Bilateral elastofibroma: a case report and review of the literature.

Elastofibroma, or elastofibroma dorsi as it was first described, is an uncommon tumor-like process that characteristically appears as an ill-defined mass in the infrascapular region of elderly patients. This lesion can occur bilaterally and may appear asynchronously. The occurrence of elastofibroma in other anatomic sites has been reported, although with much less frequency. Elastofibromas display typical diagnostic histologic, cytologic, and electron microscopic features. The use of magnetic resonance imaging can lead to a presumptive diagnosis in elderly individuals with suprascapular lesions. It is important to differentiate this lesion from other soft-tissue lesions, such as sarcomas and desmoid tumors. This study presents a case of bilateral elastofibromas in a 72-year-old man and a review of the literature.

Knee arthroscopy using regional nerve blockade.

Regional nerve block anesthesia has been less commonly used and less successful in surgery on the lower extremity than on the upper extremity because of anatomic difficulties associated with lower-extremity nerve blockade. The authors have developed a technique that combines two peripheral nerve blocks with a nerve stimulator. This has provided sufficient anesthesia for the performance of arthroscopic surgery on the knee. It simplifies earlier techniques by decreasing the discomfort associated with the procedure and increasing its accuracy. The technique has also facilitated rapid patient discharge from the same-day unit. No significant complications have been encountered.

Recreational sports and the weekend athlete.

It is important to design an exercise program that provides an adequate amount of activity to attain maximal benefits at the lowest risk to the participant. Permanent lifestyle changes in eating and activity habits should be included in the primary goals of all programs.

Anabolic steroids: performance enhancers?

Physicians must discourage steroid use in those who have not yet begun and must treat those patients already on anabolic steroids. Physicians cannot encourage anabolic steroid use by their patients or by themselves. Anabolic steroids are bad for the user.

Pyomyositis in an HIV-positive premature infant: case report and review of the literature.

Pyomyositis is a purulent infection of skeletal muscle caused predominantly by Staphylococcus aureus. Although not often encountered in the continental United States, pyomyositis is frequently seen in tropical areas. Pyomyositis is difficult to diagnose as it may mimic other diseases. Delay in diagnosis may lead to septicemia, shock, and death. Recently, two cases of patients with pyomyositis and acquired immune deficiency syndrome were reported. We report a case of pyomyositis in a 7-week-old premature infant who subsequently tested positive for anti-HIV antibodies. A brief review of the topic is included.

A complication of interference screw fixation in anterior cruciate ligament reconstruction.

Bone-tendon autografts using patellar tendon are rapidly becoming the autogenous grafts of choice for anterior cruciate ligament reconstruction. Patellar tendon is the strongest type of available autogenous tissue, and it is easily adaptable to arthroscopically assisted techniques. Secure immediate fixation is critical for the success of this procedure. The Kurosaka screw has emerged as one of the most reliable graft fixation methods. Although we have enjoyed much success with the Kurosaka screw, the following case represents the first report of failure with this fixation technique.

Pediatric update # 13. Injuries to the inferior pole of the patella in children.

Sinding-Larsen-Johansson disease and sleeve fractures are two injuries that occur at the inferior pole of the patella in children. The first is a chronic tendinitis accompanied by calcification of the avulsed patellar tendon. The latter are acute injuries that involve a complete avulsion of the proximal insertion of the patellar tendon with a small fleck of bone and portion of patellar articular cartilage. Illustrative case histories and a literature review are presented.

Pseudo-osteomyelitis in Gaucher's disease.

Gaucher's disease is an uncommon lipid storage disease sometimes associated with bone pain that can mimic an acute pyarthrosis or osteomyelitis. A case report with two incidences of pseudo-osteomyelitis with two-year follow-up is presented along with a literature review. Recommendations for evaluation and differentiation from a true infection are given. In general a needle biopsy for culture is preferable to any open biopsy or drainage if the diagnosis is in doubt.

Rehabilitation of the sports-injured patient.

We have presented an overview of basic orthopedic rehabilitative exercises, techniques, and modalities. As our athletic population has become more insistent on performance enhancement techniques, the orthopedic surgeon has adopted a more aggressive approach to rehabilitation of the injured athlete. Many of the rehabilitation techniques and modalities outlined are very inexpensive and require little space; others are very expensive and space-demanding. As our knowledge base expands, we hope we will be able to apply these scientific principles toward better treatment of the injured athlete.

Calcium pyrophosphate and pseudogout.

Calcium pyrophosphate deposition disease (CPDD) is a condition in which calcium pyrophosphate dihydrate crystals are deposited in joint articular cartilage, menisci, and synovium. The main clinical presentations of CPDD are chondrocalcinosis--calcification of cartilage, pseudogout--acute joint inflammation due to crystal-induced synovitis, and pyrophosphate arthropathy--degenerative joint disease similar to osteoarthritis associated with calcium pyrophosphate crystal deposition. The clinical importance of CPDD for the arthroscopist is the ability to recognize the condition so that appropriate treatment can be instituted. Arthroscopy is valuable for diagnosis as well as lavage and intraarticular debridement or meniscectomy. Tissue removed for microscopic examination should be sent to the laboratory in saline, since formalin dissolves the crystals. Postarthroscopy treatment of CPDD should include oral antiinflammatory medication. Asymptomatic chondrocalcinosis does not require treatment.