Median Nerve Injury Due to High-Pressure Water Jet Injection: A Case Report and Review of Literature

Abstract   High-pressure injuries that occur accidentally are potentially destructive injuries that often affect the nondominant hands of young men. A variety of products such as paint, gasoline, grease, fuel oil, cement, thinner and solvents have been reported as destructive agents. High-pressure water jet injection injuries to soft tissues have rarely been reported. In this study, we present the first case of median nerve injury due to high-pressure water jet injection by a water spray gun.     

Traumatic Hemipelvectomy: A Case Report and a Review of the Literature

Abstract Traumatic hemipelvectomy is a life threatening, devastating pelvic injury with very low survival rates. Excessive loss of blood, related systemic problems and additional injuries about the gastrointestinal and genitourinary systems increase mortality of this severe sort of injury. A young, male farmer injured violently by an agricultural heavy machine; a survivor of traumatic hemipelvectomy is described in this case report.     

Infarction of the Cervical Spinal Cord Following Multilevel Transforaminal Epidural Steroid Injection: Case Report and Review of the Literature

Abstract

Background/Objective: Transforaminal epidural steroid injection is a widely utilized nonsurgical strategy for the management of cervical radicular and axial pain. The technique has been shown to be efficacious in relieving the patients' symptoms. Although effective, there are a range of possible complications associated with this procedure. We report the case of a patient with an acute infarction of the cervical spinal cord after a multilevel transforaminal epidural steroid injection.

Methods: We performed a retrospective chart review of a single case.

Results: The patient suffered an acute brainstem and cervical spinal cord infarction despite the use of many techniques to minimize the occurrence of vascular injury during the procedure. The patient regained some function after medical and physical therapy.

Conclusions: This complication, to our knowledge, has only been reported in the literature on 2 other occasions and serves as a reminder of the potentially devastating consequences of performing procedures in proximity to the nervous system.     

Extrahepatic Duct Injury in Blunt Trauma: Two Case Reports and a Literature Review

Traumatic injuries of the extrahepatic biliary tract are rare. Associated injuries are usually responsible for immediate indication for surgical treatment, the time when an injury to the extrahepatic biliary ducts may be diagnosed. However, missed injuries are often common. The primary aim of this paper is to describe the clinical features, diagnosis, treatment, and outcome of two patients with left hepatic duct injury after blunt abdominal trauma. As a secondary objective, a literature review is presented. The two cases presented in this study are as follows: (1) A young male, involved in a motor vehicle crash, was admitted with blunt hepatic trauma in a general hospital. Endoscopic retrograde cholangiography was conducted 3 weeks later and revealed a large leakage at the left hepatic duct. Exploratory laparotomy was performed 26 days after the initial traumatic event and identified a complete section of the left hepatic duct, treated with anastomosis. (2) A male fell from a height. On exploratory laparotomy, a 30 % partial injury of the left hepatic duct was found in addition to hemoperitoneum, liver injury, gallbladder detachment together with cystic duct rupture, retroperitoneal hematoma to the right, and cecum hematoma. A high level of suspicion is necessary to identify injuries to the hepatic ducts. Early diagnosis that occurs during laparotomy due to associated injuries is important to reduce complications.     

Hand Gangrene Following Unsuccessful Cannulation of the Internal Jugular Vein: a Case Report and Literature Review

Hand gangrene following vascular cannula placement is uncommon and is usually the result of thrombotic occlusion of an artery. We describe a case of hand gangrene resulting in wrist disarticulation, following multiple unsuccessful attempts at internal jugular vein cannulation in a critically ill patient.     

Blunt Left Extrahepatic Bile Duct Injury: Case Report and Literature Review

Background  Extrahepatic biliary tract injuries following blunt abdominal trauma are very rare and pose a diagnostic and therapeutic challenge. Case Report  We report a case of blunt liver injury with left extrahepatic duct transection following a motor vehicle collision. Technetium 99m dimethyliminodiacetic acid scan confirmed a bile leak and endoscopic retrograde cholangiopancreatography (ERCP) diagnosed the injury of the left extrahepatic duct. Management was initially conservative, consisting of external drainage along with trials of stent placement. Ultimately, partial left hepatectomy was required to definitively treat the injury. Conclusion  In the setting of suspected biliary tract injury, early ERCP is essential to localize a leak and guide management decisions. In the event of a confirmed bile leak, a trial of nonoperative management consisting of endoscopic ductal decompression along with percutaneous drainage may initially be warranted although is not always successful.     

Groin Swelling,the Anatomic Way Out of Abdominal Haematomas: a Case Report and Explicative Literature Review

This case report concerns a previously healthy thirty-five-year-old female with complaints of inguinal hernia that ultimately proved to be a retroperitoneal haematoma. The patient suffered from a car accident 5 months before admission and was hospitalized. During her prior hospitalization, explorative laparotomy revealed a haematoma of the mesentery. The haematoma was treated conservatively, with fluid resuscitation and rest. During her second admission, MRI of the inguinal region revealed localized haematoma. During inguinal exploration, a fluid-filled bluish indirect hernia sac was identified and found to be contoured by free-flowing, non-clotting blood. The postoperative course was uneventful, and the patient was discharged six days following surgery.     

Proximal Tibial Sleeve Fracture: Case Report of a Rare Injury and Review of the Literature

A sleeve fracture occurs when a ‘‘sleeve’’ of cartilage or periosteum is avulsed with or without an osseous fragment, an injury most commonly reported in the patella. Proximal tibial sleeve fractures are extremely rare and we present a case in an adolescent male who had concomitant osteochondral as well as chondral fractures of his patella. Sleeve fractures present in the skeletally immature, and may look relatively benign on radiographs, but misdiagnosis may lead to adverse consequences. Clinicians should have a high index of suspicion if a child or adolescent presents with a knee injury with clinical concerns regarding the extensor mechanism. Given that the ‘‘sleeve’’ of the injury contains tissue with osteogenic potential, we recommend that displaced proximal tibial sleeve fractures should be managed operatively to avoid dysfunction of the extensor mechanism. These patients should also have perioperative assessment for occult osteochondral and chondral injuries that are potentially repairable and thus may have implications for prognosis.     

肾上腺横纹肌肉瘤1例及文献复习

目的：探讨肾上腺横纹肌肉瘤（RMs）的临床特征及诊治疗方法。方法：对1例肾上腺横纹肌肉瘤患者的临床资料进行总结,检索Pubmed和CBM数据库相关文献进行复习讨论。结果：患儿通过手术治疗,术后病理检查为右肾上腺区横纹肌肉瘤,免疫组化：Vim（＋）,Myogenin（＋）,axtin-横（＋）,CgA（-）,Syn（-）,S-100（-）,HHF35（-）,F8（-）,CD34（-）,EMA（-）。结论：肾上腺RMS是非常罕见的恶性肿瘤,其肿瘤结构、细胞形态都有一定的特征,确诊需免疫组化染色的帮助,横纹肌肉瘤的治疗和预后在很大程度上取决于手术切除的彻底性和组织类型。     

Preputial Calculi: a Case Report and Review of Literature

Preputial calculi are the rarest form of urolithiasis seen usually in an uncircumcised male with phimosis. We report a case in an elderly male who presented with azotaemia. Calculi are evident on clinical examination by palpation. Late presentation by the patient leads to complications. Treatment is by dorsal slit or circumcision. The case highlights the need of early recognition and treatment of this rare condition to prevent any complication.     

Maisonneuve Equivalent Injury With Proximal Tibiofibular Joint Dislocation: Case Report and Literature Review

We report the case of a 31-year-old male who presented with traumatic dislocation of both proximal and distal tibiofibular joints without fibular fracture. The patient underwent closed reduction of the proximal tibiofibular joint and surgical stabilization of the distal tibiofibular joint. An 18-month postoperative evaluation confirmed a very good clinical outcome after anatomic reduction. This type of trauma is very rare and, to our knowledge, has only been described 3 times previously. Furthermore, our surgical management was different from that used for the previous cases and proved to be satisfactory.     

Lumbar Intradural Disc Herniation Caused by Injury: A Case Report and Literature Review

Background

Intradural disc herniation(IDH) caused by trauma is a rare type of disease,which is difficult to diagnose clinically and is easily misdiagnosed. We received a patient with the disease, reported the case to share the process of diagnosis and treatment and put forward our own opinions, so as to increase the probability of correct diagnosis.

Case Presentation

We report the case of a 48-year-old male who fell from a scaffold at a height of 2 m. Later, he developed low back pain, restricted movement, numbness and hyperalgesia of the lower left limb, and decreased left muscle strength. He was diagnosed with IDH. Treatment with posterior decompression and intramedullary decompression with pedicle screw internal fixation was performed. His postoperative course was uneventful, and he underwent regular follow up for 1 year. Good neurologic symptom improvement was achieved.

Conclusions

IDH is rare, and comprehensive consideration and film reading can improve the correct diagnosis rate. Accurate diagnosis and early decompression of laminae and intramedullary decompression can lead to good recovery after neurologic impingement.     

Primary Multilocular Hydatid Cyst of Neck with Unique Presentation: A Rare Case Report and Literature Review

Hydatid cyst (HC) is a parasitic infection caused by larva form of Echinococcus. It occurs frequently in liver and lungs. Primary HC of neck is extremely rare occurrence and here we report it with unusual presentation. A 35-year-old male presented with slowly growing painless swelling in right side of neck for 6–7 years. The swelling measured 11 × 6 cm and cough impulse elicited on local examination. MRI scan revealed a multiloculated cystic lesion in neck. Fine needle aspiration cytology yielded fluid aspirate and smear showed fragment of laminated membrane, suggestive of HC. The intact cyst was removed surgically and histopathologic examination confirmed the diagnosis of HC. Both clinicians and radiologists should consider HC in differential diagnosis of head and neck swelling for proper management.     

Unstable Cervical Spinal Injury in Children – Case Report and Review of the Literature

Large studies about the management of pediatric patients with unstable flexion-distraction injuries of the midcervical spine are rare. We present the case of a 12-year-old girl who sustained a cervical spinal injury with unilateral facet dislocation and discuss details and problems of diagnostic procedures and treatment in the light of the recent literature. The management and pitfalls of a unilateral facet dislocation in a child are summarized. After initial reposition, a multi- segmental instability with neurology developed. Although distraction-flexion cervical spine injuries are common in adults and often occur with concomitant neurological sequelae, they also can occur in the pediatric population. In conclusion, an MRI seems advisable. A treatment of postoperative mal-alignment with reposition via a halo-fixator cannot be recommended. Repositioning is possible but was lost when the fixator was removed. Comparing the historic and recent literature there is only weak evidence overall, nevertheless a ventral fusion seems to be the treatment option of choice.     

Transmesosigmoid Hernia: Report of a Case and Review of the Literature

We report a case of a transmesosigmoid hernia in a 6 weeks postpartum woman. We found 14 previous reports of this rare type of internal hernia. Our patient presented with acute abdominal pain and developed a small intestinal obstruction. History, clinical and radiographic examination were not diagnostic. An early laparoscopy was performed and a herniation of a small intestine loop through a hole in the sigmoid mesocolon was seen. The hernia was reduced and the defect in the sigmoid mesocolon was closed laparoscopically. The small intestine was viable and enterectomy could be avoided. The role of laparoscopy and potential causes of this type of hernia are discussed.     

Complete Cuboid Dislocation With Associated Lisfranc Injury: A Case Report and Review of the Literature

Cuboid dislocations are rare midfoot injuries that usually occur in the setting of high-energy trauma. Diagnosis can be challenging and optimal treatment remains unknown. This case report and review aims to summarize the recent literature on this topic.     

Madelung Disease: Report of a Case and Review of the Literature

Madelung disease is a rare disorder characterized by the presence of multiple, symmetric, nonencapsulated fatty accumulations diffusely involving the cheeks, the neck, the upper trunk, the shoulder girdle area, and the upper extremities. The cause of this syndrome is unknown, but it has been associated with alcoholism in 60% to 90% of patients. The long-term lipomatous deposits are often large and cosmetically deforming, and the upper aerodigestive tract and great veins may be compressed. We report the case of a man with MD, involving the cervical and upper dorsal regions, who underwent surgical treatment at our Department.