Isolated fracture of the inferior scapular angle is extremely rare. We present the case of a 20-year-old female with persistent periscapular pain and a winged scapula caused by delayed union of an inferior scapular angle (ISA) fracture. Ten months previously, the patient had a car accident while seated in the left rear passenger seat. The patient visited an orthopedic clinic where a surgeon diagnosed left shoulder contusion without any abnormal radiographic findings. The left arm was kept in a sling for 2 months, as left arm elevation caused severe pain in the upper back. After sling removal, the dull pain around the left scapula continued. The patient presented at our clinic because her mother had noticed the deformity of her back. Radiographs showed a small bony fragment in the ventral side of the ISA. Computed tomography revealed a narrow gap between the ISA and the fragment. The patient's symptoms resolved with conservative treatment that consisted of relative rest for 2 months and subsequent reinforcement exercises of the serratus anterior for 2 months.
Several clinical problems related to the dorsal root entry zone lesions (DREZLs) in 15 patients with chronic pain are presented and discussed in terms of ratings of pain relief following surgery, development of sensory or motor weakness and postmortem histologies. Subjective pain relief exceeding 70% was achieved at around 2 weeks after the operations in most patients (13/15), and then decreased in some to 30 from 70% in the follow-up observations. Our new "objective" pain relief score was tested in these patients. A significant positive correlation between subjective pain relief and our objective pain relief scale was found, but some discrepancies between them were also found during the follow-up. Sensory loss, motor weakness, paraesthesia and a new pain were found as complications in 12, 7, 4 and 6 patients, respectively. Postmortem histological findings of the spinal cord in two patients with systemic lupus erythematosus and uterine cancer, who received bilateral DREZLs twice and bilateral DREZLs plus commissural myelotomy, respectively, indicate that care should be taken to avoid extension of the coagulation beyond the dorsal horn.
Two percent of scapular fractures occur as a result of indirect trauma caused by traction of the muscles and ligaments attached to the scapula. We present two cases involving adults with incomplete avulsion fractures of the scapular spine caused by violent voluntary contraction of the deltoid muscle. These cases are the first reported avulsion fractures confined to the scapular spine medial to the spinoglenoid notch. Although the fractures were incomplete, one patient had a typical symptom of scapular fracture - pseudo-rupture of the rotator cuff characterized by clinical signs of a complete rupture of the musculotendinous cuff. Although this symptom is generally thought to be caused by massive hemorrhaging under the rotator-cuff muscle bellies, it may develop from modest bleeding through the formation of an intramuscular hematoma and a resultant elevation in intramuscular pressure. Confirming the presence of tenderness on the scapular spine and performing appropriate imaging investigation constitute a clinically effective method for preventing misdiagnosis.
Hereditary angioedema (HAE) is an autosomal dominantly inherited deficiency of C1-inhibitor, and it is an extremely rare condition. During surgery, oedema can be induced by a variety of stresses, and a high mortality rate has been reported. Since open-heart surgery involves cardiopulmonary bypass, the inflammatory response and complement activity are increased, meaning that an even greater risk can be anticipated. Perhaps for this reason, the only reports to date of cases of open-heart surgery have been cases of short-term cardiopulmonary bypass or off-pump coronary artery bypass grafting (CABG). We provide the first report of long-term cardiopulmonary bypass (longer than 5h) for open-heart surgery in a patient with HAE that did not result in any postoperative decline in respiratory function, systemic oedema, laryngeal oedema or similar complications, and a favourable outcome was obtained.
Mixed tumors are relatively common in the skin and salivary glands, but extremely rare in soft tissues, often resulting in diagnostic problems. The occurrence of these tumors in the hand is especially limited. In this article we report the clinical, radiological, and histological features of a mixed tumor of the hypothenar region of the right hand.
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