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@#A 40-year-old female complains of right flank plain associated with progressive abdominal enlargement. She had stable vital signs and normal renal function. CT urogram revealed bilateral flank masses suggestive of bilateral giant angiomyolipomas. She was counseled on the various treatment options and opted to undergo open surgical excision. She underwent an open clamp-less partial nephrectomy with no intraoperative events. Operative time was 120 minutes and estimated blood loss was 250cc. She was discharged in good clinical condition on postoperative day 4. Final histopathological analysis revealed angiomyolipoma. Genetic testing was positive for mosaic variant of tuberous sclerosis. After a year of follow up, she remains stable and is maintained on everolimus. Open ischemia-free partial nephrectomy may be done safely for giant renal angiomyolipomas. Radical nephrectomy should be reserved for the last option because the presence of contralateral disease may also require surgical excision in the future.
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ABSTRACT Objective: Our aim was to describe the foot alignment in National Football League (NFL) players with different symptomatic foot and ankle pathologies using weightbearing cone-beam computed tomography (WBCBCT), comparing them to normally aligned feet as control group. Methods: 41 feet (36 active NFL players) were assessed using WBCBCT and compared to 20 normally aligned controls from a normal population. Measurements included: Foot and Ankle Offset (FAO); Calcaneal Offset (CO); Hindfoot Alignment Angle (HAA); angle between inferior and superior facets of the talus (Inftal-Suptal); angle between inferior facet of the talus and the horizontal/floor (Inftal-Hor); Forefoot Arch Angle (FAA); navicular- and medial cuneiform-to-floor distance. Results: NFL athletes showed a neutrally aligned hindfoot when compared to controls (FAO: 1% vs 0.5%; CO: 2.3 mm vs 0.8 mm; HAA: 2.9° vs 0.8° in two groups, with all p > 0.05) and a normal morphology of the subtalar joint (no difference in Inftal-Suptal and Inftal-Hor angles). Conversely, in athletes we found a decreased medial longitudinal arch (FAA: 15° vs 18.3°, p = 0.03) with smaller navicular (38.2 mm vs 42.2 mm, p = 0.03) and medial cuneiform (27 mm vs 31.3 mm, p = 0.01) mean distances to the floor when compared to controls. Conclusion: In our series, NFL players presented a lower medial longitudinal arch than controls but a neutrally aligned hindfoot. WBCBCT may help shed light on anatomical risk factors for injuries in professional players. Level of Evidence III, Retrospective comparative study.
RESUMO Objetivo: Descrever o alinhamento do pé em jogadores da National Football League (NFL) com diferentes patologias sintomáticas do pé e tornozelo usando a tomografia computadorizada de feixe cônico com suporte de peso (weightbearing cone-beam computed tomography - WBCBCT), e comparar as medidas a grupo controle de voluntários com pés de alinhamento normal. Métodos: Quarenta pés (36 jogadores ativos da NFL) foram avaliados usando WBCBCT e comparados com 20 controles da população normal. As medidas incluíram: Offset do pé e tornozelo(FAO); Calcâneo Offset (CO); ângulo de alinhamento do retropé (HAA); ângulo entre as facetas inferior e superior do tálus (Inftal-Suptal); ângulo entre a faceta inferior do tálus e o solo (Inftal-Hor); ângulo do arco do antepé (FAA); distância navicular/solo e cuneiforme medial/solo. Resultados: Atletas da NFL mostraram retropé com alinhamento neutro quando comparados aos controles (FAO: 1% vs. 0,5%; CO:2,3mm vs. 0,8 mm; HAA: 2,9° vs. 0,8°, com todos p > 0,05) e morfologia normal da articulação subtalar (sem diferença nos ângulos Inftal-Suptal e Inftal-Hor). Por outro lado, observamos nos atletas profissionais um arco longitudinal medial diminuído (FAA: 15° vs. 18,3°,p=0,03) com distâncias médias do navicular/solo (38,2 mm vs. 42,2 mm, p = 0,03) e do cuneiforme medial/solo (27 mm vs. 31,3 mm, p = 0,01) menores quando comparados ao grupo controle. Conclusão: Em nossa série, os jogadores da NFL apresentaram um arco longitudinal medial diminuído em relação aos controles, mas um retropé neutro. WBCBCT pode ajudar a esclarecer os fatores de risco anatômicos para lesões em jogadores profissionais de elite. Nível de Evidência III, Estudo retrospectivo comparativo.
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@#Background. Childhood glaucoma is a rare multifactorial disease with limited information regarding the demographics and characteristics in the Filipino setting. It can be categorized via the Childhood Glaucoma Research Network Classification scheme. Objective. Determine the clinical classification of patients diagnosed with childhood glaucoma in the ophthalmology service of a government tertiary hospital in Manila, Philippines. Methods. Medical records of all patients ≤16 years-old referred to Glaucoma Section of Philippine General Hospital from January 2015 to December 2017 were reviewed retrospectively and classified. Results. One-hundred four (104) eyes in 77 children were classified. Glaucoma associated with acquired conditions was the most prevalent in 44.2% of the patients with trauma consisting of 19.5% of all patients. Primary childhood glaucoma consisted of 15.6% and juvenile open-angle glaucoma was diagnosed in 5.2%. Glaucoma following cataract surgery was noted in 7.8% of patients. Trabeculectomy was the primary surgical intervention in 22.2% of eyes, with 78.9% of eyes reaching an IOP control of <21mmHg on final follow-up. Conclusion. Glaucoma associated with acquired conditions was the most common childhood glaucoma in the patient population. Trabeculectomy was the most common surgery done. Trauma was the most prevalent cause of glaucoma from acquired conditions.
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Background: Idiopathic clubfoot is commonly treated with the Ponseti method with the extent of invasive treatment involving tendon-Achilles lengthening. Forefoot adduction is a common complication in surgically treated clubfeet. Yet, no method has been described to measure dynamic (walking) forefoot adduction. The aim of this study was to assess the persistent pes adductus in children whose clubfeet were surgically treated using a dorsomedial soft tissue release and to find out correlations between forefoot adduction and clinical outcome measures. Methods: We analysed the dynamic adduction angle in 33 clubfeet using a pressure-sensitive foot platform and compared it to the healthy feet of an age- and weight-matched group of children without congenital foot deformities. The clinical outcome was analysed using the McKay score. Results: Mean dynamic adduction angle was 4.1o in the surgically corrected clubfeet, whereas it was 6.4º in unaffected feet of patients with unilateral clubfoot and 7.1o in control group. The McKay score were excellent in 1 patient, good in 5, average in 13, and fair in 4 of the 23 patients. There was no correlation between dynamic adduction angle and McKay score using paired t test (P > 0.05). Conclusion: High occurrence of dynamic adduction angle in surgically treated clubfeet was detected. In conclusion, no correlation between forefoot adduction, dynamic forefoot adduction angle and clinical outcome measures within the study was observed.
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Helicobacter pylori are a well-known cause of gastrointestinal diseases particularly amongst patients suffering from dyspepsia. To evaluate the recovery rate of Helicobacter pylori from suspected peptic ulcer patients with dyspepsia symptom. Gastroenterology Unit, Aseer Central Hospital, Saudi Arabia. A Prospective Study. Gastroscopy and gastric biopsy were performed on 53 patients with dyspepsia from January 2012 to January 2013; all were subjected urease CLO test and culture. The CLO-positive biopsies were cultured using brain-heart infusion agar with added blood [7%], and Skirrow's supplement was used for isolating Helicobacter pylori. Inoculated plates were incubated at 37°C for 7-10 days in a microaerophilic incubation environment and examined for suspected Helicobacter pylori colonies. Helicobacter pylori cultures were confirmed by the positive urease, oxidase and rapid antigen test. Cultures of non-Helicobacter pylori bacteria were identified using few phenotypic tests then confirmed by VITEK 2 automated system. Seventeen [32.08%] Helicobacter pylori were isolated [in pure form or in mixed cultures] using Brain-Heart Infusion agar with blood and Skirrow's supplement. Nineteen [35.85%] samples revealed no growth, 5 [9.43%%] revealed the growth of Acinetobacter spp, 4 [7.55%] revealed Brucella melitensis, 2 [3.77%] revealed Pasteurella spp. and 1 [1.89%] revealed Pseudomonas aeruginosa. The recovery rate of Helicobacter pylori from CLO positive biopsies was low, 17 [32.08%], but growth of other gram negative bacilli was documented
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The present study was undertaken to examine calmodulin-dependent effect of thyroid hormones (THs) on synaptosomal protein phosphorylation in mature rat brain. Effect of L-triiodothyronine (L-T3) on in vitro protein phosphorylation was measured in a hypotonic lysate of synaptosomes prepared from adult male rat cerebral cortex, incubated in presence and absence of calcium ion (Ca2+) and calmodulin. L-T3 significantly enhanced incorporation of 32P into synaptosomal proteins as compared to basal level of phosphorylation in the presence of Ca2+ and calmodulin. Under these conditions, increase in protein phosphorylation was 47, 74 and 52% for 10 nM, 100 nM and 1 M L-T3, respectively. Chelation of Ca2+ using ethylene glycol-bis (2‑aminoethylether)-N, N, N’, N’-tetraacetic acid (EGTA) inhibited the effects of Ca2+/calmodulin on TH-stimulated protein phosphorylation levels. This study suggests that a high proportion of L-T3-stimulated protein phosphorylation involves Ca2+/calmodulin-dependent pathways in adult rat cerebrocortical synaptosomes.