Paraplegia after epidural anesthesia in a patient with peripheral vascular disease: case report and review of the literature with a description of an original technique for hematoma evacuation.

Epidural hematoma after epidural anesthesia is a rare and uncommon complication in patients with peripheral vascular disease who require perioperative anticoagulation therapy. A low index of suspicion makes its diagnosis difficult and often delayed. Treatment usually involves extensive laminectomy, increasing the chances for patient complications. In this article, the authors report a case of epidural hematoma with secondary paraplegia after epidural anesthesia. Also described is an original technique for evacuating the epidural space.

Succinylcholine-induced rhabdomyolysis in a healthy child.

A case of Rhabdomyolysis occurred in a healthy boy 9 years of age after general anaesthesia. Succinylcholine, nitrous oxide and isoflurane were used for induction and maintenance of anaesthesia. Patient developed severe muscle pain, myoglobinuria, haemoglobinuria. Also creatinine phosphokinase was elevated up to 10,694 IU/L. Management was prompt and he was discharged home the third day in good condition. The injection of succinycholine may have precipitated rhabdomyolysis. This is a rare complication of succinylcholine without the disastrous outcome of renal failure, hyperkalaemia or cardiac arrest.

Strength in numbers.

PIP: A case study showing the attitudes and actions reinforcing discrimination against women's rights in Lebanon is presented. The study illustrates the way in which the public¿s views and the interests of families and local dignitaries can manipulate opinions. Organizations aimed at protecting women's rights have found strength in working together. The Lebanese League, an organization comprised of 17 women's and human rights associations, has established a center and a telephone hotline to encourage abused women to disclose and discuss their situation. The center provides support in the form of legal, psychological and medical assistance. Another organization working with the Lebanese League towards the same vision is the Lebanese Physically Handicapped Union. Efforts to lobby around a Lebanese legislation discriminating against women so far had no success, but all organizations involved are aware of the need to work through a range of interventions, and to take a long-term view, before they can count on any success.^ieng

Pseudoaneurysm of the popliteal artery following arthroscopic meniscectomy.

A pseudoaneurysm was diagnosed by ultrasound of popliteal fossa in a 40-year-old female following arthroscopic meniscectomy. The patient was treated successfully with a reversed saphenous vein graft (SVG). This case is used to review the literature concerning the complications of arthroscopic meniscectomy.

Osteoid osteoma of the proximal phalanx of a toe. A case report.

A case of osteoid osteoma of proximal phalanx of second toe is presented. The clinical, radiological, and pathological features are discussed. Osteoid osteoma is rare in toe phalanges but should be considered when a patient presents with unexplained chronic pain in his or her toes.

Correction of a malunited vertical shear fracture : Staged sliding osteotomy of the pelvic ring.

The authors describe a posterior and anterior osteotomy of the pelvis for correction of a posttraumatic deformity in a 22-year-old female patient. As a shortening of the leg of 4 cm had occurred, surgery was performed in 2 stages. Between these 2 operations skeletal traction was employed. Main indications for this type of surgery included shortening of the leg, gait difficulties and poor posture while sitting. However, poor general health is considered to be a contraindication for such a risky surgery. During the surgical procedure all soft tissues preventing an proper correction have to be dissected or detached, particularly the sacrospinal and sacrotuberal ligaments. Screw fixation guarantees the correction. Exercises can be started as soon as the fragments become stable. Injuries to vessels and nerves are the most frequently encountered complications.The patient was symptom-free after 1 year postoperatively, mobility of both hips and her gait were normal. The author could observe a complete remodelling of the osteotomies after 1 year.

One-lung ventilation of children during surgical excision of hydatid cysts of the lung.

One-lung ventilation was used in 13 children, undergoing surgical excision of pulmonary hydatid cysts. Five had right-sided pulmonary cysts and eight had left cysts. An ordinary cuffed tracheal tube was introduced to the main bronchus of the healthy side. One-lung ventilation using 1-2% halothane in oxygen produced PaO2 values of 12.6-33.3 KPa and PaCO2 values of 4-6kPa. After operation there was a high frequency of right upper lobe collapse in cases of selective right bronchial intubation, but this cleared completely within 3-4 days. The technique proved to be a simple and effective method of isolating and ventilating the healthy lung.