Anesthesia and perioperative medical management of children with spinal muscular atrophy

Objective:  To describe the perioperative medical care, anesthetic considerations, and the risk of postanesthetic respiratory failure in patients with pediatric spinal muscular atrophy (SMA).
Methods:  There is a retrospective chart review carried out at an urban, tertiary care pediatric hospital. All patients with ICD-9 codes corresponding to SMA diagnoses were identified, and records screened for anesthetic and perioperative medical management. Medical records were reviewed for demographic, clinical, and outcome data.
Main results:  Twenty-five children with SMA (10 type I, 8 type II, 7 type III) accounted for 56 general and regional anesthetic cases. Twenty-one (38%) cases had preexisting ventilator dependence. Total intravenous anesthesia with nitrous oxide was provided in 14 (25%) cases, balanced anesthesia with inhalational agents and epidural or systemic opioids were used in 41 (84%) cases, and one infant received a spinal anesthesia. Intraoperative and postoperative complications occurred in 2 (4%) and 2 (4%) cases respectively. One case required an unplanned postanesthetic intensive care unit admission, and there were two late deaths with redirection of care.
Conclusions:  Perioperative care can be provided for children with SMA safely and effectively with total intravenous or inhaled anesthetics along with the judicious use of opioids to improve patient comfort without increased morbidity. Further prospective studies of standardized anesthetic and perioperative respiratory medical management in this population are required to minimize the decompensation of tenuous preoperative respiratory function.     

How do symptoms have an impact on the prognosis of renal cell carcinoma?

Aim:   Symptomatic renal cell carcinoma (RCC) is well known to have a characteristic behavior. We therefore evaluated the impact of systemic symptoms on the prognosis of RCC.
Methods:   Patard's criteria were used to classify symptoms before operation into three groups defined as: S1 (incidental tumor), S2 (localized symptoms) and S3 (systemic symptoms). Selected clinicopathological factors including gender, maximum tumor diameter, clinical stage, hemoglobin, C-reactive protein (CRP) and immunosuppressive acidic protein, nuclear grade and venous invasion were measured preoperatively in 252 patients. To determine impacts of them on the prognosis of RCC, we compared quantitative results using Cox multivariate analysis.
Results:   The cancer-specific five-year survival rates were 93.1%, 71.0%, and 20.2% for S1 (144 patients), S2 (80 patients) and S3 (28 patients), respectively ( P  < 0.0001). By the univariate analysis, S2 and S3 were significant prognostic factors (risk ratio 4.5, P  = 0.0003, risk ratio 19.15, P  < 0.0001, respectively). By the multivariate analysis limited to preoperative clinical characteristics, S3 and CRP were independent factors (risk ratio 7.05, P  = 0.0006, risk ratio 3.53, P  = 0.0052, respectively). When pathological factors as well as preoperative clinical features were included on multivariate analysis, S3 and CRP remained to be independent predictive factors (risk ratio 6.01, P  = 0.0031, risk ratio 2.64, P  = 0.0040, respectively). Among pathological factors, only nuclear grade was a significant prognostic factor (risk ratio 2.92, P  = 0.013).
Conclusion:   The presence of systemic symptoms is an independent prognostic factor along with nuclear grade and CRP.     

Lamivudine or lamivudine combined with hepatitis B immunoglobulin in prophylaxis of hepatitis B recurrence after liver transplantation: a meta-analysis

There is a controversy over whether the different outcomes of prophylaxis of hepatitis B virus (HBV) recurrence are attributable to different treatments. A systematic review and a meta-analysis were conducted to evaluate lamivudine monotherapy and combined therapy of lamivudine and hepatitis B immunoglobulin (HBIG) in HBV infected liver recipients. A fixed effects model was used for statistical pooling of relative risks (RR) for the different outcomes. Six articles (551 patients) fulfilled the inclusion criteria. Statistically significant differences were observed between lamivudine monotherapy and lamivudine + HBIG therapy in hepatitis B recurrence [ P  < 0.0001; RR = 0.38; 95% CI (0.25, 0.58)], YMDD mutant [ P  = 0.002; RR = 0.40; 95% CI (0.23, 0.72)] and hepatitis B recurrence in HBV-DNA positive patients before orthotopic liver transplantation [ P  < 0.00001; RR = 0.31; 95% CI (0.21, 0.45)]. No significant differences were observed in patient survival [ P  = 0.59; RR = 1.02; 95% CI (0.95, 1.09)], graft survival [ P  = 0.56; RR = 1.02; 95% CI (0.95, 1.09)] and diseases leading to death between the two groups [HBV recurrence leading to death: P  = 0.05; RR = 0.47; 95% CI (0.22, 1.02); hepatocellular carcinoma recurrence leading to death: P  = 0.13; RR = 0.34; 95% CI (0.09, 1.36)]. In conclusion, combination of lamivudine and HBIG can effectively decrease the recurrence rate of HBV and the incidence of YMDD mutant, but it can not improve patient survival and graft survival significantly. Well-designed large-sample trials are needed to evaluate the efficiency of combined therapy of lamivudine and HBIG in prophylaxis of HBV recurrence in liver graft recipients.     

Quality of recovery from two types of general anesthesia for ambulatory dental surgery in children: a double-blind, randomized trial

Background:  Pediatric dental procedures are increasingly performed under general anesthesia because of the inability to cooperate, situational anxiety, or other behavioral problems. Volatile anesthetics have been associated with emergence delirium in children, whereas the use of propofol for anesthetic maintenance has been shown to reduce the incidence of emergence delirium after other types of surgeries. The aim of this study is to compare a sevoflurane-based anesthetic with a propofol-based technique as it relates to the incidence of emergence delirium and the quality of recovery after pediatric dental surgery, in patients who present with risk factors for perioperative behavioral issues.
Methods:  We prospectively collected data of 179 pediatric patients scheduled for ambulatory dental surgery using a double-blind and randomized trial design. Subjects were anesthetized following standardized protocols for either a sevoflurane- or a propofol-based technique. The incidence of emergency delirium, as measured by the Pediatric Anesthesia Emergence Delirium score, was the primary outcome. Secondary outcomes included the incidence of postoperative nausea and vomiting (PONV), number of nursing interventions in the recovery room, time to discharge readiness, and parental satisfaction.
Results:  We found no difference in the incidence of emergence delirium after both types of anesthesia. However, use of sevoflurane significantly increased both the risk of PONV and the number of postoperative nursing interventions. Discharge criteria were met about 10 min earlier in patients anesthetized with sevoflurane. Parental satisfaction was equally high with both anesthesia regimens.
Conclusions:  A propofol-based anesthetic technique did not lead to a lower incidence of emergence delirium after dental surgery in children but did result in significantly less PONV and fewer postoperative nursing interventions.     

Use of premedication for intubation in tertiary neonatal units in the United Kingdom

Background:  Endotracheal intubation and laryngoscopy are frequently performed procedures in neonatal intensive care. These procedures represent profoundly painful stimuli and have been associated with laryngospasm, bronchospasm, hemodynamic changes, raised intracranial pressure and an increased risk of intracranial hemorrhage. These adverse changes can cause significant neonatal morbidity but may be attenuated by the use of suitable premedication.
Aims:  To evaluate current practices for premedication use prior to elective intubation in UK tertiary neonatal units.
Methods:  Telephone questionnaire survey of all 50 tertiary neonatal units in the UK.
Results:  Ninety percent of units report the routine use of sedation prior to intubation and 82% of units routinely use a muscle relaxant. Morphine was the most commonly used sedative and suxamethonium was the most commonly used muscle relaxant. Approximately half of the units also used atropine during intubation. Seventy seven percent of units had a written policy for premedication. Ten percent of the units did not routinely use any sedatives or muscle relaxants for elective intubation.
Conclusions:  In comparison with data from a 1998 survey, our study demonstrated an increase in the number of units that have adopted a written policy for premedication use, and in the number routinely using premedication drugs for elective intubation. There remains little consensus as to which drugs should be used and in what dose.     

Risk factors for lymph node metastasis in clinically node-negative penile cancer patients

Objectives:   To analyze the effects of pathological T stage, grade, extent of surgery for primary tumor, and age group on the risk of developing lymph node metastasis in clinically node-negative penile cancer patients.
Methods:   We performed a retrospective analysis of 200 clinically node-negative penile cancer patients who were kept under surveillance, after treatment of the primary tumor in our institution. The primary outcome parameter was cytologically or histologically proven lymph node metastasis. Logistic regression analysis was used to compute odds ratios in univariate and multivariate settings.
Results:   Lymph node metastasis occurred in 31 patients at a median time of three months. Histological grade 3 and grade 2 tumors had a statistically significant increased odds ratio for lymph node metastasis, (7.1[ P  < 0.001] and 2.7 [ P  = 0.04], respectively), compared with grade 1 tumors. Although increasing pT stage was associated with increasing odds ratios, the differences were not statistically significant. Nor did the extent of surgery of the primary tumor or the age group significantly influence the risk of developing lymph node metastasis.
Conclusions:   Histological grade is the most significant parameter influencing the risk of lymph node metastasis in clinically node-negative penile cancer patients on surveillance. Patients with grade 3 and grade 2 tumors may benefit from elective inguinal lymphadenectomy.     

Growth pattern in the muscular layer reflects the biological behaviour of colorectal cancer

Objective  To determine the clinical value of evaluating the cancer morphology in muscularis propria (MP) for colorectal cancer (CRC) patients.
Method  A total of 994 patients with advanced CRC were reviewed in terms of two distinctive growth patterns in the MP: (i) horizontal spread between the circular and longitudinal muscle layers (H-spread) and (ii) 'streaming' spread between the muscle bundles of the circular muscle layer (S-spread).
Results  The incidence of H-spread ( n  = 153) and S-spread ( n  = 150) showed a positive correlation with tumour-node-metastasis (TNM) stage and both exerted a negative impact on postoperative survival. Adverse morphology in the MP (H-spread and/or S-spread) was consistent with a high grade of vascular invasion and budding in the extramural layer, as also with unfavourable fibrotic stromas in the reactive fibrous zone; the 5-year survival rate in patients with such features was 64.2%, which was lower than that in those without (86.5%, P  < 0.0001). Multivariate analysis demonstrated that adverse morphology was an independent prognostic determinant, along with T- and N -stage. As the mode of H-spread, perineural invasion in the myenteric plexus was found to be predominant over lymphatic spread on the basis of S100 and CD34 immunostaining, but neural cell adhesion molecule expression, whether on cancer cells or on neural cells, was not significant for this growth pattern.
Conclusion  A particular group of CRCs ingeniously utilizes the thin space between muscle fascicles for development in the MP. Although the biological mechanism remains unknown, this distinctive growth pattern could be a useful indicator to identify CRC patients at high risk of recurrence.     

Salbutamol premedication in children with a recent respiratory tract infection

Background :  Premedication with β-2 agonists (e.g. salbutamol) is effective in preventing increases in total respiratory resistance and in decreasing the incidence of perioperative bronchospasm in asthmatic children. Because children with recent respiratory tract infection (RTI) exhibit bronchial hyperreactivity similar to that observed in asthmatic children, the use of salbutamol in children with RTI has become popular among pediatric anesthetists for the prevention of perioperative respiratory adverse events (PRAE). In a prospective observational study, we therefore assessed the usefulness of salbutamol premedication on the occurrence of PRAE.
Methods :  Results from 600 children (0–16 years) undergoing general anesthesia were analyzed: 200 children with a recent RTI who received preoperative salbutamol 10–30 min prior to surgery, 200 children with a recent RTI without salbutamol premedication, and 200 children without a RTI during the last 4 weeks. All PRAE (laryngospasm, bronchospasm, oxygen desaturation [<95%], severe coughing) were recorded.
Results :  Children with a recent RTI who received salbutamol demonstrated a significantly reduced incidence of perioperative bronchospasm (5.5% vs 11%, P  = 0.0270) and severe coughing (5.5% vs 11.5%, P  = 0.0314) compared with children who had an RTI but did not receive salbutamol. However, healthy children presented with the lowest rate (bronchospasm 1.5%, severe coughing 4.5%) of respiratory complications compared with children with a recent RTI independent whether or not they received salbutamol preoperatively.
Conclusions :  The results from this audit suggest that children with a history of a recent RTI have significantly less PRAE following a premedication with salbutamol compared with no premedication. Therefore, premedication with salbutamol might be considered in children with recent RTI.     

Prognostic factors in survival of colorectal cancer patients after surgery

Objective  To determine the factors affecting survival, following resection of large bowel for colorectal carcinoma.
Method  From the cancer database of a single referral institution, a total of 1090 patients who had undergone colorectal resection between 1999 and 2002 were identified. Cases with recurrent colorectal cancer or previous history of neoadjuvant chemotherapy were excluded. Survival curves were plotted using the Kaplan–Meier method. Univariate analysis of factors thought to influence survival was then made using Logrank test. Criteria studied consisted of age, sex, TNM stage, T-status, nodal status, distant metastasis, histological grade, lymphatic and vascular invasion, tumour location, preoperative carcinoembryonic antigen (CEA) level and liver function tests. Multivariate analysis was conducted using Cox regression analysis.
Results  The mean survival time for all patients was 42.8 (SEM = 2.8) months. The overall 1-, 3- and 5-year survival rates were 72%, 54% and 47%, respectively. In univariate analysis, patients' age ( P  < 0.0001), TNM stage ( P  < 0.0001), T-status ( P  = 0.015), nodal status ( P  = 0.016), distant metastasis ( P  < 0.0001), grade ( P  = 0.005), lymphatic and vascular invasion ( P  < 0.0001) and presurgery CEA level > 5 ng/ml ( P  = 0.021) were found to be predictors that could affect survival. In Cox regression analysis, age ( P  < 0.0001), TNM stage ( P  = 0.001) and grade ( P  = 0.008) were determined as independent prognostic factors of survival.
Conclusion  Age, TNM stage, T-status, nodal status, distant metastasis, grade, lymphatic and vascular invasion and presurgery CEA level can predict the postsurgical survival rate in patients with colorectal cancer.     

Efficacy of a low-dose spinal morphine with bupivacaine for postoperative analgesia in children undergoing hypospadias repair

Background:  Children undergoing hypospadias repair need to be protected from highly unpleasant sensory and emotional experiences during and after surgery. We designed a double-blinded, randomized, and placebo-controlled study to compare the efficacy of a low-dose (2 μg·kg⁻¹) of intrathecal morphine with placebo for postoperative pain control of children undergoing repair of hypospadias surgery with spinal anesthesia.
Methods:  Fifty-four children were randomly assigned to one of two spinal anesthesia groups. Group M ( n  = 27) received hyperbaric bupivacaine plus 2 μg·kg⁻¹ of preservative-free morphine and group P ( n  = 27) received hyperbaric bupivacaine plus 0.9% NaCl (placebo) under inhalation anesthesia. General anesthetics were discontinued subsequent to the block. The primary outcome was the presence of pain-requiring analgesics during the first 12 h after the spinal block. Side effects were also recorded. The analgesic effects were evaluated by using the Children's Hospital of Eastern Ontario Pain Scale.
Results:  Forty-nine patients completed the trial. Fifteen patients (60%) in group P received supplementary analgesics within the first 12 h compared to only four patients (16.7%) in group M ( P  = 0.005). Mean duration of analgesia was 480 ± 209 and 720 ± 190 min in group P and group M respectively ( P  = 0.009). The groups were similar in postoperative side effects.
Conclusion:  Spinal anesthesia provided by hyperbaric bupivacaine is adequate for distal hypospadias repair in children, but adding 2 μg·kg⁻¹ intrathecal morphine provides better postoperative pain control when compared to placebo in these children.     

Advanced oxidative protein products are independently associated with endothelial function in peritoneal dialysis patients

Aim:   Oxidative stress (OS) and asymmetric dimethylarginine (ADMA) are accepted as non-classical cardiovascular risk factors in end-stage renal disease patients. To clarify the role of these factors in the atherosclerotic process, we investigated if OS and ADMA are associated with endothelial function (EF) in peritoneal dialysis (PD) patients.
Methods:   Fifty-two non-diabetic PD patients without known atherosclerotic disease as well as 30 age- and sex-matched healthy individuals were included. We measured serum thiobarbituric acid-reactive substances (TBARS), malondialdehyde (MDA), advanced glycation end-product (AGE), pentosidine, advanced oxidation protein products (AOPP), ADMA and EF as described by Celermejer et al. in all subjects.
Results:   TBARS, MDA, AOPP, AGE, pentosidine and ADMA levels were significantly higher in PD patients than in controls ( P  < 0.001). Flow-mediated dilatation (FMD)% and nitrate mediated dilatation (NMD)% in PD patients were lower than in the control group (7.7 ± 4.0% vs 11.70 ± 5.50%, P  < 0.01 and 17.6 ± 8.3% vs 26.4 ± 4.6%, P  < 0.01). Additionally, it was found that AOPP are independently correlated with FMD% and NMD% in PD patients (β = −463, P  < 0.01 and β = −420, P  < 0.05).
Conclusion:   This study shows that PD patients without known atherosclerotic disease can also be characterized by endothelial dysfunction and AOPP levels independently predict endothelial function level in PD patients.     

An audit of transfusion of red blood cell units in pediatric anesthesia

Background:  Patients undergoing surgery are an important user of red blood cells (RBC). Increasingly, medical staff and patients wish to know the likelihood of RBC transfusion for appropriate resource allocation and to inform preoperative discussions regarding risk. Although some adult data are available, little is known about RBC use in children.
Aim:  The aim of this study was to describe RBC use in the perioperative period in a large pediatric hospital.
Methods:  Over a 2-year period the hospital operating theatre database and trauma registry was merged with the blood bank database to identify episodes where RBC units were transfused in association with anesthesia. Incidence of transfusion of RBC units associated with particular procedures was then calculated.
Results:  A total of 21 441 patients underwent 32 511 anesthetics from January 1, 2006 to December 31, 2007, and 9838 units of RBC were released from the hospital blood bank of which 4070 (41%) were transfused in the perioperative period. Cardiac surgery was the greatest user of RBC units (2359 units). Acute major trauma accounted for only 159 units. Overall 6.3% of anesthetics were associated with a RBC transfusion. The procedures with the greatest frequency of RBC transfusion were cardiac surgery on bypass (79%), cardiac off bypass (55%), liver transplant (87%) and cranioplasty (61%).
Conclusion:  In a tertiary pediatric hospital surgery accounts for a substantial proportion of total RBC use, with particular procedures accounting for the majority of transfusions.     

Polymorphism of cytochrome P450 2B6 and prostate cancer risk: A significant association in a Japanese population

Objectives:   To explore whether Lys262Arg polymorphism of the Cytochrome P450 2B6 (CYP2B6) gene could act as a genetic marker for prostate cancer risk among Japanese men.
Methods:   A total of 350 patients with sporadic prostate cancer and 328 controls were examined. A single nucleotide polymorphism with non-synonymous amino acid change located at Lys262Arg of the CYP2B6 gene was genotyped using a TaqMan assay.
Results:   The frequency of the Arg/Arg genotype among prostate cancer patients was significantly higher than that among the controls ( P  = 0.027). The frequency of the G allele of the Lys262Arg polymorphism was also significantly higher in prostate cancer patients than in the controls (30.4% vs 24.8%, P  = 0.025). Patients with the Lys/Arg plus Arg/Arg genotypes carried a low Gleason score more frequently than those with the Lys/Lys genotype ( P  = 0.042). The frequency of the G allele of the Lys262Arg polymorphism was significantly higher in the low Gleason score group than that in the high Gleason score group (34.3% vs 26.8%, P  = 0.038).
Conclusions:   Lys262Arg polymorphism of the CYP2B6 gene may be a genetic marker for evaluating the risk of sporadic prostate cancer in native Japanese men.     

Laparoscopic versus open radical cystectomy for the management of bladder cancer: Mid-term oncological outcome

Objective:   To compare the mid-term oncological outcome of laparoscopic radical cystectomy (LRC) with those of open radical cystectomy (ORC).
Methods:   From June 2003 to February 2008, 36 LRCs were carried out at our institute for the treatment of bladder cancer. Clinical and oncological data were retrospectively analyzed. A match-pair comparison with an historical series of 34 patients who were submitted to ORC between 1996 and 2003 was carried out.
Results:   Median follow-up of the LRC group was 21 months (3–56 months). Pathological stage or grade was similar in the two groups. There was no significant difference between the LRC and ORC groups in terms of 3-year overall (64.2% vs 72.6%, respectively; P  = 0.682), cancer-specific (73.0% vs 75.3%, respectively; P  = 0.951), and recurrence-free survival (70.5% vs 72.5%, respectively; P  = 0.715) rates. In a subgroup analysis according to stage, there was also no significant difference in the 3-year disease-specific survival after LRC or ORC for organ-confined (pT1 and pT2; 85.7% vs 83.9%, respectively; P  = 0.256) or extravesical disease (pT3 and pT4; 73.3% vs 63.8%, respectively; P  = 0.825).
Conclusion:   These findings suggest that LRC provides mid-term oncological outcomes similar to those of ORC in the management of bladder cancer.     

Myocutaneous flap reconstruction of the perineum after radical abdominoperineal resection

Objective:  Accurate tumour re-assessment after down-sizing preoperative chemoradiotherapy (CRT) for locally advanced middle and lower rectal cancer provides valuable prognostic information prior to surgical resection. (1) We assessed the accuracy of post-CRT magnetic resonance imaging (MRI) in predicting circumferential resection margin status. (2) The accuracy of MRI in staging chemoradiation down-sized rectal tumours was also assessed.
Method:  Patients from a single tertiary referral centre who received preoperative CRT for biopsy-proven rectal cancer between January 2003 and February 2005 were identified from a database. All patients received long-course CRT (50 Gy over 5 weeks and 5-fluorouracil/leucovorin) prior to surgery. A comprehensive MRI reporting proforma was completed for each patient and results were compared directly with histological specimens.
Results:  Fifty patients were eligible for the study. The overall accuracy for predicting circumferential resection margin status was 76% (38/50, P  = 0.006, sensitivity = 96.9%, specificity = 73.8%, negative predictive value = 96.9%). For T staging, MRI was accurate in 52% (26/50) and for nodal staging MRI was correct in 60% (30/50). Venous invasion was predicted in 66% (33/50, P  = 0.04). A radiological rectal cancer regression grade was derived and this correlated with histological rectal cancer regression grade in 65% (32/49).
Conclusion:  This study demonstrates that post-CRT MRI is accurate in predicting the circumferential resection margin status, which provides useful prognostic information prior to surgery.     

The clinical characteristics of renal cell carcinoma in female patients

Objective:   To investigate the clinical characteristics of renal cell carcinoma (RCC) in female patients.
Methods:   The clinical characteristics including sex, age at diagnosis, histological tumor size, histological subtype, Fuhrman nuclear grade and pathological tumor–node–metastasis (TNM) stage of 881 consecutive patients treated with (partial) nephrectomy for RCC from 1998 to 2006 were analyzed. Characteristics of different gender groups and different female age groups were compared. The one-way anova and t -test were used to compare means. Pearson's χ²-test and the likelihood ratio test were used to compare ratios.
Results:   Low-grade tumors accounted for 79.3% of female patients and 64.1% of male patients ( P  < 0.001). The percentage of stage T1–2 was 76.6% in female patients while it was only 68.5% in male patients ( P  = 0.011). Also, female patients had more T1–2N0M0 tumors (73.0% vs 64.3%, P  = 0.009). Once female patients were classified into three groups according to age diagnosis (≤40, 41–59 and ≥60 years) young female patients seemed to have more tumors with unfavorable histology (8.7% vs 5.1% vs 4.3%), Fuhrman grade 3–4 (23.9% vs 23.1% vs 17.7%) and stage T3–4 (28.3% vs 23.1% vs 22.0%).
Conclusion:   Compared with male patients, female patients had lower stage and grade tumors. However, younger female patients had more tumors with unfavorable histology, and higher stage and grade compared to older female patients.     

Comparison between intubation and the laryngeal mask airway in moderately obese adults

Background: Obesity is a well-established risk factor for perioperative pulmonary complications. Anaesthetic drugs and the effect of obesity on respiratory mechanics are responsible for these pathophysiological changes, but tracheal intubation with muscle relaxation may also contribute. This study evaluates the influence of airway management, i.e. intubation vs. laryngeal mask airway (LMA), on postoperative lung volumes and arterial oxygen saturation in the early postoperative period.
Methods: We prospectively studied 134 moderately obese patients (BMI 30) undergoing minor peripheral surgery. They were randomly assigned to orotracheal intubation or LMA during general anaesthesia with mechanical ventilation. Premedication, general anaesthesia and respiratory settings were standardized. While breathing air, we measured arterial oxygen saturation by pulse oximetry. Inspiratory and expiratory lung function was measured preoperatively (baseline) and at 10 min, 0.5, 2 and 24 h after extubation, with the patient supine, in a 30° head-up position. The two groups were compared using repeated-measure analysis of variance (ANOVA) and t -test analysis. Statistical significance was considered to be P <0.05.
Results: Postoperative pulmonary mechanical function was significantly reduced in both groups compared with preoperative values. However, within the first 24 h, lung function tests and oxygen saturation were significantly better in the LMA group ( P <0.001; ANOVA).
Conclusions: In moderately obese patients undergoing minor surgery, use of the LMA may be preferable to orotracheal intubation with respect to postoperative saturation and lung function.     

Adiponectin is increased and correlated with the degree of proteinuria, but plasma leptin is not changed in patients with chronic glomerulonephritis

Aim:   Altered regulation of adiponectin and leptin may be relevant to endothelial dysfunction and cardiovascular complications in patients with chronic glomerulonephritis.
Methods:   The relationship between the levels of plasma adiponectin, leptin and proteinuria, glomerular filtration rate and metabolic risk factors was investigated in 38 patients with chronic glomerulonephritis.
Results:   Plasma adiponectin was much higher in patients with heavy proteinuria (38.8 ± 27.8 µg/mL) than in patients with mild proteinuria (13.3 ± 5.1 µg/mL, P  < 0.001) and with moderate proteinuria (18.1 ± 8.0 µg/mL, P  < 0.01). The levels of serum leptin were not changed among these groups. Proteinuria and lipoprotein(a) were a strong and direct correlate of plasma adiponectin ( r  = 0.75, P  < 0.0001), while serum albumin and the glomerular filtration rate correlated inversely with this protein ( r  = −0.56, P  = 0.0002; r  = 0.38, P  = 0.02). Body mass index and triglyceride were direct correlates ( r  = 0.37, P  = 0.02 and r  = 0.37, P  = 0.02, respectively) of plasma leptin in patients with glomerulonephritis.
Conclusions:   Plasma adiponectin but not plasma leptin levels correlate with proteinuria in patients with chronic glomerulonephritis.     

Effect of body mass index on prostate-specific antigen and percentage free prostate-specific antigen: Results from a prostate cancer screening cohort of 1490 men

Objectives:   Several studies have reported an effect of obesity, defined as elevated body mass index (BMI), on prostate cancer biology. We examined the relationship between BMI and total prostate-specific antigen (tPSA) as well as percent free tPSA (%f/tPSA) in a large prostate cancer screening cohort.
Methods:   Height, weight, tPSA and %f/tPSA were assessed in 1490 consecutively screened Canadian men without known prostate cancer. Continuously coded and categorized BMI were studied. Statistical analyses consisted of anova , linear regression and bivariate correlations, which adjusted for the effect of age.
Results:   Median tPSA was 1.06 ng/mL and median %f/tPSA was 27. Median BMI was 26.17 kg/m². Increasing BMI was weakly, albeit statistically significantly, associated with decreasing %f/tPSA values (correlation coefficient = −0.06, P  = 0.01). However, when the World Health Organization BMI categories were considered, there were no statistically significant differences between %f/tPSA values according to categories ( anova P  = 0.2). tPSA failed to demonstrate any statistically significant association with either continuously coded (correlation coefficient = −0.03, P  = 0.2) or categorized BMI ( anova P  = 0.5).
Conclusions:   Body mass index is not a confounder of either tPSA or %f/tPSA in Canadian men without known prostate cancer.     

Risk factors for laryngospasm in children during general anesthesia

Background:  Laryngospasm is a common and often serious adverse respiratory event encountered during anesthetic care of children. We examined, in a case control design, the risk factors for laryngospasm in children.
Material and Methods:  The records of 130 children identified as having experienced laryngospasm under general anesthesia were examined. Cases were identified from those prospectively entered into the Mayo Clinic performance improvement database between January 1, 1996 and December 31, 2005. Potential demographic, patient, surgical and anesthetic related risk factors were determined in a 1 : 2 case–control study.
Results:  No individual demographic factors were found to be significantly associated with risk for laryngospasm. However, multivariate analysis demonstrated significant associations between laryngospasm and intercurrent upper respiratory infection (OR 2.03 P  =   0.022) and the presence of an airway anomaly (OR   =   3.35, P  =   0.030). Among those experiencing laryngospasm during maintenance or emergence, the use of a laryngeal mask airway was strongly associated even when adjusted for the presence of upper respiratory infection and airway anomaly ( P  =   0.019). Ten patients experienced postoperatively one or more complications whereas only three complications were observed among controls ( P  =   0.008). No child required cardiopulmonary resuscitation and there were no deaths in either study cohort.
Conclusions:  In our pediatric population, the risk of laryngospasm was increased in children with upper respiratory tract infection or an airway anomaly. The use of laryngeal mask airway was found to be associated with laryngospasm even when adjusted for the presence of upper respiratory tract infection and airway anomaly.