UNASSIGNED: Morel-Lavallée lesion (MLL) is a closed degloving injury that occurs after traumatic damage to soft tissue, leading to the formation of an encapsulated serosanguinous collection of fluid. Although some MLLs resolve spontaneously, chronic MLLs present with a significant risk of infection and may impede patients\' quality of life. Chronic lesions require surgical intervention to evacuate and debride the hematoma, often resulting in severe cosmetic damage postoperatively.
UNASSIGNED: We documented a large 19.4 cm × 4.2 cm × 15.10 cm MLL on the right lateral hip that presented a significant impediment to the patient\'s daily functions. After the failure of conservative management, the patient was treated surgically through a minimal incision debridement procedure, utilizing a wound drain and vacuum-assisted compressional dressing upon closure. Excellent 1-year post-operative outcomes were achieved with no recurrence of the lesion and limited cosmetic evidence of the MLL.
UNASSIGNED: This case highlights the value of a limited incisional debridement procedure for the management of a chronic Morel-Lavellée lesion. When using this technique, surgeons can effectively treat these lesions with promising short-term outcomes and minimal wound scarring.

Postural sway has not been investigated before or after a neck exercise intervention in individuals with chronic whiplash-associated disorders (WAD). The aim of the study was to investigate postural sway in individuals with chronic WAD grades 2 and 3: (a) compared with healthy matched controls at baseline; (b) after three months of neck-specific exercise and (c) to investigate the correlation between postural sway with self-reported dizziness during motion and balance problems/unsteadiness. This is a longitudinal prospective experimental case-control intervention study. Individuals with WAD (n = 30) and age- and gender-matched healthy volunteers (n = 30) participated. Postural sway was assessed using an iPhone application. Measurements were carried out at baseline, and for those with WAD a second measurement was performed at the three-month follow-up when neck-specific exercise intervention ended. The WAD group performed significantly worse than the healthy group in both pathway and ellipse area double stance eyes closed at baseline (main outcome), but not at the three-month follow-up. The WAD group significantly improved after rehabilitation in both pathway double stance eyes closed and pathway single stance eyes open. The correlation between postural sway and self-rated dizziness during motion and balance problems was low to moderate. One may conclude that postural sway was improved after a neck-specific exercise programme. The study results strengthen earlier findings that individuals with WAD have worse balance outcome when they have to rely on neck proprioception (eyes closed). The study results may be important for the development of improved rehabilitation methods for WAD.

UNASSIGNED: Clavicular osteomyelitis, unlike the metaphysis of long bones, is a rare condition that poses a challenge for orthopedic surgeons in terms of diagnosis. The unique location of the clavicle makes it crucial to diagnose and effectively manage these non-traumatic clavicular lesions promptly. Localized pain and swelling are common symptoms experienced by patients with clavicular osteomyelitis.
METHODS: A 9-year-old boy presented with swelling and pain in the left clavicular area for 6 months. There was no fever or history of trauma. Physical examination revealed a tender, 2 cm by 3 cm swelling over the left clavicular area, with no abnormal findings in other body systems. This case was treated with surgical debridement and PO cloxacillin, and his condition improved.
UNASSIGNED: To achieve an accurate diagnosis, a thorough analysis of the patient\'s clinical presentation, along with blood workups, radiologic studies, bacteriological studies, and histopathological studies, is essential. Treatment options for clavicular osteomyelitis may involve surgery, medical intervention, or a combination of both. Existing literature suggests that the cure rate does not significantly differ between patients who receive medical treatment and those who undergo surgery for clavicular osteomyelitis.
CONCLUSIONS: In evaluating non-traumatic clavicular lesions, considering chronic osteomyelitis as a potential diagnosis is important. The final diagnosis is determined through analysis of the clinical presentation, laboratory and radiographic tests, and confirmation with assistance from local culture and biopsy.

UNASSIGNED: IgG4-related disease is a rare and emerging pathology, characterized by the appearance of pseudotumors. Due to the ability to mimic other pathologies, it is essential to consider it as a differential diagnosis in multisystemic processes. The diagnosis is challenging, requiring a multidisciplinary approach, to minimize the associated morbidity and mortality.
UNASSIGNED: IgG4-related disease (IgG4-RD) is a rare, emerging, systemic and chronic pathology, characterized by the appearance of pseudotumors resulting from tissue infiltration by IgG4-positive plasma cells that promote eosinophilic inflammation of the tissue with subsequent fibrosis. We present the case of a male, 45-year-old patient, with marked weight loss and skin pallor detected by his family doctor during a child health consultation of his daughter. When questioned, the patient referred complaints of postprandial discomfort in the left hypochondrium with a feeling of fullness, weight loss, chronic fatigue and hyperhidrosis that had lasted for a month. On physical examination, he was pale, and had pain at palpation of the left hypochondrium. Laboratory data showed increased inflammation markers, abdominal ultrasound and CT demonstrated numerous enlarged lymph nodes in the upper quadrants, raising concern for a malignant lymphoproliferative process. Serological, imaging, clinical and laparoscopic excisional biopsy revealed features of IgG4-related disease and excluded malignant lymphoproliferative disease. The immediate response to treatment with oral prednisolone 30 mg/day also contributed for diagnosis confirmation. Due to refractory disease after gradual prednisolone reduction, second-line therapy with rituximab was initiated. Over the 6 years of follow-up, the patient presented multiple exacerbations characterized by the emergence of systemic symptoms, being maintained under close clinical and imaging follow-up by reumathology, infectious diseases, and family medicine specialists.

Chronic abdominal pain is a challenging problem in clinical practice, with several pathophysiological mechanisms underlying its aetiologies. This case report presents a geriatric patient with multiple comorbidities who had experienced intermittent abdominal pain for over 10 years. Alarming symptoms were ruled out, and a functional gastrointestinal disorder was determined as the most likely cause. The patient\'s medical history and previous treatments were thoroughly reviewed, revealing that long-term use of metformin and an oral iron supplement was the iatrogenic symptom triggers. The abdominal pain resolved upon discontinuation of these two medications. This case report highlights the significance of reviewing iatrogenic causes and periodically assessing chronic medical conditions to identify potential contributing factors of chronic abdominal pain.

Chronic recurrent multifocal osteomyelitis (CRMO) is a rare disease. It is a non-microbial inflammatory bone affection that occurs more often in children with insidious onset and non specific presentation making diagnosis challenging. This study reports a case of CRMO with an unusual location. A 9-year-old child had a painful swelling over the medial side of clavicle with fixed mass. Radiographs showed osteolytic lesion on the medial part of clavicle extending to the acromioclavicular joint with soft tissue edema in magnetic resonance imaging (MRI). No inflammatory markers in biological exam. Needle biopsy, initially performed, suspected bone infection but children didn´t recover after 2 weeks of antibiotics. Surgical biopsy, histology sections were compatible with CRMO diagnosis. Children received a non steroid inflammatory drug with positive response, pain relief and decreasing of the clavicle swelling. CRMO should be suspected and biopsy is some time helpful in such unusual location.

Foot ulceration and infection is associated with a substantial increase in morbidity and mortality in patients with diabetes. We present a clinical case of recurrent diabetic foot infection with an atypical clinical evolution. A 58-year-old male patient with type 1 diabetes and a history of bilateral Charcot foot neuroarthropathy was followed at our Diabetic Foot Clinic for an unhealed plantar foot ulcer for >1.5 years with recurrent episodes of infection. He was admitted to hospital due to foot ulcer reinfection with sepsis and ipsilateral lower limb cellulitis. The foot infection was found to be associated with an underlying abscess in the anterior compartment of the leg, with a cutaneous fistulous course with extensive alterations of an inflammatory nature. Exudate from the lesion was drained and tissue biopsied, revealing Serratia marcescens and Klebsiella oxytoca with dystrophic calcification (DC). Surgical excision of dystrophic tissue with debridement of the fistulous tracts was performed. The excised material corroborated the presence of fibroadipose connective tissue with marked DC, as well as areas of mixed inflammation compatible with a chronic infectious aetiology. Targeted long-term antibiotic therapy was implemented, for a total of six weeks, with a favourable clinical evolution and complete closure of the lesion at the final follow-up. DC results from calcium deposition in degenerated tissues without evidence of systemic mineral imbalance and is a potential cause of non-healing ulcers. Few cases of DC have been reported in diabetic foot patients and its treatment remains challenging and controversial. A longer follow-up period is necessary to verify the effectiveness of our approach.

Chronic lower limb lymphedema is a challenging and often debilitating medical condition characterized by the abnormal accumulation of lymphatic fluid in the extremities, leading to persistent swelling and discomfort. While this condition can be caused by various underlying factors, early diagnosis, and appropriate management are crucial for improving the patient\'s quality of life. This case report presents the successful surgical management of chronic lower limb lymphedema in a 30-year-old male patient who had been grappling with this condition for a decade. The patient\'s journey from the onset of symptoms, including swelling and difficulty in walking, to the eventual diagnosis and treatment is documented herein. Despite seeking medical care from allopathic and homeopathic sources, the patient\'s condition continued to deteriorate over the years, underscoring the complexity of chronic lower limb lymphedema and its challenges in clinical management. This case highlights the importance of accurate diagnosis, multidisciplinary evaluation, and a comprehensive surgical approach in addressing the complexities of chronic lower limb lymphedema. It also sheds light on the potential complications that may arise during treatment and the postoperative care required to achieve a favorable outcome. By sharing this case, we aim to contribute to understanding this condition and provide insights into the effective management of chronic lower limb lymphedema.

Eosinophilic pneumonia is a very rare form of interstitial lung disease. It is subdivided into acute and chronic types. Both types share some characteristics differences and similarities. We report two unique cases of acute eosinophilic pneumonia (AEP) and chronic eosinophilic pneumonia seen in 37- and 30-year-old males, respectively. Both cases occurred in the summer of the same year. There was no known association between the two patients except that they were both young males. We were able to compare the unique features of AEP and chronic eosinophilic pneumonia (CEP) and how these relate to the cases presented.

This case study examines the effectiveness of using negative pressure wound therapy (NPWT) in the management of a hard-to-heal (chronic) wound with exposed ankle bone to reduce associated wound exudate and promote production of granulation tissue. A 60-year-old male patient who was able to attend wound follow-up diligently twice weekly for eight weeks, and weekly thereafter, was selected from a private hospital to take part. During each dressing change, the wound was cleansed with superoxidised cleansing solution, and minimal sharp debridement was performed. In the authors\' opinion, the NPWT device used in this study is light and convenient for use in the community or home care setting. The NPWT wound dressing was connected to the NPWT machine via a connecting tube and the device then switched on using the default setting of a negative pressure of 125mmHg. Following the application of the NPWT device, the exposed ankle bone was successfully covered with healthy granulation tissue and healed within 20 weeks with minimal exudate formation in the wound. In the authors\' opinion, NPWT is able to promote progress to wound healing; to minimise unnecessary dressing changes and, based on feedback from the patient, is comfortable to wear and when in use.