Delayed diagnosis of lung cancer after missed vertebral metastasis on CT.

A 71-year-old man presented with a 4-month history of severe atraumatic monolateral hip pain. Radiographs were normal, and MRI had to be aborted owing to heating up of a remnant of an old spinal cord stimulator. CT revealed squamous cell lung carcinoma with widespread metastases of the spine and pelvis, causing L1 nerve root compression. In retrospect, a lytic lesion consistent with spinal metastasis was found on CT taken 5 months previously, soon after the onset of hip pain, but this was missed by the reporting radiologist at that time. This case highlights that errors in radiology reporting are inevitable, but can be minimized by using a systematic approach to carefully review all available images to avoid missing unexpected pathology.

Unlinked elbow arthroplasty as primary treatment for fractures of the distal humerus.

This study reviews our experience with primary total elbow arthroplasty in the management of acute distal humeral fractures by use of the iBP unlinked elbow prosthesis. We followed up 9 elbows in 9 patients (including 2 with rheumatoid arthritis), with a mean age of 73 years, for a mean of 3.5 years. Functional outcome was assessed with the Mayo Elbow Performance Score and the recently developed Liverpool Elbow Score. Clinical examination and radiologic assessment were performed by an independent surgeon. All elbows were stable at the latest follow-up examination, all patients were able to perform daily activities, and pain relief was satisfactory. The median value for the Mayo Elbow Performance Score was 95 (range, 65-100). This is the first report of the use of an unlinked prosthesis for the treatment of distal humeral fractures. Our results show that this method of treatment provides a reliable and effective way of dealing with these very difficult fractures when internal fixation is not a viable option.

ADCON-L and hypotension during lumbar microdiscectomy.

ADCON-L anti-adhesion gel is used as an antifibrotic agent in surgery for herniated lumbar disc. We report seven patients undergoing lumbar microdiscectomy, in whom ADCON-L gel was applied to the nerve root before closure of the surgical site. After the administration of ADCON-L, tachycardia and hypotension were noted, and were quickly and effectively reversed by i.v. fluids and ephedrine. Since its routine introduction into our practice, we have given ADCON-L on 212 occasions, with an incidence of adverse haemodynamic reactions of 3.3%. Adverse cardiovascular reactions do not appear to have been reported before.