Biceps Tenodesis for Distal Biceps Tendon Repair
Harish S. Appiakannan, BS¹; Amir R. Kachooei, MD, PhD²; Asif M. Ilyas, MD, MBA, FACS¹’²
¹Sidney Kimmel Medical College at Thomas Jefferson University
²Rothman Institute at Thomas Jefferson University
Distal biceps tendon ruptures can result in loss of supination and elbow flexion strength, for which surgical repair is often indicated to restore preinjury level of functionality. The distal biceps tendon can be repaired via single- or double-incision techniques using several associated implants, including endobuttons, suture anchors, or interference screws.
Here is the case of a middle-aged male presenting with an acute distal biceps tendon rupture. The tendon was repaired via a single-incision technique using an endobutton and an interference screw.
Sebaceous Cyst Excision
Casey L. Meier, RN¹; Marcus Lester R. Suntay, MD, FPCS, FPSPS, FPALES²
¹Lincoln Memorial University, DeBusk College of Osteopathic Medicine
²Philippine Children’s Medical Center
Sebaceous cysts are closed sacs filled with foul-smelling, cheese-like material found underneath the skin. They form when a gland or hair follicle becomes blocked and are commonly found on the scalp, face, neck, or torso. Sebaceous cysts are non-cancerous and usually present as painless lumps, but can become tender when infected.
In most cases, smaller sebaceous cysts may be ignored as they do not cause any symptoms; however, larger cysts may need to be removed with complete excision recommended to prevent recurrence. Oral antibiotics may be required when a sebaceous cyst becomes infected. Here is the case of a 33-year-old male patient who underwent complete resection of a 2-year-old cyst.
Left Laparoscopic Transperitoneal Adrenalectomy for Aldosteronoma
Richard Hodin, MD
Massachusetts General Hospital
Unilateral aldosteronoma is best managed by adrenalectomy, with the laparoscopic approach being the preferred method. This is the case of a 48-year-old woman who had long-standing hypertension and hypokalemia and was found to have hyperaldosteronism and low renin levels. A CT scan showed a small mass in the left adrenal gland, and adrenal vein sampling showed higher levels of aldosterone on the left side than on the right, confirming a unilateral aldosteronoma.
Laparoscopic access was gained, the adrenal gland was exposed and dissected by controlling the periadrenal tissues with the harmonic scalpel, the adrenal vein was then ligated, and the adrenal gland was removed.
Wide Local Excision of an Intermediate-Thickness Back Melanoma with a Sentinel Lymph Node Biopsy of Left Axillary Lymph Nodes
1; 2; 1
Wide local excision (WLE) with sentinel lymph node biopsy (SLNB) remains the cornerstone for treatment of patients with intermediate-thickness and thick melanoma lesions with clinically negative nodes. This procedure involves resection of the melanoma with circumferential margins including all the subcutaneous tissue to the level of the deep fascia. WLE is accompanied by lymphatic mapping in order to localize, resect, and analyze the sentinel node(s) for the presence of lymph node metastases. In this paper with accompanying animation and video, a 40-year-old otherwise healthy patient presents with a new melanoma on his back diagnosed via biopsy. The surgical management of intermediate-thickness melanoma and rationale for treatment are reviewed, and recent advances in postoperative treatment of those with clinically occult regional disease are highlighted.
Ankle-Brachial Index, CT Angiography, and Proximal Tibial Traction for Gunshot Femoral Fracture
Johnathan R. Kent, MD; James Jeffries, MD; Andrew Straszewski, MD; Kenneth L. Wilson, MD
University of Chicago Medicine
This video demonstrates an algorithm for evaluating suspected vascular injury secondary to penetrating extremity trauma on a 42-year-old man who sustained a gunshot wound to his left lower extremity. Descriptions of how to perform an arterial-brachial index (ABI) and arterial-pulse index (API) are reviewed, along with criteria to determine if a CT angiography is indicated. Relevant imaging is reviewed with a radiology resident with descriptions of how to systematically assess the scans for injury. Lastly, a tibial traction pin is placed as a temporizing measure for long bone fractures to prevent shortening and to help with pain management.
Femoral Endarterectomy for Severe Peripheral Arterial Disease
Katherine L. Morrow, MD; Anahita Dua, MD, MS, MBA, FACS
Massachusetts General Hospital
This case describes an 85-year-old gentleman with significant peripheral arterial disease and lifestyle-limiting claudication who had previously undergone an unsuccessful attempt at endovascular treatment of his significant right common femoral artery stenosis.
A right common femoral endarterectomy was performed to remove this patient’s significant plaque burden. Postoperatively, the patient noted significant improvement in his right lower extremity claudication, and his postoperative pulse volume recordings showed improved arterial inflow.
Anterior Skull Base Resection of Esthesioneuroblastoma (Endoscopic)
David W. Jang, MD¹; Ali R. Zomorodi, MD¹; Feras Ackall, MD¹; Josef Madrigal, BS²; C. Scott Brown, MD¹
¹Duke University Medical Center
²David Geffen School of Medicine at the University of California, Los Angeles
First described by Berger in 1924, esthesioneuroblastoma (ENB) remains a rare sinonasal tumor believed to originate from specialized sensory olfactory cells. To date, the literature includes 1,000 recorded cases of ENB. Patients with ENB often present with non-specific symptoms, most often chronic nasal obstruction or epistaxis. Careful examination may reveal a pink or brown polyploid mass in the nasal cavity. Overall, ENB may demonstrate various growth patterns ranging from slow, indolent progression to aggressive invasion with widespread metastasis.
Current literature indicates that ENB should be treated with a combination of surgical resection and postoperative radiation therapy with or without chemotherapy. However, significant controversy remains regarding the appropriate surgical approach. This video demonstrates a transnasal endoscopic approach, which has gained significant popularity over the previous two decades compared to classic “open” approaches. Although this approach demonstrates improved perioperative outcomes while still achieving oncologic margins, further work is required to evaluate long-term survival.
Transperitoneal Laparoscopic Right Adrenalectomy for Cortical Adenoma
Sonia Cohen, MD, PhD; Richard Hodin, MD
Massachusetts General Hospital
Primary hyperaldosteronism, or Conn’s syndrome, is a disease in which one or both adrenal glands produce excess amounts of aldosterone, leading to hypertension and hypokalemia. High blood pressure may cause headaches or blurred vision. Low potassium may cause fatigue, muscle cramps, muscle weakness, numbness, or temporary paralysis.
Primary hyperaldosteronism is diagnosed by measuring serum levels of aldosterone, renin, and potassium. Patients classically have high aldosterone levels, suppressed renin levels, and low potassium levels. Once the diagnosis is established, the localization of the source is performed using imaging studies. Adrenal vein sampling is also performed to determine more precisely and directly the side that is producing excess aldosterone.
Primary hyperaldosteronism caused by an adrenal gland tumor is treated with adrenalectomy. This is the case of a 58-year-old female with hypokalemia and long-standing hypertension refractory to medical treatment. Her blood tests showed high aldosterone levels and low renin levels, confirming the diagnosis of hyperaldosteronism. On CT scan, an adrenal nodule was noted on both sides. Adrenal vein sampling identified the right adrenal nodule as the cause. Laparoscopic access was gained, the adrenal gland was dissected and exposed, the adrenal vein ligated, and the adrenal gland was removed.