Renal cell carcinoma in children: a report of four cases and a review of the literature

Tumors of the kidney account for approximately 25% of all (solid) neoplasms in infants and children.¹ Renal cell carcinoma had been considered so rare that Gross, in 1953, noted that there had not been a case at Children's Hospital in Boston in 30 yr.² In the last few years, however, renal cell carcinoma in children has been reported with increasing frequency. A recent case of renal cell carcinoma in a 9-yr-old girl prompted us to review our own past experience with this tumor in children. Three additional cases of hypernephroma were discovered in a review of the records of the past 11 yr. They were previously alluded to by Poole and Viamonte, in their excellent article “Unusual Renal Masses in the Pediatric Age Group.”³     

An experimental study of the vibrator in postoperative tracheobronchial clearance

Thirty-eight piglets underwent thoracotomy and endobronchial installation of thick tenacious material. External vibrations enhanced tracheal bronchial clearance significantly. The study suggests that vibrating the chest in postoperative subjects with an inexpensive commercially available vibrator may be an important aid in the prevention and treatment of postoperative respiratory complications.     

Loss of c-Kit function impairs arteriogenesis in a mouse model of hindlimb ischemia

Background

Arteriogenesis is a process whereby collateral vessels remodel usually in response to increased blood flow and/or wall stress. Remodeling of collaterals can function as a natural bypass to alleviate ischemia during arterial occlusion. Here we used a genetic approach to investigate possible roles of tyrosine receptor c-Kit in arteriogenesis.

Colloid versus crystalloid resuscitation in experimental bowel obstruction

The physiologic effects of fluid resuscitation were studied in 20 piglets with advanced small bowel obstruction. Two solutions were compared: 5% albumin in normal saline and normal saline. Animals resuscitated with albumin-containing solution showed higher serum colloid oncotic pressure, greater loss of peritoneal fluid, lower urine output, and progression of muscular dehydration, when compared to animals resuscitated with similar volumes of normal saline solution.     

A functional treatment method for interphalangeal pyogenic arthritis

A treatment plan for pyogenic arthritis has been devised in which the accessory collateral ligaments are resected through radial and ulnar midaxial incisions. The surgical wound is debrided and copiously irrigated with an antibiotic solution, and intravenous antibiotics are instituted before operation and continued after operation. Physical therapy is begun within 24 hours of surgery and includes active range of motion (ROM) of all joints, dynamic splinting, and hand therapy to ensure both full flexion and extension. Forty patients were treated with this method within a 6-year period. Of five interphalangeal (IP) joints of the thumb, four regained 0 degree to 60 degrees full ROM and one gained 15 degrees to 65 degrees limited ROM. Of the two distal IP joints, one regained full ROM and the other became fused. Among the 33 proximal IP joints, 13 regained full ROM of 110 degrees and 13 regained limited ROM. Good functional results were obtained with this treatment plan in lieu of amputation, which previously was the most likely treatment.     

Editorial comments on Brock's paper

We present a study of the white blood cell count at time of admission in patients with spontaneous subarachnoid hemorrhage. A nearly normal white blood cell count has little correlation with either the clinical grade at time of admission, or with the patient's ultimate outcome. A white blood cell count exceeding 20,000, however, is associated with poor clinical grade on admission and with a 50% mortality.     

Dislodged Nephrostomy Catheter: An Unusual Case of Idiopathic Transposition of Nephrostomy Catheter From Transplanted Kidney to Adjacent Small Bowel Loop: A Case Report

A 72-year-old man with a past medical history notable for deceased renal transplant presented to the interventional radiology department for routine right lower quadrant renal transplant nephroureteral catheter exchange. The nephroureteral catheter was placed in 2016 because of the presence of a hematoma causing partial page kidney and hydronephrosis.An antegrade nephrostogram was notable for opacification of the small bowel instead of the renal collecting system. The patient then subsequently developed urinary retention and intractable abdominal pain. Because of the combination of events, it was deemed necessary for laparotomy and surgical repair of the small bowel. Intraoperative findings were notable for small bowel adhesion to the abdominal wall but otherwise no evidence of acute inflammatory changes. In this case report, we describe the first case of an idiopathically dislodged nephrostomy catheter to the small bowel from a transplanted kidney and its successful management.     

Successful parathyroidectomy guided by intraoperative parathyroid hormone monitoring for primary hyperparathyroidism is preserved in mild and moderate renal insufficiency

Background

The effect of altered parathyroid hormone metabolism in renal insufficiency on intraoperative parathyroid hormone monitoring during parathyroidectomy is not well known. This study evaluates operative outcomes in patients undergoing parathyroidectomy guided by intraoperative parathyroid hormone monitoring for primary hyperparathyroidism with mild and moderate renal insufficiency.

Intraoperative parathormone spikes during parathyroidectomy may be associated with multiglandular disease

Background

The importance of intraoperative parathormone “spikes” during parathyroidectomy remains unclear. This study compared patients with and without intraoperative parathormone spikes during parathyroidectomy using the criterion of a?>?50% parathormone and determined the effect of intraoperative parathormone spikes on operative outcome.

Gastrinoma associated with common bile duct obstruction and the ectopic production of ACTH.

A case of adrenocortical hyperfunction due to ectopic production of ACTH by a gastrin-producing tumor of the pancreas is described. Cushing's syndrome preceded the appearance of the overt Zollinger-Ellison syndrome by 2 years and was treated by bilateral adrenalectomy. The Zollinger-Ellison syndrome was initially treated with cimetidine, which successfully reduced the secretion of gastric acid. Because the pancreatic gastrinoma continued to grow, causing obstruction of the common bile duct, biliary diversion and total gastrectomy were performed. There is evidence that the pancreatic gastrinoma was the source of the ectopic production of ACTH and possibly secretion. The role of Histamine-2 blocking agents as therapy in the Zollinger-Ellison syndrome is discussed.