This case report highlights a novel approach to strengthening the repair of a split peroneus brevis tendon tear with a peroneus quartus muscle autograft. We describe a 51-year-old woman with a longitudinal split tear of the peroneus brevis tendon confirmed by magnetic resonance imaging. Intraoperatively, a peroneus quartus muscle was appreciated, resected, and used as an autograft in the repair of the peroneus brevis tendon. Use of a peroneus quartus muscle as an autograft in peroneal tendon repair has not been documented in the literature, to our knowledge.

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OBJECTIVES The liquid–solid interactions have attracted broad interest since solid surfaces can either repel or attract fluids, configuring a wide spectrum of wetting states (from superhydrophilicity to superhydrophobicity). Since the blood–artificial surface interaction of bileaflet mechanical heart valves essentially represents a liquid–solid interaction, we analysed the thrombogenicity of mechanical heart valve prostheses from innovative perspectives. The aim of the present study was to modify the surface wettability of standard St. Jude Medical Regent™ occluders. METHODS Four pyrolytic carbon occluders were irradiated by means of ultra-short pulse laser, to create 4 different nanotextures (A–D), the essential prerequisite to achieve superhydrophobicity. The static surface wettability of the occluders was qualified by the contact angle (θ) of 2 µl of purified water, using the sessile drop technique. The angle formed between the liquid–solid and the liquid–vapour interface was the contact angle and was obtained by analysing the droplet images captured by a camera. The morphology of the occluders was characterized and analysed by a scanning electron microscope at different magnifications. RESULTS The scanning electron microscope analysis of the textures revealed 2 different configurations of the pillars since A and B showed well-rounded shaped tops and C and D flat tops. The measured highest contact angles were comprised between 108.1° and 112.7°, reflecting an improved hydrophobicity of the occluders. All the textures exhibited, to different extents, an orientation (horizontal or vertical), which was strictly related to the observed anisotropy. CONCLUSIONS In this very early phase of our research, we were able to demonstrate that the intrinsic wettability of pyrolytic carbon occluders can be permanently modified, increasing the water repellency.

The purpose of this case study was to highlight a potential limitation of magnetic resonance imaging in diagnosing longitudinal tendon tears and to emphasize the importance of clinical examination for peroneal tendinopathy. We describe a 15-year-old female with lateral ankle pain, who was negative for peroneal tendon tear on magnetic resonance imaging. Owing to high clinical suspicion of peroneal tendon pathology, we opted to take the patient to the operating room and found a 6.5-cm longitudinal tear and a low-lying muscle belly of the peroneus brevis tendon. A low-lying muscle belly of the peroneal tendon has been shown to be associated with increased tendon tears.

Background Contained rupture of the ascending aorta is a rare condition, but the severity of this complication enforces strict guidelines for its prevention and a prompt diagnosis, once already occurred. Case presentation A 66-year-old man with a history of type 2 diabetes, longstanding aortic valve stenosis and aortic root aneurysm of 47 mm was hospital admitted for elective surgery. A Bentall-De Bono procedure was performed in order to replace the stenotic bicuspid aortic valve and exclude the dilated portion of the aortic wall. Intraoperatively, a discontinuity of the aortic wall, just above the aortic annulus, at the non-coronary sinus of Valsalva was incidentally observed. The aortic wall discontinuity was none other than a contained aortic rupture. The preoperative CT-scan images were afterwards analyzed by the radiologist, in order to identify the contained aortic rupture. Indeed a false aneurysm of the non-coronary sinus of Valsalva of a maximum diameter of 15 mm was detected, thanks to a 3D reconstruction. Conclusions The diagnosis of contained aortic rupture is certainly demanding, particularly in absence of signs or symptoms of rupture in a chamber of the heart or in the pericardium. Although this case represents a consensus of experts’ opinion, the recognition of these specific cases in which the risk of dissection, rupture or death is at its highest, would allow to operate at the appropriate time, improving the outcomes.