Achondroplasia in female twins: surgical indications

Although in literature achondroplasia has been described profusely, reports on achondroplastic twins are limited. We present two cases of monozygotic female twins with achondroplasia, who underwent limb-lengthening surgical procedure with external fixation in the following five steps: tibia, femur, tibia; femur, homer. Both the cases presented a good limb length and an optimal correction of associated deformities after the treatment, fulfilling the indications. Surgical indications were mostly led by the axial deviations of the lower limbs, and the timing of the limb-lengthening procedures has been the same in both couples showing the importance of this aspect.     

Gallstone-induced inflammatory fibrosis: a relentless clinical course of retained gallstones after laparoscopic cholecystectomy

Multiple reports in the literature confirm that retained gallstones spilled during laparoscopic cholecystectomy perpetuate chronic inflammation and suppuration long after the initial operation. Two patients who had previously undergone laparoscopic cholecystectomy presented to our institution with complications of retained stones. Patient 1 presented with right upper quadrant pain and a mass involving the right hepatic lobe. Patient 2 presented with a draining right flank abscess. Both underwent exploratory laparotomy at which time multiple abscess cavities were found, many of which contained retained gallstones. Patient 1 required reoperation for recurrent abscesses 7 months after the initial procedure and has been disease free for 6 months. Patient 2 had abscess recurrence that required percutaneous drainage 1 year after the original procedure and has not had recurrence for 4 years.     

Mature presacral teratoma in an adult male: a case report.

Presacral teratomas are rare tumors derived from more than one embryonic germ layer and are usually diagnosed in infancy. It has been estimated that the incidence of presacral teratoma in children ranges from 1 in 30,000 to 1 in 43,000 live births. However, the diagnosis of these tumors in adults is extremely rare. H. Head et al. reviewed the world literature in 1975 and found only 71 reported cases. Since that time, an additional 14 cases have been reported, and only one of these was found in the United States. This study reports a case of an adult male who presented with recurrent infected pilonidal cysts that proved to be benign presacral teratoma at biopsy. The patient underwent resection by left hemisacrectomy and primary closure using a posterior approach and, since this procedure, has had no evidence of recurrence. The case is presented along with a review of the relevant literature.     

Elevated plantar pressure and ulceration in diabetic patients after panmetatarsal head resection: two case reports.

Panmetatarsal head resection (variously called forefoot arthroplasty, forefoot resection arthroplasty, the Hoffman procedure, and the Fowler procedure) was developed for the relief of pain and deformity in rheumatoid arthritis. Although there are successful retrospective series reported in the literature, such an approach is not supported by carefully designed controlled trials. This procedure has also been advocated by some for the relief of plantar pressure in diabetic patients who are at risk for plantar ulceration. The efficacy of the procedure in this context is not supported by existing pressure measurements on rheumatoid arthritis patients in the literature, which has tended to show that although pain relief is obtained, the procedure results in elevation of forefoot pressure. Case reports are described of two patients (three feet) with sensory neuropathy who presented to our clinic 1 to 2 years after panmetatarsal head resections had been performed. Peak plantar pressures in these feet during first step gait were above the 99th percentile and outside the measuring range of the device used (EMED SF platform; NOVEL Electronics Inc., St. Paul, MN). Both patients had also experienced plantar ulcers subsequent to the surgery. Combining the information on patients with rheumatoid arthritis (RA) with that from our two case studies, we conclude that panmetatarsal head resection does not necessarily eliminate focal regions of elevated plantar pressure.     

Congenital cysts of the head of the pancreas

A very rare case of an infant with a huge multilocular congenital cyst of the head of the pancreas is presented. The symptomatology, diagnosis and surgical approach are discussed, while reviewing the few scattered reports in the English literature. Selective celiac arteriography is considered to be of definite aid in the differential diagnosis of cystic lesions of the head of the pancreas and has important implications on the choice of surgical procedure. We believe this to be the first case of a congenital cyst of the head of pancreas to be diagnosed accurately preoperatively by means of selective celiac and gastroduodenal angiography. Cystoduodenostomy proved to be a simple and effective procedure.     

An unusual postoperative complication: anesthesia mumps

Anesthesia mumps is a unique clinical entity characterized by acute transient postoperative swelling of the parotid gland. Although there has been some reports in the literature of other surgical disciplines, there has been no report of anesthesia mumps in plastic surgical literature as yet. A 3-year-old patient with anesthesia mumps after hypospadias repair is presented. To our knowledge, this case is the youngest patient of anesthesia mumps in the literature. In this article, the causes, differential diagnosis, and treatment of anesthesia mumps are discussed, and preventive measures are outlined.     

Pregnancy and delivery after mid-urethral sling procedures for stress urinary incontinence: case reports and a review of literature

In this article, the effects of pregnancy and delivery on the development of stress urinary incontinence are described with special emphasis on the obstetrical management in women who wish to become pregnant or are pregnant after a preceding mid-urethral sling procedure. Three case histories and a review of literature are presented. Pregnancy after a preceding incontinence operation is rare and makes it quite difficult to formulate guidelines about delivery when a pregnancy occurs. The best advice is to postpone incontinence surgery until after the last pregnancy. There is evidence that an elective caesarean delivery protects against stress urinary incontinence in case of pregnancy after bladder neck suspension. For mid-urethral sling procedures, this evidence is not available. The presented case reports do not clearly demonstrate that caesarean delivery is necessary in case of pregnancy and delivery after a mid-urethral sling procedure. Furthermore, a second mid-urethral sling operation is a minor procedure compared to a caesarean section, and there is evidence that a second mid-urethral sling operation has the same success rate as the first procedure.     

Elemental mercury-induced subcutaneous granuloma. A case report and review of the literature

The authors report a case of suicidal elemental mercury injection in the antecubital fossa, resulting in granuloma formation, which was treated with delayed resection. A 21-year-old man presented with a granuloma in the antecubital fossa after a suicide attempt by self-injection of elemental mercury. The patient was treated surgically with excision of the necrotic skin and granuloma under X-ray guidance, with good result. Despite the fact that human exposure to mercury has been ongoing for centuries, the deposition of metallic mercury into the skin and subcutaneous tissue, causing cutaneous granuloma formation is uncommon, with fewer than 100 reports presented in the dermatologic, toxicologic and general medical literature. On the contrary, there is a lack of reports of this soft-tissue injury in the orthopaedic literature.     

Choledochocele and recurrent pancreatitis. Diagnosis and surgical management

A case history has been presented that reports a rare type III choledochal cyst (choledochocele) and describes the association of a choledochocele and recurrent acute pancreatitis. The most reliable diagnostic technique, as used in our patient and supported by our literature review, is endoscopic retrograde cholangiopancreatography. This case further supports surgical correction employing transduodenal sphincteroplasty. This procedure is highly recommended for management of the intramural choledochocele (type IIIc), especially when associated with recurrent pancreatitis. Finally, patients who present with recurrent pancreatitis without the usual historical or diagnostic findings of biliary tract or alcoholic disease should have a choledochocele included in the differential diagnosis.     

Angiosarcoma of the breast: report of two long-term survivals

Angiosarcoma of the breast is a rare mesenchymal malignancy with a poor prognosis. One hundred sixty-four cases have been reported in the literature with 19 five-year, and 7 ten-year disease-free survivals. Two new cases of angiosarcoma of the breast are presented here, with disease-free survivals of five and ten years. In most series reviewed, angiosarcoma of the breast demonstrates as a rapidly fatal disease. Because axillary lymph node metastasis is rare, simple mastectomy with wide surgical margins is the procedure of choice. The mammographic and histologic findings may appear deceptively benign. A correlation exists between the histologic characteristics and the prognosis. Although there have been reports of increased survival with Actinomycin D, adjuvant therapy has failed to significantly alter the course of the disease in most series.     

Intracranial/Extracranial meningioma arising in the hypoglossal canal: case report.

A case of a patient with a posterior fossa meningioma extending through the hypoglossal canal to the cervical region as described in this article has not been previously described in the literature. Investigations and surgical management are outlined and pathological classifications are discussed. A literature review including recent reports of extracranial meningiomas is presented. Extracranial meningiomas are exceedingly rare and a high index of suspicion is necessary to make the diagnosis.     

Aseptic meningitis after microdiscectomy: description of a case and review of the literature

BACKGROUND CONTEXT: Aseptic meningitis has rarely been described after spinal surgery. No reports of aseptic meningitis exist after microdiscectomy in the literature. PURPOSE: To report on a case of aseptic meningitis in a patient after undergoing laminotomy and microdiscectomy at L4-L5. STUDY DESIGN/SETTING: Case report. METHODS: A case of aseptic meningitis is reported after microdiscectomy at L4-L5 in a 31-year-old man. In this case, a patient underwent L4-L5 laminotomy and microdiscectomy for weakness and pain. He subsequently presented 3 days after with neck pain, photophobia, and fever. RESULTS: Cerebrospinal fluid (CSF) examination subsequently revealed a pattern for aseptic meningitis. CONCLUSIONS: Presentation of aseptic meningitis after microdiscectomy is a rare but important diagnosis to consider. Examination of CSF is an important procedure to rule out the more dangerous diagnosis of bacterial meningitis.     

Merkel cell carcinoma

A rare, primary, malignant carcinoma of the skin exists of which the Merkel cell has been implicated as the cell of origin. Until recently, reports of this cancer were sparse. A review of the literature is presented along with a case report in which the primary tumor occurred on the lower leg.     

Congenital diaphragmatic hernia with ipsilateral eventration: A report of two cases

We report herein the cases of two patients in whom the unusual association of a diaphragmatic hernia with eventration of the diaphragm on the same side were confirmed. Although various recognized patterns of malformations have been described in children with diaphragmatic defects or eventration, to the best of our knowledge, this association has never been reported before. Following our case reports, the literature on this unusual topic is reviewed and a discussion on the possible pathogenesis is presented.     

Inguinal hernia with incidental parasitic infection: A case report and literature review

Inguinal hernia repair is a common and straightforward surgical procedure. Case reports of postsurgical incidental parasitic infections are very rare. A 72-year-old male presented at our hospital with a swollen mass in the right groin area and underwent right inguinal hernia repair. Unexpectedly, parasitic ova were discovered in the hernial sac. This report describes this rare case, in addition to a review of the literature.     

Angiosarcoma around a revision total hip arthroplasty and review of literature

Development of cancer in association with metallic implants is well recognized yet poorly understood. We report a case of angiosarcoma at the site of a revision total hip arthroplasty. We found only 3 previous reports on angiosarcoma associated with hip arthroplasty in English literature. Association between malignant tumor and hip arthroplasty deserves attention because this surgical procedure is so common that possible risk of a neoplasm should be quantified. Sarcoma is rare, and its possible causation by retained foreign body material has been reported only as single cases.     

Laryngeal dysfunction and pulmonary disorder

The normal respiratory function of the larynx has been described in detailed reports in both the otolaryngology and the respiratory physiology literature. The role of the posterior cricoarytenoid muscle in vocal cord abduction has been shown to be paramount in laryngeal respiratory function. However, only in recent reports has attention been directed toward disordered laryngeal function as evidenced in pulmonary disorders, such as asthma, or in association with underlying pulmonary disorders, such as asthma (ROAD) or emphysema (COPD). In this article, cases will be presented to demonstrate the role of disordered laryngeal function appearing as pulmonary disease and associated with various degrees of underlying pulmonary disease. The effect on pulmonary function tests and the role of treatment will be discussed.     

Large benign cystic teratoma of the mesosigmoid causing intestinal obstruction: report of a case

We report the case of a large benign cystic teratoma of the mesosigmoid in a 2-year-old child. To the best of our knowledge, this type of lesion has never been described in the English literature, although there are a few reports of teratomas arising from the greater and lesser omentum. There was diagnostic confusion due to the rarity of a teratoma arising from the peritoneal folds and also because calcification was not detected radiologically. A brief review of the literature on the diagnosis and treatment of similar lesions is presented. Received: August 22, 2001 / Accepted: May 7, 2002     

Surgical treatment of metatarsus adductus using a combined soft tissue and osseous approach

Children between 6 and 8 years of age with metatarsus adductus deformity have been considered to be in the gray zone for surgical correction. Should osseous or soft tissue procedures be implemented to reduce the adducted attitude of the metatarsals? The literature clearly describes one or the other and the intermediary chondrotomy procedure described by Johnson. The use of a combined approach has not been presented. The present authors offer a brief review of metatarsus adductus, and two case reports using a modified, combined approach. Two 7-year-old girls presented with bilateral resistant metatarsus adductus deformities. The authors contend that the first and fifth metatarsals are the major deforming forces in this age group, and may be corrected with base wedge osteotomies, while the central three metatarsals are more amendable to capsular and ligamentous releases. Advantages of soft tissue procedures on the central rays include avoidance of extensive dissection, creating less trauma and avoidance of the need for internal fixation. The obvious disadvantage is the inability to adequately reduce the deformity. This can be assessed intraoperatively. These authors, therefore, conclude that this modified surgical approach is a viable alternative to the previously described procedures for resistant metatarsus adductus.