Renal cell carcinoma in children

Summary 2 cases of renal cell carcinoma in children were seen at JIPMER and General Hospital, Pondicherry, in the last 12 years. The first case came late with extensive metastases locally and to the liver, and after nephrectomy died soon with recurrence. The second case after nephrectomy is doing well for one year. Renal cell carcinoma should be considered in the differential diagnosis of renal tumours in children. The course and prognosis is very variable and seems to depend upon histological characteristics. From the departments of Surgery and Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, 6.     

Systematic review of randomized trials comparing rubber band ligation with excisional haemorrhoidectomy

BACKGROUND AND METHOD: This review compares the two most popular treatments for haemorrhoids, namely rubber band ligation (RBL) and excisional haemorrhoidectomy. Randomized trials were identified from the major electronic databases. Symptom control, retreatment, postoperative pain, complications, time off work and patient satisfaction were assessed. Relative risk (RR) and weighted mean difference with 95 per cent confidence interval (c.i.) were estimated using a random-effects model for dichotomous and continuous outcomes respectively. RESULTS: Three trials met the inclusion criteria and all were of poor methodological quality. Complete remission of haemorrhoidal symptoms was better after haemorrhoidectomy (RR 1.68 (95 per cent c.i 1.00 to 2.83)). There was significant heterogeneity between the studies (I(2) = 90.5 per cent; P < 0.001). Fewer patients required retreatment after haemorrhoidectomy (RR 0.20 (95 per cent c.i 0.09 to 0.40)), but anal stenosis, postoperative haemorrhage and incontinence to flatus were more common with this operation. CONCLUSIONS: Haemorrhoidectomy produced better long-term symptom control in patients with grade III haemorrhoids, but was associated with more postoperative complications than RBL.     

The clinical spectrum and treatment outcome of retinoblastoma in Indian children

PURPOSE: To study the clinical spectrum and treatment outcome of retinoblastoma in Indian children. PATIENTS AND METHODS: This retrospective study analyzed 488 eyes of 355 retinoblastoma patients treated at a tertiary care ophthalmic hospital in southern India during a 14-year period. RESULTS: Retinoblastoma involved one eye in 177 (50%) and both eyes in 178 (50%) patients. Mean age at presentation was 23.98 +/- 23.37.     

Surgical repair of double aortic arch: 16-year experience

Double aortic arch (DAA) is a complete form of vascular ring causing tracheoesophageal compression. We analyzed long-term results of a series of DAAs, over a period of 16 years. Between 1987 and 2003, 29 children underwent surgery for airway and/or esophageal compression secondary to a DAA. Dominant symptoms were stridor, dysphagia, choking episodes, and life-threatening apneic spells (n = 7). Diagnosis was established by barium studies, bronchoscopy, echocardiogram, angiogram, computed tomography (CT), and magnetic resonance imaging (MRI). Seven patients had concurrent cardiac anomalies. Two children had an associated tracheoesophageal fistula. Surgery was accomplished by left thoracotomy (n = 25), right thoracotomy (n = 2) or median sternotomy (n = 2). The operative mortality was zero. There was one late death due to respiratory failure. Four (13.8%) patients had a surgical complication (chylothorax, 3 cases; acute renal failure, 1 case). Follow-up (mean 7.1 years; range 6 months to 16 years) was complete in all patients, and showed complete improvement in 22 patients and partial improvement in 6 patients. Early surgical repair of DAA is associated with low mortality, and results in marked symptomatic relief in most patients. Patients with tracheomalacia or associated asthma, constitute a high-risk group and may manifest persistent symptoms and require adjunctive procedures.     

Iatrogenic arteriovenous fistula during lumbar microdiscectomy

Vascular lacerations, arteriovenous fistulae, and pseudoaneurysms are rare, but potentially life threatening, complications of lumbar disk surgery. These iatrogenic vascular injuries may present with significant hypotension during the perioperative period. Early diagnosis and surgical repair may decrease morbidity and mortality. We discuss perioperative implications of postdiscectomy vascular injuries in this report.     

Nm23 expression in retinoblastoma

PURPOSE: Nm23 is a metastasis-suppressor protein. Decreased nm23 protein contributes to aggressiveness in many tumors. Nm23 immunoreactivity was studied in retinoblastoma and correlated with differentiation and invasiveness. METHODS: Immunohistochemistry was performed on 73 formalin-fixed, paraffin-embedded specimens of retinoblastoma. Western blot was conducted to confirm the immunohistochemical study. Prognostic features such as differentiation, invasion of choroid, optic nerve, and orbit, and metastasis were analyzed. RESULTS: Intense nm23 immunoreactivity was seen in 61% of the retinoblastomas with no invasion and faint nm23 immunoreactivity was seen in 85% of the retinoblastomas with invasion (p < 0.001). Poorly differentiated retinoblastoma showed decreased nm23 immunoreactivity compared to well-differentiated retinoblastomas (p = 0.02). An inverse correlation was observed between invasion of choroid, optic nerve, orbit, and metastasis, and nm23 immunoreactivity. Western blot assays of fresh tumor extracts confirmed the immunohistochemical findings. CONCLUSIONS: Decreased nm23 immunoreactivity was seen in poorly differentiated retinoblastomas and in retinoblastomas with invasiveness. These findings may lay the groundwork for further studies to better understand the molecular mechanisms and provide a more accurate prediction of invasion and metastasis of retinoblastoma.     

Choroidal neovascular membrane associated with choroidal osteoma (CO) treated with trans-pupillary thermo therapy

Choroidal neovascular membrane, a known complication of choroidal osteoma causing visual loss when located subfoveally, can be successfully treated with transpupillary thermo therapy.