Fracture of the coracoid process of the scapula

Four cases of fracture of the coracoid process of the scapula are reported. Different mechanisms of injury resulted in different types of fracture. In the first case the injury resulted from a direct fall on the involved shoulder and the fracture was through the base of the coracoid. In the second case the fall was on the elbow and the fracture was of the avulsion type, at the tip of the coracoid and indirect in type. In the third case the fractured coracoid process was associated with fracture of the acromion and in the fourth case it was associated with a fracture of the clavicle, both combinations not previously reported. The importance of recently developed radiographic techniques is stressed. Conservative treatment appears to be suitable in most of the acute cases.     

Intraosseous Lipoma of the Calcaneus: Report of a Case and Review of the Literature

Intraosseous lipoma is a rare, benign primary tumor occurring in bone. In the present report, a case of an intraosseous lipoma of the calcaneus is presented, together with a focused review of published studies. Radiographically, the lesions will appear osteolytic and well delineated, displaying a central area of calcification. Curettage and packing with autogenous bone grafts was our treatment for this rare tumor. In the present case, and 1 previously published case, a central sclerotic mass was observed. The histologic findings were typical, with mature adipose tissue mixed with a few degenerated bone trabeculae.     

Strategy of the surgical treatment of primary tumors of the spine

The surgical treatment of the primary spinal tumors is started after the analysis of the following data: --location of the tumor, --pathological identification after the biopsy examination, --staging of the lesion according to Enneking. In case of benign tumors it is possible to realize: a total resection by morcellement until healthy margins in case of chondroma or osteochondroma, intralesional excision until healthy borders in case of osteoid osteoma, total excision by partial anterior or posterior vertebrectomy (with previously embolization) according to the location (body or neural arch resection) in case of giant cells tumour or aneurysmal bone cyst. In case of malignant tumors, the total resection is an absolute goal when the feasability occurs (total vertebrectomy), in case of chordoma, chondrosarcoma and malignant giant cells tumours; the stabilization surgery is indicated without attempt of total tumor removal because others means are availables and/or accurates (radio and/or chemotherapy) in cases of Ewing's sarcoma, plasmocytoma and lymphoma.     

Lymphangioma of the stomach--report of a case and review of the literature

A rare case of a 66 year old man with lymphangioma of the stomach is presented herein. Upper gastrointestinal X-ray series revealed a slow growing submucosal tumor in the anterior wall of the antrum of the stomach which was subsequently found to be lymphangioma after a partial gastrectomy. To our knowledge, this is only the thirteenth case of lymphangioma of the stomach to have been reported in the English literature. A brief review of the English and Japanese literature is presented following the case report.     

Atypical coarctation of the thoracic aorta with fibromuscular dysplasia--report of a successful surgical repair and review of the literature

We report a case of 14-year-old woman of fibromuscular dysplasia (FMD) with involvement of the thoracic aorta. Our case is characterized by a segmental stenosis of the thoracic aorta with multiple systemic arterial branch lesions. Atypical coarctation of the thoracic aorta was replaced with Dacron woven graft and the specimen of the lesion demonstrated medial fibroplasia. There have been reported only 9 cases of FMD of the aorta so far and all were female except one case. This report is the first case report of FMD of the thoracic aorta.     

Primary adenocarcinoma of the epididymis: the therapeutic role of retroperitoneal lymphadenectomy

Aims

This case report describes a rare case of adenocarcinoma of the epididymis and the role of locoregional surgery in the therapeutic algorithm.

Clinical case

We report a case of primary adenocarcinoma of the epididymis in a 61-year-old man who was primarily examined for nodular enlargement of the head of the epididymis. Retroperitoneal lymphadenectomy which the patient underwent after radical orchiectomy revealed lymph node metastases, subsequently he received adjuvant chemotherapy. The patient remains free of disease for 20?months after surgery.

Conclusions

Primary adenocarcinoma of epididymis is a rare finding with an unfavorable prognosis in higher stages as it responds poorly to radiotherapy and chemotherapy. Our case report confirms the importance of retroperitoneal lymphadenectomy in patients with local or locoregional disease. It may be curative even in case of proven lymphadenopathy and should be performed in all patients without distant metastases.     

Benign peptic stricture of the middle third of the esophagus

By means of a case report classification, etiology and pathogenesis of benign esophageal strictures are discussed. In the presented case an endobrachyesophagus with peptic stricture of the middle third of the esophagus was found. The most common conservative treatment consists of esophageal bouginage combined with long-term medication of proton pump inhibitors as was also done in this case. Depending on the physical status of the patient surgical treatment is given if repeated bouginage of the stricture during at least 3 months becomes necessary. Resection of the stricture or antireflux surgery in combination with bouginage of the stricture are current surgical options.     

Hemangiosarcoma of the breast.

This report of the case of a 37-year-old woman with hemangiosarcoma of the breast it is the first such case to be described in the Canadian literature. It is emphasized that lack of familiarity with the lesion is the main reason for its frequent misdiagnosis. This case is unusual in that the patient is alive and well 7 years after her initial operation.     

Plexiform angiomyxoid myofibroblastic tumor of the stomach

We report 2 cases of plexiform angiomyxoid myofibroblastic tumor of the stomach, a tumor entity that has not been described previously. The patients were a 50-year-old man (case 1) and a 68-year-old man (case 2). In case 1, the patient presented with acute abdominal pain. The tumor in case 2 was incidentally found at laparoscopic cholecystectomy. Grossly, the tumors were 4.0 cm (case 1) and 4.5 cm (case 2) in their greatest dimension, and they were recognized as submucosal tumors. The tumor caused gastric perforation in case 1. Histologically, the tumors extended from the serosa to the submucosa of the gastric wall, showing a plexiform growth pattern. Bland spindle tumor cells were observed, and they were separated by abundant intercellular myxoid matrix. The stroma was rich in small vessels. Immunohistochemically, the tumor cells were positive for alpha-smooth muscle actin and muscle actin, and negative for KIT, CD34, and S-100 protein. Electron microscopic findings were consistent with the myofibroblastic nature of the tumor cells. No mutations were found in the c-kit and platelet-derived growth factor receptor alpha genes. Although clinical follow-up data were insufficient, the histologic appearances suggested the benign nature of the tumors. However, the tumor in case 1 caused gastric perforation and necessitated an emergency operation.     

Bilateral transection of the vas deferens: an unusual trauma from a cross stab injury of the scrotum

An unusual case of division of both vas deferens in a patient with a cross stab injury to the root of scrotum is described. The management of this case in the emergency setting is discussed. The case illustrates the need to explore every case of penetrating trauma to the scrotum, even in the absence of active bleeding, to avoid missing such injuries. These injuries, although not life-threatening, can have a profound impact on the patient's future fertility and this may only manifest several years after the injury.     

腹腔镜阑尾切除术后再手术原因分析

目的 分析腹腔镜阑尾炎手术后再手术的原因,探讨腹腔镜阑尾炎手术中应注意的事项.方法 2003年5月~2013年3月,发生11例腹腔镜阑尾切除术后再手术.急性阑尾炎10例,慢性阑尾炎1例.再手术原因：腹腔脓肿4例,回盲部肿瘤1例,腹腔大出血并休克1例,腹膜后血肿1例,小肠漏1例,肠粘连1例,盆腔炎1例,胰腺炎1例.经保守治疗无效,8例行腹腔镜探查,3例开腹探查.结果 二次手术均成功.腹腔脓肿4例行腹腔镜脓肿清洗引流,腹腔大出血并休克1例行腹腔镜探查腹壁下动脉结扎,肠粘连1例行腹腔镜探查粘连带松解,盆腔炎1例行腹腔镜盆腔冲洗引流＋抗感染治疗,胰腺炎1例行腹腔镜胰腺被膜打开胰腺周围置管引流;小肠漏1例行腹腔镜探查＋开腹小肠肠管部分切除吻合术,腹膜后血肿1例行开腹探查阑尾动脉结扎,回盲部肿瘤1例行开腹右半结肠切除术（病理高分化腺癌）.术后7~21天痊愈出院.结论 腹腔镜下阑尾切除术后再手术的原因为：术前术中漏诊、误诊;术中脓液清洗不彻底,术后引流不通畅致腹腔脓肿形成;术中操作不规范,致腹壁下血管、阑尾动脉出血.腹腔镜阑尾切除术应注意规范操作,术中应探查仔细,防止漏诊、误诊.     

Giant coronary sinus and a review of the literature

We report a case of persistent left superior caval vein whom presented with angina pectoris and exertional dyspnea. Echocardiography showed wall motion disturbances with an ejection fraction of 40% and a very large coronary sinus. Our case is a very rare case with a very large coronary sinus presented with angina pectoris.     

Primary carcinoma of the cystic duct: a case report and review of the literature

The Authors, after a short introduction concerning the primary carcinoma of the cystic duct and the exact definition according to Farrar's criteria, report a case occurred to their observation, the 35th case of international literature. In particular the importance of some hemato-clinical parameters and instrumental investigation (ERCP, angio-CT) to underlined in order to surgical indication. In the case here reported cholecystectomy uses informed with partial resection of the hepato-choledochus and excision of some periductal and pericholedochus lymph nodes. Finally, the Authors discuss about clinical data and diagnostic and therapeutic trends, on the case of their experience and literature review.     

Entrapment neuropathy of the median nerve at the level of the ligament of Struthers

The presence of a supracondylar process and Struthers' ligament is a rare congenital anomaly that may cause compression of either the median nerve, the brachial artery, or both. The authors present a case in which the supracondylar process and Struthers' ligament compressed both the median nerve and the brachial artery. This case is unusual, in that the symptoms of compression of the brachial artery increased--namely, the pulse intensity decreased and the pain increased with elbow flexion.     

A case of intradural osteosarcoma of the spine

Background contextIntradural-extramedullary spinal tumors and extradural osteosarcomas are both rare entities. Only one case of primary intradural-extramedullary osteosarcoma of the spine has been previously reported. This is the second reported case.PurposeTo describe a case of primary intradural-extramedullary osteosarcoma of the spine associated with rapid clinical deterioration.Study designCase report of a 70-year-old woman who presented with a constellation of neurologic symptoms.MethodsReview of patient files, radiographic studies, surgical images, histopathology, and relevant literature.ResultsThe patient underwent tumor debulking but exhibited rapid, postsurgical, functional deterioration and died within 6 weeks. This case and the only previous case of its kind both occurred in individuals with a remote history of iophendylate (Myodil) myelogram.ConclusionsPrimary intradural-extramedullary extraosseous osteosarcoma of the spine is an exceedingly rare entity with no established management approach. Iophendylate myelography may be implicated in the etiology of this tumor type.     

Macrodactyly of the foot associated with plexiform neurofibroma of the medial plantar nerve

A case of macrodactyly of the foot associated with plexiform neurofibroma of the digital branches of the medial plantar nerve is reported. The purpose of this article is to investigate the nature of the association of the rare localization of macrodactyly with a pathognomonic feature of von Recklinghausen disease. The case was approached by semiconservative surgical treatment. Two-year follow-up has shown no relapse of the deformity. These facts suggest that this case of macrodactyly was sustained by an underlying disorder, namely, a "forme fruste" of neurofibromatosis, implying the existence of a still unknown pathogenetic mechanism.     

Lymphangioma of the stomach —Report of a case and review of the literature—

A rare case of a 66 year old man with lymphangioma of the stomach is presented herein. Upper gastrointestinal X-ray series revealed a slow growing submucosal tumor in the anterior wall of the antrum of the stomach which was subsequently found to be lymphangioma after a partial gastrectomy. To our knowledge, this is only the thirteenth case of lymphangioma of the stomach to have been reported in the English literature. A brief review of the English and Japanese literature is presented following the case report.     

Acute occlusion of the iliac arteries due to blunt trauma

Two cases of acute iliac occlusion due to blunt trauma are presented. The cause of injuries were a fall from bicycle in case 1 and a compression between an automobile and a wall in case 2. The end-to-end anastomosis was possible in case 2, but an interposition of an artificial prosthesis was necessary because of the length of damaged artery in case 1. Both cases were associated with the pelvic fracture, adding the perforation of small bowels and the bladder in case 2. Postoperative course was almost uneventful except fasciotomy was needed for the compartment syndrome of the right lower extremity in case 2.     

Leiomyosarcoma of the anal canal: case report and review of the literature

A rare case of a leiomyosarcoma of the anal canal is presented. A 68-year-old male presented with painful defecation and rectal bleeding. Endorectal ultrasound revealed a mass invading both sphincters (T4 lesion), and extending 6 cm into the anal canal. Colonoscopy revealed an ulcerated area in the anal canal, of which biopsies revealed high-grade leiomyosarcoma--only the eighteenth such case at the time of this submission. The details of the case and teaching images are presented in detail, as is a comprehensive review of the relevant literature.