Cases reported "Chronic Disease"

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1/7. Stress fracture of the hip and pubic rami after fusion to the sacrum in an adult with scoliosis: a case report.

    Correction of adult scoliosis frequently involves long segmental fusions, but controversy still exists whether these fusions should include the sacrum. It has been suggested that forces associated with activities of daily living transfer the stresses to the remaining levels of the spine and to the pelvis. The case described here was a 43-year-old woman with scoliosis and chronic back pain refractory to non-surgical modalities. Radiographically, the patient had a 110 degree lumbar curve. An anterior and posterior fusion with Luque-Galveston instrumentation was performed. Six months postoperatively the patient returned with a 2-week history of right hip pain with no history of trauma. There was radiographic evidence of a displaced femoral neck fracture and pubic rami fractures. The femoral neck fracture was treated with a total hip replacement. Further surgeries were required to correct a lumbar pseudoarthrosis and hardware failure. We believe that this case provides evidence that fusion into the lumbosacral junction may distribute forces through the pelvic bones and hip resulting in stress and potential hardware complications, especially in patients at risk due to osteopenic conditions.
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2/7. Squamous cell carcinoma arising in chronic perianal pyoderma a case report and review of Japanese literature.

    We report a rare case of squamous cell carcinoma developing from fistules of chronic perianal pyoderma in a 49-year-old Japanese man. He first noticed an abscess and nodule on his buttocks and perianal area 21 year previously (at the age of 28); the fistules formed later. These fistules were surgically removed, and an artificial anus was constructed 14 years ago (at the age of 35) in our hospital, when a histopathological examination revealed no malignant changes. However, he was recently admitted to our hospital with arterial bleeding from the ulcer of the buttock. On admission, the histological diagnosis of the ulcer was well differentiated squamous cell carcinoma. Wide local excision of the ulcer and scar tissue, including the sacrum, was performed. The defect was covered with a left latissimus dorsi flap and skin graft. He received radiation therapy after the operation. However, he died of cachexia and pneumonia. This case indicated that the CPP would better have been treated with wide excision before the development of SCC. Therefore, we recommend careful follow-up of patients affected by CPP and repeated biopsies of the lesion, particularly when the condition is severe, longstanding, and extensive. We discussed the term "CPP" and reviewed 22 cases of SCC arising in CPP reported in the Japanese literature.
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3/7. Successful treatment of post traumatic stress disorder and chronic pain with paraspinal square wave stimulation.

    OBJECTIVE: To determine if Paraspinal Square Wave Stimulation (PSWS) is effective in treating Post Traumatic Stress Disorder (PTSD) and or chronic pain. METHOD: PSWS is applied to the paraspinal area from the craniocervical junction to the lower sacrum. RESULTS: Patient achieved dramatic relief from PTSD, unequaled by any previous pharmacologic or psychotherapies. The chronic pain is almost completely disappeared, unlike any previous therapies. CONCLUSION: PSWS is the treatment of choice for this patient with PTSD and chronic pain. This patient appears to have completely recovered from PTSD, unlike any other study reported so far.
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4/7. chiropractic management of patients with bilateral congenital hip dislocation with chronic low back and leg pain.

    OBJECTIVE: To discuss conservative methods for treating patients with chronic low back and leg pain associated with the biomechanical and postural alterations related to bilateral congenital hip dislocation. CLINICAL FEATURES: This report describes the cases of 2 adult female subjects with bilateral congenital hip dislocation without acetabula formation who suffered from chronic low back and leg pain managed conservatively by chiropractic methods. The first subject is a 45-year-old woman with a 9-month history of right buttock pain and radiating right leg pain and paresthesia down to the first 2 toes, with a diagnosis of a herniated L4 intervertebral disk. The second subject is a 53-year-old woman who complained of chronic intermittent low back pain and constant unremitting pain on her right leg for the last 3 years. INTERVENTION AND OUTCOME: chiropractic manipulation utilizing Logan Basic apex and double notch contacts, as well as sacroiliac manipulation on a drop table with a sacrum contact and with a posterior to anterior and superior to inferior (PA-SI) rocking thrust, together with a spinal stabilization exercise program, were used on these 2 patients. Both patients had significant clinical improvement, with reduction on the Visual Analogue Scale (VAS) of 67% and 84%, Oswestry Disability Index improvement of 73% and 81%, and an improvement on the Harris hip score of 71% and 44%, respectively. CONCLUSION: A conservative management approach, including specific chiropractic manipulation and a spinal stabilization exercise program, can help manage the treatment of adult patients with chronic low back and leg pain related to bilateral congenital dislocation of the hips.
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keywords = sacrum
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5/7. Chronic recurrent multifocal osteomyelitis: two cases of sacral disease responsive to corticosteroids.

    Chronic recurrent multifocal osteomyelitis is a rare inflammatory form of osteomyelitis of unknown etiology. It affects children and adolescents, and signs and symptoms include recurrent episodes of bone pain, tenderness, possible constitutional upset, and increased inflammatory markers. We present 2 patients with cases of chronic recurrent multifocal osteomyelitis affecting the sacrum who responded dramatically to treatment with corticosteroids.
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6/7. chondroblastoma of the sacrum. A case report.

    death due to a chondroblastoma of the sacrum is uncommon. We report the case of a 48-year-old man with this condition. During a 10-year period, the tumor spread into the retroperitoneal space and was an enormous mass after repeated radiotherapy. The patient died of renal failure. The tumor was histologically benign even at autopsy.
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7/7. Anterior sacral meningocele. A presentation of three cases.

    Anterior sacral meningoceles are congenital lesions that consist of a spinal fluid-filled sac in the pelvis communicating by a small neck with the spinal subarachnoid space through a defect in the sacrum. The three patients with this disorder presented here had characteristic symptoms snd physical findings: chronic constipation, a pelvic mass, and almost unmistakable roentgenographic changes, but diagnosis was delayed from 11 months to 21 years in all three. After prolonged and complicated treatment, the primary lesions have been surgically eradicated and function is generally satisfactory.
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