MRI发现X线片持续阴性的胫骨疲劳骨折1例

正患者,女,40岁,现役军人。体能测试后右小腿近端内侧持续疼痛2周就诊。体能测试前4周开始长跑锻炼,每日跑3.5~4 km,偶有右小腿近端不适,休息及外敷膏药后减轻。测试当天上午50 m折返跑,下午测试3 km跑,接近最后300 m时感觉左小腿近端疼痛,逐渐加重。坚持跑完全程后行走已呈跛行。     

手术切除类风湿关节炎合并巨大腘窝囊肿1例

正患者,男,48岁,因"右侧小腿肿痛3个月,加重1个月",于2017年2月20日入院。患者既往双手近端掌指关节、近端指间关节晨僵,未行相关抗风湿治疗,入院前3个月无明显诱因出现右膝关节肿胀,疼痛。近1个月右小腿肿痛进行性加重,不能行走。既往无外伤史。查体:右小腿局部红、肿、热、痛,于右侧小腿腓肠肌肌腹可触及一囊性肿物,质韧,边界清楚(见图1A);浮髌试验     

腰椎间盘突出游离至椎间孔上部1例

笔者于2014—05诊治腰椎间盘突出游离至椎间孔上部1例,报道如下。 1病例报道 患者,男,74岁,主因间歇性跛行14年,加重1个月来院求诊。自述14年前无明显诱因出现右腿间歇性疼痛。行走距离1000m余,曾采用针灸、按摩、膏药外敷及口服止痛药物等治疗,症状时轻时重。1个月前上述症状加重,疼痛沿右大腿前内侧放射至右小腿内侧,行走距离约10m,骑三轮车或卧床屈髋屈膝位时疼痛减轻,非手术治疗无效。     

小腿胫前肌内包虫病一例报告

患者男,39岁。因右小腿近端前外侧肿块1年入院。患者1年前发现右小腿近端前外侧有一鸽蛋大小圆形肿块,质软,无压痛,后肿块逐渐增大,夜间患处酸胀不适,无疼痛,行走无障碍。查体:血压:14.0／9.0kPa,右小腿近端前外侧可见椭圆形隆起肿块,约12cm×6cm×4cm大小,皮肤无红肿、颜色正常,质柔韧、有弹性、无压痛、无波动感、无移动度,界限不清,膝踝关节活动正常。实验室检查:血、尿、便常规及血磷、钙、尿酸、碱性磷酸酶均正常。X线片示右小腿近端前外侧可见梭形软组织肿胀影,轮廓清晰,相邻胫腓骨骨膜完整,未见骨质异常(图1)。X线…     

淋巴皮肤诺卡菌病一例并文献复习

患者女,37岁,因右小腿内侧丘疹破溃1个月于2012年9月来我院就诊.就诊前1个月患者右小腿内侧出现一0.5 cm×0.5 cm大小红色丘疹,迅速破溃,无明显疼痛及瘙痒,起病前虫咬或外伤史不明确.破溃数天后局部出现肿胀不适,溃疡处有脓性分泌物,轻度疼痛,来我科就诊,考虑"软组织感染",给予莫西沙星口服,1次/d,疗程6d,结果无明显改善.就诊前2周右小腿内侧原溃疡上方出现一皮下结节,局部皮温高,伴压痛.再次就诊,先后给予左氧氟沙星、阿奇霉素治疗及定期伤口清创换药,治疗效果不佳,原溃疡及结节扩大,并于右大腿内侧下端出现一1.5 cm×1.5 cm大小皮下结节.患者2个月前被诊断为"系统性红斑狼疮、狼疮性肾炎",接受糖皮质激素甲泼尼龙治疗至今,否认家族中有类似疾病史.     

骨皮质内血管瘤一例报告

患者女,28岁,因右小腿肿痛6年,加重2个月就诊。患者6年来疼痛偶出现,不剧,多为劳累后发作;无外伤史;幼时曾因左腘窝软组织血管瘤而行手术。查体:右小腿中下段前内侧隆起,压痛,表面无血管曲张,皮温不高;左腘窝部手术瘢痕。X线片示右胫骨中下段骨皮质呈长梭形增厚,骨质疏松,边界不清,无硬化和骨膜反应(图1)。CT示胫骨前内侧骨皮质破坏,内见斑点状钙化;冠状位重建显示病灶内纵     

右胫骨近端骨膜软骨瘤一例

患者,女,68岁,因"右膝关节疼痛伴活动受限3年,加重10d"入院.既往无外伤史.查体:右膝后无红肿,局部皮温正常,右胫骨近端后内侧可及包块,大小3.0cm×3.0cm,质硬,表面光滑,边界清楚,不可推动,局部压痛,右小腿无放射痛,无搏动感,听诊无血管杂音.右膝关节活动度屈20°～100°,右腘窝及右侧腹股沟淋巴结未及肿大,右下肢血运、感觉及足趾活动正常.实验室检查:血常规及血碱性磷酸酶正常,血沉、抗O、类风湿因子偏高,超敏C反应蛋白升高126mg/L.     

腰5神经根纤维瘤误诊腰5骶1椎间盘突出症1例报告

1　病例介绍患者 ,男 ,41岁。主因腰骶部疼痛伴右下肢疼痛麻木 1月入院。入院前 1月患者无任何诱因出现腰骶部疼痛 ,并放射至右小腿、右足拇趾、示趾 ,疼痛剧烈 ,坐卧不安 ,跛行 ,疼痛持续无缓解。无潮热 ,盗汗等病史。查体右侧腰5棘突有深压痛及叩击痛 ,右小腿下段外侧及足背内侧拇趾、示趾感觉减退 ,拇指背伸肌力减退 ,拇趾、示趾活动疼痛加重。直腿抬高试验 ( ) ,加强试验 ( -) ,跟腱反射、膝反射及肛门反射均可引出。CT提示 :腰5骶1 椎间盘突出症。积极完善术前检查准备手术 ,术中见 :骶1 神经根轻度受压、侧隐窝无明显狭窄 ,腰5神经…     

骨良性纤维组织细胞瘤一例

患者　女性 ,40岁。因右小腿近端疼痛 5年 ,于 1999年 11月 2 9日入院。 5年前患者无明显诱因出现右小腿近端外侧持续性轻钝痛 ,曲膝时疼痛加重 ,一直未予治疗。查体 :右膝腓骨头部位扪及一个大小为 5ｃｍ× 4ｃｍ的肿物 ,质韧 ,无压痛 ,不活动 ,与软组织不相连。右膝屈曲受限。Ｘ线片示 :右腓骨头肿物约 5ｃｍ× 4ｃｍ大小 ,呈膨胀性生长 ,密度减低 ,瘤内见有分隔 ,呈皂泡状改变 ;骨皮质变薄 ,无明显破坏迹象 ,无骨膜反应(图 1)。ＣＴ片示 :右腓骨头处肿物呈膨胀性生长 ,近后侧已破坏骨皮质。临床拟诊骨巨细胞瘤 ,在硬膜外麻醉下行右腓骨头…     

流动性骨硬化症1例

流动性骨硬化症是一种罕见的骨质硬化性疾病,又可称为肢骨纹状增生症、蜡泪样骨病、单肢性硬化骨炎、绒形骨硬化症等。我院曾收治1例,现报告如下。1病例资料患者女,34岁,因右小腿疼痛、畸形、跛行30年就诊。查体:右小腿向前内侧弯曲畸形,无皮肤红肿,胫骨前缘可触及凹凸不平突起     

Perianal Paget's disease-Report of a rare case

INTRODUCTIONPerianal extra-mammary Paget's disease is a rare skin disorder of unknown aetiology, which is frequently associated with malignancy. This case report draws attention to this rare condition and comments upon its diagnosis and treatment.PRESENTATION OF CASEA 64-year-old otherwise fit man, presented to us in 2006 with one-year-long history of perianal irritation. On examination there was an erythematous discoid skin lesion in the right perianal area. The lesion was excised with wide margins and the defect closed with a local transposition flap. Histology confirmed extra-mammary Paget's disease (EMPD) with a focus of invasion showing a well-differentiated mucinous adenocarcinoma. Adjuvant therapy was not advised. On follow-up in 2011, a small irregular skin lesion, well away from the previous excision site was noted on the left perianal area. Biopsies from this lesion confirmed EMPD with no focus of invasion. Once again wide local excision with closure using local transposition flap was undertaken. Long term follow up has been advised.DISCUSSIONThe optimal treatment for Perianal Paget's disease (PPD) remains controversial. Surgery is the commonest modality used with wide local excision being the treatment of choice for resectable disease. We report herein a short review of various therapies reported so far in the management of this rare disorder.CONCLUSIONA thorough initial evaluation and long-term follow-up is essential to identify recurrence and the development of other related malignancies.     

A large incarcerated Meckel's diverticulum in an inguinal hernia

INTRODUCTION

Littre''s hernia is a rare finding consisting of a Meckel''s diverticulum inside of a hernia sac. Clinically, it is indistinguishable from a hernia involving small bowel and therefore may be difficult to diagnose pre-operatively.

PRESENTATION OF CASE

We report a case of an inguinal hernia involving an unusually large Meckel''s diverticulum measuring 15 cm in length. The diverticulum was resected using a linear GI stapler and the hernia was repaired without complication.

DISCUSSION

Meckel''s diverticulum is an embryologic remnant of the vitelline duct occurring in 1–3% of the adult population with an estimated 4% becoming complicated and presenting with intestinal obstruction, infection, bleeding or herniation. Surgical resection is the recommended treatment for any Meckel''s diverticulum causing symptoms. In the case of a Littre''s hernia, resection of the diverticulum should be followed by repair of the fascial defect in a standard fashion.

CONCLUSION

Littre''s hernia, although rare, should be a consideration at the time of repair for any abdominal hernia involving small bowel as resection of the Meckel''s diverticulum is critical in avoiding recurrent complications.     

Minimally invasive management of achalasia cardia: results from a single center study.

BACKGROUND: Since the performance of the first laparoscopic cardiomyotomy for achalasia cardia in 1991, the popularity of the minimally invasive approach for this troublesome disease has been growing. We present our experience of 226 patients who underwent laparoscopic cardiomyotomy and discuss the relevant issues. METHODS: A retrospective analysis was carried out of 226 patients who have undergone laparoscopic cardiomyotomy since 1993. The preoperative workup, surgical technique, and postoperative management are described. RESULTS: Patients included 146 males and 80 females; average age was 36.4 years (range, 6 to 85). Mean duration of symptoms was 1.4 years. Nearly half of the patients (112) had undergone prior pneumatic dilatation. In 20 patients, myotomy alone was done, 44 patients had a Dor's fundoplication, and 162 had Toupet's fundoplication. The average operating time was 96 minutes. Mean postoperative hospital stay was 2.2 days. Dysphagia was eliminated in 88.9% of the patients with an overall morbidity of 4.4% and nil mortality over a mean follow-up of 4.3 years. CONCLUSION: Laparoscopic cardiomyotomy with Toupet's fundoplication is a safe and effective treatment of achalasia cardia. Dor's fundoplication is done selectively, especially when suspicion is present of mucosal injury.     

Cullen's sign - Case report with a review of the literature

IntroductionCullen's sign is described as superficial oedema with bruising in the subcutaneous fatty tissue around the peri-umbilical region. It is also known as peri-umbilical ecchymosis.Presentation of caseWe report a case of a fifty-three year old gentleman who presented with non-specific abdominal pain. Significant bruising was present within the subcutaneous fatty tissue on the anterior abdominal wall in keeping with ‘Cullen's sign.’ Of note he denied any alcohol intake and his amylase was normal. A diagnosis of pancreatitis was made following a CT scan of his abdomen.DiscussionA search of the entire English literature using PubMed with the phrase ‘Cullen's sign’ has been performed. Papers were reviewed in relation to recognition of this clinical sign, differential diagnosis, and management.ConclusionOur case and review of the literature highlights the rarity of this clinical sign which a clinician may encounter. In addition we draw to attention the importance of having knowledge of the underlying possible conditions which may lead to this sign, and can be vital in successful acute management.     

Laparoscopy for treating a small bowel obstruction due to a Meckel's diverticulum.

A Meckel's diverticulum is one cause of small bowel obstruction in the virgin abdomen. A 17-year-old female presented with a 24-hour history of lower abdominal pain and emesis. Radiological imaging studies revealed a high-grade partial small bowel obstruction. A diagnostic laparoscopy was performed revealing a bowel obstruction secondary to a Meckel's diverticulum. The diverticulum was resected using an endovascular GIA stapler. The patient was discharged on postoperative day 3, tolerating a regular diet. Laparoscopy is a useful diagnostic and therapeutic tool for a patient with a small bowel obstruction with an unclear etiology.     

Corticosteroid Injection for Morton's Interdigital Neuroma: A Systematic Review

BackgroudThis review aimed to evaluate the effects of corticosteroid injections on Morton''s neuroma using an algorithmic approach to assess the methodological quality of reported studies using a structured critical framework.MethodsSeveral electronic databases were searched for articles published until April 2020 that evaluated the outcomes of corticosteroid injections in patients diagnosed with Morton''s neuroma. Data search, extraction, analysis, and quality assessments were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). guidelines, and clinical outcomes were evaluated using various outcome measures.ResultsWith 3–12 months of follow-up, corticosteroid injections provided satisfactory outcomes according to Johnson satisfaction scores except in two studies. Visual analog scale scores showed maximal pain reduction between 1 week and 3 months after injection. We found that 140 subjects out of 469 (29.85%) eventually underwent surgery after receiving corticosteroid injections due to persistent pain.ConclusionsCorticosteroid injections showed a satisfactory clinical outcome in patients with Morton''s interdigital neuroma although almost 30% of the included subjects eventually underwent operative treatment. Our recommendation for future research includes using more objective outcome parameters, such as foot and ankle outcome scores or foot and ankle ability measures. Moreover, studies on the safety and effectiveness of multiple injections at the same site are highly necessary.