1/41. Polyester fibre prosthetic anterior cruciate ligament implant rupture: necrosis of ingrown connective tissue.AIMS: To describe the histopathological and microanalytical features in seven cases of ruptured Apex(R) polyester (Terylene(R)) fibre anterior cruciate ligament prosthesis. methods AND RESULTS: Transmitted and polarized light microscopy was performed in all cases; one case was investigated by immunohistochemistry, transmission electron microscopy and scanning electron microscopy, with backscatter and X-ray detectors for elemental microanalysis. For comparison we also studied synovial biopsy material and unused polyester fibres. In the excised ligaments there was much ingrowth of fibrous tissue accompanying a florid giant cell reaction to the individual intact polyester fibres throughout the ligaments. phagocytosis of particles of prosthesis-derived material was demonstrated and a striking finding was of necrosis of the ingrown connective tissue in the central portions of the ligaments. Hyalinized areas and 'neoligament growth' were less striking. A consistent finding in the polyester fibres was of small particles containing antimony, used as a catalyst in the manufacturing process. CONCLUSIONS: The pattern of reaction to the prosthetic material and the presence of necrosis differ from previous descriptions in animal and human explants of this and other prosthesis types. The mechanical effect of the necrosis is unlikely to be of significance with this ligament, which is load-bearing ab initio.- - - - - - - - - - ranking = 1keywords = back (Clic here for more details about this article) |
2/41. Foreign body reaction to a metal clip causing a benign bile duct stricture 16 years after open cholecystectomy: report of a case.We present herein a case where a benign bile duct stricture developed 16 years after an open cholecystectomy and without any prior symptoms. The patient was thought to have a Klatskin tumor both pre- and intraoperatively and was treated with a resection of the mass and bile duct confluence, while hepaticojejunostomies were also performed to both ducts separately. A pathologic examination of the specimen revealed extensive fibrosis, chronic inflammation, and a nonnecrotizing granulomata. Any hilar mass presenting after upper abdominal surgery should therefore be considered to be potentially a benign bile duct stricture, even with a long symptom-free interval.- - - - - - - - - - ranking = 2.4582577654643keywords = upper (Clic here for more details about this article) |
3/41. Constrictive pericarditis from an embolized hypodermic needle: radiographic, CT and MR imaging findings.We present the radiographic, computed tomographic (CT), and magnetic resonance (MR) findings in a woman with constrictive pericarditis due to an embolized hypodermic needle. The chest films revealed pleural effusions but no foreign body. The CT showed pericardial thickening and a linear foreign body of metallic attenuation in the right ventricular apex, and MR imaging revealed a signal void with magnetic susceptibility artifact. This case illustrates the capabilities and limitations of CT and MR imaging in hypodermic needle-induced constrictive pericarditis.- - - - - - - - - - ranking = 2.2741520592466keywords = chest (Clic here for more details about this article) |
4/41. blepharoptosis surgery complicated by late suture migration.PURPOSE: To report late suture migration as a complication of blepharoptosis surgery. METHOD: case reports. RESULTS: After upper eyelid blepharoptosis repair, two eyes of two patients developed unusual foreign body reactions and ulceration in the conjunctiva caused by migration of nonabsorbable suture from the levator aponeurosis to the upper conjunctival fornix. The foreign body caused eyelid edema, papillary changes in the upper tarsal conjunctiva, recurrent blepharoptosis, and a foreign body sensation that started more than 3 months after the surgery and persisted until the suture was removed. The sutures, hidden in edematous conjunctiva of the superior fornix, eluded detection. CONCLUSIONS: Foreign body reaction secondary to suture migration is an uncommon complication of blepharoptosis repair.- - - - - - - - - - ranking = 7.374773296393keywords = upper (Clic here for more details about this article) |
5/41. Late operative site pain with isola posterior instrumentation requiring implant removal: infection or metal reaction?OBJECTIVES: To elucidate the cause of late operative site pain in six cases of scoliosis managed with Isola posterior instrumentation that required removal of the implants. METHOD: Microbiologic examination of wound swabs and enriched culture of operative tissue specimens was undertaken in all cases. Histologic study of the peri-implant membranes also was conducted. RESULTS: The presentation in all cases was similar: back pain appearing between 12-20 months after surgery, followed by a local wound swelling leading to a wound sinus. In only one of these cases was the discharge positive for bacterial growth. Implant removal was curative. Histologic examination of tissue specimens revealed a neutrophil-rich granulation tissue reaction suggestive of an infective etiology despite the failure to isolate organisms. Within the granulation tissue was metallic debris that varied from very sparse to abundant from fretting at the distal cross-connector junctions. A review of recent literature describing similar problems suggests that late onset spinal pain is a real entity and a major cause of implant removal. CONCLUSIONS: On reviewing the evidence for an infective etiology versus a metallurgic reaction etiology for these cases of late onset spinal pain, it was concluded that a subacute low-grade implant infection was the main cause. Histologic findings would seem to confirm low-grade infection. There may be more than one causative factor for late operative site pain, as it is possible that fretting at cross connection junctions may provide the environment for the incubation of dormant or inactive microbes.- - - - - - - - - - ranking = 1keywords = back (Clic here for more details about this article) |
6/41. Toothpick injury mimicking renal colic: case report and systematic review.We describe a case of a patient with left flank pain that was caused by a perforation in the splenic flexure of the colon by a toothpick. We conducted a systematic review of the literature to examine the nature of injuries caused by ingested toothpicks. Articles were analyzed for the following outcome variables: presenting complaint, site of injury, recollection of toothpick ingestion, time to presentation, findings from imaging studies, and mortality. Most patients (70%) presented with abdominal pain. Few patients (12%) remember swallowing a toothpick. The onset of symptoms ranged from <1 day to 15 years. Toothpicks caused perforation most frequently at the duodenum and the sigmoid. In some cases, toothpicks migrated outside the gastrointestinal tract and were found in the pleura, pericardium, ureter, or bladder. Toothpicks were apparent on imaging studies in 14% of the cases. The definitive diagnosis was most commonly made at laparotomy (53%), followed by endoscopy (19%). overall mortality was 18%. Ingested toothpicks may cause significant gastrointestinal injuries, and must be treated with caution.- - - - - - - - - - ranking = 20.745697693004keywords = abdominal pain (Clic here for more details about this article) |
7/41. Band infection with splenoportal venous thrombosis: an unusual but severe complication of gastric banding.BACKGROUND: Band infection after gastric banding is a relatively rare complication. In most cases, it is manifested by abdominal pain associated with fever, and/or an abscess surrounding the access port. The treatment of choice consists of band removal and antibiotic therapy, and is usually effective. methods: Among the 322 patients having undergone gastric banding in our department, we report a 31-year-old woman who developed an infection of the band complicated by splenic and portal vein thrombosis 21 months after gastric banding. RESULTS: BMI was 40.9 kg/m2 when she underwent gastric banding. Postoperative course was uneventful, and excess weight loss reached 105% after 18 months. An abdominoplasty combined with bilateral mammoplasty and thigh dermolipectomy were performed. About 3 weeks later, she developed an otitis with fever and left upper abdominal pain. Despite antibiotics, pain and fever persisted. The operative wounds showed no sign of infection, and there was no sign of peritonitis. Computerized tomography showed a left subdiaphragmatic abscess surrounding the catheter and thrombosis of the splenic and portal veins. Treatment consisted of band removal, antibiotics and heparin. Recovery was uneventful with complete resolution of the thrombosis. CONCLUSIONS: Late band infection after gastric banding is rare, and is usually secondary to band erosion. Our case demonstrates that severe band infection can be caused by any infection causing bacteremia. Prompt band removal along with antibiotic therapy is the treatment of choice. Rapid treatment of any infection is mandatory in patients with a gastric band. antibiotic prophylaxis during surgical and dental procedures could be useful in these patients.- - - - - - - - - - ranking = 43.949653151473keywords = abdominal pain, upper (Clic here for more details about this article) |
8/41. Arthroscopic treatment of gunshot wounds to the shoulder.Two cases are presented that demonstrate the utility of arthroscopic intervention for the management of gunshot wounds to the shoulder. The first report involves a 24-year-old man with a retained bullet in his glenohumeral joint after a drive-by shooting The intra-articular bullet was retrieved arthroscopically avoiding chondral injury from the mechanical effects of a loose body as well as the potential local and systemic effects of lead toxicity. Irrigation and debridement was performed to evacuate joint debris, which could have served as a nidus for infection or inflammation. The other case describes a 19-year-old man who sustained a gunshot wound to the lateral portion of his upper arm resulting in a proximal humerus fracture along with a retained bullet in his subacromial space. The bullet was successfully removed arthroscopically avoiding a traditional exposure, which would have complicated his fracture care.- - - - - - - - - - ranking = 2.4582577654643keywords = upper (Clic here for more details about this article) |
9/41. The histology of "reactive lines" in well-fixed components.The histologic findings from 2 total knee arthroplasties (TKAs) in 1 patient who died 5 years after surgery are reported. Cement was placed under the tibial and femoral metal backs but not around the stems. All components were securely fixed. "Reactive lines," present around the tips of the stems on radiography, were seen to contain thin, soft connective tissue without debris or macrophages. The histologic features of a reactive line are described.- - - - - - - - - - ranking = 1keywords = back (Clic here for more details about this article) |
10/41. Metal-backed patellar component failure in total knee arthroplasty presenting as a giant calf mass.Failure of total knee arthroplasty (TKA) caused by wear of the polyethylene-bearing surface of a metal-backed tibial platform or a metal-backed patellar component is a recognized complication. We present a case of a 78-year-old woman with a cystic mass in the left calf caused by metal wear debris from the failure of a Miller-Galante I TKA. The patient received a left TKA to treat advanced osteoarthritis in July 1990 and was lost to follow-up immediately after the operation. In December 1998, she presented at our clinic 2 days before admission, when an originally silent mass over the calf turned intolerably painful. A series of examinations revealed a calf mass caused by wear debris of total knee prosthesis and subsequent inflammation of the knee joint. curettage of the cyst and simultaneous revision TKA were successful in relieving her symptoms.- - - - - - - - - - ranking = 6keywords = back (Clic here for more details about this article) |
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