Intraosseous schwannoma of the humerus: a rarity yet warrants consideration

Intraosseous schwannoma is extremely rare that it is not often considered among differential diagnosis for an osteolytic lesion, especially in long bones of the extremities. Amounting to less than 0.2% of all primary bone tumours and less than 200 cases reported so far, with only 3 cases involving the humerus, we hereby report the fourth case. In addition to its rarity, this was the only case of an intraosseous schwannoma involving the humerus bone which presented with a pathological fracture in a 45-year-old woman after sustaining a trivial trauma. Radiological examination revealed a geographic type of osteolytic lesion in distal shaft region of the left humerus. Only a histopathological examination helped in revealing and confirming the diagnosis of an intraosseous schwannoma. Treatment of the tumour with complete excision with bone graft reconstruction and osteosynthesis yields good results with very low risk of recurrence.

Traumatic brachial artery injury successfully treated with a stent-graft: A case report

There are few reports on brachial artery injury treated with stent-grafts. A 69-year-old man presented with a crush injury to the left upper arm. Enhanced computed tomography revealed left humerus fracture and disruption of the blood flow of the brachial artery along with paresis of the forearm. Following external fixation of the fracture, we performed endovascular therapy for brachial artery injury. Using real-time ultrasound imaging guidance, the injured lesion was crossed by the wire, and Viabahn endoprosthesis was placed in the left brachial artery. Hemostasis was achieved, and blood flow to the forearm was restored. Subsequently, the paresis improved.

Fracture in a girl with graves’ disease induced by osteoporosis: A case report

A 6-year-old girl with long-standing Graves’ Disease (GD) presented with a left oblique non-displaced humeral fracture. Examination reveals signs of thyrotoxicosis and mild swelling of her left humerus. Investigations confirmed severe overt hyperthyroidism due to GD. A dual-energy X-ray Absorptiometry (DXA) of the lumbar vertebrae (L1-4) and femoral neck revealed that Z-score were -2.9 and -2.1, respectively, representing below the expected range for age which is consistent with osteoporosis. The girl was commenced on carbimazole in a dose of 5 mg two times daily and propranolol 10 mg two times daily. After one year of treatment, she returned to a euthyroid state, and Bone Mineral Density (BMD) increase by 19% and 23% of the lumbar spine and femur neck, respectively Keywords: Osteoporosis; Graves’ disease; Fracture.

MO782VASCULAR ACCESS IN ELDERLY PATIENTS

Background and Aims The arteriovenous fistula (AVF) continues to be the first-line vascular access (AV) in the hemodialysis population. However, it is disputed whether the profitability and survival in the elderly patient are the same as in the younger patient. Thus, there are authors who propose the tunnelled catheter as the best option in this group of patients. The objective of this study was to analyze the characteristics of vascular access in incident patients over 80 years of age at our center. Method A retrospective analysis was performed included incident hemodialysis patients >80 years between 2017-2020. Epidemiological and vascular access complications related, as well as first permanent vascular access survival were analysed. A Pearson's correlation coefficients were employed to determine the correlation between the exitus and other variables and Regression models of mixed effects of covariance (ANCOVAs) were created to determine the effect of these with the exitus. Results Demographic characteristics of forty-four patients included are shown in Table 1. Significant differences in sex and comorbidities (diabetes, ischemic heart disease, peripheral vascular disease and hypertension) were found. A total of 26 patients (62%) had a fistula at the time of beginning hemodialysis, all of them with pre-surgical mapping and monitoring, only 15 (34%) of them being working. The most prevalent type of vascular access (VA) was the left humerus-cephalic (21%). 12 (27%) patients were exitus during the 36 months after the beginning of hemodialysis, with significant differences between groups. The variables catheter, male, and type of VA showed a significant correlation with the exitus (-0.345, -0.347, -0.347 and -0.309 respectively). The multivariate analysis showed a significant association between gender and catheter as vascular access at the beginning of hemodialysis with the exitus (p<0.05) even after being adjusted for age and AVF. Conclusion In our population, male sex and catheter at the beginning of hemodialysis have a significant association with exitus. AVF should be considered as the first choice vascular access even in the subgroup of patients over 80 years old

Study of Nutrient Foramen in Humerus

Background Nutrient foramen is the gateway for the nutrient artery to provide nutrition in different parts of the bone which play important role in healing during fracture, trauma and also important for bone grafting. The aim the study is to identify the number of nutrient foramen in dry humerus and to observe direction as well as allocation of the nutrient foramen in surfaces and borders. Methods The sample for the study were collected from medical and dental colleges of Nepal in years ranging from 2018 to 2020 AD and the height were measured by the help of using vernier caliper, probe was introduced in nutrient foramen to confirmed its direction. The numbers of nutrient foramen were noted in copy and analyzed the statistics by using software called the SPSS (Statistical Package for the Social Sciences) 20. Results In the study of 200 sample of humerus from the department of anatomy from different medical and dental college of Nepal includes Nepal Medical College, Kathmandu University School of Medical Science, M.B. kedia Dental College and Lumbini Medical College. Out of 200 sample, 74 were right and 126 were left Humerus of human body. In 143 bone (i.e. 71.5%) a single nutrient foramen is present, in 44 bone (i.e. 22.0%) double nutrient foramen is present and triple nutrient foramen was also observed in 9 bone (i.e. 4.5%)whereas in 4 bone (i.e. 2.0%) no nutrient foramen were noticied. It was also noticed that nutrient foramen in 173, 15 and 3 bones were observed at medial, lateral and posterior border respectively. According to the foraminal index 1(0.5%) bone comes under Zone I, 182(91%) in zone II and zone III consists of 13(6.5%) bone and average foramina index of bone is calculated as 56.18 and the average length of Humerus is calculated as 27cm. Pearson correlation is significant at the 0.05 level which is significant for bone having single, double and triple nutrient foramen. In the study the nutrient foramen of 98.47% (193) Humerus directed downward toward the distal end of bone whereas in 1.53% (3) of bone nutrient foramen is directed vertically downward and no nutrient foramen is directed upward toward the proximal end. Conclusions Most of the nutrient foramen of humerus follows as per rule where as some of the bone with no nutrient foramen were founded and our result support the former researchers too.

Treatment of Pathologic Fracture of the Humeral Diaphysis Using Metal andPolymer Express Endoprosthetic Replacement as an Example of the Accelerated Rehabilitation of Cancer Patients

ABSTRACT. We report a case of treatment of a 60-year-old female patient D. with a metastatic fracture of the upper and middle third of the left humerus. We made a radical removal of the metastasis, which was complicated by pathological fracture of the left humerus. To replace the removed tumor defect we performed metal and polymer endoprosthetic replacement of the left humeral diaphysis using a locking screw system and bone cement (methyl methacrylate). For accelerated recovery and rehabilitation we applied adaptogenic immunomodulator «Vitavis» (Altai elixir) and neutral anolyte (NA). After the removal of the tumor, postoperative wound was treated with neutral anolyte (NA). Dressings also contained neutral anolyte (NA). These drugs were successfully combined with postoperative basic therapy. The patient was discharged from the hospital on the 4th day after surgery. The functional results of the left upper limb are satisfactory.

Granulomatous polyarthritis caused by Talaromyces georgiensis in a dog

A 6-y-old, 3.5-kg, spayed female Toy Poodle was presented with left forelimb lameness of 2-d duration. Two months before the initial presentation, radiography showed osteolysis of the medial epicondyle of the left humerus, and the left forelimb was amputated. Grossly, the articular villi of the elbow joint were markedly thickened, and the articular cartilage surfaces of the distal humerus and proximal radius had partial erosion. Histologically, granulomatous arthritis and osteomyelitis characterized by the presence of abundant macrophages containing numerous fungi were observed. ITS and β-tubulin sequences amplified from the isolate from the specimen were 100% and 99% identical to type strain UTHSC D16-145T of Talaromyces georgiensis, respectively. Canine osteoarthritis caused by T. georgiensis has not been reported previously, to our knowledge.