Hemiarthroplasty for pigmented villonodular synovitis of the shoulder: a report of two cases

Pigmented villonodular synovitis is a reactive condition characterised by exuberant proliferation of synovial villi and nodules. It may be localised or diffuse and can cause severe articular damage. This report is of 2 patients with pigmented villonodular synovitis of the shoulder causing extensive arthritic changes. Both patients underwent shoulder hemiarthroplasty and total synovectomy and achieved satisfactory painless range of motion, with no signs of local recurrence or loosening of the prosthesis after 4 to 5 years of follow-up.     

Avulsion injuries of the flexor digitorum profundus tendon

Avulsions of the flexor digitorum profundus tendon may involve tendon retraction into the palm and fractures of the distal phalanx. Although various repair techniques have been described, none has emerged as superior to others. Review of the literature does provide evidence-based premises for treatment: multi-strand repairs perform better, gapping may be seen with pullout suture-dorsal button repairs, and failure because of bone pullout remains a concern with suture anchor methods. Clinical prognostic factors include the extent of proximal tendon retraction, chronicity of the avulsion, and the presence and size of associated osseous fragments. Patients must be counseled appropriately regarding anticipated outcomes, the importance of postoperative rehabilitation, and potential complications. Treatment alternatives for the chronic avulsion injury remain patient-specific and include nonsurgical management, distal interphalangeal joint arthrodesis, and staged reconstruction.     

Giant mediastinal teratoma presenting with paroxysmal atrial fibrillation

Mediastinum is a common site where benign tumors, like teratomas, can develop. Usually, these lesions do not cause any symptoms and the diagnosis is reached accidentally. As they enlarge they may cause symptoms by compressing the nearby structures of the thorax, mostly the trachea and the bronchi. Extrinsic compression of the heart or the great vessels appears to be a very rare occurrence. Atrial fibrillation as the first clinical presentation of left atrial compression by a giant mediastinal teratoma is extremely uncommon and very few cases have been described in the English literature.     

Spontaneous left side pneumothorax and myocardial infarction: rare but potentially lethal coexistence that can frustrate clinicians

Spontaneous pneumothorax is a common surgical disease that is a surgical emergency. It can be divided into primary (caused by microscopic blebs <1 cm in diameter) and secondary (asthmatic, catamenial, neonatal, caused by emphysematic bullae or chronic respiratory obstruction) varieties. This surgical entity has been closely associated to a variety of electrocardiographic (ECG) changes, which are pathophysiologically explained by spatial changes in the anatomical structure of the mediastinum caused by increased hemithoracic pressure. Several reports on ECG variations due to pneumothorax that masquerades as myocardial ischemia have been previously recorded. However, when the underlying disease involves two pathological entities, in this case pneumothorax and myocardial infarction, time limits can be pressing. Herein, we describe an interesting case of a patient who presented with left secondary spontaneous pneumothorax associated with acute myocardial infarction. It is an intriguing and rarely encountered case in which the patient’s anamnesis can easily mislead the clinician and valuable time can be wasted.     

Localized Tongue Amyloidosis in a Patient with Neurofibromatosis Type II

Background  

Localized Amyloidosis (AL) may rarely involve oral mucosa. This is the first known reported case describing the development of tongue AL in a 30-year-old patient with Neurofibromatosis (NF) type-2.     

Transanal polypectomy using single incision laparoscopic instruments

Transanal excision of rectal polyps with laparoscopic instrumentation and a single incision laparoscopic port is a novel technique that uses technology originally developed for abdominal procedures from the natural orifice of the rectum. Transanal endoscopic microsurgery (TEM) is a well established surgical approach for certain benign or early malignant lesions of the rectum, under specific indications. Our technique is a hybrid technique of transanal surgery, a reasonable method for polyp resection without the need of the sophisticated and expensive instrumentation of TEM which can be applied whenever endoscopic or conventional transanal surgical removal is not feasible.