ABO, Rh, and Kell Blood Group Antigen Frequencies in Blood Donors of Taif City, Saudi Arabia

BACKGROUND

The ABO, Rh, and Kell blood group antigens are clinically significant. Knowledge of antigen frequencies is important to assess the risk of alloimmunization and to guide the probability of finding antigen-negative donor blood. Patients that lack such antigens may produce antibodies that may cause transfusion reaction. The frequencies of ABO, Rh, and Kell antigens in Taif city, Saudi Arabia have not yet been determined. This study aims to assess the frequencies of ABO, Rh, and Kell blood group antigens among Saudi donors in Taif city, Saudi Arabia.

METHODS

A retrospective study was conducted on 2,073 Saudi blood donors of both genders from May 2016 to May 2019. The data were collected, and calculations were done to determine the frequencies of ABO, Rh, and Kell blood group antigens.

RESULTS

Of the 2,073 donors, the ABO blood groups of the donors were O (53.8%), A (24.9%), B (16.4%), and AB (4.6%). Rh-positive samples were (87.8%) and (12.1%) were Rh-negative. The most common Rh antigen was e (95.8%), followed by the c and C antigens (81.7% and 62.3%, respectively). The lowest Rh antigen frequency was E (31.3%). DCce was the most prevalent phenotype (29.5%). The KEL1 (K) antigen was determined in (22.1%) of the donors.

CONCLUSIONS

This is the first study conducted in Taif city to assess the frequency of ABO, Rh, and Kell antigens among Saudi blood donors. This study provides the first step to create a regional donor database to obtain negative antigen blood units for patients with unexpected antibodies and to offer compatible bloods for multi-transfused cases by designing red cell panels.

Assessing the Perceptions and Practices Toward Eye Injuries First Aid Among General Population in the Western Region of Saudi Arabia: A Cross-Sectional Study

Aim  The eye is a vital and extraordinarily perceptive part of the human body. A wide spectrum of possible outcomes from eye injuries, from temporary vision loss to permanent blindness. There is a lack of information about how to handle an eye injury. Education and raising awareness are the best way to prevent severe complications and eventual loss of vision. Therefore, the purpose of this study is to evaluate and assess general population knowledge and first aid practices regarding eye injuries in the Western Region of Saudi Arabia, focusing on the importance of early management. Methodology A cross-sectional questionnaire was administered among residents of western Saudi Arabia using a validated questionnaire. One thousand two hundred seventy-nine adults of both genders were randomly chosen to represent the sample. In December 2022, we used a web-based survey to gather our data. Result This study analyzed data from 1279 responses on the online platform. Results showed that good knowledge was significantly higher among females than males, those without a history of eye injury than their peers with injuries, and those with higher educational levels than those with lower educational levels. Additionally, good knowledge was predicted by the female gender (OR = 1.6, 95% CI, 1.3 to 2.1, p < 0.001). Conclusion The study found that public awareness of eye injury first aid was good in the western region. The role of physicians should be expanded and health education campaigns and social media are recommended to achieve the goal of reduction and limiting the most crucial damage to the most sensitive organ in the body.

On the macro-micro-morphology of organs of host invasion in hemiparasite Helicanthes elasticus (Desv.) Danser

Loranthaceae family includes hemiparasitic members which are seen invading a wide range of commercial crops. Helicanthes elasticus (Desv.) Danser is very common on mango trees. Though parasitic in nature, this mistletoe is also medicinally important as fetoprotective, against vesicular calculi and kidney infections. This study is an attempt to document macro-microscopical features of parasitic root, fruit and host-mistletoe tissue interaction in the haustorium of H. elasticus growing on mango stems. Collection, preservation, sectioning, staining and photomicrography of the root, fruit and host-mistletoe union were done as per standard methodologies of anatomical studies. Though there is resemblance to the normal roots in morphology as well as anatomy, the microscopic finding of large number of branched stone cells in the roots is interesting. The morpho-anatomical features recorded would help in understanding the infection biology of this mistletoe. The eradication during the earlier stages of its establishment from seed or from the root creeping over the surface of the host can help in controlling this parasite infection on commercially important host plants.

Crosstalk of hydrogen sulfide and nitric oxide requires calcium to mitigate impaired photosynthesis under cadmium stress by activating defense mechanisms in Vigna radiata

Hydrogen sulfide (H₂S) and nitric oxide (NO) have been known to affect vast number of processes in plants under abiotic stresses. Also, calcium (Ca) works as a second messenger in plants, which underpins the abiotic stress-induced damage. However, the sequence of action of these signaling molecules against cadmium (Cd)-induced cellular oxidative damage remains unidentified. Therefore, we studied the synergistic actions and/or relationship of signaling molecules and Ca-dependent activation of tolerance mechanisms in Vigna radiata seedlings under Cd stress. The present study shows that exogenous Ca supplemented to Cd-stressed V. radiata seedlings reduced Cd accumulation and improved the activity of nitrate reductase, and L/D-cysteine desulfhydrase (LCD/DCD) that resulted in improved synthesis of NO and H₂S content. Application of Ca also elevated the level of cysteine (Cys) by upregulating the activity of Cys-synthesizing enzymes serine acetyltransferase and O-acetylserine(thiol)lyase in Cd-stressed seedlings. Maintenance of Cys pool under Cd stress contributed to improved H₂S content which together with Ca and NO improved antioxidant enzymes and components of ascorbate-glutathione (AsA-GSH) cycle. All these collectively regulated the activity of NADPH oxidase and glycolate oxidase, resulting in the inhibition of Cd-induced generation of reactive oxygen species. The elevated level of Cys also assisted the Cd-stressed seedlings in maintaining GSH pool which retained normal functioning of AsA-GSH cycle and led to enhanced content of phytochelatins coupled with reduced Cd content. The positive effect of these events manifested in an enhanced rate of photosynthesis, carbohydrate accumulation, and growth attributes of the plants. On the contrary, addition of NO scavenger cPTIO [2-(4-carboxyphenyl)-4,4,5,5-tetramethylimidazoline-1-oxyl-3-oxide], H₂S scavenger HT (Hypotaurine) and Ca-chelator EGTA (Ethylene glycol-bis(b-aminoethylether)-N,N,N',N'-tetraacetic acid) again developed a condition similar to stress and positive effect of the signaling molecules was abolished. The findings of the study postulate that Ca in association with NO and H₂S mitigates Cd-induced impairment and enhances the tolerance of the V. radiata plants against Cd stress. The results of the study also substantiate that Ca acts both upstream as well as downstream of NO signals whereas, H₂S acts downstream of Ca and NO during Cd-stress responses of the plants.

Sympathetic Ophthalmia after successful Retinal Reattachment Surgery with Vitrectomy

PURPOSE

To report a case of sympathetic ophthalmia (SO) following one successful pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment.

METHODS

Case report.

RESULTS

A 50-year-old man developed SO 5 weeks after successful repair of rhegmatogenous retinal detachment with PPV and intraocular gas tamponade. The patient presented with bilateral multifocal exudative retinal detachments and inflamed optic nerve with characteristic changes of SO detected by fluorescein angiography, indocyanine green angiography, and optical coherence tomography. Prompt use of systemic steroids and cyclosporin A resulted in control of the uveitis with significant visual improvement.

CONCLUSIONS

PPV should be viewed as a major risk factor for development of SO.

Primary paraganglioma of seminal vesicle

INTRODUCTION

Paragangliomas are rare tumors arising from neural crest tissue located outside the adrenal gland. Primary seminal vesicle paraganglioma is extremely rare entity.

PRESENTATION OF CASE

A 26-year-old male patient presented with symptoms and signs of acute appendicitis where a CT of abdomen and pelvis showed an inflamed appendix and incidental finding of left seminal vesicle mass. The patient underwent uneventful laparoscopic appendectomy followed by transrectal ultrasound (TRUS) guided seminal vesicle biopsies. Histopathology revealed a neuroendocrine neoplasm consistent with paraganglioma. Surgical excision of the left seminal vesicle was carried out.

DISCUSSION

Paraganglioma of genitourinary tract is rare. The urinary bladder is the most common site, followed by the urethra, pelvis and ureter. Seminal vesicle paragangliomas were reported in association with other genitourinary organ involvement such as bladder and prostate. Isolated seminal vesicle paraganglioma is extremely rare and surgical excision remains the standard treatment for localized paraganglioma.

CONCLUSION

Primary tumors of seminal vesicle are rare and represent a diagnostic challenge. Differential diagnosis includes a list of benign and malignant tumors. Primary seminal vesicle paraganglioma is a rare but important diagnosis to be included in the differential diagnosis.

Temperature dependant structural and electrical properties of ZnO nanowire networks

In this paper, we report a successful growth of zinc oxide nanowire networks by simple thermal evaporation process using metallic zinc powder in the presence of oxygen. The morphological investigations of the synthesized nanowire networks are conducted by using field emission scanning electron microscopy (FESEM) which reveals that the grown products are in high-density over the whole substrate surface and possessing nanowire networks like structures. The structural and compositional properties of the grown nanowire networks are analyzed by X-ray diffraction (XRD), transmission electron microscopy (TEM) and energy dispersive spectroscopy (EDS), respectively which confirm that the synthesized products are well-crystalline, with wurtzite hexagonal phase ZnO. The as-grown ZnO nanowire networks grown on silicon substrate are utilized to fabricate n-ZnO/p-Si heterojunction diode and presented in this paper. The I-V characteristics of the fabricated heterojunction diode at different temperatures (77 K-477 K) are also investigated. High values of quality factor, which are obtained from this study, indicate a non-ideal behavior of the fabricated device. The mean barrier height of -0.84 eV is also estimated and presented in this paper.

Role of herpes simplex virus-1, cytomegalovirus and Epstein-Barr virus in atherosclerosis

Infectious agents such as herpes viruses may be implicated in the inflammatory atherosclerotic process. The aim of this study was to assess the levels of IgG antibody specific for Herpes simplex virus-1 (HSV-1), Cytomegalovirus (CMV) and Epstein-Barr virus (EBV) among patients with atherosclerotic vascular diseases and to examine the relation between the levels of these antibodies and lipid profile, high-sensitive C-reactive protein (hsCRP) in these patients. Seventy five patients [20 with acute coronary artery disease (ACAD), 20 with chronic coronary artery disease (CCAD), 20 with cerebral stroke and 15 with peripheral arterial disease (PAD)] along with 15 healthy individuals as a control group. The studied individuals were subjected to complete history taking, thorough physical examination, and assessment of the blood glucose level, lipid profile, creatine kinase (CK), hsCRP by nephlemetry and virus-specific IgG antibodies by enzyme immunoassay (EIA). Results showed that the levels of cholesterol, triglycerides, LDL-c and hsCRP were significantly higher, while HDL-c was significantly lower among patients compared to that of the controls. A significantly (p<0.05) higher percentage of patients had CMV-specific IgG as compared to the controls. Higher percentage of patients had HSV- and EBV-specific IgG antibodies, however, there was no significant difference between the 2 groups. Individuals who had CMV-specific IgG were more liable to have vascular disease compared to those without (OR=4.10, CI= 1.07-15.75). The levels of CMV- and EBV-specific IgG antibodies were significantly (P<0.01 and < 0.05 respectively) elevated among patients with atherosclerotic vascular diseases when compared to those of the controls. There was no significant correlation between the levels of virus-specific IgG and lipid profile or hsCRP. In conclusion, the level of CMV- and EBV- specific antibodies are elevated among vascular disease patients and the presence of CMV-specific IgG is associated with development of the disease. Serum lipids and hsCRP were increased among the studied patients; however, no significant correlation was detected between antiviral IgG levels and lipid profile or hsCRP.

Role of Chlamydia pneumoniae, helicobacter pylori and cytomegalovirus in coronary artery disease

Coronary artery disease (CAD) is the leading cause of death in many countries. The underlying mechanism of the chronic inflammatory process in atherosclerosis is still unknown. As a possible trigger, different viruses and bacteria may be associated with atherosclerotic diseases. The aim of this work was to investigate the association of chronic infection with C pneumoniae, H pylori and cytomegalovirus (CMV) infections and CAD. Fifty patients [20 with acute coronary artery disease (ACAD) and 30 with chronic coronary artery disease (CCAD)] in addition to 15 healthy individuals as a control group were involved in this study. The studied individuals were subjected to complete history taking, thorough physical examination, electrocardiography, echocardiography and coronary angiography (for patients). Assessment of blood glucose level, lipid profile and creatine kinase (CK) was performed. Determination of hsCRP was done by nephlemetry, while C pneumoniae-, H pylori- and CMV-specific IgG antibodies was done by enzyme immunoassay. Results showed that the levels of cholesterol, triglycerides, LDL-c and hsCRP were significantly higher, while HDL-c was significantly lower among patients compared to that of the controls. A significantly (P<0.05) higher perecentage of patients had C pneumoniae and H pylori-specific IgG antibodies as compared to that of the controls. Higher percentage of patients had CMV-specific IgG antibody, however, there was no significant difference between the 2 groups. The levels of C pneumoniae and H pylori-specific IgG antibodies were significantly (P<0.001) higher among patients with CAD when compared to that of the controls. CMV-specific IgG level in patients was higher compared to that of the controls, however, the difference was not statistically significant. Among acute CAD patients, C pneumoniae-specific IgG was positively correlated with hsCRP (P<0.05), cholesterol (p<0.01) and HDL-c (P<0.05), while H pylori-specific IgG was positively correlated with triglyceride level (P<0.05). Among patients with CCAD, hsCRP was negatively correlated with HDL-c (P<0.05). There was no significant correlation between the levels of CMV-specific IgG and lipid profile or hsCRP. In conclusion, the level of C pneumoniae and H pylori-specific IgG antibodies are elevated among CAD patients and their presence was associated with development of the disease. They were significantly correlated to cholesterol level. Moreover, C pneumoniae-specific IgG was significantly correlated with hsCRP among ACAD patients, suggesting an important role of these organisms in the development of CAD by altering lipid profile and induction of inflammation.

Radiological changes in rheumatoid arthritis patients at a teaching hospital in Saudi Arabia

The frequency of radiological changes of the hands and the feet were investigated in a well-defined hospital population of patients with rheumatoid arthritis in Jeddah, Saudi Arabia. A total of 57 patients who fulfilled the American College of Rheumatology 1987 criteria for the diagnosis of rheumatoid arthritis were randomly chosen from the rheumatology outpatient clinic at King AbdulAziz University Hospital. Erosions were seen in 60% of the patients and periarticular osteopenia in 34%; deformity and soft tissue swelling were present in 26% and 14% of patients respectively. The proportion with erosions is lower than data reported from Western European and North American populations but higher than previous data from the Central region of Saudi Arabia.

Acute normovolemic hemodilution in sickle cell patient--a case report

Sickle cell disease patients with relatively high hemoglobin (> or = 12 g x dl) and those who have elevated alloimmunizations antibodies with rare phenotype subgroups, are problems challenging anesthesiologists. Acute Normovolemic Hemodilution (ANH) is rarely used in the perioperative management of homozygous sickle cell disease (SCD) in patients undergoing surgery. We hereby present a case in which ANH was used successfully. A 22 year old male patient with known homozygous sickle cell disease undergoing orthopedic surgery, underwent Acute Normovolemic Hemodilution (ANH) because of the absence of blood and suitable blood donors and high hemoglobin level. Just before establishing spinal anesthesia, a 400 ml blood was extracted from patient and then replaced by 6 % Hydroxyethylstarch HES solution.The surgery was performed uneventfully under spinal analgesia. Patient was discharged 48 hours later. A week later, his follow up visit showed no complications and his lab work returned to basic levels. We recommend the ANH technique as an on hand tool in the perioperative anesthetic management of sickle cell disease patients who have high Hb S with relatively high Hb levels, and in those special patients who have no blood available because of high alloimmunization antibodies or rare phenotype blood groups.

Autologous bone marrow transplanation for extramedullary plasmacytoma presenting as adrenal incidentaloma

Extramedullary adrenal plasmacytoma (EMP) involving the adrenal glands is rarely encountered clinically. We report a A 47-year-old male who presented with bilateral adrenal incidentalomas. After confirming EMP, the patient received two consecutive autologous hematopoietic stem cell transplants (HSCT) using high-dose melphalan. Following HSCT, a serial follow-up helical CT revealed a substantial decrease in the size of both adrenal masses. Serial periodic serum protein and urine electrophoresis and immunofixation showed abrogation of a previously noted monoclonal band. At 50 months follow-up the patient was alive and well. Our patient is the first with EMP to have received an autologous HSCT, which may prove to have a role in therapy due to the immunological effect of the infused donor marrow T-lymphocytes against the clonal proliferation of abnormal plasma cells in extrammedullary sites.This case indicates that an EMP should be added to the differential diagnosis of adrenal incidentalomas.

Autoantibodies in chronic liver disease

Some hepatotropic viruses (HBV and HCV) are capable of triggering autoimmune phenomena and manifest the features of autoimmune hepatitis (AIH) in the course of the disease. Careful attention is required to differentiate between AIH and chronic viral hepatitis (CVH) before the selection of treatment. This study was performed to assess the prevalence of rheumatoid factor (RF), antinuclear antibodies (ANA), anti-smooth muscle antibodies (ASMA), anti-mitochondrial antibodies (AMA), anti-parietal cell antibodies (APCA), anti-liver/kidney microsomal antibodies type I (ALKMA1) and anti-neutrophil cytoplasmic antibodies (ANCA) among patients with chronic liver diseases (CLD), and to assess the diagnostic value of these autoantibodies and their relation to HCV viral load and genotype and treatment with interferon-alpha (IFN-alpha). Five groups of patients with CLD (HCV, HBV, HCC, AIH and schistosomal hepatic fibrosis {SHF}) as well as a group of age- and gender-matched healthy controls were enrolled in the study. All the studied persons were subjected to full clinical assessment and laboratory investigations, including liver function tests, hepatitis markers, and HCV RNA by PCR. Detection of ANA, ASMA, APCA, AMA and ALKMA-1 was done by indirect immunofluorescence technique, while ANCA and RF were detected by EIA and latex agglutination test respectively. Results showed a significantly higher prevalence of RF, ASMA and ANCA among patients with CHC, RF and ASMA among HCC patients and ASMA and ALKMA1, among AIH patients as compared to the control group. Patients with HBV and those with SHF had a non-significantly higher prevalence of RF, ASMA and ANCA compared to controls. However, AMA was not detected in this study, and APCA showed no significant difference between the studied groups. The occurrence of these autoantibodies was not significantly related to HCV viral load, HCV genotype or treatment with IFN-alpha. There was a significant association between the occurrence of RF, ANA, ASMA, and ALKMA1 and high ALT levels, and between the occurrence of ANA, ASMA and ALKMA-1 and high AST and ALP levels. In conclusion, autoantibodies are commonly found among patients with HCV infection. The co-existence of HCV infection and autoimmune hepatitis should be considered in patients who are positive for both viral markers and autoantibodies and thorough evaluation of patients must be performed before selection of treatment. Testing for RF, ASMA and ANCA may have a good diagnostic value, however, AMA is the least useful in diagnosis.

Myopia and astigmatism in retinopathy of prematurity after treatment with cryotherapy or laser photocoagulation

BACKGROUND

Visual outcome studies have shown that laser photocoagulation may result in more favourable clinical outcomes than cryotherapy in threshold retinopathy of prematurity (ROP). Comparative refractive outcome studies have shown that patients treated with laser photocoagulation have less myopia than those treated with cryotherapy. We carried out a study to determine whether a difference in visual outcome or refraction exists in patients with threshold ROP who have been treated with cryotherapy vs. laser photocoagulation.

METHODS

A retrospective cohort study was conducted comparing treatment results after at least 3 years of follow-up in patients with threshold ROP treated with cryotherapy or laser photocoagulation at a tertiary care children's hospital. Visual acuity and refraction were the outcomes studied. Covariates measured were sex, gestational age and birth weight. Analysis was performed with both bivariate analysis and multivariate models.

RESULTS

Seventy-one eyes of 37 patients with threshold ROP were included in the study. Thirty-seven eyes received cryotherapy, and 34 eyes received laser photocoagulation. The mean spherical equivalent refraction was significantly lower in the cryotherapy group than in the laser photocoagulation group (-9.21 dioptres vs. -1.80 dioptres, p = 0.001). Patients in the cryotherapy group were more likely than those in the laser photocoagulation group to have against-the-rule astigmatism (odds ratio 6.86, p = 0.004). Laser photocoagulation did not significantly lower the frequency of an unfavourable visual outcome (visual acuity worse than 20/200) (p = 0.09).

INTERPRETATION

Eyes with threshold ROP treated with laser photocoagulation were significantly less myopic and less likely to have against-the-rule astigmatism than those treated with cryotherapy.

Hydroxyethylstarch 6% preload does not prevent the hypotension following induction with propofol and fentanyl

PURPOSE

To study the effects of volume preload with hydroxyethylstarch 6% (HES) on the changes in arterial blood pressure and heart rate following propofol/fentanyl induction of anesthesia.

METHODS

Seventy five patients, divided into three groups, scheduled for orthopedic surgery were allocated randomly to receive either no preload or 500 ml, or 1000 ml of 6% HES respectively over 20 minutes period prior to anesthetic induction. Anesthesia was induced with fentanyl 1.5 microg.kg(-1) and propofol 2.5 mg.kg(-1). Cardiovascular parameters were monitored for 5 minutes following induction.

RESULTS

Systolic blood pressure (SBP) decreased significantly (P<0.001) in all groups after anesthetic induction. Blood pressure recorded at 5 minutes was 76% of the baseline values in the control group and in the HES 500 group and was 78% in the HES 1000 group. Changes in the diastolic blood pressure (DBP) and mean blood pressure (MBP) were also similar in the three groups. There was no significant difference between the three groups in the HR decline too.

CONCLUSION

Administration of 6% HES as a preload did not attenuate the decrease in blood pressure following induction of anesthesia with propofol and fentanyl.

Laparoscopic Ablation of Giant Renal Cyst

We report a case of a symptomatic giant (18 x 10 x 8-cm) renal cyst in a 40-year-old woman that was marsupialized laparoscopically and excised. The surgical technique, based on progressive decompression of the cyst, is fully described. Excellent results were achieved. The recent application of laparoscopic ablation of different types of renal cysts is reviewed. This minimally invasive technique, when properly mastered, is highly effective and offers results similar to those of open surgery. It is associated with definitive postoperative advantages and is the treatment of choice for very large renal cysts, especially those located anteriorly, when sclerotherapy is ineffective or is contraindicated.

Estimating the depth of embedded contaminants from in-situ gamma spectroscopic measurements

The depth of radiological contamination is information required for decontamination and decommissioning of nuclear facilities. This paper proposes and tests a simple technique for measuring the depth of contamination. The method uses measurements with an HPGe detector at two distances (or heights) from the surface on the same side of the medium. The ratio of the photopeak areas easily can be used to yield the depth of an embedded source. The calculational algorithm was verified by simulations with the MCNP4C code and laboratory experiments for a point source and other special sources. Predictions of the depth for shallowly embedded sources have relatively large uncertainties (approximately 18%) but improve as depth increases. This technique provides a very easy way for a user to quickly estimate the depth of the subsurface contamination on site.

Vulvar squamous cell carcinoma in young women: a clinicopathologic study of 21 cases

OBJECTIVES

Invasive squamous cell carcinoma (ISCC) of the vulva occurs most often in older women and the clinical, pathological, and immunohistochemical features of vulvar ISCC in young women are poorly characterized. The aim of this study was to examine clinical and pathological features of ISCC presenting in women younger than 40 years of age.

METHODS

Patients younger than 40 years of age who presented with vulvar ISCC were identified in the population-based tumor registry of the British Columbia Cancer Agency (BCCA) for the period 1970-1998. Clinical data and follow-up were obtained. The pathologic material was reviewed and morphologic features assessed. Immunohistochemical staining for MIB-1 and p53 proteins was done and the presence of human papillomavirus (HPV) DNA was assessed by microdissection/PCR.

RESULTS

Twenty-one cases, accounting for 5% of all cases of vulvar ISCC encountered at BCCA during this period, were identified, with patient's ages ranging from 17 to 39 years (mean 33). The number of cases of vulvar ISCC in young women, as a percentage of all cases of vulvar ISCC, increased significantly over the study period. Lichen sclerosus was seen in 3 cases. Vulvar intraepithelial neoplasia (VIN) was present in 20 of 21 cases and was multifocal in 4 of them. VIN was subclassified as warty in 7 cases, mixed warty and basaloid in 6, basaloid in 4, and differentiated in 3. There was MIB-1 immunostaining throughout the full thickness of warty and basaloid VIN. Only basal cells stained for MIB-1 in differentiated VIN. Increased p53 expression was present in only 2 cases; both were differentiated-type VIN. HPV DNA was detected in 17 of 20 cases. The tumors were staged as follows: stage IA, 3 cases; stage IB, 13 cases; stage II, 3 cases; stage III, 2 cases. Depth of invasion ranged from <1 to 8.5 mm. The definitive surgical procedure was vulvectomy with lymph node dissection in 14 cases, wide local excision in 6, and excisional biopsy in 1. Clinical follow-up of 1 to 28 years (median, 5 years) showed that 5 patients had local recurrence and 2 died of disease. Of the 21 patients in this study, 1 had concurrent HIV infection and 1 patient with Crohn's disease was treated with corticosteroids; the remaining patients had no clinical evidence of depressed immune function.

CONCLUSIONS

The incidence of vulvar ISCC in young women has increased over time; this increase cannot be accounted for by ISCC in immunocompromised patients. The overall disease outcome was excellent, with 2 of 21 patients dead of disease. Most tumors were associated with HPV, but cases of ISCC in the absence of HPV, and associated with differentiated VIN, were encountered. p53 staining of the basal layer can aid in recognition of differentiated VIN while MIB-1 staining within the upper layers of the squamous epithelium is consistently present in warty and basaloid VIN, but not in differentiated VIN.

Intubation via LMA in pediatric patients with difficult airways

PURPOSE

To report two cases of successful tracheal intubation in difficult pediatric airways using a conventional laryngeal mask airway (LMA) with an extended polyvinyl chloride (PVC) tube after laryngeal assessment with a fibreoptic device.

CLINICAL FEATURES

Two cases, Dandy-Walker and Pierre Robin syndromes, were scheduled for surgery. They were premedicated with 0.5 mg x kg(-1) promethazine p.o. 90 min before surgery. Both patients arrived in the operating room sedated, with dry mouth, and without evidence of increased intracranial tension or airway obstruction. Inhalational induction with isoflurane 0.5-3% was commenced. Conventional tracheal intubation was impossible in both cases. In each an LMA was inserted to maintain ventilation, anesthesia, and to facilitate intubation. Fibreoptic bronchoscopy was used to assess the larynx, followed by blind intubation via the LMA using extended PVC tracheal tube (TT). Anesthesia was maintained during intubation using Mapleson F anesthesia circuit attached to a connector with fibreoptic bronchoscope adapter.

CONCLUSION

This report describes the assessment of the airway with fibreoptic bronchoscopy after LMA insertion facilitated blind tracheal intubation in two children with difficult airways.

Edrophonium antagonism of intense mivacurium-induced neuromuscular block in children

We have studied the time course of recovery after administration of edrophonium during intense mivacurium block in children aged 2-10 yr, using thumb acceleration in response to train-of-four (TOF) stimulation. Forty-three children receiving alfentanil, propofol, nitrous oxide, isoflurane anaesthesia and mivacurium 0.2 mg kg-1 were allocated randomly to one of three groups. Patients in group 1 (n = 15) received edrophonium 1 mg kg-1, 2 min after maximum block (intense block group). At the time of administration of edrophonium in this group, there was no response to TOF stimulation (100% block) and the post-tetanic count was 10.7 (range 0-20). Patients in group 2 received the same dose of edrophonium after 10% recovery of the first twitch (T1) in the TOF (conventional reversal). Patients in group 3 (n = 13) recovered spontaneously. All patients developed complete suppression of twitch height in response to the bolus dose of mivacurium. All recovery times were measured from the point of maximum block after mivacurium. Mean time for 25% recovery of T1 (clinical duration) was 3.8 (SD 1.1) min in the intense block group. This was significantly shorter than the conventional reversal (8.3 (2.4) min) and spontaneous recovery (9.2 (3.5) min) groups (P < 0.001). The times for 75% and 90% recovery of T1 were shorter in the intense block group (9.4 (2.8), 12.3 (4.2) min) compared with the conventional (13.1 (3.8), 17.3 (4.8) min) and spontaneous recovery (14.9 (4.5), 17.9 (5.2) min) groups (P < 0.01). Total recovery time required for 70% recovery of the TOF ratio (T4/T1) was 8.8 (2.4) min in the intense block group. This was significantly shorter than the conventional reversal (11.9 (3.2) min) (P < 0.05) and spontaneous recovery (17.1 (4.0) min) groups (P < 0.001). Conventional reversal was associated with a shorter total recovery time compared with spontaneous recovery (P < 0.01). The recovery index (time interval between T1 25% and 75%) was comparable in groups 1-3 (5.5 (2.0), 4.8 (2.1) and 5.7 (1.4) min respectively). Ten minutes after development of maximum block, the numbers of patients who recovered adequately (TOF ratio 70% or more) were, respectively, 12 (80%), 8 (53%) and 1 (8%) in groups 1-3. We conclude that edrophonium antagonized intense (no response to TOF stimulation) mivacurium-induced block in children, with significant reduction in the recovery times of T1 and TOF ratio compared with conventional reversal and spontaneous recovery.