Value of laparoscopy in appendix epiploica infarction – A report of four cases

Inflammation of the appendix epiploica is a rare condition which may lead to torsion and eventually infarction. It is almost always never diagnosed clinically. Our four patients were young females presenting with right lower quadrant abdominal pain and nausea. The white cell counts were marginally elevated in all four patients. Clinically, we suspected appendicitis or Meckel’s diverticulitis. Laparoscopy revealed a normal appendix with infarction of the epiploic appendix which was easily excised using ultracision shears. The appendix epiploica has no known function. Inflammation of the appendix epiploica is called appendagitis. Appendagitis and torsion will mimic appendicitis or acute abdomen. This condition usually responds to antibiotic therapy, but surgery is indicated if infarction occurs. There are very few reports of laparoscopy in surgery for appendix epiploica. Our patients were managed laparoscopically with a good outcome. The benefits of laparoscopy include avoidance of laparotomy and reduced morbidity.     

Entrapment of the saphenous nerve at the adductor canal affecting the infrapatellar branch – a report on two cases

Objective:

To present 2 cases of entrapment of the saphenous nerve at the adductor canal affecting the infrapatellar branch, and to provide insight into the utilization of nerve tension testing for the diagnosis of nerve entrapments in a clinical setting.

Rationale:

Saphenous nerve entrapments are a very rare condition within today’s body of literature, and the diagnosis remains controversial.

Clinical Features:

Two cases of chronic knee pain that were unresponsive to previous treatment. The patients were diagnosed with an entrapment of the saphenous nerve at the adductor canal affecting the infrapatellar branch using nerve tension techniques along with a full clinical examination.

Intervention and Outcome:

Manual therapy and rehabilitation programs were initiated including soft tissue therapy, nerve gliding techniques and gait retraining which resulted in 90% improvement in one case and complete resolution of symptoms in the second.

Conclusion:

Nerve tension testing may prove to be an aid in the diagnosis of saphenous nerve entrapments within a clinical setting in order to decrease time to diagnosis and proper treatment.     

Techniques in recurrent giant cell tumour of the first metatarsal in adolescents – A rare report of 2 cases

Giant cell tumour of the foot is very rare. Very few cases of first metatarsal giant cell tumour were reported. We report two cases of recurrent giant cell tumour in adolescent patients. One was treated with wide excision and fibula grafting. The second patient underwent Boyd's amputation because of superceded infection. Both had no pain, recurrence at the end of final follow up. Recurrent giant cell tumour of the first metatarsal in adolescents and its management is not described in English literature to the best of our knowledge.     

Lateral shelf acetabuloplasty in the early stage of Legg-Calvé-Perthes disease with special emphasis on the remaining growth of the acetabulum: a preliminary report

This study reports on the preliminary results in 43 patients with an early stage of unilateral Legg-Calvé-Perthes disease, treated with a shelf acetabuloplasty. The mean postoperative follow-up was 3.7 years (1.3-6.2 years). The results suggest an improved outcome in children older than 5 years of age at onset. According to the Stulberg classification, 16 hips were classified as Stulberg 2, 19 hips as Stulberg 3 and eight hips as Stulberg 4. The acetabular size, which is a measurement of the length of the acetabulum relative to the size of the shelf, increased from 48.86 to 69.13%. This reflects an incorporation of the shelf-graft into the pelvis as a result of continued growth of the lateral acetabular structures. The coverage of the femoral head by the bony acetabulum increased from 68.51 to 73.83%. The acetabular cover increases in children younger than 8 years of age and decreases in patients older than 8 years. We suggest that shelf acetabuloplasty can be considered as an appropriate surgical treatment for children older than 5 years of age, with severe Legg-Calvé-Perthes disease.     

Type I punctate palmoplantar keratoderma (Buschke-Fisher-Brauer disease) in a family—A report of two cases

BackgroundInherited palmoplantar keratoderma are a rare group of disorder affecting the palm and sole characterised by hyperkeratosis resulting in severe disability and deformities.ObjectiveTo report a rare case of punctate palmoplantar keratoderma.MethodA case attending our OPD is reported.ResultCase report.ConclusionThis case is reported for its unique presentation and rarity.     

End stage renal disease in Brunei Darussalam – report from the first Brunei Dialysis Transplant Registry (BDTR)

Abstract

The Brunei Dialysis and Transplant Registry (BDTR) was established in 2011 to collect data from patients undergoing renal replacement therapy (RRT) in Brunei Darussalam. The chief aims of the registry are to obtain general demographic data for RRT patients and to determine disease burden attributable to End Stage Renal Disease (ESRD). The registry population comprises of all ESRD patients treated in Brunei Darussalam. Data domains include general demographic data, medical history, ESRD etiological causes, laboratory investigations, dialysis treatment and outcomes. There were 545 prevalent RRT patients in Brunei at the end of 2011. The incidence and prevalence of ESRD were 265 and 1250 per million population. Hemodialysis (HD), Peritoneal Dialysis (PD) and Transplant comprised of 83%, 11% and 6% of the RRT population, respectively. Diabetes mellitus accounted for 57% of all new incident cases. The mean serum hemoglobin, phosphate, calcium and iPTH were 11.0?±?1.6?g/dL, 1.9?±?0.5?mmol/L, 2.3?±?0.2?mmol/L and 202.5?±?323.4?ng/mL. Dialysis adequacy for HD and PD were 65.1 (urea reduction ratio) and 2.0?±?0.3 (Kt/v). 71 % of all prevalent HD had functioning AV fistulae and the peritonitis incidence was one in 24.5 patient-month/episode. The first BDTR has identified some deficiencies in the renal services in Brunei. However, it signals an important milestone for the establishment of benchmarked renal practice in the country. We hoped to maintain and improve our registry for years to come and will strive to align our standards to acceptable international practice.     

Results of breast conserving surgery in clinical stage I–II breast carcinoma

Background  

The role of breast conserving surgery with radiotherapy is well established and has become a widely used procedure in breast cancer. Patient selection, a multidisciplinary approach, and expert surgical technique are important factors to avoid locoregional recurrence. The aim of this study was to analyse the outcomes of patients treated with breast conserving surgery in stage I–II breast cancer.     

Renal complications of Castleman’s disease: report of two cases and analysis of 75 cases

Biopsy-proven renal complications of Castleman’s disease (CD) are rare and current knowledge is largely based on sporadic case reports. We reported two more cases, both of which were multicentric CD with hyaline-vascular pathological pattern and presented with chronic renal failure. Case 1 was multicentric CD with renal mesangial proliferative glomerulonephritis complications, and case 2 was multicentric CD with membranoproliferative glomerulonephritis-like complications. Although both were eventually administered corticosteroids combined with cytotoxic drugs, both behaved in an aggressive and relapsing manner. We then made an analysis of 75 cases of biopsy-proven renal complications of CD (including our two cases) which were reported in 51 English literatures from January 1954 to March 2011. We found that the clinical and histological findings of renal complications of CD were heterogeneous. Death was observed in 17% patients after a median follow-up time of 22 months (0–204 months) since histological diagnosis of renal complications. The estimated 5-year cumulative survival rate was 75%. Better understanding and therapeutic interventions are required in further investigations.     

Outcomes of stage 1–5 chronic kidney disease in Mainland China

Objective: This study aims to quantify and compare the risks of death and end stage renal disease (ESRD) in a prospective cohort of patients with chronic kidney disease (CKD) stages 1–5 under renal management clinic at Peking University Third Hospital and to evaluate the risk factors associated with these two outcomes. Method: This was a prospective cohort study. Finally, 1076 patients at CKD stage 1–5 short of dialysis were recruited from renal management clinic. Patients were monitored for up to Dec, 2011 or until ESRD and death. Glomerular filtration rate was estimated (eGFR) according to the using the CKD Epidemiology Collaboration (CKD-EPI) formula. Results: At the end of follow-up, 111 patients (10.1%) developed ESRD (initiated dialysis or kidney transplantation (ESRD)) and 24 patients (2.2%) had died. There were more ESRD occurrence rate in patients with baseline diabetic nephropathy, lower eGFR, hemoglobin <100?g/L and 24?h urinary protein excretion ≥3.0?g. By multivariate Cox regression model, having heavy proteinuria and CKD stage were the risk factors of ESRD. For all-cause mortality, the most common cause was cardiovascular disease, followed by infectious disease and cancer. But we failed to conclude any significant variable as risk factors for mortality in multivariate analysis. Conclusions: Our study indicated that baseline diabetic nephropathy, lower hemoglobin level, lower baseline GFR and heavy proteinuria were the risk factors of ESRD. In this CKD cohort, patients were more likely to develop ESRD than mortality, and cardiovascular mortality was the leading cause of death, and then followed by infectious diseases and cancer in this population.     

Expectant therapy for clinical stage A nonseminomatous germ-cell cancers of the testis? A qualified “Yes”

Summary Most patients with testicular cancer can ultimately be cured. In early-stage disease, retroperitoneal lymph node dissection or radiotherapy can cure more than 90% of patients, and chemotherapy is associated with long-term remission in 60% to more than 90% of patients with metastases, depending on the extent of disease. Because of the high salvage rate with chemotherapy, efforts are now being directed toward reducing the toxicity of primary management. In several centers, a surveillance policy for selected patients with clinical Stage A nonseminomatous germ-cell tumors appears to be safe: 80% of these patients may be cured by orchiectomy alone, thus avoiding the adverse effects of lymph node dissection or radiotherapy; the remaining 20% will require chemotherapy. This approach should be used only in referral centers with a specialty interest in testicular cancer and excellent facilities for monitoring and followup.     

Dieulafoy’s disease of the lung: a report of three cases with review of pathological aspects

Dieulafoy’s disease of the lung is one of the causes of cryptogenic hemoptysis often massive and recurrent, caused by dysplastic superficially located arteries in the bronchial wall. Being a rare condition, available literature on this condition is limited to a few case reports and series. We report three such cases presenting with severe hemoptysis uncontrolled by bronchial artery embolization who subsequently underwent resection of the involved lobe of the lung. The clinical, radiological, bronchoscopic, and pathological features are discussed with emphasis on the gross and microscopic characteristics that aid in the pathological diagnosis in the resected specimens.     

Reversed rotation of the midgut in adults – a case report

Intestinal obstruction is a common surgical emergency. It is often due to adhesions; however, when the patient is young and has a virgin abdomen, we have to consider uncommon causes. We present a rare case of reversed rotation of the midgut as a cause for intestinal obstruction.     

Fibular grafting in diaphyseal Gorham’s disease: report of two cases and review of literature

Gorham’s disease of bone is a rare entity where the bone undergoes progressive osteolysis. Management of diaphyseal Gorham’s disease is a real challenge to manage as a large bony defect is created because of osteolysis. We report two such cases where we reconstructed the defect with fibular graft after a radiation dose of 30 Gy. The graft was well incorporated and radiological sign of union was noticed in proximal and distal metaphysis after a follow-up of 4 and 2 years. Fibular grafting can be a good method of reconstruction in diaphyseal Gorham’s disease of long bone, provided the diseased tissue has been excised adequately after local radiation therapy.