Computed tomography of the orbit – A review and an update

Computed tomography (CT) and magnetic resonance imaging (MRI) of the orbit have been competing for the hearts and minds of health care providers for well over 2 decades. While several drawbacks pertaining to CT have been outlined since the introduction of MRI, CT remains the standard diagnostic test for evaluating cross-sectional, 2 or 3-dimensional images of the body.     

Superior long-term results of renal transplantation in children under 5 years of age

Despite improving overall results of pediatric renal transplantation children under 5 years of age remain a high-risk group with poorer outcomes often because of a higher rate of surgical complications. This retrospective report details a 12-year experience at a single center and examines the outcome in this high-risk group of patients. We reviewed the medical records of 21 children under 5 years of age who received renal transplantation at Loma Linda University Medical Center between July 1988 and August 2000. The patients were evaluated regularly by the same pediatric nephrologist throughout the study period at our outpatient clinic. Mean recipient age was 3 +/- 1.2 (range 2-5) years; weight at transplantation was 13.3 +/- 5.4 kg. Ten (48%) patients received living related donor (LRD) kidneys and 11 (52%) received cadaver (CAD) kidneys. Mean donor ages for CAD and LRD were 14.4 +/- 10 years and 26.6 +/- 4.9 years, respectively. The mean cold ischemia time (CAD only) was 23.3 +/- 10.6 hours. Renal dysplasia (n = 8) and obstructive uropathy (n = 5) were the most common primary diagnoses. Maintenance immunosuppression consisted of Azathioprine or mycophenolate mofetil (MMF), cyclosporine or tacrolimus and prednisone. Mean follow-up was 80.1 +/- 51.4 months. Twelve (57%) grafts have a follow-up >5 years. Patient survival was 100 per cent. Overall graft survival at one, 3, 5, and 10 years were 95, 95, 88, and 88 per cent respectively. Graft survival for LRD recipients was 100 per cent. No graft was lost as a result of a technical problem or vascular thrombosis. One graft each was lost because of delayed graft function complicated by severe cytomegalovirus infection and chronic rejection. At one year the mean serum creatinine was 0.6 +/- 0.2 mg/dL with a mean calculated glomerular filtration rate of 93 +/- 32 mL/min. All 17 children who are now of school age are attending school. We conclude that excellent rehabilitation and superior long-term patient and graft survival can be achieved with renal transplantation in children of this age group with the use of good surgical techniques and close follow-up.     

Pathological characteristics and prognostic indicators of different histopathological types of urinary bladder cancer following radical cystectomy in a large single-center Egyptian cohort

Objective

To evaluate differences in pathological features and prognostics across four bladder cancer histopathological types: urothelial carcinoma (UC), urothelial carcinoma with variant histology (UCV), squamous cell carcinoma (SCC) and adenocarcinoma (ADC), utilizing a large cohort of radical cystectomy (RC) patients.

Methods

A retrospective analysis of patients who underwent RC at a single institution in Egypt between 1997 and 2004 was performed. Kaplan–Meier and multivariable analyses were performed to evaluate the prognostic significance of pathological features including tumor stage, grade, lymphovascular invasion (LVI), and lymph node (LN) involvement in the different subtypes on disease-free survival (DFS).

Results

1238 patients (975 male, 263 female) were included, of whom 577 (47%) had UC, 174 (14%) UCV, 398 (32%) SCC, and 89 (7%) ADC. Median age was 54 (20–87) years and median follow-up was 40 months (0–110). There were significant differences in stage, grade, LVI, LN involvement, and presence of schistosomiasis across the subtypes (all p?<?0.05). The prognostic significance of LVI was more evident in SCC (HR 2.14, p?=?0.003) and ADC (HR 2.17, p?=?0.044) than in UC (HR 1.66, p?=?0.008). LN involvement was the strongest prognostic factor in UCV (HR 2.14, p?=?0.012).

Conclusions

There are significant differences in clinicopathological features and their prognostic impact across bladder cancer subtypes. The prognostic significance of LVI is more evident in SCC and ADC, while LN involvement is more prognostic in UCV. Determining independent predictors in individual subtypes can guide multimodal treatment selection and clinical trial design.

     

Respiratory syncytial virus infections in hospitalized infants: association between viral load, virus subgroup, and disease severity

The relationships between host factors, virus strain, viral load, and illness severity in respiratory syncytial virus (RSV)-induced bronchiolitis are poorly defined. These relationships were evaluated prospectively in 81 previously healthy infants hospitalized with RSV bronchiolitis. Disease severity was determined by the respiratory rate, the duration of hospitalization, and whether patients during their hospitalization required pediatric intensive care unit admission or mechanical ventilation. RSV typing into subgroup A and B was obtained by RT-PCR-hybridization assay. The nasopharyngeal RSV viral loads were measured by real-time quantitative RT-PCR. Disease severity correlated significantly with the presence of risk factor (estimated gestational age < 37 weeks and/or birth weight < 2,500 g) and with chronologic age 相似文献   

The operative trauma workload in a plastic surgery tertiary referral centre in Scotland

The trauma workload in plastic surgery is not well documented in the literature. The authors wished to investigate the operative trauma caseload in a tertiary referral plastic surgery centre to determine the demographics, mechanisms of injury, sites of injury and procedures performed. This study was conducted using a prospectively tabulated comprehensive database in which details of every trauma operation performed at the Canniesburn Plastic Surgery Unit (Glasgow, Scotland) are logged. The data from an 8-year study period (2003–2010) were collected for patient demographics, site of injury and operative procedures performed. The data from a shorter study period (April 2006–December 2010) were collected separately to investigate the mechanisms of injury. Data analysis was undertaken using Mintab 15 Statistical Software English. Analysis of 21,929 operative procedures on 8,880 patients was undertaken. There was a predominance of young male patients. More than 75% of trauma affected the limbs. The mechanism of injury was predominantly accidents (31%) including RTAs. The second most common mechanism was violent crime (17%), of which more than a quarter involved a knife. Notably, alcohol was a contributing factor in 3.4% of all trauma cases. Plastic surgery trauma involves injury to all sites of the body and the mechanisms are variable. However, certain mechanisms are arguably preventable through public health initiatives and legislative change in order to reduce the unnecessary economic burden on the health service. There is a significant operative caseload with a requirement for a varying complexity of reconstruction, ranging from debridements to microvascular free tissue transfer. Arguably, the plastic surgeon must be an integral part of any trauma centre.     

Study of platelet activation,hypercoagulable state,and the association with pulmonary hypertension in children with β-thalassemia

Background

The increased survival rate of thalassemic patients has led to unmasking of management related complications which were infrequently encountered.