Total Laparoscopic Hysterectomy for Uteri Over One Kilogram

Introduction:

Laparoscopic hysterectomy for large fibroid uteri is technically a difficult procedure. In this article, we report our experience with fibroid uteri >1 kg in weight.

Materials and Methods:

An intent-to-treat study.

Results:

From 2003 to 2009, 13 patients were successfully treated for large fibroid uteri with postoperative specimens weighing >1000 g. Four patients had total abdominal hysterectomy, one patient had laparoscopically assisted vaginal hysterectomy, and 8 patients had total laparoscopic hysterectomy. The last 6 cases were total laparoscopic hysterectomy cases.

Conclusion:

With experience and specialized techniques, total laparoscopic hysterectomy can replace abdominal hysterectomy for large uteri.     

Study of Day,Month and Season Pedometer-Determined Variability of Physical Activity of High School Pupils in The Czech Republic

Long-term day-to-day monitoring of physical activity (PA) has not been undertaken in adolescents despite PA declines rapidly during adolescence. This study monitored the school year-round pedometer-determined PA of pupils attending high school in the Czech Republic. We assessed their PA levels; appraised the school year-round variability of their PA; and, assessed the associations between their PA levels and weekdays/weekends; months; seasons; and physical education (PE) lessons at school. We observed the PA levels of 10 girls and 2 boys (aged 16.0 ± 0.7 years). Each pupil wore an unsealed pedometer (Omron HJ-105) on the right side of the waist continuously for one year, and recorded steps/day and daily behaviour (e.g. after-school PA, PE lesson) into an activity diary. In total, participants recorded step counts for 2,979 person- days (82.0% of a possible 3,628 person-days). We used the Missing Values Analysis EM function of SPSS to estimate step values that were missing from the dataset. The sample’s mean daily step count was 14,727 ± 6,612 steps/day, and repeated ANOVA showed differences in steps/day across the days of the week (p < 0.0001), months (p < 0.0001) and seasons (p < 0.0001). The mean number of steps/day for weekdays (15,733 ± 6,354) was higher (p < 0.0001) than weekends values (12,196 ± 6,574), and was higher for days with PE lesson (17,280 ± 5,988) than for days without PE lesson (15,569 ± 6,318) (p < 0.0001). The total contribution of PE class (90 minutes) to pupils’ daily PA was 10.0% additional steps per PE day. In conclusion, this study contributes to understanding the day-to-day PA variability of adolescent pupils across the school year. Across all months and seasons, pupils achieved notably more steps on weekdays than on weekends; and on PE days than on non-PE days. Research is required to assess these findings for school pupils in other countries.

Key points

• Pedometer appears to be suitable for long-term monitoring of physical activity in adolescents.
• Day of the week, month and season are significant factors in pedometer-determined day-to-day variability of physical activity of adolescent pupils.
• Across all months and seasons, pupils achieved notably more steps on weekdays than on weekends, with Sunday being the least active day.
• Regular PE lessons contribute considerably to the total physical activity levels in adolescent pupils. The increase in steps/day on days with PE is relatively constant throughout the school year regardless of month, season and the content of PE lessons.

Key words: Day-to-day variability, physical education, adolescents, school year, pedometer     

Neonatal ventilation

Preventing ventilation-induced lung injury and bronchopulmonary dysplasia is an important goal in the care of ventilated neonates. Recently, there have been tremendous efforts to improve ventilation strategies, which aim at ventilating with a 'protective' and 'open-lung' strategy. Several different ventilation modes are now available, but it is important to note that, with regard to the neonatal pulmonary and neural outcome, there is still no clear evidence as to the superiority of one ventilation mode over another. Clinicians should bear in mind that any ventilation mode used to ventilate a neonate should be accompanied by real-time pulmonary monitoring to continuously adapt the ventilation strategy to the sudden changes in the respiratory mechanical properties of the lung. This article will describe the different ventilation modes available for neonates and highlight the importance of using a protective and open-lung ventilation strategy, even in the operating room.     

Anesthesia management in a young child with aromatic l-amino acid decarboxylase deficiency

Aromatic l-amino acid decarboxylase (AADC) deficiency is characterized by an almost complete absence of sympathetic autoregulation, because of very low levels of circulating catecholamines. Here, we report the successful management of four consecutive anesthesia procedures in a young child presenting with AADC deficiency. Our experience suggests that, with appropriate anticipation of the potential autonomic disturbances, anesthesia, at least for minor surgical and diagnostic procedures, can be conducted safely in patients with AADC deficiency.     

Necrotizing fasciitis caused by Aeromonas hydrophilia in an immunocompetent child

Necrotizing fasciitis is a rapidly progressive and potentially fatal infection. It is characterized by extensive subcutaneous and muscle necrosis. Aeromonus hydrophilia is a gram-negative faculatively anaerobic bacillus that is part of the normal flora of nonfecal sewage and is found in most water systems, soil, and fresh brackish water. Necrotizing fasciitis caused by A. hydrophilia have occurred in children who had underlying systemic diseases or immune dysfunction. We report a 14-year-old boy without underlying systemic diseases or immunodeficiency who developed necrotizing fasciitis secondary to A. hydrophilia and he was successfully treated with extensive surgical debridement and systemic antibiotics.