Rheumatoid nodule presenting as Morton’s neuroma

Among 101 feet that presented with symptoms and signs similar to Morton’s neuroma, intermetatarsal rheumatoid nodules were found in five feet (three patients). Two patients had bilateral involvement. Histology of the excised tissue showed the presence of a rheumatoid nodule and Morton’s neuroma in four feet and a rheumatoid nodule with unremarkable nerve bundles in one. A rheumatoid nodule can coexist with Morton’s neuroma, as seen in our patients, and the presentation is often similar to that of a Morton’s neuroma. Our patients were rendered asymptomatic with surgical treatment and went on to have appropriate management of rheumatoid arthritis. Rheumatoid nodule should be considered in the differential diagnosis of Morton’s neuroma in not only rheumatoid arthritis patients but also asymptomatic patients who have never been tested for rheumatoid antibodies.     

Motor Learning as Young Gymnast’s Talent Indicator

Talent identification plans are designed to select young athletes with the ability to achieve future success in sports. The aim of the study was to verify the predictive value of coordination and precision in skill acquisition during motor learning, as indicators of talent. One hundred gymnasts, both cadets (aged 11.5 ± 0.5 yr.) and juniors (aged 13.3 ± 0.5 years), competing at the national level, were enrolled in the study. The assessment of motor coordination involved three tests of the validated Hirtz’s battery (1985), and motor skill learning involved four technical tests, specific of rhythmic gymnastics. All the tests were correlated with ranking and performance scores reached by each gymnast in the 2011, 2012, and 2013 National Championships. Coordination tests were significantly correlated to 2013 Championships scores (p < 0.01) and ranking (p < 0.05) of elite cadet athletes. Precision, in skill acquisition test results, was positively and significantly associated with scores in 2013 (adj. R² = 0.26, p < 0.01). Gymnasts with the best results in coordination and motor learning tests went on to achieve better competition results in three- year time.

Key points

• In talent identification and selection procedures it is better to include the evaluation of coordination and motor learning ability.
• Motor learning assessment concerns performance improvement and the ability to develop it, rather than evaluating the athlete’s current performance.
• In this manner talent identification processes should be focused on the future performance capabilities of athletes.

Key words: Training, precision, coordination, talent selection, gymnastics, motor skills     

Terminal syringomyelia: is it as innocent as it seems?--Case report

A 5-day-old newborn girl presented with cutaneous signs of hypertrichosis, skin dimple, and subcutaneous lipoma in the lumbar region. Magnetic resonance (MR) imaging of the thoracolumbar spine demonstrated spinal dermal sinus, type II split cord malformation, and tethered cord. A small terminal syringeal cavity was also present. Five months after the diagnosis, weakness in dorsal flexion of the bilateral feet and toes was detected. Surgery to untether the cord was performed. Her deficits resolved completely. Nearly 4 years later, she was admitted with weakness in dorsal flexion of the right foot and toe. MR imaging of the spine showed holocord syringomyelia, postoperative changes, and tethered cord. No Chiari malformation was seen. Syringosubarachnoid shunt placement was performed. Terminal syringomyelia is common in cases of occult spinal dysraphism, but the natural history and management remain unclear. Progression, regression, or persistence of terminal syringeal cavity can occur whether untethering is performed or not. Progression of the terminal syrinx occurred after tethered cord release and the enlargement of the cavity involved the entire spinal cord in the present case. Terminal syringomyelia requires close follow up for a long time even in asymptomatic cases. Surgical treatment should be considered in symptomatic cases.     

Fournier’s gangrene: Exists and it is still lethal

Background: Fournier’s gangrene is an aggressive form of necrotizing fascitis of the perineal, perianal or genital regions, caused by a polymicrobial infection that includes virulent organisms. Patients and methods: Eleven cases of Fournier’s gangrene were treated in our department during the last 20 years. Portals of entry were ischiorectal abscess, perirectal abscesses, scrotal abscess and trauma in the perianal area. The documents were analyzed according to clinical and epidemiologic patterns. Results: We dispensed systemic chemotherapy with broad-spectrum antibiotics, and performed surgical debridement for all patients. In addition, one patient was treated by local use of 100% oxygen, with excellent results in wound healing. All patients made a full recovery, except one who died of sepsis. Conclusion: These cases are presented with some notes underlying the reasons for the persisting incidence and mortality of this disease.     

Rare extraskeletal Ewing’s sarcoma mimicking as adenocarcinoma of the sigmoid

Introduction: Extraskeletal Ewing’s sarcoma (EES) is a rare finding in comparison with Ewing’s sarcoma of bone and usually manifests in young patients. However, even in older patients, one must consider the diagnosis.

Patients and methods: In this case, we describe a 52-year-old woman diagnosed with EES, mimicking as adenocarcinoma of the sigmoid.

Results: The tumor was not visualized by a multi-slice spiral computed tomography of the abdomen and pelvis with intravenous contrast, and eventually the diagnosis was made by positive immunohistochemical staining for CD99 and by molecular testing for EWSR1 translocation.

Conclusions: This combination of the patient’s age and the localization of the tumor mimicking an adenocarcinoma of the sigmoid has never been described before.     

Takayasu’s Arteritis Presenting as Uveitis in a 5-Year-Old Girl

A 5-year-old patient presented with uveitis as initial manifestation of Takayasus arteritis. Our patient is unique not only in the initial presentation but also in the extent of arteritis in the aortic arch and great vessels. This is only the second case reported in the literature with this unusual presentation.     

Bilateral testicular gangrene: does it occur in Fournier’s gangrene?

Fournier’s gangrene (FG) is an infective necrotizing fascitis of the perineum, genital and perianal area leading to gangrene of the overlying skin and subcutaneous tissue. Testis and epididymis tend to be spared. We report a case of a young male with bilateral gangrene of the testis.     

The internet as a source of information for De Quervain’s tendinitis

Background

Many individuals are turning to the Internet for information about various health conditions, and in our study we evaluated the quality and readability of information on the internet about De Quervain’s tendinitis.

Methods

We chose the search terms “De Quervain’s Tendinitis,” “De Quervain’s Tenosynovitis,” and “De Quervain’s Syndrome,” and entered them into the search engines “Google,” “Bing,” and “Yahoo” and compiled the search results. The websites were then evaluated and assigned a quality score, a Flesch-Kincaid (FK) reading level, and a subjective quality score. They were then grouped according to the search term used, search engine used, and the order (priority) returned by the search engines. ANOVA analysis and pairwise comparisons of quality and readability among groups, as well as correlation analysis were performed.

Results

The FK readability average was 10.3, above the recommended level. The search term De Quervain’s tenosynovitis returned the highest objective quality results. There was no statistical difference found between the different search engines. The first 10 results from the searches were of higher quality than results 11–20, and there was a positive correlation between objective and subjective quality scores but no correlation between readability and objective quality.

Conclusions

We concluded that quality information about De Quervain’s tendinitis is available on the internet and is most likely to be found using the search term De Quervain’s tenosynovitis and in the first 10 results of an internet search. However, most information is written above the recommended 6th grade reading level.     

Atrial septal defect as an uncommon cardiovascular malformation with Turner’s syndrome

Cardiovascular malformations are frequently observed in Turner’s syndrome. Bicuspid aortic valve and coarctation of aorta are commonly associated with Turner’s syndrome while an atrial septal defect is unusual. Here report a rare case of artrial septal defect with Turner’s syndrome.     

Delorme’s Procedure for Full-Thickness Rectal Prolapse; Does it Alter Anorectal Function

Clinical and anorectal manometric results of Delorme’s procedure for full-thickness rectal prolapse were assessed retrospectively. Thirty-seven patients with full-thickness rectal prolapse who were operated on with Delorme’s procedure were included in the study. They were 11 males and 26 females with mean age of 54 ± 4.4 years (range 15–70 years) and mean follow-up period of 27 ± 4.6 months (15–48 months). The mean operative time was 65 ± 4.5 min (60–90 min); there was no mortality and blood loss was minimal. Mean hospital stay was 3.5 days (2–6 days). Outcomes of the procedure were satisfactory in 29 patients (78.4%). Dissatisfaction came from recurrence and persistence of fecal incontinence. Prolapse recurrence had been observed in six patients; three of them were treated by the same technique and showed no recurrence, and the others were treated by either mucosal resection (1) or abdominal resection rectopexy (2). Constipated patients showed improved symptoms in 7 of 10 cases. Of 11 patients who were incontinent preoperatively, seven patients became fully continent. Postoperatively, anorectal manometric studies (MRP, MSP, MTV, and UDV) showed significant improvement in all patients with intact RAIR. Delorme’s operation, coupled with avoidance of abdominal procedures, is the treatment of choice of rectal prolapse in elderly frail patients and in patients with defecatory disorders.     

Duodenojejunal junction web masquerading as Wilkie’s syndrome: Report of a case

Wilkie’s syndrome (superior mesenteric artery syndrome) is a rare cause of obstruction to the third part of duodenum due to compression between the superior mesenteric artery and the abdominal aorta. Pathologies like malignant growth in the mesenteric root, the presence of a lymph nodal mass compressing the terminal duodenum, dissecting aortic aneurysm, and intestinal malrotation may mimic the condition, but are not true etiologies of the syndrome. A duodenojejunal web causing narrowing of the duodenojejunal junction and mimicking Wilkie’s syndrome has not been described before in the literature. We herein report a case of gastroduodenal obstruction due to a web in the duodenojejunal junction in a young female patient, which closely mimicked Wilkie’s syndrome but was finally diagnosed postoperatively. We highlight the first case of its kind in an adult and discuss the challenges in both the diagnosis and management.     

Isolated involvement of the gallbladder by Crohn’s disease manifesting as acute cholecystitis

A 79-year-old female presented with acute cholecystitis. Having recovered on conservative management, elective laparoscopic cholecystectomy was performed. The diagnosis of Crohn’s disease of the gallbladder was a histopathological surprise. Further detailed investigation indicated this to be the isolated involvement of gallbladder.