Perirenal perivascular epithelioid cell tumor (PEComa).

A 52-year-old woman, who is a carrier of MLH-1 mutation (HNPCC-type Lynch syndrome) with a history of colon adenocarcinoma, was diagnosed with a 26 mm lobulated contrast-capturing mass located caudally of the pancreas tail, anteromedial of the spleen and medial of the splenic colon angle. She underwent an exploratory laparotomy with resection of the tumor. Initially, this mass was presumed to be metastasis in a patient with a history of colon adenocarcinoma. However, after further histopathological and immunohistochemical examination, the mass appeared to be a rare PEComa. Only a few cases of a PEComa in this retroperitoneal perirenal location have been described.

Treatment of thoracic or lumbar burst fractures with Balloon Assisted Endplate Reduction using Tricalcium Phosphate cement: histological and radiological evaluation.

BACKGROUND: Short-segment pedicle-screw instrumentation is frequently used to stabilize thoracolumbar burst fractures. A recognized disadvantage of this procedure is recurrent kyphosis from intervertebral disc creep into the fractured central endplate. Balloon Assisted Endplate Reduction (BAER) using Tricalcium Phosphate bone cement (TCP) enables elevation of the centrally depressed endplate. Our objective was to evaluate the bone-tissue response to TCP and to analyse whether BAER using TCP can prevent recurrent kyphosis after removal of the instrumentation. METHODS: Fourteen patients with traumatic thoracolumbar burst fractures were operated with BAER using TCP in combination with short-segment instrumentation. Nine months after surgery, instrumentation was removed and transpedicular biopsies were taken for histological and histochemical analysis. Roentgenograms pre- and postoperatively and at latest follow-up after removal of the instrumentation were evaluated. RESULTS: Average follow-up was 2.6 years. Analysis of the biopsies showed a variable degree of bone remodelling with incorporation of TCP into newly formed bone matrix. No extensive foreign body reactions, inflammation, granulomatous responses or tissue necrosis were observed. Wedge-angle, kyphosis-angle and both the anterior-posterior and central-posterior vertebral body height ratios improved significant postoperatively (p < 0.001). After removal of the instrumentation no significant differences in wedge-angle or height ratios were seen (p = 0.12). The kyphosis-angle increased four degrees (p = 0.01). CONCLUSION: TCP showed good histological osseointegration with no adverse events. TCP can therefore be safely used and could be beneficial in treatment of thoracolumbar burst fractures. BAER with TCP in combination with short-segment instrumentation might reduce recurrence of deformity even after removal of the instrumentation in comparison to short-segment instrumentation alone. TRIAL REGISTRATION: This study is registered at the at the Dutch Trial Registry (NTR3498).

Progression in atherosclerosis: histological features and pathophysiology of atherosclerotic lesions.

In this article, we present an illustrated and brief review of the literature concerning the histological and pathophysiological features of human atherosclerosis. Although the basic descriptive terms remain unchanged, the classification systems have evolved, and a uniform terminology is essential in clinical and laboratory researches. We discuss the major difficulties in classifying atherosclerotic lesions and give an overview of the most important histological classification systems as provided by the American Heart Association and Virmani et al (Arterioscler Thromb Vasc Biol. 2000;20:1262). Furthermore, we present the most recent literature concerning plaque progression, including enlargement of the lipid core and neovascularization.

Resection arthroplasty of the infected shoulder: a salvage procedure for the elderly patient.

Infection of the shoulder joint is a challenging problem for the orthopaedic surgeon. Several treatment options have been proposed. Here, we evaluate the results achieved following resection arthroplasty of the shoulder in seven patients. We performed resection arthroplasty in seven cases to treat a chronic uncontrollable infection of the shoulder. Three patients had an infected shoulder arthroplasty, one had an infected non-united arthrodesis, one was treated for an infected osteosynthesis, one had an infected rotator cuff repair and one patient had a septic arthritis of the shoulder joint. All patients were reviewed after a mean of 252 days. The functional outcome was evaluated using the Constant and DASH score. C-Reactive Protein levels were determined to evaluate the presence of residual infection. Except for one doubtful result, all our patients remained free of infection and there was excellent pain relief after the resection. Nevertheless, the functional outcome was poor: the mean Constant score was 25.7 and the mean DASH score was 69.3. Resection arthroplasty of the shoulder is a valuable treatment option for infection of the shoulder, especially in older patients with a poor mental and physical condition who suffer intolerable pain.

Juvenile spondylodiscitis: the value of magnetic resonance imaging: a report of two cases.

Two boys presenting with reluctance to sit straight and stand were diagnosed with spondylodiscitis of the lumbar spine. After confirmation of the diagnosis on plain radiographs, computed tomography and magnetic resonance imaging, they were successfully treated with antibiotics and in one case a lumbar orthosis. The use of magnetic resonance imaging is discussed and compared to the other radiological techniques. Magnetic resonance imaging seems to be the most sensitive and specific imaging technique used in the diagnostic process of spondylodiscitis. Computed tomography and technetium bone scan both play a specific part in the process of diagnosis and follow-up.