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.     

Embrochage en L de Vives des fractures du col du cinquième métacarpien (À propos de 24 cas)

Fractures of the neck of the fifth metacarpal (boxer's fracture) represent 20% of all fractures of the hand and are frequently observed in male patients, involve the dominant hand, and very often follow a direct blow or punch. We present a retrospective study of 24 fractures of the neck of the fifth metacarpal, treated by “L” pinning as described by Vives, between January 2004 and January 2008. All the patients were men with a mean age of 30 years (range 18 to 50). The mechanism of injury was dominated by fist strike (18 cases). Surgical treatment was performed in cases of fractures with a mean palmar tilt of 37° (range 30° to 60°). Pinning with a Vives procedure consisted of inserting two pins in an “L” configuration; the first a centromedullary pin measuring 20 mm, the second a transverse one through the fourth metacarpal bone controlling rotation and measuring 12 mm. Surgery was performed under loco-regional anaesthesia in 75% of cases, and under general anaesthesia in 25% of cases. No immobilization was recommended. Physiotherapy was performed in all cases. Fracture consolidation was obtained in all cases, and the pins were removed in the 6th week following surgery. This technique of osteosynthesis allowed us to obtain good clinical and radiological results according to the criteria of Frere with a mean follow up of 24 months.     

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.

     

Solitary subcutaneous hydatid cyst of gluteal area: an unusual localisation. A case report

Subcutaneous localization of hydatid cyst is uncommon even in endemic zone. Symptoms are often discrete. Diagnosis is confirmed by imaging: ultrasonography and/or magnetic resonance imaging, thus avoiding any untimely gesture. The treatment is surgery. Authors report a case of unusual subcutaneous localization of solitary hydatid cystis in the gluteal area.