Cervical mediastinoscopy: re-evaluation of an old technique in era of new imaging technology

CONTEXT

With the advent of modern anatomical and functional imaging technologies, application of cervical mediastinoscopy has decreased in diagnosis and staging of mediastinal diseases.

AIM

To evaluate the usefulness of cervical mediastinoscopy in assessing the mediastinal disease when imaging modalities are non-diagnostic.

SETTINGS AND DESIGN

Retrospective analysis of records of a tertiary care hospital.

PATIENTS AND METHODS

Thirty-nine patients with mediastinal pathology of varied aetiologies underwent cervical mediastinoscopy. Pre- and post-operative diagnosis was compared.

RESULTS

In 34 out of 39 cases (87.5%), cervical mediastinoscopy provided a confirmatory final diagnosis. One case had a major complication in the form of recurrent laryngeal nerve palsy.

CONCLUSION

Cervical mediastinoscopy is useful, minimally invasive modality in a scenario where anatomical and functional imaging tools are non-diagnostic.

The use of adrenaline autoinjectors by children and teenagers

BACKGROUND

Although adrenaline is recommended as first line treatment for anaphylaxis, it is often not utilized. There has been a debate about when adrenaline autoinjectors should be prescribed and how many should be dispensed.

OBJECTIVES

To see how many adrenaline autoinjectors were used during anaphylactic reactions and to determine why they were not used in situations where they were clinically indicated.

METHODS

Patients were recruited prospectively at 14 paediatric allergy clinics throughout UK. Participants completed a questionnaire covering demographic data, atopic status and details of allergic reactions in the previous year and reasons for using more than one device.

RESULTS

A total of 969 patients were recruited of whom 466 (48.1%, 95% CI: 37.9-58.2) had had at least one reaction in the previous year; 245 (25.3%, 95% CI: 16.2-34.4) of these reactions were anaphylaxis. An adrenaline autoinjector was used by 41 (16.7%, 95% CI: 11.7-21.3) participants experiencing anaphylaxis. Thirteen participants received more than one dose of adrenaline, for nine of these a health professional gave at least one. The commonest reasons for using more than one were severe breathing difficulties (40%), lack of improvement with first dose (20%) and miss-firing (13.3%). The commonest reasons for not using adrenaline in anaphylaxis were 'thought adrenaline unnecessary' (54.4%) and 'unsure adrenaline necessary' (19.1%). Many with wheeze did not use their autoinjector.

CONCLUSIONS AND CLINICAL RELEVANCE

Adrenaline is used by only a minority of patients experiencing anaphylaxis in the community. Thirteen of the 41 patients with anaphylaxis who used their autoinjector needed another dose of adrenaline. Further research is needed to consider how to best encourage the usage of adrenaline when clinically indicated in anaphylaxis.

Free radical reactions with the extract of brassica family

Using different extraction protocols, the antioxidant properties of green and red cabbage extracts were evaluated in terms of the total antioxidant capacities using the 2,2'-azino-bis(3-ethylbenzo-thiazoline-6-sulphonic acid) (ABTS) radical scavenging method. The results demonstrate that the total antioxidant capacity of green and red cabbages correlated well with the total phenolics and total flavonoids content present in the extracts. The ABTS radical scavenging capacity of red cabbage was much higher than that of green cabbage extract. Using time resolved absorption kinetic spectrophotometry, free radical reactions with the extracts of green and red cabbages were established. The reactions of extracts were examined using a pulse radiolysis technique. Kinetic studies indicated that extracts may act as free radical scavengers for O2(-), OH radicals and as an antioxidant to repair free-radical damage to biologically important guanosine radical.

Osmotic expanders in children: no filling--no control--no problem?

BACKGROUND

Self-filling, hydrogel-based osmotic tissue expanders have been successfully used for several years, mainly in adult patients. We wanted to test this novel device in pediatric plastic and reconstructive surgery.

MATERIAL AND METHODS

Between November 2004 and September 2009, we implanted 53 osmotic tissue expanders following standard surgical principles in a total of 30 children and adolescents with burn scars, congenital nevi, alopecia, or foot deformities.

RESULTS

All expanders reached their predicted volume within 6 weeks and 51 (96.2%) produced a sufficient amount of additional skin for the intended coverage of the defect. A serious infection precluding the planned reconstructive procedure occurred with 2 expanders (3.8%). Minor complications occurred at 6 implantation sites (11.4%), and consisted of small necrotic areas and perforations (n = 3) and minor infections (n = 3). These problems could be controlled and did not interfere with the subsequent plasty. The final results recorded at the last follow-up (mean: 21 months, range: 9-48 months) were rated as excellent in 25, good in 19, moderate in 6, and poor in 1 patient.

CONCLUSION

This is apparently the largest pediatric series in which self-filling expanders have been used. The data obtained indicates that self-filling expanders can be safely and effectively used for various plastic, reconstructive and orthopedic procedures in children and adolescents. The fact that numerous painful and distressing filling sessions are obviated with these expanders is particularly beneficial for those children too young to understand and cooperate. Moreover, this approach minimizes the risk of infection and lowers costs.

Abstract P2-14-11: Vitamin D Deficiency in Post-Menopausal Breast Cancer Survivors

Background: Breast cancer patients on aromatase inhibitors (AIs) are at an increased risk for decreased bone density and fractures. Given the important role vitamin D plays in bone metabolism, vitamin D deficiency may place these patients at an additional risk. Our objective was to examine the prevalence of and risk factors for vitamin D deficiency in post-menopausal breast cancer survivors (BCS) with current or past AI use. Materials and Methods: We conducted a cross-sectional study. Vitamin D levels were obtained utilizing the Diasorin radioimmunoassay using sera. Multiple logistic regression analyses were performed to identify independent risk factors associated with vitamin D deficiency. Results: In our cohort of 391 post-menopausal women with stage I to III breast cancer on AI therapy, the mean vitamin D level was 35 ng/mL, S.D. 12.49. Vitamin D levels were normally distributed in the cohort. Thirty five percent of women were vitamin D deficient, defined as a level less than 30 ng/mL. In our cohort, 73.4% of the participants had vitamin D supplementation documented in their chart; 26.8% of these women were still vitamin D deficient despite supplementation. Adjusting for demographic and clinical variables, non-white patients were more likely to be vitamin D deficient, adjusted odds ratio (AOR) of 2.00, 95% confidence interval (CI) 1.14-3.51, p=.004. Overweight (AOR 3.07, 95% CI 1.77-5.33, p<.001) and obese (AOR 2.88, 95% CI 1.64-5.06, p<.001) women were also at higher risk. In a second model, adjusting for the same covariates and chart-documented vitamin D supplementation, vitamin D supplementation was associated with lower risk for vitamin D deficiency (AOR .29, 95% CI .17-.48, p<.001). The risk for non-white women (AOR 2.19, 95% CI 1.22-3.89, p=.009) and obese women (AOR 3.21, 95% CI 1.79-5.78, p<.001) were increased after adjusting for vitamin D supplementation. Discussion: Hypovitaminosis D is common in BCS, and those who are non-white or have a BMI greater than 25 are at a higher risk of deficiency. When adjusting for vitamin D supplementation, the discrepancy between normal weight patients and obese patients became even more pronounced, suggesting that standard vitamin D supplementation may not be sufficient for these patients. In light of data linking hypovitaminosis D and bone health, oncologists should consider routine testing with particular attention to non-white or overweight patients, and repleting those patients who are deficient.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P2-14-11.