Retinoblastoma in older children.

PURPOSE: Retinoblastoma (RB) is known to present with atypical signs and symptoms in older patients. Our article reviews the clinical and histopathological features of RB encountered in children older than 5 years of age. Methods: A total of 337 consecutive patients with RB were reviewed. Eighteen (5.3%; 10 males, 8 females) who presented after the age of 5 were selected for further analysis of clinical data and histopathological material in this retrospective, non-comparative case series. Results: The age range was from 5 to 12 years (mean age 6.4). Unilateral disease was seen in 14 children, bilateral disease in 4 children. Eleven children were the product of consanguineous marriages. Seven patients had leukocoria; the others presented with signs of uveitis, cellulitis, and/or trauma. Three patients had flat, plaque-like lesions on histopathologic evaluation. Conclusions: Clinical and histopathologic features were atypical in 47% and 21% respectively in the retinoblastoma patients who presented after the age of 5 years.     

Nasolacrimal tuberculosis in a patient with conjunctivodacryocystorhinostomy.

PURPOSE: To present an unusual case of nasolacrimal tuberculosis that was diagnosed with polymerase chain reaction (PCR) and to discuss the role of PCR as a diagnostic aid. METHODS: Case presentation with diagnostic modalities including PCR, cytopathologic, and histopathologic examinations with special stains. RESULTS: A 40-year-old woman with bilateral lacrimal drainage system obstruction underwent a right dacryocystorhinostomy with stents and left conjunctivodacryocystorhinostomy with Jones bypass tube. Although the findings of direct and endoscopic examinations of the nasal cavity were within normal limits, the tissue removed during surgery from the middle turbinate revealed caseating granulomatous lesions on histopathologic examination. Acid-fast organisms were demonstrated in postoperative nasal washings, and Mycobacterium tuberculosis infection was confirmed with PCR. CONCLUSION: Primary tuberculosis of the nasolacrimal mucosa is rare, and its occurrence without any symptoms, as in this patient, is even less frequent. The most interesting aspect of this case was the identification of the M. tuberculosis DNA in the mucosa of anterior turbinate and fibrous tissue within the previous surgical site. Histopathologically, the presence of caseating granulomas was seen only in the nasal mucosa, indicating that PCR may be of use in identifying the causative organism even in the absence of typical histopathologic features.     

Acute renal failure associated with dysfunctioning detrusor muscle in multiple sclerosis

Patients with multiple sclerosis (MS) typically have neurogenic lower urinary tract dysfunction. Most patients present with bladder hyperreflexia and failure to empty the bladder secondary to detrusor-distal sphincter dyssynergia. This case study is unique in the literature in reporting on a patient presenting with acute renal failure (ARF) due to vesico-sphincter dysfunction associated with MS. A 64-year-old man with MS presented in the emergency department with the chief complaint of a marked decrease in urinary output for 2 days and weakness. He had been treated for MS for 7 years. A mass compatible with a full bladder was palpated in the suprapubic region on examination. Digital rectal examination disclosed grade I-II prostate hypertrophy. Urinary catheters were inserted and urinary output was monitored. The residual urine was drained and recorded as 1100 mL. Initial laboratory findings, such as the BUN/creatinine ratio, urinary sodium concentration, and urine gravity, were compatible with ARF. The patient recovered rapidly in 24 hours following urinary catheterization and prompt medication in the emergency department. He was admitted to the neurology ward with a diagnosis of acute urinary outflow obstruction resulting in ARF due to detrusor dysfunction complicating an MS attack. ARF may complicate the course of patients with MS and associated detrusor-external sphincter dyssynergia. Renal recovery of these patients may be facilitated by urinary catheterization and supportive treatment.     

A systematic review of safety and adverse effects in the practice of therapeutic hypothermia

Objective

To carry out a systematic review to estimate the rate and magnitude of adverse effects following therapeutic hypothermia (TH) procedure in patients resuscitated from out-of-hospital cardiac arrest (OHCA) and highlight the specific complications seen after the procedure.

A systematic review of the pain scales in adults: Which to use?

Objective

The study analysed the Visual Analogue Scale (VAS), the Verbal Rating Scale (VRS) and the Numerical Rating Scale (NRS) to determine: 1. Were the compliance and usability different among scales? 2. Were any of the scales superior over the other(s) for clinical use?