Case Study: A 17-Year-Old Female with Right Upper Quadrant Abdominal Pain and Nausea

Javariah I. Asghar MD, MPH¹ ∙ Uroghupatei P. Iyegha MD¹ ∙ Gregory J. Beilman MD^1,2 ∙ Selwyn M. Vickers MD¹

1. Department of Surgery, University of Minnesota, Minneapolis, Minnesota.

2. Department of Surgery, Division of Trauma and Critical Care, University of Minnesota, Minneapolis, Minnesota.

Download PDF

Vol%202%20Issue%203%20S02.pdf

4021 Kb

Case Study: A 53-Year-Old Female with Lower Abdominal Pain

Kristy L. Rialon MD ∙ Eugene P. Ceppa MD ∙ Leila Mureebe MD

Department of Surgery, Duke University Medical Center, Durham, North Carolina.

Download PDF

Vol%202%20Issue%203%20S01.pdf

5232 Kb

Purpose To evaluate the reported features of femoral fractures associated with prolonged bisphosphonate therapy. To retrospectively evaluate if long term bisphosphonate therapy can be suspected from radiological appearance of a fracture. To assess if a pre-fracture state can be identified to allow early internal fixation and cessation of bisphosphonate therapy.
Materials and Methods Twelve patients were identified over a 14 month period from December 2007. Seven patients presented with low energy subtrochanteric or femoral midshaft fractures whilst receiving bisphosphonate treatment for post menopausal osteoporosis. A search of the hospital’s radiology database identified 5 further patients. All available case notes and imaging were examined.
Results Seventeen low energy fractures were identified amongst 12 patients with a mean age of 74.4 years and mean minimum duration of bisphosphonate therapy of 5.5 years. A common radiographic pattern was identified, namely a simple transverse fracture with unicortical beaking occurring through an area of hypertrophic lateral cortex. Contralateral changes following initial fracture were visible in 6 patients, with nuclear scintigraphy proving more sensitive than radiograph for detection.
Conclusion Suspected bisphosphonate related insufficiency fractures of the femur can be identified with radiographs, prompting the need for contralateral limb imaging. An isotope bone scan is a sensitive means to identify a pre-fracture stress reaction in a symptomatic or asymptomatic limb, to allow cessation of bisphosphonate therapy and prophylactic internal fixation.

Download PDF

Vol%202%20Issue%203%20A09.pdf

9176 Kb

Introduction The Chiari I malformation is a rare pathological condition that is characterized by a downward herniation of the cerebellar tonsils and brainstem through the foramen magnum. The transformation from an asymptomatic to symptomatic Chiari I malformation is poorly understood, but the major inciting factor associated with this transformation has been trauma. Here, we report the first documented case of radiographic and clinical progression from an asymptomatic to symptomatic Chiari I malformation after a traumatic injury and provide a possible pathologic mechanism related to an occult cerebrospinal fluid (CSF) leak.
Clinical Presentation A 32 year old woman presented with a history of intermittent headaches and an MRI demonstrating 8 mm of tonsillar decent. After a traumatic motor vehicle collision, she developed bifrontal tussive headaches and neck and arm burning numbness with progression of tonsillar descent to 12 mm.
Intervention The patient underwent a suboccipital craniectomy and partial C1 laminectomy with a duroplasty, in addition to a subpial partial tonsillectomy. Postoperatively, symptoms improved with the exception of persistent positional recurrent headache. Myelogram demonstrated a cervical CSF leak that resolved with an epidural blood patch coincident with resolution of the patients symptoms.
Conclusion We document radiographic and symptomatic progression of a Chiari I malformation after a traumatic induction of an occult CSF leak. We believe this may provide some insight into the pathophysiology of Chiari malformation in a subset of patients.

Download PDF

Vol%202%20Issue%203%20A08.pdf

1000 Kb