Burkitt's lymphoma presenting as mandibular swelling--report of a case and review of publications

Burkitt's lymphoma in a 4-year-old Chinese boy presented with acute mandibular swelling but no associated systemic disturbance. A review of published reports shows that the diagnosis should be suspected in jaw lesions with no obvious cause.     

Immunosuppressive antilymphocyte serum. III. Different subpopulations of T lymphocytes are influenced at different doses of antilymphocyte serum.

In these experiments, we have examined the effect of antilymphocyte serum (ALS) on T lymphocyte subpopulations in animals receiving nonimmunosuppressive, weakly immunosuppressive, and strongly immunosuppressive doses of different pools of ALS. Nonimmunosuppressive (inactive) sera were defined by their inability to prolong Fischer skin grafts on Lewis recipients. Weak immunosuppression was considered to have been achieved at doses of active ALS that induced prolonged survival of Fischer skin homografts but not the more strongly antigenic Wistar-Furth homografts. Similarly, strong immunosuppression was induced with doses of active ALS that resulted in prolonged survival of not only Fischer but also the Wistar-Furth grafts. Examination of Lewis rats treated under these conditions indicated that weakly immunosuppressive ALS created a shift in peripheral T lymphocyte subpopulations with an increase in the absolute numbers of one subpopulation (lymphocytes capable of forming rosettes with guinea pig red blood cells in fetal calf serum). This population shift induced by active ALS was dose dependent and occurred in spleen slightly before lymph nodes. Nonimmunosuppressive antisera failed to induce this change. Moreover, although these doses of ALS were capable of prolonging the survival of Fischer skin grafts and inducing the population change, there was no loss of reactivity to phytohemagglutinin (PHA) and concanavalin A (Con A) in vitro. However, at doses of antiserum capable of prolonging the survival of Wistar-Furth skin grafts, the in vitro reactivity of T lymphocytes to these mitogens was more consistently suppressed. These data suggested that the degree of immunosuppression achieved with different pools or doses of ALS was attributable to variation in the susceptibility of different T lymphocyte subpopulations to suppression by ALS.     

The electrophysiological effect of dextrose 5% in water on single-shot peripheral nerve stimulation

When performing regional anesthesia, a small volume of local anesthetic or normal saline abolishes a motor response induced by a low current (0.5 mA). In this case series we describe the electrophysiological effect of a nonconducting (dextrose 5% in water, D5W) injectate on a motor response elicited by low current electrical stimulation. Twenty-nine peripheral nerve blocks were performed in 20 patients using insulated needles. Each needle was primed with D5W. The needle was advanced towards the target nerve until corresponding motor responses were observed using a current of 0.5 mA or less. Once the needle position was optimally placed, 1 mL of D5W was injected followed by a predetermined dose of local anesthetic. The effects of the injectates (D5W and local anesthetic) on the motor response were observed at all needle insertion sites. In all cases, the motor response was at least maintained or augmented (96%) immediately after the injection of D5W. All motor responses diminished after the injection of local anesthetic (100%). All blocks were considered clinically successful.     

Laparoscopic treatment of recurrent pyogenic cholangitis

Background/Purpose We reviewed the selective use of hand-assisted laparoscopic segmentectomy (HALS) and laparoscopic choledochoduodenostomy (LCD) in the management of recurrent pyogenic cholangitis (RPC).Methods We carried out a retrospective review of a prospectively maintained database of laparoscopic treatment of RPC during the period 1995 to 2004. The perioperative data were analyzed.Results There were 33 laparoscopic procedures performed in 30 patients with RPC during the period 1995–2004. There were 23 female and 7 male patients, with a mean age of 63.2 ± 14.9 years (range, 29–92 years). All these patients had a history of repeated attacks of cholangitis, and multiple sessions of endoscopic lithotripsy or operative retrieval had previously been attempted. Of these 33 procedures, there were 23 LCDs and 10 HALS. Three patients underwent simultaneous LCD and HALS in the same operation. The mean operative time was 172 ± 63.5 min (range, 75–290 min) and there were three open conversions (10%), due to (1) intraoperative bleeding from the left hepatic vein, (2) lost broken tip of ultrasonic dissector, and (3) significant bleeding during choledochotomy, respectively. Average hospital stay was 11.4 ± 11.1 days (range, 5–60 days). Eight complications (26.6%) were encountered, which included four bile leaks, three wound infections, and one intraabdominal collection. Complete stone clearance was achieved in all but 1 patient (rate, 96.6%), in whom the residual stones were extracted through a postoperative combined endoscopic and percutaneous approach. Long-term results were satisfactory, and only one stone recurrence was detected, upon a mean follow-up of 34.7 months (range, 1–107 months).Conclusions Both LCD and HALS are safe, feasible, and effective treatments for patients with RPC.     

Prevalence of male and female sexual problems, perceptions related to sex and association with quality of life in a Chinese population: a population-based study

The prevalence of sexual problems (SP) and sexual satisfaction and their associations with sex-related perceptions and quality of life (QOL) were investigated by interviewing 3257 and 1568 Chinese adults in Hong Kong by a specially designed computerized telephone-interviewing method. SP was prevalent among male (50.9%) and female (54%) respondents; approximately 50% were dissatisfied with their sexual life. Of respondents, 23.9% of men and 5.9% of women perceived sex as important and 52.5% for men and 33.8% of women reported adequate sexual knowledge. The prevalence of SP ranged from 3.4% (pain) to 29.7% (premature orgasm) for men and 6.9% (anxiety) to 24.7% (lack of interest) for women. Prevalence of erectile and lubrication problems were 9.6 and 23.6%, respectively. Sex-related knowledge, perceived importance of sex, perceived physical health status, sexual satisfaction were predictors of SP. Gender differences and strong cultural influences appear to exist. Moreover, SP and sexual satisfaction were associated with mental health and vitality QOL and overall life satisfaction.     

Discriminatory attitudes towards people living with HIV/AIDS and associated factors: a population based study in the Chinese general population

OBJECTIVES: To examine the level of discriminatory attitudes towards people living with HIV/AIDS (PLWHA) and factors in association with such attitudes. METHODS: A population based cross sectional telephone survey was conducted. A total of 808 Hong Kong Chinese aged 18-50 randomly selected from the general population participated in the study. RESULTS: Around 42% of the respondents exhibited discriminatory attitudes in at least five out of the 20 relevant items. For instance, about 42% would avoid making physical contact with PLWHA; 35% believed that all infected medical staff should be dismissed and about 47% would agree with enacting a law to prohibit PLWHA from visiting Hong Kong. A sizeable proportion of the respondents also hold negative perceptions about PLWHA (for example, 43.7% agreed that the majority of PLWHA are promiscuous, 20.7% thought that PLWHA are merely receiving the punishment they deserve, etc). Multiple regression analysis found that age, HIV related knowledge, the above mentioned negative perceptions about PLWHA, fear related to AIDS, and exposure to HIV related information were independent predictors of discriminatory attitudes towards PLWHA. About 30% would give PLWHA the lowest priority in resource allocation among five groups of patients with chronic diseases. CONCLUSIONS: The general public in Hong Kong has formed some negative perceptions of PLWHA. Discriminatory attitudes towards PLWHA are common and cover different aspects of their life. Intervention programmes are warranted and an integrated approach is required.     

Reversal of an unintentional spinal anesthetic by cerebrospinal lavage

In this case report, we describe the use of cerebrospinal fluid lavage as a successful treatment of an inadvertent intrathecally placed epidural catheter in a 14-yr-old girl who underwent a combination of epidural anesthesia and general anesthesia for orthopedic surgery. In this case, a large amount of local anesthetic was injected (the total possible intrathecal injection was 200 mg of lidocaine and 61 mg of bupivacaine), resulting in apnea and fixed dilated pupils in the patient at the end of surgery. Twenty milliliters of cerebrospinal fluid was replaced with 10 mL of normal saline and 10 mL of lactated Ringer's solution from the "epidural" catheter. Spontaneous respiration returned 5 min later, and the patient was tracheally extubated after 30 min. No signs of neurological deficit or postdural puncture headache were noted after surgery. IMPLICATIONS: Cerebrospinal lavage may be a helpful adjunct to the conventional supportive management of patients in the event of an inadvertent total spinal.     

Fiberoptic endotracheal intubation after topicalization with in-circuit nebulized lidocaine in a child with a difficult airway

This case report describes the successful fiberoptic intubation of an uncooperative child with a difficult airway due to gross burn scarring in the facial and neck region by administering 4% end-tidal sevoflurane and simultaneously delivering 4% nebulized lidocaine via a small-volume nebulizer that was connected to the inspiratory limb of the circle system via a T-piece adapter. This case suggests that simultaneously administering a volatile anesthetic with nebulized lidocaine might be an alternative way to deliver lidocaine and might provide better topical anesthesia for uncooperative patients. IMPLICATIONS: An in-circuit nebulization system to deliver topical lidocaine may facilitate fiberoptic-assisted intubation in anesthetized, spontaneously breathing children with compromised airways.