Unusual presentation of an infected primary hydatid cyst of biceps femoris muscle.

Hydatid cysts of the musculoskeletal system are rare. Unusual magnetic resonance imaging (MRI) findings of an infected primary hydatid cyst of the biceps femoris muscle are presented in a 40-year-old man on hemodialysis for chronic renal failure. No daughter cysts were present within the mother cyst cavity, but there was a fatty nodule which has not previously been described in a muscular hydatid cyst. Although the cyst was infected secondarily, no surrounding soft tissue inflammatory reaction was noted. Hydatid cysts should be included in the differential diagnosis of unusual soft-tissue masses in regions where the disease is endemic.

Osteoid osteoma in the base of the coracoid process of the scapula. Excision by anterior approach: a case report.

Osteoid osteoma in the base of the coracoid process of the scapula is very rare and diagnosis and treatment often is delayed. A lesion in this atypical location may seem surgically unreachable. This report is of a case of osteoid osteoma in the base of coracoid process in a 14-year-old female. The lesion had been diagnosed as a nontumorous condition and overlooked for four years. Computed tomography and magnetic resonance imaging revealed a nidus in the base of the coracoid process. The en bloc excision of the osteoid osteoma was managed by an anterior approach using an osteotomy of the coracoid process. A 12-month follow-up examination revealed no symptoms and computed tomography showed bone healing with no recurrence of the tumor.

Two-stage treatment of chronic staphylococcal orthopaedic implant-related infections using vancomycin impregnated PMMA spacer and rifampin containing antibiotic protocol.

To determine the clinical role of rifampin containing antibiotic combination and modified two-stage exchange arthroplasty with a vancomycin loaded polymethylmethacrylate (PMMA) spacer for the treatment of orthopaedic implant related Staphylococcus epidermidis infections, a prospective study was initiated. A total of 10 patients, with a mean age of 59 years (range: 32 to 78 years) were included in the study. The mean follow up was 23.4 months (range: 16 to 36 months). Six patients had an infected hemiarthroplasty of the hip, three had infected total hip arthroplasty, and one had an infected femoral neck fracture with implant failure and pseudoarthrosis. All had culture-proven Staphylococcus epidermidis infections, six of the isolates were methicillin resistant. Following debridement and implantation of a PMMA spacer, a rifampin-vancomycin antibiotic protocol was initiated until the erythrocyte sedimentation rate and C-reactive protein levels were within normal limits. After reimplantation and discharge from the hospital, oral antibiotics with rifampin-ciprofloxacin were continued for three to six months. At the final follow-up none of the patients had any clinical or laboratory signs of infection. Although this study includes a limited number of patients and relatively short-term follow-up the results indicate that in the presence of orthopaedic implant infection with Staphylococcus epidermidis, modified two-stage exchange arthroplasty using a vancomycin-loaded PMMA spacer and a rifampin-containing antibiotic protocol may be beneficial.

Calcific myonecrosis.

Calcific myonecrosis is a rare and late sequela of compartment syndrome, which becomes symptomatic years after the initial trauma. We diagnosed this condition in a 64-year old man, 42 years after he sustained a shot-gun wound to the right lower leg. Total excision of a peripherally calcified, cystic mass, continuous with the anterior tibial muscle belly resulted in complete resolution of symptoms. Consideration of the diagnosis is warranted in patients with a history of major injury who develop a soft tissue mass in the traumatized compartment. The treatment of choice is marginal excision.

Metastatic tumours of the hand. A case report.

Skeletal metastases of neoplastic lesions are common but are rarely encountered in the hand. We describe a patient who presented with metastases to the hand and who died one year later of squamous cell carcinoma of the lung. The aetiology, clinical findings and treatment of neoplastic metastases of the hand are discussed.