A vertebral extra dural chordoma at C5, possibly deriving from a clival chordoma

Background:

Clival chordomas are a rare type of cancer with low metastatic potential and primary metastasize to the lung or bones.

Case Description:

This case report describes a possible metastatic, paravertebral chordoma at level C4-C5 in a patient with a past medical history of a clival chordoma.

Conclusion:

Chordomas are unpredictable and may metastasise.

Agreement and discrepancy between mother and child in the evaluation of children's anxiety symptoms and anxiety life interference

This study explored the agreement and discrepancy between mother and child reports of children's anxiety symptoms and anxiety life interference. A large community sample of 1,065 Portuguese children aged between 7 and 14 years and their mothers completed a DSM-based anxiety symptoms scale. For a subsample of 135 children with an anxiety disorder, additional data on children's anxiety life interference and maternal anxiety and depression symptoms were collected. The results showed that children generally reported higher levels of anxiety symptoms than their mothers. Overall, most correlations between mother and child reports of anxiety symptoms were significant but in the low to moderate range, with the strongest associations for symptoms of specific phobias and school phobia. In the subsample of children with an anxiety disorder, mothers reported higher levels of anxiety life interference than children, and the correlation between mother and child reports of anxiety life interference was significant but again modest in magnitude. Lastly, maternal anxiety was positively associated with the discrepancy between mother and child reports of anxiety symptoms. Together, the results of this study further underline the importance of a multi-informant approach in the evaluation of children's anxiety problems.

Physiology of ileal pouch-anal anastomosis. Current concepts

PURPOSE

Increasing experience with ileal pouch-anal anastomosis (IPAA) associated with increasing knowledge about anorectal physiology has lead to a large number of publications. The purpose of this review is to evaluate the current understanding of fecal continence as revealed by the evolution of the ileoanal procedure.

METHODS

Review of the literature covering the most important physiologic parameters involved in fecal continence was undertaken.

RESULTS

Rectoanal inhibitory reflex is probably absent after IPAA but is preserved when distal anorectal mucosa is spared. Anal resting pressure decreases but is less affected when the internal anal sphincter is less traumatized. Squeeze pressure is not importantly affected, and the importance of reservoir function as a determinant of stool frequency is emphasized. IPAA does not affect the coordination between pouch and anal canal motility in the majority of cases. Normal continence is preserved, even during the night, by preserving a gradient of pressure between the pouch and anal canal.

CONCLUSIONS

Physiologic concepts are well established, but controversies about the continence mechanism related to IPAA remain. The IPAA procedure has allowed discrimination of details about the function of multiple structures involved in fecal continence.

Role of laparoscopy in colorectal surgery. A prospective evaluation of 200 cases

PURPOSE

The aim of this study was to prospectively evaluate the role of laparoscopic-assisted surgery in patients presenting for routine colorectal surgical procedures.

METHODS

Two hundred consecutive patients were assessed for the possible use of laparoscopic surgery. The decision regarding suitability of the patient for the procedure was made by the operator. For the purpose of analysis, patients were assigned to open, converted, and laparoscopic groups.

RESULTS

Ninety-five of 200 patients were considered appropriate for laparoscopic surgery, 62 (65.3 percent) being successfully completed. These completed operations included right colectomy (24/30), sigmoid colectomy (22/36), appendectomy (9/10), anterior resection (3/8), abdominoperineal resection (3/5), and left colectomy (1/2). Complications attributable to laparoscopy were infrequent (6.3 percent) and were not responsible for any deaths. Patients in the laparoscopic group required less analgesia, tolerated oral intake earlier, and were discharged from the hospital earlier than those who were converted or who had open procedures.

CONCLUSIONS

Laparoscopic-assisted surgery is safe, effective, and applicable to many of the standard colorectal procedures. Observed benefits include less postoperative pain and shorter hospital stay.

Fecal diversion for penetrating colon injuries--still the established treatment

PURPOSE

An analysis of the existing literature on primary repair of colon injuries was undertaken to determine if there is sufficient evidence that this approach is superior to fecal diversion.

METHODS

After a thorough literature search, three prospectively randomized studies comparing primary repair with fecal diversion in the management of colon injuries were identified. A variety of factors were examined, including the number of patients in each study arm, morbidity rates, as well as exclusion criteria. An analysis was performed to determine the number of patients required to establish statistical superiority of one procedure over the other.

RESULTS

Pooling of the data contained in the aforementioned reports does not provide sufficient statistical power to support the superiority of primary repair of colon injuries. To demonstrate a 5 percent difference between the two approaches, a prospective, randomized study consisting of 200 patients in each arm is necessary.

CONCLUSION

The present literature does not support a statistically valid advantage of primary repair over fecal diversion in the management of traumatic colon injuries.

Determination of Partial Photochemical Quantum Yields of Reversible Photoisomerizations of Stilbene-1 Derivatives

Partial photochemical quantum yields of derivatives of stilbene-1 can be determined by a new microprocessor controlled apparatus for the measurement of fluorescence intensities in dependence on reaction time. The consecutive photoproducts must not be known. Some of the 20 examined dyes show laser activity combined with relatively high photostability. Photochemical quantum yields and laser peak power were determined in dependence on structure. A detailed knowledge of the photokinetic parameters gives the opportunity to obtain indications of efficient and photostable laser dyes.