Idiopathic neuralgic amyotrophy in children. A distinct phenotype compared to the adult form

Two cases of neuralgic amyotrophy (idiopathic brachial plexus neuropathy) in children are presented and combined with a review of the literature. Difficulties in establishing the diagnosis are illustrated, and we give an overview of the phenotype of childhood neuralgic amyotrophy and its distinctions from the adult type. Pain, in adult cases present in over 95% of the cases, is less frequent in children, and its absence by no means excludes the diagnosis. In children under 8 weeks of age, the literature shows that a subsequent osteomyelitis of the shoulder or arm always seems to be involved, which warrants a close follow-up. Overall, recovery is less favourable in children, but when they fully recover they seem to do so in a shorter period of time than adults. We conclude that neuralgic amyotrophy in children is distinct from the adult variety, and that it has a definite place in the differential diagnosis of a sudden limp arm, even if it is painless.     

A clinical pathway to accelerate recovery after colonic resection

OBJECTIVE: To investigate the feasibility of a 48-hour postoperative stay program after colonic resection. SUMMARY BACKGROUND DATA: Postoperative hospital stay after colonic resection is usually 6 to 12 days, with a complication rate of 10% to 20%. Limiting factors for early recovery include stress-induced organ dysfunction, paralytic ileus, pain, and fatigue. It has been hypothesized that an accelerated multimodal rehabilitation program with optimal pain relief, stress reduction with regional anesthesia, early enteral nutrition, and early mobilization may enhance recovery and reduce the complication rate. METHODS: Sixty consecutive patients undergoing elective colonic resection were prospectively studied using a well-defined postoperative care program including continuous thoracic epidural analgesia and enforced early mobilization and enteral nutrition, and a planned 48-hour postoperative hospital stay. Postoperative follow-up was scheduled at 8 and 30 days. RESULTS: Median age was 74 years, with 20 patients in ASA group III-IV. Normal gastrointestinal function (defecation) occurred within 48 hours in 57 patients, and the median hospital stay was 2 days, with 32 patients staying 2 days after surgery. There were no cardiopulmonary complications. The readmission rate was 15%, including two patients with anastomotic dehiscence (one treated conservatively, one with colostomy); other readmissions required only short-term observation. CONCLUSION: A multimodal rehabilitation program may significantly reduce the postoperative hospital stay in high-risk patients undergoing colonic resection. Such a program may also reduce postoperative ileus and cardiopulmonary complications. These results may have important implications for the care of patients after colonic surgery and in the future assessment of open versus laparoscopic colonic resection.     

Antileukemic activity of genistein, a major isoflavone present in soy products

Soy has been used in traditional medicine for the treatment of various diseases, including cancer. The isoflavones present in soy have been shown in animal models to have cancer-preventing activity. However, the therapeutic effects of isoflavones against cancer are still unclear. We have evaluated the in vitro and in vivo antileukemic activity of genistein (1), a major isoflavone present in soy. We observed that it produced a dose- and time-dependent antineoplastic activity against myeloid and lymphoid leukemic cell lines. In addition, genistein treatment of the leukemic cells reactivated tumor suppressor genes that were silenced by aberrant DNA methylation. A genistein-enriched diet produced a moderate, but significant, antileukemic effect in mice. The limited extent of this in vivo response may have been due to the rapid metabolic inactivation of genistein in mice. Due to the longer half-life of genistein in humans, a soy-enriched diet has the potential to produce plasma levels of this isoflavone in the range of the concentrations used in vitro that produced an antileukemic activity.     

Post-voiding residual volume in 154 primiparae 3 days after vaginal delivery under epidural anesthesia

OBJECTIVES: To use 3-dimensional ultrasonography (3D-US) to determine the frequency of post-voiding residual volume (PVRV) > or =100 mL in primiparae 3 days after receiving epidural anesthesia for vaginal delivery. Potential relationships between day-3 PVRV > or =100 mL and obstetrical-pediatric parameters, especially those possibly implicated in post-obstetrical bladder dysfunction, were examined. STUDY DESIGN: We recruited 154 primiparae who vaginally delivered term singletons following uncomplicated pregnancies in the maternity unit of a French teaching hospital. All women had been systematically catheterized 2-h postpartum to measure precisely the volume of urine retained. On the morning of discharge (day 3), when the patient felt the urge to urinate, her 3D-US pre-voiding bladder volume was determined with BladderScan (BVI-3000), then her spontaneously voided urine was collected to accurately quantify its volume and 3D-US was repeated immediately to evaluate the PVRV. PVRV > or =100 mL on day 3 was considered pathological. RESULT: Among these 154 women, 88 (57%) felt the need to urinate and 97 (63%) had a retained volume > or =500 mL at 2-h postpartum. On day-3 postpartum, the median [range] volumes for the entire cohort were: 426.7 [158-999.7] mL 3D-US-measured pre-voiding, 350 [15-1000] mL collected by spontaneous urination, 82.2 [5.3-433.3] mL 3D-US-determined post-voiding; PVRV exceeded 100 mL for 55 (36%). According to our univariate analysis, no factor considered was able to predict PVRV > or =100 mL on day 3. CONCLUSION: Our observations confirmed the existence of PVRV > or =100 mL on day 3 in more than one-third of these primiparae who delivered vaginally under epidural anesthesia. No obstetrical-pediatric factor could be implicated in this bladder dysfunction. Therefore, we recommend frequent and systematic non-invasive 3D-US monitoring of all postpartum patients at least until day 3 to avoid excessive urine retention.     

Diurnal blood pressure variation in the evaluation of early onset severe pre-eclampsia

OBJECTIVE: To study the association between diurnal variation in blood pressure, the mean daily blood pressure and various complications of pregnancy in patients presenting with severe pre-eclampsia before 34 weeks' gestation. STUDY DESIGN: Forty-four women presenting to a tertiary hospital in South Africa with severe pre-eclampsia between 28 and 34 weeks' gestation were managed expectantly for at least 8 days. We measured maternal blood pressure every 30 min with the pregnancy validated Spacelabs 90209 automated blood pressure monitor for 24h periods on alternative days. The mean 24-h diastolic blood pressure measurement, the mean diastolic blood pressure for daytime and nighttime, the day-night blood pressure difference and the night-day ratio were compared with the occurrence of abruptio placentae, gestational age at delivery, neonatal intensive care unit admission, birth weight, abnormal umbilical artery Doppler FVW and reason for delivery. RESULTS: One hundred and seventy-six 24-h studies were analyzed. The day-night blood pressure difference decreased with increasing mean diastolic blood pressure (r=-0.323, p<0.0001). A combination of normal mean diastolic blood pressure and normal day-night blood pressure difference was associated with increased gestational age and lower caesarean section rates. CONCLUSION: The combination of mean diastolic blood pressure and day-night blood pressure difference may be a supplementary measurement of disease severity in early onset severe pre-eclampsia and seems to be of prognostic value.