Outpatient management of flexor tenosynovitis: use of On-Q system to deliver constant antibiotic irrigation and pain control improves rehabilitation.

BACKGROUND: Flexor tenosynovitis accounts for nearly 10% of all hand infections and, if untreated, can have devastating consequences. Late presentation often requires operative intervention that requires open drainage and irrigation of the flexor tendon sheath with prolonged rehabilitation. OBJECTIVE: We report the use of closed-catheter irrigation system with the On-Q delivery system that allows for simultaneous in situ antibiotic and pain control for outpatient treatment of flexor tenosynovitis. METHODS: The On-Q delivery system was placed in 6 consecutive patients who met the criteria of all 4 Knavel signs. They all underwent open drainage and closed irrigation system with 0.25% bupivacaine and 250 mg cefazolin over a 1-week period. RESULTS: In all 6 patients, there was no use of narcotic analgesics or oral antibiotics upon discharge. Postoperative hand therapy and range of motion was initiated on postoperative day 1. There was satisfactory progression of range of motion and hand therapy. CONCLUSIONS: This initial clinical case series supports the use of the closed irrigation delivery system with in situ antibiotic and analgesic delivery for more rapid rehabilitation of patients with flexor tenosynovitis.

Scar endometriosis - a rare cause for a painful scar: A case report and review of the literature.

Endometriosis is described as the presence of functioning endometrial tissue outside the uterine cavity. Scar endometriosis is a rare disease, and is difficult to diagnose. The symptoms are nonspecific, typically involving abdominal wall pain at the incision site at the time of menstruation. It commonly follows obstetrical and gynecological surgeries. The diagnosis is frequently made only after excision of the diseased tissue. A case report of a patient with a troublesome scar after a caesarian section is presented. Surgical excision led to the diagnosis of scar endometriosis. The pathogenesis, diagnosis and treatment of this somewhat rare condition are discussed.

Periappendiceal dermoid: a rare cause of right lower quadrant pain.

Dermoids are mature teratomas lined with a stratified squamous epithelium. They are known to present anywhere in the body, mostly with minimal or no associated symptoms. The authors present the case of a 44-year-old man who presented with an acute abdomen suggestive of appendiceal disease. On surgical exploration, the patient was found to have an inflamed cystic lesion in the mesoappendix that was resected and diagnosed as a dermoid cyst on pathological examination. This is the seventh case in the literature of a periappendiceal dermoid, but the first that presents in such a manner. This report is presented because of its important clinical applications for the general surgeon.

Amebiasis presenting as acute appendicitis.

Amebiasis presenting as acute appendicitis is extremely rare. The case of a 38-year-old Hispanic man who presented to the hospital with symptoms and signs suggestive of acute appendicitis is reported. He underwent laparoscopic appendectomy and the pathologic examination of the appendix revealed multiple trophozoites of Entamoeba histolytica. The patient was treated postoperatively with metronidazole for amebiasis, and follow-up stool studies showed no sign of residual infection. The patient has remained asymptomatic.

Persistent left superior vena cava: an incidental finding during central venous catheterization-a case report.

Persistent left superior vena cava (PLSVC) is an uncommon anomaly, estimated to be present in about 0.3-0.5% of the population. It results from an embryological defect involving failure of the left cardinal vein to degenerate. It is present along with a right-sided superior vena cava in 82.2% of the cases reported. The condition most commonly occurs along with other cardiovascular malformations and frequently goes undiagnosed because when not accompanied by other anomalies it is typically asymptomatic. PLSVC is most often discovered subsequent to central venous or pulmonary artery catheter placement.