Intestinal lymphangiectasia — a report of two cases

Intestinal lymphangiectasia is a rare benign disease characterised by focal or diffuse dilation of the mucosal, submucosal and subserosal lymphatics. Clinically, the patients may present with protein losing enteropathy (PLE), hypoproteinemic oedema, chylous ascites, pleural effusion, acute appendicitis and intestinal obstruction.     

Partner dyspareunia—a report of six cases

One of the rarely cited complications of the use of alloplastic materials in pelvic floor surgery is dyspareunia of the partner caused by prominence or vaginal exposure of the sling material. Even though this entity is real and an important problem, it is rarely reported in literature. We report six cases of partner dyspareunia, in which there were two incidences of partner penile injury, occurring as a complication of synthetic midurethral sling surgery. There were three tension-free vaginal tapes, two transobturator tapes and one anterior intravaginal sling in the series. Time interval between tape insertion and the presentation of complications ranged from 3 to 48 months. Vaginal exposure was seen in five of the six cases and in one patient prominence of sling material without exposure was noted. Recognizing partner dyspareunia as an important complication of the vaginal use of alloplastic prosthesis is not only important in preoperative counseling of patients but also to avoid legal implications.     

Spinal epidural abscess — a report of six cases

 Six cases of spinal epidural abscess are presented. All patients were young with no predisposing conditions. All were treated with laminectomy and intravenous antibiotics. The patients with no neurological deficit recovered completely, while patients with pre-existing neurological deficit had a poorer outcome. Emphasis is given to early detection and surgical management to prevent irreversible damage to the spinal cord.

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Résumé  6 cas d’abces épiduraux sont présentés. Tous les patients étaient jeunes et sans facteur prédisposant. Tous les patients ont été traites par laminectomie et antibiotiques injectables. Les cas sans déficit neurologique ont guéri sans séquelle, alors que la récupération des cas avec déficit neurologique a été moins bonne. L’accent est mis sur la détection et le traitement chirurgical pour prévenir les lésions irréversibles de la moelle épinière.

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Accepted: 7 February 1999     

Ruptured intrameatal AICA aneurysms—a report of two cases and review of the literature

Background  

Aneurysms of the distal part of the anterior–inferior cerebellar artery (AICA) are rare. Most are located in the cerebellopontine angle close to the internal auditory meatus. To our knowledge, only 13 patients with the aneurysm located inside the internal auditory meatus have been reported in the literature.     

Distal femoral shortening osteotomy for treatment of sciatic nerve palsy after total hip arthroplasty — a report of 3 cases

Background and purpose Minimally invasive surgery (MIS) for hip replacement is thought to minimize soft tissue damage. We determined the damage caused by 4 different MIS approaches as compared to a conventional lateral transgluteal approach.

Methods 5 surgeons each performed a total hip arthroplasty on 5 fresh frozen cadaver hips, using either a MIS anterior, MIS anterolateral, MIS 2-incision, MIS posterior, or lateral transgluteal approach. Postoperatively, the hips were dissected and muscle damage color-stained. We measured proportional muscle damage relative to the midsubstance cross-sectional surface area (MCSA) using computerized color detection. The integrity of external rotator muscles, nerves, and ligaments was assessed by direct observation.

Results None of the other MIS approaches resulted in less gluteus medius muscle damage than the lateral transgluteal approach. However, the MIS anterior approach completely preserved the gluteus medius muscle in 4 cases while partial damage occurred in 1 case. Furthermore, the superior gluteal nerve was transected in 4 cases after a MIS anterolateral approach and in 1 after the lateral transgluteal approach. The lateral femoral cutaneous nerve was transected once after both the MIS anterior approach and the MIS 2-incision approach.

Interpretation The MIS anterior approach may preserve the gluteus medius muscle during total hip arthroplasty, but with a risk of damaging the lateral femoral cutaneous nerve.     

Are the long term results of a high-flex total knee replacement affected by the range of flexion?

Purpose

The purpose of this study was to examine the effect of deep flexion on the long-term durability of a high-flex ceramic implant in total knee arthroplasty.

Methods

Five hundred and five consecutive knees replaced with a Bi-Surface knee system (Kyocera Medical, Osaka, Japan) were divided into two groups according to the range of flexion by 135° postoperatively. Comparison of implant durability was made between the high- and low-flexion groups after a minimum ten year follow-up.

Results

With revision for any surgery as the end point, the survival rates at ten years were 95.5 % and 96.2 % in the high- and low-flexion group, respectively (p = 0.63). With revision for mechanical failure as the end point, survival rates were 98.7 % and 98.5 %, respectively (p = 0.94).

Conclusion

Implant survival rate was similar for both groups. Deep flexion seemed not to affect long-term durability.     

Premature ovarian failure and oocyte donation──a report of 30 cases

IntroductionPrematureovarianfailure(POF)isacon-ditioncharacterizedtypifedbyamenorrhea,hypoestrogeniSm(E,wt1OOpmol/L)andele-vatedgonadotrophins(FSH>4OIU/L).Itisdefinedasnormoprolactinaemicamenorrhoeaof6monthsormore,apersistentlylowplas-rnaoestradiol(r1OOpmol/L)andanelevatedplasmafolliclestimulatinghormone(>4oIU/L)inawomenunder4OyearsofageL'j.inwomenyoungerthan4OyearsL'j.Thisre-sultinmenopausalsymptoms,reproductiveorganatrophyandinevitabIyinfertility.Hor-moneanalysisshowsfollicle-stim…     

Bladder paraganglioma — A report of two cases

Introduction

Bladder paragangliomas (BP) are rare tumors, with clinical manifestations ranging from hypertension to hematuria to being asymptomatic. Histologically, they can mimic urothelial carcinomas. Around 200 cases of paragangliomas arising in the urinary bladder have been described in the world literature.

Incisional hernia from iliac bone grafting site — a report of two cases

Incisional hernia is a fairly common problem in India, although there is a paucity of data from the region. The commonly implicated operations in the aetiology of incisional hernia in our setup are lower segment cesarean sections and surgery for peritonitis. Incisional hernia following iliac bone grafting is rare, despite the frequency of performance of the procedure. Two patients with incisional hernia arising from the donor site of iliac bone grafting were seen in our department over the last year. They underwent mesh hernioplasty using polypropylene mesh that was placed as an onlay. Both the patients are presently well on follow-up, with no recurrence of the hernia. Mesh hernioplasty of hernia following iliac bone grafting gives good results and may be considered the method of choice of repair of this uncommon type of hernia.     

Rostral basilar artery syndrome following transsphenoidal surgery—a report of four cases

Vascular complications can arise from transsphenoidal surgery (TSS) and have a high incidence of mortality and serious morbidity. Though haemorrhage from the injury to internal carotid is well know, ischaemic complication after TSS is rare. We report a series of four patients who remained unconscious after TSS, and on postoperative imaging infarcts were seen distributed in the rostral basilar artery. The possible mechanism of this complication is described.     

Carcinosarcoma of esophagus—a case report and review of literature

Carcinosarcoma of esophagus contains both the carcinomatous and sarcomatous elements. These are rare polypoidal malignancies of esophagus. One such case is presented and available literature is reviewed.     

Carcinoma of urachus: report of 15 cases and review of literature--is total cystectomy the treatment of choice for urachal carcinoma?

PURPOSE: This study was undertaken to determine the most appropriate type of operation for the improvement of the radical cure rate and QOL of patients with urachal cancer. We assessed the association between the stage, type of operation, and prognosis of cases we experienced and those reported in Japan. PATIENTS AND METHOD: The subjects included 15 cases of urachal cancer we have experienced in the past 14 years. While clarifying the clinical patterns of these cases, the association between stage, type of operation, and prognosis was studied. Of the cases of urachal cancer reported in Japan in the recent 20 years, 75 cases in which the stage, type of operation, and prognosis were documented were selected, and the association between the stage and outcome in each type of operation was studied. RESULTS: In regard to stage, all the cases were rated as more than IIIA. As for prognosis, 9 cases (60%) are alive without cancer at the present time with a mean survival time of 7 years. Of the above patients, 3 underwent cystectomy and 6 underwent en bloc segmental resection (herein after referred to en bloc). Recurrence or cancer death was experienced in 5 patients, 2 of which were classified as stage IIIA and 3 as IIID. Of these patients, one underwent en bloc, 3 partial resection of the bladder, and one underwent exploratory laparotomy. As far as our study of the cases reported in Japan is concerned, the prognosis of the cases having undergone only partial resection of the bladder was poor, while of the cases having undergone en bloc or total cystectomy 88-100% were alive without cancer for more than 2 years if their stage was classified as IIIA or below. On the other hand, prognosis was very poor whatever the type of operation in the cases whose cancer was stage IIIC or above. CONCLUSIONS: It appears that the en bloc is most appropriate as the type of operation for the cases of urachal cancer and that the application of total cystectomy is limited to some cases. In performing the en bloc, an extensive resection of the peritoneum, resection of the posterior sheath of the rectus muscle of the abdomen, and dissection of the intrapelvic lymph nodes in addition to the conventional types of operation should be carried out positively.