Thoracotomies in children

Thoracotomies in children have been less extensively studied, as the incidence of diseases necessitating thoracotomies is low in the pediatric age group. This study reviews childhood thoracic diseases, thoracotomy approaches, indications, and complications. Surgical procedures and complications of a total of 196 children below 16 years of age who underwent thoracotomy for various reasons at the Department of Thoracic Surgery, Ataturk Chest Diseases and Chest Surgery Training and Research Hospital, between January 2000 and December 2004, were reviewed in this study. Out of the 196 patients, 77 were female (39%) and 119 (61%) were male. The most commonly encountered indications for surgery were hydatid cyst (35%), bronchiectasis (25%), chronic nonspecific pleuritis (13%), chest wall deformities (10%), and mediastinal cystic formations and masses (10%). The other indications included tuberculosis (3%), aspergilloma (0.5%), fibrohyalinized cyst (0.5%), resection of trachea (0.5%), bronchogenic cyst (0.5%), inflammatory pseudo-tumor (0.5%), sequestration (1%), lipoblastoma (0.5%), and eosinophilic granuloma (1%). Out of the 196 patients, 176 underwent lateral thoracotomy and 20 patients with a chest wall deformity underwent midsternal incision. Complications were seen in 35 patients (18%): atelectasia and secretory retention (54%), wound infection (17%), hemorrhage (3%), chylothorax (3%), intrathoracic space (3%), and postoperative extended air leakage (20%). The mean hospital stay was 15 days and we did not encounter any mortality. The physiology and anatomy of the respiratory system and especially the respiratory control mechanism in pediatric patients vary from those of the adults, resulting in a more morbid course after thoracic surgery in children. Despite severe postoperative pain, posterolateral thoracotomy is the preferred approach in adults because of an advanced intrathoracic exposure and easy manipulation. On the other hand, lower pain threshold and the different types of diseases seen in children make lateral thoracotomy a more appropriate choice for thoracotomy, which, at the same time, spares the serratus anterior muscle decreasing its negative impact on postoperative respiratory function.     

Is it possible to predict para-aortic lymph node metastasis in endometrial cancer?

Objective

The purpose of this study was to determine the histopathologic risk factors for pelvic lymph node (PLN) and para-aortic lymph node (PALN) metastasis in endometrial cancer (EC) and to identify in which patients PALN dissection should be performed.

Study design

A total of 204 consecutive patients, with EC and underwent systematic pelvic and para-aortic lymphadenectomy extending to the renal vessels, were studied retrospectively. Statistical significance between risk factors was examined using multivariant logistic regression analysis.

Results

Cell type, depth of myometrial invasion and tumor size were found to be independently related to PLN metastasis. PLN metastasis in any site and lymphovascular invasion (LVSI) were independent prognostic factors for predicting PALN metastasis. The sensitivity, specificity and the NPV of PLN metastasis for detecting PALN metastasis were 80.8%, 89.3% and 97%, respectively. Furthermore, the 204 patients were divided into two groups according to the presence of one of these following factors: (1) non-endometrioid cell type, (2) PLN metastasis, (3) LVSI, (4) adnexal metastasis and (5) serosal involvement. Among these 204 patients, 104 had one or more of these factors (group A), and 100 patients had none of these factors (group B). PALN metastasis was significantly greater in group A, compared to group B. The sensitivity and the NPV of these combined prognostic factors for predicting PALN metastasis were 96.2% and 99%, respectively.

Conclusions

Presence of non-endometrioid cell type, PLN metastasis, LVSI, adnexal metastasis or serosal involvement diagnosed by frozen section (FS) seem to be poor prognostic factor for PALN metastasis in EC. Also, PALN dissection should be extended to the level of the renal vessels in all patients who will undergo PALN dissection, due to frequent involvement of the supramesenterial region.     

Effects of intraperitoneally administered vitamin C on antioxidative defense mechanism in rats with diabetes induced by streptozotocin

We determined the effects of intraperitoneally administered vita-min C on the lipid peroxidation (as thiobarbituric acid-reactive substances, TBARS) and vitamin C and E levels and reduced glutathione (GSH) and glutathione peroxidase (GSH-Px) activity in the plasma, red blood cells (RBC), liver, and muscle of rats in relation to oxidative damage associated with diabetes induced by streptozotocin (STZ). One group was used as control and a second as diabetic. A third group received 30 mg vitamin C i.p. every other day. On day 4 after the injection of vitamin C, animals in the second and third groups were made diabetic by i.p. injection of STZ and administered vitamin C for 21 consecutive days, and we determined TBARS, vitamin E, and GSH levels and GSH-Px activities in plasma, RBC, liver, and muscle samples. Vitamin E levels in the plasma and liver were significantly higher (P<0.05) in the control group than in the diabetic group. Also, TBARS levels in the plasma, RBC, liver, and muscle samples were significantly lower (P<0.05) in controls than in the diabetic group. The TBARS levels in the RBC, liver, and muscle samples of the vitamin C group were significantly lower (P<0.05, P<0.01, and P<0.001, respectively). However, GSH-Px and GSH activities in RBC, liver, and muscle and vitamin C levels in liver were not significantly different between control and diabetic groups. Vitamin E levels in plasma (P<0.05, P<0.01) and liver (P<0.001), vitamin C levels in liver (P<0.001), and GSH (P<0.01) and GSH-Px activities in RBC (P<0.05, P<0.01) were significantly higher in the vitamin C group than both the control and diabetic groups. These results indicate that vitamin C has significant protective effects on the blood, liver, and muscle of rats against oxidative damage in diabetes.     

Collision tumour of trichofolliculoma and basal cell carcinoma

A 52-year-old woman presented with a 2-year history of a reddish nodule on the right nasolabial sulcus. Histopathological examination revealed that the nodule was composed of trichofolliculoma and basal cell carcinoma. There was no transitional zone between the two neoplasms. The diagnosis was made as a collision tumour of trichofolliculoma and basal cell carcinoma.     

Molecular variability of group 1 and 5 grass pollen allergens between Pooideae species: implications for immunotherapy

Background Differences between major allergens from distinct grass species remain to be investigated, both in terms of structure and antigenicity. Methods Group 1 and 5 allergens purified from five common Pooideae species were analysed by mass spectrometry (MS). Major histocompatibility complex (MHC) class II‐restricted T cell epitopes were identified using predictive algorithms and human leucocyte antigen (HLA)‐binding assays. CD4⁺ T cell reactivity and IgE binding were assessed based on the induction of CD154 expression in peripheral blood mononuclear cells and using competitive ELISA assays, respectively. Results MS analysis of group 5 pollen allergens reveals considerable intra‐ and inter‐species variability in amino acid sequence, with 30–50 predominant isoforms found for each species. Differences in the amino acid sequence as well as N‐ and O‐glycosylation contribute to the variability of group 1 allergens, yielding 5–10 main isoforms, depending on the species. Out of 14 MHC class II‐restricted T cell epitopes identified within group 1, only one is conserved among the five grass species. Significant differences in binding affinities for HLA‐DR molecules result in variable CD4⁺ T cell recognition of group 1 and 5 allergens purified from the various species. Up to 38% and 85% of patients exhibit seric IgE responses to species‐restricted (or semi‐restricted) epitopes associated with group 1 or 5 allergens, respectively. Conclusion Major pollen allergens from distinct grass species bear both shared and species‐restricted T and B cell immune epitopes. When compared with single extracts, a five grass pollen extract is thus more suitable for specific immunotherapy, as it contains a broader repertoire of the IgE epitopes to which patients are sensitized. Cite this as: H. Chabre, B. Gouyon, A. Huet, V. Baron‐Bodo, E. Nony, M. Hrabina, F. Fenaille, A. Lautrette, M. Bonvalet, B. Maillère, V. Bordas‐Le Floch, L. Van Overtvelt, K. Jain, E. Ezan, T. Batard and P. Moingeon, Clinical & Experimental Allergy, 2010 (40) 505–519.     

Letrozole-induced polycystic ovaries in the rat: a new model for cystic ovarian disease

BACKGROUND: Our objective was to develop a new animal model for the study of polycystic ovaries by using the non-steroidal aromatase inhibitor, letrozole. METHODS: Thirty four rats were divided into four groups, including a control group of 10 rats that received vehicle only (1% aqueous solution of carboxmethlycellulose [CMC]) once daily orally (p.o.) and three treatment groups of eight rats each that were administered letrozole at concentrations of 0.1 or 0.5 or 1 mg/kg p.o. dissolved in 1% CMC (2 mL/kg) once daily. The treatment period was 21 days. During this period, vaginal smears were collected daily for estrus cycle determination. On the day subsequent to last letrozole dose administration, rats were killed; uteri and ovaries were then excised and weighed. Serum hormone levels and histologic changes in ovaries were examined. RESULTS: When compared to control group, ovaries from study groups showed high incidence of subcapsular ovarian cyst and capsular thickening together with incomplete luteinization and decreased number of corpora lutea. Letrozole treatment brought about dose-dependent suppression of uterine weight despite having no significant effect on ovarian weight. Although serum estradiol and progesterone levels were reduced in a dose-dependent manner, testosterone levels were elevated as were levels of luteinizing hormone (LH). Serum follicle-stimulating hormone (FSH) levels were markedly increased at higher doses of letrozole (0.5 and 1.0 mg/kg), contrary to low dose of letrozole (0.1 mg/kg) at which slight decrease was observed. CONCLUSIONS: Despite the fact that this is not a fully convincing model for the study of polycystic ovaries or of polycystic ovary syndrome (PCOS) as a whole, this animal model in several ways is similar to the human polycystic ovary syndrome.     

Spotlight on lasers. A look at potential benefits

Before lasers can be highly integrated into clinical practice, further research must prove the efficacy, efficiency, consistency and safety of this new technology. Currently, increased caries prevention and rapid laser etching are two potential benefits of laser technology.     

Desmoplastic fibroma of the mandible

Desmoplastic fibromas of the facial skeleton are the bony counterparts to the soft-tissue desmoid tumors and are almost exclusively confined to the mandible. The diagnosis should be considered whenever a rapidly increasing swelling with little functional disability is noted in the mandible. Historical, clinical, radiologic, and histologic findings must be correlated to establish the correct diagnosis. Every effort must be made to distinguish these lesions from well-differentiated fibrosarcomas. An illustrative case is presented. The treatment of desmoplastic fibromas affecting the facial skeleton should be conservative. Curettage is recommended for small tumors. Wide resections with reconstruction should be reserved for larger lesions and for those that have recurred after conservative treatment.