Spinal cord compression by a solitary metastasis from a low grade leydig cell tumour: a case report and review of the literature

<p>Abstract</p> <p>Background</p> <p>Leydig tumour is rare and there are only three cases with metastatic disease reported.</p> <p>Case presentation</p> <p>A 52 year-old Caucasian male was admitted, on emergency basis to the Orthopaedic Department with six weeks history of increasing midthoracic back pain, change in gait, poor balance, subjective weakness and numbness of the lower trunk and legs. MRI scan showed change in the signal intensity of T4 and T5 vertebral body but their height were maintained. Urgent T4 and T5 corpectomies, decompression of the spinal cord and reconstruction of the vertebral bodies were performed followed by radiotherapy. Neurological status significantly improved with a mild residual numbness over the dorsum of the right foot. The histology of the excised tumour was identical to the primary. At 2 years follow-up visit the patient is neurologically stable and disease free without other organs metastases.</p> <p>Conclusion</p> <p>This is the first case in English literature, which shows that spinal metastases could occur even in the early stage of Leydig cell tumour, without other organs involvement. Aggressive surgical management of spinal metastases combined with post operative radiotherapy can give a better chance for long survivorship.</p

The intra-articular use of ropivacaine for the control of post knee arthroscopy pain

AIMS: The purpose of this prospective randomised study is to evaluate the efficacy, safety and the appropriate dose of the ropivacaine in the control of post-knee arthroscopy pain. METHODS: We randomised 60 patients in two groups to receive 10 ml/7.5 mg/ml ropivacaine (Group B) or 20 ml/7.5 mg/ml (Group A) at the end of a routine knee arthroscopy. We monitored the patient's blood pressure, heart rate, allergic reactions, headache, nausea, we assessed the pain using the visual analogue score at intervals of 1,2,3,4 and 6 hours after the operation. and we recorded the need for extra analgesia. RESULTS: The intraarticular use of the ropivacaine provided excellent control of pain after knee arthroscopy. At two hours post-operatively there wasn't any difference between the two groups. Afterwards, the Group A showed increased pain and need for supplementary medication. CONCLUSION: We believe that intraarticular use of ropivacaine is effective to reduce post-operative pain minimising the use of systematic analgesia

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