Cervical tuberculosis in early childhood

CASE HISTORY: We present a case of spinal tuberculosis in a 4-year-old girl that grounds severe vertebral destruction involving four cervical vertebrae and a large abscess with retropharyngeal expansion. Presenting symptoms were neck and right arm pain, torticollis and weakness of the right arm. We drained the abscess and removed the infected bone and reconstructed the cervical spine with a fibular allograft. The neurological deficits were recovered and the torticollis was straightened up. CONCLUSION: We emphasize the value of early diagnosis of spinal tuberculosis and early radical surgery with spinal reconstruction.     

Staging laparoscopy for gastric cancer

Surgical resection remains the only potentially curative treatment of patients with gastric cancer. Evaluation of surgery and other treatments depends on accurate staging of the disease. The objective of the study was to compare staging laparoscopy with ultrasonography, endoscopic ultrasound, computed tomography, and histology for serosal infiltration, lymph node metastasis, peritoneal seeding, and hepatic metastasis. Diagnostic laparoscopy was carried out in 48 patients. Prelaparoscopic staging in all cases included upper gastrointestinal endoscopy and biopsies followed by endosonography, ultrasound, and computed tomography. Preoperative combined examination using CT and laparoscopy was superior when compared with each modality alone or the combinations of the other tests. The present study showed that preoperative evaluation of patients with laparoscopy is superior to all other diagnostic tests. We also found that laparoscopy and computed tomography were better in accurately assessing the serosal infiltration, peritoneal seeding, and hepatic metastases, which thus allows the surgeon to choose more effective treatment modality.     

Caudal Ropivacaine and Neostigmine in Pediatric Surgery

Background: Neostigmine has been added to local anesthetics for different nerve blocks. This study was conducted to evaluate effects of neostigmine when added to ropivacaine for caudal anesthesia.

Methods: We studied children, aged 1-5 yr, undergoing inguinal hernia and hypospadias surgery. After standard induction of anesthesia, Group I received 0.2% ropivacaine 0.5 ml/kg and Group II received 0.2% ropivacaine 0.5 ml/kg with 2 [mu]g/kg neostigmine via the caudal route. Heart rate, mean arterial pressure, and pulse oximetry were recorded before induction, after induction, and then every 10 min after caudal anesthesia. Hemodynamic, Toddler-Preschooler Postoperative Pain Scale pain score, and sedation score values were recorded 30 min after extubation and at hours 2, 4, 6, 12, and 24. A pain score greater than 3/10 resulted in administration of rectal paracetamol.

Results: There were no differences between the groups in demographic and hemodynamic data, duration of surgery and anesthesia, time to extubation, or sedation scores. The pain scores were significantly lower in Group II at 6 and 12 h (P < 0.05). Time to first analgesic requirement was statistically prolonged in Group II (19.2 +/- 5.5h) when compared with Group I (7.1 +/- 5.7 h) (P < 0.05). Total analgesic consumption was statistically larger in Group I (174 +/- 96 mg) when compared with Group II (80 +/- 85.5 mg) (P < 0.05). The incidence of vomiting (3 patients in Group II and 1 patient in Group I) was not statistically significantly different.     

Acute myeloblastic leukemia achieving complete remission with amifostine alone

Amifostine, a phosphorylated thiol-amine, is known as a cytoprotective agent especially for cisplatin containing chemotherapies. Apart from the cytoprotective role, Amifostine could also be used in the treatment of hematologic malignancies such as myelodysplastic syndrome (MDS) and acute myeloblastic leukemia (AML), as a treatment option or for potentiating the effects of cytotoxic agents. We tried to use Amifostine in a patient with AML, which did not respond to conventional cytotoxic chemotherapy and aimed to publish the results. The patient was a 77-year-old male patient, he was diagnosed as AML by peripheral blood smear and bone marrow aspiration. Treatment commenced with low dose cytosine arabinoside (Ara-C) but the therapy should have ceased due to patient intolerance. The patient refused further therapy and he was offered to have Amifostine treatment. Amifostine was administered 200 mg/m2 three times a week, with ciprofloxacin, pentoxifyllin and dexamethasone. Dramatic response was obtained after 8 weeks of administration. Blast rate was reduced from 35 to 7% in bone marrow aspiration; pancytopenia was restored to normal levels. This remission was maintained through 8 more weeks. Amifostine treatment was restarted after he relapsed but this time he did not respond to the treatment and died of gastrointestinal bleeding on the 8th week of treatment.     

An outbreak of Pichia ohmeri infection in the paediatric intensive care unit: case reports and review of the literature

Since the first report in 1998, 10 cases of Pichia ohmeri infection have been reported in the literature. Here we present two new cases of P. ohmeri infection in the paediatric age group. The first case was an 8-month-old male infant, who was admitted with fever, convulsions and altered consciousness. Conservative therapy was started with a presumptive diagnosis of encephalitis. The patient failed to respond to the given treatments and died on the 21st day of hospitalisation. The second case was a 10-year-old male with B-cell acute lymphoblastic leukaemia. He was hospitalised with neutropenic fever. He was discharged after 3 weeks of therapy. In both cases P. ohmeri was identified in blood samples. Growing evidence indicates that P. ohmeri should be added to the lengthening list of opportunistic fungal pathogens that can cause infection in all ages, including infants, and particularly in those who are immunocompromised.     

The functional and oncologic effectiveness of near-total laryngectomy

PURPOSE: To investigate the oncologic efficiency of near-total laryngectomy for advanced laryngeal and neighboring organ cancers and to evaluate the functional results. MATERIALS AND METHODS: A retrospective review of 135 cases of near-total laryngectomy carried out in a tertiary university hospital between 1989 and 2000 was undertaken. The original operation was carried out in 3 groups: classic "near-total laryngectomy" for endolaryngeal lesions; "near-total laryngectomy and partial pharyngectomy" for lesions originating from the pyriform sinus or lesions with extension to the pharynx or tongue base but reconstructed primarily; and "near-total laryngopharyngectomy" for lesions requiring pedicled flap reconstruction after resection. Oncologic success was evaluated according to the location and extent of the tumor and the particular operation. Functional outcome was evaluated according to phonation and its quality as well as to the severity of aspiration. RESULTS: Of the 135 cases, 121 were men, and 14 were women (age range, 33-80 years; mean, 56.2 years). Mean phonation time was 35.2 days, and mean onset of oral intake was 18.5 days. Of the 135 cases of the series, 124 were evaluated for survival. Thirteen of 26 (50.0%) cases of T2, 34 of 53 (64.2%) cases of T3, and 33 of 45 (73.3%) cases of T4 carcinomas survived by the end of the evaluation period. Likewise, 46 of 77 (59.7%) cases of N0, 16 of 19 (84.2%) cases of N1, and 18 of 27 (66.7%) cases of N2 survived the same period; however, none with N3 metastatic neck disease survived. The probability of survival with regard to the T and N stages of the disease did not reveal a statistically significant result (P =.15 and.49, respectively). CONCLUSIONS: According to these results, near-total laryngectomy is a valid alternative for extended laryngeal and neighboring organ cancers with an acceptable morbidity and a high success rate for voice preservation. Near-total laryngectomy should be offered as a surgical treatment alternative for these patients.     

FDG uptake in abdominal mesh implant on FDG PET/CT

A 50-year-old man with peritoneal angiosarcoma underwent total tumor excision along with removal of the total right rectus and medial part of the left rectus muscles 1 year earlier. F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) was performed for suspected recurrence. In the anterior abdominal wall extensive subcutaneous FDG uptake showing linear hypermetabolic zone on PET slices was noted. The patient had a history of a dual mesh implant, which consists of polypropylene and polyvinylidene fluoride for the reinforcement of the abdominal wall during the operation. PET/CT fusion image demonstrated that the finding was due to the dual mesh implant in the anterior abdominal wall most likely representing a foreign body reaction.     

Clinical and Pathologic Prognostic Factors That Are Influential in the Survival and Prognosis of Lung Adenocarcinomas and Invasive Predominant Subtypes

Therapeutic approaches to lung adenocarcinomas differ because of their heterogeneous morphologies, prognoses, and clinical features. For this reason, new histopathologic classifications for lung adenocarcinomas were done by the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society to form subtypes with homogeneous prognoses. There are limited clinical data in the literature on the prognosis of the subgroups formed according to the new classification. A total of 86 patients with adenocarcinoma who had undergone pathologic stages I and II curative resection and mediastinal lymph node dissection were retrospectively analyzed according to the seventh TNM staging system revised by the Union for International Cancer Control/American Joint Committee on Cancer. Histologic subtyping was reassessed according to the dominant histopathologic morphology. When survival rates of lung adenocarcinomas were compared according to their localizations, it was observed that adenocarcinomas localized to the right hemithorax had a longer survival than the ones with left hemithorax localization (P = 0.026). When necrosis was taken into account, it was seen that necrosis rate was higher in solid predominant type compared with other types, whereas it was lower in acinary type (P = 0.046). When peritumoral lymphovascular invasion data were assessed, it was observed that disease-free survival was influenced in a negative fashion (P = 0.018). New histopathologic classification of adenocarcinomas has been a step forward to attaining homogeneous groups, but when the biologic heterogeneity of the adenocarcinomas is taken into account, the authors believe that considering the peritumoral lymphatic vascular invasion, left hemithorax localization, and tumoral necrosis entities in the upcoming TNM classification will contribute to evaluating the prognosis.