Mersadies Martin

14-Year Median Follow-Up Using the Press-Fit Condylar Sigma Design for Total Knee Arthroplasty

Median 14-year follow-up (mean 11.8 years) of a cemented primary posterior cruciate-retaining total knee arthroplasty (TKA) utilizing the Press-Fit Condylar (PFC) Sigma design was evaluated in 77 patients (79 TKA). Follow-up assessment included implant survivorship, x-rays, Knee Society rating system, and clinical evaluation. Radiographic analysis demonstrated minor non-progressive osteolysis in 40% (10/25) knees. Two revisions, one for instability at 4 years and one for polyethylene wear at 10 years were performed. Survivorship of the PFC Sigma knee implant was 97% using revision for any reason and 100% using aseptic loosening as endpoints. The PFC Sigma had excellent survivorship at 14 years, the longest clinical follow-up reported.

Parenchymal Thoracic Splenosis: History and Nuclear Imaging Without Invasive Procedures May Provide Diagnosis

Splenosis is a rare finding of ectopic splenic tissue found within the thoracic cavity, abdomen or peritoneal cavity. Most cases occur in the abdomen and the thoracic location is a comparatively rare finding. In thoracic splenosis the splenic tissue most often grows in the form of a nodule and the autotransplantation is usually caused by a previous operation and/or most commonly a penetrating or blunt trauma to the thoracoabdominal region, resulting in splenic rupture and in some cases left diaphragmatic tear. In majority of the cases the patients are asymptomatic and are incidentally diagnosed with left hemithorax pulmonary lesions found via chest radiography or thoracic computed tomography. We present a 45-year-old Caucasian male who was incidentally diagnosed with parenchymal thoracic splenosis secondary to a gunshot wound to the abdomen 13 years ago that resulted in distal pancreatectomy, splenectomy and gastrorrhaphy. In this case report we will briefly discuss the current updates in the literature regarding thoracic splenosis, and highlight the fact that the findings raise the suspicion of malignancy requiring numerous investigations yet early recognition of thoracic splenosis can prevent unnecessary tests and procedures. Preoperative diagnosis of splenosis should be made with the use of nuclear imaging studies such as the 99mTc heat-damaged erythrocyte study rather than computed tomography-guided biopsy or invasive surgery. Keywords Thoracic splenosis; Computed tomography; Ppancreatectomy; Splenectomy; Gastrorrhaphy

A case of pseudohyperkalemia in a patient presenting with leucocytosis and high potassium level: a Case Report

Pseudohyperkalemia can appear in a variety of settings and should be recognized early. Treatment of pseudohyperkalemia can lead to an inappropriate decrease of actual serum potassium levels which may lead to life threatening conditions. In the case presented, an 81-year-old male presented with massive leucocytosis and an extremely elevated potassium level. This case report emphasizes the importance of recognizing pseudohyperkalemia in a patient with a severely increased potassium and WBC level; such patients may be clinically asymptomatic or may have a normal ECG.

Incidentally Discovered Intraperitoneal Masses.

A 20-year-old otherwise healthy woman presented to the emergency department after a motor vehicle crash in which computed tomographic imagesof theabdomenwereobtainedaspartof the trauma evaluation. Small free fluid within the pelvis and 2 large mesenteric masses were discovered adjacent to the liver, pancreas, and stomach (Figure 1). An endoscopic ultrasound-guided fineneedle aspiration of the abdominal mass was obtained and the diagnosis was made. The patient underwent exploratory laparotomy and en-bloc resection of the intraperitoneal tumors. Quiz at jamasurgery.com A B

The Dilemma of Breast Cancer Treatment and Existing Collagen Vascular Disease: A Case of Scleroderma and Review of the Literature

Collagen vascular diseases present a treatment dilemma for patients with breast cancer. Due to the potential for severe, acute, and late complications of radiation therapy, a history of collagen vascular disease (CVD) is a relative contraindication to breast‐conserving treatment. We present a case of early stage breast cancer in a patient with severe scleroderma treated with breast‐conserving surgery without radiation and a brief review of the published literature regarding the therapeutic approach to the patient with CVD and breast cancer.

Metastatic well-differentiated neuroendocrine carcinoma of the pancreas: case report and review of literature

Neuroendocrine carcinoma accounts for less than 5% of cancers of unknown primary site. When primary pancreatic cancer is diagnosed, 95% of cases are classified as aggressive adenocarcinoma and the remaining 5% of cases are caused by indolent behaving neuroendocrine carcinoma. We present a rare case of well-differentiated neuroendocrine carcinoma of the pancreas extending to the transverse colon, small bowel, stomach, and lymph nodes with metastasis to the caudate lobe of the liver. The patient had a two-year history of midepigastric abdominal pain that eventually sent him to the Emergency Department and after extensive tests we removed the entire tumor with margins free of growth. Included in this case report are many illustrations to show the severity and we further emphasize the importance of examining patients thoroughly especially when vague symptoms are chronic.