Adherent Capsule Research Articles

Extensor hood injuries in elite boxers: injury characteristics, surgical technique and outcomes.

We describe our experience of managing extensor hood injuries in boxers (57 fingers). The diagnosis was mostly clinical, with imaging only if the diagnosis was equivocal. The middle (61%) and index (26%) digits were most frequently injured. On exploration, 26% had no hood tear, however all required tenolysis from the adherent capsule. Of 42 hood tears, 15 were central splits between adjacent extensor tendons in the index or little fingers,15 tears were on the ulna side of the extensor tendon and 12 tears were on the radial side. A pseudobursa was encountered in 35%, capsular tears in 28% and chondral injury in one patient. Longitudinal curved metacarpophalangeal joint incisions were used, with hood repair performed in flexion using a locked running suture. Mean postoperative metacarpophalangeal joint flexion was 90°. Ninety-eight per cent returned to the same level of boxing at a mean of 8 months (range 1-24) from surgery. One finger was revised for re-rupture 6 months later. A reproducible technique for treating these injuries is described, with patients able to return to boxing with little risk of complications.Level of evidence: IV.

Arthroscopic release in adhesive capsulitis of the shoulder: a retrospective study with 2 to 6 years of follow-up.

BackgroundThis study aimed to evaluate the response rate to arthroscopic release treatment in adhesive capsulitis of the shoulder (ACS) for patients with refractory to conservative treatment.MethodsIn this retrospective study, 51 patients (age mean, 49.1±5.6 years) with unilateral adherent capsule underwent arthroscopic releasing surgery for the shoulder capsule. Etiologies of the ACS in 30 patients were idiopathic: 10 patients were affected after surgery and 11 patients following trauma. The patients were evaluated in terms of shoulder function, satisfaction rate, pain intensity, and joint range of motion (ROM) based on a Constant score, a Simple Shoulder Test, the visual analog scale, and four movements, respectively.ResultsThe mean Constant score before surgery was 48.2±3.5 and reached 74.4±6 and 77.0±6.3 at 6 months and the final follow-up, respectively (p<0.001). The mean scores of pain intensity, a Simple Shoulder Test, and ROM showed significant improvement at all follow-ups (p<0.001). Sex, age, and diabetes did not have any significant effect on patient recovery. However, patients who experienced ACS after surgery had poorer results than others at all follow-up points.ConclusionsArthroscopic releasing surgery of the shoulder in patients with ACS refractory to conservative treatment produces rare complications and an effective injury response. It seems that patients suffering ACS following surgery have a weaker response to the treatment.

Revisiting the surgical corridors for cervical Type IIb-c dumbbell neurofibroma: A series of two unconventional approaches and review of literature.

Background:Cervical sub-axial dumbbell neurofibromas (NFs) account for nearly 20% of all NFs, with prognosis depending on the extent of excision. When majority of tumor is extra-foraminal (Tomaya's Type IIb and c), certain unconventional anterolateral or posterolateral neck approaches are used for maximum safe excision. In our article, we provide a brief review of the literature regarding various surgical approaches, emphasizing the utility of posterolateral or combined anterior and posterior neck approaches for such giant NF.Methods:We performed a retrospective analysis of prospectively maintained surgical databases, from our hospital discharge codes, for all cervical Type IIb-c dumbbell NF patients, who underwent surgery at our institution between 2015 and 2019. Clinical variables included age at admission, clinical presentation, and surgical difficulties, and the outcome was analyzed.Results:Four patients of age ranging from 22 to 45 years (M:F 3:1) were operated by posterolateral (n = 3) and combined anteroposterior (n = 1) approach. Three patients underwent near-total excision and one patient had total excision. One patient with tumor capsule attached to roots of upper brachial plexus had motor deficit, who was re-admitted for neurotization. There was no intraoperative complication.Conclusion:Posterolateral approach for cervical dumbbell giant NFs is safe, effective, and promises maximum safe excision. The major blood vessels including carotid artery or jugular veins in neck and vertebral artery at foraminal portion are directly under vision and control of surgeon. Despite near-total excision, wherein small part of adhered capsule is left, recurrence rate is low.

Acute Kidney Injury and Hepatic Dysfunction

This clinical report presents a 45-year-old female patient with acute kidney injury, hepatic dysfunction and urosepsis without past history of any illness related to urinary system. Laboratory investigations showed Hb 15.6 gm/dl, neutrophilic leukocytosis, thrombocytes 9000/mm3, ESR 90 mm/h, plasma thromboplastin time (PTT) 48 seconds (control 32 seconds), INR 2, and fibrinogen degradation product 7500 ng/ml (normal <250 ng/ml). Serum creatinine was 450 μmol/L (5.1 mg/dl), direct bilirubin 68.40 μmol/L, alanine aminotransferase 1.6 mmol/L and albumin 25 gm/L. Urinalysis revealed leucocyturia, hematuria without casts and proteinuria. Abdominal plain x-ray revealed left-sided radio-opaque shadow at the ureteric line, left uretero-hydronephrosis with thickened cortex and left ureteric stone, but normal right kidney. Computerized tomography of abdomen showed a large left kidney (13.5 cm) with totally distorted architecture, multiple enhancing and non-enhancing sectors, thickening of renal capsule, moderate dilatation of renal pelvis, dilated ureter and no passage of contrast in the ureter. The patient was treated with a 2-week course of Ceftriaxone and Aztreonam and preoperative session of hemodialysis before the performance of a left-sided nephrectomy. Gross examination revealed adherent capsule, granular cortex covered with purulent exudates, no demarcation between cortico-medullary junction, and the cut surface showed minute abscess and necrosis with markedly dilated pelvis. Light microscopic examination showed fibrosis and inflammation of parenchyma with vacuolized histiocytes foam cells surrounding necrotic areas confirming the diagnosis of xanthogranulomatous pyelonephritis. The patient was discharged after 35 days of hospital stay with normal renal and hepatic function.

Brainstem epidermoid cyst: An update.

The incidence of epidermoid tumors is between 1% and 2% of all intracranial tumors. The usual locations of epidermoid tumor are the parasellar region and cerebellopontine angle, and it is less commonly located in sylvian fissure, suprasellar region, cerebral and cerebellar hemispheres, and lateral and fourth ventricles. Epidermoid cysts located in the posterior fossa usually arise in the lateral subarachnoid cisterns, and those located in the brain stem are rare. These epidermoids contain cheesy and flaky white soft putty like contents. Epidermoid cysts are very slow growing tumors having a similar growth pattern of the epidermal cells of the skin and develop from remnants of epidermal elements during closure of the neural groove and disjunction of the surface ectoderm with neural ectoderm between the third and fifth weeks of embryonic life. We are presenting an interesting case of intrinsic brainstem epidermoid cyst containing milky white liquefied material with flakes in a 5-year-old girl. Diffusion-weighted imaging is definitive for the diagnosis. Ideal treatment of choice is removal of cystic components with complete resection of capsule. Although radical resection will prevent recurrence, in view of very thin firmly adherent capsule to brainstem, it is not always possible to do complete resection of capsule without any neurological deficits.

Xanthogranulomatous Pyelonephritis in a male child with renal vein thrombus extending into the inferior vena cava: a Case Report

BackgroundWe present a case of Xanthogranulomatous pyelonephritis (XGPN) in a male child with renal vein thrombus extending into the inferior vena cava. This is a rare presentation. XGPN is a rare type of renal infection characterised by granulomatous inflammation with giant cells and foamy histiocytes. The peak incidence is in the sixth to seventh decade with a female predominance. XGPN is rare in children.Case presentationAn 11 year old male child presented with a history of high grade fever and chills, right flank pain and progressive pyuria for two months. He had a history of vesical calculus for which he was operated four years back. In our case, a subcapsular right nephrectomy was performed. The surgical specimens were formalin fixed and paraffin embedded. The sections were stained with routine Hematoxylin & Eosin stain. Grossly; the kidney was enlarged with adherent capsule and thickening of the perinephric tissue. The pelvicalyceal system was dilated and was filled with a cast of pus. Histological evaluation revealed diffuse necrosis of the renal parenchyma and perinephric fat. Neutrophils, plasma cells, sheets of foamy macrophages and occasional multinucleate giant cells were seen. The renal vein was partially occluded by an inflammatory thrombus with fibrin, platelets and mixed inflammatory cells. The thrombus was focally adherent to the vein wall with organization.ConclusionsThe clinical presentation and the macroscopic aspect, together with the histological pattern, the cytological characteristics addressed the diagnosis towards XGPN with a vena caval thrombus. Our case illustrates that the diagnosis of XGPN should be considered even in paediatric age group when renal vein and vena caval thrombi are present.

Effect of membrane permeability on capsule substrate adhesion: Computation using immersed interface method

A two-dimensional thin-walled capsule of a flexible permeable membrane is adhered onto a rigid planar substrate under adhesive forces (derived from a potential function). The capsule and the surrounding environment are filled with a diluted binary solution of different solute concentrations. The Stokes flow problem is solved by the immersed interface method (IIM) with equal viscosities for enclosed and surrounding fluid of the capsule. The numerical results obtained are verified against two simplified theoretical solutions with reasonable concurrence. The osmotic inflation of the adhered capsule is studied systematically as a function of solute concentration field and the membrane permeability properties. Our findings indicate that contact length shrinks in dimension and deformation decreases as capsule inflates. Also the equilibrium contact length does not depend on the hydraulic conductivity of the membrane as theoretically expected. Further numerical investigations show that the inflation and detachment of the initially adhered capsule depend significantly on the solute diffusive permeability and the reflection coefficient of capsule membrane.

Inguinal canal "lipoma".

Groin dissection was performed in adult male post-mortem subjects to establish the prevalence of inguinal canal "lipoma." Thirty-six body halves (age range 24-92 years) were studied. Of these, 27 (75%) contained a discrete mass of fat within the inguinal canal. This mass was always continuous with the preperitoneal fat through the deep inguinal ring. Nineteen of these 27 masses (70%), displayed a characteristic pedunculated form with a bulbous distal end. Eighteen of the 36 dissections (50%), revealed a mass more than 4 cm in length. Six dissections showed extension of the mass beyond the superficial inguinal ring and three of these six (8% of the 36 groins studied) showed distortion of the proximal spermatic cord with a mass at the superficial inguinal ring. The masses submitted for histology comprised mature adipose tissue and all but two of these were reported as having an adherent capsule. No significant correlation was found between mass length and either subject age or body mass index (BMI) but a statistically significant correlation between the length of the fat mass on the left and right sides was shown. This study demonstrates that the inguinal canal "lipoma" is a common feature in an adult male population and may be of sufficient size to cause clinical misdiagnosis. The high prevalence, characteristic location and appearance of the "lipoma" suggest a developmental etiology.

The Fate of Capsular Contracture in Augmentation Mammaplasty with Silicone Gel Implants

Formation of fibrous capsule around the prosthesis is an inevitable consequence when silicone implants are used for augmentation mammaplasty or post-mastectomy breast reconstruction. Fibrous contracture of the capsule leads to a firm irregular shaped breast, which is unacceptable for both the physicians and the patients. In this paper, we report an unusual case of severe capsular contracture with massive liquefied necrosis of the pectoralis major, minor, and the intercostal muscles secondary to the silicone implants rupture. The large siliconoma invaded not only the adjacent musculature but also the underlying sixth, seventh and eighth ribs, along with the costal cartilage and the parietal pleura. The surgical treatment was open capsulectomy via transverse mammary incisions. Meticulous debridement of the adhered capsule over the ribs, costal cartilage and pleura was performed. The pathology of the debrided material was necrotic tissue and fibrosis with foreign body reaction. The tissue culture was negative for microorganisms. After the removal of the bilateral capsules and siliconomas, the patient did not have any discomfort and denied further reconstruction of the breasts.

Encapsulation reactions in vitro by haemocytes of Heliothis virescens

A simple in vitro system for studying capsule formation by Heliothis virescens haemocytes was devised. The system produced capsules morphologically and ultrastructurally similar to those formed in vivo. Encapsulation proceeded normally when melanization was inhibited and when divalent cations were absent. Capsule development took place in two physiologically distinct phases. Aggregation of haemocytes around a foreign object (phase 1) was a passive process. Consolidation of haemocytes into a smooth, adherent capsule (phase 2) required metabolic energy. Phase 1 was inhibited irreversibly by propranolol and caffeine. Inhibition of phase 1 by mild trypsinization could be reversed by haemolymph lysate. Preliminary evidence indicates that encapsulation promoting factors in the lysate originate in haemocytes.