Minimalist shoe injuries: Three case reports

Running in minimalist shoes continues to increase in popularity and multiple mainstream shoe companies now offer minimalist shoes. While there is no evidence that traditional running shoes prevent injuries, there are concerns that the designs of minimalist shoes may increase injury risk. However, reports of injuries in runners wearing minimalist shoes are rare. We present three injuries occurring in runners that were wearing minimalist shoes at the time of injury. All three of the runners switched immediately to the minimalist shoes with no transition period. We recommend that any transition to minimalist shoe gear be performed gradually. It is our contention that these injuries are quite common and will continue to become more prevalent as more runners change to these shoes.     

Brain abscess caused by Streptococcus intermedius: two case reports

BACKGROUND: Although Streptococcus intermedius has been recognized as an important pathogen for abscess formation outside the central nervous System, the Streptococcus milleri group, of which it is a member, has not been recognized as a specific pathogen for brain abscess, often thought to be caused by Streptococcus viridans, which includes other streptococcal species. CASE DESCRIPTION: Two cases of brain abscess in the left frontal lobe caused by S. intermedius, which responded well to antimicrobial treatment combined with needle aspiration, are presented. In the first patient, the predisposing disease was paranasal sinusitis of the frontal and ethmoid sinuses. In the second patient, the source of the pathogen was not detected despite extensive examination. The patients underwent aspiration of pus under ultrasound guidance in the first patient, and via a computed tomography-guided stereotactic procedure in the second patient. They subsequently received appropriate antimicrobial therapy against S. intermedius isolated from the pus culture. Both patients were discharged without any neurological deficits. CONCLUSION: It is important to recognize S. intermedius as a pathogen of brain abscess, and to be aware of its predisposing factors, i.e., mucosal disturbance and liver abscess.     

Management of lumbar translocation injuries: case reports

Lumbar translocation (complete lumbar dislocation) injuries constitute a severe and highly unstable form of thoraco-lumbar spinal injury and are uncommon. Adequate management of such injuries includes removing the neural tissue compression and realigning and stabilizing the spine. Computerized axial tomographic scans of the spine are very dramatic in demonstrating encroachment on the spinal canal by bony fragments. We report two cases of lumbar translocation injuries with favorable outcomes. The patients were initially managed with halo-femoral traction, resulting in spinal reduction and eliminating the need for acute surgical intervention, and subsequently underwent posterior fusion for stability. Anterior decompression was done at a later date as computed tomography showed retropulsed intracanalicular bone fragments. The use of Harrington rod instrumentation and realignment of the spine did not free the canal of bony fragments and, hence, decompression was required.     

Posterior fossa hemorrhage caused by dural arteriovenous fistula: case reports

BACKGROUND: Relatively few reports are available on dural arteriovenous fistulas (AVFs) accompanied by posterior fossa hemorrhage. We now report upon two such cases and discuss the differential diagnosis and imaging findings. CASE DESCRIPTION: A 36-year-old man was admitted after experiencing sudden headache. Computerized tomography (CT) showed vermian and fourth ventricular hematoma, and magnetic resonance imaging (MRI) revealed an abnormal signal void. Angiography demonstrated a dural AVF in the region of foramen magnum. The second case, a 57-year-old man, was also admitted for the evaluation of headache. CT scan revealed tentorial subdural, subarachnoid and vermian hemorrhage. MRI showed vermian hematoma and an abnormal signal void below the tentorium. Angiography demonstrated a dural AVF in the tentorium.The first case underwent transarterial embolization, after which the dural AVF disappeared completely. The second case underwent craniotomy immediately after failure of endovascular therapy. Postoperative angiography demonstrated no remaining dural AVF. CONCLUSIONS: Dural AVF should be considered as a causative lesion in cases with posterior fossa hemorrhage with no other definitive cause.     

Enoximone in cardiac arrest caused by propranolol: two case reports

We report two clinical cases of cardiac arrest, the former due to an adverse effect of intravenous (i.v.) propranolol in a patient with systemic sclerosis, the latter from a propranolol suicidal overdose. In both cases, conventional advanced life support (ALS) was ineffective but both patients eventually responded to the administration of enoximone, a phosphodiesterase III (PDE III) inhibitor. After the arrest, both patients regained consciousness and were discharged home. The chronotropic and inotropic effects of PDE III inhibitors are due to inhibition of intracellular PDEIII and are therefore unaffected by beta-blockers. These cases suggest that PDEIII inhibitors may be useful in restoring spontaneous circulation in cardiac arrest associated with beta-blocker administration when standard ALS is ineffective.     

Spinal epidural abscess caused by brucellosis. Two case reports

Brucellosis is still an important public health problem in the Mediterranean countries, including Turkey, and is most probably underdiagnosed or underreported. Two rare cases of extradural brucellar granuloma causing spinal cord compression in the thoracic and cervical regions were identified by magnetic resonance imaging. The abscesses were totally excised surgically. Medical treatment was given immediately after diagnosis, but delayed neurosurgical intervention resulted in partial neurological recovery in one patient although the other showed complete neurological recovery. Abscess formation may cause myelopathy due to extradural compression of the spinal cord. Failure to correct this condition may cause irreversible impairment of motor functions. Magnetic resonance imaging should be performed periodically in patients with brucellosis and suspected vertebral involvement to monitor for epidural granuloma formation and prevent extradural cord compression.     

Sciatica caused by epidural gas. Four case reports.

We report four cases of sciatica caused by gas in the epidural space with no other abnormality. Only 21 similar cases have been reported. Clinical features are identical to those of common sciatica, and plain radiographs are often uninformative. Computed tomography shows a low-density epidural collection displacing the nerve root.     

Management of close-range shotgun injuries to the chest by diaphragmatic transposition: case reports

A method of reconstructing the chest wall following close-range shotgun injuries is described. This technique requires detaching the diaphragm peripherally and suturing it above the chest wall defect, resulting in an intact chest cavity and an abdominal wall defect. This latter problem can then be addressed by a variety of standard methods. Two patients are presented with excellent long-term results of diaphragmatic transposition, which should be in the armamentarium of all surgeons who deal with trunk trauma.     

Severe injuries from coin cell battery ingestions: 2 case reports

Although coin cell battery ingestion is usually not associated with adverse consequences, case reports have been published that describe serious morbidity and occasional mortality. This report describes 2 young children developing serious complications from unwitnessed Lithium coin cell ingestion. A 19-month-old developed an aortoesophageal fistula from the proximal descending aorta, whereas the other developed bilateral vocal cord paralysis. Massive bleeding from the aortoesophageal fistula occurred 10 days post battery removal, resulting in a fatal outcome despite maximal surgical efforts. The patient with bilateral vocal cord paralysis required tracheostomy for airway stridor but is recovering function. This report adds to the evidence that primary prevention efforts are needed to caution parents about the dangers associated with coin cell batteries, and secondary prevention can be improved by raising awareness among clinicians as to the various clinical presentations and therapeutic options for this condition.     

Tibia vara caused by focal fibrocartilaginous dysplasia. Three case reports

We present three cases of a previously undescribed condition characterised by unilateral tibia vara associated with an area of focal fibrocartilaginous dysplasia in the medial aspect of the proximal tibia. The three children affected were aged 9, 15 and 27 months respectively. Two required tibial osteotomy, but in one the deformity resolved without treatment. The pathogenesis of the focal lesion remains conjectural; the most likely explanation is that the mesenchymal anlage of the tibial metaphysis has, for unknown reasons, developed abnormally at the insertion of the pes anserinus.     

Massive subependymal hemorrhage caused by an occult vascular malformation--two case reports.

Two patients presented with massive subependymal hemorrhage caused by vascular anomalies occult to angiography, computed tomography (CT) scanning, and magnetic resonance (MR) imaging. A 47-year-old male initially presented with a headache and became comatose 3 weeks later. CT and MR imaging demonstrated a massive hematoma in the right caudate head projecting into the lateral ventricle. A 60-year-old male sustained heaviness of his left extremities 8 days prior to admission and his condition gradually deteriorated. Neuroimaging revealed a right thalamic hematoma adjacent to the lateral ventricle. Cerebral angiography, CT, and MR imaging failed to detect any vascular anomaly. The hematomas increased in size gradually and were surgically explored. The histological diagnosis was arteriovenous malformation for the first case and cavernous angioma for the second case that had ruptured repeatedly. These cases were unique in the unusual location in the subependyma, and diagnostic neuroimaging modalities could not disclose the vascular anomalies, and the hematomas enlarged progressively to become critically symptomatic. Surgical intervention is mandatory for mass reduction and correct diagnosis of such lesions, with favorable outcome as long as the surgery is not delayed until too late.     

Small bowel complication caused by magnetic foreign body ingestion of children: two case reports

Accidental ingestion of foreign bodies is a common pediatric problem. The majority of such cases occur between 6 months and 3 years. When several magnets are ingested, they can be attracted to each other through the intestinal wall, causing necrosis and intestinal perforation or fistula, so they should be removed while they are still in the stomach. The authors experienced 2 cases of unusual small bowel complication caused by the ingestion of magnets. The first case was in a 10-month-old boy with ileal perforation caused by to 2 ingested magnetic beads, and the second case was in a 22-month-old boy with ileo-ileal fistula caused by to 7 ingested magnetic beads.     

Hyperacute rejection of living related kidney grafts caused by endothelial cell-specific antibodies: case reports

We describe two cases of hyperacute humoral rejection of living related kidney grafts despite negative pretransplantation T- and B-lymphocyte flow cytometric crossmatches and blood group identity. Retrospectively, antiendothelial IgG antibodies were detected on a panel of umbilical cord cells in the first case, and IgM antibodies against donor endothelial precursor cells were detected using a new endothelial cell crossmatch kit in the second case. Standard crossmatch methods using donor lymphocytes failed to detect these pathogenic antibodies and did not predict the danger of hyperacute rejection.     

Free vascularized joint transfers in acute complex hand injuries: case reports.

The loss of function of the metacarpophalangeal joint is a significant disability. Simultaneous reconstruction of the soft tissue, extensor mechanism, joint, and flexor tendon in a complex hand injury is difficult and challenging. Free vascularized autogenous toe joint transplantation is a useful technique that provides not only joint replacement but also the soft tissue, extensor mechanism, and flexor tendon in more severe complex hand injuries. Two patients underwent immediate, free vascularized metatarsophalangeal joint transfer of the second toe to replace the long and ring finger metacarpophalangeal joint in acute complex hand injuries. The follow-up results at 16 months and 8 months postoperatively are presented.