Unilateral extravesical ureteral reimplantation in children performed on an outpatient basis

PURPOSE: Unilateral extravesical ureteral reimplantation is comparable to intravesical procedures for resolution of primary vesicoureteral reflux (VUR). Defining whether this operation can be consistently performed on an outpatient basis is important. MATERIALS AND METHODS: A total of 80 patients with unilateral VUR were treated with extravesical ureteral reimplantation, of whom 20 were treated on an inpatient basis and 60 on an outpatient basis. We retrospectively reviewed these groups and conducted a telephone survey to evaluate overall patient satisfaction, and pain and nausea on postoperative days 1 and 14. RESULTS: There were no significant differences in age, gender, laterality or operative time between the groups. Average length of hospital stay was 31.25 hours (range 20 to 120) for the inpatient group and 6.6 hours (3.25 to 11.20) for the outpatient group. Average intravenous narcotic use in the inpatient group was 0.39 mg/kg, compared to 0.14 mg/kg for the outpatient group (p < 0.005), and included 1.76 mg/kg ketorolac in inpatients and 0.74 ketorolac in outpatients (p < 0.005), and 0.2 mg/kg ondansetron in inpatients and 0.12 mg/kg ondansetron in outpatients (p = 0.004). Four of the 60 outpatients (6.7%) were either hospitalized postoperatively or rehospitalized on postoperative day 1. The results of the survey for the 2 groups were not significantly different. CONCLUSIONS: Extravesical ureteral reimplantation for unilateral VUR may be performed without compromise in quality on an outpatient basis with significantly less use of intravenous analgesics and anti-emetics.     

Angiomatous ureteral polyp

A case report of a benign ureteral polyp is presented. Treatment consisted of local excision. The follow-up has been uneventful.     

Providing psychosocial support for breast cancer patients based on screening for distress within a consultation-liaison service

In a consecutive sample of 100 breast cancer patients undergoing radiotherapy, cancer-related distress was assessed with the Hospital Anxiety and Depression Scale and patients' interest in and acceptance of psychosocial support with the Questionnaire for Psychosocial Support and the European Consultation Liaison Workgroup documentation form. 31% of the patients suffered moderate to severe anxiety and/or depression and 42% expressed interest in supportive counselling. The wish for psychosocial support did not correlate with distress (moderate or severe anxiety and/or depression; Kappa = 0.06; P = 0.560). Patients with elevated levels of distress and/or those expressing a wish for psychosocial support were offered counselling by a psychotherapist and a social worker within the framework of a liaison service; 69% of the 58 patients offered such support accepted it. We conclude that screening instruments are helpful in identifying and consequently offering support to patients in need of counselling.     

Intracranial abnormalities in infants treated with extracorporeal membrane oxygenation: imaging with US and CT

Findings at neuroimaging in 100 consecutive infants treated with extracorporeal membrane oxygenation (ECMO) are presented. Imaging in these infants consisted of pretreatment cranial ultrasonography (US), daily US studies while on ECMO, and follow-up cranial computed tomography (CT) after treatment. There were findings of abnormalities in 43 patients. Thirty had intracranial bleeding, often of unusual extent and distribution. Thirteen additional infants had nonhemorrhagic abnormalities alone. Bleeding considered to be major was seen in 12% of infants. Large parenchymal hemorrhages and infarcts, cerebellar hemorrhages, and diffuse edema were the most significant abnormalities, with a 50% mortality (eight of 16 patients). No lateralization was noted with respect to distribution of bleeding sites or areas of nonhemorrhagic abnormalities. US was a sensitive but imperfect screening tool for intracranial abnormalities. Abnormalities missed with US included peripheral and small parenchymal lesions, subarachnoid hemorrhage, cerebral atrophy, and sagittal sinus thrombosis.     

The relationship between critical power and the onset of blood lactate accumulation

The purpose of this investigation was to determine the contribution of the onset of blood lactate accumulation (OBLA), the heartrate-workload slope (HR-WL) and the efficiency of electrical activity (EEA = slope of IEMG vs. workload) of the leg extensor muscles to Critical Power (CP). Twelve adult males (mean age +/- SD = 24.5 +/- 2.8 yrs) volunteered as subjects for this study. Zero-order correlations indicated that OBLA was significantly (p less than 0.05) related to CP (r = 0.616) and EEA (r = -0.577). Stepwise multiple regression resulted in a one variable model with OBLA the only significant (p less than 0.05) predictor of CP. Furthermore, a related t-test resulted in a significant difference between the means of the power out-put at CP (mean +/- SD = 230.0 +/- 22.1 watts) and OBLA (179.6 +/- 31.8 watts). The results of this study indicated that the two threshold parameters, CP and OBLA, were significantly related and therefore it is likely that the physiological factors responsible for OBLA also influence CP. However, the significant mean differences indicated that the mechanisms which underly CP and OBLA were not identical. Furthermore, the HR-WL slope (mean +/- SD = 0.343 +/- 0.071 beats per watt) and EEA (0.969 +/- 0.572 microvolts per watt) were not potent predictors of CP.     

Aneurysmal bone cyst arising in fibrous dysplasia during pregnancy

A case of two secondary aneurysmal bone cysts arising in fibrous dysplasia during pregnancy is reported. Marked radiographic changes were seen in one lesion over a 3-week period. The development of these cysts during pregnancy strongly suggests that the hemodynamic and/or hormonal changes of pregnancy were responsible for their formation.     

Speech-controlled generation of radiology reports

Voice entry has been successfully employed to generate radiology reports with a word recognizer with a 1,000-word lexicon capacity. About 50% of reports were able to be dictated with a single 900-word lexicon. This was split into five sections by anatomic or subspecialty application. Each was augmented to 900 words. By switching from one lexicon to another, it was possible to dictate more than 70% of reports. With exclusive use of three lexicons in subspecialty areas (gastrointestinal radiology, neuroradiology, and mammography), and with further modification of the respective vocabulary, it has been possible to employ the system 88% of the time. Twelve percent of cases included wording that was beyond the scope of the lexicon. Computer subsets that allow different translations of some words when used in different contexts have been used. Some of these are used as triggers that will print whole lines, sentences, or even complete reports. Dictation times with voice entry take about 20% longer. Recognition reliability has been greater than 95%.