of stress fractures, the important alteration of the statics of the painful feet that had developed due to the severe insufficiency produced by this patient.
A 65-year-old male patient diagnosed with OI from the study of a daughter also affected.
She had no previous family history of the disease.
1.
She reported a history of several fractures (approximately 6-7) during childhood and adolescence following minimal trauma, the first at 2 years of age.
During adulthood, she had had two new elbow and shoulder fractures.
All had been treated conservatively.
She was treated with calcium during childhood.
He had also had multiple sprains and various muscle ruptures throughout his life.
Diagnosed as otorrhea, she had been operated on for stapedectomy of both ears.
Search was performed for osteoporosis detected in bone densitometry (DXA), showing T-scores of -3.4 in the lumbar spine (L1-L4), -3 in the femoral neck and -2.8 in the total.
He was asymptomatic.
Physical examination revealed 162 cm in size, blue sclera and presence of dentinogenesis calla.
There were no thoracic deformities, neither in the dorsolumbar spine nor in the limbs, except in the right elbow (postfracture).
No hyperlaxity was observed.
The calcium-phosphorus metabolism study showed normal levels of calcium, phosphorus, calciuria, and parathyroid hormone (PTHi).
Levels of 25 hydroxyvitamin D (25OHCC) were in the insufficiency range: 22 ng/ml (desirable values >30 ng/ml).
Bone markers were in normal range.
Other endocrine causes of osteoporosis were ruled out.
As part of our protocol for the study of patients with OI, a cervical spine X-ray ruled out basilary impression was performed, and a chest X-ray showed normal ascending aorta degenerative changes in lithiasis.
A genetic study was carried out by NGSc (Next- GuaAGE1 sequencing) of a COL1A1 heterozygosis gene, COL1A2, CRTAP and LEPRE1, detected in
This mutation results in a change in the reading pattern, which, at the level of collagen protein, gives rise to a premature stop codon (p.Gly1175Valfs*64 likely pathogenic change is treated).
Other changes that were considered polymorphisms were detected.
Treatment with weekly alendronate associated with daily supplements of calcium and vitamin D was recommended. Treatment with alendronate resulted in a slight improvement in densitometry after 1 year of treatment (T-scores of -3.2 in total femoral neck).
A 72-year-old male in HD program from December 2002 due to renal failure secondary to bilateral nephrectomy for renal neoplasia (1999 and 2002).
History of arterial hypertension, cystectomy, cholecystectomy and right inguinal hernia.
Cholecystectomy due to a bulla injury during right nephrectomy (2002).
Venous thrombosis in the right lower limb conditioned by femoral cannulation (dialysis catheter).
Ischemic colitis, colon polyposis and lower gastrointestinal bleeding in 2007.
In December-08 new episode of lower gastrointestinal bleeding due to angiodysplasia.
He was diagnosed in 2009 with moderate-severe aortic valve stenosis.
History of vascular access:
• Started treatment in December-02 with a right femoral catheter.
It was removed in February-03 (venous thrombosis).
• In January-03 he practiced a left atrial fibrillation.
It started at 4 weeks.
He developed an aneurysmal dilatation, presenting a partial thrombosis (male-03), which allowed its use in a single injection.
• In December-03 a right FAVI ̈ ̈ © 2012 Sociedad Colombiana de Anestesiología y Reanimación.
• In the same month, a right PTFE-hilar type graft was implanted, with thrombosis at 24 hours.
He had to be removed due to infection in January-04.
• Due to left fistula dysfunction, a tunnelled catheter was implanted in the left internal jugular in January-04.
It was used as VA until July-04, with removal due to infection refractory to antibiotic therapy.
• 22-7-04 there was a failed attempt to canalize the right internal jugular, placing a catheter in the right femoral vein: it was removed in sep-04, when a functioning AVF was available.
• Again, the 23-7-04 attempt was made to cannulate both the right and left internal jugular unsuccessfully.
• A PTFE prosthesis was implanted between the left femoral artery and vein on 4-8-04th day.
It was used from September to 22-10-04 (non-reusable thrombosis).
• On the same day 22-10-04 a tunnelled catheter was implanted in the right internal jugular:
- An episode of E. Coli bacteremia resolved with antibiotic therapy in October 2005.

The hip joint balance is of flexion 110o bilateral, internal rotation of 10o right, 40o left and external rotation of 30o right, 40o left.

The muscle balance in Daniels scale is 5/5 global bilateral.

There is no Valley pain, but the voiding score and the maneuvers ofix, Fabere, Lasegue and Bragard are negative.

Nor does it present pain related to palpation of the iliac crest and the Ober test is negative.

On gait examination, we observed absence of claudication and the right-to-left alternate monopodal support was stable, with negative Trendelenburg results.

You have gait pain with forced flexion of the hip and knee

Anteroposterior plain radiography (AP) showed a joroba-shaped deformity in the right cervical-cef femoral neck region.

Blood count, biochemistry, thyroid hormones, antibodies and acute phase reactants were normal.

1.

Associated findings were magnetic resonance imaging of the hip, which showed mild subchondral alteration, edema in the right hip, cortical irregularity and mild synovitis in the joint, with osseus gap between the hips.

The femoral head has a small bone islet and the alpha angle is greater than 50o.

Arthrography showed an anterior superior-anterior joint interline anterior and inferior anterolateral ligament, an incipient femoral osteophytic collar with small anterosuperior subchondral lesions of the femoral head edema and small foci.

No avascular necrosis or labrum lesions were observed.

A cystic juxtaarticular lesion in relation to the greater trochanter is also visualized.

1.

With the diagnosis of femoroacetabular impingement syndrome type VLE (also known as CAM), the patient is prescribed magnetotherapy (15), for clinical pain and improvement of bone voiding.

Pharmacological treatment was prescribed with the combination of glucosamine sulfate and oral chondroitin sulfate 400 mg every 12 hours for 3 months and nonsteroidal anti-inflammatory drugs on demand if the patient experienced pain.

Sports rest is indicated to avoid shock in the joint, with controlled active physical activity, recommending not to exceed 90 degrees of hip flexion and avoid rotations.

She was referred to the arthroscopic unit of the traumatology service for evaluation of arthroscopic surgery.

Male patient in 2009 for control of Bone Metabolic Unit (BMU) with 36 years and diagnosed in a private center of monostotic Paget disease of the left radius.

The patient reported biopsy and scintigraphy in 2007.

She was treated with risedronate at the dose used for osteoporosis.

Riseddronate was discontinued in 2009 due to the good result in P1NP levels (amino-terminal propeptide type 1).

Since then and until November 2014, it was periodically monitored with serum levels of bone markers indicating a new low-dose risedronate cycle for a few months, when they increased.

Also in this time interval a gammagraphy was performed without finding significant changes compared to the previous one.

When the treatment was administered, the patient improved his local pain clinic, but in November 2014 he went spontaneously to the consultation with the arm in a sling indicating that two days ago he suffered a casual fall and experienced intense pain in the left area.

Physical examination revealed a hematoma on the dorsum of the hand and distal third of the forearm, edema, blurred tendon grooves on the back of the hand, functional impotence and increased local wrist temperature.

a The patient was suspected of having a fracture since the Metabolic Unit was referred to the emergency department where X-rays were performed; he was discharged with the diagnosis of contusion because there was no evidence of any fracture, but a new lesion

Although the X-rays did not show evidence of malignancy, an urgent computed tomography (CAT) and nuclear magnetic resonance (NMR) were requested for the study of fracture in hyperosteum.

The CT scan showed a fracture in the hamate bone and sickle cell disease.

The limb was immobilized with a posterior splint.

Once the trauma emergency was resolved, the radiological lesion of the radius was re-evaluated in subsequent days, identifying the so-called “slip-off ulcer” sign.

The possibility of presenting meloretosis was commented on this option to the services of Radiology and Nuclear Medicine to submit it to its consideration.

Finally, it was accepted as an alternative diagnosis to Paget's disease of bone, being indistinguishable scintigraphically.

Once confirmed and agreed upon the new diagnosis of meloreostosis, we resumed the anamnesis, which highlights the report of a fall at 14 years while practicing sports.

The patient reported having suffered severe pain in the radius, but did not go to any health center and was referred to her parents with a deformity since then.

The pain subsided weeks after that fall.

We deduced that the patient fractured the radius and, as the fracture was not immobilized or reduced, he remained with this deformity, which can be seen in Figure 1, but which is not directly related to hyperostosis.

In addition to the striking central image, there are other areas of hyperostosis inside the distal extremity of the radius and in the proximal third.

We describe the case of a 47-year-old female patient with psoriatic spondyloarthritis and fibromyalgia under regular treatment with menstrual leflux, celecoxib and gabapentin, with no relevant history and cycles.

She did not report toxic habits and her body mass index (BMI) was normal.

In a routine revision, the patient complained of pain in the feet and ankles, with no history of trauma, of mechanical rhythm, which was progressively increasing until claudication at gait, with modification of foot statics due to pain.

On examination, inflammation of ankles and feet stood out, with pressure pain and bilateral fovea.

An ultrasound was performed in the office, which showed a marked inflammation of subcutaneous cellular tissue (SCT) without signs of synovitis or Doppler signal.

An X-ray of the feet was requested, which showed no pathological findings.

Due to the significant SCT edema, the patient was referred to Angiology for evaluation.

From this service, a lymphography was requested that confirmed severe bilateral lymphocytic insufficiency.

In left foot with severe pain, MRI of the right foot showed callus fracture at 3rd and 4th MTT; and edema at 2nd MTT;

Given the MRI findings, the patient was assessed by the Traumatology Department, indicating conservative treatment with discharge and rehabilitation (magnet therapy).

Due to the finding of multiple stress fractures, we proceeded to study in our consultations, performing analysis with renal function, serum and urinary calcium, ionized calcium, magnesium and PTH, which were normal.

Only 19.5 ng/ml of vitamin D was found, so supplementation was indicated.

1.

Evaluating the case of this patient as a whole, we propose, as a predisposing factor for the appearance of stress fractures, the important alteration of the statics of the painful feet that had developed due to the severe insufficiency produced by this patient.

A 65-year-old male patient diagnosed with OI from the study of a daughter also affected.

She had no previous family history of the disease.

1.

She reported a history of several fractures (approximately 6-7) during childhood and adolescence following minimal trauma, the first at 2 years of age.

During adulthood, she had had two new elbow and shoulder fractures.

All had been treated conservatively.

She was treated with calcium during childhood.

He had also had multiple sprains and various muscle ruptures throughout his life.

Diagnosed as otorrhea, she had been operated on for stapedectomy of both ears.

Search was performed for osteoporosis detected in bone densitometry (DXA), showing T-scores of -3.4 in the lumbar spine (L1-L4), -3 in the femoral neck and -2.8 in the total.

He was asymptomatic.

Physical examination revealed 162 cm in size, blue sclera and presence of dentinogenesis calla.

There were no thoracic deformities, neither in the dorsolumbar spine nor in the limbs, except in the right elbow (postfracture).

No hyperlaxity was observed.

The calcium-phosphorus metabolism study showed normal levels of calcium, phosphorus, calciuria, and parathyroid hormone (PTHi).

Levels of 25 hydroxyvitamin D (25OHCC) were in the insufficiency range: 22 ng/ml (desirable values >30 ng/ml).

Bone markers were in normal range.

Other endocrine causes of osteoporosis were ruled out.

As part of our protocol for the study of patients with OI, a cervical spine X-ray ruled out basilary impression was performed, and a chest X-ray showed normal ascending aorta degenerative changes in lithiasis.

A genetic study was carried out by NGSc (Next- GuaAGE1 sequencing) of a COL1A1 heterozygosis gene, COL1A2, CRTAP and LEPRE1, detected in

This mutation results in a change in the reading pattern, which, at the level of collagen protein, gives rise to a premature stop codon (p.Gly1175Valfs*64 likely pathogenic change is treated).

Other changes that were considered polymorphisms were detected.

Treatment with weekly alendronate associated with daily supplements of calcium and vitamin D was recommended. Treatment with alendronate resulted in a slight improvement in densitometry after 1 year of treatment (T-scores of -3.2 in total femoral neck).

A 72-year-old male in HD program from December 2002 due to renal failure secondary to bilateral nephrectomy for renal neoplasia (1999 and 2002).

History of arterial hypertension, cystectomy, cholecystectomy and right inguinal hernia.

Cholecystectomy due to a bulla injury during right nephrectomy (2002).

Venous thrombosis in the right lower limb conditioned by femoral cannulation (dialysis catheter).

Ischemic colitis, colon polyposis and lower gastrointestinal bleeding in 2007.

In December-08 new episode of lower gastrointestinal bleeding due to angiodysplasia.

He was diagnosed in 2009 with moderate-severe aortic valve stenosis.

History of vascular access:

• Started treatment in December-02 with a right femoral catheter.

It was removed in February-03 (venous thrombosis).

• In January-03 he practiced a left atrial fibrillation.

It started at 4 weeks.

He developed an aneurysmal dilatation, presenting a partial thrombosis (male-03), which allowed its use in a single injection.

• In the same month, a right PTFE-hilar type graft was implanted, with thrombosis at 24 hours.

He had to be removed due to infection in January-04.

• Due to left fistula dysfunction, a tunnelled catheter was implanted in the left internal jugular in January-04.

It was used as VA until July-04, with removal due to infection refractory to antibiotic therapy.

• 22-7-04 there was a failed attempt to canalize the right internal jugular, placing a catheter in the right femoral vein: it was removed in sep-04, when a functioning AVF was available.

• Again, the 23-7-04 attempt was made to cannulate both the right and left internal jugular unsuccessfully.

• A PTFE prosthesis was implanted between the left femoral artery and vein on 4-8-04th day.

It was used from September to 22-10-04 (non-reusable thrombosis).

• On the same day 22-10-04 a tunnelled catheter was implanted in the right internal jugular:

- An episode of E. Coli bacteremia resolved with antibiotic therapy in October 2005.