Clinical and sonographic diagnosis of occiput posterior position: a prospective study of 350 deliveries

OBJECTIVE: To evaluate clinical reliability compared to intrapartum ultrasound as a tool to diagnose occiput posterior position and to investigate the proportion of rotations occurring during labour. PATIENTS AND METHODS: 350 women in labor with a singleton fetus in a vertex position were prospectively studied using ultrasound and obstetrical examination. Outcome of labor was also monitored. RESULTS: Reliability of clinical examination is 85,7%, initial occiput posterior position represented 40,2% and most rotated in an anterior position (84, 8%) while only 0,6% of initial anterior positions delivered in occiput posterior position. Logistic regression did not allow to find significant predictor of occiput posterior position rotation. DISCUSSION AND CONCLUSION: Clinical examination is relatively reliable for posterior position diagnosis and in most cases, initially occipitoposterior positions rotate anteriorly.     

Résultats oncologiques de la reconstruction immédiate après mastectomie pour cancer du sein: à propos de 38 cas

Objective

The purpose of this study is to analyze the oncologic outcome of immediate reconstruction after mastectomy for breast cancer and the impact of adjuvant treatments on cosmetic results.

Patients and methods

This retrospective study concerns 38 consecutive advanced abdominal flap with breast prothesis, realized immediately after mastectomy for breast cancer by one surgeon between 1997 and 2008.

Results

The average retrospective period was 34.5 months. Recurrence was observed in three caseswithout late diagnosis. It was local in two cases and systemic in one case resulting in death 18 months after reconstruction. Breast tumor in these cases had several initial poor prognostic factors. Delayed scarring was noted in one case due to post-radiation cutaneous necrosis. Capsular contracture was also observed in two women who received postoperative radiotherapy. In our study, esthetic results were considered poor in three cases because of prothesis removal in these cases, acceptable in 10 cases, good in 20 cases, and excellent in 5 cases.

Conclusion

Immediate breast reconstruction using advanced abdominal flap associated to a prothesis doesn’t affect neither local and systemic recurrence rates nor overall survival. Cosmetic results are overall good.     

Prognostic significance of perineural invasion in oral and oropharyngeal carcinoma

OBJECTIVE: To evaluate the occurrence and prognostic significance of perineural invasion (PNI) in squamous cell carcinomas (SCC) of the oral cavity and oropharynx. STUDY DESIGN: A retrospective study of 101 patients with previously untreated SCC of the oral cavity and oropharynx was undertaken to evaluate the occurrence and prognostic significance of PNI in relation to local recurrence, regional recurrence, distant metastasis and survival. The logistic regression test was used for univariate and multivariate analyses. Actuarial survival curves were determined using the Kaplan-Meier method. RESULTS: PNI was present in 26 (25.7%) of 101 patients and was significantly associated with tumor differentiation, lymph node metastasis, and depth of invasion. Univariate analyses showed PNI was associated with local recurrence (P=.005), regional recurrence (P=.007), and distant metastasis (P=.013). In multivariate analysis, PNI was significantly associated with regional recurrence (P=.033) and distant metastasis (P=.021), but not with local recurrence (P=.109). The 5-year disease-specific survival for patients with and without PNI was 56.6% and 94.6%, respectively (P<.0001). CONCLUSION: PNI is an important predictor for outcome of patients with SCC of the oral cavity and oropharynx.     

A 10-year single center survey of pediatric patients with histiocytic disorders in Iran

Childhood histiocytosis is a rare and diverse group of proliferative disorders, characterized by accumulation and infiltration of antigen-presenting cells or antigen-processing cells, which can affect any tissue or organ. This study was performed in order to investigate the clinical characteristics of Iranian children with different types of histiocytic disorders. Thirty-five patients, with a median age of 3.5 years, who were referred and diagnosed with histiocytic disorders in a referral Children's Hospital in Iran from 1997-2006, were investigated in this study. According to the World Health Organization classification, 27 patients were in class 1, followed by 6 patients in class 2, and 1 patient in class 3. Moreover, 1 patient was diagnosed with sinus histiocytosis with massive lymphadenopathy. Bone lesions were the most common manifestation, which were detected in 15 cases, followed by skin lesions (11 cases) and fever (10 cases). Nonspecific findings like hepatomegaly and splenomegaly were found in 15 cases. Different types of treatment protocols were used according to the diverse groups of histiocytic disorders and different stages of disease, including surgical excision, radiotherapy, chemotherapy, and stem cell transplantation. Twelve patients did not respond well to the treatment and subsequently died due to complications of their disease. Although histiocytosis is considered a rare condition, it can be problematic for pediatric hematologists because of the unknown etiologies and pathogenesis, variable classifications and subtypes, diagnostic difficulties, poor therapeutic responses with high mortality, and some complications after different therapeutic protocols.     

Epidural hematoma secondary to sinusitis: A case report and review of the literature

Epidural hematoma is a potentially life threatening event that demands prompt diagnosis and surgical treatment, usually following head trauma. We present a case of a 9-year-old boy with no history of head trauma, and who was diagnosed with epidural hematoma secondary to frontal sinusitis; and the medical literature was reviewed.