1/12. Sequestered viscoelastic after deep lamellar keratoplasty using viscodissection.PURPOSE: Deep lamellar keratoplasty (DLKP) is an intricate procedure that preserves the host's endothelium, thus eliminating the possibility of endothelial graft rejection and potentially offering great benefits over penetrating keratoplasty. DLKP may be performed by a variety of techniques including viscodelamination, in which the stroma is separated from Descemet's membrane using viscoelastic. methods: Here we present an operative complication of this technique, which was not initially recognized, that caused significant morbidity to our patient and eventually led to the eye requiring a full thickness regraft. We also attempt to reproduce the lesion using nonviable cadaver corneas and illustrate histologically the nature of the corneal stroma and its relationship to Descemet's membrane following viscoelastic delamination.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/12. cecum malakoplakia: a tumor-like lesion with coexistent adenocarcinoma.We report the case of a 75-year-old Caucasian male who presented with acute abdomen and fecal leakage from his old appendectomy scar and required exploratory laparotomy. A large cecal mass was found and a right colectomy was performed. At pathology, the neoplastic mass was identified as malakoplakia with a small area corresponding to a moderately differentiated colonic adenocarcinoma. Occurrence of malakoplakia in the cecum, associated with adenocarcinoma, is extremely rare if we take into account the limited number of the reported cases of its coexistence with colonic cancer; our case is the second report of such an entity in the cecum. The unusual presence of fistula to the appendectomy scar may be related to the infiltrative nature of the histiocytes constituting this process. Immunochemical studies can assist in the histopathologic differentiation of malakoplakia from other entities that might represent with this tumor-like configuration.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/12. Lesion of the common peroneal nerve during arthroscopy.Arthroscopic knee surgery has been well accepted worldwide and has become an important part of orthopaedic surgery. The use of arthroscopy has reduced the duration of hospitalization, overall costs, and time required for the patient to return to sports activities or work. However, because of the closed nature of the procedure and proximity of neurovascular structures to instruments, substantial risk of injuries exists. Significant anatomic variability in the nerve course has not been reported in previous literature as a cause of a knee arthroscopy complication. We present a case of complete transection of an unusually located common peroneal nerve during a knee arthroscopy for lateral meniscal repair in a 22-year-old football player.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/12. Management of an unusual extreme extension contracture of the wrist: role of a custom-designed exercise program in achieving a good range of movement and prevention of recontraction.An extreme extension contracture of wrist with dorsal contracture of fingers 15 years after burn injury is described. Shortening of extensor tendons, secondary lengthening of flexor tendons, contracted wrist joint capsule, unusual dislocation of carpals, dorsal dislocation of metacarpophalangeal joints of fingers, and provision of sufficient amount of good-quality skin were some of the issues that had to be addressed in treatment. The contracture was released, the carpals and metacarpophalangeal joint dislocations were corrected and fixed with K wires, and the resulting defect was covered with a sheet split-thickness skin graft. An exercise program was designed that consisted of isotonic, isokinetic, and isometric resistance exercises and passive, active, and active-assistive range of motion exercises. These exercises were pursued with the intention of increasing dynamic strength, endurance, and overall functional recovery of the flexor muscles by exploiting the immature nature of early scar tissue. The resultant enhanced flexor muscle power from exercises along with the dynamic splint helped in lengthening of extensor tendons, wrist joint capsule, and split-thickness skin graft. It also helped in resisting the recontracting tendency, with further recovery of good range of wrist and fingers movements, obviating the need of tendon-lengthening surgery and flap coverage. One and half years of follow up didn't show any sign of recontracture, and the patient was able to perform his routine activities. Postburn wrist contractures of such magnitude have been seldom described. Emphasis is put on simple contracture release and a postoperative exercise program.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/12. Calvarial erosion after scalp expansion.A case is described of tissue expansion of the scalp with resultant erosion of the outer table and diploe of the calvaria. This resorption may have resulted from a prolonged period of expansion, excessive tension from inflation, and/or the nature or location of the defect. In cases of scalp expansion where the loose areolar space has become obliterated, periodic limited computed tomographic scanning may be useful to monitor the integrity of the skull. Postexpansion protective headgear may be indicated in selected patients.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/12. Blisters over burn scars in a child.We present the case of an 11-month-old baby with a burn that healed normally over a month, but subsequently developed successive crops of blisters over the scar. There were no changes in his general condition. Clinical, immunological, histological and ultrastructural studies provided a diagnosis of mechanical dermatitis produced by microtrauma. Electron microscopy studies revealed the sub-epidermal nature of the blisters and the presence of underlying fibrin deposits.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/12. Congenital unilateral orbital fibrosis with suspected prenatal orbital penetration.Congenital fibrosis of the extraocular muscles includes various abnormalities ranging from isolated fibrosis of a single muscle to bilateral involvement of all extraocular muscles. Congenital unilateral orbital fibrosis is a specific fibrosis syndrome with only five cases previously reported. Although these reports postulated that a prenatal orbital inflammatory process caused the fibrosis, no etiology was proposed, nor was a mechanism suggested for entrance of the inflammation into the orbit. We discuss three additional cases in which evidence suggested prenatal orbital penetration. In one, a dense scar was found at birth from the skin of the upper lid to beyond the trochlea. The second had a dense fibrous tract extending from the upper lid skin to the trochlea and beyond into the orbit without a skin scar. These lesions could have been inflicted by the fetuses' own fingers or toes or, in the second case, by the twin fetus. The third had a benign mesenchymoma of the nasopharynx and skull that had eroded the medial orbital wall, which was seen on computed tomography scan but not on routine x-rays. The nature of the inflammatory substance is unknown. There was no other evidence of inflammation or infection in the eight reported cases. Possibly amniotic fluid itself, entering the orbit "late" in gestation, might cause this inflammation. We recommend that all children with congenital unilateral orbital fibrosis be examined specifically for defects in the orbit, and that computed tomography be employed rather than plain x-rays.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/12. Pseudoneurilemoma of the spinal canal.Two cases are presented with the myelographic appearance of an intradural tumor believed to be neurilemoma. In one instance the defect was undoubtedly caused by a cicatrix which developed over a period of years, consequent to postoperative spinal fluid fistula. In the second case a herniated disk at the L2-3 level was mistaken as artifact and its true nature was revealed only at operation seven years later. It was suspected to be neurilemoma because of the myelographic appearance and persistence of the lesion.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/12. thumb reconstruction in the severely burned hand.The standard techniques have generally been adequate for thumb reconstruction in the severely burned hand. The basic principles of preservation of length, prevention of malposition and contracture by appropriate splinting, early motion, and early skin coverage are all applicable. The nature of the tissue changes wrought by the burn wound, however, frequently necessitates certain modifications in the approach to surgical reconstruction. We have described these and our methods used in handling 9 specific cases.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/12. A shorter lag period of mesenchymal malignancy on Marjolin's ulcer.Marjolin's ulcers generally appear on a burn scar a long time after initial burn injury. A 21-year-old man sustained a thermal burn injury to his right elbow. The ulcer appeared 3 years after and the tumour enlarged and reached a size of 11 cm in diameter in a short period of time. The tumour mass was excised and the donor site was grafted. Right axillary lymph node dissection was carried out. Immunohistochemical studies showed that the nature of the tumour was mesenchymal. Both mesenchymal malignancy and shorter lag period are rarely seen in Marjolin's ulcer.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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