Post-traumatic osteomyelitis of the clavicle: A case report and review of literature

Osteomyelitis of the clavicle is a rare form of infection occurring from hematogenous spread or trauma. This has been reported following head and neck surgery, and subclavian catheter placement. In traumatic cases, the management involves removal of bone fixation, debridement of the bone and coverage with a muscle flap.     

Renal cell carcinoma: case report and literature review

Renal cell carcinoma arising from epithelial cells of the renal tubule is a highly aggressive and malignant tumor in all ages. Less than 2% of cases occur in childhood, relatively in older age group. Only a few pediatric series have been presented in the English literature. Tumor is presented with characteristic findings of flank pain, gross hematuria, and palpable mass. Although one half of the patients have metastasis at the time of diagnosis, most cases are currently being incidentally detected using improved imaging techniques. The overall prognosis in children appears to be similar to that in adults. Tumor stage and complete surgical resection have been reported as the most meaningful prognostic factors for the outcome. The incidence of metastatic disease is same as in adults. The effect of chemotherapy and immunotherapy, either preoperatively or postoperatively, is unclear. Cure is the most likely consequence in localized and completely resected tumors. Here, we present an 8-year-old boy with renal cell carcinoma demonstrating only hematuria without any pathological physical examination findings. The mass was described by abdominal ultrasonography and computed tomography in the left kidney. After the left nephroureterectomy, the patient was given no therapy.     

Castleman's disease in the pelvic retroperitoneum: A case report and review of the Japanese literature

INTRODUCTIONCastleman's disease is a fairly rare benign tumor of lymphoid origin. It can develop anywhere lymphoid tissue is found, but the expected origin is mediastinum and rarely pelvic retroperitoneum.PRESENTATION OF CASEA 22-year-old woman was admitted to our hospital for a mass in the pelvic retroperitoneum that was detected incidentally on an ultrasonography during a routine medical checkup with no signs of symptoms. After laboratory examination, ultrasonography, and magnetic resonance imaging (MRI), surgical resection was performed successfully through a lower midline incision. But the patient was needed transfusion because of massive bleeding. Postoperative histopathological diagnosis was hyaline-vascular type of Castleman's disease. The patient is leading an active social life without any signs of sequelae or recurrence.DISCUSSIONThrough the review of Japanese literature on Castleman's disease in the retroperitoneum, the characteristics of preoperative imaging findings are studied. Castleman's disease is easily misdiagnosed clinically because of its scarcity and no specific imaging findings. And the embolization via angiography should be considered in the hypervasular tumors such as in this case to prevent massive bleeding and transfusion.CONCLUSIONAlthough Castleman's disease is uncommon, it should always be included in the differential diagnosis of pelvic retroperitoneal tumors. A better knowledge of this disease would help surgeon to avoid unnecessarily extensive resection and massive bleeding for transfusion when dealing with retroperitoneal tumors.     

Osteoid osteoma following fracture of the distal tibia: A case report and literature review

Osteoid osteoma is a benign bone-forming lesion, characterised by its small size, its clearly demarcated outline and by the usual presence of a surrounding zone of reactive bone formation. It often poses a diagnostic challenge due to its ambiguous presentation. The aetiology of osteoid osteoma is poorly understood. The previous suggestion that osteoid osteoma was not associated with trauma or infection has been challenged by more recent literature raising the possibility that it could be a reactive or healing response or a phenomenon associated with the revascularisation process. This case report describes an unusual presentation of a post-traumatic osteoid osteoma. Two years following a tibial fracture treated non-operatively, the patient developed new pain at the previous fracture site. The pain was constant, relieved by non-steroidal analgesia and not associated with systemic upset. It was initially attributed to other more likely diagnoses such as osteomyelitis and neuropathic pain. Multiple investigations and interventions were undertaken prior to the diagnosis being obtained by surgical excision of the lesion and histological studies 3 years following the initiation of the discomfort. This case report should raise the index of clinical suspicion of osteoid osteoma occurring post fracture.     

肌纤维母细胞肉瘤(附2例报告并文献复习)

[目的]总结肌纤维母细胞肉瘤的临床及组织病理特点,探讨其诊疗方法及预后情况。[方法]分析2例罕见的肌纤维母细胞肉瘤的临床特征、组织病理学特点、诊断治疗方法,并对患者的预后情况进行随访。同时复习近年来的国内外相关文献。[结果]患者1在活检诊断后,行大腿中段截肢术,术后在当地医院行化疗(具体方案不详)。术后1年,患者因肺转移,死亡。患者2行肿瘤切除术,术后3个月肿瘤复发,再次行手术切除并行化疗,术后11个月发生肺转移,3个月后死亡。两例最终病理诊断均为肌纤维母细胞肉瘤。复习近30年的文献,共有54例同样的病例报道。患者中以成年男性多见,肿瘤好发于头颈部、躯干以及四肢。逐渐增大的无痛性包块是其最常见的临床表现。依照特殊的形态学特征及肌源性标记物,即可以作出诊断。[结论]肌纤维母细胞肉瘤是一种罕见的恶性梭形细胞肉瘤,具体发病率不详。诊断时应与滑膜肉瘤、平滑肌肉瘤和纤维肉瘤等鉴别。治疗以手术切除为主,化疗效果不肯定。该肿瘤为低度恶性,具有侵袭性,术后局部复发率高,可以发生远处转移。预后尚不肯定。     

Bilateral traumatic patellar fracture: a case report and review of literature

Simultaneous isolated bilateral patellar fractures are very rare injuries and most often associated with systemic disorders such as hyperparathyroidism,osteoporosis,stress fracture and kidney failure.I...     

前列腺导管腺癌20例报告并文献复习

目的:探讨前列腺导管腺癌的临床表现、病理特征、治疗方法等。方法:报告1995～2010年天津各大医院收治的20例前列腺导管腺癌疾病的情况:患者年龄64～82岁,平均74.5岁,其中13例主因不同程度的排尿困难入院,9例PSA高于正常,17例B超和MRI提示异常,20例均经过穿刺或病理活检确诊。根据病情需要行不同的手术和药物治疗。结果:免疫组化检查提示有前列腺导管腺癌较特异性表现。术后随访12～60个月,14例患者死亡。结论:前列腺导管腺癌在前列腺癌中较罕见,难于早期诊断;确诊主要依靠病理和免疫组化检查;治疗方法可采用根治性前列腺切除术。     

塑型钛板颅骨修补20例临床应用

目的 探讨塑型钛板在颅骨修补术中的临床效果。方法 对我科在2009年4月~2010年10月收治各种原因引起的颅骨缺损20例,使用塑型钛板进行颅骨修补术的临床资料进行回顾性分析。结果 20例塑型颅骨修补术病人,手术时间除2例颅骨肿瘤为即时修补外,其余均为第一次手术后3～6个月;除1人术后出现继发癫痫外,其余均恢复良好。术后无伤口感染、皮下积液、继发出血、钛板外露等并发症,术后颅骨外观恢复满意。结论 采用塑型钛板行颅骨修补术,手术快捷方便、效果满意,具有广泛临床应用价值。     

Primary perineal hernia: a case report and review of the literature

Abstract Pelvic floor hernias are extremely rare. This study presents a successfully treated case of primary perineal hernia and takes a look at the existing literature. Case The case of a 75-year-old female patient with a great perineal hernia is presented. Diagnosis was secured by magnetic resonance tomography. The pelvic defect was successfully treated by primary suture with Prolene. Discussion The literature shows many different approaches for treatment of perineal hernia, such as open or laparoscopic mesh repair, and perineal, abdominal or combined access. Our case confirms that primary closure of the hernial orifice through an abdominal approach is also feasible.     

Focal fibrocartilaginous dysplasia of long bones: report of eight additional cases and literature review

We report eight additional cases of focal fibrocartilaginous dysplasia (FFCD) in the proximal tibia (five), distal ulna (one), and distal femur (two). Spontaneous, complete resolution of the lesion was observed in two tibiae and one ulna. Three tibial lesions with genu varum deformity were managed with osteotomy. Two femoral FFCDs caused persistent or progressive deformity: one genu valgum with patellar dislocation, and one genu varum. These patients underwent concomitant deformity correction and lengthening by the Ilizarov method. The final results were satisfactory in all patients except one, who underwent valgus tibial osteotomy and developed mild postoperative genu valgum. The analysis of a total of 46 cases in the literature and our experience suggests that (a) FFCD has a wide histopathologic spectrum, ranging from purely dense, fibrous tendon-like tissue to benign fibrocartilaginous tissue; (b) at least 45% of tibial FFCD demonstrates progressive, spontaneous resolution; (c) in contrast, femoral and humeral FFCDs appear to have a slim possibility of spontaneous regression of the deformity; and (d) corrective osteotomy is indicated when the deformity is increasing or persistent, or when the existing deformity is severe enough to jeopardize adjacent joint mechanics and alignment.     

Spontaneous bilateral patellar tendon rupture: a case report and review of the literature

Bilateral rupture of the patellar tendon is a very rare injury. It occurs in association with chronic systemic diseases or corticosteroid medications. We report a case of a 13-year-old child with Ehlers-Danlos syndrome presenting a bilateral patellar tendon disruption of proximal insertion that occurred with a trivial trauma. Surgical management consisting in tendon repair with a suture anchor technique protected temporarily with a cerclage wiring gives a good outcome.     

Fracture of the occipital condyle: case report and review of the literature

Summary Fracture of the occipital condyle is a rare injury that can be easily overlooked. We report a patient with an occipital condyle fracture who presented with pyramidal syndrome and normal plain radiographs. The diagnosis was made by high-resolution computed tomographic scanning with sagittal and coronal reconstructions and magnetic resonance imaging. Surgical treatment was deferred because of spontaneous recovery. This fracture should be considered whenever a trauma patient presents neck pain and plain cervical spine radiographs show no abnormalities.     

负压封闭引流术应用于糖尿病患者头皮感染及颅骨骨髓炎二例

病例1患者男,39岁,患2型糖尿病3年。头皮感染并溃疡形成半年余,见右颞顶部约8cm×8cm大小类圆形红肿,中央部见-2cm×2cm皮肤缺损溃疡,敏感抗菌药物治疗未愈,形成头皮缺损,常规换药未愈,行负压封闭引流术（vacuum sealingdrainage,VSD）治疗20余天后,皮缘肉芽生长,缺损缩小,皮肤红肿减轻。     

Merkel cell carcinoma in pelvic lymph nodes after surgical staging for endometrial cancer: A case report and review of the literature

INTRODUCTIONMerkel cell carcinoma (MCC) is a rare malignant neuroendocrine tumor of the skin.PRESENTATION OF CASEWe present a case of MCC in pelvic lymph nodes, revealed after surgical staging for endometrial cancer. A 54-year-old Caucasian woman presented to our department with a three-month history of postmenopausal bleeding. After proper preoperative evaluation, the patient underwent total abdominal hysterectomy, bilateral salpingo-ophorectomy and pelvic lymph node dissection. The pathology report confirmed the presence of a small, grade I, endometrioid adenocarcinoma and MCC in the pelvic lymph nodes. Primary site of the disease could not been retrieved. The tumor board decided adjuvant chemotherapy (carboplatin and etoposide) and close follow-up every 2 months. Our patient is alive with no evidence of disease 12 months after surgery.DISCUSSIONIt is noteworthy that 19% of the patients with MCC had lymph node metastasis with no apparent primary lesion. The mechanism of this regression remains unclear, although a higher apoptotic activity has been observed in MCC than other skin tumors. In addition, other co-malignancies have also been linked to MCC patients. The explanation for the frequent occurrence of other primary neoplasms in patients with MCC is still unclear. However, a reasonable cause could be an altered genetic profile or an immuno-compromised situation in these patients.CONCLUSIONFurther analytic investigations are needed to clarify the role of various factors in the spontaneous regression or not of this neuroendocrine tumor as well as in the simultaneous genesis of other primary carcinomas.     

Gallbladder carcinosarcoma: A case report and literature review

Carcinosarcoma of the gallbladder is a rare malignancy characterized by both malignant epithelial and mesenchymal components. The clinical behavior of this tumor is extremely aggressive. Only 26 cases have been reported in the world literature to date. We report the case of a 64-year-old woman who had fever associated with a right upper quadrant mass. An exploratory laparotomy through a right upper quadrant incision was performed at another institution, and the patient was thought to have severe acute cholecystitis that would require additional antibiotic therapy before attempted resection. She was referred to our center, where abdominal CT showed a 6.4 x 8.2 cm pericholecystic mass involving the hepatic flexure of the colon. The patient underwent cholecystectomy and hepatic wedge resection, pancreaticoduodenectomy, and right hemicolectomy. Pathologic examination of the surgical specimen revealed two histologic components consisting of squamous cell carcinoma and spindle cell sarcoma of gallbladder origin, consistent with carcinosarcoma. All seven lymph nodes in the pancreaticoduodenectomy specimen were negative for tumor. We present this case and a review of the literature and current treatment recommendations.     

Melanotic progonoma of temporal and occipital bones: A case report

Melanotic progonoma is a rare tumor that primarily affects the maxilla of infants during the first year of life. Involvement in the skull is rare and can mimick other benign or malignant tumors affecting the infant's skull. The authors report a case of melanotic progonoma of right occipital and temporal bones in a 7-months’ girl and discuss the histological features, immunohistochemistry study, differential diagnosis and management of this tumor.     

The anterior dislocation of the sacroiliac joint: a report of four cases and review of the literature and treatment algorism

Pelvic fractures are an uncommon injury in pediatric trauma patients, but the morbidity and mortality associated with these injuries can be profound. Of the posterior pelvic ring disruptions, the posterior dislocation of sacroiliac joint, which is the traditional dislocation of the sacroiliac joint, occurs in most incidences of pediatric trauma patients. There are few reports, however, on the “anterior” dislocation of sacroiliac joint, in which the ilium dislocates anterior to the sacrum and often combines with symphyseal diastasis and fractures of pubic rami and ilia. The distinct fracture-dislocation of sacroiliac joint is a subtype of completed posterior pelvic fracture. Literature review contains little information about such type of dislocation. We present four cases of pediatric trauma patients with the “anterior” dislocation of sacroiliac joint. After a thorough literature review of existing classification of pelvic fractures, we name it as the anterior dislocation of sacroiliac joint. Q. Zhang and W. Chen contributed equally to this work.