Genital incarceration: an unusual case report

Incarceration or strangulation of the penis is a rare clinical situation that requires emergent urologic management to prevent potentially devastating outcomes. Many different techniques have been described in the literature to remove genital foreign objects, but there is no universally successful technique. We present an unusual and challenging case involving incarceration of both the penis and scrotum by multiple metallic rings that required operative removal using an orthopedic high-speed drill.     

Peroneal nerve lesion after sural nerve graft harvest: an unusual complication--case report

After harvesting of the sural nerve, the patient developed a partial palsy of the common peroneal nerve due to a lesion of the peroneal nerve and a neuroma of the sural nerve stump. Motor function recovered after performing neurolysis of the common peroneal nerve and mobilization of the neuroma. The sural nerve, in this case originating from the common peroneal nerve, was harvested using a nerve stripper and four small skin incisions. Direct lesion by the forced use of the nerve-stripping instrument followed by the formation of a neuroma close to the peroneal nerve are the suspected reasons for motor dysfunction. Although many authors report using a nerve stripper as a safe, less invasive method to gain nerve material for transplantation, we recommend lengthening the skin incision so as to be aware of anatomical variations and to refrain from pulling the nerve distally to avoid the described complications.     

Left ventricular--right atrial shunt: an unusual cause of hemodynamic deterioration following aortic valve surgery.

Two cases of left ventricular-right atrial shunts inadvertently produced during aortic valve replacement are described. It is surprising that this complication is not more prevalent considering the close proximity of the aortic and mitral valves to the atrioventricular portion of the membranous septum. A left-to-right shunt should be a consideration in patients who fail to improve following aortic valve surgery, especially if the valve and subaortic region were heavily calcified or septal trauma occurred during the surgical procedure.     

The modified polytetrafluoroethylene Blalock-Taussig shunt: case report of an unusual complication

A case of excessive serous leak through a modified polytetrafluoroethylene Blalock-Taussig shunt is presented. This relatively rare complication was treated successfully with fibrin glue and collagen fleece.     

Splenic laceration: an unusual complication of ventriculoperitoneal shunt

Ventriculoperitoneal shunt is a commonly performed procedure. Associated complications have been well described in the literature. This is the first case report of a splenic laceration caused by the distal catheter looping around the spleen, requiring a splenectomy. Careful study of pre-operative imaging is recommended in cases where intraabdominal injury is suspected.     

Experience with a programmable valve shunt system.

OBJECT: The goal of this study was to clarify the efficacy of the Codman Hakim programmable valve. Clinical data obtained in 179 patients with hydrocephalus or other intracranial fluid-accumulating diseases were analyzed. METHODS: Shunt placement operations were effective in 168 patients, approximately one half (50.6%) of whose devices required reprogramming of opening pressure postoperatively. This was a significantly larger number of shunts than the authors had thought would need reprogramming. Extremely narrowed ventricles observed on computerized tomography scans, as well as clinical symptoms related to inadequate or excessive cerebrospinal fluid drainage, improved in patients after shunt reprogramming. Shunt reprogramming frequently was necessary in patients with posthemorrhagic acute hydrocephalus; the programmable valve proved particularly beneficial for such patients. Subdural effusion and arachnoid cyst also proved to be good indications for use of the valve. Twelve patients (7%) suffered complications postoperatively. The most common complication was valve obstruction, which occurred in five patients, most of whom had brain tumors. CONCLUSIONS: The programmable valve was beneficial for the treatment of hydrocephalus and other intracranial fluid-accumulating diseases. It is important to be careful in selecting patients for treatment with the programmable valve, because complications involving the valve seem more likely in brain tumor cases. The valve proved to be poorly resistant to magnetic fields; therefore, it is essential to confirm opening pressure after every magnetic resonance imaging examination. The authors recommend that an identification system for patients be developed so that medical personnel will be aware of the presence of the valve and the previous setting of opening pressure.     

Tricuspid valve papillary fibroelastoma: an unusual cause of intermittent dyspnea.

A 67-year-old woman was referred for investigation of intermittent dyspnea, which was known for years but had been worsening over the previous 3 months. Two-dimensional echocardiography revealed the presence of a mass attached to the anterior leaflet of the tricuspid valve. The patient was successfully operated on to excise the right atrial mass and preserve the tricuspid apparatus. Morphological examination of the excised tissue led to the diagnosis of papillary fibroelastoma. Surgical treatment should be considered when such a tumor is diagnosed, even in asymptomatic patients, because of the possible risk of embolization.     

Intrapontomesencephalic colloid cyst: an unusual location. Case report

Colloid cysts appear most commonly in the third ventricle; the occurrence of a colloid cyst in the brainstem is very unusual. The authors report on a patient with an intrapontomesencephalic colloid cyst. This 15-year-old girl complained of a headache associated with diplopia. Her neurological examination revealed right-sided sixth nerve paresis and a mild left hemiparesis. Radiological investigations revealed an intraparenchymal pontomesencephalic cystic mass. Surgical removal of the lesion was achieved via the pterional transsylvian approach and the patient experienced an excellent recovery. Histopathological examination revealed that the lesion was a typical colloid cyst. To the best of the authors' knowledge, this is the first case in which an intraparenchymal upper brainstem colloid cyst was surgically excised totally. In addition to describing this case, the authors also review other brainstem neuroepithelial cysts described in the literature and briefly discuss the concept of their origin.     

Ankle dislocation without fracture: an unusual case report.

Complete dislocation of the ankle joint without associated fracture is considered a rare injury. Few cases are reported in the literature. A case report is presented, and a review of the etiological factors and treatment principles are discussed.