Faculty Bibliography

We describe the case of a patient with a large renal cell carcinoma (RCC) who underwent cytoreductive nephrectomy utilizing liver mobilization techniques similar to those used in transplantation. Despite recurrent metastases, our patient continues to survive eight years later with several metastasectomies and adjuvant chemotherapy. We report the case of a 48-year-old Hispanic American man who presented with a 4-month history of an enlarging right upper quadrant abdominal mass and hematuria. Computerized tomography revealed a 13 x 14 x 14 centimeter mass suspicious of RCC with possible metastasis to the lungs. The patient subsequently underwent radical nephrectomy. Pathological analysis confirmed the mass as RCC. Over the following eight years, the patient developed metastases to the pulmonary lobes, buccal mucosa, thoracic spine, and second rib, which were all treated with metastasectomy. The patient continues to survive today with a reasonable quality of life. Palliative measures in patients with large RCC tumors with distant metastases require persistent, aggressive therapeutic modalities.

Orbital fractures in children are uncommon. The pattern of orbital fractures changes as children age. Although the management of pediatric orbital fractures is evolving, a thorough clinical assessment with computed tomographic scan imaging is essential. Urgent surgical intervention is indicated in cases of entrapment or acute enophthalmos. Entrapment with oculocardiac reflex is common in the white-eyed blow-out or trapdoor fractures. Otherwise, pediatric fractures may be treated conservatively with surveillance. A variety of autogenous and allogenic materials may be used to repair the fractured orbit. Resorbable plating systems are an alternative to rigid metallic fixation and may be used on the developing craniofacial skeleton.