Angioleiomyoma of the extremities — report of a recurrence at the heel

Summary Angioleiomyoma, or vascular leiomyoma, is a rare, benign, smooth muscle tumor, originated in the tunica media of veins. It is predominantly found as a solitary painful or tender intracutaneous or subcutaneous nodule, on the anterior aspect of the leg, especially in middle aged women. It should be included in the differential diagnosis of subcutaneous masses of the extremities. A case of recurrence at the right heel is described. The recurrence of this tumor is unusual, and it should be treated as a low-grade malignancy and excised widely rather than be shelled out.     

An objective sign of the presence of a dislocation of the peroneal tendon?

If being necessary to diagnose a rupture of the external ligaments of the ankle joint one must produce special "forced" X-rays of both ankle joints in the ap-direction in the apperature of "Scheuba". In these X-rays we found a sign , typical for the luxation of the peronaeus tendons: The rims of the ankle joint are not dislarged in the external areas but they show a significant dislargement of the distance between the malleolus externus and the processus subfibularis tali on the hurt side - the range is always more than 10 mm and in significant difference to the sane side, were we found this difference never more than 10 mm. The new objektive significant sign for the luxation of the peronaeus tendons is described and a comparison to X-rays of some persons is demonstrated.     

Phlebotomy: a treatment of ischaemic necrosis of the femoral head? Analysis of a hypothesis

The treatment of non-traumatic ischaemic osteonecrosis of the femoral head (ONFH) remains problematical and there is evidently scope to seek for a medical treatment of this disease which often leads to a surgical procedure for hip prosthesis. If we exclude the context of hemoglobin disorders, necrosis appears mainly in adults, when their limb bones contain a fatty marrow. Investigations such as intramedullary pressure measurement and transosseous phlebography suggest a disorder of the intraosseous blood circulation. Various studies in animals and man have provided arguments indicating that a kind of intraosseous 'obesity' due to hyperplasia and/or hypertrophy of the fatty tissue of the femoral marrow play a role in the development of necrosis. In this respect, the blood flow of the yellow marrow is close to ischemia, whereas red marrow flow can be very high. In various conditions, mainly hemolytic anemias, the femoral yellow marrow can convert to red marrow, which has also been described in anemias induced by blood loss. If it is not thought unreasonable to consider ONFH an 'ischemic' disease, these observations are an encouragement to attempt treatment by repeated phlebotomies. This procedure may locally restore red marrow, and then an adequate blood flow which could stabilize or even reverse the lesions if they are diagnosed early.     

The absence of a metal-on-metal bearing does not preclude the formation of a destructive pseudotumor in the hip—a case report

4 patients with a mean age of 20 years and isolated congenital radial head dislocation (1 unilateral anterior, 1 unilateral posterior and 2 bilateral anterior dislocations) were all pain-free and had almost normal elbow function.     

Are bone bruises a possible cause of osteochondritis dissecans of the capitellum? a case report and review of the literature

A 17-year old soccer-player sustained a fracture and dislocation of the ulnar epicondyle combined with a bone bruises at the radial head and the capitellum. An open reduction and internal fixation was performed using two K-wires. Initial recovery was uneventful. After the operation he was discharged home and reviewed on a regular basis. When bony union had occurred the two K-wires were removed. However, on follow up he continued to complain of pain on the radial aspect of the joint and did not regain his normal range of movement. A further MRI was performed. Now a grade II osteochondritis dissecans not visible on the previous MRI taken 12 weeks earlier was clearly visualised. Treatment was continued conservatively with physiotherapy but avoiding aggressive mobilisation. On final review 6 months later he was able to move painfree with residual limitation of movement (ROM 0–5–130°). Another MRI taken now was assessed as normal.This study was carried out at the Dept of MRI, Klinik für Radiologische Diagnostik, Klinikum Saarbrücken, Winterberg 1, D- 66119 Saarbrücken.     

Diagnosis of neurinoma in the region of the jugular foramen — a case report

Neurinomas in the region of the jugular foramen are extremely rare, are difficult to diagnose before surgery, and have seldom been described in the literature. The typical jugular foramen syndromes (Collet-Sicard syndrome, Vernet's paralysis) may be caused by many various disorders. The diagnostic problems are illustrated using one of our cases as an example. The differential diagnosis was made before surgery using currently available radiologic techniques. The tentative diagnosis neurinoma of the hypoglossal nerve was confirmed intraoperatively and histologically.     

Is a fracture of the transverse process of L5 a predictor of pelvic fracture instability?

In the management of a pelvic fracture prompt recognition of an unstable fracture pattern is important in reducing mortality and morbidity. It is believed that a fracture of the transverse process of L5 is a predictor of pelvic fracture instability. However, there is little evidence in the literature to support this view. The aim of this study was to determine whether a fracture of the transverse process of L5 is a reliable predictor of pelvic fracture instability. We reviewed our hospital trauma database and identified 80 patients who sustained a pelvic fracture between 2006 and 2010. There were 32 women and 48 men with a mean age of 40 years (10 to 96). Most patients were injured in a road traffic accident or as a result of a fall from a height. A total of 41 patients (51%) had associated injuries. The pelvic fractures were categorised according to the Burgess and Young classification. There were 45 stable and 35 unstable fractures. An associated fracture of the transverse process of L5 was present in 17 patients; 14 (40%) of whom had an unstable fracture pattern. The odds ratio for an unstable fracture of the pelvis in the presence of a fracture of the transverse process of L5 was 9.3 and the relative risk was 2.5. A fracture of the transverse process of L5 in the presence of a pelvic fracture is associated with an increased risk of instability of the pelvic fracture. Its presence should alert the attending staff to this possibility.     

Can the practice of yoga be dangerous? Considerations over a case of epiphyseal separation of the distal tibia in a teenager

Abstract We describe a fractureseparation of the epiphyseal plate of the distal tibia (Salter-Harris type III, or juvenile fracture of Tillaux) in a 15-year-old girl. The case is of interest, above all, in that the trauma occurred during the execution of a yoga posture. The literature does not speak of complications or traumatic consequences of this type of activity. Analyzing the biomechanics of the traumatic event, it appears that even a physical exercise characterized by slow and gradual movements can cause severe damage, such as the injury described.     

Is there a role of a small dose of propofol in the treatment of laryngeal spasm?

BACKGROUND: Propofol has been found to depress the laryngeal reflexes. We studied whether this property could be utilized to relieve laryngeal spasm. METHODS: This study was conducted over a period of 3 years, and included children aged 3-10 years, ASA status I and II. Most of the children were undergoing minor surgical procedures, under general anaesthesia with Laryngeal Mask Airway (LMA trade mark ) and caudal epidural analgesia. RESULTS: During this period, 20 patients developed laryngeal spasm on removal of the LMA at the end of surgery. Initially, they all were treated with 100% O2, with gentle positive pressure ventilation. Out of 20 patients, seven responded well with 100% O2 and gentle positive pressure ventilation. The remaining 13 were treated with a small dose of propofol (0.8 mg.kg-1 body weight). Laryngeal spasm was relieved successfully in 10 patients and three patients required intubation to improve their oxygenation. CONCLUSIONS: Propofol in a small dose (0.8 mg.kg-1 body weight) was a useful drug to relieve laryngeal spasm in most children (76.9%) following the removal of the LMA. Because it was not found to be effective in all patients, succinylcholine still has a role to play in critical conditions. However, we recommend propofol as a suitable alternative for relieving laryngeal spasm in situations where succinylcholine is contraindicated.