This article explores and reviews the controversies surrounding piriformis syndrome (PS) with respect to diagnosis, investigation and treatment. While some authors have argued that PS is analogous to other well accepted compression neuropathies such as carpal tunnel syndrome, there is a wide spectrum of opinions concerning the diagnosis. These range from the belief that cases of true piriformis-induced entrapment exist but are rare, 1-5 to strongly held skepticism regarding the piriformis muscle's causative role. 6,7 Silver and Leadbetter 7 reported on a survey of 75 U.S. physiatrists and found only 72% were confident that PS exists. Moreover, 55% felt that the disorder was over-diagnosed, while 38% felt it was underdiagnosed. Still other authors have argued that the syndrome is a symptom complex and represents a myofascial pain disorder rather than an entrapment neuropathy. 2,[8][9][10]
This modified Eilber protocol achieved 96% local control for upper extremity tumors with a wound complication rate of 11%. The liberal use of flaps of resulted in healed, stable wounds in all patients.
The neutropenic state characteristic of acute lymphoblastic leukaemia (ALL) predisposes to infections involving Gram-negative bacilli. An Escherichia coli cellulitis originating in the first web space of the hand is described in a patient undergoing reinduction chemotherapy for ALL. Proximal extension of the infection progressed at a very rapid rate and required a forequarter amputation as a life saving measure. Due to the blunted inflammatory response in neutropenic patients, the need for close monitoring and quick intervention is stressed.
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