Jejunogastric intussusception: a rare complication of gastric surgery

Jejunogastric intussusception is a rare complication of gastric surgery. We report a case in a 41-year-old woman subjected to gastrojejunostomy with truncal vagotomy 3 years before for pyloric stenosis. The jejunogastric intussusception was diagnosed by upper gastrointestinal series, ultrasonography, and computed tomography. Surgical management consisted of reduction and fixation. Treatment should be as early as possible to prevent gangrene of the invaginated segment.     

Intra-operative hyphema: a complication of retinal detachment surgery with the Choyce pseudo-phakos

During retinal reattachment surgery in an eye with a Choyce pseudo-phakos a large hyphema developed. The probable mechanism was rupture of blood vessels in the angle of the anterior chamber during drainage of sub-retinal fluid as all the eye structures collapsed around the rigid pseudo-phakos.     

The aseptic meningitis syndrome: a complication of posterior fossa surgery

The syndrome of aseptic meningitis is characterized by spiking fever and meningismus. CSF analysis generally shows increased pleocytosis, hypoglycorrhachia, elevated protein and negative cultures. In an earlier series, 70% of children with posterior fossa operations developed the syndrome. In a new review the incidence was slightly more than 30%. The incidence of aseptic meningitis following operation for structural lesions was 44%, which was higher than the tumor group, where the meningitic syndrome was seen in 25% of the children. It is the purpose of this paper to reexamine the impact that steroids have made on the prevalence of the aseptic meningitis syndrome, and to review recent studies that have attempted to distinguish between aseptic and bacterial meningitis.     

The neglected clubfoot: a salvage procedure

The study included 18 patients (28 feet), between 4 and 14 years of age. Complete homogeneous correction of the neglected clubfoot was achieved by performing a trapezoid resection osteotomy from the cuboid bone after performing an extensive posteromedial soft-tissue release. The procedure did not sacrifice any articular cartilage and allowed realignment of the forefoot. Tibialis anterior tendon transfer to the cuboid was performed in all feet to eliminate its deforming action and to help maintain the desired degree of correction. A Dwyer calcaneal lateral closing wedge osteotomy was needed in 12 feet and was performed concomitantly with the other procedures. After an average follow-up of 26 months (range 8-31 months) 14 (50%) feet had a good result with normal features, 11 (39.3%) feet had a fair result with definite improvement, and three (10.7%) feet had a poor result with limited improvement. Both good and fair results were considered satisfactory. Patients with tight ligaments were significantly more likely to have a poor outcome (p < .0005). However, neither the patient's age at the time of surgery nor the severity of the deformity was significantly associated with unsatisfactory results. The procedure is strongly recommended in supple feet with resilient ligaments, even in teenagers with severe deformity. In severely deformed rigid feet, the procedure serves to minimize bone resection, thus preventing excessive shortening of the foot if a triple arthrodesis should become necessary at a later date.     

Role of Cahuzac's operation in clubfoot varus equina revision surgery

PURPOSE OF THE STUDY: The authors report 24 cases of revision in recurrent club foot deformity. They assessed Cahuzac's procedure for treatment of the residual forefoot adduction. This procedure (opening of the first cuneo-metatarsal joint and proximal abduction osteotomy of the second, third, and fourth metatarsals) was generally associated with postero-medial, plantar release, and split tibialis anterior tendon transfer. MATERIAL: Twenty four procedures for 20 children at mean age of five years have been performed. The revision chart comprised 12 clinical and radiological items as proposed by Seringe. RESULTS: Seven feet were considered as excellent, 14 as good, 2 as fair, and 1 as poor. The mean follow-up was four years. DISCUSSION: Treatment of the adduction component with Cahuzac procedure is focused on the fore part of the foot, and on the calcaneo-pedal block by postero medial release, but never on the midfoot, as no Evans or Lichtblau's procedure has been performed. This series was compared to others procedures, and morphological results were equivalent. Cahuzac's operation is riskless for foot growth, and needs two approaches which can be useful for simultaneous procedures as split lateral transfer of tibialis anterior tendon. CONCLUSION: Metatarsal osteotomies (Cahuzac's procedure), associated with soft tissues release and split anterior tibial transfer, seems to be effective in surgical treatment of relapsed clubfeet, but the debate concerning the location of the adduction component of the deformity remains still open.     

Neuropathic beriberi as a complication of surgery of morbid obesity

We describe a women of 22 years of age who had had a vertical gastroplasty (as treatment for morbid obesity). She was admitted to hospital with a 4 week history of nausea and vomiting of food. Treatment with intravenous dextrose, without vitamin supplements was started. One week later she complained of diplopia, paresthesia and weakness of the limbs. All investigations proved to be normal. A deficiency state was suspected, probably Wernicke's encephalopathy, although no alterations were seen in her mental state. We started treatment with high doses of parenteral thiamine, other vitamins and a suitable diet. The treatment was followed by complete recovery. Few neurological complications have been described in association with vertical gastroplasty. The commonest are polyneuropathies. The probable deficiency origin of these is considered. We emphasise the importance of vitamin supplements following the surgical treatment of morbid obesity to avoid the development of deficiency states. Wernicke's encephalopathy is due to thiamine deficiency. It may be associated with any type of malnutrition, not only with chronic alcoholism. The full clinical triad which is diagnostic of this condition is only present in one third of the cases. When the condition is suspected on clinical grounds treatment should be started early to avoid the occurrence of irreversible secuelae.     

Pneumocephalus as a complication of posterior fossa surgery in the sitting position

A case of pneumocephalus complicating posterior fossa surgery in the sitting position is presented. Rapid diagnosis was obtained by computerised tomography. This condition should be suspected whenever a patient demonstrates delayed recovery or neurological deficit after craniotomy and nitrous oxide anaesthesia. The literature on the subject is reviewed.     

Clavicular osteomyelitis as a complication of head and neck surgery

To investigate the development of airway hyperresponsiveness in infantile guinea pigs, animals (10 days old) were immunized twice and challenged by inhalation of 1% ovalbumin for 10 min with 7 days intervals. Similar to adult guinea pigs, infantile ones developed an increased airway responsiveness to acetylcholine 24 hr after antigen challenge. There was a marked increase in the number of total leukocytes, eosinophils and lymphocytes in bronchoalveolar lavage fluid (BALF). Suplatast tosilate (suplatast) and pemirolast potassium (pemirolast) given orally throughout the experiments suppressed the development of airway hyperresponsiveness in infantile animals. They showed similar potency in the suppression of eosinophil accumulation in BALF and lung tissue, while suplatast inhibited lymphocyte accumulation stronger than pemirolast. Collectively, the present model of airway hyperresponsiveness in infantile guinea pigs may be useful in predicting the efficacy of antiallergic agents in the treatment of asthmatic children.     

Fracture of the tarsal navicular associated with calcaneonavicular coalition: a case report

Fracture of the navicular occurred in a 23-year-old male with unilateral cartilaginous calcaneonavicular coalition. Inversion sprain of the left foot caused the longitudinal navicular fracture next to the coalition. En bloc resection from the beak of the calcaneus to the fracture line of the navicular including the calcaneonavicular coalition was performed, and a short leg cast was applied for 10 days. Four weeks after surgery, he returned to his preinjury level of activity and job as a long-distance truck driver. Two years and 3 months after surgery, he was totally asymptomatic and had gained a full range of subtalar motion. He had no peroneal spasm or recurrence of the coalition.     

Encephalocoele as a complication of intranasal sinus surgery: optimal evaluation with magnetic resonance imaging

We report a case of post-operative frontal basal encephalocoele evaluated using a new magnetic resonance imaging (MRI) sequence, fast inversion recovery for myelin suppression (FIRMS). FIRMS was developed to enhance the differentiation between grey and white matter. In this case, the sequence was beneficial in distinguishing the encephalocoele from adjacent nasal mucosa and secretions.     

Urothelial carcinoma of the navicular fossa

We report a case of transitional cell carcinoma arising in the fossa navicularis. The patient was a 74-year-old man. He had no history of sexually transmitted disease or urethral stricture. Clinically, the tumor was suspected to be a condyloma acuminatum; however, the pathological diagnosis yielded an unexpected result: transitional cell carcinoma. Radiological examinations and cystoscopy showed no other tumor besides the primary cancer in the fossa navicularis. Partial resection of the urethra was performed and the patient has been without evidence of disease for 3 years.     

Vertical fracture dislocation of the tarsal navicular

An isolated vertical fracture dislocation of the left tarsal navicular with some comminution was successfully treated with open reduction and internal fixation with a screw. The surgical treatment is described, and early mobilization strongly recommended.     

An atypical infectious complication of anterior cervical surgery

An elderly patient suffering from the posttraumatic development of a superficial temporal artery (STA) aneurysm is described. Because the patient had renal dysfunction, angiography was performed through a direct puncture of the anterior branch of the STA in order to reduce the required dosage of contrast medium. With the patient under local anesthesia, the STA was ligated proximal and distal to the aneurysm, and thereafter removed. The diagnosis and treatment of traumatic STA aneurysms in the elderly are discussed.     

Latex allergy: a life-threatening complication

Bone mineralization of healthy preterm infants fed human milk were compared with that of similar fed preterm formula. Bone mineralization was studied by dual energy X-ray absorptiometry in 43 preterm infants divided into two groups; 21 preterm infants were fed with maternal breast milk and 22 preterm infants with a preterm formula containing 70 mg calcium and 35 mg phosphorus per decilitre. CONCLUSION: Preterm infants fed breast milk had lower bone mineral density than the preterm formula-fed group. Fortifying preterm human milk with calcium and phosphorus will improve bone mineralization in preterm infants.     

Idiopathic subluxation of the radial head

Idiopathic subluxation of the radial head is a different entity from congenital dislocation. The former is always painful, with marked loss of rotation. The radius articulates with the capitellum and the radial head is concave, possibly representing a lesser stage of dislocation. There also may be a correlation with true posterior dislocation. Since it successfully alleviates pain in this condition, radial head resection is often advisable. However, the operation should be delayed until growth is complete and the danger of disruption of the distal radioulnar joint is avoidable.     

Ultrasound contribution in the analysis of the newborn and infant normal and clubfoot: a preliminary study

This study examined the effects of coder gender on Potential for Hostility ratings. Six trained coders (3 men and 3 women) who were unaware of the coder gender effect hypothesis coded 30 male and 30 female undergraduates for Potential for Hostility. Although reliability estimates as calculated by Cronbach's alpha suggested that all coders were consistent, an analysis of variance revealed a significant main effect for coder gender, wherein female coders rated participants as displaying significantly less Potential for Hostility than did male coders. This significant difference was also meaningful, as coder gender accounted for 32% of the variance in Potential for Hostility scores. Thus, future Potential for Hostility investigations need to consider the gender of those coding, as this factor both significantly and substantially influences reported Potential for Hostility ratings.