Osteoid osteoma is a common benign osteogenic bone neoplasm characterized histologically by increased osteoid tissue formation with an intracortical nidus surrounded by cortical thickening and vascular fibrous stroma and sclerosis. The clinical presentation classically includes severe nocturnal pain that is improved with nonsteroidal anti-inflammatory drugs. Younger men (second and third decades) have the highest incidence, with the most frequent sites of involvement being the long bones or axial skeleton. Osteoid osteoma may be missed due to the lesion occurring in an atypical location or due to failure to obtain advanced imaging studies such as computed tomography (CT). Intralesional or wide excision, or CT-guided radiofrequency ablation if available, leads to predictable and rapid pain relief. The authors report the case of a 24-year-old man who had a painful flexion contracture of his dominant right elbow for 1.5 years, secondary to an intra-articular osteoid osteoma. Attempted motion, passive or active, produced a marked exacerbation of pain. Previous surgeries, including an elbow synovectomy and an ulnar nerve transposition, had been unsuccessful in relieving his pain. Plain radiographs demonstrated a small area of periosteal thickening adjacent to the sublime tubercle. Fine-cut CT scan demonstrated an osteoid osteoma within the articular surface of the trochlear notch of the olecranon, adjacent to the sublime tubercle. Because of a perceived risk to the surrounding articular cartilage, CT-guided radiofrequency ablation was not performed. Wide en bloc surgical excision of the nidus was performed, with complete resolution of pain and rapid return to normal function.
Introduction: Schistosomiasis is a tropical parasitic disease with a very high prevalence worldwide, carrying a considerable risk for serious morbidity and mortality. Hepatic schistosomiasis may lead to chronic ascites due to portal hypertension (Increased hydrostatic pressure due to periportal fibrosis). Presentation of Case:We describe the case of a 67-year-old African female with refractory ascites secondary to hepatic schistosomiasis, causing her respiratory distress. At least mid-term, she was successfully treated with a peritoneo-vesical shunt, allowing the controlled passage of ascitic fluid from the peritoneum into the bladder, enabling her to "urinate" the liquid, releasing the abdominal pressure and improving her respiratory status. She was able to return to her normal activities during months postoperatively.Discussion: Schistosomasis is quite prevalent in tropical endemic areas, leading to serious complications. Patients with hepatic schistosomiasis develop secondary ascites, which is frequently refractory to standard medical treatment. Surgical procedures are required to improve the patients quality of life. Although the idea of using a shunt to evacuate peritoneal fluid into the bladder has been reported in a clinical trial, to our knowledge, no previous report of the use of a self-devised, inexpensive, controlled peritoneo-vesical shunt for the treatment of refractory ascites secondary to hepatic schistosomiasis in the low income setting has been previously described in the literature. We propose herein a novel and inexpensive surgical approach that allows the extraction of fluid from the peritoneal cavity, eliminating the liquid through normal urination, and improving the quality of life of the patient. Conclusion:Even though a wide range of surgical approaches has been devised for the management of refractory ascites, none has so far considered the particularities of resource-limited environments. We believe this to be an innovative and feasible surgical alternative for the management of refractory ascites in the low-income setting.
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