1/467. Intercondylar notch fibrous nodule after total knee replacement.Intra-articular fibrous bands and soft-tissue impingement under the patella after total knee replacement are a well known complications that can be diagnosed and treated arthroscopically. Arthroscopic treatment of soft-tissue impingement between femoral and tibial components in a total knee arthroplasty has been recently reported. The purpose of this article is to report one more case of this pathology of a more fibrotic type resembling a nodule in the intercondylar notch that prevents total extension and to discuss the possible origin and clinical significance. Finally, we propose a classification of the fibrotic reactions after total knee arthroplasty: (A)Multiples or complex bundles reactions; and (B)singles or isolates nodular forms: fibrous nodule in the femoropatelar area (clunk syndrome), and fibrous nodule in the intercondylar notch.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
2/467. Vascularized fibular graft after excision of giant cell tumor of the distal radius. A case report.Although hemiarthroplasty of the wrist using vascularized proximal fibula has been described often, long term results with documentation of results are insufficient. A case of giant cell tumor of the distal radius with remarkable extraskeletal extension is reported. Vascularized fibula including its proximal head was used to replace the defect created after en bloc resection of the tumor. There was no deterioration in radiographic findings or function of the new joint at the time of the 10-year followup. Satisfactory range of motion of the wrist and the forearm was maintained. There was no instability in the joint, and grip strength measured 65% of the opposite side. Postoperative magnetic resonance imaging showed survival of the whole graft, including the subchondral portion. In addition to thorough revascularization of the graft, appropriate soft tissue reconstruction using dynamic tendon transfer contributed to the success. When these requirements are fulfilled, the graft can provide a functional and durable result. Although this is a single experience, the authors recommend wrist arthroplasty, rather than arthrodesis, in carefully selected patients.- - - - - - - - - - ranking = 0.5keywords = soft (Clic here for more details about this article) |
3/467. Alveolar soft part sarcoma involving the ilium. A case report.A report of alveolar soft part sarcoma of the hip region with extension to the ilium is presented to highlight an unusual presentation for this sarcoma and to discuss the treatment options for limb salvage for large malignant neoplasma involving the periacetabular region of the pelvis. A review of the literature for reports of alveolar soft part sarcoma extending to bone is presented.- - - - - - - - - - ranking = 3.8652921876577keywords = neoplasm, soft (Clic here for more details about this article) |
4/467. Management of secondary soft-tissue deficits following microsurgical head and neck reconstruction by means of another free flap.Secondary soft-tissue deficits may develop following a microsurgical reconstruction in the head and neck region because of inadequate planning or chronic effects of radiotherapy. Although most cases could be managed with alternative methods, free flaps might be necessary in difficult cases. Herein are described 11 cases of microsurgical head and neck reconstruction in which secondary soft-tissue deficits required transfer of another soft-tissue free flap. All patients had malignant tumors treated with surgical resection, and their defects were reconstructed with free flaps. Seven patients received either preoperative or postoperative adjunctive radiotherapy. These patients gradually developed signs and symptoms of soft-tissue deficiency in the reconstructed area, and a soft-tissue free flap transfer was required for treatment within an average of 21.5 months of their initial reconstruction. Five rectus abdominis, one rectus femoris, one latissimus dorsi, one tensor fasciae latae myocutaneous, one radial forearm, one medial arm, and one dorsalis pedis flap were used for this purpose. All flaps survived completely. The average follow-up time was 32 months. Significant improvement was achieved in all cases, and no further major surgical procedures were required. Secondary soft-tissue deficits that could not be predicted or prevented during the initial microsurgical reconstruction may be treated successfully by a subsequent free soft-tissue transfer in selected cases.- - - - - - - - - - ranking = 5.5keywords = soft (Clic here for more details about this article) |
5/467. hypoglossal nerve injury as a complication of anterior surgery to the upper cervical spine.Injury to the hypoglossal nerve is a recognised complication after soft tissue surgery in the upper part of the anterior aspect of the neck, e.g. branchial cyst or carotid body tumour excision. However, this complication has been rarely reported following surgery of the upper cervical spine. We report the case of a 35-year-old woman with tuberculosis of C2-3. She underwent corpectomy and fusion from C2 to C5 using iliac crest bone graft, through a left anterior oblique incision. She developed hypoglossal nerve palsy in the immediate postoperative period, with dysphagia and dysarthria. It was thought to be due to traction neurapraxia with possible spontaneous recovery. At 18 months' follow-up, she had a solid fusion and tuberculosis was controlled. The hypoglossal palsy persisted, although with minimal functional disability. The only other reported case of hypoglossal lesion after anterior cervical spine surgery in the literature also failed to recover. It is concluded that hypoglossal nerve palsy following anterior cervical spine surgery is unlikely to recover spontaneously and it should be carefully identified.- - - - - - - - - - ranking = 0.5keywords = soft (Clic here for more details about this article) |
6/467. Fatal late multiple emboli after endovascular treatment of abdominal aortic aneurysm. Case report.BACKGROUND: The short term experience of endovascular treatment of abdominal aortic aneurysms (AAA) seems promising but long term randomised data are lacking. Consequently, cases treated by endovascular procedures need to be closely followed for potential risks and benefits. CASE REPORT: A 70 year-old mildly hypertensive male without previous or present arteriosclerotic, pulmonary, or urological manifestations was subjected to endovascular treatment after his mass-screening diagnosed abdominal aortic aneurysm had expanded to above 5 cm in diameter, the aneurysm having been found by CT-scanning and arteriography to be endovascularly treatable. A Vanguard bifurcated aortic stent graft was implanted under epidural/spinal anaesthesia and covered by cephalosporine and heparin (8000 IE) protection. Apart from treatment of a groin haematoma and stenosis of the left superficial femoral artery, the postoperative period presented no problems. A few days before the monthly follow-up visit, the patient developed uraemia, gangrene of one foot and dyspnoea. blood glucose and LDH was elevated. Deterioration led to death a month and a half after stent implantation. autopsy showed extraordinary large, extensive soft, brown vegetations in the lower part of the thoracic aorta above the properly infrarenally-placed stent. Microscopic examination revealed multiple microemboli in the liver, spleen, pancreas, intestines, testes, and especially the kidneys. DISCUSSION: Early death from microemboli after aortic stent implantation has been reported. However, the present case developed fatal multiple microemboli so late that they could not have originated from the excluded mural thrombus. The sudden death of an otherwise healthy man of extensive microemboli is difficult to explain. The stent application may have altered the proximal flow and wall movements disposing to microemboli in the case of vegetations.- - - - - - - - - - ranking = 0.5keywords = soft (Clic here for more details about this article) |
7/467. Correlation between clinical course and CEA levels during chemotherapy.In order to evaluate the correlation between clinical progress and CEA levels in gastroenteric tumours, particularly during chemotherapeutic treatment, CEA assay was performed on 330 patients (126 with gastric neoplasms, 204 with large bowel carcinoma). 175 out of these had a pre-operative assay. Moreover CEA test positivity (CEA larger than or equal to 5 ng/ml according to the technique employed by us) is higher in colon neoplasms compared with gastric neoplasms and in adenocarcinomas in comparison with undifferentiated forms; besides it depends on the pathologic stage. In colon tumours CEA test showed a higher positivity for left than for right forms (66.6% versus 38%). 240 patients were followed up with repeated CEA assays: the following observations were made: a - After radical surgery 72% of the patients shows normalized CEA values. b - In 198 patients who underwent radical surgery, not requiring chemotherapy, there was a close correlation between CEA levels and clinical evolution in 98% of the cases. c - 60 out of 68 patients (88%) submitted to chemotherapy for advanced neoplasms show a close correlation between CEA response to the chemotherapy and clinical response (p less than 0.001). These investigations stress, above all, the importance of CEA test to monitor the treatments performed (surgical and chemotherapeutic) and to adopt, eventually, more effective chemotherapeutic modalities.- - - - - - - - - - ranking = 3.4611687506307keywords = neoplasm (Clic here for more details about this article) |
8/467. Peritoneal sarcoidosis: case report and review of the literature.OBJECTIVES: This study was performed to report a patient with peritoneal sarcoidosis and review the literature for similar cases. methods: We described the clinical presentation, course, and outcome of the patient, and reviewed the medical literature from 1966 till 1997 using medline and the key words sarcoidosis, scar, and peritoneum. RESULTS: Our patient presented with a rapidly growing tumor-like mass at the site of an old appendectomy scar. laparoscopy showed a large peritoneal mass and multiple small peritoneal nodules that were found to be noncaseating granulomas by pathology. The medline search uncovered only 16 cases of peritoneal sarcoidosis, most of which presented with ascites. CONCLUSION: This case illustrates the need to consider sarcoidosis, in addition to infections and neoplasms, in the differential diagnosis of peritoneal nodules and exudative ascites.- - - - - - - - - - ranking = 0.86529218765768keywords = neoplasm (Clic here for more details about this article) |
9/467. Electroconvulsive treatment of a bipolar adolescent postcraniotomy for brain stem astrocytoma.This is the first reported use of electroconvulsive treatment (ECT) in an adolescent with bipolar mania who had been treated with craniectomy for an intracranial neoplasm. The reported case is of a 16-year-old girl with a history of brain stem glioma (pontomesencephalic astrocytoma) diagnosed at 13 years of age. She presented in a psychiatric emergency room with suicidal ideation, depressed mood, irritability, olfactory hallucinations, early insomnia, grandiosity, and guilt. Her symptoms failed to respond to a trial of an antidepressant, mood stabilizer alone, and mood stabilizer in conjunction with a neuroleptic. The decision to use ECT was based on suicidal ideation, extreme disinhibition, and danger to self and others. Significant improvement in mood and remission in psychosis were noted after the eighth treatment. Comparison of 2-week pre-ECT and 3-month post-ECT cognitive testing revealed no change in IQ. This report highlights rapid response and the ability to tolerate ECT in an adolescent diagnosed with bipolar disorder, who had also been treated with radiation and craniotomy.- - - - - - - - - - ranking = 0.86529218765768keywords = neoplasm (Clic here for more details about this article) |
10/467. Necrotizing fasciitis of the pharynx following adenotonsillectomy.Necrotizing fasciitis is a rare clinical entity in the head and neck region. We report a case of necrotizing fasciitis following adenotonsillectomy in a previously healthy 2-year-old girl. The child presented in a septic state with impending airway compromise. Computed tomography (CT) showed massive soft tissue widening with air in the retropharyngeal, parapharyngeal and retromandibular spaces. Intraoperative exploration showed necrosis of the posterior pharyngeal wall from the skull base to the cricoid, with extension into the parapharyngeal and retropharyngeal spaces. Cultures from the debrided tissues grew two aerobes and three anaerobes. Management involved airway support, surgical debridement, broad spectrum antibiotic coverage and nutritional support. The patient ultimately developed nasopharyngeal and oropharyngeal stenosis requiring tracheostomy and gastrostomy tube placement. This case report highlights an extremely rare complication of adenotonsillectomy.- - - - - - - - - - ranking = 0.5keywords = soft (Clic here for more details about this article) |
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