The chessboard technique - a new freehand aiming method for rapid distal locking of tibial nails.

Distal locking is considered a difficult stage of the endomedullary tibial nailing procedure. A new rapid, simple, and inexpensive freehand aiming technique is presented that uses a galvanized metal grid. The grid is positioned to overlay the skin of the medial cutaneous face of the tibia, giving to the underlying bone under fluoroscopy a pattern that resembles a chessboard.

Immunological aspects of chronic fatigue syndrome.

Chronic fatigue syndrome (CFS) is a specific clinical condition that characterises unexplained disabling fatigue and a combination of non-specific accompanying symptoms for at least 6 months, in the absence of a medical diagnosis that would otherwise explain the clinical presentation. Other common symptoms include headaches, myalgia, arthralgia, and post-exertional malaise; cognitive difficulties, with impaired memory and concentration; unrefreshing sleep; and mood changes. Similar disorders have been described for at least two centuries and have been differently named neurasthenia, post-viral fatigue, myalgic encephalomyelitis and chronic mononucleosis.

Neurological caricatures since the 15th century.

During the Renaissance, different artists began to draw medical illustrations from various viewpoints. Leonardo da Vinci was among those who sought to portray the emotional as well as the physical qualities of man. Other European artists described caricatural aspects of medical activities.

Arthroscopic-assisted fibular synthesis and syndesmotic stabilization of a complex unstable ankle injury.

Traditional treatment of complex ankle fracture consists of open reduction and internal fixation. Nevertheless, this treatment can delay fracture healing and cause prolonged oedema. The surgeon should consider necessity of early recovery when treating athletes, especially football players.

Multiple sclerosis and Capgras' syndrome.

Psychotic disorders in patients with multiple sclerosis (MS), although reported in the literature, are quite rare. The maniac psychosis is increased in MS patients, especially after steroid use, but a pure paranoid (delusional) state is very uncommon. We report a case of a patient with MS complicated by Capgras' syndrome.

Spontaneous bilateral Achilles tendon rupture in a patient treated with oral levofloxacin.

A case of bilateral rupture of the Achilles tendon in a patient treated with levofloxacin for cystitis is reported. A 76-year-old woman suddenly developed painful ankles one day after levofloxacin treatment. Drug therapy was switched to amoxicillin/clavulanate on the fourth day.

Autonomic paraneoplastic neurological syndromes.

Autonomic paraneoplastic neurological syndromes (PNS) typically present as chronic gastrointestinal pseudo-obstruction or orthostatic hypotension and usually occur in association with other PNS rather than in isolation. Although rare, they are often debilitating, sometimes fatal, and probably seriously underdiagnosed. Here, we discuss the clinical, immunological and oncological features of these syndromes and review the molecular and cellular mechanism that may underlie the triggering and maintenance of their autoimmune pathogenesis.

Laparoscopy in afferent loop obstruction presenting as acute pancreatitis.

Background: We describe an afferent loop obstruction caused by an adhesion band in a case of distal gastrectomy with Roux-en-Y end-to-side jejunal anastomosis for cancer.

Methods: An initial clinical presentation of acute pancreatitis was ruled out by a computed tomography scan, which revealed intestinal obstruction; it was then confirmed on laparoscopy. Definitive treatment was laparoscopic adhesiolysis.

Intraoperative fracture of patellar bone plug during anterior cruciate ligament reconstruction with bone-patellar tendon-bone: clinical case.

The authors report the case of intraoperative fracture of the patellar bone plug during an operation to reconstruct an anterior cruciate ligament using bone-patellar tendon-bone. This complication, known among the problems of reconstructing the anterior cruciate ligament, is usually reported when using interference screws to block the plug at the femoral level. In the case, we describe the fracture event occurred using cross-pins.

Spontaneous healing of an avulsed ischial tuberosity in a young football player. A case report.

There is a paucity of orthopaedic literature describing avulsion of the ischial tuberosity, but its spontaneous healing does not seem to have been reported to-date. This article describes the case of a young football player who suffered an avulsion fracture of the ischial tuberosity while kicking vigorously next to the ball during a football match. The diagnosis was not made at the time of trauma, and the fracture was found five years later to have healed spontaneously.

Laryngeal paraganglioma: an endoscopic diode-laser-assisted surgical approach: a case report.

Laryngeal paraganglioma is a rare vascular neuroendocrine benign tumour. Surgery is the standard treatment. The pre-operative gold standard is Magnetic Resonance Imaging with Gadolinum contrast.

Giant osteoid osteoma of ethmoid sinus: role of functional endoscopic sinus surgery.

A case of giant ethmoid osteoma treated by functional endoscopic sinus surgery is described. The tumour was closely adherent to the surrounding anatomical structures--lamina papyracea, cribriform plate, spheno-ethmoidal recess--and protruded into the nasopharynx. Complete removal of the tumour, under general anaesthesia, using intranasal drill and diode L.