Abnormal growth of the proximal femur due to apophyseal-epiphyseal coalescence resulting in coxa valga—a report of two cases in adolescents

The efficiency of indomethacin (10 mg/kg/day) in inhibiting recurrent partial closure of the epiphyseal plate was tested in rabbits. An epiphysiodesis was done laterally in the distal left femoral epiphyseal plate in 19 adolescent rabbits. This produced a valgus deformity in 14 of them. The bone bridge was then removed operatively and the rabbits were treated with either indomethacin or vehicle for 21 days postoperatively. Indomethacin plasma levels were about 180 ng/ml. The valgus deformity improved in indomethacin-treated rabbits, whereas it became worse in the controls (P = 0.004).     

Intestinal lymphangiectasia — a report of two cases

Intestinal lymphangiectasia is a rare benign disease characterised by focal or diffuse dilation of the mucosal, submucosal and subserosal lymphatics. Clinically, the patients may present with protein losing enteropathy (PLE), hypoproteinemic oedema, chylous ascites, pleural effusion, acute appendicitis and intestinal obstruction.     

Is augmentation a possible salvage procedure after lateral migration of the proximal femur nail antirotation?

Introduction

Failed fracture fixation of proximal femur fractures in the elderly usually results in prosthetic replacement. In case of the proximal femur nail antirotation (PFNA), during lateral blade migration or periimplant fracture at the femoral shaft, the femoral head remains intact and therefore a joint preserving procedure might be performed. However, implant anchorage in the femoral head after the second blade implantation generally results in reduced anchorage in the remaining cancellous bone. Therefore, we hypothesize that in the above mentioned cases augmentation of the PFNA blade could be a treatment option before prosthetic surgery has to be performed.

Materials

Biomechanical investigations were performed in eight fresh frozen femoral heads. Implant anchorage in case of blade extraction and reinsertion was investigated by rotation and pull out of a PFNA blade with a servohydraulic testing machine. After reinsertion of the blade and augmentation with bone-cement, the anchorage of the blade was investigated again to observe changes in torque and pull-out force.

Results

Rotational stability of the implant significantly increased after augmentation of the prior extracted PFNA blade. Pull-out strength was higher in the revised case than in the initial tests but without statistical significance. After augmentation, correlation between bone mineral density and pull-out strength which was found during initial pull-out disappeared.

Discussion

Augmentation of simulated blade exchange after lateral blade migration demonstrated a good anchorage. There was superior rotational stability in the revised case and no inferiority during pull out for the investigated specimens. Furthermore, augmentation could compensate for destroyed trabeculae and poor bone stock. It could furthermore be an option when a failed implant has to be replaced by a long PFNA in case of shaft fracture at the tip of the implant to increase anchorage in the femoral head. From a biomechanical point of view, reosteosynthesis and augmentation in selected cases of PFNA revision could be an alternative to initial prosthetic replacement. In the case of cut-out or medial implant protrusion, the suggested salvage technique is not feasible.     

Ruptured intrameatal AICA aneurysms—a report of two cases and review of the literature

Background  

Aneurysms of the distal part of the anterior–inferior cerebellar artery (AICA) are rare. Most are located in the cerebellopontine angle close to the internal auditory meatus. To our knowledge, only 13 patients with the aneurysm located inside the internal auditory meatus have been reported in the literature.     

Mayer-Rokitansky-Küster-Hauser syndrome presenting as vaginal atresia: report of two cases

Mayer-Rokitansky-Küster-Hauser syndrome (MRKH syndrome) is characterized by Müllerian duct structures agenesis: the vagina atresia is the commonest variant. There can be some anomalies associated, such as renal, skeletal, spine malformations and others. Patients with MRKH can show different presentation from newborn period to adolescence. We report our experience in treatment of the vaginal atresia presenting in two young girls as a sign of MRKH syndrome.     

Roux-En-Y Fistulo-Jejunostomy as a salvage procedure in patients with post–sleeve gastrectomy fistula

Background

Sleeve gastrectomy (SG) is currently the most common bariatric procedure in France. It achieves both adequate excess weight loss and significant reduction of comorbidities. However, leak is still the most common complication after SG. Nevertheless, its risk of occurrence is <3 % in specialized centers. Its management is difficult, long, and challenging. Although the procedure is commonly endoscopic and nonoperative, the management of post-SG fistulas could sometimes be surgical, including peritoneal lavage, abscess drainage, disrupted staple line suturing, resleeve, gastric bypass, or total gastrectomy. Roux-en-Y fistulojejunostomy (RYFJ) has been described as a salvage option. In this study, we report the early results of RYFJ for post-SG fistula, emphasizing indications, operative technique, and short-term outcome.

Methods

Between January 2007 and December 2012, we treated 62 patients with post-SG fistula. Before surgery, intra-abdominal or thoracic abscesses or collections were either excluded or treated by computed tomographic scan–guided drainage or even surgery. Endoscopic stenting was then attempted. After optimization of the nutritional status in case of failure of endoscopic measures, some of the patients underwent RYFJ.

Results

Between January 2007 and December 2012, a total of 21 patients (16 women and 5 men) had RYFJ for post-SG fistula. Mean age was 47 years (range, 22–59 years). Procedures were performed laparoscopically in all but 3 cases. The rate of secondary conversion to laparotomy was 11.1 %. The was no mortality. The postoperative morbidity rate was less than 5 %. The rate of fistula control was eventually 100 %.

Conclusions

RYFJ is a safe and feasible salvage procedure for the treatment of patients with post-SG fistula. Longer outcome analysis is, however, needed especially regarding the physiological and metabolic behavior of the procedure.     

Epidural blood patch as a successful treatment of Barrè-Lièou syndrome: report of two cases

Barrè-Lièou syndrome accompanies neurological symptoms after neck sprain, and is often difficult to treat. We describe two young men with various neurological symptoms after traffic accident, who were diagnosed with Barrè-Lièou syndrome. Both case 1 (41-year-old man) and case 2 (34-year-old man) showed no abnormal findings in head and cervical X-ray, CT-scan and MRI. Only radionuclide cisternography (RNC) showed cerebrospinal fluid (CSF) leak into epidural space at thoracolumbar level. Three months (case 1) and four years (case 2) had passed after each accident. Two patients underwent epidural blood patch (EBP) for total of three times. The average volumes of the blood used for EBP were 30 ml (case 1) and 24 ml (case 2). The procedure improved various symptoms except for neck stiffness and dizziness. EBP had led to low back pain, which disappeared within three days. CSF leak vanished in RNC after EBP. Severe complication, for example epidural infection or neurological disorders due to hematoma, was not noticed. While neural blockade did not relieve pain before EBP, we could get good effect from neural blockade for remaining symptoms after EBP. We consider that Barrè-Lièou syndrome is due to CSF leak and EBP may be one of the useful treatments.     

The migration of a BioScrew® as a differential diagnosis of knee pain, locking after ACL reconstruction: a report of two cases

Introduction: Problems with the initial fixation strength and widening of the femoral and tibial canal after ACL reconstruction using a triple or quadruple semitendinosus autograft have led to the introduction of the so-called Hybrid fixation with the additional use of interference screws. Pain and intraarticular migration have been reported with metal interference screws requiring implant removal (Am J Knee Surg 11:32–34, 2000, Arthroscopy 11:289–291, 1995) but not yet with bioabsorbable screws. Materials and methods: We report on two cases were the intraarticular position of a bioabsorbable interference screw possibly due to migration in the early postoperative period lead to symptoms, the need for further surgery, and implant removal. Results: A preoperative MRI revealed the diagnosis. After removal of the tibial interference screw both knees were settling down, albeit with residual instability and only a moderate clinical result. Discussion: Despite the attractiveness of bioabsorbable screws due to the very fact that they are being reabsorbed over time, there is a slight risk of migration in the first month after the operation. In any suspicious case an MRI will easily clarify the diagnosis.This study was carried out at the Department of MRI, Klinik für Radiologische Diagnostik, Klinkum Saarbrücken, Winterberg 1, 66119 Saarbrücken     

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.)     

Entrapment of the saphenous nerve at the adductor canal affecting the infrapatellar branch – a report on two cases

Objective:

To present 2 cases of entrapment of the saphenous nerve at the adductor canal affecting the infrapatellar branch, and to provide insight into the utilization of nerve tension testing for the diagnosis of nerve entrapments in a clinical setting.

Rationale:

Saphenous nerve entrapments are a very rare condition within today’s body of literature, and the diagnosis remains controversial.

Clinical Features:

Two cases of chronic knee pain that were unresponsive to previous treatment. The patients were diagnosed with an entrapment of the saphenous nerve at the adductor canal affecting the infrapatellar branch using nerve tension techniques along with a full clinical examination.

Intervention and Outcome:

Manual therapy and rehabilitation programs were initiated including soft tissue therapy, nerve gliding techniques and gait retraining which resulted in 90% improvement in one case and complete resolution of symptoms in the second.

Conclusion:

Nerve tension testing may prove to be an aid in the diagnosis of saphenous nerve entrapments within a clinical setting in order to decrease time to diagnosis and proper treatment.     

Is revision surgery following lower-limb amputation a worthwhile procedure? A retrospective review of 71 cases

There is little written about the value of revision surgery on lower-limb amputations. We report on 71 revision amputation procedures performed by a single surgeon in this retrospective analysis. The majority of our revisions (61%) were in amputees who had suffered trauma. We judged success from a surgical and a rehabilitation perspective using scoring systems. Revisions for bony and soft-tissue pathology had good outcomes from a surgical (85% and 82%) and a rehabilitation perspective. Revisions for infection had satisfactory results from a surgical perspective (73%) but less so from a rehabilitation perspective (25%). The results of the revisions for pain were poor showing surgical success only 50% of the time where a neuroma was suspected and only 25% when there was no apparent cause. There was little or no improvement in rehabilitation in both the pain groups.Revision surgery for certain pathologies gives a good surgical outcome and can improve pain and mobility status. Patient selection for surgery is key and evaluation by a multidisciplinary team is recommended.     

Incisional hernia from iliac bone grafting site — a report of two cases

Incisional hernia is a fairly common problem in India, although there is a paucity of data from the region. The commonly implicated operations in the aetiology of incisional hernia in our setup are lower segment cesarean sections and surgery for peritonitis. Incisional hernia following iliac bone grafting is rare, despite the frequency of performance of the procedure. Two patients with incisional hernia arising from the donor site of iliac bone grafting were seen in our department over the last year. They underwent mesh hernioplasty using polypropylene mesh that was placed as an onlay. Both the patients are presently well on follow-up, with no recurrence of the hernia. Mesh hernioplasty of hernia following iliac bone grafting gives good results and may be considered the method of choice of repair of this uncommon type of hernia.     

Single-incision Eden-Lange procedure in trapezius muscle paralysis: A report of 11 cases

Objective

The aim of this study was to evaluate the outcome of single-incision Eden-Lange procedure in trapezius muscle paralysis.