Neonatal Gastric Necrosis and Perforation Treated by Subtotal Gastrectomy and Esogastric Anastomosis: A Case Report.

BACKGROUND Gastric necrosis and perforation are rare life-threatening conditions in preterm neonates, which require urgent diagnosis and surgical intervention. CASE REPORT We report a case of a 4-day-old patient with neonatal gastric necrosis. The patient presented with sudden acute abdominal distension, respiratory distress, and metabolic acidosis. The abdomen was markedly distended, tender, and tympanic with collateral circulation. An X-ray of the abdomen showed a huge pneumoperitoneum. An urgent exploratory laparotomy revealed 2 wide horizontal perforations and necrosis of the fundus and gastric body. Subtotal gastrectomy with esogastric anastomosis was done. Postoperatively, the patient was administered total parenteral nutrition and triple antibiotics and improved gradually. He passed stool and the abdomen was soft, lax, and non-distended and the wound healed. An upper gastrointestinal tract (UGIT) contrast study 1 week after the operation showed no leakage or stricture. The patient was discharged 2 months postoperatively with a bodyweight of 2 kg and was followed in the Outpatient Department (OPD). The patient survived after 80% gastric resection for necrosis of the stomach, which was a unique outcome for this major surgery. CONCLUSIONS Gastric perforation is a rare life-threatening condition in preterm neonates, usually managed by direct closure in layers. Exceptionally, partial gastrectomy is needed, which is a major operation, with a high mortality rate and poor outcome. We present a case of a preterm neonate who survived after 80% gastric resection for stomach necrosis.

Bilateral Mirror-Symmetrical Giant Cell Tumor of the Tendon Sheath in the Foot and Ankle: A Case Report.

Giant cell tumor of the tendon sheath is a slowly growing benign tumor. It usually arises from the tendon sheath and periarticular soft tissue of small joints. However, it may infrequently involve the large joints emerging around the knee, elbow, and hip joints. Giant cell tumor of the tibialis tendon sheath is rarely reported in the foot and ankle joint. Here, we report the first case in the medical literature of bilateral mirror-symmetrical giant cell tumor of the tendon sheath in the foot and ankle. A 12-year-old male presented with a bilateral and mirror-image mass on his ankles extending to the foot. It was painless but affected his gait and footwear. Staged complete resection was done first on the right then on the left side, with no recurrence after 1 year. The role of genes can be argued for this presentation and giant cell tumor's etiology, owing to the bilateralism and mirror-image presentation. Studies are needed to explore this genetic aspect and its role in management.

Use of hamstring autograft to reconstruct the patellar tendon after endoprosthetic replacement of the proximal tibia for bone sarcomas.

The surgical treatment of bone sarcoma involves wide surgical resection and endoprosthetic replacement. Surgical resection for proximal tibia bone sarcoma includes the patellar tendon. The secondary extension lag is a common complication and, although many have been described, the options for reconstruction of the patellar tendon are suboptimal. We propose adding a biological reinforcement, the hamstring tendons, to our extensor mechanism reconstruction technique (polyprolene mesh and gastrocnemius flap). We describe the surgical technique and, using an illustrative case, compare the outcome of this technique with the outcome following reconstruction without reinforcement. Level of evidence: Level III.

Reliability and validity of an adapted Arabic version of the Scoliosis Research Society-22r Questionnaire.

STUDY DESIGN: Cross-sectional validation and reliability assessment study of Arabic version of Scoliosis Research Society-22 (SRS-22r) Questionnaire. OBJECTIVE: To develop and validate the Arabic version of the SRS-22r questionnaire. SUMMARY OF BACKGROUND DATA: The diagnosis and treatment of adolescent idiopathic scoliosis may influence patient quality of life. SRS-22r is an internationally validated questionnaire used to assess function/activity, pain, self-image, and mental health of patients with scoliosis. It has been translated into several languages but not into Arabic language. Therefore, a valid health-related quality-of-life outcome questionnaire for patients with spinal deformity is still lacking in Arabic language. METHODS: The English version of SRS-22r questionnaire was translated, back-translated, and culturally adapted to Arabic language. Then, 81 patients with idiopathic adolescent scoliosis were allocated randomly into either the reliability testing group (group 1) or the validity testing group (group 2). Group 1 patients completed Arabic version of SRS-22r questionnaire twice with 1-week interval in-between. Cronbach α and intraclass correlation coefficient were measured to determine internal consistency and temporal reliability. Group 2 patients completed the Arabic version of SRS-22r questionnaire and the previously validated Arabic version of 36-Item Short Form Health Survey (Short Form-36) questionnaire concurrently, and Pearson correlation coefficient was obtained to assess validity. RESULTS: Content analysis, internal consistency reliability, test/retest reproducibility (intraclass correlation coefficient range: 0.82-0.90), and test of concurrent validity showed satisfactory results. Function/activity and satisfaction with management domains had a lower Cronbach α (0.58 and 0.44, respectively, vs. 0.71-0.85 range for others). Self-image/appearance and satisfaction with management had a lower correlation with domains of the 36-Item Short Form Health Survey. CONCLUSION: An Arabic version of the SRS-22r questionnaire has been developed and validated. This questionnaire will aid health care workers and researchers in evaluation of patient perception of the deformity, satisfaction with treatment, and quality of life in Arabic-speaking populations. LEVEL OF EVIDENCE: 3.

Posterior dislocation of a discoid meniscus in a child: a case report.

Discoid meniscus of the knee is a well-known anatomic and congenital variant of the lateral meniscus. It is often asymptomatic, but can be associated with knee pain and other symptoms. Posterior dislocation of the discoid meniscus is an extremely rare finding; to the best of our knowledge, only one case has been reported in the literature. Here, we report a case of 10-year-old girl who presented with right knee pain with no history of trauma. The radiograph of her right knee was negative but MRI showed bilateral lateral discoid menisci with posterior dislocation in the right knee and some subluxation in the left. She underwent right knee arthroscopic lateral meniscoplasty with excellent outcome. This case demonstrates the possibility of torn and dislocated discoid lateral menisci management through arthroscopic reduction and repair.

Propionibacterium acnes delayed infection following spinal surgery with instrumentation.

Propionibacterium acnes detection in culture media was previously considered a contamination but recently its infectious role was discovered in post-spinal surgery infections. P. acnes might be introduced during surgery. Its diagnosis is based on non-specific clinical signs, image indications of infection, and the conclusive microbiological sign. Furthermore, its diagnosis is difficult because of slow growth rate and low virulence, delaying its presentation. Usually, the infection is manifested after a couple of months or years. Here, a 65-year-old man presented with drainage at the site of instrumented spinal surgery performed 13 years ago. P. acnes infection was confirmed by culture with extended incubation. Our review of the literature revealed only two other reported cases of delayed P. acnes infection presenting a decade following a spinal surgery with instrumentation. This article sheds light on such delayed infections and discusses their presentation and management.

[Intraosseous ganglion cyst of the capitate: a case report]. / Kyste synovial intraosseux du capitatum : à propos d'un cas.

Intraosseous cyst of the carpal bones is a rare cause of wrist pain. Few cases have been reported. We report a rare case of intraosseous ganglion cyst of the capitate, in a girl aged 16 who plain of chronic pain of the right wrist. The radiological assessment showed an osteolytic lesion with marginal sclerosis. The diagnosis was confirmed by histopathology and treatment consisted of curettage with autologous cancellous bone graft. At 8 months follow-up, the capitate is fully consolidated and the functional result is satisfactory.

Slipped capital femoral epiphysis in a patient with Turner syndrome receiving growth hormone therapy.

OBJECTIVE: To report a case of slipped capital femoral epiphysis in a young patient with Turner syndrome (TS) receiving growth hormone therapy and to emphasize the importance of keeping this orthopedic condition in mind during management of this patient group. METHODS: Clinical, laboratory, and radiographic findings are presented, and risk factors for slipped capital femoral epiphysis are discussed. RESULTS: A child with TS presented for medical assessment because of a limp but with no history of trauma or febrile illness. Growth hormone therapy had been administered for 1 year because of her short stature. Physical examination and pelvic radiography of the patient showed the presence of bilateral slipped capital femoral epiphysis. She underwent bilateral pinning in situ, and growth hormone therapy was terminated. At follow-up after more than 2 years, no sequelae were noted. CONCLUSION: Patients with TS are at high risk for developing certain orthopedic conditions, such as slipped capital femoral epiphysis. Furthermore, slipped capital femoral epiphysis is a known complication of growth hormone therapy in growing children. A limp, hip pain, knee pain, or thigh pain might be a symptom of slipped capital femoral epiphysis in patients with TS, especially those receiving growth hormone therapy. Prompt recognition and treatment of this condition are important for prevention of sequelae.

[Bilateral floating forearm: a case report]. / Avant-bras flottant bilatéral : à propos d'un cas.

The combination of elbow dislocation and perilunate dislocation is rare. The prognosis of this condition depends mainly on that of the wrist. While some cases of floating forearm have been reported, no bilateral affection has -of yet- to our knowledge, been published. The authors report a case of a young patient who presented with bilateral floating forearm after a fall from a height. The treatment was surgical at the wrist. The functional result is similar to cases reported in the literature.

Orthopedic complications related to growth hormone therapy in a pediatric population.

Since the introduction of recombinant growth hormone, its use has diversified and multiplied. Growth hormone is now the recommended therapy for a growing indication to all forms of short stature because of its direct and indirect role on bone growth. Hereby, we discuss the orthopedic complications associated with growth hormone treatment in pediatric patients. These complications include carpal tunnel syndrome, Legg-Calve-Perthes' disease, scoliosis, and slipped capital femoral epiphysis. Their incidence rates recorded in several growth hormone therapy-related pharmacovigilance studies will be summarized in this study with focused discussion on their occurrence in the pediatric and adolescent age groups. The pathogenesis of these complications is also reviewed.

Salmonella enteritidis bacteremia with septic arthritis of the sacroiliac joint in a patient with systemic lupus erythematosus: case report and review of the literature.

An 18-year-old female presented with a ten days history of high grade fever, chills and pain of the left sacroiliac joint. The patient has systemic lupus erythematosus (SLE) and is on chronic immunosuppressive therapy (steroids, antimalarial and antimetabolites). Imaging of the left sacroiliac joint revealed inflammation. Blood cultures and an aspirate of a small gluteal abscess that she developed later grew Salmonella enteritidis resistant to nalidixic acid. The patient was treated conservatively with eight weeks of IV ceftriaxone and is currently asymptomatic. First case of SLE with this complication to be reported from Lebanon and treated conservatively, this communication deserved publishing together with a literature review.

[Chondroma of the acromion: an unusual localization]. / Le chondrome de l'acromion : à propos d'une exceptionnelle localisation.

The scapula is an uncommon site for a chondroma. We report the case of a chondroma in the left acromion, which presented as a painful shoulder in a 19-year-old teenager. The diagnosis was suspected on radiographs and CT scan and confirmed by histological findings.

[Patellar pathologic fracture secondary to aneurysmal bone cyst. A case report]. / Fracture pathologique de la patella sur kyste anévrismal osseux. A propos d'un cas.

Aneurysmal bone cyst is a tumor-like lesion which accounts for about 1% of all biopsied tumors and tumor-like lesions of bone. We report an extremely rare case of aneurysmal bone cyst of the patella in an 18-year-old patient revealed by a pathological fracture. The unexpected appearance of a pathological fracture affects the whole therapeutical management. However, in the case of a well-preserved articular surface, curettage and corticocancellous grafting are considered to be successful methods of treatment for aneurysmal bone cyst of the patella, as revealed in our study.

[Pisiform-hamate synostosis with ulnar neuropathy. Case report]. / Compression du nerf cubital dans le canal de Guyon secondaire à une synostose pisiforme-os crochu. A propos d'un cas.

Entrapment of the ulnar nerve at the wrist is rare compared with the more commun site at the elbow. This condition was secondary to reccurent blunt trauma, ganglion cyst, vasculitic disorders, and fibrous bands. Compression of the ulnar nerve caused by pisiform-hamate coalition is rare entity. One case of this condition is reported.

[Osteoblastoma in the proximal radio ulnar joint]. / Ostéoblastome de la petite cavité sigmoïde du cubitus.

Osteoblastoma is a benign but painful bone tumour, which can only be treated surgically. Localization at the elbow is rare and poses diagnostic problems. The tumour in this location causes joint stiffnesses due to pain and the regional inflammatory response. A delay in diagnosis can, despite successful treatment of the tumour, cause loss of the full range of movements of the elbow. We report a case illustrating this aspect.

[Hemangioma of the humerus: value of imaging]. / Hémangiome de l'humérus: apport de l'imagerie.

Hemangioma is an uncommon bone neoplasm that usually affects the craniofacial bones and spine, accounting for less than 1% of all primary bone tumors. The authors report a case of isolated hemangioma involving the proximal humerus in a 22-year-old man. Radiographically, the lesion was a well-defined osteolytic process with marginal sclerosis. The CT images demonstrated an osteolytic lesion with coarse trabecular pattern and partial cortical breakthrough. Magnetic resonance imaging showed a multilocular and hemorrhagic lesion with fluid-fluid level, that was suggestive of aneurysmal bone cyst.

[New varieties of lateral metatarsophalangeal dislocations of the great toe]. / Nouvelles variétés de luxations métatarso-phalangiennes du gros orteil: les luxations latérales.

PURPOSE OF THE STUDY: We report seven cases of traumatic dislocation of the great toe, detailing the anatomy, the mechanism of injury and the radiographic diagnosis. We propose an additional classification based on three hereto unreported cases. MATERIAL AND METHODS: Between october 1994 and october 1997, we treated seven patients with traumatic dislocation of the first metatarso-phalangeal joint of the great toe. There were six men and one woman, mean age 35 years (range 24 - 44 years). Dislocation was caused by motor vehicle accidents in four cases and by falls in three. Diagnosis was made on anteroposterior, lateral and medial oblique radiographs. According to Jahss' classification, there was one type I and three type IIB dislocations. There was also one open lateral dislocation and two dorsomedial dislocations. Only these dorsomedial dislocations required open reduction, done via a dorsal approach. Mean follow-up was 17.5 months (range 9 - 24 months) in six cases. One patient was lost to follow-up. The outcome was good in six cases and poor in one (dorsomedial dislocation). DISCUSSION: Dislocation of the first metatarso-phalangeal joint of the great toe is an uncommon injury. In 1980, Jahss reported two cases and reviewed three others described in the literature. He proposed three types of dislocation based on the feasibility of closed reduction (type I, II and IIB). In 1991, Copeland and Kanat reported a unique case in which there was an association of IIA and IIB lesions. They proposed an addition to the classification (type IIC). In 1994, Garcia Mata et al. reported another case which had not been described by Jahss and proposed another addition. All dislocations reported to date have been sagittal dislocations. Pathological alteration of the collateral ligaments has not been previously reported. In our experience, we have seen one case of open lateral dislocation due, at surgical exploration, to medial ligament rupture and two cases of dorsomedial dislocation due, at surgical exploration, to lateral ligament rupture. CONCLUSION: We propose another additional classification with pure lateral dislocation (type III) and dorso-lateral dislocation (type IL or IIL+), which are related to the formerly described variants.

[Rare localizations of bone tuberculosis. Three case reports]. / Localisations rares de la tuberculose osseuse. A propos de trois cas.

Bone and joint involvement is observed in 3 to 5 p. 100 of all cases of tuberculosis and in 15 p. 100 of extrapulmonary tuberculosis. Spinal and weight-bearing joints are most frequently involved. We report three cases of bone tuberculosis with rare localizations that raised difficult diagnostic problems. Our patients had tuberculosis of the sternum, the iliac bone and in the third case, the spine but solely in the posterior arch of the fourth cervical vertebra. X-ray evidenced bone lysis and invasion of adjacent tissues. The cold abscesses were evacuated surgically allowing bacteriological and histological diagnosis. The patients were successfully treated with anti-tuberculosis regimens. An infectious etiology should be considered in patients with bone lesions in order to obtain the samples necessary for positive diagnosis.

[Degenerated Buschke Loewenstein tumor of the scrotum]. / Tumeur de Buschke Loewenstein scrotale dégénérée.

The Buschke-Loewenstein tumour (BLT) is a sexually transmissible benign tumour of viral origin. It is characterized by a large tumour volume, the possibility of local recurrence and especially its potential for malignant transformation. We report a case of scrotal BLT in a 49-year-old patient with a history of recurrent scrotal fistula, with negative HIV serology, but in whom the search for Human Papilloma Virus (HPV) was not performed. The tumour arising from the scrotal skin was resected and the testis was found to be normal. Histology confirmed transformation of the tumour into a squamous cell carcinoma. The clinical course was favourable, after a follow-up of 8 months with no local recurrence. In the light of this case of rare tumour, especially in its malignant form and its unusual scrotal site, the authors review the problems related to clinical classification, histology (differential diagnosis with primary squamous cell carcinoma), clinical course and treatment raised by this tumour.