Diabetic neuropathic foot without neuropathy: Could it be cancer? - a case report

We present a case of a 64 year-old diabetic male who presented with months of progressively worsening foot pain and swelling, who was initially diagnosed with Charcot joint disease.(CJD) He was ultimately found to have a very rare tumor

A Common Pain in Pregnancy with an Uncommon Cause

Case Diagnosis: We present a case of a patient with hip pain during pregnancy determined to be pigmented villonodular synovitis (PVNS). Case Description: A 41-year-old woman presented with 9-months of persistent atraumatic left hip pain localized to the groin that had started in her second trimester of pregnancy. Five months after delivery at presentation to clinic, her symptoms had progressively worsened to require a cane for ambulation. On exam, hip range of motion was limited: flexion to 90o, external rotation to 20o, and internal rotation to 10o. She had groin pain with internal and external rotation. She was neurovascularly intact without lymphadenopathy. Radiographs showed significant erosion of the left femoral head and acetabulum with mild protrusio. Apple core erosions were visualized at the femoral neck. MRI showed extensive bone edema on both sides of the joint, with erosion of the femoral head and acetabulum. There was joint effusion, synovial hypertrophy, and excessive synovial tissue. Differential diagnoses included PVNS, avascular necrosis, rapidly progressive osteoarthritis, inflammatory arthritis, septic arthritis, insufficiency fractures, synovial chondromatosis, and transient osteoporosis of the hip. A needle biopsy confirmed the diagnosis of PVNS. She was treated with synovectomy and total hip arthroplasty, and has remained pain free and without evidence of disease for the last 5 years. Discussions: PVNS is a disorder characterized by synovial proliferation. There are only two previous case reports of patients who were diagnosed with PVNS during pregnancy, both of whom had monoarticular involvement of the knee. Conclusions: Synovectomy is the mainstay of surgical treatment of PVNS. Although, in patients with extensive articular involvement, synovectomy and arthroplasty may be required. The current understanding is that cytokines have a trophic influence leading to growth of the tumor. Further studies are needed to establish a definitive connection between PVNS and pregnancy

Don’t call me in the morning: why it might be best to see patients in-person, a case report

Case Diagnosis: Post-irradiation Sarcoma Case Description: A 58-year-old woman with a history of stage IIIB squamous cell carcinoma of the cervix who was treated with chemoradiation, considered in remission 5 years prior on PET CT, and was under every 6-months surveillance for recurrence by gynecology. She presented to the Emergency Department for severe back pain, left sided sciatica, and paresthesias. In the absence of fracture or cord compression, she was discharged with recommendations for primary care follow-up. This took place over the telephone with referral to the spine center. One week later, her pain progressed to 10+/10 with dense left leg numbness, and multiple falls. Physiatry ordered a lumbar MRI for focal neurologic findings on exam, which revealed a large destructive lesion of the left ilium and left hemisacrum with soft tissue extension. This was later determined to be undifferentiated sarcoma, likely due to prior radiation. She is currently undergoing palliative chemotherapy. Discussions: Post-irradiation sarcomas (PIS) are a relatively rare event and exhibit dose dependency. Sarcomas can present with bone pain that can be worse at night and signs and symptoms of compression of surrounding structures. The pelvis is a common site for sarcoma development. Cases of PIS have presented in even just a few months post radiation therapy. The prognosis of patients with PIS is poorer than those with primary sarcomas. This patient would require hemipelvectomy to attempt curative treatment. Conclusions: PIS are typically aggressive, have poor prognosis, and can develop within months of high doses of radiation therapies; clinicians index of suspicion for sarcomas in patients with a history of radiation must be high. Evaluation for progressive pain, weakness, and numbness may not be amenable to telemedicine until technology improves. Patients that present with signs and symptoms of progressive nerve compression and bone pain should be re-examined early on

No Woman is an Island -- Access to Care and Extreme Measures for Cancer Pain and Lymphedema: A Case Report

Background: Cancer rehabilitation is a rapidly growing diverse field in physiatry. This case provides an example where rehabilitation physiatrists played a crucial role in the pain management, education, and rehabilitation before and after a palliative amputation. Due to her limited resources, both in her home country and in her local community, she could not access appropriate care that may have prevented the need for amputation. Though amputation is not generally accepted as the first line of treatment for pain, there have been several reports of palliative amputation in metastatic cancer patients. In particular, fore quarter amputations have been reported in metastatic breast cancer patients to manage pain and recurrent fractures

Teste de anelagem em espécies arbóreas na floresta amazônica.

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Teste de duas modalidades de anelagem em oito espécies arbóreas na floresta amazoônica.

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Produção de óleo de copaíba na região do Tapajós.

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Total Joint Replacement Prehabilitation: A Feasibility Study

Objectives: Pre-operative physical therapy has been shown to reduce post-acute care service utilization. Shifting rehabilitation to the presurgical period, referred to as prehabilitation, could result in reduced recovery time and cost. Limited access to physical therapy may prevent patients from achieving the benefits, and a standard set of independent exercises may be an alternative. We aim to assess the feasibility of an independent exercise program as a pre-surgical intervention for total hip and knee replacement. Design: Participants were taught two exercises for hip or knee arthritis at least one week prior to surgery and instructed to perform them independently at home. Subjects were contacted three days to one month post-operatively and surveyed about discharge, frequency of exercise, and living status of alone or with others. No adverse effects were reported. Additional information was collected from the subjects’chart including age, BMI, and sex. Discharge outcomes were compared with pre-existing independent factors using univariate and multivariate analyses. Results: A total of 80 subjects were followed with a home discharge rate of 78.75%. Univariate analyses showed that the presence of other people in the home showed a slight, but non-significant, association with differences of discharge destination. 82.1%-83.3% of patients who live with others were discharged home versus 57.1% of patients living alone (LR chi-square: 3.84, p=0.15). Multivariate analyses showed a slight, but non-significant, association between frequency of prehabilitation and discharge destination (OR=1.212; 95% CI, 0.960-1.530). BMI showed no associated difference in discharge destination. Conclusions: Increased frequency of prehabilitation and presence of others at home showed slight associations with increased discharges to home, but were non-significant. Increased exposure to prehabilitation (duration times frequency) trends toward more frequent home discharge. Independently performed prehabilitation may be offered as an alternative pre-surgical intervention with likely little to no adverse effect. Larger numbers are needed to determine likelihood of discharge home

Informações básicas sobre ecologia e silvicultura de cinco espécies arbóreas da Amazônia brasileira.

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