Using orbital sonography to diagnose and monitor treatment of acute swelling of the eyelids in pediatric patients

OBJECTIVE. Clinical signs of acute erythematous swelling of the periorbital region may be related either to benign superficial inflammation or to the more severe and potentially life-threatening condition of orbital infection. CONCLUSION. We recommend orbital sonography in every child with periorbital swelling and erythema. In contrast to superficial infection in which edematous swelling of the eyelid can be documented without lesions of the orbital content, either a hyper- or a hypo-echoic mass displacing the medial rectus muscle laterally is highly suggestive of orbital infection. Introducing sonography into early diagnostic interventions in pediatric patients avoids delaying appropriate treatment and allows disease monitoring on a daily basis.     

Radiation-induced osteosarcoma of the chest wall

A case of radiation-induced sarcoma of the chest wall is reported. Twenty-seven years 11 months after orthovoltage radiotherapy of the right breast a 69-year-old woman developed a radiation-induced osteosarcoma of the right thoracic wall. Initial diagnosis has been T-cell lymphoma of the skin. The right breast was irradiated with tangential fields and a total dose of 40 Gy, 2 Gy/day, 5 days a week. Orthovoltage treatment was performed in two courses of 20 Gy, 3 months apart. The clinical appearance of the secondary sarcoma was a diffuse infiltrated area in the irradiated breast which seemed to be fixed to the chest wall. Magnetic resonance imaging (MRI) demonstrated a mass in the right anterior thoracic wall which destroyed the fourth to the sixth rib. The tumor infiltrated the thoracic wall, including subcutaneous tissue and pericardium, as well as extending into the subphrenic space. Biopsy of the lesion revealed a poorly differentiated osteosarcoma. The patient's general condition precluded surgical or chemotherapeutic intervention; she died due to a cerebral stroke 6 months later. This case fulfilled all criteria for radiation-induced sarcoma, as there was a prior history of radiotherapy, latency period of several years, development of sarcoma within the irradiated field, and histologic confirmation of sarcoma.     

Professional burnout among head and neck surgeons: Results of a survey

Burnout may develop in highly productive, hard-working individuals from all walks of life. Extending working hours under stressful circumstances may produce a sense of frustration resulting in emotional exhaustion, loss of empathy for patients, and a decreased sense of personal accomplishment. The membership of the American Society of Head and Neck Surgery and the Society of Head and Neck Surgeons was surveyed by mail relative to burnout. A total of 395 head and neck surgeons responded. Mean age was 48 years. The average individual worked an average of 66 hours per week. More than 70% of work was devoted to patient care of which 30% to 50% was devoted to the management of head and neck cancer. A total of 128 (34%) individuals responded that they felt “burned out.” Only 27%, however, indicated frustration with disease, whereas 67% indicated frustration by government and 58% indicated frustration by the economics of medical practice. Most respondents enjoy their work, nevertheless, the stress of extending working hours dealing with severely ill patients, and the increased need to deal with government and economic issues is of concern to the community of physicians practicing head and neck surgery. Discussion about and confrontation with these issues are appropriate to facilitate and enhance an individual's ability to continue to function productively in this environment.     

Tissue plasminogen activator mediated blood-brain barrier damage in transient focal cerebral ischemia in rats: relevance of interactions between thrombotic material and thrombolytic agent

Thrombolysis with tPA for acute ischemic stroke is associated with an increased risk of intracerebral hemorrhage. We investigated the impact of thrombolysis with tPA on the blood-brain barrier in a suture occlusion model in rats. Cerebral ischemia was performed for 2 h followed by 22 h of reperfusion. Treatment groups received either saline (A), 10 mg/kg bw rtPA (B) or "activated" rtPA (ArtPA, C, rtPA with in vitro clot contact). Blood-brain-barrier damage assessed by Evans blue extravasation as a permeability marker was significantly enhanced in basal ganglia of group C compared to groups A or B. Likewise was the upregulation of MMP-9. Interestingly, results of the rtPA and saline group showed only minor and not statistically significant differences. The results of the present study indicate a major role for thrombus-thrombolytic interaction in focal cerebral ischemia with subsequent increased BBB permeability.     

Tick-borne encephalitis in children in Styria and Slovenia between 1980 and 2003

BACKGROUND: To describe the effect of the Austrian vaccination program against tick-borne encephalitis (TBE) on the incidence of this disease in children from Styria, an Austrian federal state, and to compare it with that in Slovenia, the neighboring country with a risk to acquire TBE similar to that of Styria. METHODS: A retrospective population-based cohort study was performed with the use of discharge data from all Styrian pediatric hospitals and data from the Center for Communicable Diseases at the National Institute of Public Health in Ljubljana, Slovenia. RESULTS: From January 1980 to December 2003, 139 cases of TBE in children younger than 16 years were observed in Styria. The annual incidence of TBE/100,000 Styrian children declined from 2.5-9.3 cases between 1980 and 1986 to 0-2.2 between 1987 and 1993 and to 0-1 between 1994 and 2003. Extrapolating the incidence of 6.3 cases/100,000 children between 1980 and 1986 to the time from 1994 to 2003, 124 pediatric TBE cases had been prevented in Styria in the past 10 years. CONCLUSIONS: Our data show that the Austrian vaccination program against TBE can lead to the nearly complete disappearance of TBE in children living in areas highly endemic for TBE.     

Sinonasal myxoma: a pediatric case

The authors report a case of a rare facial myxoma arising from the maxillary sinus in a 20-month-old child. The diagnosis was confirmed by a biopsy, and the patient underwent a partial maxillectomy to achieve a total resection of the mass due to the locally aggressive nature of the lesion. Myxomas should be differentiated from malignant sarcomas, in particular embryonal rhabdomyosarcoma, which can arise from the same location and require multimodality therapy consisting of surgery, irradiation, and chemotherapy.