Squamous carcinoma in a pressure sore with a very short latency period

Malignancy in a chronic pressure sore is rare among Marjolins ulcers. Carcinomas arising in pressure sores are highly aggressive and usually fatal. Although carcinomas in pressure sores are generally well-differentiated squamous carcinomas, they can show quite an aggressive course and do not respond either to chemotherapy or radiotherapy. The mortality rate is high despite wide surgical resection. It must be kept in mind that carcinomas may arise in pressure sores and treatment must be early and aggressive. We report a squamous carcinoma arising in a pressure sore that had a very short latency period. The related literature was reviewed.     

The diagnosis and treatment of the ‘mixed’ type of depressed fractures of the calcaneum

Summary The mixed type of depressed fractures of the calcaneum is described and a classification proposed. During a six year period, 78 patients with fractures of the calcaneum were seen. Of these 32 were of the mixed type and 23 were treated by sub-talar arthrodesis and restoration of the calcaneal outline. Very good or good results were obtained in all patients subjected to operation.

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Résumé L'auteur décrit un type de fracture du calcanéum par enfoncement «mixte» (i. e. à la fois vertical et horizontal) et il en propose une classification. Sur 78 fractures du calcanéum observées en six ans, 32 étaient de ce type «mixte» et 23 d'entre elles furent traitées par arthrodèse sous-astragalienne avec reconstitution de la forme du calcanéum. D'excellents ou de bons résultats ont été obtenus chez tous les blessés qui ont bénéficié de cette intervention.

     

An HIV-negative Penil Kaposi’s sarcoma

Kaposis sarcoma is a tumour of reticuloendothelial system. Non-epidemic Kaposis sarcoma limited to the penile involvement should be aggressively treated because it is rarely associated with diffuse organ involvement localized surgical excision or small-field external beam or electron beam radiation has been effective. In this case, we presented a man 53 years old, who presents with a papular indolent lesion on the glans penis, which is reported as a Kaposi sarcoma after excision of the lesion.     

Liposuction in Benign Symmetric Lipomatosis,Sense or Senseless?

Benign symmetric lipomatosis is a rare form of typical fat distribution in the shoulders, the arms, and the neck that can compromise the respiratory, nutritional, and psychological status of the patient. Alcoholism, malignant tumors of the upper airways, endocrine tumors, hypothyroidism, diabetes, and hypertriglyceridemia are often associated with its occurrence. Surgical removal via lipectomy or liposuction can give good cosmetic results, although recurrences often occur. Liposuction has become the first choice to treat this disorder in patients with smaller masses. We have operated on four such cases in which liposuction failed and surgical excision had to be performed. We present a summary of the clinical characteristics of all four patients and discuss the different treatment options.     

Impact of laparoscopy on the management of an unusual case of nonpalpable testis in an adult patient

Dieulafoys lesion is an uncommon cause of major gastrointestinal bleeding and may be difficult to recognize. It consists of an arteriole that protrudes through a tiny mucosal defect usually within 6 cm of the gastroesophageal junction on the lesser curve of the stomach. Despite widespread awareness of this entity, it remains a diagnostic challenge for gastroenterologists because of its small size and hidden location. Emergency endoscopy is the most effective method of diagnosing the disease. We report a patient, with double Dieulafoy-like lesion, who was successfully treated endoscopically using hemostatic clip application. The characteristics of the Dieulafoys lesion, its current diagnosis, and its treatment are discussed.     

Effect of tumor necrosis factor-α and interferon-γ on the growth of human prostate cancer cell lines

Human recombinant tumor necrosis factor- (rTNF-, 10^-12–10^-8 M) inhibited the proliferation of androgen-dependent LNCaP cells by 32–56%. In contrast, proliferation of androgen-independent PC-3 and JCA-1 cells was only slightly inhibited, or not inhibited at all, respectively. Human recombinant interferon- (rIFN-, 500 U/ml) decreased proliferation of PC-3 and JCA-1 cells by 35% and 53%, respectively, but had no effect on LNCaP cells. Interestingly, the combination of rIFN- and TNF- had greater antiproliferative effects on JCA-1 cells than treatment with either cytokine alone. However, the antiproliferative effects of this combination were similar to those observed for PC-3 or LNCaP cells treated with rIFN- or TNF- alone, respectively. These data suggest that some forms of androgen-independent prostate cancer may benefit from a combination therapy of IFN- and TNF-, while the use of IFN- alone may be more efficacious in others.     

Scheuermann’s kyphosis: surgical management

Indications for surgery in Scheuermann disease are not well codified and remain rare, as the natural history of the disease is in most cases benign. In the immature adolescent, conservative treatment, such as bracing or casting, can be tried for moderate curves. For larger curves, or in the adult, conservative treatment is usually not effective, and surgery can be considered. Such indications are mostly cosmetic for large curves above 75°. Pain over the deformity or in the low back may represent another surgical indication, especially in the adult group. The question of anterior release or straight posterior fusion has become more of an actuality with the advent of powerful, third-generation stiff segmental instrumentation. However, the long-term results of a modern, posterior-only instrumentation fusion are not known. Concern about loss of correction, late pseudarthrosis or the need to remove instrumentation for infected hardware or due to late pain at the operative site must make us careful about choosing this method. Very rigid and large curves still require an anterior release, either done in a conventional or mini-open fashion, or through video-assisted thoracoscopic surgery. The extent of the posterior instrumentation has now been better defined. One must fuse the whole Cobb angle without hypercorrection and stop distally, above the first lordotic disc, to avoid sagittal decompensation. New approaches such as short anterior fusion with bone-on-bone techniques and pedicle substraction osteotomies have not yet been reported in the literature as having been used for treating Scheuermanns kyphosis. These should be considered experimental.     

Laparoscopic reduction of an ileoileal intussusception and resection of an inverted Meckel's diverticulum in an adult

Intussusception occurs commonly in children, but rarely is observed in adults. Whereas the hydrostatic pressure of a contrast enema often proves diagnostic as well as therapeutic in infants and children, resection usually is required for an underlying bowel pathology in older children and adults. Conventionally, the resection is accomplished at laparotomy. We report the case of a 20-year-old woman who presented with diarrhea and vomiting of 1 week duration. She was found unexpectedly to have intussusception on abdominal ultrasonography. The intussusception was laparoscopically reduced, and a segment of the middle small bowel that harbored an inverted Meckels diverticulum was resected laparoscopically, after which an intracorporeal anastomosis was fashioned. The ileus resolved on postoperative day 4, and the patient was discharged from hospital on postoperative day 5. The role of the laparoscopic approach in the management of intussusception is discussed.     

Colonic Volvulus Associated with Chilaiditi’s Syndrome: Report of a Case

Hepatodiaphragmatic interposition of the intestine, known as Chilaiditis syndrome, is a rare and often asymptomatic anomaly, typically found as an incidental radiographic sign. We report a case of Chilaiditis syndrome associated with transverse colon volvulus, predisposed by segmental agenesis of the right lobe of the liver. A 45-year-old man presented with a 2-day history of abdominal pain, nausea, vomiting, and constipation. Plain chest X-ray and abdominal computed tomography showed colonic interposition and segmental agenesis of the right lobe of the liver. Laparotomy revealed a clockwise volvulus of the transverse colon associated with interposition and incarceration of the colon through the space of the agenetic segment of the liver. The transverse colon, which was adherent to the agenetic space in the liver and diaphragm, was dissected away and repositioned, and the volvulus was reduced. To our knowledge, this is only the sixth reported case of a colonic volvulus associated with Chilaiditis syndrome and the first case associated with segmental agenesis of the right lobe of the liver.     

Benign Symmetric Lipomatosis (Madelung’s Disease): Case Reports and Current Management

Benign symmetrical lipomatosis (BSL) is a rare disorder characterized by the presence of multiple, symmetric, nonencapsulated fat masses in the face, neck, and other areas. Typically, this entity has been related to the presence of three anterior bulges in the neck. The disorder was first described by Brodie in 1846. After that, Madelung in 1888 and Launois and Bensaude in 1898 characterized the disease. There are multiple synonyms for this disorder, such as Madelungs disease, Launois–Bensaude syndrome, and multiple symmetrical lipomatosis. Benign symmetric lipomatosis is usually described in adults from 30 to 60 years old, with an incidence of about 1 in 25,000 and a male-to-female ratio of 15:1 to 30:1. Most cases have no hereditary pattern. More than 90% of the patients have associated alcoholism. The ethiology of benign symmetric lipomatosis remains unknown, but an abnormal lipogenesis induced by catecholamines has been observed. The transformation of BSL to a malignant tumor is extremely rare. In the current report, the authors describe two cases of benign symmetric lipomatosis treated in their department and a review of the literature.     

Perforation of Meckel’s Diverticulum by a Chicken Bone,a Rare Complication: Report of a Case

A perforation of Meckels diverticulum by foreign bodies is an extremely rare cause of acute abdomen in adults. We herein present a case of a 30-year-old man who was admitted due to symptoms of right lower quadrant pain, anorexia, and vomiting. An exploratory laparotomy was done, and a perforated Meckels diverticulum due to a chicken bone was found at exploration. A resection of a segment of ileum including the perforated diverticulum was performed, and the patient had an uncomplicated postoperative course.     

Vesicouterine fistula as a complication of forceps delivery: a case report

We report a case of vesicouterine fistula as a complication of forceps delivery revealed by urinary incontinence in a 68-year-old woman. Diagnosis was confirmed by examination and cystography. The treatment was a transperitoneal excision of the fistula. The literature is briefly reviewed and the treatment options are discussed.     

Primary Ewing’s sarcoma of the maxilla: a patient report

Primary Ewings sarcoma rarely arises in the facial skeleton and only occasionally in the maxilla. To date, there have been 22 cases of maxillary Ewings sarcoma reported in the English-language literature. We report a case arising in the maxilla, successfully treated by wide resection, followed by adjuvant radiotherapy and systemic chemotherapy.     

Acute low back pain as a first sign of Burkitt’s lymphoma in an HIV-positive adult patient

Burkitts lymphoma is rare in the general population [1–2% of non-Hodgkins lymphomas (NHL)]. Its prevalence in HIV-positive patients is grossly increased (35–40%) and it must always be taken into consideration for differential diagnosis. We describe the case of a 44-year-old man with acquired immune deficiency syndrome (AIDS) who came to the emergency department suffering from acute low back pain. He was treated conservatively for disc hernia, with recommendation for home therapy. A couple of weeks later, he was hospitalized for further research because of fever, night sweats, and no pain relief. After elaborate clinical and laboratory research consisting of physical examination, blood tests, CT of lungs and abdomen, and MRI of pelvis and spine followed by bone marrow biopsy, the patient was found to have Burkitts lymphoma. By recognizing the heterogeneity of AIDS-associated NHL presentation and the potential clinical overlap between malignancy, infection, and other rheumatologic abnormalities, physicians may obtain appropriate diagnostic studies and offer treatment recommendations.     

Bilateral asymmetrical Brodie’s abscess

Brodies abscess is a form of sub-acute pyogenic osteomyelitis. Most of them occur in the metaphysis and respond well to surgical curettage. We report the case of a 15-year-old boy with bilateral asymmetrical Brodies abscess of the distal tibia. On the left side, the abscess was purely metaphyseal, and on the right, it extended across the growth plate. We found that plain radiographs were unable to delineate the true anatomical extend of the lesion. MRI scans were done to aid in the pre-operative planning. We suggest that MRI is essential for the pre-operative planning of these rare lesions, as some of them can cross over to the epiphysis. We discuss the differential diagnosis and also present a review of the literature on Brodies abscess.The authors declare that this study complies with the current laws in the United Kingdom.     

Natural human IgG inhibits the production of tumor necrosis factor-α and interleukin-1α through the Fc portion

The overproduction of cytokines such as the tumor necrosis factor- (TNF-) and interleukin-1 (IL-1) may cause further deterioration in the already critical condition of patients with shock, sepsis, and acute inflammation. The effectiveness of infusion therapy of natural human IgG to such patients is suggested to depend partly upon the inhibition of the productivity of these cytokines. In this study, we investigated the modulation effects of IgG and its fragments on the production of TNF- and IL-1, on human peripheral blood mononuclear cells (PBMC). The production of TNF- and IL-1 was found to be dose-dependently inhibited by IgG when stimulated by lipopolysaccharide (LPS), phytohemagglutinin (PHA), concanavalin A (Con A), and interleukin-2 (IL-2). However, no inhibition was seen when stimulated by phorbormyristate acetate (PMA). The F(ab)₂ fragment showed enhancing effects on cytokine production by LPS, while the Fc fragment showed not as much inhibitory effect as whole intact IgG. IgG showed no direct cytotoxic effect on PBMC. These data suggest that natural human IgG inhibits TNF- and IL-1 production by PBMC through the Fc portion. The results of this study led us to conclude that whole intact IgG may be the best form of therapeutic delivery.     

Temporal Lift by Galeapexy: A Review of 270 Cases

The purpose of this technique is to correct the ptotic tail of the brow and crows feet as well as to redrape the premalar skin to allow us to make a greater skin resection in the lower lid. The purpose of this presentation is to expose the advantages, the inconveniences, and the complications of this technique. We reviewed the charts of 270 patients who were operated on between June 1996 and January 2002. The average age of the patients was 45 years old. Temporal lifts were performed during a frontotemporal lift in 92 cases, and during a three-stage lift (frontal, facial, and cervical) in 170 cases. In eight cases, an isolated temporal lift was performed. An upper blepharoplasty was performed in 252 cases and transconjunctival fat pad excision was performed in 188 cases. Finally, a lower lid skin resection was done following a galeapexy in 241 cases. The surgical approach consists of a temporal incision, followed by a subgaleal dissection, and then a subcutaneous dissection that allows the cephalic galea, previously incised, to be anchored to the temporal aponeurosis. This allows good cutaneous redraping that raises the brow tail and a detachment of the orbicularis fibers. The suturing of the scalp is done without tension and without eliminating hair. The results of the technique with a follow-up period of more than five years for the earlier cases and six months for the last cases, were evaluated with three criteria: (1) the distance between the brow and the eyelashes, (2) the reduction of crows feet, (3) the reduction of wrinkles at the level of the lower lid and the malar region. Overall satisfaction was also rated. Of 270 patients, 225 had ratings of very good to good, 13 had average results, and 13 had unsatisfactory results. As far as complications, five had unilateral hematoma requiring an evacuation, four patients had temporary alopecia, and eight patients had temporary frontal muscle weakness that resolved within one to three months. This technique, performed under local anesthesia, is very efficient, reproducible, and simple. The incidence of complications can be reduced when one is meticulous during dissection. Presented at the Congress of the European Association of Plastic Surgeons in Madrid, Spain, in May of 1999 and at the ISAPS Postgraduate Course in Beirut, Lebanon, May 2001.     

Non-contiguous multifocal spinal tuberculosis involving cervical, thoracic, lumbar and sacral segments: a case report

Main problem: There are only a few cases reported with non-contiguous spinal tuberculosis in the literature. Most of these patients have only two non-contiguous lesions, and in almost all of these cases, surgical treatment is required. Methods: A 17-year-old girl with non-contiguous multifocal spinal tuberculosis involving cervical, thoracic, thoracolumbar, lumbar and sacral segments is reported. The patient presented with systemic tuberculosis symptoms and signs, and progressive paraparesis. Results: The patient was treated with antituberculous drug therapy and was operated twice for thoracolumbar and cervical spinal lesions. She made an excellent neurological recovery. Conclusions: In the patients with non-contiguous spinal involvement, there is a high percentage of requirement of surgical treatment. This may be due to fulminant behaviour of the disease in these patients. Early surgical treatment of the cases with large abscesses and systemic tuberculosis may provide early improvement, and must probably be the first treatment modality after general support to the patient.     

“T”-osteotomy of the calcaneum

Summary The relative length and height of the lateral and medial walls of the calcaneum probably govern the production and persistence of structural hindfoot deformity, forefoot supination and adduction, and pronation and abduction. Anatomical restoration of the proportions of the calcaneal walls forms the basis of the T-osteotomy of the calcaneum. We have undertaken this operation on 72 feet in 60 patients for cavovarus deformity with forefoot adduction. The calcaneum is approached from the lateral side and the T-shaped osteotomy is performed through the body, the vertical limb being 1 to 1.5 cm behind and parallel to the calcaneo-cuboid joint. The horizontal limb starts from the centre of the vertical cut and ends above the attachment of the tendo achillis. The postero-inferior segment is pushed out correcting the heel varus and at the same time broadening the heel. The forefoot is manipulated downwards and outwards to correct the residual cavus and the adduction and supination of the forefoot. The over-all results, with an average follow-up of 3.7 years, have been satisfactory.Paper presented at Kyoto, Japan, during the XIVth World Congress of SICOT on October 17, 1978