Is ultrasound really helpful in the detection of rib fractures?

OBJECTIVE: To determine the usefulness of ultrasound in the detection of rib fractures. PATIENTS AND METHODS: A prospective study was performed over a 3-month period. Patients presenting with a high clinical suspicion of rib fracture(s) to the Accident and Emergency Department were referred for radiological work-up with a PA chest radiograph, an oblique rib view and a chest ultrasound. Associated lesions, e.g. pleural effusion, splenic laceration and pneumothorax were recorded. RESULTS: Fourteen patients were radiologically assessed. The mean patient age was 31 years (range 16-55 years) and the M:F ratio 3.7:1 (11 men and 3 women). Ten patients displayed a total of 15 broken ribs. Chest radiography detected 11, oblique rib views 13 and ultrasound 14 broken ribs. Ultrasound findings included discontinuity of cortical alignment in 12 fractures, an acoustic linear edge shadow in nine and a reverberation artifact in six. Concordance with plain film findings, and especially oblique rib views, was good, though better when the rib fractures fragments were markedly displaced. One splenic laceration was detected with an associated small pleural effusion. There were no pneumothoraces. The average time of ultrasound examination was 13 min. CONCLUSION: Ultrasound does not significantly increase the detection rate of rib fractures, may be uncomfortable for the patient and is too time-consuming to justify its routine use to detect rib fractures.     

Vascular invasion in malignant melanomas. An independent prognostic variable?

The role of vascular invasion as a prognostic indicator in melanoma has not been fully evaluated, mainly due to difficulty in differentiating between capillaries and artefactual spaces caused by shrinkage in routine histological sections. However, immunohistochemical staining using Ulex europaeus I (UEA-I) permits accurate identification of tumor capillaries, thus facilitating recognition of vascular invasion. Sixty-six primary cutaneous melanomas were included in this study. Sections of each case were stained with UEA-I; then, vascular invasion at the level of the tumor capillary bed was sought. Hematoxylin-and-eosin-stained sections were reviewed; the thickness of each lesion was measured and the level of invasion and the growth phase of the tumors were also assessed. The frequency of vascular invasion was found to increase with increasing tumor thickness and with increasing level of invasion. Vascular invasion was seen in only one of 29 horizontal growth phase melanomas, whereas it was identified in 28 of 37 vertical growth phase tumors. Although these results would seem to indicate that vascular invasion within melanomas is unlikely to be an independent prognostic variable, they may partly explain the deteriorating prognosis associated with increasing tumor thickness. They also lend support to the concept of "horizontal" and "vertical" growth phase in melanoma.     

Cytoreductive radical prostatectomy in metastatic prostate cancer: Does it really make sense?

Purpose

Surgical removal of the primary tumor in metastatic prostate cancer (mPCa) is becoming a hotly debated issue. The purpose of this review was to summarize the current knowledge on cytoreductive radical prostatectomy (cRP) in this setting.

Materials and methods

We performed a non-systematic Medline/PubMed literature search of articles published in the field between January 2000 and April 2015.

Results

Cytoreductive surgery has demonstrated its benefit in various malignancies with a solid biological rationale to justify its assessment in mPCa. cRP appears as a safe and feasible procedure in expert hands and well-selected patients. A growing body of evidence suggests a survival benefit for patients undergoing cRP as a part of a multimodal approach compared to those treated with systemic treatment alone. Nevertheless, little is known about the best clinical and tumor characteristics for the selection of patients most likely to benefit from cRP. The current literature is based on retrospective studies with small cohorts and limited follow-up or large uncontrolled population-based studies.

Conclusions

Data from various other malignancies together with the biological rationale and preliminary results in PCa suggest that cytoreductive surgery may be an option in some mPCa patients. The lack of randomized controlled trials and the low level of evidence in the current literature preclude any firms conclusion on the benefit of cRP in mPCa. Ongoing phase II and future phase III studies are mandatory to define the exact role of cRP in mPCa and to identify the patients who are most likely to benefit from cRP.

     

Is edema in minimal change disease of childhood really hypovolemic?

OBJECTIVES: In this study, we aimed to find out whether children with minimal change disease can be classified as hypervolemic by objective measures. METHODS: Eighteen children with minimal change disease diagnosed at our department between November 2005 and May 2007 were included in this study. All patients were newly diagnosed or relapsed but were steroid free for at least 6 months. In the first week of edema and when edema resolved (5-7 days after initiation of therapy), weight, height and blood pressure were obtained from all patients. Serum and plasma samples were taken following a starvation period of 12-14 h. The volume load of all patients was evaluated, measuring the inferior vena cava indices in each stage by echocardiography. RESULTS: Average weight at presentation was 8.5% higher than the ideal (dry) weight. There were significant differences between the first and post-treatment body weights, abdomen circumference, and systolic and diastolic blood pressure values (P < 0.05 for each). The inferior vena cava index (IVCI) values decreased significantly after diuretic treatment (P < 0.001), while inferior vena cava collapsibility index (IVCCI) values increased in the post-treatment period (P < 0.001). CONCLUSION: We believe that a close follow-up of hypervolemic children with MCD, treated solely with easy-to-handle diuretics instead of I.V. albumin and diuretics may properly solve the edematous state in these patients.     

Is adjuvant radiotherapy necessary after positive lymph node dissection in head and neck melanomas?

Introduction: Postoperative radiotherapy (PR) has been recommended in patients with advanced head and neck melanomas to improve regional control. This study examined the incidence of cervical recurrence among patients who did not receive PR after surgical management of nodepositive head and neck melanomas. Methods: A computerized search of a database listing more than 10,000 patients with melanoma prospectively acquired between 1971 and 1998 identified 217 patients with pathologically positive nodes who had undergone regional lymph node dissection (RLND). Of these patients, 21 had received PR and 196 had not. Results: Median follow-up after RLND was 20 months for nonsurvivors and 32 months for survivors. The overall incidence of cervical recurrence was 14% (27/196). The 5-year cervical recurrence-free survival rate was 83%. Five-year cervical recurrence-free survival rates were 69% vs. 87% for patients with vs. without extranodal disease (P=.004), 96% vs. 81% for patients with nonpalpable vs. palpable nodes (P=.0761), and 82% vs. 91% for patients with one to three positive nodes vs. more than three positive nodes (P=.256). Multivariate analysis, which included the timing of nodal disease presentation and the effect of systemic adjuvant therapy, identified extranodal disease as the only independent predictor of cervical recurrence (P=.034). Cervical recurrence was significantly related to the subsequent occurrence of distant relapse. Conclusions: The low incidence of cervical recurrence after RLND in patients with node-positive head and neck melanomas does not justify the routine use of PR. The only subset of patients who may benefit from PR are those with extranodal disease. Presented at the 53rd Annual Meeting of the Society of Surgical Oncology, New Orleans, Louisiana, March 16–19, 2000.     

Is living kidney donation really safe?

OBJECTIVE: Living donor kidney transplantation (LDKT) yields the best results of all renal replacement therapies in terms of patient and graft survival. It is the main method in many countries because of worsening patient outcomes due to the accumulation of aged patients with long periods on dialysis and no possibility to increase the number of cadaver donor transplantations. Because of concerns dealing the risks inflicted on the donors, we sought to evaluate the long-term complications of LDKT. PATIENTS AND METHODS: We evaluated over 3 years 86 living kidney donors (58 men, 28 women) whose procedures were >1 year ago. The mean time postoperatively was 17.24 +/- 5.04 months and their mean age, 28.97 +/- 4.75 years. Basic information regarding current health status, including physical examination and blood pressure as well as serum urea, creatinine serum albumin, blood glucose, lipid profile, urinanalysis, and 24-hour urine protein were evaluated every 6 months after donation. Also an ultrasound of the kidney, urinary tract, and testis was performed at these times. RESULTS: Donor nephrectomies were left sided in 60 (69.8%) cases and right sided in 26 (30.2%) cases. The majority of the donors (n=80) were unrelated (93%). There was a total complication rate of 54.6%. The most common complication was hypertension (37.5%). Serious complications occurred in five cases (5.8%). In six (6.9%) the patients serum creatinine was >or=1.4 mg/dL. Microalbuminuria was found in 10.4%; hematuria in 13.9%; pyuria in 8.1%; and renal stone in 6.9%. Varicocele was found in 24.1% of male patients (23.3% of patients who had left nephrectomised). Persistent pain was reported by 44.1%. Antidepressants were prescribed to 9.3% of donors because of severe depression. CONCLUSION: Living kidney donation is not so safe and has some late complications. Precise predonation evaluation and long-term follow-up of kidney donors for detection and prevention of complications is necessary.