Soft tissue echinococcosis: a report of two cases and review of the literature

Echinococcosis (hydatid cyst disease) is a zoonotic infection caused by the parasitic tapeworm Echinococcus. The larval stage of this parasite can implant in many organs of the body, most commonly the liver, and create internal budding cystic masses. Echinococcal cysts also can implant in soft tissues; however, a review of the literature revealed no published case with the patient initially presenting with a soft tissue mass. Two such cases are reported in the current study. Physicians who evaluate soft tissue masses, particularly in patients from Echinococcus-endemic areas, need to include echinococcosis in their differential diagnoses. The current treatment of choice for soft tissue echinococcosis is wide resection combined with perioperative medical therapy.     

Tibial turn-up for long distal femoral bone loss

Since 1990, seven patients have been treated by the authors with the tibial turn-up procedure. They have ranged in age from 8 to 37 years; four were skeletally mature adults and three were children. All seven patients were faced with a clinical situation that required surgical removal of a long portion of their affected distal femur. Three of the adult patients initially were treated for osteosarcoma with long distal femoral resections and allograft arthrodesis of the knee. The allografts ultimately failed, two because of aseptic failure and one because of infection. One patient required distal femoral removal for chronic osteomyelitis and pathologic fracture. Of the three children who were treated, two had turn-ups after long resection of the distal femur for bone malignancy, and one had a secondary turn-up after failure of a long distal femoral endoprosthesis. The technique uses the normal ipsilateral tibia as a vascularized pedicle graft to restore femoral length. The ultimate result, even after very high above knee resection, is a long above knee amputation stump. The followup of the patients in the current study ranged from 2 to 8 years. All patients achieved healing and were able to wear above knee prostheses. The tibial turn-up is an effective procedure that results in a long functional above knee amputation stump even after very high above knee resections.     

Ein beitrag zum lermoyez-syndrom

Zusammenfassung Es wird über einen Fall von Lermoyez-Syndrom berichtet, der anhand audiometrischer und vestibulometrischer Befundkontrollen über einen längeren Zeitraum beobachtet werden konnte. Der Lermoyezsche Symptomen-komplex gilt als eine Sonderform des Morbus Menière, bei der sick auf der Höhe der Schwindelattacke das Hörvermögen bessert. Überlegungen hinsichtlich der Ätiologie gehen deshalb von neueren Vorstellungen zur Pathogenese des übergeordneten Krankheitsbildes aus. Die mutmaßliche pathophysiologische Bedeutung der Bastschen Klappe wird herausgestellt. Danach könnte unterschiedliche Druckentwicklung in Cochlea und Sacculus einerseits, Utriculus und Bogengangen andererseits während des Anfalles durch SchIuß der Klappe zu einer Entkoppelung dieser beiden Anteile des endolymphatischen Systems führen, anschließende Kompensation des cochleären Druckes durch den Saccus endolymphaticus zur Besserung des Gehörs.Die fluktuierenden vestibule- und audiometrischen Befunde werden — bei Voraussetzung einer zentralnervösen Steuerung von Sekretion und Resorption der Endolymphe — u. a. als Ausdruck einer wechselnden Funktionssteuerlage gedeutet.

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Lermoyez' syndrome

Summary A patient with Lermoyez' syndrome was observed over a prolonged period of time during which he was repeatedly examined audiometrically as well as vestibulometrically. Lermoyez' syndrome is generally considered a special form of Meuière's disease, characterized by the fact that the hearing acuity improves at the climax of the vestibular attacks.Etiological considerations must take account of modern concepts regarding the pathogenesis of the underlying disease. A hypothesis is offered concerning the etiological role of Bast's valve. That is to say, if one assumes the endolymphatic pressure in the cochlea and saccule to change at a rate different from that in the utricle and the semicircular canals, the valve may be forced to close at some time during a given attack. This may then lead to a functional separation of the two parts of the endolymphatic system so that the pressure acting on the cochlear side may be equilibrated by way of the endolymphatic sac with subsequent improvement of hearing. Assuming that there is some central control affecting the secretion and resorption of endolymph—the fluctuations of hearing losses and impairments of vestibular function with time may be regarded as signs of the changing state of the hypothetical control center.

     

Continued growth of the proximal part of the tibia after prosthetic reconstruction of the skeletally immature knee. Estimation of the minimum growth force in vivo in humans.

We studied five skeletally immature patients who had a cemented endoprosthetic replacement involving the proximal part of the tibia because of a malignant tumor. In each patient, the cement-column fractured, allowing additional physeal growth. With plain radiographs and scanograms, we determined the cross-sectional areas of the physes, the cement-mantle, and the tibial component. Using the known tensile strength of polymethylmethacrylate cement, we then calculated the minimum force that the growth plates must have overcome to fracture the cement. This averaged 584 newtons per square centimeter. This observation of continued tibial growth after partial physeal ablation with a cemented prosthesis in skeletally immature patients presented a unique opportunity to estimate the force generated in the human physis during growth.     

The role of orosensory stimuli from ethanol and blood-alcohol levels in producing conditioned taste aversion in the rat

A taste-aversion paradigm was used to demonstrate that aversive consequences accompany the rapid oral ingestion of 5% (v/v) ethanol solutions. The learned taste aversion resulted from five 10-min self-administrations of alcohol mixed with an originally preferred flavor at a dosage of 1.69 g alcohol/kg body weight/day. In contrast, when the consumption of the alcohol solution was distributed throughout the day, a conditioned aversion was not obtained. This outcome was observed even though the distributed drinking animals were exposed to more orosensory stimuli and ingested more g/kg than the 10-min animals. The observation that those animals that drank their daily fluid in 10 min demonstrated higher peak blood-alcohol levels than the distributed animals supports the conclusion that a centrally mediated aversive state of inebriation must be present to produce a conditioned aversion.     

Recombinant human vascular endothelial growth factor enhances bone healing in an experimental nonunion model

The re-establishment of vascularity is an early event in fracture healing; upregulation of angiogenesis may therefore promote the formation of bone. We have investigated the capacity of vascular endothelial growth factor (VEGF) to stimulate the formation of bone in an experimental atrophic nonunion model.Three groups of eight rabbits underwent a standard nonunion operation. This was followed by interfragmentary deposition of 100 microg VEGF, carrier alone or autograft. After seven weeks, torsional failure tests and callus size confirmed that VEGF-treated osteotomies had united whereas the carrier-treated osteotomies failed to unite. The biomechanical properties of the groups treated with VEGF and autograft were identical. There was no difference in bone blood flow. We considered that VEGF stimulated the formation of competent bone in an environment deprived of its normal vascularisation and osteoprogenitor cell supply. It could be used to enhance the healing of fractures predisposed to nonunion.