Brown-Séquard-plus syndrome due to stab injury: a case report

STUDY DESIGN: Case report. OBJECTIVE: To describe the mechanism of injury in this case and its clinical features. Magnetic resonance (MR) images of hemorrhage in spinal cord injury due to stab wound are discussed. METHODS: We describe the case of a 21-year-old woman who was stabbed in the right side of her neck and developed left-sided Brown-Séquard syndrome plus loss of bilateral proprioceptive sensation. Neither plain radiographs nor computed tomography of the cervical spine demonstrated any foreign bodies or fractures of the cervical spine. T2-weighted cervical MR images confirm spinal cord hemiresection at C5-C6. RESULTS: MR imaging was performed serially at 4 days, 4 weeks, and 8 weeks after trauma. The signal pattern of the spinal cord at the site of injury varied iso, iso, and low on T1-weighted consecutive images. Meanwhile, high signal intensity on T2-weighted images was consistent during the 8 weeks after incidence of trauma. A T2-weighted sagittal image showed a tiny spot of low intensity in the high signal band at the site of penetration, demonstrating hemosiderin formation in the spinal cord. The patient was treated conservatively and, recovered from Frankel grade C to grade D. CONCLUSION: Spinal cord injuries (SCI) following stab wounds are rare. MR imaging is definitely useful for recording and monitoring the pathology of SCI.     

Cobalt-chromium head wear following revision hip arthroplasty performed after ceramic fracture—a case report

Out of 46 tibial shaft fractures treated by the AO method 42 healed primarily and four had delayed union. Otherwise no serious complications were encountered.     

Vault prolapse of sigmoid neovagina 26 years after vaginoplasty in Mayer-Rokitansky-Küster-Hauser syndrome: a case report

Various operative methods have been devised to create a neovagina for patients with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. Sigmoid vaginoplasty, a common modality for vaginal reconstruction, is believed to have satisfactory long-term anatomical and functional results. We herein report a patient with MRKH syndrome and vault prolapse of a sigmoid neovagina 26 years after vaginoplasty. Biopsies from the neovagina revealed colonic mucosa. Bilateral iliococcygeus fascia fixation of the neovaginal vault was performed vaginally. The patient had a low Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 (PISQ-12) score preoperatively, which further decreased postoperatively. Therefore, the surgery failed to achieve a good functional result. No recurrence of the prolapse was observed 2 years postoperatively.     

Metal-on-metal hip resurfacing compared with total hip arthroplasty: two to five year outcomes in men younger than sixty five years

Purpose

There are limited studies examining the long-term survivorship for the current generation of metal-on-metal hip resurfacing (MOMHR) implants in the young male population, and fewer studies have been published on prospectively collected outcomes data for total hip resurfacing in the USA. The purpose of this study was to demonstrate the efficacy of MOMHR in comparison with total hip arthroplasty (THA) using validated outcome measures, survivorship and complication rates.

Methods

The study prospectively followed 136 implants in 123 male patients <65 years, all with a primary diagnosis of osteoarthritis and similar comorbidities as determined by the American Society of Anesthesiologists (ASA) score. A single-surgeon cohort of 89 MOMHRs was compared with a similar cohort of 47 THAs. Outcomes were prospectively assessed with the Short-Form Health Survey of 12 questions (SF-12) and Western Ontario and McMaster Universities (WOMAC) questionnaires pre- and postoperatively at yearly intervals. Minimum follow-up was two years, and average follow-up was 3.9 years.

Results

Diagnosis, body mass index (BMI), American Association of Anesthesiologists (ASA) and pre-operative pain and function scores were not significantly different between groups. There was no difference in SF-12 scores postoperatively. At one and two years postoperatively, the MOMHR group had better WOMAC scores than the THA group, but no difference was seen at three to five years postoperatively. There were no revisions in either group over the study period.

Conclusions

This study demonstrated good results for hip resurfacing in men <65 years five years postoperatively and similar function to THA patients.     

Chronic pain due to Little Leaguer’s Shoulder in an adolescent baseball pitcher: a case report

Objective:

To describe a case of chronic Little Leaguer’s Shoulder in reference to pain presentation, physical capabilities, and recovery time.

Clinical Features:

A 17-year-old, junior baseball pitcher presented with shoulder pain when performing high velocity pitching. Conservative treatment for an assumed soft tissue injury failed to resolve the pain, which was regularly aggravated by pitching, and which subsequently prompted further evaluation, and eventual confirmation of Little Leaguer’s Shoulder on subsequent computerized tomography (CT) imaging.

Intervention and Outcome:

Prior to proper diagnosis, conservative treatment had consisted of activity modification, spinal adjusting, laser therapy, shockwave therapy, Active Release Techniques^®, Kinesiotape,^® and rehabilitation. Later, rehabilitation, consisting of general muscle and core strengthening, continued for a further six months under the supervision of college athletic trainers. The athlete was able to return to normal pitching duties approximately 12 months later.

Summary:

In this case, a potentially damaging bone injury masquerading as a simple musculo-tendinous injury created a diagnostic challenge. The patient eventually recovered with rest, time, strengthening, and eventual compliance to prescribed activity modification.     

Multiple fibroadenomas in bilateral breasts of a 46-year-old Indian woman – A case report

INTRODUCTIONFibroadenomas are among the most common tumours of the female breast, occurring most frequently in women of child-bearing age, especially those under 30 years.PRESENTATION OF CASEWe report a case with a total of 27 fibroadenomas presenting bilaterally of a 46-year-old woman. The histopathologic and immunophenotypic features of the fibroadenomata are described.DISCUSSIONMost fibroadenomas are present as single mass, however the presence of multiple fibroadenomata can be seen in 15–20% of the patients. It has been reported that the average number of masses in cases of multiple fibroadenomas is 3–4 in a single breast but occurrence of more than five fibroadenomas in an individual patient is much less common.CONCLUSIONThere are few reports of multiple fibroadenomas. We report this case hoping to expand the literature and to provide insight to aetiology of multiple fibroadenoma formation and advice on management.     

Brown-Séquard syndrome and cervical CSF leakage due to a knife injury: a case report

We report a case of Brown-Séquard syndrome and cervical CSF leakage caused by a knife injury. A 34-year-old man was involved in a fight and was stabbed on his occiput and back with a knife. Neurological examination on admission showed right hemiparesis, right hemihypesthesia and left hemihypalgesia, indicating Brown-Séquard syndrome. Furthermore, cerebrospinal fluid was leaking from the occipital stab wound. Head CT scan showed massive accumulation air in the subarachnoid space. Cervical MRI showed that the injury tract reached to the space between the occipital bone and the atlas. One week after admission, suboccipital craniectomy and duraplasty were performed because of continuous CSF leakage. Although, the CSF leakage recurred due to the wound infection, it disappeared naturally as the patient's general condition improved. Follow-up MRI studies demonstrated the cervical spinal lesion as hyperintensity on T2WI, which localized at the right side of the spinal cord. The patient's hemiparesis gradually improved and he underwent rehabilitation. Spinal cord injury due to a stab wound by a knife is rare in Japan. In this case, we suppose that the mechanism of spinal cord injury was due to direct injury by a knife avoiding the lateral corticospinal tract because his right hemiparesis obviously improved.