Advantages and limitations of day surgery in children in a developing country

Day surgery (DS) especially in children, has been widely accepted by surgeons, and the benefits to the patients, parents, and hospital have been well-established. It has become particularly popular among working parents and is accepted by hospital administrators. Proper case selection, preoperative assessment, and proper parent counselling, choice of anaesthesia, postoperative analgesia, and follow-up advice are essential for a successful outcome. This paper records our experience with 465 infants and children who underwent DS at Government Stanley Hospital and two semi-charitable trust hospitals in Madras during the years 1985–1986. The overall acceptance of the programme was excellent, with minimal complications and a fallout rate of 9.6%. The advantages of DS in our environment are discussed. Accepted: 20 October 1997     

Evaluation of clinico-immunological parameters in pediatric ABPA patients

Allergic bronchopulmonary aspergillosis patients (ten in the age group 5–13) were studied with respect to clinical and immunodiagnostic tests. All the patients showed wheal and flare reaction withA. fumigatus antigens. Clinical features included bilateral infiltration and hilar lymphadenopathy. Eosinophilic count in these patients was observed to be in the range of 300–2500/mm³. Sera of six patients indicated precipitin reaction withA. fumigatus antigens. An elevated total serum IgE was noticed in all the patients.A. fumigatus specific IgG and IgE antibodies were increased in these patients. Optical density of the sera of all the patients against controls were observed to be in the range of (0.426 to 1.8 for IgG and 0.147 to 0.562 for IgE) by ELISA. Western blot analysis indicated that there may be correlation between the clinical stages of the disease and immunological reactivity of the sera with various antigenic components.     

Technetium 99m-labeled sestamibi imaging reliably identifies retained contractile reserve in dyssynergic myocardial segments

Background

Recently there has been considerable controversy regarding the use of ^99mTc-labeled sestamibi as an agent for the detection of viable myocardium. In this study we have used dobutamine-induced left ventricular wall thickening by echocardiography in regions with evidence of resting dyssynergy of the left ventricle as an indicator of retained contractile reserve and compared this with 99m Tc-labeled sestamibi uptake in the same regions.

Methods and Results

Twenty-seven patients with documented coronary artery disease and severe regional wall motion abnormalities underwent low-dose (5 to 15 μg/kg/min) dobutamine echocardiography and maximal (15 to 40 μg/kg/min) stress dobutamine ^99mTc-labeled sestamibi single-photon emission computed tomographic imaging. Separate-day rest ^99mTc-labeled sestamibi scanning was also performed. ^99mTc-labeled sestamibi uptake was assessed semiquantitatively from grades from 1 to 4, from normal to absent perfusion. Regions with grade 3 or less uptake were considered viable by ^99mTc-labeled sestamibi. Of the 34 regions with severe wall motion abnormalities by echocardiography, 32 showed improved wall thickening with low-dose dobutamine. Rest ^99mTc-labeled sestamibi detected retained myocardial viability in 29 of these regions (91%) that were deemed to have contractile reserve by echocardiography (concordance: 91% [K=0.53; p<0.001]). Furthermore, stress-rest ^99mTc-labeled sestamibi revealed completely reversible defects in five regions (16%), partially reversible defects in 24 regions (75%), and grade 4 uptake and fixed (nonviable) defects in three (9%) of these 32 regions with retained contractile reserve.

Conclusion

Uptake of ^99mTc-labeled sestamibi at rest accurately identifies regions of segmental dyssynergy in which recovery of function may be provoked by inotropic stimulation. Addition of stress dobutamine ^99mTc-labeled sestamibi provides further proof of retained myocardial viability in these dysfunctional segments.     

Blood Metal Ion Levels Have Limited Utility in the Surveillance of Asymptomatic Large-Head Metal-on-Metal Total Hip Arthroplasties

Background

Blood cobalt (Co) and chromium (Cr) ion levels have been used as surveillance tools for adverse reaction to metal debris (ARMD) in metal-on-metal (MoM) articulations with varying thresholds in different countries. The aim of our study is to present the serial 12-year blood Co and Cr levels in a cohort of MoM total hip arthroplasties (THAs) with femoral head size ≥36 mm and analyze their utility in asymptomatic patients at current thresholds.

Numbness Around the Total Knee Arthroplasty Surgical Scar: Prevalence and Effect on Functional Outcome

Background

Numbness around the surgical scar can be a source of discomfort or dissatisfaction in a proportion of patients undergoing total knee arthroplasty (TKA). Literature reports wide variation in its prevalence and the consequence of numbness on the outcome of TKA is not clear. We investigated the prevalence of numbness, along with contributing factors, and assessed its effect on the functional outcome of TKA.