Spontaneous rupture of the digital extensor tendons of the hand in unrecognized carpal lunatefracture.

Spontaneous rupture of the digital extensor tendons of the hand has been reported after Kienbocks disease, rheumatoid arthritis, Vaughan-Jackson syndrome, distal radial fracture. Rupture may also occur as a consequence of unrecognized carpal lunate fracture. We present a case report of a man affected with spontaneous rupture of the digital extensor tendons secondary to unrecognized carpal lunate fracture with partial dorsal dislocation. The edges of the tendon were debrided and sutured using a locked modified Kessler suture. A dynamic splinting cast was applied in moderate extension of the wrist. The aim of this case report is to highlight that in absence of a clear etiology for rupture of the extensor tendons of the hand, carpal lunate fracture, though rare, is an important cause of spontaneous extensor tendons rupture.

La ruptura espontánea de tendones extensores digitales de la mano ha sido reportado después de la enfermedad de Kienböck, artritis reumatoide, síndrome de Jackson Vaughan, fractura del radio distal. La lesión del tendón también puede ocurrir como consecuencia de la fractura no reconocida de carpal semilunar. En este artículo, se presenta un caso de un hombre que sufre de rotura espontánea del tendón extensor digital secundaria a fractura semilunar no reconocida de los huesos del carpo con luxación dorsal del fragmento parcial. Los bordes del tendón se han limpiado y se sutura usando una sutura de Kessler. Un refuerzo dinámico se aplicó en extensión moderada de la muñeca. El propósito de este caso clínico es poner de relieve que, en ausencia de una etiología clara de la ruptura de los tendones extensores de la mano, una fractura de los huesos del carpo semilunar puede ser una causa importante de la ruptura espontánea de los tendones extensores de la mano.

Spontaneous rupture of the digital extensor tendons of the hand in unrecognized carpal lunatefracture / Ruptura espontánea de los tendones extensores de los dedos de la mano en una fractura oculta del semilunar

Abstract: Spontaneous rupture of the digital extensor tendons of the hand has been reported after Kienbock's disease, rheumatoid arthritis, Vaughan-Jackson' syndrome, distal radial fracture. Rupture may also occur as a consequence of unrecognized carpal lunate fracture. We present a case report of a man affected with spontaneous rupture of the digital extensor tendons secondary to unrecognized carpal lunate fracture with partial dorsal dislocation. The edges of the tendon were debrided and sutured using a locked modified Kessler suture. A dynamic splinting cast was applied in moderate extension of the wrist. The aim of this case report is to highlight that in absence of a clear etiology for rupture of the extensor tendons of the hand, carpal lunate fracture, though rare, is an important cause of spontaneous extensor tendons rupture.

Resumen: La ruptura espontánea de tendones extensores digitales de la mano ha sido reportado después de la enfermedad de Kienböck, artritis reumatoide, síndrome de Jackson Vaughan, fractura del radio distal. La lesión del tendón también puede ocurrir como consecuencia de la fractura no reconocida de carpal semilunar. En este artículo, se presenta un caso de un hombre que sufre de rotura espontánea del tendón extensor digital secundaria a fractura semilunar no reconocida de los huesos del carpo con luxación dorsal del fragmento parcial. Los bordes del tendón se han limpiado y se sutura usando una sutura de Kessler. Un refuerzo dinámico se aplicó en extensión moderada de la muñeca. El propósito de este caso clínico es poner de relieve que, en ausencia de una etiología clara de la ruptura de los tendones extensores de la mano, una fractura de los huesos del carpo semilunar puede ser una causa importante de la ruptura espontánea de los tendones extensores de la mano.

[Primitive malignant melanoma of the base of the tongue]. / Melanoma maligno primitivo della base lingua.

Although the incidence of malignant cutaneous melanoma has doubled each decade since the early 1960s, the mucous counterpart is still rare, representing 1.4% of all melanomas in caucasian patients. In the oral cavity this incidence is even higher, ranging from 0.2% to 8.0% of all melanomas. However, it is unusual for the primary location to be in the tongue and only 25 such cases have been reported in the literature. In 1974, Conley, reviewing 52 melanomas of the mucous membranes of the head and neck, observed that "it is curious that no melanomas occurred in the tongue". The prognosis for mucosal melanomas is clearly worse than for cutaneous melanoma, with most authors reporting a 5-year survival rate of 10-25%. It is not clear whether mucosal melanomas are biologically more aggressive than their cutaneous counterparts or if prognosis is simply related to the fact that they are normally more advanced at the time of diagnosis. In fact, it is clear that the etiologic and pathogenetic basis for the origin of mucosal melanomas, as well as of their treatment and prognosis, is not understood nearly as well as that of cutaneous melanomas. Historically, cutaneous melanoma has been characterized as radio-resistant, although recent observations regarding the radiobiological and clinical responses have prompted investigators to re-evaluate the role of radiotherapy in localized mucosal melanoma. The authors report a primary malignant melanoma of the tongue base, heavily pigmented, rather bulky and nodular, approximately 0.4 cm in size, very similar to one of the varices usually encountered in this portion of the tongue. The patient came to the authors' observation complaining of peripheral vertigo. The melanoma was suspected due to a pulmonary metastasis observed in a routine chest X-ray and after a thorough search for the possible primary neoplasm. Because of widespread metastases, the patient was not treated with radio or chemotherapy and died 8 weeks after surgical ablation of the primary lesion. As observed by Batsakis, at least 25% of mucosal melanomas are clinically identical to innocent lesions. For this reason, the authors stress the importance of taking into consideration the possibility of mucosal melanoma in the differential diagnosis of head and neck neoplasms and of being suspicious of lesions which appear clinically insignificant.

Assessment and treatment of neurogenic and non-neurogenic tumors of the parapharyngeal space.

The clinical and pathologic findings in eleven cases of parapharyngeal space tumors are described. The anatomy of this area and diagnostic procedures are discussed. Investigations should include a few basic examinations such as sialogram-computed tomographic (CT) scan, carotid angiogram, and echography. Several surgical approaches are considered in relation to the site and the size of the neoplasm. Prognosis depends on the histologic type of the tumor.

Extramedullary plasmacytoma of the parotid gland.

A case of solitary extramedullary plasmacytoma of the parotid gland occurring in a 47-year-old male patient is reported. Clinical examination failed to reveal evidence of this neoplasm elsewhere in the body. Problems connected with the clinical, pathological and therapeutic aspects of the neoplasm with particular regard to the rare parotid location are taken into consideration. Furthermore, stress is laid on the fact that patients with extramedullary plasmacytoma should be thoroughly followed-up as multiple myeloma may occur even decades later in life. This is the fourth case of extramedullary plasmacytoma located in salivary glands to be reported in the world literature.

Simultaneous primary oat cell carcinoma (apudoma) and squamous cell carcinoma of the hypopharynx.

The first case of the association of oat cell carcinoma and squamous carcinoma of the hypopharynx occurring in a 57-year-old man is reported. The patient underwent total laryngopharyngectomy with radical neck dissection, but died 3 1/2 months after diagnosis with multiple bone metastases of the ribs and vertebrae. The histogenesis of oat cell carcinoma in the hypopharynx is discussed, together with the therapeutic approach for the simultaneous occurrence of two primary malignant neoplasms in the same organ.

Nasal metastasis from primary cancer of the kidney.

A case of nasal metastasis, indicating primary cancer of the kidney, and occurring in a 67-year-old man, is described. Differential diagnosis and pathogenesis are discussed. In particular, stress is laid on the problems concerning diagnosis when the nasal metastasis is the first clinical symptom. A clinicosemeiologic study of the patient is mandatory, as histology alone is not always sufficient to settle all doubts, even with the support of ample histochemical investigations.

Malignant pleomorphic fibrous histiocytoma of the larynx. (Further observations).

An exceptional case of pleomorphic malignant fibrous histiocytoma of the larynx occurring in a 68-year-old male patient is reported. A significant histological documentation is given. Problems connected with histogenesis, treatment and prognosis are dealt with. Stress is laid on the need to establish differential diagnosis from other neoplasms, in particular liposarcoma and spindle-cell carcinoma.