Elephantiasis nostras verrucosa: an atypical presentation following intrapelvic lymphoma

Elephantiasis nostras verrucosa is a progressively debilitating and disfiguring disease commonly presenting with verrucous, cobblestone-like papules, nodules, or plaques with nonpitting edema in the lower extremities. Histopathology is marked by hyperkeratosis and dermal or subcutaneous fibrosis as a result of chronic lymphedema. Risk factors include obesity, recurrent cellulitis, chronic venous insufficiency, congestive heart failure, scleroderma, radiation, trauma, and tumors. We report a 72-year-old man who presented to the dermatology clinic for an 11-year history of edematous legs, occasionally associated with ulcerations. The findings developed within a year of intrapelvic non-Hodgkin lymphoma and progressed gradually over 10 years after lymphoma remission. Physical examination revealed atypical features including compressible cysts and pitting edema extending from the lower legs to the thighs bilaterally. The patient was noncompliant for the recommended compressive devices and the condition progressively worsened over the course of 7 months of follow-up. Early interdisciplinary management using compressive devices and a lymphatic pump are recommended. Underlying causative factors should be assessed with regular follow-up to optimize treatment outcomes

Clinical utility of calf front hoof circumference and maternal intrapelvic area in predicting dystocia in 103 late gestation Holstein-Friesian heifers and cows

The objective of this study was to determine the clinical utility of measuring calf front hoof circumference, maternal intrapelvic area, and selected morphometric values in predicting dystocia in dairy cattle. An observational study using a convenience sample of 103 late-gestation Holstein-Friesian heifers and cows was performed. Intrapelvic height and width of the dam were measured using a pelvimeter, and the intrapelvic area was calculated. Calf front hoof circumference and birth weight were also measured. Data were analyzed using Spearman's correlation coefficient (rs), Mann–Whitney U test, and binary or ordered logistic regression; P 0.068 cm/cm2). Determining the ratio of calf front hoof circumference to maternal intrapelvic area has clinical utility in predicting the calving difficulty score in Holstein-Friesian cattle

Intrapelvic trauma by metallic wire: Surgical challenges faced

Introduction: Penetrating pelvic trauma is rare and presents as one of the most difficult challenges to trauma surgeons. Case Report: We present an unusual case of a 23-year-old male suffering a penetrating pelvic trauma by a projected metal wire. The wire was found in intrapelvic location, caused no internal organs injury and was safelyremoved using a Pfannenstiel extended approach. Conclusion: Preoperative assessment of foreign body position is mandatory to set-up an efficient surgical procedure. The surgeon must have a profound knowledge of pelvic anatomy in order to choose the best option for the foreign body removal without any iatrogenic lesions.info:eu-repo/semantics/publishedVersio

Revision of a Failed Primary Total Hip Arthroplasty following Excessive Reaming with a Medial Cup Protrusion.

Background and Objectives: Atraumatic intrapelvic protrusion of the acetabular component following excessive reaming of the acetabulum with a far medial positioning of the cup is a rare, but serious complication of a total hip arthroplasty (THA). This study analyzes the factors contributing to this uncommon complication and presents the outcome after the revision surgery using the Ganz reinforcement ring combined with a bone graft and plating of the posterior column and/or screws for the anterior column. Materials and Methods: A retrospective case series study with seven patients (four males, mean age 76 ± 10 years (60-86)) that underwent a revision THA within 24 ± 17 days (5-60) after an atraumatic periprosthetic acetabular fracture with a medial cup protrusion was performed. All fractures were reconstructed with a Ganz reinforcement ring and bone graft with a mean follow-up of 1.7 ± 1.7 years (0.5-5). Radiographs were evaluated for the following: (i) cup positioning immediately after the primary THA and the revision surgery, (ii) cup migration in the follow-up, and (iii) fracture healing. Results: The position of the acetabular component as assessed on the postoperative radiographs after the index surgery and before the complete medial cup protrusion showed a cup placement beyond the ilioischial line indicative of a fracture of the medial wall. The revision surgery with the reconstruction of the medial wall with a Ganz reinforcement ring combined with a bone graft restored in the presented cases the center of rotation in the horizontal direction with a statistical significance (p < 0.05). During the follow-up, there was no aseptic loosening with the relevant cup migration or significant change in the position of the acetabular cup at the final follow-up (p > 0.05) after the revision. All seven fractures and bone grafts realized a bone union until the latest follow-up. Conclusions: Following excessive reaming, the acetabular component was placed too far medially and resulted in an intrapelvic cup protrusion. An unstable cup following a fracture of the medial wall was evident on the immediate postoperative radiographs. In the case of the medial wall perforation with an intrapelvic cup protrusion after the primary THA, the reconstruction with a Ganz reinforcement ring was a successful treatment option resulting in the fracture healing and a stable cup positioning. Surgeons should be aware of that rare and probably underreported complication and restore the anatomic center of rotation by treating the defect intraoperatively

Prediction of parturition and dystocia in holstein-friesian cattle, and cesarean section in dystocic beef cattle

Dystocia is a major problem in the dairy industry as it causes livestock and economic loss. It is more frequently seen in primiparous cattle compared to their multiparous counterparts due to their smaller stature and the slow maturation of pelvic dimensions. In some instances, human intervention of the parturition process is imperative to avoid pain, injury, and mortality of the neonate and the dam. The ability to accurately predict dystocia and the time of parturition will ensure that timely assistance can be given to animals that are of high risk of dystocia.^ The present thesis contains four studies that explore methods to predict dystocia and the time of parturition as well as factors that influence the presentation and outcome of cesarean sections. The first study, presented in chapter three, evaluated the clinical utility of measuring the circumference of the calf front and maternal intrapelvic dimensions to predict the incidence of dystocia in late gestation Holstein-Friesian cattle. The ratio of the calf hoof circumference to the maternal intrapelvic area was identified to have clinical utility in predicting the calving difficulty score. The second study, presented in chapter four, assessed the changes in plasma progesterone concentration, rectal temperature, sacrosciatic ligament relaxation, and feed intake to predict the time of parturition in dairy cattle. Results indicated that plasma progesterone concentration had the highest accuracy in predicting the time of parturition. The third study, presented in chapter five, explored the clinical utility of blood and plasma glucose concentrations in predicting parturition as well as their relationship with hypercortisolemia and clinical signs associated with the activation of the sympathetic nervous system namely heart rate, respiratory rate, mean arterial blood pressure, hematocrit, and rumen contraction rate. Blood glucose was determined to have the potential to predict parturition due to its accuracy, practicality, and cost effectiveness. In the fourth study, presented in chapter six, a retrospective study was conducted to examine the clinical presentations and outcomes of beef cattle that were admitted into a teaching hospital with dystocia and had cesarean sections performed. Results indicate that cesarean section was a useful method to resolve dystocia with high dam survivability but delays in admitting cattle to the hospital could result in increased calf mortality.^ Collectively, the results presented in this thesis provide methods to predict dystocia and parturition in late gestating cattle as well as highlight factors that help ensure favorable outcomes from cesarean sections

Intra-Pelvic Migration of Sliding Hip Screw During Osteosynthesis of Hip Fracture: A Rare Avoidable Intraoperative Complication.

Hip fractures, which are common among old patients, are classified into two groups: intracapsular and extracapsular fractures. Extracapsular fractures can be treated with extramedullary implants [e.g. dynamic hip screw (DHS)] or intramedullary nails. Dynamic hip screw is the treatment of choice in stable pertrochanteric fractures. Intrapelvic migration of the sliding screw is a very rare complication

Strategy to avoid vascular injuries in revision total hip arthroplasty with intrapelvic implants

Aims: Our objective was describing an algorithm to identify and prevent vascular injury in patients with intrapelvic components. Methods: Patients were defined as at risk to vascular injuries when components or cement migrated 5 mm or more beyond the ilioischial line in any of the pelvic incidences (anteroposterior and Judet view). In those patients, a serial investigation was initiated by a CT angiography, followed by a vascular surgeon evaluation. The investigation proceeded if necessary. The main goal was to assure a safe tissue plane between the hardware and the vessels. Results: In ten at-risk patients undergoing revision hip arthroplasty and submitted to our algorithm, six were recognized as being high risk to vascular injury during surgery. In those six high-risk patients, a preventive preoperative stent was implanted before the orthopaedic procedure. Four patients needed a second reinforcing stent to protect and to maintain the vessel anatomy deformed by the intrapelvic implants. Conclusion: The evaluation algorithm was useful to avoid blood vessels injury during revision total hip arthroplasty in high-risk patients

Intrapelvic migration of the hip screw of a proximal femoral nail: report of two cases and review of the literature

Two cases of medial migration of the hip screw in cases of cephalon-medullary nailing for the treatment of extra-articular proximal femoral fractures are reported. The first case was revised to hemiarthroplasty, that was subsequently complicated with infection and death of the patient, while the second was revised to a similar devise with favorable outcome. A review of the literature is performed in order to identify the contributing factors that result in the medial migration of the hip screw. Emphasis is given in further reporting of similar cases in order to abolish this potentially lethal complication. 

The usage of pelvimetry to predict dystocia in cattle

Pelvimetry is the measurement of the dimensions of the pelvis, measured internally or externally, and is typically conducted with the aid of a pelvimeter. Intrapelvic dimensions, namely the intrapelvic height and width, are used to calculate pelvic are a which has a moderate to high degree of heritability. Pelvic area measurements are associated with calving difficulty and have been used by producers to select for heifers to be included in their breeding herd

The Classic: Treatment of Malum Coxae Senilis, Old Slipped Upper Femoral Epiphysis, Intrapelvic Protrusion of the Acetabulum, and Coxa Plana by Means of Acetabuloplasty

This Classic Article is a reprint of the original work by M. N. Smith-Petersen, Treatment of Malum Coxae Senilis, Old Slipped Upper Femoral Epiphysis, Intrapelvic Protrusion of the Acetabulum, and Coxa Plana by Means of Acetabuloplasty. An accompanying biographical sketch of M. N. Smith-Petersen, MD, is available at DOI 10.1007/s11999-008-0671-z. This article is ©1936 by the Journal of Bone and Joint Surgery, Inc. and is reprinted with permission from Smith-Petersen MN. Treatment of Malum Coxae Senilis, Old Slipped Upper Capital Femoral Epiphysis, Intrapelvic Protrusion of the Acetabulum, and Coxae Plana by Means of Acetabuloplasty. J Bone Joint Surg Am. 1936;18:869–880