Hemorrhagic shock due to ruptured lower limb vascular malformation in a neurofibromatosis type 1 patient: A case report.

BACKGROUND: Neurofibromatosis type 1 (NF-1) is a common autosomal dominant genetic disorder. It is characterized by café-au-lait spots and cutaneous neurofibromas. Although NF-1 typically involves the skin, nerves, bones, and eyes, vascular manifestation in the form of devastating hemorrhage can occur rarely. CASE SUMMARY: We present the case of a 47-year-old female with NF-1 who had a ruptured right lower limb arterial malformation. She presented with sudden right lower limb swelling for two hours and symptoms of hemorrhagic shock on admission. The physical examination revealed a right lower limb presenting as elephantiasis and visible dark-brown pigmentation over a large area. Computed tomography angiography showed right lower limb arteriovenous malformation. Therefore, the patient underwent emergency right lower limb digital subtraction angiography (DSA) and vascular embolization after blood transfusions. However, after DSA, vascular embolization, and repeated blood transfusions, the anemia and right lower limb swelling and tenderness did not improve. As a result, the patient underwent right lower extremity above-knee amputation. After amputation, the patient's hemoglobin level improved significantly without blood transfusion, and she was discharged from the hospital after the incision healed. Postoperative pathological examination suggested neurogenic tumors. No other complications had occurred 1-year follow-up. CONCLUSION: Vascular malformation and rupture are fatal complications of NF-1. Embolization may not provide complete relief, the patient might need to undergo neurofibroma resection or amputation.

One-stage total hip arthroplasty for advanced hip tuberculosis combined with developmental dysplasia of the hip: A case report.

BACKGROUND: A patient with advanced tuberculosis of the hip joint combined with Crowe type IV developmental dysplasia of the hip (DDH) and a drainage sinus is a rare condition. There are no previous reports of this condition, and it is a complex challenge for surgeons to develop a treatment scheme. CASE SUMMARY: We report a 73-year-old male patient with severe hip pain and drainage sinus of the left hip for one month. Approximately 40 years ago, a drainage sinus occurred at the lateral left hip was healed at the local hospital with anti-infectious therapy. After the sinus healed, gradual pain occurred in the left hip for 40 years. Approximately one month prior, hip pain was sharply aggravated, and a drainage sinus reoccurred in the left hip. The X-ray and computed tomography examinations showed destruction of the head and neck of the left femur, as well as an acetabular deformity. The results of Mycobacterium tuberculosis antibody and Xpert were positive. Therefore, the patient was diagnosed with advanced TH combined with Crowe type IV DDH. After 22 d of treatment with anti-tuberculosis chemotherapy, the sinus healed, and the patient underwent one-stage total hip arthroplasty (THA) surgery consisting of debridement, osteotomy, and joint replacement. After surgery, the patient received anti-tuberculosis chemotherapy drugs for nine months, with no recurrent infection. After one year of follow-up, the Harris score of the patient increased from 21 pre-THA to 86. CONCLUSION: Although drainage sinuses are a contraindication to one-stage THA, one-stage THA is still an effective and safe surgical method after the sinus heals.

[Clinical study on the treatment of acromioclavicular joint dislocation of tossy grade III with double endobutton].

OBJECTIVE: To investigate the clinical effects of internal fixation with double endobutton for the treatment of acromioclavicular joint dislocation of Tossy Grade III. METHODS: From 2007.7 to 2008.12, 27 patients with acromioclavicular joint dislocation of Tossy Grade III were fixed with double endobutton. Among the patients, 17 patients were male and 10 patients were female, with an average age of (35.0 +/- 1.3) years (ranged from 23 to 60 years). Fourteen patients were injured by traffic accident, 6 patients were work-related injuries, 4 patients were sports injuries, and 3 patients were injured by falling down. Sixteen patients had injuries in the left, and 11 patients in the right. All the patients were Tossy III type dislocation without clavicle fracture. The therapeutic effects were evaluated by Karlsson criteria based on range of motion of acromioclavicular joint, pain, muscle force and postreduction X-ray. RESULTS: All the patients were followed up for 6 to 14 months, mean 10.2 months. According to the Karlsson score criteria, 24 patients obtained an excellent result, 2 fair and 1 poor. CONCLUSION: Fixation with double endobutton is to be a new method for the treatment of acromioclavicular joint dislocation, which has the advantages of minimal trauma, reliable fixation, early functional rehabilitation and so on.

[Controlled clinical trials on the Pizhen and massage for the treatment of thoracic lateral cutaneous nerve entrapment syndrome].

OBJECTIVE: To investigate the clinical effects of Pizhen for the treatment of thoracic lateral cutaneous nerve entrapment syndrome. METHODS: From March 2004 to April 2008, among the 320 patients with thoracic lateral cutaneous nerve entrapment syndrome, 160 patients (105 patients were male and 55 patients were female, ranging in age from 26 to 66 years, with an average of 46.00 +/- 0.79 years) were treated with Pizhen for 3 to 7 days, and 160 patients (98 patients were male and 62 patients were female, ranging in age from 19 to 64 years,with an average of 47.00 +/- 0.35 years) were treated with massage for 1 to 2 months. The therapeutic effects of the two groups were compared based on changes of tension test of local soft tissues, local pain and tenderness. RESULTS: All the patients were followed up and the duration ranged from 7 to 12 months, averaged in 10.3 months. Among the patients in Pizhen group, 119 patients got an excellent result, 27 good, 12 fair, and 2 poor, and the tension test of local soft tissues decreased from preoperative (3.68 +/- 0.28) to postoperative (2.13 +/- 0.35). In the control group, 73 patients got an excellent result, 38 good, 40 fair, and 9 poor, the tension test of local soft tissues decreased from preoperative (3.59 +/- 0.22) to postoperative (3.17 +/- 0.19). The therapeutic effects and tension test of local soft tissue in the two groups had statistical differences (P < 0.01). The therapeutic effects of Pizhen group was better than that of the control group, and the postoperative tension test of local soft tissues of patients in Pizhen group was lower than that of the control group. CONCLUSION: The clinical effect of Pizhen is better than the massage for the treatment of thoracic lateral cutaneous nerve entrapment syndrome. The Pizhen is effective to decrease the pressure around nerve, relax the adhesion, so as to eliminate the stimulation and compression of sensory nerve endings to relieve the pain quickly. But massage need longer course of treatment. So Pizhen therapy is safe, good and easily to practice, which is better than massage therapy.

[Comparative study on the Pizhen and acupuncture for the treatment of supraclavicular nerve-entrapment syndrome].

OBJECTIVE: To investigate the clinical effects of Pizhen for the treatment of supraclavicular nerve-entrapment syndrome. METHODS: From March 2004 to April 2006, among the 200 patients of supraclavicular nerve-entrapment syndrome, 100 patients (75 patients were male and 25 patients were female, ranging in age from 25 to 65 years, with an average of 45 years)were treated with Pizhen, 100 patients (60 patients were male and 40 patients were female, ranging in age from 16 to 63 years, with an average of 35 years) were treated with Acupuncture. The therapeutic effects of the two groups were compared. RESULTS: All the patients were followed up and the duration ranged from 6 to 12 months, 9.6 months in average. Among the patients in Pizhen group, 79 patients got an excellent result, 12 good, 8 fair, and 1 poor, and the tension exponent of soft tissues decreased from preoperative 3.56 +/- 0.35 to postoperative 2.11 +/- 0.41. In the control group, 43 patients got an excellent result, 21 good, 17 fair, and 19 poor, the tension exponent of soft tissues decreased from preoperative 3.61 +/- 0.21 to postoperative 3.13 +/- 0.56. The therapeutic effects and tension exponent of soft tissue in the two groups had statistical differences (P < 0.05 and P < 0.01). CONCLUSION: The clinical effect of Pizhen is better than the the acupuncture for the treatment of supraclavicular nerve-entrapment syndrome. The therapy of Pizhen is safe, good and easily to practice.