[Diagnostic image (73). A man with atypical back and abdominal symptoms. Inflammation of abdominal aortic aneurysm]

In a 66-year-old man a typical inflammatory abdominal aortic aneurysm was diagnosed

[Diagnostic image (73). A man with atypical back and abdominal symptoms. Inflammation of abdominal aortic aneurysm]

Item does not contain fulltextIn a 66-year-old man a typical inflammatory abdominal aortic aneurysm was diagnosed

Incidence and clinical course of de-novo malignancies in renal allograft recipients.

BACKGROUND: This study was designed to evaluate the development of malignancies after renal transplantation in a single centre. The outcome was studied in patients developing a malignant neoplasm after renal transplantation. METHODS: Malignancies are registered in a database containing relevant data about the patients with a renal transplant. This database and the files of the patients developing a malignant neoplasm, have been studied as to stage at presentation, therapy and outcome. RESULTS: In 1546 patients with 2075 renal transplantations, 240 malignancies developed in 231 recipients. Skin cancers often present with more than one lesion of the same histological type. After the first skin tumour, about half of the patients developed more lesions, of the same or a different histological type. The prognosis of skin tumours is relatively good, but most malignancies in all other categories have a poor prognosis. CONCLUSIONS: Cutaneous neoplasms tend to be multiple, but can be controlled by regular examination of the skin. Most malignant lymphomas do develop outside the lymphoproliferative system and have a poor prognosis. Patients with a solid tumour of the other tracts often present in an advanced stage of disease, which makes the outcome of treatment, if possible at all, disappointing. Copyright Harcourt Publishers Limited

Pancreatic injury in children: good outcome of nonoperative treatment.

Contains fulltext : 69038.pdf (publisher's version ) (Closed access)PURPOSE: Treatment of blunt injury of the pancreas in children remains controversial. Some prefer nonoperative treatment, whereas others prefer operative management in selected cases. This report reviews the treatment of patients with blunt pancreatic trauma admitted to a level I pediatric trauma center in The Netherlands. METHODS: Medical records of all children less than 15 years with blunt pancreatic trauma admitted to the University Medical Center St Radboud in the period 1975 to 2003 were retrospectively analyzed. RESULTS: Thirty-four children were included, age 3 to 14 years. Most injuries were because of bicycle accidents (58%). On admission, amylase was raised in 90% of the patients. Five patients had pancreatic duct injuries identified by imaging (endoscopic retrograde cholangiopancreaticography was used once, magnetic resonance cholangiopancreaticography twice) or at surgery. Thirty-one children were initially managed nonoperatively. Pancreatic surgery was performed in 3 children (1 Roux-Y, 2 drainage only). Mean hospital stay was 29 days in the operative group and 24 days in the nonoperative group. Fluid collections developed in 2 operated patients. Both resolved spontaneously. In 14 of the 31 nonoperated patients, a pseudocyst developed. Only 6 of these needed secondary intervention. Of these, 3 were drained percutaneously. There was no mortality and no long-term morbidity in both groups. CONCLUSIONS: Nonoperative management of pancreatic injury in children has good clinical outcome. Only 10% need secondary surgery. In 50%, pseudocysts develop of which half can be managed nonoperatively. The reliability of computed tomographic scan grading is of limited value to decide whether to operate primarily. There is little to gain with ERCP and stenting. The place of MRCP as a noninvasive diagnostic tool remains to be determined