Regenerating a kidney in a lymph node

The ultimate treatment for end-stage renal disease (ESRD) is orthotopic transplantation. However, the demand for kidney transplantation far exceeds the number of available donor organs. While more than 100,000 Americans need a kidney, only 17,000 people receive a kidney transplant each year (National Kidney Foundation’s estimations). In recent years, several regenerative medicine/tissue engineering approaches have been exploited to alleviate the kidney shortage crisis. Although these approaches have yielded promising results in experimental animal models, the kidney is a complex organ and translation into the clinical realm has been challenging to date. In this review, we will discuss cell therapy-based approaches for kidney regeneration and whole-kidney tissue engineering strategies, including our innovative approach to regenerate a functional kidney using the lymph node as an in vivo bioreactor.     

Ganglioglioma in a child--report of a case

A seven-year-old boy who was admitted for surgical treatment for intractable epilepsy was found to have a ganglioglioma in his left parietal lobe. Since four years old, he had been suffering from the seizure and treated with various anticonvulsants without satisfactory effects. As its frequency increased, the dose had to be increased. Thus, it was sought for the possible surgical approach. On the CT scans, an egg size low density zone without contrast enhancement was observed in the subcortical region of his parietal lobe. There was marked thinning on inner table of the skull immediately above the zone. He was operated under fronto-temporo-parietal craniotomy. When the dura matter was opened, pale cerebral cortex protruded. Complete removal of the tumor was not possible, since there was not clear boundary between the mass and normal tissue. Based on histological study, it was diagnosed as ganglioglioma, because its main body contained increased number of glia which had deeply stained ununiform size nuclei. After the operation, he showed neither motor paralysis nor sensory disturbance and was able to sustain his activity with less amount of anticonvulsant.     

Knotting of a Ureteric Stent in a Child

Knotting of ureteric stents is an unusual complication of their use and has not previously been reported in a child. We present a case of a 4-year-old that developed symptomatic hydronephroureter following removal of a multilength stent, which had knotted at the proximal loop. The child made a full recovery but knotting must be considered if resistance is encountered during stent removal.     

Medical student mentorship in a university setting as a strategy for a career in surgery

Gender balance in surgery is a respectable and necessary goal. At the University of Louisville (UL) School of Medicine, we have compared percentages of UL medical student applicants to general surgery or surgical subspecialty residency programs, surgical residents, and surgical faculty with the rest of the nation. Although UL has at times paralleled or exceeded the nation in many of these categories, there is room for improvement and the comparison data allow for strategic planning initiatives. To promote gender balance among future generations of surgeons at UL, we recently implemented a mentoring program that pairs medical students with residents and faculty in surgery. We plan to track the success over time and correct any shortcomings of this program. Virginia Commonwealth University's commitment to gender balance in surgery is exemplary. As part of a more comprehensive vision to create a mentorship program for female medical students at the UL School of Medicine, we have recently recruited female surgical residents and faculty, whom we hope will provide the type of inspiration and guidance that will increase the number of women from UL who decide to train in general surgery and the surgical specialties. To understand why women across the nation are not generally at numerical parity in these fields, it is important to consider the length and intensity of the surgical residency programs in the context of the other goals and objectives that a woman might have for her future. This article does not address this broad topic but provides a perspective of how a medical school can evaluate and perhaps intervene to mentor medical students more effectively about the satisfaction derived from a career in surgery. As part of this project, we have evaluated each step of the path through medical school and a surgical residency by comparing data for our students, residency programs, and faculty with national data.     

Carcinoma in a rectovaginal fistula in a patient with Crohn's disease

A patient with Crohn's disease underwent resection for internal fistulas. Later a rectovaginal fistula developed that persisted with minimal symptoms for 10 years before causing pain and induration in the posterior vaginal wall, due to carcinoma developing within the fistula.     

Torsion of a communicating hydrocele in a child

Among the diseases presenting as acute scrotum, torsion of a communicating hydrocele is extremely rare. A 5-year-old boy was referred with discomfort and swelling of the left scrotum. Operative findings revealed a torsion of a communicating hydrocele. We report a case of torsion with preoperative findings of ultrasonography and magnetic resonance imaging. We also emphasize the awareness of this disease as a differential diagnosis of the acute scrotum.     

Cancer arising in a choledochal cyst in a 12-year-old girl

An adenocarcinoma was found in a choledochal cyst in a 12-year-old girl. This is the youngest patient so far reported with an adenocarcinoma in a choledochal cyst. The cyst consisted of dilatations of the intrahepatic bile ducts and the extrahepatic bile duct. Most of the cyst wall was resected. However, resection of the distal part of the cyst wall in the infrapancreatic region was impossible because of invasion of the portal vein and the inferior vena cava. This patient is now being treated with chemotherapy. We believe that early diagnosis is mandatory, and that total excision of a choledochal cyst is advisably to prevent the development of carcinoma.     

Metastasis in a patella: a rare site

Primary neoplasms of the patella are rare, and metastases of the patella are rarer still. A case is presented of a 64 year old woman whose pain in the left knee, resulting from patellar neoplasms, was subsequently found to result from secondary spread from a renal adenocarcinoma.     

Nonunion of a Hoffa fracture in a child

The authors report a case of a Hoffa fracture of the lateral femoral condyle that subsequently went on to nonunion in an eight-year-old child. The child presented with symptoms of knee pain and snapping five years after a motor vehicle accident. The nonunion fragment involved most of the lateral femoral condylar articular surface but spared the physis. After treatment by open reduction and limited internal fixation, the nonunion has healed, and the child has virtually full range of motion of the knee and no evidence of growth disturbance.     

Scaphoid fracture in a patient after a fall

The patient was a 27-year-old man who was referred to a physical therapist because of persistent right wrist pain after a fall on an outstretched hand in a remote setting 3 months prior. Immediately after the injury, the patient was seen by a physician's assistant in a remote medical clinic, where right wrist radiographs were completed and interpreted as normal. Based on the history and physical exam, a potential scaphoid fracture was suspected. Therefore, the physical therapist ordered radiographs of the right wrist, which revealed a fracture through the waist of the right scaphoid with a band-like lucency.