Neural fibrolipoma of the median nerve

We report a rare case of neural fibrolipoma [lipofibromatous hamartoma] of the median nerve of the hand. An 18-year-old male complaining of progressive and chronic macrodactyly of his thumb of the left hand, with neurological complaints, was admitted to the hospital. Magnetic resonance [MR] evaluation revealed fibro-fatty infiltration of the median nerve at the level of the carpal tunnel, and the terminal branches of the median nerve in the thumb and index. The pathological examination of excised tissue confirmed the diagnosis of neural fibrolipoma of the terminal branch of the median nerve in his thumb. Imaging is recommended; MR studies on morphological abnormalities must be done in similar cases

Trauma-related infections due to cluster munitions

Trauma-related infections remain a concerning and potentially avoidable complication of conflict-related injuries. During the Israeli conflict in South Lebanon, more than four million sub-munitions were dropped over South Lebanese soil. In this study, we will explore the different types of infection caused by sub-munitions and penetrating agents. This prospective study took place from 2006 to 2012 at the Lebanese University within the Faculty of Medical Sciences' departments. This study sample consisted of 350 injured casualties. Patients suffered from blast injuries with fragmentations targeting the head, face, torso, abdomen, pelvis and extremities. Of the 350 causalities studied, 326 [93.1%] were males, and 24 [6.9%] were females. Ages varied between 10 and 70 years, with the average age being 27 years. Of the 350 patients studied, 68 [19.4%] developed infections. Infections varied between pseudomonas, Escherichia coli, Candida and fungus and sometimes led to necrosis. Vaccinations, antibiotic therapies and proper wound irrigation must be performed at appropriate emergency units. Excision and complete debridement of necrotic and contaminated tissue should also be performed. The Convention on Cluster Munitions of 2008 should be adhered to, as these weapons indiscriminately and disproportionately harm civilians, thereby violating the well-established international principles governing conflict

Vertebral scalloping in neurofibromatosis-1

A 39-year-old male patient known to have neurofibromatosis-1, presented with sciatica and low back pain. At the age of 27, an MRI of the spine revealed widening of the lumbar canal due to posterior scalloping of the last 4 lumbar vertebrae. Repeat MRI and simple lateral lumbosacral plain film at the age of 39, revealed significant progression of the lumbosacral lesion. In view of the progression of the disease during the last 15 years, we opted for insertion of a lumbo-peritoneal [LP] shunt to decrease the CSF pressure, which is the most probable cause of scalloping. We shied away from lumbar fixation as we thought that this would not stop the vertebral erosion. The LP shunt affected good symptomatic and radiologic outcome over a 2-year follow up

Dosage of intrathecal baclofen maintenance therapy in the spastic syndromes

Twenty-three patients affected with severe spasticity as a result of several clinical pathologies were treated with intrathecal Baclofen and administered at a lumbar level by means of an implantable infusion system. The system allows programming of any drug dosage in a continuous infusion fashion in the subarachnoid space. The appropriate patients were selected using specific criteria and the patients were regularly reviewed regarding the level of the spasticity and functional capacity. The required daily doses were determined using a specific detailed system. The doses needed varied according to the pathologic or clinical diagnosis. The doses administered by the global method at the beginning of the treatment were 91.96 micro g/day and 137.81 /micro g/day in the final phase. These doses were higher in patients with medullary traumatic lesion, diffuse cerebral lesion and spastic idiopathic paraparesis. Relatively mild side effects were produced by the therapeutic doses used

Long fusion for de novo adult degenerative lumbar scoliosis

We present a retrospective review of 11 patients who underwent single stage posterior correction and instrumented fusion for adult degenerative lumbar scoliosis. At an average follow-up of 28 months, up to 50% correction of the deformity was obtained with satisfactory clinical results. The results suggest that need for revision and poor clinical outcome is related to inadequate restoration of lumbar lordosis and the sagittal profile