ABSTRACT
Parathyromatosis, the presence of small nodules of hyper-functioning parathyroid tissue scattered throughout the soft tissues of the neck and superior mediastinum, is a rare cause of persistent primary hyperparathyroidism. We report the first case of parathyromatosis secondary to spontaneous rupture of a parathyroid adenoma. Despite running an indolent course, this case highlights the potential challenges of management of parathyromatosis and the value of calcimimetic therapy as an adjunct to surgery for disease control.
Subject(s)
Adenoma/diagnosis , Adenoma/therapy , Hyperparathyroidism/diagnosis , Hyperparathyroidism/therapy , Parathyroid Neoplasms/diagnosis , Parathyroid Neoplasms/therapy , Adenoma/complications , Disease Management , Female , Humans , Hyperparathyroidism/etiology , Middle Aged , Parathyroid Neoplasms/complications , Rupture, Spontaneous/complications , Rupture, Spontaneous/diagnosis , Rupture, Spontaneous/therapySubject(s)
Malignant Carcinoid Syndrome/etiology , Physical Examination/adverse effects , Abdomen , Alanine Transaminase/blood , Biomarkers/blood , C-Reactive Protein/analysis , Carcinoid Tumor/drug therapy , Carcinoid Tumor/metabolism , Carcinoid Tumor/nursing , Carcinoid Tumor/secondary , Dexamethasone/therapeutic use , Disease Progression , Education, Medical/methods , Fluid Therapy , Humans , Iatrogenic Disease , Infusions, Intravenous , International Normalized Ratio , Liver Neoplasms/drug therapy , Liver Neoplasms/secondary , Male , Malignant Carcinoid Syndrome/blood , Malignant Carcinoid Syndrome/drug therapy , Middle Aged , Octreotide/administration & dosage , Octreotide/therapeutic use , Peptides, Cyclic/therapeutic use , Somatostatin/analogs & derivatives , Somatostatin/therapeutic useABSTRACT
INTRODUCTION: Limb-salvage surgery, including endoprosthetic reconstruction after tumour resection, has become the standard management for local control of tumours around the knee. As the nature of surgery is technically complex and demanding, there is potential for significant morbidity arising from complications. This study describes our experience with complications following endoprosthetic reconstruction around the knee. METHODS: Retrospective analysis of consecutive resections and endoprosthetic reconstructions for tumours around the knee between 1996 and September 2005 performed at St Vincent's Hospital, Melbourne. RESULTS: Fifty consecutive cases were reviewed, with a median follow-up of 24.5 (range, 2-124) months. Median age was 41 (range, 13-79) years. Tumour types included 38 primary musculoskeletal malignancies, 8 metastatic tumours, 2 bony lymphomas and 2 benign lesions. There were eight deaths, nine cases of subsequent metastatic spread and no local recurrences. There were six cases of deep infection, two each of non-resolving nerve palsy, fracture and mechanical wear, and one each of symptomatic patellofemoral impingement, aseptic loosening and intraoperative popliteal artery trauma. Five patients required endoprosthetic revision, and three subsequent amputations were described. Excellent functional outcome and emotional acceptance was observed amongst patients that underwent revision. CONCLUSION: Resection and endoprosthetic reconstruction of tumours around the knee is both technically challenging and resource-intensive. It is imperative that morbidity from complications is limited through the minimisation of their incidence and the provision of optimal management. This series demonstrates that good patient outcomes can be achieved in specialist centres with experienced surgeons and adoption of a multidisciplinary approach.
Subject(s)
Arthroplasty, Replacement, Knee , Joint Diseases/surgery , Knee Joint/surgery , Limb Salvage , Neoplasms/surgery , Adolescent , Adult , Aged , Amputation, Surgical , Arthroplasty, Replacement, Knee/adverse effects , Bone Neoplasms/surgery , Female , Follow-Up Studies , Humans , Intraoperative Complications , Joint Prosthesis , Male , Middle Aged , Muscle Neoplasms/surgery , Neoplasm Metastasis , Popliteal Artery/injuries , Postoperative Complications , Prosthesis Failure , Reoperation , Retrospective Studies , Surgical Wound Infection/etiology , Survival Rate , Treatment OutcomeABSTRACT
Cadaveric dissection demonstrated the lumbar plexus to lie within the substance of psoas major, with the major branches of the lumbar plexus emerging into the psoas compartment adjacent to the L5 vertebra. Within psoas major, the lateral femoral cutaneous and femoral nerves were separated from the obturator nerve by a muscular fold in 36 of 60 plexuses. Anatomical variations were common, with the accessory obturator nerve being identified in 12 per cent of plexuses. All previously described lumbar plexus block approaches positioned the needle within close proximity to the lumbar plexus. Modifications to these approaches may increase efficacy and reduce complication rates.
