Abstract:Over the past few decades, there has been increased awareness of pectoralis major muscle injuries necessitating further evaluation of management options and, in particular, surgical repair. Injury typically occurs when an eccentric load is applied to the muscle, such as with bench pressing, and failure usually occurs through the tendon. Although nonoperative management is sometimes appropriate, given the injury's propensity for young, active male patients, surgical intervention is often warranted. Because the injury typically occurs at the muscle-tendon interface, surgery focuses on repair of the avulsed tendon into its anatomic attachment site. We describe the use of a unicortical suture button to repair the ruptured tendon. This technique achieves the goals of strong fixation and anatomic repair of the tendon back into its native footprint.
Two years after a bilateral subtotal thyroidectomy because of nodular goitre a 45-year-old woman noticed a firm nodule on the right side of her neck. Because malignant cells were suspected on cytological examination of a fine-needle biopsy, thyroidectomy was performed which revealed an immature malignant teratoma of the thyroid. A 4 cm local recurrence was noted by computed tomography only three weeks later. Despite chemotherapy (four cycles of vinblastine, cisplatin and bleomycin), radiotherapy to the neck (total dose of 60 Gy) and surgical excision of the infiltrated sternocleidomastoid muscle, bone, liver and lung metastases occurred within 10 months. Four weeks later the patient died of global cardiac failure and tumour cachexia.
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