Acute respiratory failure associated with intrathoracic masses in neonates

BACKGROUND: Intrathoracic masses are uncommon in children. Occasionally, they present with acute respiratory failure in the neonatal period. Although emergency resection usually is the treatment of choice, other modalities are sometimes necessary to stabilize the patient. METHODS: Seven neonates with intrathoracic masses were treated. Five had congenital cystic adenomatoid malformations (CCAM), 1 had a mediastinal teratoma, and 1 had a pneumatocele. These cases were reviewed retrospectively. RESULTS: Four of the 7 infants had respiratory failure in the neonatal period. A patient with a large mediastinal teratoma and 1 with a CCAM that increased rapidly after presentation underwent emergency operation, relieving respiratory distress. The other 2 large CCAMs presented with severe respiratory distress immediately after birth because of pulmonary hypoplasia. One neonate with a Stocker-I CCAM died after emergency resection. One more recent patient with a Stocker-III CCAM survived after successful treatment with delayed resection, performed 3 days after birth. Nitric oxide (NO), and extracorporeal membrane oxygenation (ECMO) were instituted as supportive care because of profound persistent fetal circulation (PFC). CONCLUSIONS: Acute respiratory failure associated with intrathoracic masses in neonates may be managed in 1 of 2 ways. A small mass that increases rapidly should be resected soon after presentation. In neonates with large masses with associated PFC, surgery can be delayed until the patient is stable. ECMO, NO, and high-frequency oscillation (HFO) can be used aggressively for stabilizing such neonates.     

Perioperative changes in Superoxide production in neonates and infants

We conducted a prospective study to investigate perioperative changes in the production of Superoxide anion (O₂⁻) by neutrophils isolated from ten neonates between the ages of five and 16 days (N group) and ten infants ranging in age from one to ten months (I group). They underwent abdominal surgery under general anaesthesia with halothane and nitrous oxide in oxygen. The O₂⁻ production (speed and amount) was measured perioperatively using the cytochrome c reduction method. Both groups showed a decrease in the speed and amount of O₂⁻ production during and after surgery. The decrease in O₂⁻ production reached its lowest level three hours postoperatively or at the end of surgery in both groups. The O₂⁻ production in the I group returned to the basal value 48 hr postoperatively. In contrast, the O₂⁻ production in the N group was still lower 48 hr after surgery than before anaesthesia. Although the total amount of O₂⁻ production by neutrophils in one mL of peripheral blood remained unchanged in the I group, the total amount of O₂⁻ production in the N group decreased at the end of surgery and thereafter. These data indicate that even relatively minor abdominal surgery with halothane anaesthesia may be associated with perioperative neutrophil impairment in both neonates and infants. This impairment of neutrophil function in infants but not in neonates may be compensated by an increase in neutrophil numbers. It is possible that perioperative susceptibility of neonates to bacterial infections is attributable, at least in part, to the inhibition of O₂⁻ production in neutrophils by surgery and general anaesthesia. Cette étude prospective vise l’évaluation périopératoire des changements de production de l’anion superoxyde (O₂⁻) par les neutrophiles prélevés chez dix nouveaux-né de 5 à 16 jours (groupe N) et dix nourrissons de un à dix mois (groupe I). Tous sont soumis à une intervention abdominale sous anesthésie générale à l’halothane et au protoxyde d’azote en oxygène. La production d’O₂⁻ (vitesse et quantité) est mesurée à la période périopératoire par la méthode de la réduction du cytochrome c. Dans les deux groupes, on décèle une baisse de vitesse et de la quantité dans la production d’O₂⁻ pendant et après la chirurgie. La production d’O₂⁻ atteint dans les deux groupes son niveau le plus bas trois heures après l’intervention ou à la fin de l’intervention. Dans le groupe I, la production d’O₂⁻ revient à sa valeur initiale 48 heures après l’opération. Par contre, dans le groupe N, la production d’O₂⁻ demeure plus basse 48 heures après la chirurgie qu’avant t’anesthésie. Alors que la quantité totale d’O₂⁻ produite par les neutrophiles dans un mL de sang périphérique demeure inchangée dans le groupe I, la quantité totale d’O₂⁻ produite dans le groupe N diminue à la fin de la chirurgie et par la suite. Ces données montrent que même une chirurgie abdominale mineure avec anesthésie à l’halothane peut être associée à une atteinte pério-pératoire tant chez le nouveau-né que chez le nourrisson. Cette atteinte de la fonction des neutrophiles chez le nourisson peut être compensée par l’augmentation du nombre de neutrophiles. Il est possible, d’autre part, que la susceptibilité périopératoire des nouveaux-nés aux infections bactériennes soit attribuable, partiellement du moins, à l’inhibition de la production d’O₂⁻ dans les neutrophiles pendant la chirurgie générale et l’anesthésie.     

Single fiber electromyography in cat extraocular muscles

Single fiber electromyography (SFEMG) was carried out in the extraocular muscles (EOMs) of 40 adult cats, and the recordings were analyzed. The small fluctuations of the interpotential interval (IPI), so-called "jitter phenomenon", were represented quantitatively as a mean consecutive difference (MCD). The MCD and the IPI recorded from the orbital layer of the rectus muscles were similar among the 4 rectus muscles: the MCD and the mean IPI measured in 58 motor units from the 4 rectus muscles averaged 25.82 microseconds and 0.94 ms, respectively. These values were similar to those recorded from the oblique muscles. The MCD and IPI were 34.12 microseconds and 1.70 ms, respectively, in the retractor bulbi muscles and 45.54 microseconds and 1.23 ms, respectively, in the triceps muscles. The MCDs of the rectus and inferior oblique muscles were considerably smaller than those in the retractor bulbi and the skeletal muscles.     

Continuous infusion of vecuronium in children

The average dose of vecuronium required in children continuous infusion to attain a steady state block of 90% was determined. The electromyographic (EMG) response and mechanical response to supramaximal stimulation of the ulnar never recorded simultaneously, were significantly correlated in four children.The steady-state infusion rate requirement of vecuronium was 1.4 ± 0.03µg/kg/min during 2% enflurane anesthesia and 3.1 ± 0.03µg/kg/min during 1% halothane anesthesia. The spontaneous recovery time to 25% of the control by EMG during halothane and enflurane anesthesia was 12.6 ± 1.1 and 10.3 ± 1.5min, respectively, after termination of the infusion. There was no cumultative effect after prolonged vecuronium infusion.(Obara H, Hoshina H, Tanaka O et al.: Continuous infusion of vecuronium in children. J Anesth 2: 8–11, 1988)     

Comparison of the antimanic efficacy of carbamazepine and chlorpromazine: A double-blind controlled study

A multiinstitutional cooperative study comparing carbamazepine (Tegretol) with chlorpromazine was performed using a controlled, double-blind trial design. In a series of 63 cases of endogenous manic psychosis, carbamazepine's clinical utility and efficacy, characteristics of therapeutic effect, and side effects were evaluated. Carbamazepine and chlorpromazine were given by a fixed, but flexible, method at an equipotent ratio of 21, starting from the initial dosages of 300 and 150 mg, respectively. The overall improvement rate, based on the number of cases showing moderate to marked amelioration of manic symptoms, was 70% in the carbamazepine group and 60% in the chlorpromazine group. No significant differences were found between the two groups. Improvements in basic mood, insomnia, headache and lassitude, and diurnal fluctuations of mood tended to be characteristic of carbamazepine efficacy for mania compared with the effects of chlorpromazine. The onset of therapeutic effect was within 10 days of treatment in 65.7% of the patients receiving carbamazepine and 50% receiving chlorpromazine. The incidence of side effects was significantly lower in the carbamazepine group than in the chlorpromazine group. It was suggested that carbamazepine is potentially useful drug for the treatment of the manic state.Revised version of a paper read at the Sixth World Congress of Psychiatry, Hawaii, August 1977     

Imbalanced Macrophage and Dendritic Cell Activations in Response to Candida albicans in a Murine Model of Diabetes Mellitus

Bloodstream infections caused by Candida species are responsible for high morbidity and mortality, and diabetes mellitus (DM) is an important underlying disease in candidemia episodes. Although DM patients show an enhanced proinflammatory profile, they are highly susceptible to mycobacterial and mycotic infections. Attempting to understand this paradox, we investigated if imbalanced macrophage and dendritic cell (DC) activations could be associated to high incidence and/or severity of Candida albicans infection in the hypoinsulinemia-hyperglycemia (HH) milieu. HH alloxan-induced mice were infected with C. albicans and peritoneal aderent phagocytes were co-cultured with or without lipopolyssaccharide or heat-killed C. albicans, and the production of cytotoxic metabolites, cytokines, and chemokines was evaluated. We also evaluated the surface expression of MHC-II and CD86 in splenic DCs. Our findings showed that both uninfected and C. albicans-infected HH mice showed less production of CCL2 and reduced expression of CD86 by peritoneal phagocytes and splenic DCs, respectively.     

Neutrophil CD64 is upregulated in RA patients with lymphoma but not in other solid cancers

Objective: To evaluate the utility of quantifying CD64 expression on neutrophils in rheumatoid arthritis patients with malignancy, especially its diagnostic role in lymphoma.

Methods: We used flow cytometry to quantify CD64 expression on neutrophils from patients diagnosed with malignancy during the follow-up period prior to initiating treatment.

Results: Neutrophils from 18 patients with lymphoma expressed significantly higher levels of CD64 (9635.6?±?2123.7 molecules/cell) than those from 32 patients with other solid cancers (carcinoma) (1250.5?±?91.1 molecules/cell) (p?<?0.001). When the cutoff value was set at 2060 molecules/cell, the sensitivity and specificity of CD64 for diagnosing lymphoma was 88.9% and 94.4%, respectively.

Conclusions: The quantitative measurement of neutrophil CD64 by flow cytometry may be useful as a subsidiary diagnostic marker in patients with suspected lymphoma. Although neutrophil CD64 is currently a well-known marker of infection, it is necessary to bear in mind that lymphoma is also a candidate in differential diagnosis when CD64 expression on neutrophils is upregulated.     

Novel strategy for cystitis glandularis: Oral treatment with cyclooxygenase‐2 inhibitor

Cystitis glandularis, a proliferative disease of the bladder, is resistant to antibiotics, non‐steroidal anti‐inflammatory drugs, anti‐allergy drugs and transurethral resection. Cystectomy or partial cystectomy is occasionally required for refractory cystitis glandularis. It has not been defined if cystitis glandularis is a premalignant lesion. We experienced a case of remission from cystitis glandularis after combination of oral treatment with selective cyclooxygenase‐2 inhibitor, celecoxib and transurethral resection. Immunohistochemistry showed positive signals of cyclooxygenase‐2 in the epithelium of pretreatment specimens, suggesting the pathophysiological role of cyclooxygenase‐2 in cystitis glandularis. Here, we show the effectiveness of celecoxib against cystitis glandularis for the first time. Celecoxib could be one of the therapeutic strategies for cystitis glandularis.