A rare case of Ganglion cyst in the thigh in a 44-year-old woman: A case report and literature review.

INTRODUCTION AND SIGNIFICANCE: Ganglion cysts in the thigh area are uncommon, typically occurring in the wrist and ankle. These cysts are usually painless but may compress nearby structures, causing discomfort. Ultrasound is a valuable tool to differentiate ganglion cysts from hematomas and lipomas. It also helps identify the fluid-filled cyst walls. Treatment typically involves surgical removal, with complete resection being the goal. CASE PRESENTATION: We present a case of a woman who experienced a gradual increase in size of a lump in her groin area. The lump was later diagnosed and completely removed. Histological analysis revealed the presence of a ganglion cyst. CLINICAL DISCUSSION: Clinical examination is crucial for diagnosing superficial ganglion cysts. It allows us to assess their separation from the skin and connection to deeper structures. It's important to consider ganglion cysts as part of the differential diagnosis for cystic lesions in the groin area during routine medical practice. This can help avoid unnecessary and expensive tests like MRI scans in some cases. CONCLUSION: Developing a thorough differential diagnosis for uncommon lesions in specific anatomical areas is essential in clinical practice. This aids in choosing appropriate diagnostic methods and surgical intervention, if necessary, to prevent recurrence of the condition.

Evaluation of efficacy and safety of perioperative tranexamic acid during Primary Total Knee Arthroplasty: A randomized, Clinical trial.

Background: Primary total knee arthroplasty (TKA) is the gold standard treatment for degenerative joint disease, but it carries a significant risk of blood loss that may require transfusion. Various techniques are implemented to reduce the possibility of the need for allogeneic blood transfusion (ABT). To this end, this study aims to assess the effectiveness of tranexamic acid (TXA) in decreasing blood loss following primary TKA. Materials and methods: This study is a randomized controlled study of 100 cases of primary total knee arthroplasty conducted in Damascus from July 2021 to September 2022, followed up with every patient for six months. The patients were randomized into two groups. We compared intraoperative, postoperative, total, and hidden blood loss and perioperative complications. Results: We observed a statistically significant difference between the two groups in total calculated, hidden, and postoperative blood loss. However, this difference does not seem clinically significant, as we didn't find a significant difference in allogeneic blood transfusion between the groups. Regarding complications, the TXA group had five cases of superficial wound infection and six cases of deep venous thrombosis. In contrast, the control group had eight cases of superficial wound infection and five cases of deep venous thrombosis. Conclusion: Our study suggests that the role of TXA in primary unilateral total knee arthroplasty in the hands of an experienced surgeon might be overrated. The reduced blood loss did not seem to have clinical importance and didn't affect the transfusion rates.

Treatment of a Brodie's abscess manifesting as persistent pain after a twisting ankle injury: A case report.

INTRODUCTION: Cystic lesions in long bones are the radiological presentation of various bone pathologies, they can easily be misdiagnosed and thus mistreated; treatment varies from observation to aggressive surgical interventions based on the nature and characteristics of the lesion. CASE PRESENTATION: A 25-year-old male had a twisting injury to his ankle and his radiographs showed a cystic lesion in the distal tibia that was asymptomatic until he injured his ankle. he had persistent pain since then. and after conservative methods failure, a two-stage surgical intervention was done; first, we curetted the lesion and filled it with antibiotics cement; then the cement was removed with autologous bone grafting. The patient eventually healed and returned to his normal activity level. DISCUSSION: Brodie's abscess has a similar radiological appearance to other bone neoplasms and tumor-like lesions. Clinically, it is minimally symptomatic, and often initially misdiagnosed; surgical treatment is very effective, but it depends on the size, location, and aggressiveness of the lesion; the goal is to eliminate the infection, refill the residual gap, and restore the normal function, especially in weight-bearing bones. CONCLUSION: Brodie's abscess is a hideous lesion that is hard to diagnose. It could mimic other tumor-like lesions. However, applying bone cement and a second stage of bone grafting might help maximize the treatment efficiency.

Management of patellar instability using knee arthroscopy and combined anterior and medial tibial tubercle transfer: A case report and literature review.

INTRODUCTION AND SIGNIFICANCE: The Fulkerson osteotomy, also known as anteromedial tibial tubercle transfer, is a surgical procedure used to address patellar instability. It aims to restore the extensor mechanism of the knee, primarily benefiting patients with recurrent patellar dislocations. CASE PRESENTATION: We present a case of a patient with chronic recurrent patellar dislocation. After arthroscopic evaluation of the patellofemoral joint, the Fulkerson osteotomy was performed arthroscopically along with a medial patellar retinacular plication. CLINICAL DISCUSSION: Selecting the appropriate surgical approach for patellar instability necessitates careful consideration of the patient's history and clinical examination. This is crucial due to the multiple surgical techniques available and the complexities associated with the condition. CONCLUSION: Patellar instability is a relatively common condition with various causes, including bone deformities. Treatment depends on the severity of the injury and clinical evaluation. In our case, a Fulkerson osteotomy was performed in conjunction with knee arthroscopy and medial plication to address the instability.

Blood Loss in Primary Unilateral Total Knee Arthroplasty with Limited Tourniquet Application: A Randomized Controlled Trial.

Background: Tourniquet application in total knee arthroplasty (TKA) has many benefits and may have a role in the incidence of perioperative complications. Our aims were to examine the safety of applying a tourniquet for a limited amount of time during primary unilateral TKA (specifically, during cementation and final component fixation only) and to compare perioperative complications between the limited-application group and the full-application group. Methods: We conducted a randomized controlled study of 62 patients undergoing primary unilateral TKA. Patients were randomly allocated to either the limited or full tourniquet application. The follow-up period was 6 months. We evaluated intraoperative, postoperative, total, and hidden blood loss as the primary outcome measures and clearance of the surgical field, operative duration, and perioperative complications as the secondary outcome measures. Results: We found a significant difference in surgical field clearance between the groups. There was no significant difference in total, hidden, or postoperative blood loss between the groups. Mean intraoperative blood loss was significantly lower in the full-application group than in the limited-application group (171.742 ± 19.710 versus 226.258 ± 50.290 mL; p = 0.001). Perioperative complications, including allogeneic blood transfusion rates, did not significantly differ between the groups. Conclusions: Limited tourniquet application is safe to use in primary unilateral TKA and does not increase the incidence of perioperative complications or total blood loss when compared with a standard, full-time tourniquet application. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Intramuscular deep forearm hemangioma aggravated by a traumatic event: A case report.

INTRODUCTION: Hemangioma is a unique benign vascular tumor. Intramuscular seated lesions tend to cause pain, swelling, and disability in adulthood, especially after a traumatic aggravating event. PRESENTATION OF CASE: A young, healthy female suffered a previous trauma to her left forearm. Persistent pain developed after it with intermediate swelling that turned out to be a deep-seated hemangioma, which was treated successfully with excision. DISCUSSION: Though it is often a benign-acting congenital lesion, with several treatment methods, early diagnosis of hemangioma is a dilemma. Expelling other similar malignant lesions is essential. Surgical intervention could be necessary and effective in specific indications. CONCLUSION: Adequately planned surgery can successfully manage traumatic aggravated intramuscular hemangioma.

Primary total knee arthroplasty in patients with a significant bone defect in the medial tibial plateau: Case series and literature review.

INTRODUCTION AND IMPORTANCE: Total knee arthroplasty (TKA) can significantly enhance a patient's quality of life and knee function. As a result, it has become a popular procedure among orthopedic surgeons. However, there are some challenging cases that surgeons may encounter, such as treating bony defects in the tibial plateau in patients with advanced degeneration. If not managed properly, these cases can have serious consequences. CASE PRESENTATION: 4 patients with severe knee joint degeneration and bone loss in the medial tibial plateau were included in the series. The patients underwent TKA using the cement and screws technique to compensate for the defect in the medial tibial plateau. After (12-24 months) follow-up, all patients showed a clear clinical and functional improvement. CLINICAL DISCUSSION: Several ways exist to address bone loss in the tibial plateau in primary total knee joint arthroplasty. Among them, metal prostheses are frequently used. In certain situations, we may need to use more affordable techniques to ensure success for patients facing financial difficulties. This is particularly common in our country, and we may utilize methods such as the cement and screws technique. This study showed a clear improvement in the patient's clinical and functional outcomes according to The Western Ontario and McMaster Universities Arthritis Index (WOMAC) at the end of the follow-up period. CONCLUSION: The cement and screw technique might be a good solution for moderate bone loss in the tibial plateau. It might be a safe and simple method for patients, and it's also a viable option for those who can't afford pricier alternatives like metal augmentation or structural allografts.

A complex TKA in a post-traumatic arthritic knee with a significant bone loss: A case report and literature review.

INTRODUCTION: Total knee arthroplasty is an effective procedure that aims at restoring function and relieving pain. While most surgeons are familiar with primary TKA, some secondary cases are unique and might create a challenge. CASE PRESENTATION: A young 30-year-old male with no comorbidities had a gunshot injury to his knee. He developed knee arthritis later, which was treated with modular TKA and a cement-screws technique for substitution for bone loss. DISCUSSION: Complex cases of TKA demand innovative solutions, many options exist now for dealing with various challenges, but they are expensive and not always available, so other choices must be utilized to afford the best possible outcome. CONCLUSION: Post-traumatic TKA could be technically challenging, and screws buttressing the cement could effectively handle bone defects when other options are unavailable.

A case report of arthroscopic treatment of a retro-patellar GCTTS causing anterior knee pain.

INTRODUCTION AND IMPORTANCE: Giant cell tumor of tendon sheath (GCTTS) is a common soft tissue tumor in hands and feet; however, it is rare in knee joints. CASE PRESENTATION: We present a case of a 52-year-old female who had a retropatellar tendon giant cell tumor (GCT) in the right knee, causing vague anterior knee pain. CLINICAL DISCUSSION: Anterior knee pain is a challenging complaint in orthopedics due to the multiple causative reasons, the combination of several complex etiologies, and the lack of clear guidelines for an effective treatment. CONCLUSION: This case report aims to shed light on unlikely pathologies in complex cases. GCTTS is a rare lesion to affect the retropatellar region. However, we must keep it in mind when dealing with challenging anterior vague knee pain complaints. A comprehensive examination is essential; surgical experience and extended follow-up are mandatory for avoiding complications.

A case report of an adult with bilateral osteochondritis dissecans of the femoral condyles in both knees.

INTRODUCTION: There are several possible treatment options for the treatment of focal cartilage defects in the knee. Determining the appropriate treatment option to compensate for an osteochondral defect caused by osteochondritis dissecans (OCD) in adults is difficult. This study was conducted to clarify the importance of Autogenous Osteochondral Grafting by a mosaicplasty method in treating OCD, relieving pain, and improving knee function. CASE REPORT: Our study is a case report of a young female patient with osteochondritis dissecans in both the medial and lateral femoral condyles of both knees. Three of these were treated with autogenous osteochondral grafting using a mosaicplasty method. The case was done in 2016 and followed up for 5 years, where the functional results were evaluated according to International Knee Documentation Committee (IKDC Questionnaire) and the pain was assessed on a visual analogue scale (VAS). DISCUSSION: There were no complications associated with surgery. We observed improvement in knee function according to the IKDC questionnaire from 38 before surgery to 85 after a year of surgery and her pain decreased significantly according to the visual analogue scale (VAS) from 7 before surgery to 1 after a year of surgery and continued until the end of the follow-up period. CONCLUSION: Autologous osteochondral grafting with the mosaicplasty method is a good treatment option to treat osteochondritis dissecans (OCD) in the knee, as it helps to relieve pain and improve the functional state of the knee.

Case report: adipose-derived mesenchymal stem cells combined with core decompression in the treatment of early-stage avascular necrosis of the femoral head.

INTRODUCTION: Core decompression is a well-known modality for treating the early stages of avascular necrosis of the femoral head (AVN), however, several methods have been suggested to augment this procedure and improve the outcomes. CASE REPORT: A 52 male was diagnosed with a stage I AVN of the femoral head and treated with core decompression (CD) and injection of adipose-derived mesenchymal stem cells (AD-MSCs). The MRI showed full healing of the lesion after 3 months with significant clinical and functional improvement. DISCUSSION: AD-MSCs could have the same capabilities as bone marrow-derived stem cells with many advantages, implantation of AD-MSCs in orthopedics and as an augmentation of core decompression has been tried before, but no clear guidelines nor methods of application are well established in the literature. CONCLUSION: Implantation of AD-MSCs with Core decompression could be an effective modality to treat osteonecrosis of the femoral head in pre-collapse stages, however, we need bigger clinical studies to determine the actual effectiveness of this method.

Expression of HPV-16 L1 Gene Human Papillomavirus (HTLV-1) Identified by Pap Smear.

The human papillomavirus (HPV) is a crucial but not the predominant cause of cervical cancer. This study aimed to identify HPV-16 L1 gene expression in human papillomavirus using a pap smear. A total of 120 serum samples, 60 samples were taken from infected females with papillomavirus and another 60 as healthy control. These samples were collected after pap smears were done. These women attended Al-Emam Hospital for delivery from March 1st, 2021, to February 28th, 2022. The levels of Pap-IgM and Pap-IgG were increasing among patients attacked by papilloma. The levels of viruses were higher than in levels than control groups, which was indicated by increases in the scores of mean and standard deviation (2.01±1.17, 0.11±0.02), (14.24±7.10, 0.4±0.17), respectively. Statistically, these differences between the levels of the studied groups were highly significant. The levels of the three markers Ca19.9, Ca125, and Ca15.3 were normal in levels among papilloma patients and the control group compared to the normal value of the three markers, which equaled N.V. (>37ng/ml). Statistically, these differences between the scores of the three markers, which were measured depending on mean and standard deviation, were highly significant. There is a low positive correlation between the levels of Pap-IgM (>1) with levels of Ca19.9 (>37) with (r=0.409**, P=0.000), while there is a moderate association between the levels of Pap-IgM (>1) with Ca125 (>35ng/ml) and Ca15.3 (>37ng/ml) levels with (r=0.574**, 0.565**, P=0.000, 0.000) respectively. Also, this table documents that there is a moderate positive correlation between the levels of Pap-IgG (>1) and the levels of the three tumor markers Ca19.9 (>37), Ca125 (>35), and Ca15.3 (>37) (r=0.521**, 0.592**, 0.647**). The HPV-16 L1 gene expression was investigated in patients infected with Papillomaviruses compared to healthy controls using real-time PCR. The results showed a high Ct value for patients and controls with a high Ct value of templates, preoperational to the gene concentration.

COVID-19 IN IRAQ, THE RURAL INITIATION (AL-MUTHANNA PROVINCE AS AN EXAMPLE)

A sustained pneumonia outbreak associated with a novel coronavirus named acute respiratory coronavirus 2 syndrome (SARS-CoV-2) was identified in Wuhan, Hubei Province, China in December 2019 which was later called COVID-19. The first confirmed case of COVID-19 was reported in Najaf/ Iraq on 24th February. This paper provided some information on COVID-19 infection in the Province of Al-Muthanna / South Iraq, which was then statistically analyzed and concluded. Confirmed cases of COVID-19 infections were reported by the Iraqi Ministry of Health in the Province of Al-Muthanna. The first foci started and the first dead infected individual was from Hilal which refers mainly to the role or rural places in starting and transmission of COVID-19 in Iraq. Many of the infections resulted in non-traveling persons because they were contaminated by contact (96%). Therefore, contact is perceived to be the best-recognized form of transmission. It was also reported that infections in Soweir District of Samawah City were the highest (45%) compared to other areas of the region. They should also be observed, however, that the steps to enforce and monitor the curfew are directly related to the direction of the City Centre, because the more they drive away from the city centers, the less stringent the procedures. Infections were focused between the ages of 20 and 50 years old, as that is the expected result, because these ranges are at the core of active age groups including social and sports events. Graphical abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=111 SRC="FIGDIR/small/21251969v1_ufig1.gif" ALT="Figure 1"> View larger version (25K): org.highwire.dtl.DTLVardef@1f01ca8org.highwire.dtl.DTLVardef@e969f9org.highwire.dtl.DTLVardef@2c81e1org.highwire.dtl.DTLVardef@3144f_HPS_FORMAT_FIGEXP M_FIG C_FIG