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.     

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.     

Supplemental maxillomandibular fixation with miniplate osteosynthesis��required or not?

Aim

To compare outcomes of open reduction and internal fixation of mandible fractures followed by either immediate mobilization or 5?days of maxillomandibular fixation.

Material and methods

We analyzed our use of supplemental maxillomandibular fixation with miniplate osteosynthesis during a 2.5-year period in 118 patients with 180 mandible fractures. A retrospective, matched pairing of identical fractures fixated with identical plating schemes was carried out. Thirty-five pairs of patients undergoing monocortical plating were identified. Patients in group 1 were treated with supplemental maxillomandibular fixation after surgery, whereas patients in group 2 (immediate release group) were treated without postoperative maxillomandibular fixation.

Results

The total rate of complications was 17% with supplemental maxillomandibular fixation and 14% without supplemental maxillomandibular fixation (p?>?0.05). No statistically significant outcome advantage could be attributed to the use of maxillomandibular fixation.

Conclusion

The current retrospective study shows no significant differences in treating isolated mandible fractures with open reduction and internal fixation and immediate release versus open reduction and internal fixation with 5?C7?days of MMF.     

Newer oral anticoagulant agents: a new era in medicine

After a gap of almost 60 years following the development of warfarin, 2 new categories of oral anticoagulant agents have been approved for clinical use - the direct thrombin inhibitors and factor Xa inhibitors. These agents promise to be more convenient to administer with fixed dosing but still have equivalent efficacy and improved bleeding risk compared to warfarin. The clinical community is looking forward to the widespread usage of these agents but there is also some apprehension regarding bleeding risks, non-availability of specific reversal strategies and lack of specific monitoring parameters. This review article will attempt to educate the reader about three representative drugs from these classes: Dabigatran, Rivaroxaban and Apixaban. We will discuss the historical perspective to the development of these drugs, available research data and pharmacology of these agents. The best strategies for monitoring and reversal of these drugs in special situations will also be touched upon.