Operation note documentation is of paramount importance, it has medical and legal implications. Educating surgeons and providing aide-memoires in theatres clearly improved documentation of operation notes in compliance with the RCS Eng guidelines.
Primary bone lymphoma (PBL) is a rare, malignant, neoplastic disorder of the skeleton that accounts for less than 5% of all primary bone tumours. We present an extremely rare case of PBL mimicking a pelvic abscess around the sacroiliac joint, which has never been reported in the medical literature, and discuss learning points highlighted from this case.
case historyA 78-year-old woman, generally fit and well with no significant past medical history, presented to a general surgical outpatient clinic complaining of having had localised pain for four days in her lower back and right buttock area. The pain was exacerbated by sitting down and lying flat; her mobility was not affected. She also complained of weight loss and loss of appetite. No neurological, abdominal or constitutional symptoms were noted.On examination, the patient was found to be afebrile. A tender, warm and fluctuant mass (10cm diameter) was noted over her right sacroiliac joint (SIJ) with no other significant findings. A plain anteroposterior abdominal radiograph was normal (Fig 1). Computed tomography, however, revealed a low density collection of 60ml extending across the right SIJ (Fig 2).A preliminary diagnosis of a pelvic abscess originating from the SIJ was made. This collection was aspirated under ultrasound guidance. Microbiology was negative for organisms. It was decided to treat the patient empirically with broad spectrum antibiotics for three weeks. After this period, the patient showed no clinical improvement; her C-reactive protein levels and white blood cell count had improved marginally from 91mg/l to 85mg/l and 17.1 to 14 x 10 3 /µl respectively. Magnetic resonance imaging revealed a mass over the SIJ eroding the posterior ileum (Figs 3 and 4). Subsequently, the patient was referred to an orthopaedic pelvic specialist.The mass over her right buttock started to enlarge and there was no improvement in her general condition. Microbiology investigations for tuberculosis were returned negative. The presumed diagnosis was still an infection of the SIJ presenting as a pelvic abscess. Haematological and imaging studies supported our presumption.The patient was taken to theatre a week later for open surgical drainage. The abscess was drained and the right SIJ debrided. Approximately 100ml of purulent looking material was drained and specimens were sent for analysis. Microbiology was once again negative but, surprisingly, histology confirmed the presence of abnormal cells and the patient was diagnosed with an anaplastic large T-cell lymphoma, ALK1 negative.The patient was referred to oncology, managed appropriately with chemotherapy protocol for high grade T-cell lymphoma and responded very well to treatment.
Posterior tibial tendon dysfunction is common and a major cause of flat foot (pes planus) and functional impairment in adults. It is frequently undiagnosed and therefore inappropriately managed. This review raises awareness of posterior tibial tendon dysfunction with the intention of improving patient management.
Traditional Ankle Foot Orthoses (AFOs) is designed to work for different range of patients. They could not perform comfortable orthotic function arising due to individual differences. This problem can be solved by custom fit AFO’s but the current method involves a lot of manual labor. Rapid Prototyping and reverse engineering can be used on 3-D parts or models designed in CAD software to solve the problem. Through the help of 3-D scanning, customized AFO’s is designed to an individual foot’s anatomy. The scanned data was used to design an AFO structure. The designed structure was virtually tested for different materials and an analysis of the same was done.
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