Wilms tumor occurring as a botryoid renal pelvicalyceal mass

Wilms tumor usually occurs as an abdominal mass arising from the renal parenchyma. A case was encountered in which the neoplasm filled the pelvicalyceal system of an 8-year-old boy as a botryoid mass, with minimal parenchymal involvement. The radiologic manifestations, pathologic features, and surgical implications are discussed.     

Regression of mediastinal Hodgkin disease after therapy: evaluation of time interval

Ninety-one patients with Hodgkin disease of the upper torso who had mediastinal masses were studied to determine the frequency of residual mass and the time required for resolution or stabilization of the mass. In 72 of these patients, radiographs from sufficient intervals were available for determination of the rate of regression. In 62 patients (86%), the mediastinum returned to normal width within 11 months, regardless of the size of the mass. The mediastinum returned to normal in all but one patient with small masses. The intrathoracic relapse rate did not correlate with the regression time of the masses, but relapse occurred more than twice as often in patients with residual mediastinal widening.     

A pilot randomized trial comparing symptomatic vs. hemoglobin-level- driven red blood cell transfusions following hip fracture

BACKGROUND: The indications for transfusion have never been evaluated in an adequately sized clinical trial. A pilot study was conducted to plan larger clinical trials. STUDY DESIGN AND METHODS: Hip fracture patients undergoing surgical repair who had postoperative hemoglobin levels less than 10 g per dL were randomly assigned to receive 1) symptomatic transfusion: that is, transfusion for symptoms of anemia or for a hemoglobin level that dropped below 8 g per dL or 2) threshold transfusion: that is, patients receive 1 unit of packed RBCs at the time of random assignment and as much blood as necessary to keep the hemoglobin level above 10 g per dL. Outcomes were 60-day mortality, morbidity, functional status, and place of residence. RESULTS: Among 84 eligible patients enrolled, mean (± SD) prerandomization hemoglobin was 9.1 (± 0.6) g/ dL. The median number of units transfused in the threshold transfusion group was 2 (interquartile range, = 1–2), and that in the symptomatic transfusion group was 0 (6; interquartile range, = 0–2) (p < 0.001). Mean hemoglobin levels were approximately 1 g per dL higher in the threshold group than in the symptomatic group: for example, on Day 2, 10.3 (± 0.9) g per dL versus 9.3 (± 1.2) g per dL, respectively (p < 0.001). At 60 days, death or inability to walk across the room without assistance occurred in 16 (39.0%) of the symptomatic transfusion group and 19 (45.2%) of the threshold transfusion group. Death occurred by 60 days in 5 (11.9%) of the symptomatic transfusion group and 2 (4.8%) in the threshold transfusion group (relative risk = 2.5; 95% CI, 0.5–12.2). Other outcomes were similar for the two groups. CONCLUSIONS: Symptomatic transfusion may be an effective blood-sparing protocol associated with the transfusion of appreciably fewer units of RBCs and lower mean hemoglobin levels than are associated with the threshold transfusion policy. However, it is unknown whether these two clinical strategies have comparable mortality, morbidity, or functional status. A definitive trial is needed.     

Is ultraviolet exposure acquired at work the most important risk factor for cutaneous squamous cell carcinoma? Results of the population‐based case–control study FB‐181

Squamous cell carcinoma (SCC) is a specific type of skin cancer. It is one of the most common cancers in Europe. SCC therefore causes a significant burden, both for the people affected and also in terms of costs to society. One main cause of SCC is exposure to natural sunlight. SCC can be prevented by avoiding sun exposure. When people go outside, they can protect themselves through clothes (e.g. long sleeves, hat) and using sunscreens. Until now, prevention programs for SCC and other skin cancers have mainly tried to reduce sun exposure during leisure time. However, there are many people working outdoors, e.g. farmers, construction workers and roofers. The role of occupational (work‐related) and leisure‐time sun exposure in causing SCC is still unclear. Our team of physicians and scientists from Germany investigated the association between occupational and leisure‐time sun exposure and the risk of SCC. More than 600 people with SCC were compared to the same number of healthy people without SCC, taking into account their sun exposure in the past. All study participants were medically examined by trained physicians. Lifetime sun exposure in occupation and leisure time was assessed by interviews. The interviews were tested before starting the study to ensure correct results. The study found that people with high levels of sun exposure at work have a 2‐fold risk of SCC. The more sun exposure people had at work, the more likely was the development of SCC. This result is important, as it indicates that sun protection is not only necessary in leisure‐time, but also at work to prevent skin cancer such as SCC.     

Tubo-ovarian abscesses: CT-guided percutaneous drainage

The results of computed tomographic (CT)-guided percutaneous drainage in eight patients with tubo-ovarian abscesses are reported. Seven patients (88%) recovered without surgery and required no further treatment. One patient had marked clinical improvement but still required a posterior colpotomy. No complications occurred. One patient had a recurrence of symptoms 20 months after the procedure that represented a new infection. The role of CT-guided percutaneous drainage in tubo-ovarian abscesses as well as an analysis of the technical aspects associated with a successful procedure are discussed.     

The effect of prior leaning on human postural responses

This study examines how human postural responses are altered by leaning about the ankles to five different initial stance positions prior to anterior or posterior horizontal translations of the support surface. When subjects leaned in the same direction as the translation-induced sway, postural strategies changed to use of less ankle torque and more horizontal shear forces at the surface to return to equilibrium. This change in strategy was associated with reduced and delayed activation of the stretched ankle muscles and an increased activation of proximal muscles producing rapid hip flexions or extensions. The changes in ankle muscle activation strength and latencies cannot be predicted based on simple stretch or load reflexes, but match predictions from computational, biomechanical models of human stance co-ordination^1–4.     

Cytogenetic features of Hodgkin's disease suggest possible origin from a lymphocyte

Surface marker and gene rearrangement data have supported various hypotheses about the origin of the malignant cell in Hodgkin's disease. Cytogenetic data about this disorder, however, are very scanty. To determine if any chromosomal abnormalities that could add further information to this controversial point are present, we studied tumor samples from 49 patients. Abnormal metaphases were obtained in 18 cases. The most common breakpoints were in 11q23, 14q32, 6q11-21, and 8q22-24. These are common breakpoints in lymphoma and raise the possibility that the malignant cell in Hodgkin's disease may be derived from a lymphocyte. The 11q23 breakpoint is also seen in t(4;11) and t(9;11), which is typical of a type of childhood B-cell acute lymphoblastic leukemia characterized by the presence of aberrant myeloid and monocytic markers. Myeloid and monocytic markers are common in Reed-Sternberg cells.