Bilateral intra-oral, infra-orbital nerve block for postoperative analgesia following cleft lip repair in paediatric patients: comparison of bupivacaine vs bupivacaine-pethidine combination

This prospective, randomised, double blind study compared the efficacy of pethidine as an adjuvant to bupivacaine with the efficacy of bupivacaine alone for infra-orbital nerve block in alleviating postoperative pain in children undergoing cleft lip repair. Forty paediatric patients aged between 5 and 60 months undergoing cleft lip repair were randomly allocated to two groups of 20. After tracheal intubation, group B received bilateral intra-oral, infra-orbital nerve block with 1 ml of 0.25% bupivacaine on each side and group P received 1 ml of 0.25% bupivacaine along with 0.25 mg.kg(-1) body weight pethidine. Sedation after recovery from anaesthesia was assessed using the University of Michigan Sedation Scale (UMSS) and pain was assessed postoperatively up to 36 h using the FLACC scale (Face, Legs, Activity, Cry, Consolability). The median (IQR) duration of analgesia from the time of administration of block in group B was 18 h (14.2-20) compared to 29.1 h (24-36) in group P (p = 0.001). Addition of pethidine as an adjunct to local anaesthetic significantly prolonged the duration of postoperative analgesia without any adverse effects.     

Use of Ponseti's technique in recurrent clubfeet following Kite's method of correction

We report the results of 18 recurrent clubfeet in 13 children after Kite's method of casting treated successfully by Ponseti's technique. The average age was 8.3 months. The average preoperative Pirani's midfoot contracture score was 1.8, hindfoot contracture score was 2.4, and total score was 4.2. All patients had full correction of deformities with plantigrade feet and the scores were reduced to zero at the end of treatment. Three recurrences were found at 6 months follow-up, amounting to 17% failure rate. Two of them necessitated percutaneous tenotomy of the tendoachilles, and one underwent posteromedial soft tissue release with good result at the end of 1 year. Ponseti's method is an effective treatment option in the management of recurrent clubfeet after Kite's method. Although short-term results are promising, larger series with long-term follow-up is warranted.     

Inhibition of pacemaker currents by nitric oxide via activation of ATP-sensitive K+ channels in cultured interstitial cells of Cajal from the mouse small intestine

We investigated the role of nitric oxide (NO) in pacemaker activity and signal mechanisms in cultured interstitial cells of Cajal (ICC) of the mouse small intestine using whole cell patch-clamp techniques at 30°C. ICC generated pacemaker potential in the current clamp mode and pacemaker currents at a holding potential of –70 mV. (±)-S-nitroso-N-acetylpenicillamine (SNAP; a NO donor) produced membrane hyperpolarization and inhibited the amplitude and frequency of the pacemaker currents, and increased resting currents in the outward direction. These effects were blocked by the use of glibenclamide (an ATP-sensitive K⁺ channel blocker), but not by the use of 5-hydroxydecanoic acid (a mitochondrial ATP-sensitive K⁺ channel blocker). Pretreatment with ODQ (a guanylate cyclase inhibitor) almost blocked the NO-induced effects. The use of cell-permeable 8-bromo-cyclic GMP also mimicked the action of SNAP. However, the use of KT-5823 (a protein kinase G inhibitor) did not block the NO-induced effects. Spontaneous [Ca²⁺]_i oscillations in ICC were inhibited by the treatment of SNAP, as seen in recordings of intracellular Ca²⁺ ([Ca²⁺]_i). These results suggest that NO inhibits pacemaker activity by the activation of ATP-sensitive K⁺ channels via a cyclic GMP dependent mechanism in ICC, and the activation of ATP-sensitive K⁺ channels mediates the inhibition of spontaneous [Ca²⁺]_i oscillations.     

Protective effects of American ginseng (Panax quinquefolium) against mitomycin C induced micronuclei in mice

Mitomycin C (MMC) is a highly active anticancer drug commonly used alone and in combination with other chemotherapeutic agents for the treatment of different cancers. Its bioactivated form critically damages the DNA present in both rapidly dividing cancerous cells as well as in normal cells. Genotoxicity in the normal cells makes this drug highly toxic; thereby decreasing its therapeutic index for clinical use. The study investigated the chemoprotective potential of American ginseng root extract against MMC by using the micronuclei test in a mouse test system. Pre-treatment with ginseng at doses 50 mg/kg and 100 mg/kg, p.o. for 3 and 7 days significantly decreased the frequency of micronucleated polychromatic erythrocytes (PCEs). Similar protective effects were also observed during co-treatment with ginseng at similar doses for 3 and 7 days. The present results indicate that American ginseng extract is capable of suppressing the chromosomal aberration induced by MMC in mice. Thus, American ginseng may be a potent chemoprotective agent against the toxicity of the anticancer drug, mitomycin C.     

Intracerebral hemorrhage secondary to thrombocytopenia in a patient treated with temozolomide

Thrombocytopenia related intracerebral hemorrhage (ICH) secondary to chemotherapy induced myelosuppression can be very difficult to manage and may result in the death of the patient. We present the case of a 26-year-old male suffering a fatal ICH in the context of treatment of a high grade glioma with temozolomide. The clinician should be aware that a dose dependent severe and possible irreversible myelotoxicity can occur with temozolomide treatment resulting in substantial morbidity.     

Malignant peripheral nerve sheath tumors of the head and neck: A clinicopathological study

Twenty-seven cases of malignant peripheral nerve sheath tumors involving the head and neck region over a period of 7 years were reviewed. They were graded from 1–3 based on necrosis, mitosis, cellularity, and pleomor-phism. Mean age of occurrence was 42 years, with a range of 12–70 years. Male preponderance was noted (M:F = 3.5:1). The most common site of involvement was the neck (44.6%). The main presenting symptom was an enlarging mass. The nerve of origin could be identified in 33% of patients. Treatment consisted of wide excision. The 5-year observed survival was 33%. Fifty-two percent of patients developed local recurrence of disease. Fifteen percent of patients died due to advanced local disease within 18 months of treatment. Distant metastasis was seen in 18.5% of patients. Lymph node metastasis was not seen. At the end of 5 years 15% of patients remained disease free. Large tumor size (>5 cm) adversely affected the prognosis (P = < 0.1). No significant correlation was noted between the grade of tumor and survival. © Wiley-Liss, Inc.     

Magnetic Resonance Imaging Radiomics Analyses for Prediction of High-Grade Histology and Necrosis in Clear Cell Renal Cell Carcinoma: Preliminary Experience

IntroductionPercutaneous renal mass biopsy results can accurately diagnose clear cell renal cell carcinoma (ccRCC); however, their reliability to determine nuclear grade in larger, heterogeneous tumors is limited. We assessed the ability of radiomics analyses of magnetic resonance imaging (MRI) to predict high-grade (HG) histology in ccRCC.Patients and MethodsSeventy patients with a renal mass underwent 3 T MRI before surgery between August 2012 and August 2017. Tumor length, first-order statistics, and Haralick texture features were calculated on T2-weighted and dynamic contrast-enhanced (DCE) MRI after manual tumor segmentation. After a variable clustering algorithm was applied, tumor length, washout, and all cluster features were evaluated univariably by receiver operating characteristic curves. Three logistic regression models were constructed to assess the predictability of HG ccRCC and then cross-validated.ResultsAt univariate analysis, area under the curve values of length, and DCE texture cluster 1 and cluster 3 for diagnosis of HG ccRCC were 0.7 (95% confidence interval [CI], 0.58-0.82, false discovery rate P = .008), 0.72 (95% CI, 0.59-0.84, false discovery rate P = .004), and 0.75 (95% CI, 0.63-0.87, false discovery rate P = .0009), respectively. At multivariable analysis, area under the curve for model 1 (tumor length only), model 2 (length + DCE clusters 3 and 4), and model 3 (DCE cluster 1 and 3) for diagnosis of HG ccRCC were 0.67 (95% CI, 0.54-0.79), 0.82 (95% CI, 0.71-0.92), and 0.81 (95% CI, 0.70-0.91), respectively.ConclusionRadiomics analysis of MRI images was superior to tumor size for the prediction of HG histology in ccRCC in our cohort.     

Validation of a food frequency questionnaire to assess folate intake of Dutch elderly people

Folate is required for 1-carbon metabolism and deficiency in folate leads to megaloblastic anemia. Low levels of folate have been associated with increased risk of vascular disease. To investigate whether RDA of folate are met, habitual folate intake needs to be assessed reliably. We developed a FFQ to specifically measure folate intake over the previous 3 months in elderly people in the Netherlands. Major sources of folate intake, i.e. foods contributing to at least 80% of the average folate intake, were identified through an analysis of the second Dutch Food Consumption Survey for the sub-population of men and women aged 50-70. In 2000 and 2001, folate intake was estimated with this questionnaire in 1286 individuals aged 50-75 years. Concentrations of serum and erythrocyte folate served as biomarkers with which relative validity of the questionnaire was assessed. The same FFQ was repeated after 3 years in 803 subjects in order to assess long-term reproducibility. Mean folate intake was estimated to be 196 (SD 69) microg/d. Spearman correlation coefficients between folate intake and serum and erythrocyte concentrations were 0.14 (P < 0.01) and 0.05 (P = 0.06) respectively. Spearman correlations between folate intakes measured at baseline and after 3 years were 0.58 (P < 0.01). 47% of the participants were classified in the same quartiles on the two occasions. Our FFQ showed a weak correlation between folate intake and blood folate concentrations and reproducibility was acceptable. This FFQ is able to rank subjects according to their folate intake.