Intravascular lymphomatosis: a case presenting with encephalomyelitis and reactive haemophagocytic syndrome diagnosed by renal biopsy

 

Aims:

To report an unusual instance of intravascular lymphomatosis presented with encephalomyelitis and reactive haemophagocytic syndrome. There was no skin involvement. The diagnosis was made on a renal biopsy. Methods and results : The marrow smear was air dried and stained with Diff-Quik. The tissue sections were stained with haematoxylin and eosin, Masson trichrome, periodic acid–Schiff's reagent, Elastic van Gieson's stain, modified hexamine-silver technique and Martius scarlet blue. Immunohistochemistry for CD45, CD20, CD45RO, Factor VIII related antigen, CD31 and CD34 was performed on paraffin-processed tissue. The marrow smear showed active haemophagocytosis in the histiocytes. The renal biopsy showed intravascular lymphomatosis with tumour cells positive for CD45 and CD20. Conclusion : The possibility of intravascular lymphomatosis should be considered in patients with reactive haemophagocytic syndrome where the underlying cause cannot be found after thorough investigation.     

The role of timing of tourniquet release and cementing on perioperative blood loss in total knee replacement

The purpose of our study is to estimate the effect of tourniquet release and cementing in perioperative blood loss associated with total knee arthroplasty. Eighty patients were randomly allocated into two equal groups concerning the timing of tourniquet release. Group A: patients with tourniquet release and haemostasis before wound closure and group B: patients with tourniquet release after skin closure and compressive bandaging. These groups were further subdivided in two subgroups (+ and -) depending on cementing or not of the tibial tray only. The total blood loss averaged 961 ml in group A and 692 ml in group B, while it was estimated 763 ml in the cemented group and 890 ml in the non-cemented group. The total blood loss within subgroups was Group A+ 904 ml, Group A- 1017 ml, Group B+ 622 ml and Group B- 762 ml. The mean number of blood units transfused per patient was 4.7 in Group A and 4.0 in Group B, while the mean operating time was 79 min and 66 min, respectively. Complications such as deep vein thrombosis, haematomata and minor wound complications occurred in patients of Group A and Group B, 0 and 2, 0 and 2, 8 and 11, respectively. Intraoperative tourniquet release seems to be related with significantly greater blood loss (P<0.001) and demands in blood transfusion P<0.05 as well as a longer operating time (P<0.001). Cementing of total knee replacements has a better haemostatic role compared to non-cemented prosthesis (P<0.05). Even though complications were more in postoperative tourniquet release group, no statistically significant difference was found between group A and B. Postoperative tourniquet release seems to offer better conditions of haemostasis probably due to the better controlled fibrolytic activity.     

Dislocation of bipolar hemiarthroplasty following breakage of the polyethylene ring

. Dislocation after bipolar hemiarthroplasty is rare. In classical dislocations of bipolar prosthesis, the prosthetic femoral head escapes from the natural acetabular cavity. Two cases of a bipolar hip prosthesis are presented in which the dislocation occurred between the cup and the metallic ball head 4 and 12 months postoperatively. The reason for the dislocation was fracturing of the edge of the polyethylene ring - either due to impingement at the full flexion position of the hip or to dislocating forces in extreme positions of the metallic ball head. To avoid this complication we recommend installation of the notch of the polyethylene ring be at the peripheral half of the acetabular cup. Résumé. La luxation de prothèse totale est rare. Classiquement, la tête fémorale s'échappe du cotyle intact. Deux cas de dislocation de prothèse totale non cimentée sont rapportés au 4è et 12è mois post-opératoire. à l'origine de la luxation fut chaque fois retrouvée une rupture de l'anneau en polyéthylène bordant la cupule prothétique. La cause peut être due à un choc en position d'hyperflexion de la hanche, ou à l'apparition d'une force luxante provoquée par une position extrême de la tête métallique. Pour éviter cette complication, il est suggéré de positionner l'entaille de l'anneau de rétention dans la partie latérale et non pas au sommet de la cupule acétabulaire.     

Orthodox versus unorthodox care: A qualitative study on where rural women seek healthcare during pregnancy and childbirth in Southwest,Nigeria

Introduction

Utilization of orthodox health facilities for maternal health services is determined by factors operating at the individual, household, community and state level. The prevalence of small family norm is one of the identified variables operating within the community which influences the decision of where to access care (orthodox/traditional). The objective of the study was to determine the use of orthodox versus unorthodox maternity healthcare and determinants among rural women in southwest Nigeria.

Methods

A qualitative study was done and involved three focus group discussions. A semi-structured interview guide was used to collect information from women of reproductive age group within a rural Local Government Area in Lagos state.

Results

Most of the women access some form of healthcare during pregnancy, orthodox, unorthodox or both. Those who patronize both services concurrently do so to benefit from the two as each has some unique features such as herbal concoctions for traditional, ultrasound and immunization of babies for orthodox. Traditional belief exerts a strong influence on decision of where to access maternal healthcare services. Actual place of delivery is determined by individual and household factors including financial resources.

Conclusion

Rural women utilize one or both orthodox and unorthodox maternal health services for different reasons. Ward Development Committees should be strengthened so as to reach the communities, educate and convince women to dispel myths which limit their use of orthodox care. Training and monitoring of Traditional Birth Attendants (TBAs) are vital to eliminate harmful practices. We also recommend improved financial access to orthodox healthcare.     

Laceration of tibialis anterior tendon complicating a closed tibial fracture: A case report

Traumatic laceration of the tibialis anterior tendon complicating a closed tibial shaft fracture is a rare injury pattern. Only 3 such cases have been reported to date in the English literature and all were missed on initial examination. A case of a 17-year-old motorcyclist with an acute laceration of the tibialis anterior tendon resulting from a closed oblique tibial shaft fracture is presented. The tendon laceration was suspected preoperatively because of the patient's inability to actively dorsiflex his ankle joint and the existence of a palpable gap in the soft tissues over the anterolateral aspect of his tibia. Tibialis anterior tendon repair was performed simultaneously with fracture fixation. The role of careful physical examination is stressed so that this rare injury combination will not be missed.     

A rare case of juxtaarticular osteoid osteoma of the calcaneus initially misdiagnosed as juvenile chronic arthritis

Juxtaarticular osteoid osteoma is frequently misdiagnosed because the symptoms may mimic arthritis, and radiographs may not be characteristic. A rare case of subtalar pain lasting 5 years in a female teenager is presented here. The initial diagnosis was monarticular juvenile chronic arthritis. Family history was misleading because her mother had rheumatoid arthritis (RA).     

Open traumatic avulsion of the flexor pollicis longus tendon from the musculotendinous area: a case report

A traumatic avulsion of the flexor tendon at the musculotendinous junction in nonamputated digits is a very rare injury. We present a 14-year-old girl who sustained a longitudinal, tensile, injurious force directly to the flexor pollicis longus tendon after an open thenar injury resulting in its avulsion at the musculotendinous junction. In an effort to minimize soft-tissue damage and preserve the transverse ligament of the carpus the tendon was retrieved through a separate forearm incision. Direct repair was made by encapsulation of the tendon into the muscle belly. The functional result 30 months after surgery was satisfactory.     

Wilson osteotomy stabilised by means of internal fixation for the treatment of hallux valgus

The results achieved in 20 patients (32 feet) who underwent Wilson's osteotomy of the first metatarsal for the treatment of hallux valgus were reviewed. In all cases the osteotomy site was stabilised with one or two cortical screws. The patients' average age was 50.7 years (range: 34-74 years) and they were followed for a mean period of 33.1 months (range 12-63 months). The average AOFAS score was 85.5 (range: 62-100) at the final follow-up and in 84.4% of the cases the final outcome was very satisfactory as far as symptomatic improvement was concerned. Wilson's osteotomy stabilised with cortical screws was found to reliably give satisfactory correction of the hallux valgus and first intermetatarsal angles, while allowing safe patient mobilisation and early weight bearing. This effectively resulted in shorter rehabilitation time, early return to work or normal activities and a very satisfactory functional outcome.     

Scrotal Pneumatocoele in the Newborn

Ip, Henrietta Man-Hing (1978). Aust. Paediatr. J., 14, 107–108. Scrotal pneumatocoele in the newborn. A case of scrotal pneumatocoele secondary to spontaneous pneumothorax with subsequent pneumoperitoneum and subcutaneous emphysema in a newborn infant is reported. Spontaneous recovery occurred.