Pulmonary sequelae in long-term survivors of bronchopulmonary dysplasia

BACKGROUND: Bronchopulmonary dysplasia (BPD) is a common problem in premature babies. Long-term sequelae are the main concerns. METHODS: A retrospective review of all BPD children born in Queen Mary Hospital, a teaching hospital of the University of Hong Kong, from January 1987 to December 1995 was conducted. Children with cerebral palsy, immunodeficiency, congenital heart disorders, renal or liver failure were excluded from analysis. Chest radiography (CXR), electrocardiogram (ECG) and pulse oximetry were routinely performed. RESULTS: Fifty-five children completed the study. The female to male ratio was 1:1.1. The mean gestational age was 28 weeks. Twenty-five children were born with a birthweight of less than 1001 g. Mean age at assessment was 5.4 years. Twenty-four children (44%) demonstrated signs or symptoms of current asthma. Only seven children managed to perform the spirometry satisfactorily. One child had low forced vital capacity and one had hyperresponsive airway. The only risk factor found to be associated with current asthma was the birth month, with those children born early in the year at higher risk of developing current asthma. Seventeen of 48 children (35%) had a bodyweight below the third percentile at the corrected age of 1 year. Eleven of these seventeen children (65%) demonstrated catch-up growth at assessment. Abnormal CXR was found in 25 of 40 children (63%). All had normal pulse oximetry and ECG. CONCLUSIONS: Bronchopulmonary dysplasia children had a significantly higher risk than the general population of developing current asthma (odds ratio 4.7; 95% confidence interval 3.4-6.5; P<0.0001). The importance of birth month suggests that early life experience is important in the pathogenesis of asthma, even in BPD children. The long-term growth of BPD children was much better than previously reported.     

Dermatofibrosarcoma protuberans—a review of 10-year experience on wide local excision

Dermatofibrosarcoma protuberans (DFSP) is a rare cutaneous sarcoma of low to intermediate grade. Correct diagnosis is very often difficult to make on initial presentation. It is a locally destructive tumour which seldom metastasizes. Excision with an adequate margin is the recommended treatment. However, local recurrence is not uncommon with ranges from 4% to 21% in the literature. Medical records of all patients suffering from DFSP who received operation in our centre were reviewed. The age, gender, location of tumour and method of wound closure were described. Factors that may contribute to tumour recurrence were analysed. Between January 1997 and December 2007, 32 patients (20 men) with DFSP, age ranging between 15 and 78 years, were treated. The lesions (22, 69%) located on the trunk and the lesions (five, 15.5%) located on the extremities were resected with a 3-cm margin, while those located in the head and neck region (5, 15.5%) were excised with a 1.5-cm margin. Intra-operative frozen section was performed in all cases. Final histological examination showed 30 cases of classic DFSP and two cases of DFSP with fibrosarcomatous transformation (FS-DFSP). The positive margin rate was 3.2%. In all cases, tumour resection and reconstruction were performed in a single-stage operation. Adjuvant therapy was given to two cases of FS-DFSP and one case of involved resection margin. With a mean follow-up of 51 months, there was no local recurrence in the classic DFSP group, while the two patients with FS-DFSP developed local recurrence at post-operative 4 and 10 months, respectively. We echo the literature that wide local excision with clear margins is the recommended treatment for the classic DFSP. The achievement of low positive margin rate is crucial for a single-stage operation and to minimise the use of adjuvant therapy.     

Obstetric outcomes in women with polycystic ovary syndrome and isolated polycystic ovaries undergoing in vitro fertilization: a retrospective cohort analysis

Objective: This retrospective cohort study evaluated the obstetric outcomes in women with polycystic ovary syndrome (PCOS) and isolated polycystic ovaries (PCO) undergoing in vitro fertilization (IVF) treatment.

Methods: We studied 104 women with PCOS, 184 with PCO and 576 age-matched controls undergoing the first IVF treatment cycle between 2002 and 2009. Obstetric outcomes and complications including gestational diabetes (GDM), gestational hypertension (GHT), gestational proteinuric hypertension (PET), intrauterine growth restriction (IUGR), gestation at delivery, baby’s Apgar scores and admission to the neonatal intensive care unit (NICU) were reviewed.

Results: Among the 864 patients undergoing IVF treatment, there were 253 live births in total (25 live births in the PCOS group, 54 in the PCO group and 174 in the control group). The prevalence of obstetric complications (GDM, GHT, PET and IUGR) and the obstetric outcomes (gestation at delivery, birth weight, Apgar scores and NICU admissions) were comparable among the three groups. Adjustments for age and multiple pregnancies were made using multiple logistic regression and we found no statistically significant difference among the three groups.

Conclusion: Patients with PCO?±?PCOS do not have more adverse obstetric outcomes when compared with non-PCO patients undergoing IVF treatment.     

Retrospective study of the success rates and complications associated with total laparoscopic hysterectomy

AIMS: Laparoscopic techniques are being used increasingly more in gynecologic surgery and the introduction of modern laparoscopic instruments has allowed complex operations to be performed laparoscopically. The aim of this study is to evaluate our surgical technique with regard to the success of total laparoscopic hysterectomy (TLH) for the removal of the uterus, by analyzing its intraoperative and postoperative surgical outcomes and complications in the hope of reducing their occurrence. METHODS: A retrospective observational study was carried out at KK Hospital, Singapore, based on TLH operations performed from January 2001 to June 2005. The KOH Colpotomizer System and the RUMI Uterine Manipulator were the surgical methods used. RESULTS: 435 women consented for a TLH. 427 women (98.2%) had a successful TLH with three mini-laparotomy and five laparotomy conversions (1.8% failure rate). Injuries included bowel injury (four), bladder base bleeding (one), uterine perforation (one), uterovaginal fistula (one) and vaginal laceration (four). 21 women (4.8%) encountered major complications (defined as laparotomy conversion, excessive bleeding requiring blood transfusion, hemorrhage >or=1000 mL, ureteric injury, bowel injury and pulmonary embolus), which compares favorably with previous reports (4.0-11.0%) of laparoscopic hysterectomy. Our mean operating time, mean estimated blood loss, mean hospital stay and readmission rate are similarly comparable. CONCLUSION: TLH is associated with a high success rate, and low morbidity with few complications.