Sinus histiocytosis mimicking metastatic melanoma in lymph nodes of a patient with a large joint prosthesis: Case report and review of the literature

Malignant melanoma metastases to regional lymph nodes may be mimicked by several non-neoplastic processes, including sinus histiocytosis induced by fragments shed from joint prostheses. A patient who had an elective lymph node dissection for malignant melanoma and was found to have “post-prosthesis lymph node histiocytosis” resembling metastatic disease is described. Knowledge of the patient's past history of a total shoulder joint replacement along with the use of polarized light microscopy to identify birefringent particles of prosthetic debris allows for an accurate histologic diagnosis. © 1995 Wiley-Liss, Inc.     

Percutaneous ultrasonic lithotripsy of symptomatic renal calculi in children

Percutaneous ultrasonic lithotripsy of upper urinary tract lithiasis is a well-established procedure in adults. We successfully applied this technique to completely remove symptomatic renal calculi in two children with idiopathic hypercalciuria. The procedure was well tolerated and no complications occurred. Both patients were discharged within 4 days of the lithotripsy. This method is an alternative to surgery for the removal of large or impacted calculi from the upper urinary tracts of pediatric patients.     

Comparison of hand assisted versus standard laparoscopic radical nephrectomy for suspected renal cell carcinoma

PURPOSE: We compared standard and hand assisted laparoscopic radical nephrectomy for suspected renal cell carcinoma. MATERIALS AND METHODS: We retrospectively reviewed 22 hand assisted and 16 standard laparoscopic radical nephrectomies performed for suspected renal cell carcinoma. Operative and recovery data were collected prospectively and from medical records as part of an institutional review board approved protocol. Patients completed pain, activity and the 12-item short form health related quality of life surveys preoperatively and postoperatively. RESULTS: Although patients undergoing hand assisted laparoscopic nephrectomy had larger tumors (mean 6.3 versus 4.1 cm., p = 0.009), tended toward greater corrected mean specimen weight (658 versus 482 gm., p = 0.111) and had greater medical co-morbidity (p = 0.0228), mean operative time for hand assisted laparoscopic procedures was significantly shorter (205 versus 270 minutes, p = 0.0004). With experience mean operative time decreased for standard but not for hand assisted laparoscopy (293 to 232 minutes, p = 0.0445, versus 206 to 204, p = 0.6162). Procedure type, surgeon experience and adrenal sparing were the only significant predictors of operative time. There was no difference in the groups in terms of the complication rate, hospital cost or stay, return to activity or overall pain score, or in the difference in preoperative and postoperative 12-item short form scores. Hand assisted laparoscopic nephrectomy tended to be associated with more abdominal pain early in convalescence and more wound complications but not significantly so. CONCLUSIONS: Hand assisted laparoscopic radical nephrectomy offers recovery, morbidity and cost that are comparable to those of standard laparoscopy. The benefits of the technique include shorter operative times, no need for specimen morcellation and direct manual control of the operative field. It is particularly useful early in surgeon experience, for large specimens or when patient co-morbidities require a rapid procedure.     

Cost-efficacy of rofecoxib versus acetaminophen for preventing pain after ambulatory surgery

BACKGROUND: Nonsteroidal antiinflammatory drugs are commonly administered as part of a multimodal regimen for pain management in the ambulatory setting. This randomized, double-blinded, placebo-controlled study was designed to compare the analgesic effect of oral rofecoxib, a cyclooxygenase-2 inhibitor, and acetaminophen when administered alone or in combination prior to outpatient otolaryngologic surgery. METHODS: A total of 143 healthy outpatients undergoing elective otolaryngologic surgery were assigned to one of four study groups: group 1 = control (500 mg vitamin C); group 2 = 2 g acetaminophen; group 3 = 50 mg rofecoxib; or group 4 = 2 g acetaminophen and 50 mg rofecoxib. The first oral dose of the study medication was taken 15-45 min before surgery, and a second dose of the same medication was administered on the morning after surgery. Recovery times, side effects, and the need for rescue analgesics were recorded. Follow-up evaluations were performed at 24 and 48 h after surgery to assess postdischarge pain, analgesic requirements, nausea, and patient satisfaction with their postoperative pain management and quality of recovery. Peak pain scores and the need for rescue analgesic medication were used as the endpoints for estimating efficacy of the study drugs, while cost to achieve complete satisfaction with analgesia was used in the cost-effectiveness analysis. RESULTS: Premedication with rofecoxib (50 mg) was significantly more effective than either placebo or acetaminophen (2 g) in reducing the peak postoperative pain, the need for analgesic medication, and improving the quality of recovery and patient satisfaction. Moreover, the addition of acetaminophen failed to improve its analgesic efficacy. An expenditure for rofecoxib of 16.76 US dollars (95% confidence interval, 7.89 to 21.03 US dollars) and 30.24 US dollars (95% confidence interval, 5.25 to 54.20 US dollars) would obtain complete satisfaction with pain control in one additional patient who would not have been satisfied if placebo or acetaminophen, respectively, had been administered prior to surgery. CONCLUSIONS: Rofecoxib, 50 mg administered orally, decreased postoperative pain and the need for analgesic rescue medication after otolaryngologic surgery. The addition of 2 g oral acetaminophen failed to improve its analgesic efficacy.     

Ventricular and periventricular structural volumes in first- versus multiple-episode bipolar disorder

OBJECTIVE: Ventriculomegaly has been reported in bipolar disorder, although whether it occurs at illness onset or progresses during the course of the disorder is unknown. In addition, it is unknown whether ventriculomegaly in bipolar disorder reflects acquired volume loss or underdevelopment of periventricular structures. METHOD: Magnetic resonance imaging was used to measure the volumes of the lateral and third ventricles and periventricular structures (caudate, putamen, thalamus, hippocampus). Patients with DSM-IV bipolar disorder, 18 who were having a first episode and 17 with multiple episodes, were compared with 32 healthy subjects. RESULTS: The lateral ventricles were significantly larger in the patients with multiple-episode bipolar disorder than in the first-episode patients or the healthy subjects, even after periventricular and total cerebral volumes were taken into account. Having larger lateral ventricles was associated with a higher number of prior manic episodes. The multiple-episode patients had a smaller total cerebral volume than the healthy subjects but not the first-episode patients. The putamen was significantly larger in the first-episode patients (and nearly so in the multiple-episode patients) than in the healthy subjects, although there was no difference between patient groups. CONCLUSIONS: Lateral ventriculomegaly was greater in bipolar disorder patients who had had repeated manic episodes, but it does not appear to be secondary to small critical periventricular structures. A larger than normal striatum, which has been reported in previous studies, was observed in first-episode patients. These results support the importance of prospectively studying neuroanatomic changes in bipolar disorder.     

Combined analysis of r-1,t-2,3,c-4-tetrahydroxy-1,2,3,4-tetrahydrophenanthrene and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol in smokers' plasma.

Polycyclic aromatic hydrocarbons (PAH) and tobacco-specific nitrosamines, such as 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), are widely accepted to be two important types of lung carcinogens in cigarette smoke. In this study, we have developed a method to estimate individual uptake of these compounds by quantifying r-1,t-2,3,c-4-tetrahydroxy-1,2,3,4-tetrahydrophenanthrene (PheT) and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) in 1 mL of smokers' plasma. PheT and NNAL are biomarkers of PAH and NNK uptake, respectively. [D10]PheT and [pyridine-D4]NNAL were added to plasma as internal standards. The plasma was treated with beta-glucuronidase to release any conjugated PheT and NNAL. The analytes were enriched by solid-phase extraction on a mixed mode cation exchange cartridge and the PheT fraction was further purified by high-performance liquid chromatography. The appropriate fractions were analyzed by gas chromatography-negative ion chemical ionization-mass spectrometry for PheT and liquid chromatography-electrospray ionization-mass spectrometry for NNAL. The method was sensitive (limits of quantitation: PheT, 13 fmol/mL; NNAL, 3 fmol/mL), accurate, and precise. Levels of PheT and NNAL in plasma from 16 smokers averaged 95 +/- 71 and 36 +/- 21 fmol/mL, respectively, which are approximately 1% to 2% of the amounts found in urine. This method should be useful in molecular epidemiology studies of carcinogen uptake and lung cancer in smokers.     

Effects of prelinguistic milieu teaching and parent responsivity education on dyads involving children with intellectual disabilities.

This study tested the effect of a method of facilitating prelinguistic communication on parents' responsivity and children's communication and productive language development. The method involved Responsivity education for the parents and Prelinguistic Milieu Teaching for the children (RPMT). Thirty-nine prelinguistic toddlers with intellectual disabilities and their primary caregivers participated in this study. Parent-child pairs were randomly assigned to either the RPMT group or a control group. Communication and language were assessed at study entry and 6, 9, and 12 months later. RPMT facilitated parental responsivity in the posttreatment period. The effect of RPMT on growth rate of child-initiated comments (i.e., the most common type of initiating joint attention) varied by pretreatment measures of that variable. The effect of RPMT on growth rate of child-initiated requests (i.e., the most common type of initiating behavior regulation) varied by presence or absence of Down syndrome. Finally, the effect of RPMT on growth of productive language varied by pretreatment frequency of canonical vocal communication. Recommended alterations in PMT and implications for defining which nonspeaking children are appropriate for prelinguistic goals and treatment were discussed.     

Anesthesia systems. Part 1: Operating principles of fundamental components

This article is the first in a two-part series on the operation of principal components within Narkomed anesthesia systems. Part 1 illustrates the structure and function of various sections of the machine's internal piping, including components of the pneumatic circuit and the oxygen flush valve, and several safety features, such as the oxygen supply pressure alarm, oxygen failure protection device, and oxygen ratio monitor controller. The article progresses to other basic components of the anesthesia system. Topics include the function of the absorber unit and the flow of gas through it, the principle of operation of the positive end-expiratory pressure valve, the function and mechanics of the adjustable pressure limiter valve, and the open reservoir scavenger system. Part 1 is a valuable tool in understanding the function and pneumatics of the primary components of the anesthesia system.All figures are compliments of the Department of Education at North American Dräger, Telford, PA.