Postoperative respiratory distress in a patient with history of familial Mediterranean fever

Postoperative respiratory distress and pulmonary edema can be seen after a wide variety of serious clinical situations, or rare diseases such as familial Mediterranean fever [FMF]. FMF is a multisystemic disorder characterized by recurrent bouts of fever and pain due to inflammation of the peritoneum, synovia, or pleura. We report a case with history of FMF who developed postoperative respiratory distress after repairing the abdominal incisional hernia. Ten hours after administration of colchicine, the patient's symptoms were reduced. This rare disease should be included as a differential diagnosis for acute-onset respiratory distress in postoperative period

CT patellar cortex tilt angle: a radiological method to measure patellar tilt

The role of patellar tilt in the anterior knee pain is indisputable. Traditionally, the lateral patellofemoral angle of Laurin has been defined in both the axial view and CT images for measuring the tilt of patella. We present a new angle, which is independent of the morphology of patella and directly relates to clinical assessment of the tilt, which is appreciated from palpation of the edges of the patella. 38 patients with anterior knee pain and forty normal control subjects were examined using CT scan of patellofemoral joint in 15 degrees of knee flexion. The amount of lateral patellar tilt was quantitatively assessed using the lateral patellofemoral angle, as described by Laurin et al, and the newly defined patellar cortex tilt angle. This angle is subtended by the line drawn along the posterior femoral condyles and the one parallel to the subchondral bone of patellar cortex. The fifteen-degree tilt was taken as normal cut-off point for patellar cortex tilt angle in the control group. In patients, the average tilt of patella, using the patellar cortex tilt angle was 15.26 versus 7.05 in the control group. Using Student's t test, the difference between the two means was significant [P<0.001]. The sensitivity and specificity of patellar cortex tilt angle were 40 and 90 percent, respectively There was a moderate agreement between our presented test and the lateral tilt angle test [kappa=0.40, P<0.001]. Our results indicate that patellar tilt can also be detected using patellar cortex tilt angle. We need more specific studies to determine the validity of the test

Urological oncology: a comparison between clinical and pathologic staging in patients with bladder cancer

To determine the accuracy of clinical staging methods of bladder cancer and TURBT results in estimating the pathologic stage of tumor. Thirty two patients who had undergone radical cystectomy were studied in this retrospective survey. The results of bimanual examination, cystoscopy, TURBT pathology report and the tumor contour in CT scan, [size, infiltrative deepness, pelvic lymph nodes involvement and hydronephrosis] were recorded. The type of surgery and pathologic report of cystectomy sample were analyzed as well. Then the results of bimanual examination, tumor size, hydronephrosis and CT scan findings including tumor infiltrative deepness, pelvic lymph adenopathy and TURBT findings were compared to pathologic results of cystectomy sample. Seven patients were females and 25 were males. Their mean age was 62 [range 36 to 80] years. Gross hematuria and irritative urinary symptoms were the most common complaints. The duration between symptom manifestation and patient's referral was 5 days to 72 months [mean 12 months]. Bimanual examination in estimating the extravesical involvement of tumor had a specificity of 82%, sensitivity of 46%, positive predictive value of 70% and negative predictive value of 63%. The size of tumor in determining extravesical involvement had a specificity of 41%, sensitivity of 93%, and positive predictive value of 58% and negative predictive value of 87%. Hydronephrosis was present in 15 patients of whom, 14 [93%] had bladder muscle involvement. CT scan specificity was 70%, and sensitivity was 46% regarding pelvic lymph adenopathy and perivesical fat involvement. In TURBT report no muscle sample was observed in 11 cases, so that the interpretations of results were impossible. The reported grade of tumor was lower than pathologic sample of cystectomy in 4 patients. Clinical staging in invasive bladder cancers has not high accuracy regarding the involvement of bladder surrounding fats and pelvic adenopathies. A tumor sized more than 5 cm could be sensitive in estimating extravesical involvement. Positive predictive value of hydronephrosis is considerable regarding bladder muscle involvement. Tumor understaging by TURBT is happened in high percentage of patients with invasive bladder cancer