Massive bone marrow involvement by clear cell variant of rhabdomyosarcoma

A 16-year-old boy with generalized myalgia and petechial hemorrhage was found to have a diffuse infiltrative disease in his bone marrow (BM). The BM aspirate contained a dense population of vacuolated blast-like cells. The BM biopsy displayed compact sheets of small round cells with clear cytoplasm, reminiscent of Ewing sarcoma. Immunostains were not diagnostically conclusive while transmission electron microscopy on the BM cells demonstrated a clear skeletal muscle differentiation. The morphologic findings led to a tentative designation of metastatic embryonal rhabdomyosarcoma (RMS). It was not until cytogenetic analysis revealed the specific translocation t(2;13)(q35;q14) did the alveolar RMS finally get confirmed. Despite an exhaustive search by imaging studies, a primary tumor was not detected. This case illustrates that the massive BM involvement by atypical alveolar RMS of unknown origin may pose serious diagnostic challenges. Multidisciplinary studies are required to reach a definitive diagnosis     

Traumatic optic neuropathy in pediatric population: early intervention or delayed intervention?

PURPOSE: The aim of this randomized prospective study was to evaluate role of early decompression in the cases of traumatic optic neuropathy in children. MATERIALS AND METHODS: Thirty-one children with a diagnosis of traumatic optic neuropathy were operated upon by transnasal trans-sphenoidal optic nerve decompression and the results were evaluated. RESULTS: Patients presenting early and those who were operated early in the course of their illness showed a better recovery. CONCLUSION: Early intervention can help preventing the blindness in as many as 80 and of the cases following the injury.     

A 16-year-old boy with acute urinary retention

Urinary retention can be described as the inability to void volitionally despite an adequate volume of urine in the bladder. It is a common complaint in adults, especially among elderly males with benign prostatic hyperplasia. Children, in contrast, are more likely to have voluntary retention of urine due to urethral irritation or dysuria. Gently massaging the suprapubic region while the child is in a warm bath often relieves the retention in these cases. Other patients described as lazy voiders can present with acute urinary retention. These patients are typically young girls who are embarrassed to void at school. Retraining or timed voiding is often successful managing lazy voiders. However, these benign disorders should only be diagnosed after anatomical or organic causes for their symptoms have been considered and ruled out.     

Boerhaave syndrome--unusual cause of chest pain

Spontaneous esophageal rupture (Boerhaave syndrome) is uncommon in children. Delayed or missed diagnosis can lead to poor outcomes in terms of morbidity and mortality. To highlight the importance of early recognition and management of spontaneous esophageal rupture in children, we report a case of a 16-year-old boy who presented in the emergency department with acute chest pain after episodes of vomiting.     

Patient and surgeon experience with the endotine forehead device for brow and forehead lift

PURPOSE:: To report our experience with the Endotine forehead fixation device (Coapt Systems, Palo Alto, CA, U.S.A.), a bioabsorbable fixation method for forehead and brow lift. METHODS:: Retrospective noncomparative case series of 31 patients who underwent forehead and brow lift surgery using the Endotine device in a single center during a 12-month period from 2004 to 2005. RESULTS: A mean brow lift of 2.8 mm (SD, 0.2-7.1 mm) was achieved. There were no cases of recurrence during the follow-up period of 4 months to 22 months. Problems encountered included palpability, tenderness, and numbness. In the majority of cases, these symptoms resolved within a few months and were not troublesome to the patient. Other problems included visible lumps, device mobility, and exacerbation of a high hairline. Patient satisfaction was high, with 95.3% of patients saying they were either happy or very happy with the results; 81% of patients said they would recommend the Endotine as a method of fixation. All surgeons were pleased by the lift achieved and felt the device was easy to use. Problems reported by the surgeons included 1 dislocated device, discomfort, palpability beyond 15 months, a lack of lateral compared with central lift, and cost. Two of the 3 surgeons are still using the Endotine device as the preferred method of fixation. CONCLUSIONS:: The Endotine device is effective, safe, and easy to use, and has high patient satisfaction. Problems included numbness, tenderness, and palpability. A preference for other fixation methods was indicated by some because of cost, length of surgery, and the amount of lift achieved.     

Gold nanoparticles: interesting optical properties and recent applications in cancer diagnostics and therapy

Recent years have seen tremendous progress in the design and study of nanomaterials geared towards biological and biomedical applications, most notable among these being the noble metal nanoparticles. In this review, we outline the surface-plasmon resonance-enhanced optical properties of colloidal gold nanoparticles directed towards recent biomedical applications with an emphasis on cancer diagnostics and therapeutics. Methods of molecular-specific diagnostics/detection of cancer, including strongly enhanced surface plasmon resonance light-scattering, surface-enhanced emission of gold nanorods and surface-enhanced Raman scattering, are described. We also discuss the plasmonic photothermal therapy of cancer achieved by using the strongly enhanced surface-plasmon resonance absorption of gold nanospheres and nanorods.     

Cisplatin/epinephrine injectable gel.

1. Cisplatin/epinephrine injectable gel is a preparation for intratumoural injection containing cisplatin 4 mg/ml, epinephrine (adrenaline) 0.1 mg/ml and bovine collagen as a protein carrier matrix. It has been evaluated for the palliative treatment of accessible inoperable metastatic or recurrent solid tumours. 2. The vasoconstrictor action of epinephrine limits the diffusion of cisplatin into the systemic circulation. Intratumoural injection of cisplatin/epinephrine injectable gel achieves high concentrations of cisplatin in the tumour with very low concentrations in plasma and other tissues. 3. In double-blind randomised trials, cisplatin/epinephrine injectable gel was more efficacious than placebo in the palliative treatment of recurrent and resistant head and neck squamous cell carcinoma. 4. Cisplatin/epinephrine injectable gel reduced tumour size and improved local symptoms in patients with metastatic breast cancer, metastatic malignant melanoma, oesophageal carcinoma and hepatic tumours in a number of noncomparative clinical trials. 5. Adverse events with the use of cisplatin/epinephrine injectable gel are mainly limited to the local site of injection. No systemic adverse events such as nephrotoxicity, neurotoxicity or ototoxicity have been reported with use of this preparation.     

A New Type of Periprosthetic Fracture: Is It the Time to Update the Unified Classification System?

IntroductionIncreased number of primary and revision arthroplasties performed globally has led to a surge in the numbers of periprosthetic fractures. The Unified Classification System (UCS) advocated a rational approach towards the classification of periprosthetic fractures. We present here an update to the UCS with addition of new fracture pattern encountered in orthopedic practice.MethodsA retrospective study was conducted to review the service arthroplasty register for the cases with unique fracture pattern where the periprosthetic fracture around total hip arthroplasty was also associated with fracture of the prosthetic component. The details were retrieved from the medical record and the patients were called for a review. The radiological assessment was done with X-rays and clinical assessment with Harris Hip Scores at the latest follow-up.ResultsBetween 2012 and 2019, 11 patients (7 males and 4 females) were operated for peri-prosthetic fracture with a unique pattern where the fracture of femur was associated with fracture of the femoral stem as well. The mean age of the patient at the time of fracture was 56.8 years (range 42–71 years). All patients were managed with revision hip surgery. One patient died due to malignancy after 7 years of revision surgery. All the surviving patients are doing well with a mean Harris Hip Score of 86.8 at the latest follow-up of 2–9 years (mean 5.0 years).ConclusionWith emergence of this new fracture pattern, it is recognition as a separate entity would help in better understanding and augmentation of the existing classification system of periprosthetic fractures.