Current application of thoracoscopy in children

BACKGROUND: The safety and efficacy of thoracoscopy for thoracic lesions and conditions in children is evolving. Our experience with thoracoscopy has expanded in recent years. Therefore, we reviewed our most recent 7-year experience to examine the current applications for thoracoscopy in children. METHODS: A retrospective review of all patients undergoing a thoracoscopic operation at Children's Mercy Hospital (Kansas City, MO) between January 1, 2000, and June 18, 2007, was performed. Data points reviewed included patient demographics, type of operation, final diagnosis, complications, and recovery. RESULTS: During the study period, 230 children underwent 231 thoracoscopic procedures. The mean age was 9.6 +/- 6.1 years with a mean weight of 36.6 +/- 24.1 kg. Fifty percent of the patients were male. The thoracoscopic approach was used for decortication and debridement for empyema in 79 patients, wedge resection for lung lesions in 37, exposure for correction of scoliosis in 26, excision or biopsy of an extrapulmonary mass in 26, operation for spontaneous pneumothorax in 25, lung biopsy for a diffuse parenchymal process in 15, lobectomy in 9, repair of esophageal atresia with a tracheoesophageal fistula (EA-TEF) in 8, clearance of the pleural space for hemothorax or effusion in 3, diagnosis for trauma in 1, and repair of bronchopleural fistula in 1. Conversion was required in 3 patients, all of whom were undergoing a lobectomy. Two of these were right upper lobectomies and the other was a left lower lobectomy with severe infection and inflammation. The mean time of chest tube drainage (excluding scoliosis and EA-TEF patients) was 2.9 +/- 2.0 days. There were no major intraoperative thoracoscopic complications. A correct diagnosis was rendered in all patients undergoing a biopsy. One patient required a second thoracoscopic biopsy to better define a mediastinal mass. Two patients developed postoperative atelectasis after scoliosis procedures. One patient had a small persistent pneumothorax after a bleb resection for a spontaneous pneumothorax. This subsequently resolved. CONCLUSIONS: In pediatric patients with thoracic pathology, thoracoscopy is highly effective for attaining the goal of the operation, with a low rate of conversion and complications.     

Laparoscopic cholecystectomy in the pediatric population

BACKGROUND: The experience with laparoscopic cholecystectomy in children trails the adult numbers and remains underreported. Therefore, we reviewed our experience with this approach. METHODS: A retrospective review of our most recent 6-year experience with laparoscopic cholecystectomy at Children's Mercy Hospital (Kansas City, MO) between September 5, 2000, and June 1, 2006, was performed. Data points reviewed included patient demographics, indication for operation, operative time, complications, and recovery. RESULTS: During the study period, 224 patients underwent a laparoscopic cholecystectomy. The mean age was 12.9 years (range, 0-21) with a mean weight of 58.3 kg (range, 3-121). Indications for laparoscopic cholecystectomy were symptomatic gallstones in 166 children, biliary dyskinesia in 35, gallstone pancreatitis in 7, gallstones and an indication for splenectomy in 6, calculous cholecystitis in 5, choledocholithiasis in 1, gallbladder polyps in 1, acalculous cholecystitis in 1, and congenital cystic duct obstruction in 1. The mean operative time (excluding patients with concomitant operations) was 77 minutes (range, 30-285). An intraoperative cholangiogram was performed in 38 patients. Common bile duct (CBD) stones were cleared intraoperatively in 5 patients. Two patients required a postoperative endoscopy to retrieve CBD stones. One sickle-cell patient developed a postoperative hemorrhage, requiring a laparotomy. There were no conversions, ductal injuries, bile leaks, or mortality. Biliary dyskinesia was diagnosed in 10% of the first 30 patients in this series and 40% of the most recent 30 patients. The mean ejection fraction in these patients was 21%. All experienced an improvement in their symptoms after the cholecystectomy. CONCLUSIONS: Laparoscopic cholecystectomy is safe and effective in children. Biliary dyskinesia is becoming more frequently diagnosed in children, and these patients respond favorably to cholecystectomy. As opposed to the adult population, the incidence of complicated gallstone disease appears less common in children, as most present with symptomatic cholelithiasis without active inflammation, accounting for the very low rate of ductal complications.     

活化的巨噬细胞介导的胰岛异种移植排异反应与细胞因子表达上调的关系

目的:笔者以往的实验证明与猪抗原接触过并被CD4 T淋巴细胞激活的巨噬细胞能识别、排斥猪的异种移植物,但不会排斥鼠的同种移植物,这表明在这种特异性移植物免疫识别及破坏过程中移植物及巨噬细胞之间存在着信号联系.方法:在免疫过继转移之前,将胎猪的胰腺碎片移植到非肥胖糖尿病/严重联合免疫缺陷(NOD/SCID)鼠.再从移植了胎猪的胰腺碎片(FPP)并发生排斥反应的受体Balb/c鼠身上分离出巨噬细胞,将这些外源性巨噬细胞植入NOD/SCID鼠.这些外源性的巨噬细胞通过Ly5.1表面抗原或通过CSFE染色标记来追踪.在移植了FPP异种移植物以后的CCR2,CCR5及它们的趋化因子的基因表达可通过实时PCR来评估.结果:形成免疫过继后较早移植的异种移植物出现了免疫排斥,而不是建立免疫过继较长时间后再移植FFP的NOD/SCID鼠.同时,前者可检测出更高水平的趋化因子的基因表达.而且,与未激活的巨噬细胞比较,已经激活的巨噬细胞CCR2,CCR5基因的表达增强更为明显.结论:趋化因子的上调与巨噬细胞的聚集、胰岛移植物的破坏有关.     

Severe methemoglobinemia due to insecticide poisoning

Methemoglobinemia is an altered state of hemoglobin resulting in impaired oxygen delivery to the tissues. Deliberate ingestion of certain insecticides and pesticides may result in this condition. We report a case of severe methemoglobinemia after deliberate ingestion of an insecticide marketed to be safe and containing only biological extracts and fillers. Methemoglobinemia should be suspected with low oxygen saturation on pulse oxymetry and the presence of chocolate colored blood. The methemoglobin level of 91% in our patient is the highest level reported among methemoglobinemia survivors.     

Rehabilitation of an Infected Eye with an Acrylic Ball Implant and a Custom made Scleral Ocular Prosthesis

This clinical report describes the prosthetic rehabilitation of a patient with corneal abscess with endophthalmitis of the left eye. Infection with a history of trauma resulted in loss of vision but with intact eye ball movements. Cornea excising evisceration was carried out following placement of poly(methyl methacrylate) ocular ball implant. Later custom made scleral prosthesis was fabricated to maintain functional integrity of the socket and to satisfy patient’s aesthetic needs.     

Eugenol,a plant-derived phenolic nutraceutical,protects thiol (SH) group in myocardium from ROS-mediated oxidation under chemotherapeutic stress induced by arsenic trioxide – a in vivo model study

Arsenic trioxide is an effective chemotherapeutic agent for the treatment of acute promyelocytic leukemia. The clinical usefulness of arsenic trioxide is narrow due to different organ toxicities. It is hypothesized that the generation of reactive oxygen species by arsenic trioxide leads to thiol-based oxidative damage in rat myocardium. In this study, the defensive effect of eugenol on thiol-based oxidative stress was investigated in arsenic trioxide-treated rats. Rats were orally administered with arsenic trioxide (4?mg/kg per day) alone and in combination with eugenol (5?mg/kg per day) for 30?days. Reduction in relative organ weight, total thiol level, protein thiol content, acid-soluble thiol content, thioredoxin activity, and protein content was witnessed in arsenic trioxide-treated rats. Additionally, the total antioxidant activity, tissue GSH level, and GSH/GSSG ratio were considerably diminished. However, the co-treatment of eugenol noticeably sheltered the arsenic trioxide-mediated cardiotoxicity. In conclusion, eugenol is a prospective phenolic compound, of natural origin, for protecting the thiol group in myocardium from oxidative stress by chemotherapeutic compounds.     

Choroidal Changes at the Leakage Site in Acute Central Serous Chorioretinopathy

Purpose: To analyze the choroidal vasculature at leak site and at the center of macula in acute central serous chorioretinopathy (CSCR) and to evaluate their co-relation with eccentricity of leak site.

Methods: This retrospective study involved optical coherence tomography analysis of 27 eyes with acute CSCR. Relationship between macular thickness; large choroidal vessels diameter; baseline subfoveal and leakage point choroidal thickness, and eccentricity of leak point was evaluated.

Results: A larger choroidal vessel caliber/choroidal thickness ratio was found at the leak site than fovea in both active (p = 0.0001) and resolved (p = 0.003) CSCR. Ratio at leakage point decreased after resolution of SRF (p = 0.004). Choroidal thickness at subfovea (p = 0.004), leakage point (p = 0.02); and difference between central and leakage point choroidal thickness (r = 0.6, p = 0.009) were significantly associated with the eccentricity of leakage point.

Conclusion: Subfoveal and leak site choroidal profile could predict the eccentricity of leakage in CSCR.