Muscle hernia in a recreational athlete

Muscle hernia is not a new entity but has received little attention in the medical literature. With the public's increased interest in fitness and physical conditioning, it is likely that the orthopaedic surgeon will encounter these injuries. We present the case of a recreational athlete with a peroneus longus muscle hernia that was successfully treated by fasciotomy.

[Spontaneous hematoma of the rectus muscle]

The possibility of heart surgery and vascular surgery and the increased number of dialyzed patients receiving dicourmarin and heparin treatment raises the question of the probable rupture of the abdominal muscles, in particular the rectus muscles, following the onset of lancing abdominal pain. The authors report a clinical case referred to them in emergency conditions. They examine the possible etiopathogenetic causes and underline the symptoms of acute abdomen in patients being treated with anti-coagulating drugs.

Omentum as gliding material after extensive forearm tenolysis

Tendon adhesion occurring after major replantation can be severe and extensive due to the nature of the trauma, ischaemia, prolonged oedema and/or infection. Therefore there is a high possibility of re-adhesion after tenolysis. In two cases of tenolysis after forearm replantation omentum was used as gliding material and good results were obtained.

Abdominal wall metastases from ovarian cancer after laparoscopy

We report three cases of abdominal wall metastases from ovarian cancer after laparoscopy. The implants occurred at the site of insertion of laparoscopy trocars. One patient had an implant of serous papillary carcinoma of low malignant potential at the trocar sites after laparoscopic oophorectomy. Laparoscopic surgery is inappropriate in patients with malignant ascites or when preoperative or intraoperative findings are suggestive of ovarian cancer.

Paraspinal soft-tissue sarcoma. Classification of 14 cases

Fourteen patients were treated surgically for soft-tissue sarcoma arising in the paraspinal muscles. Eleven patients received adjuvant irradiation administered before or after resection. In describing the treatment and outcomes of these patients, a new classification of paraspinal soft-tissue sarcoma is introduced that is based on the anatomic relationship of the tumor to the spinal lamina and the epidural space. This classification can be used in planning combined modality treatment for paravertebral sarcomas. Lesions that extend through the lamina into the epidural space present an unanswered problem for local control.

Reconstructive considerations for limb salvage surgery

Tumors in the musculoskeletal system are generally treated surgically, although radiation therapy and chemotherapy have greatly improved survival statistics of patients with high-grade sarcomas of the musculoskeletal system. The mainstay in treatment of nearly every primary tumor of the musculoskeletal system is surgical resection for cure. Radiation therapy and chemotherapy continue to be important adjuvants in the overall management of musculoskeletal tumors. Functional limb salvage following radical resection is now possible in most resectable cases by placement of an alloplastic prosthesis, homograft, or autogenous bone for skeletal reconstitution, followed by well-vascularized soft-tissue coverage.

[Actinomycosis abscess developing in the rectus muscle. (One case history)]

A 36 year old male patient having an abscess in right rectus muscle's cover 2 years after stomach operation; attended to our hospital. The abscess was discharged. Following this, at 6 months intervals new abscess were formed in left lower and right upper rectus cover and discharged. Samples from abscess were routinely observed microbiologically and for tuberculosis; but the etiologic agent could not be identified. Six months later the patient attended to our hospital with abscess in right lower rectus cover again. The sample taken from the patient was examined thinking actinomycosis. After clinical and microbiological observation, the causative agent was identified as Actinomyces israeli.

Reconstruction of the abdominal wall with a latissimus dorsi musculocutaneous flap: a case of a massive abdominal wall metastasis from a cervical cancer requiring palliative resection

A 49-year-old woman presented with a huge abdominal mass. At laparotomy, a 36-cm diameter semisolid, semicystic mass from the abdominal wall was removed. The peritoneal defect was covered by a mesh and a free latissimus dorsi myocutaneous flap. Histology showed a poorly differentiated squamous cell carcinoma consistent with metastatic tumor from a cervical primary. Surgery has a finite palliative role to extirpate a tumor mass of this size if reconstruction and some form of closure can be achieved.

Low back pain. Does it always come from the lumbar spine?

Chronic pain can be a difficult problem to manage. Nevertheless, keeping an objective approach and not passively accepting previous diagnosis can result in a good outcome for the patient.

Prosthetic replacement of the shoulder for the treatment of defects in the rotator cuff and the surface of the glenohumeral joint

We operatively treated, between 1978 and 1987, twenty-one shoulders in nineteen patients, fifty-four to eighty-four years old, who had disabling pain attributable to a massive tear of the rotator cuff, accompanied by loss of the surface of the glenohumeral joint. These patients were not candidates for total shoulder replacement because of the massive deficiency in the cuff and the fixed upward displacement of the humeral head. A prerequisite for hemiarthroplasty was a functionally intact coracoacromial arch to provide superior secondary stability for the prosthesis. One important aspect of the operative technique was the selection of a sufficiently small prosthesis so that excessive tightness of the posterior aspect of the capsule could be avoided. Eighteen shoulders in sixteen patients were available for follow-up, which ranged from twenty-five to 122 months. Pain decreased from marked or disabling in fourteen shoulders preoperatively to none or slight in ten and to pain only after unusual activity in four. Active forward elevation improved from an average of 66 degrees preoperatively to an average of 109 degrees postoperatively. One patient, who had had an excellent result, fell and sustained an acromial fracture, so the functional result changed to poor. Three patients had persistent, substantial pain in the shoulder that led to a revision. Neither infection nor prosthetic loosening developed in any shoulder.

[Primary muscular echinococcosis: a clinical case]

Muscular localization of echinococcosis is considered unusual. The authors report a case of such uncommon hydatid localization. Pathogenetic hypotheses are discussed.

Combined modality treatment for tumoral calcinosis

Tumoral calcinosis is a rare syndrome marked by periarticular and intramuscular calcifications. We present the case of a 13-year-old black girl who has received treatment since age 2 for tumoral calcinosis with bilateral shoulder involvement.

[Hemangioma of the masseter: a rare location of a pathology not always accurately diagnosed]

The hemangiomas of the skeletal muscles are rare. The authors describe a case of masseter muscle hemangioma, dwelling upon the problems of differential diagnosis that are present for the straight rapport that the muscle contract with the parotid gland. Thus, the surgeon is led to confuse the malformation with a neoplasm of the parotid gland.

[Echinococcal cysts with primary muscle localization: comments on a clinical case]

Primary muscular localization of echinococcosis is rare and unknown are the causes that determine it. The authors report a case recently observed and illustrate the etiopathogenetic hypothesis more accredited in the literature. It is concluded that surgical treatment is the best choice, although relapses are possible. Therefore, a long term follow up of the patients including clinical and serological investigations is advisable.

Evaluation and treatment of biceps tendon pathology

Until recently, the role of the long head of the biceps tendon as a source of shoulder pain had been controversial. With careful examination, improved imaging techniques, and arthroscopy, a specific diagnosis can be made. In 95% of patients, biceps tendinitis is secondary to a primary diagnosis of impingement syndrome. Subluxation of the biceps tendon and primary biceps tendinitis are diagnoses of exclusion. However, in the properly selected patient, both respond well to biceps tenodesis. Rupture of the long head of the biceps tendon can be the end result of any of these pathologic processes. In the older sedate patient, conservative treatment results in little functional loss and a mild cosmetic deformity. In the young active patient, especially those who perform tasks that require supination strength, a primary biceps tenodesis should be performed, as well as decompression if there is any evidence of impingement. The key to successful treatment of lesions of the long head of the biceps tendon is recognition of associated pathologic findings in the shoulder. With advances in arthroscopy, the orthopedist can tailor treatment exactly to the pathology, minimizing morbidity and maximizing a successful outcome.

Surgical repair of an anterior tibialis muscle hernia with Mersilene mesh

The most frequent muscle hernia of the lower extremities is the anterior tibialis muscle hernia. A number of surgical procedures are available for the treatment of symptomatic anterior tibialis muscle hernias. However, in case of a large fascial defect, their use may be unfeasible or inconvenient. Moreover, current surgical procedures are prone to the risk of an anterior tibial compartment syndrome. The use of a synthetic patch could provide an alternative, particularly for large defects. In this paper we report the repair of a large, symptomatic, long-standing anterior tibialis muscle hernia with polyester mesh (Mersilene) fixed to the edges of the defect (muscular fascia and tibial periosteum). This simple procedure provided excellent functional results and a good cosmetic appearance without complications and sequelae.

Bilateral femoral nerve compression by iliacus hematomas complicating anticoagulant therapy

An unusual case of bilateral femoral nerve compression caused by iliacus hematomas in a patient on anticoagulant therapy is herein reported with special reference to the comparative diagnostic value of ultrasonography, computerized tomorgraphy, and magnetic resonance imaging. The importance of early surgical decompression is also emphasized.

Congenital muscular torticollis: long-term follow-up of thirty-eight partial resections of the sternocleidomastoid muscle

Thirty-eight patients with muscular torticollis were treated by a partial resection of the sternocleidomastoid muscle between 1970 and 1981. Clinical evaluations were performed on 35 of these patients who were followed up for 10 years (average of 11.3 years). Of 31 patients under 5 years of age at operation, good results according to Canale's criteria were obtained in 28 (90%). In four patients aged 6 years or more at operation, three showed good results. Postoperatively, massive cotton bandaging was applied with the neck in the neutral position for 3 weeks. A plaster cast, brace, or physiotherapy involving active motion training was not necessary.

[Diagnostic difficulties and errors in neoplasms of the diaphragm]

During 1972-1990 twelve patients with tumors of the diaphragm were operated upon. Age of the patients was from 39 to 60 years. Nine patients had benign tumors and cysts, 3 patients had malignant tumors. Exact nosological diagnosis before operation was not made. Topical diagnostic errors were either due to incomplete volume of examinations or to a refusal of using special roentgen contrast methods.

Tissue characterization and assessment of preoperative chemotherapeutic response in musculoskeletal tumors by in vivo 31P magnetic resonance spectroscopy

This study investigates the potential of in vivo 31P magnetic resonance spectroscopy (MRS) to characterize musculoskeletal tumors and to determine preoperative levels of histological necrosis, which is an important clinical indicator of patient response. Pretherapy MRS was performed on 28 patients with large musculoskeletal tumors: 13 with osteosarcoma, 3 with chondrosarcoma, 5 with malignant fibrous histiocytoma, 1 with desmoid tumor, 1 with Ewing's, 2 with hemangioendothelioma, 1 with myxoid liposarcoma, 1 with synovial cell sarcoma, and 1 with rhabdomyosarcoma. Fifteen patients had follow-up MRS examinations after commencement of chemotherapy (mean of five/patient), eight of whom have now had surgery. Elevated levels of PMEs (P < 0.01), P(i) (P < 0.01), and PDEs (P < 0.02) as well as elevated tumor pH (P < 0.05) were observed in all patients. The synovial cell sarcoma was characterized by high levels of PMEs (> 20%) and low pH (pH 6.76). This contrasted with the spectra obtained from the malignant fibrous histiocytomas which had high levels of PDEs (17 +/- 5%). Reductions in PDE levels postchemotherapy were associated with a high degree of necrosis (> 90%) at surgery, while an increase in PDE levels was associated with a low level of histological necrosis. Likewise, reductions in the ratios PDE/NTP and PDE/PCr and an increase in P(i)/PDE were also associated with a high level of necrosis.

The snapping biceps femoris syndrome

Snapping of tendons is a well-described entity in the literature, occurring mostly in athletes around the hip, ankle, shoulder, and elbow, but rarely the knee. A case of snapping of the biceps femoris tendon (BFT) in a patient with a painful knee and no history of trauma is described. An abnormal anterior insertion of the BFT was found to be the cause of the pain and snapping. Surgical treatment, reinsertion of the tendon in its anatomic position, completely corrected the abnormality, whereas conservative treatment failed.

[A rare tumor: desmoid of the musculus rectus abdominis. Apropos a clinical case]

The authors report a case of left abdominal rectum muscle desmoid tumor which has been surgically treated. After some considerations of the particular pathogenetic, anatomopathological and clinical characteristics of this neoplasm, they state that a precise preoperative diagnosis is always difficult, in spite of modern diagnostic means. They conclude that, nowadays, surgical extirpation is the most reliable therapeutical method, although it is burdened by a consistent incidence of local recidives (over 30%).