肩胛骨包虫病一例报告

肩胛骨包虫病一例报告马一功王克亚房新志患者男性，３２岁，汉族。因右肩部疼痛１年余加重２个月入院。患者１年前无明显诱因感右肩部痛，疼痛反复发作，对症治疗能缓解，２个月前右肩部在一次外伤后疼痛加重，而来我院求治。摄Ｘ线片见右肩胛骨有破坏灶，以“右肩胛骨骨...     

锁骨朗格汉斯细胞组织细胞增生症1例

1.临床资料 患儿,男性,2岁.右肩部外伤50余天,发现右肩包块伴红肿20余天,偶有发热10 d入院.体格检查:右锁骨近端处皮肤突起约2 cm×2 cm×1.5 cm大小,质软,有波动感,表面红肿,皮温高,触之患儿啼哭明显.     

先天性高肩胛症1例

1病例资料 患儿,男,8岁,发现右肩部畸形1个月余.患儿父母于1个月前无意发现患儿右肩部畸形,患儿无明显外伤史.查体:右肩呈翼状,右肩胛上角上缘较左侧高约2 em,右上肢上举及外展活动受限.     

胸长神经、肩胛背神经卡压一例报告

 患者男,31岁。1年前肩部摔伤后感颈肩部酸痛不适,摄X线片示骨骼无异常。伤后1个月自觉平卧睡觉时右肩后突,后逐渐出现右上肢无力,右肩不能上举,肩胛骨后凸畸形进行性加重,但无腋、胸部不适及上肢的感觉障碍。入:前经保守治疗10个月,病情未见缓解且逐渐加重,严重影响生活及工作。     

误诊行软组织松解术3例教训

我院从1965年开展软组织松解术治疗腰腿痛以来,虽然取得较满意效果,但也发生三例误诊,分别为髂骨原发性淋巴瘤,肺癌转移至椎体及原发性椎体肿痛各一例。现结合本组三例误诊谈几点体会: 病案介绍: 黄××,男性,69岁,农民,右肩背部酸痛影响工作六个月。1981年10月感右肩背部酸痛逐渐加重,尤为晚间疼痛更为剧烈。检查右肩胛骨内侧缘压痛,上提肩胛组肌肉压痛明显。血、便常规检查正常。摄片右肩胛骨及右肩关节正常。胸透无异常发现。诊断右肩背部软组织劳损,于1982年5月18日行右肩背部软组织松解术。术后疼痛减轻,但因排便时突然发生截瘫,摄片发现第二、三胸椎体破坏缺损明显,血沉103毫米/小时,     

肩胛部软组织松解术1例报告

患者 ,男 ,5 3岁 ,因右肩胛部酸胀及发木十年就诊。十年前因外伤致右肩部酸胀 ,以后病情渐扩展 ,累及右肩胛部 ,以肩胛骨外侧软组织为主 ,自觉酸胀、发沉、发木 ,症状日渐加重并难以忍受 ,曾到全国多家医院就诊 ,并于 5年前在上海某大医院行“右肩胛外侧部分肌肉离断松解术”,无效 ,以后反复行“按摩、小针刀、封闭、中药”等治疗无效。入院检查 :肩关节活动不受限 ,右肩胛骨周围软组织压痛 ,外侧部分肌肉呈挛缩、条索状 ,距肩胛骨外缘外侧 3～ 4 cm可见纵形切口疤痕长约 15 cm,部分切口下空虚 ,按压疼痛 ,肩胛骨外角及下角部压痛最为显著。…     

1例右肩胛骨粉碎性骨折并左侧多根肋骨骨折患者术中的体位摆放

对1例右肩胛骨粉碎性骨折并左侧6～12肋骨多处骨折、双侧液气胸患者,术中先采用60°左侧卧位,行右肩胛骨关节盂下开放复位内固定术,再采用60°右侧卧位,行左6～9肋开放复位内固定术与左侧开胸探查及胸腔引流术。结果手术顺利安全实施,术后3d右肩疼痛缓解,左胸肋疼痛明显;术后18d恢复良好出院。提示针对特殊病情患者,改良标准侧卧位,灵活使用抗压啫喱垫,增加身体受力面积,减轻患侧压力,是保证患者手术顺利安全进行的关键。     

肩关节陈旧性脱位误诊一例报告

笔者于2010年10月收诊1例右肩关节陈旧性前脱位,肱骨外科颈部与肩胛骨骨性融合,报告如下.1 病例报告患者,女性,60岁,乘坐摩托车时不慎摔倒.右上肢外展外旋位撑地,立即感右肩疼痛,不能活动,未就诊,经休息一晚后,仍感右肩疼痛,不能活动,遂在本院就诊,查体见:右肩部轻度肿胀,关节盂空虚;三角肌无萎缩,Dugas征(+),右手末梢感觉运动血运均正常.摄X线片示:右盂肱关节盂下脱位(图1).诊断为“右肩关节前脱位(盂下型)”,急诊行手法复位,取手拉足蹬法,无法复位,牵拉时肱骨头无松动感觉,复位过程中,右上肢可于牵引状态下外展上举,并可内收搭于左肩上,怀疑为陈旧性脱位,遂行右肩CT三维重建,发现右侧肱骨头盂下前脱位,关节盂前下部嵌插于肱骨外科颈后外侧,并已骨性融合(图2).追问病史,患者于20多年前上山时摔倒,当时右肩疼痛、不能活动,未就诊,经休息疼痛好转,但右肩仍然不能正常活动,2个多月后右肩开始活动做事,之后右肩无疼痛,上举、外展、内收功能尚可,但前屈、后伸及旋转功能较对侧稍差.     

肱骨近端两部分骨折并同侧肱骨头劈裂骨折及浮肩损伤1例

患者,男,24岁,因骑摩托车时与汽车追尾,致右上肢及右肩部剧烈疼痛、活动受限,并头面部多处撞伤及出血,右眼肿胀,右胸前部疼痛。急诊于当地医院行头部、前额及右上臂皮肤裂伤清创缝合,后转入我院。查体:右上臂近端肿胀明显、异常活动及疼痛,右肩关节活动受限,右肩峰及右肩胛骨外侧压痛。X线片(图1a)及CT(图1b)示:右肱骨近端骨折移位明     

特殊颈肋二例报告

病例1女,18岁。因右颈部肿块2年,右肩不适、上肢乏力1年入院。病程中自觉肿块逐渐增大,右上肢乏力加重,伴有小指麻木。临床检查：右颈部锁骨上触及约3 cm×2 cm肿块,固定、无压痛。右胸大肌锁骨部明显萎缩,背阔肌和手部骨间肌轻度萎缩,右小指轻度爪形指,腕部桡动脉搏动减弱。右     

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.