Spontaneous rupture of the right gastroepiploic artery: unusual cause of acute abdomen and shock

Introduction  

Spontaneous rupture of the right gastroepiploic artery is an extremely rare case which can be a cause of abdominal apoplexy.     

Pseudogout of the wrist presenting as acute median nerve compression

Two cases are reported of acute median nerve compression due to calcium pyrophosphate deposition in the wrist, masquerading as a septic condition. There have been recent reports in the literature of the effects of calcium pyrophosphate in joints of the upper limb (Resnick 1983 and Hensley, 1983) These conditions are uncommon and the presentation and initial symptomatology of our case led in the first patient to misdiagnosis and an unnecessary operation, which was avoided in the second case.     

Traumatic rupture of an aberrant right subclavian artery

We describe a patient who sustained a traumatic rupture of an aberrant right subclavian artery. An interposition graft was used to restore continuity of the artery to the descending thoracic aorta.     

Brachial artery rupture without median nerve dysfunction after closed elbow dislocation

When closed elbow dislocation results in brachial artery injury, concomitant median nerve dysfunction often results because of anatomic proximity. In the absence of median nerve paresthesia or palsy, however, a pink hand may erroneously suggest that vascular injury has not occurred. In such cases, inadequate clinical assessment of hand perfusion may delay diagnosis of vascular injury and result in serious complication. We report a case of closed elbow dislocation that resulted in brachial artery rupture without median nerve symptoms or loss of perfusion to the hand. We underscore the importance of appropriate vascular assessment and describe surgical treatment.     

Posterior interosseous nerve compression syndrome following distal biceps brachii tendon rupture: an unusual sequel

We present an unusual case of a carpenter who had posterior interosseous nerve compression syndrome post-traumatic biceps brachii tendon rupture. The symptomatic presentation was confirmed by nerve conduction studies. Such a complication of biceps brachii tendon rupture has not been reported so far.     

Vein wrapping for recurrent median nerve compression

In cases of recurrent carpal tunnel syndrome requiring revision surgery or in patients who suffer from adhesive neuritis after a primary carpal tunnel release, the prevention of further scar formation allowing nerve gliding and reduced secondary compression owing to scar constriction may be obtained by the use of barrier tissues. This article discusses the use of a vein wrapping technique in patients undergoing secondary nerve decompression or exploration.     

Proximal median nerve compression.

Compression neuropathies of the median nerve in the proximal forearm are unusual lesions. Many patients have vague symptoms for many months or even years prior to confirming the diagnosis of either pronator syndrome or anterior interosseous syndrome of the forearm. Serial examinations clinically and electrodiagnostically may be necessary at intervals of 6 to 8 weeks as required for the evaluation of the patient's symptoms. As with other compression neuropathies, the diagnosis is solely dependent on the diagnosis of neuropathy of the median nerve using whatever parameter satisfies the surgeon's diagnostic criteria and then having made that diagnosis, localizing the site of that neuropathy by physical examination or electrodiagnosis with the support of radiographic techniques as appropriate. Surgical exploration of proximal median nerve compression is normally followed by prompt and predictable recovery from the median neuropathy and clinical symptoms between 8 and 12 weeks after surgical exploration. Prolonged symptom complexes after surgical exploration of the proximal median nerve are, in my experience, due to either (1) extremely severe median nerve injury secondary to pronator syndrome with prolonged recovery and distal nerve axomnetic recovery into the hand, or (2) sensory nerve dysesthesis of the small sensory nerves on the proximal volar surface of the forearm. The symptoms of either of these postoperative findings normally improve with time.     

Synovial cyst--an unusual cause of nerve root compression. A case report

An elderly woman presented with a tense, synovia-lined ganglion, associated with the left L3/L4 apophyseal joint, which protruded posteriorly and caudally through the joint capsule and extended anteriorly and cephally into the neural canal. The intraspinal extension produced a compression radiculopathy of the L3 nerve root. Removal of the cyst produced acute and dramatic alleviation of the symptoms.     

Iliopectineal bursitis: an unusual cause of iliofemoral vein compression

The iliopectineal bursa is the largest bursa in the region of the hip joint. Enlargement of the bursa occurs in several conditions and may be manifested by groin pain, a pelvic or inguinal mass, or lower extremity edema due to compression of the external iliac or common femoral vein. A case of lower extremity edema secondary to external iliac/common femoral vein compression caused by an enlarged iliopectineal bursa is presented. The pathophysiology, methods of diagnosis, and forms of therapy are discussed.     

Subclavian artery rupture (an unusual seat-belt injury).

A case of blunt injury to the subclavian artery in the absence of bony injury or dislocation sustained while wearing a seat belt is described. Its rarity and diagnostic pitfalls are discussed. The mechanism of the injury is analysed. The value of angiography is emphazided. It is suggested that, even in the presence of collateral circulation, exploration and repair should be undertaken.     

Traumatic rupture of the pulmonary artery

Traumatic rupture of the main pulmonary artery in a surviving patient is very rare. The case history of a 37-year-old man who sustained blunt chest trauma in a motor vehicle accident is presented. A persistent, bloody right pleural effusion led to the diagnosis of a ruptured right main pulmonary artery, which was surgically repaired using cardiopulmonary bypass. Points of diagnostic interest and therapeutic decision making are discussed.     

Another cause of median nerve compression by a lumbrical muscle in the carpal tunnel.

A case is described in which division of a flexor digitorum profundus tendon allowed the proximal end of the tendon to retract, drawing its lumbrical muscle into the carpal tunnel where it caused compression of the median nerve.