Search

Background Abdominal cocoon or "encapsulating peritoneal sclerosis" (EPS) is an uncommon and rare cause of intestinal obstruction. Only a few cases have been reported in paediatric patients. Typically, EPS is described as the primary form in young adolescent girls from tropical and subtropical countries because of viral peritonitis due to retrograde menstruation or a history of peritoneal dialysis. Most patients are asymptomatic or present with abdominal pain, which is likely to occur secondary to subacute bowel obstruction. Findings at imaging, such as ultrasound, computed tomography, and magnetic resonance imaging, are often nonspecific. When diagnosed, EPS is characterized by total or partial encasement of the bowel within a thick fibrocollagenous membrane that envelopes the small intestine in the form of a cocoon because of chronic intraabdominal fibroinflammatory processes. The membrane forms a fibrous tissue sheet that covers, fixes, and finely constricts the gut, compromising its motility. Case summary We present a case of EPS in a 12-year-old boy 8 wk after primary surgery for resection of symptomatic jejunal angiodysplasia. There was no history of peritoneal dialysis or drug intake. Conclusion In this report, we sought to highlight the diagnostic, surgical, and histopathological characteristics and review the current literature on EPS in paediatric patients.

Aneurysms of the ulnar artery and its palmar arch are usually rare events, which are mostly related to repetitive trauma of the extremity. This syndrome is also known as hypothenar hammer syndrome, which presents two pathologic entities: the aneurysmal type and the thrombotic type. Whereas surgical treatment is not necessary within the thrombotic type, it is the gold standard to treat aneurysms of the palm with resection of the aneurysm and reconstruction of the vessel with either end-to-end anastomosis, venous or arterial grafts. We report a case of a young male patient with an aneurysm of the right ulnar artery at the wrist with history of repetitive trauma. Reconstruction with a venous forearm graft showed recurrence of the aneurysm after 2 years from surgery. The authors want to elaborate an algorithm for surgical treatment to make the right decision for choice of reconstruction. Level of evidence: Level IV, therapeutic study.

The fast-evolving nature of the coronavirus disease 2019 (COVID-19) pandemic has led to unprecedented clinical, logistical, and socioeconomical challenges for health-care systems worldwide. While several studies have analyzed the impact on the presentation and management of acute appendicitis (AA) in the adult population, there is a relative paucity of similar research in pediatric patients with AA. To date, there is some evidence that the incidence of simple AA in children may have decreased during the first lockdown period in spring 2020, whereas the number of complicated AA cases remained unchanged or increased slightly. Despite a worrying trend toward delayed presentation, most pediatric patients with AA were treated expediently during this time with comparable outcomes to previous years. Hospitals must consider their individual capacity and medical resources when choosing between operative and non-operative management of children with AA. Testing for severe acute respiratory syndrome coronavirus type 2 is imperative in all pediatric patients presenting with fever and acute abdominal pain with diarrhea or vomiting, to differentiate between multisystem inflammatory syndrome and AA, thus avoiding unnecessary surgery. During the further extension of the COVID-19 crisis, parents should be encouraged to seek medical care with their children early in order that the appropriate treatment for AA can be undertaken in a timely fashion.

The denervation of the wrist is a known method to treat the painful wrist. Pain relief and therefore functional improvement is the main goal to be achieved, but very little is known about other effects such the influence on proprioception. There are references that indicate an effect on reflex arcs after a certain stimulus on the wrist, and thus, changes in proprioception may come along with a surgical denervation. This systematic review was conducted to investigate if there is evidence that assesses the influence of surgical wrist denervation on proprioceptive changes and the methods that were used. Very few articles describe an effect of denervation on the proprioception of the wrist. Reliable tests to measure proprioception are rare. Such tests exist but still they comprise bias and lack of minimation of other influences such as optic input. Subject of further investigation should be proprioception itself and methods to test this quality objectively. Level II, risk/prognostic study.

Reconstruction of trochanteric pressure sores continues to challenge reconstructive surgeons because recurrence is not uncommon and patients typically have undergone previous surgery. We herein report on the use of a large adipocutaneous TFLPP rotated for 180° facilitating reconstruction of a recurring trochanteric decubital ulcer in a 37-year-old male morbidly obese patient with diabetes mellitus. The postoperative period showed no adverse events, and no recurrence was observed to date. The TFLPP is a valuable option because skin grafts are usually not needed for donor-site closure, the muscle is spared, and minimal donor-site morbidity as well as a less bulky appearance is observed. Level of evidence: Level V, therapeutic study.

Allergic reactions occurring after tattooing, especially after the use of red tattoo ink ingredients are relatively rare. We report a painful skin reaction occurring 6 months after the tattoing of the right lower extremity in a 30-year-old female patient. Pathohistological and immunchemical results confirmed a pseudolymphoma. Only the tangential excision of the affected areas led to a sufficient healing process. Split thickness skin grafts were used for defect coverage. 2 years later, the patient was still pain free and the wounds had healed completely without any irritation.

Ziel: Ziel dieser retrospektiven Studie war es zu untersuchen, wie haufig und in welcher Form eine Medianus-Neuropathie nach perilunaren Luxationsverletzungen auftritt mit besonderem Augenmerk auf die vorausgegangene Therapie und dem langfristigen klinischen Ergebnis. Patienten und Methode: 32 Patienten wurden durchschnittlich 65 Monate (22 Monate–9,8 Jahre) nach chirurgischer Behandlung einer perilunaren Luxationsverletzung, bei 13 Patienten einschlieslich einer Karpaldachspaltung, klinisch und radiologisch nachuntersucht. Bei 10 von 11 Patienten mit klinischen Symptomen einer Me­dianus-Iirritation erfolgte zusatzlich eine elek­trophysiologische Untersuchung. Lagen 2 oder mehr pathologische Parameter vor, wurde dies als Medianus-Neuropathie gewertet. Patienten mit und ohne Medianus-Neuropathie bei der Nachuntersuchung wurden miteinander verglichen. DASH-Score, Griffkraft, Schmerzen, Handgelenksbeweglichkeit und der Mayo wrist score wurden zur Beurteilung des Ergebnisses herangezogen. Ergebnisse: Insgesamt zeigten 9 Patienten eine Medianus-Neuropathie bei der Nachuntersuchung. Bei 6 Patienten persistierte diese seit dem Unfall, bei 5 davon trotz initialer Karpaldachspaltung. 3 Patienten zeigten eine sekundare, verzogert aufgetretene Medianus-Neuropathie. Pa­tienten mit Medianus-Neuropathie hatten ein schlechteres Ergebnis hinsichtlich Griffkraft, Ruheschmerzen, dem Mayo wrist score und dem DASH-Score, hinsichtlich Belastungsschmerzen statistisch signifikant. Schlussfolgerung: Eine Medianus-Neuropathie nach perilunarer Luxationsverletzung ist haufig. Diese tritt meist nicht als typisches Karpaltunnelsyndrom, sonder vielmehr als chronischer Nervenschaden in Erscheinung. Eine primare Karpaldachspaltung kann nicht immer anhaltende neurologische Storungen verhindern.

Evaluation of early cup movement is an important diagnostic tool to predict the likelihood of long-term implant loosening and clinical failure. The investigated cementless cup is clinically proven over 10 years, but there is a paucity of information that accurately describes the migration characteristics of this component. We retrospectively analysed the clinical outcome and migration behaviour of 60 Pinnacle 100 shells after an average 3.8-year follow-up (range 2.1–5.4 years). For migration measurement, EBRA (Einzel-Bild-Rontgen-Analyse) digital software was applied. Clinical assessment was performed using the HHS, the UCLA score and the SF-36 health survey. The clinical outcome showed excellent results with a mean HHS of 95.4 (SD 7.1) and mean UCLA of 6.9 (SD 1.3). All implants were radiologically stable within the observation period and none of the cups was at risk for aseptical loosening. EBRA analysis revealed a mean total migration of 1.4 mm (SD 0.9) (95 % CI 1.1–1.6) at 3 years. Eight cups migrated more than 1 mm within the first three postoperative months, thereafter the migration curves flattened down. Surgeons may expect to find a variable amount of early migration when using the Pinnacle cup. To our knowledge, these are the first results, which show an early “impaction” of a cementless cup, followed by subsequent osseointegration. We believe that an appropriate long-term outcome of the investigated cup is ensured. The data of the present investigation will provide clinicians with useful baseline information with which to compare new cup designs.

A 45-year-old man suffered from a complex bone and soft tissue defect of the middle phalanx of his left middle finger after an electric saw injury. Here, we present the patient's clinical and radiological outcomes after reconstruction with a free vascularized metacarpal II bone graft and an extended distally based second dorsal metacarpal artery skin flap (DMCA). To our knowledge, this is the first description of a free vascularized metacarpal bone graft combined with DMCA for distal finger reconstruction.

Ultrasound elastography (USE) is a newly developed technique for the evaluation of tissue stiffness. It is known that malignancies often show a low-strain value. So far, only limited data for thyroid nodules is available.This study included 309 prospective evaluated patients with dominant, nontoxic thyroid nodules. All patients were referred to surgery. USE was performed preoperatively. Three measuring groups were formed: hard (0.15), intermediate (0.16-0.3), and soft (0.31). The measurements were correlated to the final histological findings.The strain rated from 0.01 to 0.84 (mean 0.26 ± 0.13). A total of 50 thyroid malignancies (35 papillara carcinoma, 9 medullary carcinoma, and 6 follicular carcinoma) were observed. Patients (81) were within the hard group, 35 of them (43.2%) had thyroid cancer (TC) in final histology. Out of 132 patients in the intermediate group, 15 patients had TC (11.4%). All 96 patients from the soft group showed benign histological results (NPV 100%). Seventy percent of patients with TC were within the hard group (PPV 42%). These results were highly significant (p 0.001). Coarse calcifications and cystic nodules were not connected with reliable measurements and therefore are not suitable for USE.USE is a useful adjunctive tool in the workup of thyroid nodules. A low strain value needs surgical intervention, whereas a high strain value predicts a benign histology. It might substitute fine-needle aspiration cytology in the future.

Deckung von weder primar noch mit freiem Hauttransplantat zu verschliesenden Defekten am Daumen durch gestielte, sensible Insellappenplastik von der Grundgliedstreckseite des Zeigefingers. Kombinierte Haut- und Weichteildefekte des Handruckens, der ersten Kommissur und vor allem des Daumens. Voroperationen mit Verletzungen der ersten dorsalen Mittelhandarterie oder des Rete carpale dorsale. Verletzungen im Lappenhebebereich. Akute Infektsituation im Operationsgebiet. Skizzieren einer Hautinsel am Zeigefingergrundgliedrucken entsprechend der Grose des zu deckenden Defekts. S-formiger Hautschnitt im ersten Zwischenfingerraum radial. Identifikation der Arteria metacarpalis dorsalis I. Bildung eines Faszien-Gefas-Nerven-Stiels zur Lappenversorgung unter Einschluss der Faszie des Musculus interosseus dorsalis in den Lappenstiel. Umschneidung des Insellappens am Zeigefinger. Heben und Mobilisation der Lappenplastik. Der Lappen wird dann unter der vorher untertunnelten Haut in den Defekt am Daumen durchgezogen. Einnahen des Lappens in den Defekt. Deckung der Lappenhebestelle mittels Spalthaut-/Vollhauttransplantat. Ruhigstellung in einer Gipsschiene fur 7 Tage. Einleiten der krankengymnastischen Ubungsbehandlung. Entfernung der Hautfaden nach 14 Tagen. In den Jahren 2005 und 2006 wurden an der Klinik fur Handchirurgie, Rhon-Klinikum, Bad Neustadt/Saale, 15 an der ersten dorsalen Mittelhandarterie gestielte, sensible Insel lappenplastiken nach Foucher bei elf Mannern und vier Frauen zur Defektdeckung am Daumen durchgefuhrt. In Ubereinstimmung mit der Literatur kam es zu sehr zu friedenstellenden Ergebnissen. Alle Lappenplastiken heilten ein, Teil- oder Komplettnekrosen wurden nicht beobachtet. Die Zweipunktediskrimination, ermittelt mit dem Greulich-Stern, betrug postoperativ im Durchschnitt 8,8 mm.

The operative therapy of the autonomous thyroid deals almost exclusively with nodular goiters. There are only rare situations with purely diffuse autonomy in surgical patients. The endpoint of operative therapy is permanent elimination of clinically relevant autonomous function and thereby irreversible abolition of thyrotoxicosis, even in their latent form. Clinically relevant autonomous function normally ist linked to nodular structures of different size and different distribution, so that this aim corresponds automatically with the aim of complete removal of nodular structures, both in autonomous and in non-autonomous goiters. Function is best preserved by leaving a homogenous remnant of considerable size. In different particular clinical situations (for example pregnancy, suspicion of malignancy, recurrent goiter, intrathoracic goiter, thyrotoxic crisis, Marine-Lenhart-syndrome) the basic principal of operative strategy is varied according to the respective situations. Unsatisfactory operative results are mainly caused by incomplete removal of nodules, based on insufficient surgical performance of morphological and functional diagnostics, which is related to operative uniformity. An operative strategy, which ist "fitted to morphology" and "regarding function" and which we call "selective strategy", in our opinion ist highly appropriate, to avoid remnant nodules and remnant autonomy and to preserve an normal remnant, even in different position and of different size. This selective surgery ist applicable both to autonomous and non-autonomous goiter. Compared with the classic subtotal, uniform procedure the incidence of remnant nodules is reduced from about 50% to about 5 %. Remnant autonomy is almost excluded, when mistakes are avoided (about 1%). The incidence of recurrent goiter and recurrent thyrotoxicosis is lowered to under 5%--but up to now there are too few reliable long-term follow-up studies. The selective surgery strategy demands flexibility regarding operative tactics, which can be simply classified into 5 basic situations, which we relate to the operative procedure per thyroid lobe. It requires experience and competence in carefully dissecting and--when necessary--manipulating the recurrent laryngeal nerve und the parathyroid glands. Under these conditions it is followed by a comparatively low rate of complications (permanent recurrent laryngeal nerve paralysis and hypoparathyroidism under 1%, respectively). Thus, the old dilemma of thyroid surgery can be solved, which consists of radical operation with higher morbidity and lower frequency of recurrent disease on the one hand and more limited operative procedures with fewer complications but more frequent recurrencies on the other hand.

Wiederherstellung der Beugesehnenkontinuitat und -mechanik durch direkte Naht. Aktive Nachbehandlung fur Streckung und Beugung. Durchtrennung der tiefen und der oberflachlichen Beugesehne in allen Zonen, auch in Kombination mit Begleitverletzungen, wenn eine primare Heilung und ein gutes funktionelles Ergebnis zu erwarten sind. Akute und chronische Infektion. Fehlende personelle, instrumentelle oder organisatorische Voraussetzungen. Keine spannungsfreie Naht moglich. Stark infektionsgefahrdete oder verschmutzte Wunden und ausgedehnte Quetschverletzungen. Begleitverletzungen, die eine postoperative Mobilisation verhindern. Eine Gefasverletzung verbietet eine Naht nach Mantero. Schnittfuhrung nach handchirurgischen Gesichtspunkten unter Einbeziehung der Wunde. Eroffnung der Sehnenscheide im Kreuzbandbereich. Vierstrangnaht, bestehend aus zwei versetzten geblockten Zweistrangnahten und einer epitendinosen fortlaufenden Kreuzstichnaht. Ist der Sehnenstumpf in Zone I kurzer als 1 cm, Naht nach Mantero. Bei einer ansatznahen knochernen Abscherung transossare Ausziehnaht. Aktive Beugung und Streckung in einer dorsalen Handgelenkschiene. Die in der Literatur beschriebenen Nachuntersuchungsergebnisse von Kernnahten mit mehr als zwei Strangen erbringen in 69–96% sehr gute und gute Ergebnisse.

Die selektive, morphologiegerechte und funktionskritische Operationsstrategie bei der benignen Knotenstruma vermag die Rate von Restknoten im Vergleich zur beidseitigen subtotalen Resektion (Enderlen-Hotz) zu senken. Inwieweit innerhalb dieser Strategie der intraoperative Ultraschall (IOPUS) Einfluss auf die Operation und die Rate an Restknoten nimmt, war zu prufen. Einhundert konsekutive Patienten mit benigner Knotenstruma wurden unter Verwendung des IOPUS operiert. Das makroskopische Praparat wurde mit dem praoperativen Ultraschall und dem IOPUS verglichen. Achtzig dieser Patienten wurden 3±1,6 Jahre postoperativ sonographisch nachuntersucht. Als Kontrollgruppe diente ein Kollektiv von 80 Patienten, welches mit der gleichen Operationsstrategie, aber ohne IOPUS operiert worden und ein Jahr postoperativ sonographisch nachuntersucht worden war. Der Vergleich der beiden Kollektive erfolgte hinsichtlich Operationsverfahren, Restgrosen und Knoten in der Restschilddruse. In 35% der Falle konnte der IOPUS zusatzliche Knoten identifizieren. Zusatzliche Information bezuglich Ausdehnung und Struktur der Knoten lieferte der IOPUS in 20% der Falle. Ein radikaleres als das ursprunglich geplante operative Vorgehen bewirkte der IOPUS in 24% und eine sparsamere Resektion in 10%. Verglichen mit dem Kollektiv ohne IOPUS, war das IOPUS-unterstutzte Operieren radikaler (Lobektomie 40% vs. 24%, nicht resezierte Lappen 16% vs. 26%; p

Aim To evaluate visual quality and postoperative results as well adverse events in myopic patients undergoing I-CARE anterior-chamber angle-supported phakic intraocular lens (IOL) implantation. Design A retrospective, non-randomised, case series. Participants Data on 29 eyes (16 patients) receiving I-CARE phakic IOL for high myopia (–11.66±3.3) were analysed. Methods The IOLs were implanted between 2003 and 2006 at the Department of Ophthalmology, Medical University, Graz, Austria. The mean follow-up was 51.7±16 months (17–78 months). Main outcome measures The authors measured uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA); patients underwent slit-lamp examination, corneal topography, Scheimpflug imaging and measurement of endothelial cells (EC). Results The mean UCVA and BCSVA were 0.63 and 0.94 decimal after 1 year. Endothelial cell loss was the most serious adverse event observed. The mean EC loss was 2%, 9%, 17%, 21%, 33% and 47% after 1 year (n=17), 2 years (n=20), 3 years (n=17), 4 years (n=17), 5 years (n=12) and 6 years (n=3), respectively. Eight IOL explantations were made due to severe EC loss 3–6 years after implantation. Other serious complications included one patient with Urrets–Zavalia Syndrome (one eye). Conclusion Implantation of the I-CARE phakic-IOL is not a safe method for the correction of high myopia due to serious endothelial cell loss that might occur in a high number of patients. Patients with these IOLs should be followed up at least every 6 months, and the IOL should be explanted, once the EC count drops to less than 2000 cells/mm 2 .