Carpal tunnel syndrome due to an atypical deep soft tissue leiomyoma: The risk of misdiagnosis and mismanagement

<p>Abstract</p> <p>Background</p> <p>Leiomyomas of the deep soft tissue are quite uncommon and occur even more rarely in upper extremity.</p> <p>Case presentation</p> <p>A 32-year old manual laborer man presented with a two-year history of numbness, tingling and burning pain in the palmar surface of the left hand and fingers. His medical history was unremarkable and no trauma episode was reported. According to the clinical examination and the result of median nerve conduction study (NCS) the diagnosis of carpal tunnel syndrome was established. Operative release of the transverse carpal ligament was subsequently performed but the patient experienced only temporary relief of his symptoms. MRI examination revealed a deep palmary located mass with well-defined margins and ovoid shape. Intraoperatively, the tumor was in continuity with the flexor digitorum superficialis tendon of the middle finger causing substantial compression to median nerve. Histopathological findings of the resected mass were consistent with leiomyoma. After two years the patient was pain-free without signs of tumor recurrence.</p> <p>Conclusion</p> <p>Despite the fact that reports on deep soft tissue leiomyoma are exceptional, this tumor had to be considered as differential diagnosis in painful non-traumatic hand syndromes especially in young patients.</p

Brucella cervical spondylitis complicated by spinal cord compression: a case report

A case of 65-year-old farmer who presented with Brucella-related cervical spondylitis is described. Because of the advanced form of the infection resulted in neurological impairment, cervical vertebra corpectomy and debridement of the paravertebral granulomatous tissue deposits were performed followed by stabilization with anterior plating and bone grafting. In addition, double antimicrobial chemotherapy regimen was administered for 12 weeks. After one year, follow up evaluation demonstrated resolution of the infection. The authors recommend that brucellosis should be included in the differential diagnosis of cervical spondylitis, particularly in patients who reside in countries where the zoonosis is still endemic

Ulnar Nerve Compression in the Cubital Tunnel by an Epineural Ganglion: A Case Report

Abstract Epineural ganglia are considered to be a usual cause of peripheral nerve compression. In this report, we present a rare case of ulnar nerve compression by an epineural ganglion in the cubital tunnel. A 28-year-old right-handed female secretary developed progressive pain, numbness, and weakness in her right elbow, forearm, and hand for 6 months. Atrophy of the adductor pollicis and the first dorsal interosseous muscles was apparent. Clinical examination revealed a cystic mass at the posterior side of the elbow. Magnetic resonance imaging identified a ganglion while electrophysiologic studies revealed a severe conduction block of the ulnar nerve at the elbow. During surgery a 2-cm diameter epineural ganglion was identified compressing the ulnar nerve and was excised using microsurgery techniques. Two months postoperatively, the clinical recovery of the patient was very satisfactory, although the postoperative electrophysiologic studies demonstrated a less dramatic improvement

Reamed interlocking intramedullary nailing for the treatment of tibial diaphyseal fractures and aseptic nonunions. Can we expect an optimum result?

The need for reaming and the number of locking screws to be used in intramedullary (IM) tibial nailing of acute fractures as well as routine bone grafting of tibial aseptic nonunions have not been clearly defined. We describe the results of reamed interlocked IM nails in 233 patients with 247 tibial fractures (190 closed, 27 open and 30 nonunions). Ninety-six percent of the fractures were united at review after an average of 4.9 years. No correlation was found between union and nail diameter (P = 0.501) or the number of locking screws used (P = 0.287). Nail dynamization was effective in 82% of fractures. Locking screw(s) breakage was associated with nonunion in 25% of cases. Bone grafting during IM nailing was found not to increase the healing rate in tibial nonunions (P = 0.623). None of the IM nails were removed or revised due to infection. A dropped hallux and postoperative compartment syndrome were found in 0.8 and 1.6% of cases, respectively. Anterior knee pain was reported in 42% of patients but nail removal did not alleviate the symptoms in almost half. This series confirms the place of reamed intramedullary nailing for the vast majority of tibial diaphyseal fractures. It provides an optimum outcome and minimizes the need for supplementary bone grafting in aseptic nonunions

Implantable Loop Recorder and Syncope-Rhythm Correlation

A case of syncope-rhythm correlation is presented in a patient with a history of unexplained loss of consciousness and an implantable loop recorder. A permanent pacemaker was implanted due to the bradycardia event revealed by the recorder device and the patient remained asymptomatic in the follow up period

Population viability and conservation strategies for the Eurasian Black Vulture (Aegypius monachus) in Southeast Europe

The Eurasian Black Vulture is a globally threatened raptor that in Southeast Europe only occurs in an isolated population in Greece. We examined the population viability for the species under demographic fluctuations and conservation scenarios. The current population showed no possibility of extinction for the next 100 years. However, simulated scenarios showed that the most important factor affecting the viability of the species was medium and high poisoning, leading to 94.8% and 100% probability of extinction, respectively. Furthermore, high reduction of supplementary feeding highlighted an 18.6% extinction possibility. Also, a high increase of wind farms in the area may result in 17.4% extinction possibility. Additionally, the non-establishment of the feeding station in 1987 in the study area would have resulted in an extinction risk of 7%. The species can be translocated to the Olympus National Park by releasing 80 juveniles over 10 years. The implementation of the conservation scenarios concerning the establishment of a supplementary feeding site network, and the reintroduction of the Eurasian Black Vulture in its historic range, along with the elimination of threats posed by poisoning, low food availability, and wind farms would increase the probability of the species persistence and allow the population to become a source for dispersal across Southeast Europe

Is tension band wiring technique the "gold standard" for the treatment of olecranon fractures? A long term functional outcome study

<p>Abstract</p> <p>Background</p> <p>Tension band wiring (TBW) remains the most common operative technique for the internal fixation of olecranon fractures despite the potential occurrence of subjective complaints due to subcutaneous position of the hardware. Aim of this long term retrospective study was to evaluate the elbow function and the patient-rated outcome after TBW fixation of olecranon fractures.</p> <p>Methods</p> <p>We reviewed 62 patients (33 men and 29 women) with an average age of 48.6 years (range, 18–85 years) who underwent TBW osteosynthesis for isolated olecranon fractures. All patients were assessed both clinically with measurement of flexion-extension and pronation-supination arcs and radiologically with elbow X-Rays. Functional outcome was estimated using the Mayo Elbow Performance Score (MEPS), Visual Analogue Scale (VAS) subjective pain score and VAS patient satisfaction score. Follow up: 6–13 years (average 8.2 years).</p> <p>Results</p> <p>There was a higher prevalence of fractures among men until the 5th decade of life and among women in elderly (p = 0.032). Slip or simple fall onto the arm was the main mechanism of injury for 38 fractures (61.3%) while high energy trauma, such as fall from a height (> 2 m) or road accident, was reported in 24 fractures (38.7%). Hardware removal performed in 51 patients (82.3%) but 34 of them (66.6% of removals) were still complaining for mild pain during daily activities. The incidence of pin migration and loosening was not statistically decreased when penetration of the anterior ulnar cortex was accomplished (p = 0.304). Supination was more often affected than pronation (p = 0.027). According to MEPS, 53 patients (85.5%) had a good to excellent result, 6 (9.7%) fair and 3 (4.8%) poor result. The average satisfaction rating was 9.3 out of 10 (range, 6–10) with 31 patients (50%) to remain completely satisfied from the final result. Degenerative changes recorded in 30 elbows (48.4%). However, no correlation could be found between radiographic findings and MEPS (p = 0.073).</p> <p>Conclusion</p> <p>Tension band wiring fixation remains the "gold standard" for the treatment of displaced and minimally comminuted olecranon fractures. In long term, low levels of pain may be evident regardless of whether the metalware is removed and degenerative changes have been developed.</p

Electron Paramagnetic Resonance Quantifies Hot-Electron Transfer from Plasmonic Ag@SiO2 to Cr6+/Cr5+/Cr3+

Understanding the plasmon-mediated electron-transfer mechanisms from plasmonic nanostructures to redox-active metals is a technically challenging and still developing procedure. Electron paramagnetic resonance (EPR) spectroscopy is well established as a state-of-the-art tool to selectively detect the redox evolution of paramagnetic metals; however, its use in plasmon-driven charge-transfer processes has not been explored so far. Herein, we present a quantitative study on the mechanism of hot-electron transfer, from plasmonic Ag@SiO2 nanoaggregates, to drive sequential Cr6+ reduction toward Cr5+/Cr3+. Employing flame spray pyrolysis (FSP), core-shell Ag@SiO2 nanoaggregates were engineered with varying SiO2-shell thickness, in the range of 1-5 nm. Using EPR spectroscopy, the spin Hamiltonian parameters for the S = 1/2 {oxalate-Cr5+} and S = 3/2 {oxalate-Cr3+} systems at the Ag@SiO2/Cr interface are analyzed and used to quantitatively monitor the sequential electron-transfer steps during Cr6+ reduction. In the absence of the SiO2 shell, the oxidative path via the dark reduction of Cr6+ due to the oxidation of bare Ag was deducted accordingly. Importantly, we show that the SiO2 shell plays a key role in hot-electron transfer, as the 1 nm shell allows a predominant hot-electron transfer via a light-induced decrease of the activation barrier, suppressing the oxidative path and excluding photothermal effects