Predictive factors for successful vessel-intact laparoscopic orchiopexy for intra-abdominal testes.

OBJECTIVE: To identify the predictive factors for successful vessel-intact laparoscopic orchiopexy (VILO) for nonpalpable intra-abdominal testes (NPIT). MATERIALS AND METHODS: 25 boys with 28 NPITs within 2 cm of the internal ring underwent VILO. They were divided into two groups based upon outcome, for statistical comparison. Group A (successful VILO): patients with testes pexed in scrotum during surgery, and maintained viability and scrotal position of testes at 3-month & 6-month postoperative follow up. Group B: failed VILO. RESULTS: Intrascrotal fixation at VILO was achievable for 17/28 NPITs. Postoperative follow up and final outcome data were available for 25/28 NPITs, of which 14 were successful (A) while 11 had failed VILO (B). The mean age of patients in group A differed significantly from that of patients in group B (4.16 years versus 6.64 years; p = 0.035). The mean testis-to-internal ring distance was 0.50 cm for group A and 1.05 cm for group B, but this was not statistically significant (p = 0.141). There was statistically a highly significant difference (p = 0.002) with respect to the mean internal ring-to-midscrotum distances in groups A and B: 5.56 cm and 7.05 cm, respectively. A scatter-plot of age or height against internal ring-to-midscrotum distance showed a fairly linear relationship. CONCLUSIONS: Age or height of the patient at surgery is an independent factor predicting the success of VILO for intra-abdominal testis. The internal ring-to-midscrotum distance increases with age/height, resulting in increased testis-to-midscrotum distance and higher failure rate of VILO in older children.

A rare etiology of cauda equina syndrome.

Fungal infections of the spine are very rare and usually seen in immunocompromised patients. Acute cauda equina syndrome presenting in an immunocompetent patient is usually due to a prolapse of the intervertebral disc. Infective pathology caused by Mycobacterium tuberculosis with epidural collection can also have a similar presentation. We present a case of spinal epidural abscess caused by Aspergillus fumigatus, presenting as acute cauda equina syndrome. To the best of our knowledge, spinal aspergillosis presenting as cauda equina syndrome in an immunocompetent patient has not been reported before in the English-language based medical literature. Surgical decompression with antifungal treatment with oral itraconazole yielded a good recovery.

Comparative evaluation of postreduction intra-articular distal radial fractures by radiographs and multidetector computed tomography.

BACKGROUND: Computed tomography can be an adjunct to radiographs when evaluating intra-articular fractures of the distal part of the radius. Acute-phase multidetector computed tomography has better temporal, spatial, and contrast resolution than a conventional scanner has. The aim of this study was to determine prospectively whether the addition of a multidetector computed tomography scan (with various reconstructions) results in changes in the evaluation of intra-articular distal radial fractures and thus changes in the plans for further management. METHODS: Radiographs and multidetector computed tomography scans were compared prospectively in the evaluation of 117 patients (120 wrists) with acute intra-articular distal radial fractures. The parameters that were measured included the ability to detect intra-articular step and gap displacements, central articular depression, coronal plane fracture, the number of articular fragments, comminution, and associated injuries in the wrist region (carpal bone fractures, distal radioulnar joint disruption, and ulnar styloid fracture). RESULTS: The average measurements for intra-articular step and gap were 0.4 mm and 0.9 mm, respectively, on post-reduction radiographs and 1.3 mm and 2.4 mm, respectively, on sagittal multidetector computed tomography images (p < 0.0001 for each). Central articular depression was found in twenty-one wrists (18% of the total) on radiographs, but on multidetector computed tomography it was found to be present in seventy-four wrists (62% of the total) (p < 0.0001). Twenty-six radiographically occult injuries in the wrist region, including six scaphoid fractures, were detected with the help of multidetector computed tomography. Overall, the recommended treatment plan changed in 23% of the cases when the evaluation included multidetector computed tomography images in addition to conventional radiographs. Interobserver and intraobserver agreements were significantly increased when radiographs and multidetector computed tomography images both were available for evaluation (κ = 0.73 and 0.91, respectively) as compared with interobserver and intraobserver agreement with radiographs alone (κ = 0.43 and 0.69, respectively). CONCLUSIONS: Multidetector computed tomography provides more accurate information regarding the anatomy of intra-articular distal radial fractures than radiography provides. The addition of multidetector computed tomography to plain films frequently changes the therapeutic recommendations for such cases.

Traction apophysitis of medial malleolus: a case report with review of the literature.

Traction apophysitis of medial malleolus is very rare and presented in view of its rarity. A 13 years old boy presented with pain and swelling without history of trauma around left ankle of 3 months duration. The swelling was diffuse with tenderness on anterior aspect of medial malleolus. The overlying skin was normal. The X-rays revealed fragmented accessory ossification centre of medial malleolus an left side. MRI revealed multiple foci of hypointensity in T1 and T2 weighted images of left medial malleolus apophysis. Patient was treated in below knee plaster for three weeks with restriction of sports activities for 5 weeks. The patient became asymptomatic in 8 weeks.