Giant subcutaneous bronchogenic cyst in the intergluteal cleft region of an adult: a case report and literature review.

BACKGROUND: Bronchogenic cysts (BCs) are generally detected in the mediastinum, along the tracheobronchial tree, or in the lung parenchyma. Subcutaneous BCs are rare, but, when found, are usually small (< 3 cm) and detected in children. CASE PRESENTATION: In an unusual adult case, we treated a 52-year-old woman who presented with a mass in the left intergluteal cleft region. Ultrasonography showed a well-circumscribed hypoechoic lesion with posterior enhancement and internal echogenic foci within the mass. Color Doppler images showed no signals. Computed tomography showed the mass as a homogeneous, 6.8- × 6.3- × 5.1-cm soft tissue-attenuation lesion lodged in subcutaneous fatty tissue. Magnetic resonance imaging revealed a cystic lesion of similar dimensions with heterogeneous hyperintensity on both T1- and T2-weighted images. No contrast enhancement, solid components, or restricted diffusion foci were apparent. The cyst was completely excised, and histopathological evaluation indicated it was a BC. The patient's recovery was uneventful. CONCLUSIONS: BCs should be considered in the differential diagnosis of all subcutaneous cystic masses, regardless of their location and size and the patient's age.

Clinical application of the flap based on the distal cutaneous branch of the ulnar artery.

OBJECTIVE: To introduce our experiences of using the flap based on the distal cutaneous branch of the ulnar artery. METHODS: Twenty-four patients sought surgical treatment for soft tissue defects of the hand at our medical institution between January 2003 and December 2008. Fifteen cases had soft tissue defect on the palmar aspect of the hand, and nine cases had soft tissue defects on the dorsal aspect of the hand. The flap based on the distal cutaneous branch of the ulnar artery was performed in all these patients. The size of the flaps ranged from 5 cm to 12 cm in length and from 4 cm to 8 cm in width. RESULTS: Two flaps developed partial necrosis (25-35% of their area). In the other cases, both the donor and recipient sites healed successfully. No patient complained of cold intolerance of the hand or any altered sensation in the forearm. The range of motion of the wrist and hand joints was within normal limits in most cases, with 14 cases with excellent, 8 cases with good, 2 cases with fair, and 0 case with poor results according to the total active motion (TAM) criteria. None of the patients had limitations in activities of daily living. CONCLUSION: Because the flap does not compromise the dominant hand arteries and provides a reliable blood supply, it is a good choice for soft tissue reconstruction of defects in the dorsal and palmar aspects of the hand.

Imaging presentation highly manifested as tuberculosis in a case of spinal metastatic carcinoma.

Usually the clinical manifestations between spinal tuberculosis (Pott's disease) and metastasis are not characteristic. Nevertheless, their respective imaging presentations are typical and specific, which makes it relatively easier to attain a correct diagnosis. Imaging features of Pott's disease, in general, include narrowing of intervertebral disk space, collapse of vertebral bodies with eventual progression to kyphotic deformity, destruction of the anterior parts of adjacent vertebrae, formation of a large paravertebral abscess, and calcifications or sequestra within the paravertebral abscess. Spinal tuberculosis is usually endemic, especially in Eastern countries. However, the trend of cancer incidence is also increasing in modern society, which makes it difficult to diagnose spinal osseous lesions. This article presents a case of a 45-year-old man with a 9-month history of low back pain. Both computed tomography and magnetic resonance imaging of the lumbar spine supported the initial diagnosis of spinal tuberculosis. However, pathological examination on the excised specimen resulted in the diagnosis of spinal metastatic adenocarcinoma. We suggest that a definitive diagnosis of spinal metastasis or tuberculosis should not be based on imaging alone. Instead, more attention should be paid to atypical imaging presentations. In addition, biopsy is usually necessary for final diagnosis.

Retinoic acid retards fetal and hindlimb skeletal development asymmetrically in a retinoic acid-induced clubfoot model.

Retinoic acid (RA) has been shown to induce congenital clubfoot in animal models, but it is unknown whether the effect of RA on the formation of clubfoot in vivo results from generalized growth retardation or from the specific effects of hindlimb skeletal development. Our experimental research was based on a clubfoot model treated by maternal administration of RA (120, 130 or 140 mg/kg body weight) as an intragastric dose on embryonic day 10 (E10), and a control group was administered with an equivalent dose of solvent. Prenatal RA exposure reduced fetal body weight, length and skeletal ossification of the hindlimb compared with the control fetuses in a dose-dependent manner. The normal development curves indicated that the RA-exposed fetuses showed delayed increase in body weight and skeletal ossification development. However, there was no uniform effect on the skeletons of the hindlimb, not least retardation in ossification and induction malformation on the talus and calcaneus. Our results demonstrated that prenatal RA exposure had retardation effects on the developing hindlimb skeleton that was independent of those on the overall fetal growth. The normal skeletal ossification showed that the talus and calcaneus were poorly ossified and they were delayed by almost one day in the RA 120 mg/kg group. Therefore, during the susceptible stages, different regions of the limb bud responded differently to the teratogenic effects of RA.

Evaluation of the modified Albee arthroplasty for femoral head loss secondary to septic arthritis in young children.

BACKGROUND: Surgical treatment options for femoral head deficiency in infants secondary to septic arthritis of the hip are varied and associated with uncertain long-term outcomes. The modified Albee arthroplasty has been considered an acceptable procedure; however, the long-term outcomes of this procedure have not been reported, to our knowledge. We evaluated the long-term outcomes of the modified Albee arthroplasty in young patients with severe sequelae of septic arthritis of the hip. METHODS: We retrospectively studied twenty-one children (twenty-one hips) in whom Choi type-IVB sequelae of septic arthritis of the hip had been treated with a modified Albee arthroplasty and six patients with the same sequelae who had been managed with simple observation. The Trendelenburg sign, pain, the range of motion, hip function, the Harris hip score, and limb-length discrepancy were assessed clinically. Remodeling of the femoral head, hip stability, and arthritic changes in the hip were evaluated radiographically. RESULTS: The twenty-one patients with the modified Albee arthroplasty were followed for an average of 121.2 +/- 38.6 months and had better outcomes, in terms of the Trendelenburg sign, the Harris hip score, pain, the hip range of motion, and limb-length discrepancy, than the six patients who underwent simple observation. Patients who were two years of age or younger at the time of the arthroplasty exhibited a significantly less severe limb-length discrepancy and less loss of motion than those who were older than two at the time of the surgery. Furthermore, limb-length discrepancy was positively correlated and the range of motion of the hip and the Harris hip scores were negatively correlated with the patient's age at the time of the surgery, suggesting that early surgery in patients with severe sequelae of septic arthritis of the hip is associated with a better clinical outcome. CONCLUSIONS: The modified Albee arthroplasty is a feasible and clinically useful procedure for the treatment of severe sequelae of septic arthritis of the hip, particularly in children who are two years of age or younger.