Local anesthesia in pediatric dermatologic surgery: Evaluation of a patient‐centered approach

Background/Objectives

A few studies have documented the effect of local anesthesia for minor dermatologic surgical procedures on children and their parents. Our objective was to evaluate the psychological effect and global satisfaction of a patient‐centered approach to dermatologic surgery under local anesthesia.

Methods

Two self‐administered questionnaires were used to evaluate the distress and global satisfaction of 388 children who underwent dermatologic surgery under local anesthesia, accompanied by oral and written therapeutic education measures (structured information and a cartoon brochure illustrating the procedure) addressed to children and parents. Distraction techniques were also used during the procedures.

Results

Although 54.5% of patients manifested some degree of fear, all other parameters analyzed (pain, surgery‐related distress, surgical team–patient and –family relationship, global satisfaction) indicated that the procedures resulted in limited distress and that the large majority of children and parents tolerated them well.

Conclusion

Specific measures for therapeutic pediatric patient education may be helpful in limiting discomfort, anxiety, and pain perception linked to procedures performed under local anesthesia. Further controlled studies are required to more precisely assess the benefits of specific therapeutic education measures.     

Bronchoscopic treatment of complex persistent air leaks with endobronchial one-way valves

We reported a case series including 5 patients with persistent air-leaks refractory to standard treatment. All patients were unfit for surgery for the presence of co-morbidities and/or severe respiratory failure due to underlying lung diseases. They were successfully treated with bronchoscopic placement of endobronchial one-way valves. Air-leaks stopped in the first 24 h after the procedure in three patients and 3 and 5 days later, respectively, in the remaining two. No complications were observed and follow-up was uneventful in all patients but one died 25 days after the procedure for systemic sepsis due to peritonis. Patients with important, refractory air leaks having clinical repercussions and unfit for surgery should be early reviewed for bronchoscopic valves treatment.     

Spontaneous reports of adverse drug reactions related to oral anticoagulants in the Czech Republic

International Journal of Clinical Pharmacy - Background Oral anticoagulants are established drugs of choice for the prevention and treatment of thromboembolic events. However, monitoring their...     

Melatonin down‐regulates MDM2 gene expression and enhances p53 acetylation in MCF‐7 cells

Compelling evidence demonstrated that melatonin increases p53 activity in cancer cells. p53 undergoes acetylation to be stabilized and activated for driving cells destined for apoptosis/growth inhibition. Over‐expression of p300 induces p53 acetylation, leading to cell growth arrest by increasing p21 expression. In turn, p53 activation is mainly regulated in the nucleus by MDM2. MDM2 also acts as E3 ubiquitin ligase, promoting the proteasome‐dependent p53 degradation. MDM2 entry into the nucleus is finely tuned by two different modulations: the ribosomal protein L11, acts by sequestering MDM2 in the cytosol, whereas the PI3K‐AkT‐dependent MDM2 phosphorylation is mandatory for MDM2 translocation across the nuclear membrane. In addition, MDM2‐dependent targeting of p53 is regulated in a nonlinear fashion by MDM2/MDMX interplay. Melatonin induces both cell growth inhibition and apoptosis in MCF7 breast cancer cells. We previously reported that this effect is associated with reduced MDM2 levels and increased p53 activity. Herein, we demonstrated that melatonin drastically down‐regulates MDM2 gene expression and inhibits MDM2 shuttling into the nucleus, given that melatonin increases L11 and inhibits Akt‐PI3K‐dependent MDM2 phosphorylation. Melatonin induces a 3‐fold increase in both MDMX and p300 levels, decreasing simultaneously Sirt1, a specific inhibitor of p300 activity. Consequently, melatonin‐treated cells display significantly higher values of both p53 and acetylated p53. Thus, a 15‐fold increase in p21 levels was observed in melatonin‐treated cancer cells. Our results provide evidence that melatonin enhances p53 acetylation by modulating the MDM2/MDMX/p300 pathway, disclosing new insights for understanding its anticancer effect.     

Effectiveness of primary percutaneous coronary intervention for acute ST-elevation myocardial infarction from a 5-year single-center experience

Primary percutaneous coronary intervention (PCI) is currently viewed as the preferred reperfusion strategy in patients with ST-elevation acute myocardial infarction (STEMI). This method was introduced in our hospital in 2000. From January 1, 2000, to December 31, 2004, a total of 2,393 consecutive patients with STEMI were admitted (27% transferred from 9 non-PCI hospitals and 31 prehospital emergency units/outpatient clinics). Of these patients, 1,666 (70%) underwent urgent coronary angiography and primary PCI. Platelet glycoprotein llb/llla inhibitors were used in 40% and stent placement, in 78%. Postprocedural Thrombolysis In Myocardial Infarction (TIMI) 3 flow was documented in 86%. Intra-aortic balloon counterpulsation was used in 6%; mechanical ventilation, in 8.6%; and inotropic drugs/vasopressors, in 15.8%. Mortality rates in patients with Killip's class I or II ranged from 1% to 4.9% without negative influence of ischemic time. In patients with Killip's class III or IV, mortality rates increased from 18% to 54% with increasing ischemic delay up to 6 hours (p = 0.06) and remained at around 40% afterward. Independent predictors of mortality were age (odds ratio [OR] 1.29, 95% confidence interval [CI] 1.01 to 1.64, p = 0.04), resuscitated cardiac arrest (OR 2.44, 95% CI 1.18 to 5.05, p = 0.02), and postprocedural TIMI flow (OR 0.31, 95% CI 0.16 to 0.59). Overall mortality rates of patients who underwent a primary PCI strategy from 2000 to 2004 were significantly lower than in the control group of 152 consecutive patients who underwent thrombolysis from 1995 to 1996 (6.2% vs 16.4%; p <0.001). In conclusion, introduction of a primary PCI strategy significantly decreased hospital mortality in our unselected group of patients with STEMI compared with the thrombolytic era. Our study further emphasized the importance of shortening myocardial ischemic time, particularly in the presence of severe heart failure on admission.     

Estimation of the Progenitor Cell Yield in a Leukapheresis Product by Previous Measurement of CD34+ Cells in the Peripheral Blood

To assess whether measurement of CD34+ cells in the peripheral blood allows one to estimate the progenitor cell yields of subsequent leukapheresis procedures, 733 corresponding blood and leukapheresis samples were analyzed. Peripheral blood progenitor cells of cancer patients were mobilized with hematopoietic growth factors alone or postchemotherapy, and harvested processing 10 liters of blood for each leukapheresis product. The CD34+ cell count (CD34+ cells/μl blood) correlated most closely with the progenitor cell yield in the corresponding leukapheresis product (CD34+ cells/kg bodyweight, r = 0.80), while the proportion of circulating CD34+ cells to the white blood and mononuclear cells predicted the yield less reliably (r = 0.74 and r = 0.60). The CD34+ cell yield was independent of the white blood count (r = 0.04), whereas a weak correlation was found between the mononuclear cell count and the number of CD34+ cells/kg collected (r = 0.42). It was unlikely to obtain the threshold quantity of 2.5 × 10⁶ CD34+ cells/kg required for rapid engraftment when counts below 10 CD34+ cells/μl blood were detected. At levels between 10 and 30 CD34+ cells/μl sufficient autografts could be harvested, whereas 30–100 CD34+ cells/μl were required to achieve this by a single leukapheresis. A surplus of CD34+ cells was likely above 100 CD34+ cells/μl which could be useful for progenitor cell enrichment techniques. The correlation between the CD34+ cell count and progenitor cell yield was independent of the mobilizing regimen and whether leukaphereses had been performed previously. In conclusion, the number of CD34+ cells/μl blood allows a reliable prediction of the CD34+ progenitor cell yield in subsequent leukapheresis procedures. However, rare cases of unexpectedly sufficient progenitor cell yields may be observed even at CD34+ cell levels below detection limit.