Value of laparoscopy in appendix epiploica infarction – A report of four cases

Inflammation of the appendix epiploica is a rare condition which may lead to torsion and eventually infarction. It is almost always never diagnosed clinically. Our four patients were young females presenting with right lower quadrant abdominal pain and nausea. The white cell counts were marginally elevated in all four patients. Clinically, we suspected appendicitis or Meckel’s diverticulitis. Laparoscopy revealed a normal appendix with infarction of the epiploic appendix which was easily excised using ultracision shears. The appendix epiploica has no known function. Inflammation of the appendix epiploica is called appendagitis. Appendagitis and torsion will mimic appendicitis or acute abdomen. This condition usually responds to antibiotic therapy, but surgery is indicated if infarction occurs. There are very few reports of laparoscopy in surgery for appendix epiploica. Our patients were managed laparoscopically with a good outcome. The benefits of laparoscopy include avoidance of laparotomy and reduced morbidity.     

Bladder paraganglioma — A report of two cases

Introduction

Bladder paragangliomas (BP) are rare tumors, with clinical manifestations ranging from hypertension to hematuria to being asymptomatic. Histologically, they can mimic urothelial carcinomas. Around 200 cases of paragangliomas arising in the urinary bladder have been described in the world literature.

Salvage of failed Sauvé-Kapandji procedure with an ulnar head prosthesis: report of three cases

Three failed Sauvé-Kapandji procedures were salvaged using an ulnar head prosthesis. At 7-22 month follow-up, all three patients were much improved. However, the stem of one implant subsequently fractured in a fall and this implant had to be removed.     

Osteomyelitis complicating Sever‘s disease: A report of two cases

Sever's disease is a common cause of heel pain in young children and it has a self-limiting course without long term complications. Osteomyelitis of calcaneus is a sinister condition which can lead to serious complication if treatment is delayed. Indolent nature of calcaneus osteomyelitis leads to overlap in its clinical picture with Sever's disease. Two cases of Sever's disease which were later diagnosed and managed for osteomyelitis are reported. Salient differentiating features of Sever's disease and calcaneus osteomyelitis along with management strategy are discussed.     

Rotationplasty as a salvage procedure in revision of tumor endoprosthesis of the distal femur – a report of two cases

We performed two rotationplasties (type A1 and A2) as salvage procedures in cases of custom- made endoprosthetic replacements of the distal femur and knee joint. The patients suffered from malignant bone and soft-tissue tumors of the knee, respectively. One of them developed chronic osteomyelitis around both stems of the prosthesis, and three local revisions turned out to be ineffective. The other patient, suffering from parossal osteosarcoma of the distal femur, developed a local recurrence following endoprosthetic reconstruction. The functional abilities following the operation of these two patients suggested that rotationplasty was a viable alternative to above-the-knee amputation in failed or severely complicated total arthroplasty of the knee with massive bone loss. Received: 22 April 1999     

Flexor carpi radialis brevis muscle: A case report and its prevalence in patients with carpal tunnel syndrome

Background

During the surgery for a distal radius fracture, we encountered a large anomalous muscle lying across the distal radius. The muscle was identified as a flexor carpi radialis brevis muscle (FCRB), based on its location, function, and innervation. This experience led us to clarify its prevalence in living subjects and alert surgeons of its presence.

Experience in surgical treatment of typeⅡodontoid fractures:A report of two cases and review of the literature

Two cases of typeⅡodontoid fractures were reported to share our experience in surgery treatment of such cases.A 33-year-old woman with comminuted typeⅡodontoid fracture and a 42-year-old man with fracture end hardened typeⅡodontoid fracture received surgical treatment in our hospital.Though imaging examination suggested that these two patients were suitable for anterior screw fixation,we encountered difficulties during the operation.The two patients eventually underwent posterior C1–C2 fusion surgery and recovered well.According to the experience of these two cases,we found that the fracture line angle and the degree of comminution are two important factors affecting surgical decision-making.Although anterior screw fixation is the ideal choice for typeⅡodontoid fractures with anterior superior to posterior inferior fracture line,it may not be the best choice for comminuted or fracture end hardened typeⅡodontoid fractures.     

Single-incision laparoscopic splenectomy using the ��tug-exposure technique�� in adults: results of ten initial cases

Background  

The application of single-incision laparoscopic surgery (SILS) to splenectomy is still challenging with much room for technical improvement. The purpose of this study was to describe the tug-exposure technique, an innovative technique for performing safe single-incision laparoscopic splenectomy (SILS-Sp).     

Graner's procedure in Kienböck disease: A series of four cases with 25 years of follow-up

Advanced stages of Kienböck's disease are treated by several techniques, one of which is Graner's procedure, nearly abandoned nowadays. The results of long-term follow-up of a series of four cases Graner's procedure are presented. Four patients were reviewed with a follow-up of 25 years. There were two women and two men mean aged 37 years at the time of surgery. Two of them were manual workers. Graner's procedure was the first surgery in three cases and secondary to failure of radius shortening in one case of Stage IIIa. Three patients underwent bone healing and the fourth benefited secondarily from radiocarpal arthrodesis. At maximal follow-up, the mean DASH score was 36.6 and pain assessed by visual analogic scale was 3.25 out of 10; the range of movement was half of the opposite side; the wrist strength was 80.9% of the opposite side. In the three consolidated cases, a spontaneous remodeling of the radiocarpal articular surfaces was noted. Graner's procedure is logical as it aims at creating a new radiocarpal articulation, either by the fusion of the lunate with the capitate (Graner I) or by replacing the lunate with the head of the capitate (Graner II and III). However, this old procedure should no longer be one of the surgical procedures for Kienböck disease due to its drawbacks: necrosis or non-union of the head of the capitate, necessity to perform a wrist fusion in the long-term and side effects of bone graft harvesting.Level of evidenceII. Retrospective study.     

Steroid treatment in patients with membranous nephropathy and hepatitis B virus surface antigenemia: a report of two cases

Although the clinical benefits of antiviral treatment in the management of membranous nephropathy (MN) in patients with chronic hepatitis?B virus (HBV) infection have been suggested, it should be evaluated more carefully. In this report, we present two cases with quiescent HBV who were administered lamivudine for either the initial treatment of MN or to control the reactivation of HBV during treatment with corticosteroids. No clinical benefit of lamivudine as an initial treatment was observed in one patient, which obliged us to commence administration of prednisolone (PSL). On the other hand, lamivudine seemed to play a pivotal role in the remission of an acute exacerbation of hepatitis?B during treatment with PSL and mizoribine in the other patient. These two patients seemed to tolerate administration of PSL with or without an immunosuppressive agent well, since gradual and prompt improvements of nephrotic status were confirmed within a few months, thus suggesting the potential benefit of steroid treatment. There is little consensus regarding the optimal choice of steroids and immunosuppressants for the treatment of MN with chronic HBV infection, due to the potential for stimulation of viral replication and precipitation of hepatic flares. Our observations, however, suggest that treatment with PSL still should be reserved for quiescent HBV carriers with MN. Further studies will be required to determine the optimal timing and appropriate duration of antiviral treatment in such patients requiring long-term immunosuppression.     

Techniques in recurrent giant cell tumour of the first metatarsal in adolescents – A rare report of 2 cases

Giant cell tumour of the foot is very rare. Very few cases of first metatarsal giant cell tumour were reported. We report two cases of recurrent giant cell tumour in adolescent patients. One was treated with wide excision and fibula grafting. The second patient underwent Boyd's amputation because of superceded infection. Both had no pain, recurrence at the end of final follow up. Recurrent giant cell tumour of the first metatarsal in adolescents and its management is not described in English literature to the best of our knowledge.     

Infiltrating angiolipoma or intramuscular hemangioma? A report of five cases

We report five cases of tumors composed primarily of angiomatous and adipose tissue occurring within skeletal muscle in relatively young individuals. Pain is frequently the presenting symptom. The tumors have been described in the literature as angiolipomas, infiltrating angiolipomas, and intramuscular hemangiomas. A discussion of the use of these terms is included. It is our conclusion the term "intramuscular hemangioma" is most appropriate for these lesions.     

Acute shoulder infection following acupuncture—A report of three cases

Worldwide, acupuncture is a popular alternative medicine for releasing pain, treating diseases, or promoting health. Although it is generally considered safe, a few complications have been reported. These complications ranged from minor side effects, such as pain, local hematoma formation, or the aggravation of symptoms, to serious complications including mechanical injuries, such as pneumothorax and severe infection requiring surgical treatment. In orthopedic clinics, reports of complications caused by acupuncture are rare. We present three cases who developed severe infection following acupuncture, leading to irreversible osteoarthritic changes in their glenohumeral joints. All of them mentioned a history of acupuncture therapy before their shoulder became swollen and hot and no other infection source could be detected. Possible explanations included: (1) breakdown of the sterile technique; (2) no consensus of acupoint or how deep the needle should be inserted; (3) patient’s comorbidities, such as diabetes mellitus or previous shoulder pathology, were not considered. Although these three patients underwent debridement and proper management with antibiotics according to the culture data, eventually, they still progressed to severe glenohumeral joint destruction. Strict infection control guidelines should be established to lower this type of life-threatening complication.     

Aneurysms of the mid axillary artery in major league baseball pitchers—A report of two cases

True aneurysms of the axillary artery and its branches are rarely identified. Our recent experience with successful repairs of symptomatic aneurysms of the axillary arteries at the origin of the circumflex humeral arteries in 2 major league baseball pitchers suggests a condition that may be more common than recognized previously. We report this unique experience with baseball pitchers to focus attention on a condition that should be considered in all athletes with hand pain, numbness, or signs of digital ischemia. In addition, a schedule of rehabilitation and the timing of an appropriate return to competition is presented. (J Vasc Surg 1998;28:702-7.)     

Renal complications of Castleman’s disease: report of two cases and analysis of 75 cases

Biopsy-proven renal complications of Castleman’s disease (CD) are rare and current knowledge is largely based on sporadic case reports. We reported two more cases, both of which were multicentric CD with hyaline-vascular pathological pattern and presented with chronic renal failure. Case 1 was multicentric CD with renal mesangial proliferative glomerulonephritis complications, and case 2 was multicentric CD with membranoproliferative glomerulonephritis-like complications. Although both were eventually administered corticosteroids combined with cytotoxic drugs, both behaved in an aggressive and relapsing manner. We then made an analysis of 75 cases of biopsy-proven renal complications of CD (including our two cases) which were reported in 51 English literatures from January 1954 to March 2011. We found that the clinical and histological findings of renal complications of CD were heterogeneous. Death was observed in 17% patients after a median follow-up time of 22 months (0–204 months) since histological diagnosis of renal complications. The estimated 5-year cumulative survival rate was 75%. Better understanding and therapeutic interventions are required in further investigations.