Renal venous thrombosis: an unusual cause of fetal distress.

Renal venous thrombosis (RVT) is a rare event in neonates and infants. Its incidence varies from 0.5 per thousand concerning admissions in neonatal intensive care units to 0.5% in autopsic findings. Some cases may occur in the antenatal period. Clinical presentation in infants includes a mass in the flank. hematuria and thrombocytopenia. We report a case of RVT which was diagnosed at 34 weeks' gestation by ultrasound in a fetus showing cardiotocographic signs of fetal distress. We observed the typical pattern reported by pediatric radiologists: renal enlargement, loss of the cortico-medullary boundary, echoic streaks following the direction of interlobular veins, lack of definition of renal sinus echoes and loss of venous flow in the right kidney by Doppler velocimetry. After delivery by caesarean section and transient hyperbilirubinemia and moderately impaired renal function the infant weighing 2435 g had a full recovery at 1 week and a normal evolution at 1 month of life.

[Fetal renal venous thrombosis: a typical ultrasonographic aspect]. / Thrombose veineuse rénale du foetus: un aspect échographique typique.

We report a case of RVT, diagnosed at 34 weeks' gestation in a case of fetal distress occurring four days after an acute maternal gastroenteritis. The typical ultrasonic pattern included renal enlargement, with parenchymal hyperechogenicity and venous echoic streaks, loss of the cortico-medullary boundary and lack of definition of renal sinus echoes. Color Doppler velocimetry confirmed the absence of venous flow with an increased vascular resistance in the renal artery. After delivery by an emergency caesarean section the infant had a full anatomical and functional recovery of his affected kidney at the seventh day of life.

[Neuro-arthropathy, a painless but very destructive disorder of frequently one joint]. / Neuroartropathie, een pijnloze maar zeer destructieve aandoening van vaak slechts één gewricht.

In a 38-year-old man who suffered from recurrent painless swelling of the right knee, neuroarthropathy was diagnosed, associated with tabes dorsalis. The patient was treated with a knee brace to stabilise the joint. Neuroarthropathy is a progressive degenerative joint disease caused by a central or a peripheral neurological disorder and causing denervation of the joint.

Surgeon satisfaction agreement after total knee arthroplasty using a visual analogue scale: a single surgeon series.

INTRODUCTION: The outcome of total knee arthroplasty (TKA) is traditionally rated by objective criteria such as the knee society clinical rating system (KSCRS). Subjective criteria, such as satisfaction, will be of more importance, because health-care is shifting towards a market model. The aim of this study was to investigate the agreement on satisfaction after TKA between two orthopaedics surgeons, when one of the surgeons reviews his own results. PATIENTS AND METHODS: We investigated a group of 57 patients (63 TKAs) using a visual analogue scale (VAS) for satisfaction. There were 53 TKAs available and were separately seen by the two orthopaedic surgeons for clinical follow-up. RESULTS: After we split the satisfaction rate as excellent-good and fair-poor (VAS smaller or equal to 20 was excellent-good), we found a substantial agreement (kappa = 0.77) between the orthopaedic surgeons. However, we found that the surgeon who viewed his own results (B) scored a significantly lower satisfaction than surgeon A when analysing the complete group. CONCLUSIONS: The interobserver agreement of satisfaction, using a VAS, was high between the two orthopaedic surgeons. The satisfaction VAS is a simple tool to quantify satisfaction of surgeons and patients after TKA and could be used to evaluate quality. Comparison between studies could be more efficient and reliable using the satisfaction VAS method.