Video-assisted thoracoscopic surgery for right middle lobectomy in children

This case-control study was designed to evaluate the potential advantages and disadvantages of video-assisted thoracoscopic surgery for right middle lobectomy in children. Ten children (6.1±3.0 yr, mean±SD) who underwent right middle lobectomy under videoscopy were compared with 10 controls matched for age (6.8±3.5 yr) and operated by thoracotomy (muscle-sparing technique) during the same period by the same surgeon. Operating time was significantly longer in the videoscopy group than in the thoracotomy group (146±28 mn vs 100±27 mn, P<0.001). Minimum oxygen saturation values were significantly higher in the videoscopy group whereas oxygen requirements did not differ between groups. Incidence of postoperative respiratory complications (mainly atelectasis) was similar in the two groups. No difference in postoperative analgesic requirements in the postoperative period was demonstrated. No real benefit or disadvantage of videoscopy over standard thoracotomy could be observed in this retrospective case-control study.     

Anaphylactic reactions during paediatric anaesthesia; results of the survey of the French Society of Paediatric Anaesthetists (ADARPEF) 1991–1992

A prospective survey was conducted among the anaesthetists of the French Society of Paediatric Anaesthetists (Association des Anesthésistes-Réanimateurs Pédiatriques d'Expression Française, ADARPEF) between January 1991 and June 1992 in order to evaluate the frequency of peroperative anaphylactic reactions in children. Data were collected from 38 Belgian and French institutions. During the study period, 162 551 children were anaesthetized, and 21 anaphylactic reactions were observed. Sixteen reactions were due to exposure to natural rubber, four were drug-related (vecuronium, suxamethonium, contrast medium and penicillin) and one occurred during removal of a hydatid cyst. The overall incidence (1/7741 anaesthetics) was close to that reported in adults (1/6000 to 1/6500), but anaphylaxis to latex was the main cause of anaphylactic reactions in children while it accounted for only 10% of reactions in adults. The incidence of reactions to muscle relaxants, the main aetiology reported in adults, appears to be ten times less frequent in children (1/81 275 anaesthetics) compared with adults (1/8000). All children were successfully resuscitated. Risk factors, clinical signs and treatment are described.     

Outcome of the treatment of invasive non-transitional cell carcinoma

BACKGROUND: We evaluated the treatment outcomes of non-transitional cell carcinoma (non-TCC) cases after radical cystectomy. METHODS: Radical cystectomy was performed in 259 invasive bladder cancer patients in our department and of these, 59 (22.7%) were non-TCC. Primary squamous cell carcinomas (SCC), adenocarcinomas and undifferentiated cancers (UC) were grouped as non-TCC of the bladder. Of the 59 non-TCC; 32 SCC, 20 UC, five adenocarcinoma and two sarcomatoid tumor cases were demonstrated. RESULTS: The 5-year disease-specific survival rate of TCC and non-TCC cases were 48.9 and 28.2%, respectively (P = 0.0016). The 5-year disease-specific survival rates of SCC and UC were 25.1 and 23.4%, respectively. The median survival time of SCC, UC and adenocarcinoma cases were 19, 12 and 6 months, respectively (P = 0.4579). The disease-specific survival rates of TCC and non-TCC cases at stage pT2NoMo were 79.1 and 27.2%, respectively (P = 0.0000). The median survival time of SCC, UC and adenocarcinoma cases were 19, 12 and 13.3 months, respectively, for the same stage. The survival time of TCC, SCC and UC cases at stage pT3NoMo were 23, 26 and 45 months, respectively (P = 0.2307). The median survival time at stages pT2-3N1Mo for the same groups were 18, 16 and 11 months, respectively (P = 0.0939). CONCLUSION: The study presented here demonstrates that both TCC and non-TCC cases have poor survival rates in locally advanced disease and that at the pT2NoMo stage the prognosis of non-TCC cases is poor when compared with TCC cases.     

Further studies on the metabolism of N 15-labeled uric acid in normal and toxemic pregnant women

Uric acid labeled with N¹⁵ was administered to 4 normal pregnant women, 2 pre-eclamptic patients, and one patient with eclampsia during their residence on a metabolic ward under strict dietary control. It was our consistent observation that the uric acid pool was enlarged and the urinary uric acid excretion was reduced in these toxemic women. The rate of production of urate was not increased as was reported previously. The sources of error in the initial report were discussed. It is concluded that faulty renal function is the sole causative factor in urate accumulation in acute toxemia.     

Assessment of fragmented QRS formation and its relationship with left ventricular hypertrophy in nonhypertensive acromegaly patients

Background/aim It is known that the presence of fragmented QRS (fQRS) on electrocardiography (ECG) is associated with cardiovascular events. The aim of this study was the evaluation of fQRS formation and its relationship with the left ventricular hypertrophy (LVH) parameters in acromegaly patients. Materials and methods In total, 47 previously diagnosed with non-hypertensive acromegaly patients and 48 control subjects were included in the study. ECG and transthoracic echocardiography (TTE) were performed for each participant. Acromegaly patients were divided into two groups according to the fQRS formation on the ECG. Left ventricular wall thicknesses, and left atrial diameter (LAD), left ventricular mass (LVM), left ventricular mass index (LVMi), and relative wall thickness (RWT) were obtained. Results In control group 5 (10.4%) and in acromegaly group 17 (36.2%) patients had fQRS on ECG (p = 0.003). LAD [36.0 (34.0–38.0) vs. 38.0 (35.0–41.0) mm, p < 0.001], LVM [155.27 ± 27.00 vs. 173.0 (153.0–235.0) g, p < 0.001], LVMi [83.12 ± 13.19 vs. 92.0 (83.0–118.0) g/m², p < 0.001] and RWT [0.39 ± 0.03 vs. 0.43 (0.41–0.45), p = 0.001] were significantly higher in patients with acromegaly. Disease duration was significantly higher (11.59 ± 1.3 vs. 8.2 ± 1.8 years, p < 0.001) in the fQRS (+) group. LAD [41.0 (39.0–42.5) vs. 37.0 (34.7–38.0) mm, p < 0.001], LVM [219.0 (160.5–254.5) vs. 164.0 (153.0–188.0) g, p = 0.017], LVMi [117.0 (92.5–128.5) vs. 86.0 (82.0–100.2) g/m², p = 0.013] and RWT [0.44 (0.42–0.49) vs. 0.43 (0.40–0.44), p = 0.037] were significantly higher in fQSR (+) acromegaly patients. In multivariate logistic regression analysis, disease duration (odds ratio: 10.05, 95% CI: 1.099–92.012, p = 0.041) and LAD (odds ratio: 2.19, 95% CI: 1.030–4.660, p = 0.042) were found to be the independent predictors of fQRS formation.Conclusion The results of our study revealed that fQRS (+) acromegaly patients had increased LVH parameters compared to fQRS (-) patients.