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In this report, we describe a case of delayed enteric fistula to the hip fusion mass, 30 years after the hip fusion surgery with confusing symptoms at presentation.
Fistula formation between bowel and the hip joint after a hip surgery is rare. Enteroarticular fistula can be fatal because of sepsis. The enteric fistula to the hip joint diagnosis may not always be straight forward, and it should be kept in mind as a probable differential diagnosis in many unrelated scenarios. Complete physical examination, preoperative sampling, paying attention to the intermittency of secretions during starvation, and timely consult with general surgeons can help.
Fistula formation between bowel and the hip joint after a hip surgery is rare. Enteroarticular fistula can be fatal because of sepsis. The enteric fistula to the hip joint diagnosis may not always be straight forward, and it should be kept in mind as a probable differential diagnosis in many unrelated scenarios. Complete physical examination, preoperative sampling, paying attention to the intermittency of secretions during starvation, and timely consult with general surgeons can help.
A 11-year-old boy with no medical history presented with a protective limp and worsening mechanical pain in his left knee. No recent traumatic or infectious history was reported. Radiographs and ultrasonography showed multiple intra-articular loose bodies with osteocartilaginous signal. Dysplasia epiphysealis hemimelica (DEH) was confirmed by magnetic resonance imaging (MRI) and computed tomography (CT) scan. This is the first report that describes the presence of loose bodies in a knee without previous surgery as a possible case of DEH.
We emphasize the use of CT scan and MRI before any surgical procedure when intra-articular loose bodies are unexpectedly discovered.
We emphasize the use of CT scan and MRI before any surgical procedure when intra-articular loose bodies are unexpectedly discovered.
A 7-year-old boy sustained a Monteggia fracture-dislocation. Corrective osteotomy of the ulna was performed to restore proper forearm anatomy and achieve radial head reduction. Recurrent radial head instability was noted postoperatively, and magnetic resonance imaging indicated recurrent dislocation of the radial head with, notably, an entrapped brachialis tendon and annular ligament. Open reduction of the elbow was performed. Anatomic reduction of the radiocapitellar joint and full range of motion without instability was achieved.
To the best of our knowledge, this is the first report of persistent radial head instability because of an entrapped brachialis tendon.
To the best of our knowledge, this is the first report of persistent radial head instability because of an entrapped brachialis tendon.
We report a 4-year-old girl with congenital muscular torticollis (CMT) who was treated with sternocleidomastoid muscle (SCM) tenotomy using ultrasonography (US). Prior to the surgery, US was utilized to identify the clavicle and sternum branches of the SCM, sternohyoid muscles, internal jugular vein, and common carotid artery. Then, local anesthesia was injected into the layer between the fascial sheath of the SCM and carotid sheath to reduce bleeding and avoid vascular injury. During surgery, the SCM dissection was carefully conducted under US guidance to avoid vascular injury. No residual of SCM dissection and improvement of neck motion were confirmed before the skin closure. Postoperative course was good with no obvious complications in this patient.
The intraoperative US investigation during SCM tenotomy is a useful procedure that provides vital information about dissection area of SCM and orientation of internal jugular vein that reduces the risk of insufficient tenotomy and vascular injury.
The intraoperative US investigation during SCM tenotomy is a useful procedure that provides vital information about dissection area of SCM and orientation of internal jugular vein that reduces the risk of insufficient tenotomy and vascular injury.
A 25-year-old man presented with a closed calcaneal fracture after a 6-storey fall, complicated by osteomyelitis from fixation attempts necessitating near-complete debridement of his calcaneal tuberosity. He underwent a successful single-stage calcaneal and soft-tissue reconstruction using a femoral head structural allograft vascularized with an osteocutaneous medial femoral condyle flap. At the 18-month follow-up, his limb is largely pain-free and functional, allowing ambulation and his combined allograft-vascularized bone reconstruction shows radiographic evidence of incorporation.
Calcaneal tuberosity reconstruction with a femoral head structural allograft and vascularized bone flap is a viable option for calcaneal tuberosity bone loss because of injury/infection.
Calcaneal tuberosity reconstruction with a femoral head structural allograft and vascularized bone flap is a viable option for calcaneal tuberosity bone loss because of injury/infection.
We describe a case of lymphatic injury that occurred during a 2-level vertebral column resection for spinal deformity correction from a posterior-only approach. Large surgical drain volume output with laboratory findings of high levels of triglycerides and lymphocytes prompted conservative treatment with an elastic wrap bandage and a "no fat" diet. The patient responded to the treatment with no sequelae noted.
Lymphatic complications are rare in spine surgery. All reported cases are associated with anterior approaches. The lymphatic injury presented here demonstrates the potential for this complication to occur during posterior-only approaches as well.
Lymphatic complications are rare in spine surgery. All reported cases are associated with anterior approaches. The lymphatic injury presented here demonstrates the potential for this complication to occur during posterior-only approaches as well.
Dedifferentiated chondrosarcoma is a chondrosarcoma subtype associated with high rates of recurrence and a poor prognosis. Others have proposed treatment of dedifferentiated chondrosarcoma using osteosarcoma protocols, including perioperative chemotherapy. However, the rarity of this condition poses difficulties in undertaking single- institution studies of sufficient sample size.
Is perioperative chemotherapy associated with improved overall survival in patients with dedifferentiated chondrosarcoma?
We queried the Surveillance, Epidemiology, and End Results (SEER) 1973 to 2016 database for patients with a diagnosis of dedifferentiated chondrosarcoma (n = 308). As dedifferentiated chondrosarcoma was only classified as a distinct entity in SEER starting in 2000, only patients treated in 2000 and later were included. We excluded from our analyses those patients with distant disease at diagnosis, a primary site of disease other than bone or joints, and those who did not receive cancer-directed surgery. Thefindings are nevertheless consistent with those of prior reports in which no benefit of chemotherapy could be detected. Lack of clear benefit from perioperative chemotherapy in dedifferentiated chondrosarcoma argues that it should be used only after careful consideration, and ideally in the context of a clinical trial.
Level III, therapeutic study.
Level III, therapeutic study.
A 79-year-old woman presented after a ground level fall with the inability to bear weight on her right hip. Radiographs and computed tomography (CT) imaging were negative for a femoral neck fracture. Her medical comorbidities precluded magnetic resonance imaging (MRI), so dual-energy CT with focused evaluation for bone edema was performed, identifying a femoral neck fracture that was stabilized surgically.
Dual-energy CT with processing for edema can successfully identify nondisplaced femoral neck fractures in MRI-contraindicated patients. This imaging modality could be useful for diagnosing femoral neck stress fractures and ipsilateral femoral neck fractures in patients sustaining high-energy femoral shaft fractures.
Dual-energy CT with processing for edema can successfully identify nondisplaced femoral neck fractures in MRI-contraindicated patients. This imaging modality could be useful for diagnosing femoral neck stress fractures and ipsilateral femoral neck fractures in patients sustaining high-energy femoral shaft fractures.
A large body of evidence is emerging to implicate that dysregulation of the gut microbiome (dysbiosis) increases the risk of surgical site infections. Gut dysbiosis is known to occur in patients with inflammatory bowel disease (IBD), allowing for translocation of bacteria across the inflamed and highly permeable intestinal mucosal wall. The null hypothesis was that IBD was not associated with an increased risk of periprosthetic joint infection (PJI) after primary total hip and knee arthroplasty.
A matched cohort study was designed. The primary end point was the occurrence of PJI at 2 years postoperatively. The secondary end points were aseptic revisions at 2 years postoperatively, discharge to a rehabilitation facility, complications up to 30 days after total joint arthroplasty, and readmission up to 90 days after total joint arthroplasty. The International Classification of Diseases, Ninth Revision (ICD-9) and Tenth Revision (ICD-10) codes were used to identify patients with IBD and the control cohort. Aknown, but could be related to bacterial translocation from the inflamed intestinal mucosa, the dysregulated inflammatory status of these patients, malnutrition, and potentially other factors. Some of the aseptic failures could be as a result of infection that may have escaped detection and/or recognition.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
To study the effect of Yu Linzhu on ovarian function and mitochondria in natural aging mice.
Female BALB/c mice were selected as normal group at 7-8 weeks and natural aging group at 9 months. The natural aging group was divided into Yu Linzhu intervention group and non-intervention group by intragastric administration once a day for 6 weeks. The morphology and blood flow of ovary were observed by ultrasound. Oleic Ovarian morphology and follicle were observed by HE staining. Hormone levels were analyzed by ELISA. Serum oxidative stress were detected by radioimmunoassay. The distribution of mitochondria in oocytes was observed by fluorescence staining. The ultrastructure of oocytes and the morphology of mitochondria were observed under electron microscope. The mitochondrial membrane potential was detected by JC-1.
Two groups of aging mice had serious disturbance of estrus cycle. The ovarian area of the mice in the aging non-intervention group was smaller than that in the normal group, and the ovarian area of t by improving the mitochondrial function of oocytes.Nowadays, predictive medicine begins to become a reality thanks to Artificial Intelligence (AI) which allows, through the processing of huge amounts of data, to identify correlations not perceptible to the human brain. The application of AI in predictive diagnostics is increasingly pervasive; through the use and interpretation of data, the first signs of some diseases (i.e. tumours) can be detected to help physicians make more accurate diagnoses to reduce the errors and develop methods for individualized medical treatment. In this perspective, salivary gland tumours (SGTs) are rare cancers with variable malignancy representing less than 1% of all cancer diagnoses and about 5% of head and neck cancers. The clinical management of SGTs is complicated by a high rate of preclinical diagnostic errors. Today, fine needle aspiration cytology (FNAC) represents the primary diagnostic tool in the hands of clinicians. However, it provides information that about 25% of cases are dubious or inconclusive, complicating therapeutic choices.
