Peroneal tendon injuries. Report of thirty-eight operated cases

BACKGROUND AND AIMS: Peroneal tendon injuries are probably frequently overlooked causes of lateral ankle pain after distorsion trauma. We report a series of 38 patients with peroneal tendon injuries and outcome after operation. MATERIAL AND METHODS: The mean age of the patients was 30 years (range, 13 to 61). All patients were operated by the same orthopaedic surgeon (SO) and the final outcome was evaluated. RESULTS: Eighty-two per cent of the patients were competitive athletes. There were 11 partial and 3 total ruptures of the peroneus brevis tendon (PBT), 2 partial and 2 total ruptures of the peroneus longus tendon (PLT). Nine cases of subluxations or luxations were treated. There were also 5 cases of chronic peroneal tendinitis or tenosynovitis, 5 cases of peroneal tendon anomalies and 1 ganglion. The peroneal tendon lesion was associated to ankle instability in 19 cases (50%). In ninety percent of the cases the result of the operation was excellent or good. CONCLUSIONS: The lateral ligaments are usually damaged in ankle distorsion injuries, but peroneal tendon lesions are often overlooked and probably more common cause of persistent lateral ankle pain than previously thought. Ruptures and luxations of the peroneal tendons need operative treatment in most cases.     

Report of two cases

Two patients underwent thoracotomy for resection of pulmonary or esophageal carcinoma. Postoperatively, epidural catheters were inserted for pain management. Complaints of severe injection pain over the abdomen or lower extremities were made during one administration of pain medication. Progressive weakness and numbness developed over the lower trunk and lower extremities, with subsequent respiratory difficulties. Potassium chloride (KCl) was suspected to have been mistaken for normal saline as the diluent for morphine. In addition to endotracheal intubation and ventilatory support, steroids were administered both intravenously and epidurally to suppress spinal cord irritation. The two patients regained motor and sensory functions 14 and 18 hours later, respectively, without sequelae.     

Clinicopathological features of advanced gastric cancer. Report on 400 operated cases

In the present study the Authors report the clinical and pathological characteristics of highly advanced cases of gastric carcinoma. Of 1204 primary gastric cancer cases observed between 1977 and 1994 at the Second Department of Surgery, University of Siena, 400 cases treated by non-curative surgery were selected for this study: 174 explorative laparotomies, 76 by-pass and 150 resective operations, of which 98 relatively non-curative and 52 absolutely non-curative resections. The clinical and pathological features of these cases were compared with curative resection cases. Of several variables examined at univariate analysis, tumor site, macroscopic aspect, tumor size, depth in gastric wall and lymph nodal involvement significantly influenced the operative rate and the rate of non-curative operations (p < 0.001). With reference to non-curative cases, the diffusion pattern of neoplasm, besides the above mentioned variables, significantly affected the resectability rate: distant metastases, and particularly peritoneal spread, involved a lower resection rate if compared to cases with loco-regional diffusion (p < 0.001).     

Giant midesophageal pulsion diverticulum: a report of two operated cases

A giant midesophageal pulsion diverticulum is a medical rarity. Two successfully operated cases are reported. One patient had no clinical symptoms and was misinterpreted as a mediastinal tumor. Esophageal myotomy was not performed.     

Wandering spleen with splenic torsion: Report of two cases

Introduction and importanceAnatomical variation of the spleen’s position in the abdomen, is a rare condition called Wandering Spleen (WS). WS is a vital differential diagnosis in patients presenting with acute abdomen and diagnosis should be made promptly to prevent development of serious complications.Case presentationIn this article, we report two cases of WS (27 and 20 years old females) presenting with abdominal pain due to splenic torsion. Both Patients underwent splenectomy and discharged with no further complications.Clinical discussionThe presentation of a wandering spleen varies from an asymptomatic mass to an acute abdomen due to torsion and splenic infarction, therefore recognition of this condition can be challenging. Diagnosis depends on imaging studies, and treatment options consist of performing either splenectomy or splenopexy.ConclusionConcerning the high incidence of splenic torsion and infarction in WS patients, early recognition of this condition and initiation of apt intervention is of great significance.     

Olfactory neuroblastoma with intracranial extension. Report of two cases

Two cases of olfactory neuroblastoma with intracranial extension are described. The radiological features, including those of magnetic resonance (MR) imaging, are emphasized. On plain X-rays, the nasal cavity, ethmoid, sphenoid, and/or frontal sinuses were opacified. Erosion of the bony confines of the sinuses and orbit was seen in Case 1, but no bony destruction was observed in Case 2 despite intracranial tumor invasion via the seemingly intact cribriform plate. Angiography showed tumor staining in the ethmoid sinus, and in Case 1 tumor vessels were also found in the base of the frontal lobe. Computed tomography (CT) disclosed a large, soft, enhanced tissue mass occupying the nasal cavity and paranasal sinuses and extending into the anterior cranial fossa. In Case 1, MR images (0.5 Tesla) with a short spin echo sequence (repetition time [TR], 600 msec; echo time [TE], 26 msec) and a long spin echo sequence (TR, 2100; TE, 30, 60, 90) were obtained. T1-weighted images delineated the tumor accurately in relation to the normal architecture. T2-weighted images revealed widespread brain edema, with the tumor recognizable as a mass of low signal intensity within the high-intensity region of brain edema. The CT and MR imaging findings are by no means specific to olfactory neuroblastoma. However, both modalities, particularly MR imaging, are of special value in demonstrating the precise extent of the tumor in three dimensions.     

Multicentric liposarcoma: Report of two cases

We present herein two unusual cases of multicentric liposarcoma which highlight the problems associated with the management of this disease entity. When the surgeon is confronted with multicentric liposarcomas, it is necessary to define whether they are secondary tumors or independently arising multicentric liposarcomas, since the latter situation merits a more aggressive approach. Guidelines for this differentiation are suggested in the discussion following the case reports. Surgery, which is often multiple, remains the mainstay of treatment, although adjuvant chemotherapy and radiotherapy are also usually required.     

Mesenteric thrombosis-operation-recovery: Report of two cases

Two cases of mesenteric thrombosis are reported. The most outstanding clinical feature was the severity of the abdominal pain. Vomiting was of secondary importance in the symptomatology, thereby reversing the usual picture of small intestinal obstruction. Recovery followed resection of 9 feet of ileum in one patient and $\text{4}\text{1}\text{2}$ feet in the other.     

Familial pineoblastoma. Report of two cases

Two cases of pineoblastoma are presented. One occurred in a 12-year-old girl and the other, 20 months later, in her 43-year-old mother. A possible genetic basis and mutual exposure to an environmental factor responsible for the expression of a tumor gene are postulated in the discussion.     

Intratesticular varicocele: Report of two cases

Intratesticular varicocele is a rare entity and describes dilated intratesticular veins radiating from the mediastinum testis into the testicular parenchyma. Scrotal ultrasonography of two patients who presented to our urology clinic due to left scrotal pain revealed multiple tubular structures in the testes with diameters of more than 2 mm. Duplex spectral analysis showed a reversed flow response to Valsalva's maneuver. Apropos of two cases, intratesticular varicocele is reviewed.     

Colonoscopic appendectomy. Report of two cases

Colonoscopic appendectomy has been performed in two patients, who had had their appendices inverted into the caecum as an incidental procedure at earlier abdominal surgery.