1/9317. Three cases of patella fracture in 1,320 anterior cruciate ligament reconstructions with bone-patellar tendon-bone autograft.Between September 1992 and December 1996 we reviewed three transverse displaced fractures of the patella occuring in 1,320 ACL reconstructions using bone-patellar tendon-bone autograft. All the patients suffered local injury to the donor knee between 8 and 12 weeks postoperatively. Immediate rigid fixation using single or double anterior tension band allowed early mobilization and full weight bearing. Between 6 and 9 months after fracture, the screws and the wire were removed and the grafts tested. Results of the pivot shift and Lachman test under anesthesia were negative and arthroscopic visualisation showed the graft to be intact. Postoperative assessment included the Lysholm and Tegner scales, the International knee documentation Committee Evaluation form (IKDC), KT-1000 arthrometer, and isokinetic dynamometer strength testing. No significant differences in the final outcome were noted between reconstructions complicated by patellar fracture and normal ACL reconstructions.- - - - - - - - - - ranking = 1keywords = ear (Clic here for more details about this article) |
2/9317. Postoperative gas bubble foot drop. A case report.STUDY DESIGN: An unusual case of foot drop occurring 10 days after disc surgery is reported. Imaging studies identified a gas bubble compressing the nerve root. OBJECTIVE: To describe the origin and management of a radiculopathy caused by an intraspinal gas bubble. SUMMARY OF BACKGROUND DATA: A recurrent lumbar disc herniation was diagnosed by clinical and imaging studies. A vacuum disc also was noted at the same level. These are common and not considered to be of pathologic significance. methods: The patient underwent a microdiscectomy for a lumbar disc extrusion. The postoperative course was excellent, with relief of symptoms and no neurologic deficit. Ten days later, the awoke with a foot drop and pain in the leg. Imaging studies showed a 4-mm gas bubble compressing the nerve root. Oral steroids were given for 10 days. RESULTS: Progressive improvement occurred, and the patient was asymptomatic 6 weeks later. Although in some instances it may be necessary to evacuate intraspinal gas, an initial period of observation is warranted, because the gas and its resulting symptoms may disappear spontaneously. CONCLUSION: Intradiscal gas accumulation, better known as vacuum disc, is considered to be a benign indication of degenerative disc disease. On occasion it can be a cause of symptoms. A case is reported in which gas leaked after surgery into the spinal canal, causing a foot drop. The symptoms and gas disappeared spontaneously without further treatment.- - - - - - - - - - ranking = 1keywords = ear (Clic here for more details about this article) |
3/9317. paraplegia after thoracotomy--not caused by the epidural catheter.BACKGROUND: paraplegia and peripheral nerve injuries may arise after general anaesthesia from many causes but are easily ascribed to central block if the latter has been used. CASE REPORT: A 56-yr-old woman, with Bechterev disease but otherwise healthy, was operated with left-sided thoracotomy to remove a tumour in the left lower lobe. She had an epidural catheter inserted in the mid-thoracic area before general anaesthesia was started. bupivacaine 0.5% 5 ml was injected once and the infusion of bupivacaine 0.1% with 2 micrograms/ml fentanyl and 2 micrograms/ml adrenaline (5 ml/h) started at the end of surgery. The patient woke up with total paralysis in the lower limb and sensory analgesia at the level of T8, which remained unchanged at several observations. laminectomy, performed 17 h after the primary operation, showed a large piece of a haemostatic sponge (Surgicel) compressing the spinal cord, which was then decompressed but the motor and sensory deficit remained virtually unchanged both then and a year later. CONCLUSIONS: This case shows--once again--that although central blocks may cause serious neurological complications and paraplegia, other causes are possible and have to be considered. However, all patients with an epidural catheter must be monitored for early signs and symptoms of an intraspinal process and the appropriate treatment has to be instituted instantly.- - - - - - - - - - ranking = 1keywords = ear (Clic here for more details about this article) |
4/9317. pituitary apoplexy after cardiac surgery presenting as deep coma with dilated pupils.Acute clinical deterioration due to infarction or haemorrhage of an existing, often previously unrecognized, pituitary tumour is a rare but well-described complication. It can occur spontaneously or may be caused e.g. by mechanical ventilation, infection or surgical procedures. We report on a case of pituitary apoplexy occurring in a 64-year-old patient 3 weeks after cardiac surgery. The patient presented with deep coma and dilated pupils. magnetic resonance imaging revealed a haemorrhagic pituitary tumour. After prompt endocrinologic replacement therapy with levothyroxine and hydrocortisone the patient regained consciousness. Neurological examination revealed right oculomotor nerve palsy and bilateral cranial nerve VI palsy. Subsequent trans-sphenoidal removal of a nonfunctional macroadenoma with large necrotic areas was performed. The patient recovered completely. To our knowledge, pituitary tumours presenting with a combination of deep coma and dilated pupils must be considered exceedingly rare. Possible pathophysiologic mechanisms are discussed. As our case illustrates, even in severe cases complete recovery is possible if the diagnosis is suspected, and diagnostic and therapeutic measures are initiated in time.- - - - - - - - - - ranking = 0.5keywords = ear (Clic here for more details about this article) |
5/9317. akinetic mutism after fourth ventricle choroid plexus papilloma: treatment with a dopamine agonist.BACKGROUND: akinetic mutism is a behavioral state wherein a patient seems to be awake but does not move or speak. Several patients are reported to have developed mutism after posterior fossa surgery. We present a patient who developed akinetic mutism after total excision of a choroid plexus papilloma of the fourth ventricle, and who was treated with bromocriptine. CASE DESCRIPTION: An 18-year-old woman was admitted with akinetic mutism, which had developed 6 days after posterior fossa surgery. She had had no neurologic deficit in the first 5 days after surgery and could communicate with her family. Despite antioedematous therapy and daily lumbar punctures to drain cerebrospinal fluid, there was no clinical improvement after she entered the akinetic mute state. brain magnetic resonance revealed ventriculomegaly; brain single photon emission computed tomography revealed bilateral reduction of perfusion in the frontal region. Because daily lumbar drainage did not result in clinical improvement, shunt placement was not considered. bromocriptine therapy was begun at a dose of 2x2.5 mg; 24 hours later, the patient started to speak and move her upper extremities. Further improvement occurred over the following week when the dose was increased to 3x2.5 mg. bromocriptine was replaced with a placebo to determine whether the neurologic improvement was caused by the medicine. The patient's neurologic status deteriorated progressively; therefore, bromocriptine was restarted and she was discharged from the hospital. During the 6 months of follow-up, the patient has remained in good health. CONCLUSIONS: The etiology of akinetic mutism is not clear. Monoaminergic pathways, particularly dopaminergic cell groups, are most probably involved in this syndrome, because bromocriptine has a dramatic effect on these patients, as demonstrated in our case.- - - - - - - - - - ranking = 1keywords = ear (Clic here for more details about this article) |
6/9317. scedosporium apiospermum sinusitis after bone marrow transplantation: report of a case.A forty-year-old man underwent an allogeneic BMT from his HLA identical sister. GvHD prophylaxis was done with cyclosporine (CyA), methotrexate and prednisone (PDN). On day 90 extensive GvHD was noted and higher doses of immunosuppressive drugs alternating CyA with PDN were initiated. Patient's follow-up was complicated by intermittent episodes of leukopenia and monthly episodes of sinusitis or pneumonia. One year after BMT, the patient developed hoarseness and nasal voice. No etiologic agent could be identified on a biopsy sample of the vocal chord. Upon tapering the doses of immunosuppressive drugs, the patient had worsening of chronic GvHD and was reintroduced on high doses of cyclosporine alternating with prednisone on day 550. Three months later, GvHD remained out of control and the patient was started on azathioprine. On day 700, hoarseness and nasal voice recurred. Another biopsy of the left vocal chord failed to demonstrate infection. Episodes of sinusitis became more frequent and azathioprine was withheld 3 months after it was started. One month later, the patient had bloody nasal discharge and surgical drainage of maxillary sinuses was performed. Histopathology showed hyphae and cultures grew scedosporium apiospermum. itraconazole 800 mg/day was initiated. The patient developed progressive respiratory failure and died 15 days later.- - - - - - - - - - ranking = 1keywords = ear (Clic here for more details about this article) |
7/9317. microsporidia infection in transplant patients.BACKGROUND: microsporidia are the most common cause of chronic diarrhea in patients infected with human immunodeficiency virus. patients who have undergone organ transplantation may also be infected. The precise immune defect and the clinical picture in transplant patients have not been studied. methods: We report a case of microsporidia infection in a heart transplant patient and review three other cases reported in the literature. RESULTS: infection in three solid organ transplant patients occurred when the patients were receiving immunosuppressive therapy for rejection 1.5-3 years after transplantation. patients had chronic diarrhea, vomiting, dyspepsia, and weight loss for 1 month to 3 years. CONCLUSIONS: microsporidia may be the cause of chronic unexplained diarrhea and gastrointestinal disturbances in transplant patients. Defects in cell-mediated immunity probably play a role in maintaining the chronicity of this infection. Specific screening requests should be made to the microbiology laboratory when microsporidia infection is suspected.- - - - - - - - - - ranking = 1.5keywords = ear (Clic here for more details about this article) |
8/9317. Acoustic trauma from the bone cutting burr.The amplitudes of the stapes footplate movements were determined in human temporal bones when the ossicular chain was drilled with a cutting and a diamond burr. High movements result in comparison to physiological data. The frequency distribution resembles the dB (A) curve. The intensity compared to sound pressure levels on the ear drum is higher than I30 dB. The pressure is constant over the period of contact between the burr and the ossicle. Most likely these unphysiologic movements of the stapes footplate can cause inner ear damage as we had to admit in a case of facial nerve decompression.- - - - - - - - - - ranking = 1keywords = ear (Clic here for more details about this article) |
9/9317. Treatment for empyema with bronchopleural fistulas using endobronchial occlusion coils: report of a case.We report herein the case of a woman with bronchopleural fistulas treated with the endobronchial placement of vascular embolization coils. She was referred to our hospital to undergo lavage of a postoperative empyema. She had undergone an air plombage operation for pulmonary tuberculosis 9 years previously. However, bronchopleural fistulas occurred postoperatively and she had to continue the use of a chest drainage tube since then. Lavage of her empyema space with 5kE of OK-432 (picibanil: Chugai) plus 100 mg minocycline was performed once every 2 weeks for 3 months, and the purulent discharge from the empyema remarkably decreased. Thereafter, the bronchopleural fistulas were occluded endobronchially by the placement of vascular embolization coils. Soon after the procedure, air leakage from the fistulas was stopped and the drainage tube was removed 2 days later. The patient remains well without any additional treatment at 20 months after this treatment. As treatment for empyema with bronchopleural fistulas, it would be worth trying to lavage the empyema space with OK-432 until it is cleaned out and to plug the fistulas by the endobronchial placement of embolization coils, before such radical operations as thoracoplasty and space-filling of the empyema are considered.- - - - - - - - - - ranking = 0.5keywords = ear (Clic here for more details about this article) |
10/9317. The clinical superiority of continuous exposure versus short-pulsed carbon dioxide laser exposures for the treatment of pearly penile papules.Treatment of pearly penile papules was performed both with a conventional continuous-wave (CW) and a newer generation high energy pulsed carbon dioxide laser. When compared to the short pulsed laser, the CW laser, using relatively low power densities, provided superior hemostasis and improved visualization of the operative field. Despite the increase in thermal injury, wound healing was not compromised. The results of this case report support the CO2 laser in CW mode as the infrared laser treatment of choice for exophytic lesions with increased vascularity.- - - - - - - - - - ranking = 2.5keywords = ear (Clic here for more details about this article) |
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