[RECIST classifications : our experience at a university hospital]

Since the WHO [World Health Organization]'s criteria published in 1981, many organizations and research teams worked on revising and defining criteria for response monitoring of solid tumors. The RECIST criteria in 2000 and its revised version in 2009 introduced major changes in selecting lesions to be assessed and measuring them, and determining treatment response. While treatments are becoming more specific with the emergence of targeted therapies, response criteria are becoming more diversified and specialized with a type of tumor or/and treatment. This review describes the evolution of response criteria methods and sketches our experience in this field in Lebanon

Vertebral Augmentation: State of the Art

Osteoporotic vertebral compression fractures (OVF) are an increasing public health problem. Cement augmentation (vertebroplasty of kyphoplasty) helps stabilize painful OVF refractory to medical treatment. This stabilization is thought to improve pain and functional outcome. Vertebroplasty consists of injecting cement into a fractured vertebra using a percutaneous transpedicular approach. Balloon kyphoplasty uses an inflatable balloon prior to injecting the cement. Although kyphoplasty is associated with significant improvement of local kyphosis and less cement leakage, this does not result in long-term clinical and functional improvement. Moreover, vertebroplasty is favored by some due to the high cost of kyphoplasty. The injection of cement increases the stiffness of the fracture vertebrae. This can lead, in theory, to adjacent OVF. However, many studies found no increase of subsequent fracture when comparing medical treatment to cement augmentation. Kyphoplasty can have a protective effect due to restoration of sagittal balance.

Deltoid flap for management of massive irreparable rotator cuff tears case series

Background: Muscle transfer has been reported as a good surgical option to reconstruct the deficient rotator cuff. The purpose of this study is to report the outcome of deltoid muscle flap transfer to restore shoulder function in patients with massive irreparable rotator cuff tear

Material and methods: This is a retrospective descriptive case series. Included patients had a lesion of two or more tendons of the rotator cuff or lesion of one tendon of more than 5 cm in width and no lesion to the subscapularis. Evaluation was done using the Constant score, visual analog scale for satisfaction and quality of life

Results: Twenty patients met the inclusion criteria. Three patients were lost to follow-up. The remaining [9 males and 8 females] had a mean follow-up period of 40.5 months. The mean age at surgery was 61.3 years. Thirty-five percent of patients were involved in heavy labor while the lesions affected the dominant side in 70% of the cases. Mean preoperative Constant score was 40.8 and increased to 78.8 [p < 0.05] with a difference of + 38 points on the raw Constant score and an improvement rate of 64%. The greatest improvement involved essentially pain and quality of life [improvement rate of 82%] [p < 0.05]. Eighty-nine percent of patients have good and excellent self-reported results

Conclusion: More than just a salvage procedure, deltoid muscle flap seems to be an adequate option in terms of appropriate pain relief, function recovery as well as patient satisfaction

Focus on the immediate hypersensitivity reactions products contrast iodinated [PCI]

The use of iodinated contrast agents [IC] has become common practice nowadays in the daily diagnostic and therapeutic procedures in radiology. Immediate hypersensitivity reactions occurring up to the first hour after injection of IC, can be of serious consequences, occasionally leading to death. This justifies the establishment of a prevention algorithm, including a sharp identification of those at risk and the implementation of premedication with corticosteroids. A history of previous reaction to IC is the major risk factor of a new reaction. Other risk factors include asthma, atopy and cardiomyopathy. The factors that influence the severity of the hypersensitivity allergic reactions are female gender, age, and taking beta blockers or ACE inhibitor drugs