Primary lumbosacral Wilms tumor associated with diastematomyelia and occult spinal dysraphism

Background The occurrence of an extrarenal Wilms tumor in the lumbosacral region is an extremely uncommon condition.Case report We report a case of Wilms tumor in the lumbosacral region that was associated with diastematomyelia and occult spina bifida. An 18-month-old girl presented with a swelling over the lower back with a tuft of hair on it, which she had had since birth. Imaging of the spine revealed spina bifida, bony diastematomyelia, and tethered cord. Excision of the bony spur and detethering of the cord was done. After a year, she had recurrence of swelling at the same site, weakness of both lower limbs, and incontinence of bladder and bowel. Excision of the mass and bony spur and detethering of the spinal cord were done. Histopathological examination showed features of a Wilms tumor.     

Bedside ultrasonography of optic nerve sheath diameter for detection of raised intracranial pressure in nontraumatic neuro-critically ill patients

BACKGROUND Delay in treatment of raised intracranial pressure(ICP) leads to poor clinical outcomes. Optic nerve sheath diameter(ONSD) by ultrasonography(US-ONSD)has shown good accuracy in traumatic brain injury and neurosurgical patients to diagnose raised ICP. However, there is a dearth of data in neuro-medical intensive care unit(ICU) where the spectrum of disease is different.AIM To validate the diagnostic accuracy of ONSD in non-traumatic neuro-critically ill patients.METHODS We prospectivel...     

Role of cerebrospinal fluid lactate in diagnosing meningitis in critically ill patients

BACKGROUND Meningitis is a life-threatening clinical condition associated with high mortality and morbidity. Early diagnosis and specific treatment may improve outcomes.Lack of specific clinical signs or tests make the diagnosis challenging.AIM To assess the efficacy of cerebrospinal fluid(CSF) lactate in diagnosing meningitis in critically ill patients.METHODS A prospective, observational cohort study was carried out in a neuro-medical intensive care unit(ICU) over a 22 mo period. Adult patient...     

Patterns of Failure and Determinants of Outcomes Following Radical Re-resection for Incidental Gallbladder Cancer

Background

Better appreciation of the course and factors that influence incidental gallbladder cancer is needed to develop treatment strategies aimed at improved outcomes. The purpose of this study was to determine pattern of disease recurrence and influencing factors in patients undergoing radical re-resection for incidental gallbladder cancer.

Methods

Patients undergoing radical re-resection from February 2003 to May 2010 were analyzed. Influence of variables (lymph node ratio, ASA grade, gender, adjuvant treatment, time interval between cholecystectomy and radical re-resection (in months), and TNM stage) on disease-free survival was assessed.

Results

Of 163 patients, 127 (92 female and 35 male patients; median age 50 years) underwent successful radical re-resection. Median duration between two surgeries was 2 months (range 1–10). Twenty-five percent of patients with pT1b disease had lymph node metastases. Two-year disease-free survival rate was 79.6 % (median follow-up, 16 months). On follow-up, 18 of 24 patients developed recurrences at distant sites. Lymph node metastasis was the single variable significantly influencing disease-free survival. Adjusting for disease stage when analyzing time interval between cholecystectomy and radical re-resection on a continuous scale as a prognostic factor for recurrence revealed no significant impact of increasing interval between surgeries (hazard ratio 1.12; 95 % confidence interval 0.95–1.34; p = 0.17).

Conclusions

The most important predictor of disease recurrence is lymph node metastases. In patients who undergo curative radical re-resection for incidental gallbladder cancer, recurrent disease is more likely to occur at distant sites. Patients with pT1b disease should be offered radical re-resection with a radical lymphadenectomy. It is not the delay in revision surgery but TNM stage that influences outcomes in incidental gallbladder cancer.     

Double insurance atlantoaxial fixation

BACKGROUND: An alternative technique of atlantoaxial fixation is described, which combines the trans-articular method of fixation described by Magerl in 1982 and the interarticular technique described by us in 1988. METHODS: Between January 2001 and January 2005, 18 patients underwent the discussed method of fixation at the Department of Neurosurgery at King Edward VII Memorial Hospital in Mumbai, India. Fifteen patients had congenital craniovertebral anomaly and 3 patients had posttraumatic atlantoaxial instability. Fourteen patients had basilar invagination with "fixed" atlantoaxial dislocation, and 4 patients had mobile and reducible atlantoaxial dislocation. The mean follow-up period was 22 months (range, 3-50 months). RESULTS: Successful atlantoaxial stabilization was achieved in all patients and was documented with dynamic radiography. There was no incidence of implant rejection. There were no neurological, vascular, or infective complications. CONCLUSION: The described method of atlantoaxial fixation that incorporates the advantages of the 2 currently more frequently used techniques of lateral mass fixation could be an alternative method of fixation.     

Thoracic human vertebrae. Quantitative three-dimensional anatomy

This study details the quantitative three-dimensional surface anatomy of thoracic vertebrae based on a study of 144 vertebrae. The thoracic spine was found to have three distinct regions: upper, middle, and lower segments. The two end segments appear to be transitional zones toward cervical and lumbar regions. The middle zone (T3 to T9) is of utmost importance due to the presence of the combination of narrow spinal canal and critical vascular supply. Means and standard errors of the means for linear, angular, and area dimensions of vertebral bodies, spinal canal, pedicle, pars articularis, spinous and transverse processes, and rib articulations are provided for all thoracic vertebrae. This information is necessary for constructing accurate mathematical models of the human spine. It will also provide a better understanding of the spine, and allow for a more precise clinical and surgical management of spinal problems.     

Massive ovarian edema mimicking an ovarian neoplasm in a patient with IVC web

Massive ovarian edema is an uncommon benign condition affecting young females predominantly those in the child bearing age group and preadolescent girls. Its clinical and radiologic overlap with ovarian neoplasms and torsion which require surgical intervention makes it imperative for the radiologist to consider this entity preoperatively as preserving fertility is vital in this young age group. We report a case of massive ovarian edema, a rare presentation in a patient with inferior vena cava web and consequent Budd Chiari Syndrome, an association previously unreported in literature.