4 research outputs found
The Hippocratic Oath: Analysis and Contemporary Meaning
The Hippocratic oath is traditionally taken by medical school graduates
at the time of their graduation, either in its original form or in a
modern variation. It is considered the earliest expression of medical
ethics, establishing principles of ethics that remain of paramount
significance today. However, it was written in antiquity, whereas
medicine has been constantly evolving. This article reviews, analyzes,
and interprets each section of the oath to determine to what extent it
remains relevant to contemporary medicine
Intraneural ganglion cysts of the peroneal nerve
BackgroundIntraneural ganglion cysts of the peroneal nerve are rare, and
there is lack of evidence for the surgical management of this entity. We
performed this study to evaluate the imaging, diagnosis, treatment and
outcome of seven patients with intraneural ganglion cysts of the
peroneal nerve.Materials and methodsWe retrospectively studied the files
of seven patients with intraneural ganglion cysts of the peroneal nerve,
diagnosed and treated from 2016 to 2019. Diagnostic approach included
clinical examination of the leg and foot, magnetic resonance imaging,
nerve conduction studies, surgical excision of the cyst and histological
examination. The mean follow-up was 2 years (range 1-3.5 years). We
evaluated the time and methods for surgical treatment, and the clinical
outcomes of the patients.ResultsAll patients presented symptoms of
peripheral compression neuropathy; three patients presented with foot
drop. The intraneural ganglion cysts were excised in all cases in
addition to knee articular nerve branch transection to avoid cysts
recurrence. Postoperatively, all patients experienced complete
neurological recovery without clinical evidence of intraneural ganglion
cysts recurrences.ConclusionThe treating physicians should be aware of
intraneural ganglion cysts of the peroneal nerve in patients presenting
with limb weakness, sensory deficits at the lateral and anterior side of
the leg and foot, paresis or paralysis of the foot and ankle. MR imaging
is the imaging modality of choice for a clear and accurate preoperative
diagnosis to avoid misdiagnosis and wrong treatment. In case of doubt,
these patients should be managed in an orthopedic oncology setting with
microsurgery facilities available for complete excision of the
intraneural ganglion cyst
Chondrosarcomas of the small bones: analysis of 44 patients
BackgroundChondrosarcomas of the small bones of the hands and feet are
uncommon and account for less than 2% of all chondrosarcomas in the
skeleton; a 4.2% rate of malignant degeneration of enchondromas to
secondary chondrosarcomas has been reported. We performed this study to
assess the outcome of the patients with chondrosarcomas of the small
bones. We hypothesized that the presumed better prognosis of
chondrosarcomas in these locations could be biased as the majority of
these tumors tend to be of lower grades and are removed when still small
sized, and that less aggressive surgery has an adverse effect on local
controlMaterials and methodsWe retrospectively studied the files of 44
patients with chondrosarcomas of the small bones of the hands and feet.
There were 23 female and 21 male patients with a mean age of 50.9 years
(range, 6-86 years). The mean follow-up was 13 years (range, 5-40
years). We recorded the patients’ details including gender and age at
diagnosis, type and duration of symptoms, tumor location and histology,
type of surgery and complications, and outcome (local recurrences and
metastases).ResultsThe most common anatomical location for
chondrosarcomas of the hands was the metacarpals and proximal phalanges.
The most common presenting symptom was a slowly enlarging palpable mass.
Overall, 36 chondrosarcomas were secondary to a pre-existing
cartilaginous tumor. Patients with syndromes were affected in younger
age compared to the others. The mean age at diagnosis was higher for
higher grade chondrosarcomas. Overall, 13 patients (29.5%) experienced
a local recurrence; the rate of local recurrence was higher after
curettage regardless the histological grade of the tumors. After wide
resection of the first local recurrence, five patients experienced local
re-recurrence. Five patients (11.4%) experienced lung metastases, two
patients at presentation. All these patients had a high grade
chondrosarcomas. At the last follow-up, one patient with lung metastases
died from disease, and another patient died from unrelated
cause.ConclusionsThe patients with chondrosarcomas of the small bones of
the hands and feet may have a dismal outcome if treated improperly. A
careful treatment planning is required to avoid unnecessary amputations.
Curettage is associated with a high rate for local recurrence that
should be treated with a more aggressive surgical resection to avoid
re-recurrences. Although the risk is low, the patients may develop lung
metastases, especially those with higher grade chondrosarcomas,
therefore, they should be staged and followed closely
Double fractures of the femur: a review of 16 patients
Background Double ipsilateral femoral fractures account for 1\u20139% of femoral fractures. There is no clear advantage between single or double implant osteosynthesis. We present a series of patients with double ipsilateral femoral fractures, to address the challenges in treatment, namely the implants for osteosynthesis and complications of treatment.
Materials and methods We retrospectively studied 16 patients (7 men, 9 women; mean age, 51 years) treated from January 2015 to December 2018. Motor vehicle accidents were the leading cause of injury. Types of fractures were pertrochanteric and shaft (6), pertrochanteric and distal (2), double shaft (3), neck and shaft (2), neck and distal (1), shaft and distal (1), and triple fracture including a pertrochanteric, shaft and distal (1). In five patients, two different implants were used (plate and screws, cannulated hip screws, femoral nail), whereas in 11 patients a long femoral nail was used.
Results Fourteen patients experienced union at a mean of 3 months (2\u20136 months). Two patients experienced nonunion: both had plate and screws osteosynthesis. One patient died 15 days after admission from polytrauma and another patient experienced central venous catheter thrombosis and pneumonia. Surgical complications (2 patients) included a thigh skin necrosis, and external fixator pin tract infection/infected non-union. Weight-bearing was delayed in all patients; full weight-bearing was allowed in 11 patients at 4 months postoperatively, and in four patients at 5 months.
Conclusion Due to the rarity and the difficulty of standardization of double ipsilateral femoral fractures, there is variable information on the optimal osteosynthesis of the fractures and the outcome of the patients. It seems that closed reduction and long hip nailing is the treatment of choice, with few complications