US findings of adnexal torsion in children and adolescents: size really does matter

Background Adnexal torsion is rare, and symptoms are nonspecific. Clinicians often rely on US examinations to evaluate girls with abdominal or pelvic pain. Objective To determine which sonographic findings can predict adnexal torsion by comparing pediatric and adolescent patients with surgically confirmed torsion (cases) to those without torsion (controls). Materials and methods Cases and controls were identified retrospectively by searching 7 years of medical record and radiology databases. An adnexal ratio was calculated as the volume of the affected adnexa divided by the volume of the unaffected adnexa. Results We identified 61 menarchal subjects: 33 cases and 28 controls. Adnexal volume was larger in cases than in controls (185 vs. 37.8 ml, P < 0.001). A volume of >75 ml was more common in cases than in controls (64 vs. 15%, P < 0.001). No cases had an adnexal volume of <20 ml (P < 0.001). The adnexal ratio was larger in cases than in controls (16.1 vs. 6.7, P < 0.001). An adnexal ratio of >15 was seen in 40% of cases and in no controls (P = 0.08). Doppler US results were not predictive of torsion. Conclusion An adnexal volume of <20 ml is strong evidence against adnexal torsion in menarchal females. In this age group, the diagnosis of torsion cannot be established by US examination alone.     

Immune thrombocytopenic purpura as a presentation of childhood tuberculosis

Immune thrombocytopenic purpura as a presentation of childhood tuberculosis is a rare event and occasional reports are described in the pediatric literature. We describe a 8-yr-old girl with mediastinal tubercular lymphadenitis-induced immune thrombocytopenia, who was successfully treated with anti-tubercular drugs. We also review the published reports. Tuberculosis should be considered a cause of immune thrombocytopenia in areas where tuberculosis is highly endemic.     

Lenz microphthalmic syndrome in an Indian patient

A case of Lenz microphthalmia syndrome in a seven-month-old male child having features of unilateral anophthalmia, microcephaly, external ear and finger abnormalities, hydrocele and hypospadias is being reported. The unilateral involvement and anophthalmia is rare in Lenz syndrome. The manifestation of hydrocele in association with this syndrome has not been seen in earlier cases. This is the first documented case from India.     

The Changing Use of Palliative Chemotherapy for Recurrent Esophagogastric Cancer: A Single Center Retrospective 15-Year Review

Background

Palliative chemotherapy is often recommended in the treatment of recurrent esophagogastric (EG) cancer with limited evidence of its benefit. This study aims to define the current practice and benefit of this treatment.

Methods

Retrospective analysis of patients who developed EG cancer recurrence between 1991 and 2006 following surgery with curative intent.

Results

There were 336 recurrences. Median time to disease recurrence was 13.4 months (range 1.3–118). Survival after recurrence ranged from 0–93.2 months (six patients are currently alive). A significant increase in the use of chemotherapy was observed rising from 10% prior to 1999 (n?=?100) to 23% (n?=?236) after 1999. The median survival for patients receiving chemotherapy (n?=?64) was 10.6 months (range 1.5–75.7), patients undergoing nonchemotherapy palliative intervention (n?=?142) median survival was 2.85 months (range 0–93.2), and for patients having no active intervention (n?=?130), median survival was 1.3 months (range 0–16.2). Median duration of chemotherapy was 3.1 months (range 0.5–9.2). Median survival for these patients after chemotherapy treatment was 6.6 months (range 0.4–73.5). Twenty-eight patients (44%) experienced side effects of chemotherapy. Ten cases required treatment to be modified or stopped and two patients died during chemotherapy.

Conclusion

There has been a significant increase in the use of palliative chemotherapy for recurrent EG cancer. While survival appears improved, a substantial proportion of this time was spent receiving chemotherapy with many patients experiencing significant comorbidity. Further studies assessing both quality and quantity of life are required to fully evaluate the use of palliative chemotherapy and to identify patients most likely to benefit.     

Rituximab-based therapy for gemcitabine-induced hemolytic uremic syndrome in a patient with metastatic pancreatic adenocarcinoma: a case report

Purpose  The purpose of this report is to describe the management and outcome of an unusual complication of a commonly used chemotherapeutic agent. Gemcitabine is a known risk factor for hemolytic uremic syndrome (HUS), which can often have a rapidly fatal clinical course despite intervention with steroids, plasmapheresis and hemodialysis. Methods  A retrospective report of the first case of gemcitabine-related HUS, in a patient with metastatic pancreatic adenocarcinoma, treated with a variety of standard therapies in addition to rituximab is presented. The hematologic response parameters and clinical outcomes to each of the therapies given are described. Results  Chemotherapy-induced HUS was aggressively treated with plasmapheresis, high-dose steroids, vincristine and rituximab. Platelet recovery and clinical improvement coincided with administration of rituximab. In addition, aggressive supportive measures to manage renal failure (hemodialysis) and labile hypertension, allowed this patient to have an extended survival as a result of successful therapy for this complication despite an underlying rapidly fatal malignancy. Conclusion  This case highlights the importance of timely application of aggressive measures even in patients with known diagnosis of a fatal malignancy as these interventions can prolong life and be of palliative benefit.     

Spontaneous perforation of the common bile duct in infancy: role of Tc-99m mebrofenin hepatobiliary imaging.

A 2-month-old infant had jaundice that began 3 days after birth. The clinical features were suggestive of biliary obstruction. Tc-99m mebrofenin hepatobiliary imaging confirmed the diagnosis of spontaneous perforation of the common bile duct, and surgical intervention resulted in progressive recovery.