Perioperative respiratory adverse events in children undergoing triple endoscopy.

OBJECTIVES: Children with aerodigestive disorders often have many of the reported risk factors for development of perioperative respiratory adverse events. This study sought to evaluate the incidence of such events in this group of patients undergoing general anesthesia for "triple endoscopy" (flexible bronchoscopy with bronchoalveolar lavage, rigid laryngoscopy and bronchoscopy, and esophagogastroduodenoscopy) and to identify any patient-specific or procedure-specific risk factors associated with higher incidence of perioperative respiratory adverse events. METHODS: We performed a retrospective chart review of children 18 years or younger who underwent triple endoscopy as part of an aerodigestive evaluation. Data collected from medical records included: preoperative polysomnography, symptoms of acute respiratory illness, medical comorbidities, demographics, postoperative hospital or intensive care unit admission, and all respiratory events and interventions in the perioperative period. Patient-specific and procedure-specific factors were investigated via univariate analysis for any correlations with perioperative respiratory adverse events. RESULTS: Of the 122 patients undergoing triple endoscopy, 69 (57%) experienced a perioperative respiratory adverse event. We found no difference in the incidence of perioperative respiratory adverse events among children with documented lung disease compared with those with no lung disease (OR: 0.89, p = .8 95% CI: 0.43, 1.8), and no significant difference between those children who had a respiratory illness at the time of surgery, 1-2 weeks prior, 3-4 weeks prior, and those with no preceding respiratory illness. A higher percentage of males had a perioperative respiratory adverse event, compared with females (OR: 2.7, p = .01 95% CI: 1.3, 5.09). CONCLUSION: Patients undergoing triple endoscopy for evaluation of aerodigestive disorders at our institution experienced perioperative respiratory adverse events at a rate of 57%.

Muscle force production with low and medium frequency burst modulated biphasic pulsed currents.

OBJECTIVE: Russian current, a medium frequency burst modulated alternating current (BMAC), is widely used for NMES, but has not been shown to elicit forces near voluntary maximum. In contrast, low frequency BMAC has been shown to produce greater force production than Russian and most recently, medium frequency burst modulated biphasic pulsed current (BMBPC) elicited greater force than Russian. Whether low frequency BMBPC yields greater force than medium frequency BMBPC is unknown. This study examined elicited forces using BMBPC with low and medium frequency carrier currents. DESIGN: A cross-over design where percent maximal isometric knee extensor forces (%MVIF) elicited using BMBPC with low or medium kilohertz carrier frequencies were compared in 23 subjects. Perceived discomfort was also assessed. Data were compared using paired samples t-tests. RESULTS: 98.4% of the MVIF was elicited with the low frequency BMBPC which was significantly greater (p < 0.001) than the 40.4% yielded by the medium frequency current. Cohen's d effect size of 2.146 indicated a "huge effect". Perceived discomfort of the low frequency current was 5.7/10 and was significantly greater (p < 0.001) than the medium frequency current (3.6/10). CONCLUSION: BMBPC with low frequency carrier current elicits forces approximating maximal volitional force. These findings offer new evidence with strong clinical implications when using NMES.

Pericytoma with t(7;12) and ACTB-GLI1 fusion arising in bone.

Cytogenetic analysis of a primary bone neoplasm with pericytic features in a 67-year-old man revealed a t(7;12)(p22;q13) among other karyotypic abnormalities. Subsequent molecular studies confirmed the presence of an associated ACTB-GLI1 fusion transcript. An identical 7;12 translocation is known to characterize a discrete group of soft tissue tumors belonging to the myopericytic category termed pericytoma with t(7;12). To the best of our knowledge, this is the first case of pericytoma with t(7;12) arising in bone. Cytogenetic and molecular analyses were useful, if not essential, in classifying this rare diagnostic entity.

Focal small-bowel localization of bone-imaging radiopharmaceutical in a child.

Bone scintigraphy is an important diagnostic tool in the evaluation of skeletal pathologic conditions. However, the extraskeletal uptake of bone-seeking radiotracers is still an unexpected finding in most cases. We present a 5-year-old male with an unexpected focal accumulation of the radiotracer in the small bowel. Bowel accumulation of bone-seeking radiopharmaceuticals has been seen previously in children in the colon and mainly in the cecum, but not in the small bowel. The mechanism for such accumulation is not completely clear and may be explained by focal histological disturbances of a small-bowel segment that contributed to excretion of the radiotracer from the blood-to-bowel lumen.