Osteoid osteoma of the patella: a case report.

Though osteoid osteoma is a common primary benign lesion of the bones, intra-articular involvement is rare and poses diagnostic difficulties when it affects middle-aged patients. We present the case of a 51-year-old woman with a 2.5 year history of anterior knee pain that was misdiagnosed as osteochondritis dissecans. Radiological findings were absent, whereas MRI showed a well-circumscribed lesion. A local excisional biopsy was performed and microscopic appearance confirmed diagnosis.

Echinococcal synovitis of the knee joint.

Bone lesions are present in 1% to 2% of cases of hydatid disease. Hydatid synovitis can usually be identified due to secondary extension from the adjacent bone, or infrequently after hematogenous spread. We present an extremely rare case of hydatid synovitis without bony involvement. A 74-year-old man with diagnosed hydatid disease was admitted to our department because of left knee swelling. Neither physical examination nor laboratory studies revealed any remarkable findings. Radiographic evaluation of the knee joint was noncontributory. The patient underwent an arthroscopically assisted synovectomy, and the biopsy revealed an echinococcus contamination. No complications occurred during the postoperative period.

Laparoscopic surgery of dermoid cysts--intraoperative spillage and complications.

OBJECTIVE: To assess the risks of complications including intraoperative spillage following laparoscopic dermoid cyst enucleation. STUDY DESIGN: A retrospective case series comparison of 390 patients who had surgery at our hospital from 1992 to 1998 for teratomas of the ovary. RESULTS: 43 patients were treated with laparotomy. Two malignant teratomas were observed in this group. In seven patients, the dermoid cysts were removed as part of a vaginal hysterectomy. Three hundred and forty patients had surgery via laparoscopy. Enucleation of the dermoid cyst in toto using a salvage bag for removal was only possible in few cases without contamination of the abdominal cavity by spillage of cyst contents. There were no serious complications in any patients including those with laparoscopic cystectomies and intraperitoneal spill. CONCLUSION: The laparoscopic treatment of benign teratomas is a safe procedure. Primary laparotomy as well as adenectomy is also to be taken into consideration with young patients, if suspicion of malignancy, rapid growth, doubtful infiltration or large size of tumor is present.

[Carcinosarcoma of the urinary bladder]. / Zum Karzinosarkom der Harnblase.

A female patient is presented who had a large carcinosarcoma of the urinary bladder that became clinically manifest only 2 months before treatment. The initial treatment by transurethral resection was followed by radical cystectomy; 7 months postoperatively the patient died of local tumour recurrence with widespread metastases. Carcinosarcoma of the urinary bladder is a rare tumour with a poor prognosis. The majority of such tumours are not diagnosed until tumour growth is already far advanced. Owing to the small number of cases there is no clinically proven form of management. In contrast with superficial transitional cell carcinoma of the bladder, superficial carcinosarcoma of the bladder has always invaded the lamina propria, since in addition to the carcinomatous degeneration of the mucosa, sarcomatous degeneration of the underlying submucosal stroma is also present. Any local surgical treatment, such as TUR or partial cystectomy, involves the risk of incomplete tumor removal, because the sarcomatous elements typically invade the submucosa while the overlying mucosa remains intact. Therefore, radical cystectomy appears to be the treatment of choice for both superficial and invasive carcinosarcoma of the urinary bladder.

[Spectrum of morphologic findings in cystectomy specimens]. / Spektrum der morphologischen Befunde an Zystektomiepräparaten.

A report of 64 cystectomy specimens is presented with emphasis on the macroscopic tumor pattern of the urinary bladder carcinoma. From gross observations bladder cancer gives a wide spectrum: unifocal or multiple papillary, mostly superficial carcinomas, nodular tumors more or less deeply invading the bladder muscle, flat carcinomas, widespread diffuse carcinomas with infiltration of the whole bladder wall, flat ulcers with or without tumor rest after TUR, and tumors almost filling the whole bladder and destroying the bladder wall; miscellaneous tumours were also observed. In 3 cases bladder cancer arose from the lumen of one or more diverticula. This study describes the features presented at the time that patients underwent radical cystectomy in early as well as in advanced stages.

[Pathophysiology and classification of adhesions]. / Pathophysiologie und Klassifikation von Adhäsionen.

The central issue in the pathophysiology of adhesions is the shift of the dynamic balance between fibrinolysis and fibrinogenesis to the side of fibrinogenesis. Permanent adhesions with the most varied morphology are formed by invasion of the fibrin network by fibroblasts and fibroid organization. Their classification by four degrees of severity is based on histological and morphological criteria. This classification has been shown useful and practicable for the objective examination and evaluation of relaparotomies in connection with expert opinion reports and animal experiments on adhesion research.